WHO South-East Asia Journal of Public Health
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   2012| July-September  | Volume 1 | Issue 3  
    Online since May 25, 2017

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India’s progress towards the Millennium Development Goals 4 and 5 on infant and maternal mortality
Hanimi Reddy, Manas R Pradhan, Rohini Ghosh, AG Khan
July-September 2012, 1(3):279-289
DOI:10.4103/2224-3151.207024  PMID:28615554
Background: India is in a race against time to achieve the Millennium Development Goals (MDGs) 4 and 5, to reduce Infant Mortality Rate (IMR) to ‘28’ and Maternal Mortality Ratio (MMR) to ‘109’, by 2015. This study estimates the percent net contribution of the states and the periods in shaping India’s IMR/MMR, and predicts future levels. Methods: A standardized decomposition technique was used to estimate each state’s and period’s percent share in shaping India’s decline in IMR/MMR between two time points. Linear and exponential regression curves were fitted for IMR/MMR values of the past two decades to predict IMR/MMR levels for 2015 for India and for the 15 most populous states. Results: Due to favourable maternal mortality reduction efforts in Bihar/Jharkhand (19%) and Madhya Pradesh/Chhattisgarh (11%), Uttar Pradesh (33%) - India is predicted to attain the MDG-5 target by 2016, assuming the pace of decline observed in MMR during 1997-2009 continues to follow a linear-trend, while the wait may continue until 2023-2024 if the decline follows an exponential- trend. Attaining MDG-4 may take until 2023-2024, due to low acceleration in IMR drop in Bihar/ Jharkhand, Uttar Pradesh/Uttarakhand and Rajasthan. The maximum decline in MMR during 2004-2009 coincided with the launch and uptake of the National Rural Health Mission (NRHM). Conclusions: Even though India as a nation is not predicted to attain all the MDG 4 and 5 targets, at least four of its 15 most populous states are predicted to do so. In the past two decades, MMR reduction efforts were more effective than IMR reduction efforts.
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Dengue fever: Pakistan’s worst nightmare
Muhammad T Shakoor, Samia Ayub, Zunaira Ayub
July-September 2012, 1(3):229-231
DOI:10.4103/2224-3151.207018  PMID:28615548
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A systematic review of the burden of neonatal mortality and morbidity in the ASEAN Region
Hoang T Tran, Lex W Doyle, Katherine J Lee, Stephen M Graham
July-September 2012, 1(3):239-248
DOI:10.4103/2224-3151.207020  PMID:28615550
Neonatal morbidity and mortality are major global public health challenges representing an increasing proportion of overall under-5 child mortality, with the vast majority of neonatal deaths occurring in resource-limited settings. In the Association of Southeast Asian Nations (ASEAN) region, it is estimated that approximately 200 000 neonatal deaths occur annually with reported estimates of the neonatal mortality rate ranging from 1 to over 30 per 1000 live-births, depending on the setting. The aim of this study is to conduct a systematic review of published data on neonatal morbidity and mortality from the ASEAN region over the last 10 years. Very few published studies reporting neonatal morbidity and mortality in this region were found. Importantly, data are available from just a few countries, with an underrepresentation of the most resource-limited settings. The majority of the studies describing mortality and morbidity were retrospective surveys or focussed on a specific cause of neonatal morbidity. Studies included findings from a range of settings, from neonatal intensive care to community settings utilizing verbal autopsy. Therefore, comprehensive and prospective data are needed to inform priorities and potential interventions to improve neonatal care and reduce neonatal mortality in this region.
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Mental health care in Bhutan: policy and issues
Rinchen Pelzang
July-September 2012, 1(3):339-346
DOI:10.4103/2224-3151.207030  PMID:28615560
The Royal Government of Bhutan pursues and promotes a policy of providing well integrated, equitable, cost-effective and balanced health services consisting of preventive, promotive, curative and rehabilitative programmes through its primary health care system. The government has accorded high priority to social sectors like health and education. However, there are serious concerns regarding the quality of care provided to persons with mental disorder, who on this account are subjected to stigma, discrimination and human rights abuses. This article aims to analyse, examine and highlight the policy and issues of the mental healthcare system in Bhutan. It focuses on the mental healthcare system with reference to services, policies and issues and to advocate for better policy development for mental health.
  4 938 119
Oral health status of 12-year-old children with disabilities and controls in Southern India
Bharathi M Purohit, Abhinav Singh
July-September 2012, 1(3):330-338
DOI:10.4103/2224-3151.207029  PMID:28615559
Background: This study explores the association of disabilities and oral health. The aim of the study was to compare and assess oral health status of 12-year-old children with disabilities with healthy controls in Karnataka, Southern India. Methods: A total of 191 schoolchildren with disabilities were examined from 12-year age group. For comparison, 203 healthy children were randomly selected from other government schools. Clinical data were collected on periodontal status, dental caries, treatment needs and dental malocclusion using WHO criteria. A chi-squared test was used to compare between categorical variables. Linear and logistic regression analysis was performed to determine the importance of the factors associated with caries status. Results: Significant differences were noted in the frequency of sugar consumption between subjects with disabilities and their healthy controls. Subjects with disabilities had significantly higher CPI (community periodontal index) scores than their healthy counterparts (p<0.001). Dental caries was present in 89.8% children from special schools as compared with 58.6% from the control group. Mean DMFT (decayed, missing, filled teeth) values for special school children and healthy controls were 2.52 ± 2.61 and 0.61 ± 1.12, respectively. Higher prevalence of malocclusion was seen in subjects with special healthcare needs, with 66.4% having definite malocclusion and 17.4% of controls having malocclusion (p<0.001). The mean values for treatment needs were higher in subjects with disabilities. Regression analysis showed that, type of school, male gender, low frequency of brushing, increased frequency of sugar consumption between meals and dental malocclusion were significantly related to dental caries. Conclusion: Poor oral health of children with disabilities as compared with their healthy controls in terms of periodontal status, dentition status, treatment needs, and dentofacial anomalies was found in our study, which confirms a need for preventive treatment for these children.
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Early discontinuation of intrauterine device in Nepal – a retrospective study
Subash Thapa
July-September 2012, 1(3):309-319
DOI:10.4103/2224-3151.207027  PMID:28615557
Background: The Intrauterine Device (IUD) is the least popular method of contraception for family planning in Nepal. In addition, discontinuation in the early days after insertion is very high and information related to factors affecting early discontinuation is very limited. Methods: A retrospective study was carried out over a 5-year period to determine the associated factors for early discontinuation of the IUD. Insertion, consultation and removal records of IUD users of Kshetrapati Family Welfare Centre, Kathmandu, were reviewed. Removal within 12 months of insertion is defined as early discontinuation. The study participants were selected randomly. Uni-variate and logistic regression analysis were used to analyse predictors of early discontinuation of IUD. Results: The results showed that one fifth of the 230 women using IUD discontinued within the first year of insertion. Side-effects were the main reason for early discontinuation followed by expulsion. Woman's occupational status, husband's occupational status, husband's educational status, experience of side-effects and follow-up practice were associated with early discontinuation of IUD. Menstrual disorder and abnormal vaginal discharge were also associated with early discontinuation. Conclusion and recommendation: Risks of IUD discontinuation were found to be very high during the early days of insertion and side-effects were identified as the major cause. So, proper management of side-effects would be very important to reduce early discontinuation of IUD.
  3 434 44
Factors associated with knowledge about breastfeeding among female garment workers in Dhaka city
Lucen Afrose, Bilkis Banu, Kazi R Ahmed, Khurshida Khanom
July-September 2012, 1(3):249-255
DOI:10.4103/2224-3151.207021  PMID:28615551
Background: Knowledge about breastfeeding among women is very important for healthy children. The present study aims to determine the level of knowledge and factors associated with knowledge on breastfeeding among female garment workers in a selected garment factory in Dhaka city. Methods: A cross-sectional study was conducted among 200 female garment workers in the reproductive age group (15–49 years). Data were collected through a pre-tested questionnaire using the face-to-face interview method. Bivariate and multivariate analysis was done to determine the association between sociodemographic variables and knowledge on breastfeeding. Results: The study showed that, overall the level of knowledge regarding breastfeeding is very poor (88%) among the study subjects. Most of the respondents have very poor knowledge regarding advantages of exclusive breastfeeding (89%) and breastfeeding (100%). In contrast, a majority have good knowledge on duration of exclusive breastfeeding (74%) and breastfeeding (66%). No significant association was found between the knowledge score of breastfeeding with remaining socio-demographic variables like age, marital status, family income and expenditure. Education is significantly (p<0.001) associated with a higher total knowledge score of breastfeeding. Women with secondary level of education had a significantly higher (p<0.001) level of total knowledge score than other categories (illiterate, primary and higher secondary) of education. Conclusion: A large proportion of female garment workers had inadequate knowledge regarding breastfeeding. It is also important that health education on breastfeeding is urgently provided to the female garments workers of Bangladesh.
  2 829 151
Challenges faced by visually disabled people in use of medicines, self-adopted coping strategies and medicine-related mishaps
Chamari L Weeraratne, Sharmika T Opatha, Chamith T Rosa
July-September 2012, 1(3):256-267
DOI:10.4103/2224-3151.207022  PMID:28615552
Background: Difficulties faced by visually disabled people when using medicines, self-adopted coping strategies, and medicine-related mishaps have been under-explored locally and internationally. The objective of this study was to gain insight regarding this long-neglected issue. Methods: A descriptive cross-sectional study, using an interviewer administered questionnaire on 63 visually disabled adults was carried out at a vocational training centre and a school for visually disabled students in Sri Lanka. Results: Among 63 participants, 71% wanted to be independent in medicine use and 79% in spite of difficulties had self-administered medicines. They had difficulty in locating medicines (25.39%), identifying medicines and medicine containers (17.46%), and administering liquid medications (25.39%). These difficulties led to inaccurate dosing (14.28%), missed doses (39.68%), and discontinuation of treatment prematurely (28.57%). Self-adopted coping strategies to overcome these difficulties included using different sized and shaped containers, tying medicines to the attire, and dipping their finger into a measuring cup while measuring liquid medicines. Mishaps related to medicines such as taking vinegar instead of gripe mixture and, putting ear drops into eyes were disclosed. Conclusions: There were many challenges for visually disabled people in taking medicines and some self-adopted coping strategies were inadequate to overcome these.
  2 520 51
Pesticide exposure during pregnancy and low birth weight
Liang Wang, Tiejian Wu, Xuefeng Liu, James L Anderson, Arsham Alamian, Maosun Fu, Jun Li
July-September 2012, 1(3):232-238
DOI:10.4103/2224-3151.207019  PMID:28615549
Background: Limited epidemiologic studies have investigated the effects of pesticide exposure during pregnancy on low birth weight in offspring in rural China. Methods: A survey of a total of 503 women was conducted in Ling county of Shandong Province of China following delivery from 1 November 2009 to 8 February 2010. Results: After adjustment for confounding and compared with no pesticide exposure, multiple logistic regression showed a non-significant increased likelihood of low birth weight for both children of mothers exposed to pesticides when not pregnant (OR = 1.80, 95% CI: 0.62, 5.22) and mothers exposed to pesticides during pregnancy (OR = 2.42, 95% CI: 0.73, 8.08); multiple linear regression showed a non-significant reduced birth weight for both children of mothers exposed to pesticides when not pregnant (β=–0.59, p=0.28) and mothers exposed to pesticides during pregnancy (β=–0.89, p=0.15). Conclusions: Exposure to pesticides during pregnancy was associated with a non-significant increase in low birth weight in this rural Chinese population. Future studies using larger sample sizes and longer follow-up periods are warranted.
  2 679 114
A decade of health-care decentralization in Thailand: what lessons can be drawn?
Pongpisut Jongudomsuk, Jaruayporn Srisasalux
July-September 2012, 1(3):347-356
DOI:10.4103/2224-3151.207031  PMID:28615561
This paper reviews the progress of implementation of health-care decentralization in Thailand since the promulgation of the Decentralization Act 1999, draws lessons learnt and provides recommendations. This review was carried out because of the delay in health-care decentralization, as compared with what was indicated in the Decentralization Action Plan, and to identify the possible causes of delay. The review also analyses other issues that affected implementation of this policy such as consensus on models of health-care decentralization, and other government policies being implemented during the same period. It is recommended that decentralization is not a panacea for health system development and its concept should be applied carefully, based on the country context.
  2 439 87
Screening high-risk population for hypertension and type 2 diabetes among Thais
Kulaya Narksawat, Natkamol Chansatitporn, Panuwat Panket, Jariya Hangsantea
July-September 2012, 1(3):320-329
DOI:10.4103/2224-3151.207028  PMID:28615558
Background: waist circumference (WC) and body mass index (BMI) are simple screening tools for hypertension (HT) and type 2 diabetes (DM). Cutoffs of WC for BMI for Asians have been discussed. This study aimed to assess the accuracy of screening tools and associations of WC, BMI with HT and DM. Methods: Data from the national screening programme for metabolic syndrome conducted in 2010 in 21 provinces in the central region of Thailand were analysed. A total of 10 748 participants aged >35 years were included in the analysis with cutoffs of WC set at 90 cm for men, 80 cm for women, and BMI at 23 kg/m2 for both sexes. Results: WC produced low sensitivity and high specificity among male participants, and moderate sensitivity and specificity among female participants, while BMI produced moderate sensitivity and specificity in both sexes. Significant associations were found among those who had high WC only, high BMI only, and both high WC and BMI with HT and DM in both sexes. (males for HT, OR=1.63, 95%CI: 1.15–2.33, OR=1.22, 95%CI: 1.03–1.44 and OR=2.03, 95%CI: 1.07–2.42; males for DM, OR=1.39, 95%CI: 1.05–1.83), OR=1.77, 95%CI: 1.07–2.94 and OR= 2.05, 95%CI: 1.57–2.69, females for HT, OR=1.69: 95%CI 1.38–2.07, OR=1.32; 95%CI: 1.09–1.60 and OR=2.54, 95%CI: 2.11–2.91; females for DM, OR=1.45, 95%CI: 1.08–1.94, OR=1.45, 95%CI: 1.09–1.91 and OR=1.70, 95%CI: 1.39–2.09). When the cutoff WC was lowered among male participants to 85 cm, sensitivity increased, and significant strengths of associations with HT and DM were nearly the same. Conclusion: For Thailand, WC and BMI with appropriate cutoffs can be effective screening tools to recruit high-risk populations into health promotion programmes. However, WC and BMI should be implemented with other screening tools for other risk factors because of their moderate accuracy.
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Haemoglobinopathies – major associating determinants in prevalence of anaemia among adolescent girl students of Assam, India
Santanu K Sharma, Kanwar Narain, Kangjam R Devi, Padyumna K Mohapatra, Rup K Phukana, Jagadish Mahanta
July-September 2012, 1(3):299-308
DOI:10.4103/2224-3151.207026  PMID:28615556
Prevalence of anaemia among adolescent girl students of Assam, a north-eastern state of India, was evaluated along with its associating determinants. The present study revealed that anaemia is a major public health problem among adolescent girl students of Assam. The overall prevalence of anaemia among adolescent girl students of Assam is as high as 71.5%. Non-nutritional factors such as infection due to helminths was substantially low (24.71%). Ascaris lumbricoides was the most frequent infection (10.6%), followed by Trichuris trichiura (6.2%), and hookworm infestations (3.9%). Polyparasitic infection (A. lumbricoides, T. trichiura and hookworm) was observed in 0.5% of the study subjects. While coinfection due to A. lumbricoides and T. trichiura was 2.3%, A. lumbricoides and hookworm was 1.1% and T. trichiura and hookworm was 0.9%. Serum ferritin level in a subgroup of samples was in the lower normal range. Malaria parasite was not detected in any of the slides. We have observed a gene frequency of 0.188 for βE-globin gene among the adolescent girl students of Assam. The gene frequency for βE-globin gene ranged from 0.071 to 0.266. Statistically significant difference (F=3.471; P=0.001) of mean haemoglobin level was observed in different types of haemoglobin variants. Multiple regression analysis, in a sub-set of samples having information on Hb levels (g/dl), helminthic infestation (A. lumbricoides, T. trichuria and hookworm), haemoglobin type, revealed haemoglobin type (Hb E) was the important determinant of anaemia among adolescent girl students in the present study.
  1 447 50
Newborn survival – the forgotten milestone for achieving MDG 4
Monir Islam
July-September 2012, 1(3):227-228
DOI:10.4103/2224-3151.207017  PMID:28615547
  - 328 48
Promoting antenatal care services for early detection of pre-eclampsia
Tin Tin Thein, Theingi Myint, Saw Lwin, Win Myint Oo, Aung Kyaw Kyaw, Moe Kyaw Myint, Kyaw Zin Thant
July-September 2012, 1(3):290-298
DOI:10.4103/2224-3151.207025  PMID:28615555
A prospective, quasi-experimental study was carried out in 2009 at urban health centres (UHCs) of five townships of Mandalay, Myanmar, to improve the skill of midwives (MWs) in diagnosis and referral of pre-eclampsia (PE) from UHC to the Central Women’s Hospital (CWH) and to enhance the supervision of midwives by lady health visitors (LHVs). The intervention was training on quality antenatal care focusing on PE using an updated training manual. Altogether, 75 health care providers (MWs & LHVs) participated. In this study, data were extracted from patient registers and monthly reports of UHCs and CWH. Interviewers were trained regarding the conduct of semi-structured questionnaires to elicit knowledge and to use checklists in observation of skills in screening of PE, measuring blood pressure and urine protein (dipstick test). A guide for LHVs was also used to obtain data, and data was collected six months prior to and after the intervention. Significant improvements from baseline to endline survey occurred in the knowledge (p<0.001) and skill levels (p<0.001) including skills for screening, measuring blood pressure and urine protein. At CWH, there was an increase in referred cases of PE after the intervention, from 1.25% to 2.56% (p<0.001). In conclusion, this study highlights the early detection of pre-eclampsia by widespread use of quality antenatal care, education and training of health-care providers to improve their performance and increase human resources for health care, in order to enable women in our society to have healthy pregnancies and healthy babies.
  - 551 105
Knowledge of antiretrovirals in preventing parentto-child-transmission of HIV: a cross-sectional study among women living with HIV in Tamil Nadu, India
Saumya Rastogi, Bimal Charles, Asirvatham E Sam
July-September 2012, 1(3):268-278
DOI:10.4103/2224-3151.207023  PMID:28615553
Background: India is amongst the top 10 countries in the world currently with the highest burden of pregnant women living with HIV and nearly 80% of these women do not receive antiretroviral (ARV) drugs to prevent parent-to-child transmission (PTCT) of HIV. The aim of this study was to estimate HIV-infected women’s awareness on PTCT and knowledge of ARVs as a measure to prevent PTCT. Methods: This was a descriptive, cross-sectional study in which a total of 986 women with HIV aged 18 years and above were interviewed in 13 high HIV prevalence districts of Tamil Nadu, South India. Data were analysed using descriptive, bivariate and multivariate methods. Results: Nearly one fifth (18.8%) of the women with HIV had not heard of PTCT and 40% did not know that ARVs could prevent PTCT. In addition, 39.3% were not aware of the timing of PTCT; 50.4% reported intrauterine and intrapartum and 13.7% mentioned breastfeeding period as the possible timings of PTCT of HIV. Multivariate analysis showed that single/never married women had lower knowledge of PTCT. Also, those who had undergone a prior training on reproductive and child health (RCH) and those who discussed RCH issues with their partners were more likely to have higher knowledge. Conclusion: Considering the risk of HIV transmission from HIV-infected women to their children, the knowledge level of PTCT among them is low. Appropriate strategies to generate awareness among women with HIV need be introduced to help them make informed decisions.
  - 333 40