BMJ public health最新文献

Introduction: Domestic workers (DWs) worldwide face precarious and informal working conditions, including unstable employment, extended hours and insufficient labour protections, impacting their health. This study examines the health and healthcare access of women DWs in Peru, focusing on differences related to formal and informal employment.

Methods: This participatory action research surveyed women DWs in Lima, La Libertad and Piura, Peru, from September 2023 to March 2024 using respondent-driven sampling (RDS). We gathered sociodemographic, healthcare access and health status data and reported counts and percentages with RDS-II estimators (95% CI). We compared health status and healthcare access by formal and informal employment using bootstrap RDS methods.

Results: The study analysed data from 456 DWs. Most were between 19 and 45 years old (60.0%, 95% CI 50.1% to 70.0%), resided in Lima (69.8%, 95% CI 57.5% to 82.0%) and self-identified as Mestizo (54.8%, 95% CI 45.0% to 64.7%). Most respondents were precariously employed as informal DWs (90.5%, 95% CI 87.5% to 93.6%). A higher percentage of informal workers reported difficulty obtaining workplace permission for healthcare visits (32.2%, 95% CI 21.3% to 43.1% vs 21.2%, 95% CI 4.3% to 28.2%; p=0.187) and spent over 100 PEN (US$28) out of pocket on medical visits in the past year (21.2%, 95% CI 14.1% to 28.4% versus 10.5%, 95% CI 0.0% to 32.5%; p=0.249). Despite access to public health insurance, a higher percentage of informal workers visited private healthcare facilities (14.4%, 95% CI 8.3% to 20.5%) than formal workers (4.7%, 95% CI 1.5% to 7.8%) (p=0.084). A higher percentage of informal workers reported a diagnosis of depression (9.7%, 95% CI 5.1% to 14.4% vs 1.6%, 95% CI 0.0% to 4.4%; p=0.052) and anxiety (12.3%, 95% CI 6.1% to 18.5% vs 3.5%, 95% CI 0.0% to 9.1%; p=0.322). Obesity (43.0%) and depressive symptoms (41.4%) were prevalent across the DW population, regardless of employment status.

Conclusions: Informal employment among women DWs in Peru may be linked to greater health challenges and barriers to care, despite public health insurance coverage. Addressing these inequities requires stronger labour protections.

Background: Gallstone disease (GSD) is a prevalent gastrointestinal condition with known associations to gallbladder cancer (GBC). India exhibits heterogeneity in GSD burden across different geographic regions. However, limited data are available from high and low-risk regions.

Methods: A community-based cross-sectional study was conducted across high-risk (Kamprup (Guwahati), Silchar, Mullanpur, Varanasi) and low-risk (Barshi) GBC regions using structured interviews. Self-reported history of gallstones was collected through interviewing participants from two sources, the Gallstone Survey (GS) and the 0.5 Million Indian Women Screening study. Per cent prevalence was estimated for GSD and stratified analysis based on sex, age and region was conducted. We estimated the population attributable fraction (PAF) for GSD in high and low risk GBC regions.

Results: A total of 28 395 participants (9158 males, 19 237 females) aged 30-65 years were enrolled. Gallstone prevalence was highest in Mullanpur (10.8%, 95% CI 8.4% to 13.5%) and Kamprup (Guwahati) (10.7%, 95% CI (7.7% to 14.4%) and lowest in Barshi (0.3%, 95% CI 0.3% to 0.4%). Age and gender stratified analysis showed increasing gallstone prevalence with age among females in high-risk GBC regions, and no age-linked trends in GSD prevalence were observed in low-risk regions for both genders. The estimated overall PAF for high risk GBC regions was 2.7%, whereas in the low-risk region of Barshi the overall PAF was 0.2%.

Conclusion: Significant regional and sex-based variation in GSD prevalence across India aligns with high-risk zones for GBC, underscoring the need for targeted surveillance and aetiologic research.

Introduction: In China, the increase in high-risk pregnancies along with rising maternal age and complications has underscored the need for the development of maternal and newborn risk management programmes. The Chinese National Maternal and Newborn Safety Action Plan (CNMNSAP) was initiated in 2017. Given that neonatal mortality is a key indicator of healthcare quality, we evaluate the real-world effects of CNMNSAP against neonatal mortality among pregnant women with high-risk conditions.

Methods: In this retrospective, matched, population-based cohort study, we collected information on all pregnant women with clinically diagnosed conditions from electronic medical records in Chengdu, China, between July 2014 and December 2019. Individual-level data, covering all healthcare services and testing records in public hospitals, were obtained and categorised into two groups based on the timing of CNMNSAP implementation (pre-CNMNSAP vs post-CNMNSAP). After 1:1 propensity score matching, we calculated the annual percentage change (APC) of neonatal mortality within 7 days post-delivery and compared outcomes between two groups of pregnant women with conditions. We then employed multivariate log-binomial regression models to examine the association between the CNMNSAP implementation and temporal changes in neonatal mortality.

Results: During the 5-year study period, a total of 241 343 women with high-risk conditions delivered prior to CNMNSAP and 163 367 after its implementation. After 1:1 propensity score matching, 299 190 mothers were included for analysis. We estimated that the APC changed from 10.0% (95% CI -0.4% to 21.5%) prior to the maternal risk management programme to -28.5% (95% CI -44.2% to -8.4%) after its implementation, with an attributed risk reduction of 1.29 neonatal deaths per 1000 deliveries annually. In subgroup analysis, we found a significant reduction in neonatal mortality after policy implementation among mothers aged 18-34 years, those with a normal body mass index and those having a history of abortion.

Conclusions: The CNMNSAP was found to be associated with a significant annual reduction in early neonatal mortality risk among pregnant women with high-risk conditions in Chengdu, China. The maternal risk management programme effectively improved outcomes for high-risk pregnancies, highlighting the importance of maternal risk classification and management throughout pregnancy.

Introduction: The burden of diseases related to overweight/obesity is rapidly increasing, especially in low-and-middle-income countries. University students, especially females, are at high risk of being overweight or obese, predisposing them to non-communicable diseases. This study primarily assessed knowledge and prevalence of overweight and obesity; and secondarily factors associated with Body Mass Index (BMI) categories among female undergraduate students of Makerere University Kampala.

Methods: A cross-sectional study was conducted among 380 female undergraduate students, proportionately sampled from all academic units. Data were collected using self-administered questionnaires followed by weight and height measurements to compute Body Mass Index. Knowledge was scored on (1) food characteristics, (2) predisposing practices and environments, and (3) consequences of overweight and obesity; and categorised to adequate (≥70%) and inadequate (<70%). Descriptive statistics and ordered logistic regression were used for analysis.

Results: The response rate for the study was 93.3%. The prevalence of overweight was 24.7% (95% CI 20.5% to 29.4%) while that for obesity was 6.8% (95% CI 4.5% to 9.9%). About 74% (95% CI 69.5% to 78.5%) were knowledgeable about foods, 18.4% (95% CI 14.8% to 22.7%) were knowledgeable about practices and environments that promote obesity or overweight, and 19.7% (95% CI 16.0% to 24.1%) were knowledgeable about consequences of being overweight or obese. The factors associated with BMI categories were being married (adjusted OR (aOR)=1.94, 95% CI 1.05 to 3.57, p=0.034), having adequate knowledge of foods that promote obesity and overweight (aOR=0.58, 95% CI 0.36 to 0.93, p=0.023) and being in higher years of study compared with first years (third year aOR=2.82, 95% CI 1.46 to 5.47, p value=0.002; fourth year aOR=2.99, 95% CI 1.36 to 6.55, p value=0.006).

Conclusions: The prevalence of overweight and obesity in female undergraduate students is high. This calls for designing strategies to control the problem especially targeting higher risk groups like the married and students in higher years of study. Additionally, the proportions of students knowledgeable about practices that promote obesity and overweight as well as its consequences are very low, suggesting a need for strengthening.

Introduction: Human papillomavirus (HPV) and hepatitis B (HBV) vaccines are critical to cancer prevention strategies; however, achieving high vaccination coverage remains a challenge. We aimed to investigate the proportion of Canadian 14-year-old children who received these vaccines by child's gender and examine sociodemographic factors associated with vaccination.

Methods: We used a cross-sectional design to analyse data from the 2021 Childhood National Immunization Coverage Survey. Data were collected using self-completed electronic questionnaires or telephone interviews. Parents/guardians of 14-year-old children separately reported their child's 1-dose HPV and 1-dose HBV vaccination status (categorised as vaccinated, unvaccinated or unknown vaccination status), and their sociodemographic characteristics. Univariable multinomial logistic regression models were used to calculate vaccination status by sociodemographic variables.

Results: After weights were applied, the final weighted sample size was 413 255 and 413 710 respondents for the HPV and HBV samples, respectively. Uptake of 1 dose of the HPV and HBV vaccines was 74.9% and 78.7%, respectively, with higher uptake in girls compared with boys for HPV (80.0% vs 69.9%) and HBV (80.9% vs 76.4%). Having more children in the home was associated with higher odds of being HPV unvaccinated. Less parent education, being born outside Canada, being a boy and having an Indigenous identity were associated with higher odds of an unknown HPV vaccination status. Older parent age and less parent education were associated with higher odds of being HBV unvaccinated. Less parent education and parents who were not married/common law were associated with higher odds of an unknown HBV vaccination status, while older parent age and residing in Quebec were associated with lower odds.

Conclusions: HPV and HBV vaccination coverage in Canada did not reach national and global targets of 90% in 2021. This study highlights sociodemographic disparities in vaccine uptake, which were unique to each vaccine and vaccination status. These findings provide evidence of inequities that should be systematically monitored.

Introduction: Most countries worldwide have experienced excess mortality that coincides temporally with the COVID-19 mass vaccination campaigns. This has led to speculation on the potential long-term effects of the vaccines on mortality risk.

Methods: The study was designed as a retrospective cohort study and included all individuals aged ≥18 years living in Norway during 1 January 2021 through 31 December 2023. Individuals were categorised as either unvaccinated (received no doses), partially vaccinated (received one or two doses) or fully vaccinated (received three or more doses) from the date of vaccination and onwards. Age-stratified Poisson models were used to estimate incidence rate ratios (IRRs) of death (all causes) between vaccination groups, adjusting for sex, calendar time, county of residence and risk group status (nursing home resident or pre-existing condition with increased risk of severe COVID-19).

Results: The study included 4 645 910 individuals (49.8% women) with 132 963 deaths during follow-up. There was a higher proportion of individuals that were part of a risk group among fully vaccinated individuals compared with unvaccinated individuals in all age groups and a lower unadjusted rate of death: 51.5 versus 73.6 per 100 000 person years (py) among individuals aged 18-44 years, 295.1 versus 405.3 per 100 000 py among 45-64 years and 3620.2 versus 4783.8 per 100 000 py among 65 years or older. The adjusted IRR of death for the same age groups was 0.42 (95% CI 0.38 to 0.47), 0.39 (95% CI 0.37 to 0.41) and 0.42 (95% CI 0.41 to 0.43), respectively. The differences in the rate of death between vaccination groups were larger among men and peaked during 2022.

Conclusion: Vaccinated individuals had a lower all-cause mortality rate than unvaccinated individuals during 2021-2023. This difference was larger among men and most prominent following the removal of COVID-19 control measures in 2022 but persisted throughout the study period.

Introduction: Refugee populations experience significant psychological stress in host countries. The COVID-19 pandemic worsened pre-existing vulnerabilities and also presented new vulnerabilities for substance use. The study was conducted to examine the pattern of substance use during and after the COVID-19 pandemic among youth residing in a rural refugee settlement camp in north-western Uganda.

Methods: The study was conducted in a refugee settlement camp in north-western Uganda. We used an interpretative phenomenological analysis framework to explore substance use among young people. We conducted eight in-depth interviews and four focus group discussions among youths between the ages of 18-30 years.

Results: We identified two master themes: (1) trauma led us to substance use and (2) desire for belonging and identity kept us in substance use. Young people recounted stories of trauma which served to initiate and promote substance use among them. COVID-19 restrictions on social isolation, social distancing and military enforcement of the restrictions exacerbated previous experiences of trauma resulting in substance use. Refugees, who were already separated from their families in the host country, engaged in substance use following further parental and social isolation, loneliness and reduced support systems in refugee camps. The reduced financial support, unemployment, closure of businesses and schools provided additional motivation to engage in substance use among young people. Surviving the refugee camp heightened the need for belonging to a group. The desire to belong in, to fit in and to stand out in the group altogether served to provide further avenues for substance use among young refugee populations.

Conclusion: Interventions for substance use among refugee youth, particularly during a pandemic, ought to consider the complex landscapes for refugees and their multiple layers of vulnerabilities. Peer pressures and group influence should be given special considerations while planning mitigation measures.

Introduction: Glycaemic control (GC) is crucial for preventing complications of type 2 diabetes mellitus (T2DM) and remains a major public health challenge in Nepal, particularly in Madhesh Province. Evidence on gender differences in GC and their associated factors is limited. This study examined gender-specific variations in GC and determinants of good GC among adults with T2DM.

Methods: A cross-sectional study was conducted among adults with physician-diagnosed T2DM in Madhesh Province. GC was assessed using fasting plasma glucose (FPG). Good GC was defined as FPG 80-130 mg/dL and poor GC as >130 mg/dL, following American Diabetes Association criteria. Descriptive statistics were used to summarise participant characteristics, and gender-stratified binary logistic regression analyses identified factors associated with good GC.

Results: A total of 492 individuals with T2DM (256 males and 236 females) were included. Overall, 59.3% achieved good GC, with a slightly higher proportion among males than females (60.5% vs 58.1%). Among females, good GC was significantly associated with age ≥35 years (adjusted OR (aOR) 20.81; 95% CI 8.96 to 48.28; p<0.05), normal body weight (aOR 4.76; 95% CI 1.38 to 16.36; p<0.05), antihypertensive medication use (aOR 6.94; 95% CI 2.48 to 19.42; p<0.05), regular physician visits (aOR 4.81; 95% CI 1.48 to 15.56; p<0.01), adequate sleep duration (>8 hours/day) (aOR 2.57; 95% CI 1.01 to 6.62; p<0.05), regular physical activity (≥30 minutes/day) (aOR 3.89; 95% CI 1.45 to 10.36; p<0.01) and health insurance coverage (aOR 2.96; 95% CI 1.06 to 8.34; p<0.05). Being a housewife was not significantly associated with good GC (aOR 3.66; 95% CI 0.50 to 6.96; p=0.187).Among males, primary-level education compared with higher education was negatively associated with good GC (aOR 0.34; 95% CI 0.15 to 0.76; p=0.009), and retirement status was also negatively associated with good GC (aOR 0.30; 95% CI 0.11 to 0.85; p<0.05). Regular physical activity (aOR 15.42; 95% CI 2.80 to 85.08; p=0.002), adherence to dietitian-recommended diets (aOR 10.85; 95% CI 1.70 to 69.65; p<0.05) and health insurance coverage were significantly associated with good GC among males.

Conclusions: Less than two-thirds of adults with T2DM achieved recommended GC. Gender-specific sociodemographic, behavioural and healthcare-related factors influence GC, highlighting the need for gender-responsive diabetes interventions.

Introduction: Owing to an increase in internet access, mobile health is increasingly used to deliver health interventions in low- and middle-income countries. Applications like WhatsApp have been successfully used to deliver and complement health interventions.

Methods: This qualitative study explores the feasibility and acceptability of using WhatsApp and YouTube for facilitating lifestyle modification in adults with hypertension, living in a low-income urban community in Karachi, Pakistan. 19 community members diagnosed with hypertension, with access to phone and internet (mean age±SD: 50±8.7 years; 10 male) were engaged for 3 weeks through WhatsApp and YouTube. Culturally relevant videos based on evidence-based guidelines to mitigate risk factors of hypertension, that is, low salt diet, medication adherence and emotional regulation, were created and uploaded on a YouTube channel. Participants were added to two same-sex WhatsApp groups moderated by a clinical psychologist (called behavioural coach), who shared the link to the videos, assigned and tracked practical tasks and facilitated discussions to build peer support. At the end of the 3 weeks, YouTube and WhatsApp engagement metrics were reviewed to understand the way participants engaged on both platforms. In-depth interviews with participants, content of WhatsApp chats and field notes of the behavioural coach were analysed for themes regarding feasibility and acceptability of the delivery mechanism from both the provider and participants' perspective.

Results: Asynchronous engagement was appreciated by participants as it provides convenience to engage on their time; it also provided time to the behavioural coach to curate messages according to individual needs of the participants. Acceptability of participants to engage in interventions related to lifestyle modification through such a mechanism increased through education and experience in the groups.

Conclusion: WhatsApp and YouTube are feasible and acceptable to deliver lifestyle modification interventions for patients with hypertension in a low-income urban community in Karachi.

Introduction: Public understanding of eye diseases is crucial in preventing avoidable blindness. This study aimed to assess the awareness and knowledge of cataract, glaucoma and diabetic retinopathy (DR), identify common sources of eye health information and examine the association between the sociodemographic factors and the level of awareness and knowledge.

Method: A cross-sectional study was conducted in clinics in the Lagos State University Teaching Hospital, Nigeria. Of 500 participants approached in the various clinics, 404 completed the questionnaires (response rate: 80.8%). Outpatients were recruited using consecutive convenience sampling. The data were collected using a structured questionnaire. The association between sociodemographic factors and the levels of awareness and knowledge of cataract, glaucoma and DR was assessed using the χ² test. Pearson's correlation analysis and one-way analysis of variance were conducted to determine the relationships and differences in awareness and knowledge of the eye disorders across the various clinics.

Results: The awareness of cataracts (83.4%) and glaucoma (64.4%) was significantly higher than DR (48.3%). Awareness of DR was the lowest, with only 30.4% recognising its link to diabetes. Family members were the most frequently cited source of information. Significant associations (p<0.05 for all comparisons) were seen between awareness and knowledge of the eye disorders with clinics attended (cataract: p=0.003, OR=1.45; 95% CI 1.12 to 1.88, glaucoma: p=0.005, OR=1.38; 95% CI 1.10 to 1.73, DR: p=0.001, OR=1.52; 95% CI 1.20 to 1.92). A positive association existed between educational level and cataract (p=0.012, OR=1.29, 95% CI 1.06 to 1.57) and DR with occupation (p=0.009, OR=1.34, 95% CI 1.08 to 1.66). Correlation Analysis showed a positive relationship between awareness and knowledge of cataract and glaucoma (r (404)=0.533, p=0.005); a weak relationship was seen between cataract and DR (r (404)=0.405, p<0.001); glaucoma and DR (r (404)=0.333, p<0.001). Regression analysis indicated that age (OR=2.36, 95% CI 1.08 to 5.18, p=0.032) and clinic (OR=5.25, 95% CI 1.90 to 14.53, p=0.001) were significantly associated with levels of awareness and knowledge of eye diseases.

Conclusions: Significant gaps exist in public awareness and knowledge of major eye diseases, most notably for DR, which has the lowest recognition of its link to diabetes. Given that family members are the primary source of information, targeted health campaigns using social networks are essential. Educational level, employment status and clinic attendance are key determinants of awareness and should be leveraged to inform highly specific, evidence-based public health interventions in the Lagos State population to promote early diagnosis and reduce avoidable blindness.