Urban Provinces Research Articles

The importance of assessing out-of-pocket payments when the financing of antiretroviral therapy is transitioned to domestic funding: findings from Vietnam.

To assess out-of-pocket payments and catastrophic health expenditures among antiretroviral therapy (ART) patients in Vietnam, and to model catastrophic payments under different copayment scenarios when the primary financing of ART changes to social health insurance. Cross-sectional facility-based survey of 843 patients at 42 health facilities representative of 87% of ART patients in 2015. Because of donor and government funding, no payments were made for antiretroviral drugs. Other health expenditures were about $66 per person per year (95% CI: $30-$102), of which $15 ($7-$22) were directly for HIV-related health services, largely laboratory tests. These payments resulted in a 4.9% (95% CI: 3.1-6.8%) catastrophic payment rate and 2.5% (95% CI: 0.9-4.1%) catastrophic payment rate for HIV-related health services. About 32% of respondents reported, they were eligible for SHI without copayments. If patients had to pay 20% of costs of ART under social health insurance, the catastrophic payment rate would increase to 8% (95% CI: 5.5-10.0%), and if patients without health insurance had to pay the full costs of ART, the catastrophic payment rate among all patients would be 24% (95% CI: 21.1-27.4%). Health and catastrophic expenditures were substantially lower than in previous studies, although different methods may explain some of the discrepancy. The 20% copayments required by social health insurance would present a financial burden to an additional 0.6% to 5.1% of ART patients. Ensuring access to health insurance for all ART patients will prevent an even higher level of financial hardship.

Detection of Sinkhole Precursors Through SAR Interferometry: Radar and Geological Considerations

Sinkholes are an unpredictable geohazard that endanger life and property in dolomitic terrains. Sinkholes are a significant threat in Gauteng, South Africa’s most populated and urbanized province. Small-scale surface subsidence is frequently present prior to the collapse of a sinkhole. Therefore, the presence of precursory surface deformation can be exploited to develop early warning systems. Spaceborne synthetic aperture radar (SAR) differential interferometry (DInSAR) is able to monitor small-scale surface deformation over large areas and can be used to detect and measure precursors to sinkhole development. This letter investigates the use of repeat-pass DInSAR to detect sinkhole precursors in the Gauteng province. Twenty stripmap acquisitions from TerraSAR-X were acquired over a full year. DInSAR results revealed the presence of three previously unknown deformation features, one of which could be confirmed by subsequent field investigations. Furthermore, a water supply pipeline ruptured six months after the initial observation. The detection of the deformation, therefore, provided a viable early warning to landowners who were unaware of the subsidence. Detected deformation features were between 40 and 100 m in diameter. The maximum displacement measured was 50 mm over 55 days. Despite the successful detection, seven sinkhole events occurred in the observation period, for which no deformation could be detected. The results indicate that high-resolution X-band interferometry is able to monitor dolomite-induced instability in an urban environment. However, considerations related to SAR interferometry and physical sinkhole properties need to be addressed before DInSAR can be used in an operational early warning system.

Drug Misuse among High Schoolcandidates in Mutare Urban and Peri Manicaland Province, Zimbabwe

Drug Misuse among High Schoolcandidates in Mutare Urban and Peri Manicaland Province, Zimbabwe

Staying in the cities or returning home? An analysis of the rural-urban migration behavior in Vietnam

This paper investigates the migration behavior of rural-urban migrants within Vietnam. It focuses on the length and intensity of migration and its respective determinants. The analysis uses panel data of 2200 rural households and data from a migrant tracking survey of 299 migrants from Vietnam. The findings show that migrants coming from rural households that faced a higher number of idiosyncratic shocks increase their stays in the cities, while those from households that experienced covariate shocks such as floods, droughts, or economic shocks shorten the lengths of their stays in the cities. An increased length of migration is also observed among migrants and households with higher human capital. Furthermore, a decreased income gap between rural and urban provinces due to the higher economic growth in the cities increases the duration of migration. With respect to the migration intensity, migrants intend to return sooner when they face shocks in the cities and the living conditions at their original places improve.JEL Classification: D13, J28, J61, O15, O18, Z13

Clustering Alkire Foster-Oriented Quantification in Measuring Multidimensional Poverty Indicators by Using Intelligent Adaptive Neural Fuzzy Inference Systems

Malaysia is a developing country which relies on the monetary approach when it comes to poverty measurement. The current monetary approach is simpler to measure; however, it is insensitive towards changes of the poor in multiple dimensions especially in urban area. Based on household survey data on urban province in Malaysia, this study proposes on a multidimensional poverty measurement framework, which predicts on the prominent deprived indicators based on multidimensional urban poor measurement, replacing the conventional money-metric measure. This study highlights on integration between Alkire-Foster approaches in quantification of multidimensional urban poor with Adaptive Neural Fuzzy Inference Systems (ANFIS). By addressing the deprived indicator in urban area, the combination of Alkire Foster and ANFIS approach could efficiently resolve on the issue of misfit urban poor in the country. In this study, Alkire Foster approach is proven to have promising results in improving the determination of the urban poor in Malaysia. In future, this study aims in addressing the particular combination of indicator that causes the urban poverty in Malaysia.

Characteristics and origins of air pollutants and carbonaceous aerosols during wintertime haze episodes at a rural site in the Yangtze River Delta, China

China has frequently suffered regional-scale haze pollution in recent years. In this study, real-time observation data such as PM2.5, PM10, SO2, NO2, CO and O3 were used to analyze wintertime haze events at a rural site (Dongshan) in the Yangtze River Delta (YRD). 3-hour resolution organic carbon (OC) and elemental carbon (EC) were also measured to further investigate the sources of PM2.5. The hybrid receptor models were used to identify source regions of PM2.5. The results showed that both regional transport and local emissions significantly contribute to air pollution at Dongshan during haze periods. The source areas affecting high PM2.5 concentrations were mainly located in nearby urbanized provinces (i.e., Jiangsu, Anhui and Zhejiang) and industrial provinces (i.e., Shandong and Hebei) in eastern China. Furthermore, open biomass-burning emissions in south China (i.e., Jiangxi, Hunan, Guangdong and Fujian) decreased regional air quality, which was supported by MODIS fire spots and receptor models. During clean periods, air masses were originated from remote regions such as Mongolia and oceanic areas (i.e., the Yellow Sea and the East Sea). Enhanced secondary organic carbon (SOC) formation was found under long-range transport when OC aging was favorable. Contrarily, relatively low SOC formation was found when the site was dominated by local emissions. In addition to local emissions, high PM2.5 concentrations at Dongshan were apparently affected by either regional or long-range transport, which were characterized by relatively low and high wind speeds, respectively. It is necessary to implement the emission control strategies for the industrial and urbanized areas.

A rapid appraisal of the status of mental health support in post-rape care services in the Western Cape

<p><strong>Background:</strong> Despite the well-known impact of rape on mental health and the widespread problem of rape in South Africa, mental health services for rape victims are scant and not a priority for acute-phase services. Survivors encounter multiple mental health struggles in this period including adherence to the post-exposure prophylaxis drugs to prevent HIV and finding support from important others. We have little information on what mental health is provided, by whom and how it is integrated into the post-rape package of care.</p><p><strong>Aim:</strong> The aim of the study was to do a rapid appraisal of mental health services for rape survivors to gain a better understanding of the current acute and long-term (secondary) mental health services. Method: We conducted a qualitative study using a rapid assessment with a purposive sample of 14 rape survivors and 43 service providers recruited from post-rape sexual assault services in urban and rural Western Cape Province. Data were collected using semi-structured in-depth interviews and observations of survivor sessions with counsellors, nurses and doctors. The data were coded thematically for analysis.</p><p><strong>Results:</strong> Survivors of rape experienced a range of emotional difficulties and presented varying levels of distress and various levels of coping. Receiving support and care from others assisted them, but the poor integration of mental health within post-rape services meant few received formal mental health support or effective referrals. Multiple factors contributed to the poor integration: mental health was not given the same level of priority as other rape services (i.e. clinical care, including forensic management), the inadequate capacity of service providers to provide mental healthcare, including mental health illiteracy, the lack of continuity of care, the poor linkages to ongoing mental healthcare, and the mental health challenges caused by vicarious trauma and compassion fatigue.</p><p><strong>Conclusion:</strong> Providing effective, compassionate mental health services should be seen as essential components of post-rape care. The strengthening of support for providers and linkages to ongoing mental healthcare are essential to improve mental health services within acute post-rape services.</p>

A rapid appraisal of the status of mental health support in post-rape care services in the Western Cape

Background: Despite the well-known impact of rape on mental health and the widespread problem of rape in South Africa, mental health services for rape victims are scant and not a priority for acute-phase services. Survivors encounter multiple mental health struggles in this period including adherence to the post-exposure prophylaxis drugs to prevent HIV and finding support from important others. We have little information on what mental health is provided, by whom and how it is integrated into the post-rape package of care.Aim: The aim of the study was to do a rapid appraisal of mental health services for rape survivors to gain a better understanding of the current acute and long-term (secondary) mental health services. Method: We conducted a qualitative study using a rapid assessment with a purposive sample of 14 rape survivors and 43 service providers recruited from post-rape sexual assault services in urban and rural Western Cape Province. Data were collected using semi-structured in-depth interviews and observations of survivor sessions with counsellors, nurses and doctors. The data were coded thematically for analysis.Results: Survivors of rape experienced a range of emotional difficulties and presented varying levels of distress and various levels of coping. Receiving support and care from others assisted them, but the poor integration of mental health within post-rape services meant few received formal mental health support or effective referrals. Multiple factors contributed to the poor integration: mental health was not given the same level of priority as other rape services (i.e. clinical care, including forensic management), the inadequate capacity of service providers to provide mental healthcare, including mental health illiteracy, the lack of continuity of care, the poor linkages to ongoing mental healthcare, and the mental health challenges caused by vicarious trauma and compassion fatigue.Conclusion: Providing effective, compassionate mental health services should be seen as essential components of post-rape care. The strengthening of support for providers and linkages to ongoing mental healthcare are essential to improve mental health services within acute post-rape services.

A rapid appraisal of the status of mental health support in post-rape care services in the Western Cape.

BackgroundDespite the well-known impact of rape on mental health and the widespread problem of rape in South Africa, mental health services for rape victims are scant and not a priority for acute-phase services. Survivors encounter multiple mental health struggles in this period including adherence to the post-exposure prophylaxis drugs to prevent HIV and finding support from important others. We have little information on what mental health is provided, by whom and how it is integrated into the post-rape package of care.AimThe aim of the study was to do a rapid appraisal of mental health services for rape survivors to gain a better understanding of the current acute and long-term (secondary) mental health services.MethodWe conducted a qualitative study using a rapid assessment with a purposive sample of 14 rape survivors and 43 service providers recruited from post-rape sexual assault services in urban and rural Western Cape Province. Data were collected using semi-structured in-depth interviews and observations of survivor sessions with counsellors, nurses and doctors. The data were coded thematically for analysis.ResultsSurvivors of rape experienced a range of emotional difficulties and presented varying levels of distress and various levels of coping. Receiving support and care from others assisted them, but the poor integration of mental health within post-rape services meant few received formal mental health support or effective referrals. Multiple factors contributed to the poor integration: mental health was not given the same level of priority as other rape services (i.e. clinical care, including forensic management), the inadequate capacity of service providers to provide mental healthcare, including mental health illiteracy, the lack of continuity of care, the poor linkages to ongoing mental healthcare, and the mental health challenges caused by vicarious trauma and compassion fatigue.ConclusionProviding effective, compassionate mental health services should be seen as essential components of post-rape care. The strengthening of support for providers and linkages to ongoing mental healthcare are essential to improve mental health services within acute post-rape services.

Quantitative risk assessment of human salmonellosis in the smallholder pig value chains in urban of Vietnam.

To quantify salmonellosis risk in humans through consumption of boiled pork in urban Hung Yen Province, Vietnam, using a quantitative microbial risk assessment. We collected 302 samples along the pork value chain in Hung Yen between April 2014 and February 2015. We developed a model in @Risk, based on microbiological, market, and household surveys on cooking, cross-contamination and consumption, and conducted sensitivity analysis. Salmonella prevalence of pen floor swabs, slaughterhouse carcasses and cut pork were 33.3, 41.7 and 44.4%, respectively. The annual incidence rate of salmonellosis in humans was estimated to be 17.7% (90% CI 0.89-45.96). Parameters with the greatest influence risk were household pork handling practice followed by prevalence in pork sold in the central market. Wide confidence interval in the incidence estimate was mainly due to the variability in the degree of reduction in bacteria concentration by cooking, and pork consumption pattern. The risk of salmonellosis in humans due to boiled pork consumption appears to be high. Control measures may include improving the safety of retailed pork and improving household hygiene.

Cutaneous leishmaniasis in Iran: Results from an epidemiological study in urban and rural provinces

ObjectiveTo examine the prevalence and clinical manifestations of cutaneous leishmaniasis (CL) in Iran. MethodsThis study was conducted in Iran between 2011 and 2013. Sampling, preparing, developing, and fixing of suspicious skin lesions were completed in healthcare centers in 31 Iranian provinces as well as in the Academic Reference Laboratory and the National Reference Laboratory. The information was then analyzed at the Ministry of Health's Information Management Center of Contagious Diseases. ResultsOver a three-year period, the number of people identified with CL was 56546. The highest incidence was reported in 2011 (27.5 per 100000). Wet CL accounted for 43.7% of cases while 43.3% resulted from sporotrichoid leishmaniasis. The results showed that there was a higher incidence of CL due to Leishmania major (50.2%) than to Leishmania tropica. The results of this study found that the highest incidence of CL had happened respectively in Ilam, Fars and, Khorasan Razavi Provinces between 2011 and 2013. ConclusionsAlthough the incidence of the disease is declining, CL is still a public health concern and disease control protocols need to be established. Therefore, further studies are needed to identify the vectors, reservoirs, and disease species as well as to develop appropriate disease control strategies.

Customer loyalty guidelines for independent financial advisers in South Africa

Orientation: Independent financial advisers in South Africa can make a valuable contribution to the financial well-being of the country’s citizens and, through sound financial planning and education, assist them in becoming financially independent.Research purpose: The purpose of this study was to develop guidelines for creating customer loyalty towards independent financial advisers in South Africa.Motivation: To succeed, financial advisers need to build good relationships with clients and ensure they remain loyal to them in the long term.Research design, approach and method: A convenience non-probability sampling technique was applied, and altogether 262 self-administered questionnaires were completed and used in the analysis. Descriptive and standard multiple regression analysis and the one-way analysis of variance (ANOVA) technique were used to test four hypotheses formulated for the study.Main findings: Relationship commitment must be established in a trustworthy environment, regardless of the type of province where the business is operated.Practical/managerial implications: In urban provinces (such as Gauteng) both trusting relationships and commitment could lead to customer loyalty; in semi-urban provinces (such as North-West) only the commitment variable might do so. Independent financial advisers in both provinces should explore additional factors that could foster customer loyalty.Contributions: The research findings of this study challenge the seminal work of Morgan and Hunt (1994) by establishing that in South Africa, the extent to which trust and commitment predicts customer loyalty is specific to both industrial and geographical location. This study further provides customer loyalty guidelines for independent financial advisers in South Africa.

Psychosocial factors associated with early initiation and frequency of antenatal care (ANC) visits in a rural and urban setting in South Africa: a cross-sectional survey.

BackgroundLate booking and infrequent antenatal care (ANC) are common but avoidable patient-related risk factors for maternal deaths in South Africa. The aim of the study was to examine the association of psychosocial factors with early initiation of ANC and adequate frequency of attendance of ANC clinics among women in an urban and rural location in South Africa.MethodsData from a 2006 cross-sectional household survey of 363 women from the rural Western Cape and 466 women from urban Gauteng provinces of South Africa for risk of alcohol-exposed pregnancy were analysed. We examined associations between psychosocial variables (self-esteem, cultural influences, religiosity, social capital, social support, pregnancy desire (wanted versus unwanted pregnancy), partner characteristics and mental health) and both early ANC first visit (before 16 weeks) and adequate frequency of ANC visits (4 or more visits) for respondents’ last pregnancy.ResultsOverall prevalence among urban women of early ANC initiation was 46 % and 84 % for adequate ANC frequency. Overall prevalence among rural women of early ANC initiation was 45 % and 78 % for adequate ANC frequency. After adjusting for clustering, psychosocial factors associated with early ANC initiation in the urban site were being employed (OR 1.6; 95 % CI 1.0–2.5) and wanted pregnancy (OR 1.8; 95 % CI 1.1–3.0). For the rural site, early ANC initiation was significantly associated with being married (OR 1.93; 95 % CI 1.0–3.6) but inversely associated with high religiosity (OR 0.5; 95 % CI 0.3–0.8). Adequate frequency of ANC attendance in the rural site was associated with wanted pregnancy (OR 4.2; 95 % CI 1.9–9.3) and the father of the child being present in the respondent’s life (OR 3.0; 95 % CI 1.0–9.0) but inversely associated with having a previous miscarriage (OR 0.4; 95 % CI 0.2–0.8). There were no significant associations between adequate ANC attendance and the psychosocial factors in the urban site.ConclusionThe majority of women from both sites attended ANC frequently but less than 50 % initiated ANC before the recommended 16 weeks gestational age. Interventions to reduce prevalence of late ANC booking and inadequate ANC attendance should engage religious leaders, address unintended pregnancy through family planning education and involve male partners in women’s reproductive health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0807-1) contains supplementary material, which is available to authorized users.

ANALISIS PENGARUH PENDAPATAN ASLI DAERAH (PAD), DANA ALOKASI UMUM (DAU) DAN INFLASI TERHADAP PERTUMBUHAN EKONOMI DI KABUPATEN/KOTA PROVINSI JAWA TENGAH

This research was aimed to analyze the effect of own-source revenue, general allocation grant, and inflation to economic growth in distric or urban Province of Central Java from 2011 to 2014. This research used secondary data which collected from Statistic Indonesia (BPS) of Central Java. The research uses multiple regression analysis method The result of this research show that: (1) own-source revenue has significant influence on economic growth in distric or urban Province of Central Java. (2) general allocation grant has no significant effect on economic growth distric or urban Province of Central Java. (3) Inflation has no significant effect on economic growth distric or urban Province of Central Java distric or urban Province of Central Java. (4) own-source revenue, general allocation grant, and inflation together (simultaneously) has significant influence on the economic growth in the district or urban of Central Java. DOI: 10.15408/ess.v5i2.2340

Stroke management and functional outcomes of stroke survivors in an urban Western Cape Province setting

INTRODUCTION: Long-term disability caused by stroke can be decreased through comprehensive rehabilitation. AIM: This article aims to describe the functional outcomes achieved by stroke survivors in an urban Western Cape Province setting to add to the information on stroke management. METHODS: A descriptive mixed methods study was done. Proportional, stratified random sampling was used to select 53 participants from a population of 267. Quantitative data were collected with the Stroke Impact Scale Version 3.0 and the Modified Barthel Index, and analysed with the Mann-Whitney test. A p value of < 0.05 was deemed statistically significant. Five of the 53 participants were purposively sampled for the qualitative phase of the study. Qualitative data were analysed according to predetermined themes. RESULTS: Seventy-five per cent of participants were managed in a general medical ward. Four were admitted to a specialised inpatient rehabilitation centre. Eighty-three per cent received physiotherapy, 62% received occupational therapy and 57% received both physio-and occupational therapy. Fifty-one per cent experienced communication difficulties, but only 18% received speech therapy. CONCLUSION AND RECOMMENDATIONS: Sufficient inpatient therapy (preferably in a stroke unit /ward) and family education /training should be received before discharge. Occupational therapy, speech therapy, physiotherapy as well as psychological, social work, vision screening and dietetic services should be expanded at both hospital and community level. Key words: Stroke, rehabilitation, occupational therapy

Comparison of dietary behavior, changes of diet, and food intake between 40~59 years old subjects living in urban and rural areas in Lao PDR

Purpose: The current study was conducted for evaluation and comparison of dietary behavior and food intake in different regions of Lao PDR. Methods: The survey was conducted on 979 people aged 40~59 years old living in 25 urban provinces and 25 rural provinces in four districts (VTE Capital-Chanthabuly, Xaysetha, VTE Province-Phonhong, and Thoulakhom) of Laos. General demographic information, health status, and dietary behavior were surveyed using a questionnaire. Results: The literacy ratio (p = 0.000), education level (p = 0.000), asset ownership level (p = 0.000), and government and private employee ratio (p = 0.000) were higher in urban subjects compared with rural subjects. The mean value of weight (p = 0.000), waist circumference (p = 0.000), and diastolic blood pressure (p = 0.009) and alcohol consumption (p = 0.000), self-rated health status (p = 0.001), and the rate of obesity (p = 0.000) were significantly higher in urban subjects compared with rural subjects. However, the rate of current smoker was significantly higher in the rural group (p = 0.023). Meals are becoming more westernized by higher frequency of eating out, consumption of fatty meat and fried or stir-fried food in urban areas compared to rural areas. Urban subjects had relatively better balanced meals compared to rural subjects whereas they consumed insufficient meals per day and consumed meals irregularly compared to rural subjects. Intake of fruit and milk was significantly higher in urban subjects compared with rural subjects. However, the intake of vegetables was significantly higher in rural areas than urban areas. Conclusion: The result of this study showed that the traditional Lao diet is being replaced by an unhealthy western dietary pattern, which may be a risk factor for increasing development of non-communicable disease (NCD) in Lao PDR. Planning of proper personalized nutritional intervention and education in each area is needed to decrease the health risks of NCD.

Community health centers and primary care access and quality for chronically-ill patients - a case-comparison study of urban Guangdong Province, China.

ObjectiveReform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the ‘gate-keeper’ CHC model, or the hospital-owned CHC models, was most effective in enhancing access to and quality of care for patients with chronic illness.MethodsThe case-comparison design was used to study nine health care organizations in Guangzhou, Dongguan, and Shenzhen cities within Guangdong province, China. 560 patients aged 50 or over with hypertension or diabetes who visited either CHCs or hospitals in these three cities were surveyed by using face-to-face interviews. Bivariate analyses were performed to compare quality and value of care indicators among subjects from the three cities. Multivariate analyses were used to assess the association between type of primary care delivery and quality as well as value of chronic care after controlling for patients’ demographic and health status characteristics.ResultsPatients from all three cities chose their current health care providers primarily out of concern for quality of care (both provider expertise and adequate medical equipment), patient-centered care, and insurance plan requirement. Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators. Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics. The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity. However, coordination suffered due to seemingly duplicating primary care outpatients at the hospital setting. Significant associations between types of health care facilities and quality of care were also observed such that patients from CHCs were more likely to be satisfied with traveling time and follow-up care by their providers.ConclusionThe study suggested that the Dongguan model (based on insurance mandate and using family practice physicians as ‘gate-keepers’) seemed to work best in terms of improving access and quality for patients with chronic conditions. The study suggested adequately funded and well-organized primary care system can play a gatekeeping role and has the potential to provide a reasonable level of care to patients.

Trends of sputum-smear positive tuberculosis in Zimbabwe: 2008–2011

BackgroundTuberculosis (TB) has remained one of the major public health problems in Zimbabwe with an estimated incidence rate of 552 per 100,000 persons in 2013. The aim of this study was to describe the trends in acid-fast bacilli (AFB) sputum-smear positive (SSP) TB overall and within subpopulations for the period during 2008–2011 in Zimbabwe. Results of this study will contribute towards the evaluation and implementation of targeted TB control interventions.MethodsA cross-sectional study design was used to analyze 40, 110 SSP TB patient records routinely collected during 2008–2011. Incidence trends of SSP TB were described by province, sex, and age group. A Mantel–Haenszel Chi Statistic was calculated to compare each provincial SSP TB notification rate to the national SSP TB notification rate.ResultsSSP TB notification rates were higher in the two main urban provinces, the western provinces and Manicaland. The 25–44 year age group accounted for the largest proportion of notified SSP TB. However, the 55–64 year and 65+ age groups had SSP TB notification rates in 2011 higher than the 2008 value. Finally, the average SSP TB notification rate in males was 23 % higher than in females.ConclusionThe findings of this study suggest that TB control has successfully decreased the notification rate of SSP TB in Zimbabwe during 2008–2011. However, the disproportionate distribution of SSP TB among different regions and subpopulations of the country highlights the need for more targeted interventions to accelerate the decline of TB in Zimbabwe.

Genito-anal injury patterns and associated factors in rape survivors in an urban province of South Africa: a cross-sectional study.

BackgroundThe prevalence of genito-anal injuries in rape survivors varies significantly and the factors associated with the absence of injuries are not well understood. This plays a major role in the conviction of cases as the absence of injury is equated with a lack of assault. In such cases, health care providers face major challenges in presenting and defending their findings. The aim of this paper is to describe the absence of genito-anal injuries by site in a group of rape survivors and to identify factors associated with the absence of these injuries.MethodsIn a cross-sectional study rape cases reported to the police in one province in South Africa were randomly sampled using a two stage sampling procedure. Data were obtained on the survivor, the circumstances of the rape and the findings of the medicolegal examination. Descriptive statistics were conducted for the prevalence of genito-anal injuries by site and logistic regression models were built to identify factors associated with the absence of genito-anal injuries for all survivors and those reported to be virgins.ResultsIn the sample of 1472 women injuries ranged from 1% to 36%. No significant injuries were reported for 749 (51%) survivors. In the multivariable model there was a significantly lower odds of having no injuries in survivors who were virgins, those raped by multiple perpetrators and those examined by a doctor with additional qualifications. In the model for survivors who were virgins, those with disabilities had a greater odds of having no injuries while those between the ages of 8 and 17 years had a lower odds of having no injuries compared to survivors below four years of age.ConclusionsThis study found that being a virgin, multiple perpetration rape and the examiner’s qualifications were significantly associated with the absence of genito-anal injuries. Health providers should thus be aware that in all other respects there was no difference in survivors who had injuries and those who did not. It is important to reiterate the message that the presence of injuries does not necessarily prove that rape occurred nor does the absence disprove the fact.

Incidence of cutaneous malignant melanoma by socioeconomic status in Canada: 1992-2006.

BackgroundThere are no nationwide studies documenting changes in cutaneous malignant melanoma incidence or association of incidence with socioeconomic status (SES) in Canada. We sought to determine whether melanoma incidence increased from 1992 to 2006 and if there was an association between SES and melanoma incidence. Additionally, we studied whether there was a correlation between province of residence and melanoma incidence.MethodsCases from the Canadian Cancer Registry were reviewed. Demographic and socioeconomic information were extracted from the Canadian Census of Population data. Cases were linked to income quintiles by postal code. A negative binomial regression was performed to identify relationships among these variables.ResultsOverall incidence of melanoma in Canada increased by 67 % from 1992 to 2006 (p < 0.0001). The increase in incidence was greater for melanoma in situ compared with invasive melanoma (136 % versus 52 % [p < 0.0001]). Incidence was positively correlated with higher income quintiles; the incidence rates among patients in the lowest income quintiles were 67 % of that for the highest income quintiles (p < 0.0001).DiscussionA wide variety of explanations have been postulated for an increased incidence in melanoma among persons of higher SES, including access to and awareness of screening, more access to vacations in sunny climates, and increased leisure time. Variations in incidence of melanoma by urban vs. rural location and province may indicate differences in access to dermatologists across Canada.ConclusionsMelanoma incidence is increasing in Canada and is higher among people in high SES groups. This rise is likely due to a combination of factors including a true rise in incidence due to increases in sun exposure, and also an increased detection rate, particularly in those who are more aware of the disease and have access to resources for detection.