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PubMed1997

[Antibiotics in Spanish households. Medical and socioeconomic implications. URANO Study Group].

BACKGROUND: To determine the storage of antibiotics in Spanish households and to analyse its source. POPULATION AND METHODS: Quantitative study carried out by telephone interview with housewives or head of the family members in 1,000 households that have been chosen at random and by agreement with a proportion of the territorial distribution of the Spanish population. RESULTS: In 42% of households that have been approached, one (88.1%) or more antibiotic packets were present, being a result of a doctor's prescription in two thirds of cases. In most cases (71.9%) amoxycillin was the antibiotic found. Concerning the pharmaceutical forms, 55% corresponded to solid oral (pills, tablets, capsules), 45% liquid oral forms (syrups, suspensions, sachets), whereas parenteral vials were not identified. Only in the 19% of households with antibiotic packets (8% of the total) there was a member of the family under antibiotic treatment. The economic evaluation of the non administrated antibiotic doses, present in households was about 5,000 millions pesetas. Over 3,000 millions pesetas had been financed by Health Public Administration. CONCLUSIONS: The storage of antibiotics in households is an important factor which increments the cost, reduces the efficiency and decreases the quality of the antibiotic treatment at the community level.

Anti-Bacterial Agents↗
PubMed2002

Common mental disorder symptom counts in populations: are there distinct case groups above epidemiological cut-offs?

BACKGROUND: At the lower end of IQ distributions in general populations, there is a clear excess of cases, representing the distinct pathology of severe learning disability. This study aimed to establish whether such a subpopulation exists in distributions of common mental disorder and depression symptom scores, above epidemiological 'case' cut-offs. METHOD: Data from 9556 non-psychotic respondents to the 1993 OPCS (Office of Population Censuses and Surveys) National Household Psychiatric Morbidity Survey were analysed. The distribution of total neurotic symptom and depression scores from the revised Clinical Interview Schedule were examined. Automated least squares methods were used to fit the best single statistical distribution to the data. RESULTS: A single exponential curve provided the best fit for the whole population, but floor effects produced deviations at symptom counts of 0-3. After truncation, exponential distributions fitted excellently. Proportions of the population above conventional cut-offs of > or = 12 symptoms differed by < 12% from expected for a range of low and high prevalence groups. The single exponential model also fitted the depression score. CONCLUSIONS: Symptom counts for the common mental disorders fall within single population distributions, with little apparent numerical excess in the case range. High and low prevalences of these disorders appear to be population characteristics, with shifts in exponential means predicting proportions above case cut-offs.

Adolescent↗
PubMed2006

Mortality in the Democratic Republic of Congo: a nationwide survey.

BACKGROUND: Commencing in 1998, the war in the Democratic Republic of Congo has been a humanitarian disaster, but has drawn little response from the international community. To document rates and trends in mortality and provide recommendations for political and humanitarian interventions, we did a nationwide mortality survey during April-July, 2004. METHODS: We used a stratified three-stage, household-based cluster sampling technique. Of 511 health zones, 49 were excluded because of insecurity, and four were purposely selected to allow historical comparisons. From the remainder, probability of selection was proportional to population size. Geographical distribution and size of cluster determined how households were selected: systematic random or classic proximity sampling. Heads of households were asked about all deaths of household members during January, 2003, to April, 2004. FINDINGS: 19,500 households were visited. The national crude mortality rate of 2.1 deaths per 1000 per month (95% CI 1.6-2.6) was 40% higher than the sub-Saharan regional level (1.5), corresponding to 600,000 more deaths than would be expected during the recall period and 38,000 excess deaths per month. Total death toll from the conflict (1998-2004) was estimated to be 3.9 million. Mortality rate was higher in unstable eastern provinces, showing the effect of insecurity. Most deaths were from easily preventable and treatable illnesses rather than violence. Regression analysis suggested that if the effects of violence were removed, all-cause mortality could fall to almost normal rates. INTERPRETATION: The conflict in the Democratic Republic of Congo remains the world's deadliest humanitarian crisis. To save lives, improvements in security and increased humanitarian assistance are urgently needed.

Cause of Death↗
PubMedDate not supplied

Household characteristics affecting where mothers deliver in rural Kenya.

Data from a household survey were used to analyse the distribution of newborn deliveries in a rural area of Kenya. It was found that 52% of deliveries occurred at home or with traditional birth attendants. Using regression techniques, the most significant predictors of choosing an informal delivery setting are the household's distance from the nearest maternity bed and whether a household member has insurance. The results suggest that travel time is an important barrier to access. Therefore, quality improvements at existing facilities may not result in greater use of modern sector delivery, particularly if improvements are partially offset by user fees.

Developing Countries↗
PubMed1997

Face-to-face household interviews versus telephone interviews for health surveys.

The purpose of this study was to compare response distributions in health surveys for two interview modes: face-to-face household interviews and telephone interviews. There were two samples of the Perth metropolitan general population aged 16 to 69 years: a face-to-face household sample (n = 1000) and a telephone sample (n = 222). The samples were generated by probability-based methods commonly used by commercial market research organisations. The surveys occurred in August-September 1992 as part of a larger statewide survey component of a three-year evaluation of the Western Australian Health Promotion Foundation. Respondents were drawn from a two-stage cluster sample based on private dwellings for personal interviews, and from randomly selected listed and unlisted private numbers for telephone interviews. Although the samples did not differ significantly on a number of variables, the telephone sample was significantly higher in residential social status; there was significantly lower reporting of smoking and lower unsafe alcohol consumption in the telephone sample: significantly higher proportions of the telephone sample were in Prochaska's 'action' stage of change for several health behaviours; and there was significantly greater recall of health messages in the telephone sample. Health researchers should treat comparisons between different survey modes with caution, and should be aware that campaign evaluations using telephone surveys and household surveys may yield substantially different results.

Adolescent↗
PubMed2004

Malaria in camps for internally-displaced persons in Uganda: evaluation of an insecticide-treated bednet distribution programme.

Malaria is a key health problem among displaced populations in malaria-endemic areas. Mass distribution of insecticide-treated bednets (ITN) to prevent malaria is often carried out in complex emergencies, but there are few data on the outcome or operational effectiveness of such programmes. In June 2001, Medecins Sans Frontieres completed a mass distribution of ITNs (Permanet) to internally displaced persons in Bundibugyo, southwest Uganda, distributing one to four nets per household, and aiming to provide coverage for all residents. In July 2002, we did a cross-sectional survey using three-stage cluster sampling to evaluate the programme. A total of 1245 individuals from 835 households were interviewed. An ITN was present in 75.6% (95% CI 72.7-78.5) of the households, but only 56.5% (95% CI 52.3-60.4) of individuals were sleeping under an ITN, and nets were often damaged. The prevalence of malarial parasitaemia was 11.2% (95% CI 9.4-13.0), and was significantly lower in ITN users compared to non-users (9.2% vs. 13.8%, relative risk [RR] 0.63, 95% CI 0.46-0.87); ITNs with severe damage remained effective (RR for severely damaged net 0.58, 95% CI 0.35-0.98). There was no significant difference in haemoglobin concentration between ITN users and non-users.

Adult↗
PubMed2005

Vaccination coverage survey versus administrative data in the assessment of mass yellow fever immunization in internally displaced persons--Liberia, 2004.

Yellow fever (YF) is a mosquito-borne vaccine-preventable disease with high mortality. In West Africa, low population immunity increases the risk of epidemic transmission. A cluster survey was conducted to determine the effectiveness of a mass immunization campaign using 17D YF vaccine in internally displaced person (IDP) camps following a reported outbreak of YF in Liberia in February 2004. Administrative data of vaccination coverage were reviewed. A cluster sample size was determined among 17,384 shelters using an 80% vaccination coverage threshold. A questionnaire eliciting demographic information, household size, and vaccination status was distributed to randomly selected IDPs. Data were analyzed to compare vaccination coverage rates of administrative versus survey data. Among 87,000 persons estimated living in IDP camps, administrative data recorded 49,395 (57%) YF vaccinated persons. A total of 237 IDPs were surveyed. Of survey respondents, 215 (91.9%, 95% CI 88.4-95.4) reported being vaccinated during the campaign and 196 (83.5%, 95% CI 78.6-88.5) possessed a valid campaign vaccination card. The median number of IDPs living in a shelter was 4 (range, 1-8) and 69,536 persons overall were estimated to be living in IDP camps. Coverage rates from a rapid survey exceeded 90% by self-report and 80% by evidence of a vaccination card, indicating that the YF immunization campaign was effective. Survey results suggested that administrative data overestimated the camp population by at least 20%. An emergency, mop-up vaccination campaign was avoided. Coverage surveys can be vital in the evaluation of emergency vaccination campaigns by influencing both imminent and future immunization strategies.

Adolescent↗
PubMed2001

Synthetic peptide vaccine against Taenia solium pig cysticercosis: successful vaccination in a controlled field trial in rural Mexico.

Taenia solium cysticercosis seriously affects human health when localised in the central nervous system (CNS) and causes great economic loss in pig husbandry in rural areas of endemic countries. Increasing the resistance to the parasite in the obligatory host pig may help in curbing transmission. Three synthetic peptides based on protein sequences of the murine parasite Taenia crassiceps, which had previously been shown to induce protection in mice against homologous challenge, were tested as a vaccine against T. solium cysticercosis in pigs. Vaccinated and unvaccinated piglets (240 in all) were distributed in pairs among the peasants' households of two rural villages in Mexico in which 14% of the native pigs were cysticercotic. Ten to twelve months later, the effect of vaccination was evaluated at necropsy. Vaccination decreased the total number of T. solium cysticerci (98.7%) and reduced the prevalence (52.6%). The natural challenge conditions used in this field trial strengthen the likelihood of successful transmission control to both pig and human through a large-scale pig vaccination program. We believe this is a major contribution in anticysticercosis vaccine development as these rather simple yet protective peptides are potentially more cost-effective to produce and less variable in results than antigens that are more complex.

Amino Acid Sequence↗
PubMed2005

Risk factors associated with house infestation by the Chagas disease vector Triatoma pallidipennis in Cuernavaca metropolitan area, Mexico.

Chagas disease caused by infection with Trypanosoma cruzi Chagas (Kinetoplastida: Trypanosomatidae) is widespread in Mexico, transmitted by various triatomine bugs (Hemiptera: Reduviidae). The only domestic vector in Cuernavaca (population 650 000) is Triatoma pallidipennis (Ståhl) with T. cruzi seroprevalence ranging from 1% to 9% in the resident human population. We surveyed possible risk factors for T. pallidipennis infestation at Cuernavaca (altitude 1200-2200 m) on south-western slopes of the Sierra Madre Occidental. This metropolitan area (with five administrative counties) has rapid urbanization, forested environs and proliferation of 'weekend housing' for visitors from Mexico City, 60 km to the north. To assess factors associated with T. pallidipennis infestation, we first stratified Cuernavaca by altitude and by socio-economic status of population catchment units (PCUs). Within each PCU, one to three blocks were chosen for cluster sampling (three houses/block) and information about Chagas disease was distributed. After obtaining signed consent from householders, representative houses were routinely and opportunistically inspected for T. pallidipennis and surveyed for demographic, economic, physical and other potential risk factors. Of the 1129 houses assessed, T. pallidipennis was found in 4.1% (range 3.0-6.8% per county) and the T. cruzi infection rate was approximately 50% in bugs. Rates of house infestation in poor PCUs were double those in higher socio-economic strata (odds ratio 2.12, confidence interval 1.03-4.3), with >4-fold greater crowding index of T. pallidipennis. The bug density index was inversely correlated with PCU altitude and socio-economic category (altitude of homes being associated with prosperity), while the bug colonization index (presence of nymphs indicating breeding) did not vary significantly across the PCU categories, but did vary according to altitude. Multivariate regression analysis showed that the most significant risk factors associated with T. pallidipennis infestation were lower altitude (linked with lower socio-economic status), garden area >80 m(2), dogs at liberty to enter the house, occurrence of squirrels and opossums around the house, presence of pigs in the surrounding area and having at least one of the adjacent lots empty (unconstructed). Householders who had received information about Chagas disease comprised 33% from infested houses (14/42) but only 15% from non-infested houses (148/984). Hence, the awareness of Chagas disease was significantly associated with having a bug-free house (P < 0.01). When shown specimens of T. pallidipennis, the proportions of householders who recognized them were 78% from infested houses but only 29% of those with uninfested houses. Given the low infestation rates and the high capacity of the population to act appropriately once they have received information regarding this disease and its vector, relevant health education is expected to have a significant impact on triatomine control in this metropolitan area.

Altitude↗
PubMed1992

Women on the short end of the loaf: intrahousehold food allocation among members of poor Nepalese families.

Intensive and structure intrahousehold observations of the pattern of food allocation in poor rural Nepalese households indicate no difference in the distribution of nutrients between male and female children. In contrast, preferential food distribution patterns among adults show that women are less likely to achieve recommended levels of some nutrients than are men of the same age.

Family↗
PubMed1999

Economic transition and changing relation between income inequality and mortality in Taiwan: regression analysis.

OBJECTIVE: To examine the changing relation between income inequality and mortality through different stages of economic development in Taiwan. DESIGN: Regression analysis of mortality on income inequality for three index years: 1976, 1985, and 1995. SETTING: 21 counties and cities in Taiwan. MAIN OUTCOME MEASURES: All age mortality and age specific mortality in children under age 5. RESULTS: When median household disposable income was controlled for, the association between income inequality and mortality became stronger in 1995 than in 1976. Especially, the association between income inequality and mortality in children aged under 5, with adjustment for differences in median household disposable income, changed from non-significant in 1976 to highly significant in 1995. In 1995, the level of household income after adjustment for income distribution no longer had a bearing on mortality in children under 5. CONCLUSION: The health of the population is affected more by relative income than by absolute income after a country has changed from a developing to a developed economy.

Adolescent↗
PubMed1981

Computing the level and distribution of gains from fertility reduction.

"This paper describes and illustrates new procedures for measuring monetary gains from fertility reduction that can be applied to macromodels of population and development. A previously developed method for calculating the total monetary gain from averted births is reviewed. A new technique for distributing gains between birth-averting households and society at large is explained....A technique for evaluating alternative fertility reduction programs is described. Each of the methods is applied to a macromodel estimated from a cross section of countries."

Birth Rate↗
PubMedDate not supplied

Malthus' preconditions to moral restraint and modern population economics.

The author examines the writings of Malthus and compares them with basic tenets of two modern economic approaches to fertility studies. It is suggested that "Leibenstein and Easterlin, on the one hand, base their arguments on the central role of aspirations and of relative income or status, whether it be that of the parents or of the friends and neighbors. We argue that aspirations and relative income effects are quite close to Malthus' ideas on 'forward looking' and self respect. The other modern economic approach to fertility studies, the Chicago school, is centered on the effect of human capital on consumption and fertility decisions, and we think that this idea was not too strange to Malthus when he emphasized foresight and the desire for knowledge." (SUMMARY IN FRE AND ITA)

Behavior↗
PubMed1987

[Generation, household type, and income: trends in Flanders between 1976 and 1985].

"During the period 1970-1985 a general deterioration of the income positions of the younger generations and a marked improvement of the economic position of the elderly has been documented for the U.S. and the U.K. This article shows that the same trend also appeared in Flanders. The causes of these new trends in poverty and/or insecurity are analysed, including the effects of new forms of household formation and dissolution." (SUMMARY IN ENG AND FRE)

Age Factors↗