International Health最新文献

{"title":"Arrival is not access: Nepal's third delay in maternal care.","authors":"Ashmin Bhattarai, Nilaramba Adhikari, Anil Sigdel","doi":"10.1093/inthealth/ihag103","DOIUrl":"https://doi.org/10.1093/inthealth/ihag103","url":null,"abstract":"","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A sex-disaggregated analysis of age-standardized tuberculosis prevalence in Sierra Leone (2000-2019) using World Health Organization Health Equity Assessment Toolkit data.","authors":"Augustus Osborne, Bobson Derrick Fofanah, Umaru Sesay","doi":"10.1093/inthealth/ihag096","DOIUrl":"https://doi.org/10.1093/inthealth/ihag096","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) remains a major public health challenge in Sierra Leone, contributing to high morbidity and mortality. Understanding trends in its prevalence and identifying sex-based disparities are crucial for designing targeted, evidence-based interventions. This study explored the trends in the age-standardized prevalence of TB in Sierra Leone from 2000 to 2019, with a focus on sex-based inequalities.</p><p><strong>Methods: </strong>A cross-sectional analysis was conducted using age-standardized prevalence data (per 100 000 population) from the World Health Organization's Health Equity Assessment Toolkit (HEAT). Data were analysed at five time points (2000, 2005, 2010, 2015 and 2019). Inequality measures, including difference (D), ratio (R), population attributable fraction (PAF) and population attributable risk (PAR) were calculated to assess absolute and relative disparities between males and females. Confidence intervals (CIs) were reported for all estimates to ensure the precision of findings.</p><p><strong>Results: </strong>The age-standardized prevalence of TB in Sierra Leone declined from 38 741.6 per 100 000 population in 2000 to 23 797.1 in 2019, a relative reduction of 38.6%. However, sex-disaggregated analysis revealed disparities, with males experiencing higher prevalence rates than females. In 2019, the prevalence for males was 24 968.0 per 100 000 population (95% CI 22 051.1 to 28 307.9) compared with 22 651.8 for females (95% CI 20 053.2 to 25 784.3). The absolute difference (D) widened in magnitude over time, from 1130.7 in 2000 to 2316.2 in 2019 (reported as negative values because female prevalence was lower). The inequality ratio (R) remained close to 1.0 throughout the study period, indicating modest relative disparities. The PAF increased from 1.5% in 2000 to 4.8% in 2019, and the PAR increased from 564.1 to 1145.3 per 100 000 population, indicating a small but growing share of the overall TB burden attributable to the higher prevalence among males.</p><p><strong>Conclusions: </strong>Despite a marked decline in the overall prevalence of TB in Sierra Leone from 2000 to 2019, males consistently faced a higher burden compared with females. These findings underscore the need for targeted strategies to address the sex-based disparities. Strengthening health systems, promoting equitable access to care, and implementing tailored prevention programs are critical to reducing the overall burden of TB and achieving health equity in Sierra Leone.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with measles infection during the 2025-6 outbreak in Burao, Somaliland: a case-control study.","authors":"Dek Kahin Yosef, Mohamed Omer Farah, Fadumo Osman Ahmed","doi":"10.1093/inthealth/ihag102","DOIUrl":"https://doi.org/10.1093/inthealth/ihag102","url":null,"abstract":"<p><strong>Objectives: </strong>Somaliland has recurrent measles transmission, but outbreak-specific evidence on modifiable child, household, and health-service factors is limited. We examined factors associated with measles case status during the 2025-6 Burao outbreak.</p><p><strong>Methods: </strong>We conducted a community-based unmatched case-control study among children aged <15 years from 14 June to 8 July 2026. Cases were enrolled consecutively and controls sampled systematically from households using a random start and every fourth household. Cluster-robust logistic regression estimated adjusted ORs (aORs), with indeterminate responses modeled separately.</p><p><strong>Results: </strong>Among 804 children (290 cases, 514 controls), case status was associated with non-vaccination (aOR 2.12, 95% CI 1.02-4.42), close contact (3.00, 1.72-5.25), reported health-facility attendance (2.79, 1.91-4.06), vaccine unavailability (2.62, 1.17-5.85), and trucked/vendor water (2.98, 2.03-4.36). Prior malnutrition, large-gathering attendance, household vaccination-refusal history, and poor ventilation were also associated. Health-facility attendance referred to the 21 days before rash onset/reference date, but exact visit dates were not collected.</p><p><strong>Conclusion: </strong>Measles case status was associated with immunity gaps, contact, household conditions, and service-related factors. Response priorities include reliable vaccine availability, catch-up vaccination, and contact-based action. The health-facility attendance association is temporally ambiguous and does not establish healthcare-associated transmission.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between food insecurity and inequalities in income and gender: an ecological study of global data sources.","authors":"Thomas Munday, Sebastian Stannard, Jess Boxall, Nisreen A Alwan, Dianna Smith","doi":"10.1093/inthealth/ihag100","DOIUrl":"https://doi.org/10.1093/inthealth/ihag100","url":null,"abstract":"<p><strong>Background: </strong>Women are more likely to experience food insecurity than men. Those experiencing inequalities are more likely to experience intersectional disadvantage. Wealth accumulation in high-income countries may hinder equitable food supply distribution, jeopardising individual food security.</p><p><strong>Methods: </strong>Associations between food insecurity measured using the Food Insecurity Experience Scale, income inequality measured using the World Inequality Database and gender inequality measured using the United Nations Human Development Programme's Gender Inequality Index were explored. Data from four publicly available datasets were aggregated at the national level (n=125).</p><p><strong>Results: </strong>Combined moderate or severe food insecurity was moderately correlated with country-level income inequality (RS=0.64, p<0.001) and strongly correlated with country-level gender inequality (RS=0.89, p<0.001). Unadjusted multivariable linear regression revealed stronger associations between food insecurity and gender inequality than income inequality. After adjustment, a 10% increase in gender inequality was associated with a 26% (95% confidence interval [CI] 8-49) increase in the prevalence of moderate or severe food insecurity in low- and middle-income countries (n=85) and a 61% (95% CI 21-116) increase in high-income countries (n=40). No significant interaction effects were found.</p><p><strong>Conclusions: </strong>Higher national levels of gender and income inequality could undermine efforts to address food insecurity.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Outpatient antibiotic prescribing for acute respiratory infections in children: an observational study in Nepal.","authors":"","doi":"10.1093/inthealth/ihag104","DOIUrl":"https://doi.org/10.1093/inthealth/ihag104","url":null,"abstract":"","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From eradicating wild poliovirus to eradicating vaccine-derived polioviruses: why oral polio vaccine use must now be ended.","authors":"David N Durrheim, Robert Steinglass, Norbert Hirschhorn, Dhanya Dharmapalan, Oyewale Tomori, T Jacob John","doi":"10.1093/inthealth/ihag097","DOIUrl":"https://doi.org/10.1093/inthealth/ihag097","url":null,"abstract":"<p><p>Wild poliovirus (WPV)2 was eradicated globally in 1999, and WPV3 was eradicated in 2012. Since 2016, endemic transmission of WPV1 has remained restricted to Afghanistan and Pakistan. Circulating vaccine-derived polioviruses (cVDPVs) have become the leading cause of poliovirus transmission and paralytic disease globally. As cVDPVs originate from oral poliovirus vaccine (OPV) strains, the polio endgame must address both cVDPV outbreaks and the mechanism that generates them. We propose defining cVDPV eradication as sustained zero disease, zero transmission, and zero emergence of new cVDPV lineages. Continued OPV use exposes children, predominantly in low- and middle-income countries, to avoidable risks of vaccine-associated paralysis and cVDPV outbreaks. Accelerated transition to inactivated poliovirus vaccine-only schedules and cessation of OPV use are essential for a sustainable and equitable polio endgame.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging healthcare gaps through public-private partnerships in Nigeria: a scoping review.","authors":"Tolutope Adebimpe Oso, Olalekan John Okesanya, Khalifat Boluwatife Obadeyi, Oluwatobi Babajide Ayelaagbe, Ayantunde Kayode Ayankola, Uthman Okikiola Adebayo, Oluwatimileyin Titilayo Talabi, Clement Ngele Chukwu, Gabriel Celestine Jideofor, Mohamed Mustaf Ahmed, Safayet Jamil, Afis Akanni Paul Agboola, Abdifatah Ahmed Ali Afyare, Don Eliseo Lucero-Prisno","doi":"10.1093/inthealth/ihag099","DOIUrl":"https://doi.org/10.1093/inthealth/ihag099","url":null,"abstract":"<p><p>Nigeria's healthcare system faces several persistent structural challenges. Public-private partnerships (PPPs) have emerged as a strategy to address these gaps, although evidence on their implementation and impact remains fragmented. This scoping review mapped the implementation models, outcomes, challenges and future directions of PPPs in Nigeria's healthcare system, following the Arksey and O'Malley framework and PRISMA-ScR guidelines. Literature searches were conducted across PubMed, Scopus, Web of Science, Google Scholar and grey literature sources. Studies were screened using Rayyan, while eligibility was guided by the population-concept-context framework. Data were synthesized using descriptive and thematic analysis. Twenty-four studies were included, covering PPP applications across primary, secondary, tertiary and community healthcare systems. Identified models included service delivery, financing, infrastructure, supply chain and governance partnerships. The included evidence reported improvements in healthcare access, diagnostic capacity, immunization coverage, infrastructure development and system efficiency, particularly in tuberculosis diagnostics, radiology, dialysis and radiotherapy services. However, weak governance, poor stakeholder coordination, funding instability, affordability barriers and inequitable urban concentration of benefits persisted. Strengthening regulatory frameworks, sustainable financing, accountability and equitable access may enhance PPP implementation and enable appropriately governed PPPs to contribute to selected dimensions of healthcare access and service capacity relevant to universal health coverage in Nigeria.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Persistent gaps in the prevention of mother-to-child HIV transmission in central Uganda: a case-control study.","authors":"Ercan Yılmaz, Erdem Topal","doi":"10.1093/inthealth/ihag098","DOIUrl":"https://doi.org/10.1093/inthealth/ihag098","url":null,"abstract":"","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening access to people-centred mental healthcare for people affected by skin neglected tropical diseases in Nigeria: a pilot study.","authors":"Tolulope Olumide Afolaranmi, Joy Malle Dogo, Precious Akinnusi, Cornelius Bewok Gofung, Tunde Masseyferguson Ojo, Oluwole Gabriel Afolayan, Maureen Pali, Charles Danfulani, Linda Ugwu, Charles Nwafor, Christine Iyenrhe Bestman, Judith Emma-Joseph, Pius Sunday Ogbu, Bukola Ibrahim, Philip Ochi Ode, Abdulazeez Musa, James Cleobas, Bassey Unam, Grace Ogunleye, Eric Duru, Frank Abu, Cristina Juan Jimenez, Anna Giné-March, Manuel Pozzati, Peter Iorkighir, Sedoo Saater Kumaga, Amaka Onyima, James Taiwo Obindo, Julian Eaton","doi":"10.1093/inthealth/ihag092","DOIUrl":"https://doi.org/10.1093/inthealth/ihag092","url":null,"abstract":"<p><strong>Objectives: </strong>Neglected tropical diseases (NTDs) contribute to the global burden of mental health conditions, largely mediated through mechanisms of stigma and social exclusion. Within this group, skin NTDs are particularly prominent, as visible deformities often drive stigma reinforced by cultural myths, fear of contagion, social isolation, and associated poverty. The WHO recommends a collaborative cross-sectoral approach in its NTD Road Map 2021-30, integrating care for people with NTDs. This study was conducted as a pilot to assess the feasibility, acceptability, and impact of a person-centred intervention care package on mental health outcomes and stigma among people with skin NTDs in Nigeria.</p><p><strong>Methods: </strong>This quasi-experimental mixed-methods study, with a before-and-after design, was conducted from August 2023 to June 2025 in five local government areas in Nigeria among people with skin NTDs (leprosy, lymphatic filariasis, and Buruli ulcer) using a convenience sampling technique. Depression, anxiety, and well-being were assessed before and after implementation of a package of person-centred care interventions. In addition, 10 focus group discussions were conducted among people with skin NTDs, along with 21 key informant interviews with healthcare workers and relevant stakeholders to explore the feasibility of scaling up interventions.</p><p><strong>Results: </strong>At baseline, 456 people with skin NTDs were enrolled [37.9% female; median age 45 (IQR 25-80) years], of whom 315 were followed up at endline providing paired data. The proportion screening positive for depression decreased from 213/315 (67.6%) to 88/315 (27.9%), and anxiety from 201/315 (63.8%) to 56/315 (17.8%). Well-being improved, with 156/315 (49.5%) reporting good well-being at baseline compared with 193/315 (61.3%) at endline. Additionally, a package of interventions-including capacity building for health workers, referral systems, peer support groups, livelihood support activities, and anti-stigma campaigns-was feasible, acceptable, and well integrated into existing contexts, with perceived improvements in mental health outcomes and stigma.</p><p><strong>Conclusion: </strong>This pilot study suggests that the person-centred care package is feasible and acceptable in this low-resourced setting in Nigeria and is associated with improvements in mental health outcomes and stigma among people with skin NTDs in Nigeria.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ripple Effects Mapping of a gender equity and social inclusion behaviour change activity in Uganda's trachoma effort.","authors":"Emmanuel Ssegawa, Dany Chhan, Claire Karlsson, Palma Marwas, Taroub Harb Faramand, Sharone Backers, Herbert Nturanemigisha, Alfred Mubangizi, Rapheal Opon, Hilda Kyarisiima, Alinda Peter, Boaz Habomujuni, Elizabeth Sutherland","doi":"10.1093/inthealth/ihag086","DOIUrl":"https://doi.org/10.1093/inthealth/ihag086","url":null,"abstract":"<p><strong>Background: </strong>Uganda's trachoma program has faced persistent challenges in achieving adequate preventive medicine coverage. To address these, the Ministry of Health applied Ripple Effects Mapping (REM) to assess a gender equity and social inclusion (GESI) behaviour change activity (BCA). To our knowledge, this represents one of the first documented applications of REM to a neglected tropical disease (NTD) program.</p><p><strong>Methods: </strong>Seven REM workshops were conducted with government officials, health staff and community members. Facilitators guided participants to identify the BCA's inputs, outputs and intended and unintended outcomes. Findings were consolidated and analysed using mind-mapping software.</p><p><strong>Results: </strong>Workshop participants reported that the BCA increased access, demand and uptake of trachoma preventive medicine among populations missed in previous campaigns. Workshops also demonstrated diversification of campaign stakeholders; improved water, sanitation and hygiene and prevention practices; and stronger social accountability between communities and local government.</p><p><strong>Conclusion: </strong>REM provided the Uganda NTD program with a participatory way to validate intended results and uncover additional effects of a trachoma BCA. Findings from the workshops point to REM's potential value for informing investment, replication and strategy to accelerate trachoma elimination in Uganda and similar settings.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}