Levels of adulthood physical disability in a rural community in upper Egypt

Worldwide, the rapid increase in the elderly population have led to an ongoing debate about wheather longer lives can be matched by longer active lives that are free from disability [Ostir, et al., 1999]. In many developing countries, life expectancy is increasing very rapidly, but little information is available on survival free of disability [Jitapunkul et al, 2003]. Egypt is an example of a country in the middle of its demographic transition. The median age of population has risen with a life expectancy at birth from 51 years in 1970 to 70 years in 2005. Egypt's population is projected to reach 92 million in 2020 with 6.7% aged 65 years or above; approximately 7 million elderly people [CAPMAS, 1995]. To estimate the prevalence rate, identify types and factors associated with disability among adults residing in a rural area. A cross-sectional survey with total coverage of all adult population >/= 18 years residing in Gahdam village. Upper Egypt, was undertaken in 2001. A total of 2.505 adults were screened for disability using the ADL [Activities of Daily Living] and IADL [Instrumental activities of daily living instruments. This was followed by a more detailed questionnaire to describe disability by onset, duration, severity, underlying diseases, health seeking behavior and other factors. Disability was defined as deficiency in one or more of ADL or IADL items. 15.9% of adults were disabled in one or more of the ADL items. Using both ADL and IADL instruments the prevalence of disability among adult population aged >/= 18 years was 22.1%. Disability was associated with age, gender, marital status and educational attainment. Musculo skeletal disorders ranked as the first underlying cause of disability [41.9%] followed by chest disorders [16.5%]. Health services utilization declined from 90.9% at the onset of disability to 62.3% among currently disabled adults. Although private sector had the upper hand among providers sought, a large proportion of disabled adults relied on self medication 37.7%. Hospitalization during the last year was 16.4%; with an average length of stay 16.9 days. Disability among elderly population is a significant burden to individuals, families, and health care

Childhood disability levels in a village in upper Egypt

Long term physical disability among children and adolescents is a multi-dimensional problem and though the prevalence rate of disability across age groups is higher among elderly, yet, the severity of disability and psychological impacts among adolescents and young adults is much higher. Children < 18 years of age are more than 50% of the population in developing countries, even low disability levels can amount to substantial suffering. To estimate the prevalence of disability among children <18 years age in a village in Upper Egypt, its impact on the child and family life, and describe the patterns of health care seeking behavior. A cross-sectional survey with total coverage of all children 0-18 years old residing in Gahdam village, Upper Egypt "was undertaken in 2001. A child was considered disabled if he/ she was suffering from a disability in one or more of general activities specific for his/ her age or specific activities general for all age groups. Mothers of 3.448 children were interviewed via a semi-structured questionnaire in the screening phase '10 questions questionnaire' standardized instrument. A sub-sample of the disabled children's mothers was subjected to a more detailed questionnaire on disability. 340 children [9.9%] were perceived by their mothers limited by anyway because their disability or health. General disability was the most frequently reported type followed by speech disabilities. Disability was higher in magnitude and severity in males. Psychological burden among children's families ranked the first [66.7%] followed by economic burden, [31.4%] and lastly 15.7% of disabled children's families were suffering from 'physical effort' burden. The type of disability, course and economic burden were all significant predictors in seeking health care. Development screening is essential for early identification of childhood disability

Impact of anti-female genital mutilation [FGM] intervention on attitude and self-efficacy of women and youth girls to abandon this practice

The National Council for Childhood and Motherhood [NCCM] launched an Female Genital Mutilation [FGM] free village project in 2003 to eliminate FGM practice among girls in Egypt. An interim evaluation survey completed by Population Council WestAsia and North Africa office WANA followed in 2006. The complexity of FGM/C behavioural change and involvement of multiple players in decision making directs us to explore other dimensions of the decision-making process of individuals; namely perceived self-efficacy to abandon FGM. Perceived self-efficacy is concerned with people's beliefs in their capabilities to produce given attainments, it has rarely been documented in relation to anti-FGM activities. To identify a change in attitude, self-efficacy, intention among adult -women and youth girls following the project, Using actual practice as a gold standard, verifying these changes. Mid-term survey data of [Moslem villages] was included in this analysis. 305 woman having a daughter between 7-13 years in 9 randomly selected intervention villages were compared with 203 woman in 6 control villages. Also, 288 and 189 single girls 16-24 were successfully interviewed in the intervention and control sites respectively. Both adult women and young girls 16-24 in the intervention group showed significant differences in attitude, intention, and self-efficacy against FGM. These changes are complex in interpretation when compared to behavior towards daughters. The results will assist project managers in understanding [readiness to change] of women and girls towards slopping Female Genital Mutilation/Cutting [FGM/[C]

Breast cancer services at Assiut University Hospital 2004: cost and quality issues

A study was undertaken at Assiut University Hospital in 2004 to describe the processes of service delivery to breast cancer patients and to provide an answer the following question. To what extent are breast cancer services offered cost effective? Cost was estimated by identifying all medical records of breast cancer patients at the General Surgery and at the Oncology Departments for listing the dates admission to inpatient as well as dates of discharge to compute inpatient days at the hospital. Patients receiving chemotherapy were identified from the archived one days admissions at the medical informatics department. The outpatient visits for radiotherapy were also identified from the Oncology Department register for radiotherapy. The WHO estimate of cost of hospital inpatient bed/day and outpatient visit including drugs and investigations was used to estimate the cost of services in Assiut University Hosptial. The estimated total cost of services for 2004 was 572,568 LE. For approximately 201 patients according to number of patients visiting the oncology outpatient for chemotherapy. The average cost /patient was 2848 LE. At each service point different numbers of breast cancer patients were receiving care. Some indirect measures point to the extremely poor stage of the disease for these women; notably more than 50% of the women receiving the radiotherapy are receiving it for palliative care, as they were me astatic patients. Effectiveness in term of survival was not possible to compute as medical records for inpatients are archived only for three years with the current expenditure levels, and lack of an information system can easily link elements and details of care provided with patient outcome, improvements in quality of care are not possible

Violence among secondary school students in Assiut district

Violence by young people is one of the most visible forms of violence in society. Violence among adolescents may have serious developmental, physical and mental health consequences for the affected individuals. Violent youth are more likely than their peers to have poor mental health, use drugs, drop out of school, and be delinquent. Describe pattern, magnitude, and determinants of violence among secondary school students. A cross-sectional survey of a representative sample of 1,404 secondary school students was conducted in Assiut, Egypt, 2004-2005, using a self-administered questionnaire. [Youth self-report] scale of Achenbach was used to measure [aggression], other measures of violence were included: physical fighting and weapon carrying. The main independent variables included in the study were: age, gender, religion, residence, smoking, family bonding, and attitude towards violence, depression, victimization and conflict resolution skills. Results: 59.8% of students were involved in a physical fight in the last 12 months prior to the survey, with significant gender differences and boys being more likely to be involved in such a behavior. Weapon carrying was reported almost exclusively by boys. In the Logistic regression analysis victimization, poor self-control, poor cooperation, and possessing attitudes with a positive violence orientation were found to be strong predictors of aggression and violence. Violence is a seriously growing behavior among secondary school students that needs to be addressed through school health programs investing in healthy development of adolescents pays off in mental health of tomorrow's adults

Pregnancy outcome of adolescent marriage within 5 years of marriage

A secondary analysis of a sub-sample of the Egyptian demographic health survey [EDHS-95] data set was undertaken to compare between the pregnancy outcomes of 15-19 year old married adolescent girls and 20-24 years old young adult women who married in their 20th, within 5 years of marriage. Both groups showed differences in their social and demographic background, antenatal, natal and contraceptive use. Married girls and their husbands reside mainly in rural areas and are much lower in their educational level. The antenatal care use was significantly lower among girls than the young adult women, being 45% and 60%, respectively. Home deliveries were very common and different among both groups [51% and 62%, respectively]. Young adult women differed in their timing to use a modern contraceptive for the first time and its use at a higher percentage, in particular after having the first child. The tradition that contraceptives are not used until the birth of one child was found to be strongly prevailing, despite the marked educational differences between both groups. However, despite all the differences mentioned, no differences in the pregnancy outcomes were observed in both groups and even cesarean section rate of the last birth was double in the young adult women compared with married adolescent [12% and 6%, respectively]