Global Health: Science and Practice最新文献

{"title":"A Novel Approach to Assessing the Potential of Electronic Decision Support Systems to Improve the Quality of Antenatal Care in Nepal.","authors":"Biraj Man Karmacharya, Seema Das, Abha Shrestha, Abha Shrestha, Sulata Karki, Rajani Shakya, Emma Radovich, Loveday Penn-Kekana, Clara Calvert, Oona M R Campell, Ona L McCarthy","doi":"10.9745/GHSP-D-23-00370","DOIUrl":"https://doi.org/10.9745/GHSP-D-23-00370","url":null,"abstract":"<p><strong>Introduction: </strong>Electronic decision-support systems (EDSSs) aim to improve the quality of antenatal care (ANC) through adherence to evidence-based guidelines. We assessed the potential of the mHealth integrated model of hypertension, diabetes, and ANC EDSS and the World Health Organization EDSS to improve the quality of ANC in primary-level health care facilities in Nepal.</p><p><strong>Methods: </strong>From December 2021 to January 2023, we conducted a mixed-methods evaluation in 19 primary-level ANC facilities in Bagmati Province, Nepal. Implementation was from March 2022 to August 2022. We conducted a health facility survey, ANC clinical observations, longitudinal case studies and validation workshop, in-depth interviews, monitoring visits, research team debriefing meetings, health care provider attitude survey, and stakeholder engagement and feedback meetings. Results were integrated using concurrent triangulation to develop explanations about the EDSS implementation process and the effects observed.</p><p><strong>Results: </strong>We identified 9 themes on implementation challenges that hindered the EDSS from generating the desired improvements to ANC quality. Facility readiness and provider confidence in using the EDSS were mixed. It was not always used or used as intended, and the approach to ANC provision did not change. EDSS inflexibility did not reflect how staff made decisions about pregnant women's needs or ensure that tests were done at the right time. There was mixed evidence that ANC staff believed that the EDSS benefited their work. The EDSS did not become fully integrated into existing health systems. Engagement of essential stakeholders fell short.</p><p><strong>Conclusion: </strong>Different understandings of and inconsistent use of the EDSS highlighted the need for increased training and support periods, greater stakeholder engagement, and further integration into existing health systems. Our novel approach to integrating findings from multiple substudies offers uniquely valuable insights into the many factors needed for the successful implementation of an EDSS to improve the quality of ANC in Nepal.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947699","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":"Towards Ending AIDS: The Additional Role of HIV Self-Testing in Thailand.","authors":"Cheewanan Lertpiriyasuwat, Patsaya Mookleemas, Naparat Pattarapayoon, Darinda Rosa, Viroj Tangcharoensathien","doi":"10.9745/GHSP-D-24-00156","DOIUrl":"10.9745/GHSP-D-24-00156","url":null,"abstract":"<p><strong>Background: </strong>In 2022, 10% of an estimated 560,000 people living with HIV in Thailand were unaware of their HIV status. A well-established HIV program is a solid platform for integrating HIV self-testing (HST) as part of efforts to end AIDS. We analyzed how HST was integrated into the national HIV program and became a benefit package.</p><p><strong>Policy adoption of hst: </strong>In 2015, the National AIDS Prevention and Alleviation Committee included HST as a strategy to end HIV/AIDS by 2030. This led to collaboration between the Department of Disease Control (DDC), Food and Drug Administration (FDA), and partner networks, including civil society organizations, to amend policy regulations, allowing HIV testing outside health care facilities and facilitating HST registration. By 2024, 4 HST commercial products were registered by the Thai FDA.</p><p><strong>Program pilots: </strong>In 2020, the DDC launched pilot programs distributing HST kits through private pharmacies in Bangkok and online platforms. Preliminary findings showed feasibility in reaching key populations and adolescents. In 2023, HST was included in the Universal Health Coverage benefit package, providing free access to all citizens. Guidelines, e-learning, public awareness campaigns, and a reimbursement system of HST were developed and implemented. By September 2024, over 166,000 users had received HST kits.</p><p><strong>Lessons learned: </strong>Leadership, scientific evidence, feasibility testing through pilots, regulatory adjustments, licensing, price negotiations by the National Health Security Office, and stakeholder and community engagement were key to the program's success. A nationwide distribution network through public and private health care facilities, including pharmacies, was a key enabling factor for HST delivery.</p><p><strong>Conclusions: </strong>HST is an additional intervention to increase awareness of HIV status and a key component in Thailand's effort to end HIV/AIDS.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advocating for Lesbian, Gay, Bisexual, and Transgender Youth Sexual and Reproductive Health and Rights in Central Asia.","authors":"Ulukbek Batyrgaliev","doi":"10.9745/GHSP-D-24-00207","DOIUrl":"10.9745/GHSP-D-24-00207","url":null,"abstract":"","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No Matter When or Where: Addressing the Need for Continuous Family Planning Services During Shocks and Stressors.","authors":"Sarah Rich, Lily Jacobi, Nesrine Talbi, Ashley Wolfington, Kelly McDonald","doi":"10.9745/GHSP-D-24-00124","DOIUrl":"10.9745/GHSP-D-24-00124","url":null,"abstract":"","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognizing and Addressing the Contraceptive Hesitancy-Acceptability Continuum: Adopting Lessons Learned From the Immunization Field.","authors":"Madeleine Short Fabic, Amy Ong Tsui","doi":"10.9745/GHSP-D-24-00220","DOIUrl":"10.9745/GHSP-D-24-00220","url":null,"abstract":"","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"mHealth and Digital Innovations as Catalysts for Transforming Mental Health Care in Ghana.","authors":"Enoch Sackey, Angela Ofori-Atta, Sammy Ohene, Kwadwo Obeng, Dror Ben-Zeev","doi":"10.9745/GHSP-D-24-00062","DOIUrl":"10.9745/GHSP-D-24-00062","url":null,"abstract":"","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Obstetric Care Access Dynamics in Kampala City, Uganda: Analysis of Women's Self-Reported Care-Seeking Pathways.","authors":"Catherine Birabwa, Lenka Beňová, Josefien van Olmen, Aline Semaan, Peter Waiswa, Aduragbemi Banke-Thomas","doi":"10.9745/GHSP-D-24-00242","DOIUrl":"10.9745/GHSP-D-24-00242","url":null,"abstract":"<p><strong>Introduction: </strong>Timely access to emergency obstetric care (EmOC) remains a challenge in sub-Saharan Africa, influenced by poor health care utilization and rapid urbanization. Studies show poor maternal health outcomes in African cities, reflecting weak health systems. Understanding care-seeking pathways is key to improving service delivery and health outcomes. We examined self-reported care-seeking pathways among women with obstetric complications in Kampala City, Uganda.</p><p><strong>Methods: </strong>In this cross-sectional survey, we collected sequential data from 433 women (15-49 years) from 9 health facilities in Kampala City. We developed typologies of common pathways to EmOC and descriptively analyzed key attributes, including median time spent at each step, comparing pathways across complications and participant characteristics. Provider utilization and service delivery performance issues were also assessed.</p><p><strong>Results: </strong>Participants' average age was 26 years (standard deviation=6), with 55% (237/433) living outside Kampala. We identified 4 common pathways based on number and location of steps: pathways with 1 step, directly to a facility that provided required care (42%, 183/433); 2 steps, mostly including direct facility referrals (40%, 171/433); 3 steps (14%, 62/433); and 4 or more steps (4%, 17/433). Comprehensive EmOC facilities referred elsewhere 43% (79/184) of women who initially sought care in these facilities. Peripheral facilities referred 65% of women directly to the national referral hospital. A majority (60%, 34/57) of referred women returned home before reaching the final care facility.</p><p><strong>Conclusions: </strong>Our findings suggest that care pathways of women with obstetric complications in Kampala often involve at least 2 formal providers and reflect possible inefficiencies in the referral process, including potential delays and unnecessary steps. Efforts to strengthen urban health and referral systems should adopt multidisciplinary and integrated approaches, supported by clear policies and structures that facilitate effective interfacility and interdistrict care coordination. This should include streamlined care/referral pathways and equitable emergency transportation systems.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hybrid Mentorship of Medical Laboratories to Achieve ISO 15189:2012 Accreditation in Malawi: The University of Maryland Malawi Experience.","authors":"Hannaniah Moyo, Sophia Osawe, Charles Nyangulu, Philemon Ndhlovu, Visopo Harawa, Oscar Divala, Malango Msukwa, Talishiea Croxton, Natalia Blanco, Dyson Mwandama, Memory Mkandawire, Elizabeth Kampira, Muluken Kaba, Alice Maida, Andrew F Auld, Lindsay Kim, Reuben Mwenda, Howard Kress, James Kandulu, Thresa Sumani, Joseph Bitilinyu, Thokozani Kalua, Alash'le Abimiku","doi":"10.9745/GHSP-D-24-00254","DOIUrl":"10.9745/GHSP-D-24-00254","url":null,"abstract":"<p><strong>Introduction: </strong>As part of a laboratory strengthening program in Malawi to achieve and maintain International Organization for Standardization (ISO) 15189 accreditation, we intended to mentor selected HIV molecular laboratories to achieve this accreditation. Due to the COVID-19 pandemic, mentorship pivoted to a hybrid model using an Internet-based approach and on-site mentorships. We describe the implementation of this strategy, successes, and challenges.</p><p><strong>Methods: </strong>We conducted weekly, 1-hour virtual mentorship sessions for the 5 initial laboratories (cohort 1) selected based on their Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) performance score of 3 or more stars. Laboratories presented updates and supporting documents electronically, and trainings were conducted virtually. In September 2020, when travel restrictions were relaxed, we initiated hybrid mentorships and audits for cohort 1 laboratories. The same hybrid approach was used to mentor 4 additional laboratories in cohort 2. We performed descriptive analysis, and the Wilcoxon signed-rank test was used to compare the training pre-and post-test scores.</p><p><strong>Results: </strong>Between March 2020 and May 2023, the team completed a total of 54 virtual mentorship sessions and 20 on-site visits across 9 laboratories. Overall, the team conducted 8 training sessions for 35 laboratory quality officers. Median score improvement (pre-test vs. post-test scores) was observed across individual trainings and across cohorts (<i>P</i><.01). At the end of cohort 1, 4 of 5 (80%) laboratories were accredited. One laboratory that did not reach accreditation joined cohort 2. At the end of the mentoring period, all 5 cohort 2 laboratories were accredited.</p><p><strong>Conclusions: </strong>We demonstrated that using a hybrid mentorship model for accreditation was a successful strategy during the COVID-19 pandemic. For the first time in Malawi, this strategy resulted in accrediting 9 of the 10 HIV molecular laboratories in 3 years at a reduced cost. Continuous mentorship is key in the maintenance of accreditation.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Effects of Information Revolution Interventions on Health Information System Performance in Ethiopia.","authors":"Barbara Knittel, Heather M Marlow, Afrah Mohammedsanni, Abebaw Gebeyehu, Hiwot Belay, Wubshet Denboba","doi":"10.9745/GHSP-D-23-00513","DOIUrl":"10.9745/GHSP-D-23-00513","url":null,"abstract":"<p><p>Health information systems (HISs) are essential to a country's health system as they provide critical support to health policymaking, management, financing, and service delivery. A well-functioning HIS should produce timely and reliable data that are available and easily accessible to decision-makers throughout the health system. Ethiopia has transitioned from a fragmented, paper-based health management information system (HMIS) to a harmonized, digital system used at points of collection and service delivery.In 2016, the Federal Ministry of Health (MOH) launched the Information Revolution (IR), a transformative agenda aimed at enhancing the culture of data use, scaling priority HIS tools and systems, and strengthening HIS governance. Between 2016 and 2022, the MOH, Data Use Partnership, and other partners implemented a series of IR interventions that supported this agenda. These interventions included deploying and harmonizing digital HIS systems; strengthening HIS leadership, coordination, and governance; implementing the IR pathway strategy; enhancing capacity through supportive supervision, mentorship, and training; and improving performance monitoring teams. This article aims to synthesize the key HIS interventions implemented in Ethiopia as part of the IR and document the effects of these interventions on HIS performance.Early studies indicate promising improvements in HIS performance across health facilities in Ethiopia. However, challenges remain. To ensure sustainable progress, it is essential to continue addressing key challenges, such as system interoperability, HIS workforce, and capacity for data use at all levels. By building on the successes of the first Health Sector Transformation Plan and addressing these gaps, Ethiopia can advance its vision of a robust, data-driven health system capable of improving health outcomes and driving evidence-based decision-making.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using the 5C Vaccine Hesitancy Framework to Elucidate and Measure Contraceptive Acceptability in sub-Saharan Africa.","authors":"Lotus McDougal, Caroline Deignan, Peter Kisaakye, Courtney McLarnon, Rebecka Lundgren, Shannon Pryor, Madeleine Short Fabic","doi":"10.9745/GHSP-D-24-00210","DOIUrl":"10.9745/GHSP-D-24-00210","url":null,"abstract":"","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}