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

Introduction: Health systems in developing countries suffers from both input and productivity issues. We examined the status of three domains of human resources for health, i.e., availability and distribution, capacity and productivity, and motivation and job-satisfaction, of the health-care workforce employed in the public health system of Haryana, a North Indian state.

Methodology: The primary data were collected from 377 public health facilities and 1749 healthcare providers across 21 districts. The secondary data were obtained from government reports in the public domain. Bivariate and multivariate statistical techniques were used for evaluating district performances, making inter-district comparisons and identifying determinants of motivation and job-satisfaction of the clinical cadres.

Results: We found 3.6 core health-care workers (doctors, staff nurses, and auxiliary nurses-midwives) employed in the public health-care system per 10,000 population, ranging from 1.35 in Faridabad district to 6.57 in Panchkula district. Around 78% of the sanctioned positions were occupied. A number of inpatient hospitalizations per doctor/nurses per month were 17 at the community health center level and 29 at the district hospital level; however, significant differences were observed among districts. Motivation levels of community health workers (85%) were higher than clinical workforce (78%), while health system administrators had lowest motivation and job satisfaction levels. Posting at primary healthcare facility, contractual employment, and co-habitation with family at the place of posting were found to be the significant motivating factors.

Conclusions: A revamp of governance strategies is required to improve health-care worker availability and equitable distribution in the public health system to address the observed geographic variations. Efforts are also needed to improve the motivation levels of health system administrators, especially in poorly performing districts and reduce the wide gap with better-off districts.

Dengue and leptospirosis are hyperendemic diseases in Sri Lanka. We aimed to determine the prevalence and clinical manifestations of concomitant infections of leptospirosis and acute dengue infection (ADI) in clinically suspected dengue patients. A descriptive cross-sectional study was carried out in five hospitals in the Western Province, from December 2018 to April 2019. Venous blood and sociodemographic and clinical details were collected from clinically suspected adult dengue patients. Acute dengue was confirmed by DENV NS1 antigen ELISA, IgM ELISA, IgG ELISA, and IgG quantification assay. Leptospirosis was confirmed by the microscopic agglutination test and real-time polymerase chain reaction. There were 386 adult patients. The median age was 29 years, with male predominance. Among them, 297 (76.9%) were laboratory confirmed as ADI. Concomitant leptospirosis was present in 23 (7.74%) patients. In the concomitant group, the majority (65.2%) were female, in contrast to ADI (46.7%). Myalgia was significantly more common in patients with acute dengue fever. All other symptoms were similar in both groups. In conclusion, the 7.74% of patients of ADI had concomitant leptospirosis, and it was more common in females.

Background: The purpose of this study was to use the health belief model (HBM) to predict the adoption of preventive behaviors against COVID-19 using the structural equation modeling approach.

Methods: As a descriptive-analytical study, this research was conducted on 831 men and women who were under the coverage of comprehensive health service centers in the Lorestan province of Iran in 2021. A questionnaire based on HBM was used to collect data. Data were analyzed by the SPSS software version 22 and AMOS version 21.

Results: The mean age of participants was 33.0 ± 8.5, with a range of 15-68 years. The constructs of the HBM explained about 31.7% of the variance in COVID-19-related preventive behaviors. The greatest total effect on preventive behaviors against the COVID-19 disease belonged to the constructs of perceived self-efficacy (0.370), perceived barriers (-0.294), and perceived benefits (0.270), in descending order of impact.

Conclusion: Educational interventions can be useful in promoting COVID-19 preventive behaviors by bringing about a correct understanding of self-efficacy, barriers, and benefits.

Introduction: As a validated stress questionnaire to assess ongoing adversities of adolescents in developing countries is not available, we developed a brief general checklist, the "Long-term Difficulties Questionnaire-Youth" version (LTD-Y) to measure daily stressors of adolescents and examine the psychometric properties of the instrument.

Methods: In 2008, 755 schoolchildren in Sri Lanka (54% girls), age 12-16 years, completed a self-reported questionnaire with four sections. (1) demographic information (2) daily stressors and social support (3) trauma exposures measures; different trauma exposures and tsunami impact, (4) current psychological problem measures; posttraumatic stress symptoms, emotional and behavioral problems, functional impact, happiness at home, and happiness at school. In July 2009, a subsample of 90 adolescents repeated these measures. Internal consistency factor structure, concurrent validity, construct validity, and temporal stability were assessed in the scale.

Results: LTD-Y adequately identified the ongoing adversities of adolescents. The scale showed an excellent internal consistency with Cronbach's alpha = 0.79. The principal component analysis showed two-factor solutions which concern "external" and "internal" stressors. The concurrent validity was indicated by its positive association with all measures of current psychological problems. The discriminant ability of the adversity measure was evident in cumulative trauma exposure and all variables with current psychological problems. The stability of reporting was satisfactory.

Conclusion: This school-based screening showed that the LTD-Y has sufficient validity, competency, and stability in measuring ongoing adversities of adolescents.

Purbalingga Regency had achieved zero indigenous malaria cases in April 2016, 3 years before the targeted deadline for elimination. Currently, the biggest threat to elimination efforts is the risk of local malaria reintroduction due to imported cases in the receptive areas. The aim of this study was to describe the implementation of village level migration surveillance and identify the areas for improvement in it. We performed the study in four malaria-free focus villages in Purbalingga Regency, i.e., Pengadegan, Sidareja, Panusupan, and Rembang, from March to October 2019. A total of 108 participants were involved in the processes. Data on malaria vector species, community mobility from malaria-endemic areas, and implementation of malaria migration surveillance (MMS) were collected. We use descriptive analysis for quantitative data and thematic content for qualitative data. Socialization of migration surveillance in Pengadegan and Sidareja villages has been carried out to the wider community, whereas in Panusupan and Tunjungmuli villages, it is still limited to neighbors. Communities in Pengadegan and Sidareja villages have participated in reporting the arrivals of migrant workers, and the village malaria interpreter conducts blood tests on all migrants. Community participation in reporting migrant workers arriving in Panusupan and Tunjungmuli villages is still low. Recording of migrant data reporting has been carried out by MMS officers, but malaria checks are only carried out before Eid al-Fitr to prevent importation of malaria cases. The program needs to strengthen the community mobilization and case-finding efforts.

Labor migrants (LMs) often work in precarious work environments and are exposed to various health risks. There is a lack of information on the health of international Nepalese LMs (NLMs). This scoping study was conducted to assess the health problems of international NLMs based on the six-stage scoping review process of Arksey and O'Malley. A literature review and stakeholders consultation related to NLMs' health information were conducted. A total of 455 studies were identified of which 38 studies were potentially relevant based on title and/or abstract screening, and a total of 16 studies were finally included and assessed. The literature showed that the health problems incurred by NLMs are mainly mental health problems; accidents, injuries, and infectious diseases. The Foreign Employment Board is the main public stakeholder which records deaths and disabilities of NLMs. The record showed that there were a total of 3,752,811 labor permits approval, a total of 7467 deaths, and a total of 1512 disabilities among NLMs during the 11 years from 2008-2018. There is a need to have a better investigation of causes of death and disability among NLMs to assign scientific causes of death. Predeparture orientation on mental health coping strategies, labor rights, health-care accessibility options in destination countries, traffic safety, and infectious diseases should be instituted.

Background: Chronic diseases are a major contributor to mortality, morbidity, and socio-economic costs globally, including in India. Quality of life (QoL) is an important patient-centered outcome for chronic disease. Measurement properties of tools for assessing QOL in the Indian context have not been assessed systematically.

Methods: A scoping review was conducted, and four major electronic databases were searched. Screening was conducted by at least two independent reviewers, with a third person acting as an arbiter. Data from the retrieved full texts were extracted by one reviewer, with a sample verified by another reviewer to reduce any data extraction errors. A narrative synthesis was done with a focus on measurement properties of tools, including but not limited to internal consistency, inter-rater reliability, test-retest reliability, validity, and acceptability.

Results: Out of 6706 records retrieved, a total of 37 studies describing 34 tools (both generic and disease-specific tools) for 16 chronic conditions were included. Most of the studies were cross-sectional (n = 23). Overall, most tools had acceptable internal consistency (Cronbach's alpha value ≥0.70) and good-to-excellent test-retest reliability (intra-class correlation coefficient = 0.75-0.9), but there was variability in acceptability. In terms of acceptability, seven tools were positively assessed (meeting psychometric property requirements), but all except the World Health Organization QoL tool were disease specific. Many tools have also been tested for local context, and many translated and tested in one or few languages only, thus limiting their usability across the nation. Women were underrepresented in many studies, and tools were not evaluated in other genders. Generalizability to tribal people is also limited.

Conclusion: The scoping review provides a summary of all QOL assessment tools for people with chronic diseases in India. It supports future researchers to make informed decisions for choosing tools. The study highlights the need for more research to develop QOL tools which are contextually applicable and enables the comparability across diseases, people, and regions within India and potentially in the South Asian region.

A smoke-free workplace is important to reduce secondhand smoke exposure, raise awareness, encourage smoking cessation, and increase productivity. This study aimed to assess indoor smoking in the workplace as part of a smoke-free policy implementation and the factors associated. This was a cross-sectional study at workplaces in Indonesia from October 2019 to January 2020. The workplaces were divided into private workplaces owned by a company for business and government workplaces that run for public services. Samples were selected using stratified random sampling. Data collection follows time and area observation guidelines, starting in the indoor area and then outdoor. The observation was conducted for at least 20 min for each workplace in 41 districts/cities. Of the 2900 observed workplaces, 1097 (37.8%) were private and 1803 (62.92%) were government workplaces. The proportion of indoor smoking at government workplaces was 34.7%, higher compared to private (14.4%). The results were consistent for each indicator such as people smoking (14.7% vs. 4.5%), electronic cigarette use (0.7% vs. 0.4%), cigarette butts presence (25.8% vs. 9.5%), and smell of cigarette smoke (23.0% vs. 8.6%). The factors associated with indoor smoking were indoor ashtray availability (adjusted odds ratio [AOR] =13.7; 95% confidence interval [CI]: 10.6-17.5), indoor designated smoking area (AOR = 2.4; 95% CI: 1.4-4.0), presence of indoor tobacco advertising, promotion and sponsorships (AOR: 3.3; 95% CI: 1.3-8.89), whereas the presence of no smoking sign was a preventive factor (AOR = 0.6; 95% CI: 0.5-0.8). Indoor smoking remains high, particularly in government workplaces in Indonesia.