1
|
Choy CC, Simi S, Soti-Ulberg C, Naseri T, Salinas YD, Hawley NL. Noncommunicable disease risk behaviors and protective factors among children in Samoa: Retrospective trend analysis of global school-based health surveys in 2011 and 2017. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003315. [PMID: 38861507 PMCID: PMC11166286 DOI: 10.1371/journal.pgph.0003315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/16/2024] [Indexed: 06/13/2024]
Abstract
Pacific Island countries experience a high prevalence of noncommunicable diseases (NCDs), which may be prevented by reducing risk behaviors and strengthening protective factors in childhood and adolescence. To better inform preventative interventions, our objective was to use publicly available data from the Global School-based Student Health Survey (GSHS), to provide cross-sectional and trend estimates for the prevalence of NCD risk and protective factors among school-aged children in 2011 and 2017 in Samoa. Two waves of cross-sectional data included 4,373 children (51.98% female), with a median age of 15 years, who were mainly in school years 9-10 in Samoa. Retrospective analyses were adjusted for the GSHS multistage stratified cluster sample design. Weighted prevalences of overweight/obesity, dietary behaviors, physical activity, and sedentary behavior, oral and hand hygiene, emotional and mental health, and community protective factors were reported by study year. Logistic regressions were fitted to assess differences in the prevalence of risk and protective factors, adjusted for age group, sex, and school year. In 2011 and 2017, the prevalence of overweight/obesity remained consistently high in females (59.12% and 64.29%, p = 0.428) and increased from 44.21% to 53.65% in males (p = 0.039). Time spent sitting for long periods, smoking cigarettes, using other tobacco products, and drinking alcohol were lower in 2017 compared to 2011 (all p<0.05). Many children reported experiencing bullying (33.27% for females and 59.30% for males in 2017), while physical fighting was common among males (73.72% in 2011 and 57.28% in 2017). The high prevalence of obesity and related NCD risk factors require urgent public health action in Samoa. Alongside the continued reduction of tobacco and alcohol use, emotional and mental wellness should be prioritized in interventions and programs to promote healthy behaviors and lifestyle changes starting in childhood.
Collapse
Affiliation(s)
- Courtney C. Choy
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | | | - Take Naseri
- Ministry of Health, Motootua, Apia, Samoa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Yasmmyn D. Salinas
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| |
Collapse
|
2
|
Hon KY, McMillan N, Fitridge RA. Gap analysis of diabetes-related foot disease management systems in Pacific Islands Countries and Territories. BMC Health Serv Res 2024; 24:324. [PMID: 38468255 PMCID: PMC10929083 DOI: 10.1186/s12913-024-10768-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/21/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Pacific Island Countries and Territories (PICTs) are known to have high prevalence of Diabetes Mellitus and high incidence of diabetes-related foot disease. Diabetes-related foot disease can lead to lower limb amputation and is associated with poor outcomes, with increased morbidity and mortality. The purpose of this study was to gain a better understanding of diabetes-related foot disease management in selected countries in PICTs and to identify potential barriers in management of diabetes-related foot disease management in the region. METHODS A cross-sectional survey was sent to eleven hospitals across six selected PICTs. The survey instrument was designed to provide an overview of diabetes-related foot disease (number of admissions, and number of lower limb amputations over 12 months) and to identify clinical services available within each institution. Two open-ended questions (free text responses) were included in the instrument to explore initiatives that have helped to improve management and treatment of diabetes-related foot diseases, as well as obstacles that clinicians have encountered in management of diabetes-related foot disease. The survey was conducted over 6 weeks. RESULTS Seven hospitals across four countries provided responses. Number of admissions and amputations related to diabetes-related foot disease were only reported as an estimate by clinicians. Diabetes-related foot disease was managed primarily by general medicine physician, general surgeon and/or orthopaedic surgeon in the hospitals surveyed, as there were no subspecialty services in the region. Only one hospital had access to outpatient podiatry. Common themes identified around barriers faced in management of diabetes-related foot disease by clinicians were broadly centred around resource availability, awareness and education, and professional development. CONCLUSION Despite the high prevalence of diabetes-related foot disease within PICTs, there appears to be a lack of functional multi-disciplinary foot services (MDFs). To improve the outcomes for diabetes-related foot disease patients in the region, there is a need to establish functional MDFs and engage international stakeholders to provide ongoing supports in the form of education, mentoring, as well as physical resources.
Collapse
Affiliation(s)
- Kay Y Hon
- Discipline of Surgical Specialties, The University of Adelaide, Adelaide, SA, Australia.
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, 1 Port Road, Adelaide, SA, Australia.
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA, Australia.
| | - Neil McMillan
- Discipline of Surgical Specialties, The University of Adelaide, Adelaide, SA, Australia
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, 1 Port Road, Adelaide, SA, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Robert A Fitridge
- Discipline of Surgical Specialties, The University of Adelaide, Adelaide, SA, Australia
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, 1 Port Road, Adelaide, SA, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| |
Collapse
|
3
|
You J, Guo Y, Zhang Y, Kang JJ, Wang LB, Feng JF, Cheng W, Yu JT. Plasma proteomic profiles predict individual future health risk. Nat Commun 2023; 14:7817. [PMID: 38016990 PMCID: PMC10684756 DOI: 10.1038/s41467-023-43575-7] [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: 06/16/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
Developing a single-domain assay to identify individuals at high risk of future events is a priority for multi-disease and mortality prevention. By training a neural network, we developed a disease/mortality-specific proteomic risk score (ProRS) based on 1461 Olink plasma proteins measured in 52,006 UK Biobank participants. This integrative score markedly stratified the risk for 45 common conditions, including infectious, hematological, endocrine, psychiatric, neurological, sensory, circulatory, respiratory, digestive, cutaneous, musculoskeletal, and genitourinary diseases, cancers, and mortality. The discriminations witnessed high accuracies achieved by ProRS for 10 endpoints (e.g., cancer, dementia, and death), with C-indexes exceeding 0.80. Notably, ProRS produced much better or equivalent predictive performance than established clinical indicators for almost all endpoints. Incorporating clinical predictors with ProRS enhanced predictive power for most endpoints, but this combination only exhibited limited improvement when compared to ProRS alone. Some proteins, e.g., GDF15, exhibited important discriminative values for various diseases. We also showed that the good discriminative performance observed could be largely translated into practical clinical utility. Taken together, proteomic profiles may serve as a replacement for complex laboratory tests or clinical measures to refine the comprehensive risk assessments of multiple diseases and mortalities simultaneously. Our models were internally validated in the UK Biobank; thus, further independent external validations are necessary to confirm our findings before application in clinical settings.
Collapse
Affiliation(s)
- Jia You
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, Institute of Science and Technology for Brain-Inspired Intelligence, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Yu Guo
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, Institute of Science and Technology for Brain-Inspired Intelligence, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Yi Zhang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, Institute of Science and Technology for Brain-Inspired Intelligence, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Ju-Jiao Kang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, Institute of Science and Technology for Brain-Inspired Intelligence, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Lin-Bo Wang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, Institute of Science and Technology for Brain-Inspired Intelligence, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Jian-Feng Feng
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, Institute of Science and Technology for Brain-Inspired Intelligence, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China.
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China.
- Zhangjiang Fudan International Innovation Center, Shanghai, China.
- School of Data Science, Fudan University, Shanghai, China.
- Fudan ISTBI-ZJNU Algorithm Centre for Brain-inspired Intelligence, Zhejiang Normal University, Zhejiang, China.
| | - Wei Cheng
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, Institute of Science and Technology for Brain-Inspired Intelligence, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China.
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China.
- Fudan ISTBI-ZJNU Algorithm Centre for Brain-inspired Intelligence, Zhejiang Normal University, Zhejiang, China.
- Shanghai Medical College and Zhongshan Hospital Immunotherapy Technology Transfer Center, Shanghai, China.
| | - Jin-Tai Yu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, Institute of Science and Technology for Brain-Inspired Intelligence, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China.
| |
Collapse
|
4
|
Sivapragasam N, Matchar DB, Chhoun P, Kol H, Loun C, Islam AM, Ansah J, Yi S. Developing a toolkit for implementing evidence-based guidelines to manage hypertension and diabetes in Cambodia: a descriptive case study. Health Res Policy Syst 2022; 20:109. [PMID: 36443781 PMCID: PMC9706829 DOI: 10.1186/s12961-022-00912-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In Cambodia, economic development accompanied by health reforms has led to a rapidly ageing population and an increasing incidence and prevalence of noncommunicable diseases. National strategic plans recognize primary care health centres as the focal points of care for treating and managing chronic conditions, particularly hypertension and type 2 diabetes. However, health centres have limited experience in providing such services. This case study describes the process of developing a toolkit to facilitate the use of evidence-based guidelines to manage hypertension and type 2 diabetes at the health-centre level. METHODS We developed and revised a preliminary toolkit based on the feedback received from key stakeholders. We gathered feedback through an iterative process of group and one-to-one consultations with representatives of the Ministry of Health, provincial health department, health centres and nongovernmental organizations between April 2019 and March 2021. RESULTS A toolkit was developed and organized according to the core tasks required to treat and manage hypertension and type 2 diabetes patients. The main tools included patient identification and treatment cards, risk screening forms, a treatment flowchart, referral forms, and patient education material on risk factors and lifestyle recommendations on diet, exercise, and smoking cessation. The toolkit supplements existing guidelines by incorporating context-specific features, including drug availability and the types of medication and dosage guidelines recommended by the Ministry of Health. Referral forms can be extended to incorporate engagement with community health workers and patient education material adapted to the local context. All tools were translated into Khmer and can be modified as needed based on available resources and arrangements with other institutions. CONCLUSIONS Our study demonstrates how a toolkit can be developed through iterative engagement with relevant stakeholders individually and in groups to support the implementation of evidence-based guidelines. Such toolkits can help strengthen the function and capacity of the primary care system to provide care for noncommunicable diseases, serving as the first step towards developing a more comprehensive and sustainable health system in the context of population ageing and caring for patients with chronic diseases.
Collapse
Affiliation(s)
- Nirmali Sivapragasam
- grid.428397.30000 0004 0385 0924Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - David B. Matchar
- grid.428397.30000 0004 0385 0924Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore ,grid.26009.3d0000 0004 1936 7961Duke University Medical Center, Duke University, Durham, NC United States of America
| | - Pheak Chhoun
- grid.513124.00000 0005 0265 4996KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Hero Kol
- grid.415732.6Department of Preventive Medicine, Ministry of Health, Phnom Penh, Cambodia
| | - Chhun Loun
- grid.415732.6Department of Preventive Medicine, Ministry of Health, Phnom Penh, Cambodia
| | - Amina Mahmood Islam
- grid.428397.30000 0004 0385 0924Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - John Ansah
- grid.428397.30000 0004 0385 0924Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore ,grid.67105.350000 0001 2164 3847Case Western Reserve University, Cleveland, OH United States of America
| | - Siyan Yi
- grid.513124.00000 0005 0265 4996KHANA Center for Population Health Research, Phnom Penh, Cambodia ,grid.265117.60000 0004 0623 6962Center for Global Health Research, Touro University California, Vallejo, CA United States of America ,grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| |
Collapse
|
5
|
Saif-Ur-Rahman K, Sultana S, Afrin S, Islam K. Participatory approaches in primary health care related implementation research in low-and middle-income countries: A narrative review. PUBLIC HEALTH IN PRACTICE 2022; 4:100344. [DOI: 10.1016/j.puhip.2022.100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/13/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
|
6
|
Arsyad DS, Hamsyah EF, Qalby N, Qanitha A, Westerink J, Cramer MJ, Visseren FLJ, Doevendans PA, Ansariadi A. The readiness of public primary health care (PUSKESMAS) for cardiovascular services in Makasar city, Indonesia. BMC Health Serv Res 2022; 22:1112. [PMID: 36050732 PMCID: PMC9436735 DOI: 10.1186/s12913-022-08499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022] Open
Abstract
Backgrounds The increasing burden of cardiovascular disease (CVD) has become a major challenge globally, including in Indonesia. Understanding the readiness of primary health care facilities is necessary to confront the challenge of providing access to quality CVD health care services. Our study aimed to provide information regarding readiness to deliver CVD health services in public primary health care namely Puskesmas. Methods The study questionnaire was adapted from the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA), modified based on the package of essentials for non-communicable disease (PEN) and the Indonesian Ministry of health regulation. Data were collected from all Puskesmas facilities (N = 47) located in Makassar city. We analysed relevant data following the WHO-SARA manual to assess the readiness of Puskesmas to deliver CVD services. Human resources, diagnostic capacity, supporting equipment, essential medication, infrastructure and guidelines, and ambulatory services domain were assessed based on the availability of each tracer item in a particular domain. The mean domain score was calculated based on the availability of tracer items within each domain. Furthermore, the means of all domains’ scores are expressed as an overall readiness index. Higher scores indicate greater readiness of Puskesmas to deliver CVD-related health care. Results Puskesmas delivers health promotion, disease prevention, and prompt diagnosis for cardiovascular-related diseases, including hypertension, diabetes, coronary heart disease (CHD), and stroke. Meanwhile, basic treatments were observed in the majority of the Puskesmas. Long-term care for hypertension and diabetes patients and rehabilitation for CHD and stroke were only observed in a few Puskesmas. The readiness score of Puskesmas to deliver CVD health care ranged from 60 to 86 for. Furthermore, there were 11 Puskesmas (23.4%) with a score below 75, indicating a sub-optimal readiness for delivering CVD health services. A shortage of essential medicines and a low capacity for diagnostic testing were the most noticeable shortcomings leading to suboptimal readiness for high-quality CVD health services. Conclusion Close cooperation with the government and other related stakeholders is required to tackle the identified shortcomings, especially the continuous monitoring of adequate supplies of medicines and diagnostic tools to achieve better CVD care for patients in Indonesia. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08499-w.
Collapse
Affiliation(s)
- Dian Sidik Arsyad
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, 3584, CT, Utrecht, The Netherlands. .,Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia.
| | - Esliana Fitrida Hamsyah
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Nurul Qalby
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, 3584, CT, Utrecht, The Netherlands.,Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | | | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, 3584, CT, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ansariadi Ansariadi
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| |
Collapse
|
7
|
Jaiswal A, Selva Das PA, Singh G, Sathiyamoorthy R, Deori TJ, Dwarakanathan V, Malhotra S, Verma M, Goel S. Assessment of cardiovascular risk using WHO CVD risk prediction chart with respect to hypertension status among Indian population: A secondary analysis of National Family Health Survey (2015-16). J Family Med Prim Care 2022; 11:5757-5765. [PMID: 36505633 PMCID: PMC9731046 DOI: 10.4103/jfmpc.jfmpc_158_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/05/2022] [Accepted: 03/08/2022] [Indexed: 11/07/2022] Open
Abstract
Background Hypertension, is a crucial risk factor for the development of cardiovascular disease (CVD). Studies assessing the risk of developing CVD among high-risk groups like hypertensives is limited. Aim The purpose of this study was to find the distribution of CVD risk with respect to hypertension status among Indian adults. Material and Methods This was a secondary data analysis of NFHS-4 survey data. The distribution of CVD risk among hypertensive participants using 2019 WHO CVD risk prediction charts was compared with normotensive participants among women aged 40-49 years and men in the age group of 40-54 years. Results The proportion of hypertension was higher among women who consumed alcohol (31.5%) than those who did not (24.3%). The proportion of hypertensives increased with increasing BMI, with maximum proportion among obese women (37.3%). Among women, majority (95.7%) had low CVD risk (<5%) while 4.2% had 5% to <10% CVD risk, and only 0.1% had >10% risk. Among men, those with low CVD risk (<5%) was 65%, those with 5% to <10% CVD risk was 32.3%, 10% to <20% was 2.7%, and a meagre 0.03% had 20 to <30% risk. Conclusion In the current study, prevalence of hypertension was seen to be increasing with age and was higher in urban residents than rural among both men and women. Both high blood pressure reading during the survey and self-reported hypertension was found to be higher among richest wealth index category. Although risk was higher among hypertensives, self-reported hypertensives who had their blood pressure controlled, had risk similar to normotensives indicating the importance of management of hypertension.
Collapse
Affiliation(s)
- Abhishek Jaiswal
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - P. Ananda Selva Das
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Singh
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
| | | | - Trideep Jyoti Deori
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vignesh Dwarakanathan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Malhotra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Madhur Verma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Sonu Goel, Professor of Health Management, Department of Community Medicine and School of Public Health Post Graduate Institute of Medical Education and Research, Chandigarh, India. Adjunct Clinical Associate Professor, Public Health Masters Program School of Medicine and Health Research Institute (HRI), University of Limerick, Ireland. E-mail:
| |
Collapse
|
8
|
Prevalence of Hypertension, Diabetes, and Other Cardiovascular Disease Risk Factors in Two Indigenous Municipalities in Rural Guatemala: A Population-Representative Survey. Glob Heart 2022; 17:82. [PMID: 36578912 PMCID: PMC9695220 DOI: 10.5334/gh.1171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Nearly 50% of Guatemalans are Indigenous Maya, yet few studies have examined the prevalence of modifiable cardiovascular disease (CVD) risk factors in Indigenous Maya populations. Therefore, we sought to estimate the prevalence of modifiable CVD risk factors in two Indigenous Maya areas in Guatemala. Methods We conducted, between June 2018 and October 2019, a population-representative survey of adults aged 18 years and older in two rural Indigenous Maya municipalities in Guatemala. Our primary outcomes were five modifiable CVD risk factors: diabetes, hypertension, obesity, smoking, and alcohol use. We estimated the crude and age-standardized prevalence of each outcome. We also constructed multivariable logistic regression models to assess prevalence over covariates including age, sex, education level, ethnicity, and poverty. Sampling weights adjusted for nonresponse, and appropriate survey commands were used in all analyses. Results The crude prevalence of diabetes was 12.5% (95% confidence Interval [CI] 9.6% to 16.1%), hypertension 20.3% (95% CI 17.1% to 23.9%), obesity 23.7% (95% CI 19.4% to 28.6%), smoking 10.7% (95% CI 7.8% to 14.5%), and high alcohol use 0.9% (95% CI 0.5% to 1.6%). Age-standardized prevalence of each outcome was similar to the crude prevalence. The prevalence of multiple CVD risk factors increased between the age groups 18-29 years and 50-59 years before decreasing among older age groups. Men had twenty-fold higher smoking prevalence than women (20.5% vs. 1.2%, respectively) and women had nearly double the age-adjusted prevalence of obesity as men (30.1% vs. 17.0%, respectively). Conclusion There is a substantial prevalence of modifiable CVD risk factors in rural, Indigenous populations in Guatemala, in particular hypertension, diabetes, obesity (among women), and smoking (among men). These findings can help catalyze policy and clinical investments to improve the prevention, management, and control of CVD risk factors in these historically marginalized communities.
Collapse
|
9
|
Albelbeisi AH, Albelbeisi A, El Bilbeisi AH, El Afifi A. Do Patients with Major Non-Communicable Diseases Receive Advice on Health Behaviors from Healthcare Professionals in the Gaza Strip, Palestine? Ethiop J Health Sci 2022; 32:45-54. [PMID: 35250216 PMCID: PMC8864399 DOI: 10.4314/ejhs.v32i1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/03/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND NCDs tend to be long-term and are caused by genetic, physiological, environmental, and behavioral factors. Currently, NCDs account for 71% of deaths globally. The current study aimed to explore whether patients with NCDs receive advice on health behaviors from healthcare professionals in the PHCs in the Gaza Strip, Palestine. METHODS This research applied a cross-sectional survey design in five PHCs from October 2019 to December 2019, with 360 patients selected using a convenience sampling technique. A structured questionnaire on sociodemographic, history and patients' views on receiving advice on health behaviors from health care professionals was developed and collected. Data were analyzed using descriptive analyses and a One-way ANOVA test through SPSS-v22. RESULTS The patients reported receiving advice as follows: in terms of regular physical activity (54.5% ±13.6), in terms of eating a heart-healthy diet (49.3% ±11.5), in terms of treatment adherence (86.1% ±8.1), and in terms of stop tobacco for smokers' patients (43.9% ±16.8). Statistically significant differences were found between the five Gaza strip governorates in terms of regular physical activity, eating heart-healthy, and treatment adherence (P values <.05 for all). CONCLUSION Participants claimed that the vast majority of them had received advice from healthcare professionals regarding attending regular follow-up and treatment adherence. In contrast, participants reported receiving advice from health care professionals regarding regular physical activity, eating a healthy diet, and stopping tobacco are suboptimal. There is a need to develop a strategy to ensure that healthcare professionals are committed to providing advice on health behaviors.
Collapse
Affiliation(s)
- Ahmed Hassan Albelbeisi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran, Medical Services Directorate, Gaza Strip, Palestine
| | - Ali Albelbeisi
- Department of Health Research, Ministry of Health, Palestine
| | - Abdel Hamid El Bilbeisi
- Department of Nutrition, School of Medicine and Health Sciences, University of Palestine, Gaza Strip, Palestine
| | - Amany El Afifi
- Faculty of Pharmacy, Al Azhar University of Gaza, Palestine
| |
Collapse
|
10
|
Fraser-Hurt N, Naseri LT, Thomsen R, Matalavea A, Ieremia-Faasili V, Reupena MS, Hawley NL, Pomer A, Rivara AC, Obure DC, Zhang S. Improving services for chronic non-communicable diseases in Samoa: an implementation research study using the care cascade framework. Aust N Z J Public Health 2021; 46:36-45. [PMID: 34309937 DOI: 10.1111/1753-6405.13113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/01/2020] [Accepted: 03/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Samoa needs to intensify the response to the growing non-communicable disease burden. This study aimed to assess bottlenecks in the care continuum and identify possible solutions. METHODS The mixed-methods study used the cascade framework as an analysis tool and hypertension as a tracer condition for chronic non-communicable diseases. Household survey data were integrated with medical record data of hypertension patients and results from focus group discussions with patients and healthcare providers. RESULTS Hypertension prevalence was 38.1% but only 4.7% of hypertensive individuals had controlled blood pressure. There were large gaps in the care continuum especially at screening and referral due to multiple socio-cultural, economic and service delivery constraints. CONCLUSIONS In Samoa, care for chronic non-communicable diseases is not effectively addressing patient needs. This calls for better health communication, demand creation, treatment support, nutritional interventions and health service redesign, with a focus on primary healthcare and effective patient and community engagement. Implications for public health: The proposed actions can improve the reach, accessibility, quality and effectiveness of Samoa's chronic care services. Health system redesign is necessary to ensure continuity of care and more effective primary prevention. The findings are useful for other countries in the region facing similar challenges.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, USA
| | - Alysa Pomer
- Department of Chronic Disease Epidemiology, Yale School of Public Health, USA
| | - Anna C Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, USA
| | | | - Shuo Zhang
- The World Bank Group, Washington DC, USA
| |
Collapse
|
11
|
Preferences of quality delivery of palliative care among cancer patients in low- and middle-income countries: A review. Palliat Support Care 2021; 20:275-282. [PMID: 33952378 DOI: 10.1017/s1478951521000456] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND All forms of cancer pose a tremendous and increasing problem globally. The prevalence of cancer across the globe is anticipated to double over the next two decades. About 50% of most cancer cases are expected to occur in low- and middle-income countries (LMICs), where there is a greater disproportionate level in mortality. Access to effective and timely care for cancer patients remains a challenge, especially in LMICs due to late disease diagnosis and detection, coupled with the limited availability of appropriate therapeutic options and delay in proper interventions. METHODOLOGY This study explored several mixed-method researches and randomized trials that addressed the preferences of quality delivery of palliative care among cancer patients in LMICs. A designated set of keywords such as Palliative Care; Preferences; Cancer patients; Psycho-social Support; End-of-life Care; Low and Middle-Income Countries were inserted on electronic databases to retrieve articles. The databases include PubMed, Scinapse, Medline, The Google Scholar, Academic search premier, SAGE, and EBSCO host. RESULTS Findings from this review discussed the socioeconomic and behavioral factors, which address the quality delivery of palliative care among cancer patients. These factors if measured with acceptance level in cancer patients could help to address areas that need improvement from the stage of disease diagnosis to the end-of-life. SIGNIFICANCE OF THE RESULTS Valuable collaborations among international and local health institutions are needed to build and implement a systematic framework for palliative care in LMICs. Policies and programs that are country and culturally specific, encompassing both theoretical and practical models of care in the milieu of existing quandaries should be developed.
Collapse
|
12
|
Baghirov R, Ah-Ching J, Bollars C. Achieving UHC in Samoa through Revitalizing PHC and Reinvigorating the Role of Village Women Groups. Health Syst Reform 2020; 5:78-82. [PMID: 30924751 DOI: 10.1080/23288604.2018.1539062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The increasing prevalence of NCDs such as cardio-vascular diseases, diabetes and kidney failure represents a threat to sustainable development in Samoa. The aim of this commentary is to describe the important role played by women in the community in relation to public health and to detail the lessons learnt and results of a community-based NCD prevention and management package that utilizes the strengths of community engagement at primary care level to accelerate progress towards UHC. The impetus of reforms in Samoa is to strengthen community-based care and rebuild its foundation-Primary Health Care (PHC). In doing so, the government is reinvigorating the role of women's village committees in identifying and referring people with high risks factors for non-communicable diseases. In 2015, an attempt to reinvigorate the role of Komiti Tumama in health was undertaken to address the high burden of non-communicable diseases. The government together with WHO launched a demonstration project, "NCD early detection and self-management through community participation (PEN Fa'a Samoa)", which aimed to address key issues on NCDs through an approach of contextualizing universal health coverage. Preliminary results of the program implementation are positive. PEN Fa'a Samoa achieved a high level of population screening coverage in the demonstration villages, in which the women's committee representatives played a key role. Samoa has shown in this example how such action can strengthen its health system, by utilizing critical human resources at a community level, which have proven to be essential to support the functioning of health services.
Collapse
Affiliation(s)
- Rasul Baghirov
- a Head of WHO Samoa Country Office , World Health Organization , Apia , Samoa
| | - John Ah-Ching
- b Associate Minister , Ministry of Health, Apia , Samoa
| | - Caroline Bollars
- c Department of Health Promotion, Faculty of Health, Medicine and Life Sciences , Maastricht University, Maastricht , TheNetherlands
| |
Collapse
|
13
|
Adia AC, Hawley NL, Naseri T, Reupena MS, McGarvey ST. Tobacco smoking patterns in Samoa in 2010: Implications for interventions. Tob Prev Cessat 2020; 5:50. [PMID: 32411912 PMCID: PMC7205054 DOI: 10.18332/tpc/114093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/22/2019] [Accepted: 11/17/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Tobacco use in Samoa has been described over time by age, sex and education, but little work exists on other sociodemographic factors associated with tobacco use. We describe current smoking and daily tobacco use in adults from Samoa, with a focus on sex and age stratified analyses of the influence of occupation, education, census region, household asset ownership and alcohol use in order to help develop potential targeted interventions. METHODS In 2010, a nationwide survey of 3745 adults aged 25–65 years from 33 villages was completed in Samoa. Current smoking status, daily tobacco use, as well as current alcohol use, and a variety of sociodemographic factors were assessed by interview. Bivariate and multivariable models, and sex and age group stratified analyses, were performed to determine different patterns of correlates. RESULTS More than half of all men (51.3%) and 21.8% of women were current tobacco smokers. Men and women smoked on average 10.9 and 8.7 cigarettes/day, respectively. Twenty per cent of men consumed ≥20 cigarettes/day. In men, being married, a subsistence-farmer/laborer, an alcohol user, and having low household assets, were independently associated with being a tobacco smoker (all p<0.01). Among women, not completing secondary education, being 25–34 years, residing in urban Apia, and being an alcohol user, were independently associated with being a tobacco smoker (all p<0.01). CONCLUSIONS Tobacco use in Samoa remains high and correlates of smoking suggest that interventions for cessation need to be developed within the contexts of sex, age, education, and household socioeconomic status.
Collapse
Affiliation(s)
- Alexander C Adia
- International Health Institute, School of Public Health, Brown University, Providence, United States
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, United States
| | | | | | - Stephen T McGarvey
- International Health Institute, School of Public Health, Brown University, Providence, United States.,Department of Epidemiology, School of Public Health, Brown University, Providence, United States.,Department of Anthropology, Brown University, Providence, United States
| |
Collapse
|
14
|
McNatt ZZ. Addressing noncommunicable diseases among urban refugees in the Middle East and North Africa - a scoping review. Confl Health 2020; 14:9. [PMID: 32099579 PMCID: PMC7029555 DOI: 10.1186/s13031-020-0255-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background More than 5.5 million Syrian refugees have fled violence and settled in mostly urban environments in neighboring countries. The Middle East and North Africa (MENA) region accounts for 6% of the global population but 25% of the population are ‘of concern’ to the UN Refugee Agency. In addition to large amounts of forced migration, the region is also undergoing an epidemiologic transition towards a heavier burden of noncommunicable diseases (NCDs), which in 2018 accounted for 74% of all deaths in the region. To address NCD needs globally, a myriad of policies and interventions have been implemented in low-income stable country settings. However, little is known about which policies and interventions are currently being implemented or are best suited for refugee hosting countries across the Middle East and North Africa. Methods A scoping review of peer-reviewed literature was conducted to identify policies and interventions implemented in the Middle East and North Africa to address the needs of urban refugees with noncommunicable diseases. Results This scoping review identified 11 studies from Jordan, Lebanon, Iran, West Bank, Gaza and Syria. These studies addressed three foci of extant work, (1) innovative financing for expensive treatments, (2) improvements to access and quality of treatment and, (3) efforts to prevent new diagnoses and secondary complications. All interventions targeted refugee populations including Palestinians, Sudanese, Syrians, Afghans and Iraqis. Discussion The scoping review highlighted five key findings. First, very few studies focused on the prevention of noncommunicable diseases among displaced populations. Second, several interventions made use of health information technologies, including electronic medical records and mHealth applications for patients. Third, the vast majority of publications were solely focused on tackling NCDs through primary care efforts. Fourth, the literature was very sparse in regard to national policy development, and instead favored interventions by NGOs and UN agencies. Last, the perspectives of refugees were notably absent. Conclusion Opportunities exist to prioritize prevention efforts, scale up eHealth interventions, expand access to secondary and tertiary services, address the scarcity of research on national policy, and incorporate the perspectives of affected persons in the broader discourse.
Collapse
Affiliation(s)
- Zahirah Z McNatt
- Department of Community Health and Social Medicine, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5th floor, P.O. Box 6955, Kigali, Rwanda.,2Mailman School of Public Health, Department of Population and Family Health, Columbia University, 60 Haven Avenue B3, New York, 10032 USA
| |
Collapse
|
15
|
Bollars C, Sørensen K, de Vries N, Meertens R. Exploring health literacy in relation to noncommunicable diseases in Samoa: a qualitative study. BMC Public Health 2019; 19:1151. [PMID: 31438907 PMCID: PMC6704563 DOI: 10.1186/s12889-019-7474-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/12/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Samoa is suffering from alarming rates of noncommunicable diseases (NCDs). To address this epidemic, tackling health literacy is important. A qualitative study was conducted with the aim to explore health literacy in Samoa in relation to NCDs. METHODS Six focus groups were conducted, with a total sample size of 73 participants aged over 18 years. The semi-structured interview guide was based on the conceptual model of the European Health Literacy project (HLS-EU). Data was translated, transcribed, coded, and categorized as part of the qualitative analysis. RESULTS The analysis resulted in one overarching category and seven sub-categories based on 19 themes. It revealed that health literacy in Samoa is strongly influenced by the culture. Personal responsibility is lacking. The family circle is central to health in a community where support is provided through the church and local groupings. Basic knowledge of NCDs was present in the population, but a deeper understanding of chronic disease implications was lacking. Difficulties with regards to medication adherence for chronic diseases arose as a topic, and traditional healers are still strongly embedded in the local society. Finally, the health system's performance, especially primary care services at the local level, is suffering from the high burden of NCDs and has been challenged to respond to the needs of the community it serves. CONCLUSION The findings of this study show how health literacy in Samoa is influenced by culture and suggest employing participatory, culture-sensitive, public health interventions which address the family as a whole, building on health literacy to address major public health problems like NCDs and remove barriers in the health system.
Collapse
Affiliation(s)
- Caroline Bollars
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), and Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, Maastricht, The Netherlands.
| | | | - Nanne de Vries
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), and Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, Maastricht, The Netherlands
| | - Ree Meertens
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), and Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, Maastricht, The Netherlands
| |
Collapse
|