Household-based Survey Research Articles

Exploring Antibiotic Use in the Community: A Household-Based Survey Using the Drug Bag Method in Rural Burkina Faso.

In Burkina Faso, there is lack of awareness of antibiotic use at the community level. This study aims to generate information on the commonly used antibiotics along with the reasons for which they have been used in rural Burkina Faso. The drug bag method was employed to collect information from 423 households in the health district of Nanoro. Descriptive analyses were performed using R software version 4.2.1. Of the 33 antibiotics inventoried, amoxicillin tablets and oxytetracycline were the most recognized and used antibiotics. This study indicated that antibiotics were used for a range of health problems in the community, some of which were administered as painkillers. While primary healthcare facilities constituted the primary source of drugs for households (76.8%), informal drug sellers constituted an additional option (61.5%) for community members. This is a significant concern, given that some antibiotics classified as "Watch"-such as norfloxacin-were readily available in these outlets, despite not being included on the country's Essential Medicines List. This study underscores the necessity of considering the role played by formal providers in the inappropriate use of antibiotics and the importance of understanding the circumstances and logical reasoning underlying communities' access to and use of antibiotics.

Self-perception of oral health, gender and employment among Brazilian population.

Self-perception of oral health is a recognized indicator, based on a single question. Association among oral health and socioeconomic status has been well established, however in Brazil, no results were found on the relation with type of insertion in labor market. The aim of this study was to describe the prevalence of negative self-perception of oral health and associated factors, according to gender among Brazilian workers population, in 2019. The National Health Survey, nationwide household-based survey, carried out in 2019, was used as source of data. Absolute and relative frequencies were calculated to understand the distribution of variables of interest and characterize the sample (n = 54,343). Binary logistic regression was used in the analyses. Odds ratio (OR) was estimated using a 95% confidence interval in bivariate and multivariate analyses. The prevalence of negative self-perception of oral health was 29.3%; in that, 31.0% among men and 27.2% among women. Compared to formal employees, the chance of negative self-perception of oral health among the informal workers was almost 20% higher among men and 13% among women after adjusting for all confounding factors. Unemployed women were 33% more likely to have negative self-perception of oral health. Self-reported unemployment increased the chance of a negative self-perception of oral health among women; however, the same effect was not observed among men. Why is there a difference? The association between informal work and negative SEOH is relevant in the Brazilian context of work deregulation and growth in the number of people without access to formal employment. The results suggested addressing employment conditions in adult oral health promotion actions, with emphasis on gender differences.

HIV prevalence and associated factors among adolescent boys and young men in South Africa: 2017 nationally representative household-based population survey

IntroductionThere is growing recognition that adolescent boys and young men (ABYM) have been left behind in the HIV response and are under-represented in HIV services, leading to poor outcomes across...

Test-treat-track-test-treat (5T) approach for Schistosoma haematobium elimination on Pemba Island, Tanzania

BackgroundAfter decades of praziquantel mass drug administration (MDA), several countries approach schistosomiasis elimination. Continuing MDA in largely uninfected populations no longer seems justified. Alternative interventions to maintain the gains or accelerate interruption of transmission are needed. We report results, strengths, and shortcomings of novel test-treat-track-test-treat (5T) interventions in low Schistosoma haematobium prevalence areas on Pemba, Tanzania.MethodsSchool- and household-based surveys were conducted in 2021 and 2022 to monitor the S. haematobium and microhematuria prevalence and assess the impact of interventions. In 2021, 5T interventions were implemented in 15 low-prevalence areas and included: (i) testing schoolchildren in primary and Islamic schools for microhematuria as a proxy for S. haematobium, (ii) treating positive children, (iii) tracking them to their households and to water bodies they frequented, (iv) testing individuals at households and water bodies, and (v) treating positive individuals. Additionally, test-and-treat interventions were implemented in the 22 health facilities of the study area.ResultsThe S. haematobium prevalence in the school-based survey in 15 low-prevalence implementation units was 0.5% (7/1560) in 2021 and 0.4% (6/1645) in 2022. In the household-based survey, 0.5% (14/2975) and 0.7% (19/2920) of participants were infected with S. haematobium in 2021 and 2022, respectively. The microhematuria prevalence, excluding trace results, in the school-based survey was 1.4% (21/1560) in 2021 and 1.5% (24/1645) in 2022. In the household-based survey, it was 3.3% (98/2975) in 2021 and 5.4% (159/2920) in 2022. During the 5T interventions, the microhaematuria prevalence was 3.8% (140/3700) and 5.8% (34/594) in children in primary and Islamic schools, respectively, 17.1% (44/258) in household members, and 16.7% (10/60) in people at water bodies. In health facilities, 19.8% (70/354) of patients tested microhematuria-positive.ConclusionsThe targeted 5T interventions maintained the very low S. haematobium prevalence and proved straightforward and feasible to identify and treat many of the few S. haematobium-infected individuals. Future research will show whether 5T interventions can maintain gains in the longer-term and expedite elimination.Trial registrationISRCTN, ISCRCTN91431493. Registered 11 February 2020, https://www.isrctn.com/ISRCTN91431493.

THE IMPLEMENTATION OF HOUSEHOLD-BASED SURVEYS: BASIS FOR AN ENHANCED INTERVENTION SCHEME

This study evaluates the implementation of a household-based survey conducted by the Philippine Statistics Authority (PSA) and its manifestation to respondents, serving as a basis for an enhanced survey program. Three hundred (300) households were surveyed via random sampling from the six (6) selected barangays in the Municipality of Santa Cruz, Laguna Province. Demographic characteristics of respondents provided insights into survey findings and implications. Results indicate a high level of implementation, as demonstrated by mean scores in critical indicators such as interviewer/enumerator duties, survey characteristics, and perception of the survey. Challenges persist in communication and information dissemination, yet overall implementation still needs to be higher. The study reveals significant relationships between socio-demographic profile variables and implementation variables, with the location of respondents influencing survey experiences. Age, sex, education, income, and occupation significantly correlate with survey aspects. Strong statistical correlations are observed between implementation and manifestation variables, emphasizing their influence on survey outcomes. The findings reject the hypothesis of no significant relationship between the household survey and its manifestation, providing valuable insights into survey dynamics. KEYWORDS: Household-based survey, Survey program, Implementation, Communication and information dissemination, Survey Experiences, Manifestation, Survey Outcome, Survey dynamics

Correlates of early sex debut among adolescents and young women: A National cross-sectional study

Background Early sexual debut among adolescents and young women may predispose them to unwanted pregnancies and sexually transmitted diseases. In Kenya, this consequently results in education discontinuation hence poverty levitation. Sexual debut has been studied in relation to HIV, school programs or review of demographic and health surveys. We report correlates of early sexual debut among women aged 15-24 years from a household-based survey in Kenya. Methods Performance, Monitoring for Action (PMA) is a cross-sectional survey using a multi-stage cluster design with urban-rural stratification. The sampling was done at the county level using probability proportional to size to select 11 counties and enumeration areas (EAs) achieving 308 EAs. Interviews were conducted from 35 randomly selected households, from which the eligible women were also interviewed. Descriptive statistics were generated to determine the social demographic characteristics of respondents, and bivariate analysis for the correlation of independent variables and early sexual debut. A logistic regression model was used to determine the association between social demographic characteristics and early sexual debut among women of 15-24 years old. P <0.05 was considered significant. Results A total of 3,706 women were interviewed, and about 1 in 100 (10.2%) of the respondents reported having ever engaged in sexual intercourse before the age of 16 years. Educational level, ever-given birth, contraceptive use and wealth status were found to be statistically associated with early sexual initiation in Kenya. Women who reported having ever given birth had higher odds of early sexual initiation (AOR 2.36, 95% CI, 1.51-3.68, p<0.005) than those who have never given birth. Respondents who were contraceptive users were 1.4 times more likely (AOR 1.39, 95% CI, 1.01-1.90, p<0.001) to have experienced early sex debut than non-users. Conclusions Several individual factors influence early sexual debut, and hence interventions at the policy and program levels are required.

Estimating the Size of Populations at High Risk of Malaria in 2 Operational Districts in Cambodia: Household-Based Survey.

Cambodia is targeting the elimination of malaria by 2025. The last remaining pockets of malaria in Cambodia are concentrated among populations exposed to forested areas, but the size of these populations is not well understood. To plan for the procurement and distribution of vector-control tools, chemoprophylaxis, and other commodities for malaria prevention and surveillance, robust estimates of the population at greatest risk are required. This study aims to estimate the number of forest-exposed individuals residing in Cambodia's highest-burden operational districts (ODs) in 2 provinces with active malaria transmission. In April 2023, a multistage, in-person survey was conducted among residents in the 2 ODs in Cambodia with the highest malaria burden: Sen Monorom in Mondulkiri province and Phnom Srouch in Kampong Speu province. In each OD, 10 villages were randomly selected, and 35 households were randomly selected from each village. To estimate the number of individuals at high risk of malaria-defined as residing within 1 km of a forest or traveling at least once per week to the forest-respondents were asked about the distance from their household to the nearest forested area, and their travel patterns to forested areas. To account for mobility (ie, to avoid double-counting), respondents also provided information on overnight stays at other households in the selected villages in the past month. In the 4 selected villages in Sen Monorom OD where Project BITE forest packs (an intervention in the larger research program) had been distributed prior to the survey, respondents were also asked questions to determine if they had received such a pack, to develop smaller scale "multiplier method" estimates of at-risk individuals in each of those villages. In Sen Monorom, 138 households and 872 individuals were enrolled in the survey, and in Phnom Srouch, 163 households and 844 individuals were enrolled. The estimated percentage of female householders was 49.7% (852/1716) across both ODs; the median age was 22 (IQR 12-37) years in Sen Monorom and 24.5 (IQR 16.0-40.5) years in Phnom Srouch (total age range 3-86). Based on mobility-adjusted survey estimates alone, 32% (280/706; 95% CI 19.9-47.2) of residents in Sen Monorom (an estimated 12,133-20,135 individuals) and 36% (68/198; 95% CI 24.5-45.5) of residents in Phnom Srouch (an estimated 1717-2203 individuals), met risk criteria for forest exposure. Between 125 and 186 individuals were estimated to be at risk in each of the 4 villages where the multiplier method could be applied. This study provides estimates of the number of individuals potentially at high risk for malaria infection due to forest exposure in 2 ODs in Cambodia. These estimates can support planning for malaria control and elimination efforts. The straightforward methods of household surveys and multipliers should be feasible for many national malaria control programs.

Utilization of dental services by rural riverside populations covered by a Fluvial Family Health Team in Brazil.

Rural riverside populations of Brazil face several difficulties to access health services. The Brazilian National Primary Care Policy implemented the Fluvial Family Health Teams (FFHT), which is a specific primary care team arrangement for these territories. The aim of the study was to assess the use of dental services by adults living in rural riverside areas covered by a FFHT. A household-based cross-sectional survey was carried out with a rural riverside population of 38 localities on the left bank of the Rio Negro, Manaus, Amazonas, representative of the area covered by the FFHT. Stratified random sampling was calculated based on the number of adults and households in each riverside locality. An electronic questionnaire was used to obtain information on sociodemographic and oral health conditions, and the utilization of dental services. After descriptive analysis, logistic regression analyses were performed to estimate the odds ratios for the outcome 'use of dental health services over the past 12 months'. A total of 492 individuals, aged 18 years or more, from 38 rural riverside areas were assessed. The mean age of participants was 43.5 years (standard deviation 17.0), ranging from 18.0 to 90.7 years. Of these participants, 3.1% had never been to a dentist and 21.9% had been to a dentist more than 3 years ago. Among those who attended the dental service, 77.4% of appointments occurred in public health services. Dental pain over the previous 6 months (odds ratio (OR)=2.44; 95% confidence interval (CI) 1.51-3.96), higher education (OR=2.62; 95%CI 1.23-5.56), most recent appointment in public health services (OR=1.86; 95%CI 1.19-2.93), edentulism (OR=0.38; 95%CI 0.17-0.85) and dissatisfaction with oral health (OR=0.59; 95%CI 0.38-0.93) were associated with the dental services utilization. The study results revealed that approximately a quarter of the individuals did not use dental services over the previous 3 years or have never used them. Despite the increase in access provided by the FFHT, edentulous individuals, individuals dissatisfied with their oral health, and those with lower levels of education were less likely to use dental services, while individuals who experienced dental pain sought dental services more frequently. These findings suggest that the healthcare model offered to this population must be rearranged.

Prevalência e fatores associados a interrupção do aleitamento materno em menores de dois anos: Pesquisa Estadual de Saúde e Nutrição

Abstract Objectives: to determine the prevalence of breastfeeding interruption and associated factors in children under two years old living in Pernambuco. Methods: cross-sectional study using data from the IV Pesquisa Estadual de Saúde e Nutrição (IV State Health and Nutrition Survey), a household-based survey, carried out in 2015/2016. The information was obtained through standardized forms applied to the children’s mothers and/or guardians. In a subsample of 358 children under two years old. Results: the prevalence of exclusive breastfeeding (EBF) interruption was 76.2% and of breastfeeding 61.7%. In the multivariate regression analysis, the following remained associated with EBF interruption: age range from three to six months (RP= 1.10; CI95%=1.01-1.21) and current or previous use of a pacifier (RP = 1.18; CI95%= 1.07-1.30). For breastfeeding between six and 24 months: economic class D or E (RP=1.08; CI95%=1.01-1.16); maternal work (PR=1.10; CI95%=1.02-1.18); black/mixed color mother (PR=1.07; CI95%=1.00-1.14); not having had a puerperal consultation (PR=1.08; CI95%=1.00-1.16); age group from 19 to 24 months (RP=1.09; CI95%=1.01-1.17) and among those who currently or previously used a pacifier (RP=1.40; CI95%=1.31-1.50). Conclusions: the high prevalence of early weaning reveals the need to implement policies to support and encourage breastfeeding, considering the main associated factors.

Examining the Impact of Hawking on Personal Development: Predictors and Determinants

Hawking is a prevalent economic activity in many developing countries, contributing significantly to the informal economy and the livelihoods of individuals. This is a cross-sectional study using data collected from household-based survey on April 2024 in Isoko Communities with 500 women and men aged 15-65 that had at least one vendor in the last two years. The study assessed the impacts of hawking and personal development using statistical methods. Analysis was conducted in SPSS vs 26 that provided parameters such as descriptive statistic, correlation, regression models, and -2 Likelihood ratio test. Identified push factors contributing to the prevalence of hawking are poverty (88.6%), underemployment (84.2%), low income (82.6%), unemployment (80.2%), food insecurity (75.6%), and broken-homes (58.4%). The associated “Pull factors” include poverty alleviation (79.2%), and income earnings (9.4%). The study documented some effects which include low academic performance (26.2%), unwanted pregnancy (23.8%), and early marriage (6.4%). The results reveal that multiple socioeconomic and personal factors significantly increase the likelihood of engaging in hawking. The most influential predictors are “low income” and “underemployment”, both of which dramatically increase the odds of individuals resulting to hawking. “Food insecurity” and “family instability” add further explanatory power, but their contribution is relatively smaller. Notwithstanding, all the models are statistically significant (with p-values < 0.05), meaning the relationships between these factors and hawking are valid and reliable.

Quality of life among Saudi Arabian Patients Receiving Private Healthcare: Household-Based Survey

Background: As an alternative to hospitalization, home healthcare programs are assuming greater significance on a global scale due to the expanding geriatric population and the prevalence of chronic and acute diseases that require ongoing monitoring and care. In describing and evaluating the quality of life (QOL) and associated determinants of patients enrolled in the Home Health Care (HHC) program affiliated with the Ministry of National Guard Health Affairs in Riyadh, Saudi Arabia, was the overarching purpose of this study. Methods: Participants in this cross-sectional study were HHC program enrolled patients. Utilizing the World Health Organization QOL questionnaire (WHOQOL-BREF), information regarding the various domains of patients' QOL was gathered. By fitting logistic regression models, factors associated with a low QOL score were identified. Results: In the research, 253 patients participated. Age distribution: 67.05 (± 20.0). Morbid and sociodemographic characteristics had a substantial impact on the overall quality of life of HHC patients. The final multivariate logistic regression models identified independent associations between marital status, psychological disorders, stroke, and number of illnesses and the overall quality of life (QOL) of HHC patients (p =.022, p =.002, p =.031, and.057, respectively). In a retrospective analysis, the physical health domain score exhibited significant associations with educational attainment, psychological issues, and stroke (p =.028, p =.002, p =.007). Conversely, the psychological domain score demonstrated a significant association with age (p < 0.001) and three distinct forms of chronic ailments—pulmonary (p =.002), psychological problems (p = 0.001), and p =.002. Only the marital status exhibited a significant association with the social domain score (p =.026). There was a significant association between the environmental domain and both education level and stroke incidence (p =.017 vs..027). Conclusions: Multiple factors are substantially correlated with the overall QOL and its domains. A significant number of these factors can be monitored and improved by enhancing the efficacy of HHC services; consequently, this will enhance patients' QOL.

Uncovering the Burden of Diabetes in Ekiti State, Nigeria: Insights From a Statewide, Household-Based, Cross-Sectional Study.

Diabetes mellitus (DM) is an important global public health challenge, and the burden of the disease is huge, particularly in low- and middle-income countries (LMICs), where the majority of people with this condition reside. Undiagnosed DM is more prevalent in LMICs. The aim of this study is to determine the prevalence and associated factors for DM in Ekiti State. A cross-sectional, household-based survey using a four-stage multistage sampling design and the World Health Organization (WHO)-STEPS survey manual was conducted from July to September 2020 as a part of the Ekiti State coronavirus disease 2019 (COVID-19) survey. Of the 5,145 sampled households, 4,726 individuals gave consent to participate in the survey. Out of these, 3043 had fasting plasma glucose results available and were included in the analysis. There were 2257 (74.2%) women and 786 (25.8%) men. The prevalence of DM was 6.5% (6.5% in males and 6.6% in females, P = 0.946). Diabetes was found to be more prevalent among those with a secondary school education or higher (10.9%); employed in the formal sector (13.4%); separated, divorced, or widowed (8.5%); with raised blood pressure (9.3%); and who were aged 30-59 years (all P < 0.05). Multivariable logistic regression showed that age, education, occupation, and hypertension were all positively and significantly associated with an increased risk of DM. The prevalence of DM in Ekiti State is high, and its predictors include advancing age, hypertension, education, and occupation. This calls for scaling up public health interventions for controlling DM, targeting the identified risk factors among the people of Ekiti.

Societal knowledge, attitude, and practices towards dengue and associated factors in epidemic-hit areas: Geoinformation assisted empirical evidence

Dengue is one of Pakistan's major health concerns. In this study, we aimed to advance our understanding of the levels of knowledge, attitudes, and practices (KAPs) in Pakistan's Dengue Fever (DF) hotspots. Initially, at-risk communities were systematically identified via a well-known spatial modeling technique, named, Kernel Density Estimation, which was later targeted for a household-based cross-sectional survey of KAPs. To collect data on sociodemographic and KAPs, random sampling was utilized (n = 385, 5 % margin of error). Later, the association of different demographics (characteristics), knowledge, and attitude factors—potentially related to poor preventive practices was assessed using bivariate (individual) and multivariable (model) logistic regression analyses. Most respondents (>90 %) identified fever as a sign of DF; headache (73.8 %), joint pain (64.4 %), muscular pain (50.9 %), pain behind the eyes (41.8 %), bleeding (34.3 %), and skin rash (36.1 %) were identified relatively less. Regression results showed significant associations of poor knowledge/attitude with poor preventive practices; dengue vector (odds ratio [OR] = 3.733, 95 % confidence interval [CI ] = 2.377–5.861; P < 0.001), DF symptoms (OR = 3.088, 95 % CI = 1.949–4.894; P < 0.001), dengue transmission (OR = 1.933, 95 % CI = 1.265–2.956; P = 0.002), and attitude (OR = 3.813, 95 % CI = 1.548–9.395; P = 0.004). Moreover, education level was stronger in bivariate analysis and the strongest independent factor of poor preventive practices in multivariable analysis (illiterate: adjusted OR = 6.833, 95 % CI = 2.979–15.672; P < 0.001) and primary education (adjusted OR = 4.046, 95 % CI = 1.997–8.199; P < 0.001). This situation highlights knowledge gaps within urban communities, particularly in understanding dengue transmission and signs/symptoms. The level of education in urban communities also plays a substantial role in dengue control, as observed in this study, where poor preventive practices were more prevalent among illiterate and less educated respondents.

Socioeconomic inequalities in health and healthcare utilization among the elderly in Brazil: results from the 2019 National Health Survey

ObjectivesTo assess socioeconomic-related inequalities in health and healthcare utilization among the elderly in Brazil. Study designCross-sectional nationally representative household-based survey. MethodsWe evaluated the Brazilian National Health Survey data collected in 2019. We computed the prevalence of measures of health conditions and healthcare utilization by age-bracket and markers of socioeconomic status—income, educational attainment, and race/ethnicity—among individuals aged 60 or older. We further employed logistic regression models, adjusted for a wide set of covariates, to estimate the relationship between socioeconomic status and those outcomes. ResultsHigher-income and more educated individuals exhibit better health conditions compared to their lower-income and less-educated counterparts within each age bracket. Results from regression models showed strong associations with income and educational attainment for most health conditions: health status, physical activity, difficulties with activities of daily living and instrumental activities of daily living, and depression. For most conditions, weaker or no associations with race/ethnicity were found. Individuals in the highest income quintile and that completed higher education also had higher odds of having consulted a physician, while high-income individuals had lower odds of having received emergency care at home. ConclusionsThe findings of this study highlight the significant socioeconomic inequalities in the health of the elderly population in Brazil. The substantial and pervasive nature of these inequalities stresses the need for action to address them.

Reported recommendations to address cardiovascular risk factors differ by socio-economic status in Brazil. Results from the Brazilian National Health Survey 2019

BackgroundManagement of cardiovascular risk factors (high cholesterol, diabetes, and hypertension) should start by implementing a healthy lifestyle. Whereas lifestyle recommendations are provided irrespective of the patient’s socio-economic status has not been recently assessed in the Brazilian population. AimsTo assess the preventive measures against cardiovascular risk factors according to educational level and income in the Brazilian population. MethodsSurvey data of the 2019 Brazilian National Health Survey (PNS). The PNS is a nationwide household-based survey carried out by the Brazilian Ministry of Health. The PNS included face-to-face interviews and collected information on lifestyle management of high cholesterol, diabetes, and hypertension by a healthy diet, an adequate weight, exercise, and quitting smoking. The participant’s educational level and income (in multiples of the basic salary per capita) was collected. ResultsOf the 88,052 participants included, 13,151 (14.9%), 6,986 (7.9%) and 22,516 (25.6%) reported being diagnosed with high cholesterol, diabetes, or hypertension, respectively. Dietary recommendations were the most frequently provided (94.5%, 94.6% and 88.1% for high cholesterol diabetes, and hypertension, respectively), while recommendations to quit smoking to current smokers were the least frequently provided (74.9%, 85.8% and 81.1% for high cholesterol, diabetes, and hypertension, respectively). After multivariable adjustment, participants with a higher educational level or a higher income had a higher likelihood of reporting receipt lifestyle recommendations for high cholesterol or hypertension, while no associations were found for most recommendations for diabetes. ConclusionBetter-educated, wealthier Brazilians report receiving more lifestyle recommendations regarding high cholesterol and hypertension management more frequently than lower-educated or with low-income.

The influence of household disadvantage on educational achievement inequality in Pakistan: Evidence from Annual Status of Education Report data

Inequity in education is a worldwide concern and there is a growing need to investigate educational achievement inequality in a nuanced and contextual manner. This study aims to elucidate the growing educational achievement inequality within Pakistan by addressing two key questions: What can be revealed about the influence of family socioeconomic condition and household characteristics on children’s disparate educational achievement in Pakistan? And what role do private schools and paid tuition play in exacerbating disparity in learning outcomes? In this study, we applied the concept of Equity in Education, particularly the impartiality approach, to consider disadvantaged conditions among children. We have analyzed the Annual Status of Education Report (ASER) Pakistan household-based survey data ( N = 247,978) conducted in 2021. Our analysis involved both descriptive and logistic regression techniques. Students’ achievement in the local language, arithmetic, and English language served as a dependent variable, while household factors remained a predictable variable. The results revealed that family socioeconomic factors including parents’ education and income, household facilities, and school types have a significant influence on children’s learning achievement and contribute to educational inequality. This study provides further insights for researchers and policymakers to better understand and address educational inequality in its specific context.

Prevalence of concomitant hypertension and diabetes among adults and elderly living in rural riverside areas in the Amazon.

Considering the scarcity of information on the assessment of chronic diseases in traditional Amazonian populations, as well as public health policies focused on their specificities, this study aimed to estimate the prevalence of at least one of the chronic diseases (systemic arterial hypertension (SAH) or diabetes mellitus (DM)) and their concomitant occurrence in a rural riverside population of the Amazon, and determine the associated factors. A household-based cross-sectional survey was conducted with a sample of adults and elderly people living in rural riverside locations along the left bank of the Negro River, in the municipality of Manaus, Amazonas, Brazil. The outcomes evaluated were the presence of at least one of the evaluated chronic diseases and the concomitant occurrence, based on the self-reported medical diagnosis of SAH and DM. Analysis of associated factors (sociodemographic, behavioral, and access to health services variables) was performed by Poisson regression with robust variance. The sample consisted of 495 individuals (young adults (n=257; 51.9%), middle-aged (n=132; 26.7%), and elderly (n=106; 21.4%)), of whom 51.5% were women (n=255), mean age 43.3&plusmn;17.1 years. The monthly household income was on average R$1100&plusmn;902 (A$345&plusmn;283). The diagnosis of any chronic disease was reported by 18.8% of the sample, with a preponderance of SAH (17.4%). The occurrence of at least one of the chronic diseases was associated with higher average age and worse health self-assessment. Regarding concomitant occurrence of SAH and DM, prevalent in 4.4% of the sample, the same associations were observed. The data for the occurrence of chronic diseases in the studied Amazon rural riverside populations are worrying, because these people live in areas of socioeconomic vulnerability, with a lack of basic sanitation infrastructure, difficult geographic access, and limited access to health care. Health policies fail to recognize the specificities of these populations, which implies deficiencies in the provision of necessary regular care. The findings also reinforce the need to strengthen health promotion and chronic disease prevention strategies in the context of primary care.

High Rates of Undiagnosed Target Organ Damage Among Adults with Elevated Blood Pressure or Diabetes Mellitus in a Community-Based Survey in Lesotho

IntroductionPrevalence of elevated blood pressure (BP) and diabetes mellitus (DM) is increasing in sub-Saharan Africa. Data on target organ damage such as retinopathy, left ventricular hypertrophy (LVH), renal impairment and peripheral neuropathy (PN) among persons with elevated BP and/or DM in sub-Saharan Africa remain scarce.AimTo determine at community-level the prevalence of retinopathy, LVH, renal impairment, and PN among adults with elevated BP and/or DM, and assess the association of elevated BP and/or DM with target organ damage in Lesotho.MethodsDuring a household-based survey, a sub-sample of adults with elevated BP (≥ 140/90 mmHg) and/or DM (glycosylated hemoglobin ≥ 6.5%), as well as comparators (BP < 140/90 mmHg, HbA1c < 6.5%) were screened for retinopathy, LVH, renal impairment, and PN. We used multivariable logistic regression for inferential analysis.ResultsOut of 6108 participants screened during the survey, 420 with elevated BP only, 80 with DM only, 61 with elevated BP and DM, and 360 comparators were assessed for target organ damage. Among those with elevated BP, and among those with DM with or without elevated BP, prevalence of retinopathy was 34.6% (89/257) and 14.4% (15/104); renal impairment was 45.0% (156/347) and 42.4% (56/132), respectively. Among those with elevated BP, 2.3% (7/300) and 65.7% (224/341) had LVH and left ventricular concentric remodeling, respectively. PN, only assessed among those with DM, was present in 32.6% (42/129). Elevated BP was associated with increased odds of retinopathy (aOR, 19.13; 95% CI, 8.52–42.94; P < 0.001) and renal impairment (aOR, 1.80; 95% CI, 1.27–2.55; P = 0.001). Presence of both elevated BP and DM was associated with an increased odds of retinopathy (aOR, 16.30; 95%CI, 5.69–46.68; P < 0.001), renal impairment (aOR, 2.55; 95% CI, 1.35–4.81; P = 0.004), and PN (aOR, 2.13; 95% CI, 1.04–4.38; P = 0.040).ConclusionWe found a high prevalence of undiagnosed target organ damage among adults with elevated BP and/or DM during community-based screening. These findings emphasize the importance of regular prevention and screening activities in this setting.

Awareness of and willingness to use oral pre-exposure prophylaxis (PrEP) for HIV prevention among sexually active adults in Malawi: results from the 2020 Malawi population-based HIV impact assessment

BackgroundThe World Health Organization recommends Pre-Exposure Prophylaxis (PrEP) for all populations at substantial risk of HIV infection. Understanding PrEP awareness and interest is crucial for designing PrEP programs; however, data are lacking in sub-Saharan Africa. In Malawi, oral PrEP was introduced in 2018. We analyzed data from the 2020 Malawi Population-based HIV Impact Assessment (MPHIA) to assess PrEP awareness and factors associated with PrEP interest in Malawi.MethodsMPHIA 2020 was a national cross-sectional household-based survey targeting adults aged 15 + years. Oral PrEP was first described to the survey participants as taking a daily pill to reduce the chance of getting HIV. To assess awareness, participants were asked if they had ever heard of PrEP and to assess interest, were asked if they would take PrEP to prevent HIV, regardless of previous PrEP knowledge. Only sexually active HIV-negative participants are included in this analysis. We used multivariable logistic regression to assess sociodemographic factors and behaviors associated with PrEP interest. All results were weighted.ResultsWe included 13,995 HIV-negative sexually active participants; median age was 29 years old. Overall, 15.0%, 95% confidence interval (CI): 14.2–15.9% of participants were aware of PrEP. More males (adjusted odds ratio (aOR): 1.3, 95% CI: 1.2–1.5), those with secondary (aOR: 1.5, 95% CI: 1.2-2.0) or post-secondary (aOR: 3.4, 95% CI: 2.4–4.9) education and the wealthiest (aOR: 1.6, 95% CI: 1.2-2.0) were aware of PrEP than female, those without education and least wealthy participants, respectively. Overall, 73.0% (95% CI: 71.8–74.1%) of participants were willing to use PrEP. Being male (aOR: 1.2; 95% CI: 1.1–1.3) and having more than one sexual partner (aOR: 1.7 95% CI: 1.4–1.9), were associated higher willingness to use PrEP.ConclusionsIn this survey, prior PrEP knowledge and use were low while PrEP interest was high. High risk sexual behavior was associated with willingness to use PrEP. Strategies to increase PrEP awareness and universal access, may reduce HIV transmission.

Association of both Water, Sanitation and Hygiene (WASH) and Infant and Young Child Feeding (IYCF) practices with childhood malnutrition in Lao PDR: a cross-sectional study of the 2017 Lao Social Indicator Survey II

ObjectiveWe assessed whether Water, Sanitation and Hygiene (WASH) and Infant and Young Child Feeding (IYCF), either alone or combined, were associated with malnutrition among Lao People’s Democratic Republic (Lao PDR)...