Pub Date : 2024-05-30DOI: 10.1136/bmjgh-2023-013582
Linda E Kupfer, Nalini Anand, Jessica Ott, Rao Divi, Paul Gaist, Rashmi Gopal-Srivastava, Andrea Horvath-Marques, Damali Martin, Anna E Ordóñez, Mauricio Rangel-Gomez, Natalie Tomitch-Timmons, Jenelle Walker, Dianne M Rausch
{"title":"The case for global health reciprocal innovation.","authors":"Linda E Kupfer, Nalini Anand, Jessica Ott, Rao Divi, Paul Gaist, Rashmi Gopal-Srivastava, Andrea Horvath-Marques, Damali Martin, Anna E Ordóñez, Mauricio Rangel-Gomez, Natalie Tomitch-Timmons, Jenelle Walker, Dianne M Rausch","doi":"10.1136/bmjgh-2023-013582","DOIUrl":"10.1136/bmjgh-2023-013582","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11144795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141183281","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 : 2024-05-30DOI: 10.1136/bmjgh-2023-014693
Annette Rid, Bernardo Aguilera, Chikosa Banda, Rao Divi, Matthew Harris, Amanda Kim, Miguel Ossandon, John Zervos, Virginia Rowthorn
Global health reciprocal innovation (GHRI) is a recent and more formalised approach to conducting research that recognises and develops innovations (eg, medicines, devices, methodologies) from low- and middle-income countries (LMICs). At present, studies using GHRI most commonly adapt innovations from LMICs for use in high-income countries (HICs), although some develop innovations in LMICs and HICs. In this paper, we propose that GHRI implicitly makes two ethical commitments: (1) to promote health innovations from LMICs, especially in HICs, and (2) to conduct studies on health innovations from LMICs in equitable partnerships between investigators in LMICs and HICs. We argue that these commitments take a significant step towards a more equal global health research enterprise while helping to ensure that populations and investigators in LMICs receive equitable benefits from studies using GHRI. However, studies using GHRI can raise potential ethical concerns and face legal and regulatory barriers. We propose ethical, legal and regulatory considerations to help address these concerns and barriers. We hope our recommendations will allow GHRI to move the global health research enterprise forward into an era where all people are treated equally as knowers and learners, while populations in both LMICs and HICs benefit equitably from studies using GHRI.
{"title":"Global health reciprocal innovation: ethical, legal and regulatory considerations.","authors":"Annette Rid, Bernardo Aguilera, Chikosa Banda, Rao Divi, Matthew Harris, Amanda Kim, Miguel Ossandon, John Zervos, Virginia Rowthorn","doi":"10.1136/bmjgh-2023-014693","DOIUrl":"10.1136/bmjgh-2023-014693","url":null,"abstract":"<p><p>Global health reciprocal innovation (GHRI) is a recent and more formalised approach to conducting research that recognises and develops innovations (eg, medicines, devices, methodologies) from low- and middle-income countries (LMICs). At present, studies using GHRI most commonly adapt innovations from LMICs for use in high-income countries (HICs), although some develop innovations in LMICs and HICs. In this paper, we propose that GHRI implicitly makes two ethical commitments: (1) to promote health innovations from LMICs, especially in HICs, and (2) to conduct studies on health innovations from LMICs in equitable partnerships between investigators in LMICs and HICs. We argue that these commitments take a significant step towards a more equal global health research enterprise while helping to ensure that populations and investigators in LMICs receive equitable benefits from studies using GHRI. However, studies using GHRI can raise potential ethical concerns and face legal and regulatory barriers. We propose ethical, legal and regulatory considerations to help address these concerns and barriers. We hope our recommendations will allow GHRI to move the global health research enterprise forward into an era where all people are treated equally as knowers and learners, while populations in both LMICs and HICs benefit equitably from studies using GHRI.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11144796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141183280","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 : 2024-05-29DOI: 10.1136/bmjgh-2024-015216
Nirmala Ravishankar, Inke Mathauer, Hélène Barroy, Ileana Vîlcu, Michael Chaitkin, Marie Jeanne Offosse, Pura Angela Co, Angellah Nakyanzi, Boniface Mbuthia, Salomão Lourenço, Halimah Mardani, Joseph Kutzin
The interplay between devolution, health financing and public financial management processes in health-or the lack of coherence between them-can have profound implications for a country's progress towards universal health coverage. This paper explores this relationship in seven Asian and African countries (Burkina Faso, Kenya, Mozambique, Nigeria, Uganda, Indonesia and the Philippines), highlighting challenges and suggesting policy solutions. First, subnational governments rely heavily on transfers from central governments, and most are not required to allocate a minimum share of their budget to health. Central governments channelling more funds to subnational governments through conditional grants is a promising way to increase public financing for health. Second, devolution makes it difficult to pool funding across populations by fragmenting them geographically. Greater fiscal equalisation through improved revenue sharing arrangements and, where applicable, using budgetary funds to subsidise the poor in government-financed health insurance schemes could bridge the gap. Third, weak budget planning across levels could be improved by aligning budget structures, building subnational budgeting capacity and strengthening coordination across levels. Fourth, delays in central transfers and complicated procedures for approvals and disbursements stymie expenditure management at subnational levels. Simplifying processes and enhancing visibility over funding flows, including through digitalised information systems, promise to improve expenditure management and oversight in health. Fifth, subnational governments purchase services primarily through line-item budgets. Shifting to practices that link financial allocations with population health needs and facility performance, combined with reforms to grant commensurate autonomy to facilities, has the potential to enable more strategic purchasing.
{"title":"Reconciling devolution with health financing and public financial management: challenges and policy options for the health sector.","authors":"Nirmala Ravishankar, Inke Mathauer, Hélène Barroy, Ileana Vîlcu, Michael Chaitkin, Marie Jeanne Offosse, Pura Angela Co, Angellah Nakyanzi, Boniface Mbuthia, Salomão Lourenço, Halimah Mardani, Joseph Kutzin","doi":"10.1136/bmjgh-2024-015216","DOIUrl":"10.1136/bmjgh-2024-015216","url":null,"abstract":"<p><p>The interplay between devolution, health financing and public financial management processes in health-or the lack of coherence between them-can have profound implications for a country's progress towards universal health coverage. This paper explores this relationship in seven Asian and African countries (Burkina Faso, Kenya, Mozambique, Nigeria, Uganda, Indonesia and the Philippines), highlighting challenges and suggesting policy solutions. First, subnational governments rely heavily on transfers from central governments, and most are not required to allocate a minimum share of their budget to health. Central governments channelling more funds to subnational governments through conditional grants is a promising way to increase public financing for health. Second, devolution makes it difficult to pool funding across populations by fragmenting them geographically. Greater fiscal equalisation through improved revenue sharing arrangements and, where applicable, using budgetary funds to subsidise the poor in government-financed health insurance schemes could bridge the gap. Third, weak budget planning across levels could be improved by aligning budget structures, building subnational budgeting capacity and strengthening coordination across levels. Fourth, delays in central transfers and complicated procedures for approvals and disbursements stymie expenditure management at subnational levels. Simplifying processes and enhancing visibility over funding flows, including through digitalised information systems, promise to improve expenditure management and oversight in health. Fifth, subnational governments purchase services primarily through line-item budgets. Shifting to practices that link financial allocations with population health needs and facility performance, combined with reforms to grant commensurate autonomy to facilities, has the potential to enable more strategic purchasing.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11138286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141178923","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 : 2024-05-24DOI: 10.1136/bmjgh-2023-012853
Aidan Huang, Yingxi Zhao, Chunkai Cao, Mohan Lyu, Kun Tang
Introduction: To empirically investigate sustainability of development assistance for health (DAH), we conducted a retrospective case study on the Basic Health Services Project (BHSP) for rural health system strengthening, supported by the World Bank and the UK in China between 1998 and 2007. Specifically, this study examines the integration of the BHSP interventions into China's health system.
Methods: From December 2021 to December 2022, we reviewed 64 published papers and project or policy documents, and conducted semistructured interviews with 22 key informants, ranging from managers of donor agencies and the government to township-level hospital directors. From February to March 2023, the data were analysed under an analytical framework for integration of targeted health interventions into health systems.
Results: Evidence of the BHSP shows that the integration outcomes can vary by the levels of integration (national or subnational), geographical coverage (project areas or both project and non-project areas) and approach to integration (policy or routinisation). The country's health system reform facilitated the integration of the interventions relevant to the reform policies, as the BHSP was one of the pilot schemes. However, interventions incompatible with this broad context were integrated to a limited extent. This integration occurred through embedding the project within the existing system, with a higher degree of embeddedness leading to smoother integration. Cross-sectoral leading groups and a technical support system heightened the project visibility and enabled contextualised local adaptation, contributing to the smooth integration of the project interventions.
Conclusion: The DAH-supported interventions can achieve sustainability by being integrated into the local health system. This integration can take various forms to improve health outcomes, including being accepted and internalised, modified as well as innovated and expanded. The host country and development partners can promote DAH sustainability by contextually integrating these interventions within the project scope.
{"title":"Integrating interventions supported by development assistance for health into local health system: evidence from a China-World Bank-UK rural health system strengthening project (1998-2007).","authors":"Aidan Huang, Yingxi Zhao, Chunkai Cao, Mohan Lyu, Kun Tang","doi":"10.1136/bmjgh-2023-012853","DOIUrl":"10.1136/bmjgh-2023-012853","url":null,"abstract":"<p><strong>Introduction: </strong>To empirically investigate sustainability of development assistance for health (DAH), we conducted a retrospective case study on the Basic Health Services Project (BHSP) for rural health system strengthening, supported by the World Bank and the UK in China between 1998 and 2007. Specifically, this study examines the integration of the BHSP interventions into China's health system.</p><p><strong>Methods: </strong>From December 2021 to December 2022, we reviewed 64 published papers and project or policy documents, and conducted semistructured interviews with 22 key informants, ranging from managers of donor agencies and the government to township-level hospital directors. From February to March 2023, the data were analysed under an analytical framework for integration of targeted health interventions into health systems.</p><p><strong>Results: </strong>Evidence of the BHSP shows that the integration outcomes can vary by the levels of integration (national or subnational), geographical coverage (project areas or both project and non-project areas) and approach to integration (policy or routinisation). The country's health system reform facilitated the integration of the interventions relevant to the reform policies, as the BHSP was one of the pilot schemes. However, interventions incompatible with this broad context were integrated to a limited extent. This integration occurred through embedding the project within the existing system, with a higher degree of embeddedness leading to smoother integration. Cross-sectoral leading groups and a technical support system heightened the project visibility and enabled contextualised local adaptation, contributing to the smooth integration of the project interventions.</p><p><strong>Conclusion: </strong>The DAH-supported interventions can achieve sustainability by being integrated into the local health system. This integration can take various forms to improve health outcomes, including being accepted and internalised, modified as well as innovated and expanded. The host country and development partners can promote DAH sustainability by contextually integrating these interventions within the project scope.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11129031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141093002","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 : 2024-05-24DOI: 10.1136/bmjgh-2023-013285
Karel Blondeel, Massimo Mirandola, Lorenzo Gios, Cinta Folch, Christiana Noestlinger, Maddalena Cordioli, Petra De Sutter, Marleen Temmerman, Igor Toskin
Introduction: Although sexual health has been holistically defined to include sexual satisfaction, it has been largely absent in health services and sexual and reproductive health and rights programmes in many parts of the world. We propose sexual satisfaction as a useful indicator, as one of the proxy measures for sexual health and well-being and as a component of well-being in general.
Methods: The Sialon II project is a multicentre biological and behavioural cross-sectional community-based survey implemented across 13 European cities during 2013-2014 among men who have sex with men. Sexual satisfaction was explored using one single item: 'How satisfied are you with your sex life?' A multivariable multilevel logistic random-intercept model was estimated to identify factors associated with reporting positive sexual satisfaction versus negative sexual satisfaction.
Results: Age, the number of partners and self-reported HIV status were not significantly associated with sexual satisfaction in the multivariate model. Participants reporting an insertive role or reported both an insertive and receptive role during the last anal intercourse were more likely to be sexually satisfied, compared with a receptive role. Participants reporting anal intercourse with a condom were more likely to be satisfied than those declaring no anal intercourse in the last 6 months, but no significant association was found compared with anal intercourse without condom. Knowledge of HIV-serostatus concordance with the last sexual partner was positively correlated with sexual satisfaction. Having had sexual intercourse with non-steady partners only in the last 6 months was negatively correlated. The more positive participants perceived their work/school, parents and friends/acquaintances' attitudes towards gay or bisexual persons, the higher the odds they were satisfied with their sexual life.
Conclusion: Using a single item on sexual satisfaction in a bio-behavioural study, our analysis has shown that it is associated with individual, interpersonal and social/structural factors and has proven its usefulness as a sexual health indicator among men who have sex with men.
导言:尽管性健康已被全面定义为包括性满足,但在世界许多地方的医疗服务以及性与生殖健康和权利计划中,性满足在很大程度上是缺失的。我们建议将性满足作为一个有用的指标,作为性健康和性幸福的替代措施之一,并作为一般幸福的组成部分:Sialon II 项目是一项多中心生物和行为横断面社区调查,于 2013-2014 年期间在欧洲 13 个城市的男男性行为者中开展。性生活满意度采用单一项目进行调查:您对性生活的满意度如何?我们估算了一个多变量多层次逻辑随机截距模型,以确定报告积极性满意度与消极性满意度的相关因素:结果:在多变量模型中,年龄、性伴侣数量和自我报告的 HIV 感染状况与性满意度无明显关联。在最后一次肛交中扮演插入角色或既扮演插入角色又扮演接受角色的参与者与扮演接受角色的参与者相比,更有可能获得性满意。与声称在过去 6 个月中没有肛交的人相比,报告使用安全套进行肛交的参与者更有可能感到满意,但与不使用安全套进行肛交的人相比,没有发现明显的关联。与最后一个性伴侣的艾滋病毒血清状况是否一致与性满意度呈正相关。在过去 6 个月中仅与非稳定性伴侣发生过性行为则呈负相关。参与者对其工作/学校、父母和朋友/熟人对同性恋或双性恋者的态度的看法越积极,他们对自己的性生活感到满意的几率就越高:我们的分析表明,在一项生物行为研究中,性满意度与个人、人际和社会/结构因素相关,并证明了它作为男男性行为者性健康指标的实用性。
{"title":"Sexual satisfaction, an indicator of sexual health and well-being? Insights from STI/HIV prevention research in European men who have sex with men.","authors":"Karel Blondeel, Massimo Mirandola, Lorenzo Gios, Cinta Folch, Christiana Noestlinger, Maddalena Cordioli, Petra De Sutter, Marleen Temmerman, Igor Toskin","doi":"10.1136/bmjgh-2023-013285","DOIUrl":"10.1136/bmjgh-2023-013285","url":null,"abstract":"<p><strong>Introduction: </strong>Although sexual health has been holistically defined to include sexual satisfaction, it has been largely absent in health services and sexual and reproductive health and rights programmes in many parts of the world. We propose sexual satisfaction as a useful indicator, as one of the proxy measures for sexual health and well-being and as a component of well-being in general.</p><p><strong>Methods: </strong>The Sialon II project is a multicentre biological and behavioural cross-sectional community-based survey implemented across 13 European cities during 2013-2014 among men who have sex with men. Sexual satisfaction was explored using one single item: 'How satisfied are you with your sex life?' A multivariable multilevel logistic random-intercept model was estimated to identify factors associated with reporting positive sexual satisfaction versus negative sexual satisfaction.</p><p><strong>Results: </strong>Age, the number of partners and self-reported HIV status were not significantly associated with sexual satisfaction in the multivariate model. Participants reporting an insertive role or reported both an insertive and receptive role during the last anal intercourse were more likely to be sexually satisfied, compared with a receptive role. Participants reporting anal intercourse with a condom were more likely to be satisfied than those declaring no anal intercourse in the last 6 months, but no significant association was found compared with anal intercourse without condom. Knowledge of HIV-serostatus concordance with the last sexual partner was positively correlated with sexual satisfaction. Having had sexual intercourse with non-steady partners only in the last 6 months was negatively correlated. The more positive participants perceived their work/school, parents and friends/acquaintances' attitudes towards gay or bisexual persons, the higher the odds they were satisfied with their sexual life.</p><p><strong>Conclusion: </strong>Using a single item on sexual satisfaction in a bio-behavioural study, our analysis has shown that it is associated with individual, interpersonal and social/structural factors and has proven its usefulness as a sexual health indicator among men who have sex with men.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11129029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141093004","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 : 2024-05-23DOI: 10.1136/bmjgh-2024-015098
Brayden G Schindell, Bev Fredborg, Kaarina Kowalec, Souradet Shaw, Jia B Kangbai, Jason Kindrachuk
Background: The West African Ebola virus disease (EVD) epidemic resulted in >28 000 disease cases and >11 000 fatalities. The unprecedented number of survivors from this epidemic has raised questions about the long-term mental health impacts of EVD survivorship and the capacity to meet these needs.
Objectives: Assess the frequency and factors associated with mental health consequences of EVD survivorship in Sierra Leone.
Methods: A cross-sectional study of 595 EVD survivors and 403 close contacts (n=998) from Sierra Leone assessed via in-person survey between November 2021 and March 2022. The assessment included validated mental health screening tools (Patient Health Questionnaire-9, PTSD Checklist-5, Alcohol Use Disorders Identification Test, Drug Abuse Screening Test-20) to indicate the presence/absence of disorder. The frequency of each disorder and factors associated with each disorder were assessed.
Findings: EVD-associated post-traumatic stress disorder (PTSD) was reported by 45.7% (n=257) of EVD survivors. Moreover, 3.9% (n=22) and 12.0% (n=67) of EVD survivors reported major depression (MD) and substance use, respectively; all mental health outcomes were higher than baseline rates in the region (PTSD: 6%-16%, MD: 1.1%, substance use: 2.2%). PTSD among EVD survivors was associated with acute EVD duration of ≥21 days (adjusted OR, AOR 2.24, 95% CI 1.16 to 4.43), 35-44 years of age (AOR 3.31, 95% CI 1.33 to 8.24; AOR 2.99, 95% CI 1.09 to 8.24) and residential mobility (AOR 4.16, 95% CI 2.35 to 7.35).
Conclusions: Concerningly, the levels of mental health disorders among EVD survivors in Sierra Leone remained elevated 6-8 years after recovery.
Clinical implications: Results can be used to inform policy efforts and target resources to address mental health in EVD survivors.
{"title":"The state of mental health among Ebola virus disease survivors through a cross-sectional study in Sierra Leone.","authors":"Brayden G Schindell, Bev Fredborg, Kaarina Kowalec, Souradet Shaw, Jia B Kangbai, Jason Kindrachuk","doi":"10.1136/bmjgh-2024-015098","DOIUrl":"10.1136/bmjgh-2024-015098","url":null,"abstract":"<p><strong>Background: </strong>The West African Ebola virus disease (EVD) epidemic resulted in >28 000 disease cases and >11 000 fatalities. The unprecedented number of survivors from this epidemic has raised questions about the long-term mental health impacts of EVD survivorship and the capacity to meet these needs.</p><p><strong>Objectives: </strong>Assess the frequency and factors associated with mental health consequences of EVD survivorship in Sierra Leone.</p><p><strong>Methods: </strong>A cross-sectional study of 595 EVD survivors and 403 close contacts (n=998) from Sierra Leone assessed via in-person survey between November 2021 and March 2022. The assessment included validated mental health screening tools (Patient Health Questionnaire-9, PTSD Checklist-5, Alcohol Use Disorders Identification Test, Drug Abuse Screening Test-20) to indicate the presence/absence of disorder. The frequency of each disorder and factors associated with each disorder were assessed.</p><p><strong>Findings: </strong>EVD-associated post-traumatic stress disorder (PTSD) was reported by 45.7% (n=257) of EVD survivors. Moreover, 3.9% (n=22) and 12.0% (n=67) of EVD survivors reported major depression (MD) and substance use, respectively; all mental health outcomes were higher than baseline rates in the region (PTSD: 6%-16%, MD: 1.1%, substance use: 2.2%). PTSD among EVD survivors was associated with acute EVD duration of ≥21 days (adjusted OR, AOR 2.24, 95% CI 1.16 to 4.43), 35-44 years of age (AOR 3.31, 95% CI 1.33 to 8.24; AOR 2.99, 95% CI 1.09 to 8.24) and residential mobility (AOR 4.16, 95% CI 2.35 to 7.35).</p><p><strong>Conclusions: </strong>Concerningly, the levels of mental health disorders among EVD survivors in Sierra Leone remained elevated 6-8 years after recovery.</p><p><strong>Clinical implications: </strong>Results can be used to inform policy efforts and target resources to address mental health in EVD survivors.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11116873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086837","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 : 2024-05-22DOI: 10.1136/bmjgh-2023-014749
Saroj Jayasinghe
Global rates of armed conflicts have shown an alarming increase since 2008. These conflicts have devastating and long-term cumulative impacts on health. The overriding aim in these conflicts is to achieve military or political goals by harming human life, which is the antithesis of the moral underpinnings of the health professions. However, the profession has rarely taken on a global advocacy role to prevent and eliminate conflicts and wars. To assume such a role, the health profession needs to be aware of the extensive and multiple impacts that wars have on population health. To facilitate this discourse, the author proposes a novel framework called 'The Twelve Dimensions of Health Impacts of War' (or the 12-D framework). The framework is based on the concepts of social and environmental determinants of population health. It has 12 interconnected 'dimensions' beginning with the letter D, capturing the adverse impacts on health (n=5), its social (n=4) and environmental determinants (n=3). For health, the indices are Deaths, Disabilities, Diseases, Dependency and Deformities. For social determinants of health, there are Disparities in socioeconomic status, Displacements of populations, Disruptions to the social fabric and Development reversals. For environmental determinants, there is Destruction of infrastructure, Devastation of the environment and Depletion of natural resources. A relatively simple framework could help researchers and lay public to understand the magnitude and quantify the widespread health, social and environmental impacts of war, comprehensively. Further validation and development of this framework are necessary to establish it as a universal metric for quantifying the horrific impacts of war on the planet and garner support for initiatives to promote global peace.
{"title":"The 12 dimensions of health impacts of war (the 12-D framework): a novel framework to conceptualise impacts of war on social and environmental determinants of health and public health.","authors":"Saroj Jayasinghe","doi":"10.1136/bmjgh-2023-014749","DOIUrl":"10.1136/bmjgh-2023-014749","url":null,"abstract":"<p><p>Global rates of armed conflicts have shown an alarming increase since 2008. These conflicts have devastating and long-term cumulative impacts on health. The overriding aim in these conflicts is to achieve military or political goals by harming human life, which is the antithesis of the moral underpinnings of the health professions. However, the profession has rarely taken on a global advocacy role to prevent and eliminate conflicts and wars. To assume such a role, the health profession needs to be aware of the extensive and multiple impacts that wars have on population health. To facilitate this discourse, the author proposes a novel framework called 'The Twelve Dimensions of Health Impacts of War' (or the 12-D framework). The framework is based on the concepts of social and environmental determinants of population health. It has 12 interconnected 'dimensions' beginning with the letter D, capturing the adverse impacts on health (n=5), its social (n=4) and environmental determinants (n=3). For health, the indices are Deaths, Disabilities, Diseases, Dependency and Deformities. For social determinants of health, there are Disparities in socioeconomic status, Displacements of populations, Disruptions to the social fabric and Development reversals. For environmental determinants, there is Destruction of infrastructure, Devastation of the environment and Depletion of natural resources. A relatively simple framework could help researchers and lay public to understand the magnitude and quantify the widespread health, social and environmental impacts of war, comprehensively. Further validation and development of this framework are necessary to establish it as a universal metric for quantifying the horrific impacts of war on the planet and garner support for initiatives to promote global peace.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11116856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080583","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 : 2024-05-22DOI: 10.1136/bmjgh-2024-015053
Manuela Fritz, Michael Grimm, Hoang Thi My Hanh, Jaap A R Koot, Giang Hoang Nguyen, Thi-Phuong-Lan Nguyen, Ari Probandari, Vitri Widyaningsih, Robert Lensink
Introduction: Non-communicable diseases (NCDs) have surpassed infectious diseases as the leading global cause of death, with the Southeast Asian region experiencing a significant rise in NCD prevalence over the past decades. Despite the escalating burden, screening for NCDs remains at very low levels, resulting in undetected cases, premature mortality and high public healthcare costs. We investigate whether community-based NCD prevention and management programmes are an effective solution.
Methods: In Indonesia, we compare participants in the community-based NCD screening and management programme Pos Pembinaan Terpadu-Penyakit Tidak Menular with matched non-participants with respect to their uptake of screening activities, health-related behaviour and knowledge and metabolic risk factors. We use statistical matching to redress a possible selection bias (n=1669). In Viet Nam, we compare members of Intergenerational Self-Help Clubs, which were offered similar NCD health services, with members of other community groups, where such services were not offered. We can rely on two waves of data and use a double-difference approach to redress a possible selection bias and to measure the impacts of participation (n=1710). We discuss strengths and weaknesses of the two approaches in Indonesia and Viet Nam.
Results: In Indonesia, participants have significantly higher uptake of screening for hypertension and diabetes (+13% from a control mean of 88% (95% CI 9% to 17%); +93% from a control mean of 48% (95% CI 79% to 108%)). In both countries, participants show a higher knowledge about risk factors, symptoms and complications of NCDs (Indonesia: +0.29 SD (0.13-0.45), Viet Nam: +0.17 SD (0.03-0.30)). Yet, the improved knowledge is only partly reflected in improved health behaviour (Viet Nam: fruit consumption +0.33 SD (0.15-0.51), vegetable consumption +0.27 SD (0.04-0.50)), body mass index (BMI) (Viet Nam: BMI -0.07 SD (-0.13 to -0.00)) or metabolic risk factors (Indonesia: systolic blood pressure: -0.13 SD (-0.26 to -0.00)).
Conclusion: Community-based NCD programmes are well suited to increase screening and to transmit health knowledge. Due to their extensive outreach within the community, they can serve as a valuable complement to the screening services provided at the primary healthcare level. Yet, limited coverage, insufficient resources and a high staff turnover remain a problem.
{"title":"Effectiveness of community-based diabetes and hypertension prevention and management programmes in Indonesia and Viet Nam: a quasi-experimental study.","authors":"Manuela Fritz, Michael Grimm, Hoang Thi My Hanh, Jaap A R Koot, Giang Hoang Nguyen, Thi-Phuong-Lan Nguyen, Ari Probandari, Vitri Widyaningsih, Robert Lensink","doi":"10.1136/bmjgh-2024-015053","DOIUrl":"10.1136/bmjgh-2024-015053","url":null,"abstract":"<p><strong>Introduction: </strong>Non-communicable diseases (NCDs) have surpassed infectious diseases as the leading global cause of death, with the Southeast Asian region experiencing a significant rise in NCD prevalence over the past decades. Despite the escalating burden, screening for NCDs remains at very low levels, resulting in undetected cases, premature mortality and high public healthcare costs. We investigate whether community-based NCD prevention and management programmes are an effective solution.</p><p><strong>Methods: </strong>In Indonesia, we compare participants in the community-based NCD screening and management programme <i>Pos Pembinaan Terpadu-Penyakit Tidak Menular</i> with matched non-participants with respect to their uptake of screening activities, health-related behaviour and knowledge and metabolic risk factors. We use statistical matching to redress a possible selection bias (n=1669). In Viet Nam, we compare members of <i>Intergenerational Self-Help Clubs</i>, which were offered similar NCD health services, with members of other community groups, where such services were not offered. We can rely on two waves of data and use a double-difference approach to redress a possible selection bias and to measure the impacts of participation (n=1710). We discuss strengths and weaknesses of the two approaches in Indonesia and Viet Nam.</p><p><strong>Results: </strong>In Indonesia, participants have significantly higher uptake of screening for hypertension and diabetes (+13% from a control mean of 88% (95% CI 9% to 17%); +93% from a control mean of 48% (95% CI 79% to 108%)). In both countries, participants show a higher knowledge about risk factors, symptoms and complications of NCDs (Indonesia: +0.29 SD (0.13-0.45), Viet Nam: +0.17 SD (0.03-0.30)). Yet, the improved knowledge is only partly reflected in improved health behaviour (Viet Nam: fruit consumption +0.33 SD (0.15-0.51), vegetable consumption +0.27 SD (0.04-0.50)), body mass index (BMI) (Viet Nam: BMI -0.07 SD (-0.13 to -0.00)) or metabolic risk factors (Indonesia: systolic blood pressure: -0.13 SD (-0.26 to -0.00)).</p><p><strong>Conclusion: </strong>Community-based NCD programmes are well suited to increase screening and to transmit health knowledge. Due to their extensive outreach within the community, they can serve as a valuable complement to the screening services provided at the primary healthcare level. Yet, limited coverage, insufficient resources and a high staff turnover remain a problem.</p><p><strong>Trial registration number: </strong>NCT05239572.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11116884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080579","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 : 2024-05-16DOI: 10.1136/bmjgh-2023-014943
Yusuf Ari Mashuri, David Boettiger, Siska Dian Wahyuningtias, Srila Nirmithya Salita Negara, Yanri Wijayanti Subronto, Marco Liverani, Luh Putu Lila Wulandari, Riris Andono Ahmad, Hasbullah Thabrany, Nasser Fardousi, John Kaldor, Ari Probandari, Virginia Wiseman
Introduction: In Indonesia, a country with around 280 million people and the second-highest tuberculosis (TB) incidence rate in the world, the impact of the COVID-19 pandemic on TB care needs careful assessment so that future response strategies can be strengthened. We conducted a study comparing TB testing and treatment rates before and during the first 2 years of the COVID-19 pandemic in Indonesia, and the reasons for any disruptions to care.
Methods: We conducted retrospective secondary data analysis and qualitative interviews in Yogyakarta and Bandung, Indonesia. Routine data on TB testing and treatment were sourced from the national TB information system operated by the Indonesian Ministry of Health. TB testing and treatment outcomes were compared between two time periods: pre-COVID (2018-19); and during COVID-19 (2020-21). In-depth interviews were conducted with patients and health workers to explore their experiences in accessing and providing TB services during the pandemic.
Results: There was a 45% (21 937/39 962) reduction in the number of patients tested for TB during the pandemic compared with pre-COVID-19, while the proportion of TB tests returning a positive result increased from 12% (4733/39 962) to 50% (10 945/21 937). The proportion of TB patients completing treatment increased by 2.6% during the pandemic, yet the proportion cured and the number of patients successfully treated both decreased (by 7% and 4.4%, respectively). Our qualitative interviews highlighted several factors influencing TB service access and delivery, including fear of being diagnosed with COVID-19 during TB-related clinic visits, fear of COVID-19 exposure among patients and health workers, healthcare facilities prioritising COVID-19 over other services, and mandatory mobility restrictions affecting both patients and health workers.
Conclusion: The COVID-19 pandemic impacted TB testing and treatment outcomes in Bandung and Yogyakarta. Policymakers should consider these findings in designing strategies to ensure TB services are maintained and supported during future health crises.
{"title":"\"I pity the TB patient\": a mixed methods study assessing the impact of the COVID-19 pandemic on TB services in two major Indonesian cities and distilling lessons for the future.","authors":"Yusuf Ari Mashuri, David Boettiger, Siska Dian Wahyuningtias, Srila Nirmithya Salita Negara, Yanri Wijayanti Subronto, Marco Liverani, Luh Putu Lila Wulandari, Riris Andono Ahmad, Hasbullah Thabrany, Nasser Fardousi, John Kaldor, Ari Probandari, Virginia Wiseman","doi":"10.1136/bmjgh-2023-014943","DOIUrl":"10.1136/bmjgh-2023-014943","url":null,"abstract":"<p><strong>Introduction: </strong>In Indonesia, a country with around 280 million people and the second-highest tuberculosis (TB) incidence rate in the world, the impact of the COVID-19 pandemic on TB care needs careful assessment so that future response strategies can be strengthened. We conducted a study comparing TB testing and treatment rates before and during the first 2 years of the COVID-19 pandemic in Indonesia, and the reasons for any disruptions to care.</p><p><strong>Methods: </strong>We conducted retrospective secondary data analysis and qualitative interviews in Yogyakarta and Bandung, Indonesia. Routine data on TB testing and treatment were sourced from the national TB information system operated by the Indonesian Ministry of Health. TB testing and treatment outcomes were compared between two time periods: pre-COVID (2018-19); and during COVID-19 (2020-21). In-depth interviews were conducted with patients and health workers to explore their experiences in accessing and providing TB services during the pandemic.</p><p><strong>Results: </strong>There was a 45% (21 937/39 962) reduction in the number of patients tested for TB during the pandemic compared with pre-COVID-19, while the proportion of TB tests returning a positive result increased from 12% (4733/39 962) to 50% (10 945/21 937). The proportion of TB patients completing treatment increased by 2.6% during the pandemic, yet the proportion cured and the number of patients successfully treated both decreased (by 7% and 4.4%, respectively). Our qualitative interviews highlighted several factors influencing TB service access and delivery, including fear of being diagnosed with COVID-19 during TB-related clinic visits, fear of COVID-19 exposure among patients and health workers, healthcare facilities prioritising COVID-19 over other services, and mandatory mobility restrictions affecting both patients and health workers.</p><p><strong>Conclusion: </strong>The COVID-19 pandemic impacted TB testing and treatment outcomes in Bandung and Yogyakarta. Policymakers should consider these findings in designing strategies to ensure TB services are maintained and supported during future health crises.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11103193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955953","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 : 2024-05-16DOI: 10.1136/bmjgh-2023-013902
Claire W Rothschild, Alhaji Bulama, Roselyn Odeh, Salome Chika-Igbokwe, Julius Njogu, Katherine Tumlinson, Abednego Musau
Introduction: Universal access to sexual and reproductive healthcare-including family planning (FP)-is a global priority, yet there is no standard outcome measure to evaluate rights-based FP programme performance at the regional, national or global levels.
Methods: We collected a modified version of preference-aligned fertility management (PFM), a newly proposed rights-based FP outcome measure which we operationalised as concordance between an individual's desired and actual current contraceptive use. We also constructed a modified version (satisfaction-adjusted PFM) that reclassified current contraceptive users who wanted to use contraception but who were dissatisfied with their method as not having PFM. Our analysis used data collected 3.5 months after contraceptive method initiation within an ongoing prospective cohort of married adolescent girls aged 15-19 years in Northern Nigeria. We described and compared prevalence of contraceptive use and PFM in this population.
Results: Ninety-seven per cent (n=1020/1056) of respondents were practising PFM 3.5 months after initiating modern contraception, while 93% (n=986/1056) were practising satisfaction-adjusted PFM. Among participants not practising satisfaction-adjusted PFM (n=70), most were using contraception but did not want to be (n=30/70, 43%) or wanted to use contraception but were dissatisfied with their method (n=34/70, 49%), while the remaining 9% (n=6/70) wanted but were not currently using contraception.
Conclusion: PFM captured meaningful discordance between contraceptive use desires and behaviours in this cohort of married Nigerian adolescent girls. Observed discordance in both directions provides actionable insights for intervention. PFM is a promising rights-focused FP outcome measure that warrants future field-testing in programmatic and population-based research.
{"title":"Preference-aligned fertility management among married adolescent girls in Northern Nigeria: assessing a new measure of contraceptive autonomy.","authors":"Claire W Rothschild, Alhaji Bulama, Roselyn Odeh, Salome Chika-Igbokwe, Julius Njogu, Katherine Tumlinson, Abednego Musau","doi":"10.1136/bmjgh-2023-013902","DOIUrl":"10.1136/bmjgh-2023-013902","url":null,"abstract":"<p><strong>Introduction: </strong>Universal access to sexual and reproductive healthcare-including family planning (FP)-is a global priority, yet there is no standard outcome measure to evaluate rights-based FP programme performance at the regional, national or global levels.</p><p><strong>Methods: </strong>We collected a modified version of preference-aligned fertility management (PFM), a newly proposed rights-based FP outcome measure which we operationalised as concordance between an individual's desired and actual current contraceptive use. We also constructed a modified version (satisfaction-adjusted PFM) that reclassified current contraceptive users who wanted to use contraception but who were dissatisfied with their method as not having PFM. Our analysis used data collected 3.5 months after contraceptive method initiation within an ongoing prospective cohort of married adolescent girls aged 15-19 years in Northern Nigeria. We described and compared prevalence of contraceptive use and PFM in this population.</p><p><strong>Results: </strong>Ninety-seven per cent (n=1020/1056) of respondents were practising PFM 3.5 months after initiating modern contraception, while 93% (n=986/1056) were practising satisfaction-adjusted PFM. Among participants not practising satisfaction-adjusted PFM (n=70), most were using contraception but did not want to be (n=30/70, 43%) or wanted to use contraception but were dissatisfied with their method (n=34/70, 49%), while the remaining 9% (n=6/70) wanted but were not currently using contraception.</p><p><strong>Conclusion: </strong>PFM captured meaningful discordance between contraceptive use desires and behaviours in this cohort of married Nigerian adolescent girls. Observed discordance in both directions provides actionable insights for intervention. PFM is a promising rights-focused FP outcome measure that warrants future field-testing in programmatic and population-based research.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11103226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955972","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}