Multi-stage Cluster Sampling Approach Research Articles

Prevalence and Determinants of Exclusive Breastfeeding Among Mothers of Children Aged 6-24 Months in the Aseer Region.

Background Exclusive breastfeeding (EBF) is crucial for infant and maternal health, providing optimal nutrition and immune protection for infants while reducing maternal postpartum depression and cancer risk. However, global trends show an early cessation of breastfeeding and the introduction of other foods. This study aims to determine the prevalence and factors influencing EBF among mothers in the Aseer region of Saudi Arabia. Methodology A cross-sectional study using a multistage cluster sampling approach was conducted from January to March 2024 in primary healthcare centers across the Aseer region. Participants included mothers of children aged 6-24 months attending primary healthcare centers for immunizations or routine check-ups. A pretested structured questionnaire, developed after an extensive literature review and expert consultation, was used to interview consenting participants. The questionnaire covered sociodemographic data, obstetric and medical history, child data, EBF practices, maternal knowledge and perception of breastfeeding, counseling about breastfeeding, antenatal care, breastfeeding support, and barriers and motivators of EBF. Results A total of 1,008 eligible mothers were included. Only 131 (13%) fulfilled the World Health Organization criteria for EBF. Moreover, 257 (25.5%) mothers initiated breastfeeding within the first hour after delivery, and 387 (38.4%) exclusively breastfed for six months or more. EBF was less frequent among mothers with higher education (8%, n = 2) compared to those with lower education (23%, n = 23, p = 0.017). EBF was also less frequent among mothers who delivered via cesarean section (7.9%, n = 28) compared to those who had a vaginal delivery (15.8%, n = 103, p = 0.001). Conversely, EBF was more common among mothers with more than five pregnancies (15.8%, n = 45) compared to those with one to two pregnancies (9.4%, n = 37, p = 0.023). EBF was also more common among mothers who had breastfed more than four children (16.7%, n = 39) compared to those who had not (12.1%, n = 49, p = 0.048). Finally, EBF was more common among mothers without postpartum complications (13.4%, n = 131) or whose infants had no birth complications (13.4%, n = 128) compared to their respective counterparts (p = 0.029 and p = 0.048, respectively). Conclusions This study found a low prevalence of EBF in the Aseer region, despite high maternal knowledge and positive perceptions. Factors such as low education, medical barriers, unemployment, and high parity were associated with increased EBF rates. Interventions should focus on improving workplace support and increasing maternal awareness of EBF recommendations.

Screening for frailty and its association with activities of daily living, cognitive impairment, and falls among community-dwelling older adults in China

ObjectivesFrailty is a prevalent geriatric condition that significantly impacts the health of older adults. This study aimed to examine the prevalence of frailty among older Chinese adults aged ≥ 65 years and to assess its association with adverse geriatric outcomes.MethodThis study included 20,724 older adults aged ≥ 65 years in Jiangsu Province, China, utilizing a random, stratified, multistage cluster sampling approach. Frailty was assessed using the 5-item FRAIL scale. Geriatric outcomes, such as independence in activities of daily living (ADL), cognitive impairment, and frequent fall events (occurring four or more times in the preceding year), were evaluated. Logistic regression models were employed to evaluate the association between frailty and geriatric outcomes, with results presented as odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe mean age of the participants was 73.4 ± 6.4 years. The standardized prevalence of prefrailty and frailty was 35.2% and 10.3%, respectively. Individuals identified as prefrail or frail tended to live in rural areas, have lower educational levels, be widowed, have lower incomes, and engage in less physical activity. Prefrailty and frailty were associated with an increased risk of limitations in BADL (OR: 9.62, 95% CI: 7.43–12.46; and OR: 29.25, 95% CI: 22.42–38.17, respectively) and IADL (OR: 2.54, 95% CI 2.35–2.74; and OR: 5.19, 95% CI 4.66–5.78, respectively), positive cognitive impairment screening (OR: 1.23, 95% CI: 1.16–1.31; and OR: 1.72, 95% CI: 1.56–1.91, respectively), and frequent falls (occurring four or more times in the preceding year) (OR: 3.38, 95% CI: 2.50–4.56; and OR: 8.37, 95% CI: 6.01–11.65). The association between frailty and both limitations in BADL and falls was notably more pronounced among the younger age groups (p for interaction < 0.001).ConclusionsAccording to the 5-item FRAIL scale, frailty was associated with limitations in BADLs and IADLs, positive cognitive impairment screening, and recent falls among older adults living in the community. Screening for frailty in younger age groups has the potential to prevent declines in physical function and falls.

Who is missed in a community-based survey: Assessment and implications of biases due to incomplete sampling frame in a community-based serosurvey, Choma and Ndola Districts, Zambia, 2022.

Community-based serological studies are increasingly relied upon to measure disease burden, identify population immunity gaps, and guide control and elimination strategies; however, there is little understanding of the potential for and impact of sampling biases on outcomes of interest. As part of efforts to quantify measles immunity gaps in Zambia, a community-based serological survey using stratified multi-stage cluster sampling approach was conducted in Ndola and Choma districts in May-June 2022, enrolling 1245 individuals. We carried out a follow-up study among individuals missed from the sampling frame of the serosurvey in July-August 2022, enrolling 672 individuals. We assessed the potential for and impact of biases in the community-based serosurvey by i) estimating differences in characteristics of households and individuals included and excluded (77% vs 23% of households) from the sampling frame of the serosurvey and ii) evaluating the magnitude these differences make on healthcare-seeking behavior, vaccination coverage, and measles seroprevalence. We found that missed households were 20% smaller and 25% less likely to have children. Missed individuals resided in less wealthy households, had different distributions of sex and occupation, and were more likely to seek care at health facilities. Despite these differences, simulating a survey in which missed households were included in the sampling frame resulted in less than a 5% estimated bias in these outcomes. Although community-based studies are upheld as the gold standard study design in assessing immunity gaps and underlying community health characteristics, these findings underscore the fact that sampling biases can impact the results of even well-conducted community-based surveys. Results from these studies should be interpreted in the context of the study methodology and challenges faced during implementation, which include shortcomings in establishing accurate and up-to-date sampling frames. Failure to account for these shortcomings may result in biased estimates and detrimental effects on decision-making.

The seroprevalence of toxocariasis and related risk factors in children in Ho Chi Minh City, Vietnam: results from a school-based cross-sectional study.

Children are especially vulnerable to Toxocara infection and its severe complications; however, there have not been any published data on the disease prevalence and treatment effectiveness in the population of Vietnamese children. This study was conducted to determine the prevalence of toxocariasis and explore factors associated with Toxocara infection in children aged 3-15 y in Ho Chi Minh City, Vietnam. We conducted a cross-sectional study using a multistage cluster sampling approach in public schools. Blood samples were collected, and toxocariasis cases were confirmed, based on a history of contact with dogs/cats and positive anti-Toxocara antibody detection via ELISA. We calculated the percentage of seropositive children across gender, grade levels, districts and caregiver education. Multiple regression models were employed to identify potential risk factors. Anti-Toxocara antibodies were found in 14.2% of the 986 children studied. Significant variations in seropositivity were observed across grade levels, districts and caregiver education levels. Multivariable analysis identified caregiver education, contact with dogs/cats and improper handling of pet feces as seropositivity risk factors. This was the first community-based prevalence study of toxocariasis in a pediatric population in Vietnam. Implementation of preventive measures such as public education, routine fecal examinations and chemotherapeutic treatment of animals is highly recommended.

Knowledge, attitudes, practices, and perception of COVID-19 preventive measures among adult residents of Matadi (Democratic Republic of the Congo) after the third epidemic wave.

Several governments from African countries, including the Democratic Republic of the Congo (DRC), implemented stringent public health measures to curb COVID-19 transmission in the early phases of the pandemic. While these restrictive measures are believed to have contributed to lowering case incidence and related mortality in DRC, data on the population's knowledge and adherence are limited. This study aimed to assess the knowledge, perception, attitudes, and practices of COVID-19 preventive measures and associated factors among adult residents of Matadi, thereby generating evidence for a strategy adjustment as the COVID-19 response is transitioning from emergency to control status. We used data from a population-based cross-sectional study conducted in October 2021. Consenting participants were enrolled through a multi-stage cluster sampling approach and administered a pre-tested structured questionnaire using a mobile application (Epicollect 5). We analyzed adult participants' data using STATA 15.1. Univariable and multivariable analyses were applied to identify factors associated with good knowledge, good perception, positive attitude and good practice. We included 1,269 adult respondents for the secondary analysis. One respondent in six was female. The median age was 36 years (IQR 24-50). Most respondents (76.5%) had good knowledge. Respondents aged 40-49 years and those with vocational education level were 1.7 time (AOR 1.75, 95% CI 1.07-2.87) and twice as likely (AOR 2.06, 95% CI 1.01-4.21) to have good knowledge. Preventive measures were perceived as efficient by 45% of respondents. Good perception was associated with education level, profession, average household monthly income and good knowledge. Only 40% of respondents had a positive attitude. A positive attitude was associated with age, education level, and good knowledge. Respondents having good practice represented 5.8%. Good practice was associated with good knowledge, attitude and perception. Most respondents were knowledgeable, had a good perception of government-related COVID-19 preventive measures, a moderately positive attitude and an extremely low level of good practice. Current COVID-19 preventive strategies, including vaccination rollout, need adjustment into high-efficiency, context-based and risk group-specific interventions. Evidence generated by this study will improve preparedness and response to future outbreaks.

Associations between exposure to common technology devices and reported neck pain among Iranian school-age adolescents: a cross sectional study

BackgroundThe advancement of technology has contributed to a more sedentary lifestyle, and the extensive use of handheld devices among adolescents may potentially result in neck pain. This study aimed to assess the association between exposure to common technology devices and self-reported neck pain in Iranian school-age adolescents.MethodsThis cross-sectional study was conducted between June and October 2021, employing a randomized multi-stage cluster sampling approach. We enrolled 808 adolescent students aged 11 to 19 years old. We asked participants about any neck pain they experienced in the week leading up to the study. Additionally, we gathered demographic information and assessed participants’ use of electronic devices using a questionnaire.ResultsOur study comprised 73.5% female participants with an average age of 15.1 ± 1.7 years and 26.5% male participants with an average age of 14.5 ± 1.5 years. In the regression model, the female gender (p = 0.038), using mobile for more than 6 h (p = 0.04), and using electronic devices while sitting on the floor (p = 0.02) were associated with a higher prevalence of neck pain among participants.ConclusionIn our study, we observed a relatively high prevalence of neck pain, which was linked to extended daily mobile phone usage and body posture during electronic device use. Policymakers may consider interventions aimed at reducing mobile phone usage and promoting proper body posture while using electronic devices as potential strategies to alleviate the burden of neck pain among Iranian adolescents.

The combined effect of pit and fissure sealant application and oral health education on oral health status of children aged 6–9 years: a 12-month follow-up study in Northeast China

BackgroundChildren aged 6–9 years are vulnerable to dental caries due to age-related limitations and a lack of adequate knowledge regarding oral health and hygiene practices. This study aimed to establish a cohort of children aged between 6 and 9 years and conducted a 12-month follow-up to examine the combined effect of pit and fissure sealant (PFS) application and oral health education on their oral health status.MethodsA cohort study with 12-month follow-up was conducted in Liaoning province, China. A multi-stage stratified cluster sampling approach was employed in the study. The enrolled 6- to 9-year-old children were all from the selected primary schools, who had resided in the designated area for at least 6 months. Children who were unable to cooperate with the examiner or without informed consent from their guardians were excluded. Experienced dental professionals examined the oral health status of primary school children aged 6–9 years. All children and their guardians were mandated to complete a questionnaire (qualitative data) at the beginning of the study. In the experiment group, children underwent PFS application and chairside oral health education. Clinical examinations and questionnaire surveys were repeated at the 12-month follow-up. The chi-square test and binary logistic regression were conducted to investigate the potential risk factors associated with dental caries prevalence (dependent variable). Independent variables were items from the questionnaire (such as living place, parents’ education level and children’ birth weight). The significant variables identified in the chi-square tests were subsequently included in the binary logistic regression analysis.ResultsA total of 4,085 children aged 6–9 years were included in the study, with 1805 participants assigned to the experiment group and 2280 to the control group. At baseline, the caries rates of the experimental and control group were 77.95% and 80.35%, respectively without any statistically significant differences. However, at the 12-month follow-up, the caries rate in the experimental group (83.65%) was significantly lower than that in the control group (86.62%) (P < 0.05). The results from the binary logistic regression analysis indicated that parents with a college degree and children in the experimental group exhibited lower caries rates. Conversely, higher caries rates were associated with the consumption of sweet beverages and foods more than once a day and a lack of knowledge regarding the causes of caries (P < 0.05).ConclusionsIn Liaoning, China, children aged 6 to 9 years exhibited a high prevalence of dental caries. Several factors, including the parent’s education level, the frequency of consuming sweet beverages and foods, and the children’s understanding of the cause of caries, significantly affected the caries prevalence rates. The implementation of PFS application and oral health education effectively reduce the caries rate among the surveyed children.

Unheard voices: a cross-sectional study on the perception of Sri Lankan female factory workers towards the Abortion Law

Introduction: Induced abortion is restricted in Sri Lanka and is only permitted to save the life of the mother. However, many women undergo abortion through unsafe ways, putting themselves at risk of complications and incomplete abortion. Among the most vulnerable to unintended pregnancies and induced abortions are female factory workers (FFWs).Objectives: To explore the knowledge and perception of FFWs towards Sri Lanka’s abortion lawsMethods: A structured questionnaire was administered by a team of trained interviewers among randomly selected 608 FFWs of reproductive age using a multi-stage cluster sampling approach after receiving written informed consent.Results: The study revealed that the FFWs had limited knowledge and conservative attitudes towards the abortion law. Surprisingly, a small proportion (10.9%) of the respondents were aware of the legal circumstances under which abortions are permitted. Majority of the respondents (64.8%) did not have comprehensive knowledge and they believed that providing treatment to a woman who had complications due to unsafe abortion is a violation of the law. Around half of the respondents supported legalizing abortion in cases of rape (49.6%), incest (45.6%) and lethal foetal abnormalities (75.2%). However, only a small proportion of the respondents urged in favour of legalizing induced abortion for other reasons such as contraceptive failure (13.7%) and economic hardship (9.1%). Furthermore, a mere 5.3% of the respondents agreed to legalize abortion on request.Conclusions &amp; Recommendations: FFWs possess limited awareness and conservative attitudes towards the abortion law. More focused information, communication and education interventions are needed to handle the issue.

Family planning needs to limit childbearing are unmet, yet our parity is high: characterizing and unveiling the predictive factors

BackgroundThe unmet need for limiting childbearing (UNLC) remains a problem in Nigeria. Conception after four pregnancies is considered a high-risk pregnancy. We examined the level, reasons for non-use of contraception, and predictors of UNLC among high parity (≥ 4 live birth) women in Nigeria.MethodsThis cross-sectional design study was based on the analysis of nationally representative weighted data (2018 Nigeria Demographic Health Survey). The study focused on high-parity women of reproductive age (n = 4260) who do not want to have any more children irrespective of the number of their surviving children. Multi-stage cluster sampling approach was used for sample selection. Data were analyzed using logistic regression (α0.05).ResultsMean age of the respondents and children ever born was 38.92 ± 5.7 and 6.54 ± 2.3 respectively. The prevalence of UNLC was 40.9%, higher in the rural (48.8%) than urban (32.8%) areas, highest among women with no formal education (52.0%), higher among Muslims (48.4%) than Christians (34.8%), highest in the North-West (51.7%) and least in the South-East (26.1%). The most reported reasons for non-use of family planning (FP) were; respondents opposed (25.0%), infrequent sex (15.0%), fatalistic (13.2%), husband/partner opposed (11.2%), fear of side effects/health (8.5%), and religious prohibition (3.3%). The odds of UNLC was 100% higher among women aged 40–49 years compared to the younger women in age group 20–29 years. Living in the rural area predisposes high parity women of reproductive age to higher risks of UNLC (OR = 1.35, 95% C.I = 1.14–1.59, p < 0.001). Lack of access to family planning information through health workers (OR = 1.94, 95% C.I = 1.63–2.30, p < 0.001) increased the risks of UNLC. Being an Igbo or a Yoruba ethnic group was protective for UNLC compared to Fulani/Hausa women.ConclusionsA high level of UNLC was found among high-parity women in Nigeria. Access to FP information reduces the risk of UNLC. Expanding FP services would help respond to the expressed desires for contraception among high-parity Nigerian women who want to stop childbearing.

Associations of Fruit and Vegetable Intake with Metabolic Health Status in Overweight and Obese Youth

Introduction: The objective of this study was to assess the relationship between fruit and vegetable intake with metabolic health status among overweight and obese Iranian youth. Methods: In total, 203 obese and overweight youth including 101 boys and 102 girls, 12–18 years, were randomly recruited through a multistage cluster sampling approach in this study. A validated Persian format of food frequency questionnaire was used to estimate participants’ usual food intake. Adolescents were categorized in accordance with the International Diabetes Federation (IDF) criteria as well as IDF plus insulin resistance (HOMA-IR) definition into metabolically healthy obese and metabolically unhealthy obese (MUO). Results: Based on IDF criteria, youth in the third tertile of vegetable and the combination of fruit and vegetable intake had 66% (odds ratio = 0.34, 95% CI: 0.12–0.95) and 73% (odds ratio = 0.27, 95% CI: 0.09–0.81) lower odds of MUO compared to those in the first tertile, in the fully-adjusted model. According to IDF plus HOMA-IR definition, inverse associations were also found between vegetable (odds ratio = 0.36, 95% CI: 0.12–1.02) and the combination of fruit and vegetable (odds ratio = 0.25, 95% CI: 0.08–0.79) intake with MUO phenotype. Stratified analysis indicated inverse associations between intake of vegetables and the combination of fruits and vegetables with MUO phenotype (based on IDF definition) in overweight, but not obese subjects. Conclusion: The current study demonstrated that greater consumption of vegetables as well as the combination of fruits and vegetables was related to a lower risk of MUO phenotype, particularly in overweight youth.

An Analysis of Secondary School Students' Difficulties in Mathematics at Tehsil Timergara

This study aimed to investigate the mathematical challenges experienced by secondary school pupils. The primary inquiry for this study was "how do secondary school pupils in Tehsil Timergara feel about mathematics?" Students in 9th and 10th grades from six different high schools in tehsil Timergara, district Dir lower, made up the study's populations. One hundred and thirty students were chosen using a multistage cluster sampling approach. A questionnaire was used for data collection, prepared on a five-point Likert scale. After establishing the validity and reliability of the research instrument, the data was collected from the sample population. The data were analyzed using percentage, mean score, and chi-square tests. Findings indicated that most students are unable to understand the concepts taught during math Class and show no interest in math Class. Students have weaknesses in math basics as a reason for not understanding math. And they have no access to/knowledge about the latest trends and learning tools for solving math problems, they are not regularly practicing math problems. Based on these findings it was recommended teacher should understand the concept and important of mathematics and focus on the primary classes in mathematics to strong their basic, and access to/knowledge about latest trends and learning tools of solving math problems. Students are trying regularly practicing math problems, while answer questions considering it logic, schools provide sufficient facilities and math Laboratories. Students do not show negative attitude towards mathematics. Schools have culture of asking questions and of asking questions and group discussion.

A Decomposition Analysis to Understand the Wealth-Based Inequalities in Child Vaccination in Rural Southern Assam: A Cross-Sectional Study.

The socio-environmental aspects of southern Assam reflect a general pattern of backwardness. Moreover, child healthcare resources in the region are inadequately used, leading to low vaccination coverage. Given this background, this paper attempted to comprehend wealth-based inequality in full vaccination in rural areas of southern Assam. Based on a multistage cluster sampling approach, 360 children of 12-23 months were selected from the study area. To identify the predictors of a child, a non-linear model was estimated by using the generalized linear model (GLM) approach followed by Erreygers decomposition technique to quantify the wealth inequality in the obtained predictors in explaining the disparity in full vaccination. The Bacillus Calmette-Guérin (BCG) vaccination recorded the highest vaccination coverage, at nearly 90% and the lowest was observed for the measles vaccine, around 61 percent. Slightly more than half of the eligible children (54 percent) were vaccinated against all the Universal Immunization Programme (UIP)-recommended vaccines. The decomposition analysis revealed that the occupation of the child's father, maternal age, birth order of the child, and health-seeking behavior such as antenatal care (ANC) were the prime factors related to inequality in full vaccination in the region. Vaccination coverage in the region has improved over time, however, full vaccination is concentrated towards the economically advantaged section of the society in rural southern Assam. Targeted, context-specific, and expanded government initiatives could aid in addressing the overall wealth-related full vaccination inequalities in the valley.

Health impacting behaviour & morbidity: Implications for adolescent & youth health programmes in India.

In Himachal Pradesh (HP), a comprehensive health survey was conducted to assess the prevalent health affecting habits and issues among young individuals aged 10 to 24 yr. The study was aimed to evaluate key factors such as nutrition, substance use (including tobacco and alcohol), mental health concerns such as anxiety and depression, sexual behaviours and personal hygiene, as well as incidents of violence and injury (including road traffic and other injuries). A cross-sectional survey was conducted in HP on 2895 individuals aged between 10 and 24 yr. The survey encompassed four districts, namely Shimla, Kinnaur, Kangra, and Sirmaur, and 12 blocks (three in each district). To ensure a representative sample, a stratified multistage cluster sampling approach was used. Districts and blocks were selected purposively so as to represent the diverse sociodemographic and cultural characteristics of this region. Within each block, thirty clusters were chosen using a probability proportional to size method. Clusters were defined as villages in rural areas and wards in urban areas. The World Health Organization 30 × 7 cluster technique was employed to identify households and individuals for the study. Underweight (44.39%), risk of cell phone addiction (19.62%), feeling anxious (15.54%), unintentional injuries (14.72%) and violence (8.19%) were the top five health impacting problems among young people in HP. The leading health impacting problems identified are preventable and/or modifiable factors affecting the overall health and development of young people in HP. These need to be addressed as priority health problems for interventions with a focus on maintaining positive health through integrated approaches including care provision, risk reduction and health promotion related to these health impacting behaviours. Such interventions are likely to yield better results towards the overall health and development of young people in HP.

Magnitude and associated factors of intimate partner violence among youth women in Ethiopia: multilevel analysis based on 2016 Ethiopian Demographic and Health Survey

BackgroundThe period of youth is important for the foundation of healthy and stable relationships, women’s health and well-being. Youth women face a higher risk of experiencing violence than older women. Intimate partner violence (IPV) against youth women is a significant public health concern. Despite paramount negative health consequences of IPV for the survivor, as per our knowledge, research study on IPV and associated factors among youth women in Ethiopia is scarce. Therefore, this study aimed to assess the magnitude and associated factors of IPV among youth women in Ethiopia.MethodsThe data was accessed from 2016 Ethiopia demographic and health survey (EDHS) which was a cross sectional population based household survey. It was also conducted using a multi-stage stratified random cluster sampling approach. The data were cleaned, weighted, and analyzed using STATA Version 14 software. The total weighted sample of 1077 youth women were used in this study. Multilevel logistic regression modeling was used to determine factors associated with IPV among youth women. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p value < 0.05 were used to declare the significant variables.ResultsAmong the total participants, 30.27% (95% CI 27.59, 33.09) of youth women experienced IPV. Individual level variables such as: Being widowed/divorced/separated (AOR = 2.28; 95% CI 1.33, 3.91), having a partner who drinks alcohol (AOR = 5.76; 95% CI 3.42, 9.69), witnessing inter-parental violence during childhood (AOR = 3.45; 95% CI 2.21, 5.37), being afraid of partners (AOR = 7.09; 95% CI 4.30, 11.68), and from community level variables, youth women residing in communities with a low proportion of educated youth women (AOR = 0.31; 95% CI 0.13, 0.78) were significantly associated with having experience of IPV.ConclusionThe magnitude of intimate partner violence among youth women in Ethiopia was relatively high as compared to the global estimate of IPV. Individual and community level variables such as currently widowed/divorced/separated women, having a partner who drinks alcohol, witnessing inter-parental violence, being afraid of partner, and women from a low proportion of community level youth women's education were significantly associated with intimate partner violence. To decrease this public health problem, it is better to strengthen legislation on the purchase and sale of alcohol, provide legal protection for separated/divorced women, establish effective legal response services for IPV, promote gender equality, and provide psychological support for those who witnessed inter-parental violence during childhood to reduce IPV.

Prevalence of atrial fibrillation in Northern Sri Lanka: a study protocol for a cross-sectional household survey

IntroductionAtrial fibrillation (AF) is the most common arrhythmia globally. It is associated with a fivefold risk in stroke, but early diagnosis and effective treatment can reduce this risk. AF is...

Activities of daily living and its influencing factors for older people with type 2 diabetes mellitus in urban communities of Fuzhou, China.

BackgroundType 2 diabetes mellitus (T2DM) is an independent risk factor for functional limitations among the older population. The predicted increase in T2DM cases combined with the ongoing rapidly aging population may further burden the already overloaded healthcare system and aggravate the loss of economic self-sufficiency. This study aimed to investigate the activities of daily living (ADL) and its influencing factors on older people with T2DM, and to provide implications for the development and improvement of community nursing services in the context rapidly aging population in China.MethodsFrom March 2019 to June 2020, we conducted a cross-sectional questionnaire survey among older T2DM patients in Fuzhou, using a multi-stage cluster sampling approach. Functional status was measured by the Lawton ADL scale. Stata “nptrend” test was used to examine the trend of ordinal variables on ADL. Non-conditional logistic regression was used to identify factors affecting ADL limitations.ResultsA total of 2016 questionnaires were received, with a response rate of 96%. 12.4% of participants suffered from varying degrees of functional impairment. ADL limitations increased with age. More comorbidities were associated with a greater risk of developing functional limitations in ADLs. the following sub-groups were more likely to suffer from ADL impairment: those aged 70 and over years (OR = 1.99, 95%CI 1.77–2.56), living in an aged care house or with spouse/children (OR = 2.31, 95%CI 1.25–4.26), low monthly income (OR = 1.49, 95%CI 1.28–1.64), without health insurance (OR = 1.82, 95%CI 1.40–2.40), tight family expenses (OR = 1.95, 95%CI 1.42–2.69), having stroke (OR = 6.70, 95%CI 2.22–20.23) or malignant tumor (OR = 4.45, 95%CI 1.27–15.53), irregular eating habit (OR = 2.55, 95%CI 2.23–2.92), smoking (OR = 1.40, 95%CI 1.22–1.60), sedentary lifestyle (OR = 2.04, 95%CI 1.46–2.85), lack of physical exercise (OR = 1.35, 95%CI 1.19–1.53), sleeping difficulty (OR = 1.25, 95%CI 1.10–1.42), and lack of family support (OR = 1.19, 95%CI 1.10–1.29).ConclusionOlder adults (≥70 years) with T2DM had a high prevalence of functional limitations across a range of daily living tasks, which not only affect individual life of quality but also present a huge burden on the family, health services system, and the whole society. Identified factors associated with ADL limitations may provide useful information for targeted nursing practice and health promotion.

HIV prevalence and continuum of care among incarcerated people in Iran from 2010 to 2017

BackgroundIncarcerated people are at an increased risk of contracting HIV and transmitting it to the community post-release. In Iran, HIV epidemics inside prisons were first detected in the early 1990s. We assessed the HIV prevalence and its correlates, as well as the continuum of care among incarcerated people in Iran from 2010 to 2017.MethodsWe used data collected in three national bio-behavioral surveillance surveys among incarcerated individuals in 2010 (n = 4,536), 2013 (n = 5,490), and 2017 (n = 5,785) through a multistage cluster sampling approach. HIV was tested by the ELISA method in 2010 and 2013 surveys and rapid tests in 2017. Data on demographic characteristics, risky behaviors, HIV testing, and treatment were collected via face-to-face interviews. HIV prevalence estimates along with 95% confidence intervals (CI) were reported. Using data from the 2017 round, multivariable logistic regression models were built to assess the correlates of HIV sero-positivity and conduct HIV cascade of care analysis.ResultsThe HIV prevalence was 2.1% (95% CI: 1.2%, 3.6%) in 2010, 1.7% (95% CI: 1.3%, 2.1%) in 2013, and 0.8% (95% CI: 0.6%, 1.1%) in 2017 (trend P value < 0.001). Among people with a history of injection drug use, HIV prevalence was 8.1% (95% CI: 4.6%, 13.8%) in 2010, 6.3% (95% CI: 4.8%, 8.3%) in 2013, and 3.9% (95% CI: 2.7%, 5.7%) in 2017. In 2017, 64% (32 out of 50) of incarcerated people living with HIV were aware of their HIV status, of whom 45% (9 out of 20) were on antiretroviral therapy, and of whom 44% (4 out of 9) were virally suppressed (< 1000 copies/ml).ConclusionsWhile HIV prevalence has decreased among incarcerated people in Iran, their engagement in the HIV continuum of care is suboptimal. Further investments in programs to link incarcerated people to HIV care and retain them in treatment are warranted.

Chlorhexidine cord care after a national scale-up as a newborn survival strategy: A survey in four regions of Ethiopia.

Chlorhexidine cord care is an effective intervention to reduce neonatal infection and death in resource constrained settings. The Federal Ministry of Health of Ethiopia adopted chlorhexidine cord care in 2015, with national scale-up in 2017. However, there is lack of evidence on the provision of this important intervention in Ethiopia. In this paper, we report on the coverage and determinants of chlorhexidine cord care for newborns in Ethiopia. A standardized Nutrition International Monitoring System (NIMS) survey was conducted from January 01 to Feb 13, 2020 in four regions of Ethiopia (Tigray, Amhara, Oromia, and Southern Nations, Nationalities and Peoples Region [SNNPR]) on sample of 1020 women 0-11 months postpartum selected through a multistage cluster sampling approach. Data were collected using interviewer-administered questionnaires in the local languages through home-to-home visit. Accounting for the sampling design of the study, we analyzed the data using complex data analysis approach. Complex sample multivariable logistic regression was used to identify the determinants of chlorhexidine cord care practice. Overall, chlorhexidine was reportedly applied to the umbilical cord at some point postpartum among 46.1% (95% confidence interval [CI]: 41.1%- 51.2%) of all newborns. Chlorhexidine cord care started within 24 hours after birth for 34.4% (95% CI: 29.5%- 39.6%) of newborns, though this varied widely across regions: from Oromia (24.4%) to Tigray (60.0%). Among the newborns who received chlorhexidine cord care, 48.3% received it for the recommended seven days or more. Further, neonates whose birth was assisted by skilled birth attendants had more than ten times higher odds of receiving chlorhexidine cord care, relative to those born without a skilled attendant (adjusted odds ratio [AOR]: 10.36, 95% CI: 3.73-28.75). Besides, neonates born to mothers with knowledge of the benefit of chlorhexidine cord care had significantly higher odds of receiving chlorhexidine cord care relative to newborns born to mothers who did not have knowledge of the benefit of chlorhexidine cord care (AOR: 39.03, 95% CI: 21.45-71.04). A low proportion of newborns receive chlorhexidine cord care in Ethiopia. The practice of chlorhexidine cord care varies widely across regions and is limited mostly to births attended by skilled birth attendants. Efforts must continue to ensure women can reach skilled care at delivery, and to ensure adequate care for newborns who do not yet access skilled delivery.

Prevalence of cigarette and waterpipe tobacco smoking among adults in three Eastern Mediterranean countries: a cross-sectional household survey.

ObjectivesTobacco smoking is on the rise in the Eastern Mediterranean region. In light of limited surveillance of smoking in the region, this study sought to understand the prevalence of cigarette and waterpipe smoking among adults and the factors associated with smoking in Lebanon, Jordan and Palestine (West Bank only).Design, setting and participantsHousehold surveys were conducted with participants over the age of 18 in Lebanon (n=1680), Jordan (n=1925) and Palestine (n=1679) between June and August 2019. A multistage cluster sampling approach with probability-proportional-to-size random selection method was followed in the three countries.Primary and secondary outcome measuresGender-specific prevalence rates for cigarette and waterpipe smoking were estimated. Multivariable logistic regression was used to examine factors associated with current cigarette and waterpipe tobacco smoking.ResultsThe prevalence of cigarette smoking among males and females respectively was 48.6% and 21.5% in Lebanon, 50.4% and 9.1% in Jordan, and 53.4% and 3.1% in Palestine. The prevalence of waterpipe smoking among males and females respectively was 32.7% and 46.2% in Lebanon, 13.4% and 7.8% in Jordan, and 18.0% and 7.9% in Palestine. Cigarette smokers were significantly (p<0.05) more likely to be male, younger and with lower educational attainment across the three countries. Waterpipe smokers were more likely to be young adults across the three countries (p<0.001). They were more likely to be male in Jordan and Palestine, and more likely to be female in Lebanon.ConclusionsThe high prevalence rates of smoking in Lebanon, Jordan and Palestine are concerning. Continued surveillance is key to monitor smoking patterns and inform stronger tobacco control measures.

Cyber-victimization and its association with depression among Vietnamese adolescents.

BackgroundCyberbullying has become an alarming social issue, but little is known about its prevalence and consequences in many countries. This study investigated the prevalence of cyber-victimization and its association with depression among students in Ho Chi Minh City, Vietnam.MethodsA cross-sectional study was conducted in 1,492 students from eight secondary schools and high schools in four urban and suburban areas. Multi-stage cluster sampling approach was used to recruit participants. Students participated in this study on a voluntary basis and completed a self-report questionnaire that included validated scales to measure their experience of cyber-bullying (Cyber Bullying Scale) and symptoms of depression (Center for Epidemiologic Studies–Depression Scale). Weighted logistic regression analysis was used to adjust for the cluster effect and sampling probability.ResultsAlmost all (92.4%) students reported using the internet everyday and nearly 40% used internet for more than four hours per day. Cyber-victimization was identified in 36.5% of students and almost 25% experienced multiple types of cyber-victimization. Nearly half of students reported symptoms of depression. After adjusting for other covariates, students who experienced cyber-victimization were found to have 1.81 times (95% CI [1.42–2.30]) higher in odds of having symptoms of depression.ConclusionsCyber victimization and depression are both common in Vietnamese adolescents. Those who experienced cyber bullying have a higher likelihood of having symptoms of depression. These findings indicate an urgent need for interventions and policies targeting this emerging type of bullying in Vietnam and similar settings due to its potential harmful effects on adolescents’ health.