Ward Of Residence Research Articles

Maternal perception on use of edible insects for complementary feeding and nutritional status of children in Kakamega and Siaya Counties, Kenya

Despite the high protein levels, essential fatty acids and minerals that are found in edible insects, they are still not being used in complementary feeding. The aim of this study was to investigate maternal perception on use of edible insects for complementary feeding and nutrition status of children in Kakamega and Siaya Counties, Kenya. The study adopted a cross-sectional analytical design which was used on a sample of 592 mother-child pairs (aged 6-23 months) in Kisa North, West Yimbo and West Ugenya wards. Majority of the mothers were in the childbearing age group of 15-49 years, were married and 57.9% in Kisa North, 65.7% in West Ugenya and 64.6% in West Yimbo had attained primary education. Generally, 50.9%, 54.2% and 48.8% of the household heads in Kisa North, West Ugenya and West Yimbo, respectively had attained primary education. About 49.5% and 38.9% of the mothers in Kisa North and West Ugenya practiced farming while 35.3% of those in West Yimbo engaged in business. About 40.3% of the household heads in West Ugenya were farmers, 48.7% in Kisa North were casual labourers while 66.3% in West Yimbo engaged in fishing. Approximately 42.1%, 33.7% and 39.3% of the mothers in Kisa North, West Ugenya and West Yimbo respectively disagreed about the use of edible insects for complementary feeding. More than half (65.3%, 56.6% and 61.7%) of the children in Kisa North, West Ugenya and West Yimbo respectively attained the Minimum Dietary Diversity. More than half (58.9% and 55.8%) of the children in West Yimbo and West Ugenya respectively and 29.7% in Kisa North attained the Minimum Acceptable Diet. In terms of nutrition status, the prevalence rates of wasting were (6.3% in West Ugenya, 7.0% in West Yimbo and 6.0% in Kisa North), stunting rates (19.5% in West Ugenya and an equal proportion of 19.9% in West Yimbo and Kisa North) and underweight rates (9.2% in West Ugenya, 9.0% in West Yimbo and 8.8% in Kisa North). There were significant relationships between the maternal perceptions of the appropriateness of insects in complementary food and the ward of residence (ꭓ²=16.86, p value=0.030), marital status of the mother (ꭓ²=11.14, p value=0.025), main source of income for the household head (ꭓ²=33.35, p value=0.007) and the education level of the household head (ꭓ²=48.67, p value=0.009). This information will be useful to the Ministry of Health through the division of nutrition for inclusion in the MIYCN policy the use of edible insects as a complementary food. Key words: Children, Complementary feeding, Edible Insects, Nutritional Status, Maternal Perception

Factors influencing intermittent preventive treatment for malaria prevention among pregnant women accessing antenatal care in selected primary health care facilities of Bwari Area Council, Abuja Nigeria.

Although studies in Nigeria showed the efficacy of intermittent preventive treatment using sulfadoxine-pyrimethamine (IPT-SP) in preventing malaria in pregnancy among Nigerian women there is still poor implementation of the intervention in Nigeria. A mixed method study was conducted in Bwari Area Council, Nigeria in 2018. The quantitative part of the study is presented and discussed in this paper. Pregnant women were interviewed using a validated interviewer-administered questionnaire and observations of current practice were performed. A total of 422 pregnant women were recruited into the study (mean age, 26 years) with the majority being married women (90.3%). Most respondents (68.5%) did not know who could take IPT-SP and 58.5% of respondents did not know when and how many times IPT-SP should be taken during pregnancy. Nearly all participants (99.5%) did not take SP at the facility under direct observation of the health worker. None of the facilities had free SP and all respondents paid for SP through the Drug Revolving Fund. The knowledge of the use of SP was significantly influenced by respondents' parity, ward of residence, antenatal clinic (ANC) attendance history and education. Respondents who had tertiary and secondary education were 8.3 (95% CI: 1.01-68.27) times more likely to use IPT-SP than those without formal education. Most women who attend ANC in Bwari Area council did not receive IPT-SP as per the national guidelines. The unavailability of logistics (SP, Water and Cup) on a regular basis, the cost of the SP, poor knowledge of the importance of IPT in malaria prevention, and the non-implementation of the administration of SP under direct observation were factors influencing the use of IPT-SP. Outcomes could be enhanced through the provision of measures to address identified gaps by this study.

Individual and Contextual Determinants of Ethnic Exclusionism Attitudes toward Immigrants in South Korea

The rapid increase of immigration in South Korea and divided public opinions towards immigration among Korean natives make it imperative to investigate the sources of natives’ ethnic exclusionism attitudes toward immigrants. Using data from the 2010 Korean General Social Survey (KGSS) and the 2010 Population and Housing Census in a multilevel modeling framework, we investigate the individual and contextual factors associated with ethnic exclusionism attitudes among Korean natives. Consistent with previous studies, we find that a number of individual factors, including education level and political ideology, are associated with ethnic exclusionism attitudes. Supporting the contact theory of racial and ethnic relations, we find that the percentage of multicultural households in respondents’ neighborhood—measured as the ward of residence—is positively associated with more favorable attitudes toward multicultural society. These findings suggest that researchers should consider both individual and contextual factors to gain a comprehensive understanding of ethnic exclusionism attitudes in Korea.

Mapping area variability in social and behavioural difficulties among Glasgow pre-schoolers: linkage of a survey of pre-school staff with routine monitoring data.

Social, emotional and behavioural development in early to middle childhood impact upon many outcomes in future life and are influenced by home, neighbourhood and school environments. We used linked data to investigate differences between areas in Glasgow City in level of difficulties in pre-school age children, after consideration of demographics, including area-level deprivation. Pre-school education staff completed Strengths and Difficulties Questionnaires (SDQ) on all children progressing to school from a local authority or partnership (local authority-funded private) pre-school in Glasgow City between 2010 and 2012. These data were linked to individual (age, gender) and area-level (deprivation) demographics from the City Council Education Services Department. Statistical models were fitted to the SDQ scores, adjusting for age, gender, area deprivation, year of school entry, pre-school establishment attended and electoral ward of residence. Correlation between neighbouring wards was incorporated to allow for clustering of scores. Boys and those living in more deprived areas had higher levels of difficulties. Children aged 5.0-5.5 years had fewest difficulties, while the oldest and youngest children had similar levels of difficulties. There were no significant secular trends by year of school entry. There remained differences among areas after adjusting for these variables, with children living in some areas having fewer difficulties than would be expected based on their socio-demographic characteristics. There remained differences in children's levels of difficulties between areas after adjusting for age, gender, area deprivation and year of school entry. Children in some very deprived areas had fewer difficulties than might be expected, while those in relatively affluent areas had more difficulties than expected based on their deprivation level. There may be other, unmeasured, individual- and area-level reasons for children's level of difficulties, and these require further exploration.

The association between green space and mental health varies across the lifecourse. A longitudinal study

BackgroundEpidemiological studies on green space and health have relied almost exclusively on cross-sectional designs, restricting understanding on how this relationship could vary across the lifecourse.MethodsWe used multilevel linear regression to...

Mapping the Boston Poor: Inmates of the Boston Almshouse, 1795–1801

Documentary and geographical evidence about Boston from 1795 to 1801 reveals distinct patterns in poor people's use of the Boston Almshouse and in their areas of residence within the city. A much higher percentage of Almshouse inmates came from Boston's densely populated North End than from less urban areas with lower population densities. They clustered in distinctive ways—immigrants tending to come from districts close to commercial and shipping areas, and women and families from the outskirts of town. Recurrent users of the almshouse were highly mobile, likely to have changed their ward of residence at least once from 1795 to 1801. This geographical mobility on the part of the poor continuously recreated the city and challenged the contours of class and tradition.

Mapping community viral load and social boundaries

Recently, Castel et al.[1] sought to measure and map community viral load (CVL) in Washington, DC. The authors included the most recent viral load data in the city and two indicators of socioeconomic status, namely poverty rates and the percentage of high school diplomas, as part of their analysis [1]. Findings were distributed by geopolitical regions and were presented on various maps of the city. They show an overrepresentation of racialized and poor neighbourhoods as where individuals are most likely to have a detectable viral load and suffer from HIV-related disparities. In many ways, the findings presented by Castel et al.[1] are not new or surprising. We have known for decades that the HIV epidemic concentrates in geographical areas where individuals are most vulnerable to HIV infection, areas marked by high levels of marginalization, poverty, oppression, and social exclusion. This is clearly evident in the District of Columbia where the HIV epidemic is generalized in geographical areas where target populations are most likely to present with high viral loads and live in socioeconomic conditions that make them disproportionally affected by HIV. What is innovative is the ways that CVL allows for a new form of surveillance that can then be used to draw boundaries geographically and identify specific areas for the deployment of high impact interventions, areas that are then identified as ‘risky’ and in need of attention. Despite its sophistication, CVL draws a rather partial and incomplete portrait of the HIV epidemic. We would go as far as to say that it decontextualizes HIV transmission [2]. CVL fails to consider the personal circumstances of people who are rendered visible by mapping exercises and the implications for people living with HIV who reside in areas that are being targeted by public health authorities. Not surprisingly, CVL has led to the intensification of prevention efforts and the deployment of more aggressive interventions to drive down CVL, with little further consideration of the realities of people living with HIV on the ground. The techniques of CVL allow us to measure and map concentrations of the virus, as if they might occur at random. This belies the reality that target populations we are most interested in are often forced into particular geographic areas, economic and ethnic ‘ghettos’. We are concerned that CVL and its ‘geographic’ distribution have become a proxy for naming target populations, but with new levels of sophistication. In particular, we are concerned with the potential to increase stigma directed at populations who occupy what we term ‘viral spaces’. This phenomenon has important implications for the health and safety of people living with HIV [3], and may have broader implications for everyone living in these spaces. This is especially true of geographical areas where higher CVL overlap with concentrations of racialized people as reported by Castel et al.[1]. This could result in the combining of HIV-related stigma with racism, classism and other discriminatory practices. What will it mean to know that a particular neighbourhood is where people have HIV and where people get HIV? What are the implications for those living there and for those living outside the well defined boundaries of this particular neighbourhood? We noticed Castel et al.[1] reporting measurements of CVL alongside ‘ward of residence’ and insurance status. The study is able to represent pockets of higher CVL in neighbourhoods that we imagine might be recognizable to those living in the District of Columbia, and surely recognizable to those for whom mapping risk is their trade. We appreciate the ways CVL is useful for epidemiological surveillance, but are concerned over the implications for actuarial surveillance and the possibility of decreased insurance options for individuals because of where they live. Additionally, we call for more discussions on the use of surveillance data and the ethics of CVL as a mapping exercise. Do the individuals whose viral load is calculated know that these data will be used to draw boundaries between ‘sick’ and ‘healthy’? Are they given an option over how their medical data will be used, including when used in aggregate, for such purposes? These issues have yet to be addressed in the literature on CVL. In our view, it is imperative that researchers engage in discussions and debates around the use of this new biomarker because it may very well contribute to the production of new spaces of exclusion for people living with HIV and others living in areas where the highest viral loads are found. For this reason, we argue that CVL merit closer examination. Acknowledgements Conflicts of interest There are no conflicts of interest.

Are health inequalities evident at all ages? An ecological study of English mortality records

Inequalities in mortality are often presumed to exist at all ages. Here we examine whether this is true. We conducted an ecological study of mortality in England for 1997-99 using routinely collected public records. We used a (smoothed) single year of age rate of mortality for males and females by the multiple deprivation quintile of their ward of residence, for all and specific causes to assess if inequalities varied by age. For most ages, a greater mortality risk exists for those living in the most deprived compared with the least deprived quintile of wards. However, during late adolescence there is equality. The equalization occurs at the age of 17-19 years. There is a longer period of 10 years for females and 20 years for males of convergence and then divergence centred on late adolescence and young adulthood. The equalization is driven principally through a heightened exposure to the risk of land transport accidents and a resulting higher than expected rate of mortality for the least deprived rather than a decrease in risk for the most deprived. It seems likely that an increase in risk taking associated with late adolescence combined with exposure to a relatively dangerous transport environment leads to large increases in risk for young people in the least deprived parts of England. As a result mortality inequality disappears at this age.

A Retrospective Survey of Human Hydatidosis Based on Hospital Records During The Period 1990–2003 in Ngorongoro, Tanzania

A 13-year (1990-2003) retrospective study was carried out to investigate the occurrence of cystic echinococcosis (CE) in patients at Wasso hospital in Ngorongoro district, Tanzania. Hospitalization records were reviewed and confirmed cases of CE were classified according to ward of residence, age, sex, cyst location and type. A total of 171 hydatidosis patients were diagnosed and operated giving an average of 13 cases per year, equivalent to approximately 10 cases per 100,000 people per year. Cystic echinococcosis affected more females (59.1%) than males (40.9%). A significantly higher number of CE cases were recorded in individuals <30 years of age (22.8-30.4%) than in those >30 years of age (2.3-9.4%) (P < 0.05). High proportion of CE (81.5%) occurred in the liver than in other sites, and more females had higher hepatic cysts (47.4%) than males (31.0%). Solitary cysts and single organ involvement were noted in 81.5% cases and multiple cysts in 18.5% cases. Higher multiple organ infections (14.1%) and cyst recurrences (5.3%) were also recorded in females. Orgosorok ward had the highest number (18.7%) of CE cases, while Nainokanoka had the lowest (1.2%). It was concluded that CE infection occurs frequently in humans in Ngorongoro district and female and youths are those most affected. These findings merit for more extensive epidemiological investigations of CE in human to better determine the prevalence, economic impact and risk factors for the disease in this district and other areas of Tanzania.

Socioeconomic Status and Chronic Kidney Disease at Presentation to a Renal Service in the United Kingdom

Low socioeconomic status (SES) is associated with both development and progression of chronic kidney disease (CKD). The impact of SES on severity of CKD at presentation to a renal service is less well known. This study investigated the relationship between SES and severity of CKD in a retrospective, cross-sectional analysis involving 1657 patients at the Sheffield Kidney Institute (Sheffield, UK). SES was assigned to each patient according to electoral ward of residence by postcode and ranked according to the corresponding British Index of Multiple Deprivation score, which comprises five deprivation quintiles (Q1, least deprived; Q5, most deprived). National Kidney Foundation Kidney Disease Outcomes Quality Initiative classification of CKD was used for stratification and analysis. Binary logistic regression analysis was applied for the association of variables/risk factors with CKD (lower GFR) at presentation. The age-adjusted prevalence of diagnosed CKD at presentation by area of residence, across the five deprivation quintiles, per million population was Q1 = 1495, Q2 = 3530, Q3 = 3398, Q4 = 3989, and Q5 = 19,599. Logistic regression models showed that living in the lowest SES quintile area (Q5) as compared with the highest SES (Q1) was associated with a greater risk for presenting with a lower estimated GFR, after adjustment for sociodemographic, lifestyle, and clinical variables. Low SES is related to severity of CKD at presentation. Further studies are needed to examine this issue across the various SES categories in the United Kingdom.

Cancer incidence patterns by region and socioeconomic deprivation in teenagers and young adults in England

Data on 35 291 individuals with cancer, aged 13–24 years, in England from 1979 to 2001 were analysed by region and socio-economic deprivation of census ward of residence, as measured by the Townsend deprivation index. The incidence of leukaemia, lymphoma, central nervous system tumours, soft tissue sarcomas, gonadal germ cell tumours, melanoma and carcinomas varied by region (P<0.01, all groups) but bone tumour incidence did not. Lymphomas, central nervous system tumours and gonadal germ cell tumours all had higher incidence in less deprived census wards (P<0.01), while chronic myeloid leukaemia and carcinoma of the cervix had higher incidence in more deprived wards (P<0.01). In the least deprived wards, melanoma incidence was nearly twice that in the most deprived, but this trend varied between regions (P<0.001). These cancer incidence patterns differ from those seen in both children and older adults and have implications for aetiology and prevention.

Factors affecting the uptake of cardiac rehabilitation services in a rural locality

A number of studies have investigated factors affecting uptake of cardiac rehabilitation services. However, little information on factors affecting uptake of services in rural localities is available. A cross-sectional survey. A survey of patients eligible for cardiac rehabilitation was undertaken to investigate uptake of services. The effects of individual and geographic factors on service utilization were explored. Utilization rates for cardiac rehabilitation services within the South Staffordshire locality are low, with 59.3% of eligible patients invited to attend cardiac rehabilitation services following discharge from hospital, 38.6% attending and 22.5% completing the programme. Two factors were independently associated with low service utilization. Patients under the age of 65 years are 1.90 [95% confidence intervals (CI) 1.01-3.65] times more likely to complete rehabilitation than patients aged over 65 years, and women are only 0.48 (95% CI 0.22-1.03) times as likely as men to complete rehabilitation. The major reported barrier to utilization of services was access. This included problems with public transport, parking and the time and location of classes. Access and medical problems were significantly higher in older people and may have contributed to their low overall completion rate. Electoral ward deprivation, geographical access score, living in an urban or rural electoral ward, electoral ward of residence and provider were not significantly associated with service utilization. Overall, utilization rates were low. No geographical factors were associated with uptake of services, although the possible effect may have been mediated by the relative affluence of the locality. Two individual factors, age and sex, were most likely to influence uptake.

Trends and socioeconomic inequalities in cancer survival in England and Wales up to 2001.

We examined national trends and socioeconomic inequalities in cancer survival in England and Wales during the 1990s, using population-based data on 2.2 million patients who were diagnosed with one of the 20 most common cancers between 1986 and 1999 and followed up to 2001. Patients were assigned to one of five deprivation categories (from ‘affluent’ to ‘deprived’) using characteristics of their electoral ward of residence at diagnosis. We estimated relative survival up to 5 years after diagnosis, adjusting separately in each deprivation category for background mortality by age, sex and calendar period. We estimated trends in survival and in the difference in survival between deprivation categories (‘deprivation gap’) over the periods 1986–90, 1991–95 and 1996–99. We used period analysis to examine likely survival rates in the near future. Survival improved for most cancers in both sexes during the 1990s, and appears likely to continue improving for most cancers in the near future. The deprivation gap in survival between rich and poor was wider for patients diagnosed in the late 1990s than in the late 1980s. Increases in cancer survival in England and Wales during the 1990s are shown to be significantly associated with a widening deprivation gap in survival.

The influences on preventive care provided to children who frequently attend the UK General Dental Service.

To identify the relationship between the preventive and restorative care provided to children who frequently attend the General Dental Service in the UK after taking into account socio-economic status, gender and dental caries experience. General dental practices in the North West of England. The study design involved a retrospective investigation of case notes of 677 children who regularly attended 50 general dental practitioners. The complete history of the dental care received by each child during the primary dentition period was recorded. Analyses took place at the patient level. Information was recorded on the total number of carious teeth and restorative and preventive care provided to the children. Preventive care was categorised as dietary advice, oral hygiene instruction, prescription of fluoride tablets and application of fluoride varnish. Socio-economic status was measured using the Townsend score of the electoral ward of residence of each subject. Logistic regression models, taking into account the clustering of the subjects within dental practices were fitted to identify whether or not socio-economic status was significantly associated with provision of each category of preventive care, after controlling for gender, the total number of teeth affected by caries and the proportion of carious teeth which were restored. Children from poorer backgrounds were significantly more likely to receive oral hygiene instruction than their more affluent peers. Socio-economic status did not influence dentists' decisions to prescribe fluoride tablets, but children from affluent backgrounds were significantly more likely to have fluoride varnish applied to their teeth than children from deprived backgrounds after controlling for other factors. The more teeth affected by decay significantly increased the odds of giving dietary advice, prescription of fluoride tablets and application of fluoride varnish, but had no effect on whether or not oral hygiene instruction was given. As the percentage of decayed but filled teeth decreased the odds of giving dietary advice or applying fluoride varnish increased significantly. Conclusion It would appear that dentists are providing appropriate preventive care according to the aetiological causes of dental disease. They also look to be providing preventive care in compensation for decisions not to restore carious primary teeth. However the preventive care provided seems to be reactive to disease patterns, and in this high risk group of patients does not seem to be particularly effective.

Preventive or restorative care for children?

Objectives To identify the relationship between the preventive and restorative care provided to children who frequently attend the General Dental Service in the UK after taking into account socio-economic status, gender and dental caries experience. Setting General dental practices in the North West of England. Subjects and materials The study design involved a retrospective investigation of case notes of 677 children who regularly attended 50 general dental practitioners. The complete history of the dental care received by each child during the primary dentition period was recorded. Analyses took place at the patient level. Information was recorded on the total number of carious teeth and restorative and preventive care provided to the children. Preventive care was categorised as dietary advice, oral hygiene instruction, prescription of fluoride tablets and application of fluoride varnish. Socio-economic status was measured using the Townsend score of the electoral ward of residence of each subject. Logistic regression models, taking into account the clustering of the subjects within dental practices were fitted to identify whether or not socio-economic status was significantly associated with provision of each category of preventive care, after controlling for gender, the total number of teeth affected by caries and the proportion of carious teeth which were restored. Results Children from poorer backgrounds were significantly more likely to receive oral hygiene instruction than their more affluent peers. Socio-economic status did not influence dentists' decisions to prescribe fluoride tablets, but children from affluent backgrounds were significantly more likely to have fluoride varnish applied to their teeth than children from deprived backgrounds after controlling for other factors. The more teeth affected by decay significantly increased the odds of giving dietary advice, prescription of fluoride tablets and application of fluoride varnish, but had no effect on whether or not oral hygiene instruction was given. As the percentage of decayed but filled teeth decreased the odds of giving dietary advice or applying fluoride varnish increased significantly. Conclusion It would appear that dentists are providing appropriate preventive care according to the aetiological causes of dental disease. They also look to be providing preventive care in compensation for decisions not to restore carious primary teeth. However the preventive care provided seems to be reactive to disease patterns, and in this high risk group of patients does not seem to be particularly effective.

Inequalities in the dental treatment provided to children: an example from the UK.

To identify the relationship between the socioeconomic status of frequently attending children and the dental care of their primary dentition provided by dentists working in the General Dental Service (GDS) of the UK National Health Service (NHS). The study design involved a retrospective investigation of the case notes of 658 children who were regularly attending patients of 50 General Dental Practitioners (GDPs) working in the North West of England. The socioeconomic status of each subject was measured using the Townsend score of their electoral ward of residence. Logistic regression models, taking into account the clustering of the subjects within dental practices, were fitted to identify whether or not socioeconomic status was significantly associated with the proportion of carious teeth that were restored, all dental extractions, dental extractions for pain or sepsis alone and courses of antibiotics prescribed after controlling other variables. A significant association between socioeconomic status and caries experience could not be found. There was also no association between socioeconomic status and the proportion of carious teeth filled or courses of antibiotics prescribed. Disadvantaged children were significantly more likely to have teeth extracted than their more affluent peers, but there was no association between deprivation and extractions for pain or sepsis alone. Children from deprived backgrounds who regularly attended this group of UK dentists were more likely to have extractions than their more affluent peers, irrespective of their caries experience.

Cerebral palsy, low birthweight and socio-economic deprivation: inequalities in a major cause of childhood disability.

There is currently little and conflicting evidence concerning the existence of socio-economic inequalities in cerebral palsy prevalence, or the extent to which this is influenced by socio-economic inequalities in low birthweight, a strong risk factor for cerebral palsy. The study is based on 753 children registered with cerebral palsy, resident in the former Oxford Regional Health Authority area and born in the years 1984-90. Two population definitions were used: 1. Children with cerebral palsy resident at birth in the area, with resident births as denominator, 2. Children with cerebral palsy resident at age 5 in the area, with children of ages 1-7 resident in the area in the 1991 census as denominator. Children with cerebral palsy and all births/children were classified according to the Carstairs area deprivation index (grouped into quintiles) of their ward of residence. The prevalence among residents at birth varied from 2.08 per 1000 births in the most affluent quintile to 3.33 in the most deprived quintile (trend P < 0.001). Although there was a tendency for children to move to more affluent areas during early childhood, the socio-economic gradient was similar at age 5. A greater proportion of births in the more deprived quintiles were of low or very low birthweight, the proportion rising from 5.6% in the most affluent quintile to 8.2% in the most deprived. Within the normal birthweight category there was a trend for higher prevalence of cerebral palsy in more deprived quintiles, from 1.29 per 1000 in the most affluent quintile to 2.42 in the most deprived quintile (trend P < 0.001). Within the low birthweight and very low birthweight groups, separately or combined, there was no evidence of any relationship between cerebral palsy prevalence and deprivation. We estimate that up to 17% of cerebral palsy cases might be "preventable" in terms of the reduction to be expected if the whole population had the rate of cerebral palsy of the most affluent quintile. Although the strong socio-economic gradient for cerebral palsy was restricted to the normal birthweight category, we estimate that two-thirds of the excess cases in the population associated with greater socio-economic deprivation were normal birthweight cases, and one-third were low birthweight cases owing to the greater prevalence of low birthweight in more deprived populations. The pattern of socio-economic inequalities should be further explored in other regions, and should be taken into account in aetiological research, and in the effective delivery and evaluation of services.

Social deprivation and prevalence of epilepsy and associated health usage

OBJECTIVESTo examine the relation between social deprivation and the prevalence of epilepsy and associated morbidity using hospital activity data as a proxy.METHODSThe study was conducted in the health district of...

Patterns of unintentional injury in childhood and their relation to socio-economic factors

Objective: To estimate the rate of childhood injury resulting in attendance at Accident and Emergency Departments, to describe the types of accidents and injuries seen and to relate these to socio-economic indices for ward of residence. Methods: Data were collected from Accident and Emergency records, on every fifth day for a year, for children 0–14 y, who attended following unintentional injury and were resident within the study area. Results: 1147 children fulfilled the inclusion criteria. The annual rate of attendance was 138.2 per 1000. There was a higher rate of attendance in boys than in girls in all age groups and the gender difference was particularly marked for severe injuries. Social deprivation, measured by Townsend score, of ward of residence was a powerful predictor of risk of attendance; accounting for 33% of the variance between wards. Conclusion: Unintentional injury results in high rates of attendance at Accident and Emergency Departments although the rates in this community were substantially lower than those reported from elsewhere in the United Kingdom. Risk of injury was strongly related to social disadvantage. District based data collection can be used to facilitate the development of priorities and a locally applicable safety agenda for children..

Influence of dietary factors on oral precancerous lesions in a population-based case-control study in Kerala, India.

Although tobacco is the primary etiologic factor for oral precancerous lesions in India, evidence from other sources indicates that diet may modify risk. This case-control study was designed to minimize a variety of biases in its attempt to investigate the relation between diet and oral precancerous lesions. In a house-to-house survey of 5056 tobacco users in a rural area of Ernakulam district in Kerala, India, 226 individuals (44 females and 182 males) were found to have precancerous lesions (cases), which in 4 cases proved to be cancer. From among the examinees, an equal number of controls who were free of oral mucosal lesions and were matched to the cases regarding age (+/-5 years), gender, ward of residence, and use of tobacco also were enrolled. Dietary data were obtained using a customized interviewer-administered food-frequency questionnaire. All subjects and interviewers were blinded to the disease status of the subject. After controlling for tobacco use, intake of fruits, vegetables, and beta-carotene evinced inverse trends in risk (P<0.05), with an average reduction of over 10% per quartile of exposure. Associations with certain micronutrients appeared to differ according to gender, with an apparent 20% reduction in risk per mg of zinc consumed per day among men and the suggestion of an increased risk among those women in the lowest quartile of iron intake (an increase of approximately 2.5-fold) and ascorbic acid intake (an increase of approximately 70% increase) compared with other women (P<0.10). Consumption of vegetables, fruits, and several micronutrients may inhibit precancerous lesions of the oral cavity.