Correlates of and Barriers to the Utilization of Health Services for Delivery in South Asia and Sub-Saharan Africa.

The high maternal and neonatal mortality rates in South Asia and Sub-Saharan Africa can be attributed to the lack of access and utilization of health services for delivery. Data from the Demographic and Health Surveys conducted in Bangladesh, India, Pakistan, Kenya, Nigeria, and Tanzania show that more than half of the births in these countries were delivered outside a health facility. Institutional delivery was closely associated with educational level, family wealth, place of residence, and women's media exposure status, but it was not influenced by women's work status and their roles in decision-making (with the exception of Nigeria). Controlling for other variables, higher parity and younger women were less likely to use a health facility for delivery. Within each country, the poorer, less educated and rural women had higher unmet need for maternal care services. Service related factors (accessibility in terms of cost and distance) and sociocultural factors (e.g., did not perceive the need for the services and objections from husband and family) also posed as barriers to institutional delivery. The paper concludes with some suggestions to increase institutional delivery

Medical Students’ Attitudes toward Abortion Education: Malaysian Perspective

Abortion is a serious public health issue, and it poses high risks to the health and life of women. Yet safe abortion services are not readily available because few doctors are trained to provide such services. Many doctors are unaware of laws pertaining to abortion. This article reports survey findings on Malaysian medical students’ attitudes toward abortion education and presents a case for including abortion education in medical schools. Methods and Results A survey on knowledge of and attitudes toward abortion among medical students was conducted in two public universities and a private university in Malaysia in 2011. A total of 1,060 students returned the completed questionnaires. The survey covered about 90% of medical students in Years 1, 3, and 5 in the three universities. About 90% of the students wanted more training on the general knowledge and legal aspects of abortion, and pre-and post-abortion counseling. Overall, 75.9% and 81.0% of the students were in favor of including in medical education the training on surgical abortion techniques and medical abortion, respectively. Only 2.4% and 1.7% were opposed to the inclusion of training of these two methods in the curriculum. The remaining respondents were neutral in their stand. Desire for more abortion education was associated with students’ pro-choice index, their intention to provide abortion services in future practice, and year of study. However, students’ attitudes toward abortion were not significantly associated with gender, type of university, or ethnicity. Conclusions Most students wanted more training on abortion. Some students also expressed their intention to provide abortion counseling and services in their future practice. Their desire for more training on abortion should be taken into account in the new curriculum. Abortion education is an important step towards making available safe abortion services to enable women to exercise their reproductive rights

What matters for life satisfaction among the oldest-old? Evidence from China

The world population is aging rapidly and the well-being of older people is of great interest. Therefore, this study investigates the determinants of life satisfaction among the oldest-old (i.e. individuals aged 80 or over) in China. Materials and methods We use the 2011/2012 Chinese Longitudinal Healthy Longevity Survey data (n = 6530) for this paper. Logistic regression is used to analyse the effects of socio-demographic, economic, health, instrumental activities of daily living, family and community factors on life satisfaction and depression among the oldest-old in China. Results Our analysis confirms the significance of many factors affecting life satisfaction among the oldest-old in China. Factors that are correlated with life satisfaction include respondent’s sex, education, place of residence, self-rated health status, cognitive ability (using mini mental state examination), regular physical examination, perceived relative economic status, access to social security provisions, commercialized insurances, living arrangements, and number of social services available in the community (p<0.05 for all these variables). Although life satisfaction is negatively associated with instrumental activities of daily living (β = -0.068, 95%CI = -.093—.043), and depression (β = -0.463, 95%CI = -.644—.282), the overall effect of self-rated health status is positive (p<0.001). This confirms the primacy of health as the determinant of well-being among the oldest-old. Conclusions Majority of the oldest-old in China rated their life satisfaction as good or very good. Our findings show that health and economic status are by far the most significant predictors of life satisfaction. Our finding on the primacy of health and relative income as determinants of well-being among the oldest-old, and the greater influence of self-rated health status over objective health measures is consistent with the findings of many past studies. Our results suggest that efforts should be directed at enhancing family support as well as health and social service provisions in the community to improve life satisfaction of older people

Essays on public health in developing countries / Tey Nai Peng

Reproductive health is a crucial part of general health and a central feature of human development. Since gaining global attention at the 1994 International Conference on Population and Development (ICPD), the importance of reproductive was reaffirmed as one of the eight goals of Millennium Development Goals (MDGs), and in the post-2015 development agenda. This thesis addresses the key issues of public health affecting childbearing women and the older people. Universal access to reproductive health, reducing maternal deaths and non-communicable diseases (NCDs) are among the main targets of the new agenda for the global Sustainable Development Goals (SDGs) 2015- 2030. The objectives of the thesis are: 1. To investigate problems relating to reproductive health and NCDs, 2. To examine the correlates and risk factors of reproductive health outcomes and NCDs that are of public health concerns, 3. To evaluate the barriers to the utilization of health services in the developing countries, and 4. To put forth recommendations for policy and research. The objectives are partially achieved through the writing of five essays listed below. A comprehensive review of the literature was carried out to complete the thesis. 1. Proximate Determinants of Fertility in Peninsular Malaysia 2. Medical Students’ Attitudes toward Abortion Education: Malaysian Perspectives 3. Correlates of and Barriers to the Utilization of Health Services for Delivery in South Asia and sub-Saharan Africa 4. Ethnic and Gender Differentials in Non-communicable Diseases and Self-rated Health in Malaysia 5. The Debilitating Effects of Chronic Diseases among the Oldest Old in China An analysis of the proximate determinants of fertility indicate that marriage postponement and contraceptive use are the two most important factors affecting fertility, but breastfeeding and abortion also play a role in fertility reduction. Abortion is a serious public health issue, and it poses high risks to the health and life of women. A survey on medical students in Malaysia showed that 9 out of 10 students wanted more training on the general knowledge and legal aspects of abortion, and pre- and post-abortion counseling. Hence, there is a need to incorporate abortion education in the curriculum of medical schools. Unmet need for contraception remains at a high level in some developing countries. The reproductive health needs of couples and adolescents need to be given more attention. The national family planning program needs to be revitalized to provide services beyond family planning such as infertility treatment and bio-medical research. A family policy is also needed to foster family development and to advocate for family friendly work environment for work-life balance. Chronic diseases are rising rapidly, affecting people of all ages, especially the older people. Preventive, protective and rehabilitative measures must be taken to reduce these diseases. The root cause of the chronic diseases, including modifiable factors such as unhealthy life style and diet must be addressed. There exists wide gaps in the utilization of health services. Efforts must be made to overcome supply-side and demand-side barriers. The thesis concludes by putting forth some recommendations for policy and future research

Effects of selected leisure activities on preventing loneliness among older Chinese

This study examined three types of leisure activities (playing cards/mahjong, watching TV/listening to the radio, and participation in social activities) among the older segment of the Chinese population, and the effects of these activities in preventing the feelings of loneliness. Data came from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), conducted in 2005, 2008, and 2011. The males, those who were educated, the young-old (aged between 65 and 74 years), urban dwellers, and living in institutions were more likely to participate in all three activities frequently. Frequent or occasional participation in these three activities was negatively associated with feelings of loneliness. The longitudinal study from 2005 to 2011 showed that respondents who frequently played cards/mahjong at baseline were less likely to feel persistent loneliness at the end of the 2011 wave. Instead, frequently watching TV/listening to the radio in 2008 was associated with lower odds in feeling persistent loneliness at the end of 2011. Hence, active participation in playing cards/mahjong and TV/radio entertainment can be effective treatment intervention against persistent loneliness among older Chinese. For the Chinese, a leisure activity steeped in a nation's culture and heritage, such as playing mahjong, may be used as an intervention strategy to prevent and alleviate chronic loneliness among older adults. © 2019 The Author

Interregional Migration and Graduate Earning in Malaysia

This paper investigated the interregional migration patterns and the effects of spatial mobility on the earnings of new graduates from Malaysian universities, utilising the 2013 Tracer Study data obtained from the Ministry of Higher Education. Several local studies using the same data source mainly dealt with issues of employability, but none have studied the effects of migration on their earnings. Some graduates pursued tertiary education away from their state of birth and settled to work in the state where they studied or relocated to work in another state. This study examined graduate migration between Klang Valley (KV) and the rest of Malaysia, which differs very much in terms of economic activities and development. The estimations of the wage equation using ordinal logit models show that migration from all other states towards Klang Valley was associated with higher starting salaries for the graduates

Age at menarche and sexual debut among young Filipino women

There has been a secular decline in age at menarche since the 19th century. Early-maturing women are more likely to have their sexual debut at a younger age, which in turn gives rise to a host of reproductive health and social problems. This study used data from five waves of National Demographic and Health Surveys conducted in the Philippines between 1993 and 2013 to examine the trends and socioeconomic differentials in age at menarche and sexual debut. The changing trend in age at menarche and sexual debut was examined across birth cohorts, and logistic regressions were used to identify the determinants of early sexual debut. In the Philippines, the mean and median ages at menarche declined from 13.2 years and 12.6 years, respectively, among young women born in 1973–1977, to 12.9 years and 12.3 years, respectively, among those born in 1993–1997. The proportion who had their sexual debut by age 20 increased from 41.2% for the 1968–1972 birth cohort to 53.4% for the 1988–1992 birth cohort. Filipino women with low education, from poor families and living in rural areas were more likely to have earlier sexual debut despite attaining menarche at a later age as compared with their higher educated counterparts, and those from wealthier families and urban areas. Logistic regression analysis showed that, besides marital status, women’s education and age at menarche were important determinants of early sexual debut. However, ethnicity, place of residence and family wealth had no significant effects on age at menarche. An increasing proportion of young women were found to be having unprotected sexual debut and at a younger age, with health and social ramifications. Hence, apart from increasing the enrolment of girls in schools and discouraging teenage marriage, there is a need for social and health agencies to implement appropriate adolescent sexual and reproductive health programmes such as counselling and educational campaigns, as well as support services, to address sexual problems among the youth

Family Support and Loneliness among Older Persons in Multiethnic Malaysia

This study investigates factors affecting older persons’ state of loneliness in multiethnic Malaysia using data from the 2004 Malaysian Population and Family Survey, the first nationally representative sample in Malaysia. The study sample was extracted to include Malays, Chinese, Indians and other Indigenous groups aged 60 and above, and who had children (n = 1791). Cross tabulations and ordinal logistic regression methods were used in the analysis. Among the ethnic groups, older Malays were more likely than their Chinese and Indian counterparts to experience loneliness. Loneliness was found to be associated with age, marital status, education level, sources of income, health status, and physical limitations. Among older people, feelings of loneliness were inversely related with coresidence with adult children and participation in religious activities. Sociodemographic changes have eroded the traditional family support system for the elderly, while social security remains inadequate. This study shows the important role of family in alleviating loneliness among older people. Hence the need to promote and facilitate coresidence, as well as participation in religious activities, and a healthy lifestyle as a priority strategy is in line with the objectives of the National Policy for the Older People

The debilitating effects of chronic diseases among the oldest old in China

Objectives The aims of this study were to assess the current sharp rise in chronic diseases and disabilities with advancing age, and to examine the debilitating effects of chronic diseases among the oldest old in China. Study design and outcome variables This study used data from four waves of the Chinese Longitudinal Health and Longevity Survey (CLHLS) conducted in 2002, 2005, 2008 and 2011. The sample comprised 2137 older adults who were interviewed in 2002 and re-interviewed in the following waves. Cross-tabulations were run to show the rise in chronic disease and disability with age. Ordinal logistic regression was run to examine the debilitating effects of these diseases in terms of the ability of the oldest old to perform activities of daily living. Results The prevalence of chronic diseases rose sharply with age. The prevalence rate of six major diseases increased between 38% (respiratory diseases) and 533% (neurological disorder) among respondents who were re-interviewed nine years later. Cardiovascular diseases were the most common. Neurological disorder and cancer were less common, but had the most debilitating effects on patients. Overall, 10.0%, 3.1% and 3.1% of the respondents were disabled by cardiovascular, musculoskeletal and sensorial diseases, respectively. Ordinal logistic regression showed that neurological disorder had the strongest debilitating effects, followed by musculoskeletal and cardiovascular diseases among 2137 older persons who had survived and were followed up from the base year (2002) through 2011. Conclusion The rapid rise in chronic diseases has resulted in an increased burden of disability among the oldest old in China. There is a need to improve health care systems for the prevention and management of chronic diseases

Ethnic and gender differentials in non-communicable diseases and self-rated health in Malaysia.

This paper examines the ethnic and gender differentials in high blood pressure (HBP), diabetes, coronary heart disease (CHD), arthritis and asthma among older people in Malaysia, and how these diseases along with other factors affect self-rated health. Differentials in the prevalence of non-communicable diseases among older people are examined in the context of socio-cultural perspectives in multi-ethnic Malaysia.Data for this paper are obtained from the 2004 Malaysian Population and Family Survey. The survey covered a nationally representative sample of 3,406 persons aged 50 and over, comprising three main ethnic groups (Malays, Chinese and Indians) and all other indigenous groups. Bivariate analyses and hierarchical logistic regression were used in the analyses.Arthritis was the most common non-communicable disease (NCD), followed by HBP, diabetes, asthma and CHD. Older females were more likely than males to have arthritis and HBP, but males were more likely to have asthma. Diabetes and CHD were most prevalent among Indians, while arthritis and HBP were most prevalent among the Indigenous groups. Older people were more likely to report poor health if they suffered from NCD, especially CHD. Controlling for socio-economic, health and lifestyle factors, Chinese were least likely to report poor health, whereas Indians and Indigenous people were more likely to do so. Chinese that had HBP were more likely to report poor health compared to other ethnic groups with the same disease. Among those with arthritis, Indians were more likely to report poor health.Perceived health status and prevalence of arthritis, HBP, diabetes, asthma and CHD varied widely across ethnic groups. Promotion of healthy lifestyle, early detection and timely intervention of NCDs affecting different ethnic groups and gender with socio-cultural orientations would go a long way in alleviating the debilitating effects of the common NCDs among older people