Strategies for health services

Strategies for health services need to take into account the complex nature and contexts of healthcare. Key contextual factors that need to be considered include norms and values, macroeconomics, demographic pressures, changing disease patterns, technological changes, the quest for quality and reducing waste, and rising patient expectations. Healthcare systems have responded to the evolving environment by reassessing the relationship between the state and the market, the way health services are organized and financed, and the involvement of patients in their own care. These developments bring new opportunities to reorient health services towards the maximization of health gain. This chapter discusses strategies where public health professionals can play a potentially vital role in translating these opportunities into reality. It starts by looking at the needs assessment and priority-setting process to ensure that the health services provided reflect the health needs of the population that they serve. Following that, it reviews the design and organization of health services to enhance the efficiency with which services are delivered. It concludes by discussing the enablers (i.e. intelligent purchasing, a workforce with the appropriate capacity and capability, and a robust information and knowledge management system) that are necessary to implement, sustain, and enhance these services.

Understanding Early Pregnancies: Sociocultural Factors of Teenage Childbearing in Gaborone, Botswana

The potential risk of being exposed to HIV/AIDS has structured the ways teenage or out-of-wedlock pregnancies are studied and treated in Botswana. We used feminist ethnographic research methods which focus on the narratives of young women and their social networks to understand this phenomenon. Looking at the issue from the adolescent girls’ perspective reveals that such pregnancies have always existed, and their continued existence can be attributed to local sociocultural perceptions of fertility, pregnancy, and marriage. We show that the young mothers continue with their lives without being labeled as social outcasts and that they are supported by family networks. Social policies intended to provide health services need to restructure those services based on a culturally sensitive model outlined in this article.

Transition from a renal paediatric clinic to an adult clinic: Perspectives of adolescents and young adults, parents and health professionals

The management of chronic kidney disease is complex. With disease management being the responsibility of parents in the paediatric renal clinic, the responsibility is gradually shifted to adolescents and young adults during the transition to adult care. This multi-perspective qualitative study aimed to explore the experiences of adolescents and young adults, their parents and health professionals to gain an insight into transitional care. Focussing on the transition process and transfer to adult care, 18 adolescents and young adults and eight mothers participated in individual semi-structured interviews. Additionally, three focus groups were conducted with 20 multidisciplinary health professionals. Data were transcribed verbatim and analysed thematically. Similar responses from adolescents and young adults and mothers included the reluctance to leave the paediatric health service. Mothers found the transition to adult care more challenging than the adolescents and young adults. While health professionals acknowledged that engaging adolescents and young adults in their own care was challenging, they believed parents had an important role in facilitating their child’s independence. This study highlights that health professionals in both paediatric and adult health services need to work collaboratively. However, importantly, health professionals need to be mindful that parents require an equal amount of engagement as adolescents and young adults, if not more, to mitigate parental barriers in achieving a successful transfer.

Cardiovascular Diseases and Schizophrenia in India: Evidence, Gaps, and Way Forward

Background: The importance of physical health among persons with schizophrenia is well-established. Studies from developed and developing countries indicated a strong association between cardiovascular diseases and schizophrenia, while evidence from India is scattered and in its infancy. Hence, the aims of the study were to collate available studies from India on cardiovascular diseases among persons with schizophrenia, identify knowledge gaps and challenges, and discuss recommendations to improve clinical care and research on cardiovascular diseases among persons with schizophrenia in India.Materials and methods: A comprehensive literature review of Indian studies on cardiovascular diseases and schizophrenia was conducted to collate and synthesise available knowledge.Results: Several risk factors for cardiovascular disease predominated among persons with schizophrenia. Metabolic syndrome and obesity were the key factors that were reported. Knowledge gaps were identified with respect to the prevalence of cardiovascular diseases among persons with schizophrenia. Sparse research in interventions to prevent and reduce the impact of cardiovascular diseases among persons with schizophrenia was noted.Conclusion: Targeted efforts are needed at the clinic, community, and policy levels to understand the impact of cardiovascular diseases among persons with schizophrenia. Robust and feasible interventions targeting cardiovascular diseases and its varied risk factors in persons with schizophrenia, that can be implemented in tertiary mental health services, need to be developed and tested.

Returning migrants

Although it is often not known what proportion of migrants return to their countries of origin, it can be hypothesized that as their reasons for return vary, the stresses on return will also vary. In addition, it is possible that their social support and social capital will have changed in their absence, which may affect their social support and social capital. The research on return migration is somewhat limited, but some studies indicate that levels of stress in returning migrants are high and can lead to the development of psychiatric disorders. In order to function well, they will have to review and re-establish their social contacts, as well as their social context. The clinical care and health services need to be aware of the mental and physical health needs of such individuals and appropriate interventions need to be in place.

Emergency Department Presentations by Children in Remote Australia: A Population-based Study

Background. Aboriginal leaders invited us to examine the frequency and reasons for emergency department (ED) presentations by children in remote Western Australia, where Prenatal Alcohol Exposure (PAE) is common. Methods. ED presentations (2007-11 inclusive) were examined for all children born in the Fitzroy Valley in 2002-03. Results. ED data for 127/134 (94.7%) children (95% Aboriginal) showed 1058 presentations over 5-years. Most (81%) had at least 1 presentation (median 9.0, range 1-50). Common presentations included: screening/follow-up/social reasons (16.0%), injury (15.1%), diseases of the ear (14.9%), skin (13.8%), respiratory tract (13.4%), and infectious and parasitic diseases (9.8%). PAE and higher presentations rates were associated. Commonly associated socio-economic factors were household over-crowding, financial and food insecurity. Conclusion. Children in very remote Fitzroy Crossing communities have high rates of preventable ED presentations, especially those with PAE. Support for culturally appropriate preventative programs and improved access to primary health services need to be provided in remote Australia.

Novel Coronavirus Disease (COVID-19): Social Distancing, Isolation and Quarantine are Key Success Factors of Nepal’s Public Health Practices or Something Else?

Novel Coronavirus Disease (COVID-19) is an infectious disease similar form of pneumonia/ SARS-CoV-2- impacting deadly globally. The main objective of this article is to analyze the studies and gather of the current information aimed at COVID-19 and analyze the situation of Nepal. We summarized the published articles from the web pages, Journals, Google search engine. It is declared as a public health emergency. However, why COVID-19 does not register in developing counties (Nepal) rather than China, Europe and North America it is unknown. Nepal has lower experiences of the COVID-19 where only 49 death cases registered and total cases 19,237 cases throughout the country (till 08/1/2020). Nepalese health services need to maintain up than today and follow lockdown, isolation, social distance and an advance screening test kit around the country.

Why has COVID-19 not hit the countries like Nepal yet?

Noble CORONA Virus (COVID-19) is an infectious disease similar form of pneumonia/ SARS-CoV-2- impacting globally. The fear of coronavirus looks pandemic, but its severity is uncertain. Nepal was one of the first nine countries outside of China to report a COVID-19 case. Also, its unpredictability of mode or range of surface, the lifespan of the virus, objects of transmission (a distance of air/air currents, living duration in air, humidity, duration on objects, surface). The first case was found in Wuhan in December 2019 in China. The purpose is to summarize the current information about COVID-19 and to explore in terms of why Nepal is not hitting severely, while other countries are on death toll? We summarized the published articles form the web sources and news, Academic Journals, Ministry of health and population Nepal, WHO/CDC update reports/guidelines, Google search engine. Thematic analysis is made to explore the situation. Although, Nepal has a lack of health services, testing kits, advance lab and protecting equipment (PPE), why COVID-19 does not hit Nepal than China, Europe and North America, it still tremendous uncertainty. Is lockdown, isolation, social distance and quarantine the best ways of prevention? The hypothesis is floating globally – do BCG vaccinated countries are safer than non-user OR due to not having enough kits to screen populations at risk for the virus – while lack of testing a big cause for missing case OR Nepalese have better immune systems? It has attracted global attention. We believe that the COVID-19 is still evolving and it is too early to predict of an outbreak in Nepal. The government needs to increase funding for local health departments, begin planning for future epidemics and be prepared to bolster the economy by supporting consumer spending the midst of a serious outbreak. COVID-19 is a serious health challenge for Nepal, but so far the number of death has been lower than was foretell. It is, therefore essential to carry out more scientific evidence to explore results. Nepalese health services need to maintain up than today and follow lockdown, isolation, social distance and an advance screening test kit through the country.

Occupation and maternal mortality in Brazil

OBJECTIVE: To estimate maternal mortality ratio according to occupation in Brazil. METHODS: This is a mortality study conducted with national data from the Mortality Information System (SIM) and the Live Birth Information System (SINASC) in 2015. Maternal mortality ratios were estimated according to the occupation recorded in death certificates, using the Brazilian Classification of Occupation (CBO), version 2002. RESULTS: A total of 1,738 maternal deaths records were found, corresponding to a maternal mortality ratio of 57.6/100,000 live births. It varied among occupational groups, with higher estimates among service and agricultural workers, particularly for domestic workers (123.2/100,000 live births), followed by general agricultural workers (88.3/100,000 live births). Manicurists and nursing technicians also presented high maternal mortality ratio. Maternal occupation was not reported in 17.0% of SIM registers and in 13.2% of SINASC data. Inconsistent records of occupation were found.“Housewife” prevailed in SIM (35.5%) and SINASC (39.1%). CONCLUSIONS: Maternal mortality ratio differs by occupation, suggesting a work contribution, which requires further research focusing occupational risk factors. Socioeconomic factors are closely related to occupation, and their combination with work exposures and the poor access to health services need to be also addressed.

Reducing Stigma of Cancer in Asia–An Important Strategy for Cancer Control

Half the global burden of cancer is in Asia, where 60 percent of the world population live. Ageing society, growing populations, lifestyle and socioeconomic changes have contributed to a steep rise in cancer incidences. The emerging cancer burden across Asia call for balanced investments in public and professional awareness and political recognition of cancer as a public health problem. Early detection and cancer prevention leads to both better health outcomes and better cost-savings of treatment costs. Although evolving cancer health services need to be stepped up to strengthen cancer healthcare infrastructure to improve equitable access to services, more work must be conducted in the community to address the entrenched stigma of cancer and caused a shift towards a more positive perception to help address cancer in Asia.