Objectives: This study explored the relationship between receiving healthy lifestyle advice from healthcare providers and hypertension among undiagnosed individuals in Afghanistan, defined as adults with no previous hypertension diagnosis or treatment history.Materials and Methods: Data were extracted from the 2018–19 Afghanistan National Non-Communicable Diseases Risk Factors Survey, comprising 2,838 participants. Outcomes included hypertension (systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg) and elevated blood pressure (systolic blood pressure 120–129 mmHg and diastolic blood pressure <80 mmHg). Bivariate and multivariable multinomial logistic regression analyses were conducted to assess associated factors.Results: Among the 2,838 participants, 1,344 (47.4%) had hypertension and 344 (12.1%) had elevated blood pressure. Most participants were aged <40 years (63.8%), male (55.8%), and ever-married (80.2%). Multivariable analysis revealed that not receiving healthy lifestyle advice was significantly associated with hypertension (adjusted relative risk ratio [aRRR]=1.24; 95% confidence interval [CI]: 1.04–1.47) and elevated blood pressure (aRRR=1.40; 95% CI: 1.08–1.81). Sociodemographic and behavioral factors such as age, sex, marital status, education, occupation, fruit consumption, physical activity, and excess weight were significantly associated with hypertension, whereas only sex and excess weight were significantly associated with elevated blood pressure.Conclusion: Our findings underscore the association between receiving healthy lifestyle advice from healthcare providers and a lower prevalence of hypertension among undiagnosed Afghan adults. Accordingly, healthcare providers should recommend lifestyle changes to help manage hypertension among adults.

Objective: Academic stress is associated with mental health disorders, notably depression and anxiety among students. Mitigating stress can decrease the incidence of mental health disorders and improve student well-being. This study explored factors influencing academic stress among secondary school students in Vietnam.Materials and Methods: A three-year longitudinal study was conducted using a self-reported questionnaire with 611 students from four secondary schools in Hue City, Vietnam. Academic stress was evaluated using the Educational Stress Scale for Adolescents (ESSA). Family factors, including the number of siblings and parental educational levels; lifestyle factors, including physical activity and sleep; and academic factors, including grade point average and attending extra classes were evaluated. Linear regression models were used to analyze the associations between the ESSA scores at follow-up and family, lifestyle, and academic factors at baseline.Results: A total of 341 students completed both the baseline and follow-up surveys and answered the questions required for this analysis. The mean ESSA score of 341 students increased from 46.4 ± 7.6 (mean ± SD) to 53.5 ± 10.8, from 2018 to 2021. The multivariate model revealed that the number of siblings, higher father’s educational attainment level, female gender, lower academic scores, and attending extra classes were associated with overall academic stress. In contrast, no associations were observed between the variables of lifestyle, parental concentration, and parental acceptance and overall academic stress.Conclusion: The findings highlight the impact of family factors and study workload on academic stress, emphasizing the need for proper care from family and school to reduce or prevent student academic stress and provide them with a comfortable and healthy learning environment.

Objective: The association between the sex of newborns and the utilization of prenatal healthcare services during pregnancy and childbirth has not been thoroughly studied. This study investigated the association between the sex of newborns and the extent to which women used prenatal healthcare services in Afghanistan.Materials and Methods: This study used data obtained from a nationally representative demographic and health survey. The participants in this analysis were women who had given birth in the last five years (n=19,126). Four indicators related to prenatal healthcare utilization were used: (1) number of antenatal care (ANC) visits, (2) number of ANC services provided by skilled professionals, (3) quality of ANC services, and (4) institutional delivery. Multivariate linear and logistic regression models were employed to examine the association between the sex of newborns and the use of prenatal healthcare services after adjusting for sociodemographic and decision-making autonomy variables.Results: There was a significant association between the sex of newborns and use of prenatal healthcare services. Women with female newborns used ANC services fewer times (β =−0.10, 95% CI: −0.17, −0.03), used ANC services provided by skilled professionals fewer times (β=−0.11, 95% CI: −0.18, −0.04), were less likely to receive high-quality ANC (adjusted odds ratio (AOR)=0.78, 95% confidence interval (CI): 0.67, 0.90), and were less likely to deliver their babies at health institutions (AOR=0.83, 95% CI: 0.77, 0.91) than those with male newborns, after adjusting for other variables.Conclusion: The findings revealed a negative association between female newborns and the utilization of prenatal healthcare services among women of reproductive age in Afghanistan. It is important to pay attention to this issue and ensure that all women have equal access to healthcare services regardless of their newborn’s sex.

BACKGROUND: To protect the health and safety of healthcare workers (HCWs), it is essential to ensure the provision of sustainable water, sanitation, and hygiene (WASH) services and standard precautions in healthcare facilities (HCF). The objectives of this short communication were 1) to assess the availability of WASH services and standard precautions in HCFs in seven provinces in Afghanistan before the COVID-19 pandemic, and 2) to elucidate the relevance of these patterns with the number of reported HCW infections from COVID-19 in the mentioned provinces. METHODS: We analyzed secondary data from the 2018-19 Afghanistan Service Provision Assessment survey, which included 142 public and private HCFs in seven major provinces in Afghanistan. Data on COVID-19 cases were obtained from the Afghanistan Ministry of Public Health Data Warehouse. Weighted prevalence of WASH services and standard precautions were calculated using frequencies and percentages. ArcGIS maps were used to visualize the distribution of COVID-19 cases, and scatter plots were created to visualize the relevance of WASH services and standard precautions to COVID-19 cases in provinces. RESULTS: Of the 142 facilities surveyed, about 97% had improved water sources, and over 94% had improved toilet for clients. Overall, HCFs had limited availability of hygiene services and standard precautions, which was lower in private than public facilities. More than half of the facilities had safe final disposal and appropriate storage of sharps and medical waste. Of the seven provinces, Herat province had the highest cumulative COVID-19 case rate among HCWs per 100,000 population and reported lower availability of WASH services and standard precautions in HCFs compared to other provinces. CONCLUSION Our findings show disparities in the availability of WASH services and standard precautions in public and private facilities. Private facilities had a lower availability of hygiene services and standard precautions than public facilities. Provinces with higher availability of WASH services and standard precautions in HCFs had a lower cumulative COVID-19 case rate among HCWs per 100,000 population. Pre-pandemic preparation of adequate WASH services and standard precautions in HCFs could be potentially important in combating infectious disease emergence.
Afghanistan/epidemiology* ; COVID-19/prevention & control* ; Delivery of Health Care ; Humans ; Hygiene ; Pandemics/prevention & control* ; Sanitation ; Water ; Water Supply

Objectives: Older adults in skip-generation households (SGHs) play a valuable role in maintaining the cohesion of extended families in the absence of the middle generation. Little is known about the health and well-being of older adults in SGHs or how it varies depending on their age. This study aimed to examine 1) the association between living in SGHs and subjective health and well-being and 2) the association between subjective health and well-being of older adults in SGHs across age groups.Methods: Drawing data from the 2017 national survey of older people, older adults aged ≥60 years without disability in activities of daily living (n=38,088) were included for multiple regression analyses. Living arrangements were classified into SGHs and non-SGHs. Subjective health was evaluated based on self-rated health, whereas subjective well-being was evaluated using a happiness score. Ordinal logistic regression and linear regression models, stratified by age groups (young-old, 60–69; middle-old, 70–79; and old-old, ≥80), compared subjective health and well-being of older adults in SGHs and non-SHGs, while controlling for potential covariates.Results: Among older Thai adults, 10.1% lived in SGHs, and 11.1%, 9.5%, and 6.3% were among the young-old, middle-old, and old-old, respectively. Across age groups, older adults living in SGHs reported better health status but worse well-being than those living in non-SGHs. Older adults from the old-old group living in SGHs seemed to report the best health status, whereas those in the young-old and old-old groups tended to report the worst well-being. The direction of the association between living arrangements and subjective health and well-being did not differ by age group.Conclusion: Better health status but worse well-being were observed in SGHs. Social sectors should pay attention to the well-being of these older adults.

BACKGROUND: Health policies in the Philippines have evolved in response to increasing health demands of older adults. However, there is a lack of research on equity among the ageing population in low-middle income countries. The objective of this study was to identify the trends in National Health Insurance Program (NHIP) coverage and healthcare utilization among older adults in the Philippines for the period from 2003 to 2017, during which NHIP expansion policies were implemented, focusing on reductions in socio-economic inequalities. METHODS: A literature search of policies for older adults and an analysis of four Philippine National Demographic and Health Surveys (2003, 2008, 2013, and 2017) with data from 25,217 older adults who were 60 years or older were performed. The major outcome variables were NHIP coverage, self-reported illness, outpatient healthcare utilization, and inpatient healthcare utilization. Inequalities in NHIP coverage and healthcare utilization according to wealth were evaluated by calculating the concentration index for individual years, followed by a regression-based decomposition analysis. RESULTS: NHIP coverage among older adults increased from 9.4 (2003) to 87.6% (2017). Although inequalities according to wealth quintile were observed in all four surveys (all P < 0.001), the concentration index declined from 0.3000 (2003) to 0.0247 (2017), showing reduced inequalities in NHIP coverage over time as observed for self-reported illness and healthcare utilization. NHIP coverage expansion for older adults in 2014 enabled equal opportunity for access to healthcare. CONCLUSION The passage of mandatory NHIP coverage for older Filipino adults in 2014 was followed by a reduction in inequality in NHIP coverage and healthcare utilization according to wealth.
Aged ; Aged, 80 and over ; Female ; Healthcare Disparities ; trends ; Humans ; Insurance Coverage ; trends ; Male ; Middle Aged ; National Health Programs ; legislation & jurisprudence ; statistics & numerical data ; Philippines ; Socioeconomic Factors

BACKGROUND: Promotion of oral health in children is recognized as one of the components of health-promoting schools (HPSs). However, few studies have addressed supportive school environments for children's oral health. This study aimed to evaluate the status of dental caries in school children at HPSs, with the objective of examining the impact of a supportive school environment for oral health, considering the lifestyles of individual children and the socioeconomic characteristics of their communities. METHODS: Data of 2043 5th-grade students in 21 elementary schools in Ichikawa city between 2008 and 2013 were analyzed. Children's oral health status was evaluated using the decayed, missing, and filled permanent teeth (DMFT) index. A self-reported lifestyle questionnaire, a survey of the school environment promoting tooth-brushing, and community socioeconomic characteristics derived from the National Census data were included in the analyses. Bivariate analyses were conducted to evaluate the children's DMFT status, and zero-inflated negative binominal (ZINB) regression was used to assess the relationships between DMFT and other variables. RESULTS: Prevalence of dental caries in the permanent teeth of 5th-grade children (aged 10-11 years) was 33.3%, with a mean DMFT score (± SD) of 0.83 ± 1.50. According to multilevel ZINB regression analysis, children from schools with after-lunch tooth-brushing time showed a higher odds ratio (OR) for excess zero DMFT (OR = 1.47, 95% CI = 1.00-2.15, P = 0.049) as compared to those from schools without it. Neither bivariate analysis nor ZINB model analysis revealed any significant influence of children's gender or use of a toothpaste with fluoride. CONCLUSIONS The school-based environment supportive of oral health was significantly associated with a zero DMFT status in children. School-based efforts considering the socioeconomic characteristics of the area warrant attention even with declining prevalence of dental caries.

Aim: To evaluate the costs associated with healthcare and long-term care during the last 24 months before death according to major disease groups.Methods: Individual data regarding healthcare and long-term care costs according to public insurance schemes during the last 24 months before death among all decedents older than 75 years reported in a city in Japan between April 1, 2010 and March 31, 2014 were identified; the data for nine major diseases were then analyzed.Results: For the 2149 decedents studied, the average healthcare costs per capita in the last 24 months of life for moderately-old (75 to 84 years) and extremely-old (85 years and older) decedents was 4,135,467 JPY and 2,493,001 JPY, respectively, while the average long-term care costs per capita for 24 months was 1,300,710 JPY and 2,723,239 JPY, respectively. The total costs (healthcare and long-term care combined) ranged from 9,169,547 JPY for chronic kidney disease to 5,023,762 JPY for ischemic heart disease. In all the diseases studied, the moderately-old decedents incurred higher healthcare costs while the extremely-old decedents incurred higher long-term care costs. However, for the care costs of chronic lower respiratory diseases, this pattern was not observed.Conclusion: A shift in expenditure from healthcare to long-term care as the decedents’ age increased was observed in major diseases, with some exceptions.

Objective: Evidence from developing countries on the association between women’s endorsement of attitudes justifying partner abuse and their use of reproductive health services is suggestive but inconclusive. This study uses a nationally representative dataset from Lao PDR to provide strong evidence for the relationship between women’s endorsement of attitudes justifying partner abuse and use of reproductive health services.Methods: This study used data from the 2011–2012 Lao Social Indicator survey (LSIS). The analyses were performed on the responses of 4227 women. The exposure of interest in this study was endorsement of attitudes justifying partner abuse. Antenatal care (ANC) visits divided according to amount and quality, delivery care by type and place, and utilization of postnatal care (PNC) for mothers and newborn infants were used as representative outcome variables of reproductive health service utilization.Results: Approximately seven out of ten respondents (67.9%) believed that partner abuse was justified. Women who endorsed these attitudes were significantly less likely to receive any ANC, to seek institutional delivery, and to use trained medical personnel for delivery assistance. Endorsing attitudes were associated with reduced probability of receiving PNC services for mothers and newborn infants, reduced frequency of ANC visits, and receiving a fewer number of ANC components. Other sociodemographic factors likely to affect the increased utilization of several of the indicators of reproductive health care were living in the central region, belonging to the high bands of wealth, having higher level of education, being a young adult (20–34 years) or older (35–49 years), residing in urban areas, and being sexually empowered.Conclusions: In addition to a broad range of sociodemographic factors, our findings suggested that women’s endorsement of attitudes justifying partner abuse should be treated as an important psychosocial determinant of reproductive health care service utilization in Lao PDR.

Objective: This study examined the change in physical activity status and patterns and their associations with urban and rural residence and employment status in Mongolia.Methods: We analyzed data from 7,738 adults aged from 20 to 64 years (n = 2,877 and 4,861 for 2005 and 2013, respectively) from the Mongolian STEPS Survey on the Prevalence of Non-Communicable Disease Risk Factors (NCD-STEPS survey). Physical activity in three domains, including work (occupational and household work); transport (walk or cycling); and leisure (sport or fitness) was measured by Global Physical Activity Questionnaire (GPAQ). Physical activity levels were classified into three groups: low, moderate, and high according to the GPAQ analysis framework. The associations between physical activity time, residential area, and employment status were examined using a multivariate negative binomial regression model.Results: The percentage of respondents with low-level physical activity increased from 10.9% in 2005 to 27.2% in 2013. The median minutes of physical activity time per week were 1,020 in 2005 and 600 in 2013. Physical activity time at work, transport and overall decreased in 2013. Work-related physical activity was the most dominant component of physical activity time (55.6% in 2005 and 54.6% in 2013), the transport domain was the second-highest contributor of physical activity time in 2005 (24.0%) and was replaced by the leisure domain (26.8%) in 2013. Rural residents practiced more physical activity at work, transport, and leisure than urban residents did in 2005 (prevalence ratio [PR]: 1.33, 95% confidence interval [CI]: 1.20–1.47; PR: 1.21, 95%CI: 1.14–1.29; and PR: 1.21, 95%CI: 1.13–1.30, respectively), but there was no significant difference by residential area in 2013. Mongolian adults with higher educational attainment, employee status, and non-employment status were less likely to engage in physical activity compared to those among adults with lower educational attainment and self-employed status.