Geo-spatial risk factor analysis for drug overdose death in South Florida from 2014 to 2019, and the independent contribution of social determinants of health.

PURPOSE: The physical environment and social determinants of health have been shown to influence health behaviors including drug use and fatal drug overdose. The current research examines the effects of the built environment, social determinants of health measures and aggregated risk from the built environment at neighborhood-level on drug overdose death locations in Miami-Dade County, Florida. METHODS: Risk Terrain Modeling (RTM) was used to assess the place features risk factors that significantly increase the risk of drug overdose death spatially in Miami-Dade County ZIP Code Tabulation Areas, Florida from 2014 to 2019. An aggregated neighborhood risk of fatal drug overdose measure was developed by averaging the risk per grid cell from the RTM within census block groups each year. Six logistic and zero-inflated regression models were built to examine the effects of three indices of incident-specific social determinants of health (IS-SDH) measures and aggregated risk measures separately, and simultaneously on drug overdose death locations each year. RESULTS: Seven place features including parks, bus stops, restaurants and grocery stores were significantly related to the occurrence of fatal drug overdoses. When examined separately, one or more indices of the IS-SDH were significant covariates of drug overdose locations in some years. When examined simultaneously, the three indices of the IS-SDH and aggregated risk of fatal drug overdose measure could be all significant in certain years. CONCLUSIONS: The patterns of high-risk areas and place features identified from the RTM related to drug overdose deaths may be used to inform the placement of treatment and prevention resources. A multi-factor approach that combines an aggregated neighborhood risk measure reflecting the risk from the built environment and the incident-specific social determinants of health measures can be used to identify the drug overdose death locations in certain years.

Lessons from digital technology-enabled health interventions implemented during the coronavirus pandemic to improve maternal and birth outcomes: a global scoping review.

BACKGROUND: Timely access to essential obstetric and gynecologic healthcare is an effective method for improving maternal and neonatal outcomes; however, the COVID-19 pandemic impacted pregnancy care globally. In this global scoping review, we select and investigate peer-reviewed empirical studies related to mHealth and telehealth implemented during the pandemic to support pregnancy care and to improve birth outcomes. METHODS: We searched MEDLINE and PubMed, Scopus, CINAHL and Web of Science for this Review because they include peer-reviewed literature in the disciplines of behavioral sciences, medicine, clinical sciences, health-care systems, and psychology. Because our investigative searches reviewed that there is considerable 'grey literature' in this area; we did not restrict our review to any study design, methods, or place of publication. In this Review, peer-reviewed preprints were comparable to published peer-reviewed articles, with relevant articles screened accordingly. RESULTS: The search identified 1851 peer reviewed articles, and after removal of duplicates, using inclusion and exclusion criteria, only 22 studies were eligible for inclusion in the review published from January 2020 to May 2022. mHealth interventions accounted for 72.7% (16 of 22 studies) and only 27.3% (6 of 22 studies) were telehealth studies. There were only 3 example studies that integrated digital technologies into healthcare systems and only 3 studies that developed and evaluated the feasibility of mobile apps. Experimental studies accounted 68.8% of mHealth studies and only 33.3% studies of telehealth studies. Key functionalities of the pregnancy apps and telehealth platforms focused on mental and physical wellness, health promotion, patient tracking, health education, and parenting support. Implemented interventions ranged from breastfeeding and selfcare to behavioral health. Facilitators of uptake included perceived benefits, user satisfaction and convenience. Mobile apps and short messaging services were the primary technologies employed in the implemented mHealth interventions. CONCLUSION: Although our Review emphasizes a lack of studies on mHealth interventions and data from pregnant women during the COVID-19 crisis, the review shows that implementation of digital health interventions during emergencies are inevitable given their potential for supporting pregnancy care. There is also a need for more randomized clinical trials and longitudinal studies to better understand the effectiveness and feasibility of implementing such interventions during disease outbreaks and emergencies.

Geographic disparities in violent crime during the COVID-19 lockdown in Miami-Dade County, Florida, 2018-2020.

Objectives: This study uses two cluster detection techniques to identify clusters of violent crime during the 3 months of the 2020 COVID-19 lockdown in Miami-Dade County compared to that during an equivalent period in 2018 and 2019. Methods: Violent crime data from the Miami-Dade Central Records Bureau were analyzed. The Local Indicators of Spatial Association statistics and a space-time permutation statistic were used to identify clusters of violent crimes and outliers, and Global Moran's I tool was used to assess spatial patterning in violent crime. Neighborhood disadvantage data were obtained from the American Community Survey 5-year estimates linked with arrest locations. Results: Violent crime arrests fell by 7.1% in 2020. Arrests were concentrated in predominantly Black disadvantaged neighborhoods in the northern part, and similar results were produced for core clusters by the two cluster techniques with positive global Moran's I for all study years. Although accounting for only 17% of the county population, nearly half of violent crime arrests were for Black or African American. Males comprised most violent crime arrests. Conclusions: Crime prevention and intervention efforts should be focused on both high-risk places and offenders.

Knowledge, attitudes, and practices towards mosquito control and used vehicle tire dumping by median household income, in metropolitan New Orleans, Louisiana.

Background: Discarded vehicle tires are an important artificial habitat for the larvae of many container-breeding mosquito species worldwide, including in the United States. Unmanaged discarded vehicle tires create health, environmental and social costs, and with budget and staffing constraints, effective management of discarded used vehicle tires a mosquito larval habitat depends in part on the knowledge, attitude, and practices (KAP) of community residents. Objectives: This study aims to examine the knowledge, attitude and practices of New Orleans, Louisiana residents toward illegally discarded vehicle tires, and larval mosquito control. Methods: A descriptive cross-sectional design study was used where 422 households were selected using a two-stage cluster random sampling procedure in New Orleans, Louisiana. Heads of households or a person aged 18 years or older self-administered the survey. The questionnaire comprised five parts: screening, tire sightings, preferred communication method, knowledge, attitude and precautionary measures against mosquito control, disease risk and illegal discarding. We then statistically compared above and below median income household responses to identify likely causes of detected differences. The data were analyzed using ordinal regression models via IBM SPSS statistics V.26.0. Statistical significance was set at p < 0.05. Results: Out of 290 responding households, 95.5% strongly agree or agree that mosquitoes can spread serious diseases like West Nile, Zika or Dengue. Only 2.3% of the sample had high knowledge of illegally discarded tires dumping and mosquito larval control. Those employed were 1.0 times more likely to possess good knowledge than the unemployed (p < 0.001). Despite low knowledge levels regarding mosquito breeding and polluted water in discarded tires, 29.9% of respondents had positive attitude and 20.5% reported sufficient practices. Among the socio-demographic variables, only home ownership and being employed were predictors of knowledge and attitude towards mosquito breeding in illegally discarded tires (p < 0.05). Conclusions: Despite the observed increasing number of illegally discarded vehicle tires in New Orleans, the knowledge of people about illegal tire dumping and their associated risk factors as suitable larval habitants was low. Therefore, there is a need for developing community-based and place-based tailored sensitization campaigns to prevent illegal used tire dumping, and larval control.

The impact of COVID-19 on service delivery systems: evidence from a survey of United States refugee resettlement agencies.

BACKGROUND: Key to the US refugee resettlement effort is the role of non-governmental organizations (NGOs) who receive, place, and provide transitional programs and referrals to new and recently resettled refugees. Yet only one rapid assessment study thus far examined the impact of COVID-19 on service delivery systems of US refugee resettlement agencies. This exploratory study describes the capability and preparedness of US refugee resettlement agencies to provide services and care to clients during the COVID-19 pandemic. METHODS: Using both telephone interviews and an internet survey, we assessed the impact of COVID-19 on service delivery, agency capacity, and preparedness of 101 US refugee resettlement agencies. Descriptive statistics were used to describe the dataset, while chi-square (χ2) tests were used to examine relationships by resettlement agency size (number of employees in each agency). RESULTS: Despite a temporary pause on refugee admissions, restrictive stay-at-home orders, and refugee travel restrictions, the majority of responding US refugee resettlement agencies continued to provide specialized services and care to resettled refugees and other immigrants. Among the more important findings was that agencies that continued to provide refugee services and care onsite in their existing facilities or office rather than moving such services offsite differed by agency size [χ2 (9.494, n = 101), p < 0.05]. Almost all agencies (93.1%) strongly agreed or agreed that staff have timely access to COVID-19 information. Most of the refugee services were provided offsite (n = 72 agencies, some with multiple offices across the US). CONCLUSIONS: US refugee resettlement agencies continued to perform admirably despite a lack of funding. Future research is underway to obtain a more balanced understanding of the impact of COVID-19 on practice or operations.

A proposed framework for the development and qualitative evaluation of West Nile virus models and their application to local public health decision-making.

West Nile virus (WNV) is a globally distributed mosquito-borne virus of great public health concern. The number of WNV human cases and mosquito infection patterns vary in space and time. Many statistical models have been developed to understand and predict WNV geographic and temporal dynamics. However, these modeling efforts have been disjointed with little model comparison and inconsistent validation. In this paper, we describe a framework to unify and standardize WNV modeling efforts nationwide. WNV risk, detection, or warning models for this review were solicited from active research groups working in different regions of the United States. A total of 13 models were selected and described. The spatial and temporal scales of each model were compared to guide the timing and the locations for mosquito and virus surveillance, to support mosquito vector control decisions, and to assist in conducting public health outreach campaigns at multiple scales of decision-making. Our overarching goal is to bridge the existing gap between model development, which is usually conducted as an academic exercise, and practical model applications, which occur at state, tribal, local, or territorial public health and mosquito control agency levels. The proposed model assessment and comparison framework helps clarify the value of individual models for decision-making and identifies the appropriate temporal and spatial scope of each model. This qualitative evaluation clearly identifies gaps in linking models to applied decisions and sets the stage for a quantitative comparison of models. Specifically, whereas many coarse-grained models (county resolution or greater) have been developed, the greatest need is for fine-grained, short-term planning models (m-km, days-weeks) that remain scarce. We further recommend quantifying the value of information for each decision to identify decisions that would benefit most from model input.

Fighting mosquito bite during a crisis: capabilities of Florida mosquito control districts during the COVID-19 pandemic.

BACKGROUND: The stay-at-home orders imposed in early April 2020 due to the COVID-19 pandemic in various states complicated mosquito control activities across the United States (US), and Florida was no exception. Mosquito control programs are the first line of defense against mosquito-borne pathogens. The purpose of this study was to examine the capabilities of Florida mosquito programs to implement key mosquito measures during the COVID-19 pandemic lockdown. METHODS: Using a self-administered online survey, we examined the capabilities of all Florida mosquito control programs (both state-approved mosquito districts, N = 63; and open programs, N = 27) at a time when the state of Florida was still under heightened awareness of, stay-at-home orders and planning a phase 1 reopening over the COVID-19 pandemic (June to July 2020). The final sample included mosquito control programs structured as the Board of County Commissioners (BOCC) (n = 42), independent tax district (n = 16), municipal (n = 10), and health or emergency department (n = 5). We used descriptive statistics to summarize information about the characteristics of responding programs, their implemented mosquito control and surveillance activities.  wWe used bivariate analysis to compare the characteristics of responding programs and the self-reported mosquito measures. RESULTS: Of the recruited mosquito control programs, 73 completed the survey (81.1% response rate; 73/90). Of these, 57.5% (n = 42) were Board of County Commissioners (BOCC) mosquito control programs, 21.9% (n = 16) were independent tax district programs, 13.7% (n = 10) were municipal mosquito control programs, and only 6.8% (n = 5) were either health or emergency department mosquito control programs. Except for arbovirus surveillance, most programs either fully or partially performed larval (61.8%) and adult (78.9%) surveillance; most programs conducted species-specific control for Aedes aegypti (85.2%, n = 54), Aedes albopictus (87.3%, n = 55), Culex quinquefasciatus (92.1%, n = 58), and Culex nigripalpus (91.9%, n = 57). CONCLUSIONS: Findings underscore the importance of ongoing mosquito control activities, and suggest that Florida mosquito control programs are vigilant and have significant capability to handle potential mosquito-borne disease threats, but arbovirus surveillance systems (laboratory testing of mosquito pools and testing of human and nonhuman specimens for arboviruses) are needed during pandemics as well.

The Association Between the Social Determinants of Health and HIV Control in Miami-Dade County ZIP Codes, 2017.

BACKGROUND: There were 28,055 people living with HIV (PLWH) in Miami-Dade County (MDC) in 2017; 40.1% was either out of care or was not virally suppressed (uncontrolled HIV). The purpose of this study was to determine the association between the social determinants of health (SDOH) and the number of persons with uncontrolled HIV in MDC. SETTING: This cross-sectional study included PLWH 15 and older with uncontrolled HIV in MDC, 2017. Data on PLWH's viral load, age, gender, mode of HIV transmission, and race/ethnicity were aggregated to the ZIP code level. All five SDOH per HealthyPeople 2020 were represented: economic stability, education, social and community context, health and healthcare, and neighborhood and built environment. METHODS: Descriptive analyses on all study variables and a principal component analysis on the SDOH variables were performed. To account for overdispersion, multivariate negative binomial regressions were run while controlling for confounders and testing for significant interactions. RESULTS: The results of the regression analysis indicated that an increase in Factor 1 (economic stability, education, and health and healthcare determinants) was associated with a statistically significant increase in the number of PLWH with uncontrolled HIV. Additionally, we found a significant interaction between Factor 1 and White race. Among persons of low socioeconomic status, White race is associated with a reduction in PLWH with uncontrolled HIV. CONCLUSIONS: These results suggest that reducing poverty and increasing education and rates of health insurance should result in significant reductions in PLWH with uncontrolled HIV. These results have the potential to influence future policy, interventions for retention, adherence, and continuity of care to improve suppression rates in MDC.

Variation in Risk of COVID-19 Infection and Predictors of Social Determinants of Health in Miami-Dade County, Florida.

Miami-Dade County zip code-level (N = 91 zip codes) coronavirus disease 2019 (COVID-19) cases (N = 89,556 as of July 21, 2020) reported from the Florida Department of Health were used to estimate rates of COVID-19 per 1,000 population at the census block group level (N = 1,594 study block groups). To identify associations between rates of COVID-19 infections and multidimensional indexes of social determinants of health (SDOH) across Miami-Dade County, Florida, I applied a global model (ordinary least squares) and a local regression model (geographically weighted regression). Findings indicated that a social disadvantage index positively affected COVID-19 infection rates, whereas a socioeconomic status and opportunity index and a convergence of vulnerability index had an inverse but significant connection to COVID-19 infection rates over the study area. Rates of COVID-19 infections were localized to specific geographic areas and ranged from 0 to 60.75 per 1,000 population per square mile.

Youth and weapons: Patterns, individual and neighborhood correlates of violent crime arrests in Miami-Dade County, Florida.

This study uses arrest data from the Miami-Dade County Police Department (n = 13 districts) for 2014-2017 to identify census tracts in which weapon violence arrests among young people aged 10-24 is high, and models area-level predictors of the total number of violent weapons crimes by census tract (greenness and socioeconomic status indices, population density and weapon dealers), after adjusting for arrestee-level factors (age, race and gender). Combined, handguns and firearms accounted for 23.2% (n = 1330) of all arrests (including murder and non-negligent manslaughter, rape, robbery, and aggravated assault). Arrests for weapon -related violent crime are concentrated in census tracts located in the north and south neighborhoods of Miami-Dade County. Findings indicate that arrestee factors and a neighborhood greenness index are more important than population density, weapon dealers and poverty in predicting arrests for weapon-related violent crime at the census tract level.

A Survey of Program Capacity and Skills of Florida Mosquito Control Districts to Conduct Arbovirus Surveillance and Control.

Effective and efficient surveillance systems are key for preventing arthropod-borne diseases. We examined the capacity of Florida mosquito control districts (both state-approved and open programs, n = 90; 48.9% response rate). Questions centered on budgets, staffing levels, equipment, vector control measures, and staff perceptions of own agency's capacity to implement routine surveillance and vector control activities. Bivariate analyses indicate that districts with relatively large budgets have advanced capacities regarding staffing levels, employee specialties, mosquito control equipment, conduct routine surveillance and vector control yet they serve only a small proportion of the population. Independent tax districts' average annual budgets were 9 times higher than Board of County Commissioners programs in fiscal year 2017-18. Most respondents indicated that staff is appropriately trained, and has timely access to information and needed equipment for mosquito surveillance and control. Slightly more than half of respondents feel they are understaffed. Perceived understaffing may compromise mosquito surveillance and control efforts in some districts.

Alcohol use, pregnancy and associated risk factors: a pilot cross-sectional study of pregnant women attending prenatal care in an urban city.

BACKGROUND: Alcohol consumption during pregnancy is associated with adverse pregnancy outcomes such as preventable alcohol-related developmental disability fetal alcohol syndrome. In Zambia, alcohol use and associated risk factors have not been investigated, and screening in prenatal care is nonexistent. This study determined individual correlates and the prevalence of alcohol use in pregnant women attending prenatal care at two health clinics in Lusaka, Zambia. METHODS: A study adopted a cross-sectional design and recruited 188 pregnant women after seeking their informed consent from July 19 to 31, 2017. Participants aged 18 or over completed the T-ACE (Tolerance, Annoyance, Cut Down and Eye Opener) screening tool and validated alcohol-screening questionnaires on self-reported alcohol use periconceptional and during conception period while at their regular prenatal visit. The T-ACE screening tool assessed the risk of alcohol dependence in four short questions. The questionnaires included demographic questions. Bivariate analyses were performed using the χ2 test for dichotomous variables and the t-test for continuous variables. Mixed-effects linear models were used to evaluate the effect of outcome variables with patient-level variables. RESULTS: About 40 (21.2%) pregnant women were identified by the T-ACE as at-risk for problem drinking during pregnancy. Except for regular prenatal care and distance, there was no difference in the demographic factors between pregnant women who scored < 2 on the T-ACE and those that scored > 2 points (all p's > 0.05). A small proportional of women at both clinics reported binge drinking during the periconceptional period (12.7% vs. 3.2%, p = 0.003) and beyond periconception period. Excluding employed women, no significant relationships were observed between alcohol use and demographic factors. CONCLUSION: Alcohol consumption is prevalent in the periconceptional period and during pregnancy in pregnant women attending prenatal care in Zambia. Findings underscore the need for targeted alcohol use screening and intervention for pregnant women.

Geographic gender differences in traumatic unintentional injury hospitalization and youth drinking.

INTRODUCTION: Few studies have used both spatial and non-spatial techniques to the study of alcohol outcomes. The objectives of this study were to identify clusters of traumatic unintentional injury hospitalizations by gender and blood alcohol concentration (BAC), and to determine trends and correlates by BAC levels. METHODS: State Trauma Registry data capturing unintentional injuries for those aged 10 to 24 hospitalized with negative and positive BAC levels (n = 6233) were analyzed from 2006 to 2015 for all Chicago block groups. Spatial clustering techniques were applied to detect spatial clusters and Generalized Estimating Equations to determine correlates and trends while controlling for correlation within block groups. RESULTS: Regardless of BAC level, hospitalization rates decreased for all age groups between 2006 to 2010 and 2011 to 2015 from 94.41 to 67.69 per 100,000 population. The decline for males hospitalized with positive BAC was 1.4 times greater than the decline for their female counterparts. Risk factors included being male, black or of a minority race, having no private insurance and living in a disadvantaged neighborhood. Male hospitalization rates clustered among 33 census block groups located in three Chicago Community Areas. No clustering was detected for female patients. Motor vehicle accidents were the leading cause of hospitalization. CONCLUSIONS: Hospitalizations are decreasing in Chicago, yet the risk is concentrated, with greater decreasing rates among males than females. Spatial approaches can be valuable tools in analyzing substance abuse outcomes, to identify high-risk areas and shifts in risk within a large geographic area.

Correction to: Patient-level factors are more salient than a legislation prohibiting minors in bars in predicting unintentional injury hospitalizations.

It was highlighted that in the original article [1] Fig. 1 and Fig. 2 were interchanged.

Increase in Obesity Among Women of Reproductive Age in Zambia, 2002-2014.

Objective: To describe trends in obesity in Zambian women of reproductive age and to identify factors that may have contributed to changes in trends and nutrition outcomes. Materials and Methods: We obtained data on body mass index and individual factors of women from the Zambia Demographic and Health Survey for the period 2002 to 2014. From these data, we calculated descriptive statistics and examined the extent to which factors link to the odds of obesity over time. We also reviewed primary and secondary data sources, such as government documents, theses, and search engines to identify factors that may have contributed to trends and changes in nutrition outcomes. Results: The proportion of obesity doubled from 2002 (12.5%) to 2014 (22.3%). The odds were higher among educated, currently married and wealthy women, and it increased with age. Rural residence and working in agricultural-related jobs were linked to lower odds for obesity. This disparity varies by province. In addition, despite the presence of many nutrition policies and strategies, the increase in obesity occurred within the past two decades when urbanization and other factors (e.g., sedentary work, a proliferation of fast food restaurants, and advertisements) may have affected changes in nutrition outcomes for women. Conclusions: We identified increasing trends in obesity in women of reproductive age over time. The rapid urbanization and other factors that occurred in Zambia during this period are significant risk factors for obesity in Zambian women. The findings will be of interest to countries that are undergoing a nutrition transition.

Rescuing Troves of Hidden Ecological Data to Tackle Emerging Mosquito-Borne Diseases.

Despite the major impact of mosquitoes on human health, knowledge gaps exist regarding their natural population dynamics. Even the most basic information-such as spatiotemporal abundance-is mostly unavailable. In the USA, municipalities have created agencies for mosquito control and monitoring, yet no national open-access repository for mosquito surveillance data exists. Vectors, and the pathogens they transmit, know no jurisdictions. We identify >1,000 mosquito control agencies and identify those which make their population abundance surveillance data publicly available. We directly survey Floridian mosquito districts to estimate, from one state alone, the potential amount of hidden data. We generate a large, standardized data set from publicly available online data and demonstrate that spatiotemporal population abundance can be reconstructed and analyzed across data generators. We propose that the ensemble of US mosquito control agencies can, and should, be used to develop a national-and potentially international-open-access repository of mosquito surveillance data, generating the data capital needed to gain a mechanistic understanding of vector population dynamics, and identify existing digital infrastructure that could be leveraged for digitizing and collating extant and future surveillance data for such a repository.

Patient-level factors are more salient than a legislation prohibiting minors in bars in predicting unintentional injury hospitalizations.

BACKGROUND: Alcohol related homicide, suicide and aggravated assault represent the largest costs for the state of Illinois. Previous research has examined the impact of some alcohol-related policies on youth alcohol use and alcohol-related harm in the United States but findings have been mixed. To our knowledge, no study has provided a detailed epidemiology of the relationship between the impacts of alcohol policies on unintentional injury in Illinois. Therefore, the purpose of this study is to determine whether a legislation that prohibit minors under 21 years old in establishments that serve alcohol is more salient than individual level factors in predicting hospitalization for traumatic unintentional injuries. METHODS: A retrospective observational study of data abstracted from 6,139 patients aged 10 to 19 hospitalized in Illinois Level I and Level II trauma centers. Patient data from 2006 to 2015 was linked with the city-level alcohol-related legislation (n = 514 cities). The response variable was whether a patient tested positive or negative for blood alcohol concentration (BAC) at the time of admission. Mixed-effects logistic regression analyses were conducted to model the patient and city level legislation effect of having a positive BAC test result on hospitalizations after adjusting for the legislation and patient factors. RESULTS: After adjustment, patients aged 15 to 19 and white patients who tested positive for BAC at the time of admission had the greater odds of hospitalization for traumatic alcohol-related unintentional injuries compared to patients who had a negative BAC test result. However, odds of hospitalization decreased for female patients and for those with private insurance, and over time, but a significant decrease in such hospitalizations occurred during 2010, 2014 and 2015. The alcohol-related legislation of interest was not a significant predictor of traumatic alcohol-related unintentional injury hospitalization. CONCLUSIONS: Patient-level covariates were significant predictors of traumatic alcohol-related unintentional injury hospitalization; an alcohol-related legislation may not reduce hospitalizations for young patients aged 10 to 19. Therefore, to prevent underage drinking and consequences, interventions should target sex/gender, race/ethnicity and focus on both individual and environmental strategies.

Adolescent and young adult couples' views of intravaginal practices: a qualitative analysis of a pilot study.

PURPOSE: In this study, we evaluated the risk behaviors that are drivers of the HIV epidemic among adolescent girls and young women in Zambia using a focus group research technique. SUBJECTS AND METHODS: Eighteen adolescent couples (n=18 females and 18 males) aged 16-24 participated in six focus groups discussions (3 per gender) convened at three health facilities in Lusaka, Zambia. Focus group moderators utilized a set of open-ended questions to guide the 60-minute sessions. The focus group audio recordings were transcribed, coded, and analyzed using qualitative content analysis in Nvivo 11. RESULTS: Three themes and four subthemes were identified relating to adolescent and young adult couples' knowledge, views, and male partner attitudes toward intravaginal practices (IVPs). The first theme, knowledge and rationale for IVPs, consisted of the subthemes relating to why adolescents and young adult couples engage in IVPs and assessed their knowledge of health risks associated with IVPs. The second theme, attitudes toward IVPs, consisted of the subtheme willingness to stop or support partner to discontinue IVP and practices toward IVP and strategies for changing. The third theme, strategies for changing IVPs, consisted of the subtheme raise awareness. CONCLUSION: IVPs used for cleaning purposes were perceived as essential to enhancing hygiene, health, and sexual satisfaction for both girls and boys. However, couples expressed concern about the health effects of IVPs used for tightening and a desire for learning more about this practice as well as stopping it.

Causes of Morbidity and Mortality among Neonates and Children in Post-Conflict Burundi: A Cross-Sectional Retrospective Study.

The risk of a child dying before age five in Burundi is almost 1.6 times higher than that in the World Health Organization (WHO) African region. However, variations in the all-cause mortality rates across Burundi have not yet been measured directly at subnational levels, age group and by gender. The objective of this study was to describe the main causes of hospitalization and mortality in children during the neonatal period and at ages 1 to 59 months, for boys and girls, and to assess the total annual (2010) burden of under-five morbidity and mortality in hospitals using hospitalization records from 21 district hospitals. We found variation in the gender and regional distribution of the five leading causes of hospitalization and death of children under five. Although the five causes accounted for 89% (468/523) of all neonatal hospitalizations, three causes accounted for 93% (10,851/11,632) of all-cause hospitalizations for children ages 1 to 59 months (malaria, lung disease, and acute diarrhea), malaria accounted for 69% (1086/1566) of all deaths at ages 1 to 59 months. In Burundi, human malarial infections continue to be the main cause of hospitalization and mortality among under-five children.