Global Health Action最新文献

{"title":"Interactive effects of atmospheric oxidising pollutants and heat waves on the risk of residential mortality.","authors":"Nan Ren, Huimin Huang, Baoying Liu, Chuancheng Wu, Jianjun Xiang, Quan Zhou, Shuling Kang, Xiaoyang Zhang, Yu Jiang","doi":"10.1080/16549716.2024.2313340","DOIUrl":"10.1080/16549716.2024.2313340","url":null,"abstract":"<p><strong>Background: </strong>The impact of heat waves and atmospheric oxidising pollutants on residential mortality within the framework of global climate change has become increasingly important.</p><p><strong>Objective: </strong>In this research, the interactive effects of heat waves and oxidising pollutants on the risk of residential mortality in Fuzhou were examined. Methods We collected environmental, meteorological, and residential mortality data in Fuzhou from 1 January 2016, to 31 December 2021. We then applied a generalised additive model, distributed lagged nonlinear model, and bivariate three-dimensional model to investigate the effects and interactions of various atmospheric oxidising pollutants and heat waves on the risk of residential mortality.</p><p><strong>Results: </strong>Atmospheric oxidising pollutants increased the risk of residential mortality at lower concentrations, and O3 and Ox were positively associated with a maximum risk of 2.19% (95% CI: 0.74-3.66) and 1.29% (95% CI: 0.51-2.08). The risk of residential mortality increased with increasing temperature, with a strong and long-lasting effect and a maximum cumulative lagged effect of 1.11% (95% CI: 1.01, 1.23). Furthermore, an interaction between atmospheric oxidising pollutants and heat waves may have occurred: the larger effects in the longest cumulative lag time on residential mortality per 10 µg/m3 increase in O3, NO2 and Ox during heat waves compared to non-heat waves were [-3.81% (95% CI: -14.82, 8.63)]; [-0.45% (95% CI: -2.67, 1.81)]; [67.90% (95% CI: 11.55, 152.71)]; 16.37% (95% CI: 2.43, 32.20)]; [-3.00% (95% CI: -20.80, 18.79)]; [-0.30% (95% CI: -3.53, 3.04)]. The risk on heat wave days was significantly higher than that on non-heat wave days and higher than the separate effects of oxidising pollutants and heat waves.</p><p><strong>Conclusions: </strong>Overall, we found some evidence suggesting that heat waves increase the impact of oxidising atmospheric pollutants on residential mortality to some extent.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2313340"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10883108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913890","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":"Local governance of the 2014 ebola Epidemic: a PhD synthesis.","authors":"Sabine Iva Franklin","doi":"10.1080/16549716.2024.2411742","DOIUrl":"10.1080/16549716.2024.2411742","url":null,"abstract":"<p><strong>Background: </strong>The doctoral dissertation examines how local response efforts were integrated into overall emergency management.</p><p><strong>Objectives: </strong>It seeks to understand the role and effectiveness of community-based actors in addressing collective action problems.</p><p><strong>Methods: </strong>Sixty-seven semi-structured interviews were conducted from January to July 2017 in Liberia and Sierra Leone. Key informants include healthcare workers, traditional leaders, and community stakeholders, such as non-governmental organization representatives and volunteers.</p><p><strong>Results: </strong>Findings show that traditional and community leaders responded to the public health emergency via rulemaking, quarantine, travel limitation, healthcare referrals, health sensitization, and door-to-door contact tracing. These actions by local leaders helped to change behaviors and improve cooperation. Sierra Leone had 32.3% more Ebola cases than Liberia but 18% fewer deaths. Sierra Leone had integrated traditional and community leaders before the scale up of international aid resources.</p><p><strong>Conclusion: </strong>This suggests that actions taken by traditional and community leaders improved overall efforts, and in some areas, before scaled-up humanitarian interventions. Bilateral engagement with local community actors should be integrated in every public health response to improve cooperation, and it should be done before an intervention is conceived and executed.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2411742"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401724","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":"Methodology for adapting a co-created early childhood development intervention and implementation strategies for use by frontline workers in India and Guatemala: a systematic application of the FRAME-IS framework.","authors":"Amruta Bandal, Sara Hernández, Revan Mustafa, Karyn Choy, Namrata Edwards, Magdalena Guarchaj, Marinés Mejía Alvarez, Anushree Sane, Scott Tschida, Chetna Maliye, Ann Miller, Abhishek Raut, Roopa Srinivasan, Morgan Turner, Bradley H Wagenaar, Ilgi Ertem, Maria Del Pilar Grazioso, Subodh S Gupta, Vibha Krishnamurthy, Peter Rohloff","doi":"10.1080/16549716.2024.2338324","DOIUrl":"10.1080/16549716.2024.2338324","url":null,"abstract":"<p><p>There is little evidence on optimizing the effectiveness and implementation of evidence-based early childhood development (ECD) interventions when task-shifted to frontline workers. In this Methods Forum paper, we describe our adaptation of the International Guide for Monitoring Child Development (GMCD) for task-shifting to frontline workers in Guatemala and India. In 2021-2022, implementers, trainers, frontline workers, caregivers, and international GMCD experts collaborated to adapt the GMCD for a task shifted implementation by frontline workers. We used an eight-step co-creating process: assembling a multidisciplinary team, training on the existing package, working groups to begin modifications, revision of draft modifications, tailoring of visual materials and language, train-the-trainers activities, pilot frontline worker trainings, final review and feedback. Preliminary effectiveness of adaptations was evaluated through narrative notes and group-based qualitative feedback following pilot trainings with 16 frontline workers in India and 6 in Guatemala. Final adaptations included: refining training techniques to match skill levels and learning styles of frontline workers; tailoring all visual materials to local languages and contexts; design of job aids for providing developmental support messages; modification of referral and triage processes for children in need of enhanced support and speciality referral; and creation of post-training support procedures. Feedback from pilot trainings included: (1) group consensus that training improved ECD skills and knowledge across multiple domains; and (2) feedback on ongoing needed adjustments to pacing, use of video-based vs. role-playing materials, and time allocated to small group work. We use the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) framework to document our adaptations. The co-creating approach we use, as well as systematic documentation of adaptation decisions will be of use to other community-based early childhood interventions and implementation strategies.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2338324"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11089920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899955","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":"Evaluating the implementation of person-centred care and simulation-based learning in a midwifery education programme in the Democratic Republic of Congo: a study protocol.","authors":"Frida Temple, Ewa Carlsson Lalloo, Marie Berg, Urban Berg, Alumeti Munyali Désiré, Olivier Nyakio, Aline Mulunda, Malin Bogren","doi":"10.1080/16549716.2024.2370097","DOIUrl":"10.1080/16549716.2024.2370097","url":null,"abstract":"<p><strong>Background: </strong>Investing in midwives educated according to international standards is crucial for achieving Sustainable Development Goals in maternal and newborn health. Applying a person-centred care approach and using simulation-based learning to improve the learning experience for midwifery students may enhance the quality of childbirth care. This protocol describes a study evaluating the implementation of person-centred approach and simulation-based learning in childbirth as part of a midwifery education programme at the Evangelical University in Africa, DRC.</p><p><strong>Methods: </strong>The research will be exploratory and guided by an implementation research framework. Ethical approval has been obtained. Facilitators working at the programme's five clinical practice sites will be trained in: 1) Introducing person-centred childbirth care using a training programme called'Mutual Meetings'; and 2) integrating simulation-based learning, specifically by using the three courses: Essential Care of Labor, Bleeding after Birth, and Vacuum Extraction. Data will include interviews with midwifery students, facilitators and clinical preceptors, and maternal and neonatal outcomes from birth registers.</p><p><strong>Discussion: </strong>By integrating a validated and culturally adapted person-centred care training programme and simulation-based learning into a midwifery education programme and clinical practice sites, the findings from the study anticipate an improvement in the quality of childbirth care. Training facilitators in these methodologies aim to effectively mitigate maternal and neonatal adverse outcomes. The findings are expected to provide valuable recommendations for governments, policymakers, and healthcare providers in the DRC and beyond, contributing to significant improvements in midwifery education and aligning with global health priorities, including the Sustainable Development Goals.</p><p><strong>Trial registration: </strong>The study was registered retrospectively with the ISRCTN registry on the 23rd of February 2024. The registration number is: ISRCTN10049855.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2370097"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11207909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447423","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":"Did the COVID-19 quarantine policies applied in Cochabamba, Bolivia mitigated cases successfully? an interrupted time series analysis.","authors":"Rodrigo K Arce Cardozo, Osvaldo Fonseca-Rodríguez, Yercin Mamani Ortiz, Miguel San Sebastian, Frida Jonsson","doi":"10.1080/16549716.2024.2371184","DOIUrl":"10.1080/16549716.2024.2371184","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic prompted varied policy responses globally, with Latin America facing unique challenges. A detailed examination of these policies' impacts on health systems is crucial, particularly in Bolivia, where information about policy implementation and outcomes is limited.</p><p><strong>Objective: </strong>To describe the COVID-19 testing trends and evaluate the effects of quarantine measures on these trends in Cochabamba, Bolivia.</p><p><strong>Methods: </strong>Utilizing COVID-19 testing data from the Cochabamba Department Health Service for the 2020-2022 period. Stratified testing rates in the health system sectors were first estimated followed by an interrupted time series analysis using a quasi-Poisson regression model for assessing the quarantine effects on the mitigation of cases during surge periods.</p><p><strong>Results: </strong>The public sector reported the larger percentage of tests (65%), followed by the private sector (23%) with almost double as many tests as the public-social security sector (11%). In the time series analysis, a correlation between the implementation of quarantine policies and a decrease in the slope of positive rates of COVID-19 cases was observed compared to periods without or with reduced quarantine policies.</p><p><strong>Conclusion: </strong>This research underscores the local health system disparities and the effectiveness of stringent quarantine measures in curbing COVID-19 transmission in the Cochabamba region. The findings stress the importance of the measures' intensity and duration, providing valuable lessons for Bolivia and beyond. As the global community learns from the pandemic, these insights are critical for shaping resilient and effective health policy responses.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2371184"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11218584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471926","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":"Contextual awareness, response and evaluation (CARE) of diabetes in poor urban communities in Ghana: the CARE diabetes project qualitative study protocol.","authors":"Leonard Baatiema, Daniel Llywelyn Strachan, Lydia Osetohamhen Okoibhole, Irene Akwo Kretchy, Mawuli Kushitor, Raphael Baffour Awuah, Olutobi Adekunle Sanuade, Ernestina Korleki Danyki, Samuel Amon, Kafui Adjaye-Gbewonyo, Haim Yacobi, Megan Vaughan, Ann Blandford, Publa Antwi, Hannah Maria Jennings, Daniel Kojo Arhinful, Ama de-Graft Aikins, Edward Fottrell, The Care Diabetes Team","doi":"10.1080/16549716.2024.2364498","DOIUrl":"10.1080/16549716.2024.2364498","url":null,"abstract":"<p><p>Diabetes remains a major, global clinical and public health threat with consistent rises in prevalence around the world over the past four decades. Two-thirds of the projected increases in global diabetes prevalence to 2045 are expected to come from low- and middle-income countries, including those in sub-Saharan Africa. Ghana is typical of this trend. However, there are gaps in evidence regarding the appropriate development of interventions and well-targeted policies for diabetes prevention and treatment that pay due attention to relevant local conditions and influences. Due consideration to community perspectives of environmental influences on the causes of diabetes, access to appropriate health services and care seeking for diabetes prevention and management is warranted, especially in urban settings. The 'Contextual Awareness, Response and Evaluation (CARE): Diabetes in Ghana' project is a mixed methods study in Ga Mashie, Accra. An epidemiological survey is described elsewhere. Six qualitative studies utilising a range of methodologies are proposed in this protocol to generate a contextual understanding of type 2 diabetes mellitus in an urban poor population. They focus on community, care provider, and policy stakeholder perspectives with a focus on food markets and environmental influences, the demand and supply of health services, and the history of the Ga Mashie community and its inhabitants. The results will be shared with the community in Ga Mashie and with health policy stakeholders in Ghana and other settings where the findings may be usefully transferable for the development of community-based interventions for diabetes prevention and control.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2364498"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC467110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621263","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":"Strategies to address COVID-19 vaccine hesitancy in First Nations peoples: a systematic review.","authors":"Adeline Tinessia, Katrina Clark, Madeleine Randell, Julie Leask, Catherine King","doi":"10.1080/16549716.2024.2384497","DOIUrl":"10.1080/16549716.2024.2384497","url":null,"abstract":"<p><strong>Background: </strong>First Nations peoples face disproportionate vaccine-preventable risks due to social, economic, and healthcare disparities. Additionally, during the COVID-19 pandemic, there was also mistrust and hesitancy about the COVID-19 vaccines among First Nations peoples. These are rooted in factors such as colonial histories, discriminatory medical practices, and unreliable information.</p><p><strong>Objective: </strong>To examine strategies to address COVID-19 vaccine hesitancy among First Nations peoples globally.</p><p><strong>Methods: </strong>A systematic review was conducted. Searches were undertaken in OVID MEDLINE, OVID EMBASE, OVID PsycINFO, CINAHL, and Informit. Searches were date limited from 2020. Items included in this review provided primary data that discussed strategies used to address COVID-19 vaccine hesitancy in First Nations peoples.</p><p><strong>Results: </strong>We identified several key strategies across four countries - Australia, the USA, Canada, and Guatemala in seventeen papers. These included understanding communities' needs, collaborating with communities, tailored messaging, addressing underlying systemic traumas and social health gaps, and early logistics planning.</p><p><strong>Conclusion: </strong>The inclusion of First Nations-centred strategies to reduce COVID-19 vaccine hesitancy is essential to delivering an equitable pandemic response. Implementation of these strategies in the continued effort to vaccinate against COVID-19 and in future pandemics is integral to ensure that First Nations peoples are not disproportionately affected by disease.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2384497"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11376305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127131","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":"Five lessons from a mid-level health manager intervention to increase uptake of tuberculosis prevention therapy in Uganda: 'it is a completely different thing to implement what you know.'","authors":"Jason Johnson-Peretz, Canice Christian, Cecilia Akatukwasa, Fred Atwine, Elijah Kakande, Moses R Kamya, Diane V Havlir, Carol S Camlin, Gabriel Chamie","doi":"10.1080/16549716.2024.2427434","DOIUrl":"10.1080/16549716.2024.2427434","url":null,"abstract":"<p><strong>Background: </strong>Leadership skills are essential for middle-level healthcare manager efficacy. Capacity-building efforts may attempt behavioural change by filling 'knowledge gaps' while neglecting a sustainable application of that knowledge. Sustainable application of that knowledge, or implementation know-how, must resonate with local cultural patterns. When it is neglected, root issues like unclear decision-making space and local authority to interpret policy during implementation remain unaddressed. Particularly in decentralized healthcare systems, the impact can appear in implementation challenges, subjective decision-making, poor teamwork, and an absence of disseminating best practices.</p><p><strong>Objectives: </strong>The SEARCH-IPT trial led a series of mini-collaborative meetings, which provided business leadership and management training for an intervention group of mid-level healthcare system managers in rural Eastern, East-Central, and Southwestern Uganda to see whether this would increase uptake of isoniazid-prevention therapy (IPT) for people living with HIV (PLHIV) in intervention districts. IPT is known to reduce active tuberculosis (TB), a leading cause of death among PLHIV, by 40-60%.</p><p><strong>Methods: </strong>We performed a thematic analysis of six focus-group discussions from this intervention (held in May 2019, January 2020, September 2021) and 23 key informant interviews with control group participants (between February and August 2019 and September and December 2020).</p><p><strong>Results: </strong>Analysis revealed five implementation skill sets District Health Officers (DHOs) and District Tuberculosis and Leprosy Supervisors (DTLSs) deployed to achieve sustainable implementation and realize their decision-making space. The five practices were as follows: data-based decision-making, root-cause analysis, quality assurance, evidence-based empowerment, and sharing best practices with colleagues.</p><p><strong>Conclusion: </strong>These practices reached beyond outcome measures to address root problems around the DHO's range of authority and elicit buy-in from district health workers. For successful capacity building at the mid-manager level, focusing on core practices as part of competency is objectively implementable and measurable at the system level and does not rely on DHO self-assessments.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2427434"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649430","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":"How does community health feature in Global Financing Facility planning documents to support reproductive, maternal, newborn, child and adolescent health and nutrition (RMNAH-N)? insights from six francophone West African countries.","authors":"Joël Arthur Kiendrébéogo, Orokia Sory, Issa Kaboré, Yamba Kafando, Rosie Steege, Asha S George, Meghan Bruce Kumar","doi":"10.1080/16549716.2024.2407680","DOIUrl":"10.1080/16549716.2024.2407680","url":null,"abstract":"<p><strong>Background: </strong>Community health is key for improving Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (RMNCAH-N). However, how community health supports integrated RMNCAH-N service delivery in francophone West Africa is under-researched.</p><p><strong>Objective: </strong>We examined how six francophone West African countries (Burkina Faso, Côte d'Ivoire, Guinea, Mali, Niger, and Senegal) support community health through the Global Financing Facility for Women, Children and Adolescents (GFF).</p><p><strong>Methods: </strong>We conducted a content analysis on Investment Cases and Project Appraisal Documents from selected countries, and set out the scope of the analysis and the key search terms. We applied an iterative hybrid inductive-deductive approach to identify themes for data coding and extraction. The extracted data were compared within and across countries and further grouped into meaningful categories.</p><p><strong>Results: </strong>In country documents, there is a commitment to community health, with significant attention paid to various cadres of community health workers (CHWs) who undertake a range of preventive, promotive and curative roles across RMNCAH-N spectrum. While CHWs renumeration is mentioned, it varies considerably. Most community health indicators focus on CHWs' deliverables, with few related to governance and civil registration. Challenges in implementing community health include poor leadership and governance and resource shortages resulting in low CHWs performance and service utilization. While some countries invest significantly in training CHWs, structural reforms and broader community engagement are lacking.</p><p><strong>Conclusions: </strong>There is an opportunity to better prioritize and streamline community health interventions, including integrating them into health system planning and budgeting, to fully harness their potential to improve RMNCAH-N.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2407680"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11448318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362381","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 the exodus: a 15-year retrospective cohort study on the pattern and determinants of migration among Nigerian doctors and dentists.","authors":"Oghenebrume Wariri, Patience Toyin-Thomas, Itua C G Akhirevbulu, Oladapo Oladeinde, Oluchi Omogbai, Philippa Odika, John Osakue, Avwebo Ukueku, Efetobo Orikpete, Chinelo Iwegim, Efe E Omoyibo, Jermaine Okpere, Uwaila Otakhoigbogie, Ekhosuehi T Agho, Sunday C Madubueze, Nnennaya C Ugoji, Chukwunwike W Ozegbe, Oti N Aria, Paul Ikhurionan","doi":"10.1080/16549716.2024.2432754","DOIUrl":"10.1080/16549716.2024.2432754","url":null,"abstract":"<p><strong>Background: </strong>Nigeria faces a critical shortage of healthcare professionals yet experiences a significant annual exodus of doctors and dentists. This alarming trend threatens the country's ability to provide equitable healthcare.</p><p><strong>Objective: </strong>This study investigated the patterns and determinants of migration among doctors and dentists who graduated from the University of Benin, Nigeria, 15 years ago.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study that tracked 274 of the 379 (72.3%) eligible cohort. We computed the migration incidence rate per person-year from 2008 to 2023, covering 3,455 person-years of follow-up and analysed migration drivers as push and pull factors across macro-, meso-, and micro-levels.</p><p><strong>Results: </strong>Fifteen years post-graduation, 48.9% (134/274) of the cohort had migrated. While the annual incidence rate of migration remained stable for the first 8 years, it spiked after 2016, reaching 11.4 per 100 person-years in 2023. Among those who migrated, the majority (96.3%, 129/134) relocated outside the African continent. The top three destination countries were the UK (48.5%, 65/134), Canada (20.9%, 28/134), and the USA (19.4%, 26/134). The leading push factors were insecurity of lives and property (57.8%), concerns about children's futures (50.3%), and limited career development opportunities (45.9%). The primary pull factors included security (56.3%), permanent residency (49.6%), and better pay in the destination country (46.7%). Significant predictors of migration included younger age, timing of marriage, and residency training status.</p><p><strong>Conclusions: </strong>To avert an impending crisis, the Nigerian government must address the root causes driving the increasing migration of doctors and dentists.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2432754"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752099","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}