Epi Info Statistical Software Research Articles

Alternative medicine use among workers in an urban setting in north-central Nigeria

INTRODUCTION: Alternative Medicine refers to healing practices not typically used in conventional medicine and therapeutic practices which are not currently considered an integral part of conventional allopathic medical practice. The World Health Organization estimates the prevalence of use of Nutritional Supplements and Alternative medicines among African countries to range between 20% and 80%. The objective of this study was to assess the level of use of alternative medicines and factors associated with use among working class population in an urban setting in North-Central Nigeria. METHODOLOGY: This was a cross-sectional descriptive study. The study population consisted of working-class adults in an urban setting in North-Central Nigeria. Multi-stage sampling technique was used to recruit 390 adults into the study. Data was collected from them using a self-administered structured questionnaire and analyzed using Epi-info statistical software. RESULTS: The mean age of the respondents was 34.38+9.03 years. Most of the respondents were males (66.6%); married (52.8%); had attained tertiary level of education (83.1%). The prevalence of the use of Alternative supplements and Medicines among the study population was 79.3% and it had a statistical association with respondents level of knowledge about alternative medicines (p = 0.0144) and highest level of education attained (p = 0.0429). The larger proportion of the studied subjects perceived alternative medicine to be more effective (47.9%) and safer (34.8%) than orthodox medicines although most of them (53.8%) would not prefer it as treatment over orthodox medication. CONCLUSION: There was a high prevalence of use of alternative medicines among working class people studied. There is therefore a need for better research into how to integrate its use with orthodox medicine and to ensure the safety and efficacy of the drugs and therapies in current use by relevant authorities.

Burden of intimate partner violence in The Gambia - a cross sectional study of pregnant women.

BackgroundIntimate partner violence is an important public health problem that cuts across geographic and cultural barriers. Intimate partner violence refers to the range of sexually, psychologically and physically coercive acts used against women by current or former male intimate partners. The frequency and severity of violence varies greatly but the main goal is usually to control the victims through fear and intimidation. About 80% of Gambian women believe it is acceptable for a man to beat his wife thus encouraging the perpetuation of violence against women.The objective was to ascertain the burden of intimate partner violence amongst pregnant women in Gambia.MethodsA cross sectional survey was carried out at Edward Francis Small Teaching Hospital, Banjul, The Gambia, on antenatal clinic attendees between October and December 2012, using a pre-tested structured interviewer administered questionnaire. All pregnant women were informed about the study at the antenatal booking clinic. Of the 161 pregnant women informed, 136 (84.5%) consented to take part and were recruited in the study. Descriptive analysis was done using the Epi info statistical software. Any pregnant woman booking for the first time during the period of the study was eligible to be recruited into the study.ResultsMajority of enrolled participants (61.8%) reported intimate partner violence. Verbal forms of intimate partner violence were the commonest forms, with 12% requiring medical care on account of intimate partner violence and 3% prevented from seeking healthcare as a result of such violence.ConclusionIntimate partner violence is common in The Gambia, West Africa and is a threat to women’s health.

Pattern of rates of exclusive breastfeeding in the Niger Delta region of Nigeria

Background: The promotion of exclusive breastfeeding has the potential to make a major contribution to the achievement of the child Millennium Development Goals. Objective: The aim of this study was to document the pattern of rates of exclusive breastfeeding. This was a cross-sectional descriptive study. Materials and Methods: The study was carried out at a Child Welfare Unit of the Maternal and Child Health Centre. The tool used was an interviewer-administered questionnaire among 276 mothers who brought their infants to the Child Welfare Unit in the Niger Delta region of Nigeria. A systematic sampling technique was used to recruit the subjects. The data were analyzed using Epi Info statistical package, version 3.2.2 (CDC, Atlanta, GA). Results: The maternal age ranged between 16 and 50 years with the mean age of 30.2 and a standard deviation of 7.9. The number of male infants was140 (50.7%) whereas that of the females was 136 (49.3%). Less than half of the infants (130, 47.1%) were 6 months and above whereas the remaining (146, 52.9%) were below 6 months. Of the 130 (47.1%) infants that were 6 months and above, 22.8% were exclusively breastfed for 6 months. Out of the 146 infants that were below 6 months, 56 were below 2 months, 48 were 2 to below 4 months, and 42 were 4 to below 6 months, and the rates of exclusive breastfeeding for the various categories were 41.1%, 33.3%, and 23.8%, respectively. Conclusion: The pattern of rates of exclusive breastfeeding when stratified by infant’s age from below 2 months to 6 months varies between 41.1% and 22.8%. These indicate the need to pursue public awareness on exclusive breastfeeding vigorously.

Provider Initiated HIV Testing During Antenatal Care and Labour – Knowledge and Acceptability of Patients in a Nigeria Teaching Hospital

Aim: This study aimed at accessing the knowledge and acceptance of women receiving Antenatal care (ANC) at the Jos University Teaching Hospital (JUTH) to the concept of Provider Initiated HIV Testing and Counselling (PITC) during antenatal care and in Labour, as a departure from e Client Initiated Counseling and Testing(CICT) or Voluntary Counseling and Testing(VCT). Issues /Background: Nigeria has a huge Prevention of Mother to Child Transmission (PMTCT) gap and strategies need to change to identify and prevent new infections. Since voluntary HIV testing in ANC settings still has a low yield, it is necessary for health workers to initiate HIV testing and expand testing to women in labour and those that delivered. The study was aimed at assessing clients’ acceptability of PITC. Methods: A structured questionnaire was administered to 170 women attending antenatal clinic in JUTH to evaluate their views about PITC. Findings were analyzed with the Epi Info Statistical Package. Results: The age range was 17-46 years, 52.9% were Christians and 47.1% were Moslems; 35.5% were housewives and 24.7% were students. One lady was single, 169 (99.4%) were married. Some 41.8% had tertiary education, 29.4% had secondary; others had primary and informal education. Pregnant women constituted 92.4% while 7.6% were post-natal. About 94.7% were aware of HCT and 87.1% had done the test. Some 93.5% affirmed benefits and 96.5% supported testing. Regarding PITC in labour, 87.9% felt it was beneficial if women had not tested before, others felt she should be left because of pains. About 74.1% indicated babies could benefit from preventive intervention if mothers tested positive in labour, 19.4% didn’t know and 6.5% said the baby could not be helped. Husbands of 98.1% had approved their testing, but three (1.9%) were disallowed. About 90% felt women that previously tested negative should be retested,5% felt that it was unnecessary and 4.1% didn’t know while 68.5% felt test should be discouraged regards causing marital disharmony. A total of 168 (98.5%) encouraged the test while 2 (1.5%) said they discourage people from taking the test. PITC should not be offered women faithful to spouse while 94.1% felt the test should be offered to people who don’t look ill while 3.6% felt it shouldn’t. Conclusion: Awareness of HIV screening in pregnancy and labour is high among our antenatal population, but not all accept HCT. There is need for continuing health education regarding PITC , male involvement and couple counseling.

Magnitude and Pattern of Caesarean Sections in a Teaching Hospital, Northwest Nigeria: A 5 Year Analysis

Background: The pattern of Caesarean section rate is on the rise with emergency surpassing elective caesarean deliveries. This could not be unconnected to the safety of anaesthesia in modern obstetrics. Method: Data on Caesarean deliveries conducted from January, 2005 to December, 2009 was analyzed using Epi Info Statistical Software. Results: The Caesarean section rate was 18.75%. The mean age was 28.02±5.86 years. Emergency Caesarean section was the majority (59.4%) while the remaining (40.6%) were elective. General anaesthesia was used for the majority (66.68 %) of the cases, while 33.32% had subarachnoid block. Univariate analysis, shows statistically significant association between the type of surgery and anaesthetic technique used (χ2=22.741, df = 1, p = 0.000). A statistically significant association was also established between age group of the patients and the anaesthetic technique (χ2=10.878, df = 2, p = 0.004). However, there was no statistically significant association between age group of the patients and the type of Caesarean section (χ2=0.224, df = 2, p = 0.894). Conclusion: The high rate of emergency caesarean intervention has been a persistent denominator in several studies. The root cause of these anomalies such as dearth of expertise at secondary facilities should be addressed. With effective pregnancy supervision, obstetric cases that would end with emergency intervention can be handled electively.

An audit of postpartum referrals by traditional birth attendants in rural Southeast Nigeria

Context: Immediate recognition of postpartum complications, prompt, and due management are key to reduction in maternal mortality ratio (MMR). Aims and Objectives: To evaluate the pattern and outcomes of postpartum referrals from traditional birth attendants (TBAs) in rural Nigeria. Materials and Methods: A prospective observational study of patients referred after delivery from TBAs to a Mission Hospital in rural Nigeria. Analysis was by Epi Info statistical software. Results: Two hundred and sixty-two patients were so referred. Perineal injury (29.4%) was the most common diagnosis followed by pyrexia (22.5%), postpartum hemorrhage (18.3%), and genital sepsis (10.3%). The MMR was 4961.8/100,000 live births with PPH accounting for the majority (53.8%). Conclusion: Delay in referral and transportation difficulties were major impediments to prompt access of care from the Mission Hospital. TBAs should be encouraged to refer all cases to well-equipped orthodox medical facilities and get paid for each case as if managed by them.

Prevalence and Associated Factors of Home Delivery in Arbaminch Zuria District, Southern Ethiopia: Community Based Cross Sectional Study

Background፡ Maternal morbidity and mortality is a global health challenge and developing countries contribute about 99% of maternal death. In Ethiopia about 30% of all women death is related to pregnancy related causes and current maternal mortality ratio is 676 per 100,000 live births. However, a large proportion of these maternal deaths could be prevented through timely and appropriate interventions including the presence of skilled delivery service utilization at each birth. Therefore the aim of this study was to assess prevalence and associated factors of home delivery at Arbaminch zuria district. Method: A community based cross-sectional study design was applied from July 1st to July 30 2012 to collect data from reproductive age women who gave birth in the last 2 years in Arbaminch zuria district who was sampled by systematic random sampling method. A single population proportion formula was used to estimate the sample size by using statistical software EPI info 3.5.4 by considering the assumption that the prevalence of home delivery 81.8%, 95% confidence interval, 5% of absolute precision, design effect 2 then adding non response rate of 5% a total sample size of 481 mother who gave birth in the last two years. The data was entered into EPI info version 3.5.4 and exported into SPSS then analysis was made by using SPSS version 16. Descriptive statistics to describe the study population in relation to relevant variables and multivariate analysis was used to assess the presence and degree of association between home delivery and independent variables. Result: Of the total respondents 157(36%) of the women was age in between 25-29 years, with mean age of 31.4±6.2 years and majority was married and illiterate 396(90.8%) and 234(53.6%)respectively. 346(79.4%) was gave birth at home with unskilled attendants 328(75.2%).Mothers educational status(p< 0.001), parity of the women(p<0.001),and travel time to health facility(p<0.001) was statistically significant association with home delivery. Conclusion: As revealed by this study home delivery attended by un trained personnel was high (75.2%) and the predominant factors associated with home delivery identified by this study were educational status of the women, parity of the women and travel time to health institution.

Morbidity and mortality of childhood illnesses at the emergency pediatric unit of a tertiary hospital, north-eastern Nigeria

Background: Under-five morbidity and mortality from childhood preventable diseases are still very high in most of the developing countries, especially Nigeria. We describe the morbidity and mortality of childhood illnesses at the Emergency Pediatric Unit (EPU) of the Federal Medical Centre, Azare. Materials and Methods: A retrospective study of Emergency Pediatric Unit admissions over a 1-year period. Epi-info statistical software was used for data analysis. Results: A total of 1,161 patients, aged 1 month to 13 years with a mean age (±1 SD) of 9.8 ± 2.6 years were admitted into EPU during the period. There were 576 (49.6%) males and 585 (50.4%) females and 1,034 (89.1%) patients were children under 5 years of age. The major causes of admission were malaria (44.8%). There were 103 (8.9%) discharges, 886 (76.3%) transfers to pediatric wards, 38 (3.3%) referrals to other hospitals, and 11 (0.9%) discharges against medical advice. There were 123 (10.6%) deaths during the period of the study with 107 (87.0%) of the deceased being children ≤5 years of age. Severe malaria 61 (49.6%) was the major cause of deaths in the unit, followed by Protein energy malnutrition (PEM) and pneumonia occurring in each of 10 (8.1%) patients. Conclusion: Malaria, PEM, and pneumonia remained the major causes of morbidity and mortality, especially among the under-five children.

Mothers�� Attitude Towards Childhood Diarrhea Management and Prevention in Under Five Children in Fenote Selam Town, West Gojjam, Amhara, Northwest Ethiopia

Introduction: Global deaths of children aged less than five years from diarrhea have been estimated, resulting in about 800 000 fatalities worldwide annually, most occurring in sub-Saharan Africa and south Asia. More than 80% of these deaths occur in Asia and Africa (46% in Africa alone). Objective: The aim of this study was to assess attitude of mothers towards diarrhea management and prevention in under five children, in Fenote Selam Town, West Gojjam Zone, Amhara, Northwest Ethiopia, 2014. Methods: Community based Cross-sectional study was conducted from April-May 2014. The sample size was 846. Multi-stage sampling technique was employed to select sampling kebeles. Simple random sampling technique was used to select study units. Pretest was done in none sampling kebeles. Data were entered into Epi-info (version 3.5.1) statistical software package and then exported to SPSS software package version 16.0 for further analysis. Results: A total of 830 mothers were participated in the study. Overall, 416(50.1%) of mothers had favorable attitude. Of these, 337 (40.6%) of mothers had favorable attitude towards ORS usage and 192(23.1%) of mothers had favorable attitude towards immunization to prevent diarrhea. Conclusion: Overall, half of mothers of the Fenote Selam community had unfavorable attitude towards diarrhea management and prevention.

Pattern of complications and comorbidities among diabetic patients in a tertiary healthcare center in Nigeria

Background: The prevalence of diabetes mellitus (DM) among Nigerian adults is increasing. Besides the well-recognized microvascular complications of diabetes, there is also a growing epidemic of macrovascular complications. Patients with diabetes may not only have diabetes-related complications but may also have nondiabetes-related comorbidities. Aim: To determine the pattern of chronic diabetic complications and coexisting morbidities in patients attending the diabetic outpatient clinic of a tertiary health care center in Nigeria and the factors associated with the presence of complications. Materials and Methods: This was a cross-sectional descriptive survey carried out among patients attending the follow-up diabetic clinic of a tertiary health care center in Nigeria over a 3-month period. A systematic random sampling method was used and 422 eligible patients were selected and interviewed using pretested interviewer-administered questionnaires, after written informed consent was obtained. Data were analyzed using Epi Info statistical package version 3.5.1. developed by Centers for Disease Control and Prevention (CDC) in Atlanta Georgia (USA). Results: Of the 422 patients interviewed, 400 (247 females and 153 males) had complete data for analysis. Eighty-eight patients had comorbidities, and the commonest was hypertension in 63 (71.6%). Out of the 61 patients who had complications, the majority, that is, 39 (63.9%) had eye complications. Factors significantly associated with the presence of diabetic complications were the duration of diabetes, marital status, and the presence of diabetic comorbidities. Conclusion: The frequency of diabetic complications and comorbidities is quite high in the patients studied. There is a need to improve the standard of care of patients and to ensure optimal blood glucose control. This will go a long way in reducing the frequency of complications and comorbidities.

An Investigation of Antibiotic Prescribing in Patients with Upper Respiratory Tract Infections (Urtis) at Katutura Health Centre, Windhoek, Namibia

Upper respiratory tract infections (URTIs) are of viral cause in 80% of cases and they constitute a major part of the primary health care practitioners’ workload with antibiotics commonly prescribed for these illnesses. The aim of this study was to explore antibiotic prescribing in patients with URTIs at Katutura Health Centre, Namibia. A descriptive, cross sectional, quantitative design based on patients’ prescriptions was used. Data were analyzed using Epi info statistical package version 7.1.1.14. The rate of antibiotic prescribing for patients with URTIs at Katutura Health Centre (KHC) was 78% (95% CI, 74%-82%). Further bivariate analyses of antibiotic prescribing (Response variable) and illness, age, gender and profession (exposure variables) showed that age and illness were significantly associated with antibiotic prescribing (p<0.05) while gender and profession rank were not. In conclusion, the Ministry of Health and Social Services need to develop or adopt international strategies have proven efficacy in reducing antibiotic prescribing in URTIs

Effect of health education on knowledge of malaria and long lasting insecticide-treated nets among clients accessing care in the out-patient Department of a Secondary Health Facility in Plateau State, Nigeria.

Malaria is a mosquito borne disease transmitted by female anopheles mosquito; it is life-threatening, preventable, and treatable. Approximately, 40% of the world's population is at risk of malaria. Most cases and deaths due to malaria are in sub Saharan Africa although Asia, Latin America, the Middle East and some parts of Europe are also affected. To assess the knowledge of malaria and long lasting insecticide treated nets (LLITNs) among clients assessing out-patient services in Seventh day Adventist (SDA) Hospital. A quasi experimental study conducted in 2013 among client assessing care at the Out-Patient Department of SDA Hospital Jengre, Bassa Local Government Area of Plateau State to determine the knowledge of malaria and LLITNs. EPI info statistical software version 3.5.4 was used for data analysis and 95% confidence interval was used in this study with a P ≤ 0.05 considered as statistically significant. The mean age of the respondents in this study was 36.04 ± 9.60 years. The level of knowledge on malaria improved significantly after the training (P < 0.001). Majority (98.8%) of the respondents had good knowledge of LLITNs after the training as against 77.4% who had same before the training (X2 = 17.93; P < 0.001). This study has demonstrated the effectiveness of health education as vital tool for improving the knowledge of malaria and LLITNs.

Treatment compliance of self-reported dog bite cases attending outpatient department of Tertiary Care Hospital, Maharashtra

Objectives: To assess treatment compliance of self-reported dog bite cases and to assess associated demographic and exposure factors. Materials and Methods: The present prospective study was conducted during January 2013 to July 2013 among 260 dog bite cases by purposive sampling at the outpatient department of a tertiary hospital. After obtaining verbal informed consent, a predesigned questionnaire was used. The assessment of treatment compliance of postexposure prophylaxis (PEP) regimen was considered on the basis of intramuscular anti-rabies vaccine (ARV) regimen by classifying completed PEP and defaulted PEP. At the end of PEP regimen of every participant, we obtained information about received ARV doses using telephone survey method. Data were analyzed using statistical software Epi info Version 7. Results: Of 260 dog bite cases, 76.5% cases were completed PEP. The majority, 22.3% cases from age group ≤10 years, 56.2% males, 48.1% from urban area, 25% had primary school education, 32.7% students, 53.8% had bite mark on lower limb, 58.5% were category III exposure, and 70.8% who had received previously immunization against rabies, were completed PEP. The bite due to 54.6% pet dog, 58.1% observable dog, 40% provoked bite, 71.9% cases who had not known about the rabid status of the dog, were completed PEP. The unconditional logistic regression analysis found that demographic and exposure factors were not independently associated with treatment compliance ( P > 0.05) except literacy status (P < 0.05). The present study showed maximum completed PEP cases, however, it showed the demographic and exposure factors of dog bite cases were not independently associated with treatment compliance except literacy status.

Comparison of outcome of management of unstable pertrochanteric femoral fractures with dynamic hip screw and proximal femoral nail

Context: Pertrochanteric fractures of the proximal femur are a common occurrence among elderly patients. The two types of implants most commonly used for internal fixation of these fractures are dynamic hip screw (DHS) and proximal femoral nail (PFN). However, limited data exist showing comparison between these implants for the treatment of unstable pertrochanteric fractures which are more difficult to manage than the stable ones.Aims: The purpose of this study was to compare the outcome of management between both implants in the treatment of pertrochanteric fractures.Settings and Design: It is a prospective study done at Sri Guru Ram Das Institute of Medical Sciences. Amritsar (Punjab), India.Materials and Methods: Totally, 30 cases of unstable pertrochanteric fractures (Arbeitsgemeinschaft für Osteosynthesefragen [AO] type 31A2 and 31A3) were included and treated using PFN and DHS (15 cases each) from July 2011 to June 2013. Alternate allocation to each implant group was done. Follow-up was for about 6 months. Results were obtained with regard to operation time, blood loss, fluoroscopy, time to union, time to full weight bearing, and the requirement for revision surgery. Functional scoring was done using the Salvati and Wilson hip score.Statistical Analysis Used: Clinical and radiological data were analyzed using the statistical software epi-info version 3.5.1 released in August 2008.Results: Patients who underwent fixation by PFN had a shorter operation time, lesser blood loss, and returned to full weight bearing earlier than those who had DHS. However, more fluoroscopic exposure was recorded in PFN than DHS. Time to union was more or less the same. Patients who underwent PFN fixation had better Salvati and Wilson hip scores than those with DHS.Conclusions: In unstable pertrochanteric fractures, PFN definitely holds an edge over DHS.

Spatial distribution of anti-toxoplasma antibodies in pregnant women from Aracaju, Sergipe, Brazil

To analyze the spatial distribution of the prevalence of anti-toxoplasma gondii antibodies in pregnant women from a Brazilian Northeast city, and to correlate such prevalence with average maternal age and place of residence. A descriptive, analytical and ecological study was conducted from January 1st to December 31st 2012. Data were obtained retrospectively from the Medical Specialties Center database and processed with the Epi info statistical package (Epi 7, Centers for Disease Control and Prevention, Atlanta, USA) and with Microsoft Excel 2010. The X2 test was applied to assess the association between the prevalence of antibodies to toxoplasma gondii and the average age. Spatial analysis of infection prevalence was performed using the TerraView software, version 4.2.2, with Kernel density estimation, which estimates the quantity of events through maps in order to identify areas with the highest concentration of cases in the city. The seroprevalence of IgG was 68.5% (95%CI 67.2-69.8) and the prevalence of IgM was 0.36% (95%CI 0.23-0.6). A higher IgG prevalence was associated with increased age in the oldest neighborhoods of the state capital, whereas a higher IgG prevalence among younger women was detected in suburban neighborhoods. The spatial concentration of IgM antibodies was higher in suburban neighborhoods, with no significant correlation between seroprevalence and age. Geoprocessing allowed the identification of areas with the highest prevalence, as well as the most susceptible average age and it was also useful as an instrument for the evaluation and implementation of appropriate preventive measures for this municipality and for other regions of Brazil.

Obstetric analgesia for vaginal birth in contemporary obstetrics: a survey of the practice of obstetricians in Nigeria.

BackgroundContemporary obstetrics in sub-Saharan Africa is yet to meet the analgesic needs of most women during child birth for a satisfactory birth experience and expectedly, obstetricians have a major role to play in achieving this.MethodsThis was a questionnaire-based, cross-sectional study of 151 obstetricians and gynecologists that attended the 46th Annual General Meeting and Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in Abakaliki, southeast Nigeria in November, 2012. SOGON is the umbrella body that oversees the obstetric and gynecological practice in Nigeria. Data was collated and analyzed with Epi-info statistical software, and conclusions were drawn by means of simple percentages and inferential statistics using Odds Ratio, with P-value < 0.05 at 95% Confidence Interval (CI) taken to be statistically significant.ResultsOf the 151 participants, males predominated; 110 (72.9%) practiced in government-owned tertiary hospitals in urban locations. Only 74 (49%) offered obstetric analgesia. Among users, only 20 (13.3%) offered obstetric analgesia routinely to parturients, 44 (29.1%) sometimes and 10 (6.6%) on patients’ requests. The commonest analgesia was opioids (41.1%). Among non-users, the commonest reasons adduced were fear of respiratory distress (31.1%), cost (24.7%) and late presentation in labour (15.6%).ConclusionThe routine prescription and utilization of obstetric analgesia by obstetricians in Nigeria is still low. Obstetricians are encouraged to step up its use to make childbirth a more fulfilling experience for parturients.

Factores de riesgo laboral que inciden en las cualidades de voz de los docentes de la Universidad de Sucre

This study aimed to describe the occupational risk factors affecting the voice qualities of teachers at the University of Sucre. A total of 54teachers were selected through random stratified sampling. For data collection, a questionnaire was applied to detect vocal symptoms. Occupational risk factors were identified, estimated and assessed, muscular, vocal and respiratory conditions were determined, and the Anagraf test was applied in 25teachers, revealing vocal symptoms. The EPI INFO statistical package version 3.5.5 of July 30, 2012, was used for the analysis. The association between variables was assessed with the chi-square test at a significance level of P<.05. The results showed that teachers were exposed to temperatures ranging from 20-21° C and 36-37° C, relative humidity levels from 63% amd 78%, and background noise between 61dB and 70dB. Other findings were generalized muscle tension, aggravated tone, constrained timbre, vocal intensity and strong vocal attack, upper costal breathing type, maximum phonation time, expiratory breath and decreased phonatory breathing efficiency. We conclude that the longer teachers are exposed to relative humidity, the greater the changes that will occur in vocal tone and intensity.

Health problems and the health care provider choices: A comparative study of urban and rural households in Egypt

ObjectiveTo assess families’ health problems and the health facility choices in an urban and a rural district in Egypt. MethodsA cross-sectional descriptive study with a multi-stage random sample of 948 urban and 401 rural households was undertaken in a district of Cairo and rural Giza. Data was collected through interviews. The questionnaire addressed health problems and the use of health services within the fortnight prior to the survey.A follow-up of a sub-sample of 285 urban and 114 rural households was carried out 2–3weeks after the first interview to assess the outcome of complaints. The EPi Info Statistical Package was used for analysis and comparing urban and rural families. ResultsOver 60% of urban and 78.8% of rural families had health complaints - respiratory, gastrointestinal and musculoskeletal. Outpatient clinics in public hospitals were the first choice for 49.7% of urban families and 23% of rural, while 25.7% of urban and 42.8% of rural families visited private clinics. Over half of the families with complaints recover from their illnesses within a fortnight. ConclusionUrban families have less health complaints than rural; however, rural families recover sooner. Families bypass often public primary health care services. Urban families overuse outpatient clinics in public hospitals.

An Evaluation of the Reaching Every District (RED) to Reach Every Child (REC) Immunisation Strategy in Mberengwa District, Midlands Province 2007-2010

Introduction: The immunisation program for Mberengwa district has been experiencing a decline in coverage and high dropout rates despite it having adopted the Reaching Every District strategy in 2004. This study investigates reasons for this program failure. Methods and Materials: The Logic Model Conceptual Framework was used to evaluate the program. Data were collected using questionnaires from health workers, key informants and a separate questionnaire used to collect data from mothers of children under five years old. Focus group discussions were conducted with women in the community. A checklist was used to assess program resource availability. Data were analysed using EPI info statistical software. Qualitative data were analysed thematically Results: Forty six health workers and 56 mothers were interviewed. Ten health workers had been trained in Reaching Every District. Less than half knew the tool that is used to monitor program progress. None of the health centres had zoned catchment area maps for offering the different EPI services. Program resources were reported to be inadequate. None of the facilities were conducting regular EPI meetings with the community. Main barriers to immunisation were religious objectors, unavailability of vaccines and unavailability of outreach services Discussion: Resources put into the program were inadequate. Health workers were not conversant with the operations of the strategy. Community involvement in the program was poor .Efforts to improve program performance should be aimed at training health workers in Reaching Every District, revitalising strong links with the community and re-establishing Expanded Program on Immunisation outreach services.

Evaluation of the Degree of Satisfaction of Dental Service Users of Family Health Units

Objective: To assess the degree of user satisfaction with oral health services in the National Health System. Material and Methods: This is a descriptive cross-sectional study with a quantitative approach. Overall, 325 users were interviewed in dental service units of the family health strategy in the Municipality of Aquidauana, MS, using exclusion criterion patient under the age of 15 years and any inability to answer the instrument used. The results were processed using the Epi Info statistical software using data frequency analysis. Results: Users reported treatment as the main reason for seeking dental services (39.4%), followed by pain (28.3%) and review and prevention (26.8%). It was observed that 49.2% of patients seek the service on their own (25.2%) were referred by Community Health Agent; (19.1%) by a family member or friend and (3.7%) by the dentist. Respondents showed greater satisfaction with the location of Units; with the way they were received at the Unit; with the time of service and the scheduling of consultations in primary care. In relation to self-assessment on the oral health status, 40% of users considered good and 39.4% as regular. Conclusion: The satisfaction rates with oral health services offered in the National Health System were high, and most users who were in treatment, sought the service on their own and in need for treatment.