Public health challenges最新文献

Aim: To assess Early Childhood Caries by measuring the dmft, Significant Caries Index (SiC), pufa, and caries-free status in informal settlements outside Cape Town, South Africa over a 10-year period.

Method: A series of cross-sectional studies over a 10-year period (2009-2019). Surveys were carried out in preschools in informal settlements. A total of 5090 children aged from 1 to 5 years of age were examined.

Results: For 1- to 3-year-olds, the mean dmft was 4.33 ± 1.55, and for 4- and 5-year-olds, it was 6.34 ± 1.48. The difference in dmft for 1- to 3-year-olds increased but did not differ statistically between 2009 and 2019. For 4-5 years old, there was an increase over time. For 1- to 3-year-olds, the mean pufa was 0.34 ± 0.28, and for 4- to 5-year-olds, it was 0.63 ± 0.59. For 1- to 3- and for 4- to 5-year-olds, there was a statistically significant, lower pufa 2009-2019. For 1- to 3-year-olds, the mean SiC was 11.0 ± 2.35, and for 4- to 5-year-olds, it was 12.05 ± 1.89. There was a difference in SiC for 1-3 and for 4- to 5-year-olds, which was higher but did not differ statistically 2009-2019. Among 1- to 3-year-olds, 32.1% were assessed as caries-free. Among 4- to 5-year-olds, 16.0% were caries-free. There was a statistically significant, lower number of caries-free 1- to 3-year-old and 4- 5-year-old children 2009-2019.

Conclusions: The mean dmft has been found to be continuously high from 2009 to 2019. The SiC score remained unchanged, whereas pufa was significantly lower. The frequency of caries-free children was lower over time.

Interaction among humans, livestock, and wildlife plays an important role in zoonotic disease transmission. The emergence of Leptospira in humans, rodents, and cattle remains relatively understudied. A cross-sectional study was conducted between February and May 2023 in Muheza to determine evidence of Leptospira infection and associated factors in rodents, cattle, and humans. A total of 479 serum samples from rodents (n = 201), humans (n = 198), and cattle (n = 80) were examined by microscopic agglutination test (MAT) to detect antibodies against 6 live Leptospira stock culture serovars, including Pomona, Hebdomadis, Canicola, Grippotyphosa, Sokoine, and Lora. Additionally, a questionnaire survey was conducted on 140 respondents to determine factors that are associated with Leptospira seropositivity. Descriptive statistics and Chi-square test were used to analyze the data. The overall Leptospira seroprevalence in rodents, cattle, and humans was 6.0% (12/201; 95% CI: 3.12%-10.20%), 12.5% (10/80; 95% CI: 6.16%-21.79%), and 13.1% (26/198; 95% CI: 8.76%-18.65%), respectively, and the most predominant serovars were Grippotyphosa, Sokoine, and Hebdomadis. A significant difference in the seroprevalence was observed in occupation, whereby farmers were more likely to be infected with Leptospira than those in other occupations (χ ² = 9.19, df = 3, p = 0.027). This study showed co-agglutination among rodents, cattle, and humans with serovars Hebdomadis, Sokoine, and Grippotyphosa. People aged 36-59 had the highest seropositivity, suggesting they are the most at-risk group. This study shed light on pathogenic serovars circulating among humans, rodents, and cattle and factors associated with seropositivity. The findings appeal for multisectoral One Health approach for effective control of Leptospira infection and other zoonotic diseases.

Effective communicable disease surveillance is critical in Sudan to addressing the compounded health impacts of concurrent epidemics, health systems collapse and acute conflict. This article aims to map the strengths, weaknesses, opportunities and threats of Sudan's communicable disease surveillance systems before the current conflict to inform future health system rebuilding efforts. Despite existing for 50 years, little is published on Sudan's disease surveillance systems. We conducted a scoping review to map the existing evidence on Sudan's surveillance systems and utilized a strength, weakness, opportunities and threats (SWOT) analysis to identify current and future gaps and opportunities to improve the performance of these systems for communicable diseases in Sudan. Our review shows that, prior to the conflict, disease-specific surveillance and response activities were fragmented across various divisions of the Federal Ministry of Health, hindering a clear national-level hierarchy. Sudan has committed to strengthening its disease surveillance system as part of its national health sector policy. Efforts to bolster pandemic preparedness and response were and continue to be recognized as critical. Chiefly among them is the need to invest in a fit-for-purpose national surveillance system that can operate against a background of acute crisis. Greater transparency and data sharing, clear guidelines for communication and collaboration and a centralized data management system can enhance the effectiveness of Sudan's communicable disease surveillance systems. Investment in a consolidated national surveillance system can support more efficient and coordinated responses to outbreaks and other health emergencies, with a view to future health system reconstruction.

Background: Palliative care aims to alleviate suffering and improve the quality of life for patients with life-limiting illnesses through effective pain management with opioids. Despite its global importance, opioid use in palliative care faces significant challenges, particularly in resource-poor settings like Bangladesh. In Bangladesh, opioid use is notably low, with disparities between urban and rural areas. Cultural stigmas, strict regulations, and inadequate healthcare provider training further obstruct effective pain management.

Objective: This study aims to explore the challenges healthcare providers face regarding opioid use in both hospital and home-based palliative care settings.

Method: A descriptive cross-sectional study was conducted using face-to-face semistructured interviews with 135 licensed healthcare providers from August to September 2022.

Results: The respondents, predominantly young (57% aged 20-39) and female (68.9%), primarily manage late-stage cancer patients (98.5%), with pain (100%) being the primary symptom treated. Morphine syrup is commonly used (68.1%), whereas oxycodone and buprenorphine are unavailable. Side effects such as deep sedation (43.7%) and addiction (34.1%) highlight the need for careful monitoring. Limited awareness (10.4%) of national opioid policies results in inconsistent practices (p = 0.001) and (p = 0.004). Prescribing restrictions (60.7%) and dispensing rights issues contribute to operational challenges, affecting patient access to pain management. Misconceptions about palliative care (32.6%) and inter-departmental non-cooperation (38.5%) hinder patient referrals (p = 0.001) and continuity of care.

Conclusion: Inconsistent awareness of opioid policies causes varied practices and attitudes. Addressing referral challenges and prescribing restrictions requires interdisciplinary solutions, enhanced education, better policy dissemination, and standardized guidelines for effective palliative care opioid management.

Throughout the COVID-19 pandemic, effective risk communication emerged as pivotal in fostering positive behavioral changes that aligned with the evolving evidence and stages of the pandemic. It stood alongside key strategies like enhanced surveillance, extensive testing, stringent quarantine, and strategic case management in Bhutan's response. Over the last 3 years of the pandemic, we have gained profound insights into risk communication's impact. This article aims to illuminate diverse approaches in managing public information during the pandemic. The authors also suggest potential research agendas and policy and system-level reforms in the realm of risk communication.

Introduction: Health inequality, disparity, and inequity are critical global health challenges, particularly in low- and middle-income countries (LMICs). Africa's healthcare systems have been profoundly impacted by these issues for decades, leading to severe and far-reaching consequences. This rapid review aims to explore the concepts of health inequality, disparity, and inequity in Africa, identify their root causes, and propose practical recommendations to address them.

Methodology: A comprehensive search was conducted across PubMed, Google Scholar, the Directory of Open Access Journals (DOAJ), and through manual searches on Google to identify literature on health inequalities, disparities, and inequities in Africa. Key terms, such as "Health inequality," "Health disparity," "Health inequity," "Health injustice," "Health unfairness," "Healthcare access," and "Health challenges," were employed. The identified literature was carefully reviewed, and relevant sources were selected to discuss the concepts, causes, and potential solutions to these differences in health outcomes across Africa.

Results: Although some aspects of health inequality are linked to unmodifiable factors, health disparities and inequities are often the result of preventable and modifiable factors and can be addressed through targeted efforts. The root causes of health inequality, disparity, and inequity in Africa include poverty, inadequate education, corruption, poor governance, geographic isolation, unsupportive environmental conditions, cultural norms, and international influences. Solutions to these differences in health outcome lie in reversing the root causes.

Conclusion: Addressing health inequality, disparity, and inequity in Africa requires a multifaceted approach, including improving education, healthcare infrastructure, and gender equality, alleviating poverty, and ensuring fair governance to achieve equitable health outcomes.

Introduction: Adolescent pregnancy is a global concern, with a higher occurrence among more disadvantaged groups. Within Nepal's highly marginalized Chepang community, adolescent pregnancies are notably more prevalent. This study aimed to understand the determinants of adolescent pregnancy among Chepang community in Raksirang Rural Municipality, Makwanpur District of Nepal using qualitative methods.

Methods: The study was conducted from September 2022 to April 2023. Twenty participants (10 in-depth interviews and 10 key informant interviews) were recruited through judgmental sampling. An interview guide was used for interviewing the participants. All interviews were audio-recorded, transcribed, translated, and analyzed using R-based Qualitative Data Analysis package. Braun and Clarke's six-step thematic analysis was used to perform analysis.

Results: Six key themes were identified as determinants of adolescent pregnancy among Chepang community: (i) inadequate access to and use of sexual and reproductive health services, (ii) gaps in programmatic implementation, (iii) elopement marriage as a form of escape, (iv) discontinuation of education, (v) limited knowledge and understanding of marriage, pregnancy, and childbirth, and (vi) early pregnancy as a sign of prosperity. Challenges such as difficult geographical terrain, limited access to adolescent-friendly healthcare, gender inequality, child labor, weak enforcement of child marriage laws, and societal stigma exacerbated these determinants.

Conclusion: A multifaceted approach, including improved access to adolescent-friendly healthcare, enforcement of child marriage laws, access to secondary education, efforts to raise awareness of sexual and reproductive health, and a shift in sociocultural norms, should be implemented to reduce adolescent pregnancy in the Chepang community.

Background: The lack of a conceptual framework (CF) that can be utilized to manage the psychosocial well-being of orphans and vulnerable children present a challenge in the Vhembe district, South Africa.

Aim: This article sought to provide a CF for psychosocial support of OVC in the Vhembe district, South Africa using Practice-Oriented Theory and Donabedian's structure Outcome Model features.

Method: The study incorporated a four-phased research strategy using a multiphase mixed methods approach. An exploratory, descriptive design was used for the study. The practice-oriented theory of Dickoff et al. and Donabedian's SPO model provided a starting point in the ultimate development of the framework. Data were collected from three sources, orphans and vulnerable children n = 34, to explore and describe the experiences conducted with community-based workers working with orphaned and vulnerable children within the Vhembe district to explore possible approaches for psychosocial support towards orphans and vulnerable children n = 4, CBOS, and social workers n = 10 working with OVC in the Vhembe district to explore the possible approaches for psychosocial support towards OVC until data saturation.

Results: The study revealed that OVC faces many challenges including loss/absence of parents, living arrangements, deprivation and neglect, abuse and alienation. Challenges exist and this was confirmed by the qualitative findings with community-based workers and social workers, including lack of resources, lack of proper training, lack of funding and poor relationship between stakeholders and the absence of the CF that guide the provision of psychosocial support to OVC.

Conclusion: The study findings were conceptualized to describe and develop a framework for psychosocial support of OVC in order to improve the psychosocial well-being of OVC.

Objectives: We examined the association of loss of pregnancy-related Medicaid coverage with unmet health care needs, medical financial hardship, and health care use in postpartum women participating in a nationally representative household survey.

Design: Cross-sectional study design.

Sample and measurements: Using 2012-2018 National Health Interview Survey data, we classified postpartum women as either (1) having Medicaid coverage or (2) uninsured due to loss of pregnancy-related Medicaid coverage. We examined the relationship of loss of pregnancy-related Medicaid coverage with unmet health care needs, medical financial hardship, and health care use.

Results: Compared to Medicaid-insured postpartum women, uninsured women who lost pregnancy-related Medicaid coverage had significantly greater odds of delaying medical care due to cost, as well as greater odds of unmet need for medical care, mental health care, and prescriptions. Uninsured postpartum women who lost pregnancy-related Medicaid coverage also had significantly greater odds of medical financial hardship and lower odds of health care use.

Conclusions: Findings suggest that continued Medicaid coverage during postpartum could improve health care access among uninsured women experiencing loss of pregnancy-related Medicaid eligibility. These results hold important implications for the public health impact of recent policy efforts to extend Medicaid eligibility into the postpartum period.

Skin cancer mortality disproportionately affects low- and lower-middle-income regions despite the prevalence being lower than in high-income countries. Considering the need to diagnose it early for the best outcomes, this review addresses the barriers preventing it from being diagnosed and treated promptly and proposes possible solutions. Some of the barriers we found include the low number of dermatologists and pathologists, inadequate facilities, lack of education, the cost of healthcare, the denial of needing professional help, the fear and stigmatization of a skin cancer diagnosis, and the reliance on non-medical therapies. Meanwhile, solutions we identified are training programs for healthcare professionals and the public, technological advancements (including nanotechnology-based treatments, telemedicine, and social media use, the development and implementation of artificial intelligence programs), international collaborations, research, and increasing the number of cancer registries and national cancer control plans. Despite these solutions not being foolproof, they will lead to earlier cancer diagnosis, more individuals seeking skin check-ups, better knowledge of skin cancer, improving the quality of life of vulnerable populations, and decrease in mortality.