Unmet Family Planning Need: Differences and Levels of Agreement Between Husband-Wife, Haryana, India

Research question:

Is there agreement between husbands and wives regarding unmet need of family planning?

Hypothesis:

The unmet need of family planning is perceived more by women then their husbands.

Objective:

1) To ascertain the unmet needs of family planning for husbands and wives. 2) To ascertain the level of agreement between husbands and wives regarding unmet needs of family planning.

Design:

A cross-sectional survey

Setting:

Dayalpur village in Intensive field practice area of Comprehensive Rural Health Services project (CRHSP), Ballabgarh, Haryana.

Study Period:

July 2003- June 2005.

Participants

included 200 married couples selected by simple random sampling.

Statistical Analysis:

Level of agreement between husbands and wives was analyzed using Kappa statistics.

Results:

Unmet need for family planning was 11% (22 out of 200) for husbands and 17.5% (35 out of 200) for wives. The difference was seen both in unmet need for spacing (M-3.5% vs. F-6%) as well as limiting family size (M-7.5% vs. F-11.5%). Overall, 93.5% concordance was observed amongst husbands and wives. In all the cases where disagreement was seen (6.5%), wives reported having unmet need for contraception whereas their husbands perceived none. The unadjusted Kappa statistic was 0.73 and prevalence adjusted Kappa was 0.88.

Conclusion:

Unmet need for family planning was significantly higher for wives compared to husbands. Despite high degrees of agreement amongst the couples, the nature of disconcordance reinforces the need for policy makers to take into account the perspective of men.     

How Much do Rural Indian Husbands Care for the Health of their Wives'

Objective:

To ascertain the response of husbands to their wives'' health problems.

Materials and Methods:

We selected 100 couples through a systematic random sampling from 4 purposively selected villages; these couples were interviewed by a social worker in rural North India through house-to-house survey. The role of husbands during pregnancy, puerperium and during the wives'' illness was explored. Their awareness with regard to the reproductive health problems of their wives was also ascertained. Another outpatient department (OPD)-based interview of female (n = 300) patients was conducted; 50 each at health post, subcenter, primary health centers (PHC), community health center (CHC), 50-bed hospital and apex institution. Previous consultation history was also obtained.

Results:

Husbands escorted their wives to hospital in 30–40% cases. This was mainly for a visit to bigger hospitals in cities/towns. Husbands decided regarding the treatment agency in the majority of cases. In 10% cases, they took time off their work during wives'' sickness and helped in household work. Consultation within a week was 100%. The husbands'' knowledge regarding the safe period was inadequate. Majority (78%) said that women remained ill more often. Most wives were satisfied with the role of their husbands during their pregnancy or illness. A majority (80%) of husbands favored education of women up to the 10th standard and 87% were in favor of working women.

Conclusion:

Reasonably favorable attitude of husbands towards their wives'' health problems was witnessed. This needs to the carefully nurtured.     

Evaluation of Work Place Stress in Health University Workers: A Study from Rural India

Background:

Healthcare providers being over-worked and under staffed are prone to poor mental health. Unhealthy work place compounds it further.

Aims:

This study was aimed at to assess the mental health status of a medical university employee with special reference to work place stressors.

Settings and design:

A cross-sectional study was designed and carried out at a Rural Health University.

Materials and Methods:

Both the General Health Questionnaire (GHQ)-12 and Holmes–Rahe Scale were used to evaluate 406 participants.

Statistical analysis:

Multivariate analysis, correlation, and ANOVA by SPSS 11.0.

Results:

The minimum age of the participant was 19 years and the maximum 64 years, with an average age at 35.09 years. On the GHQ scale 239(58.9%) recorded psychiatric morbidity out of which 201(49.5%) had moderate and 38(9.3%) severe morbidity. Doctors were the highest stressed group (P ≤ 0.04). Prominent work environmental stressors were poor departmental reorganization, lack of cohesiveness in department, difficult superiors and juniors (P ≤ 0.001, Pearson correlation). Stressors associated with work organization and work nature were: noninvolvement in departmental decision making and lack of proper feedback; along with; work load, lack of clarity in job, and a erratic work schedule (P ≤ 0.001 on Pearson correlation). Harassment, favoritism, discrimination, and lack of self-expression (P ≤ 0.003) were other factors responsible for work dissatisfaction.

Conclusions:

A high stress level was detected in the study population. The principal stressors were work environment related. Poor work culture was found to lead to job dissatisfaction among majority.     

Relationship of Psychosocial Risk Factors, Certain Personality Traits and Myocardial Infarction in Indians: A Case�Ccontrol Study

Objective:

To investigate the relationship of psychosocial factors (lack of social support, stress and subjective well-being) and personality traits with myocardial infarction (MI).

Materials and Methods:

A case–control study involving 100 cases and 100 matched controls was conducted in Lok Nayak Hospital, New Delhi.

Results:

Stress over 1 year was significantly higher in cases (P < 0.001). However, difference was not significant when scores of social support (P = 0.2), Presumptive Stressful Life Event (PSLE) over lifetime (P = 0.058) and subjective well-being (P = 0.987) were compared. MI was significantly associated with hyperactive (P < 0.001), dominant (P = 0.03), egoistic (P < 0.001) and introvert (P < 0.001) personalities.

Conclusion:

Certain personality traits and recent stress may be important risk factors of MI, especially in Indians. The finding may have implications on the preventive strategies planned for MI patients.     

An exploration of patient and family engagement in routine primary care visits

Background

Older adults are commonly accompanied to routine medical visits. Whether and how family companion behaviours relate to visit processes is poorly understood.

Objective

To examine family companion behaviours in relation to older adults'' medical visit processes.

Design and participants

Observational study of 78 accompanied primary care patients ages 65 and older.

Main outcome measures

Medical visit communication (coded using RIAS), patient verbal activity (as a proportion of visit statements) and visit duration (in min), from audio recordings.

Results

Companions'' facilitation of patient involvement was associated with greater patient question asking (P = 0.017) and orienting statements, less passive agreement (P = 0.004) and social talk (P = 0.013) and visits that were 3.4 min longer (P = 0.025). Facilitation of patient understanding was associated with less physician question asking (P = 0.004), visits that were 3.0 min longer (P = 0.031), and lower patient verbal activity (30.3% vs. 36.9% of visit statements; P = 0.028). Facilitation of doctor understanding was associated with greater patient biomedical information giving (P = 0.049). Autonomy detracting behaviours were not associated with visit duration but were associated with lower levels of patient verbal activity (36.3% vs. 29.1% of visit statements; P = 0.041). When companions assumed more behaviours, medical visits were incrementally longer (16.1, 19.5, 21.7 min, corresponding to 0–1, 2–4 and 5+ behaviours; P < 0.001 both contrasts), and patients were less verbally active (35.6%, 33.9%, 27.1% of visit statements; P = 0.09 and P = 0.009, respectively).

Discussion

Behaviours assumed by patients'' companions were associated with visit communication, patient verbal activity and visit duration.

Conclusions

Interventions to capitalize on family companions'' presence may benefit medical visit processes.     

Spousal Communication, Changes in Partner Attitude, and Contraceptive Use Among the Yorubas of Southwest Nigeria

Objective:

This paper highlights the relevance of spousal communication on males'' attitude towards their partners'' contraceptive use.

Design:

This was a cross-sectional study.

Materials and Methods:

Data for the study were obtained from a survey carried out in three states, Oyo, Osun, and Ondo, mainly inhabited by the Yorubas.

Results:

The results show that men have a significant role to play in the adoption of contraception. About 37% of the respondents reported joint decision making on when to have another child, 40.8% on whether to stop having children, and 44% on what to do to stop childbearing. Communication between a husband and wife on reproductive matters was also recognized as a factor that may influence male participation in family planning.

Conclusion:

This study has shown that the male partner may be highly motivated to obtain contraceptives. The results therefore suggest that male involvement in family planning should be encouraged through inter-spousal communication.     

Associations of SF-36 mental health functioning and work and family related factors with intentions to retire early among employees

Objective

To examine the associations of mental health functioning (SF‐36) and work and family related psychosocial factors with intentions to retire early.

Methods

Cross sectional survey data (n = 5037) from the Helsinki Health Study occupational cohort in 2001 and 2002 were used. Intentions to retire early were inquired with a question: “Have you considered retiring before normal retirement age?” Mental health functioning was measured by the Short Form 36 (SF‐36) mental component summary (MCS). Work and family related psychosocial factors included job demands and job control, procedural and relational justice, conflicts between work and family, and social network size. Multinomial regression models were used to analyse the data.

Results

Poor mental health functioning, unfavourable psychosocial working conditions, and conflicts between work and family were individually related to intentions to retire early. After adjustments for all work and family related factors the odds ratio for low mental health functioning was halved (from OR = 6.05 to 3.67), but nevertheless the association between poor mental health functioning and strong intentions to retire early remained strong.

Conclusions

These findings highlight not only the importance of low mental health and unfavourable working conditions but also the simultaneous impact of conflicts between work and family to employees'' intentions to retire early.     

Eating habits and eating behaviors by family dinner frequency in the lower-grade elementary school students

BACKGROUND/OBJECTIVES

Recently, there has been an increased interest in the importance of family meals on children''s health and nutrition. This study aims to examine if the eating habits and eating behaviors of children are different according to the frequency of family dinners.

SUBJECTS/METHODS

The subjects were third-grade students from 70 elementary schools in 17 cities nationwide. A two-stage stratified cluster sampling was employed. The survey questionnaire was composed of items that examined the general characteristics, family meals, eating habits, eating behaviors, and environmental influence on children''s eating. The subjects responded to a self-reported questionnaire. Excluding the incomplete responses, the data (n = 3,435) were analyzed using χ²-test or t-test.

RESULTS

The group that had more frequent family dinners (≥ 5 days/week, 63.4%), compared to those that had less (≤ 4 days/week, 36.6%), showed better eating habits, such as eating meals regularly, performing desirable behaviors during meals, having breakfast frequently, having breakfast with family members (P < 0.001), and not eating only what he or she likes (P < 0.05). Those who had more frequent family dinners also consumed healthy foods with more frequency, including protein foods, dairy products, grains, vegetables, seaweeds (P < 0.001), and fruits (P < 0.01). However, unhealthy eating behaviors (e.g., eating fatty foods, salty foods, sweets, etc.) were not significantly different by the frequency of family dinners.

CONCLUSIONS

Having dinner frequently with family members was associated with more desirable eating habits and with healthy eating behaviors in young children. Thus nutrition education might be planned to promote family dinners, by emphasizing the benefits of having family meals on children''s health and nutrition and making more opportunities for family meals.     

Epidemiological Study of Road Traffic Accident Cases from Western Nepal

Background:

Road Traffic Accident (RTA) is one among the top five causes of morbidity and mortality in South-East Asian countries.(1) Its socioeconomic repercussions are a matter of great concern. Efficient addressing of the issue requires quality information on different causative factors.

Research Question:

What are different epidemiological determinants of RTA in western Nepal?

Objective:

To examine the factors associated with RTA.

Study Design:

Prospective observational.

Setting:

Study was performed in a tertiary healthcare delivery institute in western Nepal.

Participants:

360 victims of RTA who reported to Manipal Teaching hospital in one year.

Study Variables:

Demographic, human, vehicular, environmental and time factors. Statistical analysis: Percentages, linear and logarithmic trend and Chi-square.

Results:

Most of the victims i.e. 147 (40.83%) were young (15 to 30 years); from low i.e. 114 (31.66%) and mid i.e. 198 (55%) income families and were passengers i.e. 153 (42.50%) and pedestrians i.e. 105 (29.16%). Sever accidents leading to fatal outcome were associated with personal problems (P<0.01, χ² - 8.03), recent or on-day conflicts (P<0.001, χ² - 18.88) and some evidence of alcohol consumptions (P<0.001, χ² - 30.25). Increased prevalence of RTA was also noticed at beginning i.e. 198 (55%) and end i.e. 69 (19.16%) of journey; in rainy and cloudy conditions (269 i.e. 74.72%) and in evening hours (3 to 7 p.m. 159 i.e. 44.16%). Out of 246 vehicles involved; 162 (65.85%) were old and ill maintained. The contributions of old vehicle to fatal injuries were 33 (50%). Head injury was found in 156 (43.33 %) cases and its associated case fatality rate was 90.90%. In spite of a good percentage receiving first aid i.e. 213 (59.16%) after RTA; there was a notable delay (174 i.e. 48.33% admitted after 6 h) in shifting the cases to the hospitals. The estimated total days lost due to hospital stay was 4620 with an average of 12.83 days per each case.

Conclusion:

Most of the factors responsible for RTA and its fatal consequences are preventable. A comprehensive multipronged approach can mitigate most of them.     

Pregnancy Outcome of Women With Gestational Diabetes in a Tertiary Level Hospital of North India

Background:

Women with gestational diabetes mellitus (GDM) pose an important public health problem because diabetes not only affects the maternal and fetal outcome, but these women and their fetuses are also at an increased risk of developing diabetes and related complications later in their life.

Objectives:

The study was conducted to determine the maternal and fetal outcomes of 50 diabetic vs 50 normoglycemic pregnancies.

Materials and Methods:

This was a retrospective analytical record-based study conducted in a tertiary level hospital. Detailed information regarding maternal, fetal, and labor outcome parameters was recorded in a prestructured proforma and compared in normoglycemic and diabetic pregnancies.

Results:

Patients with obesity, history of diabetes in the family, spontaneous abortions, and gestational diabetes in previous pregnancies had a greater incidence of GDM in current pregnancy (P<0.05 for all). Hypertension, polyhydramnios, macrosomia, fetopelvic disproportion, and cesarean sections were more (P<0.001) among diabetic pregnancies. Congenital anomalies, polycythemia, hypocalcemia, and hyperbilirubinemia were also observed to be more (P<0.05) in neonates born to diabetics, suggesting an adverse effect of hyperglycemia in utero.

Conclusion:

Diabetes during pregnancy is associated with higher maternal and fetal morbidity. Therefore, early screening, detection, close monitoring, and intervention is essential to reduce maternal and fetal short- and long-term adverse effects, especially in high-risk groups. Pregnancy provides an opportunity to the clinician to control the disease process and inculcate healthy lifestyle practices in these patients.     

Teenage Pregnancy: A Socially Inflicted Health Hazard

Background:

Early marriage and confinement are contributing factors to high maternal and perinatal mortality and morbidity.

Objective:

To assess the magnitude of the problem of teenage pregnancy and its complications.

Materials and Methods:

A hospital-based cohort study was undertaken over 4 months among women admitted to a rural hospital in West Bengal. The study cohort comprised of teenage mothers between 15-19 years old and a control cohort of mothers between 20-24 years old. Data included demographic variables, available medical records, and complications viz. anemia, preterm delivery, and low birth weight. Anemia was defined as a hemoglobin level below 10 gm% during the last trimester of pregnancy, preterm delivery was defined as occurring within 37 weeks of gestation, and low birth weight was defined as babies weighing less than 2500 grams at birth.

Result:

Teenage pregnancy comprised 24.17% of total pregnancies occurring in the hospital during the study period. The study group had 58 subjects and the control group had 91 subjects. The prevalence of anemia was significantly higher (P<0.05) in the women in the teenage group (62.96%) than in the women in the control group (43.59%). However, severe anemia with a hemoglobin level below 8 gm% was only found in the control group. Preterm delivery occurred significantly more (P<0.001) in the study group (51.72%) than in the control group (25.88%). The incidence of low birth weight was significantly higher (P<0.0001) among the group of teenagers (65.52%) than among the women in the control group (26.37%). Not a single newborn was above 3 kg in the study group, while none were below 1.5 kg in the control group. The mean birth weight was 2.36 kg in the study group and 2.74 kg in the control group; the difference was strongly significant (P<0.001).

Conclusion:

The study shows that anemia, preterm delivery, and low birth weight were more prevalent among teenagers than among women who were 20-24 years old. This indicates the need for enhancing family welfare measures to delay the age at first pregnancy, thereby reducing the multiple complications that may occur in the young mother and her newborn baby.     

The Effect of Education and Awareness on the Quality-of-Life in Postmenopausal Women

Objectives:

Women are one of the most important parts of the family and society, and community health is dependent on provision of the needs of this group. Menopause is one of the most critical stages of life among women. One of the aims of health services for all of the people in the 21^st century is improvement of the quality-of-life. In menopausal women, the term quality-of-life incorporates its physical symptoms such as hot flushes, night sweats and vaginal mucosa dryness. We set out this study in order to evaluate the effect of education on the quality-of-life and the improvement of health standards in menopausal women.

Materials and Methods:

Sixty-two women aged 44–55 referring to and academic outpatient clinic in Shiraz were selected by simple random sampling, and allocated in two groups. Data was collected using a modified Hildich questionnaire on quality-of-life in menopause stage. Quality-of-life of the subjects (vasomotor, psychosocial, physical and sexual aspects) were evaluated prior to and 3 months after educational intervention.

Results:

Mean quality-of-life score in study and control groups, prior to education, was 81.7 and 74.8; changing to 75.3 and 75.8, respectively three months after intervention. The study group showed a significant improvement in their quality-of-life (P = 0.001). A significant difference was seen between groups in terms of changing quality-of-life after intervention (P = 0.001).

Conclusions:

Appropriate training to menopausal women improves their quality-of-life and promotes their health.     

The Study of Lipid Profile, Diet and Other Cardiovascular Risk Factors in Children Born to Parents Having Premature Ischemic Heart Disease

Background:

Dyslipidemia is a marker for ischemic heart disease (IHD), which can be detected in early childhood and tracks to adulthood. Dyslipidemia, along with factors like diet, obesity and sedentary activity, increases the risk of a child developing IHD in adulthood. Early detection and modification of these risk factors can prevent IHD.

Objectives:

To study the lipid profile in children born to parents with history of premature IHD and also to study the effect of diet, lifestyle factors, and obesity in the study group.

Materials and Methods:

Fifty children of parents with premature IHD and 50 control children without any family history of IHD were analyzed for cardiovascular risk factors such as lipid profile, body mass index (BMI) and hypertension. The effects of modifiable risk factors like diet and physical activity on lipid profile were analyzed. The correlation between parent and child lipid profile was studied.

Results:

Mean total cholesterol, low density lipoprotein cholesterol and triglycerides were significantly higher (P<0.05) in children with family history of IHD as compared to children without family history. There was a positive correlation between lipid levels of parents and their children. Children with elevated BMI, a sedentary lifestyle, and excess oily/junk diet intake showed increased incidence of dyslipidemia (P<0.05).

Conclusions:

Children of IHD patients have significant incidence of dyslipidemia. The risk factors like BMI, diet and physical activity increase the incidence of dyslipidemia. Therefore, all children of premature IHD patients should be screened for dyslipidemia.     

Impact of a cash-for-work programme on food consumption and nutrition among women and children facing food insecurity in rural Bangladesh

Objective

To determine whether a cash-for-work programme during the annual food insecurity period in Bangladesh improved nutritional status in poor rural women and children.

Methods

The panel study involved a random sample of 895 households from over 50 000 enrolled in a cash-for-work programme between September and December 2007 and 921 similar control households. The height, weight and mid-upper arm circumference of one woman and child aged less than 5 years from each household were measured at baseline and at the end of the study (mean time: 10 weeks). Women reported 7-day household food expenditure and consumption on both occasions. Changes in parameters were compared between the two groups.

Findings

At baseline, no significant difference existed between the groups. By the study end, the difference in mean mid-upper arm circumference between women in the intervention and control groups had widened by 2.29 mm and the difference in mean weight, by 0.88 kg. Among children, the difference in means between the two groups had also widened in favour of the intervention group for: height (0.08 cm; P < 0.05), weight (0.22 kg; P < 0.001), mid-upper arm circumference (1.41 mm; P < 0.001) and z-scores for height-for-age (0.02; P < 0.001), weight-for-age (0.17; P < 0.001), weight-for-height (0.23; P < 0.001) and mid-upper arm circumference (0.12; P < 0.001). Intervention households spent more on food and consumed more protein-rich food at the end of the study.

Conclusion

The cash-for-work programme led to greater household food expenditure and consumption and women’s and children’s nutritional status improved.     

Equipment Errors: A Prevalent Cause for Fallacy in Blood Pressure Recording - A Point Prevalence Estimate from an Indian Health University

Background:

Blood pressure (BP) recording is the most commonly measured clinical parameter. Standing mercury sphygmomanometer is the most widely used equipment to record this. However, recording by sphygmomanometer is subject to observer and instrumental error. The different sources of equipment error are faulty manometer tube calibration, baseline deviations and improper arm bladder cuff dimensions. This is further compounded by a high prevalence of arm bladder miss-cuffing in the target population.

Objectives:

The study was designed to assess the presence of equipment malcalibrations, cuff miss-matching and their effect on BP recording.

Materials and Methods:

A cross-sectional check of all operational sphygmomanometers in a health university was carried out for the length of the manometer tube, deviation of resting mercury column from “0” level, the width and length of arm bladder cuff and extent of bladder cuff-mismatch with respect to outpatient attending population.

Results:

From the total of 50 apparatus selected, 39 (78%) were from hospital setups and 11 (22%) from pre-clinical departments. A manometer height deficit of 13 mm was recorded in 36 (92.23%) of the equipment in hospital and 11 (100%) from pre-clinical departments. Instruments from both settings showed significant deviation from recommended dimensions in cuff bladder length, width and length to width ratio (P < 0.001). Significant number of apparatus from hospital setups showed presence of mercury manometer baseline deviation either below or above 0 mmHg at the resting state (χ² = 5.61, D. F. = 1, P = 0.02). Positive corelationship was observed between manometer height deficit, baseline deviation and width of arm cuff bladder (Pearson correlation, P < 0.05). Bladder cuff mismatching in response to the target population was found at 48.52% for males and 36.76% for females. The cumulative effect of these factors can lead to an error in the range of 10-12 mmHg.

Conclusion:

Faulty equipments and prevalent arm bladder cuff-mismatching can be important barriers to accurate BP measurement.     

Awareness of Menstrual Abnormality Amongst College Students in Urban Area of Ile-Ife, Osun State, Nigeria

Background:

Disturbances of menstrual bleeding are major social and medical problem for women and account for high percentage of gynecological visit.

Objectives:

The objective of the study was to document menstrual abnormalities experienced by female college students, their awareness and health seeking behavior.

Materials and Methods:

A cross-sectional survey was undertaken, 400 students were selected using stratified sampling technique and interviewed using semi-structured self-administered questionnaire. Inferential statistical analysis such as Chi-square test and logistic regressions were carried out.

Results:

The mean age at menarche was 14.18 years. Irregular menstrual cycles were reported in 9.0%. Dysmenorrhea was present in 62.5%, and 12.5% reported school absenteeism. Students'' awareness of menstrual abnormalities was poor (29%). A few of them (10.5%) decided to seek help for menstrual abnormalities. The awareness of students on menstrual abnormalities was significantly influenced by their age (OR = 2.33, P = 0.03); however, age at menarche and level of study did not influence their awareness (OR = 0.45, P = 0.24 and OR = 1.42, P = 0.12). History of dysmenorrheal (OR = 10.2, P = 0.001) and academic disturbance (OR = 5.45, P = 0.001) had significant influence on the health seeking behavior of the students.

Conclusion:

There was a general lack of information about menstrual issues and when to seek help. There is a need to educate female college students about menstrual issues in order to improve their health seeking behavior as regards menstrual abnormalities.     

Equity in maternal and child health in Thailand

Objective

To assess equity in health outcomes and interventions for maternal and child health (MCH) services in Thailand.

Methods

Women of reproductive age in 40 000 nationally representative households responded to the Multiple Indicator Cluster Survey in 2005–2006. We used a concentration index (CI) to assess distribution of nine MCH indicator groups across the household wealth index. For each indicator we also compared the richest and poorest quintiles or deciles, urban and rural domiciles, and mothers or caregivers with or without secondary school education.

Findings

Child underweight (CI: −0.2192; P < 0.01) and stunting (CI: −0.1767; P < 0.01) were least equitably distributed, being disproportionately concentrated among the poor; these were followed by teenage pregnancy (CI: −0.1073; P < 0.01), and child pneumonia (CI: −0.0896; P < 0.05) and diarrhoea (CI: −0.0531; P < 0.1). Distribution of the MCH interventions was fairly equitable, but richer women were more likely to receive prenatal care and delivery by a skilled health worker or in a health facility. The most equitably distributed interventions were child immunization and family planning. All undesirable health outcomes were more prevalent among rural residents, although the urban–rural gap in MCH services was small. Where mothers or caregivers had no formal education, all outcome indicators were worse than in the group with the highest level of education.

Conclusion

Equity of coverage in key MCH services is high throughout Thailand. Inequitable health outcomes are largely due to socioeconomic factors, especially differences in the educational level of mothers or caregivers.