Comprehensive Health Services Research Articles

Bladder cancer: a retrospective audit at a single radiation oncology unit of an academic hospital in Johannesburg, South Africa

BackgroundBladder cancer (BCa) is one of the most common urological cancers and remains a leading cause of cancer-related mortality worldwide. Bladder cancer is associated with a range of risk factors, with smoking being one of the most significant contributors. In addition to smoking, exposure to certain chemicals, particularly aromatic amines found in industries such as dye, rubber, leather, and textiles, also increases the risk of bladder cancer. In low-and-middle countries with lower Human Development Index (HDI), data on the underlying causes, incident rate, modes of presentation, treatment, and prognosis of bladder cancer remains unclear and often appear to be inadequate. This study aimed to assess the prevalence, mode of presentation, treatment, and risk factors associated with bladder cancer in Johannesburg, South Africa. By examining these factors, the study seeks to identify possible patterns or predisposing factors that contribute to the development and progression of bladder cancer, which could generate insights that could help to reduce the significant morbidity and mortality associated with this cancer.MethodsThis retrospective study analyzed secondary data from 115 patients who were treated in the radiation oncology unit of an academic hospital between January 2010 and December 2020. By reviewing the medical records of these patients, the study aimed to gather comprehensive information on the prevalence of bladder cancer, modes of presentation, treatment approaches, and associated risk factors. Bladder cancer in this study was assessed using a comprehensive analysis of patient data on demographics, risk factors, clinicopathological aspects, and the specific therapies received. A comparison of patients with squamous cell carcinoma (SCC) and transitional cell carcinoma (TCC) of the bladder was conducted as part of this study. This comparison aimed to explore differences in demographic profiles, risk factors, clinicopathological characteristics, and treatment outcomes between these two histological subtypes.ResultsA total of 115 patients presenting with bladder cancer symptoms were referred to the academic hospital for evaluation and treatment. The incidence rate of bladder cancer was highest among patients with a mean age of 60.7 ± 14.9. Males constituted 60.9% of the cases, resulting in a male-to-female ratio of 1.6:1. The most common risk factors associated with bladder cancer complications included smoking, being male, black ethnicity and increasing age. Transitional cell carcinoma remained the most prevalent histological subtype at the academic hospital, compared to squamous cell carcinoma (SCC). Patients with transitional cell carcinoma (TCC) were more likely to be older (odds ratio (OR): 1.03, 95% Confidence Interval (CI): 1.01–1.06, p = 0.029), male (OR: 2.60, 95% CI:1.10–6.04, p = 0.030). The study also found that most of the TCC cases were among black patients, though white patients were four times more likely to present with TCC compared to SCC (OR:4.22, 95% CI: 1.43–12.48, p = 0.009).ConclusionBladder cancer is still widespread in LMICs, with lower HDI, with elderly males being at risk. To aggressively prevent mortality and morbidity from bladder cancer, bladder cancer health awareness must be maintained to improving prevention, as well as early detection, management and comprehensive patient care and health services for bladder cancer patients. These findings highlight the importance of targeted screening and prevention strategies for high-risk groups, particularly older males with a history of smoking.

Relationship between serum 25-hydroxyvitamin D level and preeclampsia components and metabolic parameters among overweight and obese pregnant women

Background: Studies have shown that vitamin D deficiency can be related to the occurrence of preeclampsia. Objective: The present study was conducted with the aim of determining the relationship between the serum level of 25-hydroxyvitamin D and preeclampsia and its related risk factors among obese or overweight pregnant women. Methods: This cross-sectional-analytical study was conducted on 83 pregnant women referring to comprehensive health service centers in Makoo city. Anthropometric indices and biochemical factors including vitamin D serum level, glycemic indices and lipid parameters were investigated in these women. In addition, the food intake of the participants was evaluated using an FFQ. Results: The results showed that there is a direct correlation between vitamin D serum level and dietary fat level (r=0.269, p=0.007) and high-density lipoprotein (HDL-C) (r=0.478, p<0.0001). Also, there was an inverse correlation between serum vitamin D level and pre-pregnancy body mass index (r=-0.625, p<0.0001), systolic blood pressure (r=-0.592, p<0.0001), diastolic blood pressure (r=-0.592, p<0.0001), fasting blood sugar (FBS) (r=-0.511, p<0.0001), proteinuria (r=-0.422, p<0.0001), triglyceride (TG) ( r=-0.225, p=0.020), total cholesterol (TC) (r=-0.428, p<0.0001) and low-density lipoprotein (LDL-C) (r=-0.602, p<0.0001). Conclusion: There is a direct relationship between dietary fat intake and serum vitamin D level. There is also a positive correlation between serum levels of this vitamin and serum HDL-C. On the other hand, there is an inverse relationship between the serum level of this vitamin and systolic blood pressure, degree of proteinuria, pre-pregnancy body mass index and FBS, TC and LDL-C.

1.D. Scientific session: Cross national perspectives: the many faces of health inequities

Abstract Health inequities come in different forms in different countries, often times based on country and population demographics, and exist around the world. Ample evidence has revealed how inequities to accessing and utilizing health services can have detrimental consequences for certain populations and exist across numerous strata including geography, income, race and ethnicity, age, and gender. This workshop identifies different examples of inequities across countries, and their impact on health outcomes and health care use. Health inequities, in whichever form, lead to one common outcome: worse health outcomes and lower life expectancy for those who are marginalized by inequities compared to their counterparts. This session will dive into the research on health inequities by geography (rural versus non rural), income (low/average income versus high income), race/ethnicity, and among people with substance use disorder (SUD) particularly those who use and inject drugs with the goal of 1) exposing the stark disparities in health care among these populations; 2) discussing lessons which can be learned and adapted from other countries; and 3) discussing promising solutions and approaches to restoring justice and access to care for all. The panel will be composed of 1 moderator and up to 5 panelists. Panelists are experts in their fields, established researchers and practitioners, and either employees of the Commonwealth Fund or alumni of the Harkness Fellowship from various high-income countries including Canada, Germany, Norway, the United Kingdom, and the United States. A moderator from the Commonwealth Fund will frame the discussion by introducing a deep dive into affordability barriers utilizing the Commonwealth’s Fund International Health Policy Survey of nine countries. Munira Gunja, senior researcher on the Commonwealth Fund’s International program, will present how a lack of affordability in health care is a growing threat and will likely widen the disparities by income without serious health reforms. Neil MacKinnon, Senior Harkness Fellow from Canada, will continue the discussion focusing on an analysis he and his team at Augusta University completed on disparities in health care by geography in eleven (primarily European) countries. The second panelist, Sidra Khan-Gokkaya, the 2023-2024 Harkness Fellow from Germany, will present on her study of racism in health care in Germany and the U.S. Another of the 2023-2024 Harkness Fellows, Claire Wilson, will present on her research of racial disparities in perinatal mental illness in the U.K. and U.S. Lastly, the fifth panelist, Ane Kristine Finbråten will discuss the unique health needs of those with SUD and the inequities faced by people who use and inject drugs as they navigate health care. Each panelist will speak for roughly 8 minutes, with 20 minutes saved for moderator and audience questions. Key messages • All stakeholders, including patients, public health systems, and health systems benefit when all populations are able to access comprehensive health services. • Health inequities come in many different forms, and to improve health outcomes, we must address them at all levels.

Factors associated with risky sexual behaviors among undergraduate students in Thailand

BackgroundRisky sexual behaviors refer to actions or practices that increase the likelihood engaging in sexual intercourse. Such behavior can lead to HIV infection/AIDS, sexually transmitted diseases, and unintended pregnancy. The impact of risky sexual behaviors is a growing public health concern. These issues pose significant challenges to public health, particularly among university students and younger age groups who may be more vulnerable to various factors. Thus, this research aimed to examine the factors and sexual health literacy associated with risky sexual behaviors among undergraduate students in the four major regions of Thailand.MethodA cross-sectional study was conducted among 916 undergraduate students in their final semester of the 2023 academic year, from March to May 2024, at public, autonomous, and private universities across four regions: northern, central, southern, and northeastern of Thailand. The study employed multistage random sampling method. A self-administered structured questionnaire was used to assess risky sexual behaviors and the data were analyzed using multiple logistic regression.ResultsA total of 916 students participated in the study. The prevalence of risky sexual behavior was 46.84% (95% CI:43.56% to 50.12%) students engaged in risky sexual behaviors. Risky sexual behavior was significantly associated with grade point averages (GPA) between 2.00–3.00 could protective risky sexual behaviors was 42% as compared to GPA > 3.00 (AOR = 0.58, 95%CI:0.42 to 0.79), ex-substance use (AOR = 3.48, 95%CI:1.46 to 8.26), Current smoker (AOR = 2.90, 95%CI:1.90 to 4.43), negative attitudes toward risky sexual behaviors (AOR = 2.32, 95%CI:1.32 to 4.06), access to places of ill repute and access to sexual arousal stimuli (sometime) (AOR = 2.23, 95%CI:1.41 to 3.52), social influences (high level) (AOR = 0.29, 95%CI:0.15 to 0.55), and sufficient to excellent level of the application of information about sexual health (AOR = 0.48, 95%CI:0.26 to 0.87) of statistical significance at P < 0.05, which was significantly associated with risky sexual behavior.ConclusionThe findings of this study offer important insights for preventing risky sexual behaviors among undergraduate students across four regions. By promoting healthy sexual practices and encouraging behavior modification, negative consequences can be reduced. Public health care providers, policymakers, and stakeholders should implement tailored strategies, such as comprehensive sexual education and accessible health services, to address the specific needs of these students. These targeted interventions can significantly reduce the prevalence of risky sexual behaviors.

Anthropometric indices in older adults with and without Locomotive Syndrome

BackgroundLocomotive syndrome is a major challenge for older adults, and anthropometric indices can greatly affect the musculoskeletal system. This study aimed to compare the anthropometric indices between older adults with and without locomotive syndrome.MethodsThis descriptive-analytical study was performed on 211 older adults using random cluster sampling from a population of over-60 individuals covered by comprehensive health service centers in Sari in Autumn, 2021. Participants were divided into two groups: with and without locomotive syndrome. Locomotive syndrome was assessed via the 25-item Geriatric Locomotive Function Scale questionnaire, and the level of anthropometric indices was determined through the Bioelectrical Impedance Analysis device. Data were analyzed by independent t-test, Mann-Whitney U, Chi-Square, and Binary logistic regression in SPSS, Version 23 (P < 0.05).ResultsThe average age of older adult participants was 78.4 ± 6.6 years. In older adults with locomotive syndrome, the average percentage of fat-free mass (P < 0.001) was significantly lower while the average percentage of fat mass and fat mass index (P < 0.001) was significantly higher. Older adults with locomotive syndrome were shorter in height (P < 0.001) and had a higher body mass index (P < 0.05). Fat-free mass percentage (OR = 0.59) and body mass index (OR = 1.4) predicted the incidence of locomotive syndrome in the subjects. Significant differences such as chronic diseases, chronic pain, falls, age, and gender were observed between the two groups (P < 0.05).ConclusionAnthropometric indices can play an important role in the occurrence of locomotive syndrome in older adults. Evaluation of anthropometric indices and management of body composition can help prevent locomotive syndrome and improve the quality of life of older adults.

SAHELI: Study and Action on Hysterectomy: Evidence on women’s health through the life course in India. Protocol for a mixed-methods study

Hysterectomy, removal of the uterus, is a commonly performed surgery for gynaecological morbidities. Emerging evidence indicates that hysterectomy performed before age 45 (early hysterectomy), is associated with considerable risks to women’s health. While most evidence on hysterectomy is from high-income settings, national surveys from India report high prevalence of early hysterectomy in specific regions, as well as higher prevalence amongst women in rural areas and with less education. The median age at hysterectomy in India is close to ten years before the onset of natural menopause. India has recently introduced national guidelines to address early hysterectomy, but large evidence gaps on the causes and consequences remain – which in turn limits the potential effectiveness of interventions at the clinical, health system and community level. Methods SAHELI is a Team Science study that will examine: (i) individual, social and health system determinants of early hysterectomy; (ii) women’s treatment pathways to hysterectomy and for gynaecological morbidity in general; and (iii) the consequences of undergoing hysterectomy on women’s physical, mental, economic and social well-being across the life course. This mixed-methods study includes population surveys amongst women in ages 25–49 in three high-prevalence states; qualitative health systems research to trace treatment journeys with women, health care providers and other stakeholders; evidence syntheses; and knowledge translation activities to ensure findings inform co-produced strategies and interventions. The study is grounded in a feminist epidemiology approach, aiming to examine individual and structural causes of vulnerability and prioritising the views of women, particularly in knowledge translation. Conclusions SAHELI, implemented by an all-women, multi-disciplinary team, is the first study in India to examine the causes and consequences of hysterectomy in a life course approach. We aim to influence interventions, policy and future research on women’s health, particularly access to quality gynaecological care and comprehensive health services through the life course.

Child maltreatment and insomnia symptoms among Chinese university students: the buffering role of self-efficacy.

Insomnia symptoms represent a significant public health concern, as it engenders substantial long-term health consequences. Considerable research has established the detrimental impacts of child maltreatment on sleep problems among university students. However, the role of self-efficacy in the association between childhood maltreatment and insomnia remains unclear. This study aimed to examine the associations between child maltreatment and insomnia symptoms among university students, and to investigate whether self-efficacy moderated the effects of child maltreatment on insomnia symptoms. A total of 2014 participants with random cluster sampling method were recruited from Jinan University in Guangzhou, China, from October 2022 to November 2022. Adjusting for covariates, the results of multiple logistic regression indicated that the participants with the experience of any type of child maltreatment (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.63-3.07), childhood emotional abuse (OR 2.58, 95% CI 1.95-3.41), childhood emotional neglect (OR 1.16, 95% CI 0.87-1.54), childhood physical abuse (OR 2.15, 95% CI 1.60-2.8), childhood physical neglect (OR 2.19, 95% CI 1.64-2.92), childhood sexual abuse (OR 1.98, 95% CI 1.46-2.68) were more likely to report insomnia symptoms than those without. Individuals reporting one-two types and three-five types of child maltreatment were 1.81 times (95% CI 1.30-2.52) and 3.77 times (95% CI 2.58-5.50) more likely to report insomnia symptoms than those reporting zero types of child maltreatment, respectively. Furthermore, robust linear regression analysis revealed that self-efficacy moderated the associations between child maltreatment and insomnia symptoms (β = 0.007, 95% CI 0.004-0.010). These findings underscore the need for integrated mental health education, support services, and faculty training to address the impact of child maltreatment on insomnia symptoms among university students. Policy recommendations include advocating for comprehensive mental health services, incorporating self-efficacy initiatives, and fostering community engagement for a holistic approach to student well-being.

Effect of educational intervention based on the theory of planned behavior (TPB) on amount of salt intake in pregnant women with PreHypertension

BackgroundPrehypertension is one of the common disorders during pregnancy. Reducing salt intake is among the best cost-effective interventions to reduce the risk of hypertension. The present study aimed to explore the effect of an educational intervention based on the Theory of Planned Behavior (TPB) on amount of salt consumed by prehypertensive pregnant women.MethodsThe present quasi-experimental study was conducted in 2022 on 61 prehypertensive pregnant women visiting the Comprehensive Health Services Centers in Birjand, Iran. Pregnant women were selected through a convenience sampling method and randomly assigned to intervention and control groups. A blood pressure test and a 24-hour urine test were taken in 3 stages (before, immediately after, and one month after the intervention). A reliable and valid questionnaire based on the TPB was used to measure the cognitive variables. The intervention program included three training sessions based on the TPB held on an online platform (WhatsApp social network). Data were analyzed using repeated measures ANOVA and longitudinal marginal model with the GEE approach in SPSS19. The significance level for all statistical tests was set at p < 0 0.05.ResultsAfter intervention, the mean score of perceived behavioral control (p = 0.02), intention (p = 0.004), and salt consumption behavior (p = 0.03) increased significantly in the intervention group, and the mean score of systolic blood pressure (p < 0.001) and diastolic blood pressure (P < 0.01) decreased significantly in this group. In the control group, a statistically significant difference was observed in the systolic and diastolic blood pressure of the subjects (p < 0.01). However, the score of attitude, subjective norms, perceived behavioral control, intention, salt consumption behavior and the daily salt intake did not show a statistically significant difference over time (P < 0.05).ConclusionThe present findings showed that the perceived behavioral control, intention, behavior, systolic and diastolic blood pressure can be modifiable variables to improve the amount of salt consumed by pre-hypertensive pregnant women. Therefore, we recommend that the present model be used to develop interventions to improve health indicators in pregnant women as a highly susceptible group in society.

Effect of an educational intervention based on health belief model on preventive behaviors against malaria in over 18-year-old Afghan immigrants living in Parsian

BackgroundMalaria disease is one of the most dangerous protozoan parasitic infections with a high mortality rate in developing countries. Malaria is a public health issue, especially in Hormozgan province, and is highly affected by foreign immigrants (Pakistani and Afghani); thus, the present study aimed to evaluate the effect of an intervention based on the health belief model (HBM) on the promotion of malaria prevention behaviors in Afghani immigrants over the age of 18. The participants resided in Persian city in Hormozgan province.MethodsThe present quasi-experimental study was conducted on 200 Afghans immigrants over 18 years of age who visited four comprehensive health service centers in Parsian city, south of Iran in June until December 2023. Sampling was by cluster method. In this way, the health centers were considered as clusters, and then 4 centers were randomly selected from among them (two centers of the control group and two centers of the intervention group) and participants were selected by a systematic random method by list of records in the National Integrated Health Record System (called SIB) (100participants control group, 100 participants intervention group). The data were collected using a researcher-made questionnaire based on the HBM before and after the educational intervention An educational program was designed and implemented to promote preventive behaviors against malaria in five sessions using different strategies and based on the HBM for the intervention group. The data were analyzed using independent-samples T-test, paired-samples T-test, Pearson’s correlation coefficient, analysis of covariance and linear regression. All statistical analyses and hypothesis testing were done in IBM SPSS version 25, at a significance level of 0.05.ResultsIn the intervention group, there was a significant difference in the mean scores of knowledge (6.48, 95% CI: 5.9,7.05), perceived susceptibility (10.57, 95% CI: 10.03, 11.1), perceived severity (16.61, 95% CI: 15.83, 16.83), perceived self-efficacy (18.26, 95% CI: 17.55, 18.96), perceived benefits (15.43, 95% CI: 14.68, 16.17), perceived barriers (-22.49, 95% CI: -23.63, -21.30), cues to action (15.06, 95% CI: 14.36, 15.75), and preventive behaviors (20.05, 95% CI: 19.44, 20.65), before and after the educational intervention. P-value < 0.001. The regression analysis showed that the constructs of perceived susceptibility (T = 4.72, P < 0.001), cues to action (T = 5.30, P < 0.001)and perceived self-efficacy (T = 4.93, P < 0.001) led to the greatest change in malaria prevention behaviors(R-Square = 0.549).ConclusionThe present findings showed that the HBM -based intervention was effective in preventive behaviors against malaria in Afghans. It is recommended to design suitable educational interventions in order to increase the perceived susceptibility, cues to action and self-efficacy in order to improve preventive behaviors against malaria in Afghans.

Long COVID in children and adolescents: a historical cohort study with a population-based control group from Iran

BackgroundAfter recovering from the acute phase of COVID-19, some of the infected children manifest long COVID symptoms. The present study aims to identify long COVID symptoms in children and adolescents admitted to hospitals in Bushehr, Iran, during 2021 to 2023, and compare them with the non-affected group.MethodsThis historical cohort study with a population-based control group was conducted on 141 children and adolescents with COVID-19 hospitalized in Bushehr city hospitals and 141 non-affected peers. Out of 10 comprehensive health service centers in Bushehr city, 5 centers were selected by random sampling and the non-Covid-19 group was chosen from them (matched by gender and age with the affected group). The data were collected using the data recorded in the patients’ records, conducting telephone interviews and completing the prevalent long COVID symptom form. Data were analyzed using SPSS version 18. Descriptive statistics, Chi-square/Fisher’s exact tests, and stepwise logistic regression were used. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, with p < 0.05 as the significance level.ResultsThe mean age of the hospitalized children with COVID-19 was 79 ± 5.24 months old, 57.4% of whom were boys. Also, 46 individuals of the COVID-19 group (32.6%) manifested long COVID symptoms. The most prevalent symptoms included fatigue (54.3%), impaired attention or concentration (41.3%) and depression or anxiety symptoms (34.7%). Among the hospitalized children experiencing long-term COVID symptoms, 65.2% exhibited moderate disease severity. A significant relationship was identified between disease severity and muscle and joint pain (P = 0.025), as well as between the length of hospital stay and cough (P = 0.022), weight loss (P = 0.047), and symptoms of depression or anxiety (P = 0.008). Older age [(6–11 y; OR = 3.18, CI = 1.03–9.88); (12 ≥ y; OR = 4.57, CI = 1.40-14.96)] and having history of smoking or being exposed to secondhand smoke (OR = 12.45, CI = 3.14–49.36) were considered as risk factors for long COVID.ConclusionsThe variables of age and history of exposure to tobacco smoke exhibited a significant independent relationship with the occurrence of long-term COVID symptoms in children hospitalized due to COVID-19. Specifically, as age increases and the history of tobacco smoke exposure rises, the likelihood of experiencing long-term COVID symptoms also increases.

The Realities of Caring for a Person with a Mental Disorder in Rural and Remote Capricorn District of South Africa: A Qualitative Study.

In rural African communities, family caregivers shoulder the responsibility of caring for loved ones with mental disorders, often without professional support. This qualitative explorative study, conducted in Limpopo Province, South Africa, aimed to explore the realities of caring for a family member with a mental disorder in rural and remote Capricorn District, in order to uncover insights that can inform support systems, the academic community, interventions, and policies. Non-probability purposive sampling was used to ensure the reproducibility and validity of the results by focusing on participants who are actively involved in caregiving, living in the rural and remote of Capricorn District, in order to provide a comprehensive understanding of their experiences, and this resulted in 15 participants (13 females, 2 males). Data saturation determined the sample size, with data collected through in-depth interviews and analyzed using Tesch's open-coding method. The findings revealed that cultural and spiritual beliefs strengthen caregivers, who exhibit resilience and resourcefulness, yet face financial strain, career setbacks, social isolation, and health declines. The study underscores the critical role of healthcare professionals in recognizing and addressing the challenges faced by family caregivers, while also advocating for the academic community to prioritize the development and dissemination of educational programs focused on safe and ethical coping strategies for caregivers and for policymakers to develop comprehensive mental health services that are accessible and culturally sensitive to rural and remote communities. This is essential because the well-being of caregivers directly influences the rehabilitation and community integration outcomes for individuals with mental disorders.

Access to reproductive health services by female survivors of sexual gender-based violence: a descriptive cross-sectional study of Nairobi City County, Kenya

Background: Sixty percent of women globally are exposed to reproductive health problems related to sexual gender-based violence. In Kenya, sexual violence is one of the top 10 risk factors for disease burden. The study aimed to determine access to reproductive health services by female survivors of sexual gender-based violence in Nairobi city county, Kenya. Methods: The study adopted descriptive cross-sectional design using pretested questionnaires. Study population was 269 female survivors of sexual gender-based violence. Data was analysed thematically and presented by use of percentages and frequencies distribution tables. Binary logistic regression model was used to determine relationships between dependent and independent variables. Odds ratios were evaluated for significance by considering the 95% confidence interval at p value ≤0.05. Results: Access to reproductive health services by female survivors of sexual gender-based violence was 26%. Service availability for survivors in the facilities had a 3 times likelihood of access sexual, knowledge on failure to seek immediate medical attention had 4 times likelihood to increase access while awareness of the period to have prophylaxis had 4.66 times likelihood to increase access. Services provided to survivor had 39% likelihood to increase access, survivors screened for sexually transmitted disease before admission had 10% more likelihood to access and survivors who received post exposure prophylaxis had 0.62 times likelihood of access to sexual reproductive health services. Conclusions: Availability of comprehensive sexual reproductive health services at the facility and good knowledge would increase access to reproductive health services.

Assessing the experiences of teenage mothers in accessing healthcare in Rwanda

Teen mothers are more susceptible to the negative consequences of pregnancy, due to system-wide and socio-cultural barriers to accessing needed services, posing higher pregnancy complications and health risks to the babies and mothers. Understanding their lived experience can inform context-specific health programs and interventions that address their needs and improve the health outcomes. Twenty-three women who had delivered her first child before the age of 18 years were interviewed using semi-structured interview guide. The transcripts were coded, categorized and summarized into four major themes: 1) Many pregnant teen girls were disadvantaged by the system from accessing the healthcare services, 2) Although being judged, many found the health care services positive and important, 3) Faced financial difficulty in accessing health services, despite most medical services are covered by community based health insurance, 4) Health care services focuses mostly on the medical health of pregnancy, the social and psychological needs were mostly not available. The study highlighted the gap in providing mental health services, financial support to the teen mothers as part of a comprehensive health services. Some of them consulted health services for the first time with and did not return for follow up if perceived the services was bad. More sensitive and targeted materials and ANC services can be offered to this unique group of clients. More acceptance training to the health care providers and the public is needed. For health facilities, there is a need to also check their psychological wellbeing when seeking ANC services. Online or mobile phone-based mental health interventions may provide some solutions to the issue. Government should re-evaluate the health insurance system to avoid unintentional exclusion of this group of population. Policy to facilitate men to take responsibilities on teen pregnancy issue is needed.

The effect of prenatal education on health anxiety of primigravid women

Background and aimHealth anxiety is a mental disorder that characterized by an excessive fear about health and physical symptoms. High anxiety in pregnancy is associated with adverse outcomes. The aim of this study was to investigate the effect of prenatal education on health anxiety of primigravid women.MethodsThe present study was quasi-experimental study. 122 primiparous pregnant women referred to comprehensive health services Shahrekord (A city in the southwest of Iran) clinics in 2019, after receiving consent to participate in the study, randomly divided into two intervention and control groups. The intervention group participated in 8 sessions (1.5-h), once every 2 weeks, from 20 to 37th weeks of gestation. The health anxiety questionnaire was completed on 20th (before the beginning of the courses), 28th and 37th weeks by two groups. Consequences of pregnancy included weight, Apgar score, delivery type, labor time and first breastfeeding time. SPSS version 16 software was used for data analysis.ResultsNo significant difference was found type of delivery, gestational age, height, weight, head length, Apgar score, duration of hospitalization and first breastfeeding time. The duration of the active and latent phase of labor was significantly lower and the weight of newborn was significantly higher in the intervention group than the control group (P < 0.05). At 37th week, the scores of illness concern, negative consequence and total health anxiety in the intervention group decreased by 3.42, 0.93 and 4.36 respectively and in control group increased by 2.82, 0.03 and 2.86.ConclusionPregnancy educational courses has positive effects on health anxiety, decrease duration of labor time and increased newborn weight. In order to improve the outcome of pregnancy, educational classes during pregnancy should be considered.

Program Inovasi Pengabdian Masyarakat: Pelayanan Komprehensif Kesehatan Ibu Hamil (GEBUKIN-Gerakan Ibu Hamil Sadar Pemeriksaan Kesehatan) di Wilayah Kerja UPDT Puskesmas Tumbang Kajamei Kabupaten Katingan Tahun 2021-2023

The health program for pregnant women is one of the focuses of health services which ranks first in the 12 minimum service standards (SPM) in the health sector listed in the Republic of Indonesia Minister of Health Regulation No. 04 of 2019. In the health profile of Tumbang Kajamei Community Health Center in 2021, it was stated that K4 experienced a decline of 33% from 2018 to 2020, while for K6 services it was still recorded at 0% until mid-2021. This data is what makes innovation programs a necessity in providing health services for pregnant women. The aim of the activity: increase awareness of pregnant women and the community regarding the importance of routine examinations of pregnant women and increase visits by pregnant women K4 and K6 at the end of 2022. The method of this community service innovation program is sustainable comprehensive health services with 5 activities carried out in June 2021 -December 2022 (1 year 5 months). Implementation results: there was an increase in knowledge of pregnant women by 30%, increased visits and awareness of the community (cadres and companions of pregnant women) regarding health care for pregnant women. Conclusion: there has been an increase in public awareness, especially pregnant women, families and posyandu cadres, of the importance of complete and routine examinations of the health of pregnant women with an increase in pre-post test results during activities and an increase in visits as evidenced by the final achievement in 2022 which has increased.

Socio-ecological influences on access to abortion care in Costa Rica: a qualitative analysis of key perspectives from clinical and policy stakeholders

Costa Rica prohibits abortion except under narrow circumstances to save the pregnant person’s life. The country boasts historically strong support for social policy and human rights, while also presenting a complex and restrictive abortion access landscape. From September 2021 to March 2022, we conducted 23 interviews with obstetrician-gynecologist (OB/GYN) physicians, OB/GYN medical residents, and policy stakeholders to explore the socio-ecological influences on abortion access in Costa Rica. We sampled clinicians and policy stakeholders from the Universidad de Ciencias Médicas listserv through snowball sampling and conducted semi-structured in-depth interviews in Spanish. We identified limited access to comprehensive sexual health education, lack of support from interpersonal networks, inadequate provider knowledge and training, financial and migratory status, and both provider and community stigma as substantial barriers to abortion access. This study addresses a gap in published research around the social determinants of abortion in Costa Rica and sheds light on the attitudes and opinions of the medical and policy stakeholder communities about abortion access. The results highlight the need for expanded access to comprehensive sexual health education, abortion-related training for healthcare providers, and increased programming efforts, such as funding, outreach, and implementation, to ensure comprehensive reproductive health services are available and accessible, especially for vulnerable populations in Costa Rica.

Effects of Post-Joint Comprehensive Plan of Action Sanctions on Weight Gain of Pregnant Mothers, Birth Weight, and Food Security of Their Families (2017-2020)

Background: Sanctions against a country could be a shock to the country's economy for a specific period. Iran has been subject to various sanctions for the past 40 years, and these sanctions have intensified since 2011. Unprecedented sanctions were imposed on Iranians after the United States withdrew from the Joint Comprehensive Plan of Action (JCPOA) agreement, and a disastrous economic situation was the outcome of this international issue. The present study aims to evaluate the impact of this situation on weight gain of pregnant mothers and birth weight as well as food security of their families. Methods: The data of pregnant women and newborns were extracted from Sina Electronic Health System (SinaEHR®) questionnaires. These questionnaires were completed by trained healthcare workers in comprehensive health service centers. The data of 266,182 pregnant women were collected through questionnaires from 19 comprehensive health centers related to Razavi Khorasan province and were prepared for statistical analysis. Then, data analysis was done using the statistical method of Generalized Estimating Equations (GEE) by SPSS software. R

Menggali Penyebab Tingginya Kasus Penularan Penyakit Seksual di Kabupaten Kuningan Perspektif Ham dalam Peraturan Bupati No 362 Tahun 2022

Transmission of sexually transmitted diseases and HIV/AIDS is a public health problem that is still a global challenge. This article aims to analyze the factors causing the transmission of sexually transmitted diseases and stigma towards people with HIV/AIDS, and to examine solutions that support human rights. The results of the analysis show that social, economic, cultural, and structural factors, such as poverty, gender inequality, and limited access to health information and services, increase the vulnerability of certain community groups to the transmission of sexually transmitted diseases. Meanwhile, widespread stigma and discrimination in society have robbed the basic rights of people with HIV, especially the right to health, work, and social participation. This article suggests a human rights-based approach as a comprehensive solution. Preventive and treatment interventions carried out, legal protection and anti-discrimination policies, empowerment of communities and vulnerable groups, and increasing government accountability. The implementation of these solutions is expected to address the root of the problem and encourage the fulfillment of human rights related to sexual and reproductive health. The conclusions obtained in this study include efforts to increase access to comprehensive health services, accompanied by effective public education campaigns. In addition, legal and policy reforms that respect the human rights of people with sexually transmitted diseases are also important steps to address stigma and discrimination.

Designing and Evaluating the Effectiveness of an Educational Intervention Based on the Health Belief Model (HBM) in Promoting Self-Care Behavior Among Healthcare Workers

Background: Self-care is a fundamental aspect of health, encompassing conscious and purposeful actions by individuals for themselves, their children, and their families to maintain health. Objectives: This study aimed to determine the effect of an educational intervention based on the Health Belief Model (HBM) on self-care behaviors among health workers in comprehensive urban health service centers in Rudbar in 2019. Methods: In this quasi-experimental study, 89 health workers from comprehensive urban health service centers in Rudbar city, Gilan, participated. The participants were randomly assigned into control and intervention groups. An educational intervention, consisting of five 60 - 75 minute sessions based on the HBM, was designed and implemented for the intervention group. Outcome data were collected before and three months after the educational intervention using a questionnaire that measured HBM constructs and health-promoting self-care behaviors. Data analysis was performed using the chi-square test and Mann-Whitney U test. Results: The age range of most participants (43%) was 30 - 39 years, and 86% of participants were female. Both experimental and control groups were comparable in demographic characteristics, HBM constructs, and health-promoting self-care behavior at pretest. The educational intervention based on the HBM improved the mean scores of the HBM constructs (except for perceived benefits) and dimensions of self-care behavior (P &lt; 0.05 for all). The average score of self-care behavior in the intervention group increased from 128.4 before the intervention to 148.37 after the intervention. Conclusions: According to the results, using the HBM, with its suitable methods and structure for engaging employees actively, was effective for designing educational interventions to promote self-care behaviors in health workers. Therefore, it can be used as a suitable framework for planning educational interventions to enhance self-care behaviors among health workers.

Costs and cost drivers of comprehensive sexual reproductive health services to female sex workers in Kenya

BackgroundComprehensive sexual reproductive health (SRH) programs for female sex workers (FSW) offering clinical, behavioural, and structural interventions have contributed to declining rates of HIV in this population. However, data on costs and cost drivers is needed to support programs and their donors to better allocate resources, make an investment case for continued funding, and to identify areas of improvement in program design and implementation. We aimed to estimate the annual per-FSW costs of comprehensive services for a standalone FSW program in Kenya.MethodsWe implemented a top–bottom and activity-based costing study of comprehensive FSW services at two drop-in centres (DICs), Mtwapa and Kilifi town, in Kilifi County, Kenya. Service costs were obtained from routinely collected patient data during FSW scheduled and unscheduled visits using Kenyan Ministry of Health records. Costing data were from the program and organization’s expenditure reports, cross checked against bank documents and supported by information from in-depth interviews. Data were collected retrospectively for the fiscal year 2019. We obtained approval from the AMREF Research Ethics Committee (AMREF-ESRC P862/2020).ResultsIn 2019, the unit cost of comprehensive services was 105.93 USD per FSW per year, roughly equivalent to 10,593 Kenya shillings. Costs were higher at Mtwapa DICs compared to Kilifi town DIC; 121.90 USD and 89.90 USD respectively. HIV counselling and testing cost 63.90 USD per person, PrEP was 34.20 USD and family planning was 9.93 USD. Of the total costs, staff salaries accounted for about 60%. Adjusted for inflation, costs in 2024 would be approximately 146.60.ConclusionPrograms should strive to maximize the number of FSW served to benefit from economies of scale. Given that personnel costs contribute most to the unit costs, programs should consider alternative designs which reduce personnel and other costs.