Annals of Global Health最新文献

Adolescents in sub-Saharan Africa continue to face a high burden of HIV, with adolescent girls and young women disproportionately affected. Yet despite major investments in HIV education, testing, condoms, and biomedical prevention such as PrEP, reductions in new infections remain slow in countries like Kenya and Nigeria. This viewpoint argues that current prevention strategies overlook the social realities that shape adolescent decision-making. Drawing on Bicchieri's Social Norms Theory and field experience, we highlight how visible sanctions tied to pregnancy, reputation, and respectability guide protection choices more than biomedical logic. For many adolescents, discreet hormonal contraception allows girls to avoid public shame, while boys often avoid condoms because being seen purchasing them signals sexual activity and attracts moral judgment. These gendered pressures reduce dual protection even when knowledge and access exist, and fragmented HIV and reproductive health services reinforce the divide. Health systems often deepen this pattern when adolescents feel judged or questioned by providers. Effective HIV prevention requires confronting these normative pressures and integrating youth-friendly reproductive and HIV services. Prevention becomes stronger when it aligns with how adolescents interpret risk, dignity, and responsibility within their social environments rather than focusing on biomedical solutions alone.

Climate change poses the greatest public health threat, disproportionately impacting communities in Low- and Middle-Income Countries (LMICs) where fragile health systems increase vulnerability. Despite this, clinical practice often overlooks climate-related health risks. Current approaches focus on single disciplines or settings, limiting broader integration. Incorporating a One Health approach-recognizing the interconnection of human, animal, environmental, and plant health-into routine clinical encounters offers a pathway to strengthen climate-health awareness. This manuscript presents practical guidance for integrating climate and health histories, with a focus on heat exposure, and emphasizes the role of physicians, other health providers and three categories of Community Health Workers (CHWs) across the care continuum. A case study illustrates how targeted climate and environmental inquiries during history-taking can advance diagnosis and patient education. Embedding One Health in clinical care bridges existing gaps, enhances early detection of climate-related illness, and promotes culturally sensitive, holistic health interventions in vulnerable communities.

Many global health initiatives involve partnerships between US academic institutions and low- or middle-income country (LMIC) institutions, but substantial inequities exist in short-term clinical education exchange opportunities for LMIC institutions. US medical students and physicians frequently participate in clinical experiences abroad; however, equivalent opportunities in the US for LMIC medical students and international medical graduates (IMGs) are limited, inconsistent across states, and, for IMGs, typically restricted to observerships. The authors aimed to identify pathways that facilitate clinical training and educational exchanges between California academic medical centers (CA AMCs) and LMIC institutions, and to explore the barriers and enablers for international medical students and IMGs to engage in clinical training in California. The authors conducted 16 semi-structured interviews with global health education stakeholders at CA AMCs and performed a desk review using PubMed, gray literature, and resources from the US State Department, Medical Board of California, and CA AMC websites to ensure the accuracy of information presented. Key institutional challenges include liability concerns, limited program capacity, and funding constraints; additional barriers specific to IMGs include restrictive visa policies and medical board regulations. Enablers included innovative funding mechanisms, existing administrative infrastructure, and, for IMGs, familiarity with visa processes, and the use of the Medical Board of California's Special Permits to enable participation in hands-on patient care. Several potential approaches emerged to reduce barriers and support hosting international medical students and IMGs in hands-on clinical roles at CA AMCs. While these findings offer practical strategies for expanding such exchanges within California, they also highlight the need for broader policy changes, including advocacy for a new visa category dedicated to short-term clinical training exchanges. This article advances the discourse on decolonizing global health by identifying mechanisms to allow equitable, bidirectional clinical training opportunities.

Point-of-care (POC) testing for syphilis and HIV is an effective way to provide same-day testing, results management, counseling, and treatment. Although commonly used in antenatal or sexual health clinics, our field study aimed to offer POC testing to women attending a standard care clinic in Guatemala. Nearly all women accepted testing, highlighting the patient-centered benefits and acceptability of screening in non-stigmatizing settings. Upon disclosure of results, especially positive diagnoses, patients drew comfort and resilience from their faith, an often-underprioritized resource not typically considered when addressing sexual health. These results underscore the value of integrating POC testing into routine care and reveal the important role of spirituality in how many patients and providers process diagnosis and illness.

Introduction: Arsenic exposure has been identified as a possible risk factor for neurodevelopmental disorders (NDDs). In Arica, research has been conducted to relate arsenic exposure to the prevalence of attention deficit hyperactivity disorder (ADHD). However, highlighting the need to explore other events, such as autism spectrum disorder (ASD), this study aimed to evaluate the association between current urinary arsenic concentration and the prevalence of NDDs in children from Arica. Methods: A cross‑sectional study was conducted using secondary data from the FONIS project #SA22I0119. The sample consists of 450 children born between 2013 and 2016. The outcome variable, diagnosis of NDDs, was measured through parent self‑reporting. The exposure variable corresponds to the current concentration of urinary inorganic arsenic, corrected by creatinine. A logistic regression model adjusted for confounding variables was used. Results: According to parent self‑report, the prevalence of ADHD was 9.1%, ASD 5.3%, and NDDs 12%. The mean urinary inorganic arsenic concentration was 19.8 μg/g creatinine, and 7.6% of the children had levels ≥35 μg/g creatinine. After adjusting for tutors' education, number of household members, sex, and indigenous origin, those children with urinary arsenic ≥ 35 μg/g creatinine were more likely to present some NDDs (OR: 2.93; 95% CI 1.11, 7.75). For ADHD, the association was also elevated (OR = 3.85; 95% CI 1.44, 10.29). Conclusion: The findings suggest an association between arsenic exposure and the prevalence of NDDs in children. These results contribute to the evidence of arsenic's effect on the neurodevelopment of the child population.

Background: Non-communicable diseases (NCDs) have surpassed infectious diseases as the leading cause of disability and mortality globally. However, the burden of NCDs among children and adolescents in the Asia-Pacific region remains underexplored. This study evaluates changes in NCD burden among individuals aged 0-19 years in the Asia-Pacific region from 1990 to 2021. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2021 study, we estimated deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) with 95% uncertainty intervals (UIs). We analyzed changes in disease burden by age, sex, location, and socio-demographic index (SDI) between 1990 and 2021. Results: In 2021, NCDs accounted for a YLD rate of 56488.99 (95% UI: 40849.26-75780.79) and a death rate of 356.45 (95% UI: 280.27-433.27) per 100,000 population among children and adolescents aged 0-19 years. Other NCDs were the leading cause of death (167.08 [95% UI: 116.63-216.90]), YLLs (14584.60 [95% UI: 10126.88-18,962.14]), and DALYs (20327.20 [95% UI: 14815.25-26238.15]) per 100,000, while mental disorders led in YLDs. Death rates were higher in males, but DALYs were higher in females. From 1990 to 2021, NCD death rates decreased by 44.63% (from 643.71 [95% UI: 508.48-758.86] to 356.45 [95% UI: 280.27-433.27]) and YLLs by 45.49%. However, mental disorder-related deaths, YLLs, and DALYs increased by 29.26%, 29.16%, and 10.07%, respectively. Lower SDI countries reported higher NCD burdens, particularly for other NCDs. Conclusions: While the NCD burden among children and adolescents in the Asia-Pacific region decreased significantly from 1990 to 2021, the rising burden of mental disorders is a critical public health concern.

Background: Mechanical intestinal obstruction (MIO) remains a global surgical emergency with significant morbidity and mortality. While prior studies suggest divergent etiological patterns between developed and developing nations, recent trends and underlying drivers remain understudied. Objectives: This study evaluates 30‑year trends in MIO etiology and outcomes in Jordan and compares these with global data to assess convergence of patterns. Methods: A retrospective cohort study (2020-2023) of MIO patients at a tertiary Jordanian center was combined with a systematic literature review of MIO etiologies in developed and developing nations pre‑ and post‑2000. Data included demographics, management, outcomes, and mortality. Statistical analysis employed chi‑square and t‑tests. Findings: Postoperative adhesions were the leading cause of MIO (64% in 2023, rising from 25% in 1993), followed by malignancy (20%) and hernias (5%). Mortality was 10%, with sepsis as the primary cause. Global comparisons revealed adhesions as the predominant etiology in both developed (7/9 studies, 77.7%) and developing nations (8/14 studies, 57.1%) post‑2000, contrasting with historical hernia predominance in developing regions. Conclusion: Adhesions have become the leading cause of MIO globally, reflecting increased surgical access and aging populations. Socioeconomic advancements in developing nations may explain converging trends with developed countries. Standardized global reporting and adhesion prevention strategies are urgently needed.

Background: Climate change plays a significant role in increasing dengue fever incidence by altering the habitat suitability for Aedes mosquitoes, the primary vectors. The incidence rate of dengue fever in Indonesia is increasing at an alarming rate, and strengthening the surveillance and control of the disease is important to prevent and reduce the risk of infection. This research aims to map and produce vulnerability areas that are suitable for dengue fever vectors by identifying their habitat using environmental and socio‑economic variables. Method: We use six variables as proxy for environmental and socio‑economic drivers of dengue fever, namely 1) distance to pond, 2) distance to drain, 3) building density, 4) distance to health facilities, 5) distance to social activity center, and 6) elevation to represent local temperature and variables are used within the landscape level of research area. This research was conducted in six different regions within two provinces in Indonesia, supported by the incidence rate in each region. Spatial multi‑criteria evaluation (SMCE) was used to map vulnerability areas of dengue fever vector habitats and assign weights and scores to variables according to expert judgements and existing literature. Results: Our findings show that high‑risk areas are located near major water bodies and drainage, lack supporting medical facilities, and are prone to changing climatic conditions. Given the importance of the administrative unit in conducting intervention policies, the calculated total areas of high‑vulnerable zones were given in the research and showed a variation of patterns according to their respective location. Conclusion: Our research suggests that vulnerability areas mapping of dengue fever is needed to control the disease in Indonesia. Thus, this research serves as proof of concept for national‑level mapping.

We recently completed a comprehensive systematic review of the literature on fluoride exposure and neurodevelopment and cognition, resulting in two publications. The 2024 National Toxicology Program Monograph concluded-with moderate confidence-that higher fluoride exposure is associated with lower IQ in children. The 2025 meta‑analysis, published in JAMA Pediatrics, quantitatively synthesized over 70 epidemiological studies and likewise reported an inverse association between fluoride exposure and children's IQ. This inverse association persisted when analyses were restricted to the best evidence, the high‑quality studies, and was consistent across subgroups defined by sex, age, country, outcome assessment method, timing of exposure, and exposure matrix (e.g., urine or drinking water). Notably, among the high‑quality evidence, inverse associations were still observed at fluoride exposure levels below 1.5 mg/L, based on both urinary and drinking‑water measurements. These publications have received considerable public and media attention, prompted healthy scientific discourse, and have been cited by public health decision‑makers. Many scientific comments were carefully considered and resolved during development and peer review, which contributed to the rigor of the final documents. However, some recurrent critiques continue to be raised. This viewpoint provides a high‑level summary of these key critiques and corresponding responses to help the public, media, and the scientific community better understand the strength and implications of the scientific evidence on fluoride exposures and neurodevelopment and cognition.