Annals of Global Health最新文献

Background: The Dr. LEE Jong-wook (LJW) Fellowship Program aims to enhance the capabilities of healthcare personnel in low- and middle-income countries (LMICs) through comprehensive training and education. This study evaluates the satisfaction and effectiveness of the Health Policy Administrator course within the program, focusing on participants from 2021 to 2023. Objective: This study aims to assess the impact of the Dr. LJW Fellowship Program, specifically evaluating participants' satisfaction, knowledge and competency improvement, and the adoption of learned knowledge in the workplace. Methods: A mixed- methods study design was adopted, utilizing Kirkpatrick's four-level evaluation framework to assess the program's impact. A total of 39 public health policymakers from 19 LMICs participated in the training course at an affiliated university. The evaluation focused on training satisfaction, knowledge and competency improvement, competence achievement, and the practical adoption of learned knowledge. Descriptive statistics were used to analyze participant characteristics, while paired t-tests were employed to assess knowledge and competency improvement before and after the program. Results: The program demonstrated high levels of participant satisfaction, with an overall satisfaction score of 92.9. Knowledge scores improved significantly, with an average increase of 61%, particularly in health statistics (77% improvement) and healthcare systems (56.3% improvement). Competency achievement was also high, with an average score of 92.5. However, the job adoption of learned knowledge scored lower, with supervisors and coworkers rating it at 70.9 and 72.1, respectively, indicating challenges in translating training into practical workplace applications. Conclusions: The Dr. LJW Fellowship Program effectively enhanced participants' knowledge and competencies in health policy administration. However, the lower scores in job adoption suggest a need for improved follow-up support and practical application strategies to ensure that the training's benefits are fully realized in participants' work environments.

Background: Research capacity is a critical element of health emergency preparedness, but metrics are not readily available for many countries. The COVID‑19 pandemic provided an opportunity to use publicly available data to assess correlations between national pre‑pandemic research activity, pandemic research response, and other national socioeconomic characteristics. Methods: National pre‑pandemic (2018-19) research activity was defined as the average of percentile rankings of (1) the average annual number of health science publications in Scopus and (2) the average annual number of clinical trials in the International Clinical Trials Research Platform (ICTRP). National pandemic research response (2020-21) was defined as the average of percentile rankings of (1) average annual number of COVID‑19‑related publications in Scopus and (2) average annual number of COVID‑19‑related clinical trials in ICTRP. Findings: During 2018-19, the median (interquartile range [IQR]) of national annual average health science publications was 415 (108-3,398) and of clinical trials was 21 (4-273). During 2020-21, the median (IQR) of national annual average COVID‑19‑related publications was 85 (18-798) and that of COVID‑19‑related clinical trials was 1.5 (0-11). National COVID‑19‑related research output was strongly correlated with pre‑pandemic research activity (R‑squared 0.89) and much less correlated with Human Development Index (0.26), COVID‑19 case number (0.16), case rate (0.14), gross domestic product (0.11), or population (0.10). In a multivariable linear regression analysis, national pre‑COVID‑19 research activity was the only factor with substantial or statistically significant contribution to explaining variations in COVID‑19‑related research output. Interpretation: National pandemic research responses were most strongly correlated with pre‑pandemic research activity, much more so than with other country characteristics. These findings strongly support global efforts to strengthen research capacity as a critical element of preparedness for health emergencies.

Background: India has a ship‑breaking yard at Alang in Gujarat. The workers are prone to being exposed to various hazardous chemicals, including asbestos. These workers are often interstate migrants, and there is a chance of them developing diseases caused by asbestos, manifesting decades after exposure. This includes mesothelioma, which is a malignancy caused by asbestos exposure and can manifest much after the cessation of their employment. Objective: In the absence of an operational national database of migrants, it is important to understand the source of migrants to trace future disease occurrence, especially after retiring to their home states. This study aims to find the Indian districts from which workers migrate to work at Alang‑Sosiya ship‑breaking yards. Methods: The current study uses the Right to Information Act, 2005, to find out the districts of residents of migrant workers that came to Alang in 2019 as a representative year. Findings and conclusion: The data point to districts in three states: Uttar Pradesh, Jharkhand and Bihar, and have important policy consequences and epidemiological importance as these can be used to understand the aetiology of asbestos‑related diseases.

Objectives: Equitable global health partnerships are recognized as critical for health equity; however, power imbalances and structural inequities continue to undermine these partnerships and ultimately their ability to achieve equitable health outcomes. As individuals within a US‑based academic institution engaged in global health partnerships during the current, complicated political moment, we recognize our responsibility to critically examine what it means for us to seek to engage equitably, both locally and globally. We therefore undertook an initiative to develop and adopt a set of principles to serve as internal guidance for how individuals within our institution engage in partnerships. We present our approach to promoting equity within our local and global research, education, and community partnerships, informed by existing literature, as an example of how academic institutions based in the Global North might seek to address power imbalances and to engage with others involved in similar efforts. Methods: We reviewed similar initiatives and existing principles. An internal, departmental committee coalesced around eight principles and drafted and iteratively refined their components. As part of ongoing, broader conversations with our partners, during this process, we engaged and sought the perspectives of our external partners, including from Brazil, India, and Kenya, to ensure the guidance was both informed by and resonated with their concerns about engaging with a US‑based institution. Findings: The principles of sustainability, mutual benefit and reciprocity, equitable governance, do no harm, locally identified priorities, compliance with ethical reviews and legal standards, information sharing, and accountability were elaborated and ultimately adopted by the full department faculty. Conclusions: Despite the best of intentions, we foresee challenges that may impact both implementation and outcomes. Continued reflection and dialogue with our partners and others engaged in similar initiatives is needed to address these challenges and the broader structural inequities embedded in global health.

Background: Cambodia faces significant shortages of qualified physicians and skilled faculty, posing challenges for both medical training and educational reform. Innovative faculty development initiatives are essential in resource‑limited settings to address these gaps and support broader reforms. Objectives: We describe a novel virtual faculty development program, created through regional and global collaboration, to enhance medical education in Cambodia. Methods: We conducted a faculty development program consisting of six virtual workshops between August and September 2023. The program targeted basic science faculty in the pre‑clinical curriculum, introducing integrated teaching, case‑based learning methods, and related assessment strategies. Regional and international collaboration formed the backbone of the initiative, involving expertise from neighboring Vietnam and the United States. Findings: Although participants were voluntary, and we offered no financial incentives, over 80% of the invited participants attended the sessions. Participants reported high satisfaction with the workshop content and format. Additionally, participants applied the concepts learned, as demonstrated by their creation and use of integrated clinical cases in their teaching. Conclusions: Medical education is increasingly becoming a focus of global health collaboration. Findings highlight the feasibility and benefits of a partnership‑driven virtual faculty development model. By leveraging regional and international expertise to address local challenges, this initiative contributed to strengthening faculty capacity in resource‑constrained settings.

Background: The European region is marked by pronounced disparities in healthcare access, socioeconomic conditions, and cancer control policies, which influence the mortality trends of gynecological cancers across countries and may persist or intensify in the coming decades. Objective: This study analyses mortality trends of three main gynecological cancers, including ovarian, uterine, and cervical cancers in the European region from 1992 to 2021 and projects rates for the next 25 years to support targeted public health interventions. Methods: Data from the Global Burden of Disease 2021 were used. An age‑period‑cohort (APC) model estimated overall annual percentage changes in mortality (net drifts), local drifts, and age/period/cohort effects for gynecological cancers in the European region. A log‑linear APC model projected mortality and age‑standardized mortality rates (ASMRs) from 2022 to 2046. Findings: Over the past three decades, the European region has had some of the highest mortality rates globally for ovarian and uterine cancers, while trends for cervical cancer have been more favorable. Overall, gynecological cancer mortality declined, though rates increased with age, but period and cohort effects weakened. Ovarian cancer mortality decreased in 17 of the 44 countries studied, while remaining stable in the others. Uterine cancer mortality rose in three countries, with the most pronounced increase observed in Italy. Cervical cancer mortality declined in 32 countries, with Italy being the only country to show an upward trend. Forecasts indicate a steady increase in uterine cancer deaths over the next 25 years, with slight decreases in ASMR, while ovarian cancer and cervical cancer deaths and ASMRs are projected to decline. Conclusion: Despite overall progress in reducing gynecological cancer mortality, significant disparities remain, particularly among older populations and in certain countries such as Italy. Projections indicate a rise in uterine cancer mortality, highlighting the urgent need to strengthen early screening, preventive measures, and equitable healthcare strategies to reduce future disease burden.

Emergencies significantly disrupt health systems and hinder regular and timely access to service delivery. Humanitarian assistance during crises tends to prioritize populations' immediate needs, such as injuries and infectious diseases, rather than noncommunicable diseases (NCDs), which require continuous lifelong care across different specialties and levels of healthcare systems. However, neglecting NCDs in emergency settings can have long-term negative consequences for affected populations, including increased morbidity, unnecessary preventable deaths, and straining already stressed healthcare systems even more. The purpose of this paper is threefold. First, it argues for high-level commitments to integrate NCDs into the Global Health Security Agenda (GHSA) for more effective action toward sustainable recovery. Second, it advocates for a well-coordinated integrated health systems response that holistically tackles NCDs in humanitarian emergencies, focusing on the importance of strengthening pre-crisis infrastructure, quality NCD surveillance data, health workforce, and overall health system readiness. Finally, the paper explores the challenges for effective NCD management, emphasizing the need for multisectoral collaboration, partnerships, and resource mobilization to enhance preparedness, response, and recovery efforts.

Background: Asbestos and its impacts on the population worldwide are threats to the environment and public health, striking both countries that have banned asbestos, such as Italy in 1992, and those that continue its use. In Italy, asbestos‑affected communities have experienced diverse progress in their involvement in prevention and asbestos risk management. Objectives: Exploring social stakeholders' engagement in research projects on asbestos health impacts and discussing the benefits of the ongoing SEPRA project (Epidemiological Surveillance, Prevention and Research on Asbestos). Methods: A structured communication plan was implemented, including the selection of social stakeholders and their engagement during the project's lifetime; selection of research topics to characterize the participative initiatives and communication modality; and collection and analysis of inputs for enabling impacts. Findings: Sharing major issues of concern highlighted by social stakeholders, such as the recognition of all asbestos‑related diseases besides mesothelioma and non‑occupational asbestos exposures. The need to implement health surveillance plans in all the regions of the country, including a national plan addressing the psychological support to patients and their families, and to extend social welfare to people affected by occupational and non‑occupational asbestos‑related diseases has been highlighted. Conclusions: Social stakeholders' engagement in research activities through structured interactions and trusted relationships allowed us to share information, needs and recommendations for implementing effective actions in public health. Researchers committed to asbestos research at a national scale should closely collaborate with stakeholders through structured communication, considering their diversified fields of experience, critical thinking and inputs. Giving recognition to social stakeholders of their role and expertise and providing them appropriate tools to interact with the relevant authorities and the asbestos‑affected communities are key for effectively advancing in inclusive processes and health equity.

Background: From early in its history, gold mining in South Africa involved recruiting hundreds of thousands of workers from Malawi and other neighbouring countries to work in an environment conducive to high rates of tuberculosis and silicosis. Official recruitment from Malawi ended in the 1990s, depriving large numbers of these migrant miners of their livelihood, with limited or no access to employment-linked social benefits and services. Objectives: To describe barriers faced by Malawian migrant ex-gold miners in accessing social benefits related to occupational lung disease and related health services and medical examinations, and to identify needed actions. Methods: This study, conducted in the Blantyre region of Malawi, draws from field observations and interviews with 14 ex-gold miners who had worked on South African gold mines, supplemented by five key informant interviews. Data were analysed using a phenomenological and thematic analysis approach. Findings: Ex-migrant miners described precarious livelihoods and difficulty accessing employment-linked benefit examinations and health services. They are largely uncertain about their entitlements related to their past work in South Africa and the means for pursuing such rights. The division of responsibility within South Africa and between the governments of South Africa and Malawi has resulted in confusion and misinformation. Within Malawi, scarcity of funding, administrative hurdles and limited occupational lung disease expertise are barriers to expanding current services for ex-migrant miners as well as ex-miners from Malawian mines. Conclusions: A number of actions are needed: coordination between the Malawian government and South African agencies; integration of occupational health services, including for migrant ex-gold miners, into Malawi's public health system; education of ex-gold miners and their dependents about their rights and related processes and the provision of relief aid through local and external support. Financial involvement of the South African mining industry that profited from the services of migrant miners is required to alleviate the burden on publicly funded health systems.