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Kareem YO, Ameyaw EK, Bello OO, Abdus-Salam RA, Lawal OO, Obajimi G, Alade YK, Morhason-Bello IO. Ecological analysis of demographic-, nutritional- and housing-related factors associated with anaemia among women of reproductive age group in Nigeria. J Health Popul Nutr 2022; 41:56. [PMID: 36494691 PMCID: PMC9733233 DOI: 10.1186/s41043-022-00334-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 11/04/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Anaemia remains a major public health concern, particularly, in sub-Saharan Africa (SSA), where it is one of the causes of maternal death. The most common cause of maternal anaemia is iron deficiency or malnutrition. This study examined the prevalence of and risk factors for anaemia among women that participated in the Nigerian Demographic Health Survey. METHOD We used data of 14,454 women that participated in the 2018 Nigeria Demographic and Health Survey (NDHS). We extracted information such as demographic, social and housing, dietary characteristics and haemoglobin concentration. The descriptive statistic results, prevalence and 95% confidence interval (CIs) of anaemia with the selected respondents background characteristics were presented. The Poisson regression model with robust variance was used to assess the risk of anaemia among women of reproductive age. All analyses were weighted and adjusted for the complex survey design. Statistical significance was interpreted at p value < 0.05. RESULTS Maternal status, body mass index, education, residence, religion, ethnicity, region and type of cooking fuel were all important determinants of anaemia. The prevalence of anaemia was high among pregnant women (61.8%; 95% CI: 58.5-65.0), adolescents (60.4%; 95% CI: 58.1-62.6), underweight women (62.6%; 95% CI: 59.5-65.5), women who had no formal education (64.1%; 95% CI: 62.2-66.0) and those who belonged to the poorest wealth quintile (65.8%; 95% CI: 63.1-68.4). Similarly, anaemia was high among women residing in rural areas (61.5%; 95% CI: 60.0-63.0), Muslims (59.9%; 95% CI: 58.1-61.6) and women with six or more children (62.1%; 95% CI: 60.0-64.1). The risk of anaemia were 2% less likely among women who took minimum adequate diet compared to those who do not. CONCLUSION To date, this is the largest data on maternal anaemia in Nigeria. The study highlighted the high burden of maternal anaemia in the country and different risk factors (medical and social) that are associated with this medical condition among women of reproductive age. We recommend future longitudinal studies to test hypothesis in order to assess whether there is any causal relationship between identified risk factors and anaemia in this group of women.
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Affiliation(s)
| | - Edward K. Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, New Territories Hong Kong
| | - Oluwasomidoyin O. Bello
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rukiyat A. Abdus-Salam
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olatunji O. Lawal
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Gbolahan Obajimi
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Imran O. Morhason-Bello
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Hou WH, Moo CC, Kuo TL, Kuo CL, Chu SY, Wu KF, Chen LW, Li CY. Schizophrenia, but not depression or bipolar affective disorder, adds additional risk of aspiration pneumonia among stroke survivors: A national cohort study in Taiwan. J Psychosom Res 2022; 162:111033. [PMID: 36115193 DOI: 10.1016/j.jpsychores.2022.111033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/19/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Few studies have assessed the sex-specific and age-specific risk of aspiration pneumonia (AP) in patients with stroke and evaluated whether mental disorders may increase this risk. In this population-based cohort study, we investigated the sex-specific and age-specific risk of AP in association with stroke and the joint effects of stroke and mental disorders on the risk of AP. METHODS We included 23,288 patients with incident stroke admitted between 2005 and 2017 and 68,675 matched nonstroke controls. Information on mental disorders was obtained from medical claims data within the 3 years before the stroke incidence. Cox proportional hazards models considering death as a competing risk event were constructed to estimate the hazard ratio of AP incidence by the end of 2018 associated with stroke and selected mental disorders. RESULTS After ≤14 years of follow-up, AP incidence was higher in the patients with stroke than in the controls (11.30/1000 vs. 1.51/1000 person-years), representing a covariate-adjusted subdistribution hazard ratio (sHR) of 3.64, with no significant sex difference. The sHR significantly decreased with increasing age in both sexes. Stratified analyses indicated schizophrenia but not depression or bipolar affective disorder increased the risk of AP in the patients with stroke. CONCLUSION Compared with their corresponding counterparts, the patients with schizophrenia only, stroke only, and both stroke and schizophrenia had a significantly higher sHR of 4.01, 5.16, and 8.01, respectively. The risk of AP was higher in younger stroke patients than those older than 60 years. Moreover, schizophrenia was found to increase the risk of AP in patients with stroke.
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Affiliation(s)
- Wen-Hsuan Hou
- College of Medicine, National Cheng Kung University, Tainan, Taiwan; School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cherl Cy Moo
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Teng-Lung Kuo
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Lun Kuo
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
| | - Shin Ying Chu
- Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (H-CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ke-Fei Wu
- Department of Business Management, National Taichung University of Science and Technology, Taichung, Taiwan; Department of Accounting Information, Chihlee University of Technology, New Taipei City, Taiwan
| | - Liang-Wu Chen
- Department of Chest, Tainan Sinlau Hospital, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Hsu YH, Chen CW, Lin YJ, Li CY. Urban-Rural Disparity in the Incidence of Diagnosed Autism Spectrum Disorder in Taiwan: A 10-Year National Birth Cohort Follow-up Study. J Autism Dev Disord 2022; 53:2127-2137. [PMID: 35132529 DOI: 10.1007/s10803-022-05453-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/15/2022]
Abstract
Autism spectrum disorder (ASD) is reportedly more prevalent in urban areas partly because of better accessibility and affordability to healthcare. With universal health insurance coverage in Taiwan, a previous study has shown no urban-rural disparity in the utilization rate of a child's preventive healthcare. Under this circumstance, we followed a birth cohort of 176,273 live births from 2006 to 2015 to detect the differences in ASD incidence between urbanicities. After adjusting for socioeconomic factors, children were 1.28 (95% confidence interval (CI): 1.13-1.44) and 1.54 (95% CI: 1.36-1.75) more likely to acquire ASD in satellite and urban areas compared with those in rural areas, respectively. A gradient association between parental educational attainment and ASD incidence was also noted. Greater ASD incidences in more urbanized areas and more advanced educated parents' children were detected under a circumstance with low barriers to healthcare.
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Affiliation(s)
- Yuu-Hueih Hsu
- Department of Public Health, National Cheng Kung University, No. 138, Shengli Rd., North Dist., Tainan, 704302, Taiwan
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Taipei, 112, Taiwan
| | - Yuh-Jyh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, No. 138, Shengli Rd., North Dist., Tainan, 704302, Taiwan
| | - Chung-Yi Li
- Department of Public Health, National Cheng Kung University, No. 138, Shengli Rd., North Dist., Tainan, 704302, Taiwan. .,Department of Public Health, College of Public Health, China Medical University, No. 91, Hsueh-Shih Rd., Taichung, 40402, Taiwan. .,Department of Healthcare Administration, College of Medical and Health Science, Asia University, No. 500, Lioufeng Rd., Wufeng, Taichung, 41354, Taiwan.
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Hou WH, Wu JL, Lu CL, Sulistyorini L, Isfandiari MA, Chiu CT, Li CY. Associations of hyperglycemic emergency and severe hypoglycemia incidences with seasonality and ambient temperature among pregnant women with diabetes: a nested case-control study in Taiwan. Environ Health Prev Med 2022; 27:11. [PMID: 35288489 PMCID: PMC9093638 DOI: 10.1265/ehpm.22-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Associations of acute glycemic complications with season and ambient temperature have been reported in general population with diabetes. However, little is known about the risks of acute glycemic complications in relation to season and ambient temperature in pregnant women, who are likely to be even more vulnerable. This work aimed to investigate the associations of season and ambient temperature with pregnancies complicated with hyperglycemia emergency or severe hypoglycemia. Methods Two separate case-control studies were nested within 150,153 pregnancies by women with type 1, type 2, or gestational diabetes between 2009 and 2014 in Taiwan. Hyperglycemia emergency (mainly diabetic ketoacidosis and hyperosmolar hyperglycemic state) and severe hypoglycemia occurred in 77 and 153 diabetic pregnancies (cases), respectively. Ten control pregnancies were randomly selected for each case by matching each case pregnancy on type of diabetes (i.e., T1DM, T2DM, or GDM), maternal age on the date of acute glycemic complication occurrence (i.e., index date), and “length of gestation at risk” (i.e., period between conception and index date). Meteorological parameters were retrieved from 542 meteorological monitoring stations across Taiwan during 2008–2014. Conditional logistic regression analysis with generalized estimation equation was separately performed to estimate the covariate adjusted odds ratios (ORs) of each of the two acute glycemic complications in association with season and ambient temperature within 30 days prior to the index date. Results Compared to summer, winter season was associated with a significantly elevated risk of severe hypoglycemia with an OR of 1.74 (95% confidence interval (CI) 1.08–2.79). The OR of hyperglycemic emergency was also elevated in winter season at OR of 1.88, but the significance is only marginal (95% CI 0.97–3.64, p = 0.0598). Subgroup analyses further noted that such seasonal variation was also observed in pregnancies with pre-pregnancy type 1 diabetes and gestational diabetes. On the other hand, ambient temperature was not significantly associated with the two acute glycemic complications. Conclusions A moderately but significantly elevated risk of severe hypoglycemia was found in pregnant women with diabetes during winter season, and such increased risk was more evident in pregnancies with T1DM. Supplementary information The online version contains supplementary material available at https://doi.org/10.1265/ehpm.22-00003.
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Affiliation(s)
- Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital
| | - Jia-Ling Wu
- Department of Public Health, College of Medicine, National Cheng Kung University
| | - Chin-Li Lu
- Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung Hsing University
| | - Lilis Sulistyorini
- Department of Environmental Health, Faculty of Public Health, Universitas Airlangga
| | | | - Chang-Ta Chiu
- Department of Dentistry, An Nan Hospital, China Medical University
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University
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Mostert CM. The impact of national health promotion policy on stillbirth and maternal mortality in South Africa. Public Health 2021; 198:118-122. [PMID: 34416574 DOI: 10.1016/j.puhe.2021.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/16/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES In 2015, the South African government implemented the national health promotion policy (NHPP), intending to reduce stillbirth and maternal mortality. This study was designed to quantify the impact of the NHPP on stillbirth and maternal mortality in both the South African population and immigrant citizens. STUDY DESIGN This was a panel analysis using secondary data issued by Statistic South Africa-Vital Statistics. METHODS The author exploited the changes in smoking status that the NHPP exerted between 2015 and 2017. The author then builds credible control and treatment groups based on smoking status for both groups. Women who quitted smoking post-NHPP implementation were considered as the treatment group. Women who persisted with smoking post-NHPP implementation were classified as the control group. The author then used a Two-stage Least Squared Model to quantify the impact of the NHPP on stillbirth and maternal mortality in both the South African and immigrant populations. RESULTS The model shows that NHPP averts stillbirths by 8.36% in the South African population residing in the urban areas and by 2.84% in the rural segments of the country. NHPP averts South African maternal mortalities by 20.88% in urban areas and by 15.60% in the rural segments of the country.Regarding the immigrant population, the model shows that NHPP averts immigrant's stillbirths by 7.61% in the urban areas and by 2.79% in the rural segments of the country. In addition, NHPP averts immigrant maternal mortalities by 19.22% in the urban areas and by 13.04% in the rural segments of the country. CONCLUSIONS NHPP reduces stillbirth and maternal mortality outcomes slightly biased toward the South African population. These inequalities reflect immigrant's lack of response to the NHPP framework and inadequate access to the South African health system.
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Affiliation(s)
- Cyprian Mcwayizeni Mostert
- University of the Witwatersrand, Johannesburg, South Africa; Centre for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain; University of Twente, Enshcede, Twente, the Netherlands; Albert Luthuli Leadership Institute, University of Pretoria, Pretoria, South Africa.
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Chen CC, Chen CY, Ko MC, Chien YC, Su EC, Chen YT. Factors Affecting Treatment with Life-Saving Interventions, Computed Tomography Scans and Specialist Consultations. Int J Environ Res Public Health 2020; 17:E2914. [PMID: 32340186 DOI: 10.3390/ijerph17082914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022]
Abstract
Background: Emergency treatments determined by emergency physicians may affect mortality and patient satisfaction. This paper attempts to examine the impact of patient characteristics, health status, the accredited level of hospitals, and triaged levels on the following emergency treatments: immediate life-saving interventions (LSIs), computed tomography (CT) scans, and specialist consultations (SCs). Methods: A multivariate logistic regression model was employed to analyze the impact of patient characteristics, including sex, age, income and the urbanization degree of the patient's residence; patient health status, including records of hospitalization and the number of instances of ambulatory care in the previous year; the Charlson Comorbidity Index (CCI) score; the accredited level of hospitals; and the triaged level of emergency treatments. Results: All the patient characteristics were found to impact receiving LSI, CT and SC, except for income. Furthermore, a better health status was associated with a decreased probability of receiving LSI, CT and SC, but the number of instances of ambulatory care was not found to have a significant impact on receiving CT or SC. This study also found no evidence to support impact of CCI on SC. Hospitals with higher accredited levels were associated with a greater chance of patients receiving emergency treatments of LSI, CT and SC. A higher assigned severity (lower triaged level) led to an increased probability of receiving CT and SC. In terms of LSI, patients assigned to level 4 were found to have a lower chance of treatment than those assigned to level 5. Conclusions: This study found that several patient characteristics, patient health status, the accredited level of medical institutions and the triaged level, were associated with a higher likelihood of receiving emergency treatments. This study suggests that the inequality of medical resources among medical institutions with different accredited levels may yield a crowding-out effect.
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