Quality of Life and Mental Health Status of Arsenic-affected Patients in a Bangladeshi Population.

Contamination of groundwater by inorganic arsenic is one of the major public-health problems in Bangladesh. This cross-sectional study was conducted (a) to evaluate the quality of life (QOL) and mental health status of arsenic-affected patients and (b) to identify the factors associated with the QOL. Of 1,456 individuals, 521 (35.78%) were selected as case and control participants, using a systematic random-sampling method. The selection criteria for cases (n=259) included presence of at least one of the following: melanosis, leucomelanosis on at least 10% of the body, or keratosis on the hands or feet. Control (nonpatient) participants (n=262) were selected from the same villages by matching age (±5 years) and gender. The Bangladeshi version of the WHOQOL-BREF was used for assessing the QOL, and the self-reporting questionnaire (SRQ) was used for assessing the general mental health status. Data were analyzed using Student’s t-test and analysis of covariance (ANCOVA), and the WHOQOL-BREF and SRQ scores between the patients and the non-patients were compared. The mean scores of QOL were significantly lower in the patients than those in the non-patients of both the sexes. Moreover, the mental health status of the arsenic-affected patients (mean score for males=8.4 and females=10.3) showed greater disturbances than those of the non-patients (mean score for males=5.2 and females=6.1) of both the sexes. The results of multiple regression analysis revealed that the factors potentially contributing to the lower QOL scores included: being an arsenic-affected patient, having lower age, and having lower annual income. Based on the findings, it is concluded that the QOL and mental health status of the arsenic-affected patients were significantly lower than those of the non-patients in Bangladesh. Appropriate interventions are necessary to improve the well-being of the patients.

Uptake of interventions for preventing mother-to-child HIV transmission in 11 operational districts in Cambodia

Introduction: To achieve the global goal of eliminating mother-to-child transmission of HIV, retention of HIV-positive women and their babies throughout the cascade of prevention of mother-to-child transmission of HIV (PMTCT) services is necessary. Little evidence has been published on coverage of the cascade in resource-limited settings. Along with PMTCT service expansion in Cambodia, a national routine reporting system was developed. This study examines coverage of six PMTCT interventions to improve our understanding of retention throughout the cascade. Method: We developed indicators to monitor coverage of the six key interventions: (1) maternal antiretroviral treatment or prophylaxis; (2) delivery in a health facility; (3) infant ARV prophylaxis at birth; (4) infant co-trimoxazole prophylaxis at six weeks; (5) first infant DNA-PCR test at six weeks; and (6) second infant DNA-PCR test at 30 weeks. Programme data from April 2008 to December 2011 in 11 operational districts were used to identify those eligible for each intervention. Results: Women eligible for maternal antiretroviral treatment or prophylaxis in the study were aged 18 to 48 with a median age of 30 years. Coverage of the six interventions were: (1) 79.9% (258/323); (2) 92.2% (236/256); (3) 69.9% (179/256); (4) 73.3% (184/251); (5) 85.7% (215/251); and (6) 61.6% (135/219). Among those eligible, 29.7% (65/219) received all six interventions. Discussion: This study revealed critical gaps in PMTCT service delivery under routine conditions in Cambodia. Service optimization by reducing gaps will help eliminate HIV infection among infants and improve maternal survival. Further operational studies are needed to identify determinants of service uptake.

Knowing the Consequences of Unprotected Sex with Seroconcordant Partner Is Associated with Increased Safer Sex Intentions among HIV-positive Men in Kathmandu, Nepal.

Unprotected sexual intercourse among HIV-positive people can adversely affect their own health by increasing their exposure to multiple strains of HIV-1 or other sexually transmitted infections (STIs). The study explored the relationship between knowledge of Nepalese HIV-positive men about the consequences of having unprotected sex with seroconcordant partners and their intention to practise safer sex with such partners. In total, 166 participants recruited conveniently in the Kathmandu Valley, Nepal, were interviewed. Each participant reported intention to practise safer sex with seroconcordant partners, knowledge about the consequences of having unprotected sex with seroconcordant partners, perceived partnerrelated barriers to condom-use, belief that condoms interfere with sex, and condom-use self-efficacy. Of the 166 participants, 50.6% intended to practise safer sex every time they have sex with seroconcordant partners. Results of multiple logistic regression analysis showed that the participants who were aware of the possibility of HIV superinfection [adjusted odds ratio (AOR)=2.93, 95% confidence interval (CI) 1.16- 7.34, p=0.022)] or that the presence of STIs in HIV-positive persons increases progression of HIV disease (AOR=2.80, 95% CI 1.08-7.26, p=0.033) were more likely to intend to practise safer sex with seroconcordant partners. Similarly, the participants who were employed or who had lower levels of belief that condoms interfere with sex were more likely to intend to practise safer sex. The findings suggest that improving the knowledge of HIV-positive persons about the consequences of having unprotected sex with seroconcordant partners might improve their intention to practise safer sex with such partners.

Survey of Food-hygiene Practices at Home and Childhood Diarrhoea in Hanoi, Viet Nam.

A cross-sectional study was conducted to investigate the potential factors of food-hygiene practices of mothers on the prevalence of diarrhoea among their children. Mothers who had children aged 6 months–5 years were recruited in a hamlet in Viet Nam. The food-hygiene practices included hand-washing, method of washing utensils, separation of utensils for raw and cooked food, and the location where foods were prepared for cooking. A face-to-face interview was conducted, and data on 206 mothers were analyzed. The risk of diarrhoea was significantly higher among children whose mothers prepared food for cooking somewhere other than the table (typically on the ground) compared to children whose mothers prepared food on the table (adjusted odds ratio=2.85, 95% confidence interval 1.11-7.28). The results indicate that food-hygiene practices of mothers, such as avoiding preparing food for cooking on the ground, has a potential impact in preventing diarrhoea among children in Viet Nam.

Hard-to-reach populations in Japan.

The objective of this study was to assess the trends of sampling locations and methods of studying hard-to-reach populations conducted in Japan. We accessed a Japanese medical database on 30 September 2005 to review 5 study types of hard-to-reach populations conducted in Japan: men who have sex with men, homeless, sex workers, undocumented migrants, and injecting drug users. We then categorized their sampling locations and methods. We found 298 articles on hard-to-reach populations published from 1983 to September 2005. Of the 285 studies sampled, approximately 92% were facility-based studies and the rest were community-based. This tendency was consistent in each subgroup; the majority of the studies were conducted among patients in medical facilities. Our study shows the majority of studies on hard-to-reach populations in Japan adopted a convenience sampling method and were facility-based. We suggest the utilization of comparatively valid techniques, such as time-location or respondent driven sampling to more clearly understand these populations.