Journal of Global Health最新文献

{"title":"Insights from national stakeholders and health workers on learning and performance interventions in immunisation programs: a multi-country situational analysis.","authors":"Julia Bluestone, Emily Bryce, Alexander K Rowe, Naina J Ahuja, Wincate M Murathi, Rosemary N Njogu, Arshad Chandio","doi":"10.7189/jogh.15.04109","DOIUrl":"10.7189/jogh.15.04109","url":null,"abstract":"<p><strong>Background: </strong>Health workers play a key role in providing high-quality health services, but health worker practice improvements remain limited despite significant investments in learning and performance interventions. We conducted a situational analysis to explore factors affecting health worker performance, focusing on barriers and facilitators and integrating digital solutions.</p><p><strong>Methods: </strong>In the analysis we focussed on paid professional health workers. Primary data collection occurred between April-May 2022 across seven countries, involving key informant interviews with immunisation program managers and human resource representatives. In three countries, human-centred design meetings included surveys on preferred interventions for improving learning and performance. Secondary data included a desk review of the literature, including recent strategy documents from the Gavi Alliance. We used a virtual session with human-centred design facilitators to create a health worker learning journey map.</p><p><strong>Results: </strong>Our findings show a shift towards digital and innovative approaches in learning, though traditional methods, such as in-service training and supervision, still dominate. Most initiatives depend on donor funding. There is a lack of evidence on the effectiveness of digital solutions. Integration with health workers' continuing professional development processes is limited, but career advancement motivates engagement. Challenges include inadequate staffing, limited training opportunities, and poor digital infrastructure. Preferred methods include workplace-based learning and digitally supported training. Evidence supports quality improvement or group problem-solving to improve practices, while other approaches, such as eLearning or blended learning and mentorship, require further evaluation.</p><p><strong>Conclusions: </strong>Stakeholders, including donors, should prioritise support for more effective learning approaches, combining strategies to improve outcomes. While stakeholders desire to expand digital learning, given the limited evidence, prioritising effectiveness evaluations are crucial. Educating stakeholders on evidence-based practices, promoting combined strategies, evaluating unproven interventions, and aligning donor funding with effective approaches is critical to enhancing interventions.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04109"},"PeriodicalIF":4.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736232","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":"An ensemble approach improves the prediction of the COVID-19 pandemic in South Korea.","authors":"Kyulhee Han, Catherine Apio, Hanbyul Song, Bogyeom Lee, Xuwen Hu, Jiwon Park, Liu Zhe, Taewan Goo, Taesung Park","doi":"10.7189/jogh.15.04079","DOIUrl":"10.7189/jogh.15.04079","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Modelling can contribute to disease prevention and control strategies. Accurate predictions of future cases and mortality rates were essential for establishing appropriate policies during the COVID-19 pandemic. However, no single model yielded definite conclusions, with each having specific strengths and weaknesses. Here we propose an ensemble learning approach which can offset the limitations of each model and improve prediction performances.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We generated predictions for the transmission and impact of COVID-19 in South Korea using seven individual models, including mathematical, statistical, and machine learning approaches. We integrated these predictions using three ensemble methods: stacking, average, and weighted average ensemble (WAE). We used train and test errors to measure a model's performance and selected the best covariate combinations based on the lowest train error. We then evaluated model performance using five error measures (r&lt;sup&gt;2&lt;/sup&gt;, weighted mean absolute percentage error (WMAPE), autoregressive integrated moving average (ARIMA), mean squared error (MSE), root mean squared error (RMSE), and mean absolute percentage error (MAPE)) and selected the optimal covariate combination accordingly. To validate the generalisability of our approach, we applied the same modelling framework to USA data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Booster shot rate + Omicron variant BA.5 rate was the most commonly selected combination of covariates. For raw data evaluated using the WMAPE, individual models achieved the following: Generalised additive modelling (GAM) reached a value of 0.244 for the daily number of confirmed cases, a value of 0.172 for the time series Poisson for the daily number of confirmed deaths, and a value of 0.022 for both ARIMA and time series Poisson for the daily number of ICU patients. For smoothed data, the Holt-Winters model achieved a value of 0.058 for daily confirmed cases, while ARIMA attained a value of 0.058 for the daily number of confirmed deaths and 0.013 for the daily number of ICU patients. Among ensemble models, the SVM-based stacking ensemble achieved error values of 0.235 for the daily number of confirmed cases, 0.118 for the daily number of deaths, and 0.019 for the daily number of ICU patients on raw data. For smoothed data, the average ensemble and weighted average ensemble achieved 0.060 for the daily number of confirmed cases and 0.013 for daily ICU patients. The ensemble models also generalised well when applied to data from the USA.Booster shot rate + Omicron variant BA.5 rate was the most commonly selected combination of covariates. For raw data, GAM (0.244) predicted daily confirmed cases best, time series Poisson (0.172) predicted daily confirmed deaths, and both ARIMA and time series Poisson (0.022) predicted daily ICU patients, based on WMAPE. For smoothed data, time series Poisson predicted daily confirmed cases (0.065) best, while A","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04079"},"PeriodicalIF":4.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732437","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":"Assessing courtesy reporting bias in facility-based surveys on person-centred maternity care: evidence from urban informal settlements in Nairobi and Lusaka.","authors":"Safia S Jiwani, Martin Kavao Mutua, Choolwe Jacobs, Mwiche Musukuma, Anne Njeri, Godfrey Adero, Dennis Ngosa, Amanuel Abajobir, Cheikh Mbacké Faye, Ties Boerma, Agbessi Amouzou","doi":"10.7189/jogh.15.04090","DOIUrl":"10.7189/jogh.15.04090","url":null,"abstract":"<p><strong>Background: </strong>Experience of care is typically measured through client exit surveys administered in the facility. Evidence suggests that such measures suffer from courtesy reporting bias whereby respondents do not accurately report on their experiences while in the facility. We explored the presence of courtesy bias by comparing women's reported experience of person-centred maternity care (PCMC) from facility-based client exit surveys to mobile phone-based surveys out of the facility in Nairobi and Lusaka's urban informal settlements.</p><p><strong>Methods: </strong>We randomly and independently sampled women in the facilities for either a facility-based survey (n = 233 in Lusaka and n = 112 in Nairobi) or a mobile phone-based survey (n = 203 in Lusaka and n = 300 in Nairobi) within one to two weeks of facility discharge. The questionnaire included a validated PCMC scale. After adjusting for differences in women's characteristics across groups, we compared PCMC scores between facility and phone-based samples. We ran multilevel linear regression models to assess PCMC by survey modality in each city.</p><p><strong>Results: </strong>In both cities, over 70.0% of women were aged 20-34 years and were married, at least two thirds had secondary education, and over 95.0% were unaccompanied during labour/delivery. The overall PCMC score was 69.3% among women surveyed on the phone compared to 70.2% among those surveyed in the facility in Nairobi. In Lusaka, it was 57.5% on the phone compared to 56.8% in-facility. We found no statistically significant differences in PCMC scores between survey modalities in both cities, after adjusting for differences in women's characteristics.</p><p><strong>Conclusions: </strong>We did not detect significant courtesy reporting bias in PCMC in facility-based client exit surveys in the context of urban informal settlements in Nairobi and Lusaka. Experience of PCMC can be measured through in-facility client exit surveys or mobile phone surveys. However, it is critical to address challenges related to a mobile phone-based approach.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04090"},"PeriodicalIF":4.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732535","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 monitoring and evaluation of digital health interventions in sub-Saharan Africa: big data, mHealth, and dashboards.","authors":"Oche Joseph Otorkpa, Joseph Omeiza Alao, Abiodun Paul Olaiya","doi":"10.7189/jogh.15.03013","DOIUrl":"10.7189/jogh.15.03013","url":null,"abstract":"<p><p>Digital health interventions based on digital and mobile technologies are essential for advancing healthcare in sub-Saharan Africa. However, challenges with their effective monitoring and evaluation (M&E) continue to impact their scalability and sustainability. Here we propose a set of innovative strategies to strengthen M&E frameworks, including integrating big data analytics and artificial intelligence for real-time impact assessment, leveraging mHealth platforms for enhanced data collection and stakeholder engagement, and developing interactive digital dashboards for transparent decision-making. These strategies aim to optimise digital health interventions implementation and evaluation, addressing critical healthcare access and outcome challenges exacerbated by a shortage of healthcare professionals in the region. By enhancing M&E capabilities, these approaches maximise the impact of digital health technologies in improving public health across sub-Saharan Africa.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"03013"},"PeriodicalIF":4.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671394","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 target trial framework in global health research: barriers and opportunities.","authors":"Ali Al-Kassab-Córdova, Esteban A Alarcón-Braga, Camila Olarte Parra, Niveditha Devasenapathy, Martin Gerdin Wärnberg, Anthony A Matthews","doi":"10.7189/jogh.15.03014","DOIUrl":"10.7189/jogh.15.03014","url":null,"abstract":"<p><p>A randomised trial is the best way to make causal inferences when evaluating the effectiveness and safety of health interventions in global health research. Trials, however, are inherently expensive, unfeasible in many scenarios, and may raise ethical issues. In these scenarios, we must turn to analyses of observational data to learn what works. The target trial framework provides an organising principle for the design of observational studies that can lead to clinically interpretable results and analytic approaches that can reduce common biases. In this analysis, we describe the global distribution of data sources used in applications of the target trial framework and discuss barriers to its increased use in global health research, such as limited access to high-quality observational data. We then suggest a cost-effective solution of incorporating the collection of additional high-quality observational data into the implementation of large randomised trials in low- and middle-income countries. We found that the target trial framework is underutilised in observational studies conducted in most low- and middle-income countries. The main barriers are little available data and few trained researchers, which can be overcome by incorporating high-quality observational data collection into the data collection phase of large randomised trials, and by introducing small adjustments to the teaching curriculum.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"03014"},"PeriodicalIF":4.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671488","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":"Bidirectional associations between social isolation, loneliness, and cognitive function among Chinese older adults.","authors":"Chaoping Pan, Na Cao","doi":"10.7189/jogh.15.04077","DOIUrl":"10.7189/jogh.15.04077","url":null,"abstract":"<p><strong>Background: </strong>Social isolation (SI), loneliness, and cognitive function (CF) are increasingly acknowledged as significant public health concerns globally. In this study, we aimed to investigate the bidirectional relationships and mediating effects between SI, loneliness, and CF among older adults in China.</p><p><strong>Methods: </strong>We analysed data from six waves of the Chinese Longitudinal Healthy Longevity Survey conducted between 2002-18. The sample included individuals aged ≥65 years. We used the general cross-lagged panel model to account for confounding factors and reveal mediating effects.</p><p><strong>Results: </strong>The findings indicated that SI and loneliness can independently lower CF. Moreover, loneliness may lower CF through SI, and SI may also lower CF through loneliness. Finally, we revealed that decreased CF can increase SI and loneliness.</p><p><strong>Conclusions: </strong>SI and loneliness are significantly intertwined with CF among older adults in China. Interventions aiming at reducing SI, loneliness, and CF should consider the interplay of these factors to enhance the health and well-being of older adults.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04077"},"PeriodicalIF":4.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673664","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":"Accounting for aid: estimating the impact of United States' global health investments on mortality among women of reproductive age using synthetic control and Bayesian methods.","authors":"Karar Zunaid Ahsan, Gustavo Angeles, Allysha Choudhury, Kavita Singh, Tory M Taylor, Farhan Majid, Rachel Lucas, Robert L Cohen, Atul A Gawande, William Weiss","doi":"10.7189/jogh.15.04067","DOIUrl":"10.7189/jogh.15.04067","url":null,"abstract":"<p><strong>Background: </strong>The United States government (USG) is a key global actor in preventing mortality and supporting lifesaving health services among women and children in low- and middle-income countries (LMICs). Since the Foreign Assistance Act of 1961, USG has funded global health programmes targeting specific conditions and strengthening health systems for the delivery of essential services via the United States Agency for International Development (USAID) and other USG agencies. However, directly quantifying and attributing the impact of USG health investments is challenging due to the inability of conducting randomised control trials for such large programmes at scale. In this study, we compared two quasi-experimental impact evaluation approaches to estimate the effects of sustained USG health investments on mortality among women of reproductive age (WRA).</p><p><strong>Methods: </strong>We employed synthetic control analysis and a Bayesian alternative to synthetic control to estimate the impact of USG's global health investments on WRA mortality rate across 16 LMICs that received sustained, multifaceted, and above-average USAID global health funding levels from 2005 to 2019.</p><p><strong>Results: </strong>Countries receiving sustained, multifaceted, and above-average USAID global health funding had a reduction in the annual WRA mortality rate by 0.65 deaths per 1000 WRA throughout the post-treatment period. For the years (i.e. 2009-2019) where the effect estimates are statistically significant (P < 0.001), the reduction in WRA mortality rate was 0.80 deaths per 1000 WRA. Sensitivity analyses and Bayesian modelling supported the robustness of these findings. We conservatively estimated that about 1.0-1.3 million WRA deaths were averted in study countries between 2009 and 2019 as a result of USG health investments.</p><p><strong>Conclusions: </strong>Our results suggest that well-funded donor initiatives can substantially reduce WRA mortality rates beyond what would have been achieved without such investments. Sustained donor investments significantly reduce WRA mortality, underscoring the transformative potential of well-funded global health initiatives. Our study also demonstrates that synthetic control and Bayesian models are valuable tools for evaluating the impact of large-scale global health financing.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04067"},"PeriodicalIF":4.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674770","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":"Associations between short-term exposure to fine particulate matter with ischemic stroke mortality and the role of green space: a time-series study in Zibo, China.","authors":"Sihao Song, Chuanlong Cheng, Ying Liu, Yuqi Duan, Hui Zuo, Rui Xi, Zhisong Ni, Kemeng Liang, Shufen Li, Feng Cui, Xiujun Li","doi":"10.7189/jogh.15.04068","DOIUrl":"10.7189/jogh.15.04068","url":null,"abstract":"<p><strong>Background: </strong>Previous studies on associations between short-term exposure to fine particulate matter (PM_2.5) and ischemic stroke (IS) mortality reported inconclusive results. Additionally, whether and how PM_2.5 and green space interact to precipitate IS deaths remains unclear. We aimed to examine the impacts of short-term exposure to PM_2.5 on IS mortality and the role of green space in the association.</p><p><strong>Methods: </strong>We collected data on daily IS deaths, daily PM_2.5 concentrations, and monthly normalized difference vegetation index (NDVI) in Zibo City from 2015 to 2019. Generalised additive models were adopted to investigate the short-term impacts of PM_2.5 on IS mortality, and subgroup analyses were used to examine effect modification by population characteristics. Stratified analyses by green space levels and joint effect model were conducted to test the interactions of PM_2.5 and green space on IS mortality.</p><p><strong>Results: </strong>A total of 10 799 IS deaths were included in our study. Exposure to PM_2.5 was associated with an increased risk of IS mortality, with odds ratios (ORs) of 1.0263 (95% confidence interval (CI) = 1.0017, 1.0516) for each interquartile range (IQR) increase in PM_2.5 on lag0 and 1.0317 (95% CI = 1.0016, 1.0627) on lag01. The links between PM_2.5 and IS mortality were not significantly different across genders, ages, or PM_2.5 zones. Furthermore, our results showed that the effects of PM_2.5 on IS mortality were higher in low levels of green space. Specifically, for each IQR increase in PM_2.5, the ORs (95% CIs) of IS death in the low level and the high level of NDVI were 1.0287 (95% CI = 1.0019, 1.0563) and 0.9934 (95% CI = 0.9296, 1.0615), respectively. In addition, PM_2.5 and NDVI exhibited significant interactive effects on IS mortality, with relative excess odds due to interaction (REOI) of greater than 0.</p><p><strong>Conclusions: </strong>Our findings showed that PM_2.5 was significantly associated with increasing odds of IS mortality. Furthermore, there were synergetic impacts between PM_2.5 and lack of greenness on IS mortality. Our results suggest that expanding green spaces, such as increasing park coverage and street greening, along with regulating industrial emissions to reduce PM_2.5 levels, can help prevent premature deaths from IS.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04068"},"PeriodicalIF":4.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674771","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 psychological impact of displacement and female genital mutilation/cutting.","authors":"Sargun Kaur Virk, Andrew Robert Milewski, Leslie Bull, Gunisha Kaur","doi":"10.7189/jogh.15.03011","DOIUrl":"10.7189/jogh.15.03011","url":null,"abstract":"<p><p>Although 230 million people worldwide have undergone female genital mutilation/cutting (FGM/C), its psychological consequences remain understudied. Asylum-seekers may face unique biopsychosocial burdens when migrating to countries where FGM/C is not a cultural norm. We conducted a retrospective observational study of 50 asylum seekers evaluated at the Weill Cornell Center for Human Rights between 2010 and 2020 to characterize the psychological sequelae of FGM/C. Psychological symptoms were reported in 86% of cases, with anxiety, depressed/sad mood, aversion to sexual activity and nightmare being the most common. Formal psychological diagnoses were made for 32% of cases with 30% diagnosed with posttraumatic stress disorder, 20% with major depressive disorder, and 6% with generalised anxiety disorder. Additionally, 74% of cases had experienced other forms of trauma(s), including domestic violence, sexual violence, and kidnapping signaling that violence experienced in this population is complex. Psychological disorders were diagnosed in 93% of individuals who underwent a psychological evaluation, versus 9% of those who did not, despite similar trauma history. There is a role for psychological evaluation and symptom screening for asylum-seekers who have undergone FGM/C.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"03011"},"PeriodicalIF":4.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671437","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":"Prevalence and factors associated with caesarean delivery on maternal request and its effect on maternal and foetal outcomes in selected tertiary care hospital, Odisha, Southeastern India.","authors":"Sindhu Singh, Dharitri Swain","doi":"10.7189/jogh.15.04073","DOIUrl":"10.7189/jogh.15.04073","url":null,"abstract":"<p><strong>Background: </strong>Caesarean delivery is now predominantly performed in response to the mother's request, often without medical indications, commonly referred to as caesarean delivery on maternal request (CDMR). The rise in CDMR has become a significant issue in maternal and newborn health. We aimed to explore the factors influencing CDMR and its effect on maternal and foetal outcomes.</p><p><strong>Methods: </strong>We used a prospective cohort design approach to recruit 413 participants and a consecutive sampling technique to select the participants. Those who fulfilled the inclusion criteria were taken during the six-month data collection period from October 2023 to March 2024. We used a structured interview method for data collection. We utilised inferential statistics, such as Fisher exact and χ² tests for univariate analysis and a logistic regression model in the multivariate analysis, to investigate the relationship between factors and mode of delivery.</p><p><strong>Results: </strong>The multivariate regression analysis revealed that the CDMR rate was higher among the women who preferred caesarean delivery before giving birth (odds ratio (OR) = 6.295; 95% confidence interval (CI) = 1.468-26.995, P < 0.05). Additionally, women with a history of previous caesarean delivery were more inclined to choose CDMR in the subsequent pregnancy (OR = 25.642; 95% CI = 1.199-548.221, P < 0.05). The likelihood of experiencing wound pain (OR = 42.374; 95% CI = 14.612-122.887, P < 0.05), encountering breastfeeding difficulties (OR = 11.469; 95% CI = 2.91-45.2, P < 0.05), and neonatal intensive care unit admissions (OR = 0.268; 95% CI = 0.076-0.95, P < 0.05) was significantly higher in CDMR compared to normal vaginal delivery.</p><p><strong>Conclusions: </strong>The prevalence of CDMR was 21.35%, which was relatively higher than the World Health Organization's recommended guidelines. The previous mode of delivery and maternal preference for caesarean birth were the factors that influenced CDMR. It is necessary to make childbirth readiness counselling a regular practice to assist women in selecting the best delivery method.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04073"},"PeriodicalIF":4.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674112","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}