International Journal of Translational Medical Research and Public Health

Trends in Physical and Mental Health, Mortality, Life Expectancy, and Social Inequalities Among American Indians and Alaska Natives, 1990-2019

Gopal K Singh — 2021-11-16

Objective: To address the continuing gap in data and research on health and socioeconomic inequities characterizing Native Americans in the United States, this study examines major health and social inequality trends for the American Indian and Alaska Native (AIAN) populations covering several broad areas, including infant and child health, life expectancy and leading causes of death, physical and mental health, chronic disease prevalence, disability, health-risk behaviors, and health care access and quality.

Methods: We used trend data from the 1990-2019 National Vital Statistics System, 2014-2018 National Health Interview Survey, and 2014-2018 American Community Survey to examine health, health care, mortality, and disease patterns for AIANs in relation to other racial/ethnic groups and the general population. Life tables, age-adjusted rates, risk ratios, and logistic regression were used to examine health inequalities.

Results: In 2019, life expectancy of AIANs was 76.9 years, 11.3 years shorter than that for Asian/Pacific Islanders. The infant mortality rate for AIANs was 8.7 per 1,000 live births, 79% higher than the rate for non-Hispanic Whites. Risks of infant mortality from birth defects, low birthweight/prematurity, maternal complications, SIDS, and unintentional injury were significantly greater among AIANs compared with non Hispanic Whites. Excess mortality among AIANs, particularly in rural areas, was found for working ages, diabetes, liver cirrhosis, alcohol-related causes, youth suicide, and unintentional injuries. About 18% of AIANs assessed their overall health as fair or poor, at twice the rate of non-Hispanic Whites or the general population. About 10% of AIAN adults experienced serious psychological distress, 2-to-5 times higher than the prevalence for other racial/ethnic groups. AIANs had the highest overall disability, mental and ambulatory disability, health uninsurance, unemployment, and poverty rates in the US, with differences in these indicators varying markedly across the AIAN tribes.

Conclusion and Implications for Translation: AIANs remain a disadvantaged segment of the US population in a number of key health indicators and in socioeconomic and living conditions, with poverty rates in some tribal groups approaching or exceeding 40%.

Copyright © 2021 Singh et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC By 4.0.

Estimating Contributions of Social and Behavioral Factors to Cardiovascular Disease, Cancer, COPD, and Unintentional-Injury Mortality Disparities by Psychological Distress in the United States: A Blinder-Oaxaca Decomposition Analysis of the 1997-2014 NHIS-NDI Record Linkage Study

Hyunjung Lee — 2021-12-03

Background: Previous research has shown a significant association between psychological distress (PD) and cause-specific mortality, but contributions of sociodemographic and behavioral characteristics to mortality differences by PD are not fully explored.

Methods: The Blinder-Oaxaca decomposition analysis was used to quantify the contributions of individual sociodemographic and behavioral characteristics to the observed cardiovascular disease (CVD), cancer, chronic obstructive pulmonary disease (COPD), and unintentional-injury mortality disparities between United States (US) adults with no PD and those with serious psychological distress (SPD), using the pooled 1997-2014 data from the National Health Interview Survey prospectively linked to the National Death Index (N=263,825).

Results: Lower levels of education and household income, and higher proportions of current smokers, former drinkers, non-married adults, US-born, and renters contributed to higher mortality for adults with SPD. The relative percentage of mortality explained by sociodemographic and behavioral factors was highest for cancer mortality (71.25%) and lowest for unintentional-injury mortality (20.19%). Enhancing education level among adults with SPD would decrease approximately 30% of cancer or CVD mortality disparity, and around 10% of COPD and unintentional-injury mortality disparities. Half of the cancer mortality disparity (47.4%) could be attributed to a single factor, smoking. Increasing income level will decrease 7 to 13% of the disparity in cause-specific mortality. Higher proportions of renters explained higher CVD and COPD mortality among adults with SPD by 7% and 3%, respectively. Higher proportions of former drinkers explained higher CVD, cancer, and COPD mortality among adults with SPD by 6%, 7%, and 3%, respectively. Younger age, higher proportion of females, and higher BMI among adults with SPD mitigated the mortality disparities.

Conclusion and Implications for Translation: Improved education and income levels, and reduced smoking among US adults with SPD would eliminate around 90% of the cancer mortality disparity by SPD, and half of the CVD mortality disparity.

Copyright © 2021 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Racial/Ethnic Disparities in Temporal Trends of Myocardial Infarction Hospitalizations Among Pregnant Women in the United States: 2009-2018

Deepa Dongarwar — 2021-10-24

There has been an increase in the incidence of Myocardial Infarction (MI) among pregnant women in the United States. There have been no studies examining the trends in the rates of gestational MI hospitalizations by race/ethnicity;and therefore, we undertook this study. No prior studies have examined the trends in the rates of gestational MI hospitalizations by race and ethnicity. In this study, we examined temporal trends of MI-related hospitalizations among pregnant women using the Nationwide Inpatient Sample (NIS) dataset from 2009 to 2018. We performed joinpoint regression analyses to assess trends in the rates of MI by race/ethnicity during the study period. Overall, there was an increase in the rates of MI among pregnant women during the study period (from 9.7 per 100,000 hospitalizations in 2009 to 18.1 per 100,000 hospitalizations in 2018) with an average annual percentage change (AAPC) of 7.2, (95% Confidence Interval (CI)=[4.0, 10.5]. The overall rate of MI was highest in non-Hispanic (NH)-Blacks and the greatest increments in rates of MI-related hospitalizations were noted in NH-Blacks during 2013-2018, and in Hispanics during the entire study period (2009-2018). NH-Blacks and Hispanics bear a disproportionately high burden of MI among pregnant women in the US. More worrisome is the first-ever reported finding in this study of a widening Black-White disparity in MI-related hospitalizations over the past decade.

Copyright © Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Prevalence and Associated Risk Factors of Postpartum Depression among Mothers in Pennsylvania, United States: An Analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS) Data, 2012-2015

Nhiem Luong — 2021-11-16

Background: Postpartum depression (PPD) is the most common morbidity among new mothers. With an estimated 140,000 resident births annually in the state of Pennsylvania, United States, no publication is available about the prevalence and risk factors associated with PPD specifically for Pennsylvania. This study aims to estimate the self-reported prevalence and risk factors associated with PPD.

Methods: Weighted Pregnancy Risk Assessment Monitoring System (PRAMS) surveillance data of 4,022 Pennsylvania mothers with live birth(s) during 2012-2015 were analyzed. Descriptive statistics were used for mothers’ characteristics. Between-group differences were evaluated using the Chi-square test. Risk factors associated with PPD were analyzed by logistic regression models. All analyses were performed using Stata version 13 (STATA Corp., College Station, TX), taking into account the complex survey design, and P-values <0.05 (2-tailed) were considered statistically significant.

Results: Of the 4,022 mothers, the overall prevalence of PPD was 12.1% (515 mothers); the prevalence was 12.4% (108) in 2012, spiked to 14.8% (156) in 2013, then significantly declined to 10.9% (127) in 2014 and 10.1% (124) in 2015 (p=0.03). In a multivariable logistic model, significant risk factors included depression before pregnancy (adjusted odds ratio [aOR]: 3.7, 95% CI: 2.3-6.0), abuse before or during pregnancy (aOR: 3.5, 95% CI: 1.6-7.3), the mother’s job loss (aOR: 2.1, 95% CI: 1.3-3.4), extended time away from husband/partner due to military deployment or work-related travel (aOR: 2.3, 95% CI: 1.1-4.5), a husband/partner not wanting the pregnancy (aOR: 1.7, 95% CI: 1.1-2.9), and arguing more than usual with a husband/partner (aOR: 1.6, 95% CI: 1.4-2.4).

Conclusion and Implication for Translation: PPD is relatively common in Pennsylvania; however, the prevalence declined significantly during the study period. Depression before pregnancy, abuse before or during pregnancy, job loss, extended time away from husband/partner due to military deployment or workrelated travel, husband/partner not wanting the pregnancy, or arguing more than usual with a husband/partner increased the odds of experiencing PPD. Further studies should be conducted on approaches to prevent PPD among new mothers.

Copyright © 2021 Luong et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Barriers and Facilitators to Accessing Health Care Services among Married Women in Ethiopia: a Multi-level Analysis of the Ethiopia Demographic and Health Survey

Betregiorgis Zegeye — 2021-10-24

Background and Objective: Access to health care services is a major challenge to women and children in many developing countries such as Ethiopia. In this study, we investigated the individual- and community-level factors associated with barriers to accessing health care services among married women in Ethiopia.

Methods: Data from the 2016 Ethiopia demographic and health survey on 9,824 married women of reproductive age (15-49 years) were analyzed. Multilevel logistic regression models were used to assess individual- and community-level factors associated with barriers to access health care services. Regression analysis results revealed adjusted odds ratios at 95% confidence intervals.

Results: Over two-thirds (71.8%) of married women in Ethiopia reported barriers to accessing health care services. Some of the individual-level factors that were associated with lower odds of reporting barriers to access health care services include: having secondary education (aOR=0.49, 95% CI: 0.32-0.77), being in the richest quintile (aOR=0.34, 95% CI: 0.22-0.54), and indicating wife-beating as unjustified (aOR=0.66, 95% CI:0.55-0.81). Among the community-level factors, high community-level literacy (aOR=0.56, 95% CI: 0.34-0.92) and moderate community socioeconomic status (aOR=0.62, 95% CI: 0.45-0.85) were significantly associated with lower odds of reporting barriers to access health care services.

Conclusion and Implications for Translation: The findings revealed high barriers to access health care services, and both individual- and community-level factors were significant contributing predictors. Therefore, it is important to consider multidimensional strategies and interventions to facilitate access to health care services in Ethiopia.

Copyright © Zegeye et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

HIV Prevention in sub-Saharan Africa: Where Are Adolescents in the Continuum?

Elizabeth Armstrong-Mensah — 2021-12-03

The human immunodeficiency virus (HIV) is the leading cause of death among adolescents in sub-Saharan Africa and the second leading cause of death among adolescents globally, yet this population is not expressly targeted in HIV prevention. Consequently, HIV prevalence among this population continues to rise. In 2014, McNairy and El-Sadr developed and proposed an HIV prevention continuum framework to ensure zero HIV infection among HIV uninfected people. While a step in the right direction, the continuum does not categorically focus on adolescents and thus, does not include mechanisms to offset the potential challenges this population experiences in HIV prevention. Intentionally involving adolescents in HIV prevention is crucial, as this population is considered integral to achieving the Sustainable Development Goal 3.3 target of eliminating HIV by 2030. This paper examines the challenges of adolescent participation in HIV prevention in sub-Saharan Africa using the McNairy and El-Sadar HIV prevention continuum framework as a backdrop.

Copyright © 2021 Armstrong-Mensah et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Association Between Source of Treatment and Quality of Childhood Diarrhea Management Among Under-Five Children in Nigeria

Comfort Z. Olorunsaiye — 2021-11-16

Background and Objective: Despite the availability of low-cost and effective interventions, diarrhea remains one of the leading causes of under-five morbidity and mortality in Nigeria. We assessed the relationships between the source and quality of treatment for children with diarrhea in Nigeria.

Methods: We analyzed cross-sectional data on 3,956 under-five children with a recent diarrheal episode, from the 2018 Nigeria Demographic and Health Survey. The outcome was quality of diarrhea management based on the administration of the following treatment recommendations: oral rehydration salt (ORS), zinc supplementation, increased oral fluids, and continued feeding. The exposure was the source of treatment (none; traditional/informal; public hospitals/health centers; private hospitals/clinics; and community-based services). Using adjusted, multivariable logistic regression, we estimated the odds ratio (OR) and 95% confidence intervals (CI) to predict the factors related to the quality of diarrhea management.

Results: In all, only 1 in 5 children received all the four recommended diarrhea interventions. The odds of good quality diarrhea management were higher among children who received treatment in public hospitals/health centers, private hospitals/clinics, and community-based services compared to those of children who did not receive treatment (OR=2.52, 95% CI=1.89-3.34; OR=2.46, 95% CI=1.90-3.16; and OR=1.91, 95% CI=1.40-2.59, respectively). Compared to children whose parents did not seek treatment, the odds of receiving ORS ranged from 2.1 times (OR: 2.11, 95% CI=1.44-3.11) for seeking care in traditional/informal sources to 12.3 times (95% CI=8.81-17.15) in public hospitals/health centers. We observed similar trends for zinc supplementation. The odds of increased oral fluids were higher in public and private hospitals/clinics (OR=1.44, 95% CI=1.03-2.01 and OR=2.08, 95% CI=1.57-2.76, respectively). Across all settings, the odds of continued feeding were significantly lower among children who received treatment compared to children who did not receive treatment.

Conclusion and Implications for Translation: Our findings indicate poor quality diarrhea management across various treatment settings. Policies and programs that encourage caregivers to seek treatment and improve the quality of care may contribute to reducing childhood diarrhea-related morbidity and mortality in Nigeria.

Copyright © 2021 Olorunsaiye et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

COVID-19 Pandemic: Face Mask Mandates, Hospitalization, and Infection Rates in the United States

Elizabeth Armstrong-Mensah — 2021-06-25

Face masks have been identified as one of the preventive methods for the control of the 2019 coronavirus disease (COVID-19). Although the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC) recommend the universal use of face masks, there are controversies in the implementation of a national face mask mandate in the US. This commentary discusses the relationship between facemask mandates and key COVID-19 indicators such as infection rates and hospitalization rates in the US. It also summarizes some of the political issues surrounding the implementation of the national face mask mandate. We conducted an ecological study on the relationship between face mask mandates and key COVID-19 indicators. We searched PubMed and Google Scholar and reviewed 150 English articles related to face mask challenges in the US published from 2005 to 2021. We identified seven challenges associated with face mask wearing - conflicting messaging, individualism, denial, health consequences, lack of a national masking standard, concerns of African American males, and environmental issues. We found that North Dakota, a state without a face mask mandate had the highest COVID-19 prevalence of 13.3%. The mean prevalence for the highest top 10 ranked states without and with a face mask mandate was 11.1% and 10.5%, respectively. We also found that Florida, Arizona and Georgia, states without a face mask mandates, had the highest cumulative hospitalizations of 83,381, 58,670, and 57,911 hospitalizations, respectively. Alabama, Indiana, and Minnesota, which have face mask mandates, had the lowest hospitalization rates of 47,090, 47,787, and 26,651, respectively.

Copyright © 2021 Armstrong-Mensah, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

COVID-19 Related Misconceptions and Prevention Practices Among Residents of a Populous Commercial City in Nigeria

Sorochi Iloanusi — 2021-08-14

Introduction: The COVID-19 pandemic brought several misconceptions that could hinder individuals from taking necessary measures to prevent infection, thus, undermining the public health containment efforts. We aimed to assess the prevalence of COVID-19 related misconceptions and their associations with demographic characteristics and prevention practices in Onitsha city in Anambra state, Nigeria.

Methods: We analyzed data from a cross-sectional survey of 140 adult residents of Onitsha city in Anambra state, Nigeria, conducted in March 2020. Descriptive and inferential statistics were used to describe the study population and determine the associations between COVID-19 misconceptions, demographic characteristics, and implementation of COVID-19 prevention practices. Data management and statistical analyses were conducted using SAS JMP Statistical Discovery^TM Software version 14.3 (SAS Institute, Cary, North Carolina, USA).

Results: The participants’ average age was 34.5 (SD: ±10.9) years, and most were males (54.3%). Misconceptions about COVID-19 among the study population resulted in markedly reduced compliance with nearly all prevention practices. Some participants believed that COVID-19 would not spread in Nigeria (34.4%, p<0.0001), was not fatal (10.8%, p<0.0001), can be prevented and cured through spiritual means (48.2%, P <0.0001), use of herbs (13.6%, P <0.0001), use of antibiotics (11.4%, p<0.0001) and that COVID-19 vaccine was available (25.4%, p<0.01). Misconception about the possibility of COVID-19 spread was significantly associated with non-compliance to all prevention practices (P<0.05) except travel restrictions.

Conclusions and Implications for Translation: Our study suggests the need for the government to tailor interventions targeting the common misconceptions in Onitsha in order to improve the public’s trust and compliance with recommended COVID-19 prevention practices. Misconception has become a significant public health challenge, primarily as its prioritization over scientific evidence and guidelines directly affects the pandemic preparedness and control efforts and may cause more people to be at risk of contracting COVID-19.

Copyright © 2021 Iloanusi et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

COVID-19 Pandemic and Medical Education in Nigeria

Fatima Usman — 2021-06-02

The emergence of the COVID-19 pandemic has affected the learning process and outcome of medical education. In this commentary, we discuss the effect of COVID-19 on medical education in Nigeria. The disruption of educational services due to government-imposed lockdown and subsequent transition to e-learning with reduction in direct tutor-trainee contact hours to limit virus spread have had a profound effect on the quality of medical education. These measures have impacted adversely on the proficiency, and the intellectual, psychological, financial and social wellbeing of trainees, worsened by a compromised educational system from pre-existing challenges militating against quality education. Prompt re-evaluation of all aspects of medical training with emphasis on developing digital learning platforms that will enable trainees to acquire the needed knowledge and improve learning outcomes is paramount, as it is likely the effects of COVID-19 will linger for a while.

Copyright © 2021 Usman, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.