Ervin Toçi

Health literacy, self-perceived health and self-reported chronic morbidity among older people in Kosovo.

The aim was to describe health literacy among the older population of Kosovo, an Albanian speaking post-war country in the Western Balkans, in the context of self-perceived health status and self-reported chronic morbidity. A cross-sectional study was conducted in Kosovo in 2011 including 1753 individuals aged ≥ 65 years (886 men, 867 women; mean age 73.4 ± 6.3 years; response rate: 77%). Participants were asked to assess, on a scale from 1 to 5, their level of difficulty with regard to access, understanding, appraisal and application of health information. Sub-scale scores and an overall health literacy score were calculated for each participant. Information on self-perceived health status, presence and number of chronic diseases and socioeconomic characteristics was also collected. Mean values of the overall health literacy score and all sub-scale scores (access, understanding, appraisal and application) were lower among older people who reported a poorer health status or at least one chronic condition compared with individuals who perceived their health status as good or had no chronic conditions (p < 0.001 for all). Our findings provide valuable evidence on the independent and inverse association between health literacy levels and self-perceived health and chronic morbidity in this post-war European population. The putative link with chronic morbidity and lower adherence to health services is hard to establish through this cross-sectional study. Prospective population-based studies should be conducted in Kosovo and other transitional settings to replicate these findings and properly address the causal relationship between health literacy and health status.

Socioeconomic conditions of elderly people in Kosovo: a cross-sectional study

BackgroundKosovo is the newest state in Europe facing a particularly difficult socioeconomic and political transition. The available evidence on socioeconomic conditions and quality of life of elderly people in Kosovo is scarce notwithstanding the ageing trend due to lowering of fertility rates and a higher life-expectancy. In this context, the aim of our study was to assess the socioeconomic conditions of elderly people in post-war Kosovo.MethodsA cross-sectional study was conducted in Kosovo in January-March 2011 including an age- sex-and residence (urban vs. rural)-stratified sample of 1,890 individuals (83.5% response) aged 65 years and over. A structured questionnaire included assessment of socio-demographic and socioeconomic characteristics including educational level and self-perceived poverty. Binary logistic regression was used to assess the association of self-perceived poverty with socio-demographic and socioeconomic factors.ResultsThe educational level in this representative sample of elderly people in Kosovo was quite low, particularly among women. About 47% of respondents perceived themselves as poor, or extremely poor (41% of men and 52% of women). In multivariable-adjusted models, self-perceived poverty was higher among older women, low educated individuals, urban residents, and elderly individuals living alone.ConclusionsFindings from this study indicate that the socioeconomic situation of the elderly population in Kosovo is rather challenging. Demographic trends coupled with the economic and political transition raise serious concerns about increasing needs for socioeconomic support of elderly people in Kosovo. Specific policies and actions should be considered by a number of stakeholders, including government and civil society in transitional Kosovo.

Concurrent validation of two key health literacy instruments in a South Eastern European population.

BACKGROUND Public health practice has come to increasing recognition of health promotion and the central role of knowledge, attitude, beliefs and practices in achieving health promotion. Health literacy (HL) is an under-explored topic in South Eastern European countries. There are no HL reports from Albania to date. The aim of this study was to assess the concurrent validity of the European Health Literacy Survey Questionnaire (HLS-EU-Q) and the Test of Functional Health Literacy in Adults (TOFHLA) in a population-based sample of adults in Albania. METHODS A cross-sectional study was conducted in 2013 in Tirana, Albania, including 239 individuals aged ≥ 18 years (61% women; 87% response). A structured interviewer-administered questionnaire was applied twice (test and retest procedure after 2 weeks) including HLS-EU-Q and TOFHLA instruments. RESULTS The internal consistency was high for both instruments (Cronbachs alpha for the test procedure was 0.92 for TOFHLA and 0.98 for HLS-EU-Q). Both tools exhibited a high stability over time (Spearmans rho: 0.88 for TOFHLA and 0.87 for HLS-EU). Mean values of both instruments were similar in men and women (mean score for TOFHLA: 76.0 vs. 76.5, P = 0.83; mean score for HLS-EU-Q: 32.2 vs. 32.6, P = 0.63). For both instruments, higher HL scores were significantly associated with younger age, higher educational and economic level and lower body mass index. CONCLUSIONS Our study provides valuable novel evidence on concurrent validation of two major HL instruments in a South Eastern European population-based sample. Future studies should be conducted in order to confirm and expand our findings.

Health Literacy and Socioeconomic Characteristics among Older People in Transitional Kosovo.

Aims: Health literacy among older people has received little attention in transitional countries of Southeast Europe. Our aim was to assess the level and socioeconomic correlates of health literacy among older people in Kosovo, a post-war country in the Western Balkans. Study Design: Cross-sectional study. Place and Duration of Study: Kosovo, between January-March 2011. Methods: This nationwide survey, conducted in Kosovo in 2011, included 1753 individuals aged ≥65 years (886 men, 867 women; mean age 73.4±6.3 years; response rate: 77%). Participants were asked to assess, on a scale from 1 to 5, their level of difficulty with regard to access , understanding , appraisal , and application of health information. Subscale scores and an overall health literacy score were calculated for each participant. Information on socioeconomic characteristics was also collected. Results: Subscale scores of health literacy were strongly correlated with each-other

Socio-economic correlates of functional health literacy among patients of primary health care in Kosovo

OBJECTIVES Functional health literacy (FHL) has been related to individual characteristics, ill-health and disease knowledge. However, the information about FHL in Kosovo is very limited and thus the aim of this study was to assess the demographic and socio-economic correlates of FHL among users of primary health care in Kosovo, a postconflict country in the Western Balkans. STUDY DESIGN Cross-sectional study. METHODS A cross-sectional study was conducted in Kosovo between November 2012-February 2013, including a representative sample of 1035 consecutive primary care users aged ≥18 years (60% females; overall mean age: 44.3 ± 16.9 years; overall response rate: 86%). Test of Functional Health Literacy in Adults (TOFHLA) was used to assess FHL. General linear model and logistic regression were used to assess the association of TOFHLA score with demographic and socio-economic characteristics. RESULTS Overall, four out of five participants exhibited inadequate or marginal FHL in this Kosovo sample. FHL score was independently and inversely related to age, but positively associated with educational attainment and being in a situation other than unemployed. CONCLUSIONS Limited or marginal FHL was very common among primary care users in Kosovo and considerably higher than in the neighbouring Serbia. The low health literacy levels in Kosovo may provide an additional barrier towards achievement of health care goals. There is a need to design and implement suitable and effective educational and health system interventions in the Kosovo context.

Tuberculosis Incidence and Case Notification Rates in Kosovo and the Balkans in 2012: Cross-country Comparison

Aim: Tuberculosis (TB) continues to be a considerable burden especially for millions of young adults and disadvantaged people worldwide. The TB incidence and notification rates are good indicators of TB situation in a country. Our aim was to compare TB incidence and notification rates in Kosovo and in seven other Balkan countries. Methods: Retrospective epidemiologic analysis of published data on TB incidence and notification rates in eight Balkan countries in 2012. Notification rates were expressed per 100,000 inhabitants and were calculated based on the number of TB cases reported divided by the population of each country under analysis. Results: The TB incidence in Kosovo (47/100,000) was considerably higher compared to its four neighboring countries: Albania (16/100,000), Macedonia, Montenegro (18/100,000) and Serbia (23/100,000). The TB notification rates in Kosovo and other countries closely mimicked the incidence rates in these countries. Conclusion: The exceptionally high TB incidence rate in Kosovo could be due to many factors including low health and medical-seeking behaviors of the local population, poverty and low education levels. Effective interventions should be adapted to the local context in order to increase the chances of success.

Prevalence and Factors Associated with Congenital Malformations in Tirana, Albania, During 2011-2013

Aim: Congenital Malformations (CMs) represent a challenge especially for developing countries. Data about CMs in Albania are rather scarce. In this context, our aim was to assess the prevalence and factors associated with CMs in Tirana, the capital of Albania. Methods: Information on all CMs at birth during 2011-2013 was retrieved from the National CM Surveillance System. For each CM case, three controls (babies born without CM) were retrieved as well. Overall, 831 cases and 2522 controls were included in this study. The prevalence was calculated using the total number of live births in Tirana during the same period. Binary logistic regression was used to determine the factors associated with CMs adjusting for a number of covariates. Results: The three-year prevalence of CMs was 23.41 per 1,000 live births. The most affected body systems were the musculoskeletal, cardiovascular and genital systems. CMs were more prevalent among male babies. Advanced mothers’ age, lower education, unemployment status and lower gestational age were all positively associated with increased likelihood of CMs. Conclusions: Socio-demographic factors of mothers are linked to CMs in Albania. Future surveys are needed in Albania in order to establish determinants of CMs at a national level.

Social networks, social participation and self-perceived health among older people in transitional Kosovo

BACKGROUND A number of studies proved that social networks and social participation have beneficial health effects in western countries. However, the evidence from southeast European region is scant. We aimed to assess the extent of social networks and social participation and their relationship with self-perceived health status among older people in post-war Kosovo. METHODS A nationwide cross-sectional study was conducted in Kosovo in 2011 including a representative sample of 1890 individuals aged ≥65 years (949 men, mean age 73 ± 6 years; 941 women, mean age 74 ± 7 years; response rate: 83%). Social networks were assessed by means of number of friends and family members that participants had contacts with, whereas social participation by involvement in social groupings/organizations. Information on self-perceived health status and demographic and socioeconomic characteristics was also collected. RESULTS Overall, 93% of study participants reported that they had at least weekly contacts with more than one family member, and 97% reported daily contacts with their respective friends. Conversely, only 14% of participants reported engagement with social groupings. Generally, individuals who had contacts with friends and/or engaged with social organizations reported a better health status. CONCLUSION Our findings point to strong family ties in this patriarchal society. Conversely, levels of social participation were considerably lower in Kosovo compared with the western European countries. The low participation levels in social groupings and their putative deleterious health effects should raise the awareness of policymakers to improve the conditions and increase the degree of social participation among older people in transitional Kosovo.

Users' Knowledge About Adverse Effects of Non-steroidal Anti-inflammatory Drugs in Tirana, Albania

Aim: To assess the level of knowledge of the adult users of non-steroidal anti-inflammatory drugs (NSAIDs) regarding their side effects and the socio-demographic factors associated with the use of these drugs in the adult population of Albania. Methods: This was a cross-sectional study including a representative sample of 199 individuals aged ≥18 years (77% women; overall mean age: 30.3±10.0 years; overall response rate: 90%) who were users of NSAIDs recruited in ten different pharmacies in Tirana municipality during April-May 2015. A self-administered questionnaire contained basic socio-demographic information and questions about NSAIDs use, their types, participants’ knowledge about NSAIDs side effects and their interaction with other drugs. Results: In 56% of the cases, NSAIDs were taken by participants’ own decisions, whereas in about 29% of the cases these drugs were prescribed by physicians. Acetaminophen, ketoprofen and ibuprofen were the most frequently used NSAIDs. Overall, 51% of participants thought NSAIDs could cause allergic reactions, whereas one third or fewer were aware of each of the following side effects: upper and lower gastrointestinal bleeding, hypertension, gastritis, kidney failure, myopathy, osteoporosis. About one third of participants were aware of NSAIDs-other drug interactions, whereas some of them were already taking contraindicated drugs. No significant differences were noticed regarding sex, age, educational level, employment status and marital status, with very few exceptions. Conclusion: Our findings indicate limited knowledge about NSAIDs side effects and their interaction with other drugs among the Albania adult population, which is a cause of concern.

Demographic and Social Correlates of Tobacco, Alcohol and Cannabis Use Among 15-16-Year-Old Students in Albania: Results of the ESPAD Survey

Aims Our aim was to assess the demographic and social factors associated with lifetime use of tobacco, alcohol and cannabis among school students aged 15-16 in Albania in order to make information and knowledge available for health promotion specialists working on substance use prevention. Design This cross-sectional study was conducted in March-May 2011 in the framework of the European School Survey Project on Alcohol and Other Drugs (ESPAD). In total, 3189 students born in 1995 participated in the survey. The standardised ESPAD questionnaire was used to collect data about substance use. Results Our multivariable adjustment analysis showed that being a male and having easy access to cigarettes were the only universal factors significantly increasing the likelihood of ever using tobacco, alcohol or cannabis. Own smoking was strongly and significantly associated with alcohol and cannabis use. The associations of own substance use with peer substance consumption were weak to moderate. Conclusions Own smoking seems to be the most important single independent risk factor which strongly and significantly predicted alcohol and cannabis use among Albanian school students. Policy makers need to strengthen the rule of law whereas health promotion professionals should firmly address smoking in adolescence through target interventions.