Global Health Action最新文献

Background: Sub-Saharan African countries like Burkina Faso face a dietary transition and are experiencing a shift in disease burden.

Objective: We explored perceptions of healthy and environmentally sustainable dietary habits in urban Burkina Faso in order to tailor nutritional interventions to the local population and ultimately improve public and planetary health.

Methods: We conducted an exploratory qualitative study with semi-structured face-to-face interviews in three informal and two formal neighborhoods of Ouagadougou. The sample comprised 36 adult participants. The interviews were conducted in Mooré and French, audio-recorded, and transcribed verbatim. Data were analysed inductively, using thematic analysis.

Results: Participants described their ideal healthy and environmentally sustainable diet as traditional, local, natural, pure, organic, and transparent in terms of food production, processing, and preparation. Perceived barriers to achieve such diets were: limited financial resources, reduced availability of products and limited time for food preparation. Furthermore, participants highlighted discordant food preferences in the family, and a lack of understanding around the interconnection between nutrition, health and the environment as barriers. Most of these barriers were aggravated by the experience of a life in transition due to modernizing lifestyles, globalizing food systems, and a changing environment.

Conclusions: Participants' ideal of a healthy and environmentally sustainable diet clashed with a life in transition. To improve public and planetary health, interventions should aim to empower individuals, alleviate financial constraints, and shape global and local food environments.

Background: Every year, 1.9 million stillbirths occur worldwide, of whom 1.5 million occur in sub-Saharan Africa (SSA) and Southeast Asia.

Objectives: This study aims to determine the incidence and risk factors and to describe underlying causes for term stillbirths in Eastern Uganda.

Methods: This was a cohort study of pregnant women enrolled at 34 weeks of gestation or more and followed to birth between January 2021 and January 2024. Enrolment and follow-up were done in the community by trained midwives. Using structured questionnaires, details of maternal health, pregnancy and birth were captured.

Results: We enrolled 6101 participants and analysed 5496 for incidence of term stillbirth and 5296 for risk factors. Of the participants, 4913/5296 (92.8%) were between 14 and 35 years, and 4456/5296 (84.1%) had a health facility birth. There were 101 term stillbirths (61 were intrapartum and 40 antepartum). The incidence of term stillbirth was 18.4 per 1000 births (95% CI 14.8 to 22.9). The most common underlying causes of stillbirth were prolonged or obstructed labour 32/101 (31.7%) and malaria 20/101 (19.8%). The factors associated with term stillbirths were caesarean birth (aRR 3.3; 95% CI 2.00 to 5.4), intimate partner violence (aRR 1.8; 95% CI 1.1 to 2.8) and maternal age above 35 years (aRR 2.2; 95% CI 1.2 to 3.9).

Conclusion: Eastern Uganda has a high rate of term stillbirths with more than half occurring during labour. Efforts are needed to improve the quality of birth care and to prevent intimate partner violence.

Background: Low-level viremia during antiretroviral therapy (ART) has been associated with inferior outcomes, but knowledge on the impact of low-level viremia in the current era of dolutegravir-based ART in low-income countries is limited.

Objective: To investigate whether low-level viremia predicts virologic non-suppression and attrition from care in people with HIV receiving ART in Ethiopia.

Methods: We included people receiving ART at public health facilities in an urban area in central Ethiopia and categorized persons with ≥1 available viral load 2019-2020 as having either suppression (<150 copies/mL) or low-level viremia (151-1,000 copies/mL); people with >1,000 copies/mL were excluded. We used multivariable logistic regression adjusted for age, sex, ART regimen, type of health facility, and duration of ART to analyze the associations between viremia category and incidence of unsuppressed viral load (>1,000 copies/mL) and attrition from care (death or loss to follow-up) during 3 years of follow-up.

Results: Among 12,165 participants, the median age was 44 years, 64.2% were female, and 89.1% received tenofovir/lamivudine/dolutegravir. Of the study population, 11,959 (98.3%) had suppression and 206 (1.7%) had low-level viremia. Over 3 years of follow-up, 2.2% of participants with suppression and 11.3% with low-level viremia had unsuppressed viral load. Low-level viremia was associated with both unsuppressed viremia (adjusted odds ratio [aOR], 3.7; 95% confidence interval [CI], 2.2-6.2) and attrition (aOR, 3.4; 95% CI, 1.7-6.6).

Conclusion: Among Ethiopian people with HIV receiving ART, low-level viremia predicted subsequent virologic non-suppression and attrition from care, supporting current recommendations for heightened attention to low-level viremia in ART recipients.

Background: Evidence suggests that people who are asylum seekers and refugees experience poorer physical and mental health compared to the general UK population and poor outcomes from COVID-19 if unvaccinated. However, this population can experience vaccine hesitancy and other barriers inhibiting their up-take of the COVID-19 vaccine.

Objectives: This study explored the influence of HARP (Health Access for Refugees' Project) workshops on the intention to have the vaccine in people who are asylum-seekers and refugees.

Methods: A qualitative study including clients (asylum-seekers and refugees), volunteers and HARP staff was undertaken to explore perceptions of HARP workshops and their influence on the barriers to the uptake of the COVID-19 vaccine including vaccine hesitancy. Semi-structured telephone interviews were undertaken with 10 participants, HARP clients (n = 1), HARP volunteers (n = 6, of whom 4 had been clients) and staff (n = 3). Data were thematically analysed.

Results: Intention to have the vaccine was influenced by trusted sources including peers and health professionals. Tailoring evidence-based information to individuals and challenging misinformation were important influencers on vaccine uptake. HARP activity increased the uptake of vaccines in large accommodation centres and hotels. Grassroots-level interventions such as HARP workshops appear to increase intention to take up the COVID-19 vaccine in asylum seeking and refugee communities.

Conclusion: This model could be adopted for health screening such as breast cancer and other vaccinations within asylum seeking and refugee communities.

India's Swachh Bharat Abhiyan was a nation-wide program aimed at providing households with toilets to eliminate open defecation. Between 2016 and 2021, millions of households gained access to a toilet. However, as of 2021, over 238 million people still did not have a toilet, and there was considerable variation in this outcome between India's states and Union Territories. We update the estimates on the number of no-toilet households in India using India's Household Consumption Expenditure Survey from 2022 to 2023. We find that 12.5% of India's households, most of which are in rural communities, still have no toilet. This amounts to over 162 million people still living without a toilet. Over 70% of those without a toilet live in just six states, and the lowest socioeconomic status households are the least likely to have a toilet. This emphasizes the need for policy makers to target states and socioeconomic groups that are lagging. Furthermore, policy makers should understand that a household's toilet status can fluctuate because of adverse climate events, such as flooding. This evidence highlights the need for accurate and up-to-date data on no-toilet households throughout India.

Background: Over five million children die annually from preventable and treatable illnesses. Most of these deaths occur in sub-Saharan Africa, predominantly in socioeconomically deprived regions. With nearly half of pediatric mortality occurring at the community level, serious illnesses must be detected early in the prehospital setting. The purpose of this 18-month, prospective, observational pilot study was to introduce the first use of the proinflammatory biomarker, CRP, in the prehospital setting to community health workers and to develop a prehospital predictive model to identify sick children requiring health center admission.

Methods: We recruited 636 children presenting to one of four community health worker teams who completed a prehospital evaluation and referred each child to the closest health center. The primary outcome for this study was admission at the health center for more than 24 h. We used logistic regression to quantify the area under the receiver operating characteristic curve (AUC).

Results: We found poor discrimination of danger signs and CRP, with AUCs of 0.55 (95% CI 0.52-0.57) and 0.52 (95% CI 0.47-0.57), respectively. A model comprising vital signs demonstrated superior discrimination, with an AUC of 0.66 (95% CI 0.62-0.71), which improved with the addition of danger signs (AUC 0.69; 95% CI 0.64-0.73), and when restricted to children who tested negative for malaria (n = 327; AUC 0.71; 95% CI 0.65-0.77).

Conclusions: We demonstrate that performing advanced point-of-care tests is feasible in resource-limited community settings and present one of the first prehospital prediction models developed with community health workers.

Introduction: Most people with dementia (PwD) receive home care from their family members. Caring for PwD can be challenging; however, many family caregivers do not receive adequate training. The lack of support, knowledge, and skills in dementia care places significant physical and psychological stress on family caregivers.

Objectives: This qualitative study explored the challenges faced by family caregivers in providing care for PwD and identified the knowledge and skills they need for effective caregiving roles.

Methods: In-depth interviews with 20 family caregivers of PwD were conducted face-to-face using a semi-structured questionnaire at the Department of Geriatrics at Nhan dan Gia Dinh Hospital in Ho Chi Minh City. Data analysis was conducted using inductive content analysis. The interview transcripts were coded by two independent researchers and analyzed thematically.

Results: Six key themes emerged: (1) challenges in daily care; (2) strain from behavioral and sleep disruptions; (3) difficulties in seeking help; (4) personal sacrifices of caregivers; (5) emotional burdens associated with caregiving, including comorbidity concerns of PwD; (6) limited dementia knowledge and essential caregiving skills.

Conclusions: The study highlights the need for targeted interventions in dementia care and underscores the necessity of providing educational and support programs for family carers of people with dementia in Vietnam and other low- and middle-income countries. Effective educational programs should cover dementia knowledge, comorbidity management, help-seeking strategies, caregiver self-care, and caregiving skills while also promoting support resources such as respite care and accessible information platforms.

Background: Although Nepal ratified the Palermo Protocol in 2020, significant challenges persist in fully meeting the protocol's standards on preventing trafficking, protecting survivors, prosecuting traffickers, and reintegrating survivors. Most importantly, given the complexity surrounding the reintegration of sex trafficking survivors, a comprehensive understanding of the factors influencing successful reintegration is crucial.

Objective: This study explored the challenges and opportunities associated with reintegrating survivors of sex trafficking into Nepali communities.

Methods: This was an exploratory, descriptive qualitative study in which semi-structured interviews were conducted with 15 purposively selected non-governmental organization (NGO) workers and service providers. Thematic analysis was conducted to analyze the data.

Results: Our findings revealed that existing social and contextual barriers included a lack of familial acceptance, social stigma, ineffective legal and support systems, and safety and security risks for both survivors and those providing support. Within the programs facilitating reintegration, factors such as poor service satisfaction, lack of trust, restricted living conditions in the shelters, and inadequate confidentiality practices hindered program effectiveness. Opportunities for successful reintegration included family support and acceptance, employment as social workers/activists, and well-coordinated support systems, which, however, were only accessible to a limited number of survivors.

Conclusions: This study provides insights into how social and program-specific factors, as well as existing opportunities, influence the effective reintegration of survivors. Ensuring adequate funding to scale up current reintegration programs, incorporating strategies to address community stigma, and strengthening institutional capacities could help more women achieve successful reintegration.

Background: Mistreatment of women during maternity care is a widespread global issue, particularly in low- and middle-income countries where health disparities intersect with rigid gender norms, systemic inequality and domestic violence.

Objectives: This paper aims to explore how health system failures and societal norms against women contribute to the mistreatment of women during maternity care.

Methods: A qualitative study was conducted among maternal healthcare providers in the East Wollega Zone, Ethiopia. In-depth interviews with purposively selected participants in Afan Oromo, each lasting 30-60 min, were conducted until data saturation was reached at 20 interviews. The interviews were audio-recorded, transcribed, translated into English, coded using NVivo 12 and analysed through thematic analysis guided by the Socioecological and Quality of Care frameworks.

Results: Health system conditions and constraints, such as under-resourcing and issues related to governance and providers' prejudices shaped by societal norms, were found to drive mistreatment of women during maternity care. These drivers manifest at various levels throughout the healthcare system, including personal, interpersonal, facility-level, health system and societal dimensions. Overcrowding, staff shortages and low pay led to burnout, which eventually resulted in mistreatment of women. The lack of recognition from administrators and professional hierarchies also added to provider frustration, which was sometimes directed at women. Societal issues, like gender-based violence, further influenced these behaviours.

Conclusion: Mistreatment of women during maternity care continues to hinder the delivery of quality care. Addressing gender inequality, boosting healthcare worker motivation and ensuring fair treatment among staff are essential for promoting respectful maternity care.