World Health & Population
From the Editor-in-Chief
This issue of World Health & Population presents papers that have been published online by WHP and are selected here as representative of recent outstanding contributions to the journal. The papers in this issue include two from China and one each from Bangladesh, Kenya and Kuwait.
The first article in this issue is “The Determinants of Early Cessation of Breastfeeding in Bangladesh,” by Shamina Akter and Mizanur Rahman. The study uses data from the Bangladesh Demographic and Health Survey to explore the effect of parity and demographics on early cessation of breastfeeding, a known contributor to childhood mortality and morbidity, as well as a contributing cause for resumed fertility. Interestingly, the average duration of breastfeeding in Bangladesh, 27.5 months, is generally higher than that of other South Asian countries, which can be seen as a hopeful sign. The authors found continuance of breastfeeding, however, negatively associated with parity; that is, the higher the woman’s parity, the more likely early cessation. Higher educational status was also associated with early cessation, which might indicate an appropriate group on which to focus the educational efforts recommended by the authors.
Community participation has been a recognized, if not always practised, part of international programs since the early 1980s and before. Both theory and experience (to say nothing about common sense) strongly support the idea of involving those we are trying to help in the design, implementation and evaluation of programs on their behalf. Unfortunately, efforts to involve the community have often fallen short. In “A Participatory Approach to Assessing Refugee Perceptions of Health Services,” Brett Nelson, Marya Getchell, Stephanie Rosborough and colleagues propose and pilot an innovative method, called “by-person factor analysis” or Q-Methodology, for eliciting opinions and perceptions from an extremely disenfranchised community that of residents in refugee camps. It is also an encouraging sign that new methodologies are being developed for some of the most difficult settings. Certainly if they can be found to work in these settings, they can be adapted and applied elsewhere.
In the third article, Zhen Jiang, Debin Wang and colleagues examine the relationship between demographics, symptom severity and healthcare use in the article “Use of Health Services by Women with Gynecological Symptoms in Rural China.” Utilizing a pre-tested cross-sectional survey of 1398 women (87.3% response rate), the authors found that approximately 70% had reported gynecological symptoms of varying seriousness during the last year. Of those reporting symptoms, slightly more than one-third reported seeking care. Educational level, not surprisingly, was strongly associated with seeking care and seeking it at higher-level facilities. Cost of care was clearly a factor as well. Given the importance of correct recognition of serious symptoms in reproductive health, the authors propose building a “grassroots capability” for proper health education of rural women and their healthcare providers.
Also examining health services in China, Qun Zhao, Xiaoming Li, Bonita Stanton et al. contend that the HIV/AIDS epidemic in China is still in its “early stages.” This is certainly true when compared to Sub-Saharan Africa, which we hope China will never approach in terms of the extent of the infection and disease. Being in the early stages is also true, however, in terms of discussion of the disease and understanding of the relevant factors. Their article in this issue of WHP, “HIV/AIDS Awareness and Knowledge among Secondary School Students in China,” begins filling in the knowledge gap with survey information from one of the most vulnerable populations – secondary school adolescents. The authors found low and inconsistent knowledge around HIV/AIDS, with males being more knowledgeable than females. Interestingly, the study also revealed that mass media played a more significant role in information than parents, friends and peers, offering hope for public information campaigns to have an effect.
The final article in this issue is “Exploring the Meaning of Childhood Disability: Perceptions of Disability among Mothers of Children with Disabilities (CWD) in Kuwait.” In this article, Sudha Raman, Shilpa Mandoda and colleagues report on results from Kuwait as part of their ongoing interest in perceptions of disability and health-seeking behaviours across countries and cultures. The authors point out that the concept of disability has ancient roots in societies but is changing greatly with advances in medical science, rehabilitation services and technology. Mothers, as the primary caregivers of CWDs, must often “hold in tension” traditional, fatalistic views of their child’s disability, together with faith in the efficacy of the rehabilitation process. Understanding this tension can make designing programs more responsive and effective.
Finally, I would like to point out an editorial by Jennifer Zelmer, forthcoming in our companion Longwoods journal, Healthcare Policy. Professor Zelmer discusses the Millennium Development Goals (MDGs) in the context of reduction of infant mortality in Canada. It is important to remember that the achievement of the MDGs is challenged globally, not just confined to the most resource-constrained areas of the world.
In conclusion, we hope that you find the papers in this issue interesting and valuable, and that you will also consult others recently released online at www.worldhealthandpopulation.com. WHP remains committed to its mission to provide a forum for researchers and policy makers worldwide to publish and disseminate health- and population-related research, and to encourage applied research and policy analysis from diverse global settings. WHP is indexed on MEDLINE and is accessible through PubMed. We look forward to continued enthusiastic submission of manuscripts for consideration, peer review and publication. Finally, the editors and publishers of WHP are always interested in any comments or suggestions you might have on the papers or the journal. Please feel free to write or e-mail us.
About the Author(s)John E. Paul, PhD, Editor-in-Chief, World Health & Population
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