Health Programs Research Articles

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.

Determinants of Wellness Program Utilization Among Law Enforcement Personnel: A Focus on Psychological and Physical Health

Determinants of Wellness Program Utilization Among Law Enforcement Personnel: A Focus on Psychological and Physical Health

Educational Prerogative or Public Health Program: A Comparative Approach to Sex Education Policies in the United States and Spain

Educational Prerogative or Public Health Program: A Comparative Approach to Sex Education Policies in the United States and Spain

Highly sensitive wastewater surveillance of SARS-CoV-2 variants by targeted next-generation amplicon sequencing provides early warning of incursion in Victoria, Australia.

The future of the COVID pandemic and its public health and societal impact will be determined by the profile and spread of emerging variants and the timely identification and response to them. Wastewater surveillance of SARS-CoV-2 has been widely adopted in many countries across the globe and has played an important role in tracking infection levels and providing useful epidemiological information that cannot be adequately captured by clinical testing alone. However, novel variants can emerge rapidly, spread globally, and markedly alter the trajectory of the pandemic, as exemplified by the Delta and Omicron variants. Most mutations linked to the emergence of new SARS-CoV-2 variants are found within variable regions of the SARS-CoV-2 Spike protein. We have developed a duplex hemi-nested PCR method that, coupled with short amplicon sequencing, allows simultaneous typing of two of the most highly variable and informative regions of the Spike gene: the N-terminal domain and the receptor binding motif. Using this method in an operationalized public health program, we identified the first known incursion of Omicron BA.1 into Victoria, Australia and demonstrated how sensitive amplicon sequencing methods can be combined with wastewater surveillance as a relatively low-cost solution for early warning of variant incursion and spread.IMPORTANCEThis study offers a rapid, cost-effective, and sensitive approach for monitoring SARS-CoV-2 variants in wastewater. The method's flexibility permits timely modifications, enabling the integration of emerging variants and adaptations to evolving SARS-CoV-2 genetics. Of particular significance for low- and middle-income regions with limited surveillance capabilities, this technique can potentially be utilized to study a range of pathogens or viruses that possess diverse genetic sequences, similar to influenza.

Promoting healthy sleep in 0-2-year-old infants: a study protocol for the development and mixed method evaluation of a sleep health program tailored to Dutch youth healthcare regions

BackgroundSleep problems are common among infants and can have a serious impact on the health and wellbeing of both child and parents. To sustainably promote infant sleep on a population level, it is necessary to develop evidence-based programs that can be implemented on a large scale. The Youth Health Care setting, with its focus on prevention, child health promotion and services widely available for parents, can be a suitable setting to do so. Currently however, sleep health promotion in this setting seems to be suboptimal. To promote healthy infant sleep on a population level, programs need to be accessible and comprehensible for all parents, including parents with limited (health) literacy. Therefore, this study aims to develop, implement and evaluate a program called ‘Sleep on number 1’, that is tailored to Dutch Youth Health Care, to sustainably promote healthy sleep in 0-2-year-old infants.MethodsThe program was developed based on co-creation with parents and Youth Health Care professionals, evidence-based behaviour change theories and sleep health promotion methods. Program effectiveness is investigated with a quasi-experimental study design comparing the program group with the care as usual control group. Participants consist of parents of 0-2-year-old children. Primary outcome is infant sleep quality at the age of 10 weeks and 6, 9, 14 and 24 months, measured with a sleep diary. The primary data analysis focuses on night awakenings at 9 months. Secondary outcomes focus on parental behaviour regarding infant sleep, related behavioural determinants and parental satisfaction with Youth Health Care sleep advice. Program effectiveness is analysed using a linear mixed-model in case of data clustering, and an independent samples T-test or linear regression in case no substantial clustering effects are found. A mixed methods process evaluation is performed with parents and Youth Health Care professionals, assessing program reach, adoption, implementation, maintenance and working mechanisms.DiscussionThe ‘Sleep on number 1’ program is an evidence-based sleep health program for 0-2-year-old children, tailored to Dutch Youth Health Care. If effective, this program has the potential to improve infant sleep on a population level.Trial registrationISRCTN, ISRCTN27246394, registered on 10/03/2023. https://www.isrctn.com/ISRCTN27246394.

Norwegian Health Professionals’ Attitudes Toward Addressing Sexual Health with People with Intellectual Disabilities

Abstract Introduction Staff working with individuals with intellectual disabilities face challenges addressing sexual health. Professionals in this context have diverse backgrounds and education, and little is known about their attitudes and skills in providing support for a healthy sexual life and preventing abuse. Moreover, this topic has not been explored in the Norwegian context. The current study examined health professionals’ attitudes toward addressing sexual health with individuals with intellectual disabilities in Norwegian municipal health and care services. Methods A cross-sectional study was conducted using the Norwegian version of the professionals’ attitudes toward addressing sexual health among 72 health professionals working in municipal services for people with intellectual disabilities in Mid-Norway. The data was collected from November 2022 to January 2023. Results The professionals reported feeling partially comfortable and prepared to address sexual health issues with clients. They consistently expressed a need for more basic knowledge about sexual health and training in communicating about sexuality. Attitudes toward addressing sexual health varied based on the professionals’ education, gender, age, and work experience. Conclusions More targeted training on sexual health is needed within the educational programmes in health and social sciences. Sexual health should also be continuously addressed in the workplace and among colleagues. The differences in attitudes between professionals indicate that the composition of the staff benefits from diversity. Policy Implications Healthcare managers are responsible for ensuring greater openness and reflection on attitudes toward sexuality among individuals with intellectual disabilities in workplaces. Educational institutions must provide the necessary skill development and training in communication about sexual health for this client group.

Cultivating a culture of excellence: Synthesizing employee engagement initiatives for performance improvement in LNG production

Cultivating a culture of excellence is paramount for success in LNG production, and employee engagement plays a central role in achieving this goal. This abstract explores the synthesis of various employee engagement initiatives aimed at enhancing performance in LNG production facilities. Effective employee engagement initiatives are essential for fostering a culture of excellence within LNG production facilities. By empowering employees and promoting a sense of ownership and commitment, organizations can unlock the full potential of their workforce and drive continuous improvement in performance. This abstract examines a range of employee engagement strategies tailored specifically for the unique challenges and demands of LNG production. These initiatives encompass various aspects of employee engagement, including communication, training and development, recognition and rewards, and fostering a supportive work environment. Communication lies at the heart of effective employee engagement. Open and transparent communication channels facilitate the exchange of ideas, feedback, and information, fostering collaboration and alignment towards common goals. Additionally, regular communication helps employees feel valued and informed, enhancing their sense of belonging and commitment to the organization. Investing in training and development opportunities is another critical aspect of employee engagement in LNG production. By providing employees with the skills and knowledge they need to excel in their roles, organizations can empower them to contribute meaningfully to the success of the operation. Continuous learning opportunities also demonstrate a commitment to employee growth and development, which can boost morale and job satisfaction. Recognition and rewards programs play a crucial role in reinforcing desired behaviors and motivating employees to perform at their best. Whether through monetary incentives, public recognition, or other forms of acknowledgment, recognizing employee contributions fosters a culture of appreciation and reinforces the organization's values. Finally, creating a supportive work environment that prioritizes employee well-being and work-life balance is essential for sustaining high levels of engagement and performance. Providing resources such as wellness programs, flexible work arrangements, and opportunities for social connection helps employees feel supported and valued, leading to greater job satisfaction and commitment. In summary, cultivating a culture of excellence in LNG production requires a multifaceted approach to employee engagement. By implementing a range of initiatives focused on communication, training and development, recognition and rewards, and fostering a supportive work environment, organizations can empower their employees to thrive and drive continuous improvement in performance. Keywords: Cultivating, Culture of Excellence, Performance Improvement, LNG Production, Employing Engagement Initiatives.

Sugar‐Sweetened Beverages Taxation Plan in Indonesia: Call for Political Commitment

ABSTRACTIndonesia is grappling with a rise in obesity and diabetes, partially driven by a high consumption of sugar‐sweetened beverages. The prevalence of obesity among adults more than doubled from 2007 to 2018, and diabetes rates have also increased. In response, the Indonesian government has proposed an excise tax on sugar‐sweetened beverages to reduce consumption. However, the implementation of this policy has repeatedly been delayed, with the latest postponement to 2024. Sugar‐sweetened beverages contribute significantly to chronic diseases, increasing the healthcare burden and reducing economic productivity. Taxation, a widely used public health strategy in the form of fiscal measures, can decrease consumption by raising prices, raising public awareness, encouraging product reformulation, and generating revenue. Despite its potential benefits, the proposed tax in Indonesia faces substantial political and commercial challenges. The president‐elect Prabowo Subanto has not explicitly supported the tax in his political manifesto, raising concerns about further delays due to industry lobbying. Successful implementation of the tax requires robust political will, public and civil society pressure, and effective cross‐sector cooperation. The government must ensure clear policy goals, equal application to domestic and foreign products, and supportive measures such as providing free drinking water alternatives. Transparent stakeholder consultations can build broad‐based support, whereas effective monitoring and evaluation frameworks are essential for compliance. To gain public support, allocating tax revenues to public health and social programs is crucial. Although initial resistance is expected, strong enforcement mechanisms can ensure adherence. With determined political commitment and public advocacy, the sugar‐sweetened beverage tax can significantly reduce obesity and diabetes rates, improving public health outcomes and economic productivity in Indonesia. This commentary provides an overview of the proposed tax, explores its challenges, and offers recommendations for successful implementation.

The effectiveness of the WHO school mental health package in promoting mental health literacy among secondary school teachers in Qatar: a randomized controlled trial

Teachers’ mental health literacy (MHL) is fundamental for recognizing and assisting students with mental disorders. The aim of this study was to assess the effectiveness of the World Health Organization School Mental Health Program (WHO-SMHP) in promoting MHL among secondary schools’ teachers in Qatar. We conducted a two-arm randomized control trial. Teachers working in governmental secondary schools were eligible for selection. A total of 16 schools (8 intervention, 8 control) randomly selected and stratified by gender then randomly assigned (1:1). Participants and study team were aware of group assignment. Assessment of teachers’ MHL was at day 0, 3 then 3 months afterward. Bivariat analysis and Generalized Estimating Equations were used in analysis. The primary outcome was teachers MHL. Secondary outcome was the influence of sociodemographic characteristics on the level of MHL. Between October 30, 2018 and March 21, 2019, we randomly assigned 195 teachers from 16 schools to attend training workshop on WHO-SMHP (n = 95) or usual practice (n = 100). Compared with controls, teachers from intervention group demonstrated a significant improvement in the level of MHL at day three (mean difference = 19.1, 95% CI = 17.0–21.2, Cohen’s d = 2.63; p < 0.001).) and after three months (mean difference 16.61, 95% CI = 13.96–19.26, Cohen’s d = 1.86; p < 001). There were no significant differences related to influence of other variables on MHL. To our knowledge, this is the first trial to prove the effectiveness of the (WHO-SMHP) in promoting teachers MHL, which can be successfully implemented in a wider scale.

Perceived Competencies and Training Needs of Public Health Nurses in the Philippines: Basis for the Development of NurseLEAD: A Leadership Course on Advanced Practice Nursing in Public Health

Background and Objective. Public health nurses (PHNs) perform more than the provision of direct care to clients.They are also expected to perform roles as leaders, managers, and collaborators in different settings, especially inareas where there are no physicians. Their continuous professional development must be facilitated to empower them to lead the delivery of health programs and services in pursuit of universal healthcare. This study aims to determine the perceived competencies of public health nurses and describe their training needs. Methods. A descriptive, cross-sectional study was utilized, where an online survey was administered to PHNs across the Philippines to determine their self-perceived competencies and training needs based on the eight domains of core competencies of public health professionals. Descriptive statistics was used to summarize the data. Results. A total of 330 PHNs answered the survey. The results showed that at baseline, PHNs perceived themselves to be competent (from most to least) in the following: communication, analytical/assessment, community dimensions of practice, policy development/ program planning, leadership and systems thinking, cultural competency skills, public health science, and financial planning and management. In terms of training needs, the enablers mentioned include a supportive work environment that can provide a work schedule that is inclusive of time for professional development and work-life balance; a learning environment where colleagues and supervisors support the need for training and innovation; strong internet connection; and enough equipment to participate and submit deliverables for courses taken. Conclusion. Filipino public health nurses perceived themselves to be competent in the areas of communication and community practice, but less competent in public health science, and financial planning and management. Future capacity-building programs must be designed to meet this demand. Furthermore, to make training programs truly responsive to the needs of nurses, steps must be taken to promote capacity-building enablers.

“Lusog-Linang”: Utilizing Community-engaged Research towards Capacity Building in Health of an Underserved Community

Background and Objectives. Nurses have a pivotal role in nurturing the capabilities of individuals, families, and population groups for better health. However, underserved communities in the Philippines, such as those with socioeconomic inadequacies, geographic isolation, and service access problems, have significant limitations in attaining the highest possible level of health. Hence, a community extension service (Project “Lusog-Linang”), employing community-engaged research, was launched with the residents of an underserved locality in Central Luzon. The current paper aimed to describe the engagement of the community residents in describing their current health situation and related priority problems, as well as explore appropriate initiatives to manage the identified problems. Methods. Community-engaged research was utilized to enable the residents of Barangay San Vicente, Bamban, Tarlac to participate in health capacity building. Particularly, records review and focus group discussions were conducted to assess the community’s health needs and to identify the residents’ perceived problems. The findings were presented in a community assembly, where residents further discussed their priority health concerns and potential interventions to address them. Quantitative data were summarized through descriptive statistics, while qualitative information was synthesized via content analysis. Results. The priority community health problems included healthcare inaccessibility (trained staff, health equipment, and facility access), food insecurity, water supply limitations, and environmental sanitation. Moreover, there was inadequate knowledge and skills among the residents in health promotion, disease prevention, and illness management. While Barangay San Vicente had limited socioeconomic resources to optimize their health capacities, the sense of community among the residents is a vital resource towards empowering them to improve their health. Conclusion. The results could be utilized as a launching pad for developing appropriate health programs for theresidents of Barangay San Vicente. Hence, the next steps in Project “Lusog-Linang” should include the identification and training of core group members toward community mobilization, and further exploring collaborative and sustainable partnerships across organizations to ensure that the community will have long-term solutions to their problems. Consequently, this project could guide public health workers in ensuring the active involvement and participation of the community members in managing their own health.

Knowledge towards the health impacts of climate change and associated factors among undergraduate health sciences students in Amhara region: a multi-centered study

BackgroundIncreased knowledge about the health impacts of climate change would motivate health students and health professionals to adopt sustainable healthcare practices, design climate-centered health programs, help build climate-resilient health systems, and ultimately contribute to the global effort of mitigating climate change.MethodAn Institution-based cross-sectional study was conducted among Universities in the Amhara region. A total of 616 undergraduate health science students were included from three Universities. A validated, self-administered structured questionnaire was used. Data were analyzed using STATA™ version 14.0. A Logistic regression model was used to identify the factors associated with the health impacts of climate change. A P-value less than 0.05 was considered to be statistically significant.ResultOnly 48.5% (95% CI: 44.6, 52.4) of students had good knowledge regarding the health impacts of climate change. Sex of the student—male (AOR = 1.44, 95% CI: 1.032, 2.023), University (AOR = 0.534, 95% CI: 0.360, 0.792), and Department—comprehensive Nursing, (AOR = 0.264, 95% CI: 0.117, 0.592), Midwifery (AOR = 0.201, 95% CI: 0.085, 0.476), and Medical Laboratory (AOR = 0.151, 95% CI: 0.055, 0.413) were significantly associated factors.ConclusionThe knowledge of the health impacts of climate change among health science students was low. Sex, University, and Department were the associated factors. Hence, undergraduate health science programs should incorporate at least the fundamental details of climate change. Universities should also develop and use a harmonized curriculum.

Adolescent health-risk behaviours in Uruguay: Patterns from national cross-sectional school surveys conducted in 2006, 2012 and 2019.

There are no trend studies on various health risk behaviours among adolescents in Uruguay. Therefore, this study looked at trends in a number of health-risky behaviours among adolescents in Uruguay from three separate surveys. Data from 9272 adolescents (age range: 11-16 years), who took part in three cross-sectional national in-school surveys in Uruguay in 2006, 2012 and 2019 were analysed. A self-administered survey was used to evaluate 24 health risk behaviours. By using logistic regression analyses to treat the study year as a categorical variable and adjusting food insecurity and age, linear trends were examined. We found a significant increase in the prevalence of being overweight, having obesity, inadequate fruit intake, sedentary behaviour in leisure-time, physical inactivity, bullying victimisation, loneliness, suicidal ideation, and sexual activity. We found a significant decrease in current cigarette use, physical fighting and current alcohol use. Among males, a significant increase of non-condom use, and a decrease in current other tobacco use (other than cigarettes), being physically attacked and the number of sexual partners. Among females, we found an increase in food insecurity, trouble from alcohol use, multiple sexual partners, and sleep problems. Overall, from 2006 to 2019, there was a decrease in seven health risk behaviours among boys and/or girls. Among boys, there was an increase in 10 health risk behaviours and among girls, 15 health risk behaviours increased, highlighting adolescent girls' greater vulnerability, thereby perpetuating further gendered health inequalities. In Uruguay, school health programmes for adolescents are recommended.

Young People's Barriers and Facilitators of Engagement with Web-Based Mental Health Interventions for Anxiety and Depression: A Qualitative Study.

The prevalence of anxiety and depressive symptoms in young people have increased in many countries around the world. Web-based mental health interventions (or W-MHIs) have the potential to reduce anxiety and depression symptoms for young people. Although W-MHIs have become more widely used by young people since the coronavirus disease 2019 (COVID-19) pandemic, real-world engagement in these W-MHIs has remained low compared with engagement reported in research studies. Moreover, there are limited studies examining factors influencing engagement with W-MHIs in the post-COVID-19 pandemic years. This study aims to explore barriers and facilitators of engagement with W-MHIs for anxiety and depression among young people. Seventeen semi-structured interviews and one focus group with three participants were conducted online via Zoom between February and March 2023. Participants were young people aged 18-25 years who had self-reported experience of anxiety and/or depression in the past 6months, lived in Australia, and considered using W-MHIs to manage their anxiety and/or depression symptoms. Inductive thematic analysis was performed to understand the key barriers and facilitators of young people's engagement with W-MHIs. Both individual- and intervention-related factors influenced young people's engagement with W-MHIs. Facilitators of engagement included personal trust and beliefs in W-MHIs, ability to contact a health professional, programme suitability (e.g., affordability, content aligning with user needs), programme usability (e.g., user interface), and accessibility of the online platform. Barriers included concerns about online security, lack of human interaction and immediate responses from health professionals (if any), and negative experience with mental health programmes. Participants expressed greater willingness to pay if they could contact health professionals during the programme. Better promotion strategies for mental health and W-MHI awareness are needed to increase the perceived importance and priority of mental health interventions among young people. Young people should be involved in the W-MHI co-design to enhance the programme suitability and usability for young people, fostering their engagement with W-MHIs.

Lifestyles and Academic Stress in University Students of Health Sciences: A Mixed-Methodology Study

The global health emergency generated by the COVID-19 pandemic (caused by the SARS-CoV-2 virus) led to the implementation of extraordinary measures such as confinement and isolation in many countries to mitigate the spread of the virus. (1) This study analyzes the lifestyles and academic and perceived stresses of university students of health sciences during the period of online learning due to the COVID-19 pandemic. The relationship between lifestyles and academic stress was examined. (2) A parallel mixed-method convergent study was conducted, with a correlational non-experimental design. Quantitative and qualitative data were collected and analyzed in parallel, with parametric and nonparametric testing for quantitative data and Miles and Huberman’s approach to qualitative analysis. The qualitative findings complemented the quantitative results. The number of students who participated in this study was 2734, from six programs in health, nursing, medicine, clinical laboratory, physiotherapy, dentistry, and clinical psychology at the University of Chimborazo, Ecuador. (3) Overall, the health science students had “Unhealthy or health-compromising lifestyles”, medical students being the ones who have healthier lifestyles. However, more than 80% experienced and perceived stress during the period of online learning and social isolation due to the pandemic, women being the ones who experienced it at a higher level. (4) The online learning modality during the COVID-19 pandemic modified lifestyles and generated stress in health science students, due to changes in daily routines, sedentary lifestyle, and stress, as a result of social isolation. Therefore, the students prefer face-to-face teaching, perceived as enabling more enriching interactions with their teachers and peers and the opportunity to develop essential practical skills in their health practice.

Assessment of eye health programme reach by comparison with rapid assessment of avoidable blindness (RAAB) survey data, Talagang, Pakistan

BackgroundThe purpose of this study was to quantify how much of the burden of visual impairment (VI) and unmet need in Talagang, identified by Rapid Assessment of Avoidable Blindness (RAAB) survey data, has been addressed by Community Eye Health (CEH) programme efforts.MethodsA RAAB survey was carried out in November 2018, with 2,824 participants in Talagang Tehsil, Punjab, Pakistan, aged 50 and over. Census data were used to extrapolate survey data to the population. Alongside this, a CEH programme was launched, consisting of community eye screening, and onward referral to rural health centres, secondary or tertiary ophthalmological services, as required. This health intervention aimed to address the eye care needs surfaced by the initial survey. From 2018 to 2022, 30,383 people aged 50 or over were screened; 14,054 needed referral to further steps of the treatment pathway and more detailed data collection. Programme data were compared to estimates of population unmet needs. Main outcome measures were prevalence of VI, and proportion of need met by CEH Programme, by cause and level of VI.ResultsAmong those aged 50 and over, 51.0% had VI in at least one eye. The leading causes were cataract (46.2%) and uncorrected refractive error (URE) (25.0%). In its first four years, the programme reached an estimated 18.3% of the unmet need from cataract, and 21.1% of URE, equally in both men and women.ConclusionsRobustly collected survey and programme data can improve eye health planning, monitoring and evaluation, address inequities, and quantify the resources required for improving eye health. This study quantifies the time required to reach eye health needs at the community level.

Religion- and Spirituality-Based Effects on Health-Related Components with Special Reference to Physical Activity: A Systematic Review

The positive effects of religion and/or spirituality through faith-based interventions on health and promoting health programs have been well documented over the last two decades. Research indicates that faith-related programs can motivate increased physical activity, among other behaviors. This review summarizes the literature on how religion and spirituality beliefs and practices support physical, mental, and psychosocial health, focusing primarily on physical activity. A literature search was conducted using databases (Medline/PubMed, Science Direct) and Google Scholar, with search terms like “religion”, “spirituality”, “physical activity”, “physical exercise”, and “health” to identify relevant studies from 2017 to 2023. Thirteen studies were selected, including seven cross-sectional designs, four randomized controlled trials, and two cohort studies. Eleven of these studies reported positive effects of religious faith, religiosity, and spirituality interventions on increasing physical activity or reducing sedentary behavior. These findings confirm that greater religious commitment is positively associated with better health outcomes, including increased physical activity. This research suggests that further studies are needed to identify specific religiosity/spirituality variables in the context of physical activity association and to clarify the underlying mechanisms. Such insights may inform the development of intervention programs aimed at promoting physical activity and strengthening health associations.

Socialist Retrenchment

Both China and Vietnam went through retrenchment in their rural healthcare systems during the 1980s and 1990s. However, there is a difference between the two in the depth of retrenchment. While China allowed the Cooperative Medical System (CMS) to collapse, Vietnam nationalized the Commune Health Stations (CHS) and established national health programs. Why did the retrenchment paths of these two countries diverge? This article finds that political, economic, and social factors can explain variation across China and Vietnam. Whereas in the 1980s and early 1990s, politics was the dominant factor determining variation, the combination of political and economic factors shaped different outcomes during the mid- and late 1990s. In contrast, social factors were a contributing condition with a limited impact. In both countries, political factors such as succession struggles and institutions played a dominant role in determining the direction of change for rural healthcare policies, whereas economic factors either facilitated or delayed their execution.

Prevalence and Impact of Refractive Errors in School-Aged Children: A Cross-Sectional

This cross-sectional study aims to determine the prevalence and patterns of refractive errors among 700 schoolchildren aged 5-15 years in Al-Manara School, Tobruk, Libya. A comprehensive ophthalmic examination will be conducted to assess visual acuity and identify refractive errors. Academic performance will be evaluated by reviewing school records, including grades and standardized test scores. The impact of refractive errors on quality of life will be measured using a validated pediatric vision-related quality of life questionnaire. The study seeks to provide data on the burden of refractive errors and their effects on learning and daily living in this population. We hypothesize that uncorrected refractive errors will be associated with poorer academic achievement and reduced quality of life compared to peers without vision impairment. This research can highlight the need for regular vision screening and provision of spectacles for schoolchildren in Libya. Findings may guide education policy and school health programs to address this treatable cause of impaired classroom performance. The large sample size will allow for analysis of prevalence stratified by key demographics and characterization of the patterns of refractive errors in this geographic setting.

Factors Influencing Community Engagement during Guinea Worm and Polio Eradication Endgames in Chad: Recommendations for "Last Mile" Programming.

Community engagement is a strategy commonly used in health and development programming. Many disease eradication programs engage with communities through different structures and mechanisms to detect, report, contain, and respond to the diseases they target. Qualitative operational research was conducted in a district of Chad co-endemic for both dracunculiasis (i.e., Guinea worm disease) and circulating vaccine-derived poliovirus to reveal factors influencing community engagement behavior in the context of eradication-related programming. Women and men from six communities and stakeholders from the local, district, and central levels were recruited to participate in focus group discussions and semi-structured in-depth interviews. A thematic analysis was performed to identify barriers and facilitators of community engagement. Barriers to community engagement included mistrust in exogenously established health program initiatives (i.e., initiatives designed by partners external to targeted program communities) resulting from negative past experiences with external entities and community groups and the lure of profit-motivating community engagement. Subgroup and intersectionality analyses revealed that gender and other identities influence whether and to what extent certain members of the community engage in a meaningful way. Facilitators of community engagement included leadership and the influence of authorities and leaders in community participation, perceived benefits of being engaged with community-based initiatives, and use of incentives to enhance community participation. Study findings may be used to inform the refinement of community engagement approaches in Chad and learning agendas for other "last mile" disease eradication programs.