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Background Unmet need for breast cancer screening refers to a situation where women within the recommended screening age group who have engaged with healthcare services in the last 12 months but have never undergone a breast examination by a healthcare professional. Gaining insights into the extent of unmet need for breast cancer screening is essential for designing targeted interventions to improve screening uptake and reduce screening inequalities. It is for this reason that the study sought to examine the prevalence and factors associated with unmet need for breast cancer screening among Ghanaian women. Methods Using the 2022 Ghana Demographic and Health Survey, we analyzed data of 3,317 women aged 25–49. Women aged 15–24 years were excluded in line with screening recommendations. Cross-tabulations, bivariable and multivariable logistic regression were performed. Results There was a high unmet need for breast cancer screening among women in Ghana (67.7% [65.2–70.1]). Women who reported using the internet often had a lower likelihood of unmet need compared to those who never used the internet (AOR = 0.80, 95%CI: 0.64–1.00). Also, women aged 45–49 years had lower odds of unmet need than those aged 25–29 years (AOR = 0.59, 95%CI: 0.44–0.78). Compared to those with no formal education, women with secondary education (AOR = 0.56, 95%CI: 0.44–0.73) and higher education (AOR = 0.26, 95%CI: 0.19–0.37, p  < 0.001) had significantly lower odds. Exposure to media was also protective (AOR = 0.76, 95%CI: 0.62–0.93). Women who reported that money for treatment (AOR = 1.25, 95%CI: 1.01–1.55) and distance to a health facility (AOR = 1.25, 95%CI: 1.01–1.55) were big problems had higher odds of unmet need. There was an inverse association between wealth status and unmet need, with poorest women having the highest odds of unmet need for breast cancer screening (AOR = 1.82, 95%CI: 1.29–2.57). Conclusion Unmet need for breast cancer screening is high in Ghana. Improving formal education, alleviating poverty and addressing health accessibility challenges could significantly reduce the high unmet need for breast cancer screening in Ghana.

Globally dementia is a growing public health problem, with over 135,000 people in Nepal living with dementia. Nepal lacks national and community-based data on dementia prevalence. This study aims to determine the dementia risk in Nepal and assess the effects of age, sex, and geographical location on disease prevalence. It also intends to inform policy makers about the burden of dementia, prompting them to plan and prepare appropriate health and social care services for individuals affected by dementia. A cross-sectional survey of 933 older people (aged 60 years and over) was conducted to determine the prevalence of suspected cognitive impairment or dementia risk in three geographical regions of Nepal. The Rowland Universal Dementia Assessment Scale (RUDAS) was used to measure cognitive impairment. The study evaluated the overall prevalence of suspected cognitive impairment or risk of dementia and subgroups by region, age group, and sex. Chi-squared tests and multiple logistic regression analyses were conducted to assess the effects. 53.7% (501) participants had cognitive impairment or risk of dementia, with slightly higher rates in women (56.5%) than men (51.7%). Cognitive impairment prevalence increases with age and region, with hilly and mountainous areas and low-lying regions having a greater geographic effect. There is high risk of dementia in Nepal. The risk is influenced by age and geographical regions, necessitating early diagnosis and tailored interventions for older people and who are residing in higher altitude areas. Policies implemented to address this issue should prioritise community awareness and early screening and diagnosis to reduce complications from dementia. National-level studies and exploration of factors affecting early dementia diagnosis are needed.

Background In resource-poor settings, the provision of basic maternity care within health centres is often a challenge. Despite the difficulties, Nepal reduced its maternal mortality ratio by 80% from 850 to an estimated 170 per 100,000 live births between 1991 and 2011 to achieve Millennium Development Goal Five. One group that has been credited for this is community health workers, known as Female Community Health Volunteers (FCHVs), who form an integral part of the government healthcare system. This qualitative study explores the role of FCHVs in maternal healthcare provision in two regions: the Hill and Terai. Methods Between May 2014 and September 2014, 20 FCHVs, 11 health workers and 26 service users were purposefully selected and interviewed using semi-structured topic guides. In addition, four focus group discussions were held with 19 FCHVs. Data were analysed using thematic analysis. Results All study participants acknowledged the contribution of FCHVs in maternity care. All FCHVs reported that they shared key health messages through regularly held mothers’ group meetings and referred women for health checks. The main difference between the two study regions was the support available to FCHVs from the local health centres. With regular training and access to medical supplies, FCHVs in the hill villages reported activities such as assisting with childbirth, distributing medicines and administering pregnancy tests. They also reported use of innovative approaches to educate mothers. Such activities were not reported in Terai. In both regions, a lack of monetary incentives was reported as a major challenge for already overburdened volunteers followed by a lack of education for FCHVs. Conclusions Our findings suggest that the role of FCHVs varies according to the context in which they work. FCHVs, supported by government health centres with emphasis on the use of local approaches, have the potential to deliver basic maternity care and promote health-seeking behaviour so that serious delays in receiving healthcare can be minimised. However, FCHVs need to be reimbursed and provided with educational training to ensure that they can work effectively. The study underlines the relevance of community health workers in resource-poor settings.

ObjectivesTo examine the prevalence, determinants, safety perceptions, effectiveness and knowledge of herbal medicines (HMs) and reasons for non-hospital utilisation.DesignCross-sectional study.SettingEkiti state, southwest Nigeria.ParticipantsA representative sample (n=1600) of adults (18 years or above) currently living in Ekiti state, southwest Nigeria for at least 2 years, at the time of study.ResultsThe majority of the respondents (85% n=1265) have used HMs in the last 2 years. Across economic classes use, middle income (88.3%) was the highest (p<0.001), suggesting poverty is not a major factor, even with income inequality. Their use was the most common among respondents with a primary level of education (91.4%, p=0.001); and 100% use (p=0.009) of respondents practising African traditional religion; farmers and those 70 years or above. Our study also reveals more men (p<0.001) used HMs (89.9%) than women (78.6%) and effectiveness was a major reason for use (39.6%) followed by affordability (31.9%). Although the majority of the respondents (90%) knew the difference between certified and uncertified HMs, uncertified ones were the most commonly used (37.3%) in the population.ConclusionAlthough there is a cultural history of HM use within the study population, the choice of use was based on their effectiveness. Therefore, a scientifically valid analysis of this claim within the study population may help achieve a cheaper and affordable healthcare alternative which will be safe. This is important, considering that uncertified HMs were chosen over certified ones, even though a large majority of respondents were aware of differences and likely consequences. This study highlights the need for further investment by the government, individuals and corporate stakeholders in HM research and improvement of conventional healthcare system. This is in addition to public health awareness on the danger of use of uncertified herbal products.

The COVID-19 pandemic has exceeded over sixty-five million cases globally. Different approaches are followed to mitigate its impact and reduce its spreading in different countries, but limiting mobility and exposure have been de-facto precautions to reduce transmission. However, a full lockdown cannot be sustained for a prolonged period. An evidence-based, multidisciplinary approach on risk zoning, personal and transmission risk assessment in near real-time, and risk communication would support the optimized decisions to minimize the impact of coronavirus on our lives. This paper presents a framework to assess the individual and regional risk of COVID-19 along with risk communication tools and mechanisms. Relative risk scores on a scale of 100 represent the integrated risk of influential factors. The personal risk model incorporates age, exposure history, symptoms, local risk and existing health condition, whereas regional risk is computed through the actual cases of COVID-19, public health risk factors, socioeconomic condition of the region, and immigration statistics. A web application tool ( http://www.covira.info ) has been developed, where anyone can assess their risk and find the guided information links primarily for Nepal. This study provides regional risk for Nepal, but the framework is scalable across the world. However, personal risk can be assessed immediately from anywhere.

Despite the efforts of community health workers to increase access to healthcare among ethnic minority groups in low- and -middle income countries, members of ethnic minorities are less likely than women from other ethnic groups to use maternal and child healthcare services. However, much less is known about the factors that limit access of ethnic minorities to healthcare services, including the services of community health workers in Nepal, who are known as Female Community Health Volunteers (FCHVs). To address this issue, we conducted a qualitative study to explore perceived barriers to accessing maternal and child healthcare services among ethnic minority groups in two different geographical locations (the hill and Terai regions- flatland bordering south India) with varying degrees of access to local healthcare centres. Between April 2014 and September 2014, semi-structured interviews were conducted with twenty FCHVs, 26 women service users and 11 paid local health workers. In addition, 15 FCHVs participated in four focus group discussions. A thematic analysis of the data identified five major themes underlying barriers to accessing available maternal and child healthcare services by ethnic minority groups such as Dalits, Madhesi, Muslim, Chepang and Tamang. These themes include: a) lack of knowledge among service users; b) lack of trust in volunteers; c) traditional beliefs and healthcare practices; d) low decision-making power of women; and e) perceived indignities experienced when using health centres. We conclude that community health programmes should focus on increasing awareness of healthcare services among ethnic minority groups, and the programmes should involve family members (husband and mothers-in-law) and traditional health practitioners. Both the FCHVs and local healthcare providers should be trained to communicate effectively in order to deliver respectful care among ethnic minorities if we want to achieve universal healthcare coverage for maternal and child health in low- and -middle income countries.

Background Volunteer community health workers (CHWs) are an important link between the public health system and the community. The ‘Community Participation Policy for Health’ in Cambodia identifies CHWs as key to local health promotion and as a critical link between district health centres and the community. However, research on the challenges CHWs face and identifying what is required to optimise their performance is limited in the Cambodian context. This research explores the views of CHWs in rural Cambodia, on the challenges they face when implementing health initiatives. Methods Qualitative methodology was used to capture the experiences of CHWs in Kratie and Mondulkiri provinces. Two participatory focus groups with CHWs in Mondulkiri and ten semi-structured interviews in Kratie were conducted. Results from both studies were used to identify common themes. Participants were CHWs, male and female, from rural Khmer and Muslim communities and linked with seven different district health centres. Results Findings identify that CHWs regularly deliver health promotion to communities. However, systemic, personal and community engagement challenges hinder their ability to function effectively. These include minimal leadership and support from local government, irregular training which focuses on verticalised health programmes, inadequate resources, a lack of professional identity and challenges to achieving behaviour change of community members. In addition, the CHW programme is delivered in a fragmented way that is largely influenced by external aid objectives. When consulted, however, CHWs demonstrate their ability to develop realistic practical solutions to challenges and barriers. Conclusions The fragmented delivery of the CHW programme in Cambodia means that government ownership is minimal. This, coupled with the lack of defined core training programme or adequate resources, prevents CHWs from reaching their potential. CHWs have positive and realistic ideas on how to improve their role and, subsequently, the health of community members. CHWs presented with the opportunity to share learning and develop ideas in a supportive environment would benefit health initiatives.

Background Wasting is a consequence of food insecurity, inappropriate dietary practices, and inadequate caring and feeding practices. The present study assessed association between wasting and household food insecurity among under 5 years old children, along with other socio-demographic characteristics. Methods This study is a secondary analysis of the Nepal Demographic and Health Survey 2016. The survey is cross-sectional in design with use of standardized tools. The sampling frame used is an updated version of the frame from the 2011 National Population and Housing Census. The participants were children under 5 years of age ( n  = 2414). Logistic regression was carried out to identify the odds of being wasted for children belonging to different levels of food insecure households using odds ratio and 95% confidence intervals. Results The prevalence of wasting increased with the level of food insecurity, from mild (9.4%) to moderate (10.8%) and to severe (11.3%). The highest proportions of wasted children were in Province 2 (14.3%), from rural areas (10.1%), born to mothers with no education (12.4%) and from a richer quintile (11.3%). Children belonging to severe food insecure households had 1.36 (95%CI 0.72–2.57) adjusted odds of being wasted and those belonging to mild food insecure and moderately food insecure households had 0.98 (95%CI 0.64-1.49) and 1.13 (95%CI 0.65–1.97) odds of being wasted respectively. Province 1 (AOR 2.06, 95%CI 1.01–4.19) and Province 2 (AOR 2.45, 95%CI 1.22–4.95) were significantly associated with wasting. Conclusion Considering the increment in childhood wasting as per level of food insecurity, an integrated intervention should be developed in Nepal that, 1. addresses improving knowledge and behavior of community people with respect to diet and nutrition; 2. reduce the problem of food insecurity through agricultural interventions.

Mobile health (mHealth) is increasingly being used for managing chronic diseases proving its feasibility, acceptability and effectiveness in improving the health outcomes. However, effectiveness of mHealth intervention for self-management of Type 2 diabetes remains unexplored in the context of Nepal. This study aims to develop and evaluate the effectiveness of a co-designed text based mobile health intervention for self-management of Type 2 diabetes in Nepal. We will conduct a six month, two arm (1:1) parallel group randomised control trial involving 154 adults with Type 2 diabetes. The primary outcome includes change in haemoglobin A1c level at six months follow up. Secondary outcomes include change in self-management outcomes such as self-efficacy, perceived support, diabetes related stress, health related quality of life and self-care activities. Primary and secondary outcomes will be summarized descriptively, and comparisons will be made using chi-square tests for categorical data and independent sample t-tests for continuous data. The trial is registered at ClinicalTrials.gov (NCT06623006).

Background Dementia as a global phenomenon has received significant attention in research due to the adverse effects it has on the daily functioning of its victims. Despite studies conducted in relation to the prevalence and associated factors of dementia in Ghana, not much attention has been paid to the influence of gender. The study, therefore, focused on estimating gender differences in the prevalence and associated factors of dementia in the Ashanti Region of Ghana. Methods This study adopted a cross-sectional design with surveys to recruit 800 participants who were 45 years or older. The data was obtained using the standardized Rowland Universal Dementia Assessment Scale (RUDAS) together with information on the various associated factors. A series of logistic models comprising of the total sample model, male sample model, and female sample model were estimated to analyse the data. All data analyses were completed in Stata version 14. Results The overall prevalence of dementia was 23.38% [95% CI:20.44, 26.31]. More females 24.56% [95% CI:20.81, 28.31] compared to males 21.31% [95% CI:16.57, 26.04] were at risk of dementia. Younger age, attaining formal education, and belonging to richer households were negatively associated with the risk of dementia. In the total sample model, younger age and attaining formal education were negatively associated with dementia risk. In the male-female stratified models, education and household wealth index were negatively associated with dementia risk in the male sample while age and education were negatively related to dementia risk in the female sample. Conclusion The study concludes that there are gendered differences in the prevalence and factors associated with the risk of dementia in Ghana. As such, interventions and programmes to identify dementia cases must be gender sensitive. Specifically, when addressing dementia risk in males, interventions should be directed towards those with lower wealth status. Likewise, when developing programmes to mitigate dementia risk in women, particular attention should be given to women in the oldest age category.