Public Health in Asia during the COVID-19 Pandemic

Every nation in Asia has dealt with COVID-19 differently and with varying levels of success in the absence of clear and effective leadership from the WHO. As a result, the WHO’s role in Asia as a global health organization is coming under increasing pressure. As its credibility is slowly being eroded by public displays of incompetence and negligence, it has also become an arena of contestation. Moreover, while the pandemic continues to undermine the future of global health governance as a whole, the highly interdependent economies in Asia have exposed the speed with which pandemics can spread, as intensive regional travel and business connections have caused every area in the region to be hit hard. The migrant labor necessary to sustain globalized economies has been strained and the security of international workers is now more precarious than ever, as millions have been left stranded, seen their entry blocked, or have limited access to health services. This volume provides an accessible framework for the understanding the effects of the COVID-19 pandemic in Asia, with a specific emphasis on global governance in health and labor.

need for alternative solutions when caring for patients with language barriers

Barriers to quality communication increase the risk for misunderstanding, negatively impact the thoroughness of health investigations, and can lead to delayed diagnoses and increased readmissions. In addition, language barriers disproportionately affect the most vulnerable populations; thus, a lack of appropriate interpretation services promotes health disparities and increases the vulnerability of the underserved minority populations. According to the Act Respecting Health Services and Social Services of Quebec, health organizations need to take into account the distinctive linguistic and sociocultural characteristics of each region and, “foster […] access to health services and social services through adapted means of communication for persons with functional limitations”. A language barrier is a form of functional limitation that patients face when accessing healthcare services. Despite a clear policy, the current use of professional interpretation services is limited in our healthcare facilities, thus increasing obstacles in accessing healthcare services for patients with language barriers. It is thought that by identifying how language barriers present in our healthcare system and by highlighting the tools available to mitigate their consequences, healthcare workers, including medical students, may be better placed to serve the non-French and non-English speaking community. A group of medical students from the Universities of Montreal and McGill who are part of MedComm researched the problematic, most specifically in Montreal, in the hopes of emphasizing the need for alternative solutions to the current state of affairs in regard to offering optimal care to patients with language barriers.

Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis

Background Ensuring access to health services for all is the main goal of universal health coverage (UHC) plan. Out-of-pocket (OOP) payment still remains the main source of funding for healthcare in Bangladesh. The association between barriers to accessing healthcare and over-reliance on OOP payments has not been explored in Bangladesh using nationally representative household survey data. This study is a novel attempt to examine the burden of OOP payment and forgone healthcare in Bangladesh, and further explores the inequalities in catastrophic health expenditures (CHE) and forgone healthcare at the national and sub-national levels. Methods This study used data from the most recent nationally representative cross-sectional survey, Bangladesh Household Income and Expenditure Survey, conducted in 2016–17 (N = 39,124). In order to identify potential determinants of CHE and forgone healthcare, multilevel Poisson regression was used. Inequalities in CHE and forgone healthcare were measured using the slope index of inequality. Results Around 25% of individuals incurred CHE and 14% of the population had forgone healthcare for any reasons. The most common reasons for forgone healthcare were treatment cost (17%), followed by none to accompany or need for permission (5%), and distance to health facility (3%). Multilevel analysis indicated that financial burden and forgone care was higher among households with older populations or chronic illness, and those who utilize either public or private health facilities. Household consumption quintile had a linear negative association with forgone care and positive association with CHE. Conclusion This study calls for incorporation of social safety net in health financing system, increase health facility, and gives priority to the disadvantaged population to ensure access to health services for all.

An analysis of the Gender and Social Determinants of Health in Urban Poor Areas of the Most Populated Cities of Pakistan

Background: Recent surveys, studies and reviews have highlighted the impacts of social inequities on access of women and children to health services for women and children in Pakistan. Utilising mixed methods for urban slum profiles, and facility and coverage surveys in 4431 urban poor areas of the top 10 highly populated cities of Pakistan, this paper describes and analyses the complex interactions between economic, social and gender determinants of health care access and considers health policy and program options for addressing them. Results: Findings are classified into six analytic categories of (1) access to health services, (2) female workforce participation, (3) gender friendly health services, (4) access to schools and literacy, (5) social connections, and (6) autonomy of decision making. Out of a national sample of 14,531 children in urban poor areas of 10 cities, the studies found that just over half of the children are fully immunised (54%) and 14% of children had received zero doses of vaccine. There are large shortages of health facilities and female health workforce in the slums, with significant gaps in the quality of health infrastructure, which all serve to limit both demand for, and supply of, health services for women and children. Results demonstrate low availability of schools, low levels of female literacy and autonomy over decision making, limited knowledge of the benefits of vaccination, and few social connections outside the home. All these factors interact and reinforce existing gender norms and low levels of health literacy and service access. Conclusion: The Urban Slum profiles and coverage studies provide an opportunity to introduce gender transformative strategies that include expansion of a female health workforce, development of costed urban health action plans, and an enabling policy environment to support community organisation and more equitable health service delivery access.

Care Giver Competency in Prevention Risk of Diabetic Foot Ulcer in Diabetes Mellitus Patients

Increasing in the incidence of diabetic foot ulcer (DFU) among diabetes mellitus patients (DM), which then access to health services is so far, as well as the lack of knowledge of the local community in preventing and caring for DFU made researchers try to initiate training related to prevention and basic wound care for village health cadres, community leaders, and families family members with DM and at risk for UKD. The activity, which carried out in March 2021, involved the puskesmas in Sui District. Raya, Kab. Kubu Raya. After obtained a permit to carry out activities, the Team briefly contacted the community with the assistance of the Head of RT and RW. Participants who toke part in this activity were those who lived or have a family with diabetes mellitus. Participants were given training related to prevention and treatment of basic wounds, which in the end evaluation followed by publication.

Article 24: The Right to Health

Article 24 reflects the perspective of the drafters that the right to health cannot be understood in narrow bio-medical terms or limited to the delivery of health services. Rather, in its reference, for example, to food, water, sanitation, and environmental dangers, it recognises the wider social and economic factors that influence and impact on the child’s state of health. Thus, the text of Article 24 sets out: a broad right to health for all children combined with a right of access to health services a priority focus on measures to address infant and child mortality, the provision of primary health care, nutritious food and clean drinking water, pre-natal and post-natal care, and preventive health care, including family planning the need for effective measures to abolish traditional practices harmful to children’s health a specific obligation on States Parties to cooperate internationally towards the realisation of the child’s right to health everywhere, having particular regard to the needs of developing countries. The right to health is a prime example of the interelatedness of child rights as it is contingent upon and informed by the realization of so many other rights guaranteed to children under the convention. This chapter analyses the child’s right to health in relation to four essential attributes. The first attribute of the child’s right to the highest attainable standard of health emphasizes what an exacting standard this human rights norm contains. Taking a social determinants of health perspective the right entails not just access to health services but programmatic supports in sanitation, transportation, education and other fields to guarantee the enjoyment of health. The second attribute focuses on the Basic minimum criteria of the right to health as reflected in Article 24(2). A third attribute is the insistence upon child health accountability mechanisms using the Availability, Accessibility, Acceptability and Quality Accountability Framework. Finally, given the wide discrepancies in enjoyment of children’s right to health across the globe, a fourth attribute focuses upon international cooperation to ensure equal access to the right to health.

Adherence to antiretroviral therapy by adults living with HIV/aids: a cross-sectional study

ABSTRACT Objective: To verify the association between adherence to antiretroviral treatment by adults with HIV/AIDS and sociodemographic factors, social and clinical support. Methods: Cross-sectional study, with a quantitative approach. Participation of 230 patients. Questionnaires of sociodemographic characterization, social and clinical support, and assessment of adherence to antiretroviral treatment were used. Descriptive and inferential statistics were performed. Results: Adherence was classified as good/adequate. An association with sex, income, employment, and level of education was noted. In social support: having access to health services; communication with health professionals; health education; having support to allow venting/talking about issues; information on HIV/AIDS; and company for leisure. In the clinical profile: non-interruption of the drug treatment due to absence from the service or due to changes in the medical prescription. Conclusion: Adherence was classified as good/adequate and especially associated with social support factors, which should be enhanced in clinical practice.

Analysis of Hospital Lethality of COVID-19 in Mexico

Background. COVID-19 has caused 244,830 deaths in Mexico. Evaluating the severity of this contingency is possible if the hospital fatality rate of COVID-19 is described because hospitalized patients present more severe conditions. Objective. To analyze the fatality of COVID-19 in hospitalized patients. Methods. A quantitative, descriptive, analytical, cross-sectional, and retrospective study was conducted using open database from Ministry of Health in Mexico. Results. The analysis included 71,189 discharges from patients diagnosed with COVID-19 in the Mexican Ministry of Health Hospitals during 2020. Of them, 27,403 were due to death, predominantly in men and age groups from 50 to 69 years. The general hospital fatality due to COVID-19 was 38.49%, a hospital fatality of 40.75% in men and 35.03% in women. The 55-to-99-year-old age groups, Baja California, Puebla, and Coahuila had a higher hospital fatality than the general fatality. Conclusion. Besides the deaths caused directly by COVID-19 (those that occurred due to respiratory failures), many deaths were indirect in persons with comorbidities exacerbated by this disease. Access to health services, social changes derived from job loss, home protection, and changes in social dynamics, facts expressed in the general mortality excess, cannot be quantified in our study. There are similar patterns with other persons infected worldwide: this disease is more severe for males and older age subjects.

Ischemic Heart Disease in Nigeria: Exploring the Challenges, Current Status, and Impact of Lifestyle Interventions on Its Primary Healthcare System

The burden of ischemic heart disease in Nigeria calls for an evidence-based, innovative, and interdisciplinary approach towards decreasing health inequalities resulting from individual lifestyle and poor socioeconomic status in order to uphold the holistic health of individuals to achieve global sustainability and health equity. The poor diagnosis and management of ischemic heart disease in Nigeria contributes to the inadequate knowledge of its prognosis among individuals, which often results in a decreased ability to seek help and self-care. Hence, current policies aimed at altering lifestyle behaviour to minimize exposure to cardiovascular risk factors may be less suitable for Nigeria’s diverse culture. Mitigating the burden of ischemic heart disease through the equitable access to health services and respect for the autonomy and beliefs of individuals in view of achieving Universal Health Coverage (UHC) requires comprehensive measures to accommodate, as much as possible, every individual, notwithstanding their values and socioeconomic status.

Predictors of Healthcare-Seeking Behaviour, Health Services Access and Utilization in Ajebo Community, South-West, Nigeria

Background: Health is a fundamental requirement for living a socially and economically productive life. Poor health inflicts great hardships on households, including debilitation, substantial monetary expenditures, loss of productivity and sometimes, death. Objectives: To describe healthcare-seeking behaviour, access to health services and utilisation, and their predictors in a southwestern Nigerian community. Methods: A descriptive, cross-sectional study was conducted in Ajebo community, Obafemi/Owode Local Government Area in Ogun State. A total of 420 respondents were studied using an interviewer-administered questionnaire to collect quantitative data. Results: More than half (54.0%) of the respondents had access to public health facilities, 41.7% had access to private health facilities, while patent medicine stores were accessed by 4.3% of the respondents. Out of the 249 (59.3%) who were ill in the preceding three months, 92.4% of them sought healthcare. More males utilized government-owned health services s than females (χ² = 3.878, p = 0.049). More than half (56.4%) travelled >10 minutes to access healthcare services. Lack of formal education was not a hindrance to seeking healthcare (OR = 31.392, p = 0.003, CI = 3.323-2.347). Income earning <30,000 Naira was the strongest predictor of healthcare utilization (OR = 3.304, p =0.001, 95% CI = 2.007-5.441). Education with OR = 31.392 (p = 0.003, 95% CI = 3.323-96.570) was the strongest predictor of healthcare-seeking behaviour. Conclusion: Healthcare-seeking behaviour was not limited by lack of formal education. The utilisation of public health facilities was high among the respondents. State of employment and income were strong predictors of healthcare utilisation in Ajebo community.