International Health最新文献

The persistent conflict in Sudan has worsened the impacts of the prolonged droughts, destroying crops and livestock and severely undermining people's means of survival. Furthermore, the scarcity of water and fertile land has increased competition over resources between communities, further displacing populations. This displacement leads to worsening the crisis, straining resources, spreading disease and overwhelming healthcare. For instance, rainfall, which is one of the most devastating climate changes, can reach up to 427.70 mm in one city. Consequently, Sudan confronts widespread famine threats, while ongoing hostilities significantly restrict humanitarian organizations' ability to provide assistance. Effective solutions must focus on strengthening community resilience through strategic investments, comprehensive emergency preparedness, environmentally sustainable practices and sustained peace-building initiatives that would generate substantial benefits for human welfare and economic development.

Background: In Ethiopia, despite a decline in abortion-related mortality over the past decade, substantial challenges persist in ensuring universal safe abortion access. The lived experiences of women who underwent abortion are not well understood in Ethiopia. Thus, this study aimed to explore the lived experiences of women who underwent safe abortions in eastern Ethiopia.

Methods: The study was conducted in Harari Region and Dire Dawa admiration using a descriptive phenomenological approach among 14 purposively selected women from Public health facilities. Data was collected through In-depth interviews using an interview guide. Verbatim transcription and translation of the recorded interviews were done. Finally, thematic analysis was conducted using Open Code 4.03 software.

Results: Five major themes were emerged after analysis. Facilitators of abortion, Barriers to accessing safe abortion services, the need to keep abortion secret, religious perspectives, and Beliefs regarding the health impacts of abortion were the identified major themes.

Conclusions: This study reveals that women seek abortion for various reasons and experience many challenges after abortion, but most of these reasons are not supported by Ethiopian's current abortion law. As a result, they encounter numerous obstacles when trying to obtain safe abortion services.

Background: In Ethiopia, chronic hepatitis B virus (HBV) prevalence is high (∼6%) and infant vaccination targets are unmet. We assessed HBV vaccination uptake and associations with parental sociodemographic and obstetric factors among children (aged 12-36 months) in Ethiopia.

Methods: We utilised the 2016 Ethiopian Demographic and Health Survey. We included a weighted sample of 3,855 children (aged 12-36 month) to assess HBV vaccination coverage level (none, incomplete, and complete) and its spatial distribution. Additionally, we identified associated factors of HBV vaccination coverage level using ordinal logistic regression.

Results: Overall, 51.2% of children received complete HBV vaccination, with wide regional variation. Older maternal age (adjusted odds ratio (AOR)=1.05, 95% confidence interval (CI): 1.02-1.07), better maternal education level (mean AOR=1.66-2.08), higher household wealth quantile (mean AOR=1.51-2.32), distance to a healthcare facility not a big problem (AOR=1.54, 95% CI: 1.25-1.89), and complete maternal continuum care utilisation (AOR=2.59, 95% CI: 1.25-5.30) were positively associated with HBV vaccination coverage, while higher number of children in the household (AOR=0.86, 95% CI: 0.79-0.92) was negatively associated.

Conclusions: HBV vaccination coverage falls below World Health Organization (WHO) targets in Ethiopia and has substantial regional variation. Targeted vaccination campaigns for mothers in lower socioeconomic groups and larger families may improve vaccination coverage.

The aim of this scoping review was to explore how patient-centred care (PCC) is being measured in healthcare settings in sub-Saharan Africa (SSA) and to examine the psychometric performance of reported measurement instruments for PCC. Medline, Web of Science, EMBASE and Global Health databases were searched for articles published from 1990 to 22 September 2024. Search was updated on 30th December 2024. The keywords 'patient-centred care', 'patient experience', 'measurement' and 'psychometric property' were used. Studies were included if they reported on the development, validation, evaluation or psychometric properties of tools used for measuring PCC. Of the 302 articles retrieved, 36, including 31 unique instruments, met the inclusion criteria. Eight instruments were locally developed in SSA. A total of 26 studies were conducted either in South Africa, Nigeria or Ethiopia. Twenty-two studies (60%) were conducted in hospital settings. Psychometric evaluation was either incomplete or not done at all. Locally developed instruments had better psychometric performance compared with instruments developed in the Global North. Although various instruments have been used to measure PCC in SSA, most of them only measure its subcomponents in specific patient populations. Comprehensive measures of PCC, developed and evaluated in SSA for psychometric properties, are needed.

Over the past 2 decades, Uganda's climate policies have steadily evolved, with several frameworks and legislative measures enacted. However, the explicit consideration of health impacts remains limited, with gaps in ministerial coordination, undefined health targets, insufficient funding and limited community engagement. This commentary examines current governmental strategies through a health lens, assessing how health impacts, mitigation and adaptation measures are addressed-and identifying opportunities to better integrate health into climate policies. Progress could be strengthened by improving ministerial coordination, setting explicit health targets, increasing funding, enhancing preparedness for extreme events such as floods, droughts and extreme heat, as well as climate-sensitive health outcomes through meaningful community engagement. We also identify priority research needs: developing practical health indicators, investigating the knowledge and training of health workers and assessing effective methods for community engagement and policy evaluation. Our findings highlight the need for a clear, actionable research agenda to guide policymakers and to enhance health system resilience and climate policy effectiveness in Uganda.

Background: From a public health standpoint, there is merit in determining the levels of Escherichia coli in drinking water, but surveillance datasets often report censored values that may hinder traditional statistical analysis. This study aims to identify sociodemographic factors associated with the presence of E. coli in household drinking water in Bangladesh using Bayesian models for censored data, utilizing data from 6069 households in the Multiple Indicator Cluster Survey 2019.

Methods: In terms of censoring, we considered two different Bayesian regression strategies: Bayesian Tobit Poisson regression and Bayesian Censored Generalized Poisson regression.

Results: The Bayesian Censored Generalized Poisson regression model was identified as the optimal model for analyzing household fecal contamination. Regression analysis revealed significant associations between household E. coli levels and various factors including division, livestock ownership, location of water sources, treatment of drinking water, household head education, wealth index, source of drinking water, place of handwashing and toilet facility. Households using tube wells had lower E. coli levels than those using other sources. Furthermore, households using pit latrines had 1.03 times higher contamination levels than those using flush latrines.

Conclusions: Levels of fecal contamination in household water in Bangladesh were alarming. Our findings underscore the need for targeted policy interventions in specific population segments to address household fecal contamination, highlighting the link between sociodemographic and environmental factors with E. coli levels in drinking water.

Background: This study aims to determine the prevalence and sex-based disparities in age-standardized crude suicide rates in Sierra Leone from 2000 to 2019.

Methods: This study employed a time-trend design utilizing nationally representative data on age-standardized crude suicide rates (per 100 000 population) from the WHO Health Equity Assessment Toolkit. The primary outcome measure was the age-standardized crude suicide rate, disaggregated by sex. Inequality measures, including difference, ratio, population attributable fraction and population attributable risk, were calculated to assess disparities between males and females.

Results: From 2000 to 2019, the age-standardized crude suicide rate in Sierra Leone increased from 5.7 to 6.7 per 100 000 population, with notable fluctuations observed. Significant sex-based disparities were evident throughout the study period, with males consistently exhibiting higher suicide rates than females. The absolute difference in suicide rates between males and females narrowed slightly, from -4.0 per 100 000 in 2000 to -3.3 per 100 000 in 2019. However, the ratio of male-to-female suicide rates increased from 0.5 in 2000 to 0.6 in 2019.

Conclusions: This study highlights persistent sex-based disparities in age-standardized crude suicide rates in Sierra Leone, disproportionately affecting males. This study recommends strengthening mental health services and integrating them into primary healthcare systems.

Background: This study investigates the crowding-out effect of out-of-pocket (OOP) health expenditures for non-communicable diseases (NCDs) on household consumption in Nigeria, a critical issue in sub-Saharan Africa (SSA) given the escalating prevalence of NCDs and associated high care costs.

Methods: Using data from the 2018/2019 Nigerian Living Standard Survey, we employ a Generalised Method of Moments estimator and conditional Engel curve equations derived from the Quadratic Almost Ideal Demand System to analyse the impact of NCD and non-NCD OOP expenditures on 13 household consumption categories.

Results: Despite representing <2% of household budgets, NCD OOP expenditures significantly crowded out essential spending, particularly on healthier food options (fruits, vegetables, protein) and cooking energy sources, disproportionately affecting lower-income households. Intriguingly, discretionary spending on sugar, alcoholic/sugary beverages, entertainment (including tobacco) and meals outside the home remained unaffected, possibly indicating reliance on these fast meal alternatives due to limited cooking fuel access. Middle-income households also experienced crowding out of staples and education expenditures.

Conclusions: These findings highlight the urgent need for universal health coverage to reduce OOP burdens, alongside targeted interventions addressing NCD burden, dietary quality, the energy crisis and health inequities in Nigeria and, by extension, SSA.