Prenatal care utilization in rural areas and urban areas of Haiti.

OBJECTIVES: This study is based on the 2000 Demographic and Health Survey (DHS) conducted in Haiti. Using the DHS information on women aged 15 to 49 who had given birth during the three years preceding the survey interview, this study was intended to: (1) examine the determinants of the likelihood of the women using prenatal care in the rural areas and in the urban areas of the country and (2) for the women who made at least one prenatal care visit, examine the determinants of the number of prenatal visits in the rural areas and the urban areas. METHODS: The multivariate analysis used logistic models to identify which factors explained the decision to seek prenatal care, and negative binomial models were used to determine how many prenatal visits were conducted by the subgroup of women who did make prenatal care visits. RESULTS: Estimated at the mean values of the control variables, the expected probability of using prenatal care services in rural Haiti was 77.16%, compared to 85.83% in urban Haiti. Among users of prenatal care services, mothers in rural areas made an expected number of 3.78 prenatal care visits, compared to 5.06 visits for the women in urban areas. CONCLUSIONS: A substantial percentage of pregnant women have access to prenatal care services in Haiti, but mothers in rural areas who decided to seek care still fell slightly below the four visits recommended by the World Health Organization. The education levels of both mothers and their partners is a dominant predictor of prenatal care use. Longer travel times and greater distances to health centers in rural areas constituted barriers to repeated visits. Policymakers and health care providers need to take these findings into consideration as they decide on the delivery and management of health care services in Haiti.     

2019年广西壮族自治区城乡饮用水水质监测结果分析

目的了解和掌握广西壮族自治区城乡供水水质状况,为政府及有关部门决策提供科学依据。方法从“全国饮用水水质监测信息系统”导出本区2019年城乡饮用水水质监测数据。其中供水信息通过查阅资料、现场调查等方式收集;水样采集、保存、运输和检测按《生活饮用水标准检验方法》(GB/T 5750-2006)进行;水质检测结果按《生活饮用水卫生标准》(GB 5749-2006)进行评价。结果2019年本区市政供水、城市自建设施供水、二次供水、农村集中式供水水质综合合格率分别为96.85%、65.33%、89.95%和63.18%;各项水质指标项次总体合格率分别达到99.90%、96.98%、99.67%和97.54%;微生物指标类别合格率则分别为99.52%、85.14%、98.37%和83.98%。市政供水出厂水和末梢水水质合格率比较,差异无统计学意义(P>0.05);农村集中式供水出厂水水质合格率则高于末梢水,差异有统计学意义(χ^2=6.165,P<0.05)。不同水源类型比较,在农村显示出以地下水为水源供水水质合格率较高,差异有统计学意义(χ^2=17.941,P<0.05);城市供水则差异无统计学意义(P>0.05)。不同水期水质合格率比较,市政供水各季度水质总的合格率以第4季度最高(97.95%),其余依次为第1季度、第2季度,以第3季度最低(95.91%);农村集中式供水丰水期水质合格率高于枯水期,差异均有统计学意义(χ^2=93.191,P<0.05)。结论本区城市市政供水水质总体情况较好,二次供水水质达标率低于市政供水;城市自建设施供水、农村集中式供水达标率较低,微生物污染是主要原因。相关管理部门和监管单位要加强供水卫生管理,保障生活饮用水的卫生安全。     

Birth weight predicts response to vaccination in adults born in an urban slum in Lahore, Pakistan

BACKGROUND: Substantial evidence exists linking small size at birth to later-life susceptibility to chronic disease. Evidence is also emerging that some components of immune function may be programmed in early life. However, this evidence is limited and requires confirmation. OBJECTIVE: We investigated the association between size at birth and response to vaccination in a cohort of 257 adults (mean age: 29.4 y; 146 men) born in an urban slum in Lahore, Pakistan, during 1964-1978. DESIGN: A single dose of Vi polysaccharide vaccine for Salmonella typhi and 2 doses of rabies vaccine were given to each subject. Antibody titers were measured in prevaccination serum samples (Vi) and in postvaccination samples (Vi and rabies). RESULTS: The mean birth weight of the subjects was 3.24 kg; 14% of the subjects had low birth weights (<2.5 kg). Vaccine responses were not consistently associated with contemporary variables (month of study, sex, current age, or indicators of wealth). Response to typhoid vaccination was positively related to birth weight (anti-Vi immunoglobulin G: r = 0.138, P = 0.031; anti-Vi immunoglobulin M: r = 0.197, P = 0.034). Response to the rabies vaccine was not significantly associated with birth weight. CONCLUSIONS: These findings add to a growing body of evidence suggesting that components of the immune system may be permanently programmed by events in early life. The contrasting effects on typhoid and rabies responses suggest that antibody generation to polysaccharide antigens, which have greater B cell involvement, is compromised by fetal growth retardation.     

Status of iodine-deficiency disorders as estimated by neonatal cord serum thyrotropin in Lahore, Pakistan

Cord serum thyrotropin (CST) was estimated in the blood of 1295 neonates randomly selected of 25 000 live births from various hospitals of Lahore, Pakistan, during the period of 1998-2002. Data obtained were used to assess the degree of iodine-deficiency disorder (IDD) in the local population. In iodine-sufficient areas, the percentage of neonates with CST value of >10 mIU/L is less than 3%. A frequency of 3% to 19.9% indicates mild IDD. Frequencies of 20% to 39.9% and >40% indicate moderate and severe IDD, respectively. Results indicated that on average, 13.5% of the neonates had a CST level >10 mIU/L, which indicate the existence of a mild degree of IDD. Statistically, there was no difference in the percentage of neonates with this level of CST for the 5-year study. It was observed that iodized salt has not been widely accepted despite the lack of difference in the price of iodized and noniodized salt.     

Influenza vaccine acceptance among pregnant women in urban slum areas,Karachi, Pakistan

BackgroundFacilitators and barriers to influenza vaccination among pregnant women in the developing world are poorly understood, particularly in South Asia. We assessed intention to accept influenza vaccine among ethnically diverse low-income pregnant women in Pakistan.MethodsFrom May to August 2013, we conducted a cross-sectional survey of pregnant women who visited health centers in urban slums in Karachi city. We assessed intention to accept influenza vaccine against socio-demographic factors, vaccination history, vaccine recommendation sources, and other factors.ResultsIn an unvaccinated study population of 283 respondents, 87% were willing to accept the vaccine, if offered. All except two participants were aware of symptoms typically associated with influenza. Perceived vaccine safety, efficacy, and disease susceptibility were significantly associated with intention to accept influenza vaccine (p < 0.05). Regardless of intention to accept influenza vaccine, 96% rated healthcare providers as highly reliable source of vaccine information. While a recommendation from a physician was critical for influenza vaccine acceptance, parents-in-law and husbands were often considered the primary decision-makers for pregnant women seeking healthcare including vaccination.ConclusionsMaternal influenza vaccination initiatives in South Asia should strongly consider counseling of key familial decision-makers and inclusion of healthcare providers to help implement new vaccination programs.     

Deprivation and stillbirth risk in rural and urban areas

The objective of the study was to investigate whether stillbirth risk was higher, and the effect of deprivation on inequality in stillbirth risk more marked, in rural than in urban areas. We carried out a cohort study of all 280 757 singleton births to mothers domiciled in Cumbria, north-west England, 1950-92. After allowing for individual social class and community deprivation, the risk of stillbirth was lower outside urban centres both during 1950-65 (OR = 0.91, 95% CI 0.84, 1.00) and during 1966-92 (OR = 0.82, 95% CI 0.73, 0.92). In earlier years, unsupported mothers in rural areas and mothers living in remote areas were particularly at risk. Urban/rural differences in risk were not explained by individual social class, community deprivation or overcrowding and have persisted over a 40-year time period.     

Walkability indices and children's walking behavior in rural vs. urban areas

PurposeThis study described associations between selected walk indices (WI) and walking and physical activity behaviors in rural and urban children.FindingsWI were higher in urban environments, yet children from rural areas walked for transportation more than children from urban areas. There was a negative correlation between National WI scores and walking for transportation in urban areas, and between the Frank WI scores and walking for exercise in rural areas.ConclusionsIndices of walkability are not associated with objectively measured physical activity or self-reported walking behavior in children living in rural and urban settings.     

The problem of paralytic poliomyelitis in the urban and rural population around Lucknow, India.

A house to house survey was done from October 1972 to March 1974, covering 528952 individuals of urban population at Lucknow and 50,156 individuals of rural population of Unnao district, to find out the incidence of polio-like paralysis in our population. Among 12874 urban children up to 8 years old 8.2/1000 had polio-like paralysis while 4.6/1000 children of the rural population of 13554 children were affected. The incidence was significantly higher in the urban population. In the preschool age group almost 1 out of every 100 children was affected. A higher number of children were affected during 1968-9 and 1971-2, though it did not reach epidemic proportion. The findings show that paralytic polio is a serious problem in our country where poliomyelitis is endemic: this is contrary to the views generally held so far.     

城乡医院医生工作效率的分析

分析不同地区、类别医院工作效率变动效率，为医院改革提供依据。该采用医生日均门诊数和医生床日数在1986－1997年间的变动趋势，进行投入-产出分析。结果显示12年间门诊和住院工作效率指标都有下降，平均下降1／3左右。城市医院效率优于农村、经济发达地区医院效率优于不发达地区。建议进一步分析引起医院效率下降的原因，并提出综合卫生改革的建议。     

Mortality rates in rural and urban areas of Brittany

Relative differences in environment, behaviour, social composition as well as access to health care tend to suggest that levels of health may vary between urban and rural areas. The aim of this study was to identify rural-urban variations in mortality risks in the region of Brittany for the period from 1988 to 1992. The definition of urban and rural areas used adhered to that of the zoning of urban areas established by the INSEE (the National Statistical Office). The amalgamation of all causes of standardised mortality ratios (SMR) show only a moderately increased risk in the rural areas compared with the overall regional level (+4% in men, +5-7% in women). The analysis of cause specific SMRs display higher rural mortality for cardiovascular diseases and external causes of death, road traffic accidents in particular (+24% in men). Among all specific causes investigated, only lung cancer mortality risk appears to be higher in urban areas.     

Mortality by socio-occupational categories in urban and rural areas

Mortality data in France are studied by a cross sectional analysis including both population density (urban or rural aggregates) and socio-economic groups. The socio-economic differentials in mortality increase with the size of localities. Specific social class distribution partly explains the excess of mortality in rural areas and the lowest mortality in the parisian agglomeration. On the contrary social class distribution does not affect mortality in small towns. Nevertheless, the expected effect of social class does not explain all the discrepancies in mortality between urban and rural areas. The population density is a parameter that should be taken into account when analyzing mortality.     

The increasing supply of physicians in US urban and rural areas, 1975 to 1988.

BACKGROUND. Despite the rapid growth of the US physician supply since the mid-1970s, it remains unclear whether physicians have spread into the most rural areas of the country. This report examines the urban-rural distribution of physicians between 1975 and 1988. METHODS. A county-based typology of the urban-rural continuum was employed to examine trends in the supply of nonfederal primary care physicians, specialist physicians, and osteopaths. RESULTS. All urban and rural areas gained physicians during the late 1970s and 1980s. The supply of physicians increased most rapidly in metropolitan counties. Within nonmetropolitan areas, urbanized remote counties became more prominent centers of the physician supply. Osteopaths were more likely to locate in the most rural areas than allopaths. The physician supply in all areas also became more specialized over time. CONCLUSIONS. The rapid growth of the US physician supply was associated with the spread of more practitioners into all parts of the country. However, the supply of physicians increased most rapidly in urban areas, widening urban-rural differences in the availability of physicians.     

Organochlorine pesticide exposure in rural and urban areas in Mexico

The objective of this study was to determine the level of organochlorine pesticides in maternal milk of women living in urban and rural areas in central Mexico. High levels of the DDT (1,1,1,-trichloro-2,2-bis (p-chlorophenyl) ethane) and metabolites, p,p'-DDT (1.83, 0.66 and 3.13 mg/kg) and p,p'-DDE (2.49, 4.28 and 13.32 mg/kg), were encountered for Mexico City, Cuemavaca and rural Morelos, respectively. As was expected, the highest levels of exposure to these pesticides were found in the rural areas of the State of Morelos.     

PCR assay targeting virulence genes of Helicobacter pylori isolated from drinking water and clinical samples in Lahore metropolitan, Pakistan

Helicobacter pylorus is considered for chronic gastritis, gastric ulcers and adenocarcinoma and its high infection rate is observed in overcrowded and lower socioeconomic groups in developing countries. This study was designed to identify the role of drinking water in the transmission and prevalence of H. pylori (HP). Selective HP medium was developed for enrichment and presumptive identification of H. pylori by urease, catalase and species specific 16S rRNA tests. The virulence genes (vacA ‘s’ and ‘m’ regions and cagA) of H. pylori in 90 out of 225 H. pylori positive drinking water samples were present (40%). Ten out of 18 biopsies (55.55%) and 15 out of 50 vomiting fluids of gastric disease patients (30%) were also positive for virulence genes. Anti-H. pylori antibodies were also detected in 31 out of 50 patients’ sera. The presence of virulence genes was also directly confirmed by hybridization studies using non-radioactive DNA probes of 16S rRNA, vacA and cagA genes. The presence of H. pylori in water is due to poor sanitary conditions, improper waste disposal and lack of public health education. PCR-based analysis and colony hybridization can be used for detection of H. pylori in clinical and environmental samples.