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Enteroparasitism in Hard-to-Reach Community Dwellers: A Cross-Sectional Study in Ga West Municipality in Ghana

ABSTRACT: Ga West Municipality in Ghana is predominantly rural with about forty-eight hard-to-reach communities. Several infectious diseases such as Buruli ulcer, tuberculosis, yaws, schistosomiasis, and malaria are prevalent in the municipality. However, the prevalence and characteristics of enteroparasites in the municipality are unknown. Therefore, this cross-sectional study determined the prevalence of enteroparasites in these hard-to-reach communities. Samples were collected from five communities, namely, Opah, Otuaplem, Dedeman, Onyansana, and Manchie. A total of 538 stool samples were collected from the community dwellers. Each sample was examined with eosin-saline wet preparation and formol-ether concentration technique. Body mass index, haemoglobin, and albumin concentrations were used to assess nutritional status. Seven different parasite species were identified in 178 community dwellers (33.1% prevalence (95% CI: 0.29–0.37)). The individual prevalence of the identified parasites was Schistosoma mansoni (13.4%), Entamoeba histolytica (7.2%), Ascaris lumbricoides (6.9%), Giardia lamblia (5.0%), hookworm (4.8%), Strongyloides stercoralis (4.8%), and Balantidium coli (1.6%). Among the 178 parasitized individuals, 68.0% were singly infected while 31.5% had dual parasitism. Significantly higher infections were associated with Onyansana dwellers (p = 0.019), participants aged 16–20 years (p = 0.006), unmarried participants (p < 0.001), those without formal education (p = 0.044), and crop farmers (p = 0.044). However, among the Akan tribe (p = 0.015), Christians (p = 0.03), and participants with higher incomes (p = 0.012), infections were found to be lower. Compared to monoparasitism, dual parasitism was significantly associated with underweight (17.8 vs. 20.3?kg/m2), anaemia (7.7 vs. 9.8?g/dL), and malnutrition (27.6 vs. 31.9?g/L of albumin concentration). These findings underscore the fact that the Ga West Municipality is heavily burdened with different species of enteroparasites. Therefore, education on personal hygiene to reduce parasitic infections must be intensified while implementing regular mass deworming exercise in the municipality.

SUBMITTER: Aninagyei E

PROVIDER: S-EPMC7532372 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Project description:Background: Uganda has one of the highest maternal deaths in sub-Saharan Africa, with a mortality ratio of 336 per 100 000 live births. Early regular antenatal care (ANC) helps prevent adverse outcomes, including deaths, through prevention, identification, treatment, and/or referral of at-risk women. We explored ANC practices and associated factors among women from hard-to-reach Lake Victoria islands fishing communities in Kalangala district, Uganda. Methods: A cross-sectional survey among 486 consenting women aged 15 to 49 years, who were pregnant or had a birth or abortion in the past 6 months was conducted in 6 island fishing communities of Kalangala district, Uganda, during January to May 2018. ODK software interviewer-administered questionnaires were used to collect data on sociodemographics and ANC practices. Regression modeling using STATA version 15 was used to determine factors associated with ANC visits. Results: Women's median (range) age was 26 (15-45) years, 63% (304/486) had up to primary level education, 45% (219/486) were housewives (stay home mums), 87% (423/486) were married. ANC visits ranged from 0 to 10, with over three-fifths of women having their first visit late after 3 months of being pregnant (63%, 198/316). Women without a history of pregnancy loss (adjusted odds ratio [AOR] = 1.8, 95% CI 1.1-3.0), those not staying with their partners (AOR = 2.5, 95% CI 1.1-6.0), and those whose partners were working in fishing-related activities (AOR = 1.8, 95% CI 1.0-3.0) were likely to have started care late. Women from communities with a public health facility and those with partners working in none fishing-related activities had the highest predicted number of visits. Conclusion: Antenatal practices among these communities are characterized by late start of care. Community-led early ANC awareness interventions are needed. Targeted health policies need to consider public ANC facilities for each island for improved antenatal outcomes and maternal health.

Project description:Every year in Bangladesh, approximately 5200 mothers die (172 maternal deaths/100,000 live births) due to maternal complications. The death rate is much higher in hard-to-reach areas and underprivileged communities, such as Bangladesh's tea gardens. The women living in the tea garden areas are deprived of quality health care services due to inadequate knowledge, education, and access to health care services. Poverty and early marriage, followed by early pregnancy, are also triggering factors of maternal deaths in this community. This study explored the factors associated with maternal deaths in the underprivileged tea garden community in the Moulvibazar district of Bangladesh. It was a cross-sectional study conducted between January and March 2018. All maternal deaths reported by government health care providers in two sub-districts of Moulvibazar during 2017 were selected for community verbal autopsy using a structured questionnaire. Descriptive analysis was performed on quantitative data, and content analysis was performed on qualitative data. A total of 34 maternal deaths were reported in the two sub-districts in 2017, among which 15 deaths (44%) occurred in the tea garden catchment areas, where about 34% people live in the two upazilas. The majority of the mothers who died in the tea gardens delivered their babies at home (80%), many of whom also died at home (40%). Only 27% of women who died in the tea gardens received four or more antenatal care visits. Post-partum hemorrhage was found to be the leading cause of death (47%), followed by anemia (33%) and eclampsia (20%). There is a persistent high maternal mortality observed in the marginalized tea gardens, as compared to the general community of the Moulvibazar district, Bangladesh. The sustainable development goal (SDG) that has been set for maternal mortality rate (MMR) is 70/100,000 live births in Bangladesh. The findings of our study show that focused intervention is needed to reduce the burden of maternal deaths, which will improve the overall maternal health situation and also reach the SDG on time.

Project description:BackgroundMaternal mortality is still a challenge in Uganda, at 336 deaths per 100,000 live births, especially in rural hard to reach communities. Distance to a health facility influences maternal deaths. We explored women's mobility for maternal health, distances travelled for antenatal care (ANC) and childbirth among hard-to-reach Lake Victoria islands fishing communities (FCs) of Kalangala district, Uganda.MethodsA cross sectional survey among 450 consenting women aged 15-49 years, with a prior childbirth was conducted in 6 islands FCs, during January-May 2018. Data was collected on socio-demographics, ANC, birth attendance, and distances travelled from residence to ANC or childbirth during the most recent childbirth. Regression modeling was used to determine factors associated with over 5 km travel distance and mobility for childbirth.ResultsThe majority of women were residing in communities with a government (public) health facility [84.2 %, (379/450)]. Most ANC was at facilities within 5 km distance [72 %, (157/218)], while most women had travelled outside their communities for childbirth [58.9 %, (265/450)]. The longest distance travelled was 257.5 km for ANC and 426 km for childbirth attendance. Travel of over 5 km for childbirth was associated with adolescent girls and young women (AGYW) [AOR = 1.9, 95 % CI (1.1-3.6)], up to five years residency duration [AOR = 1.8, 95 % CI (1.0-3.3)], and absence of a public health facility in the community [AOR = 6.1, 95 % CI (1.4-27.1)]. Women who had stayed in the communities for up to 5 years [AOR = 3.0, 95 % CI (1.3-6.7)], those whose partners had completed at least eight years of formal education [AOR = 2.2, 95 % CI (1.0-4.7)], and those with up to one lifetime birth [AOR = 6.0, 95 % CI (2.0-18.1)] were likely to have moved to away from their communities for childbirth.ConclusionsDespite most women who attended ANC doing so within their communities, we observed that majority chose to give birth outside their communities. Longer travel distances were more likely among AGYW, among shorter term community residents and where public health facilities were absent.Trial registrationPACTR201903906459874 (Retrospectively registered). https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5977 .

Project description:BackgroundIn the UK, hepatitis B virus (HBV) incidence is associated with migrants from particular high-burden countries and population groups deemed 'hard-to-reach' by standard healthcare services: the homeless, people who inject drugs and ex-prisoners. Currently, there is a national targeted HBV vaccine policy for such at-risk groups, but there is limited recent evidence about 1) the levels of vaccine uptake, 2) the factors associated with incomplete vaccination, and 3) reasons for incomplete vaccination.MethodsA questionnaire capturing social and medical history, demographic factors and information about HBV vaccination status was completed by individuals deemed hard-to-reach due to socio-structural factors that criminalise, isolate and stigmatise who consented to participate in a randomised controlled trial of a peer intervention to promote engagement with hepatitis C services. The questionnaire also captured the reasons for incomplete vaccination. Descriptive, univariable and multivariable regression analyses were undertaken.ResultsThree hundred fourty six participants completed the questionnaire. 1) 52.3% (n = 181) reported full HBV vaccination. 2) Within a multivariable model adjusting for sociodemographic variables, the presence of one or two or more socio-structural factors that are included in the national targeted vaccination policy was associated with protection against incomplete HBV vaccination (51.7% vaccine coverage in those with one factor, odds ratio 0.43 [95% confidence interval 0.20-0.92]); 70.1% coverage with two or more factors, 0.19 [0.09-0.39]; overall p-value < 0.001). Being female was also associated with lower vaccine uptake (2.37 [1.24-4.57], 0.01). Examining the socio-structural factors individually, intravenous drug use was associated with protection against incomplete HBV vaccination. 3) The most common reasons declared for incomplete vaccination were never being offered the vaccine or not returning for further doses.ConclusionWithin this study of HBV vaccination uptake among hard-to-reach population groups in London, UK, we document 52.3% coverage of the full vaccine course. Critically, although participants recommended for immunisation within national guidelines had an increased likelihood of receiving a complete vaccine course, we note surprisingly low coverage in the presence of the risk factors that are national indicators for vaccination. Public health bodies should make additional efforts to improve coverage in the hard-to-reach through improved vaccine delivery systems.Trial registrationISRCTN24707359 , Registered 19th October 2012.

Project description:BackgroundPopulation growth, population ageing, and urbanisation are major global demographic trends that call for an examination of the impact of urban densification on older adults' health-enhancing behaviours, such as walking. No studies have examined the pathways through which urban densification may affect older adults' walking. This information is key to evidence-based, health-oriented urban and transport planning. This study aimed to identify neighbourhood environment characteristics potentially responsible for the effects of neighbourhood densification on older adults' frequency and amount of transportation and recreation walking within and outside the neighbourhood.MethodsThe Active Lifestyle and the Environment in Chinese Seniors (ALECS) project collected self-reported data from 909 older adults (≥ 65 years) living in 128 physically and socially diverse neighbourhoods in Hong Kong (71% response rate). Walking was measured using the Neighbourhood Walking Questionnaire for Chinese Seniors. Objective residential density and other neighbourhood environmental attributes were assessed using Geographic Information Systems. Generalised additive mixed models examined the total effects of neighbourhood residential density on walking and the mediating role of other environmental attributes and car ownership.ResultsA complex network of potential pathways of positive and negative influences of neighbourhood residential density on different aspects of walking was revealed. While residential density was positively related to within-neighbourhood transportation and outside-neighbourhood recreation walking only, it exhibited positive and/or negative nonlinear indirect effects on all examined aspects of walking via recreation, public transport, food/retail and street intersection densities, and/or car ownership.ConclusionsHigh-density environments appear to support within-neighbourhood walking by providing access to food and retail outlets via well-connected street networks and discouraging car ownership. However, extreme density may lead to reductions in walking. Public transport density accompanying high-density areas may facilitate outside-neighbourhood walking but deter within-neighbourhood walking. The development of activity-friendly communities for ageing populations need to consider these opposing influences.

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Enteroparasitism in Hard-to-Reach Community Dwellers: A Cross-Sectional Study in Ga West Municipality in Ghana

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