Exploring health care seeking knowledge, perceptions and practices for childhood diarrhea and pneumonia and their context in a rural Pakistani community

BACKGROUND: Where access to facilities for childhood diarrhea and pneumonia is inadequate, community case management (CCM) is an effective way of improving access to care. In Pakistan, utilization of CCM for these diseases through the Lady Health Worker Program remains low. Challenges of access to facilities persist leading to delayed care and poor outcomes. Estimating caregiver knowledge, understanding their perceptions and practices, and recognizing how these are related to care seeking decisions about childhood diarrhea and pneumonia is crucial to bring about coherence between supply and demand-side practices. METHODS: Data was collected from family caregivers to explore their knowledge, perceptions and practices regarding childhood diarrhea and pneumonia. Data from a household survey with 7025 caregivers, seven focus group discussion (FGDs), seven in-depth interviews (IDIs), and 20 detailed narrative interviews are used to explore caregiver knowledge, perceptions and practices. RESULTS: Household survey shows that most family caregivers recognize main signs and symptoms of diarrhea such as loose stools (76%). Fewer recognize signs and symptoms of pneumonia such as breathing problems (21%). Few caregivers (18%) have confidence in lady health workers\u27 (LHWs) ability to treat childhood diarrhea and pneumonia. Care seeking from LHWs remains negligible (\u3c 1%). Caregivers overwhelmingly prefer to seek care from doctors (97%). Seventy-five percent caregivers sought care from private providers and 45% from public providers. FGDs, IDIs, and narrative interviews show that care mostly begins with home remedies and sometimes self-prescribed medicines. Treatment delays occur because of caregiver inability to recognize disease, use of home remedies, financial constraints, and low utilization of community based LHW services. Caregivers do not seek care from LHWs because of lack of trust and LHWs\u27 inability to provide medicines. If finances allow, private doctors, who caregivers perceive as more responsive, are preferred over public sector doctors. Financial resources, availability of time, support for household chores by family and community determine whether, when, and from whom caregivers seek care. CONCLUSIONS: Many children do not receive recommended diarrhea and pneumonia treatment on time. Taking into consideration caregiver concerns, adequate supply of medicines to LHWs, improved facility level care could improve care seeking practices and child health outcomes

Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? evidence from Pakistan.

BACKGROUND: The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan. METHODS: An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A household survey, a health facility survey, and focus group discussions with client and spouses were used for assessment. RESULTS: Contracted out facilities had a significantly higher utilization as compared to control facilities for antenatal care, delivery, postnatal care, emergency obstetric care, and neonatal illness. Contracted facilities had comparatively better quality of MNCH services but not in all aspects. Better household practices were also seen in the district where contracting involved administrative control over outreach programs. Contracting was also faced with certain drawbacks. Facility utilization was inequitably higher amongst more educated and affluent clients. Contracted out catchments had higher out-of-pocket expenses on MNCH services, driven by steeper transport costs and user charges for additional diagnostics. Contracting out did not influence higher MNCH service coverage rates across the catchment. Physical distances, inadequate transport, and low demand for facility-based care in non-emergency settings were key client-reported barriers. CONCLUSION: Contracting out MNCH services at government health facilities can improve facility utilization and bring some improvement in quality of services. However, contracting out of health facilities is insufficient to increase service access across the catchment in remote rural contexts and requires accompanying measures for demand enhancement, transportation access, and targeting of the more disadvantaged clientele

Cadmium phytotoxicity: issues, progress, environmental concerns and future perspectives

Cadmium, a high toxicity element, is a potential threat to plant and human health, and a dangerous pollutant in the environment. Uptake and accumulation by crops represent the main entry pathway for potentially health-threatening toxic metals into human and animal food. Crops and other plants take up Cd from the soil or water and may distribute it in their roots and shoots. Soil and/or water are usually contaminated with Cd through natural sources, industrial effluent, and anthropogenic activities. In this review, the sources of Cd contamination, evaluation of the phytotoxic effects on plants, and mode of action of Cd toxicity, were summarized. Plant defensive strategies upon excess Cd are also considered in this review. Cd-induced effects include oxidative stress, disintegration of the photosynthetic apparatus, reduction in gas exchange parameters, nutrient imbalance, and subcellular organelle degradation. In addition, Cd severely impairs biomolecules such as DNA, protein, and lipids. Although plants are sessile in nature, they are equipped with certain mechanisms to cope with unfavorable conditions. These mechanisms include synthesis of metal-helating proteins, expression of enzymatic and non-enzymatic antioxidants, organic acids, and plant root–mycorrhiza association. The built-in system of plant tolerance to Cd can be further enhanced by the application of exogenous organic and inorganic metal sources. This review will broaden the knowledge about the Cd accumulation in plants and the responses to metal exposure, as well as our understanding of metal tolerance and overcoming this serious issue for sustainable agriculture and human health worldwide. Highlights Cd accumulation has harmful effects in an organism. Cd has been listed 7th out of 275 compounds in the priority list of hazardous materials. Cd remains in the soil for 15–1100 years. Plants usually imply certain strategies to overcome Cd toxicity. Plants built-in systems can be enhanced to overwhelmed this problem.Cadmium, a high toxicity element, is a potential threat to plant and human health, and a dangerous pollutant in the environment. Uptake and accumulation by crops represent the main entry pathway for potentially health-threatening toxic metals into human and animal food. Crops and other plants take up Cd from the soil or water and may distribute it in their roots and shoots. Soil and/or water are usually contaminated with Cd through natural sources, industrial effluent, and anthropogenic activities. In this review, the sources of Cd contamination, evaluation of the phytotoxic effects on plants, and mode of action of Cd toxicity, were summarized. Plant defensive strategies upon excess Cd are also considered in this review. Cd-induced effects include oxidative stress, disintegration of the photosynthetic apparatus, reduction in gas exchange parameters, nutrient imbalance, and subcellular organelle degradation. In addition, Cd severely impairs biomolecules such as DNA, protein, and lipids. Although plants are sessile in nature, they are equipped with certain mechanisms to cope with unfavorable conditions. These mechanisms include synthesis of metal-helating proteins, expression of enzymatic and non-enzymatic antioxidants, organic acids, and plant root–mycorrhiza association. The built-in system of plant tolerance to Cd can be further enhanced by the application of exogenous organic and inorganic metal sources. This review will broaden the knowledge about the Cd accumulation in plants and the responses to metal exposure, as well as our understanding of metal tolerance and overcoming this serious issue for sustainable agriculture and human health worldwide. Highlights Cd accumulation has harmful effects in an organism. Cd has been listed 7th out of 275 compounds in the priority list of hazardous materials. Cd remains in the soil for 15–1100 years. Plants usually imply certain strategies to overcome Cd toxicity. Plants built-in systems can be enhanced to overwhelmed this problem

Schools of Public Health in Low and Middle-Income Countries: An Imperative Investment for Improving the Health of Populations?

BACKGROUND: Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges. MAIN TEXT: The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs). CONCLUSION: SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries

Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations?

BACKGROUND: Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges. MAIN TEXT: The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs). CONCLUSION: SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries

Biosorption potential of natural, pyrolysed and acid-assisted pyrolysed sugarcane bagasse for the removal of lead from contaminated water

Lead (Pb) is a ubiquitous pollutant which poses serious threats to plants, animals and humans once entered into the food chain via contaminated industrial effluents on their discharge into the surface of water bodies and/or geological materials. This study aimed to examine and compare the biosorption potential of natural sugarcane bagasse (NB), pyrolysed sugarcane bagasse (PB) and acid assisted pyrolysed sugarcane bagasse (APB) for the removal of Pb from contaminated water. To explore this objective, a series of batch experiments were conducted at various adsorbent mass (0.25, 0.5, 0.75, 1.0 g per 100 ml contaminated water), initial Pb concentration (7, 15, 30, 60 and 120 ppm), and contact time (7, 15, 30, 60 and 120 min). Results revealed that all the tested bio-sorbents have potential to adsorb and remove Pb ions from the contaminated water. In this regard, APB proved more effective since it removed 98% of Pb from aqueous solution at initial Pb concentration of 7 ppm and mass of 0.25 g per 100 ml of aqueous solution. The respective values in case of NB and PB were 90 and 95%. For a given adsorbent type, Pb adsorption decreased by increasing the mass from 0.25 to 1.0 g per 100 ml of aqueous solution. However, the greatest Pb removal occurred at adsorbent mass of 1.0 g per 100 ml of aqueous solution. Initial Pb concentration had a great impact on Pb adsorption and removal by adsorbent. The former increased and the latter decreased with the increase in initial Pb concentration from seven to 120 ppm. At seven ppm Pb concentration, maximum Pb removal took place irrespective to the adsorbent type. Out of the total Pb adsorption and removal, maximum contribution occurred within 15 min of contact time between the adsorbate and adsorbent, which slightly increased till 30 min, thereafter, it reached to equilibrium. Application of equilibrium isotherm models revealed that our results were better fitted with Freundlich adsorption isotherm model. Overall, and for the reasons detailed above, it is concluded that sugarcane bagasse has capabilities to adsorb and remove Pb ions from contaminated water. Its bio-sorption potential was considerably increased after pyrolysis and acid treatment

Influence of Adiposity-Related Genetic Markers in a Population of Saudi Arabians Where Other Variables Influencing Obesity May Be Reduced

Large scale studies in Europeans have clearly identified common polymorphism affecting BMI and obesity. We undertook a genotype study to examine the impact of variants, known to influence obesity, in a sample from the Saudi Arabian population, notable for its profound combination of low mean physical activity indices and high energy intake. Anthropometry measures and genotypes were obtained for 367 Saudis, taken from King Saud University and Biomarker Screening Project in Riyadh (Riyadh Cohort). We observed large effect sizes with obesity for rs10767664 (BDNF) (OR = 1.923, P=0.00072) and rs3751812 (FTO) (OR = 1.523, P=0.016) in our sample and, using weighted genetic risk scores, we found strong evidence of a cumulative effect using 11 SNPs taken predominantly from loci principally affecting appetite (OR = 2.57, P=0.00092). We used conditional analyses to discern which of our three highly correlated FTO SNPs were responsible for the observed signal, although we were unable to determine with confidence which best marked the causal site. Our analysis indicates that markers located in loci known to influence fat mass through increased appetite affect obesity in Saudi Arabians to an extent possibly greater than in Europeans. Larger scale studies will be necessary to obtain a precise comparison