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Jabir Mm M, Panigrahi DK, Baig MM, Vijayakumar B, Panda PK, Shriram AN, Rahi M, Kumar A. Toward Malaria Elimination: Understanding Awareness, Prevention, and Health-Seeking Patterns in Odisha, India. Am J Trop Med Hyg 2024; 111:472-480. [PMID: 38955199 PMCID: PMC11376177 DOI: 10.4269/ajtmh.23-0830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/24/2024] [Indexed: 07/04/2024] Open
Abstract
Given India's goal of eliminating malaria by 2030, this study aimed to investigate community perspectives on malaria in highly endemic areas of Odisha, a region historically prone to malaria. The research explores self-reported malaria events, community knowledge, attitudes, practices, health-seeking behaviors, and access to healthcare services. A community-based cross-sectional survey conducted among 387 households between November 2022 and May 2023 served as an extension of our recent project, monitoring malaria elimination efforts in remote and challenging-to-reach communities in Odisha. The participants, who had a mean (SD) age of 41.7 (13.17) years, were predominantly male (88.4%). Self-reported malaria in the last 12 months prior to the survey was 6.2%, with half of the patients opting for primary health centers for treatment, averaging a 5-day recovery per episode. The median cost per malaria treatment episode was U.S. dollars 20.17. A significant majority (79.8%) demonstrated a strong awareness of malaria symptoms and transmission, with 83.3% expressing a favorable attitude toward disease prevention. Notably, 65.1% reported consistent use of long-lasting insecticidal nets. However, nearly half of the participants reported inadequate larval source management and indoor residual spraying services. Although there were slight variations in knowledge, attitude, and practice scores among demographic groups, the overall understanding of and approach to malaria were consistent in the study population, with no statistically significant differences (P >0.05). The study findings offer hope, suggesting that with sustained dedication and focused surveillance, malaria could become a thing of the past.
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Affiliation(s)
- Muhammed Jabir Mm
- Department of Epidemiology and Operational Research, Indian Council of Medical Research (ICMR)-Vector Control Research Centre, Puducherry, India
| | - Dilip Kumar Panigrahi
- Indian Council of Medical Research-Vector Control Research Centre, Field Station, Koraput, India
| | - Muhammed Mustafa Baig
- Indian Council of Medical Research-Vector Control Research Centre, Field Station, Koraput, India
| | - Balakrishnan Vijayakumar
- Department of Biostatistics and Vector Borne Diseases (VBD) Modelling, Indian Council of Medical Research-Vector Control Research Centre, Puducherry, India
| | | | - Ananganallur Nagarajan Shriram
- Division of Vector Biology and Control, Indian Council of Medical Research-Vector Control Research Centre, Puducherry, India
| | - Manju Rahi
- Indian Council of Medical Research-Vector Control Research Centre, Puducherry, India
| | - Ashwani Kumar
- Center for Global Health Research, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
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Meher T, Sahoo H. Secular trend in age at menarche among Indian women. Sci Rep 2024; 14:5398. [PMID: 38443461 PMCID: PMC10914750 DOI: 10.1038/s41598-024-55657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
Age at menarche is not only a parameter that signifies biological characteristics for women but is also considered as an indicator to measure the quality of life of a population. Moreover, menarche has significant implications on women's health and information about menarcheal age is crucial for health policymakers. However, little is known about the trends in menarcheal age in India. Thus, in order to fill this research gap, the present study aimed to explore the age at menarche, its trend and regional heterogeneity among Indian women. A birth cohort approach was used by polling data from the 1st (1992-93), 4th (2015-16) and 5th (2019-21) rounds of NFHS. Descriptive statistics and bivariate analyses were performed to present the distribution of age at menarche and mean age at menarche across birth cohorts and each category of covariates. A multiple linear regression model was fitted to examine the trend in age at menarche and further to investigate the association of covariates with menarcheal age among Indian women. The analysis demonstrated that a majority of women (66.2%) attained menarche between the ages of 13-14 years. Moreover, about 17.2% of women experienced an early age at menarche, whereas 16.7% of women had a late age at menarche. The mean age at menarche for the sampled women was 13.49 years. The analysis also observed a secular declining trend in menarcheal age among Indian women and a significant variation in the mean age at menarche across birth cohorts. It also highlighted significant socio-economic patterning in menarcheal age among women.
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Affiliation(s)
- Trupti Meher
- International Institute for Population Sciences, Mumbai, India.
| | - Harihar Sahoo
- International Institute for Population Sciences, Mumbai, India
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Casella A, Monroe A, Toso M, Hunter G, Underwood C, Pillai R, Hughes J, Van Lith LM, Cash S, Hwang J, Babalola S. Understanding psychosocial determinants of malaria behaviours in low-transmission settings: a scoping review. Malar J 2024; 23:15. [PMID: 38200574 PMCID: PMC10782749 DOI: 10.1186/s12936-023-04831-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Recent estimates show progress toward malaria elimination is slowing in many settings, underscoring the need for tailored approaches to fight the disease. In addition to essential structural changes, human behaviour plays an important role in elimination. Engagement in malaria behaviours depends in part on psychosocial determinants such as knowledge, perceived risk, and community norms. Understanding the state of research on psychosocial determinants in low malaria transmission settings is important to augment social and behaviour change practice. This review synthesizes research on psychosocial factors and malaria behaviours in low-transmission settings. METHODS A systematic search of peer-reviewed literature and supplemental manual search of grey literature was conducted using key terms and eligibility criteria defined a priori. Publications from 2000-2020 in the English language were identified, screened, and analysed using inductive methods to determine the relationship between the measured psychosocial factors and malaria behaviours. RESULTS Screening of 961 publications yielded 96 for inclusion. Nineteen articles collected data among subpopulations that are at increased risk of malaria exposure in low-transmission settings. Purposive and cluster randomized sampling were common sampling approaches. Quantitative, qualitative, and mixed-methods study designs were used. Knowledge, attitudes, and perceived risk were commonly measured psychosocial factors. Perceived response-efficacy, perceived self-efficacy, and community norms were rarely measured. Results indicate positive associations between malaria knowledge and attitudes, and preventive and care-seeking behaviour. Studies generally report high rates of correct knowledge, although it is comparatively lower among studies of high-risk groups. There does not appear to be sufficient extant evidence to determine the relationship between other psychosocial variables and behaviour. CONCLUSIONS The review highlights the need to deploy more consistent, comprehensive measures of psychosocial factors and the importance of reaching subpopulations at higher risk of transmission in low transmission contexts. Malaria-related knowledge is generally high, even in settings of low transmission. Programmes and research should work to better understand the psychosocial factors that have been positively associated with prevention and care-seeking behaviours, such as norms, perceived response efficacy, perceived self-efficacy, and interpersonal communication. These factors are not necessarily distinct from that which research has shown are important in settings of high malaria transmission. However, the importance of each factor and application to malaria behaviour change programming in low-transmission settings is an area in need of further research. Existing instruments and approaches are available to support more systematic collection of psychosocial determinants and improved sampling approaches and should be applied more widely. Finally, while human behaviour is critical, health systems strengthening, and structural interventions are essential to achieve malaria elimination goals.
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Affiliation(s)
- Albert Casella
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA.
| | - April Monroe
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Michael Toso
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Gabrielle Hunter
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Carol Underwood
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
- Department of Health, Behavior, & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ruchita Pillai
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Jayme Hughes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Lynn M Van Lith
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Shelby Cash
- U.S. President's Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jimee Hwang
- U.S. President's Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stella Babalola
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
- Department of Health, Behavior, & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Finda MF, Juma EO, Kahamba NF, Mthawanji RS, Sambo M, Emidi B, Wiener S, O'Brochta D, Santos M, James S, Okumu FO. Perspectives of African stakeholders on gene drives for malaria control and elimination: a multi-country survey. Malar J 2023; 22:384. [PMID: 38129897 PMCID: PMC10740233 DOI: 10.1186/s12936-023-04787-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Gene drive modified mosquitoes (GDMMs) have the potential to address Africa's persistent malaria problem, but are still in early stages of development and testing. Continuous engagement of African stakeholders is crucial for successful evaluation and implementation of these technologies. The aim of this multi-country study was, therefore, to explore the insights and recommendations of key stakeholders across Africa on the potential of GDMMs for malaria control and elimination in the continent. METHODS A concurrent mixed-methods study design was used, involving a structured survey administered to 180 stakeholders in 25 countries in sub-Saharan Africa, followed by 18 in-depth discussions with selected groups and individuals. Stakeholders were drawn from academia, research and regulatory institutions, government ministries of health and environment, media and advocacy groups. Thematic content analysis was used to identify key topics from the in-depth discussions, and descriptive analysis was done to summarize information from the survey data. RESULTS Despite high levels of awareness of GDMMs among the stakeholders (76.7%), there was a relatively low-level of understanding of their key attributes and potential for malaria control (28.3%). When more information about GDMMs was provided to the stakeholders, they readily discussed their insights and concerns, and offered several recommendations to ensure successful research and implementation of the technology. These included: (i) increasing relevant technical expertise within Africa, (ii) generating local evidence on safety, applicability, and effectiveness of GDMMs, and (iii) developing country-specific regulations for safe and effective governance of GDMMs. A majority of the respondents (92.9%) stated that they would support field trials or implementation of GDMMs in their respective countries. This study also identified significant misconceptions regarding the phase of GDMM testing in Africa, as several participants incorrectly asserted that GDMMs were already present in Africa, either within laboratories or released into the field. CONCLUSION Incorporating views and recommendations of African stakeholders in the ongoing research and development of GDMMs is crucial for instilling stakeholder confidence on their potential application. These findings will enable improved planning for GDMMs in Africa as well as improved target product profiles for the technologies to maximize their potential for solving Africa's enduring malaria challenge.
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Affiliation(s)
- Marceline F Finda
- Environmental Health and Ecological Sciences, Ifakara Health Institute, PO Box 53, Ifakara, Tanzania.
| | - Elijah O Juma
- Pan-African Mosquito Control Association (PAMCA), Off Mbagathi Road, PO Box 44455-00100, Nairobi, Kenya
| | - Najat F Kahamba
- Environmental Health and Ecological Sciences, Ifakara Health Institute, PO Box 53, Ifakara, Tanzania
| | - Rhosheen S Mthawanji
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre 3, PO Box 30096, Chichiri, Malawi
| | - Maganga Sambo
- Environmental Health and Ecological Sciences, Ifakara Health Institute, PO Box 53, Ifakara, Tanzania
| | - Basiliana Emidi
- National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
| | - Susan Wiener
- Foundation for the National Institutes of Health, 11400 Rockville Pike, Suite 600, North Bethesda, MD, 20852, USA
| | - David O'Brochta
- Foundation for the National Institutes of Health, 11400 Rockville Pike, Suite 600, North Bethesda, MD, 20852, USA
| | - Michael Santos
- Foundation for the National Institutes of Health, 11400 Rockville Pike, Suite 600, North Bethesda, MD, 20852, USA
| | - Stephanie James
- Foundation for the National Institutes of Health, 11400 Rockville Pike, Suite 600, North Bethesda, MD, 20852, USA
| | - Fredros O Okumu
- Environmental Health and Ecological Sciences, Ifakara Health Institute, PO Box 53, Ifakara, Tanzania
- School of Life Science and Bioengineering, The Nelson Mandela African Institution of Science and Technology, P. O. Box 447, Arusha, Tanzania
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, G128QQ, UK
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 1 Smuts Avenue, Braamofontein, 2000, South Africa
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Abdelwahab SI, Elhassan IM, Albasheer O, Taha MME, Ali NA, Al-Jabiri YS, Madkhali W, Sahly AA, Oraibi B, Altraifi AAA, Hakami N, Alshehri MM, Abu Shaphe M, Beg RA, Alshamrani M. Knowledge, attitudes, and practices (KAP) during the malaria elimination phase: A household-based cross-sectional survey. Medicine (Baltimore) 2023; 102:e33793. [PMID: 37266647 PMCID: PMC10237689 DOI: 10.1097/md.0000000000033793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 06/03/2023] Open
Abstract
Malaria is a major health problem in Southwestern Saudi Arabia. This study aimed to measure the level of community understanding of malaria transmission, protection, and treatment. A questionnaire-based cross-sectional study enrolled 1070 participants from 2 districts with different malaria prevalence rates in Jazan Province. The response rate was 97.27%. Of the 1070 total; 754 (70.5%) had heard about malaria. Sixty-seven percentage know that fever was the main symptom. Approximately 59.8% did not know that stagnant water is one of the most important locations for mosquito breeding. Nevertheless, we found that 50% of the participants knew that mosquitoes bite at night and 96.9% confirmed that mosquitoes did not bite during the day. The most effective sources of information were distributed leaflets (41.8%) and video awareness (31.9%). The most significant factors affecting participants knowledge were gender, residence, family members, income, and education (P < .05). Knowledge levels were satisfactory in this study, and the majority of participants exhibited adequate attitudes and practices related to malaria prevention. However, knowledge differences were observed with regard to the place of residence. Greater emphasis should be directed towards education programs in malaria-endemic areas to ensure complete eradication of malaria.
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Affiliation(s)
| | | | - Osama Albasheer
- Family and Community Medicine Department, College of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Nasir Ahmed Ali
- College of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Waleed Madkhali
- Medical Research Centre, Jazan University, Jazan, Saudi Arabia
| | - Ahmad A. Sahly
- Department of Vector Borne Diseases, Ministry of Health, Jazan, Saudi Arabia
| | - Bassem Oraibi
- Medical Research Centre, Jazan University, Jazan, Saudi Arabia
| | | | - Nasser Hakami
- Surgical Department, College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Mohammed M. Alshehri
- Medical Research Center, Jazan University, Jazan, Saudi Arabia
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Mohammad Abu Shaphe
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Rashid Ali Beg
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Meshal Alshamrani
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
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Tairou F, Nawaz S, Tahita MC, Herrera S, Faye B, Tine RCK. Malaria prevention knowledge, attitudes, and practices (KAP) among adolescents living in an area of persistent transmission in Senegal: Results from a cross-sectional study. PLoS One 2022; 17:e0274656. [PMID: 36454893 PMCID: PMC9714833 DOI: 10.1371/journal.pone.0274656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION While malaria morbidity has sharply declined in several areas in Senegal, it remains an important problem in the southern part of the country, particularly among adolescents. Understanding adolescents' knowledge, attitudes, prevention and care-seeking practices is important to inform more targeted interventions aimed at optimizing adolescents' uptake of malaria prevention and control measures. This study assessed malaria-related knowledge, attitudes, and practices (KAP) among adolescents living in a highly persistent transmission area in Senegal. METHODS A community-based cross-sectional survey was conducted among 391 adolescents living in the Saraya health district. A multistage random sampling technique was used to select households. An electronic questionnaire developed on Open Data Kit (ODK), was used to collect data on socio-demographic characteristics, household assets, adolescents' knowledge of malaria, as well as their attitudes with regards to malaria prevention, and care-seeking behaviors. Bivariate and multivariate analyses were performed to assess factors associated with adolescents' KAP towards malaria. RESULTS Nearly, one-third of the participants had good knowledge of malaria (34.4%) and good practice in regards to malaria preventive measures (32.8%) while 59.0% had a positive attitude and 73.8% had good care-seeking behavior regarding malaria. Multivariate analysis revealed that a primary (aOR = 5.43, p = 0.002) or secondary level of education (aOR = 10.41, p = 0.000) was associated with good knowledge of malaria transmission, signs, and prevention measures. Male individuals had lower knowledge compared to female ones (aOR = 0.40, p = 0.001). Individuals belonging to households from the highest wealth quintile were more likely to have a positive attitude towards malaria compared to those from households in the lowest wealth quintile (aOR = 3.49, p = 0.004). The odds of positive attitude towards malaria decreased among participants with koranic and primary education level, respectively (aOR = 0.14, p = 0.005) and (aOR = 0.24, p = 0.019). A positive attitude was 1.89 more likely to be (aOR = 1.89, p = 0.026) associated with good practice of prevention measures compared to adolescents who demonstrated negative attitudes. Individuals from households in the fourth (aOR = 0.42, p = 0.024), middle (aOR = 0.34, P = 0.005), and second (aOR = 0.42, p = 0.027) wealth quintiles were less likely to use malaria prevention measures compared to those from households in the highest wealth quintile. CONCLUSION The study revealed that adolescents, generally have poor levels of malaria knowledge and low uptake of malaria prevention and control interventions. Targeted interventions for high-risk adolescents are needed, that focus on improving their knowledge of the disease and effective preventive measures, and on increasing their access to health care services and LLINs.
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Affiliation(s)
- Fassiatou Tairou
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | - Saira Nawaz
- Primary Health Care, PATH, Seattle, Washington, United States of America
| | - Marc Christian Tahita
- Clinical Research Unit of Nanoro, Direction Régionale du Centre-Ouest de l’Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Samantha Herrera
- Malaria & Neglected Tropical Diseases Division, PATH, Washington, District of Columbia, United States of America
| | - Babacar Faye
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | - Roger C. K. Tine
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
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Maurya P, Meher T, Muhammad T. Relationship between depressive symptoms and self-reported menstrual irregularities during adolescence: evidence from UDAYA, 2016. BMC Public Health 2022; 22:758. [PMID: 35422014 PMCID: PMC9011997 DOI: 10.1186/s12889-022-13196-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The study examined the prevalence of self-reported menstrual irregularities during adolescence and explored the association of depressive symptoms with self-reported menstrual irregularities in adolescents in two major states of Uttar Pradesh and Bihar in India.
Methods
This study is based on the data obtained from the first round of the "Understanding the lives of adolescents and young adults" (UDAYA, 2016) survey. The effective sample size for the study was 12,707 adolescent girls aged 10–19 years. A bivariate analysis with chi-square test was conducted to determine the self-reported menstrual irregularity by predictor variables. Multivariable logistic regression models were employed to examine the associations between self-reported menstrual irregularity, depressive symptoms and other explanatory variables.
Results
A proportion of 11.22% of adolescent girls reported menstrual irregularity and 11.40% of the participants had mild depressive symptoms. Adolescent girls with mild (AOR: 2.15, CI: 1.85–2.51), moderate (AOR: 2.64, CI: 2.03–3.42) and severe depressive symptoms (AOR: 2.99, CI: 2.19–4.10) were more likely to have menstrual irregularity as compared to those who had minimal depressive symptoms. Physically active adolescent girls were less likely to report menstrual irregularity (AOR: 0.82, CI: 0.73–0.93) than physically inactive girls. Adolescent girls who used piece of cloth for menstrual hygiene practices (AOR: 1.17; CI: 1.02–1.35) and those who used either napkin or cloth or other materials (AOR: 1.32; CI: 1.14–1.54) had higher likelihood of menstrual irregularity as compared to those who used only sanitary napkins.
Conclusion
A significant association of depressive symptoms with self-reported menstrual irregularity among adolescent girls was observed. Therefore, while treating females with irregular menstrual cycles, clinicians may need to pay greater attention to thir mental health peoblems.
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Shaw S, Gidugu H, Bhaumik G, Reddy MPK, Panjwani U, Ghosh D. Anti-Mullerian Hormone and Macrophage Migration Inhibitory Factor Determine the Reproductive Health of Ladakhi Women Residing at 3,500 m. High Alt Med Biol 2021; 22:317-326. [PMID: 34314630 DOI: 10.1089/ham.2021.0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Shaw, Snigdha, Himashree Gidugu, Gopinath Bhaumik, Maramreddy Prasanna Kumar Reddy, Usha Panjwani, and Dishari Ghosh. Anti-Mullerian hormone and macrophage migration inhibitory factor determine the reproductive health of Ladakhi women residing at 3,500 m. High Alt Med Biol. 00:000-000, 2021. Background: Reproductive health of Ladakhi high-altitude (HA) native females was investigated for the first time in this study. Available literature suggest that, female reproductive cycle and hormonal profile varies in different HA populations due to heterogeneity. Although these studies illustrate some progress on the role of HA hypoxia, it still leaves scope for evaluation of the remaining mechanisms involved in the maintenance of reproductive health in this contemporary population. Materials and Methods: Menstrual details, phasic variations in circulatory steroid hormones, and gonadotropins along with oxytocin in sea level (SL) and HA (∼3,500 m) native females of India were assessed. Moreover, ovarian reserve marker anti-Mullerian hormone (AMH) and proinflammatory cytokine macrophage migration inhibitory factor (MIF) were measured. Results: A difference in Ladakhi women was registered compared to SL, regarding luteinizing hormone (LH) (2.6 mIU/ml vs. 4.4 mIU/ml, p < 0.05) and progesterone (P) (4.1 ng/ml vs. 9.4 ng/ml, p < 0.05) levels in their luteal phase. Reduced LH might contribute to poor development of the ovarian corpus luteum, subsequently diminish P level. Decreased AMH level in three age groups: 21-30 years (1.4 ng/ml vs. 3.2 ng/ml, p < 0.01), 31-40 years (0.6 ng/ml vs. 2.1 ng/ml, p < 0.01), and >40 years (0.4 ng/ml vs. 1.7 ng/ml, p < 0.01) of Ladakhi women were recorded than their SL counterpart. Elevated oxytocin (83.5 ng/ml vs. 76.3 ng/ml, p < 0.05) and MIF levels (70.2 ng/ml vs. 49.7 ng/ml, p < 0.01) along with low P and AMH levels delineated the reason for recorded early menopause (43.9 years), shorter reproductive span (∼29 years), and history of miscarriage in HA dwellers compared to SL. Conclusion: Therefore, the findings insinuated that the response of the reproductive system to hypoxia in Ladakhi women differs from SL women, and the adaptive response in these women might be in favor of their reproductive health.
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Affiliation(s)
- Snigdha Shaw
- High Altitude Physiology Group, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Delhi, India
| | - Himashree Gidugu
- High Altitude Physiology Group, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Delhi, India
| | - Gopinath Bhaumik
- High Altitude Physiology Group, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Delhi, India
| | - Maramreddy Prasanna Kumar Reddy
- High Altitude Physiology Group, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Delhi, India
| | - Usha Panjwani
- High Altitude Physiology Group, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Delhi, India
| | - Dishari Ghosh
- High Altitude Physiology Group, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Delhi, India
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Farea BA, Muharram AA, Baktayan NA, Assabri AM, Farea AA, Alsada MA. Impact of Health Education on KAP towards Malaria among Basic Schools Pupils in Taiz Governorate. Republic of Yemen 2013: Pre and Post Intervention Study. Health (London) 2020. [DOI: 10.4236/health.2020.124027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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The Challenges and Knowledge Gaps in Malaria Therapy: A Stakeholder Approach to Improving Oral Quinine Use in the Treatment of Childhood Malaria in Ghana. JOURNAL OF PHARMACEUTICS 2018; 2018:1784645. [PMID: 30538884 PMCID: PMC6261397 DOI: 10.1155/2018/1784645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/30/2018] [Indexed: 11/17/2022]
Abstract
Background The study was undertaken to elicit the knowledge, views, and perceptions of key stakeholders on malaria, its bioburden, and treatment options, in order to ascertain the knowledge gabs and challenges, especially in the use of oral quinine in childhood malaria. Methods A cross-sectional survey was conducted using a well-structured Likert Scale and self-administered questionnaire. The principal site of the study was a government-run children's hospital located in the Ashiedu Keteke Sub-Metro of Accra. The study population included health workers, parents, and guardians or care givers. The participants were 300, purposively selected, and consisted of both men (41%) and women (59%) who were twenty years and above, whether employed (42%), self-employed (37%), or unemployed (21%). Results Majority of the participants (78%) demonstrated above average knowledge of malaria. However, their awareness of the causes, modes of transmission, signs, and symptoms as well as preventive mechanisms of malaria did not result in low incidence of malaria. About 77% of the respondents agreed they would seek treatment within 24 hours once signs and symptoms are detected. Though close to 50% undertook home treatment of malaria, majority eventually sought treatment at hospital or clinic. Above 92% of respondents knew that quinine is used to treat malaria and agreed its bitter taste greatly affects compliance, especially in children. Consequently, 95% of the respondents would be glad if its bitter taste is masked. Conclusion The study demonstrated the availability of substantial knowledge of the devastating effects of malaria, especially in children. Therefore, there is the need to ensure the availability and utilization of effective paediatric formulations in the fight against malaria. From this study, fast dissolving oral thin film with a good mouth feel, would be the formulation of choice for quinine.
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Regmi K, Kunwar A, Ortega L. A systematic review of knowledge, attitudes and beliefs about malaria among the South Asian population. Infect Ecol Epidemiol 2016; 6:30822. [PMID: 27141987 PMCID: PMC4854845 DOI: 10.3402/iee.v6.30822] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 04/02/2016] [Accepted: 04/06/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Malaria is one of the deadliest mosquito-borne diseases in the world. More than 80% of the total populations are at risk of malaria in the 22 countries in Asia and the Pacific. South Asia alone is home to an estimated 1.4 billion people at risk of contracting malaria. Despite the remarkable progress in reducing the burden of malaria, evidence of the disease based on knowledge of the social and cultural contexts from a South Asian perspective is limited. Our objective was to understand the knowledge, attitudes and beliefs about malaria in South Asian communities. METHODOLOGY We conducted a systematic literature review, searching six databases, between 1990 and 2015, focusing on knowledge, attitudes and beliefs about malaria in South Asia. Databases were searched using both 'free terms' and 'index terms' funnelled using Boolean operators and truncations. Inclusion and exclusion criteria were set, and included papers were scrutinised, employing a critical appraisal tool to find the best available evidences to support the study purpose. RESULTS AND DISCUSSION Evidence from 32 articles (26 quantitative, four qualitative and two mixed methods). General knowledge and awareness of the disease, its transmission, and control and preventative measures were generally found to be lacking amongst both the general public and healthcare professionals. In addition, the study shows that poor socio-economic factors - including limited access to services due to poor/limited availability - and issues of affordability are considered as major risk factors. CONCLUSION This review suggests the importance of increasing health awareness, mobilising the local or community healthcare professionals, for prevention as well as early detection and effective treatment of malaria among people who are at risk. Malaria is also a disease associated with poverty and socio-cultural factors; therefore, strong political will, wider partnerships between health and non-health sectors, and strengthening health systems' technical and managerial capabilities at all level of primary healthcare systems, is inevitable.
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Affiliation(s)
- Krishna Regmi
- Faculty of Health and Social Sciences, Institute for Health Research, University of Bedfordshire, Luton, UK;
| | - Anju Kunwar
- Faculty of Health and Social Sciences, Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Leonard Ortega
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
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Wang YJ, Wang YZ, Yeh ML. A Prospective Comparison Study of Heart Rate Variability During Menses in Young Women With Dysmenorrhea. Biol Res Nurs 2016; 18:465-72. [DOI: 10.1177/1099800416640875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Numerous studies have demonstrated autonomic abnormalities in various pain conditions. However, few have investigated heart rate variability (HRV) in young women with primary dysmenorrhea, and the conclusions have been inconsistent. More evidence is required to confirm the reported trend for consistent fluctuation of HRV parameters in dysmenorrhea. Purpose: The study’s aim was to determine whether significant differences exist between young women with and without dysmenorrhea for heart rate (HR), blood pressure (BP), and HRV parameters during menses. Design: A prospective comparison design with repeated measures was used. Setting and participants: Sixty-six women aged 18–25 with dysmenorrhea and 54 eumenorrheic women were recruited from a university in northern Taiwan. Methods: High-frequency and low-frequency HRV parameters (HF and LF), LF/HF ratio, BP, and HR were measured daily between 8 p.m. and 10 p.m. from Day 1 to Day 6 during menses. The generalized estimating equation was used to analyze the effects of group, time, and Group × Time interaction on these variables. Results: HF values were significantly lower in the dysmenorrhea than in the eumenorrhea group, but there were no differences in BP, HR, LF, or LF/HF ratio. Conclusion: Reduced HF values reflect reduced parasympathetic activity and autonomic instability in young women with dysmenorrhea. Future longitudinal studies are warranted to examine autonomic regulation in menstrual pain of varying intensities associated with dysmenorrhea-related symptoms and to clarify the causal relationship between dysmenorrhea and HRV fluctuations.
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Affiliation(s)
- Yu-Jen Wang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Yi-Zen Wang
- National Taiwan University Hospital, Taipei City, Taiwan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Mei-Ling Yeh
- Graduate Institute of Integration of Traditional Chinese Medicine with Western Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
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Sumari D, Dillip A, Ndume V, Mugasa JP, Gwakisa PS. Knowledge, attitudes and practices on malaria in relation to its transmission among primary school children in Bagamoyo district, Tanzania. MALARIAWORLD JOURNAL 2016; 7:2. [PMID: 38601350 PMCID: PMC11003216 DOI: 10.5281/zenodo.10785032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Background Communities' knowledge, attitudes and practices on malaria disease often remain unobserved during malaria control efforts. In Tanzania, many studies focus on increasing community knowledge and awareness on malaria prevention but the potential participation and contribution of schoolchildren towards knowledge, attitudes and practices on malaria has received little attention. We investigated the knowledge and understanding of primary school children on malaria transmission, recognition of symptoms, treatment seeking behaviour, preventive measures and practices in order to potentially include this group in Tanzania's malaria control efforts. Materials and methods 125 children were recruited from three purposively selected primary schools in Bagamoyo district, Tanzania. A semi-structured interview guide, including both closed and open-ended questions, was used to collect information from the participants to obtain their knowledge and understanding on malaria transmission, treatment and prevention. Results More than half of the school children (79/125; 63.2% ) had knowledge on malaria as a disease and its transmission; 101/125 (80.8%) of the respondents reported that going to the hospital was their immediate care-seeking behaviour once they felt malaria symptoms, while 14/125 (11.2%) opted for self-medication. With regard to malaria prevention and control, 115/125 (92.0%) of the respondents reported using bednets as their main malaria prevention strategy, while 6/125 (4.8%) preferred the use of medicine, mostly artemether lumefantrine, as prophylaxis. Narratives obtained were able to explain clearly the rationale behind different options children took to treat and to protect themselves against malaria. Conclusions Findings indicated that primary school children in Bagamoyo district are aware of malaria, its symptoms and preventive measures, although some had misconceptions and could not associate the disease with its transmission. We conclude that inclusion of school children on malaria control educational programmes could yield substantial benefits towards malaria elimination.
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Affiliation(s)
- Deborah Sumari
- School of Life Sciences and Bioengineering, The Nelson Mandela African Institution of Science and Technology, P.O. Box 447, Arusha, Tanzania
- Ifakara Health Institute, P.O. Box 78373, Dares Salaam, Tanzania
| | - Angel Dillip
- Ifakara Health Institute, P.O. Box 78373, Dares Salaam, Tanzania
| | - Vitalis Ndume
- Ifakara Health Institute, P.O. Box 78373, Dares Salaam, Tanzania
- Dares Salaam Institute of Technology, P. O. Box 2958, Dares Salaam, Tanzania
| | - Joseph P. Mugasa
- National Institute for Medical Research, Amani Medical Research Centre, P.O. Box 81, Muheza, Tanga, Tanzania
| | - Paul S. Gwakisa
- School of Life Sciences and Bioengineering, The Nelson Mandela African Institution of Science and Technology, P.O. Box 447, Arusha, Tanzania
- Genome Science Centre and Department of Veterinary Microbiology and Parasitology, Sokoine University of Agriculture, P.O. Box 3019, Morogoro, Tanzania
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14
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Wotodjo AN, Diagne N, Gaudart J, Richard V, Raoult D, Sokhna C. Malaria risk factors in Dielmo, a Senegalese malaria-endemic village, between October and November of 2013: a case-control study. Am J Trop Med Hyg 2015; 92:565-8. [PMID: 25582690 DOI: 10.4269/ajtmh.14-0485] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The incidence of malaria has decreased recently in parts of Africa, coinciding with the widespread use of long-lasting insecticide-treated nets (LLINs) and artemisinin-based combination therapy (ACT). This reduction was also observed in Dielmo, our study area, and it was associated with the use of ACT as the first-line treatment against malaria beginning in 2006 and the implementation of LLINs in 2008. However, an unexplained slight increase in malaria incidence was observed in October and November of 2013. The aim of this study was to identify individual and environmental risk factors for malaria using a case-control study approach. Thirty cases and sixty controls were investigated. The use of LLINs was protective against malaria (adjusted odds ratio [AOR] = 0.10; 95% confidence interval [95% CI] = 0.02-0.45; P = 0.003). The risk of malaria transmission was high among villagers who watched television outside the house or the bedroom during the night (AOR = 8.83; 95% CI = 1.39-56.22; P = 0.021). The use of LLINs should be reinforced by the use of individual protection measures to avoid malaria transmission outside of the home.
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Affiliation(s)
- Amélé N Wotodjo
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IRD198, UM63, CNRS7278, INSERMU1095, Aix-Marseille Université, Campus UCAD-IRD, Dakar, Sénégal; Aix-Marseille Université, UMR912 SESSTIM (INSERM-IRD-AMU), Marseille, France; Institut Pasteur de Dakar, Unité d'Epidémiologie, Dakar, Sénégal; Institut Hospitalo Universitaire Mediterranee-Infection, Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IRD198, UM63, CNRS7278, INSERMU1095, Marseille, France
| | - Nafissatou Diagne
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IRD198, UM63, CNRS7278, INSERMU1095, Aix-Marseille Université, Campus UCAD-IRD, Dakar, Sénégal; Aix-Marseille Université, UMR912 SESSTIM (INSERM-IRD-AMU), Marseille, France; Institut Pasteur de Dakar, Unité d'Epidémiologie, Dakar, Sénégal; Institut Hospitalo Universitaire Mediterranee-Infection, Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IRD198, UM63, CNRS7278, INSERMU1095, Marseille, France
| | - Jean Gaudart
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IRD198, UM63, CNRS7278, INSERMU1095, Aix-Marseille Université, Campus UCAD-IRD, Dakar, Sénégal; Aix-Marseille Université, UMR912 SESSTIM (INSERM-IRD-AMU), Marseille, France; Institut Pasteur de Dakar, Unité d'Epidémiologie, Dakar, Sénégal; Institut Hospitalo Universitaire Mediterranee-Infection, Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IRD198, UM63, CNRS7278, INSERMU1095, Marseille, France
| | - Vincent Richard
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IRD198, UM63, CNRS7278, INSERMU1095, Aix-Marseille Université, Campus UCAD-IRD, Dakar, Sénégal; Aix-Marseille Université, UMR912 SESSTIM (INSERM-IRD-AMU), Marseille, France; Institut Pasteur de Dakar, Unité d'Epidémiologie, Dakar, Sénégal; Institut Hospitalo Universitaire Mediterranee-Infection, Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IRD198, UM63, CNRS7278, INSERMU1095, Marseille, France
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IRD198, UM63, CNRS7278, INSERMU1095, Aix-Marseille Université, Campus UCAD-IRD, Dakar, Sénégal; Aix-Marseille Université, UMR912 SESSTIM (INSERM-IRD-AMU), Marseille, France; Institut Pasteur de Dakar, Unité d'Epidémiologie, Dakar, Sénégal; Institut Hospitalo Universitaire Mediterranee-Infection, Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IRD198, UM63, CNRS7278, INSERMU1095, Marseille, France
| | - Cheikh Sokhna
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IRD198, UM63, CNRS7278, INSERMU1095, Aix-Marseille Université, Campus UCAD-IRD, Dakar, Sénégal; Aix-Marseille Université, UMR912 SESSTIM (INSERM-IRD-AMU), Marseille, France; Institut Pasteur de Dakar, Unité d'Epidémiologie, Dakar, Sénégal; Institut Hospitalo Universitaire Mediterranee-Infection, Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IRD198, UM63, CNRS7278, INSERMU1095, Marseille, France
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Lwin MO, Vijaykumar S, Lim G, Theng YL, Foo S. 'It's effective but should I bother?' A study of personal protection measures against Malaria in urban India. Public Health 2014; 128:654-64. [PMID: 25065519 DOI: 10.1016/j.puhe.2014.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/11/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Malaria affects millions of people in urban and rural India every year. This study addresses two main gaps in current research: 1) attitudes towards personal protective strategies against Malaria among urban populations; and 2) understanding of the extent to which urban health information seeking preferences shape preventive behaviours. STUDY DESIGN Cross-sectional face-to-face surveys using stratified sampling design. METHODS A 60-min survey was carried out to 1000 middle-of-pyramid (MOP) population in five main cities in India by trained interviewers. Variables assessed included perceived effectiveness and actual practice of 14 scientific and indigenous personal protection methods, Malaria-related attitudes (susceptibility, severity and response efficacy) and health information seeking preferences. RESULTS Actual practice of Malaria preventive behaviours was found to be significantly lower than the perceived effectiveness of each of the fourteen scientific and indigenous methods. Television, newspapers, and mobile phones were reported as the top three preferred media for seeking public health information. Lastly, perceived susceptibility, response efficacy, and health-related media use were found to play significant roles in predicting actual practice behaviours. CONCLUSIONS Our study highlights a need for health authorities to focus on translating positive attitudes to actual practice of preventive behaviours. Communication efforts may focus on the use of TV, newspapers and mobile phones for greater reach and efficacy. Other implications for Malaria prevention programs are discussed.
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Affiliation(s)
- M O Lwin
- Center of Social Media Innovations for Communities (COSMIC), Nanyang Technological University, Singapore
| | - S Vijaykumar
- Center of Social Media Innovations for Communities (COSMIC), Nanyang Technological University, Singapore.
| | - G Lim
- Center of Social Media Innovations for Communities (COSMIC), Nanyang Technological University, Singapore
| | - Y L Theng
- Center of Social Media Innovations for Communities (COSMIC), Nanyang Technological University, Singapore
| | - S Foo
- Center of Social Media Innovations for Communities (COSMIC), Nanyang Technological University, Singapore
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Raha O, Sarkar B, Godi S, GhoshRoy A, Pasumarthy V, Chowdhury S, Vadlamudi RR. Menarcheal age of type 1 diabetic Bengali Indian females. Gynecol Endocrinol 2013; 29:963-6. [PMID: 23952104 DOI: 10.3109/09513590.2013.819080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND It has been observed that menstrual characteristics are generally influenced by lifestyle, socio-cultural and biological factors. AIM The present study examines: (a) variation in menstrual characteristics between Type1 Diabetic females of rural and urban adolescents, i.e. the resident status; and (b) whether these characteristics can be predicted from various socio-economic, stress variables related to place of residence. SUBJECTS AND METHODS The sample of the present study constituted 103T1DM females from West Bengal, a State of India. These girls belong to a Bengali-speaking ethnic group. Data on socio-economic variables and menstrual characteristics were collected using pretested questionnaires. RESULTS Menstrual irregularity was common in our study participants, with age of menarche, but was not associated with current BMI, physical activity or insulin dose. CONCLUSIONS Our study displays that age at menarche is delayed in young women with T1DM compared to the concurrent overall mean age at menarche in the West Bengal population.
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Affiliation(s)
- Oindrila Raha
- Anthropological Survey of India, Kolkata-700016 , West Bengal , India
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Abstract
PURPOSE OF REVIEW Vector-borne diseases (VBDs) are difficult to prevent and control because it is hard to predict the complex habits of mosquitoes, ticks and fleas; most vector-borne viruses or bacteria infect animals as well as humans, which further adds to this difficulty. Thus, prevention is the best protection against VBD. RECENT FINDINGS Vaccines are available for yellow fever, Japanese encephalitis and tick-borne encephalitis and several vaccines are in clinical trials for dengue fever. Antimalarial intermittent preventive therapy (sulfadoxine-pyrimethamine) and insecticide-treated mosquito nets are associated with a decreased risk of neonatal mortality and lower birth-weight. Permethrin-impregnated clothing for the prevention of tick bites has been shown effective in reducing tick bites. SUMMARY Much progress has been made in terms of development of preventive vaccines and medicines, but there is more work that needs to be done. Efforts still need to continue on raising awareness for prevention of VBD.
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