Annals of Global Health最新文献

Background: Global health education is important for addressing health inequities nationally and internationally. Physician shortages in underserved areas suggest more exposure during training is needed. Objective: To study the impact of a global health training program on residents' perceived preparedness and intention to care for underserved populations. Methods: Observational mixed method evaluation of the impact of an educational intervention, the Global Health Scholars Program (GHSP), on perceived knowledge and intention to practice in underserved settings. The intervention consisted of a longitudinal global health training program addressing ethics, health equity, structural determinants of health, racism, colonialism, and systems-based practice. GHSP elective clinical rotations occurred at local underserved clinics, tribal and Indian Health Services (IHS) sites (Alaska, Arizona, Oregon), and in Botswana. A 16-item survey aligned with program objectives was administered to internal medicine residents at Oregon Health & Science University who completed the GHSP. This included five groups of residents who trained before coronavirus disease 2019 (COVID-19) (2016-2020) and three groups who trained during COVID-19 (2021-2023). Qualitative content analysis was conducted on open-ended text responses. Findings: Surveys were sent to 45 participants; 37 responded (82.2%). All perceived knowledge variables increased significantly after training in the pre-COVID cohort. Among seven residents participating in GHSP during COVID, baseline scores were higher than in the pre-COVID cohort. Qualitative results indicate GHSP was a transformative educational experience and impactful on practice. Among current trainees, 42.9% reported moderate and 26.8% reported high/very high intention to practice in underserved settings. Among graduates, 40.9% reported practicing in underserved settings. Conclusions: GHSP provides transformative educational experiences to residents, with knowledge gains on global health topics higher post-program compared with pre-program. Given 41% of participants in practice reported working in underserved settings, this intervention may help ameliorate physician workforce shortages.

Background: Pakistan's health system is expected to take a proactive position in the global health security arena amidst its own indigenous structural and systemic challenges. Henceforth, understanding the intricacies of this system is vital for creating effective strategies to prevent, detect, and respond to health emergencies, ensuring regional stability and overall global health security. Objectives: This study has ventured to understand the perspectives, hurdles, threats, and both international and national implications of Pakistan's current health system capacity and the requisites for meeting global health security commitments. Methods: This descriptive qualitative study, based on phenomenology theory, involved key informant interviews with 16 senior policy‑level experts and public health professionals from the public and private sectors, international non‑governmental organizations (NGOs), development partners, and United Nations (UN) bodies. Thematic analysis was employed to identify key themes related to Pakistan's health system and its role in global health security. Findings: The study uncovered significant insights into the strengths and weaknesses of Pakistan's health system, the impact of the coronavirus disease 2019 (COVID‑19) pandemic, and challenges such as funding constraints and fragmented healthcare delivery. It also highlighted threats like antimicrobial resistance and emphasized the importance of international collaboration. Areas needing special attention include multi‑drug resistance, food safety in emergencies, surge capacity of the frontline workforce, patient safety to reduce healthcare‑associated infections, and strengthening points of entry. Conclusion: The COVID‑19 pandemic has highlighted both the vulnerabilities and the potential within Pakistan's health system. To enhance its contribution to global health security, Pakistan needs a national policy stance, targeted health system reforms, improved resource allocation, workforce development, and strengthened partnerships with development agencies.

This review examines key events, challenges, and responses to the mpox public health emergency following the Africa CDC's declaration of a Public Health Emergency of Continental Concern on August 13, 2024. In response to the crisis, over 3.6 million vaccine doses and more than $150 million in funding have been mobilized globally, with contributions from the United States, European Union, and Japan. However, challenges persist, particularly in the Democratic Republic of Congo, where a humanitarian crisis in Kinshasa has complicated mpox diagnostics and treatment. In response, the Africa CDC has deployed its One Continental Incident Management Support team, with a focus on decentralizing diagnostics and enhancing sample movement through additional PCR equipment, funded by the Pandemic Fund and USAID. To reinforce laboratory diagnostics, surveillance, and case management, the Africa CDC has adopted a comprehensive "One Team, One Plan, One Budget, One M&E" approach and has deployed 72 epidemiologists to improve data integration. Collaborative efforts with WHO, GAVI, and UNICEF aim to expedite vaccine distribution, with a target of 10 million doses by 2025, alongside enhanced vaccine safety monitoring.

Objective: To establish the prevalence of type 2 diabetes, overweight/obesity, and metabolic syndrome in individuals aged >18 years in Bogotá, Colombia and the variables associated with diabetes prevalence. Research Design and Methods: This was a cross‑sectional population survey with a representative, probabilistic sample of Bogotá, Colombia collected between 2022 and 2023. The final sample size included 2,860 households, distributed among 19 localities of Bogotá. Clinical laboratory samples were taken from randomly selected individuals (n = 1,070). Data on the Adult Treatment Panel III (ATP III) and Latin American Diabetes Association (ALAD) criteria for metabolic syndrome were collected, including physical measurements. Results: The prevalence of type 2 diabetes in Bogotá was 11.0% (95% confidence interval [CI], 9.0-13.5%). According to the ATP III and ALAD criteria, the prevalence proportions of metabolic syndrome were 33.9% (95% CI, 29.5-38.6) and 29.3% (95% CI, 26.1-32.7), respectively. The age of ≥55 years, abdominal obesity, hypertriglyceridemia, and noneducational level had higher adjusted prevalence ratios (APRs) of diabetes. The APRs of metabolic syndrome were higher in adults with a low education level (LEL) and female sex, with the ATP III and ALAD criteria, and noninsured adults or those with unknown affiliation with the healthcare system, with the ATP III criteria. Conclusions: We found a higher prevalence of type 2 diabetes in adults in Bogotá than expected in previous studies. Intervention from public policy should be requested, especially in those of lowest socioeconomic and education levels, to avoid a future increase in this prevalence. Studies on other Colombian cities are required.

Background and Objectives: Timor‑Leste is a lower‑middle‑income country in Southeast Asia. To control the significant local threat from infectious diseases, it is imperative to strengthen the knowledge and practice capabilities of the primary care workforce. Methods: We report and reflect on the development and delivery of a national training programme in infectious diseases called the Advancing Surveillance and Training to Enhance Recognition of Infectious Diseases (ASTEROID) programme, developed by the medical non‑governmental organisation (NGO) Maluk Timor and other Timorese stakeholders. The 1-week training course delivered by local doctors is multi‑modal, combining lectures with educational videos, interactive sessions and a mobile application. The ongoing training was delivered to every Timorese municipality in the participants' place of work and involved 540 healthcare professionals from 37 facilities. Training covered infectious diseases most relevant to the Timorese workforce, and focused on disease detection, management, prevention (including infection prevention and control issues) and notification. Findings: Multiple choice question (MCQ) assessment during the training has shown an average improvement in test scores from 45% to 64%, improving to 71% and 79% at 3- and 12-month follow‑up respectively. The programme has been well‑received, with participants appreciating the use of local specialists in video content, the tailoring of content to the local context and the variety of educational methods. Difficulties have been faced when it comes to delivering adequate content in a week‑long format to a workforce which has not previously received significant professional development. Conclusions: This approach could provide a model for delivering training to national healthcare workforces in low- and middle‑income countries (LMIC) and could be further refined on the basis of the lessons detailed here.

Background: Economic growth is associated with reductions in undernutrition. However, in developing countries, malnutrition still exists as a double burden. A better understanding of the dynamics of malnutrition in such societies as a means of aiding policymakers and implementers is thus needed. Objectives: This study investigated the prevalence of malnutrition in Ebonyi State, Nigeria, and the role of socio‑economic status (SES) in driving it. Methods: Standard protocols were used for all measurements. Overweight/obesity, stunting and thinness were defined using the simplified age‑ and gender‑specific height and body mass index (BMI) field tables of the World Health Organization (WHO). Results: A total of 781 adolescents (65.4% female adolescents) from nine secondary schools were studied. Subjects in the rural and urban low SES groups were shorter than the others despite being older, and were shorter than the WHO reference cohort. In the general population, 3.2% (2.0% for girls and 5.6% for boys) were stunted. Urban low SES boys had the highest prevalence of stunting (18.6%). Thinness was found in 2.6% (7.4% for girls and 2.2% for boys) of the general population. It affected rural female adolescents (16.9%) more than the others and, as with stunting, was absent in the urban upper SES group. Overweight/obesity was found in 13.8% (12.5% for girls and 16.3% for boys) of the general population. It was highest amongst the urban upper SES group (35.9%) and absent amongst rural male adolescents. Stunting coexisting with thinness or with overweight/obesity was found in 0.8% and 0.25% of the general population, respectively. Conclusions: Urban residence without improvements in SES is severely detrimental to the proper nutrition of adolescents.

Background: Anaemia is very prevalent globally and is thought to be linearly associated with wealth and to affect females and rural residents more than males and urban residents. Objectives: This study was designed to investigate this thought in a population of adolescents in Ebonyi State, Nigeria. Methods: Standard clinical protocols were used. A total of 362 adolescents (63.5% females) were studied. Anaemia was diagnosed on the basis of the World Health Organization (WHO) criteria. Results: Aggregate anaemia was found in 50.0% of the general population (43.9% males, 53.5% females) and was most prevalent in the urban upper socio‑economic status (SES) group (62.3%; 70.0% females, 52.2% males). Severe anaemia was present in 7.2% of the general population (9.1% males, 6.1% females). It was most prevalent amongst the 10-11 years age bracket (15.6%). Moderate and mild anaemia were found in 22.4% and 20.4% of the general population and in 13.0%, 11.4%, 8.3% and 6.0% of the urban upper, rural, urban low and middle SES groups, respectively. But in the rural area group, severe anaemia existed without wide sex variations. Moderate anaemia was most prevalent in the urban middle and upper SES groups (29.0% and 26.4%, respectively) with a clear female preponderance. Mild anaemia was the least prevalent (15.3%) in the urban middle SES group. Conclusions: The higher prevalence of severe anaemia in boys and the higher burden in the urban higher SES group warrant a rethink of the public health interventions used in Nigeria. Adolescent boys and urban upper SES groups should be targeted in nutrition interventions related to anaemia.

The current Medical Education system of India, with its enormous workload and academic demands tend to cause the medical students stress. There is evidence showing medical students at a higher risk of depression, anxiety and burnout compared to other Indian students. Despite, the huge reported numbers, the proportion of students and doctors who seek help for their problems is alarmingly low. One of the reasons provided for the same is stigma towards mental health and an apprehension regarding labels and treatment history on the careers of the students. Increased awareness and with a National Health Programme catered towards mental health, there has been a boost in the utilization and provision of mental health services but it rarely translates into better mental health facilities for the healthcare providers. The special set of challenges faced by a medical students are gradually being recognized and efforts are being made to address them. Curriculum guidelines, teaching methods, student welfare centres and helplines have been the areas of intervention. There should also be changes in approaches towards the students who face problems and providing a safe environment for them to discuss their problems, including encouraging peer support. Thus, a fine balance needs to be present between ensuring the protection of the mental health of a medical student and ensuring a quality medical education for them. Further exploration to address stigma and building empathy among the students and evaluation of the intervention methods devised to address the same becomes very necessary to ensure fruitful interventions. It is the need of the hour to help Indian Medical students overcome their struggles with mental health.

Background: Documentation of social behavioural change communication (SBCC) regarding challenges, opportunities and lessons drawn from past public health emergencies is worthwhile to inform priorities for future response efforts. Aim: The aim of this review is to scope the evidence on social behavioural change communication regarding challenges, opportunities and lessons drawn from Ebola, coronavirus disease 2019 (COVID-19), monkeypox and cholera outbreaks from studies published before March 2024, and suggest priorities for future response efforts. Methods: A Boolean strategy was used to search electronic databases for relevant published articles, complemented by relevant studies identified from reference lists. Results: The challenges, opportunities, lessons learnt and priorities for SBCC were consistent across study contexts, showing marked variations over time. The significance of technology, infodemic management, and behavioural data generation emerged more frequently and became increasingly important over time. Identified challenges were uptake hesitancy, limited capacity to undertake infodemic management, inadequate funding and human resources for SBCC, competing priorities, parallel or conflicting interventions due to inadequate coordination, difficulties evaluating SBCC programmes and missed opportunities for integration into routine programmes. Existing supportive structures for SBCC, strong political will and participation, as well as rapid information exchange enabled by technological advancement, represented opportunities for enhancing the effectiveness of SBCC programmes. Key lessons were that a multisectoral approach and coordination, partnership and active collaboration amongst stakeholders; building/strengthening trust, target population segmentation and localization of interventions, are important for enhancing the effectiveness of SBCC programmes. Political will, involvement and participation represent the core of social behavioural change (communication) interventions during a public health emergency. Conclusion: SBCC programming for future response to public health emergencies and disease outbreaks should consider the diverse assortment of benefits, threats/challenges and opportunities brought about by technology, infodemics and behavioural data generation to be more effective.

Introduction: The development of a strong professional identity is influenced by the motivation behind enrolling in a nursing or midwifery programme. Professional identity is a driving force that sustains the commitment of nurses and midwives to nursing/midwifery and their dedication to the well‑being of those they serve. This study evaluated Ugandan students' reasons for enrolling in nursing and midwifery programmes. Furthermore, we investigated the nurse/midwifery practices that support professional identity creation in recent graduates and undergraduate nursing/midwifery students. Methods: A mixed‑method research approach was employed amongst nursing/midwifery students of Makerere University and Mbarara University of Science and Technology and recent nursing/midwifery graduates from Mulago National and Mbarara Regional referral hospitals. We collected quantitative data from 173 participants, and for qualitative data, we conducted six focus group discussions among recent graduates and students of nursing/midwifery. We used descriptive statistics and thematic analysis to analyse the quantitative and qualitative data. Results: Nearly all - 95.4% (165/173) - of the participants were motivated to undertake nursing/midwifery as their programme of study, and 94.2% (163/173) participants identified as nurses/midwives, all with an average score above 3. They also strongly agreed that they took up the programmes because they wanted to learn new things [111/173 (64.2%)] and considered nurses' groups important [68.8% (119/173)]. Participants proposed measures to promote the formation of professional identity among students and graduates, including the improvement of clinical education, the phasing out of certain levels of practice, the empowerment and embedding of ethical principles, recognition and motivation, mentorship, leadership, career guidance and the inclusion of men and challenging of gender stereotypes. Conclusion: Participants were motivated to work in nursing. The ways to promote professional identity included the improvement of clinical education, the phasing out of certain levels of practice, the empowerment and instillation of ethical principles, recognition and motivation, mentorship, leadership, career guidance and male inclusiveness and the challenging of gender stereotypes. Nursing and midwifery leadership needs to provide guidance, mentorship and empowerment; challenge gender stereotypes in nursing/midwifery practice; and give support while advocating for ethical practice.