Journal of Global Health最新文献

Background: Despite substantial progress in maternal and child health (MCH) in China, achieving equitable outcomes across urban and rural areas remains elusive. To this end, this study investigated long-term trends in urban-rural disparities in maternal and child mortality rates in China from 1991 to 2023 and projected future trajectories for the 2024-30 period.

Methods: We obtained data on national, urban, and rural maternal mortality ratios (MMRs), under-five mortality rates (U5MRs), infant mortality rates (IMRs), and neonatal mortality rates (NMRs) for the 1991-2023 period from the National Bureau of Statistics of China. We analysed and predicted mortality rates during this period by utilising rate differences (RDs), rate ratios (RRs), average growth rates, and estimated annual percentage changes, along with the autoregressive integrated moving average model.

Results: From 1991 to 2023, the national MMRs declined from 80 per 100 000 live births to 15.1 per 100 000 live births. Over the same period, U5MRs decreased from 61.0‰ to 6.2‰, IMRs declined from 50.2‰ to 4.5‰, and NMRs declined from 33.1‰ to 2.8‰. During this period, urban MMRs decreased from 46.3 per 100 000 live births to 12.5 per 100 000 live births. Correspondingly, urban U5MRs declined from 20.9‰ to 3.9‰, IMRs declined from 17.3‰ to 2.9‰, and NMRs declined from 12.5‰ to 1.7‰. In rural areas, MMRs declined from 100 per 100 000 live births to 17.0 per 100 000 live births, while U5MRs declined from 71.1‰ to 7.2‰, IMRs declined from 58.0‰ to 5.2‰, and NMRs declined from 37.9‰ to 3.2‰. The RDs and RRs of MMRs, U5MRs, IMRs, and NMRs exhibited overall downward trends, while the autoregressive integrated moving average model predicted continued declines in mortality rates across the country, including in urban and rural areas, from 2024 to 2030.

Conclusions: China has achieved substantial progress in MCH, with mortality rates and disparities falling in both urban and rural areas, yet urban-rural disparities persist. Future MCH services should shift from broad coverage to precision quality improvement. These experiences also offer valuable insights for low- and middle-income countries (LMICs) undergoing rapid urbanisation, highlighting the importance of coordinated development of urban and rural health systems to achieve equitable and accessible health outcomes.

Background: The relationships among clinical hypothyroidism (CH), subclinical hypothyroidism (SCH), and intrahepatic cholestasis in pregnancy (ICP) remain unclear. We aimed to determine the relationship between hypothyroidism and the risk for ICP.

Methods: We conducted this retrospective cohort study at a tertiary care hospital. We used logistic regression analysis to study the risk of ICP, and restricted cubic splines to clarify the quantitative relationship between thyrotropin (TSH) or free thyroxine (FT4) and ICP. We used the Kaplan-Meier method and Cox regression to evaluate the relationship between hypothyroidism and the onset of ICP. Lastly, we checked the Cox proportional hazards assumption using the Schoenfeld residual test.

Results: We included 42 615 pregnant women in the final study. The risk of ICP was higher in the CH group (adjusted odds ratio (aOR) = 3.03; 95% confidence interval (CI) = 2.00-4.58, P < 0.001) than in the euthyroidism group. Thyroid peroxidase antibody (TPOAb)(+) CH was also significantly associated with the risk of ICP (aOR = 3.30; 95% CI = 1.92-5.68, P < 0.001). However, SCH was not significantly associated with the risk of ICP. Consistent results were observed in the subgroup analysis of ICP based on onset time and severity. Furthermore, reduced FT4 and elevated TSH levels had a dose-response relationship with ICP. Additionally, ICP occurred earlier in the TPOAb(+) CH subgroup than in other groups (log-rank P < 0.001; hazard ratio = 3.50; 95% CI = 2.05-5.98, P < 0.001).

Conclusions: We found that CH was significantly associated with a greater risk of ICP. CH, especially TPOAb(+) CH, is associated with a greater risk of both early and severe ICP. Furthermore, the prevalence of ICP increases with increasing TSH and decreasing FT4.

Background: Salmonella can be classified as either typhoidal or non-typhoidal. The former primarily causes invasive infections, while the latter typically results in self-limiting diarrhoea. Infections caused by invasive non-typhoidal Salmonella (iNTS) are becoming an emerging global health burden, particularly in low- and middle-income regions. While they account for thousands of deaths each year, we still lack systematic analysis on their burden and epidemiology in Asia, particularly in China.

Methods: We searched Web of Science, PubMed, China National Knowledge Infrastructure, Wanfang Data, Airiti Library, and the China Science and Technology Journal Database on 31 March 2024. The primary outcomes of interest included the spatiotemporal distribution of iNTS infection cases, patients' characteristics, and clinical outcomes. The secondary outcomes encompassed characterisation of isolates, medical histories, and medication usage. We used the Open Meta-Analyst software to estimate the case fatality rate.

Results: We included 199 publications for analysis. Eastern regions of China were identified as hotspots for infection, males and children were especially susceptible populations, while trauma and metabolic diseases emerged as major risk factors associated with infection. Typhimurium, Choleraesuis, and Enteritidis were the top three serovars responsible for infections, with the bloodstream being the most frequent site of invasion. The overall case-fatality rate of iNTS in China was 8.6% (95% confidence interval = 6.8-10.4).

Conclusions: In exploring the epidemiological trends of iNTS infections in China, we observed significant risk associations with both patient characteristics and pathogen-specific determinants. There is an urgent need to establish enhanced surveillance systems and implement geographically tailored interventions+, particularly in economically underdeveloped regions.

Registration: PROSPERO (CRD42024569499).

Background: The COVID-19 pandemic has affected the academic performance, financial health, scientific output, and student and staff mobility of higher education institutions globally. Here, we report on a retrospective analysis of the core activities at the University of Split, Croatia, from 2017 to 2023, with a focus on the pandemic's impact thereon.

Methods: Using interrupted time series analysis, we examined trends in student success, research output, financial indicators, and mobility patterns before, during, and after the pandemic, with a total of 34 indicators.

Results: We found no significant disruptions in academic performance, financial stability, or overall institutional operations at the university level, while the observed differences at the faculty level were unrelated to the COVID-19 pandemic.

Conclusions: These findings indicate that, in the observed period, the University of Split did not experience measurable pandemic-related disruptions in key academic, financial, and operational indicators. They emphasise the importance of institutional preparedness, digital adaptability, and financial diversification to ensure the stability and resilience of higher education institutions in future crises.

Background: Tuberculosis (TB) is a leading cause of paediatric morbidity and mortality. We sought to identify the prevalence of TB among children admitted to hospital with severe illness and to document incidence of TB, survival, and growth in the six months following discharge from hospital in two TB-endemic countries.

Methods: We screened young children 2-23 months old enrolled in the Childhood Acute Illness and Nutrition Network cohort and admitted to hospitals in Bangladesh and Uganda for participation. Eligible children underwent comprehensive diagnostic evaluation for TB and were followed during hospitalisation and for six months post-discharge. We classified children as having bacteriologically confirmed, clinically diagnosed, or unlikely TB using standardised clinical definitions and microbiologic testing of sputum samples. We compared clinical and sociodemographic characteristics, and their associations with TB disease classification and six-month growth and survival.

Results: Of 365 children eligible for participation, 17 (4.7%) were classified as bacteriologically confirmed, 46 (12%) clinically diagnosed, and 302 (83%) unlikely TB. Overall, 37 children were treated for TB; 18 (49%) during initial hospital admission and 19 (51%) during the six-month post-discharge period. All 17 children with bacteriologically confirmed TB survived through the post-discharge period and six-month survival did not differ by TB disease classification. Children with clinically diagnosed TB were more likely to be malnourished at enrolment, and anthropometric Z-scores were significantly lower among children classified as clinically diagnosed compared to unlikely TB throughout the post-discharge period.

Conclusions: One in 10 children hospitalised in two distinct TB-endemic countries required treatment for TB, with half of these TB treatment courses initiated within a six-month observational period following hospital discharge. Children who meet criteria for clinically diagnosed TB are at increased risk of poor growth during the six months following hospitalisation, regardless of TB treatment initiation. These unique findings highlight the need for post-discharge monitoring for both TB and growth trajectories among recently hospitalised young children in TB-endemic settings.

Background: Myopia progression through childhood to early adulthood can cause serious visual complications and impose a significant economic impact due to its high prevalence and associated management costs. This systematic literature review evaluates the economic impact, health care resource utilisation (HCRU), and cost-effectiveness of current myopia interventions.

Methods: The systematic literature review was performed via the OVID SP® platform (software version 04.07.00, Mumbai, India) covering literature from 2009-2024, with no geographic restriction. Economic evaluation studies used the Markov model and the risk-of-bias was assessed using the Drummond and Jefferson checklist. Abstracts and full texts were screened independently by two reviewers; uncertainties and disagreements were resolved through reconciliation or arbitration by a third independent reviewer.

Results: A total of 20 studies were included: 12 cost-effectiveness, four HCRU, and eight for health care costs across different age groups, with a predominance of studies from East Asia (China, Hong Kong, Singapore). Among the paediatric population, the most cost-effective interventions included digital strategies for early prevention and screening, low-dose atropine (0.05%) with an incremental cost-effectiveness ratio of 234 USD/Spherical Equivalent Refraction reduction, and non-pharmacological defocus incorporated multiple segment lenses (7074 USD/quality-adjusted life year (QALY) gained). In adults, ranibizumab was cost-effective (35 288 USD/QALY gained) for pathologic myopia, while small incision lenticule extraction surgery yielded long-term savings (15 USD/QALY gained). Economic burden was largely driven by vision correction procedures and specialist visits, with notable regional and socioeconomic disparities in Spain and China. In adults, HCRU (frequent treatment, monitoring, hospitalisation, and emergency visits) was higher for myopic choroidal neovascularisation compared to paediatric population, and direct costs exceeded indirect costs.

Conclusion: s Myopia presents a substantial economic burden, highlighting the need for optimising cost-effective interventions to reduce severity, prevent long-term vision loss, and lessen the financial burden. However, limited data, geographical bias, methodological inconsistencies, and heterogeneity in outcomes emphasise the need for more standardised, comprehensive evaluations to ensure broader applicability.

Background: Pakistan ranks third in global air-pollution burden, yet evidence on how its air quality-related policies are implemented remains fragmented. We aim to map the existing air quality policies in Pakistan, identify barriers to policy implementation, and highlight policy priorities for improving air quality governance.

Methods: We conducted a scoping review following Arksey-O'Malley and PRISMA-ScR guidelines to map national and provincial air-quality policies, describe their implementation, and identify barriers, facilitators and priority actions. Searches of PubMed, Scopus, and grey literature sources to January 2024 yielded 1438 records; 27 documents (eight peer-reviewed articles, 19 policy reports) met the inclusion criteria. We charted the data on policy characteristics, implementation status, and contextual factors. We synthesised the findings using a narrative descriptive approach.

Results: Seven federal and nine provincial instruments address air quality, including the Pakistan Environmental Protection Act (1997), National Clean Air Policy (2023), and four provincial clean air action plans. Devolved governance, weak enforcement capacity, limited monitoring networks, and scarce, decentralised emissions data hamper implementation. Industrial and transport emissions dominate, while household solid-fuel use and open crop burning persist. Facilitators include recent adoption of Euro-V/VI fuel standards, growing citizen-science monitoring, and policy alignment with climate-change agendas. Priority actions are: a legally mandated federal-provincial task force; an integrated national emissions database combining ground and satellite data; incentive-based regulation with clear standards and fiscal levers; and public engagement through education, media, and community monitoring.

Conclusions: Pakistan has a range of air quality-related policies but lacks the coordinated governance, data infrastructure, and market incentives needed to translate its intent into cleaner air. Bridging these gaps is essential to avert a mounting public health crisis.

Registration: Open Science Foundation (https://doi.org/10.17605/OSF.IO/6ZAE9).

Background: The global prevalence of depression is on the rise, and has evolved into a major public health concern. Given that parental favouritism in childhood exerts a long-term impact on children's mental health, we aimed to explore its association depression in old age.

Methods: We retrieved 19 180 data points from 3836 individuals aged 60 years and over from the China Health and Retirement Longitudinal Study 2011, 2013, 2015, 2018, and 2020 waves, among whom depression was measured using the Centre for Epidemiological Studies Depression Scale. We used logistic analysis to determine the relationship between parental favouritism in childhood and depression in old age, and the bootstrap method to analyse the mediating role of smoking, drinking, socialising, exercising, and sleep duration.

Results: Approximately 17% of older adults experienced parental favouritism during childhood. We found that parental favouritism significantly increased the probability of depression by 29.9% (β = 0.299; 95% confidence interval (CI) = 0.145, 0.453), as did mother's favouritism by 28.4% (β = 0.284; 95% CI = 0.117, 0.450), and father's favouritism by 23.6% (β = 0.236; 95% CI = 0.058, 0.415). Socialising (β = -0.0018; 95% CI = -0.0028, -0.0009), exercising (β = 0.0009; 95% CI = 0.0003, 0.0017), and sleep duration (β = 0.0046; 95% CI = 0.0015, 0.0076) mediated this relationship. An analysis of heterogeneity by gender found that women are more influenced by parental favouritism.

Conclusions: Parental favouritism in childhood significantly predicts the probability of depression in old age. Promoting socialising, exercising, and sleep duration could help to alleviate this issue. We also noted that women are more influenced by parental favouritism. These findings provide guidance for targeted interventions, such as mental health screening and promotion of healthy lifestyles.

Background: Up-to-date data from middle-income countries are needed to inform in-hospital feeding practices among small, vulnerable newborns. We aimed to quantify growth indicators and their associations with in-hospital diet for infants born very preterm or with a very low birth weight (VLBW) of 401-1500 g in 12 middle income countries in Africa, Asia, and Latin America.

Methods: We performed an observational cohort study of infants born at 22-29 weeks' gestation or VLBW from 2018 to 2024 among Vermont Oxford Network member hospitals in 12 middle income countries. We used linear regression to estimate adjusted mean change in weight and head circumference (z-scores based on Fenton reference) from birth to hospital discharge by category of enteral diet at discharge/transfer (human milk only, mixed (human milk with formula and/or fortifier), and formula only), adjusting for confounders, in the entire cohort and stratified by birth weight and foetal growth status.

Results: Among 35 843 infants, the median length of stay was 50 days (interquartile range = 37, 65). Eighty-four percent were receiving at least some human milk at discharge (34% human milk only, 50% mixed, 16% formula only). Adjusted mean weight z-score declined by 1.40 in the human milk only group, 1.32 in the mixed group, and 1.17 in the formula only group. The adjusted estimated difference between mixed diet and formula only groups was 0.15 z-scores (95% confidence interval (CI) = 0.10, 0.20), and between the mixed and human milk only groups was 0.08 (95% CI = 0.00, 0.15). Head growth differed little between groups.

Conclusions: Human milk use was high at discharge in this vulnerable population of infants born at 22-29 weeks or VLBW in middle- income countries. Infants fed a mixed diet gain weight more slowly than infants fed only formula. Rigorous intervention studies are needed determine optimal nutrient delivery strategies for infants fed human milk in this context.

Background: This paper introduces and describes a new integrative scientific approach - ideometrics - building on the 'sense of ideas' and 'value of information' concepts. Ideometrics is the emerging field of generating, evaluating, and prioritising ideas.

Methods: Focused on the generation, evaluation and prioritisation of ideas, we identified and then mapped the landscape of methodological approaches that have been used over time, disciplines, and epistemic paradigms across many areas of human enquiry. Although these often appeared to arise independently, isolated by geographical and disciplinary boundaries, they share remarkable conceptual and structural similarities, from creative ideation, balancing of subjective and objective criteria, to iterative refinement. Finally, we sought to integrate these traditions through an empirical scientific framework.

Results: We identified over 70 different methodological approaches. We then proposed several steps to establish ideometrics as a rigorous and practically useful field of science, rather than merely an integrative framework. Ideometrics is falsifiable: it supports testable predictions about future performance of competing ideas, while its methods are increasingly evolving into rigorous, structured, standardised and mathematically characterised tools. It enables accumulation of evidence and progressive refinement of theory, application of statistical inference, and introduction of artificial intelligence (AI).

Conclusions: Future progress will make ideometrics increasingly quantitative, digital, testable and replicable. We therefore foresee assessments of scientific footprints of each of the >70 methodological approaches, developing formal reporting guidelines to standardise ideometrics studies and allow meta-analyses, and conducting empirical comparisons between methods used to address the same challenges. Ideometrics represents an attempt to systematically unify the scientific approaches to generating, evaluating, and prioritising ideas. Its practical application should address scarcity by assisting individuals, institutions, and societies to focus their limited time, energy, capacity and resources on pursuing the ideas most that are likely to achieve their stated aims, based on an objective and scientific approach, rather than subjective and intuitive priority setting.