1
|
Lv M, Zheng B. Global burden of skin and subcutaneous diseases and its association with socioeconomic status in children and adolescents: an analysis of the Global Burden of Diseases Study 2019. Arch Dermatol Res 2024; 316:457. [PMID: 38967834 DOI: 10.1007/s00403-024-03212-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
Skin and subcutaneous diseases are one of the most common problems affecting the health of children and adolescents. The purpose of this study was to investigate the burden of skin and subcutaneous diseases among children and adolescents and its association with socioeconomic status. Data was obtained from the Global Burden of Disease Study 2019. The number of cases, incidence rate, number of deaths, and death rate in 204 countries and territories from 1990 to 2019 were extracted and stratified by age, sex, and socioeconomic status. In 2019, the global incidence and death rates of skin and subcutaneous diseases in children and adolescents were 57966.98 (95% Uncertainty Interval [UI] 53776.15 to 62521.24) per 100,000 and 0.21 (95% UI 0.13 to 0.26) per 100,000, respectively. From 1990 to 2019, the global incidence rate increased by 5.80% (95% UI 4.82-6.72%) and the death rate decreased by 43.68% (95% UI 23.04-65.27%). The incidence and death rates were negatively correlated with socioeconomic status. Incidence rates were not different between females and males, but death rates were higher among females than males. The highest incidence and death rates were found in the 1-4-year age group and < 1-year age group, respectively. The global burden of skin and subcutaneous diseases in children and adolescents was characterized by regional imbalances. The global burden of skin and subcutaneous diseases in children and adolescents from poorer regions requires more attention. This study provides strong evidence for global policymaking for childhood and adolescent diseases.
Collapse
Affiliation(s)
- Meina Lv
- Department of Pharmacy, Fujian Medical University Union Hospital, #29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Bin Zheng
- Department of Pharmacy, Fujian Medical University Union Hospital, #29 Xinquan Road, Fuzhou, 350001, Fujian, China.
| |
Collapse
|
2
|
Ijaiya MA, Anjorin S, Uthman OA. Navigating the nutritional paradox: The impact of sustainable development targets on childhood wasting and overweight prevalence. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003335. [PMID: 38905320 PMCID: PMC11192342 DOI: 10.1371/journal.pgph.0003335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/21/2024] [Indexed: 06/23/2024]
Abstract
In 2015, the United Nations member states endorsed the 2030 Agenda for Sustainable Development to chart a path towards a better future for all. Childhood malnutrition, particularly wasting, remains a critical global health challenge, disproportionately affecting children under five in low- and middle-income countries. This study evaluates the impact of achieving selected Sustainable Development Goal (SDG) targets on reducing childhood malnutrition, with a specific focus on wasting and overweight. Utilizing multi-country DHS datasets, this study analyzed data from 138,782 children under five across 27 countries, nested within 13,788 neighborhoods. We simulated the predicted prevalence of wasting and overweight as selected SDG-related health inputs and determinant indicators reached their target values. Our findings reveal a baseline prevalence of 6.3% for wasting and 4.3% for overweight among the children studied. Progress towards the SDGs can potentially decrease wasting prevalence by a quarter (25%), translating to a reduction from 6.3% to 4.7%. This significant reduction in wasting is more pronounced in rural areas (29%) than in urban settings (7%). Conversely, a 14% increase in overweight prevalence was observed, with rural areas experiencing a higher rise (15%) than urban areas (13%). The study also highlighted variations in access to safe sanitation, improved water sources, healthcare services, income, maternal employment, and education levels, underscoring the complex interplay between these factors and malnutrition outcomes. Notably, the reduction in wasting prevalence was mainly attributable to input determinants rather than direct health inputs, suggesting the importance of broader socioeconomic factors in combating malnutrition. Achieving SDG targets presents a significant opportunity to mitigate wasting, particularly in rural communities. However, the uneven distribution of improvements underscores the need for targeted interventions in less affected areas. The concurrent rise in overweight prevalence, points to the emerging challenge of addressing the dual burden of malnutrition. This necessitates integrated, multi-sectoral strategies considering the diverse health determinants and nutritional status.
Collapse
Affiliation(s)
- Mukhtar A. Ijaiya
- Data-Lead Africa, Central Business District, Abuja, Federal Capital Territory, Nigeria
| | - Seun Anjorin
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Olalekan A. Uthman
- Division of Health Sciences, Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| |
Collapse
|
3
|
Azmat SK, Thom EM, Arshad M, Hamza HB, Aabroo A, Balal A, Awan MA, Rifaq F, Hemachandra N, Qudsia U. A study protocol for integrating outpatient services at the primary health care level as part of the universal health coverage benefit package within the national health insurance program of Pakistan through private health facilities. Front Public Health 2024; 12:1293278. [PMID: 38532967 PMCID: PMC10964903 DOI: 10.3389/fpubh.2024.1293278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction and aim Pakistan has a mixed-health system where up to 60% of health expenditures are out of pocket. Almost 80% of primary healthcare (PHC) facilities are in the private sector, which is deeply embedded within the country's health system and may account for the unaffordability of healthcare. Since 2016, the existing national health insurance program or Sehat Sahulat Program (SSP), has provided invaluable coverage and financial protection to the millions of low-income families living in Pakistan by providing inpatient services at secondary and tertiary levels. However, a key gap is the non-inclusion of outpatient services at the PHC in the insurance scheme. This study aims to engage a private provider network of general practitioners in select union councils of Islamabad Capital Authority (ICT) of Pakistan to improve access, uptake, and satisfaction and reduce out-of-pocket expenditure on quality outpatient services at the PHC level, including family planning and reproductive health services. Methods and analysis A 24-month research study is proposed with a 12-month intervention period using a mixed method, two-arm, prospective, quasi-experimental controlled before and after design with a sample of 863 beneficiary families from each study arm, i.e., intervention and control groups (N = 1726) will be selected through randomization at the selected beneficiary family/household level from four peri-urban Union Councils of ICT where no public sector PHC-level facility exists. All ethical considerations will be assured, along with quality assurance strategies. Quantitative pre/post surveys and third-party monitoring are proposed to measure the intervention outcomes. Qualitative inquiry with beneficiaries, general practitioners and policymakers will assess their knowledge and practices. Conclusion and knowledge contribution PHC should be the first point of contact for accessing health services and appears to serve as a programmatic engine for universal health coverage (UHC). The research aims to study a service delivery model which harnesses the private sector to deliver an essential package of health services as outpatient services under SSP, ultimately facilitating UHC. Findings will provide a blueprint referral system to reduce unnecessary hospital admissions and improve timely access to healthcare. A robust PHC system can improve population health, lower healthcare expenditure, strengthen the healthcare system, and ultimately make UHC a reality.
Collapse
Affiliation(s)
- Syed Khurram Azmat
- Marie Stopes Society, Karachi, Pakistan
- AIPH - AAPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | | | - Hasan Bin Hamza
- Ministry of National Health Services, Regulations, and Coordination, Islamabad, Pakistan
| | - Atiya Aabroo
- Ministry of National Health Services, Regulations, and Coordination, Islamabad, Pakistan
| | | | - Muhammad Ali Awan
- Marie Stopes Society, Karachi, Pakistan
- AIPH - AAPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Faisal Rifaq
- Federal Sehat Sahulat Program, Islamabad, Pakistan
| | | | - Uzma Qudsia
- World Health Organization, Islamabad, Pakistan
| |
Collapse
|
4
|
Razafinjato B, Rakotonirina L, Cordier LF, Rasoarivao A, Andrianomenjanahary M, Marovavy L, Hanitriniaina F, Andriamiandra IJ, Mayfield A, Palazuelos D, Cowley G, Ramarson A, Ihantamalala F, Rakotonanahary RJL, Miller AC, Garchitorena A, McCarty MG, Bonds MH, Finnegan KE. Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002888. [PMID: 38470906 DOI: 10.1371/journal.pgph.0002888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/17/2024] [Indexed: 03/14/2024]
Abstract
Despite widespread adoption of community health (CH) systems, there are evidence gaps to support global best practice in remote settings where access to health care is limited and community health workers (CHWs) may be the only available providers. The nongovernmental health organization Pivot partnered with the Ministry of Public Health (MoPH) to pilot a new enhanced community health (ECH) model in rural Madagascar, where one CHW provided care at a stationary CH site while additional CHWs provided care via proactive household visits. The program included professionalization of the CHW workforce (i.e., targeted recruitment, extended training, financial compensation) and twice monthly supervision of CHWs. For the first eighteen months of implementation (October 2019-March 2021), we compared utilization and proxy measures of quality of care in the intervention commune (local administrative unit) and five comparison communes with strengthened community health programs under a different model. This allowed for a quasi-experimental study design of the impact of ECH on health outcomes using routinely collected programmatic data. Despite the substantial support provided to other CHWs, the results show statistically significant improvements in nearly every indicator. Sick child visits increased by more than 269.0% in the intervention following ECH implementation. Average per capita monthly under-five visits were 0.25 in the intervention commune and 0.19 in the comparison communes (p<0.01). In the intervention commune, 40.3% of visits were completed at the household via proactive care. CHWs completed all steps of the iCCM protocol in 85.4% of observed visits in the intervention commune (vs 57.7% in the comparison communes, p-value<0.01). This evaluation demonstrates that ECH can improve care access and the quality of service delivery in a rural health district. Further research is needed to assess the generalizability of results and the feasibility of national scale-up as the MoPH continues to define the national community health program.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Alishya Mayfield
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Daniel Palazuelos
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
| | | | | | - Felana Ihantamalala
- Pivot, Ranomafana, Fianarantsoa, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rado J L Rakotonanahary
- Pivot, Ranomafana, Fianarantsoa, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ann C Miller
- Pivot, Ranomafana, Fianarantsoa, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Andres Garchitorena
- Pivot, Ranomafana, Fianarantsoa, Madagascar
- Institut de Recherche pour le Développement, MIVEGEC Laboratory, University of Montpellier, Centre National de la Recherche Scientifique, Antananarivo, Madagascar
| | | | - Matthew H Bonds
- Pivot, Ranomafana, Fianarantsoa, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Karen E Finnegan
- Pivot, Ranomafana, Fianarantsoa, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
5
|
Mapping heterogeneity in family planning indicators in Burkina Faso, Kenya, and Nigeria, 2000-2020. BMC Med 2024; 22:38. [PMID: 38297381 PMCID: PMC10832137 DOI: 10.1186/s12916-023-03214-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Family planning is fundamental to women's reproductive health and is a basic human right. Global targets such as Sustainable Development Goal 3 (specifically, Target 3.7) have been established to promote universal access to sexual and reproductive healthcare services. Country-level estimates of contraceptive use and other family planning indicators are already available and are used for tracking progress towards these goals. However, there is likely heterogeneity in these indicators within countries, and more local estimates can provide crucial additional information about progress towards these goals in specific populations. In this analysis, we develop estimates of six family indicators at a local scale, and use these estimates to describe heterogeneity and spatial-temporal patterns in these indicators in Burkina Faso, Kenya, and Nigeria. METHODS We used a Bayesian geostatistical modelling framework to analyse geo-located data on contraceptive use and family planning from 61 household surveys in Burkina Faso, Kenya, and Nigeria in order to generate subnational estimates of prevalence and associated uncertainty for six indicators from 2000 to 2020: contraceptive prevalence rate (CPR), modern contraceptive prevalence rate (mCPR), traditional contraceptive prevalence rate (tCPR), unmet need for modern methods of contraception, met need for family planning with modern methods, and intention to use contraception. For each country and indicator, we generated estimates at an approximately 5 × 5-km resolution and at the first and second administrative levels (regions and provinces in Burkina Faso; counties and sub-counties in Kenya; and states and local government areas in Nigeria). RESULTS We found substantial variation among locations in Burkina Faso, Kenya, and Nigeria for each of the family planning indicators estimated. For example, estimated CPR in 2020 ranged from 13.2% (95% Uncertainty Interval, 8.0-20.0%) in Oudalan to 38.9% (30.1-48.6%) in Kadiogo among provinces in Burkina Faso; from 0.4% (0.0-1.9%) in Banissa to 76.3% (58.1-89.6%) in Makueni among sub-counties in Kenya; and from 0.9% (0.3-2.0%) in Yunusari to 31.8% (19.9-46.9%) in Somolu among local government areas in Nigeria. There were also considerable differences among locations in each country in the magnitude of change over time for any given indicator; however, in most cases, there was more consistency in the direction of that change: for example, CPR, mCPR, and met need for family planning with modern methods increased nationally in all three countries between 2000 and 2020, and similarly increased in all provinces of Burkina Faso, and in large majorities of sub-counties in Kenya and local government areas in Nigeria. CONCLUSIONS Despite substantial increases in contraceptive use, too many women still have an unmet need for modern methods of contraception. Moreover, country-level estimates of family planning indicators obscure important differences among locations within the same country. The modelling approach described here enables estimating family planning indicators at a subnational level and could be readily adapted to estimate subnational trends in family planning indicators in other countries. These estimates provide a tool for better understanding local needs and informing continued efforts to ensure universal access to sexual and reproductive healthcare services.
Collapse
|
6
|
Aytenew TM, Demis S, Birhane BM, Asferie WN, Simegn A, Nibret G, Kassaw A, Asnakew S, Tesfahun Y, Andualem H, Bantie B, Kassaw G, Kefale D, Zeleke S. Non-Adherence to Anti-Retroviral Therapy Among Adult People Living with HIV in Ethiopia: Systematic Review and Meta-Analysis. AIDS Behav 2024; 28:609-624. [PMID: 38157133 PMCID: PMC10876791 DOI: 10.1007/s10461-023-04252-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
Human immunodeficiency virus remains a global public health problem. Despite efforts to determine the prevalence of non-adherence to ART and its predictors in Ethiopia, various primary studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of non-adherence to ART and identify its predictors. We have searched PubMed, Google Scholar and Web of Science databases extensively for all available studies. A weighted inverse-variance random-effects model was used to compute the overall non-adherence to ART. The pooled prevalence of non-adherence to ART was 20.68% (95% CI: 17.74, 23.61); I2 = 98.40%; p < 0.001). Educational level of primary school and lower [AOR = 3.5, 95%CI: 1.7, 7.4], taking co-medications [AOR = 0.45, 95%CI: 0.35, 0.59], not using memory aids [AOR = 0.30, 95%CI: 0.13, 0.71], depression [AOR = 2.0, 95%CI: 1.05, 3.79], comorbidity [AOR = 2.12, 95%CI: 1.16, 3.09), under-nutrition [AOR = 2.02, 95%CI: 1.20, 3.43], not believing on ART can control HIV [AOR = 2.31, 95%CI: 1.92, 2.77], lack of access to health facilities [AOR = 3.86, 95%CI: 1.10, 13.51] and taking ART pills uncomfortably while others looking [AOR = 5.21, 95%CI: 2.56, 10.53] were significantly associated with non-adherence to anti-retroviral therapy. The overall pooled prevalence of non-adherence to ART was considerably high in Ethiopia. Educational status, taking co-medications, not using memory aids, depression, comorbidity, under nutrition, not believing on anti-retroviral therapy controls HIV, lack of access to health facilities and taking ART pills uncomfortably were independent predictors of non-adherence to ART in Ethiopia. Therefore, healthcare providers, adherence counselors and supporters should detect non-adherence behaviors and patients' difficulties with ART early, and provide intensive counseling to promote adherence.
Collapse
Affiliation(s)
- Tigabu Munye Aytenew
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Solomon Demis
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Worku Necho Asferie
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Simegn
- Department of Reproductive Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gedefaye Nibret
- Department of Reproductive Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Department of Pediatrics and Child health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yohannes Tesfahun
- Department of Emergency and Critical Care Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Henock Andualem
- Department of Medical Laboratory, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Berihun Bantie
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gebrie Kassaw
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- Department of Pediatrics and Child health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Shegaw Zeleke
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| |
Collapse
|
7
|
Salam RA, Khan MH, Meerza SSA, Das JK, Lewis-Watts L, Bhutta ZA. An evidence gap map of interventions for noncommunicable diseases and risk factors among children and adolescents. Nat Med 2024; 30:290-301. [PMID: 38195753 DOI: 10.1038/s41591-023-02737-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024]
Abstract
Substance misuse, obesity, mental health conditions, type 1 diabetes, cancers, and cardiovascular and chronic respiratory diseases together account for 41% of disability-adjusted life years linked to noncommunicable diseases (NCDs) among children and adolescents worldwide. However, the evidence on risk factors and interventions for this age group is scarce. Here we searched four databases to generate an evidence gap map of existing interventions and research gaps for these risk factors and NCDs. We mapped 159 reviews with 2,611 primary studies; most (96.2%) were conducted in high-income countries, and only 100 studies (3.8%) were from low- and middle-income countries (LMICs). The efficacy of therapeutic interventions on biomarkers and adverse events for NCDs appears to be well evidenced. Interventions for mental health conditions appear to be moderately evidenced, while interventions for obesity and substance misuse appear to be moderate to very low evidenced. Priority areas for future research include evaluating digital health platforms to support primary NCD prevention and management, and evaluating the impact of policy changes on the prevalence of obesity and substance misuse. Our findings highlight the wide disparity of evidence between high-income countries and LMICs. There is an urgent need for increased, targeted financing to address the research gaps in LMICs.
Collapse
Affiliation(s)
- Rehana A Salam
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Maryam Hameed Khan
- Institute for Global Health and Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Saqlain Ali Meerza
- Institute for Global Health and Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Jai K Das
- Institute for Global Health and Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Laura Lewis-Watts
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.
| |
Collapse
|
8
|
Weeks WB, Weinstein JN, Lavista JM. All Sustainable Development Goals Support Good Health and Well-Being. Int J Public Health 2023; 68:1606901. [PMID: 38205020 PMCID: PMC10777740 DOI: 10.3389/ijph.2023.1606901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 01/12/2024] Open
Affiliation(s)
- William B. Weeks
- AI for Good Lab, Microsoft Corporation, Redmond, WA, United States
| | | | - Juan M. Lavista
- AI for Good Lab, Microsoft Corporation, Redmond, WA, United States
| |
Collapse
|
9
|
Ma Y, Fu H, Li Y, Bao ZR, Dong WB, Lei XP. Interactions between long interpregnancy interval and advanced maternal age on neonatal outcomes. World J Pediatr 2023; 19:1155-1161. [PMID: 37099258 PMCID: PMC10590323 DOI: 10.1007/s12519-023-00728-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/06/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND After the implementation of the universal two-child policy in China, it was more frequent to have long interpregnancy intervals (IPIs) and advanced maternal age. However, the interactions between long IPIs and advanced maternal age on neonatal outcomes are unknown. METHODS The study subjects of this historical cohort study were multiparas with singleton live births between October 1st, 2015, and October 31st, 2020. IPI was defined as the interval between delivery and conception of the subsequent pregnancy. Logistic regression models were used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of the risks of preterm birth (PTB), low birth weight (LBW), small for gestation age, and 1-min Apgar score ≤ 7 in different IPI groups. Relative excess risk due to interaction (RERI) was used to evaluate the additive interaction between long IPIs and advanced maternal age. RESULTS Compared with the 24 ≤ IPI ≤ 59 months group, the long IPI group (IPI ≥ 60 months) was associated with a higher risk of PTB (aOR, 1.27; 95% CI: 1.07-1.50), LBW (aOR, 1.32; 95% CI 1.08-1.61), and one-minute Apgar score ≤ 7 (aOR, 1.46; 95% CI 1.07-1.98). Negative additive interactions (all RERIs < 0) existed between long IPIs and advanced maternal age for these neonatal outcomes. Meanwhile, IPI < 12 months was also associated with PTB (aOR, 1.51; 95% CI 1.13-2.01), LBW (aOR, 1.50; 95% CI 1.09-2.07), and 1-min Apgar score ≤ 7 (aOR, 1.93; 95% CI 1.23-3.04). CONCLUSIONS Both short and long IPIs are associated with an increased risk of adverse neonatal outcomes. Appropriate IPI should be recommended to women planning to become pregnant again. In addition, better antenatal care might be taken to balance the inferiority of advanced maternal age and to improve neonatal outcomes.
Collapse
Affiliation(s)
- Yan Ma
- Division of Neonatology, Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Xiaoping Lei, 8 Kangcheng Road, Luzhou, 646000, China
- Department of Perinatology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, China
| | - Hua Fu
- Division of Neonatology, Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Xiaoping Lei, 8 Kangcheng Road, Luzhou, 646000, China
- Department of Perinatology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, China
| | - Yang Li
- School of Pediatrics, Southwest Medical University, Luzhou, China
| | - Zheng-Rong Bao
- Division of Neonatology, Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Xiaoping Lei, 8 Kangcheng Road, Luzhou, 646000, China
- Department of Perinatology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, China
| | - Wen-Bin Dong
- Division of Neonatology, Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Xiaoping Lei, 8 Kangcheng Road, Luzhou, 646000, China
- Department of Perinatology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, China
| | - Xiao-Ping Lei
- Division of Neonatology, Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Xiaoping Lei, 8 Kangcheng Road, Luzhou, 646000, China.
- Department of Perinatology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Sichuan Clinical Research Center for Birth Defects, Luzhou, China.
| |
Collapse
|
10
|
Özdemir Kara D. Causes of sudden neonatal mortality disclosed by autopsy and histopathological examination. Medicine (Baltimore) 2023; 102:e35933. [PMID: 37904371 PMCID: PMC10615433 DOI: 10.1097/md.0000000000035933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/12/2023] [Indexed: 11/01/2023] Open
Abstract
The neonatal period, or the first 28 days of life, is the most vulnerable time in a child's life. Neonatal mortality has decreased in recent years. However, this progress varies at the national level, which necessitates actual regional data from different countries to identify local handicaps for life-saving precautions. This study aimed to investigate the causes for neonatal deaths as revealed by autopsy and histopathological examinations. A retrospective cross-sectional study was designed to identify the main causes of neonatal deaths in children who were autopsied at our institution between January 1, 2014, and December 31, 2021. Children who died within the first 28 days after birth (1-28 days of age) were referred to as neonatal cases. The main causes of neonatal death in children were determined via autopsy and histopathological and toxicological examinations. Furthermore, the causes of death were classified according to their manner of death. During this period, 122 neonatal children were autopsied at our institution. This group comprised 57 girls and 65 boys. For the manner of the death, natural causes were the most common cause (n = 91, 74.5%). Among natural causes, pneumonia (n = 66) was the leading one, representing 54% of all neonatal deaths, followed by perinatal conditions (n = 16, 13.1%). One of the pioneering reasons for death was sudden, unexpected postnatal collapse (n = 24, 19.6%), which was categorized under the undetermined group considering the manner of death. Unintentional (accidental) deaths accounted for 0.8% (n = 1) of total deaths, and intentional deaths were responsible for 6 neonates (4.9%) losses. This study shows that newborn children still die from simple and treatable infectious causes, probably arising from various familial and/or public inadequacies. In addition, sudden and unexpected postnatal collapse remains an important cause of neonatal mortality that has yet to be fully resolved. This study points out valuable inferences for caregivers and competent authorities to take preventive measures to prevent avoidable neonatal deaths.
Collapse
Affiliation(s)
- Doğuş Özdemir Kara
- Turkish Council of Forensic Medicine Ankara Head Office, Department of Pathology, Ankara, Turkey
| |
Collapse
|
11
|
Wang KW, Ling ZJ, Yuan Z, Zhang J, Yi SJ, Xiong YW, Chang W, Lin ZJ, Zhu HL, Yang L, Wang H. The Long-Term Effect of Maternal Iron Levels in the Second Trimester on Mild Thinness among Preschoolers: The Modifying Effect of Small for Gestational Age. Nutrients 2023; 15:3939. [PMID: 37764723 PMCID: PMC10535896 DOI: 10.3390/nu15183939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
The supplementation of multiple micronutrients throughout pregnancy can reduce the risk of adverse birth outcomes and various diseases in children. However, the long-term effect of maternal multiple micronutrient levels in the second trimester on the overall development of preschoolers remains unknown. Therefore, 1017 singleton mother-infant pairs and 6-year-old preschoolers were recruited based on the China-Wuxi Birth Cohort Study. Meanwhile, information on the demographic characteristics of pregnant women and preschoolers, maternal copper, calcium, iron, magnesium, and zinc levels in whole blood during the second trimester, and neonatal outcomes, were collected. We aimed to investigate the long-term impact of maternal copper, calcium, iron, magnesium, and zinc levels in the second trimester on mild thinness among 6-year-old preschoolers, and the modifying effect of small for gestational age (SGA), within the Chinese population. Multiple logistic regression models revealed that high-level maternal iron in the second trimester reduced the risk of mild thinness [adjusted OR: 0.46 (95% CI: 0.26, 0.80)] among 6-year-old preschoolers. However, no significant association was found for the remaining four maternal essential metal elements. Additionally, the restricted cubic spline function showed that the risk of mild thinness decreased when maternal iron concentration exceeded 7.47 mmol/L in whole blood during the second trimester. Furthermore, subgroup analysis indicated that the long-term protective effect of high-level maternal iron on mild thinness was only observed in SGA infants. Summarily, high-level maternal iron in the second trimester distinctly lowers the risk of mild thinness among 6-year-old preschoolers, especially in preschoolers with birth outcomes of SGA. Our findings offer evidence for the implementation of iron supplementation in the second trimester as a preventive measure against mild thinness in children.
Collapse
Affiliation(s)
- Kai-Wen Wang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Zheng-Jia Ling
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
- Department of Medical Genetics and Prenatal Diagnosis, Wuxi Maternity and Child Health Care Hospital, Wuxi 214002, China
| | - Zhi Yuan
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Jin Zhang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Song-Jia Yi
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Yong-Wei Xiong
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Wei Chang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Zhi-Jing Lin
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Hua-Long Zhu
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Lan Yang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Department of Medical Genetics and Prenatal Diagnosis, Wuxi Maternity and Child Health Care Hospital, Wuxi 214002, China
| | - Hua Wang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| |
Collapse
|
12
|
Mutale W, Ayles H, Lewis J, Bosompraph S, Chilengi R, Tembo MM, Sharp A, Chintu N, Stringer J. Protocol-driven primary care and community linkage to reduce all-cause mortality in rural Zambia: a stepped-wedge cluster randomized trial. Front Public Health 2023; 11:1214066. [PMID: 37727608 PMCID: PMC10505962 DOI: 10.3389/fpubh.2023.1214066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/03/2023] [Indexed: 09/21/2023] Open
Abstract
Introduction While tremendous progress has been made in recent years to improve the health of people living in low- and middle-income countries (LMIC), significant challenges remain. Chief among these are poor health systems, which are often ill-equipped to respond to current challenges. It remains unclear whether intensive intervention at the health system level will result in improved outcomes, as there have been few rigorously designed comparative studies. We present results of a complex health system intervention that was implemented in Zambia using a cluster randomized design. Methods BHOMA was a complex health system intervention comprising intensive clinical training and quality improvement measures, support for commodities procurement, improved community outreach, and district level management support. The intervention was introduced as a stepped wedge cluster-randomized trial in 42 predominately rural health centers and their surrounding communities in Lusaka Province, Zambia. Baseline survey was conducted between January-May 2011, mid-line survey was conducted February-November, 2013 and Endline survey, February-November 2015.The primary outcome was all-cause mortality among those between 28 days and 60 years of age and assessed through community-based mortality surveys. Secondary outcomes included post-neonatal under-five mortality and service coverage scores. Service coverage scores were calculated across five domains (child preventative services; child treatment services; family planning; maternal health services, and adult health services). We fit Cox proportional hazards model with shared frailty at the cluster level for the primary analysis. Mortality rates were age-standardized using the WHO World Standard Population. Results Mortality declined substantially from 3.9 per 1,000 person-years in the pre-intervention period, to 1.5 per 1,000 person-years in the post intervention period. When we compared intervention and control periods, there were 174 deaths in 49,230 person years (age-standardized rate = 4.4 per 1,000 person-years) in the control phase and 277 deaths in 74,519 person years (age-standardized rate = 4.6 per 1,000 person-years) in the intervention phase. Overall, there was no evidence for an effect of the intervention in minimally-adjusted [hazard ratio (HR) = 1.18; 95% confidence interval (CI): 0.88, 1.56; value of p = 0.265], or adjusted (HR = 1.12; 95% CI: 0.84, 1.49; value of p = 0.443) analyses.Coverage scores that showed some evidence of changing with time since the cluster joined the intervention were: an increasing proportion of children sleeping under insecticide treated bed-net (value of p < 0.001); an increasing proportion of febrile children who received appropriate anti-malarial drugs (value of p = 0.039); and an increasing proportion of ever hypertensive adults with currently controlled hypertension (value of p = 0.047). No adjustments were made for multiple-testing and the overall coverage score showed no statistical evidence for a change over time (value of p = 0.308). Conclusion We noted an overall reduction in post-neonatal under 60 mortality in the study communities during the period of our study, but this could not be attributed to the BHOMA intervention. Some improvements in service coverage scores were observed. Clinical Trial Registration clinicaltrials.gov, Identifier NCT01942278.
Collapse
Affiliation(s)
- Wilbroad Mutale
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Helen Ayles
- Zambia AIDS Related Tuberculosis (ZAMBART), Lusaka, Zambia
| | - James Lewis
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Samuel Bosompraph
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | | | - Ab Sharp
- Zambia AIDS Related Tuberculosis (ZAMBART), Lusaka, Zambia
| | | | - Jeffrey Stringer
- University of North Carolina, Global Women Health, Chapel Hill, NC, United States
| |
Collapse
|
13
|
Refaat A. Global achievement of maternal health-related sustainable development goals targets among women exposed to intimate partner violence. BMC Womens Health 2023; 23:423. [PMID: 37559045 PMCID: PMC10413587 DOI: 10.1186/s12905-023-02577-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
Health-related Sustainable Development Goal (SDG 3) aims to ensure healthy lives. This study investigates the influence of Intimate Partner Violence (IPV) on achieving maternal health related SDG3 targets among exposed women globally. METHODOLOGY This study used secondary data analysis of Domestic Violence Modules from the latest Demographic and Health Surveys (DHS) of 40 countries. IPV was defined by women ever exposed to emotional, physical, severe, or sexual violence from the spouse. Achieving maternal health related SDG3 targets among women was measured by: Proportion of births attended by skilled health personnel; Antenatal care (women received antenatal care eight or more times from any provider); and the need for family planning satisfied with modern methods. The influence of IPV was estimated through adjusted OR after controlling for socioeconomic factors using logistic regression. RESULTS Exposure to IPV was among one-third of the women (37%) mainly physical (29%) and emotional (24%). Adjusted OR with 95%CI for the influence of IPV on women's utilization of skilled birth attendants was 0.81 (0.79-0.83)); having eight or more antenatal care visits 0.61 (0.59-0.63); and the needs for family planning with modern methods satisfied was 0.85 (0.83-0.87). Achievement of maternal health services was among 57% of the women. Women exposed to IPV were less to achieve maternal health services (50% VS 61%) with adjusted OR 0.71; 95%CI: 0.70-0.73 and it was not confounded by the positive effect of socioeconomic factors. CONCLUSION & RECOMMENDATION Exposure to IPV had a statistically significant negative influence on all the maternal health related SDG3 services among women. Programs working in facilitating the achievement of the SDGs related maternal health targets should include prevention of women's exposure to IPV and support for those who are exposed to it.
Collapse
Affiliation(s)
- Amany Refaat
- Faculty of Medicine, Public Health, Suez Canal University, Ismailia, Egypt.
| |
Collapse
|
14
|
Bhatia G, Thapa P, Mathur R. The Top 100 Most Cited Publications on Suicide: A Citation Analysis. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231189642. [PMID: 37436419 DOI: 10.1177/00302228231189642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
Suicide is one of the leading causes of death globally and a matter of public health concern. Biomedical research on suicide has grown exponentially over the past few decades. Although numerous articles are published on suicide, only some exert significant influence in the evolution of scientific understanding. The number of citations a publication receives are a proxy marker of its impact on the field. Hence we aimed to analyze 100 top-cited articles on suicide till May, 2023, using Google scholar as the search database. These citation classics provide important insights into the historical development and trends in suicide research.
Collapse
Affiliation(s)
| | - Priyanka Thapa
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Mathur
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
15
|
Adekoya OB, Kenku OT, Oliyide JA, Al-Faryan MAS. On the COP26 and coal's phase-out agenda: Striking a balance among the environmental, economic, and health impacts of coal consumption. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2023; 328:116872. [PMID: 36502705 DOI: 10.1016/j.jenvman.2022.116872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/07/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Economic and environmental policy actions are often substitutionary in their impacts, as one man's food could be another's poison. One of the critical emphases at the recent Conference of Parties 26 (COP26) is the need for coal to be phased out in the energy consumption basket of nations to achieve environmental sustainability, but this could be at the expense of the positive performance of other socio-economic fundamentals. The best bet could then be to maintain an optimal consumption level to strike a balance. Relying on this, we examine the environmental, economic, and health impacts of coal consumption in the world's highest coal-consuming countries, putting the latter's threshold level into consideration. In summary, we find that there is a trade-off between pushing for a sustainable environment through a reduction in coal consumption and achieving better growth and health status. This implies that phasing out of coal totally will have severe economic and health costs. However, based on our threshold regression model results, it is most reasonable to maintain a lower level of coal use in the overall energy mix of these countries. This will definitely yield a relatively low level of carbon, but will still assure a certain level of economic growth and health performance. As such, reducing the intensity of coal gradually and simultaneously providing a substitute that can also serve economic and health needs are encouraged.
Collapse
Affiliation(s)
| | | | | | - Mamdouh Abdulaziz Saleh Al-Faryan
- School of Accounting, Economics and Finance, Faculty of Business and Law, University of Portsmouth, United Kingdom; Consultant in Economics and Finance, Riyadh, Saudi Arabia.
| |
Collapse
|
16
|
Morrison J, Malik SMMR. Population health trends and disease profile in Somalia 1990-2019, and projection to 2030: will the country achieve sustainable development goals 2 and 3? BMC Public Health 2023; 23:66. [PMID: 36627611 PMCID: PMC9832660 DOI: 10.1186/s12889-022-14960-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES This study aims to evaluate whether Somalia will reach Sustainable Development Goals 2 and 3 by 2030 and what the country requires to advance closer to these objectives. SETTING Somalia. PARTICIPANTS We carried out analyses of secondary data obtained from the following open-access databases: Global Burden of Disease 2019 study; United Nations (UN) Department of Economic and Social Affairs Population Division; World Bank World Development Indicators; United Nations Children's Fund (UNICEF); UNICEF/World Health Organisation (WHO)/World Bank Joint Child Malnutrition Estimates; and UN Interagency Group for Child Mortality Estimation (UN IGME), disaggregated by sex. PRIMARY OUTCOME MEASURES stillbirth, neonatal, infant, under-five, maternal and child mortality; under-five malnutrition; life expectancy; health-adjusted life expectancy; age-standardised all-cause mortality; age-standardised cause-specific mortality for the leading causes of death; disability-adjusted life years. SECONDARY OUTCOME MEASURES vitamin A coverage; stunting, overweight in children under 5; top risk factors contributing to cause-specific mortality. RESULTS life expectancy in Somalia will increase to 65.42 years (95% UI 62.30-68.54) for females and 58.54 years (95% UI 54.89-62.19) for males in 2030. Stunting will continue to decline to 25.2% (90% UI 13.9-39.5%), and the under-five mortality rate will drop to 85.9 per 1000 live births (90% UI 22.0-228.1 per 1000 live births) for females and 96.4 per 1000 live births (90% UI 24.8-255.3 per 1000 live births) for males in 2030. This study's analyses predict that the maternal mortality ratio in Somalia will decline to 696.42 deaths per 100,000 live births in 2030. CONCLUSIONS there has been progress towards SDG targets in Somalia since 1990. To achieve these, Somalia requires greater health improvements than observed between 1990 and 2019.
Collapse
Affiliation(s)
- Joana Morrison
- WHO Somalia, Carrer Sant Elies 22, 5-4, 08006, Barcelona, Spain.
| | - Sk Md Mamunur Rahman Malik
- WHO Representative & Head of Mission, World Health Organisation Country Office Mogadishu, Mogadishu, Somalia
| |
Collapse
|
17
|
Pinero de Plaza MA, Yadav L, Kitson A. Co-designing, measuring, and optimizing innovations and solutions within complex adaptive health systems. FRONTIERS IN HEALTH SERVICES 2023; 3:1154614. [PMID: 37063372 PMCID: PMC10103186 DOI: 10.3389/frhs.2023.1154614] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/27/2023] [Indexed: 04/18/2023]
Abstract
Objective To introduce, describe, and demonstrate the emergence and testing of an evaluation method that combines different logics for co-designing, measuring, and optimizing innovations and solutions within complex adaptive health systems. Method We describe the development and preliminary testing of a framework to evaluate new ways of using and implementing knowledge (innovations) and technological solutions to solve problems via co-design methods and measurable approaches such as data science. The framework is called PROLIFERATE; it is initially located within the ecological logic: complexity science, by investigating the evolving and emergent properties of systems, but also embraces the mechanistic logic of implementation science (IS) (i.e., getting evidence-based interventions into practice); and the social logic, as the study of individuals, groups, and organizations. Integral to this logic mixture is measuring person-centered parameters (i.e., comprehension, emotional responses, barriers, motivations, and optimization strategies) concerning any evaluated matter across the micro, meso, and macro levels of systems. We embrace the principles of Nilsen's taxonomy to demonstrate its adaptability by comparing and encompassing the normalization process theory, the 2 × 2 conceptual map of influence on behaviors, and PROLIFERATE. Results Snapshots of ongoing research in different healthcare settings within Australia are offered to demonstrate how PROLIFERATE can be used for co-designing innovations, tracking their optimization process, and evaluating their impacts. The exemplification involves the evaluation of Health2Go (the design and implementation of an innovative procedure: interdisciplinary learning within an allied health service-community-based) and RAPIDx_AI (an artificial intelligence randomized clinical trial being tested to improve the cardiac care of patients within emergency departments-tertiary care). Conclusion PROLIFERATE is one of the first frameworks to combine ecological, mechanistic, and social logic models to co-design, track, and evaluate complex interventions while operationalizing an innovative complexity science approach: the knowledge translation complexity network model (KT-cnm). It adds a novel perspective to the importance of stakeholders' agency in the system by considering their sociodemographic characteristics and experiences within different healthcare settings (e.g., procedural innovations such as "interdisciplinary learning" for Health2Go, and tech-enabled solutions such as RAPIDx_AI). Its structured facilitation processes engage stakeholders in dynamic and productive ways while measuring and optimizing innovation within the complexities of health systems.
Collapse
|
18
|
Gur Ali O. Targeting resources efficiently and justifiably by combining causal machine learning and theory. Front Artif Intell 2022; 5:1015604. [PMID: 36568581 PMCID: PMC9768181 DOI: 10.3389/frai.2022.1015604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Efficient allocation of limited resources relies on accurate estimates of potential incremental benefits for each candidate. These heterogeneous treatment effects (HTE) can be estimated with properly specified theory-driven models and observational data that contain all confounders. Using causal machine learning to estimate HTE from big data offers higher benefits with limited resources by identifying additional heterogeneity dimensions and fitting arbitrary functional forms and interactions, but decisions based on black-box models are not justifiable. Methods Our solution is designed to increase resource allocation efficiency, enhance the understanding of the treatment effects, and increase the acceptance of the resulting decisions with a rationale that is in line with existing theory. The case study identifies the right individuals to incentivize for increasing their physical activity to maximize the population's health benefits due to reduced diabetes and heart disease prevalence. We leverage large-scale data from multi-wave nationally representative health surveys and theory from the published global meta-analysis results. We train causal machine learning ensembles, extract the heterogeneity dimensions of the treatment effect, sign, and monotonicity of its moderators with explainable AI, and incorporate them into the theory-driven model with our generalized linear model with the qualitative constraint (GLM_QC) method. Results The results show that the proposed methodology improves the expected health benefits for diabetes by 11% and for heart disease by 9% compared to the traditional approach of using the model specification from the literature and estimating the model with large-scale data. Qualitative constraints not only prevent counter-intuitive effects but also improve achieved benefits by regularizing the model.
Collapse
Affiliation(s)
- Ozden Gur Ali
- College of Administrative Sciences and Economics, Koç University, Istanbul, Turkey
| |
Collapse
|
19
|
Yu D, Ou Z, Zhang W, He H, Li Y, He W, Zhang M, Gao Y, Wu F, Chen Q. Global and national trends in years of life lost and years lived with disability caused by three common gastrointestinal cancers from 1990 to 2019. BMC Gastroenterol 2022; 22:493. [DOI: 10.1186/s12876-022-02567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/04/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Gastrointestinal cancers are a critical global cancer burden, and tracking their trends would inform the health policies.
Methods
Trends of years of life lost (YLLs) and years lived with disability (YLDs) caused by three common gastrointestinal cancers were estimated using annual percentage change (EAPC) and age-standardized rate (ASR). Data was extracted from the Global Burden of Disease study 2019.
Results
The ASR per 100,000 population-year of YLLs caused by esophageal cancer, stomach cancer, and colorectal cancer were 137.98, 264.15, and 282.51 in 2019, respectively. Their overall trends of YLLs declined during 1990–2019, with the respective EAPCs being − 1.42 (95% Confidence Interval [CI]: − 1.71 to − 1.13), − 2.13 (95%CI: − 2.29 to − 1.96), and − 0.25 (95%CI: − 0.30 to − 0.19). Meanwhile, decreasing trends of YLDs caused by esophageal cancer and stomach cancer were observed, in which the EAPCs were − 0.67 (95%: − 0.94 to − 0.40) and − 0.85 (95%CI: − 0.97 to − 0.73), respectively. However, an increasing trend was seen in that of colorectal cancer (EAPC = 0.83, 95%CI: 0.77 to 0.89). Among countries, the largest decrease in trend of YLLs was that of stomacher cancer in the Republic of Korea (EAPC = − 5.88, 95%CI: − 6.07 to − 5.69). However, pronounced increasing trend of YLDs caused by colorectal cancer occurred in China (EAPC = 4.40, 95%CI: 4.07 to 4.72).
Conclusions
Decreasing trends in YLLs and YLDs caused by esophageal cancer, stomach cancer, and colorectal cancer were observed in most countries and regions, indicating that the great progress had been achieved over the past decades. However, the cancer burden was geographical heterogeneity, and cost-effective measures were still required to decline the burden caused by gastrointestinal cancers.
Collapse
|
20
|
Topic Analysis and Mapping of Tuberculosis Research Using Text Mining and Co-Word Analysis. Tuberc Res Treat 2022; 2022:8039046. [DOI: 10.1155/2022/8039046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022] Open
Abstract
Tuberculosis is still one of the most severe progressive diseases; it severely limits the social and economic development of many countries. In the present study, the topic trend of scientific publications on tuberculosis has been examined using text mining techniques and co-word analysis with an analytical approach. The statistical population of the study is all global publications related to tuberculosis. In order to extract the data, the Scopus citation database was used for the period 1900 to 2022. The main keywords for the search strategy were chosen through consultation with thematic specialists and using MESH. Python programming language and VOSviewer software were applied to analyze data. The results showed four main topics as follows: “Clinical symptoms” (41.8%), “Diagnosis and treatment” (28.1%), “Bacterial structure, pathogenicity and genetics” (22.3%), and “Prevention” (7.84%). The results of this study can be helpful in the decision of this organization and knowledge of the process of studies on tuberculosis and investment and development of programs and guidelines against this disease.
Collapse
|
21
|
Chen L, Duan D, Han L, Xu L, Li S, Zhang Y, Feng W, Gong Q, Micah AE, Zhang R, Liu S, Li H. Non-communicable Disease-Related Sustainable Development Goals for 66 Belt and Road Initiative Countries. Int J Health Policy Manag 2022; 12:6172. [PMID: 36404503 PMCID: PMC10125083 DOI: 10.34172/ijhpm.2022.6172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Since 2015, the Global Burden of Disease Study (GBD) has measured progress in achieving health-related Sustainable Development Goals (SDGs) annually worldwide. Little is known about the status and attainment of indicators of non-communicable diseases (NCDs) by 65 countries from the Belt and Road Initiative (BRI) proposed by China in 2013. METHODS Data from GBDs were used to estimate 24 NCD-related SDG indicators in BRI countries from 1990 to 2017. Each indicator was scored from 0 to 100 to compare multiple indicators over the study period. The natural log of the annual change in each location and year and weighted annual rates of change were used to generate projections for 2030. National-level estimates were determined by socio-demographic index (SDI) quintiles in BRI countries with more than 1 million inhabitants. RESULTS In 2017, the median overall score of NCD-related SDG index for the 66 BRI countries was 60 points, ranging from 29 points in Afghanistan to 84 points in Israel. More than 80% of countries achieved the SDG 2030 maternal mortality (MM) rate target in 2017, and the national skilled birth attendance rate was above 99% in more than 59% countries. However, none of the BRI countries achieved the goal for children's overweight, modern methods of contraception, and universal health coverage. It was predicted that 80.4% of NCD-related SDG targets would be achieved in these countries by 2030. The overall score of NCD-related SDG index were positively associated with SDI quintiles. CONCLUSION For many indicators, the achieved progress in many countries is less than the annual rate necessary to meet SDG targets, indicating that substantial efforts need to be made in the coming years. Progress should be accelerated through collaborations between countries, implementation of NCD prevention and control strategies, and monitoring of inequalities in NCD-related SDGs within populations.
Collapse
Affiliation(s)
- Lin Chen
- Ningbo No. 2 Hospital, Ningbo, China
| | - Donghui Duan
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Liyuan Han
- Ningbo No. 2 Hospital, Ningbo, China
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Lu Xu
- Ningbo No. 2 Hospital, Ningbo, China
| | - Sixuan Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Yuwei Zhang
- Panjin Municipal Center for Disease Control and Prevention, Panjin City, China
| | - Wei Feng
- Fenghua District Center for Disease Control and Prevention, Ningbo, China
| | - Qinghai Gong
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Angela E. Micah
- Department of Health Metrics Sciences/Institute for Health Metrics Chen et al International Journal of Health Policy and Management, 2022, x(x), 1–13 13 and Evaluation, University of Washington, Seattle, WA, USA
| | - Ruijie Zhang
- Ningbo No. 2 Hospital, Ningbo, China
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Shiwei Liu
- Division of Chronic Disease and Aging Health management, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| |
Collapse
|
22
|
Joseph NK, Macharia PM, Okiro EA. Progress towards achieving child survival goals in Kenya after devolution: Geospatial analysis with scenario-based projections, 2015-2025. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000686. [PMID: 36962627 PMCID: PMC10021401 DOI: 10.1371/journal.pgph.0000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/07/2022] [Indexed: 06/18/2023]
Abstract
Subnational projections of under-5 mortality (U5M) have increasingly become an essential planning tool to support Sustainable Development Goals (SDGs) agenda and strategies for improving child survival. To support child health policy, planning, and tracking child development goals in Kenya, we projected U5M at units of health decision making. County-specific annual U5M were estimated using a multivariable Bayesian space-time hierarchical model based on intervention coverage from four alternate intervention scale-up scenarios assuming 1) the highest subnational intervention coverage in 2014, 2) projected coverage based on the fastest county-specific rate of change observed in the period between 2003-2014 for each intervention, 3) the projected national coverage based on 2003-2014 trends and 4) the country-specific targets of intervention coverage relative to business as usual (BAU) scenario. We compared the percentage change in U5M based on the four scale-up scenarios relative to BAU and examined the likelihood of reaching SDG 3.2 target of at least 25 deaths/1,000 livebirths by 2022 and 2025. Projections based on 10 factors assuming BAU, showed marginal reductions in U5M across counties with all the counties except Mandera county not achieving the SDG 3.2 target by 2025. Further, substantial reductions in U5M would be achieved based on the various intervention scale-up scenarios, with 63.8% (30), 74.5% (35), 46.8% (22) and 61.7% (29) counties achieving SDG target for scenarios 1,2,3 and 4 respectively by 2025. Scenario 2 yielded the highest reductions of U5M with individual scale-up of access to improved water, recommended treatment of fever and accelerated HIV prevalence reduction showing considerable impact on U5M reduction (≥ 20%) relative to BAU. Our results indicate that sustaining an ambitious intervention scale-up strategy matching the fastest rate observed between 2003-2014 would substantially reduce U5M in Kenya. However, despite this ambitious scale-up scenario, 25% (12 of 47) of the Kenya's counties would still not achieve SDG 3.2 target by 2025.
Collapse
Affiliation(s)
- Noel K. Joseph
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Emelda A. Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
23
|
Khan N, Islam Trisha N, Rashid M. Availability and readiness of health care facilities and their effects on under-five mortality in Bangladesh: Analysis of linked data. J Glob Health 2022; 12:04081. [PMID: 36112406 PMCID: PMC9480612 DOI: 10.7189/jogh.12.04081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
24
|
Haakenstad A, Angelino O, Irvine CMS, Bhutta ZA, Bienhoff K, Bintz C, Causey K, Dirac MA, Fullman N, Gakidou E, Glucksman T, Hay SI, Henry NJ, Martopullo I, Mokdad AH, Mumford JE, Lim SS, Murray CJL, Lozano R. Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022; 400:295-327. [PMID: 35871816 PMCID: PMC9304984 DOI: 10.1016/s0140-6736(22)00936-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Meeting the contraceptive needs of women of reproductive age is beneficial for the health of women and children, and the economic and social empowerment of women. Higher rates of contraceptive coverage have been linked to the availability of a more diverse range of contraceptive methods. We present estimates of the contraceptive prevalence rate (CPR), modern contraceptive prevalence rate (mCPR), demand satisfied, and the method of contraception used for both partnered and unpartnered women for 5-year age groups in 204 countries and territories between 1970 and 2019. METHODS We used 1162 population-based surveys capturing contraceptive use among women between 1970 and 2019, in which women of reproductive age (15-49 years) self-reported their, or their partner's, current use of contraception for family planning purposes. Spatiotemporal Gaussian process regression was used to generate estimates of the CPR, mCPR, demand satisfied, and method mix by age and marital status. We assessed how age-specific mCPR and demand satisfied changed with the Socio-demographic Index (SDI), a measure of social and economic development, using the meta-regression Bayesian, regularised, trimmed method from the Global Burden of Diseases, Injuries, and Risk Factors Study. FINDINGS In 2019, 162·9 million (95% uncertainty interval [UI] 155·6-170·2) women had unmet need for contraception, of whom 29·3% (27·9-30·6) resided in sub-Saharan Africa and 27·2% (24·4-30·3) resided in south Asia. Women aged 15-19 years (64·8% [62·9-66·7]) and 20-24 years (71·9% [68·9-74·2]) had the lowest rates of demand satisfied, with 43·2 million (95% UI 39·3-48·0) women aged 15-24 years with unmet need in 2019. The mCPR and demand satisfied among women aged 15-19 years were substantially lower than among women aged 20-49 years at SDI values below 60 (on a 0-100 scale), but began to equalise as SDI increased above 60. Between 1970 and 2019, the global mCPR increased by 20·1 percentage points (95% UI 18·7-21·6). During this time, traditional methods declined as a proportion of all contraceptive methods, whereas the use of implants, injections, female sterilisation, and condoms increased. Method mix differs substantially depending on age and geography, with the share of female sterilisation increasing with age and comprising more than 50% of methods in use in south Asia. In 28 countries, one method was used by more than 50% of users in 2019. INTERPRETATION The dominance of one contraceptive method in some locations raises the question of whether family planning policies should aim to expand method mix or invest in making existing methods more accessible. Lower rates of demand satisfied among women aged 15-24 years are also concerning because unintended pregnancies before age 25 years can forestall or eliminate education and employment opportunities that lead to social and economic empowerment. Policy makers should strive to tailor family planning programmes to the preferences of the groups with the most need, while maintaining the programmes used by existing users. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Annie Haakenstad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Olivia Angelino
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Caleb M S Irvine
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, University of Toronto, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Kelly Bienhoff
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Corinne Bintz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kate Causey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - M Ashworth Dirac
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Swedish Family Medicine, First Hill, Seattle, WA, USA
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Thomas Glucksman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Nathaniel J Henry
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ira Martopullo
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - John Everett Mumford
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.
| |
Collapse
|
25
|
Hopkins SR, Jones IJ, Buck JC, LeBoa C, Kwong LH, Jacobsen K, Rickards C, Lund AJ, Nova N, MacDonald AJ, Lambert-Peck M, De Leo GA, Sokolow SH. Environmental Persistence of the World's Most Burdensome Infectious and Parasitic Diseases. Front Public Health 2022; 10:892366. [PMID: 35875032 PMCID: PMC9305703 DOI: 10.3389/fpubh.2022.892366] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Humans live in complex socio-ecological systems where we interact with parasites and pathogens that spend time in abiotic and biotic environmental reservoirs (e.g., water, air, soil, other vertebrate hosts, vectors, intermediate hosts). Through a synthesis of published literature, we reviewed the life cycles and environmental persistence of 150 parasites and pathogens tracked by the World Health Organization's Global Burden of Disease study. We used those data to derive the time spent in each component of a pathogen's life cycle, including total time spent in humans versus all environmental stages. We found that nearly all infectious organisms were “environmentally mediated” to some degree, meaning that they spend time in reservoirs and can be transmitted from those reservoirs to human hosts. Correspondingly, many infectious diseases were primarily controlled through environmental interventions (e.g., vector control, water sanitation), whereas few (14%) were primarily controlled by integrated methods (i.e., combining medical and environmental interventions). Data on critical life history attributes for most of the 150 parasites and pathogens were difficult to find and often uncertain, potentially hampering efforts to predict disease dynamics and model interactions between life cycle time scales and infection control strategies. We hope that this synthetic review and associated database serve as a resource for understanding both common patterns among parasites and pathogens and important variability and uncertainty regarding particular infectious diseases. These insights can be used to improve systems-based approaches for controlling environmentally mediated diseases of humans in an era where the environment is rapidly changing.
Collapse
Affiliation(s)
- Skylar R. Hopkins
- National Center for Ecological Analysis and Synthesis, Santa Barbara, CA, United States
- Department of Applied Ecology, North Carolina State University, Raleigh, NC, United States
- *Correspondence: Skylar R. Hopkins
| | - Isabel J. Jones
- Hopkins Marine Station, Stanford University, Pacific Grove, CA, United States
| | - Julia C. Buck
- Department of Biology and Marine Biology, University of North Carolina Wilmington, Wilmington, NC, United States
| | - Christopher LeBoa
- Department of Epidemiology, Stanford University, Stanford, CA, United States
| | - Laura H. Kwong
- Stanford Woods Institute for the Environment, Stanford University, Stanford, CA, United States
| | - Kim Jacobsen
- School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Chloe Rickards
- Department of Ecology and Evolutionary Biology, University of California, Santa Cruz, Santa Cruz, CA, United States
| | - Andrea J. Lund
- Emmett Interdisciplinary Program in Environment and Resources, Stanford University, Stanford, CA, United States
| | - Nicole Nova
- Department of Biology, Stanford University, Stanford, CA, United States
| | - Andrew J. MacDonald
- Department of Biology, Stanford University, Stanford, CA, United States
- Earth Research Institute, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Miles Lambert-Peck
- United Nations University for the Advanced Study of Sustainability, Tokyo, Japan
| | - Giulio A. De Leo
- Hopkins Marine Station, Stanford University, Pacific Grove, CA, United States
| | - Susanne H. Sokolow
- Hopkins Marine Station, Stanford University, Pacific Grove, CA, United States
- Marine Science Institute, University of California, Santa Barbara, Santa Barbara, CA, United States
| |
Collapse
|
26
|
Radó MK, van Lenthe FJ, Laverty AA, Filippidis FT, Millett C, Sheikh A, Been JV. Effect of comprehensive smoke-free legislation on neonatal mortality and infant mortality across 106 middle-income countries: a synthetic control study. THE LANCET PUBLIC HEALTH 2022; 7:e616-e625. [DOI: 10.1016/s2468-2667(22)00112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022] Open
|
27
|
Najafipour H, Mahdavi A, Kordestani Z, Zamaninasab Z, Shadkam Farokhi M, Shamsadini A, Azizi E. The Prevalence and 5-Year Incidence Rate of Cigarette Smoking and Water-Pipe Tobacco Smoking and Their Associated Factors among 15 to 80 Years Old Urban Population in Southeast Iran: Results from KERCADR Study. ADDICTION & HEALTH 2022; 14:205-213. [PMID: 36544984 PMCID: PMC9743829 DOI: 10.34172/ahj.2022.1273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
Background Cigarette and tobacco smoking are closely associated with chronic cardiovascular disease and lung cancer. We aimed to assess the prevalence and 5-year incidence rate (IR) of these two risk factors for cardiovascular diseases in Kerman, southeastern of Iran. Methods 10015 individuals aged 15-80 were recruited to the study between 2014 and 2018 (Kerman coronary artery disease (CAD) risk factors study, KERCADRS) of which 2820 had also participated in the first phase (5 years earlier). We took fasting blood samples and collected demographic information and data on cigarette and water-pipe tobacco smoking (WPTS) through interviews. Findings The overall prevalence of cigarette smoking increased from 8.1% in phase1 to 8.8% in phase 2. During the same period, the prevalence of WPTS increased from 10% to 14%, especially in the age groups of 15-45 years. The prevalence of opium dependance was higher among cigarette smokers compared to WPT users. The overall 5-year IR of cigarette and WPTS was 3.6 and 4.65 per 1000 person-years respectively. The highest IRs of cigarette smoking and WPTS were reported in the age group of 15-39 years, and IR of WPTS was higher among women. Obesity, diabetes, and hypertension associated with a reduced IRs of cigarette and WPTS. Conclusion Over the past five years, the prevalence of cigarette smoking has increased slightly, but WPTS has increased more rapidly, especially among women. The highest prevalence of cigarette and WPT smoking was in the age groups of 15-39 years. Smoking is shifting from cigarette smoking to WPTS. Age- and gender-oriented interventions would help correct the unhealthy life style in the community and prevent further smoking-related morbidities and mortalities.
Collapse
Affiliation(s)
- Hamid Najafipour
- Physiology Research Center, Institute of Neuropharmacology, and Department of Physiology and Pharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Amin Mahdavi
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences and Department of Cardiology, Kerman University of Medical Sciences, Kerman, Iran,Corresponding Author: Amin Mahdavi, MD, Cardiovascular Research Center and Department of Cardiology, Afzalipour Medical Faculty, Shafa Hospital, Shafa Street, Kerman, Iran. Tel: +983412264071, Fax: +983412264097, Emails: ,
| | - Zeinab Kordestani
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Zamaninasab
- Department of Biostatistics, Faculty of Health, and Gastroenterology and Hepatology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Atefeh Shamsadini
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Elnaz Azizi
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
28
|
Tan W, Chen L, Zhang Y, Xi J, Hao Y, Jia F, Hall BJ, Gu J, Wang S, Lin H, Lin X. Regional years of life lost, years lived with disability, and disability-adjusted life-years for severe mental disorders in Guangdong Province, China: a real-world longitudinal study. Glob Health Res Policy 2022; 7:17. [PMID: 35725574 PMCID: PMC9208127 DOI: 10.1186/s41256-022-00253-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To understand the magnitude and spatial-temporal distribution of the regional burden attributable to severe mental disorders is of great essential and high policy relevance. The study aimed to address the burden of severe mental disorders by evaluating the years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) in Guangdong, China. METHODS We undertook a longitudinal study based on a multicenter database established by the Health Commission of Guangdong, involving a total of 21 prefectures and four economic regions in the Guangdong province. A total of 520,731 medical records from patients with severe mental disorders were collected for 2010-2020. Data were analyzed via an integrated evaluation framework by synthesizing prevalence estimates, epidemiological adjustment as well as comorbidity assessment to develop internally consistent estimates of DALY. DALY changes during 2010-2020 were decomposed by population growth and aging and further grouped by Socio-demographic Index (SDI). DALYs were projected to 2030 by the weighted median annualized rate of change in 2010-2020. RESULTS In 2010-2020, the average DALYs for severe mental disorders reached 798,474 (95% uncertainty interval [UI]: 536,280-1,270,465) person-years (52.2% for males, and 47.8% for females). Severe mental disorders led to a great amount of disease burden, especially in Guangzhou, Shenzhen, and Foshan cities. Schizophrenia and mental retardation with mental disorders were the two leading sources of the burden ascribed to severe mental disorders. Population growth and aging could be accountable for the increasing burden of severe mental disorders. Economic regions with higher SDI carried a greater burden but had lower annualized rates of change in DALYs. The overall burden of severe mental disorders is projected to rise modestly over the next decade. CONCLUSIONS The findings urge prioritization of initiatives focused on public mental health, prevention strategies, health resources reallocation, and active involvement of authorities to effectively address the anticipated needs.
Collapse
Affiliation(s)
- Wenyan Tan
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Lichang Chen
- Department of Medical Statistics and Center for Health Information Research and Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, China
| | - Yuqin Zhang
- Department of Medical Statistics and Center for Health Information Research and Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, China
| | - Junyan Xi
- Department of Medical Statistics and Center for Health Information Research and Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, China
| | - Yuantao Hao
- Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, 100191, China
| | - Fujun Jia
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Brian J Hall
- Global Public Health, New York University (Shanghai), Shanghai, 200122, China
| | - Jing Gu
- Department of Medical Statistics and Center for Health Information Research and Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, China.,Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Shibin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Haicheng Lin
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
| | - Xiao Lin
- Department of Medical Statistics and Center for Health Information Research and Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, China. .,Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
| |
Collapse
|
29
|
Xu T, Miao H, Chen Y, Luo L, Guo P, Zhu Y. Association of Interpregnancy Interval With Adverse Birth Outcomes. JAMA Netw Open 2022; 5:e2216658. [PMID: 35696164 PMCID: PMC9194661 DOI: 10.1001/jamanetworkopen.2022.16658] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/25/2022] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Many studies have reported an association of interpregnancy interval (IPI) between 2 consecutive births with adverse birth outcomes in low- and middle-income countries. However, most of these studies ignore the implications of some unmeasured confounders. OBJECTIVE To explore the association of IPI with adverse perinatal outcomes. DESIGN, SETTING, AND PARTICIPANTS This large-scale cohort study used the Guangdong Provincial Women and Children Health Information System in Guangdong Province, China, to obtain birth data recorded between January 1, 2014, and December 31, 2020. Matched-sibling design was used. The final cohort included first-born and second-born sibling pairs delivered by mothers who were permanent residents of Guangdong Province. EXPOSURES The exposure variable was IPI, which was categorized as follows: less than 6, 6 to 11, 12 to 17, 18 to 23, 24 to 29, 30 to 35, and 36 or more months. MAIN OUTCOMES AND MEASURES The outcome variables were adverse birth outcomes: preterm birth (PTB, gestational age <37 weeks), low birth weight (LBW, <2500 g), and small for gestational age (SGA). Adjusted odds ratio (OR) and interaction odds ratio (IOR) associated with IPI were calculated. RESULTS The study consisted of 725 392 sibling pairs of multiparous mothers. Among these mothers, 718 111 (99.0%) were aged 20 to 34 years, and 715 583 (98.7%) were of Han Chinese ethnicity. Unmatched analysis showed that a short IPI of less than 6 months was associated with higher risks of PTB (adjusted OR, 1.96; 95% CI, 1.87-2.06), LBW (adjusted OR, 1.88; 95% CI, 1.79-1.98), and SGA (adjusted OR, 1.34; 95% CI, 1.30-1.38) compared with an IPI of 18 to 23 months. These associations were attenuated in the matched-sibling analysis. An association of short IPI (<6 months) with PTB (adjusted IOR, 1.40; 95% CI, 1.30-1.51), LBW (adjusted IOR, 1.30; 95% CI, 1.21-1.40), and SGA (adjusted IOR, 1.16; 95% CI, 1.11-1.22) remained in the matched analysis. For IPI of 36 months or more, the odds of PTB (adjusted OR, 1.08; 95% CI, 1.03-1.14) and LBW (adjusted OR, 1.13; 95% CI, 1.07-1.19) in the unmatched analysis were also greater than the reference interval (18-23 months), but not for SGA (adjusted OR, 0.96; 95% CI, 0.93-0.99). Associations between a long IPI (≥36 months) and PTB (adjusted IOR, 1.10; 95% CI, 1.02-1.19) and LBW (adjusted IOR, 1.16; 95% CI, 1.07-1.26) remained through the sibling comparisons. CONCLUSIONS AND RELEVANCE Results of this study indicated that mothers with a short (<6 months) or long (≥36 months) IPI had greater odds of adverse birth outcomes. The findings may inform family planning policies and guide individuals and families who are planning for another pregnancy in China.
Collapse
Affiliation(s)
- Ting Xu
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Huazhang Miao
- Department of Healthcare, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yuliang Chen
- Department of Medical Quality Management, Nanfang Hospital, Guangzhou, China
| | - Limei Luo
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Pi Guo
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou, China
| | - Yingxian Zhu
- Department of Healthcare, Guangdong Women and Children Hospital, Guangzhou, China
| |
Collapse
|
30
|
Plass D, Hilderink H, Lehtomäki H, Øverland S, Eikemo TA, Lai T, Gorasso V, Devleesschauwer B. Estimating risk factor attributable burden - challenges and potential solutions when using the comparative risk assessment methodology. Arch Public Health 2022; 80:148. [PMID: 35624479 PMCID: PMC9137119 DOI: 10.1186/s13690-022-00900-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/12/2022] [Indexed: 03/21/2024] Open
Abstract
Background Burden of disease analyses quantify population health and provide comprehensive overviews of the health status of countries or specific population groups. The comparative risk assessment (CRA) methodology is commonly used to estimate the share of the burden attributable to risk factors. The aim of this paper is to identify and address some selected important challenges associated with CRA, illustrated by examples, and to discuss ways to handle them. Further, the main challenges are addressed and finally, similarities and differences between CRA and health impact assessments (HIA) are discussed, as these concepts are sometimes referred to synonymously but have distinctly different applications. Results CRAs are very data demanding. One key element is the exposure-response relationship described e.g. by a mathematical function. Combining estimates to arrive at coherent functions is challenging due to the large variability in risk exposure definitions and data quality. Also, the uncertainty attached to this data is difficult to account for. Another key issue along the CRA-steps is to define a theoretical minimal risk exposure level for each risk factor. In some cases, this level is evident and self-explanatory (e.g., zero smoking), but often more difficult to define and justify (e.g., ideal consumption of whole grains). CRA combine all relevant information and allow to estimate population attributable fractions (PAFs) quantifying the proportion of disease burden attributable to exposure. Among many available formulae for PAFs, it is important to use the one that allows consistency between definitions, units of the exposure data, and the exposure response functions. When combined effects of different risk factors are of interest, the non-additive nature of PAFs and possible mediation effects need to be reflected. Further, as attributable burden is typically calculated based on current exposure and current health outcomes, the time dimensions of risk and outcomes may become inconsistent. Finally, the evidence of the association between exposure and outcome can be heterogeneous which needs to be considered when interpreting CRA results. Conclusions The methodological challenges make transparent reporting of input and process data in CRA a necessary prerequisite. The evidence for causality between included risk-outcome pairs has to be well established to inform public health practice.
Collapse
Affiliation(s)
- Dietrich Plass
- German Environment Agency, Section Exposure Assessment and Environmental Health Indicators, Berlin, Germany.
| | - Henk Hilderink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Heli Lehtomäki
- Finnish Institute for Health and Welfare (THL), Health Security, Environmental Health, Helsinki, Finland.,University of Eastern Finland (UEF), Faculty of Health Sciences, School of Pharmacy, Kuopio, Finland
| | - Simon Øverland
- Section for Health Care Collaboration, Haukeland University Hospital, Bergen, Norway
| | - Terje A Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Taavi Lai
- Fourth View Consulting, Tallinn, Estonia
| | - Vanessa Gorasso
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| |
Collapse
|
31
|
Levin AT, Owusu-Boaitey N, Pugh S, Fosdick BK, Zwi AB, Malani A, Soman S, Besançon L, Kashnitsky I, Ganesh S, McLaughlin A, Song G, Uhm R, Herrera-Esposito D, de Los Campos G, Peçanha Antonio ACP, Tadese EB, Meyerowitz-Katz G. Assessing the burden of COVID-19 in developing countries: systematic review, meta-analysis and public policy implications. BMJ Glob Health 2022; 7:bmjgh-2022-008477. [PMID: 35618305 PMCID: PMC9136695 DOI: 10.1136/bmjgh-2022-008477] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/05/2022] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The infection fatality rate (IFR) of COVID-19 has been carefully measured and analysed in high-income countries, whereas there has been no systematic analysis of age-specific seroprevalence or IFR for developing countries. METHODS We systematically reviewed the literature to identify all COVID-19 serology studies in developing countries that were conducted using representative samples collected by February 2021. For each of the antibody assays used in these serology studies, we identified data on assay characteristics, including the extent of seroreversion over time. We analysed the serology data using a Bayesian model that incorporates conventional sampling uncertainty as well as uncertainties about assay sensitivity and specificity. We then calculated IFRs using individual case reports or aggregated public health updates, including age-specific estimates whenever feasible. RESULTS In most locations in developing countries, seroprevalence among older adults was similar to that of younger age cohorts, underscoring the limited capacity that these nations have to protect older age groups.Age-specific IFRs were roughly 2 times higher than in high-income countries. The median value of the population IFR was about 0.5%, similar to that of high-income countries, because disparities in healthcare access were roughly offset by differences in population age structure. CONCLUSION The burden of COVID-19 is far higher in developing countries than in high-income countries, reflecting a combination of elevated transmission to middle-aged and older adults as well as limited access to adequate healthcare. These results underscore the critical need to ensure medical equity to populations in developing countries through provision of vaccine doses and effective medications.
Collapse
Affiliation(s)
- Andrew T Levin
- Economics, Dartmouth College, Hanover, New Hampshire, USA.,National Bureau for Economic Research, Cambridge, Massachusetts, USA
| | - Nana Owusu-Boaitey
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sierra Pugh
- Statistics, Colorado State University, Fort Collins, Colorado, USA
| | - Bailey K Fosdick
- Department of Statistics, Colorado State University, Fort Collins, Colorado, USA
| | - Anthony B Zwi
- School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Anup Malani
- Law School, University of Chicago, Chicago, Illinois, USA
| | - Satej Soman
- Harris School of Public Policy, University of Chicago, Chicago, Illinois, USA
| | - Lonni Besançon
- Faculty of Information and Technology, Monash University, Clayton, Victoria, Australia
| | - Ilya Kashnitsky
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Sachin Ganesh
- Department of Economics, Dartmouth College, Hanover, New Hampshire, USA
| | | | - Gayeong Song
- Department of Economics, Dartmouth College, Hanover, New Hampshire, USA
| | - Rine Uhm
- Department of Economics, Dartmouth College, Hanover, New Hampshire, USA
| | | | - Gustavo de Los Campos
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | | | | | - Gideon Meyerowitz-Katz
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown, New South Wales, Australia .,School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
32
|
Sianes A, Vega-Muñoz A, Tirado-Valencia P, Ariza-Montes A. Impact of the Sustainable Development Goals on the academic research agenda. A scientometric analysis. PLoS One 2022; 17:e0265409. [PMID: 35298518 PMCID: PMC8929641 DOI: 10.1371/journal.pone.0265409] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/01/2022] [Indexed: 11/19/2022] Open
Abstract
Today, global challenges such as poverty, inequality, and sustainability are at the core of the academic debate. This centrality has only increased since the transition from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs), whose scope is to shift the world on to a path of resilience focused on promoting sustainable development. The main purpose of this paper is to develop a critical yet comprehensive scientometric analysis of the global academic production on the SDGs, from its approval in 2015 to 2020, conducted using Web of Science (WoS) database. Despite it being a relatively short period of time, scholars have published more than five thousand research papers in the matter, mainly in the fields of green and sustainable sciences. The attained results show how prolific authors and schools of knowledge are emerging, as key topics such as climate change, health and the burden diseases, or the global governance of these issues. However, deeper analyses also show how research gaps exist, persist and, in some cases, are widening. Greater understanding of this body of research is needed, to further strengthen evidence-based policies able to support the implementation of the 2030 Agenda and the achievement of the SDGs.
Collapse
Affiliation(s)
- Antonio Sianes
- Research Institute on Policies for Social Transformation, Universidad Loyola Andalucía, Córdoba, Spain
| | | | | | | |
Collapse
|
33
|
Trends of Inequalities in Early Initiation of Breastfeeding in Ethiopia: Evidence from Ethiopian Demographic and Health Surveys, 2000-2016. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5533668. [PMID: 35265715 PMCID: PMC8898814 DOI: 10.1155/2022/5533668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 12/23/2021] [Accepted: 02/16/2022] [Indexed: 02/07/2023]
Abstract
Background Early initiation of breastfeeding (EIBF) is a costless practice with numerous neonates' survival benefits. Thus, any disparity results in an unacceptably high neonatal death rate but socioeconomic disparities on EIBF have not been well explored in Ethiopia. Therefore, this study is aimed at assessing the socioeconomic inequalities of EIBF in Ethiopia from 2000 to 2016. Methods The Ethiopian demographic and health survey data and the World Health Organization's Health Equity Assessment Toolkit were used to investigate the inequalities in EIBF across the wealth quintile, education, residence, and subnational region. Difference, ratio, slope index inequality (SII), relative index inequality (RII), and population attributable risk (PAR) were used as equity summary measures. Results In Ethiopia, EIBF practice was 47.4% in 2000, 66.2% in 2005, 51.5% in 2011, and 73.3% in 2016. Wealth-related inequality was observed in the 2000, 2005, and 2011 survey years with SII of -7.1%, -8.8%, and 8.7%, respectively, whereas educational-related inequality was observed in 2005 and 2011 with SII of -11.7% and 6.5%, respectively. However, significant change in wealth-, education-, and residence-related inequalities was detected in 2011. Regional inequality on EIBF was observed in all survey years with a difference of 35.7%, 38.0%, 29.1%, and 48.5% in the 2000, 2005, 2011, and 2016 survey years, respectively. But a significant change in regional inequality was noted in 2016 with a PAR of 17.2%. Conclusions In Ethiopia, the wealth-, residence-, and educational-related inequalities of EIBF increased significantly between the years 2000 and 2011. However, regional inequality persistently increased from 2000 to 2016. Overall, one-sixth of the national level EIBF was decreased due to regional disparity in 2016. The northern regions of Ethiopia (Tigray, Afar, and Amhara) poorly performed compared to the peer regions. Therefore, interventions targeting them would significantly improve the national level of EIBF.
Collapse
|
34
|
Araya P, Martínez C, Barros J. Lithium in Drinking Water as a Public Policy for Suicide Prevention: Relevance and Considerations. Front Public Health 2022; 10:805774. [PMID: 35252091 PMCID: PMC8891154 DOI: 10.3389/fpubh.2022.805774] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/24/2022] [Indexed: 12/07/2022] Open
Abstract
Although suicide is considered a major preventable cause of mortality worldwide, we do not have effective strategies to prevent it. Lithium has been consistently associated with lowering risk of suicide. This effect could occur at very low concentrations, such as trace doses of lithium in tap water. Several ecological studies and recent meta-analysis have suggested an inverse association between lithium in water and suicide in the general population, with a lack of knowledge of clinically significant side effects. This paper is aimed as a proposal to discuss the addition of lithium to drinking water to decrease the suicide rate. For this, we review the evidence available, use previous experiences, such as water fluoridation to prevent dental caries, and discuss the complexity involved in such a public policy. Considering the limited data available and the controversies contained in this proposal, we suggest that a consensus on lithium concentration in water is needed, where the suicide rates start to reduce, as happened with water fluoridation. This measure will require to develop community-controlled trials with strict monitoring of any side effects, where democratic procedures would constitute one of the most appropriate ways to validate its implementation according to the reality of each community.
Collapse
Affiliation(s)
- Pablo Araya
- Department of Escuela de Medicina PUC School of Medicine, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Martínez
- Department of Escuela de Medicina PUC School of Medicine, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Barros
- Departamento de Psiquiatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- *Correspondence: Jorge Barros
| |
Collapse
|
35
|
Yuan H, Long Q, Huang G, Huang L, Luo S. Different roles of interpersonal trust and institutional trust in COVID-19 pandemic control. Soc Sci Med 2022; 293:114677. [PMID: 35101260 PMCID: PMC8692240 DOI: 10.1016/j.socscimed.2021.114677] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 12/18/2022]
Abstract
The absence of pharmaceutical interventions made it particularly difficult to mitigate the first outbreak of coronavirus disease 2019 (COVID-19). The current study investigated how interpersonal trust and institutional trust influenced the control process. Trusts and COVID-19 data in 44 countries and 50 US states were analyzed; institutional trust was associated with case fatality rate, and interpersonal trust was associated with control speed. Two independent behavioral experiments showed that institutional trust manipulation increased participants’ willingness to complete the COVID-19 test and that interpersonal trust manipulation increased conscious compliance with prevention norms and decreased unnecessary outdoor activities. Agent-based modeling further confirmed these behavioral mechanisms for two types of trust in the COVID-19 control process. New interventions are needed to help countries heighten interpersonal and institutional trust as they continue to battle COVID-19 and other collective threats.
Collapse
Affiliation(s)
- Hang Yuan
- Department of Psychology, Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-Sen University, Guangzhou 510006, China
| | - Qinyi Long
- Department of Psychology, Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-Sen University, Guangzhou 510006, China
| | - Guanglv Huang
- Department of Psychology, Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-Sen University, Guangzhou 510006, China
| | - Liqin Huang
- Department of Psychology, Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-Sen University, Guangzhou 510006, China
| | - Siyang Luo
- Department of Psychology, Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-Sen University, Guangzhou 510006, China.
| |
Collapse
|
36
|
Pires AM, Reis JGM, Garcia FM, Veloso GA, Melo APS, Naghavi M, Passos VMDA. Suicide mortality among older adults in Brazil between 2000 and 2019 - estimates from the Global Burden of Disease Study 2019. Rev Soc Bras Med Trop 2022; 55:e0322. [PMID: 35107540 PMCID: PMC9009432 DOI: 10.1590/0037-8682-0322-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/29/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Older adults present a higher risk of suicide, and Brazil is experiencing a fast population aging. To understand the impact of demographic transition, we compared Brazilian suicide mortality rates (MR) among adults (50+ years) with global rates, those from one high-income country, and those from one middle-income country. Looking for regional disparities, the MR was analyzed among older adults (60+ years) by Brazilian states. METHODS This was an ecological study based on estimates from the Global Burden of Disease Study, from 2000 to 2019. Age-standardized MR and age-specific MR per 100,000 inhabitants were described, with 95% uncertainty intervals (UI). RESULTS During the period, the annual estimates and the declining trend in mortality were higher in the world than in the studied countries. In 2019, global age-standardized MR was 9.39 (95% UI 8.48-10.29), compared to 5.68 (95% UI 5.40-6.19), 6.01 (95% UI 5.10-7.04), and 6.63 (95% UI 6.43-6.95) in Brazil, Mexico, and England, respectively. In Brazil, despite a significant decline in national rates, stability was observed in 15 states. An increase in aging was only found for men, who presented 3-4 times higher MR than women. The states' rates presented large differences: in 2019, the rates among men aged 60-64 years varied from 7.24 (95% UI 5.31; 9.85) to 26.32 (95% UI 20.21; 34.50). CONCLUSIONS The smaller decline in suicide mortality among older Brazilian adults, the increasing risk with aging, and the higher mortality among men indicate the need for specific prevention policies. The variation within states suggests differences in the data quality or in socio-cultural and historical aspects, which requires further investigation.
Collapse
Affiliation(s)
- Ademar Moreira Pires
- Faculdade de Ciências Médicas de Minas Gerais, Programa de Pós-Graduação em Ciências da Saúde, Belo Horizonte, MG, Brasil
| | - Júlia Gondim Maia Reis
- Faculdade Ciências Médicas de Minas Gerais, Faculdade de Medicina, Belo Horizonte, MG, Brasil
| | - Flávia Megda Garcia
- Faculdade Ciências Médicas de Minas Gerais, Faculdade de Medicina, Belo Horizonte, MG, Brasil
| | - Guilherme Augusto Veloso
- Universidade Federal de Minas Gerais, Instituto de Ciências Exatas, Programa de Pós-Graduação em Estatística, Belo Horizonte, MG, Brasil
| | - Ana Paula Souto Melo
- Universidade Federal de São João del-Rei, Faculdade de Medicina, Divinópolis, MG, Brasil
| | - Mohsen Naghavi
- Washington University, Institute of Health Metrics and Evaluation, Seattle, USA
| | | |
Collapse
|
37
|
Bonadiman CSC, Naghavi M, Melo APS. The burden of suicide in Brazil: findings from the Global Burden of Disease Study 2019. Rev Soc Bras Med Trop 2022; 55:e0299. [PMID: 35107538 PMCID: PMC9009430 DOI: 10.1590/0037-8682-0299-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION: Suicide deaths varies according to location, sex, and age. This study analyzed the Global Burden of Disease Study 2019 (GBD 2019) concerning suicide in Brazil. METHODS: This study described the mortality and years of life lost (YLL) due to premature death caused by suicide in Brazil in 1990 and 2019. The numbers, crude and age-standardized mortality rate (ASMR), and YLL were compared among Brazilian states, age groups, and sexes. RESULTS: There were 13,502 suicides in Brazil in 2019, 46.00% more than in 1990. The crude mortality rate increased 0.32%, while the ASMR declined -21.68% during the period. Crude and age-standardized YLL rates declined by -7.24% and -18.38%, respectively. In 2019, the biggest ASMRs were found in the South, whereas from 1990 to 2019, the ASMR declined in the South, Southeast, and Midwest, and increased in the Northeast. The number of suicides was higher among individuals aged 15-49 years, and suicide rates were higher among those aged over 70 years. From 1990 to 2019, an increase in the rate was found only of 10-14 years of age. Suicide was highest in men, except in the 10-14-year age group, ranking third in mortality among men of 15-34 years of age and fourth among women of 15-24 years of age. CONCLUSIONS: The ASMR and YLL for suicide declined since 1990, but suicide remains an important factor of mortality in the country. The South Region, men, elderly, and youth should be priorities in the implementation of suicide prevention strategies in Brazil.
Collapse
Affiliation(s)
| | | | - Ana Paula Souto Melo
- Universidade Federal de Minas Gerais, Brasil; Universidade Federal de São João Del Rei, Brasil
| |
Collapse
|
38
|
Bekele FB, Shiferaw K, Nega A, Derseh A, Seme A, Shiferaw S. Factors influencing place of delivery in Ethiopia: Linking individual, household, and health facility-level data. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000535. [PMID: 36962740 PMCID: PMC10021680 DOI: 10.1371/journal.pgph.0000535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Maternal mortality remains high, especially in sub-Saharan Africa. Institutional delivery is one of the key intervention to reduce it. Despite service utilization reflects an interplay of demand- and supply-side factors, previous studies mainly focused on either sides due to methodological challenges and data availability. But, a more comprehensive understanding can be obtained by assessing both sides. The aim of this study is to assess individual, household, community, and health facility factors associated with deliveryplace in Ethiopia. METHODS We have used the 2019 Performance Monitoring for Action survey data set, which is a nationally representative sample of women linked with national sample of health facilities in Ethiopia. A total of 2547 women who recently delivered were linked with 170 health centers and 41 hospitals. Facility readiness index was calculated based on previous study conducted by Stierman EK on similar data set. We applied survey weights for descriptive statistics. Multilevel mixed-effects logistic regression was used to identify factors influencing delivery place. RESULTS Coverage of institutional delivery was 54.49%. Women aged 20-34 [AOR; 0.55 (0.32-0.85)] compared with those younger than 20 years; those with no formal education [AOR: 0.19 (10.05-0.76)] or attended only primary school [AOR: 0.20 (0.05-0.75)] compared with those attended above secondary; and women whose partners didn't encourage antinatal visit [AOR; 0.57 (0.33-0.98)] all have decreased odd of institutional delivery. Attending at least one antenatal visit [AOR: 3.09 (1.87-5.10)] and increased availability of medicines in the closest facility [AOR: 17.33 (1.32-26.4)] increase odds of institutional deliver. CONCLUSION In Ethiopia, nearly half of the total deliveries take place outside health facilities. In addition to improving women's education, utilization of antenatal care, and encouragement by partners, it is important to consider the availability of medicine and commodities in the nearby health facilities while designing and implementing programs to reduce home delivery.
Collapse
Affiliation(s)
| | - Kasiye Shiferaw
- School of Midwifery, Haromaya University, Haromaya, Ethiopia
| | - Adiam Nega
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Anagaw Derseh
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Shiferaw
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
39
|
Ni YN, Du XL, Wang T, Chen YY, Xu XQ, Zhao S, Li JQ, Wang G. Design, Synthesis, and Antidepressant Activity Study of Novel Aryl Piperazines Targeting Both 5-HT1A and Sigma-1 Receptors. PHARMACEUTICAL FRONTS 2021. [DOI: 10.1055/s-0041-1740049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
A total of 20 novel aryl piperazine derivatives were designed and synthesized, and their structures were confirmed by mass spectrometry and nuclear magnetic resonance analyses. Their 5-HT1A and sigma-1 receptor affinities were determined, and six of them showed high affinities (K
i < 20 nmol/L) to both 5-HT1A and sigma-1 targets. Then, metabolic stability (T
1/2) tests of six compounds in rat and human liver microsomes were performed. Our data indicated that compound 27 has both high affinity for 5-HT1A and sigma-1 receptors (5-HT1A: K
i = 0.44 nmol/L; sigma-1: K
i = 0.27 nmol/L), and good metabolic stability (T
1/2 values are 21.7 and 24.6 minutes, respectively). Interestingly, results from the forced swimming test, mouse tail suspension test, and preliminary pharmacokinetic test suggested the marked antidepressant activity, good pharmacokinetic characteristics, and low toxicity of compound 27 in the two models. In conclusion, compound 27 has great value of further study as an active molecule of antidepressant drugs.
Collapse
Affiliation(s)
- Yan-Na Ni
- School of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai, People's Republic of China
- Novel Technology Center of Pharmaceutical Chemistry, Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, Shanghai, People's Republic of China
| | - Xin-Li Du
- Novel Technology Center of Pharmaceutical Chemistry, Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, Shanghai, People's Republic of China
| | - Tao Wang
- Novel Technology Center of Pharmaceutical Chemistry, Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, Shanghai, People's Republic of China
| | - Yuan-Yuan Chen
- Novel Technology Center of Pharmaceutical Chemistry, Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, Shanghai, People's Republic of China
| | - Xiang-Qing Xu
- Jiangsu Enhua Pharmaceutical Co., Ltd., Jiangsu, People's Republic of China
| | - Song Zhao
- Jiangsu Enhua Pharmaceutical Co., Ltd., Jiangsu, People's Republic of China
| | - Jian-Qi Li
- Novel Technology Center of Pharmaceutical Chemistry, Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, Shanghai, People's Republic of China
| | - Guan Wang
- Novel Technology Center of Pharmaceutical Chemistry, Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, Shanghai, People's Republic of China
| |
Collapse
|
40
|
Universal coverage of the first antenatal care visit but poor continuity of care across the maternal and newborn health continuum among Nepalese women: analysis of levels and correlates. Global Health 2021; 17:141. [PMID: 34895276 PMCID: PMC8665493 DOI: 10.1186/s12992-021-00791-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background Routine maternity care visits (MCVs) such as antenatal care (ANC), institutional delivery, and postnatal care (PNC) visits are crucial to utilisation of maternal and newborn health (MNH) interventions during pregnancy-postnatal period. In Nepal, however, not all women complete these routine MCVs. Therefore, this study examined the levels and correlates of (dis)continuity of MCVs across the antenatal-postnatal period. Methods We conducted further analysis of the 2016 Nepal Demographic and Health Survey. A total of 1,978 women aged 15–49 years, who had live birth two years preceding the survey, were included in the analysis. The outcome variable was (dis)continuity of routine MCVs (at least four ANC visits, institutional delivery, and PNC visit) across the pathway of antennal through to postnatal period. Independent variables included several social determinants of health under structural, intermediary, and health system domains. Multinomial logistic regression was conducted to identify the correlates of routine MCVs. Relative risk ratios (RR) were reported with 95% confidence intervals at a significance level of p<0.05. Results Approximately 41% of women completed all routine MCVs with a high proportion of discontinuation around childbirth. Women of disadvantaged ethnicities, from low wealth status, who were illiterate had higher RR of discontinuation of MCVs (compared to completion of all MCVs). Similarly, women who speak Bhojpuri, from remote provinces (Karnali and Sudurpaschim), who had a high birth order (≥4), who were involved in the agricultural sector, and who had unwanted last birth had a higher RR of discontinuation of MCVs. Women discontinued routine MCVs if they had poor awareness of health mother-groups and perceived the problem of not having female providers. Conclusions Routine monitoring using composite coverage indicators is required to track the levels of (dis)continuity of routine MCVs at the maternity care continuum. Strategies such as raising awareness on the importance of maternity care, care provision from female health workers could potentially improve the completion of MCVs. In addition, policy and programmes for continuity of maternity care are needed to focus on women with socioeconomic and ethnic disadvantages and from remote provinces. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00791-4.
Collapse
|
41
|
Ebenso B, Okusanya B, Okunade K, Akeju D, Ajepe A, Akaba GO, Yalma RM, Dirisu O, Tukur J, Abdullahi MK, Okuzu O, Allsop MJ. What Are the Contextual Enablers and Impacts of Using Digital Technology to Extend Maternal and Child Health Services to Rural Areas? Findings of a Qualitative Study From Nigeria. Front Glob Womens Health 2021; 2:670494. [PMID: 34816223 PMCID: PMC8594044 DOI: 10.3389/fgwh.2021.670494] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Strengthening health systems to improve access to maternity services remains challenging for Nigeria due partly to weak and irregular in-service training and deficient data management. This paper reports the implementation of digital health tools for video training (VTR) of health workers and digitization of health data at scale, supported by satellite communications (SatCom) technology and existing 3G mobile networks. Objective: To understand whether, and under what circumstances using digital interventions to extend maternal, newborn and child health (MNCH) services to remote areas of Nigeria improved standards of healthcare delivery. Methods: From March 2017 to March 2019, VTR and data digitization interventions were delivered in 126 facilities across three states of Nigeria. Data collection combined documents review with 294 semi-structured interviews of stakeholders across four phases (baseline, midline, endline, and 12-months post-project closedown) to assess acceptability and impacts of digital interventions. Data was analyzed using a framework approach, drawing on a modified Technology Acceptance Model to identify factors that shaped technology adoption and use. Results: Analysis of documents and interview transcripts revealed that a supportive policy environment, and track record of private-public partnerships facilitated adoption of technology. The determinants of technology acceptance among health workers included ease of use, perceived usefulness, and prior familiarity with technology. Perceptions of impact suggested that at the micro (individual) level, repeated engagement with clinical videos increased staff knowledge, motivation and confidence to perform healthcare roles. At meso (organizational) level, better-trained staff felt supported and empowered to provide respectful healthcare and improved management of obstetric complications, triggering increased use of MNCH services. The macro level saw greater use of reliable and accurate data for policymaking. Conclusions: Simultaneous and sustained implementation of VTR and data digitization at scale enabled through SatCom and 3G mobile networks are feasible approaches for supporting improvements in staff confidence and motivation and reported MNCH practices. By identifying mechanisms of impact of digital interventions on micro, meso, and macro levels of the health system, the study extends the evidence base for effectiveness of digital health and theoretical underpinnings to guide further technology use for improving MNCH services in low resource settings. Trial Registration: ISRCTN32105372.
Collapse
Affiliation(s)
- Bassey Ebenso
- Nuffield Center for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Babasola Okusanya
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Kehinde Okunade
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - David Akeju
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Adegbenga Ajepe
- Department of Obstetrics and Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Godwin O Akaba
- Department of Obstetrics and Gynecology, University of Abuja, Abuja, Nigeria
| | - Ramsey M Yalma
- Department of Community Medicine University of Abuja, Abuja, Nigeria
| | | | | | | | - Okey Okuzu
- Instrat Global Health Solutions, Abuja, Nigeria
| | - Matthew J Allsop
- Academic Unit of Palliative Care, University of Leeds, Leeds, United Kingdom
| |
Collapse
|
42
|
Garchitorena A, Ihantamalala FA, Révillion C, Cordier LF, Randriamihaja M, Razafinjato B, Rafenoarivamalala FH, Finnegan KE, Andrianirinarison JC, Rakotonirina J, Herbreteau V, Bonds MH. Geographic barriers to achieving universal health coverage: evidence from rural Madagascar. Health Policy Plan 2021; 36:1659-1670. [PMID: 34331066 PMCID: PMC8597972 DOI: 10.1093/heapol/czab087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/29/2021] [Accepted: 07/16/2021] [Indexed: 11/12/2022] Open
Abstract
Poor geographic access can persist even when affordable and well-functioning health systems are in place, limiting efforts for universal health coverage (UHC). It is unclear how to balance support for health facilities and community health workers in UHC national strategies. The goal of this study was to evaluate how a health system strengthening (HSS) intervention aimed towards UHC affected the geographic access to primary care in a rural district of Madagascar. For this, we collected the fokontany of residence (lowest administrative unit) from nearly 300 000 outpatient consultations occurring in facilities of Ifanadiana district in 2014-2017 and in the subset of community sites supported by the HSS intervention. Distance from patients to facilities was accurately estimated following a full mapping of the district's footpaths and residential areas. We modelled per capita utilization for each fokontany through interrupted time-series analyses with control groups, accounting for non-linear relationships with distance and travel time among other factors, and we predicted facility utilization across the district under a scenario with and without HSS. Finally, we compared geographic trends in primary care when combining utilization at health facilities and community sites. We find that facility-based interventions similar to those in UHC strategies achieved high utilization rates of 1-3 consultations per person year only among populations living in close proximity to facilities. We predict that scaling only facility-based HSS programmes would result in large gaps in access, with over 75% of the population unable to reach one consultation per person year. Community health delivery, available only for children under 5 years, provided major improvements in service utilization regardless of their distance from facilities, contributing to 90% of primary care consultations in remote populations. Our results reveal the geographic limits of current UHC strategies and highlight the need to invest on professionalized community health programmes with larger scopes of service.
Collapse
Affiliation(s)
- Andres Garchitorena
- MIVEGEC, University Montpellier, CNRS, IRD, 911 Avenue Agropolis, 34394 Montpellier, Montpellier, France
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
| | | | - Christophe Révillion
- Université de La Réunion, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), 40 Av De Soweto, 97410 Saint-Pierre, Réunion, France
| | | | - Mauricianot Randriamihaja
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
- School of Management and Technological innovation, University of Fianarantsoa, BP 1135 Andrainjato, 301 Fianarantsoa, Madagascar
| | | | | | - Karen E Finnegan
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts 02115, USA
| | - Jean Claude Andrianirinarison
- Ministry of Public Health, Ambohidahy, 101 Antananarivo, Madagascar
- National Institut of Public Health, Befelatanana, 101 Antananarivo, Madagascar
| | - Julio Rakotonirina
- Ministry of Public Health, Ambohidahy, 101 Antananarivo, Madagascar
- Faculty of Medicine, BP. 375, 101 Antananarivo, Madagascar
| | - Vincent Herbreteau
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), B.P. 86, Phnom Penh, Cambodia
| | - Matthew H Bonds
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts 02115, USA
| |
Collapse
|
43
|
Nodehi M, Arani AA, Taghvaee VM. Sustainability spillover effects and partnership between East Asia & Pacific versus North America: interactions of social, environment and economy. LETTERS IN SPATIAL AND RESOURCE SCIENCES 2021; 15:311-339. [PMID: 34721703 PMCID: PMC8540881 DOI: 10.1007/s12076-021-00282-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/27/2021] [Indexed: 05/28/2023]
Abstract
The three sustainability pillars of social, environment and economy were initially introduced by the United Nations in 2002, addressing major global sustainability issues including economic problems, income inequality, environmental pollution and social shortcomings. Comparing East Asia & Pacific with North America, there is a growing concern over economic, political and even social competition as a result of recent development and industrialization that is taking place in Asian countries. This might lead to an unhealthy conflict that favors regional independency as opposed to the current globalization and trade facilitation trend. As a result, this study aims to assess the effects of development in three main pillars of sustainability (social, environment and economy) in the East Asia and Pacific on that of North America and vice versa. To estimate this interactive or spillover effects of sustainable development (or sustainability elasticities), our research employs Econometric methodologies including Simultaneous Equations System, Vector AutoRegressive (VAR) and Granger Causality approaches during 1971-2016. The results show that most of the sustainability elasticities are positive between and inside the two regions, supporting the synergetic character of the sustainability spillover effects and confirming constructive role of globalization and openness in the sustainability progress. Based on the results, this research suggests policy-makers to follow cooperative and flow-based governance rather than the placed-based or regional independent thinking that supports integrated sustainable development benefiting not only the two parties but also the overall global sustainability.
Collapse
Affiliation(s)
- Mehrab Nodehi
- Ingram School of Engineering, Texas State University, San Marcos, TX 78666 USA
| | - Abbas Assari Arani
- Department of Economic Development and Planning, Faculty of Management and Economics, Tarbiat Modares University, Tehran, Iran
| | - Vahid Mohamad Taghvaee
- Department of Economic Development and Planning, Faculty of Management and Economics, Tarbiat Modares University, Tehran, Iran
| |
Collapse
|
44
|
Leuenberger A, Cambaco O, Zabré HR, Lyatuu I, Utzinger J, Munguambe K, Merten S, Winkler MS. "It Is Like We Are Living in a Different World": Health Inequity in Communities Surrounding Industrial Mining Sites in Burkina Faso, Mozambique, and Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111015. [PMID: 34769535 PMCID: PMC8582703 DOI: 10.3390/ijerph182111015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/29/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022]
Abstract
Background: Health equity features prominently in the 2030 Agenda for Sustainable Development, yet there are wide disparities in health between and within countries. In settings of natural resource extraction (e.g., industrial mines), the health of surrounding communities is affected through myriad changes in the physical, social, and economic environment. How changes triggered by such projects translate into health inequities is poorly understood. Methods: This qualitative study explores potential layers of inequities by systematically coding perceived inequities of affected communities. Drawing on the framework method, we thematically analyzed data from 83 focus group discussions, which enrolled 791 participants from 10 study sites in Burkina Faso, Mozambique, and Tanzania. Results: Participants perceived inequities related to their individual characteristics, intermediate factors acting on the community level, and structural conditions. Due to environmental pollution and land loss, participants were concerned about unsecured livelihoods. Positive impacts, such as job opportunities at the mine, remained scarce for local communities and were claimed not to be equally distributed among community members. Conclusion: Extractive industries bear considerable risks to widen existing health gaps. In order to create equal opportunities among affected populations, the wider determinants of health must be considered more explicitly in the licensing process of resource extraction projects.
Collapse
Affiliation(s)
- Andrea Leuenberger
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (O.C.); (H.R.Z.); (I.L.); (J.U.); (S.M.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
- Correspondence:
| | - Olga Cambaco
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (O.C.); (H.R.Z.); (I.L.); (J.U.); (S.M.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
- Manhiça Health Research Centre, Maputo C.P. 1929, Mozambique;
| | - Hyacinthe R. Zabré
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (O.C.); (H.R.Z.); (I.L.); (J.U.); (S.M.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
- Research Institute of Health Sciences, Ouagadougou B.P. 7192, Burkina Faso
| | - Isaac Lyatuu
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (O.C.); (H.R.Z.); (I.L.); (J.U.); (S.M.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
- Ifakara Health Institute, P.O. Box, Dar es Salaam 78 373, Tanzania
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (O.C.); (H.R.Z.); (I.L.); (J.U.); (S.M.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Khátia Munguambe
- Manhiça Health Research Centre, Maputo C.P. 1929, Mozambique;
- Faculty of Medicine, Eduardo Mondlane University, Maputo C.P. 257, Mozambique
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (O.C.); (H.R.Z.); (I.L.); (J.U.); (S.M.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Mirko S. Winkler
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (O.C.); (H.R.Z.); (I.L.); (J.U.); (S.M.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| |
Collapse
|
45
|
Gona PN, Kimokoti RW, Gona CM, Ballout S, Rao SR, Mapoma CC, Lo J, Mokdad AH. Changes in body mass index, obesity, and overweight in Southern Africa development countries, 1990 to 2019: Findings from the Global Burden of Disease, Injuries, and Risk Factors Study. Obes Sci Pract 2021; 7:509-524. [PMID: 34631130 PMCID: PMC8488455 DOI: 10.1002/osp4.519] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 03/06/2021] [Accepted: 04/25/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND High body mass index (BMI) is associated with stroke, ischemic heart disease (IHD), and type 2 diabetes mellitus (T2DM). An epidemiological analysis of the prevalence of high BMI, stroke, IHD, and T2DM was conducted for 16 Southern Africa Development Community (SADC) using Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study data. METHODS GBD obtained data from vital registration, verbal autopsy, and ICD codes. Prevalence of high BMI (≥25 kg/m2), stroke, IHD, and T2DM attributed to high BMI were calculated. Cause of Death Ensemble Model and Spatiotemporal Gaussian regression was used to estimate mortality due to stroke, IHD, and T2DM attributable to high BMI. RESULTS Obesity in adult females increased 1.54-fold from 12.0% (uncertainty interval [UI]: 11.5-12.4) to 18.5% (17.9-19.0), whereas in adult males, obesity nearly doubled from 4.5 (4.3-4.8) to 8.8 (8.5-9.2). In children, obesity more than doubled in both sexes, and overweight increased by 27.4% in girls and by 37.4% in boys. Mean BMI increased by 0.7 from 22.4 (21.6-23.1) to 23.1 (22.3-24.0) in adult males, and by 1.0 from 23.8 (22.9-24.7) to 24.8 (23.8-25.8) in adult females. South Africa 44.7 (42.5-46.8), Swaziland 33.9 (31.7-36.0) and Lesotho 31.6 (29.8-33.5) had the highest prevalence of obesity in 2019. The corresponding prevalence in males for the three countries were 19.1 (17.5-20.7), 19.3 (17.7-20.8), and 9.2 (8.4-10.1), respectively. The DRC and Madagascar had the least prevalence of adult obesity, from 5.6 (4.8-6.4) and 7.0 (6.1-7.9), respectively in females in 2019, and in males from 4.9 (4.3-5.4) in the DRC to 3.9 (3.4-4.4) in Madagascar. CONCLUSIONS The prevalence of high BMI is high in SADC. Obesity more than doubled in adults and nearly doubled in children. The 2019 mean BMI for adult females in seven countries exceeded 25 kg/m2. SADC countries are unlikely to meet UN2030 SDG targets. Prevalence of high BMI should be studied locally to help reduce morbidity.
Collapse
Affiliation(s)
- Philimon N. Gona
- College of Nursing & Health SciencesUniversity of Massachusetts BostonBostonMAUSA
| | | | - Clara M. Gona
- Department of NursingMGH Institute for Health ProfessionsBostonMAUSA
| | - Suha Ballout
- College of Nursing & Health SciencesUniversity of Massachusetts BostonBostonMAUSA
| | - Sowmya R. Rao
- Department of Global HealthBoston University School of Public HealthBostonMAUSA
| | | | - Justin Lo
- Institute for Health Metrics and EvaluationUniversity of WashingtonSeattleWAUSA
| | - Ali H. Mokdad
- Institute for Health Metrics and EvaluationUniversity of WashingtonSeattleWAUSA
| |
Collapse
|
46
|
Simulation and Analysis of Urban Production-Living-Ecological Space Evolution Based on a Macro-Micro Joint Decision Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189832. [PMID: 34574756 PMCID: PMC8466617 DOI: 10.3390/ijerph18189832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/30/2021] [Accepted: 09/09/2021] [Indexed: 11/20/2022]
Abstract
The precise simulation of urban space evolution and grasping of the leading factors are the most important basis for urban space planning. However, the simulation ability of current models is lacking when it comes to complicated/unpredictable urban space changes, resulting in flawed government decision-making and wasting of urban resources. In this study, a macro–micro joint decision model was proposed to improve the ability of urban space evolution simulation. The simulation objects were unified into production, living and ecological space to realize “multiple planning in one”. For validation of the proposed model and method, remote sensing images, geographic information and socio-economic data of Xuzhou, China from 2000 to 2020 were collected and tested. The results showed that the simulation precision of the cellular automata (CA) model was about 87% (Kappa coefficient), which improved to 89% if using a CA and multi-agent system (MAS) joint model. The simulation precision could be better than 92% using the prosed model. The result of factor weight determination indicated that the micro factors affected the evolution of production and living space more than the macro factors, while the macro factors had more influence on the evolution of ecological space than the micro factors. Therefore, active policies should be formulated to strengthen the ideological guidance towards micro individuals (e.g., a resident, farmer, or entrepreneur), and avoid disordered development of living and production space. In addition, ecological space planning should closely link with the local environment and natural conditions, to improve urban ecological carrying capacity and realize urban sustainable development.
Collapse
|
47
|
Tan CC, Lam CSP, Matchar DB, Zee YK, Wong JEL. Singapore's health-care system: key features, challenges, and shifts. Lancet 2021; 398:1091-1104. [PMID: 34481560 DOI: 10.1016/s0140-6736(21)00252-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 10/16/2020] [Accepted: 01/19/2021] [Indexed: 01/13/2023]
Abstract
Since Singapore became an independent nation in 1965, the development of its health-care system has been underpinned by an emphasis on personal responsibility for health, and active government intervention to ensure access and affordability through targeted subsidies and to reduce unnecessary costs. Singapore is achieving good health outcomes, with a total health expenditure of 4·47% of gross domestic product in 2016. However, the health-care system is contending with increased stress, as reflected in so-called pain points that have led to public concern, including shortages in acute hospital beds and intermediate and long-term care (ILTC) services, and high out-of-pocket payments. The main drivers of these challenges are the rising prevalence of non-communicable diseases and rapid population ageing, limitations in the delivery and organisation of primary care and ILTC, and financial incentives that might inadvertently impede care integration. To address these challenges, Singapore's Ministry of Health implemented a comprehensive set of reforms in 2012 under its Healthcare 2020 Masterplan. These reforms substantially increased the capacity of public hospital beds and ILTC services in the community, expanded subsidies for primary care and long-term care, and introduced a series of financing health-care reforms to strengthen financial protection and coverage. However, it became clear that these measures alone would not address the underlying drivers of system stress in the long term. Instead, the system requires, and is making, much more fundamental changes to its approach. In 2016, the Ministry of Health encapsulated the required shifts in terms of the so-called Three Beyonds-namely, beyond health care to health, beyond hospital to community, and beyond quality to value.
Collapse
Affiliation(s)
- Chorh Chuan Tan
- Office for Healthcare Transformation, Ministry of Health, Singapore; Department of Medicine, National University of Singapore, Singapore.
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; Duke-NUS Cardiovascular Academic Clinical Program, Duke-NUS Medical School, Singapore; Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - David B Matchar
- Health Services and Systems Research, Duke-NUS Medical School, Singapore; Department of Medicine, Duke University, Durham, NC, USA
| | | | - John E L Wong
- Department of Medicine, National University of Singapore, Singapore; Department of Hematology-Medical Oncology, National University Health System, Singapore
| |
Collapse
|
48
|
Associations between increased circulating endothelial progenitor cell levels and anxiety/depressive severity, cognitive deficit and function disability among patients with major depressive disorder. Sci Rep 2021; 11:18221. [PMID: 34521977 PMCID: PMC8440504 DOI: 10.1038/s41598-021-97853-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 05/31/2021] [Indexed: 12/11/2022] Open
Abstract
The association of major depressive disorder (MDD) with cardiovascular diseases (CVDs) through endothelial dysfunction is bidirectional. Circulating endothelial progenitor cells (cEPCs), essential for endothelial repair and function, are associated with risks of various CVDs. Here, the relationship of cEPC counts with MDD and the related clinical presentations were investigated in 50 patients with MDD and 46 healthy controls. In patients with MDD, a battery of clinical domains was analysed: depressed mood with Hamilton Depression Rating Scale (HAMD) and Montgomery–Åsberg Depression Rating Scale (MADRS), anxiety with Hamilton Anxiety Rating Scale (HAMA), cognitive dysfunction and deficit with Digit Symbol Substitution Test (DSST) and Perceived Deficits Questionnaire-Depression (PDQ-D), somatic symptoms with Depressive and Somatic Symptom Scale (DSSS), quality of life with 12-Item Short Form Health Survey (SF-12) and functional disability with Sheehan Disability Scale (SDS). Immature and mature cEPC counts were measured through flow cytometry. Increased mature and immature cEPC counts were significantly associated with higher anxiety after controlling the confounding effect of systolic blood pressure, and potentially associated with more severe depressive symptoms, worse cognitive performance and increased cognitive deficit, higher social disability, and worse mental health outcomes. Thus, cEPCs might have pleiotropic effects on MDD-associated symptoms and psychosocial outcomes.
Collapse
|
49
|
Nwe TW, Lee SJ, Li L, San MTA, Htwe AT, Oo HN, Detels R. Antiretroviral therapy (ART) coverage at public and private ART facilities in Myanmar. AIDS Care 2021; 33:1218-1227. [PMID: 32583676 PMCID: PMC7759597 DOI: 10.1080/09540121.2020.1781758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
Myanmar's continuum of HIV care was surveyed to assess the National AIDS Control Programme's progress; according to its reports, ART coverage was 38% in 2014, 47% in 2015, and 56% in 2016. To evaluate ART coverage and gaps in care, a serial cross-sectional study used the national programme data reported between January 2014 and December 2016, including 228 public and 62 private ART facilities. ART coverage among PLHIV under 15 years old was 89% in 2014, 93% in 2015, and 88% in 2016. Retention in ART care among women was higher than among men, although women were more likely to discontinue care. PLHIV who were enrolled in ART facilities initiated ART at the rates of 60% in 2014, 68% in 2015, and 74% in 2016. Over the 3-year study period, these facilities reported that 2.5-3.7% of PLHIV taking ART had died, and that 3.3-4.8% were lost to follow-up. PLHIV who were tested for viral load were low (2.5-3%). The continuum of HIV care at ART facilities has improved, but more information about attrition and viral suppression are still needed. The reporting system for newly diagnosed PLHIV and facilities for viral load testing need to be strengthened.
Collapse
Affiliation(s)
- Thet Wai Nwe
- Fielding School of Public Health, University of California, Los Angeles, USA
- Department of Public Health, Ministry of Health and Sports, Myanmar
| | - Sung-Jae Lee
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Li Li
- Fielding School of Public Health, University of California, Los Angeles, USA
| | | | - Aung Thu Htwe
- World Health Organization Country Office for Myanmar
| | - Htun Nyunt Oo
- Department of Public Health, Ministry of Health and Sports, Myanmar
| | - Roger Detels
- Fielding School of Public Health, University of California, Los Angeles, USA
| |
Collapse
|
50
|
Araúz Ledezma AB, Massar K, Kok G. Social Emotional Learning and the promotion of equal personal relationships among adolescents in Panama: a study protocol. Health Promot Int 2021; 36:741-752. [PMID: 33051640 PMCID: PMC8519304 DOI: 10.1093/heapro/daaa114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Adolescents in Panama face multiple barriers that affect their health, such as
high rates of teenage pregnancy, increased human immunodeficiency virus (HIV)
infections and sexual violence. Equal relationships between women and men are
likely to reduce such risks. Here, we suggest that the school-based enhancement
of Social and Emotional Learning core competencies—awareness of self and
others, positive attitudes and values, responsible decision-making, and social
interaction skills—could foster positive changes in behaviors between
boys and girls, specifically through a focus on equal roles, equal rights in
relationships and nonviolent problem solving. This paper, using the Intervention
Mapping Protocol, describes the process of development of, and planning
surrounding the implementation and evaluation of the program ‘Me and My
new World’, a Social Emotional Learning intervention for middle school
students (12–15 years old) in Panama. Program development was
based on a needs assessment (Araúz Ledezma et al. (2020) Behavioural and environmental
influences on adolescent decision making in personal relationships: a
qualitative multi–stakeholder exploration in Panama. Health Education
Research, 35, 1–14.) and a literature review of theory- and
evidence-based Social and Emotional Learning (SEL)-programs. Intervention
outcomes, performance objectives and change objectives of the intervention were
identified. The practical applications of different theory-based methods allowed
for contextual considerations that could potentially influence the expected
behavioral outcomes of the intervention. Teachers were the implementers of the
program, and during development, implementation, and evaluation, the roles,
opinions, and teaching methods of all stakeholders were recognized. We conclude
that Intervention Mapping allows for the analysis of multiple factors
influencing the development and implementation of Social Emotional Learning
programs promoting equal relationships among adolescents in a developing
country, with a special consideration of culture, educational systems, and
policies, from a capability development perspective.
Collapse
Affiliation(s)
- Ana B Araúz Ledezma
- Department of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Karlijn Massar
- Department of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Gerjo Kok
- Department of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| |
Collapse
|