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Background Dengue is linked with climate change in tropical and sub-tropical countries including the Lao People's Democratic Republic (Laos) and Thailand. Knowledge about these issues and preventive measures can affect the incidence and outbreak risk of dengue. Therefore, the present study was conducted to determine the knowledge, attitudes, and practices (KAP) among urban and rural communities and government officials about climate change and dengue in Laos and Thailand. Methods A cross-sectional KAP survey about climate change and dengue were conducted in 360 households in Laos (180 urban and 180 rural), 359 households in Thailand (179 urban and 180 rural), and 20 government officials (10 in each country) using structured questionnaires. Data analysis was undertaken using descriptive methods, principal component analysis (PCA), Chi-square test or Fisher's exact test (as appropriate), and logistic regression. Results Significant differences among the selected communities in both countries were found in terms of household participant's age, level of education, socioeconomic status, attitude level of climate change and KAP level of dengue (P < 0.05; 95% CI). Overall, participants' KAP about climate change and dengue were low except the attitude level for dengue in both countries. The level of awareness among government officials regarding the climatic relationship with dengue was also low. In Lao households, participants' knowledge about climate change and dengue was significantly associated with the level of education and socioeconomic status (SES) (P < 0.01). Their attitudes towards climate change and dengue were associated with educational level and internet use (P < 0.05). Householders' climate change related practices were associated with SES (P < 0.01) and dengue related practices were associated with educational level, SES, previous dengue experience and internet use (P < 0.01). In Thailand, participants' knowledge about climate change was associated with the level of education and SES (P ...

International audience ; Dengue is linked with climate change in tropical and sub-tropical countries including the Lao People's Democratic Republic (Laos) and Thailand. Knowledge about these issues and preventive measures can affect the incidence and outbreak risk of dengue. Therefore, the present study was conducted to determine the knowledge, attitudes, and practices (KAP) among urban and rural communities and government officials about climate change and dengue in Laos and Thailand.

Muhammad Anwar,1 Abdul Raziq,2 Maryam Shoaib,3 Nosheen Sikandar Baloch,4 Shanaz Raza,5 Bisma Sajjad,5 Nabila Sadaf,5 Zaffar Iqbal,6 Rabia Ishaq,1 Sajjad Haider,1 Qaiser Iqbal,1 Nafees Ahmad,1 Naheed Haque,1 Fahad Saleem1 1Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan; 2Department of Statistics, University of Balochistan, Quetta, Pakistan; 3Sandeman Provincial Hospital, Quetta, Pakistan; 4Bolan Medical College, Quetta, Pakistan; 5Sardar Bahadur Khan Womens' University, Quetta, Pakistan; 6Health Department, Government of Balochistan, Quetta, PakistanCorrespondence: Fahad SaleemFaculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, PakistanTel +92 345 8326545Fax +92 81 9211288Email fahaduob@gmail.comPurpose: Quality use of antibiotics and the development of antibiotic resistance is a global catastrophe. In the conceptual context, the phenomenon is correlated with the healthcare practitioners' understanding of antibiotic use and resistance. Therefore, the study aimed to highlight nurses' perception of antibiotic use and resistance at a public healthcare institute in Quetta City, Pakistan.Respondents and Methods: By using a semi-structured interview guide through the phenomenology-based approach, in-depth, face-to-face interviews were conducted. Nurses practicing at the surgical and medical units of Sandeman Provincial Hospital (SPH), Quetta, were approached for the study. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework.Results: Although the saturation was reached after the 13th interview, an additional two were interviewed for absolute validation. Content analysis revealed five major themes: (1) defining antibiotics and antibiotic resistance, (2) antibiotic use: awareness and concern, (3) antimicrobial resistance: awareness and concern, (4) responding to antibiotic use and resistance, and (5) barriers to quality use of antibiotics and prevention of antibiotic resistance. Even though the understanding of nurses regarding antibiotic use and resistance was promising, certain apprehensions were also observed. The respondents were aware of the critical situation and provided valuable insights that can offer significant input while promoting the quality use of antibiotics in a developing country.Conclusion: While the perception towards antibiotics appeared positive, potential areas of concern and contributing factors regarding antibiotic resistance were also identified. Importantly, nurses too highlighted possible solutions to address the issue of irrational antibiotic use and the development of antibiotic resistance.Keywords: resistance, quality use of antibiotics, nurses, perception

An effective delivery strategy coupled with relevant social and behaviour change communication (SBCC) have been identified as central to the implementation of micronutrient powders (MNP) interventions, but there has been limited documentation of what works. Under the auspices of "The Micronutrient Powders Consultation: Lessons Learned for Operational Guidance," three working groups were formed to summarize experiences and lessons across countries regarding MNP interventions for young children. This paper focuses on programmatic experiences related to MNP delivery (models, platforms, and channels), SBCC, and training. Methods included a review of published and grey literature, interviews with key informants, and deliberations throughout the consultation process. We found that most countries distributed MNP free of charge via the health sector, although distribution through other platforms and using subsidized fee for product or mixed payment models have also been used. Community‐based distribution channels have generally shown higher coverage and when part of an infant and young child feeding approach, may provide additional benefit given their complementarity. SBCC for MNP has worked best when focused on meeting the MNP behavioural objectives (appropriate use, intake adherence, and related infant and young child feeding behaviours). Programmers have learned that reincorporating SBCC and training throughout the intervention life cycle has allowed for much needed adaptations. Diverse experiences delivering MNP exist, and although no one‐size‐fits‐all approach emerged, well‐established delivery platforms, community involvement, and SBCC‐centred designs tended to have more success. Much still needs to be learned on MNP delivery, and we propose a set of implementation research questions that require further investigation.

Abstract Background Throughout the world all health professionals face stress because of time-pressures, workload, multiple roles and emotional issues. Stress does not only exist among the health professionals but also in medical students. Bangladesh has currently 77 medical colleges 54 of which are private. This study was designed to collect baseline data of stress-level among Bangladeshi students, which we believe will form the basis for further in depth studies. Methods A cross-sectional study was conducted on medical students from 2 public and 6 private medical-schools in Bangladesh. All medical schools have common curriculum formulated by the Government of Bangladesh. The study population was 1,363 medical students of Year-III and IV of academic session 2013/2014. Universal sampling technique was used. The period of study was February to June 2014. Data was collected using a validated instrument, compiled and analysed using SPSS version-20. Results A total of 990 (73%) out 1,363 medical students participated in the study, of which 36% were male and 64% were female. The overall prevalence of stress of the study population was 54%. 53% of male and 55% of female were reported suffering from stress. 54% of Year-III students and 55% of Year-IV were noted suffering from stress. There was statistically significant (p = 0.005) differences in the level of stress between public (2.84 ± 0.59) and private (2.73 ± 0.57) medical schools student. Conclusions More than half of Bangladeshi medical students are suffering from measureable academic stress. It would be pertinent if the relevant authorities could address the issue so as to provide a conducive medical learning environment.

PurposeThe plethora of contributions to social learning has resulted in a wide range of interpretations, meanings and applications of social learning, both within and across disciplines. However, advancing the concept and using social learning methods and tools in areas like disaster-shocks requires interdisciplinary consolidation of understandings. In this context, the primary focus of this paper is on the contributions of social learning to disaster risk reduction (DRR).Design/methodology/approachBy applying a three-round policy Delphi process involving 18 purposefully selected scholars and expert-practitioners, the authors collected data on the meanings of social learning for two groups of professionals, DRR and social-ecological resilience. The survey instruments included questions relating to the identification of the core elements of social learning and the prospects for enhancing social-ecological resilience.FindingsThe results revealed strong agreement that (1) the core elements of social learning indicate a collective, iterative and collaborative process that involves sharing/networking, changes in attitudes and knowledge and inclusivity; (2) social learning from disasters is unique; and (3) linkages between disciplines can be built by promoting interdisciplinarity, networks and knowledge platforms; collaboration and coordination at all levels; and teaching and practicing trust and respect. Social learning is useful in preparing for and responding to specific disaster events through communication; sharing experience, ideas and resources; creating synergies for collective action and promoting resilience.Research limitations/implicationsThe policy Delphi process involved a limited number of participants to control the quality of the data. To the best of the authors' knowledge, this paper is the first of its kind to identify the core elements of social learning, specifically, in the disaster-shock context. It also makes significant contributions to the interdisciplinary integration issues.Practical implicationsThe practical implications of this study are related to pre-disaster planning and mitigation through the application of social learning on disaster-shocks.Social implicationsThe social implications of this study are related to valuing social learning for the improvement of disaster planning, management, and policy formulation and implementation in reducing disaster risks.Originality/valueThe study provides a consensus view on the core elements of social learning and its role in DRR and resilience building. Relevant to all stages of DRR, social learning is best characterized as a collective, iterative and collaborative process. It can be promoted by enhancing networking and interdisciplinarity.

Introduction Rabies is a vaccine preventable disease caused by the rabies virus. Since emergency physicians are the first point of contact with individuals who have suffered an animal-bite/scratch, knowledge of rabies, its prevention strategies and PEP recommendations is of paramount importance in them. Objectives To find out the knowledge regarding post exposure management of rabies and estimate the associationbetween socio-demographic factors and knowledge regarding rabiesamong emergency physicians working at NBMCH. Materials and Methods An institution based observational study with a cross-sectional design was carried out between March and May 2018, among 111 junior doctors who had worked in the emergency department at NBMC&H in the previous 1 year. Individual questions and cumulative scores to assess knowledge were compared using SPSS. Results The mean age of the participants was 25.75±3.26 years, with most of the participants being male (73%). Most participants knew about the epidemiology and categorisations of wounds,knowledge of the post-exposure management and prophylaxis with rabies immunoglobulin and ARV varied. One fourth (26.1%) did not know about the requirement to wash the wound in running water for 15 minutes.About half of the participants (55.0%) did not know the intradermal dosage regimen of the rabies vaccine, and almost a third also did not know the dosage regimen for re-exposure. A third of the participants had insufficient knowledge based on the cumulative scores. Designation of the physicians was significantly associated with sufficiency of knowledge regarding PE management of rabies. It was seen that physicians who had recently completed their undergraduate degrees and were posted as interns had the least knowledge (50.0%) of post-exposure management of rabies as compared to post-graduate physicians and house-staff. Conclusion Inadequate knowledge of healthcare personnel, as estimated from the current study, can endanger the life of the patients attending the centres for treatment and increase the healthcare budget of the government on unnecessary vaccines and immunoglobulins on the other.

Introduction:Knowledge regarding snakes and snake bites is important to reduce the incidence and complications following snake bites which are fairly common in tea gardens areas of Darjeeling.Objectives:The present study attempts to determine if the residents of the Kiran Chandra Tea Estate could identify the common snakes in their area, identify differences between poisonous and non poisonous snakes from their bites and to find out the usual practices regarding snake bite management in the study population.Materials and methods:: This descriptive study with cross sectional design was conducted in a convenience sample of 53 participants during May 2018 among the tribal population in Kiran Chandra Tea Estate using a Researcher Administered Questionnaire. Collected data was entered in Microsoft Excel and analyzed using descriptive statistics.Results:Among the 53 participants, 21 (39.6%) were Illiterate and the majority 40 (75.5%), were garden workers. The maximum number of participants 28 (52.8%) belonged to the above 40 years age group. Regarding identification of snake bite, 37.7% could not identify the signs and symptoms of poisonous snake bites. Only 26.4% were able to differentiate a poisonous snake bite from a non poisonous one. Fifty (94%) people thought application of a tourniquet proximal to the bite was important as First Aid. All the participants preferred using the snake stone immediately after the bite. Almost 60% preferred native / ayurvedic treatment over government hospitals.Conclusion:There is a paucity of knowledge on snake bites and its first aid management. A large section of the tribal community in the Kiran Chandra Tea Estate still prefer traditional methods of snake bite management instead of government facilities.

The rights and responsibilities of the individual are at the centre of today's armed conflicts in a way that they have never been before. This process of 'individualization', which challenges the primacy of the sovereign state, is driven by normative developments related to human rights that have elevated human-centric conceptions of security and created a new class of international crimes, as well as by technological and strategic developments that can both empower individuals as military actors and enable either the targeting or protection of particular individuals. The Individualization of War examines the status of individuals in contemporary armed conflict in three main capacities: as subject to violence but deserving of protection; as liable to harm because of their responsibility for attacks on others; and as agents who can be held accountable for the perpetration of crimes. This book presents a novel conceptualization of the phenomenon of individualization, including how it is both practiced and contested. It then convenes a set of leading thinkers from the fields of moral philosophy, international law, and international relations to further our understanding of not only how individualization is manifest in armed conflict - in theory and in practice - but also how it generates tensions and challenges for today's scholars and practitioners. The collective research on which the book is based integrates the currently segregated scholarship on individualization in different academic disciplines, thereby illuminating the important links between law, morality, and politics that constitute the day-to-day reality for national militaries, international organizations, and humanitarian actors.