BMC Public Health

With the incidence of malaria in Sri Lanka declining, intensive parasitological surveillance has been identified as a key strategy to achieve elimination by end 2014. Tropical and Environmental Diseases and Health Associates Private Limited (TEDHA) in collaboration with the Anti-Malaria Campaign established 43 malaria diagnostic laboratories (MDL) in four post-conflict districts of the Northern and Eastern Provinces. This study assesses the patterns of referral of patients with fever for malaria diagnosis by health care providers (HCPs) in four government hospitals in one of the districts of the Northern Province, and patient satisfaction with the laboratory services offered. In this prospective descriptive study, data was collected on the proportion of fever patients being referred by the HCP in hospitals for malaria screening, and the proportion thereof who underwent screening. An interviewer-administered questionnaire was also used to assess patient satisfaction among those attending MDL, which was graded on a scale of 0–4. Of patients presenting to the hospitals with fever, only 44.3% were referred for malaria screening; 81.7% of them underwent screening. Referral depended largely on the presence of a permanent staff HCP. Satisfaction levels were high, with 86.55% giving an overall rating of 4. Comfort within the laboratory was rated satisfactory in three of the four hospitals. This study demonstrates the success of a public-private partnership in the malaria control programme in Sri Lanka. Malaria is considered low on the differential diagnosis in patients with fever even in previously malaria-endemic areas, due to the declining incidence of malaria and the increase in other febrile illnesses in these areas during the recent past. Private sector run malaria diagnostic services provided free of charge within government hospitals are viable and effective, and had good patient satisfaction ratings. In a country on the brink of eliminating malaria, there should be further emphasis on ensuring that HCPs refer patients for malaria diagnosis, in order to prevent a resurgence of the disease.

While much is known about the leading causes of death (CoD) and how they have evolved over time, much less is known about the diversity of such causes of death. CoD diversity is an important marker of population health heterogeneity that has been largely overlooked in the study of contemporary health dynamics. We provide regional and national estimates of CoD diversity from 1990 to 2019. We rely on data from the Global Burden of Disease project, using information on 21 CoD. Results are presented for 204 countries and territories, for women and men separately. CoD diversity is measured with the index of Fractionalization. Results are disaggregated by age and cause of death. CoD diversity has declined across world regions, except for Latin America and the Caribbean, the region of High-income countries and women in Central Europe, Eastern Europe, and Central Asia. Changes in mortality at adult and older ages have been mostly responsible for CoD diversity dynamics, except for the regions of South Asia and Sub-Saharan Africa, where infant and child mortality still play a non-negligible role. The relationship between CoD diversity, life expectancy, and lifespan inequality is strongly non-monotonic, with turning points differing by sex and indicator. Among longevity vanguard countries, further increases in life expectancy are associated with decreasing lifespan inequality but increasing CoD diversity. As mortality declines, there is no universal pathway toward low CoD diversity, thus casting doubts on the ability of Epidemiological Transition Theory to predict prospective CoD dynamics among high- and middle-mortality countries. Despite the postponement and increasing predictability of the ages at which individuals die, low-mortality populations are composed of an increasingly heterogenous mix of robust and frail individuals, thus increasing the diversity of health profiles among older persons – an issue that could potentially complicate further improvements in longevity.

Nghiên cứu này xem xét mối quan hệ giữa dị ứng thực phẩm ở trẻ em và những lựa chọn thực phẩm không lành mạnh của cha mẹ cho con cái của họ, với thái độ đối với tình trạng béo phì ở trẻ em là các yếu tố trung gian, và giới tính, thu nhập và trình độ học vấn của cha mẹ là các yếu tố điều chỉnh tiềm năng. Chúng tôi đã khảo sát ý kiến của các bậc cha mẹ có ít nhất một đứa trẻ trong độ tuổi từ 6 đến 12 sống tại Canada và Hoa Kỳ. Chúng tôi nhận được 483 phản hồi hợp lệ đã được phân tích bằng phương pháp mô hình phương trình cấu trúc với kỹ thuật bootstrapping để kiểm tra mô hình đường giả thuyết và sự không đổi của nó qua các yếu tố điều chỉnh. Phân tích cho thấy rằng áp lực phải ăn đã trung gian hóa hoàn toàn các tác động của dị ứng thực phẩm ở trẻ em và sự hạn chế đối với những lựa chọn thực phẩm không lành mạnh của cha mẹ cho con họ. Cuối cùng, chúng tôi phát hiện ra rằng giới tính của cha mẹ đã điều chỉnh mối quan hệ giữa dị ứng thực phẩm ở trẻ em và áp lực phải ăn. Bài báo này đóng góp vào tài liệu về dị ứng thực phẩm ở trẻ em và sự thiệt thòi của các gia đình có trẻ dị ứng. Mô hình khám phá của chúng tôi là một trong những mô hình đầu tiên và cung cấp một góc nhìn mới về các mối quan hệ phức tạp giữa các biến đang xem xét. Mặc dù việc thu thập dữ liệu của chúng tôi diễn ra trước khi bùng phát dịch Covid-19, nhưng bài báo này vẫn có ý nghĩa đặc biệt khi chiếu sáng cách các gia đình có trẻ dị ứng nên được xem là một nhóm ưu tiên trong việc tiếp cận nguồn cung thực phẩm trong các thời kỳ khủng hoảng.

People living in rural and remote communities commonly experience significant health disadvantages. Geographical barriers and reduced specialist and generalist services impact access to care when compared with metropolitan context. Innovative models of care have been developed for people living with chronic diseases in rural areas with the goal of overcoming these inequities. The aim of this paper was to describe the characteristics and outcomes of studies investigating innovative models of care for people living with chronic disease in rural areas of developed countries where a metropolitan comparator was included. An integrative systematic review was undertaken. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used to understand the empirical and theoretical data on clinical outcomes for people living with chronic disease in rural compared with metropolitan contexts and their models of care in Australia, New Zealand, United States, Canada and the United Kingdom. Literature searching revealed 620 articles published in English between 1st January 2000 and 31st March 2019. One hundred sixty were included in the review including 68 from the United States, 59 from Australia and New Zealand (5), 21 from Canada and 11 from the United Kingdom and Ireland. 53% (84) focused on cardiovascular disease; 27% (43) diabetes mellitus; 8% (12) chronic obstructive pulmonary disease; and 13% (27) chronic kidney disease. Mortality was only reported in 10% (16) of studies and only 18% (29) reported data on Indigenous populations. This integrated review reveals that the published literature on common chronic health issues pertaining to rural and remote populations is largely descriptive. Only a small number of publications focus on mortality and comparative health outcomes from health care models in both urban and non-urban populations. Innovative service models and telehealth are together well represented in the published literature but data on health outcomes is relatively sparse. There is significant scope for further directly comparative studies detailing the effect of service delivery models on the health outcomes of urban and rural populations. We believe that such data would further knowledge in this field and help to break the deadly synergy between increased rurality and poorer outcomes for people with chronic disease.

Children can be highly active and highly sedentary on the same day! For instance, a child can spend a couple of hours playing sports, and then spend the rest of the day in front of a screen. A focus on examining both physical activity and sedentary behaviour throughout the day and in all seasons in a year is necessary to generate comprehensive evidence to curb childhood obesity. To achieve this, we need to understand where within a city are children active or sedentary in all seasons. This active living study based in Saskatoon, Canada, aims to understand the role played by modifiable urban built environments in mitigating, or exacerbating, seasonal effects on children’s physical activity and sedentary behaviour in a population of children in transition from preadolescence to adolescence. Designed as an observational, longitudinal investigation this study will recruit 800 Canadian children 10–14 years of age. Data will be obtained from children representing all socioeconomic categories within all types of neighbourhoods built in a range of urban designs. Built environment characteristics will be measured using previously validated neighbourhood audit and observational tools. Neighbourhood level socioeconomic variables customized to Saskatoon neighbourhoods from 2011 Statistics Canada’s National Household Survey will be used to control for neighbourhood social environment. The validated Smart Cities Healthy Kids questionnaire will be administered to capture children’s behaviour and perception of a range of factors that influence their activity, household (including family socioeconomic factors), parental, peer and neighbourhood influence on independent mobility. The outcome measures, different intensities of physical activity and sedentary behaviour, will be collected using global positioning system equipped accelerometers in all four seasons. Each accelerometry cycle will be matched with weather data obtained from Environment Canada. Extensive weather data will be accessed and classified into one of six distinct air mass categories for each day of accelerometry. Computational and spatial analytical techniques will be utilized to understand the multi-level influence of environmental exposures on physical activity and sedentary behaviour in all seasons. This approach will help us understand the influence of urban environment on children’s activity, thus paving the way to modify urban spaces to increase physical activity and decrease sedentary behaviour in children in all four seasons. Lack of physical activity and rising sedentariness is associated with rising childhood obesity, and childhood obesity in turn is linked to many chronic conditions over the life course. Understanding the interaction of children with urban spaces will reveal new knowledge, and when translated to actions will provide a strong basis for informing future urban planning policy.

In the Netherlands, human papillomavirus (HPV) vaccination is part of a national program equally accessible for all girls invited for vaccination. To assess possible inequalities in vaccine uptake, we investigated differences between vaccinated and unvaccinated girls with regard to various characteristics, including education and ethnicity, (both associated with non-attendance to the national cervical screening program), sexual behaviour and knowledge of HPV. In 2010, 19,939 nationwide randomly-selected 16–17 year-old girls (2009 vaccination campaign) were invited to fill out an online questionnaire. A knowledge scale score and multivariable analyses identified variables associated with vaccination status. 2989 (15%) of the selected girls participated (65% vaccinated, 35% unvaccinated). The participants were comparable with regard to education, ethnicity, most sexual risk behaviour and had similar knowledge scores on HPV transmission and vaccination. However, unvaccinated girls lived in more urbanised areas and were more likely to have a religious background. Irrespective of vaccination status, 81% of the girls were aware of the causal relationship between HPV and cervical cancer, but the awareness of the necessity of cervical screening despite being vaccinated was limited. HPV vaccine uptake was not associated with knowledge of HPV and with factors that are known to be associated with non-attendance to the cervical cancer screening program in the Netherlands. Furthermore, most sexual behaviour was not related to vaccination status meaning that teenage unvaccinated girls were not at a disproportionally higher risk of being exposed to HPV. Routine HPV vaccination may reduce the social inequity of prevention of cervical cancer.

In recent times, medical schools have committed to developing good communication and history taking skills in students. However, there remains an unresolved question as to which constitutes the best educational method. Our study aims to investigate whether the use of videotape recording is superior to verbal feedback alone in the teaching of clinical skills and the role of student self-assessment on history taking and communication skills. A randomized controlled trial was designed. The study was conducted with 52 of the Dokuz Eylul University Faculty of Medicine second year students. All students' performances of communication and history taking skills were assessed twice. Between these assessments, the study group had received both verbal and visual feedback by watching their video recordings on patient interview; the control group received only verbal feedback from the teacher. Although the self-assessment of the students did not change significantly, assessors' ratings increased significantly for videotaped interviews at the second time. Feedback based on videotaped interviews is superior to the feedback given solely based on the observation of assessors.

National and international strategies have increasingly promoted chronic patient participation at different levels of the health care system, building the image of an ‘active’ chronic patient engaged for example in his/her daily self-care and within associations dealing with service delivery and/or policy advocacy. Drawing upon examples of the fight against diabetes and HIV/AIDS in Mali, this article explores the factors that influence the engagement of patient associations at policy level. We focus on the openness of the institutionalised political system, and explore the role that public authorities, caregivers and donors give to diabetes and HIV/AIDS patients. Data was collected between 2008 and 2014 in Bamako in the framework of a qualitative research. Thirty-eight actors fighting against diabetes were interviewed, as well as 17 representatives of donors. For HIV/AIDS, 27 actors were interviewed. In both cases, non-participant observation was carried out and documentary sources were collected. Based on theory of public and collective action, a historical and cognitive approach was adopted. Data analysis followed an inductive and iterative method. Partnerships between public authorities and diabetes patient associations have been intermittent over time and remained rather informal. In the case of people living with HIV/AIDS, the partnership between their associations and public authorities has steadily grown and was progressively institutionalised. Three political factors explain this difference: focus and extent of the commitment of public authorities, existing policy-making processes, and how the law frames patients’ roles. Moreover, opportunities for patient participation depend on the nature and extent of the support provided by international donors. Finally, the cognitive dimension is also at stake, notably in relation to the way the two diseases and patients have been perceived by public authorities, caregivers, and donors. Chronic patients are intermittent partners for policy-makers. Despite the image of chronic active patients conveyed by national and international public health strategies, patient participation is not straightforward. Rather, political, economic, and cognitive factors underpin the presence of political opportunities that enable patient participation. Chronicity of the disease appears to play an ambiguous role in the shaping of these factors.

In low-income countries such as Nepal, indoor air pollution (IAP), generated by the indoor burning of biomass fuels, is the top-fourth risk factor driving overall morbidity and mortality. We present the first assessment of geographic and socio-economic determinants of the markers of IAP (specifically fuel types, cooking practices, and indoor smoking) in a nationally-representative sample of Nepalese households. Household level data on 11,040 households, obtained from the 2016 Nepal Demographic and Health Survey, were analyzed. Binary logistic regression analyses were conducted to assess the use of fuel types, indoor cooking practices, indoor smoking and IAP with respect to socio-economic indicators and geographic location of the household. More than 80% of the households had at least one marker of IAP: 66% of the household used unclean fuel, 45% did not have a separate kitchen to cook in, and 43% had indoor smoking. In adjusted binary logistic regression, female and educational attainment of household’s head favored cleaner indoor environment, i.e., using clean fuel, cooking in a separate kitchen, not smoking indoors, and subsequently no indoor pollution. In contrast, households belonging to lower wealth quintile and rural areas did not favor a cleaner indoor environment. Households in Province 2, compared to Province 1, were particularly prone to indoor pollution due to unclean fuel use, no separate kitchen to cook in, and smoking indoors. Most of the districts had a high burden of IAP and its markers. Fuel choice and clean indoor practices are dependent on household socio-economic status. The geographical disparity in the distribution of markers of IAP calls for public health interventions targeting households that are poor and located in rural areas.