Impact of COVID-19 Pandemic on Mental Health of Healthcare Workers–A Perception of Indian Hospital Administrators

Since the coronavirus pandemic,many factors led to the change in the mental well-being of hospital administrators and their staff.The pandemic negatively impacted the availability and capability of health professionals to deliver essential services and meet rising demand.Therefore,this study aimed to understand the perspective of hospital administrators about issues and challenges that negatively impacted their staff’s mental health and hospital administrators’coping response to mitigate those challenges and issues.An exploratory qualitative study was conducted with 17 hospital administrators(superintendents,deputy superintendents,nursing in charge and hospital in charge)working in a government district hospital of Rajasthan state during September 2022 and October 2022.This study revealed various emerging themes on mental health-related issues,challenges and coping strategies reported by the administrators.Themes and sub-themes that emerged from this study were 1)Perceived mental health of HCWs-perceived importance of mental health,2)Impact of COVID-19 on the mental health of HCWs–common mental health issues,changes in mental health pre and post-pandemic,3)Impact of COVID-19 on health behavior of HCWs-increased self-care and awareness,4)Challenges responsible for poor mental health of HCWs-organizational,ethical and societal challenges and 5)Strategies to retain mental health of HCWs-effective coping strategies.The most common problems were increased levels of stress,feeling fatigued,tiredness,weak and anxiety among the HCWs.Keeping their staff motivated was the biggest challenge reported.Social support,counseling through professionals and demystifying myths were the most effective coping strategies adopted by the participants.In conclusion,this study reported poor mental health-related issues,challenges faced by the HCWs and effective strategies adopted by hospital administrators during tough situations.This study will assist hospital administrators in developing interventions such as regular training programs and workshops to teach effective coping skills to address poor mental health during crises.

Autoantibodies related to ataxia and other central nervous system manifestations of gluten enteropathy

Gluten ataxia and other central nervous system disorders could be linked to gluten enteropathy and related autoantibodies.In this narrative review,we focus on the various neuro-logical manifestations in patients with gluten sensitivity/celiac disease,immunological and autoimmune mechanisms of ataxia in connection to gluten sensitivity and the autoantibodies that could be used as a biomarker for diagnosing and following.We focused on the anti-gliadin antibodies,antibodies to different isoforms of tissue transglutaminase(TG)(anti-TG2,3,and 6 antibodies),anti-glycine receptor antibodies,anti-glutamine acid decarboxylase antibodies,anti-deamidated gliadin peptides antibodies,etc.Most studies found a higher prevalence of these antibodies in patients with gluten sensitivity and neurological dysfunction,presented as different neurological disorders.We also discuss the role of a gluten-free diet on the clinical improvement of patients and also on imaging of these disorders.

Factors of Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Therapy among HIV-TB Co-Infected Individuals in the East Region, Cameroon in the COVID-19 Era: A Retrospective Cohort Study

Context/Objectives: Tuberculosis (TB) and HIV co-infection is a serious health problem in Cameroon. The problems associated with poor adherence to treatment are on the increase worldwide. This problem can be observed in all situations where patients are required to administer their own medication, whatever the type of illness. The general objective of this study was to assess the factors affecting adherence to treatment among HIV-TB co-infected patients in health facilities in the East Region in the COVID context. Method: A retrospective cohort study before and during COVID-19 was conducted in HIV care units in 13 health districts in the East Region of Cameroon. Data were collected using a questionnaire recorded in the Kobo Collect android application, analyzed using SPSS version 25 software and plotted using Excel. Results: The pre-COVID-19 cohort compared to the during-COVID-19 cohort had a 1.90 risk of not adhering to treatment (OR: 1.90, CI {1.90 - 3.37}) and the difference was statistically significant at the 5% level (p-value = 0.029). Frequency of adherence was 65.4% (140/214). Adherence before COVID-19 was 56.9% whereas during COVID-19, it was 74.3%. Conclusion: The implementation of targeted interventions in the COVID-19 context, using evidence-based data and integrating the individual needs of HIV-TB co-infected patients, improved adherence to concurrent anti-tuberculosis treatment and antiretroviral therapy during the COVID-19 Era.

Method“Monte Carlo”in healthcare

In public health,simulation modeling stands as an invaluable asset,enabling the evaluation of new systems without their physical implementation,experimentation with existing systems without operational adjustments,and testing system limits without real-world repercussions.In simulation modeling,the Monte Carlo method emerges as a powerful yet underutilized tool.Although the Monte Carlo method has not yet gained widespread prominence in healthcare,its technological capabilities hold promise for substantial cost reduction and risk mitigation.In this review article,we aimed to explore the transformative potential of the Monte Carlo method in healthcare contexts.We underscore the significance of experiential insights derived from simulated experimentation,especially in resource-constrained scenarios where time,financial constraints,and limited resources necessitate innovative and efficient approaches.As public health faces increasing challenges,incorporating the Monte Carlo method presents an opportunity for enhanced system construction,analysis,and evaluation.

Seroprevalence Survey of HIV and Hepatitis B Virus and Behavioral Characteristics among Heavy Truck Drivers along Port Sudan-Khartoum Highways

The prevalence of human immunodeficiency virus (AIDS) and hepatitis B virus among heavy truck drivers and their assistants has been well documented globally in correlation with their behavioral characteristics. The present study aimed to screen for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and behavioral characteristics among heavy truck drivers in Port Sudan. A cross-sectional study was conducted on 274 heavy truck drivers and their assistants who used the highway Port Sudan-Khartoum in Port Sudan city during 2019-2021. Data on behavioral characteristics and substance use habits were collected using a structured questionnaire, and an ELISA test was used to screen for HIV and HBV infections in the study participants. The chi-square test, odds ratio, and confidence intervals were used to find the association between behavioral characteristics and seropositive HIV/HBV. Of the 274 enrolled participants, the seroprevalence rates of HIV were 2.7% and HBV was 23.7%. Ninety-four (34.3%) of them had a history of high-risk sexual behavior outside of marriage;only two (0.7%) used condoms;14.2% of participants reported alcohol use;and 1.1% reported drug use. Univariate analysis revealed that having a sex history outside of marriage with ≥1 sex partner and never using a condom with a spouse or casual partner were significant risk factors for HIV and HBV among drivers. Fortunately, we found that most of the drivers reported low alcohol and drug use. Concerning this study, the seroprevalence of HIV and HBV is highly associated with a history of having sex outside of marriage and sexual behavior among truck drivers and assistances. Additional studies are needed to further investigate other STIs and behavioral characteristics associated with factors in truck drivers/assistance in different truck stop regions in Sudan.

Validity,Reliability,and Measurement Invariance of the Thai Smartphone Application-Based Addiction Scale and Bergen Social Media Addiction Scale

Background:In recent years,there has been increased research interest in both smartphone addiction and social media addiction as well as the development of psychometric instruments to assess these constructs.However,there is a lack of psychometric evaluation for instruments assessing smartphone addiction and social media addiction in Thailand.The present study evaluated the psychometric properties and gender measurement invariance of the Thai version of the Smartphone Application-Based Addiction Scale(SABAS)and Bergen Social Media Addiction Scale(BSMAS).Method:A total of 801 Thai university students participated in an online survey from January 2022 to July 2022 which included demographic information,SABAS,BSMAS,and the Internet Gaming Disorder Scale-Short Form(IGDS9-SF).Results:Confirmatory Factor Analyses(CFAs)found that both the SABAS and BSMAS had a one-factor structure.Findings demonstrated adequate psychometric properties of both instruments and also supported measurement invariance across genders.Moreover,scores on the SABAS and BSMAS were correlated with scores on the IGDS9-SF.Conclusion:The results indicated that the SABAS and BSMAS are useful psychometric instruments for assessing the risk of smartphone addiction and social media addiction among Thai young adults.

Epidemiology and Clonal Spread Evidence of Carbapenem-Resistant Organisms in the Center of Care and Protection of Orphaned Children, Vietnam

Objective: To determine the prevalence of colonization and transmission of carbapenem-resistant Gram-negative organisms in order to develop of an effective infection prevention program. Design: Cross-sectional study with carbapenem-resistant organisms (CRO) colonization detection from the fecal specimens of 20 Health Care Workers (HCWs) and 67 residents and 175 random environment specimens from September 2022 to September 2023. Setting: A Care and Protection Centre of Orphaned Children in South of HCM City. Participants: It included 20 HCWs, 67 residents, and 175 randomly collected environmental specimens. Method: Rectal and environmental swabs were collected from 20 HCWs, 67 residents (most of them were children), and 175 environmental specimens. MELAB Chromogenic CARBA agar plates, Card NID, and NMIC-500 CPO of the BD Phoenix TM Automated Microbiology System and whole genome sequencing (WGS) were the tests to screen, confirm CROs, respectively and determine CRO colonization and transmission between HCWs, residents, and the environment. Result: We detected 36 CRO isolates, including 6, 11 and 19 CROs found in 6 HCWs, 10 residents and 19 environments. The prevalence of detectable CRO was 30% (6/20) in HCWs, 14.92% (10/67) in residents, and 10.86% (19/175) in environmental swabs in our study. WGS demonstrated CRO colonization and transmission with the clonal spread of E. coli and A. nosocomialis, among HCWs and residents (children). Conclusion: Significant CRO colonization and transmission was evident in HCWs, residents, and the center environment. Cleaning and disinfection of the environment and performing regular hand hygiene are priorities to reduce the risk of CRO colonization and transmission.

A Comparative Assessment of Patient Safety Culture between Iranian Selected Hospitals and Agency for Healthcare Research and Quality (AHRQ) Report

Establishing a culture of patient safety can be effective in reducing the incidence of medical errors and solving concerns of safety inadequacy in health systems. The purpose of this study was to assess the culture of patient safety in the selected hospitals, and compare the results with published reports of AHRQ. This study was approved by the Ethical Committee of BPUMS. The subjects signed the informed consent form to participle in the study. Confidentiality was maintained throughout the study reports. Cross-sectional study was conducted in 2012;the study sample was composed of 364 staffs working at two selected hospitals affiliated to Bushehr University of Medical Sciences. Hospital Survey on Patient Safety Culture was used to collect data. Descriptive statistical analysis was used to analyze the data. No reports of events in both studied hospitals and benchmark were accounted for the most of the reported errors, although this indicator in studied hospitals was nearly 23% higher than that of the benchmark report. The highest patient safety grade in studied hospitals and benchmark was “acceptable” and “very good”, respectively. The highest percentage of positive response to patient safety dimension was organization learning and then teamwork within units in studied hospitals. Teamwork within units also was the highest average percent in benchmark report. Non-punitive response to errors had the lowest positive percentage of participant responses in both studies. To achieve the patient safety culture, we do not need to blame individual and apply punitive approach when errors occur. This makes person accept responsibility for their actions honestly and report errors in a timely manner to prevent reoccurrence of similar errors.

Health care staffs’ perception of patient safety culture in hospital settings and factors of importance for this

Many hospital patients are affected by adverse events. Managers are important when improving safety. The perception of patient safety culture varies among health care staff. Health care staff (n = 1023) working in medical, surgical or mixed medical-surgical health care divisions answered the 51 items (14 dimensions) Swedish Hospital Survey on Patient Safety Culture (S-HSOPSC). Respondents with a managerial function scored higher than non-managers for 11 of 14 dimensions, indicating patient safety culture strengths for a majority of dimensions. Enrolled nurses and staff with experience > 10 years also scored high for several dimensions. The 12 dimensions and sample characteristics explained 49% and 26% of the variance for the outcome dimensions Overall Perceptions of Safety and Frequency of Incident Reporting, respectively. RNs, ENs and physicians have different views on patient safety culture. Hospital Management Support and Organisational Learning is some important factors influencing patient safety culture. Bridging the gap in health care staff’s perceptions of safety in order to improve patient safety is of utmost importance. Managers have the responsibility to foster patient safety culture at their workplace and can thus benefit from results when improving safety for patients.

Prevalence of <i>Helicobacter pylori</i>and hygiene practices among public secondary school students in Ikeja local government area, Lagos, Nigeria

This study determined prevalence of Helicobacter pylori and hygiene practices among public secondary school students in Ikeja Local Government Area (LGA), Lagos state, Nigeria. An institutional-based, cross-sectional study was conducted among two randomly selected secondary schools. One hundred (100) consented students participated in the study and interviews were conducted using a semi-structured questionnaire while blood samples were collected by venipuncture. Respondents’ ages were 16.1 ± 2.8 years and 54.0% were females. Mean number of persons living in a room was 7.0 ± 3.5, and however, 39.0% of the respondents lived in a room with 4 - 6 persons. The prevalence of H. pylori was 59.0% (59/100). Majority, 64.4% of those infected with H. pylori were 15 years and above while 62.7% females were tested positive to H. pylori. Some, 38.9% of the participants infected with H. pylori drink tap water while 84.7% did hand washing after visiting toilets with water and soap. Mostly, 64.0% of those tested positive to H. pylori did not experience abdominal pain in the last 4 weeks. No significant association existed between drinking water source, hand washing practice after defecation and H. pylori positivity. Routine examination of school students is required to detect Helicobacter pylori in order to commence treatment immediately and awareness about the H. pylori infection should be increased throughout secondary school to prevent further infection.

Occupational exposures to blood and body fluids (BBF): Assessment of knowledge, attitude and practice among health care workers in general hospitals in Lebanon

Healthcare workers (HCWs) who are employed in traditional health care workplaces face a serious danger that may threaten their life;it is their exposure to blood and body fluids (BBF). In Lebanon, the introduction of a hospital accreditation system has put a particular emphasis on staff safety, and on the evaluation of professional practice (EPP) programs. Methods: A cross-sectional survey was conducted amongst 277 HCWs working in 4 general hospitals in South Lebanon. Objective: 1) describe the prevalence and the risk factors for occupational exposure to BBF among HCWs;2) evaluate knowledge, attitude, and practices of HCW concerning blood-borne pathogens and adherence to universal safety precautions. Results: The mean age of the respondents was 32.14 years (SD = 10.33), 57.4% were females. 43.3% of HCWs expressed that they use gloves all the time for every activeity of care. 67.1% were aware that needles should not be recapped after use;registered nurses and nursing students were more aware than physicians and nursing assistants (nurse) in this subject. 30% of HCWs declared having had at least one occupational exposure to BBF;62.7% of all accidental exposure was reported to the department responsible for managing exposures. Percutaneous injuries were the most frequently reported. Vaccination coverage was 88.4% for hepatitis B, and 48.4% against influenza. The source patient was tested in 43.4% of reported BBF exposures. Accidental exposure to BBF was more frequent in older people (OR = 3.42;p = 0.03) and the more experienced. Subjects working in intensive care unit ward reported more exposure to BBF (OR = 3;p = 0.04). Participants incurring exposure to BBF resorted to different measures after the injury suggesting a lack of a uniform policy for post-exposure prophylaxis. Conclusion: Exposure to BBF represents an important and frequently preventable occupational hazard for HCWs in Lebanon that requires continuous EPP of HCWs, and a comprehensive approach for prevention and management.

Consumption Pattern of Energy Drinks by University of Ibadan Students and Associated Health Risks Factors

Energy drinks are non alcoholic, carbonated beverages claimed to give extra burst of energy for daily obligation. They contain some form of legal stimulants and vitamins which are meant to give consumers short term boost in energy and increase mental alertness. Energy drinks enjoy patronage especially among higher institution students in Nigeria, but little is known about the consumption pattern and possible health risks to consumers. This study was carried out to determine the contribution of four commonly consumed energy drinks to energy intake of University of Ibadan students and the associated health risk factors. A descriptive cross-sectional survey of energy drinks consumption was carried out using a four-stage systematic random sampling technique to select 307 students from six out of nine halls of residence for Undergraduates and the two Postgraduate halls. A validated semi-structured, self-administered questionnaire was used to collect information on socio-demographic characteristics, consumption pattern and frequency, and factors influencing consumption of energy drinks. Samples of the four most commonly consumed energy drinks by the students (Power Horse, Emerge, Red Bull and Matador brands) were purchased from different stores within and around the University of Ibadan campus. Composite samples of all the four energy drinks (with at least six months expiration date) were analysed for physico- chemical characteristics, gross energy, minerals and B-vitamins content in triplicate using standard methods of AOAC. Data were analysed using descriptive statistics and one way ANOVA, and level of significance set at p < 0.05. Respondents mean age was 23.1 ± 4.6 years, 79.2% were undergraduates and 51.1% were female. Majority (74.6%) of respondents had ever taken energy drinks prior to the study, 42.4% reported consuming at least one can in a week, and 52.1% consumed 1 can at a sitting. Reasons for consumption included to increase: energy (48.2%), mental alertness (18.6%) and athletic performance (9.5%). Reported side effects were: insomnia (14.0%), frequent urination (12.2%), dehydration (11.3%), anxiety (9.1%), heart palpitation (3.5%). Frequency of consumption was significantly associated with gender (p < 0.05). Titratable acidity, total solids and pH of energy drinks ranged between 7.57 ± 0.60 - 8.28 ± 0.08, 7.57 ± 0.60 - 11.42 ± 0.31, and 3.36 ± 0.08 - 3.81 ± 0.12 respectively. Glucose, sucrose, and gross energy content ranged between 7.77 ± 0.01 - 7.89 ± 0.01 g, 22.61 ± 0.07 - 23.74 ± 0.09 g, and 43.59 ± 0.38 - 48.89 ± 0.28 kcal/100g respectively. Few respondents knew about the ingredients and potential health risks associated with energy drink consumption. All the four drinks had acidic pH, hence nutrition education on reduction of energy drink consumption is needed among these students.

Health related quality of life of university students in Lebanon: Lifestyles behaviors and socio-demographic predictors

Measuring and monitoring health related quality of life (HRQoL) in youth are important for both researchers and decision makers. During the time that young people are at university, many will encounter a number of academic, as well as social, emotional and psychological difficulties. The aims of this study are to: 1) assess the health related quality of life of youths using SF-36 questionnaire and its factor determinants, and 2) provide an objective basis for a health promotion structure. Methods: This is a cross-sectional study in South Lebanon, in a population of 282 young university students attending a public university which is the largest and most widespread institution of higher education in Lebanon. Socioeconomic and lifestyle behaviors data were collected. Students’ HRQoL was measured using the SF-36 Health Survey. Results: The mean age of the respondents was 18.7 years (SD = 1.16), 80.1% were women, 64.5% were living in rural area. The proportion of current smokers was significantly greater among men than women (26.8% vs. 11.5%, p < 0.01). Water pipe was the main type of smoking. Education of the fathers had negatively influenced HRQoL. Younger age scored higher in Social Functioning and Role-Emotional;the area of residence had no influences on SF-36 scales scores. Females had poorer HRQoL than males especially in mental health scales. Smokers had low Vitality and Mental Health scores. Sedentary lifestyle was linked to a lower score of Physical Functioning (β = -5.16, 95% CI = -7.67 -2.65), and Vitality ( β= -5.85, 95% CI = -10.24 -1.45). The HRQoL of the students studying business and economics was higher than those studying health. Conclusion: Youths’ HRQoL is affected by socio-demographic and behavioral characteristics. Effective health-promoting actions, social support, and counseling services should be implemented in the campus and are a necessary step towards the main goal of improving the overall HRQoL of the university young students in Lebanon.

Health and Safety Challenges, and Perceptions of Private Sector Waste Operators in Lagos, Nigeria

This study assessed the knowledge, and perceptions on safety measure practices and challenges of private sector participation (PSP) operators on solid waste management in Lagos State, Nigeria. This was a cross-sectional study and utilized interviewer administered questionnaire. The study employed purposive sampling among 256 PSP operators. Data were analyzed using descriptive statistics, Pearson’s product moment and multiple regression analysis correlation at 5% level of significance. Respondents’ age was 35.7 ± 4.2 years, and included 78.5% male. About 55.9% of the respondents spent up to 5 years in the waste management operations. Some 44.9% had at least completed secondary school education. A good knowledge of waste management was exhibited by 68.4% of the respondents. The respondents who had spent 16 years and above in waste management operations were more knowledgeable (8.0 ± 2.1) compared to those who had spent lesser time

Electromagnetic Radiation Exposure from Nearby Cellular Base Stations in the Gaza Strip, Palestine: A Concern for Public Health

The widespread mobile station’s antennas and the continued increase in the number of mobile phones users throughout the Gaza strip causing great panic in the population relating the debate overexposure to electromagnetic radiation EMR emitted from the antennas of mobile base stations. Therefore, this study was conducted to measure the levels of electromagnetic radiation emitted from the antennas of cellular base stations in Gaza governorate as well as to evaluate the citizen’s awareness and practices regarding potential health risks and mitigation methods of exposure to electromagnetic radiation emitted from cellular base stations, respectively. Fifty cellular base stations out of 197 stations were selected depending on the criteria of selecting one site per kilometer using Global Positioning System (GPS). Electromagnetic power density, electric field strength, and the magnetic field strength emitted from cellular base stations were measured using Narda-550. Assessment tool for observation was used to collect operational information of each station. A structured questionnaire with four-level Likert rating scale was used to survey 384 mobile phone users from the areas surrounding the selected cellular base stations. The results showed that the electromagnetic radiation levels of all stations were low and less than the national and international acceptable limits. Furthermore, the awareness of participant about health risks that could result from exposure to electromagnetic radiation emitted from cellular base stations and mobile phones was low. Nevertheless, the participant’s practices in mitigating the adverse impacts of electromagnetic radiation emitted from cellular base stations and mobile phones on their health were good.

Exposure to Emissions from Kerosene Cooking Stoves and the Pulmonary Health Status of Women in Olorunda Community, Ibadan, Nigeria

Exposure to high PM10 by women and children for hours on a daily basis in poor ventilated kitchen may lead to respiratory morbidity among this vulnerable group. In Nigeria, data on the levels of air pollutants associated with kerosene stove combustion are very scarce. Like-wise little had been documented on the pulmonary health of women exposed to kerosene stove emission. This study was carried out to measure the levels of kerosene combustion emissions within kitchen environments and also assess the pulmonary function status of the exposed women at baseline. Particulate matter (PM10) and gaseous emissions (GE) were measured in six purposively selected clusters of regular kerosene stove users (KSU) using gravimetric sampler and gas monitors, respectively and their values compared with WHO guideline limits. 167 randomly selected KSU were surveyed to elicit their socio demographic features. A spirometer was used to assess the lung function status (FEV1) of 72 KSU in six neighbourhood kitchen clusters. Data were analysed using descriptive statistics, and Pearson’s correlation tests. Respondents’ mean age was 38 + 12.9 years. Mean duration of exposure to GE was 18.9 + 9.8 years. Mean PM10 was 248.1 + 14.1 μg/m3 and ten folds higher than WHO guideline limit of 25 μg/m3. Mean GE in ppm were: CO (0.00), CO2 (200.1 + 12.4), SO2 (0.01 + 0.00) and NO2 (0.00). Mean FEV1 among KSU was 2.0 + 0.5 litres which was significantly lower than the mean predicted value of 2.7 ± 0.5 litres. There was a negative correlation between PM10 and FEV1 (r = -0.7539, p > 0.05). Safer cooking methods and practices to obviate health hazards are advocated.

The role of veterinarians in the One Health approach to antimicrobial resistance perspectives in Jordan

This study aims to evaluate the role of Jordanian veterinarians in terms of their knowledge,attitudes and common practices in combating antimicrobial resistance(AMR)and summarize the registered veterinary drugs between 20172020.Descriptive study data were collected using a standardized questionnaire that focused on the knowledge,attitudes,and practices of Jordanian veterinarians.The findings were analyzed descriptively;84%of the participants agreed with the statement on the definition of AMR.The majority(95.65%)of participants agreed that AMR is a challenge for the veterinary sector in Jordan and that it should be prioritized over other zoonotic diseases.Approximately 69%of the participants believed that the misuse and overuse of antimicrobials by unqualified,fraudulent,or unauthorized practitioners is the primary reason for the rise of cases associated with AMR and the challenges that accompany these.The most common practice among the respondents in this study was to recommend clients(e.g.,farmers and owners)to practice good animal husbandry(80.00%).The study also revealed that there was a significant difference(p=O.015)between attendance at AMR training sessions and the professional sector(private,public,and academic)of the veterinarians.This study underscores the importance of implementing a continuous education program on AMR so as to enhance the all-round knowledge of veterinarians and improve their advisory skills.In addition,laws should be enacted to ensure that veterinarians prescribe the correct antimicrobials and to improve surveillance systems for monitoring the use of antimicrobials in veterinary medicine.

Epidemiological Aspects and Compliance with Post-Exposure Prophylaxis of People Bitten by a Dog and Received at the Buanionzi State Health Center in Boma, DR Congo

Objective: To describe and analyze the epidemiological aspects as well as the observance of post-exposure prophylaxis (PEP) of people bitten by a dog and received at the Buanionzi State Health Center from 2014 to 2017. Methods: Descriptive cross-sectional study which took place in two stages. The first interview was an interrogation carried out at the health Center until surgical trimming (100% of cases) followed by PEP (70.3% of cases) according to the Essen protocol. The second time was a 24 h telephone interview after a missed appointment for a dose of PEP. Results: The prevalence was 5.6 bites/10.000 people. The average age was 26.4 ± 18.3 years. Age ≤ 26 years was more concerned with 59.3% of cases (p = 0.006) in which children Conclusion: The rabies risk is potential in Boma. Efforts in terms of public health strategies must be made to reduce it.

Trends and Factors Associated with Changes in Early Initiation of Breastfeeding: Analysis of the Tanzania Demographic and Health Surveys 2004-2016

Background: Despite WHO recommendations on the benefits of early initiation of breastfeeding for both the mother and child, only 53.5% of newborns in Tanzania are breastfed within the first hour of life. The trend for early initiation of breastfeeding shows little progress and Tanzania is still far behind reaching the global recommended rate of 70% of early initiation of breastfeeding. This study aims to determine trends and factors associated with changes in the early initiation of breastfeeding in Tanzania from 2004-2016. Methodology: This was an analytical cross-sectional study utilizing secondary data from the Tanzania Demographic and Health Surveys (TDHS) for the years 2004-2005, 2010, and 2015-2016. Data analysis was performed using Stata 15. Frequencies and proportions were used to summarize categorical variables. A Modified Poisson regression model was used to determine factors associated with the early initiation of breastfeeding. Multivariable Poisson decomposition analysis was used to assess factors associated with changes in the early initiation of breastfeeding across surveys. Results: Trends in early initiation of breastfeeding decreased from 59.53% in 2004/2005 to 46.72% in 2010, and then increased to 51.94% in 2015/2016. Only 5.9% of the overall change in early initiation of breastfeeding was contributed by the difference in characteristics such as mode of delivery and working status. The difference in coefficients contributed to a 94% decrease in early initiation of breastfeeding mostly due to a decrease in early initiation of breastfeeding among caesarean section delivery patients. Conclusion: The prevalence of early initiation of breastfeeding in Tanzania decreased between 2004 and 2016, then increased from 2010-2016. Interventions and health policies need to target factors that had significant effects on the early initiation of breastfeeding such as increasing health facility delivery and promoting the initiation of breastfeeding soon after caesarean section delivery.

Long-term effectiveness,outcomes and complications of bariatric surgery

Dietary imbalance and overeating can lead to an increasingly widespread disease-obesity.Aesthetic considerations aside,obesity is defined as an excess of adipose tissue that can lead to serious health problems and can predispose to a number of pathological changes and clinical diseases,including diabetes;hypertension;atherosclerosis;coronary artery disease and stroke;obstructive sleep apnea;depression;weight-related arthropathies and endometrial and breast cancer.A body weight 20%above ideal for age,gender and height is a severe health risk.Bariatric surgery is a set of surgical methods to treat morbid obesity when other treatments such as diet,increased physical activity,behavioral changes and drugs have failed.The two most common procedures currently used are sleeve gastrectomy and gastric bypass.This procedure has gained popularity recently and is generally considered safe and effective.Although current data show that perioperative mortality is low and better control of comorbidities and short-term complications is achieved,more randomized trials are needed to evaluate the long-term outcomes of bariatric procedures.This review aims to synthesize and summarize the growing evidence on the long-term effectiveness,outcomes and complications of bariatric surgery.