Characteristics of adverse drug reactions due to nonsteroidal anti-inflammatory drugs: a cross-sectional study.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for treating pain and inflammation. Spontaneous adverse drug reaction (ADR) reports represent a rich data source for the detection of unknown and rare ADRs. This cross-sectional study aimed to analyze the characteristics of ADRs due to NSAIDs in Thailand. All ADR reports of NSAIDs for systemic use from 2015 to 2019 were extracted from the national database in Thailand. Patient characteristics, drug use information, adverse event information, and source of senders in 32,857 reports were analyzed. The annual number of ADR reports due to NSAIDs decreased from 7,008 in 2015 to 5,922 in 2019. The most frequently reported drug was ibuprofen (n=12,645, 38.5%) followed by diclofenac (n=7,795, 23.7%), most patients were 40-59 years old, and the major adverse reaction was angioedema (n=7,513, 22.9%). Serious reactions were recorded in 20.7% (n=6,801) of the total ADRs. Most patients (n=20,593, 62.7%) recovered without sequelae, but there were 5,420 patients (16.5%) who could not recover and 3,109 patients (9.5%) who were recovering. Eight patients (0.02%) died of Stevens-Johnson syndrome (n=3), toxic epidermal necrolysis (n=4), and anaphylactic shock (n=1), which were possibly related to ADRs. The number of ADR reports due to NSAIDs decreased from 2015 to 2019 in Thailand. Serious ADRs and death cases accounted for 20.7% and 0.02%, respectively. Most fatal cases exhibited severe drug-induced skin reactions.

Inhibition of Transglutaminase 2 Reduces Peritoneal Injury in a Chlorhexidine-Induced Peritoneal Fibrosis Model.

Long-term peritoneal dialysis (PD) is often associated with peritoneal dysfunction leading to withdrawal from PD. The characteristic pathologic features of peritoneal dysfunction are widely attributed to peritoneal fibrosis and angiogenesis. The detailed mechanisms remain unclear, and treatment targets in clinical settings have yet to be identified. We investigated transglutaminase 2 (TG2) as a possible novel therapeutic target for peritoneal injury. TG2 and fibrosis, inflammation, and angiogenesis were investigated in a chlorhexidine gluconate (CG)-induced model of peritoneal inflammation and fibrosis, representing a noninfectious model of PD-related peritonitis. Transforming growth factor (TGF)-ß type I receptor (TGFßR-I) inhibitor and TG2-knockout mice were used for TGF-ß and TG2 inhibition studies, respectively. Double immunostaining was performed to identify cells expressing TG2 and endothelial-mesenchymal transition (EndMT). In the rat CG model of peritoneal fibrosis, in situ TG2 activity and protein expression increased during the development of peritoneal fibrosis, as well as increases in peritoneal thickness and numbers of blood vessels and macrophages. TGFßR-I inhibitor suppressed TG2 activity and protein expression, as well as peritoneal fibrosis and angiogenesis. TGF-ß1 expression, peritoneal fibrosis, and angiogenesis were suppressed in TG2-knockout mice. TG2 activity was detected by α-smooth muscle actin-positive myofibroblasts, CD31-positive endothelial cells, and ED-1-positive macrophages. CD31-positive endothelial cells in the CG model were α-smooth muscle actin-positive, vimentin-positive, and vascular endothelial-cadherin-negative, suggesting EndMT. In the CG model, EndMT was suppressed in TG2-knockout mice. TG2 was involved in the interactive regulation of TGF-ß. As inhibition of TG2 reduced peritoneal fibrosis, angiogenesis, and inflammation associated with TGF-ß and vascular endothelial growth factor-A suppression, TG2 may provide a new therapeutic target for ameliorating peritoneal injuries in PD.

Reporting system on mortality statistics in Lao People's Democratic Republic.

The system to collect information on mortality statistics in Lao PDR is not well established, accurate and timely death information is therefore not available. This article reports the system and process to make the mortality statistical data of Lao PDR. The country has a paper-based resident registration system, using a death notification document, a death certificate, and a family census book. The death notification document is important as it provides the cause of death, which is issued from a health facility and the village office. In the event of a death occurring at home, the family representative needs to report to the village office verbally to obtain a death notification document. On the other hand, if the death occurred in a medical facility, a death notification document from a health facility is provided. The family representative should bring the death notification document to the district Home Affairs office to register the death and obtain a death certificate. After that, the family representative needs to bring the death certificate to the district Public Security office for an amendment in the family census book. ICD-10 is under development regarding death notification from health facilities under the Ministry of Health. However, it is unclear how death notification from village offices can adopt ICD-10 as the majority of deaths occur outside health facilities. A comprehensive and integrated mortality reporting system is necessary in order to create a holistic health policy and welfare for the country.

Children with neuro-developmental disorders at Center for Child and Adolescent Mental Health in Cambodia.

The Center for Child and Adolescent Mental Health (CCAMH) is one of the centers that have psychiatric specialists for children in Cambodia. This study aims to understand the characteristics of children with neuro-developmental disorders, especially autism spectrum disorder (ASD), at CCAMH. This study included 440 cases that were randomly chosen from 2,147 new patients at CCAMH in 2018-2019 and were aged 0-12 years. Socio-demographic factors, parent's information, obstetrical factors, and clinical data were collected from patients' records. A logistic regression analysis and Pearson's chi-square test were used to compare the characteristics between children who were finally diagnosed with ASD and the others (non-ASD). Of the 440 patients, most were male (75.2%), 0-4 years old (57.7%), and diagnosed with ASD (50.0%). Common symptoms were delay of speech, playing alone, and hyperactivity. ASD was significantly more prevalent in male patients compared to females and in the 0-4 years age group compared to the 5-12 years age group. Parents who lived in Phnom Penh and had high education were more likely to visit the CCAMH with their children who were diagnosed with ASD. Regarding treatment, approximately half of all 440 patients had family counselling and psychosocial education. ASD patients had more speech therapy, special education and structured teaching, and networking and coordination therapy compared to non-ASD patients. To provide education and therapy to children with ASD and their parents from the early stage, information about the center and ASD should be widely distributed to all parents in Cambodia.

Underlying cause of death at medical facilities in Xaiyabouli Province, Lao People's Democratic Republic.

In Lao PDR, Ministry of Health introduced District Health Information Software 2 (DHIS2) in 2013. Although DHIS2 includes cause of death, Lao government did not request to report cause of death through DHIS2, resulting in no information on frequency of underlying cause of death even for the deaths at medical facility. This study aimed to collect the information on the underlying cause of death at all medical facilities in Xaiyabouli province, a rural area in Lao PDR. As well as the point estimate of the proportion, a 95% confidence interval (CI) based on a binomial distribution was calculated for each cause of death. According to the local government request, 226 deaths (128 males and 98 females) in 2019 were reported from all medical facilities in the province. Among them, infectious diseases were the most frequent (33.6%, 95% CI 27.5-40.2%); sepsis (16.8%, 95% CI 12.2-22.3%), pneumonia (8.8%, 95% CI 5.5-13.3%), and meningitis (4.9%, 95% CI 2.5-8.5%). Heart diseases were 15.9% (95% CI 11.4-21.4%) including heart failure and myocardial infarction. Injury was 10.2% (95% CI 6.2-14.4%) including brain injury. Neonatal death was 10.6% (95% CI 6.9-15.4%). Among those, preterm death was common (8.8%, 95% CI 5.3-13.3%). Renal failure was 8.0% (95% CI 4.8-12.3%). According to civil registration covering all deaths both at facilities and outside facilities, deaths at facilities were 16.8% of the whole deaths (1,372 deaths) in Xaiyabouli province. Although deaths outside facilities were not included, this is the first report demonstrating cause of death in one province in Lao PDR.

Development of a Vietnamese version of the Revised Hasegawa's Dementia scale.

As the aging population grows worldwide, the problem of age-related health is becoming an important public health concern. Dementia is a devastating disease that places a significant physical, emotional, and financial burden on patients, their caregivers, and society. It is predicted to increase in developing countries. The Revised Hasegawa's Dementia Scale (HDS-R) has been used in many Asian countries to measure cognitive function. However, there is still no Vietnamese version of the HDS-R. Therefore, this paper describes the development of the HDS-R scale and manual in Vietnamese language. Two Vietnamese researchers translated the HDS-R from English to Vietnamese. To confirm the accuracy of the translation, two other Vietnamese researchers conducted a back-translation. Another pair of Vietnamese researchers compared the back-translated English version to the original one. All six researchers discussed the inconsistencies between English HDS-R scale and manual and derived the most suitable version for the Vietnamese context. In Questions 4 and Question 7, we changed the words from "cherry blossom" and "train" to "daisy flower" and "bicycle" for the first option, and from "plum blossom" to "rose" for the second option. We also changed the expressions in some places in the manual to fit the Vietnamese language. Future studies are needed to validate this version to be able to access cognitive function in both clinical and public healthcare settings.

Patient delay and health system delay of patients with newly diagnosed pulmonary tuberculosis in Mongolia, 2016-2017.

Although diagnosis and treatment of tuberculosis (TB) have been improved in many countries, delays in the diagnosis and treatment remain problematic in resource-limited countries. This study aimed to identify factors affecting delays in TB care in Mongolia. Data on TB cases registered from January 2016 to December 2017 were obtained from the national registry of TB at the Department of TB Surveillance and Research in National Center for Communicable Disease. The total number of TB cases registered in these two years was 8,166, including 3,267 cases of newly diagnosed pulmonary TB. Pulmonary TB cases (1,836 males and 1,431 females) were analyzed to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Patient delays longer than the median (28 days) were significantly associated with patient age >32 years (aOR=1.31, 95%CI: 1.14-1.51), residence in areas other than Ulaanbaatar (aimags) (aOR=1.38, 95%CI: 1.20-1.59), and smear-negative (aOR=0.57, 95%CI: 0.47-0.69). Health system delays longer than the median (7 days) were significantly associated with patient age >32 years (aOR=1.16, 95%CI: 1.00-1.33), residence in aimags (aOR=0.82, 95%CI: 0.71-0.95), special facilities including a prison hospital (aOR=4.40, 95%CI: 2.42-7.83), registration in 2017 relative to 2016 (aOR=0.83, 95%CI: 0.71-0.95), and smear-negative (aOR=1.72, 95%CI: 1.42-2.07). Total delays longer than the median (45 days) were significantly associated with patient age >32 years (aOR=1.39, 95%CI: 1.21-1.60), residence in aimags (aOR=1.27, 95%CI: 1.11-1.47), and smear-negative (aOR=0.74, 95%CI: 0.62-0.90). To shorten the total delay, improvement of the access to medical facilities in aimags is necessary.

Satisfaction With Health Care Services at the Pediatric Specialist Clinic of the National Referral Center in Malaysia: Cross-sectional Study of Caregivers' Perspectives.

BACKGROUND: The concept of customer satisfaction is gaining hold in all corporate sectors worldwide, and a satisfaction survey is used as a tool to discover service problems and as a chance for customers to rate their experience with health care services. A high degree of patient satisfaction with the services given has been found in numerous studies conducted in Malaysian public health care facilities. However, there is limited information available on caregiver satisfaction with pediatric clinics run by the Ministry of Health (MoH) of Malaysia. OBJECTIVE: This was the first research performed at a public hospital's pediatric clinic, which was the first hospital to adopt the public-private-partnership model under the MoH, with the aim of discovering the prevalence and factors affecting the satisfaction of caregivers at the national referral center. METHODS: Cross-sectional research using the standard self-administered SERVQUAL questionnaire was conducted among caregivers accompanying their children to the clinic. The questionnaire consists of 16 paired statements to evaluate their expectations and experiences with the clinic services. RESULTS: A total of 459 caregivers were involved in this study with a majority aged between 30 and 39 years (n=254, 55.4%). Caregivers from the Indian community (adjusted odds ratio [AOR] 2.91, 95% CI 1.37-6.18) and lower income groups (AOR 2.94, 95% CI 1.87-4.64), and those with lower educational backgrounds (AOR 3.58, 95% CI 1.19-10.72) were more likely to be satisfied with the quality of pediatric clinic services. Housewives/househusbands (AOR 0.48, 95% CI 0.25-0.90), on the other hand, appeared less likely to be satisfied with the services provided during their visit to the clinic. Looking at overall patient satisfaction, 50.5% (n=232) of caregivers demonstrated satisfaction with the quality of services, compared to 49.5% (n=227) of dissatisfied respondents. CONCLUSIONS: This paper suggests that, although most caregivers are satisfied with the services, greater emphasis must be placed on delivering reliable service in response to the MoH's mission to provide quality and integrated people-centered health services in Malaysia.

Rates and Factors Associated With Serious Outcomes of Patient Safety Incidents in Malaysia: An Observational Study.

Introduction: This study aimed to examine the reporting rate and the factors associated with serious outcomes of patient safety incidents at public hospitals in Malaysia. Methods: All patient safety incidents reported in the e-Incident-Reporting System from January to December 2019 were included in the study. A descriptive study was used to describe the characteristics of incidents, and logistic models were used to identify factors associated with low reporting rates and severe harm or death outcomes of incidents. Results: There were 9431 patient safety incidents reported in the system in 2019. The mean reporting rate was 2.1/1000 patient bed-days or 1.5% of hospital admissions. The major category of incidents was drug-related incidents (32.4%). No-harm incidents contributed to 56.1% of all the incidents, while 1.1% resulted in death. More hospitals in the eastern (odds ratio [OR], 12.1) and southern regions (OR, 6.1) had low reporting rates compared to the central region. Incidents with severe harm or death outcomes were associated with more males (OR, 1.4) than females and with the emergency department (OR, 10.6), internal medicine (OR, 5.7), obstetrics and gynecology (OR, 2.4), and surgical department (OR, 5.0) more than the pharmacy department. Compared to drug-related incidents, operation-related (OR, 3.0), procedure-related (OR, 3.5), and therapeutic-related (OR, 4.8) incidents had significantly more severe harm or death outcomes, and patient falls (OR, 0.4) had less severe harm or death outcomes. Conclusion: The mean reporting rate was 2.1/1000 patient bed-days or 1.5% of hospital admissions. More hospitals in the eastern and southern regions had low reporting rates. Certain categories of incidents had significantly more severe outcomes.

Factors associated with severe dengue in Savannakhet Province, Lao People's Democratic Republic.

This study aimed to describe the socio-demographic and clinical characteristics of dengue inpatients at a provincial hospital, and to identify factors associated with severe dengue. This is a retrospective study involving 402 dengue patients admitted to the Savannakhet Provincial Hospital, Lao People's Democratic Republic (Lao PDR), between January 2018 and April 2019. Socio-demographic factors, clinical signs and laboratory data on admission, final diagnosis, use of health care services before admission, admission date, and hospitalization period were collected from patient records. The number of dengue inpatients was higher in the rainy season than in the dry season. Of the 402 patients, 205 patients (51.0%) were finally diagnosed with severe dengue. Children aged <15 years had more symptoms, higher proportion of severe dengue (69.8% vs. 35.9%), and longer hospitalization (3.5 days vs. 3.0 days) than adults aged ≥15 years. In multivariable analyses, factors associated with severe dengue were nausea on admission (adjusted odds ratio=3.57, 95% CI=1.05-12.09, P=0.04) in children and persistent vomiting on admission (adjusted odds ratio=3.82, 95% CI=1.23-11.92, P=0.02) in adults. In adults, the creatinine level on admission was significantly higher in patients with a final diagnosis of severe dengue compared to the others. The proportion of severe dengue in our study was higher than that in other countries. Nausea and persistent vomiting on admission were suggested to be predictive factors for severe dengue. To reduce the incidence of severe dengue in Lao PDR, improvements in access to health care, referral system, and training of health care workers are needed.

Prevalence and risk factors of anxiety and depression among the community-dwelling elderly in Nay Pyi Taw Union Territory, Myanmar.

Providing elderly mental healthcare in Myanmar is challenging due to the growing elderly population and limited health resources. To understand common mental health problems among Myanmar elderly, this study explored the prevalence and risk factors of anxiety and depression among the elderly in the Nay Pyi Taw Union Territory, Myanmar. A cross-sectional study was conducted among 655 elderly by face-to-face interviews with a pretested questionnaire. Descriptive analysis and multiple logistic regression analyses were performed. The prevalence of anxiety and depression were 39.4% (33.5% for males and 42.4% for females) and 35.6% (33.0% for males and 36.9% for females), respectively. The adjusted odds ratio of having anxiety was significant for having low education level, having comorbidity, having BMI < 21.3, poor dental health, no social participation, and having no one to consult regarding personal problems, while that of having depression was significant for having comorbidity, having BMI < 21.3, poor vision, and having no one to consult regarding personal problems. The reported prevalence of anxiety and depression indicate the demand for mental healthcare services among Myanmar elderly. Myanmar needs to improve its elderly care, mental healthcare, and social security system to reflect the actual needs of its increasing elderly population. Screening for anxiety and depression among elderly with comorbidities should be promoted. Raising community awareness of mental health, encouraging social participation, and supportive counselling are also essential in combating anxiety and depression among Myanmar elderly.

Factors associated with neonatal mortality in a tertiary hospital in Phnom Penh, Cambodia.

This study aimed to identify hospital neonatal mortality rate (NMR) and the causes of neonatal deaths, and to understand risk factors associated with neonatal mortality in a national tertiary hospital in Cambodia. The study included all newborn infants, aged 0-28 days old, hospitalized in the Pediatrics department of Khmer-Soviet Friendship Hospital between January 2016 and December 2017. In total, 925 infants were included in the study. The mean gestational age was 35.9 weeks (range, 24-42 weeks). Preterm infants and low birth weight accounted for 47.5% and 56.7%, respectively. With respect to payment methods, the government (53.5%) and non-governmental organizations (NGO) (13.7%) paid the fees as the families were not in a financial position to do so. The hospital NMR at the Pediatrics department was 9.3%. Respiratory distress syndrome (37.2%) was the main cause of deaths followed by hypoxic-ischemic encephalopathy (31.4%) and neonatal infection (21.0%). Factors associated with neonatal mortality were Apgar score at 5th minute <7 (adjusted odds ratio (AOR) = 3.57), payment by the government or NGO (AOR = 11.32), admission due to respiratory distress (AOR = 11.94), and hypothermia on admission (AOR = 9.41). The hospital NMR in the Pediatrics department was 9.3% (95% confidence interval 7.50-11.35) at Khmer-Soviet Friendship Hospital; prematurity and respiratory distress syndrome were the major causes of neonatal mortality. Introducing continuous positive airway pressure machine for respiratory distress syndrome and creating neonatal resuscitation guidelines and preventing hypothermia in delivery rooms are required to reduce the high NMR.

Rate of achievement of therapeutic outcomes and factors associated with control of non-communicable diseases in rural east Malaysia: implications for policy and practice.

Non-communicable diseases (NCDs) are an increasing problem worldwide, including in Malaysia. National surveys have been performed by the government but had poor coverage in east Malaysia, particularly in rural regions. This study aimed to describe the achievement of target therapeutic outcomes in the control of diabetes mellitus (DM), hypertension (HPT), and dyslipidemia (DLP) among diabetic patients in rural east Malaysia. A cross-sectional study was conducted among DM patients who visited the NCDs clinic in Lundu Hospital, Sarawak, Malaysia, from Jan to March 2016. In total, 214 patients (male, 37.9%; female, 62.1%) were recruited using a systemic sampling method. Multiple logistic regression models were applied to estimate the adjusted odds ratio (AOR) and confidence interval (CI) for the target therapeutic achievement in the control of DM, HPT, and DLP. Compared to the national average, therapeutic target achievement in Lundu was higher for DM (43.0% vs. 23.8%), equal for DLP (35.8% vs. 37.8%) but lower for HPT (30.9% vs. 47.9%). DM patients who had at least yearly HbA1c monitoring (AOR 2.30, 95% CI 1.04-5.06, P = 0.039), and those 58.7 years or older (AOR 2.50, 95% CI 1.32-4.74, P = 0.005) were more likely to achieve the therapeutic target for DM. Health promotion and public education regarding HPT needs to be emphasized in rural Malaysia. HbA1c monitoring at least once a year was one of the important factors associated with achieving DM control in rural east Malaysia. Accessibility to HbA1c tests and monitoring should be ensured for diabetic patients.

Trends and risk factors for infant mortality in the Lao People's Democratic Republic.

A high infant mortality rate (IMR) indicates a failure to meet people's healthcare needs. The IMR in Lao People's Democratic Republic has been decreasing but still remains high. This study aimed to identify the factors involved in the high IMR by analyzing data from 53,727 live births and 2189 women from the 2017 Lao Social Indicator Survey. The estimated IMR decreased from 191 per 1000 live births in 1978-1987 to 39 in 2017. The difference between the IMR and the neonatal mortality rate had declined since 1978 but did not change after 2009. Factors associated with the high IMR in all three models (forced-entry, forward-selection, and backward-selection) of multivariate logistic regression analyses were auxiliary nurses as birth attendants compared to doctors, male infants, and small birth size compared to average in all 2189 women; and 1-3 antenatal care visits compared to four visits, auxiliary nurses as birth attendants compared to doctors, male infants, postnatal baby checks, and being pregnant at the interview in 1950 women whose infants' birth size was average or large. Maternal and child healthcare and family planning should be strengthened including upgrading auxiliary nurses to mid-level nurses and improving antenatal care quality.

Factors associated with postpartum depression among women in Vientiane Capital, Lao People's Democratic Republic: A cross-sectional study.

Postpartum depression is a worldwide public health concern. The prevalence of postpartum depression is reported to be greater in developing countries than in developed countries. However, to the best of our knowledge, no papers on postpartum depression in the Lao People's Democratic Republic have been published. In order to strengthen maternal and child health, the current situation of postpartum depression should be understood. This study aims to determine the prevalence of postpartum depression and identify factors associated with postpartum depression in Vientiane Capital, Lao People's Democratic Republic. Study participants were 428 women 6-8 weeks postpartum who visited four central hospitals in Vientiane Capital for postnatal care from July to August 2019. Structured questionnaires were used to collect socio-demographic, obstetrical and infant, and psychiatric data about the women and their partners. The Edinburgh Postnatal Depression Scale (EPDS) was used to identify suspected cases of postpartum depression with the cut-off score of 9/10. Multivariable logistic regression was used to examine independent factors that were associated with suspected postpartum depression (EPDS ≥10). The mean age of the 428 women was 28.1 years, and the prevalence of suspected postpartum depression was 31.8%. Multivariable logistic regression using variables that were statistically significant on bivariate analyses indicated that three variables were associated with suspected postpartum depression: unintended pregnancy (AOR = 1.66, 95% CI 1.00-2.73, P = 0.049), low birth satisfaction (AOR = 1.85, 95% CI 1.00-3.43, P = 0.049), and depression during pregnancy (AOR = 3.99, 95% CI 2.35-6.77, P <0.001). In this study, unintended pregnancy, low birth satisfaction, and depression during pregnancy were independent risk factors for postpartum depression. These results suggest that the mental health of pregnant women should be monitored, and that health care services, especially family planning and supportive birth care, should be strengthened to prevent postpartum depression.

Estimation of the unvaccinated among those aged less than 25 years according to aimag and its association with incidence of measles outbreak 2015-2016 in Mongolia.

Mongolia had an epidemic of measles in 2015-2016, even though more than 90% of the population have been vaccinated since 1997. This study aimed to examine the associations between unvaccinated proportion and measles incidence according to aimag. Mongolia has 21 provinces (aimag) with Ulaanbaatar as the capital city. Vaccination coverage between 1991 and 2014 and measles incidence according to aimag were obtained from the National Center for Communicable Diseases of Mongolia database. Accumulated unvaccinated proportion (AUP) among those aged 1 to 24 years in 2015 was estimated from the unvaccinated at the 1st dose of 1991 to 2014. From 1991 to 2014, unvaccinated proportion among those aged 1 to 24 years in the whole country has been reducing from 28.0% in 1991 to 1.8% in 2014. The AUP in 2015 varied from 2.7% (Selenge) to 21.8% (Govisumber). The incidence was remarkably higher in only two aimags with a large density of the unvaccinated aged 1 to 24 years (Ulaanbaatar and Darkhan-Uul) than in the other aimags. The incidence had no significant correlation with the AUP, although the correlation between the incidence and the density of unvaccinated aged 1 to 24 years was significant when the two aimags were included. In conclusion, the AUP between 2.7% and 21.8% had no correlation with the incidence according to aimags in Mongolia measles epidemic 2015-2016.

Determinants of diarrhea in children under the age of five in Afghanistan: a secondary analysis of the Afghanistan Demographic and Health Survey 2015.

Diarrhea is the second leading cause of under-five mortality and globally accounts for 526,000 child deaths every year. Afghanistan, with 33,000 child deaths in 2012, was ranked 8th among nations, with the highest under-five deaths being from pneumonia and diarrhea. This study aimed to identify the determinants of diarrhea in children under the age of five in Afghanistan. A secondary data analysis of the Afghanistan Demographic and Health Survey (AfDHS) 2015 was focused on diarrhea in children under the age of five. The dataset of the AfDHS 2015 was used for the analysis. The subjects for this study were 30,238 under-five children. A logistic regression model was applied to examine the determinants of childhood diarrhea. This study found that 7,921 (26.2%) out of 30,238 under-five children had diarrhea within the two weeks preceding the survey. Higher maternal education accompanied a lower risk of childhood diarrhea with an adjusted odds ratio (AOR) of 0.70 (P<0.01) than did no education. Flush toilets (AOR=0.84, P<0.01) and traditional dry vaults (AOR=0.83, P<0.001) were less likely associated with diarrhea compared with pit latrines. Tube wells, public taps, and unprotected wells and springs were sources of drinking water with a higher risk of diarrhea than piped water. This study identified that the type of toilet facility, source of drinking water, age of the child, and maternal education were important determinants of under-five diarrhea. Intervention programs concerning improved sanitation facilities, sources of drinking water, and raising women's level of education and health awareness are important.

Assessment of quality of life among elderly in urban and peri-urban areas, Yangon Region, Myanmar.

BACKGROUND: In the context of an aging population, quality of life (QOL) is an important consideration for the well-being of the elderly. However, there is limited information on the QOL of the elderly in Myanmar. This study aimed to explore the risk factors for low QOL among the elderly in urban and peri-urban areas of the Yangon Region, Myanmar. METHODS: A community-based, cross-sectional study was conducted among the elderly aged 60 years or older in two urban and two peri-urban townships in the Yangon Region from July to September 2019. A multi-stage sampling method was used to recruit study participants using a pre-tested questionnaire. A total of 616 (305 males and 311 females) elderly people were interviewed using a face-to-face interview technique. Multiple linear regression analysis was performed on the four domains (physical health, psychological health, social relationship, and environment) of QOL measured with the WHOQOL-BREF. RESULTS: Income level and having intimate friends influenced the QOL scores of the elderly in all domains, while education level and marital status influenced psychological health, social relationship, and environment domains. Social interaction with neighbors increased the QOL scores for physical health, social relationship, and environment domains. Living in peri-urban areas was associated with lower QOL scores for physical health, psychological health, and environment, while participation in group activities increased QOL scores in these domains. Having comorbidities affected the QOL for psychological health and environment domains, while the frequency of going out affected physical health, and the frequency of religious performance affected social relationship. CONCLUSION: Residential location, education level, marital status, income, comorbidities, social interactions with neighbors and friends, participation in group activities, and frequencies of going out and religious activities should be considered in planning and implementing programs for the elderly in Myanmar. Peri-urban development, strengthening healthcare and social security systems, and encouraging social interaction and participation in group activities play critical roles in improving the QOL for elderly residing in Myanmar.

Assessment of nutritional status and risk factors for malnutrition among the elderly in Loikaw, Myanmar.

OBJECTIVES: Malnutrition among the elderly is an important health concern in Myanmar. The country is challenged by both an aging population and poor nutritional status. The aim of this study was to estimate the prevalence of malnutrition and elucidate its associated factors among the elderly in Loikaw, Myanmar. METHODS: A cross-sectional study was conducted from July to August 2019. Using a multistage sampling method, 747 elderly individuals (313 men and 434 women) were recruited. The nutritional status of these participants was assessed using the Mini-Nutritional Assessment tool, with a face-to-face interview method. Body mass index, mid-upper arm and calf circumference, blood pressure, and random blood sugar levels were also assessed. Multinomial logistic regression analysis was performed. RESULTS: The prevalence of malnutrition and at risk for malnutrition were 21.7% and 59.4%, respectively. In the multivariate model, dental problem (adjusted odds ratio [aOR], 2.18; 95% confidence interval [CI], 1.24-3.83), low level of education (aOR, 3.13; 95% CI, 1.44-6.81), aged ≥70 y (aOR, 3.55; 95% CI, 1.83-6.88), current betel chewing (aOR, 2.82; 95% CI, 1.64-4.87), and having heart disease (aOR, 8.04; 95% CI, 2.29-18.13) were positively associated with malnutrition. CONCLUSION: One in five elderly study participants were malnourished and 50% were at risk for malnutrition. Malnutrition was associated with being ≥70 y of age, having a low educational level, chewing betel, having a history of heart disease, and having dental problems. These findings may alert policymakers to develop and implement effective interventions for improving nutritional status of the elderly population.

Geographic distribution and utilisation of CT and MRI services at public hospitals in Myanmar.

BACKGROUND: Diagnosis by computed tomography (CT) and magnetic resonance imaging (MRI) is important for patient care. However, the geographic distribution and utilisation of these machines in countries with limited resources, such as Myanmar, have not been sufficiently studied. Therefore, this study aims to identify the geographic distribution and utilisation of CT and MRI services at public hospitals in Myanmar. METHODS: This nationwide, cross-sectional study was conducted at 43 public hospitals in Myanmar. Data were collected retrospectively using a prepared form from 1st January 2015 to 31st December 2017 at public hospitals in Myanmar. A descriptive analysis was performed to calculate the number of CT and MRI units per million population in each state and region of Myanmar. The distribution of CT and MRI units was assessed using the Lorenz curve and Gini coefficient, which are indicators of inequality in distribution. RESULTS: In total, 45 CT and 14 MRI units had been installed in public hospitals in Myanmar by 2017. In total, 205,570 CT examinations and 18,981 MRI examinations have been performed within the study period. CT units per million population in 2017 varied from 0.30 in Rakhine State to 3.22 in Kayah State. However, MRI units were available only in public hospitals in five states/regions. The Gini coefficient for CT and MRI was 0.35 and 0.69, respectively. An upward trend in the utilisation rate of CT and MRI was also observed during the study period, especially among patients aged between 36 and 65 years. CONCLUSIONS: Throughout Myanmar, CT units were more equally distributed than MRI units. CT and MRI units were mostly concentrated in the Yangon and Mandalay Regions, where the population density is higher. The geographic distribution and utilisation rate of CT and MRI units varied among states, regions, and patients' age group. However, the utilisation rates of CT and MRI increased annually in all states and regions during the review period. The Ministry of Health and Sports in Myanmar should consider the utilisation and population coverage of CT and MRI as an important factor when there will be procurement of those medical equipment in the future.