Background: Coronary heart disease (CHD), a complication of hypertension, is one of the most important and common causes of morbidity, hospitalisation, and mortality among hypertensive population. In recent decades, i...Background: Coronary heart disease (CHD), a complication of hypertension, is one of the most important and common causes of morbidity, hospitalisation, and mortality among hypertensive population. In recent decades, increased urbanisation and changes to lifestyle, diet and physical activity in developing countries have led to a major increase in the population incidence of chronic diseases including CHD. Poor medication adherence is one of the leading causes of failure to achieve hypertension control. The objective of this systematic review is to describe the prevalence of non-adherence to anti-hypertensive medications among hypertensive population in developing countries and identify factors associated with it. Methods: A literature search was conducted using the following scholarly electronic databases: Proquest, PubMed, JSTOR and Science Direct. The online search engine, Google Scholar was also used to search for and identify relevant papers. Peer-reviewed full-text articles published in English on hypertensive adults in developing countries that measured adherence to antihypertensive medications and their associations with different factors were eligible for inclusion. The review followed the PRISMA reporting and analytical guidelines for systematic reviews. Results: In all, 42 studies conducted across 19 developing countries were selected for the review. The mean prevalence of medication non-adherence (MNA) among the select hypertensive population was 47.34%. Very few studies were conducted in community settings and except for one, no study examined gender differences in MNA factors. The analysis revealed a range of factors that can influence MNA including low household income and socioeconomic status;knowledge and beliefs of hypertension and its management;avoiding side effects of medications;cost of medication;use of herbal preparations;absence of symptoms;irregular follow-up;and dissatisfaction with the treatment and health services provided. There was a general lack of consideration of role of health system in health care delivery, self-efficacy, cultural barriers, perceived individual risk of hypertension complications. There was also a lack of gender-specific research which is necessary at community settings given the social and economic vulnerabilities faced by women in developing countries that may affect adherence to antihypertensive medications. Conclusions: Future research in developing countries should consider individual risk perceptions, cultural barriers, gender and the role of local health system in health care delivery when assessing MNA among hypertensive population at community settings.展开更多
Background:Antimicrobial resistance(AMR)is a pressing global health issue,exacerbated by extensive antimicrobial use across human,animal,and plant sectors.The environment plays a crucial role in AMR emergence and spre...Background:Antimicrobial resistance(AMR)is a pressing global health issue,exacerbated by extensive antimicrobial use across human,animal,and plant sectors.The environment plays a crucial role in AMR emergence and spread due to the contamination from resistant bacteria,resistance genes,and antimicrobial residues from various sources.In Thailand,the regulatory framework that can reinforce AMR mitigation in environmental settings remains underdeveloped.This study aims to analyse the existing regulatory framework for environmental AMR control by identifying regulatory gaps and assessing the challenges of implementing these regulations.Methods:A qualitative approach was employed,combining a literature review and semi-structured interviews with 28 key informants from diverse regulatory sectors,including the ministries of health,agriculture,and environment.This included multi-level stakeholders at national,provincial,and local levels,as well as selected farmers.Content analysis of interview transcripts and regulatory documents was performed to triangulate findings on regulatory gaps and implementation barriers.Results:The study identified five regulatory categories governing water contamination across settings:rivers/canals,hospital wastewater,household wastewater,industrial waste(including pharmaceuticals),and animal farms.While the regulatory frameworks guide pollution standards,regulations lack provisions specific to AMR,highlighting a significant gap in AMR oversight and data on AMR pathogens in environmental wastewater.Key barriers include insufficient incorporation of AMR indicators in routine monitoring,limited enforcement,and inadequate technical and budgetary support.Conclusion:Thailand's current environmental AMR framework lacks comprehensive AMR-specific regulations and robust enforcement mechanisms.Addressing these gaps requires multi-sectoral coordination,enhanced funding,and capacity-building initiatives.By prioritizing indicator development and establishing AMR-focused policies,Thailand can enhance its environmental AMR control measures and contribute to global AMR mitigation efforts.展开更多
文摘Background: Coronary heart disease (CHD), a complication of hypertension, is one of the most important and common causes of morbidity, hospitalisation, and mortality among hypertensive population. In recent decades, increased urbanisation and changes to lifestyle, diet and physical activity in developing countries have led to a major increase in the population incidence of chronic diseases including CHD. Poor medication adherence is one of the leading causes of failure to achieve hypertension control. The objective of this systematic review is to describe the prevalence of non-adherence to anti-hypertensive medications among hypertensive population in developing countries and identify factors associated with it. Methods: A literature search was conducted using the following scholarly electronic databases: Proquest, PubMed, JSTOR and Science Direct. The online search engine, Google Scholar was also used to search for and identify relevant papers. Peer-reviewed full-text articles published in English on hypertensive adults in developing countries that measured adherence to antihypertensive medications and their associations with different factors were eligible for inclusion. The review followed the PRISMA reporting and analytical guidelines for systematic reviews. Results: In all, 42 studies conducted across 19 developing countries were selected for the review. The mean prevalence of medication non-adherence (MNA) among the select hypertensive population was 47.34%. Very few studies were conducted in community settings and except for one, no study examined gender differences in MNA factors. The analysis revealed a range of factors that can influence MNA including low household income and socioeconomic status;knowledge and beliefs of hypertension and its management;avoiding side effects of medications;cost of medication;use of herbal preparations;absence of symptoms;irregular follow-up;and dissatisfaction with the treatment and health services provided. There was a general lack of consideration of role of health system in health care delivery, self-efficacy, cultural barriers, perceived individual risk of hypertension complications. There was also a lack of gender-specific research which is necessary at community settings given the social and economic vulnerabilities faced by women in developing countries that may affect adherence to antihypertensive medications. Conclusions: Future research in developing countries should consider individual risk perceptions, cultural barriers, gender and the role of local health system in health care delivery when assessing MNA among hypertensive population at community settings.
基金the funding support from the Food and Agriculture Organization of the United Nations[grant number LOA/RAP/2021/15,PO Number 348413].
文摘Background:Antimicrobial resistance(AMR)is a pressing global health issue,exacerbated by extensive antimicrobial use across human,animal,and plant sectors.The environment plays a crucial role in AMR emergence and spread due to the contamination from resistant bacteria,resistance genes,and antimicrobial residues from various sources.In Thailand,the regulatory framework that can reinforce AMR mitigation in environmental settings remains underdeveloped.This study aims to analyse the existing regulatory framework for environmental AMR control by identifying regulatory gaps and assessing the challenges of implementing these regulations.Methods:A qualitative approach was employed,combining a literature review and semi-structured interviews with 28 key informants from diverse regulatory sectors,including the ministries of health,agriculture,and environment.This included multi-level stakeholders at national,provincial,and local levels,as well as selected farmers.Content analysis of interview transcripts and regulatory documents was performed to triangulate findings on regulatory gaps and implementation barriers.Results:The study identified five regulatory categories governing water contamination across settings:rivers/canals,hospital wastewater,household wastewater,industrial waste(including pharmaceuticals),and animal farms.While the regulatory frameworks guide pollution standards,regulations lack provisions specific to AMR,highlighting a significant gap in AMR oversight and data on AMR pathogens in environmental wastewater.Key barriers include insufficient incorporation of AMR indicators in routine monitoring,limited enforcement,and inadequate technical and budgetary support.Conclusion:Thailand's current environmental AMR framework lacks comprehensive AMR-specific regulations and robust enforcement mechanisms.Addressing these gaps requires multi-sectoral coordination,enhanced funding,and capacity-building initiatives.By prioritizing indicator development and establishing AMR-focused policies,Thailand can enhance its environmental AMR control measures and contribute to global AMR mitigation efforts.
