International Health最新文献

{"title":"Patient-centred care measurement in sub-Saharan Africa: a scoping review of the evidence (1990-2024).","authors":"Paul K Okeny, Chiara Pittalis, Ruari Brugha, Jakub Gajewski","doi":"10.1093/inthealth/ihaf139","DOIUrl":"10.1093/inthealth/ihaf139","url":null,"abstract":"<p><p>The aim of this scoping review was to explore how patient-centred care (PCC) is being measured in healthcare settings in sub-Saharan Africa (SSA) and to examine the psychometric performance of reported measurement instruments for PCC. Medline, Web of Science, EMBASE and Global Health databases were searched for articles published from 1990 to 22 September 2024. Search was updated on 30th December 2024. The keywords 'patient-centred care', 'patient experience', 'measurement' and 'psychometric property' were used. Studies were included if they reported on the development, validation, evaluation or psychometric properties of tools used for measuring PCC. Of the 302 articles retrieved, 36, including 31 unique instruments, met the inclusion criteria. Eight instruments were locally developed in SSA. A total of 26 studies were conducted either in South Africa, Nigeria or Ethiopia. Twenty-two studies (60%) were conducted in hospital settings. Psychometric evaluation was either incomplete or not done at all. Locally developed instruments had better psychometric performance compared with instruments developed in the Global North. Although various instruments have been used to measure PCC in SSA, most of them only measure its subcomponents in specific patient populations. Comprehensive measures of PCC, developed and evaluated in SSA for psychometric properties, are needed.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"570-590"},"PeriodicalIF":2.4,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A paradox of readiness?: diagnosing strategic implementation gaps for digital mental health in Lagos, Nigeria.","authors":"Abiodun O Adewuya, Seye Abimbola, Jibril Abdulmalik, Falmata Shettima, Asmau Dahiru, Olabisi E Oladipo, Adedolapo Fasawe","doi":"10.1093/inthealth/ihaf129","DOIUrl":"10.1093/inthealth/ihaf129","url":null,"abstract":"<p><strong>Background: </strong>Many low- and middle-income countries (LMICs) face a vast mental health treatment gap. Digital health offers scalable solutions, but successful implementation requires assessing health system readiness. This study developed and applied an integrated framework to assess this readiness in an urban LMIC.</p><p><strong>Methods: </strong>In Lagos, Nigeria, our mixed methods study used an integrated framework combining systematic policy appraisal (adapted Appraisal of Guidelines for Research and Evaluation II) with granular ecosystem mapping of national repositories and local infrastructure.</p><p><strong>Results: </strong>The assessment revealed a strategic implementation gap. Lagos State has strong policy readiness (score: 75.8/100) and a robust technology ecosystem with Nigeria's highest mobile density (nearly 26 million active lines). However, readiness was misaligned with implementation: a granular analysis of 45 national digital health projects found mental health constitutes only an estimated 2-3% of the portfolio's focus, with no dedicated platforms. This strategic oversight persists in new national digital health architecture.</p><p><strong>Conclusions: </strong>Health system readiness is multidimensional and assessments focused on isolated components can be misleading. Our findings highlight a strategic gap between an enabling policy environment and actual implementation. The integrated framework offers a replicable model for LMIC policymakers to diagnose these gaps and guide evidence-based digital health investments to bridge the mental health treatment gap.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"658-667"},"PeriodicalIF":2.4,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parity before scale: governing large language models in global health.","authors":"Carlos Fernando Mourão, Luiz Eduardo Juliasse, Pietro Montemezzi, Emanuele di Edoardo, Ignazio Scuto","doi":"10.1093/inthealth/ihag069","DOIUrl":"https://doi.org/10.1093/inthealth/ihag069","url":null,"abstract":"<p><p>Large language models (LLMs) are proposed as scalable solutions for health workforce gaps in low- and middle-income countries, yet deployment risks deepening inequities. LLM evaluation remains disproportionately centered on English-language resources, and current reporting standards do not operationalize linguistic parity, data sovereignty, or accountability for specific language communities, care pathways, and regulatory arrangements. We propose three minimum governance commitments: parity before scale, requiring pre-specified performance thresholds or non-inferiority margins by language and care setting before deployment; local ownership before extraction; and accountability before integration. Systems failing these thresholds should be restricted, redesigned, or subject to additional oversight before scale-up.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370512","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":"Improving adolescent sexual and reproductive health through digital health in Jimma, Ethiopia: a quasi-experimental study.","authors":"Afework Tadele, Getu Gizaw, Merertu Wondimu, Badiru Dawud, Rahma Ali, Oli Kitila","doi":"10.1093/inthealth/ihag068","DOIUrl":"https://doi.org/10.1093/inthealth/ihag068","url":null,"abstract":"<p><strong>Background: </strong>Investing in adolescents' sexual and reproductive health (SRH) yields great benefits, as this period marks a crucial transition from childhood to adulthood. Many young people face SRH challenges due to limited knowledge and inability to make informed decisions about their sexual and reproductive health rights (SRHR). This study aimed to assess the effectiveness of digital health interventions in improving SRH among school adolescents and youths in Jimma, Ethiopia.</p><p><strong>Methods: </strong>A quasi-experimental design was employed and data were collected from school youths. Analysis was conducted using EpiData version 4.6 and Stata version 17.0. Propensity score matching was applied to estimate average treatment effects and sensitivity analysis was conducted using a difference-in-differences approach.</p><p><strong>Results: </strong>There was a significant improvement in SRH outcomes between baseline and the end line. Knowledge of SRHR increased by 26.8 percentage points (95% confidence interval [CI] 14.5 to 38.6), knowledge of SRH by 11.5 percentage points (95% CI 1.7 to 21.4) and positive attitudes toward SRHR by 27.4 percentage points (95% CI 17.5 to 37.3) following the digital intervention.</p><p><strong>Conclusions: </strong>The digital health intervention significantly enhanced knowledge and attitudes related to SRHR among school adolescents. Further studies should explore whether improvements in knowledge and attitudes translate into longer-term reproductive health outcomes, such as contraceptive uptake, teenage pregnancy and unmet need for family planning.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370534","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":"Health before hype: a V-Model blueprint for African digital health and AI regulatory sandboxes.","authors":"Sharifah Sekalala, Shajoe J Lake, Jean Philbert Nsengimana, Martin Weiss, Jamiru Mpiima","doi":"10.1093/inthealth/ihag067","DOIUrl":"https://doi.org/10.1093/inthealth/ihag067","url":null,"abstract":"<p><p>African governments must regulate fast-growing digital health and artificial intelligence technologies while building the continent's planned digital single market. Regulatory sandboxes are increasingly promoted as a solution, but most sandbox experience comes from finance, where the primary concern is market risk, not clinical safety or public health harm. Healthtech is not fintech, and failure carries very different consequences. We argue that the Global System for Mobile Communications (GSM) standards model offers a more appropriate template. Drawing on the V-Model framework, we propose that regional bodies verify technical interoperability while national regulators validate clinical and ethical suitability. Simulation-based exercises can test governance before technologies go live, building a cautious, collectively owned approach to digital health innovation on African terms.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370429","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 influencing initiation to complete use of tetanus-toxoid containing vaccine in Nigeria: a narrative review.","authors":"Aromoke Sanjo-Odutayo, Fiona Cuthill","doi":"10.1093/inthealth/ihag066","DOIUrl":"https://doi.org/10.1093/inthealth/ihag066","url":null,"abstract":"<p><p>Ensuring lifelong protection against tetanus infection is a global concern, and Nigeria is among the 10 countries that have not yet achieved full maternal and neonatal tetanus elimination (MNTE). With pregnant women in tetanus-prone regions commonly taking neonatal protective doses of 1-2 tetanus-toxoid-containing vaccine (TTCV) during each pregnancy or not using it at all, women of childbearing age are unlikely to gain lifetime immunity. Understanding why pregnant women disregard or rarely complete the recommended five doses of TTCV after delivery can help vaccine policymakers and all stakeholders who are working towards local and global elimination of tetanus-related cases tailor their strategies. The objective of this study is to review and synthesize findings from published literature on various factors that influence initiation to complete use of the recommended five doses of TTCV from the start of pregnancy to post-delivery in Nigeria. We carried out a structured narrative search of literature and synthesis to identify factors that inform Nigerian women's non- and repetitive use of the protective doses of TTCV during pregnancy and hinder the complete use of the recommended doses after delivery. An electronic database search was carried out in Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, Global Health, MEDLINE Plus, PubMed, Google Scholar, and the Edinburgh Research Archive to retrieve relevant articles published in English from 2000 to 2025. Seven articles and one published thesis met the criteria for inclusion in the narrative review. The factors that informed the trend of non- and repetitive 1-2 doses of TTCV were reported to be largely associated with misconceptions, geographical location, religious beliefs, parity, spousal approval, women's parents, missed appointments, competing priorities, lack of knowledge of vaccine, doses, and dose intervals. The factors that hinder pregnant women from completing the recommended five doses of TTCV after delivery included forgetfulness, loss of interest, and the assumption that TTCV is not necessary after the baby has been born. Most pregnant Nigerian women who claimed to have had up to five doses of TTCV did so either out of personal determination or by repeating 1-2 doses in subsequent pregnancies. Our findings strengthen the knowledge that the factors that influence pregnant Nigerian women's initiation or complete use of TTCV are complex and multifactorial. National vaccine policy and vaccine recommendations should be informed by studies that provide balanced perspectives and knowledge of the reasons pregnant Nigerian women disregard or rarely complete the recommended doses of TTCV. The findings also emphasize the need for a reorientation of vaccine recommenders and users to the use of TTCV beyond the period of pregnancy.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320171","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":"Physical activity and psychological health in the Arabic region during COVID-19: a multi-country comparative study.","authors":"Anas H Khalifeh, Ahmad Rayan, Rami Masa'Deh, Ola El-Zein, Omar Al Omari, Bahaaeddin M Hammad, Fadwa Alhalaiqa, Mutaz I Othman","doi":"10.1093/inthealth/ihag065","DOIUrl":"https://doi.org/10.1093/inthealth/ihag065","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has had a profound impact on the daily lives of people worldwide, with social distancing measures influencing both physical activity and psychological health. In the Arab region, few data exist on the changes in lifestyle and psychological health status during COVID-19. The aim of this study was to assess physical daily life activities and psychological health impacts among the general public in Arab countries during the COVID-19 pandemic.</p><p><strong>Methods: </strong>A cross-sectional comparative correlational design was used. A convenience sample with online data collection was used to collect data from adults from seven countries. Adults completed a demographic questionnaire, Perceived Stress Scale and Hamilton Anxiety Rating Scale.</p><p><strong>Results: </strong>The study included 1396 participants. A total of 28.7% of them reported decreased physical activity, 17.2% started exercising at home and 40% reported weight gain. Participants showed moderate stress (mean 19.42 [standard deviation 5.94]) and mild anxiety (mean 14.01 [standard deviation 13.05]), with significant differences between countries (p<0.01). There was a positive correlation between stress and anxiety (r=0.590, p<0.01), while age showed a negative correlation with both stress (r=-0.300, p<0.01) and anxiety (r=-0.229, p<0.01). Anxiety was differentiated with eating behaviour, but neither stress nor anxiety were significantly different with changes in exercise activity. Regression analyses indicated that anxiety and age strongly predicted stress, while stress and age predicted anxiety.</p><p><strong>Conclusions: </strong>The changes in lifestyle and the factors associated with increased stress and anxiety during the COVID-19 pandemic must be considered in future pandemics to develop appropriate care plans for the general public.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310170","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":"Free primary health care in Ghana: a model for repositioning community-based health systems in Africa.","authors":"Abdirahman Mohamed Adan, Ahmed Mohamed Omar, Maryama Ahmed Ali, Yakub Burhan Abdullahi","doi":"10.1093/inthealth/ihag061","DOIUrl":"https://doi.org/10.1093/inthealth/ihag061","url":null,"abstract":"","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310141","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 global solidarity to strategic nationalism? The implications of 'America First' global health for low- and middle-income countries.","authors":"Justin Onyebuchi Nwofe, Kingsley Chukwuemeka Onugwu, Dickson Adeolu Adetoye, John Ogaga, Amali Owoicho, Tajudeen Disu, Emmanuel Adewale Ojo, Christian Okechukwu Ugwu, Laura Ifunanya Madukaji, Femi Emmanuel Owolagba, Babatope O Adebiyi","doi":"10.1093/inthealth/ihag062","DOIUrl":"https://doi.org/10.1093/inthealth/ihag062","url":null,"abstract":"<p><p>Global health cooperation is undergoing recalibration. The 2025 America First Global Health Strategy does not introduce entirely new governance instruments but more explicitly prioritizes bilateral agreements, co-financing requirements, and performance-based partnerships within global health cooperation. This commentary examines how the strategy formalizes and intensifies existing dynamics of strategic bilateralism and analyses its implications for low- and middle-income countries. We argue that the significance of the strategy lies less in new governance mechanisms than in the scale, visibility, and political framing of existing ones. While this approach may strengthen domestic ownership and programme integration, it may also reshape bargaining dynamics, fiscal responsibilities, and coordination structures within global health systems.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303650","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":"Serotypes associated with invasive pneumococcal disease high-risk groups: a systematic review.","authors":"Reuben E Arhin, Nicholas T K D Dayie, Eric S Donkor","doi":"10.1093/inthealth/ihag058","DOIUrl":"https://doi.org/10.1093/inthealth/ihag058","url":null,"abstract":"<p><p>This systematic review aimed to establish if higher-valent conjugate vaccines will provide significantly higher coverage and protection in high-risk groups than the 13-valent pneumococcal conjugate vaccine (PCV13). The PubMed, Science Direct, and Google Scholar search engines were searched for original articles that reported on the type of study, period of the study, high-risk group(s) involved, specimens collected, number of isolates, frequency of serotyped isolates, and serotypes/serogroups of isolates for inclusion. Data from 14 studies based in seven countries, and 789 serotyped/serogrouped isolates, were extracted. There was no significant difference (P = .23) between the frequency of the non-vaccine serotypes (51.6%) and the vaccine serotypes (48.4%). The 23-valent pneumococcal polysaccharide vaccine (PPV23) had the highest serotype coverage (36.5% ± 5.3%) identified among the high-risk groups. The serotype coverage of the vaccines was highest for the cancer group (26.2% to 40.5%) and lowest for the sickle cell disease group (20% to 28.9%). Higher-valent pneumococcal vaccines may provide significantly higher coverage for groups at a high risk of invasive pneumococcal diseases. There is a need to monitor the serotypes associated with high-risk groups.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260097","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}