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Sultan MT, Anwar MJ, Imran M, Khalil I, Saeed F, Neelum S, Alsagaby SA, Al Abdulmonem W, Abdelgawad MA, Hussain M, El-Ghorab AH, Umar M, Al Jbawi E. Phytochemical profile and pro-healthy properties of Terminalia chebula: A comprehensive review. INTERNATIONAL JOURNAL OF FOOD PROPERTIES 2023. [DOI: 10.1080/10942912.2023.2166951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | | | - Muhammad Imran
- Department of Food Science and Technology, University of Narowal-Pakistan, Narowal, Pakistan
| | - Ijaz Khalil
- Institute of Food and Nutrition, Bahauddin Zakariya University, Multan, Pakistan
| | - Farhan Saeed
- Department of Food Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Shahzadi Neelum
- Department of Biochemistry, Hamdard University, Karachi, Pakistan
| | - Suliman A. Alsagaby
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, Saudi Arabia
| | - Waleed Al Abdulmonem
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia
| | - Mohamed A. Abdelgawad
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Muzzamal Hussain
- Department of Food Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Ahmed H. El-Ghorab
- Department of Chemistry, College of Science, Jouf University, Sakaka, Saudi Arabia
| | - Maryam Umar
- Department of Food Sciences, Government College University Faisalabad, Faisalabad, Pakistan
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Tian Y, Peng J, Liu Y, Huang J. Efficiency trends of essential public health services and possible influencing factors since the new round health reform in China: a case study from Hainan Province. Front Public Health 2023; 11:1269473. [PMID: 38026396 PMCID: PMC10657853 DOI: 10.3389/fpubh.2023.1269473] [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: 07/30/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This article aimed to evaluate the efficiency trends and influencing factors of essential public health services in Hainan Province after the healthcare reform launched in 2009 in China. Methods The efficiency of essential public health services (EPHS) at primary health institutions was assessed using data envelopment analysis (DEA), and the efficiency change was analyzed by employing the Malmquist productivity index (MPI). We used Tobit regression to identify the influence of environmental factors on the efficiency of public health services. The bootstrap method was adopted to reduce the impact of random errors on the result. Results The bootstrapping bias-corrected efficiency revealed that the average values of technical efficiency, pure technical efficiency, and scale efficiency were 0.7582, 0.8439, and 0.8997, respectively, which meant that the EPHS in Hainan Province were not at the most effective state. The average bias-corrected MPI was 1.0407 between 2010 and 2011 and 1.7404 between 2011 and 2012. MPIs were less than 1.0000 during other periods investigated, ranging from 0.8948 to 0.9714, indicating that the efficiency of EPHS has been decreasing since 2013. The Tobit regression showed that the regression coefficients of per capita GDP, population density, the proportion of older people aged over 65, and the proportion of ethnic minority population were 0.0286, -0.0003, -0.0316, and - 0.0041 respectively, which were statistically significant (p < 0.05). Conclusion There was a short-term improvement in the efficiency of EPHS in Hainan after the launch of the new round of health reform. However, this trend has not been sustained after 2013. In particular, equalized financial investment in essential public health could not fulfill the needs of poor counties. This has resulted in the inability to improve scale efficiency in some counties, which in turn has affected the improvement of overall EPHS efficiency. Therefore, to promote EPHS efficiency sustainably, it is suggested that under this model of provincial control of counties, the equity of resource allocation should be effectively improved while further advancing the technology of service delivery.
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Affiliation(s)
- Ye Tian
- International School of Public Health and One Health, Hainan Medical University, Haikou, China
| | - Jia Peng
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Yumei Liu
- International School of Public Health and One Health, Hainan Medical University, Haikou, China
| | - Jiayan Huang
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
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Adhikari B, Pandey AR, Lamichhane B, Kc SP, Joshi D, Regmi S, Giri S, Baral SC. Readiness of health facilities to provide services related to non-communicable diseases in Nepal: evidence from nationally representative Nepal Health Facility Survey 2021. BMJ Open 2023; 13:e072673. [PMID: 37423630 DOI: 10.1136/bmjopen-2023-072673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE To assess the readiness of public and private health facilities (HFs) in delivering services related to non-communicable diseases (NCDs) in Nepal. METHODS We analysed data from nationally representative Nepal Health Facility Survey 2021 to determine the readiness of HFs for cardiovascular diseases (CVDs), diabetes mellitus (DM), chronic respiratory diseases (CRDs) and mental health (MH)-related services using Service Availability and Readiness Assessment Manual of the WHO. Readiness score was measured as the average availability of tracer items in per cent, and HFs were considered 'ready' for NCDs management if they scored ≥70 (out of 100). We performed weighted univariate and multivariable logistic regression to determine the association of HFs readiness with province, type of HFs, ecological region, quality assurance activities, external supervision, client's opinion review and frequency of meetings in HFs. RESULTS The overall mean readiness score of HFs offering CRDs, CVDs, DM and MH-related services was 32.6, 38.0, 38.4 and 24.0, respectively. Guidelines and staff training domain had the lowest readiness score, whereas essential equipment and supplies domain had the highest readiness score for each of the NCD-related services. A total of 2.3%, 3.8%, 3.6% and 3.3% HFs were ready to deliver CRDs, CVDs, DM and MH-related services, respectively. HFs managed by local level were less likely to be ready to provide all NCD-related services compared with federal/provincial hospitals. HFs with external supervision were more likely to be ready to provide CRDs and DM-related services and HFs reviewing client's opinions were more likely to be ready to provide CRDs, CVDs and DM-related services. CONCLUSION Readiness of the HFs managed by local level to provide CVDs, DM, CRDs and MH-related services was relatively poor compared with federal/provincial hospitals. Prioritisation of policies to reduce the gaps in readiness and capacity strengthening of the local HFs is essential for improving their overall readiness to provide NCD-related services.
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Affiliation(s)
- Bikram Adhikari
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Achyut Raj Pandey
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Bipul Lamichhane
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Saugat Pratap Kc
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Deepak Joshi
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Shophika Regmi
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Santosh Giri
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Sushil Chandra Baral
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
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Lewis TP, Aryal A, Mehata S, Thapa A, Yousafzai AK, Kruk ME. Best and worst performing health facilities: A positive deviance analysis of perceived drivers of primary care performance in Nepal. Soc Sci Med 2022; 309:115251. [PMID: 35961216 PMCID: PMC9458868 DOI: 10.1016/j.socscimed.2022.115251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022]
Abstract
Primary care services are on average of low quality in Nepal. However, there is marked variation in performance of basic clinical and managerial functions between primary health care centers. The determinants of variation in primary care performance in low- and middle-income countries have been understudied relative to the prominence of primary care in national health plans. We used the positive deviance approach to identify best and worst performing primary health care centers in Nepal and investigated perceived drivers of best performance. We selected eight primary health care centers in Province 1, Nepal, using an index of basic clinical and operational activities to identify four best and four worst performing primary health care centers. We conducted semi-structured, in-depth interviews with managers and clinical staff from each of the eight primary health care centers for a total of 32 interviews. We identified the following factors that distinguished best from worst performers: 1) Managing the facility effectively, 2) engaging local leadership, 3) building active community accountability, 4) assessing and responding to facility performance, 5) developing sources of funding, 6) compensating staff fairly, 7) managing clinical staff performance, and 8) promoting uninterrupted availability of supplies and equipment. These findings can be used to inform quality improvement efforts and health system reforms in Nepal and other similarly under-resourced health systems. Local leaders and health workers felt good management was key to best performance. Best performers reported strong leadership at both the facility and local levels. Community accountability was also seen as a critical enabler of top performance. Leaders of worst performers were less responsive to facility and community needs.
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Mengesha SD, Teklu KT, Weldetinsae A, Serte MG, Kenea MA, Dinssa DA, Woldegabriel MG, Alemayehu TA, Belay WM. Tobacco use prevalence and its determinate factor in Ethiopia- finding of the 2016 Ethiopian GATS. BMC Public Health 2022; 22:555. [PMID: 35313839 PMCID: PMC8935848 DOI: 10.1186/s12889-022-12893-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 02/28/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Tobacco, one of the risk factors for non-communicable diseases, kills 8 million people each year. Like other sub-Saharan countries, Ethiopia faces the potential challenge of a tobacco epidemic. However, there is no organized data on the prevalence of tobacco use in the country. Therefore, this study aims to determine adult tobacco use in Ethiopia. METHODS The study was conducted using the WHO and CDC GATS survey methods. Complex survey analysis was used to obtain prevalence and population estimates with 95% confidence intervals. Bivariate regression analyses were employed to examine factors related to tobacco use. RESULTS The overall tobacco use percentage was 5.0% [95% CI (3.5, 6.9)], of which 65.8% [95% CI (53.4, 76.3)] only smoked tobacco products; 22.5% [95% CI (15.7, 31.2)] used smokeless tobacco only; and 11.8% [95% CI (6.5, 20.4)] used both smoked and smokeless tobacco products. In 2016, more men adults (8.1%) used tobacco than women did (1.8%). Eight out of eleven states have a higher smoking rate than the national average (3.7%). Gender, employment, age, religion, and marital status are closely linked to current tobacco use (p-value< 0.05). Men adults who are employed, married, and mostly from Muslim society are more likely to use tobacco. CONCLUSION The prevalence of tobacco use is still low in Ethiopia. However, the percentage of female smokers is increasing, and regional governments such as Afar and Gambella have a relatively high prevalence. This calls for the full implementation of tobacco control laws following the WHO MPOWER packages. A tailored tobacco control intervention targeting women, younger age groups, and regions with a high proportion of tobacco use are recommended.
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Affiliation(s)
- Sisay Derso Mengesha
- Ethiopian Public Health Institute, Gulelle Patriot Street, P.O.Box 1242, Addis Ababa, Ethiopia
| | - Kirubel Tesfaye Teklu
- Ethiopian Public Health Institute, Gulelle Patriot Street, P.O.Box 1242, Addis Ababa, Ethiopia
| | - Abel Weldetinsae
- Ethiopian Public Health Institute, Gulelle Patriot Street, P.O.Box 1242, Addis Ababa, Ethiopia
| | - Melaku Gizaw Serte
- Ethiopian Public Health Institute, Gulelle Patriot Street, P.O.Box 1242, Addis Ababa, Ethiopia
| | - Moa Abate Kenea
- Ethiopian Public Health Institute, Gulelle Patriot Street, P.O.Box 1242, Addis Ababa, Ethiopia
| | - Daniel Abera Dinssa
- Ethiopian Public Health Institute, Gulelle Patriot Street, P.O.Box 1242, Addis Ababa, Ethiopia
| | | | | | - Wassihun Melaku Belay
- World Health organization- Country office for Ethiopia, UNECA Compound, Zambezi Building, Addis Ababa, Ethiopia
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Shrestha R, Yadav UN, Shrestha A, Paudel G, Makaju D, Poudel P, Iwashita H, Harada Y, Shrestha A, Karmacharya B, Koju R, Sugishita T, Rawal L. Analyzing the Implementation of Policies and Guidelines for the Prevention and Management of Type 2 Diabetes at Primary Health Care Level in Nepal. Front Public Health 2022; 10:763784. [PMID: 35223722 PMCID: PMC8864089 DOI: 10.3389/fpubh.2022.763784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Nepal, in recent years, is witnessing an increasing problem of type 2 diabetes that has resulted significant premature deaths and disability. Prevention and management of non-communicable diseases (NCDs) including diabetes have been prioritized in the national policies and guidelines of the Nepal Government. However, research looking at the overview of the implementation of the existing policies and guidelines for diabetes prevention and control is scarce. Hence, this study reviewed diabetes related existing policies and its implementation process at the primary health care level in Nepal. Methods This study involved two phases: Phase I: situation analyses through review of documents and Phase II: qualitative exploratory study. In phase I, four databases (Medline, Web of Science, Embase and PubMed) were systematically searched using key search terms related to diabetes care and policies between January 2000 and June 2021. Also, relevant gray literature was reviewed to understand the trajectory of policy development and its translation with regards to diabetes prevention and management at primary health care level in Nepal. Following the phase I, we conducted in-depth interviews (IDI) and key informant interviews (KII) with health care providers, policy makers, and managers (IDI = 13, and KII = 7) at peripheral and central levels in Kavrepalanchowk and Nuwakot districts of Nepal. The in-depth interviews were audio recorded, transcribed, and coded. The triangulation of data from document review and interviews was done and presented in themes. Results Four key themes were identified through triangulating findings from the document review and interviews including (i) limited implementation of policies into practices; (ii) lack of coordination among the different levels of service providers; (iii) lack of trained human resources for health and inadequate quality services at the primary health care level, and (iv) inadequate access and utilization of diabetes care services at primary health care level. Specifically, this study identified some key pertinent challenges to the implementation of policies and programs including inadequate resources, limited engagement of stakeholders in service design and delivery, lack of trained health care providers, lack of financial resources to strengthen peripheral health services, fragmented health governance, and weak reporting and monitoring systems. Conclusion This study revealed that the policies, plans, and strategies for prevention and management of NCDs in Nepal recognized the importance of diabetes prevention and control. However, a major gap remains with adequate and lack of clarity in terms of implementation of available policies, plans, strategies, and programs to address the problem of diabetes. We suggest the need for multisectoral approach (engaging both health and non-health sectors) at central as well as peripheral levels to strengthen the policies implementation process, building capacity of health care providers, ensuring adequate financial and non-financial resources, and improving quality of services at primary health care levels.
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Affiliation(s)
- Rabina Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Uday Narayan Yadav
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Abha Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Grish Paudel
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Rockhampton, QLD, Australia
| | - Deepa Makaju
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Prakash Poudel
- Centre for Oral Health Outcomes & Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Hanako Iwashita
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuriko Harada
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Archana Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Biraj Karmacharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Rajendra Koju
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Tomohiko Sugishita
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Rockhampton, QLD, Australia
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, QLD, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- *Correspondence: Lal Rawal ;
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7
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Shrestha A, Maharjan R, Karmacharya BM, Bajracharya S, Jha N, Shrestha S, Aryal A, Baral PP, Bhatt RD, Bhattarai S, Bista D, Citrin D, Dhimal M, Fitzpatrick AL, Jha AK, Karmacharya RM, Mali S, Neupane T, Oli N, Pandit R, Parajuli SB, Pradhan PMS, Prajapati D, Pyakurel M, Pyakurel P, Rai BK, Sapkota BP, Sapkota S, Shrestha A, Shrestha AP, Shrestha R, Sharma GN, Sharma S, Spiegelman D, Suwal PS, Thapa B, Vaidya A, Xu D, Yan LL, Koju R. Health system gaps in cardiovascular disease prevention and management in Nepal. BMC Health Serv Res 2021; 21:655. [PMID: 34225714 PMCID: PMC8258928 DOI: 10.1186/s12913-021-06681-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/31/2021] [Indexed: 01/19/2023] Open
Abstract
Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06681-0.
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Affiliation(s)
- Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. .,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. .,Institute for Implementation Science and Health, Kathmandu, Nepal. .,Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.
| | - Rashmi Maharjan
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.,Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Biraj Man Karmacharya
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.,Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Swornim Bajracharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Niharika Jha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Soniya Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Anu Aryal
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.,Nyaya Health Nepal, Kathmandu, Nepal
| | - Phanindra Prasad Baral
- Department of Health Services, Non Communicable Diseases and Mental Health Section, Epidemiology and Disease Control Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Rajendra Dev Bhatt
- Department of Biochemistry, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.,Faculty of Medical Sciences, School of Health Sciences, Wuhan University, Wuhan, China
| | - Sanju Bhattarai
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Durga Bista
- Department of Pharmacy, Kathmandu University, Dhulikhel, Kavre, Nepal
| | - David Citrin
- Possible, New York, NY, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Anthropology, University of Washington, Seattle, WA, USA.,Medic, Seattle, WA, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | - Meghnath Dhimal
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Annette L Fitzpatrick
- Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle, USA
| | | | - Robin Man Karmacharya
- Department of Surgery (Cardio Thoracic and Vascular unit), Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Sushmita Mali
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Tamanna Neupane
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Natalia Oli
- Department of Community Medicine, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Rajan Pandit
- Department of Physiology, Nepal Medical College and Teaching Hospital, Attarkhel, Kathmandu, Nepal
| | - Surya Bahadur Parajuli
- Department of Community Medicine, Birat Medical College and Teaching Hospital, Biratnagar, Morang, Nepal
| | - Pranil Man Singh Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Dipanker Prajapati
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal.,Department of Cardiology, National Academy of Health Sciences, Bir Hospital, Mahaboudha, Kathmandu, Nepal
| | - Manita Pyakurel
- School of Public Health, Central University of Nicaragua, Managua, Nicaragua
| | - Prajjwal Pyakurel
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Binuka Kulung Rai
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Bhim Prasad Sapkota
- Health Coordination Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal.,Teaching & Training Unit, Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU, Munich, Germany.,Center for International Health (CIH), Ludwig-Maximilians-Universität, Munich, Germany
| | - Sujata Sapkota
- Department of Pharmacy, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Anmol Purna Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Rajeev Shrestha
- Department of Pharmacology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.,Pharmacovigilance unit/ Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Guna Nidhi Sharma
- Policy, Planning and Monitoring Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Sumitra Sharma
- Department of Nursing, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Donna Spiegelman
- Center for Methods in Implementation and Preventive Science and Department of Biostatistics, Yale School of Public Health, New Haven, USA
| | - Punya Shori Suwal
- Department of Public Health, Nepal Institute of Health Sciences, Stupa Health Care Center Cooperative Limited, Jorpati, Kathmandu, Nepal
| | - Bobby Thapa
- Department of Nursing, Nepalgunj Nursing Campus, Institute of Medicine, Tribhuvan University, Banke, Nepalgunj, Nepal
| | - Abhinav Vaidya
- Department of Community Medicine, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Dong Xu
- Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China.,Peking University School of Global Health and Development, Beijing, China
| | - Rajendra Koju
- Dean, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.,Department of Medicine (Cardiology), Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Bhattarai H, McLachlan CS, Khanal P, Adhikari TB, Ranabhat K, Koirala S, Parajuli SB, Pokharel Y, Paudel S, Soti PB, Subedi B, Wagle CN, Mahato S, Pandey G, Gyawali P, Pandey S, Gyawali V, Devkota S, Lohani GR, Koirala B, Xia X, Beaney T, Neupane D. May Measurement Month 2019: an analysis of blood pressure screening results from Nepal. Eur Heart J Suppl 2021; 23:B110-B113. [PMID: 34054371 PMCID: PMC8141957 DOI: 10.1093/eurheartj/suab042] [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: 11/29/2022]
Abstract
May Measurement Month (MMM) is a global initiative to screen high blood pressure (BP) in the community and increase awareness at the population level. High BP is the leading risk factor for mortality worldwide and in Nepal. This study presents the results of the 2019 MMM in Nepal. Opportunistic BP screening was conducted in 30 out of 77 districts across Nepal and aged ≥18 years at the community and public places. BP was measured three times in a seated position. A total of 74 205 individuals participated in the study, mean age 39.9 years, and 58% were male. BP measurements for the second and third readings were available for 69 292 (93.3%) individuals. The proportion of the population that were hypertensive was 27.5% (n = 20 429). Among those hypertensives, 46.3% were aware of their hypertensive status and of these, 37.5% were on antihypertensive medication. Only 54.3% of those on antihypertensive medication had their BP controlled. Of the community screened, those self reporting to have diabetes, current tobacco users, and current alcohol drinkers were 6.7%, 23.6%, and 31.9%, respectively; 20.6% of the participants were overweight, and 6.5% were obese. Since the first BP screening campaign, MMM 2017 in Nepal, the number of participants screened has largely increased over the years. MMM’s success in Nepal is through a coordinated mobilization of trained health science students and volunteers in the communities. The Nepal MMM data demonstrates that large community-based BP screening campaigns are possible in low resource settings.
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Affiliation(s)
- Harikrishna Bhattarai
- Nepal Development Society, Bharatpur-10, Chitwan 44200, Nepal.,Research Center in Emergency and Disaster Medicine (CRIMEDIM), Università del Piemonte Orientale (UPO), Novara (NO) 28100, Italy.,Research Group on Emergency and Disaster Medicine (ReGEDiM), Vrije Universiteit Brussel (VUB), Jette 1090, Belgium
| | - Craig S McLachlan
- Centre for Healthy Futures, Health Faculty, Torrens University, NSW 2009, Sydney, Australia
| | - Pratik Khanal
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu 44600, Nepal
| | - Tara Ballav Adhikari
- Nepal Development Society, Bharatpur-10, Chitwan 44200, Nepal.,Center for Global Health, Department of Public Health, Aarhus University, Aarhus 8000, Denmark
| | - Kamal Ranabhat
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu 44600, Nepal.,Nepal Public Health Association, Talchikhel, Lalitpur 44700, Nepal.,Ministry of Health and Population, Ramshahpath, Kathmandu 44600, Nepal
| | - Sweta Koirala
- Research Center in Emergency and Disaster Medicine (CRIMEDIM), Università del Piemonte Orientale (UPO), Novara (NO) 28100, Italy
| | - Surya B Parajuli
- Birat Medical College and Teaching Hospital, Tankisinuwari, Biratnagar 56613, Morang, Nepal.,Nepal Medical Volunteer Society, Biratnagar 56613, Morang, Nepal
| | - Yashashwi Pokharel
- Nepal Development Society, Bharatpur-10, Chitwan 44200, Nepal.,Department of Medicine, Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Santosh Paudel
- Nepal Public Health Association, Talchikhel, Lalitpur 44700, Nepal.,Ministry of Health and Population, Ramshahpath, Kathmandu 44600, Nepal
| | - Pabitra Babu Soti
- Nepal Development Society, Bharatpur-10, Chitwan 44200, Nepal.,Nepal Public Health Association, Talchikhel, Lalitpur 44700, Nepal
| | - Bishal Subedi
- Nepal Public Health Association, Talchikhel, Lalitpur 44700, Nepal.,Ministry of Health and Population, Ramshahpath, Kathmandu 44600, Nepal
| | - Chetan Nidhi Wagle
- Nepal Public Health Association, Talchikhel, Lalitpur 44700, Nepal.,Ministry of Health and Population, Ramshahpath, Kathmandu 44600, Nepal
| | - Sweta Mahato
- Nepal Development Society, Bharatpur-10, Chitwan 44200, Nepal
| | - Ghanashyam Pandey
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu 44600, Nepal
| | - Pawan Gyawali
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu 44600, Nepal
| | - Sadhana Pandey
- Manmohan Memorial Institute of Health Sciences, Soalteemode, Kathmandu 44600, Nepal
| | - Vivek Gyawali
- Manmohan Memorial Institute of Health Sciences, Soalteemode, Kathmandu 44600, Nepal
| | - Surya Devkota
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Kathmandu 44600, Nepal
| | - Guna Raj Lohani
- Ministry of Health and Population, Ramshahpath, Kathmandu 44600, Nepal
| | - Bhagawan Koirala
- Department of Cardiothoracic and Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Kathmandu 44600, Nepal
| | - Xin Xia
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK.,Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London W6 8RP, UK
| | - Dinesh Neupane
- Nepal Development Society, Bharatpur-10, Chitwan 44200, Nepal.,Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD 21287, USA
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9
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Jia H, Cao P, Yu J, Zhang J, Jiang H, Zhao Q, Yu X. A New Perspective for Improving the Human Resource Development of Primary Medical and Health Care Institutions: A Structural Equation Model Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2560. [PMID: 33806526 PMCID: PMC7967509 DOI: 10.3390/ijerph18052560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
In some countries, including China, primary health care is rarely utilized because of medical personnel shortages at primary medical and health care institutions (PMHCIs). Several studies suggest that the most effective solution is to guide qualified doctors and medical graduates to work in PMHCIs, but the studies and measures have been formulated only from the perspective of the government and PMHCIs; few have considered the subjective willingness of medical personnel. Therefore, it is necessary to explore the measures to develop human resources of PMHCIs from the guiding object. This research was divided into two parts based on implicit theory and a lexical approach. The first part collected the factors affecting their choosing PMHCIs for employment, and the second part used exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modeling (SEM) to explore the dimensions and paths of the influencing factors. At last, seven factors were obtained from the EFA, and the SEM hypothesis fit the data well. Internal Organization Development, Patient Factor, Remuneration and Development, and Family Support had a significantly positive effect on the Sense of Gain of medical personnel seeking employment at PMHCIs, whereas both Job Responsibilities and Condition of the City Where the PMHCI Is Located had no significant effect. In addition, the indirect effects of Internal Organization Development and Condition of the City Where the PMHCI Is Located on the Sense of Gain were significant. The Patient Factor, Family Support, and Remuneration and Development significantly mediated the relationship between the internal and external environment of the institution and the Sense of Gain, whereas the mediating effect of Job Responsibilities was not significant. The improvement of family support, remuneration and development, and patient factors increase the willingness of medical personnel to seek employment at PMHCIs. In addition, the internal and external environments of a PMHCI play a vital role in guiding medical personnel to PMHCIs for employment. This research provides theoretical support for improving the development of human resources, guiding medical personnel to work in PMHCIs, and promoting the use of primary care services.
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Affiliation(s)
- Huanhuan Jia
- School of Public Health, Jilin University, Changchun 130000, China; (H.J.); (P.C.); (J.Y.); (J.Z.); (H.J.)
| | - Peng Cao
- School of Public Health, Jilin University, Changchun 130000, China; (H.J.); (P.C.); (J.Y.); (J.Z.); (H.J.)
| | - Jianxing Yu
- School of Public Health, Jilin University, Changchun 130000, China; (H.J.); (P.C.); (J.Y.); (J.Z.); (H.J.)
| | - Jingru Zhang
- School of Public Health, Jilin University, Changchun 130000, China; (H.J.); (P.C.); (J.Y.); (J.Z.); (H.J.)
| | - Hairui Jiang
- School of Public Health, Jilin University, Changchun 130000, China; (H.J.); (P.C.); (J.Y.); (J.Z.); (H.J.)
| | - Qize Zhao
- Jilin Province Healthcare Security Administration Management Center, Changchun 130000, China;
| | - Xihe Yu
- School of Public Health, Jilin University, Changchun 130000, China; (H.J.); (P.C.); (J.Y.); (J.Z.); (H.J.)
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