WHO South-East Asia journal of public health最新文献

Background: Medical equipment (ME) maintenance retains an asset's original anticipated useful life and preserves its reliability and cost-effectiveness. This study developed and implemented a multicomponent program to improve ME use and maintenance in nine Sri Lankan hospitals from May 2020 to May 2021.

Methods: This pre-post implementation study involved an initial baseline assessment of existing ME maintenance systems, the development and implementation of a multicomponent improvement program, and a 3-month postevaluation. Five targets ME were selected for the study: oxygen regulator, electrocardiogram (ECG) machine, suction apparatus, blood pressure apparatus, and mini autoclave. A pretested questionnaire was administered to randomly selected nursing officers (n = 101) and health-care assistants (n = 120) to obtain baseline ME maintenance data. Six focus group discussions and 24 key informant interviews were conducted with key stakeholders to codesign the multicomponent interventions, which included: developing a standard operating procedure targeting preventive maintenance activities; establishing focal points to provide technical and logistic support; staff training; and the introduction of institutional ME maintenance documents. Program effectiveness was assessed at 3 months postimplementation using the seven predefined outcome variables.

Results: Baseline assessment identified no ME maintenance programs implemented in any of the hospitals. The highest availability was observed for oxygen regulator (62% to 82.3%) and ECG machine (66.1% to 84.7%). The highest functionality improvement was observed for ECG machine (40.4% to 79.7%). The positive perception of maintenance process of ME achieved the highest (33% to 80%) improvement. Following program implementation, improvements were noted in: the availability (P = 0.00) and functionality (P = 0.00 to P = 0.02) of all selected ME; equipment maintenance processes (P = 0.000); as well as staff knowledge, skills, perceptions, and satisfaction.

Conclusions: The program improved the use and maintenance of ME and was widely supported by the key stakeholders. The approach is relevant to other resource-poor hospital settings, as inadequate ME maintenance causes health system inefficiencies.

Abstract: Among all types of health-care workers, nursing professionals are at the highest risk of violence since they have to deal with patients and their families directly and frequently. This study aimed to assess the magnitude of both physical and psychological workplace violence (WPV) among nurses at a public hospital in Myanmar and identify related factors. A cross-sectional study was carried out among 192 nurses with a minimum 1-year of working service at a large tertiary hospital using a standard self-administered questionnaire developed by the World Health Organization/International Labour Organization in 2003. The prevalence of overall WPV in the past 12 months was 29.2%. In particular, verbal abuse was the most frequent type (27.1%), followed by bullying/mobbing (7.8%) and physical violence (1.6%). Majority of perpetrators were patient's relatives (62.7%) for verbal abuse and staff members (64.3%) for bullying/mobbing. The reporting rate was very low for verbal abuse (13.5%) and bullying/mobbing were not reported. Logistic regression analysis showed that respondents who were older than 45 years' group (adjusted odds ratio [AOR]: 19.32; 95% confidence interval (CI): 1.99-186.95, P = 0.011), those who were staff nurses (AOR: 17.87; 95% CI: 1.05-33.20, P = 0.046), and those who 1-5 years and 5.1-10 years of working experiences (AOR: 18.68; 95% CI: 3.43-101.65, P = 0.001) (AOR: 15.74; 95% CI: 2.80-88.42, P = 0.002) were more likely to be exposed to WPV than their respective counterparts. Awareness generation about the importance of WPV, enforcing available legal instruments, and establishing management strategies for safe working environments should be emphasized.

Abstract: Periodontal disease is quite common in many developing countries, but no nationally representative data on periodontal disease is available in Myanmar until 2016. A nationwide cross-sectional survey with a stratified two-stage sampling method was conducted among 4668 participants aged 12-74 years. Periodontal assessments and self-administered questionnaire surveys were conducted to assess the periodontal status and risk factors in the Myanmar population using data from the first national oral health survey in 2016-2017. Descriptive statistics and logistic regression analysis were performed to assess the prevalence of periodontitis and its association with potential risk factors. The prevalence of gingivitis was 38.2%, 41.5%, 44.4%, and 43.7% in 12, 15-18, 35-44, and 60-74 year-olds, respectively. The prevalence of periodontitis in the latter three age groups was 2.3%, 16.3%, and 35.2%, respectively. After adjusting for other risk factors, younger participants aged 15-18 years (odds ratio [OR]: 0.1, 95% confidence interval [95% CI]: 0.0-0.2) and aged 35-44 years (OR: 0.4, 95% CI: 0.3-0.5) were less likely to have periodontitis. Moreover, participants educated upto junior high school level (OR: 1.6, 95% CI: 1.1-2.7), primary school and below level (OR: 1.9, 95% CI: 1.2-3.2), everyday smokers (OR: 1.6, 95% CI: 1.3-2.0), and everyday tobacco chewers (OR: 1.5, 95% CI: 1.2-1.8) were associated with increased risk of periodontitis. Periodontal complications were prevalent in Myanmar older adults. Prevention efforts should focus on tobacco control and oral hygiene.

Background: In Bangladesh, the rapid rise of noncommunicable diseases (NCDs) has become a significant public health concern. This study assesses the readiness of hypertension (HTN)- and diabetes mellitus-related services at primary health-care facilities in Northeast Bangladesh.

Methodology: A cross-sectional survey using a semi-structured interview was conducted between April 2021 and May 2021 among 51 public primary health-care facility staff (upazila health complexes [UHCs]). The NCD-specific service readiness was assessed using an adapted questionnaire from the WHO manual of Service Availability and Readiness Assessment and included four domains: guidelines and staff, basic equipment, diagnostic facility, and essential medicine. For each domain, the mean readiness index score was calculated. Facilities with a readiness score of above 70% were considered to be ready.

Results: The diagnostic capacity of the UHCs ranged from 0% to 88.9%, the availability of essential medicine and basic equipment varied between 15.4%-69.2% and 36.4%-100%, respectively, whereas the score in availability of basic amenities was between 57.1% and 100%. The score for the protocol drugs used to manage HTN was 52.9%, whereas for diabetes, it was 88.2%. The average general service readiness score for the facilities was 59.1%. Overall 17.6% of the facilities were assessed to be ready.

Conclusion: Currently, primary health-care facilities are not ready to implement the national guidelines for diagnosing and treating diabetes and HTN due to shortages of medications, staff, and diagnostic materials.

Introduction: Meaningful health research should lead to evidence-based decision-making that can be translated into policy and practice. Every country needs to have a well-functioning and resourced ethics review and clearance system to ensure health and medical research is conducted in line with ethical standards, preventing harm to research participants, and contributing to better health outcomes and national priorities. The purpose of this study is to describe the origins of the system for managing health research and ethics in Timor-Leste and how it has evolved over time; to identify the strengths and limitations of the current system; and to recommend areas for improvement.

Materials and methods: A narrative review of the literature (published papers, gray literature, and unpublished data) was conducted alongside key informant interviews with 15 Ministry of Health (MOH) policymakers and National Institute of Health staff between October 2020 and March 2021.

Results: The system for managing health research and ethics in Timor-Leste has remained largely the same since it was first established in 2009, with some adaptations to cope with a progressively increasing workload. Main findings include: the Department of Research and Studies (DRS) oversees complex ethics approval process in addition to other responsibilities; the DRS lacks the legal authority, policies, and procedures to help implement its full range of functions and responsibilities; national research priorities should be identified; MOH experiences difficulties in securing funding to support health research; training in health research, ethics and governance is an important priority for DRS.

Conclusion: It is timely and important to invest in strengthening key components of health research and ethics systems in Timor-Leste. Despite limited resources, improvements can be achieved in key areas with focused assistance and collaboration with local, national, and international partners.

Background: Acute encephalitis syndrome (AES) is an infection of the central nervous system with high case-fatality rates. Japanese encephalitis virus (JEV) is the most common vaccine preventable cause of AES in Asia and part of the Western Pacific. In 2003, the JE vaccine was introduced into Thailand's National Immunization Program and expanded to all provinces. This study reviews data from the national surveillance system on the incidence of AES, including Japanese encephalitis in Thailand to guide surveillance, control, and prevention strategies.

Materials and methods: We collected data on all patients diagnosed with AES and reported to the Bureau of Epidemiology, Ministry of Public Health, Thailand, from 2003 to 2019.

Results: A total of 9566 AES patients and 266 death cases were reported during these 17 years. Six hundred and forty-two (6.7%) patients were JE with 16 deaths. The incidence of AES increased from 0.47-0.51-1.36 cases per 100,000 population with a preponderance of cases in adults. CFR reduced from 6.25% - 6.94% in 2003-2005 to 0.78% in 2019. AES cases occurred all year round in all the age groups with a male predilection JE vaccination coverage had reached 83% by 2019. The patients were mainly from the north-eastern region of Thailand.

Conclusion: Integrated surveillance regular monitoring, strengthening, and making immunization sustainable is required to improve and maintain progress toward JE control and prevention.

Background: Airborne infection control (AIC) is a less focused aspect of tuberculosis (TB) prevention. We describe AIC practices in primary health care centres, awareness and practices of AIC among health care providers (HCPs) and TB patients. We implemented a package of interventions to improve awareness and practices among them and assessed its impact.

Methodology: The study used a quasi-experimental study design. A semi-structured checklist was used for health facility assessment and a self-administered questionnaire of HCPs. Pre- and postintervention assessments were made in urban primary health centers (UPHCs), HCPs, and patients. Interventions included sharing facility-specific recommendations, AIC plans and guidelines, HCP training, and patient education. Statistical difference between the two time periods was assessed using the Chi-square test.

Results: A total of 23 and 25 UPHCs were included for pre- and postintervention assessments. All 25 centers participated in interventions. Open areas were >20% of ground area in all facilities. No AIC committee was present in any of the facilities at both pre- and postintervention. Of all HCPs, 7% (23/337) versus 65% (202/310) had undergone AIC training. Good awareness improved from 24% (81/337) to 71% (220/310) after intervention (P < 0.001). Appropriate cough hygiene was known to 20% (51/262) versus 58% (152/263) patients at two assessments (P < 0.001).

Conclusion: Comprehensive intervention, including supportive supervision of health centers, training of HCPs, and patient education, can improve AIC practices.

Introduction: The Better Health Program has been addressing key health system issues in the prevention and control of noncommunicable diseases (NCDs) in Malaysia, Thailand, Vietnam, and the Philippines. As the program comes to an end, the sustainability and scaling-up of issues have assumed importance.

Objectives: The objective is to assess how well sustainability and scale-up strategies have been integrated into the design and implementation of a 3-year multicountry technical program; to explore enablers and barriers of sustainability and scaling up; and to identify practical strategies that can improve sustainability and scale-up of Better Health Program interventions.

Methods: We applied a staged approach to explore barriers and enablers and to identify practical strategies to improve sustainability and scale-up of four NCD interventions: community-based obesity prevention, front-of-pack labeling, local learning networks (LLNs), and NCD surveillance. We extracted evidence from peer-reviewed literature and local documents. We also conducted in-depth interviews with the implementation teams and key stakeholders. We conducted a thematic synthesis of the resulting information to identify practical strategies that improve sustainability and scale-up of the four interventions.

Results: Strong engagement of stakeholders at higher levels of the health system was identified as the main enabler, while limited funding and commitment from local governments were identified as a key barrier to sustainability and scale-up. Strengthening the social and institutional anchors of community health volunteers, enhancing evidence-based advocacy for front-of-pack labeling, trailblazing the LLN innovation, and securing the commitment of local governments in the implementation of NCD surveillance were among the key strategies for improving sustainability and scale-up of Better Health Program interventions in Malaysia, Thailand, Philippines, and Vietnam, respectively.

Conclusions: This study identified practical strategies for improving sustainability and scale-up of NCD-related interventions. Implementation of the strategies that had high priority and feasibility will improve the sustainability of critical elements of the program in the respective countries.