Public health challenges最新文献_第9页

Prevention and Management of Multimorbidity in Southeast Asia: A Narrative Review 东南亚多发病的预防和管理：叙述性综述

Public health challenges

Pub Date : 2024-07-15 DOI: 10.1002/puh2.218

Xiyu Feng, Haribondhu Sarma, Matthew Kelly

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.

多病共存是指同时存在两种或两种以上的慢性病，这是一个日益严峻的全球性挑战，尤其是在东南亚等中低收入国家。在这种趋势下，有必要发展可持续的综合护理模式，以有效预防和管理多发病。然而，这一领域的进展一直受到各种障碍的阻碍，尤其是在欠发达地区，这些障碍包括多病流行病学、如何让不同的专家和医生最有效地合作并管理多种用药问题，以及如何制定具有成本效益的方法来减轻多病带来的健康负担。东南亚的预防措施可以解决通常由多种因素构成的多病问题，包括通过学校和社区的教育活动、初级医疗保健以及对烟草、酒精和含糖饮料征税的相关政策来提高健康素养和促进健康。健康的社会决定因素--包括贫困和教育水平低，也可能影响多病症的研究。此外，国家政府、世界卫生组织（WHO）和东南亚国家联盟（ASEAN）等利益相关方的参与也至关重要。管理策略侧重于综合护理模式，包括以患者为中心的初级医疗保健、数字医疗保健技术和药物管理，以控制多种药物的使用。虽然东南亚有关多药并发症的研究在不断增加，但将研究结果转化为实际措施的工作却很有限。未来的工作应优先考虑以证据为基础的方法，有效预防和管理多药并发症，应对医疗系统独立关注单一慢性病治疗、资源限制、医疗服务提供者短缺和个人依从性问题等挑战。这些方法有望提高该地区的生活质量和健康水平。

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引用次数: 0

Improving Sustainable Financing for Universal Health Coverage in Bhutan: Exploring Policy Options and Financial Strategies 改善不丹全民医保的可持续融资：探索政策选择和财务战略

Public health challenges

Pub Date : 2024-07-08 DOI: 10.1002/puh2.216

Ugyen Tshering, Jayendra Sharma, Dorji Tshering, Tandin Dendup

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.

不丹的医疗系统深深植根于其国民幸福总值（GNH）的发展理念，努力实现全民医保（UHC）的共同目标。尽管医疗系统主要由政府资助，但仍面临着诸多挑战。要克服这些障碍，实现全民医保目标，扩大医疗卫生的财政空间和提高运营效率至关重要。本文旨在通过两个政策方案来应对不丹不断变化的医疗保健形势，并推进全民医保的实现。第一种政策方案侧重于通过利用医疗税收来改善医疗成果和促进财政可持续性的双重目标，而第二种方案则强调在不丹医疗系统中加强系统的医疗技术评估（HTA）。首先，借鉴全球经验，政策简报建议利用卫生税降低社会和医疗成本，增强卫生部门的财政可持续性。考虑到不丹烟酒消费的高流行率，并利用正在进行的商品和服务税（GST）改革的契机，继续倡导征收健康税至关重要，可考虑将健康税软性专用于资助更广泛的公共卫生计划，特别是侧重于推广健康的生活方式、健康检查和外联公共卫生活动。其次，将 HTA 纳入政策制定和决策过程对于有效分配全民保健中的资源至关重要。培育和加强卫生部现有的 HTA 治理结构，并建立一个专门的多学科 HTA 委员会，将确保知情决策和资源优化。HTA 证据应为医疗服务标准的修订、临床指南的制定、采购决策和医疗保健优先事项提供依据。这些政策选择可以帮助该国提高财政可持续性，加强资源的有效分配和利用，改善医疗服务的提供，实现国民健康总值（GNH）的愿景，并最终加快实现全民医保（UHC）的进程。

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引用次数: 0

Dietary Diversity and Nutritional Status Among Rwandan Women Engaged in Agriculture: A Cross‐Sectional Study 卢旺达农业妇女的膳食多样性和营养状况：横断面研究

Public health challenges

Pub Date : 2024-07-08 DOI: 10.1002/puh2.214

Sunday François Xavier, Philemon Kwizera, Yves Didier Umwungerimwiza, Rutayisire Reverien, Kanimba Philbert, Ilinde Niyigena Delice, Maryse Umugwaneza

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。

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引用次数: 0

Contraceptive Counselling and Uptake Among Female Kidney Transplant Recipients in Ethiopia 埃塞俄比亚女性肾移植受者的避孕咨询和接受情况

Public health challenges

Pub Date : 2024-07-08 DOI: 10.1002/puh2.215

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.

肾移植患者的避孕咨询和使用是肾移植护理的重要组成部分。在非洲，对使用标准化的避孕方法信息来防止移植后意外怀孕的研究普遍较少。这项研究旨在描述埃塞俄比亚一家肾移植中心的肾移植受者的避孕咨询和接受情况。2023年4月15日至7月15日，圣保罗医院千禧医学院（埃塞俄比亚）对埃塞俄比亚女性肾移植受者的避孕咨询和接受情况进行了描述性研究。通过使用结构化问卷对参与者进行访谈，收集了有关女性社会人口学、肾移植和避孕咨询及使用情况的数据。数据使用 SPSS 23 进行简单描述性分析。共有 60 名参与者参与了最终分析。参与者的平均年龄为 33.7 ± 8.4 岁。距离肾移植时间的中位数为 19 个月。大多数参与者（49/60，81.7%）表示，他们在移植后早期没有接受过有关避孕方法的计划生育咨询。在这项研究中，女性肾移植受者的避孕咨询率和避孕率都非常低，这与之前的研究结果一致。通过适当的避孕咨询提高女性肾移植患者对安全有效使用避孕药具的认识至关重要。

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引用次数: 0

Periodontal Health Among Pregnant Women in Sri Lanka: A Cross‐Sectional Study 斯里兰卡孕妇的牙周健康：一项横断面研究

Public health challenges

Pub Date : 2024-07-03 DOI: 10.1002/puh2.209

Kavithrini Anunadika Gammulle, Manori Dhanapriyanka, Meghashyam Bhat

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.

斯里兰卡育龄妇女的牙周病发病率相当高。本研究旨在评估在斯里兰卡具有挑战性的社会政治背景下，在社区产前检查诊所（ANC）就诊的孕妇的口腔卫生状况、牙龈状况及相关因素。诊所的选择采用了概率与规模成比例的两阶段整群抽样法。采用系统抽样法从每个诊所招募孕妇。60%以上的孕妇口腔卫生状况不佳。其中 23.3% 的孕妇患有中度至重度牙龈炎。近 67% 的参与者对牙周疾病的了解有限。其中约 67% 的人失业，32.5% 的人月收入低于 40,000 斯里兰卡卢比。回归分析表明，三个月、社会经济因素、看牙频率、全口洗牙频率和牙周病知识可预测口腔卫生状况，而年龄、三个月、刷牙频率、全口洗牙频率和牙周病知识可显著预测牙龈健康状况。口腔卫生和牙龈健康状况不佳、获得牙科护理的机会有限以及牙周健康知识不足，都凸显出迫切需要采取干预措施，如通过教育和就业措施增强年轻女性的能力。

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引用次数: 0

Responsive Complementary Feeding Practices in Rural Muhanga District of Rwanda: A Mixed Methods Study 卢旺达 Muhanga 农村地区的响应性补充喂养实践：混合方法研究

Public health challenges

Pub Date : 2024-07-02 DOI: 10.1002/puh2.206

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.

婴幼儿（IYC）的顺应性喂养决定了他们对食物的接受程度和充足的膳食摄入量，从而促进生长发育。然而，人们对卢旺达婴幼儿的顺应性喂养实践知之甚少。本研究探讨了卢旺达穆汉加区（Muhanga District）农村地区母亲采取顺应性喂养的现状和障碍。这项描述性纵向和探索性混合方法研究的对象是穆汉加区（Muhanga District）两个农村医疗中心的 29 位母亲。研究人员对母亲进行了访谈，并观察了她们在 6 个月、9 个月和 12 个月的午餐期间与孩子的互动。研究结果表明，在喂养过程中口头鼓励孩子进食的母亲人数随着孩子年龄的增长而增加。在收集数据的所有三个时间点（6 个月、9 个月和 12 个月），报告并观察到允许孩子自己进食、在喂食时微笑并与孩子交谈的母亲不到半数。在喂养过程中母子互动的主要障碍是由于其他责任的负担和贫困而缺乏时间。研究结果表明，由于缺乏时间、贫困和担心孩子在自我喂养过程中浪费食物，研究中的母亲较少采用顺应式喂养。该社区的营养干预措施应考虑通过教育提高人们对顺应喂养做法的认识，并鼓励母亲在喂养过程中投入足够的时间与孩子互动。

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引用次数: 0

Knowledge, Attitudes and Practices of Health Workers and Caregivers Towards Retinopathy of Prematurity in Uganda: A Mixed‐Methods Study 乌干达卫生工作者和护理人员对早产儿视网膜病变的认识、态度和做法：混合方法研究

Public health challenges

Pub Date : 2024-07-02 DOI: 10.1002/puh2.208

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.

早产儿视网膜病变（ROP）是一个重大的全球性问题，也是导致可预防的儿童失明的主要原因。对有风险的早产儿进行早期筛查和及时治疗至关重要。要有效实施这一策略，护理人员和医务工作者必须充分了解早产儿视网膜病变。这项研究在评估乌干达护理人员和医护人员对早产儿视网膜病变的认识、态度和做法方面发挥了重要作用，为了解目前对这一疾病的理解和处理方法提供了宝贵的见解。其中包括 12 名儿科医生、56 名新生儿护士和 146 名护理人员，他们都在医疗保健系统中发挥着重要作用。研究在乌干达的两家三级医院新生儿诊所进行。研究人员采用结构化问卷收集参与者的知识、态度和实践数据。我们招募了 146 名护理人员，他们的平均年龄为 29.4 岁（±标准差 6.5）岁，其中 12 名儿科医生的中位年龄为 37 岁（IQR：36-41），56 名护士的中位年龄为 35 岁（30-42）。新生儿科医护人员的工作年限中位数为 3 年（IQR：1.8-4.2 年）。32名护理人员（21.92%）和28名医护人员（49.12%）对早产儿视网膜病变有较好的了解，而9名护士和2名儿科医生对早产儿视网膜病变一无所知。阻碍早产儿视网膜病变筛查的因素包括资源有限（设备、时间和专业人员）以及家长参与有限。加强医疗团队之间的合作有可能改善早产儿视网膜病变筛查工作。由于护理人员对早产儿视网膜病变的了解不足，因此需要加强对他们的教育，提高他们对早产儿视网膜病变及其风险因素的认识。

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引用次数: 0

Consumer Financial Protection Versus Catastrophic Healthcare Expenditure in Zambia 赞比亚的消费者财务保护与灾难性医疗支出

Public health challenges

Pub Date : 2024-07-02 DOI: 10.1002/puh2.207

MccPowell Fombang, R. Wanzala

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.

医疗保健的自付费用（OOP）被视为灾难性支出，尤其是当自付费用占到贫困家庭有效收入的很大一部分时。本研究探讨了灾难性医疗保健支出（CHE）的频率和严重程度，以评估赞比亚现行医疗保健体系提供的货币保障水平。这项研究依赖于在 10 个不同省份开展的 2014 年赞比亚家庭医疗保健支出和使用情况调查。被调查人口被分为五等分，将家庭单位分为五组，每组占人口的 20%。数据分析采用了描述性统计、方差分析和五分位数之间的配对比较。在 5%的显著性水平下，对非食品支出中的非处方药医疗支出平均值进行配对分析，发现五分位数的平均值在统计上存在差异。如果以 10%为限，集中指数为-0.41，而五分位数为-0.67。在 10%的限制下，调整后的人数（）为 0.37，调整后的超调（）为 0.15%。然而，与富裕人群相比，不幸人群更容易受到 CHE 的影响。因此，政策改革应强调保护穷人和弱势群体，以实现全民医疗保健（UHC）的目标。最后，建议开展研究，将公平和质量纳入医疗保健服务的使用中。

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引用次数: 0

Delivery of Mental Health Services in Bhutan: Challenges and Way Forward. 在不丹提供精神保健服务：挑战和前进的道路。

Public health challenges

Pub Date : 2024-06-30 eCollection Date: 2024-09-01 DOI: 10.1002/puh2.211

Kelzang Gyeltshen, Bikram Chhetri, Dawa Gyeltshen

Bhutan is known for its developmental philosophy of Gross National Happiness. Bhutan introduced mental health services in 1997 with the launch of Mental Health Program. Mental health includes psychological, emotional, and social well-being. The Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital in the capital city Thimphu is the only psychiatric unit providing specialized mental health services in Bhutan. The psychiatric unit consists of multidisciplinary team rendering both out- and in-patient mental health services. However, mental health services were gradually integrated in district hospitals, Primary Healthcare Centres and in schools. Although mental health services are an essential component of the healthcare system, the system faces numerous difficulties. Inaccessibility to mental health services due to geographical location and inadequate mental health professionals poses challenges in addressing mental health issues. Mental health issues are perceived differently, and the people with mental health issues often suffer from stigmatization creating barriers in seeking mental health services. Therefore, misconception and stigma associated to mental illness also cause greater challenges in delivering mental health services. Mental health funding has been substantially lower than the World Health Organization recommended mental health budget, amounting to 1% of health budget. Inadequate mental health funding remained a serious concern for the last few decades. Adequate mental health funding is vital in expanding the overall Mental Health Program and improving both the quality and quantity of mental health professionals. Additionally, enhancing community mental health initiatives will reinforce mental health services. Furthermore, there is a need for advancements in evidence and mental health research to support evidence-based practices and enhance mental health literacy.

不丹以其国民幸福总值的发展理念而闻名。1997年，不丹启动了《心理健康方案》，推出了心理健康服务。心理健康包括心理健康、情感健康和社会健康。首都廷布的吉梅·多吉·旺楚克国家转诊医院精神病科是不丹唯一提供专门心理健康服务的精神病科。精神科由多学科团队组成，提供门诊和住院精神卫生服务。不过，地区医院、初级保健中心和学校逐渐纳入了精神保健服务。虽然精神卫生服务是医疗保健系统的重要组成部分，但该系统面临着许多困难。由于地理位置和心理健康专业人员不足，无法获得心理健康服务，这对解决心理健康问题构成挑战。人们对精神健康问题的看法不同，有精神健康问题的人往往遭受污名化，这在寻求精神健康服务方面造成了障碍。因此，与精神疾病有关的误解和耻辱也给提供精神卫生服务带来了更大的挑战。精神卫生资金大大低于世界卫生组织建议的精神卫生预算，仅占卫生预算的1%。过去几十年来，精神卫生资金不足仍然是一个严重问题。充足的精神卫生资金对于扩大整个精神卫生方案和提高精神卫生专业人员的质量和数量至关重要。此外，加强社区精神卫生举措将加强精神卫生服务。此外，需要在证据和心理健康研究方面取得进展，以支持循证做法并提高心理健康素养。

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引用次数: 0

Detection of Salmonella and Escherichia coli along the Fish Value Chain in Bahir Dar City, Ethiopia. 埃塞俄比亚巴希尔达尔市鱼类价值链上沙门氏菌和大肠杆菌的检测。

Public health challenges

Pub Date : 2024-06-30 eCollection Date: 2024-09-01 DOI: 10.1002/puh2.204

Temesgen Sendekie Ayalew, Habtamu Tassew Tarekegn, Belayneh Getachew Ayalew

Background: Fish is a possible source of foodborne infections with Salmonella and Escherichia coli. This study was conducted to identify Salmonella and E. coli along the fish value chain in Bahir Dar City, Ethiopia.

Methods: A cross-sectional study was undertaken with purposive sampling. A total of 121 specimens comprising fresh fish, retailing fish, filleted and cooked fish, swabs, and water samples were collected. Both culture based and molecular methods were used for detection.

Results: E. coli isolated from 41 (33.88%) and Salmonella from 6 (4.96%) specimen. The highest E. coli isolation rate was from retailing fish 16 (80%), whereas the highest Salmonella isolation rate from filleted tissue 2 (20%). At restaurants, 12 (30%) samples were positive for E. coli and 3 (7.50%) for Salmonella. All 41 E. coli isolates were resistant to amoxicillin/clavulanate, whereas no resistance was shown for gentamicin and amikacin. Two thirds of Salmonella isolate and 95.12% of E. coli were detected as they develop multidrug resistance. The highest rate of resistance was recorded for ceftazidime against all (n = 6) isolates of Salmonella species. From a total of 10 E. coli isolates tested by PCR, 4 were positive for hemolysin A1 and/or eae virulence genes.

Conclusions: The study detects the potential biological hazards along the value chain. Hygiene of fish handlers and their working environment and proper fish cooking are highly valuable. One health campaign should be carried out on drug resistance, contamination of the lake, and fish safety.

背景：鱼是沙门氏菌和大肠杆菌食源性感染的可能来源。本研究旨在鉴定埃塞俄比亚巴希尔达尔市鱼类价值链上的沙门氏菌和大肠杆菌。方法：采用目的抽样进行横断面研究。共收集了121个样本，包括鲜鱼、零售鱼、鱼片和熟鱼、棉签和水样。采用培养法和分子法进行检测。结果：检出大肠杆菌41例（33.88%），沙门氏菌6例（4.96%）。大肠杆菌分离率最高的是零售鱼16(80%)，而沙门氏菌分离率最高的是肉片组织2（20%）。在餐馆，12个（30%）样本呈大肠杆菌阳性，3个（7.50%）样本呈沙门氏菌阳性。所有41株大肠杆菌分离株均对阿莫西林/克拉维酸耐药，而对庆大霉素和阿米卡星无耐药。检出三分之二的分离沙门氏菌和95.12%的大肠杆菌出现多药耐药。头孢他啶对所有（n = 6）株沙门氏菌的耐药率最高。PCR检测的10株大肠杆菌中，4株溶血素A1和/或eae毒力基因阳性。结论：研究发现了价值链上潜在的生物危害。鱼处理人员及其工作环境的卫生和正确的鱼烹调非常重要。应该开展一项关于耐药性、湖泊污染和鱼类安全的卫生运动。

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引用次数: 0