Mental health in children conceived by Assisted Reproductive Technologies (ARTs): Insights from a longitudinal study of Australian children.

BACKGROUND: The mental health of children conceived using Assisted Reproductive Technologies (ARTs) such as In-Vitro-Fertilization (IVF) is a subject of significant controversy. Existing studies suggest children conceived through ART meet physical and cognitive developmental milestones at similar rates to their spontaneously conceived peers, however, a significant number of studies have connected ART conception with mental health conditions, particularly depression and attention-deficit hyperactivity disorder (ADHD) in adolescence. This study, therefore, aimed to determine whether maternal use of ARTs to achieve pregnancy is associated with an increased risk of mental disorders in these children, and whether these effects are sex-dependent or confounded by known covariates in the ART population. METHODS: Secondary data analysis was performed using Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) data; a nationally representative population-based cross-sequential cohort study. Multivariate logistic regression models examined the impact of ART (including IVF and other fertility drugs, from LSAC wave-1 and wave-2 conducted in 2004 and 2006, respectively) on mental health outcomes (i.e., autism, ADHD, anxiety and/or depression, from LSAC waves 8 conducted in 2018) in Australian adolescents aged 18-19 years in 2018 (n = 1735). Known sociological and obstetric covariates including maternal age, birth weight, smoking and drinking alcohol during pregnancy, maternal gestational diabetes, postnatal depression, hypertension, and socioeconomic status were considered to generate an adjusted logistic model. Variables with a p-value of <0.05 in the regression models were considered statistically significant. RESULTS: Of the 1735 mother-child dyads analysed, the maternal mean age was 35.6 years (Standard deviation = ±4.75), approximately 5% of mothers (n = 89) used ART to become pregnant, and 22% of adolescents (n = 384) had a mental disorder. Longitudinal analysis revealed no relationship between ART and children developing a mental disorder in the LSAC population. CONCLUSION: These results should reassure parents considering ART that there is no increased risk of psychological or neurodevelopmental problems in their ART conceived offspring.

Role of internet use, mobile phone, media exposure and domestic migration on reproductive health service use in Bangladeshi married adolescents and young women.

Numerous studies have identified factors that are associated with increased access to reproductive health services in lower-middle-income countries (LMICs). However, limited studies examined the influence of access to internet or a mobile phone, media exposure and domestic migration on reproductive health services use in LMICs like Bangladesh. This study investigated the role of such factors on the use of contraceptives, antenatal care (ANC) and postnatal care (PNC) by married adolescents and young women in Bangladesh and whether it was varied by area. Secondary data for 1665 married women aged 15-24 years, sourced from the 2019 Multiple Indicator Cluster Surveys, were included in both bivariate analyses and logistic regression modelling to examine the role of access to internet and/or mobile phone, media exposure and domestic migration on the outcome variables (contraceptive, ANC and PNC). All regression models were controlled for age, wealth, education and number of existing children. Among all participants, 69.8% were aged 20-24 years and 85.6% lived in rural areas. Of the total sample, 67.5% used contraceptives, 75.7% utilised ANC and 48.7% accessed PNC. Domestic migration significantly increased contraceptive use, with women who had moved locally within the last five years 1.84 times more likely to use contraception than those who had never moved (95% CI: 1.41-2.41, p<0.001). Women with internet or mobile phone access were more likely to receive ANC (aOR: 1.57, 95% CI: 1.22-2.00, p<0.001) compared to those without internet/mobile phone access. Media exposure was found to increase the likelihood of receiving ANC in urban areas. No significant influence was found on the use of PNC. Internet/mobile-based platforms are promising avenues for public health messaging regarding ANC in Bangladeshi married adolescents and young women. Further research is required into determinants of PNC service use in low-resource settings.

Prevalence, inequality and associated factors of overweight/obesity among Bangladeshi adolescents aged 15-19 years.

BACKGROUND: The objective of the current study was to estimate the prevalence and associated factors of overweight/obesity among Bangladeshi adolescents aged 15-19 y and to identify whether wealth-related inequality exists for overweight/obesity among Bangladeshi older adolescents. METHODS: We analyzed publicly available national representative secondary data from the 2019-2020 Bangladesh Adolescent Health and Wellbeing Survey. This cross-sectional survey was carried out among 18 249 adolescents aged 15-19 y regardless of their marital status using a two-stage stratified sampling technique (the data of 9128 eligible adolescents were included in this analysis). The WHO reference population for body mass index-for-age (1+Z score) was considered as overweight/obesity. RESULTS: We found that girls had significantly (p<0.05) higher prevalence of overweight/obesity (11.63%) than boys (8.25%); however, their biological sex as well their age were not significantly associated with higher odds of overweight/obesity. Those who were in their higher grade (grade 11 and higher) in the school and had been exposed to media were more likely (1.67 and 1.39 times, respectively) to be overweight/obesity compared with primary grade (0-5) and those who experienced no media exposure, respectively. Inequality analysis revealed that adolescents belonging to wealthy households had significantly higher rates of overweight/obesity than those in poorer households (concentration index=0.093). CONCLUSIONS: The study exhibited the multifaceted nature of overweight/obesity among Bangladeshi older teenagers, revealing that their school grade, exposure to media content and wealth-related inequality emerged as significant contributing factors. The findings underscore the urgent need for targeted interventions and public health strategies to address the escalating burden of overweight and obesity in this age group.

The burden of psychological distress and unhealthy dietary behaviours among 222,401 school-going adolescents from 61 countries.

We aimed to calculate the sex-specific prevalence of psychological distress and unhealthy eating habits among adolescents across countries and regions, and to explore their potential associations. We used data from the Global School-Based Health Survey (GSHS) for 61 countries. Psychological distress was defined based on the existence of ≥ 2 factors from the following: loneliness, anxiety, suicide ideation, suicide planning, and suicide attempt. Four unhealthy dietary behaviours were examined: inadequate fruit intake, inadequate vegetable intake, daily consumption of soft drinks, and weekly fast-food consumption. We used random-effects meta-analysis to estimate the overall and regional pooled prevalence. Mixed-effect multilevel logistic regressions were used to estimate adjusted odds ratios (aORs) of unhealthy dietary behaviours in relation to psychological distress. Among 222,401 school-going adolescents (53.3% girls), the prevalence of psychological distress was 17.9%, with girls reporting higher than boys (20.8% vs. 14.9%). Adolescents in the African region reported the highest prevalence (22.5%), while those in the South-East Asia region reported the lowest (11.3%). The prevalence of inadequate fruit intake, inadequate vegetable intake, daily soft drink consumption, and weekly fast-food consumption was 37.0%, 28.5%, 50.0%, and 57.4% respectively. Psychological distress was associated with inadequate fruit intake (pooled aOR = 1.19, 95% CI 1.17-1.23), inadequate vegetable intake (pooled OR = 1.19, 1.16-1.22), daily consumption of soft drinks (pooled aOR = 1.14, 1.12-1.17), and weekly consumption of fast food (pooled aOR = 1.12, 1.09-1.15). Our findings indicate a substantial variance in the burden of psychological distress and unhealthy dietary behaviours across different regions. Adolescents experiencing psychological distress were more likely to have unhealthy dietary habits.

Identifying Social Determinants and Measuring Socioeconomic Inequalities in the Use of Four Different Mental Health Services by Australian Adolescents Aged 13-17 Years: Results from a Nationwide Study.

AIM: In this study, we aimed to identify the determinants of four different forms of mental health service usage (general health services, school counselling, telephone, and online services), and the number of mental health services accessed (single and multiple) by Australian adolescents aged 13-17 years. We also measured socioeconomic inequality in mental health services' usage following the concentration index approach within the same sample. SUBJECT AND METHODS: The data came from the nationwide cross-sectional survey, Young Minds Matter (YMM): the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Random effect models were used to identify the factors associated with four different mental health services and the number of services accessed. Further, the Erreygers' corrected concentration indices for binary variables were used to quantify the socioeconomic inequality in each mental health service. The four services were the general health service (GP, specialist, psychiatrist, psychologist, hospital including emergency), school services, telephone counselling and online services. RESULTS: Overall, 31.9% of the total analytical sample (n = 2268) aged 13-17 years old visited at least one service, with 21.9% accessing a single service and 10% accessing multiple services. The highest percentage of adolescents used online services (20.1%), followed by general mental health services (18.3%), while school services (2.4%) were the least used service. Age, gender, family type and family cohesion statistically significantly increased the use of general health and multiple mental health service usage (p < 0.05). Area of residence was also found to be a significant factor for online service use. The concentration indices (CIs) were -0.073 (p < 0.001) and -0.032 (p < 0.001) for health and telephone services, respectively, which implies pro-rich socio-economic inequality. CONCLUSION: Adolescents from low-income families frequently used general mental health services and telephone services compared to those who belonged to high-income families. The study concluded that if we want to increase adolescents' usage of mental health services, we need to tailor our approaches to their socioeconomic backgrounds. In addition, from a policy standpoint, a multi-sectoral strategy is needed to address the factors related to mental health services to reduce inequity in service utilisation.

Identifying potential factors associated with PCR testing for COVID-19 among Australian young people: cross-sectional findings from a longitudinal study.

BACKGROUND: Testing has played a crucial role in reducing the spread of COVID-19. Though COVID-19 symptoms tend to be less severe in adolescents and young adults, their highly social lifestyles can lead to increased transmission of the virus. In this study, we aimed to provide population-based estimates of polymerase chain reaction testing (PCR) for the COVID-19 pandemic and identify factors associated with PCR testing in Australian youth using the latest survey data from the Longitudinal Study of Australian Children (LSAC). METHODS: We used the latest wave (9C1) of the LSAC, collected from 16 to 21-year-old Australians via an online survey between October and December 2020. In total, 2291 youths responded to the questions about COVID-19 testing including factors related to the coronavirus restriction period (CRP) in Australia. Both bivariate and multivariate logistic regression analyses were performed to identify variables (sociodemographic factors and factors related to CRP) associated with COVID-19 testing. RESULTS: During the study period, 26% (n = 587) of Australian youth aged between 16 and 21 years were tested for COVID-19. The strongest predictor of COVID-19 testing was living in major cities (aOR 1.82, 95% CI:1.34-2.45; p < 0.01). Increased age (aOR 1.97, 1.00-3.89; p < 0.05) and having a pre-existing medical condition (aOR 1.27, 1.02-1.59; p < 0.05) were also significantly associated with a higher likelihood of COVID-19 testing. CONCLUSION: Age, remoteness and having a pre-existing medical illness were associated with PCR COVID-19 testing among Australian youth aged between 16 and 21 years in the first year of the COVID-19 pandemic. More research is warranted to identify factors associated with other COVID-19 testing methods and address the specific barriers that may limit COVID-19 testing in this age group.

Oral Healthcare during Pregnancy: Its Importance and Challenges in Lower-Middle-Income Countries (LMICs).

Oral health is essential in general health and well-being to maintain overall quality of life [...].

Patient-Reported Experiences and Satisfaction with Rural Outreach Clinics in New South Wales, Australia: A Cross-Sectional Study.

Introduction: Many studies have been conducted on how physicians view outreach health services, yet few have explored how rural patients view these services. This study aimed to examine the patient experience and satisfaction with outreach health services in rural NSW, Australia and the factors associated with satisfaction. Methods: A cross-sectional study was conducted among patients who visited outreach health services between December 2020 and February 2021 across rural and remote New South Wales, Australia. Data on patient satisfaction were collected using a validated questionnaire. Both bivariate (chi-squared test) and multivariate analyses (logistic regression) were performed to identify the factors associated with the outcome variable (patient satisfaction). Results: A total of 207 participants were included in the study. The mean age of respondents was 58.6 years, and 50.2% were men. Ninety-three percent of all participants were satisfied with the outreach health services. Respectful behaviours of the outreach healthcare practitioners were significantly associated with the higher patient satisfaction attending outreach clinics. Conclusions: The current study demonstrated a high level of patient satisfaction regarding outreach health services in rural and remote NSW, Australia. Further, our study findings showed the importance of collecting data about patient satisfaction to strengthen outreach service quality.

Healthcare Avoidance before and during the COVID-19 Pandemic among Australian Youth: A Longitudinal Study.

BACKGROUND: Access to healthcare for young people is essential to ensure they can build a foundation for a healthy life. However, during the COVID-19 pandemic, many people avoided seeking healthcare, adversely affecting population health. We investigated the factors associated with the avoidance of healthcare for Australian young people when they reported that they needed healthcare. We were able to compare healthcare avoidance during the COVID-19 pandemic with healthcare avoidance prior to COVID-19. METHODS: We used two recent data collection waves from the Longitudinal Study of Australian Children (LSAC)-Wave 9C1 during the COVID-19 pandemic in 2020, and Wave 8 data which were collected in 2018. The primary outcome of this study revealed the avoidance of healthcare among those who perceived the need for care. Bivariate analyses and multiple logistic regression models were employed to identify the factors associated with the avoidance of healthcare during the COVID-19 and pre-COVID-19 periods. RESULTS: In the sample of 1110 young people, 39.6% avoided healthcare during the first year of the COVID-19 pandemic even though they perceived that they had a health problem that required healthcare. This healthcare avoidance was similar to the healthcare avoidance in the pre-COVID-19 pandemic period (41.4%). The factors most strongly associated with healthcare avoidance during the COVID-19 pandemic were female gender, an ongoing medical condition, and moderately high psychological distress. In comparison, prior to the pandemic, the factor associated with healthcare avoidance was only psychological distress. The most common reason for not seeking healthcare was thinking that the problem would spontaneously resolve itself (55.9% during COVID-19 vs. 35.7% pre-COVID-19 pandemic). CONCLUSIONS: A large proportion of youths avoided healthcare when they felt they needed to seek care, both during and before the COVID-19 pandemic.

Protective Factors against Self-Harm and Suicidality among Australian Indigenous Adolescents: A Strengths-Based Analysis of the Longitudinal Study of Indigenous Children.

Background: Understanding and encouraging social and emotional well-being (SEWB) among Indigenous adolescents is vital in countering the impacts of colonisation and intergenerational trauma. As self-harm and suicidality are considered markers of poor SEWB among Indigenous communities, we aimed to identify the individual-level and community-level factors protecting Indigenous adolescents from self-harm and suicidality. Methods: Data came from Footprints in Time­The Longitudinal Study of Indigenous Children (waves 10 and 11), conducted among Indigenous families across Australia. A strengths-based analysis fitted multilevel logistic regression to explore associations with factors proposed as protective against self-reported self-harm and suicidality among Indigenous adolescents. Results: Our study cohort included 365 adolescents with complete data for the variables of interest. Adolescents had a mean (SD) age of 14.04 (0.45) years and a sex ratio of almost 1:1, and most were attending school (96.2%). Previous self-harm was reported by 8.2% (n = 30); previous suicidality was reported by 4.1% (n = 15). Individual-level factors protecting against self-harm and suicidality were being male, living in a cohesive family, and having low total Strengths and Difficulty Questionnaire scores (p < 0.05 for all). Residing in major cities compared with regional/remote areas was protective against self-harm (OR 5.94, 95% CI 1.31−26.81). Strong cultural identity was not found to be a protective factor against self-harm and/or suicidality in the sample. Conclusions: This study identified key individual- and community-level factors that can protect Australian Indigenous adolescents against self-harm and suicidality, particularly family cohesion. Identifying strengths for this at-risk population can inform prevention strategies, particularly for rural living adolescents with high distress.

Experience of Bangladeshi Dental Students towards Online Learning during the COVID-19 Pandemic: A Web-Based Cross-Sectional Study.

BACKGROUND: During the COVID-19 pandemic, dental education institutions throughout the world experienced significant challenges, including a quick shift to an online learning paradigm. Since the pandemic has had a considerable impact on dental education, this research evaluated the perspectives and attitudes towards online learning among undergraduate dental students in Bangladesh. METHODS: The research was conducted through a cross-sectional method using self-administered online questionnaires. The questionnaire included information on the students' sociodemographic status, their views, and their attitudes about the changes in the educational system, specifically regarding online learning. The study gathered data from 952 undergraduate students from 14 dental institutions in Bangladesh. RESULTS: The results suggested that 87.5% of all the students were unsatisfied with their online programs. Most of the respondents who expressed dissatisfaction with their online classes were female, did not receive assistance in overcoming barriers to accessing the classes or materials (64.23%), did not have access to the institutional online-learning management system (OLMS) (67.35%), and did not have access to the online course materials (71.43%). The students considered that the shift to online learning failed to provide quality clinical teaching. CONCLUSIONS: The lack of an OLMS was found to be linked with dissatisfaction with online learning among Bangladeshi dental students during the COVID-19 outbreak. Additionally, insufficient time allocation and a lack of support through online training were found to be strongly correlated with the students' discontent. The overall findings highlight the need to develop and implement effective online dentistry educational interventions to promote academic advancement and key practical skills.

Does Long-Term Enrollment in Day-Care Maintain or Increase Early Developmental Gains-Findings from an Intervention Study in Rural Bangladesh.

Objective: Community day-care centers (or crèches) are gaining popularity; access to these centers can reduce cognitive gaps. This paper describes the sustained impact of enrollment in day-cares on cognitive gains. Methods: As part of a larger study, a census of all children was conducted in 2012−2013 to identify children between 9 and 17 months of age in rural Bangladesh. A sub-sample of children (n = ~1000) were assigned to receive either a day-care or playpen. Children from two sub-districts were randomly selected and assessed at 9−17 months of age for cognitive and behavioral domains using the Ages and Stages Questionnaire-III. The same children were then followed-up with after one year to see if the scores obtained by the children in the day-care intervention were different from those enrolled in the playpen intervention using a difference-in-difference estimator. Results: Children enrolled in the day-care intervention performed better (in communication, gross-motor, personal-social, and problem-solving domains) than children enrolled in the playpens when followed up with after a one-year period. Total scores were 0.31 (95% CI 0.141−0.472) higher (p value < 0.001) among children in the day-cares. Family care indicators as well as the child's and mother's weight were significantly associated with sustained and increased cognitive gains. Conclusion and relevance: The cognitive and psychosocial improvements seen with short-term exposure to structured ECD programs (day-care) were observed to be sustained over time with continued exposure. Home stimulation and parental involvement add to the long-term benefits of ECD.

Bullied Because of Their Teeth: Evidence from a Longitudinal Study on the Impact of Oral Health on Bullying Victimization among Australian Indigenous Children.

Making life better for Indigenous peoples is a global priority. Although bullying and oral health have always been a topic of concern, there is limited information regarding the impact of this problem on the general population, with no evidence in this regard among the Australian Indigenous population. Thus, we aimed to quantify the relationship between bullying victimization and oral health problems by remoteness among 766 Australian Indigenous children aged between 10−15-years using data from the LSIC study. Bivariate and multilevel mixed-effect logistic regression analyses were employed. Findings indicated children self-reported bullying more than parents reported their children were being bullied (44% vs. 33.6%), with a higher percentage from rural/remote areas than urban areas. Parents reported that oral health problems increased the probability (OR 2.20, p < 0.05) of being bullied, in Indigenous children living in urban areas. Racial discrimination, lower level of parental education and poor child oral hygiene increase the risk of bullying victimization. Parental happiness with life and a safe community were associated with a lower risk of bullying. Dental problems are linked with Australian Indigenous children experiencing bullying victimization. Cultural resilience and eliminating discrimination may be two modifiable paths to ameliorating health issues associated with bullying in the Australian Indigenous community.

The gap between perceived mental health needs and actual service utilization in Australian adolescents.

Despite being highly prevalent, adolescent mental health problems are undertreated. To better understand the mental health treatment gap, we assessed the prevalence and correlates of help-seeking, including perceived need for care and access to that care. Data were drawn from Young Minds Matter (YMM) survey-the second Australian child and adolescents survey of mental health and wellbeing. Parent-reported data and self-reported child data were combined into one dataset to analyse 2464 Australian adolescents aged 13-17 years. We employed bivariate and multivariate logistic regression models to assess the correlation between independent variables (professionally assessed with mental disorders only, self-reported self-harm/suicidality only and both) and their distribution over outcome variables (perceived need and service use). Mental disorders include depression, anxiety, ADHD and conduct disorder. Our study revealed 15.0%, 4.6% and 7.7% had professionally assessed with mental disorders only, self-reported self-harm/suicidality only and both, respectively. Overall, 47.4% and 27.5% of adolescents respectively perceived need for care and used services in the past-12-months. While among those only who perceived the need, only 53% of adolescents used any services. Professionally assessed with mental disorders only, self-reported self-harm/suicidality only and both were associated with higher likelihood of perceived need and service use (p < 0.001 for all). However, adolescents who self-reported self-harm/suicidality only were not found to be significantly associated with service use among those who perceived the need for care. Adolescents who perceived the need for mental health care but did not seek care represent a treatment gap. Our results suggest the importance of reducing the wide treatment gap that exists between need and care.

Evaluating Risk and Protective Factors for Suicidality and Self-Harm in Australian Adolescents With Traditional Bullying and Cyberbullying Victimizations.

PURPOSE: To identify and compare important risk and protective factors associated with suicidality and self-harm among traditional bullying and cyberbullying victims aged 14-17-years in Australia. DESIGN: Cross-sectional population-based study. SETTING: Young Minds Matter, a nationwide survey in Australia. SUBJECTS: Adolescents aged 14-17-years (n = 2125). MEASURES: Suicidality and self-harm were outcome variables, and explanatory variables included sociodemographic factors (age, gender, country of birth, household income, location, family type), risk factors (parental distress, family functioning, family history of substance use, child substance use, mental disorder, psychosis, eating disorders, sexual activity) and protective factors (high self-esteem, positive mental health or resilience, school connectedness, sleep) among 2 types of bullying victims-traditional and cyber. Traditional bullying includes physical (hit, kick, push) or verbal (tease, rumors, threat, ignorance), and cyberbullying includes teasing messages/pictures via email, social medial using the internet and/or mobile phones. ANALYSIS: Bivariate analysis and binary logistic regression models. Statistical metrics include Hosmer-Lemeshow Goodness-of-Fit-test, VIF test, Linktest and ROC curve for model performance and fitness. RESULTS: Overall, 25.6% of adolescents were traditional bullying victims and 12% were cyberbullying victims. The percentages of suicidality (34.4% vs 21.6%) and self-harm (32.8% vs 22.3%) were higher in cyberbullying victims than in traditional bullying victims. Girls were more often bullied and likely to experience suicidal and self-harming behavior than boys. Parental distress, mental disorder and psychosis were found to be significantly associated with the increase risk for self-harm and suicidality among both bullying victims (p < 0.05). While, eating disorder and sexual activity increased the risk of suicidality in traditional bullying victims and self-harm in cyberbullying victims, respectively. Positive mental health/resilience and adequate sleep were found be significantly associated with decreased suicidality and self-harm in both bullying victims. CONCLUSION: Suicidality and self-harm were common in bullying victims. The findings highlight that the risk and protective factors associated with suicidality and self-harm among adolescent who experienced traditional and cyberbullying victimization should be considered for the promotion of effective self-harm and suicide prevention and intervention programs.

Depression and anxiety have a larger impact on bullied girls than on boys to experience self-harm and suicidality: A mediation analysis.

BACKGROUND: The mechanism underlying the correlation between bullying victimization, self-harm and suicidality by gender are not well understood. This study, therefore, aimed to investigate whether the mediating effect of mental disorder (depression and anxiety) on the association between bullying victimization, and self-harm and suicidality vary across boys and girls. METHODS: Overall, 2522 Australian adolescents aged 12-17-year-olds were analyzed from a nationally representative cross-sectional survey: Young Minds Matter. A series of logistic regressions were employed using Baron and Kenny's approach to test the mediating effect of each mental disorder on the relationship between bullying victimization, and self-harm and suicidality across gender. Further, the Sobel test was used to estimate the indirect effect. RESULTS: Out of 784 (31.1%) bullied victims, 53.2% were girls and 46.8% were boys. A higher proportion of girls compared to boys experienced depression, anxiety, self-harm and suicidality (p < 0.001 for all). The relationships between bullying victimization, and self-harm and suicidality were mediated by depression (p < 0.05) in both boys and girls. While anxiety disorder mediated the association only in girls (p < 0.05). LIMITATIONS: Cross-sectional study design does not imply causality. Self-reported data about self-harm and suicidality may be susceptible to social desirability bias. CONCLUSION: Girls were more affected by bullying, self-harm and suicidality than boys. Depression mediated the correlation between bullying, and self-harm and suicidality in both boys and girls. While anxiety influenced only bullied girls to experience self-harm and suicidality. These findings warrant the need for gender-specific prevention programs to combat bullying and subsequently self-harm and suicidality in adolescents.

Job Satisfaction of Health Practitioners Providing Outreach Health Services during COVID-19 in Rural New South Wales (NSW) and the Australian Capital Territory (ACT), Australia.

Background: Outreach health practitioners play a key role in enhancing access to healthcare for remote, rural, regional, and Aboriginal and Torres Strait Islander communities in Australia. Outreach health practitioners are those providing ongoing and integrated health services in communities that would otherwise have limited access. In the context of the COVID-19 pandemic, it is important to understand the job satisfaction of health workers as it correlates with long-term retention of the workforce, as well as effectiveness in the role and clinical outcomes for patients. Method: The study analysed data from 258 outreach health practitioners who responded to two cross-sectional surveys conducted by the NSW Rural Doctors Network during the COVID-19 pandemic in 2020/21 and 2021/22 in NSW and the ACT, Australia. Both bivariate and multivariate analyses were employed to assess the associations between the outcome variable (outreach health practitioners' job satisfaction) and independent variables (sociodemographic factors, motivation, self-confidence, communication, capability). Results: Overall, the study showed that 92.2% of health practitioners were satisfied in their role providing outreach health services during the COVID-19 pandemic. In the multivariable model, factors significantly associated with higher satisfaction included good communication with other local health practitioners, using telehealth along with in-person care, and having high self-rated capability compared to those health practitioners who said they had lower job satisfaction. Conclusions: Outreach health practitioners' job satisfaction is important because poor satisfaction may lead to suboptimal healthcare delivery, poor clinical outcomes, and poor retention of staff in rural settings. These findings should be taken into consideration when developing future strategies to improve job satisfaction among rural outreach health practitioners and to enhance attraction, recruitment and retention and may be applicable to the broader health workforce.

Mapping and situation analysis of basic WASH facilities at households in Bangladesh: Evidence from a nationally representative survey.

BACKGROUND: Ensuring water, sanitation, and hygiene (WASH) facilities for households remains a major public health concern in low- and middle-income countries (LMICs). This study investigated the current situation of basic WASH facilities for households in Bangladesh and drew a national coverage map. METHODS: We analyzed the publicly available nationally representative 2019 Multiple Indicator Cluster Survey (MICS) dataset that was carried out by the Bangladesh Bureau of Statistics (BBS) with support from the United Nations Children's Emergency Fund (UNICEF). A total of 61,209 households (weighted) were included in the analysis. Both bivariate and multivariate analyses were employed to examine the relationships between independent variables (socio-demographic and economic status) and their distributions over outcome variables (basic water, sanitation, and hygiene). Further, the spatial distribution of WASH facilities at the household level was depicted. RESULTS: Coverage of access to basic water facilities at the household level was 99.5% (95% CI 99.4% to 99.6%), sanitation 60.7% (95% CI 60.0% to 61.5%), and hygiene 56.3% (95% CI 55.6% to 57.0%). However, coverage of combined access to all three components was 40.2% (95% CI 39.4% to 40.9%). Among all 64 administrative districts of Bangladesh, we found comparatively lower coverage of WASH facilities in the South and South-East regions and relatively higher in the households of the North and North-Western regions. An adjusted regression model revealed that richest households [AOR = 29.64, 95% CI 26.31 to 33.39], households in the rural areas [AOR = 1.64, 95% CI 1.50 to 1.79], household heads with higher educational attainment [AOR = 2.28, 95% CI 2.09 to 2.49], and households with 5+ family members [AOR = 1.64, 95% CI 1.56 to 1.71] had the higher likelihood to have basic WASH facilities. CONCLUSION: Less than half of the Bangladeshi households had access to all three major WASH components (basic water, sanitation, and hygiene facilities); however, variation exists at the individual parameter of basic water, sanitation, and hygiene facilities. A comprehensive WASH approach may reduce the gap and improve the quality of WASH facilities in Bangladesh.

Cost-effectiveness analysis of a large-scale crèche intervention to prevent child drowning in rural Bangladesh.

BACKGROUND: Drowning is the leading cause of death among children 12-59 months old in rural Bangladesh. This study evaluated the cost-effectiveness of a large-scale crèche (daycare) intervention in preventing child drowning. METHODS: The cost of the crèches intervention was evaluated using an ingredients-based approach and monthly expenditure data collected prospectively throughout the study period from two agencies implementing the intervention in different study areas. The estimate of the effectiveness of the crèches intervention was based on a previous study. The study evaluated the cost-effectiveness from both a program and societal perspective. RESULTS: From the program perspective the annual operating cost of a crèche was $416.35 (95% CI: $221 to $576), the annual cost per child was $16 (95% CI: $8 to $23), and the incremental-cost-effectiveness ratio (ICER) per life saved with the crèches was $17,008 (95% CI: $8817 to $24,619). From the societal perspective (including parents time valued) the ICER per life saved was - $166,833 (95% CI: - $197,421 to - $141,341)-meaning crèches generated net economic benefits per child enrolled. Based on the ICER per disability-adjusted-life years averted from the societal perspective (excluding parents time), $1978, the crèche intervention was cost-effective even when the societal economic benefits were ignored. CONCLUSIONS: Based on the evidence, the crèche intervention has great potential for generating net societal economic gains by reducing child drowning at a program cost that is reasonable.

Estimating income-related and area-based inequalities in mental health among nationally representative adolescents in Australia: The concentration index approach.

Despite the awareness of the importance of mental health problems among adolescents in developed countries like Australia, inequality has not been widely researched. This study, is therefore, aimed to measure and compare household income-related and area-based socioeconomic inequalities in mental health problems (bullying victimization, mental disorders-single and multiple, self-harm and suicidality-ideation, plan and attempt) among Australian adolescents aged 12-17 years. Young Minds Matter (YMM)-the 2nd national cross-sectional mental health and well-being survey involving Australian children and adolescents conducted in 2013-14, was used in this study to select data for adolescents aged 12-17 years (n = 2521). Outcome variables included: bullying, mental disorders, self-harm, and suicidal ideation, plan and attempt. The Erreygers's corrected concentration index (CI) approach was used to measure the socioeconomic inequalities in mental health problems using two separate rank variables-equivalised household income quintiles and area-based Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) quintiles. The prevalence of mental health problems in the previous 12-months among these study participants were: bullying victimization (31.1%, 95% CI: 29%-33%), mental disorder (22.9%, 95% CI: 21%-24%), self-harm (9.1%, 95% CI: 8%-10%), suicidal ideation (8.5%, 95% CI: 7%-10%), suicidal plan (5.9%, 95% CI: 5%-7%) and suicidal attempt (2.8%, 95% CI: 2%-3%). The concentration indices (CIs) were statistically significant for bullying victimization (CI = -0.049, p = 0.020), multiple mental disorders (CI = -0.088, p = <0.001), suicidal ideation (CI = -0.023, p = 0.047) and suicidal attempt (CI = -0.021, p = 0.002), implying pro-poor socioeconomic inequalities based on equivalized household income quintiles. Similar findings revealed when adolescents mental health inequalities calculated on the basis of area based IRSAD (Index of Relative Socio-economic Advantage and Disadvantage) quintiles. Overall, adolescents from economically worse-off families experienced more mental health-related problems compared to those from economically better-off families. This has implications for prevention strategies and government policy in order to promote mental health and provide equitable healthcare facility.