International Health最新文献

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.

Background: Many low- and middle-income countries (LMICs) face a vast mental health treatment gap. Digital health offers scalable solutions, but successful implementation requires assessing health system readiness. This study developed and applied an integrated framework to assess this readiness in an urban LMIC.

Methods: In Lagos, Nigeria, our mixed methods study used an integrated framework combining systematic policy appraisal (adapted Appraisal of Guidelines for Research and Evaluation II) with granular ecosystem mapping of national repositories and local infrastructure.

Results: The assessment revealed a strategic implementation gap. Lagos State has strong policy readiness (score: 75.8/100) and a robust technology ecosystem with Nigeria's highest mobile density (nearly 26 million active lines). However, readiness was misaligned with implementation: a granular analysis of 45 national digital health projects found mental health constitutes only an estimated 2-3% of the portfolio's focus, with no dedicated platforms. This strategic oversight persists in new national digital health architecture.

Conclusions: Health system readiness is multidimensional and assessments focused on isolated components can be misleading. Our findings highlight a strategic gap between an enabling policy environment and actual implementation. The integrated framework offers a replicable model for LMIC policymakers to diagnose these gaps and guide evidence-based digital health investments to bridge the mental health treatment gap.

Background: There is a need to build public support for the conduct of HIV cure research. It is important to enhance the public understanding of HIV cure strategies in resource-constrained settings with high HIV prevalence. Adopting deliberative approaches allows information to be shared interactively, building knowledge on the topic and unpacking the complexity of the science.

Methods: We conducted deliberative community dialogues in rural KwaZulu-Natal, South Africa, with the Africa Health Research Institute community engagement team and Community Advisory Board members. We discussed the public understanding of 'HIV cure' and current scientific approaches. Detailed written notes were taken in anonymised format. Data were later analysed thematically, with three main themes identified: (i) understanding of HIV cure trials; (ii) HIV scientific procedures; and (iii) HIV cure messaging.

Results: Participants' questions and discussion revealed support for research on HIV cure but limited knowledge and understanding. Participants had questions about trial procedures, risks of antiretroviral therapy interruptions, efficacy, cost and monitoring of viral loads. There is need for simple, accessible language about the complex science to avoid misunderstanding among community members.

Conclusion: On going challenges in effectively communicating complex scientific concepts highlight the importance of ongoing community engagement and education in HIV cure research.

Oral pre-exposure prophylaxis (PrEP) is efficacious in reducing human immunodeficiency virus transmission among people at substantial risk. In Myanmar's PrEP demonstration project among men who have sex with men (MSM) and transgender women (TGW), 39% (n=216) of eligible MSM/TGW initiated daily oral PrEP and 43% (n=93) of them remained on PrEP at 1 y. Here we aimed to understand the barriers and facilitators of PrEP uptake and retention among Myanmar's MSM/TGW and healthcare providers. We conducted three focus group discussions among 29 MSM/TGW (PrEP users and non-users) and in-depth interviews among 18 MSM/TGW and 8 healthcare providers (non-PrEP and PrEP prescribers) from Yangon. Interviews were audio recorded and transcribed in Burmese. Transcripts were analysed using thematic analysis. Among 47 participating MSM/TGW, the median age was 27 y, half identified as TGW (51% [n=24]) and 49% (n=23) were MSM and 53% (n=25) were taking PrEP during the study. Among healthcare providers, the median age was 31 y, seven were male, one was female and half were PrEP providers. In our study, perceived stigma linked with homosexuality, the daily pill burden and community misconceptions of PrEP as antiretroviral therapy were barriers. Providing telemedicine services and incentives and having a supportive network and peers facilitated PrEP uptake and retention.

Pneumonia is a major cause of morbidity and mortality in Ghana, especially among children <5 y of age and the elderly. However, comprehensive data on its prevalence and distribution remain limited. This systematic review addresses this gap by analysing the prevalence, regional variations, risk factors, antimicrobial resistance and mortality rates of pneumonia in Ghana. We searched PubMed, ScienceDirect, Web of Science and African Journals Online databases, including 21 studies with a total of 124 582 participants. A random-effects meta-analysis estimated pooled prevalence and subgroup differences based on age, region and participant type. Heterogeneity was assessed using the I2 test and meta-regression, with sensitivity analysis also conducted. Study quality was evaluated using standardized Joana Briggs Institute checklists for prevalence studies. The pooled prevalence of pneumonia in Ghana was 22.01%, with significant regional variations. The highest prevalence was observed in a study conducted in the Greater Accra and Northern regions (32.31%), while the lowest was in the Upper West (4.83%). The prevalence in children <5 y of age was 17.79%. Hospitalized patients had a higher prevalence (22.14%) than community children (21.49%). Streptococcus pneumoniae was the most common pathogen, with high resistance (>70%) to co-trimoxazole, gentamicin and tetracycline. Key risk factors included indoor air pollution and seasonal changes. The mortality rate for pneumonia was found to be 3.07%. This systematic review highlighted significant regional disparities, pathogen resistance patterns and environmental risk factors that shape the burden of pneumonia in Ghana, providing critical evidence for targeted public health strategies. The findings highlight avenues for future research, including environmental drivers of transmission, focusing on underreported regions and surveillance of antibiotic resistance of pathogens isolated from pneumonia patients.

Background: People affected by skin neglected tropical diseases (NTDs) are often stigmatised, experiencing discrimination in consequence of their condition. Peer advocates can help progress a person-centred agenda for people affected by NTDs, however, evidence gaps in the steps to becoming an advocate persist.

Methods: We wanted to understand the steps towards a peer advocacy role for skin NTDs. We used the participatory Stepping Stones method to identify steps on the journey to becoming an advocate with 48 participants, followed by three in-depth life histories with peer advocates for other stigmatising chronic conditions (e.g. disability, mental health, Ebola survivors).

Results: We found study participants frequently experience stigma and discrimination in consequence of their condition. The peer advocate role includes awareness raising and advocacy and providing mutual peer support. Among peer advocates, personal acceptance of their condition, vocational training and family support are important steps along the pathway to becoming a peer advocate. Outcomes of the role include personal determination and increased confidence for peer advocates, provision of help and support for others with similar conditions and broader change in understanding, attitudes and policy within the community and country.

Conclusions: We find that when appropriately enabled, peer advocates can themselves be empowered and play a key role in person-centred care.

Background: Dengue is endemic in Saudi Arabia, particularly in Jeddah, Makkah and Jizan. Outbreaks in these regions are mainly linked to climate conditions and mass travel during religious pilgrimages.

Methods: This retrospective cross-sectional study evaluated the diagnostic performance of the non-structural protein 1 (NS1) antigen test and IgM ELISA, compared with RT-PCR. A total of 2850 samples were collected from patients hospitalised with moderate to severe symptoms across six regions in Saudi Arabia from 2022 to 2024. The samples were tested simultaneously using all three methods and 95% CIs were calculated using the Wilson score method.

Results: Out of 3419 samples analysed, 1402 tested negative for dengue and 1448 tested positive. The sensitivity of the NS1 antigen test was 73.5% (95% CI 70.7 to 76.2%). The IgM ELISA test demonstrated a sensitivity of 65.8% (95% CI 62.9 to 68.7%). Combining the results of both tests increased the sensitivity to 92.4% (95% CI 90.6 to 93.9%). This combined diagnostic approach facilitates the detection of both early-phase (NS1-positive) and later-phase (IgM-positive) infections, offering a more comprehensive diagnostic tool.

Conclusions: Implementing a combined testing strategy within Saudi Arabia's diagnostic pipelines could enhance disease surveillance, enable earlier detection and strengthen public health efforts against dengue outbreaks.

Background: The determinants of insecticide-treated nets (ITNs) use and uptake of three doses or more of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp 3+) among pregnant women can vary between regions and is not well studied in Angola.

Methods: This study analysed secondary data of a cluster-randomized controlled trial that evaluated the impact of the Maternal and Child Health Handbook (MCH-HB) on the continuum of care among pregnant women and mothers in Angola from 2019 to 2020. Those who received antenatal care (ANC) were analysed. Multivariable logistic regression analyses were performed to assess factors associated with ITN use and IPTp 3+ uptake.

Results: Among 8336 participants, 62.7% used ITNs and 48.7% achieved IPTp 3+. Only 31.7% achieved both. Single women were less likely to use ITNs. Women who completed secondary education, were wealthier and achieved IPTp 3+ were more likely to use ITNs. Teenagers, multiparous mothers, rural area residents and those who attended ANC later were less likely to achieve IPTp 3+. Those who completed secondary education, were wealthier, had longer travel times to health facilities and were in the MCH-HB group were more likely to achieve IPTp 3+.

Conclusions: The identified risk groups can be targeted for interventions to improve coverage.