This study examined the non-medical factors that influence expectant mothers to opt for caesarean deliveries in Ghana. Data on 395 expectant mothers across the ten regions of Ghana who were located in urban, semi-rura...This study examined the non-medical factors that influence expectant mothers to opt for caesarean deliveries in Ghana. Data on 395 expectant mothers across the ten regions of Ghana who were located in urban, semi-rural and rural areas, and spanned a period of five years (from 2012 to 2016) were obtained from the Ghana Health Service. In fitting the logistic regression model, data on 355 expectant mothers (i.e. 89.9% of the data) was assigned to the analysis sample while 40 (i.e. 10.1%) was assigned to the hold-out sample. The hold-out sample together with other statistical measures of overall model fit, pseudo R2 measures and classification accuracy were used to validate the results obtained from the analysis sample. Significance was tested at p = 0.05. Determinants including, educational level of expectant mother, parity of expectant mother, baby’s birth weight, previous caesarean delivery, location of expectant mother, age of expectant mother and, period within the year of childbirth had a significant effect on caesarean delivery. The study recommended that health practitioners should be able to foretell expectant mothers who are likely to undergo caesarean delivery in order for them to prepare financially and psychologically to avoid further complications. Due to the significant positive attitude of women towards caesarean delivery rather than normal delivery, it is necessary to inform them about the advantages of normal delivery and the health hazards associated with caesarean delivery to the mother and child.展开更多
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 ...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.展开更多
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 ...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.展开更多
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 p...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.展开更多
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 e...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.展开更多
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-plemen...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.展开更多
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...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.展开更多
Understanding why individuals do or do not adopt optimal water, sanitation, and hygiene (WASH) practices is critical to designing successful behavior change interventions. However, policy makers and program implemente...Understanding why individuals do or do not adopt optimal water, sanitation, and hygiene (WASH) practices is critical to designing successful behavior change interventions. However, policy makers and program implementers often fail to obtain the context-specific information on behavioral determinants of WASH practices. This two-stage, randomized survey among 5000 female primary caregivers in the Lake Zone of Tanzania assessed associations between behavioral determinants and a range of hygiene and sanitation practices. Behavioral determinants of hygiene were almost always significantly associated with cleaning one’s own hands after cleaning the baby’s bottom and being able to show at least one place where family members wash their hands. In regression models, those who knew when to wash their own hands (OR = 1.8, 95% CI: 1.5, 2.1) and their child’s hands (OR = 1.5, 95% CI: 1.3, 1.7) and mothers who thought that their female friends washed their hands after cleaning the baby’s bottom (OR = 5.5, 95% CI: 4.5, 6.7) were significantly more likely to frequently clean their own hands after cleaning the baby’s bottom. This research suggests that in the Lake Zone of Tanzania, numerous determinants are associated with hygiene practices. Identifying context-specific determinants of WASH behaviors is the first step toward developing effective interventions.展开更多
Objective: Breast cancer in women of childbearing age (WCBA) is a major public health concern. This study aimed to determine variation and determinants in lipid profile among Cameroonian WCBA diagnosed with breast can...Objective: Breast cancer in women of childbearing age (WCBA) is a major public health concern. This study aimed to determine variation and determinants in lipid profile among Cameroonian WCBA diagnosed with breast cancer. Materials and Methods: A case-control study took place at two reference hospitals in Douala, Cameroon. A total of 176 WCBA (88 cases and 88 controls) were finally enrolled. Interviewer-administered questionnaires were used to collect sociodemographic, behavioural, clinical and anthropometric data. Three millilitres of venous blood were collected for analysis of total cholesterol (TC), high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c) and triglycerides (TG). Results: Overweight was predominantly seen in cases and controls. Serum levels of TC and LDL-c were significantly lower in cancer women (167.02 ± 45.46 vs 183.12 ± 27.38 mg/dL, p = 0.005 for TC;85.83 ± 40.34 vs 105.25 ± 29.95 mg/dL, p = 0.0004 for LDL-c), while HDL-c levels were higher in controls (45.09 ± 7.20 vs 38.24 ± 11.14 mg/dL, p Conclusion: This study suggests the influence of breast cancer on lipid profile parameters especially HDL-c and LDL-c, and possibly their putative clinical utility for early diagnosis in premenopausal women in Cameroon.展开更多
Introduction:The utilization of facility delivery is crucial to achieve sustainable development goals by reducing maternal and neonatal deaths.This study aimed to compare the distributions and determinants of childbir...Introduction:The utilization of facility delivery is crucial to achieve sustainable development goals by reducing maternal and neonatal deaths.This study aimed to compare the distributions and determinants of childbirth in health facilities in urban and rural regions of Bangladesh.Methods:Cross-sectional data from the 2017-2018 Bangladesh Demographic and Health Survey were analyzed.Multilevel logistic regression was applied.Results:A total of 4751 women were included in the analyses.Only 50%of childbirths took place in health facilities,63.4%and 44.6%in urban and rural regions,respectively.Overall,the odds of the association between facility delivery and the studied factors were similar.Multiparous women had significantly lower odds of facility delivery in both rural(adjusted odds ratio[AOR]=0.3,95%confidence interval[CI]:0.2 to 0.5)and urban(AOR=0.2,95%CI:0.1 to 0.5)regions.In both regions,women with higher education levels,highly educated husbands,antenatal care(ANC),and higher wealth indexes had significantly higher odds of facility delivery.Conclusion:Several common associated factors were identified.However,differences were observed regarding distributions of these factors.The differences in facility delivery utilization could result from lower ANC utilization,socioeconomic status,and transportation facilities in rural regions than urban regions;therefore,improving these conditions could increase facility delivery in these regions.展开更多
Antenatal care is a safe way to prevent pregnancy-related health problems, difficult deliveries and even further to anticipate low birth weight [1]. But pregnant women, especially in Africa, do not attend antenatal cl...Antenatal care is a safe way to prevent pregnancy-related health problems, difficult deliveries and even further to anticipate low birth weight [1]. But pregnant women, especially in Africa, do not attend antenatal clinics as recommended by the WHO. The general objective of this study was to study the norm in terms of Antenatal Consultation (ANC) frequency as well as the determinants of the frequency among women who gave birth in the maternity hospitals of Agbangnizoun. Our research was a cross-sectional, descriptive, retrospective and quantitative type, which was carried out among 335 women in Agbangnizoun, Benin from 1 February to 3 April 2020 (3 months), in order to find out the general or specific characteristics of women that we associate with the frequency of prenatal consultation. At the end of the study, we found that 60%, 68% and 15% of the surveyed population had received ANC in the first, second and third trimesters, respectively. Ethnicity, income level of spouses over the three trimesters as well as the level of their knowledge and overall practice of ANC are determinants of the frequency of prenatal consultation.展开更多
The study aimed at identifying the determinants of household’s choice of livelihood diversification strategies. The result of the study based on a total of 384 sample respondents selected using multistage sampling pr...The study aimed at identifying the determinants of household’s choice of livelihood diversification strategies. The result of the study based on a total of 384 sample respondents selected using multistage sampling procedures. Furthermore the study employed bivariate Probit econometric model to identify factors affecting household’s choice of livelihood diversification strategies. The result of the descriptive statistics showed that households in the study area were engaged in four types of combination of livelihood diversification strategies: on-farm only, on-farm plus off-farm, on-farm plus non-farm, and on-farm plus off-farm plus non-farm with their respective share of 34.9, 11.5, 47.9 and 5.7 percent respectively. The econometric model result showed that wealth, sex, education level, livestok holding, and training were negatively and significantly determined households choice of off-farm livelihood strategies;whereas past erosion hazard and distance to market were positively and significantly determined their choice of off-farm livelihood strategies. On the other hand, wealth, dependency ratio, past erosion hazard, market availability, yield loss/reduction due to drought, distance to credit source, distance to market, frequency of extension contact, and ICT ownership (Radio, TV and/or Mobile phone) positively determine household’s choice of non-farm livelihood strategies whereas access to irrigation and distance to credit negatively determined their choice of non-farm livelihood strategies.展开更多
Background: As one of the strategies to reduce infant morbidity and mortality, the World Health Organization recommends early initiation of exclusive breastfeeding and timely introduction of complementary feeding with...Background: As one of the strategies to reduce infant morbidity and mortality, the World Health Organization recommends early initiation of exclusive breastfeeding and timely introduction of complementary feeding with continued breastfeeding for up to two years or beyond. Although breastfeeding is a natural process, it is influenced by different socio-cultural factors, habits, standards, and behaviours. Rapid industrialization and changes in lifestyle have seen increasing numbers of women in the labour force, and associated poor Exclusive Breastfeeding practices among working mothers. The aim of this study was to identify the determinants of breastfeeding practices among working mothers in Solwezi District of Zambia. Methods: This was a cross-sectional comparative survey comparing determinants of breastfeeding practices among working mothers aged 15 - 49 years in urban and rural areas of Solwezi District. The study was carried out in the Under-five Clinics at Solwezi, Kimasala and Mushitala Urban Clinics, as well as St. Francis, Kapijimpanga and Kisalala Rural Health Centers. Eighty-seven participants were successfully recruited using convenience sampling. A researcher-assisted questionnaire was used to collect data. Data analysis was done using SPSS version 27.0. Descriptive statistical analysis was done using numerical measures such as measures of central tendency and dispersion. The Pearson Chi Square test, correlation and linear regression analysis were performed to test association between the variables at the 0.05 level of significance. Are you assessing exclusive breastfeeding alone or what? Results: The mean age of respondents was 27.44 years (SD = 6.042 years) and the majority of the respondents were married (71.3%, n = 62). Forty-three percent of the respondents were self-employed while the rest were in formal government or private sector employment. Overall, 97.7% of the respondents had heard of exclusive breastfeeding, with health facilities being the most frequent source of information (64.4%). Attitude towards exclusive breastfeeding was generally positive. Fifty-eight percent of respondents exclusively breastfed while the rest were on mixed feeding. Seventy-one percent of respondents reported that their workplaces did not have breastfeeding facilities at work. Only 11.5% of the respondents reported having cultural beliefs restricting breastfeeding. Statistically significant associations were obtained from cross-tabulation analysis between respondent’s occupation and baby feeding type (p 0.001);workload and feeding type (0.024);as well as knowledge of EBF and feeding type (p 0.001). Conclusion: Majority of the respondents demonstrated good knowledge and positive attitude towards exclusive breastfeeding. This study recommends sensitization campaigns in communities to raise awareness about the importance of breastfeeding, and foster behaviour change that promotes breastfeeding.展开更多
Introduction: Pregnancy is a physiological condition that can sometimes end in death. The death of a woman is a constant concern for the obstetrician and is considered a major public health problem in our developing c...Introduction: Pregnancy is a physiological condition that can sometimes end in death. The death of a woman is a constant concern for the obstetrician and is considered a major public health problem in our developing countries. Objective: To identify the determinants that contribute to maternal morbidity and mortality in the Gynaecology and Obstetrics Department of the University Community Hospital. Methodology: We conducted a retrospective study from 1 January 2015 to 31 December 2019 (5 years) in the obstetrics and gynaecology department of the Centre Hospitalier Universitaire Communautaire (CHUC). It focused on the determinants of maternal mortality. Our study population consisted of all women who died during the period and met the World Health Organization (WHO) definition of maternal mortality (MOMA). We used non-probability sampling with the exhaustive choice technique. Results: The study revealed that the number of deaths recorded was 98, while 17,172 live births were registered during the same period. The maternal mortality ratio was 570 per 100,000 live births. The most common age group was 20 to 24, with an average age of 26. The frequency of death among primiparous women was 37.74%, pauciparous women 28.30% and multiparous women 26.42%. Direct causes were dominated by abortion complications (22.41%), followed by infections (9.30%) and haemorrhage (8.19%). Indirect causes were dominated by anaemia with a proportion of 45.16%. The majority of maternal deaths occurred in the post-partum period (34.71%). Most maternal deaths occurred after vaginal delivery, 19 cases (63.33%), while 11 deaths (36.66%) occurred after caesarean section. The occurrence of direct causes was associated with age less than or equal to 25 years, abortion complications and primiparity, with a statistically significant difference. Conclusion: At the end of this study, complications of unsafe abortion and poverty are all factors contributing to the rise in the maternal mortality rate. Emphasis should be placed on promoting family planning, as this would make a major contribution to reducing maternal mortality.展开更多
It is remarkable that studying degenerate versions of polynomials from algebraic point of view is not limited to only special polynomials but can also be extended to their hybrid polynomials.Indeed for the first time,...It is remarkable that studying degenerate versions of polynomials from algebraic point of view is not limited to only special polynomials but can also be extended to their hybrid polynomials.Indeed for the first time,a closed determinant expression for the degenerate Appell polynomials is derived.The determinant forms for the degenerate Bernoulli and Euler polynomials are also investigated.A new class of the degenerate Hermite-Appell polynomials is investigated and some novel identities for these polynomials are established.The degenerate Hermite-Bernoulli and degenerate Hermite-Euler polynomials are considered as special cases of the degenerate Hermite-Appell polynomials.Further,by using Mathematica,we draw graphs of degenerate Hermite-Bernoulli polynomials for different values of indices.The zeros of these polynomials are also explored and their distribution is presented.展开更多
Investigating the spatiotemporal variation of human activity intensity and its determinants is a crucial basis for further revealing the mechanism of human-environment interaction and optimizing the human development ...Investigating the spatiotemporal variation of human activity intensity and its determinants is a crucial basis for further revealing the mechanism of human-environment interaction and optimizing the human development mode.In this study,the human activity intensity on the Qinghai-Tibet Plateau(QTP)from 1990 to 2020 was measured based on the quantitative model of land use data and the actual regional background,and the under-lying natural and socioeconomic determinants were investigated using spatial econometric methods.The results demonstrate that(1)the human activity intensity in QTP has increased by 11.96%,and there are differences in different spatial scales;the areas with high human activity intensity are distributed in the Hehuang Valley where Xining City and its surrounding areas are located,as well as the One-River and Two-River Area where Lhasa City and surrounding areas are located.(2)Human activity intensity has significant positive spatial spillover,suggesting that local changes will cause changes in the same direction in adjacent areas.(3)The human activ-ity intensity in QTP is affected by various determinants.Concerning socioeconomic factors,the economic level has no significant impact on the human activity intensity in QTP,which differs from the general regional law.Both urbanization and traffic conditions have a significant positive effect,and the impact intensity continues to increase.Concerning natural factors,topographic relief has a significant positive effect;the impacts of temper-ature and vegetation coverage have changed from insignificant to a significant positive effect;the impacts of precipitation and river network density have not been verified;there is no linear relationship between altitude and human activity intensity in the entire QTP,while it exists in local regions.Finally,this study proposes three policy implications for the realization of a more harmonious human-environment relationship in QTP.展开更多
Background: The onset of the hearing loss is a major challenge during the treatment of multidrug-resistant tuberculosis (MDR-TB). Aminoglycoside-based regimens, to a lesser extent based on bedaquiline, induce ototoxic...Background: The onset of the hearing loss is a major challenge during the treatment of multidrug-resistant tuberculosis (MDR-TB). Aminoglycoside-based regimens, to a lesser extent based on bedaquiline, induce ototoxic sensorineural hearing loss. Research on risk factors is essential to enable high-risk individuals to benefit from preventive measures in settings with limited resources. Objective: This study aimed to assess the determinants of the hearing loss in patients with MDR-TB. Methods: This prospective multicenter cohort study included 337 patients with MDR-TB. It was performed in Kinshasa (Democratic Republic of the Congo) between January 2020 and January 2021. Sociodemographic, clinical, biological, therapeutic, and audiometric data were exported and analyzed using Stata 17 and MedCalc. The fixed-effect linear regression panel model was used to assess the degree of the hearing loss over time according to the following covariates: therapeutic regimen (aminoglycosides, bedaquiline, or alternate), stage of chronic kidney disease (CKD), age at inclusion, body mass index, serum albumin level, HIV status, alcohol intake, hypertension, and hemoglobin level. The Hausman test was used to select between fixed- and random-effect estimators. The threshold for statistical significance was set at p Result: A total of 236 patients (70%) received an aminoglycoside-based regimen, 61 (18%) received a bedaquiline-based regimen, and 40 (12%) received aminoglycosides relayed by bedaquiline. The frequency of the hearing loss increased from 62% to 96.3% within six months for all therapeutic regimens. The Hearing loss worsened, with moderate (72.4%) and profound (16%) deafness being predominant. An Exposure to the treatment for more than one month (β coeff: 27.695, Se: 0.793, p β coeff: 6.102, Se: 1.779, p β coeff: 5.610, Se: 1.682, p = 0.001), and an eGFR β coeff: 6.730, Se: 2.70, p = 0.013) were the independent risk factors associated with the hearing loss in patients with MDR-TB. Conclusions: The Hearing loss was more prevalent and worsened during the treatment of the patients with MDR-TB. An Exposure for more than one month, AG-based regimens, advanced age, hypoalbuminemia, and CKD have emerged as the main determinants of the worsening of the hearing loss.展开更多
Reproduction via cis-binary mechanisms appears to have evolved fairly early in the evolution of complex organisms, and a system committed to prior to evolution of humans. While the evolution of a chromosomal-specific ...Reproduction via cis-binary mechanisms appears to have evolved fairly early in the evolution of complex organisms, and a system committed to prior to evolution of humans. While the evolution of a chromosomal-specific approach has been a successful strategy for survival of a large variety of species including humans, the fidelity of sex determination leading to 100% cis-binary outcomes is not achieved in many species, with evidence for homosexual or bisexual behaviour evident in more than 1500 species. Thus, such outcomes indicates that sex determination is a multi-step process and not a single event, and as such, could lead to the appearance of variants during the process which developed much earlier than humans. Variants could arise either due to intrinsic variation in the steps of determination, or also be influenced by environmental factors of a biological or psychological nature. In contrast to homosexual variants which do not require interventions such as hormone therapy or surgery, expression of gender dysphoria, is more based in psychology, but also has biological underpinnings and can be influenced by such hormonal interventions and surgery. While the numbers of those with gender dysphoria is small (~0.6% - 1.0% of population), the attention given to this issue raises the possibility of biological and psychological environmental factors impacting the emergence of some of those expressing gender dysphoria. Furthermore, transitioning from male-to-female or female-to-male can have consequences regarding disease risks latter in life, including the appearance of autoimmune diseases. This review will attempt to review some of the evidence regarding sex determination, discuss why the system has potentially not been improved upon during evolution, how a potential role for sex chromosome function on neurodevelopment may be central to variation in humans, and how commitment to the current strategy is likely integrated into other sex-related events such as puberty, pregnancy, and menopause to ensure species survival. It will also discuss how variants in sex determination could contribute to sex differences in disease risk and how epigenetic modifications could play a role in such risk. .展开更多
Intercropping involves the cultivation of more than one crop on a plot of land at a particular time.Tea intercropping with other crops can increase the profitability of farmers and the development of tea plants.The st...Intercropping involves the cultivation of more than one crop on a plot of land at a particular time.Tea intercropping with other crops can increase the profitability of farmers and the development of tea plants.The study estimated the profitability level of intercropped tea farms and determined the factors affecting the profitability of tea intercropping systems in the study area.Information was obtained from two hundred and four tea farmers using a well-structured questionnaire.The analytical techniques used in the study were descriptive analysis and linear regression.The results revealed that the majority(95.6%)of the farmers are from Kakara and Nyiwa towns.There are few(2.9%)women involved in tea farming in Taraba State.29%of the tea farmers are young less than 30 years and old above 60 years.Fifteen percent of the farmers are single,83.8%are married and 1.5%are divorced.About 40%of the tea farmers had no formal education,21%have between 1-6 years of education,19%had 7-12 years of education and 21%had greater than 12 years of education.The gross margin is N289,900,581.9 and the gross margin per farmer is N1,421,081.28.The net income is N2,879,055,533.3 and the net income per farmer is N1,411,301.63.The amount of profit tea farmers make in Taraba State is N1,425,001 and the profit per farmer is N6,985.30.Labour costs(weeding,pruning,application of insecticide,watering)and cost of materials(cutlass,file,chemical,bag and others)are significant determinants of the profit level of the tea intercropping system in Taraba State.Tea intercropping farming is profitable in Taraba State Nigeria.展开更多
Food security issues become one of the critical concerns and top priority areas for Ethiopia.This study analyzed rural households’food security status and its determinants in Minjar Shenkora woreda of Amhara Regional...Food security issues become one of the critical concerns and top priority areas for Ethiopia.This study analyzed rural households’food security status and its determinants in Minjar Shenkora woreda of Amhara Regional State and Ada’a woreda of Oromia Regional State.Data were collected from 240 randomly selected rural farm households.The study employed both descriptive statistics and a binary logistic regression model to estimate the status and determinants of households’food security,respectively.The findings indicated that the average dietary energy available for food secured households was 2,860.6 kilo calorie per day while 1,891.7 kilo calorie per day for the insecure group.According to the findings of the binary logit model,factors such as education level,farm size,livestock ownership,cooperatives membership,off-farm income and credit access have positive and significant effects on household food security.While household size has a negative and significant effect on household food security.The results recommend that interventions should target at improving rural financial services and off-farm activities that increase households’income and focusing on those most significant variables when attempting to enhance household food security.展开更多
文摘This study examined the non-medical factors that influence expectant mothers to opt for caesarean deliveries in Ghana. Data on 395 expectant mothers across the ten regions of Ghana who were located in urban, semi-rural and rural areas, and spanned a period of five years (from 2012 to 2016) were obtained from the Ghana Health Service. In fitting the logistic regression model, data on 355 expectant mothers (i.e. 89.9% of the data) was assigned to the analysis sample while 40 (i.e. 10.1%) was assigned to the hold-out sample. The hold-out sample together with other statistical measures of overall model fit, pseudo R2 measures and classification accuracy were used to validate the results obtained from the analysis sample. Significance was tested at p = 0.05. Determinants including, educational level of expectant mother, parity of expectant mother, baby’s birth weight, previous caesarean delivery, location of expectant mother, age of expectant mother and, period within the year of childbirth had a significant effect on caesarean delivery. The study recommended that health practitioners should be able to foretell expectant mothers who are likely to undergo caesarean delivery in order for them to prepare financially and psychologically to avoid further complications. Due to the significant positive attitude of women towards caesarean delivery rather than normal delivery, it is necessary to inform them about the advantages of normal delivery and the health hazards associated with caesarean delivery to the mother and child.
文摘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.
文摘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.
文摘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.
文摘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.
基金This study is supported by K23HL15180(NIH/NHLBI,Steiner)a grant from the American College of Cardiology Foundation.
文摘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.
文摘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.
文摘Understanding why individuals do or do not adopt optimal water, sanitation, and hygiene (WASH) practices is critical to designing successful behavior change interventions. However, policy makers and program implementers often fail to obtain the context-specific information on behavioral determinants of WASH practices. This two-stage, randomized survey among 5000 female primary caregivers in the Lake Zone of Tanzania assessed associations between behavioral determinants and a range of hygiene and sanitation practices. Behavioral determinants of hygiene were almost always significantly associated with cleaning one’s own hands after cleaning the baby’s bottom and being able to show at least one place where family members wash their hands. In regression models, those who knew when to wash their own hands (OR = 1.8, 95% CI: 1.5, 2.1) and their child’s hands (OR = 1.5, 95% CI: 1.3, 1.7) and mothers who thought that their female friends washed their hands after cleaning the baby’s bottom (OR = 5.5, 95% CI: 4.5, 6.7) were significantly more likely to frequently clean their own hands after cleaning the baby’s bottom. This research suggests that in the Lake Zone of Tanzania, numerous determinants are associated with hygiene practices. Identifying context-specific determinants of WASH behaviors is the first step toward developing effective interventions.
文摘Objective: Breast cancer in women of childbearing age (WCBA) is a major public health concern. This study aimed to determine variation and determinants in lipid profile among Cameroonian WCBA diagnosed with breast cancer. Materials and Methods: A case-control study took place at two reference hospitals in Douala, Cameroon. A total of 176 WCBA (88 cases and 88 controls) were finally enrolled. Interviewer-administered questionnaires were used to collect sociodemographic, behavioural, clinical and anthropometric data. Three millilitres of venous blood were collected for analysis of total cholesterol (TC), high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c) and triglycerides (TG). Results: Overweight was predominantly seen in cases and controls. Serum levels of TC and LDL-c were significantly lower in cancer women (167.02 ± 45.46 vs 183.12 ± 27.38 mg/dL, p = 0.005 for TC;85.83 ± 40.34 vs 105.25 ± 29.95 mg/dL, p = 0.0004 for LDL-c), while HDL-c levels were higher in controls (45.09 ± 7.20 vs 38.24 ± 11.14 mg/dL, p Conclusion: This study suggests the influence of breast cancer on lipid profile parameters especially HDL-c and LDL-c, and possibly their putative clinical utility for early diagnosis in premenopausal women in Cameroon.
文摘Introduction:The utilization of facility delivery is crucial to achieve sustainable development goals by reducing maternal and neonatal deaths.This study aimed to compare the distributions and determinants of childbirth in health facilities in urban and rural regions of Bangladesh.Methods:Cross-sectional data from the 2017-2018 Bangladesh Demographic and Health Survey were analyzed.Multilevel logistic regression was applied.Results:A total of 4751 women were included in the analyses.Only 50%of childbirths took place in health facilities,63.4%and 44.6%in urban and rural regions,respectively.Overall,the odds of the association between facility delivery and the studied factors were similar.Multiparous women had significantly lower odds of facility delivery in both rural(adjusted odds ratio[AOR]=0.3,95%confidence interval[CI]:0.2 to 0.5)and urban(AOR=0.2,95%CI:0.1 to 0.5)regions.In both regions,women with higher education levels,highly educated husbands,antenatal care(ANC),and higher wealth indexes had significantly higher odds of facility delivery.Conclusion:Several common associated factors were identified.However,differences were observed regarding distributions of these factors.The differences in facility delivery utilization could result from lower ANC utilization,socioeconomic status,and transportation facilities in rural regions than urban regions;therefore,improving these conditions could increase facility delivery in these regions.
文摘Antenatal care is a safe way to prevent pregnancy-related health problems, difficult deliveries and even further to anticipate low birth weight [1]. But pregnant women, especially in Africa, do not attend antenatal clinics as recommended by the WHO. The general objective of this study was to study the norm in terms of Antenatal Consultation (ANC) frequency as well as the determinants of the frequency among women who gave birth in the maternity hospitals of Agbangnizoun. Our research was a cross-sectional, descriptive, retrospective and quantitative type, which was carried out among 335 women in Agbangnizoun, Benin from 1 February to 3 April 2020 (3 months), in order to find out the general or specific characteristics of women that we associate with the frequency of prenatal consultation. At the end of the study, we found that 60%, 68% and 15% of the surveyed population had received ANC in the first, second and third trimesters, respectively. Ethnicity, income level of spouses over the three trimesters as well as the level of their knowledge and overall practice of ANC are determinants of the frequency of prenatal consultation.
文摘The study aimed at identifying the determinants of household’s choice of livelihood diversification strategies. The result of the study based on a total of 384 sample respondents selected using multistage sampling procedures. Furthermore the study employed bivariate Probit econometric model to identify factors affecting household’s choice of livelihood diversification strategies. The result of the descriptive statistics showed that households in the study area were engaged in four types of combination of livelihood diversification strategies: on-farm only, on-farm plus off-farm, on-farm plus non-farm, and on-farm plus off-farm plus non-farm with their respective share of 34.9, 11.5, 47.9 and 5.7 percent respectively. The econometric model result showed that wealth, sex, education level, livestok holding, and training were negatively and significantly determined households choice of off-farm livelihood strategies;whereas past erosion hazard and distance to market were positively and significantly determined their choice of off-farm livelihood strategies. On the other hand, wealth, dependency ratio, past erosion hazard, market availability, yield loss/reduction due to drought, distance to credit source, distance to market, frequency of extension contact, and ICT ownership (Radio, TV and/or Mobile phone) positively determine household’s choice of non-farm livelihood strategies whereas access to irrigation and distance to credit negatively determined their choice of non-farm livelihood strategies.
文摘Background: As one of the strategies to reduce infant morbidity and mortality, the World Health Organization recommends early initiation of exclusive breastfeeding and timely introduction of complementary feeding with continued breastfeeding for up to two years or beyond. Although breastfeeding is a natural process, it is influenced by different socio-cultural factors, habits, standards, and behaviours. Rapid industrialization and changes in lifestyle have seen increasing numbers of women in the labour force, and associated poor Exclusive Breastfeeding practices among working mothers. The aim of this study was to identify the determinants of breastfeeding practices among working mothers in Solwezi District of Zambia. Methods: This was a cross-sectional comparative survey comparing determinants of breastfeeding practices among working mothers aged 15 - 49 years in urban and rural areas of Solwezi District. The study was carried out in the Under-five Clinics at Solwezi, Kimasala and Mushitala Urban Clinics, as well as St. Francis, Kapijimpanga and Kisalala Rural Health Centers. Eighty-seven participants were successfully recruited using convenience sampling. A researcher-assisted questionnaire was used to collect data. Data analysis was done using SPSS version 27.0. Descriptive statistical analysis was done using numerical measures such as measures of central tendency and dispersion. The Pearson Chi Square test, correlation and linear regression analysis were performed to test association between the variables at the 0.05 level of significance. Are you assessing exclusive breastfeeding alone or what? Results: The mean age of respondents was 27.44 years (SD = 6.042 years) and the majority of the respondents were married (71.3%, n = 62). Forty-three percent of the respondents were self-employed while the rest were in formal government or private sector employment. Overall, 97.7% of the respondents had heard of exclusive breastfeeding, with health facilities being the most frequent source of information (64.4%). Attitude towards exclusive breastfeeding was generally positive. Fifty-eight percent of respondents exclusively breastfed while the rest were on mixed feeding. Seventy-one percent of respondents reported that their workplaces did not have breastfeeding facilities at work. Only 11.5% of the respondents reported having cultural beliefs restricting breastfeeding. Statistically significant associations were obtained from cross-tabulation analysis between respondent’s occupation and baby feeding type (p 0.001);workload and feeding type (0.024);as well as knowledge of EBF and feeding type (p 0.001). Conclusion: Majority of the respondents demonstrated good knowledge and positive attitude towards exclusive breastfeeding. This study recommends sensitization campaigns in communities to raise awareness about the importance of breastfeeding, and foster behaviour change that promotes breastfeeding.
文摘Introduction: Pregnancy is a physiological condition that can sometimes end in death. The death of a woman is a constant concern for the obstetrician and is considered a major public health problem in our developing countries. Objective: To identify the determinants that contribute to maternal morbidity and mortality in the Gynaecology and Obstetrics Department of the University Community Hospital. Methodology: We conducted a retrospective study from 1 January 2015 to 31 December 2019 (5 years) in the obstetrics and gynaecology department of the Centre Hospitalier Universitaire Communautaire (CHUC). It focused on the determinants of maternal mortality. Our study population consisted of all women who died during the period and met the World Health Organization (WHO) definition of maternal mortality (MOMA). We used non-probability sampling with the exhaustive choice technique. Results: The study revealed that the number of deaths recorded was 98, while 17,172 live births were registered during the same period. The maternal mortality ratio was 570 per 100,000 live births. The most common age group was 20 to 24, with an average age of 26. The frequency of death among primiparous women was 37.74%, pauciparous women 28.30% and multiparous women 26.42%. Direct causes were dominated by abortion complications (22.41%), followed by infections (9.30%) and haemorrhage (8.19%). Indirect causes were dominated by anaemia with a proportion of 45.16%. The majority of maternal deaths occurred in the post-partum period (34.71%). Most maternal deaths occurred after vaginal delivery, 19 cases (63.33%), while 11 deaths (36.66%) occurred after caesarean section. The occurrence of direct causes was associated with age less than or equal to 25 years, abortion complications and primiparity, with a statistically significant difference. Conclusion: At the end of this study, complications of unsafe abortion and poverty are all factors contributing to the rise in the maternal mortality rate. Emphasis should be placed on promoting family planning, as this would make a major contribution to reducing maternal mortality.
文摘It is remarkable that studying degenerate versions of polynomials from algebraic point of view is not limited to only special polynomials but can also be extended to their hybrid polynomials.Indeed for the first time,a closed determinant expression for the degenerate Appell polynomials is derived.The determinant forms for the degenerate Bernoulli and Euler polynomials are also investigated.A new class of the degenerate Hermite-Appell polynomials is investigated and some novel identities for these polynomials are established.The degenerate Hermite-Bernoulli and degenerate Hermite-Euler polynomials are considered as special cases of the degenerate Hermite-Appell polynomials.Further,by using Mathematica,we draw graphs of degenerate Hermite-Bernoulli polynomials for different values of indices.The zeros of these polynomials are also explored and their distribution is presented.
基金the National Natural Sci-ence Foundation of China(Grant No.42001139)the Second Ti-betan Plateau Scientific Expedition and Research Program(Grant No.2019QZKK0406)+1 种基金the National Natural Science Foundation of China(Grant No.42230510)the China Postdoctoral Science Foundation(Grant No.2020M670472).
文摘Investigating the spatiotemporal variation of human activity intensity and its determinants is a crucial basis for further revealing the mechanism of human-environment interaction and optimizing the human development mode.In this study,the human activity intensity on the Qinghai-Tibet Plateau(QTP)from 1990 to 2020 was measured based on the quantitative model of land use data and the actual regional background,and the under-lying natural and socioeconomic determinants were investigated using spatial econometric methods.The results demonstrate that(1)the human activity intensity in QTP has increased by 11.96%,and there are differences in different spatial scales;the areas with high human activity intensity are distributed in the Hehuang Valley where Xining City and its surrounding areas are located,as well as the One-River and Two-River Area where Lhasa City and surrounding areas are located.(2)Human activity intensity has significant positive spatial spillover,suggesting that local changes will cause changes in the same direction in adjacent areas.(3)The human activ-ity intensity in QTP is affected by various determinants.Concerning socioeconomic factors,the economic level has no significant impact on the human activity intensity in QTP,which differs from the general regional law.Both urbanization and traffic conditions have a significant positive effect,and the impact intensity continues to increase.Concerning natural factors,topographic relief has a significant positive effect;the impacts of temper-ature and vegetation coverage have changed from insignificant to a significant positive effect;the impacts of precipitation and river network density have not been verified;there is no linear relationship between altitude and human activity intensity in the entire QTP,while it exists in local regions.Finally,this study proposes three policy implications for the realization of a more harmonious human-environment relationship in QTP.
文摘Background: The onset of the hearing loss is a major challenge during the treatment of multidrug-resistant tuberculosis (MDR-TB). Aminoglycoside-based regimens, to a lesser extent based on bedaquiline, induce ototoxic sensorineural hearing loss. Research on risk factors is essential to enable high-risk individuals to benefit from preventive measures in settings with limited resources. Objective: This study aimed to assess the determinants of the hearing loss in patients with MDR-TB. Methods: This prospective multicenter cohort study included 337 patients with MDR-TB. It was performed in Kinshasa (Democratic Republic of the Congo) between January 2020 and January 2021. Sociodemographic, clinical, biological, therapeutic, and audiometric data were exported and analyzed using Stata 17 and MedCalc. The fixed-effect linear regression panel model was used to assess the degree of the hearing loss over time according to the following covariates: therapeutic regimen (aminoglycosides, bedaquiline, or alternate), stage of chronic kidney disease (CKD), age at inclusion, body mass index, serum albumin level, HIV status, alcohol intake, hypertension, and hemoglobin level. The Hausman test was used to select between fixed- and random-effect estimators. The threshold for statistical significance was set at p Result: A total of 236 patients (70%) received an aminoglycoside-based regimen, 61 (18%) received a bedaquiline-based regimen, and 40 (12%) received aminoglycosides relayed by bedaquiline. The frequency of the hearing loss increased from 62% to 96.3% within six months for all therapeutic regimens. The Hearing loss worsened, with moderate (72.4%) and profound (16%) deafness being predominant. An Exposure to the treatment for more than one month (β coeff: 27.695, Se: 0.793, p β coeff: 6.102, Se: 1.779, p β coeff: 5.610, Se: 1.682, p = 0.001), and an eGFR β coeff: 6.730, Se: 2.70, p = 0.013) were the independent risk factors associated with the hearing loss in patients with MDR-TB. Conclusions: The Hearing loss was more prevalent and worsened during the treatment of the patients with MDR-TB. An Exposure for more than one month, AG-based regimens, advanced age, hypoalbuminemia, and CKD have emerged as the main determinants of the worsening of the hearing loss.
文摘Reproduction via cis-binary mechanisms appears to have evolved fairly early in the evolution of complex organisms, and a system committed to prior to evolution of humans. While the evolution of a chromosomal-specific approach has been a successful strategy for survival of a large variety of species including humans, the fidelity of sex determination leading to 100% cis-binary outcomes is not achieved in many species, with evidence for homosexual or bisexual behaviour evident in more than 1500 species. Thus, such outcomes indicates that sex determination is a multi-step process and not a single event, and as such, could lead to the appearance of variants during the process which developed much earlier than humans. Variants could arise either due to intrinsic variation in the steps of determination, or also be influenced by environmental factors of a biological or psychological nature. In contrast to homosexual variants which do not require interventions such as hormone therapy or surgery, expression of gender dysphoria, is more based in psychology, but also has biological underpinnings and can be influenced by such hormonal interventions and surgery. While the numbers of those with gender dysphoria is small (~0.6% - 1.0% of population), the attention given to this issue raises the possibility of biological and psychological environmental factors impacting the emergence of some of those expressing gender dysphoria. Furthermore, transitioning from male-to-female or female-to-male can have consequences regarding disease risks latter in life, including the appearance of autoimmune diseases. This review will attempt to review some of the evidence regarding sex determination, discuss why the system has potentially not been improved upon during evolution, how a potential role for sex chromosome function on neurodevelopment may be central to variation in humans, and how commitment to the current strategy is likely integrated into other sex-related events such as puberty, pregnancy, and menopause to ensure species survival. It will also discuss how variants in sex determination could contribute to sex differences in disease risk and how epigenetic modifications could play a role in such risk. .
文摘Intercropping involves the cultivation of more than one crop on a plot of land at a particular time.Tea intercropping with other crops can increase the profitability of farmers and the development of tea plants.The study estimated the profitability level of intercropped tea farms and determined the factors affecting the profitability of tea intercropping systems in the study area.Information was obtained from two hundred and four tea farmers using a well-structured questionnaire.The analytical techniques used in the study were descriptive analysis and linear regression.The results revealed that the majority(95.6%)of the farmers are from Kakara and Nyiwa towns.There are few(2.9%)women involved in tea farming in Taraba State.29%of the tea farmers are young less than 30 years and old above 60 years.Fifteen percent of the farmers are single,83.8%are married and 1.5%are divorced.About 40%of the tea farmers had no formal education,21%have between 1-6 years of education,19%had 7-12 years of education and 21%had greater than 12 years of education.The gross margin is N289,900,581.9 and the gross margin per farmer is N1,421,081.28.The net income is N2,879,055,533.3 and the net income per farmer is N1,411,301.63.The amount of profit tea farmers make in Taraba State is N1,425,001 and the profit per farmer is N6,985.30.Labour costs(weeding,pruning,application of insecticide,watering)and cost of materials(cutlass,file,chemical,bag and others)are significant determinants of the profit level of the tea intercropping system in Taraba State.Tea intercropping farming is profitable in Taraba State Nigeria.
文摘Food security issues become one of the critical concerns and top priority areas for Ethiopia.This study analyzed rural households’food security status and its determinants in Minjar Shenkora woreda of Amhara Regional State and Ada’a woreda of Oromia Regional State.Data were collected from 240 randomly selected rural farm households.The study employed both descriptive statistics and a binary logistic regression model to estimate the status and determinants of households’food security,respectively.The findings indicated that the average dietary energy available for food secured households was 2,860.6 kilo calorie per day while 1,891.7 kilo calorie per day for the insecure group.According to the findings of the binary logit model,factors such as education level,farm size,livestock ownership,cooperatives membership,off-farm income and credit access have positive and significant effects on household food security.While household size has a negative and significant effect on household food security.The results recommend that interventions should target at improving rural financial services and off-farm activities that increase households’income and focusing on those most significant variables when attempting to enhance household food security.