Annals of Global Health最新文献

Background: The Hajj pilgrimage is one of the largest annual mass gatherings in the world, and it presents unique healthcare issues due to the vast number and diversity of participants. Optimizing the delivery and planning of health services requires an understanding of prevalent diseases and healthcare usage patterns. The aim of the study was to examine the patterns of disease burden and healthcare utilization among 2024 Hajj pilgrims. Methods: This study used a retrospective, descriptive cross‑sectional design. Data from 37,758 adult patient records in the outpatient clinics (OPCs) of the primary healthcare centers (PHCs) and hospitals located at the holy sites (Mena, Arafat, and Muzdalifah) during Hajj 2024 were analyzed. Data covered demographics, nationality, diagnoses, discharge outcomes, and healthcare utilization in holy sites. Patterns and associations were assessed using descriptive statistics and chi‑square testing (p < 0.05). Results: Most pilgrims were men (65.5%), and older than 60 years of age (26.4%). They came from more than 100 different countries. The most frequent diagnosis (44.6%) was upper respiratory tract infections (URTIs), which was followed by dermatitis (6.3%), gastrointestinal disorders (7.4%), headaches (7.8%), and musculoskeletal problems (7.3%). Geographically, disease prevalence varied: URTIs were most common in Mena (46.3%), dermatitis peaked in Muzdalifah (14.8%), and heat exhaustion was most common in Arafat (9.4%). Primary care use peaked in Mena (14,500 visits), mirroring pilgrim mobility. Conclusion: The results emphasize the necessity for flexible, data‑driven resource allocation by highlighting the dynamic and site‑specific character of healthcare demands during the Hajj. To improve health outcomes in upcoming Hajj seasons, it is imperative to enhance infection control, heat illness prevention, and culturally competent care, in addition to tailored interventions for older pilgrims and those with chronic illnesses.

Background: Surgical site infections (SSIs) are among the most common healthcare-associated infections worldwide and impose a disproportionate burden in low- and middle-income countries (LMICs). In Mozambique, persistent health system constraints-including limited infection prevention and control (IPC) capacity, weak surveillance infrastructure, and rising antimicrobial resistance (AMR)-likely amplify this burden. This review synthesizes available evidence on SSI incidence, etiology, antimicrobial resistance patterns, risk factors, and surveillance practices in Mozambican healthcare settings. Methods: A structured literature search was conducted in PubMed, Embase, Scopus, Web of Science, WHO Global Index Medicus, and Google Scholar for studies published between 2000 and September 2025. Eligible studies reported SSI incidence or prevalence, causative pathogens, AMR profiles, or associated risk factors in Mozambique. Additional data were retrieved from WHO reports, Joint External Evaluations (JEEs), and national surveillance assessments. Results: Published evidence remains scarce and fragmented, with no comprehensive national estimates of SSI incidence identified. The most commonly reported pathogens were Staphylococcus aureus (including MRSA), Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter spp., and Escherichia coli. MRSA prevalence in hospital settings ranged from 15% to 42%. Gram-negative isolates frequently demonstrated extended-spectrum β-lactamase (ESBL) production, suggesting substantial antimicrobial pressure. Reported risk factors were consistent with regional findings and included inadequate hand hygiene, suboptimal sterilization practices, prolonged lab or, malnutrition, HIV infection, and perioperative anemia. National SSI surveillance is largely absent, and only one hospital currently reports AMR data to the WHO Global Antimicrobial Resistance Surveillance System (GLASS). Conclusions: SSIs represent a significant yet underrecognized public health challenge in Mozambique. Despite increasing multidrug resistance, systematic data collection and coordinated national surveillance remain limited. Strengthening IPC programs, establishing structured SSI surveillance, expanding microbiological laboratory capacity, and implementing antibiotic stewardship initiatives are urgent priorities to improve surgical outcomes and reinforce national health security.

Introduction: Gastroschisis mortality in Africa is high partly due to delays in care. In Uganda, skilled birth attendants (SBAs) are the first point-of-contact for most babies, and with proper training, may be willing to participate in surgical task-sharing. Objective: Empower Ugandan skilled birth attendants with the knowledge and practical skills needed to care for babies with gastroschisis. Methods: Ugandan SBAs completed a one-day gastroschisis course, and resident physicians also requested to participate. A pre- and post-course test was administered to assess gastroschisis knowledge and confidence. Findings: A total of 69 SBAs (44 midwives, 25 nurses) and 17 residents participated. Participants were predominantly female (n = 64, 74%) with a median of 9 years of work experience. There was significant knowledge increase from pre- to post-course regarding differentiating gastroschisis from omphalocele (SBA 39% to 70%, p < 0.001; resident 48% to 77%, p < 0.001), gastroschisis incidence and outcomes (SBA 56% to 87%, p < 0.001; resident 65% to 89%, p < 0.001), risk factors (SBA 66% to 89%, p < 0.001; resident 67% to 86%, p < 0.0026), treatment (SBA 57% to 84%, p < 0.001; resident 63% to 79%, p < 0.001), and importance of community education (SBA 54% to 59%, p < 0.006; resident 56% to 65%, p < 0.0413). Only SBAs showed a significant increase in prenatal diagnosis (74% to 88%, p < 0.001). There was a significant boost in SBA clinical management confidence from 39% to 88%. Conclusion: A one-day training course can enable Ugandan SBAs to serve as task-sharers for babies with gastroschisis. While residents benefited, a future course should be developed for their learning needs. Continuing education is needed to ensure knowledge retention and clinical preparedness. Assessment of gastroschisis outcomes is necessary to determine if involving SBAs can improve survival.

Background: Particulate matter pollution (PMP), both ambient (APMP) and household (HPMP), significantly contributes to global health issues, affecting mortality and disability-adjusted life years (DALYs) across different populations. This study aims to analyze the temporal and spatial trends of deaths and DALYs attributable to APMP and HPMP from 1990 to 2021, stratified by age, sex, and SDI, to understand the evolving global health burden. Method: In this study, data on deaths, DALYs, and population attributable fractions due to overall PMP, APMP, and HPMP from 1990 to 2021 were obtained from the Global Burden of Disease Study 2021. The counts, rates per 100,000 population, and their estimated annual percentage changes, with 95% uncertainty intervals, were reported for each estimate. Results: This study reveals that the global PMP-attributable deaths increased, driven by the doubling of APMP-attributable deaths. Rates attributable to overall PMP and HPMP decreased with rising SDI, while APMP-attributable rates followed an inverted U-shaped pattern, from 1990 to 2021. In 2021, the highest age-specific death and DALY rates occurred in infants and the elderly, with males consistently exhibiting higher rates than females. Regionally, North Africa and the Middle East, and Oceania had the highest rates attributable to APMP and HPMP, respectively, while South Asia showed the largest increase in APMP-attributable rates. The leading PMP-attributable diseases were cardiovascular diseases, maternal and neonatal disorders, and respiratory infections. APMP primarily contributed to chronic obstructive pulmonary disease (COPD), ischemic heart disease, and stroke, while HPMP had the greatest impact on lower respiratory infections, COPD, and neonatal disorders. Conclusions: This study revealed that the burden of different PMP-attributable diseases varied by region, gender, and age. In addition, APMP-attributable deaths and DALYs doubled, with significant regional, gender, and age disparities, underscoring the need for targeted prevention and control strategies.

Background: The rapid evolution of artificial intelligence (AI) has enabled new approaches for health education, particularly during public health emergencies. However, evidence remains fragmented on how AI-based educational strategies support preparedness, response, and recovery phases of pandemics and epidemics. Objective: To map the use of AI-based technologies in health education strategies addressing preparedness, response, and recovery during public health emergencies, identifying target populations, intervention characteristics, outcomes, scalability, and knowledge gaps. Methods: This scoping review followed Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Searches were conducted in PubMed/MEDLINE, Scopus, Web of Science, Embase, IEEE Xplore, and LILACS, complemented by gray literature from Google Scholar. Studies published from 2010 onward in English, Portuguese, or Spanish were included. Eligible designs comprised primary studies, methodological or implementation research, and reviews with explicit educational components. Data extraction covered context, populations, AI modalities, educational purposes, delivery channels, supervision requirements, pandemic-cycle phase, scalability, outcomes, and evidence gaps. Results: Forty-one studies met the inclusion criteria. Conversational AI (chatbots and large language models) and algorithmic curation tools using machine learning and natural language processing predominated. Most interventions supported health literacy, risk communication, and misinformation management; others addressed personalized learning, microtraining, and clinical simulation for students and health professionals. Delivery channels included mobile applications, messaging platforms, websites/YouTube, and clinical AI systems. Human oversight (expert validation and curation) was consistently reported as essential for safety and reliability. Interventions mainly targeted the response phase, with emerging applications for preparedness. Major gaps included standardized learning measures, cost-effectiveness evaluations, equity analyses, and governance frameworks ensuring privacy, transparency, and bias control. Conclusions: AI-enabled educational technologies can strengthen rapid, scalable, and personalized learning during health emergencies. Future research should prioritize multicenter studies using standardized indicators, economic and equity assessments, and robust governance frameworks to ensure ethical, safe, and inclusive adoption.

Background: Asbestos remains a significant global public health issue, with approximately 255,000 deaths attributed to exposure each year, primarily through occupational contact. Mesothelioma rates continue to rise, particularly in areas with a history of industrial exposure. Despite this burden, many countries lack reliable surveillance systems. Colombia has clusters like the one observed in Sibaté, highlighting the urgency of establishing structured, evidence-based surveillance systems. Objective: The aim is to synthesize international experiences to guide the design and implementation of surveillance strategies in Colombia and other low- and middle-income countries facing similar challenges. Methods: Following the JBI methodology for scoping reviews, comprehensive searches were conducted in Medline (PubMed), Embase, the Cochrane Library (OVID), and Google Scholar. Only English-language articles were included, and no time restrictions were applied. Results: Fourteen studies from 11 countries were included, with the majority coming from Italy, followed by Colombia and Brazil. Three main themes emerged: (1) numerous cohort studies reported increased risks of mesothelioma and lung cancer among asbestos-exposed workers, supporting the need for long-term follow-up; (2) structured surveillance systems-such as Italy's ReNaM and Brazil's Datamianto-demonstrated effective models combining data integration, regular medical evaluations, and policy enforcement; (3) considerable variability in surveillance design, target populations, and reporting standards, especially between high-income and resource-limited settings, highlighting the lack of global standardization. Conclusions: Structured, context-specific surveillance programs are essential to identify and manage the health burden of asbestos exposure. International models offer practical frameworks that could be adapted to Colombia's needs. Investing in such systems would strengthen public health responses, improve early detection of asbestos-related diseases (ARDs), and support environmental and occupational justice in affected communities. The included studies do not mention monitoring according to the degree of exposure.

Background: Processes and best practices for initiating and growing university global health programs in high-income countries (HICs) synchronously and symbiotically with partners in low- and middle-income countries (LMICs) are not abundantly described in the medical literature. In particular, programs that do not have university partners in LMICs may struggle to develop sustainable, ethical, and anticolonial community and governmental partnerships. Methods: This article reviews existing literature and describes the challenges in the contemporaneous development of university global health programs and community/governmental partners. The paper goes on to describe the creation of the Office of Global Health at Rush University in conjunction with the inception and development of its partner non-governmental organization (NGO), Community Empowerment in the Dominican Republic. The success and opportunities in the evolution of this ongoing relationship are described. Guiding principles for others attempting similar work are provided. Results: Creating these entities simultaneously promotes the establishment of relationships with equal power and authority from the inception, facilitates the creation of customized programs that capitalize on the strengths of the university and infrastructure of the partner country/community, and allows both entities to grow together in scope and impact. Challenges include identifying and nurturing like-minded university, NGO, and community/government partners; securing bilateral sustainable funding; ensuring quality of clinical services and educational/scholarly activities; and consistently promoting anticolonial practices. Conclusion: Developing university global health programs in HICs simultaneously with a partner NGO can result in mutual and commensurate growth and outcomes as well as strong and equitable relationships. This paper describes the author's own experience at Rush University building connections with community partners and colleagues in the Dominican Republic and outlines strategies to achieve these results.

Background: Maternal cancer mortality represents a growing but under-recognized global public health issue with profound consequences for surviving children. Breast cancer, cervical cancer, and other common malignancies disproportionately affect women in their reproductive years, leading to substantial psychosocial, health, and socioeconomic impacts for their children. Objective: To synthesize current evidence on the global burden, determinants and consequences of maternal orphanhood due to cancer, and to identify prevention and policy opportunities aligned with existing health system goals and global cancer initiatives. Methods: A structured literature search (2010-2025) was conducted across four databases using predefined keywords, with eligibility screening based on relevance to maternal cancer mortality and orphanhood outcomes. Evidence was analyzed under four thematic domains and interpreted comparatively using World Bank income classifications. Results: An estimated 1.05 million children became orphans due to maternal cancer in 2020. The burden was greatest in Low and Middle Income Countries (LMICs) (83%), particularly in Asia and Africa (>80%), with the highest numbers in India, China, Nigeria, and Ethiopia. Breast, cervical, and upper gastrointestinal cancers are the leading causes. The majority of the affected children were ≥ 10 years old (69%). Maternal orphanhood was linked to poorer survival, mental health, education, and socioeconomic outcomes. Conclusions: Maternal orphanhood from cancer highlights preventable inequities in women's health, cancer control, and child support systems. Despite global initiatives, the burden remains largely unaddressed. Prioritizing equitable access to vaccination, screening, treatment, and social protection within national cancer policies is essential to reduce avoidable maternal deaths and protect affected children.

The co‑epidemic of silicosis and tuberculosis (TB) in South Africa's mining industry affects a large number of migrant workers and is compounded by limited access to chest X‑ray (CXR) screening. Although artificial intelligence (AI)‑based computer‑aided detection (CAD) systems for TB have demonstrated impressive accuracy against microbiological standards, validation among silica‑exposed populations has been limited. Moreover, well‑documented biases hinder CAD utility in diverse patient populations, potentially exacerbating existing healthcare inequities. In this article, we describe the challenges in developing CAD systems for TB and silicosis and present the potential benefits local public‑sector development initiatives can bring. Using a local dataset of 2000 CXRs from silica‑exposed Southern African mineworkers, alongside publicly available international datasets and pretrained CAD models, we present empirical evidence of CAD biases. Dimensionality reduction analysis produced visual mappings that demonstrate how local CXRs form a distinct cluster, separate from international images. We also found that, relative to TB, reducing image resolution disproportionately degraded silicosis detection. Further visualizations proved that accuracy metrics alone are insufficient measures of clinical reliability, possibly obscuring deployment failures. We conclude that local public‑sector CAD development offers a viable alternative to reliance on externally developed systems that likely exclude underserved populations. Addressing CAD deficiencies requires curating population‑representative datasets that capture local epidemiology and transparent, open‑source development practices that enable peer review and bias correction. Embedding technical and clinical expertise locally can transform AI‑based CAD from a potential instrument of digital colonialism into a mechanism that produces contextually appropriate diagnostics while advancing knowledge for equitable AI deployment worldwide.

Introduction: This manuscript evaluates the outcomes of a pioneering Integrative Medicine Course implemented at Eduardo Mondlane University, aiming to strengthen medical and health students' knowledge and skills while fostering a holistic approach to patient care. Delivered in two editions-an intensive in‑person program and an extended online format-the course sought to improve understanding of integrative medicine. Methods: A mixed‑methods approach was adopted, combining data from participatory observation, pre‑ and post‑course surveys, focus group discussions, and final course evaluations. Self‑assessments of knowledge and skills were collected before and after the course. Final exam results were analyzed to assess knowledge acquisition. The in‑person edition was conducted over 1 week (September 16-20, 2024), and the online edition spanned 8 weeks (January-February 2025). Both formats included weekly lectures, practical sessions, and interactive discussions. The Wilcoxon signed‑rank test was used to evaluate changes in knowledge and skills. Results and discussion: A total of 164 students enrolled, with 134 completing the course (completion rate of 82%). Most participants were female (81%), with an average age of 23 years (SD ± 3.7); 61% were medical students, and three were postgraduate students. Satisfaction was high, with 66% awarding the highest rating. The most highly rated aspects included instructors (78%), course organization (77%), and resources provided (75%). Phytotherapy emerged as the most relevant topic, followed by traditional medicine, mental well‑being, and nutrition. The participatory teaching approach was preferred, accounting for 63% of mentions. Post‑course evaluations showed significant improvements in knowledge, interest, attitudes, and competencies (p < 0.05). All students passed the final exam, with an average score of 18/20. Conclusions: The course successfully enhanced students' understanding and application of integrative medicine. Both delivery formats proved effective in engaging learners and fostering critical skills. This initiative establishes a foundation for advancing integrative medicine education and research in Mozambique.