Global Health Action最新文献

{"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":"Challenges and possible improvements for healthcare teams at outreach clinics in Nepal - a qualitative study.","authors":"Ingrid Eriksen, Eirin Helene Rasmussen, Biraj Karmacharya, Seema Das, Elisabeth Darj, Maria Lisa Odland","doi":"10.1080/16549716.2024.2385177","DOIUrl":"10.1080/16549716.2024.2385177","url":null,"abstract":"<p><strong>Background: </strong>All Nepalese citizens have the right to high-quality healthcare services free of charge. To achieve this, healthcare services for the rural population in Nepal need to be improved in terms of personnel, medicines, and medical equipment.</p><p><strong>Objectives: </strong>To explore challenges and possible improvements healthcare personnel experience when travelling to rural parts of Nepal to provide healthcare.</p><p><strong>Method: </strong>Data was collected from various health professionals using focus group discussions at Dhulikhel Hospital in Nepal. The data were transcribed and analysed using Systematic text condensation.</p><p><strong>Results: </strong>Twenty-two professional healthcare personnel participated in five group discussions. Four categories emerged from the collected material: Finding ORC services being underutilised, Wanting to fulfil tasks and do a good job, Facing inadequate resources, and Seeing the need for improved organisation and cooperation. There was consensus that rural clinics are important to maintaining health for the rural population of Nepal. However, there was frustration that the rural population was not benefitting from all available healthcare services due to underutilisation.</p><p><strong>Conclusion: </strong>Rural healthcare clinics are not utilised appropriately, according to healthcare workers at the rural outreach clinics. Potential ways of overcoming the perceived challenges of underutilising available healthcare services include financial and human resources. The rural population´s health awareness needs to be increased, and the work environment for rural healthcare workers needs to be improved. These issues need to be prioritised by the government and policymakers.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2385177"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11308952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898704","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}

{"title":"Financial inclusion for people with disability: a scoping review.","authors":"Louise Puli, Natasha Layton, Diane Bell, Abu Zafar Shahriar","doi":"10.1080/16549716.2024.2342634","DOIUrl":"10.1080/16549716.2024.2342634","url":null,"abstract":"<p><strong>Background: </strong>Financial exclusion is a human rights issue affecting health equity. Evidence demonstrates that financial exclusion is exacerbated for people with disability and those in low- to middle-income countries (LMIC). Barriers to financial access include limited demand for services, banking inadequacies in catering to people with disability, and insufficiently accessible information technologies (ICT) and infrastructure.</p><p><strong>Objectives: </strong>This scoping review sought to identify barriers to and facilitators of financial inclusion for people with disability in LMIC. As a secondary objective, the study explored the potential of financial education and ICT utilisation as viable strategies for enhancing financial inclusion.</p><p><strong>Methods: </strong>This review utilised the Arksey and O'Malley framework and PRISMA Checklist for systematic literature examination and data extraction. The WHO's Environmental Factors guided the analysis to propose potential interventions and to generate recommendations.</p><p><strong>Results: </strong>The review analysed 26 publications from various global regions and fields including finance, business, technology, health and disability policy. It identified consistent financial inclusion barriers for people with disability, resulting in a set of global recommendations across attitudes, environment, technology, services, and policy.</p><p><strong>Conclusions: </strong>Recommendations include using ICT, digital innovation and multi-stakeholder collaboration to address the financial barriers experienced by people with disability. These efforts, rooted in social justice, aim to include people with disability in LMIC as valued financial sector participants, promoting health and equity.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2342634"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11089913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899940","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 contextual awareness, response and evaluation (CARE) diabetes project: study design for a quantitative survey of diabetes prevalence and non-communicable disease risk in Ga Mashie, Accra, Ghana.","authors":"Swaib Abubaker Lule, Sandra Boatemaa Kushitor, Carlos S Grijalva-Eternod, Kafui Adjaye-Gbewonyo, Olutobi Adekunle Sanuade, Mawuli Komla Kushitor, Lydia Okoibhole, Raphael Awuah, Leonard Baatiema, Irene Akwo Kretchy, Daniel Arhinful, Ama de-Graft Aikins, Kwadwo Koram, Edward Fottrell","doi":"10.1080/16549716.2023.2297513","DOIUrl":"10.1080/16549716.2023.2297513","url":null,"abstract":"<p><p>Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual Awareness, Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed methods study that aims to understand diabetes in the Ga Mashie area of Accra, identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2297513"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139698649","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":"Validating the diagnostic accuracy of medical certification: a population-level comparison between verbal autopsy and Saudi medical records causes of death of deceased with type 2 diabetes.","authors":"Faleh Alyazidi, Deler Shakely, Fawaz R Alyazidi, Max Petzold, Laith Hussain-Alkhateeb","doi":"10.1080/16549716.2024.2448382","DOIUrl":"10.1080/16549716.2024.2448382","url":null,"abstract":"<p><strong>Background: </strong>In contexts where certifying causes of death (COD) is inadequate - either in industrialized or non-industrialized countries - verbal autopsy (VA) serves as a practical method for determining probable COD, helping to address gaps in vital data.</p><p><strong>Objective: </strong>This study aimed to validate the diagnostic accuracy of medical certifications at a population level by comparing COD obtained from medical records against those derived from VA in Saudi Arabia.</p><p><strong>Method: </strong>Death records from 2018 to 2021 were collected from a type 2 diabetes mellitus register at a major specialist hospital in Makkah. Three hundred and two VA interviews were completed with deceased patients' relatives, and the probable COD was determined using InterVA-5 software. Lin's concordance correlation coefficient was applied to examine similarities of the cause-specific mortality fractions (CSMFs) based on International Classification of Diseases chapters from both verbal autopsy causes of death (VACOD) and the physician review causes of death (PRCOD).</p><p><strong>Results: </strong>Overall, the findings demonstrated a moderate level of concordance of COD at the population between VACOD and PRCOD. However, the CSMFs for various COD categories derived from both sources showed a broad spectrum of absolute differences, with the largest disparities observed among the most prevalent COD categories.</p><p><strong>Conclusion: </strong>PRCOD was found to overestimate population-level endocrine/metabolic and respiratory disease COD while underestimating circulatory disease, demonstrating medical certification challenges. Conversely, affirming previous literature on prevalent COD in Saudi Arabia, VA appears to deliver a plausible assessment, further strengthening its potential to integrate within the Saudi health system towards an augmented medical certification process.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2448382"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014800","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":"Quality and resilience of clinical laboratories in Rwanda: a need for sustainable strategies.","authors":"Vincent Rusanganwa, Innocent Nzabahimana, Magnus Evander","doi":"10.1080/16549716.2024.2358633","DOIUrl":"10.1080/16549716.2024.2358633","url":null,"abstract":"<p><strong>Background: </strong>Quality healthcare is a global priority, reliant on robust health systems for evidence-based medicine. Clinical laboratories are the backbone of quality healthcare facilitating diagnostics, treatment, patient monitoring, and disease surveillance. Their effectiveness depends on sustainable delivery of accurate test results. Although the Strengthening Laboratory Management Towards Accreditation (SLMTA) programme has enhanced laboratory quality in low-income countries, the long-term sustainability of this improvement remains uncertain.</p><p><strong>Objective: </strong>To explore the sustainability of quality performance in clinical laboratories in Rwanda following the conclusion of SLMTA.</p><p><strong>Methods: </strong>A quasi-experimental design was adopted, involving 47 laboratories divided into three groups with distinct interventions. While one group received continuous mentorship and annual assessments (group two), interventions for the other groups (groups one and three) ceased following the conclusion of SLMTA. SLMTA experts collected data for 10 years through assessments using WHO's StepwiseLaboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. Descriptive and t-test analyses were conducted for statistical evaluation.</p><p><strong>Results: </strong>Improvements in quality were noted between baseline and exit assessments across all laboratory groups (mean baseline: 35.3%, exit: 65.8%, <i>p</i> < 0.001). However, groups one and three experienced performance declines following SLMTA phase-out (mean group one: 64.6% in reference to 85.8%, <i>p</i> = 0.01; mean group three: 57.3% in reference to 64.7%, <i>p</i> < 0.001). In contrast, group two continued to enhance performance even years later (mean: 86.6%compared to 70.6%, <i>p</i> = 0.03).</p><p><strong>Conclusion: </strong>A coordinated implementation of quality improvement plan that enables regular laboratory assessments to pinpoint and address the quality gaps is essential for sustaining quality services in clinical laboratories.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2358633"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201023","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":"Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia.","authors":"Alieu Sowe, Fredinah Namatovu, Bai Cham, Per E Gustafsson","doi":"10.1080/16549716.2024.2348788","DOIUrl":"10.1080/16549716.2024.2348788","url":null,"abstract":"<p><strong>Objectives: </strong>Six million children were under-vaccinated in 2022. Our study aimed to 1) quantify the magnitude of under-vaccination variation between health facilities, 2) assess to which extent individual and health center level factors contributed to the variation, 3) identify individual and health facility factors associated with under-vaccination, and 4), explore rural vs. urban health facility variations.</p><p><strong>Methods: </strong>We used data from 61,839 children from The Gambia national routine vaccination register. We cross tabulated under-vaccination status across study variables and fitted two-level random intercept multilevel logistic regression models to measure variance, contribution to the variance, and factors associated with the variance and under-vaccination.</p><p><strong>Results: </strong>We found that 7% of the prevalence of under-vaccination was due to variation between health facilities. Thirty-seven percent of the variation was explained by individual and health center variables. The variables explained 36% of the variance in urban and 19% in rural areas. Children who were not vaccinated at 4 months or with delayed history, due for vaccination in the rainy season, and health facilities with very small or large population to health worker ratios had higher under-vaccination odds.</p><p><strong>Conclusion: </strong>Our study indicates that one of the pathways to improving vaccination coverage is addressing factors driving under-vaccination inequities between health facilities through urban-rural differentiated strategies.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"17 1","pages":"2348788"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201038","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}