Global Health Research and Policy最新文献

Promoting healthy behaviours to improve population health requires strategies that foster supportive environments and actively engage communities. Here, we detail an evidence-informed co-creation process in Ferroviaria, a low-income neighbourhood in Quito, Ecuador, led by six members of a local Women's Association. Co-creation here involved a participatory approach that integrated local epidemiological data on non-communicable disease (NCD) risk factors and employed the "Dialogue Forum" methodology to guide collective decision-making. Through this process, community leaders and participants prioritized initiatives based on community needs, ultimately choosing to develop a community food garden. This initiative fostered social confidence, empowerment, and cohesion, though challenges emerged, including limited participation in the evaluation phase and difficulties in sustaining actions post-implementation. We demonstrate how the "Dialogue Forum" can be an effective tool for inclusive decision-making in low-resource settings. For future co-creation efforts, we underscore the importance of building strong local networks and implementing strategies to prevent dominance by either community leaders or researchers within the co-creation process. Initiatives should incorporate comprehensive community-led evaluations, and it is critical for community leaders to understand the importance of developing actions that the community can independently lead and sustain without continued institutional support. When health data is used, it should be framed to emphasize contextual determinants rather than focusing solely on behavioural risk factors. This report contributes to the growing evidence on community-driven health interventions, positioning co-creation as a pathway to social change and enhanced public health outcomes.

Health equity is a growing concern for policymakers across the globe. Conventional cost-effectiveness analysis (CEA), commonly used in evaluating health interventions, primarily focuses on the average and aggregate health outcomes in the targeted population, neglecting the distributional impacts on health equity. This gap calls for approaches that can quantify the impact of intervention of interest on health equity to support decision-making. Distributional Cost-Effectiveness Analysis (DCEA) offers a framework to assess the distributional impacts of health interventions. Based on DCEA, aggregate DCEA (A-DCEA) was proposed as a practical and simplified alternative to DCEA. Unlike full DCEA, which requires detailed subgroup data, A-DCEA utilizes aggregated data, making it accessible and feasible for broader use. In this commentary, we discuss the rationale for A-DCEA, outline the steps for its implementation, and highlight its applicability. The purpose of this article is to introduce A-DCEA as a pragmatic and accessible tool for evaluating the equity implications of healthcare interventions. A-DCEA can inform policymakers by incorporating equity considerations into healthcare decision-making, particularly when conducting a full DCEA is impractical due to data limitation. A-DCEA provides a valuable and accessible method for evaluating the distributional impact of interventions, promoting health equity in decision-making. Its adoption can lead to more informed health policy that considers health inequities as well as the efficient use of resources.

The 2022 global mpox outbreak highlighted significant public health challenges, with men who have sex with men (MSM) accounting for 86.7% of confirmed cases. As a high-risk group, MSM faced not only the direct health impacts of mpox but also an additional burden of stigma and discrimination, which severely hindered their willingness to seek care and access timely medical services. This article explores mpox-related stigma and discrimination and their profound impact on healthcare-seeking behaviors among MSM, drawing on evidence from global studies. We examine how stigma affects individual decision-making and has broader public health implications by exacerbating healthcare delays during the outbreak. In response, we propose actionable strategies to mitigate stigma, including providing accurate and responsible communication, strengthening community and social support network, building capacity for frontline workers, and engaging affected individuals for effective intervention. By integrating stigma-reduction measures into pandemic preparedness and response, public health systems can better support vulnerable populations, improve healthcare access, and ensure a more effective response to future outbreaks.

Background: There is a continued and urgent need to address the stagnation of the global maternal mortality ratio (MMR), especially for low- and middle-income countries (LMICs). We aimed to assess the impact of scaling up health intervention coverage on reducing MMR under four scenarios for 126 LMICs.

Methods: We conducted the modelling study to estimate MMR and additional maternal lives saved by intervention by 2030 for 126 LMICs using the Lives Saved Tool (LiST). We applied four scenarios to assess the impact of scaling up health intervention coverage with no scale-up (no change), a modest scale-up (increased by 2% per year), a substantial scale-up (increased by 5% per year), and universal coverage (coverage reached 95% by 2030). In sensitivity analysis, with the current trend, we assumed that coverage of each intervention remained unchanged from 2024, with MMR changing according to the annual percentage change (APC) of 2015-2020.

Results: Among the 126 LMICs, 31.7% (40/126) countries showed an increase in MMR, and 38.1% (48/126) stalled on the reduction of MMR from 2015 to 2020. With a modest, substantial, or universal scale-up, the 2030 average MMR would be 172.1 (117.6-262.9), 139.8 (95.6-213.5) or 98.6 (67.8-149.7), not reaching the SDG Target 3.1. Additional maternal lives saved by scaling up the coverage of health interventions were mainly clustered in the African Region, the Southeast Asia Region, and the Eastern Mediterranean Region. Compared with other included interventions, uterotonics for postpartum hemorrhage, assisted vaginal delivery and cesarean delivery played more important roles in reducing maternal mortality.

Conclusions: The study findings highlighted that even under a substantial scale-up of intervention coverage or scaling up to universal coverage of interventions, it would be difficult for the 126 LMICs to achieve the SDG Target 3.1 on time. Optimizing the allocation of health resources, promoting health equality, taking more decisive national, regional and global actions are urgently needed for LMICs to reduce MMR and reach the SDG Target 3.1.

To address the underreporting of mpox cases in endemic regions, a regional surveillance network, known as the Mpox Threat Reduction Network (MPX-TRN), was established between five neighboring countries in Central and West Africa in 2022. One direct outcome of the MPX-TRN has been the strengthening of regional mpox surveillance. This consortium has facilited open communication channels, detection of cross-border mpox cases, and improvements of the detection and diagnosis of mpox in Central Africa and worldwide. Importantly, the MPX-TRN provides a scalable model for addressing underreporting of diseases, such as mpox.

Inpatient cancer patients often carry the dual burden of the cancer itself and comorbidities, which were recognized as one of the most urgent global public health issues to be addressed. Based on a case study conducted in a tertiary hospital in Shandong Province, this study developed a framework for the extraction of hospital information system data, identification of basic comorbidity characteristics, estimation of the comorbidity burden, and examination of the associations between comorbidity patterns and outcome measures. In the case study, demographic data, diagnostic data, medication data and cost data were extracted from the hospital information system under a stringent inclusion and exclusion process, and the diagnostic data were coded by trained coders with the 10th revision of the International Classification of Diseases (ICD-10). Comorbidities in this study was assessed using the NCI Comorbidity Index, which identifies multiple comorbidities. Rates, numbers, types and severity of comorbidity for inpatient cancer patients together form the characterization of comorbidities. All prevalent conditions in this cohort were included in the cluster analysis. Patient characteristics of each comorbidity cluster were described. Different comorbidity patterns of inpatient cancer patients were identified, and the associations between comorbidity patterns and outcome measures were examined. This framework can be adopted to guide the patient care, hospital administration and medical resource allocation, and has the potential to be applied in various healthcare settings at local, regional, national, and international levels to foster a healthcare environment that is more responsive to the complexities of cancer and its associated conditions. The application of this framework needs to be optimized to overcome a few limitations in data acquisition, data integration, treatment priorities that vary by stage, and ethics and privacy issues.

Gestational Diabetes (GDM) is a prevalent health challenge in Mexico, affecting 10-14% of pregnancies but detected in only about 5.1% of cases, highlighting a critical gap in the healthcare system. This underdiagnosis poses severe health risks to mothers and children and reflects broader systemic healthcare failures. The disparity in detection rates points to insufficient screening protocols and uneven access to care, particularly affecting rural areas. Additionally, a lack of integrated digital health solutions exacerbates these issues, leading to inconsistent management and follow-up of diagnosed cases. The current reactive healthcare policies fail to prioritize early intervention and comprehensive patient education, crucial for effective GDM management. This paper calls for immediate and coordinated policy action to standardize GDM screening using updated protocols across all healthcare settings, bolster digital health infrastructure for better surveillance and management, and launch an extensive public health campaign focused on GDM awareness and education. These measures should be rigorously evaluated and adapted based on ongoing research and feedback to ensure they meet the needs of all segments of the population. Addressing these challenges head-on will improve health outcomes for mothers and children and reduce long-term healthcare costs associated with GDM complications.

Background: Despite 70% of global maternal death occurring in Sub-Saharan Africa (SSA) and the high rate of non-institutional delivery (NID), studies that inspect the connections are needed but lacking. Thus, we investigated the urban-rural burden and risk factors of NID and the correlate with maternal mortality to extend strategies for sinking the mortality spike towards sustainable development goal (SDG-3.1) in SSA.

Methods: Secondary analysis of recent (2014-2021) cross-sectional demographic-health-survey (DHS) were conducted across 25-countries in SSA. Primary outcome was institutional versus non-institutional delivery and secondary outcome was maternal-mortality-ratio (MMR) per 100,000 livebirths and the lifetime risk (LTR), while predictors were grouped by socio-economic, obstetrics and country-level factors. Data were weighted to adjust for heterogeneity and descriptive analysis was performed. Pearson chi-square, correlation, and simple linear regression anlyses were performed to assess relationships. Multivariable logistic regression further evaluated the predictor likelihood and significance at alpha = 5% (95% confidence-interval 'CI').

Results: Prevalence of NID was highest in Chad (78.6%), Madagascar (60.6%), then Nigeria (60.4%) and Angola (54.3%), with rural SSA dominating NID rate by about 85%. Odds of NID were significantly lower by 60% and 98% among women who had at least four antenatal care (ANC) visits (aOR = 0.40, 95%CI = 0.38-0.41) and utilized skilled birth attendants (SBA) at delivery (aOR = 0.02, 95%CI = 0.01-0.02), respectively. The odds of NID reduces by women age, educational-level, and wealth-quintiles. Positive and significant linear relationship exist between NID and MMR (ρ = 0.5453), and NID and LTR (ρ = 0.6136). Consequently, 1% increase in NID will lead to about 248/100000 and 8.2/1000 increase in MMR and LTR in SSA respectively.

Conclusions: Only South Africa, Rwanda and Malawi had achieved the WHO 90% coverage for healthcare delivery. ANC and SBA use reduced NID likelihood but, MMR is significantly influenced by NID. Hence, strategic decline in NID will proportionately influence the sinking of MMR spike to attain SDG-3.1 in SSA.

The COVID-19 pandemic has presented unique challenges and opportunities for health system reform globally. In Ireland, this period coincided with the early stages of the Sláintecare reform plan, a core goal of which is to establish universal healthcare. This policy brief synthesises key research findings from 13 studies carried out under the Foundations research programme to harness key learnings from the pandemic response for health system change. The analysis reveals how the COVID-19 crisis accelerated health system reforms in Ireland, breaking from a history of incremental change to implement rapid innovations towards universal healthcare. While a 'new normal' has emerged, the challenge remains to integrate these rapid developments into enduring health system improvements under evolving governance and leadership in the COVID-19 context. Three significant implications for health systems research and policy are identified: 1) Political consensus is essential for sustained health system reform, particularly during crises; 2) Adaptive health systems that can transform challenges into reform opportunities are crucial; and 3) Co-production in research enhances policy acceptability and implementation by aligning it with real-world complexities. Leveraging these pandemic-driven insights will be key to ensuring that the swift adaptations and lessons learned will transition into lasting elements of Ireland's health system.