BMJ Global Health最新文献

Climate change is already leading to loss of health for some people and this is expected to intensify as climate change increases. Moreover, ill health from climate change is experienced unevenly: overall, those who have been least responsible for causing the problem are often those most vulnerable to these losses due to the intersection of climate-related health threats with structural inequality. In this context, there have been multiple arguments made for reparations intended to address disproportionate climate impacts. While the United Nations Framework Convention on Climate Change has been a focus for these efforts, due to political challenges, a more distributed, multifaceted approach to reparations may be needed. This analysis provides a summary of reparative arguments and identifies multiple potential pathways towards reparative efforts intended to address losses in health due to climate change.

Introduction: The guideline development process for the WHO guideline on prevention and management of wasting and nutritional oedema highlighted extensive evidence gaps. We, the WHO Steering Committee and methodologists for the 2023 WHO guideline, therefore aimed to develop a comprehensive global research priority agenda for wasting and nutritional oedema in infants and children. It has a timeframe up to 2030 aligning with the Sustainable Development Goals and Global Nutrition Targets related to wasting and nutritional oedema.

Methods: We used a Child Health and Nutrition Research Initiative (CHNRI) exercise to develop this research priority agenda for four populations and topics of interest: (1) infants less than 6 months of age at risk of poor growth and development; (2) infants and children 6-59 months of age with severe wasting and/or nutritional oedema; (3) infants and children 6-59 months of age with moderate wasting and (4) prevention of wasting and nutritional oedema. For this CHNRI process, we conducted two anonymous surveys, the first to ensure the list of research questions was comprehensive and clear, and the second to score research questions based on their answerability, effectiveness, deliverability and effects on equity.

Results: 63 people from 28 countries completed survey 1 and 50 people from 23 countries completed survey 2. We identified 10 priority research questions for each of the four populations and topics of interest, which had median research priority scores of 89.9 (IQR 2.8) and average expert agreement scores with a median of 83.4 (IQR 4.5) indicating high agreement. The research questions are largely focused on delivery and effectiveness of interventions for prevention and management of wasting and nutritional oedema rather than discovery or development.

Conclusions: This research priority agenda will guide researchers and research institutions, funders and others to address pressing research questions on wasting and nutritional oedema.

Conflict-related sexual violence (CRSV) generates devastating harms that affect the individual victim (female, male, Lesbian, Gay, Bisexual, Transgender, Intersex, Queer and inclusive of other orientations (LGBTIQ+), disabled, young and elderly), families, communities and the whole fabric of society. CRSV is a public health concern as it can lead to health consequences including physical, psychosocial and stigma-related harms that are exacerbated by a lack of healthcare infrastructure. There has been some progress on understanding the harm, but data gaps prevail due to practical reasons, definitional problems and stigma.When violations of human rights or humanitarian law take place, diverse harms can occur, and victims have a right to reparation as enshrined in international law. Reparation aims to address, as far as possible, the multiple harms victims suffer and to positively transform their lives. The right to reparation is fulfilled through a victim-centred process and delivered via appropriate forms of reparation: restitution, compensation, rehabilitation, satisfaction measures and guarantees of non-repetition. When implemented in a timely, participatory and inclusive manner, reparations can have a transformative impact on victims of CRSV. The process should be prompt and combined with individual monetary and rehabilitation measures alongside clear institutional and societal reforms to ensure the non-repetition of such violations. Domestic reparation programmes, fully supported by government and other stakeholders such as health professionals, offer the most sustainable framework for achieving these goals.

In 2005, the governments of Bangladesh, India and Nepal, in partnership with the WHO, started the Kala-azar Elimination Programme (KEP) to reduce the incidence of visceral leishmaniasis to below 1 new case in 10 000 population. The target was achieved by Bangladesh in 2017 and validated in 2023. The KEP has demonstrated that, through a concerted approach and public-private partnership, it is possible to eliminate visceral leishmaniasis from the world's highest endemic region, Southeast Asia. The experience learnt can be used elsewhere for visceral leishmaniasis as well as for other diseases targeted for elimination.

Community engagement and approaches that aim to change unequal power relations are essential for inclusive, relevant and sustainable health interventions. A people-centred approach to research and programme implementation can amplify the voices of disadvantaged and often forgotten people and move towards genuine partnership with the communities, ensuring that research and action meaningfully reflect the priorities and realities of those most affected.

The inequitable global distribution of resources for research parallels the unequal global distribution of morbidity and mortality due to infectious diseases. Significant gaps in research capacity prevail, and equitable and accessible opportunities for research remain a priority. We argue for the democratisation of research: without equitable participation in, and ownership of, research, by those who are implementing the research or are part of the communities being researched, contextualised research needs and health system bottlenecks will remain unresolved. This perpetuates an inequitable power balance related to research and innovation. Equitable research capacity is fundamental to tackling global health challenges and reducing health inequity. We emphasise the evolution from externally driven, high-income-centric models of research capacity strengthening towards inclusive, context-sensitive approaches that prioritise local ownership, diversity and sustainability. A paradigm shift from 'imposing technical support' to 'fostering ownership of knowledge' has catalysed new models of engagement, such as implementation research capacity among health professionals and communities, and regionally anchored postgraduate training. Institutionalised, inclusive research can align with national priorities and yield measurable improvements in health outcomes. However, persistent inequities rooted in gender, geography and institutional hierarchies continue to constrain participation and impact. Addressing these requires deliberate strategies to democratise access, diversify partnerships and support under-represented institutions and individuals. Allowing dynamic roles in long-term partnerships and regional networks on a continuum between academic partners and capacity-strengthening recipients can support mitigation of intersectional inequities and lead to capacity strengthening.

Introduction: Climate-sensitive mortality in rapidly urbanising tropical Africa is poorly characterised, and how pandemics disrupt established seasonal patterns remains underexplored. We analysed long-term all-cause mortality in Lusaka, Zambia, to quantify pre-COVID-19 seasonality and examine pandemic-associated deviations.

Methods: We conducted an observational, exploratory longitudinal time-series analysis of routinely collected monthly all-cause mortality data from Lusaka, Zambia (January 2013 to December 2023; n=180 276). Seasonal dynamics were assessed using classical decomposition and Kruskal-Wallis tests. Structural breaks were identified using Bai-Perron and cumulative sum control chart (CUSUM) analyses. A parsimonious Seasonal Autoregressive Integrated Moving Average (SARIMA) model, selected via Akaike information criterion-based automated procedures and validated using rolling-origin cross-validation, was used to benchmark pre-pandemic forecast performance. Analyses were based on aggregated mortality counts in a population with a high paediatric mortality burden.

Results: Pre-pandemic mortality exhibited two seasonal peaks: the rainy season (November to March), 22% above the annual mean (95% CI 15% to 29%) and the cool-dry season (June to July), 18% above (95% CI 12% to 24%). Two structural breakpoints temporally aligned with pandemic onset (March 2020) and a subsequent transition toward more stable post-pandemic patterns (May 2022). During the pandemic period, cold-season mortality increased by 41% (95% CI 32% to 50%), while rainy-season mortality declined by 28% (95% CI -35% to -21%). Overall seasonality weakened after 2020 (p=0.14 vs pre-pandemic p=0.05). The SARIMA model showed good pre-pandemic accuracy (root mean square error (RMSE)=245; MAPE=9%) but underestimated mortality during pandemic surges.

Conclusions: COVID-19 coincided with substantial disruption and attenuation of established seasonal mortality patterns in Lusaka. These observational findings highlight the value and limitations of routine mortality surveillance and forecasting for situational awareness and preparedness in rapidly urbanising, resource-constrained settings.

This article proposes a cosmopolitan theory of global health ethics based on reconciliatory solidarity at both local and global levels. The proposed theory provides the ethical and empirical grounds for the moral imperative of global health solidarity that is often called on today. Reconciliatory solidarity requires that a people/nation-state address the historical injustice and the legacies of political violence within its boundary, with the social connection model suggested by the political philosopher Iris M Young. Reconciliatory solidarity has advantages over the prevalent human rights-based approach and utilitarianism in addressing historical injustice. Through the rectifying efforts, true parochial reconciliation would be possible at the local level, serving as the prerequisite for reconciliation beyond national borders. With a fair number of well-ordered societies and nation-states, cosmopolitan reconciliation and genuine global solidarity would be possible.

Introduction: Infectious diarrhoea causes millions of deaths annually in low-income countries. Prevention strategies minimising transmission of diarrhoeal pathogens could include adopting better food hygiene practices. The objective was to assess whether a complementary-food hygiene intervention improved family-food hygiene practices in rural Gambian households.

Methods: A parallel cluster randomised controlled trial was conducted in central Gambia. 30 villages were randomised within strata (north/south of the river, population quartiles) to intervention or control (1:1 ratio) by a UK statistician using a computer-generated sequence. Clusters had a population of 200-450, two health workers and were more than 5 km apart. The 4-day community-based intervention occurred over 1 month, with a reminder visit 4 months later. Competitions, performing arts and songs encouraged caregivers to practice five target complementary-food hygiene behaviours using emotional drivers and social norms. Control villages received a 1 day campaign on water usage in gardening. Caregivers lived in the same village during the intervention and had a 6-36 month old child, though some were new mothers. Findings reported here were secondary outcomes analysed as intention-to-treat. This included the proportion of occasions caregivers practiced five food hygiene behaviours for family-food preparation (three handwashing, one dishes/utensils washing and one re-heating food), measured by direct observation 32 months post intervention. Observers did not deliver the intervention and were masked/blinded to the group allocation of the villages.

Results: At 32 months (20 September 2017 to 26 October 2017), 371 and 376 caregivers were analysed from 15 intervention and 15 control villages, respectively. There was greater adherence to the five behaviours in the intervention group; intervention 2073/4425 (47.0%), control 1827/4559 (40.1%), rate ratio (RR) 1.17 (95% CI 1.08 to 1.27, p<0.001), driven by better adherence to handwashing behaviours.

Conclusion: This community-based complementary-food hygiene intervention additionally improved family-food hygiene behaviours 32 months post intervention.

Trial registration number: PACTR201410000859336.