Global Public Health最新文献

In May 2022, a global outbreak of mpox (formerly known as monkeypox) was declared an international public health emergency. During this time, healthcare workers scrambled to respond to the outbreak amidst a lack of resources, knowledge gaps and pressures related to COVID-19. This period posed a risk of heightened moral distress, defined as distress arising from a situation in which a healthcare worker knows the right thing to do but is externally constrained from doing so. An international survey of healthcare workers was developed to understand their experiences of responding to mpox, including open-text questions regarding moral distress. Drawing on thematic analysis of these open text responses, this paper conceptualises the forms of distress experienced by health workers as 'outbreak distress'-an emotional and psychological response to the synergistic effects that arise from stressed systems, uncertainty and stigma that characterise many, and especially new, infectious disease outbreaks. In the context of pandemic preparedness, outbreak distress represents a novel concept for understanding additional pressures on healthcare systems in future unknown and re-emerging outbreaks.

In 2015, the United Nations integrated adolescents as a unique category into the Sustainable Development Goals, a recognition the World Health Organization expanded in 2017 with the introduction of the Global Accelerated Action for the Health of Adolescents. This paper examines the emergence of the 'adolescent subject' in global health. Adolescence is a modern concept embedded in Western views that is not universally applicable, hence raising issues in global health practice by embodying a colonial legacy in using categories that may not align with all cultural contexts. Moreover, the paper explores a critical gap in global health research: while the majority of the world's adolescents reside in low- and middle-income countries, most adolescent health research is conducted in high-income settings. This disparity is due, in part, to a lack of funding for adolescent research and barriers like parental consent requirements that prevent adolescents from participating in research. This exclusion inadvertently silences some adolescents' voices and restricts their opportunities for research engagement, perpetuating an epistemic injustice in global health data production. The paper calls for a concerted effort to develop measures to inclusively engage adolescents in global health research, aiming for a fair and representative inclusion of adolescent perspectives.

This article examines the global issue of vaccine hesitancy in Brazil and South Africa, two economically unequal BRICS nations. Despite their established immunization programs, both countries are grappling with coverage decreases, leading to outbreaks. The role of vaccine hesitancy in this scenario is significant. This qualitative study aims to understand childhood vaccine hesitancy in these contexts, highlighting social and behavioral drivers. In-depth interviews were conducted in Sao Luis (Brazil), Florianopolis (Brazil), and Cape Town (South Africa), involving 42 caregivers from diverse socioeconomic backgrounds, race/color, and gender, with children up to 6 years old. Thematic analysis method was used to analyze the empirical data. The drivers of vaccine hesitancy have been arranged across three domains: 'practical issues', prevalent among lower-income non-white families; 'social processes', as informed decisions reflecting neoliberal parenting values, found among higher-income white families; and, in the 'thinking and feeling about vaccines' domain, common fears of side effects and vaccines components are presented. These findings underscore the necessity of tailored health policies, taking into account the influence of historical, cultural, and social contexts. The study also highlights the crucial role of qualitative research in comprehending the intricate interplay of social and behavioral factors in health decision-making.

Rising global temperatures and heatwaves pose major health risks, particularly for pregnant women, infants and other vulnerable groups. Using Photovoice, we aimed to foreground how pregnant and postpartum women in an urban township in Tshwane, South Africa, experience and cope with heat stress. Fourteen women participated in two structured workshops held during the hot season (December 2023-January 2024). The first included reflective discussions on coping with heat and basic photography training. Over two weeks, participants captured over 300 images using disposable cameras or mobile phones. Selected images were reviewed and discussed in the second workshop. Thematic analysis of photographs and workshop transcripts identified three key themes: health impacts, coping strategies and structural challenges. Women preferred staying home on very hot days, where they had greater control over their environment. However, they struggled to soothe overheated infants, which they found distressing. They used simple cooling methods such as bathing or wet cloths but faced constraints including heat-trapping housing materials, inadequate ventilation, and limited access to water and electricity. These challenges led to a state of "un-coping"-where adaptation efforts are insufficient or counterproductive. Viewed through the women's "lens", these findings highlight the need for targeted adaptation strategies to improve climate resilience.

Anecdotal reports highlight increased methamphetamine, cocaine, and codeine-cough syrup use in Zimbabwe, with no clear empirical basis. Therefore, the scoping review aimed to identify primary evidence of patterns, harms and responses to substance use (SU) within Zimbabwe. Arksey and O'Malley's (2005) framework and the PRISMA Extension for Scoping Reviews (Tricco et al., 2018) were followed. Medline (Pub Med), Scopus, Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus), African Index Medicus, Africa-Wide Information, Web of Science, PsycInfo, PsycArticles, and Web of Science conference proceedings were searched. 27 studies published between 2012, and February 2025 met the inclusion criteria and were synthesized using combined inductive-deductive thematic analysis. Patterns of SU included a wide range of drugs (e.g. alcohol, tobacco, cannabis, inhalants, codeine-cough syrups), with emergent literature on methamphetamine, cocaine and heroin. Socio-demographic patterns elucidated vulnerable groups (e.g. children living on the streets), and concentration of SU in high density urban areas. SU harms predominantly centered on the link to the HIV epidemic, whilst clinical and health responses to SU were significantly limited. SU should therefore be treated as a public health priority in Zimbabwe, and research capacity building is urgently required to address significant literature gaps.

Over the past century, Brazil has become a hub of excellence in public health research, biomedical sciences and health technology policymaking. However, the Zika outbreak (2016) and the COVID-19 pandemic (2020) exposed critical weaknesses in its healthcare innovation system, particularly regarding the rapid production and delivery of essential technologies. This article examines the interconnected factors shaping vaccine research and development (R&D) and production capacity for neglected and re-emerging diseases in Brazil. The study is based on semi-structured interviews with 22 participants, including university professors, laboratory leaders, scientific staff, innovation managers and policymakers. Thematic analysis identified four interconnected factors: (1) the resilience of science and technology policies (S&TPs); (2) the quality of health technology programs and initiatives (HTP&I); (3) the catalytic role of health emergencies in mobilizing funding and fostering R&D capacity; and (4) the ability of data-intensive local health R&D actors to establish international collaborations. The findings reveal how Brazil's vaccine R&D and production capacity are shaped by the interaction of policy resilience, institutional capability-building and the health system. The accumulation of technological capabilities remains influenced by discontinuous funding cycles, fragmented governance and a reactive policy mode centered on crisis response rather than long-term efforts to align S&TPs and HTP&I.

Intimate partner violence (IPV) remains a significant global health and human rights problem affecting one in three women globally and in Colombia. While IPV and feminicide are preventable, little research has documented public health-justice programs effective in addressing IPV in real-world conditions in Latin America. We investigated the functioning and limitations of Bogotá's Single Route of Attention for Women Victims of Violence and at Risk of Feminicide. From 2022-2025, we employed qualitative methods, using purposive and snowball sampling to conduct 23 in-depth interviews, one focus group and debriefings. We harnessed the perspective of human rights lawyers, supplemented by expert key informants, utilizing cycles of constant comparative analyses to derive three core findings: (1) health professionals (HPs) mistrust human rights lawyers; (2) HPs require greater sensitization to gender-based violence to assist victims; and (3) a dearth of understanding and attendant action by prosecution and police to address victims' imminent risk of harm and feminicide. Findings identified salient opportunities for these entities to minimize harm and feminicide across victims' contact with officials. Despite strengths of this novel program, lack of a public health vision for IPV prevention, systemic omissions in justice and inattention to gender norms facilitating IPV pose limitations.

This paper challenges the dominant frameworks that continue to shape our understanding of development. We argue for a necessary reframing, one that confronts how prevailing development narratives have upheld high-consumption models, defined by excessive resource use and environmental degradation, often at the expense of countries labelled as 'developing.' To reorient our thinking, we must first interrogate the colonial scaffolding behind these global categories. Terms like 'developed' and 'developing' divide the world into zones of achievement and deficiency, relying on metrics rooted in the values and interests of over-consuming countries, rather than the lived realities, knowledge systems, or priorities of countries consuming below their means. We propose a reframing of development centred on sustainable consumption, with a new language and a new categorisation of countries grounded in the reality that our shared biocapacity is finite. The classification challenges conventional labels by recasting 'developed' nations as over-consuming and 'developing' nations as low consuming, highlighting their potential leadership in shaping a more sustainable future. This reframing invites critical dialogue on reimagining development itself, moving away from capitalist-driven overconsumption, and toward models that prioritise human flourishing, honour Indigenous knowledge, and embrace alternative ways of organising life, economies, and societies.

Community engagement activities have rapidly gained recognition in global health policy, but comprehensive evaluations remain scarce. This article exemplifies the use of explicit evaluation criteria within a mixed-method and theory-guided evaluation, applied to village-based community engagement activities of a nationwide health Initiative in Lao PDR. The evaluation case study was one element in a multi-pronged evaluation approach and considered the criteria of effectiveness, efficiency, impact, relevance, coherence, sustainability, and equity. We gathered qualitative and quantitative data before and at least three months after the village-based activities, focusing on 14 case study communities across four provinces who participated in the Initiative. 3,161 survey observations, 50 semi-structured interviews, and 50 key informant interviews were collected. The Initiative was highly relevant and integrated seamlessly and synergistically into healthcare operations, creating important synergies through its relational and positive approach. Supported by enthusiastic stakeholder support, the Initiative aligned with its intentions to promote health equity while no major negative unintended side-effects materialized. This case study demonstrates the value of rapid feedback of and adaptation to emerging evaluation insights, the appreciation of unintended side-effects of interventions, and the theoretical grounding of evaluation approaches with a comprehensive set of evaluation criteria.

Antimicrobial resistance (AMR) is a critical global health issue, especially in low-resource settings. A One Health-based community engagement approach, such as the Antibiotic-Wise Village (SAJAKA) model, offers a potential solution. This study assessed SAJAKA's implementation in four Bali villages, evaluating its impact on knowledge and antibiotic use behavior. The intervention included workshops, school programs, poultry feed/water analysis, and medical audits. Using a pre-test/post-test design, 769 participants including household mothers, schoolchildren, farmers, healthcare workers were surveyed. Results showed significant knowledge improvements, particularly among farmers (30.69%) and household mothers (26.65%). Behaviorally, household antibiotic storage declined (3.39%), and addition antibiotics in poultry feed were eliminated. However, irrational prescribing by healthcare workers persisted. Water tests revealed faecal contamination but no resistant E. coli to third-generation cephalosporins was detected. Of the four villages, Buwit achieved 'Antibiotic-Wise Village' status (score = 7). The SAJAKA model successfully boosted AMR awareness and promoted responsible antibiotic use. To expand impact, healthcare workers engagement and sustained community efforts are crucial for AMR containment.