Global Health Action最新文献

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.

The COVID-19 pandemic laid bare the unpreparedness of global and public health systems to respond to large-scale health crises, while simultaneously revealing the entangled nature of disinformation and poor global and public health outcomes. This research challenges the common treatment of public health disinformation - deliberately false information - as an emergent and technical threat, and instead situates it as a more systemic and nuanced challenge for global health governance to address. This article presents an integrative narrative literature review on the interlinkages between public health disinformation, conflict, and disease outbreaks, demonstrating mutually influencing connections between them. In doing so, the analysis raises critical questions around how reactive responses, such as doubling down on information authority, can paradoxically fuel the uptake of both disinformation especially amidst global trends towards increasing conflict and decreasing cooperation. In this evolving sociopolitical landscape for global health, the discussion explores the potential to harness health diplomacy to strengthen critical public engagement and deliberation. This reimagined approach to health diplomacy offers pathways to mitigate the harmful effects of disinformation rather than seeking to eliminate false information. This article contributes to deepening an understanding of this rapidly expanding topic for global and public health in two pathways. First, by investigating the root causes and impacts of public health disinformation that intersect with conflict. Second, by exploring how health diplomacy can foster cooperative global health governance through transparency and inclusion. This research offers a new direction to strengthen preparedness for future global and public health crises amidst disinformation.

Background: Malawi has a significant burden of hypertension, including for people with HIV. The World Health Organization recommends integrated HIV-hypertension care, but such integration is not widely implemented in resource-constrained settings.

Objective: This study explored barriers to hypertension care in Malawi from the perspectives of healthcare providers and health system leaders.

Methods: We conducted a qualitative study of providers and health system leaders across 14 health facilities in Malawi. Interviews explored hypertension services in integrated (HIV and hypertension) and non-integrated clinics to identify barriers to hypertension care and compare barriers by integration status. Interview guides and analysis used the Consolidated Framework for Implementation Research. All transcripts were double coded and thematic analysis was performed.

Results: From April-May 2023, we interviewed 33 individuals (25 providers and 8 health system leaders). Barriers to hypertension care were largely the same in integrated and non-integrated clinics and included stockouts of antihypertensive medications, lack of equipment, lack of provider training, and weak medical record systems. Providers working in integrated care emphasized the benefits of reduced burden for clients and improved quality of care but also reported unique challenges, including capacity constraints (due to the large number of clients) and inability to provide aligned dispensing of antihypertensive medications and ART (due to antihypertensive medication stockouts).

Conclusions: Barriers to integrated HIV and hypertension care in our study largely reflected challenges for hypertension care more broadly. Future efforts should focus on provider training, supply chain strengthening, equipment procurement, and medical record system strengthening to improve outcomes for people with hypertension and hypertension-HIV multimorbidity.

Background: Reliable measurement of occupational stress is essential for designing effective interventions for healthcare workers; however, Vietnam currently lacks culturally validated assessment tools.

Objectives: To develop and validate the Healthcare Worker Stress Scale - Vietnam (HWSS-V), a profession-inclusive, culturally grounded instrument that extends the Health Professions Stress Inventory (HPSI) and the Nursing Stress Scale (NSS) by adding Vietnam-salient domains and crisis-monitoring utility.

Methods: We conducted a cross-sectional survey of 520 physicians, nurses, and medical technicians at two university hospitals (June-December 2021). Fifty items adapted from HPSI/NSS underwent forward - backward translation and expert review. Psychometric evaluation included item-level content validity index (I-CVI), scale-level content validity index (S-CVI), exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and reliability testing (Cronbach's alpha).

Results: All fifty items showed strong content validity (I-CVI ≥0.80; κ 0.67-0.97; S-CVI = 0.90). EFA supported a five-factor structure. After removing six low-loading items, forty-four items explained 87.1% of variance with excellent reliability (overall Cronbach's alpha = 0.96; subscales 0.85-0.95). CFA indicated acceptable fit (Root Mean Square Error of Approximation = 0.077; Standardized Root Mean Squared Residual = 0.060; Tucker - Lewis Index = 0.827; Comparative Fit Index = 0.816).

Conclusions: HWSS-V enables practical hospital-level stress surveillance and quality improvement. Hospitals can: (i) embed HWSS-V into biannual staff health checks to benchmark units and triage high-risk groups; (ii) integrate scores into dashboards to trigger tailored responses; and (iii) deploy rapid assessments during crises (e.g. outbreaks, patient surges) to guide resource allocation. By addressing culturally specific stressors across major clinical professions, HWSS-V provides actionable capabilities beyond HPSI/NSS for Vietnam's hospitals.

Background: Honduras has historically faced major barriers to building a sustainable health research system, including minimal R&D investment and limited institutional infrastructure. A Canadian-funded initiative (2007-2012) established the first research-oriented MSc program, a non-clinical ethics board, and modern laboratories at the Universidad Nacional Autónoma de Honduras (UNAH).

Objective: This article examines how health research capacity evolved between 2013 and 2025, highlighting long-term outcomes, enablers, and barriers, and situating these within a regional Central American comparison. The narrative, largely anecdotal, reflects on the experience and impact of biomedical research at UNAH, particularly through the Instituto de Investigaciones en Microbiología (IIM).

Methods: Alumni trajectories and institutional transformations are illustrated with concrete examples. Bibliometric analysis contextualizes scientific output, complemented by broader indicators (GDP, R&D investment, tertiary education, PhDs per million) from World Bank sources.

Results: More than 30 MSc graduates have strengthened biomedical and public health institutions, with several completing doctoral training abroad and returning to Honduras. Since its formal creation in 2014, the IIM has produced over 170 publications, representing more than 20% of UNAH's health-related output since 2012. Challenges to sustainability include chronic underinvestment (< 0.1% GDP in R&D), rigid bureaucracy, limited career pathways, and brain drain. Enablers have been international partnerships, the academic diaspora, and strong local leadership.

Conclusion: The Honduran case illustrates how targeted, multi-level investment in individuals, institutions, and governance can foster long-term research capacity in resource-constrained settings, while underscoring the need for national policies, career structures, private sector engagement, and sustained international collaboration.

Background: Performance-based financing (PBF) is a key health financing reform in many sub-Saharan African countries, with verification being a critical component. Counter-verification, designed to enhance the credibility of verification, remains largely under-documented and under-researched. This study examines the counter-verification activities within Côte d'Ivoire's PBF program, providing insights into its implementation and challenges.

Methods: We performed a content analysis of 14 quarterly counter-verification reports spanning from Q4 2016 to Q3 2023, supplemented by brief, informal discussions. Using the READ approach proposed by Dalglish et al., we systematically prepared the materials, extracted and analyzed data, and distilled the findings. Our analysis focused on discrepancies between verified and counter-verified data, identifying and detailing the underlying causes of these inconsistencies.

Results: Our analysis revealed mixed results when comparing the verified and counter-verified data. While discrepancies decreased over time for some activities, others remained consistent or even worsened. The primary causes of discrepancies included inadequate record-keeping and failure to meet indicator validation criteria. Challenges in retrieving documents for counter-verification were linked to poorly managed physical and electronic archiving systems, as well as a lack of qualified personnel. Furthermore, the audit of administrative and financial procedures, especially regarding invoice issuance and the use of PBF funds, highlighted several shortcomings.

Conclusions: Counter-verification is a critical component of PBF programs, designed to strengthen confidence in verifications, correct errors or weaknesses through sanctions or recommendations, and prevent misconduct by both providers and verifiers. To optimize its impact, counter-verification must be systematically integrated into the design of PBF programs.

Background: Ethiopia has experienced growth in the utilization of family planning services. However, there are reports of relatively low client satisfaction across the country.

Objective: The objective of this study was to assess client and facility level predictors of satisfaction with family planning services in Ethiopia.

Method: A multi-level mixed effects logistic regression analysis was conducted on a national survey obtained from the service provision assessment 2021-22. A total of 2071 clients (level one) and 529 facilities (level two) were included.

Results: Overall, 56% of clients were highly satisfied with the family planning service they received. Findings from the random effects of the multilevel analysis show there is a significant difference in client satisfaction between facilities, with an intra-class correlation of 0.56 in the null model. At the client-level, age above 30, auditory privacy, and discussion on side effects are significantly associated with higher client satisfaction. At the facility level, having a waiting area, facilities with a quality unit and/or committee, a DHIS2 reporting system, operating for more than 20 days a month, privately owned facilities and availability of family planning guidelines are associated with higher odds of being satisfied. On the other hand, at the client level, having a primary or higher education, increasing wait time and clients asking their providers questions are associated with lower odds of being satisfied. At the facility level, having a fixed user fee significantly reduces the odds of client satisfaction.

Conclusions: Human resource and professional development training and health system strengthening is recommended.

The COVID-19 pandemic underscored Africa's urgent need for vaccine security and self-reliance. In response, the African Union and Africa Centers for Disease Control and Prevention (CDC) established the Framework for Action (FFA) through the Platform for Harmonized African Health Products Manufacturing (PHAHM), with a goal of 60% local vaccine production by 2040. During 2024, Africa CDC, Karolinska Institutet, and Charité Universitätsmedizin Berlin organized a seminar series to discuss advancing this agenda, including a multidisciplinary international expert panel. The series concluded that achieving this requires a comprehensive approach to addressing gaps in the ecosystem, including research and development (R&D), workforce development, technology transfer, regulatory systems, demand creation, and coordination. Strengthening R&D entails investment, capacity building, and equitable academic partnerships. A skilled workforce is essential, necessitating a coordinated approach through Regional Capability and Capacity Networks (RCCNs), training of vaccine manufacturing personnel, and academic programmes for sustainable workforce development. Technology transfer requires building trust between technology holders and recipients, alongside a supportive environment for knowledge exchange. Robust regulatory frameworks, including regional harmonization and strengthened National Regulatory Authorities (NRAs), are crucial for vaccine quality and safety, with the Africa Medicines Agency (AMA) providing oversight. Necessary market shaping through demand creation is achieved by advocating for procurement of locally produced vaccines, enhancing outreach for public trust, and operationalizing the African Pooled Procurement Mechanism (APPM). Coordination mechanisms are needed to optimize resource allocation, promote information sharing, and avoid redundancy. Strategic investments and policy support will be instrumental in achieving Africa's vaccine manufacturing aspirations and long-term health security.

Background: Coverage of many routine childhood vaccinations in Afghanistan is low and declining. For instance, only 60% of eligible children received doses of the pentavalent vaccine in 2013-18, and this fell to 51% in 2022/23.

Objective: To help explain the underlying causes behind this trend, this study aims to identify socio-demographic factors relating to caregivers whose children are either entirely unvaccinated or only partially vaccinated.

Method: A secondary analysis of Multi Indictor Cluster survey (MICS) 2022/23 data was conducted that focused on the level of vaccination children had received by the time they reach their first birthday. Children were categorized into unvaccinated, under-vaccinated, and fully vaccinated groups and binary and multinomial logistic regression models were fitted with household characteristics included as explanatory variables.

Results: The study data comprised 6,178 children aged 12-23 months with a predominance of rural areas (76.2%). In the multinomial analysis, children from Pashto-speaking households had significantly higher odds of being unvaccinated (OR = 3.54, 95% CI: 2.62-4.79) and under-vaccinated (OR = 2.19, 95% CI: 1.74-2.75) compared with those who were fully vaccinated. Maternal education was found to be highly significant, with children whose mothers had no formal education found to be more likely to be under vaccinated (69.1% unvaccinated/under-vaccinated) compared to those with primary education (41.9% unvaccinated/under-vaccinated, adjusted odds ratio: 0.59. 95% CI: 0.43-0.81). Children from the richest households had a full vaccination rate of 55.9% and were less likely to be unvaccinated than fully vaccinated (adjusted odds ratio: 0.22, 95% CI: 0.14-0.35).

Conclusion: Full vaccination coverage is low, with approximately one-third of Afghan children aged 12-23 months receiving complete vaccine schedules. However, this study shows that rates vary significantly with a range of cultural, economic, and educational factors. These findings suggest that improving maternal healthcare access and education, along with focused outreach in specific demographic groups, may be effective in enhancing immunization coverage.