Objective VaveHealth is a company that developed an app-based POCUS (Point of Care Ultrasound) education platform. Our objective is to provide educators with insights into novel approaches to medical ...education by comparing the platform to PowerPoint-based education, the standard and current technique used to instruct medical students in the United States. Methods We used a non-inferiority study to assess if the app-based platform was not less efficacious than the current standard of PowerPoint-based education. Thirty-three military medical students were provided with app-based or PowerPoint-based education for instructions on performing a focused assessment with sonography for trauma (FAST exam). Physicians evaluated each image and assigned a score from 1-5. The final scores were the average of all views. In addition, a two-sample t-test of the final scores and each view of the FAST was used to measure whether the VaveHealth platform was non-inferior to a PowerPoint-based model. Results Overall, the VaveHealth group had lower average scores on each view and a lower average total score. There was no statistically significant difference in overall scores (VaveHealth = 7.65, PowerPoint = 9.04, P = 0.07). Subgroup analysis showed no statistically significant difference in student performance in the views of the splenorenal recess (VaveHealth score = 1.60, PowerPoint score = 1.65, P = 0.42), hepatorenal recess (VaveHealth score = 2.45, PowerPoint score = 3.00, P = 0.11), and suprapubic (VaveHealth score = 2.10, PowerPoint score = 2.46, P = 0.23) regions. In the subxiphoid region, students in the VaveHealth had a statistically significantly lower average score (VaveHealth score = 1.70, PowerPoint score = 2.08, P = 0.04). Conclusion VaveHealth education is not a viable alternative to traditional PowerPoint education for POCUS training based on the lower raw scores and statistically significantly lower scores on one of the views of the FAST exam.
This paper examines the extent to which under five children in households or communities adversely affected by HIV/AIDS are disadvantaged, in comparison with other children in less affected ...households/communities. The study is based on secondary analysis of the Demographic and Health Survey (DHS) data collected during 2003–2008 from 18 countries in sub-Saharan Africa, where the DHS has included HIV test data for adults of reproductive age. We apply multilevel logistic regression models that take into account the effect of contextual community/country level HIV/AIDS factors on child malnutrition. The outcome variable of interest is child undernutrition: stunting, wasting and underweight. The results suggest that across countries in sub-Saharan Africa, children whose mothers are infected with HIV are significantly more likely to be stunted, wasted or underweight compared to their counterparts of similar demographic and socio-economic background whose mothers are not infected. However, the nutritional status of children who are paternal orphans or in households where other adults are HIV positive are not significantly different from non-orphaned children or those in households where no adult is infected with HIV. Other adult household members being HIV positive is, however, associated with higher malnutrition among younger children below the age of one. Further analysis reveals that the effect of mothers’ HIV status on child nutritional status (underweight) varies significantly across communities within countries, the effect being lower in communities with generally higher levels of malnutrition. Overall, the findings have important implications for policy and programme efforts towards improved integration of HIV/AIDS and child nutrition services in affected communities and other sub-groups of the population made vulnerable by HIV/AIDS. In particular, children whose mothers are infected with HIV deserve special attention.
To investigate whether the presence of parents constitute a protective factor against adverse reproductive health outcomes for adolescents living in slums of Nairobi, Kenya.
The data come from a ...cross-sectional survey that canvassed a random sample of 4564 households representative of all Nairobi slums in February–June 2000. Structured questionnaires on household census, reproduction and adolescent health were verbally administered to household heads, women of reproductive ages, and adolescents, respectively. We restrict the analysis to a sub-sample of 788 never-married adolescent girls aged 12–19 years. We compare reproductive health outcomes of adolescents who live with neither parent, father only, mother only, and both parents. Data were analyzed using simple descriptive analysis and logistic regression models of three outcome variables: ever sexually active, ever experienced an unplanned pregnancy, and sexually active within the past 4 weeks. For each of the outcome variables, two models, one with and one without a proxy for adolescents' disorderly behavior are presented to establish whether parental presence affects adolescents' reproductive health.
When the father is present in the household (i.e., father only or both parents present), adolescent girls are 42% less likely to have ever had sex (
p < .05), 45% less likely to have been sexually active in the most recent 4-week period (
p < 0.1), and 59% less likely to have ever experienced an unwanted pregnancy (
p < .05) than when neither parent, or only the mother, is present in the household.
In the slums of Nairobi, father's presence, unlike that of the mother, is associated with stronger resilience among adolescents. When programming for adolescents in these resource-constrained settings, it is important, therefore, to involve parents.
Appropriate antenatal care is important in identifying and mitigating risk factors in pregnancy but many mothers in the developing world do not receive such care. This paper uses data from the 1993 ...Kenya Demographic and Health Survey to study the variations in the use of antenatal services in Kenya. The analysis is based on modelling the frequency and timing of antenatal visits using three-level linear regression models. The results show that the use of antenatal care in Kenya is associated with a range of socio-economic, cultural and reproductive factors. The availability and accessibility of health services and the desirability of a pregnancy are also important. Use of antenatal care is infrequent for unwanted and mistimed pregnancies; even women who use antenatal care frequently appear to be less consistent if a pregnancy is mistimed. The results also indicate that women are highly consistent in the use of antenatal care during pregnancies. The intra-woman correlation coefficient for the frequency of antenatal visits ranges between 50% and 80% with greater correlation for wanted pregnancies to women in urban areas.
Abstract
Background
Jigawa and Kano States, Northern Nigeria have some of the worst human development outcomes globally for adolescents across a wide range of health indicators. Our aim was to ...understand health awareness, beliefs, and behaviours of adolescents in school in Jigawa and Kano States, to inform prioritization and development of health promotion interventions in the region.
Methods
We carried out a cross-sectional survey followed by focus group discussions (FGDs) with adolescents aged 15 to 20 years from four schools in Jigawa and Kano States (July-August 2019). Adolescents (274 per school) were randomly selected stratified by class-year (SS1 and SS2); 64 participated in FGDs (8 groups of 8). Trained researchers administered a questionnaire face-to-face via smart phones. Topics included: mental health; tobacco use; substance misuse; violence and unintentional injury; physical and dietary behaviours; and hygiene. FGDs investigated topics in greater depth. Here we report prevalence and predictors of mental health calculated from survey responses, and thematic analysis of interview findings.
Results
One thousand and seventy-nine students completed the survey (98%);∼50% girls. Preliminary analysis showed prevalence of moderate-severe anxiety was higher in girls than boys (6.8% girls, 0.8% boys, p < 0.001); and moderate-severe depression (10.3% girls, 0.5% boys, p < 0.001). Up to 50% boys and girls experienced violence or abuse in school, and 16% used a prescription drug without a prescription in past 30 days. Multivariable logistic regression showed female gender (aOR =4.0, 95% CI; 2.7,6.0); 30-day off-prescription drug use - aOR=2.3 (1.5,3.8); and being hit or slapped by a teacher - aOR=1.7, (1.1, 2.6) were predictors of moderate to severe anxiety. Results were similar for moderate to severe depression. Qualitative findings supported and contextualized these results.
Conclusions
Results will inform school-based interventions to improve health of adolescents in the region.
Key messages
Administering a health questionnaire to gather health information of adolescents in school in Kano and Jigawa states, Nigeria was feasible. Health questionnaire and focus group data will be shared with school and community leaders to shape school-based interventions to improve health outcomes amongst adolescents.
Unplanned pregnancies account for a substantial proportion of births in Kenya and can have a variety of negative consequences on individual women, their families, and the society as a whole. This ...paper examines the correlates of mistimed and unwanted childbearing in Kenya, with special focus on the extent of repetitiveness of these events among women. A multilevel multinomial model is applied to the 1993 Kenya Demographic and Health Survey data. The results show that unplanned childbearing in Kenya is associated with a number of factors, including urban/rural residence, region, ethnicity, maternal education, maternal age, marital status, birth order, length of preceding birth interval, family planning practise, fertility preference and unmet need for family planning. In addition to these factors, women who have experienced an unplanned birth are highly likely to have a repeat occurrence.
Atherosclerotic renal artery stenosis (RAS) is a recognized cause of renal impairment. RAS is often overlooked in unexplained chronic kidney disease (CKD). A retrospective analysis of renal ...angiograms was performed to determine the prevalence of occult renovascular disease in 64 (M:F, 46:18; ages 21-81 years median 60 years) patients with unexplained CKD. Twelve patients had diabetes mellitus (type II: 11) and 43 were smokers. Median serum creatinine was 5.2 mg/dl (range 1.5-10.6 mg/dl). Group A included patients with unexplained CKD and with no risk factors for RAS and Group B had patients with increased risk for RAS. A narrowing of the renal vessel, main artery or branch, by >50% on renal arteriography was used as diagnostic criteria for RAS. 31/64 patients had positive angiographic findings. Thirteen patients had unilateral RAS, 9 had bilateral RAS, 5 had unilateral stenosis with occlusion on the opposite side, 3 had unilateral occlusion and 1 had a solitary kidney with RAS. 19/34 (54%) in Group A and 12/30 (40%) in Group B had a positive renal angiogram. In 10 patients with a rise in serum creatinine on recent introduction of ACE inhibition, 2 had evidence of RAS on renal arteriography. Eleven patients underwent angioplasty and 2 reconstructive surgeries. In 4 patients, blood pressure control improved and anti-hypertensive drug requirements were reduced, whilst renal replacement therapy was postponed in 4, by 2-24 months. In 18 patients, the lesions were not amenable to angioplasty or reconstructive surgery. Four patients did not benefit in any form with intervention. Occult atheromatous renal vascular disease is a common, not readily predictable and potentially correctable etiology of unexplained CKD.
This paper uses DHS data from 20 countries in sub-Saharan Africa, collected in the late 1990s and early 2000s, to examine perceived size of newborn and Caesarean section deliveries among teenagers in ...the region. A comparison between teenagers and older women, based on logistic regression analyses for individual countries, as well as multilevel logistic analyses applied to pooled data across countries, and controlling for the effects of important socioeconomic and demographic factors, shows that in general, births to teenagers are more likely to be small in size but are less likely to be delivered by Caesarean section compared with births among older women. An examination of the country-level variations shows significant differences in perceived size of newborn and Caesarean section deliveries between countries. However, the observed pattern by maternal age does not vary significantly between countries, suggesting that these patterns are generalizable for the region. For teenagers with characteristics associated with higher odds of Caesarean section, being in a country with an overall higher rate particularly amplifies their individual probability.
Although diarrhoea and malaria are among the leading causes of child mortality and morbidity in Sub-Saharan Africa, few detailed studies have examined the patterns and determinants of these ailments ...in the most affected communities. In this paper, we investigate the spatial distribution of observed diarrhoea and fever prevalence in Malawi using individual data for 10,185 children from the 2000 Malawi Demographic and Health survey. We highlight inequalities in child health by mapping the residual district spatial effects using a geo-additive probit model that simultaneously controls for spatial dependence in the data and potential nonlinear effects of covariates. The residual spatial effects were modelled via a Bayesian approach. For both ailments, we were able to identify a distinct district pattern of childhood morbidity. In particular, the results suggest that children living in the capital city are less affected by fever, although this is not true for diarrhoea, where some urban agglomerations are associated with a higher childhood morbidity risk. The spatial patterns emphasize the role of remoteness as well as climatic, environmental, and geographic factors on morbidity. The fixed effects show that for diarrhoea, the risk of child morbidity appears to be lower among infants who are exclusively breastfed than among those who are mixed-fed. However, exclusive breastfeeding was not found to have a protective effect on fever. An important socio-economic factor for both diarrhoea and fever morbidity was parental education, especially maternal educational attainment. Diarrhoea and fever were both observed to show an interesting association with child's age. We were able to discern the continuous worsening of the child morbidity up to 8–12 months of age. This deterioration set in right after birth and continues, more or less linearly until 8–12 months, before beginning to decline thereafter. Independent of other factors, a separate spatial process produces district inequalities in child's health.
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