Abstract Multiple long-term conditions (MLTCs) defined as the co-occurrence of ≥2 chronic conditions are rising in low- and middle-income countries such as India. MLTCs can require continued medical support, investigations, and medications calling for health system strengthening. This highlights the need for assessing the burden of MLTC in the community. We estimated the prevalence of MLTCs and assessed their social determinants in Odisha, India. A cross-sectional study was conducted in two villages of Khordha district, Odisha, employing a systematic random sampling method. We recruited 530 adults aged ≥18 years between March and June 2023. Prevalence was presented as frequency and proportion, along with a 95% confidence interval (CI) as a measure of uncertainty. The relationship between MLTCs (≥2 conditions out of 28 assessed chronic conditions) and various sociodemographic traits – such as age, gender, education, and employment elicited using a validated Multimorbidity Assessment Questionnaire for Primary Care tool was examined through a multivariable logistic regression model. Results were expressed as adjusted odds ratios (AOR) with 95% CI. The overall prevalence of MLTCs was 29.21% (95% CI: 25.4–33.32). Individuals aged 60 years or older (AOR: 23.56 [95% CI: 7.55–73.53]), compared to those aged 18–30 years, and those residing in rural areas (AOR: 3.18 [95% CI: 1.70–5.92]), compared to their urban counterparts, were more likely to have MLTCs. Almost one-third of the adults had MLTCs that suggest an immediate need to develop, strengthen, and promote healthcare services for chronic conditions in the community that is accessible and cost-effective.
Abstract This study aimed to estimate the prevalence of electronic media exposure among 18-month-old children and to identify associated factors in Khon Kaen Province. This was a descriptive cross-sectional study. Data were collected from 247 caregiver–child pairs visiting the primary care unit for their children’s 18-month vaccination, using a structured questionnaire, between February and July 2021. The primary outcome was electronic media exposure, which was defined as the child’s engagement with or exposure to electronic devices, including mobile phones and television. Descriptive statistics and Poisson regression with robust standard errors were applied to directly estimate crude and adjusted prevalence ratios (aPR). The study found that 52.2% of mothers were using electronic media to assist in child-rearing. Statistically significant characteristics of electronic media use in children at 18 months were identified ( P < 0.05) include primary caregivers with marital status divorced/separated (aPR = 0.50, 95% confidence interval [CI] = 0.27–0.91, P = 0.023), primary caregivers unemployed (aPR = 1.30, 95% CI = 1.01–1.69, P = 0.046), and 2–4 family members in family (aPR = 1.39, 95% CI = 1.02–1.90, P = 0.036). This study’s findings can guide the promotion, prevention, and care of early childhood regarding electronic media use.
Abstract Background: Although Bhutan has recently advanced beyond response to preventive services for violence against women and children, there is limited data on adolescent violence to inform policy and interventions, highlighting the need for studies like the 2016 Global School-based Health Survey (GSHS). Methods: We have analyzed the Global School-based Student Health Survey-2016, Bhutan, to assess the burden and pattern of violence among school-going adolescents (13–17 years). Two-stage cluster sampling was done; fifty schools were selected based on probability proportional to enrollment size from where classes 7 to 11 were selected using systematic sampling. Result: Of the 5808 students, 3255 (56.0%) were female and 3184 (54.8%) were day scholars. Overall, 3528 (60.7%) experienced at least one form of violence, and 2305 (57.7%) had more than one form. Involved in physical fights (39.8%), physically attacks (38.5%), bullied (26.3%), and experienced sexual violence (7.1%) were reported in descending order. The prevalence of bullying and sexual violence did not significantly differ between boys and girls. Adolescents who were younger and have reported suicidal tendency (adjusted prevalence ratios [aPR]: 1.81, 95% CI: 0.54–2.13), using tobacco (aPR: 1.72, 95% CI: 1.44–2.05), using alcohol (aPR: 1.61, 95% CI: 1.36–1.91), boarding students (aPR: 1.50, 95% CI: 1.33–1.69), reporting stress (aPR: 1.43, 95% CI: 1.15–1.78), poor social support (aPR: 1.32, 95% CI: 1.13–1.53), male (aPR: 1.28, 95% CI: 1.13–1.46), and poor parental understanding of the problem (aPR: 1.13, 95% CI: 1.00–1.26) experienced higher prevalence of any violence. Conclusion: A higher prevalence of violence among younger and boarding students calls for focused interventions.
Abstract Background: Breast cancer accounts for 26.6% of cancers among Indian women. Lack of awareness and fear lead to late-stage presentations and high mortality. This study aims to describe a novel community participatory model for cancer control in a Grama Panchayat in northern Kerala. Methods: The screening program in the Grama Panchayat was preceded by systematically planned, multifaceted, community-level cancer awareness activities, under the leadership of the Local Self Government Institution and technical support from a Comprehensive Cancer Care Center. Results: The activities led to a screening participation rate of 96% among women above 30 years, in a breast cancer screening camp organised in the Grama Panchayat. Out of the 203 (6.2%) referred, 135 women (66.5%) underwent further investigations. The detection rate was 0.96 per 1000, all in the early stages. Conclusion: Continuous community sensitization about cancer, alleviation of fear and misconceptions, accessible and approachable screening program settings, and an efficient patient navigation system, led by female Local Self Government Institution members, culminated in the successful ’Kannapuram Model’, in terms of screening participation and treatment adherence.
Abstract Vaping was introduced as an alternative to traditional cigarettes to reduce health risks attributed to smoking. However, after the initial hype, soon adverse effects of vaping were reported, including e-cigarettes or vaping-associated lung injuries (EVALI). Despite the availability of evidence that vaping has health risks, its popularity has significantly increased among adolescents and youth. Acknowledging the negative consequences of vaping, there is a definite need to implement targeted public health interventions to reduce the incidence and impact of EVALI, especially among vulnerable population groups. A range of challenges has been identified that can act as barriers to reducing the impact of EVALI, and there is an indispensable need to overcome these for better outcomes. In conclusion, vaping-induced lung injuries can affect any user, and they are not a safer alternative to smoking as was thought earlier. Considering the extent of damage, these products can cause due to the presence of harmful components, it is the need of the hour to adopt multifaceted and proactive solutions to effectively address EVALI and prevent future cases.
Abstract Background: Tobacco smoking remains a significant global public health issue, with electronic cigarette (e-cigarette) use surging in both high- and low-income countries. Objective: This study aimed to examine the determinants of e-cigarette use among Indonesian adults. Methods: We analyzed Indonesia’s 2021 Global Adult Tobacco Survey (GATS). We included a total of 4392 adults aged > 15 years selected through a multistage clustered sampling design. To investigate the association between covariates (age, sex, education, occupation, household wealth, place of residence, smoking status, knowledge, and advertisement) and e-cigarette use, we used multiple logistic regression analysis adjusted for the complex survey. Results: The weighted prevalence of e-cigarette use was 5.4%. The use of e-cigarettes was associated with adults aged 25–44 years (adjusted odds ratio [AOR] = 0.41, 95% confidence interval (CI) = 0.26; 0.63) and 45 years or older (AOR = 0.12, 95% CI = 0.06; 0.23), being in the richest household (AOR = 2.57, 95% CI = 1.27; 5.10), history of quitting smoking (AOR = 7.01, 95% CI = 2.15; 22.8), current smoking status (AOR = 20.49, 95% CI = 5.99; 70.10), perception that e-cigarette causes serious illness (AOR = 0.60, 95% CI = 0.41; 0.88), and exposure to electronic cigarette advertisement from the Internet (AOR = 1.67, 95% CI = 1.09; 2.57). Conclusion: Various factors influence the use of e-cigarettes. There is an urgent need for comprehensive tobacco control and prevention efforts, particularly among those at a higher risk of using e-cigarettes. Social behavior change communications and strict policies on e-cigarette marketing and advertising are the keys to reducing e-cigarette use.
Abstract Background: Public health authorities and decision-makers need the tools, capacity, and information necessary for assessing health needs, choosing intervention strategies, and drafting policy guidelines. Inadequate information about the oral health of populations leads to ineffective policies. Materials and Methods: A total of 47,837 randomly selected individuals participated in the study: 19,760 from urban regions and 28,077 from rural regions. The study population was the World Health Organization-specified index age groups of 5, 12, 35–44, and 60 years and above, which was modified for the Indian population. Information was collected for demographic details, behavioral practices, available infrastructure, workforce, and public dental services provided in each district. Oral examinations were conducted at individual households for dental caries, periodontal disease, malocclusion, dental fluorosis, and oromucosal lesions. Risk factors for oral diseases were identified using regression analysis. Results: A high prevalence of oral disease, extremely low utilization of dental care services, and a high dental prosthetic need were noted in the study population. Early childhood caries was noted among 46.9% and 53.6% of 5-year-old children in the urban and rural regions, respectively. The prevalence of dental fluorosis among 12-year-old rural and urban children was at 9.2% and 8.8%, respectively. Periodontal predicaments were noted among 50%, 75%, and 86% of the population in the target age groups of 12, 35–44, and 60 years and above, respectively. Malocclusion was noted among 20% and 25% of the study population in the 12 and 35–44 years’ age group, respectively. The prevalence of complete edentulism among older adults was observed in 13% and 11.5% of populations in the rural and urban regions, respectively. Conclusions: This study provides comprehensive oral health data for target age groups and aids in improved planning and management of public oral health services in a state in Central India.
Abstract Context: The COVID-19 pandemic has had a severe impact on both the formal and informal sectors globally. Loss of income and employment among informal workers has increased their vulnerability, pushing them further into poverty which is likely to impact their health as well. Aims: This paper assesses the impact of COVID-19 and its control measures on poverty dynamics within Nepal’s urban informal economy, using a public health perspective. Methods: Structured questionnaires were used to collect data from respondents. The analysis is based on 5 years of data (2015/16–2019/20) collected through face-to-face interviews with 423 informal economy workers from six metropolitan cities. The paper assesses trends in poverty transitions before and during the pandemic. Results: The poverty rate among workers in the urban informal economy, which had been declining from 2015/16 to 2018/19, increased drastically during the COVID-19 pandemic. The data show that the number of workers who remained poor decreased steadily over the first 4 years but increased in the final year. Similarly, the number of workers who remained nonpoor grew over the first 4 years but declined in the last year. Transitions from nonpoor to poor also declined until 2018/19 but rose again in 2019/20 due to COVID-19. Conclusions: The study highlights the importance of understanding poverty dynamics from a long-term perspective.The experiences in Nepal and globally highlight the need for both short-term and long-term interventions to reduce risks and support informal workers, enabling them to sustain their livelihoods and contribute to the well-being of low-income populations during public health crises.
Abstract One in every four Sri Lankans will be an older person by the year 2041 with an increasing share of the very old elderly. The share of the population aged 65 years and above is projected to rise leading to an increase of the old age dependency ratio with female preponderance. With this demographic transition, and epidemiological profile dominated by noncommunicable disease, the health system warrants major changes to meet new demands. Policy dialogue on healthy aging was initiated with the aim of providing impactful support to build better and resilient primary healthcare-centered health system. The dialogue contributed to improve evidence-based decision-making, which entails creating the platforms supporting pathways between key stakeholders. Key issues to explore through policy dialogue were framed from the available evidence and desk reviews, that included examining policy-related literature and considered the ongoing primary healthcare reorientation in Sri Lanka. The methodology adopted for dialogue on healthy aging enriched by a comprehensive context review led to focused technical dialogues that aided the construction of a conceptual model to be considered within the current overall health structure being reoriented.
AIMS AND OBJECTIVES:This study aimed to evaluate palliative care capacity across eleven northern Indian hospitals whose physicians and nurses had undergone training as part of the Cancer Treatment Centers (CTC) program. An online rapid evaluation using The "Standards audit tool for Indian palliative care programs" developed by the Indian Association of Palliative Care (IAPC) was done to audit specific aspects of palliative care delivery including staff training, recordkeeping, availability of morphine, and continuing professional development programs. A descriptive analysis of the data was conducted. Additional information was obtained through surveys, site visits, document reviews, and interviews with program leaders. For each site, the researchers determined to what extent the program met the set IAPC of the Standards Audit Tool. The eleven centers satisfied most of the essential criteria and some of the desirable criteria. One center did not have an in-house access to oral morphine. Some of the lacunae were inadequate provision of home care, unavailability of care after business hours, place of multidisciplinary collaboration, and involvement of community and volunteers. There was evidence of teaching, training, team health, audit, and administrative support. These hospitals were delivering good quality palliative care as per IAPC standards in parts of northern India that are underserved. There is scope for improvement in the outreach to the community, and a more multidisciplinary approach is required.
BACKGROUND:Nonstandard pharmaceutical or manufacturer labels may lead to medication errors. Therefore, label content and design are specified and monitored through regulatory frameworks. The aim of this study was to assess the availability of vital information in manufacturer labels of medicines used in a selected state hospital and adherence to the guidelines on labelling of medicines (GLM V1.0) of the National Medicines Regulatory Authority (NMRA), Sri Lanka. METHODS:Three hundred randomly selected medicine manufacturer labels were assessed using a checklist developed based on GLM V1.0. RESULTS:Of the 300 labels, 89.6% complied with the recommended format of the generic name followed by its pharmaceutical form and strength, and 84.0% specified their pharmacopeial monograph. Almost 40% were substandard, lacking at least one essential piece of information required by regulation. The strength of the medicine was not indicated in the principal display panel (PDP) of 5.3% of medicines. 5.0% of labels for various strengths of the same medicine or different medicines looked alike. Other observed flaws were missing necessary information and look-alike labels, reflecting a lack of quality control. CONCLUSION:Divergence from specified standards demonstrates the need for a multifaceted approach by the NMRA to prevent ambiguous labels. Key calls to action for policymakers include better manufacturer guidance, stronger pre-submission assessments, rejecting non-standard labels, and introducing barcode readers.
ABSTRACT:Equity-informative Cost-Effectiveness Analysis (CEAs) can promote fair healthcare access, yet their use in the WHO South-East Asia region (SEARO) is not well understood. This study aims to summarize methodological approaches, equity-relevant groups, health inequality measures, and healthcare provision areas addressed in equity-informative CEAs in SEARO countries. A systematic search was conducted in PubMed, Embase, Scopus, and Tufts CEA registry for equity-informative CEAs from WHO SEARO countries (2014-2023). CEAs with at least two alternative interventions and one equity criterion were included. Data extraction used Microsoft Excel. Interventions' distributional effects on cost-effectiveness were evaluated qualitatively, and bias was assessed using the CHEERS checklist. Of 828 studies identified, 10 were selected, nine from India (90%) and eight between 2014-2017 8 (80%). Studied groups included children, patients, the general population, adolescent girls, and neonates. All studies used cost-effectiveness analysis; 8 (80%) focused on healthcare providers' perspectives. Disability-Adjusted Life Years (DALYs) were primary outcome measures in 8 (80%) studies, while 9 (90%) assessed financial risk protection via out-of-pocket expenditure averted. Wealth quintiles were the equity criterion in 9 (90%) studies. About 6 (60%) conducted subgroup analyses and Extended Cost-Effectiveness Analyses (ECEA), with 2 (20%) using the Gini coefficient. Most studies 9 (90%) demonstrated 'greater value,' indicating improved public health implications. The scarcity of equity-informed CEAs in SEARO countries, excluding India, underscores the need for broader adoption. Improved public health implications highlight the necessity of equity-informed CEAs. Addressing these issues is essential to advance health equity in the SEARO region.
ABSTRACT:Nurse-led interventions are tailored to the specific needs of heart failure (HF) patients, facilitating the transfer of knowledge in ways that are more feasible and applicable within the context of diverse healthcare settings. These programs emphasize comprehensive discharge planning, patient education on self-care practices, medication management, and early symptom recognition. The meta-analysis included 11 randomized controlled trials, selected from databases including MEDLINE, EBSCO, CINAHL, and the Cochrane Library. Quality assessment of the included studies was conducted independently by two reviewers. The overall pooled effect showed a relative risk (RR) of 0.69 (95% confidence interval [CI]: 0.54-0.89) for all-cause readmission and a RR of 0.80 (95% CI: 0.71-0.91) for combined outcomes of all-cause readmission and mortality in the nurse-led group compared to the control group. These results indicate that nurse-led transitional care interventions contribute substantially to reducing both readmission rates and mortality among HF patients. The review also explored the applicability of these interventions in low-resource settings, emphasizing their potential to be adapted and implemented effectively in lower-middle-income countries. This review highlights the pivotal role of nurse-led transitional care programs in addressing these challenges by providing close support to patients and their families. Leveraging existing resources and fostering interdisciplinary collaboration are essential in optimizing healthcare delivery in low-resource settings.
