International Health最新文献

Background: This study assesses the prevalence of contraception-use intentions and evaluates the associated factors among non-users in sub-Saharan Africa (SSA).

Methods: Data from 2014-2023 Demographic and Health Surveys of 30 countries in SSA consisting of 332 986 women aged 15-49 y not already using contraception were used.

Results: The overall prevalence was 41.18% (95% CI 41.01 to 41.34%). Zimbabwe had the highest prevalence (72.34%; 95% CI 71.11 to 73.57%), whereas Ethiopia had the lowest (15.96%; 95% CI 15.40 to 16.51%). Women aged 25-49 y had lower odds of intending to use contraception compared with those aged 15-19 y, and this was striking among those aged 45-49 y (adjusted OR [AOR]=0.06, 95% CI 0.06 to 0.07). Those with a higher level of education displayed a greater likelihood of intending to use contraception (AOR=1.93, 95% CI 1.82 to 2.05) compared with those with no education. The odds increased with the number of children born, particularly for those with ≥4 children (AOR=1.59, 95% CI 1.52 to 1.67) compared with those with no children.

Conclusions: Promoting the use of contraception requires tailored, multi-pronged interventions that account for the diverse sociodemographic, fertility and informational needs of women in this population.

Debates on AI ethics in global health often privilege professionalized authority over those most exposed to harm. We argue for the need to consider redistributing ethical authority to affected communities, particularly in low- and middle-income countries, potentially through participatory councils with decision power over evaluation metrics, equity constraints, and deployment. Centering lived experience can strengthen safety, accountability, and decolonial governance, may aid in addressing algorithmic bias and financial toxicity, and could align with WHO guidance for public-interest AI. We offer potential practical mechanisms to co-lead design, trials, and post-deployment monitoring so AI advances health and rights rather than simply reproducing inequities.

Background: Children face a heavy disease burden, while healthcare utilization remains low. This study seeks to assess the proportions of children in Chongqing covered by medical insurance and identify associated factors.

Methods: From March to June 2019, a stratified cluster sampling was employed to cover 4705 participants in Chongqing's urban and rural districts. In a cross-sectional survey, univariate and multivariate mixed logistic regression analysis were performed to explore the determinants of medical insurance enrolment.

Results: The participation rates of basic medical insurance (BMI) were 83.29%, 85.29% and 81.11% in total, urban areas and rural areas, respectively. For commercial medical insurance (CMI), the corresponding rates were 29.78%, 34.95% and 24.11%, respectively. After adjusting for covariates, younger child age, better quality of life and higher annual household income were associated with a higher BMI participation rate. Conversely, children with asthma had lower odds of BMI coverage. For CMI, childhood obesity was a risk factor for being uninsured, while higher parental education, rhinitis, annual family income >150 000 RMB, caesarean section history and maternal gestational diabetes significantly increased the likelihood of CMI enrolment.

Conclusions: In summary, universal health insurance coverage for children in Chongqing remains unfulfilled. To ameliorate the gaps and inequalities in children's insurance, sustained efforts are necessary, including improving household economic conditions, enhancing parental education levels and focusing on children's physical health. Therefore, policy supports should be enhanced, especially for economically disadvantaged rural areas in southwestern China.

Background: Although the Philippines launched its Maternal, Neonatal, and Child Health and Nutrition strategy in 2008 to reduce maternal mortality, its impact on maternal health services (MHS) utilization and maternal mortality ratio (MMR) remains unclear. This study examines MHS utilization trends and their association with MMR across the Philippines from 2010 to 2019.

Methods: We conducted an ecological study using panel data in the Philippines during 2010-2019. Secondary analyses took place on datasets from the Department of Health and the Philippine Statistics Authority. Multivariate analyses were performed to investigate the association between MHS utilization and MMR.

Results: From 2010 to 2019, national mean MMR declined from 74.85 to 57.19 deaths per 100 000 live births. Facility-based deliveries increased by 39.57% and births attended by medical doctors by 19.01%. Results from fixed-effects models revealed no significant association between MHS utilization and change in MMR over the 10-y period. However, utilization of antenatal care in Luzon (β=-1.528, p=0.005) and postpartum care in Mindanao (β=-1.604, p=0.020) was attributable to MMR reduction in 2019.

Conclusions: While a national decline in MMR was observed from 2010 to 2019, significant regional disparities in MMR existed. The impact of MHS utilization varied over time and location.

Background: Nigeria has experienced several humanitarian crises and displacement over the years. The physical and psychological impact of these crises has been severe, with many experiencing trauma and stress-related disorders within internally displaced persons camps. To develop interventions that address the needs of settlers in camps, a comprehensive understanding of their experiences is essential.

Methods: Our qualitative study employed phenomenological analysis to explore the lived experiences of victims of humanitarian crises within internally displaced persons camps. Purposive sampling was used to recruit participants for the focus group discussions, and we employed snowballing to recruit participants for the in-depth interviews.

Results: Four themes and 10 subthemes emerged from the analysis. Participants' experiences were laced with harsh physical living conditions, including deteriorated and leaking roofs in camps, inadequate water, sanitation and hygiene facilities and limited autonomy and self-sustenance. The inability to connect with relatives outside the camps fostered feelings of isolation, hopelessness and anxiety.

Conclusions: Our study emphasizes the importance of establishing livable conditions for displaced persons living in camps and other resettlement settings, while fostering social connections with external communities. This connection may enhance their hopes for a normal life, build resilience and facilitate their social integration back into society.

Significant progress has been made in Cambodia towards malaria control and the goal of achieving elimination of all species by 2025. These efforts require constant vigilance and agility in malaria programming to maintain forward momentum. During the COVID-19 pandemic, these achievements were threatened by restrictive pandemic control measures, necessitating swift action from the National Center for Parasitology, Entomology and Malaria Control and partners to safeguard critical malaria services, primarily case detection and treatment by mobile malaria workers (MMWs) among hard-to-reach populations. As malaria cases have declined in Cambodia, infections are increasingly focused among remote populations further from primary healthcare services. Thus, the greatest threat to malaria control during the pandemic consisted of the logistical and communication challenges faced by MMWs travelling to remote regions while movement was restricted. Through locally tailored implementation of these services and close communication with health authorities, Malaria Consortium's MMWs were able to minimise disruption of Cambodia's malaria control programme while ensuring staff and beneficiaries were protected.

Background: The aim of this study was to assess the population and health system factors affecting the transferability of health kiosks in markets in Kenya.

Methods: A cross-sectional study with a partially mixed concurrent dominant status design was conducted among 843 households, policy actors, market chairpersons and champions, community health promoters and health workers. A χ2 test was used to test for independence with variables with a statistical significance (p<0.05) subjected to logistic regression. Qualitative data were transcribed verbatim to form nodes and themes.

Results: Level of income, knowledge, awareness and perception of cardiovascular disease (CVD) risk factors were associated with 27.5% of Nyeri respondents earning ≥Ksh 10 000 monthly compared with Vihiga respondents (17.3%). Vihiga respondents were likely to identify excessive alcohol consumption as a cause of CVD. Vihiga had fair (40%) and good (26.6%) awareness levels towards CVDs compared with Nyeri respondents (36.3% and 19.7%, respectively). Vihiga respondents had a higher positive perception towards health services at the local facility compared with Nyeri respondents.

Conclusions: CVD burden, low awareness levels, low health insurance cover and the poor attitude of health workers have the potential to affect the transferability of a health intervention such as a health market kiosk.

Background: Crimean-Congo Haemorrhagic Fever (CCHF) is a severe tick-borne viral disease. Increasing cases in West Africa suggest potential undetected circulation in Nigeria.

Methods: A One Health Joint Risk Assessment was conducted to identify transmission pathways and assess the likelihood and impact of human CCHF infections at the human-animal-environment interface in Nigeria. Risk framing involved developing structured questions for potential Crimean-Congo Haemorrhagic Fever virus (CCHFV) transmission scenarios. A scoping review was conducted and median seroprevalence values were reported. The likelihood, impact and data uncertainty for human infection scenarios were used for a qualitative estimation of risk.

Results: Human contact with infected livestock during farming, veterinary practices and exposure to ticks was identified as a key infection route. Most cases in Nigeria (66.7%) were identified via serology, with a median human seroprevalence of 6.1% and cattle seroprevalence of 30.2%. CCHFV has been isolated from Rhipicephalus ticks. Four risk assessment questions were defined and focused on veterinarians, abattoir workers, herders, wildlife rangers and healthcare workers. Animal-related professions had a moderate likelihood of infection.

Conclusion: Strengthening One Health surveillance, vector control and multisector infection prevention is crucial to reducing the risk of CCHF and averting future outbreaks.