Early childhood caries: parents' knowledge, attitude and practice towards its prevention in refugee camps in Erbil, Iraq.

BACKGROUND: Early childhood caries is a significant oral health issue in socially deprived communities, including refugees, where prevention plays a crucial role in minimizing the challenges and costs associated with treating early childhood caries. To improve oral health outcomes, it is important to understand parents' knowledge, attitudes, and practices. This study aims to assess the oral health knowledge, practices, and attitudes of refugee parents. METHODS: This cross-sectional study included 503 parents/caregivers residing in Erbil's refugee camps in Iraq, with healthy preschool children aged one to six years. Structured questionnaire was utilized in conducting individual interviews with parents to evaluate their knowledge, attitudes, and practices. The questionnaire collected demographic information and data on access to oral health services. RESULTS: A total of 503 out of 505 households actively participated in the study, resulting in a high response rate of 99.6%. Demographic analysis revealed that the majority of respondents were female parents, constituting 92.05% of the sample. Within the participant pool, the primary age groups were 26-35 years (55.3%) and 18-25 years (26.2%). Educational background analysis revealed that a significant proportion of parents had attained a secondary school education (29.6%) or primary school education (27.4%). Statistical analysis further established a noteworthy association between educational background and knowledge level. The investigation of participants' knowledge uncovered notable gaps and misconceptions pertaining to early childhood caries, with an overall mean score of 5.1. Assessing the overall attitude of parents, a mean score of 3.87 (SD = 1.29) suggested a generally unfavorable attitude towards oral hygiene practices and prevention of early childhood caries. In terms of actual practices, parents demonstrated a mean practice score of 5.7. CONCLUSIONS: This study emphasizes knowledge gaps and misconceptions among parents in refugee camps regarding early childhood caries in preschool children. Findings revealed low knowledge scores, limited understanding of hidden sugars, delayed oral hygiene practices, and limited knowledge about fluoride.

Facility level factors that determine consistent delivery of essential newborn care at health centers in Ethiopia.

BACKGROUND: Essential newborn care (ENC) is a package of interventions which should be provided for every newborn baby regardless of body size or place of delivery immediately after birth and should be continued for at least the seven days that follows. Even though Ethiopia has endorsed the implementation of ENC, as other many counties, it has been challenged. This study was conducted to measure the level of essential newborn care practice and identify health facility level attributes for consistent delivery of ENC services by health care providers. METHODS: This study employed a retrospective cross-sectional study design in 425 facilities. Descriptive statistics were formulated and presented in tables. Binary logistic regression was employed to assess the statistical association between the outcome variable and the independent variables. All variables with p < 0.2 in the bivariate analysis were identified as candidate variables. Then, multiple logistic regression analysis was performed using candidate variables to determine statistically significant predictors of the consistent delivery of ENC by adjusting for possible confounders. RESULTS: A total of 273, (64.2%), of facilities demonstrated consistent delivery of ENC. Five factors-availability of essential obstetrics drugs in delivery rooms, high community score card (CSC) performances, availability of maternity waiting homes, consistent partograph use, and availability of women-friendly delivery services were included in the model. The strongest predictor of consistent delivery of essential newborn care (CD-ENC) was consistent partograph use, recording an odds ratio of 2.66 (AOR = 2.66, 95%CI: 1.71, 4.13). Similarly, providing women-friendly services was strongly associated with increased likelihood of exhibiting CD-ENC. Furthermore, facilities with essential obstetric drugs had 1.88 (AOR = 1.88, 95%CI: 1.15, 3.08) times higher odds of exhibiting consistent delivery of ENC. CONCLUSION: The delivery of essential newborn care depends on both health provider and facility manager actions and availability of platforms to streamline relationships between the clients and health facility management.

CLEVis: A Semantic Driven Visual Analytics System for Community Level Events.

Community-level event (CLE) datasets, such as police reports of crime events, contain abundant semantic information of event situations, and descriptions in a geospatial-temporal context. They are critical for frontline users, such as police officers and social workers, to discover and examine insights about community neighborhoods. We propose CLEVis, a neighborhood visual analytics system for CLE datasets, to help frontline users explore events for insights at community regions of interest, namely fine-grained geographical resolutions, such as small neighborhoods around local restaurants, churches, and schools. CLEVis fully utilizes semantic information by integrating automatic algorithms and interactive visualizations. The design and development of CLEVis are conducted with solid collaborations with real-world community workers and social scientists. Case studies and user feedback are presented with real-world datasets and applications.

Defining an Opioid Sparing Treatment Pathway for Chronic Abdominal Pain of Somatic and Visceral Origin: A Case Series.

Chronic non-malignant abdominal pain presents a treatment challenge for pain physicians. Treatment algorithms are often defined by single specialty and are unimodal with a dependence on opioids. We present a treatment algorithm for chronic abdominal pain using a combination of interventional therapy using transversus abdominis plane (TAP) blocks along with post injection medical management for treatment of somatic and visceral pain. This is a case series of 4 patients presenting with diverse causes of chronic abdominal pain were treated with the treatment algorithm defined below. Patients received either bilateral or unilateral TAP blocks based on pain location using a combination of 0.25% bupivicaine 10ml, 40mg triamcinolone, and clonidine 50 mcg by a single physician upon admission to our acute care hospital. Follow up treatment included a combination of gabapentin, nortriptyline, and an opioid + acetaminophen combination (hydrocodone/APAP vs. oxycodone/APAP) or continuation of the patient's outpatient opioid regimen. Pre-injection opioid milligram morphine equivalents (MME) and post-injection MME were measured as well as pain along the visual analog scale (VAS). Readmissions for pain were also noted. Patients receiving TAP blocks along with post injection medical management saw their VAS scores decrease by 68.5%. Their total daily milligram morphine equivalents (MME) consumption decreased by a mean of 68.9%. There were no readmissions for abdominal pain within the 1 year follow up period.

Evaluation of a commercial intravaginal thermometer to predict calving in a Hungarian Holstein-Friesian dairy farm.

In this study, the utility of a commercial intravaginal thermometer was evaluated as an automated method for the prediction of calving in a total of 257 healthy pregnant Holstein-Friesian female cattle. The accuracy and the sensitivity of predicting calving within 48 hr before calving were also evaluated. The intravaginal temperature changes from 72 hr before and up to calving were significantly (p ≤ .001) affected by parity, season (summer vs. autumn), the time of day (8 a.m. or 8 p.m.) and the 6-hr time intervals (38.19°C: first interval 0 to 6 hr before calving vs. 38.78°C: twelfth interval 66 to 72 hr before calving), while the gender (p = .943), and the weight of the calf (p = .610), twinning (p = .300), gestation length (p = .186), foetal presentation (p = .123), dystocia (p = .197) and retention of foetal membranes (p = .253) did not affect it significantly. The sensitivity of the SMS of expecting calving within 48 hr and the positive predictive value were 62.4% and 75%, respectively, while the sensitivity and the positive predictive value for the SMS of expulsion reached 100%. It can be concluded that the investigated thermometer is not able to predict calving within 48 hr accurately; however, imminent calving can be accurately alerted.

Effect of monitoring the onset of calving by a calving alarm thermometer on the prevalence of dystocia, stillbirth, retained fetal membranes and clinical metritis in a Hungarian dairy farm.

The objective of the present study was to assess the effectiveness of an intravaginal thermometer in the field prediction of the second stage of labor and to determine its impact on the health of dams and newborn calves. Holstein cows (n = 241) were randomly selected about 5 (mean ±â€¯SD: 4.7 ±â€¯2.0) days before the expected date of calving and the thermometer was inserted into the vagina. Another 113 cattle served as controls. There was no false alarm during the experiment. The risk of dystocia (Score >1) was 1.9 times higher, the prevalence of stillbirth was 19.8 times higher, the risk of retained fetal membranes (RFM) was 2.8 times higher and the risk of clinical metritis was 10.5 times higher in the control group than in the experimental group. The prevalence of stillbirth was 7 times higher in cows with dystocia compared to cows with eutocia. The presence of dystocia and stillbirth increased the risk of RFM 4 and 5 times, respectively. The occurrence of RFM increased the risk of development of clinical metritis with a 22 times higher odds. The results indicate that the use of calving alert systems not only facilitates controlling the time of parturition and providing prompt and appropriate calving assistance but also decreases the number of dystocia cases and improves reproductive efficiency, postpartum health of the dam and newborn calf survival.

Sociocultural determinants of home delivery in Ethiopia: a qualitative study.

BACKGROUND: Maternal health remains a major public health problem in Ethiopia. Despite the government's measures to ensure institutional delivery assisted by skilled attendants, home delivery remains high, estimated at over 80% of all pregnant women. OBJECTIVE: The study aims to identify determinants that sustain home delivery in Ethiopia. METHODS: A total of 48 women who delivered their most recent child at home, 56 women who delivered their most recent child in a health facility, 55 husbands of women who delivered within 1 year preceding the study, and 23 opinion leaders in selected districts of Amhara, Oromia, Southern Nations, Nationalities, and Peoples' Region, and Tigray regions were involved in the study. Key informant interview, in-depth interviews, and focus group discussions were conducted to collect data using checklists developed for this purpose. Data reduction and analysis were facilitated by Maxqda qualitative data analysis software version 11. RESULTS: Findings show that pregnancy and delivery is a normal and natural life event. Research participants unanimously argue that such a life event should not be linked with health problems. Home is considered a natural space for delivery and most women aspire to deliver at home where rituals during labor and after delivery are considered enjoyable. Even those who delivered in health facilities appreciate events in connection to home delivery. Efforts are underway to create home-like environments in health facilities, but health facilities are not yet recognized as a natural place of delivery. The positive tendency to deliver at home is further facilitated by poor service delivery at the facility level. Perceived poor competence of providers and limited availability of supplies and equipment were found to maintain the preference to deliver at home. CONCLUSION: The government's endeavor to improve maternal health has generated positive results with more women now attending antenatal care. Yet over 80% of women deliver at home and this was found to be the preferred option. Thus, the current form of intervention needs to focus on factors that determine decisions to deliver at home and also focus on investing in improving service delivery at health facilities.

Quality and use of IMNCI services at health center under-five clinics after introduction of integrated community-based case management (ICCM) in three regions of Ethiopia.

BACKGROUND: The Integrated Management of New born and Childhood Illness (IMNCI) and the related Integrated Community Case Management (iCCM) are evidence-based strategies to reduce childhood mortality in Ethiopia at health centres and community health posts, respectively. The effect of introducing iCCM on IMNCI is not known. OBJECTIVE: To assess the caseload and quality of lMNCI service in under-five clinics in health centres after iCCM implementation. METHODS: This cross-sectional study used register review to assess the IMNCI service use (before and after iCCM, in 2010 and 2012, respectively) and quality throughout the period in randomly selected health centers in three regions of the Integrated Family Health Program (Oromia, SNNPR [Southern Nations and Nationalities and Peoples Region] and Tigray). RESULTS: Caseload of sick children at 28 health centers increased by 16% after iCCM implementation (21,443 vs. 24,882 children in 2010 and 2012, respectively. The consistency of IMNVCI treatment with classification for pneumonia, diarrhea and malaria was low (78, 45, and 67%, respectively) compared to iCCM treatment (86, 80, and 91%, respectively). CONCLUSION: Health center case load increased modestly after iCCM was introduced, but was lower than expected, even when combined with health post use from other studies. The demand strategy for sick children needs review. The quality of IMNCI needs improving even to bring it to the quality of iCCM at health posts, as measured by the same methods. Successful quality assurance approaches from iCCM, e.g., the Performance Review and Clinical Mentoring Meeting, could be adapted for IMNCI.

A descriptive study of the changes in coverage of preventive and promotive interventions before and after the introduction of integrated community case management (ICCM) in Ethiopia.

BACKGROUND: The effect of integrated community case management (iCCM) of common childhood illness on use of vital preventive services is not known. OBJECTIVE: To measure the coverage of maternal and child health preventive and promotive interventions before and after scaling up iCCM. METHODS: In 2011 and 2013, we conducted cross-sectional, population-based, household coverage surveys in four Integrated Family Health Program target regions: Amhara, Oromia, SNNP, and Tigray. RESULTS: Coverage increased for 10 of 15 indicators, mainly for maternal, immunization, and nutrition services. In some cases, we observed dramatic increases, i.e., for ≥ 4 antenatal care visits, antenatal iron and folate, and exclusive breastfeeding. Some increase occurred even when 2011 levels were already high, i.e., for immunization. Three indicators remained high and unchanged (bednet ownership, children sleeping under bednets, and any latrine). Two indicators decreased (tetanus toxoid and households with ≥ 2 bednets). CONCLUSION: Scale-up of iCCM was consistent with increased coverage of most preventative and promotive interventions, which may contribute to the life-saving effect of iCCM.

[Comparison of annual risk for tuberculosis infection (1994-2001) in school children in Djibouti: methodological limitations and epidemiological value in a hyperendemic context]. / Comparaison du risque annuel d'infection tuberculeuse (1994-2001) auprès d'enfants scolarisés à Djibouti: limites méthodologiques et intérêt épidémiologique dans un contexte hyperendémique.

The purpose of this report was to describe a tuberculin survey conducted in 2001 to assess the trend in the annual risk for tuberculosis infection in Djibouti and compare resulting data with those obtained in a previous survey conducted in 1994. In 2001 cluster sampling allowed selection of 5599 school children between the ages of 6 and 10 years including 31.2% (1747/5599) without BCG vaccination scar. In this sample the annual risk of infection (ARI) estimated using cutoff points of 6 mm, 10 mm, and 14 mm corrected by a factor of 1/0.82 and a mode value (18 mm) determined according to the "mirror" method were 4.67%, 3.64%, 3.19% and 2.66% respectively. The distribution of positive tuberculin skin reaction size was significantly different from the normal law. In 1994 a total of 5257 children were selected using the same method. The distribution of positive reactions was not significantly different from the gaussian distribution and 28.6% (1505/5257) did not have a BCG scar. The ARI estimated using cutoff points of 6 mm, 10 mm, and 14 mm corrected by a factor of 1/0.82 and a mode value (17 mm) determined according to the "mirror" method were 2.68%, 2.52%, 2.75% and 3.32 respectively. Tuberculin skin reaction size among positive skin test reactors was correlated with the presence of a BCG scar, and its mean was significantly higher among children with BCG scar. The proportion of positive skin test reactors was also higher in the BCG scar group regardless of the cutoff point selected. Comparison of prevalence rates and ARI values did not allow any clear conclusion to be drawn, mainly because of a drastic difference in the positive reaction distribution profiles between the two studies. The distribution of the skin test reaction's size 1994 study could be modelized by a gaussian distribution while it could not in 2001. A partial explanation for the positive reaction distribution observed in the 2001 study might be the existence of cross-reactions with environmental mycobacteria.

Prevalence and trends of infection with Mycobacterium tuberculosis in Djibouti, testing an alternative method.

SETTING: Djibouti, 1994 and 2001. OBJECTIVE: To estimate the prevalence of tuberculosis (TB) and average annual risk of TB infection (ARTI) and trends, and to test a new method for calculations. METHODS: Tuberculin surveys among schoolchildren and sputum smear-positive TB patients. Prevalence of infection was calculated using cut-off points, the mirror image technique, mixture analysis, and a new method based on the operating characteristics of the tuberculin test. Test sensitivity was derived from tuberculin reactions among TB patients and test specificity from a comparison of reaction size distributions among children with and without a BCG scar. RESULTS: The ARTI was estimated to lie between 2.6% and 3.1%, with no significant changes between 1994 and 2001. The close match of the distributions between children tested in 1994 and patients justifies the utilisation of the latter to determine test sensitivity. This new method gave very consistent estimates of prevalence of infection for any induration for values between 15 and 20 mm. Specificity was successfully determined for 1994, but not for 2001. Mixture analysis confirmed the estimates obtained with the new method. CONCLUSION: Djibouti has a high ARTI, and no apparent change over the observation time was found. Using operating test characteristics to estimate prevalence of infection looks promising.