PUBLIC HEALTH REVIEWS最新文献

Background: The burden of drug abuse is becoming a public health concern in Nigeria. Preventive measures should include identifying the root causes of the burden for targeted intervention. We, therefore, aim to conduct a scoping review of the literature to summarize the findings of epidemiological studies on drug abuse and provisions of drug laws in Nigeria. The review also provides appropriate recommendations as interventions for prevention. Methods: We conducted a systematic search of the literature on PubMed to identify information on drug abuse and drug laws in Nigeria from the inception of the database to March 2020. Additional information was retrieved from Google Scholar, a manual search of included articles, discussion with experts on the subject matter, and gray literature. Study selection was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. Information from gray literature was assessed for quality and accuracy using the AACODS checklist (authority, accuracy, coverage, objectively, date, significance). Results: The systematic search of the literature generated 253 studies. Nine articles were obtained from other sources. After the selection process, 23 eligible studies were included for review. A prevalence of 20-40% and 20.9% of drug abuse was reported among students and youths, respectively. Commonly abused drugs include cannabis, cocaine, amphetamine, heroin, diazepam, codeine, cough syrup and tramadol. Sources where abusers obtained drugs, were pharmacies/patent medicine shops, open drug markets, drug hawkers, fellow drug abusers, friends, and drug pushers. Drug abuse was common among undergraduates and secondary school students, youths, commercial bus drivers, farmers, and sex workers. Reason for use included to increase physical performance, stress and to derive pleasure. Poor socioeconomic factors and low educational background were the common risk factors associated with drug abuse. We identified several drug laws and policies that were established under government agencies such as the National Drug Law Enforcement Agency (NDLEA), National Agency for Foods and Drugs Administration and Control (NAFDAC), Pharmacists Council of Nigeria (PCN) and a Presidential Advisory Committee. Conclusion: Findings from epidemiological studies on drug abuse in Nigeria has demonstrated that the burden of drug abuse is still high despite the existing drug laws, policies, and strategies for prevention. Measures to reduce the burden should involve the community, government, and religious bodies. Preventive measures should target the youths, the students, identified sources of the drugs, reasons and risk factors associated with drug abuse in Nigeria.

This piece introduces the special Public Health Reviews collection on human rights in patient care (HRPC). Work on HRPC dates back to 2007 and an Open Society Foundations initiative in collaboration with partners in Eastern Europe and Central Asia. We found that for marginalized groups, health care settings often were places of coercion, punishment, and/or violence rather than of treatment or care. At the same time, health care providers often did not know of their legal obligations and how to incorporate human rights norms in their work. They themselves faced a lack of independence, unsafe working conditions, and sanctions for providing evidence-based care. Laws existed that could potentially address violations, but they were rarely enforced, and most people did not know what they were. HRPC brings human rights principles to health care delivery and addresses the rights of both patients and health care providers. It seeks to translate laws and procedures protecting rights into practical terms, linking national, regional, and international frameworks. The special collection explores various aspects of HRPC, including state responsibility in private health facilities, reproductive health, palliative care, and intersections with public health. It further explores dimensions relevant to particular populations, including Roma, people who use drugs, and transgender persons.

Background: The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process.

Methods: A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords.

Results: The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal.

Conclusions: Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

Background: Born in the Chinese city of Wuhan, the consequences of the coronavirus pandemic on global health and economies have been and continue to be devastating. In Africa, its countries grieve for unprecedented burdens of caseloads and mortality due to COVID-19, the virus responsible for the disease. This narrative review aims to establish the scale of the health and economic crisis wrought by the pandemic in Africa, including its impact on the informal economic sector, projections of the effect on national GDP, as well as its political dimensions.

Methods: Documentary evidence issued between January and 8 August 2020 was sought from the Google Scholar, PubMed, Scopus, and Web of Science databases. Searches of published and unpublished abstracts were also conducted from appropriate websites, government documents, organizational reports, newspaper commentaries, and reports issued by global, regional, and local centers of disease control and prevention.

Results: The COVID-19 pandemic is responsible for a fourfold crisis in Africa: (1) a health crisis: the victimization of frontline healthcare workers and the looming caseload and death tolls with 1.039 million (12%) cases being confirmed and over 22,966 (2.4%) deaths as of 8 August 2020. The highest death toll was recorded in Southern Africa of 11,024 (48%) followed by North Africa with 6,989 (29.2%) deaths; (2) a social crisis: with the violation of human rights, the killing of citizens by security forces and increased crime. This, in turn, exacerbates social inequalities, the breakdown of households, instances of social unrest, and general impoverishment; (3) an economic crisis: manifested by a decline in GDP and mass unemployment; (4) a political crisis: implementation of measures that may not be appropriate for Africa, discrimination of refugees and immigrants, evacuation of citizens to their home countries, resulting in distrust of political leaders and postponement of national elections, and mounting cases of conflicts and unrest.

Conclusion: Lockdown during the COVID-19 outbreak is a prevention mechanism in affluent countries, in contrast to developing regions such as Africa, where it is a race against death and starvation. Policymakers must apply novel and locally relevant prevention and management strategies to cope with this growing disaster.

Background: Public Health remains central to understand health and its determinants, and Public Health teams are essential for an integrated collaborative medical practice. However, current teaching of public health to medical students varies in the European Region though an investment in multidisciplinary workforce is recognised essential to deliver high quality public health services. A recent medical education curricula restructuring in the University of Porto Medical School resulted in the inclusion of a Public Health module linking academic teaching to field practice and provided the opportunity to make an initial appraisal of students' perceptions.

Case study: We analysed final reports (n = 196), debriefing meetings notes (n = 2), and e-mails sent by students (n = 34) regarding the activities they observed or participated at, their contact with Public Health services' teams, knowledge and critical appraisal, and opinion about the module. Students gained basic knowledge about how epidemiological surveillance, environmental health, health planning, and health promotion are performed in practice. They reported a better understanding of the roles and importance of Public Health services and its teams. Most considered that this module had an important role in their training. Some activities observed in the field lacked the needed standardisation to provide the students the feeling that core operations were experienced, which needs to be addressed in the future.

Conclusions: Public Health practice-based training within field institutions may bring a better understanding of the discipline and specialty for medical students. It may strengthen interconnectivity and coordination of healthcare agents, which may improve future medical practice with potential improvement of patient-centred care and in terms of public health response, and back their roles as health agents and decision-makers.