Browsing by Author "Abdullah, Abu"

Tobacco has been recognized as a serious public health issue that threatens people’s health in Palau, Micronesia, especially as young people consume tobacco in multiple ways. The research of this thesis begins with a description of the complex mix of habits, social norms, history, and cultural practice that make up tobacco use in Palau. Then an intervention project using “journaling behavior change paradigm” among young adults based on their own reflections on tobacco use by writing journals, is described. A high prevalence of tobacco use in all forms was revealed in this study, among which chew betel nuts with tobacco is the most popular method. Friend and family members’ attitude play important roles in affecting people’s tobacco use. Also, the evaluation of journaling paradigm reveals potential in lowering tobacco consumption in Palau and other countries by raising awareness of the problem through the writing of journals and diaries.

Background: The Kilimanjaro region has one of the highest rates of reported alcohol use per capita in Tanzania. Alcohol-related risky behaviors pose substantial threats to the health and well-being of alcohol users and people around them. This study sought to provide a better understanding of how risky behaviors are associated with alcohol use perceptions. Methods: This mixed method study took place in the Kilimanjaro Christian Medical Center. Quantitative data on alcohol use, the alcohol use disorder identification tool, alcohol-related consequences, and qualitative data on alcohol use perception and risky behaviors were collected from a hospital- and non-hospital-based sample in Moshi, Tanzania. Latent class analysis was applied to examine alcohol-related risky behaviors. Results: Three classes of risky behavior patterns were identified: “no risky behavior”, “moderate risky behaviors” and “high risky behaviors”. Membership of classes 3 was associated with the most alcohol use quantity and frequency. No association between classes and alcohol-stigma was found. Our qualitative results explored alcohol perceptions and risky behaviors and illustrated their possible associations. Conclusions: Although alcohol stigma may not associate the number of risky behaviors directly, our qualitative result helped us to understand how stigma associates with risky behaviors. This study may serve as a reference for designing and adjusting interventions for alcohol-related injury patients' needs; we can improve interventions by using our knowledge about misconception and stigma and the identified risky behaviors classes as a form of classification system.

The burden of non-communicable diseases (NCDs) continues to grow in Vietnam. Recently, Vietnam government initiated a new national plan with a strong focus on NCD prevention and control in the community. This study is intended to investigate the current role of Vietnamese village health workers (VHWs) in preventive and NCD-related care, and to explore the barriers and facilitators to expand the role by including routine community-based NCD prevention and control services. From June to July 2016, four focus group discussions with VHWs (n=24) and thirteen in-depth interviews (n=13) with public health administrators (n=13) were conducted in Chi Lin District, Hai Duong Province, Vietnam. A thematic analysis was conducted to identify themes in the data. The participants identified health education, program outreach, and case management as the current responsibilities of VHW. In NCD programs, VHWs provide these services mostly to hypertension and diabetes patients. Majority of the participants endorsed the idea of incorporating NCD early detection and risk reduction into VHW role and thought their close connection with community justified their strength in conducting these services. Currently perceived barriers included aging VHW, insufficient NCD-related knowledge, poor training quality, imbalanced workload and remuneration, lack of resource, and policy-driven guideline. While, participants believed that upon empowering through training, guidance, and proper incentive, VHWs would serve as effective NCD risk detector and healthy behavior promoter in their communities. The study indicates that, with interpersonal, organizational and policy support, VHWs may have the potential to conduct routine community-based NCD early detection and risk reduction activities in Vietnam.

Background: Tobacco control and cessation among the youth in Palau is becoming a chief concern in non-communicable disease control within the Palauan Ministry of Health. The most current research states that the trend of tobacco use and initiation among the youth in Palau is ever-increasing. This study seeks to quantitively and qualitatively explore the exposures to tobacco use in daily life in order to inform future health interventions and programs.

Methods: This study was a mixed methods cross-section study seeking to explore many aspects of tobacco exposure and use among the young people of Palau. Survey questions assessing knowledge, behavior, and attitudes regarding tobacco use were conducted with Palauan youth ages 9 to 18 years across various states of Palau. Three focus groups were also conducted to provide depth to collected qualitative data regarding domains such as tobacco initiation, acquisition, and social exposure. Qualitative analysis was conducted using Stata 14 and qualitative data was examined using Nvivo 11.

Results: 39 individuals participated in the survey portion of the study. Of the 39 participants 18 were tobacco users with the majority of users initiating tobacco use before the age of 12. The most common reason stated for tobacco initiation behavior was peer pressure and curiosity. With regard to smoking cigarettes, 82% of respondents believed it causes great harm. Whereas only 43.6% of respondents believed that chewing betel with tobacco caused great harm. Over half of ever users of tobacco (57.1%) had at least one friend who uses tobacco. Methods of tobacco acquisition, perception of tobacco use harm, tobacco imitation reasons, and tobacco exposures in daily life were themes collected from focus group discussions.

Conclusions: This study offers insight into certain characteristics of tobacco users, tobacco initiating behavior in young Palauans, attitudes and beliefs towards tobacco, as well as methods of tobacco acquisition. The results of this study emphasize a need for stricter regulation and enforcement of the tobacco policies which are in place. Though knowledge regarding the harms of tobacco are relatively high, there are still misconceptions that exist in understanding the harms of tobacco. One of the intentions of this study is to provide insight to further inform future health interventions targeting young Palauans which use tobacco. Further research should be implemented within this topic in order to fully understand the nuances and intricacies which surround the role of tobacco in the lives of young Palauans.

Background: There is limited recent data on anaemia in Sri Lanka, however previous estimates put prevalence at 25-35% in children under 5, approximately 16.3% among 5-9 year olds and 9.9-13.9% among 10-15 year olds. Iron deficiency is often cited as the most common cause of anaemia, however in Sri Lanka most anaemia cases are not iron deficiency anaemia related and alternative aetiology related to other causal factors such as heavy metals should be explored. Exposure to heavy metals has been linked with anaemia in other settings and it is plausible that it may contribute to anaemia in Sri Lanka. Aims & Methods: This study is a comparative cross-sectional study setting out to explore the relationship between exposure to lead and anaemia as well as the influence of other factors. Concentration of lead in hair samples and information regarding basic demographic characteristics was collected from children ages 2 to 14 with and without anaemia. Patients were randomly convenience sampled from the outpatient and inpatient paediatric clinics in Karapitiya teaching hospital. Results: The only predictor variables independently associated with having anaemia and lower haemoglobin were male gender and under 5 age. A logistic regression model with anaemia as the outcome found that females were significantly less likely to be anaemic (OR=0.122, p=0.0045) and overweight children were also significantly less likely to be anaemic (OR=0.777, p=0.032). A multivariable regression model assessing contributing factors including age, gender, ethnicity, body mass index (BMI) and stunting could only explain 18.44% of change in haemoglobin levels. Only female gender and age over 5 was significantly associated with higher haemoglobin levels (Coeff=0.932, p=0.015; Coeff=0.787, p=0.01). Tamil ethnicity in this model was associated with significantly lower haemoglobin levels (Coeff= -1.613, p=0.020). Conclusion: Haemoglobin levels, were expected to be negatively correlated with hair lead levels. However, due to the unforeseeable and persistent breakdown of the laboratory equipment the lead content of the collected and processed hair samples could not be analyzed by the thesis deadline. In order to enable and complete similar research in the future, strengthening of local laboratory capacity is suggested.

Contraceptive prevalence in Haiti remains low despite extensive foreign aid targeted at improving family planning. [1] Earlier studies have found that peer-informed learning have been successful in promoting sexual and reproductive health. [2-5] This pilot project was implemented as a three-month, community-based, educational intervention to assess the impact of peer education in increasing contraceptive knowledge among women in Fondwa, Haiti. Research investigators conducted contraceptive information trainings to pre-identified female leaders of existing women’s groups in Fondwa, who were recruited as peer educators (n=4). Later, these female leaders shared the knowledge from the training with the test participants in the women’s group (n=23) through an information session. Structured surveys measuring knowledge of contraceptives were conducted with all participants before the intervention began, at the end of the intervention, and four weeks after the intervention. The surveys measured general contraceptive knowledge, knowledge about eight selected types of modern contraceptives and contraceptive preferences and attitudes. Only test participants showed significant improvement in their general contraceptive knowledge score (p<0.001), but both test participants and peer educators showed significant improvement in overall knowledge scores for identifying the types and uses of modern contraceptive methods. Assessment for knowledge retention remained significantly higher four weeks after the intervention than prior to the intervention. Therefore, a one-time, three-hour peer-based educational intervention using existing social structures is effective, and might be valuable in a population with minimal access to education and little to no knowledge about contraceptives.

Background: Secondhand smoke (SHS) exposure has direct negative impacts on health, especially for vulnerable infants and young children. With the relatively higher smoking rate and lower levels of cigarette smoking-related knowledge and awareness in rural China, children were facing severe SHS exposure within households. The aim of this study is to assess whether a community health worker (CHW)–delivered tobacco control intervention for household smokers will lead to SHS exposure reduction in children in rural settings through 12-month follow-up. Methods: Households with a child aged 5 years or younger at home were randomized to the intervention group (n = 334) to receive smoking hygiene intervention or to the attention-matched comparison group (n = 334). The intervention was delivered by trained CHWs. Outcomes were assessed at 6- and 12- month follow-up. Multilevel mixed-effects logistic regression was used to access the intervention performance. Results: We found that children were less likely to be exposed to SHS in the intervention group (OR: 0.56 95% CI: .32, 1.00 P=0.049) than the children in the comparison group at 12- months as measured by the self-reported number of days smoker smoked in front of children. Our intervention had minor effect on smoking cessation, smoke-free home restriction, and improvement of children’s respiratory health. Conclusions: The findings of this first study in rural China showed that smoking hygiene intervention was promising in reducing children’s exposure to SHS. These findings have implications for improving smoking cessation and reducing SHS exposure provided by CHWs in rural China.

Background: Young black men who have sex with men (YBMSM) are a particularly vulnerable group for HIV infection. HIV-positive YBMSM often suffer from mental health challenges as a result of discrimination based on their HIV status, race, and sexual preferences. Potential associations among HIV self-disclosure, social support, and mental health have been reported in several studies. The aim of this study is to explore the associations among self-disclosure, social support and mental health, including depression and anxiety. Methods: Cross-sectional secondary data, with a sample size of 199 HIV-positive YBMSM, was retrieved from the baseline data of an on-going study. Qualitative interviews were conducted at three sites in North Carolina. Linear regression and content analysis were used in the quantitative and qualitative analysis respectively to explore the associations among self-disclosure, social support, and mental health. Results: In linear regression models for depression and anxiety, social support was significantly associated with depression (p<0.01) and anxiety (p<0.05). Self-disclosure was not significantly associated with depression or anxiety in regression analyses. Qualitative analysis showed connections between social support and mental health as well as self-disclosure and mental health. Conclusions: Both self-disclosure and social support could affect mental health in YBMSM. Further research is needed to better understand the mechanisms linking self-disclosure, social support, and mental health to develop effective and tailored mental health interventions for this marginalized population.

Background: Secondhand smoke (SHS) exposure has direct adverse health impacts, especially among young children. With high prevalence of smoking in rural China, children were faced with severe SHS exposure within households. The aim of this study is to investigate short-term (2-month) effects of a community-based smoking hygiene intervention. Method: To adapt an evidence-based intervention packet, we interviewed residents of the target community via focus group discussion. Community health workers (CHWs) and village doctors (VDs) were trained as counsellors to implement the intervention. A follow-up assessment was conducted to compare the differences between subjects in the intervention and control group in regard to their smoking behavior and household smoking hygiene practices. Relevant health workers were interviewed to learn their experience of delivering the smoking hygiene intervention. Result: We found that the intervention had minor effects on smoking cessation among the subjects (7.7% vs 7.3%, P=0.91); while smokers who received the counselling (78.9% vs 45.2%, P<0.001) were more likely to make changes in smoking behavior at home or around their children. Conclusion: It was feasible to reduce children’s SHS exposure through community-based programs. However, our intervention showed no positive impacts on smokers’ quitting and thus more studies were expected to explore effective methods for smoking cessation intervention. To have health workers from primary health centers engaged in future projects, researchers should consider the workload and improve their job satisfaction.

Background: Evidence-based medication and lifestyle modification are important for secondary prevention of cardiovascular disease but are underutilized. Mobile health strategies could address this gap but existing evidence is mixed. Therefore, we piloted a pre-post study to assess the impact of patient-directed text messages as a means of improving medication adherence and modifying major health risk behaviors among coronary heart disease (CHD) patients in Hainan, China.

Methods: 92 CVD patients were surveyed between June and August 2015 (before the intervention) and then between October and December 2015 (after 12 week intervention) about (a) medication use (b) smoking status,(c) fruit and vegetable consumption, and (d) physical activity uptake. Acceptability of text-messaging intervention was assessed at follow-up. Descriptive statistics, along with paired comparisons between the pre and post outcomes were conducted using both parametric (t-test) and non-parametric (Wilcoxon signed rank test) methods.

Results: The number of respondents at follow-up was 82 (89% retention rate). Significant improvements were observed for medication adherence (P<0.001) and for the number of cigarettes smoked per day (P=.022). However there was no change in the number of smokers who quitted smoking at follow-up. There were insignificant changes for physical activity (P=0.91) and fruit and vegetable consumption.

Background: Despite increased use of insecticide-treated nets (ITNs) among children under 5 years in Malawi, use of ITNs alone is insufficient to eliminate malaria. Therefore, other prevention methods should be explored to achieve malaria elimination. Previous studies illustrated that mother’s knowledge of ITNs positively influenced her child’s ITN use. In other settings, mothers’ knowledge of ITNs led to increased ITN use and reduced parasitemia among children under 5 years. Therefore, it may be plausible that maternal knowledge of other malaria prevention methods is associated with under-five malaria parasitemia. This study examined whether maternal knowledge of other malaria prevention methods is associated with malaria parasitemia among children under five years in Malawi. I hypothesized that higher levels of maternal knowledge of malaria prevention methods would be associated with lower odds of malaria parasitemia in children under-five.

Methods: The analytic sample included 1,880 children under 5 years of age. Maternal knowledge of malaria prevention methods was assessed using 12 items from the 2017 Malawi Malaria Indicator Survey (MMIS). Each of the 12 items was given either a score of 1 for a correct response or a score of 0 for an incorrect response. All 12 items were added up to create a continuous composite score ranging from a minimum score of 0 (low knowledge) to a maximum score of 12 (high knowledge). I also classified the total score as a 3-level categorical variable: low (score: 0-3), intermediate (score: 4), and high (score: 5-12). For the binary variable, a total score of less than or equal to 4 was considered inadequate knowledge, while a total score of greater than or equal to 5 was considered adequate knowledge. Malaria parasitemia was assessed using positive and negative malaria microscopy test results. I examined the association between maternal knowledge of malaria prevention methods and under-5 parasitemia using weighted multivariable logistic regression models. I also adjusted for sociodemographic characteristics such as mother’s highest level of education, ethnicity, type and place of residence, region, child’s age, and wealth index.

Results: Maternal knowledge of malaria prevention methods was not found to be a significant predictor of under-5 malaria parasitemia. The survey items used to create the composite score had an alpha value of 0.43 which indicated poor reliability. Of the 1,880 children included in the analytic sample, 67.5% had mothers with only primary school education, 85.7% were from rural areas, and 22.8% were from the poorest wealth index bracket. After adjustment, maternal knowledge of malaria prevention methods as a composite score (adjusted odds ratio [AOR]=1.14, 95% confidence interval [CI]: 0.96, 1.35), as a three-level categorical variable (high knowledge AOR=2.28, 95% CI: 0.63-8.25), or as a binary variable (inadequate knowledge AOR=0.78, 95% CI 0.54-1.14) were not significantly associated with under-five malaria prevalence. Only maternal knowledge of burning leaves was significantly associated with a 5.44 higher odds of malaria parasitemia among children under five years.

Conclusions: In this study, I did not find evidence supporting the hypothesis that higher levels of maternal knowledge of malaria prevention methods is associated with a lower prevalence of under-5 malaria parasitemia in Malawi. This may be because maternal knowledge of malaria prevention methods is not a good indicator of actual practice. Therefore, future studies should explore the relationship between the preventative practices used by mothers and the prevalence of malaria among their children under five years. Future research identifying how alternative malaria prevention practices to ITNs impact under-five parasitemia may help Malawi progress toward malaria elimination.

Background: Faced with the surging trends of cardiovascular diseases (CVDs) and the limited numbers of health professionals in Nepal, more innovative measures should be explored to tackle the challenges of CVD prevention and control. This study explored the feasibility of shifting some CVD-related tasks to the community by engaging female community health volunteers (FCHVs) for CVD risk screening. Methods: This study was conducted in a rural and an urban study site in Lalitpur (Kathmandu Valley), Nepal. Mixed methods were employed in this study. Ten FCHVs were recruited and trained to use the Cardiovascular Risk Scoring Chart adapted from the World Health Organization’s Package for Essential Non-Communicable Diseases (PEN). After the training, FCHVs administered cardiovascular risk factor questionnaires and used the risk scoring chart to screen eligible community residents in their catchment area. Using the data collected by FCHVs, a medical doctor calculated the second risk score with the same risk scoring chart. A kappa concordance test was used to compare these two sets of risk screening results for agreement, and a sensitivity and specificity test was conducted to assess the reliability of the FCHVs’ CVD risk screening results. Two focus group discussions were administered to investigate the FCHVs’ training and fieldwork experiences during the study. Results: There were 491 community residents screened for cardiovascular risk at two study sites. The mean level of agreement between the two sets of risk screening results was 94.5% (Kappa = 0.77, P < 0.05). The sensitivity of the FCHV screening test was 90.3% (95% CI [0.801, 0.964]); and the specificity was 97% (95% CI [0.948, 0.984]). In the FGD, FCHVs expressed a strong enthusiasm and readiness for NCD related work. Besides, all FCHVs agreed that they could manage their current workload and were confident that they could perform more tasks for the prevention and control of NCDs with the proper training. More NCD-related programs and training are called for by FCHVs. Conclusions: It is feasible to train FCHVs to use the simple cardiovascular scoring chart to screen and identify community residents at high risk of developing CVDs. Although FCHVs expressed interests in taking on more responsibility regarding the prevention and control of NCDs, further studies are needed to assess the feasibility of engaging FCHVs within the existing healthcare system.