RESUMO
Child marriage (before 18 years) is prevalent in Pakistan, which disproportionately affects young girls in rural, low income and low education households. Our study aims to determine the association between early marriage and high fertility and poor fertility health indicators among young women in Pakistan beyond those attributed to social vulnerabilities. Nationally representative data from Pakistan Demographic and Health Survey, 2006-2007, a cross-sectional observational survey, were limited to ever-married women aged 20-24 years (n = 1,560; 15% of 10,023) to identify differences in poor fertility outcomes [high fertility (three or more childbirths); rapid repeat childbirth (<24 months between births); unwanted pregnancy (any ever); pregnancy termination (any stillbirth, miscarriage or abortion ever)] by early (<18) versus adult (≥18) age at marriage. Associations between child marriage and fertility outcomes were assessed by calculating adjusted odds ratios (AORs) using logistic regression models after controlling for demographics, social equity indicators (education, wealth index, rural residence), contraception use, marriage duration and culture-specific factors (husband's desire for more children, son preference). Overall, 50% of ever-married women aged 20-24 years in Pakistan were married before the age of 18 years. Girl child marriage was significantly (p < 0.001) associated with low social equity indicators (poverty, rural residence, and no formal education). Adjusted logistic regression models showed that girl child marriage was significantly associated with high fertility (AOR 6.62; 95% CI 3.53-12.43), rapid repeat childbirth (AOR 2.88; 95% CI 1.83-4.54), unwanted pregnancy (AOR 2.90; 95% CI 1.75-4.79), and pregnancy termination (AOR 1.75; 95% CI 1.10-2.78). Girl child marriage affects half of all ever-married women aged 20-24 years in Pakistan, and increases their risk for high fertility and poor fertility health indicators, highlighting the need of increasing the age of marriage among women in Pakistan. Efforts to eliminate girl child marriage by strict law enforcement, promoting civil, sexual and reproductive health rights for women can help eliminate girl child marriage in Pakistan.
Assuntos
Fertilidade , Casamento , Fatores Etários , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Infertilidade Feminina , Razão de Chances , Paquistão , Gravidez , Estudos Prospectivos , Adulto JovemRESUMO
Drowning is the fifth leading cause of unintentional fatalities in the US. Our study described demographics and trend analysis of unintentional drowning mortality in the US from 1999 to 2006, and identifies the changes in deaths for specific population subgroups. Mortality data came from the CDC's Web-based Injury Statistics Query and Reporting System. Trends during 1999-2006 were analyzed by gender, age group and race. Annual percentage change in deaths/rates and simple linear regression was used for time-trend analysis from 1999 to 2006, and examines its significance. During 1999-2006, there were 27,514 deaths; 21,668 (78.8%) males, 21,380 (77.7%) whites, and 4,241 (15.4%) aged 00-04 years. The annual number of drowning mortality varied from a high of 3,529 in 1999 to a low of 3,281 in 2001. Overall, deaths were increased 1.4% from 3,529 during 1999 to 3,579 deaths during 2006 however, the overall mortality rate decreased by 5%. The proportion of deaths was significantly greater among males than females (27.4 vs. 13.7%: p < 0.001) and blacks than among all other races combined (32.5 vs. 21.3%: p < 0.001). Fatalities reported from California (n = 3,234; 11.75%), Florida (n = 2,852; 10.37%) and Texas (n = 2,395; 8.70%) accounted for 30.82% of all such deaths in the US. Sub-group analyses showed that drowning mortality decreased 0.72% for males but increased 9.52% for females, the trend differ significantly among males and females (p < 0.001). Males, American Indians, and blacks appear to have higher risk of drowning mortality. The trend varied among sexes, age and racial groups from 1999 to 2006. Preventive measures and continuous surveillance is warranted to further decrease these drowning mortalities.
Assuntos
Afogamento/mortalidade , Vigilância da População , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , População Negra/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Indígenas Norte-Americanos/estatística & dados numéricos , Lactente , Masculino , Pessoa de Meia-Idade , Mortalidade/etnologia , Mortalidade/tendências , Fatores de Risco , Fatores Sexuais , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
Gross Domestic Product (GDP) and unemployment has a strong documented impact on injury mortality. The aim of our study is to investigate the relationship of GDP per capita and unemployment with gender- and cause-specific injury mortalities in the member nations of Organization for Economic Cooperation and Development (OECD). Country-based data on injury mortality per 100,000 population, including males and females aged 1-74, for the 4 year period 1996-1999, were gathered from the World Health Organization's Statistical Information System. We selected fourteen cause-specific injury mortalities. Data on GDP, unemployment rate and population growth were taken from World Development Indicators. GDP and unemployment rate per 100 separately were regressed on total and cause-specific injury mortality rate per 100,000 for males and females. Overall in the OECD countries, GDP per capita increased 12.5% during 1996-1999 (P = 0.03) where as unemployment rate decreased by 12.3% (P = 0.05). Among males, most cause-specific injury mortality rates decreased with increasing GDP except motor vehicle traffic crashes (MTC) that increased with increasing GDP (coefficient = 0.75; P < 0.001). Similar trend was found in females, except suicidal injury mortalities that also increased with increasing GDP (coefficient = 0.31; P = 0.04). When we modeled cause-specific injury mortality rates with unemployment, injuries due to firearm missiles (coefficient = 0.53; P < 0.001), homicide (coefficient = 0.36; P < 0.001), and other violence (coefficient = 0.41; P < 0.001) increased with increase in unemployment rate among males. However, among females only accidental falls (coefficient = 0.36; P = 0.01) were found significantly associated with increasing unemployment rate. GDP is more related to cause-specific injury mortality than unemployment. Injury mortality does not relate similarly to each diagnosis-specific cause among males and females. Further research on causation with more predictors is needed.
Assuntos
Países Desenvolvidos/estatística & dados numéricos , Renda/tendências , Mortalidade/tendências , Vigilância da População , Desemprego/tendências , Ferimentos e Lesões/mortalidade , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Nível de Saúde , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Análise de Regressão , Fatores Socioeconômicos , Adulto JovemRESUMO
Landraces are a potential source of genetic diversity and provide useful genetic resources to cope with the current and future challenges in crop breeding. Afghanistan is located close to the centre of origin of hexaploid wheat. Therefore, understanding the population structure and genetic diversity of Afghan wheat landraces is of enormous importance in breeding programmes for the development of high-yielding cultivars as well as broadening the genetic base of bread wheat. Here, a panel of 363 bread wheat landraces collected from seven north and north-eastern provinces of Afghanistan were evaluated for population structure and genetic diversity using single nucleotide polymorphic markers (SNPs). The genotyping-by-sequencing of studied landraces after quality control provided 4897 high-quality SNPs distributed across the genomes A (33.75%), B (38.73%), and D (27.50%). The population structure analysis was carried out by two methods using model-based STRUCTURE analysis and cluster-based discriminant analysis of principal components (DAPC). The analysis of molecular variance showed a higher proportion of variation within the sub-populations compared with the variation observed as a whole between sub-populations. STRUCTURE and DAPC analysis grouped the majority of the landraces from Badakhshan and Takhar together in one cluster and the landraces from Baghlan and Kunduz in a second cluster, which is in accordance with the micro-climatic conditions prevalent within the north-eastern agro-ecological zone. Genetic distance analysis was also studied to identify differences among the Afghan regions; the strongest correlation was observed for the Badakhshan and Takhar (0.003), whereas Samangan and Konarha (0.399) showed the highest genetic distance. The population structure and genetic diversity analysis highlighted the complex genetic variation present in the landraces which were highly correlated to the geographic origin and micro-climatic conditions within the agro-climatic zones of the landraces. The higher proportions of admixture could be attributed to historical unsupervised exchanges of seeds between the farmers of the central and north-eastern provinces of Afghanistan. The results of this study will provide useful information for genetic improvement in wheat and is essential for association mapping and genomic prediction studies to identify novel sources for resistance to abiotic and biotic stresses.
Assuntos
DNA de Plantas/genética , Polimorfismo de Nucleotídeo Único , Análise de Sequência de DNA/métodos , Triticum/classificação , Afeganistão , Mapeamento Cromossômico , Evolução Molecular , Desequilíbrio de Ligação , Filogenia , Melhoramento Vegetal , Triticum/genéticaRESUMO
BACKGROUND: Our study attempts to describe the demographics, characteristics of victims and perpetrators, and circumstances leading to burn events among females in Pakistan. METHODS: Human Rights Commission of Pakistan (HRCP) systematically collected data on burns among women using newspaper reports from January 2004 till December 2005. We analyzed the aggregated data and estimated burn rates. RESULTS: A total of 222 burn events were reported from 2004 to 2005; complete data were not available for all variables. Adults (>or=18 years) constituted 74% (91/123) of cases with 95% (121/127) being married. Most burns were caused by bursting of stoves (34%; 64/189) or victims set-on fire (33%; n = 63/189). Burns using acids accounted for 13% (25/189). Husbands (52%; 51/98) and in-laws (23%; 23/98) were the perpetrators in known burn events. Burns were classified as accidental in half of cases (51%; 97/189) and related to domestic issues in a quarter (25%; 47/189). There were 49% of (92/189) burns that were reported as intentional. The mean annual rate of burns among women (15-64 years of age) was found to be 33 per 100,000. CONCLUSION: Newspaper reports are good source of surveillance when information is otherwise limited. Majority of burns (51%) were classified as accidental while 49% were reported as intentional, though there is a limitation in the accuracy of reported accidental events. There is a dire need for systematic data collection and devising preventive strategies for this important public health problem that remains largely neglected in Pakistan.
Assuntos
Queimaduras/epidemiologia , Queimaduras/etiologia , Jornais como Assunto , Adolescente , Adulto , Coleta de Dados , Demografia , Feminino , Humanos , Pessoa de Meia-Idade , Paquistão/epidemiologia , Fatores de RiscoRESUMO
BACKGROUND: Child marriage (before 18 years) is widely prevalent in Pakistan, and disproportionately affects young girls in rural, low income and poorly-educated households. Our study aims to determine the association of child marriage and attitude towards wife beating among currently married Pakistani women aged 15-24 after controlling for social equity indicators (education, wealth index, rural residence). METHODS: We limited the data from Pakistan Demographic and Health Survey, 2012-2013 to currently married women aged 15-24 years (n=2648). Five specified dichotomous variables indicating women's attitude towards wife beating (goes out without telling husband, neglects the children, argues with husband, refuses to have sex with husband, burns the food) were considered as outcome variables. The likelihood (OR and 95% CI) of each outcome variable for the child marriage group was estimated using logistic regression models. RESULTS: The prevalence of child marriage was significantly higher among women having no education and Balochi ethnicity, living in Khyber Pakhtunkhwa region and rural area, and belonging to the poorest quintile of wealth index. Women married as children compared with women married as adults were more likely to justify wife beating for all five specified reasons. However, these associations were lost when social equity indicators and national region of residence were adjusted in the regression models. CONCLUSIONS: Highly prevalent child marriage practice among women can be minimized by promoting education and providing economic opportunities in Pakistan.
Assuntos
Conflito Familiar/psicologia , Casamento/psicologia , Casamento/estatística & dados numéricos , População Rural/estatística & dados numéricos , Maus-Tratos Conjugais/psicologia , Maus-Tratos Conjugais/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Modelos Logísticos , Paquistão , Prevalência , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVE: Our study attempted to describe the differences in circumstances, risk groups, and severity of road traffic injuries (RTIs) among injured children (1-15 years) and adults (≥16 years) coming to the tertiary-care hospital, Karachi, Pakistan. METHODS: Past medical records from June 2006 to May 2007 of injured patients coming to the Emergency Department of the Aga Khan University Hospital, Karachi were reviewed. Data were recorded regarding the basic epidemiological features, hospital stay, body parts that are injured, and severity of injuries. RESULTS: Of 411 RTI patients, males outnumbered females by a ratio of 4 : 1 accounting for 81% (n = 333) of injured. Among pedestrians (82; 20%), females were injured more than males (38 vs. 16%; P < 0.01). When compared with adults, injured children were mostly pedestrians (18 vs. 36%; P = 0.01) and presented with severe Glasgow Coma Scale (GCS) (9 vs. 18%; P = 0.02). Among adults, most RTIs were caused by two wheelers crashing with four wheelers (16 vs. 19%; P = 0.01). Motor vehicle occupants (adjusted odds ratio: 3.04; 95% confidence interval: 1.382-6.668) were more likely to have severe GCS (GCS < 8) even after adjusting for injury severity. CONCLUSION: The study may assist local authorities in Karachi to prioritize interventions to address common injuries among those who are at a high risk for RTIs. Further quantitative and qualitative studies are needed to assess the factors leading to RTIs among pedestrians in Karachi.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adulto , Fatores Etários , Distribuição de Qui-Quadrado , Feminino , Escala de Coma de Glasgow , Humanos , Renda , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Paquistão/epidemiologia , Pobreza , Estudos Retrospectivos , Fatores Socioeconômicos , Estatística como Assunto , Índices de Gravidade do TraumaRESUMO
Fall injury is a leading cause of death and disability among older adults. The objective of this study is to identify the groups among the ≥ 65 population by age, gender, race, ethnicity and state of residence which are most vulnerable to unintentional fall mortality and report the trends in falls mortality in the United States. Using mortality data from the Centers for Disease Control and Prevention, the age specific and age-adjusted fall mortality rates were calculated by gender, age, race, ethnicity and state of residence for a five year period (2003-2007). Annual percentage changes in rates were calculated and linear regression using natural logged rates were used for time-trend analysis. There were 79,386 fall fatalities (rate: 40.77 per 100,000 population) reported. The annual mortality rate varied from a low of 36.76 in 2003 to a high of 44.89 in 2007 with a 22.14% increase (p=0.002 for time-related trend) during 2003-2007. The rates among whites were higher compared to blacks (43.04 vs. 18.83; p=0.01). While comparing falls mortality rate for race by gender, white males had the highest mortality rate followed by white females. The rate was as low as 20.19 for Alabama and as high as 97.63 for New Mexico. The relative attribution of falls mortality among all unintentional injury mortality increased with age (23.19% for 65-69 years and 53.53% for 85+ years), and the proportion of falls mortality was significantly higher among females than males (46.9% vs. 40.7%: p<0.001) and among whites than blacks (45.3% vs. 24.7%: p<0.001). The burden of fall related mortality is very high and the rate is on the rise; however, the burden and trend varied by gender, age, race and ethnicity and also by state of residence. Strategies will be more effective in reducing fall-related mortality when high risk population groups are targeted.
Assuntos
Acidentes por Quedas/mortalidade , Causas de Morte/tendências , Pessoas com Deficiência/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Centers for Disease Control and Prevention, U.S. , Feminino , Humanos , Masculino , Distribuição por Sexo , Estados Unidos/epidemiologia , Populações VulneráveisRESUMO
INTRODUCTION: Poisoning, specifically unintentional poisoning, is a major public health problem in the United States (U.S.). Published literature that presents epidemiology of all forms of poisoning mortalities (i.e., unintentional, suicide, homicide) together is limited. This report presents data and summarizes the evidence on poisoning mortality by demographic and geographic characteristics to describe the burden of poisoning mortality and the differences among sub-populations in the U.S. for a 5-year period. METHODS: Using mortality data from the Center for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System, we presented the age-specific and age-adjusted unintentional and intentional (suicide, homicide) poisoning mortality rates by sex, age, race, and state of residence for the most recent years (2003-2007) of available data. Annual percentage changes in deaths and rates were calculated, and linear regression using natural log were used for time-trend analysis. RESULTS: There were 121,367 (rate=8.18 per 100,000) unintentional poisoning deaths. Overall, the unintentional poisoning mortality rate increased by 46.9%, from 6.7 per 100,000 in 2003 to 9.8 per100.000 in 2007, with the highest mortality rate among those aged 40-59 (rate=15.36), males (rate=11.02) and whites (rate=8.68). New Mexico (rate=18.2) had the highest rate. Unintentional poisoning mortality rate increased significantly among both sexes, and all racial groups except blacks (p<0.05 time-related trend for rate). Among a total of 29,469 (rate=1.97) suicidal poisoning deaths, the rate increased by 9.9%, from 1.9 per 100,000 in 2003 to 2.1 per 100,000 in 2007, with the highest rate among those aged 40-59 (rate=3.92), males (rate=2.20) and whites (rate=2.24). Nevada (rate=3.9) had the highest rate. Mortality rate increased significantly among females and whites only (p<0.05 time-related trend for rate). There were 463 (rate=0.03) homicidal poisoning deaths and the rate remained the same during 2003-2007. The highest rates were among aged 0-19 (rate=0.05), males (rate=0.04) and blacks (rate=0.06). CONCLUSION: Prevention efforts for poisoning mortalities, especially unintentional poisoning, should be developed, implemented and strengthened. Differences exist in poisoning mortality by age, sex, location, and these findings underscore the urgency of addressing this public health burden as this epidemic continues to grow in the U.S.
RESUMO
Our study described demographics and trend analysis in unintentional struck by/struck against fatalities in the United States from 1999 to 2006, and identifies the changes in deaths for specific population subgroups. Mortality data came from the CDC's Web-based Injury Statistics Query and Reporting System. Trends during 1999-2006 were analyzed by gender, age group and race. Annual percentage change in deaths/rates and log-linear regression was used for time-trend analysis from 1999 to 2006, and examines its significance. During 1999-2006, there were 7,049 deaths; 6,236 (88.5%; 0.56 per 100,000) males, 6,180 (87.7%; 0.32 per 100,000) whites, and 1,925 (27.3%) aged 45-59 years. Overall deaths declined by 4.4% during 1999 to 2006 (P = 0.047 for time-related trend). The proportion of deaths was almost similar among males and females (1.1% vs. 0.3%; P = 0.58), and whites and blacks (0.8% vs. 0.7%; P = 0.44). Almost 21% of all deaths occur in only three states of the US i.e., Texas (n = 592; 0.35 per 100,000), California (n = 513; 0.18) and Florida (n = 375; 0.28). Sub-group analysis showed, injury mortality decreased 5% in males and 1% in females, this change was not statistically significant overtime in both sexes. Prevention efforts for struck by/struck against fatalities should be strengthened and surveillance for these deaths should continue to follow future trends.