Journal of Global Health最新文献

Background: While diarrhoeal disease remains a leading cause of death in children aged <5 years in low- and middle-income countries (LMICs), it also poses significant health risks for older children, underscoring the importance of our study focusing on children aged <10 years. In this systematic review, we assessed common diarrhoea aetiologies in children aged <10 years in LMICs.

Methods: We identified relevant articles in PubMed, Embase, and Web of Science using pre-defined search criteria. We included case series and case-control studies of children aged <10 years with non-bloody, bloody, acute, persistent, and chronic diarrhoea. Articles that evaluated two or more diarrhoea pathogens in LMICs conducted between 1 January 1990 and 31 July 2020 were eligible for inclusion. We stratified combined data from case series and case-control studies by age and World Health Organization (WHO) regions.

Results: 76 studies published between 1990-2020 were eligible for inclusion. Among these, eight were case-control studies. 56 papers focused only on children aged <5 years, while 20 also included children aged ≥5 years. The most common viral pathogens among <5 years old children were rotavirus, norovirus, adenovirus, and astrovirus. Bacterial pathogens included Escherichia coli, Salmonella enterica, Shigella species, and Campylobacter species, while parasitic pathogens included Cryptosporidium, Giardia, and Entamoeba species. Rotavirus was the most common viral pathogen among children across all age groups and every WHO region. Escherichia coli was prevalent in all age groups and was responsible for most diarrhoea cases in the African Region. Among parasitic pathogens, Entamoeba species and Giardia were prevalent in children aged three to five years, with the former a major cause of diarrhoea in the Eastern Mediterranean Region. Similarly, in children aged six to 10 years, bacterial pathogens, including Escherichia coli, Salmonella, and Shigella, suggest a continued significance of these pathogens beyond the age of five. Common viral pathogens for this group were rotavirus, norovirus, and sapovirus, although the number of studies for this age group is limited.

Conclusions: Escherichia coli, rotavirus, and Entamoeba species were the most common pathogens responsible for diarrhoea in children aged <5 years in LMICs. Future research should focus on characterising the pathogens responsible for causing diarrhoea in children aged six to 10 years stratified by geographic area of residence, i.e. WHO region and urban vs rural. Case-control or cohort studies covering a full 12-month period to account for seasonality are needed for a more accurate picture of diarrhoea aetiology among children.

Registration: PROSPERO (CRD42020204005).

Background: Despite the significant impact of blindness on the affected individuals' quality of life, its burden has not been assessed according to temporal cause-specific changes in severity, impeding our ability to evaluate the impact of blindness on population health accurately. Therefore, we aimed to comprehensively quantify the changes in cause-specific blindness burden according to changes in disease severity for 18 causes of blindness.

Methods: For this cross-sectional population-based study, we derived data on prevalence, disability-adjusted life-years (DALYs), and population size between 1990 and 2019 from the Global Burden of Disease 2019 study. Using the decomposition method, we attributed changes in total DALYs to population growth, population ageing, and changes in prevalence rate and disease severity between 1990 and each subsequent year globally, regionally, nationally, and by sex, cause, and sociodemographic index (SDI). The absolute and relative contributions to the variation in blindness-related DALYs between 1990 and each year from 1991 to 2019 then served as a measure of changes in disease severity.

Results: Changes in disease severity from 1990 to 2019 were associated with 15 165.11 DALYs in men and 20 639.32 DALYs in women. We observed disease severity increases in most countries/territories, with attributable DALY proportions ranging from -0.07% to 1.30% in men and from -0.06% to 1.73% in women. Notably, both attributable proportions and DALYs were greater in women than men. The largest increases in attributable DALYs were observed for cataracts, refraction disorders, and glaucoma globally; age-related macular degeneration in high-SDI countries; and trachoma and retinopathy of prematurity in lower-SDI countries.

Conclusions: Growth in the burden of cause-specific blindness due to increased disease severity reflects the lag of healthy vision life behind increasing life expectancy, necessitating the implementation of preventive and long-term therapeutic measures focussed on improving visual outcomes.

Background: Estimating the proportion of children with diarrhoea and those who are taken in as inpatients or outpatients is important for policy planning, resource allocation, and to evaluate the effectiveness of diarrhoea prevention and control interventions. We aimed to estimate the proportion of children <2 years of age with diarrhoea, explore their treatment-seeking practices, and identify factors associated with both diarrhoea and treatment seeking.

Methods: We designed a longitudinal study based on a sample of children <2 years of age in the Birhan field site from September 2018 to September 2019. The study site collected data on child mortality and morbidity and treatment-seeking practice for those with a history of illness every three months. Mothers/caregivers were asked about signs or symptoms of illnesses for a two-week period prior to each study visit. We estimated the proportion of children <2 years of age with diarrhoea and treatment-seeking practices for each of the four rounds of data collection and identified associated factors through bivariable and multivariable logistic regression.

Results: We enrolled 4678 children <2 years of age. The proportion of children with diarrhoea was the highest from 11 September 2018 to 9 December 2018 (4.47%; 95% confidence interval (CI) = 3.70-5.35) and the lowest from 10 December 2018 to 9 March 2019 (2.48%; 95% CI = 1.90-3.19). Children from households with chlorinated drinking water had a 50% (adjusted odds ratio (aOR) = 0.50; 95% CI = 0.28-0.88) lower odds of developing diarrhoea compared to those who did not. Among 339 children with diarrhoea, 275 (81.12%; 95% CI = 76.54-85.15) were taken to health facilities for treatment. Female children had lower odds of being taken to health facilities for treatment (aOR = 0.37; 95% CI = 0.17-0.80) compared to males.

Conclusions: While the proportion of children with diarrhoea in our study was lower than that observed in prior research conducted in Ethiopia, treatment-seeking practices were higher. Female children and children from the poorest families had lower odds of treatment. We recommend more studies to explore gender-based and socioeconomic differences affecting treatment-seeking practices.

Background: Despite the increasing number of primary studies on the quality of health care for sick children in Ethiopia, the findings have not been systematically synthesised to inform quality improvement in policies or strategies. This systematic review provides a narrative synthesis of published evidence on the quality of care provided to sick children in Ethiopia's health facilities and on related barriers and enablers.

Methods: We searched studies that measured the structure, process, and outcome measures of quality of care as proposed by Donabedian's framework. We searched in PubMed/Medline, EMBASE, and Web of Science using the Population, Concept, and Context (PCC) framework. Grey literature was searched in Google Scholar and institutional websites. We appraised the studies' quality using the Mixed Method Quality Appraisal Tool version 2018. Data were analysed using content thematic analysis and presented using a narrative approach.

Results: We included 36 of 701 studies. Thirty (83.3%) were nonexperimental including 21 (70%) cross-sectional studies and five (16.7%) qualitative studies. Of the 31 facility-based studies, 29 (93.5%) were conducted in public facilities. The structural, technical, and interpersonal processes of care were low quality. While some studies reported the effectiveness of interventions in reducing child mortality, the uptake of services and providers' and caretakers' experiences were suboptimal. The major structural barriers to providing quality care included inadequacy of essential drugs, supplies and equipment, training, clinical guidelines, and ambulance services. Caretakers' non-compliance to referral advice was a common demand-side barrier. The enabling factors were implementing various health system strengthening interventions including quality improvement strategies such as user-centred service delivery and optimising engagement of community-level structures such as health promotors and religious leaders to create demand.

Conclusions: The quality of care provided to sick children in health facilities is generally low in Ethiopia. Shortages of essential drugs, supplies and equipment, physical space, water, and electricity; and human resource-related challenges such as shortage, training, supervision, and retention were common structural barriers. Various health systems strengthening and quality improvement interventions, ranging from enhanced demand creation to realising a reliable and consumer-centred service delivery were key enablers. More research is needed on the quality of care provided in private facilities.

Registration: PROSPERO: CRD42021285064.

Background: Despite progress in reducing maternal and child mortality worldwide, adverse birth outcomes such as preterm birth, low birth weight (LBW), small for gestational age (SGA), and stillbirth continue to be a major global health challenge. Developing a prediction model for adverse birth outcomes allows for early risk detection and prevention strategies. In this systematic review, we aimed to assess the performance of existing prediction models for adverse birth outcomes and provide a comprehensive summary of their findings.

Methods: We used the Population, Index prediction model, Comparator, Outcome, Timing, and Setting (PICOTS) approach to retrieve published studies from PubMed/MEDLINE, Scopus, CINAHL, Web of Science, African Journals Online, EMBASE, and Cochrane Library. We used WorldCat, Google, and Google Scholar to find the grey literature. We retrieved data before 1 March 2022. Data were extracted using CHecklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies. We assessed the risk of bias with the Prediction Model Risk of Bias Assessment tool. We descriptively reported the results in tables and graphs.

Results: We included 115 prediction models with the following outcomes: composite adverse birth outcomes (n = 6), LBW (n = 17), SGA (n = 23), preterm birth (n = 71), and stillbirth (n = 9). The sample sizes ranged from composite adverse birth outcomes (n = 32-549), LBW (n = 97-27 233), SGA (n = 41-116 070), preterm birth (n = 31-15 883 784), and stillbirth (n = 180-76 629). Only nine studies were conducted on low- and middle-income countries. 10 studies were externally validated. Risk of bias varied across studies, in which high risk of bias was reported on prediction models for SGA (26.1%), stillbirth (77.8%), preterm birth (31%), LBW (23.5%), and composite adverse birth outcome (33.3%). The area under the receiver operating characteristics curve (AUROC) was the most used metric to describe model performance. The AUROC ranged from 0.51 to 0.83 in studies that reported predictive performance for preterm birth. The AUROC for predicting SGA, LBW, and stillbirth varied from 0.54 to 0.81, 0.60 to 0.84, and 0.65 to 0.72, respectively. Maternal clinical features were the most utilised prognostic markers for preterm and LBW prediction, while uterine artery pulsatility index was used for stillbirth and SGA prediction.

Conclusions: A varied prognostic factors and heterogeneity between studies were found to predict adverse birth outcomes. Prediction models using consistent prognostic factors, external validation, and adaptation of future risk prediction models for adverse birth outcomes was recommended at different settings.

Registration: PROSPERO CRD42021281725.

Background: Previous studies have typically explored daily lagged relationships among pertussis and meteorology, with little assessment of effect and interaction among pollutants mixtures.

Methods: Our researchers collected pertussis cases data from 2017-2022 as well as meteorological and contaminative factors for the Jining region. First, we reported the application of the Moving Epidemic Method (MEM) to estimate epidemic threshold and intensity level. Then we developed a Weighted Quantile Sum (WQS) regression and Bayesian Kernel Machine Regression (BKMR) model to assess single, multiple effects and interaction of meteorological and pollution factors on pertussis cases for different sex, delayed and epidemic threshold groups.

Results: There has been a yearly upward trend in the incidence of pertussis in Jining regions. High prevalence threshold years were in 2018-2019, the epidemic peak was mainly concentrated in 32 weeks. Totally, pertussis infections disease was separately 2.1% (95% confidence Interval (CI) = 1.3, 2.8) and 1.1% (95% CI = 0.3, 1.9) higher per decile increase in temperature and sulphur dioxide (SO₂). And pertussis infections disease was 1.1% lower per decile increase in humidity. In the different stratified analyses, air pressure was a strong negative effect in males and in the lagged 11-20 days group, with 7.3 and 14.7%, respectively. Sulphur dioxide had a relatively weak positive effect in males, females and the group after 20 days lag, ranging from 0.5 to 0.6%. The main positive effectors affecting the onset of disease at low and high threshold levels were ozone (O₃) and SO₂, respectively, while the negative effectors were SO₂ and carbon monoxide (CO), respectively.

Conclusions: This is the first mathematically based study of seasonal threshold of pertussis in China, which allows accurate estimation of epidemic level. Our findings support that short-term exposure to pollutants is the risk factor for pertussis. We should concentrate on pollutants monitoring and effect modeling.

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted essential health care services worldwide, including those related to immunisation. National data from Bangladesh shows that child immunisation may have been adversely affected by the pandemic but regional evidence is limited. We therefore aimed to explore the regional differences in the indirect effects of COVID-19 on child immunisation in Bangladesh.

Methods: We extracted data from the District Health Information Software (DHIS2) spanning the period from January 2017 to December 2021. We examined three essential immunisation indicators: Bacille Calmette-Guérin (BCG), pentavalent third dose, and measles vaccinations. We examined both the yearly and monthly trends to explore fluctuations in the number of immunisations to pinpoint specific periods of service utilisation regression. Segmented regression with Poisson distribution was implemented given the count-based outcome. We reported incidence rate ratios (IRRs) with 95% confidence intervals (CIs) in different regions in 2020 and 2021 compared to the reference period (2017-19).

Results: We initially observed a notable decline in vaccine administration in April 2020 compared to the pre-pandemic period of 2017-19 with a drop of approximately 53% for BCG vaccines, 55% for pentavalent third doses, and 51% for measles vaccines followed by May 2020. The second half of 2020 saw an increase in vaccination numbers. There were noticeable regional disparities, with Sylhet (IRR = 0.75; 95% CI = 0.67-0.84 for pentavalent administration, IRR = 0.79; 95% CI = 0.71-0.88 for measles administration) and Chattogram (IRR = 0.77; 95% CI = 0.72-0.83 for BCG administration) experiencing the most significant reductions in 2020. In April 2020, Dhaka also experienced the largest decline of 67% in measles vaccination. In 2021, most divisions experienced a rebound in BCG and pentavalent administration, exceeding 2019 levels, except for Chittagong, where numbers continued to decline, falling below the 2019 figure.

Conclusions: Our findings highlight the impact of the COVID-19 pandemic on childhood immunisation across regions in Bangladesh. Sylhet, Chattogram, and Dhaka divisions experienced the most significant reductions in immunisation services during 2020. This underscores the importance of targeted interventions and regional strategies to mitigate the indirect effects of future challenges on essential health care services, particularly childhood immunisation, in Bangladesh.

Background: Humanitarian crises frequently garner solidarity and robust volunteer recruitment among health care communities. However, a common obstacle is matching providers to those in need across geographic and other barriers. We examined the application of a decentralised governance strategy in establishing an emergency telemedicine response, TeleHelp Ukraine (THU).

Methods: Using a case study approach, we explored how global networking and technological advancements empower organisations to generate, access, disseminate, and utilise knowledge for sustainable health care delivery.

Results: Preliminary results suggest that a non-profit, decentralised model strengthened by robust team dynamics may optimise the distribution of clinical workload and scheduling procedures. Institutional and cultural diversity among health care providers and volunteers fosters the mobilisation of knowledge resources, synergistic collaboration, and tailored care standards that align with both provider and patient expectations. By integrating these diverse, distributed networks, a synergistic effect is achieved, combining effective learning mechanisms with intellectual capital.

Conclusions: Our study provides insights into the structure, implementation strategies, dissemination methodologies, and initial results of THU's operation. These findings may inform future emergency telemedicine responses in humanitarian scenarios, thereby reinforcing the practical implementation of health as a human right.

Background: Although dietary diversity (DD) has been confirmed to be associated with multiple health outcomes and longevity in older people, the related mechanisms have not been elucidated. In this study, we explored the mediating roles of physical activities and cognitive function in the relationship between DD and all-cause mortality.

Methods: We recruited 34 068 community-dwelling older adults aged ≥60 years from the Chinese Longitudinal Healthy Longevity Study and followed them up until 2018. Dietary diversity score (DDS) was assessed by the intake frequency of nine food sources. We evaluated physical activities and cognitive function using the Katz index and Mini-Mental State Examination. We explored the mediating roles of physical activities and cognitive function between DDS and all-cause mortality using mediated analyses in Cox proportional risk regression models.

Results: A total of 25 362 deaths were recorded during 148 188.03 person-years of follow-up. Participants with physical disability and cognitive impairment had lower DDS than the normal group (P < 0.001). After controlling for all covariates, DDS, physical activities, and cognitive functioning were negatively associated with all-cause mortality. Physical activities and cognitive function mediated 18.29% (95% confidence interval (CI) = 12.90-23.10) and 27.84% (95% CI = 17.52-37.56) of the total effect of DDS on mortality, respectively.

Conclusions: Physical activities and cognitive function mediated the association between DDS and all-cause mortality. Maintaining DD may benefit early death prevention by reducing physical disability and cognitive impairment in community-dwelling older people.

Background: Historically, the US has been the largest contributor to development assistance for health (DAH), although its allocation has shifted in response to outside forces. This included, for example, the establishment of the Millennium Development Goals (MDGs) in 2000, which emphasised child mortality, maternal health, HIV/AIDS, and malaria. This led to funds being earmarked for disease-specific interventions rather than health system strengthening (HSS). In 2007, the World Health Organization (WHO) published six health system building blocks, representing essential components of strong health systems. In 2015, the MDGs were replaced by the Sustainable Development Goals (SDGs), which emphasised capacity-building as opposed to specific health problems. The Lancet Commission on Global Surgery, meanwhile, highlighted surgical capacity building as essential to achieving Universal Health Coverage (UHC). Given the renewed emphasis on a comprehensive approach rather than disease-specific interventions, one might anticipate the US aligning with this rhetoric in its allocation of DAH. However, we hypothesise that this is not the case.

Methods: We queried the Organization for Economic Co-operation and Development (OECD) database for allocation of US DAH to low- and middle-income countries between 1995 and 2019, thereby excluding data after 2019 to avoid the influence of the coronavirus disease 2019 pandemic. OECD entries were assigned to health systems strengthening (HSS) or disease-specific interventions categories. The WHO building blocks were used as a framework for health systems strengthening.

Results: From 1995 to 1999, US DAH allocated to HSS decreased from 42% to 34%. The allocation decreased further from 34% in 2000 to 4% in 2007; correspondingly, DAH allocated to disease-specific interventions increased from 67% to 96%. Between 2008 and 2019, the distribution of US DAH remained relatively stable, with funds allocated to HSS versus disease-specific interventions ranging from 3-12% and 88-98% respectively.

Conclusions: While total US DAH contributions in the 1990s and early 2000s were significantly lower compared to the decade that followed, the distribution of these funds was more evenly divided between HSS and disease-specific interventions. Despite attempts by the WHO and United Nations to redirect attention to HSS as the path to achieving UHC, the US continues to largely support disease-specific interventions and overlook the importance of HSS, including surgical capacity building.