Annals of Global Health最新文献

Introduction: As trends in life expectancy continue to improve, the burden of loneliness in geriatric populations on a global scale is increasing. With advancing age comes an increase in the number of life events that can perpetuate a state of loneliness such as losing a life partner, dwindling social networks, and deteriorating health conditions. This burden can manifest in a variety of mental and physical consequences. While loneliness has been studied in a few communities around the world, there is a need to study loneliness in the context of Latin American communities in Central America, including Costa Rica. The aim of the present study is to assess the prevalence and associated factors of social and emotional loneliness (SEL) in a sample of elderly patients in the canton of Coto Brus, Costa Rica. Methods: A cross‑sectional study was conducted that sampled 63 adults aged 65 years or above in the canton of Coto Brus. Investigators conducted face‑to‑face interviews in Spanish with the aid of translators. The primary instruments used for the present study were a content‑validated version of the 11‑item De Jong Gierveld Loneliness Scale and socio‑demographic questions that included age, sex, address, civil status, and level of education. Results: A high degree of SEL was found, with 60.3% of participants noting at least a moderate degree of loneliness, with the average score being 3.33 on the 11‑point scale. When SEL was broken up into its respective subscores, the average score for social loneliness (SL) was found to be 0.67 on the 5‑point scale, and the average score for emotional loneliness (EL) was found to be 2.67 on the 6‑point scale. There was also evidence that supports both level of education and marital status serving as protective factors in the development of SEL. Discussion: These results could indicate a stronger association of loneliness being linked to missing a life partner compared with loneliness being linked to having smaller social networks. Given the associations that were found in this preliminary study, it is pivotal to explore loneliness in this community with a larger sample size-potentially through the integration of the country's Equipos Básicos de Atención Integral de Salud (EBAIS) healthcare system. It is also crucial to expand the study to explore any associations between loneliness and comorbid mental and physical health conditions.

Background: Ensuring timely access to safe and affordable surgery within a travel time of a 2‑h drive or 30‑min walk is crucial for achieving universal health coverage, as endorsed by the Lancet Commission on Global Surgery (LCoGS). In this study, we aimed to quantify the percentage of Indonesian women of reproductive age (WRA) who can access a hospital with emergency obstetric and gynecological services within this time frame. In addition, we aimed to identify the underserved populations. Methods: We identified hospitals across 38 provinces using the database from the Indonesian Society of Obstetricians and Gynecologists (ISOG) and the Indonesian Ministry of Health database that provide emergency obstetric services. We conducted geospatial analysis using the cost of distance and service area tools in ArcGIS Pro with WRA population data derived from Facebook's high‑resolution settlement layer (HRSL) maps. Results: Of the 3,202 recorded hospitals, 2,855 (89.2%) had an obstetric gynecologist (OBGYN). The workforce of 5,305 OBGYNs consisted of 4,857 (91.6%) actively practicing OBGYNs, of which 3,405 (64.2%) practice in hospitals only. Of the WRA population, 94.5% lived within 2 h of a facility. However, eight provinces had low timely access to these hospitals. Conclusion: Indonesia provides universal health coverage; however, stark disparities exist in the geographic access to emergency obstetric surgical care in certain provinces. Geospatial mapping and survey data work together to aid in assessing the strength of the surgical system and in identifying gaps in geographic access to timely surgery.

Introduction: In Zimbabwe, studies have mainly focused on child and maternal factors contributing to under‑5‑year mortality, and little has been published concerning the paternal social determinants, which are also important. Aim: The goal of this paper is to investigate the paternal social determinants of infant and childhood mortality in Zimbabwe. Methods: The study analyzed cross‑sectional secondary data from the Zimbabwe Demographic Health Survey (ZDHS) 2015 to investigate paternal determinants of infant and child mortality. Multivariate logistic regression and Cox regression were conducted for separate analyses of infant and child data to determine the odds and risk of death informed by paternal factors. Kaplan-Meier survival curves were used to determine the importance of paternal factors in determining under‑five survival. Results: Younger paternal age, lower level of education, lower wealth index, unemployment, and rural geographical location are important contributing factors for childhood mortality, and these factors were found to be interconnected and interrelated in producing the observed outcomes. Conclusion: Paternal characteristics are important contributing factors for child survival, but not alone. The interaction between child characteristics, household (paternal and maternal), community, and public/global‑policy‑level factors is important in shaping observed childhood mortality outcomes. Social determinants for child survival are interlinked and interdependent on each other in producing the observed childhood mortality outcomes, and no one factor is more important than the other. Each factor represents an important component but not one that is individually sufficient to produce an outcome.

Background: Lack of policy prioritization of surgical, obstetric, trauma and anesthesia (SOTA) care in South and Southeast Asian countries could be a potential contributor to limited access to care. Objective: To assess the SOTA care prioritization in National Health Policies, Strategies, and Plans (NHPSPs). Methods: We analyzed NHPSPs from twelve South and Southeast Asian countries. These documents are considered the most important health‑related policy statements. Bangladesh was excluded due to a lack of English translations. We searched sixteen electronic documents for a predefined list of keywords. The list included 52 keywords related to SOTA care and 7 keywords unrelated to SOTA care (used as a control). We used the keyword frequency (mentions per keyword or MPK) as a measure to compare prioritization between SOTA care and non‑SOTA care. We further categorized the SOTA care keywords into five different Lancet Commission on Global Surgery (LCoGS) domains and eight subgroups. Findings: Across twelve NHPSPs, MPK value for SOTA care was 54.09 compared with 202.86 for non‑SOTA, with eight NHPSPs having lower MPK values for SOTA care than non‑SOTA keywords. Four NHPSPs had no mentions related to SOTA care financing and information management. Pediatric surgery and anesthesia were among the neglected subgroups. Conclusion: The analysis of South and Southeast Asian NHPSPs suggests that SOTA care issues are not prioritized in most countries. Pathways to greater policy attention include integrating SOTA care into ongoing health policy‑making and planning efforts and developing and implementing specific national SOTA care plans.

Background: Metabolic diseases such as hypertension and diabetes are increasingly recognized as not just medical issues, but as complex conditions influenced by various factors. Objectives: This study aimed to explore the association between food insecurity (FI) and hypertension and diabetes and how socioeconomic status influences this relationship. Methods: Based on a cross‑sectional study of 1,820 participants conducted in Maputo City, FI was measured using a modified version of the US Department of Agriculture scale; metabolic diseases were assessed using self‑reports of the actual diagnoses, and data were analyzed through multinomial regression and interaction terms. Results: The findings revealed significant links between FI, socioeconomic status, hypertension and diabetes. Socioeconomic status had a clear influence on the association between FI and hypertension but showed a nuanced influence on diabetes. Specifically, regarding diabetes, the heads of households with a higher socioeconomic position were more likely to have this health condition than their counterparts with a lower socioeconomic position. Conclusions: The study underscores the complex interplay between FI and socioeconomic status in influencing the risk of metabolic diseases. Addressing FI and improving socioeconomic status may be crucial steps in mitigating the risk of hypertension and diabetes among vulnerable populations, emphasizing the importance of a holistic approach to health promotion and disease prevention.

Background: African research capacity is challenged by insufficient infrastructure to solicit and manage grants from local and international funding agencies. Objective: The manuscript provides an overview and discusses lessons learned about the pioneering role of the Mozambique Institute for Health Education and Research (MIHER) as the first research support center (RSC) in supporting the management of research grants in Mozambique, emphasizing its impact on research capacity development. Methods: Using mixed methods, data were comprehensively collected to identify MIHER's primary achievements from 2010 to 2023. The activities took place in four public universities, five training institutions for healthcare workers, and 40 public healthcare units in Mozambique. Findings: MIHER had partnership contracts with over 35 external institutions, and supported the design and implementation of one doctoral program and five masters' degree programs at three public universities. Over 70% of the 128 MSc and three Ph.D. degree recipients have gone on to become lecturers at Mozambique's public universities or are working in Mozambique's public health system. Over 9,000 lecturers and healthcare workers participated in MIHER's 261 research capacity development workshops. MIHER assisted in writing and implementing 98 research grants, amassing $29,923,197 in extramural support. Of 170 publications generated, 89% were indexed in PubMed. African researchers served as first or last author in 55% and 34% of these publications, respectively; Mozambicans were first and last authors in 44% and 23% of the articles, respectively. Two research laboratories were rehabilitated. Investments in information and communication technology also fostered training and mentorship. Conclusions: MIHER has emerged as a leading RSC of Excellence, fostering synergies and promoting a quality research culture in Mozambique, fueled in part, by its ability to identify and incorporate key collaborations. MIHER is a successful example of an RSC that can make the difference in resource‑limited settings to enable research resource mobilization, evidence-based health care delivery and policy design.

Introduction: Despite the broad improvement in air quality, air pollution remains a major leading global risk factor for ill health and deaths each year. Air pollution has a significant impact on both health and economic growth in Africa. This paper reviews the health impacts of air pollution and the benefits of air pollution mitigation and prevention on climate change. Methods: We conducted a narrative review and synthesized current literature on the health impact of air pollution in the context of changing climate in Africa. Results: Particulate matter (PM_2.5) concentrations in Africa pose significant health risks due to various sources, including household fuels and industrial emissions. Limited air quality monitoring hampers accurate assessment and public health planning. Africa's rapid urbanization exacerbates air pollution, impacting vulnerable populations disproportionately. Renewable energy adoption and improved monitoring infrastructure are crucial for mitigating air pollution's economic and health impacts. Recommendations include adopting air quality standards, identifying pollution sources, and prioritizing interventions for vulnerable groups. Integrating renewable energy into development plans is essential for sustainable growth. African leaders must prioritize environmental policies to safeguard public health amid ongoing industrialization. Conclusions: Air pollution prevention remains a vital concern that requires leaders to engage stakeholders, and other opinion leaders in society. African leaders should proactively explore new avenues to integrate non‑polluting renewable energy sources such as solar power, wind and hydropower into their national development plans.

Background: Smoking is the primary risk factor for tracheal, bronchus, and lung (TBL) cancer. Objective: This study aims to explore the epidemiological trends of smoking-attributable TBL cancer from 1990 to 2021. Methods: Mortality and disability-adjusted life-years (DALYs) data for smoking-related TBL cancer from 1990 to 2021 were sourced from the Global Burden of Disease Study (GBD) 2021. Estimated annual percentage changes (EAPCs) were calculated to evaluate trends in age-standardized mortality rates (ASMRs) and age-standardized DALY rates (ASDRs). Additionally, the relationship between disease burden, EAPCs, and the sociodemographic index (SDI) was assessed. Findings: Compared with 1990, both the mortality and DALYs due to smoking-related TBL cancer substantially increased by 2021. However, during this period, ASMR [EAPC: -0.97; 95% confidence interval (CI): -1.05 to -0.89] and ASDR (EAPC: -1.29; 95% CI: -1.37 to -1.22) demonstrated a downward trend. ASMR and ASDR in females were consistently lower than in males. In 2021, East Asia had the highest ASMR, while Central Europe recorded the highest ASDR, with Greenland exhibiting the highest ASMR and ASDR at the national level. Nationally, ASMR for smoking-related TBL cancer in 2021 showed a positive correlation with SDI, while the EAPC of both ASMR and ASDR from 1990 to 2021 displayed a negative correlation with SDI. Furthermore, in 2021, the greatest number of deaths from smoking-related TBL cancer occurred in individuals aged 70-74, while DALYs were highest in the 65-69 age group. Conclusions: The burden of smoking-related TBL cancer varies across age, sex, geography, and SDI regions. Tailored public health interventions aligned with these epidemiological characteristics are essential for alleviating the disease burden.

Background: While cancer is a leading cause of death worldwide, significant disparities exist in care access in low‑ and middle‑income countries (LMICs). In Liberia, screening and treatment for anal cancers remain limited, and are exacerbated among vulnerable groups, including men who have sex with men (MSM). Screen‑triage‑treat models for cancerous lesions have been successful in reducing cervical cancer mortality, but the feasibility of this approach has not been studied for anal cancers in a low‑resource context. Objective: The aim of this study is to determine the feasibility of implementing a screen‑triage‑treat model for anal high‑grade squamous intraepithelial lesions (aHSIL) among MSM in Liberia. Methods: This descriptive study represented a collaboration between Stop AIDS in Liberia (SAIL) and health institutions in Liberia and the USA. MSM and transgender participants were recruited through convenience sampling with SAIL peer‑educators. A survey validated by SAIL experts assessed demographics and sexual risk factors. Participants underwent anal self‑swabbing for high‑risk human papillomavirus (HPV) and offered human immunodeficiency virus (HIV) testing. Those with positive results were offered a screen‑triage‑treat model through high‑resolution anoscopy (HRA) and infrared coagulation (IRC). Data were cleaned and analyzed in SPSS. Findings: Among 110 participants, most were single (n = 94, 88%) and without formal employment (n = 21, 75%). Participants engaged in regular anal (n = 64, 60%), oral (n = 62, 58%), and receptive sex (n = 58, 54%), and sex with women (n = 51, 48%). Nearly 20% of participants reported being HIV positive (n = 21). In all, 50 participants (45%) tested positive for anal high‑risk HPV, 34 (68%) elected to undergo HRA, and 10 (84%) were treated with IRC. Of those who underwent HRA, 75% tested HIV positive. Conclusions: Our findings suggest that a screen‑triage‑treat model presents a feasible option to identify and reduce the incidence of anal cancer among MSM in Liberia. The screen‑triage‑treat model, with proven success in management of cervical dysplasia, may be a viable option to treat aHSIL for anal cancer prevention in LMICs.

Background: In 2014, the Faculty of Health Sciences at Walter Sisulu University introduced a 20‑week long integrated longitudinal clinical clerkship (ILCC) rotation block as part of its commitment to community‑based education and social responsiveness, with the goal of ensuring that the curriculum is updated to align with the contemporary health system challenges in South Africa. Aim: To explore whether medical student participants underwent social and personal transformative learning in understanding complex societal health needs during their integrated longitudinal community clerkship program. Methods: This was an exploratory qualitative research study conducted among 113 5^th year medical students based at 8 selected hospitals during their 20‑week‑long community clerkship. Data were collected through six focus group discussions, complemented by data from reflective learning journal entries. Audio recordings were transcribed verbatim and merged with complementary data for thematic analysis in NVivo Version 13®. Results: Adaptation challenges, improved social relations, coping with work demands, acquisition of relevant knowledge and skills, perceived inadequate support from the training institution and perceived lengthy programme duration emerged as key themes and were linked to personal and social transformation. Conclusion: Personal and social transformation may have transpired amongst the student participants, as demonstrated by the observed thematic consistency between data sources. Further complementary studies are required to assess whether there was a shift in students' understanding of community health needs and how the ILCC may have assisted the students in responding to community needs to have a comprehensive conclusion on whether the ILCC can be a tool for transformative learning.