Time trends and social inequalities in child malnutrition: nationwide estimates from Brazil’s Food and Nutrition Surveillance System, 2009-2017

Objective: In Brazil, national estimates of childhood malnutrition have not been updated since 2006. The use of health information systems is an important complementary data source for analysing time trends on health and nutrition. This study aimed to examine temporal trends and sociodemographic inequalities in the prevalence of malnutrition in children attending primary health care services between 2009 and 2017. Design: Time trends study based on data from Brazil’s Food and Nutrition Surveillance System. Malnutrition prevalence (stunting, wasting, overweight, and double burden) was annually estimated by sociodemographic variables. Prais-Winsten regression models were used to analyse time trends. Annual percent change (APC) and 95% confidence intervals (95%CI) were calculated. Setting: Primary health care services, Brazil. Participants: Children under five years old. Results: In total, 15,239,753 children were included. An increase in the prevalence of overweight (APC=3.4%; p=0.015) and a decline in the prevalence of wasting (-6.2%; p=0.002) were observed. The prevalence of stunting (-3.2%, p=0.359) and double burden (-1.4%, p=0.630) had discrete and non-significant reductions. Despite the significant reduction in the prevalence of undernutrition among children in the most vulnerable subgroups (black, conditional cash transfer’s recipients, and residents of poorest and less developed areas), high prevalence of stunting and wasting persist alongside a disproportionate increase in the prevalence of overweight in these groups. Conclusions: The observed pattern in stunting (high and persistent prevalence) and increase in overweight elucidates setbacks in advances already observed in previous periods and stress the need for social and political strategies to address multiple forms of malnutrition.

Assessing Spatial Accessibility to Primary Health Care Services in Beijing, China

Primary health care has been emphasized as a pillar of China’s current round of health reforms throughout the previous decade. The purpose of this study is to analyze the accessibility of primary health care services in Beijing and to identify locations with a relative scarcity of health personnel. Seven ecological conservation districts, which are relatively underdeveloped, were selected in the study. The Gini coefficient and Lorenz curve, as well as the shortest trip time and modified two-step floating catchment area (M2SFCA) approach, are used to quantify inequalities in primary health care resources and spatial accessibility. The Gini coefficient of primary medical services was calculated as high as 0.705, showing a significant disparity in primary care services. A total of 81.22% of communities reached the nearest primary care institution within 15 min. The average accessibility of primary healthcare services, as measured by the number of health professionals per 1000 population, was 2.34 in the 1715 communities of seven ecological conservation districts. Three hundred and ninety-one communities (22.80%) were identified with relatively low accessibility. More primary health professionals should be allocated to Miyun, Mentougou, and Changping Districts. Overall, the primary healthcare resources were distributed unevenly in most districts. According to our study, expanding primary healthcare institutions, increasing the number of competent health professionals, and enhancing road networks will all be effective ways to increase spatial access and reduce primary healthcare service disparity in Beijing.

Evaluation of Health Literacy Levels in Adults: The Case of Ankara Province

The concept of health literacy, which is related to issues such as health behaviors, use of health services, satisfaction, has increased in national and international level in recent years. This concept refers to the individual's cognitive and social skills in health-related issues. The aim of this study is to determine the health literacy levels of individuals living in Ankara. The study was carried out with 387 volunteers. In the study, Adult Health Literacy Scale (AHLS), which consists of 23 questions developed by Sezer, was used. Mann Whitney U and Kruskal Wallis test were used to analyze the data. The average level of health literacy obtained in the study was formulated in accordance with the European Health Literacy Study and the level of international competence was determined. Accordingly, 50.1% (194) of the participants in the study were found to be inadequate, 42.1% (163) limited and 7.8% (30) sufficient health literacy. The level of perfect health literacy has not been found. In order to increase the level of health literacy, roadmaps developed jointly by policy makers and health professionals are needed. As the impact of culture on health literacy is known, developing local strategies is thought to be an effective way to increase the level of health literacy. It is important for healthcare professionals, public health professionals and health educators working in primary health care services to take roles in targeting the target population, developing strategy and communicating in the health literacy process.

COVID-19 pandemic: Insights into genetic susceptibility to SARS-CoV-2 and host genes implications on virus spread, disease severity and outcomes

The outbreak of the newly emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) all over the world has caused global public health emergencies, international concern and economic crises. The systemic SARS-CoV-2 disease (COVID-19) can lead to death through causing unrestrained cytokines-storm and subsequent pulmonary shutdown among the elderly and patients with pre-existing comorbidities. Additionally, in comparison with poor nations without primary health care services, in developed countries with advanced healthcare system we can witness higher number of infections per one million people. In this review, we summarize the latest studies on genes associated with SARS-CoV-2 pathogenesis and propose possible mechanisms of the virus replication cycle and its triggered signaling pathways to encourage researchers to investigate genetic and immune profiles of the disease and try strategies for its treatment. Our review shows that immune response in people with different genetic background might vary as African and then Asian populations have lowest number of affected cases compared with European and American nations. Considering SARS-CoV-2 pathogenesis, we put forward some potentially important genetic gateways to COVID-19 infection including genes involved in the entry and replication of SARS-CoV-2 and the regulation of host immune response which might represent explanation for its spread, severity, and morality. Finally, we suggest that genetic alterations within these gateways could be critical factors in influencing geographical discrepancies of the virus, so it is essential to fully study them and design appropriated and reliable therapeutic agents against COVID-19.

A cross sectional study on appropriate use of face mask among adults seeking primary health care services in Chennai

Background: The WHO has recommended face mask use during COVID-19 pandemic for all people in all public settings and situations compromising the social distancing. So, face mask use, hand hygiene and social distancing are the preventive measures followed by many countries against this pandemic. But still inappropriate use of masks might lead to failure of these preventive measures against COVID. So, this study was done to determine the prevalence and determinants associated with knowledge and practices of the appropriate use of face masks among patients attending primary health care services in a slum of Chennai.Methods: A cross-sectional study was done among patients attending urban primary health centre for non-respiratory complaints. A pretested semi-structured questionnaire was used to collect information from the participants. For assessment of practice, direct observation on the use of a face mask was done. Data were entered in Excel and analysed using SPSS 23.0 software. The Chi-square test was used to analyse the determinants.Results: Only 10% had the knowledge and none had an appropriate practice of face mask use. 85.5% used face mask with the majority being fabric mask users. The male, age >40 years and low SES had significantly poor knowledge on the appropriate use of face mask.Conclusions: The high prevalence of inappropriate knowledge and practice of use of face masks implies that along with awareness of mask use, behavioral change on appropriate face mask practices is needed.

The workforce for rehabilitation in primary health care in Brazil

Background Studies on the workforce in rehabilitation in primary health care services are still unusual in health systems analysis. Data on the health worker density at the subnational level in rehabilitation in primary health care are not commonly observed in most health systems. Nevertheless, these data are core for the system's planning and essential for finding the balance between the composition, distribution, and number of workers for rehabilitation actions. Objective This study aims to analyze the temporal space distribution of health professionals with higher education who performed rehabilitation actions in primary health care in Brazil from 2007 to 2020. Method This is an ecological, time-series study on the supply of physiotherapists, audiologists, psychologists, and occupational therapists in primary health care, vis-a-vis the implementation of the Brazilian health policy denominated the Integrated Health Service Network for People with Disabilities. The data were obtained from the National Registry of Health Facilities. The period of analysis was from 2007 to 2020. The health worker density coefficient was calculated per 10,000 inhabitants annually, considering the five geographic regions of Brazil. The time trends of the coefficient of health professionals per year in Brazil and geographic regions were analyzed. For this purpose, joinpoint regression analysis was carried out. The average annual percentage variation was estimated, considering the respective confidence interval of 95%. Results In 2007, there were 0.12 physiotherapists/10,000 inhabitants (2326), 0.05 audiologists/10,000 inhabitants (1024), and 0.205 psychologists/10,000 inhabitants (3762). In 2020, there was an increase in the coefficient of professionals/10,000 inhabitants in all professional categories to 0.47 psychologists (> 268.1%), 0.46 physiotherapists (> 424.8%), 0.14 audiologists (> 297.1%), and 0.04 occupational therapists (> 504.5%). There was a significant increase in the supply of physiotherapists (AAPC: 10.8), audiologists (AAPC: 7.6), psychologists (AAPC: 6.8), and occupational therapists (AAPC: 28.3), with little regional variation. Conclusion Public health policies for rehabilitation have contributed to an increase in the workforce caring for people with disabilities in primary health care services. An increase in the workforce of physiotherapists, audiologists, psychologists, and occupational therapists was observed throughout the period studied in all regions.

Practical Epidemiology

We focus on the importance of using epidemiological concepts and skills needed to investigate, plan and deliver primary health care services and to strengthen district level public health programmes. We illustrate these with examples from LMICs and for a hypothetical district population of 200,000 people.