Search results for: community-based mental health

Authors: Yuhong Niu, Na Li, Chunlin Jin, Hansheng Ding

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The study reviewed all types of patents applied by Shanghai health system to analyze how patent development in China from the year of 1990 to 2012. The study used quantitative and comparative analysis to investigate the change and trends of patent numbers, patent types, patent claims, forward citations, patent life, patent transactions, etc. Results reflected an obviously increased numbers of invention patents, applications, and authorizations and short-life patents, but the ratio of invention patents represented an up and down change. Forward citations and transactions ratio always kept at a low level. The results meant that the protection of intellectual property in the Shanghai health sector had made great progress and lots of positive changes due to incentive policies by local government. However, the low-quality patents, at the same time, increased rapidly. Thus, in the future, it is suggested that the quality management should be strengthened, and invents should be estimated before patent application. It is also suggested that the incentives for intellectual property should be optimized to promote the comprehensive improvement of patent quantity and quality.

Keywords: patent claims, forward citations, patent life, patent transactions ratio

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Authors: Tanya Kaur Bedi, Shankha Pratim Bhattacharya

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The US Environmental Protection Agency defines indoor air quality as “The air quality within and around buildings, especially as it relates to the health and comfort of building occupants”. According to the 2021 report by the Energy Policy Institute at Chicago, Indian residents, a country which is home to the highest levels of air pollution in the world, lose about 5.9 years from life expectancy due to poor air quality and yet has numerous dwellings dependent on natural ventilation. Currently the urban population spends 90% of the time indoors, this scenario raises a concern for occupant health and well-being. The built environment can affect health directly and indirectly through immediate or long-term exposure to indoor air pollutants. Health effects associated with indoor air pollutants include eye/nose/throat irritation, respiratory diseases, heart disease, and even cancer. This study attempts to demonstrate the causal relationship between the indoor air quality and its determining aspects. Detailed indoor air quality audits were conducted in residential buildings located in Kolkata, India in the months of December and January 2021. According to the air pollution knowledge assessment city program in India, Kolkata is also the second most polluted mega-city after Delhi. Although the air pollution levels are alarming year-long, the winter months are most crucial due to the unfavorable environmental conditions. While emissions remain typically constant throughout the year, cold air is denser and moves slower than warm air, trapping the pollution in place for much longer and consequently is breathed in at a higher rate than the summers. The air pollution monitoring period was selected considering environmental factors and major pollution contributors like traffic and road dust. This study focuses on the relationship between the built environment and the spatial-temporal distribution of air pollutants in and around it. The measured parameters include, temperature, relative humidity, air velocity, particulate matter, volatile organic compounds, formaldehyde, and benzene. A total of 56 rooms were audited, selectively targeting the most dominant middle-income group. The data-collection was conducted using a set of instruments positioned in the human breathing-zone. The study assesses indoor air quality based on factors determining natural ventilation and air pollution dispersion such as surrounding environment, dominant wind, openable window to floor area ratio, windward or leeward side openings, and natural ventilation type in the room: single side or cross-ventilation, floor height, residents cleaning habits, etc.

Keywords: indoor air quality, occupant health, urban housing, air pollution, natural ventilation, architecture, urban issues

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Authors: Xing Ping Hu, Yuexun Tian, Jerome Hogsette

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Housefly, Musca domestica L., is a serious urban nuisance and public health/food safety concern. This study evaluated the topical toxicity of 17 essential oil components and 3 plant essential oils against permethrin-resistant adult females and insecticide-susceptible house fly strains. Results show that thymol had the lowest LD₅₀ values against permethrin-resistant strain (43.77 and 41.10 ug per fly) and permethrin-susceptible strain (35.19 and 29.16 ug per fly) at both 24- and 48-hours post treatments; (+)-Pulegone had the lowest LD₉₅ values against the permethrin-resistant strain (0.15 and 0.10 mg per fly) at 24- and 48-hours post treatments, whereas plant thyme oil had the lowest LD₉₅ value of 0.17 mg per fly at post-24h and post-48h against the permethrin-susceptible strain. Additionally, the LD₅₀s was slightly but not significantly negatively correlated with the boiling points of the compounds tested; but showed no correlation with the density and LogP. These results indicate that specific essential oils and compounds have topical insecticidal properties against house flies with low dose. They may have the potential for development as botanical insecticides.

Keywords: urban pest, public health, pest management, botanical chemical

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Authors: Sadaf H. Khan, Jyoti Kumar

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Sick Building Syndrome (SBS) is a situation in which inhabitants of a building develop illness symptoms or get infected with a chronic disease as a result of the building in which they reside or work. Certain symptoms tend to get more severe as an individual spends more time in the building; however, they generally improve with time or even disappear when they leave that space. Though ‘Design of Built-Spaces’ is a crucial factor in regulating these symptoms but it still needs to be identified further as to what specific design features of a ‘Built-Space’ trigger sick building syndrome (SBS). Much of the research work present to date is focused on the physiological or physical sickness caused due to inappropriate built-space design. In this paper, the psychological aspects of sick building syndrome (SBS) will be investigated across the adult population, more specifically graduate students in India trying to settle in back to their previous physical work environments, i.e., campus, classrooms, hostels, after a very long hold which lasted more than a year due to lockdowns during Covid-19 crisis all over the world. The study will follow an analytical approach and the data will be collected through self-reported online surveys. The purpose of this study is to enquire causal agents, diagnosable symptoms and remedial design of built spaces which can enhance the productive level of built environments and better facilitate the inhabitants by improving their psychological wellbeing, which is the most uprising concern. The fact that SBS symptoms can be studied only within the initial few weeks as an occupant starts interacting with a built-environment and leaves as the occupant leaves that space or zone, the post-lockdown incoming of students back to their respective campuses provides an opportunity to clearly draw multiple conclusions of the relationship that exist between the Design of Built-Spaces and Psychological Sickness Syndrome associated with it. The study will be one of a kind approach for understanding and formulating methods to improve psychological wellbeing within a built-setting by better identifying factors associated with these psychological symptoms, including anxiety, mental fatigue, reduced attention span and reduced memory span as refined symptoms of SBS discussed in 1987 by Molhave within his study.

Keywords: built-environment psychology, built-space design, healthcare architecture, psychological wellbeing

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Authors: Digdem M. Siyez, Bariscan Ozturk, Erol Esen, Ender Siyez, Yelda Kagnici, Bahar Baran

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Infertility is a reproductive disease identified with the absence of pregnancy after regular unprotected sexual intercourse that has been lasting for 12 months or more. Some of the factors that cause infertility, which has been considered as a social and societal issue since the first days of the humankind, are preventable. These are veneral diseases, age, the frequency of the intercourse and its timing, drug use, bodyweight, environmental and professional conditions. Having actual information about the reproductive health is essential to take protective and preventive measures, and it is accepted as the most effective way to reduce the rate of infertility. However, during the literature review, it has been observed that there are so few studies that focus on the prevention of the infertility. The aim of this study is to develop a psycho-education program to reduce infertility among university students and also to evaluate the program’s effectiveness. It is believed that this program will increase the information level about infertility among the university students, help them to adopt healthy attitudes, develop life skills, create awareness about the risk factors and also contribute to the literature. Throughout the study, first, the contents of sexual/reproductive health programs developed for university students were examined by the researches. Besides, “Views about Reproductive Health Psycho-education Program Survey” was developed and applied to 10221 university students from 21 universities. In accordance with the literature and the university students’ views about reproductive health psycho-education program consisting of 9 sessions each of which lasts for 90 minutes was developed. The pilot program was carried out with 16 volunteer undergraduate students attending to a state university. During the evaluation of the pilot study, at the end of each session “Session Evaluation Form” and at the end of the entire program “Program Evaluation Form” were administered to the participants. Besides, one week after the end of the program, a focus group with half of the group, and individual interviews with the rest were conducted. Based on the evaluations, it was determined that the session duration is enough, the teaching methods meet the expectation, the techniques applied are appropriate and clear, and the materials are adequate. Also, an extra session was added to psycho-education program based on the feedbacks of the participants. In order to evaluate program’s effectiveness, Solomon control group design will be used. According to this design, the research has 2 experiment groups and 2 control groups. The participants who voluntarily participated in the research after the announcement of the psycho-education program were divided into experiment and control groups. In the experiment 1 and control 1 groups, “Personal Information Test”, “Infertility Information Test” and “Infertility Attitude Scale”, “Self Identification Inventory” and “Melbourne Decision Scale” were administered as a preliminary test. Currently, at the present stage, psycho-education still continues. After this 10-week program, the same tests will be administered again as the post-tests. The decision upon which statistical method will be applied in the analysis will be made afterwards according to whether the data meets the presuppositions or not.

Keywords: infertility, prevention, psycho-education, reproductive health

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Authors: Chinwe Okpoko, Vivian Atasie

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One of the leading causes of death amongst women of child-bearing age in southeast Nigeria is pregnancy. Women in the reproductive age group die at a higher rate than men of the same age bracket. Furthermore, most maternal deaths occur among poor women who live in rural communities, and who generally fall within the low socio-economic group in society. Failure of policy makers and the media to create the strategic awareness and communication that conform with the sensibilities of this group account, in part, for the persistence of this malaise. Family planning (FP) is an essential component of safe motherhood, which is designed to ensure that women receive high-quality care to achieve an optimum level of health of mother and infant. The aim is to control the number of children a woman can give birth to and prevent maternal and child mortality and morbidity. This is what sustainable development goal (SDG) health target of World Health Organization (WHO) also strives to achieve. FP programmes reduce exposure to the risks of child-bearing. Indeed, most maternal deaths in the developing world can be prevented by fully investing simultaneously in FP and maternal and new-born care. Given the intrinsic value of communication in health care delivery, it is vital to adopt the most efficacious means of awareness creation and communication amongst rural women in FP. In a country where over 50% of her population resides in rural areas with attendant low-level profile standard of living, the need to communicate health information like FP through indigenous channels becomes pertinent. Interpersonal communication amongst family, friends, religious groups and other associations, is an efficacious means of communicating social issues in rural Africa. Communication in informal settings identifies with the values and social context of the recipients. This study therefore sought to determine the place of interpersonal communication on the knowledge of rural women on FP and how it influences uptake of FP. Descriptive survey design was used in the study, with interviewer administered questionnaire constituting the instrument for data collection. The questionnaire was administered on 385 women from rural communities in southeast Nigeria. The results show that majority (58.5%) of the respondents agreed that interpersonal communication helps women understand how to plan their family size. Many rural women (82%) prefer the short term natural method to the more effective modern contraceptive methods (38.1%). Husbands’ approval of FP, as indicated in the Mean response of 2.56, is a major factor that accounts for the adoption of FP messages among rural women. Socio-demographic data also reveal that educational attainment and/or exposure influenced women’s acceptance or otherwise of FP messages. The study, therefore, recommends amongst others, the targeting of husbands in subsequent FP communication interventions, since they play major role on contraceptive usage.

Keywords: family planning, interpersonal communication, interpersonal interaction, traditional communication

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Authors: Greg Zimmerman

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Background: Major depression is a common illness that affects millions of people globally. It is the leading cause of disability and is projected to become the number one cause of the global burden of disease by 2030. Many of those who suffer from depression also suffer from Irritable Bowel Syndrome (IBS). Acupuncture has been shown to help depression. The aim of this study was to investigate the effectiveness of acupuncture in reducing the risk of IBS in patients with depression. Methods: We enrolled patients diagnosed with depression through the Taiwanese National Health Insurance Research Database (NHIRD). Propensity score matching was used to match equal numbers (n=32971) of the acupuncture cohort and no-acupuncture cohort based on characteristics including sex, age, baseline comorbidity, and medication. The Cox regression model was used to compare the hazard ratios (HRs) of IBS in the two cohorts. Results: The basic characteristics of the two groups were similar. The cumulative incidence of IBS was significantly lower in the acupuncture cohort than in the no-acupuncture cohort (Log-rank test, p<0.001). Conclusion: The results provided real-world evidence that acupuncture may have a beneficial effect on IBS risk reduction in patients with depression.

Keywords: acupuncture, depression, irritable bowel syndrome, national health insurance research database, real-world evidence

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Authors: Witri Pratiwi, Shopa Nur Fauzah, Dini Norviatin

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WHO recommends breastfeeding exclusively for infants aged 0 to 6 months because breast milk is the best nutrition. There are several factors associated with the success of exclusive breastfeeding. This study aims to determine the factors associated with the success of exclusive breastfeeding. A cross-sectional study was conducted at 6 community health centers in Cirebon City, Indonesia. Primary data were obtained from a validated questionnaire given to mothers who have children aged 6 to 24 months. A total of 326 mothers participated in this study. Two hundred and eighteen (66.9%) mothers gave exclusive breastfeeding to their babies, and 108 (33.1%) did not give exclusive breastfeeding. The baby gender (p=0.240), birth weight (p=0.436), and place of birth (0.137) were not related to exclusive breastfeeding. Mode of delivery (p=0.029) and early initiation of breastfeeding (p=0.001) were significantly associated with exclusive breastfeeding. Infants with early initiation of breastfeeding are three times more likely to get exclusive breastfeeding compared to those who do not get breastfeeding early (p=0.001; OR=3.696 [95% CI 1.764 – 7.746]). Early initiation of breastfeeding is the most important factor in determining the success of exclusive breastfeeding. Promotion and education on the importance of early breastfeeding initiation to prospective mothers, families, and health workers are expected to be improved.

Keywords: early initiation of breastfeeding, exclusive breastfeeding, mode of delivery, Indonesia

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Authors: Lawong Damian Bernsah

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Neglected Tropical Diseases (NTDs) are most predominant among the poor and rural populations and are endemic in 149 countries. These diseases are the most prevalent and responsible for infecting 1.4 billion people worldwide. There are 17 neglected tropical diseases recognized by WHO that constitute the fourth largest disease health and economic burden of all communicable diseases. Five of these 17 diseases are considered for the cost analysis of this paper: lymphatic filariasis, onchocerciasis, trachoma, schistosomiasis, and soil transmitted helminth infections. WHO has proposed a roadmap for eradication and elimination by 2020 and treatments have been donated through the London Declaration by pharmaceutical manufacturers. The paper estimates the cost of NTD control programme and elimination for each NTD disease and total in Nigeria. This is necessary as it forms the bases upon which programme budget and expenditure could be based. Again, given the opportunity cost the resources for NTD face it is necessary to estimate the cost so as to provide bases for comparison. Cost of NTDs control and elimination programme is estimated using the population at risk for each NTD diseases and for the total. The population at risk is gotten from the national master plan for the 2015 - 2020, while the cost per person was gotten for similar studies conducted in similar settings and ranges from US$0.1 to US$0.5 for Mass Administration of Medicine (MAM) and between US$1 to US$1.5 for each NTD disease. The combined cost for all the NTDs was estimated to be US$634.88 million for the period 2015-2020 and US$1.9 billion for each NTD disease for the same period. For the purpose of sensitivity analysis and for robustness of the analysis the cost per person was varied and all were still high. Given that health expenditure for Nigeria (% of GDP) averages 3.5% for the period 1995-2014, it is very clear that efforts have to be made to improve allocation to the health sector in general which is hoped could trickle to NTDs control and elimination. Thus, the government and the donor partners would need to step-up budgetary allocation and also to be aware of the costs of NTD control and elimination programme since they have alternative uses. Key Words: Neglected Tropical Disease, Cost Analysis, NTD Programme Control and Elimination, Cost per Person

Keywords: Neglected Tropical Disease, Cost Analysis, Neglected Tropical Disease Programme Control and Elimination, Cost per Person

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Authors: Rosa L. Figueroa, Joselyn A. Hernández

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During the last couple of years, the Ministry of Health have been developing new health policies in order to regulate and improve in benefit of the patient the pharmaceutical system in our country. However, there are still some deficiencies in how medicines have been accessed, distributed, and sold. Therefore, it is necessary to empower the patient by offering new instances to improve access to drug information. This work introduces ‘the bioequivalent’ a medical drug search tool created to increase both diffusion and getting information about the therapeutic equivalence of medicines for the patient. The development of the search tool started with a study on the availability of sources of drug information accessible to the patient where advantages and disadvantages were analyzed. The information obtained was used to feed the functional design of the new tool. The design of the new tool shows an external interface that includes a header, body, sidebar and footer. The header has a menu containing ‘Home,’ ‘Who we are,’ and ‘Mission and vision.’ The Body contains the medical drug search tool, and the Sidebar is for the user logging in. It could be anonym, registered user, as well as, administrator. Anonym user could only use the tool. Registered users could add some information on existing medicines in the database; however, adding information will be restricted and limited to specific items and subject to administrator approval because the information added must be endorsed by the Chilean Public Health Institute. On the other hand, the administrator will have all the privileges, including creating or deleting drugs or information about them. The Bioequivalent was tested on different mobile devices, and no fails have been found. Moreover, a small survey was answered by ten people who tested the tool, and all of them agree that the tool was useful to get information about bioequivalent drugs, and they would recommend the tool to others. Nevertheless, an 80% of people who tested the tool says it was easy to use, and a 70% indicates that additional help is not required. These results are evidence that ‘the Bioequivalent’ may contribute to the knowledge about the therapeutic bioequivalence and bioequivalent drugs existing in Chile. As future work, the tool will be developed to make it available to the public for a first testing stage in a more massive scenario.

Keywords: collaborative database, bioequivalent drugs, search tool, web platform

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Authors: Farzaneh Askari, Jila Ganji, Sedigheh Hasani Moghadam

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Background and Aim: Endometriosis has been reported as one of the most common chronic gynecological conditions characterized by physical and psychological complications. Given that the impact of this disease on marital relationships and quality of life is multidimensional, the present review study aimed to reflect on the effect of psychosomatic aspects of endometriosis on marital relationships and quality of life. Materials and Methods: A narrative review methodology using keywords determined by the Medical Subject Headings (MeSH) thesaurus was adopted in this study. For this purpose, the databases of ScienceDirect, Scientific Information Database (SID), Google Scholar, and PubMed were searched by means of key terms including endometriosis, marital relationships, physical complications, psychological complications, and quality of life in English and Persian from 2005 to 2020. At the end of the search, 38 articles were retrieved, and ultimately a total number of 16 studies were recruited for this review. Results: A review of the selected articles demonstrated that endometriosis could affect marital relationships and quality of life among couples featuring in three different categories, i.e. “category I: physical health dimension” (chronic pelvic pain, dysmenorrhea, cramps but not period, reduction and loss of fertility), “category II: sexual health dimension” (no sexual intercourse, dyspareunia, lack of sexual satisfaction), and “category III: psychosocial health dimension” (negative self-esteem, low energy, sense of loneliness, depression, social isolation, insufficient sleep, marital distress, divorce and marriage breakdown, inability to work and socialize). Conclusion: In general, it is suggested to pay particular attention to psychosomatic aspects of marital problems in patients affected with endometriosis. Accordingly, implementing educational and counseling strategies to minimize the complications of this disease can provide the grounds for improving marital relationships and maintaining the quality of life in these patients.

Keywords: Endometriosis, marital relationships, psychosomatic complications, quality of life

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Authors: Charisse H. Tay

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Background: Schizophrenia is a severe chronic mental disorder that can result in hallucinations, delusions, reduced social engagement, and lack of motivation. While antipsychotic medications often provide the basis for treatment, psychosocial strategies complement the benefit of medications and can result in meaningful improvements in symptoms and functioning. The aim of the study was to investigate psychosocial strategies used by internet self-help forum participants to effectively manage symptoms caused by schizophrenia. Internet self-help forums are a resource for medical and psychological problems and are commonly used to share information about experiences with symptom management. Method: Three international self-help internet forums on schizophrenia were identified using a search engine. 1,181 threads regarding non-pharmacological, psychosocial self-management of schizophrenia symptoms underwent screening, resulting in the final identification and coding of 91 threads and 191 posts from 134 unique forum users that contained details on psychosocial strategies endorsed personally by users that allowed them to effectively manage symptoms of schizophrenia, including positive symptoms (e.g., auditory/visual/tactile hallucinations, delusions, paranoia), negative symptoms (e.g.., avolition, apathy, anhedonia), symptoms of distress, and cognitive symptoms (e.g., memory loss). Results: Effective symptom management strategies personally endorsed by online forum users were psychological skills (e.g., re-focusing, mindfulness/meditation, reality checking; n = 94), engaging in activities (e.g., exercise, working/volunteering, hobbies; n = 84), social/familial support (n = 48), psychotherapy (n = 33), diet (n = 18), and religion/spirituality (n = 14). 44.4% of users reported using more than one strategy to manage their symptoms. The most common symptoms targeted and effectively managed, as specified by users, were positive symptoms (n = 113), negative symptoms (n = 17), distress (n = 8), and memory loss (n = 6). 10.5% of users reported more than one symptom effectively targeted. 70.2% of users with positive symptoms reported that psychological skills were effective for symptom relief. 88% of users with negative symptoms and 75% with distress symptoms reported that engaging in activities was effective. Discussion: Individuals with schizophrenia rely on a variety of different psychosocial methods to manage their symptoms. Different symptomology appears to be more effectively targeted by different types of psychosocial strategies. This may help to inform treatment strategy and tailored for individuals with schizophrenia.

Keywords: psychosocial treatment, qualitative methods, schizophrenia, symptom management

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Authors: Ghulam Mustafa Halepota, Zaib Dahar

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Background: Low acceptance of FP services, particularly in hard to reach areas where geographic, economic, or social barriers limit-service uptake. Moreover, limited resources appeared to be a reflection of dismal contraceptive use in Pakistan. People’s Primary Health Care Initiative (PPHI) is a Public Private Partnership Program of Government of Sindh which aims to improve maternal child health through accessible family planning services in far flung areas. In 2015 PPHI launched special family planning camps to have achieved a rapid improvement in CPR. On quarterly basis, these camps focus on Long Acting Reversible Contraceptives (LARC). These camps are arranged at 250 BHU Plus (24/7 MCHCs). The Organization manages 1140 primary health care facilities all over Sindh province and focuses on maternal, newborn and child health which includes antenatal care, labor/delivery, postnatal care, family planning, immunization, nutrition, BEmONC, CEmONC, diagnostic laboratories, ambulance services. Under the FPRH program, the organization launched special family planning camps in far flung areas to achieve a rapid improvement in CPR-committed to FP 2020 goal. Objective: To assess the performance of special FP camps for the improvement of long acting reversible contraceptive in hard to reach areas. Methodology: Outreach camps are organized on quarterly basis in 250 BHUs and maternal and child health centers (available-24/7). Using observational study design, the study reports 2 years data of special FP camps conducted in 23 various districts of Sindh during April 2015-April 2017. These special camps served a range of modern contraceptive methods including IUCDs, implants, condoms, pills, and injections. Moreover, 125 male medical officers are trained across Sindh in LARC and 554 female have been trained in implants and IUCD insertions. MSI Impact calculator was used to determine health and demographic impact of services. Results: This intervention has brought exceptional results, and the response has been overwhelming in time. Total 2048 special camps during 2015 till April 2017 have been carried out. 231796 MWRAs visited camps 91% opted modern FP, of which 45% opted Implants, 6% selected IUCDs from LARC (long term reversible contraceptive) from short term, 17% opted injectable 18% choose pills, and 12% used condoms. This intervention created a high contraceptive impact in rural Sindh an estimated 125048 FP users have been created, of this 111846 LARC users and 13498 are SARC users, through this intervention an estimated 55774 unintended pregnancies, 36299 live births, 9394, 80 maternal deaths, 926 and 6077 unsafe abortion have been averted. Moreover, the intervention created an economic impact and saved 2,409,563 direct health expenditure on each woman with reproductive age. Conclusion: Special FP Camps along with routine services is an effective and acceptable model for increase in provision of long-acting and permanent methods in hard to reach areas. This innovative approach by PHHI-Sindh has also been adopted in other provinces of Pakistan.

Keywords: inequalities, special camps, family planning services, hard to reach areas

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Authors: Farzaneh Yazdani, Nastaran Yazdani, Laya Nobakht

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The aim of this study was to explore the changes that may happen in students attitudes regarding disability after attending the module ‘Disability: theories, nature and experiences’ designed around reflective self-awareness exercises. Literature indicates enhanced knowledge does not automatically lead to changes in attitude. Health care professionals are the most significant people to instil hope in their clients to pursue a happy life. As an advocate for people with disability, health care professionals need to believe themselves in people with disability being able to pursue a happy life as an abled body does. Researchers aimed to explore the impact of the ‘Disability’ module using discussion and reflective exercises, on students’ way of thinking and possible changes in attitude towards disability. Students were asked to write stories from the beginning and after completing the module. A thematic analysis was applied to identify the students’ way of communicating their thoughts and feelings about disable-bodied /disability before and after the module. Three major themes were identified to represent the differences before and after attending the module as: problem /solution oriented approach towards perceived problems, separating/ integrating disable/able-bodied, passive/ active role of disable-bodied and society.

Keywords: qualitative study, reflection, rehabilitation, thematic analysis

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Authors: K. Sunitra, T. Srisuda

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Centella asiatica, asiatic pennywort is a medicinal herb plant used widely which held in herbal health care group. The problem of asiatic pennywort production is the outbreak of Sclerotium rolfsii causing a damp-off disease which caused plant stem turn yellowish, finally they begin to die and result in extremely damaging to growers. Therefore, the studies were caried out to control damping off with Trichoderma sp., Bacillus subtilis and fermented banana as compared to the control to suppress with bi-culture under the laboratory condition. It was found that Trichoderma harzianum showed the highest percentage of inbihition, 69.44%. The pot experiments in greenhouse condition showed that chemical had minimum of damping-off (31.54%) and highest yield (1.20 tons/rai) and following by Trichoderma harzianum and Bacillus subtilis treatment. Due to the chemical usage leaving toxic residues on plants and affect the human bodies. Trichoderma harzianum and Bacillus subtilis should be considered as alternatives which have percent of damp-off disease and yields as follows: 45.50 and 43.75%, and 1.12 and 1.09 tons/rai, respectively. These two products are known that they have no health risk for growers and consumers in the future.

Keywords: Centella asiatica, Sclerotium rolfsii, Trichoderma harzianum, Bacillus subtilis

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Authors: Ghada Elshafei, A. Elazim Negm

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Recently, Green architecture becomes a significant way to a sustainable future. Green building designs involve finding the balance between comfortable homebuilding and sustainable environment. Moreover, the utilization of the new technologies such as artificial intelligence techniques are used to complement current practices in creating greener structures to keep the built environment more sustainable. The most common objectives are green buildings should be designed to minimize the overall impact of the built environment on ecosystems in general and particularly on human health and on the natural environment. This will lead to protecting occupant health, improving employee productivity, reducing pollution and sustaining the environmental. In green building design, multiple parameters which may be interrelated, contradicting, vague and of qualitative/quantitative nature are broaden to use. This paper presents a comprehensive critical state of art review of current practices based on fuzzy and its combination techniques. Also, presented how green architecture/building can be improved using the technologies that been used for analysis to seek optimal green solutions strategies and models to assist in making the best possible decision out of different alternatives.

Keywords: green architecture/building, technologies, optimization, strategies, fuzzy techniques, models

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Authors: Yali Liu, Maria Avello Iturriagagoitia

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Background: Fitness applications (apps) are one of the most popular mobile health (mHealth) apps. These apps can help prevent/control health issues such as obesity, which is one of the most serious public health challenges in the developed world in recent decades. Compared with the traditional intervention like face-to-face treatment, it is cheaper and more convenient to use fitness apps to interfere with physical activities and healthy behaviors. Nevertheless, fitness applications apps tend to have high abandonment rates and low levels of user engagement. Therefore, maintaining the endurance of users' usage is challenging. In fact, previous research shows a variety of strategies -goal-setting, self-monitoring, coaching, etc.- for promoting fitness and health behavior change. These strategies can influence the users’ perseverance and self-monitoring of the program as well as favoring their adherence to routines that involve a long-term behavioral change. However, commercial fitness apps rarely incorporate these strategies into their design, thus leading to a lack of engagement with the apps. Most of today’s mobile services and brands engage their users proactively via push notifications. Push notifications. These notifications are visual or auditory alerts to inform mobile users about a wide range of topics that entails an effective and personal mean of communication between the app and the user. One of the research purposes of this article is to implement the application of behavior change strategies through push notifications. Proposes: This study aims to better understand the influence that effective use of push notifications combined with the behavioral change strategies will have on users’ engagement with the fitness app. And the secondary objectives are 1) to discuss the sociodemographic differences in utilization of push notifications of fitness apps; 2) to determine the impact of each strategy in customer engagement. Methods: The study uses a combination of the Consumer Engagement Theory and UTAUT2 based model to conduct an online survey among current users of fitness apps. The questionnaire assessed attitudes to each behavioral change strategy, and sociodemographic variables. Findings: Results show the positive effect of push notifications in the generation of consumer engagement and the different impacts of each strategy among different groups of population in customer engagement. Conclusions: Fitness apps with behavior change strategies have a positive impact on increasing users’ usage time and customer engagement. Theoretical experts can participate in designing fitness applications, along with technical designers.

Keywords: behavioral change, customer engagement, fitness app, push notification, UTAUT2

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Authors: Espinosa Carlos, Nobrega Doris

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Children are at high risk for lead (Pb) exposure. The objective of this study was to identify risk factors that contribute to high blood lead (PbB) levels in Venezuelan children. The concentration of PbB was determined in 60 children (ages 4-9 years old), coming from the Michelena sector, Valencia District, Carabobo State. The relationship between these concentrations and socio-economical parameters (A: high quality life; B: fair quality life; C: critic poverty), Pb levels of faucet water (Pb-water) and dust Pb levels of floor (Pb-dust) of their houses, was established. Living areas were classified according to sectors and socio-economical status. Forty [40=66.7%] children resulted with PbB levels above the permissible concentration (LAPC). Average PbB was not significantly higher than the permissible levels. Odds ratio proved that children from status C are 7.28 times more likely to have LAPC of PbB than the ones coming from A or B. Thirty-four percent (34%) of the children with LAPC come from status C which could be considered the most critical status from the exposure risk point of view. The 76,3% of the sampled houses reported VSLP of Pb-water, being the Pb-water average in 35 ± 25.5 ug/L. This average significantly went superior to the permissible limit established by Venezuela and international organisms (10 ug/L). When grouping the results of PbB and Pb-water by sex, were that 50,8% of the children who presented/displayed VSLP of Pb-water and PbB. Was a significant relation (p ≤ 0.05), between masculine sex and the VSLP of PbB and Pb-water (x² = 3,672). In relation to the Pb-Dust analyses, were not statistically significant differences with respect to their permissible limit value (40 ug/pie²). This study shows that by correlating geographical and health data, we can identify 'high risk' areas, leading to a proactive public health action. The results of this study are excellent, in order to take preventive measures for the care from the health. Later studies are suggested predicting main to determine of more conclusive form of levels elevated of PbB in the investigated population.

Keywords: demographic, lead, risk, socio-economical status

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Authors: Abdessamad Dali-Ali, Houaria Beldjillali, Fouzia Agag, Asmaa Oukebdane, Ramzi Tidjani, Arslane Bettayeb, Khadidja Meddeber, Radia Dali-Yahia, Nori Midoun

Abstract:

Healthcare-associated infections are a real public health problem, especially in intensive care units. The aim of our study was to describe the epidemiological profile and to estimate the incidence of these infections at the intensive care unit of our teaching hospital. A prospective study was conducted, from June 2012 to December 2013. During this period, 305 patients having a duration of hospitalization equal or more than 48 hours were included in the study. In terms of the incidence of healthcare associated infections, nosocomial pneumonia occupied the first position with a cumulative incidence rate of 20.0%, followed by bacteremia (5.6%), central venous catheter infections (4%), and urinary tract infections (3%). In the case of isolated microorganisms, Gram-negative bacilli not enterobacteriaceae occupied the first place with 48.5%, followed by enterobacteria (32.1%). Acinetobacter baumannii was the most common germ (27.6%). Our study showed that the rate of health-care-associated infections was relatively high in the intensive care unit. A control program to reduce all infections is a priority for the Infection Control Associated Committee.

Keywords: epidemiological profile, healthcare associated infections, intensive care units, teaching hospital of Oran, Algeria

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Authors: Daniella Kucsma

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The examination of the Privat Service Organization’s performance evaluation includes several steps that help Public organizations to develop a more efficient system. Public sector organizations have different characteristics than the competitive sector, so it can be stated that other/new elements become more important in their performance processes. The literature in this area is diverse, so highlighting an indicator system can be useful for introducing a system, but it is also worthwhile to measure the specific elements of the organization. In the case of a public service organization, due to the service obligation, it is usually possible to talk about a high number of users, so compliance is more difficult. For the organization, it is an important target to place great emphasis on the increase of service standards and the development of related processes. In this research, the health sector is given a prominent role, as it is a sensitive area where both organizational and individual performance is important for all participants. As a primary step, the content of the strategy is decisive, as this is important for the efficient structure of the process. When designing any system, it is important to review the expectations of the stakeholders, as this is primary when considering the design. The goal of this paper is to build the foundations of a performance management and indexing framework that can help a hospital to provide effective feedback and a direction that is important in assessing and developing a service and can become a management philosophy.

Keywords: health sector, public sector, performance management, strategy

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Authors: Dusanee Suwankhong, Pranee Liamputtong

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Mothers living with HIV tend to experience stigma and discrimination which has an impact on their psychological and social well-being and their human rights. This paper explores the lived experience of Thai mothers with HIV in their family. In-depth interviewing and drawing methods were employed to gain a deep understanding on the experience of 30 HIV-positive mothers in the southern community of Thailand. The data was analyzed using thematic analysis method. We found that the majority of HIV-positive mothers learned about their HIV status through blood test services during their antenatal care, but some decided to visit a doctor when their partner became chronically frail and showed some signs indicating HIV/AIDS. Learning about their HIV gave them a great shock, and they could not believe that they were infected with HIV/AIDS. They feared that their illness would be disclosed and hence attempted to keep their HIV secret. This was due to the fact that people in their community would blame and labeled them as a ‘disgusting person’. Besides, they would be separated from social contacts and networks, their individual rights would be disregarded, and their potential roles would be restricted. Although participants suggested that people had more positive view on HIV-infected person nowadays, all still wanted to keep it secret because of fear of stigma and discrimination. Thai health care has provided various kinds of support programs, but many mothers chose not to participate due to the fear of disclosure. However, the women attempted to seek some strategies to live a life which would be more acceptable by the community. We conclude that HIV is still seen as a stigmatised disease in rural community of southern Thailand. Local health care providers and relevant sectors in the locality should create suitable programs to enhance self-worth among those HIV-positive mothers because this could increase a quality of life of this vulnerable mothers. Providing sufficient and appropriate supports for better emotional wellbeing is an essential role of health professionals so that the feeling of isolation among these women could be eliminated and positive social justice can be achieved.

Keywords: HIV-positive mothers, lived experience, southern Thailand, stigma and discrimination

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Authors: Aneta Nitsch-Osuch, Sylwia Dyk, Izabela Gołebiak

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Background. Since 2014 the pertussis vaccine is recommended to Polish health care workers who have close contacts with infants. Although this recommendation is implemented into the National Immunization Programme, its realization has remained unknown. The Purpose: The aim of the study, conducted at the department of Social Medicine and Public Health (Medical University of Warsaw, Poland), was to describe a perception, knowledge and coverage rates regarding pertussis vaccination among nursing staff. According to the authors' knowledge, it was the first study related to this topic in our country. Material and Methods: A total number of 543 nurses who work at pediatric or neonatal wards was included into the study (501 women and 42 men), average age was 47 years. All nurses were asked to fulfill the anonymous survey, previously validated. Results: 1. Coverage rates: The analysis of results revealed that only 4% of responders reported they were vaccinated with Tdpa within past 10 years, while 8% declared they would plan the vaccine in the future. 35% of responders would consider the Tdpa vaccine whether there is some kind of the reimbursement. 2. Perception and knowledge of the disease and vaccination: The majority (82%) of nurses did not recognize pertussis as a re-emerging infectious disease. 54% of them believed that obligatory vaccinations in the childhood protect against the disease and the protection is a life-long one. Only 15% of nurses considered pertussis as a possible nosocomial infection. The current epidemiology of the disease was known to 6% of responders, while 24% of them were familiar with pertussis vaccination schedules for infants, children and adolescents, but only 9% of responders knew that adults older than 19 years are recommended to be vaccinated with Tdpa every 10 years. Many nurses (82%) would expect more educational activities related to pertussis and methods of its prophylaxis. Conclusions: The pertussis vaccine coverage rate among Polish nurses is extremely low. This is a result of not enough knowledge about the disease and its prevention. Educational activities addressed to health care workers and reimbursement of the pertussis vaccine are required to improve awareness and increase of vaccine coverage rates in the future.

Keywords: coverage, nurse, pertussis, vaccine

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Authors: S. Ramia, N. Melhem, K. Kreidieh

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The world is facing an unprecedented displacement crisis. Recently, over 1.1 million asylum seekers have been granted protection status in the European Union (EU). The majority of these asylum seekers were from countries of the Middle East and North Africa (MENA) region.This influx carries with it a potential introduction of infectious diseases that have been eliminated in the EU, which poses a challenge for EU health authorities. Compared to MENA region countries where Hepatitis A Virus (HAV) endemicity is high to intermediate, member states of the EU show very low (Western Europe) to low (Eastern Europe) levels of HAV endemicity. Because of this situation, there is an ongoing public health concern in high-income countries, like members of the EU, that many adults remain susceptible to HAV outbreaks. The overwhelming majority of the EU members’ states do not include HAV vaccine in their immunization calendars. Hence, this paper urgently calls for the implementation of new policies regarding HAV in EU members’ states.

Keywords: European union, hepatitis A, MENA region refugees, vaccine preventable diseases

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Authors: Huei Jiun Chen, Hui Mei Huan

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Introduction: Pain is an unpleasant experience for hospitalized patients that impacts both their physical and mental well-being. It is important to select appropriate pain assessment tools to ensure effective pain management. Therefore, it is suggested to use Verbal Rating Scale (VRS) instead for better assessment. The Wong-Baker FACES Pain Rating Scale(WBS) is a widely used pain assessment tool in Taiwan to help individuals communicate the intensity of their pain. However, in clinical practice, even when using various assessment tools to evaluate pain, Numeric Rating Scale-11 (NRS-11) is still commonly utilized to quantify the intensity of pain. The correlation between NRS and other pain assessment tools has not been extensively explored in Taiwan. Additionally, the influence of gender and education level on pain assessment among elderly individuals has not been extensively studied in Taiwan. The aim of this study is to investigate the correlation between pain assessment scales (NRS-11, VRS, WBS) in assessing pain intensity among elderly inpatients. The secondary objective of this study is to examine how gender and education level influence pain assessment among individuals, as well as to explore their preferences regarding pain assessment tools. Method: In this study, a questionnaire survey and purposive sampling were employed to recruit participants from a medical center located in central Taiwan. Participants were requested to assess their pain intensity in the past 24 hours using NRS-11, VRS, and WBS. Additionally, the study investigated their preferences for pain assessment tools. Result: A total of 252 participants were included in this study, with a mean age of 71.1 years (SD=6.2). Of these participants, 135 were male (53.6%), and 44.4% had a primary level or below education. Participants were asked to use NRS-11, VRS, and WBS to assess their current, maximum, and minimum pain intensity experienced in the past 24 hours. The findings indicated a significant correlation (p< .01) among all three pain assessment tools. No significant differences were observed in gender across the three pain assessment scales. For severe pain, there were significant differences in self-rated pain scales among the elderly participants with different education levels (F=3.08, p< .01; X²=17.25, X²=17.21, p< .01), but there were no significant differences observed for mild pain. Regarding preferences for pain assessment tools, 158 participants (62.7%) favored VRS, followed by WBS; gender and education level had no influence on their preferences. Conclusion: Most elderly participants prefer using VRS (Verbal Rating Scale) to self-reported their pain. The reason for this preference may be attributed to the verbal nature of VRS, as it is simple and easy to understand. Furthermore, it could be associated with the level of education among the elderly participants. The pain assessment using VRS demonstrated a significant correlation with NRS-11 and WBS, and gender was not found to have any influence on these assessment. Further research is needed to explore the effect of different education levels on self-reported pain intensity among elderly people in Taiwan.

Keywords: pain assessment, elderly, gender, education

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Authors: Gedefaye Nibret Mihretie

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Background: Transactional sex is casual sex between two people to receive material incentives in exchange for sexual favors. Transactional sex is associated with negative consequences, which increase the risk of sexually transmitted diseases, including HIV/AIDS, unintended pregnancy, unsafe abortion, and physiological trauma. Many primary studies in Sub-Saharan Africa have been conducted to assess the prevalence and associated factors of transactional sex among women. These studies had great discrepancies and inconsistent results. Hence, this systematic review and meta-analysis aimed to synthesize the pooled prevalence of the practice of transactional sex among women and its associated factors in Sub-Saharan Africa. Method: Cross-sectional studies were systematically searched from March 6, 2022, to April 24, 2022, using PubMed, Google Scholar, HINARI, Cochrane Library, and grey literature. The pooled prevalence of transactional sex and associated factors was estimated using DerSemonial-Laird Random Effect Model. Stata (version 16.0) was used to analyze the data. The I-squared statistic was used to assess the studies' heterogeneity. A funnel plot and Egger's test were used to check for publication bias. A subgroup analysis was performed to minimize the underline heterogeneity depending on the study years, source of data, sample sizes and geographical location. Results: Four thousand one hundred thirty articles were extracted from various databases. The final thirty-two studies were included in this systematic review, including 108,075 participants. The pooled prevalence of transactional sex among women in Sub-Saharan Africa was 12.55%, with a confidence interval of 9.59% to 15.52%. Educational status (OR = .48, 95%CI, 0.27, 0.69) was the protective factors of transactional sex whereas, alcohol use (OR = 1.85, 95% CI: 1.19, 2.52), early sex debut (OR = 2.57, 95%CI, 1.17, 3.98), substance abuse (OR = 4.21, 95% CI: 2.05, 6.37), having history of sexual experience abuse (OR = 4.08, 95% CI: 1.38, 6.78), physical violence abuse (OR = 6.59, 95% CI: 1.17, 12.02), and sexual violence abuse (OR = 3.56, 95% CI: 1.15, 8.27) were the risk factors of transactional sex. Conclusion: The prevalence of transactional sex among women in Sub-Saharan Africa was high. Educational status, alcohol use, substance abuse, early sex debut, having a history of sexual experiences, physical violence, and sexual violence were predictors of transaction sex. Governmental and other stakeholders are designed to reduce alcohol utilization, provide health information about the negative consequences of early sex debut, substance abuse, and reduce sexual violence, ensuring gender equality through mass media, which should be included in state policy.

Keywords: women’s health, child health, reproductive health, midwifery

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Authors: Abdullah Al. Morshed, Mohammad Nahid Mia

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Introduction: Food security refers to the availability of food and a person’s access to it. It is a complex sustainable development issue, which is closely related to under-nutrition. Food security, in turn, can widely affect the living standard, and is rooted in poverty and leads to poor health, low productivity, low income, food shortage, and hunger. The study's aim was to identify the most vulnerable women who are in insecure positions. Method: 17,842 married women were selected for analysis from the Bangladesh Demographic and Health Survey 2011. Food security defined as dichotomous variables of skipped meals and eaten less food at least once in the last year. The outcome variables were cross-tabulated with women's socio-demographic characteristics and chi2 test was applied to see the significance. Logistic regression models were applied to identify the most vulnerable groups in terms of food security. Result: Only 18.5% of women said that they ever had to skip meals in the last year. 45.7% women from low socioeconomic status had skip meal for at least once whereas only 3.6% were from women with highest socioeconomic status. Women meal skipping was ranged from 1.4% to 34.2% by their educational status. 22% of women were eaten less food during the last year. The rate was higher among the poorest (51.6%), illiterate (39.9%) and household have no electricity connection (38.1) in compared with richest (4.4%), higher educated (2.0%), and household has electricity connection (14.0%). The logistic regression analysis indicated that household socioeconomic status, and women education show strong gradients to skip meals. Poorest have had higher odds (20.9) than richest and illiterate women had 7.7 higher odds than higher educated. In terms of religion, Christianity was 2.3 times more likely to skip their meals than Islam. On the other hand, a similar trend was observed in our other outcome variable eat less food. Conclusion: In this study we able to identify women with lower economics status and women with no education were mostly suffered group from starvation.

Keywords: food security, hunger, under-nutrition, women

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Authors: Anu Shrestha, Krassi Rumchev, Ben Mullins, Yun Zhao, Linda Selvey

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Cycling is often promoted as a means of reducing vehicular congestion, noise and greenhouse gas and air pollutant emissions in urban areas. It is also indorsed as a healthy means of transportation in terms of reducing the risk of developing a range of physical and psychological conditions. However, people who cycle regularly may not be aware that they can become exposed to high levels of Vehicular Air Pollutants (VAP) emitted by nearby traffics and therefore experience adverse health effects as a result. The study will highlight the present scenario of ambient air pollution level in different cycling routes in Perth and also highlight significant contribution to the understanding of health risks that cyclist may face from exposure to particulate air pollution. Methodology: This research was conducted in Perth, Western Austral and consisted of two groups of cyclists cycling near high (2 routes) and low (two routes) vehicular traffic roads, at high and low levels of exertion, during the cold and warm seasons. A sample size of 123 regular cyclists who cycled at least 80 km/week, aged 20-55, and non-smoker were selected for this study. There were altogether 100 male and 23 female who were asked to choose one or more routes among four different routes, and each participant cycled the route for warm or cold or both seasons. Cyclist who reported cardiovascular and other chronic health conditions (excluding asthma) were not invited into the study. Exposures to selected air pollutants were assessed by undertaking background and personal measurements alone with the measurement of heart and breathe rate of each participant. Finding: According to the preliminary study findings, the cyclists who used cycling route close to high traffic route were exposed to higher levels of measured air pollutants Nitrogen Oxide (NO₂) =0.12 ppm, sulfur dioxide (SO₂)=0.06 ppm and carbon monoxide (CO)=0.25 PPM compared to those who cycled away from busy roads. However, we measured high concentrations of particulate air pollution near one of the low traffic route which we associate with the close proximity to ferry station. Concluding Statement: As a conclusion, we recommend that cycling routes should be selected away from high traffic routes. If possible, we should also consider that if the cycling route is surrounded by the dense populated infrastructures, it can trap the pollutants and always facilitate in increasing inhalation of particle count among the cyclists.

Keywords: air pollution, carbon monoxide, cyclists' health, nitrogen dioxide, nitrogen oxide, respirable particulate matters

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Authors: Perizat Balkhimbekova

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Evolutionary changes in cognitive world view taking place in the last decades are followed by changes in perception of the key concepts which are related to the certain lingua-cultural sphere. Also, such concepts reflect the person’s attitude to essential processes in the sphere of concepts, e.g. the opposite operations like creation and destruction. These changes in people’s life and thinking are displayed in a language world view. In order to open the maintenance of mental structures and concepts we should use language means as observable results of people’s cognitive activity. Semantics of words, free phrases and idioms should be considered as an authoritative source of information concerning concepts. The regularized set of concepts in people consciousness forms the sphere of concepts. Cognitive linguistics widely discusses the sphere of concepts as its crucial category defining it as the field of knowledge which is made of concepts. It is considered that a sphere of concepts comprises the various types of association and forms conceptual fields. As a material for the given research, the data from Russian National Corpus and British National Corpus were used. In is necessary to point out that data provided by computational studies, are intrinsic and verifiable; so that we have used them in order to get the reliable results. The procedure of study was based on such techniques as extracting of the context containing concepts of creation|destruction from the Russian National Corpus (RNC), and British National Corpus (BNC); analyzing and interpreting of those context on the basis of cognitive approach; finding of correspondence between the given concepts in the Russian and English world view. The key problem of our study is to find the correspondence between the elements of world view represented by opposite concepts such as creation and destruction. Findings: The concept of "destruction" indicates a process which leads to full or partial destruction of an object. In other words, it is a loss of the object primary essence: structures, properties, distinctive signs and its initial integrity. The concept of "creation", on the contrary, comprises positive characteristics, represents the activity aimed at improvement of the certain object, at the creation of ideal models of the world. On the other hand, destruction is represented much more widely in RNC than creation (1254 cases of the first concept by comparison to 192 cases for the second one). Our hypothesis consists in the antinomy represented by the aforementioned concepts. Being opposite both in respect of semantics and pragmatics, and from the point of view of axiology, they are at the same time complementary and interrelated concepts.

Keywords: creation, destruction, concept, world view

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Authors: Valentina Milanova, Kalina Mihaylova, Iva Lazarova

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The mechanisms by which female genital infections are detected are varied and include clinician-collected high vaginal swabs, clinician-collected endocervical swabs, patient-collected vaginal swabs, and first-pass urine samples. Vaginal health screening has chronically low rates of uptake. This highlights the unmet need for a screening tool with comparable diagnostic accuracy which is familiar, convenient and easy to use for people. The Daye™ medical grade tampon offers an alternative to traditional sampling methods with the potential of increasing screening uptake among people previously too embarrassed or busy to attend gynecological appointments. In this white paper, the results of stability studies and a comparative clinical trial are discussed to assess the suitability of the device for the collection of vaginal samples for various clinical assessments. The tampon has demonstrated good sample stability and comparable sample quality compared to a self-collected vaginal swab and a clinician-collected cervical swab.

Keywords: vaginal microbiome, vaginal infections, gynaecological infections, female health, menstrual tampons, in vitro diagnostics

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Authors: Yiqi Zhu, Jean Francois Trani, Rameez Ulhassan

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Extreme weather phenomena increased by 46% between 2007 and 2017 and have become more intense with the rise in global average temperatures. This increased intensity of climate variations often induces humanitarian crises and particularly affects vulnerable populations in low- and middle-income countries (LMICs). Expectant and lactating mothers are among the most vulnerable groups. Pakistan ranks 10th among the most affected countries by climate disasters. In 2022, monsoon floods submerged a third of the country, causing the loss of 1,500 lives. Approximately 650,000 expectant and lactating mothers faced systematic stress from climatic disasters. Our study used participatory methods to investigate the systematic impact of climatic disasters on maternal health. In March 2023, we conducted six Group Model Building (GMB) workshops with healthcare workers, fathers, and mothers separately in two of the most affected areas in Pakistan. This study was approved by the Islamic Relief Research Review Board. GMB workshops consist of three sessions. In the first session, participants discussed the factors that impact maternal health. After identifying the factors, they discussed the connections among them and explored the system structures that collectively impact maternal health. Based on the discussion, a causal loop diagram (CLD) was created. Finally, participants discussed action ideas that could improve the system to enhance maternal health. Based on our discussions and the causal loop diagram, we identified interconnected factors at the family, community, and policy levels. Mothers and children are directly impacted by three interrelated factors: food insecurity, unstable housing, and lack of income. These factors create a reinforcing cycle that negatively affects both mothers and newborns. After the flood, many mothers were unable to produce sufficient breastmilk due to their health status. Without breastmilk and sufficient food for complementary feeding, babies tend to get sick in damp and unhygienic environments resulting from temporary or unstable housing. When parents take care of sick children, they miss out on income-generating opportunities. At the community level, the lack of access to clean water and sanitation (WASH) and maternal healthcare further worsens the situation. Structural failures such as a lack of safety nets and programs associated with flood preparedness make families increasingly vulnerable with each disaster. Several families reported that they had not fully recovered from a flood that occurred ten years ago, and this latest disaster destroyed their lives again. Although over twenty non-profit organizations are working in these villages, few of them provide sustainable support. Therefore, participants called for systemic changes in response to the increasing frequency of climate disasters. The study reveals the systematic vulnerabilities of mothers and children after climatic disasters. The most vulnerable populations are often affected the most by climate change. Collaborative efforts are required to improve water and forest management, strengthen public infrastructure, increase access to WASH, and gradually build climate-resilient communities. Governments, non-governmental organizations, and the community should work together to develop and implement effective strategies to prevent, mitigate, and adapt to climate change and its impacts.

Keywords: climatic disasters, maternal health, Pakistan, systematic impact, flood, disaster relief.

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