International Health最新文献

Background: We aimed to explore the variation in blood pressure (BP) control in primary care hypertensive patients with or without diabetes, and investigate potential factors associated with inadequate BP control during follow-up.

Methods: Primary care hypertensive patients with and without diabetes were recruited in 2020 from Jianye District of Nanjing and prospectively followed up until 2023. Effective BP control was measured in terms of consistent normal readings of systolic BP <140 mmHg and of diastolic BP <90 mmHg based on the most recent assessment during the follow-up period. We used the negative binomial model with total person-years as an offset to evaluate whether the study population would achieve BP control after the 3-y follow-up period in terms of rate ratio (RR) and 95% CI. We further conducted subgroup analysis based on the absence or presence of clinically confirmed diabetes and BP stability at baseline.

Results: Of a total of 32 701 patients with hypertension, compared with those without comorbid diabetes and stable BP at baseline, patients with comorbid diabetes and unstable BP at baseline were less likely to have effective BP control at follow-up (adjusted RR=2.01, 95% CI 1.89 to 2.15). We observed an elevated risk of ineffective BP control at follow-up in those aged 60-70 y (1.69; 95% CI 1.56 to 1.83) or ≥70 y (1.73; 95% CI 1.59 to 1.88), females (1.09; 95% CI 1.03 to 1.16), those with a higher waist-to-height ratio (1.25; 95% CI 1.17 to 1.34), overweight/obese in terms of body mass index (1.16; 95% CI 1.09 to 1.23) or regularly consuming alcohol (1.26; 95% CI 1.16 to 1.37). Higher educational attainment indicated a reduced risk of ineffective BP control at follow-up (0.68; 95% CI 0.63 to 0.75).

Conclusions: Achieving effective BP control remains a persistent challenge, especially for patients with comorbid hypertension and diabetes. In the absence of any novel strategies for hypertension care, the existing multidisciplinary care approaches could be repurposed and integrated for effective management of the aforementioned comorbid conditions in primary care settings.

Background: Although providing relief from labour pain can improve the mother's satisfaction with the birthing process and lead to better reproductive outcomes. This study aims to evaluate the perceptions, practices and related aspects of labour pain management among obstetric care providers in public health institutions in the Harari Region of Ethiopia.

Methods: A cross-sectional study was conducted in the labour and delivery wards of public health facilities in the Harari Region. Data were collected using a semi-structured and pretested self-administered questionnaire among systematically selected obstetrics care providers (OCPs). A multivariate logistic regression model was used to identify factors associated with the practice of labour pain management. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to determine the strength of associations and a p-value <0.05 was considered significantly associated.

Results: Data from 234 OCPs were employed for analysis. A total of 70.9% of OCPs have positive perceptions and 69.7% practiced labour pain management in the past 4 weeks. Being a female (adjusted OR [aOR] 2.33 [95% CI 1.06 to 5.15]), having a positive perception (aOR 7.76 [95% CI 3.21 to 18.72]), being a physician (aOR 6.35 [95% CI 1.94 to 20.82]), being a midwife (aOR 5.28 [95% CI 1.78 to 15.63]) and being a highly qualified OCP (aOR 17.89 [95% CI 5.22 to 61.30]) were associated with being more likely to practice labour pain management. Positive attitude (aOR 2.77 [95% CI 1.51 to 8.72]), being a physician (aOR 6.01 [95% CI 1.23 to 29.35]) and practicing labour pain management (aOR 12.89 [95% CI 4.57 to 36.38]) were associated with labour pain management perceptions.

Conclusions: Seven of ten OCPs practiced labour pain relief methods and had a positive perception of managing labour pain. Therefore, facilitating training and improving the perceptions and attitudes of OCPs towards labour pain management should be encouraged.

Background: We explored the relationship between adolescent physical activity levels, socio-economic conditions and body mass index (BMI) in order to gain a deeper understanding of the relevant factors affecting adolescent obesity.

Methods: A stratified random sampling method was used to conduct a questionnaire survey of middle school students in the Chengdu-Chongqing Economic Zone. Multiple linear and logistic regression analysis methods were used to statistically analyse the data obtained.

Results: The level of moderate to vigorous physical activity (MVPA) not only significantly reduces the incidence of obesity in adolescents, it also has a positive effect on avoiding underweight in adolescents. The impact of a father's BMI on a son's weight is higher than that of a daughter, while the impact of a mother's BMI on a child's weight is the opposite. High monthly income has a positive effect on reducing the BMI of male and female adolescents, but full-time working mothers actually increase the risk of obesity in their children. Teenagers who have exercise habits or view exercise as a form of enjoyment have a significantly reduced risk of obesity.

Conclusions: The level of MVPA and exercise habits are important factors in inhibiting the development of obesity in adolescent students.

The first 8000 days of life, from birth to adulthood, encompasses critical phases that shape a child's health and development. While global health efforts have focused on the first 1000 days, the next 7000 days (ages 2-21) are equally vital, especially concerning the unmet burden of surgical conditions in low- and middle-income countries (LMICs). Approximately 1.7 billion children globally lack access to essential surgical care, with LMICs accounting for 85% of these unmet needs. Common surgical conditions, including congenital anomalies, injuries, infections, and pediatric cancers, often go untreated, contributing to significant mortality and disability. Despite the substantial need, LMICs face severe workforce and infrastructure shortages, with most pediatric surgical conditions requiring specialized skills, equipment, and tailored healthcare systems. Economic analyses have shown that pediatric surgical interventions are cost-effective, with substantial societal benefits. Expanding surgical care for children in LMICs demands investments in workforce training, infrastructure, and health systems integration, complemented by innovative funding and equitable global partnerships. Prioritizing surgical care within national health policies and scaling up children's surgery through initiatives like the Optimal Resources for Children's Surgical Care can improve health outcomes, align with Sustainable Development Goals, and foster equity in global health. Addressing the surgical care gap in LMICs will reduce preventable mortality, enhance quality of life, and drive sustainable growth, emphasizing surgery as an essential component of universal health coverage for children.

Background: Despite the implementation of surgery, antibiotics mass administration, facial cleanliness and environmental improvement, commonly known as the SAFE strategy for several years, the persistence and recrudescence of trachoma is a prevailing challenge in Ethiopia. This study explores the treatment-related characteristics of communities within districts characterized by persistent trachoma in southern Ethiopia.

Methods: Nyangatom and Uba Debretsehay districts are predominantly inhabited by pastoralist and farming communities, respectively. A community-based, exploratory descriptive qualitative study was conducted from June to October 2023. A total of 11 key informant interviews and six focus group discussions were conducted. The interviews and discussions were digitally recorded, transcribed and thematically analysed using Atlas ti. 23.

Results: Districts characterized by persistent trachoma are characterized by segments of populations that have never been treated or suboptimally treated. This is due to the competing priorities faced by providers, the nature of campaigns and the limited ability of logistics to reach the 'must reach' population. Other barriers include limited social support and terrain hindering full geographical and population coverage. Treatment slippage is of particular concern because of treatment fatigue, misinformation and the unavailability of treatments for routine care.

Conclusions: Communities in districts characterized by persistent and recrudescent trachoma face various socioecological barriers that impact the outcome of SAFE strategy implementation. A mix of both random and systematic omissions of people who need treatment most, such as children and women, was evident.

Antimicrobial resistance (AMR) remains a critical global health threat, with significant impacts on individuals and healthcare systems, particularly in low-income countries. By 2019, AMR was responsible for >4.9 million fatalities globally, and projections suggest this could rise to 10 million annually by 2050 without effective interventions. Sub-Saharan Africa (SSA) faces considerable challenges in managing AMR due to insufficient surveillance systems, resulting in fragmented data. Technological advancements, notably artificial intelligence (AI), offer promising avenues to enhance AMR biosurveillance. AI can improve the detection, tracking and prediction of resistant strains through advanced machine learning and deep learning algorithms, which analyze large datasets to identify resistance patterns and develop predictive models. AI's role in genomic analysis can pinpoint genetic markers and AMR determinants, aiding in precise treatment strategies. Despite the potential, SSA's implementation of AI in AMR surveillance is hindered by data scarcity, infrastructural limitations and ethical concerns. This review explores what is known about the integration and applicability of AI-enhanced biosurveillance methodologies in SSA, emphasizing the need for comprehensive data collection, interdisciplinary collaboration and the establishment of ethical frameworks. By leveraging AI, SSA can significantly enhance its AMR surveillance capabilities, ultimately improving public health outcomes.

Background: Baseline prevalence surveys in Cameroon in 2010-2012 showed that trachoma was endemic primarily in the north of the country, with 23 evaluation units (EUs) requiring interventions against active (inflammatory) trachoma. This study presents data from prevalence surveys conducted in 2016-2022 following interventions against trachoma in the East, North, Far North and Adamaoua regions of Cameroon.

Methods: EUs were created based on health district boundaries. Within each EU, clusters were selected using probability of selection proportional to population size. Participants were examined for trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT).

Results: A total of 151 800 people were examined in 45 surveys across 35 EUs. Based on the most recent survey results, TF prevalence was greater than the 5% TF elimination threshold in two EUs. Ten EUs had TT prevalence estimates greater than the 0.2% elimination threshold.

Conclusions: Trachoma remains a public health problem in Cameroon. Continued interventions are needed in EUs with prevalence estimates greater than elimination thresholds, including antibiotic mass drug administration and improved access to TT surgery. Future surveys will be needed to determine when national elimination of trachoma as a public health problem has been achieved.

Background: Amputation is a life-changing experience involving the surgical removal of a body part. However, little is known about the experiences of persons who have undergone limb amputation in the Saki West Local Government Area (LGA), which prompted this study.

Methods: An exploratory qualitative study design was used. Thirty participants were interviewed using face-to-face focus group discussions. Five sessions were conducted, with six participants in each session. Data were analysed using the thematic analysis framework of Braun and Clarke.

Results: A total of 76.3% of the participants were males and 73.3% were married. Their ages ranged from 22 and 69 y, with a mean age of 48.0 y and a monthly income of 20 000 naira (US$12). Three major themes emerged from the study: the needs and challenges of those who have undergone amputation, coping strategies of those who have undergone amputation and recommendations by persons who have undergone amputation. The study revealed that people who have undergone amputation experienced psychological pain, such as a loss of self-worth and stigmatization from friends and loved ones. Coping strategies identified were accepting the situation and emotional support from family. Participants recommended providing financial support, empowerment programs, employment opportunities and fostering a community of amputees in the Saki West LGA.

Conclusions: Amputees undergo psychological and psychosocial problems that can affect their health and recovery. They need emotional and financial support, rehabilitation services and provision of prostheses from family, society and the government. These services should be adequately provided in the Saki West LGA, the largest among the 10 suburban local governments in Oyo State, with numerous commercial activities and a high risk for road traffic accidents.

Background: There is a scarcity of studies regarding the obstacles in tuberculosis (TB) screening in pregnant women. This study aimed to assess the perceptions of TB as a disease and TB screening among pregnant women and healthcare workers, describe pregnant women's perceptions on specific TB screening methods and explore associations between the perceptions of TB with the intention to have TB screening by pregnant women.

Methods: A cross-sectional study was conducted at six primary healthcare centres in Yogyakarta Municipality, Indonesia among 240 pregnant women and 126 healthcare workers interviewed with a structured questionnaire about their perceptions. Perceptions were analysed as percentages and associated factors were tested by multivariable logistic regression.

Results: Most pregnant women and healthcare workers supported TB screening in pregnant women based on their perceptions of the susceptibility to or severity of TB and the benefits and risks of TB screening. Women who perceived the high susceptibility of TB disease and the benefits of TB screening were significantly more likely to have high intentions to accept TB screening in the future.

Conclusions: Pregnant women's perceptions of TB and TB screening influenced their intention to be screened; however, appropriate testing methods for universal TB screening in pregnant women in areas with a high prevalence of TB require further studies.

Background: Integrated community case management (iCCM) programs leverage lay village health workers (VHWs) to carry out the initial evaluation of children with common conditions including malaria, pneumonia and diarrhea. Therefore, it is imperative that VHWs are able to identify children who are critically ill and require referral to a health facility. Elevated venous lactate levels have been associated with severe illness and adverse health outcomes, including death. However, lactic acidosis may not be recognized in rural settings because it is not routinely measured outside of hospitals and research studies. Point-of-care lactate tests may help identify patients in need of a higher level of care and improve VHWs' ability to make timely and appropriate referrals.

Methods: The study was a cross-sectional evaluation of children aged <5 y presenting to VHWs in rural southwestern Uganda with complaints of fever and cough. Demographics, clinical presentation, evaluation, management and disposition were recorded. VHWs were trained and instructed to perform lactate testing using a point-of-care assay in eligible participants.

Results: During the study period, 238 children were enrolled and completed an initial assessment. Of the 204 participants included in the analysis, 113 (55.4%) were female, and the median (IQR) age was 23 (9-36) months. Most participants, 139/200 (69.5%), had negative results on the malaria rapid diagnostic test. The median lactate level was 2.1 mmol/L; 12% (24/204) had a lactate ≥3.5 mmol/L and only nine participants (4.4%) had a lactate ≥5 mmol/L. Having a lactate level above either cut-off was not associated with the presence of danger signs at presentation.

Conclusions: Few children presenting with fever and cough to VHWs in western Uganda had elevated lactate levels. However, most of the children with elevated lactate levels did not otherwise satisfy established iCCM criteria based on physical examination findings for referral to a health facility. Therefore, while elevated lactate was not associated with danger signs in this small study, it is possible that there is under-recognition of severe illness using current iCCM guidelines.