bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal and new-born health policy indicators for low-resourced countries: The example of Liberia
Authors: Bjegovic-Mikanovic Vesna , Broniatowski Raphael , Byepu Stephen , Laaser Ulrich 
Published: May 2023

Aim: Over the past two decades, two catastrophic events caused a steep decline in health services in Liberia: the long-lasting civil war (1989-2003) and the weak response of the health system to the Ebola Viral Disease (EVD) outbreak (2013-2015). In early 2015 The Liberian Government reacted and developed a strategic health policy framework. This paper reviews that framework with a focus on maternal and newborn health.
Methods: The study is designed as a narrative review executed during the second half of 2017 in Monrovia. It takes advantage of triangulation, derived from recent international and national documents, relevant literature, and available information from primary and secondary sources and databases.
Results: In 2015 the severely compromised health system infrastructure included lack of functional refrigerators, low availability of vaccines and child immunization guidelines, high stock-out rates, and an absence of the cold chain minimum requirements in 46% of health facilities. The public health workforce on payroll during 2014/15 included only 117 physicians. Skilled birth attendance as an indicator of maternal health services performance was 61%. Presently, approximately 4.5 women die each day in Liberia due to complications of pregnancy, delivery, and during the post-partum period, equalling about 1,100 women per 100,000 live births. Of particular note is the adolescent birth rate of 147 per 1000 women aged 15-19 years, three times higher than the world average of 44. Additionally, with a neonatal mortality rate of 19.2 neonatal deaths per 1,000 live births, Liberia stands higher than the world average as well. The high mortality rates are caused by multiple factors, including a delay in recognition of complications and the need for medical care, the time it takes to reach a health facility due to a lack of suitable roads and transportation, and a delay in receiving competent care in the health facilities.
Conclusions: The fact that performance is above average for some indicators and far below for other points to unexplained discrepancies and a mismatch of international and national definitions or validity of data. Therefore, it is recommended to concentrate on the core of tracer indicators adopted at the global level for Universal Health Coverage and the Sustainable Development Goals to enable a permanent update of relevant information for policymaking and adjustment. At present all health policy documents miss a thorough application of the SMART objectives (Specific, Measurable, Attainable, Relevant and Timely), notably missing in most documents are realistic and detailed budgeting and obligatory timelines for set targets.
Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being
Authors: Chernyavskiy Valery , Wenzel Helmut , Mikhailova Julia , Ivanova Alla , Zemlyanova Elena , Bjegovic-Mikanovic Vesna , Mikhailov Alexander , Laaser Ulrich 
Published: May 2023

Context: The ‘Northern Dimension on Public Health and Social Well-being’ is a platform for dialogue and cooperation of countries around the Baltic Sea, established in 2003, guided by the Sustainable Development Goal 3 on Health and Social Well-being and the Strategy for the Baltic Sea Region of the European Union adopted in 2009. In this paper we determine the overall progress of the Russian Federation and its North West Federal Okrugin in particular, with regard to the reduction of mortality.
Methods: For the purpose of inter-country comparison and progress over time we make use of age-standardised Potential Years of Life Lost (PYLL) applied to quantifiable strategic targets, the Sustainable Development Goal 3 on Health and Social Well-being and the European Union Strategy of the Baltic Sea Region. A gap analysis is performed to determine whether the target achievement is in delay or on track.
Results: With reference to the baseline of 2009 – corresponding to the most relevant recent period 2009-2020 respectively 2009-2030 – the Russian Federation as a whole is on track achieving the two strategic targets in advance by 2.7 years. For the North West Federal Okrug around St. Petersburg and Kaliningrad bordering the Baltic Sea the target achievement is estimated to be 4.8 and 10.8 years in advance of the deadlines 2020 and 2030. In comparison to the Baltic Sea states the Russian Federation takes a middle position after Estonia, Latvia and Finland. The early target achievement is confirmed if the period 2003-2020 respectively 2003-2030 is considered.
Conclusion: Although the region is progressing there may be a slowdown towards 2030. A careful analysis is required to determine to which degree the activities of the Partnership for Health and Social Well-being have contributed to the success and what should be proposed to increase the impact on premature mortality.
Socio-demographic inequalities in satisfaction with primary health care and utilization of chosen doctors’ services: a cross-sectional study
Authors: Jovanovic Dragana , Jankovic Janko , Mirilovic Nikola 
Published: May 2023

Aim: The aim of the study was to examine socio-demographic inequalities in user satisfaction with PHC and utilization of chosen doctors’ services.
Methods: This cross-sectional study was conducted in 2016 among 232 respondents who participated in PHC user satisfaction survey in PHC center Valjevo, Serbia. Inclusion criteria were an age of at least 20 years, sufficient skills of Serbian language to fill in questionnaires and consent to participation. Two hundreds and six patients completed an anonymous questionnaire about the user satisfaction with PHC.
Results: The chosen doctor was seven times more often visited by the elderly (OR=7.03) and almost three times more often by the middle-aged (OR=2.66) compared to the youngest category of respondents. Those with low education and poor financial status of the household visited a doctor four (OR=4.14) and almost nine times (OR=8.66) more often, respectively, compared to those with high education and good socioeconomic status. A statistically significant higher level of PHC satisfaction was recorded in the rural population (p<0.001) and among respondents with poor socioeconomic status of the household (p=0.014).
Conclusion: The chosen doctor was more frequently visited by respondents with low education and those with poor socioeconomic status of the household, while a higher degree of satisfaction with PHC was recorded in the rural population as well as in those with poor socioeconomic status of the household.
School-based intervention to promote healthy nutrition and physical activity in Palestinian girls - Process evaluation
Authors: Husseini Maha Nubani , Donchin Milka 
Published: May 2023

Aim: School-based interventions have the potential to intervene with the students and teachers, and to reach their families. A controlled program trial was designed to promote healthy eating and physical activity among Palestinian females, while the process evaluation aimed to monitor the program’s implementation and identify factors that led to its success.
Methods: A randomized controlled program trial was conducted in 14-Palestinian schools under 4-different jurisdictions, divided into 7-control and 7-intervention schools chosen randomly after applying a sample size calculation. A monitoring system, elucidated factors which contributed to improved outcomes, was applied in the intervention schools only, while the control schools continued with their regular curriculum. The process evaluation tracked the timing and implementation of interventions including changes in the school strategy, policy and structure, teachers’ capacity building, mothers’ education and involvement, the school’s supportive health environment, and integration food consumption records and physical activity into the daily class routine.
Results: The intervention included 3,805 schoolchildren and their mothers’ as-well-as 147 teachers. At the completion of the 18-month intervention the schools had successfully participated in the various intervention activities. Only the private school did not sustain some of the interventions, which put it at 55% completion of the school supportive environment activities compared to the other schools which all reached the 100% completion of planned activities.
Conclusion: This process evaluation approach enabled a more comprehensive understanding of the intervention implementation and outcomes and identified factors that contribute to the sustainability of the intervention. Each school required a different amount of time for understanding, applying and implementing the program depending on its needs.

Acknowledgments: The authors thank the participating schools, the Palestinian Ministry of Education, the UNRWA Office of Education and Jerusalem Municipality for facilitating fieldwork. I would like to acknowledge my gratitude to my doctoral thesis supervisors, Prof. Elliot Berry and Prof. Ziad Abdeen.

Source of funding: This study is a part of Ph.D. degree. The researcher received scholarship from Joint Distribution Committee (JDC). The author thanks Nutrition and Health Research Institute Al-Quds University for funding part of the research. The Linda Joy Pollin Cardiovascular Wellness Center for Women at the Division of Cardiology of Hadassah University Medical Center, directed by Dr. Donna Zfat funded the mothers’ activities and lectures towards the end of the intervention, as well as the implementation of the program at the control schools one year after the study ended, as they were promised when they got selected
Aflatoxin B1 as an endocrine disruptor among miller flour workers
Authors: Beshir Safia , Shaheen Weam , Saad-Hussein Amal , Saeed Yuosra 
Published: May 2023

Aim: Aflatoxin В1 has been stated to inhibit the function of different endocrine glands. This study was proposed to clarify the possible effects of aflatoxin B1 as an endocrine disruptor on pituitary gland, thyroid gland and gonads among miller flour workers, and to evaluate its effects on human male sexual function.
Methods: A case-control study was conducted in a flour mill in Helwan District Cairo, Egypt in 2019. The study included 42 exposed flour milling male workers from the grinding department which showed the highest level of aspergillus flavus in the air sampling of airborne fungi and 40 non-exposed males. Serumaflatoxin В1/albumin, luteinizing hormone, follicle stimulating hormone, testosterone, 17-beta-estradiol, free triiodothyronine, free thyroxin and thyroid stimulating hormone were measured for the studied groups.
Results: Sampling of airborne fungi revealed that aspergillus flavus and penicillum were the predominant fungal types in the flour mill. Indoor/Outdoor ratios for aspergillus flavus were ≥ 1 in all the locations indicating presence of indoor sources. Serum Aflatoxin В1/albumin, luteinizing hormone and follicle stimulating, the existence of various types of sexual disorders (decreased libido, impotence and premature ejaculation) were higher while testosterone was lower in the miller flour workers compared to non-exposed. However, there was no significant difference regarding 17-beta-estradioland thyroid hormone levels between both studied groups.
Conclusion: Aflatoxin B1creates possible human male reproductive health distresses in miller flour workers.
Clinical and epidemiological evaluation of Tuberculosis in Albania during the period 2009-2018
Authors: Peposhi Lir , Tafa Holta , Bardhi Donika , Hafizi Hasan 
Published: May 2023

Aim: To estimate the clinical and epidemiological pattern of Tuberculosis (TB) in Albania over the period 2009-2018.
Methods: A retrospective analysis of clinical and epidemiological data based on TB individual notification forms during the period 2009-2018.
Results: During the 10-years period, TB incidence increased from 14 to 15.5, but without a significant increasing trend. The total number of TB cases increased from 440 to 447. The proportion of extra-pulmonary TB decreased from 32% to 25% in 2018 (p=0.015), with and average mean change of 29 cases. Males prevail among TB cases and male-to-female ratio ranges from 2:1 to 3:1. Drug susceptibility testing (DST) was carried out depending on the availability of the reagents and there were 54%, 18% and 96% culture cases confirmed positive in 2009, 2014 and 2019, respectively. The overall treatment completion rate was 85% and 88.2% in 2009 and 2018, respectively. However, there was a significant drop in cured cases from 26% in 9.3%, whereas the percentage of deaths has increased from 0.5% in 4.1%. All treatment outcomes exhibited a significant change (p<0.001).

Conclusion: TB continues to be a public health challenge in Albania regardless of the seemingly generally stable epidemiological situation.
Serbian Citizens’ Opinion on the COVID-19 Epidemic
Authors: Marta Ivanović , Mirjana Đorđević , Aleksandar MA Klarić , Filip Mikanović , Kristina Nikolić , Tamara Perić , Tamara Savić , Katarina Steljić , Laza Subotić , Marko Todorović , Irena Todorovski , Bojan Totić 
Published: May 2023

Aim: The Centre for International Public Policy has undertaken a public opinion research in which we tested the opinions of the citizens of Serbia on the coronavirus epidemic. The respondents had the opportunity to express their opinion on measures undertaken by the Serbian Government to combat the virus, to state their trust in the media, as well as the health system in general. In addition, we tested the prevalence of different conspiracy theories among citizens, whether the pandemic gave China a new image in the minds of the people and, most importantly, the level of solidarity among Serbian citizens as well as within the European / international community as a whole.
Methods: In seven days, from 8-15th April 2020, we gathered a convenient sample of N=5989 respondents, which makes this the largest public opinion research project in Serbia on the topic of COVID-19 since the start of the epidemic. The electronic questionnaire consisted of 24 questions of mixed and closed type.
Results: The findings of this research suggest that citizens of Serbia are not afraid of COVID-19, but are nevertheless cautious (86%). The percentage of those willing to consult a doctor when they notice any symptoms lies at 70%. Half of the respondents do not believe in alternative theories regarding the origin of the COVID-19 virus. The majority of the respondents (55%) hold government officials accountable for spreading panic through public speeches and daily public addresses. Moreover, 60% of the respondents do not trust the Serbian media outlets that are currently reporting on the COVID-19 pandemic. Furthermore, over half of the respondents are prepared to report their neighbour when he or she is coming from abroad and violates the obligation to self-isolate. However, mostly due to the significant fines, 65% of the respondents would not report the elderly when they are breaking the limited-movement restriction measures.
Conclusion: As before the epidemic, opinions of the Serbian population on current topics are somewhat polarized. Although the majority of the respondents are cautious, a significant number also believes in conspiracy theories and does not fully trust the information provided by the media or the government.
Navigating barriers to gender equality in the European Union context: The case of healthcare sector
Authors: Kalaitzi Stavroula 
Published: May 2023

Context: Progress towards achieving gender equality in the European Union context is reported slow and fragmented, although some achievements have been made. Scholarship has been discuss-ing extensively the gendered barriers, yet their manifestation on a comprehensive and prevalence basis has received scant attention so far. Highlighting the big picture of all (in)visible gendered barriers and their manifestation in relation to countries’ specificity may contribute in understand-ing better the missing link between policy and practice. This study aims firstly, to identify com-prehensively the gendered barriers and their prevalence, and secondly, to gain deeper insights on how a persisting policy problem at the EU and Member States level remained poorly addressed for over two decades.
Methods: A mixed methods approach was adopted to ensure the qualitative research quality cri-teria. The systematic literature review, questionnaire and semi-structured interviews methods to obtain and analyze data were included. Qualitative analysis was supplemented by the fundamental tenet of feminist research on the centrality of women.
Results: Twenty-six gendered barriers with quantitative logic and varying degree of prevalence were identified and depicted in the Barriers Thematic Map (BTM) across healthcare, academia and business sectors. Twenty and twenty-one gendered barriers in Greek and Maltese healthcare set-tings were found respectively unveiling the country’s specificity in barriers’ manifestation. The sustainable development thinking in gender equality objectives in EU and MS was found suffering from inconsistencies and misplaced priorities.
Conclusion: The gendered barriers are multiple, manifest themselves in chorus and with a varying degree of prevalence across sectors and are greatly influenced by country’s specificity. Evidence informed gendered policies respecting national priorities may need to be revisited by policy actors to deliver the promised egalitarian social orderand sustainable future for the EU citizens.
Seasonal variations of schizophrenic patients in emergency departments in Sofia, Bulgaria
Authors: Spasova Zornitsa 
Published: May 2023

Aim: The purpose of this study was to reveal the seasonal distribution of emergency department visits of schizophrenic patients in Sofia, Bulgaria.
Methods: We collected daily data for visits of patients with schizophrenia, schizotypal and delusional disorders in the emergency center of the regional dispenser for mental disorders in the city of Sofia for the period 1998-2003. The total number of emergency visits was 5723 (mean daily visits: 5.04±2.4). T-test was used to compare the monthly and seasonal distribution of visits.
Results: The season with the highest levels of emergency visits was summer, and the lowest levels were observed in winter (P<0.0001). Spring and autumn had intermediate values close to the mean value, and significantly differentiated from winter values. The month with the highest admission rates was September, followed by May and the three summer’s months. The lowest levels were observed in December, October and January, with statistically significant differences observed between the values of all the three months. Differences between July values compared with December and October values were significant, but not with January values.
Conclusion: The study showed significant seasonal and monthly differences in emergency schizophrenics’ visits. The data confirm the outcome of similar studies conducted in countries with temperate climate in the Northern Hemisphere. These results could prove useful for psychiatrists, public health specialists, and governmental authorities dealing with team planning and prevention programs in the field of psychiatry.
Factors influencing the choice of facilities among enrolees of a prepayment scheme in Ibadan, Southwest Nigeria
Authors: Adewole David Ayobami , Ilori Temitope 
Published: May 2023

Aims: Factors that influence the personal choice of a health care facility among health care consumers vary. Currently, what influences the choice of health facilities among enrollees under the National Health Insurance Scheme (NHIS) is not known. This study aimed to as-sess what influences the choice of facilities in the NHIS of Nigeria.
Methods: This was a descriptive cross-sectional study conducted among enrollees in selected NHIS facilities in the 11 Local Government Areas (LGAs) of Ibadan, Nigeria. A total of 432 enrollees were selected and were interviewed. A WHO-USAID semi-structured interviewer-administered questionnaire was used to obtain relevant data. Data collection was between Oc-tober and December 2019. Data were analyzed using STATA version 12.0 (α =0.05).Results: At unadjusted OR, older respondents (OR 3.24, CI = 2.52-4.18, p = <0.0001), and those who had attained the tertiary level of education (OR 3.30, CI 2.57-4.23, p <0.0001) were more likely to make a personal choice of health care facilities. A similar pattern was ob-served among respondents who were in the high socioeconomic group (OR 4.10, CI 3.01-5.59, p = <0.0001). However, at Adjusted OR, only high socio-economic status was a predic-tor of personal choice of health care facility (OR 1.92, CI 1.21-3.05, p = 0.005).
Conclusion: This study is suggestive that a need for and the ability to afford the cost of care influence the choice of health facilities. Policies that promote health literacy in the general populace will enhance the capability of individuals to make a personal choice of health facili-ties. Stakeholders should prioritize this for policy.Recommended citation: David A. Adewole, Temitope Ilori. Factors influencing the choice of facilities among enrolees of a prepayment scheme in Ibadan, Southwest Nigeria
Acknowledgments: The authors wish to acknowledge study participants for permission to interview them in the course of the data collection of this study.Authors' contributions: David Adewole conceived and designed the study. Temitope Ilori did data collection and analysis. Both authors contributed equally to the manuscript write-up. The two authors also read through the manuscript draft the second time and agreed to the final manuscript.
Conflict of interests: None declared.
Contribution of Information-Education-Communication in the adoption of Universal Health Coverage by the populations in the Economic and Monetary Community of Central Africa in 2020.
Authors: Ledaga Nathalie Ambounda , Mamche Robertine , Woromogo Sylvain Honore , Antaon Esse Saint Saba , Saar Fatou Sow 
Published: May 2023

Aims: This study aims to assess the knowledge of people from Central Africa about Universal Health Coverage and show the contribution of Information-Education-Communication for its adoption.
Methods: a cross-sectional analytical study across 4 of 6 Central African Countries was conducted. Independent variables are sociodemographic characteristics. Dependent variables are knowledge about Information-Education-Communication and Universal Health Coverage. The questionnaire was disseminated by WhatsApp images or word file or copy/paste of the text and send to the contacted and trained focal points. From the Smartphone, the filmed or transferred data were entered into a CSpro 5.0 input form. Mean score calculations and Odd Ratio with 95 % Confidence Interval for p < 0.005 were used to make associations.

Results: the Universal Health Coverage had never been heard of by 56.3% of the participants. The Universal Health Coverage was defined as health insurance by (43.9%), free care (30.3%). Respondents with secondary and higher education are more likely to have heard of the UHC than respondents with no education or those with elementary education [OR = 2.95 (1.01-8.64), p = 0.021] and [OR = 4.27 (1.50 – 12.16), p = 0.002] respectively.
Conclusion: 9.3% of the Economic and Monetary Community of Central Africa (CEMAC) population is aware of the Universal Health Coverage; 89.4% of these accept universal health coverage in their country, and 87.4% of them think that the Information Education Communication could enable better adherence to the Universal Health Communication. Implemention of Universal Health Coverage for the general population and adoption of Information-Education-Communication to promote Universal Health Coverage and pool efforts and affiliation procedures in the CEMAC zone is very important