Risk Factors Associated with Stunting among Children Under Five in Timor-Leste.

Background: Undernutrition, including stunting, is the cause of almost 45% of all deaths among children under the age of five. It not only affects child growth but also has a long-term negative influence on cognitive and physical abilities. Timor-Leste has the highest prevalence of child stunting in Southeast Asia. Therefore, this study aimed to identify the prevalence of stunting and factors associated with it. Methods: This was a cross-sectional study conducted using the Demographic and Health Survey of 2016 for Timor-Leste. The prevalence of stunting among children under five years of age was examined, and bivariable and multivariable logistic regression analysis was conducted to identify the factors associated with stunting. Results: Among 4,581 children under five years of age, growth in nearly 40% was stunted. The majority of the mothers with stunted children were of age 20-30 years with about 33% having their first baby at ≤19 years of age. Compared to women of <145 cm of height, those of ≥145 cm height had lower likelihood of having a stunted child (OR: 0.62, 95% CI: [0.48-0.80], p < 0.001). It was also interesting to note that the risk of stunting was lower among female children than male children [OR: 0.75, 95% CI: (0.64-0.88), p < 0.001] in our adjusted model. Similarly, other factors such as wealth index, postnatal care visits, currently breastfeeding, age of the child, and size of the child at birth were also associated with stunting. Conclusion: The present findings indicate that child stunting in Timor-Leste is mainly associated with maternal and child sociodemographic status. Hence, it is crucial to identify the quality of services provided by health facilities, the involvement of health workers and volunteers, and the intention of mothers to use the health services in Timor-Leste.

Towards elimination of cervical cancer - human papillomavirus (HPV) vaccination and cervical cancer screening in Asian National Cancer Centers Alliance (ANCCA) member countries.

About 95% of cervical cancers worldwide are caused by human papillomavirus (HPV). Cervical cancer is preventable and curable if it is detected and treated early. We reviewed the latest national cervical cancer indicators, and barriers to HPV vaccination and cervical cancer screening in 21 Asian National Cancer Centers Alliance (ANCCA) member countries. Half (n = 11, 52%) of the countries have introduced HPV vaccination for girls as part of their national vaccination programme, three countries reported coverage of over 90%. Most ANCCA member countries have cervical cancer screening programmes, only five countries reported screening uptake of over 50%. The barriers to HPV vaccination coverage and cervical cancer screening participation have been identified. Ensuring health service accessibility and affordability for women, addressing sociocultural barriers, and strengthening the healthcare system and continuum of care are essential to increase HPV vaccination and cervical cancer screening coverage.

Enhancing earthquake preparedness knowledge and practice among Nepalese immigrants residing in Japan.

This study aims at increasing earthquake preparedness knowledge perception and practice among Nepalese immigrants residing in Japan through an educational intervention. A single arm quasi experimental study was conducted among Nepalese immigrants residing in Japan. An educational intervention was prepared along with a 52 itemed questionnaire. In total, 165 participants responded to our questionnaire. Majority of them were male (67.88%), and the mean age was 32.78 years. Generalized equation model showed that the knowledge score of earthquake preparedness was 4.01 points higher immediately after the intervention [95% CI (2.78-5.24), p-value < 0.001] compared to baseline with a further increase by 7.02 points [95% CI (5.96-8.09), p-value < 0.001] at two weeks follow up. However, the practice score increased only by 2.83 points [95% CI (2.51-3.14), p-value < 0.001] immediately after the intervention with a similar increase at two weeks and 12 weeks follow up period [OR: 2.62, 95% CI (2.29-2.96), p-value < 0.001]. The educational intervention, when conducted in native language, can increase both the knowledge and practice score of earthquake preparedness hence, information related to earthquake preparedness in Nepali languages in the government websites of Japan could potentially increase information seeking behavior of people.

Factors influencing implementation of health-promoting interventions at workplaces: Protocol for a scoping review.

INTRODUCTION: Health-promoting interventions at workplaces can be effective in modifying lifestyle-related behavioral risk factors for non-communicable diseases (NCDs). However, the interventions are not always successful in the real-world setting, and the evidence for effective strategies to implement the interventions has been limited. We propose a scoping review to identify the topics in need of study and areas for future research on barriers to and facilitators of the implementation of workplace health-promoting interventions. MATERIALS AND METHODS: This scoping review will explore these issues from the perspective of supply-side stakeholders, who have a direct role in the implementation of these interventions. An electronic systematic search of MEDLINE (using PubMed), Web of Science, and Scopus databases from 1986 to 2022, in accordance with the PRISMA-ScR guidelines, will be performed. Supplementary hand searching will be undertaken with reference lists from included articles and consulting with relevant stakeholders. Two authors will be responsible for individually screening the corresponding articles by first reading the titles and abstracts and then the full texts to assess whether they meet the inclusion criteria. Data extraction will be conducted using standardized data collection forms, and data analysis will be aligned to the consolidated framework for implementation research (CFIR), a determinant framework of factors affecting implementation, using a directed content analysis approach. DISCUSSION: We will present the findings from this review at national and international conferences and submit them to a peer-reviewed journal for publication. Future workplace interventions will significantly benefit from this comprehensive scoping review to identify factors that enable improvement of the implementation, and the barriers to improvement, of evidence-based health-promoting interventions at workplaces.

Reliability of Early Estimates of the Basic Reproduction Number of COVID-19: A Systematic Review and Meta-Analysis.

OBJECTIVE: This systematic review estimated the pooled R0 for early COVID-19 outbreaks and identified the impact of study-related factors such as methods, study location and study period on the estimated R0. METHODS: We searched electronic databases for human studies published in English between 1 December 2019 and 30 September 2020 with no restriction on country/region. Two investigators independently performed the data extraction of the studies selected for inclusion during full-text screening. The primary outcome, R0, was analysed by random-effects meta-analysis using the restricted maximum likelihood method. RESULTS: We identified 26,425 studies through our search and included 151 articles in the systematic review, among which 81 were included in the meta-analysis. The estimates of R0 from studies included in the meta-analysis ranged from 0.4 to 12.58. The pooled R0 for COVID-19 was estimated to be 2.66 (95% CI, 2.41-2.94). The results showed heterogeneity among studies and strong evidence of a small-study effect. CONCLUSIONS: The high heterogeneity in studies makes the use of the R0 for basic epidemic planning difficult and presents a huge problem for risk assessment and data synthesis. Consensus on the use of R0 for outbreak assessment is needed, and its use for assessing epidemic risk is not recommended.

The RE-AIM framework-based evaluation of the implementation of the Maternal and Child Health Handbook program in Angola: a mixed methods study.

BACKGROUND: The World Health Organization recommends the Maternal and Child Health Handbook (MCH-HB) to promote health service utilization from pregnancy to early childhood. Although many countries have adopted it as a national health policy, there is a paucity of research in MCH-HB's implementation. Thus, this study aimed to evaluate the MCH-HB's implementation status based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), and identify facilitators of, and barriers to its implementation in Angola to understand effective implementation strategies. METHODS: A cross-sectional survey was conducted targeting all health facilities which implemented MCH-HB, subsamples of health workers, and officers responsible for the MCH-HB at the municipality health office. Using the 14 indicators based on the RE-AIM framework, health facilities' overall implementation statuses were assessed. This categorized health facilities into optimal-implementation and suboptimal-implementation groups. To identify barriers to and facilitators of MCH-HB implementation, semi-structured interviews were conducted among health workers and municipality health officers responsible for MCH-HB. The data were analyzed via content analysis. RESULTS: A total of 88 health facilities and 216 health workers were surveyed to evaluate the implementation status, and 155 interviews were conducted among health workers to assess the barriers to and facilitators of the implementation. The overall implementation target was achieved in 50 health facilities (56.8%). The target was achieved by more health facilities in urban than rural areas (urban 68.4%, rural 53.6%) and by more health facilities of higher facility types (hospital 83.3%, health center 59.3%, health post 52.7%). Through the interview data's analysis, facilitators of and barriers to MCH-HB were comprehensively demonstrated. MCH-HB's content advantage was the most widely recognized facilitator and inadequate training for health workers was the most widely recognized barrier. CONCLUSIONS: Strengthening education for health workers, supervision by municipality health officers, and community sensitization were potential implementation strategies. These strategies must be intensified in rural and lower-level health facilities.

Knowledge, attitude, practice and perceived barriers of natural disaster preparedness among Nepalese immigrants residing in Japan.

BACKGROUND: Natural disasters have increased during the last several decades all over the world. Due to its geographical and climate conditions, Japan has long been vulnerable to several natural disasters. Coping with disasters is a major challenge overall and even harder for foreigners residing in Japan. Thus, the objective of this study was to examine the perceived knowledge, attitude, practice and perceived barriers of disaster preparedness among Nepalese immigrants in Japan. METHODS: A cross-sectional study was conducted among Nepalese immigrants residing in Japan with an online survey questionnaire. The questionnaire was validated and then administered. The participants were recruited via Facebook for this survey. Bivariable and multivariable logistic regression analyses were conducted to examine the factors associated with the perceived knowledge, attitude and practice of Nepalese immigrants regarding disaster preparedness. RESULTS: A total of 404 respondents were analyzed in this study and among them two-third were male. We found that the mean score of disaster preparedness practice was lowest than the knowledge and attitude (mean [Formula: see text] = 15.86 [Formula: see text] 5.52) as evidenced by the majority of the participants not being prepared for disaster situations and a limited proportion had ever taken necessary natural disaster preparedness measures. Japanese language was identified as the major barrier in assessing the knowledge, attitude and practice regarding disaster preparedness and was significantly associated with the knowledge level of disaster preparedness after adjusting for some socio-demographic covariates. (aOR: 1.84, 95% CI: (1.04 - 3.25)). CONCLUSIONS: This study observed that the perceived knowledge and practices regarding natural disasters are very poor while barriers to access these are substantial among Nepalese immigrants in Japan. As Japanese language was identified as a major barrier, the availability of language translation services in every health care sector also in the government offices of Japan might encourage people to learn more about disaster preparedness.

Trends and correlates of cesarean section rates over two decades in Nepal.

BACKGROUND: Cesarean section (CS) is a major component of emergency obstetric care. There has been a substantial rise in the rate of CS in private institutions in Nepal which might reflect the successful implementation of delivery schemes introduced by the government extended to the private organizations alternatively, it may also reflect the need for more public health care facilities to provide maternal and child health care services. Hence, the objective of this study was to examine the trends in institutional-based CS rates in Nepal along with its correlates over time. METHODS: We used the National Demographic and Health Survey (NDHS) data collected every 5 years, from 1996 to 2016. The trend in CS rates based on five waves of NDHS data along with its correlates were examined using multivariable logistic regression models after adjusting for socio-demographics and pregnancy-related variables. RESULTS: We included 20,824 reproductive-aged women who had a history of delivery within the past 5 years. The population-based CS rate increased from 0.9% in 1996 [95% CI: (0.6-1.2) %] to 10.2% in 2016 [95% CI: (8.9-11.6) %, p < 0.01] whereas the institutional-based CS rate increased from 10.4% in 1996 [95% CI: (8.3-12.9) %] to 16.4% in 2016 [95% CI: (14.5-18.5) %, p < 0.01]. Private institutions had a nearly 3-fold increase in CS rate (8.9% in 1996 [95% CI: (4.8-16.0) %] vs. 26.3% in 2016[95% CI: (21.9-31.3) %]. This was also evident in the trend analysis where the odds of having CS was 3.58 times higher [95% CI: (1.83-7.00), p < 0.01] in 2016 than in 1996 in the private sectors, while there was no evidence of an increase in public hospitals (10.9% in 1996 to 12.9% in 2016; p for trend > 0.05). Education of women, residence, wealth index, parity and place of delivery were significantly associated with the CS rate. CONCLUSION: Nepal has observed a substantial increase in cesarean delivery over the 20 years, which might indicate a successful implementation of the safe motherhood program in addressing the Millennium Development Goals and Universal Health Care agenda on maternal and child health. However, the Nepal government should examine existing disparities in accessibility of emergency obstetric care services, such as differences in CS between public and private sectors, and promote equity in maternal and child health care services accessibility and utilization.