Primary Education Level Research Articles

Extended-spectrum beta-lactamase-producing Enterobacterales in human health: Experience from the tricycle project, Ghana

Background Vulnerable groups, such as pregnant women, are at increased risk of potentially life-threatening infections with extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) for both mother and newborn. However, data regarding ESBL-E carriage and associated risk factors in Ghanaian pregnant women remain scarce. Objective This study aimed to determine the prevalence of ESBL-E carriage and its associated risk factors among pregnant women attending the antenatal clinic at the Korle Bu Teaching Hospital. Methods A systematic sample of 700 pregnant women with gestational age ≥ 34 weeks attending the antenatal clinic at Korle Bu Teaching Hospital was included in the study. After administering a structured questionnaire to assess potential risk factors associated with ESBL-E carriage, patients were given a sterile stool container to submit at least 1 g of stool specimen. Recovered isolates from faecal specimens were identified using MALDI-TOF-MS technology. These isolates were then subjected to susceptibility testing and ESBL identification. A random subset of 24 ESBL-producing Escherichia coli isolates was whole-genome sequenced on the MiSeq Illumina platform. Risk factors associated with ESBL-E carriage were determined using multivariable logistic regression analysis. Results Among the 700 pregnant women, 42% (294) carried ESBL-E. The predominant ESBL-producing Enterobacterales were Escherichia coli (95%). Fifty percent (50%) of ESBL-E were multidrug resistant isolates (MDRs). Whole-genome sequencing of 24 ESBL-producing E. coli isolates revealed that blaCTX-M-15 (96%) was the most prevalent ESBL gene type. Notably, most isolates belonged to commensal phylogenetic groups (A, B1, and C; 88%). Having a primary level of education (aOR 1.45, 95% CI 1.05–1.96) and consuming legumes as the main source of protein (aOR 0.17, 0.40–0.83) were significantly associated with intestinal carriage of ESBL-E. Conclusion This study identified a high prevalence of ESBL-E and MDR-ESBL-E carriage among pregnant women. Our findings underscore the urgent need for public health interventions to control the spread of AMR.

Association between body mass index (BMI), respiratory symptoms, and asthma prevalence among the population in Khulna City, Bangladesh: an in-depth cross-sectional investigation

BackgroundAsthma, a chronic respiratory disease, has been steadily increasing in prevalence and significantly impacts global health. In Bangladesh, it remains a major public health concern. The relationship between asthma and body mass index (BMI) is complex, with higher rates observed among overweight individuals. This study aims to explore the association between BMI, respiratory symptoms, and asthma in Khulna City, Bangladesh, addressing the lack of comprehensive data for this region.MethodsThis study was a cross-sectional study. For data collection purposes, we considered Khulna Medical College and Hospital (KMC). Data collection involved a well-structured questionnaire during in-person meetings held from September 18 to November 6, 2022. We selected a total of 310 participants through simple random sampling and performed statistical analyses, including chi-square tests and logistic regression, to examine associations.ResultsThe majority of participants were aged above 60 years (36.5%), with most having a normal BMI (74.8%) and being male (69.0%). We found significant associations between the prevalence of asthma, age, BMI categories, and respiratory symptoms such as wheezing, coughing, chest tightness, and shortness of breath. Overweight individuals showed a higher likelihood of developing asthma (AOR 7.01; 95% CI 5.04–7.11), as did those with primary education (AOR 1.51; 95% CI 1.11–2.95) and smokers (AOR 2.80; 95% CI 1.27–6.15).ConclusionThis study identifies a higher asthma prevalence in Khulna City, associated with older age, overweight status, primary education level, and respiratory symptoms such as wheezing, coughing, chest tightness, and shortness of breath. Smoking further exacerbates the severity of the condition. We recommend public health strategies such as promoting healthier lifestyles, improving healthcare access, raising awareness about smoking risks, enhancing air quality, and establishing specialised asthma clinics for effective management and improved quality of life.

Development of a Frailty Prediction Model Among Older Adults in China: A Cross‐Sectional Analysis Using the Chinese Longitudinal Healthy Longevity Survey

ABSTRACTAimsTo identify the risk factors associated with frailty among older adults in China and develop a predictive model for assessing their frailty risk.DesignSecondary cross‐sectional analysis.MethodsThe 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) provided data for this study. A total of 9006 participants were included in the analysis. Their general demographic, socioeconomic status and health behaviour risk factors were collected in the CLHLS. Frailty was assessed using the Frailty Index. A visual nomogram model was constructed based on independent predictors identified using multivariate analysis. The nomogram's discrimination and calibration capabilities were evaluated using the C‐statistics and calibration curves. A 1000‐times resampling enhanced bootstrap method was performed for internal validation of the nomogram.ResultsThe results showed that living in rural settings, having a primary education level, having a spouse, having basic living security, smoking, drinking, exercising and social activities were protective factors against frailty. Increasing age, being underweight or obese, adverse self‐assessed economic status and poor sleep quality were risk factors of frailty. The AUC values of the internal validation set were 0.830. The calibration curve was close to ideal. The Brier score was 0.122. The above results showed that the nomogram model had a good predictive performance.ConclusionsA simple and fast frailty risk prediction model was developed in this study to help healthcare professionals screen older adults at high risk of frailty in China.ImpactThe frailty risk prediction model will assist healthcare professionals in risk management and decision‐making and provide targeted frailty prevention interventions. Screening high‐risk older adults and early intervention can reduce the risk of adverse outcomes and save medical expenses for older adults and society, thereby realising cost‐effective planning of health resources and healthy ageing.Patient or Public ContributionNo patient or public contribution. This study was a cross‐sectional, secondary analysis of the CLHLS data.

Rural-urban disparities in basic sanitation access among households: a multivariable decomposition analysis of Ethiopian demographic and health survey 2019

IntroductionDisparities in access to basic sanitation services between rural and urban households pose significant challenges to public health and human development. Understanding the determinants contributing to this gap is vital for advancing the Sustainable Development Goals (SDGs) and improving environmental and public health through evidence-based interventions.ObjectiveThis study aims to analyze and understand the disparities in access to basic sanitation services between rural and urban households in Ethiopia.MethodsThis study analyzed a sample of 8,663 weighted households, collected using stratified sampling techniques, utilizing the data from the 2019 Ethiopian Demographic and Health Survey (EDHS). The primary outcome was basic sanitation access, defined as access to flush or pour-flush systems, septic tanks, pit latrines, or composting toilets. A multivariable decomposition analysis was conducted to identify factors contributing to rural–urban disparities. Statistically significant variables were determined at a p-value of <0.05 with a 95% confidence interval.ResultsThe weighted proportion of basic sanitation access in Ethiopia was 13.78% (95% CI, 12.67–14.96), with significant disparities between rural (6.02%) and urban (27.15%) residents. Endowment factors accounted for 78.9% of this disparity, while behavioral coefficients contributed 22.1%. If the characteristics of respondents in rural and urban households had been similar, significant factors that would have narrowed the gap included the age of the household head (15–35 years), the absence of under-five children, smaller family size, and the attainment of secondary education, reducing the gap by 1.83, 2.07, 5.08, and 3.25%, respectively. Conversely, illiteracy and primary education levels widened the gap between rural and urban access to basic sanitation services by 16.85 and 0.23%, respectively. Additional factors exacerbating the rural–urban disparity included poverty (which widened the gap by 58.71%), residence in pastoralist regions (which widened the gap by 10.10%) or agrarian regions (which widened the gap by 7.03%), and access to water sources located more than 30 min away (which widened the gap by 7.91%).ConclusionSignificant disparities in access to basic sanitation services exist between rural and urban households in Ethiopia. Key factors contributing to these disparities include the age of the household head, education level, family size, region of residence, and water source proximity. Addressing these factors is essential for improving sanitation access and achieving the Sustainable Development Goals (SDGs).

Factors Associated With The Incidence Of Diarrhea In Toddlersin The Meureubo Health Center Working Area, Meureubo Sub-District, West Aceh District In 2023

Diarrhea is a potential endemic disease that can result in extraordinary outbreaks (KLB) and is often associated with mortality. According to data from the Meureubo Health Center in 2022, this center recorded the highest percentage of diarrhea cases among toddlers, reaching 67%. This study aims to examine the relationship between several factors clean water sources, latrine facilities, household waste management, wastewater disposal, maternal knowledge and education, nutritional status, personal hygiene, and environmental sanitation and the incidence of diarrhea in toddlers within the Meureubo Health Center working area, Meureubo District. This quantitative research utilizes a cross-sectional design and was conducted from May 13-29, 2023. The population includes all toddlers in the Meureubo Health Center working area, with a sample size of 97. Proportional random sampling was used to select the 97 respondents. Data were analyzed using the chi-square test with Stata 15, including univariate and bivariate analyses. The univariate results show that 43.30% of toddlers experienced diarrhea, 19.58% lacked access to clean water, 5.15% had inadequate latrine facilities, 57.73% faced insufficient household waste management, and 21.65% had improper wastewater disposal systems. Additionally, 30.93% of mothers had poor knowledge, 35.05% had a primary education level, 20.62% of toddlers were malnourished, and 39.18% had poor personal hygiene and environmental sanitation. Bivariate analysis reveals significant relationships between diarrhea incidence in toddlers and clean water sources (p-value: 0.0001), latrine facilities (p-value: 0.013), household waste management (p-value: 0.0001), wastewater disposal (p-value: 0.0001), maternal knowledge (p-value: 0.0001), maternal education (p-value: 0.036), nutritional status (p-value: 0.022), and personal hygiene and environmental sanitation (p-value: 0.0001). It is recommended that health workers, particularly those in health promotion, provide counseling on personal hygiene and environmental cleanliness

Determinants of nutrition status among adolescents in selected secondary schools in rural Kanungu district Uganda

Background: Adolescence, the time between childhood and adulthood, often considered relatively healthy stage of life remain highly vulnerable to malnutrition. One crucial first step in reducing teenage malnutrition may be to attend to their dietary needs. This study examined the determinants of nutrition status among secondary school adolescents in the Kanungu district, Uganda. Methods: A school-based cross-sectional analytical study was employed in this study where both qualitative and quantitative methods of data collection were used for triangulation purposes. A multi-stage random sampling method was applied to obtain the study respondents. The Cochran formula was utilized to obtain 340 study respondents. Results: More than a quarter (37.1%) of the study respondents had malnutrition. Households that were father-headed (OR=1.8,95%CI=1.03-3.20), having met the recommended number of meal frequency (OR=2, 95%CI=1.13-3.44), being aware of healthy dietary habits (OR=2.2, 95%CI=0.29-0.71), having a small household size of 1-4 members (OR=4.3, 95%CI=2.38-7.83) and being employed (OR=2.1, 95%CI=1.17-3.93) increased the odds of having a normal nutrition status while having a primary level of education (OR=3.6, 95%CI=0.11-0.68), having an inadequate dietary score (OR=2.1,95%CI=0.28-0.76) reduced the odds of having a normal nutrition status. Conclusions: From this study, malnutrition was a public health concern. Households that were father-headed, being aware of healthy dietary habits, having a small household size of 1-4 members, and being employed increased the odds of having a normal nutrition status while having a primary level of education, having an inadequate dietary score reduced the odds of having a normal nutrition status.

Mammography screening among women attending primary healthcare centers in Monastir, Tunisia

Abstract Background Breast cancer is the leading cancer among women worldwide. Early detection through mammography screening improves prognosis and enhances survival rate for this disease. The aim of this study was to identify the factors associated with mammography screening utilization among women attending primary healthcare centers. Methods A cross-sectional study was conducted in four primary healthcare centers in Monastir governorate in October 2023 using a pre-tested questionnaire. Women aged over 45 years-old were included as they were the target group in the breast cancer screening strategy. Univariate then multivariate analyses were performed in order to identify the factors associated with mammography screening utilization. Data was analyzed by SPSS 21.0. Results A total of 192 women were included in the study with a mean age of 56.7±8.8 years-old. Among them, 79.7 % (n = 153) were married and 51.6% (n = 98) had three children and less. A total of 55.3 % (n = 94) had a primary education level. Regarding participants’ practices of breast cancer screening, 35% of our participants have had mammogram. Univariate analysis showed that the knowledge about breast cancer symptoms (p = 0.015), practicing Breast self-examination (BSE) (p = 0.002), being aware about mammography (p = 0.001) and the recommended age of the screening at 45 years-old (p = 0.001) were significantly associated with adherence to breast cancer screening. Multivariate analysis revealed that practicing BSE (ORa=2.60 [95%CI: 1.22-5.55] and knowing the recommended age of mammography screening (ORa=2.28 [95%CI: 1.17-4.45] were significant (P < 0.05) predictors of mammography screening utilization. Conclusions Mammography screening rate is low. This study had provided some informations about factors influencing mammography screening. Policymakers and public health practitioners should consider the identified factors when developing intervention programs to improve breast cancer screening. Key messages • There is a need to conduct education sessions in schools to raise awareness about breast cancer screening at an early age. • Social media can be a tool for health education on mammography screening.

Assessing cancer prevention literacy among European population: a cross-sectional study

Abstract Background Cancer prevention literacy (CPL) is essential for empowering individuals to make health-informed decisions and adopt preventive measures to reduce their cancer risk. This study aims to measure CPL among the European population. Methods A cross-sectional population-based study was conducted from February to March 2024 among European residents over 18 years old (N = 2312) in the context of BUMPER Project (https://bumper.cancer.eu/). An online self-administered questionnaire was developed including: sociodemographic characteristics (age, gender, country of residence, educational level), and CPL (general and by European Code Against Cancer -ECAC- topics). A descriptive analysis was performed and the chi-square and Kruskal-Wallis test were calculated to examine the relationship between CPL and sociodemographic variables. Results 44.2% showed a high level of CPL, followed by 39.5% with medium, and 16.3% with low level. 61.1% of participants are not aware of ECAC. ECAC topics with higher levels of knowledge are: UV exposure (88.3%), pollution (81.6%), tobacco (78.7%), second-hand smoking (60.9%). ECAC topics with lower levels are: hormone replacement therapy (47.9%), breastfeeding (41.6%), and vaccination (32.9%). Statistically significant differences (p < 0.05) are observed in CPL level by gender, country of residence, and educational level. Those with a higher % of low CPL levels are men (22.8%), people from West and South Europe (20.8% and 18.1%), and primary education level (34.7%). Conclusions CPL level is medium-high among the European population, with social and gender inequalities. Further studies are needed to delve into these inequalities. Key messages • The cancer prevention literacy level is medium-high among the European population, with social and gender inequalities. • There is a need of tailored interventions to address social inequalities in cancer prevention literacy among European population.

Associated Factors of Low Birth Weight among Newborns at Hospitals in Kisangani, Democratic Republic of Congo

Background: Low birth weight remains a major public health problem in every country in the world. It is a predictor of early neonatal mortality, morbidity and long-term health. The aim of this study was to determine the prevalence of low birth weight and to identify the associated factors in a hospital setting in Kisangani. Material and Methods: An unmatched case-control study was used including all live and full-term births was conducted from 1 December 2023 to 31 May 2024 in the maternity wards of Makiso-Kisangani General Referral Hospital, Mangobo General Referral Hospital, Tshopo General Referral Hospital and Alwaleed Health Centre. A sample of 646 newborns was selected: 86 cases (newborns weighing less than 2500 grams) and 560 controls (newborns weighing 2500 grams or more). Factors associated with prehypertension were identified using logistic regression. Results: The prevalence of low birth weight was 13.4%. Factors associated with low birth weight were maternal age less than 18 years, intergenital interval less than 2 years, maternal infection during pregnancy, high blood pressure, level of primary education and urban residential environment. Conclusion: This study shows that low birth weight remains a public health problem in Kisangani. In addition to shedding light on the other contributing variables and the connections between them, prospective national research would enable the development of preventative measures.

Family planning knowledge, use, and associated factors among women with mental illness and epilepsy in Rwanda: a cross-sectional study

IntroductionFamily planning knowledge and access to quality family planning services occupy a central position in the lives of all women of reproductive age. However, women with mental illness and epilepsy who are at a high risk of sexual violence, unwanted pregnancies, poor obstetric outcomes, and drug interaction consequences, need it the most. Understanding their family planning knowledge and utilization remains crucial for meeting their needs. The present study aims to assess knowledge, use of family planning, and associated factors among women living with mental illness and epilepsy who attend the Ndera Neuropsychiatric Hospital and affiliated branches.MethodologyA cross-sectional study was conducted between October 2022 and February 2023. The study involved a purposive sample of 289 women who attended the Ndera Neuropsychiatric Hospital and its two affiliated branches during the data collection period. Psychiatric nurses administered a structured questionnaire. Data were analyzed using descriptive statistics, and multiple logistic regression analysis was performed to assess the factors associated with the use of family planning methods.ResultsOut of 289 who participated in the study, the majority (96.9%) were aware of family planning methods, most (67.8%) had used one method once in their life course, a half (51.9%) were using a family planning method at the time of data collection, and a slight number (26%) expressed intentions of using a family planning method in the future. The most known and used methods were respectively the injectable (17.5%) and oral contraceptive pill (17.5%). Regarding the natural family planning methods, breastfeeding and withdrawal were less used. Being single (AOR = 66.4, 95% CI: 9.8, 44) or married (AOR = 51.4, 95% CI: 11.9–22), having a primary level of education (AOR = 5.6, 95% CI: 2.0, 15.9), knowing a contraceptive method (AOR = 5.8, 95% CI: 0.6, 49) and suffering from brief psychotic disorders (AOR = 2.7, 95% CI: 1.1, 6.6) predicted a higher utilization of family planning.ConclusionMost of the women with mental illness in this study were aware of family planning methods and had used one of the family planning methods in life. The national average is below when it comes to family planning awareness. It is important to improve family planning education and counseling for women who attend psychiatric outpatient clinics.

Influence of socio-economic variables and extension inhibitors on food sovereignty in Akwa Ibom State, Nigeria

This study assessed the influence of socio-economic variables and extension inhibitors on food sovereignty in Akwa Ibom State, Nigeria. This study identified and proffered solutions to extension inhibitors to food sovereignty. A multi-stage sampling technique was used to select one hundred and twenty respondents used for the study. Data analysis comprised the use of percentages, frequency, means and Tobit regression model. The result of the socio-economic characteristics of the respondents showed that 27.50% of the respondents were from 41 and more years of age, while 25.00% were within the age range of 31 to 40 years. 8.33% of them were in the age brackets of 20 to 30 years. Majority of the farmers were very strong, agile and could adopt extension teaching methods easily. About 49.17% of the respondents were at tertiary level of education, while 23.32% had primary level of education. The result showed the mean (x ̅) response rate of extension inhibitors on food sovereignty as follows; inadequacy of funds (x ̅ = 4.65), use of poorly trained personnel (x ̅ = 4.04), ineffective research extension linkage (x ̅ =4.21), lack of evaluation (x ̅ = 4.422), poor policy (x ̅ = 4.04) among other factors. The hypothesis showed that gender, marital status and farm size were positive and significant at 1% level of probability. The result of the HO1, showed that any increase in farm size led to a corresponding increase in the probability and intensity of extension inhibitors on food sovereignty in the study area. Also, the coefficient of education was positively signed but not significant. This showed that education though very important but had no severe influence on the extension inhibitors. In the result, there was significant relationship between socio-economic variables and extension inhibitors on food sovereignty in the study area. The study concluded that some of the inhibitors of extension on food sovereignty are; inadequate funding, lack of extension service evaluation on food sovereignty situations, ineffective research extension linkage and use of poorly trained personnel. The study also concluded that majority of the farmers are of age and well educated to positively influence extension inhibitors with the view to improving food sovereignty situations in the study area. It was recommended that women being the majority in the study area should be involved in extension activities and evaluation, with a view to improving on food sovereignty. Key words: Akwa Ibom, Extension, Food Sovereignty, Influence, Inhibitors, Socio-economic and Variables

Values Reflected in First Language Textbooks of Primary Education in West Bengal

Textbooks function as catalysts for societal change, influencing students’ values, beliefs, and cultural awareness from their primary level of education. Textbooks serve as key learning resources for students which significantly influences students’ character development. The creation of textbooks reflecting values is essential, and achieving this goal requires a comprehensive analysis of textbooks. The objectives of the study are focused on examining values are represented in the text and images found within Bengali language textbooks of Primary Education Board, School Education Departments, govt. of West Bengal, India was the publisher of the textbook. A Bengali textbook named “Patabahar” of class IV of the West Bengal Board of Primary Education has been chosen through the purposive sampling technique as a sample in this study. This study used qualitative and documentary research methods through content analysis. The findings demonstrate that social values, moral values, environmental values, and Personal values, emotional values, cultural values are more reflected and spiritual, aesthetic, humanistic, economic, historical, civic, peace, national, cognitive values were minimally reflected across the textbooks. The study results provide a basis for state or national policy changes that promote values-balanced content in educational media and ensure the development and implementation of guidelines that are beneficial to the development of textbook development agencies. Also, helpful for textbook authors and teachers in developing a value-alignment curriculum and creating more inclusive, culturally sensitive, and ethically grounded visual materials

Homework - Necessity or Myth?

Throughout generations a question has been posed: do students benefit from writing homework and does homework fulfill its purpose? The debate about the usefulness of homework causes many doubts in the educational public. Learning outcomes and the importance of homework are different today than twenty or more years ago. Contemporary students are not very interested in this type of activity, showing a high degree of non-independence in performing tasks outside the school environment. The author discusses the expediency of writing homework and its impact on students' learning achievements in class. Accordingly, the author examines the positive and negative sides of this extracurricular activity. This article was created based on the analysis of previous research and knowledge about this subject. Some Croatian and Slovenian didacticists believe that homework should not be abolished, but it should be functional, comprising of various exercises aimed at encouraging students to be active. Tasks are justified if they expand the possibility of learning and serve to develop students' abilities and skills. The author states that homework is necessary in the mother tongue teaching, especially at the initial level of primary school education. The teacher must control the quality and quantity of the homework, taking into account the time the student needs to complete it and the type of goals he wants to achieve in relation to the linguistic and literary material. The article offers the examples of homework in the fields of mother tongue, literature, written expression, reading and media culture. Modern technology offers numerous possibilities for creating creative homework.

Changes in Alcohol Intake by Educational Level among Older Men and Women in Spain during the 21st Century

Abstract Background and objectives Despite alcohol use being very common in older adults, studies are scarce and suggest alcohol use may be increasing. Furthermore, despite the known relationship between education and alcohol consumption, there is limited evidence of educational differences in older adults. Our objective was to describe trends in alcohol consumption in individuals aged ≥65 by sex and educational level in Spain. Research design and methods 43,157 participants aged ≥65 years were drawn from Spain’s national health surveys between 2001-2020, representing the non-institutionalized population. The outcomes were various measures of self-reported past-year alcohol intake. Age-standardized rates and negative binomial regression models were used to examine trends and differences in alcohol intake by educational level, sex, and period (2001-2009 vs. 2011-2020). Results The average daily alcohol intake and prevalence of heavy average drinking (>20/10 g/day) decreased over time, especially among men, while moderate average drinking remained unchanged or even increased. Alcohol intake increased with increasing educational levels. All drinking measures showed educational inequalities, and these were greater in women than men. The mean amount of drinking showed the greatest inequality, with and adjusted prevalence ratio of 2.6 in women and 1.1 in men between university relative to primary education level. Discussion and implications Alcohol intake in older adults decreased over time in Spain for heavy average drinking and average drinking amount, although not for moderate average drinking. Consumption remains highest among the highest educational levels, which may negatively affect health. Programs addressing alcohol consumption among older adults are needed to minimize alcohol-related harm.

SOCIO-ECONOMIC CONDITIONS AND OCCUPATIONAL HEALTH CHALLENGES OF WOMEN CONSTRUCTION WORKERS: A CASE STUDY IN MADURAI DISTRICT, TAMIL NADU

The construction sector plays an important role in the livelihoods of rural poor populations, contributing significantly to their economic sustenance. This study focuses on the status and significance of women construction workers in the Madurai district of Tamil Nadu. More than 3 lakh construction workers are employed in Tamil Nadu facing various challenges on a daily basis. Women in this sector encounter numerous issues including socio-economic hardships, environmental risks and health problems at the worksite. The present study investigates the socio-economic conditions and occupational health problems faced by women in Madurai’s construction industry. The construction sector a key employer in developing countries like India predominantly hires unskilled and semi-skilled labour. Women workers in construction industry endure long working hours, wage discrimination and adverse working conditions often with limited access to social security or healthcare. Data collected from 60 respondents through purposive sampling reveals that most of the women workers are between 30 and 50 years old and have only a primary level of education. Despite their significant contributions these women face a multitude of challenges such as health issues like neck and shoulder pain, anaemia and asthma with minimal awareness of medical insurance. The study highlights the urgent need for targeted interventions aimed at improving economic security, health awareness, and working conditions for women in the construction sector. KEYWORDS: construction women workers, marginalized, health problems, wage discrimination, livelihood.

Survival Regression Model Allowing for Exposure-Mediator Interaction: Analysis of Kenya Demographic Health Survey (KDHS) 2014 Data

Although infant and under-five mortality rates have decreased over the past decade, Kenya, like many other African nations, did not achieve the Millennium Development Goal (MDG) 4 target. To accelerate progress towards reaching Sustainable Development Goal 3 by 2030, it is essential to understand the factors influencing under-five child mortality (UFCM), taking into account all potential confounding variables and effect modifiers. The child mortality rate serves as a key health indicator for any country. This study used data from the 2014 Kenya Demographic and Health Survey (KHDS). This paper introduces the concept of decomposing the total effect of an independent variable into three components: a direct effect, an indirect effect, and an interactive effect. We attempt to account for the direct effect of an independent variable on the outcome, then proceed to check the effect of the presence of a possible mediator and, furthermore, the possible interactions between an exposure variable and a mediator variable. The outcome variable was UFCM, and the study was to determine the effect of mother’s education on UFCM, in the presence of mediators such as mother’s income and the effect via the interaction between mother’s education and maternal income was estimated. To capture the effect of mediation and interactions in the context of survival analysis, an Aalen additive model, including a product term for the exposure and mediator term, was developed. The methods were further illustrated with practical approach to KDHS data. KDHS has data on a broad scope of risk factors for UFCM. Computations for all data sets was implemented using the freely available R-software package. This analysis suggests that while a significant portion of the impact of maternal education on UFCM is mediated by increasing maternal income, it is the interaction between maternal education and maternal income that leads to a reduction in UFCM. Interventions targeting an increase in income among mothers with no education level would yield a greater reduction in UFCM than interventions targeting mothers with a higher education level. The total effect was ascribed to an interaction between the mother’s education level and maternal income, and part of it is attributable to pure indirect effect, and a given proportion is attributable to pure direct effect. The majority of the total effect (70%)is attributed to the interaction between change from no education level to primary education level and maternal income. 22% is associated with the pure direct effect, while 8% is linked to the pure indirect effect. Interventions with a given increase in income among those with no education level would yield a greater reduction in UFCM than interventions targeting mothers with a higher education level.

Concomitant Infection of Helicobacter pylori and Intestinal Parasites: Burden, Sociodemographic and Clinical Characteristics in Hospitalized Children and Adolescents in Northern Lebanon

Background Helicobacter pylori and intestinal parasites are well-known for their high prevalence in children, especially in developing countries. However, their concomitant infections are poorly documented. In this study, we aimed to evaluate the association between intestinal parasites and H. pylori among hospitalized children and adolescents with upper gastrointestinal complaints in Northern Lebanon. Methods A cross-sectional study was conducted involving 297 hospitalized pediatric patients, aged between 1 and 15 years, who presented with gastrointestinal symptoms. The socio-demographic, lifestyle, and gastrointestinal characteristics of all participants were analyzed. Fresh stool samples were collected and screened for the presence of intestinal parasites and H. pylori infections. Results 6.4% of the patients were positive for intestinal parasitic infections, 5.4% were positive for H. pylori infection, and 11.8% were co-infected. The results of the Chi-square test showed that H. pylori infection is significantly associated with parasitic infection but not with a particular species. The most frequent coinfection was H. pylori-Entamoeba histolytica (77.1%). Moreover, H. pylori infection was associated with overcrowding and infrequent washing of vegetables before eating. The prevalence of co-infections increased in patients of mothers with a primary educational level or less. In regards to clinical characteristics, our findings showed a statistically significant relationship between i) gastric reflux and H. pylori, and ii) severe diarrhea and parasitic infection. Conclusion Our data highlighted the association between H. pylori and intestinal parasitic infections. Thus, H. pylori detection could be taken into consideration while screening for parasitic infections in children and adolescents.

Wealth-related inequality in vitamin A rich food consumption among children of age 6-23 months in Ethiopia; Wagstaff decomposition of the 2019 mini-DHS data.

Vitamin A (VA) cannot be made in the human body and thus foods rich in VA are the only sources of vitamin A for the body. However, ensuring availability in adequate amount of foods rich in VA remains a challenge, mainly in low-income counties including Ethiopia. In addition, children from the poorest and less educated families of same country have disproportionately limited consumptions of foods rich in VA. Therefore, the present study aimed assessing the wealth related inequality in vitamin A consumption (VAC) and decompose it to the various contributing factors. This study was conducted using the 2019 Ethiopian demographic and health survey data on a weighted sample of 1,497 children of age 6-23 months in Ethiopia. The wealth related inequality in VAC was quantified using concentration index and plotted using concentration curve. The Wagstaff decomposition analysis was performed to assess the relative contributions of each explanatory variable to the inequalities in the overall concentration index of VAC. The overall Wagstaff normalized concentration index (C) analyses of the wealth-related inequality in consumption of foods rich in VA among children aged 6-23 months was [C = 0.25; 95% C: 0.15, 0.35]. Further decomposition of the C by the explanatory variables reported the following contributions; primary level of women's education (7.2%), secondary and above (17.8%), having ANC visit during pregnancy (62.1%), delivery at a health institution (26.53%), living in the metropolis (13.7%), central region (34.2%), child age 18-23 months (4.7%) contributed to the observed wealth related inequality in the consumption of foods rich in vitamin A in Ethiopia. We found pro-rich wealth-related inequality in VAC among children of age 6-23 months in Ethiopia. Additionally, maternal education, region, ANC visit, and place of delivery were the significant contributors of wealth-related inequality of VAC. Nutritional related interventions should prioritise children from poorer households and less educated mothers. Moreover, enhancing access to ANC and health facilities delivery services through education, advocacy, and campaign programs is highly recommended in the study setting.

The Impact of Distance Learning During the Corona Pandemic on the Mental Health of Primary School Students

This paper investigates the impact of distance learning, within the context of the COVID-19 pandemic, on the mental health of primary school students, as perceived by their parents. The critical factors examined in this paper include the use of technology, the lack of physical interaction between the students and the teachers, and whether adequate psychological support was provided to the students from school. It wants to explain how such variables influenced the emotional life of students, whether they developed anxiety or stress, had behavioral changes, or had much change in social interactions. A sample of 150 parents whose students were at the primary level of education and attended distance learning classes during the pandemic took part in the data collection. The structured questionnaire would be prepared to assess the parents' perception of their children's mental health. The items would range from a 3-point Likert scale addressing mental health and wellbeing, the influence of technology, and school support. The results of the present study indicated that, from the perspective of their parents, primary school students have been considerably affected mentally as a consequence of distance learning. The highest mean, 2.26, refers to increased anxiety and stress, which is very strong. Changes in behavior were moderate, as reflected by the mean of 2.11, and so was its impact on sleep at 2.01. With the advent of technology, stress levels went up, as shown by the strong correlation of 0.66, while technology influencing independent learning was negatively correlated at -0.46. Not having physical interaction with others greatly affected the mental health status of the students, as depicted by the mean of 2.31 and significant results in introversion: F-statistic 7.06 and p-value 0.0006. Moreover, more than 53% of parents felt that psychological support from schools needed to be increased, and 60.1% needed more recommendations for helping their children cope with the psychological burden of transitioning to remote learning.

Knowledge and Practices Among Livestock Owners Regarding Brucellosis- A Cross-Sectional Study

Background: Brucellosis is one of the earliest identified and most prevalent zoonotic diseases of bacterial origin with 5, 00, 000 human cases every year globally. Cases reported are only the tip of the iceberg because of the non-specificity in clinical manifestations and chronicity in complications. The study was conducted to determine the knowledge and practices regarding brucellosis among livestock owners and to determine the sero-prevalence of brucellosis in livestock owners. Methods: A cross-sectional study was conducted among 256 livestock owners. Knowledge and practices were assessed using two-point assessment. Anti-brucellosis IgG and IgM antibodies were tested by slide agglutination test and in turn, were confirmed by standard tube agglutination test. Results: Almost 70% of participants had poor knowledge and followed poor practices. Participants with intermittent fever (aOR: 0.2465), joint pains (aOR: 0.1418), and a history of abortions in their animals (aOR: 0.2303) were less likely to have poor knowledge. Illiterate participants (aOR: 11.9512) and those without a cowshed (aOR: 7.1445) were more likely to have poor knowledge about brucellosis. Participants with low socio-economic status (aOR: 17.3726), those who had heard about brucellosis through radio/television (aOR: 3.7746), those with primary-level education (aOR: 13.9779), and illiterate participants (aOR: 43.9506) more likely to follow poor practices. Participants with a history of symptoms like intermittent fever (aOR: 0.1338) and a history of abortions in their animals (aOR: 0.052) were less likely to follow poor practices related to brucellosis. (p< 0.05). Conclusion: The study participants had a poor understanding of brucellosis and high levels of risky practices, all of which contributed to the risk of contracting brucellosis.