Trends and Associated Factors of Under-five Mortality Based on 2008-2016 Data in Kersa Health and Demographic Surveillance Site, Eastern Ethiopia.

Background: Of the 6.2 million estimated deaths of children under 15 years of age globally, the death toll of children under 5 years of age accounted for 5.3 million. In Ethiopia, even though significant progress has been made, facility-based research shows that the mortality rate of children under 5 is still high. In the country, particularly in the eastern part, evidence on trends in under-five mortality and associated factors from population-based longitudinal data is limited. Objective: The objective of the study was to assess under-five mortality focusing on the trends and associated factors based on 2008-2016 data in Kersa Health and Demographic Surveillance Site, Eastern Ethiopia. The method: The study was based on 9 years of surveillance data. The surveillance site was founded in 2007 with the aim of producing community-based health and demographic data in the eastern Ethiopia. Data were collected from the surveillance site and analyzed with STATA version 15 (for factor analysis) and/or Statistical Package for Social Sciences (SPSS) version 26 (for trend analysis) and Microsoft (MS) Excel software. The autoregressive integrated moving average (ARIMA) model and Mann-Kendall were used to analyze mortality trends. Multi-level logistic regression was used to assess the associated factors. Result: There were a total of 18 759 newborns in the surveillance sites, of which 1602 died of children under 5 years of age, and the total mortality rate for children under 5 years of age was 85 per 1000 live births. Trend analysis shows that the mortality rate of children under 5 has been steadily declining during the study period. Multi-level logistic regression shows that the variance of the random component model related to the intercept term is statistically significant, which means that there is a change in the mortality rate of children under 5 between the survey years, which is explained by the random intercept term. Antenatal care visits by mothers (AOR = .61, 95% CI = .49, .74), primary education (AOR = .58, 95% CI = .49, .68), normal birth weight (AOR = .78, 95% CI = .64, .95), and having 2 or fewer total births (AOR = .37, 95% CI = .22, .37) were all associated with child death. Conclusion: Despite the downward trend, the mortality rate of children under 5 years old at the surveillance sites is high. Effective intervention measures should be implemented.

Tobacco use and associated factors among adults reside in Arba Minch health and demographic surveillance site, southern Ethiopia: a cross-sectional study.

BACKGROUND: Tobacco use is one of the world-leading preventable killers. There was a varied prevalence of tobacco use and cigarette smoking across different areas. The aim of the study was to assess the prevalence and factors associated with current tobacco use among adults residing in Arba Minch health and demographic surveillance site (HDSS). METHODS: A community-based cross-sectional study was conducted among adults residing in Arba Minch HDSS in 2017. The estimated sample size was 3368 individuals which were selected by simple random sampling techniques using Arba Minch HDSS dataset. Data collection tools were obtained from the WHO STEPwise. Current use of tobacco, which defined as the current use of smoked and/or smokeless tobacco, was considered as the dependent variable. A binary logistic regression model was used to identify candidate variables for the multivariable logistic regression model. An adjusted odds ratio (AOR) at a p-value of less than 0.05 was used to determine a statistically significant association between independent and dependent variables. RESULT: The prevalence of tobacco use among adults was 20.2% (95% CI: 18.9-21.6%). The current use of smoked and smokeless tobacco were 17.1% (95%CI: 15.8-18.4%) and 9.7% (95%CI: 8.8-10.8%), respectively. The current use of tobacco was significantly associated with sex (female [AOR 0.54; 95%CI: 0.42-0.68] compared to men), age group (35-44 [AOR 1.57; 95%CI: 1.14-2.17], 45-54 [AOR 1.99; 95%CI: 1.45-2.74], and 55-64 [AOR 3.26; 95%CI: 2.37-4.48] years old compared to 25-35 years old), physical activity (moderate physical activity level [AOR 0.65; 95%CI: 0.44-0.96] compared with low) and residency (highland [AOR 4.39; 95% CI: 3.21-6.01] compared with at lowlander). Also, heavy alcohol consumption (AOR 3.97; 95% CI: 3.07-5.12), and Khat chewing (AOR 3.07(95%CI: 1.64-5.77) were also associated with the use of tobacco among the study participants. CONCLUSION: Nearly one in five adults used tobacco currently in the study area, which is more than the national reports. Interventions for the reduction of tobacco use need to give due attention to men, older adults, uneducated, poor, and highlanders.

Measuring child functioning: Assessing correlation and agreement between caregiver and child responses at the Iganga-Mayuge health and demographic surveillance site in Uganda.

INTRODUCTION: Empirical data is scare on assessment of concordance between caregiver-child responses on child functioning. OBJECTIVE: To assess correlation and agreement between children (11-17 years old) and their caregivers' responses to the UNICEF/Washington Group Child Functioning Module (CFM) at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Uganda. METHODS: CFM with 24-questions corresponding to 13 domains of functioning was administered to children between 11 and 17 years of age and their caregivers. Descriptive analyses of the child/caregiver responses were conducted. Correlation and agreement between caregiver and child responses were assessed. RESULTS: Of the 217 caregiver/child pairs eligible for this study, 181 pairs agreed to participate (83.4%). The mean age of children was 13.9 ± 1.9 years, and 56.4% were males. Cronbach's alpha was 0.892 and 0.886 for the caregiver and child versions of CFM respectively, showing good internal consistency in both. There was a significant overall agreement between mean score of caregiver (5.36 ± 5.63 out of 39) and child (5.45 ± 5.34) pairs. Spearman's rank correlation between the pairs was 0.806 (strong positive correlation). Bland-Altman plots for CFM scores showed greater agreement between caregiver and child at lower scores. Percentage agreement between the pairs for overall disability was greater for mild (83.53%) and moderate (79.37%) categories as compared to the severe (66.67%) category. There was substantial agreement (kappa 0.623) for overall disability between the pairs. CONCLUSION: This study indicates that there is significant correlation and agreement between self-reported caregiver-child pair responses, opening the way for considering children as CFM respondents, when possible.

Adaptation and validation of UNICEF/Washington group child functioning module at the Iganga-Mayuge health and demographic surveillance site in Uganda.

BACKGROUND: The UNICEF/Washington Group Child Functioning Module (CFM) assesses child functioning among children between 5 and 17 years of age. This study adapted and validated the CFM at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Uganda. METHODS: This cross-sectional study was conducted between September 2018-January 2019 at the IM-HDSS. Respondents were caregivers of children between 5 and 17 years of age who were administered modified Washington Group short set (mWG-SS) and CFM. The responses were recorded on a 4-point Likert scale. Descriptive analysis was conducted on child and caregiver demographic characteristics. Exploratory factor analysis (EFA) assessed underlying factor structure, dimensionality and factor loadings. Cronbach's alpha was reported as an assessment of internal consistency. Face validity was assessed during the translation process, and concurrent validity of CFM was assessed through comparison with disability short form. RESULTS: Out of 1842 caregivers approached, 1439 (78.1%) participated in the study. Mean age of children was 11.06 ± 3.59 years, 51.4% were males, and 86.1% had a primary caregiver. Based on EFA, vision, hearing, walking, self-care, communication, learning, remembering, concentrating, accepting change, behavior control, and making friends loaded on factor 1 - "Motor and Cognition," while anxiety and depression loaded on factor 2 - "Mood". Cronbach's alpha for the overall CFM was 0.899 (good internal consistency). Cronbach's alpha for each extracted factor was excellent, motor and cognition (0.904), and mood (0.902). CFM had acceptable face validity. Spearman's rank correlation between scores of CFM and modified WG short set was 0.51 (p-value < 0.001). The overall mean CFM score was 2.47 ± 3.82 out of 39. The mean score for Mood (1.35 ± 1.42 out of 6) was higher compared to Motor and Cognition (1.12 ± 3.06 out of 33). Comparing modified WG short set and CFM Likert responses, the percent agreement was greatest for "cannot do at all." CONCLUSION: CFM is a two-factor, valid and reliable scale for assessing disability in Uganda and can be applied to other similar settings to contribute towards disability data from the region. It is an easy-to-administer tool that can help in deeper understanding of context-specific burden and extent of disability in children between 5 and 17 years of age.

[Design of schistosomiasis surveillance sites based on Spatial Kluster Analysis by Tree Edge Removal (SKATER) method: an exploratory study].

OBJECTIVE: To develop a method for designing schistosomiasis surveillance sites, so as to improve the efficiency and quality of schitsosomiasis surveillance. METHODS: By using the minimum spanning tree-based Spatial Kluster Analysis by Tree Edge Removal (SKATER) method, spatially constrained clustering was performed upon 31 historical schistosomiasis-endemic counties (districts) in Anhui Province. A surveillance site was selected from each cluster to evaluate the representativeness and surveillance efficiency of these cluster-based surveillance sites for the endemic situation of schistosomiassi in Anhui Province, and to compare the surveillance efficiency with local national schistosomiasis surveillance sites. RESULTS: There was no significant difference in the environmental factors between the cluster-based schistosomiasis surveillance sites and the whole region, showing a high homogeneity. If the same number of schistosomiasis surveillance sites was selected, there was no significant difference between the cluster-based surveillance sites and national schistosomiasis surveillance sites in the efficiency of the mean risk and long-term trend of schistosomiasis surveillance in Anhui Province; however, the cluster-based surveillance sites were superior to the national schistosomiasis surveillance sites for the prediction and estimation of the endemic situation of schistosomiasis in the unmonitored areas. CONCLUSIONS: The SKATER-based selection of schistosomiasis surveillance sites may better represent the endemic situation of schistosomiasis in Anhui Province, which may serve as an effective supplement for the conventional method of selecting schistosomiasis surveillance sites.

Self-reported disability in rural Malawi: prevalence, incidence, and relationship to chronic conditions.

Background: Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and communicating) to allow collection of comparable data on disability. We aimed to improve understanding of prevalence and correlates of disability in this low-income setting in Malawi. Methods: This study is nested in the Karonga Health and Demographic Surveillance Site in Malawi; the Washington Group questions were added to the annual survey in 2014. We used cross-sectional data from the 2014 survey to estimate the current prevalence of disability and examine associations of disability with certain chronic conditions. We then reviewed the incidence and resolution of disability over time using panel data from the 2015 survey. Results: Of 10,863 participants, 9.6% (95% CI 9.0-10.1%) reported disability in at least one domain. Prevalence was higher among women and increased with age. Diabetes and obesity were associated with disability among women, and diabetes was also associated with disability among men. Neither hypertension nor HIV were associated with disability. Participants reporting "no difficulty" or "can't do at all" for any domain were likely to report the same status one year later, whereas there was considerable movement between people describing "some difficulty" and "a lot of difficulty". Conclusions: Disability prevalence is high and likely to increase over time. Further research into the situation of this population is crucial to ensure inclusive policies are created and sustainable development goals are met.

Design of schistosomiasis surveillance sites based on Spatial Kluster Analysis by Tree Edge Removal (SKATER) method: an exploratory study / 中国血吸虫病防治杂志

Objective To develop a method for designing schistosomiasis surveillance sites, so as to improve the efficiency and quality of schitsosomiasis surveillance. Methods By using the minimum spanning tree-based Spatial Kluster Analysis by Tree Edge Removal (SKATER) method, spatially constrained clustering was performed upon 31 historical schistosomiasis-endemic counties (districts) in Anhui Province. A surveillance site was selected from each cluster to evaluate the representativeness and surveillance efficiency of these cluster-based surveillance sites for the endemic situation of schistosomiassi in Anhui Province, and to compare the surveillance efficiency with local national schistosomiasis surveillance sites. Results There was no significant difference in the environmental factors between the cluster-based schistosomiasis surveillance sites and the whole region, showing a high homogeneity. If the same number of schistosomiasis surveillance sites was selected, there was no significant difference between the cluster-based surveillance sites and national schistosomiasis surveillance sites in the efficiency of the mean risk and long-term trend of schistosomiasis surveillance in Anhui Province; however, the cluster-based surveillance sites were superior to the national schistosomiasis surveillance sites for the prediction and estimation of the endemic situation of schistosomiasis in the unmonitored areas. Conclusion The SKATER-based selection of schistosomiasis surveillance sites may better represent the endemic situation of schistosomiasis in Anhui Province, which may serve as an effective supplement for the conventional method of selecting schistosomiasis surveillance sites.

Design of schistosomiasis surveillance sites based on Spatial Kluster Analysis by Tree Edge Removal (SKATER) method: an exploratory study / 中国血吸虫病防治杂志

Objective To develop a method for designing schistosomiasis surveillance sites, so as to improve the efficiency and quality of schitsosomiasis surveillance. Methods By using the minimum spanning tree-based Spatial Kluster Analysis by Tree Edge Removal (SKATER) method, spatially constrained clustering was performed upon 31 historical schistosomiasis-endemic counties (districts) in Anhui Province. A surveillance site was selected from each cluster to evaluate the representativeness and surveillance efficiency of these cluster-based surveillance sites for the endemic situation of schistosomiassi in Anhui Province, and to compare the surveillance efficiency with local national schistosomiasis surveillance sites. Results There was no significant difference in the environmental factors between the cluster-based schistosomiasis surveillance sites and the whole region, showing a high homogeneity. If the same number of schistosomiasis surveillance sites was selected, there was no significant difference between the cluster-based surveillance sites and national schistosomiasis surveillance sites in the efficiency of the mean risk and long-term trend of schistosomiasis surveillance in Anhui Province; however, the cluster-based surveillance sites were superior to the national schistosomiasis surveillance sites for the prediction and estimation of the endemic situation of schistosomiasis in the unmonitored areas. Conclusion The SKATER-based selection of schistosomiasis surveillance sites may better represent the endemic situation of schistosomiasis in Anhui Province, which may serve as an effective supplement for the conventional method of selecting schistosomiasis surveillance sites.

Poor glycaemic control and its metabolic and demographic risk factors in a Malaysian community-based study.

OBJECTIVES: The lack of population-based evidence on the risk factors for poor glycaemic control in diabetics, particularly in resource-poor settings, is a challenge for the prevention of long-term complications. This study aimed to identify the metabolic and demographic risk factors for poor glycaemic control among diabetics in a rural community in Malaysia. METHODS: A total of 1844 (780 males and 1064 females) known diabetics aged ≥ 35 years were identified from the South East Asia Community Observatory (SEACO) health and demographic surveillance site database. RESULTS: 41.3% of the sample had poor glycaemic control. Poor glycaemic control was associated with age and ethnicity, with older participants (65+) better controlled than younger adults (45-54), and Malaysian Indians most poorly controlled, followed by Malay and then Chinese participants. Metabolic risk factors were also highly associated with poor glycaemic control. CONCLUSIONS: There is a critical need for evidence for a better understanding of the mechanisms of the associations between risk factors and glycaemic control.

Implementing electronic data capture at a well-established health and demographic surveillance site in rural northern Malawi.

This article aims to assess multiple issues of resources, staffing, local opinion, data quality, cost, and security while transitioning to electronic data collection (EDC) at a long-running community research site in northern Malawi. Levels of missing and error fields, delay from data collection to availability, and average number of interviews per day were compared between EDC and paper in a complex, repeated annual household survey. Three focus groups with field and data staff with experience using both methods, and in-depth interviews with participants were carried out. Cost for each method were estimated and compared. Missing data was more common on paper questionnaires than on EDC, and a similar number were carried out per day. Fieldworkers generally preferred EDC, but data staff feared for their employment. Most respondents had no strong preference for a method. The cost of the paper system was estimated to be higher than using EDC. The existing infrastructure and technical expertise could be adapted to using EDC, but changes have an impact on data processing jobs as fewer, and better qualified staff are required. EDC is cost-effective, and, for a long-running site, may offer further savings, as devices can be used in multiple studies and perform several other functions. EDC is accepted by fieldworkers and respondents, has good levels of quality and timeliness, and security can be maintained. EDC is well-suited for use in a well-established research site using and developing existing infrastructure and expertise.

[Evaluation on Hepatitis B surveillance models at surveillance pilot points in China, 2013-2015].

Objective: To evaluate the effects on Hepatitis B surveillance models at the surveillance pilot points in China. Methods: Hepatitis B related records kept at the surveillance pilot points were downloaded from NNDRS. Data concerning proportion of unclassified Hepatitis B cases, consistency of additional records and the accuracy of reported acute Hepatitis B cases were evaluated. Results: The proportion of unclassified Hepatitis B cases was decreasing year by year (P<0.05), from 32.07% in 2012 to 4.26% in 2015, with Kappa as 0.768, 0.821 and 0.836 respectively in 2013-2015. The accuracy of reported acute Hepatitis B was improving (P<0.05), from 55.77% in 2013 to 74.49% in 2015. Conclusions: Additional records and blood testings on acute Hepatitis B cases seemed to be effective in improving the accuracy of Hepatitis B reporting system and decreasing the proportion of unclassified Hepatitis B cases. We suggested that this model of surveillance could be applied elsewhere in the nation to improve the quality of report system on Hepatitis B.

Evaluation on Hepatitis B surveillance models at surveillance pilot points in China, 2013-2015 / 中华流行病学杂志

Objective To evaluate the effects on Hepatitis B surveillance models at the surveillance pilot points in China.Methods Hepatitis B related records kept at the surveillance pilot points were downloaded from NNDRS.Data concerning proportion of unclassified Hepatitis B cases,consistency of additional records and the accuracy of reported acute Hepatitis B cases were evaluated.Results The proportion of unclassified Hepatitis B cases was decreasing year by year (P＜0.05),from 32.07％ in 2012 to 4.26％ in 2015,with Kappa as 0.768,0.821 and 0.836 respectively in 2013-2015.The accuracy of reported acute Hepatitis B was improving (P＜0.05),from 55.77％ in 2013 to 74.49％ in 2015.Conclusions Additional records and blood testings on acute Hepatitis B cases seemed to be effective in improving the accuracy of Hepatitis B reporting system and decreasing the proportion of unclassified Hepatitis B cases.We suggested that this model of surveillance could be applied elsewhere in the nation to improve the quality of report system on Hepatitis B.

Evaluation on Hepatitis B surveillance models at surveillance pilot points in China, 2013-2015 / 中华流行病学杂志

Objective To evaluate the effects on Hepatitis B surveillance models at the surveillance pilot points in China.Methods Hepatitis B related records kept at the surveillance pilot points were downloaded from NNDRS.Data concerning proportion of unclassified Hepatitis B cases,consistency of additional records and the accuracy of reported acute Hepatitis B cases were evaluated.Results The proportion of unclassified Hepatitis B cases was decreasing year by year (P＜0.05),from 32.07％ in 2012 to 4.26％ in 2015,with Kappa as 0.768,0.821 and 0.836 respectively in 2013-2015.The accuracy of reported acute Hepatitis B was improving (P＜0.05),from 55.77％ in 2013 to 74.49％ in 2015.Conclusions Additional records and blood testings on acute Hepatitis B cases seemed to be effective in improving the accuracy of Hepatitis B reporting system and decreasing the proportion of unclassified Hepatitis B cases.We suggested that this model of surveillance could be applied elsewhere in the nation to improve the quality of report system on Hepatitis B.

A community-based prospective cohort study of dengue viral infection in Malaysia: the study protocol.

BACKGROUND: Globally, dengue infections constitute a significant public health burden. In recent decades, Malaysia has become a dengue hyper-endemic country with the co-circulation of the four dengue virus serotypes. The cyclical dominance of sub-types contributes to a pattern of major outbreaks. The consequences can be observed in the rising incidence of reported dengue cases and dengue related deaths. Understanding the complex interaction of the dengue virus, its human hosts and the mosquito vectors at the community level may help develop strategies for addressing the problem. METHODS: A prospective cohort study will be conducted in Segamat district of Johor State in Peninsular Malaysia. Researchers received approval from the Malaysian Medical Research Ethics Committee and Monash University Human Research Ethics Committee. The study will be conducted at a Malaysian based health and demographic surveillance site over a 1 year period in three different settings (urban, semi-urban and rural). The study will recruit healthy adults (male and female) aged 18 years and over, from three ethnic groups (Malay, Chinese and Indian). The sample size calculated using the Fleiss method with continuity correction is 333. Sero-surveillance of participants will be undertaken to identify asymptomatic, otherwise healthy cases; cases with dengue fever who are managed as out-patients; and cases with dengue fever admitted to a hospital. A genetic analysis of the participants will be undertaken to determine whether there is a relationship between genetic predisposition and disease severity. A detailed medical history, past history of dengue infection, vaccination history against other flaviviruses such as Japanese encephalitis and Yellow fever, and the family history of dengue infection will also be collected. In addition, a mosquito surveillance will be carried out simultaneously in recruitment areas to determine the molecular taxonomy of circulating vectors. DISCUSSION: The research findings will estimate the burden of asymptomatic and symptomatic dengue at the community level. It will also examine the relationship between virus serotypes and host genotypes, and the association of the clinical manifestation of the early phase with the entire course of illness.

Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal: 2012 follow-up survey and use of skilled birth attendants.

BACKGROUND: Estimates of disease burden in Nepal are based on cross-sectional studies that provide inadequate epidemiological information to support public health decisions. This study compares the health and demographic indicators at the end of 2012 in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) with the baseline conducted at the end of 2010. We also report on the use of skilled birth attendants (SBAs) and associated factors in the JD-HDSS at the follow-up point. DESIGN: We used a structured questionnaire to survey 3,505 households in the JD-HDSS, Bhaktapur, Nepal. To investigate the use of SBAs, we interviewed 434 women who had delivered a baby within the prior 2 years. We compared demographic and health indicators at baseline and follow-up and assessed the association of SBA services with background variables. RESULTS: Due to rising in-migration, the total population and number of households in the JD-HDSS increased (13,669 and 2,712 in 2010 vs. 16,918 and 3,505 in 2012). Self-reported morbidity decreased (11.1% vs. 7.1%, respectively), whereas accidents and injuries increased (2.9% vs. 6.5% of overall morbidity, respectively). At follow-up, the proportion of institutional delivery (93.1%) exceeded the national average (36%). Women who accessed antenatal care and used transport (e.g. bus, taxi, motorcycle) to reach a health facility were more likely to access institutional delivery. CONCLUSIONS: High in-migration increased the total population and number of households in the JD-HDSS, a peri-urban area where most health indicators exceed the national average. Major morbidity conditions (respiratory diseases, fever, gastrointestinal problems, and bone and joint problems) remain unchanged. Further investigation of reasons for increased proportion of accidents and injuries are recommended for their timely prevention. More than 90% of our respondents received adequate antenatal care and used institutional delivery, but only 13.2% accessed adequate postnatal care. Availability of transport and use of antenatal care was associated positively with institutional delivery.

Uterine prolapse and its impact on quality of life in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur, Nepal.

BACKGROUND: Uterine prolapse (UP) is a reproductive health problem and public health issue in low-income countries including Nepal. OBJECTIVE: We aimed to identify the contributing factors and stages of UP and its impact on quality of life in the Jhaukhel-Duwakot Health Demographic Surveillance Site of Bhaktapur, Nepal. DESIGN: Our three-phase study used descriptive cross-sectional analysis to assess quality of life and stages of UP and case-control analysis to identify contributing factors. First, a household survey explored the prevalence of self-reported UP (Phase 1). Second, we used a standardized tool in a 5-day screening camp to determine quality of life among UP-affected women (Phase 2). Finally, a 1-month community survey traced self-reported cases from Phase 1 (Phase 3). To validate UP diagnoses, we reviewed participants' clinical records, and we used screening camp records to trace women without UP. RESULTS: Among 48 affected women in Phase 1, 32 had Stage II UP and 16 had either Stage I or Stage III UP. Compared with Stage I women (4.62%), almost all women with Stage III UP reported reduced quality of life. Decreased quality of life correlated significantly with Stages I-III. Self-reported UP prevalence (8.7%) included all treated and non-treated cases. In Phase 3, 277 of 402 respondents reported being affected by UP and 125 were unaffected. The odds of having UP were threefold higher among illiterate women compared with literate women (OR=3.02, 95% CI 1.76-5.17), 50% lower among women from nuclear families compared with extended families (OR=0.56, 95% CI 0.35-0.90) and lower among women with 1-2 parity compared to >5 parity (OR=0.33, 95% CI 0.14-0.75). CONCLUSIONS: The stages of UP correlated with quality of life resulting from varied perceptions regarding physical health, emotional stress, and social limitation. Parity, education, age, and family type associated with UP. Our results suggest the importance of developing policies and programs that are focused on early health care for UP. Through family planning and health education programs targeting women, as well as women empowerment programs for prevention of UP, it will be possible to restore quality of life related to UP.

Attention deficit hyperactivity disorder symptom self-report in adults in Kenya and its associated risk factors, an analysis from a household survey in a demographic surveillance site.

BACKGROUND: There have been no household surveys of adult attention deficit and hyperactivity disorder (ADHD) in Kenya, and only one in sub-Saharan Africa. METHODS: Data on ADHD was used from a household survey of mental disorders and their associated risk factors conducted in Maseno area (population 70 805), near Lake Victoria in Kenya, using a demographic surveillance site as the sample frame, as part of a wider survey of mental health, malaria and immunity A total of 1190 households were selected, and 1158 adult participants consented to the study while 32 refused to participate in the study interviews, giving a response rate of 97.3%. ADHD symptoms were assessed with the WHO Adult ADHD Self-Report Scale (ASRS) Screener. RESULTS: This survey found that the overall prevalence of ADHD using the ASRS was 13.1%. This suggests a high level of ADHD in the Kenyan population which needs to be further investigated for its impact on adult mental health. In the adjusted analysis, increased odds ratios (ORs) were found in those with higher assets (OR 1.7, p = 0.023), those with life events (OR 2.4, p = 0.001 for those with 2-3 life events and OR 2.6, p < 0.001 for those with 4 or more life events), and those with common mental disorders (OR 2.3, p = 0.001). CONCLUSION: The study demonstrates the magnitude of ADHD symptoms as a public health issue, relevant for health worker training, and the importance of further research into its prevalence in adults and associated risk factors.

Assessment of schistosomiasis endemic situation in national surveillance sites in Hubei Province from 2005 to 2010 / 中国血吸虫病防治杂志

Objective To assess the schistosomiasis endemic situation in the national surveillance sites in Hubei Province, so as to provide the evidence for the prevention and control of schistosomiasis. Methods According to the national surveillance protocol,a longitudinal surveillance of endemic situation of schistosomiasis was carried out in 16 national surveillance sites from 2005 to 2010. Results In general,the positive rates of IHA,Kato-Katz technique and infection rates of Schistosoma japonicum decreased from 15.67%,10.93%and 1.71%in 2005 to 10.48%,8.54%and 0.90%in 2010,and declined by 33.12%,22.70%and 47.95%,respectively. The infection rates of S. japonicum of the male were higher than that of the female,and the peak infec-tion rates were in the groups aged above 30 years. The endemic situation of fishermen and farmers were relatively serious. The in-fection rates of S. japonicum in cattle decreased from 11.69%in 2005 to 1.41%in 2010,and declined by 88.01%(χ2 =298.79, P<0.001). The areas with infected Oncomelania hupensis snails,the densities of living snails,the rates of infected snails and the densities of infected snails decreased by 90.88%,61.66%,80.00%and 92.00%,respectively. Conclusion The schistosomiasis endemic situation in the national surveillance sites in Hubei Province mitigates in 6 years,but the prevention is still a very daunt-ing task.

The association between socioeconomic status and adult mortality in rural kwazulu-natal, South Africa.

OBJECTIVE: To examine the association between socio-economic status and adult mortality in a rural South African community. METHODS: Longitudinal data of adults aged 15-64 yrs residing within the Demographic Surveillance Area [DSA] on 1(st) January 2001 and followed up for seven years, was used. Out of the total 33,677 adults who met the inclusion criteria, 4,058 died during the seven years follow up period. Mortality rates were computed using Kaplan-Meier survival estimates expressed per 1000 person-year of observation (PYO). Household wealth index was constructed by the use of PCA, while the association was assessed using Cox proportional Hazard model controlling for potential confounders such as age, sex and marital status. RESULTS: The high group of the socioeconomic quintile had the highest mortality rate of 22.2 per 1000 PYO, 95% confidence interval (20.7 - 23.7). After adjusting for the potential confounders, the effect of socioeconomic status in the highest SES category was 0.10 times less likelihood of death compared to the lowest SES group (Hazard Ratio=0.90; p=0.042; 95% confidence interval [0.81 - 0.99]). CONCLUSION: This study revealed that adult socioeconomic status is not significantly associated with adult mortality. Reducing the gap between the rich and the poor, though a worthwhile effort; might not be the most effective means of reducing adult mortality.

Convergence in fertility of South Africans and Mozambicans in rural South Africa, 1993-2009.

BACKGROUND: Although there are significant numbers of people displaced by war in Africa, very little is known about long-term changes in the fertility of refugees. Refugees of the Mozambican civil war (1977-1992) settled in many neighbouring countries, including South Africa. A large number of Mozambican refugees settled within the Agincourt sub-district, underpinned by a Health and Socio-demographic Surveillance Site (AHDSS), established in 1992, and have remained there. The AHDSS data provide a unique opportunity to study changes in fertility over time and the role that the fertility of self-settled refugee populations plays in the overall fertility level of the host community, a highly relevant factor in many areas of sub-Saharan Africa. OBJECTIVES: To examine the change in fertility of former Mozambican self-settled refugees over a period of 16 years and to compare the overall fertility and fertility patterns of Mozambicans to host South Africans. METHODS: Prospective data from the AHDSS on births from 1993 to 2009 were used to compare fertility trends and patterns and to examine socio-economic factors that may be associated with fertility change. RESULTS: There has been a sharp decline in fertility in the Mozambican population and convergence in fertility patterns of Mozambican and local South African women. The convergence of fertility patterns coincides with a convergence in other socio-economic factors. CONCLUSION: The fertility of Mozambicans has decreased significantly and Mozambicans are adopting the childbearing patterns of South African women. The decline in Mozambican fertility has occurred alongside socio-economic gains. There remains, however, high unemployment and endemic poverty in the area and fertility is not likely to decrease further without increased delivery of family planning to adolescents and increased education and job opportunities for women.