Global Health Research and Policy最新文献

{"title":"A new phase of China-ASEAN health cooperation: the China-ASEAN Beijing Declaration on Cooperation in Innovation of Health Products and Technologies.","authors":"Jie Qiao, Siyan Zhan, Minghui Ren, Haijun Wang, Yangmu Huang, Zhenyu Zhang, Yanan Luo, Hui Yin, Zhongwei Jia, Wei Huang, Hong Zhou, Jue Liu, Xiaoyun Liu, Qiudan Sun, Xiaojia Li, Jing Bai, Fangjing Liu, Yihong Liu, Yinzi Jin, Ming Xu","doi":"10.1186/s41256-024-00401-x","DOIUrl":"10.1186/s41256-024-00401-x","url":null,"abstract":"<p><p>Utilizing innovative methods to advance the research and development (R&D) of health products and enhance their accessibility has become crucial to achieving universal health coverage, addressing public health emergencies, and promoting population health and wellbeing. However, structural contradictions do exist in the supply and demand of health products in the Association of Southeast Asian Nations (ASEAN). With the joint support of the Ministry of Science and Technology of China, the Ministry of Education, and the China-ASEAN Center, Peking University established the China-ASEAN Science and Technology Cooperation Center for Public Health in April 2023. The Center held the Second Annual Forum on China-ASEAN Cooperation in Public Health on June 26-28, 2024, and the participants reached consensus on launching the China-ASEAN Beijing Declaration on Cooperation in Innovation of Health Products and Technologies, which calls on China and ASEAN countries to carry out the following actions: (1) Establish a more effective, open, and inclusive cooperation mechanism for health product innovation towards a China-ASEAN innovation ecosystem; (2) Enhance R&D capabilities by targeting new technologies, methods and appropriate and affordable health products for key populations and addressing diseases prevalent in China and ASEAN; (3) Establish a China-ASEAN Collaboration Center for Health Product Innovation, coordinate regional development plans, and enhance equitable access to pharmaceutical products at the regional level; (4) Accelerate regulatory harmonization in the region by optimizing and improving regulatory modalities of China and ASEAN Countries; and (5) Strengthen cross-sectoral cooperation to build resilient health system and achieve sustainable development of innovation cooperation. The Declaration will play an active role in regional public health governance and development cooperation, in order to promote the R&D and accessibility of health products in the region and to help achieve faster and more equitable access to health products for a broader population.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"10 1","pages":"3"},"PeriodicalIF":4.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health security-Why is 'public health' not enough?","authors":"Delaram Akhavein, Meru Sheel, Seye Abimbola","doi":"10.1186/s41256-024-00394-7","DOIUrl":"https://doi.org/10.1186/s41256-024-00394-7","url":null,"abstract":"<p><p>There is a growing tendency in global discourse to describe a health issue as a security issue. But why is this health security language and framing necessary during times of crisis? Why is the term \"health security\" used when perhaps simply saying \"public health\" would do? As reference to 'health security' grows in contemporary discourse, research, advocacy, and policymaking, its prominence is perhaps most consequential in public health. Existing power dynamics in global health are produced and maintained through political processes. Securitisation of health, which facilitates urgent and exceptional measures in response to an event, is a politically charged process with the tendency to further marginalise already marginalised individuals, groups, and nations. By exploring the ethical and practical consequences of a powerful actor's move to securitise health, the essay highlights the importance of considering the perspectives and well-being of marginalised individuals, groups and nations who may be impacted by the move. The essay challenges the assumption that securitising health or framing health as a security issue necessarily leads to good outcomes. It highlights the historical roots and explores the contemporary implications of \"health security\", and invites critically informed discourse on its use within global health.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"10 1","pages":"1"},"PeriodicalIF":4.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of malaria vector surveillance and insecticide resistance monitoring interventions in Nigeria.","authors":"Abiodun Obembe, Adedayo O Oduola, Adedapo Adeogun, Uwem Inyang, Tolulope Oyeniyi, Abiodun Olakiigbe, Ayodele Babalola, Petrus Inyama, Samdi Lazarus, Ifeanyi Okeke, Mary Esema, Okefu Oyale Okoko, Mamudu Omo-Eboh, Perpetua Uhomoibhi, Mohammed Bala, Samson Awolola","doi":"10.1186/s41256-024-00397-4","DOIUrl":"10.1186/s41256-024-00397-4","url":null,"abstract":"<p><p>Malaria vector surveillance is required to determine disease transmission dynamics, vector insecticide susceptibility status, suitable control strategies and impact of control interventions. However, capacity and resources for vector surveillance and insecticide resistance monitoring is often inadequate in most countries at risk of vector-borne diseases. Collaborations and linkages between malaria control policy makers and existing research institutions generating vector surveillance research data are often weak, thereby hindering the availability of data for decision-making. A national vector surveillance programme, mobilizing all stakeholders towards quality data generation and policy making, is required for effective data-driven country-wide vector control. This paper provides an analysis and suggested future directions for such synergized national malaria vector surveillance and insecticide resistance monitoring system currently being implemented by all research and policy stakeholders in Nigeria. The harmonized national vector surveillance system described here can be used as a model for the development or improvement of such structures in other countries with high malaria transmission risks.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"9 1","pages":"55"},"PeriodicalIF":4.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11686922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Prevalence of potential drug‒drug interactions and associated factors among elderly patients in Ethiopia: a systematic review and meta-analysis.","authors":"Tekletsadik Tekleslassie Alemayehu, Yilkal Abebaw Wassie, Abaynesh Fentahun Bekalu, Addisu Afrassa Tegegne, Wondim Ayenew, Gebresilassie Tadesse, Demis Getachew, Abebaw Setegn Yazie, Bisrat Birke Teketelew, Mekonnen Derese Mekete, Setegn Fentahun, Tesfaye Birhanu Abebe, Tefera Minwagaw, Gebremariam Wulie Geremew","doi":"10.1186/s41256-024-00402-w","DOIUrl":"10.1186/s41256-024-00402-w","url":null,"abstract":"","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"9 1","pages":"54"},"PeriodicalIF":4.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does going against the norm on women's economic participation increase intimate partner violence risk? A cross-sectional, multi-national study.","authors":"Anaise Williams, Lori Heise, Nancy Perrin, Colleen Stuart, Michele R Decker","doi":"10.1186/s41256-024-00399-2","DOIUrl":"10.1186/s41256-024-00399-2","url":null,"abstract":"<p><strong>Background: </strong>Women's economic empowerment (WEE) is believed to reduce the risk of intimate partner violence (IPV), yet the relationship between WEE and IPV has proven to be highly variable. Little attention has been given to how the normative WEE environment may influence this relationship across different settings. This study tests whether IPV is associated with Vanguard WEE, defined as individual economic participation that deviates from community norms.</p><p><strong>Methods: </strong>This cross-sectional study draws on Demographic and Health Surveys conducted in 44 low- and middle-income countries. The analytic sample was partnered women who participated in the domestic violence module, living in communities with sufficient data to construct WEE norms (n = 186,968). The relationship between Vanguard WEE-measured by the number of WEE activities a woman engaged in that were non-normative in her community-and the incidence of past-year physical IPV, sexual IPV, and partner control was evaluated using a mixed-effects multilevel logistic model. The study also explored interactions between Vanguard WEE and household wealth.</p><p><strong>Results: </strong>Women who did not deviate from the community norm had an adjusted probability of 0.15 for experiencing physical IPV in the past year. However, this probability increased to 0.17 (marginal effect (ME): 0.014; 95% CI 0.007,0.021), 0.17 (ME: 0.020; 95% CI 0.010,0.030), and 0.19 (ME: 0.037; 95% CI 0.022,0.051) for women with one, two, and three or more vanguard WEE items, respectively. Physical IPV associated with vanguard WEE was higher among poorer women (p = 0.021). Additionally, the probability of past-year sexual IPV and current partner control increased from 0.05 to 0.08 (p < 0.001) and from 0.38 to 0.44 (p < 0.001), respectively, for women with three or more vanguard WEE items.</p><p><strong>Conclusions: </strong>The study provides evidence of partner backlash in the form of IPV among vanguard women-those whose economic activities contradicted local norms. Programs designed to economically empower women in contexts where such participation is non-normative should include mechanisms to monitor and mitigate potential backlash.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"9 1","pages":"53"},"PeriodicalIF":4.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11670509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health economic evaluation alongside randomised clinical trial of a health behaviour intervention to manage type 2 diabetes in Nepal.","authors":"Padam Kanta Dahal, Zanfina Ademi, Lal Rawal, Rashidul Alam Mahumud, Grish Paudel, Biraj Karmacharya, Haruka Sakamoto, Tomohiko Sugishita, Corneel Vandelanotte","doi":"10.1186/s41256-024-00364-z","DOIUrl":"10.1186/s41256-024-00364-z","url":null,"abstract":"<p><strong>Background: </strong>Prevention of type 2 diabetes is becoming an urgent public health concern in low and middle-income countries (LMICs). However, there is currently no evidence of a cost-effective approach of health behaviour interventions from community settings in low-income countries like Nepal. Therefore, this study aimed to assess the within-trial economic evaluation of a health behaviour intervention compared with usual care for managing type 2 diabetes in a community setting in Nepal.</p><p><strong>Methods: </strong>We randomly assigned 30 clusters comprising 481 patients with type 2 diabetes of which 15 to a health behaviour intervention (n = 238 patients) and 15 to the usual care (n = 243 patients). Patients in the intervention group received community health workers-led intensive training for diabetes self-management along with regular phone calls and ongoing support from peer supporters. Costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) as costs per QALYs gained were assessed after 6-month from a healthcare system perspective. Probabilistic sensitivity analysis was conducted using 10,000 Monte Carlo simulations to assess the impact of uncertainty of cost-effectiveness analysis under the threshold of three times gross domestic product (GDP) per capita for Nepal (i.e., US $4,140).</p><p><strong>Results: </strong>Over the 6-month, the intervention yielded an incremental cost of US $28.55 (95% CI = US $21.26 to US $35.84) per person and an incremental QALYs of 0.0085 (95% CI = -0.0106 to 0.0275) per person. The ICER associated with the health behaviour intervention was US $3,358.82 (95% CI = US $-2005.66 to US $3,974.54) per QALY gained, which was below the estimated threshold, indicating a cost-effective approach with a net monetary benefit of US $6.64 (95% CI = US $-22.62 to US $78.01). Furthermore, the probabilistic sensitivity analysis consisting of 10,000 Monte Carlo simulations indicates that the intervention being cost-effective at the given threshold was 89.63%.</p><p><strong>Conclusions: </strong>Health behaviour interventions in community settings are a cost-effective approach to manage type 2 diabetes, offering good value for money. However, more studies focused on long-term follow-up across diverse setting of LMICs should be warranted to assess the maximum impact of such interventions.</p><p><strong>Trial registration: </strong>Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819) Registered on 6^th May 2021.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"9 1","pages":"52"},"PeriodicalIF":4.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India.","authors":"Kathiresan Jeyashree, Jeromie W V Thangaraj, Devika Shanmugasundaram, Sri Lakshmi Priya Giridharan, Sumit Pandey, Prema Shanmugasundaram, Sabarinathan Ramasamy, Venkateshprabhu Janagaraj, Sivavallinathan Arunachalam, Rahul Sharma, Vaibhav Shah, Bhavani Shankara Bagepally, Joshua Chadwick, Hemant Deepak Shewade, Aniket Chowdhury, Swati Iyer, Raghuram Rao, Sanjay K Mattoo, Manoj V Murhekar","doi":"10.1186/s41256-024-00392-9","DOIUrl":"10.1186/s41256-024-00392-9","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) poses a significant social and economic burden to households of persons with TB (PwTB). Despite free diagnosis and care under the National TB Elimination Programme (NTEP), individuals often experience significant out-of-pocket expenditure and lost productivity, causing financial catastrophe. We estimated the costs incurred by the PwTB during TB care and identified the factors associated with the costs.</p><p><strong>Methods: </strong>In our cross-sectional study, we used multi-stage sampling to select PwTB notified under the NTEP, whose treatment outcome was declared between May 2022 and February 2023. Total patient costs were measured through direct medical, non-medical and indirect costs. Catastrophic costs were defined as expenditure on TB care > 20% of the annual household income. We determined the factors influencing the total cost of TB care using median regression. We plotted concentration curves to depict the equity in distribution of catastrophic costs across income quintiles. We used a cluster-adjusted, generalized model to determine the factors associated with catastrophic costs.</p><p><strong>Results: </strong>The mean (SD) age of the 1407 PwTB interviewed was 40.8 (16.8) years. Among them, 865 (61.5%) were male, and 786 (55.9%) were economically active. Thirty-four (2.4%) had Drug Resistant TB (DRTB), and 258 (18.3%) had been hospitalized for TB. The median (Interquartile range [IQR] and 95% confidence interval [CI]) of total costs of TB care was US$386.1 (130.8, 876.9). Direct costs accounted for 34% of the total costs, with a median of US$78.4 (43.3, 153.6), while indirect costs had a median of US$279.8 (18.9,699.4). PwTB < 60 years of age (US$446.1; 370.4, 521.8), without health insurance (US$464.2; 386.7, 541.6), and those hospitalized(US$900.4; 700.2, 1100.6) for TB experienced higher median costs. Catastrophic costs, experienced by 45% of PwTB, followed a pro-poor distribution. Hospitalized PwTB (adjusted prevalence ratio [aPR] = 1.9; 1.6, 2.2) and those notified from the private sector (aPR = 1.4; 1.1, 1.8) were more likely to incur catastrophic costs.</p><p><strong>Conclusions: </strong>PwTB in India incur high costs mainly due to lost productivity and hospitalization. Nearly half of them experience catastrophic costs, especially those from poorer economic quintiles. Enabling early notification of TB, expanding the coverage of health insurance schemes to include PwTB, and implementing TB sensitive strategies to address social determinants of TB may significantly reduce catastrophic costs incurred by PwTB.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"9 1","pages":"51"},"PeriodicalIF":4.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the implementation gap for Trastuzumab's journey from health insurance to patient access: a preliminary study in a hospital in China.","authors":"Xingxia Yang, Yufei Jia, Jianhong Xu, Qin Zhou, Qian Long, Yi Yang, Yunguo Liu, Juanying Zhu, Xiaochen Zhang","doi":"10.1186/s41256-024-00384-9","DOIUrl":"10.1186/s41256-024-00384-9","url":null,"abstract":"<p><strong>Background: </strong>Trastuzumab, a monoclonal antibody for breast cancer, faces global accessibility challenges, primarily due to high costs. This study examines how changes in medical insurance policies and price adjustments influence Trastuzumab utilization in China, focusing on implementation challenges and their impact on drug accessibility and affordability.</p><p><strong>Methods: </strong>This retrospective study investigated Trastuzumab utilization among HER2-positive breast cancer patients at a tertiary hospital from May 2013 to December 2022 in JX, a prefecture-level city in eastern China. Patients were stratified based on their CerbB2 indicator, because those with a 2 + CerbB2 status require further FISH testing to confirm Trastuzumab eligibility. We analyzed the utilization rates of both FISH test and Trastuzumab using logistic regressions, identifying factors that influence their usage.</p><p><strong>Results: </strong>766 patients were included. The utilization rate of Trastuzumab among patients with CerbB2 3+ rose from 40.40 to 77.94% in September 2017 following the expansion of insurance coverage, and further increased to 90.41% after a price reduction in 2020. The FISH test was not covered by health insurance, and it was not available in the local hospital until Trastuzumab became available in JX city. For patients with CerbB2 2+, the proportion undergoing the FISH test increased dramatically from 8.89 to 82.08% after the price reduction in 2020. The mere inclusion into basic medical insurance, regardless of insurance types, significantly increased the utilization of Trastuzumab and the FISH test. However, rural patients in JX city are still facing financial burdens with Trastuzumab's out-of-pocket cost accounting for 62.9% of their annual disposable income in 2020.</p><p><strong>Conclusions: </strong>Our findings indicate that insurance coverage and price reduction significantly increased Trastuzumab utilization. However, failure to improve the accessibility of the FISH test can pose challenges in enhancing the uptake of Trastuzumab among eligible patients. With the expiration of Trastuzumab's patent and the development of affordable biosimilars, there are now greater opportunities to enhance treatment access globally. These insights can inform policy makers of implementation guidance about providing financial support for breast cancer patients in other LMICs.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"9 1","pages":"50"},"PeriodicalIF":4.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How the U.S. presidential election impacts global health: governance, funding, and beyond.","authors":"Yuming Liu, Brian J Hall, Minghui Ren","doi":"10.1186/s41256-024-00391-w","DOIUrl":"10.1186/s41256-024-00391-w","url":null,"abstract":"<p><p>The United States plays a crucial role in shaping global health through its policy decisions and engagements. Historically, bipartisan support underpinned U.S. involvement in multilateral and bilateral global health initiatives in advancing its national health, security interests, and foreign policy. However, recent decades have witnessed increased politicization and polarization of global health and fluctuating stances between Republican and Democratic administrations. This commentary speculates the potential implications of the 2024 presidential election on global health, focusing on how ideological differences between parties and previous administrative actions might affect U.S.'s strategies in addressing key global health issues, including governance, funding allocation, sexual and reproductive health policies, responses to humanitarian crises, and efforts to combat climate change. The election may be a critical juncture that could determine whether the U.S. global health strategies will continue to reflect the globalist and liberal policies typically associated with recent Democratic administrations or shift back to the isolationist tendencies observed during Trump's presidency. The outcome will significantly determine the direction of U.S. global health policy and its broader implications for global health equity and security. The conclusions emphasize the necessity of maintaining strong international cooperation and commitment to health as a global public good.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"9 1","pages":"49"},"PeriodicalIF":4.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 to healthcare facility utilization by non-Ebola patients during the 2018-2020 Ebola outbreak in the Democratic Republic of Congo.","authors":"Gabriel Kalombe Kyomba, Michael Robert Law, Karen Ann Grépin, Serge Manitu Mayaka, Thérèse Nyangi-Mondo Mambu, Branly Kilola Mbunga, Celestin Hategeka, Mala Ali Mapatano, Joël Nkiama-Numbi Konde, Dosithée Ngo-Bebe, Pélagie Diambalula Babakazo, Eric Musalu Mafuta, Guillaume Mbela Kiyombo","doi":"10.1186/s41256-024-00387-6","DOIUrl":"10.1186/s41256-024-00387-6","url":null,"abstract":"<p><strong>Background: </strong>An Ebola Virus Disease (EVD) outbreak occurred in North Kivu between 2018 and 2020. This eastern province of the Democratic Republic of Congo was also grappling with insecurity caused by several armed groups. This study aimed to explore the barriers and facilitators to utilizing Healthcare Facilities (HCFs) by non-Ebola patients during the crisis.</p><p><strong>Methods: </strong>A qualitative case study was conducted in Beni and Butembo with 24 relatives of 15 deceased non-EVD patients, 47 key informants from healthcare workers (HCWs), as well as community leaders. Semi-structured interviews were conducted to explore three key areas: (i) the participants' illness history, care pathway, care, and social support; (ii) their perceptions of how EVD affected the care outcome; and (iii) their opinions on the preparedness, supply, use, and quality of healthcare before and during the outbreak. All interviews were recorded, transcribed verbatim, and thematically analysed using Atlas-ti 8.0.</p><p><strong>Results: </strong>Nine of the 15 deaths were female and their ages ranged from 7 to 79 years. The causes of death were non-communicable (13) or infectious (2) diseases. Conspiracy theories, failure to establish security, and the concept of the ''Ebola business'' were associated with misinformation and lower levels of trust in government and HCFs. The negative perceptions, fear of being identified as an Ebola case, apprehension about the triage unit, and inadequacy of personal protective equipment resulted in a preference for private or informal HCFs. For half of the deceased's relatives, the Ebola outbreak hastened their death. Conversely, community involvement, employing familiar, neutral, and credible HCWs, and implementing a free care policy increased the number of visits. These results were observable despite a lack of funds, overstretched HCWs, and long waiting time.</p><p><strong>Conclusions: </strong>Our findings can inform policies before and during future outbreaks to enhance the resilience of routine HCFs by maintaining dialogue between HCWs and patients, and rebuilding confidence in HCFs. Quantitative studies including context analysis are essential to identify the determinants of care-seeking during such a crisis.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"9 1","pages":"47"},"PeriodicalIF":4.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}