Annals of Global Health最新文献

Background: Gastric cancer (GC) remains a major global health burden, yet US trends often obscure disparities hidden within national averages. Although incidence and mortality have declined overall, profound geographic, racial, and socioeconomic differences persist. Few studies have systematically examined how demographic composition and social determinants jointly shape GC burden across states. Methods: We analyzed Global Burden of Disease 2021 estimates for GC incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021 across 50 US states and the District of Columbia. Outcomes were stratified by age, sex, race/ethnicity, and sociodemographic index. Multivariable and mediation models assessed how income and education modified racial and ethnic disparities. Results: While national GC rates declined over three decades, the burden remained concentrated in states with large immigrant and low-income populations, including Hawaii, the District of Columbia, Mississippi, and New Mexico. States with higher Asian populations exhibited roughly fourfold greater incidence than those with larger Hispanic populations. Income and education together mediated 22%-31% of racial and ethnic disparities, demonstrating that socioeconomic position-not race alone-drives much of the observed heterogeneity. Conclusions: This state-level sociodemographic analysis reveals the structural underpinnings of US GC inequities within a broader global context of uneven early-life risk and population diversity. By linking racial composition, income, and education to disease burden, it identifies modifiable pathways for prevention and policy action. Viewed as a case study for migrant-receiving countries, these findings underscore the importance of equity-informed strategies-such as Helicobacter pylori screening, nutrition interventions, and targeted resource allocation-to address persistent GC disparities globally.

Background: Human papillomavirus (HPV) is a common sexually transmitted infection associated with cervical cancer. Since 2008, HPV vaccines have been available in Saudi Arabia, and in 2022, a nationwide school-based vaccination program was launched to improve coverage and reduce HPV-related diseases. Objectives: This study evaluated parental knowledge and acceptance of the HPV vaccine during a school-based vaccination campaign in Rabigh, Saudi Arabia. It also examined associations between demographic factors, parental knowledge, and vaccine acceptance. Methods: A cross-sectional study involved 261 guardians of girls attending intermediate schools in Rabigh during the academic years 2022/2023, 2023/2024, and 2024/2025. Data were collected through an online questionnaire assessing HPV vaccine knowledge, acceptance, and influencing factors. Chi-square tests were used for analysis. Findings: Vaccine acceptance increased with guardians' educational qualification, from 46.7% among those with primary or middle school to 89.3% among those with higher education (P = 0.007). Acceptance also increased with family income, from 45.2% (income < 5000 SR) to 77.7% (income ≥ 10,000 SR) (P = 0.002), and was higher when information was obtained from health practitioners (90.4%) or the Internet (80.4%) compared to relatives or social media (47%) (P < 0.001). Respondents with a knowledge score ≥80% were more likely to accept the vaccine (84.2% versus 67.3%, P = 0.04). Recommendations from the Ministry of Health (MOH) or physicians were key motivators for vaccination. Concerns about vaccine safety were the primary reason for refusal (48.1%). Among non-accepting parents, 59.5% reported that more information on benefits and safety would encourage acceptance, while 22.8% remained unwilling to vaccinate. Conclusion: Parental knowledge, education, and income significantly influenced HPV vaccine acceptance. Parents informed by healthcare professionals or the Internet were more likely to vaccinate their daughters. Targeted efforts raising awareness of vaccine benefits and safety from trusted sources like physicians and the MOH are essential.

Background: Growing attention to the proliferation of short-term medical missions (STMMs) in the Global South has increasingly taken the form of critiques of inadequately prepared volunteers, lack of community control and continuity. In response, scholars and practitioners in high-income countries have created guidelines for best practices. These have rarely incorporated the views of host community members and leaders. While research has begun to address what host countries want from STMMs, these projects have also been carried out almost exclusively by scholars from the Global North. Objectives: The aims were to provide additional insights into host views in three countries that are frequent destinations for STMMs and to explore the possibility that design and direction by host country researchers would yield new perspectives. Methods: Scholars from Ghana, Uganda, and Guatemala designed and directed studies of medical staff, public officials, and patients from multiple locations around each country. Interviews and focus groups were carried out with a total of 129 people. Findings: All three studies found widespread appreciation of STMMs for providing needed medical services. In Ghana and Guatemala, language differences were cited as a major barrier, while Ugandan participants criticized volunteers' lack of skills and mismatch between their expertise and community needs. Ghanaian and Ugandan participants voiced resentment of patients' preference for white volunteers and the arrogance of some visitors. The amount of time and effort required to host was a common theme. Conclusion: The findings confirm the importance for STMMs of understanding the local health context and language and working collaboratively and respectfully with hosts. Direction by host country researchers enhanced the value in several ways, including access to officials and establishment of trust with interviewees.

The psychological and emotional burdens experienced by informal caregivers of cancer patients highlight the need for effective coping strategies to maintain their well-being. The Brief COPE is a validated questionnaire consisting of 60 items, aimed at evaluating an individual's coping strategies and is effective in providing a comprehensive profile of responses to stress. This study examined the psychometric properties of the 60-item Brief COPE among informal caregivers of cancer patients in Uganda. A cross-sectional survey involving 200 caregivers was conducted, during which participants completed the Brief COPE alongside measures of psychological distress. Internal consistency was evaluated using Cronbach's α, while test-retest reliability was assessed to determine temporal stability. Construct validity was examined through confirmatory factor analysis (CFA) and correlational analysis with related constructs. The Brief COPE demonstrated excellent internal consistency (Cronbach's α = 0.92) and strong test-retest reliability (r = 0.89). The anticipated factor structure was validated through CFA, and significant correlational analysis corroborated its construct validity. These results affirm that the 60-item Brief COPE is a reliable and valid tool for assessing the coping strategies of informal caregivers of cancer patients in Uganda.

Background: PM_2.5 air pollution is a leading cause of disease and death. US air pollutant emissions have declined by 75% since passage of the Clean Air Act in 1970, but the Pittsburgh Metropolitan Statistical Area (MSA) continues to have elevated pollution levels and, in 2025, had the US's 12^th highest PM_2.5 concentration. Steel mills and coke ovens are major point sources. Objective: To quantify deaths, adverse birth outcomes, and children's IQ loss in the Pittsburgh MSA attributable to PM_2.5 air pollution. Methods: Mean annual PM_2.5 air pollution concentrations were obtained for each census tract in the Pittsburgh MSA from NASA's satellite-based Socioeconomic Data and Applications Center map layers and linked with vital records obtained from the Pennsylvania Department of Health. Exposure-response functions from peer-reviewed literature and EPA's BenMAP software were used to quantify deaths, adverse birth outcomes, and IQ loss attributable to PM_2.5 pollution. Results: The mean annual PM_2.5 concentration in the Pittsburgh MSA was 8.54 μg/m³. Concentrations across census tracts ranged from 5.74 to 15.90 μg/m³. Of 27,224 adult deaths in the Pittsburgh MSA in 2019, we estimate that between 3,085 and 3,467 (11.1%-12.5%) were attributable to PM_2.5 pollution. We estimate that 229 premature births, 177 low-weight births, and 12 stillbirths could be attributed to prenatal PM_2.5 exposure. Among the 24,604 children born in the Pittsburgh MSA in 2019, PM_2.5 pollution was linked to the loss of 60,668 full-scale IQ points, resulting in estimated lifetime economic losses of $2.7 billion. Conclusion: In 2019, 11.1%-12.5% of adult deaths in the Pittsburgh MSA, more than 400 adverse birth outcomes, and widespread reductions in children's IQ were attributable to PM_2.5 air pollution. Public policies and strict enforcement that reduce pollutant emissions and improve air quality will improve the health of southwestern Pennsylvania residents, save lives, and be highly cost-effective.

Background: Climate change poses a profound threat to public health globally and in India, but ironically healthcare activities themselves contribute significantly to greenhouse gas emissions. The healthcare sector produces about 4-5% of global carbon emissions. India's healthcare system is estimated to be the world's seventh-largest carbon emitter in absolute terms. To align with climate goals and protect health, India has begun instituting policies to foster a low-carbon, climate-resilient healthcare system. Objective: To comprehensively review India's national policies, operational frameworks, and strategies aimed at reducing healthcare-related carbon emissions (decarbonization) while strengthening health system sustainability. Methods: We conducted a narrative review of policy documents and PubMed-indexed literature from 2018 to 2025 focusing on climate change mitigation in the Indian health sector. Findings: India has mainstreamed health into national climate planning with the release of the National Action Plan on Climate Change and Human Health (2018) and the launch of the National Programme on Climate Change and Human Health (2019). These set targets for climate-health surveillance and low-carbon, climate-resilient medical health facilities. Climate action and sustainability are being included in accreditation standards. Early benefits include: greater energy reliability and lower cost energy services for healthcare centers with solar energy and higher health facility performance during extreme weather events. However, implementation remains nascent. Gaps remain in data, funding, and capacity to scale low-carbon practices across India's sprawling health system. Conclusions: India has made initial strides in aligning its health sector with climate mitigation imperatives through policies and guidelines for sustainable, low-carbon healthcare. Strengthening governance, financing, and technical support will be critical to fully implement decarbonization strategies. A low-carbon healthcare system in India can not only reduce emissions but also improve public health, resilience, and healthcare quality, setting an example for sustainable healthcare development in low- and middle-income countries.

Background: Global heating is associated with adverse health impacts necessitating the implementation of Heat Action Plans (HAPs) to protect communities. Gauteng in South Africa is the most populated province, housing three cities (i.e., Johannesburg, Ekurhuleni, and Pretoria) and 25% of the national population. Objective: Given rising temperatures and projected increases in heatwaves and hot days, we gathered literature and case studies to inform the development of a Gauteng HAP. Methods: We conducted a scoping review to inform baseline data on heat-related health impacts for Gauteng and South Africa too, followed by a benchmarking exercise that aimed to identify international best practices that may inform Gauteng's plan. Benchmarking was done using Maharashtra (India), Victoria (Australia), and Khyber Pakhtunkhwa (Pakistan). Findings: Thirty-six studies were included in the review, with 13 including Gauteng data and all showing impacts of heat on human health. Most studies applied epidemiological time series linking meteorological exposure (temperature/heat indices) and/or air pollutants (e.g., PM_2.5, PM₁₀, NO₂, and O₃) with health outcomes; applied remote-sensing, reanalysis, or station data for exposure assessment; and used regression or distributed lag models. The benchmarking exercise identified exemplars' distinctive strengths: Victoria's district thresholds keep activation simple and local-ideal for Gauteng's heterogeneous microclimates across metros and townships. Maharashtra's graded activation and clear departmental roles reduce ambiguity during multi-day heatwaves and thereby would help to align Gauteng Health, Infrastructure, Social Development departments. Khyber Pakhtunkhwa's cooling-camp model shows practical, low-cost interventions of a low- and middle-income country that can be replicated at taxi ranks/clinics/malls during temperature peaks. Conclusions: Insights from the literature and international exemplars provide a strong evidence base and adaptable models to guide a context-specific, multi-sectoral HAP for Gauteng that enhances preparedness, coordination, and community protection in a warming South Africa.

Background: Musculoskeletal disorders (MSDs) are a major occupational health concern among nurses, particularly in high-stress and resource-constrained armed conflict settings. This study assessed the prevalence and occupational and environmental correlates of MSDs among nurses caring for critically ill patients in Gaza City hospitals during the 2023-2025 conflict. Methods: A cross-sectional descriptive analytic study was conducted among 172 nurses in intensive care units (ICUs), emergency departments, operating rooms, and pediatric ICUs. Data were collected using a structured questionnaire adapted from the Arabic Nordic Musculoskeletal Questionnaire and ergonomic exposure assessment tools. Descriptive statistics summarized MSD prevalence and workplace exposures. MSD burden, defined as the number of affected body regions over the past 12 months, was analyzed using negative binomial regression, with logistic and multiple linear regression used as exploratory sensitivity analyses. Results: The 12-month prevalence of MSDs was high, most commonly affecting the neck (69.2%), lower back (68.0%), and shoulders (64.5%). Pain intensity was moderate to high, particularly in the lower back (mean 5.31 ± 3.08), and over 70% of nurses reported difficulty performing work tasks due to pain. Ergonomic risks were widespread, including prolonged neck flexion (84.3%) and trunk bending (67.4%). In multivariable negative binomial regression, being married was independently associated with fewer affected body regions (adjusted incidence rate ratio [aIRR] = 0.71, p = 0.002), while working in humid environments was associated with higher MSD counts (aIRR = 1.24, p = 0.026). Adequate rest showed a modest protective association (aIRR = 0.82, p = 0.045). Work pace and perceived stress were not independently associated with MSD burden. Conclusion: Critical care nurses in conflict-affected Gaza experience a high burden of MSDs, particularly in the neck and lower back. Workplace humidity and insufficient rest were key modifiable correlates. Occupational health interventions are urgently needed to protect nurses and sustain care delivery.

Background: Globally, approximately 515,000 infants with Sickle Cell Disease (SCD) are born every year. Approximately 80% of these cases occur in Sub-Saharan Africa (SSA) annually, including 14,000 newborns in Kenya. In SSA, 50%-80% of children will die before the age of 5 years due to a lack of comprehensive SCD care compared to 3% in better-resourced settings. The Academic Model Providing Access to Healthcare (AMPATH) SCD Program started in 2010 as a partnership between Moi University, Moi Teaching and Referral Hospital (MTRH), and Indiana Hemophilia and Thrombosis Center (IHTC) with a goal to improve access to comprehensive SCD care by increasing capacity through training, clinical care, research, and advocacy. Findings: The program has trained over 5,000 healthcare workers on different aspects of SCD through face-to-face instruction, virtual training and one-on-one mentorship programs. Early infant screening and support for access to medications like hydroxyurea and antibiotics have been key in improving clinical care. The program has also participated in several research projects and has been a strong advocate for the provision of comprehensive SCD care by the health facilities within the high SCD burden areas in Kenya and the Ministry of Health. Conclusion: The strategies implemented by the program can serve as a template for establishment of SCD care programs in similar resource-limited settings.

Background: Climate change-related events such as floods, droughts, and wildfires have been shown to affect global mental health. As climate change worsens, extreme weather events increase, leading to more climate-related mental health disorders globally. Objective: This review article assesses the impact of mental health and climate change in Africa to identify trends, research gaps, and potential interventions. Methods: A scoping review methodology, in accordance with the PRISMA-ScR guidelines, was employed. A search strategy was developed using MeSH and synonym terms to search PubMed, Web of Science, and African Journal Online databases from January 2000 to April 2025. A total of 2332 titles and abstracts were screened. Results: Sixteen articles were included in our final analysis. The studies included were conducted in three East African countries, three North African countries, two West African countries, two Central African countries, and one Southern African country. They were published between 2015 and 2024. Most (56%; n = 9) of the studies were cross-sectional studies. Climate change-related events, such as flooding, drought, and sea-level rise, have been found to affect mental health outcomes in countries like Ghana, Namibia, Nigeria, and Kenya. Commonly cited mental health outcomes included higher anxiety levels and lower well-being among relocated individuals, persistent stress and anxiety due to flooding in Ghana, and significant post-traumatic stress disorder symptoms among schoolchildren in Namibia. Vulnerable populations like children, adolescents, women, climate migrants, people living with HIV, and rural populations were found to be most impacted by climate change-related events. Conclusion: While this review highlights an increasing trend in the impact of climate change on the mental health of individuals in Africa, more studies are necessary to establish the relationship between mental health and climate change, and to develop interventions and policies that address the growing mental health burden resulting from climate change.