Journal of Global Health最新文献

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.

Background: The COVID-19 pandemic further exacerbated the burden of drug use disorders (DUDs), and systematic quantification of inequalities in DUDs remains limited. Thus, a comprehensive evaluation of the global burden and inequalities of DUDs following the COVID-19 pandemic is necessary.

Methods: We used data from the Global Burden of Disease 2021 study to evaluate the global burden of DUDs from 1990 to 2021, stratified by sex, age, country, region, socio-demographic index (SDI), and drug category. The slope index of inequality and the concentration index of inequality are applied to quantify absolute and relative inequalities in both overall and drug-specific burdens across SDI regions. Future trends through 2036 were projected using an autoregressive integrated moving average model and Bayesian age-period-cohort model.

Results: This study revealed that the global burden of DUDs increased greatly from 1990 to 2021, with the highest burden observed among individuals aged 15-49 years and consistently greater in males. High-income North America and the USA bore the highest burden at the regional and national levels, respectively. The analysis by drug category indicated that opioid use disorder represented the predominant contributor to the overall burden of DUDs. Both absolute and relative inequalities in the overall burden of DUDs increased across SDI levels, with marked variations in inequality patterns across drug categories. Inequalities have intensified for opioid and amphetamine use disorders, whereas those related to cannabis use disorders have declined. Both models predicted increasing incidence, deaths, and age-standardised mortality rate accompanied by declining age-standardised prevalence rate, but showed opposite trends for prevalence, disability-adjusted life years (DALYs), age-standardised incidence rate, and age-standardised DALY rate.

Conclusions: Over the past three decades, the burden of DUDs has increased markedly, accompanied by wide disparities. Addressing these challenges requires strengthened surveillance, context-specific interventions, and cross-country learning.

Background: Pregnant women in malaria-endemic countries are at risk of placental malaria (PM), which can lead to adverse outcomes for both mothers and children. Histology of placental tissue is the gold standard for diagnosing PM, as it can detect current and past infections. Prior reviews focussed on malaria in pregnancy generally; in this systematic review, we specifically examine PM due to Plasmodium falciparum, its associated risk factors, and its impact on maternal and foetal outcomes.

Methods: We included studies performed since 2013, reflecting important updates in WHO policy recommendations for PM control efforts and resistance to sufadoxine-primethamine resistance over the past decade. After extracting relevant data, we calculated the pooled prevalence, odds ratios (ORs), and risk ratios. We assessed the quality of the included studies using the Newcastle-Ottawa scale.

Results: The review included 50 studies, 45 of which were from sub-Saharan Africa (SSA), with 15 (33%) of them using histological diagnosis. Global PM prevalence was 17% (95% confidence interval (CI) = 12-21), rising to 23% (95% CI = 1-4) in histology-based studies. Prevalence was higher in SSA (19%; 95% CI = 14-24) than in other regions (4%; 95% CI = 1-9), with West Africa showing the highest rates. One study including only HIV-positive women reported a PM prevalence of 45% (95% CI = 38-52) compared to 17% (95% CI = 10-25) in HIV-negative women. One study on stillbirth showed an OR of 3.81 (95% CI = 1.22-11.94) and primigravidae had pooled ORs of 1.61 (95% CI = 0.91-2.84) compared to multigravidae. The ORs and CIs for congenital malaria, malaria in infancy, preterm birth, and low birth weight were wide, indicating imprecision.

Conclusions: Our meta-analysis reveals a high PM burden in high- malaria transmission areas, especially among primigravidae and HIV-positive women. We note that PM remains high in SSA, with regional variation, with one in four pregnant women diagnosed by histological examination of the placenta, reflecting both current and past PM exposure. Reliance on non-histological methods may lead to underestimation of true PM prevalence. Due to wide confidence intervals and limited data, we could draw no conclusions on the impact of PM on maternal and foetal outcomes. Residual high heterogeneity reflects real-world diversity across populations, strengthening the generalisability of our findings.

Background: Diarrhoea among children under five years old (i.e. childhood diarrhoea) causes significant morbidity and mortality in low and middle-income countries (LMICs). We conducted this systematic review and meta-analysis to quantify the proportion of childhood diarrhoea attributable to Campylobacter spp., diarrhoeagenic Escherichia coli (E. coli), Salmonella spp., and Shigella spp. in LMIC settings.

Methods: We included epidemiological studies published between 2000 and 2025, and extracted data on study location, sample size, and pathogen-specific parameters. Two reviewers independently performed database searches, publication screening, data extraction, and quality assessment, with any conflicts resolved by a third reviewer. We reported the results of the meta-analysis as pooled proportions (positive samples divided by the total samples tested for each enteropathogen) and 95% confidence intervals. We assessed all potential sources of heterogeneity using univariable and multivariable meta-regression, quantified moderator contributions as pseudo-R² values based on reductions in τ², and tested for interaction effects. We also evaluated robustness through leave-one-out analyses, sequentially excluding individual studies to examine their influence on pooled estimates and heterogeneity.

Results: We included 71 records encompassing 84 studies. Pooled proportions were 8.6% for Campylobacter spp., 23.0% for diarrhoeagenic E. coli (DEC), 2.6% for Salmonella spp., and 8.8% for Shigella spp., with wide variation across studies. Subgroup analyses showed higher proportions of Campylobacter spp. and Shigella spp. in Asia and with polymerase chain reaction-based detection, and greater DEC proportions in America and Africa. Salmonella spp. remained low across regions and study designs. Year- and country-specific analyses showed no consistent temporal trends, though DEC peaked in 2014 (77.9%, two studies) and Shigella spp. was higher in 2020 (20.7%, ten studies), both driven by a limited number of studies.

Conclusions: Standardising diagnostic methods and study designs is essential for reducing heterogeneity and improving the reliability of pooled proportion estimates in epidemiological research on enteric pathogens. Improving water supply, sanitation, hygiene, and food safety remains crucial for reducing the burden of childhood diarrhoea in LMICs.

Background: Emergency medical services (EMS) personnel, including paramedics, emergency medical technicians (EMTs), and firefighters are subjected to substantial occupational stressors that diminish job satisfaction and increase turnover rate, ultimately affecting efficient delivery of pre-hospital emergency care. Therefore, we performed the first meta-analysis to determine the prevalence of job satisfaction and turnover intention among EMS personnel, including paramedics, emergency medical technicians (EMTs), and firefighters.

Methods: We comprehensively searched Web of Science, PubMed, Cochrane Library, Embase, and EBSCOhost until March 2025. The pooled prevalence of job satisfaction and turnover intention was analysed using the Freeman-Tukey double-arcsine transformation model in R software. Cochran's Q and statistics assessed heterogeneity and subgroup analysis explored moderator variables.

Results: A total of 25 studies with 59 562 EMS personnel were included. The pooled prevalence of job satisfaction was 63% (95% confidence interval (CI) = 53%, 72%), with estimates of 71% for EMTs, 62% for firefighters, and 54% for paramedics. Job satisfaction was 56% during the COVID-19 pandemic and 65% in the pre-pandemic period. The pooled prevalence of turnover intention was 29% (95% CI = 24%, 36%), with estimates of 28% for paramedics, 22% for EMTs, and 17% for firefighters. Turnover intention was 34% during COVID-19 pandemic and 27% in the pre-pandemic period.

Conclusions: Approximately, 63% of EMS personnel report job satisfaction, while 29% express intent to leave the profession. Mental health support, workload management, and professional development opportunities should be promoted among EMS personnel to further enhance job satisfaction and mitigate turnover intention.

Registration: PROSPERO: CRD420251027283.