Choice and chance: determinants of short interpregnancy intervals in Denmark.

BACKGROUND: It is still unclear whether short interpregnancy intervals are a marker for women at risk of poor pregnancy outcome or a direct risk factor for poor perinatal outcomes. The study objective was to identify risk factors associated with short interpregnancy intervals in Denmark. METHODS: From a cohort of pregnant women in a geographically defined area in Denmark (n=11,288) and using register linkage, we identified 5756 multiparous mothers who completed a detailed interview on social behavior during pregnancy. We restricted our analysis to 2904 mothers who had an interpregnancy interval of less than 37 months. Multiple logistic regression was used to estimate the Odds Ratio (OR) of having a short interval as a function of a number of determinants. RESULTS: About 4.8% of the mothers had an interpregnancy interval less than 9 months. Short interpregnancy intervals were more likely to occur in an unplanned pregnancy (OR=2.9, 95% CI: 2.2-3.9), to follow irregular menstruation (OR=1.7, 95% CI: 1.1, 2.5) and to occur in older (OR=1.7, 95% CI: 1.1, 2.5) and high parity mothers (OR=1.9, 95% CI: 1.1, 3.1). Poor housing, smoking and low social status were also associated with short interpregnancy interval CONCLUSION: Short interpregnancy intervals may be a marker for women at risk and these risk factors differ among populations. They also appear to be a result of choice (e.g. in older women). Biological factors also play a significant role in determining short interpregnancy intervals.

The Economic Impact on Onchocerciasis the Case of Mbale District in Uganda

Onchocerciasis; a chronic parasitic infection caused by Onchocerca volvuli; is known to be a serious health problem. Relatively little evidence is available on how households react to onchocerciasis and its impact on household expenditure and time allocation patterns. This study was designed to investigate the impact of OSD on school attendance; cost of health care; amount of labour input by economically active individuals and whether its effects vary by gender in Mbale district. A longitudinal community based on 201 households case-control study that lasted 24 weeks in Bunabutiti parish; Mbale district provided information on use of various sources of treatment; their cost to households; time loss by people with the disease; the extent to which household members provided assistance and any financial losseses associated with onchocerciasis and related diseases. The cases studied did not fit the definition of OSD but rather onchocerciasis based primarily on the presence of nodules which indicate infection; rather than that of skin disease. School attendnance results indicated a higher rate of school attendance for households with oncherciasis (52.9) than non-onchocerciasis households (47.1)implying that onchocerciasis status of the household did not affect school attendance. Expenditure on health care differed slightly between the two cohorts with cases reporting a 0.9higher expenditure than controls. Gender analysis revealed that males spent 9.3more money on health care than females whereas among cases; males used 27more money than females while among controls females used 6.5more money than males. Productive work categorised into farming; gathering; housework; processing and tradea had more time from females among controls (42.7more time compared to males). Cases put more time (3.8) into productive activities than controls. Non-productive work basically categorised into fatique; sickness and social reasons was dominated by males among cases (108 more time compared to females) and controls (22.5more time compared to females). A longer period of sickness was reported by males among controls (169.2longer compared to females) and by females among cases (10.3longer compared to males). surprisingly; controls lost slightly more productive hours (4.4) than the cases through sickness. The majority of households appeared to cope without great difficulty with the reduction in labour supply caused by the disease; by drawing largely on the time of adult family members. A conservative total economic loss opf US$ 28;558.4 per year to the parish due to Onchocerciais and related diseases has been forecasted. This is because the intangibale costs like psycho-social effects and stigmatization have not been valued in addition to government expenses on the disease. The direct and indirect costs while 3.5was attributed to direct costs. This money could go a long way toward uplifiting the status of the parish if the disease is eradicated. it is envisaged that the report will be valuable in informing health policy makers; particularly in relation to setting priorities and onchocerciasis treatment. Since this was designed as a multi-country study of the Economic Impact of OSD; the differences in results are due to differences in the important definition of OSD. It can be concluded that onchocerciasis and other health related illnesses have a major impact on the economic and social well-being of the indiviiduals and the community. Policies to address education; women empowerment; sensitization of the masses about the causes; symptoms and effects of onchocerciasis should be formulated and implemented as a matter or priority. Direct costs can be reduced by putting up more dispensaries and the exisiting ones be more stocked with drugs. Indirect costs of medical care can be reduced by improving the roads; putting up more dispensaries to reduce the time spent in seeking health care and of course eradicating the disease