Annals of Global Health最新文献

The decolonisation of the global health movement has been a matter of intense debate over the last few years. Recent political actions by leaders in the Global North, particularly the closure of the United States Agency for International Development (USAID), call for stronger action by actors in the Global South to strengthen global health. Therefore, this is the right moment for decolonisation in global health to move from rhetoric to action. This essay attempts to inspire action by drawing lessons from the life, struggle and methods of Mahatma Gandhi, who started his life with a Western dream but later led India's freedom movement through his unique approach of ahimsa (non-violence) and satyagraha (truth force). Gandhi's life journey teaches us how decolonisation thoughts develop with the realisation of discrimination and subjugation. His struggles embody how satyagraha can be enforced by applying simple means, such as non-cooperation and civil disobedience, and upheld with strict non-violent means. In global health parlance, Gandhi's concepts can be effectively applied to foster equal and non-subsidiary partnership, based on the principle of Sarvodaya-equal opportunity for the most marginalised. His principle of self-reliance must be invoked to build up national capacities. In addition, everyone involved in global health should strive to be 'the change you want to see in the world'. In the absence of such practice, satyagraha should be invoked to ensure fairness in global health.

Background: Asbestos, a durable fibrous silicate once widely used for its thermal resistance, remains in use in countries like India and China despite being banned in over 70 nations and classified as a Group 1 carcinogen by IARC. Prolonged occupational exposure causes asbestosis, lung cancer, and malignant pleural mesothelioma, but in Low and Middle-Income Countries (LMICs) the true burden is underreported due to weak regulation, low awareness, limited diagnostics, and inadequate occupational health systems. Objectives: This review aimed to examine the epidemiological patterns and diagnostic challenges of Asbestos-Related Disease (ARDs) in emerging economies, with a focus on the applicability and limitations of existing and emerging diagnostic strategies. Methods: We conducted a narrative review of peer-reviewed literature, global databases (WHO, IARC), and recent cohort and cross-sectional studies, sourcing articles through structured keyword searches in PubMed, Scopus, and Google Scholar. Diagnostic approaches were compared across diverse healthcare settings, emphasizing radiological, histopathological, and functional tools. The review also assessed the utility of newer technologies, including low-dose CT (LDCT), ultra-low-dose CT (ULDCT), magnetic resonance imaging (MRI), FDG-PET is Fluorodeoxyglucose Positron Emission Tomography (FDG-PET), breath biomarkers using gas chromatography-mass spectrometry (GC-MS), and digital tomosynthesis (DTS). Findings: LDCT and ULDCT showed superior sensitivity for early detection of pleural abnormalities like circumscribed pleural plaques and diffuse thickening, yet distinguishing benign from malignant lesions remains difficult without biopsy. Diffusion capacity of the lungs for carbon monoxide (DLCO) emerged as a sensitive but nonspecific pulmonary function marker. Histopathological confirmation of mesothelioma remains the gold standard but is rarely accessible in low-resource settings. Conclusion: Addressing the diagnostic gap in ARDs in LMICs requires systemic strengthening of occupational health surveillance, better regulatory enforcement, expanded access to advanced diagnostic tools, and targeted clinician training. Without urgent intervention, the burden of asbestos exposure will remain an escalating public health crisis.

Background: Ethiopia faces persistent cholera outbreaks worsened by increasing droughts and heavy rainfall due to climate change. More than 15.9 million Ethiopians reside in districts historically prone to severe cholera outbreaks. There have been efforts to enhance cholera surveillance by integrating it with climate data and prioritizing forecasting to improve adaptation. Objectives: This study aimed to investigate climate adaptation measures, explore temporal associations between climate variables and cholera incidence across Ethiopian districts, and identify observed thresholds and potential climate indicators for enhancing early warning systems. Methods: We conducted a literature review and secondary analysis of climate-cholera data. Temporal patterns and lagged effects of temperature and rainfall on cholera were examined using descriptive statistics, Pearson correlation, and time-lag analysis (up to three weeks). To determine optimal outbreak conditions, we assessed historical temperature and rainfall averages to measure anomalies. Data visualization, including line graphs, time series plots, and heatmaps, was performed using MS Excel and R. Findings: District-specific temperature and rainfall variations and thresholds were identified. The analysis dataset included 2,298 cholera cases across 13 districts. Cholera transmission exhibited distinct patterns: a monomodal pattern in five districts with primary peaks during the wet season (June-September), driven by heavy rainfall, and a bimodal pattern in eight districts with secondary peaks during the secondary wet season (February-May). Most outbreaks occurred between epidemiological weeks 10 and 42, with 63.7% of cases in weeks 29-42. Rainfall strongly correlated with cholera in monomodal districts, while temperature showed broader correlations in bimodal districts. Conclusions: Understanding district-specific variations in temperature and rainfall is crucial for managing cholera outbreak risks. These insights can inform early warning systems by providing essential indicators for potential outbreaks. Strengthening epidemiological forecasting capabilities, particularly in drought- and flood-prone regions, can support the cholera early warning system, enabling more timely and proactive interventions.

Background: Karachi faced an unprecedented heatwave in 2015, causing severe health outcomes. The heat emergency awareness and treatment (HEAT) intervention was developed to train healthcare providers to identify and manage heat-related illnesses (HRIs). The HEAT intervention was implemented in major emergency departments (EDs) in Karachi in 2018. Objective: This study evaluated the long-term impact of the HEAT intervention on ED physicians' diagnosis and management of patients with HRIs in a single tertiary-care hospital. Method: This study utilized time-series analyses to evaluate the long-term impact of HEAT intervention utilizing ten-year data (pre-intervention, 2013-2017 and post-intervention, 2018-2022). Data were obtained from a single hospital related to diagnoses and management of HRIs for the study period. The outcomes assessed were the number of HRIs diagnosed, use of intravenous (IV) fluids, and use of sponging and ice packs. A zero-inflated interrupted time series Poisson regression model was used to assess the impact of HEAT intervention on diagnosis and management of HRIs, while accounting for time and maximum ambient temperature. Findings: At the crude level, analyses showed a decrease in the number of HRI diagnoses (estimate = -1.63, p < 0.001*), use of IV fluids (estimate = -0.72, p = 0.09), and in the use of sponging (estimate = -0.51, p = 0.64) in the post-intervention period. Findings from the sensitivity analyses, excluding the outlier observations due to the severe heat event of 2015, showed a statistically significant increase in HRI diagnoses (estimate = 2.18, p < 0.001*) and in the use of IV fluids (estimate = 2.07, p < 0.001*) in the post-intervention period. Conclusion: Our educational training intervention was effective in improving HRI diagnosis and management among ED physicians from a select hospital over a long-term period. Findings need to be generalized with caution to other settings.

Introduction: Across Africa, community health workers (CHWs) have become an important cadre in prevention and care services. Community-based service delivery models largely overlook non-communicable diseases (NCDs). Although Lesotho`s Village health worker program is well established, it currently offers no NCD services. This pilot study assessed the feasibility and acceptability of CHW-led home-based screening and diagnosis for arterial hypertension and diabetes mellitus in rural Lesotho. Methods: This mixed-methods pilot study involved 10 CHWs from 10 rural villages in two districts of Lesotho. From March 2022 to December 2023, the CHWs enrolled and screened all eligible and consenting participants of their villages for hypertension (using automated blood pressure (BP) measurements) and diabetes (using capillary blood glucose measurements) in a door-to-door approach. All participants aged ≥18 years were eligible for hypertension screening; those aged ≥40 years or with a body mass index (BMI) ≥25 kg/m² were eligible for diabetes screening. 10 purposively sampled participants were interviewed with subsequent qualitative thematic analysis. Results: In the 10 villages, CHWs visited a total of 687 households and enrolled 1811 participants (median age 24 years (interquartile range (IQR): 11-25.5 years), 56.5% female, median BMI 23.4kg/m²). Among 803 participants eligible for diabetes screening, 788 (98%) were screened. Overall, 28 (3%) had impaired fasting glucose and 42 (5.3%) had diabetes. Among 1091 participants eligible for hypertension screening, 998 (91.5%) were screened, 50 (5%) had high normal BP, and 268 (26.9%) had hypertension. All participants interviewed expressed a high level of acceptance and appreciation for CHW-led screening and diagnosis of diabetes and hypertension. Conclusion: In this pilot study in Lesotho, CHW-led screening and diagnosis of hypertension and diabetes was highly acceptable and feasible, achieving >90% screening coverage. These results support larger-scale studies and encourage further exploration across diverse regions to assess the impact of CHW-led screening and diagnosis for NCDs.

Background: The burden of colorectal diseases continues to rise in Ghana. However, building a surgical workforce to address these diseases has been hampered by the lack of a colorectal specialty training pathway. To address this gap, the first colorectal surgery fellowship in Ghana was established in July 2023. Objective: This study aims to identify strengths and gaps in colorectal care delivery prior to fellowship implementation by assessing relevant infrastructure, resources, and case volume at a Ghanaian teaching hospital. Methods: Data on surgical infrastructure and human resources were collected at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. Retrospective, de-identified data were collected on all colorectal procedures performed at KBTH from January 1, 2022, to December 31, 2022. Cases were categorized by common anorectal, abdominal, and endoscopic procedures. Findings: All surgical infrastructure and human resources were always available during the study period, except for immunohistochemistry services. 2,992 colorectal procedures were performed, including 173 anorectal procedures, 167 abdominal procedures, and 2,652 endoscopic procedures. The three most common colorectal surgeries performed were segmental colectomy (n = 76), excisional hemorrhoidectomy (n = 64), and stoma creation/management (n = 52). Some common colorectal services were not provided, including banding of internal hemorrhoids, seton placement for perianal fistulas, rectopexy for rectal prolapse, and pelvic floor evaluations. Conclusions: There is a need for colorectal-specific surgical training and infrastructure in Ghana. KBTH is well-equipped with the resources to support growth of the newly established colorectal surgery fellowship, which will expand colorectal services available for Ghanaians.

Background: US academic institutions increasingly seek to engage in global health education through bidirectional partnerships. One innovative approach is hosting International Medical Graduates (IMGs) at US-based programs, offering short-term global health learning experiences locally while expanding professional opportunities for IMGs from both high-resource and resource-constrained settings. Methods: Drawing on over 15 years of collective experience, this paper brings together perspectives from global authors to identify practical strategies for hosting visiting IMGs. The recommendations address the operational, legal, and financial barriers that institutions often face when building such programs. Recommendations: Key challenges include securing stakeholder engagement, navigating visa limitations, and addressing funding and institutional policy gaps. The authors outline 10 actionable recommendations designed to guide US institutions in building ethical, sustainable, and mutually beneficial IMG-hosting programs. Conclusion: While prior literature has emphasized the ethical foundations and benefits of global partnerships, this paper offers concrete guidance to support the development of IMG-hosting initiatives. These programs advance the goals of equity, reciprocity, and long-term partnership in global health education.

Background: Gender's influence on health outcomes is well-documented, yet gaps in gender expertise persist within the global health workforce. Simultaneously, accessible and interactive gender training opportunities are limited. The Johns Hopkins Bloomberg School of Public Health Gender and Health Summer Institute (GHSI), launched in 2023, aims to address these gaps by advancing the gender integration and analysis skills of health professionals. Methods: Using Stake's Countenance Model for educational evaluations, we explored whether the Institute was meeting its objective of providing applied knowledge and experience of gender integration and analysis for health research, programs, and policy. The evaluation focused on intended and actual program outcomes. We examined proposal documents and held discussions with the GHSI team. All students receive pre-course surveys one week prior to each course. Post-course surveys focused on changes in knowledge, skills, and abilities and overall experience. Two focus-group discussions were held with students. Survey data were analyzed descriptively in R, and qualitative data were analyzed thematically. Results: The pre-course survey received 137 unique responses; the post-course survey received 78 responses. Results indicate that the GHSI successfully met many of its intended goals, for example, by increasing participants' knowledge and skills in gender analysis and integration as well as confidence in applying new skills. Learning was enhanced through creating safe and inclusive spaces. However, the courses' short duration and lack of a sustained community of practice were identified as areas for improvement. Conclusion: Findings underscore the importance of applied skills training and the need for ongoing support to fully equip professionals to address gender disparities in health. The GHSI's virtual format also demonstrates a scalable, innovative approach other programs may consider. Finally, recommendations are provided for enhancing the GHSI and similar programs to better serve working professionals and foster a more equitable global health landscape.

Background: Photographic imagery holds profound power in shaping narratives, identities, and perceptions in global health education. Historically, visual representation used in global health has perpetuated colonial hierarchies, reinforcing inequities and marginalizing the voices and lived realities of the communities they depict. These images can inadvertently sustain harmful stereotypes and distort the complexity of global health challenges. Findings: This paper explores the ethical imperative of decolonizing photographic imagery within academic global health, proposing a comprehensive multi-level framework for change targeting institutions, faculty, and students. At the institutional level, strategies include developing formal ethical image-use policies, establishing accountability structures, and providing ongoing training to center principles of informed consent, dignity, and cultural context in image selection and use. Faculty have a critical role in modeling ethical practices by selecting imagery in research outputs and teaching materials, integrating visual ethics into curricula, and fostering classroom dialogue that encourages critical reflection on representation and power dynamics. Educators can actively engage students by empowering them to contribute their own experiences, thereby reshaping dominant visual narratives. Collaboration with community partners in co-creating authentic and respectful images is essential, alongside mechanisms for continuous evaluation and accountability to sustain ethical standards over time. Recommendations: We recommend that academic institutions adopt institution-wide ethical image-use policies, offer training programs for faculty and students, and develop centralized image repositories that include culturally appropriate and consented visuals. Faculty should integrate ethical image practices into research and pedagogy, while creating spaces for students to reflect on diverse perspectives. Building meaningful, ongoing partnerships with community stakeholders is crucial to ensuring that images represent the diversity and dignity of global health realities. Conclusions: By advancing a culture of ethical reflexivity and accountability around photographic imagery, academic institutions can dismantle colonial visual legacies and foster more equitable, inclusive, and humanizing global health education and practice.