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

Background: Nonstandard pharmaceutical or manufacturer labels may lead to medication errors. Therefore, label content and design are specified and monitored through regulatory frameworks. The aim of this study was to assess the availability of vital information in manufacturer labels of medicines used in a selected state hospital and adherence to the guidelines on labelling of medicines (GLM V1.0) of the National Medicines Regulatory Authority (NMRA), Sri Lanka.

Methods: Three hundred randomly selected medicine manufacturer labels were assessed using a checklist developed based on GLM V1.0.

Results: Of the 300 labels, 89.6% complied with the recommended format of the generic name followed by its pharmaceutical form and strength, and 84.0% specified their pharmacopeial monograph. Almost 40% were substandard, lacking at least one essential piece of information required by regulation. The strength of the medicine was not indicated in the principal display panel (PDP) of 5.3% of medicines. 5.0% of labels for various strengths of the same medicine or different medicines looked alike. Other observed flaws were missing necessary information and look-alike labels, reflecting a lack of quality control.

Conclusion: Divergence from specified standards demonstrates the need for a multifaceted approach by the NMRA to prevent ambiguous labels. Key calls to action for policymakers include better manufacturer guidance, stronger pre-submission assessments, rejecting non-standard labels, and introducing barcode readers.

Abstract: Equity-informative Cost-Effectiveness Analysis (CEAs) can promote fair healthcare access, yet their use in the WHO South-East Asia region (SEARO) is not well understood. This study aims to summarize methodological approaches, equity-relevant groups, health inequality measures, and healthcare provision areas addressed in equity-informative CEAs in SEARO countries. A systematic search was conducted in PubMed, Embase, Scopus, and Tufts CEA registry for equity-informative CEAs from WHO SEARO countries (2014-2023). CEAs with at least two alternative interventions and one equity criterion were included. Data extraction used Microsoft Excel. Interventions' distributional effects on cost-effectiveness were evaluated qualitatively, and bias was assessed using the CHEERS checklist. Of 828 studies identified, 10 were selected, nine from India (90%) and eight between 2014-2017 8 (80%). Studied groups included children, patients, the general population, adolescent girls, and neonates. All studies used cost-effectiveness analysis; 8 (80%) focused on healthcare providers' perspectives. Disability-Adjusted Life Years (DALYs) were primary outcome measures in 8 (80%) studies, while 9 (90%) assessed financial risk protection via out-of-pocket expenditure averted. Wealth quintiles were the equity criterion in 9 (90%) studies. About 6 (60%) conducted subgroup analyses and Extended Cost-Effectiveness Analyses (ECEA), with 2 (20%) using the Gini coefficient. Most studies 9 (90%) demonstrated 'greater value,' indicating improved public health implications. The scarcity of equity-informed CEAs in SEARO countries, excluding India, underscores the need for broader adoption. Improved public health implications highlight the necessity of equity-informed CEAs. Addressing these issues is essential to advance health equity in the SEARO region.

Childbirth fear is a prevalent concern among pregnant women, and its measurement is crucial for effective clinical intervention. This article presents a comprehensive review of existing tools for assessing childbirth fear, aiming to assist researchers and health-care professionals in selecting appropriate instruments for their work. A systematic search was conducted across multiple electronic databases, resulting in the identification of twenty tools specifically developed for assessing childbirth fear. The characteristics and psychometric properties of each tool were analyzed. Most tools were Likert scale based, with some employing visual analog tools and dichotomous tools. The identified tools were employed in diverse research designs, including experimental studies and observational studies. Among the tools reviewed, the Wijma Delivery Expectancy Questionnaire emerged as a frequently used and well-validated instrument. It demonstrated good psychometric properties, assessing fear of childbirth through women's expectations and experiences. Other notable tools included the Fear of Birth Scale, Childbirth Experience Questionnaire, and Tokophobia Severity Scale, each addressing specific aspects of childbirth fear. However, some tools lacked thorough testing for validity and reliability, indicating the need for further refinement and evaluation. Researchers can utilize this comprehensive overview to select appropriate tools for their investigations. Clinicians and health-care professionals working with pregnant women can benefit from the identified tools to assess and monitor childbirth fear, aiding in early detection and timely intervention. In conclusion, this review emphasizes the need for well-validated and culturally sensitive tools, facilitating a better understanding of this complex phenomenon and ultimately contributing to improved care for pregnant women.

Enhancing health-care workforce capacity in primary care settings is critical for delivering quality care to individuals with noncommunicable diseases (NCDs). Despite significant resources allocated to traditional face-to-face training methods, challenges persist in terms of scale, coverage, training material standards, and availability of trainers across different domains. Self-paced learning through an accessible platform with evaluation is a feasible option to overcome these challenges. Taking advantage of the technology and reach of the OpenWHO platform, the WHO South-East Asia Region developed four SEARO NCD PEN-HEARTS courses. Content was adapted from WHO guidance to low- or middle-income countries context. These courses cover NCD service planning, primary health-care interventions, diabetic foot care, and palliative care. The courses target primary health-care managers tasked with planning, training, implementing, and monitoring NCD health services. This is the first set of OpenWHO courses on NCD services for primary health-care launched on October 26, 2023. Courses were rolled out through WHO country offices in SEAR. WHO staff in HQ and regions were also informed. SEAnetNCD network which includes 10 institutions from eight countries of Southeast Asia, with more than 100 members were appraised of the courses through a web-based meeting. In addition, social media platforms such as Facebook, Twitter, LinkedIn, and WhatsApp groups were used extensively. We observed a high level of interest and uptake for the courses. Within 100 days, the four courses had 18,250 enrolments with 12,090 unique users. More than 75% of users were in the 20-39 age group and covered diverse areas of work, ranging from health professionals, students, public health experts, national health ministries, and United Nations staff. Over 7,000 certificates have been awarded through graded assessments with average scores of 75%. Such courses of short duration focusing on specific skills and built with WHO guidance can be a solution to addressing gaps in capacity building.

Unsafe child feces disposal (CFD) is another form of open defecation and can pose a risk of disease in children. More than 30% of Indonesian households practice unsafe CFD, yet, its determinants are unknown. This study aims to identify the contextual and behavioral determinants of CFD through the lens of the Risk, Attitude, Norm, Ability, and Self-regulation (RANAS) framework. The cross-sectional study was conducted in 349 households in the suburbs of Kendari City, Southeast Sulawesi Province, Indonesia, in mid-2023. About 64% of the respondents practiced unsafe CFD. Most respondents used diapers that were immediately thrown into the trash without cleaning (i.e., 60.2%). Logistic regression analysis found two significant contextual factors associated with safe CFD: having received sanitation-related information and toddler age, i.e., children below 5 years old. Perceived severity was the most influential psychological factor behind the CFD practice, followed by knowledge. This study suggests that informing caregivers about the negative health effects of practicing unsafe CFD, especially on their children, can be a positive trigger for them to practice safe CFD. In addition, the promotion of early toilet initiation and recycling programs for used diaper waste should also be conducted to ensure comprehensive CFD management.

Background: Areca nut (AN) use receives less global attention than tobacco use. Studies have linked AN consumption to a range of adverse health effects, including oral cavity and pharyngeal cancers, periodontal diseases, cardiovascular diseases, diabetes, hypertension, and addiction. The masticatory use of AN is rampant in Bhutan. There is a paucity of local evidence and limited empirical studies to understand the factors associated with current AN use in Bhutan.

Methods: This analysis uses secondary data from the Bhutan STEPS Survey 2019 that included 5575 participants aged 15-69 years, selected using multistage stratified cluster sampling. The outcome variable of interest was current AN use. Weighted analysis was done to calculate the prevalence of AN use. Factors associated with AN use were assessed using multivariable logistic regression models.

Results: The prevalence of current AN use was 56.82% (95% confidence interval [CI]: 54.27-59.33). A significantly higher prevalence of 63.58% (95% CI: 60.58-66.48) was found in the age group of 25-39 years. Tobacco users were 17% more likely to use AN as compared to those who do not consume tobacco (adjusted odds ratio: 1.17, 95% CI: 1.08-1.26). Current alcohol consumers were 45% more likely to consume AN as compared to lifetime alcohol abstainers.

Conclusions: Age, alcohol use, and tobacco use were associated with current AN use in Bhutan. There is a need to regulate access to AN while targeting young and middle-aged individuals with public health and behavioral interventions.