Journal of Global Health最新文献

Background: Approximately 70% of chronic obstructive pulmonary disease (COPD) is underdiagnosed worldwide. We aimed to develop and validate a COPD self-evaluation questionnaire (COPD-EQ) that is better suited for COPD screening in China.

Methods: We developed a primary version of COPD-EQ based on the Delphi method. Then, we conducted a nationwide multicentre prospective to validate our novel COPD-EQ screening ability. To improve the screening ability of COPD-EQ, we used a series of machine learning (ML)-based methods, including logistic regression, XgBoost, LightGBM, and CatBoost. These models were developed and then evaluated on a random 3:1 train/test split.

Results: Through the Delphi approach, we developed the primary version of COPD-EQ with nine items. In the following prospective multicentre study, we recruited 1824 outpatients from 12 sites, of whom 404 (22.1%) were diagnosed with COPD. After the score assignment assisted by ML models and the Shapley Additive Explanation method, six of nine items were retained for a briefer version of COPD-EQ. The scoring-based method achieves an AUC score of 0.734 at a threshold of 4.0. Finally, a novel six-item COPD-EQ questionnaire was developed.

Conclusions: The COPD-EQ questionnaire was validated to be reliable and accurate in COPD screening for the Chinese population. The ML model can further improve the questionnaire's screening ability.

Background: Maternal obstetric characteristics have a key role in determining the occurrence of pregnancy-related disorders and subsequent neonatal outcomes. We aimed to investigate the mediating impact of gestational diabetes mellitus (GDM) and hypertensive disorder of pregnancy (HDP) on the relationship between maternal advanced age, previous caesarean section, and the risk of either large for gestational age (LGA) or small for gestational age (SGA) infants.

Methods: We used data from a prospective multicentre cohort study conducted through China's National Maternal Near-miss Surveillance System from January 2012 to December 2021. We performed univariate and multivariate logistic regression analyses to examine the connections between maternal advanced age, previous caesarean section, GDM and HDP, and the risks of LGA and SGA, as well as mediation analyses to assess the mediating effect of GDM and/or HDP on the relationship between maternal advanced age, previous caesarean section, and the risks of LGA and SGA.

Results: We included 482 458 women in our study, of whom13.5% were classified as advanced age, 51.4% as multipara, and 16.3% had a history of uterine scarring. Following adjustments for covariates, we found statistically significant associations between maternal advanced age and GDM (adjusted odds ratio (aOR) = 1.79; 95% confidence interval (CI) = 1.75, 1.83), maternal advanced age and HDP (aOR = 1.93; 95% CI = 1.86, 2.01), previous caesarean section and GDM (aOR = 1.13, 95% CI = 1.11, 1.16), previous caesarean section and HDP (aOR = 1.24; 95% CI = 1.20, 1.28), GDM and LGA (aOR = 1.32; 95% CI = 1.30, 1.35), and HDP and SGA (aOR = 3.93; 95% CI = 3.75, 4.12). The influence of maternal advanced age on SGA was significantly mediated by HDP, accounting for 68.96% of the mediation effect. Furthermore, GDM and HDP served as significant mediators in the relationship between previous caesarean section and the risks of LGA and SGA, with mediation proportions of 5.62% and 4.49%, respectively.

Conclusions: We found HDP has a mediating role in the impact of maternal advanced age and previous caesarean section individually on SGA risk, while GDM acts as a mediator in the connection between previous caesarean section and LGA risk.

Background: As fertility rates decline and population ageing intensifies, the conflict between career and childbearing continues to impact clinicians, especially women. Exploring gender differences in the fertility intentions of male and female clinicians could help with identifying barriers to childbearing, developing effective policies to support work-life balance, and addressing the gap in research on gender disparities in this field.

Methods: We conducted a cross-sectional survey among health care personnel in Chinese public hospitals. Through cluster sampling from highly active WeChat groups, we gathered 698 responses from clinicians to the third fertility intention questionnaire online. We then used descriptive statistics and χ² tests for analysis.

Results: Men (28.28%) had higher intentions of having a third child than women (20.71%) (P = 0.013). In terms of reasons, female clinicians were more concerned than male clinicians about the impact on their career development (P = 0.002), difficulties in job hunting (P = 0.039), and physical injuries caused by multiple births (P < 0.001), and whether the elderly can help (P = 0.001). Conversely, men's apprehensions centred on economic factors such as real house costs (P < 0.001), policy support (P = 0.036), and wives' disagreement (P < 0.001). In discussing governmental interventions, men showed a higher level of interest in policies related to child care (P < 0.001), employment stability for women (P < 0.001), extended maternity leave (P < 0.001), and financial assistance than women (P < 0.001).

Conclusions: Our findings show substantial gender-specific differences in third-child fertility intentions among clinicians. To address this, the government should consider divisions in family roles, future societal needs, and women's career development. Policies should focus on balancing work and family by offering affordable childcare, flexible parenting leave, financial incentives, and career support, ensuring childbirth does not negatively impact women's professional growth, and fostering gender equality in parenting.

Background: Since 2019, China has implemented Public Health and Social Measures (PHSMs) to manage the coronavirus disease 2019 (COVID-19) outbreak. As the threat from SARS-CoV-2 diminished, these measures were relaxed, leading to increased respiratory infections and strained health care resources by mid-2023.

Methods: The study utilised WHO's FluNet and Oxford's COVID-19 Government Response Tracker to assess how policy shifts have affected influenza. It examined changes in influenza incidence, subtype prevalence, and epidemic cycles over three periods: pre-COVID-19 and pre-PHSMs, during COVID-19 and PHSMs, and post-COVID-19 and post-PHSMs. The SEIABR model estimated the transmission probability () and real-time reproduction number () across these periods, while a gradient boosting decision tree (GBDT) analysed the effects of PHSM indicators on influenza transmission.

Results: Results indicate that before PHSMs, the average incidence was 4.87 per 100 000, with a β-value of (7.95 ± 1.27) × 10^-10 and R_t-value of 1.21 ± 0.16. During PHSMs, incidence dropped to 2.55 per 100 000, and β decreased to (3.17 ± 0.75) × 10^-10 (R_t-value of 0.86 ± 0.20). Post-PHSMs, the incidence surged to 17.00 per 100 000, with β rising to 8.36 × 10^-10 (R_t-value of 2.25). The GBDT model identified testing policies, public information campaigns, and workplace closures as the most impactful PHSM indicators.

Conclusions: PHSMs effectively mitigated the spread of influenza, providing a foundation for future policy development to prevent respiratory diseases.

Background: Postpartum family planning (PPFP) is an essential component of birth care that helps avert maternal and newborn health hazards by preventing short-spaced births. Many Asian and African studies found PPFP counselling during antenatal care (ANC) and postnatal care (PNC) effective in increasing PPFP uptake. Studies in Bangladesh, however, provided limited evidence of the feasibility and effectiveness of integrating PPFP in maternal health services. The national action plan integrated PPFP services (counseling and providing methods) in maternal health care and immunisation programmes. However, no study has examined the availability of PPFP counselling, an essential component of PPFP, in maternity care points and its effectiveness in increasing PPFP initiation. We explore the prevalence and correlates of PPFP counselling during ANC and PNC and investigate whether PPFP counselling during ANC and PNC increases PPFP initiation.

Methods: We used nationally representative data from the 2017-18 Bangladesh Demographic and Health Survey to analyse whether women having the last live birth in the past three years received PPFP counselling during ANC or PNC visits. We included women's other characteristics as covariates in a multivariable logistic regression. Finally, we analysed the 12-month PPFP initiation by PPFP counselling during ANC and PNC visits. The PPFP initiation analysis used self-reported contraceptive calendar data, a life table technique, and a proportional hazards model.

Results: The prevalence of PPFP counselling was 12% during ANC and 22% during PNC. Women with higher education, higher birth order, upper household wealth quintiles, and living in the Khulna division compared to Chattogram (i.e. the division with the lowest PPFP counselling prevalence) were more likely to receive PPFP counselling during ANC and PNC. Three-fourths of the women initiated FP within 12 months postpartum. PPFP initiation was higher for women receiving PPFP counselling during PNC than those who did not receive it during PNC. We did not find evidence of increased PPFP initiation among women receiving PPFP counselling during ANC.

Conclusions: The higher PPFP initiation among women receiving PPFP counselling during PNC is encouraging. Although we did not find evidence supporting increased PPFP initiation among women receiving PPFP counselling during ANC, further investigation on the quality of PPFP counselling during ANC may guide this necessary intervention's implementation and scale-up.

Background: Flooding is a frequent and devastating hazard in Malaysia, exacerbated by the country's tropical climate and rapid urbanisation. Traditional flood management strategies, predominantly focused on engineering solutions, have proven inadequate in addressing evolving flood risks. Community-based flood mitigation (CBFM) has emerged as an alternative approach, leveraging local knowledge and public participation to enhance flood resilience. This study aims to evaluate the role of CBFM in Malaysia, focusing on the effectiveness of public involvement and policy implementation in flood risk management.

Methods: We conducted 20 in-depth interviews with stakeholders, including government officials, community members, and representatives of non-governmental organisations (NGOs), using a qualitative methodology. The data were analysed using thematic analysis to identify key themes surrounding public participation, policy challenges, and successful community-led flood mitigation initiatives.

Results: The findings highlight the critical role of public involvement in improving flood preparedness and resilience. Communities that actively participated in mitigation efforts, such as early warning systems and nature-based solutions, demonstrated enhanced resilience. However, significant challenges remain, including inadequate funding, outdated infrastructure, and bureaucratic delays. Public awareness and education on flood preparedness, especially in rural areas, were found to be insufficient, hindering the effectiveness of flood management strategies.

Conclusions: The study concludes that while CBFM initiatives in Malaysia show promise, their success depends on stronger policy enforcement, increased public engagement, and sustained investments in both green and grey infrastructure. Greater collaboration between local communities, NGOs, and government agencies is essential for improving flood risk management and building long-term resilience, particularly in the face of increasing climate-driven disasters.

Background: Numerous studies have investigated the efficacy of probiotics in treating acute and persistent diarrhoea. However, probiotics have not been established as a recommended management option for diarrhoeal illness by the World Health Organization (WHO). Therefore, we conducted a systematic review of randomised controlled trials to assess the efficacy of probiotics for the management of acute and persistent diarrhoea in children.

Methods: A systematic search on PubMed, CINAHL, Wiley Cochrane Library, Scopus, Clinicaltrials.gov, and WHO International Clinical Trials Registry Platform (ICTRP) was performed. All studies published in the year 2000 and onwards that assessed the use of probiotics in the management of acute and persistent diarrhoea in children aged 0-10 years were included. The risk of bias was assessed using the Cochrane Risk of Bias II (RoB-2) tool and the quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. This review was commissioned by WHO for revision of their guidelines for childhood diarrhoea management.

Results: The review included 98 studies with a total of 17 236 participants. Studies were categorised based on the WHO definition of diarrhoea or author-specified definition. In studies considering the WHO definition of diarrhoea, the probiotics group was more likely to achieve clinical cure (risk ratio = 1.12 (95% confidence interval (CI) = 1.01, 1.24, studies = 14)) and reduce the duration of diarrhoea (mean difference = -13.27 hours (95% CI = -16.72, -9.83, studies = 33)) than the control group in children with acute diarrhoea. However, the effect size was small, and statistical heterogeneity was very high, leading to low certainty of evidence. In children with persistent diarrhoea, probiotics reduced the duration of diarrhoea by 95 hours (mean difference = -96.45 (95% CI = -110.53, -82.37, studies = 2)), but the certainty of the evidence was very low.

Conclusions: The results from this systematic review suggest low certainty of evidence for the effect of probiotics on clinical cure and duration of diarrhoea in children. There was significant diversity in the genus, species, dosages, and duration of treatment in the trial and administration. High levels of heterogeneity reduced the certainty of evidence. Large-scale randomised clinical trials are needed to evaluate specific probiotic strains and doses. In addition, cost-effective analysis studies are needed to be explored in future research.

Registration: The protocol for this review was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023449200).

Background: The World Health Organization declared that coronavirus disease 2019 (COVID-19) constitutes an international public health emergency, which has strained health resources. In this study, we aimed to understand medical students' willingness to join the workforce fighting against the COVID-19 pandemic and identify factors associated with their decisions.

Methods: We conducted a nationwide cross-sectional study using the Wen-Juan-Xing platform and a pre-designed questionnaire from 23 March to 19 April 2021. We conducted logistic regression analyses to identify the determinants associated with the willingness.

Results: Among the 5022 medical students, the majority (n = 4289, 85.40%) expressed willingness to work on the COVID-19 frontline. Logistic regression indicated that medical students' willingness to work on the COVID-19 frontline in China was associated with gender, region, reason for choosing medicine, having medical workers in the family, students whose family members, relatives or friends experienced COVID-19, and professional attitude. Females (odds ratio (OR) = 1.305; 95% confidence interval (CI) = 1.100-1.549; P = 0.0023), medical students from urban areas (OR = 1.295; 95% CI = 1.089-1.539; P = 0.0034), medical students whose choice of a medical career was their desire (OR = 1.579; 95% CI = 1.290-1.933; P < 0.0001), medical students whose parents or relatives are medical workers (OR = 1.266; 95% CI = 1.066-1.505; P = 0.0073), medical students whose family members, relatives, or friends have never been infected with COVID-19 (OR = 4.567; 95% CI = 3.002-6.947; P < 0.0001), and medical students with undisturbed of professional attitudes (OR = 4.280; 95% CI = 3.241-5.654; P < 0.0001) showed increased willingness to work on the COVID-19 frontline compared with their counterparts.

Conclusions: Medical students demonstrated a strong willingness to contribute to COVID-19 work during the pandemic in China. The findings may provide valuable information for emergency management so that policymakers can maintain sufficient health resources and provide quality health care in similar health emergencies in the future.

Background: Clinical breast exam (CBE) by outreach healthcare workers (HCW) may help downstage breast cancer in resource-limited areas where mammography may not be feasible. We evaluated the effectiveness of a pilot cascade-model training programme for HCWs in remote areas of Pakistan.

Methods: The training programme comprised three phases. In phase one, fellowship-trained breast surgeons at a metropolitan academic centre trained six HCWs to perform CBEs. In phase two, these six HCWs (master trainers) trained 15 additional HCWs, implementing cascade training. In phase three, the consultant breast surgeon conducted a re-evaluation and refresher course for all 21 HCWs at least one year after the original training session. We assessed CBE ability and skills through pre- and post-changes through self-reported confidence and direct observation of procedural skills.

Results: Significant improvements in learners' self-reported confidence and CBE skills were observed in both phases one and two. The median scores in the learners' post-training self-reported confidence and CBE skills (inspection, palpation, and lymph node examination) improved by 20% and 46.2%, respectively, indicating excellent learning outcomes of the cascade training sessions. Phase three showed sustained high scores in self-reported confidence and CBE skills more than one year later.

Conclusions: Mass training of outreach HCWs in remote regions in performing CBE may be possible with a structured multiphase cascade-training model and may be an important step in downstaging symptomatic breast cancer in low-resource settings.