Annals of Global Health最新文献

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.

Background: Marburg virus disease (MVD) is a highly virulent viral hemorrhagic fever with reported case fatality rates of up to 90%. It is part of the same family as the Ebola virus (Filoviridae). MVD, originally identified in 1967 in the context of outbreaks associated with African green monkeys, has been reported sporadically in Africa. Recent outbreaks, including those in Equatorial Guinea and Rwanda, underscore the need for robust preparedness systems and global response. Objectives: This narrative review focuses on the pathogenesis, clinical manifestations, diagnostic challenges and treatment strategies regarding MVD. It also stresses the need for better surveillance, diagnostic capabilities and vaccines to help prepare for future outbreaks. Methods: A comprehensive review of clinical data, epidemiological trends, and diagnostic developments was performed by searching relevant literature in PubMed, Medline and Scopus. The relevant data were extracted from studies on MVD and presented as a narrative review. Findings: MVD primarily affects immune and endothelial cells, resulting in a consequent cytokine storm, coagulopathy, and multi‑organ failure. Early symptoms such as fever, headache and myalgia are nonspecific and can delay diagnosis, as they mimic other infections. Monoclonal antibodies and newer antiviral agents are presently being evaluated for the management of MVD. Conclusions: MVD leads to significant morbidity and mortality, and the high fatality rate, along with the absence of targeted therapies, represents a serious global health threat. Collectively, the establishment of infrastructure for diagnostics, global collaboration, and advanced vaccine development will help bolster the response to MVD outbreaks and thus shorten periods of spiking mortality.

Background: Vibrio, a group of Gram‑negative bacteria found in the ocean, has become a significant global threat, intensified by climate change, owing to its crucial roles in environmental, human, and animal health. Research on these bacteria and the diseases they cause has greatly influenced scientific progress, resulting in major advancements in the fields of microbiology, epidemiology, and public health. Objectives: This review aims to highlight the early groundbreaking discoveries in Vibrio research, particularly those that have significantly impacted the science of microbiology and global health. Methods: A comprehensive literature search was conducted across vast databases of biomedical and life sciences literature including PubMed, EMBASE, and Scopus. Additionally, a search of the grey literature was performed. Studies that marked early groundbreaking discoveries in Vibrio research, with wide implications for human society, were included. Findings and conclusion: Research on Vibrio has led to major advancements in our understanding of disease mechanisms, pathogen ecology, and the epidemiology of waterborne infections. A landmark discovery was the identification of Vibrio cholerae in 1884, which played a crucial role in studying waterborne diseases such as cholera and led to the development of modern approaches to treat diarrheal diseases, such as the introduction of oral rehydration salt (ORS) therapy. Certain Vibrio strains, such as Vibrio vulnificus, are important models for studying flesh‑eating diseases, while others, such as Vibrio parahaemolyticus ST3, ST36, and V. cholerae O1, are the only marine bacteria known to cause global epidemics by spreading across continents. Key mechanisms in Gram‑negative bacteria, including the viable but nonculturable (VBNC) state, quorum sensing, and the type VI secretion system (T6SS), were first discovered in Vibrio species. Today, research on Vibrio bacteria remains crucial from a global health perspective, especially owing to the expanding effects of climate change on their worldwide distribution.

Noncommunicable diseases (NCDs) and mental health conditions are responsible for 75% of deaths globally, with the greatest burden in low‑ and middle‑income countries (LMICs). The economic impact of NCDs and mental health conditions on households, health systems, and economies is also staggering. Despite the growing burden of NCDs, the available funding to address these diseases is limited, with less than 2.3% of global health development assistance spent on NCDs. The 2025 United Nations (UN) High‑Level Meeting on NCDs will provide a critical opportunity to reaffirm global commitments, enhance political will, and advocate for greater resource mobilization for the prevention and control of NCDs and mental health conditions. Investments will be needed in the strengthening of health systems, integrated models of care, multisectoral action, and a greater focus on vulnerable populations. Increased domestic and international funding will be required for implementation research as well, to ensure sustainable progress toward overcoming context‑specific barriers impeding the achievement of Sustainable Development Goals (SDG) target 3.4 on reducing premature mortality from NCDs and improving mental health and well‑being. The challenge remains to convert high‑level commitments into actionable, measurable strategies and mobilize the resources required to meet these goals, particularly in low‑income settings.

Background: The Slemenda Scholars (SS) program at Indiana University School of Medicine offers preclinical students early exposure to global health through a summer program in collaboration with the Academic Model Providing Access to Healthcare (AMPATH). AMPATH Kenya is a 30‑year partnership between a consortium of US and European universities and Moi University in Kenya that provides sustainable, high‑quality care through medical education, clinical care, research, innovation, and community service. The positive impact of electives during medical students' clinical years is well documented, but the impact of quality, immersive learning in preclinical years has not previously been studied. Methods: A cross‑sectional survey was administered to past participants of the SS program via e‑mails in 2023. Written narratives about the SS program by participants from 1998 to 2023 were evaluated using qualitative analytic methods. Narratives were obtained via internet search and compiled from open‑ended survey responses. Themes were generated on the basis of a constant comparative method using grounded theory and finalized through an iterative consensus process. Findings: Surveys were distributed to 66 SS alumni. In total, 54 responses were received (81.8% response rate). After excluding incomplete responses, 45 were included in the final analyses (68.2%). Respondents indicated they learned more about themselves (mean 4.9; 5 = strongly agree), global health (mean 5), and medicine (4.9) through the SS program and developed skills, including cultural humility and personal resilience. A qualitative review of 50 narratives identified two major themes: impactful experiences and transformative learning. Conclusions: Preclinical global health experiential learning opportunities are impactful and transformative. Immersive learning expands trainees' perspectives, promotes the development of relational skills with diverse colleagues, and fosters adaptability. Early, immersive global health exposure within the context of established institutional partnerships affirmed or informed a career addressing health disparities both locally and globally.

Aim: The study investigated the adverse impact of medical waste on Indigenous communities and explored sustainable solutions to reduce inequality and enhance resilience. Methods: We adopted a qualitative thematic analysis from primary data collected from 176 respondents. Data were collected through focus groups and interviews. Results: In the research, we examined the interconnected themes challenging medical waste management practices in Pakistan, such as poor disposal practices, health and environmental hazards of poor medical waste management through disease transmission and infections, and soil and water contamination. Socioeconomic disparities and inequality were also identified, resulting in economic burdens on vulnerable groups-the theme of which was Indigenous communities disadvantaged through health risks and vulnerabilities and disproportionate impact on health and well‑being. Themes further highlight government efforts, suggested regulatory and policy reforms, capacity building, and awareness. Recommendations: We developed three significant recommendations for sustainable solutions to reducing inequality and improving community resilience. The first is community empowerment and awareness, emphasizing the need to educate community members, healthcare professionals, and waste handlers about the risks of improper medical waste disposal. The second is strengthening infrastructure and collaboration, highlighting the urgent need to establish proper waste collection and segregation infrastructure. Collaboration among healthcare facilities, waste management agencies, government bodies, and community leaders is instrumental in designing comprehensive solutions that meet the unique needs of Indigenous communities. The third one is policy enhancement and enforcement, suggesting the importance of policy revisions and rigorous enforcement mechanisms. The study advocates for policies that reflect current challenges and encourage innovative approaches to medical waste management.

Background: Climate change is increasingly recognized as a driver of mental health disorders, exacerbating conditions such as anxiety, depression, and post-traumatic stress. However, climate policies rarely address mental health considerations. Objective: This study investigates the extent to which mental health is incorporated into national climate adaptation policies, specifically Nationally Determined Contributions (NDCs), from countries classified as high or very high risk according to the INFORM index. Methods: We conducted a systematic literature review and policy analysis of NDCs from 38 high-risk countries. A keyword-based approach was used to assess the frequency and depth of mental health references in climate policies. Findings: Only 8 of 38 countries explicitly referenced mental health in their NDCs. Most policies prioritized physical health, with little attention given to the psychological impacts of climate-related disasters. Vulnerable populations, including children, women, and individuals with preexisting mental health conditions, remain largely unaddressed in these national policies. Conclusions: There is a significant gap in the integration of mental health impact and interventional indicators within climate change policies. Greater investment in interdisciplinary research and policy reforms are needed to ensure climate adaptation strategies address both physical and mental health concerns.

Background: Agricultural migrant workers in rural Puglia, Italy, endure harsh living and working conditions that significantly affect their health and limit access to healthcare. This study evaluates their health status, explores systemic barriers to care, and evaluates the effectiveness of a mobile clinic model, identifying structural obstacles to healthcare access. Methods: Data were collected from 13,103 medical visits conducted between 2017 and 2023 by Doctors with Africa University College for Aspiring Missionary Doctors (CUAMM)'s mobile clinics operating in 12 informal settlements. Demographic, clinical, and socio‑health data from 2,537 unique patients were analyzed. Statistical methods, including multivariate regression, were employed to identify health trends and predictors of healthcare utilization. Results: The patient cohort was predominantly male (95.8%) and aged 19-45 years (83%). Work‑related musculoskeletal disorders were the most common diagnoses (27.3%), followed by respiratory infections (14.3%), dermatological conditions (12.1%), and dental problems (7.2%). Only 18% of patients had a residence permit, and 7% were registered with a general practitioner. Despite significant barriers, the average number of follow‑up visits per patient was 5.6, indicating trust in the mobile clinic model. Barriers included linguistic and cultural challenges, low health literacy, and irregular legal status. Mobile clinics provided not only primary medical care but also referrals and socio‑health guidance, effectively bridging healthcare gaps for this population. Conclusions: This study underscores the health vulnerabilities of migrant workers and the critical role of mobile clinics in addressing their needs. Integrating flexible care models with traditional systems, addressing labor exploitation, and improving living conditions are imperative. Collaborative efforts involving institutions, nongovernmental organizations (NGOs), and academia are essential to ensuring equitable, accessible, and sustainable healthcare for this marginalized population-leaving no one behind.