Countries In South-East Asia Region Research Articles

Oral health situation analysis and integration of Massive Open Online Course Modules on Oral Health Promotion in WHO SEAR Countries: A Comprehensive Report

Background: Massive Open Online Course (MOOC) modules are deemed to be novel educational models to optimize learning. They can be useful in delivering oral health education to primary health care workers to strengthen the oral health care delivery system. Therefore, the aim of this study is to analyze the current oral health situation analysis of the South East Asia region countries and to assess areas where the MOOC modules can be integrated as oral health training material. Methodology: A focus group discussion was held virtually with 70 participants from SEAR. The MOOC modules were developed as learning activities to facilitate the application of the material learned, in public settings. The themes for the situation analysis were based on oral health policy, barriers to dental treatment needs and action plan for implementation of the MOOC modules in each SEAR country. Results: Results highlighted the importance of formulating and implementing oral health policy at the national level among the participating countries. Nepal, Maldives, Timor–Leste reported on existing gaps regarding the unmet dental treatment needs. The inclusion of helath care workers in conducting dental procedures was observed in Bhutan. Global school health promoting initiatives were recorded in Maldives. The participating SEAR countries reported on the sensitization of primary healthcare workers through the developed MOOC modules. Conclusion: The developed massive open online course module was acknowledged to be an improved and interactive tool for primary health care workers by the country's oral health officers for oral health promotion and networking.

Surveillance of stroke: a South-East Asia Region (SEAR) perspective.

Surveillance of stroke is critical to track its burden and assess progress in prevention and treatment. We reviewed the literature to evaluate stroke surveillance efforts in the South-East Asia Region (SEAR) countries, identify progress and assess gaps. Epidemiological data on all the major parameters such as the incidence, prevalence and mortality of stroke were available for India and Thailand but for none of the other SEAR countries. Most of the epidemiological data came from investigator-initiated studies. National stroke surveillance was present only in India in the form of a National Stroke Registry Programme and Thailand has a national database that was used to obtain epidemiological data for stroke. Research on novel methods for stroke registration, such as using information technology, was absent. This review identified serious gaps in the monitoring and surveillance of stroke in SEAR countries. Systematic efforts are needed to fill those gaps.

The burden, risk factors and unique etiologies of stroke in South-East Asia Region (SEAR).

The World Health Organization (WHO) South East Asia Region (SEAR) comprises 11 countries, which are one of the most culturally, topographically, and socially diverse areas worldwide, undergoing an epidemiological transition towards non-communicable diseases, including stroke and other cardiovascular diseases (CVDs). This region accounts for over 40% of the global stroke mortality. Few well-designed population-based epidemiological studies on stroke are available from SEAR countries, with considerable variations among them. Ischemic stroke, a common stroke subtype, has higher frequencies of intracerebral hemorrhage in many countries. Along with an aging population, the increased prevalence of risk factors such as hypertension, diabetes mellitus, tobacco and alcohol consumption, lack of physical activity, high ambient pollution, heat, and humidity contribute to the high burden of stroke in this region. SEAR's many unique and uncommon stroke etiologies include cerebral venous thrombosis, tuberculosis, dengue, scrub typhus, falciparum malaria, snake bite, scorpion sting, etc. Current data on stroke burden and risk factors is lacking, compelling an urgent need for high-quality hospital-level and population-level data in all SEAR countries. Strategies towards a consolidated approach for implementing improved stroke prevention measures, stroke surveillance, and established stroke systems of care are the path to bridging the gaps in stroke care.

Assesing Indonesia’s Cyber Capabilities: A New Paradigm of State Power

Objective: Within international relations, power considered as a complex concept. It consists of at least two dimensions which are the scope and the domain. The rapid developments of information-technology among actors bring consequences on how the concept of power perceived in international politics. It limiting the scope and widening the domain at the same time.
 
 Method: This paper aims to put assessment on Indonesia’s cyber power through qualitative method. Firstly, the paper begins with a brief overview on the rising number of cyber threats in global level and how some state actors react to the obstacles.
 
 Result: As Joseph Nye mentioned that the shifting features of cyberspace decrease some of the power discrepancies among global politics actors, and create so-called the diffusion of power that epitomizes international relations in this century. Indonesia as one of the major countries in Southeast Asia Region is also inquired to respond such challenge by developing their cyber capabilities.
 
 Conclusion: It concludes by analysing the aspects of cyber power in Indonesia through qualitative method and also proposing on how Indonesia can utilize the power effectively to face contemporary challenges.
 
 Originality/Value: This paper then considers the development of cyber capacities in Indonesia as its respond to the international phenomenon.

Awareness and Preventive Practice on Kala-Azar among the Community People of Morang, Nepal

Background According to World Health Organization, an estimated 700000 to 1 million new cases and 26000 to 65000 deaths occur annually from Kala-azar. In the countries of South-East Asia region, Kala-azar occurs mainly in three countries- India, Bangladesh and Nepal. The disease occurs in agricultural villages where houses are frequently constructed with mud walls. Even people residing in endemic areas have poor practices for its prevention. Methods A descriptive cross-sectional study was conducted among 150 community people of Katahari Gaupalika, Morang. Simple Random sampling technique was used for the selection of three wards among seven wards, probability proportionate was used for the selection of the population from the ward. The desired sample was selected purposively. Data were collected from face-to-face interview techniques using a structured questionnaire. Statistical analysis was done by using SPSS 16 version. Results It is found that nearly two-thirds of the respondents (63.3%) had moderate awareness, more than one-fifth (22%) of the respondents had adequate awareness while (14.7%) of the respondents had inadequate awareness of Kala-azar. Similarly, more than half (55.3%) had moderate preventive practice, (25.3%) had inadequate preventive practice and nearly one-fifth (19.3%) had adequate preventive practice. The mean score for awareness and practice was 16.633 and 5.54 respectively. Conclusion The study was conducted to assess the level of awareness of Kala-azar. This concluded moderate awareness of respondents on Kala-azar which suggested that there is still a need to improve the awareness of the respondents particularly on its causative agent, preventive measures and complication. However, to improve their awareness to an adequate level, awareness-raising programs focusing on preventive practice should be conducted

An appraisal of peer-reviewed published literature on Influenza, 2000-2021 from countries in South-East Asia Region.

Influenza poses a major public health challenge in South-East Asia Region (SEAR). To address the challenge, there is a need to generate contextual evidence that could inform policy makers and program managers for response preparedness and impact mitigation. The World Health Organization has identified priority areas across five streams for research evidence generation at a global level (WHO Public Health Research Agenda). Stream 1 focuses on research for reducing the risk of emergence, Stream 2 on limiting the spread, Stream 3 on minimizing the impact, Stream 4 on optimizing the treatment and Stream 5 on promoting public health tools and technologies for Influenza. However, evidence generation from SEAR has been arguably low and needs a relook for alignment with priorities. This study aimed to undertake a bibliometric analysis of medical literature on Influenza over the past 21 years to identify gaps in research evidence and for identifying major areas for focusing with a view to provide recommendations to member states and SEAR office for prioritizing avenues for future research. We searched Scopus, PubMed, Embase, and Cochrane databases in August 2021. We identified studies on influenza published from the 11 countries in WHO SEAR in the date range of 1 January 2000-31 December 2021. Data was retrieved, tagged and analyzed based on the WHO priority streams for Influenza, member states, study design and type of research. Bibliometric analysis was done on Vosviewer. We included a total of 1,641 articles (Stream 1: n = 307; Stream 2: n = 516; Stream 3: n = 470; Stream 4: n = 309; Stream 5: n = 227). Maximum number of publications were seen in Stream 2, i.e., limiting the spread of pandemic, zoonotic, and seasonal epidemic influenza which majorly included transmission, spread of virus at global and local levels and public health measures to limit the transmission. The highest number of publications was from India (n = 524) followed by Thailand (n = 407), Indonesia (n = 214) and Bangladesh (n = 158). Bhutan (n = 10), Maldives (n = 1), Democratic People's Republic of Korea (n = 1), and Timor-Leste (n = 3) had the least contribution in Influenza research. The top-most journal was PloS One which had the maximum number of influenza articles (n = 94) published from SEAR countries. Research that generated actionable evidence, i.e., implementation and intervention related topics were less common. Similarly, research on pharmaceutical interventions and on innovations was low. SEAR member states had inconsistent output across the five priority research streams, and there was a much higher scope and need for collaborative research. Basic science research showed declining trends and needed reprioritization. While a priority research agenda has been set for influenza at the global level through the WHO Global Influenza Program since 2009, and subsequently revisited in 2011 and again in 2016-2017, a structured contextualized approach to guide actionable evidence generation activities in SEAR has been lacking. In the backset of the Global Influenza Strategy 2019-2030 and the COVID-19 pandemic, attuning research endeavors in SEAR could help in improved pandemic influenza preparedness planning. There is a need to prioritize contextually relevant research themes within priority streams. Member states must inculcate a culture of within and inter-country collaboration to produce evidence that has regional as well as global value.

Do climatic and socioeconomic factors explain population vulnerability to malaria? Evidence from a national survey, India.

Malaria remains a public health challenge across several African and South-East Asia Region countries, including India, despite making gains in malaria-related morbidity and mortality. Poor climatic and socioeconomic factors are known to increase population vulnerability to malaria. However, there is scant literature from India exploring this link using large population-based data. This study aims to study the role of climatic and socioeconomic factors in determining population vulnerability to malaria in India. We used logistic regression models on a nationally representative sample of 91,207 households, obtained from the National Sample Survey Organization (69th round), to study the determinants of household vulnerability. Households that resided in high (odds ratio [OR]: 1.876, P < 0.01) and moderately high (OR: 3.427, P < 0.01), compared to low climatically vulnerable states were at greater odds of suffering from malaria. Among households that faced the problem of mosquitoes/flies compared to the reference group, the urban households were at higher risk of suffering from malaria (OR: 8.318, P < 0.01) compared to rural households (OR: 2.951, P < 0.01). Households from the lower income quintiles, caste, poor physical condition of their houses, poor garbage management, and water stagnation around the source of drinking water, strongly predicted malaria vulnerability. Household's vulnerability to malaria differed according to state climatic vulnerability level and socioeconomic factors. More efforts by integrating local endemicity, epidemiological, and entomological information about malaria transmission must be considered while designing malaria mitigation strategies for better prevention and treatment outcomes.

Public health research priorities for WHO on COVID-19 in the South-East Asia Region: results of a prioritization survey

BackgroundEffectively addressing the coronavirus disease 2019 (COVID-19) pandemic caused by the new pathogen requires continuous generation of evidence to inform decision-making. Despite an unprecedented amount of research occurring globally, the need to identify gaps in knowledge and prioritize a research agenda that is linked to public health action is indisputable. The WHO South-East Asia Region (SEAR) is likely to have region-specific research needs.MethodsWe aimed to identify a priority research agenda for guiding the regional and national response to the COVID-19 pandemic in SEAR countries. An online, anonymous research prioritization exercise using recent WHO guidance was conducted among the technical staff of WHO’s country and regional offices engaged with the national COVID-19 response during October 2020. They were each asked to contribute up to five priority research ideas across seven thematic areas. These research ideas were reviewed, consolidated and scored by a core group on six parameters: regional specificity, relevance to the COVID-19 response, feasibility within regional research capacity, time to availability for decision-making, likely impact on practice, and promoting equity and gender responsiveness. The total scores for individual suggestions were organized in descending order, and ideas in the upper tertile were considered to be of high priority.ResultsA total of 203 priority research ideas were received from 48 respondents, who were primarily research and emergency response focal points in country and regional offices. These were consolidated into 78 research ideas and scored. The final priority research agenda of 27 items covered all thematic areas—health system (n=10), public health interventions (n=6), disease epidemiology (n=5), socioeconomic and equity (n=3), basic sciences (n=1), clinical sciences (n=1) and pandemic preparedness (n=1).ConclusionsThis exercise, a part of WHO’s mandate to “shape the research agenda”, can help build a research roadmap ensuring efficient use of limited resources. This prioritized research agenda can act as a catalyst for Member States to accelerate research that could impact the COVID-19 response in SEAR.

Comparison of common predictors of current cigarette smoking among adolescents: Across South East Asian countries

BackgroundThe Southeast Asian countries have about 600 million tobacco smokers within the global Burden of tobacco users. Nearly half of the male population and two in every five females in the South-East Asia Region (SEAR) consume tobacco. 19% (Bangladesh) to 55% (Timor-Leste) of 13–17-year old students tried their first cigarette before their 14th birthday. AimTo assess common exposure variables of current cigarette smoking in SEAR countries among school-going adolescents and compare the prevalence and common predictors within SEAR region. DataGlobal Youth Tobacco Survey (GYTS) data is used. ResultA total of 37903 school-going adolescents were included in this study from 10 SEAR countries. The overall prevalence of current cigarette smoking was found 13.1% in SEAR. The minimum prevalence is 1.5% in Sri Lanka (2015), and the maximum is 28.9% in Timor-Leste (2013). Adolescents whose close friends offered to smoke were 21.89 times more likely (AOR = 21.89; 95% CI: 19.60–24.49; P < 0.001) to commit smoking than who didn't offer to smoke. ConclusionsCigarette smoking anywhere in the presence of adolescents and their close friend can act as a promoter for adolescents to smoke. So, to reduce current cigarette smoking, efforts should be made to enforce an anti-smoking policy strictly. Media messages should be spreading aggressively to make people aware of current and second-hand smoking. The public health community may also be used to implement the anti-smoking rule in collaboration with NGOs, academia, research institutions, and regional partners.

The Future of Malaysia’s Dependency on Indonesian Foreign Labors: Findings from Key Informants’ Interview

International migration has become major contemporary change in this era, especially in both developed and developing countries, including Malaysia and Indonesia. Malaysia’s transformation in preparing the country to become industrial based economy has shaped the country as one of the favorite countries in Southeast Asia region for foreign labors migration. The highest migration for job seeking came from neighboring country especially Indonesia. The migration of Indonesians not only drive by the job opportunities but supported by the history of community mobility, geographical proximity, existence of social networks and the similarities of languages, religions and cultures. The arrival of Indonesian labors to Malaysia is a constant necessity for both countries. This paper aims to predict Malaysia’s dependency on Indonesia’s foreign labors in the future. This paper employs qualitative approach in gathering data using five key informants from various authorities involve in the recruitment and management process of foreign labors in Malaysia. It is found that geographical location and job offers are among the pulling factors for the Indonesian foreign labors to choose Malaysia as working destination. Employers in Malaysia too prefer Indonesian foreign labors to reduce their operational cost. The weakness of Malaysian policies and law also does not help in reducing the number of Indonesian foreign labors. Thus, it can be concluded that it is a tough effort to make Malaysia reduce its dependency on Indonesian foreign labors in near future.

The impact of COVID-19 on essential health service provision for endemic infectious diseases in the South-East Asia region: A systematic review.

SummaryBackgroundThere is increasing evidence that the COVID-19 pandemic has impacted adversely on the provision of essential health services. The South East Asia region (SEAR) has experienced extremely high rates of COVID-19 infection, and continues to bear a significant proportion of communicable disease burden worldwide.MethodsWe conducted a systematic literature review of quantitative evidence to estimate the impact of COVID-19 on the provision of essential prevention, detection, treatment, and management services for five high-burden infectious diseases across the SEAR.FindingsA total of 2338 studies were reviewed, and 12 studies were included in our analysis, covering six countries across the SEAR (Bhutan, Sri Lanka, Nepal, Myanmar, Thailand, and India) for three conditions of interest (HIV, TB, dengue fever). We identified significant disruption to TB testing (range=25% to 77.9%) and diagnoses (range=50% to 58%) in India, Nepal, and Indonesia; and similar disruptions were observed for screening, new diagnoses and commencing HIV treatment in India and Thailand. There was also drastically reduced case detection for dengue fever (range=75% to 90% disrupted) in Bhutan and Sri Lanka. No studies were identified for malaria nor hepatitis in any country, and nor for any service in the remaining six SEAR countries.InterpretationWe identified evidence of significant disruption to the prevention, diagnoses, treatment, and management of TB, HIV, and dengue fever due to the COVID-19 pandemic across multiple SEAR country settings. This has the potential to set back hard-fought gains in infectious disease control across the region. The lack of evidence for the impact of the pandemic on malaria and hepatitis services, and in the remaining six SEAR countries, is an important evidence gap that should be addressed in order to inform future policy for service protection and pandemic preparedness.FundingThis work was supported by the WHO Sri Lanka Country office.

Pattern of clinical presentation, lab findings and mortality risk among patients of dengue fever admitted in pediatric intensive care unit in a tertiary care centre in South-east Rajasthan

Background: India is one of the 7 identified countries in south-east Asia region regularly reporting dengue fever outbreaks. Dengue can present with varying degrees of severity of illness in Indian children, present study is aimed at studying the clinical presentation lab findings and mortality risk among patients of dengue fever admitted in PICU in a tertiary care centre in South-east Rajasthan. Methods: It is a retrospective observational study. All dengue seropositive patients admitted in PICU from August 2021 to October 2021 were included in the study. Patients were classified based on National Vector Borne Disease Control Program (NVBDCP). Clinical presentation laboratory findings and mortality risk among patient were studied. esults: Out of 61 patients with dengue, 28(46%) were males and 33(54%) were females. Fever was present in 100% cases followed by GI symptoms vomiting(54.1%), pain abdomen(52.5%) and bleeding manifestations(26.2%) were common presenting complaints. On examination common findings were conjunctival congestion (57%) , hepatomegaly (44%) and flushing (26%). Among complications hypotension/shock (51%) was the commonest followed by hemorrhage (31%), pleural effusion and hepatitis each 21%. Most common bleeding manifestation was melena (19%). Most common affected age group was between10-15 years (42.6%).

Seroprevalence and burden of hepatitis C virus infection in WHO South-East Asia Region: A systematic review.

This systematic review was aimed to estimate hepatitis C virus (HCV) seroprevalence and burden in disease in WHO South East Asia Region (SEAR). Electronic databases (PubMed, Scopus, Embase, and Google Scholar) and websites of non-indexed national medical journals, government and international health agencies were searched to identify English language literature published between 1991 and June 2020. We selected the studies reporting HCV seroprevalence in asymptomatic general (low-risk) and high-risk adult populations, that is, persons living with HIV (PLHIV), persons who inject drugs (PWID), sex workers, persons on maintenance hemodialysis (MHD), people in prison, and men sex with men (MSM). Seroprevalence data were combined to estimate weighted pooled prevalence (95% confidence interval) in each group and in each country, using the random-effects model. Estimated pooled seroprevalences were multiplied with estimated populations at risk to estimate the overall HCV burden. The analysis included 538 studies (35 Bangladesh, 6 Bhutan, 2 DPR Korea, 323 India, 43 Indonesia, 2 Maldives, 18 Myanmar, 29 Nepal, 11 Sri Lanka, 67 Thailand, and 2 Timor-Leste). In SEAR, the weighted pooled anti-HCV seroprevalence was estimated as 0.84% (0.56-1.12) in low-risk population and 13.67% (10.95-16.40) in PLHIV, 51.44% (43.67-59.20) in PWID, 25.80% (20.34-32.09) in MHD, 8.39% (5.84-11.51) in prison inmates, 2.69% (1.43-4.13) in people with high-risk sex behavior, and 11.43% (8.61-14.74) in MSM. The total HCV burden in low-risk and high-risk populations in SEAR countries was estimated as 12.45 million and 1.65 million, respectively. Our estimates of HCV seroprevalence and burden should help the respective countries in planning their HCV elimination strategies.

Mental health promotion for elderly populations in World Health Organization South-East Asia Region: Needs and resource gaps.

The accelerated population growth of the elderly (individuals aged 60 years or more) across the globe has many indications, including changes in demography, health, the psycho-social milieu, and economic security. This transition has given rise to varied challenges; significant changes have been observed in regard to developing strategies for health care systems across the globe. The World Health Organization (WHO) is also engaging in initiatives and mediating processes. Furthermore, advocacy is being conducted regarding a shift toward the salutogenic model from the pathogenic model. The concept behind this move was to shift from disablement to enablement and from illness to wellness, with the notion of mental health promotion (MHP) being promoted. This article attempts to discuss the MHP of elderly individuals, with special reference to the need to disseminate knowledge and awareness in the community by utilizing the resources of the health sector available in the WHO South-East Asia Region countries. We have tried to present the current knowledge gap by exploring the existing infrastructure, human resources, and financial resources. There is much to do to promote the mental health of the elderly, but inadequate facilities are available. Based on available resources, a roadmap for MHP in elderly individuals is discussed.

KETAHANAN PANGAN DAN PEMBANGUNAN MANUSIA SERTA DAMPAKNYA TERHADAP KEGIATAN EKONOMI : STUDI KASUS NEGARA ASEAN

Examine the effect of food security which consists of the dimensions of affordability, availability, quality &amp; safety and natural resources on the human development index (HDI) and its impact on the level of economic activity for countries in the Southeast Asia region. The research design uses hypothesis testing of the effect of the independent variable on the dependent variable using the Structural Equation Model (SEM). This study uses sample of 9 countries in Southeast Asia region (Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam) with a study period of 9 years (20120-2020). The research findings show that the dimensions of affordability and quality &amp; safety have a significant positive effect on HDI, while the dimensions of availability and natural resources have no positive effect on HDI. Other findings also prove that HDI has a positive effect on the level of economic activity (GDP).

Development of Diabetic retinopathy screening guidelines in South-East Asia region using the context, challenges, and future technology

ABSTRACT Objective To formulate guidelines for screening of diabetic retinopathy (DR) for the World Health Organization (WHO) South-East Asia Region (SEAR) aligned with the current infrastructure and human resources for health (HRH). Design A consultative group discussion of technical experts of the International Agency for the Prevention of Blindness (IAPB) from SEAR. Participants IAPB country chairs and DR technical experts from SEAR countries. Methods Data related to DR in SEAR was collected from published literature on available DM and DR guidelines and the participating experts. The 10 SEAR countries (the Democratic Republic of Korea was not included for lack of sufficient data) were divided into 3 resource levels (low, medium, and high) based on gross national income/per capita, cataract service indicators (cataract surgical rate and cataract surgical service), current infrastructure and available HRH. Two countries each were assigned to low (Myanmar, Timor-Leste) and high resource (India, Thailand) levels, and the remaining 6 countries (Bangladesh, Bhutan, Indonesia, Maldives, Nepal, Sri Lanka) were assigned the medium resource level. The DR care system was divided into 3 levels of care (essential, recommended, and desirable) and 3 levels of service delivery (primary, secondary, and tertiary). Main outcome measures Primary, secondary, and tertiary level guidelines for screening of DR Results Nine WHO SEAR countries participated in the formulation of the new country-specific DR screening guidelines. The DR screening recommendations were: advocacy at the community level, visual acuity measurement, and non-mydriatic fundus photography at the primary level, comprehensive eye examination and retinal laser at the secondary level, and intravitreal therapy and vitrectomy at the tertiary level. The systemic care of DM and hypertension are recommended at all levels commiserating with their care capabilities. Conclusions The DR guidelines for the SEAR region are the first region-specific and resource-aligned recommendations for comprehensive DR care in each country of the region. In the future, the new technological advances in retinal camera technology, teleophthalmology, and artificial intelligence should be included within the structure of the public DR care system.

Financing health care in the WHO South-East Asia Region: time for a reset

The coronavirus disease 2019 (COVID-19) pandemic is having a devastating impact and continues to take its toll in the World Health Organization South-East Asia Region. In addition to its direct impact on morbidity and mortality, the pandemic is adversely affecting economic activity as a result of lockdowns and voluntary social distancing. The average per capita economic contraction among South-East Asia Region countries is currently projected to be 5.3% in 2020, suggesting severe consequences for financing for health and sustaining progress towards universal health coverage. Health financing systems in many countries of the region – characterized by extremely low levels of public financing and a predominance of out-of-pocket spending – have contributed to weaknesses in primary health care (PHC), including in relation to pandemic preparedness and containing COVID-19. Without sustained countercyclical public spending and an increased priority for health in government budgets, countries will be likely to see a slowdown or even reversal in growth in public financing for health, which is already at a low level in several countries of the region. In the face of this economic adversity and fiscal tightening, efforts to improve the efficiency and equity of public spending on health will be key, especially for strengthening PHC and enhancing cost-effectiveness in terms of the choice and delivery of interventions. To this end, countries must emphasize the public health focus, improve targeting of public financing towards the poor and vulnerable, reduce fragmentation and duplication of financing flows, leverage strategic purchasing and cut wasteful spending. The COVID-19 pandemic also presents an opportunity to reset how health systems and PHC are prioritized and adequately financed in the countries of the South-East Asia Region, as areas of core public investment that not only contribute to better health outcomes but also are critical for ensuring a sustained economic recovery.

The Patient-Provider Continuum of Care: Narratives of People Living With Comorbid HIV and Diabetes in Northern Thailand.

Background:Among South-East Asia Region countries, Thailand has a high prevalence of HIV with an increasing significant comorbidity of diabetes mellitus (DM).Objective:Guided by syndemics, the purpose of this qualitative study is to develop insight into the experience of patients living with comorbid HIV and DM in Northern Thailand for quality improvement.Methods:Interviews were conducted in 2 groups for content analysis: (1) people living with comorbid HIV and DM and (2) health-care staff providing care to patients living with the comorbidity.Results:Participants’ (N = 12) ages ranged from 42 to 56 (mean = 49). Health staff (N = 12) generated complementary narratives. All participants reported onset of diabetes after discovering they were HIV infected. Content analysis revealed emergent themes regarding (1) knowledge and perceptions and (2) management framed by syndemics and chronicity.Conclusion:Findings suggest routine training for patient education and provider integration of care. Macrosocial factors such as limited access and resources and biological factor such as drug interactions are noted as key considerations for future interventions and alterations in the care for patients with comorbid HIV and DM.

The Impact Indonesia’s Sinking of Illegal Fishing Ships on Major Southeast Asia Countries

This study examines Indonesia’s sinking of illegal fishing ships influencing its relationship with countries in Southeast Asia region. Considering that the loss of and damages to national resources due to illegal, unreported, and unregulated (IUU) fishing in Indonesia are so huge, President Joko Widodo has a commitment to no longer tolerate such a crime. The approach of his Minister of Maritime and Fishing Affairs has been to sink IUU Fishing ships which mostly flagged foreign flags. As a result, Indonesia’s relation with neighboring countries is affected. However, the assertive policy of Indonesia did not lead to a commotion among the states in the region. Hence, this study attempts to discover why Indonesia does not find significant obstacles to continuously carry out sinking foreign IUU fishing ships from its counterparts in Southeast Asia region namely Malaysia, Thailand, Vietnam, and the Philippines. Statements of the statesmen around the countries and other related documents on the matter are used to examine their response to the Indonesia’s policy. In line with the method, this study capitalizes neoclassical realism by Gideon Rose in which foreign policies are considered a reflection of systemic pressure, domestic political demands (innenpolitik), and state power.

Dental caries prevalence among 5- to 15-year-old children from SEAR countries of WHO: A systematic review and meta-analysis.

The aim of this review was to estimate the prevalence of dental caries in children 5-15 years of age in the countries of the South-East Asia Region (SEAR) of World Health Organization (WHO) and to describe the different caries indices used in these population-based studies. A systematic search was carried out in two databases from 1st January 2005 to 31st May 2015. Studies were included if they met the predetermined eligibility criteria. Quality assessment was done with eight-item checklist. Meta-analysis was done for 5, 12, 15, and 6-15 years age group using software STATA version 12. The search strategy yielded 265 unique articles of which 36 met the inclusion criteria included for the review. Data were available for only three SEAR countries. The quality of the majority of the studies ranged from moderate to high. Heterogeneity between the studies was high (I2 > 98%). Variation in dental caries prevalence was found among different ages and among different SEAR countries. The most commonly used index for measuring dental caries was the dentition status of the 1997 WHO criteria. Dental caries continues to be a prominent oral health problem among children in the SEAR countries with huge variation in the prevalence across ages and countries. This review results can be used to update the "WHO Oral Health Country/Area Profile Program" for dental caries among children for SEAR.