Population Perspectives on Impact of the COVID-19 Pandemic on Essential Health Services-Behavioral Insights from the Federation of Bosnia and Herzegovina.

The aim of this study was to analyze the impact of the COVID-19 pandemic on patterns of use of essential health services (EHS), health-seeking behaviors, and population health and wellbeing in the Federation of Bosnia and Herzegovina (FBiH) from the perspective of its adult population. A population-based survey was implemented in the FBiH in December 2020 on a sample of 1068 adults. Overall, 64% of respondents received care, significantly more being women (67% vs. 61%, p = 0.046), those with a chronic disease (CD) (75% vs. 65%, p < 0.001), and of an older age (58% in 18−34 vs. 67% in older, p = 0.031). These groups also postponed care more often (39% in 55+ vs. 31% in 18−34 years old, p = 0.01; 55% with CD vs. 31% without, p < 0.001; and 43% in females vs. 32% males, p < 0.001). Main reasons for postponing care were lack of available appointments and fear of infection. The presence of a CD was the strongest predictor of need, access, and disruptions of health care. Respondents reported increased expenses for medicines (40%) and health services (30%). The findings of the survey add user insights into EHS disruptions to existing health statistics and other data and may be used to inform strategies for mitigating the impact of COVID-19 on the disruption of health care services, strengthening health system preparedness and building resilience for future emergencies.

Satisfaction with Health Care Services in the Adult Population of the Federation of Bosnia and Herzegovina during the COVID-19 Pandemic.

Background and Objectives: Patient satisfaction with health care can influence health care-seeking behavior in relation to both minor or major health problems or influence communication and compliance with medical advice, which is especially important in emergencies such as the COVID-19 pandemic. Thus, it is important to continually monitor patient satisfaction with provided care and their dynamics. The aim of this study was to assess patient satisfaction with health care during the COVID-19 pandemic in the adult population of the Federation of Bosnia and Herzegovina (FB&H) and compare it with levels of satisfaction in the same population before the COVID-19 pandemic. Materials and Methods: A representative, population-based survey was implemented in the adult population of the FB&H using the EUROPEP instrument, which measures satisfaction with health care using 23 items. The sample included 740 respondents who were 18 years or older residing in the FB&H and was implemented in December 2020. All data were collected using a system of online panels. The survey questions targeted the nine months from the beginning of the pandemic to the time of data collection, i.e., the period of March to December 2020. Results: The mean composite satisfaction score across all 23 items of the EUROPEP tool was 3.2 points in all age groups; the ceiling effect was 22% for the youngest respondents (18-34 years old), 23% for 35-54 years old, and 26% for the oldest group (55+), showing increasing satisfaction by age. The overall composite score for both females and males was 3.2. The ceiling effect was higher in those with chronic disease (29% vs. 23% in those without chronic disease). The composite mean score for respondents residing in rural vs. urban areas was 3.2 with a ceiling effect of 22% in rural and 24% in urban residents. When comparing mean composite scores surveyed at various points in time in the FB&H, it was found that the score increased from 3.3 to 3.5 between 2011 and 2017 and dropped again to 3.3 in this study. Despite these observations in the overall trends of satisfaction scores, we note that no statistically significant differences were observed between most of the single-item scores in the stratified analysis, pointing to the relative uniformity of satisfaction among the analyzed population subgroups. Conclusions: The rate of satisfaction with health care services in the FB&H was lower during the COVID-19 pandemic compared to 2011 and 2017. Furthermore, while an increasing trend in satisfaction with health care was observed in the FB&H during the years prior to 2020, the COVID-19 pandemic may have contributed to the reversal of this trend. It is important to further monitor the dynamics of patient satisfaction with health care, which could serve as a basis for planning, delivering, and maintaining quality services during the COVID-19 pandemic and other emergencies.

Trends in Suicide Mortality in the Federation of Bosnia and Herzegovina - 2010-2020.

BACKGROUND: Suicide is a major public health problem, with far-reaching social, emotional and economic consequences. Suicide rates are high in all age groups are particularly high in all age groups but are one of the major causes of death among younger age groups, yeilding substantial years of premature life lost. Preventing suicide is one of the major mental health challenges in the world. OBJECTIVE: The aim of this study was to estimate the number and rates of suicide deaths in the Federation of Bosnia and Herzegovina (FB&H), and describe suicide characteristics by sex, age, method of suicide over the period of 2010 to 2020. METHODS: This is a retrospective population-based study from the period 2010 - 2020. Data were from the FB&H mortality register, Institute for Statistics FB&H. Data on deaths by cause of death are given according to the 10th edition of the International Statistical Classification of Diseases, Injuries and Causes of Death. Suicide data were presented rates by three age group, total number, male and female, crude rates, age-specific death rates and suicide mechanism by age and gender. RESULTS: The total number of suicides increased until 2017 to a peak of 201, then decreased to 157 for 2020. Males comprised over 70% of the suicide deaths. Over half of suicides were among those aged 30 - 64 and nearly one third among those 65 and above. However, the greatest increases were among youth aged 15 to 29, which grew from 2% to 9% of suicides over teh study period. The most common mechanisms for suicide were for hanging and firearms, both most common amond males. Poisoning was the most common mechanism among females. CONCLUSION: Understanding age and mechanism trends over time will help prioritize prevention strategies. Focus on mental health systems needs to ensure equal access to high-quality services in community based settings. For responses to this challenge to be effective, a comprehensive multisectoral suicide prevention strategy is needed.

Dental Recordkeeping: Practice in Federation of Bosnia and Herzegovina.

BACKGROUND: Dental documentation which includes main information about a patient and dental treatment provided is a very important asset of each dental office. OBJECTIVE: This research aims to analyze the way of fulfilling and keeping mandatory dental records and periodic reporting forms by doctors of dental medicine in the Federation of Bosnia and Herzegovina (FB&H). METHODS: The study was observational with a cross-sectional design using a questionnaire as a study tool. The questionnaire was distributed electronically to the participants working in public health care facilities and private practice. RESULTS: A total of 426 Doctors of Dental Medicine (DDM) participated in the study, of whom 58.7% of respondents were employed in dental offices in the public health sector and 41.3% in dental offices in the private health sector. Dental records are filled out only manually by 53.5% of respondents, while 9.4% fill out the records only electronically, while 37.1% of respondents fill out records both manually and electronically. The manner of keeping dental documentation between respondents employed in dental offices in the public health sector and dental offices in the private health sector differs significantly (p<0.05). Almost all respondents understand the purpose and significance of keeping dental records. CONCLUSION: This paper points out that good dental records are of great importance as they allow monitoring the quality of services provided to patients for a longer period.

An Overview of Human Resources and Capacity in Health Care Institutions in the Federation of Bosnia and Herzegovina in the Context of Responding to the COVID 19 Pandemic.

BACKGROUND: The organization of health care system on Cantonal level with the coordination from Federal level represents a real situation with the possibility of decentralization of health care system according to the experiences of developed countries. OBJECTIVE: To make an overview of the situation at the primary and hospital health care level with the aim of assessing the existing human resources and capacity of health care institutions in FB&H, with which we entered in COVID-19 pandemic. METHODS: This retrospective study presents the efficiency of health care in FB&H measured by number of medical doctors, and other medical staff during the time period of five years. Data of the Institute for Public Health FB&H were used. The Institute for Public Health FB&H is authorised by the law to conduct and implement statistical research in the field of health care in line with relevant laws and by-laws. The Institute is obliged to report on organisational structure, human resources and medical equipment. RESULTS: Presented data include the number of health care employees in medical institutions in FB&H in the period 2015-2019 per 100,000 inhabitants and their numbers in primary health care, family medicine, secondary and tertiary level of health care in 2019. The study also presents the number of doctors of medicine, specialists and medical residents in FB&H, the number of nurses of all profiles and levels of education as well as medical staff and other employees in the public health care system in FB&H in 2019. CONCLUSIONS: The COVID-19 pandemic in FB&H has confirmed the fact that human resources in health care are insufficient, especially in the field of public health and epidemiology. The availability of these health facilities and human resource is not uniform throughout the FB&H, which may affect the capacity of the health system in some parts of the FB&H to meet the needs of providing services during COVID-19 pandemic.

The Effectiveness of Leaflets and Posters as a Health Education Method.

INTRODUCTION: Health education is a process of acquiring knowledge and skills in order to improve the health of the individual and the community. It is considered the most effective, most economical and most rational aspect of health care and health culture. AIM: To provide data on the effectiveness of printed health-educational materials. METHODS: This is a quantitative, applied, descriptive-analytical study. According to the type of research, it presents a public health evaluation manipulative study with triple testing. The research was conducted in elementary schools in the Zenica-Doboj Canton. The total number of students participating in the research is divided into groups: examined, control group. The research consisted of four phases. The research tool is a modified questionnaire The Health Behavior in School-aged Children (HBSC) with 38 questions, 8 modules. RESULTS: The total number of respondents was 120. The method of distribution of health-educational posters shows a lower but still present statistical significance (p<0.05) in relation to the acquired knowledge and a change in attitudes between the conducted surveys at different time points. There is no statistically significant change (p>0.05) in the level of knowledge and attitudes using leaflets between conducted surveys at three different times. In the control group without education, there was a low statistical significance (p<0.05) in terms of changing the level of knowledge and attitudes. CONCLUSION: The distribution of health-educational posters is recommended in situations where it is necessary to reach a wide audience for a long period of time, if the site of the poster is protected. According to this study, there is no evidence that the leaflet distribution method should be used when it comes to the promotion of healthy lifestyles among healthy children. Alternative methods and ways of health education need to be identified.

Water Pipe as Growing Public Health Challenge Among School Children in the Federation of Bosnia and Herzegovina.

INTRODUCTION: The water pipe is a form of tobacco smoking that recently become very popular among youth in many countries all over the globe. AIM: To highlight recent data collected through Global Youth Tobacco Survey (GYTS) in the Federation of Bosnia and Herzegovina (FBiH) 2019, related to knowledge, attitudes and behavior of school children and youth to water pipe consumption. METHODS: The GYTS questionnaire for the Federation of BiH 2019 contained 60 multiple-choice questions. The GYTS 2019 in the Federation of BiH was conducted in a total of 73 of the 75 sampled primary and secondary schools with a school response rate of 97.3%. From the 6,972 sampled students a total of 6,415 participated as eligible students in grades 8-9 of primary and 1st grade of secondary school, with a response rate for students of 92.0%. RESULTS: Survey findings show that almost half (44.1%) of the school children confirm ever smoking the water pipe, while Current smoking of water pipe is confirmed by 16.1% school children. CONCLUSION: There is a substantial need for implementing of systematic and inter sectorial tobacco control measures that involves a water pipe as new public health challenge among youth.

Can a place of living of elementary school students determine their health habit?

Aim To determine dietary habits of elementary school students in relation to a place of living and socio-economic status of the family. Methods A prospective study conducted in the Primary Health Center Zenica involved five family medicine teams in urban and five in rural settlement during 2015. Elementary school students aged 10-16 were interviewed by random selection using a questionnaire on the socio-economic status of parents and nutritional habits of adolescents. Results The survey involved 199 respondents, 103 from rural and 96 from urban area. There were significantly more pupils from employed parents who consumed non-carbonated drinks. Students from urban areas more likely consumed fruit every day than children from rural areas. More than half of the respondents did not or rarely consumed vegetables, in this case the village pupils, who consumed much less milk. It would be expected that rural students were more likely to consume fruits, vegetables and milk due to easier access to these foods in the countryside, but the results of this research did not confirm this assumption. Conclusion Changes in traditional family functioning (lower income, unemployment) could be linked with lifestyle changes (low consumption of fruits and vegetables, low consumption of milk both in rural and urban areas, consumption of carbonated drinks), especially in families in rural areas.

Tobacco and alcohol usage as risk factors of non-communicable diseases among students of Zenica University (Bosnia and Herzegovina).

Aim To establish the presence of two risk factors, smoking and alcohol use, for non-communicable diseases among students at the University of Zenica. Methods The research was conducted at eight schools of the University of Zenica in the academic year 2016/2017 during the period from 1 December 2016 to 15 February 2017. The study involved 600 students 19-29 years of age (all years of study). The research was carried out with a standardized and validated questionnaire, the STEPS non-communicable Disease Risk Factors survey, developed by the World Health Organization. Results Tobacco was used by 145 (24.2%) students, 68 (46.9%) of them being males and 77 (53.1%) females (p<0.05). Males smoked 15.62 and females 13 cigarettes per day (p<0.05). On average, male participants were 16.56 years old, and female participants 16.71 when they started consuming cigarettes (p<0.05). A total of 289 (48.1%) students consumed alcohol, of whom 135 (70.2%) were males and 154 (37.7%) females (p<0.05). Conclusion There is evidence of high prevalence of smoking and alcohol usage as the risk factors for non-communicable diseases. Two levels of the prevention measures should be applied in order to reduce the prevalence of such risk factors: strategic level with a definition of the population, actors, activities, target population and anticipated results, and tactic level which will show contingency activities at the University.

Patient satisfaction with primary care: are there differences between the approaches in family and general medicine?

AIM: To examine patients' satisfaction with health care services in primary care, and to determine a difference of attitudes towards the work of general and family medicine offices. METHODS: This descriptive analytical study was conducted among patients of the Primary Health Care Zenica, who had had recent experience with the work of family or general medicine. The questionnaire for the evaluation of general and family medicine by patients was made on the basis of standardized European Project on Patient Evaluation of General Practice Care questionnaires (EUROPEP). Random sampling was used, and the patient population was divided into two clusters: patients treated in general and family practice. Respondents in the offices were selected by simple random sampling. RESULTS: The study included 100 subjects, 50 for general and 50 for family medicine. There were 56 (56.0%) males, and the most common age group was 41-60 years with 42 (42.0%) subjects. Differences in patient satisfaction in favor of family medicine were statistically most significant when it came to scheduling examinations at times convenient to the patient (p=16.28), the possibility of telephone links with the office (p=32.55) and long waiting in waiting room (p=30.42). CONCLUSION: Collected data confirm the high level of patients' satisfaction with the family medicine units of primary health care. Elaborated EUROPEP questionnaire seems to be a useful tool for the study Key words: satisfaction, health care quality, EUROPEP questionnaire.