The soaring brain drain in the healthcare sector constitutes a pressing and formidable threat to public health in third-world countries. The increasing interconnectedness of the world has facilitated sharing of ideas and collaborations across borders, benefiting the global population. However, this has also led to the migration of skilled healthcare professionals from low-income countries to more developed nations. This is due to push factors such as the lack of proper healthcare infrastructure, low income, poor working conditions, and limited career opportunities which push healthcare workers to seek better prospects in more developed countries. Pull factors such as better remuneration, working conditions, and career advancement entice them to migrate to these countries. Consequently, the delivery of adequate healthcare services becomes severely compromised, exacerbating existing challenges in achieving public health goals. The impact of this phenomenon extends beyond mere workforce loss. It stifles local education, hinders advancements in medical research, and undermines the overall capacity to combat prevalent health issues. Urgent action is imperative to address this silent crisis. By prioritizing the improvement of domestic healthcare systems, offering competitive incentives for healthcare professionals, and fostering international collaboration, we can effectively mitigate brain drain and strengthen the foundation of public health in third-world countries. This Paper aims to identify the drivers behind brain drain, highlight implications for public health and proffer potential solutions and actionable plans to address this growing concern.

Background: Asthma and wheezing are significant health concerns for children in Africa. There is a dearth of prior research examining the occurrence of asthma and wheezing in both preschool and school-aged children within the African environment. Therefore, this meta-analysis aimed to estimate the prevalence of asthma and wheezing in African infants from zero months to children eight years of age. Methods: An electronic search was conducted in July 2023 in Scopus, Web of Science, PubMed, MEDLINE, CINAHL, and Academic Search Complete for studies published from January 2012 to July 2023 using the following subject-specific terms: 1. “Risk factors” OR “Contributing factors” OR “Predisposing factors” OR “Predictor” OR “Cause” OR “Prevalence” OR “Trends” 2. “Asthma” OR “Wheeze” OR “Wheezing” OR “Asthma symptoms”, 3. “Preschool” OR “early childhood” OR “kindergarten” OR “0 to 8 years” OR “School children”, 4. Africa/ or, 5. limit to (English language and year=“2012 -Current” and children). STATA 17 software and a fixed effects model were utilized. Heterogeneity was assessed using I2. Results: The study revealed a prevalence of asthma in preschool and school-aged children of 4.41%, with no heterogeneity observed ( I2 <0). Wheezing in the past prevalence rate was 22.91%, also without heterogeneity ( I2 <0), with no significant differences observed among the studies. This indicates a lack of heterogeneity in studies for asthma and wheezing prevalence rates. Conclusions: Asthma and wheezing are prevalent among African preschool and school-aged children, highlighting the need for comprehensive and localized research to address this public health issue.

Background: The Patient Voice Program and Citizen Voice and Action models use scorecard meetings for community-provider-government dialogue to improve health services. This study evaluates the responsiveness of leaders and providers to concerns voiced by citizens through these scorecard meetings at the health center and district office levels in Rwanda. Methods: We conducted a cross-sectional study from July to September 2022 in 325 Rwandan health centers across 20 districts. Responsiveness was measured by comparing resolved issues to raised issues. Logistic regression identified predictors of issue resolution, with a p-value less than 0.05 considered significant. Median responsiveness turnaround time was also analyzed. Results: In total, 59.4% (1,163) of the identified gaps were resolved. Facility-level issues experienced a higher resolution rate (65.9%) than district-level issues (35.4%). Gaps at the facility level were 3.24 times more likely to be resolved than those at the district level (OR: 3.24, p<0.001, 95% CI: [2.48,4.25]). Integrated gaps had 1.46 times higher odds of resolution compared to issues stemming from reproductive, maternal, newborn, and child health services (OR: 1.46, p<0.05, 95% CI: [1.13,1.88]). The median responsiveness turnaround time for resolving a gap was approximately 15.4 months (IQR: 6.7-25.8). Conclusions: The study shows that Patient Voice Program and Citizen Voice and Action models are effective in addressing healthcare service gaps. By promoting collaboration among communities, healthcare providers, and governments, these models facilitate targeted, locally-supported solutions that significantly improve the resolution of health service delivery issues.

This study examined how time and handwashing impact the inferential process related to infectious disease transmission among adults and preschoolers. Thirty-eight Japanese adults aged 18–23 years (8 men; 30 women) and 36 Japanese children aged 5–6 years (15 boys; 21 girls) reported their certainty regarding protagonists’ subsequent infection and whether handwashing affects infection risk across three scenarios (same-time, immediately-after, and next-day). Both age groups perceived a significantly higher likelihood of infection in the same-time condition than in the other conditions. Preschoolers estimated a lower likelihood of infection than adults (η p 2 = .25). Thus, preschoolers inferred infectious disease transmission more optimistically than adults. Amidst infectious disease outbreaks, adults must provide guidance regarding preventive measures, while being mindful of preschooler’s propensity to optimistically speculate about contagion.

Deeply rooted in its developmental philosophy of gross national happiness (GNH), Bhutan’s healthcare system strives towards achieving a shared goal of universal health coverage (UHC). Despite being primarily financed by the government, the healthcare system faces a plethora of challenges. To overcome these hurdles and achieve UHC goals, expanding the fiscal space for health and improving operational efficiency is crucial. This policy brief aims to address Bhutan’s evolving healthcare landscape and advance the achievement of UHC through two policy options. The first policy option focuses on dual objective of improving health outcomes and promoting financial sustainability by leveraging heath taxes, while the second option emphasises reinforcing a systematic Health Technology Assessment (HTA) in the healthcare system. First, to promote financial sustainability, the proposal suggests introducing earmarked taxes on alcohol and tobacco products for the health sector. Global evidence suggests that earmarked taxes are a reliable source of revenue for health, and Bhutan’s high prevalence of tobacco and alcohol consumers assures a reliable revenue base. The Goods and Services Tax (GST) will be implemented in 2024, and it will be a good opportunity for the Ministry of Health to advocate and negotiate with Ministry of Finance (MoF) for the earmarked taxes to the health sector. Second, integration of HTA into policymaking and decision-making processes is essential for effective resource allocation in UHC. Nurturing and strengthening the existing HTA structure under MoH and establishing a dedicated multidisciplinary HTA Committee will ensure informed decision-making and resource optimization. HTA evidence should abided to revise health service standards, develop clinical guidelines, make procurement decisions, and set healthcare priorities. These policy options can assist the country in improving ensure financial sustainability, enhance effective resource allocation and utilisation, and improve healthcare delivery, aligning with its vision of GNH and ultimately accelerating progress towards achieving UHC.

Background: Research indicates a relationship between nutrition, physiological characteristics, and mental health. It was already reported that Israeli-Arab adolescents consume more fast food, sweets, and candies than Jews. Higher energy drink consumption by Israeli-Arab adolescents emerged. Though, data on the topic still needs to be updated. The current study examined possible associations between energy drink consumption, anxiety, and well-being in Israeli-Arab adolescents. We also investigated these associations concerning fast food consumption, physical activity, and sleep hours. Methods: One hundred and fourteen adolescents (59 females) aged 12–18 from several cities & villages in northern Israel were recruited to study. A cross-sectional exploratory study assessed adolescents’ energy drink consumption, nutritional and lifestyle habits, well-being, and anxiety using self-reported questionnaires. Anthropometric measurements - weight, height, and waist circumference were also assessed. Results: Gender and energy drink consumption were associated with psychological status. Energy drink consumers reported a lower well-being index and a higher anxiety index than non-consumers. Energy drink consumers ate significantly more fast food per week than non-consumers. In addition, sleep hours were correlated with anxiety levels. These results differed between genders. Conclusions: Our study shows complex associations between energy drink consumption and mental health indices. These associations can serve as a basis for further research into this topic.

Introduction: Disrespect and abuse during childbirth represents a pervasive issue worldwide. In Rwanda, however, research in this area remains scarce. This study evaluated the factors linked to disrespect and abuse during labor and delivery in two Rwandan district hospitals. Methods: Employing a mixed method, cross-sectional design, we studied 280 women giving birth at Kabutare and Kibagabaga hospitals. Analysis was conducted with SPSS version 22, using the Chi-square test to identify factors correlated with childbirth-related disrespect and abuse. Results: Our findings revealed that 27% of women reported verbal abuse and 27.5% reported abandonment by healthcare providers, with 12% experiencing physical abuse during childbirth. Factors increasing the likelihood of experiencing disrespect and abuse included residing in rural areas [AOR=4.06, 95% CI (1.12, 14.7); p=0.03], having only primary education [AOR=2.9, 95% CI: 1.10-8.9, p=0.04], and night-time delivery [AOR=2.23, 95% CI (1.34, 3.03); p=0.03]. However, having a cesarean delivery [AOR=0.23, 95% CI: 0.09-0.59, p=0.002] or having attended antenatal care [AOR=0.28, 95% CI: 0.13-0.81, p=0.029] significantly reduced the risk of such experiences. Conclusion: The study uncovers a high incidence of disrespect and abuse during labor and delivery in Rwanda. The identified risk factors, namely rural residence, lower education, and night-time delivery, highlight specific areas requiring targeted intervention. The results advocate for effective measures to ensure dignified and equitable maternity care for all women.

Background: The feeding practices of the mothers, particularly responsive feeding, are critical determinants of acceptance of food, dietary intake as well as the growth of infants and young children (IYC). Responsive feeding refers to the interactions between mother and child that lead to a positive feeding experience, adequate dietary intake and enhanced developmental opportunities. Little is known about mothers responsive feeding practices in Rwanda. Therefore, this study sought to explore mothers’ responsive feeding practices as well as the factors that hinder the implementation of recommended practices among mothers from rural Muhanga District. Method: This qualitative, longitudinal study, recruited a purposive sample of 29 pregnant women attending prenatal consultations in two rural health centers. They were interviewed and mother-child interactions during mealtime were further observed during one lunch meal feeding episode at 6, 9 and 12 months postpartum. The interviews were recorded, transcribed and thematically analyzed using qualitative software, Atlas.ti. Frequency distribution was generated for each practice observed. Results: At 6 months, most mothers reported to verbally encourage their children to eat during feeding and the numbers increased over the age at 9 and 12 months respectively. Less than a half, at all 3 time points, reported to allow their child to self-feed, to smile and talking during feeding. During the observation, the practices were even less than the reported at all 3 time points of the observations. The burden of other responsibilities and poverty were perceived as the major barriers that made mother child- interactions during feeding difficult. Conclusion: Findings indicate that what mothers report may not always reflect the responsive feeding practices performed during feeding . Nutrition interventions in the study community should consider promoting responsive feeding practices as well as addressing the issue of poverty and the burden of other responsibilities that hinder mother-child interactions.

This study is novel in that it quantitatively exams the impact of human brucellosis, an endemic zoonotic disease in Malta from 1919 until 1954, and the impact on reproductive loss through stillbirths. Based on regression analysis, brucellosis had a statistically significant effect (t = 2.8986, p = 0.0039) on stillbirth rate for males, but the effect of brucellosis on stillbirths is not statistically significant for females (p = 0.9103). This paper points to the importance of brucellosis, one of the most common zoonotic diseases, as having implications for health burden in women and fetuses in the contemporary context; this relationship has been largely ignored in the literature.

Introduction: Despite a reported understanding of basic radiation physics principles, students face barriers that hinder effective translation of this knowledge into clinical practice, potentially leading to suboptimal outcomes.The objectives of this cross-sectional descriptive research are to assess the level of radiation physics knowledge among clinical radiography students, evaluate their ability to apply this knowledge in clinical settings, identify barriers hindering successful application, and provide recommendations for improved integration. Material and method: The study was conducted among clinical students (4 th year and 5 th year) of the department of radiography and radiological sciences, University of Nigeria, Enugu campus, Enugu state. The study design was a cross-sectional descriptive study which enables to collect data at a specific point in time. The study population comprised of students who are currently in 4 th and 5 th year in the department of medical radiography and radiological sciences. The population has a total number of 500 students. All clinical radiography students who are willing to participate in this research were included in this research Results: Among 220 participants from the University of Nigeria’s Department of Radiography and Radiological Sciences, 81.4% expressed thorough teaching of radiation physics during pre-clinical training, while 68.3% reported an excellent understanding. However, 64.3% cited disinterest due to perceived complexity, 42.0% noted a gap between theoretical teaching and practical application, and 84.6% mentioned a lack of fear of radiation’s biological effects. Suggestions for improvement included a dedicated curriculum (90.0%), increased teaching duration (69.7%), expert involvement (95.10%), hands-on training (95.5%), interactive learning methods (93.2%), and collaborative training approaches (95.0%). Conclusion: This research underscores the importance of refining radiation physics education to bridge theory and practice effectively.

This study analyzes how national intersectoral public policy experiences have been adopted and implemented using a Health in All Policies (HiAP) approach in the past two decades. It seeks to provide evidence on enabling factors that triggered three effective intersectoral public policies to improve population health in Mexico by improving nutritional, educational, and healthcare access conditions, reducing road traffic injuries, and addressing obesogenic feeding practices. We followed a qualitative approach to analyze the three intersectoral public policies selected as case studies. First, we designed an analytical framework to assess how intersectoral public policies are adopted, implemented, and sustained. The proposed framework is based on peer-reviewed articles and grey public policy literature. Second, we used information from eleven semi-structured interviews to key stakeholders conducted in previous research to identify more specific enablers and barriers of the three intersectoral policies selected according to predefined analytical categories used in the questionnaire. The analysis showed three overall key findings. First, sound empirical evidence is essential for adopting a HiAP approach. Second effective intersectoral mechanisms enhance implementation feasibility. Third, results-based monitoring and evaluation contribute to the continuity of the analyzed intersectoral public policies. Finally, political support is needed throughout the policy process to maintain governance capacity and deliver results. Finally, we drew five global policy lessons that may be applicable in similar public policy settings in other countries. First, both technical and political enablers help set the intersectoral agenda. Second, effective communication is instrumental in convincing all stakeholders to address public health-related policy issues. Third, political support at the highest level possible and the federal government’s capacity are essential to implement sound policies. Fourth, several enablers exist for enhancing collaboration between ministries during implementation. Finally, monitoring and evaluation results are necessary for sustaining intersectoral policies beyond administrations.

Background: As adolescent suicide rates have increased, there has been a nationwide focus on legislation requiring school districts to create suicide prevention policies. There is a lack of tools to make a quantitative assessment of the quality and breadth of school-district suicide prevention policies. Thus, we developed a proof-of-concept instrument, the School District Suicide Policy Evaluation Tool (SDSPET). Methods: The SDSPET is derived from the “Model School District Policy on Suicide Prevention,” a document compiled by four nationally recognized suicide organizations. As a preliminary validation of the SDSPET, four independent raters used the SDSPET in a systematic analysis of suicide prevention policies for all school districts in Utah. Results: Inter-rater reliability was calculated to be 98.8% with intraclass correlation analysis. Analysis revealed a right-skewed distribution of policy scores, and a median total score was 2.25 out of 36 possible criteria. Conclusion: This proof-of-concept study demonstrates the utility of the SDSPET in quantifying the shortcomings of school-district policies on suicide while generating specific recommendations for improvement. With further validity testing, we expect this tool to be beneficial to school district administrators, education policymakers, and those studying suicide interventions and outcomes in school-aged children and adolescents.

Background: Labor companionship has been demonstrated to enhance the childbirth experience and contribute to better maternal and neonatal outcomes. Despite this evidence, the practice remains underexplored in Rwanda. The present study aimed to investigate the perspectives and experiences of both women and healthcare providers concerning labor companionship in selected hospitals across Rwanda. Methods: We conducted a mixed-method study surveying 393 postpartum mothers within 48 hours of delivery and interviewing 23 healthcare providers and 16 mothers. Data were analyzed using frequencies, percentages, Chi-square tests, and logistic regression. Results: 95% (n=373) of mothers brought a chosen companion to the health facility, but only 11.2% (n=42) were allowed their companion’s presence during childbirth. About 47% who had companions present had reservations, mainly due to embarrassment (47%), gossip fears (14%), and privacy issues (40%). Mother’s age, education, economic status, and pregnancy planning status influenced companion presence. Barriers to labor companionship occurred at individual, provider, and institutional levels. Conclusion: This study underscores labor companionship’s role in boosting maternal-neonatal health in Rwanda, though implementation remains limited due to location, education, and socio-economic disparities. It advocates for policies and guidelines facilitating companionship during labor and delivery and emphasizes the need for healthcare provider training to enhance its application.

Introduction:Pressure ulcer disease (PUs) is a common geriatric complication that impacts national public policy and brings a huge social burden. Objective: To analyze the long-term trends in PUs prevalence among Chinese elders aged 60-94 from 1990 to 2019 to inform targeted public policies. Methods:The age-standardized prevalence rates (ASPRs) and crude rates per 100,000 population of PUs were reported in China from 1990 to 2019 from the Institute for Health Metrics and Evaluation using the Global Health Data Exchange (GHDx) online query tool.The ASPRs of elderly PUs were calculated and stratified by sex and age. Individuals aged 60-94 were divided into a group according to 5 years. The Joinpoint regression model was used to evaluate the trend of PUs elder prevalence across the time.The annual percentage rate change(APC),average annual percentage change(AAPC) and 95% confidence intervals (95%CIs) for the EAPCs were calculated to explore the characteristics of the PUs elders prevalence in China. Results: Results showed an upward trend in ASPRs for PUs in both sexes, with higher rates in males.Join-point regression analyses also confirmed a significant upward trend in ASPRs for both sexes among elders, with a more pronounced increase in males.The prevalence of PUs has decreased among 60-69 years old elders but increased after 70 years old. Conclusion:The disease burden of PUs has increased in China from 1990 to 2019, with higher rates in men. The prevalence of PUs in elders showed an overall upward trend but varies at different age stages.Different management and treatment strategies should be developed for the elderly at different age stages and gender.Collaborative efforts involving the government, society, and medical institutions are needed to address the prevention and management of pressure ulcers in China.

Introduction: Against the challenging socio-political backdrop of the country, this research examines the periodontal health of pregnant women in Sri Lanka. Methods: This analytical cross-sectional study was conducted among 576 pregnant women, attending community Antenatal Clinics in a selected Medical Officer of Health area, in Sri Lanka. A two-stage cluster sampling method with a probability proportionate to size technique was used to select the clinics. Systematic sampling was used to recruit pregnant women from each clinic. An interviewer-administered questionnaire and oral health examination form were used for data collection. Results: Over 60% exhibited poor oral hygiene. Moderate to severe gingivitis was seen among 23.3%. Approximately 67% of participants demonstrated poor knowledge about periodontal diseases. About 67% of the study participants were unemployed and 32.47% had a monthly income of less than 40,000 rupees. Regression analysis identified the trimester of pregnancy, socioeconomic indicators, frequency of dental visits, recent full mouth scaling, and knowledge about periodontal diseases as significant predictors of oral hygiene status. Age, trimester, brushing frequency, recent full mouth scaling, and knowledge about periodontal diseases predicted the gingival status. Participants with a lower socioeconomic status demonstrated poorer oral hygiene and gingival health. Conclusion: There was suboptimal oral hygiene and gingival health coupled with limited access to dental care and inadequate knowledge about periodontal health that demands urgent interventions. The high prevalence of unemployment combined with the association between low socioeconomic indicators and poor periodontal health outcomes, underscores the importance of empowering young women through education and employment.