Day 2 :
- Maternal, Infant & Child Health
Yasuj University of Medical Sciences, Iran
Mohsen Shams, MD, PhD in health education and associate professor of Yasuj University of Medical Sciences- IRAN, has his expertise in designing, implementing and evaluating the health education, health promotion, and health communication. His work is an intervention based on social marketing model to promote normal vaginal delivery and reduce the Cesarean section in primigravida pregnant women in Yasuj, Iran.
Designing and implementing the effective interventions to promote normal vaginal delivery is a main health priority in Iran. This study is aimed at reducing selection of Cesarean section by primigravida through an intervention based on social marketing in Iran. In this field trial, a mixed method was done to analyze audience, market, and channel. Pregnant women who intended to do Cesarean section were selected as the specific target segment. Tailored intervention was developed based on the findings of this formative research and marketing mix or 4P (Product, Price, Place, Promotion) was developed. The product was an educational course, and messages for brief intervention in health facilities, and phone consultations by a trained midwife. Their intention to do Cesarean section was studied and compared with baseline measure. Before the intervention, 25.2 percent of the women intended to do Cesarean section (44.5% in urban and 10% in rural regions). After the intervention, we found that the intention of 78.9% of the pregnant women who had cesarean intention was changed (76.7% in urban and 87.5% in rural regions) (P< 0.001). The study showed the effectiveness of an intervention based on consumer-oriented social marketing theory and could be used to reduce Cesarean intention.
Keywords: Social Marketing, Normal Vaginal Delivery, Promotion
Background: Evidence from India suggests access to PMTCT services for pregnant women in India remained very low with 218 priority districts identified where PMTCT services uptake remained even lower (0.27% to 29.8% - with an aggregate average of 18%) when compared with a national average of 42%. Complementing India’s dual elimination strategy of HIV and Syphilis. Districts with lower number of health facilities with a poor supply chain management system for HIV test kit and other consumables (13% HIV testing facilities to cater 45% of countries estimated pregnancy.
Methodology: India has an elaborate public health system to take care of the ANC registered pregnant women and the new born. There are 2 hundred thousand facilities with 412 medical colleges and 762 district hospitals, 1020 sub-district hospitals, 5390 community health centres, 25297 public health centres and around 150thousand sub centres to cater 28 million pregnancies for general ANC care. Programme initiated to Integrate of HIV testing services with these general public health set up. And successful integration has brought substantial progress towards achieving universal coverage of pregnant women with HIV testing. HIV testing has been initiated at the Village Health and Sanitation DY (VHND) through Ahana trained ANMS and Asha supervisors.
Result: Around 10 thousand peripheral health workers have been trained by Ahana on the HIV testing and then the related cascade. There are another pool of 10 thousand volunteers are trained under the scheme. The integration has resulted in a dramatic increase in the HIV testing among pregnant women from 21% in Sept,15 to 52% in Septmentber,16.
Conclusion: The integration of HIV testing and related services with the general public health has not only helped in increasing the HIV testing services but also contributed in removal of stigma attached to the disease. As ANMs and ASHA are very well accepted in the rural village level population so ASHA taking about the HIV and related service parameters has contributed in a big way towards generating the demand for HIV testing services among the pregnant women and also supported in getting more number of pregnant women tested towards reaching the Govt. of India mandate of MTCT.
- Occupational Safety, Health & Others
Health Service Group , Tata Power Delhi Distribution Limited ,India
Dr. Kunda D. Mendhekar has her expertise in to assess the magnitude of communicable and non- communicable disease in the community and assess the community to adopt preventive and curative measure for the same. And to demonstrate the professional skill to the community.
Noncommunicable diseases (NCDs) account for two-thirds of all deaths globally. Health Check up camp and Health Tips have the requisite expertise to initiate and lead NCD risk factor screening and prevention programmes. The workplace can provide an ideal setting for Health check up camps to screen for risk factors and implement prevention programmes.
This study was designed to identify the common modifiable risk factors for NCD among employees of a corporate institution.
A cross-sectional study of NCD risk factors was conducted in corporate institution , Delhi, India. Employees were evaluated using the World Health Organisation STEPS Instrument (Steps I and II). The prevalence of risk factors were expressed as frequencies and percentages.
A total of 1086 employees (response rate 36.2%) participated in the study. Poor dietary habits, suboptimal blood pressure, Random Blood sugar level and physical inactivity were identified as the most common modifiable NCD risk factors in this population.
Knowledge of NCD risk factors can be used by Health care workeres to implement health promotion programmes in the workplace as a means of reducing NCD-related economic and social burdens in organization.
Instituto Português da Qualidade, Portugal
Maria do Céu Ferreira hold a Ph.D. in Industrial Engineering at Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Portugal, with research focused on the study of metrological traceability of medical devices with a measuring function. For over 20 years professionally has taken a Metrologist position in conception, development and implementation of metrological activities related to scientific, legal and applied Metrology. Her scientific interest falls in the area of Quality Engineering mainly focused on Health Metrology and Quality Assurance applied to measuring instruments. Large teaching experience covering topics such as Metrology (Scientific, Applied and Legal), Measurement Uncertainty Analyses and Quality Systems Management. She is also Quality Auditor in the field of accredited laboratories.
: Interest and debates on metrology for health have grown over the last years and led to discussion about the key role of metrological and statistical principles applied in health care and health monitoring systems. Measurement results are supposed to provide accurate and reliable results and health care professionals assume they are accurate, reliable and comparable over time. This assumption implies that measurements are metrologically traceable. Nevertheless, there should be awareness that errors and uncertainties in the use of measuring instruments, methods and procedures could lead to unsuitable clinical procedures, wrong diagnoses, or inadequate treatments. Although errors occur in a wide variety of medical measurements, health care professionals believe that the most serious errors in medical measurements is motivated by any purposes other than the lack of metrological traceability. Based on the work developed by the multidisciplinary Health Metrology Task Group (HMTG), this paper depicts new approaches for best practises in health metrology. Aiming to enhance its metrological traceability, the case study is applied to an infusion technology. The specific role of metrology education is highlighted, focusing on the framework of hospitals’ policy and the related background of health professionals. The discussion is structured around the ongoing project EMPIR 15SIP03.
- Primary Health care & Social Determinants
The University of Texas, USA
Jonathan Cho is a Clinical Assistant Professor and Infectious Diseases Clinical Pharmacist at the University of Texas at Tyler College of Pharmacy. He serves as the director of the Antimicrobial Stewardship Program at Longview Regional Medical Center and on the speaker’s bureau for Allergan Pharmaceuticals. He has a strong passion for improving antimicrobial stewardship practices and post-graduate education for pharmacists. His most recent research involves patient scoring systems to optimize outcomes related to Clostridium difficile infections and educational initiatives that improve learning and retention in the classroom. Jonathan is also actively engaged within various pharmacy organizations and is currently serving as the President-Elect of the East Texas Society of Health-System Pharmacists.
Sexually transmitted diseases (STDs) are a huge healthcare concern among adults worldwide and can cause increases in healthcare costs and complications in affected individuals. Several STDs, such as hepatitis B and human papillomavirus, can be prevented through pre-exposure vaccinations while vaccines for other STDs are currently being explored. Even with the widespread availability of certain vaccines, the prevalence of vaccinated individuals remains low. The low rate of vaccination can be attributed to access to recommended care and lack of education for both providers and patients. Many patients have not heard of vaccine-preventable STDs and its related vaccines but are willing to receive vaccinations if the government recommends patients to receive vaccinations and if the vaccine is easily accessible. Some studies have also shown a significant correlation between the individuals level of education and vaccination rates. Increasing awareness and education to providers regarding their role on vaccine-preventable STDs also increased the rate of vaccinated patients. If STDs are not treated appropriately, it can lead to significant health problems such as advanced infectious complications, organ dysfunction and in some cases, cancer. By appropriately informing patients about STDs and vaccination schedules, these complications can be avoided. This presentation outlines the importance of vaccines in the setting of STDs, interventions used to increase vaccination rates, and the significance of provider interaction when educating patients.
National University of Singapore, Singapore
Dr Wenru Wang has completed her PhD received her PhD at the Chinese University of Hong Kong, Hong Kong. She is now an Assistant Professor at Alice Lee Centre for Nursing Studies, National University of Singapore. She has published more than 80 papers in reputed international refereed journals and has been serving as an editorial board member.
Background: There has been increasing evidence that elderly living alone or with another elderly are at higher risk for poorer health outcomes. However, little attention has been given to these elderly to engage in health-promoting and risk preventive actions. This study aims to evaluate the effectiveness of Salutogenic Healthy Aging Program Embracement (SHAPE) intervention for elderly-only households in Singapore. Methods: The Salutogenesis model, which focuses on positive well-being and health optimization instead of the traditional biomedical model on pathogenesis, underpins this study. This single-blinded randomized control trial will be conducted in the west of Singapore, for elderly ≥ 65 years old living alone or with another elderly. While participants in the control group receive usual care offered in the community, elderly in the experimental group receive the SHAPE intervention, a 12-week community-based program comprising of at least 2 home visits, 10 weekly group-based activity sessions and a SHAPE health-promotion booklet. Outcome measures include sense of coherence, self-efficacy, quality of life, health-promoting behavior and other health-related outcomes. Data will be collected at four time-points: baseline, 3, 6 and 12 months. Individual qualitative interviews will also be conducted for elderly receiving SHAPE intervention to explore their views on the program. Conclusion: The SHAPE intervention seeks to identify, equip and strengthen resources in elderly-only households, encouraging the adaptation of health-promoting and risk-preventing actions. It targets on a vulnerable group of older population to help them cope with health, age-related stressors and promote independent living in the comfort of their homes.
School of Public Health, Palestine
Dr El Sharif is an Associate professor of Public Health. She has a doctoral degree in medical sciences-epidemiology from the Katholieke Universiteit of Leuven-Belgium. She joined Al Quds University-Faculty of Public health in year 1998. For the past 10 years, she was the research coordinator of several international projects. Also, she worked as a consultant for several international organizations. In addition, she was the board's head of the Health Forum, an NGO, for 9 years. She has experience in research on diabetes, cancer, allergy, asthma, lead and others. Her research interest is in NCDs and its related co-morbidities in particular those related to lifestyle and environmental exposures as risk factors. She is a member of the Research Ethics Committee (REC) at Al Quds University.
Questionnaire based surveys are an importance tool in epidemiology and public health research. Although there may be a certain degree of bias in this quality of care assessment tool since some of these measurements may be misleading, it remains an inexpensive tool for such assessments. The quality of services provided to diabetic patients in Palestine has not been studied previously. This study provides a context for the measurement of the quality of care of patients with diabetes.
Objectives: To evaluate the agreement on testing at the proper time between self-report and medical record in primary care centers in the West Bank.
Methods: Data from interviews and medical records were available on 882 diabetic patients attending nine primary health care centers in Palestine. Cohen's kappa coefficient (k), agreement beyond chance, between data provided in patient medical record and self-report was calculated.
Results: Agreement on testing at the proper time between self-report and medical record was poor to fair in strength (k: 0.06- 0.28), and was poor to substantial (k: 0.10- 0.70) for diabetes comorbids.
After adjustment, clinic location and ownership were strong determinants for agreement in the proper time of testing. Also, the personal characteristic age and gender were the most important factors in determining comorbids in those patients.
Conclusion: The evaluation of the quality of care based on medical records should be treated with great caution in Palestine since it’s a manual process. However, reliance on both sources of information is useful to establish monitoring tools on which decisions can be based.
- Nutritional Epidemology
Central University of Kerala, India
Ms. Jayalakshmi Rajeev is working as an Assistant Professor at Central University of Kerala, Kasaragod, India. She pursued Master of Public Health from Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum. She has two years of research experience in Public Health including associations with reputed institutions; Indian Institute of Technology, Kharagpur, CEHAT, Mumbai and Monash University, Malaysia. She had undergone courses on “International Leadership and Organizational Behaviour” conducted by University of Bocconi and “Introduction to Global Health” conducted by University of Copenhagen and qualified University Grants Commission’s National Eligibility test for Junior Research Fellowship. She has published original articles in reputed peer reviewed journals in the fields of Palliative Care and Child health. Her research interests include Health and Nutrition of Women, Child and Elderly, Global Health and Health Policy, Health Inequities.
Statement of the Problem: Stunting is an indicator of chronic nutritional deprivation among children. However, what happens to the affected children as they grow older is not known due to the lack of adequate prospective studies in this area. Present paper addresses this issue using the data of two India Human Development Surveys (IHDS I and II) in 2005 and 2012, conducted among same samples. IHDS I and II collected data during the periods 2004-05 and 2011-12 respectively by the Inter-University Consortium for Political and Social Research. Children with anthropometric measurements were included in the present study constituting about 411 children below five years from IHDS I and 390 children of age 7-12 years from IHDS II. The prevalence of stunting among children below five years in IHDS I and children of age 7-12 years in IHDS II are compared. Pearson Chi-square test was performed to find out the associations with socioeconomic variables. A drastic reduction in the prevalence of stunting was observed among children as they grew older from 0-5 years to 7-12 years (50.4% vs. 20.3%) during the period between the two surveys. The boys of age 7-12 years were found to be more stunted than girls and the finding was significant at 10% level (23.1% vs. 17.0%). The increase in annual income and monthly per capita expenditure is also evident from the sample though a significant association could not be established with stunting. The cognitive skills of stunted and normal children did not vary widely. The results of this study indicate that the stunted children can regain their growth and development in the early adolescence provided the socio-economic conditions in which they live also improve. All stakeholders, policy makers in particular have to exploit this second ‘window of opportunity’ in children’s lives to regain the deprived growth in their younger ages.
Nanjing Medical University, China
Hui Wang has her expertise in nutritional epidemiology and molecular epidemiology. Her passion was dedicated on the mechanism of environmental and genetic impact on the diseases pathogenesis .Previously, she focused on the genetic deficiency of innate immunity would trigger the process of cancer, research has published on Hepatology. Recently, the dietary pattern of China is undergoing the transition period; meanwhile, the overweight situation gets more and more serious. Thus, she moved her research on the nutritional epidemiology. Papers have published in European Journal of Clinical Nutrition and Nutrition research.
Purpose: To investigate the gender difference of getting metabolic syndrome (MetS) and its various associations with dietary diversity at different ages. Methods: Data of adults(n=4308) aged 18+ y with three consecutive 24-h recalls and complete co-variates information were extracted from Chinese Nutrition and Health Survey in 2009. Modified Dietary Diversity Score (DDS) was adopted to capture the diversity of diet. MetS was defined by the harmonized criteria. Multivariable adjusted logistic regression was carried out to detect the association between DDS and MetS and its components for young, middle aged and elderly adults by a cross-sectional study. Results: Female were more likely to get MetS than male counterparts, especially after 50 years old, and the risk follows an inverse-U shape for both genders. Moveover, DDS played a significant protective role in MetS for young female (<45), similar trends were detected in serum TGs, abdominal adiposity, blood pressure, and fasting blood glucose (all P trends < 0.05). However, this association reversed in old female (>60) [OR (95%CI): 1.69(1.05, 2.72)] and male adults [OR (95%CI): 1.59(1.04, 2.44); 2.18(1.30, 3.65)]. Greater DDS was associated with higher serum TGs, and lower HDL-C level for male adults (45≤ & <60) [OR (95%CI): 1.56(1.17,2.08); 2.00(1.24,3.24)], higher blood pressure for old men (>60) [OR (95%CI): 2.49(1.76,3.53); 1.54(1.00,2.35)], but lower blood pressure and fasting blood glucose in young man(<45) (all P <0.05). Conclusion: The association between DDS and MetS varies at different ages and differs for male and female. Targeted strategy of health education in balanced diet should be designed for different population, especially, the old women and middle aged men to reduce the burden of chronic diseases.
Public Health Foundation of India, India
Background/Objective: Although obesity is the most important risk factor for diabetes, evidence is emerging that certain foods and dietary factors may be associated with diabetes. Empirical evidence from western countries have shown that the choice of foods plays a role in diabetes prevention. We examined the association between consumption of different food items and the risk of diabetes in adult men and women in India.
Methods: Analysis is based on a large-scale population based cross-sectional study of 99,574 women and 56,742 men aged 20-49 years included in India’s third National Family Health Survey, 2005-06. Effects of various food intake determined by frequency of consumption (daily, weekly, occasionally and never), on the reported prevalence of diabetes were estimated using multivariable logistic regression after adjusting for body mass index, tobacco smoking, alcohol drinking, television watching and socio-economic and demographic characteristics such as age, education, religion, caste/tribe, living standard of the household and residence. The analysis was done separately for men and women.
Results: Daily intakes of fruits were found to be associated with a reduced risk of diabetes both among men (OR:0.33;95%CI:0.22-0.50;p<0.0001) and women (OR:0.44;95%CI:0.32-0.61;p<0.0001) whereas weekly or occasional intake of milk or curd and pulses and beans was associated with a reduced risk of diabetes among men but not women. The risk of diabetes was 2.5 times higher among men (OR:2.46;95%CI:1.66-3.65;p<0.0001) and 1.7 times higher among women (OR:1.72;95%CI:1.26-2.33;p=0.001) who consumed fish daily as compared to those who never consumed fish. Weekly fish intake also contribute to a higher risk of diabetes both among men (OR:1.77;95%CI:1.24-2.53;p=0.002) and women (OR:1.41;95%CI:1.07-1.87;p=0.016). No significant association was observed with the consumption of green leafy vegetables, eggs, chicken or meat with risk of diabetes in adult Indians.
Conclusion: Our findings provide support for potential behavioral prevention strategies, as we identified a food intake pattern that was strongly associated with the risk of diabetes. Our results also suggest that prevention of diabetes might be aided by consumption of certain foods that are rich in nutrients with hypothesized health benefits in this population. However, more epidemiological research with better measures of food intake and clinical measures of diabetes is needed to validate the findings in a developing country setting.
Keywords: fruit; fish; vegetables; diabetes; men; women; NFHS-3; India