Journal of Global Health最新文献

{"title":"HLA-B*58:01 screening in Asia-Pacific is an ethical imperative - not just a cost question.","authors":"Wei Leik Ng, Emily Tsui Yee Tse, Prawira Oka, Hooi Min Lim, Sky Wei Chee Koh, Rizawati Ramli, Hung Chiun Lau, Benjamin Chih Chiang Lam, Laurie J Goldsmith, Adina Abdullah, Lay Hoon Goh","doi":"10.7189/jogh.15.03037","DOIUrl":"https://doi.org/10.7189/jogh.15.03037","url":null,"abstract":"<p><p>Allopurinol remains the first-line treatment for gout; however, it carries a risk of severe cutaneous adverse reactions (SCARs), particularly among carriers of the HLA-B*58:01 allele. In the Asia-Pacific region, screening practices vary widely due to infrastructure gaps, cost concerns, and differing health policies. For example, while cost-effectiveness analyses have influenced screening decisions in some countries, they often overlook long-term health system burdens and ethical imperatives. Therefore, screenings should not be withheld solely on economic grounds, especially when they can prevent life-threatening outcomes. For that reason, a targeted, risk-based approach that integrates genetic and clinical factors could offer a practical and equitable path forward, improving pharmacogenomic literacy, expanding access to testing, developing regional data-sharing platforms, and involving patients in co-designing screening strategies. Rapid point-of-care testing and integration of screening process with existing care pathway may further support this implementation. However, a coordinated regional effort is needed to ensure safer prescribing and equitable access to pharmacogenomic screening across diverse healthcare settings.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"03037"},"PeriodicalIF":4.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975316","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":"Educational and economic disparities and risk factors associated with diabetes and impaired fasting glucose in Cambodia: analysis of a national population-based study.","authors":"Rei Haruyama, Md Shafiur Rahman, Md Mahfuzur Rahman, Sam Ath Khim, Ada Moadsiri, Savina Chham, Srean Chhim, Hero Kol, Maly Phy","doi":"10.7189/jogh.15.04251","DOIUrl":"https://doi.org/10.7189/jogh.15.04251","url":null,"abstract":"<p><strong>Background: </strong>In this study, we aimed to quantify the magnitude of educational and economic disparities and examine risk factors associated with diabetes and impaired fasting glucose in Cambodia.</p><p><strong>Methods: </strong>We used data from the 2023 STEPwise approach to noncommunicable risk factor surveillance to analyse 3660 participants aged 18-69 years. We quantified the extent of disparities using the regression-based slope index of inequality (SII) and relative index of inequality (RII). We used multi-level modified Poisson regression models to identify the potential risk factors.</p><p><strong>Results: </strong>Overall, the prevalence of diabetes and impaired fasting glucose was 6.4% (95% confidence interval (CI) = 5.6, 7.3) and 4.4% (95% CI = 3.6, 5.3). The magnitude of educational inequality in the prevalence of diabetes was significant, with the disease more concentrated among the non-educated population (SII = -7.6; 95% CI = -12.0, -3.3). Economic inequality in diabetes prevalence was less pronounced than education-based inequality at the national level (SII = -0.7; 95% CI = -4.5, 3.0); however, rural areas showed a concentration of diabetes among economically disadvantaged groups (SII = -4.7; 95% CI = -9.1, -0.3). Key factors associated with diabetes were advanced age ≥40 years, overweight (prevalence ratio (PR) = 1.4; 95% CI = 1.0, 2.0), obesity (PR = 1.7; 95% CI = 1.1, 2.5), comorbid hypertension (PR = 2.4; 95% CI = 1.8, 3.1), and daily alcohol consumption (PR = 2.0; 95% CI = 1.2, 3.3). Daily sugar-sweetened beverage consumption (PR = 1.8; 95% CI = 1.1, 3.1) also showed an increased risk of undiagnosed diabetes.</p><p><strong>Conclusions: </strong>The significant educational and economic disparities underscore the need for targeted interventions aimed at supporting non-educated and economically poor populations. Strengthening public health measures to address key risk factors, particularly alcohol and sugar-sweetened beverage consumption, is essential to curbing the growing burden of diabetes in Cambodia.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04251"},"PeriodicalIF":4.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975338","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":"What opportunities exist for the governance of private sector engagement in mixed health systems in the African Region?","authors":"Michelle Amri, Omar Sam, Muriel Anye, Zandile Zibwowa, Humphrey Cyprian Karamagi, Juliet Nabyonga-Orem","doi":"10.7189/jogh.15.03038","DOIUrl":"https://doi.org/10.7189/jogh.15.03038","url":null,"abstract":"<p><p>Given the significant role of private actors in health across the African Region, there is a need to interrogate how private sector engagement (PSE) is governed. We identify three key opportunities for strengthening the governance of PSE in mixed health systems in the African Region. This work draws on a programme of activities conducted by the World Health Organization Regional Office for Africa, including a multi-country stakeholder survey, a regional meeting with participants from the public and private sectors, and a descriptive case study of the governance environment. We draw on a governance framework focused on three governance inputs - participation, consensus orientation, and strategic vision and policy design - to present opportunities. First, participation can be strengthened by formalising mechanisms for dialogue and consultation, creating partnerships, and defining roles and responsibilities. Second, better consensus orientation can be sought through aligning sectoral goals, such as through deploying champions and improving understandings of health equity. Third, strategic vision and policy design can be advanced by better integrating the private sector into mixed health systems. Integration can improve both data sharing in national health information systems and oversight. Moving forward, addressing how health equity can be re-centred and improving collaboration across sectors are essential.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"03038"},"PeriodicalIF":4.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974969","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":"Differential risk and clinical characteristics of placenta accreta spectrum in twin and singleton pregnancies: implications for perinatal outcomes.","authors":"Wei-Zhen Tang, Kang-Jin Huang, Xia Li, Qin-Yu Cai, Ying-Xiong Wang, Hong-Yu Xu, Li Wen, Lan Wang, Tai-Hang Liu","doi":"10.7189/jogh.15.04252","DOIUrl":"https://doi.org/10.7189/jogh.15.04252","url":null,"abstract":"<p><strong>Background: </strong>This study compares the prevalence of placenta accreta in singleton and twin pregnancies and examines its impact on adverse perinatal outcomes, exploring whether twin gestation increases the risk of poor outcomes in placenta accreta cases.</p><p><strong>Methods: </strong>A multivariate logistic regression analysis assessed the link between twin pregnancy and placenta accreta, comparing associated adverse perinatal outcomes in twin vs. singleton pregnancies. Stratified and interaction analyses explored clinical characteristics' relationship with placenta accreta. The Restrictive Cubic Spline (RCS) model evaluated the impact of placenta accreta on caesarean section and postpartum haemorrhage at different gestational ages. A comparative analysis examined clinical features and perinatal outcomes between twin and singleton pregnancies with placenta accreta. Finally, mediation analysis was used to determine if placenta accreta mediates the effect of twin gestation on caesarean section and postpartum haemorrhage.</p><p><strong>Results: </strong>In a large cohort study of 16 908 pregnancies, including both twin and singleton pregnancies, conducted in Chongqing, China, the risk of placenta accreta increased by 51% in twin gestations, with haemorrhagic placenta accreta rising by 133%. This condition significantly heightened the risk of adverse perinatal outcomes in both singleton and twin pregnancies, with twin pregnancies exhibiting higher risks. In twins, the risk of preterm birth was 1.77 (95% confidence interval (CI) = 1.24, 2.52), caesarean section was 4.87 (95% CI = 3.00, 7.90), postpartum haemorrhage was 3.73 (95% CI = 1.95, 7.13), and uterine rupture was 26.42 (95% CI = 2.28, 306.63). Additionally, placenta accreta showed different interactions with various factors in both twin and singleton pregnancies, influencing distinct outcomes. Restricted Cubic Splines (RCS) model analysis indicated an increasing trend in the risk of caesarean section and postpartum haemorrhage associated with placenta accreta across all gestational ages in both singleton and twin gestations. In patients with placenta accreta, the risks of preterm birth, caesarean section, pelvic inflammatory disease, atonic postpartum haemorrhage, and premature rupture of membranes in twin gestations were 6.77, 2.39, 2.54, 5.84, and 2.93 times higher, respectively, than in singleton gestations. Finally, mediation causal analysis revealed that the effect of twin gestation on caesarean section included both a direct effect and an indirect effect mediated through placenta accreta. For postpartum haemorrhage, the effect of twin gestation was mediated through placenta accreta.</p><p><strong>Conclusions: </strong>Twin gestation, regardless of known risk factors, increases the risk of placenta accreta and adverse perinatal outcomes compared to singleton pregnancies. Antenatal interventions and delivery risk management are essential for twin pregnancies with placenta","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04252"},"PeriodicalIF":4.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975149","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 strategic approach to regulating new antimicrobials.","authors":"Shilpi Malhotra, Nitin Bansal, V Ramasubramanian, Veeraraghavan Balaji, Leena Menghaney, Kamini Walia","doi":"10.7189/jogh.15.03033","DOIUrl":"10.7189/jogh.15.03033","url":null,"abstract":"<p><p>Antimicrobial resistance (AMR) is a significant threat to healthcare in India, which is experiencing increasing resistance to critical antibiotics, including last-resort treatments. Emerging data indicate that resistance to last resort life-saving drugs continues to rise, limiting treatment options for drug-resistant infections. While the introduction of new antimicrobials offers hope, historical patterns suggest that resistance may develop rapidly. Enforcement challenges of regulatory initiatives, such as Schedule H1 restrictions in India, underscore the need for a national-level strategic approach when introducing new antimicrobials in the future. We propose a regulatory and access framework designed to preserve and increase the longevity of new antimicrobials in India. Key recommendations include restricting their availability to formularies of hospitals implementing antimicrobial stewardship and infection prevention and control standards, and mandating AMR surveillance reporting. We also examine stakeholders' perspectives on policy measures necessary for the responsible introduction of these drugs.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"03033"},"PeriodicalIF":4.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12363153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876287","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 potential barriers and facilitators to integrate tuberculosis, diabetes mellitus, and tobacco control programmes in India.","authors":"Nisha Mutalikdesai, Kajal Tonde, Kanchan Shinde, Rakesh Kumar, Surbhi Gupta, Girish Dayma, Anand Krishnan, Sanjay Juvekar, Ailana Santosa, Nawi Ng, Rutuja Patil","doi":"10.7189/jogh.15.04230","DOIUrl":"10.7189/jogh.15.04230","url":null,"abstract":"<p><strong>Background: </strong>Co-integrating tuberculosis (TB), diabetes mellitus (DM), and tobacco control (TC) programmes in India could help address the triple burden of these diseases. However, limited information exists regarding the feasibility and determining factors of such integration. We explored potential barriers and facilitators to integrating TB, DM, and TC programmes in Ambegaon Block of Pune District, Maharashtra, and Ballabgarh Block of Faridabad District, Haryana, in India.</p><p><strong>Methods: </strong>We conducted a qualitative study based on in-depth interviews with health workers, programme managers, and stakeholders involved in TB, DM, and TC programme implementation whom we enrolled using purposive and snowball sampling. The interview guide was based on World Health Organization's Health System Strengthening framework. We collected the data between November 2022 and March 2023 and analysed it through the rapid analysis method.</p><p><strong>Results: </strong>We interviewed 32 participants. The major challenge for integration, according to the participants' perspectives, relates to the level of service delivery, which is primarily attributed to inadequate implementation of all the programmes. Themes that emerged as facilitators were well-designed programmes with robust guidelines and ample space for infrastructure, while those seen as barriers included inadequate referral systems, insufficient infrastructure, limited resources, a shortage of trained staff, and a lack of essential drugs and equipment, all of which impeded the uptake and coverage of services.</p><p><strong>Conclusions: </strong>Our findings highlight the critical importance of addressing barriers and facilitators to implementing programmes in India for tackling the triple burden of TB, DM, and TC. A multidimensional approach and targeted strategies are needed for overcoming these challenges. Sensitising the health system staff, implementing feedback and referral systems, and developing cross-programme digital platforms will offer a roadmap for policymakers and healthcare system managers.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04230"},"PeriodicalIF":4.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856769","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 home gardening and obstructive sleep apnoea: role of behavioural factors in the COMmunity-based Behaviour and Attitude Study in Tuvalu (COMBAT).","authors":"Chia-Chen Lin, Po-Jen Lin, Tai-Lin Lee, Stephanie M Wu, Chih-Wei Shih, Selotia Tausi, Vine Sosene, Pauke P Maani, Malo Tupulaga, Shi-Chian Shiau, Yuan-Hung Lo, José Francisco López-Gil, Maria Soledad Hershey, Chia-Rui Chang, Yu-Tien Hsu, Chih-Fu Wei","doi":"10.7189/jogh.15.04225","DOIUrl":"10.7189/jogh.15.04225","url":null,"abstract":"<p><strong>Background: </strong>Tuvalu, like many Pacific Island nations, is facing a severe obesity epidemic, which is strongly associated with obstructive sleep apnoea (OSA) - a condition linked to multiple health complications and a growing public health burden. Lifestyle interventions such as home gardening have emerged as potential strategies to address obesity and its related conditions. We investigated the association between home gardening and OSA risk in Tuvalu and explored how behavioural and demographic factors may modify this relationship.</p><p><strong>Methods: </strong>We conducted a nationwide cross-sectional study in Tuvalu in 2023 using the COMmunity-based Behaviour and Attitude Study in Tuvalu (COMBAT) questionnaire. We assessed OSA risk using the validated eight-item 'Snoring, Tiredness, Observed apnoea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender' (STOP-Bang) questionnaire, and home gardening status was self-reported. We used logistic regression models, including multivariable adjustments and overlap weighting, to assess the association between home gardening and OSA outcomes, including total STOP-Bang score, OSA risk (≥3 points), and related symptoms (snoring, daytime fatigue, witnessed apnoea). We conducted stratified analyses by behavioural and demographic characteristics.</p><p><strong>Results: </strong>We included 849 adult participants (mean (x̄) age = 32.9 years; 51.9% female). Among individuals who exercised, home gardening was associated with lower STOP-Bang scores (x̄ difference = -0.30; 95% confidence interval (CI) = -0.59, -0.01, P = 0.040 in overlap weighting model) and with lower odds of STOP-Bang score ≥3 (adjusted odds ratio = 0.85; 95% CI = 0.73, 0.98, P = 0.026) than non-gardeners. Furthermore, home gardening was associated with significantly lower odds of snoring among individuals who smoked, consumed alcohol, or exercised, and with borderline lower odds of STOP-Bang score ≥3 among individuals who consumed alcohol.</p><p><strong>Conclusions: </strong>In the COMBAT study, home gardening was associated with lower OSA probability among subgroups with specific lifestyle factors. These findings suggest that home gardening could serve as a feasible and community-based intervention to mitigate OSA risk in Tuvalu and similar low-resource settings.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04225"},"PeriodicalIF":4.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856768","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 VUCA world and paradoxical dilemma on predicaments of foreign aid withdrawal or adjustment: problematisations, implications, and lessons.","authors":"Laston Gonah, Londele Tyeshani","doi":"10.7189/jogh.15.03035","DOIUrl":"10.7189/jogh.15.03035","url":null,"abstract":"<p><p>The already impending volatile, unpredictable, complex, and ambiguous (VUCA) world, driven in part by shifts and uncertainty in global, political, and financial markets, is becoming increasingly apparent, thereby rationalising the importance of vigilance, preparedness, and resilience by aid stakeholders. The implications this has for global health and security, governance, and development deserve critical consideration in efforts to protect public well-being and achieve or sustain resilience. The recent turn of events regarding the United States Agency for International Development's humanitarian aid withdrawal/adjustment notice can be seen as an omen of an uncertain future if the implications are disregarded. Establishment of foreign aid programmes is motivated by several defining principles and factors that must be considered when critiquing problematisations related to their eventual adjustment/withdrawal. We designed and proposed a framework for critiquing motives, responsibility, benefits, opportunities, lessons, and dos (MR-BOLD), serving as a diagnosis and response planning tool to address lingering questions about the VUCA world-induced effects, such as aid adjustments/withdrawals. We should nudge and spread world consciousness that the impending VUCA world demands an antidote in the form of critical thinking, religious observance of corporate governance principles - transparency, accountability, fairness and responsibility, and measures to ensure efficiency in how all natures of relationships are managed to optimise their predictive success, lest our failures besiege us. Development stakeholders should span boundaries to critical thinking and innovation, such as diverse knowledge, approaches, perspectives, and culture, to consider the best ways to integrate, organise, and deploy available resources and opportunities in the quest for resilience.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"03035"},"PeriodicalIF":4.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856770","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 investigation into the impact of family integrated care on extrauterine growth restriction at discharge in very low birth weight infants: a multi-centre study.","authors":"Meng-Fan Qiu, Yi Zhang, Ying-Zi Tang, Ya-Lan Dou, Yuan Wang, Tian-Chan Lyu, Qiao-Ling Fan, Yue-Lan Ma, Fang Li, Hui Rong, Yun-Fei Tang, Wei-Wei Gu, Xiao-Chun Chen, Dan Liu, Hua Wang, Juan Xiao, Li-Li Zhang, Yan Wang, Ru-Ming Ye, Dan Li, Xiao-Xia Li, Yu Pang, Mei Lin, Mei Lin, Yan Xuan, Xiao-Jing Hu","doi":"10.7189/jogh.15.04168","DOIUrl":"10.7189/jogh.15.04168","url":null,"abstract":"<p><strong>Background: </strong>Family integrated care (FIC) encourages parental involvement in neonatal intensive care units (NICU) and has been found to promote weight gain in preterm infants. Extrauterine growth restriction (EUGR) results from inadequate growth among very low birth weight infants (VLBWI), which has been found to contribute to parental anxiety. To address an existing gap in research, we aimed to examine the impact of parental involvement on EUGR at discharge in VLBWI.</p><p><strong>Methods: </strong>We conducted a retrospective, multi-centre case-control study involving VLBWIs admitted to 17 NICUs across eight southeastern Chinese provinces and cities from February 2021 to November 2023. We categorised cases and control groups based on the presence of EUGR at discharge and compared their perinatal and hospitalisation characteristics, as well as FIC duration, using a generalised linear mixed model.</p><p><strong>Results: </strong>EUGR in VLBWI at discharge was associated with birth weight (odds ratio (OR) = 0.547; 95% confidence interval (CI) = 0.490, 0.610), gestational week (<28 weeks) (OR = 3.101; 95% CI = 1.909, 5.038), Apgar score at 1 minute ≤7 (OR = 1.525; 95% CI = 1.119, 2.079), being small for gestational age (OR = 3.269; 95% CI = 1.547, 6.908), maternal gestational hypertension (OR = 1.868; 95% CI = 1.270, 2.748), necrotising enterocolitis (OR = 2.254; 95% CI = 1.386, 3.667), and total FIC duration. Based on literature and clinical practice, we divided the total FIC duration into three groups. We found that the lowest OR was associated with >18 hours of care, followed by ≤18 hours, while the highest was associated with 0 hours of care.</p><p><strong>Conclusions: </strong>We identified higher birth weight and FIC as protective factors against EUGR at discharge in VLBWI. In contrast, we recognised gestational age <28 weeks, an Apgar score ≤7 at 1 minute, small for gestational age, maternal gestational hypertension, and necrotising enterocolitis as risk factors. Nevertheless, further research is required to analyse the relationship between FIC and EUGR at discharge.</p><p><strong>Registration: </strong>ClinicalTrials.gov (NCT06550440).</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04168"},"PeriodicalIF":4.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817960","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":"Can unvaccinated children be reached through mobile phones? Analyses of national cross-sectional surveys from 70 countries.","authors":"Francine S Costa, Thiago M Santos, Larissa An Silva, Tewodaj Mengistu, Taylor A Holroyd, Daniel R Hogan, Aluisio Jd Barros, Cesar G Victora","doi":"10.7189/jogh.15.04232","DOIUrl":"10.7189/jogh.15.04232","url":null,"abstract":"<p><strong>Background: </strong>Interventions using mobile phones, otherwise known as mHealth interventions, are increasingly being used in low- and middle-income countries to remind families about scheduled child immunisations. Despite this, few studies examined impact on zero-dose children - those who failed to receive a single dose of a routine vaccine. As disparities in mobile phone ownership may limit the effectiveness of mHealth interventions, we assessed associations between mobile phone ownership, gender, wealth, residence, and zero-dose and modelled their potential impact for reaching unvaccinated children.</p><p><strong>Methods: </strong>We analysed 70 nationally representative surveys with data on immunisations and mobile phone ownership by households and mothers, and correlated ownership with household wealth and place of residence. We performed analyses at the individual child level and pooled across all countries weighted by national populations. We modelled the mHealth interventions' potential impact on zero-dose prevalence by estimating how many unvaccinated children are reachable via mobile phones.</p><p><strong>Results: </strong>The surveys included 163 527 children aged 12-23 months, with 13.4% being zero-dose. Among them, 34% of mothers and 73% of households had a mobile phone, compared to 60% and 89% for vaccinated children. Mobile phone ownership by mothers ranged from 32% in the poorest to 86% in the wealthiest quintile. A hypothetical 100% effective intervention using household mobile phones would reduce zero-dose prevalence from 13% to 4%, while one using similar effectiveness assumptions for mothers' phones would reduce national prevalence to 10%. Interventions with effectiveness ranging from 10% to 50% would lead to smaller impact levels. The largest impact is expected in countries like Guinea and Cote d'Ivoire, where both zero-dose prevalence and mobile phone ownership are high.</p><p><strong>Conclusions: </strong>The potential impact of mHealth interventions for reaching zero-dose children may be limited by mobile phone ownership among mothers and families, particularly among the poor, where we find the greatest number of unvaccinated children.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04232"},"PeriodicalIF":4.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817961","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}