Journal of Global Health最新文献

{"title":"'Leave no one behind': cochlear implantation under regional anaesthesia in a humanitarian setting - a case series.","authors":"Isra Aljazeeri, Mohammad F Alzahrani, Roa Talal Halawani, Hazem Ibrahim Shoukry, Ahmad M Aldhafeeri, Ibrahim Shami, Abdulrahman Hagr","doi":"10.7189/jogh.16.04342","DOIUrl":"10.7189/jogh.16.04342","url":null,"abstract":"<p><strong>Background: </strong>Cochlear implantation (CI) is the standard of care for severe-to-profound hearing loss. While traditionally performed under general anaesthesia (GA), GA poses significant logistical and safety challenges during humanitarian missions in low-resource settings, often excluding patients with complex medical comorbidities. Regional anaesthesia (RA) offers a practical alternative that avoids GA-related risks, reduces operative time, and allows treatment for otherwise ineligible patients, upholding the humanitarian principle of 'leaving no one behind'. Therefore, the objective of the study is to report the feasibility, safety, and outcomes of cochlear implantation performed under regional anaesthesia during humanitarian missions, with the implementation of early activation protocols.</p><p><strong>Methods: </strong>This case series includes eight patients (age range 20-66 years) of Palestinian, Somali, and Senegalese nationality who underwent cochlear implantation under regional anaesthesia during humanitarian missions conducted in Jordan (serving Palestinian patients), Kenya (serving Somali patients), and Senegal (serving Senegalese patients) in April and December 2025.</p><p><strong>Results: </strong>All eight procedures were successfully completed under regional anaesthesia without conversion to general anaesthesia. The diverse case mix included medically complex patients and challenging surgical anatomy. Early activation was achieved in all cases.</p><p><strong>Conclusions: </strong>Regional anaesthesia enables cochlear implantation in medically complex patients who cannot undergo general anaesthesia - including those with failed intubation or high cardiac risk - while allowing intraoperative or immediate postoperative activation, ensuring no one is left behind in humanitarian missions. Early activation protocols are achievable with logistical efficiency in resource-limited environments.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04342"},"PeriodicalIF":5.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931737","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":"Epidemiologic trends and mortality in nontuberculous mycobacterial lung disease: a nationwide cohort study in Taiwan (2011-2020).","authors":"Chih-Hao Chang, Yu-Feng Wei, Ping-Huai Wang, Sheng-Wei Pan, Su-Mei Wang, Chin-Hao Chang, Chin-Chung Shu","doi":"10.7189/jogh.16.04292","DOIUrl":"10.7189/jogh.16.04292","url":null,"abstract":"<p><strong>Background: </strong>Nontuberculous mycobacterial lung disease (NTM-LD), a condition characterised by a heterogeneous course and complex multidrug treatment, is becoming an increasingly prevalent global health concern. Given that population-based data on real-world management and outcomes are limited, we aimed to characterise nationwide trends in treatment initiation, real-world treatment courses, and cause-specific mortality among patients treated for NTM-LD, as well as identify factors associated with three-year mortality.</p><p><strong>Methods: </strong>In this retrospective cohort study, we identified patients in Taiwan's National Health Insurance Research Database who had been newly diagnosed with NTM-LD between July 2011 and December 2020 based on diagnostic ICD codes. All identified cases served as the numerator for incidence estimation; the treated NTM-LD cohort comprised patients initiating a multidrug anti-NTM regimen sustained for at least 28 days. The primary outcome was three-year all-cause mortality, ascertained through the national death registry. We used multivariable Cox proportional hazards regression to estimate adjusted hazard ratios and 95% confidence intervals for mortality risk factors.</p><p><strong>Results: </strong>Among 15,589 patients diagnosed with NTM-LD, 3,762 received anti-NTM treatment and comprised the treated NTM-LD cohort. The incidence of NTM-LD increased from 5.4 to 8.9 per 100,000 person-years between 2012 and 2019. The median treatment duration was 158 days. The three-year mortality rate was 19.4%, with cancer, chronic airway diseases, and pneumonia being the leading causes of death. Being aged ≥65 years; male; having chronic respiratory failure, cancer, heart failure, chronic obstructive pulmonary disease, or idiopathic pulmonary fibrosis; being hospitalised (the strongest factor, adjusted hazard ratio = 3.70), and receiving intravenous antibiotic treatment were independently associated with three-year mortality.</p><p><strong>Conclusions: </strong>Our findings point to an increasing burden of treated NTM-LD in Taiwan and a substantial three-year mortality rate. Older age and multiple comorbidities were independently associated with mortality. These findings should be interpreted with caution because cases were defined without microbiologic or radiographic confirmation, and untreated individuals were excluded.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04292"},"PeriodicalIF":5.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945939","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":"Exploring mortality patterns in Pakistani children and adolescents aged 5-19: evidence from a national verbal and social autopsy study.","authors":"Sajid Bashir Soofi, Imran A Chauhadry, Sidrah Nausheen, Enas Mariam, Muhammad Umer, Shanila Nooruddin, Muhammad Atif Habib, Arjumand Rizvi, Henry D Kalter, Robert E Black, Zulfiqar A Bhutta","doi":"10.7189/jogh.16.04195","DOIUrl":"10.7189/jogh.16.04195","url":null,"abstract":"<p><strong>Background: </strong>While under-five mortality has declined by approximately 50% globally since 2000, mortality among older children and adolescents has fallen by only 31% since 1990. The age group 5-19-year-olds constitute over a third of Pakistan's population, yet estimates of mortality in this population, which are necessary for identifying preventable causes of death and developing interventions to improve health outcomes, have been limited. We aimed to investigate cause-specific mortality in children aged ≥5 years using verbal and social autopsy (VASA) to identify patterns and health risks across these age groups.</p><p><strong>Methods: </strong>We used the multistage stratified cluster sampling frame of the Pakistan National Nutrition Survey 2018, which covered 115,600 households from urban and rural areas. Through retrospective mortality surveillance, we identified 1,322 deaths among 5-19-year-olds in these households in the preceding three years. We then obtained data on their deaths from the household members through VASA interviews, after which a trained paediatrician and two computerised methods assigned specific causes of death to each case.</p><p><strong>Results: </strong>We completed VASA interviews for 1,322 deaths, out of which 29.8% were among children aged 5-9 years, 24.4% among young adolescents (10-14 years), and 45.8% among older adolescents (15-19 years). Overall mortality was higher among males (59%) than females (41%). Infectious diseases, non-communicable diseases (NCDs), and accidents/injuries were the three main causes of death, with the contribution of infectious diseases declining, and that of NCDs and injuries increasing with age. Maternal causes, particularly obstetric complications, contributed significantly to mortality among female adolescents.</p><p><strong>Conclusions: </strong>We found age- and gender-based differences in mortality causes among the 5-19-year population in Pakistan. Targeted efforts are needed to sustain the gains achieved among the under-five population by extending mortality reduction strategies that focus on age-specific risks for older children and adolescents.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04195"},"PeriodicalIF":5.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945875","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":"Understanding stillbirths and maternal deaths in Pakistan: evidence from a national household survey.","authors":"Sidrah Nausheen, Shabina Ariff, Muhammad Umer, Zainab Qadir, Shanila Nooruddin, Muhammad Atif Habib, Arjumand Rizvi, Ahmad Khan, Imran A Chauhadry, Henry D Kalter, Sajid Bashir Soofi, Robert E Black, Zulfiqar A Bhutta","doi":"10.7189/jogh.16.04193","DOIUrl":"10.7189/jogh.16.04193","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The global impact of stillbirths and maternal deaths is enormous, with over two million deaths occurring each year, affecting public health outcomes and global development practices. Despite Pakistan's commitment to the Sustainable Development Goals, the country faces a substantial burden of stillbirths and maternal deaths. However, data on cause-specific mortality and the timing of deaths remains limited. In this context, we aimed to estimate the cause distribution and proportion of stillbirths (antepartum and intrapartum) and maternal deaths among married women aged 12-49 years in Pakistan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a cross-sectional household survey with retrospective ascertainment in urban and rural households from all four provinces of Pakistan (Sindh, Punjab, Balochistan, and Khyber Pakhtunkhwa) and three administrative regions (Gilgit Baltistan, Azad Jammu and Kashmir, and the Islamabad Capital Territory) using the sampling frame of the Pakistan National Nutrition Survey 2018. For the cause of death estimation, we calculated a target sample size of 2,100 stillbirths, allocated to provinces and regions in proportion to the population. Maternal deaths were ascertained using the same household enumeration and selection process. The mortality survey questionnaire collected information on births, stillbirths, and maternal deaths, while a Verbal and Social Autopsy questionnaire was used to assess causes of death. Following extensive training, the study teams conducted fieldwork to interview households with identified deaths. Data were captured electronically in the field to enable continuous quality control and remote monitoring. Causes of death were assigned both by trained physicians (physician-certified verbal autopsy) and by two computer-coded methods (InterVA-5 and InSilicoVA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We recorded 2,076 stillbirths and 848 maternal deaths from the identified households during the 2017-2018 study period. The overall rate of stillbirth at the country level was 30.5 per 1,000 total births, while the maternal mortality ratio was 176.2 per 100,000 live births, with higher rates observed in rural areas. The leading causes of death for both stillbirths and maternal deaths were generally similar, including pregnancy-induced hypertension, obstetric haemorrhage, sepsis, and obstructed labour. Delays in seeking and accessing care, both for stillbirths and maternal deaths, resulted from issues in the identification of illness severity, decision-making, transportation issues, and delayed provision of health care once reaching a provider.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The high stillbirth (30.5 per 1,000 births) and maternal mortality (176 per 100,000 live births) rates we observed exceed Pakistan's national targets and the Sustainable Development Goals 2030 targets. Persistent inequities, particularly in rural Balochistan and Khyber Pakhtunkhwa, are driven by delays in recog","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04193"},"PeriodicalIF":5.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945944","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":"Extreme wealth loss and subsequent mental well-being among adults aged ≥50 years: a multicohort study.","authors":"Ke Peng, Minzhi Xu, Yun Liu, Yanhong Gong","doi":"10.7189/jogh.16.04156","DOIUrl":"10.7189/jogh.16.04156","url":null,"abstract":"<p><strong>Background: </strong>The association of extreme wealth loss with subsequent mental well-being in later life, as well as whether this association varies across countries with different levels of economic development, remains unclear.</p><p><strong>Methods: </strong>Our study included 23,817 participants, of which 3282 were from the China Health and Retirement Longitudinal Study (2011-2018), 11,838 from the Health and Retirement Study (2008-2019), and 8697 from the Mexican Health and Aging Study (2012-2019). Extreme wealth loss in our study is defined as a net wealth decline of 75% or more between the first two waves. Mixed-effects linear regression models were employed to examine the associations.</p><p><strong>Results: </strong>In the fully adjusted models, extreme wealth loss was associated with higher depressive symptoms (odds ratio (OR) = 1.3; 95% confidence interval (CI) = 1.2-1.4 for China, OR = 1.3; 95% CI = 1.2-1.3 for USA, and OR = 1.1; 95% CI = 1.0-1.1) for Mexico); lower life satisfaction (OR = 0.8; 95% CI = 0.7-0.9) for China, OR = 0.8; 95% CI = 0.7-0.8) for USA, OR = 0.9; 95% CI = 0.9-1.0 for Mexico) and worse self-reported health (OR = 0.9; 95% CI = 0.8-0.9 for China, OR = 0.9; 95% CI = 0.8-0.9 for USA, OR = 1.0; 95% CI = 0.9-1.1 for Mexico). Predicted standardised scores showed that the negative association between extreme wealth loss and mental well-being remained unchanged over time in China and Mexico. In the USA, we observed a significant interaction between exposure groups and follow-up time.</p><p><strong>Conclusions: </strong>Public health policy formulation should target populations experiencing significant wealth loss and provide them with stable economic security to effectively enhance mental health outcomes.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04156"},"PeriodicalIF":5.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931752","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":"Revolutionising healthcare access: student-led clinics as catalysts for change in an underserved urban community in Karachi, Pakistan.","authors":"Syed Muhammad Aqeel Abidi, Ali Hyder Nazeer, Bilal Lodhi, Syeda Kainat Fatima, Fatima Abdullah, Muhammad Ali Akbar Khan, Maheen Zakaria, Ali Azan Ahmed, Aly Hamza Khowaja","doi":"10.7189/jogh.16.04262","DOIUrl":"10.7189/jogh.16.04262","url":null,"abstract":"<p><strong>Background: </strong>Karachi, Pakistan's largest metropolitan city, faces profound healthcare disparities, with an estimated 45-49% of the population residing in underserved informal settlements. Within these communities, the primary healthcare system is not merely under-resourced but structurally fractured, leaving patients to navigate prohibitively expensive private providers or overcrowded public hospitals. To address these systemic gaps, the Humanity Initiative, a student-led non-governmental organisation, implemented student-led clinics (SLCs) as a community-embedded, cost-effective model to bridge critical care deficits.</p><p><strong>Methods: </strong>We conducted a descriptive study examining the implementation and early outcomes of two SLCs conducted in Agra Taj Colony, Lyari Town, Karachi. Operating every three weeks under licensed physician supervision, each SLC provided free primary consultations, dispensed essential medications, and delivered structured health education. We analysed patient demographics, disease burden, operational costs, and process-level indicators across both clinic cycles.</p><p><strong>Results: </strong>A total of 371 patients were seen across SLC1 (n = 194) and SLC3 (n = 177), with a higher proportion of female patients (n = 224, 60.4%). The disease burden was dominated by non-communicable diseases, including hypertension (14.3%) and diabetes (8.6%), alongside a notable number of acute infections and multi-system complaints reflecting the dual epidemiological burden characteristic of urban low- and middle-income country (LMIC) settings. Operational costs were maintained at PKR 128-136 (USD 0.45-0.48) per patient, demonstrating exceptional cost-efficiency. We found significant gaps in health literacy, particularly regarding chronic disease self-management, and gendered barriers to healthcare access.</p><p><strong>Conclusion: </strong>The SLC model demonstrates proof-of-concept as a viable, scalable strategy for bridging structural gaps in fractured primary healthcare systems in LMICs. By embedding care within the community, SLCs advance Universal Health Coverage, rebuild community trust in allopathic medicine, and provide supervised experiential learning opportunities for future healthcare professionals. Replication of this model across similar underserved communities holds significant potential for reducing healthcare inequity in resource-constrained urban settings.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04262"},"PeriodicalIF":5.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945884","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":"Oral amoxicillin for management of fast breathing or chest indrawing pneumonia without danger signs in children aged 2-59 months: a systematic review and meta-analysis.","authors":"Barsha Gadapani Pathak, Yasir Bin Nisar, Uma Chandra Mouli Natchu, Rukman Manapurath, Archana Thakur, Pranay Vats, Temsunaro Rongsen Chandola, Bireshwar Sinha","doi":"10.7189/jogh.16.04209","DOIUrl":"10.7189/jogh.16.04209","url":null,"abstract":"<p><strong>Background: </strong>World Health Organization (WHO) guidelines recommend oral amoxicillin as first-line therapy for pneumonia in children aged 2-59 months. However, uncertainty remains regarding its effectiveness compared with no antibiotics for fast breathing pneumonia and with injectable antibiotics for chest indrawing pneumonia without danger signs.</p><p><strong>Methods: </strong>We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (January 2000-August 2024) for randomised and quasi-randomised trials without language restrictions. Eligible studies compared oral amoxicillin vs. no antibiotics for fast breathing pneumonia or outpatient oral amoxicillin vs. inpatient injectable antibiotics for chest indrawing pneumonia without danger signs in children (2-59 months). Pooled relative risks (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model; certainty was assessed using GRADE.</p><p><strong>Results: </strong>Four trials (n = 7,699) compared oral amoxicillin with no antibiotics for fast breathing pneumonia, and three (n = 4,864) compared oral with injectable antibiotics for chest indrawing pneumonia. For fast breathing pneumonia, oral amoxicillin reduced treatment failure by 16% at day 14 (RR = 0.84; 95% CI = 0.75, 0.94, I² = 0%; moderate certainty). For chest indrawing pneumonia, treatment failure was similar between groups at day 6 (RR = 0.96; 95% CI = 0.83, 1.11) and day 14 (RR = 0.94; 95% CI = 0.79, 1.13), while mortality was 72% lower with oral amoxicillin (RR = 0.28; 95% CI = 0.09, 0.86). Serious adverse events did not differ between groups.</p><p><strong>Conclusions: </strong>In children (2-59 months), oral amoxicillin significantly reduces treatment failure compared to no antibiotics for fast breathing pneumonia and is comparable to injectable antibiotics for chest indrawing pneumonia without danger signs. Notably, oral amoxicillin was associated with a 72% reduction in mortality compared with injectable antibiotics in children with chest-indrawing pneumonia, although absolute risk differences were small. These findings support its broader implementation as an accessible, programmatically feasible, and WHO-recommended option for pneumonia management in low-resource settings.</p><p><strong>Registration: </strong>PROSPERO: CRD42023439851.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04209"},"PeriodicalIF":5.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945893","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":"Rates and causes of neonatal and under-five mortality: insights from a national household survey in Pakistan.","authors":"Asma Abdul Malik, Shabina Ariff, Muhammad Umer, Shanila Nooruddin, Muhammad Atif Habib, Arjumand Rizvi, Imran A Chauhadry, Sajid Bashir Soofi, Henry D Kalter, Robert E Black, Zulfiqar A Bhutta","doi":"10.7189/jogh.16.04211","DOIUrl":"10.7189/jogh.16.04211","url":null,"abstract":"<p><strong>Background: </strong>Neonatal and under-five mortality rates are critical indicators of a country's health status and progress toward Sustainable Development Goals. Despite a decline in mortality rates globally, preventable child deaths continue to occur, particularly in Pakistan, which has one of the highest child mortality rates in the world. In this analysis, we present the latest cause-specific neonatal and under-five mortality estimates determined through verbal and social autopsy (VASA) procedures in a population-based household survey across Pakistan.</p><p><strong>Methods: </strong>We used a household survey based on the Pakistan National Nutrition Survey sampling frame, which covered 115 600 households in both urban and rural areas. We identified 3880 neonatal and post-neonatal under-five deaths within the three years prior to the survey. The VASA interviews were conducted in households where deaths were reported. We determined the causes of death using the computerised InterVA-5, InSilicoVA, and Expert Algorithm VA methods and the physician-certified VASA method, utilising thorough reviews by verbal autopsy-trained paediatric and obstetric physicians.</p><p><strong>Results: </strong>Neonatal mortality was estimated at 39.8 per 1000 live births (95% confidence interval (CI) = 39.3-40.3), with higher rates in rural (40.8; 95% CI = 40.2-41.4) compared to urban areas (37.3; 95% CI = 36.5-38.1). Post-neonatal under-five mortality was 35.9 per 1000 live births (95% CI = 35.4-36.4) and was also higher in rural (36.8; 95% CI = 36.2-37.4) than in urban areas (33.6; 95% CI = 32.6-34.5). The major causes of neonatal death included preterm birth complications, birth asphyxia, and infectious diseases. For post-neonatal under-five mortality, the leading causes were infectious diseases, diarrheal disorders, and pneumonia.</p><p><strong>Conclusions: </strong>Our findings highlight the persistent burden and disparities in neonatal and under-five mortality across urban and rural areas in Pakistan. Targeted interventions are essential to address these preventable deaths and reduce mortality rates in high-risk populations.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04211"},"PeriodicalIF":5.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945949","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 verbal and social autopsy study to improve estimates of mortality determinants in Pakistan: study design and methods.","authors":"Imran A Chauhadry, Sajid Bashir Soofi, Muhammad Atif Habib, Arjumand Rizvi, Ahmad Khan, Kanza Naqvi, Henry D Kalter, Robert E Black, Zulfiqar A Bhutta","doi":"10.7189/jogh.16.05004","DOIUrl":"10.7189/jogh.16.05004","url":null,"abstract":"<p><strong>Background: </strong>Reducing newborn, child, adolescent, and maternal mortality is a global priority, yet Pakistan continues to bear a high burden of preventable deaths. Routine civil registration does not capture causes or social determinants for most of these deaths. The verbal and social autopsy (VASA) methodology fills this gap by combining symptom-based identification of the cause of death with structured assessment of social and care-seeking factors. Here we describe the methodological framework of a national VASA study conducted using the Pakistan National Nutrition Survey 2018 sampling frame, designed to estimate cause-specific mortality and social determinants of stillbirths and neonatal, post-neonatal, adolescent, and maternal deaths.</p><p><strong>Methods: </strong>We used the sampling frame of the Pakistan National Nutrition Survey 2018 and employed VASA techniques to identify biological causes and social determinants of stillbirths, neonatal, child, adolescent, and maternal deaths. By utilising adapted VASA tools and rigorous analytical methods, we sought to bridge the gap between health systems and mortality data by examining deaths that occurred in and outside of healthcare facilities. Our aim was to provide insights into preventable deaths to guide public health interventions and policymaking, such as integrating VASA into the national survey and building the capacity of community-level healthcare workers to conduct VASA.</p><p><strong>Conclusions: </strong>This study provides a vital contribution to improving health outcomes and reducing mortality in low- and middle-income countries by integrating sociocultural and systemic factors into mortality analysis.</p><p><strong>Keywords: </strong>verbal and social autopsy, cause of death, VASA methodology, Pakistan.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"05004"},"PeriodicalIF":5.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945930","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":"Unmasking bias in the evidence ecosystem: a panoramic analysis of 311,751 meta-analyses using an artificial intelligence agent-based approach.","authors":"Xi Chen, Zhenghang She, Shiqi Yang, Ming Chu, Yixin Zhou","doi":"10.7189/jogh.16.03029","DOIUrl":"10.7189/jogh.16.03029","url":null,"abstract":"<p><p>Traditional secondary meta-analysis workflows are highly labour-intensive, time-consuming, and difficult to update in real time. Currently, there is a lack of comprehensive artificial intelligence frameworks capable of automating the entire meta-analysis workflow, including literature screening, data extraction, and quality assessment. Furthermore, a large-scale structured database for systematically analysing the global landscape of published meta-analyses remains unavailable. In this viewpoint, we aimed to evaluate the feasibility of large language models in automating meta-analysis workflows and develop the Meta-Analysis Screening, Transformation and Evaluation Review Agent (MASTER) agent; establish a large-scale Unified Meta-Analysis Repository (UMAR) and perform an exploratory panoramic analysis of the current evidence ecosystem; and develop an Agent-based Secondary Meta-analysis Platform (ASAP), integrating these capabilities. We subsequently applied the agent to process 311,751 meta-analysis records to establish the UMAR database. Building upon these resources, we developed the ASAP platform to support multimodal, automated meta-analysis workflows. In benchmark evaluations, the MASTER agent demonstrated high accuracy and stability in performing core automated meta-analysis tasks. The ASAP platform enabled automated literature retrieval, quality assessment, data extraction, and visualisation generation through predefined workflows. Here, we provide an initial exploration of the technical feasibility and scalability of artificial intelligence-driven automated meta-analysis.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"03029"},"PeriodicalIF":5.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888354","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}