International Festival of Public Health

LT 5 - Prevention and Screening and Occupational and Environmental Health

“Danger: Men at Work”? A Proposal for an Exploration of Emotional Labour of Male Healthcare Workers

Presenter: Imo Emah (Edge Hill University)

Other Author(s): -

Abstract Text:

Not available.

Spectacles wearing compliance among school children in selected slums in Dhaka

Presenter: Mohammad Awlad Hossain (Orbis International, Bangladesh Country Office)

Other Author(s): Holden Kim, Mohammed Alauddin, Lutful Husain, Munir Ahmed, Nurul Kabir

Abstract Text:

Introduction: Refractive error is one of the most common visual impairments affecting school aged children in Bangladesh. Around 1.3 million children have refractive error. The children who have refractive error can not perform well in studies because of this impaired vision. Orbis International Bangladesh in collaboration with project BOM and Yonsei University, South Korea distributed spectacles free of cost to the school children who had refractive error and living in slums in Dhaka city. A compliance monitoring was carried out with the children who received spectacles to learn about the status of spectacles wearing.

Methods: A total of 82 out of 1581 children screened were identified as being refractive error through a school screening program and all of them were provided spectacles free of cost. After nine months of spectacles distribution, a monitoring team made sudden visits to the schools and administered a semi-structured questionnaire with 76 children who were available to collect the information about the status of spectacles wearing.

Results: Monitoring findings show that 71% of children were using spectacles on the day of observation; higher among girls (76.1%) and younger children (83.3%). However, among spectacles users, 46% did not wear it regularly. Only 21% of working children wear spectacles regularly while it was about 65% among non-working children (P=0.005). Average duration of spectacles wearing was 9 hours and it was higher among girls, younger children and non-working children than their counterparts. Breaking and loosing glasses, teasing by friends, parents’ unwillingness to purchase and not comfortable in using spectacles were reported as main barriers of spectacles wearing.

Conclusion: It is evident that spectacles wear compliance may be low among children when even spectacles are provided free of cost. Compliance can be increased by addressing the social and other barriers and ensuring at least bi-annual compliance monitoring visits.

A Systematic Review of the Evidence on Episiotomy to Improve the Obstetric Outcomes in Women who have undergone Female Genital Mutilation/Cutting (FGM/C)

Presenter: Pushpa Hossain (University of Chester)

Other Author(s): -

Abstract Text:

Background: Female Genital Mutilation is the act of intentionally cutting or injuring or even changing parts of the female external genitalia without having a clear medical indication. Globally, this has been done to 200 million girls and women who are alive today. Women living with FGM/C have a significantly higher rate of obstetric morbidity than those who do not have FGM/C. Long term obstetric complications affect both the mother and child. Episiotomy is the procedure of widening the vaginal opening by performing a surgical incision to reduce any obstetric morbidities and mortalities. There is very little data available to guide healthcare professionals on deciding the protective benefits, indications and types available of episiotomies in case of women who have undergone FGM/C.

Aim: This systematic review mainly aims to examine the evidence on whether episiotomy improves the obstetric outcomes in women who have undergone female genital mutilation or Cutting (FGM/C). Primary Obstetric outcomes to be measured were set to be Perineal tear, Intrapartum haemorrhage or postpartum haemorrhage.

Search Methods and Selection Criteria: A robust search was done in the following databases: Cochrane Library, PubMed, CINAHL, Medline, Psycinfo, African Index Medicus, Science direct and Proquest. Other sources like medical journals, abstracts from Conferences and registries were thoroughly searched. A time limit of fifteen years’ spanning from 01/01/2003 to 30/09/2018 was applied. No geographical restrictions were applied. All quantitative studies included compared the obstetric outcomes of vaginal delivery in women who had undergone FGM/C and had an episiotomy, against the women who had undergone FGM/C but did not have an episiotomy.

Data Collection and Analysis: This study included five observational studies of a variety of designs. Data was extracted using standardised data extraction forms. Quality assessment, risk analysis, and meta-analysis were performed using the free RevMan 5.3 software.

Results: Several Meta-analyses were performed due to the uniqueness and broad spectrum of results. For perineal tears as an obstetric outcome, the total sample size was 6,814 participants. Performing episiotomy on women who had previously undergone FGM/C has protected them from the substantial risk of perineal tears (OR= 0.31, 95% CI= 0.11, 0.89, p= 0.03). Also, episiotomy was protective against the occurrence of both intrapartum haemorrhage (OR= 0.07, 95% CI= 0.05, 0.10, p= <0.00001) and postpartum haemorrhage (OR= 0.21, 95% CI= 0.17, 0.26, p= 0.03).

Conclusion: This review summarises that episiotomy -regardless of type- proved to be of significant positive protective value against obstetric outcomes like perineal tears, intrapartum haemorrhage and postpartum haemorrhage.

Assessing the Prevalence of Fetal Alcohol Spectrum Disorders (FASD) in Greater Manchester

Presenter: Robyn McCarthy (University of Salford)

Other Author(s): Penny A. Cook, Raja Mukherjee, Kate Fleming, Jill Clayton-Smith, Clare Allely, Alan Price, Cheryl McQuire, Anna Webster.

Abstract Text:

Fetal Alcohol Spectrum Disorders (FASD) have an estimated global prevalence of 7.7 per 1000 in the general population and even higher in Europe (19.8 per 100,000). In high risk populations, including looked after children, individuals within the criminal justice system and in some rural parts of South Africa, prevalence reaches approximately 30%. This makes FASD one of the most common preventable causes of developmental disorders in the world. Despite high levels of prenatal alcohol exposure in the UK, evidence on FASD prevalence is sorely lacking. The first UK study of the screening prevalence of FASD found between 6 – 17% of children screened positive for features of FASD. While the screening measure was not equivalent to a formal diagnosis, these findings offered a starting point for understanding the potential prevalence of FASD and suggest that FASD is likely to be a significant and previously overlooked public health concern. For the first time in the UK, this study will use an active case ascertainment—the current gold standard screening method for FASD. As FASD is a diagnosis of exclusion, several other conditions must be ruled out in this process. Researchers will go into four Greater Manchester schools to identify children aged 8-9 years with developmental disorders. We will utilise developmental assessments, facial photography, DNA micro array analysis to ensure accurate identification of cases. The children and parents involved in the study will be the immediate beneficiaries of this work. The study will identify an estimated 30 children with a range of learning difficulties, including possible Autism Spectrum Disorder, Attention Deficit Hyperactivity Disorder (ADHD) and FASD. These children and their parents/carers will be provided with a tailored report and signposted for further evaluation and support. This study will provide prevalence data for FASD in children aged 8-9 years and will enable us to model prevalence in the general population. We aim to inform policy and improve efforts in prevention and the provision of support to affected individuals.

Funding: This project is funded by The Greater Manchester Health and Social Care Partnership and The University of Salford.