BMJ Global Health最新文献

Background: Non-communicable diseases (NCDs) are the leading cause of death and morbidity worldwide, responsible for 7 out of 10 deaths, 86% occurring in low- and middle-income countries (LMICs). As the NCD burden on health systems increases, community health workers (CHWs) have become increasingly involved in NCD care provision and management. This study updates a 2015 review to synthesise and critically analyse the recent evidence base on the cost-effectiveness and affordability of CHW programmes addressing NCDs in LMICs.

Methods: A scoping review searched 10 databases and the grey literature for original studies published between August 2015 and July 2024. Recognised search terms related to 'Community Health Workers' and 'Economic Evaluation(s)' in LMICs were used. Covidence software was employed to screen studies based on inclusion and exclusion criteria. Data on study methodology, costs and cost-related outcomes were then extracted, tabulated in a data-extraction form and analysed using Microsoft Excel.

Results: We identified 20 studies with 52 different scenarios covering five areas: cardiovascular disease including hypertension (n=22 scenarios); human papillomavirus and cervical cancer screening (n=13); diabetes (n=12); mental health (n=4); and behavioural risk factors (n=1). Of the 44 scenarios assessing cost-effectiveness, 35 scenarios suggest that CHW programmes are cost-effective. 11 studies compared CHW programmes against an alternative (usual care) to generate an incremental cost-effectiveness ratio, evaluated against the country's gross domestic product per capita. Methodological heterogeneity across studies and inconsistencies or data gaps in reporting (most importantly the lack of CHW salary information) limits the usefulness of the data. Few studies assessed affordability, despite being equally relevant to decision-making.

Conclusions: More studies including economic evaluations (particularly for NCDs not found in our review), along with more robust and consistent reporting are needed.

Background: The interplay between social capital and health system corruption in healthcare systems is underexplored, yet vital, a major barrier to advancing universal health coverage is underexplored. While social capital can support anticorruption by enabling collective action, it may also perpetuate corruption when networks are used to bypass procedures or access care unfairly. This study explores how social capital contributes to corrupt practices complex relationships play out in practice in Nigerian health facilities.

Method: We conducted a cross-sectional study across two Nigerian states, surveying 1659 households using a pretested interviewer-administered questionnaire. A composite measure of social capital was developed from key variables. We examined the relationship between social capital and engagement in corrupt practices, controlling for variables such as gender, age, education and group memberships. Data were analysed using univariate, bivariate and multivariate methods.

Results: Among respondents, 60.3% were female, over 90% had formal education, and 75.6% lived with their spouse. Nearly half (49.6%) had experienced corruption when accessing healthcare. Of those who used connections to receive care, 11.8% did so specifically to secure treatment. Individuals relying on family and friends (69.7%) were more likely to engage in corruption, and those using political connections always did. Non-membership in professional associations and political parties significantly reduced the likelihood of corrupt behaviour by 57% and 36%, respectively (p<0.01). Active participation in religious organisations was linked to lower corruption, while involvement in political parties, governance structures and professional bodies increased the likelihood. Higher education was associated with a 90% increased chance of engaging in corrupt practices (p<0.01).

Conclusion: Social capital has both enabling and constraining effects on corruption in Nigeria's healthcare system. Understanding its context-specific nature is crucial for designing effective anti-corruption strategies in health service delivery.

Introduction: The Indian healthcare system is consistently focusing on delivering equitable and affordable healthcare to its citizens. Yet, despite the country's progress towards universal health coverage, out-of-pocket healthcare expenses are still a significant barrier, particularly for outpatient services. This study examines the female patients' perspectives on the outpatient department's (OPD) affordability, focusing on (1) the socioeconomic profile of female respondents and its influence on perception of costing of healthcare services and (2) presents the specific Out Patient Department (OPD) expense related components that impose the financial constraints and the unmet healthcare needs. Findings can guide the healthcare providers in designing cost-effective services and policies on reducing the financial difficulties for availing the healthcare services.

Methods: We conducted the research study using the structured questionnaire survey engaging female patients visiting OPD services in private hospitals of Chennai, Tamil Nadu (n=200).

Results: Respondents accessed varied OPD specialties in the hospitals like gynaecology and obstetrics, cardiology, orthopaedics, etc, with a mean age of 40 years with the covered range of 21 to 70 years. Across the various income groups, respondents consistently emphasised the need for cost restructuring. The out-of-pocket expenditure was primarily distributed among Pharmacy costs, followed by the cost of hospital visits and other miscellaneous healthcare expenses. 83% of the respondents rated the hospital's charges as expensive for the OPD services, and 85% of them also reported unmet needs due to affordability. The cost for follow-up consultations and diagnostic scan services were presented as a major financial constraint affecting affordability of the healthcare services.

Conclusion: This study presents key components of OPD services and the cost-related unmet healthcare needs among female respondents. Addressing these concerns, targeted price structuring can help healthcare providers to improve healthcare utilisation and deliver cost-effective OPD services. Moreover, expanding the implementation of such measures at the national and global level of healthcare system would strengthen progress towards achieving Universal Health Coverage, aiming for equitable access without financial hardship.

Introduction: People with mental health conditions and psychosocial disabilities frequently experience human rights violations. This study assessed the efficacy of the WHO QualityRights e-training in promoting their rights within the mental healthcare system.

Methods: In this cluster-randomised trial in three psychiatric hospitals in Ghana, we randomly selected units within each hospital and randomised them 1:1 to the intervention (WHO QualityRights e-training) or control arm (COVID-19 e-training). The intervention included presentations, videos, interactive exercises and forum discussions. Mental health professionals in these facilities were eligible participants. Primary outcomes were changes in knowledge about the rights of persons with mental health conditions and in the attitudes towards them, measured post-intervention using the WHO QualityRights Knowledge and Attitudes questionnaires. Secondary outcomes included changes at 3 and 6 months in knowledge, attitudes and mental health professionals' practices related to substitute decision-making and coercion. Data analysts were masked to group assignment.

Results: Between 11 August 2021 and 13 April 2022, 28 clusters (14 per arm) were randomised and 252 participants enrolled (126 per arm); 179 (71%) were women. 206 (81.8%) completed the post-training follow-up. The intervention group showed significantly greater improvements in scores on the WHO QualityRights Knowledge (mean difference: 4.61 [95% CI 3.49 to 5.72], d=1.12) and Attitudes (-7.99 [95% CI -10.32 to -5.66], d=0.92) compared with the control group, with similarly significant results at 3 and 6 months. Additionally, intervention participants reported less frequent use of substitute decision-making and restraint (-2.60 [95% CI -4.05 to -1.16], d=0.52 at 3 months; -1.76 [95% CI -3.11 to -0.40], d=0.36 at 6 months).

Conclusion: This study showed that the WHO QualityRights e-training effectively improves mental health professionals' knowledge and attitudes and can lead to reduction in providers' use of substitute decision-making and coercion practices, thus suggesting a need for improved investment in rights-based interventions and further research.

Trial registration number: NCT04728243.

Introduction: Cervical cancer screening is a critical preventive measure to reduce the burden of cervical cancer. Yet, disparities persist worldwide, particularly among migrant populations. This study examined cervical cancer screening participation among migrant and non-migrant women enrolled in the primary healthcare centres in the Lisbon district.

Methods: This cross-sectional study analysed healthcare records from 88 278 women aged 25-60 years. Participation was assessed based on documented screening within nationally recommended timeframes. Migrants were classified by nationality into Portuguese-speaking and non-Portuguese-speaking groups. Screening participation was compared between groups, adjusting for age, family doctor assignment, primary healthcare unit type and provider gender. Logistic regression identified factors influencing participation.

Results: Migrants showed lower uptake of cervical cancer screening: 19.6% for non-Portuguese-speaking and 31.9% for Portuguese-speaking migrants, compared with 43.7% in non-migrants. After adjusting for confounders, non-Portuguese-speaking migrants had significantly lower odds of participation (OR 0.46, 95% CI 0.43 to 0.50, p<0.01), while Portuguese-speaking migrants had participation rates similar to non-migrants (p=0.29). Key healthcare factors that were associated with higher participation include enrolment in Family Health Units (FHUs) (OR=3.55, 95% CI 3.41 to 3.70, p<0.01) and having an assigned female family doctor (OR 1.43, 95% CI 1.37 to 1.50, p<0.01).

Conclusions: Migrant women face unique barriers to cervical cancer screening, particularly language and cultural differences. These findings highlight the need for tailored screening programmes incorporating multilingual support, cultural mediation and self-sampling for human papillomavirus testing as an alternative screening method. Enhancing healthcare delivery through training, improved access to family doctors and more incentive-driven FHUs could significantly improve screening uptake. Addressing these disparities is crucial for advancing health equity and enhancing cervical cancer prevention.

The concept of solidarity plays a central role in shaping both African and European cultural responses to social and political challenges, although its interpretations diverge significantly. In African societies, solidarity is rooted in the relational philosophy of ubuntu, where individual identity is understood as inseparable from the community, emphasising collective well-being and mutual care. This is reflected in practices, such as community-based caregiving for the sick and elderly, traditional healing networks and shared child-rearing. In parts of West Africa, for example among the Igbo, co-wives may sleep over at the home of a bereaved wife to provide emotional support and boost morale during mourning.In contrast, European models of solidarity are often institutionalised and rights-based, focusing on balancing individual autonomy with collective welfare within legal frameworks. This paper explores these two distinct approaches to solidarity and examines their implications in global health, especially in the context of the COVID-19 pandemic and other global health crises. Ubuntu's emphasis on communal responsibility offers a valuable framework for addressing health inequities, suggesting that global health is a shared responsibility that transcends national borders and individual interests. Conversely, European solidarity, shaped by enlightenment principles and liberal democratic traditions, often prioritises individual rights and institutional mechanisms to ensure health equity. This dialectical exploration highlights the evolving nature of solidarity in a globalised world, where African and European models of solidarity are increasingly hybridised to address global health disparities. Drawing on examples such as the Ritshidze community-led HIV care monitoring initiative in South Africa, alongside international efforts like COVAX, this paper evaluates how solidarity, in both its African and European forms, can influence global health policy and collective action, promoting more inclusive and equitable health systems worldwide.

Objectives: Washing hands is considered an effective way for preventing viral respiratory infections. This study systematically investigated the global and regional adherence to hand-washing behaviour and its impact on the incidence and death of viral respiratory infectious diseases (VRIDs).

Methods: In our systematic review and meta-analysis, we searched PubMed, Embase, Web of Science and Scopus for related studies. We included observational studies with raw data of adherence to handwashing (rates of acceptability of handwashing, daily habitual handwashing and key-moment handwashing) during VRID pandemics/epidemics. Pooled rates and effect of handwashing were calculated by random-effects model and generalised linear model.

Results: We analysed 108 articles, generating 227 datasets. During VRID epidemics/pandemics, the global pooled rate of daily handwashing was 72.23% (95% CI 66.95% to 76.95%). The lowest rate was observed in Africa (pooled rate 59.46%, 95% CI 50.73% to 67.68%) and among public transportation workers (18.15%, 95% CI 6.54% to 41.26%). Global pooled rate of key moment handwashing was 65.11% (95% CI 59.74% to 70.28%), with the lowest rate being after handshaking (36.40%, 95% CI 18.49% to 56.52%) and among the elderly (22.86%, 95% CI 16.77% to 29.58%) and was higher during the COVID-19 pandemic than the 2009 H1N1 pandemic (72.02% vs 31.33%). The pooled rate of global acceptability of handwashing was 90.01% (95% CI 83.73% to 94.05%). Key-moment handwashing was associated with a reduction in COVID-19 incidence (β=-151.1, p=0.010), COVID-19 mortality (β=-0.066, p<0.001) and other COVID-19 related deaths (β=-0.112, p<0.001).

Conclusion: During the VRID epidemics/pandemics, the handwashing behaviour adherence was relatively low. Health education efforts targeting public transportation workers and the elderly should be intensified. Augmented key-moment handwashing adherence potentially led to a significant reduction of the incidence and death of VRIDs.

Prospero registration number: CRD42024499090.