Global Health: Science and Practice最新文献

{"title":"Innovations in Providing HIV Index Testing Services: A Retrospective Evaluation of Partner Elicitation Models in Southern Nigeria.","authors":"Caesar C Dibia, Pius Nwaokoro, Uduak Akpan, Otoyo Toyo, Simon Cartier, Olusola Sanwo, Ngozi Sydney-Agbor, Barinaada Afirima, Kunle Kakanfo, Uwem Essien, Christa Fischer Walker, Hadiza Khamofu, Satish Raj Pandey, Moses Bateganya","doi":"10.9745/GHSP-D-24-00013","DOIUrl":"https://doi.org/10.9745/GHSP-D-24-00013","url":null,"abstract":"<p><p><b>Background:</b> This analysis aimed to evaluate the effectiveness of eliciting sexual partners from HIV-positive clients using the elicitation box model (where an HIV-positive index can report sexual contacts on paper and insert in a box for a health care provider to contact at a later time) compared to the conventional model (in which a health care provider elicits sexual contacts directly from clients) in Akwa Ibom, Southern Nigeria.<b>Methods:</b> Between March 2021 and April 2022, data were collected from index testing registers at 4 health facilities with a high volume of HIV clients currently on treatment in 4 local government areas in Akwa Ibom State. Primary outcome analyzed was the elicitation ratio (number of partners elicited per HIV-index offered index testing services). Secondary outcomes were the index testing acceptance (index HIV-positive clients accepted index testing service), testing coverage (partners tested for HIV from a list of partners elicited from HIV-index accepted index testing services), testing yield (index partners identified HIV positive from index partners HIV-tested), and linkage rate (index partners identified HIV positive and linked to antiretroviral therapy).<b>Results:</b> Of the total 2,705 index clients offered index testing services, 91.9% accepted, with 2,043 and 439 indexes opting for conventional elicitation and elicitation box models, respectively. A total of 3,796 sexual contacts were elicited: 2,546 using the conventional model (elicitation ratio=1:1) and 1,250 using the elicitation box model (elicitation ratio=1:3). Testing coverage was significantly higher in the conventional compared to the elicitation box model (<i>P</i><.001). However, there was no significant difference in the testing yield (<i>P</i>=.81) and linkage rate using the conventional compared to elicitation box models (<i>P</i>=.13).<b>Conclusion:</b> The implementation of the elicitation box model resulted in an increase in partner elicitation compared to the conventional model. Increasing the testing coverage by implementing the elicitation box model should be considered.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Politics' Role in Developing Primary Health Care Policy for Maternal Health in Papua New Guinea: A Qualitative Document Analysis.","authors":"Regina Poima Seki, Judith Daire, Delia Hendrie","doi":"10.9745/GHSP-D-22-00005","DOIUrl":"https://doi.org/10.9745/GHSP-D-22-00005","url":null,"abstract":"<p><p>Politics is one of the critical factors that influence health policy agendas. However, scholarly efforts, especially in low- and middle-income countries, rarely focus on how politics influence health policy agenda-setting. We conducted a qualitative document review to examine the factors that led to developing the free primary health care policy for maternal health in Papua New Guinea. We also discuss mechanisms through which national politics, as an overriding factor, influenced the development of the policy. The review draws on Kingdon's multiple-stream model for agenda-setting and incorporates theoretical insights from Fox and Reich's framework for analyzing the politics of health reform for universal health coverage in low- and middle-income countries.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capacity-Building Through Digital Approaches: Evaluating the Feasibility and Effectiveness of eLearning to Introduce Subcutaneous DMPA Self-Injection in Senegal and Uganda.","authors":"Siri Wood,Ericka Roberts,Aurora Anna Stout,Alain Kaboré,Allen Namagembe,Jane Cover,Marème Dia Ndiaye,Mouminatou Diokh,Farmata Sèye,Beth Balderston","doi":"10.9745/ghsp-d-24-00019","DOIUrl":"https://doi.org/10.9745/ghsp-d-24-00019","url":null,"abstract":"Training health workers is one of the biggest challenges and cost drivers when introducing a new contraceptive method or service delivery innovation. PATH developed a digital training curriculum for family planning providers who are learning to offer subcutaneous DMPA (DMPA-SC), including through self-injection, as an option among a range of contraceptive methods. The DMPA-SC eLearning course for health workers includes 10 lessons with an emphasis on informed choice counseling and training clients to self-inject. In partnership with Ministries of Health in Senegal and Uganda, the course was rolled out in select areas in 2019-2020, including during the COVID-19 pandemic when physical distancing requirements restricted in-person training. We conducted evaluations in both countries to assess the practical application of this digital training approach for contraceptive introduction. The evaluation consisted of a post-training survey, an observational assessment conducted during post-training supportive supervision, and an estimation of training costs.In both countries, a majority (88.6% in Uganda and 64.3% in Senegal) scored above 80% on a DMPA-SC knowledge test following the training. In Senegal, where there was a comparison group of providers trained in person, those providers scored similar on the post-test to eLearners. Providers in both groups and in both countries felt more prepared to administer DMPA-SC or offer self-injection to clients after receiving a supervision visit (93%-98% of eLearners felt very prepared after supervision as compared to 45%-72% prior). The evaluation results suggest that digital approaches offer a number of benefits, can be cost-effective, and are most optimal when blended with in-person training and/or supportive supervision.","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142249469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Maternity Care Where Home Births Are Still the Norm: Establishing Local Birthing Centers in Guatemala That Incorporate Traditional Midwives.","authors":"Breanne Lievense,Kaitlin Leach,Nina Modanlo,Ira Stollak,Jaqueline Wallace,Alma Dominguez,Juany Valdez,Mario Valdez,Henry B Perry","doi":"10.9745/ghsp-d-24-00057","DOIUrl":"https://doi.org/10.9745/ghsp-d-24-00057","url":null,"abstract":"More than half of births among Indigenous women in Guatemala are still being attended at home by providers with no formal training. We describe the incorporation of comadronas (traditional midwives) into casas maternas (birthing centers) in the rural highlands of western Guatemala. Although there was initial resistance to the casa, comadronas and clients have become increasingly enthusiastic about them. The casas provide the opportunity for comadronas to continue the cultural traditions of prayers, massages, and other practices that honor the vital spiritual dimension of childbirth close to home in a home-like environment with extended family support while at the same time providing a safer childbirth experience in which complications can be detected by trained personnel at the casa, managed locally, or promptly referred to a higher-level facility. Given the growing acceptance of this innovation in an environment in which geographical, financial, and cultural barriers to deliveries at higher-level facilities lead most women to deliver at home, casas maternas represent a feasible option for reducing the high level of maternal mortality in Guatemala.This article provides an update on the growing utilization of casas and provides new insights into the role of comadronas as birthing team members and enthusiastic promotors of casas maternas as a preferable alternative to home births. Through the end of 2023, these casas maternas had cared for 4,322 women giving birth. No maternal deaths occurred at a casa, but 4 died after referral.The Ministry of Health of Guatemala has recently adopted this approach and has begun to implement it in other rural areas where home births still predominate. This approach deserves consideration as a viable and feasible option for reducing maternal mortality throughout the world where home births are still common, while at the same time providing women with respectful and culturally appropriate care.","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142249736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening Capacity for Tailored Immunization Programs Using Adult Learning Principles: A Case Study from Nigeria.","authors":"Chisom Obi-Jeff,Funmilayo Oguntimehin,Abduljaleel Adejumo,Abdulrahman Ibrahim,Olympus Ade-Banjo,Dan Gadzama,Nicholas Okoli,Chidera Obi,Rachael Olorupo,Ifeyinwa Martins,Amina Usman,Audu Joy,Tanko Chadwafwa,Anthony Onimisi","doi":"10.9745/ghsp-d-23-00465","DOIUrl":"https://doi.org/10.9745/ghsp-d-23-00465","url":null,"abstract":"Introduction: Nigeria has the highest number of children who have not received any vaccines in Africa. The training-of-trainers (TOT) model used to train program managers (PMs) and health care workers (HCWs) is ineffective for adult learning and limits immunization programs' success. We incorporated adult learning principles (ALPs) in designing and delivering TOT for immunization PMs and HCWs to use data to engage communities for tailored immunization strategies.Methods: Our study was implemented in 3 local government areas (LGAs) of the Federal Capital Territory, Nigeria. A training curriculum was developed, integrating ALPs and technical and operational content based on best practices in delivering immunization training and the training needs assessment findings. State PMs (n=10), LGA PMs (n=30), and HCWs (n=42) were trained on the human-centered design for tailoring immunization programs (HCD-TIP) approaches using ALPs. We used interviews and surveys with purposively and conveniently sampled PMs and HCWs, respectively, and observations to assess participants' satisfaction, knowledge and competence, behavior changes, and results. The interviews were analyzed thematically, and surveys were statistically.Results: There was a high level of satisfaction with the training among LGA PMs (100%), state PMs (91%), and HCWs (85%), with significant knowledge and competence improvements post-training (P<.001). The trained participants conducted 2 HCD sessions with 24 undervaccinated communities and co-designed 24 prototype solutions for testing. Results showed increased coverage of the pentavalent vaccine first dose (54%) and third dose (188%) across 12 participating communities. Improved community colaboration, communication skills, and data-driven approaches were the most cited behavior changes in practice.Conclusion: The application of ALPs in training, use of HCD-TIP approaches and tools, and supportive supervision enhanced PMs' and HCWs' capacity for tailored interventions. Countries should consider adopting a holistic approach that focuses on using these approaches in immunization programs to strengthen the health system for equitable vaccine coverage.","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142249467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antenatal Care Interventions to Increase Contraceptive Use Following Birth in Low- and Middle-Income Countries: Systematic Review and Narrative Synthesis.","authors":"Ona L McCarthy, Nasser Fardousi, Vandana Tripathi, Renae Stafford, Karen Levin, Farhad Khan, Maxine Pepper, Oona M R Campbell","doi":"10.9745/GHSP-D-24-00059","DOIUrl":"https://doi.org/10.9745/GHSP-D-24-00059","url":null,"abstract":"<p><strong>Introduction: </strong>Health risks associated with short interpregnancy intervals, coupled with women's desires to avoid pregnancy following childbirth, underscore the need for effective postpartum family planning programs. The antenatal period provides an opportunity to intervene; however, evidence is limited on the effectiveness of interventions aimed at reaching women in the antenatal period to increase voluntary postpartum family planning in low- and middle-income countries (LMICs). This systematic review aimed to identify and describe interventions in LMICs that attempted to increase postpartum contraceptive use via contacts with pregnant women in the antenatal period.</p><p><strong>Methods: </strong>Studies published from January 2012 to July 2022 were considered if they were conducted in LMICs, evaluated an intervention delivered during the antenatal period, were designed to affect postpartum contraceptive use, were experimental or quasi-experimental, and were published in French or English. The main outcome of interest was postpartum contraceptive use within 1 year after birth, defined as the use of any method of contraception at the time of data collection. We searched EMBASE, Global Health, and Medline and manually searched the reference lists from studies included in the full-text screening.</p><p><strong>Results: </strong>We double-screened 771 records and included 34 reports on 31 unique interventions in the review. Twenty-three studies were published from 2018 on, with 21 studies conducted in sub-Saharan Africa. Approximately half of the study designs (n=16) were randomized controlled trials, and half (n=15) were quasi-experimental. Interventions were heterogeneous. Among the 24 studies that reported on the main outcome of interest, 18 reported a positive intervention effect, with intervention recipients having greater contraceptive use in the first year postpartum.</p><p><strong>Conclusion: </strong>While the studies in this systematic review were heterogeneous, the findings suggest that interventions that included a multifaceted package of initiatives appeared to be most likely to have a positive effect.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategic Training Executive Program 2.0: A Leadership and Change Management Program for Health Supply Chains in Low- and Middle-Income Countries.","authors":"Patricia Bobo,George Bray,Kevin Etter,Namrata Singh","doi":"10.9745/ghsp-d-23-00365","DOIUrl":"https://doi.org/10.9745/ghsp-d-23-00365","url":null,"abstract":"People that Deliver's vision is \"a world where health supply chain workforces are empowered and equipped to optimize health outcomes by improving access to health commodities.\" However, health supply chain management (HSCM) is not a recognized profession in many low- and middle-income countries (LMICs). HSCM professionalization efforts are essential if health outcomes are to be significantly improved in these countries; this means transforming supply chain management into a recognized profession of the highest integrity.The Strategic Training Executive Program (STEP) was created in 2016 to address prevailing leadership style gaps. Since then, STEP has undergone rigorous revisions to improve its applicability, scalability, and usefulness in LMICs. To date, STEP-in all its forms-has been delivered to 30 countries and contributed to building the supply chain capacities of more than 600 health supply chain professionals.This case study discusses the evolution journey of designing and sustaining the second generation of STEP (STEP 2.0). This journey is an innovative illustration of how diverse yet motivated organizations collaborated during a global lockdown and health emergency to reimagine a program recognized by all as essential for post-pandemic supply chain systems.","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142198243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Piloting of Implementation Strategies to Support Delivery of a Clinical Intervention for Postpartum Hemorrhage in Four sub-Saharan Africa Countries.","authors":"Gillian Forbes,Shahinoor Akter,Suellen Miller,Hadiza Galadanci,Zahida Qureshi,Fadhlun Alwy Al-Beity,G Justus Hofmeyr,Neil Moran,Sue Fawcus,Mandisa Singata-Madliki,Aminu Ado Wakili,Taiwo Gboluwaga Amole,Baba Maiyaki Musa,Faisal Dankishiya,Adamu Abdullahi Atterwahmie,Abubakar Shehu Muhammad,John Ekweani,Emily Nzeribe,Alfred Osoti,George Gwako,Jenipher Okore,Amani Kikula,Emmy Metta,Ard Mwampashi,Cherrie Evans,Kristie-Marie Mammoliti,Adam Devall,Arri Coomarasamy,Ioannis Gallos,Olufemi T Oladapo,Meghan A Bohren,Fabiana Lorencatto","doi":"10.9745/ghsp-d-23-00387","DOIUrl":"https://doi.org/10.9745/ghsp-d-23-00387","url":null,"abstract":"INTRODUCTIONPostpartum hemorrhage (PPH) remains the leading cause of maternal mortality. A new clinical intervention (E-MOTIVE) holds the potential to improve early PPH detection and management. We aimed to develop and pilot implementation strategies to support uptake of this intervention in Kenya, Nigeria, South Africa, and Tanzania.METHODSImplementation strategy development: We triangulated findings from qualitative interviews, surveys and a qualitative evidence synthesis to identify current PPH care practices and influences on future intervention implementation. We mapped influences using implementation science frameworks to identify candidate implementation strategies before presenting these at stakeholder consultation and design workshops to discuss feasibility, acceptability, and local adaptations. Piloting: The intervention and implementation strategies were piloted in 12 health facilities (3 per country) over 3 months. Interviews (n=58), case report forms (n=1,269), and direct observations (18 vaginal births, 7 PPHs) were used to assess feasibility, acceptability, and fidelity.RESULTSImplementation strategy development: Key influences included shortages of drugs, supplies, and staff, limited in-service training, and perceived benefits of the intervention (e.g., more accurate PPH detection and reduced PPH mortality). Proposed implementation strategies included a PPH trolley, on-site simulation-based training, champions, and audit and feedback. Country-specific adaptations included merging the E-MOTIVE intervention with national maternal health trainings, adapting local PPH protocols, and PPH trollies depending on staff needs. Piloting: Intervention and implementation strategy fidelity differed within and across countries. Calibrated drapes resulted in earlier and more accurate PPH detection but were not consistently used at the start. Implementation strategies were feasible to deliver; however, some instances of limited use were observed (e.g., PPH trolley and skills practice after training).CONCLUSIONSystematic intervention development, piloting, and process evaluation helped identify initial challenges related to intervention fidelity, which were addressed ahead of a larger-scale effectiveness evaluation. This has helped maximize the internal validity of the trial.","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142198245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promising Practices in Capacity Development for Health Supply Chains in Resource-Constrained Countries.","authors":"Mahama Duwiejua, Pamela Steele, Paul Lalvani, Dorothy Leab, Lloyd Matowe, Jonathan Moody","doi":"10.9745/GHSP-D-23-00208","DOIUrl":"https://doi.org/10.9745/GHSP-D-23-00208","url":null,"abstract":"<p><p>Performance gaps in health supply chains in low- and middle-income countries contribute significantly to inefficiencies and underperformance of their health systems. Some significant factors hindering the performance of supply chains in low and middle-income countries include low human resource capacity and capability, weak structures for monitoring supply chain performance, weak in-service and pre-service training programs, chronic underfunding, lack of transparency and an overdependence on obsolete methods, like manual data gathering, record-keeping, and analyses. Although proven health supply chain strengthening techniques exist, the level of adoption of these practices has varied across countries, resulting in multiple capacity gaps and underperforming supply chains. The resulting challenges require complementary and needs-based practices to address the gaps. While it is recognized that there is no \"one-size-fits-all\" solution to these issues, we demonstrate that real benefits can be achieved by using \"promising practices\"-that is, using targeted, innovative interventions. To demonstrate the potential of using promising practices in the health supply chain in Africa and the breadth of possible solutions available, we present 3 case studies from different contexts and with different objectives.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishment of the First Institution-Based Poison Information Center in Nepal Through a Multilateral International Partnership.","authors":"Ramu Kharel, Rakesh Ghimire, Rajesh Sharma, Kabin Maleku, Adam R Aluisio, Ziad Kazzi","doi":"10.9745/GHSP-D-24-00142","DOIUrl":"https://doi.org/10.9745/GHSP-D-24-00142","url":null,"abstract":"<p><p>Toxicological emergencies present a significant health challenge in Nepal. Despite the high burden, the country has inadequate formal toxicology training, medical toxicology expertise, and adequate poison control infrastructure. In recognition of this need, the Nepal Poison Information Center (PIC) was established as a collaborative effort involving local and international partners. Through a comprehensive partnership framework, the Nepal PIC provides 24 hours a day, 7 days a week expert guidance to health care workers, conducts educational webinars, and engages in research. Initial data from the pilot phase indicate successful consultation delivery. Challenges include bureaucratic hurdles and the need for sustainable funding. Despite these challenges, the Nepal PIC demonstrates early feasibility and potential for expansion into a comprehensive toxicology center, contributing to the advancement of clinical toxicology in Nepal. Long-term sustainability relies on governmental support and continued advocacy efforts.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}