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PubMed2006

Examining geographical and household variation in mental health in Australia.

OBJECTIVE: International research has failed to demonstrate area effects in the distribution of common mental disorders. In contrast, strong and robust household effects are evident, though relatively rarely examined. This study investigated household and area effects in the distribution of mental health scores using Australian data. METHOD: Analysis of data from the first wave of the Household, Income and Labour Dynamics in Australia Survey: a large representative survey of 13 969 Australian adults. Multilevel regression methods were used to model variance in the mental health scale and mental component summary scale of the Short-Form 36 at the individual, household and area (Census Collection District) levels. A number of risk factors at various levels of the model were also examined. RESULTS: Very little variance in mental health scores occurred at the area level (1.5%), whereas significant and substantial variance occurred at the household level (23.0%). The variance at the household level remained highly significant following the inclusion of a range of risk factors at the individual, household and area levels. CONCLUSIONS: The results confirm the absence of substantial area-level variation in mental health using Australian data. The findings highlight the importance of focusing on household-level characteristics in future research.

Adolescent↗
PubMed1999

Evaluation of four sampling methods for determining exposure of children to lead-contaminated household dust.

Childhood exposure to lead has been demonstrated to result in health effects and lead-contaminated household dust is a primary exposure source. There is a need to establish reliable methods for sampling surfaces to determine levels of lead contamination. Three vacuums (HVS3, GS80, and MVM) and one wipe method were evaluated for the collection of household floor dust under field sampling conditions within a Superfund site and demographically similar control area. Side-by-side floor samples were taken from three locations within 41 randomly selected households between August and September 1995: a child's bedroom, primary play area, and primary entrance. Analysis was performed to assess the relative collection performance of each sampler, spatial distribution of lead within a household, and correlation of lead loading with observed blood lead level, and to determine if discrete or composites samples were more predictive of blood lead levels. Approximately 90% of the floor surfaces were carpeted. The rank order of sampling methods from greatest to lowest collection efficiency was HVS3 > GS80 > wipe > MVM. The HVS3 had the highest level of precision (CV=0.05), with the GS80 and wipe precisions 0.48 and 0.053, respectively. Lead loadings for samples collected in bedrooms and living areas and composite samples using the HVS3 and wipe methods were significantly correlated with blood lead levels. Correlations between blood lead levels and composite samples were stronger for the HVS3 (R(2)=0.33, P=0.003) and wipe (R(2)=0.25, P=0.002) methods than the respective discrete samples. Regression analysis indicated that a blood lead level of 10 microgram/dl corresponds to a carpet wipe sample geometric mean of 68 microgram/ft(2). For ongoing public health purposes, such as screening and clearance testing, use of the wipe sampling method is the most appropriate. This investigation supports findings by others that the present HUD risk levels for lead in floor wipe samples may not be adequate for reducing children's blood lead levels below 10 microgram/dl.

Child↗
PubMed2005

Evaluation of long-lasting insecticidal nets after 2 years of household use.

Development of long-lasting insecticidal nets (LLINs) may eliminate the need for insecticide retreatment of ITNs. While two LLINs (Olyset, Sumitomo Chemical Co., Japan; and PermaNet 1.0, Vestergaard-Frandsen, Denmark) have received recommendations from the World Health Organization Pesticide Evaluation Scheme, field-testing under normal use has been limited. We used a survival analysis approach to compare time to net failure of conventional polyester bednets treated only with deltamethrin to two LLINs and two candidate LLINs (Olyset; PermaNet; Insector, Athanor, France; and Dawa, Siamdutch Mosquito Netting Co., Thailand). Additionally, we evaluated nets treated with a process designed to increase the wash-durability of permethrin-treated nets through the addition of cyclodextrin (a starch) in the treatment process. Houses in western Kenya were randomly assigned to one of the six net types and nets were distributed to cover all sleeping spaces. Households were visited monthly to assess reported side effects in inhabitants and washing frequency. Nets were evaluated for insecticidal activity by periodic WHO cone bioassays with mortality assessed at 24 h. Nets with bioassay mortality <70% were assayed monthly until failure, defined as the first of two consecutive bioassay mortality rates <50%. Time to failure was analyzed using an extended Cox Proportional Hazards model controlling for the cumulative number of washes. We distributed 314 nets to 177 households in June-July 2002; 22 nets (7.0%) were lost to follow-up and 196 (62.4%) failed during the first 2 years of the evaluation. Controlling for cumulative number of washes, PermaNet 1.0 [Hazard Ratio (HR) 0.14, 95% Confidence Interval (CI) 0.06-0.31] had a significantly lower risk of failure than conventional nets while Insector had a significantly higher risk of failure (HR 2.57, 95% CI 1.06-4.15). The risks of failure of the remaining nets (Olyset: HR 1.29, 95% CI 0.79-2.10; Dawa: HR 0.58, 95% CI 0.32-1.18; cyclodextrin: HR 0.65, 95% CI 0.40-1.1) were not significantly different from that of a conventional net. PermaNet 1.0 performed significantly better than conventional nets and should be recommended to malaria control programs.

Animals↗
PubMed1999

The "Let's Get Alarmed!" initiative: a smoke alarm giveaway programme.

OBJECTIVES: To reduce fires and fire related injuries by increasing the prevalence of functioning smoke alarms in high risk households. SETTING: The programme was delivered in an inner London area with above average material deprivation and below average smoke alarm ownership. The target population included low income and rental households and households with elderly persons or young children. METHODS: Forty wards, averaging 4000 households each, were randomised to intervention or control status. Free smoke alarms and fire safety information were distributed in intervention wards by community groups and workers as part of routine activities and by paid workers who visited target neighbourhoods. Recipients provided data on household age distribution and housing tenure. Programme costs were documented from a societal perspective. Data are being collected on smoke alarm ownership and function, and on fires and related injuries and their costs. RESULTS: Community and paid workers distributed 20,050 smoke alarms, potentially sufficient to increase smoke alarm ownership by 50% in intervention wards. Compared with the total study population, recipients included greater proportions of low income and rental households and households including children under 5 years or adults aged 65 and older. Total programme costs were 145,087 Pounds. CONCLUSIONS: It is possible to implement a large scale smoke alarm giveaway programme targeted to high risk households in a densely populated, multicultural, materially deprived community. The programme's effects on the prevalence of installed and functioning alarms and the incidence of fires and fire related injuries, and its cost effectiveness, are being evaluated as a randomized controlled trial.

Adolescent↗
PubMedDate not supplied

Evaluation of two strategies for heart health promotion by direct mail in a low-income urban community.

BACKGROUND: The objective of this study was to evaluate the reach of mass mailings of heart health education print materials in a low-income, urban community. Materials included a monthly newsletter and a self-help behavior change kit, both distributed to all 12,789 households in the study community. METHODS: Recall, use, and self-reported impact of the materials were measured in a cross-sectional survey of a random sample of 345 adults conducted 2 weeks after distribution of the kit and 18 months after delivery of the first newsletter. RESULTS: Over one-third of the subjects (38.6%) recalled the newsletter and 27.9% had read one or more newsletters; 21.7% recalled the kit and 10.8% had read it. Few subjects had read both materials. Female gender and older age were independent correlates of having seen and read the newsletters. Older age, being widowed/separated/divorced, and infrequent physical activity were correlates of having seen and read the kit. CONCLUSIONS: Although the newsletter and kit formats might appeal to different segments of the population, mass mailings of heart health education print materials in a low-income urban community can reach large numbers of individuals. The cost effectiveness of repeated mailings of short, simple newsletters might be higher than a single mailing of a more complex behavior change kit.

Adolescent↗
PubMed2005

Sources of household salt in South Africa.

Marketing of non-iodized salt through unconventional distribution channels is one of the factors weakening the national salt iodization program in South Africa. The aim of this study was therefore to quantify the various sources of household salt, and to relate this information to socio-economic status. Questionnaire information was collected by personal interview during home visits from a multistage, cluster, probability sample of 2164 adults representative of the adult population. Nationally 77.7% of households obtained their table salt from the typical food shops distributing iodized salt. However, in the nine different provinces between 8 and 37.3% of households used unconventional sources, distributing mainly non-iodized salt, to obtain their household salt. These alternative sources include distributors of agricultural salt, small general dealer shops called spaza shops, in peri-urban and rural townships, street vendors and salt saches placed in the packaging of maize meal bags. Country-wide around 30% of low socio-economic households obtained their salt from unconventional sources compared to less than 5% in high socio-economic households, emphasizing the vulnerability of low socio-economic groups to the use of non-iodized salt. Intervention strategies should mobilize all role players involved in unconventional marketing channels of household salt to provide only iodized salt to consumers, as required by law.

Adolescent↗
PubMed1985

Interventions for the control of diarrhoeal diseases among young children: chemoprophylaxis.

A number of situations place young children at increased risk of diarrhoea. Among these, the best documented in developing countries is contact with a diarrhoea case in a family or household. The most common application of chemoprophylaxis in developing countries is to prevent cholera or shigellosis among household contacts of known cases. There is little evidence that chemoprophylaxis is effective in reducing diarrhoea morbidity and mortality, except perhaps in travellers. Theoretical calculations in this paper (based on optimistic assumptions) suggest that chemoprophylaxis of household contacts of known cholera cases in Bangladesh might reduce overall diarrhoea incidence rates in children under 5 years of age by 0.02-0.06% and diarrhoea mortality rates by 0.4-1.2%. Chemoprophylaxis of household contacts of known shigellosis cases might reduce overall diarrhoea incidence rates by 0.15-0.35% and diarrhoea mortality rates by 0.3-0.7% in the same age group. The correct identification of index cases of cholera and shigellosis, followed by the rapid distribution of drugs to their household contacts, requires skills and resources that are scarce in the developing countries. Chemoprophylaxis can contribute to the widespread emergence and dissemination of antimicrobial resistance. The available evidence suggests that chemoprophylaxis is not feasible in many settings and that, even if successfully implemented, it is not a cost-effective intervention for national diarrhoeal diseases control programmes.

Child, Preschool↗
PubMedDate not supplied

The impact of income redistribution on fertility in Canada.

This paper speculates on the role of income redistribution as a means of raising fertility in Canada. It is argued that if the relationship between income and fertility is non-linear at the household level, then changes in the income distribution in a society have important consequences for changes in aggregate fertility. In order to test this hypothesis, a simple fertility model is estimated using micro-data collected in the 1981 Canadian Census. The relationship between income and fertility is found to be nonlinear with properties that indicate that transfers of income from "rich" to "poor" households will likely further depress the overall level of fertility in Canada.

Americas↗
PubMed2002

Factors associated with coverage in community-directed treatment with ivermectin for onchocerciasis control in Oyo State, Nigeria.

Community-directed distribution with ivermectin (CDTI) has been adopted by the African Programme for Onchocerciasis Control (APOC) as its main strategy for achieving sustained high coverage in endemic communities. This article describes the coverage results achieved when CDTI was introduced in four local government areas of Oyo State, Nigeria. Using a household survey after the second distribution, researchers documented that 68.6% of the community overall received the drug, and as did 85.0% of those who were eligible (not pregnant, not sick and at least 5 years of age). Six factors were associated with having received ivermectin. Four were personal characteristics: being male, being at least 35 years of age, belonging to the Fulani ethnic minority, having taken the drug at a previous distribution. Two village characteristics were smaller size, as measured by number of houses, and use of the central place mode of distribution as opposed to house-to-house. In-depth interviews with village leaders and volunteer community-directed distributors (CDDs) and focus group discussions among villagers provided qualitative data to help interpret the findings. Women in many villages felt excluded from decision making. The concerns of migrant farm workers living in Yoruba farm settlements were not well understood by health staff or the majority population. The main factor associated with receiving the ivermectin was having received it before, and qualitative comments about side-effects and beliefs about orthodox drugs indicated that issues of personal preferences, not addressed in a household coverage survey, need to be explored further. The findings can provide guidance in re-orienting health workers to the importance of fostering participation and cohesion among all segments of the community, especially the inclusion of women and minority groups.

Adolescent↗
PubMed2004

Willingness to pay for prevention and treatment of lymphatic filariasis in Leogane, Haiti.

BACKGROUND: Lymphatic filariasis (LF) affects more than 120 million people worldwide. Efforts to eliminate this disease require sustained community participation. This study explores community valuation of LF elimination efforts by estimating household and community willingness to pay (WTP) for the prevention of transmission and treatment of filarial lymphedema in the community of Leogane, Haiti. METHODS: A contingent valuation survey was used to assess individual WTP for specific prevention and treatment interventions. A 2-dimensional Monte Carlo simulation was developed to estimate confidence limits in mean WTP and to generate a distribution of WTP for the community, accounting for uncertainty in regression coefficients and variability within the population. RESULTS: Mean WTP was estimated to be $5.57/month/household (95% CL: $4.76, $6.72) to prevent disease transmission, and $491/yr (95% CL: $377, $662) for treatment of lymphedema for one person. Based on the estimated distributions, 7% and 39% of households were not willing to pay for prevention and treatment, respectively. CONCLUSIONS: These results suggest that the majority of the community places a positive value on both prevention and treatment of LF. Mean WTP provides a useful monetary estimate of overall societal benefit of LF prevention and treatment programs. However, for interventions which require broad and sustained community participation, the lower end of the distribution of WTP has additional implications. Cost recovery policies may result in inadequate participation and longer program duration.

Journal Article↗
PubMed1992

[Social and economic impact of dracunculosis: a longitudinal study carried out in 2 villages in Benin].

Dracunculiasis is a severely disabling parasitic disease. In endemic areas it is responsible for heavy economic losses and serious social repercussions. A prospective study in two villages of some 200 inhabitants in Zou Province, central Benin, was carried out over a period of 21 months, which covers two seasons of dracunculiasis transmission. This survey consisted of weekly visits by a medical team and a case study of 30 households conducted by an investigator on 20 days each month. The medical team had the task of detecting and treating all cases of dracunculiasis, and quantifying the duration of each case and the degree of disability of each patient. The investigator noted the number of working days and the distribution of tasks within each household. Days lost on account of dracunculiasis amount to 6.2% of the total number of working days at Lissa and 8.6% at Sozoumé. At certain times of the year as much as 19% of working days may be lost. The reduction in working time leads to a redistribution of tasks among the villagers and, less commonly, to the use of replacement labour. Mutual assistance, very widespread in small communities, makes it possible to maintain income levels. On the other hand, it often involves work by schoolchildren. Young people who stay away from school to replace disabled adults sometimes never return. The annual cost of dracunculiasis has been estimated at 16,000 CFA francs per patient (US$ 60), which corresponds to 15% of a worker's income.

Absenteeism↗
PubMed2022

Spatial-temporal and phylogenetic analyses of epidemiologic data to help understand the modes of transmission of endemic typhoid fever in Samoa.

Salmonella enterica serovar Typhi (S. Typhi) is either widely distributed or proximally transmitted via fecally-contaminated food or water to cause typhoid fever. In Samoa, where endemic typhoid fever has persisted over decades despite water quality and sanitation improvements, the local patterns of S. Typhi circulation remain unclear. From April 2018-June 2020, epidemiologic data and GPS coordinates were collected during household investigations of 260 acute cases of typhoid fever, and 27 asymptomatic shedders of S. Typhi were detected among household contacts. Spatial and temporal distributions of cases were examined using Average Nearest Neighbor and space-time hotspot analyses. In rural regions, infections occurred in sporadic, focal clusters contrasting with persistent, less clustered cases in the Apia Urban Area. Restrictions to population movement during nationwide lockdowns in 2019-2020 were associated with marked reductions of cases. Phylogenetic analyses of isolates with whole genome sequences (n = 186) revealed one dominant genotype 3.5.4 (n = 181/186) that contains three Samoa-exclusive sub-lineages: 3.5.4.1, 3.5.4.2, and 3.5.4.3. Variables of patient sex, age, and geographic region were examined by phylogenetic groupings, and significant differences (p<0.05) associated genetically-similar isolates in urban areas with working ages (20-49 year olds), and in rural areas with age groups typically at home (<5, 50+). Isolates from asymptomatic shedders were among all three sub-lineages. Whole genome sequencing provided evidence of bacterial genetic similarity, which corroborated 10/12 putative epidemiologic linkages among cases and asymptomatic shedders, as well as 3/3 repeat positives (presumed relapses), with a median of one single nucleotide polymorphism difference. These findings highlight various patterns of typhoid transmission in Samoa that differ between urban and rural regions as well as genomic subtypes. Asymptomatic shedders, detectable only through household investigations, are likely an important reservoir and mobile agent of infection. This study advances a "Samoan S. Typhi framework" that supports current and future typhoid surveillance and control efforts in Samoa.

Humans↗
PubMed2006

Contrasting patterns in the small-scale heterogeneity of human helminth infections in urban and rural environments in Brazil.

Marked heterogeneity exists in the patterns of parasitic infection between individuals, households and communities. Analysis of parasite distributions within populations is complicated by the fact that parasite distributions are highly aggregated and few studies have explicitly incorporated this distribution when investigating small-scale spatial heterogeneities. This study aimed to quantify the small-scale (within- and between-household) heterogeneity of helminth infection in an area of Minas Gerais State, Brazil, with rural and urban sectors. Parasitological data from a cross-sectional survey of 1,249 individuals aged 0-86 years from 242 households were analysed. Within-household clustering of infection was assessed using random effect logistic regression models and between-household spatial heterogeneity was assessed using a Bayesian negative binomial spatial model. The overall prevalence of hookworm (Necator americanus) was 66.9%, the prevalence of Schistosoma mansoni was 44.9% and the prevalence of Ascaris lumbricoides was 48.8%. Statistical analysis indicated significant (within) household and (between household) spatial clustering of hookworm in both rural and urban areas and of S. mansoni in rural areas. There was no evidence of either household or spatial clustering of S. mansoni in urban areas. The spatial correlation of S. mansoni was estimated to reduce by half over a distance of 700 m in the rural area. Rural hookworm had a much smaller half-distance (28 m) and urban hookworm showed an even smaller half-distance (12 m). We suggest that such species-specific differences in patterns of infection by environment are primarily due to variation in exposure and parasite life cycle, although host genetic factors cannot be ruled out.

Adolescent↗
PubMed2001

[Effect of design in cluster sampling to estimate the distribution of occupations among workers].

OBJECTIVE: To describe the effect of design associated with a sample survey carried out to estimate the distribution of occupations within an economic active population. METHODS: A cluster sample of households, chosen from a comprehensive directory via systematic random sampling, was performed including 4,782 of all residences in Botucatu, Brazil, between June and July 1997. RESULTS: Of the 4,782 households, 17,219 subjects were assessed. Due to the loss of distribution heterogeneity of the occupations within the households, the effect of design found ranged from 1.00 to 1.96. CONCLUSIONS: The results suggest that when planning similar studies aiming at estimating the distribution of occupations among economic active populations, the effect of design should be estimated as e=1.50 for surveys in urban areas, and e=2.00 for surveys in rural areas.

Cluster Analysis↗
PubMed2005

Anaerobic degradation of solid material: importance of initiation centers for methanogenesis, mixing intensity, and 2D distributed model.

Batch anaerobic codigestion of municipal household solid waste (MHSW) and digested manure in mesophilic conditions was carried out. The different waste-to-biomass ratios and intensity of mixing were studied theoretically and experimentally. The experiments showed that when organic loading was high, intensive mixing resulted in acidification and failure of the process, while low mixing intensity was crucial for successful digestion. However, when loading was low, mixing intensity had no significant effect on the process. We hypothesized that mixing was preventing establishment of methanogenic zones in the reactor space. The methanogenic zones are important to withstand inhibition due to development of acids formed during acidogenesis. The 2D distributed models of symmetrical cylinder reactor are presented based on the hypothesis of the necessity of a minimum size of methanogenic zones that can propagate and establish a good methanogenic environment. The model showed that at high organic loading rate spatial separation of the initial methanogenic centers from active acidogenic areas is the key factor for efficient conversion of solids to methane. The initial level of methanogenic biomass in the initiation centers is a critical factor for the survival of these centers. At low mixing, most of the initiation methanogenic centers survive and expand over the reactor volume. However, at vigorous mixing the initial methanogenic centers are reduced in size, averaged over the reactor volume, and finally dissipate. Using fluorescence in situ hybridization, large irregular cocci of microorganisms were observed in the case with minimal mixing, while in the case with high stirring mainly dead cells were found.

Acids↗
PubMed1995

Living together in Great Britain--displaying household structure through demographic pyramids.

Population pyramids are a demographic technique which can be used to represent the age and sex structure of a population. This article illustrates how the technique can be used to represent the age and sex distribution of co-resident members of households. The pyramids use data from the 1% household file of the Samples of Anonymised Records from the 1991 Census of Great Britain. Some comparisons are made with Spanish households.

Adolescent↗
PubMed1998

The effect of soap distribution on diarrhoea: Nyamithuthu Refugee Camp.

BACKGROUND: In January 1993, Nyamithuthu Camp in Malawi housed 64000 Mozambican refugees. Communicable diseases, primarily diarrhoea, pneumonia, malaria and measles, contribute to substantially higher mortality rates in refugee populations compared to similar non-displaced populations. METHOD: A systematic sample of 402 households in one portion of the camp were surveyed for diarrhoeal risk factors, and then interviewed twice weekly for 4 months regarding new diarrhoea episodes and the presence of soap in the household. Two-hundred grams of soap per person was distributed monthly. RESULTS: Households had soap on average only 38% of the interview days. Soap was used primarily for bathing and washing clothes (86%). Although 81% of mothers reported washing their children's hands, only 28% of those mothers used soap for that purpose. The presence of soap in a household showed a significant protective effect: there were 27% less episodes of diarrhoea in households when soap was present compared to when no soap was present (RR = 0.73, 95% CI: 0.54 < RR < 0.98). Potential confounding factors were assessed and did not appear to be responsible for the association between the presence of soap and reductions in diarrhoea incidence. CONCLUSION: In summary, our findings suggest that the provision of regular and adequate soap rations, even in the absence of a behaviour modification or education programme, can play an important role in reducing diarrhoea in refugee populations. If subsequent study confirms the soap as a cheap and effective measure to reduce diarrhoea, its provision in adequate amounts should be a high priority in refugee settings.

Adolescent↗
PubMed2000

Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition.

This paper summarizes eight country studies of inequality in the health sector. The analyses use household data to examine the distribution of service use and health expenditures. Each study divides the population into "income" quintiles, estimated using consumption expenditures. The studies measure inequality in the use of and spending on health services. Richer groups are found to have a higher probability of obtaining care when sick, to be more likely to be seen by a doctor, and to have a higher probability of receiving medicines when they are ill, than the poorer groups. The richer also spend more in absolute terms on care. In several instances there are unexpected findings. There is no consistent pattern in the use of private providers. Richer households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicate that intuition concerning inequalities could result in misguided decisions. It would thus be worthwhile to measure inequality to inform policy-making. Additional research could be performed using a common methodology for the collection of data and applying more sophisticated analytical techniques. These analyses could be used to measure the impact of health policy changes on inequality.

Data Collection↗