Annals of Global Health最新文献

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.

Introduction: Indigenous communities grapple with unique challenges in the aging process, often encountering amplified barriers to healthcare and resources, possibly due to their remote locations and distinct cultural backgrounds. Limited research exists on aging within Costa Rica's Ngäbe‑Buglé Indigenous community, particularly the La Casona community in Coto Brus. This study explores the aging experience of the Ngäbe‑Buglé community in La Casona, aiming to identify challenges and potential resources to enhance the quality of life and aging experience for elderly community members. Methods: This qualitative study utilized semi‑structured interviews to collect data from 14 elderly participants (6 female, 8 male), aged 52-90 years, living in the La Casona community. Participants were selected through purposeful snowball sampling techniques, and individual interviews were conducted at their residences. Interviews were conducted with assistance from an interpreter and lasted approximately 30-60 minutes. Thematic analysis was used to examine participants' responses to understand their experiences with aging. Results: Three primary themes emerged: economic difficulties, insufficient social support, and cultural aspects related to La Casona. Among the three primary themes were a total of eight subcategories. Economic challenges encompassed financial constraints and food insecurity, housing and infrastructure needs, and difficulties in accessing healthcare. Insufficient social support was evident through heavy reliance on family, limited community aid, and an absence of engaging activities. Cultural aspects highlighted the community's deep connection to nature and concerns about the fading cultural heritage among younger generations. These themes collectively contribute to the challenges confronted by elderly adults in the Ngäbe‑Buglé community. Conclusions: Improving healthcare access, enhancing social interactions, and preserving cultural heritage are essential when it comes to improving the aging experience in La Casona. The following participant discussions provide insight into public health interventions. Addressing these issues will require governmental support and policy changes aimed at uplifting the Ngäbe‑Buglé community.

Background: The world still grapples with alarming maternal mortality rates, particularly in developing nations, including Nigeria. Annual global deaths exceed 500,000, predominantly in developing countries (99%) and sub‑Saharan Africa (over 50%), where the lifetime risk of maternal death is 1 in 26. Millions of women of reproductive age and their children could be saved from poor outcomes through the utilization of available effective affordable maternal healthcare services. Objective: This study assessed the patterns and predictors of maternal healthcare service utilization among women of reproductive age in Lagos state, Nigeria. Methods: A cross‑sectional study was conducted among 453 women of reproductive age selected through multistage sampling between July 2022 and March 2023. Data collection employed interviewer‑administered questionnaires, and analysis was performed using SPSS V.25 software. Statistical analysis included bivariate and multivariate analyses, with a significance level set at p < 0.05. Findings: Nearly all participants (99%) were familiar with antenatal care (ANC), while 63% knew about postnatal care services, and 82% understood modern family planning methods. Most respondents (86%) accessed ANC in healthcare facilities; however, the majority (70.7%) booked during the second trimester. The majority (97%) attended ANC more than four times, and 77% gave births in healthcare facilities. Notably, 86% attended postnatal care services primarily for child vaccination. Christian religion (adjusted odds ratio (AOR): 1.810; confidence interval (CI): 0.989-3.313), self‑employment status of spouses (AOR: 2.949: CI: 1.413-6.153), and household monthly income above 60,000.00 naira (AOR: 2.015; CI: 1.002-4.005) were predictors for ANC use. Similarly, Christian religion (AOR: 2.326; CI: 1.426-3.796), self‑employment status of spouses (AOR: 3.111; CI: 1.633-5.929), and having health insurance (AOR: 5.327; CI: 1.229-23.080) were predictors for use of healthcare facilities for childbirth. Conclusion: This study reveals high awareness and utilization of maternal health services but highlights room for improvement in early antenatal care registration and postnatal care beyond the child's immunization.

In 2023, an interdisciplinary group of global health experts from five continents convened a plenary panel at the Consortium of Universities for Global Health (CUGH) annual conference entitled "Reimagining Global Health for the 21st Century." At the heart of this viewpoint article lies a fundamental question: How can we reimagine global health to best confront existing challenges and meet the demands of the future? To fully assess the scope of global health challenges and identify sustainable solutions, a clear definition of the aims and strategic approaches is needed. Such an assessment is also critical for progress in promoting equity, including decolonizing global health. Key issues examined are the following: equity, governance, research, education, and sustainability. To assure a sustainable global health enterprise, we propose the following three strategic imperatives as guiding principles: a holistic, unified approach grounded in mutual benefit, joint investment, long‑term collaborative commitment, and solidarity across low‑ to middle‑income countries (LMICs) and high‑income countries (HICs); joint priority setting of investments in research, education, practice, and workforce development; and collaborative governance, maximizing a multisectoral approach among local, national, regional, and global strategies. The viewpoint sets the stage for the development of an action roadmap to develop a unified concept of global health; identify strategies to ensure sustained funding for global health research, education and training, and practice; establish benchmarks and metrics to measure progress; and design a collaborative governance system to promote interconnectedness and engagement among local, regional, national, and global stakeholders.

Background: Pre‑exposure prophylaxis (PrEP) is an effective measure for preventing human immunodeficiency virus (HIV) infection among people at risk, including adolescents and young adults (AYA). Objectives: This study evaluates the prevalence of PrEP awareness and endorsement, as well as the factors associated with these outcomes, using data from the 2022 Tanzania Demographic and Health Survey. Methods: The analysis included participants aged 15-24 years. Participants were asked whether they had ever heard of daily medication to prevent HIV (PrEP) and whether they approved of daily PrEP use. Demographic characteristics and HIV testing information were also collected. Logistic regression models were used to assess factors associated with PrEP awareness and endorsement, and the weighted prevalence of these outcomes was calculated. Findings: A total of 8,268 respondents aged 15-24 years were evaluated, of whom 5,852 (70.9%) were female. Overall, the prevalence of PrEP awareness and endorsement was 6.9% (95% confidence interval [CI] 6.2-7.7) and 5.7% (95% CI 5.1-6.4), respectively. Female respondents (adjusted odds ratio [aOR] = 0.69; 95% CI 0.51-0.91) and rural residents (aOR = 0.78; 95% CI 0.61-1.00) had lower odds of PrEP awareness compared with male respondents and urban residents, respectively. Previously, HIV testing and receiving test results (aOR = 2.00; 95% CI 1.50-2.66) and an age of 20-24 years versus 15-19 years (aOR = 1.54; 95% CI 1.20-1.96) were associated with increased odds of PrEP awareness. The odds of AYA endorsement of PrEP were higher among those aged 20-24 years versus 15-19 years (aOR = 1.39; 95% CI 1.07-1.83) and those who previously tested for HIV and received results (aOR = 1.97; 95% CI 1.43-2.72), but lower among female respondents (aOR = 0.66; 95% CI 0.49-0.88). Conclusion: PrEP awareness and endorsement among AYA in Tanzania were low, with nearly 7 in 100 aware of PrEP and 6 in 100 approving of its use. Targeted interventions focused on adolescents, females, and rural communities are needed to increase PrEP awareness and usage to achieve the Joint United Nations Programme on HIV/Acquired Immune Deficiency Syndrome (AIDS) (UNAIDS) 95-95-95 goals for HIV epidemic control.

Introduction: Most maternal deaths are associated with home deliveries, which account for half of births in low‑income countries. To develop appropriate policies and methods that could aid in addressing the issues, it is important to understand the burden of home delivery despite having easy access to health facilities in low‑income nations such as sub‑Saharan Africa. In addition, identifying and prioritizing determinants could help executives to review their perinatal policies. Therefore, this study aimed at assessing the prevalence and factors associated with home delivery among women who have access to health facilities. Methods: A population‑based cross‑sectional study was done. The most recent Demographic and Health Survey (DHS) data from 22 sub‑Saharan African (SSA) countries from 2015 to 2022 were used. A total weighted samples of 493,396 women who gave birth at home despite having access to health facilities were included in the study. The data were examined using Stata 17. A multi‑level logistic regression model was used to identify factors associated with lactation-home delivery despite easy access to health facility. The adjusted odds ratio at the 95% confidence interval (Cl) was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p‑value of < 0.05 are declared statistically significant. Results: The pooled prevalence of home delivery among women who had easy access to health facilities in 22 SSA countries was 23.67% (95% CI, 23.55-23.79). After adjusting for confounders, being above 35 years, being a rural resident, being from the poorest and lowest wealth quintile, and living in rural regions all increase the likelihood of home birth among women in sub‑Saharan Africa who have easy access to healthcare. Women with higher education, women who have optimal antenatal care (ANC) visits, women involved in healthcare decisions in households, and households with health insurance coverage reduce the odds of home delivery among women who have easy access to health facilities in sub‑Saharan Africa. Conclusion: According to this study, a higher portion of women in sub‑Saharan Africa who had easy access to medical facilities gave birth at home. The study's findings demonstrated that factors at the individual and community levels influence home delivery with easy access to health facilities. Policymakers, the government, health planners, and implementers must therefore understand the burden of the problem and should increase media coverage, enhance health insurance coverage, empower women, and mobilize resources for maternal care.

Background: Abandoned asbestos mines are a potential source of environmental contamination and exposure for nearby residents. The asbestos exposure risk may persist even after the cessation of mining activity if the mine is not properly closed. One such abandoned mine is at Roro Hills in the Jharkhand state of India. There are limited studies examining soil contamination and asbestos exposure to nearby residents due to abandoned mines. Objectives: The aim of this study is to examine the presence of asbestos in the residential areas of villages surrounding an abandoned asbestos mine and to understand the spread of visible asbestos dust using geographic information system map analysis. Methods: This study examined the presence of asbestos in soil samples from four villages surrounding an abandoned asbestos mine using the scanning electron microscopy technique. The study also compared satellite images taken 13 years apart to determine whether the mine waste containing asbestos had spread over time. Findings: The soil sample testing indicated that, out of 16 soil samples from residential areas, 12 showed the presence of chrysotile asbestos. It was found in the map analysis that asbestos-containing areas had enlarged by around 20% in those years. Conclusion: The evidence indicated the presence of asbestos in the soil of nearby residential areas around the mine, and this contamination has spread over the years. Similar studies at other mine locations are needed, and timely interventions are warranted to protect nearby residents.

Background: Newcomer populations in urban centers experienced an exacerbated effect of coronavirus disease 2019 (COVID‑19) due to their precarious living and working conditions. Addressing their needs requires holistic care provisioning, including psychosocial support, assistance to address food security, and educational and employment assistance. Intersectoral collaboration between the public and the community sector can reduce vulnerabilities experienced by these groups. Objective(s): This research explores how community and public sectors collaborated on intersectoral initiatives during the COVID‑19 pandemic to support refugees, asylum seekers, and migrants without status in Toronto, Ontario, Canada to generate lessons for a sustainable response. Methods: The research uses a participatory governance approach to study multiple qualitative cases (with a case being an intersectoral initiative). We conducted interviews (n = 25) with community and public sector frontline workers and managers, as well as municipal/regional/provincial policymakers and funders. The data were analyzed thematically with an inductive approach. Findings: The analysis covers four key themes: (1) vulnerable newcomers' circumstances regarding accessing the social determinants of health during COVID‑19; (2) the process of designing specific interventions to target these populations' needs and service access challenges in the context of COVID‑19; (3) the implementation phase of the initiatives, including any associated challenges and lessons learned; and finally, (4) long‑term potential sustainability of the initiatives. Conclusions: The findings demonstrate that intersectoral initiatives can be implemented to develop a responsive service for marginalized populations; however, their translation beyond pandemic settings would require institutional mechanisms to bring policy shifts to provide a bottom‑up collaborative approach.

Heat stroke (HS) represents a life‑endangering condition that is due to an imbalance between heat generation and dissipation, owing to exposure to hot environments or strenuous exercise. HS is a medical condition that is gaining increased prevalence throughout the world due to a steady rise in temperature, and massive mortalities have been recorded among vulnerable populations. In 2024, extreme heat waves led to increased cases of HS and related fatalities globally, particularly in Karachi, Pakistan. This article reviews the pathophysiology, effects, treatment, and preventive strategies of HS management. Effective management includes prompt on‑site cooling and symptomatic treatment followed by intensive care for severe cases. In keeping heat‑related illnesses low, indoor stay, hydration, and public awareness campaigns play important roles. The urge of the article, therefore, is that HS demands very serious attention from the global arena and its proactive measures should be enforced to avert this medical emergency globally.

Background: Mathematical models are not integrated into the policy‑making process in low‑ and middle‑income countries, including India, primarily due to limited capacity in building mathematical models, lack of trust in the model findings and the reluctance of policy‑makers to apply the model findings to formulate policies. There is a perceived need to create a critical mass of trained infectious disease experts and modelers within the public health and clinical domain. Thus, with the support of the Department of Health Research (DHR), we developed a 3‑month post‑graduate (PG) certificate course on infectious disease modelling, the first of such a course in India. The first cycle of the course was delivered during July to September 2024, which produced the first cohort of 20 infectious disease modellers in the country. Methods: This paper describes the structure, content and key components of the first course along with the experiences, strengths, challenges and way forward from the participants' perspective using a mixed methods approach. Findings: Most of the participants felt that the learning objectives were clear (n = 18, 90%), course content was well organised and delivered (n = 19, 95%) and the course structure allowed all participants to fully participate (n = 19, 95%) in the learning process. The strengths of the course were: hybrid mode of delivery, well‑designed course content, theory lectures followed by practical sessions, regular trainer-trainee communication, interactive discussion forums and the 3‑day contact workshop. The key challenges were non‑availability of recorded videos, evening timings of the sessions and difficulty of some topics. Conclusions: The challenges and recommendations will feed into the subsequent course cycles. Future courses are planned to be hosted on an online platform to facilitate participant completion of the course at their own pace. More collaboration with various stakeholders, nationally and internationally, will be sought to improve the content, delivery and robustness of the program.