Global Health Action最新文献

Background: Bangladesh faces substantial inequalities in water, sanitation, and hygiene (WASH), with disparities across sociodemographic groups and between urban and rural populations. Evidence on temporal changes in household WASH access and its determinants remains limited.

Objective: To assess changes in household WASH and examine the influence of sociodemographic factors on access, using data from two national hygiene surveys at national and urban-rural levels.

Methods: In this repeated cross-sectional study, differences in WASH outcomes between the 2014 National Hygiene Baseline Survey and the 2018 National Hygiene Survey were assessed using prevalence differences (PD), and associations with sociodemographic factors were examined using generalized estimating equations (GEE).

Results: From 2014 to 2018, rural households maintained near-universal basic drinking water, while urban households showed a slight decline. Basic sanitation increased substantially in rural areas (PD = 27.8), driving national gains (PD = 25); urban changes were nonsignificant. Basic hygiene improved minimally across all levels. Higher socio-economic status was linked to better WASH outcomes, while larger households had poorer status. Rental housing was associated with unimproved drinking water (Coef.: 1.9) and lower basic sanitation (Coef.: -0.9) but better overall hygiene than self-owned homes. Urban households had lower access to basic drinking water and sanitation, yet better basic hygiene facilities than rural households.

Conclusion: Household WASH improved substantially, especially in rural sanitation and hygiene, while urban areas showed stagnation. Socio-economic status, household size, and housing tenure are key determinants, highlighting the need for targeted interventions to ensure equitable, universal WASH coverage.

Heritable human genome editing (HHGE) presents new possibilities for the prevention of genetic diseases but also raises ethical and societal questions. While international surveys have explored public attitudes, particularly in high-income countries, there is a lack of large-scale empirical data from the Global South. In South Africa, previous work used deliberative public engagement to examine public perspectives. The present study aims to complement this by capturing public opinion through a cross-sectional survey, enabling direct comparison with deliberative findings. This study will recruit 400 adult participants residing in South Africa using targeted Facebook advertisements. A two-phase sampling process will be employed: initial screening for demographic information, followed by stratified sampling to ensure a representative South African population. The opinion survey consists of 19 HHGE scenarios, each explored through private and public moral lenses. Additionally, participants will indicate their interpretation of 'safe and effective' genome editing. Quantitative data will be analysed using descriptive statistics, chi-square tests, and logistic regression. Qualitative responses will undergo thematic analysis using both manual coding and generative AI tools under human oversight. The study includes two stages of informed consent and ensures data confidentiality through strict data handling protocols. Results will be disseminated in peer-reviewed journals and policy forums. The study will also generate a secondary dataset for evaluating AI-assisted qualitative analysis, to be conducted under separate ethical clearance.

Background: Amid growing global recognition of the importance of young people's sexual and reproductive health and wellbeing, an intervention to support peer-based comprehensive sexuality education (CSE) for young women involved in sex work in Ethiopia was implemented in 2020. Since 2018, conflict has driven an upsurge in distress migration by young women to some intervention sites.

Objective: This article explores the experiences of young women involved in sex work alongside peer facilitators to understand the strengths and limitations of the CSE intervention and the broader impacts of conflict and distress migration, in order to identify implications for future interventions in Ethiopia.

Methods: The article draws on qualitative findings from implementation research undertaken with young women involved in sex work (n = 60) and peer facilitators (n = 15) in Addis Ababa, Bahir Dar and Hawassa cities.

Results: Participants' entry into sex work is characterised by an absence of supportive networks, yet their social isolation is exacerbated by the stigma of sex work. In areas affected by distress migration, adolescent girls and young women entering sex work are younger, and thus particularly vulnerable to abuse and exploitation by brokers, which further undermines their sexual and reproductive health and rights.

Conclusion: CSE interventions should include adolescent girls involved in sex work who are under 18, given their heightened vulnerabilities. Interventions should engage with a broader range of stakeholders, including police, social services and legal systems, to enhance the sexual and reproductive health and rights of girls and young women, and address violence and exploitation.

The rising burden of Non-Communicable Diseases (NCDs) requires a comprehensive strategy by integrating community-based interventions - especially in Low- and Middle-Income Countries (LMICs). Over the past decade, researchers have emphasized communities as key agents of change in health systems. While Community Health Participatory (CHP) interventions show promise in NCD management, their application in crisis-affected contexts remains underexplored. This scoping review examines the adoption of CHP interventions, strategies employed, their barriers and facilitators encountered in crisis-affected LMICs to prevent and control NCDs. Utilising the Arksey and O'Malley framework, comprehensive search was conducted across PubMed, Web of Science, Scopus, and Google Scholar. Primary studies and grey literature in English were included focusing on CHP interventions among adults in such settings. Studies on unrelated health issues, review articles, protocols, and conference abstracts were excluded. Data extraction was conducted using Covidence, with discrepancies resolved through consensus. The narrative analysis of the extracted data was conducted. The review identified varied CHP interventions, with the majority focusing on mental health. The included studies highlighted the role of community engagement and stakeholders' involvement. Strategies included raising awareness, providing social support and focusing on lifestyle modifications. Barriers to interventions included limited resources, socio-cultural constraints, and logistical challenges, while facilitators involved community leadership and ownership, empathy, cultural adaptations of interventions, and multi-sectoral collaboration.CHP interventions represent a promising strategy for tackling NCDs in crisis-affected LMICs, however, limited evidence on their long-term impact needs further research.This review was registered on the Open Science Framework and funding was provided by NIHR-UK (NIHR203248).

Background: Depression is a leading contributor to the global burden of diseases. Stigma associated with mental illness significantly hinders help-seeking, diagnosis, treatment, and recovery. While research on mental health stigma has expanded over the past two decades, a systematic examination of its evolution, particularly in the context of depression, is almost non-existent.

Objective: To map and analyze global research on depression stigma, focusing on publication trends, leading contributors, international collaborations, and thematic developments.

Methods: We analyzed 947 peer-reviewed articles indexed in the Scopus database using bibliometric software in R-studio. Quantitative indicators included annual publication growth, citation analysis, leading countries, institutions, and authors, as well as international collaboration patterns. Additionally, keyword co-occurrence and thematic evolution analyses were conducted to explore conceptual developments within the field.

Results: The number of publications steadily increased from 2013 to 2025. The United States, China, the UK, and Canada accounted for the highest research and citation impact, while contributions from low- and middle-income countries (LMIC) remained limited despite these regions carrying most of the global disease burden. Thematic mapping revealed a strong focus on clinical and psychosocial dimensions, with increasing attention to concepts such as resilience, social support, and the mental health effects of the COVID-19 pandemic in recent years.

Conclusions: The volume of research on depression stigma has grown, yet significant geographical and conceptual disparities continue to persist. Strengthening collaboration, supporting LMIC research capacity, and integrating stigma reduction into global mental health frameworks are essential to achieving equitable mental health outcomes worldwide.

Uganda's public healthcare system faces significant systemic challenges in delivering care, contributing to poor health outcomes. In response, a North-South partnership between Massachusetts General Hospital (MGH), Mbarara University of Science and Technology (MUST), and Mbarara Regional Referral Hospital (MRRH) implemented the First Mile Project, a seven-year initiative (2018-2024) designed to strengthen the regional health system in southwestern Uganda. Guided by local priorities, the program aimed to improve access to care, enhance clinical capacity, expand medical education, and promote research and innovation. Project activities were devised collaboratively between investigators at MGH and MUST/MRRH, with robust local leadership and oversight. Key initiatives included clinical staffing in critical departments, construction of a regional isolation ward and oxygen plant. Additionally, the program provided scholarships for medical training, support for community-based care and continuing medical education, and provision of research and innovation grants. The program trained over 1500 health workers, supported 93 scholarships, increased access to specialized clinical services, and facilitated community outreach to thousands of households. The project also awarded 74 research grants and supported over 30 locally incubated innovations. Through this comprehensive, equity-focused approach, First Mile demonstrated how collaborative, locally driven partnerships can effectively strengthen health systems in low-resource settings. Lessons from the initiative underscore the importance of sustained local leadership and integrated clinical and research efforts. A 20-year history of collaboration and mutual trust ensured open dialogue between partners and helped support the success of the project. The First Mile model provides a promising example for future health system strengthening initiatives globally.

Background: Social norms and gendered power relationships contribute to the acceptability of 'wife abuse' - a common form of domestic violence globally.

Objectives: To estimate the prevalence and overlap of emotional abuse, forced heavy work, and food deprivation during pregnancy and examine their association with women's attitudes accepting of wife abuse in Nepal.

Methods: Baseline data were used from a randomized controlled trial involving pregnant women aged 18 and older attending routine antenatal care at two public hospitals in Nepal between January 2023 and March 2025. Participants completed a color-coded audio computer assisted self-interview. Attitudes toward wife abuse were assessed using 16 items drawn from three existing instruments. Exploratory factor analysis identified three distinct attitudinal factors. The dependent variable was a composite indicator of emotional abuse, forced heavy work, or food deprivation (coded as present if any were reported). Associations between the three attitudinal factors and composite outcome were analyzed using multiple logistic regression, adjusting for relevant sociodemographic variables.

Results: Emotional abuse, forced heavy work, or food deprivation was reported by 6.7% of participants. Acceptance of wife abuse for domestic shortcomings (Factor 1) was significantly associated with higher odds of experiencing abuse (aOR [1.75 (1.23-2.50)].

Conclusions: Pregnant women who endorsed attitudes accepting wife abuse - particularly for perceived domestic shortcomings - had higher odds of experiencing emotional abuse, forced heavy work, or food deprivation. These findings highlight importance of addressing harmful gender norms within households and ensuring antenatal care settings include safe opportunities to identify and support women at risk.

Background: Frontline practitioners play a crucial role in the implementation and enforcement of child protection laws. Yet, studies on how they experience applying those laws are scarce, not least in the sub-Saharan Africa region where rates of violence against children are persistently high.

Objective: This study provides an insight into the views of frontline practitioners in the implementation and enforcement of child protection laws, with a focus on what they experience as barriers and facilitators.

Methods: Interviews were conducted with 17 frontline practitioners from child protection services in Maputo City, Mozambique's capital. The interviews addressed barriers, facilitators, gender norms and attitudes and forms of violence. Audio recorded interviews were transcribed, translated, and thematically analysed.

Results: The results resolved around two overarching themes: 1) barriers to the implementation and enforcement of child protection laws, including system-related deficiencies (material, human and organizational); Law related shortcomings (gaps in the content and constraints); and sociocultural norms and attitudes perpetuating violence. 2) facilitators to the implementation and enforcement of child protection laws, including access to resource support from non-governmental organisations and newly established multisectoral mechanism for responding to violence.

Conclusion: Effective implementation and enforcement of child protection laws in Mozambique requires adequate resource allocation and funding to strength child protection services. It may also be necessary to enhance multisectoral coordination and harmonization of child protection laws. Furthermore, adapted evidence-based interventions from the WHO INSPIRE framework may help to improve both the prevention and response to violence against children.

The global surge in migration has exposed pregnant women and children in transit to heightened risk of maternal and child health (MCH) challenges, driven by systemic barriers and unstable conditions. Evidence on how these transitory factors influence MCH remains limited. This scoping review examined the health needs and key determinants affecting migrant populations in transit, specifically pregnant women and children travelling from their countries of origin to their intended destination countries, with the aim of identifying major barriers and proposing strategies for improved health outcomes. We screened 1202 sources of evidence using five databases (PubMed, Scopus, Europe PMC, CINAHL, and Medline) as well as grey literature. Seven studies met the inclusion criteria. Data were drawn from peer-reviewed literature, charted using a standardized framework, and analysed thematically. Key barriers included financial constraints, language obstacles, and limited access to healthcare services. Although humanitarian organizations offered some support, significant unmet needs remain, including exposure to transactional sex, absence of respectful maternity care, and restricted access to essential health services. These challenges are exacerbated in conflict and crisis settings. The review underscores the importance of addressing key determinants, including location, language, financial capacity, and community support, to improve health outcomes for pregnant women and children under five on the move. This review recommends strengthening community mobilization, leveraging technology, and ensuring equitable access irrespective of users' cultural or financial constraints.

Background: The mental burdens among pregnant and postpartum women were exacerbated by cultural expectations and policy shifts, which can be mitigated by social support.

Objective: To identify the networks of comorbid somatic and mental health, diverse sources of support (interpersonal and policy), and symptom-support interactions in pregnant and postpartum women.

Methods: Participants were recruited from seven Chinese tertiary hospitals. Health conditions, supports, and combined system networks were estimated. Core symptoms and support sources were identified via centrality indices.

Results: Two thousand nine hundred and eighty-nine participants were included, network analysis identified 'feeling tired/having low energy' and 'suicidal thoughts' in depression symptoms as the most central symptoms. Strongest edges were identified between 'uncontrollable worry-trouble relaxing' (anxiety), 'slowed movement-suicidal thoughts' (depression), and 'feeling your heart pound or race-shortness of breath' (somatic symptoms). Somatic health exhibited strong connections with depression symptoms, especially between 'trouble sleeping' and 'sleep problems'. In the support network, 'my friends offer practical help' and 'fiscal assistance programs' exhibited highest strength centrality, 'friends share joys and sorrows with me' and 'family willingly helps me make decisions' were key mediators with high betweenness. All supports were negatively associated with mental/somatic symptoms. Family and friend support had stronger negative connections with hopelessness. 'Health management', 'reliable friends', and 'family emotional support' presented the strongest negative relationships with mental health.

Conclusion: Fatigue and suicidal ideation were identified as interconnected symptoms, informal interpersonal support, and fiscal assistance as key elements. Preventions and interventions should prioritize core symptoms while leveraging the power of support networks, to safeguard maternal health and well-being.