Global Public Health最新文献

Stewardship of antibiotic medicines will likely play a key role in curtailing the rise of antimicrobial resistance (AMR) globally. In East Africa, drug sellers are a critical group for interventions because they often dispense without prescription and violate regulations designed to facilitate antibiotic stewardship. Currently, measures to tackle regulatory avoidance are often rooted in individuated cognitive-behavioural approaches that label sellers' actions as 'irrational'. This study, part of a larger interdisciplinary investigation of AMR drivers in East Africa, conducted in-depth interviews [n = 105] with drug sellers in Kenya, Tanzania and Uganda to explore sellers' accounts of their own behaviours. Its findings seem contradictory; sellers are aware of regulations and express a desire to comply, yet confirm non-compliance is common. The paper's contribution is to demonstrate that such behaviour is 'situationally rational' when contextualised within a broader socio-material assemblage of unenforced regulation, fierce market competition, relational customer interactions and professional commitment to communities in resource-poor healthcare settings. The paper concludes that an understanding of the structural and relational dynamics driving current behaviours is a necessary precondition for the design of new interventions bringing professional and commercial motivations into closer alignment, something which could make antibiotic stewardship situationally rational for sellers and customers alike.

Antimicrobial resistance (AMR) education has been highlighted in both global and national policies as essential for societal efforts to address AMR, with calls for interdisciplinary and intersectoral One Health approaches that involve actors throughout society, including conventional and traditional medical practitioners. While a key aim of AMR education is to reduce the infection burden and antimicrobial use, the potential to integrate these medical practices remains largely unexplored. This paper aims to explore conventional medical practitioners' perspectives on the opportunities and challenges of integrating traditional and conventional medicine to reduce antimicrobial use through infection prevention and alternative treatments as part of AMR education efforts. Using participatory research workshop methods, data from workshops at two Zimbabwean hospitals with health practitioners are presented. The results detail workshop participants' discussions regarding the challenges of misunderstandings and lack of scientific validation and the opportunities for collaboration based on mutual respect, education and training and legitimisation between the two medical practices for health practice integration. The paper contribution includes how community and patient centred AMR educational approaches can be a foundation for integration, highlighting how health care interventions and community empowerment can go hand in hand towards more resilient and culturally relevant AMR educational efforts focusing on prevention.

This article provides a comparative analysis of digital interventions implemented in Taiwan and the UK during the COVID-19 pandemic to examine how national contexts shaped the rollout and reception of these technologies. Our analysis challenges the simplistic East/West divide often invoked in pandemic response analyses, which arose during and in the wake of the pandemic, arguing that successes or failures of digital health interventions must exceed assumed cultural traits in East or West, and consider sociohistorical factors, legal frameworks, and specific political contexts. By advancing interdisciplinary co-learning between research communities in Taiwan and the UK, this article offers actionable insights for enhancing digital preparedness for future global public health emergencies, underscoring the importance of cultures of preparedness, transparency, and public trust and responsible data governance for digital health technologies.

Clinical audit aims to improve maternal and newborn care by systematically reviewing clinical practices, identifying gaps, implementing corrective actions, and monitoring progress. Audit can improve outcomes but effective implementation requires strong teamwork, communication and trust. To explore how health professionals experience audit, individual semi-structured interviews were conducted with maternity managers in 11 rural health facilities in KwaZulu-Natal, South Africa, between November 2022 and February 2023. Participants included medical managers (5) and nursing managers (11). Analysis used inductive thematic analysis supported by Nvivo v15. Managers described the maternity team working together to systematically assess care across a range of clinical areas, suggesting that reflective practice was embedded in their work. Audit activities included auditing of clinical case records, caesarean sections, and perinatal and maternal deaths. However, managers reported that clinical audit was time consuming and required high level technical and facilitation skills. Feedback was often described as didactic, emphasising teaching rather than reflection and learning, and frequently involved elements of identifying and blaming individuals. It is important that maternity managers have skills to provide feedback in a safe, blame-free environment. Inappropriate or judgemental feedback could lead to a blame culture and negatively affect communication, teamwork and collaboration across the maternity team.

To assess disparities in healthcare acceptability between transgender and cisgender adults in Ecuador by analyzing experiences of discrimination, exclusion, and violence. This retrospective study used data from the 2012 'GLBTI' (gays, lesbians, bisexuals, transgender, transsexual, intersex) Living Conditions Survey by the National Institute of Statistics and Census (INEC) in Ecuador. Logistic regression assessed associations between gender identity (transgender vs. cisgender) and three outcomes: discrimination, exclusion, and violence. Odds ratios (ORs), standard errors (SEs), and p-values were calculated, adjusting for demographic and socioeconomic confounders. Transgender individuals were more likely than cisgender individuals to experience discrimination (OR = 11.56, SE = 1.55, p < 0.001), exclusion (OR = 7.61, SE = 1.79, p < 0.001), and violence (OR = 8.89, SE = 1.99, p < 0.001). Additional risk factors included residence in coastal regions and involvement in sex work, further exacerbating disparities. Transgender adults in Ecuador face disproportionately high risks of discrimination, exclusion, and violence in healthcare. These structural inequities undermine equitable access and worsen health vulnerabilities, demanding urgent policy attention. Training for healthcare providers, stigma-reduction campaigns, and structural reforms are needed to ensure inclusive, equitable healthcare for transgender populations in Ecuador and beyond.

Women forced to flee their home countries face significant challenges, including sexual and gender-based violence (SGBV), which impacts their physical and mental health. Addressing SGBV is complicated by cultural shifts and interaction with new social and legal systems. This study explores how refugee women in the Netherlands perceive SGBV, particularly intimate partner violence (IPV), and how they explain individual and community responses within the resettlement context. We conducted 14 semi-structured interviews and one group interview with 17 women from Syria, Iran, Iraq, and Eritrea. Women's understanding of SGBV evolved over time, influenced by their experiences in the Netherlands. They gained new vocabulary to discuss SGBV and saw the Dutch legal system as a means to break the cycle of violence. However, they also identified context-specific barriers such as double victimization and dependence on partners for residence permits. Women preferred to identify as 'survivors' or 'warriors' rather than 'victims', emphasized supporting other women, and suggested men should also be seen as victims needing support. This study reveals the complex realities and meaning-making processes of refugee women in relation to SGBV. It underscores the importance of focusing on women's agency, and highlights the importance of centering their experiential knowledge in response efforts.

Undernutrition is a major driver of the tuberculosis (TB) epidemic, with one in five TB cases worldwide attributable to undernutrition. Nutritional interventions may reduce TB incidence and mortality for those at increased risk of developing TB. The TB LION (Tuberculosis - Learning the Impact Of Nutrition) study provides nutritional supplementation to household contacts (HHC) of TB index cases (n = 60) to examine the impact of supplementation on progression from latent to active TB disease. TB LENS (Learning about Experience with Nutritional Supplementation), a qualitative sub-study of TB LION, was designed to examine attitudes and opinions regarding the provided nutritional supplementation to inform future interventions. We conducted in-depth interviews with HHCs from the TB LION study, local healthcare workers (HCWs) treating persons with TB, and with the two lead study nutritionists. Additionally, we held focus group discussions among HHCs and HCWs. We identified barriers and facilitators to intervention uptake and perspectives for future interventions. The results demonstrate the importance of culturally acceptable interventions with foods that participants enjoy eating and can prepare quickly. We also found an overwhelming preference for in-kind food delivery to the home over cash transfers. These results can inform future interventions to improve nutrition for households with TB.

The role and influence of interest groups in the healthcare sector, such as the hospital industry, insurers or physicians, are critical aspects of understanding health politics. Yet, scholarship examining the interests and actions of these actors has been surprisingly limited in health politics scholarship on Global South contexts. In India, national- and sub-national health sector reform debates have gained traction. The country's vast, underregulated and powerful private healthcare sector plays a decisive role in shaping policy outcomes. This study explores the public-facing strategies, tactics and frames used by policy actors in the debate surrounding the Right to Health Care Act 2022 in the state of Rajasthan. We describe a policy conflict in which private healthcare sector coalitions representing diverse constituencies united rapidly to effectively execute their opposition strategy. The opposing coalition deployed multiple approaches concurrently, pairing indirect and direct strategies and tactics and using diverse framing choices to "win" the public narrative and secure a dominant role in the policy process, placing supporting policy actors in a defensive position. Our findings contribute to a growing body of scholarship on domestic health politics in Global South contexts that expands our understanding of interest groups into different institutional and ideational spaces.

In Brazil, young transgender women (YTW) bear a disproportionate burden of HIV, which persists despite technological advances in biomedical prevention. This study explores how rights violations across different areas of life shape YTW's vulnerability to HIV through an intersectional lens. We conducted 13 in-depth interviews and one group interview with YTW participating in an HIV pre-exposure prophylaxis (PrEP) cohort. Thematic analysis with intersectional sensibility focused on six dimensions: family, schooling, romantic-sexual relationships, friendships, work, and health. The results show that gender transition impacted all areas. Rights violations prevailed in family and school settings, while supportive friendships and romantic relationships contributed to protecting their rights. A synergistic effect emerged: family disruptions hindered education, leading to precarious jobs and increased exposure to sexual exploitation. Conversely, family and school support promoted education continuity and access to basic needs. Though healthcare discrimination was reported, HIV services were largely respectful and extended care beyond prevention. The findings highlight how interconnected rights violations during youth can deepen HIV vulnerability. Effective prevention must extend beyond biomedical access to include strategies that protect rights and strengthen community and institutional support for YTW.

Despite Malaysia's low leprosy prevalence, new cases continue to emerge in rural and Indigenous communities. National strategies often prioritise elimination and surveillance, while overlooking the needs and challenges of individuals affected by leprosy and those managing their care. This study employed a transdisciplinary research approach, guided by the Dialogue Model, to co-develop context-specific strategies to improve the lives of those affected through participatory engagement with both groups. Conducted across three high-burden states in Peninsular Malaysia, the research involved a desk review and stakeholder mapping, followed by 40 in-depth interviews with affected individuals and other stakeholders. These were complemented by a stakeholder workshop, a focus group discussion, and an evaluation of implemented strategies. Participants identified overlapping and divergent concerns, including stigma, financial hardship, access barriers, interagency coordination, and awareness gaps. These findings informed the co-development of locally grounded strategies, some of which have since been trialled at the community level. While not primarily intended to influence national policy, the study generated actionable strategies to improve leprosy care delivery in underserved settings. This approach demonstrates how transdisciplinary methods can help align community experiences with service provision in neglected tropical disease programmes, particularly in low-endemic contexts, and contribute to more equitable global health systems.