BMJ Global Health最新文献

Introduction: The role of global health and sustainable development in medical education is often debated. However, research regarding medical doctors' views on the application of their global health knowledge in the clinical setting remains scarce. This study aimed to explore junior doctors' perceptions of global health and sustainable development, the education they have received on these issues and the relevance of this knowledge in their current and future work.

Methods: This was a qualitative study based on individual interviews conducted between May and June 2022. 16 junior doctors, in mandatory clinical training after completing medical school, were purposively sampled from five Swedish hospitals. Transcripts were analysed using qualitative content analysis.

Results: Three themes were identified. The first theme (1) 'medical doctors have a role in the transition to a sustainable society', shows that sustainable development is increasingly perceived as relevant for junior doctors' clinical work. The second theme (2) 'global health and sustainable development teaching is inconsistent and somewhat outdated', highlights that there is an assumption that global health and sustainable development can be self-taught. A discrepancy between what is being taught in medical school and the clinical reality is also recognised. This causes challenges in applying global health interest and knowledge in the clinical setting, which is described in the third theme (3) 'application of global health and sustainable development is difficult'. This theme also highlights opportunities for continued engagement, with the perceived benefit of becoming a more versatile doctor.

Conclusion: This study emphasises the need for conceptual clarity regarding global health in medical education and raises the need for clarification regarding the level of responsibility for integrating sustainable practices in Swedish healthcare settings.

The COVID-19 pandemic had a disproportionate impact on minoritised ethnic groups in the UK, including newly arrived Roma communities. Employing ethnographic and participatory methods, this study illustrates how systemic barriers, including precarious employment and overcrowded housing, coupled with strategies of identity concealment to avoid stigma, severely restrict access to healthcare among Bulgarian Roma communities in the UK. Drawing from fieldwork in Leicester and London, the research reveals how the pandemic amplified the vulnerabilities of Roma populations, directly linking the effects of the pandemic with broader sociopolitical dynamics, including the uncertainties and discrimination associated with Brexit. The findings point to the critical role of community, mutual and familial support networks as essential survival strategies. However, these social networks are also increasingly depleted, revealing the fragility and limits of informal communal resources. The study calls for the development of inclusive health strategies sensitive to the socio-economic and political complexities affecting marginalised communities in the UK and beyond.

Background: The arboviruses continue to be a threat to public health and socioeconomic development in sub-Saharan Africa (SSA). Seroprevalence surveys can be used as a population surveillance strategy for arboviruses in the absence of treatment and vaccines for most arboviruses, guiding the public health interventions. The objective of this study was to analyse the seroprevalence of arboviruses in SSA through a systematic review and meta-analysis.

Methods: We searched PubMed/MEDLINE, Web of Science, Embase, Scopus and ScienceDirect databases for articles published between 2000 and 2022 reporting the seroprevalence of immunoglobulin G (IgG) antibodies to seven arboviruses in various human populations residing in SSA. The included studies were assessed using the checklist for assessing the risk of bias in prevalence studies, and the data were extracted using a standard form. A random effects model was used to estimate pooled seroprevalences. The potential sources of heterogeneity were explored through subgroup analyses and meta-regression. The protocol had been previously registered on International Prospective Register of Systematic Reviews with the identifier: CRD42022377946.

Results: A total of 165 studies from 27 countries, comprising 186 332 participants, were included. Of these, 141 were low-risk and 24 were moderate-risk. The pooled IgG seroprevalence was 23.7% (17.9-30.0%) for Chikungunya virus, 22.7% (17.5-28.4%) for dengue virus, 22.6% (14.1-32.5%) for West Nile virus, 16.4% (7.1-28.5%) for yellow fever virus, 13.1% (6.4-21.7%) for Zika virus, 9.2% (6.5-12.3%) for Rift Valley fever virus and 6.0% (3.1-9.7) for Crimean-Congo haemorrhagic fever virus. Subgroup and meta-regression analyses showed that seroprevalence differed considerably between countries, study populations, specific age categories, sample sizes and laboratory methods.

Conclusion: This SRMA provides information on the significant circulation of various arboviruses in SSA, which is essential for the adoption and planning of vaccines. These findings suggest the need to invest in surveillance and research activities on arbovirus in SSA countries to increase our understanding of their epidemiology to prevent and respond to future epidemics.

Background: Digital adherence technologies (DATs) may provide a patient-centred approach to supporting tuberculosis (TB) medication adherence and improving treatment outcomes. We synthesised evidence addressing costs and cost-effectiveness of DATs to support TB treatment.

Methods: A systematic review (PROSPERO-CRD42022313531) identified relevant literature from January 2000 to April 2023 in MEDLINE, Embase, CENTRAL, CINAHL, Web of Science along with preprints from medRxiv, Europe PMC and ClinicalTrials.gov. Studies with observational, experimental or quasi-experimental designs (minimum 20 participants) and modelling studies reporting quantitative data on the cost or cost-effectiveness of DATs for TB infection or disease treatment were included. Study characteristics, cost and cost-effectiveness outcomes were extracted.

Results: Of 3619 titles identified by our systematic search, 29 studies met inclusion criteria, of which 9 addressed cost-effectiveness. DATs included short message service (SMS) reminders, phone-based technologies, digital pillboxes, ingestible sensors and video-observed therapy (VOT). VOT was the most extensively studied (16 studies) and was generally cost saving when compared with healthcare provider directly observed therapy (DOT), particularly when costs to patients were included-though findings were largely from high-income countries. Cost-effectiveness findings were highly variable, ranging from no clinical effect in one study (SMS), to greater effectiveness with concurrent cost savings (VOT) in others. Only eight studies adequately reported at least 80% of the elements required by Consolidated Health Economic Evaluation Reporting Standards, a standard reporting checklist for health economic evaluations.

Conclusion: DATs may be cost saving or cost-effective compared with healthcare provider DOT, particularly in high-income settings. However, more data of higher quality are needed, notably in lower-income and middle-income countries which have the greatest TB burden.

Introduction: Tsetse flies (Glossina) transmit Trypanosoma brucei gambiense, which causes gambiense human African trypanosomiasis (gHAT). As part of national efforts to eliminate gHAT as a public health problem, Uganda implemented a large-scale programme of deploying Tiny Targets, which comprise panels of insecticide-treated material which attract and kill tsetse. At its peak, the programme was the largest tsetse control operation in Africa. Here, we quantify the impact of Tiny Targets and environmental changes on the spatial and temporal patterns of tsetse abundance across North-Western Uganda.

Methods: We leverage a 100-month longitudinal dataset detailing Glossina fuscipes fuscipes catches from monitoring traps between October 2010 and December 2019 within seven districts in North-Western Uganda. We fitted a boosted regression tree (BRT) model assessing environmental suitability, which was used alongside Tiny Target data to fit a spatiotemporal geostatistical model predicting tsetse abundance across our study area (~16 000 km²). We used the spatiotemporal model to quantify the impact of Tiny Targets and environmental changes on the distribution of tsetse, alongside metrics of uncertainty.

Results: Environmental suitability across the study area remained relatively constant over time, with suitability being driven largely by elevation and distance to rivers. By performing a counterfactual analysis using the fitted spatiotemporal geostatistical model, we show that deployment of Tiny Targets across an area of 4000 km² reduced the overall abundance of tsetse to low levels (median daily catch=1.1 tsetse/trap, IQR=0.85-1.28). No spatial-temporal locations had high (>10 tsetse/trap/day) numbers of tsetse compared with 18% of locations for the counterfactual.

Conclusions: In Uganda, Tiny Targets reduced the abundance of G. f. fuscipes and maintained tsetse populations at low levels. Our model represents the first spatiotemporal geostatistical model investigating the effects of a national tsetse control programme. The outputs provide important data for informing next steps for vector control and surveillance.

Microbial data sharing underlies evidence-based microbial research, as well as pathogen surveillance and analysis essential to public health. While the need for data sharing was highlighted during the SARS-CoV-2 pandemic, some concerns regarding secondary data use have also surfaced. Although general guidelines are available for data sharing, we note the absence of a set of established, universal, unambiguous and accessible principles to guide the secondary use of microbial data. Here, we propose the Public Health Alliance for Genomic Epidemiology (PHA4GE) Microbial Data-Sharing Accord to consolidate consensus norms and accepted practices for the secondary use of microbial data. The Accord provides a set of seven simple, baseline principles to address key concerns that may arise for researchers providing microbial datasets for secondary use and to guide responsible use by data users. By providing clear rules for secondary use of microbial data, the Accord can increase confidence in sharing by data providers and protect against data mis-use during secondary analyses.

Many effective health system innovations fail to reach those who need them most, falling short of the goal of universal health coverage. In the 5 years since the Federal Ministry of Health in Ethiopia localised the Practical Approach to Care Kit (PACK) programme to support primary care reforms, PACK has been scaled-up to over 90% of the country's primary care health centres. Known as the Ethiopian Primary Healthcare Clinical Guideline (EPHCG), the programme comprises a comprehensive, policy-aligned clinical decision support tool (EPHCG guide) and an implementation strategy to embed comprehensive, integrated care into every primary care consultation for individuals over 5 years of age, while addressing barriers to streamlined primary healthcare delivery. We describe the components of the EPHCG programme and the work done to establish it in Ethiopia. Yamey's framework for successful scale-up is used to examine the programme and health system factors that enabled its scale-up within a 5-year period. These included high-level ministry leadership and support, a cascade model of implementation embedded in all levels of the health system, regular EPHCG guide and training material updates and strategies to generate stakeholder buy-in from managers, health workers, patients and communities. Challenges, including stakeholder resistance, training fidelity and quality and procurement of medicines and diagnostic tests, are described, along with efforts to resolve them. Insights and learnings will be of interest to those implementing PACK programmes elsewhere, and managers and researchers responsible for design and delivery of health systems strengthening innovations at scale in low-income and middle-income countries.

Emerging infectious diseases present a significant challenge to healthcare systems with their need for a rapid response and reallocation of resources. This paper explores the implementation of the Practical Approach to Care Kit (PACK) programme in Florianópolis, Brazil as a strategic tool for reinforcing primary healthcare (PHC) responses to emergent communicable diseases. With its focus on enhancing PHC delivery in resource-limited settings, PACK provides a flexible, evidence-based framework that integrates into local health systems. The paper describes experiences adapting PACK to provide rapid responses to outbreaks of Zika, leishmaniasis, COVID-19, Mpox and dengue in primary care between 2014 and 2023. Key features of PACK, including its flexibility to incorporate new clinical content, responsive implementation strategy and health system strengthening approach, are highlighted. The paper emphasises how PACK supported responses to specific disease outbreaks and helped maintain mainstream PHC delivery, preventing the system from becoming condition-centric during crises. We describe the limitations of the PACK approach in an outbreak scenario, the challenges experienced and efforts to tackle these. The lessons learnt from Florianópolis underscore the adaptability and relevance of comprehensive primary care approaches like PACK in supporting PHC professionals and local health systems to navigate emerging health challenges.

The care of people with multiple long-term conditions (MLTCs) is complex and time-consuming, often denying them the agency to self-manage their conditions-or for the clinician they visit to provide streamlined, person-centred care. We reconfigured The Practical Approach to Care Kit, our established, evidence-based, policy-aligned clinical decision support tool for low-resource primary care settings, to provide consolidated clinical guidance for a patient journey through a primary care facility. This places the patient at the centre of that journey and shifts the screening, monitoring and health education activities of multimorbidity care more equitably among the members of the primary care team. This work forms part of a study called ENHANCE, exploring how best to streamline MLTC care in South Africa with its high burden of communicable, non-communicable and mental health conditions. This practice paper describes the four steps of codeveloping this clinical decision support tool for eleven common long-term conditions with local stakeholders (deciding the approach, constructing the content, clinical editing, and design and formatting) along with the features of the tool designed to facilitate its usability at point of care. The process highlighted tensions around prioritising one condition over another, curative over preventive treatment and pharmacological therapies over advice-giving, along with the challenges of balancing the large volume of content with a person-centred approach. If successful, the tool could augment the response to MLTC care in South Africa and other low-resource settings. In addition, our development process may contribute to scant literature around methodologies for clinical decision support development.