Higher Educational Status Research Articles

Exploring Knowledge and Awareness of Sexual and Reproductive Health Rights Among Married Working Women: A Qualitative Study of Jaipur City

ABSTRACTKnowledge and awareness of Sexual and Reproductive Health/Rights (SRH/SRHR) have emerged as a prominent issue globally. Such knowledge leads to improved behaviors to minimize risks related to SRH as well as enhances women's autonomy regarding their fertility and sexuality. In the domain of SRH sociocultural norms and gender power dynamics play an even larger role in determining SRH outcomes. In India, despite progress in health, reproductive health remains a concern. SRH is still subjected to a social taboo in Indian society. Therefore, this study examines persistent challenges in acquiring knowledge of SRH among married working women, also, try to understand SRH issues from cultural and gender perspectives. An exploratory study conducted in Jaipur city (Rajasthan), included highly educated married working women (n = 104), using mixed‐methods with interviews and focus group discussions. Ethical guidelines ensured participant confidentiality and informed consent. Despite high educational and economic status significant gaps were found such as limited awareness of SRH concerns, family planning methods and SRHRs like rights to make informed decision, termination of pregnancy, maternity benefits, etc. This study emphasizes holistic approach to improve SRHR outcomes and advocated policy interventions for women of all sections of society.

An Examination of Teacher Self-Efficacy to Support Neurodiverse Students in Higher Education

Neurodiversity research is increasingly important to how educators view and address disabilities and neurological conditions in higher education. This study investigated if professional development could increase faculty teacher self-efficacy (TSE) to meet the needs of neurodiverse college students better. Training sessions were administered to educate faculty about neurodiverse students’ needs and equip them with evidence-based, best practice teaching strategies. Pre and post-surveys measured TSE. Findings indicate that receiving professional development for neurodiverse students increased faculty TSE. This study suggests that higher education institutions can support faculty in increasing their TSE and hopefully make a difference in the outcomes for neurodiverse students.

A LETTER FROM SPECIAL EDITION EDITOR IN CHIEF - DR. KHRIEREIZHÜNUO DZÜVICHÜ

Oriental College Kohima has successfully organised a One-Day Multi-Disciplinary Conference on "Emerging Paradigms in Social Sciences, Humanities & Commerce for the 21st Century" on the 7th of December 2024. Research scholars and teaching faculty from affiliated colleges of Nagaland University participated in the conference, and a total of 13 papers were selected to be published in the International Journal of Research -GRANTHAALAYAH as a special issue titled Emerging Paradigms in Social Sciences, Humanities & Commerce for the 21st Century The distinguished keynote speakers of the conference were Professor Nigamananda Das, Head, Department of English, Nagaland University and Dr. Jasojit Debnath, Associate Professor, Department of Commerce, Nagaland University. The papers were presented with active participation and interaction with topics ranging from Naga history, craftsmanship, self-reliance, and the sheer ingenuity and resilience of the Naga forefathers to topics intensely in tune with nature and surroundings and how the Naga forefathers understood the phenomena of nature and the sky to the benefit of their awareness and survival. The importance of the traditional institutions like the Morung, and social concepts like dignity of labour, work culture and ethics of the Naga forefathers were presented. The presentations shifted gear to recent trends like the changing and challenging roles and dynamic transformation in the status of women and participation of women in Naga politics; the success stories of the farmers of King Chilli in making a community economically stable and self –reliant; inclusivity in education; NEP 2020; status of higher Education in Nagaland, etc. Comparative literature studies found platform with works like ‘Spirited Away’ by Hayao Miyazaki, Japanese animator, filmmaker and manga artist and Easterine Kire’s ‘A Terrible Matriarchy’ being analysed in depth alongside with insightful and thought provoking take on psychoanalytic literary criticism and Naga folklore. Papers dealing with the essence and the allure of folk poetry and the plethora of feelings and emotions of poetry added much discourse on the metrical composition of Tenyimia lyrical poetry in an innovative manner. The conference is organized with the objective to bring together academicians, scientists, researchers, scholars and students to exchange and share their knowledge, experiences and research results on the aspects of advancements in the field of Social Sciences, Humanities and Commerce, based on a multidisciplinary approach through intradisciplinary, interdisciplinary and transdiciplinary research, which would benefit the academic world. The discussions during the paper presentations proved to be a great opportunity for exchanging knowledge among great minds. I express my sincere thanks to the publisher of Granthaalayah Publications for collaborating with Oriental College Kohima to motivate researchers with due recognition. Oriental College Kohima looks forward to take this partnership to the next level with substantial research contributions to promote collaborative studies in the emerging paradigms of Social Sciences, Humanities & Commerce. Sincerely,Dr. Khriereizhünuo Dzüvichü

Households With Access To Clean Fuels For Cooking And Associated Factors Towards Achieving Sustainable Development Goals In India: Insights From National Family Health Survey-5 (2019-21)

Background: Cooking using open fires or inefficient stoves fuelled by kerosene, biomass (wood, animal dung and crop waste) and coal generates harmful household air pollution. This study tried to estimate the proportion of Households with primary reliance on clean fuels and technology for cooking in India and determine the factors associated with it using the National Family Health Survey (NFHS) 5 data. Materials and methods: We used data from the 2019–2020, National Family Health Survey (NFHS-5) household level (IAHR7CFL) data. Clean cooking fuel was considered as household’s who are using electricity, LPG, biogas, natural gas and unclean cooking fuel was considered as any other fuel other than clean fuel. Multivariate logistic regression was performed to estimate the determinants of usage of unclean cooking fuel. Results: Total 6,36,699 households were included in final analysis. The national level proportion of household’s using clean fuel for cooking was 53%. Muslims, Sothern states, households with male Head of the Family (HoF), richest wealth index households, HoF with higher education status were more likely using clean fuels. Whereas Rural households, scheduled tribe households, households with kutcha houses, non-nuclear families and unmarried Hof were more likely using unclean fuels. Conclusions: More than 50 percentage of households do not have access to clean fuels and technologies for cooking. Focus should be on providing access to North Indian states, rural households, households with female as head of the family (HoF), HoF with poor education, non-nuclear families and Scheduled tribe households to fill the gap to achieve Sustainable Development goals (SDG) target by 2030.

Influenza knowledge and barriers to vaccination in immunosuppressed patients in the pediatric rheumatology clinic

BackgroundMost patients with a pediatric rheumatic disease are at increased risk of influenza due to immunosuppressive medication use. Despite initial quality improvement efforts, our influenza vaccination rate plateaued at 72%, which prompted a survey of patients and families to assess provider vaccine recommendations, influenza knowledge, and barriers to influenza vaccination.MethodsPatients on immunosuppressive medication or their parent were eligible to complete a survey between July 2019 and January 2020. Survey questions assessed demographics, rheumatology diagnosis, immunosuppressive medication(s), influenza vaccination recommendation, patient/parent influenza knowledge, and barriers to influenza vaccination. Influenza vaccination rates for immunosuppressed patients were acquired each influenza season from 2015–2020 and tracked on a control chart.ResultsOf the 226 completed surveys, 145 (64.2%) were completed by parents and 81 (35.8%) by patients. The majority (85%) reported the influenza vaccine was recommended. The most common reasons for not receiving the influenza vaccine included: worry about disease flare (25.6%), concern the vaccine will cause influenza (25.6%), and lack of vaccine effectiveness (20.5%). Parents (40.9%) were more worried about disease flare compared to patients (17%; p = 0.024). Most respondents were able to correctly answer fever, cough and/or congestion as the most common symptoms of influenza; however, 23% answered gastrointestinal symptoms and 10.2% joint swelling. Most respondents (95.1%) were aware that immunosuppressive medication increases risk of infection. The average weekly influenza vaccination rate for the 2019–2020 flu season was 85.5%, which increased from 72.0% the previous year. Parents with higher education status were more likely to have their child receive the influenza vaccine compared to parents with less education.ConclusionsThis survey indicates that respondents understand the potential severity of influenza and the increased risk of infection due to immunosuppressive medication use; however, many inaccurately identified the most common symptoms of influenza and also reported misconceptions of influenza vaccine risks. The barriers identified in this survey will help drive future improvement efforts to increase influenza vaccination rates in this high-risk population.

Factors influencing COVID-19 preventive behavior in Thanlyin township, Yangon region, Myanmar

Background: The World Health Organization (WHO) has identified COVID-19 as a novel lung condition caused by an emerging virus. Socioeconomic factors significantly influence preventive behaviors like handwashing, wearing masks, social distancing, coughing cover, and avoiding touching the face to reduce COVID-19 transmission. Aim was to determine factors influencing COVID-19 preventive behavior among selected households. Methods: The cross-sectional descriptive study with 700 samples was conducted from July 2022 to December 2023 that collected quantitative data using an interviewer-administered questionnaire that was converted to Open Data Kit, a mobile data tool in Thanlyin Township, Yangon, Myanmar. Objective of study was to determine the association between socio-demographics, knowledge and preventive COVID-19 behaviors in this township residence over the age of 18 years old. One-way analysis of variance (ANOVA), independent t-test, and multiple linear regression were used to analyze the data. Results: The overall mean score of knowledge related to COVID-19 was 25.95±7.07, whereas 37.48±15.05 was for preventive behaviors. After multiple linear regression, participants who living in urban, single, passed high educational status, family members who had COVID history, COVID-19 patients who had underlying diseases reported higher preventive behavior where as participants who had co morbidity reported lower performing preventive COVID-19 behaviors. Those participants with higher knowledge scores reported higher preventive COVID-19 behaviors (β=0.312, p=0.000). Conclusions: Public health interventions should utilize these experiences to effectively communicate and promote preventive measures, thereby enhancing the targeting and impactful nature of future infectious disease prevention efforts.

Abstract Su401: Confidence in performing CPR after training with traditional and female-breasted manikins

Introduction: Studies have documented that females experiencing an OHCA are significantly less likely to receive cardiopulmonary resuscitation (CPR) than males in public locations. Reasons for this disparity include bystanders fear of being perceived as sexualizing or assaulting females during CPR, concerns about physically injuring females, or low confidence in rendering CPR on females. This pilot study aimed to assess the confidence of CPR trainees who were trained on both traditional and female-breasted manikins. Methods: Participants were enrolled at a community bystander CPR training for teachers at an urban public school in 2024. Participants who consented to participate in the study were asked to complete surveys. All participants received a didactic on hands-only CPR, followed by two sets of hands-on practice, first with a traditional manikin, and then with a female-breasted manikin or vice versa. Results: Of the 112 participants enrolled in the study, 88.4% were women, and 14% were >50 years of age. The sample was almost all White participants, with high education status (88.4% with a Master’s or college education). The majority (86.6%) had prior CPR training, but most of them reported receiving training more than a year ago. After the two sets of practice (one with traditional manikin, and one with female manikin), 84.7% felt confident to perform CPR on both males and females, while 9.9% felt more confident to perform CPR on female and 5.4% on male. Men and women (84.6% and 84.7%, respectively) felt equally confident in performing CPR on both males and females. Although 28.4% felt either ‘slightly uncomfortable’ or ‘very uncomfortable’ with use of the female manikin, after practicing on a female manikin, 81.6% felt more comfortable with doing CPR on women (11.1% still felt uncomfortable and 7.3% were neutral). When asked which manikin made them feel more confident in performing CPR, 70.9% reported both, while 7.2% said neither, 10% said female manikin and 11.8% selected traditional manikin. 70% of women and 75% of men selected both manikins. Conclusion: Training with both types of anatomically accurate manikins is important in improving confidence of community lay responders in performing CPR and reducing community level gender disparities. Future analysis will evaluate change in confidence with each manikin type and assess confidence and knowledge retention 6 months after the training.

Problems of the public good in higher education: building the common amid sovereign individualism, capital and the state

AbstractAnglophone societies in which the sovereign individual is primary vis and vis social relations, and policy focuses on economic competition and consumption in education, find it hard to grasp non-pecuniary outcomes in higher education. These include the self-formation of students as persons and collective goods like knowledge, technological capability, social inclusion, political connectedness, tolerance and global understanding. While other cultures generate insights into non-pecuniary outcomes, the paper focuses critically on meanings of ‘public’ in English: (1) public as state, (2) public good as universal well-being, (3) public as inclusive-communicative as in ‘public opinion’, (4) public and private goods in economics. None of these meanings of ‘public’ enables the resolution of the non-pecuniary outcomes of higher education. The paper tackles four central questions. First, why is there an undue emphasis on the individual and individualised pecuniary benefits, vis a vis social relations, in Euro-American and especially Anglophone societies? Second, can these societies strengthen public or common goods by augmenting the state in higher education? Third, what other practices of public and common might advance non-pecuniary outcomes? Fourth, how to advance collective outcomes beyond the nation-state? The paper finds that while Anglophone public good is constrained by the state in capitalist society, higher education’s role in the production and distribution of common good through primarily local networks, while also pressuring central states to provide support, offers a promising way forward.

Determinants of Public Support for Fee-Contracts in Uzbekistan's Higher Education

This study examines the impact of fee-contract funding (FCF) systems on state higher education (SHES) in Uzbekistan, addressing a gap in existing literature that has primarily focused on standard tuition fees and state subsidies without exploring fee contracts, especially in emerging markets. Using a logistic regression analysis on survey data from 120 participants, the study aims to identify predictors influencing policy support for fee contracts. Findings indicate that income level and education are the strongest predictors of policy favorability, while cultural factors elevate support for "fee contract will make college access easier" as a predictor, though with weaker direct effects. Age and private sector contributions, though correlated with the outcome, were not statistically significant. These results suggest that policy elites in high-income and educated groups favor FCF systems, yet promoting fee contracts as accessibility-enhancing may garner broader support. The study underscores the need for policy interventions and expanded financial aid to promote equitable access, recommending further research into the long-term social and economic effects of fee contracts in similar contexts.

Adherence to Medication Among Diabetic Patients Attending the Non-communicable Disease Clinic of a Secondary Care Center in North Kerala, India.

People with diabetes mellitus can live longer and healthier lives if the disease is detected early and well-managed. The role of the doctor in educating the patient regarding diabetes management and that of the patient in taking responsibility for medication adherence and practicing proper self-care cannot be overemphasized. By examining the patterns and factors influencing adherence to medication, better insight can be gained into our understanding of controlling the disease. The present study aims to understand the adherence to medication among diabetic patients attending the non-communicable diseases (NCD) clinic of a secondary care center in Kerala, India. This cross-sectional study was conducted among 100 diabetic patients attending the NCD clinic of a secondary care center in Kerala, India. Data was collected by interviewer-administered questionnaire and analyzed using Epi Info version 7.2 (Centers for Disease Control and Prevention, Atlanta, GA). Among the 100 study participants, 53% were females, and 84% had a family history of diabetes; 78% had at least one comorbidity. All participants had received advice regarding the importance of regular medication. Only 39% were regular in taking medication. Being male, unemployed, having a shorter duration of disease (less than one year), absence of comorbidities, shorter duration of drug use (less than two years), and taking a single medication were significantly associated with good medication adherence. In the logistic regression model, higher educational status, living without a partner, and longer medication duration indicated potential positive associations with adherence. Only 8% of participants had blood glucose levels under control. This study highlights the challenges in diabetes management among patients in Kozhikode, Kerala.A significant proportion reported irregularities in their adherence to medication. The low percentage of participants with optimal blood glucose levels underscores the need for targeted interventions and personalized approaches to improve overall outcomes.

Prevalence, Patterns, and Predictors of Oral Morbidity in Patients With Diabetes: Evidence From the Longitudinal Ageing Study in India.

Background Diabetes mellitus (DM) and periodontal disease share a complex bidirectional relationship, resulting in worsening of oral health with persistent impairment of glycemic control. Objective The objective of this study was to ascertain the burden, patterns, and predictors of oral morbidities in older patients with DM, including their health-seeking behavior in India. Materials and methods We used the nationally representative Longitudinal Ageing Study in India (LASI) wave-1 dataset (2017) to analyze data from 8,564 patients with DM aged ≥45 years. Results The median duration of DM in the participants was eight years. The weighted prevalence of at least one or more self-reported oral health morbidities was 59.85% (95% CI: 56.57% to 63.13%) including tooth pain (33.47%), loose teeth (29.98%), swelling in gums (10.08%), and bleeding gums (9.1%). Furthermore, patients with DM had a substantial burden of total (8.84%) and partial edentulism (66.35%). On adjusted analysis, female gender, higher educational status, higher wealth quintile, tobacco use, alcohol use, and greater duration of DM had significantly higher odds of having oral health morbidities excluding caries. Only 79 (0.12%) patients reported visiting dentists in the previous 12 months. Conclusions Integration of oral healthcare services with existing diabetes care in outpatient settings should be strengthened to improve oral health related quality of life.

Including educational status may improve cardiovascular risk calculations such as SCORE2.

The association between education and atherosclerotic cardiovascular disease (ASCVD) has been well described for decades. Nevertheless, most cardiovascular risk models, including SCORE2, still do not take educational status into account even if this factor is easily assessed and costs nothing to acquire. Using carotid plaques as a proxy for ASCVD, we analysed educational status as associated with carotid plaque development, to determine if the relationship remains, how it relates to traditional risk factors and, how it impacts the European cardiovascular risk model, SCORE2. Our study also provides further data on plaque development in a well-characterised population nearly equally weighted by gender. 9,083 subjects (51% female, 49% male) from the Paracelsus 10,000 cohort, underwent a carotid doppler duplex as part of thorough screening for subclinical ASCVD. Well over 90% of carotid doppler duplex examinations were performed by the same experienced clinician. Subjects were then classified by educational status using the Generalized International Standard Classification of Education. Plaque absence or presence was dichotomised and variables analysed using regression modelling to examine educational status relative to cardiovascular risk factors and with respect to the SCORE2 model. Using medium educational status as a reference, subjects in our cohort with low educational status had higher odds, while subjects with high educational status had lower odds for carotid plaques compared to subjects with medium education (aOR 1.76 95%CI 1.50-2.06; and 0.0.63 95%CI 0.57-0.70, respectively). Even after adjusting for common risk factors including metabolic syndrome and SCORE2, the relationship was maintained. Furthermore, when comparing the potential predictive power of SCORE2 alone and plus educational status using the Akaike information criterion, we showed a 'better fit' when educational status was added. Measuring educational status is cost-free and easy for clinicians to obtain. We believe cardiovascular risk prediction models such as SCORE2 may more accurately reflect individual risk if educational status is also taken into account. Additionally, we believe clinicians need to understand and appropriately address educational status as a risk factor, to better quantify individual risk and take appropriate measures to reduce risk so that the association may finally be broken.

Latent classes of learners in people with type 2 diabetes, stratified by educational status: A cross-sectional study

ObjectiveResearch suggests that people with type 2 diabetes (PWT2D) exhibit different approaches to learning about disease-management. This study’s aims to identify distinct learner groups among PWT2D and stratify them by educational status (ES). MethodsCross-sectional data from 227 PWT2D, collected through 46 Likert-scale questions on learning behaviors, preferences, and attitudes, were analyzed using latent class analysis, to identify learner groups. Participants were recruited via healthcare practices in central Germany and a countrywide online survey. Group membership was displayed according to low, medium, and high ES, defined by years of schooling. ResultsFour learner groups were identified: casual, versatile, insecure, and theorist learners. Insecure learners accounted for almost half of all respondents in the low ES group (46 %), casual learners were most prevalent among PWT2D with a medium (27 %), versatile (34 %) and theorist (29 %) learners among those with a high ES. ConclusionThis study sheds light on learner groups among PWT2D, which differ by ES, suggesting social disparities in diabetes care. Further research is needed to validate these findings. Practice ImplicationsUnderstanding individual learning preferences and motivations is crucial for developing effective diabetes self-management trainings, which may involve providing additional background material for theorists and practical applications for insecure learners.

Association between quality of antenatal care service utilisation and adverse birth outcomes among adolescent women in 22 Sub-Saharan African countries. A mixed-effects multilevel analysis

ObjectivesThis study aimed to assess the association between the quality of antenatal care (ANC) service utilisation and adverse birth outcomes among adolescent women in Sub-Saharan Africa (SSA). MethodsA two-level mixed-effects model was employed using the recent Demographic Health Survey (DHS) data from 22 SSA countries. Both bivariable and multivariable multilevel analyses were conducted to assess the association between individual and community level factors with adverse birth outcomes. The results of the fixed effects model were interpreted in the form of adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs). ResultsIn SSA, 23.5 % of adolescent mothers experienced adverse birth outcomes. This study found that receiving high quality ANC was associated with a 28 % reduction in the likelihood of adverse birth outcomes (AOR = 0.72, 95 % CI: 0.63, 0.83). Among the individual-level factors, middle-aged adolescence (AOR = 1.23, 95 % CI: 1.11, 1.36), being a female newborn (AOR = 1.15, 95 % CI: 1.05, 1.26), single marital status (AOR = 0.87, 95 % CI: 0.78, 0.96) and higher educational status (AOR = 0.83, 95 % CI: 0.74, 0.93) were significantly associated with adverse birth outcomes. From the community-level variables, women from Eastern Africa had positive significant association with adverse birth outcomes (AOR = 1.30, 95 % CI: 1.15, 1.46). ConclusionsNearly one-fourth of adolescent women in SSA experienced at least one type of adverse birth outcome. Low quality of ANC was significantly associated with adverse birth outcomes. Policymakers need to consider a comprehensive, essential, and minimal package of ANC to enhance the quality of ANC, which is crucial for better adolescent birth outcomes.

Knowledge, attitude and the associated factors regarding spectacle use among adults living in Debre Birhan Town, North Shewa, Ethiopia, 2023: a community-based, cross-sectional study

ObjectiveThis study aimed to assess the knowledge, attitude and the associated factors regarding spectacle use among adults living in Debre Birhan Town, North Shewa, Ethiopia.DesignA community-based, cross-sectional study was conducted...

Help-seeking behaviors and determinant factors among women exposed to intimate partner violence in East Africa based on recent demographic and health survey data: a multilevel analysis.

Human rights violations and violence against women are serious public health issues that have numerous detrimental repercussions on one's physical, emotional, sexual, and reproductive health. According to studies, women's perceptions and traits of violence are highly predictive of their likelihood of seeking help against violence. Even though intimate partner violence is a huge challenge nowadays in Africa, there is a low level of help-seeking behavior. Conducting this study at the East African level on help-seeking behavior can provide a clue for policy-makers. Therefore, this study aimed to reveal the prevalence of help-seeking behavior against intimate partner violence and determinant factors among women in East Africa. Multilevel logistic regression analysis was carried out among East Africans using recent demographic and health survey data. A total of 7,387 participants aged 15 to 49 years were included in this study from East African countries. Individual- and community-level variables were considered to determine the associated factors with help-seeking behaviors against intimate partner violence with 95% CI and AOR. The prevalence of help-seeking behavior against intimate partner violence among women was 38.07% with 95% CI (36.96%, 39.18%). Husbands drink alcohol [AOR = 1.46: 95% CI (1.33, 1.61)], women who have work [AOR = 1.33: 95% CI (1.19, 1.50)], and women with higher educational status [AOR = 1.36: 95% CI (1.16, 1.59)] were factors associated with help-seeking behavior against intimate partner violence. Approximately four out of 10 women were seeking help for intimate partner violence in East Africa. Husbands drinking alcohol, women's high educational status, and women having occupations were the factors that were associated with help-seeking behaviors against intimate partner violence.

Eye care service utilization and associated factors among adults in Debre Berhan Town, North Shewa, Ethiopia, 2023.

Globally, the utilization of eye care services varies widely, ranging from 18 to 90%. Low utilization of eye care services can lead to delayed detection of vision problems. However, there are limited data on the proportion of eye care service utilization and its associated factors in Ethiopia at the community level. The objective of this study was to determine the proportion of eye care service utilization and its associated factors among adults in Debre Birhan town, North Shewa, Ethiopia. Using a multistage sampling method, a community-based cross-sectional study was conducted on 960 adults in Debre Birhan town from 8 May to 8 June 2023. Binary logistic regression was performed. Variables with a p-value of less than 0.05 were considered significant. A total of 940 study participants participated, resulting in a response rate of 97.9%. The mean age of the participants was 54.67 years (SD ± 8.69). The proportion of good-level eye care service utilization was found to be 32.98% [95% confidence interval (CI): 29.97, 35.99]. Factors positively associated with good-level eye care service utilization included older age [adjusted odds ratio (AOR) = 1.58, 95%CI: 1.00, 2.51], higher educational status (AOR = 2.25, 95%CI: 1.25, 4.06), high family monthly income (AOR = 8.70, 95%CI: 4.99,15.18), awareness of regular eye checkups (AOR = 1.77, 95%CI: 1.15, 2.73), a history of eye disease (AOR = 2.57, 95%CI: 1.77,3.74), health insurance (AOR = 1.99, 95% CI: 1.34, 2.95), and history of spectacle use (AOR = 1.94, 95%CI:1.34, 2.80). The study revealed that the proportion of good-level eye care service utilization was low. Older age, higher educational status, high family monthly income, awareness of regular eye checkups, a history of eye disease, health insurance, and history of spectacle use were significantly associated with a good level of eye care service utilization.

Factors associated with facility childbirth and skilled birth attendance in Migori County, Kenya and the effect of Lwala Community Alliance intervention: a cross-sectional assessment from the 2019 and 2021 Lwala household surveys

BackgroundDespite evidence of the beneficial effects of skilled birth attendance (SBA) on maternal health and childbirth outcomes, there are disparities in access across counties in Kenya. These include Migori County which has historically recorded high maternal mortality rates. In 2007, the Lwala Community Alliance was founded to improve health outcomes in this county. The objective of this study is to provide a baseline status of facility childbirth and SBA in Migori and to characterize the effect of Lwala intervention on these outcomes.MethodsA cross-sectional household survey was designed for a 10-year study to evaluate the effectiveness of Lwala initiatives. The 2019 and 2021 household surveys were conducted in Lwala intervention wards and in comparison wards with sample sizes of 3,846 and 5,928 mothers, respectively. The survey captured demographic, health, and socioeconomic data at each household, data on SBA and facility childbirth, and explanatory variables. A generalized linear model was used to determine factors associated with SBA. A secondary trend analysis was conducted to determine change over time in the explanatory variables and SBA. To determine the change in SBA rate due to Lwala intervention, controlling for background temporal trends, a difference-in-differences (DiD) model compared SBA rates in intervention wards and comparison wards.ResultsSBA increased in all surveyed wards and across all explanatory variables from 2019 to 2021. The DiD analysis showed that the SBA rate increased more in Lwala intervention wards than in comparison wards (Adjusted Prevalence Rate Ratio 1.05, p < 0.001, 95%CI 1.03–1.08). The 2021 survey found the highest rates of both facility childbirths (97.9%, 95%CI 96.5–98.7) and SBA (98.2%, 95%CI 97.0–99.0) in North Kamagambo, the oldest ward of Lwala intervention. Higher educational status, four or more ANC visits, marriage/cohabitation, and wealth were significantly associated with increased SBA.ConclusionsWe provide the first quasi-experimental evidence that Lwala interventions are significantly improving SBA which may inform related initiatives in similar settings. The household-survey data provides a baseline for continued evaluation of Lwala programs, and the breakdown by ward allows for development of specific programmatic targets.

The use of nonpharmacological interventions for chronic pain treatment in community-dwelling older adults with a certified need for care

BackgroundChronic pain is a major health issue and rapid population ageing exacerbates the burden to health systems in countries like Germany. Nonpharmacological interventions (NPIs) are essential in pain care and the prioritization of active NPIs is emphasized in guidelines. This paper examines the utilization of NPIs for chronic pain management in community-dwelling older adults with a certified need of care in Berlin, Germany.MethodsCross-sectional data was collected through standardized face-to-face surveys with older adults (≥65 years), using validated instruments (e.g., Brief Pain Inventory), and structured lists for NPI utilization. Categorization into active and passive NPIs was performed through a literature-based, iterative process by an interdisciplinary team. For not normally distributed data, non-parametric tests were used as appropriate. Logistic regression was conducted for multivariate analysis.ResultsIn total, 250 participants were included in this analysis (aged 65-104, x̅ = 81.8, 68.8% female). Most (92%) use NPIs for chronic pain management: 85.6% use active NPIs, 50.4% active movement and only 5.6% use solely passive approaches. Most common NPIs are distraction, thermotherapy/compresses, and physiotherapy. The odds of utilizing physiotherapy are three times higher for those with high educational status when compared to those with low education while those with low educational status had higher odds of using thermotherapy/compresses.ConclusionsIn our sample, most community-dwelling older adults with a certified need of care use active NPIs for chronic pain management with about half using active movement approaches. Considering the high vulnerability of this population, physiotherapy (in the form of therapeutic exercise) is a particularly appropriate intervention, and it was the third most frequent NPI in our sample. However, there is a social gradient in the utilization of physiotherapy for chronic pain management which might be rooted in issues around awareness, appeal, and access to such measures. It is important to take socioeconomic differences into account when planning the care for older chronic pain patients but also when designing research or user-friendly guidelines for this target group.Trial registrationEthical approval from the Ethics Committee of Charité - Universitätsmedizin Berlin (EA1/368/14) and study registration with the Central Study Register (ZSR no. 20009093).

Geospatial patterns, and individual and community levels factors of cesarean section deliveries in Ethiopia: A spatial and multilevel analysis.

Cesarean Section (CS) is the most popular surgery worldwide in obstetric care to save a mother's or the fetus's life. The prevalence of CS delivery in Ethiopia was 0.7% and 1.9% in 2000 and 2016 respectively and its spatial distribution and variation in Ethiopia are limited. This study provides evidence for healthcare providers and pregnant women on the national CS geospatial distribution and variation to promote evidence-based decision-making and improve maternal and neonatal outcomes. Therefore, this study aimed to determine geospatial patterns and individual and community-level factors of CS deliveries in Ethiopia. A secondary data analysis of 5,527 weighted samples of mothers using the 2019 Ethiopian mini demographic and health survey was conducted. The spatial hotspot analysis using Getis-Ord Gi* hot spot analysis of ArcGIS version 10.7.1 was used to show the spatial cluster of CS and multilevel mixed effect logistic regression analyses were employed. Statistical significance was declared at p-value <0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported. The prevalence of CS delivery in Ethiopia was 5.4% with 95%CI (4.6%, 6.4%). The spatial autocorrelation shows CS was clustered in Ethiopia (global Moran's index = 1.009, and p-value<0.001). Spatial hotspot indicates CS was prevalent in Addis Ababa, Diredewa, Oromo, and Somali regions. The odds of CS delivery were higher among mothers aged 24-35: AOR = 1.98, 95% CI (1.3, 3.1), and 35-49: AOR = 3.7, 95% CI(2.2, 6.1), live with female household heads: AOR = 1.9, 95% CI (1.2, 3.1), mothers with primary AOR = 1.6, 95% CI (1.07, 2.7), secondary: AOR = 2.4, 95% CI (1.3, 4.25) and higher education: AOR = 2.06, 95% CI (1.03, 4.2), multiple births: AOR = 8.1, 95% CI (3.4, 19.74), mothers in Addis Ababa: AOR = 3.4, 95% CI (1.1, 11.9) and Diredewa: AOR = 7, 95% CI (1.23, 40.7) as compared to their counterparts. In Ethiopia, CS deliveries remain below the World Health Organization estimate with distinct geospatial variation. Geographically, CS delivery is concentrated in urban areas like Addis Ababa and Diredewa, as well as in parts of the Somali and Oromia regions. Maternal age, female household head, Muslim religion, higher educational status, and multiple births at the individual level, and region at the community level were factors of CS delivery in Ethiopia. Therefore, efforts should be geared towards strategies and interventions to ensure fair access to CS delivery in line with WHO recommendations, especially in the regions where the CS delivery rate is below WHO estimates in Tigray, Amhara, Afar, and Benishangul Gumze regions.