The persistent "know-do gap"—the lag between the development of evidence-based practices (EBPs) and their routine use in health systems—remains a barrier to achieving global health equity. Implementation science offers a pathway to bridge this gap, but without an explicit equity focus, it risks reinforcing existing disparities. In this perspective, we propose an equity-centered adaptation of the PEDALs model (Problem, Evidence-based practice, Determinants, Action, Long-term use, and Scale) to guide more just and context-sensitive implementation efforts in global health. We describe how each stage of PEDALs can be used to embed equity considerations in implementation research and practice. These include identifying root causes of inequity-linked health problems (P), using both scientific and practice-based evidence while adapting or de-implementing interventions (E), engaging marginalized voices when analyzing barriers and facilitators (D), co-designing contextually grounded implementation strategies (A), and measuring long-term implementation outcomes through an equity lens (L), including attention to scalability, iterative learning, and proper design and methods (s).We highlight methodological considerations—such as hybrid designs, embedded and workflow-based research, and rapid and participatory methods—that support timely, relevant, and equitable implementation. Our model builds on the concept of “radical incrementalism” to emphasize steady, equity-driven change that is responsive to diverse settings, especially in low- and middle-income countries. This modified PEDALs-based approach offers a practical structure for design and methodological considerations in advancing equity-centered implementation science.

BackgroundAccess to adequate sanitation and hygiene is an important global health issue and remains a serious problem in Nepal. ObjectiveThis study aimed to apply the alliance model to manage a sanitation and hygiene project. The project sought to increase sanitation access and improve households’ basic knowledge of sanitation and hygiene, as well as the hygiene practices of household members, in Dhading District, a remote area of Nepal. MethodsA mixed-method design was applied for data collection. The study sample included 18 alliance members and 492 household respondents. The alliance model consisted of three steps: (1) Preparation, including a situation assessment, formation of the alliance, and baseline measurement of study variables; (2) Action research using a one-group pre-test–post-test design to strengthen the management capacity of alliance members through planning, implementation, and evaluation of the sanitation and hygiene project; and (3) Reinforcement of capacity strengthening through a one-day review and reflection workshop with key alliance members and a final evaluation of post-alliance outcomes. ResultsSix months after implementing the model, the overall management capacity of alliance members increased significantly (p < 0.001). Households’ access to sanitation, basic knowledge of sanitation and hygiene, and hygiene practices also increased significantly (p < 0.001). The prevalence of diarrhea in the project area significantly decreased (p < 0.05) nine months after implementing the model. DiscussionThe model addressed key management issues within the alliance, fostered collaboration among major stakeholders, established a clear goal and action plan, mobilized resources, and secured the active participation of local residents in improving sanitation and hygiene in the Village Development Committee. ConclusionsThe model can be applied to strengthen alliance members' management capacity, thereby improving the effectiveness of rural sanitation and hygiene practices.

Women living with Human Immunodeficiency Virus have the right to a family life and equal access to information on a range of family planning options. Understanding the factors influencing family planning practices for HIV positive women is essential for tailoring reproductive health services and informing policy implementation. This cross-sectional study investigated the prevalence of family planning use and its associated factors among women living with HIV in Magway, Myanmar. A total of 349 women of reproductive age living with HIV were recruited for the study. Family planning practices and factors based on the Theory of Planned Behavior were assessed using structured questionnaires. Associations were examined using bivariate and multiple logistic regression analyses. The results showed that 24.4% of women living with HIV were using family planning methods, with condoms being the most commonly used method. The main reason for discontinuing family planning was fear of side effects. Age, marital status, number of living children, attitude toward family planning, subjective norms, and perceived behavioral control were significantly associated with family planning practice. These findings provide important insights for developing public health interventions that address individual and social contexts and promote family planning through the integration of family planning services with HIV treatment services.

Area-level socioeconomic deprivation is a key determinant of health disparities and quality of life. This study aimed to develop and validate the Thailand district-level Socioeconomic Deprivation Index (TSDI)—a nationwide, district-level index to identify deprived areas and their specific deprivation dimensions using national census data. In this methodological cross-sectional study, we constructed the TSDI from a 20

Pneumonia is a major cause of morbidity and mortality in Thailand. In this study, we aimed to assess the strengths and weaknesses of an active population-based pneumonia surveillance system implemented in Nakhon Phanom Province, Thailand, in order to inform public health resource allocation in that province. The surveillance system recorded the incidence and causative organisms of pneumonia in the study province. In order to assess this surveillance system, we purposely recruited 15 key local, national, and international subjects with the experience to accurately conduct this assessment: policymakers (n = 6), epidemiologists (n = 5), laboratory technicians (n = 3) and a physician (n = 1). Each subject was interviewed using standardized questions and the answers were recorded. Interview transcripts were analyzed using conventional content analysis. The 15 subjects, consisted of 11 (73.3%) males and 4 (26.7%) females. The mean age of subjects was 51 (range: 39-61) years. The study subjects stated the surveillance system should have 5 main objectives: 1) identify the pneumonia etiological organisms, 2) detect and report pneumonia cases in a timely manner, 3) support public health policy decisions, including resource allocation and targeted prevention, such as vaccination of high-risk groups, 4) monitor changes in respiratory pathogens over time, and 5) estimate the incidence of pneumonia and associated mortality. Subjects stated the strengths of the surveillance system were 1) its strong inter-agency collaboration, 2) the surveillance system support by hospital administrators and 3) the good cooperation among physicians, nurses and surveillance officers. The subjects stated the weaknesses of the surveillance system were lack of limited sharing of the surveillance findings with the medical providers and inadequate integration between pneumonia-specific and routine hospital laboratory systems. More specifically, medical providers and routine hospital laboratories in the study area could not access the summarized laboratory results produced by the surveillance system. The subjects suggested the following improvements be made to the surveillance system: 1) improve data-sharing mechanisms among all those involved in the system, including the medical providers, 2) improve integration between the pneumonia-specific laboratory activities and routine hospital laboratory systems and 3) improve communication across local, national and international levels. In summary, the aims of the surveillance system should be to identify the causes of pneumonia, their change over time and the incidence of pneumonia in a timely manner following national public health policies. Strengths of the system were the support the system had at multiple levels but weaknesses were inadequate communication of data and lack of systems to easily share this data. We conclude more effort should be put into the system at all levels to allow adequate communication and sharing of system data. Further studies are needed to determine what reasonable technologies are needed to allow good communication and data sharing in the system at all levels and how best to integrate this into other active surveillance systems nationally.

Primary health care (PHC) in Thailand’s border regions remains challenged by the needs of mobile and marginalized populations, despite the country’s progressive Universal Health Coverage (UHC). This qualitative study explores the dynamics of cross-border PHC systems along Thailand’s borders with Myanmar, Lao PDR, and Cambodia through a people-centered lens. We conducted 101 semi-structured interviews with diverse stakeholders across six border provinces. Findings reveal that migrants and refugees face complex barriers, including legal exclusion, geographic isolation, and fear of deportation, leading to reliance on self-medication and delayed care. Health priorities consistently included communicable diseases, maternal and child health, and occupational risks, yet the context varied significantly by border. The Myanmar border was characterized by Non-Government Organizations (NGOs)-dependent, fragmented services for undocumented migrants and refugees. In contrast, the Lao PDR border demonstrated more stable, seasonal migration and smoother bilateral health cooperation. The Cambodia border was defined by labor migration and inconsistent employer-based health arrangements. Multi-stakeholder collaboration—particularly through migrant health volunteers and NGOs—was identified as both feasible and essential for service delivery, but remains ad hoc and donor-dependent. Sustainable solutions require formalizing the roles of community-based actors, creating institutionalized coordination platforms, and developing tailored, context-specific strategies that address the fundamental social determinants of health. Achieving health equity in these borderlands necessitates inclusive policies that bridge the gap between national UHC ambitions and the realities of cross-border mobility.

With aging populations, a double burden of disease, and post-COVID-19 economic strain, managing non-communicable diseases (NCDs) has become a major challenge in low- and middle-income countries (LMICs). While most studies examine inequities in general healthcare utilization, few focus specifically on NCDs services. This review addresses that gap by synthesizing evidence on associated factors of equitable NCDs service utilization and assessing interventions to improve utilization. A systematic review and meta-analysis were conducted following PRISMA-Equity guidelines, including studies published between 2014 and 2024. Eligible studies examined socioeconomic and demographic associated factors of NCDs service utilization or evaluated interventions to reduce inequities. In the meta-analysis, pooled estimates for NCDs service utilization were performed using a random effects model. Heterogeneity among studies was assessed using I² statistics. Twenty-three studies were included. Overall, NCDs service utilization showed a clear pro-rich pattern, with wealthier groups consistently utilizing more services. The pooled outpatient NCD service utilization was 52.84

Thailand has made notable progress in HIV prevention, yet challenges persist, particularly among high-risk groups. Pre-exposure prophylaxis (PrEP) is a proven biomedical strategy to prevent HIV, but its uptake remains below national targets. This study examined whether PrEP knowledge mediates the relationship between PrEP-eligible behaviors and intention to use PrEP among clients accessing voluntary counseling and testing (VCT) services at government health facilities in Thailand. A cross-sectional, web-based survey was conducted between October 2024 and March 2025. A two-stage sampling approach was used to select 62 public hospitals across country. There were 2,007 eligible VCT clients voluntarily participated the study. Mediation analysis was performed using the SPSS PROCESS macro. Results showed that PrEP-eligible behaviors significantly predicted both PrEP knowledge (β = 0.42, p < 0.001) and intention to use PrEP (β = 0.38, p < 0.001). PrEP knowledge was also positively associated with intention to use PrEP (β = 0.47, p < 0.001) and partially mediated the relationship between eligibility and intention (indirect effect = 0.20, 95% CI [0.15, 0.26]). These findings underscore the importance of enhancing PrEP knowledge to drive preventive behavior. Targeted educational strategies and improved integration of PrEP services into public health infrastructure are essential to expand uptake and meet Thailand's goal of eliminating AIDS as a public health threat by 2030.

Previous literature showed that mental health conditions and substance use are prevalent in international migrant workers due to acculturation stress. Given the rapid increase in labour migration within the Association of Southeast Asian Nations (ASEAN) countries, this study aimed to conduct a meta-analysis of the pooled prevalence of mental health conditions and substance use among international migrant workers in ASEAN countries and to identify associated factors. We searched MEDLINE, PubMed, Scopus, and ASEAN Citation Index (ACI) for articles published in English between January 2010 and October 2023. The included outcomes were mental health (depression, anxiety, and post-traumatic stress disorder (PTSD)) and substance use (alcohol, tobacco, and illicit drugs). Study quality was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Of 19 eligible studies, 18 articles (11 for depression, 5 for anxiety, 1 for PTSD, and 8 for substance use) were included in the meta-analysis. A significant number of studies included in this study targeted Myanmar migrant workers living in Thailand. The pooled prevalence was 34.77% for depression, 37.72% for anxiety, and 24.29% for substance use. Factors associated with mental disorders were younger age, being female, low education and income level, workers in construction and sex industry, while male gender, other substance use, and peer influence are associated with substance use. A high prevalence of mental disorders and substance use among international migrant workers warrants a collective effort by various parties to provide proactive support to prevent and manage mental health conditions and substance use in the ASEAN countries.

Suicide is a significant public health concern globally, with disproportionate impacts in low- and middle-income countries. Thailand’s suicide rate has risen steadily, particularly in northern provinces such as Lamphun. In response, the Lamphun Provincial Health Office developed the “Four Pillars,” a community-based, multisectoral suicide prevention strategy. This study evaluates the feasibility and effectiveness of the Four Pillars using the RE-AIM framework. A convergent parallel mixed-methods study was conducted across three districts in Lamphun Province. Quantitative data included suicide surveillance reports from 2020–2022 and a community survey of 600 adults. Qualitative data were collected through in-depth interviews (n = 36), three focus group discussions (n = 21), and document reviews. The RE-AIM framework guided tool development, data collection, and analysis, evaluating the strategy across five dimensions: Reach, Effectiveness, Adoption, Implementation, and Maintenance Reach: A total of 2,876 individuals at suicide risk were identified and received integrative interventions. Effectiveness: None subsequently exhibited suicidal behavior. Suicide rates in Lamphun declined modestly post-implementation, though not significantly (p = 0.331). Adoption: Adoption varied due to cultural beliefs, resource limitations, and stigma; survey findings revealed lower suicide literacy and persistent stigma in ethnic communities (p < 0.01). Implementation: Community-based surveillance was successfully adapted across contexts (e.g., via local language dissemination, engaging monks and street vendors as gatekeepers) with high fidelity to the model’s core principles. Strong partnerships were critical. The Four Pillars strategy is a feasible and promising approach to reduce suicide risk through a community-based integrated surveillance and response system. Strategic local adaptations enhanced its feasibility without compromising core components. Addressing stigma, improving literacy, and strengthening multisectoral capacity are critical for broader scale-up and sustainability in Thailand and similar settings.

BACKGROUND:Thailand's Tak and Mae Hong Son (MHS) provinces, bordering Myanmar, are critical entry points for individuals seeking employment or healthcare. The COVID-19 pandemic and Myanmar's political instability have significantly impacted the health and performance of border-area health systems. This analysis examines the current state of the health sector, border health challenges resulting from cross-border movement, and identifies key gaps through data from health organizations and interviews in Tak and MHS provinces. METHODS:A mixed-method situational analysis was conducted, incorporating documentary analysis (quantitative health facility data, national reports, and online survey data) and key informant interviews in five districts: Umpang, Mae Ramat, and Tha Song Yang (TSY) in Tak province, and Mueang and Pang Mapha in MHS province. A purposive sample of 42 participants, including community health workers and service providers, was interviewed on-site. Thematic analysis was used to interpret patterns within the interview data. RESULTS:The non-Thai population makes up 20-30% of Tak and MHS provinces, with varying compositions across districts. Umpang has a high number of hill tribe ethnic minorities, TSY sees many cross-border patients, Mae Ramat has a large migrant worker population, and Mueang and Pang Mapha host people displaced by conflict. Between 2020 and 2023, malaria cases surged in Umpang and TSY, while TB incidence spiked in TSY, with non-Thais being 2-3 times more affected than Thais. This puts significant financial pressure on local health systems, as many non-Thais, including cross-border Myanmar nationals, lack health insurance, limiting access to subsidized healthcare. Additionally, resource shortages and insufficient healthcare staff further strain border health management. To bridge these gaps, many non-governmental organizations actively work to support healthcare services in Tak province. Addressing these challenges requires coordinated efforts to ensure equitable healthcare access and sustainable resource allocation in border regions. CONCLUSION:The study highlights significant health challenges in Tak and MHS provinces, particularly in districts with high non-Thai populations. Diseases like malaria and TB are more prevalent in these areas, straining local health systems. Financial and staffing challenges underscore the need for proactive government support and cross-sector collaboration to improve health equity in these culturally diverse border communities.

This cross-sectional study investigated the mental health outcomes and associated factors among Bangladeshi migrants in Thailand. A sample of 360 participants completed questionnaires assessing depressive symptoms, anxiety, and stress using the DASS-21 scale, along with sociodemographic and acculturative factors. Results revealed that 35.8%, 42.2%, and 17.8% of participants experienced symptoms of depression, anxiety, and stress, respectively. Lower education levels were associated with increased risk of all three mental health outcomes. Unexpectedly, assimilation as an acculturation strategy and higher Thai language proficiency were linked to poorer mental health. Experiences of discrimination and low social support significantly increased the likelihood of mental health issues. Difficulty accessing healthcare services was also associated with worse mental health outcomes. These findings highlight the complex interplay between acculturation, social factors, and mental health among migrant populations, emphasizing the need for culturally sensitive mental health services and policies to support Bangladeshi migrants in Thailand.

Abstract Background Metabolic syndrome (MetS) elevates the risk of heart disease and stroke. In recent decades, the escalating prevalence of MetS among people living with HIV/AIDS (PLWHA) has garnered global attention. Despite MetS development being associated with both traditional and HIV-related factors, evidence from prior studies has shown variability across geographical regions. This study aimed to conduct a systematic review and meta-analysis of MetS burdens in adult PLWHA at the regional and global levels, focusing on the common effect size of HIV infection and antiretroviral therapy (ART) on MetS. Methods This review followed the PRISMA 2020 guidelines. A comprehensive search and review of original articles related to MetS and HIV published in peer-reviewed journals between January 2000 and December 2023 were conducted. A random effects model was used to calculate the pooled prevalence/incidence of MetS and the common effect size of HIV infection and ART exposure on MetS. Results A total of 102 studies from five continents comprising 78,700 HIV-infected participants were included. The overall pooled prevalence of MetS was 25.3%, 25.6% for PLWHA on ART, and 18.5% for those not receiving treatment. The pooled incidence of MetS, calculated from five studies, was 9.19 per 100 person-years. The highest pooled prevalence of MetS was observed in the Americas (30.4%), followed by the Southeast Asia/Western Pacific regions (26.7%). HIV-infected individuals had 1.6 times greater odds of having MetS than non-HIV-infected individuals did (pooled OR = 1.604; 95% CI 1.154–2.230), and ART exposure had 1.5 times greater odds of having MetS than nontreatment had (pooled OR = 1.504; 95% CI 1.217–1.859). Conclusions HIV infection and ART exposure contribute significantly to the increased burden of MetS. Regions with a high burden of HIV and MetS should prioritize awareness and integrated care plans for major noncommunicable diseases (NCDs), such as heart disease and stroke. The implementation of integrated care for HIV/AIDS patients and NCDs is essential for addressing the high burden of multimorbidity in PLWHA. Registration number INPLASY202290018

Introduction: The aim of the study was to determine the effect of a dietary iron education programme (DIEP) on children’s iron status and intelligence quotient (IQ) score. Methods: This pre-test post-test quasi-experimental study with followup utilised the Health Belief Model (HBM). Participants were children who had iron deficiency (ID) (serum ferritin <30 µg/L), with anaemia (haemoglobin 80.0 – 114.0 g/L) or without, and their caregivers. The DIEP incorporated group talks, presentations, game-based learning, and cooking. Knowledge of ID and dietary iron, caregivers’ perceptions of preventing anaemia and ID in their children, and children’s dietary intake, iron status, and IQ score (based on 60-question items adjusted for age) were determined. Statistical tests (one-way MANOVA, Friedman’s two-way ANOVA by ranks, Wilcoxon signed-rank test, Monte Carlo exact test) determined differences between pre-test, post-test, and follow-up. Results: A total of 32 child-caregiver dyads completed the study; 6.3% (n=2) of children met the Thai dietary reference intake for iron at pre-test versus 28.1% (n=9) at post-test (p=0.039) and 31.3% (n=10) at follow-up (p=0.021). Almost half of the children (n=15) who had ID at pre-test were iron replete at post-test and half (n=16) were iron replete at follow-up (p<0.001). Median IQ scores improved from pre-test to posttest (109.0 vs. 116.0; p=0.010) and were similar at post-test and follow-up (116.0 vs. 117.0; p=0.952). Conclusion: Iron status and IQ score improved following the implementation of DIEP. We recommend that this programme serves as a model for similar interventions in other schools.

OBJECTIVES:This study aimed to examine cigarette use distribution, pattern of e-cigarette use and to determine socioecological model (SEM) factors associated with e-cigarette use among Thai youth (aged 15-24). DESIGN:An institution-based cross-sectional study. PARTICIPANTS:The study conducted in five regions: the north, south, central, northeast and Bangkok area of Thailand from May to October 2021. An internet-based, self-administered questionnaire was developed based on the SEM. We enrolled 13 139 students who understood Thai and voluntarily consented to participate in the study. Hierarchical generalised estimating equations identified the related factors to e-cigarette use consistent with the SEM. RESULTS:Of 12 948 respondents (95.5%), 181 were excluded due to a lack of cigarette use status. Of 12 767, the prevalence of cigarette use was 4.3%, e-cigarette use was 3.5% and dual-use was 2.4%. E-cigarettes were a much more favourable choice among female youth than cigarettes. E-cigarette users tended to express more positive beliefs towards e-cigarettes than non-users. Although the use of e-cigarettes is illegal in Thailand, 66% of users obtained e-cigarettes from online markets and 4% from grocery stores. We found that having a girlfriend or boyfriend who uses e-cigarettes increased the odds of e-cigarette use by 3.239 times. Interestingly, higher odds of e-cigarette use were associated with peer use than with sibling use among e-cigarette users. (Adjusted OR 2.786, 95% CI 1.844 to 4.208 and 2.485, 95% CI 1.402 to 4.404, respectively). Exposure to e-cigarette use in school increased the odds of e-cigarette use by four times. CONCLUSION:This institution-based cross-sectional study revealed that youth e-cigarette use is a significant problem. To prevent the increasing rate of e-cigarette use, health literacy about e-cigarette use, including media and information literacy, should be launched across all levels of the school environment to enlist youth to stand against the negative impacts of e-cigarette use among all those of school age.

The healthcare services for non-communicable diseases (NCD) are commonly affected by public health crises like the COVID-19 pandemic. During the pandemic, all healthcare facilities in Bangkok had been overwhelmed by the extreme caseload of COVID-19. Health service resiliency is crucial for the continued service of healthcare facilities post pandemic. This study aims to explore the impacts of COVID-19 on NCD service disruption and addressed the resilience of healthcare services at the operational level. Healthcare facility-based surveys and in-depth interviews were conducted among representatives of the facilities in Bangkok from April 2021 to July 2021. The web-based, self-administered questionnaire, was sent to directors or authorities of all healthcare facilities in Bangkok Thailand (n = 169). Two healthcare facilities from three levels of health services were purposively selected. The directors or medical doctors and nurses who are in charge of the NCD service, and working at the six selected health facilities, were invited to participate in the in-depth interviews. Descriptive statistics were used to analyze the survey data, and thematic analysis was used to analyze the data from the in-depth interviews. The impact of COVID-19 on NCD service disruption in the second wave (2021) was more severe than in the first wave (2020). The main reasons for NCD service disruptions are insufficient staff, and the closure of some services offered by the healthcare facilities. Surprisingly, both the budget and medical supply for healthcare facilities in Bangkok are less affected by the COVID-19 pandemic. Our study revealed resilience capability i.e. absorptive, adaptive, and transformative capabilityamong the healthcare facilities that provide a continuum of care by increasing availability and accessibility to healthcare services for chronic illness as DM. The service disruption in Bangkok may alter from other provinces because of variations in COVID-19 incidence and health services contexts. During the public health crisis, using affordable and common digital technologies to ensure DM patients can access a continuum of care and providing alternative services such as mobile medical laboratories, medication delivery, and medical refill at drug stores can increase consistent monitoring of glycemic levels and use of prescribed medication.

Due to the COVID-19 pandemic, the Thai government implemented the lockdown measure to restrict the widespread transmission of SARS-CoV-2 between April 3 and May 3, 2020. This measure might subsequently affect ambient air quality and its consequent health effect. Therefore, this study aimed to examine the change of ambient air pollution during the lockdown amid COVID-19 pandemic and its consequent change in mortality. The time-stratified case-crossover design with the conditional Poisson model was utilized to examine province-specific effect of individual air pollutants on non-accidental mortality and the random-effect meta-analysis was used to derive the national estimate of individual air pollutants on mortality during the period 2016–2019. The machine learning algorithm with random forests model was also applied to predict the business-as-usual concentration of air pollutants during lockdown period adjusting for weather variables and long-term trend. Changing in mortality attributed to air pollution change during lockdown period was then calculated. Results indicated that PM10, PM2.5, NO2, and O3 concentrations during lockdown period were lower than the business-as-usual scenario, leading to a reduction in mortality attributable to air pollutants. Findings from this study imply that stringent implementation of the air pollution control policies could reduce health impacts attributable to air pollution.

Early childhood caries (ECC) is a common problem in Thailand. In this study, we aimed to determine factors associated with ECC among children aged 3 years living in sugar palm plantation communities in Phetchaburi Province, Thailand in order to inform efforts to prevent ECC in this study population. Study participants were children aged 3 years who presented to any one of 11 Primary Healthcare Centers or 1 Community Hospital serving sugar palm plantation communities in Phetchaburi Province for medical care during February-April 2020. These children were divided into cases and controls with a ratio of 1:1 and the two groups were compared to obtain our study results. Cases were defined as children who had a decayed, missing and filled teeth (DMFT) index >0 based on an oral examination by a dental hygienist. Controls were children who had a DMFT index = 0. Cases and controls were both gender-matched. Cases were divided into groups by severity of ECC by DMFT score, where: a DMFT score of 1-2 was defined as a mild case, a DMFT score of 3-4 as a moderate case and a DMFT score of >4 as a severe case. The caregiver of each subject was interviewed using a questionnaire asking about demographic characteristics, breast -and bottle-feeding history, toothbrushing practices, use of fluoridated toothpaste, history of having a fluoride varnish and consumption of foods or beverages containing sugar. We compared cases and controls using conditional logistic regression analysis. A total of 171 cases and 171 controls were included in the study with 96 females in each group of cases and controls. 28.1%, 26.9% and 45.0% of cases had mild, moderate and severe ECC, respectively. The factor significantly positively associated with developing ECC was consuming food or beverages containing sugar (adjusted odds ratio (aOR) = 2.0; 95% CI: 1.2-3.3; p= 0.006) and the factor significantly negatively associated with developing ECC was subject toothbrushing by the caregiver (aOR = 0.3; 95% CI: 0.1-0.6; p=0.001). In summary, the factor significantly positively associated with ECC was consuming food or beverages containing sugar. The factor significantly negatively associated with ECC was subject toothbrushing by the caregiver. We conclude, programs to reduce ECC in the study population need to limit consumption of sugary foods and beverages and encourage caregivers to brush their child's teeth or supervise their toothbrushing. Further studies are needed to determine how best to conduct these education programs, what the current prevalence of ECC in the study population is and after the program intervention what the prevalence of ECC is in order to evaluate its efficacy.

Background Cardiovascular diseases (CVD) due to atherosclerosis have become one of the major causes of death among people living with HIV (PLHIV) since effective antiretroviral therapy (ART) has been available throughout the world. However, the epidemiologic evidence of this problem from the Asia-Pacific region remains unclear. We conducted a systematic review of the situation and risk factors for CVD among PLHIV in countries with the greatest impact of CVD attributable to HIV in the Asia-Pacific region. Methods A systematic search in PubMed/MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews databases for articles published before 2019 was conducted. Publications reported situations and risk factors both traditional and HIV-specific for CVD among PLHIV in the region were included. Two reviewers working on duplicate and quality assessments, independently extracted data, and thematically analyzed the data. Results Among PLHIV, the prevalence of subclinical CVD ranged from 10 to 28% and the incidence rate of clinical CVD ranged from 0.37 to 1.17 /100 person-years. Clinical CVD was frequently observed in the early era of the highly active antiretroviral therapy. A higher prevalence of subclinical CVD such as abnormal cIMT and carotid plaques was frequently observed in the PLHIV rather than in the nonHIV population and a high proportion of early onset of CVD was found among young PLHIV adults. The traditional risk factors for CVD such as hypertension, diabetes and smoking behavior were prevalent in both PLHIV and nonHIV populations ranging from 5 to 45%. HIV-specific risk factor, and lower CD4 presented almost twice the significantly increased risks for CVD while the synergistic interaction among traditional risk factors, i.e., diabetes mellitus, dyslipidemia and family history steeply increased the risk for CVD among PLHIV by almost 20 times. Conclusion The limited existing data suggested the risk of early CVD among PLHIV. We identified the crucial gaps in HIV/CVD work from the Asia-Pacific region and recommended longer prospective studies with larger sample sizes or meta-analyses to better capture CVD risk and interactions of crucial risk factors of this vulnerable population in this region. Registration number INPLASY202290108 ( https://inplasy.com/inplasy-2022-9-0108/ ).