Psychosocial factors influencing acceptance of laparoscopic tubal ligation

Research Problem: What are the psychosocial factors influencing acceptance of laparoscopic tubal ligation? Objectives: To study psychosocial factors influencing acceptance of laparoscopic tubal ligation. Study Design: Hospital based study by questionnaire method. Setting: Postpartum unit of Irwin Group of Hospitals, M.P. Shah, MedicalCollege, Jamnagar, Gujarat. Participants: Acceptors of laparoscopic tubal ligation. Sample Size: 500 acceptors. Study Variables: Age of acceptor, family size, contra­ceptive use. Statistical Analysis: By proportions. Result: Out of 500 acceptors, 58% belonged to rural areas. Mean number of children per acceptor was 4.01 ± 1.8. Mean age of acceptor was 28.3±4.3years. 76.8% of the acceptors did not use any contraceptive prior to acceptance of laparoscopic tubal ligation. An important finding of the study was that monetary incentives had no role in acceptance of tubal ligation

Suicide and deliberate self-harm in Pakistan: A scoping review

Background: Suicide is a major global public health problem with more than 800,000 incidents worldwide annually. Seventy-five percent of the global suicides occur in low and middle-income countries (LMICs). Pakistan is a LMIC where information on suicidal behavior is limited. The aim of the review is to map available literature on determinants, risk factors and other variables of suicidal behavior in Pakistan.Method: This study was based on Arksey and O\u27Malley\u27s methodological framework of scoping review, combining peer reviewed publications with grey literature. Ten databases including Applied Social Sciences Index and Abstracts (ASSIA), Cochrane Trials Register (CRG), Cumulative Index to Nursing and Allied Health (CINAHL), National Library of Medicine Gateway (NLMG), ExcerptaMedica (EMBASE), National Library of Medicine\u27s MEDLINE (PUBMED), PSYCHINFO, Social Science Citation Index and Science Citation Index (SCI) and Pakmedinet.com were searched from the beginning of their time frames until December 2016 using a combination of key terms. The inclusion criteria included studies of various study designs covering different aspects of suicidal behavior in English language.Results: Six hundred and twenty three articles were initially retrieved from all ten databases. Two independent reviewers screened the titles and abstracts for relevance. One hundred and eighteen articles were read in full, out of which 11 were excluded because they did not fit the eligibility criteria. One hundred and ten articles, including two student theses and one report, were included in the final review. Most studies were descriptive in nature, with only three that used a case-control design. Majority of the studies were from urban areas, and addressed determinants rather than risk factors. Gender differences and age were predominantly reported, with more males committing suicide. Suicidal behavior was more common among individuals younger than 30 years of age. The three most common methods for suicides were hanging, poisoning and use of firearms. Mental illness as a risk factor for suicides was mentioned in only three studies.Conclusions: This review is the first attempt to synthesize available literature on suicidal behavior in Pakistan. The evidence is limited, and calls for more robust analytical research designs, along with a focus on risk factors

Caregivers’ Compliance and Perception of Daycare Centers:A Community-Based Childhood Drowning Prevention Intervention Implemented in Rural Bangladesh

Drowning was one of the most prevalent causes of death worldwide for children under five in 2020. Drowning was the second leading cause of death for children under five in Bangladesh, while 58% of all deaths in the 1–5 years old age group resulted from drowning. Adult supervision helps prevent child drowning in rural areas where water bodies are easily accessible and located very close to homes. This paper aims to assess caregivers’ compliance and perception of community daycare centers in rural Bangladesh, piloted as a child drowning prevention intervention. In this longitudinal study, each child enrolled in the daycare intervention was visited and data on compliance and satisfaction with the daycare were collected. Descriptive statistics on daycare attendance, patterns of supervision, and caregivers’ perceptions about daycare were reported. When inquired about daycare attendance (n = 226,552), a total of 77.4% of children (n = 175,321) were found to attend daycare. The distance from homes and an adult’s unavailability to take the child to daycare were the most common reasons for not attending or discontinuing enrollment. The majority of children (76.4%) were supervised by their mothers during daycare closures. A total of 67.7% of respondents perceived daycare to be a safe place, where children also developed cognitive (51.7%) and social skills (50.6%). There were no incidences of drowning among children while attending daycare. Rural families were found to be compliant with the daycare and professed it to be a safe place protecting children from drowning and other injuries, while allowing them to focus on household chores or income-generating activities. These findings indicate a potential for the expansion of this intervention in rural Bangladesh and similar settings

Suggesting global insights to local challenges: expanding financing of rehabilitation services in low and middle-income countries

PurposeFollowing the rapid transition to non-communicable diseases, increases in injury, and subsequent disability, the world—especially low and middle-income countries (LMICs)—remains ill-equipped for increased demand for rehabilitative services and assistive technology. This scoping review explores rehabilitation financing models used throughout the world and identifies “state of the art” rehabilitation financing strategies to identify opportunities and challenges to expand financing of rehabilitation.Material and methodsWe searched peer-reviewed and grey literature for articles containing information on rehabilitation financing in both LMICs and high-income countries.ResultsForty-two articles were included, highlighting various rehabilitation financing mechanism which involves user fees and other innovative payment as bundled or pooled schemes. Few studies explore policy options to increase investment in the supply of services.Conclusionthis paper highlights opportunities to expand rehabilitation services, namely through promotion of private investment, improvement in provider reimbursement mechanism as well as expanding educational grants to bolster labor supply incentive, and the investment in public and private insurance schemes. Mechanisms of reimbursement are frequently based on global budget and salary which are helpful to control cost escalation but represent important barriers to expand supply and quality of services

Liposomal amphotericin B for visceral leishmaniasis in human immunodeficiency virus-coinfected patients: 2-year treatment outcomes in Bihar, India

Reports on treatment outcomes of visceral leishmaniasis (VL)-human immunodeficiency virus (HIV) coinfection in India are lacking. To our knowledge, none have studied the efficacy of liposomal amphotericin B in VL-HIV coinfection. We report the 2-year treatment outcomes of VL-HIV-coinfected patients treated with liposomal amphotericin B followed by combination antiretroviral treatment (cART) in Bihar, India

Provision of rehabilitation for congenital conditions.

Considerable progress has been made in saving the lives of children younger than 5 years. Nevertheless, these advances have failed to help all children thrive, particularly children with disabilities. We describe the increasing prevalence of disability among children and adolescents. We evaluate the current situation regarding children with disabilities and rehabilitation in the context of health systems, particularly those in low- and middle-income countries. Within the newborn health agenda, congenital anomalies often require early intervention and rehabilitation. We provide Argentina as an example of a country where rehabilitation for congenital anomalies is integrated into the health system. We argue that congenital anomalies that require rehabilitation have the potential to strengthen rehabilitation systems and policies by: strengthening coordination between primary care and rehabilitation; identifying and understanding pathways that allow families to engage with services; providing human resources for rehabilitation; and building systems and resources that support assistive technology and rehabilitation. We propose ways for countries to prioritize and integrate early identification, referral and care for children with congenital anomalies to strengthen health systems for all. We identify opportunities to expand policy and planning and to design service delivery and workforce strategies through World Health Organization guidelines and frameworks for rehabilitation. We argue that the global health community must act to ensure that rehabilitation services to support functioning from birth are well established, accepted and integrated within health systems, and that disability is prioritized within child health. These steps would strengthen health systems, ensure functioning from birth and make rehabilitation accessible to all

Assessing the effectiveness of intervention strategies to address home injuries among children in Malaysia: a cluster randomized trial evaluation of evidence

Background Malaysia is facing an increasing burden of childhood injuries, not unlike many other low- and middle-income countries (LMICs). Across the globe, more than 95 percent of total child injury mortality occurs in LMICs. A considerable proportion of these injuries occur in and around the home. Effective approaches to prevention include home safety education, parenting education and home modification. Through this study, we aim to evaluate the effectiveness of two intervention strategies in reducing in-home hazards for unintentional injuries among children. Methods We conducted a prospective cluster randomized controlled trial (cRCT) to compare the effectiveness of an in-home safety tutorial program and an educational pamphlet intervention in reducing safety hazards to child injuries. The study randomized 39 clusters to two study arms (home safety tutorial vs educational pamphlet), with around 30 households per cluster. Our exposure and outcome were assessed using a household survey instrument with self-reported and observer-reported components. Results Our initial analysis is a comparison of overall safety scores across the baseline arm that found a mean safety score of 30 of a maximum possible 45 (translating to a mean percentage of 66.7%), with improvement on average in both intervention arms. The overall safety score mean for educational pamphlets was 32.3 with a mean percentage of 71.7%, and the corresponding numbers for the in-home tutorial were 31.8 and 71%. Discussion This study compares a labor-intensive and ‘active’ intervention, the in-home safety tutorial, with a more passive intervention through handing out educational pamphlets. In our preliminary findings from the cRCT, we see an improvement in the mean safety scores between baseline and follow-up measurement in both intervention arms; between the two intervention arms, the safety scores are comparable. We believe that educational pamphlets can be an effective intervention to reduce child injuries, with particular relevance to resource constrained settings

Adolescent and Young Adult Injuries in Developing Economies: A Comparative Analysis from Oman and Kenya

Background: Adolescence is a distinct period of rapid and dramatic biological, cognitive, psychological, and social development. The burden of injuries among young people (aged 10-24) is both substantial and maldistributed across regions and levels of economic development. Objectives: Our objective was to compare sociodemographic correlates of injury cause, intentionality, and mortality between Kenya and Oman, 2 countries with different levels of economic development and position in the demographic and epidemiologic transitions. Methods: Data on 566 patients in Oman and 5859 in Kenya between 10 and 24 years old were extracted from 2 separate multicenter trauma registries. Multivariable log binomial and Poisson regressions were used to evaluate social and demographic factors associated with injury cause, intentionality, and mortality. Literature on adolescent development was used to parameterize variables, and Akaike information criteria were used in the final model selections. Findings: The trauma registry data indicated a substantial burden of adolescent and young adult injury in both Oman and Kenya, particularly among males. The data indicated significant differences between countries ('P' interpersonal violence also resulting in severe injury across contexts. Both road traffic injuries and interpersonal violence were more common among older adolescents and young adults. Education and being in school were protective against injury, after controlling for gender, age category, occupation, and country. ConclusionsA rising burden of injuries among young people has been documented in every region of the world, irrespective on income status or level of development. Cost-effective injury control measures targeting this age group exist, including involvement in educational, vocational, and other prosocial activities; environmental alterations; and road safety measures

Role and promise of health policy and systems research in integrating rehabilitation into the health systems

Despite recognized need and reasonable demand, health systems and rehabilitation communities keep working in silos, independently with minimal recognition to the issues of those who require rehabilitation services. Consolidated effort by health systems and rehabilitation parties, recognizing the value, power and promise of each other, is a need of the hour to address this growing issue of public health importance. In this paper, the importance and the need for integration of rehabilitation into health system is emphasized. The efforts being made to integrate rehabilitation into health systems and the potential challenges in integration of these efforts were discussed. Finally, the strategies and benefits of integrating rehabilitation in health systems worldwide is proposed. Health policy and systems research (HPSR) brings a number of assets that may assist in addressing the obstacles discussed above to universal coverage of rehabilitation. It seeks to understand and improve how societies organize themselves to achieve collective health goals; considers links between health systems and social determinants of health; and how different actors interact in policy and implementation processes. This multidisciplinary lens is essential for evidence and learning that might overcome the obstacles to the provision of rehabilitation services, including integration into health systems. Health systems around the world can no longer afford to ignore rehabilitation needs of their populations and the World Health Assembly (WHA) resolution marked a global call to this effect. Therefore, national governments and global health community must invest in setting a priority research agenda and promote the integration of rehabilitation into health systems. The context-specific, need-based and policy-relevant knowledge about this must be made available globally, especially in low- and middle-income countries. This could help integrate and implement rehabilitation in health systems of countries worldwide and also help achieve the targets of Rehabilitation 2030, universal health coverage and Sustainable Development Goals