Global Health Research and Policy最新文献

Background: During the past decade, China has witnessed a rapid increase in healthcare utilization. However, whether this surge in healthcare use is reasonable remains an urgent question to be answered, particularly for informing scientific policy design and adjustment in future health systems reform. We aimed to analyze the differences in healthcare utilization trends among Chinese adults aged 50 and above in comparison with other countries and regions, and to investigate the association between socioeconomic status (SES) and healthcare utilization in China.

Methods: Participants aged 50 and over were drawn from the ageing surveys conducted in China, the United States, South Korea, and Europe. SES was measured using education level, total household income, and employment status. Random-effects negative binomial regression models were employed to examine the association between SES and healthcare utilization.

Results: From 2011 to 2020, the outpatient utilization rates in China showed no clear long-term upward or downward trend. The inpatient utilization rates in the United States (tau-b = - 0.02, P < 0.001) and South Korea (tau-b = - 0.05, P < 0.001) declined gradually, whereas inpatient utilization rates in China continuously grew (tau-b = 0.08, P < 0.001). In China, inpatient utilization rates across different SES groups generally showed an upward trend (P < 0.01). Elementary and lower education was positively associated with inpatient utilization rates compared to middle school and higher education (IRR = 1.11, 95% CI: 1.04-1.18, P = 0.003). Similar patterns were observed for low household income (IRR = 1.08, 95% CI: 1.02-1.14, P = 0.007), non-employment (IRR = 1.39, 95% CI: 1.32-1.47, P < 0.001) and retirement (IRR = 1.38, 95% CI: 1.26-1.52, P < 0.001). These associations remained significant even among individuals covered by the Urban and Rural Resident Basic Medical Insurance (URRBMI). Participants with lower SES were more likely to report having two or more chronic diseases and poor self-rated health (P < 0.001).

Conclusions: Inpatient utilization rates among middle-aged and older adults in China have experienced excessive growth over the past decade. Low SES was associated with high inpatient utilization, likely attributable to the poorer health status of low-SES groups. This association persisted in people covered by URRBMI. Policy reforms should prioritize the development of primary care, targeted health management, and equitable adjustments to health insurance. These measures are essential for curbing unnecessary hospitalizations and advancing healthcare equity in China.

Background: As benign prostatic hyperplasia (BPH) becomes increasingly prevalent, there is a growing need for simple and accurate methods to predict its risk. This study aimed to develop and validate a prediction model to identify males at high risk of developing BPH.

Methods: The model was developed using data from 210,408 participants in the UK Biobank and externally validated with 5394 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 294 participants from the Fengshen study. Six methods were employed to construct prediction models utilizing readily available medical characteristics at baseline. The DeLong tests were used to assess the differences in the area under the curves (AUCs). Cox regression was adopted to examine the relationships between the predictors and BPH.

Results: During a median follow-up period of 13.2 years (interquartile range [IQR] 12.3-14.0), 7.0 years (IQR 6.8-7.0) and 4.0 years (IQR 2.2-5.0), 18,681 males in the UK Biobank, 309 males in the CHARLS, and 27 males in the Fengshen study developed BPH. The model developed using the LightGBM method exhibited the highest discriminative capability among the six methods. Following feature reduction based on importance ranking, a full model with 17 predictors was established for BPH prediction (AUC = 0.688 ± 0.004). Age was the most important feature that contributed to the model, with older males showing a higher hazard ratio (HR) of 1.091 (95% confidence interval [CI] 1.089-1.094) for BPH incidence. Furthermore, a final simplified model was developed using five predictors (age, hypertension time, blood glucose, urate, and serum creatinine) identified in both the CHARLS and Fengshen studies for potential clinical application. It has been transformed into a user-friendly web tool to facilitate clinical utility.

Conclusions: The model, incorporating five easily accessible predictors with acceptable predictive abilities for incident BPH, can help identify individuals at high risk of BPH in the general population.

Background: Malaria elimination in the Asia-Pacific region has stalled in recent years, partially due to disrupted access to antimalarial drugs during public health emergencies. This study aims to explore the access to antimalarial drugs and its contextual factors in health emergencies based on investigation into six Asia-Pacific countries during the COVID-19, including Bangladesh, India, Indonesia, Pakistan, Thailand and Viet Nam.

Methods: We extracted the quarterly data for 37 antimalarial drugs using the IQVIA database from the first quarter in 2020 to the second quarter in 2022. We used standard units (SU) sold per 1000 incident cases and US dollars per 1000 incident cases to evaluate consumption (accessibility). Changes in consumption were estimated using compound annual growth rate (CAGR). Associations between consumption and country's socioeconomic, health performance and product supplier indicators were measured using least squares (pooled) panel data regression model.

Results: Available antimalarial drugs ranged from 31 in India, and 6 in Bangladesh and Viet Nam. The predominant medicine category in all six countries was quinine and other quinoline derivatives. The highest level of average consumption per 1000 incident cases was observed in Viet Nam (2004141.9 SU per 1000 incident cases). The country presenting the lowest level of accessibility was Indonesia (3668 SU per 1000 incident cases). Between 2020 and 2022, all countries except Viet Nam presented a decreased consumption per 1000 incident cases, with CAGRs being respectively - 15.11% in Bangladesh, - 3.66% in India, - 23.56% in Indonesia, - 13.28% in Pakistan and - 12.07% in Thailand. Increased Log consumption per 1000 incident cases was associated with higher proportion of health expenditure out of total government expenditure (coefficient 1.84, 95% confidence interval 0.47-3.21) and higher proportion of local supply (coefficient 0.43, 95% confidence interval 0.06-0.80).

Conclusions: There has been a disruption in the access to antimalarial drugs during the COVID-19 pandemic in the Asia-Pacific region, and the predominant available medicines were those with documented resistance. Greater priority should be given to drug innovation aimed at improving availability, along with strengthening health systems and local production to maintain accessibility to these drugs, especially during health emergencies.

Background: Access to primary healthcare remains a major challenge in sub-Saharan Africa. In 2016, Burkina Faso introduced the free healthcare policy, eliminating financial barriers by offering free healthcare services for children under five and pregnant women. While previous studies have reported increased healthcare utilization under the policy, its effects on health outcomes remains unassessed. Here, we evaluate the free healthcare policy's effects on three key indicators: frequency of clinical visits, malaria prevalence, and severe malaria.

Methods: Routine health and demographic data for children under five were collected from health facilities using the government's Electronic Medical Record (EMR) platform. Generalized Linear Mixed Effects Models (GLMM) with a Differences-in-Differences design assessed changes in the three indicators between baseline (2015) and 2018 while Bayesian hierarchical models were used to forecast trends through 2020.

Results: Analysis of 344,935 clinical visits from 199,664 children across 192 villages showed an increase in healthcare utilization, with clinical visits rising from 1.1 to 2 per child between 2015 and 2018 (p < 0.001) resulting in a percentage increase of 82%. However, disparities persisted, as children living within 5 km of a health facility accessed more care than those in remote areas (2.2 vs. 1.7 visits, p < 0.001). Malaria prevalence decreased from 98 to 80% (p < 0.001), and severe malaria declined from 6% to 2.2% (p < 0.001) during the same period. Bayesian forecasts indicated continued increases in clinical visits (from 2.36 in 2019 to 2.75 in 2020) and further declines in malaria prevalence (to 64%) and severe malaria (to 1.02%) by 2020.

Conclusions: Our study highlights the transformative effects of the free healthcare policy in improving healthcare access and outcomes for children under five in Burkina Faso. However, inequities in access remain a challenge. Strengthening community health worker programs and expanding community health activities are critical to addressing these gaps. The findings offer valuable insights for policymakers in Burkina Faso and contribute to global efforts to leverage health reforms to improve malaria control and progress toward universal health coverage.

Childhood diarrhea remains a formidable public health challenge in Africa, exacerbated by limited access to clean water, poor sanitation, and inadequate healthcare infrastructure, impacting millions of children annually. In sub-Saharan Africa, diarrhea ranks as the leading cause of death among children under five, representing 9% of all deaths in this age group. Zinc supplementation and oral rehydration solution have emerged as pivotal treatments for childhood diarrhea, addressing electrolyte imbalances, dehydration, reducing the severity and duration of diarrhea episodes, while rehydrating children by replacing lost fluids and electrolytes. However, there are several challenges in accessing these essential components, including limited availability, affordability, supply chain challenges, and lack of awareness. In this article, we explored the burden of diarrheal diseases, the impact of zinc and oral rehydration solution, and highlight the urgent need to prioritize and strengthen access to these interventions to significantly improve treatment outcomes and reduce the burden of childhood disease in Africa. Through implementing key strategies such as addressing affordability of these commodities, training and capacity building and supply chain strengthening, community engagement, and monitoring and evaluation, significant progress can be made in overcoming barriers and improving health outcomes for children. These will ultimately contribute to the reduction of childhood mortality and the attainment of global health goals in Africa.

Background: Many sub-Saharan African countries are increasingly adopting national health insurance policies to improve access to essential services. Informal sector workers, however, often lack coverage because their earnings are typically not low enough to qualify for government subsidies but insufficient to cover insurance premiums, resulting in a phenomenon known as "missing middle". This paper examined socioeconomic inequalities in national health insurance enrolment and determinants of participation among informal sector workers in Kenya.

Methods: We used nationally representative cross-sectional household survey data (n = 5168) collected from informal sector workers in Kenya in December 2020. First, we examined levels of national health insurance enrolment among informal sector workers. Second, we examined socioeconomic inequalities in national health insurance enrolment using concentration curves and the Wagstaff index. Third, we employed a three-level mixed effects logistic regression model to assess the determinants of national health insurance enrolment.

Results: Overall, 21.75% (95% Confidence Interval 20.63-22.89) of informal sector workers in Kenya were enrolled in the national health insurance scheme. We observed pro-rich inequalities in national health insurance enrolment, with a concentration index of 0.35 (95% CI 0.30-0.41). Older age (adjusted odds ratio (AOR) = 1.66, 95% CI 1.31-2.10), employment in the non-agricultural sector (AOR = 1.96, 95% CI 1.60-2.39), microfinance institutional membership (AOR = 1.44, 95% CI 1.23-1.69), higher education level (AOR = 2.49, 95% CI 1.99-3.11), household's prior positive experience with healthcare (AOR = 1.45, 95% CI 1.22-1.72), and higher socioeconomic status based on the wealth asset index (AOR = 3.87, 95% CI 2.97-5.05) were all significantly positively associated with national health insurance enrolment. Larger households had lower odds of enrollment (AOR = 0.76, 95% CI 0.60-0.96).

Conclusions: Our findings suggest that enrollment rates among informal sector workers remain low, and important pro-rich inequalities prevail. Economic factors, education, and prior experience with healthcare services were key drivers of national health insurance enrollment. Further policies are needed to increase enrollment among informal sector workers, including differential premium levels, reliance on expanded targeted subsidies, and enhanced awareness campaigns. Our findings are also applicable to other low-resource settings experiencing conditions similar to those in Kenya as they transition toward national health insurance policies, with the goal of achieving universal health coverage.

Global health financing has been dominated by philanthropic and donor-driven vertical programs over the past two decades. While this model has achieved major public health gains, it has also entrenched power asymmetries, fostered fragmentation, and undermined the sustainability and sovereignty of health systems in low- and middle-income countries. This perspective critiques the ethical and practical shortcomings of donor-driven approaches, including the marginalization of local ownership and democratic accountability. The COVID-19 pandemic exposed the fragility of relying on voluntary, unpredictable funding and underscored the need for a shift toward treating health as a global public good. The paper argues for a transition to more sustainable models based on domestic resource mobilization, pooled multilateral funding, and participatory governance, and outlines concrete recommendations for reform. Transitioning to a public goods approach requires reforming funding mechanisms to enhance predictability and alignment with national priorities, embedding participatory budgeting and accountability frameworks, and investing in health systems and governance. A new social contract grounded in solidarity, equity, and shared responsibility is essential to secure health for all.

Innovative financing mobilizes funds across varied channels using solidarity, Public-Private Partnerships and catalytic mechanisms to address unmet global health needs and engage investors as partners in development. As a supplementary measure to official development assistances (ODA), it offers a potential remedy for the current challenges in global health financing. Its significance has been magnified in the post-COVID era, where inadequate funding presents a significant hurdle to achieving Universal Health Coverage by 2030. Although efforts to promote innovative financing mechanisms have yielded some impactful results, existing bottlenecks hinder their widespread adoption and implementation. Collaboration among stakeholders is now imperative to foster the development and adoption of innovative financing tools in global health, necessitating the upgrading of existing methods and exploration of new avenues. We strongly advocate for engagement with the private sector, as it could revitalize investments in global health through the infusion of additional financial resources. The significance of innovation and the transformation of global health financing mechanisms also warrant attention. It is high time for all stakeholders to join forces and take actions.

Background: Self-care behaviors are essential for managing type 2 diabetes mellitus (T2DM), even among patients receiving specialized clinical care. However, limited evidence exists on how these behaviors affect glycemic outcomes in Nigerian patients already engaged with endocrinology services. This study assessed self-care practices and their association with glycemic control among T2DM patients attending two specialized clinics in Gusau, Nigeria.

Methods: A cross-sectional study was conducted among 262 adult T2DM patients from two endocrinology clinics in Gusau, Nigeria. Participants were recruited using a convenience sampling approach during routine clinic visits. Each completed questionnaires on demographics, the Summary of Diabetes Self-Care Activities (SDSCA), and the Morisky Medication Adherence Scale (MMAS-4). Fasting blood glucose levels were used to assess glycemic control. Logistic regression analyzed the association between self-care behaviors and glycemic outcomes; linear regression identified influencing factors.

Results: Among 262 participants, 45.8% had uncontrolled fasting blood glucose (≥ 7 mmol/L). Higher overall self-care scores were significantly associated with better glycemic control (OR 0.83; 95% CI 0.78-0.88; P < 0.001). Dietary adherence (OR 0.72; 95% CI 0.61-0.85), physical activity (OR 0.74; 95% CI 0.65-0.84), and blood glucose monitoring (OR 0.22; 95% CI 0.09-0.54) were significantly associated with improved glycemic outcomes. Foot care (OR 0.98; P = 0.797) and medication adherence (OR 3.21; P = 0.095) showed no significant association. Males, older adults (≥ 60 years), and Yoruba/Igbo participants had lower dietary scores, while exercise scores were higher among males, singles, and Igbo patients. Longer diabetes duration (≥ 20 years) was linked to better medication adherence and exercise.

Conclusions: Self-care behaviors were significantly associated with glycemic control among T2DM patients attending two specialized endocrinology clinics in Gusau, Nigeria. Interventions tailored to demographic and cultural contexts are essential to strengthen adherence in key areas such as diet, physical activity, and glucose monitoring. These findings underscore the importance of supporting self-management, even in patients with established access to clinical care.

Driven by climate change, viral evolution, intensified human mobility, and increasing population susceptibility, mosquito-borne diseases are extending their geographic range and public health impact worldwide. The 2025 chikungunya outbreak in Foshan, Guangdong Province, provided a critical real-world assessment of the province's local surveillance and emergency response system. This commentary aims to elucidate the effectiveness, strengths, and limitations of Foshan's outbreak response, and to identify lessons for strengthening early warning and vector-borne disease preparedness. Containment was achieved within three weeks through coordinated multi-sectoral emergency activation, rapid case detection, and precision vector control. However, the response also exposed systemic vulnerabilities, including delayed activation of warning mechanisms, limitations in entomological surveillance, and deficiencies in multi-source data integration. Addressing these gaps will require establishing a multi-source, data-driven early warning system; institutionalizing standardized cross-border surveillance and response protocols; expanding genomic and epidemiological research capacity; and strengthening research capacities and workforce resources from a global perspective to enhance global preparedness against emerging mosquito-borne diseases.