Dr. P. Veeramuthumari
Assistant professor,
Department of Zoology, V.V.Vanniaperumal College for Women, Virudhunagar, Tamil Nanu, India. Mobile: 9443829599.

ISBN 978-93-90431-82-3 (Print)
ISBN 978-93-90431-90-8 (eBook)
DOI: 10.9734/bpi/cdhr/v5

This book covers key areas of disease and health Research. The contributions by the authors include HIV/AIDS, reproduction, sexuality, sexuality education, sexual transmitted infection, health status, Candida-induced gastric ulcer, gastric candidiasis, Helicobacter pylori-negative gastric ulcer, non-NSAIDs gastric ulcer, recurrent gastric ulcer, Zika virus, Preventive medicine; heath status, dental status, pupils, medical ethics, cardiovascular risk factors, screening programs, risk factor management, the Africa and Middle East cardiovascular epidemiological study, Tuberculosis,  spondylitis, hormesis, chronic irradiation, neoplasms, regeneration, hemopoiesis, asthma, allergy, risk factors, genital microbiome, acinetobacter, hafnia, campylobacter, infection, pregnancy, neonate. This book contains various materials suitable for students, researchers and academicians in the field of medical sciences.


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A Study on Parents’ Participation in the Sexuality Education of Their Children in Rural Namibia

Linda Ndeshipandula Lukolo, Agnes van Dyk

Challenges in Disease and Health Research Vol. 5, 8 February 2021, Page 1-14

This study aims to explore and describe how rural parents are providing sexuality education for their children, to explore and identify the needs of children regarding sexuality education and to identify and describe challenges encountered by rural parents in the provision of sexuality education of their children. Talking about sexuality has never been easy in most Namibians cultures and it seems that most parents feel uncomfortable and embarrassed to talk openly with their children about sexuality. They do not participate in the sexuality education of their children, because they believe they are unable to provide quality and adequate sexuality information due to their lack of knowledge about human sexuality or their perceived inability to explain what they do know. Sexuality education is a lifelong process of acquiring information and forming attitudes, beliefs and values about identity, relationships and intimacy. It encompasses sexuality development, reproductive health, interpersonal relationships, affection, intimacy, body image and gender roles.

The ultimate purpose of this study was to develop, describe, implement and evaluate an educational programme to empower rural parents to participate in the sexuality education of their children. The study was designed to be qualitative, explorative, descriptive and contextual in nature. It was performed in three phases. Phase 1 consisted of a situational analysis to explore and describe how parents provide sexuality education. Phase 2 consisted of the development of a conceptual framework that facilitated the development of an educational programme. In phase 3 the programme was implemented and evaluated, recommendations were made and conclusions drawn. The main findings revealed two themes: Factors influencing parental participation in their children’s sexuality education, and the need for parental participation in their children’s sexuality education.

This article is part of series of three article stems from a study on the topic of sexuality education empowerment programme of rural parents in Namibia. The three articles have the following titles: one: parent’s participation in sexuality education of their children: A situational analysis; two: conceptual framework developments that facilitate the development of an educational programme and three: programme implementation and evaluation. This article dealt with parent’s participation in sexuality education of their children: a situational analysis. Parents should fulfil an important function as socializing agents by providing norms and values to their children and that they are primary sources from which children obtain their norms and values. Effective sexuality education also provides young people with an opportunity to explore the reasons why people have sex, and to think about how it involves emotions, respect for oneself and other people and their feelings, decisions and bodies.

An Advanced Study of Health Status among School Going Adolescents in South India

Pravin N. Yerpude, Keerti S. Jogdand, Mohini Jogdand

Challenges in Disease and Health Research Vol. 5, 8 February 2021, Page 15-20

Introduction: In human growth and maturation, adolescence period is significant. In India, 21.4 percent population is adolescents (10-19 years) which accounts for one fifth of the total population. One of the important index of the national investment in the development of its future manpower is the health and nutritional status of the children in the country. For maintaining good health in adult, it is very important to achieve optimum growth during adolescent age. Many of health problems in children can be detected by providing school health services. We can treat and prevent many of serious complications in children through regular school survey. The present study was carried out with the objective to assess health status and morbidity pattern among school going adolescents in urban area of South India.

Materials and Methods: The present study was conducted in the year 2010 in 3 urban schools which are in the field practice area of department of community medicine. A team of doctor, social workers and school teachers examined all children in the age group of 10 to 19 Years studying in these schools.

Results: In the present study, 210 adolescents participated. Out of them 72(34.29%) were girls and 138 (65.71%) were boys. According to weight for age criteria, 53.33% of the adolescents were found to be normal and 46.67% were malnourished. By applying height for age criteria it was found that 32.86 % of the adolescents were stunted with boys suffering more 66.67% as compared to girls 33.3%. The dental caries was the commonest (41.90%) among all health problems.

Conclusion: The study shows that the health and nutritional status among the adolescents was low. Under nutrition is common public health problem worldwide mostly in developing countries including India. Proper nutrition is required for adequate growth and development of the child. A periodical and regular health check-up with concerted efforts towards nutrition of adolescents along with focused health education will improve the health and nutritional status of these schools going adolescents in their future.

Candida-associated gastric ulcer, though formerly thought to affect only debilitated persons, has been reported to occur in apparently healthy individuals.  Though had been reported to demonstrate nothing but nonspecific endoscopic features, the disease occasionally exhibits an apparently typical finding the author designated a candidarium. The natural history of the disease had been unknown but the ulcer is shown not only to occur but also to recur in a different site with a different shape in a non-diabetic, Helicobacter pylori (H. pylori)-negative, apparently immunocompetent patient without antecedent ulcers or history of the lesions, who has not been given non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, antineoplastic agents, systemic corticosteroids which implies that Candida is no innocuous bystander but an etiologic perpetrator.  Immune deficiency has recently been reported in relation to candidiasis, which might explain the cause of intractable Candida-associated gastric ulcer.  In the oropharyngeal field, Candida albicans has recently been shown to secrete a hitherto unknown cytolytic peptide pore-forming toxin (PFT), candidalysin, into a pocket in the epithelium which it penetrates into and to activate mitogen-activated protein kinase (MAPK)/MAPK phosphatase 1 (MKP1)/c-Fos pathway, triggering release of damage as well as immune cytokines.  While the PFT, exerting an effect even on the adjacent cells, directly injures the tissue with damage cytokines, it induces immune counterparts to activate polymorphonuclear leukocytes (PMN) to eventually terminate inflammation, which results in restoring the fungus to the commensal state or eradicating it.  Since it cannot be negated that such a phenomenon occurs in the gastric mucosa, a theoretically strong possibility has come up that the so-called Candida-associated gastric ulcer is actually Candida-induced ulcer.  Owing to the recent advances in microbiology, molecular biology, and immunology, a logically definitive possibility has emerged that the so-called Candida-associated gastric ulcer is Candida-induced ulcer.  The disease has come to a stage, in which the etiology should be reinvestigated and the disease itself should be reconsidered in the light of not only pathogens’ character but also hosts’ immunological status Therefore, the disease should be reinvestigated in the light of the recent immunological, microbiological, and molecular biological findings.

Background: Zika virus is an infective agent of significant Public Health importance, which re-emerged in 2015. It is transmitted through mosquito bite, and associated with microcephaly and some other neurological malformations in some babies of infected mothers. Mild infections with this virus were recorded in Americas, Asia, Africa, and the Pacific region in the past; but it was in 2015 that it re-emerged in Brazil as a disease of real Public Health importance. WHO declared Zika virus infection a "Public Health Emergency of International Concern" on February 1, 2016, but lifted the emergency declaration in November of the same year.

Objectives: The objective of this study was to assess the age-related pattern of the awareness and basic knowledge of Zika virus infection among women who bring children for immunization, in a teaching hospital, southeast Nigeria.

Materials and Methods: The study was conducted in the Immunization unit of a Teaching Hospital, Southeast Nigeria, between November 2016 and February 2017. It was a quantitative, observational, descriptive, cross-sectional study, involving randomly selected 256 women who brought children for immunization. Pre-tested, interviewer-administered, structured questionnaire was used; and data was analyzed using SPSS version 20.0 for windows.

Results: Highest number of respondents [112 (43.8%)] were from 30 to 39 age group, followed by those aged 20 to 29 years [108(42.2%)]. Up to 38.3% of respondents had never heard about Zika virus, though this was not statistically significant when compared to the 61.7% that were aware of Zika Virus Disease (P = 0.92). Highest number heard it through television [57(36.1%)]. Overall, respondents that were 20 to 29 years of age recorded mean percentage basic knowledge score of 54.6%, while those in the 30 to 39 years age range recorded 49.8%.

Conclusions: Many respondents either had never heard about Zika virus, and also many exhibited poor basic knowledge on Zika virus disease. Among respondents within the child bearing age group, only those within the age range of 20 to 29 recorded mean percentage basic knowledge score that was over 50.0% (54.6%). It is therefore important to develop good strategies aimed at addressing these awareness and knowledge gaps among women of child-bearing age, who are mostly affected by Zika virus disease.

Introduction: The policy for effective functioning of maternity, child and school healthcare comprises actions for integrated approach of the institutions and publicity for children’s health. The health status of the population mostly depends on factors, whose influence starts in childhood. It is also a reflection of the statement that the cares for children’s health are investment in future healthy generations, as in childhood are set the foundations for human health and is formed the health behaviour of each person, which ensure higher quality of life and health of the national human capital. A significant and permanent limitation of the pandemic of chronic and other diseases may be expected by health promotion and preventive measures which were taken in early childhood, because of their radical and long–term effect. The purpose of the present work is to study the health and dental status of pupils aged between 7 and 15 from municipality of Kardzhali and Sandanski by benchmarking.

Materials and Methods: There are included in the survey schools from municipality of Kardzhali and Sandanski, determined by the method of random selection. The survey comprises 1594 children aged between 7-15. The examinations were performed by physician-specialists: A paediatrician, an otorhinolaryngologyst, an ophthalmologist and a dentist. For registration of the data from the prophylactic examinations are used “Dental Treatment/ Examination Form” and “Medical History and Screening Form”. For the statistical processing of the data there is used the Fisher’s criterion.

Results and Discussion: The comparative analysis of the results for health and dental status of the examined children from municipality of Kardzhali and Sandanski shows statistically significant difference in the early development of the children from the two municipalities in favour of the children from municipality of Kardzhali (94% against 1% for Sandanski). There is a significant difference between them concerning allergies, respectively 1.38% and 15.44%. There were also reported the diseases (Heart Diseases and Diabetes) of children from Kardzhali. The examination by physician-otorhinolaryngologyst shows significantly lower levels of all indicators of the examined children from Kardzhali. The visual acuity of the children from Kardzhali is with better values in comparison to the children of Sandanski, respectively 79% against 64%. The main share of the cases with colour deficiency is also lower in Kardzhali-0.13% against 1.29%. The cases of esotropia/exotropia show higher levels of the examined patients in Kardzhali (4% against 0.4%). As a whole the dental status of the children from Kardzhali is better (64% against 53%), but by indicators: presence of caries, gingivitis and orthodontic problems are observed more favourable values of the children from Sandanski.

Conclusion: The showed results are disturbing and it is necessary to develop intervention program, which include preventive actions with focus on health promotion and health changes in the environment and way of life of children.

Emphasizing the Health Care Ethics: Overview of the Basics

Ahmed Bait Amer

Challenges in Disease and Health Research Vol. 5, 8 February 2021, Page 55-59

Medicine and health care deal with human health, life, and death, and medical ethics deals with ethical norms for the practice of medicine and health care or how it ought to be done so the concerns of medical ethics are among the most important and consequential in human life. In this overview we answers certain Questions in order to increase the awareness towards the basic of the health care ethics: what is ethics, what are the several fields of ethics connected to medical activities, what are the types of Ethical approaches in relation to the medical practice.

Conclusion: Through understanding the basics of the ethics, the awareness of the medical ethics in the health care can be increased.

Assessment of Cardiovascular Risk Factors in Adult General Out-patient Clinics in Nigeria: A Country Analysis of The Africa and Middle East Cardiovascular Epidemiological (ACE) Study

Geoffrey C. Onyemelukwe, Oluwagbenga Ogunfowokan, Amam Mbakwem, A. Kayode Alao, Kodjo Soroh, Osahon Omorodion, Paula Abreu

Challenges in Disease and Health Research Vol. 5, 8 February 2021, Page 60-72

Background: With globalization and rapid urbanization, demographic and epidemiologic transitions have become important determinants for the emergence of cardiovascular disease (CVD). Cardiovascular disease (CVD) has emerged in recent decades as a major cause of morbidity and mortality worldwide An estimated 17-million deaths globally were due to CVD in 2002, and CVD or stroke are projected to become the worldwide leading cause of morbidity and mortality by 2020.

Objective: To estimate the prevalence of CVD risk factors in adult out-patients attending general practice and non-specialist clinics in urban and rural Nigeria.

Methods: As part of the Africa and Middle East Cardiovascular Epidemiological (ACE) study, a cross-sectional epidemiologic study was undertaken for the presence of hypertension, diabetes mellitus, dyslipidemia, obesity, smoking and abdominal obesity in Nigeria.

Results: In total, 303 subjects from 8 out-patient general practice clinics were studied, 184 (60.7%) were female and 119 (39.3%) were male. Mean age was 42.7±13.1 years; 51.8% were aged <45 years; 4% ?65 years. Over 90% of subjects had ?1 of 6 selected modifiable cardiovascular risk factors: 138 (45.6%) had 1-2; 65 (21.5%) had 3; 60 (19.8%) had 4; and 11 (3.6%) had 5 concurrent risk factors. Screening identified 206 subjects (68.0%) with dyslipidemia who did not have a prior diagnosis.

Conclusion: Cardiovascular risk factors are highly prevalent in Nigerian subjects attending out-patient clinics. Moreover, many subjects were undiagnosed and therefore unaware of their cardiovascular risk status. Cardiovascular risk factors are highly prevalent in adults attending general out-patient clinics in Nigeria, many of whom were undiagnosed and therefore unaware of their cardiovascular risk status prior to screening. Opportunistic screening alongside intensive national, multisectoral education or risk factor education is needed, should be scaled up nationwide and rolled out in both urban and rural communities in Nigeria.

Reporting a Case of Bone Tuberculosis on Child

Fabiana Cristina Fulco Santos, André Luiz Alves do Nascimento, Laís Ariane de Siqueira Lira, Juliana Figueirêdo da Costa Lima, Rosana de Albuquerque Montenegro, Lilian Maria Lapa Montenegro, Haiana Charifker Schindler

Challenges in Disease and Health Research Vol. 5, 8 February 2021, Page 73-78

Bone tuberculosis (TB) is one of the forms of extrapulmonary tuberculosis that affects, above all, the spine, long bones and joints. The authors report a case of a 12-year-old child with a complaint of pain and deformity in the lower thoracic region that had lasted for two years. Clinical, epidemiological and laboratory characteristics associated with images of apparent damage in the T9-T10 and T11-T12 vertebrae taken by radiography of the thoracic spine and nuclear magnetic resonance in addition to the positivity of the molecular test based on the polymerase chain reaction, led to tuberculous spondylitis being diagnosed and specific therapy was started. Culture of vertebral biopsy was positive for Mycobacterium tuberculosis after thirty days. The early detection of disease and referral to a specialist service for rapid diagnostic’s investigation are measures that helps on patient prognosis. It should be a concern of pediatricians when they come across chronic cases of back pain and arthralgia in endemic areas.

The Lifespan Hormesis Phenomenon in a Population does not Make It's Healthier

Aleksey N. Shoutko, Ludmila P. Ekimova

Challenges in Disease and Health Research Vol. 5, 8 February 2021, Page 79-93

Recently, radiation hormesis has been considered a form of useful cancer therapy when total-body irradiation (TBI) is delivered to a cumulative dose of 1.5 Gy at about 0.1 Gy/day. Many studies have attributed hormesis to potentiation of the immune system. The goal of this study was to evaluate the influence of natural variation in the regenerative status of dog tissues on the signs of hormesis, which are evident after total body exposure to low daily doses of external gamma radiation throughout the lifespan. Ninety beagle dogs of both sexes were irradiated with cobalt 60 at 0.003 Gy/day commencing 1 year after birth to death. Control (n = 169) and irradiated animals underwent whole-life clinical observation and autopsy, and were then retrospectively divided into two subgroups with (W) or without benign tumors or tumors of unknown nature (WO) that were clinically recorded on single days throughout the lifespan. Radiation hormesis was only detected in subgroup WO, which had life span (LS) of 10.7 years in the absence of radiation. The radiogenic prolongation of life to 11.8 years in the WO subgroup (p < 0.05) was similar to that in the W control and irradiated W subgroups (11.8 and 11.5 years, respectively). The number of solid malignancies found upon autopsy of the control WO subgroup was less (39.5%) than that evident in the control W subgroup (60%). Compared to the irradiated W subgroup, irradiation of the WO subgroup was accompanied by a slight increase (1.14-fold) in the number of solid malignancies evident at autopsy and in the clinical signs of tissue atrophy and body weight loss (2.4-fold and 2.4-fold, respectively), but was accompanied by strong reductions in the extent of anemia and hematoblastoses (>10-fold for both). The data exclude the notion that radiation is associated with healing, but suggest that certain pathologies (e.g., hematoblastoses) may be substituted with other less dangerous somatic diseases in weaker animals only. It suggests that the notion of radiobiological “stimulation” is inappropriate, at least in mammals.

Domestic Violence in Senegal: A Quantitative and Qualitative Study

Mamadou Makhtar Mbacké Leye

Challenges in Disease and Health Research Vol. 5, 8 February 2021, Page 94-104

Introduction: Faced with the predominance of domestic violence, the under-denunciation remains shrill among victims linked to socio-cultural constraints. The objective of this study is to make a descriptive analysis of the epidemiological and clinical aspects of domestic violence and the perceptions of victims in Senegal.

Methodology: A mixed method was conducted. The data was collected from the court records of female victims of physical and/or sexual violence registered from 2006 to 2015. Female victims of physical and/or sexual violence at the hands of their husbands who had a court record at one of Senegal’s high courts during this period were also included. All records that met the inclusion criteria were selected for the study and the data was analyzed using Epi Info 3.3.2. A qualitative analytical study was carried out. The study population was the victims. Individual interview guides have been produced to collect victims' perceptions of violence. Content analysis supported by thematic analysis was conducted with Iramuteq software.

Results: According to the court records of 148 female victims of domestic violence, the average age of the victims was 30.6 ± 10.1 years. More than ¾ (76.4%) of the victims were housekeepers, 82.4% of whom were uneducated. The average age of the perpetrators was 40.4 ± 11.4 years, and they were self-employed in the informal sector in 47.3% of the cases. Additionally, more than ¾ (78.4%) of the perpetrators were uneducated. Eleven women (8% of the victims), were abused while pregnant. Physical violence was predominant (95.3%), while those associated with sexual assault accounted for 4.7% of cases. Of the 7 recorded cases of sexual violence, 3 were cases of unwanted sexual touching, and all cases of physical violence were cases of assault and battery. The violence took place at the home of the perpetrators in 81.8% of cases. In 84.7% of the cases, victims received treatment and care within 24 hours or less. Among the victims, 73% showed clinical lesions. Contusions, hematomas and penetrating wounds were most frequent, representing 23.1%; 19.4% and 13.9% of cases respectively. The husband, the main aggressor, is at the origin of all forms of violence. For example, he beats his wife (physical violence), he insults his wife (verbal abuse) or he refuses his spouse to have sex. Often, for fear of divorce, women conceal the violence suffered from those around them and refuse any denunciation.

Conclusion: Despite the low number of cases registered in the judicial system in the past ten years, much more violence is occurring without being denounced by the victims. Therefore, it seems appropriate to increase awareness within the community and break sociocultural barriers that hinder the recognition of women’s rights in the couple.

Monitoring the Risk Factors Associated with Asthma among Saudi Adults in Najran

N. K. Elfaki, A. Y. Shiby

Challenges in Disease and Health Research Vol. 5, 8 February 2021, Page 105-112

Background: Asthma is a chronic illness that affects people of all ages. Its prevalence has risen over the last few decades in Saudi Arabia. The aim of this study was to explore the common risk factors that associated with asthma among Saudi adults in Najran during the period December 2016 to October 2017. One hundred eighty four patients who were over 18 years of age and who had a diagnosis of definite asthma (cases), beside another 184 healthy individuals as control group, that matched the cases in terms of age and sex constituted the study sample. A questionnaire as a tool of data collection was completed by cases as well as from controls. It was consisting of data that include personal, familial and indoor environmental factors that could be potential risk factors for asthma. The mean ages for cases and controls were 21.3 (± 16.5) and 21.7 (± 16.8) years respectively. Each group consisted of 108 (58.7%) males beside 76 (43.3%) females. There were no significant association between asthma occurrence and level of education and indoor plants with P-value >0.05. On the other hand, multivariate logistic regression analysis showed that family history (OR=5.01 and CI=2.09-8.42), using sprays of insecticides or air fresheners (OR=8.5, CI=2.34-11.09), as well as rhinitis (OR=4.76, CI=2.19-6.45) were significantly associated with asthma occurrence. Additionally, active or passive smoking was significantly (P-value= 0.041 and 0.012) associated with asthma among adults in Najran. Based on the obtained results, it was concluded that there are different risk factors patterns for asthma, those factors appear to play a major role and likely contribute to the magnitude of this burden. It was concluded that family history, smoking, allergic rhinitis and smoking the most risk factors for developing asthma among Saudi adults. Further studies for investigating other factors were recommended. Moreover, health education programs for educating people about the risk factors, preventive measures, early diagnosis and proper management were highly recommended.

Acinetobacter, Hafnia and Campylobacter are three Gram-negative bacterial genera involved with low frequencies in genital infections that result in adverse pregnancy outcomes. This study reviews characteristics of the microbiology, epidemiology, diagnosis and treatment of each of these taxa, and describes several specific cases of maternal and infant infections that illustrate problems encountered with these pathogens and in the treatments of maternal and neonate infections. It is concluded that cultivation-independent investigations to identify and characterise the bacteria that cause intra-amniotic infections associated with histological chorioamnionitis and spontaneous preterm birth will reveal species that warrant further study. This knowledge, in conjunction with the application of improved microbial detection methods in the clinical setting will facilitate the development of new prevention, diagnosis and treatment strategies.