Global Health Action最新文献

{"title":"A multilevel analysis on the predictors of client satisfaction with family planning services in Ethiopia: evidence from the Ethiopian service provision assessment (ESPA) 2021/22.","authors":"Michael Endale Mengesha, Henrik Holmberg","doi":"10.1080/16549716.2025.2463215","DOIUrl":"10.1080/16549716.2025.2463215","url":null,"abstract":"<p><strong>Background: </strong>Ethiopia has experienced growth in the utilization of family planning services. However, there are reports of relatively low client satisfaction across the country.</p><p><strong>Objective: </strong>The objective of this study was to assess client and facility level predictors of satisfaction with family planning services in Ethiopia.</p><p><strong>Method: </strong>A multi-level mixed effects logistic regression analysis was conducted on a national survey obtained from the service provision assessment 2021-22. A total of 2071 clients (level one) and 529 facilities (level two) were included.</p><p><strong>Results: </strong>Overall, 56% of clients were highly satisfied with the family planning service they received. Findings from the random effects of the multilevel analysis show there is a significant difference in client satisfaction between facilities, with an intra-class correlation of 0.56 in the null model. At the client-level, age above 30, auditory privacy, and discussion on side effects are significantly associated with higher client satisfaction. At the facility level, having a waiting area, facilities with a quality unit and/or committee, a DHIS2 reporting system, operating for more than 20 days a month, privately owned facilities and availability of family planning guidelines are associated with higher odds of being satisfied. On the other hand, at the client level, having a primary or higher education, increasing wait time and clients asking their providers questions are associated with lower odds of being satisfied. At the facility level, having a fixed user fee significantly reduces the odds of client satisfaction.</p><p><strong>Conclusions: </strong>Human resource and professional development training and health system strengthening is recommended.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"18 1","pages":"2463215"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410895","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":"Cultivating resilience and adaptability through hands-on One Health.","authors":"Phaedra Henley, Anselme Shyaka","doi":"10.1080/16549716.2025.2478694","DOIUrl":"10.1080/16549716.2025.2478694","url":null,"abstract":"<p><p>The University of Global Health Equity's (UGHE) One Health Field School (OHFS) in Rwanda exemplifies an experiential approach to education that integrates human, animal, and environmental health. This field-based program engages students in real-world settings such as abattoirs, health centers, and mining sites to confront pressing public health issues, from zoonotic diseases and antimicrobial resistance to food safety and environmental health. Following Kolb's experiential learning model, OHFS equips graduate students to observe, analyze, and apply solutions to complex health challenges, fostering adaptability, resilience, and collaborative problem-solving skills. By bridging classroom theory with practical application, OHFS cultivates leadership and a holistic understanding of health, preparing graduates to navigate the interconnected global health landscape. Through this innovative approach, UGHE aims to train a generation of health professionals capable of addressing crises such as climate change, biodiversity loss, and emerging infectious diseases at the human-animal-environment interface.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"18 1","pages":"2478694"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659343","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":"Barriers and facilitators for implementation of HPV-based cervical cancer screening in Tanzania: a qualitative study among healthcare providers, stakeholders, and Tanzanian women.","authors":"Karen Grønlund Madsen, Julie Skipper Mosgaard, Martha Oshosen, Patricia Swai, Julius Mwaiselage, Vibeke Rasch, Ditte Søndergaard Linde","doi":"10.1080/16549716.2025.2491852","DOIUrl":"https://doi.org/10.1080/16549716.2025.2491852","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer is the leading cause of cancer-related deaths in Tanzania and the most common form of cancer among Tanzanian women. Screening attendance remains among the lowest globally, necessitating improved attendance and screening methods.</p><p><strong>Objective: </strong>This study aims to assess the feasibility of implementing the World Health Organization's 2021 hPV-based screening guideline in Tanzania by identifying potential barriers and facilitators to HPV-based screening among screening clients, healthcare providers, and stakeholders.</p><p><strong>Methods: </strong>From October 2022 to February 2023, 25 semi-structured interviews were conducted with screening clients (<i>n</i> = 16) and healthcare providers and stakeholders (<i>n</i> = 9) in Moshi and Dar es Salaam. Data were analyzed using a deductive framework based on Bronfenbrenner's Social Ecological Model, supplemented with inductive subcategories from the transcripts.</p><p><strong>Results: </strong>Barriers and facilitators emerged across all levels of the Social Ecological Model. At the individual level, clinic-based screening and a one-visit approach were barriers, while HPV-self-sampling was a facilitator. Interpersonal barriers included limited social support, while referrals served as facilitators. Community-level barriers included fear and misconceptions, countered by facilitators such as increased awareness and health education. Health system challenges included restrictive age limits and urbanization of human resources, with uptake through other health services acted as a facilitator. Political barriers highlighted the need for a steady local supply chain, while cost reduction could serve as a facilitator for guideline implementation.</p><p><strong>Conclusion: </strong>WHO's 2021 hPV-based screening guideline shows promise in Tanzania, but barriers such as clinic availability, fear, misconceptions, and supply chain issues must be addressed to ensure successful implementation.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"18 1","pages":"2491852"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12024489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065111","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 benefits, barriers, and specific needs of palliative care for adults with cancer in sub-Saharan Africa: a systematic review.","authors":"Fawziyyah Usman Sadiq, Yu-Lyu Yeh, Hung-En Liao, Muhammad Alwi Eka Pranata, Sneha Patnaik, Yin-Hwa Shih","doi":"10.1080/16549716.2025.2485742","DOIUrl":"https://doi.org/10.1080/16549716.2025.2485742","url":null,"abstract":"<p><p>People living in low - and middle-income countries are less likely to receive palliative care. Early delivery of palliative care reduces unnecessary hospital admissions and improves patients' and their families' quality of life. This systematic review has compiled and scrutinized adult cancer patients' benefits, barriers, and specific palliative care needs in sub-Saharan Africa (SSA) to provide stakeholders with vital information that can improve the support and care provided to this expanding patient population. A systematic literature search was conducted using PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, Medline, and ProQuest under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included in the review focused on the utilization of palliative care among adult cancer patients in sub-Saharan Africa. The Joanna Briggs Institute (JBI) Critical Appraisal tools assessed study quality. This review synthesized findings from 16 studies and highlights that access to palliative care improves cancer patients' quality of life, satisfaction, and outlook on diagnosis. However, limited knowledge, financial constraints, and systemic obstacles impede access. Patients' needs were categorized into four themes: physical comfort, psychosocial support, spiritual well-being, and socioeconomic assistance. Palliative care improves adult cancer patients' quality of life in sub-Saharan Africa, but barriers hinder access. To address the challenges and meet patients' needs, enhancing literacy about palliative care, providing financial support, and implementing structured and sustainable palliative care models are essential for strengthening services and improving regional healthcare.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"18 1","pages":"2485742"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065121","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 twinning initiative between midwife associations in Ghana and Sweden -A process evaluation study.","authors":"Hanna Fjellström, Emelie Sandberg, Johanna Blomgren, Malin Grahn, Fredrica Hanson, Netta Ackon, Gifty Baidoo, Louise Nordström, Malin Bogren","doi":"10.1080/16549716.2025.2457824","DOIUrl":"10.1080/16549716.2025.2457824","url":null,"abstract":"<p><strong>Background: </strong>This study describes the evaluation of a twinning initiative between the Ghana Register Midwives Association and the Swedish Association of Midwives. Recognising the importance of midwives being supported by a national midwife association, the initiative was to strengthen the professional association in Ghana as a labour union and to inspire Swedish midwives to involve themselves in international work.</p><p><strong>Objective: </strong>The study aimed to evaluate a twinning initiative between the Ghana Registered Midwives Association and the Swedish Association of Midwives.</p><p><strong>Method: </strong>Two focus group discussions and four individual interviews were held with nine midwives from the Ghana Registered Midwives Association (<i>n</i> = 6) and the Swedish Association of Midwives (<i>n</i> = 3). The interviews and analysis were guided by a process evaluation framework using content analysis.</p><p><strong>Results: </strong>The twinning initiative was successfully implemented regarding fidelity, dose, and reach, despite adaptations to the original project plan. Both associations gained visibility, with the Ghana Registered Midwives Association growing its paid membership by 97%, from 631 to 1,245 members during the twinning initiative. The results suggest that the Swedish Association of Midwives enhanced its understanding of international midwifery, promoted knowledge exchange, and raised awareness of midwives' global roles in improving care.</p><p><strong>Conclusion: </strong>The Ghana Registered Midwives Association and the Swedish Association of Midwives had a positive experience with the twinning initiative, despite deviations from the original plan. Midwives from both associations benefitted from sharing best practices and mutual support in their roles as newly formed labour trade unions. These findings could benefit other midwife associations in future twinning initiatives.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"18 1","pages":"2457824"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080951","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":"'Too much, too little' - heat wave impact during pregnancy and the need for adaptation measures.","authors":"Ashish Kc, Masoud Vaezghasemi","doi":"10.1080/16549716.2025.2476277","DOIUrl":"10.1080/16549716.2025.2476277","url":null,"abstract":"<p><p>The balls are rolling for climate change, with increasing vulnerability to women and children related to climate extreme events. Recent evidence has shown that acute exposure to heat wave during pregnancy can be associated with adverse health outcomes in childhood, with the risk being significantly higher among socially disadvantaged population, despite their lack of contribution to global carbon dioxide emissions and the rising global ambient temperature. This unequal impact requires utmost attention to develop tools, establish interdisciplinary teams, and to implement evidence-based interventions for the betterment of women and children in climate-vulnerable populations.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"18 1","pages":"2476277"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617801","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":"Service providers' self-perceived competence in supporting women with disabilities subjected to intimate partner violence: insights from a Swedish survey.","authors":"Cartrine Anyango, Erling Häggström Gunfridsson, Fredinah Namatovu","doi":"10.1080/16549716.2025.2476822","DOIUrl":"10.1080/16549716.2025.2476822","url":null,"abstract":"<p><strong>Background: </strong>Intimate partner violence (IPV) is a global issue, with women, especially those with disabilities, facing a higher lifetime risk than those without disabilities. Given the elevated risk factors and challenges related to having a disability, it is crucial to provide effective IPV support. The competence and expertise of service providers regarding IPV significantly influence their ability to provide adequate IPV support. Understanding service providers' self-perceived competence is essential for improving the quality of IPV support for women with disabilities.</p><p><strong>Objective: </strong>This study assesses the self-perceived competence of service providers in supporting women with disabilities subjected to IPV in Sweden.</p><p><strong>Methods: </strong>A cross-sectional survey was distributed to professionals in healthcare, social services, and the police, and 1,151 people participated. Descriptive statistics and linear regression analyses were performed to assess the factors influencing service providers' self-perceived competence.</p><p><strong>Results: </strong>The findings indicate that healthcare, police, and social services professionals often encounter women with disabilities, but they rarely ask them directly about IPV. Many don't routinely inquire about IPV exposure. While institutional routines for addressing IPV exist, service providers don't consistently implement or use them. Key factors influencing self-perceived competence include receiving IPV and disability-specific training and sufficient employer support for addressing IPV among women with disabilities.</p><p><strong>Conclusions: </strong>The findings underscore the need for a more consistent application of routines and enhanced training to strengthen the capacity of service providers to support women with disabilities subjected to IPV.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"18 1","pages":"2476822"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796834","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":"Financial motivation models for community health workers in low- and middle-income countries: a scoping review.","authors":"Oumar Mallé Samb, Mariétou Niang, Emilie Gelinas, Ndeye Thiab Diouf, Titilayo Tatiana Agbadje, Abir El Haouly","doi":"10.1080/16549716.2025.2480412","DOIUrl":"10.1080/16549716.2025.2480412","url":null,"abstract":"<p><p>Community health workers (CHWs) are key players in providing primary healthcare in low- and middle-income countries. However, their absence from the formal health system in many of these countries often presents a challenge to their remuneration. The objective of this scoping review is to document programs implemented at both small and large scales in low- and middle-income countries, the remuneration strategies they have established, and the effects of these strategies on the work of CHWs. In total, we included 50 articles in this review. We have identified four types of compensation: fixed compensation, performance-based compensation, compensation based on income-generating activities (IGAs), and combined compensation. We identified the strengths and weaknesses of each type of compensation. A common strength for most models was improvement in motivation and performance. A common weakness for most models was irregular payments. The results of this review highlight the need to consider the economic, social, and cultural settings of the countries or environments at hand, and to include CHWs in discussions regarding the selection of a compensation model.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"18 1","pages":"2480412"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781849","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":"Term stillbirths in Eastern Uganda: a community-based prospective cohort study.","authors":"Martin Chebet, Peter Olupot-Olupot, Andrew D Weeks, Ingunn Marie S Engebretsen, Noela Regina Akwi Okalany, Francis Okello, Thorkild Tylleskär, Kathy Burgoine, David Mukunya","doi":"10.1080/16549716.2024.2448895","DOIUrl":"10.1080/16549716.2024.2448895","url":null,"abstract":"<p><strong>Background: </strong>Every year, 1.9 million stillbirths occur worldwide, of whom 1.5 million occur in sub-Saharan Africa (SSA) and Southeast Asia.</p><p><strong>Objectives: </strong>This study aims to determine the incidence and risk factors and to describe underlying causes for term stillbirths in Eastern Uganda.</p><p><strong>Methods: </strong>This was a cohort study of pregnant women enrolled at 34 weeks of gestation or more and followed to birth between January 2021 and January 2024. Enrolment and follow-up were done in the community by trained midwives. Using structured questionnaires, details of maternal health, pregnancy and birth were captured.</p><p><strong>Results: </strong>We enrolled 6101 participants and analysed 5496 for incidence of term stillbirth and 5296 for risk factors. Of the participants, 4913/5296 (92.8%) were between 14 and 35 years, and 4456/5296 (84.1%) had a health facility birth. There were 101 term stillbirths (61 were intrapartum and 40 antepartum). The incidence of term stillbirth was 18.4 per 1000 births (95% CI 14.8 to 22.9). The most common underlying causes of stillbirth were prolonged or obstructed labour 32/101 (31.7%) and malaria 20/101 (19.8%). The factors associated with term stillbirths were caesarean birth (aRR 3.3; 95% CI 2.00 to 5.4), intimate partner violence (aRR 1.8; 95% CI 1.1 to 2.8) and maternal age above 35 years (aRR 2.2; 95% CI 1.2 to 3.9).</p><p><strong>Conclusion: </strong>Eastern Uganda has a high rate of term stillbirths with more than half occurring during labour. Efforts are needed to improve the quality of birth care and to prevent intimate partner violence.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"18 1","pages":"2448895"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081438","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":"Low-level viremia in people with HIV in Ethiopia is associated with subsequent lack of viral suppression and attrition from care.","authors":"Ilili Jemal Abdulahi, Per Björkman, Alemseged Abdissa, Patrik Medstrand, Anton Reepalu, Olof Elvstam","doi":"10.1080/16549716.2025.2464342","DOIUrl":"10.1080/16549716.2025.2464342","url":null,"abstract":"<p><strong>Background: </strong>Low-level viremia during antiretroviral therapy (ART) has been associated with inferior outcomes, but knowledge on the impact of low-level viremia in the current era of dolutegravir-based ART in low-income countries is limited.</p><p><strong>Objective: </strong>To investigate whether low-level viremia predicts virologic non-suppression and attrition from care in people with HIV receiving ART in Ethiopia.</p><p><strong>Methods: </strong>We included people receiving ART at public health facilities in an urban area in central Ethiopia and categorized persons with ≥1 available viral load 2019-2020 as having either suppression (<u><</u>150 copies/mL) or low-level viremia (151-1,000 copies/mL); people with >1,000 copies/mL were excluded. We used multivariable logistic regression adjusted for age, sex, ART regimen, type of health facility, and duration of ART to analyze the associations between viremia category and incidence of unsuppressed viral load (>1,000 copies/mL) and attrition from care (death or loss to follow-up) during 3 years of follow-up.</p><p><strong>Results: </strong>Among 12,165 participants, the median age was 44 years, 64.2% were female, and 89.1% received tenofovir/lamivudine/dolutegravir. Of the study population, 11,959 (98.3%) had suppression and 206 (1.7%) had low-level viremia. Over 3 years of follow-up, 2.2% of participants with suppression and 11.3% with low-level viremia had unsuppressed viral load. Low-level viremia was associated with both unsuppressed viremia (adjusted odds ratio [aOR], 3.7; 95% confidence interval [CI], 2.2-6.2) and attrition (aOR, 3.4; 95% CI, 1.7-6.6).</p><p><strong>Conclusion: </strong>Among Ethiopian people with HIV receiving ART, low-level viremia predicted subsequent virologic non-suppression and attrition from care, supporting current recommendations for heightened attention to low-level viremia in ART recipients.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"18 1","pages":"2464342"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411043","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}