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Sunuwar DR, Singh DR, Pradhan PMS, Shrestha V, Rai P, Shah SK, Adhikari B. Factors associated with anemia among children in South and Southeast Asia: a multilevel analysis. BMC Public Health 2023; 23:343. [PMID: 36793012 PMCID: PMC9933407 DOI: 10.1186/s12889-023-15265-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND South and Southeast Asian countries (SSEA) account for the highest burden of anemia globally, nonetheless, progress towards the decline of anemia has almost been stalled. This study aimed to explore the individual and community- level factors associated with childhood anemia across the six selected SSEA countries. METHODS Demographic and Health Surveys of SSEA countries (Bangladesh, Cambodia, India, Maldives, Myanmar, and Nepal) conducted between 2011 and 2016 were analyzed. A total of 167,017 children aged 6-59 months were included in the analysis. Multivariable multilevel logistic regression analysis was used to identify independent predictors of anemia. RESULTS The combined prevalence of childhood anemia across six SSEA countries was 57.3% (95% CI: 56.9-57.7%). At the individual level, childhood anemia was significantly higher among (1) mothers with anemia compared to non-anemic mothers (Bangladesh: aOR = 1.66, Cambodia: aOR = 1.56, India: aOR = 1.62, Maldives: aOR = 1.44, Myanmar: aOR = 1.59, and Nepal: aOR = 1.71); (2) children with a history of fever in the last two weeks compared to those without a history of fever (Cambodia: aOR = 1.29, India: aOR = 1.03, Myanmar: aOR = 1.08), and; (3) stunted children compared to those who were not (Bangladesh: aOR = 1.33, Cambodia: aOR = 1.42, India: aOR = 1.29, and Nepal: aOR = 1.27). In terms of community-level factors, children with mothers in communities with a high percentage of community maternal anemia had higher odds of childhood anemia in all countries (Bangladesh: aOR = 1.21, Cambodia: aOR = 1.31, India: aOR = 1.72, Maldives: aOR = 1.35, Myanmar: aOR = 1.33, and Nepal: aOR = 1.72). CONCLUSION Children with anemic mothers and stunted growth were found vulnerable to developing childhood anemia. Individual and community-level factors identified in this study can be considered to develop effective anemia control and prevention strategies.
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Affiliation(s)
- Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Nepal Armed Police Force Hospital, Kathmandu, Nepal.
| | - Devendra Raj Singh
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
- Research and Innovation Section, Southeast Asia Development Action Network (SADAN), Lalitpur, Nepal
| | - Pranil Man Singh Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Nepalese Society of Community Medicine, Kathmandu, Nepal
| | | | - Pushpa Rai
- Department of Nursing, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal
| | - Sunil Kumar Shah
- Public Health and Nutrition Section, Bagmati Welfare Society Nepal, Sarlahi, Nepal
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Adhikari B, Mishra SR, Schwarz R. Transforming Nepal's primary health care delivery system in global health era: addressing historical and current implementation challenges. Global Health 2022; 18:8. [PMID: 35101073 PMCID: PMC8802254 DOI: 10.1186/s12992-022-00798-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/08/2022] [Indexed: 02/07/2023] Open
Abstract
Nepal’s Primary Health Care (PHC) is aligned vertically with disease control programs at the core and a vast network of community health workers at the periphery. Aligning with the globalization of health and the factors affecting global burden of diseases, Nepal echoes the progressive increase in life expectancy, changes in diseases patterns, including the current impact of COVID-19. Nepal’s health system is also accommodating recent federalization, and thus it is critical to explore how the primary health care system is grappling the challenges amidst these changes. In this review, we conducted a narrative synthesis of literature to explore the challenges related to transformation of Nepal’s primary health care delivery system to meet the demands incurred by impact of globalization and recent federalization, covering following database: PubMED, Embase and Google Scholar. Of the 49 articles abstracted for full text review, 37 were included in the analyses. Existing theories were used for constructing the conceptual framework to explain the study findings. The results are divided into four themes. Additional searches were conducted to further support the narrative synthesis: a total of 46 articles were further included in the articulation of main findings. Transforming Nepal’s primary health care system requires a clear focus on following priority areas that include i) Revised efforts towards strengthening of community based primary health care units; ii) Adapting vertical programs to federal governance; iii) Reinforcing the health insurance scheme; and iv) Strengthening an existing network of community health workers and health human resources. This review discusses how these broad goals bear challenges and opportunities.
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Affiliation(s)
- Bipin Adhikari
- Nepal Community Health and Development Centre, Kathmandu, Nepal. .,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | | | - Ryan Schwarz
- Possible, New York, NY, USA.,Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA.,Harvard Medical School, Department of Medicine, Boston, MA, USA
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Adhikari B, Pokharel S, Raut S, Adhikari J, Thapa S, Paudel K, G C N, Neupane S, Neupane SR, Yadav R, Shrestha S, Rijal KR, Marahatta SB, Cheah PY, Pell C. Why do people purchase antibiotics over-the-counter? A qualitative study with patients, clinicians and dispensers in central, eastern and western Nepal. BMJ Glob Health 2021; 6:bmjgh-2021-005829. [PMID: 33975888 PMCID: PMC8118002 DOI: 10.1136/bmjgh-2021-005829] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Over-the-counter (OTC) use of antibiotics contributes to the burgeoning rise in antimicrobial resistance (AMR). Drawing on qualitative research methods, this article explores the characteristics of OTC sales of antibiotic in Nepal, its drivers and implications for policy. Methods Data were collected in and around three tertiary hospitals in eastern, western and central Nepal. Using pre-defined guides, a mix of semi-structured interviews and focus group discussions were conducted with dispensers at drug stores, patients attending a hospital and clinicians. Interviews were audio-recorded, translated and transcribed into English and coded using a combination of an inductive and deductive approach. Results Drug shops were the primary location where patients engaged with health services. Interactions were brief and transactional: symptoms were described or explicit requests for specific medicine made, and money was exchanged. There were economic incentives for clients and drug stores: patients were able to save money by bypassing the formal healthcare services. Clinicians described antibiotics as easily available OTC at drug shops. Dispensing included the empirical use of broad-spectrum antibiotics, often combining multiple antibiotics, without laboratory diagnostic and drug susceptibility testing. Inappropriately short regimens (2–3 days) were also offered without follow-up. Respondents viewed OTC antibiotic as a convenient alternative to formal healthcare, the access to which was influenced by distance, time and money. Respondents also described the complexities of navigating various departments in hospitals and little confidence in the quality of formal healthcare. Clinicians and a few dispensers expressed concerns about AMR and referred to evadable policies around antibiotics use and poor enforcement of regulation. Conclusions The findings point to the need for clear policy guidance and rigorous implementation of prescription-only antibiotics.
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Affiliation(s)
- Bipin Adhikari
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sunil Pokharel
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Shristi Raut
- Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal
| | | | - Suman Thapa
- Patan Academy of Health Sciences, Patan, Nepal
| | - Kumar Paudel
- Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal
| | - Narayan G C
- Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal
| | - Sandesh Neupane
- Country Coordinating Mechanism, The Global Fund, Ministry of Health and Population, Kathmandu, Nepal
| | | | - Rakesh Yadav
- Nepal Public Health Research & Development Centre, Kathmandu, Nepal
| | - Sirapa Shrestha
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Nepal
| | | | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christopher Pell
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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Parikh P, Diep L, Hofmann P, Tomei J, Campos LC, Teh TH, Mulugetta Y, Milligan B, Lakhanpaul M. Synergies and trade-offs between sanitation and the sustainable development goals. UCL OPEN ENVIRONMENT 2021; 3:e016. [PMID: 37228800 PMCID: PMC10208324 DOI: 10.14324/111.444/ucloe.000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/18/2021] [Indexed: 05/27/2023]
Abstract
To better leverage opportunities arising out of sustainable and inclusive management of sanitation services there is a need for robust and comprehensive evidence of the wide-ranging benefits that sanitation can deliver. The Sustainable Development Goals (SDGs) provide a comprehensive framework for sustainable development broken down into 169 interconnected Targets which are articulated under 17 Goals. Based on a methodology developed at University College London (UCL), this study identifies linkages between sanitation and the 169 Targets corroborated by published evidence. We show that there are synergies between sanitation and all 17 Goals and 130 (77%) of the Targets, and trade-offs for 28 (17%) of the Targets. We identified 83 Targets (49%) that call for action in the sanitation sector. The results demonstrate the far-reaching benefits that can be unlocked from investment in sanitation, which extend beyond health and spread across sectors. The evidence base for the 17 Goals establishes links that can inform cross-sectoral action, collaborations and investment across governance levels for integrated sanitation solutions. The research provides different stakeholders with a framework that can be applied to context-specific cases and projects. We propose a range of recommendations to policy makers, practitioners and researchers who seek to take this study further to help achieve the SDGs.
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Affiliation(s)
- Priti Parikh
- Engineering for International Development Centre, Bartlett School of Construction Project Management, University College London, 1–19 Torrington Place, London WC1E 7HB, UK
| | - Loan Diep
- Engineering for International Development Centre, Bartlett School of Construction Project Management, University College London, 1–19 Torrington Place, London WC1E 7HB, UK
| | - Pascale Hofmann
- Environmental and Sustainable Development, The Bartlett Development Planning Unit, University College London, 34 Tavistock Square, London WC1H 9EZ, UK
| | - Julia Tomei
- Energy, Resources and Development, UCL Institute for Sustainable Resources, 14 Upper Woburn Place, London WC1H 0NN, UK
| | - Luiza C. Campos
- Environmental Engineering, Centre for Urban Sustainability and Resilience, Civil, Environmental and Geomatic Engineering, University College London, Chadwick Building, London WC1E 6BT, UK
| | - Tse-Hui Teh
- The Bartlett School of Planning, Central House, 14 Upper Woburn Place, London WC1H 0NN, UK
| | - Yacob Mulugetta
- Energy and Development Policy, UCL Department of Science, Technology, Engineering & Public Policy (STEaPP), Shropshire House (4th Fl), 11–20 Caper Street, London WC1E 6JA, UK
| | - Ben Milligan
- Sustainable Development Law and Policy, University of New South Wales, Sydney, NSW 2052, Australia
| | - Monica Lakhanpaul
- Integrated Community Child Health, Population, Policy & Practice Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
- Whittington NHS Trust, Magdala Ave, London N19 5NF, London, UK
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Adhikari B, Ozaki A, Marahatta SB, Rijal KR, Mishra SR. Earthquake rebuilding and response to COVID-19 in Nepal, a country nestled in multiple crises. J Glob Health 2020; 10:020367. [PMID: 33110561 PMCID: PMC7567410 DOI: 10.7189/jogh.10.020367] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Sujan Babu Marahatta
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal.,Nepal Open University, Lalitpur, Nepal
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
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Lack of Safe Drinking Water for Lake Chapala Basin Communities in Mexico Inhibits Progress toward Sustainable Development Goals 3 and 6. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228328. [PMID: 33187103 PMCID: PMC7697277 DOI: 10.3390/ijerph17228328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/29/2020] [Accepted: 11/08/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Access to safe, affordable and accessible drinking water is a human right and foundational to the third and sixth World Health Organization's Sustainable Development Goals (SDGs). Unsafe drinking water is a risk factor for chronic and enteric diseases. Both chronic kidney disease (CKD) and diarrheal disease are highly prevalent in the Lake Chapala basin, Jalisco, Mexico, suggesting disparities in factors leading to successful achievement of these two SDGs. METHODS This study aimed to assess progress towards SDG three and six in the Lake Chapala basin. Qualitative, quantitative, and geospatial data were collected between May and August of 2019 from three towns within the municipalities of Poncitlán and Chapala. RESULTS Ninety-nine households participated in this study. Water sampling analyses determined 81.18% of samples from water jugs (garrafones) and 70.05% of samples from tap water were contaminated with total coliform bacteria, often including E. coli. Additionally, 32% of garrafón samples and 61.9% of tap water samples had detectable levels of arsenic. Approximately 97.94% of respondents stated that they believe clean water is a human right, but 78.57% feel the Mexican government does not do enough to make this a reality. CONCLUSIONS This mixed methods approach highlights water quality as a serious issue in communities around Lake Chapala, and demonstrates inadequate drinking water as a key hazard, potentially perpetuating the high disease burden of both CKD and enteric disease in the region.
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Faust L, Klowak M, MacRae C, Kopalakrishnan S, Showler AJ, Boggild AK. Ofloxacin-Containing Multidrug Therapy in Ambulatory Leprosy Patients: A Case Series. J Cutan Med Surg 2020; 25:45-52. [PMID: 32869655 DOI: 10.1177/1203475420952437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Standard dapsone and clofazimine-containing multidrug therapy (MDT) for leprosy is limited by drug tolerability, which poses treatment adherence barriers. Although ofloxacin-based regimens are promising alternatives, current efficacy and safety data are limited, particularly outside of endemic areas. We evaluated treatment outcomes in patients with leprosy receiving ofloxacin-containing MDT (OMDT) at our center. METHODS We performed a retrospective chart review of patients treated for leprosy at our center over an 8-year period (2011-2019). Primary outcomes evaluated were clinical cure rate, occurrence of leprosy reactions, antibiotic-related adverse events, and treatment adherence. Analyses were descriptive; however, data were stratified by age, sex, spectrum of disease, region of origin, and treatment regimen, and odds ratios were reported to assess associations with adverse outcomes. RESULTS Over the enrolment period, 26 patients were treated with OMDT (n = 19 multibacillary, n = 7 paucibacillary), and none were treated with clofazimine-based standard MDT. At the time of analysis, 23 patients (88%) had completed their course of treatment, and all were clinically cured, while 3 (12%) were still on treatment. Eighteen patients (69%) experienced either ENL (n = 7, 27%), type 1 reactions (n = 7, 27%), or both (n = 4, 15%). No patients stopped ofloxacin due to adverse drug effects, and there were no cases of allergic hypersensitivity, tendinopathy or rupture, or C. difficile colitis. CONCLUSIONS We demonstrate a high cure rate and tolerability of OMDT in this small case series over an 8-year period, suggesting its viability as an alternative to standard clofazimine-containing MDT.
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Affiliation(s)
- Lena Faust
- 5620 McGill International TB Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Michael Klowak
- 7938 Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Cara MacRae
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Adrienne J Showler
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,8368 Division of Infectious Diseases, Georgetown University, Washington, DC, USA
| | - Andrea K Boggild
- Tropical Disease Unit, Toronto General Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Reed SL, McKerrow JH. Why Funding for Neglected Tropical Diseases Should Be a Global Priority. Clin Infect Dis 2019; 67:323-326. [PMID: 29688342 DOI: 10.1093/cid/ciy349] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/19/2018] [Indexed: 01/01/2023] Open
Abstract
Neglected tropical diseases affect >1 billion of the world's poorest persons. Control programs range from near-elimination (dracunculiasis) to increasing prevalence (dengue and cutaneous leishmaniasis). These are some of the most cost-effective public health interventions and should be a global priority.
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Affiliation(s)
- Sharon L Reed
- Departments of Pathology and Medicine, UC San Diego Health
| | - James H McKerrow
- Skaggs School of Pharmacy and Pharmaceutical Science, University of California, San Diego
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