Prevalence and Determinants of Substance Abuse Among Slum Dwellers in Islamabad-Pakistan

IJTMRPH

ISSN: 2576-9499 (Online) ISSN: 2576-9502 (Print) www.ijtmrph.org

Vol 3 No 2 (2019) Research · Translate · Save Lives

INTERNATIONAL JOURNAL of TRANSLATIONAL

MEDICAL RESEARCH and PUBLIC HEALTH Int. J. Trans Med Res Pub Hlth

A Journal of the Global Health and Education Projects, Inc.

ADOLESCENT AND YOUNG PEOPLE'S UTILIZATION OF HIV/SEXUAL AND REPRODUCTIVE HEALTH SERVICES: COMPARING HEALTH FACILITIES AND MOBILE COMMUNITY OUTREACH CENTERS Ikenna J. Nwakamma, MPH | Carol S. Talla, BMLS | Stephanie E. Kei, MD | Genevieve C. Okoro, BNS | Godwin Asuquo, PhD | Kema A. Onu, MD ABSTRACT

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Background/Objectives: Demand creation for uptake of HIV and sexual reproductive health (HIV/SRH) services among adolescents and young people (AYP) in Nigeria is challenging. This study compares the reach, and • Add yourpatterns, first bullet point utilization and here factors that drive the patterns of utilization of HIV/SRH services by AYP in mobile outreach service centers and health • Add your second bullet pointcapital here care facilities in Nigeria's city.

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Methods: Data were obtained from service exit surveys and HIV/SRH service utilization records in selected health facilities and mobile testing outreaches from January to April 2018. The service providers were provided a checklist to capture key information during their interaction with their AYP clients. Data were captured with Microsoft Excel, imported to and analysed with Statistical Package for Social Sciences, version 16.

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Results: Community-based mobile outreaches reached a significantly higher proportion of participants, with 88% of them from the community HIV testing points. Among the participants in the SRH service utilization assessment, 20 (15%) and 142 (19%) voluntarily asked for SRH-related information in the health facility and mobile outreach respectively; 53 (40%), and 224 (30%) accepted offer of SRH counselling in the health facility and mobile outreach respectively. There were significant differences in the waiting time for testing and waiting time for result collection at the mobile testing posts and the health facilities.

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Conclusion and Implications for Translation: AYP friendly mobile community outreach model shows more promise in terms of reach and also seems to encourage voluntary request for HIV/SRH services among AYP. The costs and waiting times favor the mobile outreach model; however, the quality in terms of personnel and environment was an issue of concern.

Hospitals are not providing friendly environments that encourage voluntary uptake of HIV/SRH services by AYPs. A model for AYPs should prioritize community based and friendly services with well-trained personnel in order to build the confidence of AYPs for improved SRH seeking behaviors.

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Key words: • HIV • Sexual and reproductive Health • Adolescents and Young People • Preferences • Mobile outreaches services • Health facility testing • Abuja Nigeria

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Vol 3 No 2 (2019), Published: 2019-08-08; DOI: https://doi.org/10.21106/ijtm

SOCIAL ISOLATION, LONELINESS, AND MENTAL AND EMOTIONAL WELL-BEING AMONG INTERNATIONAL STUDENTS IN THE UNITED STATES Mehrete Girmay, PhD, MPH, CGH | Gopal K. Singh, PhD, MS, MSc

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Background: Loneliness and social isolation have the ability to affect an individual's mental and physical health. With research linking both to morbidity and mortality, their effects must be viewed as • Add your firstpremature bullet point here important public health problems. Loneliness and social isolation can be especially pronounced in the • Add your second bullet point hereinternational student community, particularly at the university level, as this population encounters challenges assimilating to their surrounding community, and host • Add your third bullethost point university, here country. This study explores the risks and sociocultural factors associated with loneliness, social isolation, and psychological distress with regards to the overall adjustment of international students.

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Methods: In this qualitative, narrative case study, 10 international graduate students at a university in the United States participated in two focus group sessions followed by individual interviews. Thematic areas and topics were identified using Barrer's three models of social support. Study was completed between December 2016 and September 2017.

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Results: All of the participants shared that they had experienced loneliness and social isolation at some point during their acculturative process resulting in perceived xenophobia and a sense of insincerity on behalf of domestic students when attempting to forge connections. For some, these experiences elicited feelings of depression, a disinterest in building connections with domestic students, and in attending social events held on campus and within the community, further exacerbating feelings of loneliness and social isolation.

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Conclusions and Implications for Translation: Results shed light on the impact that poor acculturation can have on the student's mental and physical health and how bridges between the international and noninternational communities can be built and more importantly, sustained.

There is a critical need for more effort to be focused on attending to both the mental and physical health needs of migrant students during their stay at the host university.

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Key words: • Acculturation • Social Isolation • Loneliness • Mental Health • International • Student Vol 3 No 2 (2019), Published: 2019-08-13; DOI: https://doi.org/10.21106/ijtm

POLIO ERADICATION IN NIGERIA AND INDIA: A SYSTEMATIC REVIEW OF CHALLENGES AND SUCCESSES Ahmed A. Bulama, MBBS, MSPH, MTID | Jane Goodman-Brown, MSc, PGCHE, BSc (Hons) RGN, RM, RHV ABSTRACT

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Background: The global eradication of polio is considered an emergency and an unaccomplished task until completely eliminated. Vaccinating children against Add your firstconfers bullet point here on them and breaks the transmission of the polio the• polio virus immunity virus. Afghanistan, Nigeria and Pakistan remain the only three countries in the world that have notbullet eliminated polio. The aims of this paper were to: (1) to • Add your second point here identify the factors that impact the failure to eliminate polio from Nigeria and (2) determine the factors • Add your third bullet that pointled hereto the successful elimination of polio from India.

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Methodology: A systematic literature review was carried out to meet the above research objectives.

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Methods: Four electronic databases were searched (Cochrane Library, Medline, PubMed and Google Scholar) and articles that fulfilled the inclusion and exclusion criteria were selected and critically appraised.

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Results: In all, 98 articles were retrieved. After selection based on our selection criteria, fourteen studies were identified and included in the study. These were 5 systematic reviews: 3 cross-sectional studies, 3 mixed methods studies, 2 casecontrol studies and one quantitative (survey) study. In all, seven themes were identified from the review of the articles. Four themes were identified from the factors associated with the failure to eliminate polio from Nigeria: (1) Failure of the oral polio vaccine (OPV); (2) Institutional and geographical failures in vaccine programs; (3) Program and campaign management limitations; and (4) Vaccine refusal. Similarly, three themes were identified from the factors that contributed to the elimination of polio from India: (1) Replacement of the trivalent OPV with the monovalent and bivalent OPVs; (2) Implementation of intensive social mobilization strategies; and (3) Effective program micro planning and campaign management.

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Conclusion: Based on the findings from the literature review, we highlight areas where Nigeria can learn from India in its quest to eliminate polio. These factors can form the basis for future theoretical and policy reforms in the fight against polio not only in Nigeria but in countries where it remains endemic. Further research should compare the success of polio eradication in other countries.

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Key words: • Polio • Immunization • Nigeria • India • Pakistan • Eradication • Systematic review Vol 3 No 2 (2019), Published: 2019-09-10; DOI: https://doi.org/10.21106/ijtm

QUALITY AND SAFETY MANAGEMENT OF HEALTH CARE SERVICE DELIVERY AMONG PUBLIC HOSPITALS IN RWANDA: A CROSS-SECTIONAL SURVEY Deogratias Ndagijimana, MPH, RN | Connie Mureithi, PhD | Nicholas Njau Ngomi, PhD

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Background or Objectives: Quality and safety of health care service delivery remain a challenge worldwide due to unsafe care, inappropriate practices, adverse events and medication errors that result in harm, disability and death of • Add your bulletexamines point here the status of quality and safety management of patients.

Thisfirst study health care service delivery in public hospitals in Rwanda.

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Methods: The study descriptive cross-sectional study. Overall population • Add your third bulletwas pointahere of interest comprised of 564 hospital managers from 47 hospitals. An online email-based questionnaire was used for data collection. Statistical analysis included bivariate, multivariable, and logistic regression analyses with significance at p<0.05. Data were analyzed using Statistical Package for social Sciences (SPSS) Software v.21.

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Results: The study sample population was 235 managers (5 persons from each hospital). Of the 235 responses received, 72.3% were from male managers and 27.7% were from female managers. The prevalence of adverse events among public hospitals in Rwanda is 0.007% (p=0.02, 95% CI: 0.017-0.023) with risk of incidents of 0.073%. In all, 98.7% of public hospitals reported incidents, and only 39.3% of them have regularly reported all types of incidents. The most common incidents were adverse drug event (25.3%), loss to follow-up/referrals (25%), and surgical site infection (20%). Rwanda has 0.043 (IQR: 0.032-0.060) doctors per 1,000 population. The country also has 0.25 (IQR: 0.18-0.33) nurses per 1,000 population. The 76.5% of respondents reported that variation of consultation time is between 10-15 minutes (p=0.003, 95% CI: 0.002-0.004) which is associated with 0.12% risk of incidents. The public hospitals have on average 44.25 ± 13.46 SD consultations per clinician per day. More than a half of respondents 54.3% (p=0.033, 95%CI: 0.029- 0.036) reported that 10-20% of treatment given to patients were not needed and are significantly associated with high risk of incidents. The public hospitals score Level 1(documentation) (p=0.016, 95%CI: 0.014-0.019) for quality health care services delivery and, over half score Level 2(implementation). They also score Level 1(documentation) (p: 0.209, 95%CI: 0.201-0.216) for safe health care, and approximately half of them score Level 2(implementation).

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Conclusion and Implications for Translation: The quality and safety of health care services should be a priority for health care professionals and healthcare systems. The culture of blame and punishment is a challenge across hospitals.

Reassuring adverse events reporting and learning from errors need to be emphasized and prioritized in public hospitals.

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Key words: • Quality and Safety Management • Health Care Service Delivery • Rwanda • Quality and Safety Score levels Vol 3 No 2 (2019), Published: 2019-09-10; DOI: https://doi.org/10.21106/ijtm

PREVALENCE AND DETERMINANTS OF SUBSTANCE ABUSE AMONG SLUM DWELLERS IN ISLAMABADPAKISTAN Bashir Faiza, MBBS, MSc | Hassan Mehmood, MBBS, MPH | Sumera Naz, MPhil | Saima Naz, MPhil ABSTRACT •

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Background: The slums are illegal settlements and are always left out in health surveys. However, studies around the world show that substance or drug abuse is higher among slum dwellers and may have different patterns and determinants • Add yourto first pointin here which need bebullet studied order to frame targeted programs and policies. The present study was aimed at estimating the magnitude as well as determinants of • Add your second bulletamong point here substance/drug abuse slum dwellers in Islamabad, the capital city of Pakistan.

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Methodology: This community-based cross-sectional study was conducted among the residents of slums/nomadic settlements of Islamabad. A total of 207 statistically calculated sample size comprised of adults from both genders aged 15 years and above, consenting to participate from the randomly selected 9 clusters in Islamabad was needed for the study. From each cluster, 23 households, and from each household one individual was randomly selected for estimating the prevalence. All those who were abusing substances were counted as cases and others as controls for case-control analysis. A structured questionnaire was used to gather information on demographics, trends, types of substances abused, risk factors for getting engaged in substance abuse, whether they had tried to quit at any stage and what difficulties they faced when trying to quit. Results were entered and analyzed using Epi-info version 7.2.

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Results: A total of 204 participants were enrolled in this study. Among these 68 (33%) were substance or drug abusers. For the case-control study, substance/drug users were considered as cases 68 and rest as controls.

Bivariate analysis of the risk factors indicated that easy of availability of drugs in slum areas (OR: 20.3, p= 0.000); exposure to tobacco smoking (OR: 8.8, p= 0.000); and being a working child (OR: 6.0, p= 0.000) were the strong predictors of high substance abuse. Education (OR: 0.2, p= 0.000) and living with own parents during childhood (OR: 0.7 p= 0.2) had protective effects against substance abuse.

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Conclusion and Implications for Translation: The study concludes that the following were the determinants of substance/drug abuse among the slum dwellers in the study: easy availability due to unregulated sales of drugs, high rate of tobacco consumption, poverty, low level of literacy, and being a workingchild. Specific policies and plans focused on law enforcement for curbing the illegal drug sales and reduction of child labor along with the provision of education should be devised and implemented to help these neglected communities and modify the determinants.

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Key words: • Substance abuse • Drug abuse • Slum dwellers • Case-control • Islamabad • Pakistan Vol 3 No 2 (2019), Published: 2019-12-14; DOI: https://doi.org/10.21106/ijtm

International Journal of Translational Medical Research and Public Health Journal Information

TitleEditor-in-Chief: and ContentRomuladus Layout with List E. Azuine, DrPH, MPH, RN. •

Add your first bullet point here Gopal K. Singh, PhD Editor:

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Editorial Assistant: Carl Dowling, SAP.

Contact Information: submissions@ijtmrph.org

Website: www.ijtmrph.org