American Journal of Public Health Research

Many research outcomes highlight the use of behavioral changes to combat obesity. This study attempts to examine and discuss the potential use of physical activity and less energy intakes in mitigating obesity among the adults in Appalachia, USA. Within the context of utility theory and behavioral aspect of energy balances of an individual, a system of simultaneous equations with three endogenous variables; decision to reduce energy intakes, time engaged in physical activity and Body Mass Index (BMI) were used for the analysis. The results highlight the potentials of weight control by reducing energy intakes and engaging in more physical activity. Importantly, the results emphasize that elderly individuals are less likely to engage in physical activity and reduce energy intakes to control BMI at the same time. The individuals with high BMI values are more likely to reduce energy intakes than engage in physical activity. The male are more likely to engage in physical activity to control obesity than reducing energy intakes while the female are more likely to reduce energy intakes than engaging in physical activity. Higher income generation, job opportunities, service of health professionals, and availability of recreational facilities play a key role in changing behaviors for controlling obesity.

American Journal of Public Health Research. 2014, 2(4), 176-181. DOI: 10.12691/ajphr-2-4-8
Pub. Date: September 16, 2014

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An Ecological Study of the Role of Obesity and Excessive Alcohol Consumption on the Risk for Epithelioid Hemangioendothelioma Cancer of the Liver, Lungs, and Bones

by Brina M. Hollis

Original Research

Purpose: To examine excessive alcohol consumption and obesity as risk factors for epithelioid hemangioendothelioma (EHE) of the liver, lungs, and bones. Methods: The nine tenets of the Bradford Hill criteria of epidemiological causation served as the conceptual framework of this study. Documented cases of EHE of the liver, lungs, and bones were collected from the International Hemangioendothelioma Epithelioid and Related Vascular Disorders registry database. A secondary data analysis was conducted using the Behavioral Risk Factor Surveillance System telephone survey. US census data were employed to obtain regional demographic data that were used as covariate controls for the study. Correlation and regression analyses were conducted to examine relationships among the rates of regional obesity, alcohol consumption, and prevalence of EHE of the liver, lungs, and bones. Results: Obesity proved to be a significant predictor of EHE of the liver, lungs, and bones; excessive alcohol consumption was not a significant predictor. Income was found to be a statistically significant covariate. Conclusions: The results highlight the need for research further examining the link between obesity and EHE. Knowledge of potential risk factors may facilitate greater understanding of this rare cancer and the development of improved protocols to expand EHE screening and documentation.

American Journal of Public Health Research. 2014, 2(4), 170-175. DOI: 10.12691/ajphr-2-4-7
Pub. Date: August 31, 2014

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Improvement of Health Sector in Kenya

by Haradhan Kumar Mohajan

Original Research

Kenya faces major socio-economic and health challenges since the independent 1963. Tuberculosis, HIV/AIDS and malaria are the leading causes of morbidity and mortality in Kenya. The Government of Kenya has been trying to build a health system which can effectively provide quality health services to the population of the country. In Kenya, health services are provided through a network of over 5,000 health facilities countrywide. The country spends 5.1% of its GDP on health sector. As a result both mortality and morbidity rates are decreasing in Kenya. Infant and under-5 mortality rates are high in the country compare to the some other developing countries. Despite many attempts are taken by the Government yet the health sector of Kenya is far to reach the Millennium Development Goals. The paper discusses aspects of health of Kenya to make a healthy nation in the world.

American Journal of Public Health Research. 2014, 2(4), 159-169. DOI: 10.12691/ajphr-2-4-6
Pub. Date: August 25, 2014

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Maternal Autonomy, Distance to Health Care Facility and ANC Attendance: Findings from Madiany Division of Siaya County, Kenya

by C.O. Asweto, J.R. Aluoch, C.O. Obonyo and J.O. Ouma

Original Research

Half a million women die annually from pregnancy related causes. In Kenya, maternal mortality ratio (MMR) remains high in spite of great efforts to improve maternal health care. We studied some factors linked to maternity in a rural community setting. A survey was conducted in the community living in Madiany division of Siaya County, Kenya. We randomly sampled 403 mothers of children under three years old. Variables of interest were antenatal care attendance (ANC), parity, distance from the health facility and women empowerment (autonomy). Nearly 94% of the mothers had at least one ANC visit and 48.6% had completed the recommended four or more ANC visits; about 65.7% initiated ANC at first trimester. Parity, distance to the health facility and autonomy were associated with ANC visits. Mothers with one child had a twice higher chance of at least four ANC visits than those with more than one child. Those living at most 60 minutes travel-time from the health facility were seven times more likely have early ANC initiation and five times more likely to have at least four ANC attendance than those living more than 60 minutes travel-time from the health facility. Autonomy was linked to early initiation of ANC visit. This may indicate that improving maternal care and achieving Millennium Development Goal (MDG) 5 target, it is important to improve coverage of health facilities and implement development programs that empower rural women.

American Journal of Public Health Research. 2014, 2(4), 153-158. DOI: 10.12691/ajphr-2-4-5
Pub. Date: August 18, 2014

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Family Based Directly Observed Therapy on Culture Conversion in Newly Diagnosed Pulmonary Tuberculosis Patients

by Duangjai Duangrithi, Kamol Phojanamongkolkij, Vipa Thanachartwet, Varunee Desakorn, Yuthichai Kasetjaroen, Pasakorn Jitruckthai, Duangjai Sahassananda and Punnee Pitisuttithum

Original Research

Background: The effectiveness of directly observed therapy (DOT) on TB treatment outcome has been debated and different findings regarding different DOT practices and settings were demonstrated. Methodology: The observational study was conducted in new sputum smear and culture positive pulmonary TB patients at Queen Savang Vadhana Memorial Hospital and Chonburi Hospital, Chonburi province, Thailand during April 2010 and July 2012. The aim of this study was to evaluate the effect of family based DOT toward sputum culture conversion. Sputum AFB smear, culture and drug susceptibility test were performed at the time of diagnosis, the second and the fifth month of treatment. Baseline characteristic, clinical and laboratory parameters, treatment regimens and adverse events were recorded. Descriptive statistics were applied as appropriate. Results: Proportion of patients with illiteracy, visual alteration and hepatitis was significantly higher in family based DOT group (p=0.026, p=0.011 and p=0.031). Sputum smear and culture conversion at 2 and 5 months after treatment were not significantly different between family based DOT and self administer groups. Patients in both group achieved over 90% cure rate without significant difference (p=0.262). Conclusions: Continuing patient education, counseling and AEs monitoring should be incorporated into family based DOT to achieved successful outcome. DOT can be interfered by many factors. Therefore appropriate implementing of DOT can enhance effectiveness of DOT toward patient adherence and further achieve success in TB treatment and control.

American Journal of Public Health Research. 2014, 2(4), 147-152. DOI: 10.12691/ajphr-2-4-4
Pub. Date: August 06, 2014

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Health Inequity at The Local Level: Theoretical Aspects and The Experience of Stavropol

by Karen Amlaev

Review Article

1. The article describes the state of the problem of inequality in health in the world. The main causes of increasing inequality in health. The authors refer to them economic differentiation of society, the transition from health to the health of clinical medicine, unequal access to health services. Analyzed the influence of socio-economic determinants that shape inequality in health. As the most important factors are considered poverty, ecological trouble, lack of education. Shown that lifestyle residents largely confined to socio economic factors that do not depend directly on the person. 2. This article discusses the concept of adherence and compliance of patients. We describe the pharmacological, clinical, and physical methods for assessing adherence. Factors affecting patient compliance, which include sex and age; characterological features of the patient, low education, level of will power, lack of education and intelligence, characteristics of the disease, the correct choice of the drug: it is fast enough and good efficacy and good tolerability; treatment regimen, the presence of drugs prescribed by your doctor pharmacies. 3. The article describes the situation with health literacy. The article describes the state of the problem of inequality in health in the world. The main causes of increasing inequality in health. The authors refer to them economic differentiation of society, the transition from health to the health of clinical medicine, unequal access to health services. Analyzed the influence of socio-economic determinants that shape inequality in health. As the most important factors are considered poverty, ecological trouble, lack of education. Shown that lifestyle residents largely confined to socio economic factors that do not depend directly on the person. The facts of correlation of health literacy to self-assessment of their own health, with personal income, economic growth, empowerment of women, life expectancy were presented. A review of effective European strategies for improving health literacy was done.

American Journal of Public Health Research. 2014, 2(4), 136-146. DOI: 10.12691/ajphr-2-4-3
Pub. Date: June 29, 2014

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Providers’ Knowledge of the Guidelines for Intermittent Preventive Treatment for Malaria in Pregnancy: Evidence from Bungoma East District, Kenya

by Angela Chepkemoi Ng’etich-Mutulei and Tom Odhiambo

Original Research

Introduction: Intermittent Preventive Treatment for malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine is a key intervention for malaria prevention. Providers’ knowledge of IPTp guidelines is crucial for effective services and achievement of the Roll Back Malaria target. This study assessed providers’ knowledge of the IPTp guidelines, with a view to contributing towards policy deliberations aimed at improving providers’ knowledge and service quality. Methods: We sourced primary data from 34 providers working in public health facilities, including the district and sub-district hospitals, health centres, and dispensaries. The test items included definition of IPTp; timing of the first IPTp dose; whether women on cotrimoxazole should be given IPTp; as well as whether IPTp can be given with folic acid, among others. Quantitative analysis techniques included frequency distributions and cross-tabulations with Chi Square statistic. Findings: Only one-third (29.4%) of the participants provided correct responses to all the ten test items; hence, were considered to be ‘knowledgeable’ about the guidelines. About 56% of the providers had accessed some training on IPTp, while a significant variation in IPTp knowledge emerged between trained and untrained providers. The study also found significant variation in providers’ knowledge of most guidelines across the cadres as well as across health facility tiers. Interpretation: The failure of about 71% of the providers to state correct responses to all the test items suggests that providers’ knowledge of the guidelines remains low. Trained providers were likely to be more knowledgeable than their untrained counterparts were; clinical officers were likely to be more knowledgeable than community health workers were, while providers at the district hospital were likely to be more knowledgeable than providers at the dispensaries were. The study recommends the need to scale-up in-service training; package and disseminate the guidelines in portable materials; and prioritize training opportunities for lower cadres and providers in lower tier facilities.

American Journal of Public Health Research. 2014, 2(4), 125-135. DOI: 10.12691/ajphr-2-4-2
Pub. Date: June 25, 2014

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User-Fees in Health Services: Assessing how it Impacts on Access, Utilization and Quality of Care in a Tertiary Health Facility in Delta State, Nigeria

by Ejughemre Ufuoma John and Ivrogbo Stanley

Original Research

Objective: To assess how user-fees policy impacts on clienteles’ access to care, willingness to utilize health services and their satisfaction with the quality of healthcare, having to pay at the point of service in a tertiary health facility. Method: This was a cross-sectional descriptive study. The instrument was a pre-tested, semi-structured self administered questionnaire. Descriptive statistics as well as chi-square test and regression analysis were done to show statistically significant associations. Results: The findings reveal different modes money was made available for payment for health services. On the whole, about 98% of payment were through ‘formal’ out-of pocket spending (user-fees) with most respondents having to source for funds from own money. It was shown that user-fees increases ‘rational’ demand for services and at the same time decreasing the willingness to seek such level of care. However, it is associated with better quality service delivery. Conclusion: The findings from this study has brought to the fore that user-fee policy is an effective mechanism for achieving desired health outcomes in tertiary care. However, there remain the problems of inequities in tertiary healthcare coverage. The evidence so far suggests that user fees alone will not accomplish the sustainability objectives in health financing in the country. This suggests that charges levied for tertiary health services should therefore be linked to the broader package of financing through health insurance coverage.

American Journal of Public Health Research. 2014, 2(4), 119-124. DOI: 10.12691/ajphr-2-4-1
Pub. Date: June 22, 2014

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