Status of water, sanitation, and hygiene and standard precautions in healthcare facilities and its relevance to COVID-19 in Afghanistan

BACKGROUND@#To protect the health and safety of healthcare workers (HCWs), it is essential to ensure the provision of sustainable water, sanitation, and hygiene (WASH) services and standard precautions in healthcare facilities (HCF). The objectives of this short communication were 1) to assess the availability of WASH services and standard precautions in HCFs in seven provinces in Afghanistan before the COVID-19 pandemic, and 2) to elucidate the relevance of these patterns with the number of reported HCW infections from COVID-19 in the mentioned provinces.@*METHODS@#We analyzed secondary data from the 2018-19 Afghanistan Service Provision Assessment survey, which included 142 public and private HCFs in seven major provinces in Afghanistan. Data on COVID-19 cases were obtained from the Afghanistan Ministry of Public Health Data Warehouse. Weighted prevalence of WASH services and standard precautions were calculated using frequencies and percentages. ArcGIS maps were used to visualize the distribution of COVID-19 cases, and scatter plots were created to visualize the relevance of WASH services and standard precautions to COVID-19 cases in provinces.@*RESULTS@#Of the 142 facilities surveyed, about 97% had improved water sources, and over 94% had improved toilet for clients. Overall, HCFs had limited availability of hygiene services and standard precautions, which was lower in private than public facilities. More than half of the facilities had safe final disposal and appropriate storage of sharps and medical waste. Of the seven provinces, Herat province had the highest cumulative COVID-19 case rate among HCWs per 100,000 population and reported lower availability of WASH services and standard precautions in HCFs compared to other provinces.@*CONCLUSION@#Our findings show disparities in the availability of WASH services and standard precautions in public and private facilities. Private facilities had a lower availability of hygiene services and standard precautions than public facilities. Provinces with higher availability of WASH services and standard precautions in HCFs had a lower cumulative COVID-19 case rate among HCWs per 100,000 population. Pre-pandemic preparation of adequate WASH services and standard precautions in HCFs could be potentially important in combating infectious disease emergence.

Reduction in inequalities in health insurance coverage and healthcare utilization among older adults in the Philippines after mandatory national health insurance coverage: trend analysis for 2003-2017

BACKGROUND@#Health policies in the Philippines have evolved in response to increasing health demands of older adults. However, there is a lack of research on equity among the ageing population in low-middle income countries. The objective of this study was to identify the trends in National Health Insurance Program (NHIP) coverage and healthcare utilization among older adults in the Philippines for the period from 2003 to 2017, during which NHIP expansion policies were implemented, focusing on reductions in socio-economic inequalities.@*METHODS@#A literature search of policies for older adults and an analysis of four Philippine National Demographic and Health Surveys (2003, 2008, 2013, and 2017) with data from 25,217 older adults who were 60 years or older were performed. The major outcome variables were NHIP coverage, self-reported illness, outpatient healthcare utilization, and inpatient healthcare utilization. Inequalities in NHIP coverage and healthcare utilization according to wealth were evaluated by calculating the concentration index for individual years, followed by a regression-based decomposition analysis.@*RESULTS@#NHIP coverage among older adults increased from 9.4 (2003) to 87.6% (2017). Although inequalities according to wealth quintile were observed in all four surveys (all P < 0.001), the concentration index declined from 0.3000 (2003) to 0.0247 (2017), showing reduced inequalities in NHIP coverage over time as observed for self-reported illness and healthcare utilization. NHIP coverage expansion for older adults in 2014 enabled equal opportunity for access to healthcare.@*CONCLUSION@#The passage of mandatory NHIP coverage for older Filipino adults in 2014 was followed by a reduction in inequality in NHIP coverage and healthcare utilization according to wealth.

The impact of a school-based tooth-brushing program on dental caries: a cross-sectional study

BACKGROUND@#Promotion of oral health in children is recognized as one of the components of health-promoting schools (HPSs). However, few studies have addressed supportive school environments for children's oral health. This study aimed to evaluate the status of dental caries in school children at HPSs, with the objective of examining the impact of a supportive school environment for oral health, considering the lifestyles of individual children and the socioeconomic characteristics of their communities.@*METHODS@#Data of 2043 5th-grade students in 21 elementary schools in Ichikawa city between 2008 and 2013 were analyzed. Children's oral health status was evaluated using the decayed, missing, and filled permanent teeth (DMFT) index. A self-reported lifestyle questionnaire, a survey of the school environment promoting tooth-brushing, and community socioeconomic characteristics derived from the National Census data were included in the analyses. Bivariate analyses were conducted to evaluate the children's DMFT status, and zero-inflated negative binominal (ZINB) regression was used to assess the relationships between DMFT and other variables.@*RESULTS@#Prevalence of dental caries in the permanent teeth of 5th-grade children (aged 10-11 years) was 33.3%, with a mean DMFT score (± SD) of 0.83 ± 1.50. According to multilevel ZINB regression analysis, children from schools with after-lunch tooth-brushing time showed a higher odds ratio (OR) for excess zero DMFT (OR = 1.47, 95% CI = 1.00-2.15, P = 0.049) as compared to those from schools without it. Neither bivariate analysis nor ZINB model analysis revealed any significant influence of children's gender or use of a toothpaste with fluoride.@*CONCLUSIONS@#The school-based environment supportive of oral health was significantly associated with a zero DMFT status in children. School-based efforts considering the socioeconomic characteristics of the area warrant attention even with declining prevalence of dental caries.

Cost of shifting from healthcare to long-term care in later life across major diseases: analysis of end-of-life care during the last 24 months of life / Journal of Rural Medicine

Aim: To evaluate the costs associated with healthcare and long-term care during the last 24 months before death according to major disease groups.Methods: Individual data regarding healthcare and long-term care costs according to public insurance schemes during the last 24 months before death among all decedents older than 75 years reported in a city in Japan between April 1, 2010 and March 31, 2014 were identified; the data for nine major diseases were then analyzed.Results: For the 2149 decedents studied, the average healthcare costs per capita in the last 24 months of life for moderately-old (75 to 84 years) and extremely-old (85 years and older) decedents was 4,135,467 JPY and 2,493,001 JPY, respectively, while the average long-term care costs per capita for 24 months was 1,300,710 JPY and 2,723,239 JPY, respectively. The total costs (healthcare and long-term care combined) ranged from 9,169,547 JPY for chronic kidney disease to 5,023,762 JPY for ischemic heart disease. In all the diseases studied, the moderately-old decedents incurred higher healthcare costs while the extremely-old decedents incurred higher long-term care costs. However, for the care costs of chronic lower respiratory diseases, this pattern was not observed.Conclusion: A shift in expenditure from healthcare to long-term care as the decedents’ age increased was observed in major diseases, with some exceptions.

Changes in the configuration and patterns of physical activity among Mongolian adults, 2005–2013 / Journal of Rural Medicine

Objective: This study examined the change in physical activity status and patterns and their associations with urban and rural residence and employment status in Mongolia.Methods: We analyzed data from 7,738 adults aged from 20 to 64 years (n = 2,877 and 4,861 for 2005 and 2013, respectively) from the Mongolian STEPS Survey on the Prevalence of Non-Communicable Disease Risk Factors (NCD-STEPS survey). Physical activity in three domains, including work (occupational and household work); transport (walk or cycling); and leisure (sport or fitness) was measured by Global Physical Activity Questionnaire (GPAQ). Physical activity levels were classified into three groups: low, moderate, and high according to the GPAQ analysis framework. The associations between physical activity time, residential area, and employment status were examined using a multivariate negative binomial regression model.Results: The percentage of respondents with low-level physical activity increased from 10.9% in 2005 to 27.2% in 2013. The median minutes of physical activity time per week were 1,020 in 2005 and 600 in 2013. Physical activity time at work, transport and overall decreased in 2013. Work-related physical activity was the most dominant component of physical activity time (55.6% in 2005 and 54.6% in 2013), the transport domain was the second-highest contributor of physical activity time in 2005 (24.0%) and was replaced by the leisure domain (26.8%) in 2013. Rural residents practiced more physical activity at work, transport, and leisure than urban residents did in 2005 (prevalence ratio [PR]: 1.33, 95% confidence interval [CI]: 1.20–1.47; PR: 1.21, 95%CI: 1.14–1.29; and PR: 1.21, 95%CI: 1.13–1.30, respectively), but there was no significant difference by residential area in 2013. Mongolian adults with higher educational attainment, employee status, and non-employment status were less likely to engage in physical activity compared to those among adults with lower educational attainment and self-employed status.

Assessing the link between endorsing attitudes justifying partner abuse and reproductive health care utilization among women in Lao PDR / Journal of Rural Medicine

Objective: Evidence from developing countries on the association between women’s endorsement of attitudes justifying partner abuse and their use of reproductive health services is suggestive but inconclusive. This study uses a nationally representative dataset from Lao PDR to provide strong evidence for the relationship between women’s endorsement of attitudes justifying partner abuse and use of reproductive health services.Methods: This study used data from the 2011–2012 Lao Social Indicator survey (LSIS). The analyses were performed on the responses of 4227 women. The exposure of interest in this study was endorsement of attitudes justifying partner abuse. Antenatal care (ANC) visits divided according to amount and quality, delivery care by type and place, and utilization of postnatal care (PNC) for mothers and newborn infants were used as representative outcome variables of reproductive health service utilization.Results: Approximately seven out of ten respondents (67.9%) believed that partner abuse was justified. Women who endorsed these attitudes were significantly less likely to receive any ANC, to seek institutional delivery, and to use trained medical personnel for delivery assistance. Endorsing attitudes were associated with reduced probability of receiving PNC services for mothers and newborn infants, reduced frequency of ANC visits, and receiving a fewer number of ANC components. Other sociodemographic factors likely to affect the increased utilization of several of the indicators of reproductive health care were living in the central region, belonging to the high bands of wealth, having higher level of education, being a young adult (20–34 years) or older (35–49 years), residing in urban areas, and being sexually empowered.Conclusions: In addition to a broad range of sociodemographic factors, our findings suggested that women’s endorsement of attitudes justifying partner abuse should be treated as an important psychosocial determinant of reproductive health care service utilization in Lao PDR.

Inequalities in Use of Antenatal Care and Its Service Components in India / Journal of Rural Medicine

<b>Objectives:</b> This study was performed to evaluate the use of individual components of antenatal care (ANC) services by pregnant women across India in addition to counting of ANC visits and then analyze differences according to state, socioeconomic condition, and access to health care services. <br><b>Methods:</b> The study used a nationally representative sample of 36,850 women from the National Family Health Survey (2005–2006) of India. Outcome measurements were medication, number of ANC visits, and components of ANC, including physical examination and measurements, laboratory examination, and advice about pregnancy. Differences in these outcomes according to 29 states, socioeconomic conditions, and access to health care services were examined. Independent associations between outcome measures and social and health care factors were analyzed. <br><b>Results:</b> The percentages of women who used ANC at least once and four times or more were 81.5% (ranges by states: 38.0 –99.9%) and 46.1% (15.2–97.9%), respectively. Among those who used ANC four times or more, 86.4% (54.2–98.9%) received a blood examination, and 85.8% (70.3–96.3%) were advised to deliver in a hospital. Greater wealth (OR=3.38; 95%CI 2.58–4.42) and higher education level (OR=3.19; 95%CI 2.49–4.14) were associated with receiving a blood examination during ANC. Rural residence was negatively associated with using ANC four times or more (OR=0.64; 95%CI 0.59–0.67) and receiving a blood examination (OR=0.67; 95%CI 0.59–0.76). Those who received ANC at community health centers were less likely to receive a blood pressure examination, blood and urine examination, and advice to deliver in a hospital compared with those who received ANC at public hospitals. <br><b>Conclusion:</b> This study showed substantial inequalities in use of ANC and service components of ANC received in India across geographic areas, socioeconomic conditions, and levels of access to health care services. In addition to reducing socioeconomic inequalities, it is necessary to provide quality services to those withlimited access to health care services.

Inequalities in Use of Antenatal Care and Its Service Components in India / Journal of Rural Medicine

<b>Objectives:</b> This study was performed to evaluate the use of individual components of antenatal care (ANC) services by pregnant women across India in addition to counting of ANC visits and then analyze differences according to state, socioeconomic condition, and access to health care services.<b>Methods:</b> The study used a nationally representative sample of 36,850 women from the National Family Health Survey (2005–2006) of India. Outcome measurements were medication, number of ANC visits, and components of ANC, including physical examination and measurements, laboratory examination, and advice about pregnancy. Differences in these outcomes according to 29 states, socioeconomic conditions, and access to health care services were examined. Independent associations between outcome measures and social and health care factors were analyzed.<b>Results:</b> The percentages of women who used ANC at least once and four times or more were 81.5% (ranges by states: 38.0 –99.9%) and 46.1% (15.2–97.9%), respectively. Among those who used ANC four times or more, 86.4% (54.2–98.9%) received a blood examination, and 85.8% (70.3–96.3%) were advised to deliver in a hospital. Greater wealth (OR=3.38; 95%CI 2.58–4.42) and higher education level (OR=3.19; 95%CI 2.49–4.14) were associated with receiving a blood examination during ANC. Rural residence was negatively associated with using ANC four times or more (OR=0.64; 95%CI 0.59–0.67) and receiving a blood examination (OR=0.67; 95%CI 0.59–0.76). Those who received ANC at community health centers were less likely to receive a blood pressure examination, blood and urine examination, and advice to deliver in a hospital compared with those who received ANC at public hospitals.<b>Conclusion:</b> This study showed substantial inequalities in use of ANC and service components of ANC received in India across geographic areas, socioeconomic conditions, and levels of access to health care services. In addition to reducing socioeconomic inequalities, it is necessary to provide quality services to those with limited access to health care services.

Out-of-pocket Costs of Disabilities and Their Association with Household Socioeconomic Status Among School-aged Children in Vietnam / Journal of Rural Medicine

<b>Objective:</b> The aim of this study was to assess the economic burden of disability of school-aged children and to evaluate the association between disabilities and household socioeconomic status, as well as the economic burden of disability and household socioeconomic status in Vietnam.<br><b>Materials and Methods:</b> Nationally representative data for 9,882 children aged 6 to 17 years from the Vietnam Household Living Standard Survey 2006 were used. Disabilities were measured in six basic functional domains, including vision, hearing, remembering or concentrating, mobility, self-care, and communication. We evaluated the association between area, household income, educational attainment, or occupation of household head, and each difficulty. The ratio of health-care expenditure to per capita household income was compared by presence of a disability as well as household socioeconomic status.<br><b>Results:</b> The prevalence of difficulty was 1.9% for vision and 2.3% for at least one of the other five domains. Difficulty in vision was more prevalent in the richer households (p=0.001), whereas difficulty in the other five domains was more prevalent in the poorer households (p=0.002). The ratio of health-care expenditure to per capita household income was greater than 0.05 in 4.6% of children. The adjusted odds ratio of children with difficulty in vision having a health-care expenditure share greater than 0.05 compared with children without difficulty was 4.78 (95% CI: 2.95, 7.73; p<0.001), and that for difficulty in the other five domains was 3.13 (95% CI: 2.04, 4.80; p<0.001). Among children with difficulty in at least one of the five domains other than vision, the proportion of children with a health-care expenditure share greater than 0.05 was higher among children from the poorer households (p=0.033).<br><b>Conclusions:</b> Children with a disability spent more on health care relative to their income than those without. Visual disability was more prevalent among children from the richer households, whereas other disabilities were more prevalent among children from the poorer households.

Greater Adherence to Mass Drug AdministrationAgainst Lymphatic Filariasis through TraditionalVillage Forums in Fiji / Journal of Rural Medicine

<b>Objective:</b> The aim of this study was to elucidate the roles of knowledge related to lymphatic filariasis (LF), contributions of taking roles in community activities to eradicate LF and participation in traditional village forums in adherence to mass drug administration (MDA) in a preventive chemotherapy program targeted at the community residents.<br><b>Materials and Methods:</b> A survey on ingestion of diethylcarbamazine (DEC) and albendazole (ALB), knowledge related to LF, taking roles in community activities and participation in traditional village forums was carried out for 400 adult subjects randomly selected from the Central Division of Fiji within three months after the MDA campaign in 2010 in the respective communities. Multilevel logistic regression analysis and multilevel linear regression analysis were performed to examine relationships between knowledge, community activities, traditional village forums and ingestion of anti-filarial drugs. The LF knowledge score was defined as a factor score of five knowledge variables.<br><b>Results:</b> Among 324 respondents, 40.4% of them ingested both DEC and ALB. Participation in traditional village forums was independently and significantly related to ingestion of DEC and ALB (OR=1.78, 95% CI=1.04-3.05) and taking roles in community activities for MDA (OR=1.87, 95% CI=1.18-2.94), regardless of the subject’s gender, education, knowledge and taking roles in community activities. Taking roles in community activities for MDA was independently related to the LF knowledge score (β=0.24, 95% CI=0.15-0.33).<br><b>Conclusion:</b> Participation in traditional village forums in Fiji was related to taking roles in community activities for MDA and associated with adherence to MDA regimen regardless of the educational attainment of the individual residents.

Bacterial quality of drinking water stored in containers by boat households in Hue City, Vietnam

<p><b>OBJECTIVES</b>To examine the bacterial quality of drinking water stored in containers by boat households in the river basin of Hue City, and associated factors.</p><p><b>METHODS</b>Ready-to-drink water stored in containers on boats was collected from 766 households. Escherichia coli (E. coli), total coliforms, and Enterobacteriaceae in the water were examined by the rehydratable dry-film plating method. Socioeconomic characteristics, water source, handling practices, and proficiency of disease prevention of individual households were assessed.</p><p><b>RESULTS</b>E. coli, over ten counts of total coliforms, and over ten counts of Enterobacteriaceae were detected in 25.7, 44.5, and 51.5% of 1-ml samples of ready-to-drink water stored in containers on the boats. Bacterial contamination of the water stored in containers by boat households was significantly associated with use of river water as a source of drinking water, non-boiling before storing containers for drinking, and limited proficiency in disease prevention regardless of the influence of socioeconomic characteristics of the households (P < 0.01, P < 0.05, P < 0.01, respectively).</p><p><b>CONCLUSIONS</b>Bacterial contamination of ready-to-drink water stored by boat households was indicated. The households' proficiency in disease prevention buffered contamination. A comprehensive health promotion program with a wide range of contents is required for the communities of boat households.</p>

Water quality and concentration of alkylphenols in rivers used as source of drinking water and flowing through urban areas

<p><b>OBJECTIVES</b>To examine nonylphenol (NP) and 4-t-octylphenol (OP) concentrations and general water quality indicators along a river in the greater Tokyo area and to specify the distribution and origin of alkylphenols.</p><p><b>METHODS</b>Water was sampled from the Edogawa River, a main river in the greater Tokyo area, which is a source of public drinking water; and the Sakagawa River system, a tributary of the Edogawa River. To determine alkylphenol in river water. NP and OP concentrations were quantified using gas chromatography-mass spectrometry (GC-MS).</p><p><b>RESULTS</b>The detection rates of NP above the detection limit were 100% in both rivers, and those of OP were 75.0% in the Edogawa River and 92.9% in the Sakagawa River system. The median NP and OP concentrations in the Edogawa River were 0.24 μg/1 and 0.066 μg/l, and those in the Sakagawa River system were 0.87 μg/l and 0.19 μg/l respectively. Alkylphenol concentrations are significantly higher in the Sakagawa River system than in the Edogawa River. In the Sakagawa River system, the NP and OP concentrations were highest in the water along the nonindustrial area with an underdeveloped sewerage system.</p><p><b>CONCLUSIONS</b>NP and OP were detected widely in the Edogawa River and Sakagawa River system. Endocrine-disrupting chemical (EDC) pollution in a river by the inflow of urban wastewater was demonstrated. A systematic monitoring of alkylphenols in tributary rivers and streams as well as in main rivers will help control EDC pollution and protect the source of drinking water in urban areas.</p>

Improved perinatal health through qualified antenatal care in urban Phnom Penh, Cambodia

<p><b>OBJECTIVES</b>The aim of this study is to examine the utilities of antenatal care with comprehensive health education qualified in Phnom Penh for the health of mothers and infants during perinatal and postpartum periods. Attention was given to the existing socioeconomic disparties among women in this urban area, and the utilities were discussed irrespective of socioeconomic status.</p><p><b>METHODS</b>A total of 436 pregnant women in an urban area in Phnom Penh were selected using a complete survey in randomly sampled villages and were followed up. Participating in antenatal care with comprehensive health education at least three time was regarded as the use of "qualified antenatal care" during pregnancy. In this study, we investigated the independent associations of the use of qualified antenatal care with the following outcome variables after the adjustment for the influence of socieconomic variables: postpartum maternal health knowledge, postpartum maternal anemia, low birth weight, and infant immunization.</p><p><b>RESULTS</b>Of the 314 subjects who completed the follow-up examination, 66.8% used qualified antenatal care during pregnancy. The use of qualified antenatal care was positively associated with postpartum maternal health knowledge (OR=2.38, 95% CI: 1.12-5.05). and reductions in the incidences of postpartum anemia (OR=0.22,95% CI: 0.05-0.95) and low birth weight (OR=0.05,95% CI: 0.01-0.39) after the adjustment of the influence of socioeconomic status. The infants born to mothers who used qualified antenatal care had significantly higher coverage of BCG, DPT(1), and DTP(3) immunizations (P<0.001,P<0.001, andP<0.01, respectively), independent of their socioeconomic conditions.</p><p><b>CONCLUSION</b>This study shows the solid utilities of qualified antenatal care in Phnom Penh for perinatal health.</p>

Improved Perinatal Health through Qualified Antenatal Care in Urban Phnom Penh, Cambodia

Objectives: The aim of this study is to examine the utilities of antenatal care with comprehensive health education qualified in Phnom Penh for the health of mothers and infants during perinatal and postpartum periods. Attention was given to the existing socioeconomic disparities among women in this urban area, and the utilities were discussed irrespective of socioeconomic status. Methods: A total of 436 pregnant women in an urban area in Phnom Penh were selected using a complete survey in randomly sampled villages and were followed up. Participating in antenatal care with comprehensive health education at least three times was regarded as the use of “qualified antenatal care” during pregnancy. In this study, we investigated the independent associations of the use of qualified antenatal care with the following outcome variables after the adjustment for the influence of socioeconomic variables: postpartum maternal health knowledge, postpartum maternal anemia, low birth weight, and infant immunization. Results: Of the 314 subjects who completed the follow-up examination, 66.8% used qualified antenatal care during pregnancy. The use of qualified antenatal care was positively associated with postpartum maternal health knowledge (OR=2.38, 95%CI: 1.12–5.05), and reductions in the incidences of postpartum anemia (OR=0.22, 95%CI: 0.05–0.95) and low birth weight (OR=0.06, 95%CI: 0.01–0.39) after the adjustment of the influence of socioeconomic status. The infants born to mothers who used qualified antenatal care had significantly higher coverage of BCG , DPT1, and DPT3 immunizations (P<0.001, P<0.001, and P<0.01, respectively), independent of their socioeconomic conditions. Conclusion: This study shows the solid utilities of qualified antenatal care in Phnom Penh for perinatal health.

Water Quality and Concentration of Alkylphenols in Rivers Used as Source of Drinking Water and Flowing through Urban Areas

Objectives: To examine nonylphenol (NP) and 4-t-octylphenol (OP) concentrations and general water quality indicators along a river in the greater Tokyo area and to specify the distribution and origin of alkylphenols. Methods: Water was sampled from the Edogawa River, a main river in the greater Tokyo area, which is a source of public drinking water; and the Sakagawa River system, a tributary of the Edogawa River. To determine alkylphenol in river water, NP and OP concentrations were quantified using gas chromatography-mass spectrometry (GC-MS). Results: The detection rates of NP above the detection limit were 100% in both rivers, and those of OP were 75.0% in the Edogawa River and 92.9% in the Sakagawa River system. The median NP and OP concentrations in the Edogawa River were 0.24 μg/l and 0.066 μg/l, and those in the Sakagawa River system were 0.87 μg/l and 0.19 μg/l respectively. Alkylphenol concentrations are significantly higher in the Sakagawa River system than in the Edogawa River. In the Sakagawa River system, the NP and OP concentrations were highest in the water along the nonindustrial area with an underdeveloped sewerage system. Conclusions: NP and OP were detected widely in the Edogawa River and Sakagawa River system. Endocrine-disrupting chemical (EDC) pollution in a river by the inflow of urban wastewater was demonstrated. A systematic monitoring of alkylphenols in tributary rivers and streams as well as in main rivers will help control EDC pollution and protect the source of drinking water in urban areas.