Evaluation of an interactive electronic health education tool in rural Afghanistan

INTRODUCTION: Low education levels may limit community-based health worker (CHW) efforts in rural Afghanistan. In 2004, LeapFrog Enterprises and the United States Department of Health and Human Services developed the Afghan Family Health Book (AFHB), an interactive, electronic picture book, to communicate public health messages in rural Afghanistan. Changes in health knowledge among households exposed to the AFHB vs. CHWs were compared. METHODS: From January-June 2005, baseline and follow-up panel surveys were administered in Pashto-speaking Laghman and Dari-speaking Kabul provinces. Within each province, an AFHB and a CHW district were randomly sampled using a stratified, 2-staged cluster sample design (total 98 clusters and 3,372 households). Surveys tested knowledge of 17 health domains at baseline and on follow-up at three months. For each domain, multivariate logistic regression was used to assess the effect of the AFHB on followup pass rates, controlling for demographics and differences in baseline knowledge. RESULTS: Both AFHB and CHW resulted in statistically significant changes in pass rates on follow-up, although there were greater gains among AFHB users for five domains among Pashto-speakers (micronutrients, malaria, sexually transmitted diseases, postpartum care, and breast-feeding) and seven domains among Dari-speakers (diet, malaria, mental health, birth-spacing, and prenatal/neonatal/postpartum care). Community-based health workers effected greater knowledge gains only for the Dari breast-feeding module. Participants favored CHW over the AFHB, which they found poorly translated and difficult to use. CONCLUSIONS: The AFHB has potential to improve public health knowledge among rural Afghans. Future efforts may benefit from involvement of local health agencies and the integration of interactive technology with traditional CHW approaches.     

MC1R, SLC45A2 and TYR genetic variants involved in melanoma susceptibility in Southern European populations: Results from a Meta-analysis

Background and methodsSeven genetic biomarkers previously associated with melanoma were analysed in a meta-analysis conducted in three South European populations: five red hair colour (RHC) MC1R alleles, one SLC45A2 variant (p.Phe374Leu) and one thermosensitive TYR variant (p.Arg402Gln). The study included 1639 melanoma patients and 1342 control subjects.ResultsThe estimated odds ratio (OR) associated with carrying at least one MC1R RHC variant was 2.18 (95% confidence interval (CI): 1.86–2.55; p-value = 1.02 × 10⁻²¹), with an additive effect for carrying two RHC variants (OR: 5.02, 95% CI: 2.88–8.94, p-value = 3.91 × 10⁻⁸). The SLC45A2 variant, p.Phe374Leu, was significantly and strongly protective for melanoma in the three South European populations studied, with an overall OR value of 0.41 (95% CI: 0.33–0.50; p-value = 3.50 × 10⁻¹⁷). The association with melanoma of the TYR variant p.Arg402Gln was also statistically significant (OR: 1.50; 95% CI: 1.11–2.04; p-value = 0.0089). Adjustment for all clinical potential confounders showed that melanoma risks attributable to MC1R and SLC45A2 variants strongly persisted (OR: 2.01 95% CI: 1.49–2.72 and OR: 0.50, 95% CI: 0.31–0.80, respectively), while the association of TYR p.Arg402Gln was no longer significant. In addition, stratification of clinical melanoma risk factors showed that the risk of melanoma was strong in those individuals who did not have clinical risk factors.ConclusionIn conclusion, our results show without ambiguity that in South European populations, MC1R RHC and SCL45A2 p.Phe374Leu variants are strong melanoma risk predictors, notably in those individuals who would not be identified as high risk based on their phenotypes or exposures alone. The use of these biomarkers in clinical practice could be promising and warrants further discussion.