Global Health Action最新文献

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.

Despite the devastating impact of COVID-19 and repeated calls for political commitment to health security, our analysis of 43 manifestos from 16 countries and the European Parliamentary elections revealed that only four parties made specific policy pledges on pandemic prevention, preparedness and response, with six providing brief mentions. The vast majority (33 parties) did not mention pandemic prevention, preparedness and response. When referenced, the pandemic was often framed as a rare, one-off crisis or an economic shock rather than a catalyst for systemic health reform. Some parties used it for political critique or validation of past performance, while others framed preparedness in terms of national security or economic resilience rather than public health. In contrast, manifestos overwhelmingly prioritized healthcare system expansion, equity, and access, with a significant emphasis on universal health coverage, mental health, and workforce development. The findings underscore a stark misalignment between global health priorities and domestic political agenda. Political reluctance to emphasize pandemic prevention, preparedness and response appears to be influenced by pandemic fatigue, voter preferences for forward-looking narratives, and institutional incentives favouring short-term tangible outcomes. This persistent neglect of the pandemic in electoral discourse raises concerns about the global community's ability to sustain momentum for pandemic resilience. We call for stronger engagement between the global health community and political actors to elevate pandemic prevention, preparedness and response as a strategic, cross-cutting priority for future policymaking.

Background: Hypertension is a major risk factor for cardiovascular diseasemorbidity and mortality, affecting 25% of adults in Ghana. Access to adequate care is critical for effective hypertension management.

Objective: Evaluate healthcare utilisation among patients with hypertension and identify determinants.

Methods: Guided by the Andersen and Newman model, we examined predisposing, enabling, and need factors affecting HCU. Data were collected from 600 patients with hypertension, 19 in-depth interviews with health workers, and six focus group discussions with patients. Logistic regression was used for quantitative analysis, while qualitative data were analyzed thematically.

Results: In all, 73% of patients with hypertension used health care. Key predisposing factors included age 70+ years (adjusted odds ratio [aOR]: 1.97, 95% CI: 1.06-3.69) and being female (aOR: 2.32, 95% CI: 1.53-3.54). Enabling factors included health insurance (aOR: 4.07, 95% CI: 2.04-8.20), closer proximity to referral facilities (aOR: 2.28, 95% CI: 1.44-3.65), and care at district hospitals (aOR: 3.37, 95% CI: 1.94-6.03). Need factors were not associated with HCU. Barriers included financial difficulties, reliance on alternative medicines, poor health-seeking behavior, delays, erratic medication supplies, and health insurance limitations.

Conclusions: This study finds high healthcare use (73%) among rural Ghanaian hypertension patients, mainly driven by demographic and structural factors. It highlights ongoing inequalities, especially among men. Interventions should focus on addressing gender issues, enhancing access to insurance, and strengthening district hospital services. Future research should evaluate the quality and consistency of hypertension care to improve health outcomes.

Background: Major depressive disorder (MDD) frequently co-occurs with other medical conditions. Care integration and task shifting are two frameworks that may strengthen person-centered care among individuals with MDD and comorbid diagnoses, including for adults with limited access to healthcare resources living in rural settings within sub-Saharan Africa.

Objective: We assessed the acceptability and feasibility of group psychotherapy (Problem Management Plus [PM+]) integrated into chronic healthcare services in Neno District, based on key informant (KI) interviews with clients who received PM+ services from local counselors.

Methods: We conducted in-depth interviews with 31 KIs, comprising adult patients participating in group PM+ in rural Malawi. The interview covered facets such as knowledge acquisition, logistical considerations for organizing PM+ sessions, selection of appropriate venues, session format, and overall perceived acceptability. Themes were identified through thematic content analysis.

Results: We identified five emergent themes: limited prior awareness and understanding of MDD, positive elements of the PM+ service delivery model, patients' perceived effectiveness of PM+, logistical challenges with effectively engaging PM+, and positive views on acceptability of PM+. Findings revealed a strong appreciation and enthusiasm for PM+, although KIs noted areas for improvement - including lengthy travel times to receive PM+, limited compensation and privacy, and counselors arriving late.

Conclusion: Insights from clients underscore the potential utility of group PM+ as a task-shifted model of MDD care that can be integrated into existing service packages in resource-limited settings, as well as opportunities for improvements such as reducing travel time to care and identifying venues with greater client privacy.

Trial registration: ClinicalTrials.gov identifier: NCT04777006.

Previous literature showed that mental health conditions and substance use are prevalent in international migrant workers due to acculturation stress. Given the rapid increase in labour migration within the Association of Southeast Asian Nations (ASEAN) countries, this study aimed to conduct a meta-analysis of the pooled prevalence of mental health conditions and substance use among international migrant workers in ASEAN countries and to identify associated factors. We searched MEDLINE, PubMed, Scopus, and ASEAN Citation Index (ACI) for articles published in English between January 2010 and October 2023. The included outcomes were mental health (depression, anxiety, and post-traumatic stress disorder (PTSD)) and substance use (alcohol, tobacco, and illicit drugs). Study quality was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Of 19 eligible studies, 18 articles (11 for depression, 5 for anxiety, 1 for PTSD, and 8 for substance use) were included in the meta-analysis. A significant number of studies included in this study targeted Myanmar migrant workers living in Thailand. The pooled prevalence was 34.77% for depression, 37.72% for anxiety, and 24.29% for substance use. Factors associated with mental disorders were younger age, being female, low education and income level, workers in construction and sex industry, while male gender, other substance use, and peer influence are associated with substance use. A high prevalence of mental disorders and substance use among international migrant workers warrants a collective effort by various parties to provide proactive support to prevent and manage mental health conditions and substance use in the ASEAN countries.

Background: Chronic conditions cause notable health and economic burdens. While health insurance enables access to healthcare, its effects on chronic care outcomes remain under-explored.

Objective: To examine the association between health insurance coverage and cardiometabolic risk factors among people with chronic conditions in India.

Methods: Data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) and Solan studies, including 2,926 adults with chronic conditions were analyzed using propensity score weighting to evaluate the associations between health insurance and cardiometabolic risk factors (HbA1c, low-density lipoprotein cholesterol [LDLc], and blood pressure [BP]) and self-reported health status (measured using European Quality of Life Visual Analogue Scale [EQ-VAS]). Mediation analysis evaluated healthcare visits as a potential mediator.

Results: Among 2,926 respondents meeting criteria, mean (SD) age was 54.6 years (11.8), and 1630 (55.7%) were women. Health insurance coverage was low (6.5%) and more prevalent among men, higher-income groups, and rural vs urban residents. Insured participants had lower mean diastolic BP (84.8 vs 86.0 mmHg), mean LDLc (113.3 vs 117.2 mg/dl), mean HbA1c (6.9% vs 7.5%), and higher health status (EQ-VAS: 74.6 vs 69.1) than uninsured participants, respectively (p < 0.05). Mediation analysis showed healthcare visits strongly mediated the relationship between insurance and BP and partially mediated effects on LDLc, HbA1c, and self-rated health.

Conclusion: Health insurance coverage was associated with better cardiometabolic risk profiles and health status, largely mediated by increased healthcare utilization. Expanding insurance coverage to include outpatient chronic care services should be prioritized to improve health outcomes in low- and middle-income countries.

The World Health Organisation recommends a target rate of 10% to 15% of births by caesarean sections (CS) to save lives. According to the Ghana Demographic and Health Survey report (2022), Ghana's CS rate is now 21% which is similar to the global rate. The objective of this scoping review is to explore what is known about the prevalence of CS and its uptake across Ghana. Qualitative, quantitative, and mixed-methods studies, as well as published grey literature, exploring the prevalence of CS, as well as the barriers and facilitators influencing CS uptake in Ghana, will be included. This review will be conducted in accordance with the Joanna Briggs Institute methodological guidelines for scoping reviews, and it will report findings in line with the Preferred Reporting Items for Systematic and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Database searches will be conducted in MEDLINE, PsycINFO, EMBASE, Web of Science and CINAHL (EBSCO). The Theoretical Domains Framework will be used to examine the factors influencing healthcare professionals' recommendations for CS to women, as well as women's choices regarding undergoing a CS or not. The results will be presented descriptively and in a visual format. The findings will underpin recommendations for future research, policy and practice to support health improvement, and optimal use of CS in Ghana.