Journal of Global Health最新文献

Background: Factors impacting on the conversion of prediabetes to diabetes or normoglycemia remain unclear. This study aimed to investigate the role of subclinical inflammation, assessed by high-sensitivity C-reactive protein (hsCRP), in the progression to diabetes from prediabetes, assessed by impaired fasting glucose (IFG).

Methods: Time-to-event survival analyses were conducted among 82 475 participants without diabetes from Kailuan Study (a real-life prospective cohort in China) to access the isolated and joint effect of hsCRP and IFG on diabetes risk, and quantify their relative contribution to incident diabetes.

Results: Over a median 11-year follow-up, 14 215 diabetes cases were recorded. IFG and hsCRP independently and jointly increased diabetes risk. Diabetes incidence was higher in those with elevated inflammation (hsCRP≥2 mg/L: 90.45 vs. 66.76 per 1000 person-years). The joint effect risk (hazard ratios (HR) = 4.96; 95% confidence interval (CI) = 4.66-5.28) exceeded the sum of individual risks (HR = 4.29; 95% CI = 4.09-4.49 for IFG and HR = 1.11; 95% CI = 1.06-1.16 for elevated inflammation), with a relative excess risk due to interaction of 0.56 (95% CI = 0.23-0.89). Attributable proportions were 83.08% for IFG, 2.78% for hsCRP, and 14.14% for their interaction. The joint risks and the additive interaction were significant in both men and women, and were more pronounced among individuals aged <60 years than those aged ≥60 years.

Conclusions: Elevated inflammation synergistically amplifies diabetes risk in prediabetes among Chinese adults, particularly in those <60 years.

Background: Adequate quality of paediatric care remains one of the key factors for reducing child mortality and improving child health in Central Asia. We aimed to assess the quality of paediatric care in hospitals in Kyrgyzstan and Tajikistan before and after a two-year intervention. We implemented a multifaceted approach to improve healthcare quality, focussing on case management, hospital policies, and service organisation.

Methods: We assessed the quality of care in nine hospitals in Kyrgyzstan and ten hospitals in Tajikistan, using a World Health Organization paediatric hospital care assessment tool. The assessment considered three main pillars of care: hospital support services, case management, and policies and organisation of services. We collected the data through direct observation, analysis of general hospital data, case files, policies and procedures, clinical guidelines, reports and interviews with staff, management, and caretakers. We compared the scores (0-3) at baseline with those at the end of the project.

Results: We found many areas of inadequate care at the baseline assessments in both countries. The endline assessment showed improvements in areas such as clinical management of acute respiratory infections, staff training, hospital policies, and the reduction of unnecessary painful procedures. The management of pneumonia, including the use of appropriate antibiotics and oxygen therapy, has improved in most hospitals in both countries. The mean score for assessing suspected pneumonia improved from 2.1 to 2.7 (P = 0.018) in Kyrgyzstan and from 1.6 to 2.1 (P = 0.020) in Tajikistan. Unnecessary, painful, and invasive procedures decreased from 70% to 48% of cases in Tajikistan and from 66% to 36% in Kyrgyzstan. Gaps remained in infrastructure, chronic disease management, and the rational use of medicines.

Conclusions: A set of quality improvement measures led to improvements in the hospitals. Irrational antibiotic prescribing, overmedicalisation, and unjustified hospitalisation continue to be issues related to the broader health system. Systemic issues, including human resource constraints, infrastructure limitations, and supply shortages, need to be addressed. Scaling up the project to other hospitals would improve the overall quality of care.

Background: To address the limited evidence in Asian populations, we aimed to elucidate the association of weight changes from young to middle adulthood with blood pressure and hypertension among Chinese adults.

Methods: We used data from the China Health Evaluation and Risk Reduction Through Nationwide Teamwork (ChinaHEART) project conducted in Shandong Province, China between December 2015 and November 2022. Within the ChinaHEART project, participants aged 35 to 64 years were selected, and standardised measurements (including questionnaires, physical examinations, and laboratory measurements) were performed. We used multivariable adjusted restricted cubic splines, linear regression models and logistic regression models for analysis.

Results: We included 56 459 participants for analysis. Compared to stable normal weight, all other weight trajectories (maximum overweight, obesity to non-obesity, non-obesity to obesity, and stable obesity) showed positive associations with systolic and diastolic blood pressure. Hypertension risk increased progressively across these groups, with adjusted odds ratios (OR) of 1.83 (95% confidence interval (CI) = 1.73, 1.94), 2.29 (95% CI = 1.81, 2.89), 3.88 (95% CI = 3.62, 4.17), and 4.96 (95% CI = 4.09, 6.00), respectively.

Conclusions: Weight gain from young to middle adulthood independently predicts elevated blood pressure and hypertension. Public health strategies should prioritise weight management across the life course to mitigate hypertension burden.

Background: Core capacities in preparedness, detection, and response to health emergencies were fundamental to achieving health equity. However, evidence on the socioeconomic inequalities in country-level global health security (GHS) capacities remains limited, and the role of the health system in contributing to these disparities is insufficiently understood.

Methods: We assessed the socioeconomic inequalities in country-level GHS capacities and decomposed the role of health systems in shaping these inequalities by applying the GHS index and Joint External Evaluation. We conducted the decomposition based on a linear regression model with the determinants reflecting economic status, social development, and the health system. We also decomposed the changes in the concentration index (CI) using an Oaxaca-type decomposition.

Results: Disparities in country-level health security capacities in response to health emergencies have been reported (CI = 0.143; P < 0.001). Economic status accounted for 44.639% of the total inequality, while social development accounted for -13.386%, and the health system for 67.454%. Disparity of the health system was the leading cause of inequality in health security capacity. From 2019 to 2021, economic status contributed to the change of inequality by 70.168%, social development by -62.544%, and the health system by -42.219%.

Conclusions: Our results emphasised the fundamental role of health system strengthening in improving health security. Strengthening health systems, particularly through the enhancement of the universal health coverage framework by recognising the interconnection between health systems and health security, offers a viable strategy for achieving equality-driven GHS goals.

Child mortality continues to pose a major public health challenge in South Asia, where under-five and neonatal mortality remain high, especially in Afghanistan, Pakistan, and parts of India. Here, we synthesised evidence from 38 studies published between 2012 and 2024, examining predictors of mortality, barriers to effective nursing and midwifery interventions, and strategies to strengthen these roles. We identified four barrier domains: inadequate education and professional development, socio-cultural and gender constraints, infrastructure and resource shortages, and systemic policy challenges. Across several countries, over half of midwives lacked adequate pre-service training, more than 60% of facilities reported critical equipment shortages, and restrictive policies limited midwives' autonomy. Despite these challenges, community-based interventions and targeted policy reforms demonstrated measurable improvements, including up to 49% increases in institutional deliveries and reductions in neonatal mortality by 2-3 per 1000 live births. Strengthening midwifery and nursing capacity through competency-based education, investment in rural health systems, and culturally sensitive community engagement - guided by World Health Organization and International Confederation of Midwives frameworks - represents a feasible pathway for reducing preventable child deaths and advancing progress toward Sustainable Development Goal 3 in South Asia.

Background: Dietary diversity (DD) is the consumption of a variety of different and healthy foods that promote an adequate supply of nutrients, a high-quality diet, and the maintenance of optimal health. It is critical to identify the factors that influence pregnant women's eating habits so that relevant interventions can be developed. We estimated the pooled odds ratio of appropriate dietary practices to identify factors that affect the dietary practices of pregnant women.

Methods: We conducted an electronic-based systematic search for observational studies conducted in Ethiopia and published in English. We retrieved published articles up to the last search date on 1 July 2022, from databases, including the Web of Science, PubMed, EMBASE, Cochrane library, CINHAL, and HINARI. Grey literature was included from Google and Google scholar searches. The measure of effect was a pooled odds ratio examining the association between the risk factors and adequate dietary diversity among pregnant women. The Cochran's-Q statistic and I² statistic tests with corresponding P-values were used to determine the existence of heterogeneity between studies. Publication bias was tested using a funnel plot of symmetry and further investigated using Egger and Begg tests. The results were presented using forest plots, funnel plots, tables, and figures.

Results: We included 29 articles with maximum and minimum sample sizes of 759 and 241, respectively. Among the included articles, 13 were facility-based cross-sectional studies;16 studies were community-based cross-sectional studies. The pooled proportion of adequate DD was 42.48% (95% confidence interval (CI) = 31.82, 53.14). Knowledge of DD (OR = 3.10; 95% CI = 1.92, 4.99), income (OR = 0.35; 95% CI = 0.14, 0.85), and nutritional information (OR = 1.91; 95% CI = 1.15, 3.17) were predictors for adequate DD practice among pregnant women.

Conclusions: The pooled proportion of adequate DD among pregnant women was low. Knowledge of DD, household income, and nutritional information were associated factors with the adequate dietary diversity of pregnant women. We recommend focusing on interventions that will enhance the knowledge of dietary diversity through improved nutritional awareness and enhance access to food resources through existing maternal health initiatives.

Registration: PROSPERO: CRD42022298172.

Background: Standardised herbal products present a solution to the high burden of diseases and inadequate access to drugs in Africa. This literature review explores the steps that the Member States of the World Health Organization Regional Office for Africa have taken to standardise herbal medicines.

Methods: We retrieved publications from Google and Google Scholar search engines and through published and non-published information physically available at the WHO AFRO. The search terms to identify the publications were 'herbal medicine' OR 'traditional medicine' AND 'member state' between 2013 and 2023, where 'member state' stood for the individual names of the World Health Organization African region member states. We extracted information on the regulation, established structures in the ministry of health, registration systems, and research and training facilities on herbal medicines from the retrieved publications.

Results: Member States have taken significant steps toward standardising herbal medicines through policymaking and research, such as clarifying the necessary regulatory framework; establishing a department, division, national office, or expert committee in their ministries of health; instituting a system for registering herbal medicines; and establishing research and training facilities for herbal medicine. However, only a few Member States have implemented all four aspects of herbal medicine standardisation and registration processes, with several of them lacking dedicated registration systems.

Conclusions: The WHO AFRO Member States are steadily establishing systems for the standardisation and registration of herbal medicines. Those that have made strides in specific aspects of standardisation and registration, as highlighted in the country-by-country analysis, should serve as benchmarks to others.

Background: During the COVID-19 pandemic, an increasing number of patients have reported persistent symptoms after recovery, a phenomenon known as long COVID. These symptoms may persist for weeks or months, affecting the patient's daily life and health. To systematically understand the long-term impact of long COVID, this study conducted a systematic review and meta-analysis. This study aims to determine the long-term effects of long COVID by identifying, evaluating and summarising the incidence and duration of persistent symptoms after the acute phase of COVID-19.

Method: We searched PubMed, Embase, and medRxiv up to August 2021 for articles and preprints presenting original research on the symptoms of long COVID. Following title/abstract and full-text screening, based on the PICOS framework, we excluded articles that did not clearly report on diagnoses, reported on symptoms lasting less than four weeks, lacked epidemiological data, or did not provide complete data. We assessed the bias of included studies using the Newcastle-Ottawa Scale. For effects reported in more than two studies, we performed meta-analysis of prevalence, and also counted the duration of each symptom.

Results: We included 19 observational studies in the meta-analysis, through which we determined the incidence and duration of five common long COVID symptoms, including cognitive/memory/attention disorders (36%, unreported duration), fatigue (34%, 5.5 months), mental health problems (including anxiety and depression, 31%, 3.5-3.8 months), and dyspnoea (24%, 6.52 months) and chest pain (23%, 2 months).

Conclusions: The symptoms of long COVID usually persist after the acute phase of COVID-19. The clustering of long COVID symptoms provides a direction for studying the aetiology, diagnosis, and management of post-COVID conditions. Our findings provide important baseline data for the prevention and treatment of long COVID.

Background: Rural communities face challenges to mental health care, including cultural barriers and lack of accessibility. There is a general scarcity of data on the mental health of adolescents in rural regions of Mexico. The aim of the present study was to determine the prevalence of depression in adolescents and young adults in a rural Mexican community.

Methods: A cross-sectional observational study was conducted from April to September 2023, of individuals aged 15-25 of rural communities of San Luis Potosí, Mexico. Stratified sampling (n = 1057) ensured gender/age representation. Participants received two psychoeducation sessions, followed by a Spanish-language the 9-item Patient Health Questionnaire (PHQ-9) scale to quantify depressive symptoms. Mann-Whitney U and Fisher Exact tests were used to compare continuous and categorical variables, respectively. Principal component analysis was used to identify the most important items associated with probable clinical depression.

Results: Sixty-one percent of the participants exhibited depressive symptoms, 23% met criteria indicating a probable diagnosis of major depressive disorder, and 29% reported suicidal ideation. A probable diagnosis of major depressive disorder was significantly more frequent in female subjects, those with a personal history or familial antecedents of depression, and those that experienced suicidal ideation. Most endorsed PHQ-9 items were sleep disturbances and feeling tired or low on energy, and females had significantly higher PHQ-9 scores than males. Principal Component Analysis indicated a single factor that explained 55% of the variance and encompassed all nine items, while suicidal ideation was additionally associated with a second factor that accounted for an additional 10% of variance.

Conclusions: There is a significant depression burden among rural Mexican youth. Psychoeducation may help adolescents identify past and present episodes of depression in themselves as well as in their family and peers. Targeted mental health services in rural communities are necessary to confront disparities in mental health care.

Background: There are currently no World Health Organization and United Nations Children Fund benchmarks or 'norms' for scaling up small and sick newborn (SSN) service delivery in health facilities in low- and middle-income countries (LMICs). Specifically, there is limited evidence on optimal bed space requirements in SSN units such as special care nurseries and neonatal intensive care units (NICUs). Through this systematic review, we aimed to gather evidence on the optimal space requirements needed for SSNs and their mothers in health facilities, particularly at level 2 district hospitals.

Methods: We included simulation, experimental, and observational studies, as well as guidelines and formal expert opinion processes that described the optimal bed space for SSN units within any health facility. We searched Medline (via Ovid), EMBASE (via Ovid), CENTRAL (via the Cochrane Library), CINAHL (via EBSCO), and LILACS from inception to October 2023. We assessed the quality of included studies using the RoB 2, ROBINS I, ROBINS E, and AGREE-II tools. We narratively described and synthesised all data.

Results: We identified 10 574 studies and, after deduplication, screened 8453 titles and abstracts and assessed, followed by the full texts of 125 studies for eligibility. We included 12 reports which discussed three guidelines and one simulation-based study. All four came from high-income countries. Only one guideline specified the required bed space and floor space to be 2.8 m² and 14 m² per bed in an open bay unit, respectively. One study defined the mother-NICU bed space requirements for a mother and her infant as 20 m² (inclusive of the bathroom), while another stated it to be 28 m² (exclusive of the bathroom).

Conclusions: We found no studies describing space requirements for SSN units in LMICs and limited evidence for the optimal space requirements for open bay and mother-NICU beds in high-income countries. Much of the data reported was too heterogeneous to combine. More research, especially simulation studies, is needed to establish optimal space requirements for SSN units, including benchmarks that demonstrate functionality and the impact on infection control.

Registration: PROSPERO: CRD42022378329.