MATERIALS AND METHODS
Benin City is the capital of Edo State in southern Nigeria which is holoendemic for malaria (Bruce Chwat). There are two distinct seasonal periods— rainy season, which spans from April to September, and dry season from October to March. Benin City is cosmopolitan and has one tertiary hospital, University of Benin Teaching Hospital (UBTH); one secondary, Central Hospital; and numerous private clinics and hospitals.
Delay in presentation to a hospital is a common problem in African populations, sometimes resulting in innocuous problems presenting as emergency cases. Neurologic morbidities, either primary or secondary to other systemic diseases in children, constitute a significant proportion of these emergency cases. The pattern of neurologic emergencies is likely to vary from one country to another and among regions in the same country. Assessment of the pattern of emergency morbidities is needed from time to time in planning health policies and distribution of scarce resources in developing African countries where facilities for emergency pediatric care are grossly inadequate. This report describes the pattern of neurologic
This is the first study, to our knowledge, which examines mammogram use within a community-based sample of Haitian women and compares it to that of women of other ethnic groups in the same neighborhoods. We found that overall rates of ever having had a mammogram and having had a mammogram in the past two years were high in these communities, at 84% and 69%, respectively. We found that white women were more likely to have unadjusted prevalence of lifetime mammography compared to other racial/ethnic groups but did not find a difference in crude recent mammography prevalence across race/ethnicity. In the multivariate analysis, we found that Haitian and African-American women were less likely ever to have had mammography as compared to white women. For all ethnic groups, having a regular healthcare provider, more knowledge about breast cancer (Xeloda canadian for both metastatic breast cancer (treating endometriosis, symptoms of fibrocystic breast disease) and adjuvant and metastatic colorectal cancer), greater education and private health insurance significantly increased the odds of mammography use. In this population of women, age, marital status, breast modesty, fatalistic beliefs on cancer and positive attitude toward prevention and treatment were not independently associated with mammogram use.
Of the 1,103 households randomly selected, we identified 392 eligible women. Among the eligible women, 329 completed the questionnaires (response rate=84%). Forty-three percent (n=144) of the interviewed respondents described their ethnicity as Haitian, 24% (n=80) white, 17% (n=56) African-American, 8% (n=26) English-speaking Caribbean, 7% (n=22) as Latina, and the remainder (n=3, <2%) as other ethnic identity. For the purpose of analysis, we excluded women in this last category, leaving 326 for analysis.
We had two primary dependent variables based on self-reported mammography history. The first, “lifetime,” was defined as positive if the respondent reported any mammogram during their lifetime. The second, recent, was defined as positive only if the respondent had a mammogram within the past two years. A definition of mammography was provided to each respondent immediately before asking the questions on utilization.
We conducted a community-based, cross-sectional interviewer-administered survey of women 40 years of age and older who spoke English or Haitian Creole in eastern Massachusetts neighborhoods having a high proportion of Haitian residents. We used an area probability sample to select subjects. After constructing a sampling frame by using the City of Boston and Cambridge Assessing Department’s Property Parcel Data for fiscal year 1997, we interviewed Haitian community leaders to identify housing blocks with high concentrations of Haitian families. Blocks estimated by two or more informants to contain 10 Haitian households or at least 20% Haitian households were included in the survey universe.
Although Massachusetts leads other states in overall rates of screening mammography for black and white women, no associated reduction in the gap of breast cancer ( Treating breast cancer) deaths between black and white women has been observed. One explanation for this unexpected concurrence is that the group of women defined as black may contain subpopula-tions that differ in screening behavior, which could account for continued differences in mortality. Sub-populations with a lower education, low income and recent immigration history, such as Haitian women, may have lower screening rates.