Determinants Of Vaccination Coverage In Malawi: Evidence From The Demographic And Health Surveys

The purpose of this paper is to identify groups of children in Malawi who are less or not reached by vaccination services by using data from the Demographic and Health Surveys conducted in Malawi in 1992, 1996, 2000 and 2004. These surveys have shown that the proportion of children aged 12–23 months who were fully vaccinated by 12 months of age has been decreasing: it was 67% in 1992, then 55%, 54% and 51% in 1996, 2000 and 2004, respectively. The review has also shown that birth order of the child, residence (rural/urban) and mother''s education are major determinants of the immunization status of the child.     

Women empowerment and use of contraception

Background

Use of contraception is influenced by many processes most by the women's empowerment. Women's decision making power and their autonomy within the household is the most important factor affecting contraceptive use. This paper aims to analyze the relationship between these two indicators of women's empowerment and the use of contraception.

Methods

This cross sectional study was conducted by personally interviewing 385 currently married women selected by systematic sampling on a pretested and validated questionnaire. Two indices, women's decision-making power index and women's autonomy index, were constructed and association with contraception use analyzed.

Results & Conclusion

The study gives the evidence that decision making power is low in the respondents with 48.2% (95% CI 43.34, 53.31) of them having low level of power, while 27.6% (95% CI 23.24, 32.16) have medium level and 3.6% (95% CI 2.08, 5.88) having high level of power. 22.4% (95% CI 18.39, 26.70) of women do not have any autonomy as against 43.9% (95% CI 38.99, 48.89) with low level, 25% (95% CI 20.80, 29.44) with medium autonomy and 8.7% (95% CI 6.29, 11.98) scoring above 7 (high level of autonomy). In the study population it was found that 273 (70.7%, 95% CI 66.2, 75.28) of the respondents were using contraceptives. Women's autonomy, years of marriage and number of children were significant variables.     

Women empowerment and use of contraception

Background

Use of contraception is influenced by many processes most by the women''s empowerment. Women''s decision making power and their autonomy within the household is the most important factor affecting contraceptive use. This paper aims to analyze the relationship between these two indicators of women''s empowerment and the use of contraception.

Methods

This cross sectional study was conducted by personally interviewing 385 currently married women selected by systematic sampling on a pretested and validated questionnaire. Two indices, women''s decision-making power index and women''s autonomy index, were constructed and association with contraception use analyzed.

Results & Conclusion

The study gives the evidence that decision making power is low in the respondents with 48.2% (95% CI 43.34, 53.31) of them having low level of power, while 27.6% (95% CI 23.24, 32.16) have medium level and 3.6% (95% CI 2.08, 5.88) having high level of power. 22.4% (95% CI 18.39, 26.70) of women do not have any autonomy as against 43.9% (95% CI 38.99, 48.89) with low level, 25% (95% CI 20.80, 29.44) with medium autonomy and 8.7% (95% CI 6.29, 11.98) scoring above 7 (high level of autonomy). In the study population it was found that 273 (70.7%, 95% CI 66.2, 75.28) of the respondents were using contraceptives. Women''s autonomy, years of marriage and number of children were significant variables.     

Prevalence and correlates of hunger among primary and secondary school children in Malawi: results from the 2009 Global School-based Health Survey

Background

Education is important in improving economies and creating literate, self-reliant and healthy societies. However, hunger is a barrier to basic education in Malawi. Hunger is also associated with a number of health risk behaviours, such as bullying, suicide ideation and unhygienic behaviours that may jeopardize the future of children. There are, however, limited data on the prevalence and associated factors of hunger among school children in Malawi.

Methods

The study used data from the Malawi Global School-Based Health Survey conducted in 2009 to estimate the prevalence of self-reported hunger within the last 30 days among primary and secondary school age group. It also assessed the association between self-reported hunger and some selected list of independent variables using frequency distribution, chi-squared test and logistic regression.

Results

A total of 2359 students were available for analysis. The overall self-reported prevalence of hunger within the last 30 days was 12.5% (18.9% (172) in the rural and 8.3% (115) in urban areas; and 11.9%(123) for male and 12.5(148) for female children). In the final analysis, geographical location, eating fruits, having been bullied, suicide ideation, and washing hands with soap were significantly associated with hunger.

Conclusion

Hunger in both primary and secondary school children in Malawi is a major social problem. The design of school feeding programmes aimed to reduce hunger should incorporate the factors identified as associated with hunger.     

239名孕妇口腔健康状况调查

目的 调查孕妇患龋与患牙龈炎的情况。方法 按照世界卫生组织制定的标准检查孕妇的龋失补数（DMFT）和牙龈指数（GI），以问卷形式记录其口腔行为，并结合孕妇的口腔保健行为进行分析。结果 孕妇总患龋率为53.56%，龋均1.38，患牙龈炎率72.39%。结论 随着妊娠时间的延长，孕妇患龋率与牙龈炎发生率均增加，提示应加强育龄妇女及孕妇的口腔卫生宣传，做好口腔预防保健工作。     

Non-use of Formal Health Services in Malawi: Perceptions from Non-users

Background

The study upon which this paper is based was undertaken to understand users'' and non-users'' perceptions concerning facilitators and barriers to equitable and universal access to health care in resource-poor countries such as Malawi. In this study, non-users of health services were defined as people who were not in need of health services or those who had stopped using them due to significant barriers.

Methods

A total of 80 interviews with non-users of health services were conducted in Rumphi, Ntchisi, Phalombe and Blantyre Districts of Malawi. Interviews focused on why informants were not using formal health services at the time of data collection. In order to identify non-users, snowballing was used health surveillance assistants, village headmen and community members also helped. One focus group discussion was also conducted with non-users of health services who were members of the Zion Church.

Results

Informants described themselves as non-users of health services due to several reasons: cost of health services; long distances to health facilities; poor attitude of health workers; belief in the effectiveness of traditional medicines; old age and their failure to walk. Others were non-users due to their disability; hence they could not walk over long distances or could not communicate effectively with health providers. Some of these non-users were complete non-users, namely members of the Zion Church and those who believed in traditional medicine, and they stated that nothing could be done to transform them into users of health services. Other non-users stated that they could become users if their challenges were addressed e.g. for those who were non-users of health services due to poor attitudes of health workers, they stated that if these health workers were transferred they would be able to access health services.

Conclusions

Public health education targeting both health workers and non-users, ensuring a functional outreach program and addressing other health system challenges such as shortage of drugs and human resources would assist in transforming non-users into users of health services.     

包头市土右旗妇女产褥期营养与卫生知识知晓情况调查

目的:了解包头市农区妇女产褥期营养知识与卫生知识知晓情况。方法:采用整群抽样方法,选取土右旗491例分娩后12个月内的产妇,根据调查目的制定统一的调查表,由经过培训的调查员进行面对面的问卷调查。结果:包头市土右旗产褥期妇女对牛奶补钙最佳、新鲜水果蔬莱补充维生素C、鸡肉的营养价值比鸡汤高等营养知识知晓率较高,分别为88.8%、87.4%和71.9%;但对补充矿物质的营养知识知晓率很低,在38.7%～27.6%之间。结论:包头市土右旗妇女对于产褥期相关的营养卫生知识知晓率较低。     

133名流动人口妇幼卫生保健服务意向调查分析

目的了解流动人口妇幼卫生保健服务意向。方法对133名流动人口妇女进行深入访谈。结果流动人口妇幼卫生保健服务利用水平较低。结论影响流动人口保健服务利用的主要因素为经济、健康观念、服务信息缺乏和违反计划生育政策等。为改善流动人口妇幼卫生保健服务利用,应加强宣传提高流动人口保健意识,降低流动人口接受妇幼卫生保健服务的经济门槛。     

Oral contraceptive use and the occurrence of pituitary prolactinoma

To determine whether prior oral contraceptive (OC) use is a risk factor for pituitary prolactinoma, we attempted to identify all women (n = 72) with a prolactinoma diagnosed between 1976 and 1980 in three counties in western Washington. A control group of 303 women was selected by dialing random telephone numbers from the same counties. Prior OC use, according to OC indication, was ascertained during a standardized telephone interview. Relative to the risk for women who had never used an OC, the risk of prolactinoma for women who had used OCs for birth control was 1.3 (95% confidence interval, 0.7 to 2.6). This risk was 7.7 for women who used OCs for menstrual regulation (95% confidence interval, 3.7 to 17.0). Previous findings of an association between OC use and prolactinoma may have resulted from OC treatment of menstrual irregularity in women with an undiagnosed prolactinoma.     

广州市荔湾区育龄妇女艾滋病认知调查及健康干预

目的探讨广州市荔湾区站前街社区育龄妇女对艾滋病的认知水平,以期为这一人群中开展艾滋病健康教育提供依据。方法以该社区中18～35岁的育龄妇女为研究对象,在艾滋病宣传月进行为期1个月的相关艾滋病健康教育宣传。采用定量(问卷调查)与定性研究(小组访谈)相结合的方法对社区育龄妇女进行调查。自行设计调查问卷,分别于健康教育前后收集调查问卷,分析健康教育对育龄妇女艾滋病防治知识、态度及行为的影响。结果84.1%的人认为艾滋病病毒感染者值得同情和关心。大多数社区育龄妇女愿意参加到防治艾滋病的活动中。经过健康教育后,调查对象对艾滋病基础知识、传播途径知识知晓率显著提高(P<0.01)。结论该社区育龄妇女艾滋病知识缺乏,应加强对这一人群的艾滋病健康教育,并不断地改进方法,消除育龄妇女对艾滋病的恐惧心理和对当前流行形势的麻痹认识。     

邛崃市未婚女性人工流产相关因素及生殖健康状况调查

目的：对邛崃市未婚女性人工流产相关因素及生殖健康状况进行调查。方法：对门诊未婚妊人工流产病例682例以问卷调查的方法收集资料进行分析。结果：初次人工流产466例（68．3％）,两次者169例（24．8）％,两次以上者47例（6．9％）。682例中635例（93．1％）是由于未取避孕措施造成的,她们的避孕知识得分大于60分者243例（35．6％）,小于60分409例（62％）,0分30例（4．4％）。能说出三种以上避孕药具及正确使用方法者仅82例（12％）,能正确描述紧急避方法者96例（14．1％）,听说过紧急避孕方法但不能正确描述者205例（30％）,不知道紧急避孕者（55．9％）。有膀腔炎史者（占21％）,宫外孕占0．9％,性传播疾病36例（5．3％）。80％的调查对象认为社会对他们提供的性与生殖健康信息和服务不到住。结论：未婚女性生殖健康知识贫,婚前性行为普遍,无防护性性为高,人工流产率高,身心健康损害严重。     

Rural Health Clinic Efficiency and Effectiveness: Insight from a Nationwide Survey

This study reports the results of a nationwide survey of Rural Health Clinics (RHCs). The purpose was to identify factors that contribute to efficiency and effectiveness in RHCs. Factors related to cost efficiency were analyzed using multiple regression; factors related to the likelihood of providing preventive diabetic care, an effectiveness indicator, were analyzed using logistic regression. The study found: (1) technical efficiency to be positively related to cost efficiency; (2) non-profit control to be inversely related to cost efficiency in independent RHCs; and (3) provider-based RHCs and technology use to be related to the likelihood of providing preventive diabetic care. Implications for RHCs are: (1) improvement in technical efficiency could enhance cost efficiency; (2) visits to PAs and NPs, an indicator of process efficiency, may not guarantee the provision of preventive diabetic care; and (3) strategies for improving RHC efficiency and effectiveness may be different for provider-based and independent clinics.     

Assessing Health Consumerism on the Web: A Demographic Profile of Information-Seeking Behaviors

The growing diversity of the online health information community is increasingly cited as a limiting factor related to the potential of the Internet as an effective health communication channel and information resource. Public-access Internet portals and decreasing costs of personal computers have created a consensus that unequal access to information, or a “Digital Divide,” presents a like problem specific to health care consumers. Access to information, however, is an essential part of the consumer-centric framework outlined in the recently proposed U.S. National Health Information Infrastructure (NHII) and Health Architecture initiatives. To date little research has been done to differentiate the types of health information sought on the Web by different subgroups, linking user characteristics and health-seeking behaviors. Data from a study of consumer Web search activity in a post-intervention era serves as a natural experiment, and can identify whether a “digitally underserved group” persists in the United States. Such an environment would serve to exclude traditionally underserved groups from the benefits of the planned national heath information infrastructure. This exploratory technology assessment study seeks to differentiate and delineate specific behaviors, or lack of desired behaviors, across targeted health care subgroups. Doing so allows the design of more effective strategies to promote the use of the Web as a health education and health promotion tool, under the envisioned shared decision-making, consumer-centric health information model.     

围绝经期及绝经期妇女取环的临床观察及体会

目的探讨影响围绝经期及绝经期妇女取环困难度的相关因素及有效方法。方法对235例要求取环的围绝经期及绝经期妇女行取环术,对个人基本情况、取环过程及结局进行观察,分析患者年龄、绝经年限、宫颈萎缩程度、置环年限、文化程度、工作情况、居住环境、体检情况、妊娠史及流产史与取环困难度的关系。结果患者年龄、绝经年限、重度宫颈萎缩与取环困难度呈正相关(P<0.05);无稳定工作、未定期体检者取环困难率高于有稳定工作、定期体检者(P<0.01);置环年限≥20年者取环困难率高于置环年限<20年者(P<0.05)。结论绝经期妇女应尽早取环,最好围绝经期妇女症状稳定后即取环;对于宫颈萎缩严重、组织坚硬的妇女,可用米非司酮与米索前列醇软化宫颈,降低取环难度;做好宣教工作,普及节育环相关知识,督促妇女定期体检。     

Smartphones and Health Promotion: A Review of the Evidence

Communication via mobile phones has become an essential tool for health professionals. The latest generation of smartphones is comparable to computers, allowing the development of new applications in health field. This paper aims to describe the use of smartphones by health professionals and patients in the field of health promotion. We conducted a bibliographic search through Pubmed. Then, research results were analyzed critically in order to select the best experiences available. All searches were carried out on November 2012 and were not limited by date. Each item from the initial search was reviewed independently by members of the project team. Initial search returned 472 items with PubMed. After the removal of duplicates, 406 items were reviewed by all the members of the project team and 21 articles were identified as specifically centered on health promotion. In the nutrition field there are applications that allow to count calories and keep a food diary or more specific platforms for people with food allergies, while about physical activity many applications suggest exercises with measurement of sports statistics. Some applications deal with lifestyles suggestions and tips. Finally, some positive experiences are reported in the prevention of falls in elderly and of sexually-transmitted diseases. Smartphones are transforming the ways of communication but the lack of monitoring of contents, the digital divide, the confidentiality of data, the exclusion of the health professional from the management of patient, are the main risks related to their use.