Journal of Global Health最新文献

Background: Constipation significantly impacts quality of life and is a common public health issue. For affected individuals, especially those who are inactive and experience constipation symptoms, it is recommended to engage in physical activity (PA) to improve their condition. However, the relationship between PA and improvement in constipation remains unclear. We performed this systematic review of cohort studies to evaluate this potential association.

Methods: We systematically searched the Embase, Cochrane Library, PubMed, and CINAHL databases for all cohort studies examining the relationship between PA and constipation from the inception of the databases up to 5 November 2023. We calculated the reported risk ratios (RRs) and 95% confidence intervals (CIs), conducted a random effects model, and performed a subgroup analysis based on factors such as gender, geographic region, and PA intensity to comprehensively explore the link between PA and constipation. Furthermore, we used the Newcastle-Ottawa Scale to evaluate the quality of the studies included in our analysis.

Results: The analysis included 13 studies with 119 426 participants and 63 713 cases. The results indicated that higher levels of PA were associated with a decreased risk of constipation compared with lower levels of PA (RR = 0.69; 95% CI = 0.88-0.83) and moderate levels of PA (RR = 0.87; 95% CI = 0.79-0.95). Furthermore, adherence to international PA guidelines was correlated with a significantly reduced risk of constipation (RR = 0.87; 95% CI = 0.81-0.93). Notably, the risk of constipation was lowered among Asian populations (RR = 0.67; 95% CI = 0.56-0.79) and Oceanian populations (RR = 0.72; 95% CI = 0.63-0.83) who engaged in regular PA. Moreover, when comparing the risk of constipation between men and women collectively, PA was associated with a 34% lower risk (RR = 0.66; 95% CI = 0.55-0.80).

Conclusions: The study findings indicated that moderate to high levels of PA significantly reduced the risk of constipation, showing a negative correlation between PA and constipation.

Registration: PROSPERO: CRD42023479653.

Background: Active case finding could effectively detect tuberculosis (TB) patients, but it can be costly. Therefore, a feasible, cost-saving, and efficient algorithm for community-based TB screening is needed.

Methods: The study population was based on a previous TB prevalence survey conducted in the Zambia/South Africa Tuberculosis and HIV/AIDS Reduction trial. We developed predictive scoring models for HIV-positive and HIV-negative/unknown populations for practical purposes. We compared the cost-effectiveness of our models with that of WHO tools through average cost-effectiveness ratio (ACER) and incremental cost-effectiveness ratio.

Results: The prediction model for HIV-positive population presented higher area under the curve (AUC) = 0.652, 95% confidence interval (CI) = 0.602-0.701) than WHO-recommended four-symptom screen (AUC = 0.568, 95% CI = 0.524-0.612) among South African participants. The AUC of the model for HIV-negative/unknown population was 0.673 (95% CI = 0.648-0.697), which was higher than that of the WHO tools as well. The ACER of our model can range from 246 to 1670 USD per TB case detected in the South African communities.

Conclusions: The scoring system for active TB case finding presented a better performance and showed cost-effectiveness, which can provide new strategies for active TB case finding with multiple options under budget considerations.

Background: There is mixed evidence on the cost-effectiveness of cash transfers, along with food supplements and behaviour change communication interventions in improving child nutrition outcomes. To add to existing literature, we examined the cost-effectiveness of medium-quantity lipid-based nutrient supplement (LNS) and social and behaviour change communication (SBCC) messaging, separately and combined, compared to an existing unconditional cash transfers (UCT) programme in children 6-23 months of age in the district Rahim Yar Khan, Pakistan.

Methods: This was a four-arm, community-based cluster randomised controlled trial. The UCT provided a quarterly sum of USD 32, the medium-quantity LNS contained a daily ration of 50 g of LNS, and the SBCC included monthly and quarterly messaging on nutrition, health, and hygiene to eligible households. Cost data were collected from a provider perspective through the review of procurement invoices and budgets, as well as interviews with stakeholders. We examined cost-effectiveness via statistically significant differences between the intervention and control arms, and estimated as cost per case of stunting, and disability-adjusted life years (DALYs) averted at six and 18 months of intervention.

Results: Costs were higher for SBCC intervention combinations (UCT + SBCC and UCT + LNS + SBCC) due to high training costs for lady health workers. UCT + LNS achieved a reduction in stunting at a per-case cost of USDS 278.74 at six months and USD 897.15 at 18 months. UCT + LNS + SBCC achieved a reduction in stunting at per case cost of USD 846.48 at six months and USD 2324.58 at 18 months. The cost per DALYs averted for preventing stunting was USD 234 to USD 557.42 at six months, and USD 787.73 to USD 1537 at 18 months without discounting and age-weights.

Conclusions: Although the affordability of such interventions is arguable, combining UCTs with LNS appears to be very cost-effective for reducing undernutrition and averting DALYs, while combining cash transfers with LNS and SBCC showed limited cost-effectiveness when targeting stunting.

Registration: Clinicaltrials.gov: NCT03299218.

Background: Prioritising actions is urgently needed to address the stagnation of the global maternal mortality ratio (MMR). As most maternal deaths occur in low- and middle-income countries (LMICs), we aimed to assess the impact of scaling up health intervention coverage on reducing MMR under four scenarios for 26 LMICs.

Methods: We conducted a modelling study to estimate the MMR and additional maternal lives saved by intervention by 2030 for 26 LMICs using the Lives Saved Tool (LiST). We used four scenarios to assess the impact of scaling up health intervention coverage by no scale-up (no change), modest scale-up (increased by 2% per year), substantial scale-up (increased by 5% per year), and universal coverage (coverage reached 95% by 2030). We divided the selected 26 countries into three groups according to their MMR levels in 2020.

Results: Among 26 LMICs, six (23.1%) countries showed an increase in MMRs and 13 (50.0%) stalled on the reduction of MMR from 2015 to 2020. Under a substantial scale-up of coverage or scaling up to universal coverage, the average MMR in 2030 of 26 LMICs would be 62.8 or 52.8, reaching the Sustainable Development Goal (SDG) 3.1. Caesarean delivery, uterotonics for postpartum haemorrhage, and assisted vaginal delivery had a more important role in this reduction compared to other interventions.

Conclusions: Scaling up the coverage of health interventions is critical for reducing MMRs. If a substantial scale-up or scaling up to universal coverage of continuous maternity interventions from preconception to postpartum period can be achieved, LMICs in Southeast Asia and Western Pacific regions could reach the SDG 3.1 on time.

Background: Considering the well-established link between experiencing violence in childhood and poor mental health, it is important to understand the role of contextual factors in which young people live, learn, work, and play. Evidence has highlighted the importance of work as a contextual factor in the lives of young people, but it is unclear whether being in work mitigates, entrenches, or exacerbates the association between violence against children and poor mental health.

Methods: This study is based on nationally representative data of males and females aged 13-24 years who completed the Violence Against Children Surveys in Nigeria, Uganda, and Colombia. We used multivariable logistic regression models to explore the association between lifetime violence and past 30-day mental distress, and explored whether working in the past year modified this association. All analyses were age- and sex-stratified and conducted separately in each country.

Results: We found a high prevalence of lifetime violence among young people in all three countries and strong associations between violence and mental distress. In Colombia, there was strong evidence (P-value for interaction = 0.014) that work in the past year (adjusted odds ratio (aOR) = 0.42; 95% confidence interval (CI) = 0.07-2.57) reduced the risk of mental distress among girls who had experienced violence compared to not working in the past year (aOR = 6.12; 95% CI = 2.60-14.41). There was also evidence among boys in Nigeria (P-value for interaction = 0.045), where there was a reduction in risk of mental distress among those not in work in the past year (aOR = 0.99; 95% CI = 0.46-2.13) compared to those in work in the past year (aOR = 2.10; 95% CI = 1.32-3.33). There was also a pattern of effect modification by work in the association between childhood violence and mental health in other population groups, with variation by country, sex, and age groups.

Conclusions: Our findings suggest that work can mitigate, entrench, or exacerbate risk of mental distress among young people who have experienced violence, depending on their age, sex, and country of residence. While additional research is needed to explore these mechanisms, this highlights the importance of work as a contextual factor in the lives of young people and points to the need for safe and secure workplaces and the integration of context-specific interventions into workplaces for young people.

Background: Clinical research is marked by its multifaceted nature, presenting a multitude of different approaches, designs, and objectives that can complicate the planning, initiation, and conduct of clinical trials. The role and organisation of the sponsor institution are pivotal in this context. We aimed to investigate possible challenges and needs, including their underlying factors, for academia and industry during the set-up and conduct of clinical trials.

Methods: We conducted a cross-sectional survey-based study within an international network of highly qualified academic research institutions (ARIs). The main outcome measures were the regulatory framework for clinical trials, scope and organisation of academic and industry-sponsored trials, funding sources of academic clinical trials, submission and approval process, as well as study conduct of academic vs. industry-sponsored trials.

Results: We surveyed employees of ARIs with extensive experience in phase I-IV clinical trials. All ARIs participated in academic clinical trials and 90% were involved in industry-sponsored trials. Respondents reported that academic trials faced greater challenges in communication with relevant institutional review boards/ethics committees and competent authorities compared to industry-sponsored trials. Additionally, academic trials were found to have significantly less financial support during their conduct. Specific challenges for academia vs. industry included 'insufficient personnel resources' (60% vs. 50%), 'recruitment problems' (60% vs. 78%) and 'lack of knowledge/experience' (35% vs. 11%).

Conclusions: Our findings indicate that industry-sponsored trials encounter fewer issues in set-up, funding, and trial conduct compared to academic trials. Improving collaboration between academic sponsors and ARIs is essential to address these challenges. ARIs provide critical support and guidance for academic researchers, not only in planning and implementing projects, but also in assessing feasibility and securing funding.

Background: The coronavirus disease 2019 (COVID-19) pandemic had substantially disrupted maternal health care provision and utilisation in Bangladesh. However, the extent of geographical disparities in service utilisation and how the health system withstood these challenges have not been studied. This study explores the divisional disparities in trends and disruptions in maternal health service utilisation caused by the COVID-19 pandemic.

Methods: Data was extracted from the District Health Information Software of Bangladesh from January 2017 to December 2021. We assessed the trend of first antenatal care visit, institutional delivery and number of caesarean sections over these years. We explored both the yearly and monthly trends to see the variations in the number of utilisations. Segmented regression with Poisson distribution was used to assess changes in service utilisation during the COVID-19 period. We reported incidence rate ratio (IRR) of service utilisation with a 95% confidence interval (CI) in different divisions during COVID-19 (2020-2021) compared to the reference period (2017-2019).

Results: Initially, a notable decline in maternal health care utilisation was observed in 2020 compared to the pre-pandemic period of 2017-2019. Divisional disparities were observed in this trend. Overall, compared to the pre-pandemic period, we observed around 30% decline in all three selected indicators of maternal health care. The lowest value was observed in Chattogram in 2020 (IRR = 0.66; 95% CI = 0.55-0.79) and Rajshahi in 2021 (IRR = 0.71; 95% CI = 0.60-0.82). For institutional delivery, Barishal division had the lowest IRR (0.64; 95% CI = 0.60-0.68) in 2020 and, in 2021 Rajshahi had the lowest IRR (0.71; 95% CI = 0.60-0.82). For caesarean section, the lowest value was observed in Barishal division (IRR = 0.48; 95% CI = 0.44-0.53) in 2020 and in Mymensingh (IRR = 0.37; 95% CI = 0.32-0.43) in 2021. By 2021, the three maternal health care utilisation indicators demonstrated recovery.

Conclusions: The effect of the pandemic, including lockdown, on the selected maternal service utilisation was observed in Bangladesh though there were substantial geographic disparities. These disruptions slightly recovered after the initial shock. These results will support the government in preparing the national and regional health systems for future epidemics in Bangladesh.

Background: We aimed to evaluate the trend of post-term births over time and their association with perinatal mortality based on prospective pregnancy cohorts in a rural area in Bangladesh.

Methods: This cohort study included 72 373 singleton births with gestational ages ≥28 weeks recorded by a health and demographic surveillance system from 1990 to 2019 in Matlab, Bangladesh. We expressed the gestational age as X (weeks) + Y (days)/7 weeks, where X indicated complete weeks, and Y presented the number of completed days out of seven days or a week. Using Poisson regression with robust variances, we estimated the population-based proportion of post-term births and assessed the association between gestational age categories and perinatal mortality. We presented results by adjusted relative risk (aRR) with 95% confidence intervals (CIs).

Results: Post-term births declined from 5.8% in 1990 to 2.8% in 2019. Perinatal mortality declined from 58 to 27 per 1000 births from 1990 to 2019. Compared to full-term births (39 + 0/7 to 40 + 6/7 weeks), the aRRs of perinatal mortality were 1.39 for late-term (41 + 0/7 to 41 + 6/7 weeks) and 1.93 for post-term (≥42 + 0/7 weeks) births. The population-attributable fraction of perinatal mortality was 15% for births at ≥41 + 0/7 weeks out of the total perinatal deaths occurring at ≥39 gestation weeks.

Conclusions: In this rural setting in Bangladesh, we observed a decline in post-term birth proportions from 1990 to 2019. We found increased perinatal mortality when pregnancy continued beyond 40 + 6/7 weeks of gestation. This implies that planning the management of pregnant women approaching the post-term period may be needed to further improve perinatal health outcomes.

Background: Olfactory dysfunction has been suggested to be associated with all-cause mortality. Yet, there is a lack of large-scale cohorts to study this relationship.

Methods: Using data from the Kailuan cohort, we assessed 97 327 Chinese adults for perceived olfactory dysfunction at baseline and gathered mortality data from government records. We used Cox proportional hazards regression models to analyse the risk of all-cause mortality associated with perceived olfactory dysfunction, yielding hazard ratios (HRs) and 95% confidence intervals (CIs) with adjustment for multiple potential confounders.

Results: Over a median follow-up of 6.4-year, we recorded a total of 3903 deaths. Individuals reporting perceived olfactory dysfunction had a higher risk of mortality (adjusted HR = 1.42; 95% CI = 1.02-2.00) compared to those without the dysfunction. In sensitivity analyses, we found similar results after excluding participants with pre-existing obesity, cardiovascular diseases, those younger than 50 years old, individuals diagnosed with cancer or stroke during follow-up, and those who died within two years of follow-up.

Conclusions: Perceived olfactory dysfunction was associated with a high risk of all-cause mortality among Chinese adults. Our study is limited by failure to include a national-representative sample and misclassification of exposure assessment due to use of a subjective question to assess olfactory dysfunction. Further studies with objective are warranted to replicate our findings and understand the underlying mechanisms.

Background: The global obesity epidemic of all ages has increased the demand for accurate management of body fat in each stage of life. The primary aim of this study was to provide reference centiles of body fat indices for Chinese children and adults and compare those with ethnicities from USA using dual-energy x-ray absorptiometry (DXA).

Methods: The samples were drawn from two nationwide cross-sectional surveys of China Body Composition Life-course Study (2013-2023) and the US National Health and Nutrition Examination Survey (2011-2018). Age- and sex-specific centile curves were generated for a set of fat measurements, including total fat mass (FM), fat mass index (FMI), body fat percentage (BF%), trunk-to-leg fat ratio (TLR), android-to-gynoid fat ratio (AGR) and visceral-to-subcutaneous fat ratio (VSR), using the general additive model for location scale and shape method.

Results: The age-related variations from childhood to adulthood were generally similar among Chinese, Non-Hispanic Whites, Non-Hispanic Blacks and Mexican American population, with distinct levels across races and ethnicities. For whole-body fat (FM, FMI, and BF%), Mexican American population consistently presented the highest levels before 40 years old, followed by Non-Hispanic White, Non-Hispanic Black and Chinese individuals. For central fats indices, although the TLR and AGR levels in Chinese males were second to Mexican American counterparts in most stages of life, the VSR was much higher in Chinese than other races and ethnicities from eight years old.

Conclusions: DXA-based centiles for body fat quantity and distribution in Chinese population aged 3-60 years old were presented, and their differences with other race and ethnicity were noted across periods from early childhood to middle adulthood. Our findings will promote age-, sex- and ethnic-specific assessment of life-course body fat and obesity-related risks in clinical practice.