Health Facilities Readiness and Determinants to Manage Cardiovascular Disease in Afghanistan, Bangladesh, and Nepal: Evidence from the National Service Provision Assessment Survey.

Background: In South Asia, cardiovascular diseases (CVDs) are an increasing public health concern. One strategy for dealing with the growing CVDs epidemic is to make health facilities more ready to provide CVDs services. The study's objectives were to: (1) assess healthcare facilities' readiness to offer CVDs services; and (2) identify the variables that influence such readiness. Methods: This study employed data from the Afghanistan Service Provision Assessment Survey 2018-2019, Bangladesh Health Facility Survey 2017, and Nepal Health Facility Survey 2021 that were cross-sectional and nationally representative. In Afghanistan, Bangladesh, and Nepal, 117, 368, and 1,381 health facilities, respectively, were examined. A total of 10 items/indicators were used to measure a health facility's readiness to provide CVDs services across three domains. Results: The mean readiness scores of managing CVDs were 6.7, 5.6, and 4.6 in Afghanistan, Bangladesh, and Nepal, respectively. Availability of trained staff for CVD services are not commonly accessible in Afghanistan (21.5%), Bangladesh (15.3%), or Nepal (12.9%), except from supplies and equipment. Afghanistan has the highest levels of medicine and other commodity availability. Among the common factors linked with readiness scores, we ought to expect a 0.02 unit rise in readiness scores for three nations for every unit increase in number of CVDs care providers. In Afghanistan, Bangladesh, and Nepal, availability of both diagnosis and treatment facilities was associated with increases in readiness scores of 27%, 9%, and 17%, respectively. Additionally, an association was observed between nation-specific facility types and the readiness scores. Conclusions: Country-specific factors as well as universal factors present in all three nations must be addressed to improve a health facility's readiness to provide CVDs care. To create focused and efficient country-specific plans to raise the standard of CVD care in South Asia, more investigation is necessary to ascertain the reasons behind country-level variations in the availability of tracer items.

Regional Prevalence of Hemoglobin C Across Saudi Arabia: An Epidemiological Survey.

INTRODUCTION: HbC is a common structural hemoglobinopathy especially in West Africa. Prevalence and regional distribution of HbC in Saudi Arabia are widely undocumented. Patients with homozygous HbC disease may have mild hemolytic anemia whereas combination with hemoglobin S (HbS) leads to a clinically severe phenotype. AIM: The current epidemiological study, considered the largest from Saudi Arabia, aimed to evaluate the regional prevalence of the HbC variant among the couples participating in the premarital screening program from 2011 to 2018. METHODS: Data from the PMSGC program were obtained for premarital screening and genetic counseling. The collected data were then entered into the SEHA platform, a centralized electronic repository for the 13 designated regions in Saudi Arabia. Hemoglobin electrophoresis samples are analyzed using either HPLC, capillary electrophoresis, or a combination of both methods to confirm the presence of abnormal hemoglobin bands. RESULTS: This study included 1,871,184 individuals from 2011 to 2018. Of those, 49.8% were males and 50.2% were females. 112,618 (6.0%) had an abnormal test. Total number of Hb C cases were 778 (0.04%). HbC trait (HbAC) was detected in 764 participants while homozygous HbC (HbCC) and combined heterozygous (HbSC) were found in 9 and 5 cases, respectively. The regions near the Red Sea have higher rates than the central and eastern regions. CONCLUSION: HbC is a rare variant in Saudi Arabia with varying regional frequencies. HbC variant is more common in Mecca and Madina regions. The geographic area of HbC distribution differs from the areas with high prevalence of HbS, which explains why HbSC disease cases are overwhelmingly rare.

Factors mediating the association between recurring floods and child chronic undernutrition in northern Bangladesh.

OBJECTIVES: Although there is some evidence that flood exposure in Bangladesh and other developing countries increases the risk of chronic undernutrition in children, the underlying mechanisms are, to our knowledge, unknown. The objectives of this research are to examine the association between recurrent flood exposure and the likelihood of chronic undernutrition in children and to investigate the mediators of this association. METHODS: This cross-sectional study was conducted in the Naogaon District in northern Bangladesh. Purposive sampling was used to choose 800 children between the ages of 12 and 59 mo in equal numbers in the specified flood-affected and flood-unaffected areas: 400 children from the flood-affected area and 400 from the flood-unaffected area. The nutrition indicator height for age, expressed as z scores, was used to define child chronic undernutrition. Our study focused on children who have been exposed to multiple floods in the past 5 y. RESULTS: In our sample data, children who had experienced flooding had a 1.74-times higher chance of having chronic undernutrition (95% CI, 1.53-2.28) than children who had not experienced flooding. The mediation analyses found inadequate minimum dietary diversity, history of diarrhea, not being fully vaccinated, not using clean cooking fuel, and not having a separate kitchen contributed 19.5%, 10%, 9.8%, 14.8%, and 10%, respectively, to the flood exposure-child undernutrition association. CONCLUSIONS: Flood exposure was found associated with the likelihood of child chronic undernutrition, and this relationship was mediated through lack of having a separate kitchen, history of diarrhea, insufficient vaccination, use of unclean cooking fuel, and poor minimum dietary diversity. Interventions to reduce the prevalence of these risk factors could contribute to reducing the disparities in child undernourishment brought on by exposure to flooding.

Assessing the readiness of health facilities to provide family planning services in low-resource settings: Insights from nationally representative service provision assessment surveys in 10 Countries.

BACKGROUND: Many low-income countries continue to have high fertility levels and unmet need for family planning (FP) despite progress in increasing access to modern contraceptive methods and in reducing the total fertility rate (TFR). Health facilities in sub-Saharan Africa (SSA) and South Asia (SA) are thought to be unable to adequately deal with the burden of high unmet FP demands due to their weaker health systems. As a result, determining the readiness of health facilities that offer FP services is critical for identifying weaknesses and opportunities for continued development of FP health systems in those regions. Service Provision Assessment (SPA) tools-which break down health systems into measurable, trackable components-are one useful way to assess service readiness and the ability of health institutions to deliver FP services. METHODS: Using data from nationally representative SPA surveys, we conducted a study that aimed to: (1) evaluate healthcare facilities' readiness to provide FP services; and (2) identify the factors that affect FP service readiness. Using a cross-sectional survey design, we used data from SPA surveys conducted in 10 low-resource SA and SSA countries: Afghanistan, Bangladesh, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and the Democratic Republic of the Congo (DRC). We analyzed data from public and private health facilities in Afghanistan (84), Bangladesh (1,303), Kenya (567), Malawi (810), Namibia (357), Nepal (899), Rwanda (382), Senegal (334), Tanzania (933), and the DRC (1,061) for a total of 6,730 facilities. We used 17 items/indicators recommended by the Service Availability and Readiness Assessment to measure a health facility's readiness to provide FP services across four domains. RESULTS: Only 3.6% to 34.1% of the health facilities were reporting at least 75% (12-13 of 17) of the relevant items for FP service provision. Most of the health facilities in the countries under investigation suffered from lack of readiness, meaning that they did not fulfill at least 75% of the standards (12-13 items of 17 items on the availability of trained staff and guidelines, equipment, and commodities components). The factors associated with higher readiness scores varied among the 10 countries analyzed. Regression models showed that increases in the number of FP healthcare providers available at a health facility and infection control measures for FP exams were factors linked to increased readiness scores in all 10 countries. The low readiness of health facilities to provide FP services in the countries studied showed that the health systems in these low-resource settings faced significant problems with providing FP services. Differences in country-specific variability in the characteristics linked with better preparedness ratings could be attributed to data collected across different years in different nations or to country-specific healthcare financing policies. CONCLUSIONS: To increase a health facility's readiness to offer FP services, country-specific factors must be addressed, in addition to common factors found in all 10 countries. Further research is required to determine the causes of country-level differences in FP tracer item availability to develop targeted and effective country-specific strategies to improve the quality of FP services in the SA and SSA regions and address unmet need for FP.

The double burden of maternal overweight and short stature and the likelihood of cesarean deliveries in South Asia: An analysis of national datasets from Bangladesh, India, Maldives, Nepal, and Pakistan.

BACKGROUND: The aim was to investigate: (a) whether there is an association between the maternal double burden of overweight and short stature and the risk of cesarean delivery and (b) whether socioeconomic status (SES) acts as a moderator in the association between the maternal double burden of overweight and short stature and the risk of cesarean birth (CB). MATERIALS AND METHODS: The data for this study were obtained from the nationally representative Demographic and Health Survey databases of five South Asian countries. The analyses were based on responses from married women between 15 and 49 years of age. The risk of CB was the primary outcome, while the maternal double burden of overweight and short stature (coexistence of overweight and short stature) was the exposure of interest. RESULTS: Maternal double burden of overweight and short stature was significantly associated with 179% higher likelihood of undergoing CB in South Asia (SA), with 304%, 200%, 167%, 155%, and 125% higher likelihood of undergoing CB in Nepal, Pakistan, India, Maldives, and Bangladesh, respectively. Findings also demonstrated that mothers belonging to low SES groups with a double overweight and short stature burden were not uniquely disadvantaged. CONCLUSIONS: A significant marker in SA of higher risk of CB is the maternal double burden of overweight and short stature. The negative effect of the maternal double burden of overweight and short stature extends across all economic backgrounds in relation to the risk of CB. It is not limited to poor mothers who suffer from the double burden of overweight and short stature.

Prevalence of asthma symptoms and associated risk factors among adults in Saudi Arabia: A national survey from Global Asthma Network Phase â .

PURPOSE: Estimating the prevalence and severity of asthma symptoms with standardized methods of population-based surveys is a critical step in reducing asthma burden. However, no sufficient surveys have been conducted in most countries of the Middle East especially at the national level. In this survey, we applied sound measures to estimate the prevalence and severity of asthma symptoms and related risk factors in adults in Saudi Arabia. PATIENTS AND METHODS: In this national cross-sectional study, the prevalence and severity of asthma symptoms were estimated throughout the country. Overall, 7955 adult individuals were selected from 20 regions across Saudi Arabia through their children at schools using a multistage, stratified cluster-sampling technique. A validated questionnaire, including the core and environmental questions of the Global Asthma Network questionnaires, was applied from March 4 to April 25, 2019. In addition, multivariate logistic regression analysis was performed to investigate the independent relationships between current wheeze and related risk factors. RESULTS: The overall prevalence of current wheeze (wheeze during the past 12 months) was 14.2%. Among persons with current wheeze, 38.1% were affected by severe asthma symptoms. Although a high percentage of those who had experienced asthma-ever reported that their asthma was diagnosed by doctors (83.3%), only 38.4% had a written plan for controlling their asthma. Women were more likely to develop current wheeze (adjusted odds ratio (aOR) 1.4; 95% CI: 1.1-1.7), while other statistically significant factors associated with current wheeze were jobs (aOR 11.8; 95% CI: 7.3-18.9), current exposure to moisture or damp spots (aOR 2.2; 95% CI: 1.5-3.4), heating the house when it is cold (aOR 1.7; 95% CI: 1.3-2.1), and ever using tobacco daily (aOR 2.7; 95% CI: 2.0-3.5). CONCLUSIONS: These findings provide enough evidence for health authorities in Saudi Arabia about the prevalence and severity of asthma symptoms, asthma control, and associated risk factors to scale up monitoring projects, control plans, and high-impact interventions.

The burden of asthma among children and adolescents in Saudi Arabia: A national cross-sectional survey.

Background: Asthma disease is one of the most common chronic diseases of childhood. Studies assessing asthma prevalence in Saudi Arabia have been variable and not recently updated. Objectives: We sought to assess asthma prevalence, severity, and related risk factors among children and adolescents in Saudi Arabia. Methods: A national, cross-sectional design was used following the Global Asthma Network phase I design. A total of 3817 children aged 6 to 7 years and 4138 adolescents aged 13 to 14 years were recruited from 137 primary and 140 intermediate schools across 20 regions by using a multistage stratified cluster sampling technique. Standardized written questionnaires were answered by the adolescents and by the parents or guardians of the children. The adolescents also answered a video-based questionnaire. Results: Overall, the prevalences of current wheeze were 10.4% and 13.3% and the prevalences of asthma ever were 13.8% and 15.7%, % in children and adolescents, respectively. Of all the children and adolescents, 5.2% and 5.6% had symptoms of severe asthma, respectively. Among those who reported asthma, 86.0% of the children and 74.8% of the adolescents had their asthma confirmed by a doctor, and 53.0% and 32.4%, respectively, were provided with a written plan to control their asthma. The main risk factors associated with current wheeze included antibiotic use in the first year of life, a history of being diagnosed with pneumonia in children, paracetamol use, and having a cat at home during the past 12 months in adolescents. Conclusions: The prevalence of asthma in children and adolescents in Saudi Arabia is within the average international range and is at a plateau phase.

Determinants of the Underlying Causes of Mortality during the First Wave of COVID-19 Pandemic in Saudi Arabia: A Descriptive National Study.

Since the emergence of the COVID-19 pandemic, the mortality statistics are constantly changing globally. Mortality statistics analysis has vital implications to implement evidence-based policy recommendations. This study aims to study the demographic characteristics, patterns, determinants, and the main causes of death during the first half of 2020, in the Kingdom of Saudi Arabia (KSA). METHODOLOGY: A retrospective descriptive study targeted all death (29,291) registered in 286 private and governmental health settings, from all over KSA. The data was extracted from the ministry of health's death records after the ethical approval. The International Classification of Diseases (ICD-10) and WHO grouping, were used to classify the underlying causes of deaths. The collected data were analyzed using the appropriate tables and graphs. RESULTS: 7055 (24.9%) died at the middle age (40-59 year), and 19,212 (65.6%) were males, and 18,110 (61.8%) were Saudi. The leading causes of deaths were non-communicable diseases (NCDs) 15,340 (62.1%), mainly Cardiovascular diseases (CVDs) 10,103 (34.5%). There was a significant relationship between the main causes of deaths and sex (p < 0.05) and nationality (p = 0.01). CONCLUSION: NCDs mainly CVDs are the leading cause of death. The COVID-19 mortalities were mainly in males, and old age > 55 year. The lockdown was associated with a reduction in the NCDs and Road traffic accidents mortalities.

Evidence from cluster surveys on the association between home-based counseling and use of family planning in conflict-affected Darfur.

OBJECTIVE: To examine the association between home counseling and awareness and use of modern family planning (FP) methods among women in internally displaced person (IDP) camps in conflict-affected West Darfur, Sudan. METHODS: In a community-based cross-sectional study, two questionnaire-based surveys were performed in three camps. Home-based counseling had been introduced in March 2006. An initial survey (February 2007) and a follow-up survey (April 2009) targeted women of child-bearing age. A sample of 640 randomly selected women aged 15-49 years who had experienced pregnancy after joining the camp were interviewed for each survey. RESULTS: Overall, modern FP use increased from 10.9% (70/640) in 2007 to 21.6% (138/640) in 2009 (P<0.001). As compared with the initial survey, women in the follow-up survey were more likely to be aware of and to use any modern FP method (adjusted odds ratio [aOR] 5.4, 95% confidence interval [CI] 3.9-7.4; and aOR 2.8, 95% CI 2.0-4.1, respectively). Contraceptive pills were the most common modern method used. Home counseling and loss of a child under 5years were the most significant predictors of awareness and use of modern FP methods. CONCLUSION: After the introduction of home-based FP counseling for couples and FP services in clinics, women's awareness and use of modern FP methods increased in a conflict-affected setting.

The influence of maternal health education on the place of delivery in conflict settings of Darfur, Sudan.

BACKGROUND: Armed conflict and socio-demographic characteristics of internally displaced persons (IDPs) are very important factors that influence the provision of reproductive health (RH) in humanitarian settings. Maternal health education plays a crucial role to overcome the barriers of RH care, reduce home births conducted by traditional birth attendants (TBAs), and improve increasing births in a health facility. The objectives of this study were to (1) determine the association between the place of delivery and home visits for maternal health education and (2) describe the socio-demographic characteristics of women who gave birth during the last two years. METHODS: A cross-sectional study among married women aged (15-49 years old) in IDP camps. All women were subjected to intensive maternal health education at their homes for 3 years prior to the survey. A sample of 640 women who gave birth during the last two years was randomly selected. RESULTS: Among all women investigated, 36.9 % (95 % CI: 33.1, 40.8) reported a home-based delivery, while 63.1 % (95 % CI: 59.2, 66.9) reported a facility-based delivery. Receiving visits for maternal health education at home was associated with an estimated 43.0 % reduction in odds of giving birth at home, compared to not receiving home visits (adjusted odds ratio [ aOR] 0.57; 95 % CI: 0.35, 0.93). The level of women's education and camp of residence were important predictors for home birth. CONCLUSION: Maternal health education at home was associated with a reduction in home-based delivery performed by TBAs in the conflict-affected setting of Darfur. Our study proposes that when facility-based delivery is made available in camp's clinics, and the targeted women educated at home to refrain from home-based delivery, they will choose to undergo facility-based delivery.

Relationship between implementing interpersonal communication and mass education campaigns in emergency settings and use of reproductive healthcare services: evidence from Darfur, Sudan.

OBJECTIVES: (1) To examine changes in women's awareness and utilisation of reproductive healthcare services in emergency settings following provision of interpersonal communication (IPC) and mass education campaigns, and (2) to describe factors associated with reproductive healthcare service use in internally displaced person (IDP) camps. SETTING: Three camps containing 88 984 IDPs in Darfur, Sudan. PARTICIPANTS: 640 women aged 15-49 who had experienced pregnancy in the camp during the previous 2 years were enrolled in each of two independent cross-sectional surveys 26 months apart. INTERVENTIONS: IPC and mass education campaigns where community health workers disseminated information by home/shelter visits, clinic sessions, public meetings and other means to raise awareness and promote reproductive healthcare service use. PRIMARY OUTCOME MEASURES: Awareness of the existence of antenatal care (ANC) and tetanus toxoid (TT) vaccination services, reception of ANC and TT vaccination, place of delivery and use of postnatal care (PNC). RESULTS: The percentage of women who received home visits, and attended in-clinic sessions and public meetings increased from 61.6% to 86.7%, from 43.0% to 68.8%, and from 3.8% to 39.8%, respectively, between the initial and follow-up surveys. More women were aware of ANC (OR 18.6, 95% CI 13.1 to 26.5) and TT vaccination (OR 3.2, 95% CI 2.4 to 4.4) in the follow-up than the initial survey, after multivariable adjustment. More women received ≥3 ANC visits (OR 8.8, 95% CI 6.4 to 12.0) and ≥3 doses of TT (OR 2.5, 95% CI 1.9 to 3.3), delivered at a healthcare facility (OR 5.4, 95% CI 4.0 to 7.4) and received a PNC visit (OR 5.5, 95% CI 4.0 to 7.7) in the follow-up than in the initial survey, after multivariable adjustment. CONCLUSIONS: Awareness about and utilisation of reproductive healthcare services were higher in the follow-up survey. An integrated IPC and mass education campaign is effective for improving women's reproductive health in emergency settings.