Resilience level and its association with maladaptive coping behaviours in the COVID-19 pandemic: a global survey of the general populations.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has induced a significant global concern on mental health. However few studies have measured the ability of individuals to "withstand setbacks, adapt positively, and bounce back from adversity" on a global scale. We aimed to examine the level of resilience, its determinants, and its association with maladaptive coping behaviours during the pandemic. METHODS: The Association of Pacific Rim Universities (APRU) conducted a global survey involving 26 countries by online, self-administered questionnaire (October 2020-December 2021). It was piloted-tested and validated by an expert panel of epidemiologists and primary care professionals. We collected data on socio-demographics, socioeconomic status, clinical information, lifestyle habits, and resilience levels measured by the Brief Resilience Scale (BRS) among adults aged ≥ 18 years. We examined factors associated with low resilience level, and evaluated whether low resilience was correlated with engagement of maladaptive coping behaviours. RESULTS: From 1,762 surveys, the prevalence of low resilience level (BRS score 1.00-2.99) was 36.4% (America/Europe) and 24.1% (Asia Pacific). Young age (18-29 years; adjusted odds ratio [aOR] = 0.31-0.58 in older age groups), female gender (aOR = 1.72, 95% C.I. = 1.34-2.20), poorer financial situation in the past 6 months (aOR = 2.32, 95% C.I. = 1.62-3.34), the presence of one (aOR = 1.56, 95% C.I. = 1.19-2.04) and more than two (aOR = 2.32, 95% C.I. = 1.59-3.39) medical conditions were associated with low resilience level. Individuals with low resilience were significantly more likely to consume substantially more alcohol than usual (aOR = 3.84, 95% C.I. = 1.62-9.08), take considerably more drugs (aOR = 12.1, 95% C.I. = 2.72-54.3), buy supplements believed to be good for treating COVID-19 (aOR = 3.34, 95% C.I. = 1.56-7.16), exercise less than before the pandemic (aOR = 1.76, 95% C.I. = 1.09-2.85), consume more unhealthy food than before the pandemic (aOR = 2.84, 95% C.I. = 1.72-4.67), self-isolate to stay away from others to avoid infection (aOR = 1.83, 95% C.I. = 1.09-3.08), have an excessive urge to disinfect hands for avoidance of disease (aOR = 3.08, 95% C.I. = 1.90-4.99) and transmission (aOR = 2.54, 95% C.I. = 1.57-4.10). CONCLUSIONS: We found an association between low resilience and maladaptive coping behaviours in the COVID-19 pandemic. The risk factors identified for low resilience in this study were also conditions known to be related to globalization-related economic and social inequalities. Our findings could inform design of population-based, resilience-enhancing intervention programmes.

Effectiveness of health education intervention on diabetes mellitus among the teachers working in public sector schools of Pakistan.

BACKGROUND: Diabetes Mellitus (DM) is considered as one of the major public health problems globally. Health education strategies can help in managing blood glucose level and complications among DM patients. Health education intervention is effective to manage and control the blood glucose levels among diabetic patients. This study explored the effectiveness of health education intervention on DM among school teachers in public sector schools of Pakistan. METHODS: This was quasi-experimental study where baseline & end line assessments were conducted on teachers of public sector schools of Sindh province, Pakistan, from October to December 2019. Pretested structured questionnaire was used in this study. Participants (n = 136). were randomly selected from the list of government schools registered with district education department An intervention comprised of health education sessions with DM patients was undertaken after conducting baseline assessment followed by end line assessment. The institutional review board of Health Services Academy Pakistan ethically approved this study. RESULTS: All the respondents completed post-test with mean ± SD age of participants being 39.2 ± 1.34 years. Female teachers comprised 65% out of which 70% were living in rural areas. Knowledge on DM pre-test score was 20.03 ± 3.31 that increased in post-test to 49.11 ± 2.21 (p < 0.05). Mean score of information on symptoms and causes of DM was 1.98 ± 0.21 for pre-test whereas for post-test it was 4.78 ± 0.12 (p < 0.05). The effect of intervention was significant on diabetes related complications (p < 0.05), symptoms (p < 0.05), overall score (p < 0.05) and preventive practices (p < 0.05). CONCLUSIONS: The study provides evidence of the importance and effectiveness of health education intervention related to diabetes among school teachers, which has a positive impact on the knowledge and practices. We concluded that the health education session sensitized the teachers and they can bring cogent changes to enhance their knowledge about diabetes and its risks.

Predictors of knowledge and use of long-lasting insecticidal nets for the prevention of malaria among the pregnant women in Pakistan.

BACKGROUND: Malaria is endemic to Pakistan with high prevalence among pregnant women and linked with maternal anaemia, intrauterine growth retardation, preterm birth, and low birth weight. The use of long-lasting insecticidal nets (LLINs) is a proven and cost-effective intervention preventing malaria among pregnant women. The present study aimed to explore predictors of knowledge and use of LLINs among pregnant women in Pakistan. METHODS: This was part of a quasi-experimental study of 200 pregnant women conducted in a rural district of Sindh province in Pakistan. Data were collected using Malaria Indicator Survey questionnaires developed by Roll Back Malaria Partnership to end Malaria Monitoring and Evaluation Reference Group. Pregnant women and mothers with newborns of six months of age were interviewed in their homes. RESULTS: The age of the women was from 18 to 45, two thirds of the respondents (72.5%) were uneducated and married (77%). Majority (92%) of the women had received antenatal care during pregnancy, and 29.5% women had received counseling on malaria during their antenatal care visits. Multiple linear regression showed that the type of latrine was the most significant (ß = 0.285, p < 0.001) determinant of knowledge about malaria among pregnant women followed by the death of a newborn (ß = 0.271, p < 0.001). The use of mobile phone was the most significant (ß = 0.247, p < 0.001) predictor of usage of LLINs among pregnant women followed by the death of a newborn (ß = 0.232, p < 0.05). CONCLUSIONS: Maternal education, type of latrine, use of mobile phone, malaria during previous pregnancy and newborn death were strong predictors of knowledge and use of LLINs in pregnant women in Pakistan. There is a need to scale-up programmes that aim to create awareness regarding malaria among pregnant women. Mobile phone technology can be used to implement awareness programmes focusing on malaria prevention among women.

Effectiveness of a health education intervention on the use of long-lasting insecticidal nets for the prevention of malaria in pregnant women of Pakistan: a quasi-experimental study.

BACKGROUND: About one quarter of pregnant women in the population of Pakistan are using long-lasting insecticide-treated bed nets (LLINs) for prevention of malaria. Past research reported that adequate information and education would act as mediator to change behaviour among patients for prevention of malaria infection. The effective use of LLINs would contribute to reduction of disease burden caused by malaria. The aim of this study was to determine the effectiveness of health education on the adoption of LLINs among pregnant women living in Tharparkar, a remote district in Sindh Province, Pakistan. METHODS: A quasi-experimental study design with control and intervention groups was conducted with 200 pregnant women (100 in each group). Women in the intervention group were provided with health education sessions on malaria for 12 weeks, while those in the control group obtained routine information from lady health workers (LHWs). Pre- and post-intervention assessment was done of knowledge about malaria and use of LLIN, which was statistically analysed using descriptive statistics and difference in difference (DID) multivariable regression analysis to test effectiveness of the intervention. RESULTS: Baseline was conducted with 200 pregnant women. Demographic characteristics were similar in both groups with slight differences in age, education, income, type of latrine, and source of drinking water. There were no significant differences between mean knowledge and use of LLINs scores between groups at baseline. However, the estimated DID value after the intervention was 4.170 (p < 0.01) and represents an increase in scores of knowledge in the intervention group compared to control. Similarly DID value of 3.360 (p < 0.05) showed an increase in use of LLINs score after the intervention which was significant, showing that the intervention had a positive effect. CONCLUSIONS: Results proved that health education could be an effective intervention for improving knowledge and usage of LLINs among pregnant women for the prevention of malaria. Such educational interventions have a positive potential to be implemented at larger scale by incorporating them into routine health sessions provided by health workers.

Why under five children are stunted in Pakistan? A multilevel analysis of Punjab Multiple indicator Cluster Survey (MICS-2014).

BACKGROUND: Pakistan is facing a serious problem of child under-nutrition as about 38% of children in Pakistan are stunted. Punjab, the largest province by population and contributes high gross domestic product (GDP) share in economy has reported 27% moderately and 10% severely stunted children of less than 5 years. Thus, this study aims at examining the determinants of stunting (moderate and severe) at different level of hierarchy empirically in Punjab province of Pakistan. METHODOLOGY: Data for this study is coming from Punjab Multiple Indicators Cluster Survey (MICS-2014), used two-stage, stratified cluster sampling approach. Sub-national level data covering urban and rural areas were used for this study consists of 25,067 children less than 5 year's ages, from nine administrative divisions and 36 districts of Punjab province of Pakistan. Descriptive statistics and multilevel hierarchical models were estimated. Multilevel data analyses have an advantage because it provides robust standard error estimates and helps in finding variation in the data at various levels. RESULTS: Punjab has a stunting prevalence of about 27% moderately and 10% severely stunted children of less than 5 years. The results depict that increasing the age of the child, increasing birth order, illiterate mothers and fathers, lack of sanitation facilities and being poor are associated significantly with the likelihood of moderate and severe stunting. Surprisingly, there is a gender bias in stunting in Punjab, Pakistan and being a girl child is more likely associated with moderate and severe stunting, which shows the patriarchal nature of the society and a substantial prevalence of gender bias in household resource allocations. CONCLUSION: This outcome of our analysis points towards targeting not only households (focus on girls) but also their families and communities.

Availability of emergency obstetric and newborn care services at public health facilities of Sindh province in Pakistan.

BACKGROUND: Basic and comprehensive emergency obstetric care services in Pakistan remain a challenge considering continued high burden of maternal and newborn mortality. This study aimed to assess the availability of emergency obstetric and newborn care in Sindh Province of Pakistan. METHODS: This cross-sectional survey was conducted in twelve districts of the Sindh province in Pakistan. The districts were selected based on the maternal neonatal and child health indicators. Data were collected from 63 public-sector health facilities including district, Taluka (subdistrict) headquarters hospitals and rural health centers. Basic and comprehensive emergency obstetric newborn care services were assessed through direct observations and interviews with the heads of the health facilities by using a World Health Organization pretested and validated data collection tool. Participants interviewed in this study included the managers and auxiliary staff and in health facilities. RESULTS: Availability of caesarean section (23, 95% C.I. 14.0-35.0) and blood transfusion services (57, 95% CI. 44.0-68.0), the two components of comprehensive emergency obstetric and newborn care, was poor in our study. However, assessment of the seven components of basic emergency obstetric and newborn services showed that 92% of the health facilities (95% C.I. 88.0-96.0) had parenteral antibiotics, 90%, (95% C.I. 80.0-95.0) had oxytocin, 92% (95% CI 88.0-96.0) had manual removal of the placenta service, 87% (95%, C.I. 76.0-93.0) of the facilities had staff who could remove retained products of conception, 82% (95% C.I. 71.0-89.0) had facilities for normal birth and 80% (95% C.I. 69.0-88.0) reported presence of neonatal resuscitation service. CONCLUSION: Though the basic obstetric and newborn services were reasonably available, comprehensive obstetric and newborn services were not available as per the World Health Organization's standards in the surveyed public health facilities. Ensuring the availability of caesarean section and blood transfusion services within these facilities may improve population's access to these essential services around birth.

Women's preferences and factors influencing their obstetric care service utilization in rural Sindh: A Cross sectional Study.

The objective of this study was to explore women's preferences and factors influencing the obstetric services in a rural setting of Sindh Province. This cross sectional study was conducted on 100 women who were interviewed by using a validated questionnaire. The women who had given birth during the year preceding the study were eligible for inclusion in the study. The mean age of the participants was 27.5±2.0 and majority 86 (86%) of them were housewives. About 87 (87%) participants had an opinion that their obstetrical health decisions were always taken by their household members and families. 65 (65.7%) women reported that they consulted public hospitals for their antenatal care visits and 69 (69.6%) women preferred private health facilities for antenatal visits. More than half (62.2%) of the participants had delivered their last child in a public health facility, however, 39 (39.2%) women still preferred to deliver at home. Factors such as availability and affordability for health services were significant among pregnant women, those with income more than twenty thousand rupees per month, those with formal education as they were getting better obstetric care compared to those who had less income (<0.05) and those with no formal education. Study concluded that affordability and availability of services around pregnancy and birth were major factors responsible for preference for maternal care and could be linked with poor obstetrical care among rural women of Sindh. However, it is imperative to provide the obstetric care which is accessible without inconvenience.

Effectiveness of case based cultural competency among nurses working in private hospitals of Bangkok, Thailand: A Quasi-experimental study.

OBJECTIVES: To evaluate the effect of case based cultural competency level and its factors affecting on nurse job in two private hospitals of Bangkok, Thailand. METHODS: This was a quasi-experimental study implemented the cased-based cultural competent intervention in two private hospitals of Thailand in 2015. One hundred sixty six nurses from two control and intervention private hospitals through simple random selection method were selected for this study. Data was collected at the beginning of study (pre-test), immediately after the intervention and after two months of intervention (post-test). Tool was pretested, validated and piloted before to conduct study. RESULTS: Total 166 nurses were included in this study. The characteristics among the study participants were similar between both hospitals at the baseline and found statistically non-significant (p= > 0.05). However, after the intervention the cultural knowledge, attitude and practice competency score levels have significantly increased among the nurses in the intervention group as compared to control group (p= < 0.05). CONCLUSION: Study has concluded that an intervention has positively affected on cultural knowledge, practice and attitude competency among nurses working in private hospital of Bangkok Thailand.

Effectiveness of self-empowerment-affirmation-relaxation (Self-EAR) program for postpartum blues mothers: A randomize controlled trial.

BACKGROUND AND OBJECVITES: Approximately 55-85% of women worldwide have experienced postpartum blues (PPB) during 6-9 weeks after delivery without receiving the counseling program; more than 20% of them have developed into postpartum depression. Study objectives were to evaluate the effect of the Self-EAR program to improve the postpartum blues scores and serum allopregnanolone level among newly blues mothers. METHODS: During June 2015 to May 2016, the randomized controlled trial was conducted among 76 Nulliparous blues mothers who were screened with Stein's postpartum blues scores ≥ 3. All participants were randomly assigned either to the intervention group (Self-EAR program) and the control group (standard postpartum care program). The Self-EAR program was transformed into audio files which were installed in an MP3 digital device before providing it to the intervention group in order to be implemented at home three times per day for four weeks. Participants were assessed at baseline, 1-month, 2-month and 3-month follow-up for serum allopregnanolone level. Data were analyzed by using descriptive statistic, chi-square test, t-test, and repeated measure analysis of variance. RESULT: After the 3-month follow-up, the results revealed positive effects of the Self-EAR program on postpartum blues scores (p-value=0.002) and serum allopregnanolone concertation (p-value=0.001). The participants in the intervention group had experienced significantly lower postpartum blues scores; on the other hand, they had significantly higher serum allopregnanolone level when compared with the control group. CONCLUSIONS: The findings suggested that the Self-EAR program was effective to improve postpartum blues scores and allopregnanolone level among newly postpartum blues mothers.

Determinants of severe acute malnutrition among children under five years in a rural remote setting: A hospital based study from district Tharparkar-Sindh, Pakistan.

OBJECTIVES: To understand and catalogue the specific determinants of this alarming rate of malnutrition among children of Tharparkar district, Sindh Pakistan. METHODS: This was a hospital based analytical survey. Data was collected through a semi-structured questionnaire by interviewing mothers of the children (age 6-59 months), admitted in the hospital. Following WHO guidelines, weight and length/ height of 105 children were recorded. Study was conducted in District Headquarters Hospital, Tharparkar district of Sindh province. RESULTS: Almost 48% children admitted in the hospital were identified with severe acute malnutrition. More males (55%) were malnourished as compared to females (45%). Maternal education, household income, family size, breastfeeding, vaccination status, and frequent infections were found to be significantly associated with the severe acute malnutrition. CONCLUSION: Specific interventions on promoting exclusive breastfeeding, vaccination, and timely health care seeking behaviors would definitely improve the outcomes. Nevertheless, sector wide approaches would be needed on girls' education, poverty, and food security in the district in order to address the issue of malnutrition.

Contraceptive practices among married women of reproductive age in Bangladesh: a review of the evidence.

BACKGROUND: Bangladesh has experienced a sevenfold increase in its contraceptive prevalence rate (CPR) in less than forty years from 8% in 1975 to 62% in 2014. However, despite this progress, almost one-third of pregnancies are still unintended which may be attributed to unmet need for family planning and discontinuation and switching of methods after initiation of their use. METHODS: We conducted an extensive literature review on contraceptive use among married women of reproductive age (MWRA) in Bangladesh. A total of 263 articles were identified through database search and after final screening ten articles were included in this synthesis. RESULTS: Findings showed that method discontinuation and switching, method failure, and method mix may offset achievements in the CPR. Most of the women know of at least one contraceptive method. Oral pill is the most widely used (27%) method, followed by injectables (12.4%), condoms (6.4%), female sterilization (4.6%), male sterilization (1.2%), implants (1.7%), and IUDs (0.6%). There has been a decline in the use of long acting and permanent methods over the last two decades. Within 12 months of initiation, the rate of method discontinuation particularly the short-acting methods remain high at 36%. It is important to recognize the trends as married Bangladeshi women, on average, wanted 1.6 children, but the rate of actual children was 2.3. CONCLUSIONS: A renewed commitment from government bodies and independent organizations is needed to implement and monitor family planning strategies in order to ensure the adherence to and provision of the most appropriate contraceptive method for couples.

Quality Of Life Through Listening Music Among Elderly People In Semi-Urban Area, Thailand.

BACKGROUND: Aging is one of the biggest problems in Southeast Asia due to their rapidly growing population of the older person. Old aging population is usually confined to their homes resulting in poor quality of life (QOL). Music has been found to be the great activity for older peoples with physical, emotional and social disorders hence, it affects on quality of their life. This study explored the music preference among elderly people and their quality of life in the semi-urban of Thailand. METHODS: A cross-sectional study was conducted by interviewing 353 elderly individuals living in the semi-urban area of Thailand. A validated, reliable world health organization quality of life (WHOQOL-OLD) tool was adapted for this study. Logistic regression analysis was performed to identify the factors associated with QOL and its six domains with adjusted covariates, and the potential factors including chronic disease, community participation, traditional event participation, the experiences of music listening, and the types of music preference were entered in the model. RESULTS: Findings revealed that more than half of respondents were married female with an average age of 68.92±6.99. Around (80.7%) suffered from chronic diseases and the hypertension was found the highest (66.32%). The quality of life among the elderly was found at the moderate level with the total QOL score of 83.41±SD=10.32. Respondents with chronic diseases have the total QOL score (OR=0.95, 95% CI 0.93-0.98). Respondents who preferred to listen to Look Krung (Thai popular classic music) type have the total QOL score (OR=1.03, 95% CI 1.01-1.05), Autonomy Facet(AUT) score (OR=1.11, 95% CI 1.02-1.21), and Intimacy facet(INT) score (OR=1.14, 95% CI 1.05-1.24) as compared to those who did not listen the music. CONCLUSIONS: The study highlights the relationship between the QOL among aging people and the listening of music in the semi-urban area of Thailand.

Effect Of Medical Waste Management Trainings On Behavior Change Among Doctors Versus Nurses And Paramedical Staff In Pakistan.

BACKGROUND: Healthcare waste management is a neglected issue in hospitals of developing countries due to poor practices among health staff. This study was aimed to determine the differences in knowledge, attitude and practices of physicians versus nursing and paramedical staff about standard health care waste management (HCWM). METHODS: This quasi-experimental study was conducted among healthcare workers of the two tertiary care hospitals in Rawalpindi. A total of 138 hospital workers in intervention and 137 in control hospital were given training on HCWM. Subjects were followed up at one year and after 18 months of the intervention. RESULTS: We found that nursing and paramedical staff was more knowledgeable and compliant with the HCWM standards, knowledge and practices as compared to physicians. A higher proportion of nursing and paramedical staff was able to retain more of high level of knowledge but more of the doctors had achieved and retained positive attitudes towards HCWM standards after the training. More of nursing and paramedical staff also had good HCWM practices; both at first as well as second follow up. CONCLUSIONS: As nursing and paramedical staff was more knowledgeable and practiced optimum standards they needed to be rewarded adequately and given further regular trainings to help them maintain their knowledge and best practices about HCWM. As HCWM and patient safety standards keep on changing regularly, the hospital workers especially doctors need to be focused to comply with the standard practices in hospitals.

Factors Predictive Of Alcohol Consumption Among Elderly People In A Rural Community: A Case Study In Phayao Province Thailand.

BACKROUND: Alcohol consumption is recognized as a public health issue. Study objectives were to identify factors predictive of alcohol consumption among elderly people in Phayao province Thailand, where there was high prevalence of alcohol consumption. METHODS: This was a cross-sectional study. Four hundred elderly people participated in a survey. Data was collected by face-to-face interviews. Chi-square and multivariate logistic regression were used to determine the factors predictive of alcohol consumption among the study subjects. RESULTS: One thirds of elderly (31.7%) had consumed alcohol in their lifetime, and (15.7%) of them were current drinkers. Following univariate analysis, seven factors included gender, working, sickness, smoking, quality of life (QOL), daily activities and economic recession - were identified as being significantly associated with drinking (p<0.05). Multivariate analysis revealed four factors to be predictive of alcohol among elderly people: gender (OR=6.02, 95% CI=3.58-10.13), smoking (OR=4.34, 95% CI=2.57-7.34), economic recession (OR=2.79, 95%, CI=1.66-4.71), and QOL (OR=1.86, 95%, CI=1.09-3.16). CONCLUSIONS: Gender (male) and smoking were strongly predictive factors of elderly alcohol consumption. Hence, an effort to reduce alcohol consumption should be placed on male elderly and those who smoke.

Impact of waste management training intervention on knowledge, attitude and practices of teaching hospital workers in Pakistan.

OBJECTIVE: To evaluate the sustainability and effectiveness of training as an intervention to improve the knowledge, attitude and practices of hospital workers on health care waste management. METHOD: We conducted this quasi-experimental study in two tertiary care teaching hospitals in Rawalpindi in October 2013. Training, practical demonstrations and reminders on standard waste management were given to 138 hospital workers in one hospital and compared with 137 workers from the control hospital. We collected data 18 months after intervention through a structured questionnaire to assess the impact of the intervention. We used paired t-test to compare the scores on knowledge, attitude and practices at baseline and first follow up and final impact assessment. Chi square test was used to compare group variables between intervention and control groups. RESULTS: After 18 months since intervention the mean scores on knowledge attitude and practices differed statistically significantly since baseline and intervention group had statistically significantly better knowledge positive attitudes and good health care waste management practices (p < 0.001). Health care and sanitary workers in intervention group scored statistically significantly higher (p < 0.001). CONCLUSION: Trainings of health and sanitary workers on health care waste management guidelines were sustainable among the intervention group after 18 months which shows the positive impact of our intervention. It is recommended that the trainings as intervention be included in the overall policies of the public and private sector hospitals in Pakistan and other similar settings.

Effectiveness of intensive healthcare waste management training model among health professionals at teaching hospitals of Pakistan: a quasi-experimental study.

BACKGROUND: Infectious waste management has always remained a neglected public health problem in the developing countries, resulting in high burden of environmental pollution affecting general masses. Health workers are the key personnel who are responsible for the management of infectious waste at any hospital, however, their proper training and education is must for an optimal performance. This interventional study was conducted to assess the effectiveness of Intensive healthcare waste management (IHWM) training model at two tertiary care hospitals of Rawalpindi city, Pakistan. METHODS: This study was quasi-experimental pre and post design with control and intervention groups. Out of 275 health care workers enrolled for the study, 138 workers were assigned for intervention group for 3 months trainings, hands-on practicum and reminders on infectious waste management; whereas 137 workers were assigned to the control hospital where routine activities on infectious health care waste management were performed. Pre and post intervention assessment was done for knowledge, attitude and practices (KAP); and was statistically analyzed. Bivariate and multivariate analysis, independent, paired and unpaired t-test, chi-square with p values, and mean of the responses were calculated. Overall the response rate was 92% at the end of intervention. RESULTS: During the baseline survey, 275 healthcare workers (HCW) included doctors, nurses, paramedics and sanitary workers, and after 3 months of intervention, 255 were reached out to complete the questionnaire. With regard to KAP at baseline, there were no significant differences between two groups at baseline, except for gender and department. However, in the post intervention survey, statistically significance difference (<0.05) between intervention and control group's knowledge, attitude and practices was found. Moreover, within the control group no statistically significant difference was reported (>0.05) after 3 months. CONCLUSIONS: Study results suggest that IHWM training could be an effective intervention for improving knowledge, attitudes and practices among health workers regarding infectious waste management. Such training should become a regular feature of all hospitals for reducing the hazards attached with infectious wastes.

Personal Protective Equipment Use and Handwashing Among Animal Farmers: A Multi-site Assessment.

The goal of this study was to compare and contrast the use of personal protective equipment (PPE) and the practice of handwashing among participants of four studies assessing poultry and swine farms in the midwestern United States and in Thailand. This largely descriptive exercise was designed to assess and compare the frequency of these protective practices among the study populations. There were a total of 1113 surveys analyzed across the four studies. The respondents included workers in direct contact with animals as well as flock owners and veterinarians tending to farms. Handwashing was the most common practice observed among all participants with 42% "always" and 35% "sometimes" washing their hands after contact with the animals. This practice was least common among Minnesota swine workers. Even Thai poultry farmers, who demonstrated the lowest overall PPE use, reported a higher frequency of handwashing. Mask use during animal farming activities ("always" or "sometimes") was least commonly practiced, ranging from 1% in Thailand to 26% among backyard poultry farmers in Minnesota. Minnesota poultry and swine farmers had similar frequencies of mask (26%) and glove use (51% and 49%). All other comparisons differed significantly across the four sites (p-values <0.05). The use of PPE in animal farming differed by study location and is likely related to prevalent norms in the respective regions. Overall, the use of PPE did not appear to be influenced by the particular animal (poultry or swine) being farmed. These findings may prove useful to regulating bodies and farm owners in formulating policy or planning strategies for improving personal hygiene practices in animal farming and preparing for influenza and other potential zoonotic disease outbreaks.

QUALITY OF LIFE AND FEAR OF FALLING AMONG AN AGING POPULATION IN SEMI RURAL, THAILAND.

BACKGROUND: Thailand is the country where large numbers of old population are living in rural areas. Multiple factors are influencing the health of old people but falling is the biggest cause affecting their quality of life. This study explores the relationship between the quality of life, and fear of fall among aging people in the semi-rural, Thailand. METHODS: A cross sectional study was conducted on 394 old aged individuals living in Nakornnayok Province. Participants were selected through simple random method (SRM) from village population list. Old people were interviewed by adapting World Health Organization quality of life instrument-older module (WHOQOL-OLD) to access the quality of life. Multiple logistic regression analysis was applied to identify factors associated with QOL. RESULTS: Above half of respondents during this study were female, married, educated with age 70.45 ± 6.99. Majority of aging had low income and were not enrolled for their health check-up at hospitals on regular basis. Over a half of them suffered from chronic diseases, and one third of them were using instrumental aids such as visual glasses, walker support, wheel chair and hearing aids etc. Majority, (70%) of the participants was living in safe houses but (34%) reported fall at least one time in past year. Mean of fear of fall score (FFS) was calculated (26.97 ± 4.31) and mean of FFS during using public transportation was (9.8756 ± 2.19467). Two third of aging population reported the moderate quality of life (QOL). CONCLUSIONS: Study has concluded that the QOL in aging people is related with household safety and confidence to use public transportation.

Practices and challenges of infectious waste management: A qualitative descriptive study from tertiary care hospitals in Pakistan.

BACKGROUND AND OBJECTIVE: Infectious waste management practices among health care workers in the tertiary care hospitals have been questionable. The study intended to identify issues that impede a proper infectious waste management. METHODS: Besides direct observation, in-depths interviews were conducted with the hospital administrators and senior management involved in healthcare waste management during March 2014. We looked at the processes related to segregation, collection, storage and disposal of hospital waste, and identified variety of issues in all the steps. RESULTS: Serious gaps and deficiencies were observed related to segregation, collection, storage and disposal of the hospital wastes, hence proving to be hazardous to the patients as well as the visitors. Poor safety, insufficient budget, lack of trainings, weak monitoring and supervision, and poor coordination has eventually resulted in improper waste management in the tertiary hospitals of Rawalpindi. CONCLUSION: Study has concluded that the poor resources and lack of healthcare worker's training in infectious waste results in poor waste management at hospitals.

Discrimination and violence against women migrant workers in Thailand during the COVID-19 pandemic: A mixed-methods study.

BACKGROUND: Women migrant workers are vulnerable to discrimination and violence, which are significant public health problems. These situations may have been intensified during the COVID-19 pandemic. This study aimed to investigate discrimination against women migrant workers in Thailand during the COVID-19 pandemic and its intersection with their experiences of violence and associated factors. METHODS: A mixed-methods study design was employed to collect data from 572 women migrant workers from Myanmar, Lao People's Democratic Republic, and Cambodia. Face-to-face interviews were conducted with 494 participants using a structured questionnaire for quantitative data, whereas qualitative data was collected through 24 in-depth interviews and focus group discussions with 54 migrant women. Simple and multiple logistic regression and content analysis were employed. RESULTS: This study found that about one in five women migrant workers experienced discrimination during the COVID-19 pandemic. Among those who experienced discrimination, 63.2% had experienced intimate partner violence and 76.4% had experienced non-intimate partner violence in their lifetime. The multivariable analysis revealed that women migrant workers who had experienced any violence (AOR = 2.76, 95% CI = 1.49, 5.12), lost their jobs or income during the pandemic (AOR = 3.99, 95% CI = 2.09, 7.62), and were from Myanmar (AOR = 4.68, 95% CI = 1.79, 12.21) were more likely to have experienced discrimination. CONCLUSION: The results suggest that the intersection of discrimination and violence against women migrant workers in Thailand demands special interest to understand and address the problem. It is recommended that policymakers provide interventions and programs that are inclusive and responsive to the unique needs of women migrants depending on their country of origin and job profile.