Global Health Action最新文献

Background: While there is now extensive research on how COVID-19 lockdowns negatively affected unpaid care burdens and intimate partner violence (IPV), the structural determinants shaping both experiences are less well understood.

Objectives: The review seeks to answer: how did structural determinants of gender inequality shape both the experiences of increased unpaid care burdens and IPV during the COVID-19 pandemic lockdown? Which policy proposals might mitigate these effects during future pandemic preparedness and response?

Methods: We conducted a scoping review of two sets of literature: on COVID-19 and unpaid care and COVID-19 on IPV. Following systematic searches of key databases and the application of inclusion/exclusion criteria, we analyzed articles using a gender matrix framework to identify common themes and policy recommendations.

Results: Common themes include adherence to traditional gender norms, power dynamics featuring coercive control, narrowed pathways to formal and informal supports, and compounding emotional tolls. Policy recommendations from the literature aimed at addressing structural determinants of gender inequality common to both unpaid care and IPV, including expanded access to virtual support services, workplace policies that value the contributions of caregivers, enhanced engagement efforts to incorporate intersectional understandings, and funding for caregiver support services and the anti-violence sector which recognize the value of their contributions.

Conclusions: Enhanced understanding of the structural determinants of gender inequality at play in experiences of unpaid care work and IPV highlights gaps in pandemic response, which overlooked the role of gender inequities in shaping relationship dynamics, as well as areas for more gender transformative policies.

Background: Rights-based Respectful Maternity Care (RMC) is crucial for quality of care and improved birth outcomes, yet RMC measurements are rarely included in facility improvement initiatives. We aimed to (i) co-create a routine RMC measurement tool (RMC-T) for congested maternity units in Dar es Salaam, Tanzania, and (ii) assess the RMC-T's acceptability among women and healthcare stakeholders.

Method: We employed a participatory approach utilizing multiple mixed methods. This included a scoping review, stakeholder engagement involving postnatal women, healthcare providers, health leadership, and global researchers through interviews, focus groups, and two surveys involving 201 and 838 postnatal women. Cronbach's alpha and factor analysis were conducted for validation using Stata 15. Theories of social practice and Thematic Framework of Acceptability guided the assessment of stakeholder priorities and tool acceptability.

Results: The multi-phased iterative co-creation process produced the 25-question RMC-T that measures satisfaction, communication, mistreatment (including physical, verbal, and sexual abuse; neglect; discrimination; lack of privacy; unconsented care; post-birth clean-up; informal payments; and denial of care), supportive care (such as food intake and mobility), birth companionship, post-procedure pain relief, bed-sharing, and newborn respect. The pragmatic validation process prioritized stakeholder feedback over strict statistics, lowering Cronbach's alpha from 0.70 in version 1 to 0.57 for the RMC-T. Women valued the opportunity to share their experiences.

Conclusions: The RMC-T is contextualized, validated, and acceptable for measuring women's experiences of RMC. Routine use in facility-based quality improvement initiatives, along with targeted actions to address gaps, will advance rights-based RMC. Further validation and community-based studies are needed.

As the world is facing challenges such as pandemics, climate change, conflicts, and changing political landscapes, the need to secure access to safe and high-quality abortion care is more urgent than ever. On 27th of June 2023, the Swedish government decided to cut funding resources available for developmental research, which has played a fundamental role in the advancement of sexual and reproductive health and rights (SRHR) globally, including abortion care. Withdrawal of this funding not only threatens the fulfilment of the United Nations sustainable development goals (SDGS) - target 3.7 on ensuring universal access to SRHR and target 5 on gender equality - but also jeopardises two decades of research capacity strengthening. In this article, we describe how the partnerships that we have built over the course of two decades have amounted to numerous publications, doctoral graduates, and important advancements within the field of SRHR in East Africa and beyond.

Background: Ni-kshay Poshan Yojana (NPY), a direct benefit transfer scheme under the National Tuberculosis Elimination Program (NTEP) in India, provides a monthly benefit of INR500 for nutritional support of persons with TB (PwTB).

Objectives: To determine the proportion of PwTB receiving atleast one NPY instalment and pattern of utilisation; to ascertain factors associated with NPY non-receipt and association of NPY receipt with TB treatment outcome.

Methods: In our cross-sectional study, we used multi-stage sampling to select PwTB whose treatment outcome was declared between May 2022 and February 2023. A cluster-adjusted, generalized linear model was used to identify factors associated with the non-receipt of NPY and determine association between NPY receipt and TB treatment outcome.

Results: Among 3201 PwTB, 2888 (92.7%; 95% CI 89.8%, 94.8%) had received at least one NPY instalment, and 1903 (64.2%; 95% CI 58.9%, 69.2%) self-reported receipt of benefit. The median (IQR) time to receipt of first instalment was 105 (60,174) days. Non-receipt was significantly higher among PwTB from states with low TB score (aPR = 2.34; 95%CI 1.51, 3.62), who do not have bank account (aPR = 2.48; 95%CI 1.93, 3.19) and with unknown/missing diabetic status (aPR = 1.69; 95%CI 1.11, 2.55). Unfavorable treatment outcomes were associated with non-receipt of NPY (aPR 4.93; 95%CI 3.61,6.75) after adjusting for potential confounders.

Conclusion: Majority of the PwTB received atleast one NPY instalment, but they experience significant delays. Most of the recipients utilised NPY for nutrition. Longitudinal follow-up studies are required to study the impact of NPY on treatment outcomes.

Background: Local and global surveillance of antibiotic resistance (ABR) has proven a challenge to implement effectively in low- and middleincome (LMI) settings. Environmental surveillance solutions are increasingly highlighted as a strategy to help overcome such problems, and thus to promote global health as well as the local management of ABR in LMI countries. While technical and scientific aspects of such solutions are being probed continuously, no study has investigated their practical feasibility.

Objective: Explore practical barriers for environmental surveillance of ABR in LMI countries, and pathways for surveillance experts to manage these.

Methods: To start charting this unknown territory, we conducted an explorative, qualitative interview study with key informants, applying a constructivist grounded theory approach to analyze the results.

Results: Barriers were identified across infrastructural, institutional and social dimensions, and pathways to manage them were mostly counterproductive from an ABR management perspective, including avoiding entire regions, applying substandard methods and failing to include local collaborators.

Conclusion: The research community as well as international agencies, organizations and states have key roles and responsibilities for improving the prospects of feasible environmental ABR surveillance in LMI-settings.

Background: The Global Financing Facility (GFF) was launched in 2015 to catalyse increased domestic and external financing for reproductive, maternal, newborn, child, adolescent health, and nutrition. Half of the deaths along this continuum are neonatal deaths, stillbirths or maternal deaths; yet these topics receive the least aid financing across the continuum.

Objectives: To conduct a policy content analysis of maternal and newborn health (MNH), including stillbirths, in GFF country planning documents, and assess the mortality burden related to the investment.

Methods: Content analysis was conducted on 24 GFF policy documents, investment cases and project appraisal documents (PADs), from 11 African countries. We used a systematic data extraction approach and applied a framework for analysis considering mindset, measures, and money for MNH interventions and mentions of mortality outcomes. We compared PAD investments to MNH-related deaths by country.

Results: For these 11 countries, USD$1,894 million of new funds were allocated through the PADs, including USD$303 million (16%) from GFF. All documents had strong content on MNH, with particular focus on pregnancy and childbirth interventions. The investment cases commonly included comprehensive results frameworks, and PADs generally had less technical content and fewer indicators. Mortality outcomes were mentioned, especially for maternal. Stillbirths were rarely included as targets. Countries had differing approaches to funding descriptions. PAD allocations are commensurate with the burden.

Conclusions: The GFF country plans present a promising start in addressing MNH. Emphasising links between investments and burden, explicitly including stillbirth, and highlighting high-impact packages, as appropriate, could potentially increase impact.

Background: Population data on mortality and causes of death among 5-19-year-olds are limited.

Objectives: To assess levels, trends, and risk factors of cause-specific mortality and place at death among 5-19-year-olds in Tanzania (1995-2022).

Methods: Using longitudinal data from the Magu Health and Demographic Surveillance System in northwest Tanzania, we identified leading causes of death among 5-19-year-olds from verbal autopsy interviews, using physician review and a Bayesian probabilistic model (InSilicoVA). We analyzed trends in cause and place of death using three periods: 1995-2004, 2005-2014 and 2015-2022, and assessed risk factors in a Cox-proportional hazards model. We compared the results with children aged 1-4 years and global estimates for Tanzania.

Results: Between 1995 and 2022, communicable disease mortality decreased by 73%, similar to the 76% decline among 1-4-year-olds. This decline in communicable disease mortality drove all-cause mortality declines of 43% and 48% among 5-14- and 15-19-year-olds, respectively. Non-communicable diseases and injuries gained importance, with their relative share of all deaths increasing from 15% in 1995-2004 to 58% in 2015-2022. Mortality risks were significantly higher among boys (particularly for injuries), those residing in rural areas (for non-communicable diseases), and those from the poorest households (for communicable diseases). By 2015-2022, 48% of 5-14 and 42% of 15-19-year-olds died in health facilities, up from 25% in 1995-2002.

Conclusions: Since 1995, the decline in communicable disease mortality drove a major all-cause mortality reduction among 5-19-year-olds. Further progress will depend on continued reduction in communicable disease mortality, particularly among the poorest, and effectively addressing non-communicable and injury mortality.

Background: Direct obstetric causes of maternal mortality account for approximately 86% of all global maternal deaths. In Nepal, 12% of all deaths of women of reproductive age are due to preventable obstetric complications in significant part due to the limited distribution and skill level of human resources.

Objectives: To address this, the Advanced Skilled Birth Attendant (ASBA) task-shifting initiative was developed to train medical officers to perform Cesarean sections (CSs) and manage obstetric emergencies in Nepal. Until now, there has been limited study of the program's efficacy.

Methods: A survey targeting all 234 ASBA graduates resulted in 93 usable surveys for multivariate regression. Additionally, seven rural government hospitals with ASBA graduates were selected for 13 in-depth interviews and 6 focus group discussions. Results were then triangulated.

Results: Immediately after training, 92.7% of ASBA graduates reported performing CSs, with the majority (65.6%) continuing to perform CSs today. Of the ASBAs not performing CSs, 51.7% could be explained by the lack of a functional operating theater, despite being at hospitals expected to provide CSs. ASBAs were significantly more likely to be performing CSs with a family physician or another ASBA present (p < 0.001; p < 0.001). Their work was perceived to increase the use of services, improve access, reduce out-referrals, and reduce the burden of CSs on any one staff member.

Conclusions: The ASBA program successfully reduces human resource shortages, expands the provision of life-saving Cesarean section, and improves the working conditions in rural hospitals within the LMIC setting.

Intentional and unintentional pesticide poisoning is an important public health problem, especially in low- and middle-income countries. Individuals who have been exposed to toxic pesticides, particularly organophosphorus insecticides, need early treatment. Atropine autoinjector devices offer a potential solution, allowing storage of effective treatment near agricultural workers' fields and homes that could be reached within minutes by the worker or fellow villagers to provide first-line emergency care. Here we present the design of a qualitative, formative study that will constitute the first phase of an implementation science study exploring the introduction of atropine autoinjectors in rural villages.This study will employ a qualitative design to investigate the feasibility and operational opportunities and challenges in providing pre-hospital emergency care with atropine autoinjectors in rural communities in Sri Lanka. We will conduct semi-structured interviews, ethnographic observations, oral history interviews, participatory mapping, and focus group discussions in villages and in hospitals.This study will allow the design of an autoinjector intervention that is tailored to specific needs of rural communities, maximise the potential benefits in the villages where they are placed, and contribute to knowledge related to biomedical technologies designed for use in LMICs. It will also contribute to social science scholarship in the context of pesticide poisoning. Study approvals have been obtained from the University of Edinburgh Medical School Research Ethics Committee (23-EMREC-039) and from Ethics Review Committee, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (ERC/2023/4).

Background: Reducing inequalities in women's nutrition and health care can accelerate progress towards Sustainable Development Goals for maternal and child health. Nutrition interventions for women are delivered through maternal health services such as antenatal care and institutional deliveries, but whether they reach and protect the disadvantaged against malnutrition is not well documented.

Objective: To assess the similarities in socioeconomic disparities and inequalities in the nutritional status and health care of women.

Methods: We analyzed nationally representative data from Demographic and Health Surveys (DHS) conducted in Bangladesh, Ethiopia, India, and Nigeria to calculate Erreygers index. This index measures the inequality in outcomes across socioeconomic spectrums. We investigated inequalities in low and high body mass index (BMI), anaemia, iron and folic acid supplementation, four or more antenatal care visits, institutional deliveries, and access to health services.

Results: Anaemia (-0.068 to -0.123), low BMI (-0.088 to -0.139), perceived distance to health services (-0.219 to -0.406), and needing permission to visit health facilities (-0.062 to -0.147) were concentrated among the less well-off, as shown by negative values. Iron and folic acid supplementation (0.043 to 0.230), antenatal care visits (0.260 to 0.495), and institutional deliveries (0.168 to 0.573) favored the better-off, as shown by positive values. Inequalities in urban vs. rural areas differed by indicator and country.

Conclusions: Nutritional status and health care inequalities among women followed patterns of socioeconomic disparities. Inequalities in nutritional status favored the better-off and educated women, and inequalities favoring the better-off were even greater for health care across countries.