American Journal of Public Health Research

Medical referral is the act of sending a patient by one professional care giver to another, who may be a specialist and therefore be more knowledgeable in the diagnosing and further management of the patient. Most cases of referral of patients is therefore for proper diagnosis, adequate investigations and their proper treatment by the receiving specialists. It is mostly assumed and believed that patients depend on the medical information available to their health care providers. Therefore, the need for a referral, its appropriatness, timing and to whom the referral is made to mostly depends on the attending physician. This should be done after due consultation with the patients family and appropriate consent obtained. It is believed that a health practitioner should make a referral when he thinks that it will be of benefit to the patient and not when he wants to avoid the challenges of unraveling the patients’ complex problems. Also, referral should not be made to avoid possible death of the patient in a hospital so as not to worsen its statistics. Unfortunately, the seemingly good intention of referring of patients may cause a conflict of interests when physicians because of inherent financial gains refer patients to facilities that they own or have investment interest in. Such referral challenges as self-referral, and fee-splitting whereby a fee is paid to one physician by another for a referral is unethical, and are known to occur. Several “Anti-referral Laws” have subsequently been set up to prevent such actions and protect patients against abuse by health workers.

American Journal of Public Health Research. 2015, 3(1), 31-35. DOI: 10.12691/ajphr-3-1-5
Pub. Date: February 08, 2015

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Socio-Demographic Factors Influencing Maternal and Child Health Service Utilization in Mwingi; A Rural Semi-Arid District in Kenya

by Japheth M. Nzioki, Rosebella O. Onyango and James H. Ombaka

Original Research

By the end of this year (2015), Kenya is expected to meet the targets of Millennium Development Goals number 4 and 5 among others. Available evidence suggests that utilization of Maternal and Child Health services is critical in realization of these goals. The aim of this study was to explore the socio-demographic factors influencing Maternal and Child Health service utilization in Mwingi district. This was a descriptive cross-sectional study. Data was collected from a sample of 416 women. Variables of interest were; socio-demographic variables and selected MCH service utilization indicators. Binary logistic regression model was used to assess the influence of socio demographic characteristics on MCH service utilization. Results indicated that Women who sought WHO recommended Antenatal Care services (at least 4 visits) were 38.9%, 47% delivered assisted by Skilled Birth Attendants , 46.2% sought postpartum care within 2 days after delivery, 88.7% ensured their children completed routine immunizations in time and 35.6% used modern family planning within 6 weeks after postpartum. Women with secondary education and above, women in households earning more than 1 US Dollar in a day and women in employment or operating a business were more likely to utilize MCH services. Women over 26 years of age and these with 3 children and above were less likely to utilize MCH services with exception of utilization of Family Planning services in which Women with 3 children and above were more likely to utilize Family Planning services compared to these with 2 children and below. Increasing the number of women with secondary level of education and above, creating initiatives to economically empower people especially these living in rural semi-arid regions, and developing and implementing age specific health education programs may improve utilization of MCH services in Mwingi district and other semi- arid regions in Kenya.

American Journal of Public Health Research. 2015, 3(1), 21-30. DOI: 10.12691/ajphr-3-1-4
Pub. Date: February 08, 2015

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Stress, a Major Determinant of Nutritional and Health Status

by Paulina Oludoyin ADENIYI

Review Article

The continual desire to thrive against all odds even with the current global economic and other livelihood challenges coupled with various natural and man-made disasters has subjected humanity incessantly to physical, physiological and psychological stress traceable to different etiologic stressors. This has consequently resulted into increasing prevalence in stress and stress-related diseases worldwide. Hence, this paper reviews stress as it relates to appetite, digestion, nutrient metabolism, immunity and other diseases with a view of creating public awareness on this concept and the possible stress management techniques. The search engines used are HINARI, PubMED and Google Scholar. Stress can have both orexigenic and anorexigenic effect thus influencing appetite and food intake via the metabolic activities of glucocorticiods and Neuropeptide Y commonly produced during a fight-or-flight response to stress. Vagus nerve activation which occurs during stress directly and profoundly influences metabolic responses to food via altered digestion, absorption and metabolism of nutrients thus pre-disposing the body to malnutrition. Glucocorticoids may adversely affect immune system by suppressing the helper T-cells and over-expressing the T suppressor cells thus inhibiting the body’s defence mechanism against both infectious and non-infectious diseases. More still, glucocorticoids have been implicated in the pathogenesis of diabetes via increased hepatic blood glucose by increased gluconeogenesis and may exacerbate or inhibit tumorigenicity in cancer progression. Regular exercise, healthy diet, deep breath exercise, adequate sleep and limiting exposure to stressors if possible are generally effective in coping with stress and managing stress.

American Journal of Public Health Research. 2015, 3(1), 15-20. DOI: 10.12691/ajphr-3-1-3
Pub. Date: February 04, 2015

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HIV/AIDS Knowledge and Attitude among Military Recruits at Depot Nigeria Army, Zaria, Nigeria

by Chinedu John-Camillus IGBOANUSI, Tukur DAHIRU and Istifanus Anekoson JOSHUA

Original Research

Military personnel have higher HIV/AIDS prevalence than the general population. They tend to be young, single, sexually active and highly mobile and may stay away from their home. This study assessed HIV/AIDS knowledge and attitude among recruits at Nigerian Army Depot in Zaria Nigeria. It was a cross sectional descriptive study carried out February 2011 using 300 structured, self-administered questionnaires. Majority of the respondents (80.3%) were within the age bracket of 20- 24 years with mean age of 21.8 ± 2.0 years, 93% single and 53.3% secondary school graduate. Majority of the respondents (91.0%) have heard of HIV/AIDS, while a lot of them (72.6%) knew those that are victims of the disease. Majority of the respondents (74.3%) also knew that HIV/AIDS was caused by virus. On the overall, only 48.7% of the respondents had good knowledge of the disease. About 80.7% of the respondents would offer assistance to HIV infected people, 62.3% agreed that HIV positive women should not be having babies, while 66.0% believed that HIV/AIDS patients should not be stigmatized against among others. The study revealed amongst others that the recruits had very good knowledge of HIV/AIDS and also good attitudes to it. The recommendations include- aggressive regular HIV/AIDS awareness campaigns, development of attitudinal and behavioural change communication strategies for the recruits in particular, health education by faith based organisations. There is also the need to develop a good practical tool and quality control programs for monitoring and evaluation of the various HIV/AIDS awareness programs in the barracks for enhanced effectiveness and efficiency.

American Journal of Public Health Research. 2015, 3(1), 8-14. DOI: 10.12691/ajphr-3-1-2
Pub. Date: January 29, 2015

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Study of the Effects of Snack-Centered Dietary Education on First-Grade Elementary Students and Duration of These Effects

by Toshiyuki Kohri and Naoko Kaba

Original Research

Irregular diets and nutrient imbalances that result from a lack of interest in food have become more common among not only adults but also children. Snacks are a category of food that most children like and can select for themselves. This study validated the effects of snack-centered dietary education for children on the ability of snack selection and duration of these effects. Twenty-three types of snacks, including drinks, were lined up on a table and presented to 103 Japanese first grade elementary students (intervention group) in a snack selection test in which children were allowed to freely select the snacks they would eat in one day. The ability of children to select the proper quality and quantity of snacks was evaluated on the basis of the energy and nutrient content of the selected snacks. Subsequently, snack-centered dietary education intervention lessons were provided to the children, and the same test conducted at baseline was immediately reconducted after the intervention and seven months after the end of the intervention. The control group comprised 118 children who were in the first grade during the subsequent school year. In the intervention group, the snacks selected in the baseline test had excessive energy content; post-intervention, the energy content approached a more appropriate level and the nutrient density of vitamins, iron, and dietary fiber increased. Moreover, these improvements were observed even seven months after the intervention ended. However, in the control group, there were no significant changes. These findings suggested that snack-centered dietary education for first grade elementary students contributed to improving the quality and quantity of snack selection, and these effects persisted for more than half a year.

American Journal of Public Health Research. 2015, 3(1), 1-7. DOI: 10.12691/ajphr-3-1-1
Pub. Date: January 16, 2015

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