PLOS global public health最新文献

{"title":"Menstrual stigma and mental health for adolescent girls in South Sudan: A cross-sectional analysis.","authors":"Ashley Smith, Alexandra Blackwell, Eleonora Mansi, Thomas Hussein, Ambaku Peter Lomena, Cosmas Ayella, Anywar Sam Okot, Kathryn Falb","doi":"10.1371/journal.pgph.0004916","DOIUrl":"10.1371/journal.pgph.0004916","url":null,"abstract":"<p><p>Menstrual stigma, characterized by negative beliefs, attitudes, and practices surrounding menstruation, often leads to the social exclusion and discrimination of menstruators. The intersection of menstrual stigma and period poverty, which is marked by limited access to menstrual hygiene products and safe sanitation has a profound impact on the mental health and well-being of adolescent girls, particularly in low- and middle-income countries. This study aimedto examine the associations between menstrual stigma and mental health (Mood and Feelings Questionnaire) among female adolescents aged 10-20 in primary schools in Panyijar County, South Sudan. Cross-sectional baseline data were analyzed from a school safety evaluation using unadjusted and adjusted linear regression models In unadjusted analyses, knowing whether female classmates had their period was significantly associated with poorer mental health (β = 1.75, p < 0.001). Feeling ashamed if boys knew about one's period was also associated with poorer mental health (β = 1.49, p = 0.05). In individually adjusted models, ajusting for demographic characteristics, feeling the need to hide one's period was associated with better mental health (β = -1.80, p = 0.02). In fully adjusted models, which included all stigma variables and demographic controls, hiding one's period remained significantly associated with mental health (β = -1.99, p = 0.04), while knowing when a classmate had their period showed a marginal association with poorer mental health (β = 0.88, p = 0.08). Disability was significantly associated with poorer mental health (β = 2.52, p < 0.01), while displacement showed a marginal association (β = 0.84, p = 0.06). No other demographic variables retained significance. These findings highlight the need for comprehensive strategies that address menstrual stigma and its impact on mental health, including interventions that challenge harmful social norms, promote safe latrine environments, and ensure access to hygiene products and menstrual education.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 5","pages":"e0004916"},"PeriodicalIF":2.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847238","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":"Correction: Challenges and responses of malaria elimination in a high-endemic area along the Thai-Myanmar border: A health systems perspective.","authors":"Sayambhu Saita, Daniel M Parker, Kritsana Suk-Uam, Suparat Phuanukoonnon, Kasama Pooseesod","doi":"10.1371/journal.pgph.0006446","DOIUrl":"10.1371/journal.pgph.0006446","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1371/journal.pgph.0006286.].</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 5","pages":"e0006446"},"PeriodicalIF":2.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847076","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":"Living through Cyclone Freddy: \"Gendered Health Impacts and Coping Responses in Malawi\".","authors":"Chipiliro Payesa, Edith Milanzi, Junious Sichali, Ruth Holla, Thelma Kaliu","doi":"10.1371/journal.pgph.0005799","DOIUrl":"10.1371/journal.pgph.0005799","url":null,"abstract":"<p><p>Malawi has increasingly faced severe climate-related disasters, with Cyclone Freddy in 2023 among the most devastating in the country's history. While disasters are often considered gender-neutral events, their impacts are shaped by gendered social roles and structural inequalities, resulting in differentiated experiences among women and men.This study examined the gendered health impacts and the responsiveness of humanitarian interventions during and after Cyclone Freddy in Malawi. We conducted a cross-sectional qualitative study in Blantyre (urban) and Chiradzulu (rural) districts between August and September 2024. Forty-six in-depth interviews were held with survivors, complemented by eight key informant interviews with representatives of governmental and non-governmental organizations involved in the response. Thematic analysis was applied to explore gender-specific experiences, health challenges, and perceptions of response efforts. Findings revealed significant gendered disparities. Women reported heightened loss of reproductive health services, and severe disruption to menstrual hygiene management and exposure to gender-based violence. Maternal health needs were largely unmet, and mental health services were delayed and under-resourced, exacerbating psychological distress among women and girls. Men primarily emphasized loss of livelihoods contributing to psychological distress linked to provider roles. While some humanitarian actors adopted gender-responsive measures, such as dignity kits and separate sanitation facilities, these efforts were inconsistent, often reactive, and limited by funding and planning gaps. Cyclone Freddy underscored the urgent need for gender-sensitive disaster preparedness and response frameworks in Malawi. Integrating gender considerations into health, protection, and recovery strategies is essential to mitigate inequitable impacts across all genders.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 5","pages":"e0005799"},"PeriodicalIF":2.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847057","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":"Evaluation and estimation of epidemic trajectories for SARS-CoV-2 from clinical and wastewater data in Gauteng Province, South Africa.","authors":"Zinhle E Mthombothi, Adrian Lison, Fiona Els, Cari van Schalkwyk, Leon Danon, Gillian Maree, Jeremy L Bingham, Sipho Gwala, Victor Mabasa, Natasha Singh, Emmanuel Phalane, Mokgaetji Macheke, Said Rachida, Nkosenhle Ndlovu, Chenoa Sankar, Sibonginkosi Maposa, Mukhlid Yousif, Kerrigan McCarthy, Kathleen M O'Reilly","doi":"10.1371/journal.pgph.0006424","DOIUrl":"10.1371/journal.pgph.0006424","url":null,"abstract":"<p><p>Inferring epidemic trajectories of viral infections from wastewater data can be a useful addition to clinical-based surveillance, as it provides low cost, population-level data that includes both symptomatic and asymptomatic individuals who contribute to the sewer system. However, methods for analyzing wastewater data have been primarily applied to high-resource settings. It remains an open question to what extent epidemic dynamics can also be estimated from wastewater data in low-resource settings, where measurements are less frequent and the underlying catchment population is not clearly characterized. We used SARS-CoV-2 wastewater data from the Gauteng Province in South Africa (June 2021 to March 2022). We used the R packages EpiSewer and EpiNow2 to estimate the effective reproduction number (Rt) from wastewater data and geographically matched clinical surveillance data, respectively. The comparison between wastewater and clinical Rt showed that the observed trends are not perfectly aligned. Despite these differences, wastewater and clinical Rt estimates identified similar transmission patterns, which were similar to the trend seen directly from the recorded data. Maximum wastewater Rt of 1.38 (95% CI: 1.17-1.44) was observed in early November 2021, whilst clinical Rt was 1.18 (90% CI: 0.85-1.27) in June 2021. The change in Rt aligned with an increase or decrease in recorded cases. Our findings demonstrate that, even with limited data, estimating epidemic trajectories is feasible, providing valuable insights for informing public health recommendations. However, whenever possible, we recommend using wastewater surveillance as a complementary tool for clinical surveillance.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 5","pages":"e0006424"},"PeriodicalIF":2.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847141","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":"Awareness, utility and preferences of campus-based mental health services at tertiary institutions in Harare, Zimbabwe: A cross-sectional study.","authors":"Omega Mukubvu, Gamuchirai C Tonono, Ropafadzo L Mupinga, Chris T Uriga, Yola A Machona, Shalom R Doyce, Edwin Mavindidze, Rufaro H Mushonga, Beatrice K Shava, Sidney Muchemwa, Dixon Chibanda, Anotida R Hove, Jermaine M Dambi","doi":"10.1371/journal.pgph.0005107","DOIUrl":"10.1371/journal.pgph.0005107","url":null,"abstract":"<p><p>Mental health (MH) disorders are highly prevalent among university students, with multi-level impacts. Although campus-based mental health services (CBMHS) are available, awareness and utilisation rates remain low. This study examined the awareness and utilisation of CBMHS among Zimbabwean tertiary students, including the barriers, facilitators, and preferences that influence their access to services. This descriptive cross-sectional study recruited 1070 students from five tertiary institutions in Harare, Zimbabwe. Participants completed questionnaires evaluating awareness, utilisation, preferences, and barriers to accessing CBMHS. Data were analysed using descriptive statistics and multivariate logistic regression. The mean age of the participants was 21.7 (SD = 2.7) years. 76.5% of students were aware of CBMHS. Awareness of MH services was associated with familial history of MH conditions [AOR = 1.35 (95% CI: 1.05; 1.83), p = .05] and personal experience of a MH condition [AOR = 0.71 (95% CI: 0.52; 0.97), p = .030]. Only 16.5% of students had utilised CBMHS. High utility of CBMHS was associated with drug and substance use [AOR = 2.388 (95% CI: 1.227; 4.644), p = 0.01], availability of a psychologist [AOR = 1.69 (95% CI: 1.10; 2.59), p = .017] and availability of campus-wide MH workshops [AOR = 1.62 (95% CI: 1.00; 2.60), p = .049]. Key barriers to MH service utilisation included lack of resident/institutional MH service providers [AOR = 2.02 (95% CI: 1.16; 3.51), p = .013], past MH experiences [AOR = 1.53 (95% CI: 1.16; 2.02), p = .002], and friend's history of MH condition [AOR = 1.44 (95% CI: 1.11; 1.86), p = .006]. Students preferred self-help services, individual therapy, and psychologists for MH support. Universities should promote MH awareness through effective awareness campaigns and workshops, provide tailored services that align with the students' preferences, and ultimately create a supportive environment that fosters students' overall MH service utilisation and well-being.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 5","pages":"e0005107"},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847062","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":"A formative evaluation of the TB Think Tank's role and influence on TB policy in South Africa.","authors":"Bey-Marrie Schmidt, Chanelle Mulopo, Lilian Mayieka","doi":"10.1371/journal.pgph.0006229","DOIUrl":"10.1371/journal.pgph.0006229","url":null,"abstract":"<p><p>Tuberculosis (TB) remains one of the leading causes of death globally, despite being both preventable and treatable. South Africa continues to experience a high burden, with an estimated 56,000 TB-related deaths recorded in 2023. In response to this public health crisis, the TB Think Tank (TB TT) was established in 2014 to strengthen the government's programmatic response to TB. This formative evaluation examines the activities, processes, and outputs through which the TB TT has influenced TB policy between 2021 and 2024, identifies areas for improvement, and provides actionable recommendations to enhance its impact. To conceptualise the TB TT as a Knowledge Translation Platform, Bennett and Jessani's (2011) framework was applied, focusing on knowledge generation, dialogue, and capacity building. Data were collected through 14 in-depth interviews with key stakeholders, a survey of 65 TB TT members conducted between June and July 2024, document review, and observational data to provide contextual insight; survey data were analysed using descriptive statistics, while qualitative data were analysed using inductive thematic analysis. Findings indicate that the TB TT has played a significant role in shaping South Africa's TB response, with 97% of survey respondents affirming its effectiveness in advising the National Department of Health on policy. Key strengths include diverse membership, strong leadership, and alignment with national priorities, which have supported influential outputs such as the TB Strategic Plan 2023-2028. However, several challenges persist, including delays in the approval of recommendations, underrepresentation of key stakeholders such as district and provincial practitioners and other government sectors, limited monitoring mechanisms, and broader systemic constraints such as bureaucratic processes, competing priorities, and data access issues. Overall, the TB TT has made a substantial contribution to South Africa's public health landscape and remains well positioned to advance the national TB agenda by strengthening evidence-informed decision-making and promoting equitable care.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 5","pages":"e0006229"},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847048","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":"Assessing the approach to perinatal mental health screening and treatment in maternal-child health clinics in Western Kenya.","authors":"Asterico Neema, Anna Larsen, Agnes Karingo Karume, Anne Kaggiah, Anjuli D Wagner, Barbra Richardson, Bryan Weiner, Catherine Maina, Clinton Ndambuki, David Owaga, Nancy Ngumbau, Lincoln Pothan, Yuwei Wang, Alexandra Rose, Linnet Ongeri, Amritha Bhat, Keshet Ronen, John Kinuthia","doi":"10.1371/journal.pgph.0005191","DOIUrl":"10.1371/journal.pgph.0005191","url":null,"abstract":"<p><p>Integrating mental health care into well-attended health services, such as maternal-child health (MCH), offers a promising approach to increasing access to mental health care. To inform integration, we assessed the current approach to screening and treatment of perinatal mood and anxiety disorders (PMAD) in MCH facilities in Western Kenya. We conducted a cross-sectional survey among the facility managers (\"in-charges\") at 20 MCH facilities in Western Kenya. Trained data collectors administered questionnaires to assess facility infrastructure and human resources, perinatal mental health screening, psychological interventions, psychiatric medication availability, and level of perinatal mental health integration into standard MCH services. Across 20 MCH facilities, the majority were located in rural areas (16,80%), 2 peri-urban (10%), and 2 urban (10%). Facilities had a median of 37.5 medical staff (IQR: 31.0, 45.5); the most common cadre was nurses (median: 9.0, IQR: 6.0, 12.5). Under half of the facilities (8, 40%) screened for PMAD using a validated tool and documented results; most (19, 95%) reported diagnosing PMAD (not necessarily through a systematic approach), yet only half (10, 53%) documented the diagnosis. The most common psychotherapy reported across the sites was supportive counseling (15, 75%). Some facilities offered evidence-based psychotherapies (e.g., cognitive behavioral therapy, problem-solving therapy, etc.), but did not report on training, supervision or guidance from the evidence-based intervention manual. Across all facilities, the availability of mental health medications was limited. Only (12, 60%) had any antidepressant available, (16, 80%) had antiepileptics, (9, 45%) had antipsychotics, and (2, 10%) had mood stabilizers available. Mental health services in MCH clinics in Western Kenya are currently not offered in a structured and systematic manner to effectively alleviate PMAD. Available infrastructure and human resources offer an opportunity to integrate an evidence-based treatment model to improve perinatal mental health in the MCH clinics in Western Kenya.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 5","pages":"e0005191"},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847053","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 impact of US Government Stop Work Order on HIV epidemic trajectory in Zimbabwe.","authors":"Isaac Taramusi, John Stover, Ali Feizzadeh, Ngwarai Sithole, Amon Mpofu, Tsitsi Apollo, Owen Mugurungi, Benard Madzima, London Makwanya, Henry Damisoni, Richard Makurumidze, Simbarashe Rusakaniko","doi":"10.1371/journal.pgph.0006288","DOIUrl":"10.1371/journal.pgph.0006288","url":null,"abstract":"<p><p>Zimbabwe is highly dependent on United States Government (USG) funding for the HIV Response, where 42% of the HIV expenditures in 2020 were financed by the USG and in 2023, PEPFAR invested more than $200 million to support HIV programmes. In late January 2025, the USG issued a \"Stop Work Order,\" suspending funding for international aid and development during a 90-day review period and this was expected to have a significant negative impact on the Zimbabwean healthcare system therefore an epidemiological assessment was conducted to assess the impact of the stop work order. To assess the impact on incidence and mortality, an epidemiological assessment using the Avenir Health Goals model simulated five scenarios ranging from temporary pauses to the indefinite withdrawal of PEPFAR and 11% reduction in the Global Fund funding support. The stopping funding specified in the waiver plus 11% reduction in the Global Fund funding results in 74% (11,000) additional new HIV infections. The 90-day stop-work order will result in 35% (6,000) additional new HIV infections in 2025. The stopping of PEPFAR direct funding will result in additional 7,000 new HIV infections in 2025. Stopping all PEPFAR direct funding will add 35,000, 90-days pause will add 31,000, while stopping support to HIV prevention programs will add 22,000 additional new HIV infections through 2030. Stopping all PEPFAR direct funding will result in more than 13% increase in AIDS-related deaths with additional 107,000 deaths through 2030. The 90 days pause will reduce adult treatment coverage by 10% from 95% to 85% in 2025, while stopping direct PEPFAR funding will result in a reduction in adult ART coverage by 40% to 55% in 2025. These disruptions pose a significant threat to Zimbabwe's ability to achieve epidemic control and reach the 2030 target of ending AIDS as a public health threat.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 5","pages":"e0006288"},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847149","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 experiences of female community health workers during COVID-19 and the influence of gender norms and values in Nepal: A qualitative study.","authors":"Abriti Arjyal, Sushil Baral, Sulata Karki, Ayuska Parajuli, Obindra Bahadur Chand, Shophika Regmi, Wesam Mansour, Sally Theobald, Sophie Witter, Joanna Raven","doi":"10.1371/journal.pgph.0006393","DOIUrl":"10.1371/journal.pgph.0006393","url":null,"abstract":"<p><p>Female Community Health Volunteers (FCHVs) are close-to-community providers who voluntarily serve their communities in Nepal. Gaps exist in evidence regarding the challenges posed by shocks such as the pandemic, as well as the gendered experiences of FCHVs in the general context. This study aimed to explore the experiences and challenges faced by FCHVs during COVID-19 and the influence of gender norms and values. We conducted a qualitative study in two municipalities, Gulariya in Lumbini province and Chandragiri in Bagmati province, Nepal. A total of 22 interviews were conducted between December 2020 and January 2021 using topic guides. These included key informant interviews with purposively sampled health coordinators, health facility managers, and local mayors, as well as in-depth interviews with FCHVs. A thematic framework approach, incorporating a gender framework, was applied for data analysis. NVivo 11 Pro software was used to support the analysis. FCHVs faced significant challenges due to gender norms, family expectations, and insufficient support from the health system during COVID-19. Balancing dual responsibilities at home and work created further difficulties in their daily lives. Although FCHVs were from and embedded within their communities and gained trust over time, they experienced some unsupportive behaviours, particularly from men who were not receptive to their roles. Inadequate support, such as a lack of supervision and training on COVID-19, further undermined the confidence of FCHVs and affected their ability to provide services. Shortages of personal protective equipment, lack of financial incentives, and male-dominated leadership hindered gender-sensitive planning, exacerbating the challenges FCHVs faced during the crisis. FCHVs are vital to Nepal's health system, especially during crises like COVID-19. Addressing gender norms, providing tailored training, promoting inclusivity, and involving male volunteers are key policy priorities. Future efforts should focus on strengthening FCHVs' resilience and addressing societal gender challenges.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 5","pages":"e0006393"},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847226","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":"Measuring health financing vulnerability due to reductions in official development assistance: A conceptual framework with empirical application across 47 African countries.","authors":"James Avoka Asamani, Sophie Faye, Kouadjo San Boris Bediakon, Hilary Kipruto, Sunny C Okoroafor, Janet Kayita, Ame Dioka, Azzam Ali, Benson Droti, Ogochukwu Chukwujekwu","doi":"10.1371/journal.pgph.0006282","DOIUrl":"10.1371/journal.pgph.0006282","url":null,"abstract":"<p><p>Despite a 33% increase in Official Development Assistance (ODA) from 2019 to 2023, aid declined by 7% in 2024 and projected to further decline in 2025-2027. Health systems in Africa are being impacted by the sudden aid freezes and cuts. There are no multicriteria metrics to estimate the vulnerability of countries to facilitate dialogue and decisions. This paper proposes an approach to assess country's vulnerability to external aid cuts, considering dynamic health financing and macro-fiscal risk factors. We proposed a framework using four proxy health financing and macro-fiscal factors. Using a polychoric principal component analysis to derive the weight of contribution of each variable, we parameterized the framework with data from existing databases. We applied the framework to assess the health financing vulnerability to external aid cuts/freezes across different countries and explored its validity. Health expenditure per capita in the WHO African Region averaged US$125.2 of which almost 24% depended on external funding. Almost 70% of countries face potential stagnation or contraction in public spending, while 49% of the countries are in debt distress or at high risk of debt distress. The interplay among these factors resulted in the vulnerability of countries averaging almost 60% (range: 23 - 92%), with 27 countries facing \"very highly\" or \"highly\" vulnerable health financing situations. Health financing vulnerability explained 31.4% of the variation in UHC attainments and 32.8% of the variation in the number of people pushed further into poverty. We conclude that low spending on health, high donor dependence and unfavourable macro-fiscal conditions, including debt crisis is driving heightened vulnerability across Africa. Countries need to protect essential health services by prioritizing the most vulnerable populations, protect their health budgets through increasing efficiency, generating new revenue through taxes, aligning external aid with national plans and priorities, and better pooling health spending.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 5","pages":"e0006282"},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847158","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}