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: Regulating unhealthy food marketing is critical as it is a recognized driver of childhood obesity. Two voluntary self-regulatory policies governing food advertising in the media were introduced in Malaysia in 2008 and 2013.

Objectives: To assess food advertising on Malaysian children's popular television channels across a decade using the standardized INFORMAS protocol.

Methods: The main dataset was collected cross-sectionally from 2020 to 2022 evaluating three television channels. Additionally, a retrospective comparison between the 2022 and 2012 datasets was limited to two channels commonly available for both years. Advertised foods were classified as permitted (healthy) or not-permitted (unhealthy) using a nutrient profile model of the World Health Organization. We compared advertising rates and use of persuasive marketing techniques during children's peak viewing time (PVT) versus non-PVT.

Results: Unhealthy food advertising rates remained significantly higher than healthy food for all years of measurement (all p < 0.001). For the main dataset years (2020, 2021, 2022), unhealthy food advertising rates were 84%, 65%, and 72% higher during PVT compared to non-PVT (all p < 0.001). For all 3 years, the use of persuasive marketing techniques engaged in unhealthy food advertising during PVT was greater compared to non-PVT (all p < 0.05), whereas this pattern was not observed for the 2012 dataset (all p > 0.05). In 2022, fast foods emerged as the most frequently advertised unhealthy food (1.33 ± 2.23 ads/h/channel), a six-fold increase compared to 2012 (0.21 ± 0.47 ads/h/channel).

Conclusions: Unhealthy food advertising dominates Malaysian children's popular television channels, especially during PVT despite the presence of voluntary self-regulatory policies. These findings underscore the need for government-led mandatory regulations to control unhealthy food marketing targeting children.

Vaccine coverage and disease surveillance data are valuable for monitoring protection against vaccine-preventable diseases; however, they do not directly measure population immunity. High-quality, representative serological studies can provide key insights into immunity gaps, outbreak susceptibility, and inform targeted vaccination strategies, even in high-performing immunization programs. This study aims to estimate location-specific and age-specific immunity profiles for measles and rubella while evaluating the predictive value of indirect immunity estimates derived from vaccination and surveillance data against direct serological measurements. Additionally, it seeks to model the risk of measles outbreaks and assess the impact of mitigation strategies. A multi-stage, stratified cluster sampling design will be implemented across six districts in The Gambia's North Bank and Upper River Regions. Survey clusters (i.e. 5 km × 5 km areas) encompassing all settlements within their boundaries will be selected, proportionally to district population sizes. Cluster selection ensures representativeness of both the population and vaccine coverage within each district. Based on detecting a 10% difference in protective immunity across vaccine coverage levels, power analysis assumes an intraclass correlation coefficient (ICC) of 0.01. In each cluster, 70 children aged 9 months to 14 years will be recruited, yielding a total sample size of 1,750 children across 25 selected clusters. Dried blood samples will be collected and tested for anti-measles and anti-rubella IgG using enzyme immunoassays (EIA). District-specific measles seroprevalence will be estimated using a hierarchical spatial model. This study will generate key evidence needed to refine immunization strategies and reduce the risk of measles and rubella outbreaks.

Background: Antimicrobial resistance (AMR) is a global health threat, disproportionately affecting Africa South of the Sahara, where young people have been identified as key stakeholders in AMR prevention and awareness; however, effective engagement beyond symbolic participation remains challenging, limiting the impact of youth-led initiatives in addressing AMR in the region.

Objectives: To examine how youth-led actors in Africa South of the Sahara engage in AMR awareness, education and advocacy; the challenges they encounter; and the institutional conditions needed to move beyond symbolic participation.

Methods: A qualitative study design was employed, involving semi-structured interviews with young professionals engaged in AMR efforts across Africa South of the Sahara. Participants were recruited through convenience and snowball sampling. Online interviews were conducted between March and September 2023. Data were analysed using reflexive thematic analysis.

Results: Seventeen participants (age range 22-34) from 15 countries shared insights on AMR awareness, community engagement, and barriers in their work. Major findings included the perception of AMR as an invisible threat, generational and structural challenges in community outreach, and the need for financial and institutional support. Despite these obstacles, participants demonstrated innovative approaches, including adapting AMR outreach methods to specific social groups and a strong commitment to AMR education and policy advocacy.

Conclusions: Findings underscore the essential role of youth in AMR efforts in Africa South of the Sahara and the need for greater institutional support and capacity-building. Enhancing youth involvement beyond symbolic roles is crucial to advancing AMR initiatives, particularly through tailored communication strategies and collaborative policymaking.

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.