WHO South-East Asia Journal of Public Health
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The burden of iron-deficiency anaemia among women in India: how have iron and folic acid interventions fared?
Rajesh Kumar Rai, Wafaie W Fawzi, Anamitra Barik, Abhijit Chowdhury
April 2018, 7(1):18-23
DOI:10.4103/2224-3151.228423  PMID:29582845
Iron-deficiency anaemia (IDA) among women in India is a problem of major public health significance. Using data from three waves of the National Family Health Survey, this article discusses the burden of and trend in IDA among women in India, and discusses the level of iron and folic acid (IFA) supplementation and its potential role in reducing the burden of IDA. Between 2005–2006 and 2015–2016, IDA in India decreased by only 3.5 percentage points (from 56.5% in 2005–2006 to 53.0% in 2015–2016) for women aged 15–49 years. However, during the same period, of 27 states compared, IDA increased in eight: Delhi, Haryana, Himachal Pradesh, Kerala, Meghalaya, Tamil Nadu, Punjab and Uttar Pradesh; furthermore, some of these (e.g. Kerala) are states that rank among the highest on the state Human Development Index but had failed to contain the burden of IDA. Although there is a standard guideline for IFA supplementation in place, the IFA intervention appears to be ineffective in reducing the burden of IDA in India (nationally only 30.3 % of mothers consumed IFA for 100 days or more when they were pregnant), probably due to irregular consumption of IFA where the provision of screening under the National Iron+ Initiative scheme appears to be unsuccessful. To strengthen the IFA intervention and its uptake, a concerted effort of community-level health workers (accredited social health activists, auxiliary nurse midwives and anganwadi workers) is urgently needed. In addition, food-based strategies (dietary diversification and food fortification), food supplementation and improvement of health services are required to reduce the burden of anaemia among women in India.
  31,152 3,109 23
Current status of master of public health programmes in India: a scoping review
Ritika Tiwari, Himanshu Negandhi, Sanjay Zodpey
April 2018, 7(1):29-35
DOI:10.4103/2224-3151.228425  PMID:29582847
There is a recognized need to improve training in public health in India. Currently, several Indian institutions and universities offer the Master of Public Health (MPH) programme. However, in the absence of any formal body or council for regulating public health education in the country, there is limited information available on these programmes. This scoping review was therefore undertaken to review the current status of MPH programmes in India. Information on MPH programmes was obtained using a two-step process. First, a list of all institutions offering MPH programmes in India was compiled by use of an internet and literature search. Second, detailed information on each programme was collected via an internet and literature search and through direct contact with the institutions and recognized experts in public health education. Between 1997 and 2016–2017, the number of institutions offering MPH programmes increased from 2 to 44. The eligibility criteria for the MPH programmes are variable. All programmes include some field experience. The ratio of faculty number to students enrolled ranged from 1:0.1 to 1:42. In the 2016–2017 academic year, 1190 places were being offered on MPH programmes but only 704 students were enrolled. MPH programmes being offered in India have witnessed a rapid expansion in the past two decades. This growth in supply of public health graduates is not yet matched by an increased demand. Despite the recognized need to strengthen the public health workforce in India, there is no clearly defined career pathway for MPH graduates in the national public health infrastructure. Institutions and public health bodies must collaborate to design and deliver MPH programmes to overcome the shortage of public health professionals, such that the development goals for India might be met.
  28,890 1,121 5
Health workforce in India: assessment of availability, production and distribution
Indrajit Hazarika
April-June 2013, 2(2):106-112
DOI:10.4103/2224-3151.122944  PMID:28612768
Background: India faces an acute shortage of health personnel. Together with inequalities in distribution of health workers, this shortfall impedes progress towards achievement of the Millennium Development Goals. The aim of this study was to assess health-workforce distribution, identify inequalities in health-worker provision and estimate the impact of this maldistribution on key health outcomes in India. Materials and Methods: Health-workforce availability and production were assessed by use of year-end data for 2009 obtained from the Indian Ministry of Statistics and Programme Implementation. Inequalities in the distribution of doctors, dentists, nurses and midwives were estimated by use of the Gini coefficient and the relation between health-worker density and selected health outcomes was assessed by linear regression. Results: Inequalities in the availability of health workers exist in India. Certain states are experiencing an acute shortage of health personnel. Inequalities in the distribution of health workers are highest for doctors and dentists and have a significant effect on health outcomes. Conclusion: Although the production of health workers has expanded greatly in recent years, the problems of imbalances in their distribution persist. As India seeks to achieve universal health coverage by 2020, the realization of this goal remains challenged by the current lack of availability and inequitable distribution of appropriately trained, motivated and supported health workers.
  22,140 2,489 43
A review of Japanese encephalitis in Uttar Pradesh, India
Roop Kumari, Pyare L Joshi
October-December 2012, 1(4):374-395
DOI:10.4103/2224-3151.207040  PMID:28615603
Background: Japanese encephalitis (JE) is a major public health problem in India. When the first case was reported in 1955, the disease was restricted to south India. The disease spread to north India in 1978 from where extensive and recurrent outbreaks of JE have been reported ever since. An attempt has been made to review the epidemiology of JE over the past 30 years and suggestions made for its prevention and control. Methods: An epidemiological profile of JE (1978–2009) has been compiled and analysed to understand the trend and status of the disease. Results: In India, while 24 states are endemic for JE, Uttar Pradesh contributed more than 75% of cases during the recent past. Over the years, the seasonal trend has changed and the epidemic peak of the disease has advanced by one month. Conclusion: JE is closely associated with the pattern of precipitation, flooding and rice production systems. Analysis of trends and influencing factors will help in designing suitable strategies for the prevention and control of JE in the country. Continuous monitoring of vector populations and JE virus infection rates in vector mosquitoes will help in predicting an outbreak and in taking effective intervention measures.
  18,787 1,130 22
Stigma related to HIV and AIDS as a barrier to accessing health care in Thailand: a review of recent literature
Sian Churcher
January-March 2013, 2(1):12-22
DOI:10.4103/2224-3151.115829  PMID:28612818
Background: Thailand has been recognized as a regional leader in its response to the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. However, low rates of voluntary testing, late entry into healthcare and delayed treatment continue to be major challenges. Stigma associated with HIV has been cited as a significant barrier preventing a successful and co-ordinated response. HIV-related stigma is known to exist among Thai communities. However, less is known about the attitudes of healthcare workers towards people living with HIV, and how this impacts health-seeking behaviours. This paper considers recent literature from Thailand (2007-2012), which discusses how HIV-related stigma affects health-seeking behaviour, as well as experiences of HIV-related stigma in healthcare settings. Materials and Methods: Information was collected from electronic databases and websites using the search terms 'HIV stigma healthcare'. Literature published in English, from 2007 onwards, discussing the relationship between HIV-related stigma and health-seeking behaviour, or HIV-related stigma in healthcare settings in Thailand was included in this review. Results: There is scarcity of information assessing the forms of stigmatizing attitudes known to exist within the Thai healthcare sector. Literature highlights that key affected populations feel most stigmatized against. Interactions and negative experiences in government healthcare settings have contributed to a reduced engagement around seeking healthcare. Discussion and Conclusions: More research is needed on HIV-related stigma in healthcare settings in Thailand. Evidence suggests that interventions at the policy, environmental and individual levels are required to address stigma and protect the health and rights of people living with HIV/AIDS.
  17,679 1,447 30
A framework for comparative analysis of health systems: experiences from the Asia Pacific Observatory on Health Systems and Policies
Judith Mary Healy, Shenglan Tang, Walaiporn Patcharanarumol, Peter Leslie Annear
April 2018, 7(1):5-12
DOI:10.4103/2224-3151.228421  PMID:29582843
Drawing on published work from the Asia Pacific Observatory on Health Systems and Policies, this paper presents a framework for undertaking comparative studies on the health systems of countries. Organized under seven types of research approaches, such as national case-studies using a common format, this framework is illustrated using studies of low- and middle-income countries published by the Asia Pacific Observatory. Such studies are important contributions, since much of the health systems research literature comes from high-income countries. No one research approach, however, can adequately analyse a health system, let alone produce a nuanced comparison of different countries. Multiple comparative studies offer a better understanding, as a health system is a complex entity to describe and analyse. Appreciation of context and culture is crucial: what works in one country may not do so in another. Further, a single research method, such as performance indicators, or a study of a particular health system function or component, produces only a partial picture. Applying a comparative framework of several study approaches helps to inform and explain progress against health system targets, to identify differences among countries, and to assess policies and programmes. Multi-method comparative research produces policy-relevant learning that can assist countries to achieve Sustainable Development Goal 3: ensure healthy lives and promoting well-being for all at all ages by 2030.
  14,336 1,669 2
Composition and distribution of the health workforce in India: estimates based on data from the National Sample Survey
Krishna D Rao, Renu Shahrawat, Aarushi Bhatnagar
July-December 2016, 5(2):133-140
DOI:10.4103/2224-3151.206250  PMID:28607241
Background: The availability of reliable and comprehensive information on the health workforce is crucial for workforce planning. In India, routine information sources on the health workforce are incomplete and unreliable. This paper addresses this issue and provides a comprehensive picture of India’s health workforce. Methods: Data from the 68th round (July 2011 to June 2012) of the National Sample Survey on the Employment and unemployment situation in India were analysed to produce estimates of the health workforce in India. The estimates were based on self-reported occupations, categorized using a combination of both National Classification of Occupations (2004) and National Industrial Classification (2008) codes. Results: Findings suggest that in 2011–2012, there were 2.5 million health workers (density of 20.9 workers per 10 000 population) in India. However, 56.4% of all health workers were unqualified, including 42.3% of allopathic doctors, 27.5% of dentists, 56.1% of Ayurveda, yoga and naturopathy, Unani, Siddha and homoeopathy (AYUSH) practitioners, 58.4% of nurses and midwives and 69.2% of health associates. By cadre, there were 3.3 qualified allopathic doctors and 3.1 nurses and midwives per 10 000 population; this is around one quarter of the World Health Organization benchmark of 22.8 doctors, nurses and midwives per 10 000 population. Out of all qualified workers, 77.4% were located in urban areas, even though the urban population is only 31% of the total population of the country. This urban–rural difference was higher for allopathic doctors (density 11.4 times higher in urban areas) compared to nurses and midwives (5.5 times higher in urban areas). Conclusion: The study highlights several areas of concern: overall low numbers of qualified health workers; a large presence of unqualified health workers, particularly in rural areas; and large urban–rural differences in the distribution of qualified health workers.
  12,397 1,056 22
Choice of health-care facility after introduction of free essential health services in Nepal
Rajendra Karkee, Jhalka Kadariya
April-June 2013, 2(2):96-100
DOI:10.4103/2224-3151.122941  PMID:28612766
Background: Choice of health-care services depends on patients' characteristics and the features of health-care facilities available. In Nepal, a significant proportion of health care is provided through the private sector, despite the introduction of free essential health care for all citizens in 2008. We sought to determine whether people chose private or public facilities in the first instance for acute health problems. We also assessed the reasons for their choice. Materials and Methods: A cross-sectional survey was done by use of a questionnaire administered to 400 household heads in Jhapa district, Nepal. Results: 272 (68%) respondents sought treatment from public health-care facilities in the first instance. On adjusted analysis, illiterate people were more likely to choose public facilities than people with higher secondary education (OR 5.47, P = 0.002). Similarly, lower-caste and religious-minority respondents were more likely to choose public facilities than disadvantaged janajati (OR 2.33, P = 0.01). Among respondents who used public facilities, 174 (64.0%) and 109 (40.0%) stated that that their choice was based on financial accessibility and physical accessibility, respectively. Among respondents who used private facilities, 65 (50.7%) and 54 (42.1%) said their choice was based on adequacy of resources/services and health-care delivery, respectively. Conclusion: A substantial portion of respondents used public health-care facilities in the first instance, mainly because of financial and physical accessibility rather than adequacy of resources or better health-care delivery. These results may indicate a positive impact of removal of user fees for public health-care facilities in Nepal, especially for impoverished people.
  11,631 1,048 7
Suicide and depression in the World Health Organization South-East Asia Region: A systematic review
Helal Uddin Ahmed, Mohammad Didar Hossain, Afzal Aftab, Tanjir Rashid Soron, Mohammad Tariqul Alam, Md Waziul Alam Chowdhury, Aftab Uddin
April 2017, 6(1):60-66
DOI:10.4103/2224-3151.206167  PMID:28597861
Background Depression is the most common comorbid psychiatric disorder in people who die by suicide and 39% of global suicides occur in the World Health Organization (WHO) South-East Asia Region. The aim of this systematic review was to identify, for countries of this region, first the prevalence of depression among people who (i) die by, or (ii) attempt, suicide, and second, the proportion of people with depression who attempt or die by suicide. Methods PubMed, PsycINFO, EMBASE and Google Scholar were searched, together with five available national databases, for quantitative research papers published in English between 1956 and 4 September 2016 from the 11 countries of the WHO South-East Asia Region. Results The 19 articles that met the predefined eligibility criteria were from five countries: Bangladesh (1), India (12), Indonesia (1), Sri Lanka (3) and Thailand (2); no eligible papers from the remaining countries of the region were retrieved. Eight studies, from Bangladesh, India, Indonesia and Sri Lanka, reported the prevalence of depression among people who had died by suicide. The study settings varied, as did the proportion of depression recorded (6.9–51.7%), and the study sample sizes ranged from 27 to 372. Eight studies from India and one from Sri Lanka investigated depression among people who had attempted suicide. Using a range of screening and diagnostic tools, the reported prevalence of depression ranged between 22.0% and 59.7%. The study sample sizes ranged from 56 to 949. Only two articles were found, both from Thailand, that reported on suicide in people with depression. Conclusion Despite the high burden of mortality of suicide in the WHO South-East Asia Region, evidence on the relation between suicide and depression is scarce. There is a need to understand this phenomenon better, in order to inform suicide-prevention strategies in the region.
  11,131 1,534 18
Chronic disease management in the South-East Asia Region: a need to do more
Jayendra Sharma
April-June 2013, 2(2):79-82
DOI:10.4103/2224-3151.122935  PMID:28612763
Chronic diseases account for a substantial proportion of deaths in the South-East Asia Region, ranging from 34% in Timor-Leste to 79% in Maldives. Fuelled by the epidemiological shift towards noncommunicable diseases, the burden of chronic conditions is steadily increasing. Care structures for chronic diseases in most of these countries focus only on certain conditions and are often oriented towards episodic illnesses. An opportunity exists for holistic, country-driven applications of the World Health Organization Innovative Care for Chronic Conditions framework to improve quality of care for chronic conditions in the region.
  11,473 1,156 4
Suicide burden and prevention in Nepal: The need for a national strategy
Kedar Marahatta, Reuben Samuel, Pawan Sharma, Lonim Dixit, Bhola Ram Shrestha
April 2017, 6(1):45-49
DOI:10.4103/2224-3151.206164  PMID:28597859
Suicide is a major cause of deaths worldwide and is a key public health concern in Nepal. Although routine national data are not collected in Nepal, the available evidence suggests that suicide rates are relatively high, notably for women. In addition, civil conflict and the 2015 earthquake have had significant contributory effects. A range of factors both facilitate suicide attempts and hinder those affected from seeking help, such as the ready availability of toxic pesticides and the widespread, although erroneous, belief that suicide is illegal. Various interventions have been undertaken at different levels in prevention and rehabilitation but a specific long-term national strategy for suicide prevention is lacking. Hence, to address this significant public health problem, a multisectoral platform of stakeholders needs to be established under government leadership, to design and implement innovative and country-contextualized policies and programmes. A bottom-up approach, with active and participatory community engagement from the start of the policy- and strategy-formulation stage, through to the design and implementation of interventions, could potentially build grass-roots public ownership, reduce stigma and ensure a scaleable and sustainable response.
  11,486 719 14
India’s health and wellness centres: realizing universal health coverage through comprehensive primary health care
Rajani R Ved, Garima Gupta, Shalini Singh
April 2019, 8(1):18-20
DOI:10.4103/2224-3151.255344  PMID:30950425
In common with other countries in the World Health Organization South-East Asia Region, disease patterns in India have rapidly transitioned towards an increased burden of noncommunicable diseases. This epidemiological transition has been a major driver impelling a radical rethink of the structure of health care, especially with respect to the role, quality and capacity of primary health care. In addition to the Pradhan Mantri Jan Arogya Yojana insurance scheme, covering 40% of the poorest and most vulnerable individuals in the country for secondary and tertiary care, Ayushman Bharat is based on an ambitious programme of transforming India’s 150 000 public peripheral health centres into health and wellness centres (HWCs) delivering universal, free comprehensive primary health care by the end of 2022. This transformation to facilities delivering high-quality, efficient, equitable and comprehensive care will involve paradigm shifts, not least in human resources to include a new cadre of mid-level health providers. The design of HWCs and the delivery of services build on the experiences and lessons learnt from the National Health Mission, India’s flagship programme for strengthening health systems. Expanding the scope of these components to address the expanded service delivery package will require reorganization of work processes, including addressing the continuum of care across facility levels; moving from episodic pregnancy and delivery, newborn and immunization services to chronic care services; instituting screening and early treatment programmes; ensuring high-quality clinical services; and using information and communications technology for better reporting, focusing on health promotion and addressing health literacy in communities. Although there are major challenges ahead to meet these ambitious goals, it is important to capitalize on the current high level of political commitment accorded to comprehensive primary health care.
  9,946 1,427 18
Monitoring medicines use to support national medicines policy development and implementation in the Asia Pacific region
Elizabeth E Roughead, Karma Lhazeen, Engko Socialine, Salmah Bahri, Byong Joo Park, Kathleen Holloway
April-June 2013, 2(2):113-117
DOI:10.4103/2224-3151.122946  PMID:28612769
Critical to the successful implementation of a national medicines strategy is evaluation of the policy and ongoing monitoring of medicine use. Methods for monitoring medicines use within countries vary depending on the country and its stage of medicines policy development and implementation. In this paper, we provide four case studies on monitoring medicines use to support national medicines policy development and implementation. Cases come from Bhutan, Indonesia, Malaysia and the Republic of Korea.
  10,367 661 7
Improving access to assistive technologies: challenges and solutions in low- and middle-income countries
Viroj Tangcharoensathien, Woranan Witthayapipopsakul, Shaheda Viriyathorn, Walaiporn Patcharanarumol
September 2018, 7(2):84-89
DOI:10.4103/2224-3151.239419  PMID:30136666
Assistive technologies can benefit a wide range of people, including those with disabilities; those with age-related frailties; those affected by noncommunicable diseases; and those requiring rehabilitation. Access to these technologies is limited in low- and middle-income countries but the already-high need will inevitably rise further because of demographic and epidemiological transitions. Four key gaps contribute to limited access. First, although need is high, demand is low, not least because of widespread lack of awareness among potential beneficiaries, their caregivers, and their health-care providers. Second, product designs are insufficiently informed by users’ and caregivers’ preferences and environments, and transfer of technologies to low-resource settings is limited. Third, barriers to supply include low production quality, financial constraints and a scarcity of trained personnel. Fourth, there is a dearth of high-quality evidence on the effectiveness of different types of technology. Adoption of the World Health Assembly Resolution WHA71.8 in 2018 marked convergence of, commitment to and strengthening of efforts to close these gaps and improve access to assistive devices. The Global Cooperation on Assistive Technology workplan identifies four overarching, interlinked solutions for countries to improve access. First, a national policy framework for assistive technology is needed. Second, product development should be encouraged through incentive schemes that support and promote affordable assistive products. Third, capacity-building of personnel is needed, through undergraduate and in-service training. Fourth, provision needs to be enhanced, especially through integration of services with the health system. These actions need to be underpinned by government leadership, a multisectoral approach and adequate funding.
  9,874 1,103 18
Prevalence and predictors of hypertension among residents aged 20-59 years of a slum-resettlement colony in Delhi, India
Sanjeet Panesar, Sanjay Chaturvedi, NK Saini, Rajnish Avasthi, Abhishek Singh
April-June 2013, 2(2):83-87
DOI:10.4103/2224-3151.122937  PMID:28612764
Background: Slum-resettlement communities are increasingly adopting urban lifestyles. The aim of this study was to assess the prevalence and identify correlates of hypertension among residents aged 20-59 years of a slum-resettlement colony. Materials and Methods: A community-based cross-sectional study was done from 2010 to 2012 in NandNagri, a slum-resettlement area in east Delhi. 310 participants aged 20-59 years were enrolled through multistage systematic random sampling. Each study subject was interviewed and examined for raised blood pressure; data on risk factors including smoking, alcohol intake, physical activity and salt consumption were also collected. Data were analysed by use of univariate and multivariate regression. Results: The overall prevalence of hypertension was 17.4% and 35% participants were prehypertensive. On multiple logistic regression, age 40-49 years (P = 0.020) and 50-59 years (P = 0.012), clerical/professional occupation (P = 0.004), abnormal waist circumference (≥90 cm in males and ≥ 80 cm in females; P = 0.001), positive family history of hypertension in both parents (P = 0.013) and above-average daily salt intake (P = 0.000) were significantly associated with hypertension. Conclusions: These findings indicate that hypertension is a significant health problem in the study population. Many study participants diagnosed with prehypertension are at risk of developing hypertension, thus immediate public-health interventions are indicated.
  9,826 1,087 6
Strengthening primary health care in the COVID-19 era: a review of best practices to inform health system responses in low- and middle-income countries
David Peiris, Manushi Sharma, Devarsetty Praveen, Asaf Bitton, Graham Bresick, Megan Coffman, Rebecca Dodd, Fadi El-Jardali, Racha Fadlallah, Maaike Flinkenflögel, Felicity Goodyear-Smith, Lisa R Hirschhorn, Wolfgang Munar, Anna Palagyi, KM Saif-Ur-Rahman, Robert Mash
February 2021, 10(3):6-25
Amid massive health system disruption induced by the coronavirus disease 2019 (COVID-19) pandemic, the need to maintain and improve essential health services is greater than ever. This situation underscores the importance of the primary health care (PHC) revitalization agenda articulated in the 2018 Astana Declaration. The objective was to synthesize what was already known about strengthening PHC in low- and middle- income countries prior to COVID-19. We conducted a secondary analysis of eleven reviews and seven evidence gap maps published by the Primary Health Care Research Consortium in 2019. The 2020 World Health Organization Operational framework for primary health care was used to synthesize key learnings and determine areas of best practice. A total of 238 articles that described beneficial outcomes were analysed (17 descriptive studies, 71 programme evaluations, 90 experimental intervention studies and 60 literature reviews). Successful PHC strengthening initiatives required substantial reform across all four of the framework’s strategic levers – political commitment and leadership, governance and policy, funding and allocation of resources, and engagement of communities and other stakeholders. Importantly, strategic reforms must be accompanied by operational reforms; the strongest evidence of improvements in access, coverage and quality related to service delivery models that promote integrated services, workforce strengthening and use of digital technologies. Strengthening PHC is a “hard grind” challenge involving multiple and disparate actors often taking years or even decades to implement successful reforms. Despite major health system adaptation during the pandemic, change is unlikely to be lasting if underlying factors that foster health system robustness are not addressed.
  9,717 991 2
Changing epidemiology of dengue in South-East Asia
Rajesh Bhatia, Aditya P Dash, Temmy Sunyoto
January-March 2013, 2(1):23-27
DOI:10.4103/2224-3151.115830  PMID:28612819
The burden of dengue and its potential threat to global health are now globally recognized, with 2.5 billion people at risk worldwide. The pathogenesis of severe dengue is particularly intriguing with the involvement of different immune factors. Also, the epidemiology of dengue in South-East Asia is undergoing a change in the human host, the dengue virus and the vector bionomics. Shift in affected age groups, sex differences and expansion to rural areas are evident, while the virulence and genotype of the virus determine the severity and time interval between sequential infections. The Aedes mosquito, a potent and adaptive vector, has evolved in longevity and survival, affected by seasonality and climate variability, socio-cultural and economic factors of human habitation and development. This review provides insights into the changing epidemiology and its factors in South-East Asia, one of the most important epicentres of dengue in the world, highlighting the major factors influencing these rapid changes. Addressing the changes may help mitigate the challenges in the current dengue control and prevention efforts.
  9,115 1,552 31
Nipah virus outbreaks in Bangladesh: a deadly infectious disease
Mahmudur Rahman, Apurba Chakraborty
April-June 2012, 1(2):208-212
DOI:10.4103/2224-3151.206933  PMID:28612796
During 2001-2011, multidisciplinary teams from the Institute of Epidemiology, Disease Control and Research (IEDCR) and International Centre for Diarrhoeal Disease Research, Bangladesh(icddr,b) identified sporadic cases and 11 outbreaks of Nipah encephalitis. Three outbreaks were detected through sentinel surveillance; others were identified through event-based surveillance. A total of 196 cases of Nipah encephalitis, in outbreaks, clusters and as isolated cases were detected from 20 districts of Bangladesh; out of them 150 (77%) cases died. Drinking raw date palm sap and contact with a case were identified as the major risk factors for acquiring the disease. Combination of surveillance systems and multidisciplinary outbreak investigations can be an effective strategy not only for detection of emerging infectious diseases but also for identification of novel characteristics and risk factors for these diseases in resource-poor settings.
  9,732 611 11
Growth parameters at birth of babies born in Gampaha district, Sri Lanka and factors influencing them
Priyantha J Perera, Nayomi Ranathunga, Meranthi P Fernando, Tania D Warnakulasuriya, Rajitha A Wickremasinghe
January-March 2013, 2(1):57-62
DOI:10.4103/2224-3151.115845  PMID:28612825
Background: Growth parameters at birth are important for clinical decision-making. In Sri Lanka, the data from the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) are used to interpret these measurements. Materials and Methods: A descriptive cross-sectional study was conducted between September and October 2010 in hospitals of Gampaha district, Sri Lanka. The weight, length and head circumference of all normal-term babies born in the Gampaha district during this period were measured within 8 h of birth using standard techniques. Measurements were taken by medical graduates trained and supervised by a consultant paediatrician. Socio-demographic data were obtained using an interviewer-administered questionnaire. Results: Of the 2215 babies recruited, 1127 were males. The mean birth weight, mean length and mean head circumference at birth were 2.92 kg, 49.1 and 33.6 cm, respectively. Boys weighed and measured more than girls in all parameters, but the differences were not statistically significant. Growth parameters of babies included in this study deviated from that in the MGRS data. Mean values of MGRS data were between 75th and 90th centiles of this study population. Birth order, family income and maternal education were significantly (P < 0.01) associated with growth parameters. Contrary to common belief, growth parameters continued to increase progressively up to 41 weeks. Maternal age less than 20 years or more than 35 years was negatively associated with birth weight (P < 0.01). Conclusions: Growth parameters of new-born babies deviated significantly from the values of the MGRS data. Growth characteristics of one population may not be applicable to another population due to variations in maternal, genetic and socio-economic factors. Using growth charts not applicable to a population will result in wrong interpretations.
  9,573 489 2
Health-sector responses to address the impacts of climate change in Nepal
Meghnath Dhimal, Mandira Lamichhane Dhimal, Raja Ram Pote-Shrestha, David A Groneberg, Ulrich Kuch
September 2017, 6(2):9-14
DOI:10.4103/2224-3151.213795  PMID:28857057
Nepal is highly vulnerable to global climate change, despite its negligible emission of global greenhouse gases. The vulnerable climate-sensitive sectors identified in Nepal's National Adaptation Programme of Action (NAPA) to Climate Change 2010 include agriculture, forestry, water, energy, public health, urbanization and infrastructure, and climate-induced disasters. In addition, analyses carried out as part of the NAPA process have indicated that the impacts of climate change in Nepal are not gender neutral. Vector-borne diseases, diarrhoeal diseases including cholera, malnutrition, cardiorespiratory diseases, psychological stress, and health effects and injuries related to extreme weather are major climate-sensitive health risks in the country. In recent years, research has been done in Nepal in order to understand the changing epidemiology of diseases and generate evidence for decision-making. Based on this evidence, the experience of programme managers, and regular surveillance data, the Government of Nepal has mainstreamed issues related to climate change in development plans, policies and programmes. In particular, the Government of Nepal has addressed climate-sensitive health risks. In addition to the NAPA report, several policy documents have been launched, including the Climate Change Policy 2011; the Nepal Health Sector Programme – Implementation Plan II (NHSP-IP 2) 2010–2015; the National Health Policy 2014; the National Health Sector Strategy 2015–2020 and its implementation plan (2016–2021); and the Health National Adaptation Plan (H-NAP): climate change and health strategy and action plan (2016–2020). However, the translation of these policies and plans of action into tangible action on the ground is still in its infancy in Nepal. Despite this, the health sector's response to addressing the impact of climate change in Nepal may be taken as a good example for other low- and middle-income countries.
  9,072 753 4
Services for depression and suicide in Thailand
Thoranin Kongsuk, Suttha Supanya, Kedsaraporn Kenbubpha, Supranee Phimtra, Supattra Sukhawaha, Jintana Leejongpermpoon
April 2017, 6(1):34-38
DOI:10.4103/2224-3151.206162  PMID:28597857
Depression, together with suicide is an important contributor to the burden of disease in Thailand. Until recently, depression has been significantly under-recognized in the country. The lack of response to this health challenge has been compounded by a low level of access to standard care, constraints on mental health personnel and inadequate dissemination of knowledge in caring for people with these disorders. In the past decade, significant work has been undertaken to establish a new evidence-based surveillance and care system for depression and suicide in Thailand that operates at all levels of health-care provision nationwide. The main components of the integrated system are: (i) community-level screening for depression in at-risk groups, using a two-question tool; (ii) assessment of the severity of depression using a nine-question scale; (iii) diagnosis and treatment by general practitioners; (iv) psychosocial care provided by psychiatric nurses; (v) continuous care for relapse and suicide prevention; and (vi) promotion of mental well-being and prevention of depression in at-risk populations. Factors such as appropriate financial mechanisms, capacity-building programmes for health-care workers, and robust treatment guidelines have contributed to the success and sustainability of this comprehensive surveillance and care system. By 2016, more than 14 million people at risk had been screened for depression and received mental health education; more than 1.7 million people with depression had received psychosocial interventions; 0.7 million diagnosed patients had received antidepressants; and 0.8 million were being followed up for relapse and suicide prevention. The application of this surveillance and care system has led to an enormous increase in the accessibility of standard care for people with depressive disorders, from 5.1% of those with depressive disorders in 2009 to 48.5% in 2016.
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Annual risk of tuberculosis infection in Sri Lanka: a low prevalent country with a high BCG vaccination coverage in the South-East Asia Region
Pushpa Ranjan Wijesinghe, Paba Palihawadana, Sunil De Alwis, Sudath Samaraweera
January-March 2013, 2(1):34-40
DOI:10.4103/2224-3151.115835  PMID:28612821
Introduction: Despite its simplicity, efficiency and reliability, Sri Lanka has not used the Annual Risk of Tuberculosis Infection (ARTI) to assess the prevalence and efficiency of tuberculosis (TB) control. Hence, a national tuberculin survey was conducted to estimate the ARTI. Materials and Methods: A school-based, cross-sectional tuberculin survey of 4352 children aged 10 years irrespective of their BCG vaccination or scar status was conducted. The sample was selected from urban, rural and estate strata using two-stage cluster sampling technique. In the first stage, sectors representing three strata were selected and, in the second stage, participants were selected from 120 clusters. Using the mode of the tuberculin reaction sizes (15 mm) and the mirror-image technique, the prevalence and the ARTI were estimated. Results: The prevalence of TB estimated for urban, rural and estate sectors were 13.9%, 2.2% and 2.3%, respectively. The national estimate of the prevalence of TB was 4.2% (95% CI = 1.7-7.2%). ARTI for the urban, rural and estate sectors were 1.4%, 0.2% and 0.2%, respectively, and the national estimate was 0.4% (95% CI = 0.2-0.7%). The estimated annual burden of newly infected or re-infected TB cases with the potential of developing into the active disease (400/100 000 population) was nearly 10-fold higher than the national new case detection rate (48/100 000 population). Conclusion: The national estimate of ARTI was lower than the estimates for many developing countries. The high-estimated risk for the urban sector reflected the need for intensified, sector-specific focus on TB control activities. This underscores the need to strengthen case detection. Repeat surveys are essential to determine the annual decline rate of infection.
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Risk factors for nonfatal drowning in children in rural Bangladesh: a community-based case-control study
Syed AHM Abdullah, Meerjady S Flora
April-June 2013, 2(2):88-95
DOI:10.4103/2224-3151.122939  PMID:28612765
Introduction: Most studies of drowning in Bangladeshi populations to date have described mortality and trends. We sought to identify associations between socioeconomic status and child-care practices and nonfatal drowning in rural Bangladeshi children. Materials and Methods: This community-based case-control study was conducted in rural children aged 1-5 years in Raiganj subdistrict of Bangladesh. 122 cases and 134 age-matched controls were recruited and their mothers were interviewed by use of a structured questionnaire. Univariate analyses and logistic regression were done to analyse the data. Results: Child nonfatal drowning was significantly associated with mothers: With low educational status (P < 0.001), of younger age (P < 0.005), of single status (P < 0.001) and with more than three children (P < 0.001). Nonfatal drowning was 12 and five times more likely in children of illiterate mothers than in children of mothers with academic knowledge equivalent to sixth to tenth grade (OR [95% CI] 0.08 [0.02-0.26]) and above tenth grade (OR [95% CI] 0.21 [0.04-0.95]) (P < 0.001), respectively. Low socioeconomic status, indicated by lower family expenditure (P < 0.001) and no house (P < 0.05; OR [95% CI] 0.58 [0.17-0.99]), were found to be risk factors for childhood nonfatal drowning. Improved child care, as measured by a child-care index, was associated with significantly lower non-fatal drowning (P < 0.001). Child care improved with higher educational attainment of mothers (P < 0.005) and increased socioeconomic status. Nonfatal drowning was more common when the main caregiver was not the mother (P < 0.001). Forward likelihood ratio logistic regression indicated mothers' lower educational status as the best predictor of nonfatal drowning. Conclusion: Better child care and prevention of nonfatal drowning might be ensured through increasing mothers' educational attainment and improvements in socioeconomic status.
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Mental health policies in South-East Asia and the public health role of screening instruments for depression
Pratap Sharan, Rajesh Sagar, Saurabh Kumar
April 2017, 6(1):5-11
DOI:10.4103/2224-3151.206165  PMID:28597852
The World Health Organization (WHO) South-East Asia Region, which contributes one quarter of the world’s population, has a significant burden due to mental illnesses. Mental health has been a low priority in most countries of the region. Although most of these countries have national mental health policies, implementation at ground level remains a huge challenge. Many countries in the region lack mental health legislation that can safeguard the rights of people with mental illnesses, and governments have allocated low budgets for mental health services. It is imperative that concerned authorities work towards scaling up both financial and human resources for effective delivery of mental health services. Policymakers should facilitate training in the field of mental health and aim towards integrating mental health services with primary health care, to reduce the treatment gap. Steps should also be taken to develop a robust mental health information system that can provide baseline information and insight about existing mental health services and help in prioritization of the mental health needs of the individual countries. Although evidence-based management protocols such as the WHO Mental Health Gap Action Programme (mhGAP) guidelines facilitate training and scaling up of care in resource-limited countries, the identification of mental disorders like depression in such settings remains a challenge. Development and validation of brief psychiatric screening instruments should be prioritized to support such models of care. This paper illustrates an approach towards the development of a new culturally adapted instrument to identify depression that has scope for wider use in the WHO South-East Asia Region.
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Observations and lessons learnt from more than a decade of water safety planning in South-East Asia
David Sutherland, Payden
September 2017, 6(2):27-33
DOI:10.4103/2224-3151.213788  PMID:28857060
In many countries of the World Health Organization (WHO) South-East Asia Region, drinking water is not used directly from the tap and faecal contamination of water sources is prevalent. As reflected in Sustainable Development Goal 6, access to safer drinking water is one of the most successful ways of preventing disease. The WHO Water Safety Framework promotes the use of water safety plans (WSPs), which are structured tools that help identify and mitigate potential risks throughout a water-supply system, from the water source to the point of use. WSPs not only help prevent outbreaks of acute and chronic waterborne diseases but also improve water-supply management and performance. During the past 12 years, through the direct and indirect work of a water quality partnership supported by the Australian Government, more than 5000 urban and rural WSPs have been implemented in the region. An impact assessment based on pre- and post-WSP surveys suggests that WSPs have improved system operations and management, infrastructure and performance; leveraged donor funds; increased stakeholder communication and collaboration; increased testing of water quality; and increased monitoring of consumer satisfaction. These achievements, and their sustainability, are being achieved through national legislation and regulatory frameworks for water supply, including quality standards for drinking water; national training tools and extensive training of sector professionals and creation of WSP experts; model WSPs; WSP auditing systems; and the institution of longterm training and support. More than a decade of water safety planning using the WSP approach has shown that supplying safe drinking water at the tap throughout the WHO South-East Asia Region is a realistic goal.
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