Public health challenges最新文献

Gambling advertising has become ubiquitous in sub-Saharan Africa influencing social norms and attitudes towards gambling. The delay or failure of governments to effectively regulate gambling advertising poses a significant threat to public health. This article provides contemporary insights into gambling advertising, its forms, mechanics and influence on gambling behaviour. It provides contextual understanding to policy-makers, health advocates and public health actors, including a call to action for effective regulation. With sub-Saharan Africa becoming important to the gambling industry for market growth and profits, there is the need for public health actors to instigate advocacy for strong regulations and enforcement of gambling advertising.

Background: Burnout, characterized by emotional exhaustion, depersonalization, and a diminished sense of accomplishment, is a serious problem among healthcare workers. Burnout negatively impacts provider well-being, patient outcomes, and healthcare systems globally and is especially worrisome in settings with shortages of healthcare workers and resources.

Methods: This study explores the experience of burnout among labor and delivery (L&D) providers in Tanzania, using three data sources. A structured assessment of burnout was collected at four timepoints from a sample of 60 L&D providers in 6 clinics. The same providers participated in an interactive group activity from which we drew observational prevalence data. Finally, we conducted in-depth interviews (IDIs) with 15 providers to further explore their experience of burnout.

Results: Prior to any introduction to the concept, 18% of respondents met criteria for burnout. Immediately after a discussion and activity on burnout, 62% of providers met criteria. One and 3 months later, 29% and 33% of providers met criteria, respectively. In IDIs, participants saw the lack of understanding of burnout as the cause for low baseline rates and attributed the subsequent decrease in burnout to newly acquired coping strategies. The activity helped them realize they were not alone in their experience of burnout. High patient load, low staffing, limited resources, and low pay emerged as contributing factors.

Conclusion: A lack of exposure to the concept of burnout leads to providers being unaware of the issue as a collective burden. Therefore, burnout remains rarely discussed and not addressed, thus continuing to impact provider and patient health.

Introduction: Iodine deficiency disorder (IDD) can lead to health issues as it is necessary for metabolic functions. This study investigated the iodine content of commonly consumed salt and the potential impact on daily iodine requirements and IDDs.

Methods: A cross-sectional survey was employed using multistage cluster sampling among 240 households, dividing them into eight clusters from four stratified areas. The sampled salts were analyzed using the World Health Organization's iodometric titration method.

Results: The study revealed that most salt samples from the studied brands had an iodine content within the Bangladesh Standards and Testing Institution (BSTI) recommended range of 20-50 ppm, with two exceptions. The study found that most socioeconomic groups in cities, towns, and semirural areas meet their daily iodine requirements at over 100%. At the same time, many rural homes, regardless of income, fail to meet these requirements. However, the study found iodized salt in 97.9% of all surveyed households. Although 48.3% of unions, that is, rural respondents, was knowledgeable about the existence of iodized salt, 66.7% of respondents was not aware of the health benefits of iodized salt. Surprisingly, 63.3% of the town's household members and 61.7% of the rural population still consume raw salt. Additionally, 79.6% of individuals reported having no IDDs. However, only 44.2% of thyroid patients used iodine supplements.

Conclusion: Although salt usage and consumption practices are satisfactory, there are still a few concerns about the 100% iodization of branded and raw salts. As a result, many households need help to satisfy their daily iodine requirements.

Background: Estimating malnutrition risk among hospitalized patients is challenging, yet critical due to its association with adverse outcomes such as prolonged hospital stays, increased mortality, impaired wound healing, depression, and increased hospital costs. This research study aims to evaluate the risk of malnutrition among Type 2 diabetic hospitalized patients and its impact on the patient's length of stay in two tertiary hospitals based in Kigali.

Method: In this retrospective cross-sectional study, 300 adult hospitalized Type 2 diabetic patients from Kigali's tertiary hospitals were enrolled between January 2021 and October 2022. Data collected include demographics, anthropometrics, serum albumin, and length of hospital stay. The nutrition risk index was used to determine malnutrition risk.

Results: Overall, 55.3% of hospitalized Type 2 diabetes patients was found to be at risk of malnutrition on the basis of the nutrition risk index. Gender distribution showed no significant difference (p = 0.724), with 56.6% females and 54.5% males at risk. Significant associations were found with age (r = 0.018, p = 0.017), hypertension as comorbidity (r = -0.169, p = 0.004), hospital stay duration (r = 0.139, p = 0.002), and blood glucose levels (r = -0.087, p = 0.001).

Conclusion: A study finds high malnutrition risk in hospitalized Type 2 diabetes patients, linked to longer stays and poor outcomes. Early malnutrition screening, proper nutrition support, and a multidisciplinary care team are crucial for improved clinical care and cost-effectiveness.

For over 70 years, the addition of fluoride to public water as community water fluoridation (CWF or fluoridation) with intent to prevent dental caries continues to be controversial, and risks are seldom included in monetary evaluations. Published operational costs and benefits of fluoridation are used, whereas published and clinical experience treating dental fluorosis are utilized to estimate treatment costs of patient-perceived dental fluorosis and lost wages from lower IQ (intelligence quotient). Published estimated caries averted, less operational costs at $8 PPPY (per person per year) were used, compensation for functional and cosmetic dental fluorosis $126 PPPY, and lower earnings from presumed harm of developmental neurotoxicity estimated at $438 PPPY. Net loss from CWF is estimated at $556 PPPY, although some individuals will have significantly more or less loss. Previous economic evaluations of fluoridation have estimated caries averted and costs of operations; however, few evaluations include the costs of treating harm. Fluoridation is not cost-effective if the cost of harm is included. Alternatives for the prevention of dental caries should be promoted, and the cessation of fluoridation is indicated.

Background: Depression among patients with sickle cell disease (SCD) is crucial as it is often underdiagnosed and undertreated. Therefore, this study aimed to determine the prevalence of depression and to identify its determinants.

Methods: This cross-sectional study was conducted in the Bardiya district of Nepal, based on registered cases of SCD. Depression was measured using the validated Nepalese version of the Beck Depression Inventory (BDI). A random sample of 358 participants with SCD aged >13 years was included in the study. Descriptive and inferential statistics were applied to sociodemographic, clinical and psychological variables. Logistic regression analysis was performed for bivariate analysis. Variables with a p value of less than 0.05 were subjected to final multivariate logistic regression.

Results: The prevalence of depression was 36.31% among patients with SCD, age (p = 0.0178), education (p = 0.0178) and sociodemographic status (p = 0.0328) were strongly associated. Factors such as patients aged 40-49 years (adjusted odds ratio [AOR] = 3.05), complications due to SCD (AOR = 1.86) and genetic counselling group (AOR = 4.72) had higher chances of experiencing depression compared to their relative counterparts. However, patients with lower middle-class economic status, who experience pain crisis, with moderate self-esteem and who experience discrimination were 52%, 83%, 58% and 58% less likely to have depression compared to their respective counterparts, respectively.

Conclusions: Depression was prevalent in patients with SCD, and multiple sociodemographic, clinical and psychological factors were strongly associated. This warrants the urgent need for early diagnosis and treatment of depression among participants with SCD.

Introduction: Globally malnutrition is considered one of the greatest threats to public health, particularly in low- and middle-income countries. The present study examined the extent of undernutrition and the associated determinants among children aged 6-59 months in Bangladesh using data from the Nutrition Survey of Bangladesh (NSB), 2017-18.

Methods: The sampling frame of NSB 2017-18 was specified by a 30 (locations) × 30 (households) cluster approach where 20 locations were from rural areas and the other 10 were from urban areas. Out of the sampled households, 566 children aged between 6 and 59 months were included in the analysis. Determinants of three anthropometric measures, weight-for-age (stunting), weight-for-height (wasting), and weight-for-age (underweight), were analyzed using a multiple logistic regression model.

Result: The prevalence of stunting, underweight, and wasting of children was 34.5%, 40.6%, and 20.1%, respectively. Although the child's age, family size, cleanliness of the residential area, and food insecurity were significant determinants of malnutrition, inadequate and low-quality protein consumption strongly predicted the development of underweight and stunting in infants and children. The odds of being stunted were 2 times (adjusted odds ratio [AOR]: 2.02, 95% confidence interval [CI]: 1.17-3.46; p = 0.011) and underweight was almost 2.5 times (AOR: 2.41; 95% CI: 1.27-4.56; p < 0.01) higher, respectively, among children who consumed inadequate amounts of protein.

Conclusion: Because the percentage of children from wealthy families was relatively low in the present study, cleanliness of residential areas, food insecurity, and inadequate protein intake are likely to be key drivers of malnutrition in Bangladesh, which might be significantly reduced with better coverage of preventive nutrition programs.

Tobacco farming and tobacco control are closely inter-related issues, particularly in developing countries that are heavily reliant on tobacco farming like Malawi. This commentary explores the relationship among tobacco farming, economic sustainability, and public health, focusing on the context of Malawi as one of the major tobacco producers in Africa. Malawi's economy is significantly dependent on tobacco farming, yet the country also struggles with smoking-related health risks, creating a dilemma between socioeconomic and public health considerations. The commentary highlights the lack of empirical evidence regarding the socioeconomic implications of tobacco control measures on tobacco farming in the country. Moreover, despite the country's economic dependence on tobacco farming, a majority of cigarettes consumed domestically are imported, demonstrating the complexity of Malawi's tobacco industry. On public health implications, the article highlights the disease and death burden that is a result of tobacco smoking, underscoring the need for tobacco control measures. The article further draws insights from tobacco end-game strategies in other countries and proposes a comprehensive approach to tobacco control. However, the article notes Malawi's limited financial resources and healthcare infrastructure to implement traditional tobacco control measures and highlights an emphasis on tobacco harm reduction, a third pillar of the Framework Convention on Tobacco Control. The article also advocates for an emphasis on alternative livelihood opportunities for smallholder tobacco farmers in Malawi.

Background: Vaccination protects the population against infectious diseases and reduces their transmissibility. Potentials exist for local production of vaccines in Nigeria, as a means of addressing public health needs. However, challenges exist in certain critical aspects which limit development in this area. This study aimed at evaluating the challenges of local vaccines' manufacturing in Nigeria from the perspectives of relevant stakeholders.

Methods: This was a cross-sectional study. A structured questionnaire was used for data collection. The data obtained from the study were analysed descriptively.

Results: More than half of the study participants (55.5%) agreed that significant gaps exist with respect to access to vaccines in Nigeria. Only about one-quarter of the respondents (25.8%) were of the view that relevant legislative frameworks exist to support government funding in the area of vaccine production. One-third of the participants (32.3%) expressed confidence in the availability of trained human resources for vaccine production. Close to two-thirds of the respondents (61.7%) expressed dissatisfaction regarding the current funding for vaccine research and development, and a similar proportion (65.2%) were of the opinion that a lack of local manufacturing capacity contributed to the sub-optimal access to vaccines. Moreover, two-thirds (62.3%) disagreed that Nigeria was prepared for future pandemics.

Conclusion: Ill-suited policies, sub-optimal infrastructure, and inadequate research and development funding, are some factors which the study identified as contributory to the lack of access to vaccines in Nigeria. There is a need to improve incentives, infrastructural development and build human resource capacity for vaccine research and development to enhance local production in Nigeria.

Background: Antimicrobial resistance (AMR) presents a significant global mortality burden which particularly affects the low- and middle-income countries (LMICs). Enhancing diagnostics to identify drug-resistant infections and improving appropriate access to novel Reserve antibiotics in LMICs can address AMR-related morbidity, mortality and healthcare costs. This article characterizes the AMR landscape across 14 LMICs and describes an introductory pathway for novel Reserve antibiotics.

Methods: This mixed-method study was completed in 14 LMICs in Africa, the Americas, Asia and Europe through a combination of qualitative interviews with physicians and public health experts (PHEs), and a quantitative survey of physicians, supported by an assessment of secondary materials relating to antibiotic introduction and AMR burden.

Results: A total of 54 physicians and 17 PHEs were interviewed, and 209 physicians participated in the survey. Top unmet needs across public and private settings were as follows: access to new antibiotics to better manage drug-resistant infections; affordability; adequate safety profile for prescribed antibiotics. Access to diagnostics and antibiotic susceptibility testing was noted as a barrier, with large tertiary and private centres experiencing better access. Implementation of antibiotic stewardship programmes was variable and limited by insufficient funding, shortage of infectious disease physicians, poor AMR education and lack of restrictions to limit antibiotic use. Antibiotic access varies by sector, centre type, location and strength of individual state procurement systems. In particular, private sector facilities have better access to Reserve products. In most countries, most Reserve antibiotics included in WHO's Essential Medicines List (EML) were not included in national EMLs or not registered in countries.

Conclusion: This study has helped to identify common barriers and pathways to Reserve antibiotic access, irrespective of the level of preparedness of countries. The data offer insights into possible solutions to improve access and highlight opportunities to strengthen access pathways and expedite access, for example, by identifying priority antibiotics based on national public health need. A six-step introductory pathway for novel Reserve antibiotics is described.