Asia Pacific Journal of Public Health

The primary aim of this study is to assess the evidence on the cost-effectiveness of type 2 diabetes mellitus (T2DM) interventions with a focus on diabetes education, lifestyle modifications, surgical intervention, and pharmacological therapy in low- and middle-income countries (LMICs). A systematic review was conducted to identify economic evaluations of T2DM interventions published in LMICs for the period 2009-2019. A total of 25 studies were identified, with more than half of the studies being decision analytic models. Critical appraisal of the identified studies showed they were of good quality. Overall, the reported interventions in this review were very heterogeneous, which made them difficult to compare. However, there was strong evidence suggesting that diabetes education was a very cost-effective strategy in LMICs. Further evidence on affordability and budget impact of bariatric surgery is required before adopting the intervention. Metformin-based therapy showed promising evidence on cost-effectiveness and thus should be offered to T2DM patients in LMICs. On the contrary, the cost-effectiveness of lifestyle modifications remains understudied in LMICs. The findings in this review can inform policy guidance toward the inclusion of T2DM interventions in the benefit packages for Universal Health Coverage in LMICs.

Despite the overwhelming evidences on the health consequences of smoking, studies in Asian population in low-to-middle income countries are very limited. Baseline data of a prospective cohort study were collected in year 1985. Endpoints regarding all-cause mortality and major adverse cardiovascular events (MACE) were followed for 30 years. Cox proportional hazard models were used for analysis. Participants had an average age of 43 years, 23% were female, and 43% were current smokers. All-cause mortality was significantly higher in ex-smokers (hazard ratio [HR] 1.32) and current smokers (HR 1.70) when compared with never smokers. Participants with any history of smoking had significantly higher risk of developing MACE. Furthermore, all-cause death, cardiovascular death, and MACE increased with increasing pack years. Statistically significant dose-response relationships were established. Therefore, cigarette smoking increased the risk of all-cause mortality, cardiovascular mortality, and MACE in Thai population. Results emphasized the importance of tobacco control in Thailand.

Tobacco use among youth in the South-East Asian region is quite prevalent. This study aims to examine if psychosocial factors (perceived loneliness, peer, and parental relationships) were associated with adolescent smoking, and whether the effects were different according to sex and age. Data came from the Global School-based Student Health Surveys collected between 2012 and 2015 in Brunei, Cambodia, Indonesia, Laos, Malaysia, Philippines, Thailand, Timor-Leste, and Vietnam. 64 578 (males = 48.5%) adolescents aged 13-18 completed the survey. Prevalence of past-month cigarette use was 10.6%. Adolescent smoking was associated with loneliness (OR = 1.75), lack of close friends (OR = 1.43), and lack of parental understanding (OR = 1.35). There was significant interactions between sex with loneliness, close friends, and parental understanding (p < .001). Interactions indicated having no close friends is associated with smoking and is stronger for females than males. Conversely, loneliness was associated with smoking more strongly in males than females. Results indicate that psychosocial factors are linked to adolescent smoking in South-East Asia, suggesting a further need for research on the relation of psychosocial factors with smoking, and their underlying factors.

This study aimed to evaluate the occupational health risks of benzene, toluene, and xylenes (BTX) exposure in the automobile repair industry in Beijing city in China. The concentrations of BTX were monitored at 140 operating positions of 51 randomly selected automobile repair enterprises in 2018. Samples analysis showed that all monitoring concentrations were not higher than the occupational exposure limits. The long-term exposure concentration ranges of benzene, toluene, and xylenes were 0.1 to 0.3, 0.1 to 49.7, and 0.2 to 49.5 mg/m³, respectively. The short-term exposure concentration ranges of benzene, toluene, and xylenes were 0.1 to 0.3, 0.1 to 98.7, and 0.2 to 100.0 mg/m³, respectively. But assessment results revealed unneglectable occupational health risks, especially the combined health risks of BTX exposure. Thereafter, effective control and improvement measures were put forward, including strengthening the management of the production, sale, and use of vehicle paints and coatings; improving ventilation; and implementing hierarchical management measures for occupational health risks.

In 2016, World Health Organization (WHO) estimated more than 650 million obese adults, resulting in a country’s health burden. This study aims to determine the prevalence of obesity and its associated factors among Malaysian adults. A total of 5820 respondents, aged 18 to 59 years, from the National Health and Morbidity Survey 2019, were included for the data analysis. The prevalence of obesity was described and multivariate analyses were conducted to determine the factors associated with obesity. The prevalence of obesity among Malaysian adults was 20.1%, based on the findings from this study. Multivariate analyses showed that women, being Malays, Indians, and other Bumiputeras, were significantly associated with a higher risk of obesity. Besides, those diagnosed with diabetes mellitus and hypertension were also significantly associated with greater risk of obesity. This information is crucial for policy makers in formulating effective strategies or targeted programs in preventing obesity among Malaysian adults.

When the third wave of the COVID-19 epidemic broke out, the double burden of the pandemic and political instability meant that people in Myanmar did not have access to adequate hospital care. The aim of this study was to explore the lived experience of COVID-19 survivors in the community. A qualitative, descriptive, phenomenological approach was used, and participants were selected through purposive sampling. Fifteen individuals described their experiences using four themes and 17 categories. The main themes were the aggressive natures of the pandemic, suffering from the disease, receiving vital support for survival, and the hardships due to political pressure. The pandemic and subsequent waves of different variants should not be underestimated, and people’s health should take priority over economic development and political crisis. Knowledge and practices of family members and society should be promoted by providing timely and comprehensive information regarding pandemic diseases.

This study aimed to compare the clinical outcomes and program satisfaction of diabetes self-management education and support (DSMES) for type 2 diabetes patients delivered by telehealth during COVID-19 pandemic to in-person delivery during pre-COVID-19. A retrospective case-controlled study was conducted (95 telehealth and 95 on-site). Differences in hemoglobin A1c (HbA1c) reductions between groups were analyzed by linear mixed-effects models, and satisfaction was collected. Compared with baseline, at the three-month follow-up, the HbA1c reductions of the telehealth and on-site DSMES were 1.20 ± 0.15% and 1.21 ± 0.15%, respectively (P < .001), whereas these were 1.28 ± 0.16% and 1.18 ± 0.15% at six-month follow-up, respectively (P < .001). There were no significant differences in HbA1c reduction between the two groups (P = .967 and .674 at three- and six-month follow-up). Majority of participants in both groups had high program satisfaction (telehealth 98.7% vs on-site 95.1%, P = .269). In conclusion, DSMES delivered via telehealth is as effective in lowering HbA1c as that delivered in-person, with a high satisfaction rate.

Tobacco use remained the most preventable cause of premature morbidities and deaths. Despite notable decrement of tobacco use prevalence globally, the prospect of the low- and middle-income countries lies at crossroads due to government’s complacence and increased influence of the tobacco industry. Tigray regional state in Ethiopia which received World Health Organization recognition in 2017 spearheaded the tobacco control endeavor using cost-effective and whole-government approach via customized tobacco control vaccine framework. The job required interrelated endeavors of law making, advocacy, and law enforcement, but all with an effective community engagement and ownership framework. It did not require re-inventing the wheel but synthesizing available evidence and exhibiting the potential to reverse the course; enlisting challenges alone do not bear fruit. Tigray’s notable achievement and Ethiopia’s promising results should be supported by rigorous law enforcement and accountability mechanisms. The evolving tobacco industry influence and illicit tobacco trade pose a serious concern.

Coronavirus disease (COVID-19) is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and presents with mild to severe symptoms. Vaccines have been developed, but COVID-19 persists. Therefore, it is necessary to analyze big data at an early stage to establish an effective infection prevention strategy. To reduce SARS-CoV-2 infection, this study aimed to analyze the infection factors by region within Seoul, Korea and identify the major factors affecting the infection rate. For ease of data aggregation, the study was conducted after a data refinement operation that organized data in the same group into categories, and classified them in detail by specific keywords. Based on the results of this study, if preventive measures are established after identifying the representative infectious factors, periods, and routes of COVID-19 infection, the infection rate could be effectively reduced in the future.