Tobacco use and associated factors among adults reside in Arba Minch health and demographic surveillance site, southern Ethiopia: a cross-sectional study.

BACKGROUND: Tobacco use is one of the world-leading preventable killers. There was a varied prevalence of tobacco use and cigarette smoking across different areas. The aim of the study was to assess the prevalence and factors associated with current tobacco use among adults residing in Arba Minch health and demographic surveillance site (HDSS). METHODS: A community-based cross-sectional study was conducted among adults residing in Arba Minch HDSS in 2017. The estimated sample size was 3368 individuals which were selected by simple random sampling techniques using Arba Minch HDSS dataset. Data collection tools were obtained from the WHO STEPwise. Current use of tobacco, which defined as the current use of smoked and/or smokeless tobacco, was considered as the dependent variable. A binary logistic regression model was used to identify candidate variables for the multivariable logistic regression model. An adjusted odds ratio (AOR) at a p-value of less than 0.05 was used to determine a statistically significant association between independent and dependent variables. RESULT: The prevalence of tobacco use among adults was 20.2% (95% CI: 18.9-21.6%). The current use of smoked and smokeless tobacco were 17.1% (95%CI: 15.8-18.4%) and 9.7% (95%CI: 8.8-10.8%), respectively. The current use of tobacco was significantly associated with sex (female [AOR 0.54; 95%CI: 0.42-0.68] compared to men), age group (35-44 [AOR 1.57; 95%CI: 1.14-2.17], 45-54 [AOR 1.99; 95%CI: 1.45-2.74], and 55-64 [AOR 3.26; 95%CI: 2.37-4.48] years old compared to 25-35 years old), physical activity (moderate physical activity level [AOR 0.65; 95%CI: 0.44-0.96] compared with low) and residency (highland [AOR 4.39; 95% CI: 3.21-6.01] compared with at lowlander). Also, heavy alcohol consumption (AOR 3.97; 95% CI: 3.07-5.12), and Khat chewing (AOR 3.07(95%CI: 1.64-5.77) were also associated with the use of tobacco among the study participants. CONCLUSION: Nearly one in five adults used tobacco currently in the study area, which is more than the national reports. Interventions for the reduction of tobacco use need to give due attention to men, older adults, uneducated, poor, and highlanders.

Adaptation and validation of UNICEF/Washington group child functioning module at the Iganga-Mayuge health and demographic surveillance site in Uganda.

BACKGROUND: The UNICEF/Washington Group Child Functioning Module (CFM) assesses child functioning among children between 5 and 17 years of age. This study adapted and validated the CFM at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Uganda. METHODS: This cross-sectional study was conducted between September 2018-January 2019 at the IM-HDSS. Respondents were caregivers of children between 5 and 17 years of age who were administered modified Washington Group short set (mWG-SS) and CFM. The responses were recorded on a 4-point Likert scale. Descriptive analysis was conducted on child and caregiver demographic characteristics. Exploratory factor analysis (EFA) assessed underlying factor structure, dimensionality and factor loadings. Cronbach's alpha was reported as an assessment of internal consistency. Face validity was assessed during the translation process, and concurrent validity of CFM was assessed through comparison with disability short form. RESULTS: Out of 1842 caregivers approached, 1439 (78.1%) participated in the study. Mean age of children was 11.06 ± 3.59 years, 51.4% were males, and 86.1% had a primary caregiver. Based on EFA, vision, hearing, walking, self-care, communication, learning, remembering, concentrating, accepting change, behavior control, and making friends loaded on factor 1 - "Motor and Cognition," while anxiety and depression loaded on factor 2 - "Mood". Cronbach's alpha for the overall CFM was 0.899 (good internal consistency). Cronbach's alpha for each extracted factor was excellent, motor and cognition (0.904), and mood (0.902). CFM had acceptable face validity. Spearman's rank correlation between scores of CFM and modified WG short set was 0.51 (p-value < 0.001). The overall mean CFM score was 2.47 ± 3.82 out of 39. The mean score for Mood (1.35 ± 1.42 out of 6) was higher compared to Motor and Cognition (1.12 ± 3.06 out of 33). Comparing modified WG short set and CFM Likert responses, the percent agreement was greatest for "cannot do at all." CONCLUSION: CFM is a two-factor, valid and reliable scale for assessing disability in Uganda and can be applied to other similar settings to contribute towards disability data from the region. It is an easy-to-administer tool that can help in deeper understanding of context-specific burden and extent of disability in children between 5 and 17 years of age.

Trends and Associated Factors of Under-five Mortality Based on 2008-2016 Data in Kersa Health and Demographic Surveillance Site, Eastern Ethiopia.

Background: Of the 6.2 million estimated deaths of children under 15 years of age globally, the death toll of children under 5 years of age accounted for 5.3 million. In Ethiopia, even though significant progress has been made, facility-based research shows that the mortality rate of children under 5 is still high. In the country, particularly in the eastern part, evidence on trends in under-five mortality and associated factors from population-based longitudinal data is limited. Objective: The objective of the study was to assess under-five mortality focusing on the trends and associated factors based on 2008-2016 data in Kersa Health and Demographic Surveillance Site, Eastern Ethiopia. The method: The study was based on 9 years of surveillance data. The surveillance site was founded in 2007 with the aim of producing community-based health and demographic data in the eastern Ethiopia. Data were collected from the surveillance site and analyzed with STATA version 15 (for factor analysis) and/or Statistical Package for Social Sciences (SPSS) version 26 (for trend analysis) and Microsoft (MS) Excel software. The autoregressive integrated moving average (ARIMA) model and Mann-Kendall were used to analyze mortality trends. Multi-level logistic regression was used to assess the associated factors. Result: There were a total of 18 759 newborns in the surveillance sites, of which 1602 died of children under 5 years of age, and the total mortality rate for children under 5 years of age was 85 per 1000 live births. Trend analysis shows that the mortality rate of children under 5 has been steadily declining during the study period. Multi-level logistic regression shows that the variance of the random component model related to the intercept term is statistically significant, which means that there is a change in the mortality rate of children under 5 between the survey years, which is explained by the random intercept term. Antenatal care visits by mothers (AOR = .61, 95% CI = .49, .74), primary education (AOR = .58, 95% CI = .49, .68), normal birth weight (AOR = .78, 95% CI = .64, .95), and having 2 or fewer total births (AOR = .37, 95% CI = .22, .37) were all associated with child death. Conclusion: Despite the downward trend, the mortality rate of children under 5 years old at the surveillance sites is high. Effective intervention measures should be implemented.

Measuring child functioning: Assessing correlation and agreement between caregiver and child responses at the Iganga-Mayuge health and demographic surveillance site in Uganda.

INTRODUCTION: Empirical data is scare on assessment of concordance between caregiver-child responses on child functioning. OBJECTIVE: To assess correlation and agreement between children (11-17 years old) and their caregivers' responses to the UNICEF/Washington Group Child Functioning Module (CFM) at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Uganda. METHODS: CFM with 24-questions corresponding to 13 domains of functioning was administered to children between 11 and 17 years of age and their caregivers. Descriptive analyses of the child/caregiver responses were conducted. Correlation and agreement between caregiver and child responses were assessed. RESULTS: Of the 217 caregiver/child pairs eligible for this study, 181 pairs agreed to participate (83.4%). The mean age of children was 13.9 ± 1.9 years, and 56.4% were males. Cronbach's alpha was 0.892 and 0.886 for the caregiver and child versions of CFM respectively, showing good internal consistency in both. There was a significant overall agreement between mean score of caregiver (5.36 ± 5.63 out of 39) and child (5.45 ± 5.34) pairs. Spearman's rank correlation between the pairs was 0.806 (strong positive correlation). Bland-Altman plots for CFM scores showed greater agreement between caregiver and child at lower scores. Percentage agreement between the pairs for overall disability was greater for mild (83.53%) and moderate (79.37%) categories as compared to the severe (66.67%) category. There was substantial agreement (kappa 0.623) for overall disability between the pairs. CONCLUSION: This study indicates that there is significant correlation and agreement between self-reported caregiver-child pair responses, opening the way for considering children as CFM respondents, when possible.

Self-reported disability in rural Malawi: prevalence, incidence, and relationship to chronic conditions.

Background: Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and communicating) to allow collection of comparable data on disability. We aimed to improve understanding of prevalence and correlates of disability in this low-income setting in Malawi. Methods: This study is nested in the Karonga Health and Demographic Surveillance Site in Malawi; the Washington Group questions were added to the annual survey in 2014. We used cross-sectional data from the 2014 survey to estimate the current prevalence of disability and examine associations of disability with certain chronic conditions. We then reviewed the incidence and resolution of disability over time using panel data from the 2015 survey. Results: Of 10,863 participants, 9.6% (95% CI 9.0-10.1%) reported disability in at least one domain. Prevalence was higher among women and increased with age. Diabetes and obesity were associated with disability among women, and diabetes was also associated with disability among men. Neither hypertension nor HIV were associated with disability. Participants reporting "no difficulty" or "can't do at all" for any domain were likely to report the same status one year later, whereas there was considerable movement between people describing "some difficulty" and "a lot of difficulty". Conclusions: Disability prevalence is high and likely to increase over time. Further research into the situation of this population is crucial to ensure inclusive policies are created and sustainable development goals are met.

Poor glycaemic control and its metabolic and demographic risk factors in a Malaysian community-based study.

OBJECTIVES: The lack of population-based evidence on the risk factors for poor glycaemic control in diabetics, particularly in resource-poor settings, is a challenge for the prevention of long-term complications. This study aimed to identify the metabolic and demographic risk factors for poor glycaemic control among diabetics in a rural community in Malaysia. METHODS: A total of 1844 (780 males and 1064 females) known diabetics aged ≥ 35 years were identified from the South East Asia Community Observatory (SEACO) health and demographic surveillance site database. RESULTS: 41.3% of the sample had poor glycaemic control. Poor glycaemic control was associated with age and ethnicity, with older participants (65+) better controlled than younger adults (45-54), and Malaysian Indians most poorly controlled, followed by Malay and then Chinese participants. Metabolic risk factors were also highly associated with poor glycaemic control. CONCLUSIONS: There is a critical need for evidence for a better understanding of the mechanisms of the associations between risk factors and glycaemic control.

Implementing electronic data capture at a well-established health and demographic surveillance site in rural northern Malawi.

This article aims to assess multiple issues of resources, staffing, local opinion, data quality, cost, and security while transitioning to electronic data collection (EDC) at a long-running community research site in northern Malawi. Levels of missing and error fields, delay from data collection to availability, and average number of interviews per day were compared between EDC and paper in a complex, repeated annual household survey. Three focus groups with field and data staff with experience using both methods, and in-depth interviews with participants were carried out. Cost for each method were estimated and compared. Missing data was more common on paper questionnaires than on EDC, and a similar number were carried out per day. Fieldworkers generally preferred EDC, but data staff feared for their employment. Most respondents had no strong preference for a method. The cost of the paper system was estimated to be higher than using EDC. The existing infrastructure and technical expertise could be adapted to using EDC, but changes have an impact on data processing jobs as fewer, and better qualified staff are required. EDC is cost-effective, and, for a long-running site, may offer further savings, as devices can be used in multiple studies and perform several other functions. EDC is accepted by fieldworkers and respondents, has good levels of quality and timeliness, and security can be maintained. EDC is well-suited for use in a well-established research site using and developing existing infrastructure and expertise.

A community-based prospective cohort study of dengue viral infection in Malaysia: the study protocol.

BACKGROUND: Globally, dengue infections constitute a significant public health burden. In recent decades, Malaysia has become a dengue hyper-endemic country with the co-circulation of the four dengue virus serotypes. The cyclical dominance of sub-types contributes to a pattern of major outbreaks. The consequences can be observed in the rising incidence of reported dengue cases and dengue related deaths. Understanding the complex interaction of the dengue virus, its human hosts and the mosquito vectors at the community level may help develop strategies for addressing the problem. METHODS: A prospective cohort study will be conducted in Segamat district of Johor State in Peninsular Malaysia. Researchers received approval from the Malaysian Medical Research Ethics Committee and Monash University Human Research Ethics Committee. The study will be conducted at a Malaysian based health and demographic surveillance site over a 1 year period in three different settings (urban, semi-urban and rural). The study will recruit healthy adults (male and female) aged 18 years and over, from three ethnic groups (Malay, Chinese and Indian). The sample size calculated using the Fleiss method with continuity correction is 333. Sero-surveillance of participants will be undertaken to identify asymptomatic, otherwise healthy cases; cases with dengue fever who are managed as out-patients; and cases with dengue fever admitted to a hospital. A genetic analysis of the participants will be undertaken to determine whether there is a relationship between genetic predisposition and disease severity. A detailed medical history, past history of dengue infection, vaccination history against other flaviviruses such as Japanese encephalitis and Yellow fever, and the family history of dengue infection will also be collected. In addition, a mosquito surveillance will be carried out simultaneously in recruitment areas to determine the molecular taxonomy of circulating vectors. DISCUSSION: The research findings will estimate the burden of asymptomatic and symptomatic dengue at the community level. It will also examine the relationship between virus serotypes and host genotypes, and the association of the clinical manifestation of the early phase with the entire course of illness.