Evaluating the indoor and outdoor environment: using a simple method.

Housing is the conjunction of the dwelling, the home, the immediate environment and the community. Between 1960 and 1980, the urban population in developing countries more than doubled and is expected to reach 56% of the total population by the year 2025. In many cities, the development of squatter settlements and shanty towns had grown rapidly causing the destruction of green areas. The number of people living in urban slums and shanty towns is an indicator of conditions in the cities and the United Nations had estimated that about one-third of urban dwellers in developing countries live in such settlements. Poverty is highly prevalent among the residents of these areas. Outdoor environmental degradation, together with the social degradation affects the health of the urban population especially the poor causing a burden of ill-health, disability, poor indoor housing, and high maternal and infant mortality. The aim of the present study is to evaluate the indoor and outdoor environment using a simple method and to assess its reliability and validity. The scoring system, which was developed for the assessment of the indoor and outdoor environmental levels included 36 items (18 for the indoor and 18 for the outdoor) using a questionnaire. Results revealed that the proposed scoring system was able to reveal significance difference between served (water, electricity, and sewerage system were available) and unserved areas when using t-test, z-test, and chi-square testing. The proposed scoring system was reliable and valid especially in indoor assessment. Outdoor scores might need more modifications to improve its reliability.

Maternal serum alpha fetoprotein among pregnant females in Alexandria.

UNLABELLED: Maternal serum alpha fetoprotein (MSAFP) was introduced as a screening test for congenital malformations especially neural tube defects (NTDs) two decades ago. However, many factors were known to affect its level. From these are racial differences and maternal weight. The aim of the present work is to illustrate the normal distribution of MSAFP among working pregnant women in Alexandria in gestational age 16-18 weeks, to identify some of its determinants, and to determine the specificity and sensitivity of MSAFP for the detection of congenital anomalies and adverse pregnancy outcome. MATERIAL AND METHODS: A sample of 608 pregnant working women who were 16-18 week gestation was recruited for the study from the antenatal clinic affiliated to Gamal Abdel Nasser Health Insurance Hospital in Alexandria. The enrolled women were interviewed using a structured questionnaire and a blood sample was collected from each of them to measure the level of MSAFP. At the expected time of delivery, Gamal Abd el Nasser Health Insurance Hospital was visited to collect data about the outcome of pregnancy of the enrolled women. RESULTS: The median of MSAFP level for deliveries with no congenital anomalies were 25.5, 33.5, and 53.2 IU/ml, at gestational weeks 16, 17 and 18 respectively. The significant variables related positively to MSAFP level included abortion or stillbirth, congenital anomalies in the index pregnancy, gestational age, bleeding during pregnancy, gestational diabetes, twin pregnancy, consanguinity between maternal parents, history of congenital or genetic diseases in maternal family, and caesarian section deliveries. Fatigue score was negatively correlated to MSAFP level. Using MSAFP multiples of median (MOM), 42.9 % of abortions and stillbirths, 57.1 % of twin pregnancies, 31.25 % of preterm deliveries and 27.3 % of low birth weight had levels of 3 MOM or more. One fourth of the congenital anomalies were below 0.5 MOM and 41.7 % were at or above 3 MOM. The sensitivity of MSAFP test for the detection of NTDs (cutoff point 2.5+ MOM) or Down syndrome (cutoff point <0.5 MOM) among the study sample was 100% (CI: 19.8-100%). Specificity for NTDs was 92.7% (CI: 90.3-94.6%), while the specificity for Down syndrome was 89.1% (86.3-91.4%). The sensitivity for adverse pregnancy outcome (cutoff point <0.5 or 2.5+ MOM) was 41.6, and the specificity was 85.8%. In conclusion, the cutoff points of MSAFP of the study sample are different from those for other populations. Different factors affect the level of MSAFP including adverse pregnancy outcomes. It is recommended to introduce antenatal screening for congenital anomalies as a routine screening test during pregnancy using levels adapted from the local population for cutoff point determination.