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.

Factors associated with weight gain during COVID-19 pandemic: A global study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in changes in lifestyle habits and experiences of mental health outcomes, some of which were possibly related to weight gain, leading to an increase in the prevalence of obesity, which is associated with the development of several severe diseases. Concerns regarding weight gain and its impact on health outcomes are prevalent worldwide, with obesity being one of the highest causes of mortality in current society. METHODS: A self-reported questionnaire collected data from participants aged 18 years of age and above from 26 countries and regions worldwide. Post-hoc multiple logistic regression analyses have been done to evaluate the association between demographic and socioeconomic factors, and the perspectives that were identified to be associated with weight gain. RESULTS: Participants belonging to a younger age group; with a higher level of education; living in an urban area; living with family members; employed full-time; and had obesity were found to be more vulnerable to weight gain. After adjusting for socio-demographic factors, participants who were quarantined; exercised less prior to the pandemic; consumed unhealthy foods; and reported negative thoughts such as helplessness and the perceived risk of COVID-19, were more likely to experience weight gain; while negative thoughts such as having no means of control over the COVID-19 pandemic and the consequences of the COVID-19 pandemic will have great personal effect were associated with females, students, and people living in the rural area. CONCLUSIONS: Weight gain risk during the pandemic was significantly associated with certain socio-demographic and COVID-19 related factors. To improve public health outcomes, future research should conduct a longitudinal evaluation on the effects of COVID-19 experiences upon health choices. Streamlined mental support should also be provided to the vulnerable groups which were prone to negative thoughts that were associated with weight gain.

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.

Factors Associated with Vaccination Intention against the COVID-19 Pandemic: A Global Population-Based Study.

Several vaccines have been developed for COVID-19 since the pandemic began. This study aimed to evaluate the factors associated with COVID-19 vaccination intention. A global survey was conducted across 26 countries from October, 2020 to December, 2021 using an online self-administered questionnaire. Demographic information, socio-economic status, and clinical information were collected. A logistic regression examined the associations between vaccine intention and factors such as perceptions and the presence of chronic physical and mental conditions. The sample included 2459 participants, with 384 participants (15.7%) expressing lower COVID-19 vaccination intent. Individuals who identified as female; belonged to an older age group; had a higher level of education; were students; had full health insurance coverage; or had a previous history of influenza vaccination were more willing to receive vaccination. Conversely, those who were working part-time, were self-employed, or were receiving social welfare were less likely to report an intention to get vaccinated. Participants with mental or physical health conditions were more unwilling to receive vaccination, especially those with sickle cell disease, cancer history within the past five years, or mental illness. Stronger vaccination intent was associated with recommendations from the government or family doctors. The presence of chronic conditions was associated with lower vaccine intention. Individuals with health conditions are especially vulnerable to health complications and may experience an increased severity of COVID-19 symptoms. Future research should evaluate the effectiveness of interventions targeting the vaccine perceptions and behaviours of at-risk groups. As such, public awareness campaigns conducted by the government and proactive endorsement from health physicians may help improve COVID-19 vaccination intention.

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.

Impact of children born with low birth weight on stunting and wasting in Sindh province of Pakistan: a propensity score matching approach.

Low Birth Weight (LBW) is considered as a major public health issue and leading cause of neonatal death. Almost one in four newborns are reported as underweight in Pakistan. Children born with low birth weight are highly vulnerable to develop diseases and death and/or remain undernourished (i.e., stunted and wasted). This study determines the LBW newborns are more prone to develop stunting and wasting in province of Sindh, Pakistan. Moreover, regression-based estimation of the impact of LBW on the child health outcomes of under five years of age, may be prone to selection bias because of the nature of non-experimental data set, thus, propensity score matching methods are used in this study. Data for this study was used from Multiple Indicators Cluster Survey (MICS-2014). MICS is a two-stage, stratified cluster sampling household level data covering urban and rural areas and consists of 19,500 households from five administrative divisions and 28 districts of Sindh province of Pakistan. The total sample size of children less than five years of age after cleaning the data are 7781, of which 2095 are LBW having birth weight categorized as "smaller than average and very small" and 5686 are normal birth weight (NBW) having birth weight very large, larger than average, and average. This study employed propensity score matching (PSM) regression methods to understand whether the children born as low birth weight are more prone to stunting and wasting and/or both. In province of Sindh, moderate wasting children under five years were 21%, severe wasting 6% and both wasting and stunting 10%. The propensity score results are shown significant in all groups. Specifically, all four types of PSM methods confirm a significant difference in the potential outcome variables-meaning that a child born with LBW has a significant adverse effect on the potential child health outcome variables (stunting, wasting and both). Thus, the propensity score matching findings confirm a significant and adverse effect of LBW on potential health outcomes of under five children. Similarly, low birth weight children are significantly more likely to be moderately wasted (OR = 1.5, CI = 1.3-1.6) and severely wasted (OR = 1.6, CI = 1.3-2.0) and both (stunted and wasted, OR = 2.0, CI = 1.7-2.3) as compared to children with normal birth weight. Male children, if born with low birth weight, are significantly more likely to be moderately wasted (OR = 1.3, CI = 1.1-1.5) and both (wasted and stunted, OR = 1.3, CI = 1.1-1.5) than girls. This large data analysis finding proved that the LBW newborns are on higher risk to develop wasting and stunting in Pakistan.

Effects of diabetes self-management education program on lowering blood glucose level, stress, and quality of life among females with type 2 diabetes mellitus in Thailand.

AIM: The aim of this study is to assess the effect of diabetes self-management education (DSME) on lowering blood glucose level, stress, and quality of life (QoL) among female patients with type 2 diabetes mellitus (T2DM) in Thailand. BACKGROUND: The burden of noncommunicable diseases has increased globally, and it has negatively affected the QoL of diabetic patients. METHODS: A quasi-experimental study was conducted by including 77 T2DM patients selected from 2 public health centers in Thailand. The respondents were randomly selected 38 in control group and 39 in intervention group. Pretested, piloted, and validated tool were used during this study. Knowledge on blood glucose level, stress, and QoL was measured at baseline and then compared to end line after 3 months of the intervention. The effects of intervention were estimated by regression coefficient of intervention on blood glucose level and QoL. The study was ethically approved by the Chulalongkorn University, Thailand. FINDINGS: Baseline characteristics of both the groups were similar before the start of the intervention and there were no significant differences observed in age, education, blood sugar monitoring behavior, medical checkup, knowledge, self-care, stress, and hemoglobin HbA1c (>0.05). However, blood HbA1c, stress level, and QoL among the T2DM patients had significant changes (<0.05) after the intervention. The control group was remained same and there was no statistically significant difference reported (>0.05). CONCLUSIONS: The study concluded that the designed intervention of DSME has proved effective in lowering the blood sugar level, HbA1c level, stress level, and improved QoL among T2DM patients during this limited period of time. Hence, policy-makers can replicate this intervention for diabetic patients in a similar context.

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.

Effects of mobile health education on sexual and reproductive health information among female school-going adolescents of rural Thailand.

Background: Adolescent pregnancy is one of the major public health issues globally, as well as in Thailand. Sexual health literacy (SHL) has been a proved effective intervention for preventing teenage pregnancy. The objective of this study was to evaluate the effects of mobile messages to improve sexual and reproductive health literacy among secondary school female students. Methods: A comparative cross-sectional study with pre-post design was conducted in two secondary schools of rural Thailand. 128 respondents were selected through a simple random sampling method; equal number of female secondary school students were selected from each school. Health education through mobile messages on sexual and reproductive health literacy were delivered in one group while the other group was observed through routine care for 24 weeks. Baseline (pre) and endline (post) measurement was taken to compare the effects of mobile messages. Study was ethically approved by the institutional review board of Chulalongkorn University, Thailand. Results: Both groups were same at baseline and found statistically non-significant (p>0.05). After the 24-week health education program, the mean scores of health education groups was found statistically significant (p<0.05), while the mean score in observed group did not show any statistical change (p>0.05) . Level of sexual health literacy scores among female students in the health education group was found statistically significant (p<0.05) in all four domains. While, the observation group was remained same at both measurements pre and post (p=0.521). Conclusion: The study concluded that the mobile messages have proved an effective information method for sexual and reproductive health information among female secondary students of rural Thailand.

Effects of the Older Family Network Program on Improving Quality of Life Among Older Adults in Thailand.

BACKGROUND: The evidence of promoting family members' health care for older adults by applying family networks and theory of planned behavior will lead to mental health and lower the quality of life among older adults in rural community in Thailand is unclear. OBJECTIVE: The study aimed to assess the effects of health promotion among older adults using an aging family network program to reduce depression and improve quality of life (QOL) among older adults. PATIENTS AND METHODS: This quasi-experimental study was enrolled on one hundred and ten older adults and their family members. Fifty-five older adult participants joined the health promoting program using family member involvement. This program trained them to change health behaviors such as eating healthy food, exercising, emotion management and disability preventive activities to reduce dementia, stroke and falls. The program was conducted in a rural community for 12 months. A comparison group program conducted usual health promoting activities by health personnel. They evaluated quality of life (QOL) using WHOQOL-OLD measurement, and 30-item geriatric depression scale before implementing interventions and after interventions at 9th and 12th months. Data were analyzed using general linear mixed model analysis. RESULTS: After the intervention, social support and perception of health care from family members were significantly improved at the 9th month. At the 12th month, overall QOL, sensory ability, social participation, intimacy, social support, and perception of health care from family members significantly improved. Depression was also reduced at the 12th month. CONCLUSION: These findings demonstrated that health promotion using family members improved QOL and reduced depression long term. Policymakers should implement programs to improve QOL among older adults. They need to improve the involvement of family members when conducting health promotion among older adults and support funding due to conduct on weekends or in the evening.

Effect Of Interpersonal Communication Training Program On Child's Immunization Among Mothers Living In Kebbi State Of Nigeria.

BACKGROUND: Sharing of information through health education training of mothers on child vaccination has proved an effective intervention for better outcome and increased immunization coverage. This study aimed to examine the effect of interpersonal communication (IPC) training program on mothers' knowledge of child's vaccination and routine childhood immunization uptake in local government areas (LGAs) of Kebbi State, Nigeria. METHODS: A quasi-experimental study was conducted in two local government areas in Kebbi State, from October 2016 to March 2017. Four hundred twenty mothers participated in the study and were allocated equally (210) in both intervention and control group (n=210) and data were collected on vaccination status of the children after intervention from children's vaccination cards and mother's verbal reports. Independent t test and Chi-square were used to test the effect of intervention on mother's knowledge of child's vaccination and routine childhood immunization uptake between intervention and control group. Study was ethically approved from the review board of Ministry of Health, Nigeria. RESULTS: Mean knowledge scores has improved in the intervention group (M = 5.42, SD = 3.35) and control group (M=1.96, SD=2.37) after intervention with p<0.001. Routine childhood immunization uptake fully immunized (53.8% vs. 9.5%), partially immunized (16.6% vs. 32.8%) and un-immunized (29.5% vs. 57.6%) in both group after intervention with p<0.001. Approximately fifty-four percentages of children in the intervention group were fully immunized after intervention. However, there was minimal change of 2% has been observed in control group. Percentage of unimmunized children was high in both groups at pre-intervention (66%) but this decreased to 29.5% in the intervention group and 57.6% in the control group. CONCLUSIONS: This study concludes that, IPC skill is an effective intervention and a sustainable service for improving the knowledge and uptake of mother's face-to-face education, social mobilization and reminder services about routine childhood immunization within entire population.

Comparison of mobile health education messages verses face-to-face consultation for weight reduction among overweight female adolescents in Thailand.

Background: Obesity is considered a significant public health problem in Thailand. This study was conducted to compare the impact of mobile health education messages verses face-to-face consultation on weight reduction among overweight female university students. Methods: This comparative cross-sectional study comprised three groups: a control group, a group receiving mobile health education, and a group receiving face-to-face consultation. Each group contained 26 participants taking part over a period of 12 weeks, with a 12-week follow-up thereafter. The data analysis used two-way repeated measures ANOVA with least significant difference testing. The study was ethically approved at Chulalongkorn University, Thailand. Results: The results revealed that the group receiving mobile health education had the lowest average body mass index and waist-hip ratio after intervention ( p < 0.05). In addition, both intervention groups significantly improved their health belief, social support, and health behavior scores in comparison to the control group ( p < 0.001). The results show that the average scores for social support for eating and exercise at baseline were significantly lower than at post-intervention or follow-up ( p < 0.001). In addition, the results of both aspects of social support showed that the average social support score at post-intervention was significantly higher than at follow-up. Furthermore, the health behavior score measured post-intervention was higher than at follow-up. There was a statistically significant difference in average metabolism during physical activity ( p < 0.001) but no statistical difference in average eating behavior score. Conclusion: The study found that the use of mobile health education to deliver health programs facilitates communication between the healthcare provider and individual, and can empower adolescent females in their pursuit of weight loss by improving their attitudes and knowledge, leading to better health behavior.

Effectiveness of a Multidisciplinary Approach Intervention to Improve Blood Pressure Control Among Elderly Hypertensive Patients in Rural Thailand: A Quasi-Experimental Study.

PURPOSE: Uncontrolled blood pressure among Thai elderly hypertensive patients is a significant public health issue in primary health care facilities under the Universal Health Coverage Scheme in Thailand. This study examines the effectiveness of a multidisciplinary approach intervention to improve blood pressure control among elderly persons in rural Thailand. PATIENTS AND METHODS: This was quasi-experimental study conducted on 200 elderly persons who receive care for hypertension at primary health care facility in rural areas of Thailand. Participants were assigned to either the intervention or control groups. The intervention group was subjected to a multidisciplinary approach intervention program. This program included community-based care for hypertension, family-supportive care for hypertension, antihypertension medication adherence education program, the use of a reminder electronic pill box, and monthly pill counts and blood pressure measurements. The intervention continued for three months. The control group received care for hypertension at the hypertension clinic of the health center. Three measurements were taken at baseline, one month, and three months after the intervention. Data analysis included descriptive statistics and independent sample t-tests. Repeated-measure analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were used to compare the differences between the two groups. RESULTS: At one month and three months after the intervention, the multidisciplinary approach intervention controlled blood pressure more effectively compared with the control group. Furthermore, the intervention group had lower systolic and diastolic blood pressure compared with the control group (P-value < 0.001). CONCLUSION: These results suggest that the multidisciplinary approach intervention can be effective in controlling blood pressure in elderly hypertensive patients. Future studies should investigate a cost-effective means of integrating multidisciplinary approach interventions in routine hypertension care for elderly hypertensive patients.

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.

Predictors and Level of Knowledge Regarding Parkinson's Disease among Patients: A Cross-sectional Study from Thailand.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disorder that results in gradual decline of motor, autonomic, and neuropsychiatric functions of the patient. Knowledge and factors responsible for Parkinson's disease (PD) are important among patients that could positively affect their attitude and perceptions. This study was conducted to determine the factors influencing and level of the knowledge regarding Parkinson's disease in Thailand. METHODS: This cross-sectional study was conducted on 125 patients admitted in King Chulalongkorn Memorial Hospital Bangkok, Thailand. Sociodemographic variables and clinical characteristics were collected as predictors of knowledge, treatment, and self-care for PD. A validated, piloted, pretested tool was used for data collection. Multiple linear regressions were used to find the most influencing predictor of knowledge about PD. The study was approved by the Ethical Board of Chulalongkorn University, Thailand. RESULTS: The level of education was found to be the most significant (P = 0.005) predictor of PD knowledge. PD patients with high education had significantly higher knowledge scores than those with low education in all aspects of disease (P = 0.041), treatment (P = 0.014), and self-care (P = 0.011). PD knowledge was poor in variables such as levodopa (62%), nonmotor symptoms (54%), and stem cell transplantation (40%), respectively. CONCLUSION: The study results conclude that educational level is the most important predictor of knowledge about Parkinson's disease.

Effect of Integrated Pictorial Handbook Education and Counseling on Improving Anemia Status, Knowledge, Food Intake, and Iron Tablet Compliance Among Anemic Pregnant Women in Indonesia: A Quasi-Experimental Study.

PURPOSE: To determine the effect of individual education through a pictorial handbook on anemia in conjunction with counseling on improving hemoglobin and hematocrit level, birth weight, knowledge, iron-rich food and iron-folic acid (IFA) intake. PATIENTS AND METHODS: The study developed a pictorial handbook that was conceptualized based on the Health Belief Model and adjusted to some cultural and local contexts. A quasi-experimental pre-test-post-test control group design was used, purposefully conducted between two homogenous municipalities, each having a rate of anemic pregnancy that was 40% or greater. The sample consists of 140 anemic pregnant women randomly allocated via lottery into two groups; the intervention group (n=70), which received two home visits-one for education and another for a counseling session, and control group (n=70), which received routine antenatal care. A chi-square test and a Mann-Whitney U-test were conducted to compare the baseline socio-demographics. An analysis of covariance (ANCOVA), controlling some possible confounders, was performed to analyze the effect of intervention. RESULTS: The post-test means of hemoglobin F (1, 132) = 122, p-value <0.001, and hematocrit levels F (1, 132) = 373, p-value <0.001, were significantly different and higher in the intervention group compared to the control group. Similar results were found in knowledge, food frequency score, number of IFA intake (with p-value <0.001), birth weight and daily iron intake from food (with p-value <0.05). The intervention had a particularly large effect on food frequency score and number of IFA intake, and medium effect on hemoglobin and hematocrit levels. CONCLUSION: Individual education through a pictorial handbook on anemia in conjunction with the counseling intervention program had a positive impact on hemoglobin and hematocrit levels for anemic pregnant women in their third trimester of pregnancy.

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.

Factors predicted with quality of life among hemodialysis patients in private hospital of Thailand.

Background: The quality of life (QOL) among the end-stage renal disease patients is an essential component for assessing the success of treatment. This study aimed to determine the factors predicted with quality of life among hemodialysis patients in private hospital of Thailand.Method: This cross-sectional study was conducted by interviewing 188 Thai patients with end-stage renal disease (ESRD), who were on hemodialysis (HD) at Sanamchan Hospital Bangkok. Patients with stable hemodynamic status without any history of mental illness were included in this study. However, those who could not properly communicate were excluded. The descriptive statistics and the multiple linear regression were applied to identify the predictive factors of quality of life (QOL) scores in the end-stage renal disease (ESRD) patients on maintenance hemodialysis (HD). The QoL was assessed in three components including kidney disease component score (KDCS) physical component score (PCS) and mental component score (MCS).Findings: More than half of the participants (57%) in this research were male and (44%) were unemployed. The mean average systolic value of the participants was 157 (25.12 SD) mmHg and the diastolic blood pressure was 81 (5.85 SD) mmHg. Average hematocrit (Hct) was 30.95 (4.38 SD), Kt/v was 1.86 (0.96 SD), and average normalized protein catabolic rate (nPCR) was 1.12 (1.09 SD). The age, income, patients with more than three associated diseases, enough expenses for living, frequency of dialysis per week, and duration of treatment was statistically significant with the kidney disease component score (KDCS) (F = 6.28, p < 0.05). Furthermore, the age, income, patients with more than three associated diseases, hematocrit (Hct) and frequency of dialysis per week were the statistically significant with the physical component score (PCS) (F = 4.99, p < 0.05) while patients with more than three associated diseases and enough expenses for living were the statistically significant with the mental component score (MCS) (F = 3.30, p ≤ 0.05).Conclusion: Study concluded that the factors like; age, expenses for living, frequency of dialysis, patients with more than three associated diseases were had a positive impact on the quality of life among the end-stage renal disease patients coming for dialysis in private hospital of Thailand.

The Effect of a Club in Making Differences in Knowledge, Attitude, and Practices on Family Planning Among Married Adolescent Girls in Urban Slums in Bangladesh.

Early marriage and childbearing have led to Bangladesh having the highest adolescent fertility rate in the Asia Pacific region. Adolescent pregnancy is correlated with pregnancy-related complications, preterm delivery, delivery of low-birth weight babies, and spousal violence. A quasi-experimental study was conducted in four urban slums (two intervention and two control areas) of Dhaka from July 2014 to August 2016 to assess the effectiveness of a married adolescent girls club (MAG club) in reducing the unmet need for family planning (FP) among married girls between the ages of 14 and 19 (n = 1601, 799 in intervention and 802 in control areas). The percentages of the targeted population using any modern method of contraception were significantly higher among respondents in the intervention areas than those in the control areas (72.6% versus 63.5%). The unmet need for FP was significantly lower among respondents in the intervention areas than that of the control areas (16.2% versus 20.7%). The MAG club was a well-received strategy to provide comprehensive information on FP, which in turn helped improve contraceptive method practices and reduced the unmet need for FP among married adolescent girls in urban slums in Bangladesh. The government could leverage its existing resources to expand the MAG Club model in rural parts of the country to achieve the targets outlined in its Adolescent Reproductive Health Strategy.