Nossal Institute for Global Health - Theses
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ItemThe epidemiology of dyslipidaemia in the cardiovascular epidemic in China( 2019)Background In recent decades, the prevalence of cardiovascular diseases (CVDs) around the world has been increasing, and researchers have paid more attention to understand the epidemiology of CVDs to provide reference for healthcare professionals and policy makers. China is one of the countries where rapid development of economy occurs accompanied by changes in people’s socioeconomic status and lifestyle, and is also facing the challenge of increasing burden of CVDs. This challenge exists not only in the rising prevalence of CVDs and increasing deaths from CVDs, but also in the low awareness and treatment rates of some CVDs. This Master research will focus on one important risk condition of CVDs, abnormal blood lipid levels or called dyslipidaemia, as a window to help understand more about the cardiovascular epidemics in China in recent years, based on secondary data analysis of a representative cohort study called China Health and Retirement Longitudinal Study. (CHARLS). Objectives This Master research aims to provide a reliable estimation of the prevalence, awareness, treatment and control rates of dyslipidaemia in middle-aged and elderly population in China, and analyse their related influential factors. Methods This research includes two phases of analysis: Phase 1: A cross-sectional study of the CHARLS baseline survey to investigate the prevalence, awareness, treatment and control rates of dyslipidaemia, using the blood test data from CHARLS. Phase 2: A cohort study of the CHARLS baseline and follow-up surveys to estimate the changes in prevalence, awareness and treatment rates of dyslipidaemia and to investigate related influential factors for the development, awareness and treatment uptake of dyslipidaemia. Results In the cross-sectional study of the baseline data, the weighted prevalence, awareness, treatment and control rates of dyslipidaemia were 43.8% (95%CI: 42.8, 44.8%), 22.7% (95%CI: 20.9, 24.6%), 13.5% (95%CI: 11.7, 15.2%) and 5.1% (95%CI: 4.3, 5.8%), respectively. Urban residents had significantly higher prevalence, awareness and treatment rates of dyslipidaemia compared with rural residents, while the control rates did not differ significantly. In the cohort study of the baseline and two follow-up surveys, the estimated prevalence of dyslipidaemia did not increase much from 2011 to 2015, while the awareness and control rates in both urban and rural areas increased significantly. Waist circumference (cm, OR: 1.04, 95%CI: 1.02, 1.07) was identified as the most important predictors for the development of dyslipidaemia during the observation. Urban residence (OR: 1.50, 95%CI: 1.10, 2.05) and higher education (OR: 1.69/1.97/1.64 for primary/secondary/high school or higher compared with illiterate education level) were found to be significantly associated with awareness of dyslipidaemia, while awareness of dyslipidaemia (OR: 5.75, 95%CI: 3.95, 8.36) was directly associated with the treatment uptake of dyslipidaemia. Conclusions Dyslipidaemia was found to be widespread in China with high prevalence, but its awareness, treatment and control rates remained relatively low, indicating its poor detection and inadequate control. However, the awareness and treatment rates were gradually increasing over years, possibly showing the outcomes of China’s healthcare reform and public health promotion programs. Obesity was a crucial contributor of dyslipidemia, and therefore management of dyslipidemia could refer to obesity management for policy making. Urban residence and higher education were important for awareness of dyslipidemia, while awareness was important for treatment uptake, so public education programs of health promotion were needed to raise awareness of dyslipidemia and better manage dyslipidemia epidemic in China.
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ItemHarm reduction and law enforcement in Vietnam: influences on street policing( 2013)Background and rationale: The HIV epidemic in Vietnam has from its start been concentrated among injecting drug users. Vietnam instituted the 2006 HIV/AIDS Law which includes comprehensive harm reduction measures, but these are unevenly accepted and inadequately implemented. Ward police are a major determinant of risk for injecting drug users (IDUs), required to participate in drug control practices (especially meeting quotas for detention centres) which impede support for harm reduction. Influences on ward level police regarding harm reduction were studied in Hanoi to learn how to better target education and structural change. Methods: After document review, key informants were interviewed from government, NGOs, INGOs, multilateral agencies, and police, using semi-structured guides. A survey was carried out among ward level police (n=27). Topics covered in both phases included perceptions of harm reduction and the police role in drug law enforcement, and harm reduction training and advocacy among police. Results: Police perceive conflicting responsibilities, but overwhelmingly see their responsibility as enforcing drug laws, identifying and knowing drug users, and selecting those for compulsory detention. Harm reduction training was very patchy, ward police not being seen as important to it; and understanding of harm reduction was limited, tending to reflect drug control priorities. Justification for methadone was as much crime prevention as HIV prevention. Competing pressures on ward police create much anxiety, with performance measures based around drug control; recourse to detention resolves competing pressures more safely. There is much recognition of the importance of discretion, and much use of it to maintain good social order. Policy dissemination approaches within the law enforcement sector were inconsistent, with little communication about harm reduction programs or approaches, and an unfounded assumption that training at senior levels would naturally reach to the street. Discussion: Ward police have not been systematically included in harm reduction advocacy or training strategies to support or operationalise legalised harm reduction interventions. The practices of street police challenge harm reduction policies, entirely understandably given the competing pressures on them. For harm reduction to be effective in Vietnam, it is essential that the ambiguities and contradictions between laws to control HIV and to control drugs be resolved for the street-level police.