Global Public Health最新文献

Before COVID-19, a few studies examined adult vaccination programmes for disease outbreaks in Nigeria. Recent studies explored vaccine uptake factors, but few examined implementation. We aimed to understand factors influencing the implementation and uptake of adult vaccination programmes in Nigeria, through the COVID-19 example, to support subsequent outbreak interventions. We systematically searched seven databases and conducted a meta-ethnography of eight studies published between 2022 and 2024, involving 207 participants. Through reciprocal and refutational translation, higher-order interpretations, a new line of argument and a conceptual model on factors influencing implementation and uptake of COVID-19 vaccination in Nigeria were developed. We reported findings using eMERGe guidance. We developed eight higher-order interpretations operating at individual, health system and policy levels. Four concerned vaccination uptake: an ethical paradox, self-preservation, socioeconomic characteristics and trust. Another four concerned vaccination implementation and uptake: policy actions, local leadership from government, supply chain challenges and health services information. Our findings suggest that improved vaccination programme implementation during disease outbreaks in Nigeria would support enhanced vaccine uptake by adults. Our findings can inform vaccine implementation strategies for successful rollout and uptake of adult vaccines in future outbreaks.

Participating in and working for HIV interventions is both a source of both pride and suffering for many men who have sex with men (MSM) who engage in low-paying sex work in Kenya. Drawing on ongoing intermittent ethnographic research conducted among MSM sex workers since 2010, we analyse the relationship between hope and resilience on one hand, and narratives of suffering and hustling on the other. We show how HIV technologies that provide spaces for visibility and mobilising, such as new treatment regimes, accompanying support groups and training programmes, as well as activist led organisations, allow MSM sex workers to contribute to national and global HIV responses with a sense of both pride and shared suffering. We argue that pride, suffering and hustling are central to male sex workers' identity, solidarity and resilience. Attempts to build resilience among MSM sex workers and other highly marginalised people at continued risk for HIV would be advised to take their complex ambivalences towards health and rights-based interventions into account.

Despite almost a century's research capacity strengthening in Africa, HIV/AIDS research has been dominated by high-income countries (HICs), illustrating broader inequalities in the global knowledge economy. The perpetuation of weak social science capacity in east Africa is analysed as part of a complex system with multiple causes at different socio-ecological levels. Furthermore, although primarily driven by HIC/ neo-colonialist interests, causes also stem from low-income countries (LICs), and individual actions reproduce macro-level structures. Most factors link to global economic inequalities, and the extraction of data and intellectual capacity from east Africa operates akin to Dependency Theory, but this is exacerbated by African governments. At the meso-level, HIC institutions prioritise revenue and publications over strengthening LIC research capacity, whatever their rhetoric, while serious impediments exist in east African institutions. At the micro-level, HIC researchers perpetuate inequalities through, e.g., prioritising output, maintaining dependency, and choosing HIC rather than LIC conferences and journals. Multiple responses are needed, particularly at the macro-level, especially long-term, tailored funding. Meso-level responses include meritocratic career structures and institutional research consultancies. Individual HIC researchers should, ideally, prioritise training and mentoring, but this risks career advancement. Above all, honesty is required about motives and conflicting interests, at institutional and individual levels.

In the era of the Anthropocene and the ensuing transitions, the One Health approach is one of the possible answers to rethinking our place on the planet. The aim of this article is to propose an epistemological reflection on the psychosocial processes that concern researchers working with the One Health approach, developing some perspectives that have received limited attention to date. We argue for the importance of making these processes explicit, and to focus on the complexity associated with sticking to both a One Health and a community-based approach. Drawing on our experience as researchers engaged in participatory and community-based research in the field of social psychology of health and ecology, and involved in research projects oriented towards the One Health perspective, we outline four key challenges researchers may face: (1) moving beyond anthropocentric conceptions of health, particularly in human medicine, the social sciences, and public health; (2) integrating moral commitments, values, and plural identities into scientific reflection; (3) collaborating with other 'disciplinary communities'; (4) integrating non-academic researchers into the co-construction of science, by legitimising the experiential knowledge. For each challenge, we propose theoretical and methodological tools, conceived as resources to support researchers navigating these transitions.

The COVID-19 pandemic underlined stark inequalities in timely access to health technologies worldwide. Universities, by conducting a significant amount of early biomedical research and development, have a critical but often overlooked role in determining downstream equitable access to health technologies. This paper reviews university's policies and practices regarding COVID-19 health technologies in the United Kingdom (UK) during the recent pandemic using annual freedom of Information (FOI) requests between 2019 and 2023 to a cohort of 35 UK universities and website searches. We provide an overview of all patents and licenses filed for COVID-19 technologies, changes in technology transfer policies or strategies, and engagement with international mechanisms designed to enhance equitable transfer of knowledge and intellectual property rights during the pandemic. Despite a time-limited increase in non-exclusive licensing of COVID-19 health technologies at the height of the pandemic, there was a lack of systemic change in university policies for technology transfer, and limited to no engagement with international mechanisms to promote equitable access. Universities can promote global equitable access to health technologies by publishing clear technology transfer policies, attaching conditions to technology transfer agreements, increasing transparency, and engaging with non-exclusive licensing mechanisms, now and in future health emergencies.

ABSTRACTMalaria remains a major global public health burden and is a potential priority for Chinese health cooperation. However, limited analysis exists on the reference value of China's malaria elimination experience for other countries. While existing studies have focused on specific control strategies used in China, few have examined how Chinese malaria policy and practice have been adapted over time in response to heterogeneity across a vast country. This paper draws on literature, policy reviews, and in-depth interviews with key informants, including government officials and experts involved in malaria policy or implementation. It analyses the evolution of Chinese malaria policy from the 1950s to 2020 and presents case studies profiling specific practices through the lenses of policy experimentation and 'policy capacity'. The findings highlight how adaptive malaria policy and practice in China responded not only to the changing distribution and burden of malaria but also to shifts in institutions and the political economy as the country developed. Experimentation facilitated adaptive, sequential problem-solving, starting from a low base with limited data availability and capacity. China's experience offered valuable insights for other countries and for the evolution of its health cooperation initiatives.

This paper draws from qualitative research undertaken with the mothers and primary caregivers of children aged under 5 years old and in recovery from severe acute malnutrition (SAM), as well as other community members, across three study sites in Kenya, Zambia, and Zimbabwe. The paper highlights how nutrition-related stigma is constructed and enacted in complex ways, by multiple actors and across diverse settings. Adopting an intersectional approach, the paper identifies how stigma emerges at the intersections of social identity, especially age, gender, and associated beliefs about women's, and especially young women's, assumed (in)capacity to care. The paper highlights how such stigmatising practices have the potential to place the children of mothers and primary caregivers affected by stigma at heightened vulnerability to SAM as well as to impair their recovery because of its impact upon health-seeking behaviours. In conclusion, we argue that intersectional approaches to stigma are crucial to better understand the social construction of stigma pertaining to SAM, the differential experiences, and responses, of caregivers, as well as how these shape pathways to differing forms of care.

Health lifestyles in China reflect complex interplays of various structural forces, yielding intricate and evolving patterns. Leveraging data from the 2004-2015 China Health and Nutrition Survey (N = 9,986), this study discerns latent health lifestyles, tracks transitional dynamics, and probes socioeconomic disparities in these shifts. Three distinct lifestyle categories emerge: 'high risk', 'overall healthy but inactive', and 'modernized and active'. Notably, the prevalent trend favours the 'overall healthy but inactive' lifestyle, steadily expanding over time, followed by the 'high-risk' group. Conversely, the 'modernized and active' lifestyle, while being the least common, exhibits a modest decline. Individuals engaged in primary industries are more likely to sustain an overall healthy but inactive lifestyle. Socioeconomic advantages, particularly in education and income, were linked to maintaining or transitioning into a modernised and active lifestyle, while lower income and unemployment were more prone to maintaining high-risk behaviours. These findings illuminate the intricate dynamics of health lifestyles in China's rapidly evolving landscape, highlighting socioeconomic influences on lifestyle transitions.

In 2022, the World Health Organization endorsed self-managed abortion (SMA) with medical abortion pills as a safe abortion method. This study utilises India's National Family Health Survey Round 5 (2019-2021) data from 724,115 women to estimate state-level self-managed abortion (SMA). It examines SMA characteristics, trends over time, and self-reported complications in India using descriptive and multivariate analysis. This study finds significant regional disparities, with a higher proportion of self-managed abortions in the eastern (45%), central (39%), and north-eastern (31%) regions. A rising trend in SMA was observed, increasing from 19% in 2014-45% in 2021. There were higher odds of SMA among economically disadvantaged, less educated, and employed women. The study found no increased odds of self-reported complications in SMA, suggesting its safety and effectiveness, especially at early gestational ages. These findings underscore the importance of supporting reproductive choices, including access to quality drugs and information, while highlighting the continued relevance of provider-assisted care, particularly for surgical abortions and later gestational needs. This study offers crucial insights on SMA for programmatic and policy advocacy while underscoring the need for more research in the SMA field.