Annals of Global Health最新文献

Background: We are early in our understanding of how to effectively implement interventions to mitigate the harm of extreme climate events on human health. We study the actions of the state government in Nuevo Leon, Mexico, which, in 2022, declared a state of emergency due to water shortages resulting from climatic and infrastructural issues. Objective: To document the facilitators and challenges to the rollout of the government's strategy to mitigate water insecurity, using the EquIR Implementation Science framework. Our analysis focused on the activities of the Ministry of Social Policy, which coordinated emergency activities. The government's response included water delivery by tanker trucks, installation of household and community cisterns, and distribution of packaged drinking water. Methods: We used three sources of information: gray and academic literature review, government documents, and 10 key-informant interviews. Findings: Facilitators of government actions were the declaration of an emergency as a policy instrument; multi- and inter-sectoral collaboration; the use of pre-existing social and data infrastructure; technical capacity to identify low-income households without water; and flexibility to convert regular activities to emergency response tasks. Salient challenges included citizen discontent about the lack of water; the absence of a preparedness plan; the scarcity of household equipment to store water; initial inefficiencies with water distribution using tanker trucks; difficulties in installing community cisterns in steep terrain; and staff burnout. A positive externality of the response was the improvement of water distribution in informal settlements. Conclusions: As the need to buffer human health from extreme climate events increases, lessons from Mexico about linking climatic events, social policy, and health outcomes can guide strategies in other locations with increasing drought. This case shows how climatic stressors, infrastructure deficiencies, and the population's coping capacity interact with the government's actions to shape the impacts of a crisis and its mitigation efforts. Successful mitigation strategies may result from strengthening inter-sectoral collaboration and an evidence-based culture of prevention.

Background: Chad is highly vulnerable to climate change, posing significant threats to health systems and population health. Rising temperatures, irregular rainfall, droughts, and resource scarcity exacerbate food insecurity, malnutrition, and vector-borne diseases like malaria. In Ngouri, a rural area in the Lac Region, these climate stressors have led to worsening health outcomes and strained healthcare services. Without adaptation measures, facilities will struggle to maintain essential services amid escalating climate pressures. This case study presents a facility-adapted climate vulnerability and capacity assessment (VCA) for a rural hospital in Chad, identifying key risks and prioritizing solutions to enhance climate resilience. Objectives: This case study describes the development and implementation of a facility-adapted climate VCA in a high-vulnerability, low-resource setting and outlines prioritized solutions for an actionable adaptation plan. Methods: The study employed a participatory mixed-methods design, incorporating five stages: (1) literature review on climate hazards, exposure pathways, and population vulnerabilities; (2) facility audit assessing infrastructure and healthcare delivery gaps; (3) qualitative focus groups to refine risk identification; (4) development of a matrix of solutions with cost estimates and feasibility analysis; and (5) a participatory prioritization process to develop a multi-year facility improvement plan. Findings: The VCA identified climate risks, including elevated malarial mortality and power outages disrupting oxygen supply. A list of 35 solutions was generated, with 22 priority actions selected for implementation. These included anticipatory planning, community sensitization, supplementary feeding programs, and improved waste management. The process highlighted the importance of community engagement, multidisciplinary collaboration, and staff motivation for climate-resilient and sustainable healthcare. Conclusion: The adapted VCA offers a replicable approach to assessing climate-related vulnerabilities and capacities in healthcare facilities. It revealed significant risks to health service delivery and informed the development of locally feasible, sustainable adaptation measures. The framework applied in Ngouri hospital demonstrates relevance for similarly affected contexts, supporting efforts to align health systems with global sustainability goals and to secure quality healthcare under changing climatic conditions.

Background: The prevalence of chronic kidney disease and other non-communicable diseases in Guatemala has been rising. Recently, chronic kidney disease of non-traditional origin (CKDnt) has been identified among occupational cohorts and linked to heavy workloads in hot environments. Objective: To describe a systems-based community participatory approach to occupational safety and health. Methods: Over the last eight years, academic researchers have partnered with a large agribusiness in Southwest Guatemala to address the health, safety, and well-being concerns of workers, especially in relation to CKDnt. This case study presents the Total Worker Health® approach used to develop, implement, and evaluate interventions to address potential causes of CKDnt. The results of these interventions are presented using the Consolidated Framework for Implementation Research and RE-AIM. Findings: A Total Worker Health (TWH) approach addressing both transactional and transformational organizational behavior change to reduce the incidence of reduced kidney function in this workforce can be successfully implemented. Our findings highlight the need for collaborative approaches to the development and implementation of strategies to adapt to climate change in the workplace. The sustainability of interventions needs constant re-evaluation to adapt to changing contexts. Discussion: This case study illustrates a practical, evidence-based TWH approach to address the immediate impacts of heat stress and nephrotoxins on the kidney health of sugarcane workers in Guatemala. It also illustrates the importance of multi-modal interventions implemented and evaluated in a dissemination and implementation science framework informed by the community that is at risk. The principles underlying our approach may have applicability and generalizability to less extreme circumstances, and beyond those with heat-associated kidney disease.

Background: Loneliness is emerging as a key risk factor for child and adolescent mental health. Exacerbated by lack of support, busy routines, continuous adversities, and poor social networks, it is a public health concern. Sleep is essential for healthy development and emotional regulation, critical for modulating risk‑taking, and determines optimal learning and mental health. However, the connection between loneliness and sleep and their impact on mental health and educational outcomes is not well known in low‑ and middle‑income countries (LMICs) like Kenya, where a large portion of the population is young. Objectives: (1) Examine the bidirectional relationship between loneliness and impaired sleep in a Kenyan adolescent cohort. (2) assess the individual and joint contribution of loneliness and sleep impairment relationship in common mental health problems such as anxiety, depression, and anger, while controlling for adverse childhood experiences (ACEs). Methods: A cross‑sectional study with 70 adolescents (ages 11-15) from Nairobi schools. Measures used: Loneliness (NIH Toolbox), Sleep Impairment (PROMIS), Mental Health (PROMIS‑Anger, Anxiety, Depression), ACEs (WHO ACEs‑IQ). Findings: We found a strong association between loneliness and sleep impairment, even after controlling for ACEs (associated with 32.0%-33.9% of variance). Higher ACEs were also associated with increased loneliness and sleep impairment. Notably, after adjusting for the ACE confounder, both sleep impairment and loneliness were significantly associated with adolescent mental disturbances (anxiety, depression, and anger), with sleep impairment explaining greater variance (27.2%-30.4%) than loneliness (11.8%-27.4%) for the anxiety, anger, depression outcomes. Jointly, loneliness and sleep impairment were associated with 28.8%-30.4% of the variance in adolescents' mental health problems. Conclusion: Our article contributes new evidence that sleep health is critical to mental well‑being for adolescents living in high ACEs and LMIC contexts. Providing intervention strategies to reduce loneliness and promote sleep health should be considered to improve adolescent mental health.

Aims: This paper explores the current global health landscape and the transformative potential of empowering Advanced Practice Nurses (APNs) to address global health challenges. It highlights successful models of APN integration from various countries, showcasing their positive impact on patient outcomes and the efficiency of the healthcare system. Introduction: This narrative provides an overview of the current impact of APNs and Nurse Practitioners (NPs) on global health, as well as areas where APNs/NPs can enhance healthcare outcomes. It emphasizes the crucial role that APNs play in addressing healthcare issues and outlines their potential to expand access to quality care through their practice and leadership. Methods: A review of the literature examines current trends and research; this paper highlights critical areas where APNs can make substantial contributions, such as chronic disease management, primary care access, emergency care, and overall health system improvement. Results: It is essential to optimize the utilization of APNs/NPs, standardize APN roles and scope of practice internationally, enhance APN educational programs, and promote interprofessional collaboration. Conclusion: The global healthcare landscape faces unprecedented challenges, including aging populations, increasing burdens from chronic diseases, and persistent health disparities. By empowering APNs, healthcare systems can better address the diverse and evolving health needs of global populations. Impact: APNs and NPs can significantly and multifacetedly impact global health. They are uniquely positioned to provide holistic and patient‑centered care, improve access to services, mitigate provider shortages, enhance quality, and address health disparities. Nursing contribution: APNs/NPs are underutilized in healthcare. They are experts in health promotion and disease prevention, both of which are crucial for improving global population health. APNs/NPs can contribute to achieving the United Nations Sustainable Development Goals (SDGs) related to improved health, greater gender equality, and stronger economies.

Background: Training allied health professionals in oral health promotion and disease prevention, and integrated into noncommunicable disease (NCD) management, has been shown to improve access to essential oral health services. Oral diseases in the WHO African region are a significant public health problem, and trained dental professionals are scarce. Objectives: The WHO African Regional Office (WHO AFRO) aims to create a novel tiered oral health workforce, beginning with community health worker (CHW) training on oral health, and utilizing combined in-person and virtual/digital learning through mobile technologies (mOral Health). Successful scale of the program will assist in improving the oral health knowledge, skills, and behaviors of CHWs in Africa, as part of their essential packages of basic services. Approach: Guided by a logic model framework, our approach for developing the mOral Health curriculum was based on a proven six-step model for curriculum development in health professions education. Steps 1-3 describe our approach for developing the training program: Step 1: Problem Identification and General Needs Assessment; Step 2: Targeted Needs Assessment; and Step 3: Goals and Objectives. Results: Step 4 describes the resulting curriculum and educational strategies. This is the WHO African region's first competency-based CHW training program universally accessible to all member states. Step 5 (Implementation) and Step 6 (Evaluation and Revision) are planned for subsequent work at a future stage of this project. Conclusion: The mOral Health curriculum for CHWs in the WHO African region leverages digital technologies as part of the WHO mHealth initiative and aligns with the WHO Global Strategy on Oral Health. This mOral Health curriculum can lay the groundwork for further development of an evidence-based, tiered oral health workforce in Africa and will integrate oral health services into the WHO AFRO agenda for the prevention, control, and management of NCDs across the region.

Background: Uptake of evidence-based care for acute myocardial infarction (AMI) is limited in Tanzania. To address this, a tailored intervention, the Multicomponent Intervention to Improve Acute Myocardial Infarction Care (MIMIC), was co-designed by an interdisciplinary team. Objectives: To determine implementation outcomes from a pilot trial of the MIMIC intervention in a Tanzanian emergency department (ED). Methods: The MIMIC intervention was implemented by the ED staff for one year. Fidelity, penetration, and costs were observed for each of the intervention components: designated champions to audit care, an online training module for staff, a triage card for nurses to flag patients with AMI symptoms, pocket cards summarizing AMI management for physicians, and an educational pamphlet for patients. Thirty days following enrollment, patient participants were contacted via telephone to inquire whether they had read the pamphlet. Results: Physician champions and nurse champions were actively engaged in the intervention across the twelve-month study period. Fidelity to the pocket card was excellent, with all 22 (100%) physicians observed to have ever brought their pocket cards to work, and penetration across physician-shifts was 96.1% (1835/1910). The training module was started by 20 out of the 22 (91%) physicians and 25 of the 32 (78%) nurses observed. Penetration, measured by module completion, was the same for physicians (20 of 22, 91%) but lower among nurses (21 of 32, 65.6%). Triage cards were used for 453 out of the 577 (78.5%) patients with chest pain or dyspnea. Fidelity to patients with AMI receiving the educational pamphlet was 37.6% (53 of 141). Only 22 of the 39 (56%) surviving AMI patients who received the pamphlet reported reading it, with most of the rest reporting being unaware that they had received it. The total annual cost of the MIMIC intervention was USD 1324.24. Conclusions: There was high variability in fidelity and penetration of the individual intervention components. Future studies should explore reasons for incomplete penetration and analyze cost-effectiveness for scale-up efforts across Tanzania.

Background: Mercury contamination remains a significant public health concern in the Amazon basin. This review synthesizes recent evidence on mercury exposure, health outcomes, and emerging co-exposures in the Amazon countries. Data were presented at the Annual Conference of Global Health in the Americas, organized by Florida International University in Cartagena, Colombia on September 15, 2023, at a virtual session of the Consortium of Universities for Global Health on November 29, 2023, and subsequently updated with further literature search. Findings: Reported mercury concentrations in fish range from 0.10 to 4.73 µg/g, while hair mercury levels in exposed populations span 3.07-24.6 µg/g. Cross-sectional studies among Indigenous and traditional communities consistently demonstrate associations between mercury biomarkers-primarily measured in hair and urine-and neurocognitive as well as neuromotor impairments. Additional evidence links mercury exposure to increased cardiovascular and metabolic risk. Genetic susceptibility, notably APOE4 and GSTP1 polymorphisms, may modulate mercury absorption and toxicity. Co-exposures to microplastics and agrochemicals are increasingly reported in the region, raising concern over synergistic toxic effects. However, scientific evidence on these combined exposures remains fragmented and insufficient. Conclusions and recommendations: To address this critical gap, we propose the formation of a cross-national scientific consortium to foster collaboration, enhance epidemiological capacity, and strengthen laboratory infrastructure. Crucially, efforts to address mercury contamination must center the voices of Amazonian Indigenous peoples, who bear the greatest burden of exposure while facing persistent social, environmental, and health inequalities. Meaningful engagement with these communities is essential to overcome marginalization and ensure that research, policy, and intervention strategies are culturally informed, equitable, and effective. Coordinated regional action is urgently needed to protect the health and rights of vulnerable Amazonian populations.

Background: Multi-Sectoral Action (MSA) for health involves the collaboration of various stakeholder groups within and beyond the health sector and is seen to be critical for the attainment of the Sustainable Development Goals. In Kerala, India, decentralisation reforms have been in place for some time, and we sought to characterise the roles specifically played by locally elected representatives or Local Self-Government (LSG) members, in relation to MSA. Methods: Between July and October 2021, we conducted in-depth interviews with 80 participants from four districts in the southern Indian state of Kerala. Participants were community leaders, healthcare professionals, public health officials and elected members of LSG bodies. After obtaining written informed consent, participants were interviewed about the roles of various stakeholders in implementing primary care reforms with a particular focus on MSA at the grassroots level. The interviews were recorded, translated into English, and thematically analysed by the research team using ATLAS.ti 9.1 software. Results: Participants ranged in age from 35 to 60 years. LSGs played a number of critical MSA roles, including being a gatekeeper for local action; coordinator of departments, sectors and actors (departments of health, revenue, labour, and education departments as well as volunteers); custodian of community, particularly those 'left behind,' crisis manager, team builder and advocate even for communities for which they did not have direct responsibility. Conclusion: LSGs were widely seen by implementers as central figures in coordinating MSA for health in Kerala, before and during the COVID-19 pandemic, and in relation to 'left behind' groups. The multiplicity of roles played by LSGs suggests the need for flexibility on the one hand as well as the plurality of roles on the other hand, which may be necessary to enable convergence and MSA, particularly at local levels.

Background: The Sundarbans, prone to cyclones and tidal surges, witnessed 13 cyclones (1961-2020), causing widespread water and vector-borne diseases, injuries, deaths, crop and livestock loss, and long-term health issues. Objectives: This study investigates the impact of multi-purpose cyclone shelters on the health outcomes of the Sundarbans population, focusing on epidemic-prone diseases caused by these natural disasters. Methods: The study used secondary data from the Health Management Information System (HMIS) portal, Census of India, International Best Track Archive for Climate Stewardship (IBTracs), Department of Disaster Management, and Environmental Systems Research Institute, Inc (ESRI) India, to understand the association of environmental, social, demographic, geographic, and economic factors on water and vector-borne diseases and cyclonic events for 19 census development (CD) blocks. Maps were prepared using ArcGIS Pro v.2.8. A literature review was undertaken to assess the effectiveness of cyclone shelters and potential shortcomings in addressing and mitigating these unintended health outcomes post-disaster. Data analysis in SPSS used the chi-square test and Student's t-test. Findings: The study found that the prevalence of waterborne diseases across the CD blocks in Sundarbans was significantly higher in the cyclonic years compared to the non-cyclonic years (t = 6.69), regardless of the seasons. Prevalence of vector-borne diseases was also significantly higher in the cyclonic years compared to the non-cyclonic years (t = 2.55). It was also found that the existing literature lacks detailed accounts of shelter residents' experiences, illnesses, and pre-existing health issues, particularly addressing the needs of vulnerable populations like women, children, and the elderly. Conclusion: The study highlights gaps in India's research on evacuee experiences in cyclone shelters, particularly for vulnerable populations like women, children, and the elderly and sick. Future research should focus on primary studies focusing on evacuee experiences, material innovation, and climate-resilient design of cyclone shelters.