Asia-Pacific Journal of Public Health recent issues

Diversity in Public Health Issues

Low, W. Y. — Fri, 25 Sep 2009 01:30:00 PDT

Review Paper: Gender Competencies in the Medical Curriculum: Addressing Gender Bias in Medicine

Wong, Y.-L. — Fri, 25 Sep 2009 01:30:00 PDT

Gender inequalities in health and gender bias in medicine are interrelated challenges facing health care providers and educators. Women and girls are disadvantaged in accessing health care because of their low social status and unequal treatment in medical care. Gender bias has long been inherent in clinical practice, medical research, and education. This can be traced to the medical curriculum that shapes the perceptions, attitudes, and behavior of the future doctor. The author advocates medical curricula change to address gender inequalities in health and gender bias in medicine. She analyses the reasons for integration of gender competencies in the medical curriculum, discusses what gender competencies are, and reviews ways to in-build gender competencies and their assessment. Efforts to change and gender sensitize medical curricula in developed and developing countries are also reviewed. The review hopes to contribute to strategic medical curriculum reform, which would lead to gender-sensitive health services and equity in health.

Politicians in Apron: Case Study of Rebel Health Services in Nepal

Devkota, B., van Teijlingen, E. R. — Fri, 25 Sep 2009 01:30:00 PDT

This article presents the findings of a systematic review on the health consequences of Nepal’s armed conflict waged by the Maoists and the development and trajectory of their health workers. Nepal’s decade-long violent conflict resulted in more than 13 000 deaths, the destruction of more than 1000 health posts and poor health services delivery. At present, most of the former rebel health workers live in remote/rural areas and some are running health centers. The review found that the Maoists had trained more than 2000 health workers, who can be categorized into 4 levels. However, there is little evidence on their competencies and career motivation. The Maoists demand restructuring of the Nepalese health sector and the integration of their health workforce into the national health system. However, there has been no national discussion in Nepal of what kind of health reform and integration model is appropriate for a sustainable peace and improved service delivery.

Prevalence of Diabetes Mellitus, Glycemic Control, and Associated Factors in a Malay Population in Singapore

Fri, 25 Sep 2009 01:30:00 PDT

There is substantial heterogeneity regarding diabetes mellitus prevalence and glycemic control in Asian populations. The authors examined a population-based sample of 3000 adults (52% women) of Malay ethnicity (40-80 years) in Singapore. The age-standardized prevalence of diabetes mellitus was 18.4% (95% confidence interval = 17.0% to 19.8%). Being overweight, presence of hypertension, presence of cardiovascular disease, and family history of diabetes were found to be positively associated with diabetes mellitus. Higher education, employment status, and current smoking were found to be inversely associated with diabetes mellitus. Among those treated for diabetes, 29% achieved the optimal glycemic goal (glycosylated hemoglobin <7%). Lower levels of low-density lipoprotein cholesterol, total cholesterol, and systolic and diastolic blood pressure were associated with good glycemic control. Nearly 1 in 5 middle-aged Malay adults living in a developed Asian society had diabetes mellitus and a substantial proportion had suboptimal glycemic control.

Health Promotion Financing With Mongolia's Social Health Insurance

Bayarsaikhan, D., Nakamura, K. — Fri, 25 Sep 2009 01:30:00 PDT

Health promotion is receiving more attention in Mongolia. A survey is undertaken to examine health promotion in terms of health-related information, education, counseling, screening, and preventive and medical checkups. Almost all (97.5%) the participants feel that access to reliable and systematically organized health-related information is important. About 60% of the participants said that the amount of currently available information is inadequate. There are several factors that limit the implementation of public health programs. These include inadequate focus on promoting health at the individual level, lack of funds, and limited incentives to promote health. This article examines social health insurance as an option to address these issues. Three hypothetical benefits package options expanded to health promotion were developed and simulated by a computerized tool. The simulations show that all 3 options are financially sustainable at the existing level of contribution if Mongolia will gain near universal health insurance coverage and improve revenue collection practices.

Cardiovascular Disease Risk in a Semirural Community in Malaysia

Chia Yook Chin, , Pengal, S. — Fri, 25 Sep 2009 01:30:01 PDT

Background and aim. It has been argued that cardiovascular disease (CVD) is not very prevalent in developing countries, particularly in a rural community. This study examined the prevalence of CVD risk of a semirural community in Malaysia through an epidemiological survey. Methods. Subjects were invited to a free health screening service carried out over a period of 6 weeks. Then, a follow-up study of the initial nonresponders was done in the villages that showed a poorer response. The survey was conducted using a standardized questionnaire. Hypertension was defined as blood pressure ≥140/90 mm Hg. The Framingham Coronary Disease Risk Prediction Score (FRS) was used as a measure of CVD risk. Results. A total of 1417 subjects participated in this survey. The response rate was 56%. A follow-up survey of the nonresponders did not show any differences from the initial responders in any systematic way. The prevalence of CVD risk factors was high in both men and women. The mean (±SD) FRS was 9.4 (±2.5) and 11.3 (±4.1) for men and women, respectively. The mean predicted coronary heart disease (CHD) risk was high at 20% to 25% for men and medium at 11% to 13% for women. Overall, 55.8% of the men had >20% risk of having a CHD event in the next 10 years whereas women’s risk was lower, with 15.1% having a risk of ≥20%. Conclusion. The prevalence of CVD risk even in a semirural community of a developing country is high. Every effort should be made to lower these risk factors.

Correlates of College Students' Physical Activity: Cross-Cultural Differences

Seo, D.-C., Torabi, M. R., Jiang, N., Fernandez-Rojas, X., Park, B.-H. — Fri, 25 Sep 2009 01:30:01 PDT

This study examined cross-cultural differences in personal and behavioral determinants of vigorous-intensity and moderate-intensity physical activity (PA) among college students living in distinctly different cultures, that is, the United States, Costa Rica, India, and South Korea. Participants of this study were recruited from randomly chosen public universities in the 4 countries during the 2006-2007 academic year. A total of 4685 students participated in the study (response rate 90%). Vigorous-intensity PA was measured by asking on how many of the past 7 days the participants participated in PA for at least 20 minutes that made them sweat or breathe hard. For moderate-intensity PA, participants were asked on how many of the past 7 days they participated in PA for at least 30 minutes that did not make them sweat or breathe hard. Findings indicate that whereas perceived overweight and fruit and vegetable consumption are relatively culture-free predictors of PA, gender and TV/video watching are culture-specific predictors. Binge drinking was not predictive of meeting the vigorous-intensity and moderate-intensity PA guidelines in any of the 4 countries.

Alcohol Expectancies Among High School Students in Inner Mongolia, China

Shell, D. F., Newman, I. M., Qu, M. — Fri, 25 Sep 2009 01:30:01 PDT

Objective. This study examines differences in Chinese high school students’ alcohol expectancies by drinking status (nondrinker, occasional drinker, regular drinker) and gender (male, female). Method. The authors administered the Chinese Adolescent Alcohol Expectancy Questionnaire (CAEQ) to a convenience sample of 1244 high school students (M = 627; F = 617) from schools in Huhhot City and Tongliao City in Inner Mongolia, China. Results. Differences were found in the 8 CAEQ factors (3 negative and 5 positive factors). Regular drinkers had lower negative consequences and higher positive perception expectancies than nondrinkers or occasional drinkers. Nondrinkers had higher harm to person/reputation expectancies than occasional or regular drinkers. Occasional drinkers had higher beneficial/moderation and lower harm to person/ reputation expectancies than nondrinkers. Boys had higher positive perception expectancies than girls. Conclusions . Expectancies are associated with Chinese adolescents’ drinking. Identifying the characteristics of alcohol consuming youth can inform the development of prevention interventions and alcohol policies.

Factors Contributing to Utilization of Health Care Services in Malaysia: A Population-Based Study

Fri, 25 Sep 2009 01:30:01 PDT

Objective. This paper examines the factors contributing to the under utilisation of health care services in the Malaysian population. Methodology. Using data derived from Malaysian Mental Health Survey (MMHS) information on utilisation of four basic health services in the previous three months, namely contact with health care professionals, ward admissions, having diagnostic or laboratory tests done and being on any medications were obtained. Results. A total of 2202 out of 3666 or 60% of the MMHS participants were included in this study. Thirty percent of the subjects (n = 664) had contacts with health care professionals. Those with health complications, disabilities and those aged 50 years and above utilised health services more significantly as compared to those who lacked health facilities near their homes, had little family support during illnesses and were from the Chinese ethnic group. Conclusion. Factors leading to the under utilisation of health care services need to be further studied and needs in certain groups in the population should be addressed. Healthcare providers must be prepared to fulfil these needs.

Sexual Behavior Model Among Young Thai Women Living in Slums in Bangkok, Thailand

Powwattana, A. — , 01 Oct 1664 00:00:00 PST

There has been a dramatic drop in age at first intercourse and concurrent rise in HIV infections among young Thai women living in slums. The participants included 492 young Thai women (average age = 19.7 years). They provided detailed self-perception, emotion, sexual self-efficacy, cognitive strategies, and power in relationships. Logistic regression analysis was used to explore sexual behavior model. Findings highlight the extreme vulnerability of Thai female adolescents who engage in risky sexual behaviors: 55.8% were sexually active with 41.8% having vaginal sex without using condom. Significant enabling factors included perceived ability to precautions (odds ratio [OR] = 1.7), relational gain thinking (OR = 1.5), and curious gain thinking (OR = 1.3). The significant protective factors were decision-making dominance (OR = 0.3), perceived ability to say no (OR = 0.7), and ethical-related punishment avoidance thinking (OR = 0.8). These findings contribute to greater understanding of factors involved in sexual risk taking. Implications for behavioral modification addressing cognition and power in relationships are discussed.

A Phase II Randomized Controlled Trial to Evaluate the Safety and Efficacy of Praneem Polyherbal Vaginal Tablets Compared With Betadine Vaginal Pessary in Women With Symptoms of Abnormal Vaginal Discharge

Salhan, S., Tripathi, V., Sehgal, R., Kumar, G., Talwar, G. P., Chatterjee, A. — Fri, 25 Sep 2009 01:30:01 PDT

Abnormal vaginal discharge (AVD) caused by a variety of reproductive tract infections is a widespread syndrome among women in India and in other developing countries. The purpose of this study was to determine whether a polyherbal formulation, Praneem, can be used for the regression of the syndrome. A phase II randomized controlled study was carried out with Praneem polyherbal tablets and Betadine vaginal pessary in 99 women with AVD. The authors found that 92% of women using Praneem were relieved of their symptoms of AVD as against 81.6% women using Betadine. Significant reduction was also seen with both treatments in lower abdominal pain, vaginal itching, and dysuria. Thus, the study indicates the efficacy of Praneem for the treatment of AVD and provides a rationale for planning a further Phase III study on a larger sample size for definitive conclusions.

Public Health and Health Services Development in Postconflict Communities: A Case Study of a Safe Motherhood Project in East Timor

Marlowe, P., Mahmood, M. A. — Fri, 25 Sep 2009 01:30:01 PDT

Armed conflict causes suffering in many countries; it contributes to poor health and hinders health services development. The effects of conflict are evidenced by weakened community structures and can make reconstruction efforts challenging. East Timor has a history of prolonged conflict and saw a resurgence of internal violence in 2006. This participant observation study discusses considerations for implementing public health and health systems development projects in postconflict settings using a case study of a maternal and child health project. It illustrates the importance of appreciating the historical context and community dynamics when implementing development projects. The sequelae of conflict are often characterized by reduced human resource development capacity, distrust of hierarchy, and limited capacity for resource mobilization. Working in such postconflict communities requires flexibility in program design, stronger efforts for community capacity building, and rebuilding trust between various stakeholders.

Key Quality Aspect: A Fundamental Step for Quality Improvement in a Resource-Poor Setting

Su, T. T., Sax, S. — Fri, 25 Sep 2009 01:30:01 PDT

The objective of the study is to identify user’s perception of key quality aspects of the hospital and its influence on willingness to pay. The study was conducted in 2001 in Dhading District Hospital, Nepal. This was a descriptive, cross-sectional study design using quantitative and qualitative methods: questionnaire exit interview and focus group discussions with inpatients and outpatients, focus group discussion with service providers, and key informant interviews. The research identified attitude, technical and interpersonal skills of health personnel, availability of drugs and services as important quality aspects to be improved. Users were motivated to use this hospital and were ready to pay if they received proper treatment from skilled and communicative staff. This study highlights the importance of identifying the quality factors important to service users as a first step in improving quality. For the users within this study, this meant improving attitude, interpersonal skills, and technical skills of service personnel.

The Association Between Socioeconomic Status and Overweight/Obesity in a Malay Population in Singapore

Sabanayagam, C., Shankar, A., Saw, S. M., Tai, E. S., Wong, T. Y. — Fri, 25 Sep 2009 01:30:01 PDT

In developed countries in the West, lower socioeconomic status (SES) is associated with a higher prevalence of overweight/obesity. The authors examined the association between SES defined by education and income and overweight/obesity in a population-based cohort of 2807 individuals of Malay ethnicity (age 40-80 years, 51% women) in Singapore. The prevalence of overweight/ obesity (body mass index ≥25 kg/m²) in men and women was 50.4% and 65.1%, respectively. In women, the prevalence of overweight/obesity increased with lower levels of education and income. Compared with the higher categories of SES, the odds ratio (95% confidence interval) of overweight/obesity in women was 1.42 (1.06-1.89) for education and 2.08 (1.33-3.26) for income. In contrast, in men, the prevalence of overweight/obesity decreased with lower levels of education and income (P interaction by gender <.05 for all SES variables). Lower SES was positively associated with overweight/obesity in Malay women, and the association was in the opposite direction in Malay men.

Migration and Hypertension: A Cross-Sectional Study Among Neo-Migrants and Settled-Migrants in Delhi, India

Kusuma, Y., Gupta, S., Pandav, C. — Fri, 25 Sep 2009 01:30:01 PDT

Understanding the blood pressure (BP) distribution within populations is fundamental to an understanding of the etiology of cardiovascular diseases and to develop effective preventive strategies. This study focuses on whether the BP levels and hypertension prevalence differ between neo-migrants and settled-migrants in the city of Delhi. Data on BP, anthropometry, social variables, and demographic variables were collected from a cross-sectional sample of 226 settled-migrants and 227 neo-migrants. Men possessed significantly higher BP levels than women. Settled-migrants possessed higher BP levels, except diastolic BP in males. The prevalence of hypertension ranges from 15% (neo-migrant women) to 25% (settled-migrant men), with no significant gender differences. Group differences were significant for men. Hypertension was more prevalent in older settled-migrants and younger neo-migrants. Recent migration was found to be a significant contributor to hypertension prevalence. Age contributed significantly to BP variation in both groups except in neo-migrant men. Pulse rate also contributed to systolic BP among neo-migrant women and settled-migrant men. Thus, urban residence and migration to urban areas can be a leading cause of increased prevalence of hypertension. Neo-migrants were subjected to more lifestyle insults and the stress generated during the adjustment process may be contributing to rise of BP even at younger ages.

A Survey of Occupational Exposure to Blood and Body Fluids in Physiotherapists in Western Australia

von Guttenberg, Y., Spickett, J. — Fri, 25 Sep 2009 01:30:01 PDT

The aim of this pilot project was to investigate the occurrence of occupational exposure to blood and body fluids in registered physiotherapists in Western Australia. Surveys were sent to physiotherapists with questions regarding personal background, exposure characteristics, and contributing factors included. Descriptive statistical methods were used to identify the area of practice posing the highest risk of exposure to physiotherapists. The authors found that 56.1% of surveyed physiotherapists recorded one or more exposures within the past 5 years. Work in hospitals was found to carry the highest rate of exposure for the physiotherapy profession. Other areas of practice, including community work, private practice, nursing homes/hostels, and work at sporting events carry comparable but lower risks of exposure. In private practice, 50% of exposures were associated with acupuncture. In nursing homes, 60% of exposures were brought on by exposure to contaminated materials, whereas in the community setting most exposures (64%) were attributed to unpredictable/uncontrollable situations. At sporting events, 90% of all exposures were associated with already existing sources of blood and body fluids (wounds). Within the hospital setting, the 3 dominant immediate causes reported were unpredictable situations (33.3%), existing sources (28.4%), and procedural causes (22.2%). The use of personal protective equipment for prevention of exposure is investigated and discussed. Data collected for this survey were not enough to draw conclusive assumptions regarding hazard management. A repeat of this study on a larger scale may provide physiotherapists with the tools and knowledge to minimize the likelihood of exposure and harm arising from exposure.

Book Review: Teng CL, Khoo EM, Ng CJ, eds. Family Medicine, Healthcare & Society: Essays by Dr MK Rajakumar. Kuala Lumpur, Malaysia: Academy of Family Physicians of Malaysia; 2008

Wong, W. C. W. — Fri, 25 Sep 2009 01:30:01 PDT

Occupational Cancer: An Emerging Problem in Newly Industrializing Countries

Sim, M. R., Boffetta, P. — Mon, 22 Jun 2009 02:22:33 PDT

Review Paper: Epidemiology, Evidence-Based Medicine, and Public Health

Tang, J.-L., Griffiths, S. — Mon, 22 Jun 2009 02:22:33 PDT

This article reviews the relation between evidence-based medicine and epidemiology and the recent evolution of the former. The meaning of evidence and the international efforts to collect, summarize, and disseminate findings from scientific research that are relevant for medical decision making are discussed. Evidence, current resources, and people's values, all play a role in making evidence-based medical decisions. This also has important implications for public health practice. However, decision making differs considerably between clinical care of individual patients and public health decision and policies that normally apply to populations. Although more closely related to epidemiology than clinical medicine, public health should also adopt a more systematic approach to evidence-based practice.

Prevalence of Work-Related Upper Limbs Symptoms (WRULS) Among Office Workers

Zairina Abdul Rahman, , Abdul Sallam Atiya, — Mon, 22 Jun 2009 02:22:33 PDT

An analytical cross-sectional study was carried out to determine the prevalence of work-related upper limbs symptoms (WRULS) among office workers and factors associated with it. A self-administered questionnaire was used to collect the information. A total of 463 (87.7%) office workers from selected government agencies participated in this study. The mean age of the respondents was 34.1 years (range = 18-55 years). Majority (91.6%) were Malay and female (72.8%), and 58.1% were from clerical group. Mean duration of work was 8.7 years. This study found that prevalence of WRULS was 33.0% (95% CI [confidence interval] = 28.8%, 37.3%). Computer users at work had 2.0 (95% CI = 1.1, 3.4) higher odds ratio of developing WRULS and those who used it for 5 hours and more per day had 7.5 (95% CI = 2.3, 24.2) higher odds ratio of developing WRULS. Hand-intensive hobbies and higher education were also found to be associated with WRULS.

Exposure to and Attitudes Regarding Secondhand Smoke Among Secondary Students in Taiwan

Mon, 22 Jun 2009 02:22:33 PDT

The 2003 School Health Act of Taiwan stipulated that school campuses of senior high and below should be smoke free, but data from the Global Youth Tobacco Survey show that the majority of students are exposed to smoke in public and at home. More than 50% of nonsmokers indicated that they had been exposed to secondhand smoke (SHS) in public places, with the exposure rate as high as 90% among smokers. More than 40% of junior and senior high school students were exposed to SHS at home. Support for banning smoking in public places ranged from almost 60% to almost 80%. More than 60% of current smokers and almost 90% of never smokers think that smoke from others is harmful to them. With a clear body of evidence detailing the harmful effects, reduction and eventual elimination of exposure to SHS should be the goal of the tobacco control community.

Strategies to Change Body Shape Among Men and Women Who Attend Fitness Centers

McCabe, M. P., James, T. — Mon, 22 Jun 2009 02:22:33 PDT

The current study examined the association between exercise behaviors, disordered eating, and other behaviors to change body shape among fitness center attendees. The participants were 520 adults (245 men, 275 women) who attended fitness centers. Data were gathered using an anonymous questionnaire. Women who attended fitness centers were generally trying to lose weight and improve fitness; men were generally trying to increase their muscles and improve their fitness level. Reasons for exercise predicted the nature of the body change strategies adopted by respondents. Regression analyses demonstrated that exercises performed by people who attend fitness centers are a reflection of whether or not they want to lose weight, increase muscle or improve fitness. All groups were equally likely to engage in health risk behaviors, but the specific nature of these behaviors varied by group. The implications of these findings for health-related messages among people who attend fitness centers are discussed.

Effects of Oral Health Care on Salivary Flow Rate in Patients With Type 2 Diabetes: Preliminary Study

Mon, 22 Jun 2009 02:22:33 PDT

The purpose of this study is to evaluate the effects of the authors' oral health care program on the stimulated whole salivary flow rate and buffer capacity before and after a 6-month intervention. The authors conducted the intervention study among 25 participants with diabetes. The salivary flow rate and buffer capacity were evaluated before and after this intervention. Overall, the results showed a significant increase in salivary flow rate and no significant change in buffer capacity. Also, it was likely that salivary flow rate significantly increased among patients with more than 20 remaining teeth and patients with well-controlled diabetes. The findings suggest that this program for type 2 diabetes led to an increase in the stimulated whole salivary flow rate.

Prevalence of Primary Infertility in the Islamic Republic of Iran in 2004-2005

Vahidi, S., Ardalan, A., Mohammad, K. — Mon, 22 Jun 2009 02:22:33 PDT

This study aimed to determine the prevalence of lifetime and current primary infertility in Iran. The study was conducted in 2004-5 in all the 28 provinces of Iran. A cluster sampling method was used to select 10 783 women aged 19 to 49 years for the survey. Lifetime primary infertility was defined based on 1 of 2 contraception scenarios immediately after marriage to find experience of infertility despite 1 year of unprotected intercourse. The term "current primary infertility" designated a woman who, in addition to meeting the definition of lifetime infertility, had been unable to conceive up to the study time. A complex sampling design and SVY commands in the software package STATA 8.0 were used to derive 95% confidence intervals. A history of lifetime primary infertility was present in 24.9% of the subjects (95% CI: 23.5-26.2), and the prevalence of current primary infertility was 3.4% (95% CI: 3.0-3.8). As for age trends in lifetime primary infertility, the highest prevalence rates were observed in individuals with the lowest age at marriage. Minimum prevalence (17.2%) occurred with marriage age of 21 to 26 years, and the rates rose with higher age at marriage. About one fourth of the Iranian couples experience primary infertility at some point in their lives and 3.4% suffer from this problem at any time. For a correct interpretation of prevalence rates and the implications in terms of health care and service delivery, factors such as age at marriage and the couple's fertility potential must be taken into consideration.

Acute Malnutrition in Bangladeshi Children: Levels and Determinants

Rahman, A., Chowdhury, S., Hossain, D. — Mon, 22 Jun 2009 02:22:33 PDT

The main purpose of the study was to identify the levels and determinants of acute malnutrition or wasting in Bangladeshi children. A 2-stage stratified random sampling design was used to collect the Bangladesh Demographic and Health Survey data during November 1999 to March 2000, in which 5333 living children aged 0 to 59 months and their mothers were weighed and measured to obtain their anthropometric data. The prevalence of wasting was assessed by the z scores approach, using the anthropometric criterion of weight-for-height and following the WHO guidelines and cutoff points. Results reveal that the prevalence of severe and moderate wasting were more common among children, and the overall prevalence of acute malnutrition was about 10%, indicating that it is one of the major public health problems in the country. Multivariate analysis showed that mother's BMI and media exposure, child's age and birth size, and respiratory sickness in childhood were significantly associated with both severe and moderate wasting.

Vision-Related Quality of Life Among Elders With Cataract in Sri Lanka: Findings From a Study in Gampaha District

Nanayakkara, S. D. — Mon, 22 Jun 2009 02:22:33 PDT

The objective of this study was to establish the prevalence of cataract and measure vision related quality of life among elders in Sri Lanka. The 4-part study consisted of a survey to establish cataract prevalence, a case control study of risk factors, an assessment of the National Eye Institute Visual Functional Questionnaire (NEI-VFQ), and a comparison of quality of life among elders with and without cataract. Cataract prevalence was 56%. Significant risk factors were age, being female, occupational exposure, lower social class, presence of chronic illnesses, and smoking. The NEI-VFQ was validated for use in Sri Lanka and quality of life of elders with cataract was significantly lower on the NEI-VFQ and 2 other standard measures. The findings inform the development of public health strategies for treatment and prevention of cataract in Sri Lanka where the impact of cataract is increasingly being felt with rapid population aging and are applicable to other developing countries.

A Study of the Impact of Tuberculosis on the Quality of Life and the Effect After Treatment With DOTS

Mon, 22 Jun 2009 02:22:33 PDT

A prospective study was conducted on 90 patients of tuberculosis at 2 directly observed treatment short course (DOTS) cum microscopy centers in an urban area of Delhi. The WHOQOL-BREF (Hindi) questionnaire was used to assess the QOL at the onset of treatment, after 3 months of treatment under DOTS, and at completion of treatment. Patients with tuberculosis had significantly lower mean scores than controls for overall QOL. The most affected domains were physical and psychological. Women scored significantly better than men in the physical and environmental domains. Overall QOL scores were lowest for category II and significantly lower for the psychological and social domains. The mean scores after treatment were significantly lower than controls for overall QOL, the social and environmental domains. The DOTS regimen improves the QOL and its domains; however, they remain significantly affected compared to the healthy controls

A Qualitative Evaluation of the Information, Education, and Communication Component of the Tuberculosis Control Program in Delhi, India

Sharma, N., Nath, A., Davender Kumar Taneja, , Gopal Krishnan Ingle, — Mon, 22 Jun 2009 02:22:34 PDT

Tuberculosis control programs have recognized and addressed those system components in which knowledge and behavior of the patient and the general population are key issues because they have a profound influence on the treatment-seeking behavior and completion of course of treatment. As a part of the Revised National Tuberculosis Control Program, the ongoing information, education, and communication (IEC) efforts in Delhi were further intensified in the form of a multipronged media campaign. The objectives of this study are to evaluate (a) the impact of the campaign on awareness generation among the target audiences, (b) their opinion for making the campaign more effective and suited to their needs, and (c) perceptions of health personnel regarding the campaign. The study follows a descriptive cross-sectional design. The following qualitative methods were used: (a) focus group discussions of patients and the general population, (b) 3 key informant interviews of the health care personnel and a defaulter patient, and (c) in-depth interviews of 20 DOTS (directly observed treatment, short course) providers. The study observed that (a) different sociocultural segments of the population varied in terms of their observations of IEC messages, (b) stigma associated with tuberculosis is widely prevalent despite having a campaign, and ( c) television was voted as the most effective IEC medium. IEC strategies should be tailor-made and suited to the needs of a particular subpopulation.

Is It Really Medicine? The Traditional and Alternative Medicine Act and Informal Health Economy in the Philippines

Lee Mendoza, R. — Mon, 22 Jun 2009 02:22:34 PDT

This article examines one developing country's (Philippines) experience in legalizing the age-old but controversial practice and use of traditional, complementary, and alternative medicine (TCAM). The case studies in this article shed light on the problems, challenges, and opportunities offered by herbal therapies, natural products, and alternative healing methods, and the policy context in which they exist. The study finds that normative, axiological, and ethical considerations underlie the legitimacy of TCAM. These become critical when the scientific basis or validity of a therapy, product, or modality is at issue and political consensus is not readily available. The study suggests that both the objective and subjective aspects of TCAM be carefully evaluated in the process of integrating the informal and formal health care systems in developing countries. That, in turn, would require proactive regulatory and development-oriented roles on the part of their governments.

Book Review: Wong WCW, Lindsay M, Lee A, eds. Diagnosis and Management in Primary Care: A Problem-Based Approach. Hong Kong: Chinese University Press; 2008

Jackson, C. — Mon, 22 Jun 2009 02:22:34 PDT

Book Review: Jayakumar G, Retneswari M, eds. Occupational Health for Health Care Professionals: Caring for the Carers. 1st ed. Kuala Lumpur, Malaysia: Malaysian Medical Association; 2008

Smith, D. R. — Mon, 22 Jun 2009 02:22:34 PDT

Promoting Public Health Research and Collaboration in the Asia-Pacific Region

Wah Yun Low, — Wed, 18 Mar 2009 17:55:40 PDT

Collaboration and "Visibility" of Health Research in the Western Pacific Region

Paraje, G., Sadana, R., Salmela, R. — Wed, 18 Mar 2009 17:55:40 PDT

Using more than 3.5 million bibliographic references in Thomson ISI Web of Science (health-related articles, notes, and reviews) and a broad definition of health (covering related social, medical, environmental, and physical sciences) research production, collaboration patterns and "visibility" of that production for largest producers in the Western Pacific Region of the World Health Organization are estimated for the 1992-2001 period. Two findings are of particular interest in relation to the production of relevant knowledge on health topics and equity in the access to this knowledge. The first is that intraregional collaboration is low and that large regional producers of research (ie, Japan, Australia, China, etc) collaborate more with high-income countries from other regions than among themselves within the region, or with smaller regional research producers. The second one is that "visibility" of health research in the region is relatively low, even for high-income countries. High "visibility" research is mostly done with the involvement, through collaboration, of extra-region high-income countries. Collaboration between low-income or middle-income countries is mostly in low "visibility" research.

Women's Autonomy in Decision Making for Health Care in South Asia

Senarath, U., Nalika Sepali Gunawardena, — Wed, 18 Mar 2009 17:55:40 PDT

This article aims to discuss women's autonomy in decision making on health care, and its determinants in 3 South Asian countries, using nationally representative surveys. Women's participation either alone or jointly in household decisions on their own health care was considered as an indicator of women's autonomy in decision making. The results revealed that decisions of women's health care were made without their participation in the majority of Nepal (72.7%) and approximately half of Bangladesh (54.3%) and Indian (48.5%) households. In Sri Lanka, decision making for contraceptive use was a collective responsibility in the majority (79.7%). Women's participation in decision making significantly increased with age, education, and number of children. Women who were employed and earned cash had a stronger say in household decision making than women who did not work or worked not for cash. Rural and poor women were less likely to be involved in decision making than urban or rich women.

Factors Associated With Underweight and Stunting Among Children in Rural Terai of Eastern Nepal

Pramod Singh, G.C., Nair, M., Grubesic, R. B., Connell, F. A. — Wed, 18 Mar 2009 17:55:40 PDT

Malnutrition continues to affect a large proportion of children in the developing world. The authors undertook this study to identify biologic, socioeconomic, and health care factors associated with underweight and stunting in young children in an the eastern Tarai (plains) district of Nepal. Data were collected via questionnaires from mothers of 443 children aged 6 to 36 months in Sunsari district. Multistage cluster sampling was used to select villages and children. Anthropometric measurements were made on both children and their mothers. Logistic regression was used to measure the independent (adjusted) effect of risk and protective factors on the odds of underweight or stunting. More than half (53.3%) of the children were found to be underweight (<2 standard deviations weight for age below reference median) and more than one third (36.6%) had stunting (<2 standard deviations height for age below reference median). Low maternal body mass index, child's age, higher birth order, and lower standard of living score were strong predictors of underweight, whereas mother's education >5 years and participation in vitamin A and nutritional programs were protective. Infant age, low maternal body mass index, and low standard of living score were significant risk factors for stunting, whereas mother's education >5 years was strongly protective. These results suggest that underweight and stunting are the result of a nexus of biological, socioeconomic, and health care factors.

Prevalence of Obesity Among Adolescents (10 to 14 Years) in Kuwait

El-Bayoumy, I., Shady, I., Lotfy, H. — Wed, 18 Mar 2009 17:55:40 PDT

The purpose of this cross-sectional study was to find out the prevalence of obesity and overweight among intermediate school adolescents aged 10 to 14 years. The study comprised a multistage stratified random sample that included 5402 children (2657 males and 2745 females). They represent 12.7% of the total number of children between 10 and 14 years during the educational year 2005-2006. The weights and heights of adolescents were measured, from which the body mass index (BMI) was calculated, which is the weight in kilograms divided by the height in meters squared (kg/m²). BMI values higher than 95 percentile were accepted as being obese and those in between 85 and 94 percentile were accepted as overweight. Dietary intake was assessed by the investigators using food exchange lists designed by American Diabetic Association and physical fitness was measured by modified Harvard step test. Data regarding monthly income of the chosen sample were collected from parents of those children. The overall prevalence of overweight and obesity in adolescent Kuwaiti children aged 10 to 14 years was 30.7% and 14.6%, respectively. The overall prevalence of overweight and obesity among males was 29.3% and 14.9%, respectively (P < .001) and the prevalence of overweight and obesity among females was 32.1% and 14.2%, respectively (P < .001). High daily caloric intake by the obese and overweight children and physical inactivity was reported among the majority of them. Health education programs should be conducted to control this syndrome in order to prevent future risk of obesity-related disease, and physical activity programs should be incorporated in the schools. Any management plan for overweight and obese children should include 3 major components: diets, exercise, and family-based behavior and they should not be placed on restrictive diets because adequate calories are needed for proper growth.

A New Japanese Vegetarian Food Guide

Wed, 18 Mar 2009 17:55:40 PDT

Vegetarianism continues to gain popularity in Japan and the Westernized world, in part from decades of science supporting the health advantages of properly planned vegetarian-based diets. Although there are Asian nutritional tools, one specific to a Japanese vegetarian diet is lacking. Thus, the Japanese vegetarian food guide (JVFG) was developed and based in part on the American Dietetic Association position paper for vegetarian diets and the Japanese Food Guide Spinning Top. The JVFG was developed by collecting dietary information from 3 different institutes in Japan that specialize in regularly offering vegetarian meals. The JVFG was divided into 6 groups with respective recommended servings: vegetables (7.5), grains (4.5), protein foods (4), milk (3), fruits (2), and fats, sugar, and seasonings (<3). The JVFG was developed so that it would adequately provide for all nutrients and be structured for practical use by the general public as well as health professionals.

Alcohol Consumption by Older Adults in Central and Southern Japan

Hirayama, F., Lee, A. H., Binns, C. W., Okumura, C., Yamamoto, S. — Wed, 18 Mar 2009 17:55:40 PDT

This study ascertained the level of alcohol intake and alcoholic beverages consumed by Japanese older adults. Persons aged 55 to 75 years residing in central and southern Japan were recruited and interviewed face-to-face on their habitual alcohol consumption. Among the 577 (359 men and 218 women) participants from 10 districts/prefectures, 60.5% (75.5% for men and 35.7% for women) regularly drank alcoholic beverages on at least a monthly basis. Beer was the most preferred beverage (45.2%), followed by shochu (19.8%) and sake (16.1%). The mean alcohol consumption was 22.2 g/day (95% confidence interval 19.3-25.2) overall, but drinkers had a much higher mean intake of 36.6 g/day (95% CI 32.4-40.8). Moreover, it is alarming that 25.5% of male drinkers were heavy drinkers consuming more than 60 g of alcohol on average per day. Alcohol control measures should be developed to curtail the excessive drinking by older adults.

Effects of Dental Caries on Nutritional Status Among First-Grade Primary School Children

Ngoenwiwatkul, Y., Leela-adisorn, N. — Wed, 18 Mar 2009 17:55:40 PDT

The aim of this study was to explore association between caries prevalence and nutritional status among first-grade primary school children. A cross-sectional study of 212 students was conducted. All students were weighed and measured and then the body mass index (BMI) was calculated. Each student underwent dental examination and was interviewed. Overall, caries prevalence was 80.2% and the average decayed, missing, and filled surfaces (dmfs) were 12.4 ± 12.3. Although none of the students was in the underweight category, 45.8% were in low percentile (5th < BMI-for-age < 15th). Multiple logistic regression showed that each extra carious surface (dmfs) increased the odds of being at risk for underweight (5th < BMI-for-age < 15th) by 3.1% after adjusting for gender and dental visits. Our findings stressed that caries has significant implications on overall child health and health personnel should increase awareness of negative impacts and promote healthy nutritional choices for children.

Costing Dental Restorations in Public Sector Dental Clinics

Wed, 18 Mar 2009 17:55:40 PDT

The objective of this study is to share cost analysis methodology and to obtain cost estimates for posterior restorations in public sector dental clinics. Two urban and 2 rural dental clinics in Selangor state were selected. Only cases of 1 posterior restoration per visit by dental officers were included over 6 months. One capsulated amalgam type, 1 capsulated tooth-colored, and 1 non-capsulated tooth-colored material were selected. A clinical pathway form was formulated to collect data per patient. Annual capital and recurrent expenditures were collected per clinic. The mean cost of an amalgam restoration was RM 30.96 (sdRM 7.86); and tooth-colored restorations ranged from RM 33.00 (sdRM 8.43) to RM 41.10 (sdRM 10.61). Wherein 1 USD = RM 2.8. Restoration costs were 35% to 55% higher in clinics in rural areas than in urban areas. The findings demonstrate economy of scale for clinic operation and restoration costs with higher patient load. Costs per restoration were higher in rural than in urban dental clinics. More studies are recommended to address the dearth of dental costs data in Malaysia.

Profile of Hospital Charges for Chronic Conditions by Health Status and Severity Level: A Case Study of 4 Provinces in Thailand

Thanapop, S., Pannarunothai, S., Chongsuvivatwong, V. — Wed, 18 Mar 2009 17:55:40 PDT

The objective of this study is to identify charges for common chronic patients, by health status and severity of illness. Patients having 4 common chronic diseases—diabetics, hypertension, chronic lower respiratory diseases, and chronic renal failure—from 4 provinces were included (between 2002 and 2004). Patients were classified into clinically defined and health plan categories; charges were analyzed according to core health status and severity level of the chronic disease groups. Patients classified as single chronic condition (69.8%) had mean annual charges between 4089 and 7461 baht. Patients with multiple chronic conditions (30.2%) had mean annual charges varying, by health status and severity, from 611 to 16 794 baht, accounting for 40% of the total charges. Distribution of charges varied across health status groups. 1 USD = 35.1 baht The percentages of chronic health expenditures vary according to health status and severity of illness. This analysis can be used to identify patients for various purposes.

Predictors of Malaria Among Malaysian Aborigines

Kaur, G. — Wed, 18 Mar 2009 17:55:40 PDT

The Asia-Pacific region has at least 50% of its population at risk for malaria. In Malaysia, indigenous malaria is largely concentrated among the Orang Asli in Peninsular Malaysia. A cross-sectional study was conducted in an Orang Asli community in the district of Raub, Pahang, to determine the predictors of malaria. Age, seldom/never wearing protective clothing while in the jungle, going out at night, ever staying in another village, and living in bamboo-walled homes were found to be associated with malaria (crude odds ratio = 1.8-4.5; 95% confidence interval [CI] = 1.1-9.1) After adjusting for confounding, major predictors of malaria were age ≤12 years (adjusted odds ratio [aOR] = 4.3;95% CI = 2.2-8.4),), never/seldom wearing protective clothing while in the jungle (aOR = 3.8; 95% CI = 1.8-8.0), and going out at night (aOR = 2.5; 95% CI = 1.4-4.8). The findings lend support for intensifying behaviour modification in this population.

Reliability (Internal Consistency) of the Job Content Questionnaire on Job Stress Among Office Workers of a Multinational Company in Kuala Lumpur

Maizura, H., Masilamani, R., Aris, T. — Wed, 18 Mar 2009 17:55:40 PDT

This small, cross-sectional study assessed the reliability of 3 scales from the Job Content Questionnaire (JCQ)—decision latitude, psychological job demand, and social support—in a group of office workers in a multinational company in Kuala Lumpur. A universal sample of 30 white-collar workers from a department of the company self-administered the English version of the JCQ comprising 21 core items selected from the full recommended version of 49 items onsite. Reliability (internal consistency) was evaluated using Cronbach's coefficients for each scale. Corrected item—total correlation was presented for each and every item. Cronbach's coefficients were acceptable for decision latitude (.76) and social support (.79) but slightly lower for psychological job demand (.64). Values for all item—total correlations for all 3 scales were greater than .3. In conclusion, this study suggests that the JCQ is a reliable scale for assessing job stress in this group of workers.

Child Immunization Coverage in Rural Hard-to-Reach Haor Areas of Bangladesh: Possible Alternative Strategies

Wed, 17 Dec 2008 00:43:47 PST

This article assessed the status of childhood vaccination coverage and the possibility of using selected alternative vaccination strategies in rural hard-to-reach haor (low lying) areas of Bangladesh. Data were collected through survey, in-depth interviews, group discussion, and observations of vaccination sessions. Complete immunization coverage among 12- to 23-month-old children was found to be significantly lower in study areas when compared with the national coverage levels. The study identified reasons for low complete immunization coverage in hard-to-reach areas, including irregular/cancelled extended program on immunization (EPI) sessions, less time spent in EPI spots by field staff, and absence of any alternative strategy for remote areas. The findings indicated that the existing service delivery strategy is not sufficient to improve immunization coverage in hard-to-reach areas. However, most of the strategies assessed are considered possible to implement by health care providers in hard-to-reach areas. The study suggested that before implementing alternative strategies in hard-to-reach areas, feasibility and effectiveness of the possible strategies need to be tested to identify evidence-based strategies.

Assessment of Mental Health Status of Senior Secondary School Children in Delhi

Wed, 17 Dec 2008 00:43:47 PST

Background. Schoolchildren undergo rapid mental, emotional, and social changes and are susceptible to psychiatric disorders. Objectives. This study aimed to assess the mental health status and some determinants in senior secondary school children in Delhi. Methodology. A cross-sectional study was carried out on a sample of 458 children, selected by 2-stage sampling. Goldberg's General Health Questionnaire containing 60 items (GHQ-60) was used for assessment of mental health. Results. GHQ was administered to 239 boys and 219 girls in the age group of 15 to 20 years. Of 458 students, 113 (24.7%) had a score ≥16, the cutoff score, indicating mental morbidity among them. Among boys and girls, 28.5% and 20.5%, respectively, had some component of mental morbidity. Morbidity was significantly higher in children hailing from nuclear families and among children who had either failed or those who had scored highest in the class. Conclusion. Mental health needs of schoolchildren need to be addressed by the school health services.

Sentinel Surveillance of Soil-Transmitted Helminthiasis in Selected Local Government Units in the Philippines

Wed, 17 Dec 2008 00:43:47 PST

This study describes baseline prevalence and intensity of soil-transmitted helminth infections as well as baseline anthropometric and school performance data among public elementary school children in 6 sentinel provinces in the Philippines. Stratified cluster sampling was used to select 6 provinces, where grade 3 elementary school pupils were surveyed. Secondary anthropometric data and achievement test results of the immediate past academic year were examined. Overall cumulative prevalence and proportion of heavy intensity infections for the 6 selected provinces were 54.0% and 23.1%, respectively. These recent findings further support the need for mass treatment to be given at least twice a year. The findings of the study also demonstrate the relationship that exists between worm burden and nutritional status. Strategies focusing on mass treatment integration, environmental sanitation, personal hygiene, and health education should be developed to control soil-transmitted helminth infections and their detrimental effects.

Severity of Visual Impairment and Depression Among Elderly Malaysians

Wed, 17 Dec 2008 00:43:47 PST

Objective. This study aimed at evaluating the relationship between severity of visual impairment and depression among elderly Malaysians attending an eye clinic. Methods. This was a cross-sectional study. The study population included patients, aged ≥60 years who attended the Eye Clinic in University Malaya Medical Centre. Exposure measurement was based on ophthalmologic examinations by an ophthalmologist. Data on outcome were measured using the Geriatric Depression Scale. Results. After adjusting for important confounders, severity of visual impairment either having low vision or blind were independent risk factors of depression. The odds of developing depression among elderly with low vision were 2 times more than those with normal vision, and elderly who were blind had almost 5 times the odds to be depressed compared with those having normal vision. Conclusion. Findings from this study suggest a positive relationship between the severity of visual impairment and depression among elderly Malaysians.

Chronic Disease Risk Factors in Rural Australia: Results From the Greater Green Triangle Risk Factor Surveys

Wed, 17 Dec 2008 00:43:47 PST

The aim of this article was to assess the level and prevalence of major chronic disease risk factors among rural adults. Two cross-sectional surveys were carried out in 2004 and 2005 in the southeast of South Australia and the southwest of Victoria. Altogether 891 randomly selected persons aged 25 to 74 years participated in the studies. Surveys included a self-administered questionnaire, physical measurements, and a venous blood specimen for lipid analyses. Two thirds of participants had cholesterol levels ≥5.0 mmol/L. The prevalence of high diastolic blood pressure (≥90 mm Hg) was 22% for men and 10% for women in southeast of South Australia, and less than 10% for both sexes in southwest of Victoria. Two thirds of participants were overweight or obese (body mass index ≥25 kg/m²). About 15% of men and slightly less women were daily smokers. The abnormal risk factor levels underline the need for targeted prevention activities in the Greater Green Triangle region. Continuing surveillance of levels and patterns of risk factors is fundamentally important for planning and evaluating preventive activities.

Home Smoking Restrictions Among Koreans in Seoul

Wed, 17 Dec 2008 00:43:47 PST

The prevalence and correlates of home smoking bans in the Republic of Korea were examined using population-based data from telephone interviews with 500 Seoul adult residents in 2002. Most (97%) respondents indicated that they smoked, or that their spouse, other family member, or a regular friend smoked. Nearly all indicated that environmental tobacco smoke (ETS) is harmful. Only 19% of homes banned smoking, 65% allowed smoking anywhere, and 16% allowed smoking by special guests or in certain areas. The odds of having a full ban were significantly greater for men, married individuals, those less than 35 years or more than 50 years of age, non-smokers, individuals whose nonspouse family members did not smoke, and individuals with more sources of anti-ETS messages. Home smoking bans should be promoted by media campaigns and other tobacco control activities, because knowledge of the effects of ETS was already high.

The Stages of Physical Activity and Exercise Behavior: An Integrated Approach to the Theory of Planned Behavior

Wed, 17 Dec 2008 00:43:47 PST

This research aims to verify whether it is possible to explain the health-promoting behaviors based on sociodemographic characteristics by integrating the theory of planned behavior (TPB) proposed by Ajzen in 1988 and the transtheoretical model (TTM) proposed by Prochaska and DiClemente in 1983. In particular, the aim was to verify whether the variables of the TPB can properly distinguish the stages of change in exercise in the proposed integrated model and to figure out how attitude, subjective norm, perceived behavior control, influence, and intention-can explain the stages of change in exercise. Investigators who have taken previous training for the survey visited and interviewed 3658 people older than 30 years in the chosen town by multistage sampling method from July 27 to July 31, 2003. After the exclusion of inappropriate data out of 760 participants, only data from 584 participants were used for this research. ² test, t test, and 1-way analysis of variance were used to identify the difference between the distribution of the stages of change in exercise and the variables of the means. A discriminant analysis to verify the accuracy of the stages of change in exercise by means of the variables of the TPB and a path analysis to verify the fit of the integrated model were also used. The variables of the TPB were useful to satisfactorily distinguish and predict the stages of change in exercise. But to clarify the validity of this model, more diversified research should be conducted in the future, and the results must be accumulated.

Estimating Unit Costs for Dental Service Delivery in Institutional and Community-Based Settings in Southern Thailand

Tianviwat, S., Chongsuvivatwong, V., Birch, S. — Wed, 17 Dec 2008 00:43:47 PST

In this cross-sectional study, the cost of different dental services was estimated and the unit costs of dental services for schoolchildren were compared between 2 settings: hospital-based and community-based mobile dental clinics. Heads of all departments in a selected community hospital were invited to attend 2 workshops to collect relevant data. Unit costs of different dental services varied from 41 to 2693 baht, with services falling into 4 unit cost groups: very high, high, moderate, and low. The very-high-unit-cost services included rehabilitative dental services. The high-unit-cost services covered removal of an impacted tooth, root canal treatment, and tooth-color fillings. The moderate-unit-cost group included a wide range of other dental services, with screening and oral hygiene instruction in community-based dental clinics falling into the low-unit-cost group. Generally, services provided in the community-based mobile clinic had lower unit costs than the same services provided in the hospital dental clinic.

Public Health Policy and Medical Missions in the Philippines: The Case of Oral--Facial Clefting

Mendoza, R. L. — Wed, 17 Dec 2008 00:43:47 PST

This article examines the critical role of medical missions as alternative or proxy health delivery agencies in developing countries like the Philippines. Why and how they exist, what they can and cannot do, how they interact with the for-profit and public health sectors, and what challenges they face in the context of underdevelopment are analyzed by using a proposed structural— behavioral framework. We find that these missions can offer short-term benefits to specialized public health problems, such as oral—facial clefting, but depend on public and private partnerships and resources for long-term solutions. The article thus suggests that health care provision in developing countries should also be treated as a managerial issue. The challenge is for Third World governments to promote effective trisector collaborations, improve accessibility and adequacy of services, and support socially redistributive health policies.

Socioeconomic Determinants of Age at First Birth in Rural Areas of Bangladesh

Aminul Haque, Md., Amir Mohammad Sayem, — Wed, 17 Dec 2008 00:43:47 PST

The age at first birth is very low under existing rural sociocultural settings in Bangladesh. This study examined the socioeconomic and cultural determinants of age at first birth. The study subjects were married women aged 15 to 29 years in 2 rural areas that were identified through a multistage sampling technique. To collect the relevant information, a semistructured interviewer schedule was applied to the eligible women. This study found that 72.8% women gave first birth at <20 years of age with mean age at first birth 18.74 years. Simple linear regression model explained 30.9% of variance in age at first live birth. Among socioeconomic and cultural determinants, family pressure explained the most significant variance. It is really difficult to reduce fertility in complex sociocultural settings in rural Bangladesh. However, the findings of this study may provide an answer to increase the age at first birth and hence to reduce the high fertility among these group of women.

Clinicians' Attitude on Mass Drug Administration Under the Program to Eliminate Lymphatic Filariasis: A Qualitative Study From Orissa, India

Anna Salomi Kerketta, , Bontha Veerraju Babu, — Wed, 17 Dec 2008 00:43:47 PST

The global program to eliminate lymphatic filariasis (LF) is currently based on mass drug administration (MDA) with annual single dose of antifilarials. In India, the MDA is implemented by primary health centers (PHC) of the district health system. The aim of the present study was to explore the attitudes of clinicians working at PHC level in three districts of Orissa, India. The data are obtained from interviews of 50 clinicians (35 from PHCs and 15 private). Only 11 PHC clinicians and 1 private clinician opined that the elimination of LF is possible through MDA of diethylcarbamazine (DEC); and 40% PHC and 87% private clinicians strongly felt that the elimination is not feasible through MDA and that the yearly single dose of DEC was not efficacious. The remaining clinicians were unable to comment on the feasibility and efficacy of MDA. The indifferent attitudes arise from lack of knowledge or erroneous beliefs. A good understanding of the program through reorientation and rigorous training should be emphasized to make the MDA successful.