Global Public Health最新文献

Editorial boards (EBs) can shape global health research by determining what is published, which methods are legitimised, and whose knowledge is prioritised. The persistent underrepresentation of scholars from minoritised backgrounds raises concerns about which researchers and types of knowledge may be systemically disregarded. This review consolidates all evidence on EB diversity, highlighting how power and representation are distributed in global health publishing. Five databases were searched from inception to 30 July 2025, with no language restrictions. Eligible studies included primary, peer-reviewed, quantitative studies examining diversity among EB members in global health journals. Of the 266,669 records screened, 226 specifically addressed EBs, analysing a median of 15 (IQR: 5.0, 41.0) journals and 859 (IQR: 374.0, 2754.0) editors. Most studies examined gender (n = 213) and geographic representation (n = 53), with limited assessment of race and ethnicity (n = 16), academic rank (n = 12), sexual orientation (n = 3), and disability (n = 1). Despite incremental gains, EB members and editors-in-chief were predominantly men based in high-income countries, particularly the US. A supplementary analysis of 603 studies on global health authorship found similar patterns. The composition of EBs reflects and may perpetuate systemic epistemic inequities. Addressing this requires structural reform beyond improving representation to ensure meaningful inclusion, accountability, and equitable governance.

This article critically examines the absence of a public health approach to the well-being of coca leaf producers in Colombia, a group disproportionately affected by the War on Drugs. While harm reduction frameworks address drug consumption as a public health issue, no comparable strategy has been developed to tackle the health vulnerabilities afflicting those involved in drug production. Drawing on ethnographic research and interviews in Catatumbo - a coca-producing region in northeastern Colombia - this study highlights the multiple health risks faced by coca producers and leaf pickers, including toxic chemical exposure, vector-borne diseases, and the mental health consequences of pervasive violence, economic hardship, and sexual exploitation. These issues are exacerbated by stigmatization, infrastructural deficits, and militarized forms of state action. The article contests prevailing security and rural development models for tackling the public health challenges of populations engaged in criminalized agrarian activities, advocating instead for a reconceptualization of community health that incorporates harm reduction principles. It proposes an 'oblique' model of healthcare that values the mediation of community health workers and the autonomous organization of coca-growers. By bridging public health and peacebuilding discourses, it reframes the health challenges of coca leaf producers as matters of care and justice, rather than solely criminality or development.

Vaccines are essential for preventing infectious diseases and promoting population health; however, equitable global access to vaccines remains elusive. Regulatory approval of vaccines is a critical step on the path towards global vaccines justice, yet the resources required can impede timely decision making. Regulatory reliance, where authorities use other agencies' assessments of new vaccines to make local decisions about their benefit-risk profile, can expedite regulatory decision making. In this Commentary, we apply a critical lens inspired by 'Third World Approaches to International Law' to vaccine justice that challenges the dominant narratives in international pharmaceutical regulatory policy from the perspective of historically marginalised LMICs. This Commentary's main contribution is to illustrate how modern trends in regulatory reliance - namely South-South reliance and reliance on opinions by the European Medicines Agency about medicinal products for global health (rather than evaluations of medicines destined for the European Union market) - are embracing 'third world approaches' to vaccines justice. Strengthening capacity through international regulatory pathways can help alleviate bottlenecks in the approval of vaccines that have already been deemed safe, effective, and quality-assured by qualified regulators, thereby streamlining registration processes and accelerating global access, particularly in an emergency situation.

The absence of reliable administrative data from many countries means that there is little global surveillance of femicide. We conducted femicide surveillance with four dedicated national retrospective mortuary-based surveys to understand its magnitude among women 14 years and older in South Africa from 1999 to 2020/21, including the first year of COVID-19. The surveys included data from police on the investigation to ascertain who perpetrated the femicide (i.e. an intimate partner or someone else). We found overall femicides declined between 1999 and 2009, but the rate of decline slowed in subsequent years. Intimate partner femicide increased during the first year of COVID-19, unlike non-intimate partner femicide. Firearm-related femicides also increased in parallel with the increased availability of firearms in the country during the same period. The data show that South Africa remains one of the countries with the highest recorded rate of intimate partner femicide globally (5.5/100,000 female population), almost five times the global average. We have shown that femicide is preventable, but the conditions of the COVID-19 response likely increased the risk for women in abusive relations. We have also shown the value of dedicated surveys in the absence of reliable information systems.

The Middle East and North Africa (MENA) region is one of the few areas experiencing an increase in HIV prevalence, attributed to insufficient political commitment, stigma, and the criminalization of key populations (KPs). This study provides a human rights-based analysis of the experiences of KPs and individuals living with HIV (PLHIV). Using a convergent mixed-methods design, data were collected through an online survey (N=100) and qualitative interviews/focus groups (N=38) across Arabic-speaking MENA. Findings indicate that participants perceive their socio-legal environments as hostile, leading them to prioritize structural challenges and survival strategies over access to HIV services. The most significant challenges identified include social and familial violence (N=66), criminalization (N=57), and poverty (N=56), while access to HIV medical services was ranked as the least pressing concern (N=26). The primary advocacy priority identified was 'law and policy reform' (N=60), with the most sought-after services being 'pro bono legal aid' (N=37) and 'mental health support' (N=34). This research highlights a disconnect between community realities and the prevailing medicalized response to HIV, emphasizing the need for funders and policymakers to reorient strategies from a narrow service delivery model to a comprehensive human rights framework that prioritizes legal reform and holistic security.

This scoping review aimed to understand the comprehensive evidence on solitary death occurring in the community. A database search was conducted in PubMed, Embase, Cochrane Library, and CINAHL using the following keywords: live alone, solitary death, and community. A manual search was also conducted using Google Scholar. Sixteen studies that met the inclusion criteria were reviewed. Approximately 60% of studies were retrospective, and 53.3% were conducted in Japan. The studies included in the review described solitary death using different expressions. However, they consistently encompassed the shared notion of a death experienced in the absence of anyone's presence, in a state of social isolation. Most solitary deaths occur at home and are discovered by family, neighbors, police officers, or someone who visited regularly. The risk of solitary death is higher among middle-aged and older adults, particularly among men, individuals living alone, those with low socioeconomic status or poor health conditions, and those experiencing social isolation. People who live alone are at particularly high risk for solitary death. The findings present insights into how solitary death has been defined in research, as well as how and why solitary death occurs in the community. The findings are expected to contribute to the development of intervention programs and government policies to prevent solitary death.Protocol registration: https://doi.org/10.17605/OSF.IO/AE39Q.

Malaria continues to be one of the leading causes of morbidity and mortality in Africa. Recent progress towards eliminating malarias has stagnated and, in some cases began to reverse. One key dimension which remains poorly understood in malaria research is the social determinants of the disease, which direct attention to the conditions in which people live and work. We present findings from a qualitative study that explored perceptions and understanding of the social determinants of malaria in Uganda, one of the main endemic countries. We conducted 14 key informant interviews, 10 focus group discussions with community members, and 11 in-depth interviews with households recently impacted by malaria. Our participants identified livelihoods and related practices as important social determinants. These included engaging in crop production with a focus on maize cultivation, livestock husbandry, construction, a range of activities conducted at dusk/night, and the gendered nature of specific livelihoods. The precise mechanisms noted through which these livelihood activities were related to malaria include increasing exposure to mosquitoes at dusk/night, the creation of new mosquito breeding sites, attracting mosquitoes to housing, providing feeding sites for mosquitoes, working near mosquito breeding sites, and the role that gendered care responsibilities play in exposing children to mosquitoes. Our findings emphasize the importance of engaging in these livelihood activities, given that they are widespread in Uganda and other African countries. We recommend that malaria prevention be incorporated into socio-economic development strategies, and urge researchers, policy makers, practitioners and other stakeholders to engage with the social determinants of malaria.

In humanitarian settings with high levels of sexual violence (SV), care is often offered through fragmented silos, exacerbating the burden on the health workforce and survivors. We aimed to identify contextual and health systems barriers and enablers to providing integrated medical and mental health & psychosocial support (MHPSS) in the care for SV survivors in humanitarian settings. Using Valentijn's framework, a qualitative, real-time Delphi study (RTD) approach was conducted with 17 experts representing seven geographical subregions. Challenges and enablers identified across the participants' contexts were consistent. Contextual challenges included volatile contexts, collapsed health systems, and insufficient basic infrastructure. Professional-related challenges included lacking expertise among healthcare professionals (HCPs), high staff attrition rates, and compassion fatigue. Health systems-related challenges included poor referral and coordination mechanisms, lack of funding and resources, misaligned donor priorities and low prioritisation of SV comprehensive care. Effective networking, community engagement, capacity building, co-locating services, participatory management, promoting employees' sense of ownership, establishing a digital information system, and a unified joint patient file were key identified enablers. Further research should be conducted to assess HCPs' and SV survivors' perceptions and experiences of how best to integrate MHPSS services, and understand the challenges and opportunities in delivering integrated services.

The Biomedical Ethics and Regulatory Capacity Building for Portuguese-Speaking African Countries Project (BERC-Luso) was a four-year project that aimed to enhance biomedical ethics and regulatory capacities in five Portuguese-Speaking African Countries (PSAC). BERC-Luso was developed considering the PSAC scarce number of clinical trials, exploring an untapped potential. The project's interventions focused on three primary areas: legislative, institutional, and capacity building. The common aim was to create attractive conditions for conducting clinical trials, guaranteeing population protection and benefit of the country. The project evaluated national legislative frameworks and recommended strengthening actions. Through implementing top-down and bottom-up approaches, BERC-Luso involved ministries, political stakeholders, policymakers, and diplomatic channels. These strategies prompted legislative initiatives and reforms. The outcomes evaluation reflected a high level of success rate, with 78.59% of the targets being achieved. The impact level was demonstrated by the engagement with stakeholders, resulting in activities that impacted over 71,149 professionals. The project emphasises the need for more investment in capacity-building, reinforcing best practices' implementation at legislative, institutional and training levels. BERC-Luso fostered collaboration between partner countries, contributing to a supportive environment of African biomedical research.

Leprosy reactions occur in 20-50% of people affected by leprosy. Previous studies have shown that lack of awareness and understanding of leprosy reactions among affected individuals and healthcare workers. This study aims to design and validate a knowledge, attitudes, and practices (KAP) questionnaire to assess understanding of leprosy reactions among leprosy-affected individuals. This study employed a sequential exploratory design in three phases. During interviews, affected individuals expressed dissatisfaction with the level of information provided by medical practitioners regarding leprosy reactions. People affected by leprosy reactions shared experiences of frustration, treatment barriers, and difficulties with daily activities during interviews and workshops. The pilot test with eight affected individuals let to the removal of one question, the addition of a new question, and adjustment to wording and instructions. Cronbach's alpha was calculated based on data collected from 63 individuals. The overall Cronbach's alpha was 0.71. The final KAP questionnaire consists of 39 questions, is considered clear and acceptable by users and can therefore be used to measure the KAP of individuals with leprosy reactions in Indonesia. KAP questionnaires have the potential to identify gaps in understanding of leprosy reactions and are expected to be helpful in assessing the effectiveness of interventions.