Annals of Global Health最新文献

Background: Agricultural migrant workers in rural Puglia, Italy, endure harsh living and working conditions that significantly affect their health and limit access to healthcare. This study evaluates their health status, explores systemic barriers to care, and evaluates the effectiveness of a mobile clinic model, identifying structural obstacles to healthcare access. Methods: Data were collected from 13,103 medical visits conducted between 2017 and 2023 by Doctors with Africa University College for Aspiring Missionary Doctors (CUAMM)'s mobile clinics operating in 12 informal settlements. Demographic, clinical, and socio‑health data from 2,537 unique patients were analyzed. Statistical methods, including multivariate regression, were employed to identify health trends and predictors of healthcare utilization. Results: The patient cohort was predominantly male (95.8%) and aged 19-45 years (83%). Work‑related musculoskeletal disorders were the most common diagnoses (27.3%), followed by respiratory infections (14.3%), dermatological conditions (12.1%), and dental problems (7.2%). Only 18% of patients had a residence permit, and 7% were registered with a general practitioner. Despite significant barriers, the average number of follow‑up visits per patient was 5.6, indicating trust in the mobile clinic model. Barriers included linguistic and cultural challenges, low health literacy, and irregular legal status. Mobile clinics provided not only primary medical care but also referrals and socio‑health guidance, effectively bridging healthcare gaps for this population. Conclusions: This study underscores the health vulnerabilities of migrant workers and the critical role of mobile clinics in addressing their needs. Integrating flexible care models with traditional systems, addressing labor exploitation, and improving living conditions are imperative. Collaborative efforts involving institutions, nongovernmental organizations (NGOs), and academia are essential to ensuring equitable, accessible, and sustainable healthcare for this marginalized population-leaving no one behind.

Introduction: Following the introduction of the Global Health Security Index (GHSI), the coronavirus disease 2019 (COVID‑19) pandemic emerged as an unprecedented global health crisis, underscoring the need for robust health security frameworks and preparedness measures. This study conducts a scoping review to analyze the existing literature on the GHSI and assess national COVID‑19 responses across different countries. Method: A comprehensive search of electronic databases (EBSCO, EMBASE, PubMed, Scopus, and Web of Science) was conducted for articles published from 2020 to 2024. Search terms included "Global Health Security Index" and terms related to COVID‑19. The study followed the Preferred Reporting Items for Systematic Reviews and Meta‑analyses for Scoping Reviews (PRISMA‑ScR) guidelines. The Newcastle-Ottawa Scale (NOS), adjusted for cross‑sectional studies, was used for quality assessment. Results: A total of 3,243 studies were identified, of which 20 were finalized for data synthesis. Specific COVID‑19 parameters were analyzed to provide a comprehensive overview of each country's pandemic response capacity. Among the selected studies, 17 (85%) had a low risk of bias, while 3 (15%) had a medium risk. Countries' response capacities were categorized into five key parameters: detection, mortality, transmission, fatality, and recovery. Findings revealed significant discrepancies between GHSI scores and actual national responses, with some high‑scoring countries struggling to control the pandemic. This raises concerns about the GHSI's predictive reliability. Conclusion: The study highlights that the GHSI does not fully capture a country's capacity to respond effectively to COVID‑19. However, it remains a valuable tool for identifying gaps in pandemic preparedness. To enhance its relevance, the index should integrate a wider range of factors, including political leadership, governance, public health infrastructure, and socio‑cultural elements, which are crucial in managing public health emergencies.

Background: Effective and scalable strategies are needed to develop health research capacity in low- and middle‑income countries (LMICs). Health research capacity strengthening (HRCS) focuses on boosting production and utilization of health research, with clinicians as key target participants. Despite the increased prevalence of virtual HRCS programs, there has been no review of the evidence for those targeting LMIC clinicians to date. Objective: This review characterizes the use of virtual tools in HRCS programs for clinicians in LMICs and describes the impacts, facilitators, and barriers associated with these programs. Methods: Following our protocol (PROSPERO; CRD42020152510), we employed an integrative review methodology. We adapted Cooke's Research Capacity Development for Impact framework by adding "equity" as a new domain and used it to evaluate programmatic impacts. We retrieved relevant articles from five databases and gray literature. Included articles were extracted and stratified by degree of virtual delivery. We analyzed virtual tool usage via content analysis. Using NVivo, we coded until theoretical saturation and analyzed data using the constant comparison method. Findings: From 1397 articles, 58 met inclusion criteria. Most programs were hybrid, and e‑courses were the most used virtual tool. Articles described impacts across all framework domains; the most discussed were skills and confidence building. Facilitators included user‑friendly platforms, interactive content, and strategies to improve program access, including financial and technological support. Some programs incorporated hybrid strategies to foster trust among participants and virtual mentors. Barriers included a lack of or an unfavorable local research culture. Conclusions: Recommendations from this review may guide the design and implementation of virtual HRCS programs for LMIC clinicians. These include selecting well‑fitted program participants, intentionally designing program structure and content, conducting needs assessments or pilots, incorporating equity as a programmatic target, ensuring longitudinal program evaluation and monitoring, and utilizing a comprehensive conceptualization of program sustainability.

Background: Participation in global health (GH) training experiences is common for US medical trainees (students, residents, and fellows). However, little is known about their experience of "culture shock" (CS), which frequently occurs during these transformative cross‑cultural immersions. Objectives: The objectives of this study include: (1) quantitatively measure medical trainee psychosocial responses to short‑term GH electives, (2) identify factors that influence their CS experiences, and (3) determine if the stage‑based CS conceptual framework applies to medical trainees. Methods: Undergraduate and graduate medical education trainees (UME and GME) who participated in short‑term GH electives between 2016 and 2020 were recruited across nine US institutions. Using a longitudinal survey method, we gathered data predeparture (demographics, resilience, perceived stress (PS), and CS assessments), every 5 days during the elective (CS, PS assessments, and training site conditions), and 30 days postreturn (perceptions of CS experiences). Analyses included summary statistics, linear regressions, and a linear mixed effects model (LMM). Findings: 252 trainees were enrolled, with 140 (56%) included in the LMM. The primary outcome was a culture shock profile (CSP) score, with 96% reporting CS. The only trainee‑specific factor that significantly increased CSP score was trainee type (UME > GME (+22%)). Several GH elective site‑specific factors significantly influenced CSP score (e.g., support network [-10%], role clarity [-11%], and overwhelmed by medical needs [+10%]). CS experiences were variable and did not progress in predictable, stage‑based fashions, which is discordant from common CS descriptions. Conclusions: Culture shock was a near‑universal, diverse experience during GH electives. On‑site training conditions and elective site host factors influenced CS more than trainee factors in this prepandemic cohort. Further research is required to (1) determine the optimal CS "balance" (i.e., promoting transformative learning while mitigating negative professional and personal impacts), (2) offer insight into harmful CS thresholds, (3) identify host perspectives, and (4) inform best practices for GH electives and global partnerships.

Background: Antimicrobial resistance (AMR) and migration are two interlinked issues and both pose an escalating threat to global health. With an increasing trend, there are 281 million migrants globally, while AMR is contributing to over 5 million deaths annually, with a projected rise to 10 million by 2050 if left unaddressed. Both AMR and migration are multifaceted problems that extend beyond human health, involving animals, plants, and the environment-a fact highlighted by the One Health approach. Objective: The aim of this work is: (1) to examine the complex relationship between migration and AMR, drawing on epidemiological data, surveillance strategies, and healthcare access challenges and (2) to address an interventional strategy proposal. Methods: We performed a narrative review of the most updated literature about migration and AMR using three primary databases: PubMed, Scopus, and Embase. Findings: Migrants, particularly from low‑ and middle‑income countries, represent a unique group at increased risk of AMR due to factors such as overcrowded living conditions, limited access to healthcare, uncontrolled use of antibiotics, and high prevalence of AMR in origin countries. Studies reveal higher rates of AMR colonization and infection among migrants compared with native populations, with specific pathogens such as MRSA and multidrug‑resistant gram‑negative bacteria posing significant risks. Migratory conditions, socioeconomic vulnerability, and healthcare barriers contribute to this heightened risk. Conclusion: To address the intersection of migration and AMR, interventions must focus on improving living conditions, enhancing healthcare access, promoting appropriate antibiotic use, and strengthening microbiological surveillance. Multisectoral collaboration is essential to mitigate the spread of AMR and safeguard both migrant and global public health.

Background: There is widespread agreement on the potential of multisectoral action to address the social determinants of maternal health. We conducted an implementation research study in Meghalaya, a northeastern Indian state with a high burden of maternal mortality where the government initiated "Rescue Mission" to strengthen the health system and to address underlying determinants to improve maternal health indicators. The initiative was grounded in building state capability and decentralised leadership. Objective: We developed a theory of change and examined implementation barriers and enablers through an implementation research study with government and community actors and institutions. Methods: We conducted multiple rounds of qualitative data collection over a period of eighteen months across six districts. Participants included primary care providers in the public health system and frontline workers in thirty sampled facilities. We also interviewed officials across three government departments, observed meetings and met regularly in a feedback loop with government. Data were analysed thematically and synthesised according to pathways of change. Findings: The state institutionalised multisectoral collaboration across governance levels through building technical and adaptive leadership. Processes included joint meetings at the facility, district and state levels to develop action plans and facilitate collaboration, community engagement through frontline workers and decentralised use of data. Strength of participation by different sectors varied widely; non‑health cadres reported challenges such as being accountable to multiple departments. Political priority and administrative leadership were the key elements of the State's ability to implement a multisectoral approach. Overall, health outcomes improved and the State largely achieved its commitment to building technical skills, but also recognised the need for further investments to develop a sense of purpose amongst government officials. Conclusions: Meghalaya's experience in multisectoral collaboration demonstrates the potential of health systems reform grounded in a state capabilities enhancement approach, with a focus on participation and building decentralised leadership.

Background: Children in Indonesia are especially vulnerable to air pollution due to their developing respiratory systems and unique exposure patterns. As one of the top 50 nations most at risk from environmental degradation, Indonesia faces significant public health concerns, especially in rapidly urbanizing areas such as Greater Jakarta, where emissions from transportation contribute heavily to pollution. This study investigates the relationship between PM_2.5 exposure and cases of asthma and pneumonia in children across Greater Jakarta's 11 cities and districts from 2020 to 2022, aiming to provide essential data for health planning and policy. Methods: The data were collected from NafasID's PM_2.5 monitoring network and local health offices reporting monthly cases of asthma and pneumonia in children. Analytical methods included correlation and regression modeling to assess the association between air pollution and respiratory health across different regions. The results reveal a high number of respiratory disease, with 73,694 pneumonia and 15,825 asthma cases reported. Results: Average PM_2.5 concentration in Greater Jakarta was 42.5 µg/m³, with notable variation between areas. Bekasi District recorded the highest levels, while North Jakarta was lower. Depok City showed the strongest correlation between PM_2.5 and pneumonia (r = 0.61, p = 0.004), indicating a sharp increase in cases with rising PM_2.5, while other areas showed weaker correlations. Asthma cases had weak-to-moderate correlations with PM_2.5, which is largely nonsignificant, suggesting complex factors beyond outdoor air pollution may influence asthma. Conclusion: The findings highlight the critical need for improved air quality measures and targeted public health interventions. Addressing air pollution will be vital for reducing respiratory illness and supporting child health resilience in Indonesia's urban centers.

Background: In Tanzania, iron and steel manufacturing industries are based on manual work with minor automation, as workers segregate scrap metals and add them to furnaces for melting. The workers here are exposed to hazardous conditions, posing a risk to their health. Objective: To determine the prevalence of occupational injuries and possible predictors for injuries among workers in the iron and steel industries in Tanzania. Methods: The cross‑sectional study was conducted in 2022 in Tanzania. Workers from the production lines in four iron and steel factories participated in the study. The data were collected by interviews, using a structured questionnaire modified from the International Labour Organization (ILO) manual on occupational injury statistics from household surveys and establishment surveys. Chi‑squared tests and regression analyses were used. Results: Out of 381 invited workers, 321 participated in the study (response rate: 84). Of the respondents, 209 had experienced at least one injury that restricted them from work at least one day in the past year, giving an overall prevalence of occupational injuries of 65.1% per year. Out of the injured respondents, 135 (64.6%) reported being hospitalized or lying on the bed at home due to the injury. Working years, working hours per day, working 12‑hour shifts, and their section at the workplace (rolling mill or furnace) were factors significantly associated with occupational injuries in univariate regression analyses. Working hours of more than 10 hours per day, adjusted for all other factors, gave an odds ratio of 2.54 for experiencing injuries at work, with a 95% confidence interval (1.46-4.41), while no other factors showed significant association with injuries after adjustment. Conclusion: The prevalence of occupational injuries in the Tanzanian iron and steel industries was 65.1%. Working for more than 10 hours per day was a significant predictor of occupational injuries.