Access to Digital Information and Protective Awareness and Practices towards COVID-19 in Urban Marginalized Communities.

Due to digital inequality, poor living, and health care conditions, marginalized people are the most vulnerable group to the COVID-19 pandemic. This study examined how digital information influences knowledge, practices, threat appraisals, and motivation behaviors of urban marginalized communities. It examined slum people's digital competencies, their access to COVID-19 online information, and their trust in COVID-19 information provided by both online and offline media. A total of 453 slum people in Bangkok city, Thailand were surveyed, and multiple regression was performed to examine whether socio-demographic factors influence the access to online communication of slum people. We hypothesized that access to online information might affect marginalized people's awareness of COVID-19 and resulted in greater levels of their practices and protective behaviors. The finding showed that slum people who had access to online information tended to have a better awareness of self-protection against COVID-19, while elderly, female, and foreign migrant workers faced a number of constraints in accessing COVID-19 online information. Such results are important considering the pandemic is compelling societies to turn toward digital technologies to confront the COVID-19 pandemic and address pandemic-related issues. We also discuss how to enhance the role of digital communication in helping urban marginalized communities during and after the pandemic.

A systematic analysis of worldwide disasters, epidemics and pandemics associated mortality of 210 countries for 15 years (2001-2015).

In recent years, the unprecedented death tolls resulting from epidemics and natural disasters made everyone interested, from the general public to country heads, to know about the mortality rates. The coronavirus issue is the most recent example all over the media, and everyone is talking about corona-induced mortality. The study aimed to estimate the disaster-induced mortality rates at the global level for two hundred and ten countries for fifteen years (2001-2015). Using a retrospective study design, we extracted datasets from two data sources, EM-DAT and UNFPA, in October 2019. The cut-off time for the data download was midnight Central European Time, October 17, 2019. The most noticeable finding in this study is that, against the common prevailing notion, both developed and developing countries equally carry the brunt of disaster-induced mortality. This study proposes empirical confirmation of the direction and magnitude of any year-over-year correlation of disaster and mortality rates. Furthermore, the analysis of the trend in mortality rate over the past fifteen years concludes it is not linear. However, there are huge variations across the years and the countries. The study is of paramount importance to initiate a debate amongst the concerned policymakers and stakeholders to regularly monitor the disaster-induced mortality rates. So that effective interventions can be devised to decrease the mortality rates.

Disparities in Physical Accessibility among Rural Thais Under Universal Health Coverage.

This study aims to explore various barriers in accessing outpatient care among the participants from different age groups and to identify determinants associated with physician visits. The study had adopted Andersen's Behavioral Model (ABM) of Health Services Use. A cross-sectional study design was adopted to collect data from 417 participants through a questionnaire survey. Poisson regression models were used to explore determinants for explaining the differences in outpatient care use. The regression results revealed that divergent relationships existed among age groups. Children and elderly participants tended to decrease the probability of seeking care. Elderly participants confronted more difficulties in access and were dependent on family members. Despite free care provisions, participants visited and spent their out-of-pocket expenditure mostly at non-universal health coverage (non-UHC) facilities. Convenience and the availability of specialist physicians led the higher-income parents to seek care of their children at non-UHC facilities. Highly educated people of working age preferred more self-care or institutionalized care to save time. Children up to the primary level of education were more likely to visit a doctor. We concluded that investments in education or well-informed health services provision would improve health care utilization. Findings of Andersen's Behavioral Model variables suggested that improvements in the quality of services, medical professional skills, and efficient resource allocation may induce seeking care at UHC facilities. Consequently, it will reduce the number of referred cases, caseloads at tertiary care units, and visits to non-UHC facilities at longer distances.

Care and social support from family and community in patients with pulmonary tuberculosis in Pakistan.

OBJECTIVES: This study aimed to validate the Medical Outcome Study-Social Support Survey (MOS-SSS) instrument in Pakistan and to quantify the nature of care and social support currently extended to patients with pulmonary tuberculosis (TB) in Pakistan. DESIGN: This is a cross-sectional study design conducted within a period of 3 months from 1 November 2016 to 31 January 2017. PARTICIPANTS: A total of 269 patients, registered at 11 TB centres and private clinics, were interviewed through an interviewer-administered questionnaire. MAIN OUTCOME MEASURES: Cronbach's alpha was used to measure the internal consistency and reliability of the MOS-SSS survey instrument. Univariate and multivariable logistic regressions have been used to explore the association between care and social support, and socioeconomic factors. RESULT: This study validated the use of the MOS-SSS among patients with TB in Pakistan. Findings of the study revealed significant differences among the socioeconomic groups of patients in each subscale of social support. Additionally, results of logistic regressions showed that patients who were older (adjusted OR=6.17, 95% CI 1.55 to 24.59, p≤0.01), male (adjusted OR=2.73, 95% CI 1.49 to 4.98, p≤0.01), widow (adjusted OR=0.17, 95% CI 0.04 to 0.80, p≤0.05), and had a larger household size (adjusted OR=5.69, 95% CI 1.32 to 24.65, p≤0.05), higher monthly income (adjusted OR=2.00, 95% CI 1.11 to 3.60, p≤0.05) and house ownership (adjusted OR=1.99, 95% CI 1.10 to 3.60, p≤0.05) were significant factors associated with the extent of care and social support that the participants received. CONCLUSION: To cure TB, this study suggests a coordinated approach that includes not only clinical services to address this issue but also a strong social support system based on family and community necessary throughout the treatment process.

Earthquake-Induced Injuries: Retrospective Epidemiological Analysis of the 2015 Hindu Kush Earthquake in Pakistan.

OBJECTIVE: The aim of this study was to analyze retrospectively the earthquake-induced injuries caused by the October 2015 Hindu Kush earthquake in Pakistan. This is the first population-based study to assess epidemiologically earthquake-induced injuries in the Hindu Kush region, one of the world's most mountainous and seismically active regions. Unfortunately, only limited studies have investigated the earthquake-induced injuries and deaths in the region epidemiologically. METHODS: The 5 worst affected districts were selected according to the highest number of deaths and injuries recorded. A total of 1,790 injuries and 232 deaths were reported after the 2015 earthquake. In our study area, 391 persons were recorded and verified to have been injured as a result of the earthquake. We attempted to investigate all of the 391 injured people, but the final study looked at 346 subjects because the remaining 45 subjects could not be traced because of the non-availability of their complete records and their refusal to participate in the study. RESULTS: Using the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD 10), we found that the highest number - 20.23% (70 of 346) - of injuries in the earthquake fall in the class of "Injuries to an unspecified part of trunk, limb, or body region (T08-T14)." The class of "Injuries to knee and lower leg (S80-S89)," which count 15.61% (54 out of 346), followed it, and "Injuries involving multiple body regions (T00-T07)" were making 14.74% of total injuries (51 out of 346). CONCLUSION: In times of natural disasters like earthquakes, collecting and analyzing real-time data can be challenging. Therefore, a retrospective data analysis of deaths and injuries induced by the earthquake is of high importance. Studies in these emerging domains will be crucial to initiate health policy debates and to prevent and mitigate future injuries and deaths. (Disaster Med Public Health Preparedness. 2018;13:732-739).

Treatment Delay among Pulmonary Tuberculosis Patients within the Pakistan National Tuberculosis Control Program.

Delay in diagnosis and treatment worsens the disease and clinical outcomes, which further enhances transmission of tuberculosis (TB) in the community. Therefore, this study aims to assess treatment delay and its associated factors among pulmonary TB patients in Pakistan. A cross-sectional study was conducted among 269 pulmonary TB patients in the district. Binary and multivariate logistic regressions were used to explore the factors associated with delay in TB treatment. Results reveal that most patients were from low socioeconomic backgrounds. For example, 74.7% were living in kacha houses, 54.7% were from lowest the income group (< 250 US$/month), 60.2% married, 54.3% illiterate, 62.5% rural, 56.1% had no house ownership, and 56.5% had insufficient income for daily family expenditures. Significant delays were revealed by this study: 160 patients had experienced a delay of more than 4 weeks, whereas the median delay was 5 weeks. Results show that the most important reason for patient delay was low income and poverty (42.0%) followed by unaware of TB center (41.6), stigma (felt ashamed = 38.7%), and treatment from local traditional healers. Old age (adjusted odds ratio [AOR] = 6.6; 95% confidence interval [CI] = 1.63-26.95); and rural areas patients (AOR = 2.1; 95% CI = 1.15-3.71) were more likely to have experienced delay. However, the higher income and sufficient income category (AOR = 0.5; 95% CI = 0.31-0.95) were associated factors and less likely to experience delay in patient treatment. Integrative prevention interventions, such as those involving community leaders, health extension workers such as lady health workers, and specialized TB centers, would help to reduce delay and expand access to TB-care facilities.

Mapping displaced populations with reference to social vulnerabilities for post-disaster public health management.

Millions of people are currently displaced from their homes because of local and international conflicts. In the last two decades, a substantial increase in the number of displaced people has been recorded. We measured the social vulnerabilities of displaced populations using a mathematical approach in combination with application of geographical information systems (GIS) tools and techniques to visualise movement and draw attention to the location of significant concentration of vulnerabilities. A retrospective study approach based on datasets collected from governmental and non-governmental organisations working with refugees and internally displaced persons in Pakistan was used. We applied simple mathematical formulas to calculate and map various types of vulnerability, such as refugee population, absorption capacity, unmet needs and overall vulnerability. This approach displays risks and vulnerabilities of displaced populations in an easily understood and straightforward manner that can be replicated in other parts of the world.

Vulnerability to typhoon hazards in the coastal informal settlements of Metro Manila, the Philippines.

In many low- and middle-income countries informal communities-also termed slum and squatter areas-have become a dominant and distinct form of urban settlement, with ever increasing populations. Such communities are often located in areas of high hazard exposure and frequently affected by disasters. While often recognised as one of the highest 'at risk' populations, this paper will argue that informal settlers have been directly and indirectly excluded from many formal mechanisms, thereby increasing their vulnerability to disaster events. Household surveys were conducted across several frequently flooded informal coastal communities in Metro Manila, the Philippines, following a major typhoon and storm surge disaster. The study revealed a large level of diversity in socio-economic vulnerability, although all households faced similar levels of physical exposure and physical vulnerability. Disaster risk reduction policies and responses need to better integrate informal settlement areas and recognise the diversity within these communities.