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

Abstract: This study aimed to estimate the prevalence of electronic media exposure among 18-month-old children and to identify associated factors in Khon Kaen Province. This was a descriptive cross-sectional study. Data were collected from 247 caregiver-child pairs visiting the primary care unit for their children's 18-month vaccination, using a structured questionnaire, between February and July 2021. The primary outcome was electronic media exposure, which was defined as the child's engagement with or exposure to electronic devices, including mobile phones and television. Descriptive statistics and Poisson regression with robust standard errors were applied to directly estimate crude and adjusted prevalence ratios (aPR). The study found that 52.2% of mothers were using electronic media to assist in child-rearing. Statistically significant characteristics of electronic media use in children at 18 months were identified (P < 0.05) include primary caregivers with marital status divorced/separated (aPR = 0.50, 95% confidence interval [CI] = 0.27-0.91, P = 0.023), primary caregivers unemployed (aPR = 1.30, 95% CI = 1.01-1.69, P = 0.046), and 2-4 family members in family (aPR = 1.39, 95% CI = 1.02-1.90, P = 0.036). This study's findings can guide the promotion, prevention, and care of early childhood regarding electronic media use.

Background: Although Bhutan has recently advanced beyond response to preventive services for violence against women and children, there is limited data on adolescent violence to inform policy and interventions, highlighting the need for studies like the 2016 Global School-based Health Survey (GSHS).

Methods: We have analyzed the Global School-based Student Health Survey-2016, Bhutan, to assess the burden and pattern of violence among school-going adolescents (13-17 years). Two-stage cluster sampling was done; fifty schools were selected based on probability proportional to enrollment size from where classes 7 to 11 were selected using systematic sampling.

Result: Of the 5808 students, 3255 (56.0%) were female and 3184 (54.8%) were day scholars. Overall, 3528 (60.7%) experienced at least one form of violence, and 2305 (57.7%) had more than one form. Involved in physical fights (39.8%), physically attacks (38.5%), bullied (26.3%), and experienced sexual violence (7.1%) were reported in descending order. The prevalence of bullying and sexual violence did not significantly differ between boys and girls. Adolescents who were younger and have reported suicidal tendency (adjusted prevalence ratios [aPR]: 1.81, 95% CI: 0.54-2.13), using tobacco (aPR: 1.72, 95% CI: 1.44-2.05), using alcohol (aPR: 1.61, 95% CI: 1.36-1.91), boarding students (aPR: 1.50, 95% CI: 1.33-1.69), reporting stress (aPR: 1.43, 95% CI: 1.15-1.78), poor social support (aPR: 1.32, 95% CI: 1.13-1.53), male (aPR: 1.28, 95% CI: 1.13-1.46), and poor parental understanding of the problem (aPR: 1.13, 95% CI: 1.00-1.26) experienced higher prevalence of any violence.

Conclusion: A higher prevalence of violence among younger and boarding students calls for focused interventions.

Background: Public health authorities and decision-makers need the tools, capacity, and information necessary for assessing health needs, choosing intervention strategies, and drafting policy guidelines. Inadequate information about the oral health of populations leads to ineffective policies.

Materials and methods: A total of 47,837 randomly selected individuals participated in the study: 19,760 from urban regions and 28,077 from rural regions. The study population was the World Health Organization-specified index age groups of 5, 12, 35-44, and 60 years and above, which was modified for the Indian population. Information was collected for demographic details, behavioral practices, available infrastructure, workforce, and public dental services provided in each district. Oral examinations were conducted at individual households for dental caries, periodontal disease, malocclusion, dental fluorosis, and oromucosal lesions. Risk factors for oral diseases were identified using regression analysis.

Results: A high prevalence of oral disease, extremely low utilization of dental care services, and a high dental prosthetic need were noted in the study population. Early childhood caries was noted among 46.9% and 53.6% of 5-year-old children in the urban and rural regions, respectively. The prevalence of dental fluorosis among 12-year-old rural and urban children was at 9.2% and 8.8%, respectively. Periodontal predicaments were noted among 50%, 75%, and 86% of the population in the target age groups of 12, 35-44, and 60 years and above, respectively. Malocclusion was noted among 20% and 25% of the study population in the 12 and 35-44 years' age group, respectively. The prevalence of complete edentulism among older adults was observed in 13% and 11.5% of populations in the rural and urban regions, respectively.

Conclusions: This study provides comprehensive oral health data for target age groups and aids in improved planning and management of public oral health services in a state in Central India.

Background: Tobacco smoking remains a significant global public health issue, with electronic cigarette (e-cigarette) use surging in both high- and low-income countries.

Objective: This study aimed to examine the determinants of e-cigarette use among Indonesian adults.

Methods: We analyzed Indonesia's 2021 Global Adult Tobacco Survey (GATS). We included a total of 4392 adults aged > 15 years selected through a multistage clustered sampling design. To investigate the association between covariates (age, sex, education, occupation, household wealth, place of residence, smoking status, knowledge, and advertisement) and e-cigarette use, we used multiple logistic regression analysis adjusted for the complex survey.

Results: The weighted prevalence of e-cigarette use was 5.4%. The use of e-cigarettes was associated with adults aged 25-44 years (adjusted odds ratio [AOR] = 0.41, 95% confidence interval (CI) = 0.26; 0.63) and 45 years or older (AOR = 0.12, 95% CI = 0.06; 0.23), being in the richest household (AOR = 2.57, 95% CI = 1.27; 5.10), history of quitting smoking (AOR = 7.01, 95% CI = 2.15; 22.8), current smoking status (AOR = 20.49, 95% CI = 5.99; 70.10), perception that e-cigarette causes serious illness (AOR = 0.60, 95% CI = 0.41; 0.88), and exposure to electronic cigarette advertisement from the Internet (AOR = 1.67, 95% CI = 1.09; 2.57).

Conclusion: Various factors influence the use of e-cigarettes. There is an urgent need for comprehensive tobacco control and prevention efforts, particularly among those at a higher risk of using e-cigarettes. Social behavior change communications and strict policies on e-cigarette marketing and advertising are the keys to reducing e-cigarette use.

Background: In Bhutan, the maternal mortality rate has drastically decreased over the years. In situations where maternal mortality is not a public health concern anymore, severe maternal conditions have been used as an alternative to maternal health quality indicators.

Aims and objectives: This study aimed to report the prevalence, underlying causes, and outcomes of maternal near-miss (MNM) cases in Bhutan.

Materials and methods: The study involved a secondary analysis of routine data on MNM cases recorded in three referral hospitals in Bhutan from 2018 to 2020. The World Health Organization MNM, 2011 approach guided the investigation.

Results: The incidence of potentially life-threatening conditions was 12.8 and MNM was 6.7 per 1000 live births. Obstetric hemorrhage, pregnancy with abortive outcomes, and hypertensive disorders in pregnancy were some of the leading conditions, which had led to women experiencing near-miss complications. About 68.5% of women had received blood products, 20.2% had undergone laparotomy, and 5.9% required intensive care unit admission.

Conclusion: An audit of MNM cases, which occur more frequently than maternal deaths, could provide better insights into the existing quality of care.

Background: There is a need to institutionalize respectful maternity care (RMC) as a standard of care in public health systems.

Aim and objectives: This study demonstrates the development, implementation, and impact of an intervention package for providing RMC to women availing antenatal, natal, and postnatal services.

Methodology: An intervention package was developed in consultation with healthcare providers incorporating, (a) capacity-building workshops to empower healthcare staff, (b) mentoring support for developing action plans, and (c) development of behavior change communication material. Key practices such as allowing birth companions and the development of consent forms for different procedures were institutionalized. Baseline (January 2018) and endline (March 2020) evaluations were conducted using mixed methods in the department of obstetrics and gynecology at a medical college in Maharashtra, India. Exit interviews with 100 antenatal women, in-depth interviews (IDIs) with postnatal women (19 in baseline and 8 in endline), and 16-h of labor room observations were conducted.

Results: Of the 35 types of disrespect and abuse (D and A) instances, 20 were reported by atleast two methods (any two out of exit interviews/IDIs/labor room observations) - hence considered "definite." A significant improvement was observed in nine types of D and A. However, 11 types of D and A such as issues in providing verbal comfort, using curtains and drapes for examination, provision of changing rooms, taking informed consents for the procedures, and attending to women at her call were still reported/observed at the endline. The interventions led to improved service delivery.

Conclusions: Written policies and procedures, regular training, focused interventions, and using behavior change communication materials have the potential to enhance RMC. However, despite the interventions, many instances of D and A persisted indicating it to be a systemic problem.

Background: Indonesia faces the challenges in distributing its health workforce across its diverse geographic barriers, leading to disparities in health status. By examining the distribution patterns and identifying the areas of critical need, the study seeks to inform policy interventions that can more effectively address the health worker (HW) distribution.

Methods: We conducted a descriptive analysis of healthcare workforce data across all 514 districts in Indonesia. The study focused on five categories of HWs: General practitioners (GPs), medical specialists, dentists, nurses, and midwives. We calculated the HW-to-population ratio to quantify the availability of healthcare workers. We employed the Gini Index as a measure of distribution equality. In addition, we conducted a comparative metric approach to assess the quantity and the equity of healthcare worker distribution across the districts.

Results: In Indonesia, the current HW ratio stands at 3.84 per 1000 people, falling short of the World Health Organization's threshold of 4.45 for achieving 80% universal health coverage. This shortfall translates to a need for an additional 166,000 HWs. While midwives show a relatively equitable distribution, specialists and dentists exhibited significantly unequal distribution, especially at the district level. There were greater disparities at the district than at the provincial level. There has been notable progress in the distribution of medical specialists across provinces, with the between-provinces Gini Index for specialists decreasing from 0.57 in 1993 to 0.44 in 2022. However, the inter-district Gini Index remains high at 0.53 in 2022, signifying a concentration of specialists in major cities and provincial capitals.

Conclusion: This study shows that human resources for health in Indonesia are both inadequate in terms of quantity, and unevenly distributed. Our finding underscores the importance of considering inter-province and inter-district disparities to tailor policies to tackle each region's unique problems.

Abstract: Nurse-led interventions are tailored to the specific needs of heart failure (HF) patients, facilitating the transfer of knowledge in ways that are more feasible and applicable within the context of diverse healthcare settings. These programs emphasize comprehensive discharge planning, patient education on self-care practices, medication management, and early symptom recognition. The meta-analysis included 11 randomized controlled trials, selected from databases including MEDLINE, EBSCO, CINAHL, and the Cochrane Library. Quality assessment of the included studies was conducted independently by two reviewers. The overall pooled effect showed a relative risk (RR) of 0.69 (95% confidence interval [CI]: 0.54-0.89) for all-cause readmission and a RR of 0.80 (95% CI: 0.71-0.91) for combined outcomes of all-cause readmission and mortality in the nurse-led group compared to the control group. These results indicate that nurse-led transitional care interventions contribute substantially to reducing both readmission rates and mortality among HF patients. The review also explored the applicability of these interventions in low-resource settings, emphasizing their potential to be adapted and implemented effectively in lower-middle-income countries. This review highlights the pivotal role of nurse-led transitional care programs in addressing these challenges by providing close support to patients and their families. Leveraging existing resources and fostering interdisciplinary collaboration are essential in optimizing healthcare delivery in low-resource settings.