Family Role Towards Smoking Behaviour Among Children in Jakarta

In Indonesia, the prevalence of smoking among 5 – 9 years old children has increased from 0.4% in 2001 to 2% in 2007. Among present adults smokers (>20 years), 17% started to smoke before the age of 13 years. This study identified factors related to smoking behaviour among 8 – 12 years old children in Jakarta, Indonesia using a questionnaire based cross sectional survey to obtain smoking status and possible predictors towards smoking habit. The total sample size was 1,097 students among 3rd - 7th grade students from schools in Jakarta. Self-reported smoking status was defined as whether the child had smoked tobacco within the past two months prior to the interview. The prevalence of smoking was 13.4%. Logistic regression analysis showed that high parental approval on tobacco use (OR=13.4; CI 95%: 5.1 – 35.1) was the strongest predictor on children smoking status, followed by low parental control (OR=12.1; CI 95%: 6.9 – 21.2), being a male compared to a female (OR=10.7; CI 95%: 5.3 – 21.7), mother (OR=10.58; CI 95%: 3.96 – 28.28), father (OR=7.69; CI 95%: 3.59 – 16.47), sibling (OR=7.91; CI 95%: 4.41 – 14.17) smoking status. Smoking parents and siblings, low parental control, and high parental approval on smoking were related to higher odds of smoking among children. The results were used as a rationale for suggestions and recommendations of relevance for future intervention programs and tobacco related research with specific focus on children.Prevalensi anak perokok umur 5-9 tahun di Indonesia meningkat dari 0,4% di tahun 2001 menjadi 2% di tahun 2007. Tujuh belas persen perokok dewasa menyatakan mulai merokok ketika berumur di bawah 13 tahun. Penelitian ini bertujuan untuk menentukan faktor terkait perilaku merokok anak umur 8-12 tahun di Jakarta dengan menggunakan pendekatan potong lintang untuk menjaring perokok anak dan faktor yang mungkin menyebabkan perilaku tersebut. Kuesioner digunakan untuk menjaring status perilaku merokok anak dalam dua bulan terakhir sebelum survei. Total 1.097 murid kelas 3 sampai 7 di Jakarta menjadi sampel penelitian dengan 13,4% responden merokok dalam 2 bulan terakhir. Analisis regresi logistik menunjukkan bahwa pembolehan merokok di dalam rumah oleh orang tua (OR=13,4; CI 95%: 5,1 – 35,1) menjadi penyebab terkuat, diikuti dengan rendahnya kontrol orang tua (OR=12,1; CI 95%: 6,9 – 21,2), siswa laki-laki (OR=10,7; CI 95%: 5,3 – 21,7), ibu (OR=10.58; CI 95%: 3.96 – 28.28), ayah (OR=7,69; CI 95%: 3,59 – 16,47), dan saudara kandung yang perokok (OR=7,91; CI 95%: 4,41 – 14,17). Orang tua dan saudara kandung yang merokok, rendahnya pengawasan orang tua, dan tingginya pembolehan merokok di dalam rumah menjadi penyebab perilaku merokok anak umur 8- 12 tahun. Hasil penelitian dapat dimanfaatkan sebagai rekomendasi untuk program intervensi di masa depan dan penelitian terkait tembakau dengan fokus kepada anak-anak

Primary Health Care: a strategic framework for the prevention and control of chronic non-communicable disease

In 2014, chronic, non-communicable diseases (NCDs) represent the leading causes of global mortality and disability. Government-level concern, and resulting policy changes, are manifesting. However, there continues to be a paucity of guiding frameworks for legislative measures. The surge of NCDs will require strong and effective governance responses, particularly in low and middle-income countries. Simultaneously following the 2008 World Health Report, there has recently been renewed interest in Primary Health Care (PHC) and its core principles. With this, has come strengthened support for revitalizing this approach, which aims for equitable and cost-effective population-health attainment. In this light and reflecting recent major global reports, declarations and events, we propose and critique a PHC approach to NCDs, highlighting PHC, with its core themes, as a valuable guiding framework for health promotion and policy addressing this group of diseases

Exploring knowledge, attitudes, and practices related to alcohol in Mongolia: A national population-based survey

BACKGROUND: The leading cause of mortality in Mongolia is Non-Communicable Disease. Alcohol is recognised by the World Health Organization as one of the four major disease drivers and so, in order to better understand and triangulate recent national burden-of-disease surveys and to inform policy responses to alcohol consumption in Mongolia, a national Knowledge, Attitudes and Practices survey was conducted. Focusing on Non-Communicable Diseases and their risk factors, this publication explores the alcohol-related findings of this national survey. METHODS: A door-to-door, household-based questionnaire was conducted on 3450 people from across Mongolia. Participants were recruited using a multi-stage random cluster sampling technique, and eligibility was granted to permanent residents of households who were aged between 15 and 64 years. A nationally representative sample size was calculated, based on methodologies aligned with the WHO STEPwise approach to Surveillance. RESULTS: Approximately 50% of males and 30% of females were found to be current drinkers of alcohol. Moreover, nine in ten respondents agreed that heavy episodic drinking of alcohol is common among Mongolians, and the harms of daily alcohol consumption were generally perceived to be high. Indeed, 90% of respondents regarded daily alcohol consumption as either ‘harmful’ or ‘very harmful’. Interestingly, morning drinking, suggestive of problematic drinking, was highest in rural men and was associated with lower-levels of education and unemployment. CONCLUSION: This research suggests that Mongolia faces an epidemiological challenge in addressing the burden of alcohol use and related problems. Males, rural populations and those aged 25-34 years exhibited the highest levels of risky drinking practices, while urban populations exhibit higher levels of general alcohol consumption. These findings suggest a focus and context for public health measures addressing alcohol-related harm in Mongolia

Hypertension and hypertension-related disease in Mongolia; Findings of a national knowledge, attitudes and practices study

BACKGROUND: Mongolia has a high and increasing burden of hypertension and related disease, with cardiovascular diseases among the leading causes of death. Yet little is known about the knowledge, attitudes and practices of the Mongolian population with regards to blood pressure. With this in mind, a national Non-Communicable Diseases knowledge, attitudes and practices survey on blood pressure was implemented in late 2010. This paper reports on the findings of this research. METHODS: Using a multi-stage, random cluster sampling method 3450 participant households were selected from across Mongolia. This survey was interviewer-administered and included demographic and socio-economic questions. Sample size was calculated using methods aligned with the World Health Organization STEPS surveys. RESULTS: One fifth of participants reported having never heard the term ‘blood pressure’. This absence of health knowledge was significantly higher in men, and particularly younger men. The majority of participants recognised high blood pressure to be a threat to health, with a higher level of risk awareness among urban individuals. Education level and older age were generally associated with a heightened knowledge and risk perception. Roughly seven in ten participants were aware of the relationship between salt and blood pressure. Exploring barriers to screening, participants rated a ‘lack of perceived importance’ as the main deterring factor among fellow Mongolians and overall, participants perceived medication and exercise as the only interventions to be moderately effective at preventing high blood pressure. CONCLUSION: Rural populations; younger populations; men; and less educated populations, all with lower levels of knowledge and risk perception regarding hypertension, present those most vulnerable to it and the related health outcomes. This research intimates major health knowledge gaps in sub-populations within Mongolia, regarding health-risks related to hypertension

Exploring knowledge, attitudes and practices related to diabetes in Mongolia: A national population-based survey

BACKGROUND: Non-communicable diseases (NCDs) are now the leading causes of mortality in Mongolia, and diabetes, in particular, is a growing public health threat. Mongolia is a nation undergoing rapid and widespread epidemiological transition and urbanisation: a process that is expected to continue in coming decades and is likely to increase the diabetes burden. To better inform policy and public-health responses to the impact of the growth in NCDs, a national NCD Knowledge, Attitudes and Practices survey was implemented in Mongolia in 2010; a section of which focused on diabetes. METHODS: This survey was a nationally-representative, household-based questionnaire conducted by field-workers. Households were selected using a multi-stage, cluster sampling technique, with one participant (aged 15–64) selected from each of the 3540 households. Questions explored demographic and administrative parameters, as well as knowledge attitudes and practices around NCDs and their risk factors. RESULTS: This research suggests low levels of diabetes-related health knowledge in Mongolia. Up to fifty percent of Mongolian sub-populations, and one in five of the total population, had never heard the term diabetes prior to surveying. This research also highlights a high level of misunderstanding around the symptomatology and natural progression of diabetes; for example, one-third of Mongolians were unaware that the disease could be prevented through lifestyle changes. Further, this study suggests that a low proportion of Mongolians have received counseling or health education about diabetes, with lowest access to such services for the urban poor and least educated sub-populations. CONCLUSIONS: This research suggests a low prevalence of diabetes-related health-knowledge among Mongolians. In this light, health-education should be part of any national strategy on diabetes

Is the Current Decline in Malaria Burden in Sub-Saharan Africa due to a Decrease in Vector Population?

In sub-Saharan Africa (SSA), malaria caused by Plasmodium falciparum has historically been a major contributor to morbidity and mortality. Recent reports indicate a pronounced decline in infection and disease rates which are commonly ascribed to large-scale bed net programmes and improved case management. However, the decline has also occurred in areas with limited or no intervention. The present study assessed temporal changes in Anopheline populations in two highly malaria-endemic communities of NE Tanzania during the period 1998-2009. Between 1998 and 2001 (1st period) and between 2003 and 2009 (2nd period), mosquitoes were collected weekly in 50 households using CDC light traps. Data on rainfall were obtained from the nearby climate station and were used to analyze the association between monthly rainfall and malaria mosquito populations.\ud The average number of Anopheles gambiae and Anopheles funestus per trap decreased by 76.8% and 55.3%, respectively over the 1st period, and by 99.7% and 99.8% over the 2nd period. During the last year of sampling (2009), the use of 2368 traps produced a total of only 14 Anopheline mosquitoes. With the exception of the decline in An. gambiae during the 1st period, the results did not reveal any statistical association between mean trend in monthly rainfall and declining malaria vector populations. A longitudinal decline in the density of malaria mosquito vectors was seen during both study periods despite the absence of organized vector control. Part of the decline could be associated with changes in the pattern of monthly rainfall, but other factors may also contribute to the dramatic downward trend. A similar decline in malaria vector densities could contribute to the decrease in levels of malaria infection reported from many parts of SSA

Learning from changes concurrent with implementing a complex and dynamic intervention to improve urban maternal and perinatal health in Dar es Salaam, Tanzania, 2011-2019

Introduction Rapid urbanisation in Dar es Salaam, the main commercial hub in Tanzania, has resulted in congested health facilities, poor quality care, and unacceptably high facility-based maternal and perinatal mortality. Using a participatory approach, the Dar es Salaam regional government in partnership with a non-governmental organisation, Comprehensive Community Based Rehabilitation in Tanzania, implemented a complex, dynamic intervention to improve the quality of care and survival during pregnancy and childbirth. The intervention was rolled out in 22 public health facilities, accounting for 60% of the city’s facility births. Methods Multiple intervention components addressed gaps across the maternal and perinatal continuum of care (training, infrastructure, routine data quality strengthening and utilisation). Quality of care was measured with the Standards-Based Management and Recognition tool. Temporal trends from 2011 to 2019 in routinely collected, high-quality data on facility utilisation and facility-based maternal and perinatal mortality were analysed. Results Significant improvements were observed in the 22 health facilities: 41% decongestion in the three most overcrowded hospitals and comparable increase in use of lower level facilities, sixfold increase in quality of care, and overall reductions in facility-based maternal mortality ratio (47%) and stillbirth rate (19%). Conclusions This collaborative, multipartner, multilevel real-world implementation, led by the local government, leveraged structures in place to strengthen the urban health system and was sustained through a decade. As depicted in the theory of change, it is highly plausible that this complex intervention with the mediators and confounders contributed to improved distribution of workload, quality of maternity care and survival at birth

Change in Composition of the Anopheles Gambiae Complex and its Possible Implications for the Transmission of Malaria and Lymphatic Filariasis in North-Eastern Tanzania.

A dramatic decline in the incidence of malaria due to Plasmodium falciparum infection in coastal East Africa has recently been reported to be paralleled (or even preceded) by an equally dramatic decline in malaria vector density, despite absence of organized vector control. As part of investigations into possible causes for the change in vector population density, the present study analysed the Anopheles gambiae s.l. sibling species composition in north-eastern Tanzania. The study was in two parts. The first compared current species complex composition in freshly caught An. gambiae s.l. complex from three villages to the composition reported from previous studies carried out 2-4 decades ago in the same villages. The second took advantage of a sample of archived dried An. gambiae s.l. complex specimens collected regularly from a fourth study village since 2005. Both fresh and archived dried specimens were identified to sibling species of the An. gambiae s.l. complex by PCR. The same specimens were moreover examined for Plasmodium falciparum and Wuchereria bancrofti infection by PCR. As in earlier studies, An. gambiae s.s., Anopheles merus and Anopheles arabiensis were identified as sibling species found in the area. However, both study parts indicated a marked change in sibling species composition over time. From being by far the most abundant in the past An. gambiae s.s. was now the most rare, whereas An. arabiensis had changed from being the most rare to the most common. P. falciparum infection was rarely detected in the examined specimens (and only in An. arabiensis) whereas W. bancrofti infection was prevalent and detected in all three sibling species. The study indicates that a major shift in An. gambiae s.l. sibling species composition has taken place in the study area in recent years. Combined with the earlier reported decline in overall malaria vector density, the study suggests that this decline has been most marked for An. gambiae s.s., and least for An. arabiensis, leading to current predominance of the latter. Due to differences in biology and vectorial capacity of the An. gambiae s.l. complex the change in sibling species composition will have important implications for the epidemiology and control of malaria and lymphatic filariasis in the study area