Dev R, O'Neill Z, Norris CM
… +3 more, Raparelli V, Sarkar S, Pilote L
Asia Pac J Public Health
· 2026 Jan · PMID 41492804
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The prevalence of overweight/obesity (OW/OB-defined by body mass index) in low- and middle-income countries is rising, and the sociodemographic characteristics of the most affected populations are changing. The relations...The prevalence of overweight/obesity (OW/OB-defined by body mass index) in low- and middle-income countries is rising, and the sociodemographic characteristics of the most affected populations are changing. The relationship between education, widely recognized as a gender-related variable, and OW/OB in high-income countries is well understood; however, the impact in South Asian (SA) countries is less clear. This systematic review interrogated the relationship between educational attainment and OW/OB, by searching Ovid MEDLINE, CINAHL, EMBASE, and Web of Science for studies published after 2013, reporting the prevalence of OW/OB by educational attainment in eight SA countries. Data were extracted and the association between education and OW/OB was coded as direct, indirect, null, or U-shaped. A total of 32 studies were included in the review. The mean age was 38.5 years. The prevalence of OW/OB ranged between 4.6% and 64.4%. Females were reported to be at higher risk of OW/OB compared with males. Most of the studies reported women with higher education at greater risk of being OW/OB. SA countries are undergoing substantial transformations in their economic and social frameworks that influence how sex and gender mediate cardiovascular risk factors like OW/OB. Preventive strategies must be tailored to the unique characteristics of the SA population.
Yang YJ, Kim KH, Park JH
… +3 more, Ro YS, Song KJ, Shin SD
Asia Pac J Public Health
· 2026 Jan · PMID 41482689
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The purpose of this study was to investigate the effects of the COVID-19 pandemic on the mortality of traumatic brain injury (TBI) patients transported by emergency medical services (EMS). Adult TBI patients who were ass...The purpose of this study was to investigate the effects of the COVID-19 pandemic on the mortality of traumatic brain injury (TBI) patients transported by emergency medical services (EMS). Adult TBI patients who were assessed and transported by EMS between January 2018 and December 2021 were analyzed. The main exposure was during the COVID-19 pandemic period at the time of the event. The primary outcome was in-hospital mortality. A total of 18 988 patients were analyzed. The in-hospital mortality in the COVID-19 era group was 1812 (20.9%), and that in the non-COVID-19 era group was 2040 (19.8%). Multivariate logistic regression analysis revealed a significantly greater probability of in-hospital mortality in the COVID-19-era group; adjusted odds ratio of 1.16. Compared with non-COVID-19 era patients, TBI patients who were assessed and transported during the COVID-19 era were more likely to have higher in-hospital mortality.
Tyebally A, Sampurna MTA, Widodo MR
… +1 more, Damayanti NA
Asia Pac J Public Health
· 2026 Jan · PMID 41454736
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In Indonesia, weaknesses in the neonatal emergency referral and transport system have been identified as important factors in preventable neonatal deaths. To address this, a bottleneck analysis study was conducted in Sur...In Indonesia, weaknesses in the neonatal emergency referral and transport system have been identified as important factors in preventable neonatal deaths. To address this, a bottleneck analysis study was conducted in Surabaya using the modified Tanahashi model to identify bottlenecks in four key domains: supply, demand, quality, and the enabling environment. A mixed-method approach was employed. Qualitative data from interviews and focus groups identified gaps and underlying causes. Tracer indicators were used for targeted quantitative data collection through Health Facility Assessments and secondary data review to measure the gap extent. Primary health care facilities lacked trained staff, and bed shortages delayed transfers. Nonstandardized processes hindered transfer efficiency and affected neonatal care at specialized hospitals. Systemic weaknesses were found in data collection, monitoring, interagency coordination, and policy implementation. The bottleneck analysis framework effectively identified critical gaps and guided strategic prioritization for system improvement. Findings highlight the need for reviewing facility standards, modifying staff training, streamlining referral processes, establishing clear oversight roles for referral and prioritizing systematic monitoring and evaluation. The selected tracer indicators offer a framework for assessing neonatal emergency referral systems in other resource-limited settings, supporting efforts to improve neonatal survival through more effective referral and transport mechanisms.
Kato D, Kawachi I, Saito T
… +2 more, Yasufuku Y, Kondo N
Asia Pac J Public Health
· 2026 Jan · PMID 41437835
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Japan launched a municipal financial incentive program in 2018 to promote higher-quality long-term care (LTC). We quantified the association between municipal incentive performance and subsequent incident LTC certificati...Japan launched a municipal financial incentive program in 2018 to promote higher-quality long-term care (LTC). We quantified the association between municipal incentive performance and subsequent incident LTC certification and all-cause mortality among community-dwelling older people. Baseline 2016 data from the Japan Gerontological Evaluation Study (N = 90 896 adults aged ≥65 years in 23 municipalities) were linked to 2018-2020 administrative records. Each municipality received a composite incentive score (0-612). Using multivariable logistic regression with fixed effects, we estimated odds ratios (ORs) per 1 SD score increase, adjusting for demographics, socioeconomic status, and health. Over three years, 10.7% newly required LTC certification and 5.1% died. A 1 SD higher incentive score was associated with lower odds of incident LTC (OR: 0.91) and all-cause mortality (OR: 0.66). These benefits were driven by the "Support Functional Independence/Prevent Progression" domain in less-urban areas, while plan-do-check-act-style activities predominated in cities. Overall, better municipal performance under Japan's financial incentive policy correlated with short-term reductions in LTC utilization and mortality among older residents, supporting continued monitoring and policy refinement.
Abdul Rashid NH, Othman S, Lin BNZ
… +1 more, Ngu JL
Asia Pac J Public Health
· 2026 Jan · PMID 41388721
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Informal carers are essential to post-stroke recovery in Malaysia but often encounter significant challenges with minimal support. This qualitative study examined the lived experiences of 10 carers of stroke survivors wi...Informal carers are essential to post-stroke recovery in Malaysia but often encounter significant challenges with minimal support. This qualitative study examined the lived experiences of 10 carers of stroke survivors with moderate to severe dependency in Klang Valley. Guided by Schlossberg's transition theory, in-depth interviews were analyzed using inductive thematic analysis. Five main themes emerged: (1) focus shifted toward the stroke survivors, (2) caregiving repercussions, (3) lack of resources, (4) ways of surviving hardships, and (5) beauty emerging from hardships. Findings highlighted the public health importance of integrating carer support into post-stroke services, particularly in aging societies. Policy measures should include structured carer training, expanded community rehabilitation, workplace flexibility, and stronger linkages between health care, social services, and non-governmental organizations. Addressing these needs can enhance carer wellbeing, improve survivor outcomes and reduce long-term health system burdens.
Khalil MKN, Sahril N, Awaluddin SM
… +3 more, Shawaluddin NS, Mohd Hisham MF, Asari FN
Asia Pac J Public Health
· 2025 Dec · PMID 41388716
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Evidence on modern contraceptive use among Orang Asli women is limited. This study aimed to assess the prevalence and factors influencing modern contraceptive use among married or cohabiting Orang Asli women of reproduct...Evidence on modern contraceptive use among Orang Asli women is limited. This study aimed to assess the prevalence and factors influencing modern contraceptive use among married or cohabiting Orang Asli women of reproductive age (15-49 years). Data from 3249 Orang Asli women in the 2022 Orang Asli Health Survey (OAHS), a cross-sectional study employing a two-stage stratified random sampling design, were analyzed. Complex sample analysis with logistic regression was applied. The study found that 53.3% of Orang Asli women used modern contraceptives. Key factors significantly associated with contraceptive use included residence in remote areas (aOR=1.88; 95% CI = 1.08, 3.27), age 20-34 years (aOR = 2.43; 95% CI = 1.91, 3.09), and having three or more children (aOR = 2.17; 95% CI = 1.75, 2.70). The prevalence of modern contraceptive use among Orang Asli women exceeded Malaysia's national average and Indigenous populations globally. Improving accessibility and affordability remains critical, particularly for Orang Asli women in urban areas, to reduce disparities.
Asia Pac J Public Health
· 2026 Jan · PMID 41388709
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The Council of Indigenous Peoples in Taiwan has established tribal-based Cultural Health Stations offering basic health services and social activities for Indigenous communities. However, little is known about the factor...The Council of Indigenous Peoples in Taiwan has established tribal-based Cultural Health Stations offering basic health services and social activities for Indigenous communities. However, little is known about the factors influencing participation. This pilot study examined the reasons for attendance among older adults from five Paiwan communities in eastern Taiwan. A structured questionnaire, informed by Andersen's Behavioral Model of Health Services Use and shaped through community consensus, was administered to 211 elders, 77 of whom were attending Cultural Health Stations. Participants who attended were generally older, female, living alone, not engaged in paid work or farming, and reported positive perceptions of the activities. Common reasons for non-attendance included time constraints, preference for alternative social settings, and dissatisfaction with the programs. Multivariable logistic regression analysis revealed that being aged 75 years or older, living alone, and reporting a higher self-rated ability to manage health issues were positively associated with attendance. In contrast, having paid employment was negatively associated. Findings from the open-ended questions suggested attendees appreciated services and activities but requested more cultural content. Non-attendees expressed that activities should be inclusive of different age groups and ability levels, culturally connected to local communities, and mindful that many elders still need to work. These findings highlight the importance of incorporating elders' perspectives in the planning and evaluation of community-based services and may inform policy improvements for Indigenous elder care in Taiwan. However, it is also necessary to consider the economic circumstances of elders, design culturally centered activities, and respond to their interest in courses related to cultural transmission to ensure services are both accessible and meaningful.
Mohd Noh SN, Rata Mohan DS, Abdul Mutalib NE
… +7 more, Ab Rahim I, Jawahir S, Ab Hamid J, Manual A, Amer Nordin A, Abd Razak MA, Saminathan TA
Asia Pac J Public Health
· 2025 Nov · PMID 41235637
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The Orang Asli, the indigenous community of Peninsular Malaysia, experience significant health disparities. This study assesses the prevalence and factors associated with poor self-rated health (SRH) among adults aged 18...The Orang Asli, the indigenous community of Peninsular Malaysia, experience significant health disparities. This study assesses the prevalence and factors associated with poor self-rated health (SRH) among adults aged 18 and above using data from the Orang Asli Health Survey 2022. The prevalence of poor SRH was 12.8% (95% CI: [9.74, 16.68]). Factors associated with poor SRH are health-related factors (acute illness [adjusted odds ratio, aOR = 4.61, 95% CI: [3.54, 5.99]], recent hospitalization [aOR = 2.58, 95% CI: [1.78, 3.74]]), sociodemographic (unemployment [aOR = 1.51, 95% CI: [1.30, 1.76]], older age [aOR = 0.43, 95% CI: [0.30, 0.64]], and the Negrito tribes [aOR = 0.61, 95% CI: [0.37, 0.99]]) as well as lifestyle (tobacco use [aOR = 1.26, 95% CI: [1.03, 1.53]]). These findings underscore the importance of integrated health and social interventions sensitive to Orang Asli beliefs to improve health equity.
Paraja J, Mohamad Hanifah MH, Ismail AL
… +4 more, Marcus M, Bolong MF, Zhen LZ, Kadir F
Asia Pac J Public Health
· 2025 Nov · PMID 41235622
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During Malaysia's Delta wave in 2021, the island of Labuan faced a surge of COVID-19 cases that overwhelmed its only hospital. In response, a 100-bed field hospital with four transit ICU beds was rapidly established thro...During Malaysia's Delta wave in 2021, the island of Labuan faced a surge of COVID-19 cases that overwhelmed its only hospital. In response, a 100-bed field hospital with four transit ICU beds was rapidly established through multi-agency collaboration. Prior to patient admission, seven simulation exercises were conducted with 98 personnel to prepare workflows and identify system vulnerabilities. Scenarios included oxygen outages, patient collapse, fire drills, intubation, specimen transport, and portable x-ray deployment. The simulations revealed gaps in logistics, communication, and role clarity, leading to immediate corrective measures. Over 4 weeks, the hospital admitted 243 patients, 30% aged 60 years or older. Twelve required advanced respiratory support, yet no in-hospital deaths or cardiopulmonary arrests occurred. Staff debriefings highlighted improvements in teamwork, communication, preparedness, and workflow efficiency. This experience demonstrates how low-resource simulation can function as a strategic public health intervention to enhance preparedness in resource-limited settings.
Yıldız S, Ozumut SS, Ayaz Bılır R
… +1 more, Arslanoglu S
Asia Pac J Public Health
· 2025 Nov · PMID 41220105
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Delayed cord clamping is recommended in current guidelines. However, due to traditional practices, it has not been adopted sufficiently yet. This study was planned to evaluate its effects on mother-baby health. This was...Delayed cord clamping is recommended in current guidelines. However, due to traditional practices, it has not been adopted sufficiently yet. This study was planned to evaluate its effects on mother-baby health. This was a single-center, randomized controlled trial. A computer-based table of random numbers was used to allocate treatments. The study groups were compared in terms of hypothermia, cord blood gas, hematocrit, frequency of polycythemia, phototherapy requirements at birth, iron deficiency anemia at the fourth-month follow-up. The mean of early cord clamping time was 9.34 ± 4.91 seconds, and the mean of delayed cord clamping time was 106.48 ± 51.86 seconds. In the fourth-month follow-up, ferritin level and percentile mean of head circumference were significantly higher in the delayed cord clamping group. The results of this study support that delayed cord clamping does not pose a risk of hypothermia, polycythemia, and hyperbilirubinemia and also protects against iron-deficiency anemia.
Wu Y, Ching L, Prieto C
… +2 more, Phillips MM, Braun KL
Asia Pac J Public Health
· 2025 Nov · PMID 41217001
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The COVID-19 pandemic was assoicated with a significant drop in US life expectancy, with a 2.4-year decline from 2019 to 2021. This study evaluated if changes in life expectancy in Hawai'i followed the national trend fro...The COVID-19 pandemic was assoicated with a significant drop in US life expectancy, with a 2.4-year decline from 2019 to 2021. This study evaluated if changes in life expectancy in Hawai'i followed the national trend from 2018 to 2022. We calculated life expectancy at birth for Hawai'i's overall, male, and female populations from 2018 to 2022 using Chiang's abridged life table method, with data from the Hawai'i State Department of Health and population estimates from the American Community Survey and 2020 Census. Life expectancy in Hawai'i was stable from 2018 to 2020, then declined by 1.3 years in 2021 to 80.7, with a partial rebound to 81.2 in 2022. Males saw a drop from 79.2 years in 2018 to 77.5 in 2021, rising to 78.2 in 2022, while females declined from 85.4 years in 2018 to 84.0 in 2021, rebounding slightly to 84.4 in 2022. Hawai'i's COVID-19 response shows that early interventions and high vaccine uptake reduce mortality and preserve life expectancy. Future policy should focus on rapid-response systems and maintaining high vaccination rates.
See BK, Rajandram R, Lim XJ
… +2 more, Khong TL, Roslani AC
Asia Pac J Public Health
· 2025 Nov · PMID 41216654
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Despite effective screening tools, colorectal cancer (CRC) screening uptake remains low in Malaysia. We aimed to determine whether a locally contextualized patient navigation programme could improve adherence to and redu...Despite effective screening tools, colorectal cancer (CRC) screening uptake remains low in Malaysia. We aimed to determine whether a locally contextualized patient navigation programme could improve adherence to and reduce the psychological impact of screening colonoscopy. A pilot study determined barriers to colonoscopy adherence. The navigation programme was developed (phase 1), and navigators trained (phase 2). Fifty-two average-risk patients with positive immunochemical faecal occult blood tests were randomized to the patient navigation programme (intervention) or standard care (control) (phase 3). The primary outcome was adherence to colonoscopy. Secondary outcomes, assessed pre-colonoscopy and post-colonoscopy, used the Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire-12 (GHQ-12) scores. Navigated patients were 2.4 times more likely to complete colonoscopy ( < .001), had significant reduction in anxiety ( < .001) and depression ( = .008) while general wellbeing was better ( < .001) compared with controls. This culturally contextualized navigation programme is effective in improving adherence to colonoscopy, with reduction in anxiety, depression and general psychological distress. Wider implementation should be considered in national CRC screening strategies to improve effectiveness.
Mohamed N, Yacob Ya'akub H, Sharif S
… +2 more, Chan YY, Khalil MKN
Asia Pac J Public Health
· 2025 Oct · PMID 41169082
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Betel quid chewing is a traditional practice prevalent in many Asian countries, including among the Indigenous people (Orang Asli) in Malaysia. This habit poses serious health risks, such as oral cancer, diabetes, hypert...Betel quid chewing is a traditional practice prevalent in many Asian countries, including among the Indigenous people (Orang Asli) in Malaysia. This habit poses serious health risks, such as oral cancer, diabetes, hypertension, cardiovascular disease, and adverse pregnancy outcomes. Despite these known health implications, there is limited data and targeted interventions addressing this culturally significant behavior among the marginalized Orang Asli population. This study examined the prevalence and sociodemographic and risk behavioral factors associated with betel quid chewing among Orang Asli communities in Peninsular Malaysia. Data of 10,787 respondents aged 13 years and above were extracted from the 2022 Orang Asli Health Survey (OAHS), a population-based cross-sectional study using stratified random sampling. Complex sample design analysis and multivariable logistic regression were applied. The prevalence of betel quid chewing was 45.5%. Significant factors associated with betel quid chewing included being female (adjusted odds ratio [aOR] = 1.58,95% CI [1.21, 2.06]), Proto-Malay tribe (aOR = 7.41,95% CI [3.87, 14.15]), married/living with a partner (aOR = 1.60,95% CI: [0.28, 2.01]), employed (aOR = 2.80,95% CI [1.35, 5.76]), housewife/homemaker (aOR = 2.87,95% CI [1.35, 6.11]), tobacco user (aOR = 2.22,95% CI [1.85, 2.66]), and alcohol drinker (aOR = 1.41,95% CI [1.08, 1.85]). These findings highlight the need for culturally tailored interventions and preventive strategies targeting high-risk subgroups, such as married women and the Proto-Malay tribe, to reduce betel quid use and its associated health consequences.
Gasim N, Yıldırım S, Eylasov N
… +2 more, Durmuş A, Çoban H
Asia Pac J Public Health
· 2025 Nov · PMID 41169077
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This study investigated the impact of economic growth and unemployment on obesity within the Obesity Kuznets Curve (OKC) framework across 15 post-Soviet countries using annual data from 1991 to 2016. Employing the Augmen...This study investigated the impact of economic growth and unemployment on obesity within the Obesity Kuznets Curve (OKC) framework across 15 post-Soviet countries using annual data from 1991 to 2016. Employing the Augmented ARDL (A-ARDL) cointegration test for the first time in this context, the study reveals cointegration in nine countries, with the OKC hypothesis validated for Armenia, Azerbaijan, Belarus, Kazakhstan, Russia, and Turkmenistan. Initial economic growth increases obesity rates, but beyond specific GDP thresholds, healthier lifestyles emerge. The FADF-SB unit root test confirms variable stationarity at varying levels. Findings also highlight unemployment's diverse regional effects: a negative impact in Kazakhstan and Uzbekistan but a positive one elsewhere. The Fourier Toda-Yamamoto test identifies bidirectional causality between GDP and obesity in Kyrgyzstan and varying causal relationships in other countries. These results emphasize the complex interplay between economic and health factors, informing policies to address obesity trends in transitioning economies.
Asia Pac J Public Health
· 2025 Nov · PMID 41139219
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Malaysia's aging population faces a growing burden of noncommunicable diseases (NCDs), with obesity as a key modifiable risk factor. While body mass index (BMI) is commonly used to assess obesity, the waist-hip ratio (WH...Malaysia's aging population faces a growing burden of noncommunicable diseases (NCDs), with obesity as a key modifiable risk factor. While body mass index (BMI) is commonly used to assess obesity, the waist-hip ratio (WHR) may better capture central adiposity, which increases with age-related changes in body composition. This study examined the associations between BMI and WHR with hypertension, diabetes, hypercholesterolemia, and multimorbidity among 2,137 older Malaysians from the 2022 Malaysia Aging and Retirement Survey. Multivariable logistic and ordinal regressions showed that both BMI and WHR were significantly associated with all NCD outcomes after adjusting for sociodemographic and lifestyle factors. The findings highlight the critical need to routinely include both BMI and WHR in health screenings, emphasizing central adiposity as a key focus in public health strategies.
Shaikh S, Atif M, Adil SO
… +2 more, Ahmer Z, Shafique K
Asia Pac J Public Health
· 2026 Jan · PMID 41139218
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This systematic review, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, aimed to synthesize evidence on the effect of contracting the management of prima...This systematic review, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, aimed to synthesize evidence on the effect of contracting the management of primary health care (PHC) services on utilization, coverage, quality of care, and equity in low- and lower-middle-income countries. Published research and gray literature were searched using PubMed, Ovid Medline, and Google Scholar with relevant keywords. Outcome indicators included overall utilization or coverage for any sickness, maternal care, child care, quality of care, and equitable utilization. Meta-analysis was performed using STATA to calculate pooled estimates of percentage differences in outcomes. A total of 47 137 titles were screened, of which 18 studies met the final inclusion criteria. The review found that PHC contracting significantly increased utilization of PHC services for any sickness by 17%, facility deliveries by 19%, and family planning services by 12%. No significant effect was observed for community antenatal care or skilled birth attendance. Positive effects were also seen for patient satisfaction, while equitable utilization of services showed mixed results. Overall, contracting demonstrated benefits in improving service utilization, coverage, quality of care, and equity. However, assessments that are more rigorous are needed to strengthen the quality of evidence.
Song SD, Kon ZK, Stephens TA
… +10 more, Saladino PA, An KJ, Carson AB, Okamura KH, Marshall SM, Chin SK, Kaholokula JK, Subica AM, Pokhrel P, Okamoto SK
Asia Pac J Public Health
· 2025 Nov · PMID 41104849
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E-cigarette use among youth has become a significant public health issue, with Native Hawaiian and Pacific Islander (NHPI) youth exhibiting some of the highest usage rates in the United States. Despite the role of gender...E-cigarette use among youth has become a significant public health issue, with Native Hawaiian and Pacific Islander (NHPI) youth exhibiting some of the highest usage rates in the United States. Despite the role of gender-specific motivations in shaping substance use behaviors, limited research has examined these dynamics within NHPI populations. This study explored the gendered influences on e-cigarette use and non-use among rural NHPI youth through data collected from 17 gender-specific focus groups (N = 69) conducted across eight public schools on Hawai'i Island. Key findings revealed two distinct themes: girls emphasized relational harmony, basing their decisions on the impact to familial and peer relationships, whereas boys were primarily driven by individual goals, such as enhancing athletic performance and avoiding negative consequences. These insights underscore the necessity for culturally tailored, gender-specific prevention strategies that address the unique relational and individual factors affecting NHPI youth substance use behaviors.