Evaluation of the incorporation policy for Korean public hospitals

남은우 Dept. of Public Health, Graduate School of Medical 1991 해외박사

한국의 시도립병원은 그의 중요성에 비추어 보아 보건의료체제의 복잡성, 공공병 원에 대한 투자 및 정책적 지도의 미흡등이 있어 왔다. 또한, 의료시설은 영세성을 탈피하지 못하고 있으며, 운영상의 경직성,의료인력의 부족등으로 병원의 기능이 점차 약화되었다. 이에 한국정부는 이러한 불합리한 사항을 줄이고, 병원관리의 전문성 및 보건의료사업의 효율성을 높이기 위하여 시도립 병원을 지방공사체제로 전환하였다 . 본 연구는 시도립병원을 지방공사화한 정부의 병원정책을 평가하는데 있다. 전국에 는 34개소의 지방공사병원이 있는데 이 중 28개 병원을 대상으로 공사화 전·후의 병 원경영성과를 비교하였다. 조사의 자료: 본 연구의 자료는 1981년도와 1986년도의 조사 대상 병원의 연보와 재무제표를 이용하였다. 이의 자료는 내무부 지방재정과, 보건사 회부, 지방공사병원회 등에서 입수하였다. 분석방법: 병원수의 증감, 병원 업적의 변화 등을 검토하여 공사화 전·후의 차이를 비교하였다. 공사화 전·후의 경영성과 비교시 "One-group before and after design"을 사용하여 측정변수간의 평균차를 검정하였으 며,통계분석은 paired t-test를 시행하였다. 이의 결과를 요약하면 다음과 같다. 1. 조사대상병원의 평균 병상수는 공사화 이전 73. 29 병상에서 96. 54병상으로 증가하였 다. 2. 입원환자의 경우 공사화 이전 28. 10명에서 공사화 이후 65. 77명으로 증가하였 다. 외래환자의 경우 공사화 이전 171. 1명에서 공사화 이후 240. 90명으로 증가하였다. 3. 일병상당 평균수익은 공사화 이전 10,247천원에서 공사화 이후 13,094천원으로 증 가하였다. 4. 총지출비용중 인건비 비율은 공사화 이전 52. 0% 에서 공사화 이후 50. 0% 로 감소하였다. 5. 병상점유율은 공사화 이전 38. 34%에서 공사화 이후 68. 15%로 증가 하였다. 6. 일병상당 의사수는 공사화 이전 0. 11명에서 공사화 이후 0. 15명으로 증가 하였다. 7. 재정자립도의 경우 공사화 이전 79. 2%에서 공사화 이후 93. 85%로 증가하였 다. 결론적으로 시·도립병원의 지방공사화가 환자수의 증가, 재정수지의 호전등의 결 과를 가져와 병원의 운영관리에 긍정적인 영향을 미친 것으로 사료된다.

Analysis on barriers to development of the public-private partnership (PPP) in health sector of Pakistan : analytic hierarchy process approach

Ali, Saadat Graduate School of Public Health, Yonsei Universit 2022 국내석사

Introduction: In the recent years, public-private partnership (PPP) has become one of the most commonly used mechanisms with regards to providing healthcare services in various countries, and the ventures have gone successful. Despite of many accomplishments, still there are many challenges to development of PPP projects in the health care sector of Pakistan. Purpose: Current research was conducted to identify the most critical barriers in public-private partnerships in health sector of Pakistan using the Analytic hierarchy process technique. Methods: Based on the literature review and responses of interviewees, AHP model was developed. The model was developed with five main criteria barriers and twenty-one sub-criteria barriers. All the barriers were analyzed through pairwise comparisons to calculate relative weights and rankings as per experts’ evaluations. Results: A total of fourteen participants’ responses were analyzed and their relative weights were calculated. The criteria ranking was evaluated from the most influential to the least influential as follows: governance and regulatory barriers (w=0.4633), financial barriers (w=0.2465), socio-cultural barriers (w=0.1534), political barriers (w=0.0898), and technical and legal barriers (w=0.0471). Conclusion: Based on the results, it is concluded that decision-makers/policy-makers may consider the most influential barriers and their ranking while formulating the policies to develop PPPs in the healthcare sector Pakistan. After, eliminating the critical barriers, the policies and strategies may become more effective and efficient.

Factors affecting the implementation of improved community health fund (iCHF); case of Ubungo Municipality area, Dar-es-salaam region, Tanzania

Mselle, Goodluck Msafiri Graduate School of Public Health, Yonsei Universit 2022 국내석사

Introduction; In developing countries, lower-income households use their income to pay for healthcare services, which has contributed to many families remaining poor. Therefore, community-based health insurance schemes were targeted to help these households to help them to afford healthcare services even if they didn’t have income at that time. Purpose; The purpose of this study was to analyze health facility, community, and related governmental factors that led to the proper functioning of the improved Community Health Fund scheme in Ubungo Municipality in Tanzania. Methodology; A cross-sectional descriptive study was conducted using online questionnaires distributed among healthcare providers and community members using public-owned health facilities in the Ubungo Municipal Council area between October and November 2021. A Chi-square test was used to analyze the data. Results; Results have shown there was statistically significant (x2=15.697, df=2, n=174, p=0.000) between the health facility level with adequate availability of healthcare providers. Likewise, it was statistically significant (x2=17.527, df=2, n=174, p=0.000) between education level and medical supplies/equipment availability in a health facility. And on the community, it was statistically significant (x2=14.559, df=2, n=199, p=0.001) between income level with satisfaction with the iCHF scheme at a health facility. On community-related factors, it was shown that income level was statistically significant (x2=12.075, df=2, n=199, p=0.000) between with involvement of local leaders in iCHF implementation. Also, it was statistically significant (x2=16.922, df=2, n=199, p=0.000) between income level with community behavior/culture towards iCHF. The occupation was statistically substantial (x2=48.726, df=2, n=199, p=0.000) with the involvement of local leaders in iCHF implementation iCHF. Governmental related factors It was statistically significant between income (x2=21.818, df=2, n=199, p=0.000) and iCHF membership size and (x2=18.676, df=2, n=199, p=0.000) and iCHF premium. Also, on occupation (x2=19.086, df=2, n=199, p=0.001 was statistically significant with iCHF premium and statistically significant (x2=21.289, df=2, n=199, p=0.000) with iCHF membership size. Conclusion; If the quality of health service under the iCHF scheme increases, people are willing to pay for the premium the government will allocate and reduce challenges like the preference of user fee scheme over iCHF, problems faced by the enrollment officers, and inadequate iCHF premium membership size.

(The) effect of breast-feeding on the oral health in the early childhood

Kim, Ye-lin Graduate School of Public Health, Yonsei Universit 2018 국내석사

Early childhood is an age group who are most susceptible to dental caries and in this regard, early childhood caries(ECC) is a significant public health problem. According to the statistics of National Health Insurance Service in South Korea, the total medical expense on dental caries has increased about 29.2% from 2010 to 2015, of which the age group from 1 to 9 years comprises a large proportion, around 23.9% in 2015. Another epidemiologic data from 2015 Korean Children’s Oral Health Survey indicates the decayed and filled rate (df rate) among 5-year-old children have risen from 62.2% in 2012 to 64.4% in 2015 (Ministry of Health and Welfare, 2015) Associated risk factors for ECC are mainly microbiological risk factors, dietary and socioeconomic ones. Among those related risk factors, however, the effect of breast-feeding on ECC remains a controversial issue. Neither has there been no agreement on the exact duration of breast-feeding affecting ECC. The purpose of this study was to evaluate the effect of breast-feeding on the early child hood caries. The subjects for this study were was sampled from the 5th (2010~2012) and the 6th (2013~2015) KNHANES. Those children are at age over 12 months, and have been both breast-fed and formula fed. Based on the previous studies, independent variables were determined and grouped into each category of biological, socioeconomic, dietary and oral health behavior factors. The percentage of children with experience of more than one decayed or filled primary teeth(DFT) and that of those with non-experience of DFT were compared per independent variable, using cross-tabulation procedure and the relative proportions within each independent variable were analyzed using chi-square test. Additionally, logistic regression analysis was conducted to evaluate the risk of the early childhood caries in relation to each independent variable. Then, significant factors were selected to figure out the risk of early childhood caries in relation to the duration of breast-feeding through sub-group analysis. The statistics software, SAS version 9.4(Cary, NC), was used to analyze the data. Associated factors with ECC were analyzed using the multivariable logistic regression analysis. The odds ratio of children who were breast-fed for over 12 months is 3.96(95% CI: 1.77-8.86), which indicates the highest risk for prevalence of ECC compared to other quartile of the duration of breast-feeding. Among the related factors, significant variables related with ECC were analyzed for sub-groups of the duration of breast-feeding. It was observed that the odds ratio of each factor associated with the prevalence of ECC was the highest when the duration of breast-feeding is over 12 months. This study demonstrated that the longer the duration of breast-feeding practices is, the higher the risk for the prevalence of ECC is. However, other confounding factors such as intake of snack and sugar-contained drinks, frequency of feeding practice, etc., should be measured to confirm the association between breast-feeding and ECC. Considering the enormous benefits of breast-milk, the breast-feeding practice should be strongly encouraged. However, the breast-feeding promotion programs provided by the public health centers rarely explains the association between the breast-feeding practice and infant oral healthcare. Moreover, dentists for the infants' dental examination in the local communities hardly explain the effect of breast-feeding practice on children's oral health. Thus, infants' oral health care and education should be aggressively promoted as well as proper management of breast-feeding. 유아기는 치아 우식에 가장 취약한 시기이며, 특히 유아기 우식증은 심각한 공공 보건 문제로 규명된다. 국민건강보험공단 조사 통계에 따르면, 치아 우식에 소비되는 의료비용이 2010부터 2015년까지 5년 사이에 약 29.9% 가 증가했으며, 이중 1세~9세의 치아 우식 치료비용이 2015년에 약 23.9%로 가장 큰 비중을 차지했다. 또한 2015년도 아동구강건강실태조사에 따르면, 5세 아동 중 평균 유치 우식경험율이 2012년에 62.2%에서 2015년에 64.4%로 증가했다(보건복지부, 2015) 유아기 우식증과 관련된 주요 요인은 미생물학적 요인, 식이요인, 그리고 사회경제적 요인이 있다. 하지만, 이러한 요인 중 모유수유가 유아기 우식증에 미치는 영향은 아직 논란의 여지가 있으며, 모우수유의 적절한 기간에 대한 의견도 일치하지 않다. 따라서 본 연구에서는 모유수유가 유아기 우식증에 미치는 영향에 대해 조사하고자 한다. 본 연구는 제 5기(2010~2012)와 제 6기(2013~2015) 국민건강영양조사 자료를 분석하였고, 12개월 이상의 유아 중 모유수유와 조제분유 수유를 모두 받은 경험이 있는 유아들을 대상으로 하였다. 기존 문헌을 바탕으로, 독립변수들을 선택하였으며 이 변수들을 생물학적 요인, 사회경제적 요인, 식이요인 그리고 구강건강 행위 요인으로 분류하였다. 각 독립변수에 따른 1개 이상의 유치 우식 경험이 있는 군과 유치 우식 경험이 없는 군의 비율을 카이제곱 검정을 통해 먼저 분석하였다. 추가적으로 다변수 로지스틱 회귀 분석을 시행하여 각 독립변수가 유아기 우식증에 미치는 영향을 분석하였다. 그리고 하위그룹 분석을 실시하여 유아기 우식증에 유의한 연관성을 보이는 요인을 규명하였다. 모든 자료 분석은 통계 소프트웨어, SAS version 9.4(Cary, NC)을 사용하였다. 유아기 유식증과 연관된 요인을 다변수 로지스틱 회귀분석을 실시한 결과, 0~3개월 동안 모유수유한 대상자에 비해 12개월 이상 모유수유한 대상자의 오즈비는 3.96(95% CI: 1.77-8.86)이다. 하위그룹 분석결과에서 대상자의 나이, 모친의 나이, 가구소득수준, 모친의 교육수준, 엄마의 직업 유무, 최근 1년 이내 모친과 대상자의 구강검진 여부를 나누어 분석했을 시 12개월 이상 모유수유한 그룹이 유아기 우식증이 발생할 오즈비가 높았다. 이 연구에서 연장된 모유수유가 유아기 우식증 발생 위험을 높인 다는 것을 확인하였다. 그러나 유아기 우식증에 큰 영향을 미칠 수 있는 간식섭취, 설탕이 들어간 음료 섭취 그리고 수유 횟수와 같은 혼란 변수들이 통제되지 않았다. 모유수유의 여러 가지 장점을 고려할 때, 모유수유는 적극적으로 권장되어야 한다. 그러나 보건소에서 제공하는 모유수유 증진 프로그램은 유아기 구강건강과 모유수유 행위의 연광성에 대하여 언급하고 있지 않다. 게다가, 지역사회 영유아 구강검진을 시행하는 치과의사들도 이 둘의 연관성에 대해 거의 설명하지 않는다. 따라서 영유아 구강건강 교육은 모유수유가 권장됨에 따라 함께 강조 되어야 한다.

(The) approach of healthcare infrastructure public-private partnership (PPP) in developing countries : for the equal good to Korea interest group and the recipient country

이슬기 Graduate School of Public Health, Yonsei Universit 2021 국내석사

Over the past decade, Public-Private Partnerships (PPPs) have increasingly found their application in the sector of health infrastructure. The objective of this paper is to determine whether PPPs are a viable option for health infrastructure projects in developing countries. For this purpose, the author discusses and describes PPPs in general and specifies features of PPPs, which may be relevant for the healthcare sector and developing countries. In the next step, the author analyses PPP projects that are operating and projects that the author had involved and establishes key learnings from the undertaking. The combined evidence suggests that the PPP model for health infrastructure projects in developing countries can be highly risky for the countries, but also it possesses great insecurity for the participant entities. The author concludes PPP is not a better alternative to ODA in health infrastructure development in developing countries, but it should be an option. Also, the author suggests three conditions, those are prioritizing countries to build partnerships, secure evidence of partner country’s commitment, testify project design through multiple steps for both the public and the private to successfully use PPP for better health delivery.

(The) health-seeking behavior of the elderly with non-communicable diseases at coastal areas, Vietnam

Ho, Minh Duy Graduate School of Public Health, Yonsei Universit 2022 국내석사

Background The aging population is rapidly increasing globally. It proves a severe impact on developing and low-income countries due to insufficient resources and lack of awareness towards the challenges of health issues. In Vietnam, over 11 million people aged 60 and over, accounting for 11.8% of the population. It is projected that by 2050 there will be nearly 29 million people (HelpAge, 2018). People over 60 years old have 2.6 diseases, over 80 years old have 6.8 diseases on average (Dang Thi Thanh et al., 2018; MOH, 2020). Therefore, healthcare facilities and the health services behavior of older populations with non-communicable diseases are considered important in formulating a health program targeting this group. Significantly, the coastal area is a challenging area where participants live (Government, 2016b). Purpose This study aimed to investigate the health-seeking behavior of the elderly with non-communicable diseases, and its associated factors.   Method A Cross-sectional study was conducted in seven coastal areas in Thua Thien Hue province, Vietnam, with a sample of 370 people aged 60 years and older. Physicians diagnosed the presence of non-communicable diseases at health care facilities. Information on independent variables such as social, demographic, perceived health status, etc., and dependent variables such as health-seeking behavior through the utilization of healthcare services were collected using a structured questionnaire. In addition, a pilot investigation questionnaire on patients who visit a primary healthcare unit in one of seven coastal areas was conducted, and investigators were trained before collecting data. Chi-square and multiple logistic regression analyses were used to examine the factors associated with the utilization of health care services. Results The mean age of participants was 69.70 ± 6.6 (SD). Over half of the participants were fishery or agriculture, 14.3% of them were under an average standard of economic. The proportion of multiple non-communicable diseases was 18%. The disease duration was mainly about 5-10 years and more than ten years with the rate over 40%, respectively. Most participants were diagnosed at public health facilities. A third of quarter of participants required health care counseling. The results of the study showed that 69.8% of the total participants had health-seeking behavior. The findings also revealed that the elderly living alone were likely to have 4.5 times less health-seeking behavior than those who did not live alone (OR: 4.48, 95% CI: 1.016-19.78, p=0.048). Similarly, the economic status was related to the health-seeking behavior. People with an average and wealthier income seemed to have 2.8 times higher utilization of healthcare services than the poor and below the average group (OR: 2.81, 95% CI: 1.11-7.11, p=0.029). A group with multiple NCDs were more likely to have nine times higher health-seeking behavior than those with only one disease (OR: 9.24, 95% CI: 2.665-32.15, p=<0.001). Health insurance and the needed for health care counseling were also relevant (OR: 4.16, 95% CI: 1.30-13.31, p=0.016), (OR: 3.91, 95% CI: 2.04-7.49, p<0.001), respectively. Conclusion Health-seeking behavior is one of the most important positive implications for the aged population, encompassing one's physical, mental, and psychological wellbeing. The future study would be clarifying the same results in-depth to understand and improve the health-seeking behavior in the elderly and enhance their quality of life.

Factors associated with catastrophic health expenditure and impoverishment in Mongolia in 2021

Michidmaa Chinges Graduate School of Public Health, Yonsei Universit 2024 국내석사

Background: Globally, almost a billion people allocated 10% of their household budget on health, and half a billion people were impoverished due to paying for health out of their pocket in 2017 (WHO, 2021a). Health costs paid directly by individuals, known as out-of-pocket (OOP) expenses, affect the financial resources of households, and it is crucial to avoid exceeding a certain amount of their budget when it comes to spending on health. Mongolia, a country with a lower-middle-income status and extensive social health insurance coverage, has witnessed a significant increase in OOP health spending over the past decade. In 2018, around 7.2% of the population allocated more than 10% of their household budget towards healthcare (WHO, 2022). Objectives: The objective of this study is to quantify the incidence and financial hardship caused by catastrophic health expenses in Mongolia throughout the year 2021, as well as to determine the factors associated with it. Methods: This study is a retrospective cross-sectional analysis that examines the factors associated with catastrophic health expenditure (CHE) and destitution in Mongolia in 2021. Two distinct methodologies were utilized in this investigation to compute the incidence rate of CHE: OOP payments made directly by individuals that surpass 10% of the total amount spent by the household (Wagstaff & van Doorslaer, 2003), households that spend more than 40% of their nonfood spending on OOP payments (Ke Xu et al., 2003). Multivariate logistic regression model was used to evaluate the likelihood of incurring CHE on the socio-economic determinants of CHE. Results: At the threshold is 10% of the total household consumption, 13.8% of households at the threshold of 40% of capacity to pay 5.3% of households experienced CHE in Mongolia. Around 110,000 people were impoverished due to paying for health in 2021 in Mongolia. Households who have elderly members, household heads who are single, who are economically inactive, household members who sought inpatient and outpatient care were more likely to incur CHE at both thresholds. Conclusion: Despite the mandated status of national health insurance in Mongolia and the government's efforts to protect citizens from financial hardship during the last decade, it still falls short in terms of providing adequate financial protection and achieving universal health care. The government needs to implement consistent policies in protecting the population from financial burden.

Pediatric cardiac program in Haiti : challenges and improvement strategies

김하윤 Graduate School of Public Health, Yonsei Universit 2022 국내석사

전 세계 모든 인류가 행복을 누리기 위함을 목적으로 2015 년 UN 이 채택한 지속가능한발전목표(SDG)는 예방 가능한 아동사망 및 소외계층에 대한 건강 불평등 해소를 위해 필수적으로 달성해야 할 인류공동의 목표이자 해결과제이다. 세계 최빈국 중 하나인 아이티는 매년 수 백명의 아이들이 선천성 및 후천성 심장병으로 인해 생명의 위협을 받지만, 외과적 진단과 치료를 받는데 한계가 있으며 NGO 들이 운영하는 소아심장수술프로그램을 통해 소수의 선택된 아이들 만이 대부분 해외로 이동하여 수술을 받고 있다. 본 연구는 아이티 소아심장수술프로그램 운영에 있어서 제약점들과 이를 극복하기 위한 개선전략방안을 모색함으로써 궁극적으로는 더 많은 생명을 살리기 위한 발전방향을 제시하고자 한다. 이를 위해 소아심장수술 프로그램에 참여한 경험이 있는 전문가 5 명을 대상으로 심층면담을 실시한 후 질적연구 프로그램인 NVivo12 software 를 사용하여 면담내용을 분석하였다. 총 27 개의 개념들은 6 개의 제약점들로 요약 및 분류되었다. 연구 분석결과에 따르면 6 개의 제약점들은, NGO 차원에서 겪는 어려움인 환자 해외이동수술 및 의료진 교육 프로그램의 운영과 관련된 문제점들과 이들에 근본적인 원인을 제공하는 정부적 차원의 문제점들인 정치적 불안정, 취약한 공공보건 시스템, 훈련된 의료진의 부족, 심장센터의 부재였다. 이에 대한 개선방안은 정부적 차원에서의 노력으로 개선되어야 할 장기적인 목표와 NGO 자체 내 추구해야 할 중-단기목표를 제시함으로써 전략방안을 제시하였다. 정부적 차원에서 개선이 요구되는 부분은 먼저, 정치적 안정이다. 정치적안정은 예측이 불가하나 외부의 지속적인 관심과 협조가 필요하며, 내국인 및 외국인들의 안전을 보장할 수 있는 제도가 마련되어야 한다. 둘째, 공공보건시스템 강화로서 공공보건분야 예산 확충을 통해 의료보장제도를 확대하고, 1 차보건의료접근성을 향상시킴으로써 항생제 배부를 통한 질병발생률 감소와 질병증상조기대응 및 위생교육을 통한 인식개선활동으로 1 차 및 2 차 질병예방을 기대한다. 셋째, 의료진 역량을 강화하기 위해 의료진 수를 높이고 의료의 질을 개선하는데 초점을 둔다. 기본급여 인상을 포함한 근무환경개선을 통해 두뇌유출을 방지하고, 다자간협력을 통한 교육프로그램개발을 하여 장기적이고 지속적인 의대교육과 기존 의료진 보수 교육을 실시한다. 정부는 교육의 참여증대를 위해 의료시설에서 의무적으로 의료진들을 교육에 참여하도록 장려하는 것이 필요하다. 넷째, 정부주도의 적극적인 재정 마련을 통한 심장센터구축을 통해 환자들에게 수술 제공, 의료진 훈련 및 일자리를 제공한다. 이와 같은 정부의 장기적인 목표들은 NGO 들의 궁극적인 목표인 영구적인 소아심장프로그램구축과 병행한다. 그러므로 프로그램을 운영하는 NGO 들은 영구적인 소아심장프로그램 구축으로 가는 과도기 동안 현재 프로그램들을 유지하면서 부가적으로 인접국가인 도미니카공화국을 중점으로 환자수술 및 아이티 의료진 훈련 프로그램을 운영하는 삼각협력을 도모하는 방안을 탄력적으로 운영한다. 더불어, 아이티 내 NGO 간 협업 및 정부와의 소통, 외부 후원팀들과 지속적인 파트너십을 개발하고 유지하는 것이 중요할 것이며, 사명감 있는 외부단체 및 개인의 헌신이 요구된다. 이 연구의 결론은 아이티에 영구적인 심장센터 및 프로그램구축이 필요하며 정부 주도의 적극적인 재정 및 인적 투자와 함께 현재 활동하고 있는 NGO 들과의 협력을 통해 공동의 목적이 달성될 수 있을 것임을 시사한다. 향후 아이티의 독립적인 심장수술역량 확립을 통해 많은 생명들이 구해지길 기대한다. The SDGs adopted by the UN in 2015 for the purpose of achieving happiness for all mankind in the world are a common goal and solution that should be achieved to resolve preventable child deaths and health inequality for the underprivileged. In Haiti, one of the world's poorest countries, hundreds of children are life-threatening each year due to congenital and acquired heart disease. However, there is a limit to receiving surgical diagnosis and treatment, and only a small number of selected children benefit from surgery abroad. This study aims to explore the challenges and improvement strategies of pediatric cardiac surgery programs in Haiti, ultimately saving more lives. To this end, in-depth interviews were conducted with five experts who had experienced participating in the pediatric cardiac surgery program, and the interview contents were analyzed using NVivo12 software, a qualitative data analysis program. A total of 29 concepts were classified into six challenges, which were divided into two categories: government and NGO. The government had the challenges of political instability, a weak public health system, a lack of trained medical personnel, and the absence of a cardiac center, and the NGOs faced challenges related to the operation of overseas surgery program and medical staff training program. The improvement required at the government level is first of all, political stability. Although this is unpredictable, it requires continuous interest and cooperation from the outside of Haiti, and a system ensuring safety for foreigners as well as citizens of Haiti should be prepared. The second, improving strategic plan is to strengthen the public health system. By increasing the budget in the public health sector, extend health care coverage and improve access to primary health care. It is expected to reduce the incidence rate and prevent acquired heart disease through public awareness improvement activities. Third, another strategy to strength the medical personnel’s capabilities is accomplished through improving quality of education for medical students and providing CME program for the medical personnel by developing the programs through public-private cooperation. It is also important to prevent brain drain by raising basic salary and improving working environment. Fourth, by establishing a cardiac center through government-led financial support, surgery is provided to patients and jobs and training are offered to medical staff. These long-term goals of the government are in parallel with the ultimate goal of NGOs, and the purpose of the establishment of a permanent pediatric cardiac program. During the transition period until a permanent cardiac program is established in Haiti, while maintaining the current programs, flexibly operate patient surgery and medical staff training programs based on triangular cooperation in the neighboring Dominican Republic. In addition, it will be important to develop and maintain ongoing partnerships with the Haitian government and external support teams and experts. The conclusion of this study is to suggest the necessity of establishing a permanent cardiac center and programs in Haiti. The common goals can be achieved through cooperation with NGOs along with government-led active investment in financial and human resources. It is expected that this study may be used as a supporting data to establish independent cardiac surgery capacity in Haiti in the future for the purpose of saving more lives.

Impact of COVID-19 on oral health services utilization among Peruvian children : a cross-sectional study

Katherine Quiroz Gonzales Graduate School of Public Health, Yonsei Universit 2024 국내석사

Background Oral Health is the first step for general health and well-being. Unfortunately, Oral health conditions have consistently ranked as some of the most widespread Non-Communicable Diseases (NCDs) globally (WHO, 2022), affecting the financial burden and compromising the country’s health expenditure. Therefore, early diagnosis, treatment, and monitoring through visits to oral health services are essential to reduce the burden of Oral Health Diseases (Di Spirito et al., 2022; Huang & Chang, 2022; Kazeminia et al., 2020). Due to the emergence of the novel Coronavirus Disease (COVID-19) different public health measures were triggered exacerbating health inequalities affecting access to health services (Bambra et al., 2020; Gudipaneni et al., 2023). In addition, the patterns of children's dental attendance could be influenced by different factors involving parents/caregivers, household characteristics, and others that were changed by the pandemic context (Gudipaneni et al., 2023; Torres-Mantilla & Newball-Noriega, 2023). In Peru, Oral Health Services Utilization has remained relatively low in the past years while caries prevalence remained high for the past 20 years, especially in children, becoming a public health concern (MINSA, 2019) Purpose The objective of this research was to assess the impact of the COVID-19 pandemic on oral health services utilization among Peruvian children under 12 years old. Method A cross-sectional study with secondary data from the Demographic and Family Health Survey (ENDES, in Spanish) from the years 2019 (before COVID-19), 2020 (during COVID-19), and 2022 (after COVID-19) was carried out. This study involved children aged 0-11 years old. Those with complete data of all variables and who were habitual residents were considered, resulting in a total sample of 40,341 children for 2019, 19,530 for 2020, and 39,863 for 2022. The main variable was Oral Health Services Utilization in the last 6 months and the independent variables were the sociodemographic factors classified according to Andersen’s Healthcare Utilization Model into predisposing (child’s age and sex; parent/caregiver’s sex, age, marital status, relationship with the head of the household; natural region of residence; area of residence; and altitude) and enabling factors (child’s insurance, wealth index, parent/caregiver’s education level and knowledge about oral healthcare). Descriptive analysis involving absolute and relative frequencies was conducted, for the bivariate analysis Chi-square test was employed. Finally, to determine the association between predisposing and enabling factors with Oral Health Services Utilization Hierarchical Logistic Regression was performed for the multivariate analysis. Results: The prevalence of Oral Health Services Utilization (within the last 6 months of ENDES surveys) in Peruvian children under 12 years of age was 40.4% in 2019, 31% in 2020, and 41.2% in 2022. For the bivariate analysis, Oral Health Services Utilization showed a significant association (p0.001) with the following predisposing factors: child’s age, parent/caregiver’s age, natural region of residence, and area of residence before, during, and after the COVID-19 pandemic. All enabling factors (child’s insurance, wealth index, parent/caregiver’s education level, and knowledge about oral healthcare) showed significant association (p0.001) with Oral Health Services Utilization before, during, and after the COVID-19 pandemic. The parent/caregiver’s sex showed a significant association (p0.001) with Oral Health Services Utilization only before the pandemic. While. parent/caregiver’s marital status (p0.05) and their relationship with the head of the household (p0.001) were significantly associated with Oral Health Services Utilization only after the pandemic. On the other hand, the child’s sex and the altitude showed insignificantly association. Within the multivariate analysis, the child’s age, the parent/caregiver’s sex, the natural region of residence, the parent/caregiver’s level of education, the parent/caregiver’s information received about oral Healthcare, and the wealth quintile of the household were significantly associated with Oral Health Services Utilization before, during and after the COVID-19 pandemic. The parent/caregiver’s age was associated with Oral Health Services Utilization only before and after the COVID-19 pandemic. The parent/caregiver’s marital status, the area of residence, and the health insurance were associated with Oral Health Services Utilization only before and during the COVID-19 pandemic. The child’s sex was associated with Oral Health Services Utilization in children only after the COVID-19 pandemic. Finally, after analyzing samples as a whole and adding the “year” as a variable, this was significantly associated with Oral Health Service Utilization, therefore Peruvian children in 2019 (OR: 1.11, 95%CI: 1.07-1.14, p=0.000) were more likely to use Oral Health Services before the COVID-19 than after COVID-19 (2022). In addition, there was a negative association between the year 2020 (during the COVID-19) and Oral Health Services Utilization, then Peruvian children in 2020 (OR: 0.65, 95%CI: 0.63-0.68, p=0.000) were less likely to use Oral Health Services during the COVID-19 (2019) than after COVID-19 (2022). Conclusion The pre-existing low rate of Oral Health Services Utilization in Peruvian children under 12 years was exacerbated during the COVID-19 pandemic, as well as the sociodemographic factors determining Oral Health Services Utilization that were affected or even modified, changing the patterns of Oral Health Services attendance in Peruvian children. Therefore, the COVID-19 pandemic had a negative impact on Oral Health Services Utilization which is increasing again nowadays after 2 years.

The association between health risk behaviors and health-related quality of life by socioeconomic status

김미선 Graduate School of Public Health, Yonsei Universit 2009 국내석사