1
|
Fernandez B, Gaitonde R. Non-communicable diseases and its risk factors among the transgender population in Kerala: a cross-sectional study. Int J Equity Health 2024; 23:107. [PMID: 38789986 PMCID: PMC11127387 DOI: 10.1186/s12939-024-02167-7] [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: 04/04/2023] [Accepted: 03/28/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are high on the priority list of the Kerala government, and exploring the extent to which transgender and gender diverse (TGD) community members benefit from the services of national programmes for NCDs can provide valuable insights on improving the inclusivity of the health system as it moves towards Universal Health Coverage. This study was conducted to explore the prevalence of NCD risk factors as well as facilitators and barriers to NCD management among the TGD population in Kerala. METHODS A multiple methods study, including a cross-sectional survey of 120 self-identifying TGD people that included an adaptation of the WHO STEPS questionnaire, as well as in-depth interviews with thirteen individuals, was conducted in three districts of Kerala to explore the barriers and facilitators to NCD prevention and management. RESULTS The results are presented using the key dimensions emerging out of the Diederichsen framework. A range of discrimination faced by TGD people in Kerala traps them in situations of low educational outcomes with consequent disadvantages in the job market when they search for livelihoods. This results in a large proportion of our sample living away from families (69 percent), and finding themselves in precarious jobs including sex work (only 33 percent had a regular job), with all these aforementioned factors converging to marginalise their social position. This social position leads to differential risk exposures such as increased exposure to modifiable risk factors like alcohol (40 percent were current alcohol users) and tobacco use (40.8 percent currently used tobacco) and ultimately metabolic risk factors too (30 and 18 percent were hypertensive and diabetic respectively). Due to their differential vulnerabilities such as the discrimination that TGD people are subjected to (41.7 percent had faced discrimination at a healthcare centre in the past one year), those with higher exposure to risk factors often find it hard to bring about behavioural modifications and are often not able to access the services they require. CONCLUSIONS The disadvantaged social position of TGD people and associated structural issues result in exacerbated biological risks, including those for NCDs. Ignoring these social determinants while designing health programmes is likely to lead to sub-optimal outcomes.
Collapse
Affiliation(s)
- Bhavya Fernandez
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
| | - Rakhal Gaitonde
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| |
Collapse
|
2
|
Cheah YK, Kee CC, Lim KK, Cheong YL. Demographic, lifestyle, social, and psychological factors associated with worry-related sleep problems among school-going adolescents in Timor-Leste. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12468. [PMID: 38654575 DOI: 10.1111/jcap.12468] [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: 12/06/2023] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Adolescent sleep problems are a worldwide public health issue. The present study examines factors associated with worry-related sleep problems among school-going adolescents. The country of interest is Timor-Leste, a low-income country, where studies pertaining to adolescent sleep problems are lacking. DESIGN AND MEASURES Data were analysed from the Global School-Based Student Health Survey Timor-Leste (n = 3455). An ordered probit model was used to assess the effects of demographic, lifestyle, social, and psychological factors on different levels of worry-related sleep problems (i.e., no, mild and severe sleep problems). RESULTS School-going adolescents were more likely to face mild or severe worry-related sleep problems if they were older, passive smokers, alcohol drinkers and moderately active. School-going adolescents who sometimes or always went hungry were more likely to experience worry-related sleep problems than those who did not. Involvement in physical fights, being bullied, and loneliness were positively associated with the probability of having modest or severe worry-related sleep problems. CONCLUSION Age, exposure to second-hand smoke, alcohol consumption, physical activity, going hungry, physical fights, being bullied and loneliness are the important determining factors of adolescent worry-related sleep problems. Policymakers should pay special attention to these factors when formulating intervention measures.
Collapse
Affiliation(s)
- Yong Kang Cheah
- School of Economics, Finance and Banking, College of Business, Universiti Utara Malaysia, Sintok, Malaysia
| | - Chee Cheong Kee
- Sector for Biostatistics and Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Kuang Kuay Lim
- Centre for Occupational Health Research, Institute for Public Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Yoon Ling Cheong
- Special Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Jalan Pahang, Malaysia
| |
Collapse
|
3
|
Chireshe R, Manyangadze T, Naidoo K. Diabetes mellitus and associated factors among HIV-positive patients at primary health care facilities in Harare, Zimbabwe: a descriptive cross-sectional study. BMC PRIMARY CARE 2024; 25:28. [PMID: 38221613 PMCID: PMC10789024 DOI: 10.1186/s12875-024-02261-3] [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: 07/31/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Highly active antiretroviral therapy (HAART) has improved the life expectancy of people living with HIV (PLWH) and has increased the risk of chronic non-communicable diseases. Comorbid HIV and diabetes mellitus (DM) significantly increase cardiovascular disease and mortality risk. This study aimed to determine the prevalence of type 2 diabetes mellitus among HIV-positive patients receiving HAART in Zimbabwe and its associated risk factors. METHODS This cross-sectional study was conducted at eight primary healthcare facilities in Harare, Zimbabwe, between January 2022 and March 2023. Non-probability convenience sampling was used to recruit adult HIV-positive patients undergoing HAART attending the facilities. Data were captured on clinical history and socio-demographic and behavioral characteristics, and analyzed using descriptive statistics to determine DM prevalence rates. Additionally, bivariate and multivariate logistic regression models were employed to examine factors associated with HIV and DM comorbidities. RESULTS A total of 450 participants were included in this study, of which 57.6% (n = 259) were female. The majority were married (73.8%) and older than 35 years (80.2%). Most participants had completed high school (87.6%) and 68.9% were employed either formally or self-employed. The prevalence of diabetes mellitus (DM) was 14.9%. HIV/DM comorbidity was more prevalent in patients who were female, self-employed, and smoked (p < 0.05). Multivariate logistic regression analysis revealed that the factors associated with DM-HIV comorbidity were gender, age, education, marital status, employment status, smoking, physical activities, duration of HAART, and diet. Age, level of education, marital status, and occupation were not associated with HIV-DM comorbidity. Obesity (body mass index > 30 kg/m2), smoking, and alcohol consumption were associated with an increased risk of DM. Regular physical activity is associated with a reduced risk of DM. CONCLUSION A substantial burden of DM was found in PLWH. The intersectoral integration approach is advocated, and active screening for DM is recommended. Gender-specific interventions are necessary to target diseases and health behaviors that differ between men and women. These interventions should be customized to the specific diseases and behaviors of each group.
Collapse
Affiliation(s)
- Rumbidzai Chireshe
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Howard Campus, Mazisi Kunene Road, Glenwood, Durban, 4041, South Africa.
| | - Tawanda Manyangadze
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Howard Campus, Mazisi Kunene Road, Glenwood, Durban, 4041, South Africa
- 2Department of Geosciences, School of Geosciences, Disasters, and Development, Faculty of Sciences and Engineering, Bindura University of Science Education, Bindura, Zimbabwe
| | - Keshena Naidoo
- Department of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
4
|
Francis JR, de Araujo RM, da Silva Viegas O, Lobo S, Coelho D, Mathur A, Bothra V, Yu D, Draper ADK, Yan J, Martins N. The response to COVID-19 in Timor-Leste: lessons learnt. BMJ Glob Health 2023; 8:e013573. [PMID: 37821115 PMCID: PMC10583031 DOI: 10.1136/bmjgh-2023-013573] [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: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
The response to the COVID-19 pandemic in Timor-Leste offers lessons that may be useful for incorporating into future responses to infectious disease outbreaks in similar resource-limited settings. In this paper, we identify nine key areas for learning from Timor-Leste's experience of the COVID-19 pandemic: (1) the importance of prior preparation for health emergencies, (2) the establishment of effective leadership and governance structures, (3) the protective impact of early border restrictions, (4) the rapid expansion of diagnostic laboratory capacity, (5) the impact of effective health communications in supporting the vaccine roll-out, (6) the opportunity to build capacity for clinical care, (7) the use of public health interventions that were found to have limited public health impact, (8) the broader effects of the pandemic and the public health response and (9) translation of lessons from COVID-19 to other public health priorities.
Collapse
Affiliation(s)
- Joshua R Francis
- Centro Integrado de Gestao de Crises, Dili, Timor-Leste
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | | | - Odete da Silva Viegas
- Centro Integrado de Gestao de Crises, Dili, Timor-Leste
- Ministerio da Saude, Dili, Timor-Leste
| | - Sergio Lobo
- Centro Integrado de Gestao de Crises, Dili, Timor-Leste
| | - Danina Coelho
- Centro Integrado de Gestao de Crises, Dili, Timor-Leste
| | - Arvind Mathur
- Centro Integrado de Gestao de Crises, Dili, Timor-Leste
- World Health Organization, Dili, Timor-Leste
| | - Vinay Bothra
- Centro Integrado de Gestao de Crises, Dili, Timor-Leste
- World Health Organization, Dili, Timor-Leste
| | - Dongbao Yu
- Centro Integrado de Gestao de Crises, Dili, Timor-Leste
- World Health Organization, Dili, Timor-Leste
| | - Anthony D K Draper
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- National Centre for Epidemiology and Population Health, Canberra, Australian Capital Territory, Australia
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Nelson Martins
- Centro Integrado de Gestao de Crises, Dili, Timor-Leste
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| |
Collapse
|
5
|
Geta ET, Wakjira A, Hailu WB. Disparities in modern health service utilization across socio-demographic and economic inequalities among households in Gida Ayana district, Oromia Regional state, Ethiopia: a community-based cross-sectional study. BMC Health Serv Res 2023; 23:597. [PMID: 37291621 PMCID: PMC10251700 DOI: 10.1186/s12913-023-09527-z] [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: 09/05/2022] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Health care disparities (HCD) occur across a broad range of dimensions and achieving equity in health care is a strenuous task. To overcome the disparities, countries worldwide have started implementing varies policies. HCD remains a challenge in the health care system of Ethiopia. Hence, the study aimed to estimate the disparities in health care utilization (HCU) among households. METHODS A community-based cross-sectional study was conducted from February 01 to April 30, 2022, among households in Gida Ayana District, Ethiopia. A single population proportion formula was used to determine the 393sample size, and participants were selected using systematic sampling. Data was entered into Epi-data 4.6 and exported to SPSS 25 for analysis. Descriptive analysis and binary and multivariable logistic regressions were performed. RESULTS Of the 356 households that participated in the study, 321 (90.2%) of them reported at least one member of their family perceived morbidity in the last six months. The overall level of HCU determined was 207(64.5%), 95% confidence interval (CI),59.0-69.7%. Urban residents (AOR = 3.68, 95% CI = 1.94-6.97), attending secondary school and above (AOR = 2.79, CI = 1.27-5.98), rich (AOR = 2.47, CI = 1.03-5.92), small families (AOR = 2.83, CI = 1.26-6.55), and insured (AOR = 4.27, CI = 2.36-7.71) significantly contributed to HCD. CONCLUSIONS Households' overall level of HCU for perceived morbidity was moderate. However, significant disparities were observed in HCU across place of residence, wealth status, level of education, family size, and health insurance. Hence, strengthening the strategy of financial protection by implementing health insurance that focuses on the socio-demographic and economic status of households is recommended to reduce the disparities.
Collapse
Affiliation(s)
- Edosa Tesfaye Geta
- Department of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia.
| | - Abebe Wakjira
- Gida Ayana hospital, East Wollega zone, Ayana, Oromia Regional State, Ethiopia
| | - Wase Benti Hailu
- Department of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| |
Collapse
|
6
|
Geta ET, Wakjira Bidika A, Etana B. Does community-based health insurance reduce disparities in modern health service utilization among households in Ethiopia? A community-based comparative cross-sectional study. Front Public Health 2023; 10:1021660. [PMID: 36711342 PMCID: PMC9881413 DOI: 10.3389/fpubh.2022.1021660] [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: 08/17/2022] [Accepted: 12/05/2022] [Indexed: 01/15/2023] Open
Abstract
Background Community-based health insurance (CBHI) is an emerging and promising concept to access affordable and effective healthcare by substantially pooling risks to improve health service utilization (HSU) and equity. While there have been improvements in healthcare coverage in Ethiopia, disparities in healthcare remain a challenge in the healthcare system. Hence, the study aimed to assess the effects of CBHI on the reduction of disparities in modern health service (MHS) utilization among households. Methods A community-based comparative cross-sectional study was conducted between 1 February and 30 April 2022 among households in the Gida Ayana district, Ethiopia. The sample size of 356 was determined using the double population proportion formula, and participants were selected using multistage sampling. Data were entered into EpiData 4.6 and exported to SPSS 25 for analysis. Results Among 356 households, 321 (90.2%) reported that at least one member of their family fell ill in the previous 6 months; 153 (47.7%) and 168 (52.3%) households were among the insured and uninsured, respectively. Only 207 [64.5, 95% confidence interval (CI) = 59.0-69.7%] of them utilized health services. The level of MHS was 122 (79.7, 95% CI = 75.5-85.8%) and 85 (50.6, 95% CI = 42.8-58.4%) among insured and uninsured, respectively. Insured households were four times more likely to utilize MHS compared to uninsured households [adjusted odds ratio (AOR) = 4.27, 95% CI = 2.36-7.71]. Despite the households being insured, significant disparities in MHS utilization were observed across the place of residence (AOR = 14.98, 95% CI = 5.12-43.82) and education level (AOR = 0.20, 95% CI = 0.05-0.83). Conclusion Overall, the CBHI scheme significantly improved the level of MHS and reduced disparities in utilization across wealth status and family size differences. However, despite households being insured, significant disparities in the odds of MHS utilization were observed across the place of residence and education level. Hence, strengthening the CBHI scheme and focusing on the place of residence and the education level of households are recommended to improve MHS utilization and reduce its disparities.
Collapse
Affiliation(s)
- Edosa Tesfaye Geta
- Department of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia,Gida Ayana Hospital, Nekemte, Oromia, Ethiopia,*Correspondence: Edosa Tesfaye Geta ✉
| | | | - Belachew Etana
- Department of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| |
Collapse
|
7
|
Salendo J, Ximenes J, Soares A, Guest G, Hagander L. Acute burn care and outcomes at the Hospital Nacional Guido Valadares (HNGV), Timor-Leste: A 7-year retrospective study. Medicine (Baltimore) 2022; 101:e32113. [PMID: 36550901 PMCID: PMC9771211 DOI: 10.1097/md.0000000000032113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The purpose of this study was to describe the epidemiology of patients presenting with acute burns and undergoing admission at Hospital Nacional Guido Valadares (HNGV) in Dili, Timor-Leste in the period 2013 to 2019. HNGV is the only tertiary referral hospital in Timor-Leste. This was a retrospective study involving all acute burn patients admitted to the surgical wards of HNGV from 2013 to 2019. The data was collected from patient charts and hospital medical archives. Data were reviewed and analyzed statistically in terms of age, gender, residence, cause, total body surface area (TBSA), burns depth, length of stay (LOS), and mortality. The outcomes were analyzed using logistic regression. Over the 7-year period, there were 288 acute burn patients admitted to the surgical wards of HNGV. Most patients were children (55%), male (65%) and from the capital city of Dili or surrounding areas (59%). The most common cause of burns in children was scalds and the most common cause among adults was flames. Of the admitted patients 59% had burns affecting >10% of the TBSA and 41% had full thickness burns. The median LOS was 17 days (1-143) and the average mortality for admitted burn patients in HNGV was 5.6% (annual mortality 0-17%). The odds ratio for extended LOS was 1.9 (95% confidence interval 1.1-3.2) in female compared with male patients. The odds ratio for mortality was 14.6 (95% confidence interval 2.7-80.6) in the older adults when compared with younger adults. Higher TBSA, full thickness burns, and flame burns were also significantly associated with longer LOS and higher mortality. Children and male patients were disproportionately overrepresented among patients admitted to HNGV, while female patients had longer LOS and older adults had more severe injury and a higher risk of mortality. Establishment of a national program for the prevention of burns is essential.
Collapse
Affiliation(s)
- Junius Salendo
- Institute of Tropical Medicine and International Health Charité, Universitätsmedizin Berlin, Berlin, Germany
- Global Health, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Joao Ximenes
- Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Alito Soares
- Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Glenn Guest
- Epworth Geelong Hospital and Department of Clinical and Biomedical Sciences, Deakin University, Geelong, Victoria, Australia
| | - Lars Hagander
- Department of Clinical Sciences in Lund, Pediatric Surgery, Skåne University Hospital in Lund, Faculty of Medicine, Lund University, Lund, Sweden
- * Correspondence: Lars Hagander, Department of Clinical Sciences in Lund, Pediatric Surgery, Skåne University Hospital in Lund, Faculty of Medicine, Lund University, Lund, Sweden (e-mail: )
| |
Collapse
|
8
|
Chen Y, Liu W. Utilization and out-of-pocket expenses of primary care among the multimorbid elderly in China: A two-part model with nationally representative data. Front Public Health 2022; 10:1057595. [PMID: 36504938 PMCID: PMC9730339 DOI: 10.3389/fpubh.2022.1057595] [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: 09/29/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background Multimorbidity has become an essential public health issue that threatens human health and leads to an increased disease burden. Primary care is the prevention and management of multimorbidity by providing continuous, comprehensive patient-centered services. Therefore, the study aimed to investigate the determinants of primary care utilization and out-of-pocket expenses (OOPE) among multimorbid elderly to promote rational utilization of primary care and reduce avoidable economic burdens. Methods The study used data from CHARLS 2015 and 2018, which included a total of 4,384 multimorbid elderly aged 60 and above. Guided by Grossman theory, determinants such as education, gender, marriage, household economy, and so on were included in this study. A two-part model was applied to evaluate primary care utilization and OOPE intensity in multimorbid populations. And the robustness testing was performed to verify research results. Results Primary care visits rate and OOPE indicated a decline from 2015 to 2018. Concerning primary outpatient care, the elderly who were female (OR = 1.51, P < 0.001), married (OR = 1.24, P < 0.05), living in rural areas (OR = 1.77, P < 0.001) and with poor self-rated health (OR = 2.23, P < 0.001) had a significantly higher probability of outpatient utilization, whereas those with middle school education (OR = 0.61, P < 0.001) and better household economy (OR = 0.96, P < 0.001) had a significantly less likelihood of using outpatient care. Rural patients (β = -0.72, P < 0.05) may have lower OOPE, while those with better household economy (β = 0.29, P < 0.05; β = 0.58, P < 0.05) and poor self-rated health (β = 0.62, P < 0.001) occurred higher OOPE. Regarding primary inpatient care, adults who were living in rural areas (OR = 1.48, P < 0.001), covered by Urban Employee Basic Medical Insurance (UEBMI) or Urban Rural Basic Medical Insurance (URBMI) (OR = 2.46, P < 0.001; OR = 1.81, P < 0.001) and with poor self-rated health (OR = 2.30, P < 0.001) had a significantly higher probability of using inpatient care, whereas individuals who were female (OR = 0.74, P < 0.001), with middle school education (OR = 0.40, P < 0.001) and better household economy (OR = 0.04, P < 0.001) had a significantly lower tendency to use inpatient care. Significantly, more OOPE occurred by individuals who were women (β = 0.18, P < 0.05) and with better household economy (β = 0.40, P < 0.001; β = 0.62, P < 0.001), whereas those who were covered by URBMI (β = -0.25, P < 0.05) and satisfied with their health (β = -0.21, P < 0.05) had less OOPE. Conclusion To prompt primary care visits and reduce economic burden among subgroups, more policy support is in need, such as tilting professional medical staff and funding to rural areas, enhancing awareness of disease prevention among vulnerable groups and so on.
Collapse
|
9
|
Samad N, Das P, Dilshad S, Al Banna H, Rabbani G, Sodunke TE, Hardcastle TC, Haq A, Afroz KA, Ahmad R, Haque M. Women's empowerment and fertility preferences of married women: analysis of demographic and health survey’2016 in Timor-Leste. AIMS Public Health 2022; 9:237-261. [PMID: 35634022 PMCID: PMC9114782 DOI: 10.3934/publichealth.2022017] [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: 10/28/2021] [Revised: 12/26/2021] [Accepted: 01/04/2022] [Indexed: 11/21/2022] Open
Abstract
A recently independent state, Timor-Leste, is progressing towards socioeconomic development, prioritizing women empowerment while its increased fertility rate (4.1) could hinder the growth due to an uncontrolled population. Currently, limited evidence shows that indicators of women's empowerment are associated with fertility preferences and rates. The objective of this study was to assess the association between women empowerment and fertility preferences of married women aged 15 to 49 years in Timor-Leste using nationally representative survey data. The study was conducted using the data of the latest Timor-Leste Demographic and Health Survey 2016. The study included 4040 rural residents and 1810 urban residents of Timor-Leste. Multinomial logistic regression has been performed to assess the strength of association between the exposures indicating women's empowerment and outcome (fertility preference). After adjusting the selected covariates, the findings showed that exposures that indicate women empowerment in DHS, namely, the employment status of women, house and land ownership, ownership of the mobile phone, and independent bank account status, contraceptive use, and the attitude of women towards negotiating sexual relations are significantly associated with fertility preferences. The study shows higher the level of education, the less likely were the women to want more children, and unemployed women were with a higher number of children. Our study also found that the attitude of violence of spouses significantly influenced women's reproductive choice. However, employment had no significant correlation with decision-making opportunities and contraceptive selection due to a lack of substantial data. Also, no meaningful data was available regarding decision-making and fertility preferences. Our findings suggest that women's empowerment governs decision-making in fertility preferences, causing a decline in the fertility rate.
Collapse
Affiliation(s)
- Nandeeta Samad
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Pranta Das
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
| | - Segufta Dilshad
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Hasan Al Banna
- Institute of Social Welfare and Research, University of Dhaka, Dhaka, Bangladesh
| | - Golam Rabbani
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Ahsanul Haq
- Gonoshasthaya-RNA Molecular Diagnostic & Research Center, Dhanmondi, Dhaka-1205, Bangladesh
| | - Khandaker Anika Afroz
- Deputy Manager (Former), Monitoring, Learning, and Evaluation, CEP, BRAC, Bangladesh
| | - Rahnuma Ahmad
- Department of Physiology, Medical College for Women and Hospital, Dhaka, Bangladesh
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sugai Besi, 57000 Kuala Lumpur, Malaysia
- * Correspondence: ,
| |
Collapse
|
10
|
Estimates of Antibacterial Consumption in Timor-Leste Using Distribution Data and Variation in Municipality Usage Patterns. Antibiotics (Basel) 2021; 10:antibiotics10121468. [PMID: 34943680 PMCID: PMC8698407 DOI: 10.3390/antibiotics10121468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 12/19/2022] Open
Abstract
The association between antimicrobial resistance and antimicrobial usage has become a growing global concern. Many lower-middle income countries including Timor-Leste (TL) have limited information on antimicrobial usage, although recent research suggests increasing resistance rates among human pathogens there. The aim of this study was to use distribution data to estimate antibiotic consumption at both the national and sub-national level in Timor-Leste, stratifying into resistance class and adherence to the national essential medicines list (EML) and WHO AWaRe guidelines. A retrospective review of distribution data from Timor-Leste central medical store (SAMES) was undertaken to give a defined daily dose (DDD)/1000 inhabitants/day using WHO methodology. National antibiotic distribution in the TL EML in 2019 was estimated at 11.1 DDD/1000 inhabitants/day, comparable to consumption rates observed in other lower-middle-income countries using similar methodology. Differences in distribution quantities were noted between municipalities, with 4 of the 13 municipalities notably above the national average and around 32% of listed restricted antimicrobials distributed incongruent with the EML. This study provides insights into estimated antimicrobial consumption in Timor-Leste that has previously been poorly defined. Estimates of consumption can be used to understand emerging resistance in this small island nation, add to the body of knowledge on antimicrobial use to advise policy and guideline development, and help with stewardship activities.
Collapse
|
11
|
Ng TC, Teo CH, Toh JY, Dunn AG, Ng CJ, Ang TF, Abdullah A, Syed A, Lim HM, Yin K, Liew CS. Factors influencing healthcare seeking in patients with dengue: systematic review. Trop Med Int Health 2021; 27:13-27. [PMID: 34655508 DOI: 10.1111/tmi.13695] [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: 11/26/2022]
Abstract
OBJECTIVE Delays in seeking healthcare for dengue are associated with poor health outcomes. Despite this, the factors influencing such delays remain unclear, rendering interventions to improve healthcare seeking for dengue ineffective. This systematic review aimed to synthesise the factors influencing healthcare seeking of patients with dengue and form a comprehensive framework. METHODS This review included both qualitative and quantitative studies. Studies were obtained by searching five databases, contacting field experts and performing backward reference searches. The best-fit meta-synthesis approach was used during data synthesis, where extracted data were fitted into the social-ecological model. Sub-analyses were conducted to identify the commonly reported factors and their level of statistical significance. RESULTS Twenty studies were selected for meta-synthesis. Eighteen factors influencing healthcare seeking in dengue were identified and categorised under four domains: individual (11 factors), interpersonal (one factor), organisational (four factors) and community (two factors). The most reported factors were knowledge of dengue, access to healthcare, quality of health service and resource availability. Overall, more barriers to dengue health seeking than facilitators were found. History of dengue infection and having knowledge of dengue were found to be ambiguous as they both facilitated and hindered dengue healthcare seeking. Contrary to common belief, women were less likely to seek help for dengue than men. CONCLUSIONS The factors affecting dengue healthcare-seeking behaviour are diverse, can be ambiguous and are found across multiple social-ecological levels. Understanding these complexities is essential for the development of effective interventions to improve dengue healthcare-seeking behaviour.
Collapse
Affiliation(s)
- Tze Chang Ng
- Department of Computer System & Technology, Faculty of Computer Science & Information Technology, Universiti Malaya, Malaysia
| | - Chin Hai Teo
- University of Malaya eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Jia Yong Toh
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Adam G Dunn
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Chirk Jenn Ng
- University of Malaya eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Tan Fong Ang
- Department of Computer System & Technology, Faculty of Computer Science & Information Technology, Universiti Malaya, Malaysia
| | - Adina Abdullah
- University of Malaya eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Ayeshah Syed
- Department of English Language, Faculty of Languages & Linguistics, Universiti Malaya, Malaysia
| | - Hooi Min Lim
- University of Malaya eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Kathleen Yin
- Centre of Health Informatics, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Chee Sun Liew
- Department of Computer System & Technology, Faculty of Computer Science & Information Technology, Universiti Malaya, Malaysia.,University of Malaya eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia
| |
Collapse
|
12
|
Talukder A, Das Gupta R, Hashan MR, Haider SS, Sajal IH, Sarker M. Association between television viewing and overweight and obesity among women of reproductive age in Timor-Leste: evidence from the demographic health survey 2016. BMJ Open 2021; 11:e045547. [PMID: 34380718 PMCID: PMC8359523 DOI: 10.1136/bmjopen-2020-045547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study aimed to assess the possible relationship between television viewing and overweight and obesity among Timorese women of reproductive age. METHODS This cross-sectional study analysed the Timor-Leste Demographic and Health Survey 2016 dataset. A weighted sample of 11 398 Timorese women aged 15-49 years was chosen using a two-stage stratified random sampling technique. Asian criteria-based body mass index (BMI) cut-offs were used to define overweight (BMI 23.0 to <27.5 kg/m2) and obesity (BMI ≥27.5 kg/m2). Frequency of TV viewing was categorised into three groups: (1) not at all, (2) less than once a week and (3) at least once a week. Multilevel ordered logistic regression was performed to identify the correlates of overweight and obesity. Both crude and adjusted odds ratios (AOR) along with a 95% CI were calculated to show the strength of association. RESULTS Among 11 398 respondents, 19.4% were overweight or obese (overweight: 15.7% and obese: 3.8%). Although about half of the respondents reportedly did not watch TV at all, just over two-thirds watched TV at least once a week. Women who watched TV at least once a week were found to have 1.3 times the odds of being overweight or obese compared with those who never watched TV (AOR: 1.3, 95% CI: 1.1 to 1.5; p<0.001). However, when stratified by settlement type, the statistical significance stood for the rural women only (AOR: 1.5, 95% CI: 1.2 to 1.8; p<0.001), after adjusting for the covariates. CONCLUSION Watching TV at least once a week was found to be a significant correlate of overweight and obesity in rural Timorese women of reproductive age. Further studies need to be undertaken to assess physical activity, sedentary and dietary patterns to clarify the possible mechanism through which TV viewing may influence BMI in those groups.
Collapse
Affiliation(s)
- Animesh Talukder
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Rajat Das Gupta
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | | | - Shams Shabab Haider
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Ibrahim Hossain Sajal
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Mathematical Sciences, School of Natural Sciences & Mathematics, University of Texas at Dallas, Dallas, Texas, USA
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
13
|
Paratz ED, Mock N, Gutman SJ, Horton A, Creati L, Appelbe A, Eggleton S, Kushwaha V, da Silva Almeida IT, Monteiro A, Bayley N. Taking the pulse of Timor-Leste's cardiac needs: a 10-year descriptive time-trend analysis. Intern Med J 2021; 50:838-845. [PMID: 31237730 DOI: 10.1111/imj.14411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/13/2019] [Accepted: 06/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Timor-Leste is one of the poorest countries in the world. The East Timor Hearts Fund is a charitable organisation involving Australian cardiologists providing outreach screening and access to cardiac interventions. AIMS To assess ten years of clinical volume, demographics and patient outcomes. Our intention was to identify existing limitations to facilitate planning for further capacity building over the next decade. METHODS The East Timor Hearts Fund database was sectioned into 2-year intervals (2009/2010, 2011/2012, 2013/2014, 2015/2016 and 2017/2018). Demographics and clinical outcomes of patients were compared, with subgroup analysis of adult (>18 years old), paediatric and interventional patients. RESULTS Over 10 years, 2050 patient encounters have occurred; 1119 (54.6%) encounters occurred in 2017/2018; 73.6% of patients were assessed in the capital Dili. Rheumatic and congenital cardiac diseases remain very common (39.1% of adult new patients and 74.2% of paediatric new patients), with 1.4% of new patients exhibiting both pathologies. The number of new patients with rheumatic or congenital heart disease tripled in 2017/2018 compared to 2009/2010 (99 vs 34 patients, P < 0.0001). Paediatric case volume increased over 10-fold over 10 years (288 new patients in 2017/2018 vs 24 in 2009/2010, P < 0.0001), with corresponding increase in proportion of paediatric interventions (59.4% in 2017/2018 vs 25.0% in 2009/2010, P = 0.027). For patients undergoing intervention (n = 87), post-procedural complications and mortality are extremely low (3.4% and 1.1%, respectively), with all eligible patients attending at least one post-procedure appointment. CONCLUSION Demand for cardiac services in Timor-Leste is rising exponentially, with inequitable geographic coverage. Rheumatic and congenital cardiac diseases remain priorities for assessment, and paediatric case volume is increasing. Patients undergoing intervention experience good medical outcomes.
Collapse
Affiliation(s)
- Elizabeth D Paratz
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Cardiology Department, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nicki Mock
- East Timor Hearts Fund, Melbourne, Victoria, Australia
| | - Sarah J Gutman
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Cardiology Department, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Ari Horton
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Paediatric Cardiology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Louise Creati
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alan Appelbe
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, Geelong Hospital, Geelong, Victoria, Australia
| | - Simon Eggleton
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, Eastern Heart Clinic, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Virag Kushwaha
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, Eastern Heart Clinic, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Inez T da Silva Almeida
- Internal Medicine, Hospital Nacional Guido Valdares, Dili, Timor-Leste.,Valdares Cardiology, Warrnambool Base Hospital, Warrnambool, Victoria, Australia
| | - Andre Monteiro
- Internal Medicine, Hospital Nacional Guido Valdares, Dili, Timor-Leste.,Valdares Cardiology, Warrnambool Base Hospital, Warrnambool, Victoria, Australia
| | - Noel Bayley
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Valdares Cardiology, Warrnambool Base Hospital, Warrnambool, Victoria, Australia
| |
Collapse
|
14
|
da Silva RN, Ferreira MDA. Enhancing citizenship through nursing care in Brazil: Patients' struggle against austerity policies. Nurs Inq 2020; 27:e12337. [PMID: 31960538 DOI: 10.1111/nin.12337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 11/28/2022]
Abstract
Interpersonal relations play a critical role in both the conception and dynamics of Brazilian citizenship. Under the influence of neoliberalism, patients must build strategies to access high-quality health care services. This study aimed to analyze the role of interpersonal relations involved in the access to and delivery of health care services in Brazil amid the influence of austerity policies and the role of nurses in enhancing citizenship through nursing care. Thirty-one patients in a public hospital in Rio de Janeiro, Brazil, participated in qualitative interviews. A lexical analysis was conducted to analyze the interview data using Alceste® software, version 2012. The results were interpreted in light of both theoretical constructs of the Brazilian citizenship and biological subcitizenship propositions. Two lexical classes revealed contents about strategies used by patients to access high-quality health care. In the context of budget cuts due to austerity policies, cultural aspects of Brazilian citizenship have influenced access to high-quality health care services by creating two distinct conditions. Some patients acted as super-citizens, while others acted as subcitizens. Nurses across the globe must spearhead the struggle for universal and equitable health care access at all levels, without losing sight of wider sociocultural aspects.
Collapse
|
15
|
Adult and Paediatric Cardiac Intervention in Timor-Leste: Disease Burden, Demographics and Clinical Outcomes. Heart Lung Circ 2019; 29:1112-1121. [PMID: 31831263 DOI: 10.1016/j.hlc.2019.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The East Timor Hearts Fund (ETHF) is a charitable organisation of Australian cardiologists providing outreach screening in Timor-Leste. For patients requiring intervention, ETHF arranges logistics, procedures, and postoperative care. The aim of this project is to evaluate outcomes of patients requiring intervention. METHODS The ETHF database of all patients was utilised to identify patients with disease warranting surgical or percutaneous intervention. Both patients who underwent intervention and those who did not proceed to intervention were included in this study. Patients who had intervention arranged by other organisations but have then had follow-up with ETHF were also included. Overall demographics and pre and postoperative factors were assessed, with sub-group analysis of adult and paediatric patients to identify any differences in care. RESULTS Of 221 patients requiring intervention, 101 patients underwent intervention, receiving 22 different operations or procedures. Patients were predominantly young (median age 17.5 years) and female (64.7%), with rheumatic heart disease (63.8%). Twenty-four (24) (33.3%) women aged 15-45 years old with cardiac disease warranting intervention were documented as pregnant or breastfeeding at time of clinic assessment. Of patients who did not proceed to intervention, adults were more likely to be lost to follow-up (42.4% vs 18.5%) while paediatric patients were more likely to experience progression of disease (18.5% vs 7.5%, p=0.005). Median waitlist time was 5 months, with no significant difference between adults and children, correlating with a preoperative mortality rate of 5.4%. For patients who underwent intervention, post-procedure mortality was extremely low (0.9%) and attendance of at least one post-procedure review was excellent (99.0%). Eleven (11) (10.9%) patients have required repeat intervention, with no difference in rates between adult and paediatric patients. Length of follow-up extends up to 20 years for some patients. CONCLUSION The Timor-Leste interventional cohort was predominantly a young female population with rheumatic and congenital cardiac disease. There were also high rates of pregnancy amongst female patients with severe cardiac disease. Delayed access to intervention may result in preoperative adverse events and mortality, and is a key target for improvement. Patients who undergo intervention have very low post-procedural mortality, good adherence to early medical follow-up and good long-term outcomes.
Collapse
|
16
|
Wittmeier K, Brockman GH, Garcia AP, Woodgate RL, Ball GDC, Wicklow B, Sellers E, Jong G', Sibley KM. Access to Multidisciplinary Care for Pediatric Weight Management: Exploring Perspectives of the Health Care Team within Canada and the United States. Child Obes 2019; 15:363-370. [PMID: 31099587 DOI: 10.1089/chi.2019.0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: In Canada and the United States, most families referred for pediatric weight management services do not start treatment. Of families who initiate care, many discontinue before the program ends. Parents and youth have reported difficulties in accessing services as an important barrier to starting or completing programming. The purpose of this study was to understand barriers and identify potential solutions related to access to care from the perspective of health care team members from Canada and the United States. Methods: Qualitative description method guided the study design. Participants were health care team members, purposefully recruited through Canadian and US-based pediatric weight management program registries. Telephone interviews were conducted with participants between February and May 2017. Interviews were transcribed verbatim and analyzed using content analysis. Results: Eighteen individuals from 16 sites participated (n = 8 Canada, n = 8 United States). Access barriers and potential solutions were related to: (1) referral and eligibility, (2) wait lists and program capacity, (3) logistics and costs, and (4) stigma and weight bias. Barriers were similar between Canadian and US sites, with the exception of cost-related barriers. Conclusions: Health care providers from Canada and the United States reported multiple societal, organizational, service, and family-level barriers to accessing multidisciplinary pediatric weight management care. Proposed solutions suggest that service providers can play a key role alongside families to improve access to appropriate care. Further research is needed to demonstrate the feasibility and effectiveness of proposed solutions.
Collapse
Affiliation(s)
- Kristy Wittmeier
- 1Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Gwenyth H Brockman
- 3George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Arnaldo Perez Garcia
- 4Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Roberta L Woodgate
- 2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,5College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geoff D C Ball
- 6Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Brandy Wicklow
- 1Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Sellers
- 1Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Geert 't Jong
- 1Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Kathryn M Sibley
- 3George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada.,7Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|