8^th International Conference on Epidemiology & Public Health October 21-22, 2019 | ANA Crowne Plaza Narita | Tokyo, Japan

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Background: Uterine fibroids(UF), also referred to as uterine myomas, leiomyomas, myomatas, or simply fibroid are benign soft-tissue tumours that arise from uterine smooth muscle tissue (myometrium) .Nigeria is thought to have a high prevalence of fibroids due to its indigenous black population, since uterine fibroids are more prevalent in black women .Although uterine leiomyomata affect the reproductive health and well-being of approximately 25% of premenopausal women, risk factors are poorly understood. 

Objective: To examine public health impact and associated risk factors associated with UF among women in Imo State, its prevalence of, women’s knowledge about health services and to develop modalities to improve awareness to prevent morbidity and improve quality of life. 

Materials and Methods: A four year epidemiological, non-interventional, retrospective and descriptive study research was carried out .The data of all female patients (ages 14-55) within the inclusion criteria that presented with UF during the study period 3^rd January 2015 to 3^rd January 2019 was  obtained from medical records, theatre records of  gynaecology clinics and Laboratories selected in Imo State. In addition, a pretested and structured questionnaires structured questionnaire with open interviews was used to collect the data from the subjects. The main outcome measures were socio-demographic data, clinical history, myoma clinical features, symptomatology, and risk factors associated to myomas. Clinical, local and ultra-sonographic examination was done for the morphology of the fibroids. Comparison was done with histological picture for accuracy in clinical and sonographic diagnosis. Multivariable adjustment of risk ratios was based on log binomial regression. 

Result: A total of 520 subjects were studied. Fibroids mainly affected those in the reproductive age group (31-40 years). The common clinical presentations- were abdominopelvic mass (95%); menorrhagia (98.7%), infertility (43.9%), anaemia (30.9%) dysmenorrhoea (15.5%), and abdominopelvic pain (15.8%) miscarriages (3.5%) amongst other symptoms. The average uterine size at presentation was 15±9.7 weeks. Most of the patients were nulliparous (76.7%, 79/103) and 51.5% (53/103) were married. The mean age of the women was 35.42yrs ± 9.34 (range, 20-74 years). A significant relationship was found between Level of Education and development of fibroid (R= -0.196; χ2 value= 29.618; p = 0.001) and (R= 0.399, χ2 value= 92.923; p = 0.001) respectively.Majority of the women 88 (44.4%) had tertiary education, (24.7%) secondary, (24.3%) primary and (6.6%) had no formal education. Most of the patients had multiple fibroids, (40.9%) had intramural, (35.4%) submucous and (26.3%) subserous. Out of this number, (216) 37.0% and 45.4% were overweight and obese respectively. 

Conclusion: we identified nine possible risk factors that play an important role in UF epidemiology. The UF risk factors with the strongest evidence were age, weight and parity. High-quality prospective observational data are needed to improve our understanding of UF epidemiology, and thus its aetiology and optimal management and early detection thereby reducing morbidity. Health intervention programmes and healthy lifestyle should be encouraged with routine check-ups should be conducted so as to detect and possibly treat such tumours early. Further research is needed to find out biological factors causing fibroids including diet, stress, and environmental factors and adequate resources towards managing symptomatic patients at a subsidized rate.

Key words

Uterine fibroids, leiomyoma, incidence, prevalence, risk factors, Imo Epidemiology.

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She is working in the King Hussein Cancer Foundation, Jordan. 

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Marco Balenci has completed his PhD from Universities of Florence and Rome. He is a Psychoanalyst and also a Member of the American Psychological Association, Associazione Italiana di Psicologia Analitica (AIPA), International Association for Analytical Psychology. 

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Roman Goloshchapov-Aksenov is a Surgeon of the highest qualification category, a cardiovascular surgeon, an interventional radiologist, associate professor of cardiovascular surgery of the Russian University of peoples ' friendship, head of vascular surgery and interventional radiology department. Medical work experience in the field of cardiovascular and endovascular surgery 18 years ago. Endovascular practice generalist - interventional oncology, gynecology, urology, neurosurgery, cardiology and cardiovascular surgery with a low complication rate and absence of fatal outcomes in patients when performing scheduled operations. 

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Lili Meng has completed her PhD from Sun Yat-Sen University. She has published more than 5 papers in reputed journals. She has been serving as an Obstetrician at Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University. 

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Rajvir Singh has completed his PhD in Biostatistics from All India Institute of Medical Sciences, New Delhi and Post-graduation in Mathematics from Agra University, India. He is currently working as a Senior Consultant in Biostatistics at Hamad Medical Corporation, Doha, Qatar. 

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She works for Jordan Breast Cancer Program in King Hussein Cancer Foundation, Jordan.

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The purpose of this research were to studies the epidemiology of health problems, need assessment of health problems and factors associated with health problem in elderly people in Thaklong Municipality and Muang Patumthani Municipality, Patumthani Province. The study design was cross-sectional study among 2,027 elderly people. The results found that the majority of elderly people in the sample were female (62.8%). There were 54.6% in the young old group (60-69 years old), 31.6% the middle age old group (70-79 years old) and 13.7% the old old group (more or equal 80 years old). The status of couples living together with getting married were 57.4%. Source of income in elderly people received from subsistence allowance for elderly 85.3%. Almost of elderly has underlying of diseases around 80.9%, such as hypertension, diabetes, arthrosis, osteoarthritis, cardiovascular diseases, allergic rhinitis, asthma and paresis. Physical health and mental health need assessment of elderly in Thaklong Municipality and Muang PathumThani Municipality were health check-up 82.8% and health education from public health officer and health care clinic 79.49%.  Social environmental need assessment of elderly were elderly club 31.6% and activities for elderly such as occupational training or exercised 15.9%.  Moreover, elderly need for good waste management, community cleaning and facility management. In conclusion, Health services provided for elderly people by local government should be offer a promotion and support the activity both physical health, mental health, and social environment for quality of life among elderly people.

Key words; health problem, healthcare environmental, services program, Town Municipality.

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In 2012, 68 % of the global deaths were attributed to NCDs. About 48 % of NCDs in LMICs occur amongst people under the age of 70, compared to 28 % in high-income countries (HICs). The UN High-Level Meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases passed a Political Declaration on NCD prevention and control in 2011, emphasizing the need for NCD surveillance. The WHO has assessed the current capacity for NCD surveillance as inadequate in several countries. Therefore the objectives are to identify certain literatures that support the development of an NCD surveillance system, conceptualize an NCD surveillance system to the existing health information system for informed decision making, to identify prioritise areas of focus for the surveillance system. A systematic review was conducted and set for full text citations published in English dated 1 January, 2007 to 31 December 2016 using the following words “Health surveillance systems” and “NCD monitoring and surveillance system”. The literatures were tabulated according to the authors, date that was published and which journal, the title of the study, the surveillance design and their recommendations. Further analysis was conducted on the literature towards the country and its existing NCD surveillance design and what are some of the output of the countries adapted surveillance design. The 10 citations that were identified only one was conducted in a developing country while the rest were conducted in high income countries. Through literature there was less evidence on surveillance in LMIC but `the following surveillance systems were identified as essential for Fiji’s proposed NCD surveillance system. Summarising most of the countries monitoring and surveillance system it shows that the best surveillance system to be adopted for Fiji is a passive surveillance system that relies on readily collated data from primary health care facilities, hospital and with existing data sources and based on Fiji’s geographical location and vast distribution of its population to these islands, the inclusion of a spatial surveillance system as an addition to its proposed passive surveillance system would be and added benefit.

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Surveillance, Population health, wellbeing and behavioural modification, Non-communicable disease.

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Background: The identification and referral of women with risk pregnancies is recognized as one of key interventions during antenatal care. In Tanzania, the Reproductive and Child Health card number 4 (RCH4 card) is a guideline used in screening of pregnancy in order to identify risk pregnancies early and refer to hospital where emergency care can be provided to the woman. Women’s awareness of pregnancy risk factors and proper use of the RCH4 card can lead to early identification of risk pregnancies and hence timely and appropriate referral. Late or no referral due to missed risk factors has been associated with high maternal mortality. 

Main Objective: To assess identification and referral of at risk pregnancies and associated factors in Kilombero district, Morogoro Region, Tanzania.

Methods: The study design was a cross-sectional facility-based. It involved 418 pregnant women who were attending ANC in randomly selected health facilities in Kilombero district. A two stage cluster sampling technique was used to select the study sample. In the first stage, 27 dispensaries were selected randomly using simple random sampling technique and all health centres and the only hospital in the district were included. The sample size was calculated using Leslie’s formula for a single proportion. For the second sampling stage, the sampling frame was the list of pregnant women registered in the facility Antenatal Clinic (ANC) register. A questionnaire with structured questions was used to interview women. Data was collected from RCH4 cards on risk factors identified and women were re-examined by the investigators to identify missed risk factors. The referral advice given was also noted. Data collected was analyzed using SPSS version 20 software where by descriptive, bivariate and multivariate analysis was done to determine independent factors influencing identification and referral of high risk pregnancies.

Results: A total of 418 women were recruited into the study with age range of 17- 43 years. About 32% of the women had pregnancy risk factors identified in the current pregnancy and recorded in their RCH4 cards. On re-examination, the proportion of women with pregnancy risk factors was found to be 55%. Around 44% of women had pregnancy risk factors missed. Age below 20 years and height less than 150 cm were the most missed pregnancy risk factors. Category C pregnancy risk factors were not assessed because they were not measured in most health facilities. Women who had no pregnancy risk factors during previous pregnancies had higher odds of having missed risk factors (OR=3.57, 95%CI=1.35-3.92). Similarly women with less than 4 antenatal visits had higher odds of having missed risk factors (AOR=1.51; 95%CI=1.26-4.97). Respondents with no formal education had 3.53 higher odds of having missed pregnancy risks (95%CI=1.24-9.98) as compared to those who had primary or secondary education. Out of 132 women who were identified with risk factors on their RCH4 cards, only 44(33.3%) were provided with appropriate referral advice. Majority of women, who were identified to be at high risk during ANC visits with either age below 20 years, or five or more pregnancies and previous caesarian section delivery, were not provided with appropriate referral advice. Women with pregnancy of ≥24 weeks had higher odds (AOR=3.40; 95%CI=1.60-19.14) of receiving appropriate referral advice as compared to those with lower gestation age. Respondents with 3 or more antenatal visits had almost 5-fold higher odds of being provided with appropriate referral advice (95%CI=1.26-10.21) as compared to those with 2 antenatal visits. Compared to women with no formal education, those who had secondary level education had significantly higher odds (AOR=8.12; 95%CI=1.40-16.99) of receiving appropriate referral advice. Attending ANC at dispensary level had higher odds (AOR=1.37; 95%CI=1.17-1.79) of being provided with appropriate referral advice as compared to those seen at Health centres.

None of the 30 health facilities visited had all essential equipments and supplies required for antenatal care services. Less than 50% of facilities had Hemoglobin level test, grouping and Rhesus factor, VDRL for syphilis or sugar for urine test available. Only 15(50%) of all facilities had urine albumin test available and 14(47%) of all facilities had an ambulance or an emergency transport for referred cases.

Conclusion: There is a significant proportion of missed risk pregnancies in Kilombero districts. Moreover, referral advice for women identified with risk factors is not being provided according to RCH4 guideline, with only a small proportion provided with appropriate referral advice. Antenatal Clinics do not have adequate essential equipment and supplies needed for provision of quality Antenatal care services which will include diagnosis of the risk factors.

Recommendations: Women should be made aware of the importance of communicating personal characteristics/obstetric history which is used to identify risk status to the health care providers. The Ministry of Health should ensure that health providers are trained on risk screening and referral of at risk pregnancies and conduct further studies to assess the effectiveness of the RCH4 card as a guideline used to identify and refer women with pregnancy risks. The Ministry of Health should also ensure that health facilities are well equipped and have essential supplies to enable provision of quality antenatal care risk screening services.

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High resolution remotely sensed (RS) data products remain of interest in disease mapping studies. Previous usage of such satellite-derived products had been limited by high costs. There is unprecedented space activity characterized by prolific satellite launches for various purposes, the chief of which being land cover observation. Therefore, there is need for information availability on the type of data products obtainable from the satellite images in order to facilitate utilization. The remote sensing landscape is changing with the advent of Unmanned Aerial Vehicle and spatially explicit images being captured at relatively low costs. We conducted a review to find out which RS data products were accessible for disease mapping. Our aim was to document RS data products for disease mapping and to propose other such products that could be incorporated in disease mapping studies. RS data products are rapidly evolving, image data of higher spatial and temporal resolutions in near-real time are available to aid disease mapping. We presented a catalogue of indices from ecological studies that could be used as variables in disease mapping. Remotely sensed data products related to climate, meteorology, land use/cover, cartography and urban mapping are explored as potential indices for disease mapping. There remains a substantial amount of work to be conducted on the evaluation and validation of some of the indices presented in this study. Conversely, synergies between remote sensing experts and epidemiologists could be useful in the uptake and testing of some of the proposed RS data products presented in this work.

Biography:

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High resolution remotely sensed (RS) data products remain of interest in disease mapping studies. Previous usage of such satellite-derived products had been limited by high costs. There is unprecedented space activity characterized by prolific satellite launches for various purposes, the chief of which being land cover observation. Therefore, there is need for information availability on the type of data products obtainable from the satellite images in order to facilitate utilization. The remote sensing landscape is changing with the advent of Unmanned Aerial Vehicle and spatially explicit images being captured at relatively low costs. We conducted a review to find out which RS data products were accessible for disease mapping. Our aim was to document RS data products for disease mapping and to propose other such products that could be incorporated in disease mapping studies. RS data products are rapidly evolving, image data of higher spatial and temporal resolutions in near-real time are available to aid disease mapping. We presented a catalogue of indices from ecological studies that could be used as variables in disease mapping. Remotely sensed data products related to climate, meteorology, land use/cover, cartography and urban mapping are explored as potential indices for disease mapping. There remains a substantial amount of work to be conducted on the evaluation and validation of some of the indices presented in this study. Conversely, synergies between remote sensing experts and epidemiologists could be useful in the uptake and testing of some of the proposed RS data products presented in this work.

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Background: To advance knowledge about childhood neurodevelopmental disorders and study their environmental determinants, we conducted a study in Tehran, Iran to assess the feasibility of prospective birth cohort study.

Methods: We identified 838 eligible pregnant women who referred to three hospitals and two healthcare centers (Tehran, Iran) from February 2016 to October 2017. We collected data (by detailed questionnaires) and biological samples in four steps: (1) in first trimester of pregnancy; (2) in third trimester of pregnancy; (3) at delivery; and (4) two to three months after delivery. Various biological samples were obtained from mothers (blood, urine, milk and nails—hands and feet) and newborns (umbilical cord blood, meconium, and urine samples).

Results: The participation rate was 25% in our study and about 90% of subjects were recruited in hospitals. Out of 206 participants in the first trimester, blood, urine, hand nail, and foot nail samples were collected from 100%, 93%, 99%, and 99%, respectively. These values dropped to 54%, 69%, 70%, and 70% for the remaining participants (n=120, 58%) in the third trimester, respectively. Also, we gathered milk samples from 60% of mothers at two to three months after delivery.

Conclusions: Our findings suggest that hospitals were better places for recruitment of subjects in a birth cohort in Tehran than healthcare centers. We further concluded that birth cohort study recruitment can be improved by choosing appropriate gestational ages. Obtaining the newborn's urine, meconium, and umbilical cord blood were challenging procedures and require good collaboration between hospital staff and researchers.

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Objectives: A hospital based retrospective study was conducted to determine the relationship of maternal factors and obstetric complications with term singleton vs term twin neonatal outcomes in Wuhan University Renmin Hospital,  Hubei, China during 2013- 2017.

Materials and methods: A total of 7956 neonatal births were recorded and were further divided into singleton (n=7787) and twins (n=169) birth. All the data was collected and documented in the obstetrics register by trained nurses during individual check -ups in the Gynecology and obstetrics department. Birth weight and birth length were measured immediately after birth.

Results: Women with singleton gestation have increased rate of obstetric complications compared to women with twin gestation. However, higher frequency of cesarean section and breech were found in twin gestation compared to singleton gestation. Weight before pregnancy, gestational weight gain, and gestational diabetes mellitus were significantly positive (p<0.05) associated with singleton neonatal birth length and weight.  In contrast, pre-eclampsia, placenta previa, oligohydramnios, premature rupture of membrane, breech, and multiparity had significantly negative (p<0.05) association with singleton neonatal birth length and weight. Maternal age was significantly positive (p<0.05) associated with only singleton neonatal birth weight. Moreover, nuchal cord was significantly positive (p<0.05) associated with neonatal birth length. On the other hand, maternal age and multiparity was significantly positive (p<0.05) associated with twins neonatal birth length and weight.  Furthermore, gestational weight gain was significantly positive (p<0.05) associated with only twins neonatal birth weight.

Conclusion: It is concluded that in term gestation, maternal factors and obstetric complications was significantly associated with singleton birth weight and length. However, only maternal factors were significantly associated with twin neonatal birth weight and length rather than obstetric complications in term gestation.  Furthermore, increased rate of obstetrical complications have found in women with singleton gestation compared to twin gestation. 

Keywords: Birth weight; Birth length, Maternal factors; Obstetric complications; Singleton, Twins. 

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Statement of the Problem: All children deserve the best possible start in life. Unfortunately, not all children get this. Early interventions provided to those at risk can substantially improve childrens’ later socioemotional development, only if the assessment procedures are robust and standardised to reach those families who need it the most. Various assessment tools are used to assess parent-child interactions from birth up to 12 months, but these are generally based on measurement scales which assess either parenting behaviour or infant behaviour and not both (dyadic context). Infant CARE-Index is a multi-dimensional observational tool, which assesses the parent-child interaction in a dyadic context from birth up to 15 months. It has the added advantage of detecting child abuse and  neglect and can be used for screening and planning and monitoring interventions. The purpose of this systematic review is to highlight the measurement properties of Infant CARE-Index which have been assessed in literature so far. Methodology: Main databases searched included; MEDLINE, CINAHL plus, ERIC, EMBASE, PsycINFO, Web of Science and Scopus. Inclusion criteria for articles consisted of sample population consisiting of parent-child dyads, child age range:0-15 months, use of Infant CARE-Index and English Language. 620 articles were identified with the initial search. 27 articles meeting the inclusion criteria were subjected to data extraction. COSMIN checklist was extensively used for assessing reliability and validity evidence in the included articles. Results showed that none of the included studies were designed to test the measurement properties of Infant CARE-Index. The only evidence that was retrieved was on inter rater reliability and hypothesis testing. Conclusion and recommendations: There is a need to conduct good quality validity and reliability studies on Infant CARE-Index.This may aid in filling the evidence gap indicated in NICE guidelines on attachment difficulties regarding the need of a standardised tool for measuring parent-child interactions (0-12 months).

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Background: There is an increased risk of serious neonatal infection arising through exposure of the umbilical cord to invasive pathogen in home and facility births where hygienic practices are difficult to achieve. The World Health Organization currently recommends ‘dry cord care’ because of insufficient data in favor of or against topical application of an antiseptic. The primary objective of this meta-analysis is to evaluate the effects of application of chlorhexidine (CHX) to the umbilical cord to children born in low income countries on cord infection (omphalitis) and neonatal mortality. Standardized guidelines of Child Health Epidemiology Reference Group (CHERG) were followed to generate estimates of effectiveness of topical chlorhexidine application to umbilical cord for prevention of sepsis specific mortality, for inclusion in the Lives Saved Tool (LiST).

Methods: Systematic review and meta-analysis. Data sources included Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, PubMed, CINHAL and WHO international clinical trials registry. Only randomized trials were included. Studies of children in hospital settings were excluded. The comparison group received no application to the umbilical cord (dry cord care), no intervention, or a non-CHX intervention. Primary outcomes were omphalitis and all-cause neonatal mortality.

Results: There were three cluster-randomised community trials (total participants 54,624) conducted in Nepal, Bangladesh and Pakistan that assessed impact of CHX application to the newborn umbilical cord for prevention of cord infection and mortality. Application of any CHX to the umbilical cord of the newborn led to a 23% reduction in all-cause neonatal mortality in the intervention group compared to control [RR 0.77, 95 % CI 0.63, 0.94; random effects model, I2 =50 %]. The reduction in omphalitis ranged from 27 % to 56 % compared to control group depending on severity of infection. Based on CHERG rules, effect size for all-cause mortality was used for inclusion to LiST model as a proxy for sepsis specific mortality.

Conclusions: Application of CHX to newborn umbilical cord can significantly reduce incidence of umbilical cord infection and all-cause mortality among home births in community settings. This inexpensive and simple intervention can save a significant number of newborn lives in developing countries.

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Background: In May 2015, an outbreak of lead poisoning (LP) was reported and confirmed in Unguwar Kawo (UK) and Unguwar Magiro (UM) villages, in Niger State. Information on demographic characteristics and household participation in artisanal gold ore-processing activities were collected. The height and weight of lead exposed children were assessed and their blood lead levels were characterized.

Methods:  We conducted a cross-sectional house to house survey. Using structured interviewer-questionnaire, parental participation in gold-ore processes and other risk-factor activities were recorded. Height and weight of the U5 children were measured and blood samples were collected for analysis using lead care II. SPSS 18 and Epi-Info 7 were used for data analysis.

Results: A total of 116 children were surveyed ranging from 2 to 59 months. The mean age was 38.8±16 months and 41% were females. 72% were underweight; none was overweight. The mean BLL was 72.8±43 µg/dL and 74% had blood lead levels equal or above 45ug/dl. 88% of the parents participated in mining activities. Following linear regression, age correlated negatively with BLLs (OR= -0.22, p=0.014). Following logistic regression, children that were underweight (OR=5, p<0.01) and whose parents participated in mining (OR=22, p<0.01) were more likely to have BLLs ≥45 µg/dL.

Conclusions:   Underweight younger children with parental participation in gold-ore processing activities had higher blood lead levels. Recommendations include environmental soil remediation, chelation therapy and safer mining practices.

Keywords: Lead poisoning, gold-ore, chelation therapy, soil remediation, safer mining.

Biography:

Lili Meng has completed his Ph.D. at the age of 31 years from Sun Yat-Sen University. She has published more than 5 papers in reputed journals and 2 fundings for “Cervical insufficiency” of Guangdong province. She has been serving as an obstetrician in Sun Yat-Sen memorial hospital of Sun Yat-Sen University. Besides, she is very interested in biostatistics and epidemiology. During this year, she is a visiting researcher of Karolinska Institute in biostatistics and epidemiology department.

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Background.  The prisoners are at a greater risk for hypertension because of prevalent tobacco use, unhealthy diet and incarceration-induced stress. We investigated the prevalence of hypertension and its risk factors in prisoners in Kuje, Abuja, Nigeria.

Methods. Cross-sectional study was conducted among 180 male prisoners. WHO STEPwise approach to surveillance of chronic disease risk factors was used to conduct the study.  Hypertension was defined as a systolic blood pressure≥140mmHg and/or a diastolic blood pressure ≥ 90mmHg and/or self-reported current treatment for hypertension. Body mass index (BMI) was determined. Statistical analysis was performed using Epi-Info version 7.

Results. The mean systolic blood pressure was 131 ± 15 mmHg, diastolic 81 ± 12 mmHg, BMI  24.8 ±3.6 and  RBS 97.1 ±21.8mg/dl. Overall, 60 (33.3%) were overweight, 13 (7.2%)were obese ,65 (36.1%) were prehypertensive, 57 (31.6%) were hypertensive and 1(0.6%) diabetic.  The risk for elevated systolic BP  increased in respondents that has first degree relative with hypertension (OR = 5.6; CI = 1.6 – 19.9; P = 0.008) and with age, higher among those aged ≥ 45years compared with ≤ 34years  (OR=7.5: CI= 1.6-35.9, P =0.01) and high for those with insufficient physical activity (OR = 4.3; CI = 1.5 – 12.5; P =0.007). Increased BMI was a risk factor for hypertension (OR=9.1; CI=2.7-31.1,P=<0.001)

Conclusion: There is significant burden of hypertension in prisoners in Abuja. Age, low physical activity, family history of hypertension and obesity were independent risk factors for hypertension.

Key words: CVD risk factors, BMI, Hypertension, Prisoners.