Determinants of uptake of hepatitis B testing and healthcare access by migrant Chinese in the England: a qualitative study.

BACKGROUND: Global migration from hepatitis B endemic countries poses a significant public health challenge in receiving low-prevalence countries. In the UK, Chinese migrants are a high risk group for hepatitis B. However, they are an underserved population that infrequently accesses healthcare. This study sought to increase understanding of the determinants of hepatitis B testing and healthcare access among migrants of Chinese ethnicity living in England. METHODS: We sought to obtain and integrate insights from different key stakeholders in the system. We conducted six focus group discussions and 20 in-depth interviews with community members and patients identifying themselves as 'Chinese', and interviewed 21 clinicians and nine health service commissioners. Data were thematically analysed and findings were corroborated through two validation workshops. RESULTS: Three thematic categories emerged: knowledge and awareness, visibility of the disease, and health service issues. Low disease knowledge and awareness levels among community members contributed to erroneous personal risk perception and suboptimal engagement with services. Limited clinician knowledge led to missed opportunities to test and inaccurate assessments of infection risks in Chinese patients. There was little social discourse and considerable stigma linked to the disease among some sub-sections of the Chinese population. A lack of visibility of the issue and the population within the health system meant that these health needs were not prioritised by clinicians or commissioners. Service accessibility was also affected by the lack of language support. Greater use of community outreach, consultation aids, 'cultural competency' training, and locally adapted testing protocols may help. CONCLUSIONS: Hepatitis B among migrants of Chinese ethnicity in England can be characterised as an invisible disease in an invisible population. Multi-modal solutions are needed to tackle barriers within this population and the health system.

Value of urban green spaces in promoting healthy living and wellbeing: prospects for planning.

There has been considerable work done in recent years exploring the value of urban green space for health and wellbeing. Urban green spaces provide environmental benefits through their effects on negating urban heat, offsetting greenhouse gas emissions, and attenuating storm water. They also have direct health benefits by providing urban residents spaces for physical activity and social interaction, and allowing psychological restoration to take place. Consequently, there is a real need to understand the mechanisms by which these benefits accrue. Previously, much of the focus has been on the characteristics of the urban green space that are likely to influence its use, such as its accessibility, quality, facilities, attractiveness, and security. This assumes a causal relationship, when in reality the relationship is more complex and multifactorial. It is more likely that it is the functionality of the green space, be it for exercise or sociocultural activities, rather than its character, which translates to the reported benefits. Challenges exist, such as competing urban planning priorities, economic considerations, and market forces. There is thus a need for urban planning to match the health benefits sought with the needs of the community and the functionality that the urban green space will serve.

Disaster management in low- and middle-income countries: scoping review of the evidence base.

INTRODUCTION: Globally, there has been an increase in the prevalence and scale of disasters with low- and middle-income countries (LMICs) tending to be more affected. Consequently, disaster risk reduction has been advocated as a global priority. However, the evidence base for disaster management in these settings is unclear. METHODS: This study is a scoping review of the evidence base for disaster management in LMIC. Potentially relevant articles between 1990 and 2011 were searched for, assessed for relevance and subsequently categorised using a thematic coding framework based on the US Integrated Emergency Management System model. RESULTS: Out of 1545 articles identified, only 178 were from LMIC settings. Most were of less robust design such as event reports and commentaries, and 66% pertained to natural disasters. There was a paucity of articles on disaster mitigation or recovery, and more were written on disaster response and preparedness issues. DISCUSSION: Considerably more articles were published from high-income country settings that may reflect a publication bias. Current grey literature on disaster management tends not to be peer reviewed, is not well organised and not easy to access. The paucity of peer-reviewed publications compromises evidence review initiatives that seek to provide an evidence-base for disaster management in LMIC. As such, there is an urgent need for greater research and publication of findings on disaster management issues from these settings.

An integrated approach to treat tobacco addiction in countries with high tuberculosis incidence.

Communicable diseases as well as maternal and child health in low- and middle-income countries continue to be the main focus of global attention. There are also rising trends in the prevalence of non-communicable diseases and further increases are predicted. Several countries are facing this 'dual burden of disease'. There is therefore a need to find ways to integrate the prevention and control of non-communicable diseases into the current health agenda. Tobacco treatment interventions in patients suspected with tuberculosis (TB) offer one such opportunity for a linked healthcare response. Many countries with a high incidence of TB are doubly burdened by an epidemic of tobacco use and tobacco-related diseases. Tobacco use increases the risk of TB infection and is associated with poor treatment compliance, increases in relapse rates and higher secondary mortality. In countries where TB is epidemic, this modest relative risk of infection leads to a significant attributable risk. Regular clinical contact with patients suspected with TB during the diagnosis and treatment phases provides considerable opportunity for health promotion to influence their tobacco-related behaviour. Consequently, treating tobacco addiction in patients suspected with TB is likely to improve the control of TB and prevent tobacco-related diseases. However, despite a high prevalence of tobacco use among TB patients, the treatment of tobacco addiction has not been a priority of TB control programmes. In countries with the dual epidemics of TB and tobacco use, considerable health and economic gains could potentially be made. If effective, such an approach would be highly desirable. We argue that further research assessing the cost-effectiveness and feasibility of linking healthcare interventions such as the treatment of tobacco addiction among TB suspects should receive high priority.