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Tobacco epidemic is a serious global health issue, and it is responsible for various illnesses. The objective of this study is to examine sociodemographic and lifestyle factors associated with the ...

In the Asia Pacific region, pigs play an important cultural and economic role in society. However, the cultural significance and use of livestock is often overlooked in agricultural research and de...

This study examines the role of high‐yielding maize varieties as one of the key drivers of smallholder farmers’ market participation in a highly subsistence rural economy. The analysis is based on the End‐of‐Program Survey data collected by the Seeds of Life program in 2016 covering 700 households in rural Timor‐Leste. The results reveal significant positive impacts of technology adoption on farmers’ market participation. Households where women are relatively more active in agriculture than men are more likely to engage in agricultural commerce. The results also show a positive impact of technology adoption on maize productivity. These findings present the first empirical evidence of the causal link between technology adoption and market participation choices.

BACKGROUND Papua New Guinea, Pacific Island nations, and Timor-Leste represent a range of island nations with populations ranging from a few thousand to 8 million. They perform on average about 25% of the Lancet Commission of Global Surgery's target 5000 per 100 000 population and their health workforce have significant deficits of trained surgeons and anaesthetists. This study was conducted to determine how the current national health plans of these nations have included surgery and anaesthesia. METHODS The most recent (as of December 2018) published national health plans of 10 Pacific Island nations (Cook Islands, Fiji, Nauru, Federated States of Micronesia, Kiribati, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu), Papua New Guinea and Timor-Leste were reviewed for content and process, searching for key words and identifying themes related to surgery and anaesthesia. RESULTS There were 12 national health plans with a combined total of 478 pages. There was limited surgical and/or anaesthesia input within the planning process. Injuries, blindness, cancer and non-communicable diseases were included themes, but the potential role of surgical care in addressing these conditions was not well documented. The need for better information and registries was noted by several nations but possible surgical care delivery or outcome metrics were not included. CONCLUSION There is limited mention of surgical and anaesthesia care planning within current health plans in the Pacific, PNG and TL. There is a need for greater surgical and anaesthesia engagement in future plans with performance measured against World Health Organization core surgical indicators.

Dengue is an ongoing health risk for Peace Corps Volunteers (PCVs) working in the tropics. On May 2019, the Peace Corps Office of Health Services notified the Centers for Disease Control and Prevention (CDC) of a dengue outbreak among PCVs in Timor-Leste. The purpose of this investigation was to identify the clinical, demographic, and epidemiological characteristics of PCVs with dengue and recommend dengue preventive measures. To identify PCVs with dengue and describe disease severity, the medical records of PCVs reporting fever during September 2018–June 2019 were reviewed. To identify factors associated with dengue virus (DENV) infection, we administered a questionnaire on demographics, travel history, and mosquito avoidance behaviors and collected blood specimens to detect the anti-DENV IgM antibody to diagnose recent infection. Of 35 PCVs in-country, 11 (31%) tested positive for dengue (NS1, IgM, PCR), eight requiring hospitalization and medical evacuation. Among 27 (77%) PCVs who participated in the investigation, all reported having been recently bitten by mosquitoes and 56% reported being bitten most often at home; only 16 (59%) reported having screens on bedroom windows. Nearly all (93%) PCVs reported using a bed net every night; fewer (70%) reported using mosquito repellent at least once a day. No behaviors were significantly associated with DENV infection. Raising awareness of dengue risk among PCVs and continuing to encourage mosquito avoidance behavior to prevent dengue is critical. Access to and use of measures to avoid mosquito bites should be improved or implemented. Peace Corps medical officers should continue to receive an annual refresher training on dengue clinical management.

Hypertension is persistent blood pressure with systolic> 140/90 mmHg. One of the causes of hypertension is lifestyle, age and activity factors. The purpose of this study was to evaluate the incidence of hypertension in the community of Horaiquick Ainaro village, Maubessie Timor Leste. This study is an observational analytic study, with respondents in the age range 26–65 years. The sampling technique was carried out by observation and interviews. Data analysis was performed using univariate analysis. The results showed that there was no significant relationship between smoking lifestyle, coffee drinking habits and physical activity on the incidence of hypertension in the village of Horai Quick Ainaro Maubessie Timorleste. Keywords: Hypertension, lifestyle, smooking, age

This study aims to analyze and explain; (1) The effect of entrepreneurial orientation on the development of small businesses of members of Lanamona; (2) The effect of creativity on the development of small businesses of members of Lanamona. The population in this study was 130 members of CU Lanamona engaged in small business, in the municipality of Bobonaro. Of this total collected all questionnaires distributed. The data analysis method uses SPSS. The findings of this study are that the entrepreneurial orientation variable has a positive and partially significant effect on the development of small businesses. This is evidenced by the value of t-count 2.775 greater than t-table 1.97810. These results suggest that entrepreneurial orientation is a factor that plays an important role in determining the level of improvement of small business development. The higher entrepreneurial orientation, will encourage the higher development of small businesses. Conversely, if entrepreneurship orientation is low, business development will also experience a decline. The variable of creativity has a positive and partially significant effect on the development of small businesses. Therefore, the higher the creativity that is carried out by entrepreneurs, the business development will increase. This is evidenced by the value of t-count (3.857) is greater than t-table (1.97810). Entrepreneurial orientation and creativity variables simultaneously have a positive and significant effect on the development of small businesses. This is evidenced by the calculated F-count (32,746) greater than F-table (3.07). So that it can be said that the higher or better the entrepreneurial orientation and creativity of an entrepreneur, the more business development will increase. Keywords: Entrepreneurial Orientation, Creativity, Small Business Development

The process of implementing development projects has many obstacles that were not predicted beforehand resulting in delays in project completion which have an impact on increasing the cost of project implementation. sometimes the project is not completed in accordance with a predetermined schedule that may be caused by certain factors. Various ways can be done to anticipate and be a solution to the delay. The purpose of the study is to analyze the factors that influence delays in bridge construction projects in Bidau Timor - Leste and how to anticipate delays in project work. The research method used is descriptive method by observation and direct interviews. So that there are several dominant factors that influence the delay of the Bidau Timor-Leste bridge construction project, including the types of weather, material and financial. To anticipate delays in construction projects, it is necessary to do a work contract in accordance with the contract law in which all matters are regulated, so that the anticipation, mitigation and accountability are clear. Identification of the application of overcoming delays in the Bidau Timor-Leste bridge construction project if viewed from the side of the existing contract there are still shortcomings, so it needs to be improved in terms of working contract documents and refer to the contract law.

BACKGROUND Timor-Leste is one of the poorest countries in the world. The East Timor Hearts Fund is a charitable organisation involving Australian cardiologists providing outreach screening and access to cardiac interventions. AIMS To assess ten years of clinical volume, demographics and patient outcomes. Our intention was to identify existing limitations to facilitate planning for further capacity building over the next decade. METHODS The East Timor Hearts Fund database was sectioned into 2-year intervals (2009/2010, 2011/2012, 2013/2014, 2015/2016 and 2017/2018). Demographics and clinical outcomes of patients were compared, with subgroup analysis of adult (>18 years old), paediatric and interventional patients. RESULTS Over 10 years, 2050 patient encounters have occurred; 1119 (54.6%) encounters occurred in 2017/2018; 73.6% of patients were assessed in the capital Dili. Rheumatic and congenital cardiac diseases remain very common (39.1% of adult new patients and 74.2% of paediatric new patients), with 1.4% of new patients exhibiting both pathologies. The number of new patients with rheumatic or congenital heart disease tripled in 2017/2018 compared to 2009/2010 (99 vs 34 patients, P < 0.0001). Paediatric case volume increased over 10-fold over 10 years (288 new patients in 2017/2018 vs 24 in 2009/2010, P < 0.0001), with corresponding increase in proportion of paediatric interventions (59.4% in 2017/2018 vs 25.0% in 2009/2010, P = 0.027). For patients undergoing intervention (n = 87), post-procedural complications and mortality are extremely low (3.4% and 1.1%, respectively), with all eligible patients attending at least one post-procedure appointment. CONCLUSION Demand for cardiac services in Timor-Leste is rising exponentially, with inequitable geographic coverage. Rheumatic and congenital cardiac diseases remain priorities for assessment, and paediatric case volume is increasing. Patients undergoing intervention experience good medical outcomes.

Background Nine South Pacific nations, Papua New Guinea and Timor Leste, have collaborated to report and publish their surgical metrics as recommended by the Lancet Commission on Global Surgery (LCoGS). Currently, these countries experience about 750 postoperative deaths per year, representing 1% of crude mortality in the region. Given that more than 400 000 annual procedures are needed in the nine nations to reach the LCoGS target of 5000/100 000, we aimed to calculate the potential contribution of perioperative mortality to national mortality where these procedures are performed. Methods We utilized reported surgical metrics with current rates for surgical volume (SV) and perioperative mortality (POMR), as well as World Bank/WHO mortality statistics, to predict the likely impact of surgical scale-up to recommended targets by 2030. We tested correlations between SV and POMR in countries from our region using Pearson's r statistic. Funnel plots were used to evaluate the dataset for outliers. Results Surgical scale up would result in perioperative mortality contributing on average to 3.3% of all national crude mortality. This prediction assumes POMR stays the same, which is challenging to predict. In our region countries that achieved the LCoGS target (n = 5) had a lower POMR than countries that did not (n = 8). Conclusions Surgical volumes in the South Pacific region must increase to meet the LCoGS target. Postoperative mortality as a proportion of all mortality may increase with the surgical scale up, however, the overall number of premature deaths is expected to reduce with better access to timely and safe surgical care.

The discussion in this paper is intended to describe how Australian Broadcasting Corporation (ABC) and British Broadcasting Corporation (BBC) views Timor Leste during the period of Portuguese occupation, Indonesia’s presence, until the present-day conditions. Using some van Dijk’s models of CDA to examine the statements to represent its history in some editorials published by ABC and BBC news resources, the analysis was carried out at the levels of selected statements with regard to the linguistic features of lexical choices, nominalization, passivization, and overcompleteness. The results of the analysis show that the statements constructed by ABC and BBC’s news editorials as the news discourse about the history of Timor Leste in such relations are discursively biased in terms of CDA. With various differences in terms of the linguistic features, the result also in line with the view that both ABC and BBC’s statements are mostly dichotomizing Portuguese into ‘Us’ while Indonesia into ‘Them’ in terms of van Dijk’s ‘ideological square’.

Microfinance programs targeting poor women are considered a ‘prudent’ first step for international financial institutions seeking to rebuild post conflict economies. IFIs continue to visibly suppor...

This article examines the political economy of national ownership, focusing on the reconstruction of the healthcare system in post-conflict Timor-Leste in relation to the shift from aid dependence ...

Politically, the focus in Timor-Leste in 2019 shifted from infighting to crucial decision-making on petroleum exploitation. Contrary to international advice on risk management and the need to diversify the non-oil economy, a going-for-broke mindset with respect to a multi-billion-dollar onshore gas development appeared to have carried the day.

Small and medium enterprises (SMEs) play a large role in the economic development of each country. This can be seen from their contribution to the Gross Domestic Product (GDP). In addition, the existence of impact on the development of several countries, especially small and developing countries. This study was conducted with the aim of exploring the influence of skills, knowledge and abilities on the performance of SMEs with a quantitative approach. The population in this study was SMEs domiciled in Dili, Timor-Leste and the sampling Method was simple random sampling technique. The data collection was conducted by distributing questionnaires to 250 units of SMEs business owners and managers. The measurement scale Used was a Likert scale. The data were analyzed using SPSS version 23 with multiple regression analysis. The results of the F test (Simultaneous) analysis show that the skills (X1), knowledge (X2) and ability (X3) have positive and significant effects on SMEs’ performance (Y). While t test (Partial) results show skills is positive, but Do not significantly influence SMEs performance while knowledge and abilities show positive and significant effects on SMEs performance.

The association between antimicrobial resistance and antimicrobial usage has become a growing global concern. Many lower-middle income countries including Timor-Leste (TL) have limited information on antimicrobial usage, although recent research suggests increasing resistance rates among human pathogens there. The aim of this study was to use distribution data to estimate antibiotic consumption at both the national and sub-national level in Timor-Leste, stratifying into resistance class and adherence to the national essential medicines list (EML) and WHO AWaRe guidelines. A retrospective review of distribution data from Timor-Leste central medical store (SAMES) was undertaken to give a defined daily dose (DDD)/1000 inhabitants/day using WHO methodology. National antibiotic distribution in the TL EML in 2019 was estimated at 11.1 DDD/1000 inhabitants/day, comparable to consumption rates observed in other lower-middle-income countries using similar methodology. Differences in distribution quantities were noted between municipalities, with 4 of the 13 municipalities notably above the national average and around 32% of listed restricted antimicrobials distributed incongruent with the EML. This study provides insights into estimated antimicrobial consumption in Timor-Leste that has previously been poorly defined. Estimates of consumption can be used to understand emerging resistance in this small island nation, add to the body of knowledge on antimicrobial use to advise policy and guideline development, and help with stewardship activities.

SETTING: Seventeen health care facilities that report to the national tuberculosis (TB) programme in Timor-Leste. Participants were TB patients.OBJECTIVE: To determine the proportion of TB patients who experienced catastrophic costs due to their TB diagnosis and care, and the magnitude and composition of these costs.DESIGN: This was a cross-sectional health facility-based survey, conducted in 17 DOTS centres between October 2016 and March 2017. TB patients were interviewed by trained nurses using a standardised questionnaire.RESULTS: Among the 457 TB patients who participated (response rate 96.6%), the median age was 32 years; 39.2% were from the capital, Dili. The patient was the main income earner in 26.3% of households. Annual individual and household incomes before and after TB diagnosis decreased by respectively 30.4% and 31.1%. Using a cut-off of 20% of annual household income, 83.0% of patients experienced catastrophic costs related to their TB diagnosis and care. Income loss and nutritional supplementation accounted for respectively 40.7% and 37.9% of these costs.CONCLUSION: Four of five TB patients in Timor-Leste experienced catastrophic costs related to TB diagnosis and care. Financial and social protection to mitigate against these costs are urgently needed, in addition to universal health coverage.

The centrality of gender equality for sustainable human development is well recognised and reflected in the Sustainable Development Goals (SDGs), however in many countries in the Pacific region gender inequality is widespread. Working with men and boys presents an important opportunity to address gender inequality. A ‘Men’s Health Project’ was implemented in rural districts in Timor-Leste and Papua New Guinea (PNG) in 2014-17, which aimed to promote gender equality and improve sexual and reproductive health and maternal and child health outcomes by actively engaging men. Community surveys were undertaken in each community before and after project implementation to enable a greater understanding of men’s knowledge and attitudes at these different time points. This paper reports findings from the more recent surveys with 400 men in Timor-Leste in 2016 and 243 men in PNG in 2017, in order to provide a ‘snapshot’ of the situation in these rural communities at this time. In both countries, the vast majority of men reported that the husband makes the major decisions in the household (80% in Timor-Leste and 84% in PNG). In Timor-Leste, 5% of respondents felt it was okay for a husband to beat his wife, with 13% reporting this in PNG. Findings suggest that meeting SDGs 3 and 5 will require ongoing and concerted efforts in Timor-Leste and PNG.

Introduction: Since its independence in 2002, Timor Leste has made significant strides in improving childhood vaccination coverage. However, coverage is still below national targets, and children continue to have missed opportunities for vaccination (MOV), when eligible children have contact with the health system but are not vaccinated. Timor Leste implemented the updated World Health Organization methodology for assessing MOV in 2016. Methods: The MOV data collection included quantitative (caregiver exit interviews and health worker knowledge, attitudes, practices surveys (KAP)) and qualitative arms (focus group discussions (FGDs) with caregivers and health workers and in-depth interviews (IDIs) with health administrators). During a four-day period, health workers and caregivers with children

Objectives The aim of this study was to assess knowledge, attitudes, and practices regarding tuberculosis (TB) in the general population in Timor-Leste. Methods In the nationally representative cross-sectional 2016 Timor-Leste Demographic and Health Survey, 4622 men (aged 15-59 years) and 12 607 women (aged 15-49 years) were randomly selected using stratified multistage sampling and interviewed. Results Overall, 66.9% of men and 62.8% of women were aware of TB, 4.4% of men and 12.6% of women had TB courtesy stigma, and 83.3% of men and 88.6% of women reported intention to receive TB treatment. The mean±standard deviation overall TB knowledge score was 3.9±2.0 (out of 8) among men and 3.0±1.8 among women. In a multivariable linear regression analysis, among both men and women, older age, higher education, rural residence, and sources of TB information (family/friends, school/workplace, health care provider, Internet, television, and newspaper) were associated with higher TB knowledge scores. In addition, among women, higher wealth status and having heard about TB from the radio were associated with higher TB knowledge scores. Negative associations with TB courtesy stigma were found for urban residence and having heard about TB from family or friends among men, and for older age, higher TB knowledge, and TB information sources (family/friends and school/workplace) among women. Among both men and women, higher TB knowledge scores and having heard of TB from a health care provider were associated with intention to receive TB treatment. Conclusions This study identified socio-demographic risk factors for deficiences in population-based TB knowledge in Timor-Leste; these findings should be considered when designing TB communication, prevention, and control strategies.

This paper presents a study of wind speeds for heights of 100 and 120 m above Hera mountain which is located in Dili. The results of wind speed simulation from January to December 2014 are used as input data to estimate wind energy. The weather research and forecasting (WRF) model is used to simulate one year’s wind speed for nesting domain $1\times 1$ km at 100 and 120 m heights above Hera mountain. It is done using six-hourly interval $1^\circ \times 1^\circ $ NCEP FNL analysis data for initial simulation. The system advisor model version SAM 2017.9.5 is used to estimate wind energy performance with the power purchase agreement (single owner) model. The results show the lowest average wind speed is 3.83 m/s obtained in November with an average monthly energy of 3.8 GWh for 100 m height and 5.57 GWh for 120 m height. The highest average monthly wind energy is 33.9 GWh obtained in January for 100 m height and 50 GWh for 120 m height when average wind speeds from both heights reached ±9 m/s. Finally, it is concluded that the WRF model performed with SAM is a good combination to simulate local wind speed and wind energy for local consumption.

African Swine Fever (ASF) has been spreading in numerous southeast Asian countries since a major incursion in mainland China in 2018. Timor-Leste confirmed an outbreak of ASF in September 2019 which resulted in high mortalities in affected pigs. Pigs in Timor-Leste are the second most common type of livestock kept by villagers and represent a traditionally important source of income and prestige for householders. In order to understand the extent of ASF infected villages in Timor-Leste a prevalence survey was designed and conducted in November-December 2019. Timor-Leste has limited laboratory facilities and access to qPCR diagnostic tests. Therefore, a loop mediated isothermal amplification (LAMP) assay was used to detect ASF positive blood samples collected during the prevalence survey. The LAMP assay was proven to be a robust, highly specific and sensitive laboratory test for ASF suitable for use in the field and where there are limited laboratory facilities. The results of the prevalence survey allowed the extent of the ASF incursion to be delineated and the introduction of a disease response strategy to limit the spread of ASF and assist in the recovery of the pig population in Timor-Leste.

This paper aims at providing a theoretical framework of the significance of (1) virtual teaching and learning activities through information and communication technology (ICT) to achieve the full realization of right to education in the Indonesia – Timor Leste border and (2) the role of State-owned enterprises (SOEs) engaging in ICT for investing in infrastructure for virtual teaching and learning to achieve the equal quality education (SDGs4). The relevance of studying this theoretical framework arises from the assumption that digitally mediated learning dan teaching can provide a useful alternative to address the problems of the lack of teachers that have been facing by many remote communities in the border areas. Using literature review and secondary sources, the paper argues that the SOEs’ investment in ICT learning and teaching is imperative. However, the appropriateness and effectiveness of its method and substance that will lead to a meaningful realization of SDG4 will be very much dependent on: 1) the State's and SOEs’ knowledge about the connection between human rights and SDGs; 2) clear educational objectives, conducive pedagogical environment, dynamic learning and teaching processes and responsive educational governance suitable for digitally mediated education system; and 3) the capability of SOEs engaged in ICT to use SDG4 as an overarching framework to shape, steer, communicate and report their strategies, goals and activities when they invest in digitally mediated education system.

Monitoring veterinary antimicrobial use is part of the global strategy to tackle antimicrobial resistance. The purpose of this study was to quantify veterinary antimicrobials imported into Timor-Leste between 2016 and 2019 and describe the antimicrobial import profile of importers. Data were obtained from import applications received by the Ministry of Agriculture and Fisheries (MAF) of Timor-Leste. Import quantities were analysed by antimicrobial class, importance for human medicine, recommended route of administration and type of importer. An average of 57.4 kg (s.d. 31.0 kg) and 0.55 mg/kg (s.d. 0.27 mg/kg) animal biomass of antimicrobials was imported per year. Tetracyclines (35.5%), penicillins (23.7%), and macrolides (15.9%) were the commonly imported antimicrobial classes. Antimicrobials imported for parenteral administration were most common (60.1%). MAF was the largest importer (52.4%). Most of the critically important antimicrobials for human medicine were imported by poultry farms for oral administration and use for growth promotion could not be ruled out. In conclusion, the use of antimicrobials in animals in Timor-Leste is very low, in keeping with its predominantly subsistence agriculture system. Farmer education, development of treatment guidelines, and strengthening of the veterinary service is important for addressing the potential future misuse of antimicrobials especially in the commercial poultry industry.

Despite their implications for tobacco control, data on concurrent dual (using two tobacco products) and poly-tobacco use (using more than two products) are relatively scarce globally. This study aimed to estimate the prevalence of dual and poly-tobacco use among men in 19 low-and middle-income countries (LMICs) and assess potential associations with individual and country level factors. Data from 19 LMICs were obtained from the most recent wave of the Demographic and Health Survey (DHS), collected between 2015 and 2016 comprising 235,975 men aged 15–49 years. The prevalence of current single, dual and poly-tobacco use were estimated using available sample weights. Mixed-effect multilevel models were used to estimate associations of individual and country level factors with tobacco use. Results showed that the prevalence of dual or poly-tobacco use among men was highest in Timor Leste (27.1%), Nepal (18.3%), Lesotho (13.2%) and India (9.3%). Factors associated with dual and poly-tobacco use were older age, low academic achievement, low income status, being divorced, living in urban areas and high frequency of media use. Among country-level characteristics, national wealth was not associated with dual and poly-tobacco use. Implementation of MPOWER measures was inversely associated with single tobacco use; this was not the case for dual and poly-tobacco use. Findings suggest that dual and poly-tobacco use are common among men especially in South-East Asian countries. This study highlights the need for MPOWER measures to be expanded and strengthened to address all tobacco products and explicitly consider dual and poly use.

After gaining its independence in 2002, Timor Leste struggled for joining ASEAN�s membership. Timor Leste changed foreign policy orientation from PIF to ASEAN. Then, Timor Leste had put its decision in 2011 which officially enrolled as member of ASEAN. This article seeks to analyze Timor Leste�s decision to join ASEAN�s membership. The authors sought to find the answers by using foreign policy decision-making model. This article focused on international factors which are derived from two important variables namely international context and economic and military conditions. The authors found from international context that Timor Leste decided to join ASEAN due to ASEAN�s attractiveness as prospective regional organization and strong support emanating from Indonesia as an influential state regionally. Economic conditions comprise close economic relations of Timor Leste with ASEAN countries. Military conditions are analyzed from Timor Leste�s military capability amidst neighbor�s military capability and its need to collective security. Keywords: Foreign Policy, Decision-Making Model, International Context, Economic and Military Conditions

Purpose: This research aims to obtain a description of the policy of developing human resource educators at the University of Dili in accordance with applicable academic regulations. Research methodology: The method used in this research was a descriptive qualitative method. Six respondents were determined as research samples. The research instruments for this study were interview guides, notebooks, recording devices, test books and researchers. Data collection was done through interview method and the data was analyzed by referring to Miles and Huberman's Intractive model framework. Results: there are some efforts to develop the human resources of educators in universities such as sending of teaching staff to continue their education and various policies that enable the development of educators' human resources. Some factors that influence the development of human resource educators in universities are the organizational structure, organizational policies, allocation of funds, the level of educators’ education and the participation of educators in support for the development of human resources Limitations: this research only discusses the development of educators as human resources at the University of Dili and various factors that influence it. Contribution: This research was conducted to answer problems related to the management of development for educators as human resources at the University of Dili and what factors influence the development of teaching human resources at the University of Dili Timor-Leste Keywords: Development, Human resource, Educator

BACKGROUND There is limited information about the type of skin disease in Timor-Leste. In order to determine the type and magnitude of skin disease in Timor-Leste, we conducted a cross-sectional point prevalence study of 271 patients from rural and urban Timor-Leste. The aim of the study was to estimate the magnitude and burden of dermatological disease. METHODS Two Australian-trained dermatologists conducted clinics in the city of Dili (urban) and village of Manusae (rural) in Timor-Leste between the period of June and July 2016. They independently recorded all patient presentations and diagnoses. RESULTS A total of 271 patients were reviewed over two months, of whom 37% were seen in an urban setting and 63% in a rural setting. Scabies accounted for 96% of all presentations in the rural setting, which was significantly higher than its presentation in the urban setting (8%), P

Background The Rheumatic Heart disease in Timor Leste school students (RHD-TL) study identified Timor Leste as having some of the highest rates of definite rheumatic heart disease (RHD) in the world. The RHD-TL follow-up study aimed to assess the delivery and outcomes of the secondary prophylaxis program in known patients with echocardiographic screen detected definite and borderline RHD. Methods School-students in Timor Leste where reassessed over a 3-year period since the initial study in 2016. Prospective assessments included adherence to secondary prophylaxis, complications of prophylaxis, follow-up clinical assessment and serial echocardiography. Of the 48 patients, 25 Definite and 23 Borderline, 38 (79%) of all patients, and 92% of definite RHD cases have had one or more follow-up assessments including full datasets for adherence, recurrence rates and progression of disease. Follow-up is provided by the volunteer paediatric cardiology team and rheumatic heart disease team of two NGOs in collaboration with local clinics. Results The median duration of follow-up of the 38 patients was of 1.6 years. The median age was 13 years (range 8-22) and 75% were female. Adherence rates in patients with definite RHD was on average greater than 95% during the follow-up period. Of the 23 patients with mild or moderate RHD one case with documented acute rheumatic fever (ARF) recurrence progressed whilst 8 cases improved on benzathine-penicillin G (BPG) therapy. There was no progression of the 6 borderline cases who were not prescribed BPG. Out of the 9 borderline cases in whom BPG was prescribed, one, with 67% adherence, had a documented episode of ARF leading to echocardiographic progression and moderate definite RHD. Conclusion This was the first follow-up study to look at disease natural history, both in treated and untreated groups, in Timor-Leste and brought practical insights into the efficacy of the Timor Leste RHD monitoring and prophylaxis programs. Its ongoing project will enable advocacy and quality assessment for the program as it expands. Abstract 225 Figure 1.

Over a 6-month period, eight neonates weighing less than 3 kg were operated on at Hospital Nacional Guido Valadares, Dili, Timor-Leste. Each was operated on for an abdominal condition. There is no postoperative neonatal ventilation, neonatal inotropes, fluid warmers, or parenteral nutrition available at Hospital Nacional Guido Valadares. Medical air and nitrous oxide are unavailable. Oxygen from cylinders is the only gas available in theaters and on the wards. Generally equipment is problematic and not designed for neonates. Five of these infants perished in hospital perioperatively, representing an in-hospital mortality of 62%, another is presumed to have died following discharge, and two recovered well. This represents an estimated overall mortality rate of 75%. This is not surprising given the difficult circumstances in theater and the limited postoperative support services available. The resources and time deployed in operating on these small neonates is significant. As difficult as it may be surgical enthusiasm and the uncertainties surrounding prognostication should not displace practical and realistic assessment of the likely outcome of operating on very small babies in low resource facilities where perioperative support is limited. Future development in the Timor-Leste healthcare sector will hopefully provide an environment where improvements in outcome can be achieved.

Despite being one of the newest countries in the world today, Timor-Leste has made great progress in building its institutions and economic capacity.With international support, Timor-Leste aims to improve its public financial management systems according to global benchmarks. Grounded upon the principles of the OECD’s Recommendation on Budgetary Governance and building on existing diagnostic and analytical materials this review performs a fresh assessment of the country’s current financial management systems and outlines a practical “roadmap” for progress in key areas of budgeting and planning over coming years.

Objective Timor Leste has one of the highest maternal death rates in the world at 215 per 100 000 live births.1 Post-partum haemorrhage (PPH) accounts for 27% of maternal deaths globally. Annually the Timor Leste National Ambulance Service (TLNAS) attends over 20 000 cases, of which 2% are diagnosed with PPH. The objective of this study was to evaluate prehospital care of PPH patients transported by the TLNAS. Methods A retrospective audit of PPH patients transported between May 2015 and May 2017. The inclusion criteria were patients diagnosed with PPH and transported during the study period. Results Data from the patient care records of 214 TLNAS PPH patients were abstracted using the PPH care evaluation tool. Paramedics diagnosed 211 (97%) PPH patients, took observations on 181 (85%) and obtained a patient history from 193 (90%) patients. TLNAS paramedics did not regularly provide other treatment including oxygen 36 (17%), intravenous isotonic crystalloid fluid 117 (55%), uterine massage 0 (0%), external aortic compression 0 (0%) and non-pneumatic anti-shock garments 9 (4%). Conclusions This research has shown that paramedics are not consistently using available clinical interventions.

The US-China relationship continues to be characterized by both competition and cooperation in recent years. Cooperation in the development sector is one little-known new aspect of such cooperation...

We tested a trauma-focused, cognitive-behavior therapy treatment (TF-CBT-anger) for intermittent explosive disorder (IED) and related dimensions of anger adapted to the local culture in postconflict Timor-Leste. The intention-to-treat sample (n = 78) comprised Timorese nationals (women = 49; men = 29), ages 18 years and older, meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for IED, with equal numbers (n = 39 each) being randomized to the treatment group (TG) and wait-list (WL). Assessments were made at 1 week prior to therapy, immediately at posttreatment, and at 1 month follow-up. Primary measures included an IED diagnosis made according to the East Timor explosive anger measure and the directionality of expression and control of anger assessed by 4 dimensions of the State-Trait Anger Expression Inventory (STAXI-2). Secondary measures included psychological distress assessed using the Kessler scale and an index of posttraumatic stress disorder (PTSD) assessed using the Harvard Trauma Questionnaire. In the TG, there was a decline in IED from 100% to zero at follow-up. In the WL, more than 70% (of the 100% at baseline) showed persisting IED at second and third assessments. The TG alone showed significant (p.05) improvements on all STAXI-2 scales, the effect sizes for the intervention being uniformly large (0.80). Psychological distress and PTSD showed substantial reductions in the TG but not the WL group. Although based on a modest-sized sample, our findings provide the first evidence in support of the efficacy of TF-CBT-anger for IED in a culturally diverse, postconflict setting. (PsycINFO Database Record

Women’s empowerment is essential to improve nutrition in low and middle-income countries. We investigated the empowerment of women in agriculture in association with household production and the dietary diversity of children 12–59 months old and their mothers in Timor-Leste. Using the Abbreviated Women’s Empowerment in Agriculture Index (A-WEAI) we analyzed 156 dual-adult rural households applying multivariable regression models. We found that the dietary diversity scores of empowered women and their children were higher than among those disempowered. The associations between different measures of empowerment and dietary diversity were larger and more significant among women than children. Food production diversity was consistently associated with children’s improved diets. We found small gender gaps in decisions on production, access to resources, and control over income, similar to findings in other Southeast Asian countries. Nutrition-sensitive policies and programmes in Timor-Leste could gain from prioritizing women’s empowerment and promoting agriculture diversification strategies as valuable investments to improve the diets and wellbeing of mothers and children.

Culture has a strong influence on the representations and health behaviour of individuals and groups. This is reflected in the reproductive health of the Timorese women, intervention in this field being of a priority nature in Timor-Leste in view of its high fertility and maternal mortality rates. The purpose of this ethnographic study is to analyse beliefs, representations and practices associated with pregnancy, birth and the postnatal period. It was conducted in Timor-Leste and involved the participation of health professionals, traditional midwives, women and couples, all of them selected through a snowball chain sampling procedure. Data was collected by means of exploratory semi-structured interviews and observation, and its content was duly analysed. The results show the existence of various recommendations, taboos and restrictions which aim at protecting the health of both mother and child, making use of traditional care practices which may vary among ethnolinguistic groups, communities or families. info:eu-repo/semantics/publishedVersion

Coffee is not only the main export product in Timor Leste, but also a source of income for farmer household. The importance of coffee for Timor Leste community should be developed through market oriented farm management on coffee farming. The aim of this research was to analyze financial feasibility of Arabica coffee farming at farmer level; analyze sensitivity of coffee farming toward change in coffee productivity and price; and analyze correlation between productivity with socio-economic characteristics of farmers. This research was carried out at Poetete Village, Ermera Sub-district, Ermera District, Timor Leste. Primary and secondary data were collected in this research. Respondents were selected by stratified random sampling method. Financial feasibility study on coffee farming were analyzed by using Net Present Value (NPV), Internal Rate of Return (IRR) dan Net Benefit Cost Ratio (NBCR). Rank Spearman test was used to analyze the correlation between productivity with variable of production factors and socioeconomic characteristics of farmers. The results showed that Arabica coffee farming was financially feasible to be develop with NPV of USD 205,291,130; IRR of 17.449%; and Net B/C ratio of 2.911 at discount factor 10%. Arabica coffee farming at Poetete Village was classified less responsive toward productivity increasing at 10% and price decreasing at 10% with NPV of USD 37,367,151; IRR of 25.95%; and Net B/ C ratio of 3.862 at discount factor 1%. The correlation between productivity with land ownership (0.965), experience of farmers (0.613), age of farmers (0.663), farmers education level (0.748) and household size (0.791) were categorized as strong to very strong.