Journal of Global Health最新文献

Background: The Kyrgyz Republic has recently implemented health programmes to improve the quality of care for mothers, newborns and children. To support these efforts, a three-year World Health Organization (WHO) quality improvement (QI) project aimed to strengthen clinical practices and service delivery. This study was conducted to independently assess the project's effectiveness and inform policy and programming.

Methods: Data were collected retrospectively from 18 hospitals: nine that implemented the intervention (IH) and nine control hospitals (CH). Medical records were randomly selected for women in labour, newborns and children hospitalised in 2019, 2021 (pre-QI project), and 2023 (post-QI project).

Results: We reviewed 1707 women's, 1736 newborns', and 1593 children's records. The proportion of women with a planned caesarean section before 39 + 0 weeks of gestation was 44.8% (2021) and 28.3% (2023) in IH, and 53.3% and 50.0%, respectively, in CH. Antibiotic prophylaxis use for caesarean sections was high in both IH and CH. The proportion of newborns breastfed within the first 30 minutes of life in IH was 58.3% (2021), and 50.6% (2023), and in CH 56.6% and 64.1%, respectively. Newborns were unnecessarily prescribed antibiotics in IH (13.7% in 2021, 16.2% in 2023), and in CH (24.2% and 6.1%, respectively). Children were frequently prescribed unnecessary antibiotics both in IH and CH. Children with pneumonia were unnecessarily prescribed corticosteroids both in IH (35.5% in 2019, 54.7% in 2023) and in CH (28.3% in 2019, 50.9% in 2023). The proportion of children with diarrhoea receiving oral rehydration salts (ORS) and zinc increased between the start and the end of the QI project in IH while this was not the case for zinc prescription in CH.

Conclusions: These results highlight the importance of continuous monitoring and targeted interventions to enhance quality care. Routine clinical audits based on medical record reviews should be institutionalised to support hospital managers in enhancing clinical practices.

Background: Although the link between smoking and various sleep disorders has been well-established, it is still unknown whether smoking increases the risk of restless legs syndrome (RLS). We investigated this association using a meta-analysis and explored the causality through Mendelian randomisation (MR).

Methods: We searched six databases for studies reporting associations between smoking and RLS in overall adults, and the results were presented as odds ratios (ORs) with 95% confidence intervals (CIs). We performed sensitivity, subgroup and meta-regression analyses to identify potential sources of heterogeneity. We obtained data used in MR analyses from the UK Biobank and the Genome-wide Association Studies Catalogue. We applied the inverse-variance weighted method, MR Egger, weighted median, simple mode and weighted mode for data analyses, and further conducted pleiotropy and heterogeneity tests, as well as leave-one-out analyses.

Results: Based on 30 studies, we found that smoking was associated with increased risk of RLS (OR = 1.40; 95% CI = 1.17, 1.67, P < 0.001), with the risk significantly increased (P = 0.04) in pregnant women (OR = 2.41; 95% CI = 1.39, 4.16, P = 0.002) than in the non-pregnant adults (OR = 1.30, 95% CI = 1.09, 1.55, P = 0.004), and in current smokers compared with former smokers (OR = 1.09; 95% CI = 1.02, 1.16, P = 0.01). We identified multi-centre studies, diagnostic criteria for RLS and participants' age as potential sources of heterogeneity; however, MR results did not show any causal association between smoking and RLS (OR = 0.50; 95% CI = 0.16, 1.56, P = 0.23).

Conclusions: Although the meta-analysis suggested that smoking increases the risk of RLS, MR analyses did not provide evidence for a causal relationship. Future studies are needed to elucidate the biological mechanisms underlying this association.

Registration: PROSPERO: CRD420251048406.

Background: To meet the 2030 aims of the Global Strategy for Women's, Children's and Adolescents' Health and Sustainable Development Goals, annual rates of maternal and newborn mortality and stillbirth must decrease. The organisation of maternal and newborn health (MNH) services influences access to and quality of care. We designed this scoping review to understand how levels of MNH care are organised in different country contexts.

Methods: We conducted a scoping review of peer-reviewed literature published after 2009. Based on the World Health Organization (WHO) quality-of-care framework, we conducted descriptive and deductive textual narrative analysis to identify the reported number of levels of MNH care stratified by country and mortality rates; describe how levels are conceptualised; and explore alignment of levels for the maternal-newborn dyad.

Results: We included 162 of 3591 reports. The number of MNH facility levels of care across 56 countries ranged from two to seven. Types of identified MNH care facilities were described at varying levels. Two levels of care were reported in 5% of cases, three levels in 55%, four levels in 30%, five levels in 8%, and six and seven levels in <1% of cases. Home and community-based MNH care (non-facility) was reported in 8% of country descriptions. Countries with the lowest stillbirth, maternal, and newborn mortality rates mostly reported three or four facility levels. The criteria used to distinguish MNH levels of care as low, intermediate, and high were aligned with domains of the WHO quality-of-care framework, mostly human and physical resources.

Conclusions: Levels of MNH care described in the literature were distinguished by characteristics, including provision and experience of routine and emergency care. Three or four levels of MNH facility care were most commonly reported. Linking maternal and newborn facility care to community connections is an important consideration to ensure equitable access to routine and emergency care.

Background: Although obesity is a well-established risk factor for metabolic dysfunction-associated steatotic liver disease (MASLD), the impact of long-term weight trajectories on MASLD risk remains unclear. We aimed to examine the association between weight change trajectories across adulthood and the risk of ultrasound-defined MASLD.

Methods: We analysed data from 4999 participants from the Healthy Happy Aging Community Cohort. Weight trajectories were assessed using body mass index (BMI) at age 25 years, ten years before baseline, one year before baseline, and at baseline. MASLD was defined as a median (MD) controlled attenuation parameter (CAP) of ≥274 dB/m and severe steatosis as a MD CAP of ≥302 dB/m via vibration-controlled transient elastography.

Results: There were 2247 (44.9%) patients with MASLD, of whom 1468 (29.4%) had severe steatosis. Compared with stable normal weight, sustained obesity (BMI ≥ 30 kg/m² at all time points) demonstrated a strong association with MASLD risk (adjusted odds ratio (aOR) = 2.17; 95% confidence interval (CI) = 1.64-2.86), particularly for severe steatosis (aOR = 2.52; 95% CI = 1.74-3.66). The transition from non-obese to obese status was associated with a 2.5-fold increase in risk (aOR = 2.51; 95% CI = 1.81-3.48), with a more pronounced effect observed in men (P-interaction <0.05). Weight gain of ≥5 kg between ages 25-40 years showed particularly strong associations (aOR = 2.20; 95% CI = 1.70-2.86), while baseline severe obesity (BMI ≥ 35 kg/m²) remained the strongest independent predictor (aOR = 4.12; 95% CI = 2.70-6.29).

Conclusions: Long-term obesity and weight gain, especially in early adulthood, significantly increase MASLD risk. Sustained obesity and progression to obesity were key risk factors, with severe obesity showing the strongest association. Early weight management is crucial for MASLD prevention.

Background: Antenatal magnesium sulphate reduces the risk of cerebral palsy (CP) for infants born very preterm. While endorsed by the World Health Organization for global implementation in 2015, studies underpinning this recommendation were conducted in high-income countries. Our objective was to systematically gather, organise, and map published research studies on the use of antenatal magnesium sulphate for preterm foetal neuroprotection in low- and middle-income countries (LMICs), and to obtain existing relevant national and international clinical practice guidelines from (or for) LMICs.

Methods: Following scoping review methods, we searched nine databases and the websites of societies/ministries of health for relevant qualitative or quantitative studies and national or international guidelines, published from 2015, from any LMIC. We screened each publication for inclusion, and two reviewers independently extracted information. Content analysis included narrative summaries and descriptive statistics.

Results: In total, 57 research studies (12 randomised controlled trials) and 25 clinical guidelines were included in the analysis. Most (n = 75) were in English, from lower-middle (n = 45) and upper-middle (n = 31) countries, and published between 2020 and 2025 (n = 60). The most common research scope was effects and/or safety (n = 38). The remaining studies focused on intervention uptake or quality improvement programmes (n = 10), mechanisms of action (n = 5), or regimen comparisons (n = 4). Short-term outcomes were common, and CP was described in only four studies. Regarding clinical guidelines, magnesium sulphate was usually included in general guidelines (n = 24), those published by professional associations (n = 18), or those published by government bodies (n = 6). After categorisation, an upper gestational limit of 32 weeks was most common (n = 18). Treatment regimens varied, commonly including a 4 g intravenous loading dose (n = 12) and a 1 g/h intravenous maintenance dose (n = 11). One in three recommended no specific regimen.

Conclusions: A sizeable number of heterogeneous studies and clinical guidelines exist, primarily from middle-income countries, regarding magnesium sulphate for neuroprotection. Further context-specific research may include regimen comparisons, impact, and implementation studies, informing future updates to clinical guidelines globally.

Registration: OSF 10.17605/OSF.IO/ASN67.

Background: Neonatal herpes simplex virus (nHSV) infection, caused by HSV-1 or HSV-2, is a global health concern due to its high mortality and long-term morbidity. In this study, we assessed nHSV global epidemiology, regional variations, and temporal trends.

Methods: We conducted a systematic review of PubMed, Embase, and national surveillance reports through 12 December 2024, and reported findings in accordance with PRISMA guidelines. We used random-effects meta-analysis to estimate pooled mean outcomes and meta-regression analyses to assess associations, temporal trends, and potential sources of heterogeneity.

Results: We identified 143 relevant publications from three of the six World Health Organization regions, providing 140 nHSV incidence rate measures and 103 proportions of incident nHSV-1 vs. nHSV-2 cases. The global pooled and regional population-weighted mean incidence rate was 8.2 (95% confidence interval (CI) = 5.9-10.7) per 100 000 live births. Incidence rate was highest in the Americas (13.3 cases per 100 000 live births; 95% CI = 9.9-17.2), followed by the European Region (5.2 cases per 100 000 live births; 95% CI = 3.4-7.3) and the Western Pacific Region (2.9 cases per 100 000 live births; 95% CI = 2.2-3.6). Globally, nHSV-1 and nHSV-2 accounted for pooled and weighted means of 47.3% (95% CI = 39.5-55.0) and 52.8% (95% CI = 45.2-60.5) of cases, respectively. The highest nHSV-1 proportion was in the Western Pacific Region (57.7%; 95% CI = 49.2-66.1), while the highest nHSV-2 proportion was in the Region of the Americas (60.5%; 95% CI = 55.8-65.1). Meta-regression analyses showed an annual increase of 3.5% (95% CI = 1.5-5.6) in nHSV incidence rate, alongside a yearly 1.4% (95% CI = 0.9-1.9) increase in the proportion of nHSV-1 cases and a 1.1% (95% CI = 0.6-1.6) decrease in the proportion of nHSV-2 cases.

Conclusions: nHSV affects approximately one in 10 000 newborns, with regional variations and a rising incidence rate. The increasing dominance of nHSV-1 over nHSV-2 reflects shifting HSV epidemiology.

Background: Evidence suggests that environmental exposures induce epigenetic modifications that can have long-lasting effects on multiple health outcomes, and an in-depth review of the epidemiological evidence is urgent. We aimed to comprehensively assess the associations between long-term exposure to air pollution and epigenetic changes in adults.

Methods: We systematically searched EMBASE, MEDLINE, and Web of Science databases for relevant articles published in English from inception through 17 November 2023. We assessed and narratively synthesised eligible studies on ambient (i.e. non-occupational) and epigenetic alterations in adults. We separately documented relevant occupational studies identified by the search.

Results: We analysed 52 eligible articles, including 30 ambient air pollution and 22 occupational air pollution exposure studies. Long-term exposure to ambient particulate matter (PM) with aerodynamic diameters of ≤2.5 μm (PM_2.5) and ≤10 μm, (PM₁₀), and nitrogen oxides (NOx) showed no consistent association with global DNA methylation across different studies in adults. Two candidate-gene studies indicated that sex-determining region Y-box 2 (SOX2) hypermethylation was associated with ambient PM_2.5 exposure. Results from epigenome-wide association studies suggest that long-term exposure to specific ambient air pollutants can alter blood methylation at up to 189 loci. In addition, decreased methylation of cg00475490 by polychlorinated biphenyls, increased methylation in cg08500171 associated with nitrogen dioxide (NO₂) exposure, and decreased methylation in cg17629796 associated with PM_2.5 exposure were successfully replicated in external validation cohorts. Epigenetic alterations in specific genes were associated with multiple occupational exposures.

Conclusions: We demonstrated that long-term exposure to air pollution is associated with locus-specific methylation changes and histone modification in adults. Further elucidation of these epigenetic changes through epidemiological and laboratory work could provide new avenues to identify potential biomarkers linked to air pollutant exposure and to clarify their impacts on health outcomes.

Registration: PROSPERO: CRD42023480771.

Shortages of health care providers necessitate task shifting and sharing (TS/S), yet few implementation frameworks guiding these strategies exist. In 2023, we developed the first iteration of the Strategic Healthcare Implementation Framework for Task Shifting, Sharing, and Resource Enhancement (SHIFT-SHARE), a six-stage cyclical framework drawing on change management theories and implementation science. Here we present SHIFT-SHARE 2.0, updated to incorporate stakeholder consultations in India, where we ran eight focus group discussions with 35 stakeholders (November 2023 to September 2024), including health care staff, organisational leaders, academics, and students. Participants reviewed SHIFT-SHARE materials beforehand and gave feedback on its accessibility, terminology, structure, and utility, after which we mapped the framework's strengths, weaknesses, and required modifications through thematic analysis. Stakeholders valued SHIFT-SHARE's visual clarity and comprehensiveness, while identifying changes to make its language more accessible, restructuring risk assessment as a continuous process, adding workforce incentivisation as a core consideration, and reconceptualising the framework's logic model to represent continuous cycles, terminating loops, and contingency exits. We also propose implementation support tools, including a term of reference document and a workbook of question-based prompts. The SHIFT-SHARE 2.0 addresses stakeholder-identified barriers to TS/S and may help make implementation planning more systematic, responding to the World Health Organization's calls for TS/S-specific frameworks. Further validation across diverse contexts will be needed to assess its broader utility.

Background: There is currently a lack of nationally representative assessments of myopia based on gold-standard cycloplegic refraction among Chinese children and adolescents. Therefore, we aimed to systematically review and meta-analyse the prevalence of myopia, diagnosed by cycloplegic refraction (spherical equivalent ≤-0.50 D), among Chinese children and adolescents, and examine its distribution across sexes, age groups, time periods, and geographic regions.

Methods: We searched PubMed, Web of Science, Science Direct, CNKI, and Wanfang for population- or school-based studies published between January 2020 and March 2025 that used cycloplegic refraction. We calculated the pooled prevalence and 95% confidence intervals using a meta-analysis, with subgroup analyses by sex, educational stage, time periods, and regions. We assessed publication bias using Egger's and Begg's tests.

Results: The overall myopia prevalence among 34 studies with 139 765 participants was 30.1%. Prevalence was higher in females (28.6%) than males (26.0%) and increased markedly with education stage from 4.2% in kindergarten, 28.4% in primary school, 64.1% in junior high, and 81.0% in high school. Temporally, prevalence peaked in 2016 (57.5%). Geographically, the highest provincial prevalence was observed in Taiwan (66.5%), while the lowest was identified in Henan (6.6%). At the regional level, Eastern China had the highest prevalence (40.3%), close to the national average in Northwestern China (31.2%), and the lowest in Central China (6.6%).

Conclusions: The pooled prevalence of myopia among Chinese children and adolescents was 30.1%, with a pronounced increase by educational stage. A slightly higher prevalence was observed in females. Geographically, Eastern China had the highest burden, while Central China had the lowest. These findings highlight marked age, sex, and regional disparities, providing evidence for targeted public health interventions.

Registration: PROSPERO: CRD420251236626.

Background: Childhood tuberculosis (TB) remains difficult to diagnose, even among exposed household contacts. We assessed age- and sex-specific gaps in TB screening, evaluation, diagnosis, and treatment among child contacts in a high-burden setting.

Methods: As part of a large active screening program in Kotri, Pakistan, from 2014-2016, children aged 0-14 years with household TB exposure were screened for TB disease. We analysed their progression through the TB care cascade and identified factors associated with drop-off at each stage.

Results: Of 3014 child contacts screened, 56.3% were males. Despite clear exposure risk, only 1608 (53.4%) were completely evaluated. Evaluated children were more likely to have lower weight percentiles and report cough, fever, and weight loss (P < 0.001). Among those evaluated, 390 (24.3%) were diagnosed with TB (25.8% males vs. 22.2% females; P = 0.103). Nearly all initiated treatment (98.7%) and completed it successfully (98.2.%) with no significant differences by sex. As age increased, symptom reporting declined into adolescence, and the percentage being evaluated and diagnosed decreased. However, males in certain age groups were significantly more likely to be diagnosed (at age six) or evaluated (at ages seven and 14) than females of the same ages.

Conclusions: The largest gap occurred at the evaluation stage, despite symptoms and known exposure. While treatment initiation and completion were high, observed differences in evaluation completion across age and sex represent a critical barrier to TB elimination in children. Interventions addressing this drop-off - especially among young females - are urgently needed.