SSM - Health Systems最新文献

{"title":"Unlocking adolescent and youth health - Insights from adolescent youth-friendly services in Migori County, Kenya: A cross-sectional mixed-methods study","authors":"Lillian Njoki Nyaga ,&nbsp;Eunice Muthoni Mwangi","doi":"10.1016/j.ssmhs.2025.100067","DOIUrl":"10.1016/j.ssmhs.2025.100067","url":null,"abstract":"<div><h3>Background</h3><div>The provision of adolescent and youth-friendly services (AYFS) can be facilitated by various strategies, including capacity building of health care providers (HCPs), coordination of AYFS, community engagement, and networking of AYFS stakeholders. Adolescents and youth face various health challenges including but not limited to adolescent pregnancies, HIV infections, sexual and gender based violence, strategies that would help curb these challenges is paramount. Although various studies have evaluated AYFS utilization and integration in Kenya, scant data exist on strategies facilitating or hindering the provision of the AYFS in accordance with the Kenya 2016 AYFS guidelines. The aim of this study was to document the implementation of AYFS strategies and how they affect the provision of AYFS in Migori County, Kenya.</div></div><div><h3>Methods</h3><div>This cross-sectional study targeted 159 public health facilities and 455 HCPs in Migori County. The study utilized Taro Yamane’s formula to determine a sample size of 114 health facilities with a target population of 455HCPs, from which a sample of 213 HCPs was drawn. The data were collected from the 210 providers using a structured questionnaire, whereas the qualitative data were collected from three health facility-in-charges using a key informant interview guide. Statistical significance was set at p &lt; 0.05 for quantitative data.</div></div><div><h3>Results</h3><div>Bivariate analysis reported positive and significant associations between capacity building, coordination of actors and activities, stakeholder networking, and community engagement and the provision of the AYFS, with p = 0.001, r = .548; p = 0.001, r = .482; p = 0.001, r = .390; and p = 0.001, r = .460, respectively. There was a 10.092-fold ( CI 4.007–25.417) increase in the odds of providing AYFS among workers who were trained on the AYFS compared with those who were not trained; a 2.987-fold (CI 1.124–7.937) increase in the odds of providing an AYFS when the coordination of AYFS actors and activities was performed compared with that where coordination was not performed; and a 4.979-fold ( CI 1.844–13.441) increase in the odds of providing AYFS when there was community involvement compared with that where there was no community involvement. The networking of stakeholders (<em>p = 0.135) was</em> not found to be significant in the provision of the AYFS.</div></div><div><h3>Conclusion</h3><div>Policy interventions should prioritize healthcare worker training initiatives, foster effective coordination mechanisms, and promote community involvement. These strategies demonstrate substantial increases in AYFS provision, emphasizing the need for sustained investment and commitment. Prioritizing these factors can catalyze transformative policy actions toward youth-centric healthcare services.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100067"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using fuzzy set qualitative comparative analysis to identify conditions for good performance in the decentralized health system of Tanzania","authors":"M. Baroudi ,&nbsp;S. Maluka ,&nbsp;P. Kamuzora ,&nbsp;M. San Sebastián ,&nbsp;A.N. Kapologwe ,&nbsp;A.K. Hurtig","doi":"10.1016/j.ssmhs.2025.100065","DOIUrl":"10.1016/j.ssmhs.2025.100065","url":null,"abstract":"<div><h3>Background</h3><div>Decentralization has been a prominent strategy to enhance health systems’ efficiency, service quality, autonomy and accountability in low- and middle-income countries (LMICs) like Tanzania since the 1990s. Previous studies have mainly focused on assessing how much power for decision-making on different health system functional areas is granted to local-level authorities from the central government and the interconnections between decision space, organizational capacity, and accountability mechanisms. Empirical evidence on its impact on performance remains limited. This study investigates conditions for good performance in a decentralised health system of Tanzania.</div></div><div><h3>Methods</h3><div>We used fuzzy set qualitative comparative analysis to analyse the necessary and sufficient conditions for good health system performance. Eighteen purposively districts were chosen to capture variations in performance and geography in a multiple case study approach.</div></div><div><h3>Results</h3><div>Functional Health Facility Governing Committees (HFGCs) emerged as a necessary condition for good performance. To achieve good performance, however, there is a need for functional decision space among managers or high accountability among managers or high capacity of staff/ okay level of staffing.</div></div><div><h3>Conclusion</h3><div>The study underscores the importance of the interplay between decision space, organizational capacity, and accountability in improving health system performance. While decentralization aims to provide greater autonomy, effective implementation depends on the development of local capacities and oversight through accountability. Decentralization alone is not sufficient to enhance healthcare delivery; HFGCs and their local context that promote (social) accountability are essential. Further research is warranted to identify interventions supporting HFGCs in fulfilling their mandates and enhancing health service delivery.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100065"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of environmental health services on patient well-being and quality of care: A qualitative study in Malawi’s public healthcare facilities","authors":"Tara Fitzpatrick ,&nbsp;Lucy K. Tantum ,&nbsp;Jennifer Mmodzi Tseka ,&nbsp;Innocent Mofolo ,&nbsp;Holystone Kafanikhale ,&nbsp;Irving Hoffman ,&nbsp;Ryan Cronk ,&nbsp;Darcy M. Anderson","doi":"10.1016/j.ssmhs.2025.100064","DOIUrl":"10.1016/j.ssmhs.2025.100064","url":null,"abstract":"<div><div>Healthcare facility environmental conditions – including water, sanitation, hygiene, waste management, cleaning, energy, and building design – contribute to safe and quality care delivery. However, how environmental conditions shape patient experiences have not been systematically assessed. We conducted a case study to examine the impacts of environmental conditions on patient well-being and quality of care through interviews with 56 patients and caregivers from all service delivery levels and geographic areas in public healthcare facilities in Malawi. We analyzed interview data to identify impacts of environmental conditions on multiple dimensions of well-being (physical, mental, social, and economic well-being) and quality of care (patient-centeredness, equity, safety, efficiency, and timeliness). Many participants reported poor environmental conditions and extensive impacts on well-being. Patients felt stress, fear of infection, and dissatisfaction with inadequate water, sanitation, and hygiene services. To cope with poor conditions, patients and family caregivers cleaned areas, fetched water, or spent money on supplies, leading to economic impacts. Facility conditions influenced perceptions of dignified and respectful care. Inadequate or overcrowded conditions led to negative encounters with other patients and healthcare workers. Patients felt more satisfied and respected when they observed healthcare workers performing hand hygiene or maintaining the facility. Findings demonstrate that environmental conditions influence numerous aspects of patient experience and well-being. The development of quantitative measures for well-being and quality of care would allow programs to routinely monitor these impacts and detect changes over time. Patient perspectives and priorities should be considered in future efforts to evaluate and improve environmental conditions in healthcare facilities.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100064"},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards a common understanding of gender-responsive monitoring and evaluation for health programs and interventions: Evidence from a scoping review","authors":"Anna Kalbarczyk ,&nbsp;Daniel Krugman ,&nbsp;Shatha Elnakib ,&nbsp;Elizabeth Hazel ,&nbsp;Amy Luo ,&nbsp;Anju Malhotra ,&nbsp;Rosemary Morgan","doi":"10.1016/j.ssmhs.2025.100059","DOIUrl":"10.1016/j.ssmhs.2025.100059","url":null,"abstract":"<div><div>Given the many approaches to and definitions of gender responsive monitoring and evaluation (M&amp;E) for health programs and interventions there is a lack of clarity on how to operationalize it including what to measure and how to measure it. We conducted a scoping review to understand what makes M&amp;E gender responsive. We included 31 studies and conducted two rounds of extraction to delineate ways in which gender was integrated into M&amp;E. Twelve articles described the use of theory to guide M&amp;E though most were not related to gender. Twelve articles employed a gender score in data collection, most of which measured Likert scale responses related to gender equity. Even though most studies did not use a specific gender framework, most incorporated gender domains in their analysis. Seven studies used participatory methods in the design and implementation of M&amp;E. Most studies conducted M&amp;E on programs or interventions that were designed to be gender intentional and related to gender issues. Gender responsive M&amp;E intentionally integrates gender into the M&amp;E process, regardless of how gender-intentional the program or intervention is. Gender dimensions can be identified through gender theories, models, scores, and frameworks to inform tool development, data collection, analysis, and stakeholder engagement processes.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100059"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143550582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Theoretical foundations and mechanisms of health systems responsiveness: a realist synthesis","authors":"Tolib Mirzoev ,&nbsp;Ana Manzano ,&nbsp;Irene Akua Agyepong ,&nbsp;Bui Thi Thu Ha ,&nbsp;Linda Lucy Yevoo ,&nbsp;Elizabeth Awini ,&nbsp;Anthony Danso-Appiah ,&nbsp;Leveana Gyimah ,&nbsp;Do Thi Hanh Trang ,&nbsp;Le Minh Thi ,&nbsp;Kimberly Lakin ,&nbsp;Sumit Kane","doi":"10.1016/j.ssmhs.2025.100061","DOIUrl":"10.1016/j.ssmhs.2025.100061","url":null,"abstract":"<div><div>Health systems responsiveness is a key health systems goal, operationalised as an outcome measured across domains such as dignity and confidentiality. It also reflects values and inputs towards improved health. In this realist synthesis, we critically reviewed underpinning theories, examined mechanisms, and propose a theoretical model of health systems responsiveness. Four theories enhance the understanding of responsiveness: Complex Adaptive Systems, Human Agency, Health Equity, Justice and Social Accountability, and Cultural Capital. It is a social construct reflecting what people expect from the system within social and cultural contexts; and what systems actors (providers, managers) expect from people in the context of standards of care and available resources. Responsiveness is shaped by the societal context of care and the health systems context. Domains of responsiveness are inter-related and comprise values, processes and resources. Our proposed theory highlights the importance of favourable social and organisational contexts in triggering sense of agency, literacy and empowerment that contribute to enhanced people’s capacity to engage with health systems and health system’s capacity to respond to people’s expectations. We hope it offers a useful heuristic to inform efforts in improving health systems responsiveness.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100061"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the complex knowledge economy toward antimicrobial stewardship in West Bengal, India","authors":"Ayako Ebata ,&nbsp;Meenakshi Gautham ,&nbsp;Anne-Sophie Jung ,&nbsp;Mathew Hennessey ,&nbsp;Sanghita Bhattacharyya ,&nbsp;Gerald Bloom","doi":"10.1016/j.ssmhs.2025.100063","DOIUrl":"10.1016/j.ssmhs.2025.100063","url":null,"abstract":"<div><div>Knowledge dissemination and awareness raising is a common strategy for fostering antimicrobial stewardship and tackling antimicrobial resistance (AMR). However, empirical evidence suggests that the dissemination of technical/biomedical information about AMR, alone, is insufficient to improve antibiotic use in resource-poor settings. This is because antibiotic users’ decisions are based not only on biomedical knowledge but also on social and clinical information that is specific to local healthcare realities, and healthcare providers’ clinical knowledge and judgement. In this article, we propose a framework that identifies knowledge critical to deciding a course of antibiotic treatment for possible infection in resource-poor settings, and how to improve the knowledge flow to improve antibiotic use. Specifically, we focus on understanding three domains of knowledge that guide antibiotic users’ decisions: 1) scientific evidence, and evidence-based treatment guidelines; 2) local knowledge of infection patterns and risks, and the susceptibility of organisms causing infection to different antibiotics; and 3) personal and social characteristics of the patient. Drawing from the theory of information asymmetry and empirical data from West Bengal, India, we show that all three domains of knowledge demonstrated degrees of asymmetry, and community-level practitioners’ knowledge was not effectively taken into account in clinical guidance. We conclude that interventions targeting AMR need to reflect all three knowledge domains to be effective in clinical settings.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100063"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing healthcare facility selection in an urban setting in Lao PDR: Findings from a qualitative study","authors":"Amit Aryal ,&nbsp;Emma Clarke-Deelder ,&nbsp;Doris Osei Afriyie ,&nbsp;Souksanh Phommalangsy ,&nbsp;Günther Fink","doi":"10.1016/j.ssmhs.2025.100062","DOIUrl":"10.1016/j.ssmhs.2025.100062","url":null,"abstract":"<div><h3>Background</h3><div>In Lao People’s Democratic Republic (Lao PDR), health care is provided through a public system comprised of central, provincial and district hospitals, health centers, and a growing private sector. Despite efforts to strengthen primary care, recent data suggests that Laotians often bypass primary care facilities. This study aims to understand the factors influencing health facility selection in an urban setting in Lao PDR.</div></div><div><h3>Methods</h3><div>We conducted a qualitative study using 16 focus-group discussions in four districts in Vientiane capital. Guided by Constructivist Grounded theory, we analyzed the findings using the Framework Method.</div></div><div><h3>Results</h3><div>The study revealed several key factors influencing health facility selection among urban residents of Vientiane capital. Accessibility of care facilities was a primary consideration. Participants preferred tertiary-level hospitals because of their perceived clinical superiority and modern amenities, however, they were unsatisfied with long waiting times, confusing procedures, and demands for informal payments. Lack of respect and empathy drove participants to private providers, which were perceived to be efficient and friendly.</div></div><div><h3>Conclusion</h3><div>We found that key factors influencing facility selection included accessibility, perceived severity of illness, cost, perceived clinical competence of health workers, respectfulness of health workers and staff, standards of health facilities, timeliness of care and personal connections. Among the key findings of this study was that lack of respect and empathy drove individuals towards private providers, which were perceived to offer a friendlier atmosphere. This study underscores the need to consider primary care models that foster a culture of respect and empathy.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100062"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling health insurance satisfaction: Exploring key determinants and bottlenecks in Bangladesh","authors":"Rumana Huque ,&nbsp;S.M. Abdullah ,&nbsp;Tahia Anan Dhira ,&nbsp;Salina Siddiqua ,&nbsp;Deepa Barua ,&nbsp;Md. Abdullah ,&nbsp;Muhammod Abdus Sabur ,&nbsp;Nazma Begum ,&nbsp;Omara Dogar ,&nbsp;Md. Nurul Amin ,&nbsp;Mohd. Shahadat Hossain Mahmud","doi":"10.1016/j.ssmhs.2025.100058","DOIUrl":"10.1016/j.ssmhs.2025.100058","url":null,"abstract":"<div><h3>Background</h3><div>Less than 1 % of the population in Bangladesh has access to health insurance (HI). Accordingly, the health care financing is largely reliant on out-of-pocket expenses. We explored determinants of client satisfaction with HI for a comprehensive model and made effort to identify the bottlenecks for HI expansion in Bangladesh.</div></div><div><h3>Methods</h3><div>We used an explanatory sequential mixed-methods approach, surveying 291 active HI subscribers on satisfaction with service quality, claim settlement, premium, coverage, deductible, co-payment and company support. Experience-based perceptions on availing HI, premium payment, client service, claim settlement and HI benefit package were recorded on a Likert scale. Further, we conducted 25 key informant interviews to understand the bottlenecks for HI expansion in Bangladesh. We used thematic framework approach to analyse qualitative data. Principal Component Analysis was carried out to generate indices. Determinants of HI satisfaction were identified using multiple linear regression.</div></div><div><h3>Results</h3><div>Among experience-based perception domains, client service and claim settlement were key factors in HI satisfaction, with client service having a greater impact (coefficients: 0.45 and 0.30). Adding dependent healthcare and longer coverage enhanced client satisfaction. Though 74 % of clients were willing to recommend their HI scheme establishing good satisfaction level, issues related to low awareness, lack of specialized providers, high taxes, and an image crisis hinder HI expansion in Bangladesh</div></div><div><h3>Conclusions</h3><div>Improving client satisfaction and hence, expanding HI market requires quality service and better claim settlement. Strengthening awareness and building the image for HI in Bangladesh need collaborative efforts.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100058"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brazilian healthcare bureaucracies and the production of antimicrobial resistance","authors":"Roberto Rubem da Silva-Brandão ,&nbsp;Katherine Kenny ,&nbsp;Michelle Peterie ,&nbsp;Alex Broom","doi":"10.1016/j.ssmhs.2025.100060","DOIUrl":"10.1016/j.ssmhs.2025.100060","url":null,"abstract":"<div><div>The growing concern over the rise of antimicrobial resistance (AMR) has brought to light the ways AMR is produced through interconnected structural, political, clinical, and biological factors. In this study, set in São Paulo, Brazil, we articulate how healthcare bureaucracies feature in this production of AMR in primary care by drawing on a series of interviews with primary care-based health professionals, health services managers, and policymakers, completed between late 2021 and early 2023. Our results show how expanding and contracting bureaucracies are highly politicized and variously contribute to the production of AMR in primary care. In particular, healthcare labour force dynamics and managerial relations within healthcare settings contribute to the bureaucratic elements of AMR risks in clinical practice. We argue that the invisibility of AMR in everyday practice is deeply entwined with its bureaucratic form; that is, with the instability between institutions and individual action, public and private sectors, work and clinical practice, and social and clinical entanglements of resistance.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100060"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is mother's education essential to improving the nutritional status of children under five in Côte d′Ivoire?","authors":"Sonia A.W. Gbratto-Dobe ,&nbsp;Hugues B. Segnon","doi":"10.1016/j.ssmhs.2025.100056","DOIUrl":"10.1016/j.ssmhs.2025.100056","url":null,"abstract":"<div><div>This paper analyses the effect of mothers’ education on the nutritional status of children under 5 in Côte d’Ivoire. We used data on 8743 children aged 0–59 months, of the MICS5–2016 conducted in Côte d’Ivoire. Child nutritional status was measured with their height-for-age and weight-for-age, according to WHO standards. Multilogistic estimates were carried out using Stata 17. We find that children whose mothers had at least primary education were less at risk of having moderate stunting as well as moderate underweight. Those whose mothers reached a higher level were less at risk of having severe stunting as well as severe underweight. Controlling by significant variables such as child's sex and age, paternal education, household place of residence, household wellbeing index, and mother access to media slightly increased the impact of mothers’ education. Mothers’ education is essential to improving child nutritional status during his first 5 years of life. Her impact in reducing child malnutrition is greater on stunting than on underweight, suggesting an improvement in the long-term. Promoting women's education, by improving their access to formal education is fundamental to fight against child malnutrition. Considering multi-sectoral actions in the fight against malnutrition could make this objective more effective.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100056"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143176589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}