The Gambia is the smallest country in mainland Africa. Along with the rapid urbanization rate, motorization has increased rapidly as well, contributing to an increased number of road traffic crashes. Road traffic crashes are the 4th leading cause of in-patient deaths in adults in the Gambia and currently are a significant public health problem. This study utilized the Gambia Traffic Force’s data registry to become the first epidemiological study on road traffic injuries in the Gambia as well as the first to analyze the Gambia’s traffic data registry on a national level. Reported crashes from October 1st, 2014 to June 30, 2015 were converted from the paper-based data registry into an electronic database and analyzed statistically, and the location data were geocoded and plotted on the Gambian map. The results of this study showed that crashes involving pedestrian victims and crashes that occurred on unpaved roads were more likely to be associated with outcomes that were fatal or serious. When multiple vehicles were involved in a crash, the involvement of motorcycles and bicycles were more likely to lead to a fatal or serious injury. The mapped data showed that towards the center of each district, the number of crashes increased as pedestrian and vehicle density increased, but that injury severity outcomes were generally minor or none. In contrast, as pedestrian and vehicle density decreased, crash frequency decreased as well, but injury outcomes were more likely to be severe or fatal. The findings of the study also helped in identifying areas in policy and education that need improvement.

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

The present study was designed to contribute to the application of human security principles in vulnerable populations, using the Bateyes (sugar mill camps) from the Dominican Republic (DR) as a case study. Following the Robin Hood principle of using resources allocated for the identification and treatment of human immunodeficiency virus (HIV) as a base from which to build infrastructure for other health and human security needs, this project sought to reduce inequalities and promote equal rights in a vulnerable population living in isolated rural areas of the DR. The impact of a human security model versus non-intervention (standard of care) was examined longitudinally in relationship to the outcomes (prevention of morbid events such as HIV, tuberculosis, diarrhea, dengue, malaria, and model impact on breastfeeding and vaccines rates). The project was implemented in three phases: baseline assessments, implementation of a human security model over a six month period, and evaluation of the interventions at six and twelve months after the initiation of the intervention. Qualitative evaluation methods were used to complement quantitative assessments. An economic analysis was also conducted to evaluate the costs of the intervention and potential sources of economic benefits. Overall, at baseline, the owners of the houses from Batey A (Case) were more likely to respond incorrectly than the residents of Batey B (Control) questions about knowledge, attitudes and practices, for the most prevalent infectious diseases of the southwestern area of the Dominican Republic. To control for baseline differences between the study groups, a Knowledge, Attitudes and Practices (KAP) score system was created. The KAP score system showed that the people living in Batey A had a higher percentage of right answers than residents of Batey B, six months after the intervention. These findings, however, were not observed at the 12 month follow-up visit, suggesting that future studies using the human security intervention model may need to be maintained for more than 6 months, to promote sustainability. Economic analysis revealed that the total cost-savings of the Program to the Ministry of Health and society overall to be 252,399USD. In addition, at the follow-up visits, morbidity and mortality rates of the study population were lower than the rates reported in a recent Demographic Health Survey conducted in the Southwestern Bateyes of the DR. The qualitative interviews allowed for the identification of community perceptions of the model, as well as the necessity for an interdisciplinary approach, including structural interventions (i.e. water pump, construction of latrines, etc) and monitoring community security-related issues through household monthly visits. The use of HIV resources demonstrated that the money allocated for HIV prevention could be utilized, not only to reduce the burden of disease, but also to invest in health systems and services. Applied to other settings, the design and outcomes of this study could have a beneficial impact on refugee and undocumented populations in other countries under the impact of the structural violence observed in the Bateyes of the DR.

Immunization has been used as an upstream, protective measure in public health for decades. Although immunization programs have been introduced in Pakistan, new and emerging infectious disease remains a concern in the country. The province of Sindh, Pakistan is of special concern because of its large rural population.<p>The purpose of this study was to: 1) determine and compare complete and age-appropriate immunization uptake in children 12 to 36 months and birth to 9 months, respectively living in Sindh, Pakistan in 1994 and 1997; and 2) determine the correlates of complete and age-appropriate immunization in children 12 to 36 months and birth to 9 months, respectively living in Sindh, Pakistan in 1997.<p>This study reviewed data that was collected as part of the School Nutrition Program (SNP) and Family Health Project (FHP) in 1994 and 1997, respectively. Analyses included immunization data on 1877 children from the SNP survey and 1694 children from the FHP survey.<p>Females were found to have higher statistically significantly age-appropriate uptake than males in 1997 (p=0.015). Complete immunization status was also found to vary significantly by district of residence in 1994 and 1997 (p<0.001). Both complete and age-appropriate immunization status was found to decrease from 1994 to 1997.<p>Multivariable logistic regression revealed that not owning a radio, electricity, or bicycle was indicative of lower odds of complete immunization uptake (OR<1, p<0.05). Other correlates predictive of lower odds of complete immunization included owning a water pump (OR=0.360), not having a Lady Health Worker (LHW) visit the home (OR=0.489), living in a kucha house (OR=0.637), and living in Tharparkar (OR=0.290), Badin (OR=0.599), or Mirpur Khas (OR=0.271).<p>A similar regression analysis revealed childs sex, ownership of a refrigerator, and having heard of contraception to be correlates of age-appropriate immunization (p<0.05). Females had higher odds of age-appropriate immunization (OR=1.851) compared to males. Not having a refrigerator was indicative of lower odds (OR=0.079). Not having heard of at least one type of contraception was a predictor age-appropriate immunization (OR=1.925).

Immunization has been used as an upstream, protective measure in public health for decades. Although immunization programs have been introduced in Pakistan, new and emerging infectious disease remains a concern in the country. The province of Sindh, Pakistan is of special concern because of its large rural population.<p>The purpose of this study was to: 1) determine and compare complete and age-appropriate immunization uptake in children 12 to 36 months and birth to 9 months, respectively living in Sindh, Pakistan in 1994 and 1997; and 2) determine the correlates of complete and age-appropriate immunization in children 12 to 36 months and birth to 9 months, respectively living in Sindh, Pakistan in 1997.<p>This study reviewed data that was collected as part of the School Nutrition Program (SNP) and Family Health Project (FHP) in 1994 and 1997, respectively. Analyses included immunization data on 1877 children from the SNP survey and 1694 children from the FHP survey.<p>Females were found to have higher statistically significantly age-appropriate uptake than males in 1997 (p=0.015). Complete immunization status was also found to vary significantly by district of residence in 1994 and 1997 (p<0.001). Both complete and age-appropriate immunization status was found to decrease from 1994 to 1997.<p>Multivariable logistic regression revealed that not owning a radio, electricity, or bicycle was indicative of lower odds of complete immunization uptake (OR<1, p<0.05). Other correlates predictive of lower odds of complete immunization included owning a water pump (OR=0.360), not having a Lady Health Worker (LHW) visit the home (OR=0.489), living in a kucha house (OR=0.637), and living in Tharparkar (OR=0.290), Badin (OR=0.599), or Mirpur Khas (OR=0.271).<p>A similar regression analysis revealed childs sex, ownership of a refrigerator, and having heard of contraception to be correlates of age-appropriate immunization (p<0.05). Females had higher odds of age-appropriate immunization (OR=1.851) compared to males. Not having a refrigerator was indicative of lower odds (OR=0.079). Not having heard of at least one type of contraception was a predictor age-appropriate immunization (OR=1.925).