Proceedings of the Global Public Health Conference

VIOLENT ATTACKS ON NURSES AS BARRIERS TO ACHIEVING UNIVERSAL HEALTH COVERAGE IN SOUTH AFRICA

Sogo Matlala, Bernad Mutsago, Olinda Chabalala — Wed, 11 Jun 2025 00:00:00 +0530

Crime in South Africa delays progress towards universal health coverage. Universal health coverage means citizens have access to quality essential healthcare services without suffering financial hardships. The media reports about increasing violent attacks on nurses where valuable medical equipment and infrastructure at healthcare facilities are destroyed and stolen resulting in some nurses withdrawing their labour, others refusing to work after-hours leaving some facilities with inadequate staff, medicines, supplies and equipment. Violent attacks on nurses phenomenon is a complex public health issue which requires multidisciplinary solutions. This qualitative study explores and describes the impact of violent attacks on nurses through a public health and criminology lens to suggest multidisciplinary and comprehensive solutions. Data was obtained from South African online news articles, mainly Google News and Juta MedicalBrief, using key word searches such as ‘attack on nurses’ and ‘healthcare workers violence’. Retrieved news articles referred to other articles resulting in a chain-referral sampling. A thematic analysis guided by the three elements of universal health coverage was conducted, the three themes being population coverage, range of health services provided, and out-of-pocket expenditure emerged. Two criminological theories are applied to provide the possible explanation of the victimisation of nurses; these theories are the Routine Activity Theory and the Self-Control Theory. Results show that some essential services become unavailable, some facilities stop operating during the evenings and over weekends, which forces patients to spend money to access services far from where they reside and, in the process, suffer financial hardships. Crime is reported to be high in South Africa and affects everyone. The media increasingly reports about violent attacks on nurses. These attacks retards progress towards achievement of universal health coverage as it affects availability of nurses, negatively leading to unavailability of services at affected facilities. Patients are then forced to travel long distances to access healthcare services elsewhere. The media raises public awareness on this challenge, and this should spur a joint action to develop comprehensive solutions. Based on the Routine Activity Theory, the authors argue that nurses are victimised in public healthcare facilities because of the convergence of three elements which are the motivated offender, a suitable target, and a lack of capable guardian. The capable guardian could be the security personnel or other workers to intervene during the criminal victimisation. Applying the Self-Control Theory to explain victimisation of nurses, the authors put forth that perpetrators who victimise nurses are low in self-control and are in pursuit of immediate, easy and short-term pleasure. As such, they insult, physical manhandle nurses or steal from them, without considering that they may be punished for their actions.

THE IMPACT OF MEDICAID COVERAGE ON MENTAL HEALTH, WHY INSURANCE MAKES PEOPLE HAPPIER IN OHIE: BY SPENDING LESS OR BY SPENDING MORE?

Yangyang Li — Wed, 11 Jun 2025 00:00:00 +0530

The Oregon Health Insurance Experiment (OHIE) offers a unique opportunity to examine the causal relationship between Medicaid coverage and happiness among low-income adults, using an experimental design. This study leverages data from comprehensive surveys conducted at 0 and 12 months post-treatment. Previous studies based on OHIE have shown that individuals receiving Medicaid exhibited a significant improvement in mental health compared to those who did not receive coverage. The primary objective is to explore how Medicaid coverage impacts happiness, specifically analyzing in which direction do variations in healthcare spending significantly improve mental health: higher spending or lower spending after Medicaid. Utilizing instrumental variable (IV) regression, I conducted six separate regressions across subgroups categorized by expenditure levels and happiness ratings, and the results reveal distinct patterns. Enrolling in OHP has significantly decreased the probability of experiencing unhappiness, regardless of whether individuals had high or low medical spending. Additionally, it decreased the probability of being pretty happy and having high medical expenses, while increasing the probability among those with lower expenses. Concerning the probability of being very happy, the OHP only had a positive effect on being very happy and spending less, and its effect on those with high expenses was insignificant. These findings align with the benefit of Medicaid: alleviating financial burden, contributing to the well-being of distinct subgroups.

EXPERIENCE OF CYBERBULLYING AND PRACTICES TO COPE WITH IT AMONG HIGHSCHOOL STUDENTS IN HANOI

Julia D — Wed, 11 Jun 2025 00:00:00 +0530

This cross-sectional study investigated the prevalence, types, and coping strategies
associated with cyberbullying among adolescents in Hanoi, Vietnam. This demographic is
particularly vulnerable as Vietnamese adolescents lack access to adequate support
resources. Using respondent-driven sampling to provide a safe and confidential platform
for discussing a sensitive topic, data was collected through self- administered online
surveys based on the cyberbullying measurement scale and coping strategy framework
developed by Patchin and Hinduja. A total of 253 students aged 13–18 from public schools
participated in the study. Results revealed that 51.4% of participants had experienced at
least one of six forms of cyberbullying, and 77.9% had witnessed others being
cyberbullied. These behaviors often led to emotional distress among victims, emphasizing
the significant psychological impact of cyberbullying on adolescents. Additionally, the
study explored coping strategies and found that students frequently lacked effective
mechanisms to address cyberbullying incidents. The most common response was seeking
advice from friends, reported by 40.7% of participants, while fewer students turned to
parents, teachers, or professional support systems for help. This limited reliance on adults
or institutional resources highlights a potential gap in support systems available to students
in the effectiveness or accessibility of current support systems. These findings underscore
the urgent need for comprehensive educational interventions aimed at raising awareness
about cyberbullying and equipping students with practical tools to manage and respond to
such incidents effectively. Schools and policymakers should prioritize the development of
programs that foster digital resilience, enhance peer support networks, and encourage the
involvement of trusted adults to create a safer online environment for adolescents.
Initiatives like peer mentoring programs can empower adolescents to support one another,
fostering a safer and more connected online environment.

RISK PERCEPTIONS AND SELF-CARE BEHAVIOR TOWARD CHRONIC KIDNEY DISEASE IN PEOPLE WITH TYPE 2 DIABETES MELLITUS IN LAO PDR

vannasith phonlevong — Wed, 11 Jun 2025 00:00:00 +0530

Diabetes mellitus (DM) is the second leading cause of chronic kidney disease (CKD) and related mortality worldwide. Previous reports indicated an increased risk of CKD in the Lao PDR due to poor diet and poor physical activity. The number of patients with CKD has increased, from 4.24% in 2020 to 8.55% in 2022. This cross-sectional study aims to examine factors in self-care behavior among people with type 2 DM who visited three tertiary care hospitals in Lao PDR. The study was conducted at the OPD of these hospitals. Face-to-face interviews were conducted to collect information using structured questionnaires from September to October 2024. A total of 433 subjects completed this study. Descriptive and multiple logistic regression analyses were conducted on the data. Only 41% of respondents demonstrated good self-care behavior. Those who were underweight and normal BMI (AOR: 1.72, 95% CI: 1.12 - 2.65), less knowledge of self-care practices (AOR: 0.49, 95% CI: 0.26-0.93), high perceived severity of CKD (AOR: 2.03, 95% CI: 1.32-3.14), low perceived barriers to performing self-care practices (AOR: 1.71, 95% CI: 1.09-2.69). Based on the findings, it is recommended that CKD prevention among individuals with Type 2 DM be enhanced. Culturally tailored awareness campaigns and health services specifically for high-risk groups are essential. Local healthcare authorities and relevant institutions are encouraged to implement targeted interventions to address these issues effectively. Policymakers and health officials should prioritise improving diabetes care and preventing CKD. Enhancing education about the risks of CKD for individuals with Type 2 DM is crucial. Furthermore, developing risk assessment tools that connect risk perception to health- related behavior could help reduce the burden of CKD and diabetes complications in Laos.

CHRONIC EXPOSURE TO AMBIENT AIR POLLUTION AND ALZHEIMER'S DISEASE: A NARRATIVE REVIEW

Tavon — Wed, 11 Jun 2025 00:00:00 +0530

Ambient air pollution is a global threat in the 21^st century, and its relationship to human health has been the focus of increasing research. The effects on development of Alzheimer's disease and cognitive impairment, however, have not been extensively researched. Information is sparse on whether there is an association and what exactly the mechanism of insult might be. Meanwhile, global life expectancy and the incidence of Alzheimer’s disease as a cause of elderly dementia are on the rise. This study aims to explore the association between Alzheimer's disease and chronic exposure to ambient air pollution. PubMed and Embase were queried with the following string: Air AND (pollution OR PM_2.5 OR PM₁₀ OR NO₂ OR SO₂ OR carbon monoxide OR ozone) AND (Alzheimer OR dementia OR cognition OR cognitive decline) for papers published between 2020 and 2024. 36 articles meeting review criteria were found, and 8 articles were selected for contextual information. The simple answer was yes; ambient air pollution, most often PM_2.5, appears to increase the risk for dementia and cognitive decline. Insights into mechanisms were also found, including direct deposition of particles and cortical atrophy. There is even some evidence that the damage is attenuable. However, the study has limitations as there has been no statistical analysis of the studies presented, and the search criteria were not created in accordance with any standard. As countries tend toward clean air, further research into the prevention of air pollution related cognitive impairment is warranted. The greatest gap in research is in prevention, though one study herein suggests a strong policy enforced by governments may help prevent excess cases of Alzheimer’s disease due to air pollution.

CASE-CONTROL STUDY OF A CHIKUNGUNYA OUTBREAK IN GUNUNGKIDUL DISTRICT, INDONESIA (MAY–AUGUST 2024)

Denis Oxy Handika, Sidig Hery Sukoco, Riris Andono Ahmad — Wed, 11 Jun 2025 00:00:00 +0530

Gunungkidul District Early System was notified by the Paliyan Public Health Center about a rise in cases of sudden fever and arthralgia in the week of the 22nd. A team of the District Health Office and Paliyan Public Health Center’s staff and FETP UGM residents conducted an epidemiological investigation.We used 1:1 unmatched case-control study design. Cases were defined as individuals with fever and arthralgia, with/without positive chikungunya lab results, who lived in Pampang Village, Paliyan Sub-district. The controls were healthy residents in the same neighborhood with cases. The total sample was 184 (92 cases and 92 controls). In-depth interviews and observation with structured questionnaires were used for data collection demographics, risk factors, and environmental data. Blood samples were tested using Rapid Diagnostic Test at a health laboratory. The analysis involved chi-square and multiple binomial regression methods.The majority of the cases were female (57.6%), with an age group of 19-59 (58.7%), and residents living in the neighborhood of RT 10/RW 03 (35.9%). All cases had fever and arthralgia. More than half had headaches (59.8%), rash (40.2%), and nausea (22.8%). Eleven samples were tested positive for Chikungunya. The House Index (HI) for larvae is 28.97%. The presence of mosquito larvae around the house (aOR=2.12; 95% CI=1.36 – 2.87) and the habit of collecting rainwater (aOR=1.68; 95% CI=1.02 – 2.45) were associated with higher illness risk in this outbreak. A chikungunya outbreak occurred in Gunungkidul District from 15 May 2024 to 5 August 2024, was linked to mosquito larvae presence and the community's rainwater collection habit. Education and promotion of health behaviors and implementation of the comprehensive 3M Plus Mosquito Nest Eradication Program (PSN) must be improved

DETERMINANTS OF NATIONAL HEALTH INSURANCE RETENTION AMONG INFORMAL WORKERS IN PHNOM PENH, CAMBODIA

Nimol Kheng — Wed, 11 Jun 2025 00:00:00 +0530

This study aimed to investigate the determinants of Retention in National Health Insurance (NHI) in Cambodia, among the informal workers in Phnom Penh, Cambodia. Surveys of 424 informal workers in Phnom Penh from September to October 2024 were conducted. Multivariate logistic regression analyses were performed to assess the factors associated with NHI retention among the informal workers. The results revealed that having completed secondary school or higher, working in industrial or service sectors, perceiving high technical and interpersonal quality of healthcare, perceiving comprehensive benefit coverage, and perceiving good availability of healthcare services were significantly associated with retention in the NHI scheme. Additionally, participants with a good level of knowledge about the benefit package were more likely to maintain active membership. It was concluded that while socio-economic and accessibility factors play a critical role, motivational and ability-related factors, such as knowledge of benefit packages, positive perceptions of service quality, and attitudes toward coverage, substantially influence informal workers’ decision to remain enrolled in the scheme. Improving awareness of benefit entitlements and promoting the technical and interpersonal aspects of healthcare quality through targeted health education interventions may enhance NHI retention among informal workers.

ASSOCIATED FACTORS IN TUBERCULOSIS CONTACT INVESTIGATION: STUDY FROM JANUARY TO SEPTEMBER 2024 IN BOYOLALI DISTRICT, INDONESIA

Amira Nada Fatikha — Wed, 11 Jun 2025 00:00:00 +0530

Tuberculosis (TB) contact investigation is a crucial part of the TB control strategy. Boyolali District has yet to reach the contact investigation target, with only 21.1% of cases having undergone contact investigation in September 2024, far below the targeted 90%. This study aims to identify factors associated with tuberculosis contact investigation in Boyolali District. Using a cohort retrospective study on bacteriological TB patients registered in the tuberculosis information system from January to September 2024. Individual data (age, gender, residence, history of TB treatment, and HIV status) and health facilities characteristics (ownership and type) were analyzed with chi-square and logistic regression. We found that contact investigation was primarily conducted in aged 31-40 years (24.3%) and 51-60 years (24.3%), male gender (63.5%), living in Boyolali District (94.6%), having no history of TB disease (70.3%), not knowing HIV status (94.6%), seeking treatment at government-owned health facilities (93.2%) at public health centers (75.7%). Chi-square analysis showed that residencies (p-value = 0.02), ownership of health facility (p-value = 0.00), and type of health facility (p-value = 0.01) were associated with case investigation. Logistic regression revealed that patients living in Boyolali District (p- value = 0.03; OR = 3.3; 95%CI = 1.15 – 9.56), those treated at government-owned health facilities (p- value = 0.01; OR = 3.7; 95%CI = 1.42 – 9.52), and those attending public health center (p- value = 0.00; OR = 2.4; 95%CI = 1.34 – 4.40) were more likely to be investigated for tuberculosis contact. Outreach to patients outside the district and those treated at private health facilities, particularly hospitals, is essential for improving TB contact investigation coverage. Furthermore, strengthening health facility coordination, health worker capacity, and regular evaluations are crucial for optimizing investigations and reducing TB transmission.

EVALUATION OF PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT) IMPLEMENTATION IN YOGYAKARTA, INDONESIA: A 2023 ASSESSMENT

Niken Meilani, NS, YK, Primus Radixto Prabowo; Queenaisya Elfaiza Wibowo — Wed, 11 Jun 2025 00:00:00 +0530

The Prevention of Mother-to-Child Transmission (PMTCT) program is essential for reducing new HIV infections. This study evaluated PMTCT implementation in Yogyakarta, Indonesia, in 2023 using a descriptive qualitative approach and the CIPPO model (Context, Input, Process, Product, Outcome). Data were gathered through interviews with stakeholders from the Provincial and District Health Offices, Community Health Centers, and hospitals. The results showed that PMTCT has been integrated into antenatal care, including HIV testing, referrals, labor management, newborn prophylaxis, breastfeeding support, and follow-up for HIV-positive mothers. Community education efforts helped reduce HIV stigma. However, challenges such as the absence of routine HIV testing in pre-marital medical exams, unplanned pregnancies, and the high mobility of pregnant women hinder case detection and monitoring. While implementation aligns with health regulations, improvements are needed to strengthen collaboration across sectors and with NGOs. This study highlights key areas for enhancing PMTCT services and contributes practical insights for achieving the goal of zero new HIV infections by 2030. Addressing identified barriers and leveraging existing strengths can lead to more comprehensive and equitable HIV prevention strategies in maternal and child health services.

COMPARATIVE EVALUATION OF THE DIAGNOSTIC ACCURACY OF ARTIFICIAL INTELLIGENCE-ASSISTED TOOLS AND CONVENTIONAL TOOLS FOR PULMONARY TUBERCULOSIS SCREENING: A SYSTEMATIC REVIEW AND META-ANALYSIS

Conrigo Boya Santos, Jejunee Rivera, Vladimir Alexis Sustento — Wed, 11 Jun 2025 00:00:00 +0530

Tuberculosis is a preventable and curable disease, however, it remains as the second leading cause of death worldwide. Systematic screening for TB is one of the key active approaches of the End TB Strategy. However, conventional tools for TB screening have some limitations. AI-based algorithms could be developed, which can help in improving the performance of conventional screening methods. This study intends to evaluate the diagnostic test accuracy of AI-assisted PTB screening tools by meta-analyzing existing literature, and comparison of sensitivity and specificity, as well as assessment of factors which may influence the diagnostic performance of AI-assisted TB screening tools. Literature search was done through electronic databases, reference tracking, and library search. The Preferred Reporting of Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram was used to report the selection and screening of relevant studies between 2014 to 2024. A final count of 31 studies were included in this analysis. Quality assessment was done through the use of QUADAS-C tool. Meta analysis was done through RevMan 5.4.1 and STATA 17. Sensitivity and specificity were used in this analysis. A subgroup analysis was also conducted. The AI-assisted screening tools for pulmonary tuberculosis showed a pooled sensitivity of 93.84% (95% CI: 90.88-95.88) and 83.27% (95% CI: 73.41-89.97), and a diagnostic odds ratio (DOR) of 75.829 (95% CI: 33.19-173.23). Machine Learning (ML) algorithms yielded the highest sensitivity and specificity at 95.06% (95% CI:83.57-98.64) and 91.01% (95% CI: 76.76-96.88) respectively among the AI algorithm subgroup. The results of the meta-analysis done show that AI-assisted screening tools for pulmonary tuberculosis are viable options to improve screening for pulmonary tuberculosis. More robust, multi-center clinical studies regarding the diagnostic accuracy of these AI-assisted tools must be conducted in order to ensure a more valid and generalizable study.

MPOX OUTBREAK INVESTIGATION AMONG HIV-POSITIVE PATIENTS IN YOGYAKARTA CITY, INDONESIA, 2024

Wed, 11 Jun 2025 00:00:00 +0530

In July 2022, WHO declared mpox as a Public Health Emergency of International Concern (PHEIC) due to its rapid spread and caused outbreaks worldwide. In December 2023, an outbreak of mpox infections occurred in Yogyakarta City. The investigation aimed to explore sociodemographic and risk factors of the outbreak -and recommend control measures. A descriptive study was conducted from December 6, 2023, to March 2, 2024. Active case finding through direct interviews with the cases followed by contact tracing. Cases defined as individuals presenting with skin rashes include single or multiple lesions on the anogenital area or other areas of the body, for which the rash is not caused by other diseases and confirmed through diagnostic tests using Polymerase Chain Reaction (PCR). Two confirmed cases of mpox were found without an epidemiological link with zero death. Both cases were 35 and 34 years-old males with a history of HIV-positive under regular ARV treatment, experiencing fever, lesions, anogenital pain, fatigue, and diarrhea. One of them had syphilis (50%). Risk factors include sexual orientation as a man who has sex with men (MSM) and bisexual, with no history of travelling abroad. During treatment, they were instructed to self-isolation along with close contacts, including sexual partners. There has been local transmission of mpox in Yogyakarta City, especially among key populations. Health authorities should increase awareness, enhance surveillance, case detection and health promotion to limit the spread of the disease.

PEER EDUCATION MODEL FOR FAMILY LIFE PREPARATION IN FEMALE ADOLESCENTS OF ISLAMIC BOARDING SCHOOLS

Wed, 11 Jun 2025 00:00:00 +0530

The high rate of early marriage in Indonesia is linear with the number of early marriages that occur among female adolescent in Islamic Boarding Schools (IBS). Several studies have shown that female adolescent do not yet have a good family life plan (do not know the safe age to marry, plan to have many children, do not know the safe pregnancy spacing and do not plan to use contraception). The purpose of this study was to develop peer education model in the intention of preparing family life for female adolescent in IBS (age of first marriage, number of children, pregnancy spacing and family planning). The study was conducted using quasi eksperimen pre-post test with control group design. The study was conducted in traditional IBS in EastJava Province, Indonesia. The research period was December 2022 to October 2023. The research sample was female adolescent aged 15-24 years, have been boarding for more than one year, in good health and have never participated in reproductive health education programs and preparation for family life during at IBS. The total sample is 204 with 51 respondents per group. There are three intervention groups (conventional, peer education of young ustadzah, peer education of fellow dormitories). Data analysis was carried out using the Generalized Linear Model Repeated Measure statistical test. The results of the study show that peer education has an effect in increasing the intention of preparing for family life of female adolescent in traditional IBS. Peer education of fellow dormitories has the most effect on increasing intention, especially in the 2nd and 3rd month measurements. Statistically showed no difference between young ustadzah and fellow dormitories peer education. So that pesantren administrators need to involve peers in program implementation to maximize the expected results.