Journal of Public Health and Development

Mercury exposure from fish consumption: A systematic review and meta-analysis of health risks and effects in urban vs. rural settings

Aqsa Aufa Syauqi Sadana — 2026-08-31

Mercury presents a significant environmental health hazard due to its ability to bioaccumulate in the food chain, posing risks through the consumption of contaminated fish. This systematic review aims to analyze and compare mercury levels in human populations, specifically focusing on the health risks associated with fish consumption in urban versus rural areas. The review followed PRISMA guidelines and included articles published between January 1, 2020 and March 15, 2025 from PubMed, Scopus, and ScienceDirect. A total of 768 articles were identified, and seven studies met the inclusion criteria. Data extraction was performed, and study quality was assessed using the JBI checklist and risk of bias assessment with ROBINS-E. Data were extracted and synthesized using RevMan 5.4 for the meta-analysis. The meta-analysis showed substantially higher mercury levels in rural populations (SMD 2.76; 95% CI: 2.63–2.89), largely influenced by dietary patterns, predominant fish species, and environmental contamination levels. Health effects associated with elevated mercury exposure included neurodevelopmental risks, elevated mercury levels in pregnant women, and increased vulnerability among populations with high reliance on freshwater fish. These findings highlight the need for targeted public health strategies to mitigate mercury exposure while maintaining the nutritional benefits of fish consumption.

Mapping Global Media and Communication Strategies in Adolescent Reproductive Health Promotion: A Scoping Review

Najma Afifa — 2026-08-31

Reproductive health issues among adolescents remain a global public health challenge due to high rates of adolescent pregnancy and sexually transmitted infections (STIs), limited access to contraception, and low levels of sexual health literacy. Current technological developments provide opportunities to expand the use of media and communication to promote adolescent sexual and reproductive health (ASRH). This scoping review synthesizes global media strategies and communication mechanisms for promoting ASRH. The procedure began with a comprehensive search of Scopus, ScienceDirect, EBSCOhost, and PubMed for studies published between 2020 and 2025, using the Arksey and O'Malley framework and the PRISMA-ScR checklist. A total of 10 peer-reviewed studies met the inclusion criteria, with a focus on adolescents as the primary recipients of the intervention. The critical appraisal using the Joanna Briggs Institute (JBI) tool covered qualitative studies, prevalence studies, cross-sectional studies, and RCTs. The findings identified three strategies: digital media, educational entertainment, and peer or expert hybrid models. Most studies report improvements in knowledge, attitudes, self-efficacy, and parent-adolescent communication, although behavioral changes such as condom use and HIV testing remain limited. These findings indicate that communication mechanisms involving digital interactivity, entertainment narratives, and social learning play an important role in shaping the acceptance of SRHR information. However, the effectiveness of global strategies cannot be fully generalized to the Indonesian context due to differences in digital readiness, cultural norms, and access to services. Policy implications include the need for improved digital literacy, strengthened youth-friendly services, and cross-sector collaboration. Further research is needed to evaluate the long-term impact of interventions and identify the most relevant communication approaches for adolescents in diverse local contexts.

Digital nutrition interventions and dietary adherence outcomes in Indonesia: A systematic review

Muh Siddik Ibrahim — 2026-08-31

The growing burden of diet-related diseases in Indonesia highlights the need for innovative strategies to improve dietary behaviors. Digital nutrition interventions, including mobile applications and tele-nutrition services, have emerged as potential tools to support dietary adherence; however, evidence from the Indonesian context remains fragmented. This systematic review aimed to synthesize existing evidence on the effectiveness of digital nutrition interventions in improving dietary adherence and nutrition-related outcomes in Indonesia. A systematic review was conducted following the PRISMA 2020 guidelines. Articles published between 2015 and 2025 were retrieved from PubMed, ScienceDirect, and SpringerLink. Eligible studies included empirical research evaluating digital nutrition interventions among Indonesian populations and reporting dietary or nutrition-related behavioral outcomes. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Ten studies met the inclusion criteria, encompassing a total of diverse population groups, including adolescents, pregnant women, caregivers, and community health workers. The reviewed interventions included mobile-based applications, web-based platforms, tele-nutrition services, and messaging-based tools. Early evidence suggests that these interventions were associated with short-term improvements in nutrition knowledge, dietary diversity, and self-monitoring behaviors, with several studies reporting statistically significant effects compared to baseline or control conditions. However, the magnitude and consistency of outcomes varied across studies. Quality appraisal indicated that two studies were of high methodological quality, while eight were rated as having moderate quality. Overall, early evidence suggests that digital nutrition interventions may support dietary adherence and positive nutrition-related behaviors in Indonesia, particularly when combined with professional support. Further high-quality, longitudinal studies are needed to assess long-term impacts, scalability, and integration within national nutrition and primary health care systems.

The implementation of health coaching among people with mental disorders: A scoping review

Andriani Andriani — 2026-08-31

People with mental disorders often face the complexity of both physical and mental health issues which can cause various negative impacts on patients and those around them. Therefore, appropriate strategies are needed to overcome these various impacts. Health Coaching is an appropriate strategy to address these issues. This scoping review aims to explore existing research about the implementation of health coaching for people with mental disorders (benefits and implementation methods). The search for articles was conducted across several databases, namely Scopus, Embase, PubMed, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), and citation searching. We used review guidelines from The Joana Briggs Institute (JBI). We utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidelines to ensure that this review is systematic, structured, transparent, and used ‘Convidence Support’ tools to organize and analyze the data. Searches turned up 708 studies. Twenty studies were found for data extraction and analysis after the full-text review process. Information was compiled and shown in 3 themes for benefits (reduced symptoms and improved mental health, improved physical activity and healthy, and effectiveness-economics benefits) and 2 for implementation methods (delivery modes and techniques). The analysis of 20 articles led to the conclusion that health coaching can be a tactical choice that improves the mental illness patients' physical and psychological circumstances. This is due to the various benefits of health coaching and its highly diverse methods of implementation, both in terms of delivery modes and techniques.

Effects of a Yoga–DASH Diet program on blood pressure in older adults with hypertension in Bangkok Communities

Warissara Mangkalad — 2026-08-31

This randomized controlled trial research was aimed at exploring the effectiveness a yoga-DASH diet program applying a revised self- and family management framework on blood pressure for older adults with hypertension in communities in Bangkok. The sample consisted of 106 male and female older adults with hypertension aged 60–75 years and living in Bangkok communities. The sample was obtained by computerized multi-stage sampling. The participants were randomly assigned to either an experimental group or a control group, with 53 individuals in each group. The control group performed normal daily routines, while the experimental group participated in the yoga-DASH diet program for eight consecutive weeks. The program included hypertension education, the DASH diet, ten yoga poses, provision of a handbook, and home visits. The experimental group practiced ten yoga poses and followed the DASH Diet once a week for 8 weeks. The data collection tools included a personal information questionnaire, a DASH diet and yoga practice log, and an automatic blood pressure monitor. All instruments were checked for validity and reliability. The researcher analyzed data before and after the experiment using descriptive analysis, independent t-test and paired t-test statistics.

The findings revealed that the older adults with hypertension in the experimental group who participated in the program had significantly lower mean systolic and diastolic blood pressure compared to both baseline and the control group. Paired t-tests showed significant reductions after the intervention in the experimental group (SBP: t = 19.34; DBP: t = 4.78; p < .001), and independent t-tests confirmed significantly lower values compared to the control group (SBP: t = 24.41; DBP: t = 20.75; p < .001).

Factors predicting self-protective behaviors against PM2.5 exposure among rural community-dwelling older adults in the Central Region of Thailand: A cross-sectional study

Winthanyou Bunthan — 2026-08-31

Health problems resulting from exposure to Particulate Matter 2.5 (PM2.5) have been increasing rapidly, especially among vulnerable groups such as older adults. This cross-sectional survey research aimed to examine the level of self-protective behaviors and the factors predicting such behaviors against PM2.5 exposure among 885 rural community-dwelling older adults in the central region of Thailand. The research instruments consisted of three parts: 1) a demographic questionnaire for older adults including related modifying factors; 2) a questionnaire assessing predictive factors based on the six-dimension Health Belief Model, including perceived risk of health problems, perceived severity of health problems, perceived benefits of self-protection, perceived barriers to self-protection, perceived self-efficacy, and perceived cues to action; and 3) a questionnaire on self-protective behaviors against PM2.5 exposure. The data were analyzed using descriptive statistics and stepwise multiple regression analysis.

The results revealed that the mean score for overall self-protective behaviors against PM2.5 exposure among Thai rural community-dwelling older adults was at a good level (µ = 2.23, σ = 0.61). Factors based on the Health Belief Model, including age, perceived benefits of prevention, perceived barriers to prevention, perceived self-efficacy, and perceived cues to action, jointly predicted self-protective behaviors against PM2.5 exposure, accounting for 57.00% of the variance, with statistical significance at .05 (R² = .570, p < .001). Based on the findings, healthcare providers should incorporate these predictive factors when designing interventions aimed at modifying health behaviors to effectively prevent health problems and diseases caused by PM2.5 exposure among Thai rural community-dwelling older adults.

Food consumption behaviors among preschool children from ethnic minority groups in child development centers, Chiang Rai, Thailand: A qualitative study

Thapakorn Ruanjai — 2026-08-31

Dietary behaviors during early childhood play a crucial role in shaping long-term health, growth, and cognitive development. Among ethnic minority groups in northern Thailand, disparities in food access, cultural practices, and parental nutrition knowledge may contribute to inappropriate food consumption patterns. Understanding these behaviors within community childcare settings is essential for designing culturally responsive nutrition interventions. This study aimed to explore food consumption behaviors and their influencing factors among preschool children aged 2–6 years from ethnic minority groups attending child development centers in Chiang Rai Province, Thailand. A qualitative study design was employed. Purposive sampling was used to recruit 30 teachers and caretakers from nine child development centers in Mae Fah Luang District, Chiang Rai Province. Data were collected through nine focus group discussions guided by semi-structured interview questions. Transcripts were analyzed thematically following Braun and Clarke’s six-phase framework.

Two major themes emerged from the analysis. Food consumption behaviors included reliance on snacks and milk as the main food source. Food was provided by the centers, which allowed children to engage in selective eating. Factors influencing consumption behaviors included cultural traditions, socioeconomic constraints, and the influence of media and advertising on children’s food preferences. Preschool children from ethnic minority communities exhibited diverse and culturally influenced dietary behaviors. These findings highlight the importance of culturally sensitive nutrition education and participatory, school-based programs involving teachers, caretakers, and media literacy components to foster healthier eating habits among young children.

Determinants of low birthweight in Indonesia: a provincial-level ecological study

Andi Kustanto — 2026-08-31

Low birthweight (LBW; <2500 g) serves as a significant indicator of maternal and fetal health, with implications for predicting mortality, stunting, and the development of chronic conditions in adulthood. Inadequate maternal nutrition during pregnancy is a key contributing factor to LBW. However, the determinants of LBW are complex and context-specific, and evidence at the subnational level in Indonesia remains limited. This ecological study aimed to analyze the determinants of LBW in 34 provinces of Indonesia from 2019 to 2023 using panel data analysis. The results of this study indicated that the factors that significantly influenced the decline in LBW were antenatal care visits 4+ (ANC4+), antenatal care visits 6+ (ANC6+), diphtheria, tetanus, and pertussis (DTP) immunization, iron supplement consumption, supplementary feeding programs for pregnant women, health insurance, mean years of schooling, social assistance, sanitation, public health centers, hospitals, and midwives. The factors that significantly influenced the increase in LBW cases were unemployment, early marriage, smoking, and forest fires. These determinants spanned the health system and socioeconomic, environmental, and climatic domains, reflecting the multidimensional nature of LBW at the provincial level in Indonesia. Policy recommendations focus on two areas. First, health service-level interventions include strengthening health infrastructure and resources, integrating cross-sectoral LBW case surveillance data, and implementing performance-based budget allocation in priority provinces. Second, interventions should address socioeconomic and environmental determinants by improving living standards and employment opportunities, implementing conflict-of-interest tobacco control governance, and mitigating air pollution. Further ecological studies should utilize microeconomic data, analyze them quantitatively, and systematically explore them using a qualitative approach.

Risk factors for tuberculosis and diabetes mellitus comorbidity in West Sumatra, Indonesia: A matched case-control study

Irwan Ashari — 2026-08-31

The comorbidity between tuberculosis (TB) and diabetes mellitus (DM) (TB-DM) is a growing public health issue globally. Patients with TB-DM tend to experience more severe disease, including an increased risk of death, treatment failure, and pulmonary complications. This study aims to analyse the sociodemographic, clinical, and environmental risk factors that influence the prevalence of TB-DM comorbidity in West Sumatra Province. This study used a matched case-control study design. The population in this study consisted of TB-DM patients recorded in 2024. The study sample consisted of 830 people in the case group (TB-DM) and 830 people in the control group (TB). The sampling technique used was total sampling. Statistical tests used the McNemar test and Conditional Logistic Regression. Significant risk factors for tuberculosis and diabetes mellitus (TB-DM) comorbidity are age (OR = 11.500; 95% CI: 8.39–15.76, p = 0.0001), occupation (OR = 1.559; 95% CI: 1.201–2.022, p = 0.0001), pulmonary tuberculosis (OR = 6.615; 95% CI: 3.692–11.853, p = 0.0001), and history of TB treatment, with patients who had a history of relapse being at higher risk (OR = 2.857; 95% CI: 1.857–4.393, p = 0.0001). Meanwhile, residential area and referral status did not show significant differences, with ORs of 1.218 (95% CI: 0.852–1.740, p = 0.277) and 1.246 (95% CI: 0.899–1.727, p = 0.185), respectively. In the final model, age (OR = 11.031; 95% CI: 8.014–15.185) and type of tuberculosis (OR = 4.895; 95% CI: 2.327–10.296) remained significant as risk factors for TB-DM comorbidity. Age, occupation, type of tuberculosis, and history of TB treatment are significantly associated with tuberculosis and diabetes mellitus (TB-DM) comorbidity. It is important to conduct early screening for diabetes in TB patients and to manage both diseases simultaneously to improve treatment outcomes and reduce morbidity and mortality.

Work and non-work concerns and impact on healthcare workers during the COVID-19 first wave in Brunei Darussalam: Identifying key risk groups for targeted support

Ashish Trivedi — 2026-08-31

Healthcare workers (HCWs) played an integral role as front-line essential workers during the COVID-19 pandemic. They were at high risk of COVID-19 transmission and faced psychological effects of fatigue and burnout, which ultimately influenced their participation and performance during the pandemic. This study was conducted to assess work and non-work concerns and the impact of COVID-19 on HCWs in Brunei Darussalam. A cross-sectional study using a web-based and self-administered questionnaire was conducted from July to August 2020, with 511 HCWs in Brunei Darussalam. Data were analysed for associations between demographic profile and perceived work, non-work concerns, and impact of the outbreak on the HCWs during the first wave of the COVID-19 pandemic. The risk of acquiring COVID-19 (79.8%) and the risk of transmission to family members (90.8%), friends (88.6%) and colleagues (87.2%) were the primary concerns reported by HCWs. Additionally, 62.8% reported being tasked with additional work duties, 59.2% experienced increased workload, 54.5% experienced feeling stressed, and 45.5% felt the effects of manpower shortages. Multivariate analysis showed higher work concerns among doctors (OR=2.29, CI:1.14-4.61), nurses (OR=2.47, CI:1.37-4.48), and those working in hospitals (OR=3.22, CI:1.54-6.73), health centres/clinics (OR=3.82, CI:1.78-8.18), and the National Isolation Centre (OR=6.16, CI:1.97-19.2). HCWs reporting stigma and discrimination had greater non-work concerns (OR=1.74, CI:1.09-2.79) and perceived impact (OR=4.57, CI:2.82-7.46). In conclusion, front-line HCWs, such as medical and nursing staff working in hospitals and health centres, reported higher work concerns compared to allied health professionals and support staff. The majority of HCWs experienced staff shortages, increased workload, and stress due to the demands of the pandemic. These findings highlight the need for targeted organisational and psychosocial support measures and increased awareness for frontline HCWs to improve their resilience during such health crises.

Factors associated with parental stress among mothers of school-age children in rural Bangladesh

Yorin Watabe — 2026-08-31

Given the paucity of studies on parental stress among mothers with school-age children in low- and middle-income countries (LMICs), this study examined the association between maternal parental stress and child characteristics including behavioral and psychosocial difficulties and growth status in rural Bangladesh. A total of 617 mother–child dyads were recruited and interviewed using structured questionnaires in Lohagora Upazila, Narail District, Bangladesh. Maternal stress was measured with the Parental Stress Scale (PSS). Multiple linear regression analysis was performed to understand the relationship between the PSS scores and children’s factors including Strength and Difficulties Questionnaire (SDQ)-Total Difficulties Score (TDS), growth status and gender. The analyzed covariates included the mothers’ socio-demographics and distribution of the maternal and child health (MCH) handbook. Results showed that higher SDQ-TDS and stunting were significantly associated with higher maternal parental stress. Distribution of the MCH handbook had a modifying effect on the SDQ-TDS factors. In subgroup analysis of a multiple regression model, the partial regression coefficient of SDQ-TDS was 0.308 (p<0.001) in the MCH handbook group and 0.542 (p<0.001) in the non-MCH handbook group. SDQ-TDS was significantly associated with PSS in both the MCH handbook and the non-MCH handbook groups; these partial regression coefficients were statistically different (interaction p=0.012). PSS among mothers in nuclear families and those with more monthly expenditure were significantly higher in covariate variables. Results suggested that children’s behavioral and psychosocial difficulties and stunting were associated with the mother’s parental stress. Although SDQ-TDS was the factor most affecting maternal parental stress, having the MCH handbook moderated its influence on parental stress level. More research is needed to understand effective support for mothers experiencing higher stress due to their children’s difficulties and growth, including the role of the MCH handbook.

Effects of a structured nutrition literacy enhancement program on the knowledge, skills, and dietary behaviors of village health volunteers in Rural Thailand: Single-group repeated-measures evaluation

Somhwang Sakunsenanarong — 2026-08-31

Non-communicable diseases represent Thailand's predominant health challenge, with nutrition-related factors critically influencing disease prevention. Village health volunteers (VHVs) serve as essential healthcare intermediaries connecting Thailand's primary care system to rural communities but demonstrate insufficient nutrition literacy competencies. This single-group repeated-measures study evaluated a structured 12-week nutrition literacy enhancement program among 35 VHVs in rural Thailand from July to October 2024. The intervention comprised interactive workshops, peer learning sessions, and community-based activities grounded in Social Cognitive Theory and Adult Learning Theory. Validated instruments assessed three nutrition literacy domains (functional, interactive/communicative, and critical), nutrition knowledge, and dietary behaviors at baseline and weeks 4, 8, 12, and 16. Linear mixed-effects models with random intercepts and AR(1) covariance structures were used to analyze trajectories. Significant improvements occurred across all domains: Knowledge increased 60.3% (β=0.52, 95%CI: 0.48-0.56, p<.001), functional literacy improved 26.4% (β=0.24, 95%CI: 0.21-0.27, p<.001), interactive/communicative literacy increased 24.8% (β=0.22, 95%CI: 0.19-0.25, p<.001), critical literacy enhanced 23.5% (β=0.21, 95%CI: 0.18-0.24, p<.001), and dietary behaviors improved 25.1% (β=0.23, 95%CI: 0.20-0.26, p<.001). Cross-sectional correlations at follow-up ranged from r=0.60 to r=0.73. This theory-based nutrition literacy program effectively improved VHV competencies, supporting its integration into Thailand's VHV training curriculum to strengthen community-based NCD prevention.

The role of the Inflammatory Cytokine Interleukin-6 (IL-6) in moderating the relationship between pesticide exposure and metabolic syndrome in vegetable farmers

Bibit Nasrokhatun Diniah — 2026-08-31

Pesticide exposure has been associated with metabolic syndrome (MetS). However, the moderating role of inflammatory cytokines, such as interleukin-6 (IL-6), remains unclear. This study examined how IL-6 moderates the relationship between acetylcholinesterase (AChE) activity, as a pesticide-exposure biomarker, and the risk of MetS among vegetable farmers. We conducted a case–control study involving 134 male farmers (44 MetS cases and 90 controls) selected from a 13-week population screening of 307 farmers in Kuningan, West Java from January to May 2025. Exposure was assessed through the measurement of acetylcholinesterase (AChE) activity, while IL-6 served as an inflammatory biomarker. MetS was diagnosed according to the International Diabetes Federation criteria. Venous blood samples were collected twice for AChE analysis and once for IL-6 measurement. Moderation analysis using linear regression with the PROCESS Macro SPSS revealed that IL-6 significantly moderated the effect of AChE on waist circumference (WC), systolic and diastolic blood pressure (BP), and MetS. The conditional effect of AChE on MetS according to IL-6 values increased with high inflammation (B = 0.0031, p = 0.0004 for WC; B = 0.0059, p = 0.0008 for systolic BP; B = 0.0027, p = 0.0064 for diastolic BP; and B =-0.0009, p = 0.0041 for MetS). Scatter plot patterns further supported the biological plausibility of this moderating mechanism. IL-6 modifies the strength and direction of the inflammatory response, enhancing the impact of pesticide exposure on key MetS components. These results underscore the central role of IL-6 in the cholinergic pathway and indicate that lowering chronic low-dose pesticide exposure may reduce inflammation-related metabolic risks.

Development and psychometric evaluation of a quality of work life scale for professional nurses in primary care

Wasana Boonyamanee — 2026-08-31

Quality of Work Life (QWL) significantly impacts nurse retention, organizational effectiveness, and healthcare delivery. This research centered on the development and psychometric evaluation of an instrument designed to measure the QWL of professional nurses in Thailand's primary care facilities. The evaluation focused on establishing its content validity, construct validity, and reliability. A sample of 400 professional nurses was selected via multi-stage sampling from primary healthcare units in Thailand. The instrument's content was synthesized from various QWL theories. Utilizing a mixed-methods approach, the study began with semi-structured interviews with subject matter experts. The qualitative data gathered from these interviews were subsequently validated through triangulation. These findings informed the development of the quantitative structured questionnaire.

The developed instrument underwent rigorous validation. The final 77-item, 8-dimension instrument, structured as a 5-point Likert-scale questionnaire, demonstrated a Content Validity Index (CVI) of 0.82 and a Cronbach’s alpha of 0.886. Exploratory factor analysis (EFA) revealed a Kaiser-Meyer-Olkin (KMO) value of 0.901 and a significant Bartlett’s Test of Sphericity (p < 0.001). Varimax orthogonal rotation yielded eight components with eigenvalues greater than 1, explaining 67.28% of the total variance. Confirmatory factor analysis (CFA) indicated a strong model fit (χ² = 523.472, df = 160, p = 0.056; CFI = 0.972; SRMR = 0.035; RMSEA = 0.045). The integration of qualitative insights from expert interviews supports the conclusion that the new QWL instrument corresponds effectively with empirical data. It demonstrates robust reliability and validity while also reflecting the unique context of professional nurses in primary care. Nursing policymakers can utilize this tool to monitor and improve the QWL among nurses, potentially leading to enhanced job satisfaction, retention, and healthcare service quality.

Development and evaluation of an application-based system with LINE chatbot for pesticide-exposure risk assessment among sugarcane farmers

Peanthip Srisutam — 2026-08-31

This study developed and evaluated a mobile application integrated with a LINE chatbot for assessing pesticide-use behaviors and related health risks among rice and sugarcane farmers in Thailand. A research and development (R&D) design combined with a quasi-experimental approach was applied, using the standardized assessment tool of the Department of Disease Control. Expert evaluation (n=3) confirmed strong content validity (IOC =0.67–1.00) and reliability testing with30participants(n=30), including health officers and volunteers (Cronbach’s alpha 0.729), Indicated very high satisfaction, particularly regarding convenience, clarity of results, and applicability. Field testing with 125 farmers (n=125) showed that unsafe practices were highly prevalent, including self-spraying herbicides (85.6%), not reading labels (82.4%), and not washing hands before meals (81.6%). Symptom monitoring revealed that 74.6% of farmers reported health problems, mainly at moderate severity (55.1%), with dizziness, nausea, and abdominal pain being common. Overall risk assessment classified 38.9% of farmers as high risk, 27.1% as moderately high risk, and only 7.9% as low risk. The application significantly reduced assessment and reporting time compared with paper-based methods (mean total time: 22.6 vs. 3.2 minutes, p<0.001). These findings suggest that the developed tool enhances efficiency, supports real-time health risk communication, and can serve as a scalable digital health prototype for agricultural occupational safety.

Spatial determinants of disability prevalence in Myanmar: A district-level spatial regression analysis

Ei Sandar U — 2026-08-31

Myanmar, a country with a significant number of persons with disability, needs an understanding of the variation in disability prevalence and its determinants for efficient intervention strategies. This study aims to identify geographic patterns and spatial determinants of disability prevalence across Myanmar's districts. This cross-sectional spatial analysis utilized data from Myanmar's 2019 Inter-Censual Survey covering all 80 districts. Getis-Ord Gi* statistics were employed to discover spatial patterns and identify district-level clusters of disability prevalence. Beyond traditional spatial autocorrelation assessment, we applied comparative spatial regression modeling through Spatial Error Model (SEM) and Spatial Lag Model (SLM) to identify determinants of geographic disparities in disability prevalence. Our analytical framework distinguished between demographic vulnerabilities, technological protective factors, and district-level socioeconomic indicators. Heat mapping revealed substantial geographic variation in disability prevalence across Myanmar (ranging from 4.9 to 24.8 per 100 population). Gi* statistics identified eight hotspots and ten cold spots (p < 0.05), demonstrating non-random distribution of disability prevalence. The optimal SEM (R² = 0.579) identified child dependency ratio (β = 0.135, p < 0.001) and old dependency ratio (β = 0.665, p < 0.001) as key determinants. Myanmar's disability landscape is characterized by significant district-level disparities. Demographic vulnerabilities, particularly child and elderly dependency ratios, constitute primary drivers of these disparities. These findings provide an evidence-based geographic framework for addressing disability disparities through targeted intervention and resource allocation rather than uniform approaches

Gamification of health classes: A quasi-experimental study of the diabetes monopoly game to enhance children’s fruit and vegetable interest

Arief Andriyanto — 2026-08-31

Low fruit and vegetable intake among school-aged children poses risks to health and development, often influenced by family habits and limited nutrition education. The Diabetes Monopoly (DIABETAMON) card game was developed as an engaging educational tool to promote balanced nutrition, emphasize the benefits of fruits and vegetables, and raise awareness of the consequences of unhealthy eating in a fun, child-friendly format. The objective of this study was to determine the effect of the DIABETAMON game on the interest in fruit and vegetable consumption among school-age children. A quasi-experimental design was employed, with school-aged children selected through purposive sampling and assigned to an intervention group (n = 47) and a control group (n = 52). Data were collected using a questionnaire, and statistical analysis was performed with a paired-sample t-test (α < 0.05). The results indicated that the intervention group showed a significant increase in interest in consuming fruits and vegetables (p = 0.001), whereas the control group showed no significant change (p = 0.085). The education provided incorporates elements of learning and play, which enhance interest among school-aged children and facilitate faster absorption of information emphasizing the importance of fruit and vegetable consumption. Promotive and preventive initiatives can be implemented within health services, particularly through the School Health Services (SHS). For example, increasing the provision of interactive and engaging health education games can help promote fruit and vegetable consumption among school-aged children.

Risk factors and clinical features associated with death at the COVID-19 isolation ward of Clairwood Hospital/KwaZulu-Natal, South Africa: A retrospective case-control study.

Riziki Ghislain Manimani — 2026-08-31

The COVID-19 pandemic posed significant challenges to healthcare systems worldwide. This study aimed to investigate the risk factors associated with death among patients admitted directly to the COVID-19 isolation ward at Clairwood Hospital. A case-control study was undertaken, involving a total of 400 study participants divided equally into 200 cases (deaths) and 200 controls (survivors). Data were collected retrospectively from medical records and analysed using Chi-square tests, univariate, and multivariate logistic regression. The patients had a mean age of 54.1 years (SD=18.9), with 217(54.2%) being female. A respiratory rate exceeding 20 breaths per minute was documented in 177 patients (44.2%), a heart rate greater than 100 beats per minute in 99 patients (24.7%), and a SpO₂ level below 85% on room air in 79 patients (19.7%). Cough was the most common symptom, occurring in 239 (59.7%) patients, while hypertension was the most prevalent comorbidity, present in 157 (39.2%) patients at the time of admission. Chi-square test analyses demonstrated statistically significant associations between mortality and age, fever, cough, shortness of breath, hypertension, diabetes, chronic kidney disease (CKD), obesity, respiratory rate, heart rate, and oxygen saturation (SpO₂) (all p < 0.05). On multivariate analysis, increasing age (adjusted odds ratio [aOR]: > 60 years: 12.27 [95% CI: 1.27–118.44]), fever (aOR: 2.86 [95% CI: 1.29–6.31]), shortness of breath (aOR: 9.86 [95% CI: 5.64–17.24]), hypertension (aOR: 2.07 [95% CI: 1.05–4.11]), obesity (aOR: 4.68 [95% CI: 1.43–15.28]), were associated with increased odds of death among COVID-19 patients at admission. No statistically significant associations were observed for other variables after adjustment. Proactive measures to identify and manage these risk factors are crucial in reducing mortality rates and enhancing the overall care of COVID-19 patients in isolation wards.

Prevalence and associated factors of depressive symptoms among first-year medical students at Hue University of Medicine and Pharmacy, Vietnam

Bao Tran Nguyen — 2026-08-31

Recent international evidence reveals a high burden of mental disorders among first-year students and highlights negative trajectories during medical training. The WHO-5 Well-Being Index is a concise, validated tool with robust measurement properties for academic settings. In Vietnam, previous studies have predominantly utilized the DASS-21, with limited evidence on WHO-5 screening for first-year medical students. This study aims to describe the prevalence of depressive symptoms (WHO-5) and analyze associated factors with a specific focus on gender differences. A cross-sectional study was conducted among 405 first-year medical and preventive medicine students (July–December 2024). Signs of depressive symptoms were defined as a WHO-5 score < 13. Descriptive statistics, Chi-square tests, and multivariable logistic regression were performed. The mean WHO-5 score was 14.2 (SD = 5.7); 36.5% of participants exhibited signs of depressive symptoms. Female students had a higher risk than males (AOR = 1.538; 95% CI = 1.010–2.342). This is the first study to apply the WHO-5 to first-year medical students in Central Vietnam, revealing a considerable proportion with depressive symptoms and significant gender disparities. Findings highlight the need for early WHO-5 screening and tailored interventions, especially targeting female students.

Rethinking successful aging concepts: Insights from a culturally grounded model among older adults in Odisha, India

Aditya Narayan Das — 2026-08-31

Despite the widespread use of the biomedical model of successful aging, it overlooks the cultural and lived experiences of older adults in low- and middle-income countries, such as India. Therefore, this cross-sectional study aims to empirically test a culturally grounded model of successful aging in India. Using a multistage stratified sampling with a structured interview schedule, this study used 600 older adults aged 60 years and above from Odisha, India. We used a dichotomous measure of successful aging, which includes 1) being free from disability, 2) having high cognitive function, 3) being engaged in physical activity, 4) experiencing social engagement, and 5) having a positive attitude towards physical health. Descriptive statistics and correlation analysis were carried out to present the initial results. An association between successful aging and explanatory variables was carried out by multivariable logistic regression. One in five older adults fulfilled the requirements for successful aging with rural disadvantage. Being highly educated (AOR: 8.47; 95% CI: 2.89-24.82), having higher wealth (AOR: 4.86; 95% CI: 1.14-20.68), and living with a spouse only (AOR: 8.51; 95% CI: 1.91-37.98) had higher odds of successful aging. Positive psychology towards physical health had a strong positive correlation with successful aging (r = 0.68, p<0.001), whereas disability was found to have a significant negative correlation (r = -0.61, p<0.001). These findings highlight the inadequacy of universalist, biomedical definitions in capturing the lived experiences of Indian older adults, where education, familial roles, and wealth status were integral for successful aging. Policies should support family- and community-centered aging policies, including incentives for intergenerational co-residence and caregiving, which can foster stronger social support networks and improve overall well-being in later life. Additionally, there is a need for further qualitative studies to understand how older adults in rural Odisha define and perceive successful aging.

A covariance-based structural equation model of structural pathways influencing the performance of village health volunteers in Kranuan District, Khon Kaen, Thailand

Ratchaneekon Khueacharee — 2026-08-31

This cross-sectional study aimed to develop and test a model explaining the performance of Village Health Volunteers (VHVs) in Kranuan District, Khon Kaen Province, Thailand. VHVs are community residents selected and trained under the guidelines of the Ministry of Public Health and play a key role in community participation and access to primary healthcare services. A total of 413 VHVs were randomly selected for the study, of whom 384 completed the structured questionnaire and were included in the analysis (response rate: 92.98%). Covariance-based structural equation modeling (CB-SEM) was employed, with the measurement model first evaluated using confirmatory factor analysis (CFA) prior to testing the structural model. The final model demonstrated good fit to the data ( = 323.72, df = 286, p = 0.062; RMSEA = 0.019, 90% CI: 0.000 – 0.028; SRMR = 0.033; CFI = 0.994; TLI = 0.991) and explained 73% of the variance in VHV performance (. Empowerment and job satisfaction were directly associated with performance, whereas leadership, social networks, and work motivation were indirectly associated with performance through mediated pathways. In terms of total effects, empowerment emerged as the strongest factor associated with performance. Overall, the findings suggest that motivation, empowerment, leadership, and social networks are closely interrelated and jointly associated with VHV performance. These results highlight the importance of empowerment-oriented and motivation-supportive strategies within routine primary health care systems to strengthen VHV performance.

Occupational future time perspective and associated factors among older workers in urban communities of Bangkok, Thailand: A cross-sectional study

Natchanok Khampitak — 2026-08-31

Thailand has become a completely aged society in 2024, with a growing proportion of older adults remaining in the workforce. However, evidence on occupational future time perspective (OFTP), which shapes motivation, work engagement, and retirement decisions, remains limited. This study examined OFTP and its subdimensions: Focus on Opportunities (FO); Perceived Remaining Time (RT); and Focus on Limitations (FL), and associated factors among older workers in urban Bangkok. A cross-sectional survey was conducted among 746 adults aged ≥ 50 years in 15 urban communities between January and July 2025. OFTP was measured using the validated Thai OFTP Scale (10 items, Cronbach’s α=0.88). Descriptive statistics, bivariate analysis, and multiple linear regression were applied. Participants’ median age was 59 years; 54.0% were female. The mean OFTP score was 3.10 ± 0.65. Younger age, better perceived health, and absence of chronic disease were positively associated with OFTP. District-level variation was observed, with Pathum Wan residents reporting lower OFTP. Findings suggest that OFTP among older urban workers is shaped by personal, health, and socioeconomic factors. Policies enhancing healthcare access and supportive urban environments are crucial for sustaining productive employment in later life.

Predictors of post-pandemic COVID-19 preventive behaviors among Hmong Communities in Rural Phayao, Thailand: A PRECEDE–PROCEED study

Pornpana Somjit — 2026-08-31

This study examined predictors of COVID-19 preventive behaviors among Hmong communities in rural Phayao, Thailand, using the PRECEDE–PROCEED framework. A cross-sectional survey was conducted between November 2022 and March 2023 among adults residing in three Hmong villages. Stratified simple random sampling was applied to household lists, yielding a final sample of 402 respondents. Data were collected using a structured questionnaire comprising sociodemographic variables, five theory-based determinants, and a multi-item preventive behavior scale. The instrument demonstrated strong content validity (item–objective congruence index, IOC = 0.97) and acceptable internal consistency (KR-20 = 0.82 for knowledge; Cronbach’s α = 0.77–0.80 for attitudinal and behavioral scales). A pre-specified hierarchical multiple regression model was fitted. Block 1 (covariates) included gender, age, two education dummies (secondary and post-secondary; reference = ≤primary/no schooling), and monthly household expenditure (per 1,000 THB, approximately 29 USD). After an initial screening, age and secondary education were excluded, and gender, post-secondary education, and expenditure were retained in Block 1. Block 2 contained five determinants (knowledge, attitudes, perceived policy, perceived access to health resources, and exposure to health advice/support) and was estimated using Stepwise selection with Block 1 fixed. The final model explained 30.4% of the variance in COVID-19 preventive behaviors (R² = 0.304, adjusted R² = 0.293, ΔR² = 0.156; p < 0.001). Attitudes, perceived access, exposure to health advice/support, and post-secondary education emerged as significant positive predictors, whereas female gender and higher household expenditure were negatively associated with preventive behaviors; age and secondary education remained statistically non-significant after adjustment.

Effectiveness of a hybrid practice-based training program for community-based elderly caregivers in Chiang Rai during the COVID-19 pandemic

Ananya Eusawat — 2026-08-31

The study aimed to evaluate the effectiveness of the program, which was a hybrid practice-based training program for community-based elderly caregivers in Chiang Rai during the COVID-19 pandemic. It was a mixed-methods design. Research instruments included caregiver knowledge and skill assessment and the hybrid practice-based caregiver training program adapted for the COVID-19 situation. Phase 1 involved program refinement based on feedback from 39 stakeholders. Phase 2 examined the influence of individual learning modules on caregiving skills. The sample consisted of 165 purposively selected caregivers from 16 districts. The sample size was determined using the Bentler and Chou ratio. Phase 3 evaluated program effectiveness in 60 caregivers using a two-group pretest–posttest design. The sample size was calculated based on a large effect size, α = 0.05, and power = 0.80. Data analysis comprised qualitative synthesis from focus-group discussions, multiple regression analysis, t-test, Mann–Whitney U test and the Wilcoxon signed-rank test.

The results from the multiple regression analysis showed that all learning modules were significant predictors of scores of caregiving skills (R² = 0.57, p < .001). In the quasi-experimental phase, post-training scores of the experimental group on knowledge and skills were significantly greater than those of the control group with a large effect size (knowledge: t = 14.13, p < .001, r = 0.85; caregiving skills: U = 0.00, p < .001, r = 0.87). Therefore, the hybrid practice-based caregiver training program with mentorship could improve caregiving knowledge and skills. However, larger-scale studies with longer follow-up periods are needed before broader implementation.

Effectiveness of an integrated nutrition and sanitation education on community health cadres' knowledge and attitudes: A quasi-experimental study

Akifa Syahrir — 2026-08-31

Stunting continues to represent a critical public health concern in Indonesia, with community health cadres playing a pivotal role in preventive efforts at the grassroots level. Despite this, empirical evidence evaluating integrated training approaches combining nutrition education with sanitation-based approaches remains limited. This study aimed to evaluate the effectiveness of the Integrated Stunting Prevention Education (SIDUCETING) program in improving the knowledge and attitudes of community health cadres. A quasi-experimental study with non-equivalent control groups was conducted from June to September 2019. A total of 63 cadres participated in the study, comprising an intervention group (n=32), and a control group (n=31). The intervention group consisted of a two-day SIDUCETING training program integrating nutrition-specific education with Community-Based Total Sanitation (STBM) principles, emphasizing experiential learning through practical demonstrations and hands-on skill development. Cadre’s knowledge was measured using a 20-item questionnaire, while attitudes were assessed using a 15-item Likert-scale instrument at baseline and immediately following post-intervention. Data were analyzed using the Mann-Whitney U test and the Wilcoxon signed-rank test. Baseline assessments indicated no significant differences between groups in knowledge (p=0.357) or attitude scores (p=0.985). Post-intervention, the intervention group demonstrated significant improvements in both knowledge (median: 10 to 18, p<0.001) and attitudes (median: 42 to 54, p<0.001), while the control group remained unchanged. Between-group analysis revealed significant differences in knowledge change (Cohen’s d=0.22; 95% CI: 0.05–0.39) and attitude change (Cohen’s d=0.76; 95% CI: 0.52–1.01). No significant correlations were identified between demographic characteristics and outcomes. These findings indicate that the SIDUCETING intervention is effective in improving community health cadres’ knowledge and attitudes toward stunting prevention, supporting the scalability of short-duration, integrated training programs for broader implementation with Indonesia’s community health system.