Pub Date : 2024-08-16DOI: 10.1136/bmjgh-2023-014170
Nandakumar Menon, Regi George, Raman Kataria, Ravi Manoharan, Meredith B Brooks, Alaska Pendleton, Veena Sheshadri, Sudarshana Chatterjee, Wesley Rajaleelan, Jithen Krishnan, Simone Sandler, Saurabh Saluja, David Ljungman, Nakul Raykar, Emma Svensson, Isaac Wasserman, Anudari Zorigtbaatar, Gnanaraj Jesudian, Salim Afshar, John G Meara, Alexander W Peters, Craig D McClain
Background: Task-sharing of spinal anaesthesia care by non-specialist graduate physicians, termed medical officers (MOs), is commonly practised in rural Indian healthcare facilities to mitigate workforce constraints. We sought to assess whether spinal anaesthesia failure rates of MOs were non-inferior to those of consultant anaesthesiologists (CA) following a standardised educational curriculum.
Methods: We performed a randomised, non-inferiority trial in three rural hospitals in Tamil Nadu and Chhattisgarh, India. Patients aged over 18 years with low perioperative risk (ASA I & II) were randomised to receive MO or CA care. Prior to the trial, MOs underwent task-based anaesthesia training, inclusive of remotely accessed lectures, simulation-based training and directly observed anaesthetic procedures and intraoperative care. The primary outcome measure was spinal anaesthesia failure with a non-inferiority margin of 5%. Secondary outcome measures consisted of incidence of perioperative and postoperative complications.
Findings: Between 12 July 2019 and 8 June 2020, a total of 422 patients undergoing surgical procedures amenable to spinal anaesthesia care were randomised to receive either MO (231, 54.7%) or CA care (191, 45.2%). Spinal anaesthesia failure rate for MOs (7, 3.0%) was non-inferior to those of CA (5, 2.6%); difference in success rate of 0.4% (95% CI=0.36-0.43%; p=0.80). Additionally, there were no statistically significant differences observed between the two groups for intraoperative or postoperative complications, or patients' experience of pain during the procedure.
Interpretation: This study demonstrates that failure rates of spinal anaesthesia care provided by trained MOs are non-inferior to care provided by CAs in low-risk surgical patients. This may support policy measures that use task-sharing as a means of expanding anaesthesia care capacity in rural Indian hospitals.
Trial registration number: NCT04438811.
背景:在印度农村医疗机构中,非专科毕业的医生(被称为医务人员(MO))通常分担脊柱麻醉护理任务,以缓解劳动力紧张的问题。我们试图评估医务人员的脊柱麻醉失败率是否不低于采用标准化教育课程的麻醉顾问(CA):我们在印度泰米尔纳德邦和恰蒂斯加尔邦的三家农村医院进行了随机、非劣效试验。年龄在 18 岁以上、围手术期风险较低(ASA I 级和 II 级)的患者被随机分配接受 MO 或 CA 护理。试验前,麻醉医生接受了基于任务的麻醉培训,包括远程讲座、模拟培训以及直接观察麻醉程序和术中护理。主要结果指标是脊髓麻醉失败率,非劣效区为 5%。次要结果指标包括围手术期和术后并发症的发生率:2019年7月12日至2020年6月8日期间,共有422名接受适合脊髓麻醉护理的外科手术的患者被随机分配接受MO(231人,54.7%)或CA护理(191人,45.2%)。MO(7 例,3.0%)的脊柱麻醉失败率不低于 CA(5 例,2.6%);成功率相差 0.4% (95% CI=0.36-0.43%; p=0.80)。此外,两组患者在术中、术后并发症以及术中疼痛体验方面均无统计学差异:这项研究表明,在低风险手术患者中,由训练有素的医护人员提供的脊髓麻醉护理的失败率并不低于由CA提供的护理。这可能会支持将任务分担作为扩大印度农村医院麻醉护理能力的一种手段的政策措施:NCT04438811.
{"title":"Task-sharing spinal anaesthesia care in three rural Indian hospitals: a non-inferiority randomised controlled clinical trial.","authors":"Nandakumar Menon, Regi George, Raman Kataria, Ravi Manoharan, Meredith B Brooks, Alaska Pendleton, Veena Sheshadri, Sudarshana Chatterjee, Wesley Rajaleelan, Jithen Krishnan, Simone Sandler, Saurabh Saluja, David Ljungman, Nakul Raykar, Emma Svensson, Isaac Wasserman, Anudari Zorigtbaatar, Gnanaraj Jesudian, Salim Afshar, John G Meara, Alexander W Peters, Craig D McClain","doi":"10.1136/bmjgh-2023-014170","DOIUrl":"10.1136/bmjgh-2023-014170","url":null,"abstract":"<p><strong>Background: </strong>Task-sharing of spinal anaesthesia care by non-specialist graduate physicians, termed medical officers (MOs), is commonly practised in rural Indian healthcare facilities to mitigate workforce constraints. We sought to assess whether spinal anaesthesia failure rates of MOs were non-inferior to those of consultant anaesthesiologists (CA) following a standardised educational curriculum.</p><p><strong>Methods: </strong>We performed a randomised, non-inferiority trial in three rural hospitals in Tamil Nadu and Chhattisgarh, India. Patients aged over 18 years with low perioperative risk (ASA I & II) were randomised to receive MO or CA care. Prior to the trial, MOs underwent task-based anaesthesia training, inclusive of remotely accessed lectures, simulation-based training and directly observed anaesthetic procedures and intraoperative care. The primary outcome measure was spinal anaesthesia failure with a non-inferiority margin of 5%. Secondary outcome measures consisted of incidence of perioperative and postoperative complications.</p><p><strong>Findings: </strong>Between 12 July 2019 and 8 June 2020, a total of 422 patients undergoing surgical procedures amenable to spinal anaesthesia care were randomised to receive either MO (231, 54.7%) or CA care (191, 45.2%). Spinal anaesthesia failure rate for MOs (7, 3.0%) was non-inferior to those of CA (5, 2.6%); difference in success rate of 0.4% (95% CI=0.36-0.43%; p=0.80). Additionally, there were no statistically significant differences observed between the two groups for intraoperative or postoperative complications, or patients' experience of pain during the procedure.</p><p><strong>Interpretation: </strong>This study demonstrates that failure rates of spinal anaesthesia care provided by trained MOs are non-inferior to care provided by CAs in low-risk surgical patients. This may support policy measures that use task-sharing as a means of expanding anaesthesia care capacity in rural Indian hospitals.</p><p><strong>Trial registration number: </strong>NCT04438811.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995308","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}
Introduction: Routine health information systems (RHISs) are an essential source of data to inform decisions and actions around health facility performance, but RHIS data use is often limited in low and middle-income country contexts. Determinants that influence RHIS data-informed decisions and actions are not well understood, and few studies have explored the relationship between RHIS data-informed decisions and actions.
Methods: This qualitative thematic analysis study explored the determinants and characteristics of successful RHIS data-informed actions at the health facility level in Mozambique and which determinants were influenced by the Integrated District Evidence to Action (IDEAs) strategy. Two rounds of qualitative data were collected in 2019 and 2020 through 27 in-depth interviews and 7 focus group discussions with provincial, district and health facility-level managers and frontline health workers who participated in the IDEAs enhanced audit and feedback strategy. The Performance of Routine Information System Management-Act framework guided the development of the data collection tools and thematic analysis.
Results: Key behavioural determinants of translating RHIS data into action included health worker understanding and awareness of health facility performance indicators coupled with health worker sense of ownership and responsibility to improve health facility performance. Supervision, on-the-job support and availability of financial and human resources were highlighted as essential organisational determinants in the development and implementation of action plans. The forum to regularly meet as a group to review, discuss and monitor health facility performance was emphasised as a critical determinant by study participants.
Conclusion: Future data-to-action interventions and research should consider contextually feasible ways to support health facility and district managers to hold regular meetings to review, discuss and monitor health facility performance as a way to promote translation of RHIS data to action.
{"title":"Determinants of translating routine health information system data into action in Mozambique: a qualitative study.","authors":"Nami Kawakyu, Celso Inguane, Quinhas Fernandes, Artur Gremu, Florencia Floriano, Nelia Manaca, Isaías Ramiro, Priscilla Felimone, Jeremias Armindo Azevedo Alfandega, Xavier Alcides Isidor, Santana Mário Missage, Bradley H Wagenaar, Kenneth Sherr, Sarah Gimbel","doi":"10.1136/bmjgh-2024-014970","DOIUrl":"10.1136/bmjgh-2024-014970","url":null,"abstract":"<p><strong>Introduction: </strong>Routine health information systems (RHISs) are an essential source of data to inform decisions and actions around health facility performance, but RHIS data use is often limited in low and middle-income country contexts. Determinants that influence RHIS data-informed decisions and actions are not well understood, and few studies have explored the relationship between RHIS data-informed decisions and actions.</p><p><strong>Methods: </strong>This qualitative thematic analysis study explored the determinants and characteristics of successful RHIS data-informed actions at the health facility level in Mozambique and which determinants were influenced by the Integrated District Evidence to Action (IDEAs) strategy. Two rounds of qualitative data were collected in 2019 and 2020 through 27 in-depth interviews and 7 focus group discussions with provincial, district and health facility-level managers and frontline health workers who participated in the IDEAs enhanced audit and feedback strategy. The Performance of Routine Information System Management-Act framework guided the development of the data collection tools and thematic analysis.</p><p><strong>Results: </strong>Key behavioural determinants of translating RHIS data into action included health worker understanding and awareness of health facility performance indicators coupled with health worker sense of ownership and responsibility to improve health facility performance. Supervision, on-the-job support and availability of financial and human resources were highlighted as essential organisational determinants in the development and implementation of action plans. The forum to regularly meet as a group to review, discuss and monitor health facility performance was emphasised as a critical determinant by study participants.</p><p><strong>Conclusion: </strong>Future data-to-action interventions and research should consider contextually feasible ways to support health facility and district managers to hold regular meetings to review, discuss and monitor health facility performance as a way to promote translation of RHIS data to action.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995306","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 : 2024-08-16DOI: 10.1136/bmjgh-2024-015438
Günther Fink, Lindsey M Locks, Jacqueline M Lauer, Mpela Chembe, Savanna Henderson, Dorothy Sikazwe, Tamara Billima-Mulenga, Doug Parkerson, Peter C Rockers
Background: Childhood stunting remains common in many low-income settings and is associated with increased morbidity and mortality, as well as impaired child development.
Methods: The main objective of the study was to assess whether home-installed growth charts as well as small-quantity lipid-based nutrient supplements (SQ-LNS) can reduce growth faltering among infants. All caregivers of infants between 2 and 10 months of age at baseline, and at least 6 months old at the beginning of the interventions, in 282 randomly selected enumeration areas in Choma, Mansa and Lusaka districts in Zambia were invited to participate in the study. Cluster randomisation was stratified by district. A software-generated random number draw was used to assign clusters to one of four arms: (1) no intervention (control); (2) home installation of a wall chart that contained a growth monitoring tool along with key messages on infant and young child feeding and nutrition (growth charts only); (3) 30 sachets of SQ-LNS delivered each month (SQ-LNS only) or (4) growth charts+SQ LNS. The primary outcomes were children's height-for-age z-score (HAZ) and stunting (HAZ <-2) after 18 months of intervention. Secondary outcomes were haemoglobin (Hb), anaemia (Hb<110.0 g/L), weight-for-height, weight-for-age z-score (WAZ), underweight (WAZ<-2) and child development measured by the Global Scales of Early Development (GSED). Outcomes were analysed intention to treat using adjusted linear and logistic regression models and compared each of the three interventions to the control group. Assessors and analysts were blinded to the treatment-blinding of participating families was not possible.
Results: A total of 2291 caregiver-child dyads across the 282 study clusters were included in the study. 70 clusters (557 dyads) were assigned to the control group, 70 clusters (643 dyads) to growth charts only, 71 clusters (525 dyads) to SQ-LNS and 71 clusters (566 dyads) to SQ-LNS and growth charts. SQ-LNS improved HAZ by 0.21 SD (95% CI 0.06 to 0.36) and reduced the odds of stunting by 37% (adjusted OR, aOR 0.63, 95% CI (0.46 to 0.87)). No HAZ or stunting impacts were found in the growth charts only or growth charts+SQ LNS arms. SQ-LNS only improved WAZ (mean difference, MD 0.17, 95% CI (0.05 to 0.28). No impacts on WAZ were seen for growth charts and the combined intervention. Child development was higher in the growth charts only (MD 0.18, 95% CI (0.01 to 0.35)) and SQ-LNS only arms (MD 0.28, 95% CI (0.09 to 0.46). SQ-LNS improved average haemoglobin levels (MD 2.9 g/L (0.2, 5.5). The combined intervention did not have an impact on WAZ, Hb or GSED but reduced the odds of anaemia (aOR 0.72, 95% CI (0.53 to 0.97)). No adverse events were reported.
Interpretation: SQ-LNS appears to be effective in reducing growth faltering as well as improving anaemia and child development. Growth charts also show the potential
{"title":"The impact of home-installed growth charts and small-quantity lipid-based nutrient supplements (SQ-LNS) on child growth in Zambia: a four-arm parallel open-label cluster randomised controlled trial.","authors":"Günther Fink, Lindsey M Locks, Jacqueline M Lauer, Mpela Chembe, Savanna Henderson, Dorothy Sikazwe, Tamara Billima-Mulenga, Doug Parkerson, Peter C Rockers","doi":"10.1136/bmjgh-2024-015438","DOIUrl":"10.1136/bmjgh-2024-015438","url":null,"abstract":"<p><strong>Background: </strong>Childhood stunting remains common in many low-income settings and is associated with increased morbidity and mortality, as well as impaired child development.</p><p><strong>Methods: </strong>The main objective of the study was to assess whether home-installed growth charts as well as small-quantity lipid-based nutrient supplements (SQ-LNS) can reduce growth faltering among infants. All caregivers of infants between 2 and 10 months of age at baseline, and at least 6 months old at the beginning of the interventions, in 282 randomly selected enumeration areas in Choma, Mansa and Lusaka districts in Zambia were invited to participate in the study. Cluster randomisation was stratified by district. A software-generated random number draw was used to assign clusters to one of four arms: (1) no intervention (control); (2) home installation of a wall chart that contained a growth monitoring tool along with key messages on infant and young child feeding and nutrition (growth charts only); (3) 30 sachets of SQ-LNS delivered each month (SQ-LNS only) or (4) growth charts+SQ LNS. The primary outcomes were children's height-for-age z-score (HAZ) and stunting (HAZ <-2) after 18 months of intervention. Secondary outcomes were haemoglobin (Hb), anaemia (Hb<110.0 g/L), weight-for-height, weight-for-age z-score (WAZ), underweight (WAZ<-2) and child development measured by the Global Scales of Early Development (GSED). Outcomes were analysed intention to treat using adjusted linear and logistic regression models and compared each of the three interventions to the control group. Assessors and analysts were blinded to the treatment-blinding of participating families was not possible.</p><p><strong>Results: </strong>A total of 2291 caregiver-child dyads across the 282 study clusters were included in the study. 70 clusters (557 dyads) were assigned to the control group, 70 clusters (643 dyads) to growth charts only, 71 clusters (525 dyads) to SQ-LNS and 71 clusters (566 dyads) to SQ-LNS and growth charts. SQ-LNS improved HAZ by 0.21 SD (95% CI 0.06 to 0.36) and reduced the odds of stunting by 37% (adjusted OR, aOR 0.63, 95% CI (0.46 to 0.87)). No HAZ or stunting impacts were found in the growth charts only or growth charts+SQ LNS arms. SQ-LNS only improved WAZ (mean difference, MD 0.17, 95% CI (0.05 to 0.28). No impacts on WAZ were seen for growth charts and the combined intervention. Child development was higher in the growth charts only (MD 0.18, 95% CI (0.01 to 0.35)) and SQ-LNS only arms (MD 0.28, 95% CI (0.09 to 0.46). SQ-LNS improved average haemoglobin levels (MD 2.9 g/L (0.2, 5.5). The combined intervention did not have an impact on WAZ, Hb or GSED but reduced the odds of anaemia (aOR 0.72, 95% CI (0.53 to 0.97)). No adverse events were reported.</p><p><strong>Interpretation: </strong>SQ-LNS appears to be effective in reducing growth faltering as well as improving anaemia and child development. Growth charts also show the potential","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995243","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 : 2024-08-16DOI: 10.1136/bmjgh-2024-015678
Mo Al-Haddad
{"title":"International medical graduates: defining the term and using it consistently.","authors":"Mo Al-Haddad","doi":"10.1136/bmjgh-2024-015678","DOIUrl":"10.1136/bmjgh-2024-015678","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995307","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 : 2024-08-16DOI: 10.1136/bmjgh-2024-015420
Raphael Lencucha
The field of global health is at a pivotal moment of transformation. Decoloniality has emerged as a critical framework to assess and transform the pathologies that mark the field. These pathologies include the inequitable sharing of resources, the power hierarchies that entrench decision-making in institutions largely based in North America and Europe and the general predisposition towards paternalistic and exploitative interactions and exchange between North and South. The energy being generated around this transformative moment is widening circles of participation in the discourse on what transformation should look like in the field. The importance of decoloniality cannot be overstated in driving the transformative agenda. At the same time, the popularity of decoloniality as a critical framework may risk omissions in our understanding of the origins of injustice and the pathways to a new global health. To complement the work being done to decolonise global health, I illustrate how the 'human condition' intersects with the transformative agenda. By human condition, I mean the universal features of humanity that lead to oppression and those that lead to cooperation, unity and a shared humanity.
{"title":"Transforming global health: decoloniality and the human condition.","authors":"Raphael Lencucha","doi":"10.1136/bmjgh-2024-015420","DOIUrl":"10.1136/bmjgh-2024-015420","url":null,"abstract":"<p><p>The field of global health is at a pivotal moment of transformation. Decoloniality has emerged as a critical framework to assess and transform the pathologies that mark the field. These pathologies include the inequitable sharing of resources, the power hierarchies that entrench decision-making in institutions largely based in North America and Europe and the general predisposition towards paternalistic and exploitative interactions and exchange between North and South. The energy being generated around this transformative moment is widening circles of participation in the discourse on what transformation should look like in the field. The importance of decoloniality cannot be overstated in driving the transformative agenda. At the same time, the popularity of decoloniality as a critical framework may risk omissions in our understanding of the origins of injustice and the pathways to a new global health. To complement the work being done to decolonise global health, I illustrate how the 'human condition' intersects with the transformative agenda. By human condition, I mean the universal features of humanity that lead to oppression and those that lead to cooperation, unity and a shared humanity.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995244","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 : 2024-08-13DOI: 10.1136/bmjgh-2024-016586
Trish Cotter, Sandra Mullin
{"title":"The Olympic game's up: it's time for the IOC to stop promoting sugary drinks.","authors":"Trish Cotter, Sandra Mullin","doi":"10.1136/bmjgh-2024-016586","DOIUrl":"10.1136/bmjgh-2024-016586","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975132","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 : 2024-08-13DOI: 10.1136/bmjgh-2024-015475
Emily Thompson, Getachew Mullu Kassa, Robera Olana Fite, Clara Pons-Duran, Frederick G B Goddard, Alemayehu Worku, Sebastien Haneuse, Bezawit Mesfin Hunegnaw, Delayehu Bekele, Kassahun Alemu, Lisanu Taddesse, Grace J Chan
Introduction: Despite the progress in reducing child mortality, the rate remains high, particularly in sub-Saharan African countries. Limited data exist on child survival and other birth outcomes by sex. This study compared survival rates and birth outcomes by sex among neonates and children under 2 in Ethiopia.
Methods: Women who gave birth after 28 weeks of gestation and their newborns were included in the analysis. Survival probabilities were estimated for males and females in the neonatal period as well as the 2-year period following birth using Kaplan-Meier curves. HRs and 95% CIs were compared between males and females under 2. Descriptive statistics and χ2 tests were used to determine the sex-disaggregated variation in the birth outcomes of preterm birth, low birth weight (LBW), stillbirth, small for gestational age (SGA) and large for gestational age (LGA).
Results: The study included a total of 3904 women and child pairs. The neonatal mortality rate for males (3.4%, 95% CI 2.6% to 4.2%) was higher compared with females (1.7%, 95% CI 1.1% to 2.3%). The hazard of death during the first 28 days of life was approximately two times higher for males compared with females (HR 1.99, 95% CI 1.30 to 3.06) but was not significantly different after this period. While there was a non-significant difference between males and females in the proportion of preterm, LBW and LGA births, we found a significantly higher proportion of stillbirth (2.7% vs 1.3%, p=0.003) and SGA (20.5% vs 15.6%, p<0.001) for males compared with females.
Conclusions: This study identified a significant sex difference in mortality and birth outcomes. We recommend focusing future research on the mechanisms of these sex differences in order to better design intervention programmes to reduce disparities and improve outcomes for neonates.
{"title":"Birth outcomes and survival by sex among newborns and children under 2 in the Birhan Cohort: a prospective cohort study in the Amhara Region of Ethiopia.","authors":"Emily Thompson, Getachew Mullu Kassa, Robera Olana Fite, Clara Pons-Duran, Frederick G B Goddard, Alemayehu Worku, Sebastien Haneuse, Bezawit Mesfin Hunegnaw, Delayehu Bekele, Kassahun Alemu, Lisanu Taddesse, Grace J Chan","doi":"10.1136/bmjgh-2024-015475","DOIUrl":"10.1136/bmjgh-2024-015475","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the progress in reducing child mortality, the rate remains high, particularly in sub-Saharan African countries. Limited data exist on child survival and other birth outcomes by sex. This study compared survival rates and birth outcomes by sex among neonates and children under 2 in Ethiopia.</p><p><strong>Methods: </strong>Women who gave birth after 28 weeks of gestation and their newborns were included in the analysis. Survival probabilities were estimated for males and females in the neonatal period as well as the 2-year period following birth using Kaplan-Meier curves. HRs and 95% CIs were compared between males and females under 2. Descriptive statistics and χ<sup>2</sup> tests were used to determine the sex-disaggregated variation in the birth outcomes of preterm birth, low birth weight (LBW), stillbirth, small for gestational age (SGA) and large for gestational age (LGA).</p><p><strong>Results: </strong>The study included a total of 3904 women and child pairs. The neonatal mortality rate for males (3.4%, 95% CI 2.6% to 4.2%) was higher compared with females (1.7%, 95% CI 1.1% to 2.3%). The hazard of death during the first 28 days of life was approximately two times higher for males compared with females (HR 1.99, 95% CI 1.30 to 3.06) but was not significantly different after this period. While there was a non-significant difference between males and females in the proportion of preterm, LBW and LGA births, we found a significantly higher proportion of stillbirth (2.7% vs 1.3%, p=0.003) and SGA (20.5% vs 15.6%, p<0.001) for males compared with females.</p><p><strong>Conclusions: </strong>This study identified a significant sex difference in mortality and birth outcomes. We recommend focusing future research on the mechanisms of these sex differences in order to better design intervention programmes to reduce disparities and improve outcomes for neonates.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975131","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 : 2024-08-09DOI: 10.1136/bmjgh-2024-015097
Heidi Bart Johnston, Katy Footman, Mohamed Mahmoud Ali, Eman Abdelkreem Aly, Chilanga Asmani, Sofonias Getachew Asrat, Dominic Kwabena Atweam, Sayema Awais, Richard Mangwi Ayiasi, Martin Owusu Boamah, Ovost Chooye, Roseline Doe, Benson Droti, Hayfa Elamin, Chris Fofie, Karima Gholbzouri, Azmach Hadush, Nilmini Hemachandra, Yelmali Hien, Francis Chisaka Kasolo, Hillary Kipruto, Yolanda Barbera Lainez, Nasan Natseri, Pamela Amaka Onyiah, Christopher Garimoi Orach, Assane Ouangare, Leopold Ouedraogo, Olive Sentumbwe-Mugisa, Ashley Sheffel, Amani Siyam, Martin Ssendyona, Ellen Thom, Rose Koirine Tingueri, Soumaïla Traoré, Qudsia Uzma, Wendy Venter, Bela Ganatra
Routine assessment of health facility capacity to provide abortion and post-abortion care can inform policy and programmes to expand access and improve quality. Since 2018, abortion and/or post-abortion care have been integrated into two WHO health facility assessment tools: the Service Availability and Readiness Assessment and the Harmonised Health Facility Assessment. We discuss lessons learnt through experiences integrating abortion into these standardised tools. Our experiences highlight the feasibility of including abortion in health facility assessments across a range of legal contexts. Factors facilitating the integration of abortion include cross-country collaboration and experience sharing, timely inputs into tool adaptations, clear leadership, close relationships among key stakeholders as in assessment coordination groups, use of locally appropriate terminology to refer to abortion and reference to national policies and guidelines. To facilitate high-quality data collection, we identify considerations around question sequencing in tool design, appropriate terminology and the need to balance the normalisation of abortion with adequate sensitisation and education of data collectors. To facilitate appropriate and consistent analysis, future work must ensure adequate disaggregation of recommended and non-recommended abortion methods, alignment with national guidelines and development of a standardised approach for measuring abortion service readiness. Measurement of abortion service availability and readiness should be a routine practice and a standardised component of health facility assessment tools. Evidence generated by health facility assessments that include abortion monitoring can guide efforts to expand access to timely and effective care and help normalise abortion as a core component of sexual and reproductive healthcare.
{"title":"Measuring availability of and facility readiness to deliver comprehensive abortion care: experiences and lessons learnt from integrating abortion into WHO's health facility assessments.","authors":"Heidi Bart Johnston, Katy Footman, Mohamed Mahmoud Ali, Eman Abdelkreem Aly, Chilanga Asmani, Sofonias Getachew Asrat, Dominic Kwabena Atweam, Sayema Awais, Richard Mangwi Ayiasi, Martin Owusu Boamah, Ovost Chooye, Roseline Doe, Benson Droti, Hayfa Elamin, Chris Fofie, Karima Gholbzouri, Azmach Hadush, Nilmini Hemachandra, Yelmali Hien, Francis Chisaka Kasolo, Hillary Kipruto, Yolanda Barbera Lainez, Nasan Natseri, Pamela Amaka Onyiah, Christopher Garimoi Orach, Assane Ouangare, Leopold Ouedraogo, Olive Sentumbwe-Mugisa, Ashley Sheffel, Amani Siyam, Martin Ssendyona, Ellen Thom, Rose Koirine Tingueri, Soumaïla Traoré, Qudsia Uzma, Wendy Venter, Bela Ganatra","doi":"10.1136/bmjgh-2024-015097","DOIUrl":"10.1136/bmjgh-2024-015097","url":null,"abstract":"<p><p>Routine assessment of health facility capacity to provide abortion and post-abortion care can inform policy and programmes to expand access and improve quality. Since 2018, abortion and/or post-abortion care have been integrated into two WHO health facility assessment tools: the Service Availability and Readiness Assessment and the Harmonised Health Facility Assessment. We discuss lessons learnt through experiences integrating abortion into these standardised tools. Our experiences highlight the feasibility of including abortion in health facility assessments across a range of legal contexts. Factors facilitating the integration of abortion include cross-country collaboration and experience sharing, timely inputs into tool adaptations, clear leadership, close relationships among key stakeholders as in assessment coordination groups, use of locally appropriate terminology to refer to abortion and reference to national policies and guidelines. To facilitate high-quality data collection, we identify considerations around question sequencing in tool design, appropriate terminology and the need to balance the normalisation of abortion with adequate sensitisation and education of data collectors. To facilitate appropriate and consistent analysis, future work must ensure adequate disaggregation of recommended and non-recommended abortion methods, alignment with national guidelines and development of a standardised approach for measuring abortion service readiness. Measurement of abortion service availability and readiness should be a routine practice and a standardised component of health facility assessment tools. Evidence generated by health facility assessments that include abortion monitoring can guide efforts to expand access to timely and effective care and help normalise abortion as a core component of sexual and reproductive healthcare.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11344866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911695","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 : 2024-08-09DOI: 10.1136/bmjgh-2024-015173
Schenelle Dayna Dlima, Alex Hall, Abodunrin Quadri Aminu, Asangaedem Akpan, Chris Todd, Emma R L C Vardy
Frailty is a complex, age-related clinical condition that involves multiple contributing factors and raises the risk of adverse outcomes in older people. Given global population ageing trends, the growing prevalence and incidence of frailty pose significant challenges to health and social care systems in both high-income and lower-income countries. In this review, we highlight the disproportionate representation of research on frailty screening and management from high-income countries, despite how lower-income countries are projected to have a larger share of older people aged ≥60. However, more frailty research has been emerging from lower-income countries in recent years, paving the way for more context-specific guidelines and studies that validate frailty assessment tools and evaluate frailty interventions in the population. We then present further considerations for contextualising frailty in research and practice in lower-income countries. First, the heterogeneous manifestations of frailty call for research that reflects different geographies, populations, health systems, community settings and policy priorities; this can be driven by supportive collaborative systems between high-income and lower-income countries. Second, the global narrative around frailty and ageing needs re-evaluation, given the negative connotations linked with frailty and the introduction of intrinsic capacity by the World Health Organization as a measure of functional reserves throughout the life course. Finally, the social determinants of health as possible risk factors for frailty in lower-income countries and global majority populations, and potential socioeconomic threats of frailty to national economies warrant proactive frailty screening in these populations.
{"title":"Frailty: a global health challenge in need of local action.","authors":"Schenelle Dayna Dlima, Alex Hall, Abodunrin Quadri Aminu, Asangaedem Akpan, Chris Todd, Emma R L C Vardy","doi":"10.1136/bmjgh-2024-015173","DOIUrl":"10.1136/bmjgh-2024-015173","url":null,"abstract":"<p><p>Frailty is a complex, age-related clinical condition that involves multiple contributing factors and raises the risk of adverse outcomes in older people. Given global population ageing trends, the growing prevalence and incidence of frailty pose significant challenges to health and social care systems in both high-income and lower-income countries. In this review, we highlight the disproportionate representation of research on frailty screening and management from high-income countries, despite how lower-income countries are projected to have a larger share of older people aged ≥60. However, more frailty research has been emerging from lower-income countries in recent years, paving the way for more context-specific guidelines and studies that validate frailty assessment tools and evaluate frailty interventions in the population. We then present further considerations for contextualising frailty in research and practice in lower-income countries. First, the heterogeneous manifestations of frailty call for research that reflects different geographies, populations, health systems, community settings and policy priorities; this can be driven by supportive collaborative systems between high-income and lower-income countries. Second, the global narrative around frailty and ageing needs re-evaluation, given the negative connotations linked with frailty and the introduction of intrinsic capacity by the World Health Organization as a measure of functional reserves throughout the life course. Finally, the social determinants of health as possible risk factors for frailty in lower-income countries and global majority populations, and potential socioeconomic threats of frailty to national economies warrant proactive frailty screening in these populations.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911694","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}
{"title":"AI in conflict zones: the potential to revitalise healthcare in Syria and beyond.","authors":"Munzer Alkhalil, Aula Abbara, Caroline Grangier, Abdulkarim Ekzayez","doi":"10.1136/bmjgh-2024-015755","DOIUrl":"10.1136/bmjgh-2024-015755","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905936","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}