Fleas are small wingless hematophagous insect that are frequently infesting on rodents and other small mammals while acting as vectors of many zoonotic diseases including plague, a disease challenging public health in many part of the world including Tanzania. 291 rodents from nine species were captured with Sherman traps in farm land, peridomestic areas, bush and forest buffer zone across wet and dry season in plague and non-plague foci villages. Captured rodents were anaesthetized and 190 fleas comprising four species were collected and morphologically identified with available dichotomous key. Dinopsyllus lypusus were (46.32%) , Ctenophthalmus spp (26.84%), Xenopsylla brasiliensis (16.32%) and Xenopsylla cheopis (10.53%). 38.42% of fleas were collected from Mastomy natalensis, 22.63% from Lemniscomys striatus and 18.42% from Rattus rattus. Highest flea infestation prevalence was found on R.rattus and was strongly associated with X.cheopis and X.brasiliensis. Specific flea index of X.cheopis on R.rattus was (01) in plague foci and (<0.5) in non-plague foci. Result of GLM final model indicated that flea abundance was significant influenced by rodent species ( p < .001), season ( p= .031), habitats ( p= .02), rodent weight ( p < .001), rodent sex ( p < .001) and plague locations ( p= .02). There was significance difference in variation of flea abundance between rodent sexes (W = 9158.5, p = .009) and weak positive correlation between rodent’s weight and fleas abundance ( R= 0.17, p< 0.05). Despite that, specific flea index of X.cheopis on rats in both plague foci and non-plague foci villages were not indicating alarming condition that would require urgent control of fleas, still society should consistently adhere to rodent and fleas control methods especially in farm land and peridomestic areas where flea abundance is high and human activities are customarily implemented.

Background For over 70 years the addition of fluoride to public water with intent to prevent dental caries continues to be controversial and risks are seldom included in monetary evaluations. Objectives To estimate an economic cost-benefit-risk of Community Water Fluoridation (CWF) using 2021 USA dollars Per Person Per Year (PPPY), with the inclusion of two risks: dental fluorosis and lower income resulting from developmental neurotoxicity as measured with lower IQ. Methods Published operational costs and benefits of CWF are used. Published and clinical experience treating dental fluorosis are utilized to estimate treatment costs of patient perceived dental fluorosis, and lost wages from lower IQ. Patients of record provided consent for photographs. Results: Published estimated caries averted, less operational costs, were calculated at $8 PPPY and estimates of compensation for functional and cosmetic dental fluorosis were $126 PPPY. Lower earnings from presumed harm of developmental neurotoxicity $438 PPPY. Net loss from CWF is estimated at $556 PPPY. Conclusions Previous economic evaluations of CWF have estimated caries averted and costs of operations. Few evaluations include the costs of treating harm. CWF is not cost effective if the cost of harm is included. Policy Implications Alternatives for the prevention of dental caries should be promoted and the cessation of CWF is indicated.

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

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

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

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

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

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

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

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

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

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

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