Public health challenges最新文献

Background: Providing abortion services during pandemics without interruption is essential. The objective of the study was to compare the utilization of second-trimester safe abortion care services between early pandemic and peak pandemic months.

Methods: We conducted a retrospective comparative study of second-trimester safe abortion service provision during the peak of COVID-19 pandemic in Ethiopia (April 2021) versus during that of early pandemic (April 2020). Data were collected using data extraction form from MICHU clinic HMIS registry. Data were analyzed using SPSS version 23. Chi-squared test and simple descriptive statistics were applied as appropriate. A p-value of less than 0.05 was used to describe the significance of the results.

Results: There were significantly more second-trimester abortions performed during the peak pandemic month as compared to early pandemic month (32.6% vs. 67.4%, respectively). Nearly half of the abortions were done for maternal health problems (47.8%, 44/92), and of which over 80% of them used medical methods for abortion (83.7%, 77/92). There was only one case of dilation and evacuation (D&E) during the early pandemic, compared to 14 D&E procedures during the pandemic peak.

Conclusion: We found a significant increment in the second-trimester abortion service coverage during the peak of COVID-19 pandemic. The measures we took during the early pandemic: increasing public awareness about continuation of abortion care services during the pandemic, change in the attitude of care-providers, and early sticking to national guidelines on essential care during COVID-19 should be passed on as important lessons for future pandemics.

Background: This study analyzes how national intersectoral public policy experiences have been adopted and implemented using a Health in All Policies (HiAP) approach in the past two decades. It seeks to provide evidence on enabling factors that triggered three effective intersectoral public policies to improve population health in Mexico by improving nutritional, educational, and healthcare access conditions, reducing road traffic injuries, and addressing obesogenic feeding practices.

Methods: We followed a qualitative approach to analyze the three intersectoral public policies selected as case studies. First, we designed an analytical framework to assess how intersectoral public policies are adopted, implemented, and sustained. The proposed framework is based on peer-reviewed articles and gray public policy literature. Second, we used information from eleven semi-structured interviews with key stakeholders conducted in previous research to identify more specific enablers and barriers of the three intersectoral policies selected according to predefined analytical categories used in the questionnaire.

Results: The analysis showed three overall key findings. First, sound empirical evidence is essential for adopting a HiAP approach. Second, effective intersectoral mechanisms enhance implementation feasibility. Third, results-based monitoring and evaluation contribute to the continuity of the analyzed intersectoral public policies. Finally, political support is needed throughout the policy process to maintain governance capacity and deliver results.

Conclusion: We drew five global policy lessons that may be applicable in similar public policy settings in other countries. First, both technical and political enablers help set the intersectoral agenda. Second, effective communication is instrumental in convincing all stakeholders to address public health-related policy issues. Third, political support at the highest level possible and the federal government's capacity are essential to implement sound policies. Fourth, several enablers exist for enhancing collaboration between ministries during implementation. Finally, monitoring and evaluation results are necessary for sustaining intersectoral policies beyond administrations.

The worldwide anaesthesia workforce shortage is a concern and 'shared responsibility' for all the national or state anaesthetic societies and Ministries of Health. The Lancet Commission on Global Surgery estimated the need for 143 million additional surgeries each year globally. These would be included in the World Health Organization's (WHO) 44 essential surgeries to be performed at district hospitals. However, insufficient availability of safe anaesthesia is a key barrier. The World Federation of Societies of Anaesthesiologists (WFSA) recommends at least five specialist physician-anaesthesia providers per 100,000 population. India requires at least 60,000 additional physician-anaesthesiologists over the next 10 years. This paper discusses the two-decade journey of a policy initiative by the Ministry of Health and Family Welfare (MoHFW) in India to create a new category of a physician with Life Saving Anaesthetic Skills (LSAS). This addressed the shortage of anaesthetists specifically for the dire emergency obstetric situations at the First Referral hospitals. The annual training capacity for physicians for LSAS training was 40-100 in 5 of the poorest states of India, with the maximum shortages of anaesthetists. On following up a sample of 838 LSAS physicians, only about two-thirds were able to practice their life-saving skills. The MoHFW innovated further by pairing a physician trained in Emergency Obstetric Care with an LSAS-physician (buddy-pairing) as a functioning team. For comparison, we discuss the midwife model supported by the professional association of obstetricians in India. The flexible, 'team-based' task-sharing approach optimizes anaesthesia care within available resources. Leadership and vision from the professional societies of anaesthesiology are key to policy reform in India. National engagement can be facilitated through support for district-level non-specialist physician provider with life-saving anaesthesia skills training, engagement in research and formulation of the national surgical and anaesthesia plans to achieve universal healthcare in India.

Background: Fleas infest rodents and other small mammals, serving as vectors for zoonotic diseases such as plague. This study investigates the flea burden on rodents and its associated determinants within the plague-endemic localities of Karatu district, Tanzania.

Methods: A repeated cross-sectional design was employed to capture rodents with Sherman traps in farmland, peridomestic area, bush land, and forest buffer zones across the wet and dry seasons of 2022 in plague and nonplague foci villages. Captured rodents were anaesthetized and thoroughly brushed to collect fleas, which were then identified using a dichotomous key.

Results: A total of 291 rodents (9 species) were captured, from which 190 fleas (4 species) were collected. The collected fleas were Dinopsyllus lypusus (46.32%), Ctenophthalmus sp (26.84%), Xenopsylla brasiliensis (16.32%), and Xenopsylla cheopis (10.53%). Approximately 38.42% of fleas were found on Mastomys natalensis, 22.63% on Lemniscomys striatus, and 18.42% on Rattus rattus. High flea abundance was recorded in farmland and peridomestic areas. The specific flea index (SFI) of X. cheopis on R. rattus was 1.0 in plague foci and <0.5 in nonplague foci. A generalized linear model revealed significant influences of rodent species, season, habitats, rodent weight, sex, and plague locations on flea abundance. Significant variation was observed between rodent sexes (p = 0.009), and a weak positive correlation existed between rodent weight and flea abundance (R = 0.17, p < 0.05).

Conclusion: Villages in plague foci exhibited higher abundances of fleas in comparison to nonplague foci villages. The SFI results for X. cheopis on rats in both types of villages did not surpass critical thresholds. Factors such as dry season, farmlands, and rodent characteristics influenced flea abundance on rodents in the study area.

Background: Smartphone addiction is exponentially increasing worldwide. It has negative health consequences. Previous systematic reviews identified several risk factors of smartphone addiction; however, they were based on cross-sectional data. This systematic review aimed to fill the gap by assessing smartphone addiction risk factors using longitudinal studies.

Methods: This systematic review is registered with PROSPERO (CRD42023431529) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six databases, including Scopus, Medline, Web of Science, PubMed, ProQuest Central and PsycINFO, were searched to identify eligible studies. Studies were eligible if they assessed smartphone addiction as the outcome variable, were longitudinal and were published in English. All papers included in this review were assessed for the risk of bias and quality.

Results: A total of 22 papers met the inclusion and exclusion criteria after the screening process. The results were categorised into three groups, including personal, social and environmental factors. Within the groups, seven risk factors, including mental health, emotions, academic stress, social rejection and peer victimisation as well as family dysfunction and parental phubbing, were identified. All of the risk factors were significant predictors of smartphone addiction. Mental health problems, social rejection and peer victimisation also displayed a bidirectional relationship with smartphone addiction. Inconsistent smartphone addiction measurements were used.

Conclusion: This review has significant implications for policymakers as it identified seven risk factors for smartphone addiction. Further studies are warranted to improve the understanding of the aetiology of smartphone addiction and inform education, counselling and coping with smartphone addiction.

The coronavirus-2019 (COVID-19) pandemic has tremendously impacted both the small and large world economies. Schools and businesses were shut down and national borders closed, interrupting international trade and movement of people. This eventually led to huge economic losses and rendered many people jobless. Unlike in high-income countries, recovery in the post-pandemic period is yet to be fully actualized as many countries, especially from Africa that were hit the most by the pandemic continue to face other health and economic setbacks. The African continent is endemic to diseases such as tuberculosis, malaria and HIV which already required funding before the COVID-19 pandemic. During the pandemic, the Cameroonian health authorities reported numerous confirmed cases. Vaccination continues to be an effective means to avoid further spread of the virus and minimize possible occurrences of other COVID-19 variants across the globe. Despite the efforts made towards COVID-19 vaccination, only 12% of Cameroonians were reported to have completed the COVID-19 vaccinations in the basic series. In the country, multiple resorts were used to attenuate the impact of the virus, including barrier measures, vaccines and even traditional therapies. The initial promotion of traditional remedies as control measures created a preference over vaccines due to misinformation from social media platforms, contributing to fear of vaccines, and consequently resulted in a high vaccine hesitancy (VH) reported at 56.9%. This VH coupled with cold chain management challenges resulted in vaccine wastage. Consequently, the target of vaccinating 15 million Cameroonians by December 2022 to reach the threshold vaccination coverage expected to confer immunity was not attained. Hence, it is important to reduce expenditures on extra doses of vaccines, maximize uptake through vaccination sensitization campaigns and increase access to avoid vaccine wastage. This will be instrumental in attaining herd immunity and contribute to the fight against new COVID-19 variants.

Background: Human brucellosis, otherwise known as undulant fever, is one of the most widespread zoonotic diseases in the world. Even though 9%-15% of stillbirths are known to be caused by infectious diseases, the study of the link between human Brucella melitensis and the termination of births in humans is a topic that has received little attention. This study examines if there was an association between infection of undulant fever, an endemic zoonotic disease in the Maltese Islands from 1919 until 1954, and reproductive loss through stillbirths.

Methods: A univariate descriptive analysis was used to show the temporal trend of undulant fever time, as well as the age and sex distribution. Time series analysis was used to assess the relationship between time (months) and undulant fever cases with stillbirth proportions.

Results: On the island of Gozo, the majority of undulant fever cases for both males and females occurred in their reproductive period between 15 and 45 years of age. Based on regression analysis, undulant fever had a statistically significant effect on the stillbirth rate for males (t = 2.8986, p = 0.0039). The effect of undulant fever on stillbirths was not significant for females (p = 0.9103).

Conclusion: This paper highlights the importance of undulant fever as having implications for the health burden in pregnant women and potential fetal loss through stillbirths in the contemporary context.

The increasing effects of climate change have intensified floods globally, especially in Africa, where millions of people live in poverty and are highly vulnerable to flooding. Climate change disproportionately affects the vulnerable, who are least equipped to handle its consequences, by exacerbating their situation. One such consequence is the potential for increased human immunodeficiency virus (HIV) transmission. Africa has been disproportionately affected by the HIV epidemic. It now faces the additional challenge of a changing climate and floods, which are capable of increasing HIV transmission in Africa through several pathways. They can force population displacement and migration, leading to the expansion of sexual networks among people living with HIV (PLWHIV). They may also create conditions conducive to the spread of other infections. Floods can cause food insecurity, which can result in various sexual behaviors that expose people to HIV infection. As global warming is linked to a decrease in African food production capacity, the effect of food insecurity on HIV may be prominent in countries where transactional sexual means is a major route of HIV transmission. Floods can also hinder the provision of HIV services, such as pre- and postexposure prophylaxis and antiretroviral therapy distribution, which may worsen the health outcomes of PLWHIV and promote HIV transmission, particularly in rural and remote communities. It is crucial to develop a climate-resilient framework, including education, sustained access to HIV services, and promotion of social welfare for HIV prevention and treatment, to address the complex relationship between HIV, floods, and climate change.

Background: Q fever, brucellosis, and leptospirosis are zoonoses typically associated with terrestrial animal reservoirs. These bacterial agents are now known to infect marine mammal species, though little is known about potential human health risks from marine mammal reservoir species. We investigated potential risks of these bacteria in humans associated with marine mammal exposure.

Methods: The Marine Mammal Center (TMMC) in Sausalito, California, requested a Health Hazard Evaluation by the National Institute for Occupational Safety and Health. In June 2011, an investigation occurred, which included a written questionnaire and serosurvey among workers for Coxiella burnetii, Brucella spp., and Leptospira spp., and an environmental assessment for C. burnetii.

Results: Serologic evidence of past exposure was detected in 4% (C. burnetii), 0% (Brucella), and 1% (Leptospira) of 213 participants, respectively. One of 130 environmental samples tested positive for C. burnetii. No significant marine mammal-specific risk factors were identified, but some safety deficiencies were noted that could lead to a higher risk of exposure to zoonotic diseases.

Conclusion: Although this study did not identify disease exposure risks associated with marine mammals, additional studies in different settings of other groups with frequent exposure to marine mammals are warranted. Some deficiencies in safety were noted, and based on these, TMMC modified protocols to improve safety.

Background: Leptospirosis is a zoonotic disease and a challenge to global public health. There is an occupational risk, particularly in populations with direct contact with animals and in high-humidity environments, which favors the survival of leptospires. This study aimed to determine the seroprevalence of leptospirosis in military personnel working in close contact with animals in México and to describe the available preventive measures and protection levels.

Methods: A cross-sectional study was conducted from March to October 2015. Information regarding protective factors in daily activities was gathered through a self-evaluation questionnaire. The serum samples of participants were analyzed through enzyme-linked immunoassay (ELISA) and microscopic agglutination test.

Results: Serums were obtained from 65 active military personnel, 56 males (86.2%) and 9 females (13.8%). Out of the total, 54 (83.1%) tested positive for infection by leptospirosis, 49 were males (87.5%) and 5 were females (55.6%). The highest seroprevalence age group was in the ≥45 years group (15, 23.07%), where all tested positive. Regarding military ranks, 100% of the highest hierarchy turned out positive: Officers (4 out of 4) and Chiefs (14 out of 14); and troops resulted in a seroprevalence of 76.5%. Protection equipment available during daily chores included: Overall, 64.6% had gloves and 53.8% had boots; the reported frequency for the use of gloves was 35.3% (46/65) if worn during more than half of the workday, yet 29.2% (19/65) reported never wearing them.

Conclusions: This study makes the petition to implement protocols of continuous training regarding labor risks and having an epidemiologic surveillance program for exposed personnel indispensable to improve the health and sanitary conditions of military personnel who work in direct contact with animals.