Association between antenatal care utilization pattern and timely initiation of postnatal care checkup: Analysis of 2016 Ethiopian Demographic and Health Survey.

BACKGROUND: Despite significant public health intervention, maternal mortality remains high in low- and middle-income countries, including Ethiopia. Effective postnatal care is a critical service to reduce maternal mortality. In Ethiopia, only 17% of mothers received postnatal care services in 2016. OBJECTIVE: This study examined the association between antenatal care and timely postnatal care checkup among reproductive-age women in Ethiopia. METHODS: The study used the 2016 Ethiopian Demographic and Health Survey data. The current study included 4,081 women who give birth in the two years preceding the survey. Chi-square test and multivariable logistic regression analyses were used to examine the association between antenatal care and timely initiation of postnatal care. RESULTS: Postnatal care services within 2 days of delivery were received by 16.5% of women. Women who had at least four timely antenatal care visits had higher odds of timely postnatal checkups compared to women who had no antenatal care [adjusted Odds Ratio (aOR): 2.50; 95% CI 1.42-4.42]. Women who had at least four antennal care visits without timely initiation also had higher odds of postnatal check-up than their counterparts (aOR: 2.46; 95%CI: 1.22-4.97). Other factors significantly associated with timely initiation of PNC were secondary and above education (aOR: 1.64; 95%CI: 1.03-2.60), perceived distance to the nearby health facility as a significant barrier (aOR: 1.55; 95%CI: 1.15-2.09), primiparous (aOR: 0.34; 95%CI: 0.19-0.61) and institutional delivery (aOR: 14.55; 95%CI: 2.21-95.77). CONCLUSION: The prevalence of timely initiation of postnatal care in Ethiopia is very low. Women who received recommended antenatal care services had higher odds of timely initiation of postnatal care. Thus, strengthening the existing maternal and child health programs to adhere to the recommended ANC care guidelines may improve the timely initiation of postnatal care.

Association between maternal high-risk factors and anemia among women in Ethiopia.

OBJECTIVES: The aim of this study was to examine the association between maternal high-risk factors and anemia among reproductive-age women in Ethiopia. METHODS: A cross-sectional study was conducted using data from the 2016 Ethiopia Demographic and Health Survey (N = 5282). Hemoglobin levels were used to determine anemia status. Maternal high-risk factors were measured using maternal age at delivery, birth order, and birth interval. We performed χ2 test and multivariable regression models. RESULTS: There was a significant antagonistic interaction between maternal high-risk factors and place of residence on anemia (relative excess risk due to interaction, -1.79, synergy index, 0.48) with an attributable proportion due to interaction (AP) of -67% (AP = -0.67; 95% confidence interval [CI], -0.95 to -0.29). Multiplicative interaction was also significant (odds ratio for interaction, 0.38; P = 0.003). The odds of anemia were higher among women with any maternal high-risk factor than in those who did not experience any high-risk factors (adjusted odds ratio [AOR], 2.64; 95% CI, 1.24-5.63 for urban and AOR, 1.27; 95% CI, 1.01-1.61 for rural women). Exposure to a single maternal high-risk factor was significantly associated with increased odds of anemia among urban residents only (AOR, 2.61; 95% CI, 1.17-5.81). Exposure to multiple maternal high-risk factors significantly increased the odds of anemia (AOR, 2.82; 95% CI, 1.15-6.91) and (AOR, 1.55; 95% CI, 1.10-2.17) for urban and rural women, respectively. CONCLUSIONS: Place of residence moderated the relationship between maternal high-risk factors and anemia. Context-specific strategies and interventions are needed to prevent anemia.

Residence and young women's comprehensive HIV knowledge in Ethiopia.

BACKGROUND: Human immunodeficiency virus (HIV) infection is a global health problem. The epidemic is very serious in sub-Saharan Africa with approximately 70% of the global cases. The disease particularly affects youth, accounting for half of the new HIV infections yearly. Inadequate knowledge may contribute to the high rates among youth. Hence, the main aim of this study was to examine the association between residence and comprehensive HIV knowledge among women aged 15-24 years in Ethiopia. METHODS: This cross-sectional study used nationally representative data from the 2016 Ethiopian demographic health survey (n = 5926). Chi-square tests and multivariable logistic regression modeling were performed. RESULTS: Approximately 23.9% of the study participants had a comprehensive HIV knowledge and 74.7% were rural residents. In the multivariable-adjusted model, we found a significant interaction between place of residence and HIV testing on comprehensive HIV knowledge (P for interaction = 0.005). In the subgroup analysis, a statistically significant associations between place of residence and comprehensive HIV knowledge was found only in women who have never been tested for HIV. In this subgroup, rural women had lower odds of having a comprehensive HIV knowledge compared to their urban counterparts (OR 0.42, 95% CI: 0.23-0.74; P = 0.003). Furthermore, in the subgroup of women who have never been tested for HIV, education and region were significantly associated with comprehensive HIV knowledge. Compared to women with no education, the odds of having a comprehensive HIV knowledge were higher in women who had primary (OR 2.86, 95% CI: 1.63-5.02; P < 0.001) and secondary or above education (OR 5.49, 95% CI: 2.92-10.32; P < 0.001), respectively. The odds of having a comprehensive HIV knowledge were lower in women from the Somali region compared to women from Addis Ababa region (OR 0.41, 95% CI: 0.18-0.90; P = 0.027). CONCLUSIONS: Rural residence was negatively associated with comprehensive HIV knowledge only in women who have never been tested for HIV. These findings suggest that the development and implementation HIV education and awareness programs should target rural areas, especially where there is limited access to HIV testing.

Osteopathic medical students' understanding of the Patient Protection and Affordable Care Act: a first step toward a policy-informed curriculum.

CONTEXT: Current osteopathic medical students will play an important role in implementing, modifying, and advocating for or against the Patient Protection and Affordable Care Act (ACA) of 2010. Accordingly, medical educators will need to address curricular gaps specific to the ACA and medical practice. Research that gauges osteopathic medical students' level of understanding of the ACA is needed to inform an evidence-based curriculum. OBJECTIVE: To assess first- and second-year osteopathic medical students' beliefs about the ACA. METHODS: In this descriptive cross-sectional survey-based study, first- and second-year students were recruited because their responses would be indicative of what, if any, information about the ACA was being covered in the preclinical curriculum. A 30-item survey was distributed in November 2013, after the health insurance exchanges launched on October 1, 2013. RESULTS: A total of 239 first- and second-year osteopathic medical students completed the survey. One hundred ten students (46%) disagreed and 103 (43.1%) agreed that the ACA would provide health insurance coverage for all US citizens. The ACA was predicted to lead to lower wages and fewer jobs (73 students [30.5%]), as well as small business bankruptcy because of employees' health insurance costs (96 [40.2%]). Regarding Medicare recipients, 113 students (47.3%) did not know whether these individuals would be required to buy insurance through the health insurance exchanges. The majority of students knew that the ACA would require US citizens to pay a penalty if they did not have health insurance (198 [82.8%]) and understood that not everyone would be required to purchase health insurance through health insurance exchanges (137 [57.3%]). Although students took note of certain clinical benefits for patients offered by the ACA, they remained concerned about the ACA's impact on their professional prospects, particularly in the area of primary care. CONCLUSION: These findings build on the existing literature that emphasize the need for incorporating into the osteopathic medical curriculum knowledge of the dynamics of health care policy and reform and for creating opportunities for students to follow health policy developments as they evolve in real time.

Non-therapist identification of falling hazards in older adult homes using digital photography.

Evaluation and removal of home hazards is an invaluable method for preventing in-home falls and preserving independent living. Current processes for conducting home hazard assessments are impractical from a whole population standpoint given the substantial resources required for implementation. Digital photography offers an opportunity to remotely evaluate an environment for falling hazards. However, reliability of this method has only been tested under the direction of skilled therapists. Ten community dwelling adults over the age of 65 were recruited from local primary care practices between July, 2009 and February, 2010. In-home (IH) assessments were completed immediately after a photographer, blinded to the assessment form, took digital photographs (DP) of the participant home. A different non-therapist assessor then reviewed the photographs and completed a second assessment of the home. Kappa statistic was used to analyze the reliability between the two independent assessments. Home assessments completed by a non-therapist using digital photographs had a substantial agreement (Kappa = 0.61, p < 0.001) with in-home assessments completed by another non-therapist. Additionally, the DP assessments agreed with the IH assessments on the presence or absence of items 96.8% of the time. This study showed that non-therapists can reliably conduct home hazard evaluations using digital photographs.

Stress associated with caregiving: an examination of the stress process model among Kenyan Luo elders.

Globally, a growing number of grandparents are caring for their grandchildren. The impact and burden associated with increases in custodial grandparenting, however, may differ by culture. In the United States, the caregiving role has been shown to be a significant source of stress for older adults. In cultures in which grandparents are more commonly involved in the care of young children, however, increasing caregiving roles may not be viewed as stressful. This study examines the impact of caregiving on perceived and physiological measures of stress among 640 Luo elders (60+) in western Kenya, where high HIV prevalence among younger-to-middle aged adults has led to a heavy burden of orphan care. Perceived stress levels were measured using the Luo Perceived Stress Scale (LPSS). Salivary cortisol and casual blood pressure were used as biomarkers of stress. Results were analyzed using random mixed effects models. Overall this study showed that caregivers have higher levels of perceived stress than non-caregivers. For women, household composition, including the number of orphans and adults in the homestead impacted perceived stress. Among men, those who perceived caregiving as burdensome had higher perceived stress. Despite the association between caregiving and perceived stress, there was a minimal relationship between caregiving and the two biomarkers of stress. This may be because caregiving is superimposed onto other stressors and therefore has a minimal physiological impact. These results highlight the importance of local context in determining the impact of the caregiving role on older adult well-being.

Caregiving, gender, and nutritional status in Nyanza Province, Kenya: grandmothers gain, grandfathers lose.

UNLABELLED: Based on anecdotal and qualitative reports, a general assumption is that caregiving negatively impacts grandparents in Africa. OBJECTIVES: The purpose of this article is to determine how caregiving and gender impact nutritional status over four waves of data from Luo elders. METHODS: Luo elders, aged 60 and over (age 73.6 ± 7.9) were sampled. Participant recruitment was rolling and included 287 Luo grandparents in 2005, 396 in 2006, 389 in 2007, and 390 in 2009. A total of 689 elders participated in at least 1 year. Standard anthropometric measures were used to determine nutritional status. Impact of caregiving was examined using structural equation models. RESULTS: Caregiving positively associated with nutritional status among women. This main effect was mediated by caregiving intensity, which also positively associated with nutritional status. Among men, caregiving negatively associated with nutritional status, although caregiving intensity did not significantly associate with most anthropometric measures. Socioeconomic status (SES) positively associated with five of nine anthropometric measures in women and all measures in men. Several measures indicated that both men and women became larger over time but few of the variables tested predicted growth. CONCLUSIONS: The beneficial impact on grandmothers might indicate a coping strategy. These results indicated that researchers should shift away from comparing caregivers to noncaregivers and instead look at the multiple factors which may make some families resilient and others at risk. Human biologists can contribute to this literature by examining the ecological and cultural contexts under which caregiving represents a burden with physiological repercussions.

Caregiving and cardiovascular disease risk factors in male and female Luo elders from Kenya.

BACKGROUND: The HIV/AIDS pandemic has created over 11 million orphans, who are primarily being cared for by grandparents. It has been suggested that this renewed parenting responsibility presents elders with added stressors. Few studies have systematically examined the impact of caregiving on health outcomes. AIM: The aim of this study was to examine the impact of caregiving on cardiovascular risk. It was hypothesized that caregiving would increase cardiovascular disease risk as measured by Framingham risk scores. SUBJECTS AND METHOD: 386 Luo elders (age = 73+/-8), divided into caregiving and non-caregiving groups, were recruited from the Nyanza Province, Kenya. Data were obtained from the participants including: Total cholesterol, HDL cholesterol, glucose, blood pressure, age, sex and smoking status. RESULTS: No significant difference was found between the Framingham risk scores of caregivers and non-caregivers. Among women increased BMI was positively associated with Framingham score (p=0.017), and among men increased waist circumference was positively associated with the score (p<0.001). Among women, the number of orphans under one's care lowered the risk of falling into the top quartile of the Framingham score while being a caregiver increased the risk of falling into the top quartile. CONCLUSION: This study demonstrates that there is not a simple relationship between caregiving and cardiovascular risk.

Does being an orphan decrease the nutritional status of Luo children?

The HIV/AIDS pandemic is creating a generation of orphaned children in Africa. The number of orphans will continue to increase long after the HIV/AIDS crisis has peaked; therefore, it is important to determine how best to assist these children. Current studies investigating the impact of orphanhood have conflicting results and conclusions. Several studies report that orphans are at a disadvantage and are more likely to suffer from malnutrition, whereas other studies report no difference between the nutritional status of orphans and nonorphans. Four hundred eleven Luo children (mean age 9 +/- 1 years) were recruited to participate in a study investigating the impact of orphanhood on nutritional status. Participants underwent an interview, anthropometric measurements, testing for anemia, a clinical history, and a physical exam. Anthropometric variables and hemoglobin level were compared across groups using a t-test. The reference population used for comparison of anthropometric variables is the 2000 CDC growth reference data. All analyses were gender specific, and the effect of length of orphanhood was also investigated. The data presented here suggest that there is no significant difference between the nutritional status of orphaned and nonorphaned Luo children. This study supports research indicating there is little, if any, difference in nutritional indicators between orphans and nonorphans. Orphans may live in households with higher socioeconomic statuses than nonorphans. Luo orphans may not be at higher risk for poor nutritional status than nonorphans; therefore, interventions targeted at this age group should include both orphaned and nonorphaned children.

Health and health perceptions among Kenyan grandparents.

The dramatic increase in the aging population in developed countries has led to an explosion of research on health and aging in the United States. Few studies, however, have been conducted in developing countries, even though many of these populations are experiencing a faster rate of growth in the 65+ population. Thus, although our knowledge of health and aging has increased, our knowledge of the variation in health as people age is limited. While the numbers of older adults is increasing in Africa, very little is known about the health and well-being of African elders. Recently, a growing number of researchers have focused on the plight of elders who find themselves caring for orphaned grandchildren. While several anecdotal reports have suggested that this new burden negatively impacts their health, there are few studies that systematically examine the health of African elders. As part of the Kenyan Grandparents Study, the health of 287 grandparents (age 73 +/- 8) was examined using multiple methods including objective measures, clinical history, physical examination, and a modified version of the SF-36. Although all health variables were correlated with each other, different patterns were found between predictor variables and the various measures of health. Caregiving status was only associated with mental health, with caregivers having better mental health than non-caregivers. Age was associated with poorer health as measured by several SF-36 scales, physical exam, and body mass index (BMI). Women generally had a greater number of health complaints and lower quality of life as measured by the SF-36. Higher socioeconomic status was associated with better health as measured by physical exam, clinical history, SF-36, and BMI. Caring for a greater number of orphans was associated with better health on examination but no other measure of health. More social support was associated with better physical function and general health as measured by the SF-36. These data suggest that there is no strong evidence that caregiving results in poor health.

Biological anthropology and aging.

As the number of persons aged 65 and older is increasing dramatically in both developed and developing nations of the world, the health and well-being of elders has become a worldwide public health concern. Although older adults are now found in higher proportions across all cultures, the biology, behavior, and environment vary tremendously across older populations. Biomedical research largely follows a reductionist paradigm separating the domains of culture and biology. Even when health is examined in association with culture and behavior, biomedical researchers largely focus on static unidirectional associations instead of examining the dynamic multidirectional impact of culture, behavior, and the environment on physiology and ultimately health. Since aging and the processes of senescence clearly involve complex interactions among biological, environmental, and cultural domains, anthropologists with a bio-cultural and evolutionary perspective are well-equipped to study variation in aging and senescence. While relatively few biological anthropologists have focused their attention on aging, a growing literature has demonstrated the utility of biocultural approaches to aging. This paper serves as an introduction to a special issue that highlights the core of the biological anthropology of aging.

Factors influencing cortisol level and slope among community dwelling older adults in Minnesota.

Cortisol has frequently been used as a stress marker and has been shown to be elevated in response to laboratory stressors, severe real-life stressors, and daily hassles. Furthermore, variation in cortisol rhythms has been observed in some disease states and may be related to health outcomes. The majority of cortisol and stress research has been conducted on young adults. This study examines factors associated with cortisol level and slope in healthy older adults. Forty-eight older adults from the Twin Cities, MN (age = 76.4 +/- 5.8) were interviewed regarding health, stress, affect, and social networks. Participants collected saliva every two hours over a three-day period while keeping a record of their emotions and activities. Cortisol was assayed by radioimmunoassay. Data were analyzed using a random mixed effects model and linear regression. In univariate models cortisol was associated with age (p < 0.0001), time of day (p < 0.001), stress level (p = 0.01), positive affect measured in interview (p = 0.005), positive mood state (p < 0.0001), negative mood state (p = 0.09), and morningness (p = 0.0006). In multivariate models, affect was no longer significantly associated with cortisol. Age (p < 0.001), morningness (p = 0.014), physical activity (p = 0.017), and hours slept (p < 0.001) predicted cortisol slope. These results suggest that while cortisol reactivity to current mood and daily stressors may be diminished in older adults, perception of average stress on a trait level is predictive of cortisol level. As such, salivary cortisol might not be a good marker of acute stress in older adults, while still valuable to measure stress over a longer period of time.

Blood pressure variation in the institutionalized elderly.

Ambulatory blood pressure (ABP) monitoring has been used to examine stress responses in a variety of settings and populations, demonstrating that both the environment and activities influence BP. Little is known, however, about the effects of such factors on the BP of elders, particularly those in institutional settings. This paper examines sources of variation in BP among elders living in two long-term care settings. Twenty-seven residents of a nursing home (NH) facility and 29 residents from independent living (IL) facilities wore ABP monitors for approximately 24-hours. Individual pressures were transformed to z-scores and analyzed by ANOVA. Posture, mood and activity were significantly associated with systolic BP among IL while location and activity were significantly associated among NH. Posture and activity were associated with diastolic BP among IL residents. The specific effects of location, posture, and activity did not differ across settings.

Biological anthropology of aging--past, present and future.

Biological anthropologists have a strong tradition of studying growth and development and research on aging has been limited. This paper explores the past and current contribution of biological anthropologists to the field of aging through an examination of the American Journal of Physical Anthropology (AJPA) and the American Journal of Human Biology (AJHB). It is clear from this survey that biological anthropologists and human biologists have predominantly studied growth and developmental processes relative to aging. However, there is a trend of increasing interest in aging over time. In the AJHB, papers discussing chronic disease were predominant, followed by reproductive aging (19%), bone aging (15%) and body composition (10%). Within the AJPA, the majority of articles were in the field of human biology (43%) and bioarchaelogy (42%) with a lesser contribution from primatology (14%) and dermatogliphics (1%). Biological anthropologists still have great potential to make contributions to gerontology with our evolutionary and holistic perspectives and focus on cross-cultural research.

Screening, education, and associated behavioral responses to reduce risk for falls among people over age 65 years attending a community health fair.

BACKGROUND AND PURPOSE: Because of the high risk of falling and the recognition that falling is a "geriatric syndrome," screening for risk of falls has become popular at community health fairs. The purposes of this study were to determine whether health fair screening and educational intervention would result in behaviors that could reduce the risk of falls and to determine whether adoption of risk-reduction behaviors differed between people over age 65 years screened as being at high risk for falls and those screened as being at lower risk for falls. SUBJECTS AND METHODS: The Berg Balance Test was used to classify fall risk in 68 individuals aged 57 to 89 years who were attending a community health fair. A score of 45 or lower led to a categorization of the person being at high risk for falls. All subjects were provided recommendations intended to reduce fall risk. Participants were interviewed by telephone 30 days after the screening to assess implementation of these recommendations. RESULTS: Seventy-two percent of the participants reported implementing at least one risk-reduction behavior. The high-risk group was more likely to implement risk-reduction behaviors than the low-risk group. DISCUSSION AND CONCLUSION: Screening and education in a health fair setting appear to promote behaviors that could reduce fall risk among elderly people. Future study with a control group that does not receive an educational intervention is needed to draw more definite conclusions about the value of this health promotion activity for fall prevention.

Diurnal blood pressure patterns in long-term care settings.

BACKGROUND: Some research suggests that individuals whose blood pressure does not decline at night may be at increased risk of end-organ damage. Few studies have examined ambulatory blood pressure among elders, particularly those living in institutions. This study therefore evaluates ambulatory blood pressure variation in two groups of institutionalized elderly, independent living and nursing home residents. It was suggested that the nursing home sample would have a higher rate of non-dipping than the independent-living residents. DESIGN AND METHODS: Twenty-seven residents (aged 87 +/- 8 years) of a nursing home facility and 29 residents (aged 80 +/- 6 years) from two independent living facilities wore ambulatory monitors for approximately 24 h. Several definitions of dipping were examined. RESULTS: Neither mean daytime nor mean night-time systolic blood pressure differed between the two groups. Daytime diastolic blood pressure was significantly higher in the independent living sample, as was night-time diastolic pressure in the nursing home residents. Neither asleep nor awake blood pressure varied significantly between groups. The decline in night-time blood pressure and sleep blood pressure was significantly greater among the independent living residents (P < 0.05). Ratios of night-time/daytime and asleep/awake blood pressure were significantly higher in the nursing home group. Non-dippers were significantly more frequent among the nursing home residents. CONCLUSIONS: Nursing home residents were significantly more likely to be non-dippers. Both groups of resident were more frequently non-dippers than were individuals in community-dwelling samples. The high prevalence of non-dipping among institutionalized elderly people may be a result of age, health status or institutional activity patterns.