Abstract
Assess Child Vaccination Dropout and Related Factors in CORE Group Polio Project (CGPP) Etiopia Implementation areas
Legesse Bezabih1, Filimona Bisrat, MPH1 and Tenager Jemberi2
(1)CORE Group Polio Project, Addis Ababa, Ethiopia, (2)CORE Group Polio Project Ethiopia, Addis Ababa, Addis Ababa, Ethiopia
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction: Vaccine preventable diseases are among the major causes of under five children morbidity and mortality in Ethiopia. Immunization is the most cost effective intervention to reduce child morbidity and mortality. The national routine EPI recommends an infant to get one dose BCG; three doses of DPT-HepB-Hib; at least three doses of OPV three doses of PCV; two doses of Rota virus vaccine and one dose measles vaccine.
Objectives: to assess vaccination dropout rates and identify factors for vaccination dropout among children aged 12-23 months in CORE Group Polio Project implementation areas.
Methods: A cross-sectional descriptive survey with 30 by 10 modified WHO EPI cluster sampling technique was used. The study population was all children between 12-23 months of age and their mothers/caretakers. Standardized structured questionnaire with fixed response categories was used.
Results: A total of 577 children and mother pairs were included in the study. Majority of study subjects were rural residents, 94.63%; Islam in religion 51.3%; and illiterate 67.9%. The child vaccination dropout rate for Penta 1 - Penta 3 was 2.8% and Penta 1 - Measles was 3.6%. The dropout rate among children of rural mothers was 3.3% for Penta1- Penta3 and 6.2% for Penta1 - measles which was higher than urban mothers. The dropout rate among children of mothers who follow traditional religion was 10% for Penta1- Penta3 and 30% for Penta1 - measles which was higher than other religion followers. The dropout rate among children of mothers who attended formal education (grade 1- 4) was 7.7% for Penta1- Penta3 and 15.4% Penta1 - Measles which was higher than other study groups.
Recommendation: Strong interpersonal communication between mothers and service providers; proper recording on vaccination cards and registration books; education of mothers on the importance of card retention and completion of all vaccination doses.
Program planning
Abstract
Medicine sellers' practices related to childhood diarrhea treatment: Mystery client survey results from Ghana and Nigeria
Kathryn Banke, Ph.D. and Phoebe Sloane, MA
Abt Associates Inc., Bethesda, MD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Purpose: The World Health Organization (WHO) and UNICEF recommend low-osmolarity oral rehydration solution (ORS) plus zinc as the first line treatment for acute childhood diarrhea. Antibiotics and antidiarrheals are inappropriate in most cases, but are often still prescribed. The Strengthening Health Outcomes through the Private Sector (SHOPS) project trained medicine sellers and pharmacists in Ghana and Nigeria on correct diarrhea management and diagnosis and prescribing practices, then monitored their actual prescribing behaviors.
Data and Methods: We used mystery client surveys to assess prescribing behaviors of 372 medicine sellers in Ghana and 450 in Nigeria after SHOPS training. Following a script, trained interviewers played the role of parents of a child with acute diarrhea and recorded details from their interactions with sellers on a checklist after the visit.
Results: In both countries, sellers engaged in minimal diagnostic questioning; few inquired about signs of dehydration or blood or mucus in the stools. The most commonly recommended treatments in Ghana were zinc (60 percent) and ORS (59 percent). In Nigeria, 71 percent recommended antibiotics, 48 percent ORS, 38 percent antidiarrheals, and 30 percent zinc. Only 62 percent of zinc prescribers in Ghana and 48 percent in Nigeria explained the importance of completing a10 day course; 64 percent in Ghana and 42 percent in Nigeria prescribed the correct dosage.
Recommendations/policy implications: Even after training, a substantial proportion of medicine sellers in both countries require follow-up support to reduce the incorrect prescription of antibiotics and antidiarrheals and increase correct provision of ORS and zinc.
Public health or related research
Abstract
Assessing the Complex System of Casual Factors to Child Stunting in the Department of Escuintla, Guatemala
Lee Voth-Gaeddert, MS, EIT and Daniel Oerther, PhD, PE, BCEE, D.AAS, F.AAN, F.RSPH
Missouri University of Science and Technology, Rolla, MO
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Low height-for-age, or stunting, is a critical public health indicator and is associated with negative long term outcomes including physical limitations, retarded cognitive development, and increased susceptibility to diseases and premature mortality. The World Health Organization has reported enteric infections and nutrition as the two primary factors contributing to child stunting. Guatemala reports a child stunting rate 5th worst in the world, at 49% of all children under the age of five stunted. The purpose of this work is to rank order causal factors to child stunting in Escuintla, Guatemala. In this study factors such as feeding practices, prenatal health, and baby wearing were incorporated into a model focused on the following hypotheses; 1) mycotoxin exposure is associated with enteric infections, 2) enteric infections are associated with child stunting, and 3) mycotoxin exposure is associated with child stunting. Two types data sets were utilized in the assessment; secondary data from other organizations and a geographically tailored survey administered to 50 mothers with children less than five years. System dynamics modeling, structural equation modeling, and machine learning algorithms were utilized in the statistical analysis. Preliminary results show that the outcome variable, child stunting, crossed an inflection point in 2014, where the increase in the annual number of children stunted is now slowing. However, chronic exposure to bacterial pathogens and helminths, poor child feeding practices, and high mycotoxin exposure continue to deter significant improvements to child stunting rates. A longitudinal panel study is now underway to investigate direct and indirect effects.
Biostatistics, economics Social and behavioral sciences Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Pilot feasibility of dietary heat-stabilized rice bran supplementation in Nicaraguan and Malian children
Erica Borresen, MPH1, Sylvia Becker-Dreps, MD, MPH, Lijuan Yuan, PhD, Luis Enrique Zambrana, Johann Perez, Abdoulaye Bore, Alima Cissoko, Ababacar Maiga, Lassina Doumbia, Samuel Vilchez, PhD, Ousmane Koita and Elizabeth Ryan, PhD1
(1)Colorado State University, Fort Collins, CO
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Rice remains an important cereal crop as it supplies nearly half of the caloric intake of humanity. Rice bran, the agricultural byproduct, is a globally accessible, underutilized food ingredient that merits development for human consumption in many regions of the world suffering from food insecurity, malnutrition, and environmental enteric dysfunction (EED). Our studies in animal models support that dietary rice bran reduces enteric pathogen induced diarrhea; though the tolerance of heat-stabilized rice bran supplementation in weaning children with susceptibility to diarrhea infections was unknown. Our main objectives were to 1) determine whether rice bran consumption is acceptable and palatable to weaning children living in Nicaragua and Mali (NCT02615886 and NCT02557373) and 2) determine changes in gut markers of EED compared to control. A 6-month randomized-controlled dietary intervention was completed in Nicaragua and Mali. Heat-stabilized RB was given to weaning infants aged six months starting at 1 gram/day and increasing up to 5 grams/day by twelve months of age. Control group participants received no intervention in Nicaragua or a Vitamin A supplement in Mali. Blood and stool samples were collected, along with any diarrhea that occurred during the intervention. Providing rice bran daily for consumption was safe and palatable for 6-12 month-old infants with nearly 100% compliance. EED biomarkers (C-reactive protein, Alpha-1 Acid Glycoprotein, Glucagon-Like Peptides, Neopterin, Myeloperoxidase, Calprotectin, Alpha-1 Antitrypsin, Iron, and Zinc) are being analyzed over time in control and rice bran groups. This untapped food source has tremendous global public health opportunities to supply essential nutrients and develop a healthy gastrointestinal tract.
Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs
Abstract
Maternal education as a determinant of ORS use during under-five diarrhea episode in Nigeria: Findings from the 2013 Nigeria Demographic and Health Survey
Ucheoma Nwaozuru, MS1, Sarah Blackstone, MPH2 and Juliet Iwelunmor, PhD3
(1)University of Illinois Urbana Champaign, Champaign, IL, (2)University of Illnois at Urbana-Champaign, Champaign, IL, (3)University of Illinois at Urbana Chamapaign, Champaign, IL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: In Nigeria, an estimated 150,000 children under the age of five die each year as a result of diarrhea. Majority of these deaths can be prevented by the prompt use of oral rehydration solution (ORS) and immediate medical attention. Nevertheless, some children do not receive prompt care which sometimes leads to premature deaths.
Objective: We examined the influence of maternal education on the use of ORS with children under-five with an episode of diarrhea using data from the 2013 Nigerian Demographic and Health Survey.
Method: We used chi-square test and logistic regression analyses to determine the relationship between maternal characteristics and the use of ORS as well as visit to a medical facility during diarrhea episode.
Results: The logistic regressions found that maternal education was an important determinant of diarrhea management among under-five children. Compared to mothers with no education, mothers with tertiary education or higher were found to be 2.81 times more likely to give their children ORS than those with no education (OR=2.81, 95% CI: 1.68-4.69). Similarly, mothers who have higher education were 3.68 times more likely to take their children to a medical facility during diarrhea episode than those with no education (OR=3.68, 95% CI 2.23-6.05).
Conclusion: The findings revealed that maternal education is an important determinant of under-five diarrhea management in Nigeria. We argue for strengthening women's education to assist with management of under-five diarrhea while ensuring that every child in countries like Nigeria have the right to health.
Basic medical science applied in public health Biostatistics, economics Environmental health sciences Public health or related public policy