Annals of Global Health最新文献

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.

Background: Adapting health systems for climate change can lessen the negative impact of climate change on human health. Even when not targeting climate-health links explicitly, broad health system strengthening interventions (HSSis) can ensure that the health workforce, infrastructure, and networks are robust enough to respond to and recover from climate-driven shocks. Objective: We explored the ability of an HSSi in a rural health district of southeastern Madagascar to serve as a climate change adaptation in response to Cyclone Batsirai in 2022. Method: We conducted interrupted time series analyses of eight indicators of infectious disease and health system performance to assess the impact of Batsirai on two zones of the HSSi. We then examined how traditional domains of HSS, such as physical and human resources, combined with less formal domains, such as collective values, influenced health system resilience during this time. Findings: We found that the majority of indicators were resilient to Cyclone Batsirai, with only vaccination rates affected in the two months following the cyclone, particularly in the zone where the HSSi had only begun eight months prior. Changes in long-term trends were rare, and, when observed, revealed a slight slowing of progress, but not a regression to historical levels. After re-establishing the road network and providing additional supplies through an emergency response, the health system was able to resume routine service delivery without further external input, and health system indicators continued to improve. The agility and responsiveness of the health workforce were enabled by formalized protocols, a culture of flexibility, open communication, and data-informed action. Conclusions: HSSis that are designed to encourage local adaptation may increase health systems' resilience to extreme weather events, resulting in health systems better adapted to climate change overall.

Background: This paper focuses on the impacts of climate change on vulnerable ecosystems and its implications for the health and well-being of populations. It specifically examines the semi-arid region of Brazil, where the introduction of a social climate adaptation tool, cisterns, has brought about significant positive changes. Cisterns, a low-cost climate adaptation technology, can be replicated globally, reducing the negative health impacts of frequent droughts, especially for vulnerable groups in remote rural areas. Objective: We analyze the impact of the "One Million Cisterns Program" (P1MC) on health by synthesizing the literature and modeling its interactions with climatic and environmental factors with the Driving Force-Pressure-State-Exposure-Effect-Action (DPSEEA) framework. Methods: Our case study employs a multidisciplinary approach, focusing on two key objectives: (i) synthesizing the literature on the implementation of the P1MC and its association with health outcomes, using search criteria that specifically target articles linking the program to health impacts; and (ii) developing a conceptual framework to model the relationship between climatic and environmental factors, adaptive ecosystems, and health outcomes. The DPSEEA framework evaluates the structural connections between climate change and human health. Findings: The study found a significant gap in the literature concerning the relationship between P1MC and health outcomes. Cisterns target the pressure/state linkages related to contextual factors and health effects, addressing the root causes of drought-related health issues. This framework also provides a foundation for collaboration among health, environmental, and policy sectors to address shared challenges, such as water security and health outcomes. Conclusion: We offer a multidisciplinary analytical framework that can be used to explore various perspectives-environmental, social, and health-related-with experts and stakeholders to develop and improve adaptive social technology strategies for living in the era of climate change. This framework also facilitates the implementation of qualitative and quantitative well-being and health assessments.

Background: The University of San Francisco, California (USFCA) and the Lesotho-Boston Health Alliance (LeBoHA) collaborated in designing and implementing an intensive, interprofessional global health immersion program for nursing and public health students from the United States. The program focused on health systems strengthening in Lesotho. This article reports on the curriculum development process, learning outcomes, and lessons learned from implementing the program. Methods: USFCA and LeBoHA began collaborating in March 2023. The partners codeveloped curriculum with the goal of introducing US students to global health systems challenges and ways to address them in a resource-constrained setting. The program sought to facilitate interprofessional collaboration between undergraduate nursing and graduate public health students, promote cross-cultural awareness and humility, and foster global perspectives and relationships to create a healthier and more humane world. The activity prioritized mutual respect in how the partner institutions worked together. Results: Three nursing and five public health students participated in the program held in January 2024 in Hlotse, Leribe District, Lesotho. The program included classroom learning sessions, health facility site visits, and extracurricular activities. Evaluation data suggested that students achieved course objectives and appreciated the active, experiential learning format. Lessons learned include planning for additional field visits and expanding the experience, possibly through Sesotho language instruction and interaction between students and LeBoHA faculty/staff before arrival and after the program ends. Conclusion: Short-term global health immersions can help to prepare nursing and public health students for careers in global health or working with underserved communities in the United States and strengthen interprofessionalism. Immersion programs should be developed in partnership and provide reciprocal benefits to the institutions involved.

Background: Access to congenital cardiac surgical care in Africa is limited and poorly characterized, with current assessments examining only the number of surgeons in individual countries compared to their respective national population. Objective: To characterize geographic catchment areas in Africa served by the nearest congenital cardiac surgeon(s), estimate patient travel distance, and map both the incidence and unmet surgical need due to congenital heart disease (CHD). Methods: Subnational population, CHD incidence, surgeon, and geographic data were collected from credible, publicly accessible sources. Quantum Geographic Information System was used to create a subnational map of Africa and conduct nearest neighbor analyses to determine the location and distance of each subnational region's nearest cardiac surgeon. Catchment areas were defined and characterized. Incident CHD cases and surgical needs due to CHD were calculated and mapped at the subnational level across Africa. Findings: There were 779 subnational regions from 54 countries included in this analysis. Africa was estimated to have 290 congenital cardiac surgeons located in 63 subnational regions corresponding to 63 catchment areas and 1,097,388 incident CHD cases annually. The average travel distance to a congenital cardiac surgeon was 324.40 km (201.57 miles). The ratio of incident CHD to total surgical case capacity was 20.79. Congenital cardiac surgical need was not limited to areas of high incidence and was compounded by distance to the nearest surgeon, with the greatest need occurring in the Congo Basin and Horn of Africa. Conclusions: Access to congenital cardiac surgery is limited in Africa with the capacity to surgically treat less than 5% of annual CHD cases. Surgical need is exacerbated by the geographic distribution of surgeons, which requires patients to travel great distances.

Evidence regarding the impact of the private health sector on healthcare outcomes is often fragmented. Knowledge gaps remain around the impact of private sector care on health outcomes. This systematic review examines the quality of maternal, newborn, and child health (MNCH) care delivery by private sector providers. The review aims to systematically assess the evidence from studies reporting outcome data on morbidity and mortality among mothers, newborns, and children. Searches were conducted in eight electronic databases (Cumulative Index to Nursing and Allied Health, EconLit, Excerpta Medica Database, International Bibliography of the Social Science, Popline, PubMed, ScienceDirect, and Web of Science) and two websites and supplemented with hand-searches and expert recommendations. We conducted the searches and application of inclusion/exclusion criteria using the PRISMA method. For inclusion, studies in low- and middle-income countries must have examined at least one of the following primary outcomes: maternal morbidity, maternal mortality, newborn morbidity, newborn mortality, child morbidity, or child mortality. Quantitative and qualitative data were extracted for descriptive statistics and thematic analysis. Of the 46 studies included, most studies were conducted in India, Bangladesh, Uganda, and Kenya. Thirty-six studies were quantitative, and over one-third implemented a specific intervention that went beyond the broad delivery of quality care in the private sector. Studies indicated that the outcomes of private sector delivery of MNCH care across health systems were mixed. Studies frequently reported on the utilization of health facilities for the treatment of morbidities. Interventions to improve MNCH care included improved coverage and contracting services, community-based training, and public-private partnerships. Studies often did not provide greater contextual detail, including the complexities and realities of people seeking care across provider types. Future research should disaggregate data on quality of care, as well as describe the methods and specific facility details in their sample.