Proceedings of the Global Public Health Conference

HEALTHCARE WASTE MANAGEMENT PRACTICES IN SELECTED HEALTHCARE FACILITIES: A QUANTITATIVE CROSS-SECTIONAL DESCRIPTIVE STUDY

P Paudel — 2023-07-21

The management of healthcare waste, known as Health Care Waste Management (HCWM), is an essential component of maintaining hygiene and proper upkeep within health facilities. This includes tasks such as the collection, transportation, treatment, and disposal of waste. Unfortunately, in developing countries like Nepal, poor HCWM practices pose a significant public health risk. Sadly, HCWM has not been prioritized, and has only received sporadic attention in recent years. In numerous instances, healthcare waste is disposed of through burning in metal drums or openly, leading to the release of toxic by-products into the environment. In Nepal, inadequate HCWM practices contribute to a range of health hazards, such as needle stick injuries (NSI) or other sharps injuries that can cause Hepatitis B, Hepatitis C, and HIV, as well as other health risks such as hemorrhagic fevers, skin infections, and gastroenteric infections. This study aimed to assess the practices of Health Care Waste Management (HCWM) in a specifically chosen health facility (HF) located in the Kailali district of Nepal. The research employed a descriptive cross-sectional study design and a quantitative method, in addition to a review and analysis of relevant literature and previous studies. The health facilities included in the study were both hospitals and health posts. The study employed an exploratory approach, and a purposive sampling method was used, where a total of 10 health facilities were visited; 5 government-run facilities and 5 private facilities. A semi-structured questionnaire was used to gather data, and responsible individuals from the institutions were interviewed regarding HCWM. On average, the ten health institutions (HI) generated 9 kg of waste per day. Out of the ten HIs, only five provided training in HCWM. Three HIs did not have guidelines for healthcare waste management and only four had waste management plans. Only one HI ensured that their waste handlers wore the necessary Personal Protective Equipment (PPE). Furthermore, nine out of the ten HIs did not have a monitoring system in place for HCWM. These findings highlight the need for mandatory training in HCWM for all responsible parties and the implementation of strict rules and regulations requiring the use of complete and necessary PPE by all responsible persons and waste handlers. Such measures would help prevent and protect against needle stick injuries and other diseases.

NOVEL CHAKRA SADHANA YOGA-BASED TREATMENT APPROACH FOR POST-TRAUMATIC STRESS DISORDER (PTSD) AND DISSOCIATIVE IDENTITY DISORDER (DID)-A CASE STUDY

A Sakthivel — 2023-07-21

This study investigates the efficacy of yoga therapy in improving quality of life in a patient diagnosed with dissociative identity disorder with the application of ancient yogic chakra sadhana method. This case study is of 35year female who had six different dissociative characters of different age groups from 6years to 74years females. All these characters are identified as a distress caused due to sexual abuse. Intervention of the applied chakra sadhana was based on the 7 central chakras prepared along our spine from our sacrum at its base and up to that crown at the uppermost point of our head. It is referenced in old-fashioned Vedic writings. After the application of this therapy for the initial 15 days along with basic yoga asanas, pre and post clinical interview results are scaled as per APA’s PTSD checklist (PCL-5) and Diagnostic Statistical Manual (DSM-II). This clearly indicate the improvement of mental health in patient. Further follow up and medical check-ups are conducted weekly for post treatment of 2 months. Then the all six characters disappeared from her.

NUDGING HEALTHIER PRODUCT CHOICE: FORMULATION OF ADOLESCENTS FOOD-CHOICE MOTIVES INTERVENTION IN SERANG DISTRICT, INDONESIA

AN Zahira — 2023-07-21

Studies found that in low-middle-income countries, many people changed their lifestyle into a modern and industrialized lifestyle. Eating habits inevitably induced by personal food choice which has an independent effect on health. Establishment of eating habits and preferences mostly occurred in young age. Eating habits during adolescence period may sustain until adulthood with consequences for long-term health problem. This project aims to develop community-based intervention programme to tackle this adolescent food choice problem, and examine the effectiveness of a selected method in a sub-urban area in Serang district, Banten, Indonesia. A research on factors that drive food choice motives on adolescents was conducted through a focus group discussion, analysed by thematic analysis. Intervention program recommendation was then formulated by intervention mapping method. To examine the effectiveness of nudging application in minimarket, an experiment with customer acceptance and shopping motives survey was executed and analysed by SPSS. The results of the research show that behaviour of target groups is determined mostly by low self-regulation, family and peer influence, and limited food preparation time. Some intervention recommendations were developed to address these determinants, e.g. family-based intervention, peer-led intervention, and school collaboration. Culturally-sensitive learning environments could also be examined to ensure the effectiveness of nutrition education in that area. Nudging as one of assumed appropriate method to tackle an impulsive behaviour seemed to be not effective in increasing healthy product sales (p=0,741; p=0,316; p=0,342; p=0,247) but the customers showed a positive attitude towards its future application

BREASTFEEDING DURATION AS A PREDICTOR RELATED TO THE INCIDENCE OF EATING DIFFICULTIES IN CHILDREN AGED 24-36 MONTHS

HD Anggraheny — 2023-07-21

Background: The condition of eating difficulties in children can cause disruption to the growth and development of children. One study in 2015 in the Kedungmundu district stated that most malnourished children had eating difficulty. Factors that influence it include organic factors related to medical conditions, and non-organic factors related to diet, breastfeeding behavior, and parental factors. This study aims to determine the relationship between breastfeeding behavior, maternal emotional factors, the application of basic feeding rules (BFR), culture in applying BFR to children’s eating difficulties. Methods: This study used mixed method with a cross sectional design. The study was conducted in the Kedungmundu district, Semarang City, Indonesia, in October 2022. The research subjects were taken by consecutive sampling as many as 55 subjects. Eating difficulty, implementation of BFR, cultural in implementing BFR, and maternal emotional factors were assessed using a questionnaire that had been through previous validity and reliability tests. Test analysis was carried out by using Mann Whitney and Chi Square. Results: The majority of children had eating difficulty (87.3%), female (54.2%), breastfed for 2 years (93.8%), exclusively breastfed (64.6%), had direct breastfeeding method (66.7%), mother’s emotional state isn’t good (58.3%), applies the BFR for child’s diet (79.2%), and had culture that supports the implementation of the BFR (93.8%). There is a significant relationship (p=0,018) between duration of breastfeeding and eating difficulties. Children also tend to get bored with monotonous food. Conclusion: Factor that influence the incidence of eating difficulties in children aged 24-36 months are the duration of breastfeeding. Food variations also affect children’s appetite which causes children to have eating difficulty.

ASSESSMENT OF THE STATUS OF TUBERCULOSIS MULTIDRUG-RESISTANCE (MDR-TB) IN ABU-ANGA TB REFERENCE HOSPITAL, SUDAN 2015 - 2021

MEH Mohamed — 2023-07-21

Scarce information is available regarding the incidence, prevalence, diagnosis, and management outcomes of Multi Drug Resistant-Tuberculosis (MDR-TB) in Sudan.. This study aimed to assess MDR-TB diagnosis, management, treatment outcomes and predictors of treatment in Abu-Anga TB Reference Hospital in Sudan between the period 2015 - 2021. A retrospective facility-based study was conducted on the records of 60 patients with MDR-TB. Twenty three patients with complete file records were enrolled in the study. Data collected from the hospital registry of the 23 MDR-TB case files was analyzed using (SPSS. Ver 24). Descriptive analysis was also used for counts percentages. Results of the study participants showed that among the 23 patients, multiple drug resistance type had the highest percentage (39.1%), Rifampicin resistance was (21.7%), poly-drug resistance represented (26%) with the Pre-XDR percentage (8.7%) and XDR types being at the lowest percentages (4.3%). The outcome of the treatment indicated that 10 patients (43.4%) were cured, 6 patients (26%) were lost to follow up, 4 patients (17.4 %) failed treatment, and 3 (13%) patients died. The findings of this study indicated that good outcome predictors were the adoption of Directly Observed Treatment Strategy, hospitalization treatment model, and in-patient treatment with family support. Poor treatment outcomes were significantly related to rural residency, HIV (human immunodeficiency virus) co-infection, and treatment relapse. It is recommended to increase patient awareness among those living in rural areas to available treatment regimens and improve disease perception to increase treatment compliance and adherence. The study findings highlighted the importance of training of health providers on the proper recording and maintenance of all MDR-TB case files.

ANALYSIS OF THE EFFECT OF POST-COVID OFFICE HYBRID WORK ARRANGEMENT ON EMPLOYEE HEALTH AND SAFETY: A CASE STUDY OF UNI4 ONLINE WESTVILLE DURBAN SOUTH AFRICA

S Bangura — 2023-07-21

As a result of the COVID-19 pandemic economy, health, and care systems were disrupted and this affected and shaped the future of work. The pandemic augmented many trends in employee work arrangement that had a major impact on businesses and employee health and safety and one of these trends is hybrid work arrangement. Globally, employers, government officials, health organisations, unions, and professional associations struggled to stay compliant. Occupational exposure and working conditions can have an undesirable or positive effect on the safety, health, and well-being of workers. Therefore, this study aims to analyse the effect of post-COVID office hybrid work arrangement on employee health and safety: a case study of Uni4 Online Westville Durban South Africa. Taking into consideration the aim of the study the following objectives guide the study i) to understand what hybrid work arrangement is. ii) to understand how the COVID-19 pandemic has affected employee work arrangement, iii) determine the perceived challenges and opportunities in the application of hybrid work arrangement iv) make recommendations on the effective application of hybrid work arrangement at Uni4 Online Westville Durban South Africa. For this study, a secondary approach to data collection was undertaken. In this regard a total of 15 relevant articles were searched from different databases and search engines, The keywords were explored in three databases namely, Google Scholar, Ebsco-host, and Emerald. The findings from the literature showed that post-COVID hybrid work arrangements can affect workers psychologically because physical distancing through staying at home contributes to isolation and a lack of distinction between work life and home life. Furthermore, it was deduced that hybrid work arrangement creates challenges for workers because it creates fewer opportunities for career development and promotions because of weakened ties. In addition, workers in a hybrid work arrangement who were more dependent on others and generally received more feedback had fewer positive appraisals than those with more independent roles. The study recommends that both employees and managers need to develop new skills and capabilities to adjust to the new ways of working and utilising the prospects of Post COVID hybrid work. Also, firms should be concerned about sustainability implications when developing guidelines for Post COVID hybrid work, both in terms of social and ecological aspects.

THE GLOBAL EMERGENCE OF VENTILATOR-ASSOCIATED PNEUMONIA (VAP) IN THE ERA OF THE COVID-19 PANDEMIC: A DESCRIPTIVE STUDY

C Pai — 2023-07-21

Ventilator-associated pneumonia has been a well-known complication in the intensive care unit (ICU) and continues to be a real threat in patients infected with coronavirus disease (COVID- 19), particularly in those that progress to acute respiratory distress syndrome (ARDS) with subsequent mechanical ventilation. Through a global perspective, this descriptive study was aimed at describing the patterns of co-infection with ventilator-associated pneumonia (VAP) in patients with COVID-19 ARDS. The global incidence rate of VAP in COVID-19 patients on mechanical ventilation was determined to be 41.2% supported by extended time spent on mechanical ventilation, increase in mortality rate, and the emergence of drug-resistant microbes. These outcomes are accompanied by the concomitant presence of previous antimicrobial use, invasive respiratory operations due to COVID-19 ARDS, and in some cases, corticosteroid treatment. The results of our findings add to the emergent threat of VAP as an important nosocomial infection as the COVID-19 pandemic persists.

INEQUALITIES IN ACCESS TO COVID-19 VACCINES AND POTENTIAL SOLUTIONS FOR LOW- AND MIDDLE-INCOME COUNTRIES

C Pai — 2023-07-21

Despite approved vaccines against Coronavirus Disease 2019 (COVID-19) having been available for more than a year, low- and middle-income countries (LMICs) have been unequally affected by low vaccination coverage. The overarching goal of the COVID-19 Vaccine Global Access (COVAX) mission is to ensure that all countries can secure enough doses to vaccinate 20% of their population before any one country vaccinates more than 20% of their population. However, limited resources, poor infrastructure and constrained financial capabilities have contributed to challenges in producing, acquiring, and distributing vaccines amongst developing nations. This review was aimed at identifying inequalities and proposing mitigation measures to minimize disparities in access and distribution of COVID-19 vaccines in LMICs. A narrative literature review of scientific papers published during 2020-2022 was carried out accessing databases including Google Scholar and Medline (PubMed). Factors affecting access to COVID-19 vaccine research, manufacturing, procurement, and deployment capabilities were studied. The results revealed that the combined populations in LMICs that make up 84% of the global population were able to secure only 30% of the COVID vaccine doses produced in 2021. Alternatively, high-income countries make up 16% of the global population and had purchased 70% of vaccine doses produced in 2021. The causes were multifactorial and included challenges involving production, procurement and allocation, deployment, accessibility, and vaccine hesitancy. Mitigation measures include better manufacturing or procurement capabilities based on shared intellectual property and aid as well as better storage systems for temperature-sensitive vaccine deployment. Vaccine hesitancy can be mitigated by leveraging the influences of well-informed health care workers, social workers, political, religious and community leaders who can help dispel misinformation and improve vaccine acceptance among the masses. Reducing disparities in vaccination coverage of LMICs is an important step towards the global progress in combating the pandemic and especially in preventing the spread of potential viral variants.

COVID-19 ASSOCIATED MUCORMYCOSIS: A CASE SERIES REPORT AND AN UMBRELLA REVIEW

C Pai — 2023-07-21

The emerging epidemic of COVID-19 Associated Mucormycosis(CAM) has been recognized as a significant global public health threat. India accounted for majority of the globally detected CAM cases especially during the second wave of the pandemic in 2021. A severe form of invasive CAM called Rhino-orbital-cerebral mucormycosis (ROCM) led to high mortality and morbidity especially in COVID patients with predisposing factors causing immunosuppression such as diabetes mellitus, malignancies, and steroid therapy. This study was carried out to describe the demographic features as well as analyze the comorbidities and outcomes of patients diagnosed with CAM and to provide an umbrella review of published global systematic reviews on CAM with special reference to ROCM. In this case series report, we have noted the findings and outcomes of 12 COVID patients with CAM treated at two different tertiary care hospitals in India. All were males, with an average age of 54.25 years. 66.6% had invasive ROCM and 91.7% had poorly controlled diabetes. All received liposomal amphotericin B, 58.3% underwent surgical interventions and the mortality rate was 33.3%. We also conducted an umbrella review of systematic reviews reported from 2020-2022. PubMed, Embase, Scopus and Google scholar databases and the PRISMA 2020 checklist were used to refine retrieval and review based on our study criteria. Common patterns were noted regarding the predisposing factors and treatment outcomes. Good glycemic control, the regulated use of steroids, proper decontamination of oxygen cylinders and the hospital environment as well as avoidance of overzealous use of steam inhalation have been proposed as important measures to control this epidemic.