Modified Cluster Sampling Research Articles

The aftermath of war; mental health, substance use and their correlates with social support and resilience among adolescents in a post-conflict region of Sri Lanka

BackgroundArmed conflicts impact on the health and well-being of everyone, but its effect on adolescent mental health is a significant, yet under-explored area in global health. Mental health disorders which develop during adolescence often lead to behavioural problems, risky decision-making, under-age substance use and can adversely impact on educational attainment. This study aimed to estimate the prevalence of common mental disorders, substance use and their correlates with social support and resilience among adolescents (age 12–19 years) in Vavuniya; a post-conflict region of Sri Lanka.MethodsA population-based cross-sectional study was conducted, with a modified cluster sampling method used for participant selection. Eight culturally adapted instruments were used for data collection. A total of 585 adolescents participated in the study. Analyses were performed using SPSS Version 23 statistical software package. All statistical tests were two-sided (p < 0.05) and p-values less than 0.05 were considered significant. Chi-square tests were used to explore associations between variables of interest. Spearman rank order correlation was used to examine correlations among depression, hopelessness, quality of life, social support, and resilience.ResultsThe mean age of participants was 15.02 (± 2.13) years. Ninety-one (15.6%) participants reported being exposed to one or more war-related events, and 85 (93.4%) participants in this group reported being internally displaced due to war. Fifty-two (8.9%) had dropped out of school and the prevalence of depression (3.9%) and substance use (7%) were low. Correlational analyses revealed that depression and hopelessness were significantly negatively correlated with social support, resilience, and quality of life (p < 0.01). Linear regression analysis suggested that 40% of the variance in resilience of the participants can be explained by perceived social support.ConclusionThe low prevalence of hopelessness and depression highlights the resilience of this group in the face of adversity. Furthermore, significant negative correlations between hopelessness and depression with perceived social support and resilience suggest that social support and resilience could be protective factors against mental health issues in these adolescents. However, the prevalence of school dropouts calls for a focus on academic attainment to promote better educational outcomes in the adolescents of this conflict-affected region.

Gender norms and ideologies about adolescent sexuality: A mixed-method study of adolescents in communities, south-eastern, Nigeria.

BackgroundSexual and reproductive health choices and behaviors of adolescents are shaped by gender norms and ideologies which are grounded in cultural beliefs. This study examined the perspectives of adolescents about the influence of gender norms and ideologies on sexuality.MethodsA cross-sectional study was undertaken in three urban and three rural communities in south-eastern Nigeria using quantitative and qualitative research methods. A modified cluster sampling procedure was used to select respondents. Data were collected from 1,057 adolescents and twelve focus group discussions with unmarried adolescents aged 13 to 18 years. For the quantitative data, univariate, bivariate and probit regression analyses were performed using Stata while the thematic framework approach was used to analyze qualitative data.ResultsThe dominant beliefs among adolescents are that: it is wrong for unmarried adolescents to have sex (86.4%); unmarried adolescents should abstain from sex (89.3%); consent should be obtained before sexual intercourse (89.1%); it is a girl's responsibility to ensure she does not get pregnant (66.5%), and sex should be initiated by boys (69.6%). Gender (boy or girl) was a predictor of belief in premarital abstinence (t-value = −3.88), belief that premarital sexual intercourse is acceptable provided contraceptive is used (t-value = 3.49, CI 1.14–0.49), belief that premarital sexual intercourse is wrong (t-value = −2.24) and, belief that sex should be initiated by boys only (t-value = −4.37). Adolescent boys were less likely to believe in pre-marital abstinence and less likely to believe that pre-marital sex among adolescents is wrong compared to girls. They were also more likely to believe adolescents can have sex provided contraceptive is used compared to girls. Qualitative findings revealed adolescents' beliefs that girls feel shy initiating sex and that boys experience more urge for sex hence, boys were perceived to be responsible for initiating sex. Both boys and girls experience pressure to have sex however, boys were described to experience more pressure from peers to have sex. Peer-to-peer communication, quest for material possessions and low socioeconomic conditions contribute to peer pressure to engage in sex.ConclusionAdolescents' beliefs about sexuality underline the need to contextualize interventions to address these norms and ideologies.

A household-based survey of the morbidity profile of under-five children in Port Harcourt Metropolis, Southern Nigeria.

Introductionthe commonest causes of childhood morbidity and deaths are avoidable and curable, and have been well reported in country-wide surveys. This study was conducted to validate the locality-specific childhood morbidity profile among households in urban Port Harcourt Metropolis in the oil-rich South-South Nigeria.Methodsan observational, cross-sectional survey was conducted involving 806 mother/under-five children pairs that were randomly selected by a modified cluster sampling design. Data were collected using a pre-tested, interviewer-administered structured questionnaire that was adapted from the Nigeria Demographic and Health Survey instrument (2018), which explored information on common causes of morbidity by verbal autopsies. Analysis was done with the Statistical Package for Social Sciences, version 21.Resultsthe under-five children were 406 males (50.4%) and 400 females (49.6%) with an average age of 27.7 ± 17.9 months. Fever was the most frequent morbidity, reported in 364 (45.2%, 95% CI = 0.4175-0.4861) of the children, followed by cough in 362 (44.9%, 95%CI = 0.4150-0.4836), fast breathing in 49 (6.1%, 95%CI = 0.0458-0.0789), and diarrhoea in 17 (2.1%, 95%CI = 0.0139-0.0308). Symptoms of fever (chi-square = 31.117, P-value=0.001) and cough (chi-square=21.416, P-value = 0.001), were higher in the 48-59 month age group.Conclusionfebrile illness, acute respiratory tract infection, and diarrhoea disease were found to be common in under-five children in the metropolitan city of Port Harcourt. Tailored community-based health interventions and surveillance are needed to reduce the frequency of childhood morbidity and prevent mortality in this age group.

Socio-demographic and economic determinants of awareness and use of contraceptives among adolescents in Ebonyi State, South-east, Nigeria.

Understanding factors that explain levels of awareness and use of contraceptives among adolescents is a critical entry point for improving their sexual and reproductive health. This study assessed the demographic and socioeconomic determinants of awareness and use of contraceptives among adolescents in rural and urban communities in Ebonyi State, Nigeria. A cross-sectional household survey was conducted in three rural and urban communities in August, 2018. Modified cluster sampling technique was used to select eligible households. A total of 1045 adolescents (598 females and 447 males) were randomly selected from the households and interviewed using a pre-tested structured questionnaire. The mean age is 15.4years (15.3 - 15.5) and the median age is 15.5years. Univariate, bivariate and multivariate analysis were undertaken. Statistical significance was set at p-value of <0.05. Majority of respondents, 723 (68.9%), were aware of male condom. Place of residence predicts awareness of contraceptive pills (AOR 0.66, CI 0.48-0.91); schooling predicts awareness of male condoms (AOR 0.57; CI 0.32-0.99). Predictors of awareness of female condoms are place of residence (AOR 0.66, CI 0.47-0.93), gender (AOR 0.57, CI 0.32-0.99) and wealth index (AOR 1.16, CI 1.03-1.30). Demographic and socioeconomic characteristics of respondents did not predict contraceptive use in the last sex. Although awareness of contraceptives is high, utilization is low among sexually active adolescents. Hence, the need to promote access to and utilization of contraceptives through comprehensive contraceptive education to improve adolescents sexual and reproductive health.

Coping or adapting? Experiences of food and nutrition insecurity in specialised fishing households in Komodo District, eastern Indonesia

BackgroundThere is growing recognition of the need for fish to be better integrated into nutrition-sensitive strategies for addressing malnutrition. Fish are overwhelmingly produced by the small-scale sector, which supports food and nutrition security directly through the provision of fish and indirectly through the generation of income which can be used to purchase other desired foods. However, there has been relatively little research on the extent of food and nutrition security in specialised fishing communities. This study assessed food and nutrition security among households in specialised fishing communities in Komodo District, eastern Indonesia.MethodsWe assessed the seasonal nutrition quality of household diets using the Food Consumption Score for nutritional analysis and food insecurity using the Household Food Insecurity Access Scale in 66 households across three communities, using a modified cluster sampling strategy. We calculated and generated descriptive statistics for these indicators with Microsoft Excel and ran a logistic generalized linear mixed model to determine factors associated with severe food insecurity using SPSS. We used semi-structured interviews and focus group discussions to understand perceptions of, change over time, and strategies for dealing with food shortfalls.ResultsWhile most households have acceptable access to nutritious foods, especially protein and heme iron-rich foods, nearly one half of households consumed vitamin A rich foods on less than 3 days of the 7-day recall period in either season. More than half of households reported experiencing a moderate or severe level of food insecurity, with higher food insecurity in the wet season. Low maternal education (OR: 3.8, 95%CI 1.5–9.9) and lower household wealth (OR: 0.5, 95%CI 0.3–0.9) were found to be associated with a severe level of food insecurity. Household’s consumptive and non-consumptive response strategies reflect adaptation to chronic food insecurity but are nutritionally and economically unsustainable.ConclusionHouseholds in specialised fishing communities in Komodo District consumed diets with low diversity and experienced high levels of food insecurity. There is a need for culturally-appropriate nutrition-sensitive strategies to enhance food and nutrition security in vulnerable fishing communities.

A comparison of the accuracy of different types of samples for spatial structure indices determination in beech forests in Serbia

In this paper we compared the accuracy of different samples (minus the sample with the NN1 edge correction and buffer zone, plus sample and modified cluster sample) to determine indices of spatial structure in beech forests in Serbia, which can be used in regular forest inventory. The research was conducted in 11 forest stands of different structure at the territory of Central Serbia. Field data used for the assessment of spatial structure indices were collected across the examined stands on the sample plots of different sizes, using systematic grid, with the square layout of sample plots (100x100 meters). The study was conducted on 242 sample plots. For accuracy comparison of different sample types, five indices were used: Uniform angle index, Mean directional index, Species mingling index, DBH differentiation and DBH dominance indices. One-way ANOVA showed that at the stand level there were no statistically significant differences between mean values of indices obtained by different sample types. However, Simple linear correlations confirmed for most indices that if the spatial structure is to be determined with accuracy at the level of sample plots (in this case, a circular fixed radius plot of 5 acres) it is necessary to use a plus sample during data collection. For species mingling and DBH differentiation indices, Simple linear correlations show that both minus sampling with edge correction buffer zone and modified cluster sampling with somewhat less accuracy can be used to a certain extent. Minus sampling with NN1 edge correction is not practical for use on sample plots of this size in beech forests in Serbia.

Survey data of adolescents\u2019 sexual and reproductive health in selected local governments in southeast Nigeria

A cross-sectional survey of adolescents and heads of households was done in six urban and rural local government areas in Ebonyi state, Nigeria in August 2018. Modified cluster sampling technique was used to select households from which eligible adolescent boys and girls were recruited. This data article describes two datasets that, for the first time, expansively describe adolescents’ sexual and reproductive behaviors in Nigeria. The datasets include variables on adolescents’ demographic and socioeconomic characteristics; family relationships; sexual behaviors; awareness and use of contraceptives; access to sexual and reproductive health information and services; gender norms and ideology about adolescent sexuality; and potential strategies for reducing unwanted teenage pregnancies and unsafe abortions. This dataset would be useful to public health researchers and social scientists investigating drivers of adolescent sexual and reproductive behaviour, as well as programme managers seeking potential strategies for improving adolescent health outcomes. The datasets also provide a template that could be replicated for national or regional surveys on adolescent sexual and reproductive behaviours.

Biochemical assessment of risk factors in coronary artery disease patients: An observational study in suburban hospital of Hapur, Uttar Pradesh

Background: Coronary risk factors such as hypertension, diabetes and coronary artery disease (CAD) have become major health problem in Indian subcontinent, despite low fat intake and low rates of obesity. It is a paradox that the increased risk of people of Indian origin to diabetes and CAD is not explained by conventional risk factors. It is possible that the presence of new risk factors may explain this paradox.&#x0D; Aims and Objective: The present study was undertaken to estimate the prevalence of coronary artery disease and identify &amp; compare some socio-demographic and lifestyle risk factors associated with coronary artery disease in urban and rural populations of Hapur.&#x0D; Materials and Methods: It’s a community based study in which 350 adults each were randomly selected from urban and rural populations of Hapur using modified cluster sampling method. Selected individuals were examined. Data entry and analysis was done using SPSSversion16 for windows version 8.1. Several published epidemiological and case-controlled studies are reviewed. The prevalence of hypertension (3.2%), diabetes (2.6%) and CAD (3.2%) is very low in the rural population of India. However, in urban and immigrant populations, the prevalence of hypertension (≥160/95, 12–20%), diabetes (6–8%) and CAD (7–14%) is significantly higher than in the developed countries.&#x0D; Result: Out of 350 patients of CAD included in study, 133(38%) were females and 217(62%) were males. Among those 54(15.4%) were below 45 years of age and 296(84.6%) were equal to and above 45 years of age. Risk factors like gender prevalence, family history of IHD, lifestyle, triglycerides level, HDL level, BMI and smokingwere not significantly associated with different age groups(p-value &gt;0.05). While HTN, DM, stress, LDL level and cholesterol were found to be significantly associated with age ≥45 years.&#x0D; Conclusions: These studies support the consensus that people of urban origin wherever they are settled should have lower desirable limits of serum cholesterol, body mass index and dietary fat intake and should also decrease new risk factors for preventionof CAD. This finding may require modification of the existing guidelines of the International Task Force for Prevention of CAD.

Interictal burden attributable to episodic headache: findings from the Eurolight project.

BackgroundMost primary headaches are episodic, and most estimates of the heavy disability burden attributed to headache derive from epidemiological data focused on the episodic subtypes of migraine and tension-type headache (TTH). These disorders give rise directly but intermittently to symptom burden. Nevertheless, people with these disorders may not be symptom-free between attacks. We analysed the Eurolight dataset for interictal burden.MethodsEurolight was a cross-sectional survey using modified cluster sampling from the adult population (18–65 years) in 10 countries of the European Union. We used data from nine. The questionnaire included headache-diagnostic questions based on ICHD-II and several question sets addressing impact, including interictal and cumulative burdens.ResultsThere were 6455 participants with headache (male 2444 [37.9 %]). Interictal symptoms were reported by 26.0 % of those with migraine and 18.9 % with TTH: interictal anxiety by 10.6 % with migraine and avoidance (lifestyle compromise) by 14.8 %, both much more common than in TTH (3.1 % [OR 3.8] and 4.7 % [OR 3.5] respectively). Mean time spent in the interictal state was 317 days/year for migraine, 331 days/year for TTH. Those who were “rarely” or “never” in control of their headaches (migraine 15.2 %, TTH 9.6 %) had significantly raised odds of interictal anxiety, avoidance and other interictal symptoms. Among those with migraine, interictal anxiety increased markedly with headache intensity and frequency, avoidance less so but still significantly. Lost productive time was associated with high ORs (up to 5.3) of anxiety and avoidance.A third (32.9 %) with migraine and a quarter (26.7 %) with TTH (difference: p < 0.0001) were reluctant to tell others of their headaches. About 10 % with each disorder felt families and friends did not understand their headaches. Nearly 12 % with migraine reported their employers and colleagues did not.Regarding cumulative burden, 11.8 % reported they had done less well in education because of headache, 5.9 % reported reduced earnings and 7.4 % that their careers had suffered.ConclusionsInterictal burden in those with episodic headache is common, more so in migraine than TTH. Some elements have the potential to be profoundly consequential. New methodology is needed to measure interictal burden if descriptions of headache burden are to be complete.

Prevalence of skin diseases in suburban Sri Lanka.

In Sri Lanka the only available measures of disease frequency related to skin disorders are from hospital-based clinic studies. They reflect only the patterns of clinic attendance, and the actual prevalence of skin diseases in the community is unknown. The main objective of this study was to determine the prevalence of skin diseases in a selected area. A household survey based on health interviews and clinical examination was conducted over a period of 4 months. 418 households were selected for modified cluster sampling from predetermined areas in Piliyandala. There were 1806 people residing in the 418 households surveyed. 894 cases were identified, of which 34 people could not be traced for clinical examination. 33 households did not have anyone with a skin lesion. The prevalence of skin disease was 47.6%. Fungal infections, followed by dermatitis, were found to be the commonest problems. There was only one case of leprosy. Psoriasis was found to be of low prevalence. The overall prevalence of skin disease was high in the community that we surveyed. There were marked differences between community prevalence and hospital dermatology clinic attendance data for a number of skin diseases.

The impact of headache in Europe: principal results of the Eurolight project.

BackgroundEuropean data, at least from Western Europe, are relatively good on migraine prevalence but less sound for tension-type headache (TTH) and medication-overuse headache (MOH). Evidence on impact of headache disorders is very limited. Eurolight was a data-gathering exercise primarily to inform health policy in the European Union (EU). This manuscript reports personal impact.MethodsThe study was cross-sectional with modified cluster sampling. Surveys were conducted by structured questionnaire, including diagnostic questions based on ICHD-II and various measures of impact, and are reported from Austria, France, Germany, Italy, Lithuania, Luxembourg, Netherlands, Spain and United Kingdom. Different methods of sampling were used in each. The full methodology is described elsewhere.ResultsQuestionnaires were analysed from 8,271 participants (58% female, mean age 43.4 y). Participation-rates, where calculable, varied from 10.6% to 58.8%. Moderate interest-bias was detected. Unadjusted lifetime prevalence of any headache was 91.3%. Gender-adjusted 1-year prevalences were: any headache 78.6%; migraine 35.3%; TTH 38.2%, headache on ≥15 d/mo 7.2%; probable MOH 3.1%. Personal impact was high, and included ictal symptom burden, interictal burden, cumulative burden and impact on others (partners and children). There was a general gradient of probable MOH > migraine > TTH, and most measures indicated higher impact among females. Lost useful time was substantial: 17.7% of males and 28.0% of females with migraine lost >10% of days; 44.7% of males and 53.7% of females with probable MOH lost >20%.ConclusionsThe common headache disorders have very high personal impact in the EU, with important implications for health policy.

A Rapid Needs Assessment of the Rockaway Peninsula in New York City After Hurricane Sandy and the Relationship of Socioeconomic Status to Recovery

We conducted a rapid needs assessment in the Rockaway Peninsula-one of the areas of New York City most severely affected by Hurricane Sandy on October 29, 2012-to assess basic needs and evaluate for an association between socioeconomic status (SES) and storm recovery. We conducted a cross-sectional survey within the Rockaways 3 weeks after the hurricane made landfall to elicit information regarding basic utilities, food access, health, relief-effort opinions, and SES. We used a modified cluster sampling method to select households with a goal of 7 to 10 surveys per cluster. Thirty to fifty percent of households were without basic utilities including electricity, heat, and telephone services. Lower-income households were more likely to worry about food than higher-income households (odds ratio = 4.5; 95% confidence interval = 1.43, 15.23; P = .01). A post-storm trend also existed among the lower-income group towards psychological disturbances. Storm preparation should include disseminating information regarding carbon monoxide and proper generator use, considerations for prescription refills, neighborhood security, and location of food distribution centers. Lower-income individuals may have greater difficulty meeting their needs following a natural disaster, and recovery efforts may include prioritization of these households.

Nutritional and health status of primary school children in rural Uganda

Poor nutrition and health can affect children’s education. The nutritional status of school children (9-15 years) was assessed in Kumi district, Eastern Uganda in 2006-2007. Selection of schools was done using modified cluster sampling involving 34 schools (n=645). Assessments for nutritional status were done anthropometrically (height and weight), biochemically (iron, n=145; iodine, n=87; and vitamin A, n=145) and assessment for health status was done following the formal ether concentration technique for examination for intestinal helminths (n=189) and a quick malaria (n=119) test for malaria parasites. Prevalence rates for stunting, underweight and thinness were 8.7% (95CI 6.7-11.1); 13.0% (95CI 10.6-15.8); and 10.1% (95CI 7.9-12.6), respectively of which males and the older age group of children were more affected. Prevalence rates for iodine deficiency, anaemia, iron deficiency and vitamin A deficiency (VAD) were 3.4% (95CI 0.9-9.1); 24.1% (95CI 17.7-31.6); 82.1% (95CI 75.2-87.7); and 30.3% (95CI 23.3- 38.2), respectively. Anaemia (measured as haemoglobin status), iron deficiency (measured as serum Ferritin) and VAD (measured as serum retinol) were higher among females (26.3%, 95CI 17.5-36.7; 83.8%, 95CI 74.4-90.7; 33.8%, 95CI 24.0-44.6) compared to males (21.5%, 95CI 12.8-32.8; 80%, 95CI 69.0-88.4; 26.2%, 95CI 16.6-37.8). Geohelminth (S.mansoni &amp; N.americanus) and malaria parasitemia were 4.8% and 46.2%, respectively. Prevalence rates for stunting, iodine deficiency and geohelminth infections were low. The high prevalence rates of wasting/thinness, underweight, iron and vitamin A deficiencies show these as significant public health problems among school children in Kumi district. There is a need to focus attention on nutritional and health conditions of school children to improve their conditions. Much can be done to prevent malaria infection by promoting the use of Insecticide Treated Nets and chemoprophylaxis. The biennial dosage with albendazole for deworming, and universal use of iodized salt in Uganda are success stories that should continue; iron deficiency anaemia can be controlled through nutrition education, provision of nutritious school meals coupled with control of malaria and deworming. Since many children attend school, such services if delivered through school systems would assist those school children who most need them.

Breakfast, midday meals and academic achievement in rural primary schools in Uganda: implications for education and school health policy

BackgroundUnderachievement in schools is a global problem and is especially prevalent in developing countries. Indicators of educational performance show that Uganda has done remarkably well on education access-related targets since the introduction of universal primary education in 1997. However, educational outcomes remain disappointing. The absence of school feeding schemes, one of the leading causes of scholastic underachievement, has not been given attention by the Ugandan authorities. Instead, as a national policy, parents are expected to provide meals even though many, especially in the rural areas, cannot afford to provide even the minimal daily bowl of maize porridge.ObjectiveTo assess and demonstrate the effect of breakfast and midday meal consumption on academic achievement of schoolchildren.Design, Materials and MethodsWe assessed household characteristics, feeding patterns and academic achievement of 645 schoolchildren (aged 9–15 years) in Kumi district, eastern Uganda, in 2006–2007, using a modified cluster sampling design which involved only grade 1 schools (34 in total) and pupils of grade four. Household questionnaires and school records were used to collect information on socio-demographic factors, feeding patterns and school attendance. Academic achievement was assessed using unstandardized techniques, specifically designed for this study.ResultsUnderachievement (the proportion below a score of 120.0 points) was high (68.4%); in addition, significantly higher achievement and better feeding patterns were observed among children from the less poor households (p<0.05). Achievement was significantly associated with consumption of breakfast and a midday meal, particularly for boys (p<0.05), and a greater likelihood of scoring well was observed for better nourished children (all OR values>1.0).ConclusionWe observed that underachievement was relatively high; inadequate patterns of meal consumption, particularly for the most poor, significantly higher scores among children from ‘less poor’ households and a significant association between academic achievement and breakfast and midday meal consumption.

Nutritional and health status primary schoolchildren in rural Uganda

Poor nutrition and health can affect children’s education. The nutritional status of school children (9-15 years) was assessed in Kumi district, Eastern Uganda in 2006-2007. Selection of schools was done using modified cluster sampling involving 34 schools (n= 645). Assessments for nutritional status were done anthropometrically (height and weight), biochemically (iron, n=145; iodine, n=87; and vitamin A, n=145) and assessment for health status was done following the formal ether concentration technique for examination for intestinal helminths (n=189) and a quick malaria (n=119) test for malaria parasites. Prevalence rates for stunting, underweight and thinness were 8.7% (95CI 6.7-11.1); 13.0% (95CI 10.6-15.8); and 10.1% (95CI 7.9-12.6), respectively of which males and the older age group of children were more affected. Prevalence rates for iodine deficiency, anaemia, iron deficiency and vitamin A deficiency (VAD) were 3.4% (95CI 0.9-9.1); 24.1% (95CI 17.7-31.6); 82.1% (95CI 75.2-87.7); and 30.3% (95CI 23.3- 38.2), respectively. Anaemia (measured as haemoglobin status), iron deficiency (measured as serum Ferritin) and VAD (measured as serum retinol) were higher among females (26.3%, 95CI 17.5-36.7; 83.8%, 95CI 74.4-90.7; 33.8%, 95CI 24.0-44.6) compared to males (21.5%, 95CI 12.8-32.8; 80%, 95CI 69.0-88.4; 26.2%, 95CI 16.6-37.8). Geohelminth ( S.mansoni & N.americanus ) and malaria parasitemia were 4.8% and 46.2%, respectively. Prevalence rates for stunting, iodine deficiency and geohelminth infections were low. The high prevalence rates of wasting/thinness, underweight, iron and vitamin A deficiencies show these as significant public health problems among school children in Kumi district. There is a need to focus attention on nutritional and health conditions of school children to improve their conditions. Much can be done to prevent malaria infection by promoting the use of Insecticide Treated Nets and chemoprophylaxis. The biennial dosage with albendazole for deworming, and universal use of iodized salt in Uganda are success stories that should continue; iron deficiency anaemia can be controlled through nutrition education, provision of nutritious school meals coupled with control of malaria and deworming. Since many children attend school, such services if delivered through school systems would assist those school children who most need them.

Respiratory symptoms amongst females in a fishing settlement in the Niger Delta, Nigeria

BackgroundApproximately half of the earth's population in the rural areas of developing countries uses energy obtained from biomass burning, which is harmful to people.ObjectivesThis study is aimed at determining which respiratory symptoms can be associated with biomass burning amongst fish smokers in the Oyorokoto fishing settlement.MethodA community-based, cross-sectional questionnaire, which employed a modified cluster sampling technique, was used.ResultsA total of 300 subjects were recruited for the study, of which 210 (70%) were fish smokers. The mean age was 31.46 ± 13.03 years, with the majority (42.0%) having only primary school education. The prevalence of respiratory symptoms amongst the subjects was 86.7%, the most frequent of which were catarrh (30.48%) and a cough (28.57%). The respiratory symptom occurring least frequently was breathlessness (2.38%). The symptoms most often experienced during fish smoking were those of catarrh (75.5%) and sneezing (73.0%), whereas breathlessness occurred the least, in only 7 (3.3%) of the participants. Sneezing stopped in 64.2% of the subjects after fish smoking had ceased. Most of the fish smoking took place indoors.ConclusionHealth promotion featuring preventive interventions, such as the wearing of face-masks and the use of modern fish smoking methods, which is associated with fewer health risks, is essential to improving the quality of life of fish smokers. The government's provision of certain social services, including better education opportunities for the young, is advocated, and should be especially targeted at improving the lot of the girl child.

Respiratory symptoms amongst females in a fishing settlement in the Niger Delta, Nigeria

Background: Approximately half of the earth’s population in the rural areas of developing countries uses energy obtained from biomass burning, which is harmful to people. Objective: This study is aimed at determining which respiratory symptoms can be associated with biomass burning amongst fish smokers in the Oyorokoto fishing settlement. Methods: A community-based, cross-sectional questionnaire, which employed a modified cluster sampling technique, was used. Results: A total of 300 subjects were recruited for the study, of which 210 (70%) were fish smokers. The mean age was 31.46 ± 13.03 years, with the majority (42.0%) having only primary school education. The prevalence of respiratory symptoms amongst the subjects was 86.7%,the most frequent of which were catarrh (30.48%) and a cough (28.57%). The respiratory symptom occurring least frequently was breathlessness (2.38%). The symptoms most often experienced during fish smoking were those of catarrh (75.5%) and sneezing (73.0%), whereas breathlessness occurred the least, in only 7 (3.3%) of the participants. Sneezing stopped in 64.2% of the subjects after fish smoking had ceased. Most of the fish smoking took place indoors. Conclusion: Health promotion featuring preventive interventions, such as the wearing of facemasks and the use of modern fish smoking methods, which is associated with fewer health risks, is essential to improving the quality of life of fish smokers. The government’s provision of certain social services, including better education opportunities for the young, is advocated, and should be especially targeted at improving the lot of the girl child.

A Study Of Socio-Cultural Factors, Water Quality And Diarrhea In Bangalore

The study was aimed to find the socio--cultural factors in relation to acute diarrhea andbacteriological quality of water in households with diarrhea and time trend of diarrhea. 150 houses in each of the two areas, one supplied by bore well and the other by Bangalore Water Supply and Sewage Board[BWSSB] water selected by modified cluster sampling. Weekly morbidity details were collected and water samples assessed from diarrhea reported houses. The study revealed an incidence rate of diarrheal diseases of 3.2%. It was also noted that children less than 5 years showed an incidence of 38.89% and 57.14% in bore well and piped water supply areas respectively. Peak incidence of diarrhea was observed in the month of November. From our study it was inferred that the practices such as washing vessel, hygienic transportation, storage and drawing of water, and pretreatment of drinking water among the individuals with morbidities in the two areas were considerably different. Thus the study recommends improved water quality at point of use along with promotion of better water handling during collection, storage and treatment can produce better health outcomes.

Rapid Assessment of the Needs and Health Status in Santa Rosa and Escambia Counties, Florida, after Hurricane Ivan, September 2004

Hurricane Ivan, a Category 3 storm, devastated the Florida panhandle on September 16, 2004, causing extensive property damage and 24 deaths. The Florida Department of Health requested assistance from the Centers for Disease Control and Prevention to conduct a rapid assessment in Santa Rosa and Escambia counties to determine the health impact of the hurricane and needs of the affected population. A questionnaire was administered 6 days after the hurricane made landfall. The survey instrument elicited information about house damage, illness/injury, and access to utilities. A modified cluster sampling method was used to select 30 clusters in each county. Seven households were interviewed in each cluster and reported weighted frequencies. Three quarters of houses in each county were damaged. Households in Santa Rosa and Escambia lacked basic utilities, including regular garbage pick-up, telephone service, and electricity. Fifty-four percent of households in Santa Rosa and 27% in Escambia reported using a generator. The most commonly self-reported health conditions were sleep disturbances in Santa Rosa (54%) and upper respiratory problems in Escambia (46%). Injuries were reported in fewer than 15% of households in each county. Rapid restoration of power, telephone services, and debris pick-up remained a priority 1 week after the event. Findings demonstrated the need for (1) mental health and primary care services, (2) information about safe generator use, and (3) ways to access medical care and medications.

The utility of geographic information systems (GIS) in rapid epidemiological assessments following weather-related disasters: Methodological issues based on the Tropical Storm Allison experience

Flooding is the most common natural disaster worldwide, and is the leading cause of weather-related deaths in the United States. Tropical storm Allison hit landfall near Galveston, Texas on June 5, 2001, causing the most severe flood-related damage ever recorded in the Houston metropolitan area. This devastating storm dumped 37 in of rain in 24 h on parts of the city, killing 22 people and causing more than $5 billion in damage. The main goal of the public health response to tropical storm Allison was to rapidly evaluate the immediate health needs of the community. Geographical information system (GIS) technology was instrumental to the timeliness of this effort. We conducted a rapid needs assessment in the areas most affected by flooding using modified cluster sampling facilitated by GIS methodology. Of the 420 households participating in the survey, we found a significant increase in illness (OR, 5.1; 95% CI, 2.7–9.4), injuries (OR, 4.8; 95% CI, 1.9–12.8), and immediate health needs (OR, 3.3; 95% CI, 1.7–6.1) among persons living in flooded homes compared to non-flooded homes. There were 60 households reporting serious damage, 24 of which were outside the 500-year flood plain. We also obtained reliable estimates of the extent of damage and household needs to help guide relief efforts. These findings underscore the usefulness of rapid needs assessment as a tool to identify actual health threats and to facilitate delivery of resources to those with the greatest and most immediate need. Our ability to swiftly plan and implement a rapid needs assessment over a large geographical region within 1 week following the damage would not have been possible without the utilization of GIS methodology and the availability of skilled personnel and timely data resources.