International Health最新文献

Background: Sepsis in the first week or two of life is a major cause of newborn deaths. People from diverse cultural backgrounds use different substances for umbilical cord care. Evidence-based umbilical cord care practices have a large potential to lower infant morbidity and mortality linked to infection. This study investigated the knowledge and use of chlorhexidine gel for umbilical cord care.

Methods: A cross-sectional descriptive survey was employed among 191 postpartum women at the Poly General Hospital Asata, Enugu, selected through simple random sampling. A researcher-developed questionnaire was used for data collection.

Results: More than one-half (n=101; 52.1%) had poor knowledge of chlorhexidine gel use in umbilical cord care. There was no significant association between educational status and knowledge of chlorhexidine gel use in umbilical cord care among the participants (p=0.072). Only 89 (46.6%) had ever used chlorhexidine gel for umbilical cord care, while 49 (25.7%) used chlorhexidine gel for their last child. Parity was not significantly associated with the use of chlorhexidine gel (p=0.736). Both educational status (p=0.019) and knowledge of chlorhexidine use for umbilical cord care (p<0.001) were found to be significantly associated with its use.

Conclusions: There was poor knowledge of chlorhexidine gel use for umbilical cord care among the participants. Use of chlorhexidine gel in this population is still suboptimal. Healthcare providers should continue to provide information on chlorhexidine gel use in umbilical cord care in order to optimise its knowledge and use. Other factors associated with the use of chlorhexidine gel for umbilical cord care should be explored.

Background: Contextualizing in China's recent health reform, we empirically explore the heterogeneous effects of two distinct government roles, accommodating private hospitals vs investing in public hospitals, on health system efficiency.

Methods: We use panel data covering 31 provinces during 2010-2019 to assess health system efficiency. We incorporate health service volumes and population health outcomes to ascertain health system outputs, employing the non-radial directional distance function to estimate efficiency. We employ Bayesian Tobit quantile regression to explore the heterogeneous effects of the share of private hospitals and government subsidy to public providers on efficiency.

Results: China's health system inefficiency scores range from 0 to 0.45. The association between the share of private hospitals and inefficiency score are only significant in higher-inefficiency quantiles (coefficients -0.0258, -0.0315 and -0.0327 for quantiles 0.7, 0.8 and 0.9), meaning a heterogeneously positive impact for low-efficiency provinces. The association between government subsidy and inefficiency score are positive for all quantiles (from 0.0339 to 0.0567), meaning persistent negative impacts on efficiency.

Conclusions: The heterogeneous impacts of the share of private hospitals suggest that the government should accommodate more private hospitals in provinces with low efficiency. The persistent negative impacts of government subsidy suggest that the government investment seems not be subjected to economic objectives.

Background: Centralized quarantine was applied in response to the coronavirus disease 2019 outbreak. The present study aimed to investigate changes in psychological status of isolated individuals before and after quarantine.

Methods: Between August 2020 and July 2021, 648 participants completed the following psychometric evaluations before and after centralized quarantine: 9-item Patient Health Questionnaire for depression, 7-item Generalized Anxiety Disorder for anxiety, the Chinese version of the Connor Davidson Resilience Scale for psychological resilience, the Chinese version of the Simplified Coping Style Questionnaire for coping style, Jiang's revised Chinese version of the Perceived Social Support Scale for social support and the Chinese version of the Impact of Events Scale for stress.

Results: At the beginning of centralized quarantine, 83.2% (n=539) of participants had no depressive mood, 11% (n=71) had mild depressive mood and 5.8% (n=38) had moderate-severe depressive mood. At the end of quarantine, 80.8% (n=524) of participants had no depressive mood, 13% (n=84) had mild depressive mood and 6.2% (n=41) had moderate-severe depressive mood. At the beginning of the centralized quarantine, 86.7% (n=562) of participants had no anxiety, 9.6% (n=62) had mild anxiety and 3.7% (n=24) had moderate-severe anxiety. At the end of quarantine, 85.8% (n=556) of participants had no anxiety, 11.6% (n=75) had mild anxiety and 2.6% (n=17) had moderate-severe anxiety. After 2 weeks of centralized quarantine, anxiety (t=2.175, p<0.05), stress (t=7.453, p<0.01) and three stress subscale scores (p<0.01) decreased significantly; psychology resilience (t=-3.63, p<0.01), tenacity (t=-4.747, p<0.01), active coping style (t=-3.83, p<0.01) and support outside family (t=-3.07, p<0.05) all increased significantly. No significant change was observed in depression, strength, optimism, passive coping style or support inside family. Depression and anxiety scores associated significantly with resilience, stress, coping styles and social support scores. Anxiety (B=0.488, β=0.413, p<0.01), psychological resilience (B=-0.047, β=-0.203, p<0.01) and stress (B=1.475, β=0.167, p<0.1) scores before centralized quarantine were associated with depression after quarantine. Depression (B=0.323, β=0.422, p<0.01), psychological resilience (B=-0.022, β=-0.123, p<0.01) and stress (B=1.408, β=0.207, p<0.01) scores before quarantine also influenced anxiety levels after quarantine. A cross-lagged panel model indicated that depression, anxiety, resilience and stress scores at the first assessment were predictive of depression and anxiety levels at the second assessment.

Conclusions: Good mental health during centralized quarantine was associated with high scores of psychological resilience, impact of events, coping styles and social support and did not become worse in settings where adequate support wa

Benzathine benzylpenicillin is a globally indispensable medicine. As a long-lasting injectable penicillin, it serves as the primary treatment for syphilis, group A streptococcal infections, rheumatic fever and rheumatic heart disease. A competitive market and low profit margins, compounded by limited visibility of demand, have resulted in a decreased number of active pharmaceutical ingredient (API) manufacturers. By 2016, only three Chinese API manufacturers remained, continuing to supply to the global market today. Recurring global shortages, a consequence of supply and demand imbalances, indicate underlying market risks. Therefore, the need for mitigation strategies is imperative.

Background: Nearly one-third of the world's population (2.4 billion people) rely on unclean cooking fuel sources. The study assessed the association of the type of cooking fuel and hypertension risk in sub-Saharan Africa (SSA).

Methods: The study analysed pooled data from 97 942 individuals in the Demographic and Health Survey (DHS) between 2014 and 2021 in 10 SSA countries. Univariate, bivariate and multivariate analyses were performed, including basic descriptive statistics and binary logistic regression. The independent variable of interest was the type of cooking fuel, while hypertension served as the outcome variable.

Results: Women using unclean cooking fuel were 1.21 times more likely to be hypertensive compared with those using clean cooking fuel (adjusted odds ratio [aOR] 1.21 [95% confidence interval {CI} 1.11 to 1.31]). Older age (aOR 5.78 [95% CI 5.04 to 6.62]), higher education (aOR 1.14 [95% CI 1.05 to 1.23]), being married (aOR 1.64 [95% CI 1.49 to 1.80]), working in sales and services occupations (aOR 1.34 [95% CI 1.24 to 1.44]), frequent health facility visits (aOR 1.59 [95% CI 1.51 to 1.68]), higher wealth index and exposure to media were significantly associated with hypertension risk.

Conclusions: Efforts to reduce reliance on unclean cooking fuel at both the household and population levels need to be intensified in SSA countries. Promoting the use of clean cooking technologies and fuels and implementing supportive policies for transitioning from unclean cooking fuels are crucial. Targeted interventions to reduce hypertension risk in SSA should focus on women using unclean cooking fuel, older women, individuals from wealthier households and those with higher education levels.

Trichomonas vaginalis is a protozoan parasite and probably one of the main causes of adverse birth outcomes. Still, there is a paucity of information regarding the burden of T. vaginalis infection in Iranian women. To address this gap, we conducted a systematic review and meta-analysis of studies on trichomoniasis among females in Iran from January 2000 to January 2023. We searched multiple electronic databases (PubMed, Science Direct, Scopus, ProQuest, Web of Science, Google Scholar, Scientific Information Database, Iran Medex, Magiran and Iran Doc) and identified 108 articles with a total of 200 728 women. Using a random effects model, we found a pooled prevalence of 4.30% (95% CI 3.23 to 5.52%). Subgroup analysis, also, demonstrated a statistically significant association between the T. vaginalis prevalence in Iranian women, and the age range, city, sample type, being in prison, sex working and symptomatic infections. Our findings provide important information for healthcare authorities and can inform prevention strategies against trichomoniasis in Iran.

Background: Human landing catches (HLCs) are required to collect blackflies for entomological evaluation to verify onchocerciasis elimination. However, there are ethical concerns regarding exposure of vector collectors to infectious blackflies and safer alternative methods are needed. This study evaluated a modified HLC technique where collectors wore coloured trousers (blue, black or blue-black), protecting them from bites during fly collection, and their performance was compared with the standard.

Methods: The study was conducted in Makouopsap, Cameroon, in the Massangam health district for 4 months. Four collector pairs-one 'standard' (bare-legged) and three modified-were placed 50 m apart along known breeding sites on the Mbam and Nja Rivers. Collections were performed from 07:00 to 17:00 h, 4 d/month. Hourly rates of flies caught were analysed using a negative binomial generalised linear model to explore associations between flies caught and collection techniques and seasons.

Results: Overall, 17 246 blackflies were caught. There was no significant statistical difference in the number of blackflies and parous flies caught between black trousers and the standard. Thus there is a strong indication that wearing black trousers is a viable non-inferior alternative to the standard HLC.

Conclusions: Further studies are needed to confirm generalisability in different ecozones and transmission environments and among different blackfly species.

Background: Eclampsia causes maternal mortality in Nigeria. This study presents the effectiveness of multifaceted interventions that addressed institutional barriers in reducing the incidence and case fatality rates associated with eclampsia.

Methods: The design was quasi-experimental and the activities implemented at intervention hospitals included a new strategic plan, retraining health providers on eclampsia management protocols, clinical reviews of delivery care and educating pregnant women and their partners. Prospective data were collected monthly on eclampsia and related indicators from study sites over 2 y. The results were analysed by univariate, bivariate and multivariable logistic regression.

Results: The results show a higher eclampsia rate (5.88% vs 2.45%) and a lower use of partograph and antenatal care (ANC; 17.99% vs 23.42%) in control compared with intervention hospitals, but similar case fatality rates of <1%. Overall, adjusted analysis shows a 63% decrease in the odds of eclampsia at intervention compared with control hospitals. Factors associated with eclampsia were ANC, referral for care from other facilities and older maternal age.

Conclusion: We conclude that multifaceted interventions that address challenges associated with managing pre-eclampsia and eclampsia in health facilities can reduce eclampsia occurrence in referral facilities in Nigeria and potential eclampsia death in resource-poor African countries.