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Pham GN, Dang TTH, Nguyen TA, Zawahir S, Le HTT, Negin J, Schneider CH, Fox GJ. Health system barriers to the implementation of the national action plan to combat antimicrobial resistance in Vietnam: a scoping review. Antimicrob Resist Infect Control 2024; 13:12. [PMID: 38273403 PMCID: PMC10809436 DOI: 10.1186/s13756-024-01364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 01/08/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Vietnam is among 11 countries in the Western Pacific region that has developed a National Action Plan for Antimicrobial Resistance (NAPCA). METHODS This scoping review characterises health system barriers to the implementation of the Vietnam NAPCA, with reference to the WHO Health Systems Framework. RESULTS Over 7 years, between 2013 and 2020, the Ministry of Health (MOH) of Vietnam has been implementing activities to achieve the six NAPCA objectives. They include revision of regulations needed for antimicrobial resistance (AMR) prevention programs; formation and operation of national management bodies; improvement of antimicrobial stewardship (AMS) in hospitals; maintenance of surveillance systems for AMR; provision of trainings on AMR and antibiotics use to doctors and pharmacists; and organization of nation-wide educational campaigns. Limited cooperation between MOH management bodies, shortages of human resource at all health system levels, a low degree of agreement between national and hospital guidelines on antibiotic use, low capability in the domestic supply of standardised drugs, and unequal training opportunities for lower-level health professionals present ongoing challenges. Actions suggested for the next period of the NAPCA include a final review of what has been achieved by the plan so far and evaluating the effectiveness of the different components of the plan. Different options on how to improve coordination across sectors in the development of a new NAPCA should be put forward. CONCLUSIONS The 6-year implementation of the Vietnam NAPCA has yielded valuable lessons for AMS in Vietnam, guiding the development of future national plans, with a central focus on scaling up AMS in hospitals and promoting community AMS programs to combat AMR.
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Affiliation(s)
- Giang N Pham
- Administration of Science Technology and Training, Ministry of Health, Hanoi, Vietnam
| | - Tho T H Dang
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - Thu-Anh Nguyen
- Woolcock Institute of Medical Research, Hanoi, Vietnam
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Shukry Zawahir
- Woolcock Institute of Medical Research, Hanoi, Vietnam
- Central Clinical School, The University of Sydney, 90-92 Parramatta Road, Sydney, NSW, 2006, Australia
| | - Hien T T Le
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - Joel Negin
- School of Public Health, The University of Sydney, Sydney, Australia
| | | | - Greg J Fox
- Woolcock Institute of Medical Research, Hanoi, Vietnam.
- Central Clinical School, The University of Sydney, 90-92 Parramatta Road, Sydney, NSW, 2006, Australia.
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Merritt JD, Yen PN, Thu-Anh N, Ngo CQ, Giap VV, Nhung NV, Ha BT, Thuy MT, Anh NT, An NT, Marks GB, Negin J, Velen K, Fox GJ. Smoking behaviour, tobacco sales and tobacco advertising at 40 'Smoke Free Hospitals' in Vietnam. Tob Control 2023:tc-2023-058003. [PMID: 37669854 DOI: 10.1136/tc-2023-058003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/13/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Tobacco remains the leading cause of preventable death globally. Vietnam's 2012 Law on Prevention and Control of Tobacco Harms establishes all healthcare facilities as smoke-free environments. We aimed to evaluate the implementation of these policies within health facilities across Vietnam. METHODS A cross-sectional study was undertaken at 40 central, provincial, district and commune healthcare facilities in four provinces of Vietnam. The presence of tobacco sales, smoke-free signage, evidence of recent tobacco use and smoking behaviours by patients and staff were observed over a 1-week period at multiple locations within each facility. Adherence with national regulations was reported using descriptive statistics. RESULTS 23 out of 40 facilities (57.5%) followed the requirements of the national smoke-free policy regarding tobacco sales, advertising and signage. Smoking was observed within health facility grounds at 26 (65%) facilities during the observation period. Indirect evidence of smoking was observed at 35 (88%) facilities. Sites where smoking was permitted (n=2) were more likely to have observed smoking behaviour (relative risk (RR) 2.16, 95% CI 1.83 to 2.56). Facilities where tobacco was sold (n=7) were more likely to have smoking behaviour observed at any of their sites (RR 1.53, 95% CI 0.93 to 2.51). CONCLUSIONS Implementation of current smoke-free hospital regulations remains incomplete, with widespread evidence of smoking observed at three levels of the Vietnamese healthcare facilities. Further interventions are required to establish the reputation of Vietnamese healthcare facilities as smoke-free environments.
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Affiliation(s)
- Joshua David Merritt
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Pham Ngoc Yen
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - Nguyen Thu-Anh
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - Chau Quy Ngo
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Vu Van Giap
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
- Respiratory Department, Hanoi Medical University, Hanoi, Vietnam
| | | | - Bui Thi Ha
- Vietnam Steering Commitee on Smoking and Health (VINACOSH), Ministry of Health, Hanoi, Vietnam
| | - Ma Thu Thuy
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - Nguyen Thuy Anh
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Nguyen Thuy An
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Guy Barrington Marks
- South Western Sydney School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Joel Negin
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kavindhran Velen
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Greg James Fox
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
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Nyirenda M, Mnqonywa N, Tutshana B, Naidoo J, Kowal P, Negin J. An analysis of the relationship between HIV risk self-perception with sexual behaviour and HIV status in South African older adults. Afr J AIDS Res 2022; 21:277-286. [PMID: 36102066 DOI: 10.2989/16085906.2022.2090395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 02/17/2022] [Accepted: 06/11/2022] [Indexed: 06/15/2023]
Abstract
Objective: To examine how older adults perceive their own risk of acquiring HIV; and how this perception correlates with their sexual behaviour and HIV status.Methods: We used cross-sectional survey data for 435 adults aged 50 years and older from South Africa. All participants completed a questionnaire on their basic socio-demographic and economic factors, self-reported health, sexual behaviour, HIV knowledge and attitudes, and self-perceived risk of HIV acquisition. In addition, anthropometrical measurements (weight, height, blood pressure, cholesterol) and HIV testing were conducted. Multinomial logistic regressions were used to determine the association between self-perceived HIV risk (categorised as "not at risk", at "low risk", at "high risk" and "didn't know") and being sexually active and testing HIV-positive, controlling for socio-demographic, behavioural and health-related factors.Results: Of the 435 respondents, 9.4% perceived themselves as at high risk of HIV infection, 18.9% as at low risk and 53.6% believed they were not at risk of HIV. Most respondent who perceived themselves as at low risk or not-at-risk at all of HIV were not sexually active. Older adults that were sexually active were more likely to consider themselves as at high risk of acquiring HIV (relative risk ratio [RRR] 2.05; 95% confidence interval (CI) 1.05-4.00; p = 0.036), as well as to test HIV positive (RRR 10.5; 95% CI 3.8-29.1; p < 0.001). Self-perceived HIV risk was significantly associated with age, sex, population group, and a greater awareness about HIV and how it is transmitted.Conclusions: Older persons who perceived themselves as at high risk of HIV were closely associated with sexual activity and testing HIV positive. Therefore, there is an urgent need for older persons, particularly those who remain sexually active, to screen and test for HIV routinely. Furthermore, there should be policy and programme interventions, such as the development of a simple risk-assessment tool for older adults to determine their risk for HIV. Older persons have been neglected in sexual health and HIV programmes. There is, therefore, a need to encourage older persons to take up appropriate HIV risk reduction and prevention behaviours.
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Affiliation(s)
- Makandwe Nyirenda
- South African Medical Research Council, Burden of Disease Research Unit, Cape Town, South Africa
- University of KwaZulu-Natal, College of Health Sciences, School of Nursing and Public Health, Durban, South Africa
| | - Nonzwakazi Mnqonywa
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Bomkazi Tutshana
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Jayganthie Naidoo
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Paul Kowal
- International Health Transitions, Canberra, Australia
| | - Joel Negin
- The University of Sydney, School of Public Health, Sydney, Australia
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Randell M, Li M, Rachmi CN, Jusril H, Fox O, Wibowo L, Rah JH, Pronyk P, Harmiko M, Phebe N, Ahmad A, Ariawan I, Negin J, Raynes-Greenow C. Prevalence of, and factors associated with anaemia in children aged 1-3 years in Aceh, Indonesia: A cross-sectional study. Nutr Health 2022:2601060221116195. [PMID: 35876347 DOI: 10.1177/02601060221116195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: Child anaemia continues to represent a major public health challenge in lower-and-middle income countries. It has serious long-term consequences for child growth and development. In Indonesia, there was a 10% increase in the national prevalence of child anaemia between 2013 and 2018. Aim: This study aims to assess the prevalence of, and factors associated with anaemia among children aged one to three years in eight districts in Aceh Province, Indonesia. Methods: A cross-sectional study was conducted on a sample of 1148 mother-child dyads aged one to three years between November and December 2018. The sampling process involved a three-stage cluster sampling design using the probability proportionate to size methodology. Anaemia status was determined using haemoglobin level (Hb < 11.0 g/dL). Data were analysed using multivariable logistic regression to estimate adjusted odds ratios (aOR) and their 95% confidence intervals (95% CI) for associated factors. Results: The overall prevalence of anaemia was 76.1% (869/1142). 44.7% (510/1142) and 28.6% (327/1142) had moderate and mild anaemia, respectively. Child aged 12-24 months (aOR: 2.00, 95% CI: 1.26-3.17), not receiving routine immunisation (aOR: 2.62, 95% CI: 1.34-5.10), and maternal anaemia (aOR: 2.15, 95% CI: 1.59-2.90) were significantly associated with anaemia. Conclusion: The prevalence of anaemia among the children in this study was high, and was associated with child age, immunisation status, and maternal anaemia. These findings provide further insight into anaemia as a public health issue at a sub-national level in Indonesia and for development of targeted programmes to address associated risk factors of child anaemia.
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Affiliation(s)
- Madeleine Randell
- Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | - Mu Li
- Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | | | | | - Olivia Fox
- Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | | | | | - Paul Pronyk
- SingHealth Duke-NUS Global Health Department, Singapore
| | | | | | - Aripin Ahmad
- Nutrition Department of 483792Aceh Health Polytechnic, Ministry of Health, Banda Aceh, Aceh, Indonesia
| | - Iwan Ariawan
- 608659Reconstra Utama Integra, Jakarta, Indonesia
| | - Joel Negin
- Sydney School of Public Health, The University of Sydney, Camperdown, Australia
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Velen K, Nguyen VN, Nguyen BH, Dang T, Nguyen HA, Vu DH, Do TT, Pham Duc C, Nguyen HL, Pham HT, Marais BJ, Johnston J, Britton W, Beardsley J, Negin J, Wiseman V, Marks GB, Nguyen TA, Fox GJ. Harnessing new mHealth technologies to Strengthen the Management of Multidrug-Resistant Tuberculosis in Vietnam (V-SMART trial): a protocol for a randomised controlled trial. BMJ Open 2022; 12:e052633. [PMID: 35732397 PMCID: PMC9226862 DOI: 10.1136/bmjopen-2021-052633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Multidrug-resistant tuberculosis (MDR-TB) remains a major public health problem globally. Long, complex treatment regimens coupled with frequent adverse events have resulted in poor treatment adherence and patient outcomes. Smartphone-based mobile health (mHealth) technologies offer national TB programmes an appealing platform to improve patient care and management; however, clinical trial evidence to support their use is lacking. This trial will test the hypothesis that an mHealth intervention can improve treatment success among patients with MDR-TB and is cost-effective compared with standard practice. METHODS AND ANALYSIS A community-based, open-label, parallel-group randomised controlled trial will be conducted among patients treated for MDR-TB in seven provinces of Vietnam. Patients commencing therapy for microbiologically confirmed rifampicin-resistant or multidrug-resistant tuberculosis within the past 30 days will be recruited to the study. Participants will be individually randomised to an intervention arm, comprising use of an mHealth application for treatment support, or a 'standard care' arm. In both arms, patients will be managed by the national TB programme according to current national treatment guidelines. The primary outcome measure of effectiveness will be the proportion of patients with treatment success (defined as treatment completion and/or bacteriological cure) after 24 months. A marginal Poisson regression model estimated via a generalised estimating equation will be used to test the effect of the intervention on treatment success. A prospective microcosting of the intervention and within-trial cost-effectiveness analysis will also be undertaken from a societal perspective. Cost-effectiveness will be presented as an incremental cost per patient successfully treated and an incremental cost per quality-adjusted life-year gained. ETHICS Ethical approval for the study was granted by The University of Sydney Human Research Ethics Committee (2019/676). DISSEMINATION Study findings will be disseminated to participants and published in peer-reviewed journals and conference proceedings. TRIAL REGISTRATION NUMBER ACTRN12620000681954.
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Affiliation(s)
- Kavindhran Velen
- Faculty of Health and Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Tho Dang
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Hoang Anh Nguyen
- National Drug Information and Adverse Drug Reaction Monitoring Centre, Hanoi, Vietnam
| | - Dinh Hoa Vu
- National Drug Information and Adverse Drug Reaction Monitoring Centre, Hanoi, Vietnam
| | | | - Cuong Pham Duc
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | | | | | - Ben J Marais
- Faculty of Health and Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - James Johnston
- BCCDC, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Warwick Britton
- Centenary Institute of Cancer Medicine and Cell Biology, The University of Sydney, Sydney, New South Wales, Australia
- Department of Clinical Immunology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Justin Beardsley
- Faculty of Health and Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Joel Negin
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Virginia Wiseman
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Health Economics, LSHTM, London, UK
| | | | | | - Greg J Fox
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Zawahir S, Le HTT, Nguyen TA, Beardsley J, Dang AD, Bernays S, Viney K, Cao TH, Drabarek D, Tran HH, Nguyen ST, Pham VTT, Luong TM, Tran HTM, Nguyen NV, Jan S, Marais BJ, Negin J, Marks GB, Fox GJ. Inappropriate supply of antibiotics for common viral infections by community pharmacies in Vietnam: A standardised patient survey. Lancet Reg Health West Pac 2022; 23:100447. [PMID: 35465041 PMCID: PMC9019242 DOI: 10.1016/j.lanwpc.2022.100447] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study aimed to evaluate the appropriateness of antibiotic dispensing of private pharmacies in Vietnam. METHODS Standardised patient surveys were conducted in randomly selected community pharmacies across 40 districts in Vietnam. Four clinical scenarios were represented by patient actors: (a) an adult requesting treatment for a sibling with a viral upper respiratory tract infection (URTI), (b) a parent requesting treatment for a child with acute diarrhoea, (c) an adult making a direct antibiotic request, and (d) an adult presenting with an antibiotic prescription. We calculated the proportion of interactions that resulted in inappropriate supply of antibiotics and patient advice. Predictors of inappropriate antibiotic supply were assessed. FINDINGS Patient actors attended 949 pharmacies, resulting in 1266 clinical interactions. Antibiotics were inappropriately supplied to 92% (291/316) of adults requesting treatment for URTI symptoms, 43% (135/316) for children with acute diarrhoea symptoms and to 84% (267/317) of direct request for antibiotics. Only 49% of pharmacies advised patients regarding their antibiotic use. Female actors were more likely to be given antibiotics than male actors for URTI (aOR 2·71, 1·12-6·60) but not for diarrhoeal disease. Pharmacies in northern Vietnam were more likely than those in southern Vietnam to supply antibiotics without a prescription: for adult URTI (aOR=5·8, 95% CI: 2·2-14·9) and childhood diarrhoea (aOR=3·5, 95% CI: 2·0-6·0) symptoms, but less likely to dispense for direct antibiotics request. INTERPRETATION Inappropriate antibiotic supply was common in Vietnamese private pharmacies. Multifaceted measures are urgently needed to achieve WHO's global action plan for the optimal use of antimicrobials. FUNDING This study was funded by a grant from the Australian Department of Foreign Affairs and Trade.
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Affiliation(s)
- Shukry Zawahir
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | | | | | - Justin Beardsley
- The University of Sydney Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, NSW, Australia
| | - Anh Duc Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Sarah Bernays
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Kerri Viney
- Centre of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Research School of Population Health, Australian National University, Canberra ACT, Australia
| | - Thai Hung Cao
- Medical Service Administration, Ministry of Health, Viet Nam
| | - Dorothy Drabarek
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Hoang Huy Tran
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | | | | | - Tan Minh Luong
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | | | | | - Stephen Jan
- The George Institute for Global Health Australia, Institute for Global Health, Sydney, Australia
| | - Ben J Marais
- The University of Sydney Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, NSW, Australia
| | - Joel Negin
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, University of Sydney, Glebe, Australia
- University of New South Wales, Sydney, Australia
| | - Greg J Fox
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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Nelson S, Drabarek D, Jenkins A, Negin J, Abimbola S. How community participation in water and sanitation interventions impacts human health, WASH infrastructure and service longevity in low-income and middle-income countries: a realist review. BMJ Open 2021; 11:e053320. [PMID: 34857572 PMCID: PMC8640661 DOI: 10.1136/bmjopen-2021-053320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To understand how, and under what circumstances community participation in water and sanitation interventions impacts the availability of safe water and sanitation, a change in health status or behaviour and the longevity of water, sanitation and hygiene (WASH) resources and services. DESIGN Realist review. DATA SOURCES PubMed, Web of Science and Scopus databases were used to identify papers from low-income and middle-income countries from 2010 to 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Criteria were developed for papers to be included. The contribution of each paper was assessed based on its relevance and rigour (eg, can it contribute to context, mechanism or outcome, and is the method used to generate that information credible). ANALYSIS Inductive and deductive coding was used to generate context-mechanism-outcome configurations. RESULTS 73 studies conducted in 29 countries were included. We identified five mechanisms that explained the availability, change and longevity outcomes: (1) accountability (policies and procedures to hold communities responsible for their actions and outcomes of an intervention), (2) diffusion (spread of an idea or behaviour by innovators over time through communication among members of a community), (3) market (the interplay between demand and supply of a WASH service or resource), (4) ownership (a sense of possession and control of the WASH service or resource) and (5) shame (a feeling of disgust in one's behaviour or actions). Contextual elements identified included community leadership and communication, technical skills and knowledge, resource access and dependency, committee activity such as the rules and management plans, location and the level of community participation. CONCLUSIONS The findings highlight five key mechanisms impacted by 19 contextual factors that explain the outcomes of community water and sanitation interventions. Policymakers, programme implementers and institutions should consider community dynamics, location, resources, committee activity and practices and nature of community participation, before introducing community water and sanitation interventions.
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Affiliation(s)
- Sarah Nelson
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dorothy Drabarek
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Aaron Jenkins
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Joel Negin
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Seye Abimbola
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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8
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Negin J, Bell J, Ivancic L, Alpers P, Nassar N. Gun violence in Australia, 2002-2016: a cohort study. Med J Aust 2021; 215:414-420. [PMID: 34494268 DOI: 10.5694/mja2.51251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the burden, geographic distribution, and outcomes of firearm-related violence in New South Wales during 2002-2016. DESIGN, SETTING, PARTICIPANTS Population-based record linkag study of people injured by firearms in NSW, 1 January 2002 - 31 December 2016. MAIN OUTCOME MEASURES Frequency, proportion, and rate of firearm-related injuries and deaths by intent category (assault, intentional self-harm, accidental, undetermined/other) and socio-demographic characteristics; medical service use (hospitalisations, ambulatory mental health care) before and after firearm-related injuries; associations between rates of firearm-related injury and those of licensed gun owners, by statistical area level 4. RESULTS Firearm-related injuries were recorded for 2390 people; for 849 people, the injuries were caused by assault (36%), for 797 by intentional self-harm (33%), and for 506 by accidents (21%). Overall rates of firearm injuries were 4.1 per 100 000 males and 0.3 per 100 000 females; the overall rate was higher in outer regional/rural/remote areas (3.8 per 100 000) than in major cities (1.6 per 100 000) or inner regional areas (1.8 per 100 000). During 2002-2016, the overall firearm-related injury rate declined from 3.4 to 1.8 per 100 000 population, primarily because of declines in injuries caused by assault or accidental events. The rate of self-harm injuries with firearms were highest for people aged 60 years or more (41.5 per 100 000 population). Local rates of intentional self-harm injuries caused by firearms were strongly correlated with those of licensed gun owners (r = 0.94). CONCLUSIONS Rates of self-harm with firearms are higher for older people, men, and residents in outer regional and rural/remote areas, while those for assault-related injuries are higher for younger people, men, and residents of major cities. Strategies for reducing injuries caused by self-harm and assault with firearms should focus on people at particular risk.
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Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Sydney, NSW
| | - Jane Bell
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW
| | - Lorraine Ivancic
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW
| | - Philip Alpers
- Sydney School of Public Health, University of Sydney, Sydney, NSW
| | - Natasha Nassar
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW
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Zawahir S, Le H, Nguyen TA, Beardsley J, Duc AD, Bernays S, Viney K, Cao Hung T, McKinn S, Tran HH, Nguyen Tu S, Velen K, Luong Minh T, Tran Thi Mai H, Nguyen Viet N, Nguyen Viet H, Nguyen Thi Cam V, Nguyen Trung T, Jan S, Marais BJ, Negin J, Marks GB, Fox G. Standardised patient study to assess tuberculosis case detection within the private pharmacy sector in Vietnam. BMJ Glob Health 2021; 6:bmjgh-2021-006475. [PMID: 34615661 PMCID: PMC8496389 DOI: 10.1136/bmjgh-2021-006475] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Of the estimated 10 million people affected by (TB) each year, one-third are never diagnosed. Delayed case detection within the private healthcare sector has been identified as a particular problem in some settings, leading to considerable morbidity, mortality and community transmission. Using unannounced standardised patient (SP) visits to the pharmacies, we aimed to evaluate the performance of private pharmacies in the detection and treatment of TB. Methods A cross-sectional study was undertaken at randomly selected private pharmacies within 40 districts of Vietnam. Trained actors implemented two standardised clinical scenarios of presumptive TB and presumptive multidrug-resistant TB (MDR-TB). Outcomes were the proportion of SPs referred for medical assessment and the proportion inappropriately receiving broad-spectrum antibiotics. Logistic regression evaluated predictors of SPs’ referral. Results In total, 638 SP encounters were conducted, of which only 155 (24.3%) were referred for medical assessment; 511 (80·1%) were inappropriately offered antibiotics. A higher proportion of SPs were referred without having been given antibiotics if they had presumptive MDR-TB (68/320, 21.3%) versus presumptive TB (17/318, 5.3%; adjusted OR=4.8, 95% CI 2.9 to 7.8). Pharmacies offered antibiotics without a prescription to 89.9% of SPs with presumptive TB and 70.3% with presumptive MDR-TB, with no clear follow-up plan. Conclusions Few SPs with presumptive TB were appropriately referred for medical assessment by private pharmacies. Interventions to improve appropriate TB referral within the private pharmacy sector are urgently required to reduce the number of undiagnosed TB cases in Vietnam and similar high-prevalence settings.
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Affiliation(s)
- Shukry Zawahir
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hien Le
- Woolcock Institute of Medical Research, Kim Ma, Hanoi, Vietnam
| | - Thu Anh Nguyen
- Woolcock Institute of Medical Research, Kim Ma, Hanoi, Vietnam
| | - Justin Beardsley
- The Marie Bashir Institute, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Anh Dang Duc
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Sarah Bernays
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kerri Viney
- Centre of Global Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Thai Cao Hung
- Medical Service Administration, Government of Viet Nam Ministry of Health, Hanoi, Vietnam
| | - Shannon McKinn
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hoang Huy Tran
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Son Nguyen Tu
- Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Kavindhran Velen
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tan Luong Minh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | | | - Ha Nguyen Viet
- Woolcock Institute of Medical Research, Kim Ma, Hanoi, Vietnam
| | | | | | - Stephen Jan
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity and the Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Joel Negin
- Faculty of Medicne and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Guy B Marks
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Gregory Fox
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Affiliation(s)
- Joel Negin
- The University of Sydney School of Public Health, Sydney, NSW 2006, Australia.
| | - Janet Seeley
- London School of Hygiene & Tropical Medicine, London, UK; The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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11
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Ngoc Yen P, Obeid MJ, Quy Chau N, Van Giap V, Viet Nhung N, Yen NH, Thi Ha B, Thu Anh N, Barrington Marks G, Freeman B, Negin J, James Fox G. Behaviors and Attitudes Toward Smoking Among Health Care Workers at Health Facilities in 4 Provinces of Vietnam: A Representative Cross-Sectional Survey. Asia Pac J Public Health 2021; 34:79-86. [PMID: 34330179 DOI: 10.1177/10105395211036275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tobacco smoking is a leading cause of premature death. Smoking prevalence in Vietnam ranks among the highest in Southeast Asia. Given the important role of health care workers (HCWs) in promoting and supporting smoking cessation, this project aimed to characterize the prevalence of smoking among HCWs in Vietnam, and their attitudes toward smoking cessation interventions. A cross-sectional survey was conducted among care workers in 4 levels of the health system, within 4 provinces of Vietnam. Descriptive statistics evaluated participant attitudes, perception, behaviors, and knowledge about smoking. Multivariable logistic regression models evaluated risk factors for smoking. Among 3343 HCWs, 7.5% identified as current smokers, comprising 22.2% males and 0.5% of females. Males had substantially greater odds (adjusted odds ratio = 55.3; 95% confidence interval = 29.0-105.6) of identifying as current smokers compared with females. HCWs in urban settings had higher odds of identifying as smokers compared with rural workers (adjusted odds ratio = 1.72; 95% confidence interval = 1.23-2.24). Strong support for smoking cessation policies and interventions were identified, even among staff who smoked. HCWs play an integral role in identifying smokers and supporting smoking cessation interventions for their patients. Efforts to support affordable smoking cessation interventions within health facilities are likely to contribute to a reduction in smoking prevalence in Vietnam.
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Affiliation(s)
- Pham Ngoc Yen
- The Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - Mary Jo Obeid
- Duke University Medical Center, Durham, NC, USA.,The University of Sydney, Sydney, New South Wales, Australia
| | - Ngo Quy Chau
- Bach Mai Hospital, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | - Vu Van Giap
- Bach Mai Hospital, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Viet Nhung
- Hanoi Medical University, Hanoi, Vietnam.,National Lung Hospital, Hanoi, Vietnam
| | - Nguyen Ha Yen
- The Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - Bui Thi Ha
- Vietnam Steering Committee on Smoking and Health, Ministry of Health, Hanoi, Vietnam
| | - Nguyen Thu Anh
- The Woolcock Institute of Medical Research, Hanoi, Vietnam.,The University of Sydney, Sydney, New South Wales, Australia
| | - Guy Barrington Marks
- The Woolcock Institute of Medical Research, Hanoi, Vietnam.,The University of NSW, Liverpool, New South Wales, Australia
| | - Becky Freeman
- The University of Sydney, Sydney, New South Wales, Australia
| | - Joel Negin
- The University of Sydney, Sydney, New South Wales, Australia
| | - Greg James Fox
- The Woolcock Institute of Medical Research, Hanoi, Vietnam.,The University of Sydney, Sydney, New South Wales, Australia
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12
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Lam TT, Dang DA, Tran HH, Do DV, Le H, Negin J, Jan S, Marks GB, Nguyen TA, Fox GJ, Beardsley J. What are the most effective community-based antimicrobial stewardship interventions in low- and middle-income countries? A narrative review. J Antimicrob Chemother 2021; 76:1117-1129. [PMID: 33491090 DOI: 10.1093/jac/dkaa556] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Antimicrobial resistance (AMR) is a major global issue and antimicrobial stewardship is central to tackling its emergence. The burden of AMR disproportionately impacts low- and middle-income countries (LMICs), where capacity for surveillance and management of resistant pathogens is least developed. Poorly regulated antibiotic consumption in the community is a major driver of AMR, especially in LMICs, yet community-based interventions are neglected in stewardship research, which is often undertaken in high-income settings and/or in hospitals. We reviewed the evidence available to researchers and policymakers testing or implementing community-based antimicrobial stewardship strategies in LMICs. We critically appraise that evidence, deliver recommendations and identify outstanding areas of research need. We find that multifaceted, education-focused interventions are likely most effective in our setting. We also confirm that the quality and quantity of community-based stewardship intervention research is limited, with research on microbiological, clinical and economic sustainability most urgently needed.
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Affiliation(s)
- Thanh Tuan Lam
- The Woolcock Institute of Medical Research, Kim Ma, Ha Noi, Vietnam
| | - Duc Anh Dang
- National Institute of Hygiene and Epidemiology, Hai Ba Trung, Hanoi, Vietnam
| | - Huy Hoang Tran
- National Institute of Hygiene and Epidemiology, Hai Ba Trung, Hanoi, Vietnam
| | - Dung Van Do
- The University of Medicine and Pharmacy, Hong Bang, Q5, Ho Chi Minh City, Vietnam
| | - Hien Le
- The Woolcock Institute of Medical Research, Kim Ma, Ha Noi, Vietnam
| | - Joel Negin
- The Sydney School of Public Health, University of Sydney, NSW 2006, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, NSW 2042, Australia
| | - Guy B Marks
- The University of New South Wales, Sydney, NSW 2052, Australia
| | - Thu Anh Nguyen
- The Woolcock Institute of Medical Research, Kim Ma, Ha Noi, Vietnam.,The Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Greg J Fox
- The Woolcock Institute of Medical Research, Kim Ma, Ha Noi, Vietnam.,The Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Justin Beardsley
- The Marie Bashir Institute, Westmead Institute for Medical Research, The University of Sydney, NSW 2145, Australia.,Oxford University Clinical Research Unit, Vo Van Kiet, Q5, Ho Chi Minh City, Vietnam
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13
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Nguyen TA, Pham YN, Doan NP, Nguyen TH, Do TT, Van Vu G, Marks GB, McKinn S, Negin J, Bernays S, Fox GJ. Factors affecting healthcare pathways for chronic lung disease management in Vietnam: a qualitative study on patients' perspectives. BMC Public Health 2021; 21:1145. [PMID: 34130687 PMCID: PMC8207672 DOI: 10.1186/s12889-021-11219-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and asthma rank among the leading causes of respiratory morbidity, particularly in low- and middle-income countries. This qualitative study aimed to explore the healthcare pathways of patients with chronic respiratory disease, and factors influencing their ability to access healthcare in Vietnam, where COPD and asthma are prevalent. METHODS We conducted 41 in-depth interviews among patients, including 31 people with COPD, eight with asthma and two with asthma-COPD overlap syndrome. Participants were recruited at provincial- or national-level health facilities in two urban and two rural provinces in Vietnam. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. RESULTS Patients' healthcare pathways were complex and involved visits to multiple health facilities before finally obtaining a definitive diagnosis at a provincial- or national-level hospital. Access to healthcare was affected considerably by participants' limited knowledge of their respiratory conditions, the availability of social support, especially from family members, the costs of healthcare as well as health system factors (including the coverage of public health insurance, the distance to health facilities, and attitude of healthcare providers). CONCLUSION The study demonstrated the need for improved access to timely diagnosis and treatment of chronic lung disease within the lower level of the health system. This can be achieved by enhancing the communication skills and diagnostic capacity of local healthcare workers. Health education programmes for patients and caregivers will contribute to improved control of lung disease.
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Affiliation(s)
- Thu-Anh Nguyen
- Woolcock Institute of Medical Research, 298 Kim Ma, Ba Dinh, Hanoi, Vietnam. .,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Yen Ngoc Pham
- Woolcock Institute of Medical Research, 298 Kim Ma, Ba Dinh, Hanoi, Vietnam
| | - Nhung Phuong Doan
- Woolcock Institute of Medical Research, 298 Kim Ma, Ba Dinh, Hanoi, Vietnam
| | - Thao Huong Nguyen
- Woolcock Institute of Medical Research, 298 Kim Ma, Ba Dinh, Hanoi, Vietnam
| | - Toan Thanh Do
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | | | - Guy B Marks
- Australia South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Shannon McKinn
- School of Public Health, University of Sydney, Sydney, Australia
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
| | - Sarah Bernays
- School of Public Health, University of Sydney, Sydney, Australia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Greg J Fox
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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14
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Huang WC, Pham NY, Nguyen TA, Vu VG, Ngo QC, Nguyen VN, Freeman B, Jan S, Negin J, Marks GB, Fox GJ. Smoking behaviour among adult patients presenting to health facilities in four provinces of Vietnam. BMC Public Health 2021; 21:845. [PMID: 33933063 PMCID: PMC8088640 DOI: 10.1186/s12889-021-10880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background Attendance at healthcare facilities provides an opportunity for smoking cessation interventions. However, the smoking behaviours of patients seeking healthcare in Vietnam are not well-understood. We aimed to evaluate behaviours related to smoking among patients presenting to health facilities in Vietnam. Methods We conducted a cross-sectional study in 4 provinces of Vietnam. Consecutive patients aged ≥15 years presenting to 46 health facilities were assessed. Current smokers were randomly selected to complete a full survey about smoking behaviour, quit attempts, and preparedness to quit. Results Among 11,245 patients who sought healthcare, the prevalence of current smoking was 18.6% (95% CI: 17.8–19.4%) overall, 34.6% (95% CI: 33.2–36.0%) among men and 1.1% (95% CI: 0.8–1.3%) among women. Current smokers who were asked about smoking by healthcare providers in the last 12 months were more likely to make quit attempts than those not asked (40.6% vs 31.8%, p = 0.017). Current smokers who attempted to quit in the past 12 months made limited use of cessation aids: counselling (1.9%) and nicotine replacement therapy (10%). A higher proportion of patients wanted to quit in the next month at national/provincial hospitals (30.3%) than those visiting district hospitals (11.3%, p < 0.001) and commune health centres (11.1%, p = 0.004). Conclusions Smoking is common among male patients presenting to healthcare facilities in Vietnam. Formal smoking cessation supports are generally not used or offered. This population is likely to benefit from routine smoking cessation interventions that are integrated within the routine healthcare delivery system. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10880-z.
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Affiliation(s)
- Wan-Chun Huang
- Woolcock Institute of Medical Research, Hanoi, Vietnam. .,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia. .,Division of Thoracic Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Ngoc Yen Pham
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | | | - Van Giap Vu
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Quy Chau Ngo
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Becky Freeman
- School of Public Health, University of Sydney, Sydney, Australia
| | - Stephen Jan
- Health Economics and Process Evaluation Program, George Institute for Global Health, Sydney, Australia
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Hanoi, Vietnam.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Gregory J Fox
- Woolcock Institute of Medical Research, Hanoi, Vietnam.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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15
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Negin J, Alpers P, Nassar N, Hemenway D. Australian Firearm Regulation at 25 - Successes, Ongoing Challenges, and Lessons for the World. N Engl J Med 2021; 384:1581-1583. [PMID: 33909963 DOI: 10.1056/nejmp2102574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Joel Negin
- From the Faculty of Medicine and Health, University of Sydney School of Public Health (J.N., P.A.), and the Faculty of Medicine and Health, University of Sydney Children's Hospital Westmead Clinical School (N.N.) - both in Sydney; and the Harvard T.H. Chan School of Public Health, Boston (D.H.)
| | - Philip Alpers
- From the Faculty of Medicine and Health, University of Sydney School of Public Health (J.N., P.A.), and the Faculty of Medicine and Health, University of Sydney Children's Hospital Westmead Clinical School (N.N.) - both in Sydney; and the Harvard T.H. Chan School of Public Health, Boston (D.H.)
| | - Natasha Nassar
- From the Faculty of Medicine and Health, University of Sydney School of Public Health (J.N., P.A.), and the Faculty of Medicine and Health, University of Sydney Children's Hospital Westmead Clinical School (N.N.) - both in Sydney; and the Harvard T.H. Chan School of Public Health, Boston (D.H.)
| | - David Hemenway
- From the Faculty of Medicine and Health, University of Sydney School of Public Health (J.N., P.A.), and the Faculty of Medicine and Health, University of Sydney Children's Hospital Westmead Clinical School (N.N.) - both in Sydney; and the Harvard T.H. Chan School of Public Health, Boston (D.H.)
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16
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Al-Ansari F, Mirzaei M, Al-Ansari B, Al-Ansari MB, Abdulzahra MS, Rashid H, Hill-Cawthorne GA, Al Ansari M, Negin J, Conigrave K. Health Risks, Preventive Behaviours and Respiratory Illnesses at the 2019 Arbaeen: Implications for COVID-19 and Other Pandemics. Int J Environ Res Public Health 2021; 18:ijerph18063287. [PMID: 33810092 PMCID: PMC8005097 DOI: 10.3390/ijerph18063287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 01/03/2023]
Abstract
COVID-19 poses grave challenges for mass gatherings. One of the world’s largest annual gatherings, Arbaeen, occurs in Iraq. We studied respiratory symptoms and risk and protective factors using representative sampling of Arbaeen pilgrims in 2019 to inform prevention of COVID-19 transmission. Structured sampling was used to recruit walking pilgrims. A questionnaire asked about respiratory symptoms, risk, and preventive factors, including hygiene-related resources of toilet facilities. The commonest symptom reported by the 1842 participants (63.3% male, 36.7% female) was cough (25.6%). Eating in mawkibs (rest areas) with indoor kitchens and drinking only packaged water were associated with lower risk of cough (AOR = 0.72, CI = 0.56–0.94; AOR = 0.60; CI = 0.45–0.78, p < 0.05). Facemask use was associated with increased risk of cough (AOR = 2.71, CI = 2.08–3.53, p < 0.05). Handwashing was not protective against cough, or against (one or more of) cough, fever, or breathlessness in multivariate analysis. Toilet facilities often lacked running water (32.1%) and soap (26.1%), and had shared hand towels (17%). To reduce risk of respiratory infections including COVID-19 during Arbaeen or other mass gatherings, needs include running water, soap, and hygienic hand drying options or hand sanitiser. Education on proper handwashing and facemask approaches and monitoring around food preparation and eating spaces are needed.
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Affiliation(s)
- Farah Al-Ansari
- Faculty of Medicine and Health, Sydney School of Medicine (Central Clinical School), University of Sydney, Camperdown, NSW 2006, Australia; (B.A.-A.); (M.A.A.); (K.C.)
- Correspondence:
| | - Masoud Mirzaei
- Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd 89151-73160, Iran;
| | - Basma Al-Ansari
- Faculty of Medicine and Health, Sydney School of Medicine (Central Clinical School), University of Sydney, Camperdown, NSW 2006, Australia; (B.A.-A.); (M.A.A.); (K.C.)
| | | | | | - Harunor Rashid
- The Children’s Hospital at Westmead, National Centre for Immunisation Research and Surveillance (NCIRS), Westmead, NSW 2145, Australia;
- The Discipline of Child and Adolescent Health, Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Grant A. Hill-Cawthorne
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia; (G.A.H.-C.); (J.N.)
| | - Mustafa Al Ansari
- Faculty of Medicine and Health, Sydney School of Medicine (Central Clinical School), University of Sydney, Camperdown, NSW 2006, Australia; (B.A.-A.); (M.A.A.); (K.C.)
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia; (G.A.H.-C.); (J.N.)
| | - Joel Negin
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia; (G.A.H.-C.); (J.N.)
| | - Katherine Conigrave
- Faculty of Medicine and Health, Sydney School of Medicine (Central Clinical School), University of Sydney, Camperdown, NSW 2006, Australia; (B.A.-A.); (M.A.A.); (K.C.)
- Drug Health Services, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
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17
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Elbarbary M, Oganesyan A, Honda T, Morgan G, Guo Y, Guo Y, Negin J. Systemic Inflammation (C-Reactive Protein) in Older Chinese Adults Is Associated with Long-Term Exposure to Ambient Air Pollution. Int J Environ Res Public Health 2021; 18:ijerph18063258. [PMID: 33809857 PMCID: PMC8004276 DOI: 10.3390/ijerph18063258] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/07/2021] [Accepted: 03/15/2021] [Indexed: 01/08/2023]
Abstract
There is an established association between air pollution and cardiovascular disease (CVD), which is likely to be mediated by systemic inflammation. The present study evaluated links between long-term exposure to ambient air pollution and high-sensitivity C reactive protein (hs-CRP) in an older Chinese adult cohort (n = 7915) enrolled in the World Health Organization (WHO) study on global aging and adult health (SAGE) China Wave 1 in 2008–2010. Multilevel linear and logistic regression models were used to assess the associations of particulate matter (PM) and nitrogen dioxide (NO2) on log-transformed hs-CRP levels and odds ratios of CVD risk derived from CRP levels adjusted for confounders. A satellite-based spatial statistical model was applied to estimate the average community exposure to outdoor air pollutants (PM with an aerodynamic diameter of 10 μm or less (PM10), 2.5 μm or less (PM2.5), and 1 μm or less (PM1) and NO2) for each participant of the study. hs-CRP levels were drawn from dried blood spots of each participant. Each 10 μg/m3 increment in PM10, PM2.5, PM1, and NO2 was associated with 12.8% (95% confidence interval; (CI): 9.1, 16.6), 15.7% (95% CI: 10.9, 20.8), 10.2% (95% CI: 7.3, 13.2), and 11.8% (95% CI: 7.9, 15.8) higher serum levels of hs-CRP, respectively. Our findings suggest that air pollution may be an important factor in increasing systemic inflammation in older Chinese adults.
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Affiliation(s)
- Mona Elbarbary
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (G.M.); (J.N.)
- Correspondence: or ; Tel.: +61-416-405-016
| | - Artem Oganesyan
- Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan 0051, Armenia;
| | - Trenton Honda
- Bouvé College of Health Sciences, Northeastern University, Boston, MA 02115, USA;
| | - Geoffrey Morgan
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (G.M.); (J.N.)
- School of Public Health, University Centre for Rural Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3800, Australia;
| | - Yanfei Guo
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China;
| | - Joel Negin
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (G.M.); (J.N.)
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18
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Huang WC, Fox GJ, Pham NY, Nguyen TA, Vu VG, Ngo QC, Nguyen VN, Jan S, Negin J, Le TTL, Marks GB. A syndromic approach to assess diagnosis and management of patients presenting with respiratory symptoms to healthcare facilities in Vietnam. ERJ Open Res 2021; 7:00572-2020. [PMID: 33681343 PMCID: PMC7917231 DOI: 10.1183/23120541.00572-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/05/2020] [Indexed: 12/05/2022] Open
Abstract
Background The aim of the study was to establish syndromic diagnoses in patients presenting with respiratory symptoms to healthcare facilities in Vietnam and to compare the diagnoses with facility-level clinical diagnoses and treatment decisions. Methods A representative sample of patients aged ≥5 years, presenting with dyspnoea, cough, wheezing, and/or chest tightness to healthcare facilities in four provinces of Vietnam were systematically evaluated. Eight common syndromes were defined using data obtained. Results We enrolled 977 subjects at 39 facilities. We identified fixed airflow limitation (FAL) in 198 (20.3%) patients and reversible airflow limitation (RAL) in 26 (2.7%) patients. Patients meeting the criteria for upper respiratory tract infection (URTI) alone constituted 160 (16.4%) patients and 470 (48.1%) did not meet the criteria for any of the syndromes. Less than half of patients with FAL were given long-acting bronchodilators. A minority of patients with either RAL or FAL with eosinophilia were prescribed inhaled corticosteroids. Antibiotics were given to more than half of all patients, even among those with URTI alone. Conclusion This study identified a substantial discordance between prescribed treatment, clinician diagnosis and a standardised syndromic diagnosis among patients presenting with respiratory symptoms. Increased access to spirometry and implementation of locally relevant syndromic approaches to management may help to improve patient care in resource-limited settings. This study identified discordance between a standardised syndromic diagnosis of respiratory diseases and the diagnosis reached within the Vietnamese health system. Implementing a syndromic approach to case management might help to improve patient care.https://bit.ly/36oJORg
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Affiliation(s)
- Wan-Chun Huang
- Woolcock Institute of Medical Research, Hanoi, Vietnam.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Division of Thoracic Medicine, Dept of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Gregory J Fox
- Woolcock Institute of Medical Research, Hanoi, Vietnam.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ngoc Yen Pham
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | | | - Van Giap Vu
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Quy Chau Ngo
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Stephen Jan
- Health Economics and Process Evaluation Program, George Institute for Global Health, Sydney, Australia
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
| | - Thi Tuyet Lan Le
- Society of Asthma and Allergy & Clinical Immunology, Ho Chi Minh City, Vietnam
| | - Guy B Marks
- Woolcock Institute of Medical Research, Hanoi, Vietnam.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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19
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Farrell P, Thow AM, Rimon M, Roosen A, Vizintin P, Negin J. An Analysis of Healthy Food Access Amongst Women in Peri-urban Honiara. Hawaii J Health Soc Welf 2021; 80:33-40. [PMID: 33575663 PMCID: PMC7871453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Highly processed and energy-dense foods are contributing to the high and rising rates of non-communicable diseases and nutrient deficiencies in Solomon Islands. Non-communicable diseases currently cause 69% of deaths in Solomon Islands, and the rate is rising, fuelled in part by limited health system capacity to treat these conditions. Solomon Islands also has the highest reported undernourishment rate in the Pacific. Recent decades have seen several factors change the food and economic environment in Solomon Islands. Importantly, rural-to-urban migration has caused a disconnect between urban residents and access to land and home gardens. This study aimed to examine the complexities of nutritious food access in urban Solomon Islands. Data were collected from 32 women in Honiara, the islands' capital, using a novel survey instrument. There were 3 important findings: (1) the dominant influencers of the diet patterns described by participants in this study were food affordability and access to land on which to grow it, (2) all participants experienced food insecurity, and (3) reported diet patterns reflected unhealthy diets which were particularly high in processed and sugary foods. These findings suggest a need for improvements in the food environment in Honiara.
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Affiliation(s)
- Penny Farrell
- Sydney School of Public Health, Edward Ford Building A27, The University of Sydney, NSW, 2006, Australia (PF, PV, JN)
| | - Anne Marie Thow
- Menzies Centre for Health Policy, Charles Perkins Centre D17, The University of Sydney, NSW, 2006, Australia (AMT)
| | - Mia Rimon
- Pacific Community (SPC). Port Vila, Vanuatu and Honiara, Solomon Islands (MR)
| | - Andy Roosen
- Synergies Ltd, Ngossi Ridge, Honiara, Solomon Islands (AR)
| | - Pavle Vizintin
- Sydney School of Public Health, Edward Ford Building A27, The University of Sydney, NSW, 2006, Australia (PF, PV, JN)
| | - Joel Negin
- Sydney School of Public Health, Edward Ford Building A27, The University of Sydney, NSW, 2006, Australia (PF, PV, JN)
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20
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Sawleshwarkar S, Zodpey SP, Negin J. Indian Public Health Students' Perspectives on Global Health Education. Front Public Health 2021; 8:614744. [PMID: 33585385 PMCID: PMC7873986 DOI: 10.3389/fpubh.2020.614744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/22/2020] [Indexed: 12/04/2022] Open
Abstract
Global health discipline is of increasing interest for educators and students in public health across the world. Public health education is recently gaining momentum in India, but global health is still at an embryonic stage. Value of students as stakeholders in curriculum development is increasingly recognized but literature about perspectives of public health students regarding global health education is limited. This study aimed to explore Indian public health students' perspectives about global health education and to provide platform for the development of global health education framework for future public health professionals. This study involved a series of focus groups with students and sought to understand perceptions about global health and global health education framework. We recruited public health students at three institutes across India for focus group discussions. Focus groups questions covered current understanding of global health, opinions regarding global health education for public health curriculum and the relevance of global health competency domains for future employment. Recordings were transcribed verbatim and the transcripts were read along with field notes and then analyzed thematically. A total of 36 students participated in four focus groups. There was a general recognition that global health is transnational and that a global outlook is now essential. But there were concerns regarding local and global priorities in public health. Global health was regarded as being wider than public health by some, but others viewed public health being the umbrella term with global health as a specialization. Global health competencies were viewed as a “step up” from the public health competencies but core public health competencies were considered essential. International experiences and use of technology were key themes for delivery of global health education. Employability and career progression for global health graduates were of concern for many participants. This study provides insight into the student perspectives regarding global health education for public health programs in India. Clear direction in terms of curriculum and its utility for career growth and employability as a global health professional needs to be established for global health education in India and other similar settings.
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Affiliation(s)
- Shailendra Sawleshwarkar
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia.,Public Health Foundation of India, New Delhi, India
| | - Sanjay P Zodpey
- Faculty of Medicine and Health, Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia.,Public Health Foundation of India, New Delhi, India
| | - Joel Negin
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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21
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Elbarbary M, Oganesyan A, Honda T, Kelly P, Zhang Y, Guo Y, Morgan G, Guo Y, Negin J. Ambient air pollution, lung function and COPD: cross-sectional analysis from the WHO Study of AGEing and adult health wave 1. BMJ Open Respir Res 2020; 7:e000684. [PMID: 33334858 PMCID: PMC7747603 DOI: 10.1136/bmjresp-2020-000684] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/10/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Long-term exposure to ambient air pollution leads to respiratory morbidity and mortality; however, the evidence of the effect on lung function and chronic obstructive pulmonary disease (COPD) in older adult populations is inconsistent. OBJECTIVE To address this knowledge gap, we investigated the associations between particulate matter (PM), nitrogen dioxide (NO2) exposure and lung function, as well as COPD prevalence, in older Chinese adults. METHODS We used data from the WHO Study on global AGEing and adult health (SAGE) China Wave 1, which includes 111 693 participants from 64 townships in China. A cross-sectional analysis explored the association between satellite-based air pollution exposure estimates (PM with an aerodynamic diameter of ≤10 µm [PM10], ≤2.5 µm [PM2.5] and NO2) and forced expiratory volume in one second (FEV1), forced vital capacity (FVC), the FEV1/FVC ratio and COPD (defined as post-bronchodilator FEV1/FVC <70%). Data on lung function changes were further stratified by COPD status. RESULTS Higher exposure to each pollutant was associated with lower lung function. An IQR (26.1 µg/m3) increase in PM2.5 was associated with lower FEV1 (-71.88 mL, 95% CI -92.13 to -51.64) and FEV1/FVC (-2.81 mL, 95% CI -3.37 to -2.25). For NO2, an IQR increment of 26.8 µg/m3 was associated with decreases in FEV1 (-60.12 mL, 95% CI -84.00 to -36.23) and FVC (-32.33 mL, 95% CI -56.35 to -8.32). A 31.2 µg/m3 IQR increase in PM10 was linked to reduced FEV1 (-8.86 mL, 95% CI -5.40 to 23.11) and FEV1/FVC (-1.85 mL, 95% CI -2.24 to -1.46). These associations were stronger for participants with COPD. Also, COPD prevalence was linked to higher levels of PM2.5 (POR 1.35, 95% CI 1.26 to 1.43), PM10 (POR 1.24, 95% CI 1.18 to 1.29) and NO2 (POR 1.04, 95% CI 0.98 to 1.11). CONCLUSION Ambient air pollution was associated with lower lung function, especially in individuals with COPD, and increased COPD prevalence in older Chinese adults.
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Affiliation(s)
- Mona Elbarbary
- School of Public health, The University of Sydney, Sydney, New South Wales, Australia
| | - Artem Oganesyan
- Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia
| | - Trenton Honda
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Patrick Kelly
- School of Public health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ying Zhang
- School of Public health, The University of Sydney, Sydney, New South Wales, Australia
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, Monash Medical School, Clayton, Victoria, Australia
| | - Geoffrey Morgan
- School of Public health, The University of Sydney, Sydney, New South Wales, Australia
| | - Yanfei Guo
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Joel Negin
- School of Public health, The University of Sydney, Sydney, New South Wales, Australia
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22
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Jenkins A, Jupiter SD, Capon A, Horwitz P, Negin J. Nested ecology and emergence in pandemics. Lancet Planet Health 2020; 4:e302-e303. [PMID: 32800145 PMCID: PMC7423328 DOI: 10.1016/s2542-5196(20)30165-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Aaron Jenkins
- School of Public Health, University of Sydney, Westmead, NSW, Australia; Centre for Ecosystem Management, Edith Cowan University, Joondalup 6027, Australia.
| | - Stacy D Jupiter
- Wildlife Conservation Society, Melanesia Program, Suva, Fiji
| | - Anthony Capon
- Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
| | - Pierre Horwitz
- Centre for Ecosystem Management, Edith Cowan University, Joondalup 6027, Australia
| | - Joel Negin
- School of Public Health, University of Sydney, Westmead, NSW, Australia
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23
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Elbarbary M, Honda T, Morgan G, Kelly P, Guo Y, Negin J. Ambient air pollution exposure association with diabetes prevalence and glycosylated hemoglobin (HbA1c) levels in China. Cross-sectional analysis from the WHO study of AGEing and adult health wave 1. J Environ Sci Health A Tox Hazard Subst Environ Eng 2020; 55:1149-1162. [PMID: 32615056 DOI: 10.1080/10934529.2020.1787011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
Over the past decades, air pollution has become one of the critical environmental health issues in China. The present study aimed to evaluate links between ambient air pollution and the prevalence of type 2 diabetes mellitus (T2DM) and the levels of glycosylated hemoglobin (HbA1c). A multilevel linear and logistic regression was used to assess these associations among 7,770 participants aged ≥50 years from the WHO Study on global AGEing and adult health (SAGE) in China in 2007-2010. The average exposure to each of pollutants (particulate matter with an aerodynamic diameter of ≤10 μm/≤2.5 μm/≤1 μm [PM10/PM2.5/PM1] and nitrogen dioxide [NO2]) was estimated using a satellite-based spatial statistical model. In logistic models, a 10 µg/m3 increase in PM10 and PM2.5 was associated with increased T2DM prevalence (Prevalence Odds Ratio, POR: 1.27; 95% CI: 1.11, 1.45 and POR: 1.23; 95% CI: 1.03, 1.46). Similar increments in PM10, PM2.5, PM1 and NO2 were associated with increase in HbA1c levels of 1.8% (95% CI: 1.3, 2.3), 1.3% (95% CI: 1.1, 1.5), 0.7% (95% CI: 0.1, 1.3), and 0.8% (95% CI: 0.4, 1.2), respectively. In a large cohort of older Chinese adults, air pollution was liked to both higher T2DM prevalence and elevated HbA1c levels.
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Affiliation(s)
- Mona Elbarbary
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Trenton Honda
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Geoffrey Morgan
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- School of Public Health, University Centre for Rural Health, Lismore, Australia
| | - Patrick Kelly
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine at the School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joel Negin
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
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24
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Elbarbary M, Honda T, Morgan G, Guo Y, Guo Y, Kowal P, Negin J. Ambient Air Pollution Exposure Association with Anaemia Prevalence and Haemoglobin Levels in Chinese Older Adults. Int J Environ Res Public Health 2020; 17:ijerph17093209. [PMID: 32380747 PMCID: PMC7246731 DOI: 10.3390/ijerph17093209] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Health effects of air pollution on anaemia have been scarcely studied worldwide. We aimed to explore the associations of long-term exposure to ambient air pollutants with anaemia prevalence and haemoglobin levels in Chinese older adults. METHODS We used two-level linear regression models and modified Poisson regression with robust error variance to examine the associations of particulate matter (PM) and nitrogen dioxide (NO2) on haemoglobin concentrations and the prevalence of anaemia, respectively, among 10,611 older Chinese adults enrolled in World Health Organization (WHO) Study on global AGEing and adult health (SAGE) China. The average community exposure to ambient air pollutants (PM with an aerodynamic diameter of 10 μm or less (PM10), 2.5 μm or less (PM2.5), 1 μm or less (PM1) and nitrogen dioxide (NO2)) for each participant was estimated using a satellite-based spatial statistical model. Haemoglobin levels were measured for participants from dried blood spots. The models were controlled for confounders. RESULTS All the studied pollutants were significantly associated with increased anaemia prevalence in single pollutant model (e.g., the prevalence ratios associated with an increase in inter quartile range in three years moving average PM10 (1.05; 95% CI: 1.02-1.09), PM2.5 (1.11; 95% CI: 1.06-1.16), PM1 (1.13; 95% CI: 1.06-1.20) and NO2 (1.42; 95% CI: 1.34-1.49), respectively. These air pollutants were also associated with lower concentrations of haemoglobin: PM10 (-0.53; 95% CI: -0.67, -0.38); PM2.5 (-0.52; 95% CI: -0.71, -0.33); PM1 (-0.55; 95% CI: -0.69, -0.41); NO2 (-1.71; 95% CI: -1.85, -1.57) respectively. CONCLUSIONS Air pollution exposure was significantly associated with increased prevalence of anaemia and decreased haemoglobin levels in a cohort of older Chinese adults.
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Affiliation(s)
- Mona Elbarbary
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (G.M.); (J.N.)
- Correspondence: ; Tel.: +61-416405016
| | - Trenton Honda
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT 84108, USA;
| | - Geoffrey Morgan
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (G.M.); (J.N.)
- School of Public Health, University Centre for Rural Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine at School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3800, Australia;
| | - Yanfei Guo
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China;
| | - Paul Kowal
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Joel Negin
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (G.M.); (J.N.)
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25
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Luo M, Ding D, Bauman A, Negin J, Phongsavan P. Social engagement pattern, health behaviors and subjective well-being of older adults: an international perspective using WHO-SAGE survey data. BMC Public Health 2020; 20:99. [PMID: 31973695 PMCID: PMC6979381 DOI: 10.1186/s12889-019-7841-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social engagement forms the basis of social relationships by providing a sense of belonging, social identity, and fulfillment. Previous research demonstrates that social engagement was associated with positive health behaviors among older adults. However, the results have been different across health-related behaviors, and mostly based on data from high-income countries. For example, studies from the US and UK showed that social engagement was protective against smoking, while others found social engagement encouraged more smoking in many Asian cultures. In this study, we aim to examine the association between social engagement and a range of health-related behaviors and subjective well-being among older adults in six low- to middle-income countries. METHODS Data from the WHO Study on Global Ageing and Adult Health (SAGE Wave 1) were used. A total of 33,338 individuals aged 50 and older in China, Russia, India, Ghana, South Africa, and Mexico were included. Social engagement, tobacco use, alcohol consumption, fruit and vegetable intake, physical activity, sedentary behavior, sleep duration, depression symptoms, self-rated health status, and quality of life were assessed using established self-reported measures. Multiple logistic regression models were used to examine the relationship between social engagement and nine outcome variables, adjusting for socio-demographic characteristics. RESULTS Lower levels of social engagement were positively related to physical inactivity, prolonged sitting time, unhealthy sleep duration, perceived depression, poor self-rated health, and low quality of life. However, the associations between social engagement and tobacco use, excessive drinking, and insufficient fruit and vegetable intake were mixed across countries. CONCLUSION This international study found high social engagement as a potential health-promoting factor in some low- to middle-income countries. Although the impacts of social engagement on tobacco and alcohol use and diet were complicated and culture-specific, interventions at both individual and community levels should encourage healthy lifestyles through positive social engagement.
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Affiliation(s)
- Mengyun Luo
- The University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health and Charles Perkins Centre, Sydney, NSW 2006 Australia
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025 People’s Republic of China
| | - Ding Ding
- The University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health and Charles Perkins Centre, Sydney, NSW 2006 Australia
| | - Adrian Bauman
- The University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health and Charles Perkins Centre, Sydney, NSW 2006 Australia
| | - Joel Negin
- The University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health and Charles Perkins Centre, Sydney, NSW 2006 Australia
| | - Philayrath Phongsavan
- The University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health and Charles Perkins Centre, Sydney, NSW 2006 Australia
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26
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Al-Ansari F, Al Ansari M, Hill-Cawthorne GA, Abdulzahra MS, Al-Ansari MB, Al-Ansari B, Rashid H, Negin J, Conigrave KM. Arbaeen public health concerns: A pilot cross-sectional survey. Travel Med Infect Dis 2019; 35:101546. [PMID: 31838209 DOI: 10.1016/j.tmaid.2019.101546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/07/2019] [Accepted: 12/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Arbaeen is an annual religious procession in Iraq with an estimated 17-20 million participants. Public health risks associated with such a mass gathering can be serious at both local and global levels. This is the first quantitative examination of risk factors for, and symptoms of, infectious disease among Arbaeen participants. METHODS A cross-sectional survey was conducted of a convenience sample of 191 Arbaeen participants in 2017. Interviewers administered a structured questionnaire. Questions included food sources, preventive measures used and symptoms of infectious diseases during the procession. RESULTS Data were collected for 191 participants (143 males, 58 females). The most prevalent symptoms were respiratory (runny nose: 22.6%, cough: 22.5%). Diarrhoea was reported by 12.6% of participants, with a strong association with high-income country origin and eating (commercial) street food (odds ratios 6.1 and 4.1, respectively, p < 0.05). All symptoms investigated, except breathlessness, were more prevalent in high-income country participants (p < 0.05). CONCLUSION Street food and high-income country origin were independent risk factors for respiratory or gastrointestinal infection symptoms in this sample of Arbaeen participants. However, these results cannot be generalised due to possible selection bias. Further studies are required to inform policy development and health system preparedness to reduce Arbaeen-associated health risks.
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Affiliation(s)
- Farah Al-Ansari
- University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, 2006, NSW, Australia.
| | - Mustafa Al Ansari
- University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, 2006, NSW, Australia; University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, 2006, NSW, Australia
| | - Grant A Hill-Cawthorne
- University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, 2006, NSW, Australia
| | | | | | - Basma Al-Ansari
- University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, 2006, NSW, Australia
| | - Harunor Rashid
- The Children's Hospital at Westmead, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Westmead, 2145, NSW, Australia; University of Sydney, Faculty of Medicine and Health, Children's Hospital Westmead Clinical School, The Discipline of Child and Adolescent Health, Westmead, 2145, NSW, Australia
| | - Joel Negin
- University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, 2006, NSW, Australia
| | - Katherine M Conigrave
- Royal Prince Alfred Hospital, Drug Health Services, Missenden Rd, Camperdown, 2050, NSW, Australia; University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, 2006, NSW, Australia
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27
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Humphries N, Connell J, Negin J, Buchan J. Tracking the leavers: towards a better understanding of doctor migration from Ireland to Australia 2008-2018. Hum Resour Health 2019; 17:36. [PMID: 31138211 PMCID: PMC6540407 DOI: 10.1186/s12960-019-0365-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/11/2019] [Indexed: 05/28/2023]
Abstract
BACKGROUND The recession of 2008 triggered large-scale emigration from Ireland. Australia emerged as a popular destination for Irish emigrants and for Irish-trained doctors. This paper illustrates the impact that such an external shock can have on the medical workforce and demonstrates how cross-national data sharing can assist the source country to better understand doctor emigration trends. METHOD This study draws on Australian immigration, registration and census data to highlight doctor migration flows from Ireland to Australia, 2008-2018. FINDINGS General population migration from Ireland to Australia increased following the 2008 recession, peaked between 2011 and 2013 before returning to pre-2008 levels by 2014, in line with the general economic recovery in Ireland. Doctor emigration from Ireland to Australia did not follow the same pattern, but rather increased in 2008 and increased year on year since 2014. In 2018, 326 Irish doctors obtained working visas for Australia. That doctor migration is out of sync with general economic conditions in Ireland and with wider migration patterns indicates that it is influenced by factors other than evolving economic conditions in Ireland, perhaps factors relating to the health system. DISCUSSION Doctor emigration from Ireland to Australia has not decreased in line with improved economic conditions in Ireland, indicating that other factors are driving and sustaining doctor emigration. This paper considers some of these factors. Largescale doctor emigration has significant implications for the Irish health system; representing a brain drain of talent, generating a need for replacement migration and a high dependence on internationally trained doctors. This paper illustrates how source countries, such as Ireland, can use destination country data to inform an evidence-based policy response to doctor emigration.
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Affiliation(s)
- Niamh Humphries
- Research Department, Royal College of Physicians of Ireland, Dublin, Ireland
| | - John Connell
- School of Geosciences, University of Sydney, Sydney, Australia
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
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28
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Palagyi A, Marais BJ, Abimbola S, Topp SM, McBryde ES, Negin J. Health system preparedness for emerging infectious diseases: A synthesis of the literature. Glob Public Health 2019; 14:1847-1868. [PMID: 31084412 DOI: 10.1080/17441692.2019.1614645] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This review reflects on what the literature to date has taught us about how health systems of low- and middle-income countries (LMICs) respond to emerging infectious disease (EID) outbreaks. These findings are then applied to propose a conceptual framework characterising an EID prepared health system. A narrative synthesis approach was adopted to explore the key elements of LMIC health systems during an EID outbreak. Overarching themes ('core health system constructs') and sub-themes ('elements') relevant to EID preparedness were extracted from 49 peer-reviewed articles. The resulting conceptual framework recognised six core constructs: four focused on material resources and structures (i.e. system 'hardware'), including (i) Surveillance, (ii) Infrastructure and medical supplies, (iii) Workforce, and (iv) Communication mechanisms; and two focused on human and institutional relationships, values and norms (i.e. system 'software'), including (i) Governance, and (ii) Trust. The article reinforces the interconnectedness of the traditional health system building blocks to EID detection, prevention and response, and highlights the critical role of system 'software' (i.e. governance and trust) in enabling LMIC health systems to achieve and maintain EID preparedness. The review provides recommendations for refining a set of indicators for an 'optimised' health system EID preparedness tool to aid health system strengthening efforts.
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Affiliation(s)
- Anna Palagyi
- Faculty of Medicine and Health, The University of Sydney School of Public Health , Sydney , Australia.,The George Institute for Global Health, University of New South Wales , Sydney , Australia
| | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity and the Children's Hospital at Westmead, University of Sydney , Sydney , Australia
| | - Seye Abimbola
- Faculty of Medicine and Health, The University of Sydney School of Public Health , Sydney , Australia.,The George Institute for Global Health, University of New South Wales , Sydney , Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University , Townsville , Australia.,Nossal Institute for Global Health, University of Melbourne , Melbourne , Australia
| | - Emma S McBryde
- Australian Institute of Tropical Health & Medicine, James Cook University , Townsville , Australia
| | - Joel Negin
- Faculty of Medicine and Health, The University of Sydney School of Public Health , Sydney , Australia
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29
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Hill-Cawthorne G, Negin J, Capon T, Gilbert GL, Nind L, Nunn M, Ridgway P, Schipp M, Firman J, Sorrell TC, Marais BJ. Advancing Planetary Health in Australia: focus on emerging infections and antimicrobial resistance. BMJ Glob Health 2019; 4:e001283. [PMID: 31139446 PMCID: PMC6509602 DOI: 10.1136/bmjgh-2018-001283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/19/2019] [Accepted: 02/25/2019] [Indexed: 02/05/2023] Open
Abstract
With rising population numbers, anthropogenic changes to our environment and unprecedented global connectivity, the World Economic Forum ranks the spread of infectious diseases second only to water crises in terms of potential global impact. Addressing the diverse challenges to human health and well-being in the 21st century requires an overarching focus on ‘Planetary Health’, with input from all sectors of government, non-governmental organisations, academic institutions and industry. To clarify and advance the Planetary Health agenda within Australia, specifically in relation to emerging infectious diseases (EID) and antimicrobial resistance (AMR), national experts and key stakeholders were invited to a facilitated workshop. EID themes identified included animal reservoirs, targeted surveillance, mechanisms of emergence and the role of unrecognised human vectors (the ‘invisible man’) in the spread of infection. Themes related to AMR included antimicrobial use in production and companion animals, antimicrobial stewardship, novel treatment approaches and education of professionals, politicians and the general public. Effective infection control strategies are important in both EID and AMR. We provide an overview of key discussion points, as well as important barriers identified and solutions proposed.
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Affiliation(s)
- Grant Hill-Cawthorne
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), The University of Sydney, Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joel Negin
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tony Capon
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gwendolyn L Gilbert
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), The University of Sydney, Sydney, New South Wales, Australia
| | - Lee Nind
- Department of Agriculture and Water Resources, Canberra, Australian Capital Territory, Australia
| | - Michael Nunn
- Australian Centre for International Agricultural Research, Canberra, Australian Capital Territory, Australia
| | - Patricia Ridgway
- Research Policy and Translation, National Health and Medical Research Council (NHMRC), Canberra, Australian Capital Territory, Australia
| | - Mark Schipp
- Department of Agriculture and Water Resources, Canberra, Australian Capital Territory, Australia
| | - Jenny Firman
- Department of Health, Office of Health Protection, Canberra, Australian Capital Territory, Australia
| | - Tania C Sorrell
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), The University of Sydney, Sydney, New South Wales, Australia
| | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), The University of Sydney, Sydney, New South Wales, Australia
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Abstract
The adult obesity prevalence in Samoa is the third highest globally, and diet is a significant contributor. Our study aimed to explore the behavioral and demographic factors which influence diets in Samoa. The most important findings for strategic policy design were: i) cost was the most important reason for food choice, ii) participants reported high rates of consumption of sugary and fatty energy foods - along with high rates of food insecurity, and iii) the food frequency questionnaire findings from our small sample are in line with the existing evidence that the nutrition transition is underway in Samoa.
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Affiliation(s)
- Penny Farrell
- a Sydney School of Public Health , The University of Sydney , Sydney , Australia
| | - Anne Marie Thow
- b Menzies Centre for Health Policy , The University of Sydney , Sydney , Australia
| | - Suzie Schuster
- c Department of Education , National University of Samoa , Apia , Samoa
| | - Pavle Vizintin
- d National University of Samoa Chancellery, Le Papaigalagala Campus , To'omatagi , Samoa
| | - Joel Negin
- a Sydney School of Public Health , The University of Sydney , Sydney , Australia
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Chol C, Negin J, Agho KE, Cumming RG. Women's autonomy and utilisation of maternal healthcare services in 31 Sub-Saharan African countries: results from the demographic and health surveys, 2010-2016. BMJ Open 2019; 9:e023128. [PMID: 30867200 PMCID: PMC6429737 DOI: 10.1136/bmjopen-2018-023128] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine the association between women's autonomy and the utilisation of maternal healthcare services across 31 Sub-Saharan African countries. DESIGN, SETTING AND PARTICIPANTS We analysed the Demographic and Health Survey (DHS) (2010-2016) data collected from married women aged 15-49 years. We used four DHS measures related to women's autonomy: attitude towards domestic violence, attitude towards sexual violence, decision making on spending of household income made by the women solely or jointly with husbands and decision making on major household purchases made by the women solely or jointly with husbands. We used multiple logistic regression analyses to examine the association between women's autonomy and the utilisation of maternal healthcare services adjusted for five potential confounders: place of residence, age at birth of the last child, household wealth, educational attainment and working status. Adjusted ORs (aORs) and 95% CI were used to produce the forest plots. OUTCOME MEASURES The primary outcome measures were the utilisation of ≥4 antenatal care visits and delivery by skilled birth attendants (SBA). RESULTS Pooled results for all 31 countries (194 883 women) combined showed weak statistically significant associations between all four measures of women's autonomy and utilisation of maternal healthcare services (aORs ranged from 1.07 to 1.15). The strongest associations were in the Southern African region. For example, the aOR for women who made decisions on household income solely or jointly with husbands in relation to the use of SBAs in the Southern African region was 1.44 (95% CI 1.21 to 1.70). Paradoxically, there were three countries where women with higher autonomy on some measures were less likely to use maternal healthcare services. For example, the aOR in Senegal for women who made decisions on major household purchases solely or jointly with husbands in relation to the use of SBAs (aOR=0.74 95% CI 0.59 to 0.94). CONCLUSION Our results revealed a weak relationship between women's autonomy and the utilisation of maternal healthcare services. More research is needed to understand why these associations are not stronger.
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Affiliation(s)
- Chol Chol
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joel Negin
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kingsley Emwinyore Agho
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Robert Graham Cumming
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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32
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Farrell P, Thow AM, Abimbola S, Faruqui N, Negin J. How food insecurity could lead to obesity in LMICs: When not enough is too much: a realist review of how food insecurity could lead to obesity in low- and middle-income countries. Health Promot Int 2019; 33:812-826. [PMID: 28541498 DOI: 10.1093/heapro/dax026] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
While food insecurity is a well-known cause of under-nutrition and stunting, in recent decades it has also been linked with obesity. Understanding and thus minimising the risk factors for obesity in low- and middle-income country contexts, which often lack the health system capacity to treat the consequent obesity-related illnesses, is crucial. This study adopted realist review methodology because it enabled us to analyse and organise the evidence from low- and middle-income countries into a coherent scheme. By comparing this evidence to existing theory on food security and nutrition, we aimed to provide a richer understanding of the nuances and the socio-demographic nature of the food insecurity-obesity relationship. The review generated 13 peer-reviewed articles which studied the relationship between food insecurity and overweight/obesity in low- and middle-income countries. Affordability of high-energy, processed foods was identified as a main mechanism, which determined whether or not food insecurity leads to obesity in low- and middle-income countries. Other mechanisms identified were: quantity and diversity of food consumed; spatial-temporal access to nutritious food; inter-personal food choice and distribution; and non-dietary behaviours. Despite the limited empirical evidence available, our review presents meaningful and policy-relevant insights into the food insecurity-obesity relationship in from low- and middle-income countries. Interventions to address the food insecurity-obesity link need to address diet quality, and demand a broad understanding across a variety of experiences.
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Affiliation(s)
- Penny Farrell
- Sydney School of Public Health, A27 Edward Ford Building, Fisher Road, The University of Sydney, Sydney, NSW, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, D17 Charles Perkins Centre, University of Sydney, NSW, Australia
| | - Seye Abimbola
- Sydney School of Public Health, A27 Edward Ford Building, Fisher Road, The University of Sydney, Sydney, NSW, Australia
| | - Neha Faruqui
- Sydney School of Public Health, A27 Edward Ford Building, Fisher Road, The University of Sydney, Sydney, NSW, Australia
| | - Joel Negin
- Sydney School of Public Health, A27 Edward Ford Building, Fisher Road, The University of Sydney, Sydney, NSW, Australia
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33
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Matlho K, Randell M, Lebelonyane R, Kefas J, Driscoll T, Negin J. HIV prevalence and related behaviours of older people in Botswana - secondary analysis of the Botswana AIDS Impact Survey (BAIS) IV. Afr J AIDS Res 2019; 18:18-26. [PMID: 30782058 DOI: 10.2989/16085906.2018.1552162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The focus of HIV interventions in Botswana, a country with the second highest prevalence of HIV in the world, remains targeted at those aged 15-49 years despite a growing cohort of older people living with the disease - driven largely by the successful roll-out of antiretroviral therapy (ART). Primarily utilising the Botswana AIDS Impact Survey IV, we set out to examine HIV related characteristics and behaviours of this often ignored older cohort (50-64 years) relative to younger (25-49 years) adults. Analysis revealed that more than 80% of older people living with HIV were on ART. HIV prevalence among this older cohort was 24.6% in 2013 compared to 35.1% among the younger cohort, p < 0.0001. Prevalence in older adults was higher among older males (27.8%) than females (21.9%), p = 0.02. Furthermore, 58.9% of older adults acknowledged being sexually active, with 59.0% of these admitting to inconsistent condom use during sexual intercourse. In addition to this low condom usage, older men (6.0%) were significantly more likely to be unaware of their HIV-positive status than older women (3.0%), p = 0.002. While HIV prevalence showed a dramatic increase among older men over time (17.2% in 2004, to 23.4% in 2008, to 27.8% in 2013), the trend was flatter among older women (16.3% in 2004, to 22.4% in 2008, to 21.9% in 2013). These trends are likely attributable to a large increase in ART coverage and uptake. Going forward, more targeted interventions acknowledging the ageing epidemic are important to consider.
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Affiliation(s)
- Kabo Matlho
- a School of Public Health , University of Sydney , Sydney , Australia
| | - Madeleine Randell
- a School of Public Health , University of Sydney , Sydney , Australia
| | | | - Joseph Kefas
- c National AIDS Coordinating Agency , Gaborone , Botswana
| | - Tim Driscoll
- a School of Public Health , University of Sydney , Sydney , Australia
| | - Joel Negin
- a School of Public Health , University of Sydney , Sydney , Australia
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Schatz E, Seeley J, Negin J, Weiss HA, Tumwekwase G, Kabunga E, Nalubega P, Mugisha J. "For us here, we remind ourselves": strategies and barriers to ART access and adherence among older Ugandans. BMC Public Health 2019; 19:131. [PMID: 30704445 PMCID: PMC6357505 DOI: 10.1186/s12889-019-6463-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 01/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Very little is known about the barriers and facilitators to antiretroviral therapy (ART) access and adherence among older Africans. Most studies on ART have focused on individuals who are 15-49 years of age. METHODS We used in-depth interviews with 40 persons living with HIV, aged 50 to 96 years, who had either initiated ART (n = 26) or were waiting to initiate ART (n = 14), to explore barriers and facilitators to ART access and adherence in rural Uganda. RESULTS Guided by the Andersen Behavior Model, thematic content analysis highlighted 21 primary factors related to environment, patient and health behavior. Nine of the factors were common to both access and adherence, the remaining 12 were evenly split between access and adherence. Transportation costs, food insecurity, and healthcare workers' knowledge, attitudes and behaviors were key barriers. CONCLUSIONS These barriers were similar to those outlined for younger populations in other studies, but were compounded by age. Despite barriers, either due to the exceptional nature of HIV care or overreporting, both ART access and self-reported adherence were better than expected. Older persons living with HIV highlighted health care needs for non-HIV-related illnesses, suggesting while HIV care is adequate, care for the ailments of "old age" is lagging.
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Affiliation(s)
- Enid Schatz
- Department of Health Sciences, University of Missouri, Columbia, 535 Clark Hall, Columbia, MO, 65211, USA.
| | - Janet Seeley
- Department of Global Health, London School of Hygiene and Tropical Medicine, London, UK.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Grace Tumwekwase
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Elizabeth Kabunga
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Phiona Nalubega
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Joseph Mugisha
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
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Marais BJ, Williams S, Li A, Ofrin R, Merianos A, Negin J, Firman J, Davies R, Sorrell T. Improving emergency preparedness and response in the Asia-Pacific. BMJ Glob Health 2019; 4:e001271. [PMID: 30775010 PMCID: PMC6352770 DOI: 10.1136/bmjgh-2018-001271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Ben J Marais
- Centre for Research Excellence in Emerging Infectious Diseases (CREID) and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie Williams
- Department of Foreign Affairs and Trade, Indo-Pacific Centre for Health Security, Canberra, Australia
| | - Ailan Li
- Division of Health Security and Emergencies, WHO Health Emergencies Programme, WHO Western Pacific Regional Office, Manila, Philippines
| | - Roderico Ofrin
- WHO Health Emergencies Programme, WHO South-East Asia Regional Office, New Delhi, India
| | - Angela Merianos
- Pacific Health Security, WHO Communicable Disease and Climate Change Division, Suva, Fiji
| | - Joel Negin
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jenny Firman
- Department of Health, Office of Health Protection, Canberra, Australia
| | - Robin Davies
- Department of Foreign Affairs and Trade, Indo-Pacific Centre for Health Security, Canberra, Australia
| | - Tania Sorrell
- Centre for Research Excellence in Emerging Infectious Diseases (CREID) and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
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36
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Jenkins A, Capon A, Negin J, Marais B, Sorrell T, Parkes M, Horwitz P. Watersheds in planetary health research and action. Lancet Planet Health 2018; 2:e510-e511. [PMID: 30526933 DOI: 10.1016/s2542-5196(18)30228-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/09/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Aaron Jenkins
- School of Public Health, University of Sydney, Westmead, NSW 2145, Australia; Centre for Ecosystem Management, Edith Cowan University, Joondalup, Australia.
| | - Anthony Capon
- School of Public Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Joel Negin
- School of Public Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Ben Marais
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Tania Sorrell
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Margot Parkes
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - Pierre Horwitz
- Centre for Ecosystem Management, Edith Cowan University, Joondalup, Australia
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37
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Mugisha JO, Schatz EJ, Hansen C, Leary E, Negin J, Kowal P, Seeley J. Social engagement and survival in people aged 50 years and over living with HIV and without HIV in Uganda: a prospective cohort study. Afr J AIDS Res 2018; 17:333-340. [PMID: 30466365 DOI: 10.2989/16085906.2018.1542322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined the association between social engagement and survival in people with or without HIV aged 50 years and over in Uganda. We analysed two waves of a survey from two sites in Uganda to assess predictors of mortality between waves. The first wave was conducted between 2009 and 2010 while the second wave was conducted between 2012 and 2013. A standardised questionnaire adapted from the World Health Organization study on global AGEing and adult health (SAGE) was administered through face-to-face interviews at both survey waves. Cox proportional hazards models and Nelson-Aalen cumulative hazards functions were used to investigate associations between the strength of participants' social ties, using distance and intimacy metrics, and their social engagement with mortality between waves. Of the original 510 participants, 63 (12.3%) died between waves. Being more socially engaged and able to provide in-kind or financial contributions to family or friends were protective. After adjusting for covariates neither social tie measure was predictive of mortality. There were no significant differences in social engagement and survival by HIV status. Further research is needed in African settings on the relationship between social relationships and subsequent mortality in older adults to assess if improved social relationships could moderate mortality.
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Affiliation(s)
- Joseph O Mugisha
- a Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine , Uganda Research Unit on AIDS , Entebbe , Uganda.,b Department of Health Sciences , University of Missouri , Columbia , Missouri , USA
| | - Enid J Schatz
- b Department of Health Sciences , University of Missouri , Columbia , Missouri , USA
| | - Christian Hansen
- a Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine , Uganda Research Unit on AIDS , Entebbe , Uganda.,g Tropical Epidemiology Group , London School of Hygiene and Tropical Medicine , London , UK
| | - Emily Leary
- c Biostatistics and Research Design Unit, School of Medicine , University of Missouri , Columbia , USA
| | - Joel Negin
- d School of Public Health , University of Sydney , New South Wales , Australia
| | - Paul Kowal
- f World Health Organization study on global AGEing and adult health , WHO , Geneva , Switzerland
| | - Janet Seeley
- a Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine , Uganda Research Unit on AIDS , Entebbe , Uganda.,e Department of Global Health and Development , London School of Hygiene and Tropical Medicine , London , UK
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38
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Topp SM, Abimbola S, Joshi R, Negin J. How to assess and prepare health systems in low- and middle-income countries for integration of services-a systematic review. Health Policy Plan 2018; 33:298-312. [PMID: 29272396 PMCID: PMC5886169 DOI: 10.1093/heapol/czx169] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 12/26/2022] Open
Abstract
Despite growing support for integration of frontline services, a lack of information about the pre-conditions necessary to integrate such services hampers the ability of policy makers and implementers to assess how feasible or worthwhile integration may be, especially in low- and middle-income countries (LMICs). We adopted a modified systematic review with aspects of realist review, including quantitative and qualitative studies that incorporated assessment of health system preparedness for and capacity to implement integrated services. We searched Medline via Ovid, Web of Science and the Cochrane library using terms adapted from Dudley and Garner’s systematic review on integration in LMICs. From an initial list of 10 550 articles, 206 were selected for full-text review by two reviewers who independently reviewed articles and inductively extracted and synthesized themes related to health system preparedness. We identified five ‘context’ related categories and four health system ‘capability’ themes. The contextual enabling and constraining factors for frontline service integration were: (1) the organizational framework of frontline services, (2) health care worker preparedness, (3) community and client preparedness, (4) upstream logistics and (5) policy and governance issues. The intersecting health system capabilities identified were the need for: (1) sufficiently functional frontline health services, (2) sufficiently trained and motivated health care workers, (3) availability of technical tools and equipment suitable to facilitate integrated frontline services and (4) appropriately devolved authority and decision-making processes to enable frontline managers and staff to adapt integration to local circumstances. Moving beyond claims that integration is defined differently by different programs and thus unsuitable for comparison, this review demonstrates that synthesis is possible. It presents a common set of contextual factors and health system capabilities necessary for successful service integration which may be considered indicators of preparedness and could form the basis for an ‘integration preparedness tool’.
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Affiliation(s)
- Stephanie M Topp
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4812, Australia.,Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Seye Abimbola
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Rohina Joshi
- The George Institute, University of New South Wales, NSW 2042, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Joel Negin
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
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Matlho K, Lebelonyane R, Driscoll T, Negin J. Policy-maker attitudes to the ageing of the HIV cohort in Botswana. SAHARA J 2018; 14:31-37. [PMID: 28922992 PMCID: PMC5639611 DOI: 10.1080/17290376.2017.1374879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: The roll out of antiretroviral therapy in Botswana, as in many countries with near universal access to treatment, has transformed HIV into a complex yet manageable chronic condition and has led to the emergence of a population aging with HIV. Although there has been some realization of this development at international level, no clear defined intervention strategy has been established in many highly affected countries. Therefore we explored attitudes of policy-makers and service providers towards HIV among older adults (50 years or older) in Botswana. Methods: We conducted qualitative face-to-face interviews with 15 consenting personnel from the Ministry of Health, medical practitioners and non-governmental organizations involved in the administration of medical services, planning, strategies and policies that govern social, physical and medical intervention aimed at people living with HIV and health in general. The Shiffman and Smith Framework of how health issues become a priority was used as a guide for our analysis. Results: Amidst an HIV prevalence of 25% among those aged 50–64 years, the respondents passively recognized the predicament posed by a population aging with HIV but exhibited a lack of comprehension and acknowledgement of the extent of the issue. An underlying persistent ageist stigma regarding sexual behaviour existed among a number of interviewees. Respondents also noted the lack of defined geriatric care within the provision of the national health care system. There seemed, however, to be a debate among the policy strategists and care providers as to whether the appropriate response should be specifically towards older adults living with HIV or rather to improve health services for older adults more generally. Respondents acknowledged that health systems in Botswana are still configured for individual diseases rather than coexisting chronic diseases even though it has become increasingly common for patients, particularly the aged, to have two or more medical conditions at the same time. Conclusions: HIV among older adults remains a low priority among policy-makers in Botswana but is at least now on the agenda. Action will require more concerted efforts to recognize HIV as a lifelong infection and putting greater emphasis on targeted care for older adults, focussing on multimorbidity.
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Affiliation(s)
- Kabo Matlho
- a PhD Candidate (Medicine) at School of Public Health, Sydney Medical School , University of Sydney , Sydney , Australia
| | - Refelwetswe Lebelonyane
- b MD, MPH, is Principal Researcher and Coordinator of the Botswana Combination Prevention Project - Ministry of Health , Gaborone , Botswana
| | - Tim Driscoll
- c MD, PhD, FAFOEM, FAFPHM, is a Professor of Epidemiology and Occupational Medicine at School of Public Health, Sydney Medical School , University of Sydney , Sydney , Australia
| | - Joel Negin
- d MIA, PhD (The Main Supervisor), is the Associate Professor of International Public Health, Head of School, School of Public Health, Sydney Medical School , University of Sydney , Sydney , Australia
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Sarma S, Nemser B, Cole-Lewis H, Kaonga N, Negin J, Namakula P, Ohemeng-Dapaah S, Kanter AS. Effectiveness of SMS Technology on Timely Community Health Worker Follow-Up for Childhood Malnutrition: A Retrospective Cohort Study in sub-Saharan Africa. Glob Health Sci Pract 2018; 6:345-355. [PMID: 29959274 PMCID: PMC6024632 DOI: 10.9745/ghsp-d-16-00290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 05/08/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Millennium Villages Project facilitated technology-based health interventions in rural under-resourced areas of sub-Saharan Africa. Our study examined whether data entry using SMS compared with paper forms by community health workers (CHWs) led to higher proportion of timely follow-up visits for malnutrition screening in under-5 children in Ghana, Rwanda, Senegal, and Uganda. METHODS Children under 5 years were screened for malnutrition every 90 days by CHWs using mid-upper arm circumference (MUAC) readings. CHWs used either SMS texts or paper forms to enter MUAC data. Reminder texts were sent at 15 days before follow-up was needed. Chi-square tests assessed proportion of timely follow-up visits within 90 days between SMS and paper groups. Logistic regression analysis was conducted in a step-wise multivariate model. Post-hoc power calculations were conducted to verify strength of associations. RESULTS SMS data entry was associated with a higher proportion of timely malnutrition follow-up visits compared with paper forms across all sites. The association was strongest with consistent SMS use over consecutive visits. SMS use at the first of 2 consecutive visits was most effective, highlighting the importance of SMS reminder alerts. CONCLUSIONS SMS technology with reminders increased timely CHW malnutrition screening visits for under-5 children in Ghana, Rwanda, Senegal, and Uganda, highlighting the importance of such technology for improving health worker behavior in low-resource settings.
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Affiliation(s)
- Shohinee Sarma
- Mailman School of Public Health, Columbia University, New York, NY, USA. Now with McMaster University, Hamilton, Canada.
| | - Bennett Nemser
- Millennium Villages Project, Earth Institute, Columbia University. Now with UNICEF, New York, NY, USA. Now with University of the Western Cape, Cape Town, South Africa
| | - Heather Cole-Lewis
- Yale University School of Epidemiology and Public Health, New Haven, CT, USA. Now with Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Nadi Kaonga
- Tufts University School of Medicine, Boston, MA, USA
| | - Joel Negin
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Patricia Namakula
- Millennium Villages Project, Earth Institute, Columbia University. Now with Columbia Global Centers Africa, Nairobi, Kenya
| | - Seth Ohemeng-Dapaah
- Millennium Villages Project, Earth Institute, Columbia University. Now with Millennium Promise, Dakar, Senegal
| | - Andrew S Kanter
- Millennium Villages Project, Earth Institute, Columbia University, New York, NY, USA. Now with Departments of Biomedical Informatics and Epidemiology, Columbia University, New York, NY, USA
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41
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Chol C, Hunter C, Debru B, Haile B, Negin J, Cumming RG. Stakeholders' perspectives on facilitators of and barriers to the utilisation of and access to maternal health services in Eritrea: a qualitative study. BMC Pregnancy Childbirth 2018; 18:35. [PMID: 29351782 PMCID: PMC5775611 DOI: 10.1186/s12884-018-1665-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 01/09/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Wars affect maternal health services by destroying health systems. Eritrea experienced two wars with neighbouring Ethiopia. Despite this, the maternal mortality ratio (MMR) in Eritrea fell by 69% from 1590 per 100,000 live births in 1990 to 501 in 2015. This study aimed to examine facilitators of and barriers to the utilisation of and access to maternal health services in Eritrea. METHODS Using in-depth interviews and field observations for data collection, this qualitative study was conducted in five healthcare facilities in Asmara, the capital of Eritrea, in February and March 2016. The participants were: women (n = 40), husbands (n = 5), healthcare providers (n = 10), and decision makers (n = 5). RESULTS There were two perceived facilitators of utilisation of and access to maternal health services: health education (related to the WHO health service delivery building blocks) and improvement in gender equality driven by the role played by Eritrean women as combatants during the War of Independence (1961-1991). The only perceived barrier was poor quality of care due to lack of ultrasound machines, short clinic opening hours, and shortage of healthcare workers (related to the WHO health workforce building block). CONCLUSION This study assessed women and their husbands/partners' perceptions and the possible effects of contemporary Eritrean culture and the history of war on the utilisation of and access to maternal health services in the country. As well, we examined healthcare providers' and decision makers' perspectives. The two key facilitators of women's utilisation of and access to maternal health services were health education and women's empowerment driven by their role as combatants during the War of Independence. One main barrier was poor quality of care due to lack of ultrasound machines, short clinic opening hours, and a shortage of healthcare workers. As only a limited number of qualitative studies have been published about maternal health services in war-affected sub-Saharan African countries, our findings regarding health education and women's empowerment could be considered in other war-affected countries similar to Eritrea. Nevertheless, further research is needed to investigate our findings - particularly regarding female empowerment driven by women's role in combat in relation to their maternal health.
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Affiliation(s)
- Chol Chol
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Cynthia Hunter
- Senior Lecturer, School of Public Health, The University of Sydney, Sydney, Australia
| | - Berhane Debru
- Director General of Research and Human Resource Development, Ministry of Health, Asmara, Eritrea
| | - Berhana Haile
- Director of Family and Community Health, Ministry of Health, Asmara, Eritrea
| | - Joel Negin
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Robert G. Cumming
- School of Public Health, The University of Sydney, Sydney, Australia
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Chol C, Negin J, Garcia-Basteiro A, Gebrehiwot TG, Debru B, Chimpolo M, Agho K, Cumming RG, Abimbola S. Health system reforms in five sub-Saharan African countries that experienced major armed conflicts (wars) during 1990-2015: a literature review. Glob Health Action 2018; 11:1517931. [PMID: 30270772 PMCID: PMC7011843 DOI: 10.1080/16549716.2018.1517931] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/23/2018] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has had more major armed conflicts (wars) in the past two decades - including 13 wars during 1990-2015 - than any other part of the world, and this has had an adverse effect on health systems in the region. OBJECTIVE To understand the best health system practices in five SSA countries that experienced wars during 1990-2015, and yet managed to achieve a maternal mortality reduction - equal to or greater than 50% during the same period - according to the Maternal Mortality Estimation Inter-Agency Group (MMEIG). Maternal mortality is a death of a woman during pregnancy, or within 42 days after childbirth - measured as maternal mortality ratio (MMR) per 100,000 live births. DESIGN We conducted a selective literature review based on a framework that drew upon the World Health Organisation's (WHO) six health system building blocks. We searched seven databases, Google Scholar as well as conducting a manual search of sources in articles' reference lists - restricting our search to articles published in English. We searched for terms related to maternal healthcare, the WHO six health system building blocks, and names of the five countries. RESULTS Our study showed three general health system reforms across all five countries that could explain MMR reduction: health systems decentralisation, the innovation related to the WHO workforce health system building block such as training of community healthcare workers, and governments-financing reforms. CONCLUSION Restoring health systems after disasters is an urgent concern, especially in countries that have experienced wars. Our findings provide insight from five war-affected SSA countries which could inform policy. However, since few studies have been conducted concerning this topic, our findings require further research to inform policy, and to help countries rebuild and maintain their health systems resilience.
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Affiliation(s)
- Chol Chol
- School of Public Health, Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
| | - Joel Negin
- School of Public Health, Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
| | | | | | - Berhane Debru
- Research and Human Resource Development, Ministry of Health, Asmara, The State of Eritrea
| | - Maria Chimpolo
- Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola
| | - Kingsley Agho
- School of Science and Health, Western Sydney University, Sydney, Australia
| | - Robert G Cumming
- School of Public Health, Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
| | - Seye Abimbola
- School of Public Health, Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
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Coffman J, Chanda-Kapata P, Marais BJ, Kapata N, Zumla A, Negin J. Tuberculosis among older adults in Zambia: burden and characteristics among a neglected group. BMC Public Health 2017; 17:804. [PMID: 29025403 PMCID: PMC5639764 DOI: 10.1186/s12889-017-4836-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/06/2017] [Indexed: 01/14/2023] Open
Abstract
Background The 2010 Global Burden of Disease estimates show that 57% of all TB deaths globally occurred among adults older than 50 years of age. Few studies document the TB burden among older adults in Southern Africa. We focused on adults older than 55 years to assess the relative TB burden and associated demographic factors. Methods A cross sectional nationally representative TB prevalence survey conducted of Zambian residents aged 15 years and above from 66 clusters across all the 10 provinces of Zambia. Evaluation included testing for TB as well as an in-depth questionnaire. We compared survey data for those aged 55 and older to those aged 15–54 years. Survey results were also compared with 2013 routinely collected programmatic notification data to generate future hypotheses regarding active and passive case finding. Results Among older adults with TB, 30/ 54 (55.6%) were male, 3/27 (11.1%) were HIV infected and 35/54 (64.8%) lived in rural areas. TB prevalence was higher in those aged ≥55 (0.7%) than in the 15–54 age group (0.5%). Males had higher rates of TB across both age groups with 0.7% (15–54) and 1.0% (≥55) compared with females 0.4% (15–54) and 0.6% (≥55). In rural areas, the prevalence of TB was significantly higher among older than younger adults (0.7% vs 0.3%), while the HIV infection rate was among TB patients was lower (11.1% vs 30.8%). The prevalence survey detected TB in 54/7484 (0.7%) of older adults compared to 3619/723,000 (0.5%) reported in 2013 programmatic data. Conclusion High TB rates among older adults in TB endemic areas justify consideration of active TB case finding and prevention strategies.
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Affiliation(s)
- Jenna Coffman
- School of Public Health, University of Sydney, Sydney, Australia.
| | - Pascalina Chanda-Kapata
- Department of Disease Surveillance, Control and Research, Ministry of Health, Lusaka, Zambia
| | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.,Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Nathan Kapata
- National TB and Leprosy Control Program, Lusaka, Zambia
| | - Alimuddin Zumla
- Division of Infection and Immunity, Department of Infection, University College London, London, UK
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
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Abimbola S, Topp SM, Palagyi A, Marais B, Negin J. Global health security: where is the data to inform health system strengthening? BMJ Glob Health 2017; 2:e000481. [PMID: 29082024 PMCID: PMC5656113 DOI: 10.1136/bmjgh-2017-000481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 11/04/2022] Open
Affiliation(s)
- Seye Abimbola
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Anna Palagyi
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Ben Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity and the Children’s Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - Joel Negin
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Abimbola S, Negin J, Martiniuk AL, Jan S. Institutional analysis of health system governance. Health Policy Plan 2017; 32:1337-1344. [DOI: 10.1093/heapol/czx083] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seye Abimbola
- School of Public Health, Sydney Medical School, University of Sydney, NSW 2006, Australia
- National Primary Health Care Development Agency, Abuja, FCT 900247, Nigeria
- The George Institute for Global Health, Sydney, NSW 2042, Australia and
| | - Joel Negin
- School of Public Health, Sydney Medical School, University of Sydney, NSW 2006, Australia
| | - Alexandra L Martiniuk
- School of Public Health, Sydney Medical School, University of Sydney, NSW 2006, Australia
- The George Institute for Global Health, Sydney, NSW 2042, Australia and
- Dalla Lana School of Public Health, University of Toronto, ON M4N 3 M5, Canada
| | - Stephen Jan
- School of Public Health, Sydney Medical School, University of Sydney, NSW 2006, Australia
- The George Institute for Global Health, Sydney, NSW 2042, Australia and
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Porter K, Brennan-Ing M, MacPhail C, Minichiellp V, Karpiak S, Negin J, Venter F. GRANDPARENTS WITH HIV IN SOUTH AFRICA CARING FOR GRANDCHILDREN: VULNERABILITIES AND RESILIENCE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K.E. Porter
- Center on HIV & Aging, ACRIA, Quincy, Massachusetts,
| | | | - C. MacPhail
- University of New England, Armidale, New South Wales, Australia,
| | | | - S. Karpiak
- Center on HIV & Aging, ACRIA, Quincy, Massachusetts,
| | - J. Negin
- University of Sydney, Sydney, New South Wales, Australia
| | - F. Venter
- University of Sydney, Sydney, New South Wales, Australia
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Schatz E, Seeley J, Negin J, Mugisha J, Weiss H. LEAVING NO ONE BEHIND: SUPPORTING ART ACCESS AND ADHERENCE AMONG OLDER UGANDANS LIVING WITH HIV. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E. Schatz
- University of Missouri, Columbia, Missouri,
| | - J. Seeley
- London School of Hygiene and Tropical Medicine, London, United Kingdom,
| | - J. Negin
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia,
| | - J. Mugisha
- Medical Research Council, Entebbe, Uganda
| | - H. Weiss
- London School of Hygiene and Tropical Medicine, London, United Kingdom,
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Sawleshwarkar S, Negin J. A Review of Global Health Competencies for Postgraduate Public Health Education. Front Public Health 2017; 5:46. [PMID: 28373970 PMCID: PMC5357810 DOI: 10.3389/fpubh.2017.00046] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/24/2017] [Indexed: 12/20/2022] Open
Abstract
During the last decade, the literature about global health has grown exponentially. Academic institutions are also exploring the scope of their public health educational programs to meet the demand for a global health professional. This has become more relevant in the context of the sustainable development goals. There have been attempts to describe global health competencies for specific professional groups. The focus of these competencies has been variable with a variety of different themes being described ranging from globalization and health care, analysis and program management, as well as equity and capacity strengthening. This review aims to describe global health competencies and attempts to distill common competency domains to assist in curriculum development and integration in postgraduate public health education programs. A literature search was conducted using relevant keywords with a focus on public health education. This resulted in identification of 13 articles that described global health competencies. All these articles were published between 2005 and 2015 with six from the USA, two each from Canada and Australia, and one each from UK, Europe, and Americas. A range of methods used to describe competency domains included literature review, interviews with experts and employers, surveys of staff and students, and description or review of an academic program. Eleven competency domains were distilled from the selected articles. These competency domains primarily referred to three main aspects, one that focuses on burden of disease and the determinants of health. A second set focuses on core public health skills including policy development, analysis, and program management. Another set of competency domains could be classified as "soft skills" and includes collaboration, partnering, communication, professionalism, capacity building, and political awareness. This review presents the landscape of defined global health competencies for postgraduate public health education. The discussion about use of "global health," "international health," and "global public health" will continue, and academic institutions need to explore ways to integrate these competencies in postgraduate public health programs. This is critical in the post-MDG era that we prepare global public health workforce for the challenges of improving health of the "global" population in the context of sustainable development goals.
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Affiliation(s)
- Shailendra Sawleshwarkar
- Western Sydney Sexual Health Centre, Sydney Medical School Westmead, Marie Bashir Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Joel Negin
- School of Public Health, Sydney Medical School, University of Sydney , Sydney, NSW , Australia
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Arokiasamy P, Uttamacharya, Kowal P, Capistrant BD, Gildner TE, Thiele E, Biritwum RB, Yawson AE, Mensah G, Maximova T, Wu F, Guo Y, Zheng Y, Kalula SZ, Salinas Rodríguez A, Manrique Espinoza B, Liebert MA, Eick G, Sterner KN, Barrett TM, Duedu K, Gonzales E, Ng N, Negin J, Jiang Y, Byles J, Madurai SL, Minicuci N, Snodgrass JJ, Naidoo N, Chatterji S. Chronic Noncommunicable Diseases in 6 Low- and Middle-Income Countries: Findings From Wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (SAGE). Am J Epidemiol 2017; 185:414-428. [PMID: 28399566 PMCID: PMC6075549 DOI: 10.1093/aje/kww125] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 05/01/2016] [Accepted: 05/02/2016] [Indexed: 12/20/2022] Open
Abstract
In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged ≥50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Somnath Chatterji
- Correspondence to Dr. Somnath Chatterji, Division of Information, Evidence and Research, World Health Organization, Avenue Appia, CH 1211 Geneva, Switzerland (e-mail: or )
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Negin J, Dhillon RS. Authors' response — WHO must prioritise its roles and then be positioned and supported to execute effectively. BMJ Glob Health 2017; 2:i5. [PMID: 28609490 PMCID: PMC5418652 DOI: 10.1136/bmjgh-2016-000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ranu S Dhillon
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
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