Semi-rural Community Research Articles

Linear and Nonlinear Associations between Sleep and Adjustment in Adolescence

ABSTRACT Background & Objectives A growing body of work supports linear associations between sleep and socioemotional adjustment in adolescence. However, associations between sleep and adjustment are not necessarily linear and investigations of nonlinear effects are scarce. This study examined linear and nonlinear relations between several sleep-wake parameters and externalizing behavior and internalizing symptoms in adolescence, and assessed the role of adolescent sex as a moderator of effects. Participants Participants were high school students (N = 180; M age = 17.49, SD = .62; 59% female; 68% White/European American, 32% Black/African American) from a wide range of socio-economic backgrounds living in semirural communities and small towns in Alabama. Methods Sleep-wake parameters were indexed by actigraphy-derived sleep minutes and adolescents’ reports on morningness-eveningness (circadian preference), sleep-wake problems (sleep quality), and sleepiness. Adolescents completed questionnaires on externalizing behaviors and internalizing symptoms. Results Controlling for sleep duration, a higher preference for eveningness and poor sleep quality were associated in a linear fashion with increased externalizing and internalizing symptoms. Nonlinear relations between sleepiness and internalizing symptoms emerged with pronounced sex-related effects, including somewhat delayed accelerating relations for males and rapidly accelerating associations that tended to plateau for females. Conclusions Results illustrate the importance of examining multiple sleep-wake and adjustment variables as well as linear and nonlinear associations.

Clinicopathologic Features of Uterine Fibroids in a Private Gynecologic Setting in Calabar, Nigeria

Abstract Introduction Uterine fibroid is a common gynecologic problem among adult females in Nigeria with variable clinical presentations. Unfortunately, these patients often seek medical attention very late after having consulted nonorthodox and/or traditional health practitioners. Objectives To assess the clinical outcome of patients diagnosed with uterine fibroids and review the pathologic features of specimens obtained from such patients managed over a 48-months period at Davis Medical Centre, a specialist gynecologic private health facility in Calabar, Nigeria. Methods This retrospective study was conducted at Davis Medical Centre, located in a semirural community in Calabar Municipality. It involved the extraction of data from case notes of patients and review of laboratory reports and H&E-stained histopathologic slides of surgical specimens removed from patients who presented with abdominal mass/swelling, heavy menstrual bleeding, abdominal pain, and inability to get pregnant having excluded other causes of infertility and ultrasonographic features suggestive of leiomyoma. Results A total of 82 patients aged between 26 and 54 years (mean age 36 ± 2 SD) were seen, giving an annual rate of about 20 cases yearly in the 4-year period (2015-2018) studied. Forty-eight (58.5%) had giant uterine fibroids with uterine size between 16 and 28 weeks. Myomectomy was the mainstay of treatment in 93.9% while 6.1% had abdominal hysterectomy. Histologically, the number of fibroid nodules ranged from 1 to 60 nodules with the largest weighing 4,097 g. All had the typical whorled grayish-tan gross appearance of leiomyoma uteri with a large proportion histologically showing degenerative changes of the hyaline type (39%) and few having features suggestive of adenomyosis. Conclusion Despite the grotesque, unusual macroscopic and characteristic microscopic findings, timely and careful surgical intervention can remedy the reproductive outcome and save lives of the affected patients when seen and managed by an experienced specialist gynecologist.

Disability prevalence-context matters: A descriptive community-based survey.

BackgroundThere is increasing interest in the collection of globally comparable disability data. Context may influence not only the rates but also the nature of disability, thus locally collected data may be of greater use in service delivery planning than national surveys.ObjectivesThe objective of this article was to explore the extent to which two areas, both under-resourced but geographically and socially distinct, differed in terms of the prevalence and patterns of disability.MethodA cross-sectional descriptive survey design was utilised, using stratified cluster sampling in two under-resourced communities in the Western Cape, South Africa. Nyanga is an informal urban settlement in Cape Town and Oudtshoorn is a semi-rural town. The Washington Group Short Set of questions was used to identify persons with disabilities (PWD), and a self-developed questionnaire obtained socio-demographic information.ResultsThe overall prevalence of disability was 9.7% (confidence intervals [CIs] 9.7–9.8) and the proportion of PWD was significantly different between the two sites (Chi-Sq = 129.5, p < 0.001). In the urban area, the prevalence rate of any disability was 13.1% (CIs 12.0–14.3) with 0.3% (CIs 0.1–0.6) reporting inability to perform any function at all. In contrast, the semi-rural community had a lower overall prevalence rate of 6.8% (CIs 6.0% – 7.8%) but a higher rate of those unable to perform any function: 1% (CIs 0.07–1.4). Disability was associated with gender, age, unemployment and lower income status in both areas.ConclusionDeprived areas tend to show higher disability prevalence rates than the National Census estimates. However, the discrepancy in prevalence and patterns of disability between the two under-resourced areas indicates the need for locally specific data when planning health interventions.

"Not Just One, It's Both of Us": Low-Income Mothers' Perceptions of Structural Family Therapy Delivered in a Semi-rural Community Mental Health Center.

Qualitative methods were used to explore mothers' perceptions of structural family therapy (SFT) delivered in a semi-rural community mental health clinic. In-depth, semi-structured interviews were conducted with sixteen mothers who received SFT after seeking services for their children. Thematic analysis suggests mothers found SFT acceptable and valuable. Mothers reported using SFT strategies to regain parental authority, which they believed improved their ability to manage their child's needs and decreased their own stress. SFT also increased some mothers' receptivity to individual treatment. Mothers identified their low dose of treatment and lack of father involvement as impediments to improvement, raising concerns about intervention sustainability.

A Case Study of Household Food-Related Assessment Using an Innovative Passive Dietary Assessment Device in Mampong-Akuapem, Ghana (FS17-03-19)

ObjectivesTraditional dietary assessment methods in low-middle income countries (LMICs) have significant limitations. The objective of this study was to test the feasibility of using the Automatic Ingestion Monitor (AIM), an eyeglasses-mounted wearable chewing sensor and micro-camera, to monitor food acquisition, preparation and consumption of a household in a LMIC setting. MethodsThis is a case of an 8-member household from Mampong-Akuapem, a semi-rural community in the Eastern Region of Ghana. The household was made up of mother (35 years), father (37 years), and six children (ages 17 years, 13 years [twins], 8 years, 5 years, and 18 months). Mother has no formal education and works as a cook, whereas the father has elementary education and is a farmer/construction worker. All members of the household consume the same prepared meals. The AIM was used to monitor household activities for a day. The primary food preparer (mother) wore the AIM during all waking hours on the chosen day as she went about her daily activities, except any activities where she wanted to preserve privacy. The mother also responded to a socio-demographic questionnaire and evaluated her perceived burden of wearing the AIM. Images captured by the AIM were processed and annotated in custom software. Major household related activities around food are reported. ResultsOverall, a total wear time of 776 minutes (12.9 hr; 76.1% of usual wake time) was recorded with images spanning a total of 681 minutes (11.4 hr; 87.8% of total wear time). Cooking and food preparation (four different meals) accounted for 47.9%, shopping 1.5%, breastfeeding and other child feeding 5.1%, and eating 5.4% (communal 4.9% and non-communal 0.5%), and other daily activities 40.1% of usual wake time. Three main meals captured on the AIM were breakfast (rice porridge - boiled watery rice with added sugar, milk and bread), lunch (fufu - pounded boiled cassava and plantain, and chicken soup), and dinner (kelewele - fried spiced yellow plantains). The AIM was generally accepted by the participant and household members although they preferred a smaller size version. ConclusionsThe AIM has the potential of capturing household food related activities and practices that affect dietary intake and nutritional health in LMIC. Funding SourcesFunded by the Bill & Melinda Gates Foundation.

Diverse Commensal Escherichia coli Clones and Plasmids Disseminate Antimicrobial Resistance Genes in Domestic Animals and Children in a Semirural Community in Ecuador

The increased prevalence of antimicrobial resistance (AMR) among Enterobacteriaceae has had major clinical and economic impacts on human medicine. Many of the multidrug-resistant (multiresistant) Enterobacteriaceae found in humans are community acquired, and some of them are possibly linked to food animals (i.e., livestock raised for meat and dairy products). In this study, we examined whether numerically dominant commensal Escherichia coli strains from humans (n = 63 isolates) and domestic animals (n = 174 isolates) in the same community and with matching phenotypic AMR patterns were clonally related or shared the same plasmids. We identified 25 multiresistant isolates (i.e., isolates resistant to more than one antimicrobial) that shared identical phenotypic resistance patterns. We then investigated the diversity of E. coli clones, AMR genes, and plasmids carrying the AMR genes using conjugation, replicon typing, and whole-genome sequencing. All of the multiresistant E. coli isolates (from children and domestic animals) analyzed had at least 90 or more whole-genome SNP differences between one another, suggesting that none of the strains was recently transferred. While the majority of isolates shared the same antimicrobial resistance genes and replicons, DNA sequencing indicated that these genes and replicons were found on different plasmid structures. We did not find evidence of the clonal spread of AMR in this community: instead, AMR genes were carried on diverse clones and plasmids. This presents a significant challenge for understanding the movement of AMR in a community.IMPORTANCE Even though Escherichia coli strains may share nearly identical phenotypic AMR profiles and AMR genes and overlap in space and time, the diversity of clones and plasmids challenges research that aims to identify sources of AMR. Horizontal gene transfer appears to play a more significant role than clonal expansion in the spread of AMR in this community.

Barriers to contraceptive use among adolescents in two semi-rural Nicaraguan communities.

Objective To identify barriers to contraceptive use among adolescents in two neighboring semi-rural communities in Nicaragua. Methods We recruited and surveyed a convenience sample of 287 adolescents, ages 15-19 years old, in July and August, 2013 about barriers to contraceptive use. We compared adolescents by gender, sexually active status (sexual intercourse in the previous year) and frequency of contraceptive use. Results More than 40% (43.5%) of the adolescents surveyed reported that they had ever had sexual intercourse. The likelihood of ever having had sexual intercourse differed based on gender, relationship status, sexual activity of peers, and the presence of a father in the home. Contraceptive use was low and female adolescents were more likely than their male counterparts to report never or rarely using contraceptives (46.5% vs. 21.4%, p < 0.007). Contraceptive use for females was positively associated with discussing contraception with a healthcare professional (HCP) [adjusted odds ratio (AOR) 13.32; 95% confidence interval (CI) 1.35-139.98] and a family member (AOR 4.64; 95% CI 1.09-19.72). Reasons for non-use also varied significantly by gender. Low rates of contraceptive use in these two semi-rural Nicaraguan communities appear to be primarily related to gender norms, social stigma, and poor communication about family planning. Conclusions Interventions that focus on promoting gender equality and encouraging adolescent communication with HCPs, schools, families, and partners are imperative to combating adolescent pregnancy in Nicaragua and countries worldwide.

Interactions between sleep duration and quality as predictors of adolescents' adjustment

ObjectivesWe examined interactions between adolescents' sleep duration and quality as predictors of their internalizing symptoms and externalizing behaviors. As a secondary aim, we assessed adolescent sex, race/ethnicity, and socioeconomic status (SES) as additional moderators of risk (ie, 3-way interactions among sleep duration; quality; and sex, race, or SES). DesignThe study used a cross-sectional design. SettingParticipants were from small towns and semirural communities in Alabama. ParticipantsThe sample consisted of 235 adolescents (Mage = 15.78 years, SD = 9.60 months) and was diverse with respect to sex (54% female), race/ethnicity (32% Black/African American, 67% White), and SES. MeasurementsSleep duration (actual sleep minutes) was examined with actigraphs for 1 week. Adolescents reported on their subjective sleep quality, internalizing symptoms, and externalizing behavior with psychometrically sound measures. ResultsFindings revealed interactions between sleep duration and sleep quality as predictors of adolescents' adjustment. Adolescents with both short sleep duration in conjunction with poor sleep quality had the highest levels of internalizing symptoms and aggressive and rule-breaking behavior. SES interacted with sleep duration and sleep quality to predict rule-breaking behavior, and the highest level of problems was observed for adolescents from lower-SES homes who had short sleep duration accompanied by poor sleep quality. ConclusionsFindings identify the conjoint role of sleep duration and quality as predictors of adolescents' socioemotional adjustment and emphasize the importance of examining multiple sleep parameters simultaneously toward a better understanding of adaptation in adolescence.

Interpretations of self-rated health in stroke survivors from a semi-rural community in South East Asia

ABSTRACT Purpose : Stroke survivors report poorer self-rated health (SRH) compared to the general population but there is limited understanding on what contributes to SRH. This ethnographic study examined the individual and contextual factors that shape stroke survivors’ SRH in a rural middle income country situated in South East Asia. Methods: Ethnographic methods which encompasses various data collection methods from different data sources were used in this study to describe the socio-cultural context of 16 stroke survivors living in a rural village. Within this context, the experiences of these participants were then interpreted in terms of what contributed to their perception of health and recovery, juxtaposed with objectively measure physical and cognitive states. Results: SRH reflected the post stroke adjustment of stroke survivors. Better SRH was influenced by good post-stroke adjustment that was achieved by a combination of physical functioning, cognitive functioning, emotional well-being and family support. Poorer SRH appear to reflect poor post-stroke adjustment regardless of the objective physical and cognitive states of the stroke survivors. It was also observed that cognitive deficits, though its presence was acknowledged by participants, were usually not taken into account when rating SRH. However, while physical functioning was perceived by participants to directly impact SRH, the presence of cognitive deficits (often in tandem with depressive symptoms) indirectly complicated the recovery of physical functions treasured by participants. Conclusion: Stroke survivors reporting poorer SRH warrant further attention and intervention from health practitioners supporting the longer-term needs of stroke survivors in similar settings.

Knowledge about Sexual and Reproductive Health among School Enrolled Adolescents in Tololar, Nicaragua, A Cross-Sectional Study

Abstract Background Nicaragua has the highest prevalence of teenage pregnancies in Latin America. Knowledge regarding sexual and reproductive health plays an integral part in sexual behavior. The objective was to assess school going adolescents' knowledge about sexual and reproductive health and possible factors affecting it in the semi-rural community of Tololar, Nicaragua. Methods A cross-sectional study with a self-administered questionnaire on tablets was used for data collection. All 253 registered students at the school present at the time of fieldwork who gave written informed consent were deemed eligible for the study. A total of 225 participants in the ages of 11-19 years were included. Simple linear regression and multiple linear regression were performed analyzing the outcome knowledge. A p-value <0.05 was considered significant. Results The general knowledge about sexual and reproductive health was moderate; however, knowledge gaps were found such as prevailing myths and poor knowledge regarding human immunodeficiency virus (hiv) transmission and contraceptive methods. Being female and single were significant negative determinants of knowledge (p-value < 0.01) and knowledge increased significantly with age (p-value < 0.05). School teachers, websites, social networks, and TV were the most frequently chosen sources of information on the topic. Conclusions Increased education on sexual and reproductive health with new interventions particularly for young females is recommended. Using IT-based materials as a complement may be an effective way to reach out to adolescents.

Think Locally and Act Globally: Understanding Human Development in the Era of Globalisation

Abstract For well over two decades the phrase “Think Global, Act Local” shaped the rhetoric used by social movements, environmental activists and intellectuals critical of the neoliberal narrative of globalisation. The intention was to obtains ideas and solutions elaborated in various parts of the world implemented in local communities and to give special meaning to progressive proposals of international social movement contesting globalisation. This approach could certainly be beneficial in terms of the diffusion of good environmental practices or spreading civil society ideas in developing countries. However, when global ideas reach local ground, they remain global ideas, and sometimes very foreign ones, which may take over or eclipse local concepts in unintended or less-than-ideal ways. Occasionally, this approach could even lead to overpowering what is local instead of empowering it. Therefore, having the empowerment of local communities in mind, we propose that those who really contest globalisation of the neoliberal narrative should turn the tables and work to “Think Locally, Act Globally.” Thinking locally and acting globally helps to ensure that adequate attention will be paid to local needs and local ideas. Presently, no local community exists outside of the global context and its influences, which affects the writings of contemporary sociologists who tend to emphasise the concept of “place” when analysing local communities. The nature of bonds on the local level changes in the globalised world, as local communities become more goal-oriented, utilising the functional proximity of people and other assets of the community. These new types of communities emerge even in places previously recognised as being shaped by local customs and traditions. These changes can be seen in the rural, semi-rural and small-town communities of Zalipie and Dąbrowa Tarnowska in Małopolska, as well as Radzionków in Silesia and in the nationwide study of rural communities in Poland. Their potential as the communities of the new type can be recognised as matching with neo-endogenous and sustainable development concepts.

Maternal Carriage of Group B Streptococcus and Escherichia coli in a District Hospital in Mozambique.

In low-income countries, data on prevalence and effects of group B Streptococcus (GBS) and Escherichia coli (E. coli) colonization among pregnant women are scarce, but necessary to formulate prevention strategies. We assessed prevalence of GBS and E. coli colonization and factors associated among pregnant women, its effect in newborns and acceptability regarding the utilized sampling methods in a semirural Mozambican hospital. Pregnant women were recruited from June 2014 to January 2015, during routine antenatal clinics at gestational age ≥ 34 weeks (n = 200); or upon delivery (n = 120). Maternal risk factors were collected. Vaginal and vagino-rectal samples for GBS and E. coli determination were obtained and characterized in terms of antimicrobial resistance and serotype. Anti-GBS antibodies were also determined. Neonatal follow-up was performed in the first 3 months after birth. Semistructured interviews were performed to investigate acceptability of sample collection methods. In total, 21.3% of women recruited were GBS carriers, while 16.3% were positive for E. coli. Prevalence of HIV was 36.6%. No association was found between being colonized by GBS and E. coli and maternal risk factors. GBS isolates were fully susceptible to penicillin and ampicillin. Serotypes V (32.4%), Ia (14.7%) and III (10.3%) were the most commonly found and 69.2% of the women tested had immunoglobuline G antibodies against GBS. E. coli isolates showed resistance to ampicillin in 28.9% and trimethoprim/sulfamethoxazole in 61.3% of the cases. Prevalence of GBS and/or E. coli colonization among pregnant women is high in this semirural community and comparable with those reported in similar settings. Four serotypes accounted for nearly 70% of all isolates of GBS. Population-based data on infant GBS infections would enable the design of prevention strategies for GBS disease in Mozambique.

Protocol Paper: Oral Poliovirus Vaccine Transmissibility in Communities After Cessation of Routine Oral Poliovirus Vaccine Immunization.

BackgroundWe aimed to elucidate household and community-level shedding and transmission of trivalent oral polio vaccine (tOPV) in communities with inactivated polio vaccine (IPV) routine immunization after tOPV is administered during a national health week (NHW).MethodsWe conducted a 3-arm, randomized trial with data collected at baseline through 10 weeks post-NHW in households with at least 1 child <5 years old in 3 semi-rural communities in Orizaba, Mexico. Selected communities were geographically isolated but socio-demographically similar. Each community was assigned an oral polio vaccine (OPV) immunization rate: 10, 30, or 70% of participating households. From 2653 households in the 3 communities, ~150 households per community were selected, for 466 in total. Households were randomized as vaccinated or unvaccinated, with only 1 child under 5 in the vaccinated household receiving OPV during the February 2015 NHW. No other community members received OPV during this NHW. Stool samples were collected up to 10 weeks post-vaccination for all members of the 466 study households and were analyzed for the presence of OPV serotypes using a multiplex polymerase chain reaction assay.ResultsWe will report on the factors associated with, and incidence and duration of, household and community shedding and transmission of OPV. The secondary outcomes will characterize temporal and geospatial OPV serotype shedding patterns.ConclusionsThe current global polio eradication plan relies on transitioning away from OPV to IPV. This study contributes to understanding patterns of OPV shedding and transmission dynamics in communities with primary IPV immunity, in order to optimize the reduction of OPV transmission.

Reproductive preferences during middle childhood and early adolescence in Guatemala

Reproductive preferences and the spread of low fertility norms occupy a key position in debates regarding the causal mechanisms underlying sustained fertility declines. Most of the literature on reproductive preferences focuses on stability and variability of adult fertility preferences, and their relationship with behavioural outcomes. Little work has focused on the developmental origins of these preferences, particularly in populations undergoing rapid social and demographic change. This study explores the utility of integrating the ontogeny of fertility preferences into accounts of fertility declines. We analyse data on child and adolescent (age 8–15) reproductive preferences collected from a semi-rural community in the Guatemalan Highlands. We explore (1) the distribution of reproductive preferences across age and gender, (2) relationships between family structure and preferences, (3) the relationship between personal economic and occupational aspirations and reproductive preferences, and (4) the effects of parental investments in education on reproductive preferences. Findings reveal the early development of gender and ethnic differences in reported reproductive preferences, as well as evidence for the differential impact of family background and personal aspirations on the timing of reproductive events and ideal family size.

Speaking through pictures: Canvassing adolescent risk behaviours in a semi-rural community in KwaZulu-Natal

Background. Adolescent risk behaviours, such as substance abuse and unprotected sex, are leading social and health challenges in South Africa (SA). Objective. To investigate adolescents’ perspectives on the prevalence of adolescent risk behaviours in rural settings in SA. Method. Using a qualitative photovoice methodology, the current study explored adolescents’ perspectives and experiences of living in a peri-urban community in KwaZulu-Natal Province. KwaZulu-Natal is the epicentre of the South African HIV epidemic, and adolescents – especially young girls – are at heightened risk for HIV infection. Male and female participants aged 15 - 18 years ( N =33) were asked to respond to a series of questions by taking photographs that best describe their perspectives or experiences. Results. The photovoice methodology allowed adolescents to represent their perspectives and experiences as experts on their lives and needs. The participants reported that adolescents in their community engage in various risky behaviours, of which risky sexual behaviours and hazardous substance use emerged as significantly problematic. Risky sexual behaviours entailed unprotected sex, having multiple sexual partners, cellphone sharing of pornography, and sex while intoxicated. Problematic substance use involved harmful drinking behaviours such as binge drinking and illicit drug use. Conclusion. Contextually relevant interventions aimed at reducing adolescent engagement in risky sexual behaviours and harmful substance use need to be prioritised. Additional recommendations are discussed.

Shisha waterpipe use and awareness of health risks among young adults in a semi-rural underprivileged community in North West England.

INTRODUCTIONWaterpipe smoking has become increasingly popular among young adults across the globe. Evidence suggests waterpipes have overtaken cigarettes in popularity among university students in the UK. This survey aimed to measure the prevalence of use, awareness of the tobacco content and associated health risks of waterpipes among young adults in a non-university semi-rural underprivileged community in England.METHODSA self-completed questionnaire was distributed by six schools and colleges to young adults aged 16–25 in Tameside, North West England.RESULTSA total of 210 young adults completed the survey, of these 12% smoked cigarettes and 16% smoked waterpipes. Of those that smoked waterpipes, 45% smoked at home and 88% smoked in shisha bars. Of the respondents, 62% did not know that shisha waterpipes contained tobacco and 18% believed that waterpipes were less harmful than smoking cigarettes. There was no difference in knowledge of tobacco content, or of the associated health risks, between those who smoked waterpipes and those that did not. The majority of respondents (81%) stated that if they wanted to know more about how shisha tobacco could affect their health they would access information via the internet. Social networking websites was by far the most popular route for communication for messages about the health risks associated with smoking shisha waterpipes.CONCLUSIONSThese results suggest that waterpipes may have overtaken cigarettes as the method of choice for smoking tobacco among the young adult population in the UK.

Sleepiness as a pathway linking race and socioeconomic status with academic and cognitive outcomes in middle childhood

ObjectivesThis study examined self-reported sleepiness as a pathway of effects underlying racial and socioeconomic disparities in children's academic and cognitive performance. DesignThe study design was longitudinal, and path modeling was used to test study hypotheses. SettingData were collected from participants residing in semirural communities and small towns surrounding Auburn, AL. ParticipantsChildren (N = 282; 52% boys) participated in the study when they were 9 (M = 9.44, SD = .71) and 11 (M = 11.33, SD = .69) years old. The sample was 65% White/European American and 35% Black/African American. The majority of the children (63%) were living at or below the poverty line. MeasurementsAt age 9, children reported on their daytime sleepiness over the prior 2 weeks. At ages 9 and 11, children completed cognitive assessments in the laboratory, teachers reported on children's academic functioning, and schools provided state (Alabama) standardized test scores. ResultsAfrican American children and children from lower socioeconomic status homes reported greater sleepiness. Greater sleepiness, in turn, predicted lower academic functioning, cognitive performance, and Alabama standardized test scores. Sleepiness was a significant intervening variable, but not a mediator, in these pathways. Race was a stronger predictor of sleepiness than socioeconomic status when both were entered in the same model. ConclusionsResults highlight sleepiness as a pathway of effects linking race and socioeconomic status to academic and cognitive outcomes. Psychoeducation targeting sleepiness for African American and lower–socioeconomic status children may be beneficial for boosting achievement.

Impoverishing effect of household healthcare expenditure in semi-rural communities in Yenagoa, Nigeria

Inequity in the payment mechanism for healthcare systematically affects poorer households more than the rich. This article examines the impoverishing effect of healthcare expenditure on households in Yenagoa. Data was obtained from a crosssectional survey of households in 2 communities in Yenagoa selected by simple random sampling. A pretested, structured, interviewer-administered questionnaire was used to obtain information on household (HH) income, general expenditures and financing for healthcare. Two international poverty lines designed by World Bank were employed to classify households as poor, extremely poor and to determine the impoverishing effects of households’ healthcare expenditures. Responses were received from 525 HHs with 9.2% of HHs falling below poverty line, another 9% pushed deeper into poverty after healthcare spending. A 12.3% and 16% increase in the poverty and extreme poverty gaps respectively were attributable to health payment. A significant percentage of households who were non-poor were pushed into poverty after healthcare spending. There is need for increased public spending and implementation of innovative pre-payment mechanisms and social insurance that assures financialrisk protection and equity in health financing in Yenagoa.

Sociodemographic Characteristics, Dietary Practices, and Nutritional Status of Adults with Hypertension in a Semi-Rural Community in the Eastern Region of Ghana.

Introduction Hypertension is a major contributor to the global disease burden and mortality. Evidence suggests increasing hypertension prevalence in Ghana but there is limited public awareness and information on the characteristics of those with the disease. Objective To describe the baseline characteristics of adults with hypertension who were randomized to receive either hypertension related nutrition education plus hospital-based standard of care or only the standard of care (control group) in Asesewa, a semi-rural community in the Eastern Region of Ghana. Only baseline data were used in the present analysis. Methods A cross-sectional baseline survey was completed for 63 adults with confirmed hypertension diagnosis. Data on sociodemographic characteristics and diet were obtained through interviews and participants' body mass index (BMI) was computed. Pearson chi-square statistic was used to assess differences between those with both elevated diastolic blood pressure (DBP) and systolic blood pressure (SBP) and those with only elevated SBP. Results Mean ± SD age of participants was 54.5±13.8 years. Approximately 71% of participants had both elevated SBP (>140 mmHg) and DBP (>90 mmHg) while the remaining 29% had only elevated SBP. The median number of times the food groups beneficial to hypertension management were consumed in the preceding week to the interview was 1 for green leafy vegetables, 1 for dairy products, 2 for fruits, and 4 for legumes. The median number of times for consuming harmful food groups was 3 for salted fish and 7 times for fats and oils. Signifcantly more participants in the age group above 50 than the younger participants had elevated SBP (83.3 vs. 16.7:P=0.027) and those with BMI equal to or greater than 25 were more likely to have both elevated SBP and DBP (P=0.047). Conclusions Findings from this study have implications for the prevention and management of hypertension in this semi-rural population.

Factor Structure of Parent- and Adolescent-Perceived Functional Impairment

Impairment of adaptive functioning is a critical criterion in the diagnostic process for mental disorders, as well as clinicians’ preferred target when treating clients. At the same time, clinical research with youth overemphasizes mental health symptoms and undervalues measures of adaptive functioning. Moreover, there is a dearth of comprehensive assessments of functioning that are practical and validated for use with both youth and parents in clinical outpatient settings. The current study addresses these issues by examining the factor structure of both youth and parent versions of a measure of functional impairment. This study used an archival dataset of adolescents aged 11–19 years (87% Caucasian, 50% female) receiving services at a semi-rural community mental health clinic in Northwest Ohio. To determine the factor structure of functional impairment, exploratory and confirmatory factor analyses were conducted separately on youth and parent versions of the Ohio Scales Functioning Scale. Prior to analyses, the final sample of 1080 adolescents was randomly split in half in order to perform principal axis factoring on one half and confirmatory factor analysis on the other half. Overall, youth and parent Functioning Scales tapped into five domains encompassing youths’ school, social-emotional, recreation, self-care, and responsible behavior. However, there were slight differences in the item compositions of some domains, suggesting that youth and parents view certain behaviors as indicators of different aspects of functioning. Results support that youth adaptive functioning is a multi-dimensional construct, and the Ohio Scales may offer a more comprehensive assessment of functional impairment than other measures.