5^th World Congress on Public Health, Nutrition & Epidemiology July 23-24, 2018 Melbourne, Australia

Biography:

Lynn Cheong is a Clinical Assistant Professor of Pharmacy at the University of Canberra in Australia. She is a registered pharmacist with a wide array of experience in hospital and community pharmacy, as well as government and education.  She continues to remain professionally active and strives to advance the role of pharmacists in improving patient and health system outcomes. Lynn is particularly interested in the application of social network analysis theories and techniques in health service research. Her research lies in the areas of patient-centered care, quality use of medicines, interprofessional education and practice

Abstract:

Statement of the Problem: The rising prevalence and burden of obesity represents an important global health issue. Despite effective dietary and lifestyle interventions, few succeed with long-term maintenance of weight loss. Whilst interventions have been developed to serve the best interest of overweight and obese individuals, none have analyzed the social relationships that individuals may develop or require as they attempt to lose weight over time. There is a need to address the interplay between weight management and social networks. Using a novel approach, this project aims to explore the networks of overweight and obese individuals over time, by identifying the people with whom they interact with in their weight loss attempt, to better understand the influences of social interactions on weight loss behavior and outcomes.

Methodology & Theoretical Orientation: Social network analysis (SNA) is an approach that allows the detailed study of complex communication and interaction patterns. It is based on the theoretical framework of social network theory. This project employed a longitudinal mixed-methods approach to SNA. Participants were recruited through advertisements in various healthcare settings. Data were collected at four points over a 12-month period through surveys and a semi-structured interview at completion. The network software, E-Net, was used to generate visual representations of individual’s networks, while qualitative analysis of data assisted in the interpretation of network structures, providing an insider’s view.

Findings: A total of 17 individuals were recruited. Participants reported small weight loss networks (median 3, range 1-7) which predominantly included family, friends, and coworkers. Participants indicated that the most influential weight loss connection was their spouse. Despite their reported desire to lose weight, minimal changes was observed in existing networks even with a lack of weight loss over time. This research highlights the need for future interventions to consider with whom individuals are willing to engage in their weight loss journey.

 

Biography:

Muhammad Sarwat Mirza possesses wide experience in the field of program/ project designing and development, program management, Monitoring, Evaluation & Research especially related to Reproductive Health, Nutrition and Family Planning, working with HANDS for last 22 years. He had experience of developing Behavior Change Communication material for promotion of breast feeding, dietary habits of pregnant and lactating women, nutrition for children and adolescents. among the rural communities. Recently he has concluded two operation research projects with multiple partners and donors on “Nutrition and Reproductive health issues of Pregnant women to improve the birth outcome and reduce the low birth weight incidence”, and Rapid assessment of drought stricken area in Pakistan. He played a major role in organizing the Pakistan SUN movement (Scale Up Nutrition) CSO Alliance.

 

Mr. Mirza did MBBS and master in Public health and had served at Dept. of Pediatrics, The Aga Khan University Hospital Pakistan. He worked on several clinical research projects such as Dietary management of diarrhea, control trial of local food, zinc supplementation in malnourished children.  He is serving as Research advisor for Community Health Initiatives related to Food, Nutrition and Research to Allama Iqbal Open University Pakistan for post graduate medical students.  He is a citizen of Pakistan and fluent in English and Urdu.

 

Abstract:

Statement of the Problem:

Over last many years Contraceptive Prevalence rate in Pakistan is slightly improved but the situation in rural areas are unchanged. The high population growth rate, poor maternal and child health indicators are the main challenges effecting the economic status of the families and the country. In rural remote areas, access to quality care services, availability and sustained supplies of contraceptives are the major hurdles.  

 

Methodology & Theoretical Orientation:

For improving access to birth spacing services an innovative approach was introduced. 600 female Community Based Workers, in under-served areas were selected and trained. They did the community mobilization, and facilitated the assigned female health care providers (LHVs) for provision of birth spacing services within their communities.  The government health and population welfare departments were involved as a partner to provide FP products and other FP services to referral clients. The data of Married Women of Reproductive Age (MWRA) was collected and maintained. The same data was used to generate new clients and for their follow up. The data was regularly followed/ checked, validated by monitoring and back check at various level.

 

Findings:

Female workers registered all Married Women of Reproductive Age (MWRA) in their catchment population, and collected socio-demographic information about the women and families. Majority of the women (95.8%) are illiterate. Average no. of children is 4.3, and average age of youngest child is 1.8 years. Out of these women, only 4.5% were current users of FP, 3.8% are ever users and 91.7% are never users.  

In the intervention (24 months period), Female workers reached 98.5% of the target women, deliver messages and information through group meetings and follow up on home visits. Supervisors LHVs provided birth spacing services through Mobile clinics in each village. 46% of the women adopted one of the contraceptive method for birth spacing. The trend of contraceptives by methods is Condoms 13%, oral pills 20%, Injectables 46% and IUCD 21%. The most encouraging thing in the pattern is the adoption of modern contraceptive methods and mostly long term. It reduces the cost and exposes the clients to lesser side effects and provides more durable and sustained birth spacing.

 

Conclusion:

In rural remote areas, the improved access to the continued birth spacing services and commodities through community based female workers and supervisors trained LHVs for clinical services may be one of the effective and sustainable approach for bringing sustainable behavior change for adoption of birth spacing as a health behavior. This effect largely in reducing the economic burden on the family and contributed in national economy by reducing the DALYs.

 

Biography:

Amir E. Johri is a public health physician and has extensive experience in environmental/public health.  He has worked for many international and national organizations around the world.  His expertise include; environmental health in emergencies, environmental and occupational health policies and strategies, environmental health risk assessment, migrants & refugees health, etc.

Dr. Johri has worked for World Health Organization (WHO) at the national and international level.  He was also engaged with International Organization for Migration (IOM) with Syrian refugees in Jordan.  Currently he is the advisor at the Department of Environmental and Occupational Health, Ministry of Health – Oman. 

Dr. Johri has presented several papers at different international forums.  He is actively involved developing national environmental health & occupational policies, strategies and actions plans, as well as training and teaching of environmental and occupational health disciplines

Abstract:

World Health Organization estimates that 23% of all deaths worldwide and 22% of all DALYs are attributable to the environmental factors.  From conception to adulthood and later ages, we all are exposed to environmental influences that effect our health.  Environmental risks like water and air quality, food and chemicals safety, waste disposal and built environment can lead to various detrimental health effects.   It is now widely recognized that public health challenges and environmental sustainability are interlinked, therefore these should be addressed jointly.    

In recent years, the environmental scientists have focused on the implications on human health by the built environment, e.g. food outlets, road designs, transportation systems, housing, parks etc.  It has been documented that living in low socioeconomic neighborhood has been linked to higher rates of injuries and accidents.      

At present, the public health community is concerned with rapid environmental change leading to detrimental health effects on human population, therefore they are tasked with integration of public health and environmental sustainability as common course for partnerships, alliances in policy developments. Eventually, reducing environmental exposures would greatly reduce the global burden of disease.    

 

Biography:

Mohammod Jobayer Chisti, have been working in icddr,b since 1998 and intending to continue as clinician as well as researcher for the rest of the life.

Abstract:

Background: Management of pneumonia in severely malnourished children is critically important in reducing deaths in such children. Understand the etiology of pneumonia in severely malnourished children is one of the essential components of appropriate management. Diagnosis of pneumonia in children with severe malnutrition is also intriguing. Etiology and diagnosis of pneumonia in SAM is not well described in medical literature. Data on management of pneumonia in such children are also lack. Methods: We have done a systematic review using specific search criteria in PUBMED to evaluate the overall role of severe malnutrition in children with pneumonia in SAM children.

Results: Among a total of 215 isolates 26% were Klebsiella and 25% S. aureus species, 18% Pneumococcus, 8% each E. coli and Salmonella species. A recent study conducted in Bangladesh found 87/385 (23%) MTB as the bacterial etiology of pneumonia in SAM children. In SAM children, the sensitivity of fast breathing as a predictor of radio graphically proven pneumonia ranged from 14% to 76%, and specificity from 66% to 100%.

Surprisingly, metabolic acidosis found to have no impact on the diagnostic clinical features of pneumonia in SAM children having diarrhea. Studies revealed that as a first line therapy ampicillin and gentamicin are more effective against enteric Gram-negative bacilli than chloramphenicol in SAM children with pneumonia. Both the groups received in addition to diet, micronutrients, vitamins and minerals.

Conclusions: The currently available data suggests that the spectrum and frequency of causative agents of pneumonia in severely malnourished children differ from that observed in well-nourished children. Clinical signs are relatively poor predictors of pneumonia in severely malnourished children.  However, injectable antibiotics in addition to diet, micronutrients, vitamins and minerals are the sine quanon. High prevalence of pulmonary tuberculosis in severely malnourished children having acute pneumonia underscores the importance of further research that may help to evaluate the determinates of TB in such children.

 

Biography:

Abu Sadat Mohammad Sayeem Bin Shahid has his experience in public health especially in nutrition and other emerging problems like childhood TB and pneumonia in developing world. He has been involved in different epidemiological research starting from observational study to clinical trial for the last 8 years. He also published his different work in different journals by which people from all over the world will be benefited in the long run.

Abstract:

Background: Bacteremia is quite common in severe acute malnourished (SAM) children with pneumonia, who often experience a fatal outcome, especially in developing countries. There is limited information in the medical literature on the risks of bacteremia in SAM children with pneumonia. We have examined the factors associated with bacteremia and their outcome in under-five children who were hospitalized for the management of pneumonia and SAM.

 

Methods: In this unmatched case-control study, SAM children of either sex, aged 0-59 months, admitted to the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) with cough or respiratory distress and radiological pneumonia during April 2011 to July 2012 were enrolled (n=405). Those with pneumonia as well as bacteremia constituted the cases (n=18), and randomly selected SAM children with pneumonia without bacteremia constituted controls (n=54).

 

Results: A wide range of bacterial pathogens were isolated among the cases of which 13 (72%) were Gram negatives. Death rate was higher among the cases than the controls (28% vs. 9%) but the difference was not statistically significant (p=0.111).  In logistic regression analysis, after adjusting for potential confounders, such as the lack of DPT/oral polio/HIV/hepatitis vaccination, measles vaccination, vomiting, and clinical dehydration (some/severe) the SAM children with pneumonia as well as bacteremia more often had the history of lack of BCG vaccination (95% CI=1.17-29.98) and had diastolic hypotension (<50 mm of Hg) (95% CI=1.01-12.86) not only after correction of dehydration but also in its absence.

 

Conclusion: The results of our study suggest that history of lack of BCG vaccination and presence of diastolic hypotension in absence of dehydration on admission are the independent predictors of bacteremia in SAM children with pneumonia. The results indicate the importance of continuation of BCG vaccination to produce benefits beyond the primary benefits.

 

Biography:

Frances O’Callaghan is a Health Psychologist in the School of Applied Psychology, Griffith University, Australia. Her research focuses on psychosocial influences on health and illness, sleep disorders and fetal alcohol spectrum disorders.

 

Abstract:

Statement of the Problem: Poor sleep quality and excessive daytime sleepiness are positively associated with common mental disorders such as depression, anxiety and somatoform disorders, as well as lapses in concentration and daytime tiredness. These relationships are complicated among university students who have high caffeine consumption and high stress, both of which affect sleep quality.

 

Methodology & Theoretical Orientation: This was a quantitative study involving 175 full-time university students from 17 to 25 years (mean=19.43, SD=2.06). Students completed an online questionnaire about their sleep quality, daytime functioning, caffeine consumption and recent level of stress symptomatology.

 

Findings: Poor quality sleep was associated with diminished daytime functioning. Increased caffeine consumption influenced daytime functioning by lowering the quality of an individual’s sleep. However, the relationship between quantity of caffeine consumption and sleep was dependent on the time of day the caffeinated beverages were consumed. Increased stress was related to both reduced sleep quality and reduced daytime functioning.

 

Conclusion: The findings highlight the implications for daytime functioning of university students not getting sufficient quality sleep and the role of lifestyle factors pertaining to caffeine use and stress.

 

Biography:

Shuai is currently undertaking a Doctor of Philosophy at Melbourne School of Population and Global Health, University of Melbourne. With her sustained interests in ageing, gender equality, health system, non-communicable diseases and sub-Saharan Africa, Shuai aspires to improve access to quality health care and services for all, especially for the underprivileged groups. 

Abstract:

Statement of the Problem: mHealth is increasingly becoming a promising solution to cardiovascular management around the world. Information and communication technology (ICT) play key roles for such intervention to succeed for improved health outcomes, however the underlying infrastructure required for mHealth implementation has not been adequately assessed, especially in limited-resource settings.

Objective: To evaluate the capacity of ICT in cardiovascular management in limited-resource primary healthcare centers (PHCs) in China, Vietnam and Kenya, from both patients’ and PHC providers’ perspectives.

Methods: Cross-sectional surveys were conducted in Kunshan City and Nanhe County in China, Chi Linh District in Vietnam and Nairobi City and Machakos County in Kenya. Our study included a total of 46 PHCs in limited-resource settings and 305 patients who utilized cardiovascular-related services at those PHCs.

Findings: We found that mobile phone ownership was highly prevalent among the sampled patients as on average 85% of sampled patients possessed a mobile phone. Patients in Kenya sent or received 3.84 text messages daily on average whereas the number was 1.4 and 1.6 among Chinese and Vietnamese patients, respectively.

All PHCs in China and Vietnam could access Internet although only 20% of sampled facilities in Kenya had Internet access. In terms of hardware, all of the 46 PHCs had at least one desktop or laptop computer. Ownership of tablet devices was rare in both Kenya and Vietnam whereas almost half of the facilities in China owned at least one tablet device. Almost all of the PHCs owned at least one basic or smart phone.

Conclusion : In selected PHCs in China, Kenya, and Vietnam, use of ICT was prevalent at both the facility and patient levels with varying degree of deficit across platforms and countries. ICT environment appraisal is crucial to the design and implementation of mHealth interventions for limited-resource settings.

 

Biography:

Raminder Kaur has received her MSc in Anthropology from Panjab University, Chandigarh, India. She is a Junior Research Scholar (UGC) in the Department of Anthropology, Panjab University, India. Her current PhD research work is on polycystic ovary syndrome.

 

 

Abstract:

Polycystic ovary syndrome is one of the common endocrine dysfunction in women of reproductive age and is responsible for heterogeneous and manifold disorders. It is associated with enhanced risk of morbidity in terms of both reproductive and non-reproductive events such as increased possibility of cardio-metabolic, obstetric, oncology and psychological complication throughout the life span. The major determinants for these diseases are obesity, raised glucose level, raised cholesterol, physical inactivity, decreased vegetables and fruit intake and high blood pressure, etc. PCOS patients not only show classic cardiovascular risks such as hypertension, diabetes mellitus and dyslipidemia, but also non-classic cardiovascular risks factors like mood disorder, depression and anxiety. Overall obesity is common among PCOS women and it further worsens the health status of women. Women suffering from PCOS exhibit higher prevalence of abdominal body fat as compared to their obese non PCOS counterparts. Currently, it is unclear whether long term risks are due to PCOS or obesity. Previous literature illustrated that androgen excess may be primary cause of fat deposition particularly visceral fat and leads to insulin insensitivity which is significantly reduced in obese and overweight PCOS women and further promote androgen excess. PCOS being a hidden epidemic across globe and needs awareness in diagnosis and management of the disorder with lifestyle modification like physical activity and diet.

 

Biography:

Dr. Mikal Finkelstein is on the board of Directors and serves as medical director for CapraCare, a Haitian relief organization. Dr. Finkelstein has a deep commitment to advancing health equity in low resource settings with a particular focus on maternal child health. She has worked in private practice in NYC and has also had global public health experience in Haiti, Africa and Central America. She is a Pediatrician and Supervising Physician in the School Based Health Program at Morris Heights Medical Center in the Bronx, NY. She has also served as a consultant to UNICEF in Health Systems Strengthening and Health Equity. Dr. Finkelstein earned a Doctor of Medicine degree from Albert Einstein College of Medicine and Master of Public Health at New York University.  She completed her medical training at New York University Medical Center and Bellevue Hospital.

 

Abstract:

Cervical cancer has become a disease of the poor. In low resource settings such as Haiti, most women do not have access to preventive screenings such as Pap smears. Haiti, therefore, has among the highest incidence and death due to cervical cancer in the world. The “See and Treat” approach using Visual Inspection with Acetic Acid (VIA) has been successfully utilized in many developing countries to improve cervical cancer prevention. It is simple and cost effective and can be performed by nurses. Women can be treated the same day for precancerous lesions with cryotherapy or thermocoagulation.

 

Methods: The CapraCare clinic in Fonfrede is a community run facility in southern Haiti. The Greater Fonfrede area encompasses 160,000 people with little access to healthcare. This initiative included the training of local physicians and community health workers. Local staff conducted community outreach and cervical cancer education of the greater Fonfrede community. The “See and Treat” protocol led to the diagnosis, treatment and referral for precancerous and cancerous lesions in a population that would have previously not have had such access to care.

 

Results: Significant results include the education of community health workers, training local clinicians, and strengthening community partnerships. In addition, we created cervical cancer educational materials and a clinical training program. We performed community outreach in (n=1529) and monthly cervical cancer education sessions (n=295). Approximately half of those educated came in for the screening test. Clinical outcomes reflected those in the literature. Lessons were learned about community engagement, outreach and how implementation may influence screening utilization.

Conclusions:

Approaches such as ‘See and Treat” can have great impact on improving social disparities in health, however too few community-based programs that have been studied. Learning from this experience can help to expand such programs and lead to future implementation in other settings.

 

Biography:

Sangeeta Gupta is a physician epidemiologist, working as an associate professor at Delaware State University.  Her area of expertise is chronic disease epidemiology and social determinants of health.

 

Abstract:

Background: In this exploratory study, we examined the relationship between receipt of health information on one’s mobile phone and their health literacy on foodborne diseases. In the developing world, diarrheal diseases are still the leading cause of death among children under five years of age. Ghana experiences high incidence of foodborne illnesses annually.

Methods: A survey questionnaire was administered to a random sample of 401 individuals in James Town, Accra. ANOVA tests were undertaken to assess bivariate association between health literacy and m-health. Multiple adjusted linear regression models were used to examine the relative effects of receipt of health information on mobile phone on health literacy.

Results: The instrument was internally consistent (Cronbach alpha=0.754) and valid. At the bivariate stage of analyses, receipt of health information on mobile phone, age of respondents, and educational level of participants were statistically significant with health literacy. The multiple regression models showed that receipt of health information on mobile phone and educational level are predictors of health literacy. After controlling for age, we found that a unit increase in the extent of receipt of health information is associated with 0.478 increase in health literacy score. Although, receipt of health information on mobile phone loses its predictive power after controlling for both education and age, we found that a unit increase in one’s education was associated with 0.644 increase in health literacy score.

Conclusion: The study demonstrated a direct positive relationship between receiving health information on mobile phone and heath literacy controlling for covariates in the urban poor context. That means, m-health programs that use the mobile phone as health messaging outlet may, in fact, enhance health literacy among the poor. Future studies may have to design examine specific health information and messages received and their association with different health literacy typologies.

 

Biography:

Deepak Timsina (MA, Tribhuvan University) has ten years of experience in public health program implementation and public health research. Currently, he works for UNICEF Supply Division, Copenhagen, out-posted to Nepal, for its acute respiratory illness diagnostic aids (ARIDA) research project as Country Project Manager for Nepal. He has worked for innovative approaches on the concept of maternity waiting homes and comprehensive center of excellence in Nepal. He worked for two years on hospital management, and earthquake recovery/reconstruction project for health sector from 2015-2017.  His current model of maternity waiting homes is popular in Nepal. 

Abstract:

Statement of the problem: The Nepal Health Sector Strategy (2015-2020) has outlined quality of care through “improved infection prevention and healthcare waste management (HCWM) practices”. The Health Facility Survey (2015) depicts 92% of district hospitals segregate health care waste, but only 77% adhered to the Ministry of Health HCWM guidelines. This study was conducted between mid-2016 and December 2017 to investigate the gaps and feasibility of a quality improvement process through HCWM at District Trishuli Hospital.

Methodology and Theoretical Orientation: The study included a mixed-method baseline assessment to evaluate: a) the quantity of waste (hazardous/non-hazardous) generated b) equipment/infrastructure, c) readiness of the hospital, and d) existing HCWM practices. Based on the findings, awareness raising and capacity building interventions were instrumented for fifteen months, along with a HCWM plan with specific interventions on infrastructure, capacity building and localized actions. Final assessment was held in December 2017.

Findings:

Baseline assessment: Trishuli hospital generated 36.05kg of health care waste daily, composed of hazardous infectious waste (65%), hazardous sharps (16%), pathological waste (15%) and other (4%). Challenges include lack of HCWM plan, lack of technical skills, aggravated by poor hospital infrastructure. Like NHFS findings, the non-segregated wastes were burnt in an open pit near the hospital.

Final assessment: Health care risk waste reduced from 33% -20% of the total waste. While wards practiced proper segregation into color-coded bins, the hospital constructed a treatment plant and institutionalized HCWM through mentoring/coaching and regular monitoring. Hospital had adherence to HCWM standards and increased staff readiness followed by municipal sponsorship on ‘exposure visit’ to health workers to good practices in two other hospitals and commitment to remove treated HCW from the hospital.

Conclusion: Multidimensional intervention covering infrastructure, awareness and capacity development improves HCWM practices to reduce hazardous waste to 20% and adherence to national standards in Nepal.
 

Key words: health care waste management/guidelines, health care risk waste, mentoring, coaching, awareness raising, district hospital, multi-dimensional intervention.