Global Health Action最新文献

Background: Evidence on long COVID remains limited in sub-Saharan countries.

Objective: This study explored the occurrence of COVID-19-related symptoms and factors affecting recovery and long COVID severity in Nairobi, Kenya.

Methods: A prospective cohort of individuals testing positive for SARS-CoV-2 between February 2022 and February 2023 was followed until June 2023. COVID-19-related symptoms were assessed every three months. Time to recovery was analyzed using survival analysis, while factors affecting recovery factors and long COVID severity using Cox proportional hazard and Poisson regression, respectively.

Results: Among 291 participants (median age 34, 59.1% female), 42 (14%) had severe/critical infection. At 6 and 12 months post-positive PCR, 53.1% and 33.5% had ≥ 1 COVID-19-related symptoms, respectively. Fatigue (40.2%), pain (36.8%), sore throat (36.8%), headaches (36.4%), and loss of strength (31.6%) were most common. Median time to recovery was longer for severe/critical cases than mild/moderate (234 vs 206 days, p = 0.016). Participants aged 40-64 years experienced slower recovery than those aged < 40 years (aHR = 0.635 [95%CI, 0.429;0.941]). Participants with tertiary education recovered faster than those with primary education (aHR = 1.869 [95%CI, 1.050;3.327]). Long COVID severity was associated with female sex (aIRR = 1.418 [95%CI; 1.078;1.864]), tertiary education (aIRR, 0.489 [95%CI, 0.415;0.576]), and ≥ 1 comorbidity (aIRR = 2.415 [95%CI, 1.639;3.559]).

Conclusions: Six months post-infection, half had lingering symptoms, with a third still affected after a year. Recovery was faster in younger, educated individuals, while severe long COVID was more common in women, those with low education and pre-existing conditions. The burden of long COVID in Kenya requires support for vulnerable groups.

World Health Organization (WHO) played an important role in supporting the Member States of the Eastern Mediterranean Region (EMR) apply for awards from the Pandemic Fund - a vital source of funding for pandemic preparedness and response. The aim of this commentary is to reflect the contributions of WHO EMR during the first two funding rounds of the Pandemic Fund, while highlighting the lessons learned, and addressing the ongoing challenges faced across the region. As EMR Member States continue to build and strengthen their health security capacities, WHO's involvement has catalyzed the improvement of early warning systems, laboratory capacity, and workforce development. However, challenges remain, including sustainability, enhancing regional cooperation, the widespread state fragility, and multiple conflicts across the region.

Background: There is a limited population-based data on hazardous alcohol use and associated social determinants in many African countries.

Objectives: To examine patterns of hazardous alcohol use across a range of social determinants of health in Uganda, with a particular focus on gender differences.

Methods: This cross-sectional study used data collected in 2021-2022 from an open population cohort spanning urban, semi-urban, and rural communities. Alcohol use was assessed with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Covariates were selected according to the WHO's Social Determinants of Health framework. Poisson regression with robust variance was used for data analysis.

Results: Of the 3459 participants, 2085 (60%) were women. Overall, the prevalence of hazardous alcohol use was 5% among women and 18% among men. Strong positive associations with hazardous use were found for individuals residing in semi-urban areas (female aPR 2.1 [95% CI 1.3-3.3], male aPR 1.8 [95% CI 1.4-2.5]), past-year perpetration of intimate partner violence (female aPR 2.2 [95% CI 0.8-5.6], male aPR 1.4 [95% CI 0.9-2.2]), smoking, middle age for men (aPR 1.6 [95% CI 1.2-2.2]), and employment as a vendor in a restaurant or bar for women (aPR 1.5 [95% CI 1.0-2.2]). Strong negative associations were found for high educational attainment, Muslim or Pentecostal religion, and living in a marriage or union for women (aPR 0.7 [95% CI 0.5-1.0]).

Conclusions: Hazardous alcohol use was prevalent, especially among men, in a representative Ugandan population sample. Specific target groups for public health and clinical interventions were identified, such as women working in the hospitality sector. Residents of semi-urban communities may encounter unique risks for hazardous alcohol use, compared with rural and highly urban populations.

Background: Despite improved access to malaria healthcare, adherence to the National Malaria Guidelines for maintaining quality of care remains a concern in the DRC.

Objective: We aimed to assess whether the management of malaria cases for children under 5 years of age using Integrated Community Case Management (ICCM) is conducted according to the National Malaria Guidelines in the DRC.

Methods: We used a sample of 2,326 children from 30 ICCM sites. To determine adherence, we compared treatments received with items recommended by the National Malaria Guidelines. The chi-square tests were used to assess adherence to guidelines. Multiple logistic regression with adjusted odds ratios (AOR) and 95% confidence intervals (CI) were used to assess the association between the provinces and adherence to guidelines.

Results: About 63.8% of children had malaria, and 94.8% (n = 1,407) of children who were clinically diagnosed with malaria received rapid diagnostic test (RDT) vs. 2.8% (n = 42) children who did not receive RDT, p-value = 0.0001. Additionally, those who had malaria were more likely to receive malaria treatment (93.4% vs. 6.6%, p-value = 0.0001). However, 18.5% of children who did not have malaria still received malaria treatment (p-value = 0.0001). Compared to Lualaba, ICCM sites in Kasai Oriental were more likely to adhere to RDT testing (AOR = 1.89, CI: 1.51-2.37) and Tanganyika was less likely to adhere to RDT testing (AOR = 0.40, CI: 0.81-0.92).

Conclusion: Our study provides insight into ICCM's compliance with the malaria guidelines in the DRC, which can inform programs and contribute to improving adherence to guidelines and the quality of care.

Background: Preterm parents face higher risks of postpartum depression and anxiety, affecting bonding and infant development. Sensory stimulation shows promise, but its long-term impact on parental mental health needs further study.

Objectives: This study aimed to evaluate whether a home-based integrated sensory stimulation program, administered to preterm infants by their parents, could alleviate parental mental health issues and enhance maternal bonding and parenting competence.

Methods: The program, including tactile, auditory, visual, gustatory, and olfactory stimuli, was assessed in a block-randomized controlled trial from November 2018 to January 2020. A total of 200 parents of preterm infants were recruited, and the intervention continued at home until the infants reached six months corrected age. Parents' depression and anxiety were assessed using validated scales at baseline, and at first, third, and sixth month follow-ups.

Results: The intervention group included 98 parents, and the control group comprised 102 parents. At the six-month follow-up, the intervention group demonstrated significant improvements in maternal depression, state anxiety, and trait anxiety compared to the control group. In the mixed linear model, the intervention was associated with reductions in maternal trait anxiety (d =-2.18; 95% CI: -4.30, -0.06), paternal trait anxiety (d =-3.37; 95% CI: -5.62, -1.11) and state anxiety (d =-4.63; 95% CI: -7.00, -2.26).

Conclusion: The home-based integrated sensory stimulation program, when provided by parents to preterm infants, was effective in improving parents' mental health and can serve as an alternative treatment for postpartum depression and anxiety in parents of preterm infants at home.

Background: Antimicrobial resistance (AMR) in the environment is an important component of One Health AMR research and is increasingly incorporated into AMR National Action Plans (NAPs), including the UK's AMR NAP 'Tackling antimicrobial resistance 2019-2024'. However, implementation of the environmental commitments has yet to be evaluated.

Objective: In this study, we aimed to understand UK stakeholder perspectives on the delivery and implementation of the environmental components of the UK's AMR NAP 2019-2024, with a particular focus on wastewater, which could be used to inform the 2024-2029 NAP.

Methods: We undertook semi-structured, qualitative interviews with informed UK stakeholders to discuss how the NAP had been implemented and future directions relevant to environmental AMR.

Results: Two main themes emerged from the interviews: 1) the perception of 'risk', and 2) barriers that have hampered policy action. Some wanted more evidence to inform policy and mitigations, particularly concerning the relative risk posed by different pollution sources in driving and maintaining AMR in the environment, and the risk posed by transmission of AMR from the environment to humans. Where evidence was lacking, several academics and regulators proposed that policy action could be justified based on the precautionary principle.

Conclusions: Although we do not know the impact environmental exposure plays in driving clinical AMR infections relative to other sources, evidence suggests that exposure to environmental and wastewater sources may play a role, and thus requires policy interventions. Government leadership is critical for ensuring the uptake of environmental AMR research to inform mitigation and interventions based on the precautionary principle.

Background: In 2015, Tanzania joined the Global Financing Facility (GFF), a global health initiative for Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (RMNCAH-N). Despite its resource mobilization goals, little is known about power dynamics in GFF policy processes. This paper presents the first power analysis of Tanzania's GFF engagement.

Objective: To examine policy processes in developing GFF documents during its first two phases in Tanzania.

Methods: An exploratory qualitative case study using document reviews (*n* = 22) and key informant interviews (*n* = 21) conducted in 2022-2023. Data were thematically analyzed and interpreted using Gaventa's power cube (levels, spaces, and forms of power).

Results: Stakeholders praised the GFF's country-led, evidence-based approach and local autonomy. However, closed-door decision-making in phase one excluded civil society and the private sector. Invisible power imbalances in funding allocations left stillbirths and adolescent health without dedicated budgets, while vulnerable groups (e.g. people with disabilities) were overlooked. Disbursement-linked indicators emphasized measurable outcomes, reflecting visible power. Phase two showed adaptive learning, with improved inclusivity.

Conclusion: While government-led, global actors (e.g. World Bank, donors) heavily influenced decisions. Greater civil society engagement is needed for accountability. Future efforts must address power imbalances through meaningful citizen participation to strengthen RMNCAH-N services.

Background: Allergic rhinitis (AR) is an increasingly prominent global public health issue, where air pollution significantly contributes to its rising incidence. Although numerous studies have explored the link between air pollution and AR pathogenesis, comprehensive summaries are still limited.

Objective: This study performs a bibliometric analysis to identify research hotspots and emerging trends, offering insights into AR prevention and management.

Methods: Literature related to on air pollution and AR was retrieved from the Web of Science Core Collection database. Visualization tools, including VOSviewer, CiteSpace, and Bibliometrix R, were utilized to analyze contributions by countries, institutions, authors, journals, and keywords, with the aim of predicting future research trends.

Results: A total of 4,020 authors, 1,368 institutions, and 75 countries contributed to 753 publications. The United States leads in research contributions, while China has shown rapid growth since 2012. Prominent authors include Deng Qihong and Lu Chan have made significant contributions. Keyword analysis revealed five major clusters: Asthma and Allergic Diseases, Environmental Factors, Climate Change and Exposures, Epidemiology and Risk Factors, and Population-Specific Research. Key topics covered include atopy, childhood asthma, climate change, pollution exposure, and air pollutants.

Conclusion: This first bibliometric analysis of air pollution and AR highlights a strong link between air pollution and AR pathogenesis. Enhanced environmental controls and air quality monitoring are essential for AR prevention. However, the complex composition of air pollutants presents challenges in elucidating specific mechanisms.

Background: Global mortality transitions are driven by the epidemiologic transition, resulting in a rise in non-communicable diseases (NCDs), which are partly shaped by the nutrition transition and associated chronic conditions. In low- and middle-income countries, these shifts are often viewed as primarily urban phenomena. Rural populations may therefore be overlooked in efforts to prevent and manage NCDs, despite facing critical public health challenges.

Objective: This study examines changing patterns of adult mortality and causes of death in rural Senegal to illustrate ongoing mortality, epidemiologic, and nutrition transitions.

Methods: Using data from three rural sites in the Senegalese Health and Demographic Surveillance System, we analysed adult mortality from 1985 to 2020. We calculated all-cause and cause-specific mortality rates among individuals aged 15 to 70 years, based on causes of death determined through verbal autopsy.

Results: Mortality declined across all age groups. Deaths from communicable diseases, maternal conditions, and undernutrition decreased substantially. NCDs have surpassed communicable diseases as the leading cause of death. Causes of death associated with undernutrition have declined, while diet-related NCDs have increased.

Conclusions: Adult mortality is declining in the three rural Senegalese sites studied, due to a decline in epidemics. However, NCDs now pose a major rural health threat, consistent with epidemiologic transition theory. The reversal between mortality patterns associated with undernutrition and diet-related NCDs may signal an ongoing nutrition transition. Strong health systems are crucial for both preventing and treating NCDs, and robust health information systems are needed to support deeper analysis of this issue.