Journal of Global Health最新文献

Background: Risk prediction models for cardiovascular diseases (CVDs) have been widely applied in clinical practice and in designing prevention policies globally, yet their accuracy across different regions with distinct epidemiological profiles remains uncertain. We examined the regional variation in risk distribution and agreement between these models.

Methods: We analysed 53 nationally representative health surveys in seven regions. Using the World Health Organization (WHO), SCORE2, and Framingham CVD risk prediction models, we estimated the respondents' 10-year CVD risk and categorised them into low-, moderate-, or high-risk groups.

Results: We included 86 430 individuals aged 40-69 years without a history of CVD in our analysis. Globally, CVD risk estimates differed substantially across models (WHO: 7.75%; 95% confidence interval (CI) = 7.70-7.80; SCORE2: 3.72%; 95% CI = 3.69-3.75; Framingham: 12.42%; 95% CI = 12.34-12.50). We also noted regional disparities in identifying moderate- and high-risk subjects, particularly in South Asia (WHO: 12.57%; 95% CI = 11.63-13.51; SCORE2: 18.24%; 95% CI = 17.14-19.33; Framingham: 29.40%; 95% CI = 28.11-30.70), sub-Saharan Africa (WHO: 16.30%; 95% CI = 15.78-16.83; SCORE2: 22.69%; 95% CI = 22.09-23.28; Framingham: 33.85%; 95% CI = 33.18-34.52), East Asia & the Pacific (WHO: 21.06%; 95% CI = 20.57, 21.55; SCORE2: 31.03%; 95% CI = 30.47, 31.59; Framingham: 45.54%; 95% CI = 44.93-46.14), and Latin America & the Caribbean (WHO: 23.09%; 95% CI = 21.48-24.70; SCORE2: 41.56%; 95% CI = 39.68-43.44; Framingham: 55.83%; 95% CI = 53.94-57.72), with greater than two-fold differences across models. Agreement in classifying individuals into low-, moderate-, or high-risk groups remained relatively high across risk models (63.1%), but varied considerably across regions, from 73.91% in South Asia to 47.54% in Latin America & the Caribbean.

Conclusions: The CVD risk estimates produced by the WHO, SCORE2, and Framingham models varied significantly across regions, with poor consistency in identifying at-risk individuals in some regions. These discrepancies may lead to undertreatment and inefficient use of otherwise limited healthcare resources. Region-specific adaptations are needed to enhance risk targeting, promote equity, and improve the overall effectiveness of primary prevention.

Background: Previous epidemiological studies indicated a potential correlation between air pollution and anaemia, particularly in children, pregnant women, and the elderly. However, evidence is insufficient for workers exposed to air pollution while working in environments with other occupational hazards. Based on data from a substantial population of workers in southern China, we aimed to examine the relationships between different air pollutants and both haemoglobin (Hb) concentration and the prevalence of anaemia.

Methods: In this cross-sectional analysis, we recruited 372 290 workers from the National Occupational Disease Surveillance Platform and utilised a mixed-effects model to explore the association of various air pollutants (including PM_2.5, PM₁₀, PM_coarse, O₃, and NO₂) with Hb concentration and the prevalence of anaemia. We ran stratified analyses by various demographic characteristics and occupational variabels.

Results: Each 5 μg/m³ increase in the concentration of PM_2.5, PM₁₀, PM_coarse, O₃, and NO₂ corresponds to a 2.037 g/L (95% confidence interval (CI) = 1.938, 2.137), 1.096 g/L (95% CI = 1.040, 1.152), 1.412 g/L (95% CI = 1.313, 1.510), 0.518 g/L (95% CI = 0.489, 0.547), and 0.250 g/L (95% CI = 0.219, 0.281) decrease in Hb concentration, respectively. The prevalence of anaemia increased by 11.3% (95% CI = 7.3, 15.5), 5.0% (95% CI = 2.8, 7.3), and 4.5% (95% CI = 6, 8.5) for a 5 μg/m³ increase in PM_2.5, PM₁₀, and PM_coarse, respectively, with the impact being more pronounced in the non-benzene-exposed population. Subgroup analyses suggested potential variations in susceptibility to the same air pollutant across different demographics and occupational variables.

Conclusions: The Hb levels among the workers in our sample were associated with various atmospheric pollutants, with certain demographic and occupational subgroups being particularly vulnerable. These results highlight the need for targeted air pollution control and occupational health interventions, particularly for vulnerable demographic and occupational subgroups.

Background: Improving data quality and use is a priority identified by the World Health Organization (WHO) to reduce stillbirths and newborn deaths; however, few studies have documented newborn and stillbirth data use in the African Region. To address this gap, we conducted a cross-sectional study from November 2022 to July 2024 in 12 regions and four city administrations across the Central African Republic (CAR), Ethiopia, Tanzania, and Uganda.

Methods: We collected data using Every Newborn - Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) tools, through direct observation, and from routine electronic and/or paper-based forms and reports. We analysed both the overall and country-level samples following the Performance of Routine Information System Management User's Kit.

Results: We assessed 142 sites, comprising 93 health facilities and 49 data offices. Enabling factors, such as electronic systems, guidelines, annual plans, and feedback mechanisms, were highly available in Ethiopia (n/N = 22/30), moderately available in Uganda and Tanzania (n/N = 15/30 and n/N = 12/30), and scarce in the CAR (n/N = 1/30), with key indicators in all countries being ≥80%. Key data-use indicators showed similar patterns across countries, but lower frequencies (Ethiopia: n/N = 15/66; Uganda: n/N = 14/66; Tanzania: n/N = 5/66; the CAR: n/N = 1/66). Decisions documented in meetings rarely focussed on healthcare quality improvement, particularly at the district level (47.1% in Tanzania vs. 44.4% in Uganda vs. 30% in Ethiopia vs. 0% in the CAR). Data dissemination to public representatives was also subpar (40.8% in facilities, 71.4% in subnational offices). Among 141 end-users, 100% of respondents in the CAR, 75-82.4% in Tanzania and Uganda expressed the need to improve the newborn and stillbirth data use compared to 16.7-21.7% in Ethiopia.

Conclusions: Newborn and stillbirth data use was low, despite variations across countries and health system levels. Evidence-based decision-making in health service delivery remains a priority action to reduce stillbirths and newborn deaths. This study identified context-specific, sustainable, and scalable interventions co-created with end-users to ensure wider newborn and stillbirth data use.

Background: China has the largest diabetic population, accounting for over a quarter of global cases. As a chronic condition frequently accompanied by comorbidities, diabetes requires research on the patterns and burdens of associated conditions, particularly within primary care settings. We aim to provide longitudinal insights into the evolution of comorbidity patterns and burdens among China's diabetic population, examining trends and influencing factors.

Methods: We used longitudinal data in five waves (2011-20) of the China Health and Retirement Longitudinal Study (CHARLS). We classified comorbidities into three categories based on their aetiological relationship with diabetes: traditional concordant (TCC), non-traditional concordant (NCC), and discordant (DC). We used generalised estimating equation (GEE) models to identify factors influencing comorbidity burden.

Results: Between 2011 and 2020, the prevalence of diabetes among individuals aged ≥45 years in China increased from 6.3% to 17.6%, while diabetes-related comorbidities rose from 5.3% to 16.9%. The most prevalent comorbidities in 2020 were hypertension (68.3%) and dyslipidemia (62.3%). The average number of conditions per diabetic patient increased by 1.5, and the Charlson comorbidity index (CCI) increased by 50%. At the final follow-up, 65.4% of patients had TCC, 92.4% had NCC, and 75.9% had DC. GEE analysis showed that the number (β = 0.034; P = 0.009) and CCI (β = 0.041; P = 0.021) of comorbidities increase with age. Diabetes control was significantly associated with a decrease in both the numbers (β = -0.720; P < 0.001) and CCI of TCC (β = -0.951; P < 0.001), a modest but significant reduction in NCC numbers (β = -0.134; P = 0.021) without a corresponding decrease in its CCI, and no significant association with DC.

Conclusions: The increasing comorbidity burden in diabetic patients highlights the need for primary care-centred interventions tailored to comorbidity types. Targeted management of diabetes is instrumental in reducing the severity of comorbidities within the TCC pattern.

Background: Respiratory syncytial virus (RSV) disease burden is highest in low- and middle-income countries; yet data for costs of RSV-related illness in these settings are scarce. We estimated RSV costs of illness to inform decision-making for RSV preventive strategies in Nigeria.

Methods: This prospective study assessed the costs of care per episode of (severe) acute respiratory infection during one RSV season (April to November 2023). Children <2 years old, were recruited at tertiary inpatient and outpatient facilities in North-West Nigeria and grouped as non-severe (outpatient), severe (inpatient non-intensive care), and life-threatened (intensive care or fatality) cases. Direct medical, direct non-medical, and indirect cost data were collected using caregiver questionnaires at the index visit or day of admission and follow-up and gathered from hospital records at discharge. We summarised average costs in 2023 USD.

Results: We included 792 children (mean age 8.7 months) with non-severe (n = 692), severe (n = 52), and life-threatening (n = 48) respiratory infections. Among these groups we confirmed RSV infection in 130 (19%), 19 (37%), and 14 (29%) children. The average societal costs were USD 13 (95% confidence interval (CI) = 11-14), USD 244 (95% CI = 198-290), and USD 179 (95% CI = 120-239) per episode of non-severe, severe, and life-threatening RSV infection, respectively. Costs associated with RSV did not increase stepwise with the severity categories due to small group sizes and fatalities with low costs included in the life-threatened group. For severe RSV, average household costs were over 200% of the national monthly minimum wage. Most households (89%) resorted to personal savings to cover costs.

Conclusions: In young children in Nigeria, RSV presented a significant health and economic burden. This study can inform health economic evaluations of emerging RSV pharmaceutical interventions for Nigeria and may be adjusted for rural/urban contexts and level of care.

Intersecting crises, such as complex health threats, deep-rooted inequities, and intergenerational vulnerabilities, expose the critical limitations of fragmented, disease-specific global health programmes. While the life course approach to health (LCAH) is theoretically recognised, it is inadequately implemented in global health governance and financing. In this viewpoint, we aim to reposition LCAH as an operational blueprint for the future global health agenda. Based on a 'problem-principles-pathway' logic model, we articulate why and how LCAH can address key challenges of today's global health context. The LCAH is reframed around three actionable shifts: from vertical programmes to holistic integration via person-centred, primary care-based systems; from opportunity-equality to temporal equity, addressing cumulative disadvantage across the lifespan; and from short-term reactivity to proactive resilience, built through sustained investment in 'health capital' at critical life stages. We call for coordinated action between policymakers, donors, global health actors, and community health workers to operationalise this framework. While barriers like short-term political and financial cycles still need be overcome, the LCAH offers a vital paradigm shift for building societal resilience and achieving equitable health trajectories in an uncertain world.

Background: Acute malnutrition, also known as wasting, affected an estimated 45 million children under five (CU5) globally in 2023. Wasting is measured using a child's mid upper arm circumference (MUAC), weight-for-height z-score (WHZ), or nutritional oedema. In low-resource contexts, MUAC is often the only measurement used to regularly screen for malnutrition, but recent research suggests MUAC alone fails to diagnose 25-80% of WHZ-wasted children. Mid upper arm circumference, an age-adjusted MUAC z-score, may identify additional cases missed by MUAC alone.

Methods: This was a secondary analysis of 1408 CU5 enrolled in a cluster-randomised controlled trial in two high-wasting regions of Somalia. This analysis explored wasting prevalences, concordance between indicator pairs, linear regression modelling, and receiver operating characteristic (ROC) analysis using WHZ as a reference standard to examine alternative MUAC and MUACZ thresholds.

Results: Wasting prevalence was 1.5% by MUAC, 8.5% by MUACZ, and 14.8% by WHZ. Mid upper arm circumference alone failed to identify 94% of WHZ-wasted children. There was slight concordance between MUAC and WHZ (kappa (κ) = 0.089) and fair concordance between MUACZ and WHZ (κ = 0.385). Linear regression indicated that MUAC, age, sex, and stunting were all statistically significant variables for estimating child WHZ. Using WHZ as a reference standard, a MUAC of 13.7cm and MUACZ of -0.9 both accurately diagnosed >82% of wasted children ages 9-23 months. A MUAC of 14.4 cm and MUACZ of -1 both accurately diagnosed >76% of wasted children ages 24-59 months.

Conclusions: Poor concordance between MUAC and WHZ should prompt review of wasting measurement guidelines for this population. Stratified analyses and regression modelling showed increased MUAC with age among CU5. MUACZ or age-specific MUAC thresholds may identify more truly wasted children, improving coverage of treatment interventions. Policymakers should examine how adapting screening guidelines impacts health facilities and treatment availability. Future studies should consider long-term outcomes and mortality associated with increased thresholds of MUAC and MUACZ.

Registration: The cluster-RCT is registered at ClinicalTrials.gov, ID: NCT06642012.

Background: To address Somalia's high wasting burden, it is imperative to understand the country's context-specific correlates of wasting. We aimed to assess the correlates of wasting among children under five (CU5) and mothers in Bay and Hiran.

Methods: We analysed midline (CU5 n = 956; mothers n = 1066) and endline (CU5 n = 833; mothers n = 1023) data from a randomised controlled trial. We explored child (weight-for-height z-scores (WHZ)) and maternal outcomes (mid-upper arm circumferences) via linear regression for children and via Poisson regression for children and mothers, implementing a backwards elimination approach in a hierarchical way. We stratified CU5 models by region and age.

Results: CU5 wasting was 12.9% at midline and 14.4% at endline, with a higher burden in Hiran. At midline, maternal underweight and maternal open defecation adversely affected WHZ, while having >1 CU5 was protective. At endline, no maternal education, a high reduced coping strategy index, and not consuming animal-based protein were associated with lower WHZ, while maternal overweight was protective. Stratifying by age did not reveal additional correlates. The following additional correlates appeared when stratifying by region: child illness, household decision-making, and household head gender in Bay and household open defecation and non-food item kits in Hiran. Mothers' wasting was 8% at midline and 12% at endline, with the following identified correlates: an unacceptable food consumption score, moderate-to-severe household hunger, and poor child stool disposal practices at midline and household open defecation at endline. Maternal decision-making was protective at midline.

Conclusions: Our results highlight variation in the key correlates of wasting by region, season, and age and contribute to evidence on the multifactorial correlates of wasting, encouraging context-specific approaches addressing the immediate, underlying, and basic causes of malnutrition. The findings emphasise the importance of maternal nutrition for child nutrition and the need for interventions considering household food security, sanitation, and gender dynamics in this humanitarian setting.

Registration: The cluster-RCT is registered at ClinicalTrials.gov (ID: NCT06642012).

Background: As few studies systematically analysed organisational and management factors related to newborn and stillbirth data quality, we sought to identify specific gaps in these factors to provide evidence for planning tailored actions.

Methods: We performed a cross-sectional survey in 12 regions and 4 city administrations in the Central African Republic (CAR), Ethiopia, Tanzania, and Uganda between November 2022 and July 2024, collecting data related to organisational and management factors at different health system levels through the Every Newborn - Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) tools. We reported the results as frequencies/normalised PRISM scores, both on the overall sample and by country, and conducted exploratory subgroup analyses by region.

Results: We included 151 sites (56 data offices; 95 facilities) and 108 health/data professional respondents. Availability of written documents describing the routine health information system (RHIS) mission, roles, and responsibilities (71.4% in the CAR to 94.1% in Tanzania; P = 0.380), and designated staff for internal data quality review (83.3% in Ethiopia to 100% in the CAR, Tanzania, or Uganda; P = 0.245) showed high percentages and low heterogeneity across countries at data office level. Most of the other measures explored - i.e. those related to governance, planning, financing, capacity development, relevant guidelines, data quality assurance systems, feedback mechanisms and supportive supervision - showed high heterogeneity across countries, with Ethiopia and Uganda, followed by Tanzania, showing the highest percentages, and the CAR showing the lowest. We observed low percentages in all countries at the data office level in the domains of financing (budget for RHIS supplies: 0% in the CAR to 35.3% in Tanzania; P = 0.079) and capacity development (availability of a report with RHIS training needs: 0% in the CAR to 41.2% in Tanzania; P = 0.333; training schedule: 17.6% in Tanzania to 42.9% in Uganda; P = 0.412). Subgroup analyses suggested high within-country heterogeneity. Needs for improvement in management and organisational factors were reported by most respondents (72.7% in Ethiopia to 100% in the CAR; P = 0.629).

Conclusions: Our findings reveal a need for tailored interventions to improve organisational and management aspects at different levels of the health system, to ensure better quality and use of newborn and stillbirth data.

Background: Low physical activity (LPA) is associated with cardiovascular and cerebrovascular pathologies. This study aimed to assess the prevalence of several noncommunicable diseases relating to LPA.

Methods: Using the 2021 Global Burden of Disease data set, we modelled LPA-related disease burdens across 204 countries and territories, quantifying mortality counts, age-standardised mortality rates, and disability-adjusted life years (DALYs) for five noncommunicable diseases. We conducted multivariable stratification analyses to assess variations by gender, age, and sociodemographic index (SDI) quintiles. We used age-period-cohort modelling to project burden trajectories, while applying counterfactual decomposition frameworks to delineate synergistic interactions between LPA and risk factors.

Results: We found that LPA accounted for 555 101 related deaths globally in 2021 across the five studied pathologies, mostly among individuals aged 60-94 years. Association between LPA-related disease burden and SDI followed a U-shaped distribution across regions and diseases. Among individuals aged 60-89 years, LPA-related deaths were significantly higher in women than in men, indicating a disproportionate burden on elderly females. Ischaemic heart disease (IHD) trends stabilised in low- and middle-SDI regions but declined significantly in high-SDI regions, underscoring global health disparities. From 2007 to 2011, LPA DALYs and mortality risk ratios for IHD, stroke, and lower extremity peripheral arterial disease declined from >1 to <1, whereas diabetes mellitus exhibited an opposite trend, highlighting LPA's persistent and significant impact on diabetes-related morbidity. Demographic shifts and epidemiological transitions were primary drivers of LPA-related disease burden across five pathologies. In high-SDI regions, epidemiological changes predominated, whereas population growth was a key factor in low- and middle-SDI regions. Synergistic interaction of these factors with LPA is projected to substantially amplify future disease burden.

Conclusions: Physical activity should be increased among elderly women to address health risks associated with LPA. Likewise, urgent public health interventions are needed for LPA-related diabetes. As IHD burden rises in low- and middle-SDI regions, vascular disease care strategies require optimisation. Moreover, high-SDI regions should strengthen nationwide physical activity promotion, while low- and middle-SDI areas must enhance healthcare infrastructure and manage population growth to reduce LPA-related disease burdens.