Intimate partner violence among women in Togo: a generalised structural equation modeling approach.

OBJECTIVE: This study aimed to assess the magnitude and identify associated factors with intimate partner violence (IPV) in Togo. DESIGN: Cross-sectional study. SETTING: Togo. PARTICIPANTS: Women of reproductive age (15-49 years). PRIMARY OUTCOME: Intimate partner violence. METHODS: This study used data from the 2013 Togolese Demographic and Health Survey. A total of 4910 married or partnered women were included. A Generalised Structural Equation Model (GSEM) was performed to identify significant factors associated with IPV. Results of the GSEM were reported as adjusted ORs (aOR) with their corresponding 95% CIs. RESULTS: The pooled prevalence of IPV was 35.5% (95% CI: 34.2% to 36.8%). Emotional violence and physical violence were the most reported forms of IPV (29.7% and 20.2%, respectively), while sexual violence was the least common, with a prevalence of 7.5%. Additionally, the results indicated that the following factors related to women, men and households were significantly associated with IPV in Togo: ethnicity, region, religion, wealth index, working status, age at the first union, having attitudes toward wife-beating, participation in household decision-making, education level, alcohol use and controlling behaviour. CONCLUSION: IPV is a complex and multifactorial phenomenon in Togo. The Togo government as well as women's human rights organisations should consider these factors when designing IPV programmes.

Trends and factors associated with recent HIV testing among women in Haiti: a cross-sectional study using data from nationally representative surveys.

INTRODUCTION: In the Latin America and Caribbean region, Haiti is one of the countries with the highest rates of HIV. Therefore, this study examined the factors associated with HIV testing among women in Haiti and trends in HIV testing in 2006, 2012, and 2016/17. METHODS: Data from the last three Haitian Demographic and Health Surveys (2006, 2012, and 2016/17) were used. The analysis was restricted to women aged of 15-49 years who made their sexual debut. STATA/SE 16.0 was employed to analyze the data by computing descriptive statistics, Chi­square, and multilevel regression model to describe the trends and identify factors associated with HIV testing in Haiti. P-value less than 0.05 was taken as a significant association. RESULTS: HIV testing prevalence increased more than twofold from 2006 (8.8%) to 2017 (21.3%); however, it decreased by 11.6% between 2012 and 2016/17. Additionally, the results indicated that age, place of residence, region, education level, wealth index, mass media exposure, marital status, health insurance, age at first sex and number of sexual partners were significantly associated with HIV testing. CONCLUSIONS: To significantly increase HIV testing prevalence among women, the Haitian government must invest much more in their health education while targeting vulnerable groups (youth, women in union, and women with low economic status).

Tobacco use in Haiti: findings from demographic and health survey.

INTRODUCTION: Although tobacco has harmful effects on the physical and mental health of individuals, its use remains significant, according to the World Health Organization. To understand this phenomenon, studies have been carried out in many countries around the world, while in Haiti where more than 5,000 people die each year due to tobacco use, little is known about the use of this substance. The aim of this study was to examine the prevalence and the factors associated with tobacco use in Haiti. METHODS: We used data from the 2016/17 Haitian Demographic Health Survey. Both descriptive and multivariate analyses were conducted using STATA 16.0 software to assess the prevalence and identify factors associated with tobacco use. Results were reported as adjusted odds ratios with 95% confidence intervals. Statistical significance was declared at p < 0.05. RESULTS: The prevalence of tobacco use was estimated at 9.8% (95% CI: 9.2-10.4) among men and 1.7% (95% CI: 1.5-1.9) among women. Although the prevalence of tobacco use was low among young people, it increased with age. Respondents aged 35 and above, with no formal education, non-Christians, divorced/separated/widowed, from poorest households, rural areas, "Aire Métropolitaine de Port-au-Prince" region, with high media exposure had a higher likelihood of tobacco use. CONCLUSION: The low prevalence of tobacco use among Haitian women and youth represents a public policy opportunity to prevent these vulnerable groups from starting smoking. Adult male smokers should also be targeted by appropriate policy to reduce the different health burdens associated with tobacco, both for the smokers and other people they may expose to passive smoking. Government and health sector stakeholders, along with community leaders, should create and enforce awareness strategies and rules to control advertisements that encourage irresponsible and health-risky consumption behaviors.

Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016-2017 Haitian Demographic and Health Survey.

INTRODUCTION: For several decades, the rate of caesarean section (CS) has been increasing in the world. In some countries, the CS rate is below the WHO recommended range (10-15%), while in other countries, it is significantly higher. The aim of this paper was to identify individual and community-level factors associated with CS in Haiti. METHODS: Secondary data analysis was conducted on nationally representative cross-sectional survey data from the 2016-2017 Haitian Demographic and Health Survey (HDHS). The analysis was restricted to 6303 children born in 5 years prior the survey (of the interviewed women). The study population' characteristics, and the prevalence of CS were analysed using descriptive analysis (univariate/bivariate). In addition, multilevel binary logistic regression analysis was performed to identify factors associated with CS. Both descriptive and multivariate analysis were conducted using STATA 16.0 software (Stata Corp, Tex, USA). Statistical significance was declared at p < 0.05. RESULTS: The overall prevalence of CS delivery was estimated at 5.4% (95% CI 4.8-6.0) in Haiti. Results also revealed that mothers aged 35 and above (aOR = 1.38; 95% CI 1.00-1.96); who attended secondary (aOR = 1.95; 95% CI 1.39-2.76) and higher education level (aOR = 3.25; 95% CI 1.92-5.49); who were covered by health insurance (aOR = 2.57; 95% CI 1.57-4.19); with less than 3 children (aOR = 4.13; 95% CI 2.18-7.85) or 3-4 children (aOR = 2.07; 95% CI 1.09-3.94); who received 9 or more antenatal visits (aOR = 2.21; 95% CI 1.40-3.50) were significantly more likely to deliver by CS. Children in communities with high preponderance of private health facilities had greater odds to be delivered through CS (aOR = 1.90; 95% CI 1.25-2.85). Furthermore, children with an average birth weight (aOR = 0.66; 95% CI 0.48-0.91) were less likely to be delivered through CS than their counterparts with high birth weight. CONCLUSIONS: While the CS prevalence was low in Haiti, it masks significant geographic, social and economic disparities. To better develop and implement maternal and child health programs that address CS deliveries, the government authorities and NGOs operating in the field of women's health in Haiti should take these disparities into account.

Prevalence and factors associated with condom use among sexually active young women in Haiti: evidence from the 2016/17 Haiti demographic and health survey.

BACKGROUND: Young women in Haiti remain vulnerable to sexually transmitted infections and unintended pregnancy. However, little is known about condom use among this population. This study examined the prevalence and the factors associated with condom use among sexually active young women in Haiti. METHODS: Data from the 2016/17 Haiti demographic and health survey were used. The prevalence and the factors associated with condom use among sexually active young women in Haiti were assessed using descriptive statistics and binary logistic regression model. RESULTS: The prevalence of condom use was 15.4% (95% CI 14.0-16.8). Being teenage (AOR = 1.34; 95% CI: 1.04-1.74), living in urban areas (AOR = 1.41; 95% CI = 1.04-1.90), having higher education level (AOR = 2.39; 95% CI: 1.44-4.00), being in the middle or rich category of household wealth index (AOR = 2.32; 95% CI: 1.53-3.53 and AOR = 2.93; 95% CI: 1.90-4.52), having correct knowledge of ovulatory cycle (AOR = 1.65; 95% CI: 1.30-2.10), having 2-3 lifetime sexual partners and one lifetime sexual partner (AOR = 2.04; 95% CI: 1.36-3.06 and AOR = 2.07; 95% CI: 1.35-3.17) had significantly higher odds of using condom. In addition, sexually active young women whose last partner was their boyfriend (AOR = 4.38; 95% CI: 2.82-6.81), and those whose last partner was a friend/casual acquaintance/commercial sex worker (AOR = 5.29; 95% CI: 2.18-12.85) were associated with increased likelihood of using condom compared with their counterparts whose partner was their spouse. CONCLUSION: The Haitian government as well as institutions involved in sexual health should consider these factors when designing sexual and reproductive health interventions targeting young women. More specifically, to increase condom use and reduce risky sexual behaviors, they should combine efforts to raise awareness and induce sexual behavioral changes at two levels. In the education system, they should reinforce sexual education in primary and secondary schools while paying special attention to rural areas. In the whole society, it is important to deepen efforts toward increased awareness on family planning and condom use, through mass media and local organizations including religious ones. Priority should be given to the poorer households, young people and women, and rural areas, in order to maximize reduction in early and unintended pregnancy, and sexually transmitted infections. Interventions should include a condom price subsidy and a campaign to destigmatize condom use which is actually a "male affair".

Knowledge of the ovulatory cycle and its determinants among women of childbearing age in Haiti: a population-based study using the 2016/2017 Haitian Demographic Health Survey.

BACKGROUND: The knowledge of ovulatory cycle (KOC) is the base for natural family planning methods, yet few studies have paid attention to women's KOC. This study aimed to assess the prevalence of correct KOC and its determinants among women of childbearing age in Haiti. METHODS: Data from the nationally representative cross-sectional Haiti Demographic and Health Survey 2016/17 were used. STATA/SE version 14 was employed to analyse the data by computing descriptive statistics, Chi­square, and binary logistic regression model to assess the socio-economic and demographic predictors of correct KOC. P-value less than 0.05 was taken as a significant association. RESULTS: Out of 14,371 women of childbearing age who constituted our sample study, 24.1% (95% CI 23.4-24.8) had correct KOC. In addition, the findings showed that place of residence, respondent's education level, wealth index, currently working, husband/partner's education level, contraceptive use, exposure to mass media FP messages, and fieldworker visit were significantly associated with correct KOC. CONCLUSION: Policies should include increasing the literacy at community level as well as of individual women and their partners. Moreover, increasing awareness about family planning should be prioritized, especially for women from poor households and rural areas.

Socio-economic and demographic factors influencing open defecation in Haiti: a cross-sectional study.

BACKGROUND: Open defecation (OD) remains an important public health challenge in Haiti. The practice poses a significantly high risk of disease transmission. Considering these negative health consequences, this paper aims to identify socio-economic and demographic factors that influence OD practice among households in Haiti. METHODS: The study used secondary data from 13,405 households from the Haiti Demographic and Health Survey 2016-2017. Descriptive statistics and bivariate analysis were used to find the preliminary results. Further, multivariate analysis was performed to confirm the findings. RESULTS: Around one quarter (25.3%) of Haitian households still defecate in the open, almost 10% in urban areas, and nearly 36% in rural areas. Multivariate analysis revealed that the age and sex of the household head, household size, number of children aged 1-14 years old in the household, education level, wealth index, access to mass media, place of residence, and region were significant predictors of OD practice among households in Haiti. CONCLUSION: To accelerate the elimination of OD by 2030 and therefore achieve sustainable open defecation-free status, the government of Haiti and its partners should consider wealth disparities among regions and mobilize mass media and community-based networks to raise awareness and promote education about sane sanitation practices. Furthermore, because the possibilities to build toilets differ between rural and urban areas, specific interventions must be spearheaded for each of these regions. The public program can subsidize individual toilets in rural areas with room to collect dry excreta for the preparation of fertilizers, while in urban areas collective toilets can be built in slums. Interventions should also prioritize households headed by women and young people, two underpriviledged socioeconomic groups in Haiti.

Facteurs associés à la surmortalité infanto-juvénile des jumeaux à Haïti.

Introduction : In Haiti, excess mortality among twins is an additional health burden, given that child mortality levels are already very high there. Haiti is the country in the Latin America and Caribbean region with the highest rate of twin births (about 17 ‰). However, there, the excess mortality among twins has been little studied. PURPOSE OF RESEARCH: To identify factors associated with excess mortality among twins. METHODS: With data from the Demographic and Health Surveys, calculation of under-five mortality rates (U5MR) and using a Cox regression to analyze factors associated with excess mortality among twins. RESULTS: Twins have U5MRs that are three times higher than those of singletons. However, these U5MRs fell sharply, but more sharply among twins than singletons. Indeed, between 1994 and 2016, the U5MR for twins decreased by about 53% (from 432 ‰ to 204‰), while for singletons, it was only 36% (from 121‰ to 77‰). The multivariate results show that all else being equal, twins have a 3.3 (2.86-3.87) times higher Hazard Ratio of death than singletons. They also show low birth weight, lack of prenatal visits, and lack of breastfeeding are independently associated with excess mortality among twins in Haiti.Conclusions : The health of twin children remains a major challenge for Haiti. To further reduce their excess mortality, the government has to develop accessible obstetric and pediatric services essential for the care of twin pregnancies.

Methods for segmentation of rheumatoid arthritis bone erosions in high-resolution peripheral quantitative computed tomography (HR-pQCT).

OBJECTIVE: The comparison between different techniques to quantify the 3-dimensional size of inflammatory bone erosions in rheumatoid arthritis(RA) patients. METHODS: Anti-cyclic citrullinated peptide antibody(ACPA) positive RA patients received high-resolution peripheral quantitative computed tomography (HR-pQCT) scans of the metacarpophalangeal joints (MCP). Erosions were measured by three different segmentation techniques: (1) manual method with calculation by half-ellipsoid formula, (2) semi-automated modified Evaluation Script for Erosions (mESE), and (3) semi-automated Medical Image Analysis Framework (MIAF) software. Bland & Altman plots were used to describe agreement between methods. Furthermore, shape of erosions was classified as regular or irregular and then compared to the sphericity obtained by MIAF. RESULTS: A total of 76 erosions from 65 RA patients (46 females/19 males), median age 57 years, median disease duration 6.1 years and median disease activity score 28 of 2.8 units were analyzed. While mESE and MIAF showed good agreement in the measurement of erosion size, the manual method with calculation by half-ellipsoid formula underestimated erosions size, particularly with larger erosions. Accurate segmentation is particularly important in larger erosions, which are irregularly shaped. In all three segmentation techniques irregular erosions were larger in size than regular erosions (MIAF: 19.7 vs. 3.4mm3; mESE: 15.5 vs. 2.3mm3; manual = 7.2 vs. 1.52mm3; all p < 0.001). In accordance, sphericity of erosions measured by MIAF significantly decreased with their size (p < 0.001). CONCLUSION: MIAF and mESE allow segmentation of inflammatory bone erosions in RA patients with excellent inter reader reliability. They allow calculating erosion volume independent of erosion shape and therefore provide an attractive tool to quantify structural damage in individual joints of RA patients.

Quantification and Impact of Secondary Osteoarthritis in Patients With Anti-Citrullinated Protein Antibody-Positive Rheumatoid Arthritis.

OBJECTIVE: To search for evidence of secondary osteoarthritis (OA) in patients with rheumatoid arthritis (RA) in a cross-sectional and longitudinal setting, and to relate osteophyte formation to functional outcome. METHODS: Anti-citrullinated protein antibody (ACPA)-positive RA patients underwent high-resolution peripheral quantitative computed tomography of the hand. Cross-sectional and longitudinal measurements were performed. The number and size (volume) of osteophytes as well as bone erosions were documented. The relationship of osteophytes to bone erosions and to demographic and disease-specific data was evaluated by multiple logistic regression models. RESULTS: A total of 202 ACPA-positive RA patients were enrolled in the cross-sectional part of the study, and a total of 77 ACPA-positive RA patients were enrolled in the longitudinal analysis (interval of 1.5 years between baseline and follow-up assessment). The mean ± SD number of osteophytes per patient was 1.3 ± 2.3, and the mean ± SD osteophyte volume per patient was 2.6 ± 4.9 mm(3) . The total number of erosions was significantly correlated with the total number of osteophytes (P < 0.001), and the total volume of erosions was significantly correlated with the total volume of osteophytes (P < 0.001). Moreover, the number of osteophytes was related to age (P < 0.001) and disease duration (P = 0.001), while the volume of osteophytes was related to age (P = 0.001), disease duration (P < 0.001), and function as measured by the Health Assessment Questionnaire (P = 0.013). Multivariate regression analyses showed an independent association between osteophytes and erosions. In the longitudinal analysis, the mean number (P = 0.033) and volume (P < 0.001) of osteophytes increased significantly in RA patients during their disease course. CONCLUSION: Age, disease duration, and bone erosions are associated with osteophytes, indicating development of secondary OA in patients with RA.

Bacterias similares a Helicobacter pylori, en aguas de acueductos del estado Táchira y su probable asociación con patología gástrica / Similar bacteria to Helicobacter pylori, in water supplies of Táchira state and its possible association with gastric pathology

Introducción: Helicobacter pylori es uno de los agentes asociado al cáncer gástrico y posee una alta prevalencia en los países en vías de desarrollo. Sus rutas de transmisión no han sido totalmente establecidas; sin embargo, en algunos estudios se ha detectado su ADN en muestras de aguas residuales, subterráneas y superficiales. El objetivo de este trabajo fue detectar el ADN del género Helicobacter en muestras provenientes de acueductos rurales del municipio San Cristóbal y el Acueducto Regional del Táchira (ART). Materiales y métodos: Se recolectaron 500 ml de seis acueductos rurales y el ART. Se determinó la presencia de ADN del género Helicobacter a través de PCR y PCR semianidada con la posterior secuenciación de los productos de reacción. Resultados y discusión: El género Helicobacter no fue detectado mediante PCR, pero se observó la banda esperada en tres muestras mediante una PCR semianidada. La secuenciación de dos amplicones mostraron una similitud del 99% con Ralstonia pickettii, indicando que Helicobacter no fue detectada en los acueductos muestreados. Conclusiones: La secuenciación de los amplicones para el género Helicobacter, mostraron que se trata de R. pickettii un patógeno oportunista, con características similares a H. pylori.

Background: Helicobacter pylori is one of the agents associated with gastric cancer and has high prevalence in developing countries. Its routes of transmission have not been fully established, however, some studies have detected H. pylori DNA in wastewater, groundwater and surface water. The aim of our study was detect H. pylori DNA in water samples from rural water supplies of San Cristóbal and the Tachira’s Regional Water Supply (TRWS). Materials and methods: Water (500 ml) of six rural water supplies and the TRWS were collected. T DNA of Helicobacter genus was detected by Polimerase Chain Reaction (PCR) and seminested PCR and the PCR amplicons were sequenced. Results: Helicobacter genus PCR results were negative but the seminested PCR were positive in three samples. However the two amplicons sequenced showed a 99% similitud with Ralstonia pickettii. Conclusions: Helicobacter amplicon sequenced, showed a high similarity with R. pickettii, an oportunist pathogen, with similar characteristics to H. pylori.

Frequency of the D620N mutation in VPS35 in Parkinson disease.

OBJECTIVE: To evaluate the frequency and clinical spectrum of the recently identified p.D620N mutation in the VPS35 gene in Parkinson disease (PD) in an international sample. DESIGN: Genetic analysis by DNA sequencing and detailed clinical and neuropsychiatric assessment as well as neuroimaging in mutation carriers. SETTING: Tertiary referral centers in Germany, Serbia, Chile, and the United States. PATIENTS: One thousand seven hundred seventy-four patients with PD. MAIN OUTCOME MEASURE: Frequency of the p.D620N mutation. RESULTS: A single mutation carrier was identified. The mutation carrier was a 60-year-old German man who had tremor-dominant PD since the age of 45 years. Longitudinal follow-up over 13 years revealed a disease progression from Hoehn and Yahr stage 1 to 3. There was evidence of mild cognitive impairment on the Montreal Cognitive Assessment. No abnormalities were observed by multimodal neuroimaging. He had a family history consistent with autosomal dominant inheritance. An affected paternal aunt and 3 reportedly unaffected siblings were also found to be mutation carriers. CONCLUSION: VPS35 mutations are a rare cause of PD in different populations. The clinical phenotype may be indistinguishable from idiopathic PD with the possible exception of an earlier age at onset. Genetic analysis of the extended family revealed incomplete penetrance of the p.D620N mutation.

Determinación de la factibilidad técnica y seguridad de un abordaje endoscópico transgástrico a la cavidad peritoneal en un modelo porcino / Determination of the technical feasibility and safety of transgastric peritoneal approach in a pig model

La viabilidad de un abordaje transgástrico para realizar peritoneoscopia y biopsia hepática ha sido demostrada en estudios previos en animales. Objetivo. Nuestro objetivo fue determinar la viabilidad y seguridad de un abordaje transgástrico peritoneal en una experiencia local. Resultados. El abordaje transgástrico con modelo similar a PEG (gastrostomía endoscópica percutánea) se realizó en 3 cerdos de la especie suis scrofa domesticus; el tiempo promedio del procedimiento fue de 102 minutos, no hubo complicaciones relacionadas con el acceso, y la necropsia no evidenció ningún daño de órganos adyacentes al estómago, aunque el cierre de la pared gástrica no fue exitoso en 2 cerdos. Conclusiones. Este estudio reporta la experiencia local con un abordaje transgástrico peroral a la cavidad peritoneal, técnicamente viable. El abordaje similar a PEG es simple y seguro, el cierre de la pared gástrica requiere destreza y mejor tecnología

Background. The feasibility of peroral transgastric peritoneoscopy and liver biopsy has been demonstrated in prior animal studies.Objective. Our purpose was to determine the feasibility and safety of transgastric peritoneal approach in local experience. Designs. Animal experimental feasibility study. Results. The peritoneal transgastric approach with PEG- like model was used in 3 pigs suis scrofa domesticus specie. The average procedure was 102 minutes, it did no have complications related to the access, and the necropsy did not reveal any damage to organs adjacent to the stomach. Nevertheless the gastric wall close was not successful in 2 pigs. Conclusions. This study report the local experience with peroral transgastric approach to peritoneal cavity, it’s technically feasible, a PEG- like transgastric model is simple and safe, the close of gastric wall requires skill and best technology.

Mitochondrial complex I gene variant associated with early age at onset in spinocerebellar ataxia type 2.

BACKGROUND: A common mitochondrial complex I gene polymorphism (10398G) is reported to be inversely associated with the risk of Parkinson disease. We hypothesized that this variant might have a protective effect on the central nervous system and therefore might delay the onset of symptoms in spinocerebellar ataxia type 2 (SCA2). OBJECTIVE: To assess the association of the 10398G polymorphism with age at onset in Cuban patients with SCA2. DESIGN: Genetic association study. SETTING: Holguin, Cuba. PATIENTS: Forty-six Cuban patients with SCA2. MAIN OUTCOME MEASURES: Presence or absence of the 10398G polymorphism was determined in 46 Cuban patients with SCA2 and early or late onset of symptoms, defined as at least 2 SDs lower than or higher than the mean age at onset for patients with a similarly sized triplet repeat expansion. RESULTS: The polymorphism was present in 11 of 27 Cuban patients with SCA2 and early onset (41%) vs 2 of 19 with late onset (11%) (Fisher exact test; P = .04). CONCLUSION: Contrary to our prediction of a later onset of SCA2 in patients with the 10398G polymorphism, we find that this variant is associated with an earlier age at onset in Cuban patients with SCA2.