The impact of health promotion on health in old age : Results from community-based studies in rural Bangladesh

Background: It is common knowledge that Bangladesh has a high prevalence of illness among its older people and that the government healthcare services offer them inadequate support. Despite this, however, information about older people s health and illnesses as a function of health promotion is scant. Aims: To examine the impact of a health promotion intervention on health in old age; to examine associations between bone and joint diseases and health-related quality of life; and to study associations between social capital and quality of life among older people in rural Bangladesh. Methods: This thesis is compiled based on two intervention studies and two cross-sectional studies. Data for Studies I, III and IV were derived from the Primary Healthcare in Later Life: Improving Services in Bangladesh and Vietnam (PHILL) project. Data for Study II were derived from the Poverty and Health in Aging (PHA) project. The projects were located in one of the 64 districts of Bangladesh and situated 70 kilometers southeast of the capital Dhaka. In the PHILL project, eight villages were selected through simple random selection and all the older people (≥60 years) who were residing in the selected villages (n=1,135) were chosen for the study. In PHA (n=850) older people were selected through simple random selection from two purposively selected research blocks. Health promotion interventions in PHILL included physical activity, advice on healthy food intake and other aspects of management. To create an enabling environment, social awareness was provided by means of information about the contribution of and challenges faced by older people at home and in the community, including information about their health and healthcare. The intervention activities were provided to older people themselves, their caregivers, household members, community people, and healthcare providers for a period of 15 months. During analyses, participants in the intervention area were further stratified into compliant (n=315) and non-compliant (n=110) groups based on reported compliance with the intervention activities. Arthritis-related illness and bone and joint diseases were indicated by the presence of any form of arthritis, joint and back pain. Health-related quality of life (HRQoL) was measured using a multi-dimensional generic instrument. Quality of life was assessed using a single global question. Results: Study I revealed that older people who adhered to health promotion activities reported significantly less arthritis-related illness and less healthcare expenditure. Study II showed that bone and joint diseases were significantly associated with various dimensions and overall HRQoL. Furthermore, being an elderly woman and being a woman with self-reported joint and back pain were associated with lower scores in various dimensions of HRQoL. Study III indicated that, in the non-compliant group, the probability of increased HRQoL scores was less likely only in overall HRQoL. In the control group, the probability of increased scores was less likely in the physical, social, spiritual, environment dimensions and overall HRQoL. Study IV revealed that low social capital, both at the individual and community levels, was significantly associated with poor quality of life. Conclusions: This thesis suggests that the provision of community-based health promotion intervention among older people could help to both reduce the burden of arthritis-related illness and its related healthcare expenditure, and improve their health-related quality of life

Changes in condom use among males who have sex with males (MSM): Measuring the effect of HIV prevention programme in Dhaka city.

BackgroundA systematic assessment was done to examine the effect of HIV interventions among MSM in Dhaka, Bangladesh. MSM were defined as males having sex with males but did not sell sex in the last year. MSM are hidden, marginalized and stigmatized population groups not only in Bangladesh but also globally. In 2010, HIV interventions for MSM were expanded in 40 districts of Bangladesh through 65 drop-in-centres (DICs) and peer outreach workers.MethodsData from two surveys on MSM in Dhaka in 2010 (baseline) and 2013 (midline) were used to analyse the effect of ongoing HIV prevention services. Both surveys used time location sampling to randomly select MSM for risk behaviour interviews. Two outcome variables were considered; condom use in the last anal sex act and consistent condom use during anal sex in the last month. Univariate and multivariate logistic regression methods were used to determine factors associated with condom use.ResultsCondom use significantly increased at the midline than baseline (pConclusionTo sustain positive changes in HIV risk behaviours, HIV prevention programmes for MSM need to be continued and strengthened

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality