Physical inactivity and associated factors among university students in 23 low-, middle- and high-income countries

Objectives

The aim of this study was to determine estimates of the prevalence and social correlates of physical inactivity among university students in 23 low-, middle- and high-income countries.

Method

The International Physical Activity Questionnaire was used to collect data from 17,928 undergraduate university students (mean age 20.8, SD = 2.8) from 24 universities in 23 countries.

Results

The prevalence of physical inactivity was 41.4 %, ranging from 21.9 % in Kyrgyzstan to 80.6 % in Pakistan. In multivariate logistic regression, older age (22–30 years), studying in a low- or lower middle-income country, skipping breakfast and lack of social support were associated with physical inactivity. In men, being underweight, being overweight or obese, not avoiding fat and cholesterol, not having severe depression symptoms, low beliefs in the health benefits of physical activity, low personal control and knowledge of exercise-heart link, and in women, not trying to eat fibre, low personal mastery and medium personal control were additionally associated with physical inactivity.

Conclusion

Four in each ten students are physically inactive, calling for strategic interventions by relevant professionals in higher educational institutions.

     

Defining and redefining harm reduction in the Lao context

ABSTRACT: The response to drug use in Laos has focused on reducing opium supply (supply reduction) and rates of drug use (demand reduction). However, recently there is increased interest among government counterparts to discuss and develop broader responses to injecting drug use (IDU) including the introduction of harm reduction programs. The concept of harm reduction has just been introduced to Lao PDR and as yet there is no agreement on a definition of the concept. We highlight here a range of issues that remain controversial in Lao PDR in the HIV, drug use and harm reduction discourse, the definition of 'harm reduction' and related terms; and the scope of harm reduction.This was a qualitative study, consisting of in-depth interviews with 27 law enforcement and 8 health officers who work in the fields of HIV and/or drug control about their understanding of HIV related to drug use, and concepts of harm reduction. Content analysis was performed to identify the coding, categories and themes.We found that law enforcement officers in particular had limited understanding about harm reduction and the feasibility and appropriateness of harm reduction services in the Lao context.Harm reduction should be a core element of a public health response to HIV where drug use and IDU exists. Recommendations include the necessity of increasing the awareness of harm reduction among law enforcement officers and providing appropriate evidence to support the needs of harm reduction policy and programs. HIV prevention and treatment strategies should be integrated within existing social and cultural frameworks, working with the task force for HIV/IDU and other government counterparts.     

Customary adolescent sexual practices among the Akha of northern Lao PDR: considerations for public health

Based on interviews and focus group discussions conducted in northern Laos, this study explores Akha understandings of customary first pre-pubertal sex acts, a thonh thong ('break through vagina' [BV]) for girls and yaha heu ('open foreskin' [OF]) for boys, which are thought to enable the maturing of bodies into adulthood. The study also examines the practice of a thor ta yang ('Welcome Guest') in which sexually initiated girls have sex with male visitors to Akha villages. The study found that many young women experience BV as painful and traumatic. However, since all Akha in the study 'knew' that young bodies will not mature into attractive, healthy adults if they do not perform BV and OF, attitudes were largely positive. Both men and women are at increasing risk of STIs, including HIV, since resettlement and an influx of non-Akha into the area. We conclude that Akha villagers should be included in the planning of future public health strategies that do not violate their cultural commitments and dignity but that help them resist potential exploitation and threats to their health. Such strategies might include sexual education programs and encouraging the delay of BV and OF.     

Concurrent multiple health risk behaviors among adolescents in Luangnamtha province,Lao PDR

Background

Switzerland has a low mortality rate from cardiovascular diseases, but little is known regarding prevalence and management of cardiovascular risk factors (CV RFs: hypertension, hypercholesterolemia and diabetes) in the general population. In this study, we assessed 10-year trends in self-reported prevalence and management of cardiovascular risk factors in Switzerland.

Methods

data from three national health interview surveys conducted between 1997 and 2007 in representative samples of the Swiss adult population (49,261 subjects overall). Self-reported CV RFs prevalence, treatment and control levels were computed. The sample was weighted to match the sex - and age distribution, geographical location and nationality of the entire adult population of Switzerland.

Results

self-reported prevalence of hypertension, hypercholesterolemia and diabetes increased from 22.1%, 11.9% and 3.3% in 1997 to 24.1%, 17.4% and 4.8% in 2007, respectively. Prevalence of self-reported treatment among subjects with CV RFs also increased from 52.1%, 18.5% and 50.0% in 1997 to 60.4%, 38.8% and 53.3% in 2007 for hypertension, hypercholesterolemia and diabetes, respectively. Self-reported control levels increased from 56.4%, 52.9% and 50.0% in 1997 to 80.6%, 75.1% and 53.3% in 2007 for hypertension, hypercholesterolemia and diabetes, respectively. Finally, screening during the last 12 months increased from 84.5%, 86.5% and 87.4% in 1997 to 94.0%, 94.6% and 94.1% in 2007 for hypertension, hypercholesterolemia and diabetes, respectively.

Conclusion

in Switzerland, the prevalences of self-reported hypertension, hypercholesterolemia and diabetes have increased between 1997 and 2007. Management and screening have improved, but further improvements can still be achieved as over one third of subjects with reported CV RFs are not treated.     

Meeting the contraceptive needs of unmarried young people: attitudes of formal and informal sector providers in Vientiane Municipality, Lao PDR

In Lao PDR, evidence is emerging of considerable sexual activity among unmarried youth, but contraceptive services remain inadequate to meet their needs. This study explored the attitudes of formal and informal sector providers in serving the contraceptive needs of unmarried youth in Vientiane Municipality, their perceptions of quality of care, confidentiality and privacy, level of comfort in discussing sexual matters, and any differences between providers in the two sectors. In-depth interviews were carried out with 56 key informants, followed by a quantitative survey of 150 formal sector and 100 informal sector providers. We found ambivalence and discomfort among providers in communicating with unmarried youth and providing contraceptives to them, and low priority placed on their right to privacy and confidentiality. Providers tended to attribute difficulties almost entirely to young people's inhibitions and unwillingness to listen. Less than 60% of formal sector providers would supply contraceptives to unmarried youth, compared to 80% of informal providers, but the latter were more likely to charge a fee for supplies. Both formal and informal sector providers need training in communication and counselling skills for serving unmarried youth. Programmes must ensure that unmarried youth have access to good quality contraceptive services and supplies.     

Health information systems and disability in the Lao PDR: a qualitative study

The Convention on the Rights of Persons with Disabilities provides an opportunity to strengthen disability‐related health information. This study analysed the health information system in Lao PDR and sought evidence of interventions to improve disability‐related health information. The study was based on a literature review and key informant interviews (N = 17) informed by the Health Metrics Network's Framework and Standards and the Performance of Routine Information System Management framework. The Lao health information system is in an embryonic stage with health data often incomplete, inaccurate and poorly used. Indicators related to disability or functioning are not included, and capacity to diagnose the health condition of disability is limited. No studies of health information interventions were found. As a State Party to the CRPD, the Lao PDR has a legal obligation to collect health‐related information on people with disabilities. Given the nascent stage of development of the health information system in the Lao PDR and diagnostic capacity, indicators related to basic functioning and access to services should be integrated into household level surveys. As the health information system further develops, small, incremental changes in the type of disability information and rehabilitation and the way it is collected can be implemented. Copyright © 2015 John Wiley & Sons, Ltd.     

Laos case study

ABSTRACT: Peuan Mit is a Lao organization working to address the needs of children and youth living and working on the streets. This case study outlines how a trusted and strong relationship with local police provides mutual benefit.     

Pneumococcal carriage in vaccine-eligible children and unvaccinated infants in Lao PDR two years following the introduction of the 13-valent pneumococcal conjugate vaccine

Pneumococcal carriage is a prerequisite for disease, and underpins herd protection provided by pneumococcal conjugate vaccines (PCVs). There are few data on the impact of PCVs in lower income settings, particularly in Asia. In 2013, the Lao People's Democratic Republic (Lao PDR) introduced 13-valent PCV (PCV13) as a 3?+?0 schedule (doses at 6, 10 and 14?weeks of age) with limited catch-up vaccination. We conducted two cross-sectional carriage surveys (pre- and two years post-PCV) to assess the impact of PCV13 on nasopharyngeal pneumococcal carriage in 5–8?week old infants (n?=?1000) and 12–23?month old children (n?=?1010). Pneumococci were detected by quantitative real-time PCR, and molecular serotyping was performed using DNA microarray. Post PCV13, there was a 23% relative reduction in PCV13-type carriage in children aged 12–23?months (adjusted prevalence ratio [aPR] 0.77 [0.61–0.96]), and no significant change in non-PCV13 serotype carriage (aPR 1.11 [0.89–1.38]). In infants too young to be vaccinated, there was no significant change in carriage of PCV13 serotypes (aPR 0.74 [0.43–1.27]) or non-PCV13 serotypes (aPR 1.29 [0.85–1.96]), although trends were suggestive of indirect effects. Over 70% of pneumococcal-positive samples contained at least one antimicrobial resistance gene, which were more common in PCV13 serotypes (p?<?0.001). In 12–23?month old children, pneumococcal density of both PCV13 serotypes and non-PCV13 serotypes was higher in PCV13-vaccinated compared with undervaccinated children (p?=?0.004 and p?<?0.001, respectively). This study provides evidence of PCV13 impact on carriage in a population without prior PCV7 utilisation, and provides important data from a lower-middle income setting in Asia. The reductions in PCV13 serotype carriage in vaccine-eligible children are likely to result in reductions in pneumococcal transmission and disease in Lao PDR.     

Concurrent multiple health risk behaviors among adolescents in Luangnamtha province, Lao PDR

Background  

Multiple health risk behaviors (HRBs) among adolescents pose a threat to their health, including HIV/AIDS. Health risk behaviors such as alcohol use, smoking, substance use, and sexual risk behaviors among youth have been shown to co-occur with each others. The objectives of this study was to estimate the prevalence of single and concurrent health risk behaviors and to explore how health risk behavior is associated with socio-demographic factors and peers' behaviors.