BMJ public health最新文献

{"title":"Assessing the value-added contributions of community health workers and communities to early child development: a longitudinal study in a low-income setting.","authors":"Caitlin Hemlock, Maria Dieci, Lia C H Fernald, Emanuela Galasso, Lisy Ratsifandrihamanana, Ann M Weber","doi":"10.1136/bmjph-2024-001192","DOIUrl":"10.1136/bmjph-2024-001192","url":null,"abstract":"<p><strong>Background: </strong>Early child development (ECD) programs in low-resource settings can be effective when delivered through community health workers (CHWs), but there are significant challenges when moving to scale. This analysis aimed to determine the value-added, or relative effectiveness, of CHWs and communities on ECD outcomes within a home-visiting trial and examine associations between observable characteristics of the CHW or community and value-added.</p><p><strong>Methods: </strong>We analysed data from the four treatment arms of a cluster-randomised trial conducted in 100 communities in rural Madagascar from 2014 to 2016. CHWs (one per cluster) and enrolled children (0-12 months) were surveyed at baseline and 2 years later. Child development scores were assessed using the Ages and Stages Questionnaire-Inventory (ASQ-I) and were internally age-standardised. We determined value-added by estimating CHW/community-level fixed effects on ASQ-I Z-score trajectories (change from baseline to endline), conditional on baseline ASQ-I Z-score and child and household characteristics. We also assessed associations between value-added and observable CHW and community-level characteristics.</p><p><strong>Results: </strong>We analysed data from 1456 children present at baseline and endline. CHW/community fixed effects explained 26% of ASQ-I trajectory variance and estimates ranged from -1.68 SD to 1.31 SD. CHWs who had another income-generating position were associated with a 0.54 SD (95% CI 0.22, 0.87) increase in ASQ-I Z-score from baseline to endline. Greater increases in children's ASQ-I Z-scores were also associated with communities that had better healthcare, education and transportation infrastructure and were less geographically dispersed.</p><p><strong>Conclusions: </strong>Children gained or lost over one standard deviation of ASQ-I Z-score depending on the community and CHW where they lived. Children's development trajectories benefitted from CHWs involved in an external income-generating activity and communities with better access to healthcare, education, and transportation. Careful consideration of the contexts in which child development interventions are implemented and potential correlates of improved CHW performance are crucial for improved outcomes.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001192"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525879","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":"Evaluating the utilisation patterns of pharmacological therapy in COVID-19 patients: an ecological study in Italy.","authors":"Maria Lucia Marino, Aurora Di Filippo, Graziano Onder, Davide Eleuteri, Francesco Trotta","doi":"10.1136/bmjph-2024-001767","DOIUrl":"10.1136/bmjph-2024-001767","url":null,"abstract":"<p><strong>Backgound: </strong>The drug central monitoring system set up in Italy to evaluate the real-time trends of medicines used in hospital and primary care settings contributed to inform drug supplies, avoided stockpiling and allowed to monitor adherence to clinical practice guidelines for the treatment of COVID-19 patients. The primary objective of the study is to understand how and to what extent the drug utilisation tracked the evolution of COVID-19 pandemic and evaluate the different pharmacological approaches adopted in hospital and primary care settings.</p><p><strong>Methods: </strong>A national ecological study correlating the drug utilisation of specific categories of drugs related to SARS-CoV-2 with the number of SARS-CoV-2 hospitalised or positive subjects. The correlation is estimated by using linear regression models and reporting the angular coefficients (slope) with relative p value.</p><p><strong>Results: </strong>Overall, 15 drug categories are identified: 7 categories are available in both settings, 6 categories are prevalent in hospital setting and 2 categories are used in primary care. As for drugs common to both settings, a statistically significant positive association between the number of SARS-CoV-2-positive subjects and drug consumption is found only for low-molecular-weight heparin, oxygen, azithromycin and steroids. As regards drugs used exclusively in hospital, a significant correlation is observed for cardiac stimulants, general anaesthetics, hypnotics and sedatives as well as muscle relaxant drugs. Among drugs used exclusively in primary care, the study has shown a positive correlation only for vitamin D. Finally, the adoption in clinical practice of the recommendations issued by the competent authorities was assessed: at hospital level, the use of drugs with a negative recommendation (such as hydroxychloroquine and azithromycin) was promptly stopped.</p><p><strong>Conclusions: </strong>Study findings show a positive correlation between the use of specific drug categories used during the pandemic and the number of COVID-19-positive and hospitalised patients, suggesting the relevant role of evaluating drug utilisation patterns in tracking the evolution of pandemics and guideline adherence in clinical practice.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001767"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525946","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":"Availability, prices and affordability of self-monitoring blood glucose devices: surveys in six low-income and middle-income countries.","authors":"Margaret Ewen, Molly Lepeska, Aida Abdraimova, Stéphane Besançon, Nguyen Thi Phuong Cham, Asel Dunganova, Moise Nguemeni, Lachlan Oldfield, Janeth Tenorio-Mucha, Hesty Utami Ramadaniati, Beatrice Vetter, David Beran","doi":"10.1136/bmjph-2024-001128","DOIUrl":"10.1136/bmjph-2024-001128","url":null,"abstract":"<p><strong>Introduction: </strong>Accessing glucose meters, test strips, lancets and continuous/flash glucose monitoring devices for self-monitoring blood glucose (SMBG) is crucial for the management of diabetes. Yet little is known about access to SMBG devices in low-income and middle-income countries.</p><p><strong>Methods: </strong>In 2022/2023, facility-based surveys were undertaken in selected regions and sectors in Fiji, Indonesia, Kyrgyzstan, Mali, Peru and Vietnam. Availability and patient prices were collected in public sector outlets (hospital dispensaries/clinics) and private pharmacies in the community by in-person visits (except in Mali where it was collected by phone). Data were also collected in medical device shops (Vietnam), online marketplaces (Indonesia) and online from device manufacturers.Availability was assessed as the percentage of outlets with the device in stock on the day of data collection. Median prices were calculated and reported in US dollars (US$). Affordability was assessed as the number of days' wages needed by the lowest-paid unskilled government worker to purchase each device. The affordability of self-monitoring was then compared with that of insulin.</p><p><strong>Results: </strong>SMBG devices were not generally provided to individuals for self-testing by governments in Fiji, Indonesia, Kyrgyzstan and Peru. Public sector availability ranged from 0% to 57% (meters) and 0% to 53% (strips). In private pharmacies, availability was 31% to 100% (meters) and 39% to 100% (strips). Some large regional variations were seen within countries. Median prices for one meter ranged from US$15.62 to US$35.18. For one strip, median prices ranged from US$0.27 to US$0.56. Continuous/flash glucose monitoring devices were only found online at US$88-US$107 per sensor. Between 1.5 and 10.9 days' wages were needed to purchase 1 meter, and 1.0-12.8 days' wages for 50 strips. Online purchases of 1-month supply of continuous/flash device sensors required 15-65 days' wages. The cost of self-testing exceeded the cost of human insulin vials/syringes. However, analogue prefilled pens/pen needles were often higher priced than the cost of self-testing.</p><p><strong>Conclusion: </strong>Poor availability and high prices were found for SMBG devices which can impact diabetes management. Prices of meters, test strips and sensors were unaffordable. Pricing for these essential tools requires further investigation including cost of goods sold; government procurement prices and volumes; and price components in supply chains. Accessing SMBG devices must not be considered in isolation to accessing insulin. Governments need to include SMBG devices in their package of essential diabetes services. They must also support ongoing monitoring to ensure people are accessing SMBG devices.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001128"},"PeriodicalIF":0.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525926","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 lights are on, and the doors are always open': a qualitative study to understand challenges underlying the need for emergency care in people experiencing homelessness in rural and coastal North East England.","authors":"Steven A Thirkle, Emma A Adams, Jill Harland, Deepti A John, Eileen Kaner, Sheena E Ramsay","doi":"10.1136/bmjph-2024-001468","DOIUrl":"10.1136/bmjph-2024-001468","url":null,"abstract":"<p><strong>Introduction: </strong>People experiencing homelessness have high rates of emergency care attendance compared with the general population. This study explores the factors underlying the need for emergency care services among people experiencing homelessness in rural and coastal areas of North East England.</p><p><strong>Methods: </strong>The study was conducted in Northumberland and North Tyneside (North East England). One-to-one semistructured interviews were conducted with people experiencing homelessness. Interviews and focus groups were undertaken with frontline staff from housing associations, police, ambulance services, emergency care, primary healthcare, mental health services and alcohol and drug recovery services. Discussions centred on emergency care experiences, reasons for access and underlying health and social needs.</p><p><strong>Results: </strong>Participants included 20 people experiencing homelessness (aged 18-56, 70% male) and 18 service professionals (aged 20-56, 56% female). Emergency care was often viewed by participants as an accessible safe place. Four key themes were found in this rural and coastal context: accessibility challenges due to limited public transport and geographic isolation; fragmented support exacerbated by widely dispersed services; service restrictions and limited alternatives having particular impact where options are few and prioritisation of immediate needs influenced by limited local resources.</p><p><strong>Conclusion: </strong>Challenges in accessing primary healthcare and social care, alongside varying levels of timely support and understanding of individual contexts, can contribute to the increased use of emergency care for people experiencing homelessness in rural and coastal areas. Integrating services with a focus on flexibility could be crucial for addressing the needs of these populations. This involves adapting to the unique circumstances of multiple deprived groups who lack access to community support.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001468"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525940","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 safety and health paradox of workers at social venues: a regulatory compliance gap analysis of the existing relevant legislation and the unwritten rules at social venues in Uganda.","authors":"Susan Babirye, Kristien Michielsen, Lenzo Robijn, Ines Keygnaert, Freddie Ssengooba","doi":"10.1136/bmjph-2023-000732","DOIUrl":"10.1136/bmjph-2023-000732","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to analyse the disparity between the rules and procedures at social venues in Uganda and the current regulatory requirements concerning venue worker safety.</p><p><strong>Methods: </strong>Between 2021 and 2023, we analysed national laws/policies impacting the safety and health of venue workers in Uganda. This analysis was complemented by data collected from 66 in-depth interviews with venue workers. Additionally, we organised two subnational/national dialogues with key stakeholders in Uganda.</p><p><strong>Results: </strong>Our findings revealed minimal adherence to national regulations concerning workplace safety and health at venues. Many rules/procedures implemented at these venues directly contradicted the principles outlined in national regulations. There were barely any laws explicit to the safety and health of workers at social venues with the exception of the Hotels Act, 2000, which only applies to venues offering accommodation services. The identified significant regulatory compliance gaps in social venues include inconsistent and low wages, discriminatory recruitment practices such as a preference for young and beautiful females and the employment of underage workers.</p><p><strong>Conclusion: </strong>Employment in social venues continues to lack regulations that address the unique occupational hazards, many of which are linked with increased risk of HIV acquisition. Furthermore, existing regulations relevant to the sector are not complied with by social venues, and consequently safe workplace in these environments remains a significant challenge.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e000732"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525942","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":"Drivers of onward HIV transmission risk among adolescent boys growing up with HIV: a longitudinal cohort study.","authors":"Rachel Kidman, Xiaoyue Zhang, Janan Janine Dietrich, Stefanie Vermaak, Candice W Ramsammy, Phumla Madi, Given Leshabane, Avy Violari","doi":"10.1136/bmjph-2024-001718","DOIUrl":"10.1136/bmjph-2024-001718","url":null,"abstract":"<p><strong>Introduction: </strong>HIV transmission to sexual partners is determined jointly by viraemia and condomless sex, both of which are higher among adolescents living with HIV compared with adults. Moreover, decisions around condom use vary day to day. We are the first study to investigate both the stable and time-varying factors contributing to HIV transmission risk.</p><p><strong>Methods: </strong>The cohort study enrolled 251 adolescent boys 15-19 years old who were born with HIV and resided in Soweto, South Africa. Participants had viral load testing concurrently with completing baseline and 12-month follow-up surveys. Over the study year, participants completed repeated mobile surveys to capture time-variant exposures and condom use in the past 24 hours. Associations between baseline factors and high transmission risk (a composite of detectable viral load and any reported non-condom use) were analysed using logistic regression models. Associations between time-variant factors and condomless sex were analysed using generalised linear mixed-effect models.</p><p><strong>Results: </strong>Experiencing an additional adverse event in the last year (adjusted OR (aOR) 1.33; 95% CI 1.09, 1.64), intimate partner violence (IPV; aOR 6.07; 95% CI 1.69, 21.80) and depression (aOR 2.96, 95% CI 1.03, 8.57) each increased the adjusted odds of being in the high-risk group for HIV transmission. When we examined time-variant factors, we found that a 10% higher average experience of stress (aOR 1.23; 95% CI 1.04, 1.46) and anger (aOR 1.26; 95% CI 1.04, 1.53) was significantly associated with increased odds of having condomless sex. There was no evidence that day-to-day changes in exposure to potential risk factors influenced condom use decisions.</p><p><strong>Discussion: </strong>Global strategies largely focus on reducing HIV infection risk from the perspective of adolescent girls and young women. This study adds to the growing evidence that childhood adversity, IPV victimisation and depression are related to sexual transmission risk, and importantly extends this finding to the expanding population of adolescent boys born with HIV. Tailoring violence and mental health support services to the needs of adolescent boys may have important implications for their well-being and the health of their partners.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001718"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525928","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":"Work motivation and job satisfaction among local government health workers in Chitwan, Nepal: a cross-sectional study.","authors":"Sunita Poudel, Hari Prasad Kaphle, Sagar Parajuli, Arjun Poudel","doi":"10.1136/bmjph-2024-001736","DOIUrl":"10.1136/bmjph-2024-001736","url":null,"abstract":"<p><strong>Introduction: </strong>The health workforce is a crucial component of the WHO Health System Framework and is vital for sustainable, high-quality service delivery. Job satisfaction and motivation are key factors influencing the retention and performance of health workers. This study aimed to assess job satisfaction and its associated factors among health workers working under the local government in the Chitwan District, focusing on sociodemographics, job characteristics and work motivation.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 219 health workers from 46 health facilities in the Chitwan district using a multistage sampling technique to include workers from various facility types and municipalities. Data were collected using a pretested, self-administered structured questionnaire and analysed with Statistical Product for Service Solutions V.22. Univariate, bivariate and logistic regression analyses were performed.</p><p><strong>Results: </strong>The study found that 76.3% of participants were satisfied with their jobs. Opportunities for advancement (adjusted OR (AOR): 3.61, 95% CI: 1.35 to 9.66), nature of work (AOR: 3.54, 95% CI: 1.16 to 10.84) and supportive supervision (AOR: 3.58, 95% CI: 1.25 to 10.27) were significantly associated with higher job satisfaction.</p><p><strong>Conclusion: </strong>Over three-quarters of health workers under local government were satisfied with their jobs. The study emphasises the significance of promoting supportive work environments, providing effective supervision and offering career development opportunities to enhance job satisfaction among health workers.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001736"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525960","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":"Investigating the general effects of different types of toluene exposure on the health of workers: an integrative review of the literature.","authors":"Ahmed Mohsen Abbas El-Hagrasy, Ramadan Hani Karrout, Alexa Lulu Mcguinness, Tarek Ziyad Assaf Mousa Albutain, Dana Khalifa, Fatema Mohamed Hasan Ali Khalil, Eman Tawash, Maryam Alaradi","doi":"10.1136/bmjph-2024-001046","DOIUrl":"10.1136/bmjph-2024-001046","url":null,"abstract":"<p><strong>Objectives: </strong>This integrative review aims to evaluate the available empirical and theoretical literature on the effects caused by different types of occupational toluene exposure on the health of workers. We aim to guide future research, legislation, and guidelines with evidence-based recommendations on toluene exposure.</p><p><strong>Design: </strong>An integrative review of the literature.</p><p><strong>Data sources: </strong>A systematic search strategy was undertaken across five electronic databases; PubMed, Scopus, Medline, CINAHL and ScienceDirect. Furthermore, grey literature was incorporated through hand-searching databases, Google Scholar, open-access engines and Google Advanced Search tool, among other tools.</p><p><strong>Eligibility criteria: </strong>Studies investigating the effects of occupational toluene exposure between 2010 and July 2023 were included. Inclusion criteria included full-text English articles, workers aged 18-65, and studies with co-exposures to benzene, toluene, ethylbenzene and xylene or volatile organic compound if direct findings to toluene were reported. Notable exclusion criteria were non-human studies, pregnant women, paediatric and geriatric populations, and studies addressing toluene abuse and not occupational exposure.</p><p><strong>Data extraction and synthesis: </strong>27 studies met the eligibility criteria and were appraised using the Mixed Methods Appraisal Tool. Data were systematically extracted, guiding the synthesis of various themes, namely acute exposure effects, chronic exposure effects, short-term effects, long-term effects, low-dose effects, high-dose effects and reversible versus irreversible effects.</p><p><strong>Results: </strong>The review demonstrated that occupational toluene exposure impacts health differently depending on the nature and context of the exposure. Effects can arise in both acute and chronic scenarios, with outcomes that vary by duration, dose and whether the effects are reversible or irreversible.</p><p><strong>Conclusions: </strong>The results demonstrate that toluene exposure can cause a wide range of effects based on the type of occupational toluene exposure. These findings can be used to update current guidelines on the recommended threshold limit for toluene exposure. Furthermore, strategies such as implementing mandatory personal protective equipment, improving ventilation and educating workers on the risks of toluene exposure can be put in place to mitigate the risks.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001046"},"PeriodicalIF":0.0,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525911","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":"'Involve those who are managing these outbreaks': stakeholders' perspectives on the barriers and facilitators to the implementation of clinical management guidelines for high-consequence infectious diseases in Uganda-a thematic network analysis.","authors":"Olive Kabajaasi, Stefan Schilling, Mathias Akugizibwe, Peter W Horby, Peter Hart, Louise Sigfrid, Shevin T Jacob","doi":"10.1136/bmjph-2024-001165","DOIUrl":"10.1136/bmjph-2024-001165","url":null,"abstract":"<p><strong>Introduction: </strong>Prior research highlighting the complexity of clinical management guidelines' (CMGs) implementation during high consequence infectious disease (HCID) outbreaks has suggested that limited access to treatments and equipment and substantial issues regarding availability, inclusivity, quality and applicability hinders the implementation of CMGs in low- and middle-income countries (LMICs). This in-depth case study of Uganda-coincidentally occurring during the 2022 Sudan virus disease outbreak-aimed to explore contextual and supplementary factors which hinder or facilitate CMG development and implementation.</p><p><strong>Methods: </strong>Between August and December 2022, 43 interviews were conducted with medical personnel, consultant physicians, case managers and Uganda Ministry of Health officials. Interviews were analysed using a thematic network analysis approach to visualise thematic codes in qualitative data and highlight inherent relationships between codes.</p><p><strong>Results: </strong>Six thematic topics emerged as the main barriers to the implementation of CMGs during HCID outbreaks in Uganda: (1) deficient content and slow updates of CMGs; (2) scarce resources and healthcare disparities; (3) slow dissemination and limited access to guidelines; (4) improvisation of patient care (5) lack of training for healthcare workers (HCWs); and (6) limited pandemic preparedness and response infrastructure. Codes most strongly linked to facilitators and suggestions included: (1) HCW training in CMG implementation; (2) adequate resourcing; (3) involvement of personnel with prior HCID response experience in CMG development and (4) improvements in access to CMGs.</p><p><strong>Conclusions: </strong>By illustrating linkages to resource constraints, healthcare disparities, and limited surveillance and referral infrastructure, our study displays how insufficient training, patchy dissemination and slow updating exacerbate many of the underlying difficulties for CMG implementation in LMIC contexts. Findings offer valuable insights for LMICs to improve HCID outbreak responses and inform implementation of CMGs in future HCID outbreaks, where evidence is often initially limited. Recommendations to enhance CMG implementation are provided.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001165"},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525913","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":"Incidence and determinants of households' catastrophic payments for TB care: evidence from a multi-country trial (EXIT-TB project) implemented in East Africa.","authors":"Francis Donard Ngadaya, Doreen Philbert, Amani Wilfred, Johnson Jeremia Mshiu, Peter Binyaruka, Nicholaus P Mnyambwa, Godfather Kimaro, Amani Thomas Mori, Steve Wandinga, Blandina T Mmbaga, Bruce J Kirenga, Getnet Yimer, Sayoki Mfinanga, Esther Ngadaya","doi":"10.1136/bmjph-2024-001543","DOIUrl":"10.1136/bmjph-2024-001543","url":null,"abstract":"<p><strong>Background: </strong>Despite free tuberculosis (TB) services in low-resource settings which are provided under countries' respective National TB programmes, TB patients incur substantial costs when seeking care. These costs not only act as a barrier to access but also reduce adherence to TB treatment which further affects patients' health outcomes and poses a financial burden to households. In the context of the EXIT-TB project implementation, we nested a patient cost study aiming at estimating the costs incurred by patients when seeking TB services. In addition, we also assessed the incidence and determinants of catastrophic health expenditure (CHE) among households affected by TB.</p><p><strong>Methods: </strong>A cross-sectional analytical study was carried out in four East African Countries, namely; Tanzania, Kenya, Uganda and Ethiopia alongside EXIT-TB project implementation from 2019 to 2022. Direct and indirect costs incurred by drug-sensitive TB patients were collected after they had received TB services. Costs were considered catastrophic if they exceeded 20% of annual household income. Cost data were collected in each country's national currency and converted to 2023 US dollars afterwards.</p><p><strong>Results: </strong>The mean total cost incurred by patients when seeking TB care were US$130.85, US$97.90, US$84.63 and US$101.60 in Tanzania, Kenya, Uganda and Ethiopia, respectively. Overall, more than half (51.81%) of the TB-affected households experienced CHE due to TB. CHE was high among TB-affected households with poor socioeconomic status. TB patients residing in Ethiopia, households with >5 members, households with TB patients as household heads, unemployed and poor socioeconomic status were among the factors associated with a high incidence of CHE (p<0.05).</p><p><strong>Conclusion: </strong>Despite the availability of free TB services in East Africa provided by the respective National TB programmes, more than half of TB-affected households experienced CHE due to TB. Our findings reinforce the need for cost mitigation policies among TB-affected households, particularly the worse offs so as to reduce the incidence of CHE and further impoverishment.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001543"},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525902","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}