Indonesia is grappling with a rise in obesity and diabetes, partially driven by a high consumption of sugar‐sweetened beverages. The prevalence of obesity among adults more than doubled from 2007 to 2018, and diabetes rates have also increased. In response, the Indonesian government has proposed an excise tax on sugar‐sweetened beverages to reduce consumption. However, the implementation of this policy has repeatedly been delayed, with the latest postponement to 2024. Sugar‐sweetened beverages contribute significantly to chronic diseases, increasing the healthcare burden and reducing economic productivity. Taxation, a widely used public health strategy in the form of fiscal measures, can decrease consumption by raising prices, raising public awareness, encouraging product reformulation, and generating revenue. Despite its potential benefits, the proposed tax in Indonesia faces substantial political and commercial challenges. The president‐elect Prabowo Subanto has not explicitly supported the tax in his political manifesto, raising concerns about further delays due to industry lobbying. Successful implementation of the tax requires robust political will, public and civil society pressure, and effective cross‐sector cooperation. The government must ensure clear policy goals, equal application to domestic and foreign products, and supportive measures such as providing free drinking water alternatives. Transparent stakeholder consultations can build broad‐based support, whereas effective monitoring and evaluation frameworks are essential for compliance. To gain public support, allocating tax revenues to public health and social programs is crucial. Although initial resistance is expected, strong enforcement mechanisms can ensure adherence. With determined political commitment and public advocacy, the sugar‐sweetened beverage tax can significantly reduce obesity and diabetes rates, improving public health outcomes and economic productivity in Indonesia. This commentary provides an overview of the proposed tax, explores its challenges, and offers recommendations for successful implementation.
{"title":"Sugar‐Sweetened Beverages Taxation Plan in Indonesia: Call for Political Commitment","authors":"Risyad Abiyyu Siregar, Fona Qorina, Ayers Gilberth Ivano Kalaij, Hera Afidjati, Dhani Latifani, Muhammad Faisal Putro Utomo, Louisa Patricia Sophia, Azizah Salsabila Mahmud","doi":"10.1002/puh2.217","DOIUrl":"https://doi.org/10.1002/puh2.217","url":null,"abstract":"Indonesia is grappling with a rise in obesity and diabetes, partially driven by a high consumption of sugar‐sweetened beverages. The prevalence of obesity among adults more than doubled from 2007 to 2018, and diabetes rates have also increased. In response, the Indonesian government has proposed an excise tax on sugar‐sweetened beverages to reduce consumption. However, the implementation of this policy has repeatedly been delayed, with the latest postponement to 2024. Sugar‐sweetened beverages contribute significantly to chronic diseases, increasing the healthcare burden and reducing economic productivity. Taxation, a widely used public health strategy in the form of fiscal measures, can decrease consumption by raising prices, raising public awareness, encouraging product reformulation, and generating revenue. Despite its potential benefits, the proposed tax in Indonesia faces substantial political and commercial challenges. The president‐elect Prabowo Subanto has not explicitly supported the tax in his political manifesto, raising concerns about further delays due to industry lobbying. Successful implementation of the tax requires robust political will, public and civil society pressure, and effective cross‐sector cooperation. The government must ensure clear policy goals, equal application to domestic and foreign products, and supportive measures such as providing free drinking water alternatives. Transparent stakeholder consultations can build broad‐based support, whereas effective monitoring and evaluation frameworks are essential for compliance. To gain public support, allocating tax revenues to public health and social programs is crucial. Although initial resistance is expected, strong enforcement mechanisms can ensure adherence. With determined political commitment and public advocacy, the sugar‐sweetened beverage tax can significantly reduce obesity and diabetes rates, improving public health outcomes and economic productivity in Indonesia. This commentary provides an overview of the proposed tax, explores its challenges, and offers recommendations for successful implementation.","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"51 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141644560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Multimorbidity, the coexistence of two or more chronic conditions, presents a growing global challenge, particularly in low‐ and middle‐income countries such as Southeast Asia. This trend necessitates the development of sustainable integrated care models to prevent and manage multimorbidity effectively. However, progress in this area has been hampered, especially in underdeveloped regions, by various barriers, including the epidemiology of multimorbidity, how to get different specialists and doctors to work together most availably and manage the multiple medication issues and how to develop cost‐effective approaches to reduce the health burden of multimorbidity. Preventive measures in Southeast Asia, which could tackle multiple components which commonly comprise multimorbidity, include enhancing health literacy and health promotion through school‐ and community‐based educational activities, primary healthcare and related policies on employing taxes on tobacco, alcohol and sugary beverages. The social determinants of health‐encompassing poverty and low education may also influence research on multimorbidity. Moreover, stakeholder engagements involving national governments, World Health Organization (WHO) and Association of Southeast Asian Nations (ASEAN) are crucial. Management strategies focus on integrated care models, including patient‐centred primary healthcare, digital healthcare technologies, and medication management to control polypharmacy. Although research on multimorbidity in Southeast Asia is increasing, translating findings into practical measures was limited. Future efforts should prioritize evidence‐based approaches to prevent and manage multimorbidity effectively, addressing challenges like health system focusing on single chronic disease treatment independently, resource limitations, healthcare provider shortages and individual adherence issues. These ways promise to enhance the quality of life and health outcomes in this region.
{"title":"Prevention and Management of Multimorbidity in Southeast Asia: A Narrative Review","authors":"Xiyu Feng, Haribondhu Sarma, Matthew Kelly","doi":"10.1002/puh2.218","DOIUrl":"https://doi.org/10.1002/puh2.218","url":null,"abstract":"Multimorbidity, the coexistence of two or more chronic conditions, presents a growing global challenge, particularly in low‐ and middle‐income countries such as Southeast Asia. This trend necessitates the development of sustainable integrated care models to prevent and manage multimorbidity effectively. However, progress in this area has been hampered, especially in underdeveloped regions, by various barriers, including the epidemiology of multimorbidity, how to get different specialists and doctors to work together most availably and manage the multiple medication issues and how to develop cost‐effective approaches to reduce the health burden of multimorbidity. Preventive measures in Southeast Asia, which could tackle multiple components which commonly comprise multimorbidity, include enhancing health literacy and health promotion through school‐ and community‐based educational activities, primary healthcare and related policies on employing taxes on tobacco, alcohol and sugary beverages. The social determinants of health‐encompassing poverty and low education may also influence research on multimorbidity. Moreover, stakeholder engagements involving national governments, World Health Organization (WHO) and Association of Southeast Asian Nations (ASEAN) are crucial. Management strategies focus on integrated care models, including patient‐centred primary healthcare, digital healthcare technologies, and medication management to control polypharmacy. Although research on multimorbidity in Southeast Asia is increasing, translating findings into practical measures was limited. Future efforts should prioritize evidence‐based approaches to prevent and manage multimorbidity effectively, addressing challenges like health system focusing on single chronic disease treatment independently, resource limitations, healthcare provider shortages and individual adherence issues. These ways promise to enhance the quality of life and health outcomes in this region.","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"41 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141645008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deeply rooted in its developmental philosophy of gross national happiness (GNH), Bhutan's healthcare system strives towards achieving a shared goal of universal health coverage (UHC). Despite being primarily financed by the government, the health system faces a plethora of challenges. To overcome these hurdles and achieve UHC goals, expanding the fiscal space for health and improving operational efficiency are crucial. This article aims to address Bhutan's evolving healthcare landscape and advance the achievement of UHC through two policy options. The first policy option focuses on the dual objective of improving health outcomes and promoting financial sustainability by leveraging health taxes, whereas the second option emphasizes reinforcing a systematic health technology assessment (HTA) in the Bhutanese health system. First, drawing lessons from global experiences, the policy brief recommends leveraging health taxes to reduce societal and healthcare costs and enhance financial sustainability in the health sector. Considering Bhutan's high prevalence of tobacco and alcohol consumption, and taking opportunity from the ongoing Goods and Services Tax (GST) reform, continued advocacy on health taxes is essential, and soft earmarking the health taxes may be considered to finance a broader array of public health programmes, particularly focusing on the promotion of healthy lifestyle, health screening and outreach public health activities. Second, the integration of HTA into policymaking and decision‐making processes is essential for effective resource allocation in UHC. Nurturing and strengthening the existing HTA governance structure under the Ministry of Health (MoH) and establishing a dedicated multidisciplinary HTA Committee will ensure informed decision‐making and resource optimization. HTA evidence should inform the revision of health service standards, clinical guidelines development, procurement decisions and healthcare priorities. These policy options can assist the country in improving financial sustainability, enhancing effective resource allocation and utilization and improving healthcare delivery, aligning with its vision of GNH and ultimately accelerating progress towards achieving UHC.
{"title":"Improving Sustainable Financing for Universal Health Coverage in Bhutan: Exploring Policy Options and Financial Strategies","authors":"Ugyen Tshering, Jayendra Sharma, Dorji Tshering, Tandin Dendup","doi":"10.1002/puh2.216","DOIUrl":"https://doi.org/10.1002/puh2.216","url":null,"abstract":"Deeply rooted in its developmental philosophy of gross national happiness (GNH), Bhutan's healthcare system strives towards achieving a shared goal of universal health coverage (UHC). Despite being primarily financed by the government, the health system faces a plethora of challenges. To overcome these hurdles and achieve UHC goals, expanding the fiscal space for health and improving operational efficiency are crucial. This article aims to address Bhutan's evolving healthcare landscape and advance the achievement of UHC through two policy options. The first policy option focuses on the dual objective of improving health outcomes and promoting financial sustainability by leveraging health taxes, whereas the second option emphasizes reinforcing a systematic health technology assessment (HTA) in the Bhutanese health system. First, drawing lessons from global experiences, the policy brief recommends leveraging health taxes to reduce societal and healthcare costs and enhance financial sustainability in the health sector. Considering Bhutan's high prevalence of tobacco and alcohol consumption, and taking opportunity from the ongoing Goods and Services Tax (GST) reform, continued advocacy on health taxes is essential, and soft earmarking the health taxes may be considered to finance a broader array of public health programmes, particularly focusing on the promotion of healthy lifestyle, health screening and outreach public health activities. Second, the integration of HTA into policymaking and decision‐making processes is essential for effective resource allocation in UHC. Nurturing and strengthening the existing HTA governance structure under the Ministry of Health (MoH) and establishing a dedicated multidisciplinary HTA Committee will ensure informed decision‐making and resource optimization. HTA evidence should inform the revision of health service standards, clinical guidelines development, procurement decisions and healthcare priorities. These policy options can assist the country in improving financial sustainability, enhancing effective resource allocation and utilization and improving healthcare delivery, aligning with its vision of GNH and ultimately accelerating progress towards achieving UHC.","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":" 732","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141669254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dietary diversity is crucial for nutritional adequacy, particularly among women of reproductive age who have increased nutritional needs due to menstruation, pregnancy, and lactation. This is especially important in addressing anemia in Rwanda, which poses significant health risks for both mothers and children. This study assessed the dietary diversity, nutritional status, and related factors among Rwandan women engaged in agriculture.In 2022, a cross‐sectional study in Nyamagabe, Karongi, and Nyabihu districts, Rwanda, focused on high malnutrition rates. Agriculture households with children under 5 were sampled using a multistage method. Data, including nutritional status via MUAC and dietary diversity via 24‐h recall, were collected digitally through Kobo Collect.The study included 439 respondents, with a mean age of 33 years. Among participants, 359 (81.8%) had low dietary diversity, with Nyamagabe having the highest proportion at 39%. Anemia prevalence was 22.1%, with Karongi having the highest at 10.7%. Factors associated with higher odds of high dietary diversity included the education of the household head (adjusted OR = 6.4, 95% CI: 1.05–39.7), age of women (adjusted OR = 3.03, 95% CI: 1.1–7.8), and wealth status (adjusted OR = 1.66, 95% CI: 0.51–5.4). Conversely, the occupation of women (adjusted OR = 0.13, 95% CI: 0.001–0.19), reading skills (adjusted OR = 0.27, 95% CI: 0.1–0.72), and family size (adjusted OR = 0.63, 95% CI: 0.35–1.1) were associated with lower odds of lower dietary diversity.The findings highlight a significant nutritional challenge among Rwandan women, with low dietary diversity, significant rates of anemia, and food insecurity. The study calls for an urgent need for targeted nutritional interventions to improve dietary diversity and address micronutrient deficiencies among women in agriculture to enhance maternal health and child development, thereby contributing to broader public health goals.
膳食多样性对于营养充足至关重要，尤其是育龄妇女，她们因月经、怀孕和哺乳而对营养的需求增加。这对于解决卢旺达的贫血问题尤为重要，因为贫血会对母亲和儿童的健康造成严重威胁。这项研究评估了卢旺达从事农业的妇女的饮食多样性、营养状况和相关因素。2022 年，在卢旺达尼亚马加贝、卡隆吉和尼亚比胡地区开展了一项横断面研究，重点关注营养不良率高的问题。采用多阶段方法对有 5 岁以下儿童的农户进行了抽样调查。通过 Kobo Collect 以数字方式收集数据，包括通过 MUAC 收集的营养状况数据和通过 24 小时回忆收集的膳食多样性数据。在参与者中，359 人（81.8%）的膳食多样性较低，其中尼亚马加贝的比例最高，为 39%。贫血患病率为 22.1%，其中卡隆吉最高，为 10.7%。户主受教育程度（调整后 OR = 6.4，95% CI：1.05-39.7）、妇女年龄（调整后 OR = 3.03，95% CI：1.1-7.8）和财富状况（调整后 OR = 1.66，95% CI：0.51-5.4）等因素与饮食多样性较高的几率相关。相反，妇女的职业（调整后 OR = 0.13，95% CI：0.001-0.19）、阅读能力（调整后 OR = 0.27，95% CI：0.1-0.72）和家庭规模（调整后 OR = 0.63，95% CI：0.35-1.1）与较低的膳食多样性几率相关。这项研究呼吁，迫切需要采取有针对性的营养干预措施，以改善农业妇女的膳食多样性并解决微量营养素缺乏问题，从而增强孕产妇健康和儿童发育，为实现更广泛的公共卫生目标做出贡献。
{"title":"Dietary Diversity and Nutritional Status Among Rwandan Women Engaged in Agriculture: A Cross‐Sectional Study","authors":"Sunday François Xavier, Philemon Kwizera, Yves Didier Umwungerimwiza, Rutayisire Reverien, Kanimba Philbert, Ilinde Niyigena Delice, Maryse Umugwaneza","doi":"10.1002/puh2.214","DOIUrl":"https://doi.org/10.1002/puh2.214","url":null,"abstract":"Dietary diversity is crucial for nutritional adequacy, particularly among women of reproductive age who have increased nutritional needs due to menstruation, pregnancy, and lactation. This is especially important in addressing anemia in Rwanda, which poses significant health risks for both mothers and children. This study assessed the dietary diversity, nutritional status, and related factors among Rwandan women engaged in agriculture.In 2022, a cross‐sectional study in Nyamagabe, Karongi, and Nyabihu districts, Rwanda, focused on high malnutrition rates. Agriculture households with children under 5 were sampled using a multistage method. Data, including nutritional status via MUAC and dietary diversity via 24‐h recall, were collected digitally through Kobo Collect.The study included 439 respondents, with a mean age of 33 years. Among participants, 359 (81.8%) had low dietary diversity, with Nyamagabe having the highest proportion at 39%. Anemia prevalence was 22.1%, with Karongi having the highest at 10.7%. Factors associated with higher odds of high dietary diversity included the education of the household head (adjusted OR = 6.4, 95% CI: 1.05–39.7), age of women (adjusted OR = 3.03, 95% CI: 1.1–7.8), and wealth status (adjusted OR = 1.66, 95% CI: 0.51–5.4). Conversely, the occupation of women (adjusted OR = 0.13, 95% CI: 0.001–0.19), reading skills (adjusted OR = 0.27, 95% CI: 0.1–0.72), and family size (adjusted OR = 0.63, 95% CI: 0.35–1.1) were associated with lower odds of lower dietary diversity.The findings highlight a significant nutritional challenge among Rwandan women, with low dietary diversity, significant rates of anemia, and food insecurity. The study calls for an urgent need for targeted nutritional interventions to improve dietary diversity and address micronutrient deficiencies among women in agriculture to enhance maternal health and child development, thereby contributing to broader public health goals.","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":" 1016","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141668954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abraham Fessehaye Sium, Lina Mohamed, Martha Tesfalul, Filagot Tadesse
Contraceptive counselling and utilization for kidney transplant patients is a vital component of their kidney transplant care. The use of standardized information on contraceptive methods to prevent unplanned post‐transplant pregnancies in Africa in general is less studied. This study aimed to describe contraceptive counselling and uptake among kidney transplant recipients at a kidney transplant centre in Ethiopia.A descriptive study on contraceptive counselling and uptake among female Ethiopian kidney transplant recipients was conducted at St. Paul's Hospital Millennium Medical College (Ethiopia) from April 15 to July 15, 2023. Data on women's sociodemographic, renal transplantation and contraceptive counselling and use were collected through interviewing the participants using a structured questionnaire. Data were analyzed on SPSS 23 using simple descriptive analysis. Percentages and frequencies were used to present the results.A total of 60 participants were included in the final analysis. The mean age of the participants was 33.7 ± 8.4 years. The median duration from the time of renal transplant was 19 months. Most (49/60, 81.7%) of the participants reported that they did not receive family planning counselling on contraceptive methods in the early post‐transplant phase. The rate of contraceptive uptake was 8.3% (5/60) with two patients being copper IUD users, and Implanon, tubal ligation and combined oral contraceptives each utilized by a single kidney transplant patient.Contraceptive counselling and uptake rates among female kidney transplant recipients in this study were very low, which is consistent with findings from previous studies. Increasing female kidney transplant patients’ awareness on safe and effective contraceptive use through adequate contraceptive counselling is essential.
{"title":"Contraceptive Counselling and Uptake Among Female Kidney Transplant Recipients in Ethiopia","authors":"Abraham Fessehaye Sium, Lina Mohamed, Martha Tesfalul, Filagot Tadesse","doi":"10.1002/puh2.215","DOIUrl":"https://doi.org/10.1002/puh2.215","url":null,"abstract":"Contraceptive counselling and utilization for kidney transplant patients is a vital component of their kidney transplant care. The use of standardized information on contraceptive methods to prevent unplanned post‐transplant pregnancies in Africa in general is less studied. This study aimed to describe contraceptive counselling and uptake among kidney transplant recipients at a kidney transplant centre in Ethiopia.A descriptive study on contraceptive counselling and uptake among female Ethiopian kidney transplant recipients was conducted at St. Paul's Hospital Millennium Medical College (Ethiopia) from April 15 to July 15, 2023. Data on women's sociodemographic, renal transplantation and contraceptive counselling and use were collected through interviewing the participants using a structured questionnaire. Data were analyzed on SPSS 23 using simple descriptive analysis. Percentages and frequencies were used to present the results.A total of 60 participants were included in the final analysis. The mean age of the participants was 33.7 ± 8.4 years. The median duration from the time of renal transplant was 19 months. Most (49/60, 81.7%) of the participants reported that they did not receive family planning counselling on contraceptive methods in the early post‐transplant phase. The rate of contraceptive uptake was 8.3% (5/60) with two patients being copper IUD users, and Implanon, tubal ligation and combined oral contraceptives each utilized by a single kidney transplant patient.Contraceptive counselling and uptake rates among female kidney transplant recipients in this study were very low, which is consistent with findings from previous studies. Increasing female kidney transplant patients’ awareness on safe and effective contraceptive use through adequate contraceptive counselling is essential.","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"114 47","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141666589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The prevalence of periodontal disease among Sri Lankan women in the reproductive age group is considerably high. The present study aimed to assess the oral hygiene status, gingival status, and the associated factors among pregnant women attending community Antenatal Clinics (ANC) in Sri Lanka, against the challenging sociopolitical backdrop.This cross‐sectional study was conducted among 576 pregnant women attending community ANCs within a specific Medical Officer of Health area in Sri Lanka. The clinics were selected using a two‐stage cluster sampling method with probability proportionate to size technique. Pregnant women were recruited from each clinic using a systematic sampling method. Data was collected with an interviewer‐administered questionnaire and an oral health examination form.Poor oral hygiene was detected among over 60% of pregnant women. Moderate‐to‐severe gingivitis was seen among 23.3% of them. Nearly 67% of the participants demonstrated limited knowledge of periodontal diseases. Approximately, 67% of them were unemployed, and 32.5% had a monthly income of less than 40,000 Sri Lankan rupees. Regression analysis revealed that the trimester, socioeconomic factors, frequency of dental visits, recency of full mouth scaling, and knowledge of periodontal diseases predicted the oral hygiene status, and age, trimester, frequency of brushing, recency of full mouth scaling, and knowledge of periodontal diseases were significant predictors of gingival health. Particularly, individuals with a lower socioeconomic status experienced both poor oral hygiene and gingival health.The suboptimal oral hygiene and gingival health, limited access to dental care, and inadequate periodontal health knowledge, highlight an urgent need for interventions such as empowering young women through educational and employment initiatives.
{"title":"Periodontal Health Among Pregnant Women in Sri Lanka: A Cross‐Sectional Study","authors":"Kavithrini Anunadika Gammulle, Manori Dhanapriyanka, Meghashyam Bhat","doi":"10.1002/puh2.209","DOIUrl":"https://doi.org/10.1002/puh2.209","url":null,"abstract":"The prevalence of periodontal disease among Sri Lankan women in the reproductive age group is considerably high. The present study aimed to assess the oral hygiene status, gingival status, and the associated factors among pregnant women attending community Antenatal Clinics (ANC) in Sri Lanka, against the challenging sociopolitical backdrop.This cross‐sectional study was conducted among 576 pregnant women attending community ANCs within a specific Medical Officer of Health area in Sri Lanka. The clinics were selected using a two‐stage cluster sampling method with probability proportionate to size technique. Pregnant women were recruited from each clinic using a systematic sampling method. Data was collected with an interviewer‐administered questionnaire and an oral health examination form.Poor oral hygiene was detected among over 60% of pregnant women. Moderate‐to‐severe gingivitis was seen among 23.3% of them. Nearly 67% of the participants demonstrated limited knowledge of periodontal diseases. Approximately, 67% of them were unemployed, and 32.5% had a monthly income of less than 40,000 Sri Lankan rupees. Regression analysis revealed that the trimester, socioeconomic factors, frequency of dental visits, recency of full mouth scaling, and knowledge of periodontal diseases predicted the oral hygiene status, and age, trimester, frequency of brushing, recency of full mouth scaling, and knowledge of periodontal diseases were significant predictors of gingival health. Particularly, individuals with a lower socioeconomic status experienced both poor oral hygiene and gingival health.The suboptimal oral hygiene and gingival health, limited access to dental care, and inadequate periodontal health knowledge, highlight an urgent need for interventions such as empowering young women through educational and employment initiatives.","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141684100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Ahishakiye, L. Vaandrager, Eric Matsiko, Philemon Kwizera, Maria Koelen
Responsive feeding among infants and young children (IYC) determines their food acceptance and adequate dietary intake, which enhances growth and developmental opportunities. However, little is known about responsive feeding practices among IYC in Rwanda. This study explored the status and barriers of responsive feeding practices among mothers from rural areas of Muhanga District in Rwanda.This descriptive longitudinal and exploratory mixed methods study was conducted among 29 mothers from 2 rural health centers in Muhanga District. Mothers were interviewed, and their interactions with children during lunch meals at 6, 9, and 12 months were observed. The interviews were recorded, transcribed, and thematically analyzed using Atlas.ti software.The study shows that the number of mothers who reported to verbally encourage their children to eat during feeding increased with the child's age. Less than half of mothers, at all three time points of data collection (at 6, 9, and 12 months), reported and were observed allowing their children to self‐feed, smiling and talking to them during feeding. The perceived major barriers to mother–child interaction during feeding were lack of time due to the burden of other responsibilities, and poverty. In addition, fear of messing up and food waste were barriers to child self‐feeding opportunities.Findings indicate that responsive feeding was less practiced among study mothers due to lack of time, poverty, and fear of food waste during child self‐feeding. Nutrition interventions in this community should consider raising awareness of responsive feeding practices through education and encouraging mothers to devote sufficient time to interact with their children during feeding episodes.
{"title":"Responsive Complementary Feeding Practices in Rural Muhanga District of Rwanda: A Mixed Methods Study","authors":"J. Ahishakiye, L. Vaandrager, Eric Matsiko, Philemon Kwizera, Maria Koelen","doi":"10.1002/puh2.206","DOIUrl":"https://doi.org/10.1002/puh2.206","url":null,"abstract":"Responsive feeding among infants and young children (IYC) determines their food acceptance and adequate dietary intake, which enhances growth and developmental opportunities. However, little is known about responsive feeding practices among IYC in Rwanda. This study explored the status and barriers of responsive feeding practices among mothers from rural areas of Muhanga District in Rwanda.This descriptive longitudinal and exploratory mixed methods study was conducted among 29 mothers from 2 rural health centers in Muhanga District. Mothers were interviewed, and their interactions with children during lunch meals at 6, 9, and 12 months were observed. The interviews were recorded, transcribed, and thematically analyzed using Atlas.ti software.The study shows that the number of mothers who reported to verbally encourage their children to eat during feeding increased with the child's age. Less than half of mothers, at all three time points of data collection (at 6, 9, and 12 months), reported and were observed allowing their children to self‐feed, smiling and talking to them during feeding. The perceived major barriers to mother–child interaction during feeding were lack of time due to the burden of other responsibilities, and poverty. In addition, fear of messing up and food waste were barriers to child self‐feeding opportunities.Findings indicate that responsive feeding was less practiced among study mothers due to lack of time, poverty, and fear of food waste during child self‐feeding. Nutrition interventions in this community should consider raising awareness of responsive feeding practices through education and encouraging mothers to devote sufficient time to interact with their children during feeding episodes.","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"5 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141684324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. C. Lusobya, I. Atukunda, A. W. Semulimi, Carol Nalukenge, Abubaker Kalinaki, Erima Denis, Mary Nyanzi, C. Batte, David Mukunya, John Mukisa, Juliet Otiti-Sengeri, Geoffrey Wabulembo
Retinopathy of prematurity (ROP) is a significant global issue and a leading cause of preventable childhood blindness. Early screening and timely management of preterm babies at risk are crucial. To effectively implement this strategy, it is essential that caregivers and health workers are well‐informed about ROP. This study plays a vital role in assessing the knowledge, attitudes and practices of caregivers and healthcare workers towards ROP in Uganda, providing valuable insights into the current understanding and approach towards this condition.We conducted a sequential explanatory mixed‐methods study, involving 214 participants. This group included 12 paediatricians, 56 neonatal nurses and 146 caregivers, all of whom play crucial roles in the healthcare system. The study was conducted at two tertiary hospital neonatal clinics in Uganda. A researcher‐administered structured questionnaire was used to collect the data on the participants’ knowledge, attitudes and practices. Descriptive statistics were used to describe variables, while qualitative data were analysed using thematic content analysis.We recruited 146 caregivers with a mean age of 29.4 (±standard deviation 6.5) years, 12 paediatricians with a median age of 37 years (IQR: 36–41) and 56 nurses with a median age of 35 years (30–42). The median working duration of health workers at the neonatal unit was 3 (IQR: 1.8–4.2) years. Thirty‐two (21.92%) caregivers and 28 (49.12%) health workers had good knowledge about ROP, whereas 9 nurses and 2 paediatricians did not know about ROP. Barriers to ROP screening included limited resources (equipment, time and skilled personnel) and limited parental involvement. Enhancing collaboration among medical care teams has the potential to improve ROP screening.Insufficient knowledge about ROP among caregivers calls for increased efforts to educate and sensitise them about ROP and its risk factors.
{"title":"Knowledge, Attitudes and Practices of Health Workers and Caregivers Towards Retinopathy of Prematurity in Uganda: A Mixed‐Methods Study","authors":"R. C. Lusobya, I. Atukunda, A. W. Semulimi, Carol Nalukenge, Abubaker Kalinaki, Erima Denis, Mary Nyanzi, C. Batte, David Mukunya, John Mukisa, Juliet Otiti-Sengeri, Geoffrey Wabulembo","doi":"10.1002/puh2.208","DOIUrl":"https://doi.org/10.1002/puh2.208","url":null,"abstract":"Retinopathy of prematurity (ROP) is a significant global issue and a leading cause of preventable childhood blindness. Early screening and timely management of preterm babies at risk are crucial. To effectively implement this strategy, it is essential that caregivers and health workers are well‐informed about ROP. This study plays a vital role in assessing the knowledge, attitudes and practices of caregivers and healthcare workers towards ROP in Uganda, providing valuable insights into the current understanding and approach towards this condition.We conducted a sequential explanatory mixed‐methods study, involving 214 participants. This group included 12 paediatricians, 56 neonatal nurses and 146 caregivers, all of whom play crucial roles in the healthcare system. The study was conducted at two tertiary hospital neonatal clinics in Uganda. A researcher‐administered structured questionnaire was used to collect the data on the participants’ knowledge, attitudes and practices. Descriptive statistics were used to describe variables, while qualitative data were analysed using thematic content analysis.We recruited 146 caregivers with a mean age of 29.4 (±standard deviation 6.5) years, 12 paediatricians with a median age of 37 years (IQR: 36–41) and 56 nurses with a median age of 35 years (30–42). The median working duration of health workers at the neonatal unit was 3 (IQR: 1.8–4.2) years. Thirty‐two (21.92%) caregivers and 28 (49.12%) health workers had good knowledge about ROP, whereas 9 nurses and 2 paediatricians did not know about ROP. Barriers to ROP screening included limited resources (equipment, time and skilled personnel) and limited parental involvement. Enhancing collaboration among medical care teams has the potential to improve ROP screening.Insufficient knowledge about ROP among caregivers calls for increased efforts to educate and sensitise them about ROP and its risk factors.","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"33 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141685441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Out‐of‐pocket (OOP) expenses for healthcare are regarded as catastrophic, especially if they account for a substantial amount of a poor household's effective income. This study looks at the frequency and severity of catastrophic healthcare expenditures (CHE) to evaluate the level of monetary safeguarding provided by the present healthcare system in Zambia.The study relied on the 2014 Zambia Household Health Expenditure and Utilization Survey, which was carried out in 10 different provinces. The investigated population is divided into quintiles, which divide family units into five groups, each of which represents 20% of the population. The data were analyzed using descriptive statistics, analysis of variance, and pairwise comparisons among the quintiles.At 5% level of significance, pairwise analyses of the average of OOP healthcare expenditures as a proportion of non‐food spending reveal that the quintiles have statistically different means. If 10% limit is employed, the concentration index was −0.41, whereas was −0.67. At a 10% limit, the adjusted headcount () is 0.37, and the adjusted overshoot () is 0.15%.The frequency and severity of CHE were negligible during the study period. However, the less fortunate are more susceptible compared to the wealthy to be subjected to the occurrence and severity of CHE. Therefore, policy changes ought to emphasize the protection of the poor and vulnerable to accomplish the goal of universal healthcare (UHC). Finally, research is suggested to include equity and quality in the use of healthcare services.
{"title":"Consumer Financial Protection Versus Catastrophic Healthcare Expenditure in Zambia","authors":"MccPowell Fombang, R. Wanzala","doi":"10.1002/puh2.207","DOIUrl":"https://doi.org/10.1002/puh2.207","url":null,"abstract":"Out‐of‐pocket (OOP) expenses for healthcare are regarded as catastrophic, especially if they account for a substantial amount of a poor household's effective income. This study looks at the frequency and severity of catastrophic healthcare expenditures (CHE) to evaluate the level of monetary safeguarding provided by the present healthcare system in Zambia.The study relied on the 2014 Zambia Household Health Expenditure and Utilization Survey, which was carried out in 10 different provinces. The investigated population is divided into quintiles, which divide family units into five groups, each of which represents 20% of the population. The data were analyzed using descriptive statistics, analysis of variance, and pairwise comparisons among the quintiles.At 5% level of significance, pairwise analyses of the average of OOP healthcare expenditures as a proportion of non‐food spending reveal that the quintiles have statistically different means. If 10% limit is employed, the concentration index was −0.41, whereas was −0.67. At a 10% limit, the adjusted headcount () is 0.37, and the adjusted overshoot () is 0.15%.The frequency and severity of CHE were negligible during the study period. However, the less fortunate are more susceptible compared to the wealthy to be subjected to the occurrence and severity of CHE. Therefore, policy changes ought to emphasize the protection of the poor and vulnerable to accomplish the goal of universal healthcare (UHC). Finally, research is suggested to include equity and quality in the use of healthcare services.","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"8 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141685869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jean Jacques Irakiza, Christian Mazimpaka, Dieudonne Ndatimana, John Baptist Kalach, Vincent Hatangimbabazi, Edouard Kamuhangire, Alphonsine Mukamunana, Olive Ntakirutimana, Joseline Tengera, Olivier Ruhumuriza, Onesime Manishimwe, A. Mwali, E. Rutayisire
Infection prevention and control (IPC) is important in ensuring patient safety, protecting healthcare workers, and reducing healthcare‐associated costs. The World Health Organization (WHO)‐validated Infection Prevention and Control Assessment Framework (IPCAF) was used to evaluate IPC practices in Rwandan healthcare facilities.In this cross‐sectional study, we assessed 25 health facilities across Rwanda, including district and referral hospitals. Using the IPCAF tool, we assessed eight core components (CCs) of IPC programs. We calculated median scores and interquartile ranges to determine the levels of implementation of IPC practices.Among the 25 facilities, all showed some degree of IPCAF implementation, with an overall median IPCAF score of 545.0, reflecting an intermediate level. Three facilities (12%) were at a basic level, 16 (64%) at an intermediate level, and 6 (24%) at an advanced level of IPC practices. The presence of IPC guidelines scored the highest among CCs (median: 87.5). About 96% of facilities did not have a dedicated full‐time IPC staff, 64% of facilities did not offer IPC training to new staff, and 84% did not have protocols for multidrug‐resistant pathogens.This initial IPCAF assessment in Rwanda reveals critical IPC strengths and gaps. These findings highlight the necessity for targeted interventions, such as appointing dedicated IPC staff, strengthening IPC committees, and enhancing IPC training and resources.
{"title":"Status of infection prevention and control programs in 25 facilities of Rwanda: Results from the WHO infection prevention and control assessment framework","authors":"Jean Jacques Irakiza, Christian Mazimpaka, Dieudonne Ndatimana, John Baptist Kalach, Vincent Hatangimbabazi, Edouard Kamuhangire, Alphonsine Mukamunana, Olive Ntakirutimana, Joseline Tengera, Olivier Ruhumuriza, Onesime Manishimwe, A. Mwali, E. Rutayisire","doi":"10.1002/puh2.183","DOIUrl":"https://doi.org/10.1002/puh2.183","url":null,"abstract":"Infection prevention and control (IPC) is important in ensuring patient safety, protecting healthcare workers, and reducing healthcare‐associated costs. The World Health Organization (WHO)‐validated Infection Prevention and Control Assessment Framework (IPCAF) was used to evaluate IPC practices in Rwandan healthcare facilities.In this cross‐sectional study, we assessed 25 health facilities across Rwanda, including district and referral hospitals. Using the IPCAF tool, we assessed eight core components (CCs) of IPC programs. We calculated median scores and interquartile ranges to determine the levels of implementation of IPC practices.Among the 25 facilities, all showed some degree of IPCAF implementation, with an overall median IPCAF score of 545.0, reflecting an intermediate level. Three facilities (12%) were at a basic level, 16 (64%) at an intermediate level, and 6 (24%) at an advanced level of IPC practices. The presence of IPC guidelines scored the highest among CCs (median: 87.5). About 96% of facilities did not have a dedicated full‐time IPC staff, 64% of facilities did not offer IPC training to new staff, and 84% did not have protocols for multidrug‐resistant pathogens.This initial IPCAF assessment in Rwanda reveals critical IPC strengths and gaps. These findings highlight the necessity for targeted interventions, such as appointing dedicated IPC staff, strengthening IPC committees, and enhancing IPC training and resources.","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"31 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141123651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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