Master of Public Health

Permanent URI for this collectionhttps://192.168.0.29/handle/123456789/127

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Factors associated with overweight/obesity among children of Mogoditshane Adventist School children in Botswana
(Adventist University of Africa, School of Postgraduate Studies, 2020-05) Mponwane, Mpho
The epidemic of childhood overweight/obesity, which in the developed world is mainly found in rural areas, has increased the incidence of plaguing cities and towns of the developing world. This is particularly the case in developing nations that are also experiencing nutritional transition, such as Botswana. The hypothesis of this study stated that there is no statistically significant association between demographic profiles/eating behavior/activity habits/parental factors with overweight/obesity status amongst children of the Mogoditshane Adventist School in Botswana. Both the questionnaires for the teachers and the parents were mainly interviewer-administered, although there were instances where some participants took the questionnaire and filled it independently. A certified Tanita scale was used to measure BMI for validity and reliability. Scales were calibrated and checked by the Botswana Bureau of Standards and certified to be appropriate for use in this study. Height measurements for the children were taken by trained measurers with thechildren standing in a standardized position of up straight with their legs and feet together and head vertical for precision. Both quantitative and qualitative data were analyzed. Chi-square was used for testing the socio-demographic variables, as well as the factors, eating behavior, and activity habits for association with overweight/obesity status (BMI z scores). Furthermore, multivariate logistic regressions were used to assess the independent factors associated with overweight/obesity. Data were collected from 152 parents of children 6-13 years of age to describe the aforementioned factors. Mothers were the majority at 63.6% of the sample. Batswana comprised 81.6 % of the sample. Child male participants were 42.8% while females comprised 57.2%. The children’s weight status was categorized using BMI z scores. 14.5% had BMI z scores > +2SD (Obesity), 19.1% had BMI z scores > +1SD (Overweight), 63.2% had BMI z scores between +1 and -2 (Normal), 2.6% had BMI z scores of <-2 (Underweight), and 0.7% had BMI z scores <-3 (Severe underweight). There was only one statistically significant variable (factor) found to be associated with overweight/obesity: Parental concern for child’s body weight [PV = 0.000; AOR = 4.659 (2.207-9.955)]. Additionally, whether the child eats fast food weekly [PV = 0.007; AOR = 0.207 (0.066-0.649)], whether child eats breakfast in the morning before school [PV = 0.048; AOR = 2.790 (1.008-7.727)], education of participant parent [PV = 0.036; AOR = 0.155 (0.027-0.886)] were the three statistically significant variables (factors) found to be associated with children’s obesity status. Therefore, we failed to reject the null hypothesis. The recommendations of the study show that consideration of the socio-demographics, healthy diet and activity factors is needed in developing child overweight and obesity prevention programs.
Assessment of exclusive breastfeeding knowledge and practices among post-natal mothers attending Ashaiman Polyclinic in the greater Accra region of Ghana
(Adventist University of Africa, School of Postgraduate Studies, 2019-04) Ofosuhene, Frank
It is expected that every country promotes, protects and supports breastfeeding program for infants and the mother’s health (WHO 1990). This study was designed to assess the knowledge and the extent to which breastfeeding was practiced among postnatal mothers who accessed Ashaiman Polyclinic in the Greater Accra Region of Ghana. The study utilized a survey as a research design by employing structured questionnaire as data collection technique. A sample size of 422 breastfeeding mothers whose children were less than two years old was used for the study. The data was analyzed using the Statistical Package for Social Sciences (SPSS version 21). The results were presented in frequency, percentages and inferences were made using a paired sample test. The significant values were computed to check for the relationship between the participants’ knowledge and the practice of exclusive breastfeeding and the P-value was set at 0.05.The exclusive breastfeeding rate according to WHOs recommendation was found to be 71%. Although there were considerably variations in the exclusive breastfeeding duration, the mothers generally had good knowledge (98%) and practices (96%) regarding exclusive breastfeeding.
Determinants of breast cancer awareness and screening practices of women within Tamale, Ghana
(Adventist University of Africa, School of Postgraduate Studies, 2019-04) Adams, Patsy Ago
Breast cancer is now ranked the most common cancer worldwide, increasing from 1.7 million incident cases in 2005 to 2.4 million cases in 2015. Both early detection and treatment have been shown to be the most effective methods to address the impact of this devastating disease. This study assessed the determinants of breast cancer awareness and practice of breast cancer screening among women in the Tamale, Ghana. A cross-sectional survey of 396 adult women, chosen by stratified random sampling was undertaken using a questionnaire. Results showed that the majority of the respondents were below 40 years of age (75.5%). Almost all participants (99.0%) had heard of breast cancer (awareness). Interestingly, the majority (51.3%) knows the cause of breast cancer to be bacteria. The most practiced method of screening was breast self-examination (86.4%), clinical breast examination and mammogram had 77.3%. We found that 93.4% of the population respectively never practiced either. Age, religious affiliations and ethnicities were seen to have statistically significant relations to awareness and practice.
Solid waste disposal practices of primary school children in Kajiado North Sub-County, Kenya
(Adventist University of Africa, School of Postgraduate Studies, 2020-03) Mugo, Dorcas Wanjiku
Littering is rampant in Kenya and leads to numerous environmental health challenges by contributing to unsanitary conditions that proliferate diseases. Although the national and county governments are increasing investments in solid waste management systems and banning the generation of certain waste material such as single-use plastic bags, it is clear that the behavior of littering is a factor that needs to be addressed to significantly reduce littering. Numerous studies have been done all over the world to profile litterers and study littering trends to identify the factors that contribute to littering behavior and suggest ways to change littering behavior. However, such studies have not been done in Kenya and especially in Kajiado North Sub-County, which is a settlement area for people who work in Nairobi due to its proximity to the capital city. Being so, it, therefore, experiences waste generation levels and trends akin to those of an urban area. This study examined the solid waste disposal practices of primary schoolchildren to determine reasons for these, and identify potential solutions to curb littering behavior. This is reasonable because by addressing the behavior in children it may be that the cycle of littering can be broken from one generation to another since behavior change usually takes a long time to happen. The target population consisted of primary school children aged 6-14 years in both private and public schools in Kajiado North Sub-county from which a total of 400 students were sampled. Questionnaires were administered and interviews carried out for the younger children. The data collected was coded, entered, and analyzed using PSPPIRE Data Editor version 3, and both descriptive and inferential analyses were conducted. The findings of the self-reported littering frequency are that 46.73% of primary school children never litter, while 8.72% always litter and 25.23% litter sometimes. There is also no difference in littering frequency between children in public and private schools, meaning that socio-economic status does not affect littering frequency. Also, boys litter slightly more than girls. An ordinal logistic regression analysis was carried out between littering frequency and environmental attitude of the children, which was considered a significant factor, and with location significance values of p=0.3, p=0.49, and p=0.453 for the three categories Action-Oriented, Concern, and Apathy, there is no significant relationship between environmental attitude and littering behavior. This pointed to the fact that other significant factors also affect littering behavior and not just environmental attitude, and so though most children have a positive attitude toward the environment, it is not a significant explanatory variable of their littering behavior. Other factors examined were: understanding of what litter is, parental behavior, lack or presence of punitive measures, size and nature of litter, and place of littering. Students believe that most people have a wrong environmental attitude which makes them litter, but they recommend that proper infrastructure, especially more littering bins, to be put in place to empower them to reduce littering. Therefore, even though environmental attitudes can be addressed in the long run, the infrastructure to enable proper disposal should be the first intervention that creates immediate impact. The study recommends that county government, national government, schools, and companies enable primary school children to dispose of litter properly by availing the infrastructure for proper disposal, maintaining cleanliness, educate children on proper waste disposal, carry out environmental awareness campaigns and anti-littering campaigns to the general population, and not over-rely on punitive measures to change littering behavior.
Determinants Of diarrhoea among under-five children in Umzingwane District, Zimbabwe: a case-control study
(Adventist University of Africa, School of Postgraduate studies, 2018-03) Mkandla, Sifelani
Diarrhoeal disease remains a leading cause of mortality and morbidity among children less than five years old in the developing world. The average annual incidence rate of diarrhoea in children less than five years of age (under-fives) is estimated to be 2.6 episodes in developing countries. It is also estimated that there are 100 million episodes and 3.3 million deaths occurring each year among under-fives globally. In Africa, a child typically experiences five episodes of diarrhoea per year, and 800,000 children die each year from diarrhoea and dehydration. In Zimbabwe diarrhoea is the fourth highest cause of death for children under five and is the reason for 12% of child hospital admission (Zimbabwe Maternal and Child Health Integrated Programme, 2014). According to World Bank Collection of Development Indicators, 2014 the prevalence of diarrhoea in under-fives in Zimbabwe was 16%. Umzingwane District recorded a high number of diarrhoea cases in underfives in 2016. The total number of diarrhoea cases from under- fives was 1 018 andconstituted 40% of the total number of diarrhoea cases in the district. The figure constitutes an overrepresentation of morbidity among this age group since the underfives make up 13.7% of the total population. The cause for the upsurge of diarrhoea cases was not documented by epidemiological studies or the literature. The aim of this study was to examine or discover context-specific conditions in Umzingwane district that may have led to an uptick in diarrhoea cases among under-fives in 2016. The study was a 1:1 unmatched case-control study. The research surveyed 200 cases and 200 controls. The cases were under-fives in Umzingwane District who had diarrhoea in 2016. The researcher used the standard case definition for diarrhoea as cited in the literature. The controls were under-fives who did not have diarrhoea in 2016 and came from the same neighbourhood as cases. A pre-tested, interviewer-administered questionnaire, was used to collect data from caregivers of cases and controls and under-fives. The questionnaire was filled by trained research assistants. Sanitary inspections were conducted through visual assessment of the infrastructures and the sanitary state surrounding the household water supply, water-holding containers, household sanitary conditions, food storage, personal hygiene, kitchen hygiene and vaccination status of the children as these factors have a potential risk to health and wellbeing of the child. Water samples were collected from boreholes and shallow unprotected wells to check for Escherichia Coli (E. coli) contamination and turbidity Data were analyzed using Epi Info 7.2.1.0 version. Odds ratios and Chi-square tests at 5% significant levels and 95% confidence intervals were generated using the software. Forward stepwise logistic regression analysis was used to control for confounding and effect modification. The adjusted odds ratios were calculated toquantify the strength of association between risk factors and outcome and factors with a p-value less than 0.05 were considered significant. Out of 35 borehole water samples tested, 33(94.29%) were below the threshold limit for contamination with Escherichia coli and 2 of the 35 (5.71%) borehole water samples tested were above the threshold for contamination with Escherichia coli. Out of 50 unprotected shallow wells water samples tested 9(18%) were below the threshold limit for contamination with Escherichia coli and 41(82%) unprotected shallow wells water samples tested were above the threshold for contamination with Escherichia coli. Independent risk factors for contracting diarrhoea were: source of water [OR=2.2457, CI=1.0924-4.6164, p-value=0.0278], disposal of solid waste [OR=4.62, CI=1.9380-11.0330, p-value=0.0006], sanitary state of the kitchen [OR=2.2307, CI=1.0185-4.8854, p-value=0.0449]. Independent protective factors for contracting diarrhoea were: household income [OR=0.2273, CI= 0.1180-0.4378, pvalue=0.0000], caregiver knowledge on diarrhoea prevention and control [OR=0.2940, CI=0.1316-0.6566, p-value=0.0028], washing hands by caregivers at all critical times [OR=0.0461, CI=0.0227-0.0937, p-value=0.0000] The study has highlighted the disaggregated household level risk factors for diarrhoea in under-fives in Umzingwane District. The environmental risk factors were drinking water from contaminated sources, indiscriminate disposal of waste around the home and unsanitary status of the kitchen where food is prepared. This clearly indicates the importance of environmental health as a determinant of child health. Therefore, there is a need for effective measures to enhance universal access to safe water, improved food hygiene practices and appropriate waste management strategies at the household level. The socioeconomic protective factors were knowledge of diarrhoea prevention and economic stability of the caregivers. The behavioural protective factor was washing of hands at all critical times by caregivers. This implies that hygiene promotion interventions should prioritise protective factors such as increasing caregiver knowledge of diarrhoea prevention, establishment and use of hygienic hand washing facilities and improving socioeconomic status of households.
Prevalence of Hypertension and Associated Risks Among Gospel Workers of the Seventh-Day Adventist Church in Northern Ghana Union Mission
(Adventist University of Africa, School of Postgraduate studies, 2017-04) Amponsem-Boateng, Cecilia
This study was conducted on 200 gospel workers who were mainly Seventhday Adventists from the South Central, Ashanti South, Ashanti Central and the Central Ghana Conferences of Ghana, as means of addressing hypertension and its associated risks. It had a broad objective of determining the prevalence of hypertension and its associated risks, among Gospel workers of the Northern Ghana Union Mission (NOGH) of the Seventh-day Adventist Church, and specific objectives of firstly determining the level of knowledge on hypertension among them; secondly to identify the nature of management of hypertension among gospel workers; and lastly, to determine the risk factors associated with hypertension among the gospel workers. The study adopted the mixed method approach by using a combination of cross-sectional, descriptive and non-experimental survey design. Data was collected by using both quantitative and qualitative approaches. These were questionnaires,interviews, documentary analysis and field survey. The questionnaires which contributed the larger part were analyzed by using SPSS, while interviews response were interpreted as the respondents meant them. The results of the study discovered that the majority of the gospel workers had adequate knowledge about the causes and symptoms of hypertensive disease. Regardless of this high knowledge, there was a high prevalence rate (38%) of hypertension. Though some gospel workers claimed they were aware of being hypertensive and had adopted various anti-hypertension management and prevention measures, there was still a poor health behavior and lifestyle among the gospel workers leading to the prevalence of hypertension. It was therefore concluded that, in the case of Gospel workers such as pastors, elders of churches and church financial officers where most activities are taken to be more spiritual in nature, less attention is typically paid to the prevention and management of lifestyle/medical conditions like hypertension. Based on the findings of the study and the conclusions, it is recommended that various measures, such as effective nutrition/health education on topics such as Myplate guidelines, as well as enlightenment on the causes and symptoms of hypertension, will be a step toward the reduction in the prevalence of hypertension. General improvement of the lifestyle and health behavior of gospel workers such as engaging in good dieting system, exercising regularly, and having enough rest. Part of a good prevention intervention would also include visiting the hospitals, clinics, and other health centers regularly to assess health status. Of course, it is also vital to report cases of hypertension to the health centers as another method to manage and prevent the prevalence of hypertension.

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