Determinants of Modern Contraceptive Uptake among the Youth in Akuse Township in the Lower Manya Krobo Municipality, Ghana

Background: Access to safe and effective contraception is crucial for sexual and reproductive health to be at its best. This allows improved pregnancy results and the avoidance of unintended births. Teenagers’ views on using contraceptives are influenced by the information available at their disposal. The study assessed the influential factors affecting the utilization of modern contraceptives among the youth in Akuse in the Eastern Region of Ghana. Methods: The data for the study were gathered from 378 consented youth aged 15 - 24 years using a quantitative cross-sectional study design and a well-structured questionnaire. Person’s Chi-Square test was adopted to measure the association between the outcome variable and selected independent variables. Logistic regression models were utilized to measure the odds of the factors influencing modern contraceptive use among the respondents. Results: The results of the study suggested a high knowledge level of contraceptives;however, the prevalence of utilization was low. The level of education and age were factors found to influence the uptake of contraceptives. A bivariate analysis to examine the association between selected socio-demographic variables revealed that educational level (p = 0.044), religious affiliation (p = 0.002), and ethnicity (p = 0.016) were statistically associated with modern contraceptive use among the respondents. All other tested demographic variables including the age groups, gender, marital status, and residential status proved otherwise at the observed p-values greater than the 0.05 threshold. Respondents who indicated staying with partners were 6.79 times more likely to use contraceptives compared to their counterparts staying with a parent, after controlling for all other covariates. Conclusions: Based on the findings of this study, it was concluded that high contraceptive knowledge influences the choice of contraceptive preferred by the youth, and contraceptive use is also influenced by the advancement in age and educational level of the youth. It is however recommended that parents, guidance, and teachers be entreated to offer relevant and timely sexual information or education as these will most likely improve the uptake of modern contraceptives among the targeted population.

TOEPLITZ DETERMINANTS IN ONE AND HIGHER DIMENSIONS

In this study,we derive the sharp bounds of certain Toeplitz determinants whose entries are the coefficients of holomorphic functions belonging to a class defined on the unit disk U.Furthermore,these results are extended to a class of holomorphic functions on the unit ball in a complex Banach space and on the unit polydisc in C^(n).The obtained results provide the bounds of Toeplitz determinants in higher dimensions for various subclasses of normalized univalent functions.

Rabies by Dog Bites in Benin: Determinants of Good Knowledge of the Rabies Risk among Subjects Exposed in the Plateau Department in 2023

Rabies, a viral zoonosis, is one of the neglected tropical diseases (NTDs) that mainly affects poor and vulnerable populations. Human rabies is endemic in Benin. Although listed among the notifiable diseases, it nevertheless remains a neglected and under-reported disease. The objective of this study was to investigate the determinants of knowledge of rabies risk among subjects exposed to human rabies by dog bites in the Plateau department of Benin. Methods: This was a cross-sectional study with an analytical aim which involved a sample of 900 people aged at least 18 years old chosen randomly and residing in the Plateau department for at least six months. A pre-tested and validated digital questionnaire served as a data collection tool. Data analysis was done with R 3.4.1 software. The prevalence ratio was used as a measure of association. The confidence threshold was set at 5%. We carried out a multiple logistic regression using the likelihood ratio (top-down approach) in order to identify the main factors which influenced the good knowledge of human rabies in the population of Plateau. Results: In the study population, 80.89% of the subjects surveyed lived in a rural area. The sex ratio (Male/Female) was 1.11. The average age of the subjects was 40.24 ± 14.52 years. The prevalence of dog bites was 4.11% (95% CI = [3.00;5.63]) or 37 subjects bitten. After evaluation of knowledge of rabies risk in the study population, the main factors which positively influenced good knowledge of human rabies were age (p linear trend 0.01), residence of the subject in the municipality of Pobè (ORa = 8.34;95% CI = 0.83 - 1.23;p < 0.01), individual dwelling (ORa = 17.95;95% CI = 13.12 - 49.58;p < 0. 01), educational level of at least secondary (ORa = 5.53;CI 95 = 3.06 - 10.15;p = 0.01), the existence of a veterinary center (ORa = 3.66;CI 95 = 1.07 - 12.43 p = 0.01) and knowledge of a dog bites victim (ORa = 6.55;95% CI = 2.73 - 8.25;p < 0.01). Conclusion: This population study confirms that human rabies remains a public health problem with a need to raise awareness among populations on good prevention practices against human rabies after a dog bite in the Plateau department. This could help to improve strategies surveillance for the control and eradication of human rabies through the implementation of the One Health approach.

Unintended Pregnancy Determinants among Antenatal Clinic Attendees: A University of Port Harcourt Teaching Hospital Experience

An unintended pregnancy is a pregnancy that is either mistimed or unplanned. The objectives of this study were to determine the prevalence of unintended pregnancy as well as to document the determinant factors among pregnant women attending antenatal clinics at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Rivers State, Nigeria. It was a descriptive, cross-sectional study of 215 women attending the antenatal clinic of UPTH from July to August 2022. Information on socio-demographic characteristics, reproductive history, desirability of the current pregnancy at the time of conception, knowledge and use of contraceptive methods were collected using a pretested questionnaire and analyzed using SPSS version 26.0. Chi-square test was used for test of associations with the level of significance set at P < 0.05. The prevalence rate of unintended pregnancy from the study was 16.28% (≈16%). The contraceptive awareness was very high (209, 97.21%), however, 101 (46.98%) participants had never used any form of contraceptives. Univariate analysis using Chi-square test showed a statistically significant association between age and unintended pregnancy (P = 0.042), level of education and unwanted pregnancy (P = 0.033) as well as parity and unintended pregnancy (P = 0.019). The prevalence of unintended pregnancy among women attending antenatal clinics was high, possibly due to low contraceptive usage. More efforts should be geared towards ensuring access to comprehensive contraceptive care and contraceptive methods, this will enhance uptake and reduce the rate of unintended pregnancy.

Determinants of Early Survival of Breast Cancer Patients in Yaoundé-Cameroon

Introduction: Breast cancer is one of the leading causes of death worldwide. We carried out this study with the aim of evaluating the determinants of early survival of women with breast cancer in two hospitals in the city of Yaoundé. Methodology: This was an analytical cross-sectional study with retrospective and prospective data collection of breast cancer patients during 6 years in two Hospitals of Yaoundé from January 2017 to December 2022. We consulted the files in search of epidemiological, clinical, paraclinical, therapeutic and survival variables. We completed the survival data directly from the patients or their relatives after their consent. We analyzed the data using SPSS version 23.0 software. Survival analysis was done using the Kaplan-Meier method and survival curves were compared using the Log Rank test. Factors influencing survival were evaluated using the Cox model. The significance threshold (P value) was set at 0.05 at 95% confidence interval. The study was approved by the ethics committees. Results: We included 500 patients whose ages varied between 22 and 83 years with a mean age of 47.19 ± 11.61 years. The most represented age group was 30 to 45 years old (45.8%). Less than half (41.6%) were postmenopausal. The most frequent reason for consultation was a breast lump (79.9%). The most common clinical stage at presentation was stage-3 (47.6%). Infiltrating ductal carcinoma was the most represented histological type (84.7%). The most represented histological grade was grade 2 (40.2%). Immunohistochemistry was performed in 34.20% of cases. The most represented molecular subtype was triple negative (41.8%) followed by Luminal A (30%). Concerning treatment, 17.2% did not receive any, 45% had surgery, 79.4% had chemotherapy, 34.2% hormone therapy, and 14.6% radiotherapy. The survival of patients with breast cancer at 1, 2, 3, 4 and 5 years was respectively 90.6%;83.1%;74.2%;69.8% and 59.2%. The median survival was not reached;however, the first quartile (Q1) was 36 months (3 years). Independent factors associated with reduced survival were breast ulceration (aHR = 3.23;p = 0.002), bilateral tumor location (aHR = 9.2;p < 0.001) and clinical stage 3 (aHR = 1.72;p = 0.010) while patients classified ACR3 on imaging (aHR = 0.19;p = 0.005) had improved survival. Conclusion: Breast cancer survival from 1 to 5 years decrease from 90 to 59%. Mortality was highest in the first 40 months. Independent factors associated with reduced survival were breast ulceration, bilateral tumor location and clinical stage 3 while patients classified ACR3 on imaging had improved survival.

Rationale of a Cross Sectional Analytic Study on Determinants of Recurrent Preeclampsia at University Clinics of Kinshasa (Democratic Republic of Congo) and at Victor Dupouy Hospital Center (France)

Research Background: Pre-eclampsia is one of main causes of materno-foetal mortality and morbidity worldwide, with a prevalence of 3% - 7%. Although considered a primiparous condition, it can nevertheless recur. Several factors appear to be associated with risk of recurrence of pre-eclampsia, such as the term of delivery of previous pregnancy, severity of disease, the existence of co-morbidities and the inter-genital space. Purpose: The aim of our study will be to analyse and identify in a population of pregnant women with a history of preeclampsia risk factors associated with occurrence of recurrent preeclampsia at University clinics of Kinshasa (Democratic Republic of Congo) and at Victor Dupouy Hospital Center (France). Methods: In this study, pregnant women with an history of preeclampsia who will give birth between November 2018 and October 2024 at University Clinics of Kinshasa (UCK) and Victor Dupouy Hospital Center (VDHC) will be included. This will be a cross-sectional analytical study, data from previous and subsequent pregnancies will be studied. Expected Result: The prevalence of recurrent preeclampsia in the study population will be determined. And we will highlight the factors that will determine the recurrence of preeclampsia by analysing the risk factors. Conclusion: Knowledge of the factors associated with recurrent preeclampsia could be an excellent tool for predicting and preventing the disease.

Disparities in Prevalence and Determinants of Hypertension amongst Bamiléké Adults Residing in Two Different Agroecological Zones of Cameroon

Background: Cardiovascular diseases such as hypertension (HTN) are one of the main causes of death in Cameroon. This study aimed at assessing prevalence disparities and determinants of hypertension amongst Bamiléké adults residing in two different agroecological zones of Cameroon. Methods: A cross-sectional and descriptive survey was conducted among Bamiléké population living in the Highlands zone (Western region) and in the Monomodal Rainforest zone (Littoral region) of Cameroon from August 2016 to August 2017. Participants (962) were aged at least 20 years old. Data on sociodemographic, hemodynamic, anthropometric, and biochemical parameters and lifestyle of the participants were collected. Results: Results obtained revealed that 34.2% were hypertensive and those residing in the highland zone were more affected than those living in the monomodal rainforest zone (44.5% vs 22.9%). The different subtypes of HTN (Isolated systolic hypertension (14.1%), isolated diastolic hypertension (7.2%) and Systo-diastolic hypertension (23.3%)) were also more prevalent in the Highlands Zone. The most prevalent stage of HTN was pre-HTN (31.5%). However, people living in the monomodal rainforest zone were more affected by pre-HTN compared to Bamiléké living in the highland zone (33.6% vs. 29.6%). Results also showed that high consumption (≥ 3 times/week) of carbohydrate- and fat-rich foods, ageing, obesity, and marital status were associated with high blood pressure in both agroecological zones. Besides, secondary education (OR = 0.68;95% CI: 0.42 - 0.99) in the Highlands Zone and high (≥3 times/week) vegetable consumption (OR = 0.66;95% CI: 0.44 - 0.98) in the Monomodal Rainforest Zone had a protective effect on elevated blood pressure of population. Conclusion: There is a disparity in the prevalence of hypertension and some of its determinants among Bamiléké adults residing in different agroecological zones. This work highlights the need to advocate for local and ethno-cultural health policies to prevent, diagnose and manage hypertension.

Determinants of Tobacco Cultivation and the Associated Impacts of Adoption in Hurungwe District, Zimbabwe

Tobacco is an essential cash crop in Zimbabwe and a strategic livelihood option for hundreds of thousands of rural households. However, the crop is linked to negative environmental, economic, and social impacts. The existing studies on tobacco cultivation in Zimbabwe present contradictory findings on the determinants and impacts of adoption, leaving unanswered questions about the crop’s sustainability impact in the country. This article investigates the determinants of smallholder farmers’ decisions to grow tobacco and the associated impacts of adoption. Random and purposive sampling were used to select 273 household surveys, including tobacco and non-tobacco smallholder farmers, and 56 expert interviews to answer the research questions. We employed regression models alongside expert interviews and document analysis to identify the determinants influencing the decision-making process of smallholder farmers in Zimbabwe regarding tobacco cultivation. Additionally, our investigation aimed to elucidate the perceived impacts associated with the adoption of this agricultural practice. The regression analysis indicated that the farmer’s age, education level, farming experience, family size, household income, and perceived high farm profitability are significant drivers of tobacco adoption. We also discovered divergent and convergent perceptions of the critical impacts of tobacco cultivation. The study highlights the need for proactive multi-stakeholder collaboration and sustainable financial arrangements to address the negative impacts of tobacco production. As the primary stakeholder responsible for regulating and promoting agricultural activities, the Zimbabwean government should provide meaningful financial support, increase access to credit, and ensure better market facilities for alternative crops to reduce the over-dependence on tobacco.

Impact of Social Determinants of Health on Self-Perceived Resilience: An Exploratory Study of Two Cohorts of Adults with Congenital Heart Disease

Social determinants of health(SDOH)affect quality of life.We investigated SDOH impacts on self-perceived resilience among people with adult congenital heart disease(ACHD).Secondary analysis of data from two com-plementary studies:a survey study conducted May 2021–June 2022 and a qualitative study conducted June 2020–August 2021.Resilience was assessed through CD-RISC10 score(range 0–40,higher scores reflect greater self-perceived resilience)and interview responses.Sociodemographic and SDOH(education,employment,living situa-tion,monetary stability,financial dependency,area deprivation index)data were collected by healthcare record review and self-report.We used linear regression with robust standard errors to analyze survey data and performed a thematic analysis of interview data.Survey participants(N=127)mean age was 42±14 years;51%were female,87%white.ACHD was moderate(75%)or complex(25%);41%functional class C or D.Resilience(mean 30±7)varied by monetary stability:compared to people with difficulty paying bills,resilience was 15.0 points higher(95%CI:6.9–23.1,p<0.001)for people reporting having enough money and 14.2 points higher(95%CI:5.9–22.4,p=0.001)for those reporting just enough money.Interview participants’(N=25)mean age was 32 years(range 22–44);52%were female,72%white.ACHD was moderate(56%)or complex(44%);76%functional class C or D.Participants discussed factors affecting resilience aligned with each of the major SDOH,prominently,economic stability and healthcare access and quality.Financial stability may be important for supporting self-perceived resi-lience in ACHD.This knowledge can inform the development of resilience interventions for this population.

Acceptance of COVID-19 vaccine and its related determinants in Nigeria:An online survey

BACKGROUND Vaccine hesitancy is a major challenge in the fight against the coronavirus disease 2019(COVID-19)pandemic.Identifying the sociodemographic factors associated with vaccine acceptance among Nigerians is crucial for improving vaccine uptake.AIM To assess the acceptance rate of COVID-19 vaccine and its related determinants among Nigerians.METHODS An online cross-sectional survey(observational study)was conducted between February 2021 and May 2021,using a questionnaire hosted on SurveyMonkey.The invitation to take part in the poll was sent out to participants through social networking platforms.A logistic regression was used to determine which sociodemographic factors were associated with vaccine acceptance constructs.RESULTS A total of 1800 persons responded to the survey,a larger proportion of whom were males(53.9%)and within the age group of 21-30 years(29.4%)and earned an average income of less than$500 per month(43.3%).Only 0.56%of participants had a high perceived risk of COVID-19 infection,while only 1.11%had a perceived risk of dying from COVID-19.The perception rate of the COVID-19 vaccine among participants was 51.1%,while the acceptance rate was 63.9%.There was no significant association between the COVID-19 vaccine acceptance rate and related determinants assessed,particularly age(χ²=3.049,P=0.550),sex(χ²=0.102,P=0.749),average income(χ²=3.802,P=0.875),and religion(χ²=2.819,P=0.420).Participants with chronic conditions demonstrated a higher acceptance rate compared to the general population.CONCLUSION Despite the positive perception observed and substantial vaccine acceptance rate among the study participants,more public health interventions are still needed to enhance vaccine acceptability in Nigeria.

Sociodemographic determinants associated with breastfeeding in term infants with low birth weight in Latin American countries

BACKGROUND A progressive decrease in exclusive breastfeeding(BF)is observed in Latin America and the Caribbean compared with global results.The possibility of being breastfed and continuing BF for>6 months is lower in low birth weight than in healthy-weight infants.AIM To identify factors associated with BF maintenance and promotion,with particular attention to low-and middle-income countries,by studying geographic,socioeconomic,and individual or neonatal health factors.METHODS A scoping review was conducted in 2018 using the conceptual model of social determinants of health published by the Commission on Equity and Health Inequalities in the United States.The extracted data with common characteristics were synthesized and categorized into two main themes:(1)Sociodemographic factors and proximal determinants involved in the initiation and maintenance of BF in low-birth-weight term infants in Latin America;and(2)individual characteristics related to the self-efficacy capacity for BF maintenance and adherence in low-birth-weight term infants.RESULTS This study identified maternal age,educational level,maternal economic capacity,social stratum,exposure to BF substitutes,access to BF information,and quality of health services as mediators for maintaining BF.CONCLUSION Individual self-efficacy factors that enable BF adherence in at-risk populations should be analyzed for better health outcomes.

Determinants of Knowledge, Attitudes, and Practices among Young Adults Type 2 Diabetes Patients in Selected Tertiary Hospitals in Shandong Province, China

Objective: The purpose of this study is to understand the current situation of knowledge, attitude, and practice of self-management in young patients with type 2 diabetes mellitus (T2DM) and to explore the relationship between general conditions (personal, social, and environment, clinical factors) and their knowledge, attitude, and practices (KAP) of diabetes self-management, This aims to provide patients with high-quality nursing care management and services, as well as to provide relevant recommendations for effective self-management. Methods: This study is a descriptive correlational study that used the purposive sampling method to investigate 359 patients with T2DM aged 18-25 years in four designated tertiary hospitals in Shandong Province. Results: Knowledge of self-management was correlated with sex, age, education level, occupation and work situation, monthly household income, medical payment method, family and friend support, frequency of diabetes health education, and diabetes complications. The attitude subscale was correlated with sex, age, education level, work situation, and family and friend support. The practice subscale was associated with age, education level, work situation, family and friend support, frequency of diabetes health education, and HbA1c values. Conclusion: Young adults aged 18-25 with T2DM have positive attitudes towards diabetes self-management, but there are still deficiencies in knowledge acquisition and behavioral practice. The KAP of self-management of diabetes is influenced by personal factors such as sex, age, and education level, and socio-environmental factors such as family income and family or friends’ social support. Additionally, clinical factors such as complications and HbA1c values significantly impacted the patient’s disease self-management ability.

Survey of HIV/AIDS-related Knowledge, Attitude and Determinants in Urban Residents

Objectives: To provide references for HIV/AIDS-re-lated health education strategies through survey onHIV/AIDS-related knowledge, attitude and determi-nants of HIV/AIDS awareness. Methods: The study subjects were selected by ran-dom interception in a downtown street of Guangzhoucity on World AIDS Day-December 1,2002. The uni-form questionnaires were finished by means of self-administration. Results: Two hundred questionnaires were distrib-uted and 147 qualified questionnaires were collected.The results showed, the awareness rate of HIV/AIDS-related knowledge was 63.3%, and awareness rate oftransmission routes was 76.2%, whilst non-transmis-sion route was 60.5%; the awareness rate of trans-mission was 59.2%; the awareness rate of preventionwas 47.0%; the positive attitude to people living withHIV/AIDS was 65.6%. Multiple variable Logistic re-gression analysis showed the determinants of HIV/AIDS-related knowledge were education level, age,marital status and gender, of which people with highlevel of education, young age and the group of maleand married had better awareness of HIV/AIDS. Conclusion: Current HIV/AIDS-related knowledgeof urban residents is relativly low, especially for thenon-transmission route, hence further HIV/AIDS-re-lated education should be strengthened, especially fo-cusing on non-transmission route to eliminate dis-crimination over people living with HIV/AIDS.Further, education efforts also should be put on fe-male population, unmarried population and poorly edu-cated population.

Invariant Determinants in Banach Algebras

The invariant determinants ha Banach algebras are discussed and a necessary and sufficient condition for those integral traced unital Barach algebra(A,τ) admitting a G-invari- ant determinant is obtained,where G is a group of trace preserving automorphisms of A.

Irrigation Water Use Efficiency of Farmers and Its Determinants: Evidence from a Survey in Northwestern China

Irrigation water shortage is becoming an increasingly serious problem in agricultural production. In this case, it is very important for policy makers to take measures to improve irrigation water use efficiency, especially in the water-scarce areas. In this paper, the data envelopment analysis （DEA） techniques, based on the concept of input-specific technical efficiency were used to develop farm-level technical efficiency measures and sub-vector efficiencies for irrigation water use. The Tobit regression technique was then adopted to identify the factors that influence irrigation water efficiency differentials under the shortage of water resources. Based on a sample data of 432 wheat farmers in northwestern China, our experimental results of the DEA analysis showed the average technical efficiency of 0.6151. It suggested that wheat farmers could increase their production by as much as 38.49% by using inputs more efficiently. Further, the mean irrigation water efficiency of 0.3065, suggested that wheat farmers could produce the same quantity of wheat using the same quantity of inputs but with 69.35% less water. The results of the Tobit regression analysis showed that the farmer＇s age, income, education level, and the farm size tended to affect the degree of irrigation water efficiency positively, and the channel conditions and different irrigation methods made a significant impact on irrigation water use efficiency. Furthermore, the arrangements of exclusive water property rights and competitive water price mechanism have effectively encouraged the water saving behavior of farmers. These results are valuable for policy makers since it could help to guide policies towards high irrigation water use efficiency.

IUD Expulsion and its Socio-demographic Determinants in China

To identify the determinant of the occurrence of IUD expulsion Materials & Methods Based on 25 733 IUD uses from the Chinese Two per Thousand Fertility Survey data, this study examines the patterns and differentials of IUD expulsion rate by characteristics of women, and identifies the socio demographic determinants of IUD expulsion. A Life Table method was used to calculate the cumulative expulsion rate and a random effects discrete time survival model was employed to assess the impact of potential determinants simultaneously on the risk of expelling an IUD. Results Three major findings are observed in this study. First, IUD expulsion was the second main reason, after pregnancy during IUD use, for IUD discontinuation during the first four years of IUD insertion; the expulsion rates were 6.4%, 9.1%, 10.8 %, and 12.0% at 12, 24, 36 and 48 months, respectively. Second, there was a clustering of IUD expulsion: some women experienced repeated IUD expulsions. Third, some socio demographic characteristics and fertility history were associated with the occurrence of IUD expulsion. In particular, the expulsion rate was high among young women, among those with two or more children and among those living in rural areas. Conclusion The above mentioned factors shoald be addressed in order to decrease the IUD expulsion rate and enhance the reprocluctive he alth of women.

Spatial Evolution and Locational Determinants of High-tech Industries in Beijing

Using datasets on high-tech industries in Beijing as empirical studies, this paper attempts to interpret spatial shift of high-tech manufacturing firms and to examine the main determinants that have had the greatest effect on this spatial evolution. We aimed at merging these two aspects by using firm level databases in 1996 and 2010. To explain spatial change of the high-tech firms in Beijing, the Kernel density estimation method was used for hotspot analysis and detection by comparing their locations in 1996 and 2010, through which spatial features and their temporal changes could be approximately plotted. Furthermore, to provide quantitative results, Ripley′s K-function was used as an instrument to reveal spatial shift and the dispersion distance of high-tech manufacturing firms in Beijing. By employing a negative binominal regression model, we evaluated the main determinants that have significantly affected the spatial evolution of high-tech manufacturing firms and compared differential influence of these locational factors on overall high-tech firms and each sub-sectors. The empirical analysis shows that high-tech industries in Beijing, in general, have evident agglomeration characteristics, and that the hotspot has shifted from the central city to suburban areas. In combination with the Ripley index, this study concludes that high-tech firms are now more scattered in metropolitan areas of Beijing as compared with 1996. The results of regression model indicate that the firms′ locational decisions are significantly influenced by the spatial planning and regulation policies of the municipal government. In addition, market processes involving transportation accessibility and agglomeration economy have been found to be important in explaining the dynamics of locational variation of high-tech manufacturing firms in Beijing. Research into how markets and the government interact to determine the location of high-tech manufacturing production will be helpful for policymakers to enact effective policies toward a more efficient urban spatial structure.

DETERMINANTS OF STRUCTURE IN AQUATIC NON-PELAGIC PROTOZOAN COMMUNITIES

Although microbes have traditionally been used as models for testing ecological theory, research on the organization of these communities has largely been isolated from other areas of community ecology. Early studies indicated that microbial populations can form dynamic, interacting assemblages. Observations of distributional patterns suggest that certain deterministic forces regulate community structure. It appears that protozoans are tolerant of a wide range of environmental conditions although evidence for this is largely based on gross environmental analyses. Laboratory studies have suggested the importance of negative and positive biotic interactions in determining community membership, but little field evidence for this exists. The importance of transport processes in controlling community composition is being increasingly recognized. All three types of processes likely act to regulate the colonization and successional dynamics of these communities. A simple model is presented to promote the

Social determinants of under-five mortality in Ethiopia: Event history analysis using evidence from Ethiopian Demographic and Health Survey (EDHS)

Background: Under-five mortality is one of the indicators of the millennium development goals (MDGs) for the child mortality reduction goal. Understanding the social determinants of under-five mortality is helpful to narrow the gap between different social classes. Therefore, this study focused on the social determinants of under-five mortality inEthiopiausing EDHS 2011 data. Methods: The data source for this analysis was the 2011 EDHS which was undertaken over a five-month period from 27 December, 2010 to 3 June, 2011. The sample was selected using a stratified, two-stage cluster design. Samples of 16,515 women of reproductive age were interviewed. The questionnaire used to collect information from these women who?had among other things such as?background characteristics of women, birth history of these women and the survival of each birth at the time of the interview. Births that had occurred to women in the last 10 years prior to the date of the?interview were extracted for the analysis. Descriptive statistical methods were used to describe the distribution of the characteristics of the data. Kaplan Meier plots and incidence rates per 1000 person years were used to compare survival across different categories of the risk factors. The effect of the risk factors on survival was analyzed using Cox proportional hazards regression. Data management and analysis were carried out using STATA 10. Results: A total of 23,581 under-five children were included in the study. The under-five mortality incidence rate in Ethiopia for the last ten years was 29.6 per 1000 person years. Maternal education beyond primary level of education reduced the risk of under-five mortality by about half. A significant reduction in risk of under-five mortality was observed among births to mothers residing in richest households. The hazard ratio (HR) was higher for under-five mortality among boys than daughters, twins than singleton, teen age mother than higher ages and short births than optimal. Conclusions: Empowering mothers with education and making them productive for improving their income are important aspects for reducing under-five mortality. Emerging regions were disadvantaged on the incidence of under-five mortality;however, there was a positive result in narrowing the urban-rural under-five mortality risks. Being teenage mother at birth, short birth interval and twin births were identified risk factors for increased under-five mortality in Ethiopia. Interventions targeted at empowering women and much effort in emerging regions are required. Preventing teenage motherhood and promoting optimal birth spacing are also required to reduce under-five mortality in Ethiopia.

Determinants of Treatment Delays among Pulmonary Tuberculosis Patients in Enugu Metropolis, South-East, Nigeria

Introduction: Globally, the burden of Tuberculosis is escalating. Early diagnosis and prompt initiation of treatment are essential to achieve an effective tuberculosis control programme. Objective: To investigate the duration of delay for treatment and assess the determinants of treatment delays among pulmonary tuberculosis patients in Enugu metropolis, South-East, Nigeria. Methods: This cross sectional study was conducted among 219 pulmonary tuberculosis patients in six randomly selected DOTS centres in the three LGAs in Enugu metropolis. Data were analysed using SPSS version 17, and statistical significance of association between variables was assessed using Chi-square test at p 2 = 23.412, df = 8, p = 0.003), knowledge of the cause of TB (X2 = 42.322, df = 28, p = 0.040), TB symptoms experienced (X2 = 46.857, df = 20, p = 0.001), occupation (X2 = 34.217, df = 20, p = 0.025), and distance of the health facility from the respondents’ residence (X2 = 34.908, df = 8, p = 0.000). The positive predictors of delayed treatment, using logistic regression, were first presentation at: patent medicine dealer (OR 12.3 CI: 3.22 - 36.23), private hospital (OR 10.6 CI: 5.73 - 17.94), prayer house (OR 7.2 CI: 2.75 - 23.64), and traditional healer (OR 11.9 CI: 6.87 - 32.85). Conclusion: Majority of TB patients in this study did not present early to health facilities. The positive predictors of delayed presentation for appropriate PTB treatment were first presentations at inappropriate treatment centres. There is need to intensify public health awareness among potential TB patients on the associated risks of treatment delay to prevent transmission. Unskilled health care providers should refer suspected PTB patients promptly to facilitate their treatment.