BMJ Global Health最新文献

The WHO South-East Asia Region (SEAR), with its high population density, is recognised by epidemiologists as a critical reservoir for the emergence and global dissemination of novel influenza strains, making it a potential epicentre for future influenza pandemics. Despite this significant risk, most SEAR countries lack comprehensive seasonal influenza vaccination policies, resulting in low vaccine uptake across the region. This review analysed the latest WHO National Influenza Programme factsheets from the 11 SEAR member states and supplemented this with extensive manual literature searches using electronic databases and government websites. As of October 2022, only three countries-India, Bhutan and Thailand-had established seasonal influenza vaccination policies. Among them, Bhutan and Thailand have policies that cover all five WHO-recommended high-risk groups. While national influenza surveillance systems are in place across SEAR, only India and the Democratic People's Republic of Korea claim full population coverage. Influenza vaccine production capacity is limited to Bangladesh, India and Indonesia. The region's varied climatic conditions and insufficient local data have further obscured the true burden of influenza. Thailand offers a successful model for other countries in the region, beginning with the most vulnerable groups and gradually expanding coverage. To effectively develop and implement national influenza vaccination policies, SEAR countries must close the evidence gap by strengthening surveillance systems to provide accurate, timely data and prioritise context-specific research, leverage existing vaccine infrastructure, enhance public education and finally engage with local and international stakeholders to establish strong international cooperation to support these efforts and improve pandemic preparedness.

Introduction: There is a dearth of evidence regarding the global economic burden of ischaemic heart diseases (IHDs). This systematic review aims to synthesise national-level studies worldwide quantifying the economic burden of IHDs from a provider's perspective.

Methods: We searched PubMed, Embase, Cochrane, DARE and EconLit databases from 1 January 2000 to 29 June 2022. We included observational, cost-of-illness and economic modelling studies reporting direct healthcare cost data for IHDs at the national level. At least two reviewers independently screened titles and abstracts and full texts, extracted data and assessed quality using a seven-question assessment tool. We synthesised findings by country, focusing on three key economic estimates: total annual costs of IHDs, costs of managing acute IHD episodes and chronic IHD care. We correlated these costs with country-specific macroeconomic measures and disease burden.

Results: We included 65 national-level studies conducted in 21 countries worldwide, with a majority in high-income countries. The median direct healthcare cost per episode of IHDs was 8062 Int$ 2019 (IQR: 5770-9580), and the median direct healthcare cost of IHDs per patient-year was 10 064 Int$ 2019 (IQR: 7619-14 818). These estimates positively correlated with country-specific macroeconomic and DALY measures.

Conclusion: IHDs impose a substantial economic burden on health systems globally. Economic costs in countries exceed per capita public health expenditure, primarily driven by acute episodes. National-level data were available for only 21 countries, and none from low-middle-income and low-income countries. Economic costs of IHDs need to be quantified to inform resource allocation decisions at national and global levels.CRD42022337577.

Introduction: The health consequences of secondhand smoke (SHS) are a long-standing concern. The WHO Framework Convention on Tobacco Control (FCTC) is an evidence-based treaty that aims to protect people from health and environmental harms of commercial tobacco use and exposure to SHS. This study quantified the prevalence of daily smoking inside the house (indoor smoking) and change over time and examined the determinants of indoor smoking in 24 WHO FCTC Parties.

Methods: We used data from the 2 most recent Demographic and Health Surveys (DHS) from 24 countries. Counties were selected if they submitted at least one FCTC implementation report and had two DHS surveys conducted after 2010. The weighted prevalence and percentage changes in daily indoor smoking in the two consecutive surveys were calculated, including rate of change, and a two-sample test of proportions was used to assess changes. Multinomial logistic regression model was employed to examine the association between socioeconomic characteristics and indoor smoking. All results were presented by country.

Results: A significant decline in the prevalence of daily indoor smoking was detected in 16/24 countries, with the rate of decline ranging from -45.8% in Liberia to -15.2% in India. Jordan reported a significant increase in daily indoor smoking from 57% to 60%; p=0.002. The meta-analytical estimate showed that overall, the relative risk ratio (RRR) of daily indoor smoking was significantly lower for households in the 5th wealth quintile compared with counterparts in the 1st quintile (RRR=0.40; 95% CI: 0.30 to 0.52), and in households where head of the household attended higher education compared with no formal education (RRR=0.60; 95% CI: 0.53 to 0.69).

Conclusions: This study demonstrated that prevalence of daily indoor smoking was associated with low socioeconomic status. Reducing SHS exposure is critical, including addressing inequities to help improve health outcomes. Currently, over 2.8 billion people in low-income countries are not protected by smoke-free environment laws, and only 18% of the world's population is covered by strong restrictions on tobacco marketing.

Introduction: Over 60% of premature infants are born in Africa or South Asia. Infants born early, small or who become sick after birth have a higher risk of death, poor growth and developmental impairments. Innovative interventions tailored for low- and middle-income countries are essential to help these newborns survive and develop optimally. This study evaluated the feasibility, acceptability and preliminary effectiveness of Hospital to Home (H2H), a discharge and follow-up programme for small and sick newborns in rural Uganda.

Methods: We compared two cohorts of high-risk hospitalised neonates in Uganda: a historical-comparison cohort receiving standard facility-based care and an intervention cohort that received the H2H programme, a hospital and community spanning package of interventions designed to improve neurodevelopmental outcomes. We compared 6-month corrected neurodevelopmental, growth, nutritional and vaccination outcomes between the cohorts complemented by qualitative interviews of caregivers, community health workers and health facility staff.

Results: We recruited 191 participants: 91 historical-comparison cohort (born between July and September 2018), and 100 intervention cohort (born July 2019 to February 2020). No statistically significant difference was seen in neurodevelopmental outcomes (adjusted OR 0.68; 95% CI: 0.32 to 1.46). Improved vaccination completion (88.5% intervention vs 76.9% comparison, p=0.041), and exclusive breastfeeding rates (42% vs 6.6%, p<0.001) were seen. Caregivers and healthcare workers reported the intervention to be acceptable and feasible in this rural Ugandan setting.

Conclusion: The H2H programme was feasible and acceptable to caregivers and healthcare providers. Improved vaccination and exclusive breastfeeding rates were seen in the intervention group when compared with a historical comparison cohort in this rural Ugandan setting. Further investigation on the short and long-term effectiveness of the H2H programme in a government health services setting is warranted.

Trial registration number: ISRCTN51636372.

Introduction: Good health system governance is essential for reducing high mortality and morbidity after injury in low- and middle-income countries (LMICs). Unfortunately, the current state of governance for injury care is not known. This study evaluated governance for injury care in Ghana, Pakistan, Rwanda and South Africa, four LMICs with diverse contexts, to allow understanding of similarities or difference in the status of governance systems in different LMICs.

Method: This cross-sectional study captured the perceptions of 220 respondents (31 policymakers and 189 policy implementers) on injury care governance using the framework for governance in health system developed by Siddiqi. Input was captured in 10 domains: strategic vision; participation and consensus; rule of law; transparency; responsiveness; equity and inclusion; effectiveness and efficiency; accountability; intelligence and information; and ethics.

Result: The median injury care governance score across all domains and countries was 29% (IQR 17-43). The highest median score was achieved in the rule of law (50, 33-67), and the lowest scores were seen in the transparency (0, 0-33), accountability (0, 0-33), and participation and consensus (0, 0-33) domains. Median scores were higher for policymakers (33, 27-48) than for policy implementers (27, 17-42), but the difference was not statistically significant.

Conclusion: The four studied countries have developed some of the foundations of good injury care governance, although many governance domains require more attention. The gap in awareness between policymakers and policy implementers might reflect a delayed or partial implementation of policies or lack of communication between sectors. Ensuring equitable access to injury care across LMICs requires investment in all domains of good injury care governance.

Introduction: There is limited research on applying theory to retention in complex intervention trials. To address this gap, this study aimed to qualitatively examine retention in the Bukhali randomised controlled trial, from the perspective of trial participants and staff, through the lens of self-determination theory (SDT). The Bukhali trial is part of the Healthy Life Trajectories Initiative in Soweto, South Africa, with young women.

Methods: Nine focus group discussions were used to generate data from Bukhali trial staff (n=45, 23-64 years), and participants, including those currently enrolled (n=16, 25-31 years) and those who had withdrawn from the trial (n=20, 24-32 years). A codebook thematic approach was taken to data analysis; SDT was used to develop a conceptual model to analyse the data in context. The main themes identified were external influences on the trial, trial implementing environment, controlled motivation and intrinsic autonomous motivation.

Results: Our findings highlighted the contextual issues influencing the trial, including participants' socioeconomic circumstances, and the presence or absence of social support, the trial complexity and participant burden. Issues related to controlled motivation comprised challenges of staying in contact, financial incentives and food, health services provided and other incentives. We also identified aspects of the trial supporting participants' psychological needs of autonomy, competence and relatedness, which in turn contributed to their intrinsic autonomous motivation. These included participants' interest in the trial and its relevance to them; participants' sense of agency, meaning and purpose through their involvement; the building of their knowledge and awareness about their health; relating to other participants and the relationships built with staff and being treated well.

Conclusion: SDT provides a helpful frame for a contextualised understanding of the complexity of retention of Bukhali trial participants (longitudinal study and intervention). These findings have relevance for trials in under-resourced settings.