Prevalence of using non prescribed medications in economically deprived rural population of Pakistan

Weekend physical activity profiles and their relationship with quality of life: The SOPHYA cohort of Swiss children and adolescents

INTRODUCTION

Quality of life (QoL) is an important health indicator among children and adolescents. Evidence on the effect of physical activity (PA)-related behaviors on QoL among youth remains inconsistent. Conventional accelerometer-derived PA metrics and guidelines with a focus on whole weeks may not adequately characterize QoL relevant PA behavior.

OBJECTIVE

This study aims to a) identify clusters of accelerometer-derived PA profiles during weekend days among children and adolescents living in Switzerland, b) assess their cross-sectional and predictive association with overall QoL and its dimensions, and c) investigate whether the associations of QoL with the newly identified clusters persist upon adjustment for the commonly used PA metrics moderate-to-vigorous physical activity (MVPA) and time spent in sedentary behavior (SB).

METHODS

The population-based Swiss children's Objectively measured PHYsical Activity (SOPHYA) cohort among children and adolescents aged 6 to 16 years was initiated at baseline in 2013. PA and QoL information was obtained twice over a five-year follow-up period. The primary endpoint is the overall QoL score and its six dimension scores obtained by KINDL® questionnaire. The primary predictor is the cluster membership of accelerometer-derived weekend PA profile. Clusters were obtained by applying the k-medoid algorithm to the distance matrix of profiles obtained by pairwise alignments of PA time series using the Dynamic Time Warping (DTW) algorithm. Secondary predictors are accelerometer-derived conventional PA metrics MVPA and SB from two combined weekend days. Linear regression models were applied to assess a) the cross-sectional association between PA cluster membership and QoL at baseline and b) the predictive association between PA cluster membership at baseline and QoL at follow-up, adjusting for baseline QoL.

RESULTS

The study sample for deriving PA profile clusters consisted of 51.4% girls and had an average age of 10.9 [SD 2.5] years). The elbow and silhouette methods indicated that weekend PA profiles are best classified in two or four clusters. The most differentiating characteristic for the two-clusters classification ("lower activity" and "high activity"), and the four-clusters classification ("inactive", "low activity", "medium activity", and "high activity"), respectively was the participant's mean counts per 15-seconds epoch. Participants assigned to high activity clusters were younger and more often male. Neither the clustered PA profiles nor MVPA or SB were cross-sectionally or predictively associated with overall QoL. The only association of a conventional PA metrics with QoL while adjusting for cluster membership was observed between MVPA during the weekend days and social well-being with a mean score difference of 2.4 (95%CI: 0.3 to 4.5; p = 0.025).

CONCLUSION

The absence of strong associations of PA metrics for the weekend with QoL, except for the positive association between MVPA during the weekend days and social well-being, is in line with results from two randomized studies not showing efficacy of PA interventions on youth QoL. But because PA decreases with age, its promotion and relevance to QoL remain important research topics. Larger longitudinal study samples with more than two follow-up time points of children and adolescents are needed to derive new novel accelerometer-derived PA profiles and to associate them with QoL dimensions.

Prevalence of Soil-Transmitted Helminth Infections and Associated Risk Factors Among School Children in Dembecha Town, Ethiopia

Soil-transmitted helminth (STH) infections are among the most common infections that affect the poorest and most deprived communities. In most developing countries, children aged 5 to 15 years are at risk for chronic helminth infection and associated morbidity. This study aimed to determine the prevalence of STH infections and associated risk factors among three government elementary schools in Dembecha town, Ethiopia. We conducted a school-based cross-sectional study involving 316 participants between November 2019 and March 2020. A systematic random sampling method was used to select study participants from the study schools. Data related to the sociodemographic characteristics of the study participants and risk factors for STH infections were collected using a pretested questionnaire survey. Parasitological examinations of stool samples were performed using the formal-ether concentration method. Study participants aged 5 to 15 years were enrolled in this study. The overall prevalence of STH infection was 21.5% (68/316). Ascaris lumbricoides ranked highest, with a prevalence of 11.4%, followed by hookworms 7.3%, Trichuris trichiura 1.9%, and Strongloides stercoralis 0.9%. Age groups of 10-15 years (AOR =3.109; 95% CI: 1.033, 9.350), residence in Kebele 2 (AOR =2.990; 95% CI: 1.082, 8.264), illiterate mothers (AOR =4.689; 95% CI: 1.410, 15.59), and a family size of 4-6 (AOR =3.286; 95% CI: 1.299, 8.313) were significantly associated with STH infections. The prevalence of STH infections remains an important health issue for study participants. Therefore, school deworming programs twice a year are crucially needed until the prevalence falls below the level of public health importance.

Balancing Innovation and Patient Care in Breast Cancer: Integrating Hypofractionated Proton Therapy With Breast Reconstruction Outcomes

This review aims to assess the application of hypofractionated proton therapy in breast cancer reconstruction, analyzing its advantages, challenges, and broader implications for patient care. The goal is to comprehensively understand how this innovative approach can be integrated into breast cancer treatment. Proton therapy exhibits superior target coverage and safety, reducing radiation-induced complications and sparing critical organs, but skin toxicity outcomes differ from photon therapy. Tissue expanders are vital in breast reconstruction, employing innovative planning for positive long-term outcomes and highlighting the importance of balancing cancer treatment effectiveness with cosmetic outcomes. Hypofractionated proton therapy and breast cancer reconstruction present promising innovations with notable advantages in target coverage and organ sparing. However, variations in skin toxicity outcomes and the need for a careful balance between treatment effectiveness and cosmetic outcomes underscore ongoing challenges. Future directions should focus on refining treatment protocols, optimizing patient selection criteria, and integrating emerging technologies to enhance therapeutic outcomes while minimizing adverse effects.

The Magnitude of Hypertension and Its Contributing Factors Among Patients Receiving Antiretroviral Therapy in Public Hospitals in Harar City, Eastern Ethiopia: A Cross-Sectional Study

Background

Although people living with HIV (PLHIV) are surviving longer due to the development of highly active antiretroviral therapy (HAART), hypertension continues to be a significant obstacle for human immunodeficiency virus (HIV) positive patients.

Purpose

This study aims to determine the prevalence of hypertension and its contributing factors among patients receiving HAART in public hospitals in Harar City, Eastern Ethiopia.

Patients and Methods

A hospital-based cross-sectional study was conducted among adult PLHIV who receive HAART in public hospitals in Harar City, Eastern Ethiopia, from 20 March to 14 April 2023. A simple random sampling technique was employed to select a total of 406 clients (382 participated in the study). Data were collected through patient interview and chart review using a questionnaire. The binary logistic regression was used for data analysis. The association was declared statistically significant at a p-value less than 0.05.

Results

The magnitude/prevalence of hypertension was 23% (95% CI: 19.1, 27.5) in study settings from a total of 382 adults who participated in this study. Factors significantly associated with hypertension in a multivariable binary logistic regression model include residence (rural residence, AOR = 1.95, 95% CI: 1.04, 3.65); body mass index (obese, AOR = 4.35, 95% CI: 1.08, 16.77); cigarette smoking (past cigarette smoking, AOR = 4.7, 95% CI: 1.10, 21.8); and HAART regimen change (AOR = 0.44, 95% CI: 0.20, 0.97).

Conclusion

The prevalence of hypertension observed among adult PLHIV in the study settings was high. Adults from rural areas, with a history of past smoking cigarette, and obesity need close attention during their clinic visits for more health education to reduce risk factors. The changed HAART regimen was associated with a reduced risk of hypertension. Generally, hypertensive PLHIV need consideration for their double burden of communicable and non-communicable diseases during disease management and hospital guideline development.

Discovering new pathways toward integration between health and sustainable development goals with natural language processing and network science

BACKGROUND

Research on health and sustainable development is growing at a pace such that conventional literature review methods appear increasingly unable to synthesize all relevant evidence. This paper employs a novel combination of natural language processing (NLP) and network science techniques to address this problem and to answer two questions: (1) how is health thematically interconnected with the Sustainable Development Goals (SDGs) in global science? (2) What specific themes have emerged in research at the intersection between SDG 3 ("Good health and well-being") and other sustainability goals?

METHODS

After a descriptive analysis of the integration between SDGs in twenty years of global science (2001-2020) as indexed by dimensions.ai, we analyze abstracts of articles that are simultaneously relevant to SDG 3 and at least one other SDG (N = 27,928). We use the top2vec algorithm to discover topics in this corpus and measure semantic closeness between these topics. We then use network science methods to describe the network of substantive relationships between the topics and identify 'zipper themes', actionable domains of research and policy to co-advance health and other sustainability goals simultaneously.

RESULTS

We observe a clear increase in scientific research integrating SDG 3 and other SDGs since 2001, both in absolute and relative terms, especially on topics relevant to interconnections between health and SDGs 2 ("Zero hunger"), 4 ("Quality education"), and 11 ("Sustainable cities and communities"). We distill a network of 197 topics from literature on health and sustainable development, with 19 distinct network communities - areas of growing integration with potential to further bridge health and sustainability science and policy. Literature focused explicitly on the SDGs is highly central in this network, while topical overlaps between SDG 3 and the environmental SDGs (12-15) are under-developed.

CONCLUSION

Our analysis demonstrates the feasibility and promise of NLP and network science for synthesizing large amounts of health-related scientific literature and for suggesting novel research and policy domains to co-advance multiple SDGs. Many of the 'zipper themes' identified by our method resonate with the One Health perspective that human, animal, and plant health are closely interdependent. This and similar perspectives will help meet the challenge of 'rewiring' sustainability research to co-advance goals in health and sustainability.

Access to non-prescription medicines via vending machines: key considerations to help transfer the self-care concept to the next generation while managing safety risks

Objectives

Non-prescription vending machines are automated self-service systems that are increasingly used to dispense these medicines. Whilst regulatory health academics have devoted considerable attention to non-pharmacy medication outlets in Gulf Cooperation Council countries and others, the public health literature on these vending machines remains lacking. Whilst non-prescription vending machines undoubtedly provide a number of benefits, they are not without their risks, which include polypharmacy and medication interactions.

Methods

The purpose of this article is to provide a framework for further investigation of the function, advantages, and practical constraints of non-prescription vending machines.

Key findings

Overall, more research is required to determine the optimal balance between achieving the benefits of non-prescription vending machines whilst avoiding unnecessary constraints on regulatory bodies and vending machine providers but minimizing patient harm.

Conclusions

Further studies are also required to assess the consequences of these policy experiments. Specifically, there is a need to better understand the extent to which vending machines can provide beneficial and reasonable access to non-prescription medicines to enhance the quality of life of the population especially during pandemics.

Current state of poultry waste management practices in Bangladesh, environmental concerns, and future recommendations

This review paper focuses on the current state of poultry waste generation, composition, and management techniques in commercial poultry farms and trading in Bangladesh, to reduce pollution and generate economic benefits from poultry waste. It also underlines the negative impact of poultry waste disposal on the environment. In Bangladesh, collection of poultry waste into bags and, subsequently, direct use as fertilizer in agricultural fields and aquaculture is common, while alternative disposal methods such as composting and biogas generation are now attracting commercial poultry producers. Direct use of poultry manure results in poor air and soil quality, environmental deterioration, detrimental effects on global health, climate change due to high levels of atmospheric ammonia, and the creation of significant amounts of greenhouse gases. Lack of knowledge and investment, as well as high demand for free land for composting, are important obstacles. Future research on precise waste characterization, improved understanding of poultry waste management, and increased efforts on developed waste disposal for a safe environment are therefore recommended. So, poultry waste, which is currently a burden for the environment, could be turned into a useful agricultural resource, which would be useful for the poultry industry.

Solid waste management and health hazards associated with residence around open dumpsites in heterogeneous urban settlements in Southwest Nigeria

The existence and multiplication of open dumpsites (ODs) around residential settlements are associated with environmental health outcomes in urbanizing settlements of developing countries. The study assessed existing practice and perceived health hazards of residence around ODs in Nigerian heterogeneous urban settlements. The cross-sectional, mixed-method study administered a validated questionnaire on 195 respondents using a 4-stage sampling technique. Two focus group discussions (FGDs) were conducted and analysed by ATLAS.ti software. Continuous and categorical variables were respectively presented by means and proportions; associations among variables were determined by chi-square and logistic regression at Pα<0.05. Seventy-two per cent of the respondents disposed of solid waste in ODs, despite good knowledge (95%) and a positive attitude (85%) on perceived health-hazards. One-sixth (15%) of respondents were willing to pay for waste collection service and 50% considered burning as an alternative to open dumping. The most and least perceived health outcomes were malaria and breathing difficulties. Improved water sources and skin irritations were significant predictors of sound SWM practices.

Association between intimate partner violence and nutritional status of married Nepalese women

Background

Intimate partner violence (IPV) is physical, sexual, or psychological harm perpetrated by a spouse or an intimate partner. Its detrimental effects on women’s physical, mental, sexual, and reproductive health are well-documented. However, its impact on nutritional status is not well-studied, and previous studies have led to contradictory findings. This study aimed to explore the association between intimate partner violence and the nutritional status of married Nepalese women.

Methods

The study used the 2016 Nepal Demographic Health Survey data, which employed a modified version of the Conflict Tactics Scale to determine women’s exposure to IPV. Anemia and low body mass index (BMI) were used as proxies of nutritional status. Multinomial regression was used to analyze the relationship between BMI and IPV; multivariable logistic regression was used to analyze the association between anemia and IPV.

Results

The prevalence of underweight, overweight/obesity, and anemia were respectively 13.9%, 25.1%, and 38.7%. The prevalence of physical, sexual, and emotional IPVs experienced in the preceding year were respectively 9.8%, 4.6%, and 7.6%. Likewise, the prevalence of lifetime physical, sexual, emotional, and controlling behavior IPVs were respectively 21.8%, 7.4%, 12.3%, and 32.1%. The low intensity of emotional IPV (AOR 1.62; CI: 1.02–2.56) and moderate intensity of physical IPV (AOR 3.70; CI: 1.64–8.35) experienced in the preceding year, and low intensity of lifetime emotional IPV (AOR 1.69; CI: 1.11–2.58) were associated with an increased risk of overweight/obesity. Moderate intensity of sexual IPV (AOR 2.59; CI: 1.099–6.108) experienced in the preceding year was associated with an increased risk of underweight BMI. The low intensity of lifetime controlling behavior (AOR1.25; CI: 1.03–1.53) was associated with an increased risk of anemia.

Conclusions

Emotional and Physical IPVs are significantly associated with an increased risk of overweight/obesity. Sexual IPV is significantly associated with an increased risk of underweight BMI, and controlling behavior is significantly associated with an increased risk of anemia. Seeking help could offset the detrimental effects of IPV; therefore, IPV screening should be a part of regular healthcare assessment for married women, and appropriate rehabilitation should be offered to IPV survivors.

Bayesian multilevel analysis of determinants of acute respiratory infection in children under the age of five years in Ethiopia

BACKGROUND

Acute respiratory tract infection (ARI) is one of the leading causes of illness and mortality in children under the age of five worldwide. Pneumonia, which is caused by a respiratory tract infection, kills about 1.9 million children under the age of 5 years around the world. The majority of these deaths occur in underdeveloped countries. According to the 2016 Ethiopia Demographic and Health Survey (EDHS), the prevalence rate of ARI in Ethiopia was 7%. Prevalence is defined as the number of infectious diseases present at a given period in relation to the total number of children under the age of five who have been exposed to ARI. The goal of this study was to determine the risk factors for acute respiratory infection among children under the age of five in Ethiopia.

METHODS

To provide representative samples of the population, a community-based cross-sectional sampling scheme was designed. Bayesian multilevel approach was employed to assess factors associated with the prevalence of ARI among children under age five in Ethiopia. The data was collected from 10,641 children under the age of 5 years out of which 9918 children were considered in this study.

RESULTS

The ARI prevalence rate in children under the age of 5 years was assessed to be 8.4%, somewhat higher than the country's anticipated prevalence rate. Children whose mothers did not have a high level of education had the highest prevalence of ARI. The key health, environmental, and nutritional factors influencing the proportion of children with ARI differed by area. Tigray (15.3%) and Oromia (14.4%) had the highest prevalence of ARI, while Benishangul Gumuz had the lowest prevalence (2.6%). The use of vitamin A was investigated, and the results revealed that roughly 43.1% of those who received vitamin A had the lowest prevalence of ARI (7.7%) as compared to those who did not receive vitamin A. Diarrhea affected 11.1% of children under the age of five, with the highest frequency of ARI (24.6%) and the highest prevalence of ARI reported in children whose drinking water source was unprotected/unimproved (9.4%).

CONCLUSIONS

The prevalence of ARI among children under the age of 5 years was found to be strongly affected by the child's age, household wealth index, mother's educational level, vitamin A supplement, history of diarrhea, maternal work, stunting, and drinking water source. The study also found that the incidence of ARI varies significantly between and within Ethiopian areas. When intending to improve the health status of Ethiopian children, those predictive variables should be taken into consideration.

Community pharmacists' perception and exposure to drug promotion in Pakistan: a cross-sectional study

OBJECTIVE

Drug promotion is a factor that promotes the irrational use of drugs and sometimes negatively influences the prescribing/dispensing pattern. So there was a need to assess the views about accepting gifts and attitudes/influence towards drug promotion among community pharmacists in Punjab, Pakistan.

SETTING

Adopting a preused questionnaire, we conducted a cross-sectional multiple-site survey study. We distributed questionnaires to pharmacists in the community pharmacies to investigate the exposure, scepticism and acceptance to drug promotion as well as their perception about the appropriateness of gifts and to check if they had been taught about dealing with medical representatives. Data were analysed in simple percentages, and the χ² test was used to evaluate association with demographics. All the analysis was done using SPSS V.23.0.

RESULTS

A total 86.9% (463/533) pharmacists completed the survey. One out of four pharmacists reported being taught about the ethics of drug promotion (26.8%) and about how to interpret drug promotional material (25.0%) and were significantly associated with higher age (age 31%-35 years, 81.9%; p<0.05). More than two-thirds of the respondents found it appropriate to accept stationery (73.4%) and textbooks (70.6%) as gifts, and only 17.5% felt it was appropriate to accept direct money. Less than half of the pharmacists (47.3%) perceived drug companies were useful for gaining knowledge about new drugs. Majority (76.2%) thought these drug promotions play a role in the irrational prescribing of antibiotics and 18.6% dispensed antibiotics due to these promotions.

CONCLUSION

The majority of pharmacists participating in this study felt it was appropriate to receive small value gifts from pharmaceutical companies. Only a small proportion of the respondents was given ethical training and education about drug promotion. Improving the syllabus and updating the pharmacist's knowledge after graduation, as part of continued pharmacy education, will eventually improve the healthcare professionals' capability to act for the patients' welfare.

Household solid waste management practices and perceptions among residents in the East Coast of Malaysia

BACKGROUND

Poor waste disposal practices hamper the progress towards an integrated solid waste management in households. Knowledge of current practices and perception of household solid waste management is necessary for accurate decision making in the move towards a more sustainable approach. This study investigates the household waste practices and perceptions about waste management in Panji, one of the sub-districts in Kota Bharu, Kelantan, Malaysia.

METHODS

A stratified random sampling technique using a cross-sectional survey questionnaire was used to collect data. A total of 338 households were interviewed in the survey and data were analyzed using SPSS. Chi-square goodness of fit test was used to determine the relationships between categorical variables, whereas Chi-square bivariate correlation test was performed to observe the correlation between the perceptions of waste segregation with socio-demographic background of the respondents. The correlation between perception of respondents with the locality, house type and waste type were also conducted. Principal component analysis was used to identify grouping of variables and to establish which factors were interrelated in any given construct.

RESULTS

The results of the study revealed that 74.3 % of households disposed of food debris as waste and 18.3% disposed of plastic materials as waste. The study also showed that 50.3% of the households segregate their waste while 49.7% did not. About 95.9% of the respondents were aware that improper waste management leads to disease; such as diarrhea and malaria. There were associations between locality, age and house type with waste segregation practices among respondents (Chi-square test, p<0.05). Associations were also found between locality with the perception of improper waste management which lead to disease (Chi-square test, p<0.05). Principal Component Analysis showed that 17.94% of the variance has high positive loading (positive relationship) with age, marital status and, type of house.

CONCLUSION

This study highlights the importance to design waste separation programs that suit the needs of targeted population as a boost towards sustainable solid waste management practices.

Undernutrition and Associated Risk Factors among Adult HIV/AIDS Patients Attending Antiretroviral Therapy at Public Hospitals of Bench Sheko Zone, Southwest Ethiopia

Even though there are advancements in the treatment of patients with HIV, many deaths are related to undernutrition. Despite this fact, the burden of undernutrition and associated factors among adults receiving ART is a significant shortcoming in the study area. A cross-sectional study was done in public hospitals of the Bench-Sheko zone. Face-to-face interviews were used to gather information. Odds ratio with a 95% confidence level was used to identify determinants of undernutrition. The proportion of undernutrition, normal, and overweight were 29.2%, 61.2%, and 9.6% respectively. Food insecurity, poor ART adherence, low CD4 count, and substance use were factors associated with under nutrition among HIV patients. Undernutrition was so high in comparison to other studies in Ethiopia; the local concerned bodies should focus on identified risk factors for improving HIV/AIDS treatment via health education, nutritional assistance and counseling.

Determinants of acute respiratory infection among under-five children in rural Ethiopia

INTRODUCTION

In low- and middle-income nations, acute respiratory infection (ARI) is the primary cause of morbidity and mortality. According to some studies, Ethiopia has a higher prevalence of childhood acute respiratory infection, ranging from 16 to 33.5%. The goal of this study was to determine the risk factors for acute respiratory infection in children under the age of five in rural Ethiopia.

METHODS

A cross-sectional study involving 7911 children under the age of five from rural Ethiopia was carried out from January 18 to June 27, 2016. A two stage cluster sampling technique was used recruit study subjects and SPSS version 20 was used to extract and analyze data. A binary logistic regression model was used to identify factors associated with a childhood acute respiratory infection. The multivariable logistic regression analysis includes variables with a p-value less than 0.2 during the bivariate logistic regression analysis. Adjusted odds ratios were used as measures of effect with a 95% confidence interval (CI) and variables with a p-value less than 0.05 were considered as significantly associated with an acute respiratory infection.

RESULTS

The total ARI prevalence rate among 7911 under-five children from rural Ethiopia was 7.8%, according to the findings of the study. The highest prevalence of ARI was found in Oromia (12.8%), followed by Tigray (12.7%), with the lowest frequency found in Benishangul Gumuz (2.4%). A multivariable logistic regression model revealed that child from Poor household (AOR = 2.170, 95% CI: 1.631-2.887), mother's no education (AOR = 2.050,95% CI: 1.017-4.133), mother's Primary education (AOR = 2.387, 95% CI:1.176-4.845), child had not received vitamin A (AOR = 1.926, 95% CI:1.578-2.351), child had no diarrhea (AOR = 0.257, 95% CI: 0.210-0.314), mothers not working (AOR = 0.773, 95% CI:0.630-0.948), not stunted (AOR = 0.663, 95% CI: 0.552-0.796), and not improved water source (AOR = 1.715, 95% CI: 1.395-2.109). Similarly, among under-five children, the age of the child, the month of data collection, anemia status, and the province were all substantially linked to ARI.

CONCLUSIONS

Childhood ARI morbidity is a serious health challenge in rural Ethiopia, according to this study, with demographic, socioeconomic, nutritional, health, and environmental factors all having a role. As a result, regional governments, healthcare staff, and concerned groups should place a priority on reducing ARI, and attempts to solve the issue should take these variables into account.

Suicide methods in South Asia over two decades (2001-2020)

BACKGROUND

Suicide is a global preventable public health problem. About a quarter of all suicides in the world occur in South Asia. As means restriction is an important suicide prevention strategy, gaining knowledge of the common suicide methods and their changing trends in each country and region is crucial.

AIMS

We aimed to assess the suicide methods in South Asian countries over the last two decades.

METHODS

A search was performed in PubMed, PubMed Central, Scopus, and Google Scholar with the search terms. Original articles of quantitative studies, published in the English language, from 2001 to 2020, with full-accessible text, that rank different methods of suicide in eight South Asian countries, were included.

RESULTS

A total of 68 studies were found eligible for review. The Maximum number of studies were found from India (n = 38), followed by Bangladesh (n = 12), Pakistan (n = 9), Sri Lanka (n = 6), and Nepal (n = 3). Hanging (n = 40, 55.8%) and poisoning (n = 24, 35.3%) were the two most common suicide methods reported, in that order. Hanging followed by poisoning were the commonest suicide methods in Bangladesh, India, and Pakistan while in Sri Lanka, poisoning was the preferred method to hanging. There is a decline in suicide by poisoning and an increase in suicide by hanging in Sri Lanka, Bangladesh, and India. Although hanging is still the commonest method in Pakistan, the use of firearms is growing in recent years (2011-2020).

CONCLUSIONS

There is a steady decline in the incidence of suicides by poisoning following pesticide regulations in South Asian countries. However, there is heterogeneity of study methods, probable under-reporting of suicide, and lack of robust suicide data.

Progress on the national action plan of Pakistan on antimicrobial resistance (AMR): a narrative review and the implications

Introduction: The emergence of antimicrobial resistance (AMR) is a threat to public health. In 2015, the World Health Organization (WHO) introduced a global action plan to tackle AMR in the World Health Assembly. Pakistan's national action plan (NAP) for AMR was released in May 2017 by the Ministry of National Health Services. Based on the NAP, strategies have been initiated on a national and provincial scale in Pakistan.Areas covered: This narrative review of the five components of the Pakistan NAP has been undertaken to discuss some of the challenges in implementation of the NAP for AMR in Pakistan including different opinions and views of key stakeholders, combined with suggestions on potential ways to reduce the burden of the AMR.Expert opinion: Going forward, healthcare authorities should focus on screening and monitoring of all the objectives of the NAP by establishing proper policies as well as promoting antimicrobial stewardship interventions and Infection prevention and control (IPC) practices. Overall, the comprehensive strengthening of the healthcare system is required to adequately implement the NAP, tackle continued inappropriate antimicrobial use and high AMR rates in Pakistan.

Dispensing of Non-Prescribed Antibiotics from Community Pharmacies of Pakistan: A Cross-Sectional Survey of Pharmacy Staff's Opinion

Community pharmacies are the main channel of antibiotics distribution. We aimed to analyze the dispensing of non-prescribed antibiotics and knowledge of pharmacy staff. We conducted a cross-sectional study in Punjab, Pakistan between December 2017 and March 2018. A self-administered, structured, pretested, and validated bilingual questionnaire was used, and we used chi-square tests in the statistical analysis. A total of 573 (91.7%) pharmacy retailers responded to the survey; 44.0% were aged 31-40 years and all were men. Approximately 81.5% of participants declared that dispensing non-prescribed antibiotics is a common practice in community pharmacies, and 51.1% considered themselves to be authorized to dispense these drugs; 69.3% believed this a contributing factor to antimicrobial resistance. Most (79.1%) respondents believed that this practice promotes irrational antibiotics use, and half (52.2%) considered antimicrobial resistance to be a public health issue. Only 34.5% of respondents reported recommending that patients consult with a doctor prior to using antibiotics, and 61.8% perceived that their dispensing practices reduce patients' economic burden. Approximately 44.9% of pharmacy retailers stated that they have proper knowledge about antibiotics use. Nitroimidazole was the main class of antibiotic dispensed without a prescription. Dispensing of injectable and broad-spectrum antibiotics can be potential threat for infection cure. Poor knowledge of staff is associated with dispensing of non-prescribed antibiotics. This inappropriate practice must be addressed immediately.

Self-medication practices in riverside communities in the Brazilian Amazon Rainforest

OBJECTIVES

to analyze the practice of self-medication and the associated factors in the riverside population of the Middle Solimões river region - Amazon rainforest.

METHODS

a cross-sectional population-based study conducted between April and July 2015, through interviews at home.

RESULTS

the prevalence of self-medication among the riverside population was 76.3%. Analgesics and antibacterials were the main therapeutic classes used in self-medication. Self-medication proved to be associated with the male gender, young people, not having sought the health service in the last month, longer commuting from the community to the urban area and the habit of consuming allopathic medicines on their own.

CONCLUSIONS

self-medication among the riverside population of Coari - Amazon may reflect the need to seek self-care by people, with the use of allopathic medicines without prescription, mainly due to the restricted access to health services.

A comparison of the frequency, risk factors, and type of self-medication in pregnant and nonpregnant women presenting to Shahid Akbar Abadi Teaching Hospital in Tehran

Background

Self-medication is a serious health problem that leads to an increased per capita consumption of medications, drug resistance, lack of optimal treatment, drug poisoning, and other unwanted complications. This study was conducted to compare self-medication in pregnant and nonpregnant women presenting to Shahid Akbar Abadi Teaching Hospital in Tehran, Iran.

Materials and Methods

To conduct this cross-sectional study, 210 pregnant women and 210 nonpregnant women aged 15-45 years presenting to Shahid Akbar Abadi Teaching Hospital, Tehran, Iran, were selected through random sampling. Data were collected through interviews using a semi-structured questionnaire. The Chi-square test, t-test, and logistic regression model were used to analyze the data.

Results

The prevalence of self-medication was 34.8% in the pregnant and 77.1% in the nonpregnant women. The age group in which the most frequent instances of self-medication were observed (53.4%) was the 21-30 age group in the pregnant women and the 31-40 age group (44.4%) in the nonpregnant women, suggesting a statistically significant intergroup difference in terms of age (P = 0.0001). Medicinal plants were the most common medications used by the pregnant women (19.6%) and synthetic medications were the most common used by the nonpregnant women (38.1%). The reasons for using medications without a prescription included believing in the illness being mild (22.8%), not having health insurance (9%), easy access in the pregnant women, a previous history of the illness, and easy access in the nonpregnant women.

Conclusions

As medicinal plants are the most common medications used by pregnant women and since assessing the risk of herbal substances is difficult, pregnant women should be advised against the arbitrary use of these substances.

Frequency of use of non-prescribed medication among population sample from Al Madina City and its impact on quality of care in Saudi Arabia

OBJECTIVE

Self-medication can be defined as the practice of using drugs that have not been prescribed, recommended, or controlled by a certified health-care professional. This term can be used when discussing patients who use non-prescription medications to treat self-diagnosed disorders or symptoms, without consulting a medical practitioner and without any medical supervision. The objectives of this study are to identify patterns of self-medication in Saudi Arabia, to measure the association between gender and the use of non-prescribed medication, and to identify the type of medications involved, the dosages used, and patient's sources of knowledge regarding the types, and doses of medications.

METHOD

Cross-section analytical observational study, conducted in Al Medina city, Saudi Arabia, over 6 months using a pretested self-administered questionnaire using a convenience sampling technique.

RESULTS

With a response rate of 68.8%, it was found that 72.5% reported the use of non-prescribed medication and 24.3% reported a history of experiencing side effects from using non-prescribed medication with no significant difference between male and female. 81% were keen to read the medication instruction with higher response among females.Analgesics were the most common type of medication used with an 86.5% agreement with no statistical significant differences between male and females.

CONCLUSION

The study found heavy use of non-prescribed medication among the Al Medina residents sampled. This suggests a need for specialist training programs that could be directed at pharmacists, to help them disseminate information on the safe use of OTC or non-prescribed medications.

Stunting and its determinant factors among children aged 6-59 months in Ethiopia

Background

Though Ethiopia has implemented different nutritional interventions, childhood stunting on which literature is limited continues as a severe public health problem. Thus, this study aimed to investigate stunting and its determinants among children aged 6–59 months in the predominantly rural northwest Ethiopia.

Methods

A community based cross-sectional study was conducted from May to June 2015 at Dabat Health and Demographic Surveillance System (HDSS) site. A total of 1295 mother-child pairs were included for analysis. An ordinal multivariable logistic regression analysis was carried out to identify the determinants of severe stunting. To show the strength of associations, both Crude Odds Ratio (COR) and Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) were estimated. Also, a P-value of <0.05 was used to declare statistical significance in the final model.

Results

The overall prevalence of stunting among children aged 6–59 months was 64.5%, of which about 37.7% and 26.8% were moderately and severely stunted, respectively. Farming occupation of mother [AOR = 1.45; 95% CI: 1.08, 1.93], lack of postnatal vitamin-A supplementation [AOR = 1.54; 95%: 1.19, 2.00], poorer household wealth status [AOR = 2.07; CI: 1.56, 2.75] and accessing family food from farms [AOR = 1.44; 95% CI: 1.09, 1.89] were identified as the key determinants of severe stunting.

Conclusion

In the district, the magnitude of stunting was a critical public health concern. Therefore, emphasis should be given to improving mothers’ postnatal vitamin A supplementation coverage and building knowledge about appropriate child feeding practices among farmer mothers and poorer households.

Getting started with tables

Background

Tables are often overlooked by many readers of papers who tend to focus on the text. Good tables tell much of the story of a paper and give a richer insight into the details of the study participants and the main research findings. Being confident in reading tables and constructing clear tables are important skills for researchers to master.

Method

Common forms of tables were considered, along with the standard statistics used in them. Papers in the Archives of Public Health published during 2015 and 2016 were hand-searched for examples to illustrate the points being made. Presentation of graphs and figures were not considered as they are outside the scope of the paper.

Results

Basic statistical concepts are outlined to aid understanding of each of the tables presented. The first table in many papers gives an overview of the study population and its characteristics, usually giving numbers and percentages of the study population in different categories (e.g. by sex, educational attainment, smoking status) and summaries of measured characteristics (continuous variables) of the participants (e.g. age, height, body mass index). Tables giving the results of the analyses follow; these often include summaries of characteristics in different groups of participants, as well as relationships between the outcome under study and the exposure of interest. For continuous outcome data, results are often expressed as differences between means, or regression or correlation coefficients. Ratio/relative measures (e.g. relative risks, odds ratios) are usually used for binary outcome measures that take one of two values for each study participants (e.g. dead versus alive, obese versus non-obese). Tables come in many forms, but various standard types are described here.

Conclusion

Clear tables provide much of the important detail in a paper and researchers are encouraged to read and construct them with care.