BMC global and public health最新文献

{"title":"Mortality risk during the COVID-19 pandemic is shaped by human development.","authors":"Kolja Nenoff, Sarah Habershon, Miguel D Mahecha, Sabine Attinger, Khalil Teber, Guido Kraemer","doi":"10.1186/s44263-026-00255-0","DOIUrl":"10.1186/s44263-026-00255-0","url":null,"abstract":"<p><strong>Background: </strong>During the global COVID-19 pandemic (2020-2021), excess mortality varied substantially across countries. Notably, upper-middle-income countries experienced greater variability in excess mortality than both low- and high-income countries, despite reporting fewer COVID-19 cases than high-income countries but more than low-income countries. This disconnect between case numbers and mortality suggests more complex structural vulnerabilities. Socioeconomic conditions and healthcare system performance, collectively referred to as National Framework Conditions (NFCs), are likely key determinants of pandemic outcomes. However, the specific relationship between these factors and excess mortality remains poorly understood.</p><p><strong>Methods: </strong>We constructed a predictive model of excess mortality using reported COVID-19 case counts and a wide array of NFCs derived from the World Development Indicators (WDI), employing a tree-based machine learning method (XGBoost). To reduce dimensionality, we applied a non-linear method (e-Isomap), extracting latent components called compressed National Framework Conditions (cNFCs). We applied SHapley Additive exPlanations (SHAP) values to estimate the feature importance and quantify the contribution of each cNFC.</p><p><strong>Results: </strong>Our machine learning model explained nearly half of the global variance in excess mortality ( <math><msup><mi>R</mi> <mn>2</mn></msup> </math> : median 49.7; interquartile range (IQR): 10.9). SHAP analysis revealed that cNFCs contributed most strongly to model predictions of excess mortality (SHAP: median 8.1; IQR 1.2), followed by pandemic indicators, such as reported COVID-19 cases (SHAP: median 6.4; IQR 0.7). Using explainable artificial intelligence (XAI), we further identified how interconnected socioeconomic conditions, including labor force participation age and health spending, shaped mortality outcomes.</p><p><strong>Conclusions: </strong>Our findings demonstrate that cNFCs outperform conventional epidemiological or preparedness metrics, in explaining cross-country differences in COVID-19 excess mortality during 2020-2021. By capturing latent socioeconomic structures, the cNFC framework reveals systemic vulnerabilities that reported COVID-19 cases and other indicators fail to detect. This approach offers a new perspective on structural resilience and pandemic preparedness.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12952034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328912","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":"The power of powerful others: health locus of control and vaccination behavior in rural Namibian pastoralists.","authors":"Sean Prall, Brooke Scelza, Aparicio Lopes","doi":"10.1186/s44263-026-00251-4","DOIUrl":"10.1186/s44263-026-00251-4","url":null,"abstract":"<p><strong>Background: </strong>Who we believe controls our health, whether it is ourselves, chance, or powerful others, shapes how we make healthcare decisions. The health locus of control (HLC) framework has been key to understanding self-efficacy in healthcare behaviors. Health promotion often emphasizes self-efficacy in decision-making. However, in more traditional, subsistence based societies with low levels of market integration (the shift from traditional subsistence towards reliance on market-based consumption) self-efficacy may not be sufficient to understand health decisions. This is particularly true with regard to vaccine beliefs and behaviors, where evidence for the role of HLC is mixed, and in populations where entities associated with vaccines may be viewed with suspicion.</p><p><strong>Methods: </strong>Using a novel ranking task, we examined the association between HLC and vaccine interest and perceptions in Namibian agro-pastoralists (N = 293) across a spectrum of market integration. Market integration was estimated via a principal components analysis. Sets of Bayesian multi-level models were used to assess HLC on vaccination questions via a monotonic function.</p><p><strong>Results: </strong>External HLC dominated: powerful others (e.g., 'doctors') and God domains were ranked highest, while internal HLC ('self') was consistently lowest. Greater market integration was associated with higher internal HLC and lower powerful others HLC. Individuals who ranked 'doctor' highly expressed more pro-vaccine sentiments, whereas those who ranked 'self' highly were more skeptical of vaccines. No HLC ranks predicted COVID-19 vaccination status.</p><p><strong>Conclusions: </strong>Variation in HLC across levels of market integration suggests that exposure to broader economic and cultural systems shifts beliefs about health control, with external sources of control playing a more dominant role in more rural areas. In contrast to studies of HLC in industrialized populations, internal HCL was negatively associated with interest and perceptions of vaccine safety. Public health efforts that emphasize individual decision-making may not resonate as well in such contexts, whereas carefully considering the role of powerful others may improve outreach efforts.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12950233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322520","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":"Childhood experiences and adult self-rated physical health in 22 countries.","authors":"Matt Bradshaw, Blake Victor Kent, Jennifer Susan Wortham, Noémie Le Pertel, Tyler J VanderWeele, Byron R Johnson","doi":"10.1186/s44263-026-00253-2","DOIUrl":"10.1186/s44263-026-00253-2","url":null,"abstract":"<p><strong>Background: </strong>Relatively little research has examined the associations between childhood experiences and subsequent adult self-rated health in diverse countries and cultures around the world using nationally representative data.</p><p><strong>Methods: </strong>The current study addresses this limitation by analyzing data from the Global Flourishing Study (GFS), an international survey of 202,898 individuals from 22 countries collected in 2022-2023. Associations between a measure of self-rated physical health and a variety of childhood experiences and characteristics including parent-child relations, parent marital status, income, abuse, feeling like an outsider, health, immigration, religious service attendance, year of birth, and gender were examined using a random effects meta-analysis.</p><p><strong>Results: </strong>Findings from the pooled analysis of the 22 countries combined in the meta-analysis showed that all childhood variables except parental marital status and immigration were associated with self-rated physical health in adulthood. Results varied across individual countries, but each childhood characteristic, including marital status and immigration, was associated with adult self-rated physical health in at least one country. E-values showed that many of these relationships were fairly robust against confounding from unmeasured covariates.</p><p><strong>Conclusions: </strong>Findings suggest that childhood experiences and characteristics are associated with adult self-rated physical health in countries around the world. They also demonstrate considerable variation in these associations across nations and cultures, inviting further exploration and examination.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12908356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146204415","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":"Association between neighborhood-level overall social vulnerability and cumulative incidence of reported hepatitis C virus infection in Los Angeles County from 2018 to 2023.","authors":"Cassidy Hernandez-Tamayo, Laura Katherine Thompson, Mirna Jewell, Melissa Lee Wilson, Albert J Farias, Chrysovalantis Stafylis, Myles Cockburn, Prabhu Gounder, Jeffrey D Klausner","doi":"10.1186/s44263-026-00246-1","DOIUrl":"10.1186/s44263-026-00246-1","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis C is a serious public health problem in Los Angeles County. Only 30% of diagnosed persons are treated, and transmission is increasing. To further understand how social determinants impact hepatitis C, we assessed the association between neighborhood-level socioeconomic factors and the reported incidence of hepatitis C infection.</p><p><strong>Methods: </strong>We conducted an ecological study of Los Angeles County residents aged 18 to 29 years with a reported positive hepatitis C viral nucleic acid test between July 2018 and June 2023. We used negative binomial regression to estimate reported hepatitis C incidence rate ratios by neighborhood with 95% confidence intervals (CI). A composite index score (range: 0-1) was created by ranking neighborhoods by combined social vulnerability and reported hepatitis C incidence.</p><p><strong>Results: </strong>Among our final analytic sample of 7616, the Metro and South areas of Los Angeles County had the highest proportions of neighborhoods in the lowest quartile for composite index scores, with 50% of neighborhoods in each area in the lowest quartile, compared to 0%-19% in others. Among 10 Social Vulnerability Index factors, reported hepatitis C incidence was 9% higher (95% CI 3%-16%) in neighborhoods with more uninsured residents, 2% lower (95% CI 1%-3%) in neighborhoods with greater proportions of racial and ethnic minorities, and 5% higher (95% CI 1%-9%) in neighborhoods with more residents lacking access to vehicles.</p><p><strong>Conclusions: </strong>Lack of health insurance and access to vehicles correlated with increased reported hepatitis C incidence, while greater racial and ethnic diversity was associated with decreased reported hepatitis C incidence. Integrating social and epidemiologic data can help identify neighborhoods with characteristics associated with hepatitis C incidence.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12903217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146196012","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":"Cross-border vaccination behaviour of residents living in a European Union border region: a cross-sectional survey study.","authors":"Daniël C M Huijten, Veja Widdershoven, Selena Paardekooper, Christian J P A Hoebe, Rianne P Reijs","doi":"10.1186/s44263-026-00249-y","DOIUrl":"10.1186/s44263-026-00249-y","url":null,"abstract":"<p><strong>Background: </strong>Border regions comprise over 30% of the European Union's territory and are home to more than 125 million people. Despite open market policies, access to public health services and transparency of public health records are still limited by national borders. As people in border regions can display cross-border vaccination behaviour, which is defined as residents of one country receiving vaccinations in a neighbouring country, they can create misinterpretations of vaccination coverage rates. This study assessed the frequency of cross-border vaccination behaviour and described how cross-border vaccination behaviour is associated with other transnational factors.</p><p><strong>Methods: </strong>This cross-sectional survey study assessed vaccinations received by participants and their children. A total of 15,002 invitations were posted to residents of South-Limburg, a Dutch border region. The web-based questionnaire was available in Dutch, English, German, and French. Three vaccination groups (National Immunisation Program vaccinations for participants' children, pandemic vaccinations, and regular adult vaccinations) were analysed using multivariable logistic regressions.</p><p><strong>Results: </strong>Among the 2800 participants (response rate = 18.7%), the majority were vaccinated exclusively in their country of residence, with rates ranging from 95.6% for pandemic vaccinations to 96.7% for regular adult vaccinations. Across all vaccination groups, participants born (adjusted Odds Ratio (aOR) range: 3.40-131.87) or raised (aOR range: 3.18-91.33) in another country demonstrated significantly higher levels of cross-border vaccination behaviour. Cross-border vaccination behaviour was also more common among those reporting casual (aOR range: 3.14-14.62) or structural (aOR range: 6.98-18.77) cross-border mobility. The most frequently self-reported reasons for cross-border vaccination were receiving paediatric care in the neighbouring country for National Immunisation Program vaccinations (N = 13/25), availability of the vaccination itself for pandemic vaccinations (N = 72/125), and being born in a neighbouring country for regular adult vaccinations (N = 45/52).</p><p><strong>Conclusions: </strong>Cross-border vaccination behaviour appeared to have a limited effect on the overall vaccination coverage; however, it was found to be significantly associated with transnational factors. These findings highlight the importance of monitoring cross-border public health access to improve vaccination coverage data and inform public health policies in border regions.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":"19"},"PeriodicalIF":0.0,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168909","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":"Integrating life course perspectives into research involving people living with perinatally acquired HIV.","authors":"Gabriela Toledo, Marthe Le Prevost, Ali Judd, Intira Jeannie Collins","doi":"10.1186/s44263-026-00252-3","DOIUrl":"10.1186/s44263-026-00252-3","url":null,"abstract":"","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168948","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":"Feasibility, acceptability and validity of electronic adherence monitoring among adolescents in Zimbabwe: a mixed methods study.","authors":"Nyasha V Dzavakwa, Constance Rs Mackworth-Young, Palwasha Y Khan, Hilda A Mujuru, Mazvita Paradza, Marshall T Chiwodza, Panashe Bluck, Nicol Redzo, Tsitsi Bandason, Katharina Kranzer, Rashida A Ferrand, Victoria Simms","doi":"10.1186/s44263-026-00248-z","DOIUrl":"10.1186/s44263-026-00248-z","url":null,"abstract":"<p><strong>Background: </strong>Electronic monitoring devices (EMDs) may provide an objective method for assessing medication adherence. However, evidence on their validity compared to other adherence measures, their functional feasibility, and their acceptability, especially among adolescents, remains limited. Adolescents face multifaceted adherence challenges, yet there is a lack of evidence to inform the use of digital tools for adherence monitoring and support in this age group, particularly in low-income settings. We assessed feasibility, acceptability, and validity of an EMD among adolescents enrolled in the multi-country clinical trial VITALITY.</p><p><strong>Methods: </strong>An explanatory sequential mixed methods study was embedded within the Zimbabwean site of the VITALITY trial, a randomised controlled trial evaluating weekly vitamin D supplementation on bone health in adolescents living with HIV. A random sample of 97 participants (aged 11-19 years) was provided an EMD for 24 weeks to monitor adherence to vitamin D or placebo. Validity was assessed by correlating EMD-measured adherence with serum vitamin D levels. Feasibility of the EMD was investigated through records of battery duration, network connectivity, and EMD malfunction. Seventeen participants were purposively selected for qualitative exit interviews to explore acceptability and reasons for discordance between adherence measured through the EMD and pill count.</p><p><strong>Results: </strong>Ninety-seven participants, median age 16.7 (interquartile range13.5, 18.7) years, 50 (51.5%) female were provided with the EMD for a median of 24 (range 22-25) weeks. There was a strong positive correlation between EMD-measured adherence and week-48 vitamin D levels (β = 0.63, 95% CI: 0.42-0.85; R² = 0.42; p < 0.001), supporting the validity of EMD data as a proxy for medication intake. The EMD functioned reliably despite intermittent network coverage, and no major malfunctions were reported. Adolescents found the EMDs highly acceptable due to their ease of use, discretion, and perceived motivational benefits.</p><p><strong>Conclusions: </strong>This study demonstrates that EMDs are valid, feasible, and acceptable tools for monitoring adherence among adolescents in low-income settings. These findings support the potential for broader use of EMDs to promote and monitor adherence to long-term treatments in adolescents beyond research settings.</p><p><strong>Trial registration: </strong>Pan African Clinical Trials Registry (PACTR), PACTR202009897660297 .</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12892711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146159736","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":"Publisher Correction: Case study guided development of an implementation science framework and checklist for campus sexual violence intervention.","authors":"Rebecca Fielding-Miller, Anh Vo, Vinton Omaleki, Pinky Mahlangu, Yandisa Sikweyiya, Fortunate Shabalala, Sakhile Masuku, Menelisi T T Dlamini, Mercilene Machisa","doi":"10.1186/s44263-025-00232-z","DOIUrl":"10.1186/s44263-025-00232-z","url":null,"abstract":"","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12874691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146128521","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":"Characterization of post-acute multi-organ sequelae following SARS-CoV-2 Infection in the Delta and Omicron Eras in a highly boosted population.","authors":"Peihong Guo, Jue Tao Lim, Liang En Wee, An Ting Tay, Yichen Zhai, Calvin J Chiew, Benjamin Ong, David Chien Boon Lye, Kelvin Bryan Tan","doi":"10.1186/s44263-026-00247-0","DOIUrl":"10.1186/s44263-026-00247-0","url":null,"abstract":"<p><strong>Background: </strong>Multi-organ post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) is extensively documented. Recent studies in predominantly Caucasian populations suggest that the evolution of SARS-CoV-2 variants can influence risk (as measured by hazard ratios) and rates (as measured by incidence rate ratios) of PASC, and they also highlight the protective effects of COVID-19 vaccination. However, it is unclear whether risks or rates of PASC have changed over different Omicron subvariants in an Asian population with high uptake of COVID-19 vaccine booster doses.</p><p><strong>Methods: </strong>We constructed a national cohort of individuals infected with SARS-CoV-2 and estimated the 31-300-day risks and rates of pre-specified new-incident diagnoses across the cardiovascular, neuropsychiatric, auto-immune, renal, and gastrointestinal domains between 1,427,985 and 3,284,081 unique individuals who tested positive or negative for SARS-CoV-2 infection respectively, across Delta, Omicron BA.1/2, BA.4/5, and XBB predominance. We compared risks/rates of new-incident diagnoses between test positives and test negatives in each era.</p><p><strong>Results: </strong>Compared to test-negatives, asides from increased risk of renal outcomes in BA.1/2 (aHR, 1.17; 95% CI, 1.09-1.26), there were no increased risks of composite diagnoses in other organ systems across all 4 variants of concern. In terms of individual outcomes, there were increased risks or rates of diagnosis of individual neuropsychiatric outcomes, such as memory problems, Alzheimer's disease across all eras, and loss of smell or taste only in Delta. There were also increased risks of diagnosis of individual renal outcomes, such as end stage renal failure in BA.1/2 (aHR, 1.52; 95% CI, 1.27-1.81). In COVID-19 survivors who were hospitalised, risks and rates of cardiovascular, neuropsychiatric, and renal diagnoses in the post-acute period were increased in most eras. COVID-19 vaccinations reduced the risks of composite diagnoses.</p><p><strong>Conclusions: </strong>The risks/rates of pre-specified new-incident multi-organ PASC were modest over all studied COVID-19 eras. The risk was further attenuated with booster vaccination during the Omicron BA.4/5 and XBB periods compared with the Omicron BA.1/2 period.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12874983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121302","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":"Access to surgery in Ecuador using the enhanced 2-step floating catchment area approach.","authors":"Taylor Wurdeman, Alejandro Torres Balarezo, Alfredo Borrero Vega, Tanujit Dey, Maria Falconi, Maria José Garcia, Mateo Iza, Nikathan Kumar, Ayla Gerk, Zachary Fowler, Edgar Rodas, Juan Carlos Salamea, Sabrina Juran, John G Meara, Tarsicio Uribe-Leitz","doi":"10.1186/s44263-026-00241-6","DOIUrl":"10.1186/s44263-026-00241-6","url":null,"abstract":"<p><strong>Background: </strong>Traditional surgical access metrics are often presented at the national level, providing poor insight for local policy makers. The Enhanced Two-Step Floating Catchment Area (E2SFCA) method is an alternative to current methods with two key advantages: it provides granular estimates of access and incorporates surgical supply variables. Using this method, we calculate surgical access in Ecuador, and discuss the benefits over traditional methods.</p><p><strong>Methods: </strong>We collected surgical supply data (number of providers, number of surgeries) from all governmental hospitals in Ecuador in 2022. Traditional global surgery indicators were calculated, including the surgical density per 100,000, surgical volume per 100,000, and two-hour access to surgery. We then performed an E2SFCA analysis, depicting the output as supply per 100,000 at the one km x one km level. Adequate access was defined as the percentage of the population meeting each of the supply indicator thresholds defined by the Lancet Commission on Global Surgery. The relationship between access to providers and surgeries was tested using robust regression. Finally, we performed a case study on expansion of supply in a single city.</p><p><strong>Results: </strong>Two-hour geospatial access is 89.7% in Ecuador, with 23.7 surgical providers and 2,473 surgical volume per 100,000. Using the E2SFCA method, 1.2% of the population has adequate access to all three indicators, gated by access to adequate surgical volume. There is significant geospatial variation in access to both supply variables. Robust regression revealed that one additional surgeon/anesthesiologist/obstetrician (SAO) provider is associated with 104.6 additional procedures.</p><p><strong>Conclusions: </strong>Without increasing the complexity of primary data collection, the E2SFCA method estimates access to surgery at a granular scale through considering the supply of procedures and SAO providers. This more granular evaluation of surgical access gives policy makers more specific methods of targeting interventions to improve surgical access.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":"14"},"PeriodicalIF":0.0,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12874969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121720","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}