Global Health Action最新文献

Community health workers (CHWs) are key players in providing primary healthcare in low- and middle-income countries. However, their absence from the formal health system in many of these countries often presents a challenge to their remuneration. The objective of this scoping review is to document programs implemented at both small and large scales in low- and middle-income countries, the remuneration strategies they have established, and the effects of these strategies on the work of CHWs. In total, we included 50 articles in this review. We have identified four types of compensation: fixed compensation, performance-based compensation, compensation based on income-generating activities (IGAs), and combined compensation. We identified the strengths and weaknesses of each type of compensation. A common strength for most models was improvement in motivation and performance. A common weakness for most models was irregular payments. The results of this review highlight the need to consider the economic, social, and cultural settings of the countries or environments at hand, and to include CHWs in discussions regarding the selection of a compensation model.

The University of Global Health Equity's (UGHE) One Health Field School (OHFS) in Rwanda exemplifies an experiential approach to education that integrates human, animal, and environmental health. This field-based program engages students in real-world settings such as abattoirs, health centers, and mining sites to confront pressing public health issues, from zoonotic diseases and antimicrobial resistance to food safety and environmental health. Following Kolb's experiential learning model, OHFS equips graduate students to observe, analyze, and apply solutions to complex health challenges, fostering adaptability, resilience, and collaborative problem-solving skills. By bridging classroom theory with practical application, OHFS cultivates leadership and a holistic understanding of health, preparing graduates to navigate the interconnected global health landscape. Through this innovative approach, UGHE aims to train a generation of health professionals capable of addressing crises such as climate change, biodiversity loss, and emerging infectious diseases at the human-animal-environment interface.

Background: Cervical cancer is the leading cause of cancer-related deaths in Tanzania and the most common form of cancer among Tanzanian women. Screening attendance remains among the lowest globally, necessitating improved attendance and screening methods.

Objective: This study aims to assess the feasibility of implementing the World Health Organization's 2021 hPV-based screening guideline in Tanzania by identifying potential barriers and facilitators to HPV-based screening among screening clients, healthcare providers, and stakeholders.

Methods: From October 2022 to February 2023, 25 semi-structured interviews were conducted with screening clients (n = 16) and healthcare providers and stakeholders (n = 9) in Moshi and Dar es Salaam. Data were analyzed using a deductive framework based on Bronfenbrenner's Social Ecological Model, supplemented with inductive subcategories from the transcripts.

Results: Barriers and facilitators emerged across all levels of the Social Ecological Model. At the individual level, clinic-based screening and a one-visit approach were barriers, while HPV-self-sampling was a facilitator. Interpersonal barriers included limited social support, while referrals served as facilitators. Community-level barriers included fear and misconceptions, countered by facilitators such as increased awareness and health education. Health system challenges included restrictive age limits and urbanization of human resources, with uptake through other health services acted as a facilitator. Political barriers highlighted the need for a steady local supply chain, while cost reduction could serve as a facilitator for guideline implementation.

Conclusion: WHO's 2021 hPV-based screening guideline shows promise in Tanzania, but barriers such as clinic availability, fear, misconceptions, and supply chain issues must be addressed to ensure successful implementation.

People living in low - and middle-income countries are less likely to receive palliative care. Early delivery of palliative care reduces unnecessary hospital admissions and improves patients' and their families' quality of life. This systematic review has compiled and scrutinized adult cancer patients' benefits, barriers, and specific palliative care needs in sub-Saharan Africa (SSA) to provide stakeholders with vital information that can improve the support and care provided to this expanding patient population. A systematic literature search was conducted using PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, Medline, and ProQuest under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included in the review focused on the utilization of palliative care among adult cancer patients in sub-Saharan Africa. The Joanna Briggs Institute (JBI) Critical Appraisal tools assessed study quality. This review synthesized findings from 16 studies and highlights that access to palliative care improves cancer patients' quality of life, satisfaction, and outlook on diagnosis. However, limited knowledge, financial constraints, and systemic obstacles impede access. Patients' needs were categorized into four themes: physical comfort, psychosocial support, spiritual well-being, and socioeconomic assistance. Palliative care improves adult cancer patients' quality of life in sub-Saharan Africa, but barriers hinder access. To address the challenges and meet patients' needs, enhancing literacy about palliative care, providing financial support, and implementing structured and sustainable palliative care models are essential for strengthening services and improving regional healthcare.

Over the coming decades Africa is projected to undergo a significant demographic shift towards an older population. Healthcare provision for older adults is made more complex by age-related multimorbidity and frailty, which contribute to older adults more frequently requiring intensive, hospital-based treatment than those in younger age groups. We investigate age and sex-stratified, diagnosis-specific hospital referral patterns in Harare, Zimbabwe to understand referral practices for older adults. This retrospective analysis of attendance records from primary health clinics (n = 8) over six years (2016 to 2021) investigated associations between age, sex and diagnosis and recommended hospital referral. Analysis compared the percentage referred between those aged ≥65 years and those younger than 65 years. The records contained 195,999 attendances. Median attendee age was 9 years (IQR 1.75-32); 52.5% were female; 5.4% were aged ≥65 years. Overall, 14.9% attendances resulted in hospital referral. The highest referral percentage by diagnosis was for trauma (47.8% referred overall, 40.5% of those aged ≥65 years referred). The overall percentage referred in those aged ≥65 years (18.5%) was the same as those aged 35-44 years (18.0%); this pattern was observed across diverse diagnoses including acute respiratory infections, hypertension and musculo-skeletal pain. Despite age-associated morbidity and theoretically free public healthcare to those aged ≥65 years in Zimbabwe, older adults are no more likely to be referred than young adults to higher level care, across multiple disease classes, including infective, musculoskeletal and cardiovascular diseases. This may reflect a healthcare system not yet orientated towards an ageing population's needs.

Background: People with disabilities face more barriers accessing healthcare and on average experience worse health outcomes. Strengthening health access for people with disabilities requires coordinated action across the health system. The Missing Billion Inclusive Health System Framework is a new tool to support policy makers to assess levels of disability inclusion within health systems.

Objectives: This study uses the Missing Billion framework in Brazil to i) contribute to the further testing and development of the framework and ii) assess the level of disability inclusion within the Unified Health System.

Methods: Information sources used to complete the assessment included Brazilian laws and policies, publicly available data, published literature, literature reviews and interviews with people with disabilities and service providers in São Paulo, Santos, Brasília and Arcoverde. A workshop with stakeholders was held to co-develop key recommendations.

Results: Overall, the Missing Billion framework was comprehensive and feasible to complete. It highlighted key strengths in terms of disability inclusion in the Brazilian health system as well as gaps and leverage points for action.

Conclusions: The Missing Billion framework can identify progress and opportunities to strengthen disability inclusion in health systems. In Brazil, key promotive factors include supportive policies, leadership and financing structures. There are also opportunities for strengthening data and evidence, healthcare worker training on disability and health service accessibility. Actions must be centered on and informed by people with disabilities.

Background: Endocrine-disrupting chemicals (EDCs) are environmental pollutants that interfere with hormonal systems and may pose serious risks to children's health during critical developmental stages. Despite many studies, a comprehensive overview of global research trends is still lacking.

Objective: This study aimed to provide a comprehensive bibliometric and visual analysis of global research trends on EDCs and pediatric health over the past two decades.

Methods: Relevant publications from 1 January 2005 to 4 June 2025 were retrieved from the Web of Science Core Collection. Microsoft Excel, CiteSpace, VOSviewer, and the R package 'bibliometrix' were used to analyze publication trends, influential countries, institutions, authorship, journal distribution, keyword co-occurrence, and emerging research topics.

Results: A total of 3,241 publications from 95 countries and regions were identified. The United States led with 38.29% of publications and the highest citation frequency. Among the top 10 productive authors, seven were based in the US. The Centers for Disease Control and Prevention (CDC) was the most prolific institution. Environmental Research published the largest number of articles (199, 6.14%). Major research hotspots included autism spectrum disorder, precocious puberty, child behavior, postnatal exposure, and human exposure. The most frequent keywords were 'endocrine-disrupting chemicals,' 'bisphenol A,' and 'exposure.'

Conclusions: This study provides the first systematic bibliometric overview of global research on EDCs and children's health. The results highlight increasing academic attention and identify key contributors and emerging themes, offering guidance for future research and policy development in pediatric environmental health.

Cardiometabolic diseases (CMDs) are increasingly prevalent in Sub-Saharan Africa (SSA), underscoring the need to understand the existing public health burden. This would guide future policy strategies and interventions to mitigate the challenges posed. The aim of this systematic review was to provide a comprehensive overview of CMDs prevalence in SSA. A PRISMA 2020 compliant systematic literature search was conducted using MEDLINE and The Cochrane Library up to December 2024, including population-based studies with ≥100 participants, aged ≥15 years, and reporting CMDs prevalence in SSA. Random effects meta-analyses were conducted for prevalence, and meta-regression, for temporal trends, evaluated using the median data collection year. Overall, 266 unique studies of 846,511 participants were included; Ethiopia (n = 53), Nigeria (n = 36) and Ghana (n = 20) represented the most studies. Prevalences for the most widely studied condition included type 2 diabetes (T2D) (6.1%; 95% CI = 5.3-7.0), hypertension (27.1%; 95% CI = 25.5-28.8), stroke (1.4%; 95% CI = 1.0-2.0), hypercholesterolemia (11.3%; 95% CI = 7.4-17.0) and cardiovascular diseases (4.8%; 95% CI = 2.5-8.9). The temporal prevalence of hypertension and T2D between 2006 and 2014 showed no statistical significance (β = -0.0289 per year; p = 0.11) and (β = 0.0131 per year; p = 0.49), respectively. For stroke, a statistically significant temporal decline was observed beginning 2010 (β = b-0.1244 per year; p < 0.001). This systematic review reveals a substantial public health burden of CMDs in SSA. The high prevalence emphasises the need for targeted CMDs preventative care strategies in SSA. Notably, most studies were from Ethiopia and Nigeria, indicating the need for more research in other SSA countries for a comprehensive understanding of CMDs in the region.

Background: Amidst the onset of the COVID-19 pandemic, crucial integrated service post for women and children at the community level in Indonesia experienced disruptions. This change resulted in shifts in maternal and child health (MCH) surveillance.

Objectives: This research aims to examine lessons from Indonesia's community-based maternal and child health surveillance practices amid the challenges posed by the COVID-19 pandemic.

Methods: The study was conducted in Depok, West Java, an urban area in Indonesia. A total of 20 key informant interviews with communities and government officials were carried out between October and December 2022. Data was analysed through content analysis.

Results: The COVID-19 emergence led to an increased community-based MCH surveillance due to a growing public awareness to protect communities. The informants, while all acknowledging the importance of MCH surveillance, showed varied perspectives, highlighting gaps in perception. Four strategies in community-based MCH surveillance, including digital technology utilization, door-to-door visits, oral communication for identifying MCH cases, and community gatherings, had a positive impact on reporting and response. However, the incorporation of technology posed challenges, such as the diverse skill levels among community health workers (CHWs) and the general habit of producing hard copies after data entry.

Conclusion: While the practices had a positive impact, the findings highlight the need to mitigate the challenges in data reporting. Two approaches may include standardization of reporting practices by using a single MCH surveillance application that can be accessed by CHWs and training programs to bridge the proficiency gaps in digital technology.

Investing in health drives individual wellbeing, productivity, educational achievements, and economic growth. Collective global efforts have historically eradicated diseases like smallpox and are making progress against others, such as polio and malaria. In many low- and middle-income countries (LMICs), public health spending is insufficient, with per capita expenditure far below what is needed to deliver and sustain essential health services. High-income countries, such as the United States, are contributing to LMICs to bridge these gaps through bilateral and multilateral development assistance. The United States Government's longstanding support in Nepal has helped to strengthen the health systems and resulted remarkable achievements. However, the new United States administration's abrupt decisions to halt the development assistance and closure of most of the projects will significantly impact global health initiatives, jeopardize health gains, and pose a risk to global health security. This call-for-action urge stakeholders to evaluate the current and potential impact of these decisions and adopt a cohesive approach to maintain development cooperation. LMICs also must reassess their health investments and implement reforms to build resilient, self-sustaining health systems.