Journal of Global Health最新文献

Pakistan's neonatal and under-five mortality rates remain among the highest in South Asia. This challenge is exacerbated by a critical shortage of paediatric intensive care staff, with <30 trained specialists serving >80 million children. Recent national data indicate that only 70% of accredited paediatric hospitals have functional paediatric intensive care units, and nearly half lack adequate nurse-to-patient ratios. These shortages are most severe in rural regions, where delayed access to life-saving interventions contributes to preventable deaths. Emerging solutions such as telemedicine, neonatal care units within general hospitals, and public-private partnerships demonstrate potential for scalable reform. Strengthening paediatric critical care is essential to achieving Sustainable Development Goal 3.2 and ending preventable child deaths by 2030.

Background: This meta-analysis aims to determine the clinical manifestations, prevalence, and risk factors of asthenopia across diverse populations.

Methods: We systematically searched PubMed up to April 2024 for studies published within the last five years on asthenopia, without language or design restrictions. Reference lists were also reviewed. The study quality was evaluated using the Newcastle-Ottawa Scale. A random-effects meta-analysis was conducted to calculate proportions, prevalence rates, odds ratios (ORs) and their 95% confidence intervals (CIs).

Results: Overall, 63 studies were included. The pooled prevalence of asthenopia detected via questionnaires or symptom report was 51% (95% CI = 50%, 52%). Subgroup analyses showed high prevalence among digital device users (90%) and computer workers (77%). During the COVID-19 pandemic, prevalence rose among adults (39%-45%), university students (36%-57%), and school-aged children (45%-64%). The most frequent ocular symptoms were eye tiredness (65%, 95% CI = 46%, 84%), eye strain (47%, 95% CI = 37%, 58%), and burning/irritation (43%, 95% CI = 35%, 51%). Musculoskeletal symptoms, including neck pain (45%, 95% CI = 28%, 62%) and shoulder pain (30%, 95% CI = 12%, 48%) were also prevalent. Neuropsychological symptoms included headache (50%, 95% CI = 41%, 59%) and difficulty concentrating (44%, 95% CI = 32%, 56%). Risk factors included short sleep duration (OR = 1.28; 95% CI = 1.04, 1.57), prior eye disease (OR = 2.59; 95% CI = 1.43, 4.69), prolonged screen time (OR = 1.15; 95% CI = 1.09, 1.21), and ambient conditions like air conditioning use (OR = 23.02; 95% CI = 4.94, 107.18). Protective measures included anti-glare filters (OR = 0.34; 95% CI = 0.19, 0.64), regular breaks (OR = 0.21; 95% CI = 0.09, 0.51), and computer use knowledge (OR = 0.20; 95% CI = 0.13, 0.30).

Conclusions: Asthenopia is prevalent across diverse populations, characterised by a wide range of symptoms and influenced by modifiable risk factors. Our findings support a unified definition to improve clinical recognition and offer preliminary evidence to help shape future research on preventive strategies.

Registration: PROSPERO: CRD42024536841.

Background: Astigmatism is a common refractive error in children and adolescents. This study aimed to investigate the prevalence, severity, types, correction status, and associated risk factors of astigmatism among children and adolescents in Shaanxi Province, China.

Methods: A cross-sectional study was conducted involving 236 397 children and adolescents aged 3-20 years from Shaanxi Province, selected through multistage stratified cluster random sampling. Demographic information was gathered via structured questionnaires, and refractive status was assessed using an autorefractor without cycloplegia. Astigmatism was defined as cylindrical refractive error ≥0.50 dioptres.

Results: The overall prevalence of astigmatism was 73.81% among the studied population. Age showed a clear positive association with prevalence, which was significantly higher in adolescents compared to younger children. Similar patterns were observed across advancing educational levels. Males showed slightly higher prevalence than females. Geographic distribution revealed a north-to-south gradient, with northern regions having the highest prevalence. Regarding astigmatism types, with-the-rule astigmatism and compound myopic astigmatism were the predominant forms. Only 30.73% of affected subjects had received refractive correction, with correction rates markedly increasing with age and educational level. Multivariate analyses confirmed that older age, higher educational attainment, male gender, northern residence, and non-Han ethnicity were independent risk factors for astigmatism.

Conclusions: Astigmatism prevalence among children in Shaanxi Province is considerably higher than previously reported in other Chinese regions, with significant variations across demographic factors. The low correction rate, particularly among younger children, highlights the need for enhanced early screening and timely intervention programmes to prevent visual function impairment.

Background: Monitoring children's growth is crucial in paediatric care for early identification of health issues, with the World Health Organization (WHO) advocating for its practice throughout childhood. However, the focus and implementation of growth monitoring vary globally, reflecting different health priorities and practices.

Methods: We conducted a global, cross-sectional, questionnaire-based survey, targeted at representatives of the ministry responsible for growth monitoring and promotion, and at representatives of national paediatric societies.

Results: We obtained responses from 122 countries. Of these, 88% had national growth monitoring guidance, most often issued by the ministry of health. Weight was the most consistently measured early childhood growth monitoring indicator, recorded routinely in 98% of countries during growth monitoring visits for children aged <1 year. The WHO Child Growth Standards were used in 86% of countries. The most common follow-up action for growth faltering was provision of nutritional or health advice, cited by 91% of respondents for children aged <1 year, with advice frequency decreasing as child age increased.

Conclusions: Childhood growth monitoring is widely adopted, but implemented with considerable variation across countries. Strengthening its impact will require standardising indicators, integrating evidence-based guidelines into primary care, and ensuring equitable, actionable use across age groups.

Background: Traditional medicines can contribute to achieving universal health coverage, particularly in low- and middle-income countries where access to conventional treatments is limited. International collaboration is crucial to bridge the lag in modernised research and promote access to traditional medicines. This study focused on China's global collaborative research and development (R&D) efforts on traditional medicine, in the hope of improving global recognition for traditional medicine.

Methods: We conducted a cross-sectional study to analyse collaborative R&D outputs on Chinese patent medicines from 1996 to 2022. The study cohort included the collaborative outputs of scientific research, patent applications, and clinical trials between China and other countries. We analysed the outputs using data from the Web of Science, Worldwide Patent Statistical Database, and the International Clinical Trials Registry Platform. The Zero Inflated Negative Binomial regression model was employed to investigate the association between outputs and the characteristics of participating countries.

Results: The majority of collaborative outputs (n = 964, 92.4%) originated from collaborations with high-income countries, with only 7.6% involving low- and middle- income countries (LMICs). The percentage of R&D collaborations with LMICs showed an increasing trend from 0% in 1996 to 11.7% in 2022. Most collaborations focused on non-communicable diseases (n = 912, 87.4%). Low-income countries accounted for a larger share of collaborative R&D on communicable diseases (14.3%) compared with high-income countries (1.4%). The total number of outputs was positively associated with the degree of cooperative institutionalisation and the collaborator's traditional medicine development score.

Conclusions: Gaps still remain in the involvement of low- and middle-income members compared with high income countries. Findings highlight the importance of encouraging greater engagement of low- and middle- income countries in global R & D collaboration on traditional medicine, particularly through South-South partnerships. Such collaborations should prioritise research agendas that address local health priorities, especially those related to communicable diseases.

Background: Stress-related sleep disturbance have become a serious public health problem among adolescents worldwide. There is a paucity of research employing standardised methodologies to evaluate the association between sedentary behaviour, physical activity, and stress-related sleep disturbance among adolescents. We aimed to examine the association between sedentary behaviour and/or physical activity with stress-related sleep disturbance among adolescents worldwide.

Methods: We used data from the Global School-based Student Health Survey (GSHS) conducted from 2010 to 2019, encompassing 275 483 adolescents aged 12-17 years across 69 countries. Multi-variable logistic regression analysis was performed to assess the independent and joint effect of sedentary behaviour and physical activity on stress-related sleep disturbance.

Results: 30.0% of adolescents spend ≥2 hours in sedentary behaviour daily, only 15.4% engage in physical activity for over one hour each day, and 8.3% of adolescents suffer from stress-related sleep disturbances. Compared with those who engaged sedentary behaviour <2 hours/day, 3-4 hours (odds ratio (OR) = 1.168; 95% CI = 1.027-1.329), 5-6 hours (OR = 1.413; 95% CI = 1.169-1.707), and ≥7 hours (OR = 1.792; 1.548-2.076) of daily sedentary behaviour are positively associated with stress-related sleep disturbances among adolescents. Compared with adolescents with low sedentary behaviour and sufficient physical activity, adolescents with low sedentary behaviour and insufficient physical activity (OR = 1.303; 95% CI = 1.052-1.615), high sedentary behaviour and insufficient physical activity (OR = 1.666; 95% CI = 1.350-2.056), and adolescents with high sedentary behaviour and sufficient physical activity (OR = 1.852; 95% CI = 1.432-2.396) are positively associated with stress-related sleep disturbance.

Conclusions: Sedentary behaviour is associated with a higher risk of stress-related sleep disturbances among adolescents. Reducing sedentary behaviour time may serve as a potential intervention strategy for addressing stress-related sleep disturbances, while the potential benefits of increasing physical activity require further research and validation.

Background: Knowledge gaps persist regarding paediatric COVID-19 clinical presentation, treatment and outcomes in high HIV prevalence settings, with low COVID-19 vaccine coverage.

Methods: An ambi-directional cohort study was conducted in 13 South African public sector hospitals. Hospitalised children with SARS-CoV-2 infection or post-infection syndrome were included. Main outcomes measures included severe disease and primary COVID-19 (hospitalisation for SARS-CoV-2 infection).

Results: There were 2363 SARS-CoV-2 positive children included (March 2020 through May 2023); median age 23.6 months (interquartile range (IQR) = 4.3-98.2 months). Excluding missing values, 1618 (68.9%) children had primary COVID-19; 1121 (69.3%) of these had severe primary COVID-19. In the primary COVID-19 group with data, 318 / 1588 (20.0%) received intensive or high care, 121/1285 (9.4%) received a blood transfusion and 48/1616 (3.0%) died. Multivariable analyses demonstrated that severe primary COVID-19 was 32% higher in children aged 29-365 days (adjusted Risk Ratio (aRR) = 1.32 (95% confidence interval (CI) = 1.13-1.55); reference: 0-28 days), 13% higher with one or more comorbidities (aRR = 1.13; CI = 1.05-1.22)), and 14-22% lower during the Beta, Delta and Omicron periods (reference: ancestral period). Amongst all hospitalised children with a positive SARS-CoV-2 test, severe disease was commoner in underweight children (aRR 1.09; CI = 1.02-1.17, P = 0.013)). Severe signs were commoner in children living with HIV (CLHIV), 88/121 (72.7%), vs. HIV uninfected 1320 / 2104 (62.7%), P = 0.026, and in antiretroviral therapy-naïve CLHIV, (37 / 41 (90.2%), vs. CLHIV on therapy 51 / 80 (63.8%), P = 0.002).

Conclusions: In a high HIV prevalence country, approximately 70% of children with a positive SARS-CoV-2 test were hospitalised for COVID-19 treatment; almost 70% of these children were severely ill. Controlling for other factors, disease severity was highest in the hypothesised pre-immunity Ancestral period. HIV infection and delayed ART initiation were associated with severe signs. In such settings, strengthening general child health programmes to reduce underweight and prevent or treat paediatric HIV may reduce the severity of new diseases of pandemic proportion.

Background: Pancreatic cancer (PC) ranks among the most lethal malignant neoplasms, primarily due to its late-stage diagnosis and lack of available therapeutic modalities. This study aimed to characterise the current PC epidemiological profiles, lifestyle-related contributors, and projections to unveil its global disease burden.

Methods: Using 2022 data from the Global Cancer Observatory (GCO), we estimated PC incidence, mortality, 5-year prevalence, and mortality-incidence-ratio. Modifiable risk factors were extracted from the Global Health Observatory to identify its predictive model. The temporal trends were assessed via estimated annual percentage changes (EAPCs) stratified by age and gender, and the future projection was also collected from GCO, 2022-2050, estimated number of new cases and deaths data.

Results: In 2022, Northern America and Europe had the highest PC burden, with males consistently affected more than females. Alarmingly, a concerning increase in PC mortality was observed among older females. Projections indicate an 85-91% increase in elderly PC cases by 2050, with Asia facing the greatest challenge (487 087 estimated new cases) and Africa being estimated with the fastest mortality growth (159.2%). Strong positive correlations were observed between PC prevalence and human development index (HDI), as well as lifestyle factors e.g. raised total cholesterol (correlation coefficient (r) = 0.695, P < 0.001), cigarette smoking (r = 0.528, P < 0.001), and alcohol drinking (r = 0.505, P < 0.001).

Conclusions: This research underlines the urgent need for region-specific interventions, not only for Northern America and Europe, which currently bear a high PC burden, but also for high-risk populations like Asia and Africa. The projected 85-91% rise in elderly PC cases by 2050, coupled with emerging risks in young females (incidence rose in n/N = 39/52 countries), demands prioritised research on modifiable factors and sex-tailored prevention strategies. These discoveries call for global action to mitigate the escalating PC burden through demographic-targeted public health measures.

Background: Folate is essential for normal growth and in human health throughout the lifecycle. Clinical deficiency of folate impairs DNA synthesis and results in megaloblastic anaemia, while suboptimal folate status before and in early pregnancy results in an elevated risk of neural tube defects (NTD). The evidence on the association of folate status with other health outcomes is largely fragmented and understudied. We conducted a series of umbrella reviews examining the association between folate and multiple health outcomes in various populations and settings.

Methods: We searched MEDLINE, Embase, CINAHL, the Cochrane Library, and DARE from inception to February 2024 for systematic reviews with or without meta-analyses examining an association between folate intake/status and any health outcome. We performed screening and data extraction in duplicate and assessed the risk of bias using the ROBIS tool. Evidence was then characterised into unique associations (unique exposure measure - unique outcome measure - unique setting). For each category of unique associations, we identified the evidence based on the statistical power, recency of publication and the potential risk of bias. All unique associations were evaluated for credibility using predefined criteria.

Results: We retrieved 3565 records and included 283 in the final synthesis. The evidence on anaemia consisted of four intervention trials demonstrating effectiveness of folic acid supplementation during pregnancy in reducing the risk of megaloblastic anaemia (relative risk (RR) = 0.21; 95% CI = 0.11, 0.38; I² = 15%). Maternal folic acid use was also significantly inversely related to the prevention of NTD at birth (RR = 0.31; 95% CI = 0.16, 0.60; I² = 0%) and NTD recurrence (RR = 0.30; 95% CI = 0.14, 0.65; I² = 0%). This relationship was supported by the inverse association reported between low maternal blood folate concentrations and the increased risk of NTD. Further evidence showed that fortification of food with folic acid was associated with the lower prevalence of NTD on a population-level.

Conclusion: In NTDs and anaemia, we identified strong evidence supporting the protective role of folate status based on intervention trials and observational studies. More recent reviews examining the role of folate in other less well understood health conditions will be presented in the subsequent reports.

Registration: PROSPERO: CRD42021265041.

Background: High altitude polycythaemia (HAPC) has posed a major burden due to its high prevalence and multisystem involvement among highlanders, but clinical data on HAPC is scarce. We aimed to describe the clinical characteristics of patients with HAPC in China.

Methods: Adult patients diagnosed with HAPC in five hospitals of China between August 2012 to May 2024 were retrospectively enrolled. We analysed information including demographics, living altitude, haemoglobin concentration (Hb) and comorbidities, and fitted restricted cubic splines models with multivariable adjustments to investigate the relationship between age, altitude and Hb.

Results: A total of 1098 HAPC patients were included and 97 individuals of them did not provide information on ethnicity. Of the remaining 1001 participants, 93% were native Tibetans. The median Hb showed a significant difference (P < 0.0001) between male (21.9 g/dL, interquartile range (IQR) = 21.4-22.9 g/dL) and female patients (19.6 g/dL, IQR = 19.2-20.8 g/dL), and was slightly higher in Tibetans than Han migrants, especially in females (19.6 g/dL, IQR = 19.2-20.7 g/dL vs. 19.3 g/dL, IQR = 19.2-19.5 g/dL) (P = 0.198). Restricted cubic splines models revealed Hb exhibited a positive linear correlation with altitude (P-overall = 0.027, P-nonlinear = 0.291), with a rate of 0.3g/dL/1000 m of elevation, whereas no significant relationship with age (P-overall = 0.974, P-nonlinear = 0.860). The commonest comorbidities were hypertension (18.5%) and pneumonia (17.6%). Besides, heart failure (P < 0.001), chronic airway disease (P = 0.018) and pulmonary heart disease (P < 0.001) were more prominent in females while liver disease (P = 0.079) was more frequent in males.

Conclusions: This study suggests a much higher proportion of HAPC in native Tibetans, and the Hb in HAPC patients remains significant gender-specific and altitude-dependent variations. Moreover, in addition to hypertension and pneumonia, gender-specific comorbidity surveillance should pay attention to digestive system disease in male HAPC patients and cardiopulmonary system disease in female HAPC patients.