Global School-based Student Health Survey reveals correlates of suicidal behaviors in Brunei Darussalam: a nationwide cross-sectional study.

BACKGROUND: This study aimed to determine the prevalence of and correlates for suicidal behaviors among school attending adolescents in Brunei. METHODS: Nationally representative cross-sectional data on (n=2599) adolescents derived from the Global School-based Health Survey in Brunei Darussalam were examined. Data on suicidal behaviors, psychosocial and demographic characteristics were analyzed using multiple logistic regression taking survey design into account. RESULTS: Twelve months prior to being surveyed, the prevalence of suicidal behaviors was 9.3%, 6.5% and 5.9% for suicidal ideation, suicidal plan and suicidal attempt, respectively. Females were overrepresented in attempts (61.2%). Several self-reported characteristics such as suicide ideation (69%), anxiety (28%), and loneliness (30%) were significantly different between the attempters of suicide and non-attempters (p less than 0.05). Also, some suicide-related behaviors such as having planned a suicide (52%), being bullied (21%), involved in a physical fight (29%), serious injury (29%), early sexual debut (8.5%), alcohol use at early age (21%), alcohol use in the past 30-days (12%), and being physically attacked (30%) differed by suicide category (p less than 0.05). Compared to those who did not report attempting suicide, attempters were more likely to have suicide ideation (OR=10.58; 95% CI 5.10, 21.97); have planned suicide (OR=9.82; 95% CI 4.60, 20.96); or sustained serious injury (OR=4.01; 95% CI 2.03, 7.93) within the recall period. CONCLUSIONS: This study provided evidence, which overall confirm that the psycho-social environment in school settings modify suicidal behavior. The results, taken together emphasize the importance of the school environment on the development of school attending adolescents. Where possible, the results may provide additional information on which self-reported behaviors represent avenues for potential preventive programming.

Tobacco use in school students in Afghanistan, Oman and Kuwait and association with parental monitoring: analysis of data from Global School-based Student Health surveys.

BACKGROUND: Nationally representative data are lacking on cigarette smoking in adolescents in Afghanistan, Oman and Kuwait, which are considered low-income, middle-income and high-income countries respectively of the World Health Organization Eastern Mediterranean Region. AIMS: This study examined the effect of parental monitoring on the tobacco use of adolescent school students in Afghanistan, Oman and Kuwait. METHODS: Using data from the 2014 Afghanistan, 2015 Oman and 2015 Kuwait Global School-based Student Health surveys, factors associated with cigarette smoking and tobacco use among the students in the 30 days before the survey were analysed. These factors included: parental understanding of their problems/worries, parental awareness of how they spent their free time, parents searching their belongings without their approval, and parents checking if homework was done. Logistic regression analysis was used to determine the association between tobacco use and parental monitoring. RESULTS: The prevalence of cigarette smoking and/or use of other tobacco products by the students on one or more days in the 30 days before the survey was 10.6% in Afghanistan, 9.3% in Oman and 28.8% in Kuwait. Adolescents whose parents understood their problems, were aware of how they spent their free time, and checked if their homework was done were less likely to be current tobacco users in all three countries (P < 0.05). Adolescents in Oman and Kuwait whose parents searched their belongings were more likely to use tobacco (P < 0.01). CONCLUSION: The prevalence of tobacco use in the adolescents, especially in Kuwait, suggests the need for better schoolbased health education and promotion programmes in these countries.

Spatial distribution and accessibility to public sector tertiary care teaching hospitals: case study from Pakistan.

BACKGROUND: Public sector provision of health care services is important for addressing health morbidity and mortality burden for population health in developing countries like Pakistan. Physical accessibility and spatial distribution of healthcare facilities affect their utilization for improving population health. AIMS: This study aimed to analyze the spatial distribution of five public sector, tertiary care, teaching, general hospitals in the city of Lahore, Pakistan. METHODS: The point locations of all five hospitals were obtained from Google Earth. While the vector road network file was downloaded from the OpenStreetMap website. GIS software ArcGIS 10.5 and the Network Analyst extension were used for processing, analysis and mapping. The Lahore city shapefiles and the hospital point locations were projected to ensure correct spatial distance analysis. RESULTS: The five hospitals are located in the northeastern and east-central parts of Lahore. Most of the Lahore "towns" (administrative subdivisions) are either partially or completely covered by the 12-kilometre buffer as well as the 12-kilometre service area around these five selected hospitals. However, either the 12-kilometre buffer or service area did not cover large swaths of Wagha, Nishtar, and Iqbal towns. CONCLUSIONS: Availability of geographic and attribute data on road network and population characteristics would facilitate planning for allocating locations for new health care facilities based on utilitarian principles.

Suicide attempts and behavioral correlates among a nationally representative sample of school-attending adolescents in the Republic of Malawi.

BACKGROUND: Suicide is among the top causes of adolescent mortality worldwide. While correlates of suicidal behavior are better understood and delineated in upper-income countries, epidemiologic knowledge of suicidal behavior in low-income countries remains scant, particularly in the African continent. The present study sought to add to the epidemiologic literature on suicidal behavior in Africa by examining the behavioral correlates of suicide attempts among Malawi adolescents. METHODS: A cross-sectional study using a nationally-representative sample extracted from publically-available data was conducted. Bivariate and multivariate analyses were performed to discern associations between suicide attempts and a host of behavioral variables. 2225 records were included in the study. RESULTS: At the multivariate level, suicide attempters had significantly higher odds of being anxious, being physically bullied, having sustained a serious injury and having a greater number of lifetime sexual partners. Alcohol use (at an early age and within the past 30 days) was also associated with suicide attempts. CONCLUSIONS: These findings have the potential to guide public health interventions geared toward suicide prevention in Africa and other, similar regions, as well as provide the impetus for future epidemiologic studies on suicidal behavior in low-income countries.

Nurses' use of global information systems for provision of outreach reproductive health services to internally displaced persons.

INTRODUCTION: A long and protracted civil war compounded by the occurrence of nature-related disasters have forced thousands of Somalis to take refuge in camps for internally displaced persons (IDPs) to escape violence and seek shelter. Dwellers of these camps have limited accessibility to and affordability of the fractured healthcare facilities located in nearby towns. A free, outreach, mobile, reproductive healthcare delivery system staffed with nurses and using an ambulance guided by a global information systems (GIS) map was established to address the accessibility and affordability issues hindering provision of quality reproductive healthcare to the women in the IDP camps and in the outskirts of Baidoa City, Somalia. METHODS: All 14 IDP camps in Baidoa City were visited to determine the number of families/huts, and to acquire their global positioning system (GPS) central point locations. Global information systems (GIS) shape files containing major roads, river, and dwellings, and straight-line distances from the base clinic to each IDP camp were computed. The objective of creating and using this specially designed map was to help nurses in determining which camps realistically could be visited on a given day, and how best to access them considering the security situation and the condition of rain-affected areas in the city. RESULTS: Use of the GIS map was instrumental in facilitating the delivery of healthcare services to IDPs and ensuring that resources were adequately utilized. Free healthcare services were provided each work day for the month long duration of the project; 3,095 consultations were provided, inclusive of 948 consultations for children under the age of 16 years, and delivery of three babies. CONCLUSIONS: Creation and use of a simple, need-specific GIS map in this pilot project effectively aided the logistical planning and delivery of mobile, outreach reproductive health services by directing the ambulance and nurses safely to accessible IDP camps in an area marred with long and protracted disasters from both natural and human causes.

Proportion of complications in patients practicing clean intermittent self-catheterization (CISC) vs indwelling catheter.

OBJECTIVE: To compare the complications especially infection in two groups; group-A: those performing clean intermittent self-catheterization (CISC) and group-B: patients with indwelling catheters. METHODS: Comparative study, conducted at Department of Urology, Jinnah Postgraduate Medical Centre, Karachi. A total of 80 patients with ages between 15 - 80 years were studied. There were 40 patients in each group comprising of 35 males and 5 females in group-A and 38 males and 2 females in group-B. Group-A patients were mainly those with neurogenic bladder (n = 25) and postoperative cases of stricture. While in indwelling group 35 patients had neurogenic bladder with the remaining (n = 5) having benign prostatic hypertrophy. Group-A performed CISC 1-4 times/24 hours depending on the primary disease while in group-B fortnightly catheter change was done under aseptic conditions. Symptomatic infections were taken into consideration in both the groups proven by urine C/S. RESULTS: Symptomatic infections as pyelonephritis, epididymorchitis and urosepsis occurred in both groups. In group-A 2 (5%) patients developed pyelonephritis as compared to 10 (25%) in group-B (P value 0.01). Epididymorchitis and urosepsis occurred in 1 (2.5%) and 0 patients in group-A while 3 (7%) and 2 (5%) patients in group-B. Statistically significant infection (pyelonephritis) occurred in group-B. CONCLUSION: CISC is much safer practice with less complications and infection rate than indwelling catheters.