Public health challenges最新文献

Background: Vaccination protects the population against infectious diseases and reduces their transmissibility. Potentials exist for local production of vaccines in Nigeria, as a means of addressing public health needs. However, challenges exist in certain critical aspects which limit development in this area. This study aimed at evaluating the challenges of local vaccines' manufacturing in Nigeria from the perspectives of relevant stakeholders.

Methods: This was a cross-sectional study. A structured questionnaire was used for data collection. The data obtained from the study were analysed descriptively.

Results: More than half of the study participants (55.5%) agreed that significant gaps exist with respect to access to vaccines in Nigeria. Only about one-quarter of the respondents (25.8%) were of the view that relevant legislative frameworks exist to support government funding in the area of vaccine production. One-third of the participants (32.3%) expressed confidence in the availability of trained human resources for vaccine production. Close to two-thirds of the respondents (61.7%) expressed dissatisfaction regarding the current funding for vaccine research and development, and a similar proportion (65.2%) were of the opinion that a lack of local manufacturing capacity contributed to the sub-optimal access to vaccines. Moreover, two-thirds (62.3%) disagreed that Nigeria was prepared for future pandemics.

Conclusion: Ill-suited policies, sub-optimal infrastructure, and inadequate research and development funding, are some factors which the study identified as contributory to the lack of access to vaccines in Nigeria. There is a need to improve incentives, infrastructural development and build human resource capacity for vaccine research and development to enhance local production in Nigeria.

Background: Asthma, chronic obstructive pulmonary disease (COPD), and pneumonia are significant contributors to morbidity and mortality worldwide. Identifying the predictors of mortality due to these diseases is crucial for effective public health interventions.

Methods: We conducted a longitudinal trajectory modeling using SAS TRAJ procedures on data from 81 provinces in Turkiye, categorizing death rates into two profiles for asthma and COPD and three for pneumonia. Environmental and socioeconomic factors were examined as potential predictors through logistic regression modeling.

Results: For asthma, none of the predictors met the false discovery rate (FDR) threshold for significance, suggesting the need for further research. In contrast, COPD predictors showed robust associations with mortality rates, particularly concerning environmental factors such as humidity and temperature. Pneumonia mortality was significantly associated with factors, including air pressure, humidity, temperature, alcohol use, and particulate matter.

Conclusion: The study reveals distinct mortality profiles for respiratory diseases and highlights the importance of environmental and lifestyle factors as predictors. These findings emphasize the need for targeted public health strategies and interventions to manage these diseases effectively.

The World Health Organization's definition of oral health underscores its holistic nature encompassing physiological, psychosocial, and functional dimensions. The current estimates of oral diseases in Tanzania and around the world underscore the urgency of intervention, particularly in light of rising sugar consumption trends. The unique challenges facing Tanzania, including inadequate knowledge, limited infrastructure, and disparities in oral healthcare access, are analyzed within the broader context of sub-Saharan Africa's health priorities. This article addresses the multifaceted challenges of oral health neglect in Tanzania, emphasizing the imperative need for a comprehensive and integrated approach. The discussion offers a detailed exploration of determinants contributing to oral health neglect, spanning socioeconomic, behavioral, and commercial factors, with a focus on their implications for Tanzanian communities. Recommendations are presented as a strategic roadmap, encompassing public health education, integrated healthcare services, government intervention, educational programs, community engagement, financial accessibility, and research initiatives. By synthesizing these recommendations into a cohesive framework, a proactive and collaborative approach to mitigate the consequences of oral health neglect in Tanzania, emphasizing the need for transformative policies and cultural sensitivity, is therefore envisioned.

Background: The coronavirus pandemic has profoundly affected global health, economic stability, and environmental sustainability. Despite these challenges, significant gaps in data remain, particularly in effectively assessing and engaging diverse communities such as color, LGBTQIA+ individuals, and low-income groups. This shortage of comprehensive research limits our capacity to undertake sensitive studies, specifically in dealing with the complexities of long COVID, which some individuals continue to suffer from after their initial recovery.

Objective: This review delves into the ongoing repercussions of long-term COVID-19, a postinfectious syndrome marked by neurological symptoms such as cognitive deficits and sensory impairments, which may last well beyond the acute phase of the illness. These symptoms frequently overlap with mental health issues (e.g., anxiety and depression), which can aggravate the socioeconomic challenges faced by vulnerable populations, especially within the LGBTQA+ communities.

Methods: To tackle these complex interactions, we have introduced a novel public health framework: model-based systems thinking (MBST), which incorporates System Dynamics and causal loop diagrams (CLD).

Results and discussion: The articles were selected on the basis of their discussion of COVID-19-associated anosmia, exploration of olfactory dysfunction alongside neurocognitive disorders, and the challenges experienced in LGBQA+ communities. This approach offers a robust framework for dissecting the intricate ties between socioeconomic factors, health outcomes, and the extended recovery trajectories associated with long-term COVID-19, with a particular focus on olfactory dysfunction. We also explore strategies to make our models more accessible to healthcare providers and the LGBTQA+ communities, encouraging its broader adoption.

Conclusion: Long COVID's impact on public health and marginalized communities highlights the urgent need for adopting systems thinking models. Additionally, this article calls for a concerted effort from all experts to foster multidisciplinary, team-based research and implement effective support measures for COVID-19 survivors across all communities, mainly focusing on the scientific, social, and behavioral challenges LGBTQIA+ and low-income individuals face.

Background: Diabetes is a major public health problem worldwide, currently affecting more than 537 million people. The disease is associated with high morbidity and mortality rates. Modern diabetes care has evolved toward more patient-centered approaches, emphasizing individualized treatment plans and targets. This study sought to assess the level of satisfaction with diabetes care and related factors among patients attending public diabetes clinics in Dar es Salaam, Tanzania.

Methods: This descriptive cross-sectional study used a simple random sampling method to recruit 423 diabetic patients from May to October 2023. Data collection was conducted using a structured questionnaire administered by an interviewer. The collected data were coded and analyzed using Statistical Package for the Social Sciences (SPSS) version 25.

Results: The mean (±SD) age of participants was 58.7 (±11.68) years. About half (51.1%) of participants reported being satisfied with the diabetes care provided, 26.2% were very satisfied, and 22.7% were dissatisfied. Participants who usually spend 1-3 h pursuing services at the facilities had 0.40 less odds of being dissatisfied with diabetes care offered at the clinics compared to those who spend more than 3 h on each attendance (adjusted odds ratio [adjusted OR] 0.40, 95% confidence interval [CI] 0.21-0.76, p = 0.005). For each one-unit increase in the communication subscale score, the likelihood of satisfaction (as opposed to being very satisfied) increased (adjusted OR 1.23, 95% CI 1.09-1.38, p = 0.001). Each one-unit increase in the accessibility subscale score increased the probability of satisfaction (adjusted OR 1.12, 95% CI 1.02-1.24, p = 0.023) and decreased the probability of dissatisfaction (adjusted OR 0.85, 95% CI 0.76-0.95, p = 0.004).

Conclusion: These findings highlight the importance of effective communication and accessibility in improving patient satisfaction with diabetes care in public clinics. Health facilities and allied stakeholders should engage in continual capacity building among healthcare providers. Furthermore, other studies should be conducted at different levels of health facilities across the country to capture new insights on the satisfaction of homogenous sub-groups of patients.

Prenatal genetic testing is to determine the possibility of the fetus having a genetic aberration or birth defect. Prenatal screening consists of serum analytes screening with or without nuchal translucency (NT) scanning or with cell-free DNA (CfDNA) screening. Prenatal screening is recommended for all pregnant women regardless of the duration of pregnancy and maternal age or baseline risk. It is not advisable to screen with serum analytes and CfDNA concurrently to avoid discordant results. In developed countries, prenatal testing has been a part of routine antenatal care for a long time with adopting newer methods of screening and testing. In Bhutan, since the integration of the Safe Motherhood Program into primary healthcare in 1994, there has been an unprecedented improvement in obstetric care services. Almost all pregnant women attend antenatal and postnatal care, and 98.5% of deliveries are attended by trained health workers. The maternal mortality has reduced to 53 in 2023 from 770 per 100,000 live births in 1984 and the neonatal dealth has reduced to 15.2 per 1000 live births in 2023. However, despite improvements in the care of pregnant women, many babies are detected with congenital anomalies, syndromes, and birth defects during the postnatal period. Bhutan, being an underdeveloped country, could not initiate any form of prenatal testing program except for the anatomical scanning performed at 18-22 weeks of gestation. Early ultrasound dating scans, limited anomaly scanning, and growth scanning are offered to all pregnant women. There is a need to start centralized prenatal testing services in Bhutan to provide a comprehensive package of obstetric care to pregnant women. In addition, legal rights for parents to terminate severely deformed fetuses or severe genetic diseases before 24 weeks of pregnancy need to be established.

Background: Epidemiological and economic literature has revealed that low birth weight (LBW) is related to poor health conditions and a broader range of negative socio-economic outcomes, including academic achievement, income levels, and working status. However, Japanese evidence for labor outcomes is particularly lacking, as is the question of whether the impact of LBW on adulthood worsens when disasters occur. We aimed to reveal the impact on LBW on labor outcomes during the disaster recovery phase.

Methods: We used a cross-sectional data set of 4156 national health insurance holders, males aged 40-60 years, from the Miyagi and Iwate prefectures during the earthquake recovery phase. Employing a multinomial probit and logistic model, we estimated the impact of LBW on the employment status, changes in income, and the propensity to face a decline in income with a job change.

Results: The very low birth weights (VLBWs) have a disadvantage in all labor market outcomes. Compared to the non-LBWs, the VLBWs were 15.2% less likely to be full-time/self-employed and 17.1% more likely to be contingent/temporary/part-time workers. Moreover, 32.9% are more likely to face a decline in income and approximately 3.7 times more likely to change jobs leading to income decline. The LBWs were likely to face a decline in income by 8.6% and 4.6%, respectively, but no other significant effects were found on other outcomes.

Conclusions: The effects were apparent for the VLBW, but not so much for the LBW. The effects became larger during the disaster recovery phase, even though the regional economies were boosted.

Introduction: The COVID-19 pandemic has underscored the importance of preventive measures like handwashing and mask-wearing. However, preschoolers often struggle to comprehend disease transmission. This study examined how time and handwashing impact adults' and preschoolers' inferential processes related to infectious disease transmission.

Methods: Thirty-eight Japanese adults aged 18-23 years (8 men; 30 women) and 36 Japanese children aged 5-6 years (15 boys; 21 girls) participated in this study. Participants were presented with scenarios involving an infectious individual who was present (1) at the same time, (2) immediately before, or (3) the previous day. Scenarios were presented via PowerPoint for adults and as a picture-story for preschoolers, with questions on infection likelihood pre- and post-handwashing.

Results: Both age groups perceived a significantly higher likelihood of infection for same-time exposure than for other exposures. Preschoolers estimated a lower likelihood of infection than adults ( ${\eta }_p^2$  = 0.25). Handwashing significantly reduced perceived infection risk, particularly for same-time ( ${\eta }_p^2$  = 0.34) and immediately after ( ${\eta }_p^2$  = 0.10) exposures.

Conclusion: This study highlights the critical need for age-appropriate communication about infection prevention, particularly for young children. Preschoolers exhibited a more positive perception of infectious disease transmission, which necessitates reinforcing multiple preventive measures beyond handwashing. The findings underscore the importance of considering cognitive development and the influence of contemporary experiences like the COVID-19 pandemic when educating about disease transmission. Future research should further explore the relationship between cognitive development, individual differences, and infection reasoning to enhance public health strategies for varying age groups.

Introduction: Breast cancer poses significant health risks to women and strains healthcare systems extensively. In low- and middle-income countries (LMICs), limited resources and inadequate healthcare infrastructures further exacerbate the challenges of breast cancer prevention, treatment, and awareness.

Methods: We examined the prevalence, risk factors, and trends of breast cancer in LMICs. Data on disability-adjusted life years (DALYs) and breast cancer risk factors were extracted from the Global Burden of Disease (GBD) databases for 203 countries or territories from 1990 to 2019. LMIC DALY rates were examined using joinpoint regression analysis.

Results: Among the income groups, the lower middle-income category had the highest DALYs value, with 1787 years per 100,000 people. LMICs collectively accounted for 74% of the global burden of DALYs lost due to breast cancer in 2019. However, it remained relatively consistent in lower middle income countries (LMCs). In LMCs, the risk associated with metabolic syndromes was higher compared to that with behavioral factors alone. For the past three decades, breast cancer incidences increased significantly in LMCs (average annual percent change [AAPC]: 1.212, confidence intervals [CI]: 1.51-1.87, p < 0.001), upper middle income countries (AAPC: 1.701, CI: 1.12-1.48, p < 0.001), and low-income countries (AAPC: 1.002, CI: 1.57-1.68, p < 0.001).

Conclusion: This research shows how breast cancer in LMICs is aggravated by low resources and healthcare infrastructure. To effectively combat breast cancer in these areas, future strategies must prioritize improvements in healthcare infrastructure, awareness campaigns, and early detection mechanisms.