by Richard Kalisa
Original Research
Obstructed labor (OL) needs to be addressed effectively so as to reduce maternal morbidity and mortality and also improve fetal outcome. We conducted this study to establish the incidence, predisposing factors of OL and to compare birth outcome of OL to normal labor from three rural district hospitals in north-west Rwanda. Retrospective case–control design of women with OL from January to December 2011. OL was diagnosed as documentation of any or all the four pre-specified criteria and these were; i) crossed action line on partogram, ii) membranes ruptured, iii) oxytocin augmentation done, iv) and in second stage when was assisted vaginal delivery performed. Any cases with documented OL and fulfilled all our four pre-specified criteria were considered “with diagnosis”. The remaining cases were considered “without diagnosis”. The cases were retrospectively collected from the patients’ case files at the hospital archives office. Controls were women who had spontaneous vaginal delivery (SVD) or were delivered by vacuum extraction without OL as a complication. For every case, three consecutive patient’s file were picked and retrieved as controls. All available case files were retrieved from hospital’s archives office. Every fourth woman was recorded as OL. The incidence of documented OL with diagnosis was (n=299; 3.7%) and without diagnosis was (n=1780; 21.9%). The predisposing factors for OL were maternal age <19 years, primiparas status, attending < 4 antenatal care (ANC), no formal or primary education and being resident of one specific district. Maternal complications were two and half times higher among women with OL (n=252/2079; 12.1%) compared to those with SVD (n=327/6054; 5.4%), with OR 2.5 (2.0-3.0). Puerperal sepsis and transfusion were more common in women with OL. There was significant difference in the rate of the composite maternal outcome between OL and SVD (4.10% vs. 2.0%; OR 1.9, 95% CI 1.6-4.7) and after adjusting for confounding variables with multivariable logistic regression (OR = 3.1, CI: 1.9-8.7; p = <0.01). There were 28 maternal deaths from the three hospitals giving maternal mortality ratio of (n=28/8133; 344/100,000 live births), of which 4 maternal deaths were due to OL with a case fatality rate of 0.19%. Perinatal mortality rate in OL was (n=123; 59 per 1000 OLs) compared to SVD (n=169; 28 per 1000 SVDs). OL is over diagnosed by the clinicians from rural Rwanda. Increasing clinical skills and a good documentation for the progress of labor is paramount for early identification and prevention of OL, in order to improve care for both women and infants. Improving girl child education, referral system, quality of ANC, availing comprehensive obstetric care in nearby health institution are recommended to prevent OL and its complications.
American Journal of Public Health Research. 2016, 4(5), 191-195. DOI: 10.12691/ajphr-4-5-6
Pub. Date: October 27, 2016
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by David C. Schwartz and Patrick C. Hardigan
Original Research
Objective: The purpose of the studies reported here is: 1.) to evaluate the effectiveness of a multi-factorial, socio-medical fall prevention program among 1,894 community-resident elders in Philadelphia; 2.) to present the data from a replicative study among 1,053 identically selected and identically treated elders. Methods: In study #1, a random sample of Medicaid-eligible seniors, geographically representative of Philadelphia County’s dual-eligible, was selected using a geographic density procedure by zip code. Subjects participated in informational workshops, non-invasive somatic fall risk factor analysis, HIPPA compliant sharing of risk reports with physicians and pharmacists, in-home environmental fall risk analysis, pre- and post-fall counseling, and periodic safety grams. The treatment group was compared with two (2) large scale control groups for: a.) reduced hospitalizations for all injurious falls; and 2b) reduced hospitalization for fall-caused fractures. In study #2, 1,054 community-resident elders were selected via similar procedures and accorded to identical arrays of interventions. Results: In study #1, using Medicaid claims data, the treatment group was shown to have significantly fewer instances of healthcare utilization due to injurious falls compared to the control groups (p < 0.05): hospitalizations for fractures were 55% lower and hospitalizations for all fall-caused injuries were 65% lower. In study #2, participants who accepted all offered interventions were 400% less likely to suffer a self-reported fall than were non-participants. Conclusions: Multi-disciplinary, socio-medical fall prevention programs for community-resident elders can significantly reduce healthcare utilization due to injurious falls.
American Journal of Public Health Research. 2016, 4(5), 188-190. DOI: 10.12691/ajphr-4-5-5
Pub. Date: September 14, 2016
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by Miki Uematsu and Carlos Zúniga Mazier
Original Research
The incidence of dengue infections continues to rise worldwide, including the Americas where a dramatic increase in dengue infections has been reported during the last 5 decades. Honduras had the worst epidemic of dengue in 2010. Good knowledge, attitudes, and practices (KAP) among the public are required to successfully prevent or minimize dengue outbreaks. However, very little is known about the public’s KAP on dengue and its prevention in Honduras. This study aimed to assess the level of KAP regarding dengue among the general population in Honduras. A household survey was conducted in eight communities in Gracias, Lempira in Honduras. Four hundred and twenty-three households were interviewed for this study. We found correlations between the educational level and knowledge score and between the knowledge and practice scores. Conversely, the lack of access to water affected dengue prevention practices. In multivariate analyses, dengue prevention practices significantly differed by educational level and access to water (P < 0.05). High education group had better practices than the low education group [adjusted odds ratio (aOR) of 1.62]. People who had access to water in their households had better practices than others who lived without access to water (aOR, 1.83). Our findings suggested that although the population had sufficient knowledge about dengue prevention, their actions against dengue could be limited by a lack of access to water. For eliminating mosquito breeding sites, not only providing education, but also improving water supply systems is essential.
American Journal of Public Health Research. 2016, 4(5), 181-187. DOI: 10.12691/ajphr-4-5-4
Pub. Date: September 06, 2016
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by Sumith Gunawardane, Randilini Angammana, Shyama Bannaheka and Manil Fonseka
Original Research
There is an under-researched area in scientific literature, regarding the oral health status and dental epidemiological investigations of the socially marginalized groups such as institutionalized children. The aim of this survey was to determine “the oral health status and impact of socio-behavioral factors of children under probationary care in Sri Lanka. A cross sectional population based study was conducted at 36 homes of institutionalized children in Central Province, Sri Lanka. All the children (1104) were screened and those who were above 6 years old has included to the study. An interview administered questionnaire was filled out for each child. Comprehensive oral examination was conducted by three calibrated examiners. The prevalence of dental caries in deciduous teeth was 26.86% while 56.79% in permanent teeth. The mean dmft was 0.75±1.61 while the mean DMFT was 1.19±1.43. Gingival bleeding presented in 44.67% of study subjects. Despite reporting higher usage of tooth brush and tooth paste, high percentage of bleeding gums were found in these children and this could be attributable to improper tooth brushing techniques and lack of individual supervision.
American Journal of Public Health Research. 2016, 4(5), 176-180. DOI: 10.12691/ajphr-4-5-3
Pub. Date: August 27, 2016
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by Devendra Raj Singh and Trishna Jha
Original Research
Background: High maternal mortality rate is still a major public health issue in resource poor countries. In Nepal, the regional socio-economic disparity explicitly reflects inequalities in maternal health service utilization and differences in maternal mortality rate. Only about 50% of pregnant women complete four antenatal care visits. Nearly 80% delivery is still conducted at home in absence of trained health worker among Terai/Madheshi dalits communities in Nepal. The present study intended to explore the factors influencing antenatal care visit dropout at government health facilities of Dhanusha district in Nepal. Methods: This is a descriptive cross sectional study. A total sample of 206 women who had received at least 1st ANC check up from the government health facility during March 2014 to March 2015 were selected using multistage sampling procedure. Interview method was adopted and semi-structure questionnaire was used to gather the study data. Data analysis was carried out in SPSS 20. Ethical clearance was taken from Nepal Health Research Council Ethical Review Board. Results: Out of total 206 respondents 104 (49.52%) of respondents have completed four ANC visits and 106 (50.47%) respondents have not completed four ANC visits. The study confirmed the significant association of antenatal visit dropout with respondents education (OR= 2.22, 95% CI= 1.264-3.917), economic status (OR= 2.37, 95% CI= 1.264-4.462, dissatisfaction with the health service provided at public health facilities (OR=17.48, 95% CI=8.764-34.88), dissatisfaction with the information provided during ANC visit (OR= 0.167, 95% CI=0.092-0.303) and unreceptive attitude of health worker (OR=3.766, 95% CI=2.095-6.769) as major hindering factors among respondents for not attending four ANC visit at government/public health facilities in Dhanusha district of Nepal. Conclusion: The study suggests promotion of positive attitude and behavior of health workers towards clients and building trust on government health facilities from health care provider side are equally important to increase antenatal service utilization among rural pregnant women.
American Journal of Public Health Research. 2016, 4(5), 170-175. DOI: 10.12691/ajphr-4-5-2
Pub. Date: August 27, 2016
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by Sovannary Tuot, Kouland Thin, Mayumi Shimizu, Samedy Suong, Samrithea Sron, Pheak Chhoun, Khuondyla Pal, Chanrith Ngin and Siyan Yi
Original Research
Background: In Cambodia, the circumstances surrounding people living with HIV (PLHIV) remain serious conditions. To ameliorate these situations, KHANA has implemented livelihoods programs since 2010, including village saving and loans (VSL), skill trainings, and cash grants with on-going technical support. This study aims to evaluate the impacts of the programs in improving socio-economic conditions, health, and psychological well-being of PLHIV in Cambodia. Methods: In August 2014, a case-control study was conducted in six selected provinces. The cases were defined as PLHIV who lived in the selected operational districts where KHANA has implemented the livelihoods programs, and have participated in the programs for at least one year. Several indicators in socio-economic situations, food security, health conditions, and psychological well-being of the cases (n= 358) and the controls (n= 329) were compared. Results: The mean of monthly income of the cases who attended the programs for three years or more was 13.6% higher than that of the controls. A significantly higher proportion of the cases reported having three meals per day, while a significantly lower proportion of them received food assistance in the past 12 months. The mean total score for frequency of occurrence also indicated less severity of food insecurity among the cases. Regarding child education, the cases reported a significantly lower rate of out-of-school children. The proportion of the cases who rated their quality of life as good was significantly higher, and they were significantly less likely to report that they felt guilty being HIV-positive persons. Regarding psychological well-being, the mean total score of depressive symptoms for the cases was significantly lower than that for the controls, and the proportion of the cases with a cut-off score smaller than 1.75, which indicated less depressive symptoms, was also significantly higher than that of the controls. Conclusions: Findings from this study portray the positive impacts of KHANA’s livelihoods programs in maintaining and upgrading the livelihoods and quality of life of PLHIV in Cambodia. With these noticeable impacts, the programs should be scaled up to support PLHIV and vulnerable households across the country.
American Journal of Public Health Research. 2016, 4(5), 159-169. DOI: 10.12691/ajphr-4-5-1
Pub. Date: August 09, 2016
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