The 1999 international emergency humanitarian evacuation of the Kosovars to Canada: A qualitative study of service providers' perspectives at the international, national and local levels

Ensemble model for predicting chronic non-communicable diseases using Latin square extraction and fuzzy-artificial neural networks from 2013 to 2019

Background

The presented study tracks the increase or decrease in the prevalence of seventeen different chronic non-communicable diseases in Serbia. This analysis considers factors such as region, age, and gender and is based on data from two national cross-sectional studies conducted in 2013 and 2019. The research aims to accurately identify the regions with the highest percentage of affected individuals, as well as their respective age and gender groups. The ultimate goal is to facilitate organized, free preventive screenings for these population categories within a very short time-frame in the future.

Materials and methods

The study analyzed two cross-sectional studies conducted between 2013 and 2019, using data obtained from the Institute of Public Health of Serbia. Both studies involved a total of 27801 participants. The study compared the performance of Decision Tree and Support Vector Regressor models with artificial neural network (ANN) models that employed two encoding functions. The new methodology for the ANN-L36 model was based on artificial neural networks constructed using a Latin square (L36) design, incorporating Taguchi's robust design optimization.

Results

The results of the analysis from three different models have shown that cardiovascular diseases are the most prevalent illnesses among the population in Serbia, with hypertension as the leading condition in all regions, particularly among individuals aged 64 to 75 years, and more prevalent among females. In 2019, there was a decrease in the percentage of the leading disease, hypertension, compared to 2013, with a decrease from 34.0% to 32.2%. The ANN-L36 model with Fuzzy encoding function demonstrated the highest precision, achieving the smallest relative error of 0.1%.

Conclusion

To date, no studies have been conducted at the national level in Serbia to comprehensively track and identify chronic diseases in the manner proposed by this study. The model presented in this research will be implemented in practice and is set to significantly contribute to the future healthcare framework in Serbia, shaping and advancing the approach towards addressing these conditions. Furthermore, experimental evidence has shown that Taguchi's optimization approach yields the best results for identifying various chronic non-communicable diseases.

Gender identity and sexual orientation: a glossary

Gender and sexually diverse populations remain understudied and under-represented in research. This is attributable not only to significant and ongoing data collection limitations, where large population-based studies fail to ask adequate questions around gender and sexuality, but also due to continuously evolving terminology in this space. This glossary takes a preliminary step in rectifying these issues by defining and clarifying the application and understanding of key terms related to gender, gender identity, expression and sexuality. In doing so, this glossary provides a point of reference for understanding key differences in gender and sexually diverse terminology to (1) help guide researchers and practitioners in the use and understanding of terms and (2) facilitate the utility of more respectful, inclusive and consistent language application across the public health arena.

Prevalence and associated risk factors of overweight and obesity among adult population in Dubai: a population-based cross-sectional survey in Dubai, the United Arab Emirates

OBJECTIVE

To study the prevalence of overweight and obesity and determine the associated risk factors among adults in Dubai.

DESIGN AND SETTING

A cross-sectional survey with a multistage, stratified random sampling design was conducted in the Emirate of Dubai in 2019.

PARTICIPANTS

The study included 2142 adults aged 18+ years in the Emirate of Dubai.

RESULTS

The overall prevalence of obesity, which was defined as body mass index (BMI) ≥30 kg/m², was 17.8%. The highest obesity rates were reported among women (21.6%) and the United Arab Emirates (UAE)-nationals (39.6%). Moreover, 39.8% of the population was overweight (BMI ≥25-29.9 kg/m²). Multivariate logistic regression showed associations between obesity and age, sex, nationality, hypertension and occupation. Obesity increases with age, with the highest risk at age group 50-59 years (OR 4.30; 95% CI 1.57 to 11.78) compared with the reference group (18-24 years). Females had a higher risk of obesity than males (OR 1.62; 95% CI 1.10 to 2.38). Compared with those in the reference group (Western and others), UAE nationals, other Arabs and Asians were more likely to be obese ((OR 2.08; 95% CI 1.18 to 3.67), (OR 3.61; 95% CI 2.41 to 5.44) and (OR 1.98; 95% CI 1.12 to 3.50), respectively). Clerical and service workers (OR 4.50; 95% CI 2.54 to 8.00) and elementary and unskilled occupation categories (OR 2.57; 95% CI 1.56 to 4.25) had higher risks of obesity than the reference group (professionals), p<0.01). Hypertensive individuals had a higher risk of obesity than normotensive individuals (OR=3.96; p<0.01).

CONCLUSIONS

Obesity and overweight are highly prevalent among adults in Dubai and are remarkably associated with sociodemographic and behavioural risk factors. Comprehensive strategic initiatives are urgently needed to control obesity in the high-risk populations in the Emirate of Dubai.

Cardiovascular (Framingham) and type II diabetes (Finnish Diabetes) risk scores: a qualitative study of local knowledge of diet, physical activity and body measurements in rural Rakai, Uganda

BACKGROUND

Non-communicable diseases such as cardiovascular conditions and diabetes are rising in sub-Saharan Africa. Prevention strategies to mitigate non-communicable diseases include improving diet, physical activity, early diagnosis, and long-term management. Early identification of individuals at risk based on risk-score models - such as the Framingham Risk Score (FRS) for 10-year risk of cardiovascular disease and the Finnish type 2 Diabetes risk score (FINDRISC) for type 2 diabetes which are used in high-income settings - have not been well assessed in sub-Saharan Africa. The purpose of this study was to qualitatively assess local knowledge of components of these risk scores in a rural Ugandan setting.

METHODS

Semi-structured qualitative in-depth interviews were conducted with a purposively selected sample of 15 participants who had responded to the FRS and FINDRISC questionnaires and procedures embedded in the Rakai Community Cohort Study. Data were summarized and categorized using content analysis, with support of Atlas.ti.

RESULTS

Participants described local terms for hypertension ("pulessa") and type 2 diabetes ("sukaali"). Most participants understood physical activity as leisure physical activity, but when probed would also include physical activity linked to routine farm work. Vegetables were typically described as "plants", "leafy greens", and "side dish". Vegetable and fruit consumption was described as varying seasonally, with peak availability in December after the rainy season. Participants perceived themselves to have good knowledge about their family members' history of type 2 diabetes and hypertension.

CONCLUSIONS

While most items of the FRS and FINDRISC were generally well understood, physical activity needs further clarification. It is important to consider the seasonality of fruits and vegetables, especially in rural resource-poor settings. Current risk scores will need to be locally adapted to estimate the 10-year risk of cardiovascular diseases and type 2 diabetes in this setting.

Assessing barriers, opportunities and future directions in health information sharing in humanitarian contexts: a mixed-method study

OBJECTIVES

Health information sharing continues to play a crucial yet underappreciated role in humanitarian settings, to guide evidence-based disease prevention, detection and response. We conducted a mixed-methods study to investigate and analyse existing approaches and practices to health information sharing across humanitarian settings over the past 20 years.

SETTING

We sought to identify studies from any self-described humanitarian setting worldwide, and also targeted experts familiar with refugee settings, specifically long-term camps in Kenya, Jordan and Bangladesh, for key informant interviews.

PARTICIPANTS

The systematic review did not directly involve participants. The identified reports were largely retrospective and observational, and focused on populations affected by humanitarian crises worldwide. Participants in the key informant interviews were experts with either broad geographical expertise or direct experience in refugee camp settings.

PRIMARY AND SECONDARY OUTCOME MEASURES

Our study was qualitative, and both the systematic review and analysis of key informant interview responses focused on identifying themes related to barriers, tools and recommendations used between stakeholders to share health information, with a particular emphasis on infectious disease and surveillance data.

RESULTS

We identified logistical challenges, difficulties with data collection and a lack of health information sharing frameworks as the most significant barriers to health information sharing. The most important tools to health information sharing included the use of third-party technologies for data collection and standardisation, formalised health information sharing frameworks, establishment of multilevel coordination mechanisms and leadership initiatives which prioritised the sharing of health information.

CONCLUSIONS

We conclude that health information sharing can be strengthened in humanitarian settings with improvements to existing frameworks, coordination and leadership tools, in addition to promotion of health information communication. Furthermore, specific recommendations for improving health information sharing should be pursued according to the nature of the humanitarian setting and the efficacy of the health system present.

Dietary fructose and its association with the metabolic syndrome in Lebanese healthy adults: a cross-sectional study

BACKGROUND

Epidemiological studies investigating the association between dietary fructose intake and the metabolic syndrome (MetS) are scarce and have produced controversial findings. This study aimed at (1) assessing total dietary fructose intake in a sample of Lebanese healthy adults, and determining the intake levels of natural vs. added fructose; (2) investigating the association of dietary fructose with MetS; and (3) identifying the socioeconomic and lifestyle factors associated with high fructose intake.

METHODS

A cross-sectional survey was conducted on a representative sample of adults living in Beirut, Lebanon (n = 283). Anthropometric and biochemical data were collected, and dietary intake was assessed using a food frequency questionnaire. Intakes of naturally-occurring fructose from fructose-containing food sources, such as fruits, vegetables, honey, were considered as "natural fructose". Acknowledging that the most common form of added sugar in commodities is sucrose or High Fructose Corn Syrup (HFCS), 50% of added sugar in food products was considered as added fructose. Total dietary fructose intake was calculated by summing up natural and added fructose intakes. Logistic regression analyses were conducted to investigate the association of total, added and natural fructose intakes with the MetS and to identify the socioeconomic predictors of high fructose intake.

RESULTS

Mean intake of total fructose was estimated at 51.42 ± 35.54 g/day, representing 6.58 ± 3.71% of energy intakes (EI). Natural and added fructose intakes were estimated at 12.29 ± 8.57 and 39.12 ± 34.10 g/day (1.78 ± 1.41% EI and 4.80 ± 3.56% EI), respectively. Participants in the highest quartile of total and added fructose intakes had higher odds of MetS (OR = 2.84, 95%CI: 1.01, 7.94 and OR = 3.18, 95%CI: 1.06, 9.49, respectively). In contrast, natural fructose intake was not associated with MetS. Age, gender and crowding index were identified as factors that may modulate dietary fructose intakes.

CONCLUSIONS

The observed association between high added fructose intake and the MetS highlights the need for public health strategies aimed at limiting sugar intake from industrialized foods and promoting healthier dietary patterns in Lebanon.

Interaction of physical activity on the association of obesity-related measures with multimorbidity among older adults: a population-based cross-sectional study in India

OBJECTIVE

To explore the associations between obesity-related measures and multimorbidity among older Indian adults and the interactive effects of physical activity in those associations.

DESIGN

A cross-sectional study was conducted using large representative survey data.

SETTING AND PARTICIPANTS

The present study used data from the Longitudinal Aging Study in India (LASI) conducted during 2017-2018. Participants included 15 098 male and 16 366 female older adults aged 60 years and above in India.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome variable was multimorbidity among older adults coded as no and yes. Descriptive statistics along with bivariate analysis are presented in the paper. Additionally, binary logistic regression analysis was used to fulfil the study objectives.

RESULTS

About 24% of older adults in the LASI cohort suffered from multimorbidity. Older adults who were overweight/obese (adjusted OR (AOR): 1.61, CI 1.48 to 1.74), had high-risk waist circumference (AOR: 1.66, CI 1.52 to 1.80) and had high-risk waist to hip ratio (AOR: 1.45, CI 1.33 to 1.59) were significantly more likely to suffer from multimorbidity compared with their counterparts. Older adults who were obese and physically inactive had significantly increased odds of suffering from multimorbidity compared with older adults who were obese and physically active. Similarly, older adults with high-risk waist circumference (AOR: 1.30, CI 1.11 to 1.53) and high-risk waist to hip ratio (AOR: 1.32, CI 1.20 to 1.46) along with being physically inactive had significantly higher odds of suffering from multimorbidity in comparison with older adults with high-risk waist circumference and waist to hip ratio along with being physically active.

CONCLUSION

While developing health strategies for older adults, physical activity needs to be recognised as a way of minimising comorbidities. Further, the study highlights the importance of using multiple obesity-related measures to predict chronic conditions in the older population.

Challenges in the provision of healthcare services for migrants: a systematic review through providers' lens

BACKGROUND

In recent years, cross-border migration has gained significant attention in high-level policy dialogues in numerous countries. While there exists some literature describing the health status of migrants, and exploring migrants' perceptions of service utilisation in receiving countries, there is still little evidence that examines the issue of health services for migrants through the lens of providers. This study therefore aims to systematically review the latest literature, which investigated perceptions and attitudes of healthcare providers in managing care for migrants, as well as examining the challenges and barriers faced in their practices.

METHODS

A systematic review was performed by gathering evidence from three main online databases: Medline, Embase and Scopus, plus a purposive search from the World Health Organization's website and grey literature sources. The articles, published in English since 2000, were reviewed according to the following topics: (1) how healthcare providers interacted with individual migrant patients, (2) how workplace factors shaped services for migrants, and (3) how the external environment, specifically laws and professional norms influenced their practices. Key message of the articles were analysed by thematic analysis.

RESULTS

Thirty seven articles were recruited for the final review. Key findings of the selected articles were synthesised and presented in the data extraction form. Quality of retrieved articles varied substantially. Almost all the selected articles had congruent findings regarding language andcultural challenges, and a lack of knowledge of a host country's health system amongst migrant patients. Most respondents expressed concerns over in-house constraints resulting from heavy workloads and the inadequacy of human resources. Professional norms strongly influenced the behaviours and attitudes of healthcare providers despite conflicting with laws that limited right to health services access for illegal migrants.

DISCUSSION

The perceptions, attitudes and practices of practitioners in the provision of healthcare services for migrants were mainly influenced by: (1) diverse cultural beliefs and language differences, (2) limited institutional capacity, in terms of time and/or resource constraints, (3) the contradiction between professional ethics and laws that limited migrants' right to health care. Nevertheless, healthcare providers addressedsuch problems by partially ignoring the immigrants'precarious legal status, and using numerous tactics, including seeking help from civil society groups, to support their clinical practice.

CONCLUSION

It was evident that healthcare providers faced several challenges in managing care for migrants, which included not only language and cultural barriers, but also resource constraints within their workplaces, and disharmony between the law and their professional norms. Further studies, which explore health care management for migrants in countries with different health insurance models, are recommended.

Challenges in the provision of healthcare services for migrants: a systematic review through providers' lens

BACKGROUND

In recent years, cross-border migration has gained significant attention in high-level policy dialogues in numerous countries. While there exists some literature describing the health status of migrants, and exploring migrants' perceptions of service utilisation in receiving countries, there is still little evidence that examines the issue of health services for migrants through the lens of providers. This study therefore aims to systematically review the latest literature, which investigated perceptions and attitudes of healthcare providers in managing care for migrants, as well as examining the challenges and barriers faced in their practices.

METHODS

A systematic review was performed by gathering evidence from three main online databases: Medline, Embase and Scopus, plus a purposive search from the World Health Organization's website and grey literature sources. The articles, published in English since 2000, were reviewed according to the following topics: (1) how healthcare providers interacted with individual migrant patients, (2) how workplace factors shaped services for migrants, and (3) how the external environment, specifically laws and professional norms influenced their practices. Key message of the articles were analysed by thematic analysis.

RESULTS

Thirty seven articles were recruited for the final review. Key findings of the selected articles were synthesised and presented in the data extraction form. Quality of retrieved articles varied substantially. Almost all the selected articles had congruent findings regarding language andcultural challenges, and a lack of knowledge of a host country's health system amongst migrant patients. Most respondents expressed concerns over in-house constraints resulting from heavy workloads and the inadequacy of human resources. Professional norms strongly influenced the behaviours and attitudes of healthcare providers despite conflicting with laws that limited right to health services access for illegal migrants.

DISCUSSION

The perceptions, attitudes and practices of practitioners in the provision of healthcare services for migrants were mainly influenced by: (1) diverse cultural beliefs and language differences, (2) limited institutional capacity, in terms of time and/or resource constraints, (3) the contradiction between professional ethics and laws that limited migrants' right to health care. Nevertheless, healthcare providers addressedsuch problems by partially ignoring the immigrants'precarious legal status, and using numerous tactics, including seeking help from civil society groups, to support their clinical practice.

CONCLUSION

It was evident that healthcare providers faced several challenges in managing care for migrants, which included not only language and cultural barriers, but also resource constraints within their workplaces, and disharmony between the law and their professional norms. Further studies, which explore health care management for migrants in countries with different health insurance models, are recommended.

Chronic respiratory disease among the elderly in South Africa: any association with proximity to mine dumps?

BACKGROUND

There is increasing evidence that environmental factors such as air pollution from mine dumps, increase the risk of chronic respiratory symptoms and diseases. The aim of this study was to investigate the association between proximity to mine dumps and prevalence of chronic respiratory disease in people aged 55 years and older.

METHODS

Elderly persons in communities 1-2 km (exposed) and 5 km (unexposed), from five pre-selected mine dumps in Gauteng and North West Province, in South Africa were included in a cross-sectional study. Structured interviews were conducted with 2397 elderly people, using a previously validated ATS-DLD-78 questionnaire from the British Medical Research Council.

RESULTS

Exposed elderly persons had a significantly higher prevalence of chronic respiratory symptoms and diseases than those who were unexposed., Results from the multiple logistic regression analysis indicated that living close to mine dumps was significantly associated with asthma (OR = 1.57; 95% CI: 1.20 - 2.05), chronic bronchitis (OR = 1.74; 95 CI: 1.25 - 2.39), chronic cough (OR = 2.02; 95% CI: 1.58 - 2.57), emphysema (OR = 1.75; 95% CI: 1.11 - 2.77), pneumonia (OR = 1.38; 95% CI: 1.07 - 1.77) and wheeze (OR = 2.01; 95% CI: 1.73 - 2.54). Residing in exposed communities, current smoking, ex-smoking, use of paraffin as main residential cooking/heating fuel and low level of education emerged as independent significant risk factors for chronic respiratory symptoms and diseases.

CONCLUSION

This study suggests that there is a high level of chronic respiratory symptoms and diseases among elderly people in communities located near to mine dumps in South Africa.

Advancing adolescent health and health services in Saudi Arabia: exploring health-care providers' training, interest, and perceptions of the health-care needs of young people

BACKGROUND

Adolescent health is regarded as central to global health goals. Investments made in adolescent health and health services protect the improvements witnessed in child health. Though Saudi Arabia has a large adolescent population, adolescent health-care only began to emerge in recent years, yet widespread uptake has been very limited. Health-care providers are key in addressing and providing the necessary health-care services for adolescents, and so this study was conducted with the aim of identifying opportunities for the advancement of knowledge transfer for adolescent health services in Saudi Arabia.

METHODS

This Web-based, cross-sectional study was carried out at four hospitals in Saudi Arabia. Physicians and nurses were invited to participate in an online survey addressing their contact with adolescent patients, and training, knowledge, and attitudes towards adolescent health-care.

RESULTS

A total of 232 professionals participated. The majority (82.3%) reported sometimes or always coming into contact with adolescent patients. Less than half (44%), however, had received any sort of training on adolescent health during their undergraduate or postgraduate education, and only 53.9% reported having adequate knowledge about the health-care needs of adolescents. Nurses perceived themselves as having more knowledge in the health-care needs of adolescents and reported feeling more comfortable in communicating with adolescents as compared with physicians. The majority of participants were interested in gaining further skills and knowledge in adolescent health-care and agreed or strongly agreed that adolescents have specific health-care needs that are different than children or adults (82.3% and 84.0%, respectively). With respect to health services, the majority (85.8%) believed that adolescents should be hospitalized in adolescent-specific wards. Only 26.7% of health-care providers believed that patients should be transferred from child to adult health-care services at 12-13 years of age, as is currently practiced in the country.

CONCLUSION

A gap exists between the training, knowledge and skills of health-care providers, and the needs to address health-care issues of adolescents in Saudi Arabia. This coupled with the fact that health-care providers are interested in gaining more knowledge and skills and are supportive of changes in the health-care system provides an opportunity for building local capacity and instituting medical and nursing education and health-care reform that can better serve the needs of the country's young population.

Disaster-driven evacuation and medication loss: a systematic literature review

AIM

The aim of this systematic literature review was to identify the extent and implications of medication loss and the burden of prescription refill on medical relief teams following extreme weather events and other natural hazards.

METHOD

The search strategy followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Key health journal databases (Medline, Embase, PsycINFO, Maternity and Infant Care, and Health Management Information Consortium (HMIC)) were searched via the OvidSP search engine. Search terms were identified by consulting MeSH terms. The inclusion criteria comprised articles published from January 2003 to August 2013, written in English and containing an abstract. The exclusion criteria included abstracts for conferences or dissertations, book chapters and articles written in a language other than English. A total of 70 articles which fulfilled the inclusion criteria were included in this systematic review.

RESULTS

All relevant information was collated regarding medication loss, prescription loss and refills, and medical aids loss which indicated a significant burden on the medical relief teams. Data also showed the difficulty in filling prescriptions due to lack of information from the evacuees. People with chronic conditions are most at risk when their medication is not available. This systematic review also showed that medical aids such as eye glasses, hearing aids as well as dental treatment are a high necessity among evacuees.

DISCUSSION

This systematic review revealed that a considerable number of patients lose their medication during evacuation, many lose essential medical aids such as insulin pens and many do not bring prescriptions with them when evacuated.. Since medication loss is partly a responsibility of evacuees, understanding the impact of medication loss may lead to raising awareness and better preparations among the patients and health care professionals. People who are not prepared could have worse outcomes and many risk dying when their medication is not available.

Understanding the Health of Refugee Women in Host Countries: Lessons from the Kosovar Re-Settlement in Canada

Introduction:

Refugees from Kosovo arrived in several Canadian cities after humanitarian evacuations in 1999. Approximately 500 arrived in Hamilton, Canada. Volunteer sponsors from community organizations assisted the families with settlement, which included providing them access to healthcare services.

Hypothesis/Problem: It was anticipated that women, in particular, would have unmet health needs relating to trauma and a lack of healthcare access after experiencing forced migration.

Methods:

This study describes the results of a self-administered survey regarding women's health issues and experiences with health services after the arrival of refugees. It also describes the sponsor group's experience related to women's health care. The survey was administered to a random sample of 85 women refugees, and focus groups with 14 sponsors.Women self-completed questionnaires about their health, which included the Harvard Trauma Questionnaire for post-traumatic stress disorder (PTSD) and use of preventive health services. Sponsor groups participated in a focus group discussing healthcare needs and experiences of their assigned refugee families. Themes pertaining to women's issues were identified from the focus groups.

Results:

Preventive screening rates were low, only 1/19 (5.3%) women ≥50- years-old had ever received a mammogram; 34.1% (28/82) had ever received a Pap test); and PTSD was prevalent (25.9%, 22/85). Sponsor groups identified challenges relating to prenatal care needs, finding family physicians, language barriers to health care services, cultural influences of women's healthcare decision-making, mental health concerns, and difficulties accessing dental care, eye care, and prescriptions.

Conclusions:

Many women refugees from Kosovo had unmet health needs. Culturally appropriate population level screening campaigns and integration of language and interpretation services into the healthcare sector on a permanent basis are important policy actions to be adequately prepared for newcomers and women in displaced situations. These needs should be anticipated during the evacuation period by host countries to aid in planning the provision of health resources more efficiently for refugees and displaced people going to host countries.

Five-year Evaluation of Chronic Diseases in Hamadan, Iran: 2005-2009

BACKGROUND

Now the increasing growth of chronic diseases is the major health challenge worldwide. This survey was conducted to assess noncommunicable diseases related risk factors.

METHODS

A population-based cross sectional study was conducted in 2005 and repeated annually by 2009 in Hamadan province, the west of Iran using two-stage cluster sampling method. A total sample of 6500 subjects 15 to 64 years old were enrolled.

RESULTS

The total prevalence of cigarette smoking was 18% [95% CI 17% to 19%], 35.1% in men versus 1.1% in women. The smokers consumed on average 15 cigarettes per day. Almost 26.3% [95% CI 24.8% to 27.7%] of the target population eat five or more servings of fruits and vegetables per day; 52.8% [95% CI 51.2% to 54.3%] had work related physical activity; 28.1% [95% CI 26.7% to 29.4%] had physical activity during leisure time; 80.3% [95% CI 79.0% to 81.5%] had transportation related physical activity; 47.2% [95% CI 46.0% to 48.4%] were either overweight or obese; 8.1% [95% CI 7.1% to 9.2%] had impaired fasting blood sugar or were confirmed diabetes; 33.7% [95% CI 31.9% to 35.5%] had hypercholesterolemia; and 15.6% [95% CI 13.0% to 18.3%] had hypertriglyceridemia. There was a statistically significant association of age and gender with body mass index, systolic and diastolic hypertension, hyperglycemia, hypercholesterolemia and hypertriglyceridemia.

CONCLUSIONS

The evidences of the present survey promise a silent progressive epidemic of chronic diseases among Iranian citizens that may lead to an increasing growth of noncommunicable diseases in the next decade.

Gender inequities, relationship power, and childhood immunization uptake in Nigeria: a population-based cross-sectional study

BACKGROUND

This study aimed to simultaneously examine the association between multiple dimensions of gender inequities and full childhood immunization.

METHODS

A multilevel logistic regression analysis was performed on nationally representative sample data from the 2008 Nigeria Demographic and Health Survey, which included 33,385 women aged 15-49 years who had a total of 28,647 live-born children; 24,910 of these children were included in this study.

RESULTS

A total of 4283 (17%) children had received full immunization. Children of women whose spouse did not contribute to household earnings had a higher likelihood of receiving full childhood immunization (odds ratio (OR) 1.96, 95% confidence interval (95% CI) 1.02-3.77), and children of women who lacked decision-making autonomy had a lower likelihood of receiving full childhood immunization (OR 0.74, 95% CI 0.60-0.91). The likelihood of receiving full childhood immunization was higher among female children (OR 1.28, 95% CI 1.06-1.54), Yoruba children (OR 2.45, 95% CI 1.19-4.26), and children resident in communities with low illiteracy (OR 1.82, 95% CI 1.06-3.12), but lower for children of birth order 5 or above (OR 0.64, 95% CI 0.45-0.96), children of women aged ≤ 24 years (OR 0.66, 95% CI 0.50-0.87) and 25-34 years (OR 0.79, 95% CI 0.63-0.99), children of women with no education (OR 0.33, 95% CI 0.21-0.54) and primary education (OR 0.66, 95% CI 0.45-0.97), as well as children of women resident in communities with high unemployment (OR 0.34, 95% CI 0.20-0.57).

CONCLUSIONS

The woman being the sole provider for her family (i.e., having a spouse who did not contribute to household earnings) was associated with a higher likelihood of fully immunizing the child, and the woman lacking decision-making autonomy was associated with a lower likelihood of fully immunizing the child. These findings draw attention to the need for interventions aimed at promoting women's employment and earning possibilities, whilst changing gender-discriminatory attitudes within relationships, communities, and society in general.