Needs Assessment and Prenatal Education Program for Local Midwives of the Ngöbe Population of Panama

·

 Indigenous communities of Panama, like many resource-limited populations, suffer high rates of maternal and fetal morbidity and mortality. This study aims to identify barriers to prenatal care within Ngöbe communities and implement a prenatal education program for local midwives. Administration of needs assessment survey and prenatal health education took place in indigenous communities in Bocas del Toro. Questionnaire results showed that 47 of 101 surveyed pregnant women reported planning a home delivery. Forty-six of 101 women used prenatal vitamins during pregnancy, yet only three (2.97%) women initiated prenatal vitamins prior to pregnancy or during the first trimester. The increased use of prenatal vitamins with advancing gestational age suggests a delay between confirmation of pregnancy and receipt of vitamins. Forty of 68 (58.8%) women with zero to four children desired contraception, while 18 of 21 women (85.7%) with five children or more desired contraception (p=0.02). However, only 14 of 89 women had ever used contraception. Regarding the prenatal health education curriculum, there was a significant increase in test performance when comparing pre- and post-presentation surveys (p=0.0002). The success of the prenatal curriculum demonstrates the ability to effectively increase knowledge and empower women to improve health outcomes within their communities.

Development of Patient Education Materials for Total Joint Replacement during an International Surgical Brigade

·

Temporary brigade trips to deliver international surgical care are increasingly common. Many brigade programs have begun to collect and publish data on outcomes and complications but few have examined their own patient education practices. We utilized evidence-based methods and interviews with patients to develop improved patient education materials for Operation Walk Boston (OpWalk Boston), a total joint replacement surgical brigade in the Dominican Republic. Existing OpWalk Boston patient education materials required an 8th grade reading level and lacked suitability based on principles of educational theory. The re-designed materials required 5th grade reading skills or less and had superior suitability. Pilot testing with patients from the target population suggested that the materials were appealing and appropriate. Patient education may play an important role in optimizing outcomes in the setting of surgical brigades where resources and access to follow-up care are limited. More research is needed to bring attention to the importance of patient education during brigades, and programs should work with patients to develop educational materials which are suitable and effective.

Computer-Assisted Diabetes Risk Assessment and Education (CADRAE) for Medically Vulnerable Populations in the Middle East: a Novel and Practical Method for Prevention

·

The prevalence of diabetes in the Middle East is increasing rapidly due to urbanization, reduced levels of physical activity, and a nutritional transition toward increased consumption of fats and refined carbohydrates. Preventive strategies are of paramount importance to stemming the tide. Portable touch-screen computer technology may hold an answer for alleviating the burdens of cost, time, and training that limit the implementation of diabetes risk screening and intervention, especially among refugees and other vulnerable populations. The Computer-Assisted Diabetes Risk Assessment and Education (CADRAE) Arabic-language intervention program is proposed as a model method for practicing proactive type 2 diabetes prevention in resource-limited settings of the Middle East that combines the efficiency of risk-score screening methods, the advantages of portable computer interface, and the spirit of brief motivational interviewing. This paper aims to describe the theory and novel design of CADRAE—introduced at the Noor Al Hussein Foundation’s Institute of Family Health in January 2014—as well as discuss opportunities and challenges for its implementation and evaluation in primary or emergency care settings. Features of CADRAE are elucidated in detail, including development, translation, conceptual framework, theoretical basis, method of risk assessment, brief intervention style, definition of outcomes, requirements for implementation, and potential means of evaluation and quality improvement. CADRAE offers the first example of portable computer technology integrating diabetes risk screening with behavior change counseling tailored for an Arabic-speaking population of mostly refugees and could offer a valuable model for researchers and policy makers of the Middle East as well as other resource-limited settings.

Use of Traditional Botanical Medicines During Pregnancy in Rural Rwanda

·

Objective: To evaluate the perceptions of healthcare and traditional medicine providers regarding the type, indications, side effects, and prevalence of traditional medicine use amongst pregnant women in a rural Rwandan population.

 

Methods: Six focus groups with physicians, nurses, and community health workers and four individual in-depth interviews with traditional medicine providers were held. Qualitative data was gathered using a structured questionnaire querying perceptions of the type, indications, side effects, and prevalence of use of traditional medicines in pregnancy.

 

Results: The healthcare provider groups perceived a high prevalence of traditional botanical medicine use by pregnant women (50-80%). All three groups reported similar indications for use of the medicines and the socioeconomic status of the pregnant women who use them. The traditional medicine providers and the healthcare providers both perceived that the most commonly used medicine is a mixture of many plants, called Inkuri. The most serious side effect reported was abnormally bright green meconium with a poor neonatal respiratory drive. Thirty-five traditional medicines were identified that are used during pregnancy.

 

Conclusion: Perceptions of high prevalence of use of traditional medicines during pregnancy with possible negative perinatal outcomes exist in areas of rural Rwanda

Influences of Value Added Taxes on Alcohol Consumption in Grenada

·

The focus of this study was to understand the role of alcohol consumption within Grenadian male social support networks. In particular, the research presented examines the degree to which a 15% Value Added Tax (VAT) adopted in 2008, influences the drinking habits of this cohort. While VAT was found to have no significant impact on drinking habits, the data collected points to the overwhelming significance of alcohol consumption as a dominant cultural practice in post-colonial Grenada. The habitual consumption of alcohol as a Grenadian cultural practice should be studied further as a social determinant. In an effort to design effective social remediation programs, additional data collected regarding Grenadian male alcohol consumption will inform and compliment earlier published work by one of the researchers, which found that traditional cultural norms for Grenadian male identity endorse male physical dominance over their partners. 

Host Perspectives of Visiting Medical Trainees: a Qualitative Analysis of Global Health Electives

·

Medical trainees from Northern, developed regions of the world increasingly travel to Southern or less developed regions of the world for a clinical experience or ‘global health elective’. There is little research regarding these types of activities. This qualitative project aimed to generate the perceptions that medical students from Uganda hold regarding their Northern counterparts who visit on a global health elective. The purpose was to gain insight into the benefits and challenges of these increasingly popular activities. Thirty-two medical students from Makerere University in Uganda took part in tape-recorded semi-structured interviews. Questions revolved around perceived benefits, challenges, and impressions of visiting Northern medical students. Interviews were analyzed qualitatively. Study participants perceived that visitors come to learn tropical medicine and to practice on patients. Students also felt that there was a lack of interaction and engagement with the visitors. They were, however, eager to benefit from the teaching that could potentially be provided by visitors. This project identified perceptions that medical students in Uganda possess towards students who visit from the North. These ideas provide insight into how global health electives can become more mutually beneficial and with a more accurate definition of their intent.

Child Health Inequalities in Nigeria: Magnitude and Determinants of Mortality in Children Under Five

·

This study aimed to assess the magnitude of inequalities in mortality in children under the age of five (U5M) across socio-cultural groups and to evaluate the social determinants of U5M in Nigeria. A cross-sectional study using the dataset of women in reproductive age group obtained from the 2008 Nigeria Demographic Health Survey was examined. Mortality among children under five born to women between the years 2003-2008 was explored. The relative gap between U5M was estimated and determinants of U5M were explored with logistic regression analysis. Wide inequalities were observed across population groups. Rural areas had 41% higher U5M than urban areas and families in the poorest wealth quintile had double the U5M of the richest. U5M inequality was greater in urban than rural groups. There were also variations by ethnicity and the gradient of U5M favored the southern zones of the country. The predictors of U5M were: increasing paternal age, Hausa ethnicity, living in the northern regions of the country, lack of formal education of mothers and being in the lowest wealth quintile. These inequalities in U5M will continue to impede the attainment of the Millennium Development Goal targets for Nigeria unless decisive actions are taken.

Improving Tuberculosis Case Detection and Treatment Adherence in Ethiopia: Using Behavioral Economics to Redefine the Need for Cultural Competence

·

Tuberculosis case detection and treatment success rates in the country of Ethiopia trail those of neighboring sub-Saharan African countries, despite comparable application of DOTS [1]. This paper is the first of a two-part series to theoretically and practically assess ways in which models of cultural competence and behavioral economics can be implemented to improve TB outcomes in Ethiopia. In this first article, perceived irrationality on the part of the TB patient will be explained via application of behavioral economics. Three tenets of behavioral economics are defined and analyzed: loss aversion, hyperbolic discounting, and social bias. These components are then used to describe the ways in which cultural competence can be re-evaluated in the context of global health, with emphasis on tuberculosis in Ethiopia. The analysis concludes by offering the Purnell Model of Cultural Competence to parse the patient irrationality as perceived by providers (and identified via principles of behavioral economics) from the inherent cultural norms of the patient to better inform TB control efforts.

Cruzada de la Esperanza (Crusade of Hope)

Women’s Health Promotion and the Prevention and Diagnosis of Breast Cancer, Cervical Cancer, Uterine Cancer, and Sexually Transmitted Diseases in Rural Honduras, 2008-2009

·

A pilot public health project in Honduras aimed at providing services for women’s health promotion and the prevention and diagnosis of breast, cervix and uterus cancers, sexually transmitted diseases and HIV/AIDS was implemented. “Cruzada de la Esperanza” targeted 789,415 women of fertile age older than 18 years in impoverished and hard to reach rural areas. The project was funded by The Democratic Republic of China-Taiwan and The Honduras Health Ministry. “COCSIDA” Centro de Orientación y Capacitación en SIDA (Center for Counseling and Training on HIV/AIDS) was the institution administrating and implementing the project in 98 municipalities and 576 villages. The health threats in this population are due to the close relationship between women’s reproductive health issues and components of human sexuality, influenced by socio-cultural factors expressed through male “machismo”, female subordination and lack of empowerment and education. The project’s demographic coverage was every person who directly or indirectly benefited from the services. The criteria for intervention were those for the targeted health threats and pregnant women. The Crusade’s main goal was to decrease late detection for the stated cancers and other health problems. Another goal was the increase of access and services utilization including mammography, vaginal cytology, rapid HIV testing and counseling, diagnosis of sexually transmitted diseases and positive case referral to a higher quality health care center. By achieving the above goals the Honduras female population was educated to adopt better and safer health care practices and access to those services will increase. The main strategy of implementation was the use of 3 mobile mammograms, radiological and laboratory diagnostic equipped vehicles available in a community health fair atmosphere. The plan was to provide 10,800 mammograms, 25,920 ultrasounds, 25,920 vaginal cytologies, 12,920 rapid HIV tests and 20,000 sexually transmitted disease attentions. The Crusade began in May 2008 but ended in March 2009. A total of 98 municipalities in 13 departments and 263,242 people were serviced. A total of 330,154 attentions out of 312,736 planned (105.6%) were accomplished. Of these, 15,390 were mammograms, 9,187 were ultrasounds, 27,271 were cytologies, 13,681 were rapid HIV tests and 8,808 were STD attentions. 305 vaginal cytologies and 70 mammograms were suggestive of malignancy. 21 cases were HIV-positive. 100% of the suggestive malignancy and HIV cases were referred and inserted in a specialized institution for medical care. Due to the successful results, the funding donor entities granted one more year of activities, sadly canceled due to the Honduran political crisis.

The Implications of Rapid Economic Growth for Health-Related Behaviors and Chronic Metabolic Diseases: An Exploratory Study in Post-Earthquake West China

·

A devastating earthquake struck west China in 2008. Reconstruction efforts have focused on urbanization and modernization, hastening economic growth in the area. This rapid growth provides a unique opportunity to explore the potential impact of rapid environmental changes on metabolic disease risk. The study objective was to gather qualitative information from residents of a rapidly changing area in China to determine perceived changes in food- and physical activity-related aspects of the environment and their perceived effects on health. We conducted extensive interviews with 30 residents of an area where towns were rapidly rebuilt after being destroyed by the 2008 Wenchuan earthquake. Findings suggest that a longitudinal investigation of children and their families in this rapidly developing region may identify mechanisms by which environmental factors influence the development of diet-related chronic illnesses.

Assessing and Applying Evidence-Based Interventions at the Community Level in India as a Model Policy to Reduce Neonatal Mortality Rates in Nigeria

·

The percentage of deaths in Nigeria that occur in the first month of life make up 28% of all deaths under five years, yet most of these deaths can be prevented by simple interventions, such as exclusive breastfeeding. This paper aims to address the challenges of reducing neonatal mortality in Nigeria by examining the efficacy of home-based, newborn care interventions and policies that have been implemented successfully in India. A comparison of similarities and differences between India and Nigeria was done using qualitative and quantitative data of various health indicators. The analysis included identifying policy-related factors contributing to India’s newborn survival rates. A literature search of randomized controlled trials of community health worker interventions shown to reduce neonatal mortality was also conducted. While it appears that Nigeria spends more money than India on health per capita and as percent GDP, it still lags behind India in its neonatal, infant, and under five mortality rates. Both countries have comparably low numbers of healthcare providers. In contrast to Nigeria, India’s community health workers receive training on how to deliver postnatal care in the home setting. Three randomized controlled trials of home-based, newborn care strategies revealed that community health workers trained to provide a preventive package of interventions during multiple postnatal visits in rural India, Bangladesh, and Pakistan reduced neonatal mortality percentages by 54%, 34%, and 15-20%, respectively. To address the urgency of neonatal mortality, countries with weak health systems need to invest in evidence-based, newborn care interventions that utilize available human resources. The current available evidence of models of postnatal care provision demonstrates that home-based care and health education provided by community health workers can effectively reduce neonatal mortality rates.

HIV Testing in Rural Ecuador: Use of a Hospital-Based Public Service Announcement

·

This study aims to understand factors related to hospital-based human immunodeficiency virus (HIV) testing in rural Ecuador. Following a visual public service announcement (PSA), persons aged 18 or older were invited to complete an anonymous survey in a hospital waiting room. Comparing those who volunteered for an HIV test (n=269, 63.4%) to those who did not (n=155, 36.6%), there was a positive association between past testing and testing the day of survey administration (p

Nutritional Status of 9th Grade Students in Amman, Jordan

·

Jordan, like many countries around the world, is experiencing a nutrition transition. While Jordan has primarily dealt with malnutrition issues in the past, an influx of foods high in sodium, carbohydrates, and fat has steered the country towards realizing the impacts of overnutrition on its population. A cross-sectional study design was used to evaluate 488 ninth-grade students from six public schools in Amman, Jordan. To assess students’ dietary habits, a twenty-eight item validated questionnaire was administered. A one-way analysis of variance showed that red meat, fish, manakeesh pastries, mortadella, candy and desserts and energy drinks were significantly associated with BMI categories. A crude, unadjusted linear regression model showed that candy and desserts were significantly associated with BMI (RR=1.40, 95%CI -2.52, -0.28, p=0.014). In an adjusted linear regression model, candy and desserts remained significantly associated with BMI (adjusted RR=-1.49, 95% CI: -2.64, -0.33, p=0.012). Results from this study indicate that Jordan seems to be undergoing a nutrition transition in school-aged children where undernutrition and overnutrition are taking place simultaneously. Food aid and policy efforts should focus on the impact of diet on Jordanians, and in particular on school-aged children, to lessen the burden of chronic diseases on this future generation.

Food Security Monitoring and Evaluation in Dissan, Rural Mali: Preliminary Findings

·

African Sky is a non-profit organization that has been continuously involved in community development efforts in the Sikasso, Koulikoro, and Segou regions of Mali since 2001. To inform these efforts, an assessment of survey and census data was conducted focusing on the rural village of Dissan, in the Sikasso region. During the evaluation period between 2001-2010 Dissan experienced highly variable rainfall. We hypothesized these conditions would negatively impact farming output, and as a result, nutritional status of the people living in Dissan. Our analysis shows that while land use did not change significantly, by household the variety of sorghum crops increased and non-sorghum food crops decreased. Farmers in Dissan are changing crop distribution due to an increased availability of new sorghum seed and in response to a variety of environmental factors.

The Relationship between Exclusive Breastfeeding Duration and Growth in San Pablo, Ecuador

·

This study sought to determine (1) the relationship between Exclusive Breastfeeding (EBF) duration and future height; (2) the prevalence of EBF in San Pablo, Ecuador (3) the risk factors for stunting in an impoverished setting. This study surveyed the mothers of 148 first graders in primary schools in San Pablo, Ecuador, and then measured the height of the children. The study revealed that 8.1% of women performed EBF for 12 months. Stunting did not correlate to the duration of EBF (p=0.9484). Stunted children and non-stunted children did not differ in many potential confounders; however, the number of children in the family was higher for stunted children than non-stunted children (p=0.0139). This study suggests that EBF duration has no effect on future stunting. The number of children in the family increased the risk of stunting. Unlike previous research, which showed underfeeding in South America, this study revealed an Ecuadorian community that values prolonged EBF culturally.

An Analysis of Ethiopian Rural-to-Urban Migration Patterns from Primary Interviews

·

Urbanization is a growing phenomenon around the world. In Ethiopia, urbanization is often initiated by extreme climatic events such as drought where rural-to-urban migration is a last-resort effort to maintain a family’s farming livelihood. To better understand the influence that climate has on macro-level drivers of migration, namely political, demographic, economic, social, and environmental factors, primary interviews were conducted with rural-to-urban migrants in the capitol city of Ethiopia, Addis Ababa. For this study, two sources of data are used. The first is primary interviews with 59 adult migrants from rural villages in the Debub, Amhara, and Oromia regions, who were recruited and interviewed across 18 sub-districts of Addis Ababa. Beggars, house workers, shoe shiners, labor workers, and other workers, were interviewed with the help of an Amharic/English speaking translator. The second source of data is rainfall and climate data from the Ethiopian Central Statistics Agency. The most common reason for migrating cited by 73% of the sample is being unable to grow enough food or other products as a result of not enough land, high fertilizer prices, high cost of farm inputs, or poor harvest. The majority of migrant families (73%) held less than 1 hectare of land, 22% held between 1 and 2 hectare, and only 6% held more than 2 hectare. The second most common reason for migrating cited by 64% of the sample is the need for more money or job opportunity due to not earning enough from the harvest or labor work in their village. Cross-referencing migration year with available rainfall data indicates that where data is available, 71% of individuals migrated in years where rainfall was less than average. Length of time residing in Addis Ababa ranged from less than 1 year to more than 3 years, and nearly everyone in the sample reports they would not have migrated if they had enough in their villages or had received enough government support. Political, social, economic, demographic, and environmental drivers of migration are represented in the responses of Ethiopian rural-to-urban migrants. Inadequate land, a political and social phenomenon, affects demographic and economic factors. Lack of land itself is a proxy for household wealth. These factors are influenced by environmental extremes that without adequate economic buffers such as animals or labor, lead to migration. A number of policy recommendations that target each of the driving factors are provided in addition to areas of interest for future research.

Health Perceptions and Participation among the Tibetan Community-in-Exile in Dharamsala, India

·

This analysis examines health framings within the Tibetan community-in-exile in Dharamsala, India. It reviews both objective and subjective interpretations of health within the community and assesses such findings in terms of theories of participation. The analysis synthesizes both pertinent research and perceptions of key informants from qualitative interviews. The interviews revealed a plethora of information on interpretations of transmission of disease, methods of treatment, mental health, and health needs. This health assessment in turn yielded two conclusions: (1) perceptions of health within the Tibetan community and specifically Dharamsala are complex and at times conflicting, and (2) needs as reported by informants are misaligned with current development programming. This analysis examines these conclusions according to participation theory and finds that the misalignment of needs results from the aggregation of community perspectives into oversimplified models. Through a discussion of participation theory, this analysis determines that the negative consequences of participation have underestimated the complexity of the community in Dharamsala and in turn created unmet needs. Ultimately, by recognizing the plural framings of health in the community and embracing such complex health needs, this analysis recommends a move towards a more inclusive development model. Such valued development engages the community in its own growth without making assumptions of development trajectories or aggregated community identities.

Understanding Women’s Intergenerational Knowledge Transfer in Rural Mali: Lessons from the African Sky Mothers and Daughters Summit

·

In January 2011, the nonprofit African Sky facilitated an educational conference in Markala, Mali for pre-existing associations to come together and share knowledge and skills for mutual benefit. The participating groups (N = 6) held expertise in areas of: organizational management, income generation, and family health and sanitation, and were grouped as “established” peri-urban (N=2) and “emerging” rural (N=4) associations. Proficiency was measured on a four-point scale (1 = below basic, 2 = basic comprehension, 3 = proficient, 4 = advanced proficiency) for 14 items. Six months following the Summit, the two established women’s associations achieved 100% proficiency in organizational management, family health and sanitation, and income generation. After six months, the remaining emerging association decreased in knowledge to 50% proficiency in income generation, and only 10% proficiency in both organizational management and well as family health and sanitation. The authors hypothesize that the gains were maintained in the established organizations as these associations had the monetary means to implement the business plans they developed at the conference. Organizational support for immediate application of newly acquired skills may increase retention of skills and knowledge.

Women’s Health in Yemen: Factors Influencing Maternal and Infant Health, Fertility Rates, the Public Health Care System, Education, and Globalization

·
Women's Health in Yemen

Women in Yemen face numerous obstacles to education, self-sufficiency, and health care. Infant and maternal mortality rates are not on track to meet the Millennium Development Goals, and multiple disparities exist along economic, rural-urban, and educational divides. Women in Yemen tend to marry young and have high fertility rates. Many structural barriers to health care exist due to poor infrastructure and government corruption. One of the poorest countries in the Middle East, Yemen has a complex political, cultural and religious history which influences the current state of women’s health. I lived, worked and studied in Sana‘a, Yemen for a year and a half from 2008-2010, throughout which time I volunteered at several different women’s clinics and hospitals. I observed doctor-patient interactions and talked to both international and Yemeni health care workers and local women about their views on women’s health in Yemen. These experiences guided me in my research into local and international aid organizations. The purpose of this paper is to describe the primary health care issues experienced by women in Yemen, identify some of the major organizations that provide health care for women and describe a few of their projects that address women’s health, as well as discuss the primary cross-cultural issues encountered by international aid workers.

Dietary Differences of Ngöbe Living within the Territorio Indigena Guaymi de Coto Brus, Costa Rica: an Indicator for the Development of Chronic Disease

·

This study was developed to evaluate the diet and lifestyle of a Latin American indigenous population, the Ngöbe of southern Costa Rica, and provides a baseline to assess whether diet and nutrition-related diseases are emerging within the Ngöbe population. Anthropometric and lifestyle characteristics of 204 male and female Ngöbes over the age of 18 were assessed through interviews, a recollection of dietary intake, and direct body measurements from October 2010 to April 2011. A subset of respondents was administered glucose intolerance (IGT) tests to assess risk factors for type 2 diabetes. These data indicated that there are differences between the general health status of males and females and between young and old adults. Daily diets show discrepancies in nutritional intake that point to both macro and micronutrient deficiencies. Differences in diet diversity for older and younger respondents and negative correlations of these values with Body Mass Index and blood glucose point toward causes of poor nutrition. More specifically, these data suggest a link between the shift in food behaviors away from the diverse and nutritious traditional diet and the increasing rates of diseases such as type 2 diabetes. Proper surveillance, diagnosis, treatment of nutrition-related diseases, implementation of comprehensive programs that work to improve food access, and providing incentives to practice a more active lifestyle, are of the utmost importance to battle the onset of this disease and reduce future health costs.

Health Perceptions and Participation among the Tibetan Community-in-Exile in Dharamsala, India

·

This analysis examines health framings within the Tibetan community-in-exile in Dharamsala, India. It reviews both objective and subjective interpretations of health within the community and assesses such findings in terms of theories of participation. The analysis synthesizes both pertinent research and perceptions of key informants from qualitative interviews. The interviews revealed a plethora of information on interpretations of transmission of disease, methods of treatment, mental health, and health needs. The research on the Tibetan community also yielded significant information on the evolving demographic structure of the Tibetan population. This health assessment in turn yielded two conclusions: (1) perceptions of health within the Tibetan community and specifically Dharamsala are complex and at times conflicting, and (2) needs as reported by informants are misaligned with current development programming. This analysis examines these conclusions according to participation theory and finds that the misalignment of needs results from the aggregation of community perspectives into oversimplified models. Through a discussion of participation theory, this analysis determines that the negative consequences of participation have underestimated the complexity of the community in Dharamsala and in turn created unmet needs. Ultimately, by recognizing the plural framings of health in the community and embracing such complex health needs, this analysis recommends a move towards a more inclusive development model. Such valued development engages the community in its own growth without making assumptions of development trajectories or aggregated community identities.

An Analysis of Ethiopian Rural-to-Urban Migration Patterns from Primary Interviews

·

Urbanization is a growing phenomenon around the world. In Ethiopia, urbanization is often initiated by extreme climatic events such as drought where rural-to-urban migration is a last-resort effort to maintain a family’s farming livelihood. To better understand the influence that climate has on macro-level drivers of migration, namely political, demographic, economic, social, and environmental factors, primary interviews were conducted with rural-to-urban migrants in the capitol city of Ethiopia, Addis Ababa. For this study, two sources of data are used. The first is primary interviews with 59 adult migrants from rural villages in the Debub, Amhara, and Oromia regions, who were recruited and interviewed across 18 sub-districts of Addis Ababa. Beggars, house workers, shoe shiners, labor workers, and other workers, were interviewed with the help of an Amharic/English speaking translator. The second source of data is rainfall and climate data from the Ethiopian Central Statistics Agency. The most common reason for migrating cited by 73% of the sample is being unable to grow enough food or other products as a result of not enough land, high fertilizer prices, high cost of farm inputs, or poor harvest. The majority of migrant families (73%) held less than 1 hectare of land, 22% held between 1 and 2 hectare, and only 6% held more than 2 hectare. The second most common reason for migrating cited by 64% of the sample is the need for more money or job opportunity due to not earning enough from the harvest or labor work in their village. Cross-referencing migration year with available rainfall data indicates that where data is available, 71% of individuals migrated in years where rainfall was less than average. Length of time residing in Addis ranged from less than 1 year to more than 3 years, and nearly everyone in the sample reports they would not have migrated if they had enough in their villages or had received enough government support. Political, social, economic, demographic, and environmental drivers of migration are represented in the responses of Ethiopian rural-to-urban migrants. Inadequate land, a political and social phenomenon, affects demographic and economic factors. Lack of land itself is a proxy for household wealth. These factors are influenced by environmental extremes, and without adequate economic buffers, including animals or labor, lead to migration. A number of policy recommendations that target each of the driving factors are provided in addition to areas of interest for future research.

The Relationship between Exclusive Breastfeeding Duration and Growth in San Pablo, Ecuador

·

This study sought to determine (1) the relationship between Exclusive Breastfeeding (EBF) duration and future height; (2) the prevalence of EBF in San Pablo, Ecuador (3) the risk factors for stunting in an impoverished setting. This study surveyed the mothers of 148 first graders in primary schools in San Pablo, Ecuador, and then measured the height of the children. The study revealed that 8.1% of women performed EBF for 12 months. Stunting did not correlate to the duration of EBF (p=0.9484). Stunted children and non-stunted children did not differ in many potential confounders; however, the number of children in the family was higher for stunted children than non-stunted children (p=0.0139). This study suggests that EBF duration has no effect on future stunting. The number of children in the family increased the risk of stunting. Unlike previous research, which showed underfeeding in South America, this study revealed an Ecuadorian community that values prolonged EBF culturally.

Copyright © 2017. First Aid WorldWide. All rights reserved