Impact of oral intervention on the oral and overall health of children living with HIV in Cambodia: a randomized controlled trial.

BACKGROUND: Maintaining oral health is essential for improving overall health of children living with HIV. Therefore, we evaluated the effectiveness of an oral health intervention for improving their oral and overall health. In addition, we examined their longitudinal association between changes in oral and overall health. METHODS: We conducted a 2-year randomized controlled trial involving children living with HIV in Cambodia. Children aged 3-15 years and their caregivers were randomly allocated either to the intervention (group A) or control (group B) arm. A second control arm (group C) included children without HIV. The group A children received oral health education sessions and practiced home-based daily care. RESULTS: In the baseline survey, 482 children participated (group A: n = 160, group B: n = 168, group C: n = 154), and 350 completed the endline survey. An interaction effect in teeth brushing duration was observed in children in group A relative to group B (AOR = 2.69, 95% CI: 1.37-5.31) and group C (AOR = 3.78, 95% CI: 1.70-8.40). Longitudinal associations were observed between changes in oral hygiene and overall health, as presented by alterations in dental caries in permanent teeth with viral load detection (adjusted odds ratio = 3.58, 95% CI: 1.10 - 11.73), in salivary flow quantity with the overall quality of life (ß = 0.07, 95% CI: < 0.01 - 0.13), as well as in dental caries, salivary pH, debris index with body mass index for age among group A children. CONCLUSIONS: Oral health intervention may improve oral care behaviors and potentially enhance overall health among children living with HIV in antiretroviral therapy in a resource-constrained setting. TRIAL REGISTRATION: ISRCTN 15177479.

Sexual and reproductive health services access and provision in Cambodia during the COVID-19 pandemic: a mixed-method study of urban-rural differences.

BACKGROUND: The COVID-19 pandemic pushed governments worldwide to implement unprecedented mitigation measures, including safe-distancing, lockdowns, disruption of non-essential services, border closures and travel restrictions, with both potential to affect rural and urban service-users differently and unintended consequences including reductions in sexual and reproductive health (SRH) services. We aimed to explore rural-urban differences in progress and challenges in SRH services provision in Cambodia, particularly during initial months of the COVID-19 pandemic. METHODS: We used a mixed-methods study design, including a household survey of 423 adolescents and women aged 18-49 and semi-structured interviews with 21 healthcare providers. We analysed survey data using multivariable logistic regression to identify associations between rural-urban setting and contraceptive perceptions or access. We analysed interview data thematically. RESULTS: Rural-urban residence was significantly associated with reported perceptions about and access to contraceptives. Rural participants had higher odds of stating it was possible to change contraceptive methods early in the COVID-19 pandemic, compared with urban participants. Qualitative data showed that although SRH services continued, health-workers faced differential challenges in rural and urban areas, e.g. service-users not attending due to job losses in urban areas and not complying with safe-distancing and mask-wearing requests in rural areas. CONCLUSIONS: COVID-19 and inadequate mitigation responses differentially affected rural and urban SRH service providers and service-users, exacerbating existing socioeconomic stressors while adding new fears of infection, transport constraints, and reduced livelihoods. Added financial support could help mitigate challenges in both rural and urban areas.

Income loss and gender-based violence during the COVID-19 pandemic among female entertainment workers in Cambodia: a cross-sectional phone survey.

BACKGROUND: In Cambodia, female entertainment workers (FEWs) are disproportionately affected by global and local disasters, such as the COVID-19 pandemic. To prevent the spread of COVID-19, the government imposed tight restrictions, including closures of entertainment venues, such as karaoke bars, beer gardens, nightclubs, or massage parlors, leading FEWs to face economic and social disruptions. This study aims to assess the relationship between income loss during the pandemic and gender-based violence (GBV) among FEWs in Cambodia to inform future disaster response programs. METHODS: We conducted a phone survey in August 2021 with 369 randomly sampled FEWs from a national organization's email list. We used a structured questionnaire to ask the participants about job and income loss, food security, mental health, access to health services, and GBV. We fit a linear regression model to examine the differences in GBV experience between FEWs who lost all their income and those who lost partial income due to the COVID-19 pandemic. Key covariables comprised the number of dependents, smartphone ownership, internet access, food security, and mental health. Multivariable linear regression analysis was conducted. RESULTS: The mean age (31.6 vs. 30.6), years of formal education (6.3 vs. 6.3), marital status (24.2 vs. 23.8 never married), and the number of children (1.3 vs. 1.1) of women reporting having lost all income were not significantly different from those who experienced partial income loss. Overall, GBV experiences were significantly higher in FEWs who lost all income than in those who lost partial income (62.9% vs. 47.4%, p = 0.03). Controlling for the number of dependents, smartphone ownership, and food security, the adjusted odds ratio for GBV was significant in the adjusted model (AOR = 1.23 (1.08-1.40), p = 0.001) indicating that those who experienced total income loss were more likely to experience GBV than those who experienced partial income loss. In addition, they were significantly less likely to be food secure (p = 0.04), less likely to own a smartphone (p = 0.02), and had more dependents (p < 0.001). CONCLUSION: Disaster response programs should consider the implications of safety measures and government support for both formal and informal workers regarding safety, food access, and mental health support. Food assistance programs should target the most vulnerable informal sector workers during crises.

Alcohol Consumption, Loneliness, Quality of Life, Social Media Usage and General Anxiety before and during the COVID-19 Pandemic in Singapore.

This cross-sectional study aims to identify factors associated with anxiety levels of adults living in Singapore before and during the COVID-19 pandemic. Data were collected using a web-based survey conducted from July to November 2020, accruing 264 eligible participants. Ordered logistic regression was used to assess factors associated with Generalized Anxiety Disorder-7 (GAD-7), ranked as minimal (0-4), mild (5-9), moderate (10-14), and severe (15-21) before and during the pandemic. About 74% of participants were female, 50% were aged 25-34, and 50% were married. The GAD-7 level went up from the pre-pandemic for moderate (12.5% to 16%) and severe GAD (2% to 11%). Alcohol consumption (AOR 1.79, 95% CI 1.04-3.06), loneliness (AOR 1.28, 95% CI 1.05-1.54), and difficulty in switching off social media (AOR 2.21, 95% CI 1.29-3.79) predicted increased GAD-7 levels. The quality of life (AOR 0.84, 95% CI 0.79-0.90) was significantly associated with decreased GAD-7 levels. The results heighten the awareness that early initiation of mental health support is crucial for the population in addition to the various financial support measures provided by the government as they are adapting to live with the COVID-19 pandemic.

Hesitancy in COVID-19 vaccine uptake and its associated factors among the general adult population: a cross-sectional study in six Southeast Asian countries.

BACKGROUND: Vaccines are effective and reliable public health interventions against viral outbreaks and pandemics. However, hesitancy regarding the Coronavirus disease (COVID-19) vaccine is evident worldwide. Therefore, understanding vaccination-related behavior is critical in expanding the vaccine coverage to flatten the infection curve. This study explores the public perception regarding COVID-19 vaccination and identifies factors associated with vaccine hesitancy among the general adult populations in six Southeast Asian countries. METHODS: Using a snowball sampling approach, we conducted a descriptive cross-sectional study among 5260 participants in Indonesia, Malaysia, Myanmar, Philippines, Thailand, and Vietnam between February and May 2021. Binary logistic regression analysis with a backward conditional approach was applied to identify factors associated with COVID-19 vaccine hesitancy. RESULTS: Of the total, 50.6% were female, and the median age was 30 years (range: 15-83 years). The majority of the participants believed that vaccination effectively prevents and controls COVID-19 (81.2%), and 84.0% would accept COVID-19 vaccines when they become available. They agreed that health providers' advice (83.0%), vaccination convenience (75.6%), and vaccine costs (62.8%) are essential for people to decide whether to accept COVID-19 vaccines. About half (49.3%) expressed their hesitancy to receive the COVID-19 vaccines. After adjustment for other covariates, COVID-19 vaccine hesitancy was significantly associated with age, residential area, education levels, employment status, and family economic status. Participants from Indonesia, Myanmar, Thailand, and Vietnam were significantly more likely to express hesitancy in receiving COVID-19 vaccines than those from Philippines. CONCLUSIONS: In general, participants in this multi-country study showed their optimistic perception of COVID-19 vaccines' effectiveness and willingness to receive them. However, about half of them still expressed their hesitancy in getting vaccinated. The hesitation was associated with several socioeconomic factors and varied by country. Therefore, COVID-19 vaccination programs should consider these factors essential for increasing vaccine uptake in the populations.