Epidemiological Situation and Social Vulnerability in the Era of the COVID-19 Pandemic

The December 2019 outbreak in China of a novel coronavirus infection (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus quickly spread globally. In the era of economic globalization, as of February 24, 2021, the cumulative number of people with COVID-19 has reached 110 million worldwide, with more than 24.7 million deaths, with containment of the pandemic not likely to happen soon. Conventional outbreaks have spread in low- and middle-income countries where poverty and immature health systems prevail, resulting in significant human and social inequity. However, middle- and upper-income people account for more than 85% of the total cumulative deaths. The spread of infection in Africa and Asia is relatively limited despite their fragile health systems. These unexpected phenomena are noteworthy when reconsidering the definition of social vulnerability. To prevent direct or indirect mortality associated with the COVID-19 pandemic, society has made efforts to minimize disruptions to health systems and mitigate social, racial, and gender inequity globally. While facing conventional and newly emerged social vulnerabilities, we are standing at a historical turning point to promote our new normal lifestyle of "coexisting with viruses" through a promising paradigm shift that focuses on improving the sustainability of our entire planet

Self-care behaviours among people with type 2 diabetes mellitus in South Asia : a systematic review and meta-analysis

Background The burden of Type 2 diabetes mellitus (T2DM) in South Asian countries is increasing rapidly. Self-care behaviour plays a vital role in managing T2DM and preventing complications. Research on self-care behaviours among people with T2DM has been widely conducted in South Asian countries, but there are no systematic reviews that assess self-care behaviour among people with T2DM in South Asia. This study systematically assessed the studies reporting self-care behaviours among people with T2DM in South-Asia. Methods Adhering to the PRISMA guidelines, we searched six bibliographic databases (Scopus, PubMed, CINAHL, Embase, Web of Science, and PsychInfo) to identify the relevant articles published between January 2000 through March 2022. Eligibility criteria included all observational and cross-sectional studies reporting on the prevalence of self-care behaviours (ie, diet, physical activity, medication adherence, blood glucose monitoring, and foot care) conducted in South Asian countries among people with T2DM. Results The database search returned 1567 articles. After deduplication (n = 758) and review of full-text articles (n = 192), 92 studies met inclusion criteria and were included. Forward and backward reference checks were performed on included studies, which resulted in an additional 18 articles. The pooled prevalence of adherence to blood glucose monitoring was 65% (95% CI = 49-80); 64% for medication adherence (95% CI = 53-74); 53% for physical activity (95% CI = 39-66); 48% for diet (95% CI = 38-58); 42% for foot care (95% CI = 30-54). About a quarter of people with T2DM consumed alcohol (25.2%, IQR = 13.8%-38.1%) and were using tobacco products (18.6%, IQR = 10.6%-23.8%). Conclusions Our findings suggest that the prevalence of self-care behaviours among people with T2DM in South Asia is low. This shows an urgent need to thoroughly investigate the barriers to the practising of self-care and design and implement interventions to improve diabetes self-care behaviour among people with T2DM in South Asia

Determinants of health facility utilization for childbirth in rural western Kenya: cross-sectional study

Background: Skilled attendance at delivery is recognized as one of the most important factors in preventing maternal death. However, more than 50% of births in Kenya still occur in non-institutional locations supported by family members and/or traditional birth attendants (TBAs). To improve this situation, a study of the determinants of facility delivery, including individual, family and community factors, was necessary to consider effective intervention in Kenya.Methods: This study was conducted to identify the factors which influence the place of delivery in rural western Kenya, and to recommend ways to improve women\u27s access to skilled attendants at delivery. A community-based cross-sectional survey was carried out from August to September 2011 in all 64 sub-locations which were covered by community health workers (CHWs). An interviewer-administered questionnaire on seventeen comprehensive variables was administered to 2,560 women who had children aged 12-24 months.Results: The response rate was 79% (n = 2,026). Of the respondents, 48% of births occurred in a health facility and 52% in a non-institutional location. The significant determinants of facility delivery examined using multivariate analysis were: maternal education level, maternal health knowledge, ANC visits, birth interval, economic status of household, number of household members, household sanitation practices and traveling time to nearest health facility.Conclusions: The results suggest that the involvement of TBAs to promote facility delivery is still one of the most important strategies. Strengthening CHWs\u27 performance by focusing on a limited number of topics and clear management guidance might also be an effective intervention. Stressing the importance of regular attendance at ANC (at least four times) would be effective in enhancing motivation for a facility delivery. Based on our findings, those actions to improve the facility delivery rate should focus more on pregnant women who have a low education level, poor health knowledge and short pregnancy spacing. In addition, women with low economic status, a large number of family members and a long distance to travel to a health facility should also be targeted by further interventions

Applying systems thinking to identify enablers and challenges to scale-up interventions for hypertension and diabetes in low-income and middle-income countries: protocol for a longitudinal mixed-methods study.

INTRODUCTION: There is an urgent need to reduce the burden of non-communicable diseases (NCDs), particularly in low-and middle-income countries, where the greatest burden lies. Yet, there is little research concerning the specific issues involved in scaling up NCD interventions targeting low-resource settings. We propose to examine this gap in up to 27 collaborative projects, which were funded by the Global Alliance for Chronic Diseases (GACD) 2019 Scale Up Call, reflecting a total funding investment of approximately US$50 million. These projects represent diverse countries, contexts and adopt varied approaches and study designs to scale-up complex, evidence-based interventions to improve hypertension and diabetes outcomes. A systematic inquiry of these projects will provide necessary scientific insights into the enablers and challenges in the scale up of complex NCD interventions. METHODS AND ANALYSIS: We will apply systems thinking (a holistic approach to analyse the inter-relationship between constituent parts of scaleup interventions and the context in which the interventions are implemented) and adopt a longitudinal mixed-methods study design to explore the planning and early implementation phases of scale up projects. Data will be gathered at three time periods, namely, at planning (TP), initiation of implementation (T0) and 1-year postinitiation (T1). We will extract project-related data from secondary documents at TP and conduct multistakeholder qualitative interviews to gather data at T0 and T1. We will undertake descriptive statistical analysis of TP data and analyse T0 and T1 data using inductive thematic coding. The data extraction tool and interview guides were developed based on a literature review of scale-up frameworks. ETHICS AND DISSEMINATION: The current protocol was approved by the Monash University Human Research Ethics Committee (HREC number 23482). Informed consent will be obtained from all participants. The study findings will be disseminated through peer-reviewed publications and more broadly through the GACD network

Job preferences of Japanese global health personnel: results from a discrete choice experiment

# Background The disintegration of the boundary between global and national health due to the emergence of global health issues, such as COVID-19, led to the increasing need to nurture global health experts so as to strengthen global and national health capacity. One approach is to engage in work at health-related United Nations (UN) and international organizations. However, the issue of member states underrepresentation exists, which poses a challenge both in nurturing global health experts and realizing the equitable geographical distribution prescribed in Article 101 of the United Nations Charter. Japan, among other member states, remains underrepresented in UN organizations. This study aimed to understand the job preferences of Japanese experts wishing to work at health-related international organizations and present policy proposals for strengthening capacity development and promoting international dispatch. # Methods The discrete choice experiment (DCE) survey was conducted online to determine the job preferences of health/non-health experts and students -- (i) who wished to work at health-related international organizations (*Seekers*), (ii) who are currently working at these organizations (*Workers*), and (iii) who resigned from these organizations (*Resignees*). The binary logit main effects model was used to examine the relative importance of various job attributes. # Results DCE analysis showed the relative importance of duty station, salary, work--life balance (WLB), and job satisfaction for all groups and return post and employer's contribution to welfare benefits for *Seekers* and *Resignees* but not for *Workers*. # Conclusions The "uncertainty-avoidance" characteristics mainly perceived in *Seekers* and *Resignees* propose two separate approaches, which entails supporting (i) the few selected ones, and (ii) the majority who are interested but remain uncertain and indecisive to work overseas. The social structural challenge associated with the lack of national organizations and hospitals that value experiences gained at international organizations needs to be addressed by introducing systems such as sabbatical leaves or reemployment systems for returnees. Furthermore, an incentive information package combining both financial and nonfinancial incentives focusing on favorable conditions relating to duty station, salary, WLB, and job satisfaction, which could be achieved at international organizations, could be actively publicized at career development seminars

Living Well as a Muslim through the Pandemic Era—A Qualitative Study in Japan

This study explored the living situations, financial conditions, religious obligations, and social distancing of Muslims during the COVID-19 pandemic. In total, 28 Muslim community members living in the Kanto region were recruited; 18 of them were included in in-depth qualitative interviews and 10 in two focus group interviews. The snowball method was used, and the questionnaires were divided into four themes. The audio/video interviews were conducted via Zoom, and NAVIO was used to analyse the data thematically. The major Muslim events were cancelled, and the recommended physical distancing was maintained even during the prayers at home and in the mosques. The Japanese government’s financial support to each person was a beneficial step towards social protection, which was highlighted and praised by every single participant. Regardless of religious obligations, the closing of all major mosques in Tokyo demonstrates to the Japanese community how Muslims are serious about adhering to the public health guidelines during the pandemic. This study highlights that the pandemic has affected the religious patterns and behaviour of Muslims from inclusive to exclusive in a community, and recounts the significance of religious commitments

Effectiveness of oral health promotion interventions for people with type 2 diabetes delivered by non-dental health care professionals: a systematic review: Oral health promotion for people with diabetes by non-dental healthcare professionals

Background Oral health problems among people with diabetes mellitus are an emerging public health problem. Despite the rising concerns of oral health and diabetes mellitus comorbidity, there is a lack of dental health care professionals such as dentists, to address this problem, especially at the primary care level in low- and middle-income countries. Objective This review systematically synthesizes the current evidence in terms of the involvement of non-dental health care professionals in promoting oral health among people with type 2 diabetes mellitus and assessed the effectiveness of such programs. Methods Six electronic databases (CINAHL, Cochrane, Embase, PsycINFO, PubMed, and Scopus) and Google Scholar were systematically searched. The inclusion criteria were: 1) had an intervention promoting oral health; 2) targeted but not limited to people with type 2 diabetes mellitus; 3) intervention led but not limited to by non-dental health care professionals; 4) published in English language between January 2000 and July 2021. This review was registered in PROSPERO (#CRD42021248213). Results A total of five studies from four countries (Finland, Thailand, Iran, and the Netherlands) met the inclusion criteria. The interventions included oral health education, a dental care reminder system, and the implementation of oral health care protocols in general practices, all of which were mainly implemented by nurses. All interventions improved clinical outcomes, including decreased probing depth, attachment loss, and plaque index scores, and non-clinical outcomes such as enhanced knowledge, attitudes, and behaviors. Three studies also reported an improvement in diabetes mellitus outcomes. Conclusion This review suggests that non-dental health care professionals play a promising role in promoting oral health among people with type 2 diabetes mellitus. Our findings support the potential for integrating oral health promotion programs in primary health care, as such programs could bring better oral health and diabetes mellitus outcomes

Effectiveness of four interventions in improving community health workers\u27 performance in western Kenya: a quasi-experimental difference-in-differences study using a longitudinal data

BACKGROUND: Community health workers (CHWs) are up-front health workers delivering the most effective life-saving health services to communities. They are the key driver to achieve Universal Health Coverage. However, maintaining CHWs\u27 performance is one of the challenges in sustaining their effectiveness. This article assessed the effectiveness of the four interventions and their combinations on the CHWs\u27 performance in terms of health knowledge, job satisfaction, and household coverage. METHODS: We used the longitudinal survey data collected in western Kenya. Our study participants were the representative of all CHWs working in the four districts, Kenya. The four types of interventions were composed of a basic core intervention (i.e., refresher training with/without defaulter tracing) and three supplementary interventions (i.e., provision of a bicycle, frequent supportive supervision, and financial incentives). We performed the three fixed-effect models to assess the effectiveness of the four interventions and their combinations on the three performance indicators. RESULTS: Three single and combination interventions significantly increased CHWs\u27 health knowledge: refresher training only [Coef.: 48.43, 95% CI: 42.09-54.76, P \u3c 0.001]; refresher training plus defaulter-tracing [Coef.: 38.80, 95% CI: 32.71-44.90, P \u3c 0.001]; combination of refresher training plus defaulter-tracing and frequent supervision [Coef.: 17.02, 95% CI: 7.90-26.15, P \u3c 0.001]. Financial support was the only intervention that significantly increased job satisfaction among CHWs [Coef.: 4.97, 95% CI: 0.20-9.75, P = 0.041]. There was no single intervention that significantly increased household coverage. Yet, the combinations of the interventions significantly increased household coverage. CONCLUSIONS: There was no single intervention to improve all the aspects of CHWs\u27 performance. The refresher training significantly improved their health knowledge, while financial incentive enhanced the level of their job satisfaction. The combinations of regular refresher training and other intervention(s) are the recommended as the effective interventions in improving and further sustaining CHWs\u27 performance

MOESM1 of Cost-effectiveness analysis of the national decentralization policy of antiretroviral treatment programme in Zambia

Additional file 1. Markov Model