Journal of Global Health最新文献

{"title":"The treatment responses among different inhalation therapies for GOLD group E patients with chronic obstructive pulmonary disease.","authors":"Qing Song, Ling Lin, Tao Li, Ping Zhang, Yuqin Zeng, Dingding Deng, Rong Yi, Dan Liu, Yan Chen, Shan Cai, Ping Chen, Cong Liu","doi":"10.7189/jogh.15.04055","DOIUrl":"10.7189/jogh.15.04055","url":null,"abstract":"<p><strong>Background: </strong>The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 revised the combined chronic obstructive pulmonary disease (COPD) assessment, merging groups C and D into group E, and revised the initial inhalation therapy recommendation. We aimed to evaluate the treatment responses among different inhalation therapies in GOLD group E patients stratified by the COPD assessment test (CAT) scores and forced expiratory volume in one-second percentage of predicted (FEV1%pred).</p><p><strong>Methods: </strong>In this retrospective cohort study, we included patients with COPD registered in the Real World Research of Diagnosis and Treatment of COPD (RealDTC) study between January 2017 and June 2023. According to the GOLD 2023 report, we enrolled patients assigned to GOLD group E based on exacerbations in the past year (≥2 exacerbations or ≥1 hospitalisation) in this study. We classified them into the FEV1%pred <50% and FEV1%pred ≥50% groups, or CAT<10 and CAT≥10 groups. Subsequently, we divided all groups into four subgroups: long-acting muscarinic antagonist (LAMA), long-acting β2-agonist (LABA) + inhaled corticosteroid (ICS), LABA + LAMA, and LABA + LAMA + ICS. All patients finished one year of follow-up, during which we collected data on exacerbations, frequent exacerbations, hospitalisations, and all-cause mortality. We defined frequent exacerbations as ≥2 exacerbations per year.</p><p><strong>Results: </strong>We enrolled a total of 3173 patients in this study. During one year of follow-up, there were no significant differences in exacerbations, frequent exacerbations, hospitalisations, and all-cause mortality among LAMA, LABA + LAMA, LABA + ICS, and LABA + LAMA + ICS in the FEV1%pred ≥50% and CAT<10 groups. However, the patients treated with LABA + LAMA or LABA + LAMA + ICS had a lower incidence of exacerbations and frequent exacerbations compared with the patients treated with LAMA or LABA + ICS in the FEV1%pred <50% and CAT≥10 groups (P < 0.05).</p><p><strong>Conclusions: </strong>Patients with COPD in GOLD group E should be further stratified to determine the appropriate initial inhalation therapy. This approach may provide more precise treatment for GOLD group E patients.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04055"},"PeriodicalIF":4.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469265","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":"Evidence of rapid rise in population immunity from SARS-CoV-2 subclinical infections through pre-vaccination serial serosurveys in Pakistan.","authors":"Junaid Iqbal, Zahra Hasan, Muhammad Atif Habib, Asma Abdul Malik, Sajid Muhammad, Kehkashan Begum, Rabia Zuberi, Muhammad Umer, Aamer Ikram, Sajid Bashir Soofi, Simon Cousens, Zulfiqar A Bhutta","doi":"10.7189/jogh.15.04078","DOIUrl":"10.7189/jogh.15.04078","url":null,"abstract":"<p><strong>Background: </strong>Understanding factors associated with protective immunity against emerging viral infections is crucial for global health. Pakistan reported its first COVID-19 case on 26 February 2020, but experienced relatively low COVID-19-related morbidity and mortality between 2020 and 2022. The underlying reasons for this remain unclear, and our research aims to shed light on this crucial issue.</p><p><strong>Methods: </strong>We conducted a serial population-based serosurvey over 16 months (rounds 1-4, July 2020 to November 2021) across households in urban (Karachi) and rural (Matiari) Sindh, sampling 1100 households and 3900 individuals. We measured antibodies in sera and tested a subset of respiratory samples for COVID-19 using polymerase chain reaction (PCR) and antigen tests, also measuring haemoglobin (Hb), C-reactive protein (CRP), vitamin D, and zinc in round 1.</p><p><strong>Results: </strong>Participants showed 23% (95% confidence interval (CI) = 21.9-24.5) antibody seroprevalence in round 1, increasing across rounds 2-4 to 29% (95% CI = 27.4-30.6), 49% (95% CI = 47.2-50.9), and 79% (95% CI = 77.4-80.8), respectively. Urban residents had 2.6 times (95% CI = 1.9-3.6) higher odds of seropositivity than rural residents. Seropositivity did not differ between genders. Individuals aged 20-49 years had 7.5 (95% CI = 4.6-12.4) times higher odds of seropositivity compared to children aged 0-4 years. Most participants had no symptoms associated with COVID-19, with no reported mortality. Vitamin D deficiency was linked to seroprevalence. COVID-19 was confirmed in 1.8% of individuals tested via RT-PCR and antigen tests.</p><p><strong>Conclusions: </strong>The data suggests a steady increase in humoral immunity in Pakistan, likely due to increased transmission and associated asymptomatic disease. Overall, this reflects the longitudinal trend of protection against severe acute respiratory syndrome coronavirus 2, leading to the relatively low morbidity and mortality observed in the population.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04078"},"PeriodicalIF":4.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469591","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":"Spatial patterns and temporal trends in stillbirth, neonatal, and infant mortality: an exploration of country-level data from 2000 to 2021.","authors":"Andrea Maugeri, Martina Barchitta, Gaia Schillaci, Antonella Agodi","doi":"10.7189/jogh.15.04034","DOIUrl":"10.7189/jogh.15.04034","url":null,"abstract":"<p><strong>Background: </strong>Despite significant progress in improving child survival and health, substantial disparities persist and are being increasingly threatened by a complex and dynamic global environment. In this ecological study, we investigated spatial patterns, temporal trends, and key determinants of disparities in stillbirth, neonatal, and infant mortality rates across 195 countries from 2000 to 2021.</p><p><strong>Methods: </strong>We sourced our data from two publicly available databases: the United Nations Children's Fund Data Warehouse for mortality indicators and the World Bank for World Development Indicators. We conducted spatial analysis to assess spatial autocorrelation and identify geographical clusters of countries and applied joinpoint regression to evaluate temporal trends in mortality indicators, reported as annual percentage change. We also used forward regression analysis to determine the primary indicators influencing stillbirth, neonatal, and infant mortality rates.</p><p><strong>Results: </strong>The average stillbirth rate in 2021 was 10.9 per 1000 total births, a significant decrease from 16.3 per 1000 in 2000. Neonatal mortality also declined from 23.6 to 13.5 per 1000 live births during the same period, while infant mortality dropped from 45.0 to 22.5 per 1000 live births. Despite these improvements, spatial analysis showed notable positive spatial autocorrelations for stillbirth, neonatal, and infant mortality rates, indicating that high mortality rates were geographically clustered, particularly in African countries forming hot-spot clusters. Conversely, developed countries in Europe and Asia formed cold-spot clusters characterised by low mortality indicators. Some countries, identified as low-high or high-low clusters, stood out due to dissimilar mortality rates compared to their neighbours, warranting further investigation. Key determinants of mortality rates included the young-age dependency ratio, prevalence of undernourishment, the percentage of women aged 15 and older living with HIV, the incidence of tuberculosis, and the adolescent fertility rate - all of which showed a positive association with higher mortality rates. In contrast, factors such as the use of at least basic sanitation services, mean years of schooling, and government effectiveness had an inverse relationship, contributing to lower mortality rates.</p><p><strong>Conclusions: </strong>By identifying hotspots and outliers, this study highlights the need for targeted health interventions and efficient resource allocation. This approach ensures that efforts are strategic and impactful, focussing on areas with the greatest need.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04034"},"PeriodicalIF":4.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469218","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":"Multimorbidity patterns and influencing factors in older Chinese adults: a national population-based cross-sectional survey.","authors":"Xinyu Xue, Ziyi Wang, Yana Qi, Ningsu Chen, Kai Zhao, Mengnan Zhao, Lei Shi, Jiajie Yu","doi":"10.7189/jogh.15.04051","DOIUrl":"10.7189/jogh.15.04051","url":null,"abstract":"<p><strong>Background: </strong>This study aims to develop specific multimorbidity relationships among the elderly and to explore the association of multidimensional factors with these relationships, thereby facilitating the formulation of personalised strategies for multimorbidity management.</p><p><strong>Methods: </strong>Cluster analysis identified chronic conditions that tend to cluster together, and then association rule mining was used to investigate relationships within these identified clusters more closely. Stepwise logistic regression analysis was conducted to explore the relationship between influencing factors and different health statuses in older adults. The results of this study were presented by network graph visualisation.</p><p><strong>Results: </strong>A total of 15 045 individuals were included in this study. The average age was 73.0 ± 6.8 years. The number of patients with multimorbidity was 7426 (49.4%). The most common binary disease combination was hypertension and depression. The four major multimorbidity clusters identified were the tumour-digestive disease cluster, the metabolic-circulatory disease cluster, the metal-psychological disease cluster, and the age-related degenerative disease cluster. Cluster analysis by sex and region revealed similar numbers and types of conditions in each cluster, with some variations. Gender and number of medications had a consistent effect across all disease clusters, while aging, body mass index (BMI), waist-to-hip ratio (WHR), cognitive impairment, plant-based foods, animal-based foods, highly processed foods and marital status had varying effects across different disease clusters.</p><p><strong>Conclusions: </strong>Multimorbidity is highly prevalent in the older population. The impact of lifestyle varies between different clusters of multimorbidity, and there is a need to implement different strategies according to different clusters of multimorbidity rather than an integrated approach to multimorbidity management.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04051"},"PeriodicalIF":4.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469593","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":"Impact of Ghana's fee exemption policy on maternal health service utilisation: an inverse probability of treatment weighting analysis of pooled national data.","authors":"Kennedy Mensah Osei, Andreana Ayiilaboro Awog-Badek, Danik Iga Prasiska, Durga Datta Chapagain, Min Jin Ha","doi":"10.7189/jogh.15.04058","DOIUrl":"10.7189/jogh.15.04058","url":null,"abstract":"<p><strong>Background: </strong>Fee exemption policies are key strategies for reducing the barriers to accessing maternal health services and improving maternal and child health outcomes. This study used pooled national data to determine the impact of Ghana's user fee exemption policy on maternal health service utilisation since it was implemented in 2008.</p><p><strong>Methods: </strong>Using four rounds of cross-sectional data from national surveys on women with live births, we conducted an inverse probability of treatment weighting analysis to evaluate the causal effects of Ghana's user fee exemption policy intervention on the timing of first antenatal care (ANC) visit, completion of four or more ANC visits and facility-based delivery as indicators of maternal health service utilisation.</p><p><strong>Results: </strong>The average treatment effect of the fee exemption policy was an increase of 8, 9, and 21% in the utilisation of timely first ANC visit, completion of the recommended number of ANC visits, and facility-based delivery, respectively. Wealth index categorisation showed a clear stepwise increase in the likelihood of facility-based delivery. Compared to the poorest group, the odds were 1.48 times higher for the poorer group adjusted odds ratio (aOR) = 1.48 (95% confidence interval (CI) = 1.33-1.66), 2.27 times higher for the middle group aOR = 2.27 (95% CI = 1.95-2.64), 3.84 times higher for the rich group aOR = 3.84 (95% CI = 3.13-4.69), and 5.96 times higher for the richest group aOR = 5.96 (95% CI = 4.43-8.02). Women who reside in the Upper East region were more likely to utilise maternal health services.</p><p><strong>Conclusions: </strong>Ghana's fee exemption policy positively impacts maternal health service utilisation among pregnant women. However, there still exist disparities across geographical regions and wealth indexes.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04058"},"PeriodicalIF":4.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469592","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":"Paediatric healthcare in Manhiça district through a gender lens: a retrospective analysis of 17 years of morbidity and demographic surveillance data.","authors":"Núria Balanza, Aura Hunguana, Sara Ajanovic, Rosauro Varo, Justina Bramugy, Teodimiro Matsena, Tacilta Nhampossa, Dan Ouchi, Arsénio Nhacolo, Jéssica Dalsuco, Antonio Sitoe, Llorenç Quintó, Sozinho Acácio, Ariel Nhacolo, Maria Maixenchs, Khátia Munguambe, Inácio Mandomando, Pedro Aide, Francisco Saúte, Caterina Guinovart, Charfudin Sacoor, Quique Bassat","doi":"10.7189/jogh.15.04010","DOIUrl":"10.7189/jogh.15.04010","url":null,"abstract":"<p><strong>Background: </strong>Sex and gender are important determinants of health. Gender-based health inequities in the paediatric population have been reported in various countries, but data remain limited. In Mozambique, research on this topic is very scarce. Here we aimed to explore whether boys and girls in Manhiça district, southern Mozambique, differ in access to and provision of healthcare.</p><p><strong>Methods: </strong>This retrospective analysis includes data on all paediatric (<15 years old) visits to six outpatient clinics and admissions to one hospital in Manhiça district from 2004 to 2020, collected through the morbidity surveillance system of the Manhiça Health and Demographic Surveillance System (HDSS). We compared characteristics and outcomes between boys and girls using descriptive statistics, standardised mean differences, and logistic regression. Post-discharge events were analysed using Cox proportional hazards regression and Fine-Gray competing risk regression. Minimum community-based incidence rates of outpatient clinic visits and hospitalisations were calculated using demographic surveillance data from the Manhiça HDSS and analysed with negative binomial regression.</p><p><strong>Results: </strong>Girls represented 49.2% (560 630 out of 1 139 962) of paediatric visits to outpatient clinics and 45.1% (18 625 out of 41 278) of hospitalisations. The girls-to-boys incidence rate ratio (IRR) for hospitalisations was 0.81 (95% confidence interval (CI) = 0.79-0.84). Both boys and girls experienced symptoms for a median duration of one day (interquartile range (IQR) = 1-2) before seeking care. Severe manifestations at presentation to an outpatient clinic or upon hospitalisation tended to be less frequent in girls (girls-to-boys odds ratios (ORs) = 0.71-1.11). Girls were less frequently referred or admitted to hospital after an outpatient clinic visit (OR = 0.82; 95% CI = 0.79-0.86 and OR = 0.85; 95% CI = 0.84-0.87, respectively). The hospital case fatality ratio was 4.1% in boys and 4.2% in girls. The median duration of hospitalisation was three days (IQR = 2-5) and did not differ between boys and girls. Revisits to outpatient clinics, hospital readmissions, and hospital post-discharge mortality were similar in both groups.</p><p><strong>Conclusions: </strong>Girls had fewer referrals and admissions to hospital in Manhiça district, but they were also less likely to present with severe manifestations. Other studied indicators of healthcare access and provision were overall similar for boys and girls. Further research is needed to continue assessing potential gender biases and sex differences in paediatric healthcare in Mozambique.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04010"},"PeriodicalIF":4.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469217","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":"Synergising universal health coverage and global health security in the Western Pacific Region.","authors":"Yuhua Lai, Di Liang, Albino Bobogare, Buyanjargal Yadamsuren, Esabelle Yam, Siyan Yi, Hugo Bugoro, Jiayan Huang","doi":"10.7189/jogh.15.04037","DOIUrl":"10.7189/jogh.15.04037","url":null,"abstract":"<p><strong>Background: </strong>Universal health coverage (UHC) and global health security (GHS) should be pursued synergistically to strengthen health systems. However, existing studies found that the efforts toward the two agendas were divergent worldwide. We reviewed the synergy status between UHC and GHS in the Western Pacific Region (WPR) to provide evidence for decision-makers to promote synergy.</p><p><strong>Methods: </strong>We collected the UHC service coverage index (UHC SCI) and the GHS index (GHSI) scores. We created a four-quadrant diagram to discover the gap in UHC and GHS capacities within WPR and divide WPR countries into four groups based on the global mean scores. Further, we adopted global spatial autocorrelation analysis to discover spatial aggregations of high and low scores by calculating Moran's I. In addition, we conducted a correlation analysis to assess the synergy level in WPR and reveal the gap between Pacific Island countries or territories (PICTs) and non-PICTs. We conducted key informant interviews to uncover actual scenarios and address gaps in the quantitative evidence.</p><p><strong>Results: </strong>Compared to the global mean UHC SCI and GHSI scores, nine out of 13 non-PICTs had higher scores, while all 14 of the PICTs had lower scores for both indexes. The Moran's I for WPR countries' UHC SCI and GHSI scores in 2021 were 0.20 and 0.23, respectively (Z-score >2.58; P < 0.01). The correlation coefficients between the two index scores were 0.722 (P < 0.001) at the global level and 0.869 (P < 0.001) at WPR. Within the WPR, the correlation coefficients were 0.859 (P < 0.001) in the non-PICTs and -0.026 (P > 0.05) in the PICTs.</p><p><strong>Conclusions: </strong>The synergy level between UHC and GHS was high in the WPR, but this mainly came from the synergy in the non-PICTs. The two agendas have barely synergised the PICTs. To build a safer and healthier WPR, it is important to pay more attention to the countries that have weaker health capacities in the region and narrow the gap.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04037"},"PeriodicalIF":4.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416008","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":"Building an effective coverage cascade for antenatal care: linking of household survey and health facility assessment data in eight low- and middle-income countries.","authors":"Safia S Jiwani, Saqib Rana, Elizabeth A Hazel, Abdoulaye Maïga, Emily B Wilson, Agbessi Amouzou","doi":"10.7189/jogh.15.04048","DOIUrl":"10.7189/jogh.15.04048","url":null,"abstract":"<p><strong>Background: </strong>Substantial gaps exist between pregnant women's contact with health facilities and the quality of care they receive (effective coverage) in low- and middle-income countries (LMICs). An effective coverage cascade is a useful analytical approach to uncover gaps due to poor facility service readiness and quality of care. We estimated readiness-adjusted antenatal care (ANC) coverage and built an effective coverage cascade in countries with available data.</p><p><strong>Methods: </strong>We used data from latest household and health facility surveys in eight countries accounting for 28 925 women and 8621 facilities. Service readiness was assessed based on the availability of core items needed to provide quality ANC. We linked the household surveys with health facility data by subnational region and facility type to estimate readiness-adjusted ANC coverage for at least one, four, and eight or more ANC contacts and ANC content. We built a four-step ANC effective coverage cascade and calculated loss of coverage in terms of ANC readiness coverage gaps and missed opportunities.</p><p><strong>Results: </strong>The majority of women sought ANC services in lower-level facilities, except in Bangladesh, Nepal and Senegal. While at least one antenatal care contact (ANC1+) service coverage was high, ranging from 89.2% (95% confidence interval (CI) = 87.2-90.9) in Haiti to 98.1% (95% CI = 97.5-98.6) in Malawi, readiness-adjusted ANC1+ coverage was lower, ranging from 64% (95% CI = 62.4-65.5) in Haiti to 76.2% (95% CI = 75.1-77.2) in Nepal. We obtained readiness gaps as high as 33.7 percentage points in Malawi and missed opportunities of 21 percentage points in Tanzania. Poor diagnostic capacity and insufficient trained human resources drove the low ANC facility readiness. We found large inequalities in readiness-adjusted ANC1+ by socioeconomic status favouring wealthier and urban resident women.</p><p><strong>Conclusions: </strong>The effective coverage cascade for ANC services helped uncover large readiness gaps, missed opportunities, and socioeconomic inequalities. Improvements in facilities' diagnostic capacity and availability of trained human resources will enhance their ability to provide high quality health services and ensure health gains.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04048"},"PeriodicalIF":4.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415940","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":"Delivering remote pulmonary rehabilitation in Bangladesh: a mixed-method feasibility study.","authors":"G M Monsur Habib, Nazim Uzzaman, Roberto Rabinovich, Sumaiya Akhter, Mustari Sultana, Mohsin Ali, Hilary Pinnock","doi":"10.7189/jogh.15.04002","DOIUrl":"10.7189/jogh.15.04002","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary rehabilitation (PR) is an effective and essential component of care for the increasing number of individuals with chronic respiratory diseases (CRDs). Despite the benefits, it remains underutilised and poorly accessible in low- and middle-income countries (LMICs). We aimed to determine the feasibility of delivering PR in Bangladesh at home because of pandemic travel restrictions.</p><p><strong>Methods: </strong>Aligned with the Medical Research Council framework of development and evaluation of complex interventions, we recruited individuals with CRDs from the Community Respiratory Centre, Khulna, to a mixed-methods feasibility study. We assessed their functional exercise capacity and quality of life before and after an eight-week course of home PR, and conducted semi-structured interviews with PR providers and professional stakeholders by using a topic guide aligned with the normalisation process theory (NPT) and interpreting the findings within its constructs.</p><p><strong>Results: </strong>We recruited 51 out of 61 referred patients with a range of CRDs, of whom 44 (86%) completed ≥70% of their home PR course. Functional exercise capacity, measured by the endurance shuttle walk test, improved in 78% of patients, with 48% exceeding the minimum clinically important difference (MCID). Health-related quality of life, measured by the Chronic Obstructive Pulmonary Disease Assessment Test, improved by more than the MCID in 83% of patients. Through the interviews, we found that PR providers encountered challenges in remote video supervision due to unstable internet connections, forcing them to resort to telephone calls. The strength of support for NPT constructs varied; many participants understood and appreciated the role of PR and could make sense of the innovation (NPT-1), and most were assessing the potential of a PR service in Bangladesh to decide if it was worthwhile (NPT-4). Participants were not yet ready to endorse or actively support (NPT-2) or operationalise (NPT-3) the roll-out of PR.</p><p><strong>Conclusions: </strong>A home PR programme, supported by remote supervision and monitoring, is feasible in Bangladesh, but local evidence will be needed to promote implementation.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04002"},"PeriodicalIF":4.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415993","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 impact of integrating medical oxygen indicators into DHIS-2 on the reporting of hypoxaemia diagnosis and management: the case of Cameroon.","authors":"Yauba Saidu, Clarence Mbanga, Ngassa Andinwoh, Andreas Frambo, Ousmane Diaby, Rogers Ajeh, Audrey Battu, Zakary Katz","doi":"10.7189/jogh.15.04088","DOIUrl":"10.7189/jogh.15.04088","url":null,"abstract":"<p><strong>Background: </strong>Between 2021 and 2023, the Cameroon Ministry of Public Health, with support from the Clinton Health Access Initiative (CHAI), made considerable investments in establishing a reliable medical oxygen system in Cameroon. To monitor the impact of said investments, medical oxygen indicators were identified and integrated into the country's health information management system. This integration aimed to enhance the collection, reporting, and analysis of medical oxygen data, ultimately improving decision-making regarding oxygen needs, procurement volumes, and patient referrals based on real-time data on the availability of oxygen supplies. Here we outline the integration approach and assess its impact on medical oxygen reporting one year post-investment.</p><p><strong>Methods: </strong>We adopted an iterative, consultative approach involving multiple meetings and workshops with all key stakeholders to define medical oxygen indicators and their technical specifications, develop the necessary data collection forms and guides, pre-test the defined indicators, review and validate them, and finally integrate them into the District Health Information System 2 (DHIS-2). Following integration, we rolled out the indicators within DHIS-2 nationwide using a two-step process, beginning with cascaded training of regional- and district-level data managers on the reporting of medical oxygen indicators into DHIS-2, and followed by supervision and mentoring. We assessed the impact of this rollout by comparing reporting rates on medical oxygen use before and after the integration and training process.</p><p><strong>Results: </strong>We validated 15 indicators and integrated them into the DHIS-2, and we trained 218 regional- and district-level data managers from eight of the country's ten regions on leveraging the defined indicators to capture data on medical oxygen use and hypoxaemia management at the facility and input it into the system. We observed a 23% absolute increase in the completeness of medical oxygen reports, with rates rising from 3% in December 2022 (pre-intervention) to 26.2% in December 2023 (one year post-intervention). We also noted a considerable increase in the reporting of case management, with, for instance, the number of newborns diagnosed with hypoxaemia rising from zero pre-integration and training to 213 by March 2024.</p><p><strong>Conclusions: </strong>Integration of medical oxygen indicators into DHIS-2, along with staff training, improved reporting rates for medical oxygen use and hypoxaemia management. Continuous support and infrastructure upgrades are needed to sustain investment.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04088"},"PeriodicalIF":4.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416016","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}