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Recent eLetters

Displaying 11-20 letters out of 376 published

  1. Re: Associations between source of information about sex and sexual health outcomes in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles

    Dear editor Addressing issues of sexuality among young people at this point is timely. Many studies have attributed inadequate sexual information among young people to their inability to make informed sexual choices which results into negative sexual outcomes including sexual transmitted diseases and unintended pregnancies.

    The authors in this study attribute sources of information to transformational change among young people in developed countries. The study also showed that, implementing sexual education in schools enable adolescents to make informed choices on sexual matters. This study suggested that schools and parents are the main source of sexual and reproductive health information to youths. While this is true in developed countries, studies done in LMICs show different results in that, in LMICs, schools have well designed and elaborate sexual education curriculum, but with inadequate implementation, enforcement of educational guidelines and un-examinable curriculums. In addition, majority of parents are shy to openly discuss sexual matters with their Adolescents - owing to socio- cultural backgrounds. The study could have made comparisons in LMICs and see the outcome of such findings. On methodology, this study used cross-sectional design; further research on this topic in LMICs can employ qualitative design to explore associations between source of information and sexual health outcomes among young people this is due to socio- cultural factors. By Faith Chesire

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  2. DATA COLLECTION LIMITATION TO THE RESPONDENT

    The idea of community involvement is relevant and ideal since it is recommended as one of the elements of primary health care which would then lead to the achievement of health care for all. This study has presented interesting findings which are good for the general health care system however, being that this was a qualitative study, the participants should have been given more time to express their understanding of over diagnosis and this could have given room for probes which could have produce more information for the study's conclusion. This is a very good study and it's recommendations are very good and should be taken up by the relevant persons.

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  3. Comments on the referenced article

    Dear Editor, Ref: Article: Predictors of skilled attendance at delivery among antenatal clinic attendants in Ghana: a cross-sectional study of population data - Amoakoh Coleman M, Ansah EK, Agyepong IA, et al

    It is interesting to learn about the identified demographic, maternal, community and contextual predictors of skilled attendance at delivery among women who attend ANC at least once during their pregnancy in Ghana.

    Characteristics of the study population on Table 2 could have been separated into the categories studied for ease of understanding, reference and also to guide the discussion.

    The author indicates that women who are less likely to have skilled attendance at delivery can be identified during antenatal care using data using their socio economic and socio demographic data, and can be targeted with interventions to improve skilled attendance at delivery. Are there any of such existing interventions around the world and how effective have they been? Would such interventions be sustainable in the study area considering the economic constraints faced in developing countries?

    Thank you, Liz Otieno

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  4. Urgent need to conduct similar studies in developing countries

    Dear Editor,

    I have enjoyed reading the article which has well highlighted the fact that tobacco consumption and secondhand smoke (SHS) exposure in vehicles is indeed a serious health issue because of the high concentrations especially in confined environments.

    The results have global repercussions yet in the discussions the authors largely ignore low income and more crowded societies like India, Nigeria, Brazil and Kenya and only focus on high income settings like Spain, Italy and New Zealand. It would create better balance and become more comprehensive if similar studies were conducted as a matter of urgency in the developing world.

    The impressive results indicating high prevalence of SHS exposure to young children justify the need for more public education and the need for legislation to help introduce regulations to reduce exposure.

    Thank You

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  5. Re: Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys

    The association of child stunting and water, sanitation and hygiene is an eye opening study. Concentration has been on what the child is missing from their diet, without really auditing how their surrounding would affect the ultimate absorption of these nutrients in their bodies. The study identifies diarrhoea and other water borne, water washed and other contact diseases as affecting the alimentary canal of the children and even their appetites. Thus a child who is constantly affected by these diseases has a higher chance of stunting due to malnutrition which the parent may not notice and would simply attribute the child's wasting to the effects of the illness. The association of stunting and water and sanitation and hygiene would definitely explain the many deaths and ill health among the vulnerable communities.

    The study highlights many pertinent issues surrounding water and sanitation in India which also affect Sub Saharan African households. It would be interesting to see if a similar study among sub-Saharan African households would reveal the same outcomes. The study revealed a relationship between stunting of the children and the level of formal education of their care givers in regards to WASH. I would like to know if the following considerations were made; 1. Were the care givers exposed to informal education systems on WASH and stunting through media campaigns? 2. Were the caregivers exposed to informal education systems using the informal health workers in their homes? 3. Were the caregivers exposed to informal education systems at the health facilities when they go to seek medical attention for the conditions related to WASH.?

    Finally the overall presentation of the paper was very concise. The key points were articulated clearly. The organization of the paper was good. I was able to follow the train of thought of the authors and enjoyed reading the paper. It had new knowledge on the relationship between childhood stunting and water sanitation and the personal hygiene of the caregivers. It opens up other follow up researches that may be of interest to many. The reference to previous studies gave a strong background to their case findings and therefore was very compelling.

    Conflict of Interest:

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  6. Safe-sex belief and sexual risk behaviors among adolescents from three developing countries: a cross-sectional study

    Title: Views on Condom effectiveness among adolescents in three Latin American countries. This research made great contribution as a stepping stone in comparing safe sex and sexual risk behaviors in Latin American countries and by extension Spain, however similar studies conducted in Kenya, Uganda and South Africa revealed different levels on infection. Whereas the three countries had prevalence of HIV for the general population below 1%, conversely, the three sub-Saharan countries had HIV prevalence ranging from 5.6% (MOH Kenya, 2014) ,7% in Uganda and an all time worrying 12.2% South Africa respectfully. It is for this reason therefore, I could have suggested having countries with similar or close prevalence rates ranked together for a better comparison based on population dynamics and regional diversity. On safe sex belief, the research revealed that one out of seven adolescent believed that condoms are 100% effective in the three Latin America countries. As much as the results were appealing, a supplement article on Epidemiology of HIV and AIDS Among Adolescents: Current Status, Inequities, and Data Gaps indicated that knowledge in belief of condom effectiveness and use among the adolescents in developing countries remained low : HIV, AIDS, adolescents, prevention, care, treatment (J Acquir et.al ,2014;66:S144-S153). Based on the above results, comparing Kenya, Uganda and South Africa on the same parameters would less likely yield the same results. This is because there are different factors associated to condom use ranging from religious to cultural beliefs about safe sex. The paper also sought to find out whether the adolescents had had sex. Adolescents who believed that condoms were 100% effective were 82% likely to have had sex and used condoms. This was very good results if the paper would have been able to truly prove of scientifically that they used condoms. However, it is of crucial importance to note that early sexual debut among adolescents begins before 15 years of age. There are several researches showing significant variations of early sexual debut based on different regions of the world. The paper ought to have put in consideration the element of costs. Condoms access was not discussed in the paper. In Kenya for example, Condoms are sold or placed in specific dispensing points. Adolescents living in rural areas will either shy off or feel ashamed to pick condoms where their relatives dine and wine. Various reports indicate that where condoms are not available adolescents either improvise small micron polythene papers for condoms or practice unprotected sex. Adolescents also have tendency of using condoms at initial contacts and discard their use later. These has shown considerable rise in sexually transmitted infections as echoed by supplementary report on Epidemiology of HIV and AIDS among adolescents (J Acquir et.al, 2014; 66:S144-S153). Condoms use cannot guarantee protection of infections i.e. Herpes simplex and Human papilloma. This gives me a valid reason to say that it is not safe for adolescents in sub-Saharan Africa with little access to approve of its use. In as much as I respect the research findings, Wood, in his work on social cultural effects of HIV in South Africa wrote "Local understanding of the gendered effects of sexual intercourse and lack of it on men causes retention of semen which in turn is thought by many young South African men to cause an array of undesirable effects, including 'madness'.(Wood,2002)".Based on the above, adolescents growing up in this kind of settings will less likely use condoms because condoms may be considered like a barrier causing madness. The adolescents do not live in isolation, they operate and interaction in a society guided by cultural norms, I therefore, highly doubt them going against the dictates of cultural perception on condom use. When in doubt on condom information, adolescents would frequently ask these questions to peers who may not have befitting correct answers. His second finding was equally not possible to measure but has detrimental effects on adolescents. He further wrote "Women are said to have sexual appetites which are, again, thought to need regulating as well as satisfying too frequent sex and too many partners for women are considered to jeopardize vaginal tightness, which is desirable because it is associated with 'heat', which is central to male sexual pleasure (Wood, 2002)." Going by these findings revealing that condoms are100% effective and ready to be used by the adolescents in Sub Saharan Africa leaves me with many unanswered questions to our next generation. In spite of this inspiring work, the study in future may consider making comparison of researches done in Latin America and sub-Saharan Africa to inform on condom use as key prevention intervention among the adolescents. By: Benjamin Macharia

    Conflict of Interest:

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  7. The Lisbon Cohort of Men Who Have Sex With Men

    The Lisbon Cohort of men who have sex with men (MSM) identified gays, bisexuals and MSM aged between 20-29 years as key populations most affected by HIV/AIDS1 and key contributors to the epidemic in Portugal. The study identified the need to establish instruments for monitoring HIV and syphilis incidence, determinants of infection and risk-taking behaviors in MSM. A community-based walk-in centre was used to recruit MSM as participants of a cohort study despite the obvious limitation of recruiting only men that walked into the centre. Chinese and European studies recommended the Internet as an effective avenue for recruiting study subjects, and other authors have used formal health or academic institutions to recruit participants2. The article highlighted several cultural, anthropological and sociological challenges in the conduct of community-based studies with MSM. The use of community-based or Internet strategies for recruiting participants from vulnerable populations such as MSM may be difficult in low-income countries; this is related to the reality that MSM is still not accepted in these countries. Conducting such a study in low-income settings may yield evidence which may not be generalized across populations. However, the Lisbon cohort provides a good foundation for researchers that would like to conduct research around MSM in similar settings.

    Conflict of Interest:

    None declared

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  8. The relationship between smoking status and health-related quality of life among smokers who participated in a 1-year smoking cessation programme in Taiwan: a cohort study using the EQ-5D Pei-Ching Chen, 1, 2 Raymond Nien-Chen Kuo, 3 Chih-Kuan Lai,4 Shih-

    Dear Editor, This article is an important study addressing priority areas of disease burden particularly in high income settings. The study is well designed with a large sample size. Unfortunately, the limitations mentioned by the authors seems rather severe, hindering the validity of conclusions both due to lack of funds to cover up the study period as intended and loss of follow up on some of the participants. The tool used also according to Mathias et al., 2012, gives inadequate information on health-related quality of life (HRQoL) which differs across the populations. In all, it is an important study that is worth exploring in other places particularly in the low and middle income countries on the road towards cancer prevention.

    References Matthias Vogl, Christina M Wenig, Reiner Leidl and Subhash Pokhrel . (2012) Smoking and health-related quality of life in English general population: implications for economic evaluations.

    Conflict of Interest:

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  9. Who is in control? Clinicians' view on their role in self-management approaches: a qualitative metasynthesis

    I enjoyed reading this article on clinician's View on their role in self management approaches. Nowadays a large number of people are living with chronic illnesses. Often, one living with chronic illness needs to be assisted with some skills to take care themselves better, applying the approach of self management. The findings of this study showed that clinicians may find it difficult to shift some tasks to or share control in health care with the patient or family care givers. However there is need for change in position moved from the more traditional approach of provider dominated care to a partnership as innovative approach to patient centered care. The method used to gather the data for this article were clearly explained. Metasynthesis as the methodology to synthesize data from several studies. Complete articles included in the study, on experiences, or views on clinicians' roles on self management approach were recaptured. The approach of synthesizing findings coming from different opinions can be complex, in generating harmonized results. Synthesis could be used as the primary study while qualitative design can used as secondary to explore how they applied the self management approach. Self management approach have many advantages in improving patients' wellbeing in the community, in coping with chronic illness. In low income settings where there is lack of health professionals, primary care teams may have difficulty finding time to provide patient education sessions and to monitor health indicators to ensure safety even when patients and their caretakers have been trained. Thus the needed change cannot be effected by the clinicians alone. It also needs community education, where education depends on the curiosity, educational background and socio economic status of those to included in a programme of education about self management .

    Conflict of Interest:

    None declared

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  10. The Lsibon Cohort of Men Who Have Sex With Men

    The Lisbon Cohort of men who have sex with men (MSM) identified gays, bisexuals and MSM aged between 20-29 years as key populations most affected by HIV/AIDS1 and key contributors to the epidemic in Portugal. The study identified the need to establish instruments for monitoring HIV and syphilis incidence, determinants of infection and risk-taking behaviors in MSM. A community-based walk-in centre was used to recruit MSM as participants of a cohort study despite the obvious limitation of recruiting only men that walked into the centre. Chinese and European studies recommended the Internet as an effective avenue for recruiting study subjects, and other authors have used formal health or academic institutions to recruit participants2. The article highlighted several cultural, anthropological and sociological challenges in the conduct of community-based studies with MSM. The use of community-based or Internet strategies for recruiting participants from vulnerable populations such as MSM may be difficult in low-income countries; this is related to the reality that MSM is still not accepted in these countries. Conducting such a study in low-income settings may yield evidence which may not be generalized across populations. However, the Lisbon cohort provides a good foundation for researchers that would like to conduct research around MSM in similar settings.

    Conflict of Interest:

    None declared

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