Engagement of private healthcare sector in addressing noncommunicable diseases at primary care level in the Eastern Mediterranean Region.

Background: The private healthcare sector is a critical stakeholder in the provision of health care services, including noncommunicable diseases (NCDs), and engagement with the sector is increasingly being advocated in efforts to achieve Universal Health Coverage. Aim: This study was conducted to explore the role of the private health sector in delivering NCD-related primary care services in selected countries of the WHO Eastern Mediterranean Region (EMR): Jordan, Oman, Pakistan, Sudan, and the Syrian Arab Republic. Methods: We adapted the analytical framework for this study from the "Framework for action to implement the United Nations political declaration on noncommunicable diseases". We conducted a desk review to gather evidence, identify gaps and provide direction for the subsequent stakeholder interviews. Key informant interview respondents were selected using the snowball sampling method. Data from the interviews were analysed using MAXQDA, version 2020. Results: We reviewed 26 documents and interviewed 19 stakeholders in Jordan, Oman, Pakistan, Sudan and the Syrian Arab Republic. Our results indicated increasing advocacy at the regional and national levels to align the private and public health sectors, just as there were efforts to reduce the risk factors for NCDs by implementing tobacco laws, introducing food labelling guidelines, increasing taxes on soft drinks, and promoting the healthy cities approach. NCDs health information systems varied widely among the countries, from being organized and developed to having poor recordkeeping. The private health sector is the predominant provider of care at primary level in most of the EMR countries. Conclusion: Increased collaboration between the public and private sectors is essential for better management of NCDs in the EMR. Governments need to strengthen regulation and defragment the private health sector and harness the sector's strengths as part of efforts to achieve national health targets, NCD goals and Universal Health Coverage.

The science of micronutrients in clinical practice - Report on the ESPEN symposium.

BACKGROUND & AIMS: The European Society for Clinical Nutrition and Metabolism published its first clinical guidelines for use of micronutrients (MNs) in 2022. A two-day web symposium was organized in November 2022 discussing how to apply the guidelines in clinical practice. The present paper reports the main findings of this symposium. METHODS: Current evidence was discussed, the first day being devoted to clarifying the biology underlying the guidelines, especially regarding the definition of deficiency, the impact of inflammation, and the roles in antioxidant defences and immunity. The second day focused on clinical situations with high prevalence of MN depletion and deficiency. RESULTS: The importance of the determination of MN status in patients at risk and diagnosis of deficiencies is still insufficiently perceived, considering the essential role of MNs in immune and antioxidant defences. Epidemiological data show that deficiencies of several MNs (iron, iodine, vitamin D) are a global problem that affects human health and well-being including immune responses such as to vaccination. Clinical conditions frequently associated with MN deficiencies were discussed including cancer, obesity with impact of bariatric surgery, diseases of the gastrointestinal tract, critical illness, and aging. In all these conditions, MN deficiency is associated with worsening of outcomes. The recurrent problem of shortage of MN products, but also lack of individual MN-products is a worldwide problem. CONCLUSION: Despite important progress in epidemiology and clinical nutrition, numerous gaps in practice persist. MN depletion and deficiency are frequently insufficiently searched for in clinical conditions, leading to inadequate treatment. The symposium concluded that more research and continued education are required to improve patient outcome.

Tobacco use among young adolescents in Myanmar: Findings from global youth tobacco survey.

BACKGROUND: Tobacco consumption among youths poses significant public health problem in developing countries. This study utilized the available data of Global Youth Tobacco Survey (GYTS) to assess the prevalence of tobacco use among Myanmar adolescents. OBJECTIVES: We have conducted the fourth round of the GYTS in Myanmar during 2016 to monitor trends in tobacco use. METHODS: We have selected 51 schools using random sampling based on probability proportional to school enrollment. In each school, we selected grades 9-11 by random sampling. All students in these classes completed a self-administered standard questionnaire. RESULTS: A total of 3633 students who were participated in the survey 2621 students were 13-15 year. Overall 13.6% of students currently used tobacco; boys 26.3% and girls 3.7%. The prevalence of current cigarette smoking was 8.3%; boys 17.0%, girls 1.5%, whereas 5.7% of students currently smokeless tobacco users; boys 11.0%, girls 1.5%. Exposure to secondhand smoke (SHS) at home, in enclosed public places, and school was reported by 33.2%, 28.4%, and 64.5%, respectively. More than four out of 5 (83.4%) students had noticed someone using tobacco on television, videos or movies, and 42.3% had noticed tobacco advertising at points of sale. Among current smokers, 62.9% were not refused by purchasing cigarettes because of their minor age. CONCLUSION: Myanmar has higher prevalence of tobacco use among students, especially among boys. The study provides evidence-based information for developing comprehensive tobacco control programs - both education and policy interventions to reduce smoking rate among young people in Myanmar.