South Eastern European Journal of Public Health

5

Authors: Genc Burazeri, Peter Achterberg

The former communist countries of South Eastern Europe (SEE) have been undergoing a rapid process of transformation from state-enforced rigid economies to market-oriented societies in the past 25 years. However, these fast changes have unevenly affected various countries and different segments of the populations within each country.

8

Authors: Edlira Harizi (Shemsi), Arben Rroji, Elton Cekaj, Sazan Gabrani

Aim: The purpose of this study was twofold: i) in a case-control design, to determine the relationship between anatomical variations of the circle of Willis and cerebrovascular accidents; ii) to assess the association between anatomical variations of the circle of Willis and aneurisms among patients with subarachnoid hemorrhage. Methods: A case-control study was conducted in Albania in 2013-2014, including 100 patients with subarachnoid hemorrhage and 100 controls (individuals without cerebrovascular accidents). Patients with subarachnoid hemorrhage underwent a CT angiography procedure, whereas individuals in the control group underwent a magnetic resonance angiography procedure. Binary logistic regression was used to assess the association between cerebrovascular accidents and the anatomical variations of the circle of Willis. Conversely, Fisher’s exact test was used to compare the prevalence of aneurisms between subarachnoid hemorrhage patients with and without anatomical variations of the circle of Willis. Results: Among patients, there were 22 (22%) cases with anatomical variations of the circle of Willis compared with 10 (10%) individuals in the control group (P=0.033). There was no evidence of a statistically significant difference in the types of the anatomical variations of the circle of Willis between patients and controls (P=0.402). In age- and-sex adjusted logistic regression models, there was evidence of a significant positive association between cerebrovascular accidents and the anatomical variations of the circle of Willis (OR=1.87, 95%CI=1.03-4.68, P=0.048). Within the patients’ group, of the 52 cases with aneurisms, there were 22 (42.3%) individuals with anatomical variations of the circle of Willis compared with no individuals with anatomical variations among the 48 patients without aneurisms (P<0.001). Conclusion: This study provides useful evidence on the association between anatomical variations of the circle of Willis and cerebrovascular accidents in transitional Albania. Furthermore, findings from this study confirm the role of the anatomical variations of the circle of Willis in the occurrence of cerebral aneurisms.

10

Authors: Adesuwa Q. Aigbokhaode, Essy C. Isah, Alphonsus R. Isara

Aim: Timely and appropriate healthcare seeking behaviours if practiced by caregivers of under-five children can have a significant impact on child survival. This study assessed the knowledge of, and general health seeking practices among mothers of under-five children in Nigeria. Methods: This descriptive cross-sectional study was carried out among caregivers of under-five children in Edo State, Nigeria, in 2013. A multi-staged sampling technique was used to recruit respondents. Data collection was done by means of a structured interviewer-administered questionnaire adapted from UNICEF/IMCI household baseline survey questionnaire. Results: A total of 370 caregivers (mean age: 31.1±5.9 years) participated in the study. Almost all of them were females 368 (99.5%), 234 (63.2%) had secondary education and 283 (76.5%) were in the unskilled social class. Over 70%, 76%, 72%, 76% and 82% of participants did not know that being unable to eat/drink, fast breathing, blood in stool and convulsion, respectively, were symptoms of a child not feeling well. The place of primary care of children by caregivers was at home 142 (38.4%), chemist shop 91 (24.6%) and health facility 80 (21.6%). Cost and long waiting time were major reasons for not seeking care in health facilities. Conclusion: This study showed poor health seeking practices among caregivers of under-five children in Edo State, Nigeria. There should be continuous education of caregivers on recognition of danger signs in children and the need to seek appropriate medical care in health facilities.

12

Authors: Mihajlo Jakovljevic, Ulrich Laaser

Aim: Population aging has profoundly reshaped demographic landscapes in all South Eastern European (SEE) countries. The aim of this study was to provide a thorough comparative inter-country assessment on the speed of population aging in the entire SEE region for the period 1950-2010. Methods: Descriptive observational analysis of long-term trends on core primary and composite indicators of population aging across seventeen countries of the wider SEE region, with panel data sets at a national level. Results: During the past six decades, the entire SEE region has experienced a rapid increase in the median age (from 25.2 years in 1950 to 37.9 years in 2010), with a simultaneous fall of fertility rates for two children per woman (from 3.55 children per each childbearing woman in 1950 to 1.49 in 2010), coupled with significant rise in the population of elderly citizens. The speed of population aging has vastly accelerated (with a 2.5 fold increase) over the past three decades. The percentage of individuals over 65 years has doubled from 7% in 1950 to 14% in 2010. Conclusion: Complex national strategies are needed to cope with the shrinking labour force coupled with the growing proportion of the older population. With all likelihood, population aging will further accelerate in the near future. This profound long-term demographic transition will threaten financial sustainability of current health systems in all SEE countries.

13

Authors: Maria Ruseva, Snezhana Chichevalieva, Meggan Harris, Neda Milevska Kostova, Elke Jakubowski, Hans Kluge, Jose M. Martin-Moreno

Inter-country alliances, articulated through regional approaches, have increasingly been used to drive economic development and social progress in the past several decades. The South Eastern Europe Health Network (SEEHN) stands out among these types of initiatives for the tangible improvements it has achieved in regional governance for health, with several important lessons for public health leaders worldwide. This review paper, written by several key participants in SEEHN operation, follows the main milestones in network development, including its foundation under the Stability Pact’s Initiative for Social Cohesion and the three ministerial forums that have shaped its evolution, in order to show how it can constitute a model for regional collaboration in public health. Herewith we summarise the main accomplishments of the network and highlight the keys to its success, drawing lessons that both international bodies and other regions may use in their own design of collaborative initiatives in health and in other areas of public policy. Keywords: collaborative networks, health systems, public health, regional cooperation, South Eastern Europe.

21

Authors: Hans Stein

Aim: The article contains a personal view of the history as well as the future of the European Union‟s (EU) health policy. Describing and evaluating the developments on the road from the Treaty of Maastricht to a new Europe it asks and tries to answer the question if we – especially the EU Member States – really know where we want to go to and how to get there. Method: Based on personal experiences, countless EU documents, as well as scientific publications the paper shows the impact EU Health policy has had in the Member States in the past. Historical development: Considering that the legal basis for health has been and remains to be very weak limiting EU action to support, coordinate, and supplement actions of Member States – which, as a rule, still consider health to be first and foremost a national responsibility and therefore do not want interference from international institutions – the amount and content of EU health activities in the past years has been quite remarkable. Health policy may not be an EU priority and as a crosscutting policy sector it is dominated by many other EU policies. However, especially the “hard law” regulations and directives of the Internal Market give EU the power and competence to achieve health objectives. The size of this growing influence is shown by direct interventions, made possible by the legal acts to improve economic policy coordination. Health and health care in this context are considered as a key policy area for economic growth and EU macroeconomic policy. On the other hand, there is a risk that such regulations affecting health policy and population health may be dominated too much by economic institutions and their interests, whereas health authorities play only a minor role to date. Conclusion: For the future of EU health policy it is essential that its position is considerably strengthened, in order to assure that health interests of the EU population are sufficiently safeguarded.