Introduction: Climate change is shaping adolescent and young people's (AYP) transitions to adulthood with significant and often compounding effects on their physical and mental health. The climate crisis is an intergenerational inequity, with the current generation of young people exposed to more climate events over their lifetime than any previous one. Despite this injustice, research and policy to date lacks AYP's perspectives and active engagement.
Methods: Participatory, youth co-led qualitative focus group discussions were held in Bangladesh, Guatemala and Nigeria in mid-2023. A total of 196 AYP ages 12-25 years participated. Open-ended questions elicited responses regarding AYP knowledge, experiences and perceptions of climate change. Using NVivo software, translated transcripts were coded to explore and synthesise key thematic areas.
Results: Respondents discussed varied climate exposures and associated health risks, for example, how flooding events were impeding access to sexual and reproductive health commodities. Acute climate events like flooding and cyclones increased perceived risk of early marriage and gender-based violence in Bangladesh and Guatemala. In Nigeria, respondents discussed health effects of extreme heat, and how droughts were shifting women into more traditionally male roles in agriculture and income-generating activities, increasing the perceived risk of household tensions and gender-based violence. Commonly reported themes included perceived climate impacts on sexual and reproductive health including early marriage or gender-based violence. Another common theme was anxiety about climate change, its effects on economic and food insecurity in communities and feeling hopeless, lacking agency and not feeling supported by local institutions, all linked with worse mental health.
Conclusion: Our results summarise how AYP perceive climate change is affecting their physical and mental health, finding similarities and differences across these three settings. Our results can inform the development of policies and programmes that directly address AYP needs in a way that is inclusive and responsive.
{"title":"How climate change is shaping young people's health: a participatory, youth co-led study from Bangladesh, Guatemala and Nigeria.","authors":"Jessie Pinchoff, Eno-Obong Etetim, Damilola Babatunde, Eleanor Blomstrom, Sigma Ainul, Toyin Olamide Akomolafe, Brian Medina Carranza, Angel Del Valle, Karen Austrian","doi":"10.1136/bmjgh-2024-016788","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-016788","url":null,"abstract":"<p><strong>Introduction: </strong>Climate change is shaping adolescent and young people's (AYP) transitions to adulthood with significant and often compounding effects on their physical and mental health. The climate crisis is an intergenerational inequity, with the current generation of young people exposed to more climate events over their lifetime than any previous one. Despite this injustice, research and policy to date lacks AYP's perspectives and active engagement.</p><p><strong>Methods: </strong>Participatory, youth co-led qualitative focus group discussions were held in Bangladesh, Guatemala and Nigeria in mid-2023. A total of 196 AYP ages 12-25 years participated. Open-ended questions elicited responses regarding AYP knowledge, experiences and perceptions of climate change. Using NVivo software, translated transcripts were coded to explore and synthesise key thematic areas.</p><p><strong>Results: </strong>Respondents discussed varied climate exposures and associated health risks, for example, how flooding events were impeding access to sexual and reproductive health commodities. Acute climate events like flooding and cyclones increased perceived risk of early marriage and gender-based violence in Bangladesh and Guatemala. In Nigeria, respondents discussed health effects of extreme heat, and how droughts were shifting women into more traditionally male roles in agriculture and income-generating activities, increasing the perceived risk of household tensions and gender-based violence. Commonly reported themes included perceived climate impacts on sexual and reproductive health including early marriage or gender-based violence. Another common theme was anxiety about climate change, its effects on economic and food insecurity in communities and feeling hopeless, lacking agency and not feeling supported by local institutions, all linked with worse mental health.</p><p><strong>Conclusion: </strong>Our results summarise how AYP perceive climate change is affecting their physical and mental health, finding similarities and differences across these three settings. Our results can inform the development of policies and programmes that directly address AYP needs in a way that is inclusive and responsive.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1136/bmjgh-2024-015977
Christelle Geneviève Jouego, Tom Decroo, Palmer Masumbe Netongo, Tinne Gils
Introduction: The WHO endorsed the Xpert MTB/RIF (Xpert) technique since 2011 as initial test to diagnose rifampicin-resistant tuberculosis (RR-TB). No systematic review has quantified the proportion of pretreatment attrition in RR-TB patients diagnosed with Xpert in high TB burden countries.Pretreatment attrition for RR-TB represents the gap between patients diagnosed and those who effectively started anti-TB treatment regardless of the reasons (which include pretreatment mortality (death of a diagnosed RR-TB patient before starting adequate treatment) and/or pretreatment loss to follow-up (PTLFU) (drop-out of a diagnosed RR-TB patient before initiation of anti-TB treatment).
Methods: In this systematic review and meta-analysis, we queried EMBASE, PubMed and Web of science to retrieve studies published between 2011 and 22 July 2024, that described pretreatment attrition for RR-TB using Xpert in high TB burden countries. Data on RR-TB patients who did not start treatment after diagnosis and reasons for not starting were extracted in an Excel table. A modified version of the Newcastle-Ottawa scale was used to evaluate the risk of bias among all included studies. The pooled proportion of pretreatment attrition and reasons were assessed using random-effects meta-analysis. Forest plots were generated using R software.
Results: Thirty eligible studies from 21 countries were identified after full-text screening and included in the meta-analysis. Most studies used routine programme data. The pooled proportion of pretreatment attrition in included studies was 18% (95% CI: 12 to 25). PTLFU and pretreatment mortality were, respectively, reported in 10 and nine studies and explained 78% (95% CI: 51% to 92%) and 30% (95% CI: 15% to 52%) of attrition.
Conclusion: Pretreatment attrition was widespread, with significant heterogeneity between included studies. National TB programmes should ensure accurate data collection and reporting of pretreatment attrition to enable reliable overall control strategies.
Prospero registration number: CRD42022321509.
{"title":"Pretreatment attrition after rifampicin-resistant tuberculosis diagnosis with Xpert MTB/RIF or ultra in high TB burden countries: a systematic review and meta-analysis.","authors":"Christelle Geneviève Jouego, Tom Decroo, Palmer Masumbe Netongo, Tinne Gils","doi":"10.1136/bmjgh-2024-015977","DOIUrl":"10.1136/bmjgh-2024-015977","url":null,"abstract":"<p><strong>Introduction: </strong>The WHO endorsed the Xpert MTB/RIF (Xpert) technique since 2011 as initial test to diagnose rifampicin-resistant tuberculosis (RR-TB). No systematic review has quantified the proportion of pretreatment attrition in RR-TB patients diagnosed with Xpert in high TB burden countries.Pretreatment attrition for RR-TB represents the gap between patients diagnosed and those who effectively started anti-TB treatment regardless of the reasons (which include pretreatment mortality (death of a diagnosed RR-TB patient before starting adequate treatment) and/or pretreatment loss to follow-up (PTLFU) (drop-out of a diagnosed RR-TB patient before initiation of anti-TB treatment).</p><p><strong>Methods: </strong>In this systematic review and meta-analysis, we queried EMBASE, PubMed and Web of science to retrieve studies published between 2011 and 22 July 2024, that described pretreatment attrition for RR-TB using Xpert in high TB burden countries. Data on RR-TB patients who did not start treatment after diagnosis and reasons for not starting were extracted in an Excel table. A modified version of the Newcastle-Ottawa scale was used to evaluate the risk of bias among all included studies. The pooled proportion of pretreatment attrition and reasons were assessed using random-effects meta-analysis. Forest plots were generated using R software.</p><p><strong>Results: </strong>Thirty eligible studies from 21 countries were identified after full-text screening and included in the meta-analysis. Most studies used routine programme data. The pooled proportion of pretreatment attrition in included studies was 18% (95% CI: 12 to 25). PTLFU and pretreatment mortality were, respectively, reported in 10 and nine studies and explained 78% (95% CI: 51% to 92%) and 30% (95% CI: 15% to 52%) of attrition.</p><p><strong>Conclusion: </strong>Pretreatment attrition was widespread, with significant heterogeneity between included studies. National TB programmes should ensure accurate data collection and reporting of pretreatment attrition to enable reliable overall control strategies.</p><p><strong>Prospero registration number: </strong>CRD42022321509.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1136/bmjgh-2024-017055
Moses Mwale, Peter Jay Chipimo, Precious Kalubula, Ladislas Hibusu, Stella Mumba Chomba Mulima, Kafusha Kapema, Kelvin Mwangilwa, Nyuma Mbewe, Fred Kapaya
Cholera has remained a persistent public health challenge in Zambia since the country's first reported outbreak in 1977. The recent outbreak, which began in October 2023 and is ongoing as of June 2024, is the most severe in Zambia's history and part of the larger 2022-2024 Southern Africa cholera outbreak, which has affected multiple countries in the region. This article describes the implementation of the integrated community strategy for cholera control (ICSCC) in three districts of the Copperbelt Province during this outbreak. The ICSCC is a comprehensive, community-centric public health approach that integrates surveillance, case management, water, sanitation and hygiene interventions, community engagement and infection prevention measures. The strategy's implementation involved deploying multidisciplinary technical teams, training community-based volunteers and healthcare workers in the affected communities. This approach led to a rapid reduction in cholera cases and mortality, largely due to enhanced surveillance, community education sessions and improved sanitation practices. The ICSCC also improved stakeholder coordination and enabled rapid communication for early response to cholera hotspots. Key lessons learnt include the importance of robust coordination, early community involvement and context-specific adaptations. The strategy's emphasis on data-driven decision-making and adaptation to local socio-cultural dynamics was crucial for its effectiveness. These findings underscore the potential of integrated community-based approaches in managing cholera outbreaks, enhancing public health preparedness and building long-term resilience. The ICSCC strategy offers a scalable model for regions facing similar public health challenges, providing valuable insights for policymakers and practitioners on the effectiveness of community involvement in managing public health crises.
{"title":"Building resilience against cholera: lessons from the implementation of integrated community strategy for cholera control in Zambia.","authors":"Moses Mwale, Peter Jay Chipimo, Precious Kalubula, Ladislas Hibusu, Stella Mumba Chomba Mulima, Kafusha Kapema, Kelvin Mwangilwa, Nyuma Mbewe, Fred Kapaya","doi":"10.1136/bmjgh-2024-017055","DOIUrl":"10.1136/bmjgh-2024-017055","url":null,"abstract":"<p><p>Cholera has remained a persistent public health challenge in Zambia since the country's first reported outbreak in 1977. The recent outbreak, which began in October 2023 and is ongoing as of June 2024, is the most severe in Zambia's history and part of the larger 2022-2024 Southern Africa cholera outbreak, which has affected multiple countries in the region. This article describes the implementation of the integrated community strategy for cholera control (ICSCC) in three districts of the Copperbelt Province during this outbreak. The ICSCC is a comprehensive, community-centric public health approach that integrates surveillance, case management, water, sanitation and hygiene interventions, community engagement and infection prevention measures. The strategy's implementation involved deploying multidisciplinary technical teams, training community-based volunteers and healthcare workers in the affected communities. This approach led to a rapid reduction in cholera cases and mortality, largely due to enhanced surveillance, community education sessions and improved sanitation practices. The ICSCC also improved stakeholder coordination and enabled rapid communication for early response to cholera hotspots. Key lessons learnt include the importance of robust coordination, early community involvement and context-specific adaptations. The strategy's emphasis on data-driven decision-making and adaptation to local socio-cultural dynamics was crucial for its effectiveness. These findings underscore the potential of integrated community-based approaches in managing cholera outbreaks, enhancing public health preparedness and building long-term resilience. The ICSCC strategy offers a scalable model for regions facing similar public health challenges, providing valuable insights for policymakers and practitioners on the effectiveness of community involvement in managing public health crises.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1136/bmjgh-2024-016168
Fred Kapaya, Mory Keita, Vincent Dossou Sodjinou, Miriam Nanyunja, Allan Mpairwe, Ebenezer Obi Daniel, Godwin Akpan, Tamayi Mlanda, Shikanga O-Tipo, Amarachi Tikal Abianuru, Ibrahim Mamadu, John Masina, Alice Igale Ladu, Fred Athanasius Dratibi, Otim Patrick Cossy Ramadan, Fiona Braka, Etien Luc Koua, Philippe Barboza, Dick Chamla, Abdou Salam Gueye
High-burden cholera outbreaks, spreading beyond the traditional cholera-endemic countries, have been reported since 2021 in the WHO African region. Member states in the region have committed to the global goal of cholera elimination by 2030. To track progress towards this goal, WHO-African countries adopted a regional cholera prevention and control framework in 2018. This study reports on 27 countries' 5-year achievements in implementing the cholera regional framework for cholera prevention, and control. Data collected through a web-based self-assessment tool were analysed and visualised through Power BI. Data were provided by national teams of experts on cholera based on the milestones of the framework. Countries' specific progress and regional progress were calculated. The overall regional progress was 53%, ranging from 19% in Mauritania to 76% in Ethiopia. Out of the 27 countries, 3 had made good progress while 14 had fair and 10 had insufficient progress. At the regional level, 4 milestones were on track, 7 were fair and 10 had insufficient progress. Cholera hot spot mapping had the highest score at 85%, while development of investment cases for cholera control scored the lowest at 14%. Although appreciable progress was noted in some milestones, the progress against critical milestones, including for water, sanitation and hygiene, that form the bedrock of cholera control, was insufficient. Effective implementation of the cholera prevention and control framework anchored on strong government commitment and ownership is essential to curb the current trend of cholera outbreaks and improve the likelihood of cholera elimination by 2030 in Africa.
{"title":"An assessment of the progress made in the implementation of the regional framework for cholera prevention and control in the WHO African region.","authors":"Fred Kapaya, Mory Keita, Vincent Dossou Sodjinou, Miriam Nanyunja, Allan Mpairwe, Ebenezer Obi Daniel, Godwin Akpan, Tamayi Mlanda, Shikanga O-Tipo, Amarachi Tikal Abianuru, Ibrahim Mamadu, John Masina, Alice Igale Ladu, Fred Athanasius Dratibi, Otim Patrick Cossy Ramadan, Fiona Braka, Etien Luc Koua, Philippe Barboza, Dick Chamla, Abdou Salam Gueye","doi":"10.1136/bmjgh-2024-016168","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-016168","url":null,"abstract":"<p><p>High-burden cholera outbreaks, spreading beyond the traditional cholera-endemic countries, have been reported since 2021 in the WHO African region. Member states in the region have committed to the global goal of cholera elimination by 2030. To track progress towards this goal, WHO-African countries adopted a regional cholera prevention and control framework in 2018. This study reports on 27 countries' 5-year achievements in implementing the cholera regional framework for cholera prevention, and control. Data collected through a web-based self-assessment tool were analysed and visualised through Power BI. Data were provided by national teams of experts on cholera based on the milestones of the framework. Countries' specific progress and regional progress were calculated. The overall regional progress was 53%, ranging from 19% in Mauritania to 76% in Ethiopia. Out of the 27 countries, 3 had made good progress while 14 had fair and 10 had insufficient progress. At the regional level, 4 milestones were on track, 7 were fair and 10 had insufficient progress. Cholera hot spot mapping had the highest score at 85%, while development of investment cases for cholera control scored the lowest at 14%. Although appreciable progress was noted in some milestones, the progress against critical milestones, including for water, sanitation and hygiene, that form the bedrock of cholera control, was insufficient. Effective implementation of the cholera prevention and control framework anchored on strong government commitment and ownership is essential to curb the current trend of cholera outbreaks and improve the likelihood of cholera elimination by 2030 in Africa.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1136/bmjgh-2024-017368
Simon Mwima, Laura M Bogart, William Musoke, Semei C Mukama, Stella Allupo, Herbert Kadama, Rose Naigino, Barbara Mukasa, Rhoda Kitti Wanyenze
Introduction: In Uganda, fisherfolk have an HIV prevalence between 15% and 40%, significantly higher than the national average of 5.5%. Pre-exposure prophylaxis (PrEP) is effective in preventing HIV but faces challenges in uptake and continuation among fisherfolk. This study explores factors influencing PrEP continuation and discontinuation among fisherfolk in Uganda using the Consolidated Framework for Implementation Research (CFIR).
Methods: Participants were recruited from two fishing communities near Entebbe, Uganda. One community received enhanced PrEP support (adherence support, educational workshops and check-in calls), while the other received standard healthcare outreach. Forty fisherfolk (20 who continued PrEP and 20 who discontinued PrEP) were interviewed 6 months after initiating PrEP. Data were analysed using directed content analysis, with high inter-rater consistency. Ethical approval and informed consent were obtained.
Results: Findings highlighted several determinants of PrEP continuation and discontinuation across the CFIR domains. Intervention characteristics such as side effects and the pill burden were significant barriers, particularly for women who reported nausea and stomach issues. Individual characteristics revealed that perceived HIV risk influenced PrEP use, with women's decisions often influenced by their partners' behaviours and mobility. However, insufficient information and education, especially among women, led to misunderstandings and discontinuation. Inner-setting factors like mobility issues and the distance to healthcare clinics posed significant barriers exacerbated by the geographical isolation of fishing communities. In the outer setting, high HIV prevalence motivated PrEP initiation, but stigma, particularly the misconception that PrEP is an antiretroviral drug used by people living with HIV, led to discontinuation.
Conclusion: Fisherfolk in Uganda encounter multiple barriers to PrEP continuation, with women facing more significant challenges. Enhanced support strategies are essential for improving PrEP adherence and informing future HIV prevention interventions in high-risk populations.
{"title":"Applying implementation science frameworks to understand why fisherfolk continue or discontinue pre-exposure prophylaxis for HIV prevention in Uganda: a qualitative analysis.","authors":"Simon Mwima, Laura M Bogart, William Musoke, Semei C Mukama, Stella Allupo, Herbert Kadama, Rose Naigino, Barbara Mukasa, Rhoda Kitti Wanyenze","doi":"10.1136/bmjgh-2024-017368","DOIUrl":"10.1136/bmjgh-2024-017368","url":null,"abstract":"<p><strong>Introduction: </strong>In Uganda, fisherfolk have an HIV prevalence between 15% and 40%, significantly higher than the national average of 5.5%. Pre-exposure prophylaxis (PrEP) is effective in preventing HIV but faces challenges in uptake and continuation among fisherfolk. This study explores factors influencing PrEP continuation and discontinuation among fisherfolk in Uganda using the Consolidated Framework for Implementation Research (CFIR).</p><p><strong>Methods: </strong>Participants were recruited from two fishing communities near Entebbe, Uganda. One community received enhanced PrEP support (adherence support, educational workshops and check-in calls), while the other received standard healthcare outreach. Forty fisherfolk (20 who continued PrEP and 20 who discontinued PrEP) were interviewed 6 months after initiating PrEP. Data were analysed using directed content analysis, with high inter-rater consistency. Ethical approval and informed consent were obtained.</p><p><strong>Results: </strong>Findings highlighted several determinants of PrEP continuation and discontinuation across the CFIR domains. Intervention characteristics such as side effects and the pill burden were significant barriers, particularly for women who reported nausea and stomach issues. Individual characteristics revealed that perceived HIV risk influenced PrEP use, with women's decisions often influenced by their partners' behaviours and mobility. However, insufficient information and education, especially among women, led to misunderstandings and discontinuation. Inner-setting factors like mobility issues and the distance to healthcare clinics posed significant barriers exacerbated by the geographical isolation of fishing communities. In the outer setting, high HIV prevalence motivated PrEP initiation, but stigma, particularly the misconception that PrEP is an antiretroviral drug used by people living with HIV, led to discontinuation.</p><p><strong>Conclusion: </strong>Fisherfolk in Uganda encounter multiple barriers to PrEP continuation, with women facing more significant challenges. Enhanced support strategies are essential for improving PrEP adherence and informing future HIV prevention interventions in high-risk populations.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1136/bmjgh-2024-018238
Akanksha A Marphatia, Sheillah Simiyu, Meriel Flint O'Kane, Kelly T Alexander, Ana Carolina Argolo Nascimento de Castro, Ginette Azcona, Patience Esi Boni-Morkla, Salome A Bukachi, Phylis Busienei, Bethany A Caruso, Claire Chase, Jenala Chipungu, Anju Dwivedi, Richard Johnston, Indira Khurana, Antoinette Kome, Wanjiku Kuria, James Labadia, Fungai Makoni, Blessing Mberu, Sujoy Mojumdar, Janet Mule, Lydia Namatende Sakwa, Naomi Njeri, Fernanda Abreu Oliveira de Souza, Lauren Pandolfelli, Petunia Ramunenyiwa, Isha Ray, Malini Reddy, Pritum Kumar Saha, Utkarsh Sinha, Sheela S Sinharoy, Tom Slaymaker, Emmanuel Uguru, Kara Uhl, Sera L Young, Ian Ross, Oliver Cumming
{"title":"Gender equality and quality of life must be central to the design and delivery of sanitation.","authors":"Akanksha A Marphatia, Sheillah Simiyu, Meriel Flint O'Kane, Kelly T Alexander, Ana Carolina Argolo Nascimento de Castro, Ginette Azcona, Patience Esi Boni-Morkla, Salome A Bukachi, Phylis Busienei, Bethany A Caruso, Claire Chase, Jenala Chipungu, Anju Dwivedi, Richard Johnston, Indira Khurana, Antoinette Kome, Wanjiku Kuria, James Labadia, Fungai Makoni, Blessing Mberu, Sujoy Mojumdar, Janet Mule, Lydia Namatende Sakwa, Naomi Njeri, Fernanda Abreu Oliveira de Souza, Lauren Pandolfelli, Petunia Ramunenyiwa, Isha Ray, Malini Reddy, Pritum Kumar Saha, Utkarsh Sinha, Sheela S Sinharoy, Tom Slaymaker, Emmanuel Uguru, Kara Uhl, Sera L Young, Ian Ross, Oliver Cumming","doi":"10.1136/bmjgh-2024-018238","DOIUrl":"10.1136/bmjgh-2024-018238","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1136/bmjgh-2024-016491
Etien Luc Koua, Fleury Hybriel Moussana, Vincent Dossou Sodjinou, Freddy Kambale, Jean Paul Kimenyi, Saliou Diallo, Joseph Okeibunor, Abdou Salam Gueye
Introduction: Cholera outbreaks remain persistent in the WHO African region, with an increased trend in recent years. This study analyses actual drivers of cholera including correlations with water, sanitation, and hygiene (WASH) indicators, and climate change trends.
Methods: This was a cross-sectional descriptive and analytic study. Cholera data from 2000 to 2023 and data relating to cholera drivers were compiled and analysed through multi-level exploratory analysis. We cross-referenced several WASH indicators, and generated a similarity matrix to categorise countries or subnational units into groups using principal component analysis and K-means clustering. We integrated cholera outbreak data with WASH indicators and created a matrix of indicators relevant for analysing cholera burden. We conducted summary statistics, temporal visualisations, Geographic Information System (GIS) mapping, trend analysis and statistical tests for correlations to derive patterns and trends from the data, derive similarities and develop projections.
Results: A total of 2 727 172 cases and 63 182 deaths were reported from 44 countries, representing 94% of the 47 countries in the region, from 2000 to 2023. The case fatality ratio of 2.3% is suggestive of issues in case management. A total of 684 outbreaks were reported, with the highest burdens in Nigeria and the Democratic Republic of the Congo. Median detection time to outbreak was 2 days, while median time for outbreak control was 92 days. Cholera incidence seemed higher in the period 2014 to 2023 than in the period before 2014. The study results confirmed correlations between WASH indicators and cholera outbreaks. Risks factors include drinking surface water, lacking soap and/or water, and open defaecation. Over 29% and 58.8% of the population lack access to basic water and basic sanitation, respectively.
Conclusion: Insufficient access to WASH services remains the main predisposing factor for cholera in the WHO African region. Political leaders should invest more in access to WASH, strengthen multisectoral collaboration, and improve availability of needed tools to increase the likelihood of meeting cholera elimination goals by 2030.
{"title":"Exploring the burden of cholera in the WHO African region: patterns and trends from 2000 to 2023 cholera outbreak data.","authors":"Etien Luc Koua, Fleury Hybriel Moussana, Vincent Dossou Sodjinou, Freddy Kambale, Jean Paul Kimenyi, Saliou Diallo, Joseph Okeibunor, Abdou Salam Gueye","doi":"10.1136/bmjgh-2024-016491","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-016491","url":null,"abstract":"<p><strong>Introduction: </strong>Cholera outbreaks remain persistent in the WHO African region, with an increased trend in recent years. This study analyses actual drivers of cholera including correlations with water, sanitation, and hygiene (WASH) indicators, and climate change trends.</p><p><strong>Methods: </strong>This was a cross-sectional descriptive and analytic study. Cholera data from 2000 to 2023 and data relating to cholera drivers were compiled and analysed through multi-level exploratory analysis. We cross-referenced several WASH indicators, and generated a similarity matrix to categorise countries or subnational units into groups using principal component analysis and K-means clustering. We integrated cholera outbreak data with WASH indicators and created a matrix of indicators relevant for analysing cholera burden. We conducted summary statistics, temporal visualisations, Geographic Information System (GIS) mapping, trend analysis and statistical tests for correlations to derive patterns and trends from the data, derive similarities and develop projections.</p><p><strong>Results: </strong>A total of 2 727 172 cases and 63 182 deaths were reported from 44 countries, representing 94% of the 47 countries in the region, from 2000 to 2023. The case fatality ratio of 2.3% is suggestive of issues in case management. A total of 684 outbreaks were reported, with the highest burdens in Nigeria and the Democratic Republic of the Congo. Median detection time to outbreak was 2 days, while median time for outbreak control was 92 days. Cholera incidence seemed higher in the period 2014 to 2023 than in the period before 2014. The study results confirmed correlations between WASH indicators and cholera outbreaks. Risks factors include drinking surface water, lacking soap and/or water, and open defaecation. Over 29% and 58.8% of the population lack access to basic water and basic sanitation, respectively.</p><p><strong>Conclusion: </strong>Insufficient access to WASH services remains the main predisposing factor for cholera in the WHO African region. Political leaders should invest more in access to WASH, strengthen multisectoral collaboration, and improve availability of needed tools to increase the likelihood of meeting cholera elimination goals by 2030.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-20DOI: 10.1136/bmjgh-2024-016711
Deepshikha Batheja, Srishti Goel, Esmita Charani
Antimicrobial resistance (AMR) poses a critical public health threat, with gendered implications that are often overlooked. Key drivers of bacterial AMR include the misuse of antibiotics, inadequate water, sanitation and hygiene infrastructure and poor infection control practices. Persistent gender discrimination exacerbates these issues, resulting in disparities in healthcare access and outcomes. This review explores how biological, sociocultural and behavioural factors contribute to the differential incidence of AMR in women. We present a conceptual framework to understand how gender norms influence antibiotic use and AMR. Differences in infection susceptibility, health-seeking behaviours, the ability to access and afford essential antibiotics and quality healthcare and appropriate diagnosis and management by healthcare providers across genders highlight the necessity for gender-sensitive approaches. Addressing gender dynamics within the health workforce and fostering inclusive policies is crucial for effectively mitigating AMR. Integrating intersectional and life course approaches into AMR mitigation strategies is essential to manage the changing health needs of women and other vulnerable groups.
{"title":"Understanding gender inequities in antimicrobial resistance: role of biology, behaviour and gender norms.","authors":"Deepshikha Batheja, Srishti Goel, Esmita Charani","doi":"10.1136/bmjgh-2024-016711","DOIUrl":"10.1136/bmjgh-2024-016711","url":null,"abstract":"<p><p>Antimicrobial resistance (AMR) poses a critical public health threat, with gendered implications that are often overlooked. Key drivers of bacterial AMR include the misuse of antibiotics, inadequate water, sanitation and hygiene infrastructure and poor infection control practices. Persistent gender discrimination exacerbates these issues, resulting in disparities in healthcare access and outcomes. This review explores how biological, sociocultural and behavioural factors contribute to the differential incidence of AMR in women. We present a conceptual framework to understand how gender norms influence antibiotic use and AMR. Differences in infection susceptibility, health-seeking behaviours, the ability to access and afford essential antibiotics and quality healthcare and appropriate diagnosis and management by healthcare providers across genders highlight the necessity for gender-sensitive approaches. Addressing gender dynamics within the health workforce and fostering inclusive policies is crucial for effectively mitigating AMR. Integrating intersectional and life course approaches into AMR mitigation strategies is essential to manage the changing health needs of women and other vulnerable groups.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-20DOI: 10.1136/bmjgh-2024-016180
Laura Jane Brubacher, Vijayashree Yellappa, Bony Wiem Lestari, Petra Heitkamp, Nathaly Aguilera Vasquez, Angelina Sassi, Bolanle Olusola-Faleye, Poshan Thapa, Joel Shyam Klinton, Surbhi Sheokand, Madhukar Pai, Charity Oga-Omenka
Introduction: The COVID-19 pandemic was an unprecedented challenge to health systems worldwide and had a severe impact on tuberculosis (TB) case notifications and service delivery. India, Indonesia and Nigeria are high TB-burden countries where the majority of initial care-seeking happens in the private health sector. The objectives of this study were to (1) explore policy-makers' perspectives on the impact of the COVID-19 pandemic on private sector TB service delivery in India, Indonesia and Nigeria and (2) identify cross-cutting insights for pandemic preparedness with respect to TB service delivery.
Methods: From May to November 2021, 33 interviews were conducted with key policy-makers involved in health service administration, TB service delivery and/or the COVID-19 response in India, Indonesia and Nigeria (n=11 in each country). Interviews focused on the impact of COVID-19 on TB services and lessons learnt for pandemic preparedness with respect to TB in each study context. Data were analysed thematically using a hybrid inductive-deductive approach, informed by Haldane et al's Determinants of Health Systems Resilience Framework.
Results: Policy-makers highlighted the crucial role of intersectoral collaboration, effective governance, innovative financing strategies, health workforce reallocation and technological advancements such as virtual consultations and mHealth in strengthening TB service delivery amid the COVID-19 pandemic. India relied on patient-provider support agencies to implement a joint strategy for TB care across sectors and states. Indonesia engaged networks of private provider professional associations to facilitate coordination of the COVID-19 response. Nigeria implemented a pandemic policy for public-private referral for the continuity of TB care.
Conclusions: Countries implemented varied measures to support TB service delivery during the COVID-19 pandemic. This study presents insights from three countries (India, Indonesia and Nigeria) that together offer a 'menu' of possibilities for supporting pandemic preparedness with respect to TB care vis-à-vis strengthening health systems resilience.
{"title":"Health and tuberculosis systems resilience, the role of the private sector and pandemic preparedness: insights from a cross-country qualitative study with policy-makers in India, Indonesia and Nigeria.","authors":"Laura Jane Brubacher, Vijayashree Yellappa, Bony Wiem Lestari, Petra Heitkamp, Nathaly Aguilera Vasquez, Angelina Sassi, Bolanle Olusola-Faleye, Poshan Thapa, Joel Shyam Klinton, Surbhi Sheokand, Madhukar Pai, Charity Oga-Omenka","doi":"10.1136/bmjgh-2024-016180","DOIUrl":"10.1136/bmjgh-2024-016180","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic was an unprecedented challenge to health systems worldwide and had a severe impact on tuberculosis (TB) case notifications and service delivery. India, Indonesia and Nigeria are high TB-burden countries where the majority of initial care-seeking happens in the private health sector. The objectives of this study were to (1) explore policy-makers' perspectives on the impact of the COVID-19 pandemic on private sector TB service delivery in India, Indonesia and Nigeria and (2) identify cross-cutting insights for pandemic preparedness with respect to TB service delivery.</p><p><strong>Methods: </strong>From May to November 2021, 33 interviews were conducted with key policy-makers involved in health service administration, TB service delivery and/or the COVID-19 response in India, Indonesia and Nigeria (n=11 in each country). Interviews focused on the impact of COVID-19 on TB services and lessons learnt for pandemic preparedness with respect to TB in each study context. Data were analysed thematically using a hybrid inductive-deductive approach, informed by Haldane <i>et al</i>'s Determinants of Health Systems Resilience Framework.</p><p><strong>Results: </strong>Policy-makers highlighted the crucial role of intersectoral collaboration, effective governance, innovative financing strategies, health workforce reallocation and technological advancements such as virtual consultations and mHealth in strengthening TB service delivery amid the COVID-19 pandemic. India relied on patient-provider support agencies to implement a joint strategy for TB care across sectors and states. Indonesia engaged networks of private provider professional associations to facilitate coordination of the COVID-19 response. Nigeria implemented a pandemic policy for public-private referral for the continuity of TB care.</p><p><strong>Conclusions: </strong>Countries implemented varied measures to support TB service delivery during the COVID-19 pandemic. This study presents insights from three countries (India, Indonesia and Nigeria) that together offer a 'menu' of possibilities for supporting pandemic preparedness with respect to TB care vis-à-vis strengthening health systems resilience.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-20DOI: 10.1136/bmjgh-2024-016786
Muhulo Muhau Mungamba, Felix P Chilunga, Eva L van der Linden, Erik Beune, Engwa A Godwill, Charles F Hayfron-Benjamin, Karlijn Meeks, Samuel N Darko, Sampson Twumasi-Ankrah, Ellis Owusu-Dabo, Liffert Vogt, Bert-Jan H van den Born, Benedicta N Chungag, Charles Agyemang
Background: Limited longitudinal data exist on chronic kidney disease (CKD) in African populations undergoing epidemiological transitions. We investigated incidence, long-term predictors and progression of CKD among Ghanaians residing in Ghana and Ghanaian migrants in the Netherlands (Amsterdam).
Methods and findings: We analysed data from 2183 participants in the transcontinental population-based prospective Research on Obesity and Diabetes among African Migrants cohort, followed for approximately 7 years. CKD incidence and its progression to end-stage kidney disease (ESKD) were defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. CKD incidence was calculated using age- and sex standardisation for those without CKD at baseline. Long-term predictors of CKD incidence were identified using one-step robust Poisson regression. CKD progression to ESKD from baseline was also assessed using robust Poisson regressions. Overall age- and sex standardised CKD incidence was 11.0% (95% CI 9.3% to 12.3%) in the population, with Ghanaians residing in Amsterdam at (7.6%; 5.7% to 9.5%) and Ghanaians residing in Ghana at (12.9%; 10.9% to 14.9%). Within Ghana, rural Ghanaians had similar CKD incidence to urban Ghanaians (12.5%; 8.5% to 15.5% vs 12.3%; 8.2% to 15.8%). Residence in Amsterdam was associated with lower CKD incidence compared with Ghana after adjustments (incidence rate ratio=0.32; 0.13-0.77). CKD incidence predictors were advanced age, female sex, alcohol consumption, uric acid levels and hypertension. CKD progression to ESKD was 2.3% among Ghanaians residing in Ghana and 0.0% among Ghanaians residing in Amsterdam.
Conclusion: One-tenth of Ghanaians developed CKD over 7 years, with higher incidence in Ghana compared with Europe. Age, female sex, alcohol use, uric acid levels and hypertension were predictive factors. CKD progression to ESKD was minimal. High CKD incidence among Ghanaians, especially those residing in Ghana, calls for in-depth assessment of contributing factors and targeted interventions.
背景:在流行病学转变的非洲人群中,慢性肾脏疾病(CKD)的纵向数据有限。我们调查了居住在加纳的加纳人以及在荷兰(阿姆斯特丹)的加纳移民的CKD的发病率、长期预测因素和进展。方法和研究结果:我们分析了来自2183名参与者的数据,这些参与者来自横贯大陆的非洲移民群体中肥胖和糖尿病的前瞻性研究,随访了大约7年。使用肾脏疾病:改善全球预后(KDIGO)标准定义CKD发病率及其进展到终末期肾脏疾病(ESKD)。对基线时无CKD的患者,使用年龄和性别标准化来计算CKD发病率。采用一步稳健泊松回归确定CKD发病率的长期预测因素。从基线到ESKD的CKD进展也使用稳健泊松回归进行评估。总体年龄和性别标准化CKD发病率为11.0% (95% CI 9.3%至12.3%),其中居住在阿姆斯特丹的加纳人为7.6%;5.7%至9.5%)和居住在加纳的加纳人(12.9%;10.9%至14.9%)。在加纳,农村加纳人的CKD发病率与城市加纳人相似(12.5%;8.5%对15.5%对12.3%;8.2%至15.8%)。调整后,与加纳相比,居住在阿姆斯特丹的CKD发病率较低(发病率比=0.32;0.13 - -0.77)。CKD发病率预测因子为高龄、女性、饮酒、尿酸水平和高血压。居住在加纳的加纳人CKD进展为ESKD的比例为2.3%,居住在阿姆斯特丹的加纳人为0.0%。结论:加纳有十分之一的人在7年内患上CKD,与欧洲相比,加纳的发病率更高。年龄、女性、饮酒、尿酸水平和高血压是预测因素。CKD进展为ESKD的情况极少。加纳人,特别是居住在加纳的加纳人CKD发病率高,需要深入评估影响因素和有针对性的干预措施。
{"title":"Incidence, long-term predictors and progression of chronic kidney disease among African migrants and non-migrants: the transcontinental population-based prospective RODAM cohort study.","authors":"Muhulo Muhau Mungamba, Felix P Chilunga, Eva L van der Linden, Erik Beune, Engwa A Godwill, Charles F Hayfron-Benjamin, Karlijn Meeks, Samuel N Darko, Sampson Twumasi-Ankrah, Ellis Owusu-Dabo, Liffert Vogt, Bert-Jan H van den Born, Benedicta N Chungag, Charles Agyemang","doi":"10.1136/bmjgh-2024-016786","DOIUrl":"10.1136/bmjgh-2024-016786","url":null,"abstract":"<p><strong>Background: </strong>Limited longitudinal data exist on chronic kidney disease (CKD) in African populations undergoing epidemiological transitions. We investigated incidence, long-term predictors and progression of CKD among Ghanaians residing in Ghana and Ghanaian migrants in the Netherlands (Amsterdam).</p><p><strong>Methods and findings: </strong>We analysed data from 2183 participants in the transcontinental population-based prospective Research on Obesity and Diabetes among African Migrants cohort, followed for approximately 7 years. CKD incidence and its progression to end-stage kidney disease (ESKD) were defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. CKD incidence was calculated using age- and sex standardisation for those without CKD at baseline. Long-term predictors of CKD incidence were identified using one-step robust Poisson regression. CKD progression to ESKD from baseline was also assessed using robust Poisson regressions. Overall age- and sex standardised CKD incidence was 11.0% (95% CI 9.3% to 12.3%) in the population, with Ghanaians residing in Amsterdam at (7.6%; 5.7% to 9.5%) and Ghanaians residing in Ghana at (12.9%; 10.9% to 14.9%). Within Ghana, rural Ghanaians had similar CKD incidence to urban Ghanaians (12.5%; 8.5% to 15.5% vs 12.3%; 8.2% to 15.8%). Residence in Amsterdam was associated with lower CKD incidence compared with Ghana after adjustments (incidence rate ratio=0.32; 0.13-0.77). CKD incidence predictors were advanced age, female sex, alcohol consumption, uric acid levels and hypertension. CKD progression to ESKD was 2.3% among Ghanaians residing in Ghana and 0.0% among Ghanaians residing in Amsterdam.</p><p><strong>Conclusion: </strong>One-tenth of Ghanaians developed CKD over 7 years, with higher incidence in Ghana compared with Europe. Age, female sex, alcohol use, uric acid levels and hypertension were predictive factors. CKD progression to ESKD was minimal. High CKD incidence among Ghanaians, especially those residing in Ghana, calls for in-depth assessment of contributing factors and targeted interventions.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}