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Hypertension (HTN) is a major cardiovascular risk factor that affects 1.3 billion people and accounts for 17.9 million deaths annually worldwide. Seventy-five percent of global deaths due to HTN occur in low- and middle-income countries where HTN prevalence is higher, and HTN control and population awareness are lower, than in high-income countries. Approximately 26% of Egyptian adults meet criteria for HTN, but the prevalence of HTN unawareness is unknown in this population. The purpose of this study was to assess prevalence and predictors of HTN unawareness among Egyptian adults. Using data from the 2015 Egyptian Health Issues Survey (EHIS), we identified 2869 participants 18-59 years of age whose blood pressure met criteria for HTN at the time of data collection. Our outcome of interest, hypertension unawareness, was indicated when a participant reported that they had not been diagnosed with HTN (despite meeting criteria). Descriptive statistics and multivariable logistic regression were performed to determine prevalence of, and risk factors for, HTN unawareness. Fifty-six percent of the sample were unaware of their HTN status. The odds of HTN unawareness were highest among participants 18-39 years old compared to those 40-59 years old (OR 1.91; 95% CI 1.48-2.47); males compared to females (OR 2.59; 95% CI 1.85-3.62); and never married compared to currently married participants (OR 1.96; 95% CI 1.19-3.24). Compared to those who had a college level education, the odds of HTN unawareness were highest among participants who had no education (OR 2.21; 95% CI 1.45-3.38). In addition, the odds of HTN unawareness were higher for participants who had a normal body mass index compared to those who were obese (OR 1.82; 95% CI 1.26-2.65); and those considered healthy compared to those who had at least one chronic illness (OR 4.53; 95% CI 3.29-6.24). Our findings indicate that more than half of Egyptian adults who meet criteria for HTN are unaware of their blood pressure status. Younger, healthier, and normal weight people-who are typically at lowest risk for HTN-appear mostly likely to be unaware of their HTN status. Less educated people are least likely to know their hypertensive status. This suggests the need for a targeted health education campaign and regular blood pressure screening in Egypt.

Objectives The aim of this study was to examine the association between maternal high-risk factors and anemia among reproductive-age women in Ethiopia. Methods A cross-sectional study was conducted using data from the 2016 Ethiopia Demographic and Health Survey (N = 5282). Hemoglobin levels were used to determine anemia status. Maternal high-risk factors were measured using maternal age at delivery, birth order, and birth interval. We performed χ2 test and multivariable regression models. Results There was a significant antagonistic interaction between maternal high-risk factors and place of residence on anemia (relative excess risk due to interaction, –1.79, synergy index, 0.48) with an attributable proportion due to interaction (AP) of –67% (AP = –0.67; 95% confidence interval [CI], –0.95 to –0.29). Multiplicative interaction was also significant (odds ratio for interaction, 0.38; P = 0.003). The odds of anemia were higher among women with any maternal high-risk factor than in those who did not experience any high-risk factors (adjusted odds ratio [AOR], 2.64; 95% CI, 1.24–5.63 for urban and AOR, 1.27; 95% CI, 1.01–1.61 for rural women). Exposure to a single maternal high-risk factor was significantly associated with increased odds of anemia among urban residents only (AOR, 2.61; 95% CI, 1.17–5.81). Exposure to multiple maternal high-risk factors significantly increased the odds of anemia (AOR, 2.82; 95% CI, 1.15–6.91) and (AOR, 1.55; 95% CI, 1.10–2.17) for urban and rural women, respectively. Conclusions Place of residence moderated the relationship between maternal high-risk factors and anemia. Context-specific strategies and interventions are needed to prevent anemia.

Background Despite significant public health intervention, maternal mortality remains high in low- and middle-income countries, including Ethiopia. Effective postnatal care is a critical service to reduce maternal mortality. In Ethiopia, only 17% of mothers received postnatal care services in 2016. Objective This study examined the association between antenatal care and timely postnatal care checkup among reproductive-age women in Ethiopia. Methods The study used the 2016 Ethiopian Demographic and Health Survey data. The current study included 4,081 women who give birth in the two years preceding the survey. Chi-square test and multivariable logistic regression analyses were used to examine the association between antenatal care and timely initiation of postnatal care. Results Postnatal care services within 2 days of delivery were received by 16.5% of women. Women who had at least four timely antenatal care visits had higher odds of timely postnatal checkups compared to women who had no antenatal care [adjusted Odds Ratio (aOR): 2.50; 95% CI 1.42–4.42]. Women who had at least four antennal care visits without timely initiation also had higher odds of postnatal check-up than their counterparts (aOR: 2.46; 95%CI: 1.22–4.97). Other factors significantly associated with timely initiation of PNC were secondary and above education (aOR: 1.64; 95%CI: 1.03–2.60), perceived distance to the nearby health facility as a significant barrier (aOR: 1.55; 95%CI: 1.15–2.09), primiparous (aOR: 0.34; 95%CI: 0.19–0.61) and institutional delivery (aOR: 14.55; 95%CI: 2.21–95.77). Conclusion The prevalence of timely initiation of postnatal care in Ethiopia is very low. Women who received recommended antenatal care services had higher odds of timely initiation of postnatal care. Thus, strengthening the existing maternal and child health programs to adhere to the recommended ANC care guidelines may improve the timely initiation of postnatal care.

Background Hypertension is a major risk factor for cardiovascular disease that affects 1·3 billion people and accounts for 17·9 million deaths worldwide annually. Most deaths from hypertension (around 75%) are in low-income and middle-income countries where hypertension prevalence is higher but control and population awareness of the condition are lower. Approximately 26% of Egyptian adults meet criteria for hypertension, but the prevalence of hypertension unawareness is unknown in this population. Here, we aim to assess prevalence and predictors of hypertension unawareness in Egyptian adults. Methods We undertook a cross-sectional study using data from the 2015 Egyptian Health Issues Survey (EHIS). We included data from respondents aged 18–59 years. The outcome of interest was hypertension unawareness, defined by objectively measured blood pressure done during the EHIS survey and a self-reported unawareness of hypertension status. We used descriptive statistics and multivariable logistic regression for analysis. Findings We analysed data from 2869 participants; 1915 of the respondents (65·5%) were in the 40–59 year age group, and 1639 respondents (56·5%) were women. More than half (56%) of EHIS respondents were unaware of their hypertension. The likelihood of hypertension unawareness was higher in participants aged 18–39 years than in those aged 40–59 years (odds ratio 1·91 [95% CI 1·48 −2·47]); men than in women (2·59 [1·85–3·62]; and never married compared with currently married participants (1·96 [1·19–3·24]). Compared with those who had college level education, hypertension unawareness was more likely in participants who had no education (2·21 [1·45–3·38], primary education (1·80 [1·20–2·70]), and secondary education (1·71 [1·21–2·40]). Additionally, hypertension unawareness was more likely in participants who had normal BMI than in those who were obese (1·82 [1·26–2·65]); and more likely in healthy participants than in those who had at least one chronic illness (4·53 [3·29–6·24]). Interpretation More than half of Egyptian adults with hypertension are unaware of their condition. Those typically at lowest risk for hypertension appear to be at highest risk for hypertension unawareness. Younger, healthier, and less educated men are least likely to know of their hypertension. Our findings suggest the need for a targeted health education campaign and regular blood pressure screening in Egypt. Funding None

Objectives Anemia constitutes a major public health problem in low- and middle-income countries. The purpose of this study was to examine the individual and combined influence of high-risk fertility behavior on anemia among reproductive age women in Ethiopia.Methods Secondary data analysis was conducted using a nationally representative sample of women aged 15-49 years from the 2016 Ethiopia Demographic and Health Survey (n=5799). Anemia status was the outcome of interest. Maternal high-risk fertility behaviors were measured using maternal age at delivery, birth order and birth interval. Descriptive statistics and multivariable regression models were performed.Results Overall, 28.7% of women had anemia and 71.4% experienced at least one high-risk fertility behavior. In the multivariable model, there was a significant interaction between high-risk fertility behavior and place of residence on anemia. Women with any high-risk fertility behavior were more likely to have anemia than women without any high-risk fertility behavior. However, the strength of association differed by place of residence (AOR: 2.68; 95% CI, 1.26-5.67 for urban and AOR: 1.27; 95% CI, 1.01-1.61 for rural residents). Single high-risk fertility behavior was significantly associated with anemia only among urban residents (AOR: 2.65; 95% CI, 1.20-5.83). Multiple high-risk fertility behavior significantly increased the odds of anemia, with stronger association among urban residents (AOR: 2.82; 95% CI, 1.14-6.95) than rural residents (AOR: 1.56; 95% CI, 1.11-2.19).Conclusions Place of residence moderated the relationship between high-risk fertility behaviors and anemia. Our findings suggest the need for context-specific strategies and interventions to prevent anemia.

Background Globally, the magnitude of maternal mortality is the major public health problem. Nearly all (99%) of maternal deaths occur in low- and middle-income countries. Of which 66% occur in sub-Saharan Africa. Institutional delivery under the hygienic environment with the necessary skills and equipment promotes to identify and treat complications, infections, and the death of the mother and baby. In Ethiopia, the utilization of maternal health services is very low. For instance, 62% of women had antenatal care utilization during pregnancy while only 26% of women utilize institutions for delivery in 2016. Therefore, this study examined the association between antenatal care follow up and intestinal delivery among a nationally representative woman in Ethiopia. Methods A cross-sectional study design was used to examine 7575 women from the 2016 Ethiopia Demographic and Health Survey. Both descriptive and inferential statistics were utilized. Variables in the bivariate logistic regression with p-value p-value Results The prevalence of institutional delivery service utilization for last childbirth was 11.3%. In comparison with women with no antenatal care visits, the multivariable odds ratio (95% confidence interval) of institutional delivery among those who attend one to three and four or more antenatal care visit were 2.49 (1.66, 3.74) and 3.90 (2.60, 5.84), respectively. Other factors significantly associated with institutional delivery include urban residence 2.25 (1.44, 3.51), complete primary education 3.22 (2.09, 4.98), complete secondary or higher education 1.59 (1.16, 2.17), poorer household wealth index 2.57 (1.57, 4.20), middle household wealth index 1.63 (1.05, 2.52), and richer household wealth index 1.56(1.03, 2.58). Conclusion Antenatal care follow-up was significantly associated with institutional delivery service utilization. As the number of antenatal care visits increased the odds of facility delivery increased. Thus, improved access and utilization of antenatal care can be an effective strategy to increase institutional deliveries and optimal maternal and child health outcomes.

In Botswana, an estimated 350 000 people live with HIV/AIDS. HIV/AIDS testing rates are low, suggesting that many other people remain undiagnosed. Stigma related to HIV/AIDS is prevalent and contributes to low testing rates and under-diagnosis of the virus. Identifying factors that contribute to stigma, such as insufficient or inaccurate knowledge of HIV/AIDS, may be critical in increasing early identification and treatment. This cross-sectional study used nationally representative data from the 2013 Botswana AIDS Impact Survey (BAIS) IV to examine the relationship between HIV/AIDS knowledge and stigmatising attitudes toward people living with HIV/AIDS (PLWHA). The mean (standard error) for stigma towards PLWHA score and HIV/AIDS knowledge score were 0.99 (0.02) and 5.90 (0.03) respectively. HIV/AIDS knowledge score and stigma towards PLWHA score were strongly positively correlated r (4,4045) = 0.415, p < 0.001). After adjusting for potential confounders, HIV/AIDS knowledge score significantly predicted stigma towards PLWHA score [coefficient β (95% CI)] [−0.25 (−0.29, −0.20), p < 0.001]. These findings imply that programmes and interventions that increase HIV/AIDS knowledge may reduce the pervasive apprehension, blame, and stigmatising attitude held towards PLWHA in Botswana.Keywords: BAIS, HIV knowledge, prevention, social stigma, sub-Saharan Africa, transmission

Adequate knowledge of sexual health among young adults is a critical step in prevention of sexually transmitted diseases and maintenance of adult sexual health. Knowledge of specific barriers to accessing sexual health knowledge can help tailor approaches appropriately. The purpose of this paper was to identify sexual health knowledge barriers among Somali young adults in Ohio.In-depth interviews were conducted with a convenience sample of 27 Somali young adults aged 18-25 years. Using a grounded theory approach, a semi-structured interview guide comprising open-ended questions and probes was utilized to collect data. Data were analyzed and coded using constant comparative analysis.Findings revealed sexual health knowledge barriers in the following broad categories: religion, culture and stigma. Cultural and religious norms were deemed an important influence on the community norms largely impacting sexual health knowledge due to stigma and fear of judgment. Participants overcame barriers by seeking information from external sources such as doctors, Internet and peers.Study findings support an approach that will address sexual health barriers in the Somali immigrant young community at multiple levels: individual, interpersonal and community levels. A collaborative effort across religious, cultural and educational setting is necessary to tailor approaches that meet the needs of the priority group.

Despite a growing number of publicly available datasets, the use of these datasets for secondary analyses in human biology is less common compared with other fields. Secondary analysis of existing data offers an opportunity for human biologists to ask unique questions through an evolutionary and biocultural lens, allowing for an analysis of cultural and structural nuances that affect health. Leveraging publicly available datasets for human biology research is a way for students and established researchers to complement their data collection, use existing data for master's and doctoral theses, pilot test questions, and use existing data to answer interesting new questions or explore questions at the population level. Here we describe where publicly available data are stored, highlighting some data repositories and how to access them. We then discuss how to decide which dataset is right, depending on the research question. Next, we describe steps to construct datasets, analytical considerations and methodological challenges, best practices, and limitations depending on the structure of the study. We close by highlighting a number of publicly available datasets that have been used by human biologists and other datasets that may be of interest to the community, including research that has been conducted on some example datasets.

Context:Current osteopathic medical students will play an important role in implementing, modifying, and advocating for or against the Patient Protection and Affordable Care Act (ACA) of 2010. Accordingly, medical educators will need to address curricular gaps specific to the ACA and medical practice. Research that gauges osteopathic medical students' level of understanding of the ACA is needed to inform an evidence-based curriculum.Objective:To assess first- and second-year osteopathic medical students' beliefs about the ACA.Methods:In this descriptive cross-sectional survey-based study, first- and second-year students were recruited because their responses would be indicative of what, if any, information about the ACA was being covered in the preclinical curriculum. A 30-item survey was distributed in November 2013, after the health insurance exchanges launched on October 1, 2013.Results:A total of 239 first- and second-year osteopathic medical students completed the survey. One hundred ten students (46%) disagreed and 103 (43.1%) agreed that the ACA would provide health insurance coverage for all US citizens. The ACA was predicted to lead to lower wages and fewer jobs (73 students [30.5%]), as well as small business bankruptcy because of employees' health insurance costs (96 [40.2%]). Regarding Medicare recipients, 113 students (47.3%) did not know whether these individuals would be required to buy insurance through the health insurance exchanges. The majority of students knew that the ACA would require US citizens to pay a penalty if they did not have health insurance (198 [82.8%]) and understood that not everyone would be required to purchase health insurance through health insurance exchanges (137 [57.3%]). Although students took note of certain clinical benefits for patients offered by the ACA, they remained concerned about the ACA's impact on their professional prospects, particularly in the area of primary care.Conclusion:These findings build on the existing literature that emphasize the need for incorporating into the osteopathic medical curriculum knowledge of the dynamics of health care policy and reform and for creating opportunities for students to follow health policy developments as they evolve in real time.

Evaluation and removal of home hazards is an invaluable method for preventing in-home falls and preserving independent living. Current processes for conducting home hazard assessments are impractical from a whole population standpoint given the substantial resources required for implementation. Digital photography offers an opportunity to remotely evaluate an environment for falling hazards. However, reliability of this method has only been tested under the direction of skilled therapists. Ten community dwelling adults over the age of 65 were recruited from local primary care practices between July, 2009 and February, 2010. In-home (IH) assessments were completed immediately after a photographer, blinded to the assessment form, took digital photographs (DP) of the participant home. A different non-therapist assessor then reviewed the photographs and completed a second assessment of the home. Kappa statistic was used to analyze the reliability between the two independent assessments. Home assessments completed by a non-therapist using digital photographs had a substantial agreement (Kappa = 0.61, p, Highlights • Alternative approaches to traditional home safety assessments were analyzed. • In-home assessments were compared to assessments completed from digital photographs. • Home assessments of falling hazards using photographs are reliable. • Non-therapists can reliably identify falling hazards from photographs. • Utilizing non-therapists and technology can promote fall prevention implementation.

Background Chronic diseases contribute a large share of disease burden in low- and middle-income countries (LMICs). Chronic diseases have a tendency to occur simultaneously and where there are two or more such conditions, this is termed as ‘multimorbidity’. Multimorbidity is associated with adverse health outcomes, but limited research has been undertaken in LMICs. Therefore, this study examines the prevalence and correlates of multimorbidity as well as the associations between multimorbidity and self-rated health, activities of daily living (ADLs), quality of life, and depression across six LMICs. Methods Data was obtained from the WHO’s Study on global AGEing and adult health (SAGE) Wave-1 (2007/10). This was a cross-sectional population based survey performed in LMICs, namely China, Ghana, India, Mexico, Russia, and South Africa, including 42,236 adults aged 18 years and older. Multimorbidity was measured as the simultaneous presence of two or more of eight chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, and vision impairment. Associations with four health outcomes were examined, namely ADL limitation, self-rated health, depression, and a quality of life index. Random-intercept multilevel regression models were used on pooled data from the six countries. Results The prevalence of morbidity and multimorbidity was 54.2 % and 21.9 %, respectively, in the pooled sample of six countries. Russia had the highest prevalence of multimorbidity (34.7 %) whereas China had the lowest (20.3 %). The likelihood of multimorbidity was higher in older age groups and was lower in those with higher socioeconomic status. In the pooled sample, the prevalence of 1+ ADL limitation was 14 %, depression 5.7 %, self-rated poor health 11.6 %, and mean quality of life score was 54.4. Substantial cross-country variations were seen in the four health outcome measures. The prevalence of 1+ ADL limitation, poor self-rated health, and depression increased whereas quality of life declined markedly with an increase in number of diseases. Conclusions Findings highlight the challenge of multimorbidity in LMICs, particularly among the lower socioeconomic groups, and the pressing need for reorientation of health care resources considering the distribution of multimorbidity and its adverse effect on health outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12916-015-0402-8) contains supplementary material, which is available to authorized users.

The HIV/AIDS epidemic has increased care burden in sub-Saharan Africa but studies on the impact on older persons are equivocal and benefits of caregiving have also emerged. This presentation discusses two qualitative studies in western Kenya and Rwanda. In Kenya, caregiving necessitated an unexpected disruption and many burdens but the change of identity/roles with caregiving was both a source of pride and empowerment for older adults. Caregivers described multiple burdens yet they felt a moral, familial or spiritual obligation to provide care. Further, many participants also assistance from orphans or anticipated reciprocity. In Rwanda, caregiving was viewed as an opportunity for older persons to make themselves useful community members. Caregiving, in this setting, was not considered a burden in the conventional sense but a moral responsibility and a practice that brought communities together. These results suggest that caregiving is multidimensional with a balance of burden and empowerment, caregiving and care-receiving.