Annals of Global Health最新文献

Background: Effective and scalable strategies are needed to develop health research capacity in low- and middle‑income countries (LMICs). Health research capacity strengthening (HRCS) focuses on boosting production and utilization of health research, with clinicians as key target participants. Despite the increased prevalence of virtual HRCS programs, there has been no review of the evidence for those targeting LMIC clinicians to date. Objective: This review characterizes the use of virtual tools in HRCS programs for clinicians in LMICs and describes the impacts, facilitators, and barriers associated with these programs. Methods: Following our protocol (PROSPERO; CRD42020152510), we employed an integrative review methodology. We adapted Cooke's Research Capacity Development for Impact framework by adding "equity" as a new domain and used it to evaluate programmatic impacts. We retrieved relevant articles from five databases and gray literature. Included articles were extracted and stratified by degree of virtual delivery. We analyzed virtual tool usage via content analysis. Using NVivo, we coded until theoretical saturation and analyzed data using the constant comparison method. Findings: From 1397 articles, 58 met inclusion criteria. Most programs were hybrid, and e‑courses were the most used virtual tool. Articles described impacts across all framework domains; the most discussed were skills and confidence building. Facilitators included user‑friendly platforms, interactive content, and strategies to improve program access, including financial and technological support. Some programs incorporated hybrid strategies to foster trust among participants and virtual mentors. Barriers included a lack of or an unfavorable local research culture. Conclusions: Recommendations from this review may guide the design and implementation of virtual HRCS programs for LMIC clinicians. These include selecting well‑fitted program participants, intentionally designing program structure and content, conducting needs assessments or pilots, incorporating equity as a programmatic target, ensuring longitudinal program evaluation and monitoring, and utilizing a comprehensive conceptualization of program sustainability.

Background: Participation in global health (GH) training experiences is common for US medical trainees (students, residents, and fellows). However, little is known about their experience of "culture shock" (CS), which frequently occurs during these transformative cross‑cultural immersions. Objectives: The objectives of this study include: (1) quantitatively measure medical trainee psychosocial responses to short‑term GH electives, (2) identify factors that influence their CS experiences, and (3) determine if the stage‑based CS conceptual framework applies to medical trainees. Methods: Undergraduate and graduate medical education trainees (UME and GME) who participated in short‑term GH electives between 2016 and 2020 were recruited across nine US institutions. Using a longitudinal survey method, we gathered data predeparture (demographics, resilience, perceived stress (PS), and CS assessments), every 5 days during the elective (CS, PS assessments, and training site conditions), and 30 days postreturn (perceptions of CS experiences). Analyses included summary statistics, linear regressions, and a linear mixed effects model (LMM). Findings: 252 trainees were enrolled, with 140 (56%) included in the LMM. The primary outcome was a culture shock profile (CSP) score, with 96% reporting CS. The only trainee‑specific factor that significantly increased CSP score was trainee type (UME > GME (+22%)). Several GH elective site‑specific factors significantly influenced CSP score (e.g., support network [-10%], role clarity [-11%], and overwhelmed by medical needs [+10%]). CS experiences were variable and did not progress in predictable, stage‑based fashions, which is discordant from common CS descriptions. Conclusions: Culture shock was a near‑universal, diverse experience during GH electives. On‑site training conditions and elective site host factors influenced CS more than trainee factors in this prepandemic cohort. Further research is required to (1) determine the optimal CS "balance" (i.e., promoting transformative learning while mitigating negative professional and personal impacts), (2) offer insight into harmful CS thresholds, (3) identify host perspectives, and (4) inform best practices for GH electives and global partnerships.

Background: Antimicrobial resistance (AMR) and migration are two interlinked issues and both pose an escalating threat to global health. With an increasing trend, there are 281 million migrants globally, while AMR is contributing to over 5 million deaths annually, with a projected rise to 10 million by 2050 if left unaddressed. Both AMR and migration are multifaceted problems that extend beyond human health, involving animals, plants, and the environment-a fact highlighted by the One Health approach. Objective: The aim of this work is: (1) to examine the complex relationship between migration and AMR, drawing on epidemiological data, surveillance strategies, and healthcare access challenges and (2) to address an interventional strategy proposal. Methods: We performed a narrative review of the most updated literature about migration and AMR using three primary databases: PubMed, Scopus, and Embase. Findings: Migrants, particularly from low‑ and middle‑income countries, represent a unique group at increased risk of AMR due to factors such as overcrowded living conditions, limited access to healthcare, uncontrolled use of antibiotics, and high prevalence of AMR in origin countries. Studies reveal higher rates of AMR colonization and infection among migrants compared with native populations, with specific pathogens such as MRSA and multidrug‑resistant gram‑negative bacteria posing significant risks. Migratory conditions, socioeconomic vulnerability, and healthcare barriers contribute to this heightened risk. Conclusion: To address the intersection of migration and AMR, interventions must focus on improving living conditions, enhancing healthcare access, promoting appropriate antibiotic use, and strengthening microbiological surveillance. Multisectoral collaboration is essential to mitigate the spread of AMR and safeguard both migrant and global public health.

Background: There is widespread agreement on the potential of multisectoral action to address the social determinants of maternal health. We conducted an implementation research study in Meghalaya, a northeastern Indian state with a high burden of maternal mortality where the government initiated "Rescue Mission" to strengthen the health system and to address underlying determinants to improve maternal health indicators. The initiative was grounded in building state capability and decentralised leadership. Objective: We developed a theory of change and examined implementation barriers and enablers through an implementation research study with government and community actors and institutions. Methods: We conducted multiple rounds of qualitative data collection over a period of eighteen months across six districts. Participants included primary care providers in the public health system and frontline workers in thirty sampled facilities. We also interviewed officials across three government departments, observed meetings and met regularly in a feedback loop with government. Data were analysed thematically and synthesised according to pathways of change. Findings: The state institutionalised multisectoral collaboration across governance levels through building technical and adaptive leadership. Processes included joint meetings at the facility, district and state levels to develop action plans and facilitate collaboration, community engagement through frontline workers and decentralised use of data. Strength of participation by different sectors varied widely; non‑health cadres reported challenges such as being accountable to multiple departments. Political priority and administrative leadership were the key elements of the State's ability to implement a multisectoral approach. Overall, health outcomes improved and the State largely achieved its commitment to building technical skills, but also recognised the need for further investments to develop a sense of purpose amongst government officials. Conclusions: Meghalaya's experience in multisectoral collaboration demonstrates the potential of health systems reform grounded in a state capabilities enhancement approach, with a focus on participation and building decentralised leadership.

Background: Children in Indonesia are especially vulnerable to air pollution due to their developing respiratory systems and unique exposure patterns. As one of the top 50 nations most at risk from environmental degradation, Indonesia faces significant public health concerns, especially in rapidly urbanizing areas such as Greater Jakarta, where emissions from transportation contribute heavily to pollution. This study investigates the relationship between PM_2.5 exposure and cases of asthma and pneumonia in children across Greater Jakarta's 11 cities and districts from 2020 to 2022, aiming to provide essential data for health planning and policy. Methods: The data were collected from NafasID's PM_2.5 monitoring network and local health offices reporting monthly cases of asthma and pneumonia in children. Analytical methods included correlation and regression modeling to assess the association between air pollution and respiratory health across different regions. The results reveal a high number of respiratory disease, with 73,694 pneumonia and 15,825 asthma cases reported. Results: Average PM_2.5 concentration in Greater Jakarta was 42.5 µg/m³, with notable variation between areas. Bekasi District recorded the highest levels, while North Jakarta was lower. Depok City showed the strongest correlation between PM_2.5 and pneumonia (r = 0.61, p = 0.004), indicating a sharp increase in cases with rising PM_2.5, while other areas showed weaker correlations. Asthma cases had weak-to-moderate correlations with PM_2.5, which is largely nonsignificant, suggesting complex factors beyond outdoor air pollution may influence asthma. Conclusion: The findings highlight the critical need for improved air quality measures and targeted public health interventions. Addressing air pollution will be vital for reducing respiratory illness and supporting child health resilience in Indonesia's urban centers.

Background: In Tanzania, iron and steel manufacturing industries are based on manual work with minor automation, as workers segregate scrap metals and add them to furnaces for melting. The workers here are exposed to hazardous conditions, posing a risk to their health. Objective: To determine the prevalence of occupational injuries and possible predictors for injuries among workers in the iron and steel industries in Tanzania. Methods: The cross‑sectional study was conducted in 2022 in Tanzania. Workers from the production lines in four iron and steel factories participated in the study. The data were collected by interviews, using a structured questionnaire modified from the International Labour Organization (ILO) manual on occupational injury statistics from household surveys and establishment surveys. Chi‑squared tests and regression analyses were used. Results: Out of 381 invited workers, 321 participated in the study (response rate: 84). Of the respondents, 209 had experienced at least one injury that restricted them from work at least one day in the past year, giving an overall prevalence of occupational injuries of 65.1% per year. Out of the injured respondents, 135 (64.6%) reported being hospitalized or lying on the bed at home due to the injury. Working years, working hours per day, working 12‑hour shifts, and their section at the workplace (rolling mill or furnace) were factors significantly associated with occupational injuries in univariate regression analyses. Working hours of more than 10 hours per day, adjusted for all other factors, gave an odds ratio of 2.54 for experiencing injuries at work, with a 95% confidence interval (1.46-4.41), while no other factors showed significant association with injuries after adjustment. Conclusion: The prevalence of occupational injuries in the Tanzanian iron and steel industries was 65.1%. Working for more than 10 hours per day was a significant predictor of occupational injuries.

Background: The world still grapples with alarming maternal mortality rates, particularly in developing nations, including Nigeria. Annual global deaths exceed 500,000, predominantly in developing countries (99%) and sub‑Saharan Africa (over 50%), where the lifetime risk of maternal death is 1 in 26. Millions of women of reproductive age and their children could be saved from poor outcomes through the utilization of available effective affordable maternal healthcare services. Objective: This study assessed the patterns and predictors of maternal healthcare service utilization among women of reproductive age in Lagos state, Nigeria. Methods: A cross‑sectional study was conducted among 453 women of reproductive age selected through multistage sampling between July 2022 and March 2023. Data collection employed interviewer‑administered questionnaires, and analysis was performed using SPSS V.25 software. Statistical analysis included bivariate and multivariate analyses, with a significance level set at p < 0.05. Findings: Nearly all participants (99%) were familiar with antenatal care (ANC), while 63% knew about postnatal care services, and 82% understood modern family planning methods. Most respondents (86%) accessed ANC in healthcare facilities; however, the majority (70.7%) booked during the second trimester. The majority (97%) attended ANC more than four times, and 77% gave births in healthcare facilities. Notably, 86% attended postnatal care services primarily for child vaccination. Christian religion (adjusted odds ratio (AOR): 1.810; confidence interval (CI): 0.989-3.313), self‑employment status of spouses (AOR: 2.949: CI: 1.413-6.153), and household monthly income above 60,000.00 naira (AOR: 2.015; CI: 1.002-4.005) were predictors for ANC use. Similarly, Christian religion (AOR: 2.326; CI: 1.426-3.796), self‑employment status of spouses (AOR: 3.111; CI: 1.633-5.929), and having health insurance (AOR: 5.327; CI: 1.229-23.080) were predictors for use of healthcare facilities for childbirth. Conclusion: This study reveals high awareness and utilization of maternal health services but highlights room for improvement in early antenatal care registration and postnatal care beyond the child's immunization.

Introduction: Indigenous communities grapple with unique challenges in the aging process, often encountering amplified barriers to healthcare and resources, possibly due to their remote locations and distinct cultural backgrounds. Limited research exists on aging within Costa Rica's Ngäbe‑Buglé Indigenous community, particularly the La Casona community in Coto Brus. This study explores the aging experience of the Ngäbe‑Buglé community in La Casona, aiming to identify challenges and potential resources to enhance the quality of life and aging experience for elderly community members. Methods: This qualitative study utilized semi‑structured interviews to collect data from 14 elderly participants (6 female, 8 male), aged 52-90 years, living in the La Casona community. Participants were selected through purposeful snowball sampling techniques, and individual interviews were conducted at their residences. Interviews were conducted with assistance from an interpreter and lasted approximately 30-60 minutes. Thematic analysis was used to examine participants' responses to understand their experiences with aging. Results: Three primary themes emerged: economic difficulties, insufficient social support, and cultural aspects related to La Casona. Among the three primary themes were a total of eight subcategories. Economic challenges encompassed financial constraints and food insecurity, housing and infrastructure needs, and difficulties in accessing healthcare. Insufficient social support was evident through heavy reliance on family, limited community aid, and an absence of engaging activities. Cultural aspects highlighted the community's deep connection to nature and concerns about the fading cultural heritage among younger generations. These themes collectively contribute to the challenges confronted by elderly adults in the Ngäbe‑Buglé community. Conclusions: Improving healthcare access, enhancing social interactions, and preserving cultural heritage are essential when it comes to improving the aging experience in La Casona. The following participant discussions provide insight into public health interventions. Addressing these issues will require governmental support and policy changes aimed at uplifting the Ngäbe‑Buglé community.

In 2023, an interdisciplinary group of global health experts from five continents convened a plenary panel at the Consortium of Universities for Global Health (CUGH) annual conference entitled "Reimagining Global Health for the 21st Century." At the heart of this viewpoint article lies a fundamental question: How can we reimagine global health to best confront existing challenges and meet the demands of the future? To fully assess the scope of global health challenges and identify sustainable solutions, a clear definition of the aims and strategic approaches is needed. Such an assessment is also critical for progress in promoting equity, including decolonizing global health. Key issues examined are the following: equity, governance, research, education, and sustainability. To assure a sustainable global health enterprise, we propose the following three strategic imperatives as guiding principles: a holistic, unified approach grounded in mutual benefit, joint investment, long‑term collaborative commitment, and solidarity across low‑ to middle‑income countries (LMICs) and high‑income countries (HICs); joint priority setting of investments in research, education, practice, and workforce development; and collaborative governance, maximizing a multisectoral approach among local, national, regional, and global strategies. The viewpoint sets the stage for the development of an action roadmap to develop a unified concept of global health; identify strategies to ensure sustained funding for global health research, education and training, and practice; establish benchmarks and metrics to measure progress; and design a collaborative governance system to promote interconnectedness and engagement among local, regional, national, and global stakeholders.

Background: Pre‑exposure prophylaxis (PrEP) is an effective measure for preventing human immunodeficiency virus (HIV) infection among people at risk, including adolescents and young adults (AYA). Objectives: This study evaluates the prevalence of PrEP awareness and endorsement, as well as the factors associated with these outcomes, using data from the 2022 Tanzania Demographic and Health Survey. Methods: The analysis included participants aged 15-24 years. Participants were asked whether they had ever heard of daily medication to prevent HIV (PrEP) and whether they approved of daily PrEP use. Demographic characteristics and HIV testing information were also collected. Logistic regression models were used to assess factors associated with PrEP awareness and endorsement, and the weighted prevalence of these outcomes was calculated. Findings: A total of 8,268 respondents aged 15-24 years were evaluated, of whom 5,852 (70.9%) were female. Overall, the prevalence of PrEP awareness and endorsement was 6.9% (95% confidence interval [CI] 6.2-7.7) and 5.7% (95% CI 5.1-6.4), respectively. Female respondents (adjusted odds ratio [aOR] = 0.69; 95% CI 0.51-0.91) and rural residents (aOR = 0.78; 95% CI 0.61-1.00) had lower odds of PrEP awareness compared with male respondents and urban residents, respectively. Previously, HIV testing and receiving test results (aOR = 2.00; 95% CI 1.50-2.66) and an age of 20-24 years versus 15-19 years (aOR = 1.54; 95% CI 1.20-1.96) were associated with increased odds of PrEP awareness. The odds of AYA endorsement of PrEP were higher among those aged 20-24 years versus 15-19 years (aOR = 1.39; 95% CI 1.07-1.83) and those who previously tested for HIV and received results (aOR = 1.97; 95% CI 1.43-2.72), but lower among female respondents (aOR = 0.66; 95% CI 0.49-0.88). Conclusion: PrEP awareness and endorsement among AYA in Tanzania were low, with nearly 7 in 100 aware of PrEP and 6 in 100 approving of its use. Targeted interventions focused on adolescents, females, and rural communities are needed to increase PrEP awareness and usage to achieve the Joint United Nations Programme on HIV/Acquired Immune Deficiency Syndrome (AIDS) (UNAIDS) 95-95-95 goals for HIV epidemic control.