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Determinants and patterns of care-seeking for childhood illness in rural Pune District, India.


  • 影响因子:3.08
  • DOI:10.7189/jogh.10.010601
  • 作者列表:"Marsh A","Hirve S","Lele P","Chavan U","Bhattacharjee T","Nair H","Juvekar S","Campbell H
  • 发表时间:2020-06-01

Background:An estimated 1.2 million children under five years of age die each year in India, with pneumonia and diarrhea among the leading causes. Increasing care-seeking is important to reduce mortality and morbidity from these causes. This paper explores the determinants and patterns of care-seeking for childhood illness in rural Pune district, India. Methods:Mothers having at least one child <5 years from the study area of the Vadu Health and Demographic Surveillance System were enrolled in a prospective cohort study. Household sociodemographic information was collected through a baseline questionnaire administered at enrollment. Participants were visited up to six times between July 2015 and February 2016 to collect information on recent childhood acute illness and associated care-seeking behavior. Multivariate logistic regression explored the associations between care-seeking and child, participant, and household characteristics. Results:We enrolled 743 mothers with 1066 eligible children, completing 2585 follow-up interviews (90% completion). Overall acute illness prevalence in children was 26% with care sought from a health facility during 71% of episodes. Multivariable logistic regression showed care-seeking was associated with the number of reported symptoms (Odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.5-3.9) and household insurance coverage (OR = 2.2, 95% CI = 1.1-4.3). We observed an interaction between the associations of illness severity and maternal employment on care-seeking. Somewhat-to-very severe illness was associated with increased care-seeking among both employed (OR = 5.0, 95% CI = 2.2-11.1) and currently unemployed mothers (OR = 7.0, 95% CI = 3.9-12.6). Maternal employment was associated with reduced care-seeking for non-severe illness (OR = 0.3, 95% CI = 0.1-0.7), but not associated with care-seeking for somewhat-to-very severe illness. Child sex was not associated with care-seeking. Conclusions:This study demonstrates the importance of illness characteristics in determining facility-based care-seeking while also suggesting that maternal employment resulted in decreased care-seeking among non-severe illness episodes. The nature of the association between maternal employment and care-seeking is unclear and should be explored through additional studies. Similarly, the absence of male bias in care-seeking should be examined to assess for potential bias at other stages in the management of childhood illness.


背景: 印度每年估计有 120万名 5 岁以下儿童死亡,肺炎和腹泻是主要原因。增加护理寻求对于降低这些原因的死亡率和发病率是重要的。本文探讨了印度浦那区农村儿童疾病护理的决定因素和模式。 方法: 从Vadu健康和人口统计监测系统的研究区域中至少有一个孩子 <5 年的母亲被纳入一项前瞻性队列研究。通过入组时给予的基线问卷收集家庭社会人口学信息.在 2015 年 7 月至 2016 年 2 月期间,参与者被访问了多达六次,以收集关于近期儿童急性疾病和相关寻求护理行为的信息。多变量逻辑回归探讨了寻求照顾与儿童,参与者和家庭特征之间的关联。 结果: 我们招募了 743 名母亲和 1066 名符合条件的儿童,完成了 2585 次随访访谈 (90% 完成)。在 26% 的发作期间,在医疗机构寻求护理的情况下,儿童的总体急性病患病率为 71%。多变量logistic回归分析显示,寻求护理与报告的症状数量相关 (比值比 (OR)  = 2.4,95% 可信区间 (CI)  = 1.5-3.9) 和家庭保险 (or = 2.2,95% ci = 1.1-4.3)。我们观察到疾病严重程度与孕产妇就业之间的相互作用。某种程度到非常严重的疾病与两名就业者寻求护理的增加有关 (or =   5.0,95% ci =   2.2-11.1) 和目前失业的母亲 (or   =   7.0,95% ci   =   3.9-12.6)。孕产妇就业与非严重疾病寻求护理的减少相关 (or = 0.3,95% ci = 0.1-0.7),但与寻求某种程度至非常严重疾病的护理无关。儿童性行为与寻求护理无关。 结论: 本研究证明了疾病特征在确定基于机构的护理寻求中的重要性,同时也表明孕产妇就业导致非严重疾病发作中护理寻求减少。孕产妇就业和寻求护理之间联系的性质尚不清楚,应通过更多的研究进行探索。同样,应该检查在寻求护理中没有男性偏见,以评估在儿童疾病管理的其他阶段的潜在偏见。



来源期刊:Nature immunology
作者列表:["Adrover JM","Aroca-Crevillén A","Crainiciuc G","Ostos F","Rojas-Vega Y","Rubio-Ponce A","Cilloniz C","Bonzón-Kulichenko E","Calvo E","Rico D","Moro MA","Weber C","Lizasoaín I","Torres A","Ruiz-Cabello J","Vázquez J","Hidalgo A"]

METHODS::The antimicrobial functions of neutrophils are facilitated by a defensive armamentarium of proteins stored in granules, and by the formation of neutrophil extracellular traps (NETs). However, the toxic nature of these structures poses a threat to highly vascularized tissues, such as the lungs. Here, we identified a cell-intrinsic program that modified the neutrophil proteome in the circulation and caused the progressive loss of granule content and reduction of the NET-forming capacity. This program was driven by the receptor CXCR2 and by regulators of circadian cycles. As a consequence, lungs were protected from inflammatory injury at times of day or in mouse mutants in which granule content was low. Changes in the proteome, granule content and NET formation also occurred in human neutrophils, and correlated with the incidence and severity of respiratory distress in pneumonia patients. Our findings unveil a 'disarming' strategy of neutrophils that depletes protein stores to reduce the magnitude of inflammation.

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翻译标题与摘要 下载文献
作者列表:["Yang LC","Suen YJ","Wang YH","Lin TC","Yu HC","Chang YC"]

METHODS::Pneumonia is a common respiratory infectious disease that involves the inflammation of the pulmonary parenchyma. Periodontal disease is widespread and correlated with pneumonia. However, the relationship between periodontal treatment and clinical infectious outcomes in patients with pneumonia has remained undetermined. The aim of this study was to investigate the association between periodontal treatment and the risk of pneumonia events in the Taiwanese population. A nationwide population-based cohort study was conducted using data from the Taiwanese National Health Insurance Research Database (NHIRD). A total of 49,400 chronic periodontitis patients who received periodontal treatment from 2001 to 2012 were selected. In addition, 49,400 healthy individuals without periodontal diseases were picked randomly from the general population after propensity score matching according to age, gender, monthly income, urbanization, and comorbidities. The Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between the periodontal treatment cohort and the comparison cohort. The average ages of the periodontal treatment and comparison groups were 44.25 ± 14.82 years and 44.15 ± 14.5 years, respectively. The follow up durations were 7.66 and 7.41 years for the periodontal treatment and comparison groups, respectively. We found 2504 and 1922 patients with newly diagnosed pneumonia in the comparison cohort and the periodontal treatment cohort, respectively. The Kaplan-Meier plot revealed that the cumulative incidence of pneumonia was significantly lower over the 12 year follow-up period in the periodontal treatment group (using the log-rank test, p < 0.001). In conclusion, this nationwide population-based study indicated that the patients with periodontal treatment exhibited a significantly lower risk of pneumonia than the general population.

翻译标题与摘要 下载文献
作者列表:["Ngocho JS","Horumpende PG","de Jonge MI","Mmbaga BT"]

METHODS:OBJECTIVE:To describe the treatment of community-acquired pneumonia (CAP) in children under five years in Tanzania. METHODS:Between January and December 2017, children aged 2-59 months with chest radiography-confirmed CAP were enrolled. The parents were interviewed to collect information on the patients and home-based medication. Clinical information was derived from the patient files. Nasopharyngeal swab and blood samples were collected for isolation of the causative pathogens. Swab samples were analysed by quantitative PCR whereas blood samples were tested using BacT/Alert 3D. RESULTS:Overall, 109 children with CAP were included in this analysis. Provision of care to most children was delayed (median = 4.6 days). A quarter (26.6%) were given unprescribed/leftover antibiotics at home. Only one child had positive bacterial culture. Referrals were associated with nasopharyngeal carriage of Streptococcus pneumoniae (p = 0.003) and Haemophilus influenzae (p = 0.004). Of all admitted children, more than a quarter (n = 29) did not need to be hospitalised and inappropriately received injectable instead of oral antibiotics. CONCLUSION:We found high rates of home treatment, particularly with antibiotics. Appropriate health care was delayed for most children because of home treatment. Efforts are needed at the community level to improve awareness of antimicrobial resistance.

翻译标题与摘要 下载文献