BMC global and public health最新文献

{"title":"Resilience measurement for environmental shocks and stressors: scale development and psychometric assessment for coastal urban informal settlements in Fiji and Indonesia.","authors":"Hemali H Oza, Allison P Salinger, Ruzka Taruc, Autiko Tela, S Fiona Barker, Karin Leder, Matthew C Freeman, Thomas Clasen, Sheela S Sinharoy","doi":"10.1186/s44263-025-00177-3","DOIUrl":"10.1186/s44263-025-00177-3","url":null,"abstract":"<p><strong>Background: </strong>Climate change and weather-related hazards, such as droughts and floods, pose substantial threats to the human health and well-being, especially for those in low-income households and informal settlements. Resilience, defined as the ability to cope, adapt, and recover, is critical for communities to manage these evolving threats. While there has been increased interest in ensuring that global public health and development programs contribute to resilience, the lack of valid and user-friendly resilience measurement tools limits the evidence base on the effectiveness of interventions to build resilience.</p><p><strong>Methods: </strong>We developed scales to measure economic, environmental, and social resilience to environmental shocks/stressors among urban informal settlements in low- and middle-income countries. Using an evidence-based conceptual framework, we collected data from 882 households in coastal informal settlements in Makassar, Indonesia and Suva, Fiji. We used factor analysis and item response theory approaches and assessed internal scale validity, reliability, and measurement equivalence.</p><p><strong>Results: </strong>Analysis supported a one-factor model for economic resilience, which showed a positive correlation with a financial satisfaction item, providing evidence of internal construct validity. The results also indicated a four-factor model for social resilience, with subscales for inclusion, social cohesion, collective efficacy and action, and preparedness. These subscales correlated with relevant external items-community satisfaction and perceived safety-supporting internal construct validity. The environmental resilience scale performed poorly in item response theory analysis and requires substantial refinement. The economic resilience scale demonstrated configural, metric, and scalar equivalence, suggesting that scores are comparable between households in Indonesia and Fiji. The social resilience scales showed only configural equivalence, indicating potential differences in how items relate to the underlying construct across countries. Both the economic and social resilience scales demonstrated acceptable reliability, with omega coefficients > 0.70.</p><p><strong>Conclusions: </strong>We developed and internally validated scales to measure economic and social resilience to environmental disturbances that quantify resilience as a latent construct and are grounded in resilience theory. These scales are suitable for application in urban informal settlements in Indonesia and Fiji. We recommend their use, with re-validation as needed, in the monitoring and evaluation of resilience-building interventions and policies targeting urban households in low-income settings.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"3 1","pages":"61"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual and reproductive health of in-transit migrant women en route to the United States: a mixed-methods study in Ciudad Juárez, Mexico.","authors":"Silvana Larrea-Schiavon, César Infante, Jay Graham, Sylvia Guendelman","doi":"10.1186/s44263-025-00180-8","DOIUrl":"10.1186/s44263-025-00180-8","url":null,"abstract":"<p><strong>Background: </strong>The number of undocumented in-transit migrant women (UITMW) traveling through Mexico to the U.S. is increasing, with longer stays in Mexico. We explore how UITMW's sexual and reproductive health (SRH) needs and service utilization for these needs vary by time spent in Mexico and availability of instrumental social support. We also identify barriers to care and propose actionable steps to improve service delivery.</p><p><strong>Methods: </strong>We conducted a sequential quantitative-qualitative mixed-methods study in Ciudad Juárez, Mexico. It includes a secondary analysis of a 2021 survey of 252 UITMW and a primary analysis of 31 stakeholder interviews in 2023, that elaborated on the survey findings. Guided by Andersen's Behavioral Model of Health Care Utilization, we performed bivariate analyses to assess SRH needs and service utilization by time spent in Mexico and instrumental social support. Multivariate logistic regression models estimated unadjusted (ORs), adjusted odds ratios (aORs), and 95% confidence intervals (95% CIs) to assess these associations and the modifying effect of instrumental social support. For the qualitative component, we applied a framework analysis structured around four key themes from the quantitative findings to contextualize results and identify barriers and actionable solutions.</p><p><strong>Results: </strong>Nine in ten UITMW experienced at least one SRH need, yet only 33.6% accessed SRH services. Interviewees cited fear of organized crime, government authorities, and constant mobility as key barriers. While longer stays in Mexico were initially associated with higher SRH utilization, this was no longer significant when adjusting for covariates (aOR 1.87; 95% CI 0.83-4.19). However, among women without instrumental social support, longer stays significantly increased the odds of SRH service utilization (aOR 6.99; 95% CI 1.42-34.45). This pattern may reflect greater challenges accessing care earlier in their stay. Qualitative findings suggest that instrumental social support may facilitate service utilization by enabling childcare, sharing information, and fostering connections.</p><p><strong>Conclusions: </strong>UITMW face SRH needs and multiple barriers to care while in Mexico. Utilization is particularly challenging for UITMW who experience sexual violence and lack instrumental social support. Understanding the factors influencing the health needs and SRH utilization of UITMW can help Mexico's health system plan effective interventions.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"3 1","pages":"60"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translating risk-based breast cancer screening to limited-resource settings.","authors":"Kimberly Badal, Akash Maniam, Sarafina Urenna Otis, Laura J Esserman","doi":"10.1186/s44263-025-00176-4","DOIUrl":"10.1186/s44263-025-00176-4","url":null,"abstract":"","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"3 1","pages":"59"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12224836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality risk in migrant and non-migrant individuals with chronic hepatitis B virus infection: a French hospital-based cohort study (ANRS CO22 HEPATHER).","authors":"Marta Lotto, Clémence Ramier, Fabrice Carrat, Lauren Périères, Elisabeth Delaroque-Astagneau, Jérôme Nicol, Fabienne Marcellin, Fabien Zoulim, Vincent Di Beo, Mathilde Bertheau, Stanislas Pol, Camelia Protopopescu, Marc Bourlière, Patrizia Carrieri","doi":"10.1186/s44263-025-00173-7","DOIUrl":"10.1186/s44263-025-00173-7","url":null,"abstract":"<p><strong>Background: </strong>Migrants in Europe are disproportionately affected by hepatitis B virus (HBV) infection, especially those coming from endemic countries. We aimed to determine whether migrant status was associated with all-cause mortality risk in people living with chronic HBV infection integrated into a hospital-based care pathway in France.</p><p><strong>Methods: </strong>We analysed clinical and socio-behavioural data collected over 8 years of follow-up among patients with chronic HBV infection enrolled in the French prospective multicentre cohort ANRS CO22 HEPATHER. Migrant status was tested as a binary variable (non-migrants versus migrants) and according to three categories (low, moderate, and high) of HBV endemicity in the migrants' region of birth. The association between migrant status and all-cause mortality risk was assessed using a multivariable Cox proportional hazards model. A competing risks analysis was conducted for liver-related and non-liver-related mortality.</p><p><strong>Results: </strong>Of the 5597 study participants, accounting for 33,222.8 person-years (PY), 68.1% were migrants, mainly from Sub-Saharan Africa and Asia. During follow-up, 247 patients died and the all-cause mortality rate [95% confidence interval (CI)] was 7.4 [6.6-8.4]/1000 PY. Migrants had a lower mortality rate than non-migrants: 4.5 [3.7-5.5]/1000 PY versus 13.5 [11.4-15.8]/1000 PY (p < 0.001), irrespective of migrants' region of birth and time since arrival in France. After adjustment for sex, age, living in poverty, alcohol use, tobacco smoking, diabetes, and HBV disease phase, the all-cause mortality risk was still lower in migrants than in non-migrants (adjusted hazard ratio [95% CI] 0.58 [0.43-0.78], p < 0.001). All three migrant HBV endemicity categories had a lower risk of all-cause and non-liver-related mortality than non-migrants. By contrast, these differences were not significant for liver-related mortality.</p><p><strong>Conclusions: </strong>A lower all-cause, liver-related and non-liver-related mortality risk was found among migrants with chronic HBV infection in France compared to non-migrants. However, after multivariable adjustment, the liver-related mortality risk was similar between migrants and non-migrants, indicating that mortality advantage for migrants is explained by the protective adjustment factors, such as younger age, less advanced liver disease and fewer unhealthy behaviours. In contrast, these factors did not fully explain the observed mortality advantage for both non-liver-related and all-cause mortality.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov registry number: NCT01953458.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"3 1","pages":"58"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rnaught: a web tool for estimating the basic reproduction number.","authors":"Tatiana Krikella, Naeem Model, Sawitree Boonpatcharanon, Kseniia Lipikhin, Jane M Heffernan, Hanna Jankowski","doi":"10.1186/s44263-025-00178-2","DOIUrl":"10.1186/s44263-025-00178-2","url":null,"abstract":"","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"3 1","pages":"57"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modelling the effect of a nutritional shock on tuberculosis in India.","authors":"Rebecca A Clark, Roel Bakker, Peter Alexander, Roslyn Henry, Richard G White, Pranay Sinha, Rein M G J Houben, C Finn McQuaid","doi":"10.1186/s44263-025-00153-x","DOIUrl":"10.1186/s44263-025-00153-x","url":null,"abstract":"<p><strong>Background: </strong>Environmental or social changes and shocks that reduce access to adequate nutrition have potential consequences for tuberculosis (TB), as undernutrition is a major driver of TB incidence and poor TB treatment outcomes.</p><p><strong>Methods: </strong>We developed a transmission model of TB in India with an explicit body mass index (BMI) strata linked to disease progression and treatment outcomes, calibrated to country-specific TB estimates. We projected nutritional shock scenarios affecting supply chains, similar to those experienced at the beginning of the war in Ukraine, using the LandSyMM food system model, compared to a continuation of previous food system trends. Within each scenario, increases in food, fertiliser, and energy prices were linked to changes in the population BMI distribution by food availability and prices. We estimated the impact on TB incidence and mortality in India between 2022 and 2035 of these nutritional shock scenarios compared to maintenance of prior trends.</p><p><strong>Results: </strong>The worst-case scenario, involving sustained increases in food, fertiliser, and energy prices, predicted that shocks increasing undernutrition could result in a 5.0% (95% uncertainty interval = 4.4, 5.9) and 4.9% (4.2, 5.9) increase in TB incidence and mortality respectively in India in 2035 compared to continuation of previous food system trends. In this scenario, an additional 1.1 million (0.9, 1.3) TB episodes and 177.5 thousand (144.7, 224.3) TB deaths were predicted to occur between 2022 and 2035.</p><p><strong>Conclusions: </strong>Shocks affecting the population-level BMI distribution could lead to changes in the burden of TB disease. Our findings suggest that the impact of crises on TB disease may be underestimated if the impacts of external shocks on nutrition are not explicitly considered.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"3 1","pages":"56"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is membership in microfinance initiatives associated with viral load suppression among HIV patients? Evidence from western Kenya.","authors":"Bishnu Bahadur Thapa, Becky Genberg, Juddy Wachira, Jon Steingrimsson, Omar Galarraga","doi":"10.1186/s44263-025-00170-w","DOIUrl":"10.1186/s44263-025-00170-w","url":null,"abstract":"<p><strong>Background: </strong>Social and economic factors have considerable influence on the lives of people living with HIV (PLHIV). These factors shape their health behaviors, willingness to engage with other members of their communities for support, and ability to seek appropriate and timely treatment options. Evidence has shown that microfinance initiatives, by providing access to credit and social networks, have the potential to help PLHIV overcome some of these barriers. The objective of this study was to understand the association between microfinance membership and viral load suppression among HIV patients.</p><p><strong>Methods: </strong>We used data from the Academic Model Providing Access to Healthcare (AMPATH)-Kenya's Group Integrated Savings for Health Empowerment (GISHE), a microfinance initiative (MFI), to study the association between GISHE participation and viral load suppression. Our longitudinal dataset consisted of a matched group of 3609 HIV patients. We examined the association between GISHE membership and viral load suppression by addressing the missing data problem with respect to the viral load count via multiple imputation.</p><p><strong>Results: </strong>Our study revealed that GISHE membership was associated with increased viral load suppression (adjusted odds ratio (AOR) = 1.15; 95% confidence interval (CI), 1.03-1.29). Further, the study found that male patients were less likely to be virally suppressed (AOR = 0.85; 95% CI, 0.74-0.97), as were the patients in the most advanced disease stage (AOR = 0.71; 95% CI, 0.52-0.95). The finding that GISHE participation was associated with a greater likelihood of viral load suppression held even after addressing the missing data problem.</p><p><strong>Conclusions: </strong>We conclude that GISHE-type programs hold promise as scalable interventions to combat HIV/AIDS in Kenya and other countries where the disease is a generalized epidemic.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"3 1","pages":"55"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12199483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using implementation science to enhance specialized mental health supervision: pre-implementation assessment and rapid qualitative methods.","authors":"Tonya Van Deinse, Allison Waters, Kasey Barton, Sherri Bloodworth, Nicholas Powell","doi":"10.1186/s44263-025-00174-6","DOIUrl":"10.1186/s44263-025-00174-6","url":null,"abstract":"<p><strong>Background: </strong>Although implementation science methods have been widely used across all sectors of healthcare, they are less commonly used to promote health interventions within criminal legal system settings. This gap in the research is problematic given the need for effective treatments to address comparatively worse health and mental health outcomes among people involved in the criminal legal system. Additionally, there have been relatively few published studies documenting methods at the pre-implementation phase. This article reports on a pre-implementation assessment conducted as part of a grant-funded initiative with a statewide community supervision agency to address key limitations in the state's Specialized Mental Health Supervision program by piloting two implementation strategies: clinical case consultation and enhancing mental health officers' relationships with behavioral health service providers.</p><p><strong>Methods: </strong>The purpose of this study was to provide agency leaders with practical and timely information to make decisions regarding their plan for rolling out the initiative. Within a 30-day timeframe, the research team conducted 22 brief, semi-structured interviews with members of the implementation team and community supervision officers and their supervisors. The team then used rapid qualitative analysis methods to identify potential challenges and facilitators of the implementation strategies and make recommendations to improve implementation.</p><p><strong>Results: </strong>Although participants indicated that considering mental health symptoms was a top factor in caseload assignment and step-down, they believed other stabilizing factors (e.g., housing, employment) and risk for re-offense should also be considered. Participants described the need for more training on mental health topics and the local service system. Lastly, the agency learned about factors that could impact the consultation process (e.g., trusting the consultant, maintaining a growth mindset) and relationships with behavioral health service providers (e.g., having a common language between community supervision and behavioral health), officer workload, and leadership engagement.</p><p><strong>Conclusions: </strong>Pre-implementation assessments, including those conducted using rapid analysis methods, should be routine practices when launching an intervention or an implementation strategy under real-world conditions. These assessments provide agencies and their research partners with actionable and tailored information that can enhance the pace and effectiveness of their implementation efforts.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"3 1","pages":"54"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the intersection of demographics, behavior, and government response to the COVID-19 pandemic: an observational cohort study.","authors":"Katherine M Kennedy, Erica N DeJong, Alexander W Y Chan, Allison E Kennedy, Alainna Jamal, Michael G Surette, Maggie J Larché, Mark Larché, Nathan Hambly, Kjetil Ask, Stephanie A Atkinson, Paul D McNicholas, Allison McGeer, Brenda L Coleman, Dawn M E Bowdish","doi":"10.1186/s44263-025-00162-w","DOIUrl":"10.1186/s44263-025-00162-w","url":null,"abstract":"<p><strong>Background: </strong>During the early phase of the COVID-19 pandemic, the province of Ontario enacted restrictions and recommendations that changed over time. These measures were effective in reducing COVID-19-related illness and deaths, but adherence to these non-pharmaceutical interventions may be modified by individual factors including demographics and health status which shape exposure risk behaviors.</p><p><strong>Methods: </strong>A total of 348 participants completed baseline questionnaires (to assess demographics, pre-pandemic exposure risk, and health status), weekly illness reports, and monthly social distancing behavior questionnaires to evaluate exposure risk over time in response to changing levels of government restrictions. Exposure risk behaviors were calculated using seven categories: attendance at social events, receiving care (hospital, etc.), visiting or volunteering at care facilities, public transportation use, hours working outside of the home, hours volunteering outside of the home, and handwashing frequency. The impact of individual and environmental factors on exposure risk over time was evaluated by a Poisson family generalized linear mixed model.</p><p><strong>Results: </strong>Participants across all age groups and health statuses adapted their behaviors in response to evolving regulations, but older individuals and those with pre-existing conditions had the largest change in behavior. These individuals also had the most severe symptoms when they developed COVID-19 or other influenza-like illnesses. Participants who were older or had pre-existing health conditions had lower levels of exposure risk overall, and this was largely driven by a lower prevalence and frequency of in-person work. Female participants also had lower levels of exposure risk overall, consistent with an increased frequency of handwashing in this group. Unexpectedly, we found no effect of vaccination on total exposure risk.</p><p><strong>Conclusions: </strong>Participant behavior was generally responsive to government-imposed restrictions, with increased stringency coinciding with decreased exposure risk among participants. Demographic-associated differences in exposure risk behaviors appear to be driven by systemic factors (i.e., a return to in-person work) to a greater extent than personal choices (i.e., social gatherings). These findings emphasize the interplay between demographic factors and government interventions in shaping individual behaviors over the course of the pandemic. Understanding these dynamics is crucial for informing interventions and mitigating the impact of future pandemics.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"3 1","pages":"52"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144277323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Households of tuberculosis (TB) patients face high TB-related costs in Somalia.","authors":"Joseph Kuye, Ireneaus Sebit Sindani, Mukhtar Abdi Shube, Mohamed Jafar Salah, Abukar Ali Hilowle, Vianney Rusagara, Faith Ngima, Michael Lei Abaasiku, Stephen Balogun, Barinaadaa Afirima, Emmanuel Olashore, Abiodun Hassan","doi":"10.1186/s44263-025-00175-5","DOIUrl":"10.1186/s44263-025-00175-5","url":null,"abstract":"<p><strong>Background: </strong>The out-of-pocket spending and costs incurred by households affected by tuberculosis (TB) while accessing TB services in Somalia remain unclear. This study is the first of its kind in Somalia, estimating the proportion of TB-affected households that experience catastrophic costs among individuals with TB.</p><p><strong>Methods: </strong>A nationally representative, descriptive, cluster-sampled cross-sectional survey was conducted among individuals receiving TB care within the Somali National TB network from December 28, 2023, to February 3, 2024. It utilized retrospective data collection to gather information on participants' sociodemographic and clinical characteristics, including care models, self-reported income and expenses, and the costs (out-of-pocket expenses and indirect) associated with a single episode of TB. The survey also examined risk factors for incurring these costs and mechanisms for dissaving. TB catastrophic cost is defined as the total costs (both direct and indirect) incurred during TB illness and treatment that exceed 20% of a household's annual income.</p><p><strong>Results: </strong>Overall, 68% (95% CI: 64%-71%) of households affected by TB in Somalia faced costs exceeding 20% of their household income. Among patients receiving first- and second-line drug treatment, the percentages were 69% (95% CI: 65%-73%) and 62% (95% CI: 52%-71%), respectively. Individuals with TB living in the Southwest states were the most likely to incur catastrophic costs associated with the disease. Self-reported monthly household income decreased by 43%, dropping from US $176 before contracting TB to US $101 during the interview. A total of 75.4% (364) of households facing TB-related catastrophic costs reported a decline in their financial situation while seeking TB services. To cope with the economic burden of TB-related catastrophic expenses, 42% (375) of individuals with TB and their households relied on one or more dis-saving strategies, such as taking out loans or selling assets.</p><p><strong>Conclusions: </strong>This study found that almost three out of four patients in TB care and their households experience a substantive economic burden accessing TB services in Somalia, particularly during the continuation phase of their treatment, and mainly driven by the direct nonmedical costs. A sustainable and equitable social protection program is required to reduce the proportion of households facing economic burdens due to TB in Somalia.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"3 1","pages":"53"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144277322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}