scholarly journals Financial risks of care seeking for malaria by rural households in Jimma Zone, Oromia Region, Southwest Ethiopia: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e056162
Author(s):  
Lelisa Fekadu Assebe ◽  
Dereje Dillu ◽  
Gemu Tiru ◽  
Kjell Arne Johansson ◽  
Sarah Bolongaita ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Financial Risk ◽  
Rural Households ◽  
Secondary Outcome ◽  
Financial Risks ◽  
Monthly Income ◽  
Poverty Level ◽  
Cross Sectional ◽  
Southwest Ethiopia ◽  
Jimma Zone

ObjectivesDespite major progress in the prevention and control of malaria in recent years, the disease remains a major cause of morbidity in Ethiopia. Malaria also imposes substantial socioeconomic costs on households. The aim of this study is to estimate the financial risk of seeking malaria service for rural households across socioeconomic statuses in the Jimma Zone, Oromia Region.DesignA facility-based cross-sectional survey.SettingJimma Zone, Oromia Region, Southwest Ethiopia.ParticipantsA total of 221 patients with malaria from 10 public health facilities were interviewed between September 2018 and December 2019.Primary and secondary outcome measuresThe main outcome measures capture the financial risks associated with malaria services, specifically catastrophic and impoverishing health expenditures. Catastrophic health expenditure (CHE) occurs when healthcare costs reach 10% of a household’s monthly income, whereas impoverishment occurs when a household’s monthly income falls below the national poverty level after paying for health service. Descriptive statistics were used to summarise the expenditure patterns associated with malaria services. All costs were gathered in Ethiopian birr and reported in 2019 US$.ResultsThe average cost of receiving malaria services was US$4.40 (bootstrap 95% CI: 3.6 to 5.3), with indirect costs accounting for 52% of total costs. Overall, at the 10% threshold, 12% (bootstrap 95% CI: 8.1% to 16.7%) of patients with malaria incurred CHE: 40% (bootstrap 95% CI: 26.7% to 55.6%) of the household in the poorest quintile experienced CHE, but none from the richest quintile did. The proportion of households living in poverty increased by more than 2-3% after spending on malaria-specific health services.ConclusionHealthcare seeking for malaria imposes a substantial financial risk on rural households, particularly for the poorest and most vulnerable. Malaria policies and interventions should therefore seek to alleviate both the direct costs and productivity losses associated with the disease, especially among the poor.

scholarly journals Effect of ultraprocessed food intake on cardiometabolic risk is mediated by diet quality: a cross-sectional study

2021 ◽  
pp. bmjnph-2020-000225
Author(s):  
Jennifer Griffin ◽  
Anwar Albaloul ◽  
Alexandra Kopytek ◽  
Paul Elliott ◽  
Gary Frost
Keyword(s):  
Food Intake ◽  
Energy Intake ◽  
Food Consumption ◽  
Outcome Measures ◽  
Diet Quality ◽  
Cardiometabolic Risk ◽  
Saturated Fat ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Occupational Cohort

ObjectiveTo examine the effect of the consumption of ultraprocessed food on diet quality, and cardiometabolic risk (CMR) in an occupational cohort.DesignCross-sectional.SettingOccupational cohort.Participants53 163 British police force employees enrolled (2004–2012) into the Airwave Health Monitoring Study. A total of 28 forces across the UK agreed to participate. 9009 participants with available 7-day diet record data and complete co-variate data are reported in this study.Main outcome measuresA CMR and Dietary Approaches to Stop Hypertension score were treated as continuous variables and used to generate measures of cardiometabolic health and diet quality. Secondary outcome measures include percentage of energy from fat, saturated fat, carbohydrate, protein and non-milk extrinsic sugars (NMES) and fibre grams per 1000 kcal of energy intake.ResultsIn this cohort, 58.3%±11.6 of total energy intake was derived from ultraprocessed (NOVA 4) foods. Ultraprocessed food intake was negatively correlated with diet quality (r=−0.32, p<0.001), fibre (r=−0.20, p<0.001) and protein (r = −0.40, p<0.001) and positively correlated with fat (r=0.18, p<0.001), saturated fat (r=0.14, p<0.001) and nmes (r=0.10, p<0.001) intake . Multivariable analysis suggests a positive association between ultraprocessed food (NOVA 4) consumption and CMR. However, this main effect was no longer observed after adjustment for diet quality (p=0.209). Findings from mediation analysis indicate that the effect of ultraprocessed food (NOVA 4) intake on CMR is mediated by diet quality (p<0.001).ConclusionsUltraprocessed food consumption is associated with a deterioration in diet quality and positively associated with CMR, although this association is mediated by and dependent on the quality of the diet. The negative impact of ultraprocessed food consumption on diet quality needs to be addressed and controlled studies are needed to fully comprehend whether the relationship between ultraprocessed food consumption and health is independent to its relationship with poor diet quality.

scholarly journals Government management capacities and the containment of COVID-19: a repeated cross-sectional study across Chinese cities

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e041516
Author(s):  
Wenchao Li ◽  
Jing Li ◽  
Junjian Yi
Keyword(s):  
Outcome Measures ◽  
Cross Sectional Study ◽  
Control Measures ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Travel Restrictions ◽  
Government Management ◽  
The Government ◽  
Laws And Policies ◽  
Novel Coronavirus

ObjectivesBetter understanding of the dynamics of the COVID-19 (2019 novel coronavirus disease) pandemic to curb its spread is now a global imperative. While travel restrictions and control measures have been shown to limit the spread of the disease, the effectiveness of the enforcement of those measures should depend on the strength of the government. Whether, and how, the government plays a role in fighting the disease, however, has not been investigated. Here, we show that government management capacities are critical to the containment of the disease.SettingWe conducted a statistical analysis based on cross-city comparisons within China. China has undergone almost the entire cycle of the anticoronavirus campaign, which allows us to trace the full dynamics of the outbreak, with homogeneity in standards for statistics recording.Primary and secondary outcome measuresOutcome measures include city-specific COVID-19 case incidence and recoveries in China.ResultsThe containment of COVID-19 depends on the effectiveness of the enforcement of control measures, which in turn depends on the local government’s management capacities. Specifically, government efficiency, capacity for law enforcement, and the transparency of laws and policies significantly reduce COVID-19 prevalence and increase the likelihood of recoveries. The organisation size of the government, which is not closely related to its capacity for management, has a limited role.

scholarly journals Validation of the German Life-Space Assessment (LSA-D): cross-sectional validation study in urban and rural community-dwelling older adults

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e049926
Author(s):  
Sandra Angelika Mümken ◽  
Paul Gellert ◽  
Malte Stollwerck ◽  
Julie Lorraine O'Sullivan ◽  
Joern Kiselev
Keyword(s):  
Older Adults ◽  
Construct Validity ◽  
Outcome Measures ◽  
Total Sample ◽  
Community Dwelling ◽  
Secondary Outcome ◽  
Life Space ◽  
Cross Sectional ◽  
The Past ◽  
Community Dwelling Older Adults

ObjectivesTo develop a German version of the original University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA-D) for measurement of community mobility in older adults within the past 4 weeks and to evaluate its construct validity for urban and rural populations of older adults.DesignCross-sectional validation study.SettingTwo study centres in urban and rural German outpatient hospital settings.ParticipantsIn total, N=83 community-dwelling older adults were recruited (n=40 from urban and n=43 from rural areas; mean age was 78.5 years (SD=5.4); 49.4% men).Primary and secondary outcome measuresThe final version of the translated LSA-D was related to limitations in activities and instrumental activities of daily living (ADL/iADL) as primary outcome measure (primary hypothesis); and with sociodemographic factors, functional mobility, self-rated health, balance confidence and history of falls as secondary outcome measures to obtain construct validity. Further descriptive measurements of health included hand grip strength, screening of cognitive function, comorbidities and use of transportation. To assess construct validity, correlations between LSA-D and the primary and secondary outcome measures were examined for the total sample, and urban and rural subsamples using bivariate regression and multiple adjusted regression models. Descriptive analyses of LSA-D included different scoring methods for each region. All parameters were estimated using non-parametric bootstrapping procedure.ResultsIn the multiple adjusted model for the total sample, number of ADL/iADL limitations (β=−0.26; 95% CI=−0.42 to −0.08), Timed Up and Go Test (β=−0.37; 95% CI=−0.68 to −0.14), shared living arrangements (β=0.22; 95% CI=0.01 to 0.44) and history of falls in the past 6 months (β=−0.22; 95% CI=−0.41 to −0.05) showed significant associations with the LSA-D composite score, while living in urban area (β=−0.19; 95% CI=−0.42 to 0.03) and male gender (β=0.15; 95% CI=−0.04 to 0.35) were not significant.ConclusionThe LSA-D is a valid tool for measuring life-space mobility in German community-dwelling older adults within the past 4 weeks in ambulant urban and rural settings.Trial registration numberDRKS00019023.

scholarly journals Willingness of patients to use unused medication returned to the pharmacy by another patient: a cross-sectional survey

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e024767 ◽  
Author(s):  
Charlotte Bekker ◽  
Bart van den Bemt ◽  
Toine CG Egberts ◽  
Marcel Bouvy ◽  
Helga Gardarsdottir
Keyword(s):  
Outcome Measures ◽  
Patient Characteristics ◽  
Secondary Outcome ◽  
High Educational Level ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Included Patient ◽  
Willingness To Use ◽  
High Educational ◽  
Patient Willingness

ObjectivesRedispensing by pharmacies of medication unused by another patient could contribute to optimal use of healthcare resources. This study aimed to assess patient willingness to use medication returned by another patient and patient characteristics associated with this willingness.DesignCross-sectional survey.SettingA total of 41 community and 5 outpatient pharmacies in the Netherlands.ParticipantsTotal of 2215 pharmacy visitors.Primary and secondary outcome measuresPatients completed a questionnaire regarding their willingness to use medication returned unused to the pharmacy by another patient, assuming quality was guaranteed. Secondary outcome measures included patient sociodemographic characteristics that were associated with patient willingness, analysed using logistic regression analysis and reported as ORs with 95% CIs.ResultsOf the 2215 patients (mean (SD) age 50.6(18.0) years; 61.4% female), 61.2% were willing to use medication returned unused to the pharmacy by another patient. Patients who were unwilling mostly found it risky. Men were more willing to use returned medication (OR 1.3 95% CI 1.1 to 1.6), as did patients with a high educational level (OR 1.8 95% CI 1.3 to 2.5), those who regularly use 1–3 medications (OR 1.3 95% CI 1.1 to 1.7), those who returned medication to the pharmacy for disposal (OR 1.5 95% CI 1.0 to 2.3) and those who ever had unused medication themselves (OR 1.3 95% CI 1.1 to 1.6)). Patients with non-Dutch cultural background were less willing to use returned medication (OR 0.395% CI 0.3 to 0.4)).ConclusionsWhen quality is guaranteed, a substantial proportion of patients are willing to use medication returned unused to the pharmacy by another patient. This suggests that implementation of redispensing may be supported by patients.

scholarly journals Association between socioeconomic status and prevalence of non-communicable diseases risk factors and comorbidities in Bangladesh: findings from a nationwide cross-sectional survey

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025538 ◽  
Author(s):  
Tuhin Biswas ◽  
Nick Townsend ◽  
Md Saimul Islam ◽  
Md Rajibul Islam ◽  
Rajat Das Gupta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Outcome Measures ◽  
Adult Population ◽  
Multivariable Analysis ◽  
Communicable Diseases ◽  
Secondary Outcome ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Non Communicable Diseases

ObjectivesThis study aimed to examine the prevalence and distribution in the comorbidity of non-communicable diseases (NCDs) among the adult population in Bangladesh by measures of socioeconomic status (SES).DesignThis was a cross-sectional study.SettingThis study used Bangladesh Demographic and Health Survey 2011 data.ParticipantsTotal 8763 individuals aged ≥35 years were included.Primary and secondary outcome measuresThe primary outcome measures were diabetes mellitus (DM), hypertension (HTN) and overweight/obesity. The study further assesses factors (in particular SES) associated with these comorbidities (DM, HTN and overweight/obesity).ResultsOf 8763 adults,12% had DM, 27% HTN and 22% were overweight/obese (body mass index ≥23 kg/m2). Just over 1% of the sample had all three conditions, 3% had both DM and HTN, 3% DM and overweight/obesity and 7% HTN and overweight/obesity. DM, HTN and overweight/obesity were more prevalent those who had higher education, were non-manual workers, were in the richer to richest SES and lived in urban settings. Individuals in higher SES groups were also more likely to suffer from comorbidities. In the multivariable analysis, it was found that individual belonging to the richest wealth quintile had the highest odds of having HTN (adjusted OR (AOR) 1.49, 95% CI 1.29 to 1.72), DM (AOR 1.63, 95% CI 1.25 to 2.14) and overweight/obesity (AOR 4.3, 95% CI 3.32 to 5.57).ConclusionsIn contrast to more affluent countries, individuals with NCDs risk factors and comorbidities are more common in higher SES individuals. Public health approaches must consider this social patterning in tackling NCDs in the country.

scholarly journals Willingness to Join and Pay for Community-Based Health Insurance Among Rural Households of Selected Districts of Jimma Zone, Southwest Ethiopia

2020 ◽  
Vol Volume 12 ◽  
pp. 45-55
Author(s):  
Muluneh Getachew Garedew ◽  
Shimeles Ololo Sinkie ◽  
Dejene Melese Handalo ◽  
Waju Beyene Salgedo ◽  
Kidus Yitebarek Kehali ◽  
...  
Keyword(s):  
Health Insurance ◽  
Rural Households ◽  
Community Based ◽  
Southwest Ethiopia ◽  
Community Based Health Insurance ◽  
Jimma Zone

Care and not wealth is a predictor of wasting and stunting of ‘The Coffee Kids’ of Jimma Zone, southwest Ethiopia

2017 ◽  
Vol 23 (3) ◽  
pp. 193-202 ◽  
Author(s):  
Kalkidan Hassen Abate ◽  
Tefera Belachew
Keyword(s):  
Dietary Diversity ◽  
World Health ◽  
Feeding Practice ◽  
Cross Sectional Survey ◽  
Child Feeding ◽  
Cross Sectional ◽  
Southwest Ethiopia ◽  
Household Level ◽  
Young Child Feeding ◽  
Jimma Zone

Background: The generation of cash from agricultural products is the mainstay of the livelihood of many households in developing countries. However, critics of cash cropping have highlighted its influence on dietary diversity and availability of food at the household level, eroding the potential for optimal child caring practices. Methods: A community-based cross-sectional survey was carried out in three randomly selected coffee-producing districts of Jimma Zone in southwest Ethiopia. The underlying causes of malnutrition, food access, hygiene and care were assessed using the household food insecurity access scale, morbidity reports and infant and young child feeding practice core indicators of the World Health Organization. Anthropometric data were converted into weight for age, height for age, body mass index for age and weight for height Z-scores to determine child nutritional outcomes. Results: Prevalence of underweight, wasting, stunting and thinness were 14.2%, 9.1%, 24.1% and 9.9%, respectively. Multivariable logistic regression showed that children with suboptimal meal frequency were more than three times more likely to develop wasting (AOR = 3.3, p < 0.0001). Female children were twice as likely to develop wasting compared with males (AOR = 2.00, 4.1, p = 0.05). Children with suboptimal dietary diversity were almost four times as likely to develop stunting (AOR = 3.95, p < 0.0001). Those who were not exclusively breastfed during their first 6 months were almost five times as likely to develop stunting (AOR = 4.66, p < 0.0001). Conclusions: The findings imply that in coffee-producing areas, child caring practices are stronger independent predictors of nutritional status than wealth or economic indicators alone.

scholarly journals Relevance of anthropometric measurements as predictors of prevalent diabetes type 2: a cross-sectional study on a Norwegian population

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e046162
Author(s):  
Anton Hasselgren ◽  
Biraj Man Karmacharya ◽  
Ann-Katrin Stensdotter
Keyword(s):  
Diabetes Mellitus ◽  
Outcome Measures ◽  
Diabetes Mellitus Type 2 ◽  
Diabetes Mellitus Type ◽  
Secondary Outcome ◽  
Anthropometric Indices ◽  
Cross Sectional ◽  
Norwegian Population ◽  
Potential Association

ObjectivesThe objective was to determine the predictive potential of anthropometric indices to screen prevalent diabetes mellitus type 2 in a Norwegian population.DesignThis is a cross-sectional design to determine the potential association of waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), waist circumference (WC) and body mass index (BMI) with prevalent diabetes mellitus type 2 through logistic regression analysis. Receiver operating characteristic (ROC) curves were used to determine the predictive potential of the anthropometric indices. Youden’s index was applied to determine the optimal cut-off points for each anthropometric index.SettingThis study used cross-sectional data from the populations-based Health Study in Nord-Trøndelag which invited all citizens in the county above 20 years of age.ParticipantsThis study included all those who were non-pregnant and had complete data (N=50 042), 98.5% of the participants. The sample is to be considered representative for the population of Norway.Primary and secondary outcome measuresOR and ROC of the potential association between diabetes mellitus type 2 and anthropometric indices were the main planned and performed outcome measures.ResultsThe results suggest that the anthropometric indices performed differently within the Norwegian population with WHR and WHtR being the stronger predictor with (ROC) of 0.746 (0.735 to 0.757) and 0.741 (0.730 to 0.752). The predictive potential for the investigated anthropometric indices was generally stronger for women than men.ConclusionAnthropometric indices of size BMI and the highly correlated WC are less associated with prevalent diabetes mellitus type 2 than WHR (WC adjusted for hip circumference) or WHtR (WC adjusted for height) in a Norwegian population.

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