Tuberculosis awareness in Gezira, Sudan: knowledge, attitude and practice case-control survey.

This case-control study aimed to assess tuberculosis (TB) awareness and its associated sociodemographic characteristics in Gezira, Sudan. New smear-positive TB patients registered in Gezira in 2010 (n = 425) and age-matched controls who attended the same health facilities for other reasons (n = 850) formed the study sample. Awareness was measured using a modified standard World Health Organization TB knowledge, attitude and practice instrument. There was no significant difference between TB cases and the controls in overall levels of TB awareness. About two-thirds of TB cases and controls had good TB awareness. Respondents' sex was associated with awareness among the controls. Age, level of education, type of residence and type of occupation were significantly associated with TB awareness, whereas marital status had no effect. The good level of TB awareness found among TB cases and controls is a baseline for further TB awareness-raising among the Gezira population.

Tuberculosis awareness in Gezira, Sudan:knowledge, attitude and practice case-control survey

This case control study aimed to assess tuberculosis [TB]awareness and its associatedsociodemographic characteristics in Gezira, Sudan.New smear-positive TB patients registered in Gezira in 2010 [n - 425]and age-matched controls who attended the same health facilities for other reasons [n = 850]formed the study sample.Awareness was measured using a modified standard World Health Organization TB knowledge, attitude and practice instrument.There was no significant difference between TB cases and the controls in overall levels of TB awareness.About two-thirds of TB cases and controls had good TB awareness.Respondents' sex was associated with awareness among the controls.Age, level of education, type of residence and type of occupation were significantly associated with TB awareness, whereas marital status had no effect.The good level of TB awareness found among TB cases and controls is a baseline for further TB awareness-raising among the Gezira population

تهدف دراسة الحالات والشواهد هذه إلى تقييم مدى الوعي بالسل، والسمات الاجتماعية والديموغرافية المصاحبة له في الجزيرة بالسودان. واعتمدت عينة الدراسة على مرضى السل الجدد إيجابيي اللطاخة المسجلين في ولاية الجزيرة بالسودان في عام 2010 [العدد = 425]والشواهد الذين يضاهون الحالات في السن ممن حضروا إلى المرافق الصحية نفسها لأسباب أخرى [العدد = 850]. وتم قياس مدى الوعي باستخدام المقياس المعدل لمنظمة الصحة العالمية لقياس المعارف والمواقف والممارسات. ولم يكن هناك أي فروق يعتد بها بين حالات السل والشواهد من حيث المستوى الكلي للوعي بالسل. ولقد اتضح أن ثلثي حالات السل والشواهد لديها مستوى جيد من الوعي بالسل. وأن جنس المستجيب للدراسة يؤثر على مدى الوعي بين الشواهد. فالسن، ومستوى التعليم ونمط الإقامة ونوع المهنة كلها من الأمور التي ترتبط بشكل كبير بمدى الوعي بالسل، في حين نجد أن الحالة الزواجية لم يكن لها أي أثر. ومن ثم فإن مستوى الوعي الجيد بالسل لدى الحالات المصابة به ولدى الشواهد تمثل خط الأساس لإذكاء المزيد من الوعي بالسل لدى سكان ولاية الجزيرة

La présente étude cas-témoin visait à évaluer la sensibitisation à la tubercutose et les caractéristiques sociodémographiques associées dans l'état de Gézira [Soudan]. L'échantillon de l'étude était compose de nouveaux patients a frottis positifs pour la tuberculose au Gézira en 2010 [n = 425]et de témoins appariés pour l'âge qui consultaient dans les mêmes établissements de santé pour d'autres motifs [n = 850]. Le degré de sensibilisation à la maladie a été mesuré à l'aide de l'instrument standard modifié de l'Organisation mondiale de la Santé évaluant les connaissances, les attitudes et les pratiques en matière de tuberculose.Aucune différence significative n'a été observée entre les patients tuberculeux et les témoins dans les niveaux généraux de sensibilisation à la tuberculose.Environ deux tiers des patients tuberculeux et des témoins avaient un niveau de sensibilisation à la tuberculose satisfaisant.Dans le groupe des témoins, les hommes et les femmes n'avaient pas le même niveau de sensibilisation à la question.L'âge, le niveau d'études, le type de résidence et la profession étaient des facteurs nettement corrélés à la sensibilisation à la tuberculose, contrairement à la situation matrimoniale.Le niveau satisfaisant de sensibilisation à la tuberculose observé chez les patients atteints de tuberculose est un point de départ pour l'augmentation de la sensibilisation à cette maladie dans la population du Gézira

Domestic violence against women in Kersa, Oromia region, eastern Ethiopia.

Intimate partner violence is common in rural areas of Ethiopia. The aim of this study was to assess the knowledge and prevalence of domestic violence among women in Kersa district of Oromia region and identify the types, perpetuators and triggers for violence. A community-based cross-sectional interview-based survey was conducted in 2008 on 858 women of reproductive age. Only 39.7% of women reported that they recognized that violence against women was a problem in their area. Ever experience of violence by an intimate partner was reported by 166 women (19.6%) and 70.3% of the perpetuators were husbands. Ever experience of domestic violence among women was significantly related to Amhara ethnicity and age group 30-49 years. Only 33 (19.9%) women who ever experienced violence had reported it to the legal authorities. Women's reasons for failing to report to the legal system were not wanting to expose the issue and not knowing where to go.

Tuberculosis stigma in Gezira State, Sudan: a case-control study.

OBJECTIVE: To evaluate the prevalence of tuberculosis (TB) stigma and to determine the relation between socio-demographic characteristics and TB stigma among TB cases and their controls in Gezira State, Sudan. METHODS: A case-control study design was used. New smear-positive TB patients registered in Gezira State in 2010 (n = 425) and controls who attended the same health facility for other reasons (n < 850) formed the study population. Stigma was measured using a standard modified World Health Organization TB KAP (knowledge, attitudes, practice) instrument. RESULTS: TB stigma did not differ between TB cases and controls; mild stigma was found in both groups. The higher degree of stigma among both groups was significantly associated with higher age, lower level of education, residence in rural areas, unemployment and poor TB awareness, while sex had no association with the degree of stigma in either group. CONCLUSION: Although TB stigma among the Gezira population was found to be mild, it can affect treatment adherence. Empowering both TB patients and communities by increasing their knowledge through proper education programmes could effectively contribute to the effort of controlling TB in the state.

Domestic violence against women in Kersa, Oromia region, eastern Ethiopia

Intimate partner violence is common in rural areas of Ethiopia. The aim of this study was to assess the knowledge and prevalence of domestic violence among women in Kersa district of Oromia region and identify the types, perpetuators and triggers for violence. A community-based cross-sectional interview-based survey was conducted in 2008 on 858 women of reproductive age. Only 39.7% of women reported that they recognized that violence against women was a problem in their area. Ever experience of violence by an intimate partner was reported by 166 women [19.6%] and 70.3% of the perpetuators were husbands. Ever experience of domestic violence among women was significantly related to Amhara ethnicity and age group 30-49 years. Only 33 [19.9%] women who ever experienced violence had reported it to the legal authorities. Women's reasons for failing to report to the legal system were not wanting to expose the issue and not knowing where to go

Perceived discrimination among people living with HIV in Nepal.

BACKGROUND: HIV is one of the major public health problems in Nepal, fuelled by several socio-economic factors. The objective of this study was to explore perceived discrimination among people living with HIV in their own family, society and health facilities. METHODS: A qualitative descriptive cross-sectional study was conducted with semi-structured face-to-face in-depth interview of 18 people (10 men, 8 women) living with HIV in four districts of Nepal. RESULTS: Perceived discriminations among people living with HIV were found among family, society and health facilities. In families, the major forms of perceived discrimination were restriction to go outside, exposure to media and use of different utensils for eating purpose. Female HIV positive perceived more violence at household level than males. Financial restriction was also found imposed upon some respondents by the family for being HIV positive. Similarly, restriction to participate in social work, restriction to buy from shops, social harassment and insult were the main forms of discrimination. Perceived discrimination experienced in the health facility yielded very bitter experiences to some respondents, while many had refused treatment because of their HIV status. CONCLUSIONS: People living with HIV faced different forms of perceived discrimination within family, society and health facility which are thought to be crucial in supporting a person at the time of crisis. Intensive programs that can reduce social stigma and discrimination faced by people living with HIV are a most.

Assessment of core activities and supportive functions for the communicable diseases surveillance system in Khartoum state, Sudan, 2005-2007.

We conducted a descriptive, retrospective, cross-sectional study to assess the core activities and supportive functions of the communicable diseases surveillance system (CDSS) in Khartoum state, Sudan, for the period 2005-2007. This is the first assessment conducted for CDSS in Khartoum state. The CDSS was studied in terms of core activities and supportive functions. We found that knowledge of the system was 100% at all levels. Data reporting was over the recommended standard of 80% at all levels. Data analysis, epidemic preparedness and feedback were below the recommended standard. All assigned CDSS staff members were trained. Lower levels lacked modern technologies for data reporting and analysis. The CDSS system in Khartoum state is centralized; moreover, the system has not been updated, it is poorly documented and has a shortage of staff at lower levels.

Feasibility of implementing recommendations to improve communicable diseases surveillance--a modified Delphi study.

BACKGROUND: Effective control of communicable diseases requires an effective disease surveillance system (CDSS) which provides information for action on priority communicable diseases. It is the basis for public health decision-making worldwide. Implementation of any public health recommendations for improving a disease surveillance system depends on the acceptability of such recommendations by the relevant stakeholders and the feasibility of implementing the recommendations in practice. OBJECTIVES: The aim of this study was to assess the acceptability and the feasibility of recommended improvements in CDSS among relevant stakeholders in Khartoum state. METHODS: A Delphi consensus process was used in the form of three analytical written rounds and individual face-to-face discussions among relevant stakeholders in Khartoum state to study the feasibility of the recommended improvements in CDSS in Khartoum state. RESULTS: The stakeholders in Khartoum state agreed with most of our statements to improve the CDSS core activities, supportive functions and quality in Khartoum State, and that the existing CDSS in Khartoum state needs to be strengthened with more effective coordination at different levels. Regarding the feasibility of implementing our recommendations, the results of our Delphi survey suggest neither expanding CDSS system, nor including vertical programmes; formulation of updated objectives; improving data management and feedback; strengthening epidemic management, as well as the quality of the system in terms of timeliness, completeness and acceptability. CONCLUSION: This study added strength to our recommendations, based on two previous studies assessing the CDSS in Khartoum state. The Ministry of Health in Khartoum state can implement our consensus recommendations to improve the CDSS system in the future in order to achieve its targeted goals.

Staff views about the quality of the Communicable Diseases Surveillance System in Khartoum State, Sudan, 2005-2007: a qualitative study.

Surveillance staff are vital to the success of surveillance of infectious diseases. In this study, we interviewed staff of the Communicable Diseases Surveillance System (CDSS) in Khartoum state individually and in focus groups to assess their views about the quality of the system for the years 2005-07. The quality of CDSS was considered poor because the system was not representative as it included neither the private nor military sectors nor the important teaching hospitals. It also lacked timeliness due to poor documentation, was inflexible since it did not rapidly respond to emerging and re-emerging diseases such as SARS and avian flu in its notification lists, and it did not use the data collected to apply interventions for control and prevention of communicable diseases on a routine basis. While staff were committed to the surveillance system and felt they worked hard, they were also demotivated and in the long run this might affect their performance.

Staff views about the quality of the communicable diseases surveillance system in Khartoum state, Sudan, 2005-2007: a qualitative study

Surveillance staff are vital to the success of surveillance of infectious diseases. In this study, we interviewed staff of the Communicable Diseases Surveillance System [CDSS] in Khartoum state individually and in focus groups to assess their views about the quality of the system for the years 2005-07. The quality of CDSS was considered poor because the system was not representative as it included neither the private nor military sectors nor the important teaching hospitals. It also lacked timeliness due to poor documentation, was inflexible since it did not rapidly respond to emerging and re-emerging diseases such as SARS and avian flu in its notification lists, and it did not use the data collected to apply interventions for control and prevention of communicable diseases on a routine basis. While staff were committed to the surveillance system and felt they worked hard, they were also demotivated and in the long run this might affect their performance

Prevalence of menopause symptoms and their association with lifestyle among Finnish middle-aged women.

BACKGROUND AND AIM OF THE STUDY: The aim of this study is to report the prevalence of menopausal symptoms by severity among the Finnish female population and the association of their symptoms with lifestyle (smoking, use of alcohol, physical activity) and body mass index (BMI). MATERIAL AND METHODS: Health 2000 is a nationally representative population-based study of Finnish adults. Data were collected by home interview, three self-administered questionnaires and a clinical examination by a physician. This study included women aged 45-64 years (n=1427). All symptoms included menopause-specific symptoms. Both univariate analysis and a factor analysis based on symptom factors were performed by menopausal group. Multiple regression analysis included each symptom factor as a dependent variable and confounding and lifestyle factors (age, education, smoking, alcohol use, physical activity, BMI, use of hormonal replacement therapy (HRT) and chronic disease status). RESULTS: Over one-third (38%) of the premenopausal, half of the perimenopausal, and 54% of both postmenopausal and hysterectomized women reported bothersome symptoms. The difference between pre- and perimenopausal women was largest and statistically most significant in the case of back pain and hot flushes. Physically active women reported fewer somatic symptoms than did women with a sedentary lifestyle. Smoking was not related to vasomotor symptoms. CONCLUSION: Bothersome symptoms are common in midlife, regardless of menopausal status. Inverse association between physical activity and menopausal symptoms needs to be confirmed in randomized trials.

Developing policy options for SARS and SARS-like diseases - a Delphi study.

The objective of the SARSControl Delphi study was to develop options for national and international emerging infectious diseases policies. The aim of this paper is to present the results of the study, which gathered expert opinions on gaps and inconsistencies concerning preparedness and response planning for Severe Acute Respiratory Syndrome (SARS) and SARS-like diseases. The Delphi technique was employed, which comprised a pilot round, two written rounds and a face-to-face meeting. The Delphi panel consisted of 38 experts from 22 countries, who highlighted the necessity to test plans and stressed the importance of surveillance measures for the swift containment of communicable disease outbreaks and the inclusion of detailed triage plans in national pandemic plans. The experts also suggested a need to define criteria for testing pandemic preparedness plans at different regional levels. New policy alternatives were identified, such as the need for generic plans on pandemics and universal access to healthcare during an outbreak. The usefulness of some non-medical interventions, such as bans on travel, could not be established and need further research. Dissemination of the findings will help to bridge gaps and rectify inconsistencies in current pandemic planning and response strategies for SARS and SARS-like diseases, as well as add valuable knowledge towards the development of national and international emerging infectious disease policies.

Public health research in Denmark in the years 1995--2005.

BACKGROUND: The objective of this study was to find out the number of publications (in Danish) and research projects (including grey literature) either carried out or ongoing within the field of public health in Denmark, using the same criteria as the SPHERE project, but looking at Danish research databases. METHODS: The Danish research database served as the main resource for the study supported by national research reports. RESULTS: There is an increasing trend in the number of public health research projects and publications. Compared with public health research projects published in English there are differences in some categories. Overall, public health research in Denmark seems to contribute around 4.8%-6.5% of the total amount of health research. CONCLUSIONS: Public health research has a relatively low share of overall health research in Denmark.

Assessment of core activities and supportive functions for the communicable diseases surveillance system in Khartoum state, Sudan, 2005-2007

We conducted a descriptive, retrospective, cross-sectional study to assess the core activities and supportive functions of the communicable diseases surveillance system [CDSS] in Khartoum state, Sudan, for the period 2005-2007. This is the first assessment conducted for CDSS in Khartoum state. The CDSS was studied in terms of core activities and supportive functions. We found that knowledge of the system was 100% at all levels. Data reporting was over the recommended standard of 80% at all levels. Data analysis, epidemic preparedness and feedback were below the recommended standard. All assigned CDSS staff members were trained. Lower levels lacked modern technologies for data reporting and analysis. The CDSS system in Khartoum state is centralized; moreover, the system has not been updated, it is poorly documented and has a shortage of staff at lower levels

SARS knowledge, perceptions, and behaviors: a comparison between Finns and the Dutch during the SARS outbreak in 2003.

BACKGROUND: The SARS outbreak served to test both local and international outbreak management and risk communication practices. PURPOSE: The study compares SARS knowledge, perceptions, behaviors, and information between Finns and the Dutch during the SARS outbreak in 2003. METHOD: The participants of the study, who used a modified SARS Psychosocial Research Consortium survey, were drawn from Internet panels in Finland (n = 308) and the Netherlands (n = 373) in June 2003. Multiple logistic regression analyses were used to calculate odds ratios (with 95% confidence intervals) to compare Finns with the Dutch for various levels of perceptions and behaviors. RESULTS: Adjusted for age, education, and income, Finns were more likely to be knowledgeable and worried about SARS as well as to have low perceived comparative SARS risk and poor personal efficacy beliefs about preventing SARS. Finns were also more likely than the Dutch to have high confidence in physicians on SARS issues but less likely to have received information from the Internet and have confidence in Internet information. CONCLUSIONS: The study shed light on how two European populations differed substantially regarding lay responses to SARS. Understanding these differences is needed in formulating and executing communication and outbreak management.

Willingness to take travel-related health risks--a study among Finnish tourists in Asia during the avian influenza outbreak.

BACKGROUND: Health risk perception and behavior of tourists during epidemics is a challenge for behavioral medicine. PURPOSE: The purpose was to analyze associations of psychosocial factors and willingness to take health risks on holiday and business trips. METHOD: Subjects (survey n = 338) were Finnish tourists visiting South-East Asia during the avian influenza epidemic of 2004. On holidays, 13.8%, and on business trips, 6.3% would take (rather) high risks, 14.1% reported having tendency to take health risks. Willingness to take health risks on both kinds of trips was lower among those +40 years old than those <40. Comparatively high risk-taking tendency and high perceived HIV risk were related to the increased willingness to take health risks on both kinds of trips. RESULTS: On holidays, willingness to take health risks was related to trust in fate, and on business trips, this was also related to trust in God and less precautionary behavior of avoiding hand shaking, but also to higher estimation of other risks in life. CONCLUSION: Younger travelers and those on holidays are willing to take more health risks than those who are older or on business trips. Travel advice during epidemics could be differentially targeted to different age groups and to holiday and business travelers.

Evaluation of tuberculosis control programme in Khartoum State for the year 2006.

BACKGROUND: Tuberculosis (TB) is among the top ten causes of global mortality. Sudan is among the countries with high TB prevalence; with an estimated incidence of 90/100,000 smear-positive cases. In 1993, the Khartoum State tuberculosis control programme was established. Since its establishment, however, the programme has never been adequately assessed. AIM: To evaluate and describe the tuberculosis control programme in Khartoum State, Sudan in 2006; to find out if the programme achieved its global targeted goals; and to identify the challenges and needs for performing a good standard tuberculosis control programme. METHODS: A descriptive cross-sectional and retrospective study design was used. The study population was tuberculosis control departments at the levels of the state (n = 1), localities (n = 7), health areas (n = 19) and health facilities (n = 42). Records review and group interviews were used to collect the required data. RESULTS: The study found that the TB control programme in Khartoum State achieved a 77.2% case detection rate of the smear-postive cases, and 73.5% treatment success rate, and a case fatality rate of 2.2%, treatment failure rate of 2.2%, and default rate of 14.1%. There was no system to detect the prevalence of MDR-TB (multi-drug resistant TB) or HIV (human immunodeficiency virus) among the TB cases. The programme was not well implemented at locality or health area levels. Conversely, drugs and laboratory supply systems were functioning well. CONCLUSIONS: The tuberculosis control programme in Khartoum State is centralized, not updated, and does not achieve the targeted goals.

Review article: communicable diseases surveillance lessons learned from developed and developing countries: literature review.

BACKGROUND: Surveillance of infectious diseases is recognized as the cornerstone of public health decision-making and practice. The aim of the evaluation of communicable diseases surveillance systems (CDSS) is ensuring that communicable diseases are monitored efficiently and effectively. The aim of this paper is to reflect on the experiences of both developed and developing countries in the evaluation of CDSS in order to learn lessons from these experiences to improve systems everywhere. METHODS: A literature review of studies published in English in PubMed and databases of the World Health Organization (WHO), and Center of Diseases Control (CDC) from 1981 to 2007 was undertaken assessing CDSS. The studies were divided into those from developed and developing countries. RESULTS: A total of 32 studies were included, 20 from developed and twelve from developing countries. Both developed and developing countries faced difficulties in CDSS. Studies from the developed countries have been analysed based on the quality of the system alone. In developing countries, most of the studies have been on the integrated diseases surveillance (IDSR) and have been performed shortly after the adoption of the IDSR. Thus it might be too early to make a fair evaluation. Some of the systems over-centralized, while some lacked private health sector involvement in the system. Further, some of the systems were affected by conflicts and civil wars which are common problems in developing countries. CONCLUSIONS: None of the countries had ideal CDSS. The strategy of integrated diseases surveillance seems to be functioning well especially in Africa.