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

Den andra kränkningen - målsäganden och rättsprocessen

I massmedia har det under senare tid förts en diskussion rörande missnöje med rättsprocessen från vissa målsägandes sida. Dessa känner sig av olika anledningar kränkta i samband med förundersökning och rättegång. Långt tillbaka i historien var målsäganden själv i kontroll av brottmålsprocessen. I dagens rättsprocess har målsäganden mer eller mindre förpassats till åskådarplats och istället har olika professionella aktörer gjort entré i rättsprocessen. Forskning visar att målsäganden fortfarande behöver mycket stöd och information och att många målsägande är missnöjda med rättsprocessen i just detta avseende. Ett missnöje från målsägandes sida kan få till konsekvens att dessa känner sig kränkta under den rättsliga processen. Detta kan leda till att målsäganden upplever en så kallad sekundär traumatisering. Det kan även undergräva tron på rättssystemet och i förlängningen i vissa fall urholka rättsstaten. Målsägande förväntar sig att få informationen av åklagaren och blir därför missnöjd när han eller hon inte får tillfälle till personligt kontakt med denne. Målsägande missuppfattar åklagarrollen och tror att åklagaren är deras representant i processen. Åklagaren har en komplicerad roll, inte minst i förhållande till objektivitetsprincipen. Även om det är klart att åklagaren utan att riskera att komma i konflikt med kravet på objektivitet, kan lämna information av allmän karaktär till målsäganden, kan det fortfarande vara svårt att dra gränsen för hur mycket information, stöd och hjälp åklagaren kan lämna. Ett annat problem är att åklagaren ofta har en stor arbetsuppgift i processen och att det därför kan vara svårt att hinna med att fullt ut tillgodose målsägandens kontaktbehov. En lösning på detta problem borde vara målsägandebiträdet. För att kunna tillgodose målsägandes informationsbehov krävs någon som har den kunskap i straffprocess som målsägande oftast saknar. De arbetsuppgifter som man tänkte sig, när man införde den nya professionella aktören målsägandebiträdet i rättsprocessen, var att biträdet skulle lämna information till målsäganden samt ge stöd och hjälp. Därmed skulle målsägandebiträdet i förekommande fall bli det naturliga stödet för målsäganden i rättsprocessen. Även om lagstiftaren sedan införandet av lagen (1988:609) om målsägandebiträde bland annat flera gånger har utvidgat möjligheterna för målsäganden att få biträde i rättsprocessen, finns det fortfarande problem med detta institut. Den undersökning som genomförts som en del i detta arbete pekar på en del problemområden som rör förordnandet av målsägandebiträde åt målsäganden, lagens tillämpningsområde samt hur målsägandebiträdet fungerar i sin roll. I min slutsats betonar jag att det är angeläget att överväga nya utrednings och ökade utbildningsinsatser i syfte att ta itu med dessa problem och därigenom ta till vara den viktiga roll som målsägandebiträdet kan fylla för målsäganden i den moderna rättsprocessen

Tobacco smoking in mongolia: findings of a national knowledge, attitudes and practices study

Background: In 2009, 48% of males aged 15 or over in Mongolia consumed tobacco, placing Mongolia among the countries with the highest prevalence of male smokers in the world. Importantly, tobacco use is one of the four major risk factors contributing to the global burden of non-communicable diseases (NCDs) – the leading cause of mortality in Mongolia. However, the knowledge, attitudes and practices of the Mongolian population with regards to smoking are largely unmeasured. In this context, a national NCDs knowledge, attitudes and practices survey focusing, among other things, on NCD risk factors was implemented in Mongolia in late 2010 to complement the previous WHO STEPwise approach to Surveillance Survey (STEPS) findings from 2009. This publication explores the smoking-related findings of the Knowledge, Attitudes and Practices Survey (KAPS). Methods: A nationally representative sample size was calculated using methodologies aligned with the WHO STEPS surveys. As a result, 3450 people from across Mongolia were selected using a multi-stage, random cluster sampling method from permanent residents aged between 15 and 64 years. The KAP survey questionnaire was interviewer-administered on a door-to-door basis. Results: In Mongolia at 2010, 46.3% of males and 6.8% of females were smokers. This practice was especially dominant among males and urban dwellers (MOR 2.2), and more so among the middle-aged (45–54) (MOR 2.1) while still displaying a high prevalence among Mongolian youth (15.5%). The probability of smoking was independent of the level of education. Although the level of awareness of the health hazards related to tobacco smoking was generally very high in the population, this was influenced by the level of education as more people with a primary and secondary level of education believed that smoking at least one pack of cigarette per day was required to harm one’s health (MOR 5.8 for primary education and 2.5 for secondary). Finally, this knowledge did not necessarily translate into a behavioural outcome as 15.5% of the population did not object to people smoking in their house, and especially so among males (MOR 4.1). Conclusion: The findings of this KAP survey corroborate the 2009 WHO STEPS Survey findings with regards to the prevalence of tobacco smoking in Mongolia. It identifies males, urban dwellers and Mongolian youth as groups that should be targeted by public health measures on tobacco consumption, while keeping in mind that higher levels of awareness of the harms caused by tobacco smoking do not necessarily translate into behavioural changes

Lymphatic Filariasis Control in Tanzania: Effect of Six Rounds of Mass Drug Administration with Ivermectin and Albendazole on Infection and Transmission.

Control of lymphatic filariasis (LF) in most countries of sub-Saharan Africa is based on annual mass drug administration (MDA) with a combination of ivermectin and albendazole, in order to interrupt transmission. We present findings from a detailed study on the effect of six rounds of MDA with this drug combination as implemented by the National Lymphatic Filariasis Elimination Programme (NLFEP) in a highly endemic rural area of north-eastern Tanzania.\ud The effect of treatment on transmission and human infection was monitored in a community- and a school-based study during an 8-year period (one pre-intervention and 7 post-intervention years) from 2003 to 2011. Before intervention, 24.5% of the community population had microfilariae (mf) in the blood, 53.3% had circulating filarial antigens (CFA) and 78.9% had specific antibodies to the recombinant filarial antigen Bm14. One year after the sixth MDA, these values had decreased considerably to 2.7%, 19.6% and 27.5%, respectively. During the same period, the CFA prevalence among new intakes of Standard 1 pupils in 10 primary schools decreased from 25.2% to 5.6%. In line with this, transmission by the three vectors (Anopheles gambiae, An. funestus and Culex quinquefasciatus) as determined by dissection declined sharply (overall vector infectivity rate by 99.3% and mean monthly transmission potential by 99.2% between pre-intervention and fifth post-intervention period). A major shift in vector species composition, from predominantly anopheline to almost exclusively culicine was observed over the years. This may be largely unrelated to the MDAs but may have important implications for the epidemiology of LF in the area. Six MDAs caused considerable decrease in all the measured indices for transmission and human infection. In spite of this, indices were still relatively high in the late period of the study, and it may take a long time to reach the recommended cut-off levels for interruption of transmission unless extra efforts are made. These should include increased engagement of the target population in the control activities, to ensure higher treatment coverage. It is expected that the recent initiative to distribute insecticide impregnated bed nets to every household in the area will also contribute towards reaching the goal of successful LF elimination

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

Community members' perceptions of mass drug administration for control of lymphatic filariasis in rural rural and urban Tanzania

Lymphatic filariasis is one of several neglected tropical diseases with severely disabling and stigmatizing manifestations that are referred to as ‘neglected diseases of poverty’. It is a mosquito-borne disease found endemically and exclusively in low-income contexts where, concomitantly, general public health care is often deeply troubled and fails to meet the basic health needs of impoverished populations. This presents particular challenges for the implementation of mass drug administration (MDA), which currently is the principal means of control and eventual elimination. Several MDA programmes face the dilemma that they are unable to attain and maintain the required drug coverage across target groups. In recognition of this, a qualitative study was conducted in the Morogoro and Lindi regions of Tanzania to gain an understanding of community experiences with, and perceptions of, the MDA campaign implemented in 2011 by the National Lymphatic Filariasis Elimination Programme. The study revealed a wide variation of perceptions and experiences regarding the aim, rationale and justification of MDA. There were positive sentiments about the usefulness of the drugs, but many study participants were sceptical about the manner in which MDA is implemented. People were particularly disappointed with the limited attempts by implementers to share information and mobilize residents. In addition, negative sentiments towards MDA for lymphatic filariasis reflected a general feeling of desertion and marginalization by the health care system and political authorities. However, the results suggest that if the communities are brought on board with genuine respect for their integrity and informed self-determination, there is scope for major improvements in community support for MDA-based control activities

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