Acceptability of condom promotion and distribution among 10 to 19 year-old adolescents in Mpwapwa and Mbeya rural districts, Tanzania

ABSTRACT: BACKGROUND: The HIV/AIDS pandemic remains a leading challenge for global health. Although condoms are acknowledged for their key role on preventing HIV transmission, low and inappropriate use of condoms persists in Tanzania and elsewhere in Africa. This study assesses factors affecting acceptability of condom promotion and distribution among Tanzanian adolescents. METHODS: Data were collected in 2011 as part of a larger cross-sectional survey on condom use among 10-19 year-olds in Mpwapwa and Mbeya rural districts of Tanzania using a structured questionnaire. Associations between acceptability of condom promotion and distribution and each of the explanatory variables was tested using Chi Square. Multivariate logistic regression model was used to examine independent predictors of the acceptability of condom promotion and distribution using STATA (11) statistical software at 5% significance level. RESULTS: Mean age of the 1,327 adolescent participants (50.5% being males) was 13.5 years (SD=1.4). Acceptance of condom promotion and distribution was found among 37% of the adolescents. Being sexually active and aged 15-19 was the strongest predictor of the acceptability of condom promotion and distribution (OR=7.78, 95% CI 4.65-12.99). Others were; not agreeing that a condom is effective in preventing transmissions of STIs including HIV (OR=0.34, 95% CI 0.20-0.56), being a resident of Mbeya rural district (OR=1.67, 95% CI 1.28-2.19), feeling comfortable being seen by parents/guardians holding/buying condoms (OR=2.20, 95% CI 1.40-3.46) and living with a guardian (OR=1.48, 95% CI 1.08-2.04). CONCLUSION: Acceptability of condom promotion and distribution among adolescents in Mpwapwa and Mbeya rural is low. Effect of sexual activity on the acceptability of condom promotion and distribution is age-dependent and was the strongest. Feeling comfortable being seen by parents/guardians buying or holding condoms, perceived ability of condoms to offer protection against HIV/AIDS infections, district of residence and living arrangements also offered significant predictive effect. Knowledge of these factors is vital in designing successful and sustainable condom promotion and distribution programs in Tanzania. Key words Acceptability, condom promotion and distribution, adolescents, Tanzania.     

Wound healing genes and susceptibility to cutaneous leishmaniasis in Brazil

Leishmania braziliensis causes cutaneous (CL) and mucosal (ML) leishmaniasis. In the mouse, Fli1 was identified as a gene influencing enhanced wound healing and resistance to CL caused by Leishmania major. Polymorphism at FLI1 is associated with CL caused by L. braziliensis in humans, with an inverse association observed for ML disease. Here we extend the analysis to look at other wound healing genes, including CTGF, TGFB1, TGFBR1/2, SMADS 2/3/4/7 and FLII, all functionally linked along with FLI1 in the TGF beta pathway. Haplotype tagging single nucleotide polymorphisms (tag-SNPs) were genotyped using Taqman technology in 325 nuclear families (652 CL cases; 126 ML cases) from Brazil. Robust case-pseudocontrol (CPC) conditional logistic regression analysis showed associations between CL and SNPs at CTGF (SNP rs6918698; CC genotype; OR 1.67; 95%CI 1.10-2.54; P=0.016), TGFBR2 (rs1962859; OR 1.50; 95%CI 1.12-1.99; P=0.005), SMAD2 (rs1792658; OR 1.57; 95%CI 1.04-2.38; P=0.03), SMAD7 (rs4464148; AA genotype; OR 2.80; 95%CI 1.00-7.87; P=0.05) and FLII (rs2071242; OR 1.60; 95%CI 1.14-2.24; P=0.005), and between ML and SNPs at SMAD3 (rs1465841; OR 2.15; 95%CI 1.13-4.07; P=0.018) and SMAD7 (rs2337107; TT genotype; OR 3.70; 95%CI 1.27-10.7; P=0.016). Stepwise logistic regression analysis showed that all SNPs associated with CL at FLI1, CTGF, TGFBR2, and FLII showed independent effects from each other, but SNPs at SMAD2 and SMAD7 did not add independent effects to SNPs from other genes. These results suggest that TGFβ signalling via SMAD2 is important in directing events that contribute to CL, whereas signalling via SMAD3 is important in ML. Both are modulated by the inhibitory SMAD7 that acts upstream of SMAD2 and SMAD3 in this signalling pathway. Along with the published FLI1 association, these data further contribute to the hypothesis that wound healing processes are important determinants of pathology associated with cutaneous forms of leishmaniasis.     

Who should receive recruitment and retention incentives? Improved targeting of rural doctors using medical workforce data

Objective: The objective of this study was to define an improved classification for allocating incentives to support the recruitment and retention of doctors in rural Australia. Design and setting: Geo‐coded data (n = 3636 general practitioners (GPs)) from the national Medicine in Australia: Balancing Employment and Life study were used to examine statistical variation in four professional indicators (total hours worked, public hospital work, on call after‐hours and difficulty taking time off) and two non‐professional indicators (partner employment and schooling opportunities) which are all known to be related to difficulties with recruitment and retention. Main outcome measures: The main outcome measure used for the study was an association of six sentinel indicators for GPs with practice location and population size of community. Results: Four distinct homogeneous population size groups were identified (0–5000, 5001‐15 000, 15 001–50 000 and >50 000). Although geographical remoteness (measured using the Australian Standard Geographical Classification – Remoteness Areas (ASGC‐RA)) was statistically associated with all six indicators (P < 0.001), population size provided a more sensitive measure in directing where recruitment and retention incentives should be provided. A new six‐level rurality classification is proposed, based on a combination of four population size groups and the five ASGC‐RA levels. A significant increase in statistical association is measured in four of six indicators (and a slight increase in one indicator) using the new six‐level classification versus the existing ASGC‐RA classification. Conclusions: This new six‐level geographical classification provides a better basis for equitable resource allocation of recruitment and retention incentives to doctors based on the attractiveness of non‐metropolitan communities, both professionally and non‐professionally, as places to work and live.     

WHAT FACTORS INFLUENCE THE EARNINGS OF GENERAL PRACTITIONERS AND MEDICAL SPECIALISTS? EVIDENCE FROM THE MEDICINE IN AUSTRALIA: BALANCING EMPLOYMENT AND LIFE SURVEY

To date, there has been little data or empirical research on the determinants of doctors' earnings despite earnings having an important role in influencing the cost of health care, decisions on workforce participation and labour supply. This paper examines the determinants of annual earnings of general practitioners (GPs) and specialists using the first wave of the Medicine in Australia: Balancing Employment and Life, a new longitudinal survey of doctors. For both GPs and specialists, earnings are higher for men, for those who are self‐employed and for those who do after‐hours or on‐call work. GPs have higher earnings if they work in larger practices, in outer regional or rural areas, and in areas with lower GP density, whereas specialists earn more if they have more working experience, spend more time in clinical work and have less complex patients. Decomposition analysis shows that the mean earnings of GPs are lower than that of specialists because GPs work fewer hours, are more likely to be female, are less likely to undertake after‐hours or on‐call work, and have lower returns to experience. Roughly 50% of the income gap between GPs and specialists is explained by differences in unobserved characteristics and returns to those characteristics. Copyright © 2011 John Wiley & Sons, Ltd.     

Nutritional vulnerability of older persons living in urban areas of Lake Victoria Basin in East Africa: a cross sectional survey

The aim of this study was to (1) determine the prevalence of malnutrition and (2) investigate factors affecting nutritional status of older persons living in urban areas of Lake Victoria Basin. The prevalence of underweight was 16.5%, with men (24.1%) being significantly more likely to be underweight (P < 0.05) than women (12.3%). Overall, 61.2% had normal body mass indices, 13.2% were overweight, and 9.1% were obese. Energy intake was low (1596.3-1630.5 Kcal), with only 22% and 38% of men and women, respectively, meeting their daily requirements. Protein intake was adequate in more than half of men and women. Vitamin A, iron, and zinc intakes were moderate, while calcium intake was low (P < 0.05). Inadequate food access, poor health, living arrangements, and poor eating patterns were the main nutritional risk factors. There is a need to plan nutrition programs that can improve living conditions, health, and nutritional status of older adults in these urban areas of the Lake Victoria Basin.     

Maternal smoking during pregnancy and the prevalence of autism spectrum disorders, using data from the autism and developmental disabilities monitoring network

Background: Reported associations between gestational tobacco exposure and autism spectrum disorders (ASDs) have been inconsistent.Objective: We estimated the association between maternal smoking during pregnancy and ASDs among children 8 years of age.Methods: This population-based case–cohort study included 633,989 children, identified using publicly available birth certificate data, born in 1992, 1994, 1996, and 1998 from parts of 11 U.S. states subsequently under ASD surveillance. Of these children, 3,315 were identified as having an ASD by the active, records-based surveillance of the Autism and Developmental Disabilities Monitoring Network. We estimated prevalence ratios (PRs) of maternal smoking from birth certificate report and ASDs using logistic regression, adjusting for maternal education, race/ethnicity, marital status, and maternal age; separately examining higher- and lower-functioning case subgroups; and correcting for assumed under-ascertainment of autism by level of maternal education.Results: About 13% of the source population and 11% of children with an ASD had a report of maternal smoking in pregnancy: adjusted PR (95% confidence interval) of 0.90 (0.80, 1.01). The association for the case subgroup autistic disorder (1,310 cases) was similar: 0.88 (0.72, 1.08), whereas that for ASD not otherwise specified (ASD-NOS) (375 cases) was positive, albeit including the null: 1.26 (0.91, 1.75). Unadjusted associations corrected for assumed under-ascertainment were 1.06 (0.98, 1.14) for all ASDs, 1.12 (0.97, 1.30) for autistic disorder, and 1.63 (1.30, 2.04) for ASD-NOS.Conclusions: After accounting for the potential of under-ascertainment bias, we found a null association between maternal smoking in pregnancy and ASDs, generally. The possibility of an association with a higher-functioning ASD subgroup was suggested, and warrants further study.