Journal of Global Health最新文献

Background: Adequate functionality of electronic routine health information systems (eRHISs) is crucial for data use, yet few studies explored it in relation to newborn and stillbirth data in Africa.

Methods: We conducted this cross-sectional study between November 2022 and July 2024 in data offices at central and subnational levels in 12 regions and 4 city administrations in the Central African Republic (CAR), Ethiopia, Tanzania, and Uganda. Except for end-user perspectives (collected via interviews), we collected data related to eRHIS functionalities by direct observation following standard operating procedures as for the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tool 3.1, based on the Performance of Routine Information System Management (PRISM) framework. We analysed data according to the PRISM Users' Kit.

Results: We assessed 53 data offices in total. All countries used the same software application, the District Health Information Software 2 (DHIS2). Settings were heterogeneous across countries, with a tendency for DHIS2 to offer fewer functionalities to users in the CAR. Overall functionalities for generating facility annual summary reports (100% in all countries) and for calculating percentage of reports received/expected (75.0% in Ethiopia to 88.9% in Tanzania) were widely available. Data integration and data disaggregation, meanwhile, had lower availability. Functionalities for calculating coverage on specific indicators, such as respectful care, were lacking in all countries, those for quality assurance varied across countries, while those related to data visualisation were almost always available in Uganda and Tanzania, but showed specific gaps in Ethiopia (i.e. for early initiation breastfeeding), and most often lacked in the CAR. Most end-users indicated needs for eRHIS improvement (ranging from 37.5% in Ethiopia to 100% in the CAR; P = 0.001), with 17.0% reporting needs for major improvement (from 10.0% in Uganda to 28.6% in the CAR; P = 0.001). Subgroup analyses suggested high within-country heterogeneity and more eRHIS functionalities available at central vs. subnational level.

Conclusion: Identified strengths and gaps in existing DHIS2 functionalities can inform the design of context-specific interventions that will enhance data use for reducing neonatal mortality and stillbirth rates.

Background: The study explored the relationship between body mass index (BMI) and activities of daily living (ADL) disability among Chinese older adults.

Methods: Using 2011-2020 data from the China Health and Retirement Longitudinal Study, we included 3975 older individuals and assessed their baseline BMI, ADL disability, other covariates, and ADL disability over the follow-up period. Cox proportional hazards regression, restricted cubic spline, and two-piecewise linear regression models were performed. We also conducted subgroup analyses to explore effect heterogeneity across different subpopulations and sensitivity analyses to confirm the robustness of our findings.

Results: During a median follow-up of seven years, 2003 participants developed ADL disability. The Cox proportional hazards models demonstrated a significant association between BMI and the risk of ADL disability. When BMI was categorised into groups, only obese older adults exhibited a significantly higher risk of ADL disability compared to those with normal weight. The restricted cubic spline model further revealed a nonlinear U-shaped relationship between continuous BMI and ADL disability risk, indicating that the risk of ADL disability initially decreased and then increased with rising BMI. Subgroup analyses revealed that the U-shaped relationship was observed only among individuals aged 60-69 years and female older adults, while sensitivity analyses consistently confirmed the robustness of this U-shaped association between BMI and ADL disability risk.

Conclusions: A nonlinear U-shaped relationship between BMI and ADL disability risk was observed among Chinese adults aged 60-69 and older female adults, suggesting that both high and low BMI are associated with increased ADL disability risk. Despite limitations such as baseline-only BMI measurements, observational study design, potential residual confounding, and limited generalisability beyond Chinese older adults, these findings highlight the importance of routine BMI screening and targeted weight management strategies to help prevent or delay the onset of ADL disability in older adults.

Background: Most medical research on pneumonia in children focuses on those <5 years, leaving a gap in understanding pneumonia in children aged 5-9. We aimed to identify the characteristics of children from this age group who had pneumonia and required hospital care, including critical care service.

Methods: In this retrospective chart analysis, we examined clinical, demographic, and laboratory characteristics of children aged 5-9 years with clinical and radiologic pneumonia admitted to Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh, from 2011 to 2020. We categorised the children into two groups: those who required critical care (admitted to the intensive care unit (ICU)) and those who did not. We compared the two groups to identify factors independently associated with the need for critical care using a log binomial regression model.

Results: Among a total of 154 children who fulfilled the enrolment criteria, 34 were admitted to the ICU requiring critical care, and 120 children were treated in the inpatient ward, as they did not require any critical care. The median age of the children requiring critical care was 69 (interquartile range (IQR) = 60-81) months, compared to 72 (IQR = 62-84) months for those who didn`t require critical care (P = 0.259). Using a log binomial regression model we found hypoxemia (odds ratio (OR) = 10.1; 95% confidence interval (CI) = 1.42-71.92, P = 0.021), convulsion (OR = 281.37; 95% CI = 12.99-6091.72, P < 0.001], sepsis (OR = 27.69; 95% CI = 3.33-230.39, P = 0.002), hypokalaemia (OR = 10.37; 95% CI = 1.40-76.96, P = 0.022) were the independently associated with critical care service among children aged five to nine with pneumonia.

Conclusions: Our results suggest that early recognition and prompt treatment of hypoxemia, convulsions, sepsis, and hypokalaemia may significantly reduce the need for critical care and possibly avert fatal consequences in children with pneumonia, aged 5-9, especially in resource-limited settings.

Background: Risk communication is a fundamental component of public health resilience during health emergencies. While the Joint External Evaluation (JEE) framework established by the World Health Organization under the International Health Regulations assesses risk communication capacity, cross-country comparisons to identify good practices that could inform improvements in global risk communication remain unexamined. We aim to identify the key elements of effective risk communication practices by analysing high-scoring countries in JEE mission reports.

Methods: We conducted a retrospective observational study using publicly available JEE mission reports from 103 countries that had completed evaluations as of October 2022. Using a five-point evaluation scale, we defined good practices as highlighted strengths in risk communication for indicators reflecting 'demonstrated capacity' (score four) or 'sustainable capacity' (score five). We documented the JEE-assessed countries and score descriptions to contextualise good practice identification. We performed a cluster analysis of the extracted good practices to identify the recurring themes and key elements across five risk communication indicators.

Results: We identified 420 good practices and coded them based on the JEE technical questions. Frequently cited key elements included 'clear roles and responsibilities', 'regular testing and exercises', 'dedicated staff and funding', and 'feedback mechanisms from the audience'. Additionally, innovative approaches such as 'rumour monitoring systems' and 'digital literacy education' were identified, thus providing insights into practical strategies for effective risk communication during health emergencies.

Conclusions: This analysis of JEE mission reports highlights the key features of sustainable risk communication capacities. By identifying key elements that can inform the development of risk communication strategies, we offer insights to help countries enhance systems and strengthen public health resilience in the face of future emergencies.

Statin guidelines for older adults are predominantly informed by evidence from high-income countries (HICs), making them less relevant in low- and middle-income countries (LMICs) with varying healthcare capacities. Identical patients may receive different recommendations depending on the geographic context, as seen in European Systematic Coronary Risk Evaluation 2 (SCORE2) and USA's Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) guidelines. LMICs often rely on the World Health Organization cardiovascular risk charts and implementation frameworks, such as the package of essential non-communicable disease interventions and HEARTS. While these frameworks are generally more feasible in resource-limited settings, they lack the clinical specificity of HIC-based guidelines. Emerging biological evidence challenges uniform cholesterol-lowering therapies in older adults. Polypharmacy, potential adverse effects, and the limited capacity for ongoing monitoring in many settings further complicate the net benefit of statin therapy in this population. These challenges underscore the need for context-sensitive, age-appropriate guidelines. We outline a context-sensitive approach to statin use in older adults and propose guiding principles to support more equitable, feasible, and clinically appropriate decision making. These include aligning treatment with functional status and prognosis, using fixed-dose combinations, and integrating statin use into broader primary care strategies through task-sharing and simplified protocols. To ensure meaningful cardiovascular disease prevention in ageing populations, global guidelines must evolve to reflect regional capacity, biological variation, and implementation.

Background: Cardiometabolic disorders (CMDs) are common in pregnancy and can harm the offspring's health. While prior studies have explored clustered cardiometabolic risks in pregnancy, most have focused on a limited number of conditions or a single period. We aimed to examine the associations of individual, multiple, and separate and combined patterns of six pre-pregnancy and gestational CMDs with preterm birth and infant mortality.

Methods: Using data from US National Vital Statistics System (2014-2020), we analysed pre-pregnancy CMDs (body mass index, diabetes, hypertension) and gestational CMDs (gestational weight gain, gestational diabetes, hypertensive disorders). We estimated the prevalence and time trends in CMDs using Joinpoint regression models and examined associations with preterm birth and infant mortality using multivariable logistic regression.

Results: Among 24 447 869 mother-infant pairs, 1 932 716 (7.9%) were preterm births and 108 891 (0.5%) were infant deaths. Prevalence rates of most multi-CMD patterns increased significantly. There was a dose-response association between the number of pre-pregnancy and gestational CMDs and the risk of preterm birth and infant mortality (P for trend <0.001). Co-occurring pre-pregnancy diabetes and hypertension showed the strongest associations with preterm birth (odds ratio (OR) = 10.52; 95% CI = 9.71-11.40) and infant mortality (OR = 3.93; 95% CI = 2.99-5.18). Co-occurring inadequate gestational weight gain, gestational diabetes and hypertensive disorders showed the strongest association with preterm birth (OR = 4.57; 95% CI = 4.46-4.68). Specific combinations of pre-pregnancy and gestational CMD patterns such as pre-pregnancy diabetes and developed additional gestational hypertensive disorders experienced highest risk of preterm birth (OR = 18.80; 95% CI = 17.38-20.35).

Conclusions: Increasing prevalence of multiple CMDs was associated with higher risks of preterm birth and infant mortality, emphasising the need for enhanced prevention and management of cardiometabolic health before and during pregnancy.

Background: Evidence regarding the association between physical activity (PA) and diabetic retinopathy (DR) remains inconsistent. Furthermore, its effects on retinal vessel diameters in type 2 diabetes are not well established. We aimed to investigate the relationship between PA, DR, and retinal vessel diameters, explore underlying mechanisms, and identify protective exercise regimens.

Methods: We included patients with type 2 diabetes from the Shanghai Cohort Study of Diabetic Eye Disease. Retinal vessel diameters were measured using computer vision and deep learning. Anthropometric data were collected using standard methods, and PA data through interviews. In 2017, participants were categorised by their DR status. Those without DR were divided into active and inactive groups and followed for three years to assess the effect of PA. For statistical analyses, we used independent t-tests, χ² tests, one-way analysis of variance, Bonferroni tests, multiple linear and logistic regression models, Kaplan-Meier, and Cox regression models.

Results: In the cross-sectional analysis, we analysed a sample of 42 992 individuals, with a mean age of 64.42 (standard deviation (SD) = 6.87) years. PA was associated with reduced odds of moderate and severe non-proliferative DR, and with wider retinal arterioles and venules. In the longitudinal cohort, we analysed 3669 individuals, with a mean age of 63.1 (SD = 6.65) years. PA was a protective factor against incident DR (hazard ratio = 0.812; 95% confidence interval = 0.679-0.971) and was associated with increased peripheral retinal arteriolar calibre and arterio-venous ratio.

Conclusions: PA improved retinal vessel diameters and lowered DR incidence, highlighting the necessity for further research into the physiological mechanisms linking PA and DR. Promoting awareness and engagement in moderate/high-intensity exercise may enhance diabetes health management.

Registration: ClinicalTrials.gov NCT03665090.

Background: With declining funding for population-based household surveys, routine health facility data offer a promising alternative for tracking newborn health and service quality. However, their utility depends on data quality. We assessed the quality of ten data elements within routine health information systems in the Central African Republic (CAR), Ethiopia, Tanzania, and Uganda, seven of which align with the Every Newborn Action Plan core newborn indicators.

Methods: We conducted a cross-sectional study in 97 emergency obstetric and newborn care facilities across 4 countries between November 2022 and July 2024. We extracted three months of routine register and summary report data on ten maternal and newborn elements (two denominators, three outcome numerators, five newborn care interventions) and one tracer maternal indicator. We evaluated data quality on four dimensions (availability, completeness, accuracy, and internal consistency) and measured internal consistency using the ratio of (total births - live births)/stillbirths, with a value of 1 suggesting ideal internal consistency.

Results: Denominator completeness exceeded 90% in Uganda and Tanzania, but was lower in the CAR (87%) and Ethiopia (82%). Impact numerator completeness averaged 79% for neonatal mortality and 81% for low birth weight, with Ethiopia performing worst, with scores of 45% and 32%, respectively). Completeness for newborn interventions (early breastfeeding, kangaroo mother care, bag-mask ventilation, sepsis management) remained below 90%, with the CAR lacking neonatal sepsis data and Ethiopia lacking early breastfeeding data. Accuracy was poor: concordance between register recounts and summary reports ranged from 9% to 40%. Internal consistency checks revealed mismatches in 80% of facilities, including negative ratios in Uganda and ratios >1 in the CAR.

Conclusions: Significant gaps in completeness, accuracy, and internal consistency undermine the reliability of newborn and stillbirth data in routine health information systems, highlighting a need for their strengthening, the integration of standardised newborn indicators, and institutionalized quality verification processes to ensure timely, reliable, and actionable data for improving newborn care.

Background: The concept of small vulnerable newborns has been proposed, including preterm birth, low birth weight, and small for gestational age, leading causes of perinatal mortality. We aimed to identify high-risk factors for small vulnerable newborns and develop a predictive model through a retrospective analysis.

Methods: We collected clinical data from pregnant women who met inclusion criteria between January 2015 and December 2023 and divided them into training and validation cohorts. We used univariate analysis and mean decreases in the Gini index to screen for potential risk factors. We applied the least absolute shrinkage and selection operator regression to select final predictors and construct a nomogram. We assessed model performance using receiver operating characteristic curves, calibration curves, and clinical decision analysis, with internal validation via 10-fold cross-validation and temporal internal validation.

Results: Among 129 554 women, 13 801 (10.66%) had small vulnerable newborn, with the incidence increasing from 2015 (10.15%) to 2023 (11.61%). Key risk factors included multiple pregnancies (odds ratio (OR) = 37.2), pre-pregnancy body mass index (BMI) of <18.5 (OR = 8.61) and ≥25 kg/m² (OR = 6.40), maternal age of <25 (OR = 6.81) and ≥35 years (OR = 3.72), hypertensive disorders of pregnancy (OR = 2.81), and placental disorders (OR = 3.03). Other significant factors were assisted reproductive technology, mycoplasma/chlamydia infection, and elevated bile acids. The nomogram demonstrated strong predictive performance (area under the curve = 0.873).

Conclusions: The incidence of small, vulnerable newborns rose notably during 2021-2023. The developed model, incorporating age, pre-pregnancy BMI, multiple pregnancies, hypertensive disorders of pregnancy, and placental disorders, is designed to be applied in the third trimester and enables risk identification, facilitating targeted interventions to reduce neonatal mortality and complications.

Registration: Chinese Clinical Trial Registry, ChiCTR2400093923.