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OBJECTIVES: The double burden of malnutrition (DBM) is a major public health problem in the world. Overweight and obesity with concurrent stunting (called stuntingoverweight) is one of the specific forms of DBM at the individual level, and it has been documented in several low- and middle-income countries (LMICs). However, the changes in country-level prevalence of stuntingoverweight has not been known. The impact of socioeconomic inequalities on the prevalence of stuntingoverweight also have not been done across LMICs. Thus, this study aimed to investigate the changes of stuntingoverweight prevalence among children under five-years, and to assess socioeconomic inequality in the prevalence in LMICs. METHODS: Secondary data analysis was conducted in 58 LMICs between 2006 and 2018, comprising 692,704 children under five years old by using the Demographic and Health Surveys (DHS). For stuntingoverweight, the following values were estimated: rate ratio, mean difference, the slope index of inequality (SII), and the relative index of inequality (RII). RESULTS: The range of the prevalence of stuntingoverweight was lower than the ranges in the country-level prevalence of stunting and overweight. The relative index of inequality (RII) by wealth status ranged from 0.16 (Peru) to 2.31 (Nepal). RII by maternal education ranged from 0.06 (Kyrgyz Republic) to 15.11 (Tajikistan). Stuntingoverweight was found more in the poorest households. Among 31 LMICs, 27 countries reduced the prevalence of stuntingoverweight except four countries. However, to what extent the prevalence of stuntingoverweight reduced varied between countries. CONCLUSIONS: The prevalence of stuntingoverweight had been reduced in most countries, and socioeconomic inequalities existed in the prevalence and its change. Governments require health policies in addition to preventing stunting to ensure that children who are already stunted have a healthy life without becoming overweight concurrently. FUNDING SOURCES: N/A.

Abstract Background The 5S management method (where 5S stands for sort, set in order, shine, standardize, and sustain) was originally implemented by manufacturing enterprises in Japan. It was then introduced to the manufacturing sector in the West and eventually applied to the health sector for organizing and standardizing the workplace. 5S has recently received attention as a potential solution for improving government health-care services in low- and middle-income countries. We conducted a narrative literature review to explore its applicability to health-care facilities globally, with a focus on three aspects: (a) the context of its application, (b) its impacts, and (c) its adoption as part of government initiatives. Methods To identify relevant research articles, we researched public health databases in English, including CINAHL, PubMed, ScienceDirect, and Web of Science. We found 15 of the 114 articles obtained from the search results to be relevant for full-text analysis of the context and impacts of the 5S application. To identify additional information particularly on its adoption as part of government initiatives, we also examined other types of resources including reference books, reports, didactic materials, government documents, and websites. Results The 15 empirical studies highlighted its application in primary health-care facilities and a wide range of hospital areas in Brazil, India, Jordan, Senegal, Sri Lanka, Tanzania, the UK, and the USA. The review also found that 5S was considered to be the starting point for health-care quality improvement. Ten studies presented its impacts on quality improvements; the changes resulting from the 5S application were classified into the three dimensions of safety, efficiency, and patient-centeredness. Furthermore, 5S was adopted as part of government quality improvement strategies in India, Senegal, Sri Lanka, and Tanzania. Conclusions 5S could be applied to health-care facilities regardless of locations. It could be not only a tool for health workers and facility managers but also a strategic option for policymakers. They could consider 5S as the starting point of a government-led quality improvement initiative for improving safety, efficiency, or patient-centeredness aspects particularly in low- and middle-income countries. However, the evidence base, particularly in resource-poor settings, must be expanded.

Abstract The Japanese health system places great emphasis on healthy development. However, the prevalence of Exclusive Breastfeeding at one month postpartum between 1980 and 2005 has remained unchanged, fluctuating between 42% and 49%. At the same time, the Any Breastfeeding prevalence has gradually increased from about 80% to 95%. In 2010, the latest national breastfeeding report showed that 'exclusive' and 'any' breastfeeding rates have improved. However, as the World Health Organization (WHO) definition of breastfeeding practices was not used in this study or in other national surveys, it is difficult to interpret these latest results. While the Japanese government has launched several promotion projects, there have been few studies and reviews of risk factors that influence breastfeeding duration. The objectives of this review were to summarise the factors that have influenced the duration of breastfeeding in Japan to provide information relevant to breastfeeding promotion programs. A search of electronic databases in Japanese and English was undertaken up to 2011. The inclusion criteria for this review were studies that focused on infant feeding practices and targeted Japanese mothers, fathers, or health professionals, but excluded mothers' friends and peer groups. In total, 12 articles were selected for the final analysis. Smoking status, low birth weight of infants and maternal perceptions of insufficient breast milk supply were negative influences on breastfeeding duration, while support from husbands/partners is associated with continued breastfeeding. Some factors that have been found to be associated with breastfeeding in other countries, including maternal age, family income, maternal educational levels, and living with grandparents of infants have not been confirmed in Japan. While the national breastfeeding rates were higher than other countries of similar health status, inconsistent knowledge of breastfeeding benefits and inappropriate hospital practices remain in Japan may be associated with increased the use of infant formula and reduced breastfeeding duration. Most of the studies reviewed were cross-sectional in design, with only a limited number of cohort studies. Also many published studies used small sample sizes. Cohort studies of infant feeding practices with larger sample sizes are required to monitor trends in rates and risk factors for breastfeeding outcomes.

Aims:To explore the association between MMORPG addiction and mental health status, and between self-control ability and mental health status among young male MMORPG players in Hanoi, Vietnam.Methods:In this cross-sectional study, 10 computer game rooms were randomly selected out of 77 in five communes in Hanoi. From these game rooms, 350 MMORPG players were purposively recruited as a study group, of whom 344 completed the questionnaire. In the same five communes, 344 non-players were selected as a control group. An online game addiction scale, a self-control scale and the Vietnamese SRQ-20 were used to measure the degree of MMORPG addiction, self-control ability and level of mental disorders.Results:MMORPG players had significantly higher mental disorders scale scores than non-players ( p < .001). The strongest positive correlation was detected between MMORPG addiction scale scores and mental disorders scale scores ( r = 0.730, p < .001). Self-control scale scores were negatively associated with mental disorders scale scores ( r = -0.345, p < .001). The average amount of money spent on games per month, MMORPG addiction scale score and self-control scale score were considered the best predictors of a higher mental disorders scale score.Conclusion:Young, male MMORPG players with higher addiction scores were more likely to have higher mental disorders scale scores, and such mental status was negatively associated with the level of self-control in Hanoi, Vietnam. Closer attention should be paid to prevent mental disorders among MMORPG players.

The Philippine government is facing a burden of improving health and social services for both the growing elderly and young population. The extent of discussion on aging issues and concerns, however, is minimal at best. Therefore, this study aimed to examine the perceptions of unmet needs and to explore the coping mechanisms of senior citizens across local stakeholders in an urban area in the Philippines. In this qualitative study, we collected data using focus group discussions among senior citizens (n = 4) and health providers (n = 4) as well as in-depth interviews among local administrators (n = 7). We analyzed the data through thematic analysis using the social determinants of health as the theoretical framework. We used qualitative research software NVivo10® to track the coding and manage the data. Four major themes related to unmet needs emerged in the analyses: (1) financial security, (2) health care services, (3) age-friendly environment, and (4) family support. Senior citizens responded either positively or negatively to cope with the challenges associated with aging. The government must then revisit existing national policies to address their unmet needs. Actions should be taken to strengthen positive coping and modifying the negative coping mechanisms, with a particular focus on community and family interventions.

OBJECTIVES: This mixed methods study was conducted to explore the barriers and facilitators for health-seeking behaviours in a malaria endemic district in Lao PDR. DESIGN: A convergent mixed methods design. SETTING: Two malaria endemic villages in Thapangthong district, Savannakhet Province, Lao PDR. PARTICIPANTS: Villagers and healthcare workers in the two villages in Thapangthong district. METHODS: In the quantitative part, a pretested questionnaire was used to identify the health-seeking behaviours of the villagers. In the qualitative part, focus group discussions were employed to explore health-seeking behaviours of the villagers and in-depth interviews were used to explore the perceptions of the healthcare workers. Descriptive statistics were computed and multiple logistic regressions were used to identify the factors associated with perceived severity and perceived susceptibility. Thematic analysis was used to analyse the qualitative data. Quantitative and qualitative results were integrated in joint displays. RESULTS: In the quantitative part, data were collected from 313 villagers from both villages. For malaria, 96.0% and 98.2% of villagers from villages A and B, respectively, would first seek treatment at public health facilities. Villagers who have not experienced malaria before were more likely to perceive that the consequences of malaria were serious compared with those who have experienced malaria before (adjusted OR=1.69, 95% CI: 1.03 to 2.75). However, qualitative data showed that villagers faced problems such as lack of medicines and medical equipment. Healthcare workers also mentioned the lack of manpower and equipment in the in-depth interviews. Nevertheless, villagers still preferred to seek treatment at the health center as the National Health Insurance was introduced. CONCLUSIONS: Public health facility usage was high but barriers existed. Effective policy and enabling environment such as the introduction of the National Health Insurance could help accelerate the progress towards the ...

Background Two international Conventions from the International Labor Organization (ILO; C162 Asbestos Convention) and the UN (Basel Convention) offer governments guidelines for achieving a total asbestos ban policy, but the long-term effect of these Conventions on policy implementation, and the role of government effectiveness, remains unknown. We aimed to investigate associations between government ratification of the ILO and UN international Conventions, government effectiveness, and implementation of a national total asbestos ban. Methods We obtained data for year of a national asbestos ban, year of ratification of one or both international Conventions, and World Bank government effectiveness scores for 108 countries that ever used asbestos. We did a survival analysis for countries with data in the follow-up period (March 22, 1989, to Feb 2, 2018) to assess whether ratification of the international Conventions and greater government effectiveness were associated with time of implementation of a national total asbestos ban. Findings Of 108 countries with data for asbestos consumption, nine were excluded because they implemented an asbestos ban before 1989. Therefore, 99 countries were included in the survival analysis. 26 countries ratified both international Conventions and 73 ratified either one or no Convention. Countries that ratified both Conventions had a shorter time to adoption of a total asbestos ban (mean 8·9 [SD 6·4] years) than did countries that ratified one or no Conventions (16·9 [6·1] years). After controlling for government effectiveness, countries that ratified both Conventions had a significantly higher conditional probability of banning asbestos than did those ratifying one or no Convention (hazard ratio [HR] 41·8, 95% CI 4·5–383·3; p=0·0010). For every 1 point increment in government effectiveness, the percentage change in HR for persistent asbestos consumption significantly increased by 127% (95% CI 13–354; p=0·021). Interpretation This study confirms that adoption of both the C162 Asbestos Convention and the Basel Convention facilitates countries in moving towards a total asbestos ban. The effect was reinforced by government effectiveness. Both international programmes and new agreements towards total asbestos bans and government commitments are needed.

Abstract Background Adherence to antiretroviral (ARV) drugs is essential for eliminating new pediatric infections of human immunodeficiency virus (HIV). Since the Zambian government revised the national guidelines based on option A (i.e., maternal zidovudine and infant ARV prophylaxis) of the World Health Organization's 2010 guidelines, no studies have assessed adherence to ARVs during pregnancy up to the postpartum period. This study aimed to examine adherence to ARVs and identify the associated risk factors. Methods A prospective cohort study was conducted in the Chongwe district from June 2011 to January 2014. Self-reported adherence to ARVs was examined during pregnancy and at one week, six weeks, and 24 weeks postpartum among 321 HIV-positive women. The probability of remaining adherent to ARVs was estimated using the Kaplan-Meier method, and the risk factors for non-adherence were identified using the Cox proportional hazard regressions—treating loss to follow-up as non-adherence. The statuses of HIV in HIV-exposed infants were assessed in January 2014. Results During the study period, 326 infants were born to HIV-positive women, 262 (80.4 %) underwent HIV testing, and 11 (3.4 %) had their HIV infection detected at the time that they had the latest HIV testing as of January 2014. The ARV adherence rate was 82.5 % during pregnancy, 84.2 % at one week postpartum, 81.5 % at six weeks postpartum, and 70.5 % at 24 weeks postpartum. The probability of remaining adherent to ARVs was 0.61 at day 50, 0.35 at day 100, 0.18 at day 200, and 0.06 at day 300. Attending a referral health center (HC) was a risk factor for non-adherence compared with attending rural HCs that provided HIV care/treatment (adjusted hazard ratio [aHR] 0.71, 95 % confidence interval [CI] 0.57–0.88) and those that did not provide HIV care/treatment (aHR 0.58, 95 % CI 0.46–0.74). A new diagnosis of HIV infection compared to a known HIV-positive status before pregnancy was another risk factor for non-adherence (aHR 1.24, 95 % CI 1.03–1.50). Conclusions Maintaining adherence to ARVs through pregnancy to the postpartum period remains a crucial challenge in Zambia. To maximize the treatment benefits, adherence to ARVs and retention in care should be improved at all health facilities.

IntroductionEvery year, approximately 260,000 children are infected with HIV in low‐ and middle‐income countries. The timely initiation and high level of maintenance of antiretroviral therapy (ART) are crucial to reducing the suffering of HIV‐positive children. We need to develop a better understanding of the background of children's ART non‐adherence because it is not well understood. The purpose of this study is to explore the background related to ART non‐adherence, specifically in relation to the orphan status of children in Kigali, Rwanda.MethodsWe conducted 19 focus group discussions with a total of 121 caregivers of HIV‐positive children in Kigali. The primary data for analysis were verbatim transcripts and socio‐demographic data. A content analysis was performed for qualitative data analysis and interpretation.ResultsThe study found several contextual factors that influenced non‐adherence: among double orphans, there was psychological distance between the caregivers and children, whereas economic burden was the primary issue among paternal orphans. The factors promoting adherence also were unique to each orphan status, such as the positive attitude about disclosing serostatus to the child by double orphans' caregivers, and feelings of guilt about the child's condition among non‐orphaned caregivers.ConclusionsKnowledge of orphan status is essential to elucidate the factors influencing ART adherence among HIV‐positive children. In this qualitative study, we identified the orphan‐related contextual factors that influenced ART adherence. Understanding the social context is important in dealing with the challenges to ART adherence among HIV‐positive children.

BACKGROUND: The United Nations' Millennium Development Goals call for improving maternal and child health status. Their progress, however, has been minimal and uneven across countries. The continuum of care is a key to strengthening maternal, newborn, and child health. In this context, the Japanese government launched the Ghana Ensure Mothers and Babies Regular Access to Care (EMBRACE) Implementation Research Project in collaboration with the Ghanaian government. This study aims to evaluate the implementation process and effects of an intervention to increase the continuum of care for maternal, newborn, and child health status in Ghana. METHODS/DESIGN: We will conduct a cluster randomized controlled trial using an effectiveness-implementation hybrid design in Dodowa, Kintampo, and Navrongo, Ghana. We will provide an intervention package to women living in randomly allocated intervention clusters. The study population is women of reproductive age between the ages of 15 and 49 years. The package includes: 1) use of a new continuum of care card, 2) continuum of care orientation for health workers, 3) 24-hour health facility retention of mothers and newborns after delivery, and 4) postnatal care by home visits. We will measure maternal, newborn, and child health outcomes for both intervention and implementation impacts. The intervention outcomes are continuum of care completion rate, rate of postnatal care within 48 hours, complication rate requiring mothers' and newborns' hospitalizations, and perinatal and neonatal mortality. The implementation outcomes are intervention coverage of the target population, intervention adoption and fidelity, implementation cost, and sustainability. DISCUSSION: In this trial, we will investigate how successful continuum of care can contribute to improving maternal, newborn, and child health outcomes. If successful, this model will then be implemented further in Ghana and other neighboring countries. TRIAL REGISTRATION: Current Controlled Trials ISRCTN90618993 . Registered on 3 September 2014.