BMJ public health最新文献

{"title":"Identification of factors associated with acute malnutrition in children under 5 years and forecasting future prevalence: assessing the potential of statistical and machine learning methods.","authors":"Meike Reusken, Christopher Coffey, Frans Cruijssen, Bertrand Melenberg, Cascha van Wanrooij","doi":"10.1136/bmjph-2024-001460","DOIUrl":"10.1136/bmjph-2024-001460","url":null,"abstract":"<p><strong>Introduction: </strong>Eliminating acute malnutrition in children under 5 years of age stands as a critical health priority outlined in the United Nations Sustainable Development Goal 2, 'Zero Hunger'. This requires targeted provision of treatment and preventative services. However, accurately forecasting future prevalence of cases remains challenging, with the application of predictive models being notably scarce. Addressing this gap, this paper aims to identify factors associated with Global Acute Malnutrition (GAM) and explores the potential of machine learning in predicting its prevalence using data from Somalia.</p><p><strong>Methods: </strong>Survey data on GAM prevalence systematically collected in Somalia every 6 months at a district level from 2017 to 2021 were collated alongside a range of potential climatic, demographic, disease, environmental, conflict and food security-related factors over a matching time period. We conducted both simple and multiple, parametric and non-parametric statistical analyses to identify factors associated with GAM to be used as input in forecasting future GAM prevalence. We then applied tree-based machine learning algorithms to a dataset comprising the GAM prevalence estimates and associated factors to try to forecast the trajectory and fluctuations in GAM prevalence 6 months into the future.</p><p><strong>Results: </strong>We found factors statistically associated with GAM prevalence relating to rainfall, land vegetation quality, food security status, crop production and demographics. The majority of these associations were nonlinear, motivating the use of tree-based machine learning-based forecasts. Among the forecasting methods tested, random forest machine learning proves to be the most effective and was found to accurately forecast the direction of GAM prevalence in test data for many of the districts in Somalia.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001460"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575030","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":"Excess mortality and years of life lost from 2020 to 2023 in France: a cohort study of the overall impact of the COVID-19 pandemic on mortality.","authors":"Paul Moulaire, Gilles Hejblum, Nathanaël Lapidus","doi":"10.1136/bmjph-2024-001836","DOIUrl":"10.1136/bmjph-2024-001836","url":null,"abstract":"<p><strong>Introduction: </strong>Excess mortality has been frequently used worldwide for summarising the COVID-19 pandemic-related burden. Estimates for France for the years 2020-2022 vary substantially from one report to another, and the year 2023 is poorly documented. The present study assessed the level of excess mortality that occurred in France between 2020 and 2023 together with the corresponding years of life lost (YLL), in order to provide a reliable, detailed and comprehensive description of the overall impact of the pandemic.</p><p><strong>Method: </strong>This open cohort study of the whole French population analysed the 8 451 372 death occurrences reported for the years 2010-2023. A Poisson regression model was trained with years 2010-2019 for determining the age-specific and sex-specific evolution trends of mortality before the pandemic period. These trends were then used for estimating the excess mortality during the pandemic period (years 2020-2023). The life expectancies of the persons in excess mortality were used for estimating the corresponding YLL.</p><p><strong>Results: </strong>From 2020 to 2023, the number of excess deaths (mean (95% CI) (percentage of change versus expected mortality)) was, respectively, 49 541 (48 467; 50 616) (+8.0%), 42 667 (41 410; 43 909) (+6.9%), 53 129 (51 696; 54 551) (+8.5%), and 17 355 (15 760; 18 917) (+2.8%). Corresponding YLL were 512 753 (496 029; 529 633), 583 580 (564 137; 602 747), 663 588 (641 863; 685 723), and 312 133 (288 051; 335 929). Individuals younger than 60 years old accounted for 17% of the YLL in 2020, 26% in 2021, 32% in 2022 and 50% in 2023. Men were more affected than women by both excess mortality and YLL.</p><p><strong>Conclusion: </strong>This study highlights the long-lasting impact of the pandemic on mortality in France, with four consecutive years of excess mortality and a growing impact on people under 60, particularly men, suggesting lasting and profound disruption to the healthcare system.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001836"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575007","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 associated with school dropout and sexual and reproductive health: a cross-sectional analysis among out-of-school girls in western Kenya.","authors":"Susan Nungo, Anna Maria van Eijk, Linda Mason, Elizabeth Nyothach, Benard Asuke, Philip Spinhoven, David Obor, Christine Khaggayi, Daniel Kwaro, Penelope A Phillips-Howard, Garazi Zulaika","doi":"10.1136/bmjph-2024-001528","DOIUrl":"10.1136/bmjph-2024-001528","url":null,"abstract":"<p><strong>Introduction: </strong>Out-of-school girls are at higher risk of sexual and reproductive health (SRH) harms. Schools provide a protective environment for adolescents and lessen their exposure to such risks. This paper explores factors associated with school dropout, sexual activity, marriage and pregnancy among out-of-school girls in western Kenya.</p><p><strong>Methods: </strong>Eligible adolescents were systematically recruited from area households in Siaya County. Generalised linear models were fit to obtain adjusted ORs (aOR) and 95% CIs of key covariates against individual outcomes. Factors with p values <0.1 in the univariate analysis were added to a multivariable model using backward stepwise regression techniques, and factors significant at p<0.05 were retained in the final adjusted models. Models were bootstrapped at 1000 replications to validate factor selection.</p><p><strong>Results: </strong>Of the 915 girls enrolled (mean 18.3 years, SD: 1.3), 2.1% had never attended school. Of those who started school, 34.6% dropped out during primary education. Reasons for dropout included marriage, pregnancy and needing childcare (42.5%), financial reasons (eg, lack of school fees, needing to work, 42.5%), lack of interest (5.6%), illness (3.0%), failing school (2.2%) and other factors (4.1%). Reaching menarche prior to age 13 (aOR 1.50, 95% CI 1.00 to 2.23, p=0.048), experiencing physical violence (aOR 1.48, 95% CI 1.01 to 2.17, p=0.042) or sexual partner violence (aOR 2.16, 95% CI 1.08 to 4.34, p=0.030) were associated with not completing primary school. Experiencing sexual harassment (aOR 2.20, 95% CI 1.35 to 3.58, p=0.002) or needing to engage in transactional sex (aOR 1.74, 95% CI 1.20 to 2.51, p=0.003) were associated with being sexually active. Low socioeconomic status (aOR 1.98, 95% CI 1.36 to 2.90, p<0.001), having an older partner (aOR 1.65, 95% CI 1.10 to 2.47, p=0.016) and higher parity (aOR 2.56, 95% CI 1.42 to 4.62, p=0.002) were associated with being married or cohabiting with a partner. Girls identified provision of school fees and schooling items (67.9%) as the primary solution to resuming school; obtaining counselling, mentorship and support services (22.2%) for their general health; and provision of menstrual products (24.2%) for daily challenges.</p><p><strong>Conclusions: </strong>Out-of-school girls in western Kenya face numerous SRH challenges related to menstruation, sexual and physical violence, and poverty. Social and financial support and interventions for school re-entry are warranted for this neglected population. National policies and multisectoral strategies to support adolescent girls' education and health should be prioritised, enforced and monitored for impact.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001528"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575013","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":"Scaling up structured lifestyle interventions to improve the management of cardiometabolic diseases in low-income and middle-income countries: a systematic review of strategies, methods and outcomes.","authors":"Abha Shrestha, Lu Yang, Getu Debalkie Demissie, Rolina Dhital, Jeemon Panniyammakal, Ganeshkumar Parasuraman, Sabrina Gupta, Biraj Karmacharya, Kavumpurathu R Thankappan, Brian Oldenburg, Tilahun Haregu","doi":"10.1136/bmjph-2024-001371","DOIUrl":"10.1136/bmjph-2024-001371","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiometabolic diseases (CMDs), the leading causes of death in low-income and middle-income countries (LMICs), are proven to be mitigated through structured lifestyle interventions (SLIs-dietary changes, physical activity, tobacco cessation and alcohol intake), but the challenge lies in scaling them up in LMICs. Therefore, we undertook a systematic review to identify the strategies, methods and outcomes used in scaling up SLI programmes to improve cardiometabolic outcomes in LMICs.</p><p><strong>Methods: </strong>We searched studies implementing scale-up strategies (delivery approaches enhancing an intervention's adoption, implementation and sustainability), methods (theories, models and frameworks) and present outcomes (feasibility, fidelity, etc) following the Proctor E framework. We searched six databases to identify studies published in English with no time restriction, guided by the Setting, Perspective, Intervention, Comparison and Evaluation framework. Quality assessment was performed using the Cochrane risk-of-bias, National Institutes of Health and Joanna Briggs Institute tools. Given the heterogeneity of the outcome measures, we conducted a narrative synthesis of the extracted information.</p><p><strong>Results: </strong>Out of the 26 studies included, 18 (69%) adapted SLI interventions to suit local contexts. Strategies such as system integration, strengthening facility services and training led to up to 100% attendance of participants. Notably, only four studies (15%) used theories, models and frameworks for the full scale-up process, which is crucial for large-scale implementation in resource-limited settings. 15 (58%) studies reported the feasibility of scale-up, whereas 7 (27%) reported no significant differences in lifestyle behaviours or CMD biomarkers.</p><p><strong>Conclusions: </strong>Early community and local stakeholders' engagement is crucial for codeveloping strategies for the scale-up of SLIs. Conducting readiness assessments and system integration are all essential considerations for improving scale-up outcomes. Additionally, we strongly recommend using suitable frameworks to guide the scale-up of SLIs to maximise the benefit for the population.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001371"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575054","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":"Global patterns in access and benefit-sharing: a comprehensive review of national policies.","authors":"Gunnar V Ljungqvist, Ciara M Weets, Tess Stevens, Hailey Robertson, Ryan Zimmerman, Ellie Graeden, Rebecca Katz","doi":"10.1136/bmjph-2024-001800","DOIUrl":"10.1136/bmjph-2024-001800","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Introduction: </strong>The goal of access and benefit-sharing (ABS) in global health governance is to ensure that countries that provide access to genetic resources, including pathogens, receive equitable access to the benefits derived from their use. The increasing digitalisation of health data has brought this issue to the forefront of discussions on global health security and health equity. While originally conceptualised in supranational agreements, implementation of these treaties requires national-level legislation in each country. This descriptive analysis represents to our knowledge the first open-access comprehensive effort to map ABS policies in all 193 United Nations member states.</p><p><strong>Methods: </strong>We conducted a standardised review of the legislation for 193 United Nations Member States across three global legal databases (ABS Clearing House, WIPOLEX and FAOLEX), national legal databases and a systematic Google search. Legally enforceable policies were identified, and data were extracted across the following eight aspects of ABS legislation: Scope of Legislation, Digital Sequence Information (DSI), Access to Resources, Prior Informed Consent, Contractual Terms, Benefit-Sharing, Compliance and Legal Sanctions.</p><p><strong>Results: </strong>We found that 104 countries have legally enforceable policies on ABS, with 92 countries having ABS policies relevant to microorganisms. Of these, 74 countries have chosen to restrict access to their domestic pathogens, and 53 have chosen to link access to pathogenic resources with an obligation to share benefits. Altogether 22 countries have a codified position on DSI with regard to ABS in legally enforceable policy: 16 have explicitly included it, 2 have explicitly excluded it and 4 have ambiguous wording. WHO regional coverage of ABS policy on genetic resources ranged from 28% (3/11) of countries in the Eastern Mediterranean Region to 57% (21/35) in the Region of the Americas. Likewise, regional coverage of legally enforceable ABS policy related to DSI ranged from 0% in the Eastern Mediterranean and European Regions to 36% (4/11) of countries in the Southeast Asian Region.</p><p><strong>Conclusion: </strong>These findings highlight the heterogeneity found in the global policy landscape as it pertains to ABS, and provide data to inform future agreements and research efforts related to ABS.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001800"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575025","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":"Secondary care for people experiencing homelessness in Scotland: a retrospective cohort study.","authors":"Anna Ct Gordon, Haris Haseeb, Sarah Johnsen, Claire Mackintosh","doi":"10.1136/bmjph-2024-001766","DOIUrl":"10.1136/bmjph-2024-001766","url":null,"abstract":"<p><strong>Introduction: </strong>People experiencing homelessness (PEH) face multimorbidity and poor health outcomes alongside deep exclusion in accessing health and social care. A large proportion of PEH use unscheduled emergency care heavily due to a multitude of barriers to primary care. No existing research in Scotland has explored experiences of PEH in secondary care.</p><p><strong>Methods: </strong>In view of new national guidelines for the care of PEH, we conducted a retrospective study of 230 unscheduled presentations to secondary care, comparing 115 PEH with 115 patients matched by age and sex (July to December 2021). We aimed to profile morbidity, mortality and explore measures of quality of secondary care, particularly the involvement of multidisciplinary teams (MDTs), readmission rates, attendance at follow-up appointments and place of discharge.</p><p><strong>Findings: </strong>Our findings demonstrate that the PEH population were young (mean age 43.9), 79% of whom experience multimorbidity, with a mortality rate of 13% at 1 year (mean age of death 47.3). 86.09% of PEH experienced additional disadvantages including problematic alcohol use or illicit drug use, and over a third experience two. Despite this, few PEH were seen by relevant hospital MDT members during admission. 8% were discharged to permanent accommodation, 14% were discharged to rooflessness (without shelter) and 8.7% chose to terminate their admission. Significantly less PEHs were offered outpatient follow-up (52% compared with 80%) or attended follow-up (47% compared with 87%), and readmission rates within 1 month were double in the PEH cohort.</p><p><strong>Conclusions: </strong>Data clearly demonstrate the need for specialist support for PEH within secondary care during admission and integrated care beyond.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001766"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575058","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":"Uptake of and willingness to pay for health insurance in rural Senegal: a reinforcement effect.","authors":"Marwân-Al-Qays Bousmah, Cheikh Sokhna, Sylvie Boyer, Bruno Ventelou","doi":"10.1136/bmjph-2024-001636","DOIUrl":"10.1136/bmjph-2024-001636","url":null,"abstract":"<p><strong>Introduction: </strong>Expanding health insurance is viewed as a core strategy for achieving universal health coverage. In Senegal, as in many other developing countries, this strategy has been implemented by creating community-based health insurance (CBHI) schemes with voluntary enrolment and a fixed premium paid by enrollees. Yet little is known about how the individuals' experience of CBHI enrolment further influences their willingness to pay (WTP). In this paper, we test the existence of a reinforcement effect between effective enrolment in a CBHI and WTP for health insurance by analysing their mutual relationship.</p><p><strong>Methods: </strong>We rely on primary survey data collected in 2019-2020 in the rural area of Niakhar in Senegal. We use an econometric methodology involving: (1) Heckman-type selection models to estimate the determinants of CBHI membership conditioned on awareness of health insurance, addressing the issue of sample selection due to differential awareness and (2) a simultaneous equation model to jointly estimate the uptake and WTP for health insurance, addressing the issue of endogeneity due to reverse causality between both variables. We also focus on the roles that informational and geographical barriers, as well as individual risk preference and trust, play in both outcomes.</p><p><strong>Results: </strong>The final sample includes 1607 individuals. Results show that WTP further increases with the individuals' direct experience in a CBHI scheme, despite an environment characterised by low enrolment rates. We also provide evidence for a U-shaped relationship between risk tolerance and WTP for health insurance.</p><p><strong>Conclusion: </strong>We provide novel evidence on a reinforcement effect of enrolment in a CBHI on WTP for health insurance, with the presence of a substantial consumer surplus among enrolled individuals at the actual premium. Our findings suggest that policies aiming at improving health insurance awareness should foster the demand for health insurance in rural Senegal.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001636"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575063","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":"Prevalence and associated factors of psychological distress among patients with oral cancer in the selected tertiary care institutes in Sri Lanka: a combined cross-sectional and case-control study.","authors":"Nadisha Ratnasekera, Irosha Perera, Pushpakumara Kandapola Arachchige, Sumeth Perera, Prasanna Jayasekara","doi":"10.1136/bmjph-2024-001638","DOIUrl":"10.1136/bmjph-2024-001638","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Introduction: </strong>Oral cancer represents the most prevalent malignancy among Sri Lankan males. This aggressive disease is associated with significant psychological distress, driven by disfigurement and impairments of vital functions.While the detrimental impact of psychological distress on patients with oral cancer is well documented, its prevalence and associated determinants remain underexplored in the Sri Lankan context. This study aims to evaluate the prevalence and identify the factors associated with psychological distress in a selected cohort of patients with oral cancer in Sri Lanka.</p><p><strong>Methods: </strong>A hospital-based cross-sectional study was conducted among 355 patients with oral cancer to determine the prevalence of psychological distress. Additionally, a nested case-control study comprising 140 patients per group was carried out to evaluate the factors associated with psychological distress. Multivariate logistic regression analysis was performed to identify significant associated factors of psychological distress.</p><p><strong>Results: </strong>The prevalence of psychological distress among patients with oral cancer was 31.0% (95% CI=27.8-35.3%). Being <50 years of age (adjusted OR (AOR)=1.2, 95% CI=0.7-1.7, p=0.006), having pain (AOR=44.7, 95% CI=34-53.21, p=0.001), late stages of cancer at the diagnosis (AOR=10.7, 95% CI=1.07-28.78, p=0.04), being worried about basic functional disabilities (AOR=11.4, 95% CI=10.3-14.8, p=0.006) and the two psychological factors-<i>worry</i> (\"Other people <i>worry</i> about me more than I do\"; AOR=5, 95% CI=2.8-6.9) and <i>anger</i> (\"I feel very <i>angry</i> about what has happened to me\"; AOR=12.1, 95% CI=6.8-15.4)-emerged as significant independent factors that were associated with increased risk of psychological distress among patients with oral cancer.</p><p><strong>Conclusion: </strong>Approximately one-third of patients with oral cancer in the selected tertiary care hospitals were found to experience psychological distress, highlighting its high prevalence in this population. The identification of key factors associated with psychological distress provides valuable insights for the development of targeted intervention strategies aimed at mitigating psychological morbidity among patients with oral cancer.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001638"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575050","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":"Healthcare workers' perceptions of postoperative care and implementation challenges in conflict-affected northwest Syria: a mixed-methods analysis.","authors":"Stefany M Lazieh, Maia C Tarnas, Kelli Wagner, Ismail Alkhatib, Camila Polinori, Measser Netfagi, Ahmad Ghandour, Sameeh Qaddour, Bara Zuhaili, Gilbert Burnham","doi":"10.1136/bmjph-2024-001236","DOIUrl":"10.1136/bmjph-2024-001236","url":null,"abstract":"<p><strong>Introduction: </strong>Protracted violent conflict has severely reduced healthcare provision in northwest Syria (NWS), and this is especially concerning for postoperative care as conflict-related injuries have further compounded this strain. Without sufficient postoperative care, minor complications can evolve into life-threatening events. In this study, we aim to understand healthcare workers' attitudes, practices and perceptions regarding postoperative care in NWS and identify key barriers to postoperative care.</p><p><strong>Methods: </strong>Individuals with experience in health leadership positions in NWS were identified using purposive and snowball sampling and interviewed using a semistructured interview guide. Interview summaries were analysed using a standardised codebook to identify potential themes. In addition to these interviews, an online survey on hospital practices was sent to hospital administrators and non-governmental organisation leadership who disseminated the survey to all employees engaging in clinical work.</p><p><strong>Results: </strong>Eighteen key informants were interviewed, and 466 survey responses from doctors (39%), nurses (37%), medical technicians (13%) and administrators (11%) were recorded. Through key informant interviews, we demonstrate several barriers to postoperative care, including health system fragmentation, limited healthcare workforce, insufficient resources due to conflict, disinterest, and lack of clinical documentation and discharge standards. Survey respondents reported poor patient compliance (66%), lack of routine follow-up visits (42%) and non-sterile operating room instruments (42%) as primary reasons for postoperative complications. Identified pathways to improve postoperative care included increased staffing and training, improved operating room sterilisation, and enhanced patient follow-up and discharge processes.</p><p><strong>Conclusion: </strong>In conclusion, the health system in NWS is extremely overburdened from over a decade of violent conflict, increased demand for health services and insufficient resources. This has made implementing consistent and adequate postoperative care nearly impossible, contributing to unnecessary complications and mortality. Solutions to address postoperative complications in NWS must account for these complex realities and the broader context in which this system exists.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001236"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575027","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":"Assessing trends in non-coverage bias in mobile phone surveys for estimating insecticide-treated net coverage: a cross-sectional analysis in Tanzania, 2007-2017.","authors":"Matt Worges, Ruth A Ashton, Janna Wisniewski, Paul Hutchinson, Hannah Koenker, Tory Taylor, Hannah Metcalfe, Ester Elisaria, Mponeja P Gitanya, Charles Dismas Mwalimu, Frank Chacky, Joshua O Yukich","doi":"10.1136/bmjph-2024-001379","DOIUrl":"10.1136/bmjph-2024-001379","url":null,"abstract":"<p><strong>Introduction: </strong>Monitoring insecticide-treated net (ITN) coverage and use generally relies on household surveys which occur on a relatively infrequent basis. Because indicators of coverage are used to forecast the need for ITNs and aid in planning ITN distribution campaigns, higher frequency monitoring could be helpful to guide programme strategies. The use of mobile phone-based survey (MPS) strategies in low-income and middle-income countries has emerged as a rapid and comparatively inexpensive complement to large-scale population-based household surveys, considering the dramatic growth trend of mobile phone ownership.</p><p><strong>Methods: </strong>The potential for non-coverage bias in the calculation of ITN coverage estimates from MPSs was assessed through the use of five consecutive Tanzania-specific Demographic and Health Surveys (DHS). Primary comparisons were made between all households included in the data sets (the reference standard) and mobile phone-owning households (the comparator). Deviations in ITN coverage estimates between the reference standard and mobile phone-owning households were used as a proxy for assessing potential non-coverage bias, with estimates calculated using a bootstrap method.</p><p><strong>Results: </strong>By the 2017 DHS, regional measures of non-coverage bias for ITN coverage indicators rarely exceeded a ±3 percentage point difference when comparing mobile phone-owning households to the overall sample. However, larger differences were observed when comparing mobile phone-owning households to non-mobile phone-owning households, particularly in periods without recent mass ITN distributions.</p><p><strong>Conclusion: </strong>Results suggest that MPSs can reliably estimate ITN coverage at the population level when both ITN coverage and mobile phone ownership are high. However, as ITN coverage declines, the gap between phone-owning and non-phone-owning households widens, indicating potential non-coverage bias and underscoring the need for caution in interpreting MPS data under such conditions.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001379"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575009","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}