Journal of Global Health最新文献

Background: Globally, 10% of children and adolescents live with mental health problems and often lack high-quality care. Over 80% of people facing mental health issues reside in low- and middle-income countries (LMICs). Failing to address children's mental health may prolong these challenges into adulthood, impeding their chances for a healthy life. This scoping review aims to describe the types, implementation strategies, effectiveness, and gaps of existing interventions for preventing and treating mental health problems in early childhood (<10 years) in LMICs.

Methods: The study employed a scoping review of experimental studies published 2007-2023. Major databases including PubMed, Embase, Web of Science, and PsycINFO were searched using key terms related to the population (children), intervention (mental and/or behavioural health programmes), and outcome (mental health problems). Three authors independently conducted search strategy, article screening, data extraction, and quality assessment. The findings were presented using descriptive analysis and narrative synthesis.

Results: Of 39 499 identified articles, 33 were included in the study, covering 7629 children and published between 2009-2022. Seventeen studies (51.5%) were from upper-middle-income countries, 13 (39.4%) were from lower-middle-income, and three (9.1%) were from low-income countries. Enrolment was community-based in 23 studies and health-facility based in 10 studies; the majority (79%) focused on children aged 3-8 years old. Almost two-third (63.6%) of studies were conducted in urban settings. Programmes encompassed various interventions such as parenting programmes (33.3%). A majority of studies (57.5%) employed group therapy for delivering the programme, with mental health professionals (21.2%) acting as the primary intervention providers. Interventions were primarily received by children (39.4%), followed by mothers/caregivers (33.3%). Most studies explored disruptive disorders (20 studies), social and behavioural problems (16 studies), and anxiety disorders (12 studies). Statistically significant intervention effects on child mental health outcomes were reported for 90% of published studies.

Conclusions: Diverse behavioural programmes that improve the mental health of young children are available and effective in LMICs. Most interventions were delivered in urban settings and focus was on the use of health care professionals. Diverse intervention approaches, including parenting programmes and group therapy, were effective in addressing various mental health issues among young children.

In this viewpoint, we explore Vietnam's health system vulnerabilities and its national response to the COVID-19 pandemic, as well as critical areas of health system resilience, including health financing, workforce distribution, information systems, and governance. While Vietnam achieved early success through strong governance and mass vaccination campaigns, the pandemic revealed weaknesses in resource procurement, workforce imbalance, and limitations of its health information system. There are challenges in ensuring the rapid disbursement of financial resources and reliance on imported medical supplies, which delayed response times. Uneven healthcare workforce distribution, particularly in rural areas, further strained the health system. Although telemedicine and digital health solutions were implemented, weak digital infrastructure and inadequate information technology literacy hindered their effectiveness. Governance efforts, while generally strong, highlighted the need for better coordination and role clarity during health emergencies. Our findings identify areas for improvement, including effective resource mobilisation and allocation, enhanced digital infrastructure, expanded telemedicine access, and better support for healthcare workers. Governance enhancements, such as improved priority setting and interagency coordination, were also critical. These insights offer valuable guidance for strengthening Vietnam's health system and ensuring greater preparedness for future pandemics, but could also help other low- and middle-income countries facing similar challenges.

Background: Adverse birth outcomes (ABO), such as preterm birth (PTB), small and large for gestational age (SGA/LGA), can compromise both the short- and long-term health of mothers and their foetuses. The purpose of this observational study was to investigate the association between maternal serum alkaline phosphatase (ALP) levels in late pregnancy and the risk of ABO, and to evaluate its predictive value of maternal ALP levels for ABO in women with singleton pregnancies.

Methods: A total of 11 853 consecutive pregnant women underwent hepatic and renal function tests, lipid profile assessments, ALP and high-sensitivity C-reactive protein levels measurements upon admission for labour. Their clinical perinatal parameters and outcomes were also analysed.

Results: The prevalence of PTB, SGA, and LGA in this study was 7.2% (n = 849), 8.9% (n = 1053), and 15.6% (n = 1844), respectively. With increasing quartiles of maternal serum ALP levels, the foetal gestational age increased by 0.58 weeks (95% confidence interval (CI) = 0.50-0.66), 0.78 weeks (95% CI = 0.70-0.86), and 0.98 weeks (95% CI = 0.90-1.06), respectively, and the birth weight increased by 62.91 g (95% CI = 43.96-81.86), 91.54 g (95% CI = 72.41-110.67), and 117.92 g (95% CI = 98.18-137.67), respectively. Compared to women in the bottom quartile of ALP, those in the top quartile had a lower risk of PTB (adjusted odds ratio (OR) = 0.14; 95% CI = 0.11-0.18), a lower risk of SGA (adjusted OR = 0.65; 95% CI = 0.53-0.80), and a higher risk of LGA (adjusted OR = 1.92; 95% CI = 1.62-2.28). Sensitivity analyses conducted among individuals without advanced maternal age, obesity, multiparity, pregnancy complications, and PTB (for SGA/LGA) validated the consistency of these results. More importantly, adding ALP to the established model significantly increased the area under the curve (AUC) for predicting adverse birth outcomes: for PTB, the AUC increased from 0.761 to 0.809 (P < 0.001); for SGA, it increased from 0.754 to 0.759 (P = 0.014); and for LGA, it increased from 0.750 to 0.755 (P < 0.001).

Conclusions: Maternal serum ALP levels in late pregnancy are significantly associated with the risk of ABO. When combined with clinical characteristics and routine laboratory results, ALP has incremental predictive value for ABO, particularly for PTB.

Background: The aim of the present study was to investigate the willingness of elderly individuals regarding their choice of elderly care modes in underdeveloped regions of Western China and to identify the key factors influencing the willingness.

Methods: We distributed a total of 20 000 questionnaires using the multistage stratified cluster random sampling method, and successfully collected 19 460 of them. After conducting quality checks, we deemed 19 040 questionnaires valid for analysis. The survey covered seven cities, 24 counties, and 255 villages in Gansu Province. We conducted statistical analyses, including univariate χ² test, Kruskal-Wallis test and multivariate logistic regression, to assess the willingness of elderly individuals regarding care modes and the factors influencing these choices.

Results: Among the 19 040 valid responses, 88.55% preferred home care, 5.01% opted for community care, 5.01% chose institutional care, 1.08% preferred mutual care, and 0.36% selected smart care. Elderly individuals who have a lower level of education, residence within a 15-minute walking distance to the nearest health care facility, and believe that elder care should rely on themselves or their children, etc. exhibit a higher willingness for choosing the home care mode (P < 0.05). Elderly individuals who believe that elderly care should be reliant on their children, and possess a greater knowledge for the combination of medical and elderly care, etc. exhibit a stronger willingness for choosing the community care (P < 0.05). Elderly individuals with lower educational level and lack endowment insurance, etc. exhibit a higher willingness for choosing the mutual care (P < 0.05). Elderly individuals who are not afflicted with chronic illnesses and reside within a 15-minute distance from the nearest medical centre exhibit a higher willingness for choosing the smart care mode (P < 0.05).

Conclusions: In underdeveloped regions in China, home care continues to be the predominant choice among elderly individuals. However, the growing demand for diverse elderly care modes warrants attention. Multiple factors influence the willingness of elderly individuals when selecting care modes. This study offers valuable insights for policymakers, enabling government departments to implement targeted strategies and interventions to meet the diverse service needs of the elderly population effectively.

Background: Programmatic interventions to increase the detection of children with tuberculosis (TB) are rarely evaluated to understand age- and sex-specific completion rates. We applied modified TB screening and treatment cascade frameworks to assess indicators of effective implementation by age and sex of a TB screening program for children (zero to 14 years) in Bangladesh.

Methods: We implemented an intensified screening program for paediatric TB detection in 119 health care facilities (2018-21). We followed systematic verbal screening by referral for full evaluation for children who reported symptoms or contact history with a patient with TB. Further, we linked children to treatment if diagnosed and followed for outcomes. We calculated the percentage of children, by age and sex, progressing through each step of the care cascade and compared the frequency of step completion by sex using χ² tests.

Results: In total, we screened 552 182 males and 461 419 females for TB. 2.8% of males and 2.6% of females screened positive (P < 0.001). 74.2% of males and 73.9% of females underwent appropriate evaluation (P = 0.560). 10.3% of males and 11.5% of females were diagnosed with TB (P = 0.008). 100% of children initiated treatment, and 97.6% of males and 97.1% of females achieved a successful treatment outcome (P = 0.428). The percent of children screening positive on verbal screen, who were clinically evaluated for TB, and who were diagnosed with TB generally increased with age, with some variability throughout (ranges: 1.2-9.1%, 59.8-88.5%, 6.5-21.9%, respectively).

Conclusions: The largest gap observed for both sexes and among all ages was children who were not appropriately evaluated for TB despite screening positive. In our research, we highlight the value of identifying gaps in paediatric TB care to inform innovative, age- and sex-tailored interventions to improve future care in children.

Background: The implementation of non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic may inadvertently influence the epidemiology of tuberculosis (TB). (TB). However, few studies have explored how NPIs impact the long-term epidemiological trends of TB. We aimed to estimate the impact of NPIs implemented against COVID-19 on the medium- and long-term TB epidemics and to forecast the epidemiological trend of TB in Henan.

Methods: We first collected monthly TB case data from January 2013 to September 2022, after which we used the data from January 2013 to December 2021 as a training data set to fit the Bayesian structural time series (BSTS) model and the remaining data as a testing data set to validate the model's predictive accuracy. We then conducted an intervention analysis using the BSTS model to evaluate the impact of the COVID-19 pandemic on TB epidemics and to project trends for the upcoming years.

Results: A total of 590 455 TB cases were notified from January 2013 to September 2022, resulting in an annual incidence rate of 57.4 cases per 100 000 population, with a monthly average of 5047 cases (5.35 cases per 100 000 population). The trend in TB incidence showed a significant decrease during the study period, with an annual average percentage change of -7.3% (95% confidence interval (CI) = -8.4, -6.1). The BSTS model indicated an average monthly reduction of 25% (95% CI = 17, 32) in TB case notifications from January 2020 to December 2021 due to COVID-19 (probability of causal effect = 99.80%, P = 0.002). The mean absolute percentage error in the forecast set was 14.86%, indicating relatively high predictive accuracy of the model. Furthermore, TB cases were projected to total 43 584 (95% CI = 29 471, 57 291) from October 2022 to December 2023, indicating a continued downward trend.

Conclusions: COVID-19 has had medium- and long-term impacts on TB epidemics, while the overall trend of TB incidence in Henan is generally declining. The BSTS model can be an effective option for accurately predicting the epidemic patterns of TB, and its results can provide valuable technical support for the development of prevention and control strategies.

While maternal mortality decreased during the Millennium Development Goals era, it remains unacceptably high, with stagnation in reductions possible due to shocks such as COVID-19. Most women in low- and middle-income countries already receive antenatal care and over half give birth in health facilities. In cities, use of health facilities for childbirth is near universal (>90%). Cities present complex challenges in ensuring pregnant women receive equitable, high-quality care. The UrbanBirth Collective is a portfolio of projects in sub-Saharan African cities seeking to address an important knowledge gap: how to adapt urban healthcare systems and lived environments to improve maternal and perinatal well-being? Its key focus is care during labour, childbirth, and the early postnatal period, when most poor maternal and perinatal outcomes occur. Our starting projects focus on harnessing open source data to examine and compare cities on the continent, including in-depth case studies of three cities: Grand Conakry (Guinea), Grand Nokoué metropolitan area (Benin), and Lubumbashi (Democratic Republic of the Congo), where we will capture and analyse three main dimensions of the dynamics: maternal health service provision; maternal healthcare use by women; and the complex, nonlinear interactions between the provision and use of care within the spatial, social, and political ecosystem of a city. By comparing these three cities, we shall propose a generalisable model which can be validated and applied in other cities in sub-Saharan Africa. The growth of cities demands increasing attention on future-proofing them with the capacity to develop, implement, and continuously adapt a coherent strategy for the provision of equitable maternal and newborn care. Our ambition is to contribute to reaching zero preventable maternal deaths in cities. To achieve these goals through understanding specific contexts and facilitating the adoption and application of research findings and recommendations, we will collaborate closely with local stakeholders, including healthcare workers, community leaders, and policymakers.

Background: Yoghurt is a commonly consumed fermented food recommended by many guidelines. Yoghurt consumption can contribute to the intake of multiple nutrients and reduce the risk of several diseases. However, prospective evidence is limited on the associations between full/low-fat yoghurt consumption and mortality risk. In this prospective cohort study, we aimed to assess the dose-dependent associations between full/low-fat yoghurt intake and all-cause or cause-specific mortality.

Methods: We enrolled 186 168 participants from the UK Biobank who had joined the study between 2006 and 2010 and were followed up until 2022. We obtained data on self-reported intake of full/low-fat yoghurt and mortality from all causes and specific causes of death, including cancers and cardiovascular diseases (CVDs). We then used Cox proportional hazard models to calculate the hazard ratio (HR) and 95% confidence interval (CI) to evaluate the associations between full-fat and low-fat yoghurt intake and mortality. Lastly, we conducted subgroup and sensitivity analyses to examine the robustness of our findings.

Results: A total of 9402 deaths occurred during a mean follow-up of 13.4 years, including 1687 CVD-related and 5073 cancer-related deaths. Relative to non-consumers, the HRs (95% CIs) for all-cause mortality risk in participants consuming >0-50, 50-100, and >100 g of full-fat yoghurt a day were 0.82 (95% CI = 0.72, 0.93), 0.97 (95% CI = 0.86, 1.09), and 0.96 (95% CI = 0.84, 1.1) respectively. The corresponding HR estimates relative to non-consumers for participants consuming low-fat yoghurt were 0.88 (95% CI  = 0.81, 0.95), 0.91 (95% CI = 0.85, 0.98), and 0.95 (95% CI = 0.89, 1.01), respectively. Subgroup analysis indicated women who had moderate consumption of full-fat yoghurt had lower all-cause mortality risk, while men consuming low-fat yoghurt had lower all-cause mortality risk.

Conclusions: Moderate consumption of full-fat and low-fat yoghurt was correlated with decreased all-cause mortality. Future cohort studies are warranted to verify the potential of adopting yoghurt consumption as part of a healthy diet to reduce mortality.

Background: Inequity in healthcare resources has been identified as a global public health priority, yet the geographic variations and temporal trends in distribution and inequity in China remain unclear. We aimed to investigate these variations and temporal trends in healthcare resources and evaluate inequity in healthcare resource allocation in China.

Methods: In this nationwide descriptive study, we used provincial-level data on healthcare infrastructure, human, and service resources from 31 provinces of mainland China, publicly released by the National Health Commission of China between 2010-21. We assessed the spatial autocorrelation of healthcare infrastructure, human, and service resources using Moran's I index, and identified spatial clusters of resource allocation. We evaluated the equity in healthcare resource allocation using the Lorenz curve, Gini coefficient, and Theil index by population and geographic dimensions.

Results: Between 2010-21, the density of healthcare infrastructure and human resources in China increased, with the average stay decreasing from 10.5 to 9.2 days. There were substantial regional disparities, with higher resource density exhibited in eastern regions compared to western regions. Spatial autocorrelation was more pronounced for the density of practising (assistant) physicians (Moran's I = 0.465; P < 0.001), practising physicians (Moran's I = 0.351; P < 0.001), and bed occupancy rate (Moran's I = 0.256; P < 0.001), with significant geographic clusters of resource allocation. Lorenz curves showed that healthcare resource allocation was closer to the absolute equity by population but not geographic dimension, with Gini coefficients indicating severe inequity (>0.6) by geographic dimension compared to perfect equity (<0.2) by population dimension. Intraregional Theil index by population was higher than the inter-regional index, with contribution rates exceeding 60%.

Conclusions: Per capita access to healthcare resources in China has improved, but significant geographic variations and clustering exist, particularly with higher resource density in eastern regions. While resource allocation by population showed better equity than by geographic area, substantial intra-regional disparities highlight the need for targeted strategies to enhance equitable distribution, particularly in the western regions.

Background: Household food insecurity (HFI) and poor dietary diversity (DD) are major public health challenges in Asia, greatly contributing to stunting among children under five. While previous research has focussed primarily on African regions, this systematic review provides novel insights into the association between HFI, DD, and stunting within the Asian context.

Methods: We searched across six major databases for studies published between 2019 and 2023 exploring the association between HFI, DD, and stunting in children under five across Asia. We then extracted their characteristics, evaluation methods, and outcomes related to stunting for analysis.

Results: From 3215 records, 37 met the inclusion criteria. Most studies were from South Asia (n = 22), followed by Southeast Asia (n = 8), with fewer from West (n = 4), East (n = 2), and Central Asia (n = 1), highlighting geographical research gaps. We found high stunting rates among children under five, especially in South and Southeast Asia. Stunting was strongly linked to HFI and poor DD, suggesting that these factors are critical in addressing malnutrition. Socioeconomic factors, maternal education, and access to clean water also influence stunting outcomes.

Conclusions: Current research on HFI, DD, and stunting in Asia shows substantial variation, with the highest stunting rates in South and Southeast Asia. Limited data from Central and East Asia highlights the need for more comprehensive research in these regions. Addressing HFI and improving DD is critical for reducing stunting and achieving global nutrition targets by 2030.