Journal of Global Health最新文献

The Lives Saved Tool (LiST) is a widely used software package for modelling changes in child, neonatal, and maternal mortality. Until recently, it has mainly been used as a standalone tool that people manipulate using its desktop or online interface. The developers of LiST have now created a web-based application programming interface (API) allowing other software programmes to interact directly with LiST to use its internal calculations. This opens the door for using LiST within more complex models, for which coverage-to-mortality calculations are only a part, or for building topic-specific tools with a custom interface. The API also allows other software programmes to access the data that has been gathered and maintained by the LiST team on the effectiveness and coverage of 70+ interventions, along with data on mortality rates, cause-of-death structures, and child nutritional status in low- and middle-income countries. In this viewpoint, we describe how we see the API being used and give examples of tools that are already using it. Our hope is that others can now take full advantage of LiST and its 20+ years of development to build their own tools for effective data use in global health.

Background: In China, most primary health care institutes (PHCIs) support ground-level medical services which are essential to residents' health levels. The Chinese government implemented a health reform in 2009 to strengthen PHCIs through increased fiscal inputs. However, how efficiently these inputs were converted into PHCIs' services remains unclear. We aimed to examine the efficiency of PHCIs' medical services and investigate if any changes occurred following the implementation of the health reform.

Methods: We aggregated data from PHCIs from Hainan's 18 districts (2011-21), treating those from the same district as one decision-making unit (DMU). We used three-stage data envelopment analysis (DEA) to assess the efficiencies of these PHCIs, adjusting the approach for environmental factors, managerial ineffectiveness, and statistical errors potentially arising from the background variability of measured data that deviates from the input and output values, allowing all DMUs to be compared in a homogeneous environment. We used the adjusted efficiency scores to evaluate the efficiency of PHCIs in Hainan each year and the Malmquist Productivity Index (MPI) to explore the productivity change of PHCIs over time.

Results: After adjusting for environmental factors between 2011-21, technical efficiency (TE) decreased from 0.825 to 0.745, pure technical efficiency (PTE) increased from 0.936 to 0.954, and scale efficiency (SE) decreased from 0.883 to 0.783. Seven districts had full PTE (1.0) and two districts had full TE (1.0) after adjustment. The mean MPI from 2011 to 2021 was 0.9430, indicating a 5.7% decrease in PHCIs' efficiency. After excluding the low productivity index possibly influenced by COVID-19 (2019 to 2021), PHCIs' efficiency decreased by 0.49%, with a mean MPI of 0.9951.

Conclusions: The efficiency of PHCIs in Hainan has declined slightly since the health reform. Low level of scale efficiency posed a significant impact on the overall efficiency of the medical services in PHCIs. Among potential inefficient technological performances, future policy formulation might focus more on the imbalanced allocation of resources in less-developed regions and PHCIs' lack of attractiveness to local patients.

Background: There is a knowledge gap regarding the effectiveness and utility of various preventive interventions during the COVID-19 pandemic. In this study, we aimed to evaluate the cost-effectiveness of various COVID-19 preventive interventions, including non-medical interventions (NMIs) and vaccination programs, using real-world data across different demographic and socioeconomic contexts worldwide.

Methods: We searched Medline, Cochrane Library, Embase, and Web of Science Core Collection from December 2019 to March 2024. We identified 75 studies which compared 34 COVID-19 preventive interventions. We conducted a network meta-analysis to assess the incremental net benefits (INB) of these interventions from both societal and health care system perspectives. We adjusted purchasing power parity (PPP) and standardised willingness to pay (WTP) to enhance the comparability of cost-effectiveness across different economic levels. We performed sensitivity and subgroup analyses to examine the robustness of the results.

Results: Movement restrictions and expanding testing emerged as the most cost-effective strategies from a societal perspective, with WTP-standardised INB values of USD 21 050 and USD 11 144. In contrast, combinations of NMIs with vaccination were less cost-effective, particularly in high-income regions. From a health care system perspective, vaccination plus distancing and test, trace, and isolate strategy were highly cost-effective, while masking requirements were less economically viable. The effectiveness of interventions varied significantly across different economic contexts, underlining the necessity for region-specific strategies.

Conclusions: In this study, we highlight significant variations in the cost-effectiveness of COVID-19 preventive interventions. Tailoring strategies to specific regional economic and infrastructural conditions is crucial. Continuous evaluation and adaptation of these strategies are essential for effective management of ongoing and future public health threats.

Registration: PROSPERO: CRD42023385169.

Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 revised the combined chronic obstructive pulmonary disease (COPD) assessment, merging groups C and D into group E, and revised the initial inhalation therapy recommendation. We aimed to evaluate the treatment responses among different inhalation therapies in GOLD group E patients stratified by the COPD assessment test (CAT) scores and forced expiratory volume in one-second percentage of predicted (FEV1%pred).

Methods: In this retrospective cohort study, we included patients with COPD registered in the Real World Research of Diagnosis and Treatment of COPD (RealDTC) study between January 2017 and June 2023. According to the GOLD 2023 report, we enrolled patients assigned to GOLD group E based on exacerbations in the past year (≥2 exacerbations or ≥1 hospitalisation) in this study. We classified them into the FEV1%pred <50% and FEV1%pred ≥50% groups, or CAT<10 and CAT≥10 groups. Subsequently, we divided all groups into four subgroups: long-acting muscarinic antagonist (LAMA), long-acting β2-agonist (LABA) + inhaled corticosteroid (ICS), LABA + LAMA, and LABA + LAMA + ICS. All patients finished one year of follow-up, during which we collected data on exacerbations, frequent exacerbations, hospitalisations, and all-cause mortality. We defined frequent exacerbations as ≥2 exacerbations per year.

Results: We enrolled a total of 3173 patients in this study. During one year of follow-up, there were no significant differences in exacerbations, frequent exacerbations, hospitalisations, and all-cause mortality among LAMA, LABA + LAMA, LABA + ICS, and LABA + LAMA + ICS in the FEV1%pred ≥50% and CAT<10 groups. However, the patients treated with LABA + LAMA or LABA + LAMA + ICS had a lower incidence of exacerbations and frequent exacerbations compared with the patients treated with LAMA or LABA + ICS in the FEV1%pred <50% and CAT≥10 groups (P < 0.05).

Conclusions: Patients with COPD in GOLD group E should be further stratified to determine the appropriate initial inhalation therapy. This approach may provide more precise treatment for GOLD group E patients.

Background: This study aims to develop specific multimorbidity relationships among the elderly and to explore the association of multidimensional factors with these relationships, thereby facilitating the formulation of personalised strategies for multimorbidity management.

Methods: Cluster analysis identified chronic conditions that tend to cluster together, and then association rule mining was used to investigate relationships within these identified clusters more closely. Stepwise logistic regression analysis was conducted to explore the relationship between influencing factors and different health statuses in older adults. The results of this study were presented by network graph visualisation.

Results: A total of 15 045 individuals were included in this study. The average age was 73.0 ± 6.8 years. The number of patients with multimorbidity was 7426 (49.4%). The most common binary disease combination was hypertension and depression. The four major multimorbidity clusters identified were the tumour-digestive disease cluster, the metabolic-circulatory disease cluster, the metal-psychological disease cluster, and the age-related degenerative disease cluster. Cluster analysis by sex and region revealed similar numbers and types of conditions in each cluster, with some variations. Gender and number of medications had a consistent effect across all disease clusters, while aging, body mass index (BMI), waist-to-hip ratio (WHR), cognitive impairment, plant-based foods, animal-based foods, highly processed foods and marital status had varying effects across different disease clusters.

Conclusions: Multimorbidity is highly prevalent in the older population. The impact of lifestyle varies between different clusters of multimorbidity, and there is a need to implement different strategies according to different clusters of multimorbidity rather than an integrated approach to multimorbidity management.

Background: Sex and gender are important determinants of health. Gender-based health inequities in the paediatric population have been reported in various countries, but data remain limited. In Mozambique, research on this topic is very scarce. Here we aimed to explore whether boys and girls in Manhiça district, southern Mozambique, differ in access to and provision of healthcare.

Methods: This retrospective analysis includes data on all paediatric (<15 years old) visits to six outpatient clinics and admissions to one hospital in Manhiça district from 2004 to 2020, collected through the morbidity surveillance system of the Manhiça Health and Demographic Surveillance System (HDSS). We compared characteristics and outcomes between boys and girls using descriptive statistics, standardised mean differences, and logistic regression. Post-discharge events were analysed using Cox proportional hazards regression and Fine-Gray competing risk regression. Minimum community-based incidence rates of outpatient clinic visits and hospitalisations were calculated using demographic surveillance data from the Manhiça HDSS and analysed with negative binomial regression.

Results: Girls represented 49.2% (560 630 out of 1 139 962) of paediatric visits to outpatient clinics and 45.1% (18 625 out of 41 278) of hospitalisations. The girls-to-boys incidence rate ratio (IRR) for hospitalisations was 0.81 (95% confidence interval (CI) = 0.79-0.84). Both boys and girls experienced symptoms for a median duration of one day (interquartile range (IQR) = 1-2) before seeking care. Severe manifestations at presentation to an outpatient clinic or upon hospitalisation tended to be less frequent in girls (girls-to-boys odds ratios (ORs) = 0.71-1.11). Girls were less frequently referred or admitted to hospital after an outpatient clinic visit (OR = 0.82; 95% CI = 0.79-0.86 and OR = 0.85; 95% CI = 0.84-0.87, respectively). The hospital case fatality ratio was 4.1% in boys and 4.2% in girls. The median duration of hospitalisation was three days (IQR = 2-5) and did not differ between boys and girls. Revisits to outpatient clinics, hospital readmissions, and hospital post-discharge mortality were similar in both groups.

Conclusions: Girls had fewer referrals and admissions to hospital in Manhiça district, but they were also less likely to present with severe manifestations. Other studied indicators of healthcare access and provision were overall similar for boys and girls. Further research is needed to continue assessing potential gender biases and sex differences in paediatric healthcare in Mozambique.

Background: Universal health coverage (UHC) and global health security (GHS) should be pursued synergistically to strengthen health systems. However, existing studies found that the efforts toward the two agendas were divergent worldwide. We reviewed the synergy status between UHC and GHS in the Western Pacific Region (WPR) to provide evidence for decision-makers to promote synergy.

Methods: We collected the UHC service coverage index (UHC SCI) and the GHS index (GHSI) scores. We created a four-quadrant diagram to discover the gap in UHC and GHS capacities within WPR and divide WPR countries into four groups based on the global mean scores. Further, we adopted global spatial autocorrelation analysis to discover spatial aggregations of high and low scores by calculating Moran's I. In addition, we conducted a correlation analysis to assess the synergy level in WPR and reveal the gap between Pacific Island countries or territories (PICTs) and non-PICTs. We conducted key informant interviews to uncover actual scenarios and address gaps in the quantitative evidence.

Results: Compared to the global mean UHC SCI and GHSI scores, nine out of 13 non-PICTs had higher scores, while all 14 of the PICTs had lower scores for both indexes. The Moran's I for WPR countries' UHC SCI and GHSI scores in 2021 were 0.20 and 0.23, respectively (Z-score >2.58; P < 0.01). The correlation coefficients between the two index scores were 0.722 (P < 0.001) at the global level and 0.869 (P < 0.001) at WPR. Within the WPR, the correlation coefficients were 0.859 (P < 0.001) in the non-PICTs and -0.026 (P > 0.05) in the PICTs.

Conclusions: The synergy level between UHC and GHS was high in the WPR, but this mainly came from the synergy in the non-PICTs. The two agendas have barely synergised the PICTs. To build a safer and healthier WPR, it is important to pay more attention to the countries that have weaker health capacities in the region and narrow the gap.

Background: Substantial gaps exist between pregnant women's contact with health facilities and the quality of care they receive (effective coverage) in low- and middle-income countries (LMICs). An effective coverage cascade is a useful analytical approach to uncover gaps due to poor facility service readiness and quality of care. We estimated readiness-adjusted antenatal care (ANC) coverage and built an effective coverage cascade in countries with available data.

Methods: We used data from latest household and health facility surveys in eight countries accounting for 28 925 women and 8621 facilities. Service readiness was assessed based on the availability of core items needed to provide quality ANC. We linked the household surveys with health facility data by subnational region and facility type to estimate readiness-adjusted ANC coverage for at least one, four, and eight or more ANC contacts and ANC content. We built a four-step ANC effective coverage cascade and calculated loss of coverage in terms of ANC readiness coverage gaps and missed opportunities.

Results: The majority of women sought ANC services in lower-level facilities, except in Bangladesh, Nepal and Senegal. While at least one antenatal care contact (ANC1+) service coverage was high, ranging from 89.2% (95% confidence interval (CI) = 87.2-90.9) in Haiti to 98.1% (95% CI = 97.5-98.6) in Malawi, readiness-adjusted ANC1+ coverage was lower, ranging from 64% (95% CI = 62.4-65.5) in Haiti to 76.2% (95% CI = 75.1-77.2) in Nepal. We obtained readiness gaps as high as 33.7 percentage points in Malawi and missed opportunities of 21 percentage points in Tanzania. Poor diagnostic capacity and insufficient trained human resources drove the low ANC facility readiness. We found large inequalities in readiness-adjusted ANC1+ by socioeconomic status favouring wealthier and urban resident women.

Conclusions: The effective coverage cascade for ANC services helped uncover large readiness gaps, missed opportunities, and socioeconomic inequalities. Improvements in facilities' diagnostic capacity and availability of trained human resources will enhance their ability to provide high quality health services and ensure health gains.

Background: Pulmonary rehabilitation (PR) is an effective and essential component of care for the increasing number of individuals with chronic respiratory diseases (CRDs). Despite the benefits, it remains underutilised and poorly accessible in low- and middle-income countries (LMICs). We aimed to determine the feasibility of delivering PR in Bangladesh at home because of pandemic travel restrictions.

Methods: Aligned with the Medical Research Council framework of development and evaluation of complex interventions, we recruited individuals with CRDs from the Community Respiratory Centre, Khulna, to a mixed-methods feasibility study. We assessed their functional exercise capacity and quality of life before and after an eight-week course of home PR, and conducted semi-structured interviews with PR providers and professional stakeholders by using a topic guide aligned with the normalisation process theory (NPT) and interpreting the findings within its constructs.

Results: We recruited 51 out of 61 referred patients with a range of CRDs, of whom 44 (86%) completed ≥70% of their home PR course. Functional exercise capacity, measured by the endurance shuttle walk test, improved in 78% of patients, with 48% exceeding the minimum clinically important difference (MCID). Health-related quality of life, measured by the Chronic Obstructive Pulmonary Disease Assessment Test, improved by more than the MCID in 83% of patients. Through the interviews, we found that PR providers encountered challenges in remote video supervision due to unstable internet connections, forcing them to resort to telephone calls. The strength of support for NPT constructs varied; many participants understood and appreciated the role of PR and could make sense of the innovation (NPT-1), and most were assessing the potential of a PR service in Bangladesh to decide if it was worthwhile (NPT-4). Participants were not yet ready to endorse or actively support (NPT-2) or operationalise (NPT-3) the roll-out of PR.

Conclusions: A home PR programme, supported by remote supervision and monitoring, is feasible in Bangladesh, but local evidence will be needed to promote implementation.

Background: Between 2021 and 2023, the Cameroon Ministry of Public Health, with support from the Clinton Health Access Initiative (CHAI), made considerable investments in establishing a reliable medical oxygen system in Cameroon. To monitor the impact of said investments, medical oxygen indicators were identified and integrated into the country's health information management system. This integration aimed to enhance the collection, reporting, and analysis of medical oxygen data, ultimately improving decision-making regarding oxygen needs, procurement volumes, and patient referrals based on real-time data on the availability of oxygen supplies. Here we outline the integration approach and assess its impact on medical oxygen reporting one year post-investment.

Methods: We adopted an iterative, consultative approach involving multiple meetings and workshops with all key stakeholders to define medical oxygen indicators and their technical specifications, develop the necessary data collection forms and guides, pre-test the defined indicators, review and validate them, and finally integrate them into the District Health Information System 2 (DHIS-2). Following integration, we rolled out the indicators within DHIS-2 nationwide using a two-step process, beginning with cascaded training of regional- and district-level data managers on the reporting of medical oxygen indicators into DHIS-2, and followed by supervision and mentoring. We assessed the impact of this rollout by comparing reporting rates on medical oxygen use before and after the integration and training process.

Results: We validated 15 indicators and integrated them into the DHIS-2, and we trained 218 regional- and district-level data managers from eight of the country's ten regions on leveraging the defined indicators to capture data on medical oxygen use and hypoxaemia management at the facility and input it into the system. We observed a 23% absolute increase in the completeness of medical oxygen reports, with rates rising from 3% in December 2022 (pre-intervention) to 26.2% in December 2023 (one year post-intervention). We also noted a considerable increase in the reporting of case management, with, for instance, the number of newborns diagnosed with hypoxaemia rising from zero pre-integration and training to 213 by March 2024.

Conclusions: Integration of medical oxygen indicators into DHIS-2, along with staff training, improved reporting rates for medical oxygen use and hypoxaemia management. Continuous support and infrastructure upgrades are needed to sustain investment.