Global Health Action最新文献

Background: Most health service classification systems are based on organisational components such as service provision, financing, and regulation. This study considers health systems using data focusing on child health outcomes, service provision, and selected social characteristics. This more accurately reflects the reality of health service provision for children, young people, and their families.

Objective: To classify health systems based on child health data through cluster analysis and exploratory and descriptive data analysis.

Method: Data were extracted from the current version of the UNICEF (2023) State of the World's Children full dataset, concentrating on outcomes related to mortality. Cluster analyses were conducted, and a heatmap was produced to identify patterns and groups among countries and child health indicators. Row and column distances were calculated using the Euclidean distance, and clustering was performed using the complete linkage method. Each variable was centred and scaled using the scale command, allowing variables measured on different scales to be compared without those with large values being weighted more heavily. Countries that performed better or were less healthy than expected were identified through linear regression analysis using the ggplot2 package.

Results: Analysis of countries by cluster reveals six main groups, characterised by child and maternal mortality rates, vaccination levels, access to maternal and child healthcare, access to water and sanitation, and population migration levels.

Conclusion: Identifying patterns in outcomes and identifying countries that perform above or below expectations concerning child health can inform a more nuanced approach to improving a country's child health outcomes.

Background: In a cluster-randomised trial in Uganda and Tanzania, we showed that integrated management, compared with standard vertical care, could achieve a high standard of care for diabetes and hypertension without adversely affecting outcomes for HIV. However, evidence on the value for money of integrated care is needed to inform policy.

Objective: Our economic evaluation aimed to establish the value for money of integrated care compared with vertical care for HIV, diabetes and hypertension.

Methods: A societal perspective was adopted, considering provider and patient costs for integrated and standard care in Uganda and Tanzania over one year. Provider costs were estimated for 6714 participants based on five representative health facilities per country. Patient costs were captured via questionnaire from a sub-sample of 2708 participants. Provider costs at scale were estimated using national prevalence and utilisation data. Key inputs were varied in two-way sensitivity analyses.

Results: Among participants with single conditions, mean provider and patient costs per patient-visit did not differ significantly between integrated and standard care. Among participants with multiple conditions, mean provider and patient costs per patient-visit were, respectively, Int$18.67 (95%CI 10.89-26.45, p < 0.0001) and Int$5.86 (95%CI 2.57-9.16, p = 0.0005) lower in integrated clinics. If scaled up, integrated care could save providers Int$229 million in Uganda and Int$72 million in Tanzania. From a societal perspective, integrated care for participants with multiple conditions generated mean cost-savings of Int$41.54 (95%CI 29.42-53.67, p < 0.0001) per patient-visit.

Conclusion: Integrated care is cost-saving from a societal perspective and should be considered for scale-up in Tanzania, Uganda and similar settings.

Trial registration number: ISRCTN43896688.

Primary school-age children are particularly vulnerable to undernutrition, especially anaemia and underweight. School feeding programs in food-insecure areas aim to reduce undernutrition, but many vulnerable children in Ethiopia have not benefitted due to inadequate food quality and sustainability challenges. Exploring underutilized nutrient-rich foods may help address the shortage of energy-dense supplements for these programs. Amaranth, with its leaves consumed as a vegetable and seeds used like cereals, has shown superior nutrient content when compared to maize. Previous interventions with amaranth in younger children demonstrated a significant reduction in anaemia prevalence. This study aims to assess nutritional health and to reduce undernutrition among school children by promoting amaranth-plus-flaxseed food from locally grown, standardised foods in Sidama, Ethiopia. Under this research project, the following three study designs will be undertaken: a laboratory-based food analysis study, a cross-sectional study, and an experimental pilot study. In the pilot study, we aim to observe a weight increase of 0.5 kg, a haemoglobin increase of 0.5 mg/dl, and a reduction in school dropout. This protocol outlines the detailed procedure of the school intervention from food formulation to the pilot study. The outcomes generated from this project will provide policymakers with valuable insights to consider alternative approaches for school intervention.

Lessons learned convey information and experiences that were studied when carrying out projects or policies, in order to improve procedures and practices to better cope with future similar problems in other contexts. Although the term lessons learned appears in the titles of thousands of scientific articles, most do not describe how these lessons were produced or the level of rigor involved in their development. As part of a project aimed at deriving lessons from hospitals' resilience during the COVID-19 pandemic in five countries (the HoSPiCOVID project), we sought to systematised the process of producing these lessons. To do so, we conducted a rapid review to identify the best ways of developing quality lessons learned (QLLs). A QLL results from a systematic process of collecting, compiling, and analysing data derived from a research project. The rapid review follows the same key steps as a systematic review, adapted to a more accelerated and pragmatic format. From 1,881 documents initially identified, 18 were retained. Their analysis identified three principles to guide the process of developing QLLs: 1) Creating a supportive climate; 2) Choosing the right leaders or facilitators for the process; and 3) Engaging in a scientific approach. Based on these findings, we developed a guide comprising 11 steps, structured into two main phases: preparatory steps for QLL development, and steps for identifying and formulating QLLs. This guide offers a structured process for teams seeking to enhance the rigor, clarity, and potential transferability of the lessons they formulate.

Background: Since the establishment of national health insurance in Ghana, the government's health policy has focused on reducing out-of-pocket expenditure (OOP) to ensure that people do not become poorer while accessing healthcare services. However, studies show that OOP expenditure remains high, and a substantial portion of the population experiences catastrophic health expenditure (CHE).

Objective(s): We estimated the level and determinants of catastrophic health expenditures for hypertension management among adults in the Greater Accra Region of Ghana.

Methods: We conducted a cross-sectional CHE survey at two randomly selected district primary health facilities in the Greater Accra Region. Data collection took place between December 2023 and February 2024. A questionnaire was used to collect data on direct and indirect medical expenditures related to hypertension care from 382 participants. CHE was defined at thresholds of 10% and 40% of the household's capacity for direct and indirect medical expenditures, respectively. Multivariate logistic regression was used to assess the determinants of CHE.

Results: A total of 382 patients were included in the analysis; the majority were females (76%), and Christians (95%). Based on the 10% and 40% thresholds of household income capacity to pay, 65% and 58% of the total sample experienced CHE, respectively. The regression model revealed that being widowed (OR = 0.32, 95% CI: 0.09-1.10, p = 0.07), unemployed (OR = 0.26, 95% CI: 0.08-0.09, p = 0.03), and having a large household size (OR = 1.32, 95% CI: 0.95-1.84, p = 0.09) correlate with CHE for hypertension management and care.

Conclusion: The study demonstrates that hypertension care imposes a considerable financial burden on households.

Background: This study describes the evaluation of a twinning initiative between the Ghana Register Midwives Association and the Swedish Association of Midwives. Recognising the importance of midwives being supported by a national midwife association, the initiative was to strengthen the professional association in Ghana as a labour union and to inspire Swedish midwives to involve themselves in international work.

Objective: The study aimed to evaluate a twinning initiative between the Ghana Registered Midwives Association and the Swedish Association of Midwives.

Method: Two focus group discussions and four individual interviews were held with nine midwives from the Ghana Registered Midwives Association (n = 6) and the Swedish Association of Midwives (n = 3). The interviews and analysis were guided by a process evaluation framework using content analysis.

Results: The twinning initiative was successfully implemented regarding fidelity, dose, and reach, despite adaptations to the original project plan. Both associations gained visibility, with the Ghana Registered Midwives Association growing its paid membership by 97%, from 631 to 1,245 members during the twinning initiative. The results suggest that the Swedish Association of Midwives enhanced its understanding of international midwifery, promoted knowledge exchange, and raised awareness of midwives' global roles in improving care.

Conclusion: The Ghana Registered Midwives Association and the Swedish Association of Midwives had a positive experience with the twinning initiative, despite deviations from the original plan. Midwives from both associations benefitted from sharing best practices and mutual support in their roles as newly formed labour trade unions. These findings could benefit other midwife associations in future twinning initiatives.

Background: To attain universal health care, health managers need to monitor progress in service uptake, changes and geographic coverage. Although routine health management information systems are now well established in many resource-constrained countries, such data have not yet been used to examine geographic access trends over time.

Objective: This study aims to quantify changing patterns of geographic access to healthcare in the Volta Region, Ghana.

Methods: The repeated cross-sectional ecological spatio-temporal analysis used routine health management information systems data from 2016 to 2022, and geospatial data to examine changes in healthcare accessibility and services provided for population subgroups. Changes in healthcare provision, travel time to services and population coverage were estimated.

Results: Most health facilities (60.6%) provided the same range of services or added new services between 2016 and 2022. Childhood immunisation services had the highest geographic coverage within 30 min of the nearest health facility from 2016 to 2022 (minimum 97.2%), while Caesarean births had the lowest (maximum 75.2%). More health facilities provide antenatal services (2022: 59.9%) than birthing care (2022: 52.6%). Of all new health facilities, 93.2% were Community Health Planning and Services (CHPS) facilities. The majority of the population lived within 30 min of services in 2016 and 2022 for all the services studied.

Conclusion: The study provides a new approach to monitoring service changes through routine health data and spatial analysis. The analysis provided evidence to improve geographic accessibility, address gaps in service changes and consolidate the gains of high geographic coverage with quality care.

The balls are rolling for climate change, with increasing vulnerability to women and children related to climate extreme events. Recent evidence has shown that acute exposure to heat wave during pregnancy can be associated with adverse health outcomes in childhood, with the risk being significantly higher among socially disadvantaged population, despite their lack of contribution to global carbon dioxide emissions and the rising global ambient temperature. This unequal impact requires utmost attention to develop tools, establish interdisciplinary teams, and to implement evidence-based interventions for the betterment of women and children in climate-vulnerable populations.

Background: Intimate partner violence (IPV) is a global issue, with women, especially those with disabilities, facing a higher lifetime risk than those without disabilities. Given the elevated risk factors and challenges related to having a disability, it is crucial to provide effective IPV support. The competence and expertise of service providers regarding IPV significantly influence their ability to provide adequate IPV support. Understanding service providers' self-perceived competence is essential for improving the quality of IPV support for women with disabilities.

Objective: This study assesses the self-perceived competence of service providers in supporting women with disabilities subjected to IPV in Sweden.

Methods: A cross-sectional survey was distributed to professionals in healthcare, social services, and the police, and 1,151 people participated. Descriptive statistics and linear regression analyses were performed to assess the factors influencing service providers' self-perceived competence.

Results: The findings indicate that healthcare, police, and social services professionals often encounter women with disabilities, but they rarely ask them directly about IPV. Many don't routinely inquire about IPV exposure. While institutional routines for addressing IPV exist, service providers don't consistently implement or use them. Key factors influencing self-perceived competence include receiving IPV and disability-specific training and sufficient employer support for addressing IPV among women with disabilities.

Conclusions: The findings underscore the need for a more consistent application of routines and enhanced training to strengthen the capacity of service providers to support women with disabilities subjected to IPV.