Health Action Research Articles

Evaluating maternal death surveillance and response system in Sunyani Municipality of Bono region in Ghana from 2017-2021

IntroductionMaternal death rates in Ghana have decreased overall but remain high in rural areas. The Maternal Death Surveillance and Response System (MDSR) aims to eliminate preventable maternal deaths effectively. However, its effectiveness is less pronounced at district and subdistrict levels than at national and regional levels. Despite the requirement for periodic evaluation, there is a lack of evidence supporting these assessments. This study focuses on evaluating the MDSR in Sunyani Municipal.MethodsThe evaluation was conducted using a cross-sectional design, using both qualitative and quantitative approaches. Data from the District Health Information Management Systems (DHIMS) and the maternal death line list from January 2017 to December 2021 on maternal deaths were reviewed. Stakeholders, including health professionals, were interviewed. The means, proportions, and other statistical measures were calculated using Epi Info Version 7. Qualitative data underwent content analysis, and the results were visually presented in tables and flowcharts to illustrate the flow of surveillance information.ResultsMost respondents were female, constituting 51.4% (19/37), with midwives comprising the largest group at 32.4% (12/37). Approximately 75.7% (28/37) were able to explain how the surveillance data has been used for public health action. The notification and reporting process was clear to 85% (17/20) of respondents. Although 94.6% (35/37) expressed willingness to notify and participate in audits at facility and community levels, the audits remained facility-based. All facilities consistently reported maternal deaths, but data storage equipment was lacking. Approximately 80% (20/25) of forms were reported within 24 h, and 88% (22/25) were investigated within seven days. Only 68% (17/25) of forms were filled out correctly, with no municipal and facility-level line list. All reported deaths came from healthcare facilities, with no community-reported maternal deaths.ConclusionsThe MDSR system in Sunyani Municipal demonstrates high awareness and willingness to participate among healthcare providers but faces challenges in data accuracy and community engagement. Death audits remain facility-based, and the lack of community-reported maternal deaths and municipal-level line lists indicates gaps in comprehensive reporting and data management. To improve the system, it is recommended that community case searches be enhanced for better reporting and to address data management issues by ensuring proper data quality assessment.

Public Health Ethics: The State of Arts

LANGUAGE NOTE | Document text in English ; abstract also in Chinese. 本文介紹生物倫理學與公共健康倫理學領域，並描述兩者之間的關係；文章尾聲將展望公共健康倫理學論未來既廣泛又多變的方向。本文首先簡介公共健康倫理學的本質，以及如何把其與比之更廣闊的生物倫理學作出區分，因此需要提出公共健康倫理學的定義，以助釐清公共健康倫理的重點。隨後，本文簡述公共健康倫理學文獻的一些最新進展，包括圍繞新冠病毒、大流行病、抗菌素抗藥性、「生活方式」疾病及正義等道德問題。本文同時論及就干預公共健康的「合法範圍」所提出的觀點之間於政治及形而上學的角力。其後本文探討公共健康倫理學所面臨的挑戰，包括其複雜又多元的性質。而且公共健康實踐高度政治化，其政治化的原因是因為公共健康影響整個人口及社區，而很多關於公共健康的決策由政治人物而非公共健康專家所作出。此外，公共健康倫理也因為公共健康的範圍擴展至納入非政府公共健康行動者而面臨進一步的挑戰。本文最後闡述有關公共健康的一些未來方向，包括「公共健康觀」的出現，以作為為人熟知的健康與社會問題的形而上學框架、把該領域的認知和道德基礎去殖民化以涵蓋更廣泛的知識，以及一些包括美德在内的公共健康倫理學的理論發展。筆者建議讀者把文章視為對公共健康倫理學領域的一部分介紹，並鼓勵他們閲讀本文所引用的論文，並以這些論文作為進入所涵蓋主題的大量文獻之門徑。公共健康倫理學是一個相對年輕的領域，而該領域有著巨大的成長及發掘更多新概念的潛力。 This essay begins by introducing the fields of bioethics and public health ethics and describing the relationship between them. It ends with some glimpses into the wide-ranging and discourse-changing directions of the literature on public health ethics. To open, the paper describes the field of public health ethics and how it is differentiated from the wider field of bioethics. This requires a brief description of public health to clarify the nature of public health ethics. The essay then provides a brief overview of a few recent developments in the public health ethics literature, including the moral issues raised by COVID-19 and pandemics, anti-microbial resistance, ‘lifestyle’ diseases and justice. The paper also touches on the political and metaphysical tensions in views on what counts as a ‘legitimate area’ of intervention for public health. The essay then turns to a couple of challenges in the field of public health ethics, specifically the complex and multi-disciplinary nature of the field and the fact that public health practice is a highly political area. Public health is political both in the sense that it affects entire populations or communities and in the sense that many decisions about public health are made by politicians rather than public health experts. A further challenge to public health ethics is the question of what counts as ‘public health’, as the scope has been broadened to include non-governmental public health actors. Finally, the essay describes some future directions for research in public health ethics, including ‘public health view’ becoming a metaphysical framing for familiar health and social issues and decolonising the epistemic and moral foundations of the field to include a wider set of knowledge sources and values. There are also some theoretical developments that integrate virtue into public health ethics. The reader should take this essay as a partial introduction to the field, and they are highly encouraged to read the papers that are cited here and to use those papers as a gateway into the large literature on the topics covered. Public health ethics is a relatively young field, with an enormous potential for growth and new ideas.

Global Burden of Disease from Environmental Factors.

Estimation of the disease burden attributable to environmental factors is a powerful tool for prioritizing environmental and pollution management and public health actions around the world. The World Health Organization (WHO) has been estimating the environmental disease burden since 2000, which has formed the basis for the modern estimation approach conducted in the Global Burden of Disease, Injuries, and Risk Factor (GBD) study. In 2021, environmental and occupational risk factors in the GBD were responsible for 18.9% (12.8 million) of global deaths and 14.4% of all disability-adjusted life years (DALYs), led by ambient PM2.5 air pollution (4.2% DALYs, 4.7 million deaths) and household air pollution (3.9% DALYs, 3.1 million deaths). Climate change exacerbates many environmental hazards, leading to increased disease burdens from heat, air pollution, vector-borne diseases, storms, and flooding. Other environmental risk factors not included in the GBD, such as poor indoor air quality, various chemical exposures, and environmental noise pollution, also significantly contribute to disease burden in many countries, though more efforts are needed to generate and integrate data resources for inclusion in global estimations.

Fatores associados à depressão pós-parto: uma análise de agregação

Introduction: Postpartum depression (PPD), according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is a multifactorial disease, which occurs during pregnancy until the fourth week postpartum. Objective: To assess whether family support, depression and/or anxiety before or during pregnancy, alcohol consumption and/or smoking during pregnancy, and age (<20 or >35 years), together or separately, in puerperal women influence the occurrence of PPD. Methods: A longitudinal and multicenter study, called “Projeto Viver”, with 3435 women who gave birth in three maternity hospitals in Espírito Santo. At the last follow-up, at the end of the neonatal period, 1818 puerperae were interviewed by telephone (52.9%). Poisson analysis with robust variance adjustment was performed for one, two, three and even four grouped factors, and adjusted for covariates. Results: The prevalence of PPD was 7.3% (95% CI 6.1% - 8.5%) in the first month after delivery. Most puerperae with PPD were between 20 and 34 years old (71.2%; 95%CI 62.8% - 78.3%), more than 12 years of education (60.7%; 95%CI 51.5% - 69.2%), non-white skin color (77.3%; 95%CI 69.2% - 83.8%) and social class C (51.5%; 95%CI 42.9% - 60.0%). The most prevalent risk factor in puerperae with PPD was the lack of family support (34.1%; 95%CI 26.4% - 42.6%) and the least was depression and/or anxiety before or during pregnancy (3.8%; 95%CI 1.6% - 8.8%). Women without family support, who smoked and/or drank during pregnancy had 98% and 60% risk for PPD, respectively. The presence of two and three risk factors doubled and tripled the risk for PPD among puerperae, respectively. In puerperae with two concurrent factors, such as lack of family support and smoking/ethylism, as well as those with depression and/or anxiety before or during pregnancy and age extremes, the risk for PPD was 2.1 (95% CI 1.2 - 3.9) and 3.7 (95% CI 1.2 - 11.7), respectively. Conclusion: The result of this study allowed the knowledge of the risk of aggregate factors, and can contribute to public health actions that minimize them in pregnant women, in order to reduce the occurrence of depression after childbirth.

Does Universal Health Coverage Include the Caregivers? A Mixed Method Study on Accessibility and Out-of-pocket Expenditure for Healthcare Services by Accredited Social Health Activists of North India

Abstract Background: Despite the load of voluntary work done by Accredited Social Health Activists (ASHAs), they are not recognized and are not provided any health security measures. The current study aims to estimate the proportion of income spent on healthcare services by ASHA and her family in the past 6 months and to explore their access to healthcare services. Methods: A mixed-method study was done among ASHAs under one community health center in North India in 2022. A self-administered questionnaire was used to collect data on the healthcare preferences and expenses of the ASHAs and their family. In the second phase, focused group discussions were conducted among the ASHAs in groups of 6–8 to collect data on their experiences with healthcare services. One of the co-investigators was the moderator, another was conducting audio recordings and taking notes. Results: Eighteen ASHAs were included in the study, and 38.8% of them had health insurance. For preventive services, they preferred community health centers (CHCs) (83.3%). Health expenses in the past 6 months were about 12.18% of their family income. The focused group discussion was based on themes including ASHAs’ expectations from the system they are working with, their healthcare-seeking behavior, and both of its effects on their performance in the implementation of the target-oriented program at the ground level. Conclusion: Being part of the health system, the community health worker is aware of the quality of services provided. Not preferring the public health system was reported due to disrespect in the system and unavailability of some curative services.

Explain the behavior change and maintenance in diabetic patients using MTM-HAPA framework

ObjectivesThe aim of the study was to to uncover the factors influencing the initiation and maintenance of health behaviors indiabetes mellitus (DM) patients, utilizing baseline data from a randomized controlled trial to construct a structural equation model based on the Multi-Theory Model (MTM) and Health Action Process Approach (HAPA) scales.MethodsThe study recruited participants with type 2 diabetes, aged between 18 and 75 years, from 45 distinct locations in Beijing, China.Patients [N = 406, n = 232 (57.1%) females, n = 232 (42.9%) males; Mean (SD) age = 56.7(10.9)] completed self-reported questionnaire about constructs from integrated theories concerning health behavior. To test the associations between the variables, structural equation modeling with latent variables was employed. Based on the path coefficients of Structural Equation Modeling(SEM), we verified all the hypotheses.ResultsDisadvantages, Advantages, Self-efficacy for Initiating Behavior, and Changes in Physical Environment are all prove to have an effect on intention, with the effect of Disadvantages being negative. Intention positively influenced Action Planning and Coping Planning, both of which in turn significantly predicted Initiation of Behavior Change. Practice for change, Emotional Transformation, Changes in Social Environment, and Self-efficacy for Sustaining Behavior were all affected by Outcome Expectancies and Risk Perception positively. Meanwhile, Practice for change, Emotional Transformation, Changes in Social Environment and Self-efficacy for Sustaining Behavior- would have a significant predictive effect on Maintenance of Behavioral Change.ConclusionThe empirical evidence from this study robustly validates the majority of its theoretical constructs, affirming that MTM-HAPA possess significant explanatory capability in delineating the factors that underpin both the Maintenance of health-related behaviors and the Initiation of Behavior Changes in individuals suffering from DM.

Assessing Challenges and Sources of Dissatisfaction among Accredited Social Health Activists Employees

Accredited Social Health Activists (ASHAs) are integral to India’s healthcare system, particularly in rural and underserved areas like those in district Aligarh, Uttar Pradesh. They serve as community health workers who facilitate access to essential health services, but their roles often place them in vulnerable positions. Operating within patriarchal societies and situated at the lower levels of the healthcare hierarchy, ASHAs are prone to various forms of violence and harassment. Despite their crucial role, there is limited understanding of the specific challenges they face, particularly regarding harassment in their work environment. This study aims to identify the key challenges encountered by ASHA workers in the Aligarh district of Uttar Pradesh and sources of dissatisfaction faced by ASHAs. A cross-sectional survey was conducted involving a representative sample 150 of ASHAs across several blocks of in Aligarh of Uttar Pradesh. Data were collected through structured questionnaires and semi-structured interviews. The survey addressed various aspects, including working conditions, support from healthcare systems, remuneration, training, and community relations. In a study of 150 ASHA workers, key challenges include delays in incentives (70%), excessive workload (92%), and unsatisfactory training (71.3%). Many faces harsh working conditions (73.3%), harassment (95.3%), and high stress (89.3%). Issues like inadequate facilities (97%) and transportation difficulties (90.6%) further impact their performance and well-being. This study evaluates ASHA workers’ duties, challenges, and well-being. Despite their critical role, they face financial instability, inadequate facilities, harsh conditions, and harassment, including from hospital staff. Long travel, stigma, and social discrimination further impact their effectiveness and morale, emphasizing the need for better support and protective measures.

Guidelines for Reporting Oral Epidemiologic Studies to Inform Burden Estimation (GROESBE).

High-quality prevalence and incidence studies of oral conditions are essential for estimation of disease burden and comparison of estimates among countries and over time, as well as for priority setting, resource allocation, and planning public health action. Existing systematic reviews of the epidemiology of untreated dental caries, severe periodontitis, and edentulism, carried out for the Global Burden of Disease study, showed inadequate and incomplete reporting of the measurement of oral conditions as well as a lack of consistency and comparability with other health conditions. These issues are more accentuated in studies from low- and middle-income countries. Studies must meet the highest standards so that these efforts do not waste resources. This report extends the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines to improve and standardize the reporting of descriptive oral epidemiologic studies of common oral conditions. The aim of the Guidelines for Reporting Oral Epidemiologic Studies to Inform Burden Estimation (GROESBE) is to promote transparency, clarity, and comparability of scientific reporting, specifically for prevalence and incidence studies of untreated caries, severe periodontitis, and edentulism. The GROESBE guidelines and checklist were developed following a structured and formal consultation process with a geographically diverse group of 23 individuals involved in the conduct and analysis of oral epidemiologic studies. GROESBE focuses on elements that are not included in STROBE, adding 14 specific recommendations to existing guidelines. They will facilitate reliable comparison of emerging prevalence and incidence data on untreated caries, severe periodontitis, and edentulism across settings worldwide and the synthesis of robust evidence to inform estimation of disease burden in future iterations of the Global Burden of Disease study.

The role of the public health service in the implementation of heat health action plans for climate change adaptation in Germany: A qualitative study

BackgroundIn response to climate change-induced increases in heat periods, the WHO recommends the implementation of heat health action plans (HHAPs). In Germany, HHAPs are implemented neither comprehensively nor nationwide. Several recommendations have identified the public health service (PHS) at municipal and federal state levels as a key actor regarding to heat and health. Therefore, this study aimed at assessing the role of the PHS in implementing HHAPs at municipal and federal state levels in Germany.MethodsWe conducted a policy document analysis to assess the legal basis for the work of the PHS in the 16 federal states in Germany. Furthermore, we conducted semi-structured interviews with 16 experts from within and outside the PHS to explore their perceptions of the PHS in the implementation of HHAPs. The interviews were analysed using reflective thematic analysis.ResultsThe policy document analysis revealed that heat is not mentioned in any of the federal states’ regulatory frameworks for the PHS, while tasks related to environment and health are addressed, but tend to remain vague. The interviews confirmed that there is currently no clearly defined role for the PHS in implementing HHAPs in Germany and that the actual role primarily depends on the local setting. Main barriers and facilitators could be assigned to three levels (individual, organizational and political), and two overarching contextual factors (awareness of the need for adaptation and existence of other public health emergencies) influenced the implementation of HHAPs across all levels. At the individual level, motivation, knowledge and competencies, and previous experience were possible barriers or enablers. At the organizational level, administrative structures, financial and human resources, leadership and networks were barriers or facilitators, while at the political level they included legislation and political decisions.ConclusionsThe PHS could and should be a relevant actor for implementing measures addressing health and climate change locally, in particular because of its focus on vulnerable populations. However, our findings suggest that the legal basis in the federal states of Germany is insufficient. Tailored approaches are needed to overcome barriers such as rigid, non-agile administrative structures and competing priorities, while taking advantage of facilitators such as awareness of relevant actors.

Public engagement to refine a whole-school intervention to promote adolescent mental health.

Despite high rates of adolescent mental health problems, there are few effective school-based interventions to address this. Whole-school interventions offer a feasible and sustainable means of promoting mental health, but few have to date been evaluated. Previously we trialled the Learning Together intervention comprising local needs assessment, student and staff participation in decision-making, restorative practice, and a social and emotional skills curriculum. This was effective not only in preventing bullying (primary outcome), but also in promoting mental well-being and psychological functioning (secondary outcomes). We aimed to adapt Learning Together to develop Learning Together for Mental Health, focused on promoting mental health. This paper reports on how we refined and elaborated intervention materials to produce the Learning Together for Mental Health intervention including through patient and public involvement and engagement. We reviewed evidence to inform choice of the curriculum component and the contents of our needs assessment survey. We conducted patient and public involvement and engagement with school staff and students, and children and young people from the National Children's Bureau to adapt the intervention. We also conducted a systematic review of reviews to inform a menu of evidence-based actions, but this is reported separately. Southern England. Patient and public involvement and engagement was conducted with four staff and five students from one secondary school, and a group of two school senior leadership team members from different schools, and about eight children and young people who were members of the Young National Children's Bureau. None. We refined and elaborated our initial plans for Learning Together for Mental Health to generate an intervention supported by full materials, training and external facilitation. We focused needs assessment on mental health, added a menu of evidence-based whole-school mental health actions, and switched to a different social and emotional skills curriculum. We retained restorative practice and staff/student involvement in decisions. No further refinements were made to the intervention theory of change or overall approach. Patient and public involvement and engagement was useful, but not all suggestions were acted on either because some participants suggested dropping pre-determined elements (e.g. needs survey) or because suggestions (e.g. to include aromatherapy) lacked evidence of effectiveness. Not all of our engagements with patient and public involvement and engagement stakeholders were sustained over time. Our patient and public involvement and engagement work was affected by its having occurred within the recovery period from COVID-19 when schools were more stressed than normal. We had planned for the school involved in patient and public involvement and engagement to be above average in student free-school-meals eligibility, but the school initially recruited dropped out at the last minute. Its replacement had a lower-than-average rate of free-school-meal entitlement. This paper reports on the process of adaptation and reflects on the various ways in which engagement and evidence review were useful in this process. We found that it is possible to refine interventions and elaborate them to provide full materials and support via processes drawing on evidence review and patient and public involvement and engagement. The latter proved valuable in informing refinement of Learning Together for Mental Health in terms of ensuring its feasibility, acceptability, and inclusiveness. However, in our opinion, not all suggestions from patient and public involvement and engagement can or should be acted on, especially when they do not align with the evidence base. A feasibility study to optimise the intervention and assess whether progression to a full trial is justified. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131594.

CONHECIMENTO DOS ALUNOS DO CURSO DE PEDAGOGIA SOBRE NOÇÕES BÁSICAS DE PRIMEIROS SOCORROS

Introduction: In the school environment, many accidents can happen to a child, and many situations can lead to death if first aid is not properly applied. Training educators in first aid is important to prevent and reduce this rate. In addition to including the course in the pedagogy curriculum, the study sought to assess the knowledge of pedagogy students related to the basic notions of first aid. This is an exploratory-descriptive, quantitative and cross-sectional action research study conducted at the Campo Limpo Paulista University Center (UNIFACCAMP), located in the city of Campo Limpo Paulista, in the state of São Paulo. The questionnaires prepared by the researchers were used as data collection tools. They included data for sociodemographic characterization, eight questions about first aid in situations of sprain, dislocation/fracture, contusion, syncope, convulsion and choking (airway obstruction by a foreign body) and one question focused on the Lucas Law and another on the importance of implementing first aid in the curriculum of the pedagogy course, obtaining descriptive and quantitative data. The questionnaire was applied before and after the intervention of the health action and consisted of a practical demonstration and explanation of the procedures in situations of sprain, dislocation/fracture, contusion, syncope, convulsion and choking, distribution of the folder with illustrations in images and informative text about the first aid maneuvers. The sample consisted of 33 regular students of the pedagogy course. At the end of the meeting, a positive effect was observed in relation to the expansion of knowledge about the practices that can be adopted in situations that require first aid care. Thus, this study demonstrated and reinforced the importance of first aid from the undergraduate period, thus contributing to the protection of life, both in the school environment and in everyday situations.

Historical Traces Of Health Law: Tracing The Dynamics Of Health Regulation Development Through Literature

This article discusses the historical development of health law, focusing on the evolution and dynamics of health regulation. The study in this research uses the literautr research method. The purpose of this study is to provide insight into the current legal challenges and future directions of Health regulation. The results found that the historical development of health law was influenced by various socio-political factors and significant medical advances. Key milestones such as 19th century sanitary regulation and public health policy in the 1918 influenza pandemic show how health law has evolved. Important figures such as health activists and legal academics were instrumental in shaping influential legal frameworks, such as the Public Health Act and bioethics. The impact of these legal reforms on public health varies depending on the responsiveness and adaptivity of the regulations to current global health challenges, such as health data privacy and access to medicines. By understanding the historical evolution of health law, it can be concluded that an adaptive legal framework is necessary to achieve optimal public health outcomes in the future.

Four analysis moments for fuzzy cognitive mapping in participatory research

ABSTRACT Fuzzy cognitive mapping (FCM) is a practical tool in participatory research. Its main use is clarifying causal understandings from several knowledge sources. It provides a shared substrate or language for sharing views of causality. This makes it easier for different interest groups to agree what to do next. Each map is a collection of causal relationships with three elements: factors (cause and outcome), arrows linking factors, and weights indicating the perceived influence of each cause on its outcome. Stakeholder maps are soft models of how they see causes of an outcome, such as access to services or systemic racism. Based on a standardized FCM protocol, we present four moments in FCM analysis. (1) Agree shared meaning across maps. (2) Calculate the maximum influence of perceived causes. (3) Simplify the maps for communication. (4) Identify priorities for action. We provide explanations of the four moments in FCM analysis, with examples from five countries. FCM offers a practical means to guide health action. It incorporates local perspectives with transparent and traceable procedures.

Contributions of neo-Aristotelian phronesis to ethical medical practice.

Virtue-based ethics prioritizes phronesis (practical wisdom) because, as rules have become less action-guiding, good judgment (phronesis) becomes more necessary as a guiding meta-virtue. The view of phronesis that MacIntyre proposed in After Virtue (hereafter, AV phronesis) has been applied in medical ethics despite his substantial deviations from his source (Aristotle) in After Virtue. In this paper, we clarify the differences between the neo-Aristotelian and AV phronesis views and argue for a neo-Aristotelian phronesis with four functions (constitutive, adjudicative, emotion regulative, and blueprint). In referring to neo-Aristotelians, we refer to the recent scholars that who hark back strongly to Aristotle and have amended some of Aristotle's less palatable views by adding insights from current empirical science to the domains that he left vague. Then we discuss how AV phronesis and neo-Aristotelian phronesis differ, focusing on the distinction between technical (i.e., alterable means toward patient health such as medication choices) and phronetic (i.e., actions that are inseparable from patient health) actions in medicine. This distinction is understated in AV phronesis, but central to neo-Aristotelian phronesis. Accordingly, the neo-Aristotelian approach makes an important and unique contribution to physician ethical development.

Assessment of services provided by urban ASHAs to mothers of urban slums in Lucknow district – A cross-sectional study

ABSTRACT Context: Maternal and child health is an important public health issue which indicates the level of socioeconomic development in any country. Urban accredited social health activist (U-ASHA) workers in India are the main front-line urban health workers in primary health care delivery for slum and urban poor. Aims: To assess the services provided by U-ASHA workers to mothers of urban slums for antenatal and postnatal care. Settings and Design: Cross-sectional study in urban slums of Lucknow where recently delivered women (up to 2 years) were selected. Methods and Material: To include the desired sample size of 320 recently delivered women (RDW), the U-ASHAs of the selected slums were contacted and a list of RDWs was made for each slum. By simple random sampling, 20 RDWs were selected from each slum. A predesigned and pretested interview schedule was used for data collection. Statistical Analysis Used: SPSS-version-26 was used. P <0.05 was considered statistically significant. Results: The registered pregnancies were 95%. Only 43.1% of RDW had at least four ANC visits. The institutional delivery was 84.7%. Only 27.7% of RDW visited health facilities for PNC services. About 39.4% received Janani Suraksha Yojana incentives. Contraceptive users were only 41.9%. Counseling by U-ASHA workers regarding all the ANC and PNC services had better utilization among counseled RDW except for child-care counseling. Conclusions: Counseling services regarding ANC and PNC services have a significant impact on their utilization. Better results can be achieved if the counseling by U-ASHA is enhanced to reach out more beneficiaries.

Decoding morbidity patterns in ASHA workers of Vadodara, Gujarat – A cross-sectional study

ABSTRACT Introduction: Accredited Social Health Activists (ASHA) play a pivotal role as village-level functionaries under the National Health Mission, driving community transformation, facilitating health planning, and ensuring access to healthcare services. Objectives: To assess the physical health status of ASHA workers and to investigate the prevalence of morbidities among ASHA workers. Material and Methods: This is a cross-sectional study, conducted in Vadodara’s east zone, and involves 123 ASHA workers. A questionnaire focusing on health profiles, encompassing age, weight, height, body mass index, and blood pressure, as well as histories of acute and chronic illnesses, was employed for data collection. Descriptive statistics were employed to summarize demographic and professional characteristics, and inferential statistics, such as Chi-square tests, were applied to assess associations and factors influencing the morbidity profile of the ASHA workers. Results: The participant’s mean age was 38.9 ± 6.85 years. The majority, 74 (60.2%), of them reported no morbidity, whereas 40 (32.52%) had a chronic illness and 9 (7.32%) had acute morbidity at the time of visit. Among the chronic morbidity, 50% of ASHA had poly morbidity. Anemia was found among most ASHAs, 32 (26.02%), followed by diabetes, 19 (15.45%), and hypertension, musculoskeletal problems, thyroid disorders, and obesity were the other major diseases found among the ASHAs in 14.63%, 13.82%, 13.01%, and 11.38%, respectively. Skin problems like fungal infection and rashes were found among 5.69%. Based on body mass index, 27 (21.95%) were found overweight and 14 (11.38%) were obese. Conclusion: The study revealed a 32% chronic morbidity prevalence among ASHA workers who are taking care of citizens’ health. It is high time to take care of our health team. First, they should be healthy as they are the role models of the community.

Overcoming doubt: developing CDoH Essentials, a practical tool to introduce the commercial determinants of health.

Despite growing awareness of the importance of commercial determinants of health (CDoH), there has been limited development or evaluation of educational and practice-focused support for public health professionals. This article reports findings from an action-research approach bringing together people with academic and practice expertise (n = 16) to co-create workshop materials (called 'CDoH Essentials'), test and improve them through five trial workshops and explore their effects. Five English local public health teams co-facilitated the workshops in their organizations, with participants from public health teams and their internal partners (n = 94). Quantitative and qualitative data were collected throughout and analysed to understand: (1) whether the workshops met the expectations of participants, public health and academic observers, and (2) the effects of workshop participation on (a) participants' knowledge, understanding and critical CDoH literacy, and (b) subsequent working practices and attitudes. The co-created CDoH Essentials appeared effective in meeting expectations, improving knowledge and critical CDoH literacy and promoting action on CDoH. The proportion of participants reporting 'little' or 'no' CDoH knowledge fell significantly following the workshop (55.4% vs 2.7%). Participants' increased understanding supported reflection on the implications of the CDoH for their roles and for wider strategy and action. After 3 months, all five settings reported greater consideration of CDoH and had initiated or planned action. CDoH Essentials could be used to galvanize more effective public health action to tackle the CDoH in England and trialled in other public health contexts.

Tobacco industry narratives of e-cigarette use in the UK: a qualitative framing analysis.

Public health actors have expressed concerns over the entry of the tobacco industry into the UK e-cigarette market. It is important to be aware of the tobacco industry's involvement and stated aims for e-cigarettes in the UK, given their historical attempts to divert attention from and escape responsibility for the harms caused by combustible cigarettes. The use of e-cigarettes amongst young people in the UK has remained constant, despite the law prohibiting sales to adolescents and claims by manufacturers and others that they are designed solely as a tool to quit smoking. This study sought to examine how tobacco-related organizations in the UK e-cigarette market frame the use of e-cigarettes. Publicly available materials between September 2015 and June 2023 were collected from four transnational tobacco companies which have invested in the e-cigarette category, and from a UK e-cigarette trade association. A qualitative framing analysis of materials was conducted guided by relevant frameworks from the Commercial Determinants of Health literature. The analysis identified seven framings used by tobacco-related organizations relevant to e-cigarette usage in the UK. These were: co-opting of harm reduction; consumer choice; following the 'evidence'; insufficient evidence; the right kind of regulation; 'us' and 'them' rhetoric and marketing and advertising. By highlighting tobacco-related organizations' e-cigarette framings and contradictions, this study raises awareness of the rhetorical strategies used by the industry which aim to relegitimize tobacco companies in the political and public spheres.

Towards Understanding Contemporary Gambling Advertising in Sub‐Saharan Africa

ABSTRACTGambling advertising has become ubiquitous in sub‐Saharan Africa influencing social norms and attitudes towards gambling. The delay or failure of governments to effectively regulate gambling advertising poses a significant threat to public health. This article provides contemporary insights into gambling advertising, its forms, mechanics and influence on gambling behaviour. It provides contextual understanding to policy‐makers, health advocates and public health actors, including a call to action for effective regulation. With sub‐Saharan Africa becoming important to the gambling industry for market growth and profits, there is the need for public health actors to instigate advocacy for strong regulations and enforcement of gambling advertising.

ANÁLISE DE PERFIS EPIDEMIOLÓGICOS DA LEISHMANIOSE TEGUMENTAR AMERICANA: UMA REVISÃO INTEGRATIVA

American tegumentary leishmaniasis (ATL) is an infectious disease caused by protozoa of the genus Leishmania, transmitted by sandflies of the genus Lutzomyia. ATL has a wide geographical distribution and is endemic in several tropical and subtropical regions, including Latin America. This study is an integrative review aimed at gathering and synthesizing information about American tegumentary leishmaniasis in terms of its epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment. Eleven articles published between 2019 and 2021 were selected from the SciELO, LILACS, Google Scholar, and BVS Saúde databases. The integration of public health actions with continuous monitoring, vector control strategies, and community awareness initiatives can contribute to reducing the incidence and impact of the disease in the region. An expanded understanding of the determinants of ATL supports the development of more effective public policies, capable of mitigating the impact of this neglected disease and promoting better health conditions for vulnerable populations.