bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rising trends and persisting inequalities in cesarean section rates in Nepal: evidence from demographic and health surveys 2006-2016
Authors: Acharya Kiran , Paudel Yuba Raj , Dhungana Chandra Mani 
Published: March 2020

Abstract
BackgroundSustainable development goals require member countries to reduce maternal mortality below 70 per 100,000 live births by 2030. Addressing inequalities in access to emergency obstetric care is crucial for reducing the maternal mortality ratio. This study was done to examine the time trends and socio-demographic inequalities in the utilization of cesarean section (CS) in Nepal during 2006-2016.MethodsWe used data from the Nepal Demographic and Health Surveys (NDHS) conducted during 2006-2016. Women who had a live birth in the last five years of the survey (most recent birth if there were two or more child birth) were the unit of analysis for this study. Absolute and relative inequalities in CS rates by different characteristics were measured in-terms of rate difference and rate ratios, respectively. Bivariate analyses and multivariate logistic regression models were used to assess the rate of cesarean sections by background socio-demographic characteristics of women. ResultsAge and parity adjusted CS rates were found to have increased almost three-fold (from 3.2%,95% CI:2.1-4.3 in 2006 to 10.5%;95% CI:8.9-11.9 in 2016) over the decade. In 2016, women from Mountain region (3.0%;95% CI:1.1-4.9), those from poorest wealth quintile (2.4%,95% CI:(1.2-3.7) and those living in province 6(2.4%,95% CI:1.3-3.5) had CS rate below 5%. Whereas, women from the richest income quintile (25.1%,95% CI :20.2-30.1), with higher education (21.2%,95% CI:14.7-27.8) and those delivering in private facilities (37.1%,95% CI:30.5-43.7) had CS rate above 15%. The absolute inequality in CS rate increased for maternal educational status, income quintiles, ecological region, province and place of delivery over the period. Relative inequality increased for provinces and place of delivery. Women from the richest income quintile (OR-3.3,95% CI: 1.6-7.0) and those delivered in private/NGO-run facilities (OR-3.6;95% CI:2.7-4.9) were more than three times more likely to deliver by CS compared to women from the poorest income quintile and those delivering in public facilities, respectively. ConclusionTo improve maternal and newborn health, strategies need to be revised to address the underuse of C-section in poor, mountain region and province 6. Simultaneously, policies and guidelines are needed to reduce overuse in rich women, women with higher education and those delivered in private facilities.
Nutritional status and dietary diversity of school-age children living with HIV: a cross sectional study in Phnom Penh, Cambodia
Authors: Yasuoka Junko , Yi Siyan , Okawa Sumiyo , Tuot Sovannary , Murayama Makoto , Huot Chantheany , Chhoun Pheak , Yem Sokunthea , Yuzuriha Kazuki , Mizutani Tetsuya , Kikuchi Kimiyo 
Published: March 2020

Abstract
Background: HIV/AIDS continues to be a major public health concern for children. Each day, worldwide, approximately 440 children became newly infected with HIV, and 270 children died from AIDS-related causes in 2018. Poor nutrition has been associated with accelerated disease progression, and sufficient dietary diversity is considered a key to improve children’s nutritional status. Therefore, this study aims to 1) examine nutritional status of school-age children living with HIV in Phnom Penh, Cambodia, and 2) identify factors associated with their nutritional status, especially taking their dietary diversity into consideration.Methods: This cross-sectional study was conducted in May 2018 within the catchment area of the National Pediatric Hospital, Cambodia. Data from 298 children and their caregivers were included in the analyses. Using semi-structured questionnaires, face-to-face interviews were conducted to collect data regarding sociodemographic characteristics, quality of life, and dietary diversity. To assess children’s nutritional status, body weight and height were measured. Viral load and duration of antiretroviral therapy (ART) were collected from clinical records. Multiple logistic regression analyses were performed to identify factors associated with stunting and wasting.Results: Of 298 children, nearly half (46.6%) were stunted, and 13.1% were wasted. The mean number of food groups consumed by the children in the past 24 hours was 4.6 out of 7 groups. Factors associated with children’s stunting were age (adjusted odds ratio [AOR] 2.166, 95% confidence interval [CI]: 1.151, 4.077), household wealth (AOR 0.543, 95%CI: 0.299, 0.986), duration of receiving ART (AOR 0.510, 95%CI: 0.267, 0.974), and having disease symptoms during the past one year (AOR 1.871, 95%CI: 1.005, 3.480). The only factor associated with wasting was being male (AOR 5.304, 95%CI: 2.210, 12.728).Conclusions: Prevalence of stunting was more than double that of non-infected school-age children living in urban areas in Cambodia. This highlights the importance of conducting nutritional intervention programs, especially tailored for children living with HIV in the country. Although dietary diversity was not significantly associated with children’s nutritional status in this study, the findings will contribute to implementing future nutritional interventions more efficiently by indicating children who are most in need of such interventions in Cambodia.
Food insecurity and lipid profile abnormalities are associated with an increased risk of non- alcoholic fatty liver disease (NAFLD): a case-control study in northwest of Iran
Authors: Tutunchi Helda , Saghafi-Asl Maryam , Attar Mohammad-Javad Hosseinzadeh , Asghari-Jafarabadi Mohammad , Ostadrahimi Alireza 
Published: March 2020

Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is an important public health problem and a significant cause of morbidity and mortality. Little is known about the relation between food insecurity and NAFLD. This study aimed to assess the relationship between food insecurity, risk factors associated with food insecurity, and NAFLD prevalence in a sample of Iranian adults.Methods In this age-matched and gender-matched case–control study, 210 subjects were recruited. NAFLD diagnosis was performed by a single expert radiologist using ultrasonography. The demographic and socioeconomic characteristics, anthropometric indices, body composition, along with food insecurity and depression status were assessed. Blood samples were collected to determine the lipid profile parameters. Chi-square, independent samples t-test, and uni-and multi-variate logistic regression tests were used. Data were analysed using SPSS V.23.0.Results The prevalence of food insecurity was 56.8% and 26.1% in cases and controls ( P<0.001 ), respectively. According to final analysis model, food insecurity, depression, number of children ≥ 4, overweight, and obesity were identified as significant independent risk factors for NAFLD. The chance of NAFLD in the food insecure, depressed, overweight, and obese subjects was 2.2 (95%CI: 1.12-3.43), 1.9 (95%CI: 1.02-3.62), 2.6 (95%CI: 1.81-3.92), and 2.9 (95%CI: 2.02- 5.34) times higher, respectively. Additionally, a higher waist circumference (men, OR = 2.9, P < 0.001 ; women, OR= 2.6, P< 0.001 ), an elevated waist-to-hip ratio (men, OR=2.3, P<0.001 ; women, OR=2.7, P<0.001 ), an increased waist-to-height ratio (OR=2.9, P<0.001 ), and a higher body fat percentage (men, OR=3.0, P<0.001 ; women, OR=3.3, P<0.001 ) were independently associated with an increased risk of NAFLD. The odds of NAFLD increased by increment in serum triglyceride (TG) levels (OR=2.6, P<0.001 ) and decreased by increase in serum high-density lipoprotein cholesterol (HDL-C) (OR=0.34, P<0.001 ). Compared to controls, NAFLD patients were more likely to have higher TG/HDL-C ratio (OR =3.3, P<0.001 ).Conclusions The prevalence of food insecurity in patients with NAFLD was significantly higher compared to controls. Food insecurity was associated with an increased risk of NAFLD, even after adjusting for potential confounding factors. Additionally, NAFLD was significantly related to some indicators of dyslipidemia.
Empirical analysis of socio-economic determinants of maternal health services utilisation in Burundi
Authors: Habonimana Desire , Batura Neha 
Published: March 2020

Abstract
Background Timely and appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. However, factors such as poverty and low education levels, long distance to a health facility, and high costs of health services may present barriers to timely access and utilisation of maternal health services. Despite prenatal, childbirth and postanal care being free at the point of use in Burundi, utilisation of these services remains low: between 2011 and 2017, only 49% of pregnant women attended at least four antenatal care (ANC) visits. This study explores the socio-economic determinants that affect utilisation of maternal health services in Burundi.Methods We use data from the 2017 Burundian Demographic and Health Survey (DHS) collected from 8,941 women who reported a live birth in the five years preceding the survey. We use multiple regression analysis to explore the factors that determine the likelihood of seeking ANC services from a trained health professional, the number of ANC visits made and the choice of assisted childbirth.Results Occupation, marital status and wealth increase the likelihood of seeking ANC services from a trained health professional. The likelihood that a woman consults a trained health professional for ANC services is 18 times and 16 times more for married women and women living in partnership, respectively. More educated women and those who currently live a union or partnership attend more ANC visits than others. At higher birth orders, women tend to not attend ANC visits. The more ANC visits attended, and the wealthier women are; the more likely they are assisted during childbirth. Women who complete four or more ANC visits are 14 times more likely to have an assisted childbirth.Conclusions In Burundi, utilisation of maternal health services is low. There is inequality in services utilisation among women based on wealth, parity, religion, and occupation. ANC is an important determinant of subsequent delivery care. There is a gap between married and unmarried women. This has a strong health policy implication to improve access to maternal health services for unmarried women.
Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands
Authors: Spruijt Ineke , Haile Dawit Tesfay , Hof Susan van den , Fiekert Kathy , Jansen Niesje , Jerene Degu , Klinkenberg Eveline , Leimane Ieva , Suurmond Jeanine 
Published: March 2020

Abstract
Background Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands.Methods We interviewed adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment. We used a thematic analysis to identify, analyse and report patterns in the data.Results Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment.Conclusion The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.
Opportunities for the development of drowning interventions in West Bengal, India: A review of policy and government programs
Authors: Gupta Medhavi , Zwi Anthony B , Jagnoor Jagnoor 
Published: March 2020

Abstract
Background: Four million people living in the Indian Sundarbans region in the state of West Bengal face a particularly high risk of drowning due to rurality, presence of open water, lack of accessible health systems and poor infrastructure. Although the World Health Organization has identified a number of interventions that may prevent drowning in rural low-and middle-income country contexts, no drowning interventions are currently implemented in this region. Interventions that build on existing policy targets or government programs are more likely to be sustainable and scalable.Methods: A detailed content review of national and state policy (West Bengal) was conducted to identify policy principles and/or specific government programs that may be leveraged for drowning interventions. The enablers and barriers of these programs as well as their implementation reach were assessed through a systematic literature review. Identified policies and programs were also assessed to understand how they catered for underserved groups and their implications for equity.Results: Three programs may be leveraged for drowning interventions: the Integrated Child Development Scheme (ICDS), Self-Help Group (SHG) and Accredited Social Health Activist (ASHA) programs. All three had high coverage in West Bengal and considered underserved groups such as women and rural populations.Conclusions: This is the first systematic analysis of both policy content and execution of government programs to provide comprehensive insights into possible implementation strategies for a health intervention, in this case drowning. Programs targeting specific health outcomes should consider interventions outside of the health sector that address social determinants of health. This may enable the program to better align with relevant government agendas and increase sustainability.
A cross-sectional analysis of falsified, counterfeit and substandard medicines in a low-middle income country
Authors: Khurelbat Daariimaa , Dorj Gereltuya , Sunderland Bruce Vivian , Sanjjav Tsetsegmaa , Bayarsaikhan Enkhtuul , Damdindorj Davaadagva , Dorj Gantuya , Jigjidsuren Altantuya , Lkhasuren Oyun , Erdenetsetseg Baasandorj 
Published: March 2020

Abstract
Background: High prevalence of falsified, counterfeit and substandard medicines pose a threat to public health and treatment failure. This study aimed to investigate the quality of selected essential medicines available in Mongolia.Methods: A cross-sectional study collected essential medicines from pharmacy outlets in Mongolia, during June and July, 2017. These products were then submitted for pharmacopoeial analysis and registration status.Results: A total of 1770 samples from 118 pharmacy entities were purchased from wholesalers in urban and rural areas. Pharmacopoeial analysis found 179 (10.1%) samples or eleven product groups were unacceptable. The prevalence of substandard locally produced medicines (n=105, 5.9%) was higher than imported equivalents [ (n=74, 4.17%, p=0.0001)]. Approximately one-third of all unacceptable tests were related to assay (n=73, 30.8%) and weight variation. Of 1770 samples, 76 (4.3%) were unregistered and the prevalence of unregistered samples was 3.8% in Ulaanbaatar city and 5.8% in rural areas, respectively. Conclusions: This study has indicated that falsified and substandard medicines are prevalent in Mongolia. Considerable effort is required by regulatory authorities, private manufacturers, as well as importers to increase the quality of essential medicines in Mongolia.
Determinants and impact of role-related time use allocation on self-reported health among married men and women: a cross-national comparative study
Authors: Jonsson Kenisha Russell , Oberg Gustav , Samkange-Zeeb Florence , Adjei Nicholas Kofi 
Published: March 2020

Abstract
Background: Research on the effects of marriage on health has largely maintained that there is a distinctly gender-specific gradient in health, with men deriving far greater benefits than women. One reason provided for these differences is the disproportionate amount of time spent by women on housework activities and childcare. However, this hypothesis has yet to be explicitly tested for these role-related time use activities. This study provides empirical evidence on the associations between role-related time use activities (i.e. housework, childcare and paid work) and self-reported health among married men and women.Methods: Data from the Multinational Time Use Study (MTUS) on 32,881 men and 26,915 women from Germany, Italy, Spain, UK and the US were analyzed. Seemingly unrelated regression (SUR) models and multivariable logistic regression were used to estimate the association between role-related time use activities and self-reported health among married men and women.Results: The findings showed that education, occupation and number of children were the most consistent predictors of time allocation among married men and women. Significant gender differences were also found in time allocation, with women sacrificing paid working time or reducing time devoted to housework for childcare. Men, in contrast, were less likely to reduce paid working hours to increase time allocation to childcare, but instead reduced time allocation to housework. Allocating more time to paid work and childcare was associated with good health, whereas time spent in housework was associated with poor health, especially among women.Conclusions: Time allocations to role-related activities have differential associations on health and these effects varies by gender and across countries. To reduce the gender health gap among married men and women, public policies need to take into account social and gender roles.
Prevalence of positive TST among Healthcare workers in a high-burden TB setting in Peru
Authors: Sedamano Juana , Schwalb Alvaro , Cachay Rodrigo , Zamudio Carlos , Ugarte-Gil Cesar , Soto-Cabezas Gabriela , Munayco César V. , Seas Carlos 
Published: March 2020

Abstract
Background Tuberculosis (TB) transmission has long been recognized as an important occupational hazard for healthcare workers (HCWs). HCWs possess a 5.8% annual risk of exposure and three times greater risk of developing active TB than the general population.Methods We conducted an observational cross-sectional study between September 2014 and March 2015 among HCWs in a high-burden TB setting in Lima to estimate the prevalence of positive Tuberculin Skin Test (TST) and to investigate factors associated with a positive TST.Results 240 participants were included in the analysis; TST was administered to 190 (79.2%) while the rest were exempted due to a previous positive TST result, history of TB or refused the test. A positive TST result was found among 56.2% of participants (95% CI: 49.22% - 63.55%). When considering those who had a previous positive TST result and those with a history of TB, the prevalence of a positive TST was 64.3% (95% CI: 57.8% - 70.3%). No significant differences of TST results were observed between clinical/paramedical and administrative staff in the health center. The use of N95 mask during work hours was reported by 142 (69.9%) participants. Prevalence ratios (PR) show that workers with more than 120 months as a HCW were 1.44 times more likely to be TST positive. The multivariate analysis found that HCWs with over 10 years of service were 1.62 times more likely to be TST positive.Conclusion This study supports previous reports that TB infection is an occupational hazard for HCWs. Prevention of TB transmission through control measures, as well as timely diagnosis of LTBI in this selected risk group, is critical for the individual and for public health.
Trends and Determinants of Underweight and Overweight/Obesity among Urban Ethiopian Women from 2000 to 2016
Authors: Ahmed Kedir Yimam , Abrha Solomon , Page Andrew , Arora Amit , Shiferaw Solomon , Tadese Fentaw , Negash Canaan , Yeneabat Tebikew , Alemu Emana , Gebremichael Delelegn Yilma , Seiko Abdulaziz , Ogbo Felix Akpojene 
Published: March 2020

Abstract
Background: Nutritional, epidemiological and demographic transitions have been associated with the emergence of the double burden of malnutrition globally. In Ethiopia, there has been no nationally representative investigation of trends and determinants of both underweight and overweight/obesity among urban women. This study examined the trends and determinants of underweight and overweight/obesity in urban Ethiopian women from 2000 to 2016.Methods: Trends in the prevalence of underweight and overweight/obesity were investigated based on a series of the Ethiopia Demographic and Health Survey (EDHS) data for the years 2000 (n=2559), 2005 (n=1112), 2011 (n=3569), and 2016 (n=3106). Multivariate multinomial logistic regression was used to investigate the association between socioeconomic, demographic, behavioural, and community-level factors with underweight and overweight/obesity.Results: The prevalence of underweight in urban Ethiopian women improved significantly from 23.2% (95% confidence interval [CI]: 20.3%, 26.3%) in 2000 to 14.8% (95% CI: 13.1%, 16.7%) in 2016, while overweight/obesity increased significantly from 10.9% (95% CI: 9.1%, 13.0%) in 2000 to 21.4% (95% CI: 18.2%, 25.1%) in 2016. Urban women from rich households and those who had never married were less likely to be underweight. Urban women who were from wealthy households and those who attained at least secondary education were more likely to be overweight/obese. Women who were informally employed and listened to the radio were less likely to be overweight/obese compared to those who were unemployed and did not listen to the radio, respectively.Conclusion: The prevalence of overweight/obesity increased from 2000 to 2016, with a concurrent reduction in the prevalence of underweight. Context-specific policy interventions that target improvement in socioeconomic status, regular physical activity and healthier dietary choices for urban Ethiopian women are needed.