Journal of Global Health最新文献

{"title":"Risk factors associated with disease severity among children hospitalised with community-acquired pneumonia in Angola.","authors":"Linda Reitala, Maija-Katri Lehto, Satu Kekomäki, Miia Salaspuro, Elizabete Dos Anjos, Silvia Silvestre, Elsa Gomes, Manuel Leite Cruzeiro, Asuncion Mejias, Octavio Ramilo, Tuula Pelkonen","doi":"10.7189/jogh.16.04138","DOIUrl":"10.7189/jogh.16.04138","url":null,"abstract":"<p><strong>Background: </strong>Community-acquired pneumonia (CAP) is a major cause of paediatric mortality worldwide, disproportionately affecting children in low- and middle-income countries. Yet, to date, no studies have examined the risk factors for severe CAP in Angolan children. We aimed to identify these risk factors to improve CAP-associated morbidity and mortality.</p><p><strong>Methods: </strong>We conducted a prospective, observational study enrolling a convenience sample of children aged two months to 13 years hospitalised with CAP in the Hospital Pediátrico David Bernardino in Luanda, Angola. We included healthy children and those with asthma, human immunodeficiency virus, or sickle cell disease. We used multivariable logistic regression to assess risk factors associated with mortality as the primary outcome and prolonged hospitalisation as the secondary outcome.</p><p><strong>Results: </strong>From September 2019 to May 2021, we enrolled 372 patients hospitalised with CAP, confirmed by chest x-ray. Multivariable analysis identified age <1 year (adjusted odds ratio (aOR) = 7.51; 95% confidence interval (CI) = 1.72-34.12), seizures (aOR = 10.62; 95% CI = 1.17-80.71), and C-reactive protein ≥150 mg/L (aOR = 27.77; 95% CI = 4.48-575.26) as risk factors for mortality, while cough prior to hospitalisation was a protective factor (aOR = 0.05; 95% CI = 0.01-0.2). Cooking at home with coal or wood (aOR = 2.05; 95% CI = 1.13-3.80), malnutrition (aOR = 2.15; 95% CI = 1.17-4.01), inability to drink on admission (aOR = 2.43; 95% CI = 1.22-5.00), diminished breath sounds on auscultation (aOR = 2.67; 95% CI = 1.49-4.82), and pleural effusion on chest x-ray (aOR = 3.99; 95% CI = 2.23-7.27) were risk factors for prolonged hospitalisation (>7 days).</p><p><strong>Conclusions: </strong>We identified various demographic, environmental, clinical, laboratory, and radiologic findings as key risk factors for severe CAP in Angolan children.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04138"},"PeriodicalIF":4.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786530","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":"Strengthening microbial genomics capacity in Africa for epidemic preparedness: key lessons from the AFROSCREEN programme.","authors":"","doi":"10.7189/jogh.16.03012","DOIUrl":"10.7189/jogh.16.03012","url":null,"abstract":"<p><p>The AFROSCREEN initiative, implemented in 13 countries, has strengthened regional genomic surveillance through investments in sequencing infrastructure, workforce training, and cross-country coordination, evolving from a SARS-CoV-2-focused effort into a multi pathogen platform. By building local capacity, AFROSCREEN reduced dependence on external laboratories, helped close critical surveillance gaps, and generated genomic data that could inform mitigation of national health risks. However, persistent structural challenges related to inequity, including procurement delays, limited bioinformatics autonomy, reliance on short term funding, high staff turnover, and weak integration of genomic data into national decision making, continue to constrain its full potential, underscoring the need to embed genomics within national systems to advance genomic sovereignty and preparedness for future epidemics.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"03012"},"PeriodicalIF":4.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786553","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":"Priority implementation research for measles-rubella microarray patches identified using the Child Health and Nutrition Research Initiative methodology.","authors":"Sara Sá Silva, Melissa Ko, Thomas Cherian, Shamim Qazi, Diana Chang Blanc, Mercy Mvundura, Christopher Morgan, Sonali Kochhar, Auliya Suwantika, Bruce Innis, Katrina Kretsinger, Natasha Crowcroft, Courtney Jarrahian, Anna Thorson, Mahnaz Vahedi, Oniovo Efe-Aluta, Jessica Joyce Mistilis, Birgitte Giersing, Mateusz Hasso-Agopsowicz","doi":"10.7189/jogh.16.04141","DOIUrl":"10.7189/jogh.16.04141","url":null,"abstract":"<p><strong>Background: </strong>Measles and rubella continue to be a significant global health challenge, disproportionately impacting marginalised communities in low- and middle-income countries (LMICs). Innovative technologies such as measles-rubella microarray patches (MR-MAPs) are currently in development and can potentially improve immunisation coverage and equity through their unique product characteristics. Nonetheless, the limited evidence around their use cases, optimal implementation, cost-effectiveness, and integration into national immunisation programmes raises the need for the development of a prioritised implementation research agenda.</p><p><strong>Methods: </strong>We used the Child Health and Nutrition Research Initiative (CHNRI) methodology to prioritise 36 research questions (RQs), which we identified through a rapid literature assessment and consultations with experts. We then prepared an online survey and asked stakeholders to assess each question considering the selected CHNRI criteria. We calculated research priority scores (RPS) and average expert agreement (AEA) and conducted stratified analyses restricted to: LMIC government representatives, respondents based in middle-income countries, those with at least moderate experience in implementing health products in LMICs, those with at least moderate knowledge of MR-MAPs, and representatives from academic or research institutions.</p><p><strong>Results: </strong>A total of 139 respondents identified a diverse range of priorities for MR-MAP implementation research. The 36 RQs had a median RPS of 80%. The key priorities identified included research on vaccine supply chain management, vaccine uptake among underserved populations, and human resource implications for integration in routine immunisation services. Stratified analyses revealed a diversity of scores, with representatives from LMIC governments generally prioritising operational questions related to human resources, vaccine administration, and managing dual delivery mechanisms. Fifteen RQs were prioritised to accommodate different perspectives.</p><p><strong>Conclusion: </strong>This exercise prioritised implementation questions that will inform MR-MAPs' research investments and efforts over the next 10 years in order to prepare for their introduction in LMICs. While the questions identified in this exercise were specifically about MR-MAPs, the RQs and potential evidence may apply to other vaccine MAPs. This research addresses critical evidence needed towards the successful roll-out of this innovative technology in LMICs, to ensure equitable access to measles and rubella vaccination and accelerate progress towards measles and rubella control and elimination.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04141"},"PeriodicalIF":4.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786490","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":"The relationship between alcohol consumption, social distancing, and crime rates: insights from the COVID-19 pandemic.","authors":"Agnus M Kim, Jin-Seok Lee, Doojin Ryu","doi":"10.7189/jogh.16.04144","DOIUrl":"10.7189/jogh.16.04144","url":null,"abstract":"<p><strong>Background: </strong>While there was a global shift in social interaction and alcohol consumption during the COVID-19 pandemic, their associations with changes in crime rates remain underexplored. We aimed to examine the associations between crime rates and alcohol use within the context of pandemic-related social distancing.</p><p><strong>Methods: </strong>We calculated crime rates across crime categories from 2011 to 2022 using crime statistics from the Korean National Police Agency. We estimated two linear regression models with the crime rate as the dependent variable. The first model examined the association of movie attendance (a proxy for social distancing) and the unemployment rate with crime rates. The second model additionally included per capita alcohol consumption to determine how the association between social distancing and crime rates was attenuated when accounting for alcohol use.</p><p><strong>Results: </strong>As of 2022, 19% of total crimes involved offenders under the influence of alcohol, with particularly high proportions in murder (64%), traffic accidents (47%), arson (32%), violence (28%), and rape (20%). Overall crime rates and offences committed under the influence of alcohol, which had steadily declined from 2011, fell sharply during the COVID-19 pandemic. Both alcohol consumption and social interaction declined during the pandemic. While the rates of overall crime, violence, rape, traffic accidents, and arson were initially associated with social contact, these associations were no longer significant after adjusting for alcohol consumption; instead, strong positive associations with alcohol consumption were observed. The rate of murder was not significantly associated with social contact, but exhibited a significant association only with alcohol consumption.</p><p><strong>Conclusions: </strong>The concurrent declines in crime and alcohol consumption, along with the attenuating effect of alcohol in the relationship between social distancing and crime, suggest that addressing social drinking environments may be an effective strategy for reducing crime rates.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04144"},"PeriodicalIF":4.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786606","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":"A district-based health facility assessment for maternal and newborn care across Pakistan.","authors":"Muhammad Ayaz Mustufa, Shabina Ariff, Nimra Shahid, Fareeha Javaid, Faiz Ahmed Raza, Uzair Ansari, Sajid Soofi, Aamer Ikram, Imran Ahmed Chauhadry, Zulfiqar Ahmed Bhutta","doi":"10.7189/jogh.16.04103","DOIUrl":"10.7189/jogh.16.04103","url":null,"abstract":"<p><strong>Background: </strong>The shift from home to facility births has not translated into substantial mortality reduction in Pakistan. Therefore, we assessed whether health care facilities (HCFs) offer or have the capacity to offer critical maternal and newborn interventions. We aimed to propose tailored facility-based maternal and newborn care strategies, especially for the perinatal period.</p><p><strong>Methods: </strong>We conducted an HCF assessment in 275 public and private HCFs across 141 districts of Pakistan. We employed a comprehensive, quantitative tool to assess the availability and readiness of resources needed for critical maternal and newborn interventions, including Basic Emergency Obstetric and Newborn Care, Comprehensive Emergency Obstetric and Newborn Care signal functions, and Every Newborn Action Plan interventions. We analysed the data using Stata, version 13.0.</p><p><strong>Results: </strong>A high proportion of facilities offered delivery services (93%), yet lacked specialised staff, especially paediatric surgeons (18%) and neonatologists (18.5%). Availability of neonatal nurses was also critically low, especially in Balochistan (19.4%) and Gilgit-Baltistan (22.2%). Clinical guidelines, especially for newborn resuscitation (8.8%), kangaroo mother care (KMC) (8.4%), and use of injectable antibiotics (10.9%), were largely unavailable. Notable regional disparities were observed, with Balochistan displaying the poorest service availability and readiness. Only 8.3% of facilities in Balochistan had newborn resuscitation equipment, and none had guidelines.</p><p><strong>Conclusions: </strong>To make a substantial impact on reducing maternal and newborn mortality, data-driven, equitable allocation of funds and resources to HCFs is crucial. The availability of skilled health care providers, basic newborn care, and low-cost, high-impact interventions, such as the optimal use of antenatal corticosteroids, KMC, newborn resuscitation, and injectable antibiotics, should be prioritised and scaled up.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04103"},"PeriodicalIF":4.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786515","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":"Comparative risk of psychiatric comorbidities associated with codeine and tramadol in patients with hip osteoarthritis: a nationwide population-based cohort study.","authors":"Yujin Kim, Eunjung Choo, Sooyoung Shin, Yeo Jin Choi","doi":"10.7189/jogh.16.04121","DOIUrl":"https://doi.org/10.7189/jogh.16.04121","url":null,"abstract":"<p><strong>Background: </strong>Weak opioids are often prescribed for osteoarthritis (OA), yet their comparative psychiatric risks are not well established. We aimed to comprehensively compare the composite psychiatric risks associated with codeine and tramadol in patients diagnosed with hip OA.</p><p><strong>Methods: </strong>We conducted a nationwide, population-based retrospective cohort study, using Korean Health Insurance Review and Assessment Service database on patients diagnosed with hip OA between 2014 and 2017. We included patients who received either opioid, with a total of 22 651 patients (of whom 4533 codeine and 18 118 tramadol users) after 1:4 propensity score matching (PSM). We applied Cox proportional hazards models to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for incident psychiatric outcomes.</p><p><strong>Results: </strong>Codeine use was associated with a significantly lower hazard of composite psychiatric disorders (aHR = 0.86; 95% CI = 0.78-0.96), particularly anxiety (aHR = 0.81; 95% CI = 0.69-0.95), and showed a borderline reduction in sleep disorders (aHR = 0.81; 95% CI = 0.65-1.00, P = 0.048) after adjustment for age, sex, comorbidities, and concomitant medications. Subgroup analyses revealed consistently lower psychiatric risk among patients with a high comorbidity burden (Charlson's comorbidity index ≥3), cardiovascular disease, or those without concomitant psychotropic medications. Sensitivity analyses using inverse probability treatment weighting and 1:1 PSM demonstrated broadly similar patterns, although statistical significance varied across models. No clear duration-response relationship was observed.</p><p><strong>Conclusions: </strong>Codeine was associated with lower hazards of anxiety and sleep disorders in several analyses. These findings suggest that strengthening opioid stewardship through structured psychiatric risk assessment and individualised prescribing may enhance patient safety. Further controlled studies incorporating detailed clinical data are warranted to validate these associations and to better define their implications for long-term opioid management and policy development.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04121"},"PeriodicalIF":4.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13105788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786464","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":"Time in target range for body mass index and risk of new onset multimorbidity in middle-aged and older adults: a landmark analysis of two prospective cohorts.","authors":"Jingru Bi, Yilin Pan, Pengcheng Ji, Wenkai Guo, Zhiwei Yin, Yuansheng Xie","doi":"10.7189/jogh.16.04134","DOIUrl":"https://doi.org/10.7189/jogh.16.04134","url":null,"abstract":"<p><strong>Background: </strong>Static body mass index (BMI) measurements overlook longitudinal weight dynamics. We examined the association between time in target range for BMI (TTR-BMI), which integrates stability and target attainment, and incident multimorbidity.</p><p><strong>Methods: </strong>We performed a landmark analysis using the English Longitudinal Study of Ageing and China Health and Retirement Longitudinal Study. We included participants aged ≥45 years free of multimorbidity. We calculated TTR-BMI via linear interpolation based on the trapezoidal rule to quantify continuous exposure to a target weight range. We used stratified Cox proportional hazards models to estimate hazard ratios (HRs) for incident multimorbidity. To address proportional hazards violations, we employed time-dependent coefficient analysis to examine temporal heterogeneity (≤3 years vs. >3 years). Lastly, we used negative binomial regression to assess secondary outcomes (disease accumulation).</p><p><strong>Results: </strong>Among 6935 participants, there were 2483 incident cases. Higher TTR-BMI was inversely associated with multimorbidity risk in a dose-response manner. In fully adjusted models, each one standard deviation increase in TTR-BMI reduced risk by 6% (HR = 0.94; 95% confidence interval (CI) = 0.90-0.99). Time-dependent analysis revealed this protection was specific to the late (>3 years) follow-up phase (HR = 0.91; P = 0.003), with no significant effect in the early phase. Furthermore, higher TTR-BMI was associated with a lower rate of disease accumulation (incidence rate ratio = 0.97; 95% CI = 0.95-1.00, P = 0.046).</p><p><strong>Conclusions: </strong>We found that TTR-BMI is an independent predictor of incident multimorbidity. Maintaining a higher TTR-BMI serves as a protective factor against disease onset. Maximising time spent in a healthy weight range offers a precise, longitudinal target for primary prevention in older adults.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04134"},"PeriodicalIF":4.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13105787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785680","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":"Identifying delays impacting maternal and perinatal deaths using a facility-based death audit review system integrated with community engagement: a mixed methods study.","authors":"Zahid Memon, Wardah Ahmed, Shah Muhammad, Sajid Soofi, Shanti Chouhan, Arjumad Rizvi, Paul Barach, Zulfiqar A Bhutta","doi":"10.7189/jogh.16.04117","DOIUrl":"https://doi.org/10.7189/jogh.16.04117","url":null,"abstract":"<p><strong>Background: </strong>Pakistan's persistently high maternal (178 per 100 000 livebirths) and neonatal (41 per 1000 livebirths) mortality ratios are compounded by lack of reliable data on the root causes and preventable risk factors, which hinders their effective use in improving care and progress toward safe, high-quality services. We sought to identify system delays impacting maternal and perinatal deaths using a facility-based death audit review system integrated with community engagement for implementing actionable solutions.</p><p><strong>Methods: </strong>We used a mixed methods, concurrent parallel study design at three secondary level healthcare facilities in District Matiari, Sindh, Pakistan. We reviewed 319 cases that included 19 maternal deaths (MDs), 185 neonatal deaths (NDs) and 115 cases of stillbirth (SB) using the WHO based death audit review system integrated with community engagement. We documented quantitative data for all cases using descriptive statistics and simultaneously collected qualitative narratives, which we then analysed and categorised across the four delays model. Audit committees comprising facility staff and community representatives met quarterly to review cases.</p><p><strong>Results: </strong>We observed delay patterns across death types. MDs were predominantly influenced by delays 3 (reaching facility: 74%) and 4 (receiving adequate care: 74%), reflecting system-level barriers in access and quality of care. SB cases were primarily associated with delays 1 (recognition of danger signs: 64%) and 2 (decision to seek care: 60%), highlighting household-level knowledge and decision-making gaps. NDs were primarily affected by delays 4 (receiving adequate care: 54%) and 1 (recognition of danger signs: 48%), indicating both facility capacity constraints and early recognition failures. The analysis revealed four interconnected themes explaining these delays: lack of education and awareness (delays 1 and 2), inadequate transport mechanisms (delay 3), multiple referrals (overlapping delays 3 and 4), and limited facility operational hours and delayed medical care (delay 4).</p><p><strong>Conclusions: </strong>The four delays model identified patterns of preventable factors contributing to maternal and perinatal deaths across household and health system levels. Health systems need to invest in women's access to, and the availability of, healthcare facilities both during and after pregnancy. Scaling up and implementing audit review systems with learning feedback loops is key to systematically identifying and contributing to addressing preventable delays in resource constrained settings, particularly when comprehensive national-level mortality data are lacking.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04117"},"PeriodicalIF":4.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786523","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":"Enhancing health professional clinical performance through supervision strategies: from 5311 facilities across eight countries in sick child healthcare.","authors":"Mengyao Li, Zhongliang Zhou, Rebecca Mitchell, Dan Wang, Brendan Boyle, Wenhua Wang","doi":"10.7189/jogh.16.04123","DOIUrl":"https://doi.org/10.7189/jogh.16.04123","url":null,"abstract":"<p><strong>Background: </strong>Supervision remains a widely implemented strategy to improve clinical quality, but its independent impact and the means to enhance its effectiveness remain uncertain. We investigated the effectiveness of supervision alone and, in combination with feedback or training, on clinical quality in child healthcare, and explored the relationship between supervision alone and performance across different organisational contexts.</p><p><strong>Methods: </strong>Data were sourced from the Service Provision Assessment survey, covering 5311 health facilities, 6722 health providers, and 20 880 sick children across eight low- and middle-income countries (LMICs). We assessed health worker performance using 20 clinical quality indicators. We examined various supervision modalities, including supervision alone, supervision with feedback, and supervision with training. We considered organisational factors, such as quality assurance activities and data collection systems and applied multilevel regression models, adjusting for relevant covariates.</p><p><strong>Results: </strong>Supervision alone was not significantly related to clinical performance (coefficient = 0.101; 95% confidence interval (CI) = -0.00, 0.20). However, supervision combined with feedback (Coefficient = 0.171; 95% CI = 0.07, 0.27) or training (coefficient = 0.514; 95% CI = 0.41, 0.62) were both significantly associated with better performance. Organisational support, particularly through quality assurance activities (coefficient = 0.290; 95% CI = 0.14, 0.44) or data collection systems (coefficient = 0.130; 95% CI = 0.02, 0.24), transformed otherwise ineffective supervision into effective ones. The positive impact was stronger when both quality assurance and data collection systems were present (coefficient = 0.319; 95% CI = 0.17, 0.47).</p><p><strong>Conclusions: </strong>Supervision alone is inadequate in relation to better clinical quality in sick child healthcare services. A combination of supervision strategies, including feedback and training, along with institutional support, is likely to be associated with better health worker performance, particularly in LMICs. These findings highlight the need for integrated approaches to supervision, emphasising the role of institutional support in driving quality improvements in child health services.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04123"},"PeriodicalIF":4.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13105789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786481","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":"Elevated gamma-glutamyl transferase levels in early pregnancy increase pregnant women's risk of gestational hypertension and preeclampsia.","authors":"Chuanlu Xu, Yuping Tang, Yirong Bao, Yuhong Li, Jia Zuo, Xiaohua Liu, Xiaoxian Qu, Hao Ying","doi":"10.7189/jogh.16.04132","DOIUrl":"https://doi.org/10.7189/jogh.16.04132","url":null,"abstract":"<p><strong>Background: </strong>The association between liver dysfunction in early pregnancy and the hypertensive disorders in pregnancy (HDP) remains unclear.</p><p><strong>Methods: </strong>This retrospective cohort study included all singleton pregnant women (n = 57 386) who underwent liver function tests (LFTs) at their first antenatal visit from six to 19⁺⁶ weeks of gestation. The exposure was liver dysfunction. The primary outcome was the development of hypertensive disorders of pregnancy (HDP), categorised into gestational hypertension and preeclampsia (PE). Preeclampsia was categorised into mild and severe forms, as well as early-onset and late-onset types. Multiple logistic regression analyses were conducted to estimate the risk for HDP and its subtypes across different liver function biomarker levels.</p><p><strong>Results: </strong>Among the 50 423 women included in the study, 17.1% had abnormal liver function. The overall HDP rate was 3.9%. Across the different serum Gamma-glutamyltransferase (GGT)groups, the HDP incidence rates were 2.9% (0-12 units per litre /U/L)), 5.4% (12.1-32 U/L), 10.0% (32.1-64 U/L), and 10.5% (>64 U/L) (P < 0.001 for trend). Compared with the reference range for GGT (0-12 U/L), the group with GGT levels of 12.1-32 U/L exhibited a 48.6% greater risk (adjusted odds ratio (OR) = 1.486; 95% confidence interval (CI) = 1.344-1.642), the group with GGT levels of 32.1-64 U/L had a 50.9% increased risk (aOR = 1.509; 95% CI = 1.375-1.657), and those with GGT levels >64 U/L had a 25.0% greater risk (aOR = 1.250; 95% CI = 1.078-1.449) of HDP. We further assessed the associations between varying GGT levels and HDP subtypes (gestational hypertension, mild PE, severe PE, early onset PE, and late-onset PE), and similar results were obtained for all subtypes. Restricted cubic spline (RCS) curves revealed that elevated serum GGT levels have a dose-response relationship with HDP, along with its subtypes.</p><p><strong>Conclusions: </strong>GGT levels during early pregnancy have a dose-response relationship with the development of HDP and its subtypes.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04132"},"PeriodicalIF":4.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13107083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786525","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}