Voluntary medical male circumcision and educational gradient in relation to HIV infection among sexually active adult men in Eswatini: evidence from the national surveys in 2006-2007 and 2016.

BACKGROUND: To address knowledge gaps, this study examined social determinants, such as education attainment and HIV prevention, among sexually active men (SAM), with a focus on voluntary medical male circumcision (VMMC). METHODS: Two nationally representative surveys, the Eswatini Demographic and Health Survey 2006 and the Eswatini HIV Incidence Measurement Survey 2016, were used to estimate whether or not VMMC at the individual and community levels contributes to HIV disparities to any meaningful extent. Multilevel logistic regression models further explored the educational gradient in HIV infection for 2006-2007 and 2016 with regard to VMMC among SAM, while adjusting for household poverty, sexual practices and individual characteristics. RESULTS: Among SAM with tertiary education, HIV prevalence declined from 25.0% in 2006-2007 to 10.5% in 2016. A 51% decrease in HIV prevalence was found to be associated with an increase in VMMC (adjusted odds ratio 0.49; 95% CI 0.40 to 0.60). Compared with SAM with tertiary education, those who had a lower level of education were more likely to have HIV infection and this education gradient effect had become particularly profound in 2016. CONCLUSIONS: VMMC began to be promoted in 2008 in Eswatini and results suggest its effect, along with the education attainment effect, significantly resulted in a meaningful reduction in HIV prevalence among SAM by 2016.

A large outbreak of COVID-19 linked to an end of term trip to Menorca (Spain) by secondary school students in summer 2021.

BACKGROUND: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in young people from Catalonia (Spain) who travelled to Menorca (Spain) in summer 2021. This outbreak appeared when governments relaxed Covid-19 preventive measures: the mask usage and the opening of nightlife. It was related to a super-disseminating mass event: Sant Joan festivities in Ciutadella. The aim of this article is to describe an outbreak of COVID-19 in young people aged 17-19 years from Catalonia travelling to Menorca. METHODS: This is an observational study of a COVID-19 outbreak. The study population comprised Catalonian youth aged 17-19 years who travelled to Menorca from 15 June to 10 July. Epidemiological descriptive indicators were obtained. Descriptive and geographical statistics were carried out. Bivariate Moran's I test was used to identify spatial autocorrelation between the place of residence and deprivation. The outbreak control method was based on identifying and stopping chains of transmission by implementing the test-trace-isolate-quarantine (TTIQ) strategy. RESULTS: We identified 515 confirmed cases infected in Menorca, 296 (57.5%) in girls and 219 (42.5%) in boys, with a total of 2,280 close contacts. Of them, 245 (10.7%) were confirmed as cases. The cases were diagnosed between 15 June and 10 July. None of the persons with confirmed infection died or required hospitalisation. The attack rate was 27.2%. There was an inverse relationship between deprivation and number of confirmed cases (p<0.005), there were clusters of confirmed cases in the most socioeconomic favoured areas. DISCUSSION: The outbreak is related with young people from socioeconomic favoured areas who travelled to Menorca in summer 2021. Failure to comply with preventive measures in binge-drinking events and during holidays may have favoured SARS-CoV-2 transmission. The interauthority coordination and establishment of a clear line of leadership allowed continuous communication between institutions, which were key to managing this complex COVID-19 outbreak.

A multilevel analysis of the social determinants associated with symptoms of acute respiratory infection among preschool age children in Pakistan: A population-based survey.

BACKGROUND: As advocated by WHO in "Closing the Health Gap in a Generation", dramatic differences in child health are closely linked to degrees of social disadvantage, both within and between communities. Nevertheless, research has not examined whether child health inequalities include, but are not confined to, worse acute respiratory infection (ARI) symptoms among the socioeconomic disadvantaged in Pakistan. In addition to such disadvantages as the child's gender, maternal education, and household poverty, the present study also examined the linkages between the community environment and ARI symptoms among Pakistan children under five. Furthermore, we have assessed gender contingencies related to the aforementioned associations. METHODS: Using data from the nationally representative 2017-2018 Pakistan Demographic and Health Survey, a total of 11,908 surviving preschool age children (0-59 months old) living in 561 communities were analyzed. We employed two-level multilevel logistic regressions to model the relationship between ARI symptoms and individual-level and community-level social factors. RESULTS: The social factors at individual and community levels were found to be significantly associated with an increased risk of the child suffering from ARI symptoms. A particularly higher risk was observed among girls who resided in urban areas (AOR = 1.42; p<0.01) and who had a birth order of three or greater. DISCUSSIONS: Our results underscore the need for socioeconomic interventions in Pakistan that are targeted at densely populated households and communities within urban areas, with a particular emphasis on out-migration, in order to improve unequal economic underdevelopment. This could be done by targeting improvements in socio-economic structures, including maternal education.

Associations Between Early Circumcision, Sexual and Protective Practices, and HIV Among a National Sample of Male Adults in Eswatini.

To reduce HIV incidence in countries such as Eswatini (Swaziland), UNAIDS has recommended male circumcision as one possible effective strategy. We analyzed the 2016s Swaziland HIV Incidence Measurement Survey to explore the association between early circumcision and HIV history among 2964 sexually active adult males aged 15 to 64 years old. Early circumcision was defined as circumcision practiced at an age of 15 years old or younger. Results from logistic regression and OLS regression found that male adults with early circumcision are more likely to have multiple sexual partners and to use condoms. Multiple partners and condom use at last sex encounter remained associated with a higher odds of being HIV positive after controlling for all factors. Nevertheless, early circumcision is significantly associated with a lower odds of being HIV positive (AOR 0.53, p < 0.01). These findings suggest that HIV prevention may benefit when early male circumcision is carried out.

RESUMEN: Con el objetivo de reducir la incidencia de VIH en países como Eswatini (Suazilandia), UNAIDS ha recomendado la práctica de la circuncisión como una estrategia efectiva con este fin. A partir del análisis de la Encuesta de Medición de la Incidencia del VIH en Suazilandia (SHIMS 2), la presente investigación tiene como objetivo explorar la asociación entre la circuncisión a edad temprana (practicada a la edad de 15 años o menos) y la infección por el VIH en 2,964 hombres adultos que son sexualmente activos con edades comprendidas entre 15 y 64 años. Mediante la regresión logística y de mínimos cuadrados ordinarios (ordinary least squares), se encontró que los hombres circuncidados a temprana edad tienden más a tener múltiples parejas sexuales y a usar preservativos. El uso de preservativos en la última relación sexual y el hecho de tener múltiples parejas sexuales permaneció asociado con la infección por el VIH tras ajustar por factores de confusión. La circuncisión a temprana edad se asoció con un menor riesgo de infección por el VIH (OR ajustado=0.53, p<0.01). Estos resultados sugieren que la circuncisión a edad temprana debería tenerse en cuenta como estrategia de prevención del VIH.

Is left-behind status related to differences in sexual health of Armenian mothers? Evidence from the Demographic and Health Survey in 2010 and 2015.

BACKGROUND: Migration caused by poverty is a growing public health issue around the world. Migrants are at heightened risk of HIV/STIs and yet the vulnerability to poor sexual health of their left-behind partners, in relation to their household wealth, remain understudied. This investigation examines differences in sexual health from 2010 to 2015 among Armenian mothers, with a specific focus on their left-behind migration status and household wealth. METHODS AND FINDINGS: Using the population-based Demographic and Health Surveys from Armenia, multilevel logistic models were used to examine the various relationships between sexual health, left-behind status, and household wealth. The multivariate analysis results showed that self-reported sexually transmitted infection (STI) symptoms (AOR = 1.45; p<0.01) and intimate partner violence (IPV) (AOR = 1.45; p<0.01) increased from 2010 to 2015; furthermore, negotiation power over sex (AOR = 0.77; p<0.01) declined among Armenian mothers. Left-behind mothers (LBMs) were more likely to report STI symptoms than their non-LBM counterparts (AOR = 1.61; p<0.01). In addition, significant differences in sexual health between LBMs and non-LBMs with different levels of household wealth were observed. The poorest wealth quintiles were associated with a higher likelihood of self-reported STI symptoms (AOR = 1.74; p<0.05) and IPV (AOR = 1.78; p<0.01), as well as a lower likelihood of utilizing HIV testing (AOR = 0.48; p<0.01) and negotiating power over sex (AOR = 0.47; p<0.01). CONCLUSIONS: This study strives to fill gaps in the literature related to the relationship between left-behind status, household wealth, and sexual health among Armenian mothers in a context of economic expansion. Among these mothers, poor sexual health outcomes increased from 2010 to 2015. Both low household wealth and a left-behind status were associated with adverse sexual health outcomes. These findings suggest future campaigns aimed at improving the sexual health of Armenian mothers need to be migration-status appropriate and socioeconomic-sensitive.

Hygiene practices: Are they protective factors for eczema symptoms?

INTRODUCTION: Exact etiology and proper treatment of eczema are still unknown. The hygiene hypothesis and epidermal barrier dysfunction hypothesis attempted to give some plausible explanations for these issues but they still remain unclear. The identification of factors, including hygiene practices, related to eczema symptoms (ES) could shed some light on these matters. Therefore, this study aimed to determine risk factors related to ES and the ES prevalence in two disparate areas in terms of urbanization in Aceh, Indonesia. METHODS: A cross-sectional study with convenience sampling was conducted among schoolchildren living in urban and rural Aceh. Data on ES, socio-demographic characteristics, environmental factors, partial ablution and other hygiene related factors were collected by parental questionnaires. In addition, children's anthropometric measurements were also collected. RESULTS: The prevalence of current ES in the study population was 21%. When stratifying by residency, the prevalence of ES in urban and rural area was 20.93% versus 21.05%. Partial ablution was independently associated with a reduced risk of ES (OR = 0.36; 95% CI 0.13-0.96). Important risk factors for ES were paternal history of allergic disease (OR = 4.09%; 95% CI 1.51-11.11) and belonging to the older group of schoolchildren (10-13 years old) (OR = 2.57; 95% CI 1.03-6.40). CONCLUSIONS: There were no significant differences in the prevalence of ES between urban and rural settings, and partial ablution had a protective effect on ES. These findings support the epidermal barrier dysfunction hypothesis as a possible pathway of eczema.