PLOS global public health最新文献

{"title":"Invasive mosquito surveillance in the United Kingdom 2020 to 2024: First detection of Aedes aegypti eggs in the UK and further detection of Aedes albopictus.","authors":"Colin J Johnston, Amy C Edwards, Alexander G C Vaux, Anthony J Abbott, Harrison Hardy, Roxanna Wilson, Bathsheba L Gardner, Arran J Folly, Clare Strode, Daniel W Crosgrove, Archie K Murchie, Christopher O'Connor, Ian Rea, Kirsty Hewitt, Charlotte Flynn, Rachel Hornigold, Emma Widlake, Matthew Baylis, Marcus S C Blagrove, Gillian Armstrong, Jacqueline Gallavin, Annmarie Goodwin, Nicole Wakely-Griffiths, Jolyon M Medlock","doi":"10.1371/journal.pgph.0004968","DOIUrl":"10.1371/journal.pgph.0004968","url":null,"abstract":"<p><p>Here, we provide an update on invasive mosquito surveillance activities coordinated by the UK Health Security Agency (UKHSA) between May 2020 and November 2024. Aedes albopictus and Aedes aegypti are invasive mosquitoes and not currently established in the UK. Both are vectors of various arboviruses including emerging pathogens such as dengue. Therefore, their introduction into the UK poses a threat to public health. In 2024, vector surveillance to detect and limit the establishment of invasive mosquito species involved 1070 ovitraps at 117 localities across England, Wales and Northern Ireland, expanding from 58 in 2019. Ovitraps at seaports, airports, and highway transport hubs were examined every two weeks, between May and October, each year. In 2020, 2021 and 2022, no Ae. albopictus specimens were detected. In September 2023, Aedes aegypti eggs were detected in a freight storage facility near Heathrow Airport. Identification of these eggs was confirmed morphologically and molecularly. Targeted enhanced surveillance yielded no further detections, suggesting an isolated incursion. In August 2024, Ae. albopictus was detected for the first time since 2019. Four eggs were found in an ovitrap at a service station along the M20 motorway in Kent, in South East England. In accordance with existing national contingency planning, the local authority collaborated with the landowner and UKHSA to conduct larval source reduction, and UKHSA conducted enhanced surveillance. There were no further detections of eggs or adult Ae. albopictus mosquitoes during the enhanced surveillance period. This project is complemented by UKHSA's broader mosquito surveillance efforts, including deploying adult mosquito traps in 307 localities across England and Wales, and a mosquito recording scheme that accepts submissions from the public. Combined, our findings suggest that future incursions of invasive mosquitoes in the UK are likely and undertaking enhanced surveillance is key to identifying and reducing the likelihood of their establishment.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 10","pages":"e0004968"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208546","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":"Perceptions and experiences of the prevention, testing, and treatment of anaemia in pregnant women: A qualitative evidence synthesis.","authors":"Ebony Verbunt, Martha Vazquez Corona, Özge Tunçalp, Lisa M Rogers, Khic-Houy Prang, Cathy Vaughan, Meghan A Bohren","doi":"10.1371/journal.pgph.0005158","DOIUrl":"10.1371/journal.pgph.0005158","url":null,"abstract":"<p><p>Anaemia during pregnancy is a serious public health problem, inequitably burdening women in low-and middle-income countries. Despite numerous strategies and programs, anaemia prevalence rates have stagnated. We aimed to explore women's, health workers', and other key stakeholders' perceptions of anaemia in pregnant women, or their experiences with its prevention, testing, or treatment. We conducted a qualitative evidence synthesis. We searched MEDLINE (Ovid), Scopus, and CINAHL from inception to 12 November 2024, with no language or geographical restrictions. Data were analysed using thematic synthesis, and confidence in each review finding was assessed using the GRADE-CERQual approach. We included 61 papers from 23 countries. We grouped 25 review findings under four themes: (a) socio-cultural context of anaemia in pregnant women; (b) prevention and/or treatment of anaemia in pregnant women through diet, supplementation, or clinical intervention; (c) testing pregnant women for anaemia; and (d) factors affecting health workers' engagement in the management of anaemia in pregnant women. Women's management of anaemia in pregnancy was affected by the socio-cultural context, particularly their limited decision-making power and social position. Many women perceived a nutritious diet as integral to managing anaemia; however, high cost was often a barrier. Reasons women did not adhere to supplements included side-effects and difficulty remembering to take them, with family support improving adherence. Blood transfusion was perceived as treatment for severe anaemia, while intravenous iron was considered for women with iron-deficiency anaemia who were unable to take supplements, attended antenatal care late, or could not receive a transfusion. Health workers described difficulties testing pregnant women for anaemia and structural health-system deficiencies that affected their engagement. Findings may inform future WHO recommendations for managing anaemia in pregnant women. Future research could use review findings alongside implementation science frameworks to develop strategies for improving prevention, testing, and/or treatment of anaemia in pregnant women.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 10","pages":"e0005158"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208554","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 triangulation of multimorbidity: A systematic review of primary sleep disorders, hypertension, and psychiatric disorders.","authors":"Chadia Haddad, Hala Sacre, Samah Tawil, Pascale Salameh, Sola Aoun Bahous","doi":"10.1371/journal.pgph.0005216","DOIUrl":"10.1371/journal.pgph.0005216","url":null,"abstract":"<p><p>Despite the growing evidence of the interconnectedness of hypertension, sleep disorders, and mental health, the exact nature of the relationships and the potential for combined or synergistic effects remain unclear. Potential mechanisms include environmental factors, family stressors, financial difficulties, treatment side effects and shared pathophysiological comorbidities. Therefore, this systematic review aimed to address this gap by assessing comprehensively the interrelationships between these three conditions among adults. A systematic review was conducted in line with the preferred reporting items for systematic reviews and meta-analyses. The literature search was performed across three databases: PubMed, SCOPUS, and CINAHL. From an initial pool of 1759 articles, 45 met the inclusion criteria and were used in the analysis. Most studies assessed the associations between the three conditions pairwise, using different definitions and methods. Positive (60-75%) or non-significant associations (25-40%) were commonly reported, with no inverse associations identified. This consistent pattern suggests that these conditions are interrelated, even when statistical significance was not reached in some cases. In conclusion, the association between sleep disorders, hypertension, and psychiatric diseases is highlighted in the majority of studies, showing predominantly positive or non-significant relationships, with no studies reporting inverse associations among these three conditions. These findings suggest that addressing these conditions in an integrated manner may improve clinical management and patient outcomes.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 10","pages":"e0005216"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208603","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":"Machine learning based prediction of low birth weight and its associated risk factors: Insights from the Bangladesh Demographic and Health Survey 2022.","authors":"Nourin Sultana, Zeba Afia, Isteaq Kabir Sifat, Shamsuz Zoha, Tajin Ahmed Jisa, Md Kaderi Kibria","doi":"10.1371/journal.pgph.0005187","DOIUrl":"10.1371/journal.pgph.0005187","url":null,"abstract":"<p><p>Low birth weight (LBW) is a major public health concern particularly in low and middle-income countries as it contributes to increased infant mortality and long-term health complications. This study applies and evaluates machine learning (ML) algorithms to predict LBW and identify its key risk factors in Bangladesh. Data were collected from 3,192 complete records of ever-married women aged 15-49 years from the Bangladesh Demographic and Health Survey, 2022. Risk factors for LBW were identified by four feature selection techniques including Boruta-based selection (BFS), LASSO regression, Elastic Net and Random Forest (RF). Six ML algorithms, including Logistic Regression (LR), RF, Decision Tree (DT), Artificial Neural Networks (ANN), Extreme Gradient Boosting (XGB), and Light Gradient Boosting Machine (LGBM) were performed to predict LBW. Model performance was evaluated using accuracy, precision, recall, F1-score, AUC, and ROC analysis. SHAP values were utilized to examine the influence of individual features on the model's prediction. The prevalence of LBW in Bangladesh was 27.8%. Twelve features were identified and the XGB model outperformed the other models by achieving the highest performance in predicting LBW with an accuracy of 80% and area under the curve of 0.761 in holdout (90:10) cross-validation. SHAP analysis revealed that 'pregnancy duration' and 'division' were the strongest predictors of LBW risk followed by 'marriage to first birth interval' 'ANC visits' 'C-section' and 'place of delivery'. These findings demonstrate that XGB can serve as an effective tool for predicting LBW and identifying important risk factors that may guide targeted interventions. The insights generated from this study can support public health strategies aimed at reducing LBW prevalence in Bangladesh.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0005187"},"PeriodicalIF":2.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12483264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202412","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":"Health care needs survey to improve preparedness of community outreach clinics after severe flooding in Mulanje district, Malawi.","authors":"Joseph Njala, Kelvin Balakasi, Khumbo Phiri, Harrison Chimbaka, Amos Makwaya, Deanna Smith, John Songo, Misheck Mphande, Lloyd Njikho, Jackeline R Chinkonde, Anteneh Worku, Kathryn Dovel, Sam Phiri, Joep J van Oosterhout","doi":"10.1371/journal.pgph.0005204","DOIUrl":"10.1371/journal.pgph.0005204","url":null,"abstract":"<p><p>Due to the rising impact of climate change, Malawi has increasingly experienced extreme weather events in the last decade, including flooding that resulted in large-scale displacement of vulnerable populations. In response, the Ministry of Health and partners set up outreach clinics at camps for displaced persons. However, little is known about health care needs of the affected populations. We conducted a cross-sectional survey among individuals aged ≥18 years utilizing health services at mobile outreach clinics at 7 campsites in Mulanje district, set up after flooding caused by cyclone Freddy (2023). We describe demographic characteristics, prevalence of self-reported acute and chronic conditions, depression (PHQ-9 tool), intimate partner violence (IPV) and health service satisfaction. Of 341 participants surveyed, median age was 32 (IQR 23-47) years, and 80.1% were female. Fifty-eight percent were displaced persons, the rest resided close to the camps. Compared to non-displaced residents, displaced individuals significantly more frequently had: no formal education (32.5% vs. 15.3%; p < 0.001); worse self-reported health (41.6% vs. 23.6%; p < 0.001) and respiratory illness (31.0% vs. 20.1%; p = 0.025). They had similar prevalence of chronic heart disease or hypertension (23.9% vs. 20.1%; p = 0.415) and unknown HIV status (1.0% vs. 4.2%; p = 0.163), but lower prevalence of disabilities (5.6% vs. 11.8%; p = 0.039). Similar proportions in both groups screened positive for depression (53.5% vs. 56.3%, p = 0.598; 95.7% had minimal/mild depression symptoms) and IPV (78.2% vs 70.8%, p = 0.225), but sexual violence prevalence was higher in displaced persons (34.5% vs 21.4%, p = 0.225). Low satisfaction with health services was uncommon (11.7%) and significantly associated with male sex and a positive depression score. After severe flooding, mobile outreach clinics were frequented by displaced persons and nearby residents, unable to reach their regular health facility. Given high rates of acute illnesses, chronic conditions, depression and IPV, outreach clinics in these settings require multidisciplinary teams with diverse skills to meet the health needs of the attending population.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0005204"},"PeriodicalIF":2.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12483276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202458","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":"\"You can't see what you've never had to live\"-Cultivating imagination and solution spaces in global health and development.","authors":"Safieh Shah, Shruti Bora, Esme Supriya Gupta Longley, Erika Valtierra, Madhukar Pai","doi":"10.1371/journal.pgph.0005242","DOIUrl":"10.1371/journal.pgph.0005242","url":null,"abstract":"","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0005242"},"PeriodicalIF":2.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12483197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202423","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":"Diagnostic performance of red cell indices in detecting iron deficiency and iron deficiency anemia among rural adolescent girls aged 14-19 years in Nagpur District.","authors":"Varsha S Dhurde, Archana B Patel, Lindsey M Locks, Patricia L Hibberd","doi":"10.1371/journal.pgph.0005108","DOIUrl":"10.1371/journal.pgph.0005108","url":null,"abstract":"<p><p>Iron deficiency anemia (IDA) remains a major public health concern among adolescent girls in rural areas. This study assessed the diagnostic performance of red cell distribution width (RDW) and hemoglobin (Hb) in detecting IDA. A cross-sectional study was conducted among 221 healthy rural adolescent girls (14-19 years) randomly selected from 24 government schools across 18 villages under four primary health centers in Nagpur district, Maharashtra (CTRI/2020/01/023035). Venous blood samples were analyzed for hematological parameters, and ROC curve analysis determined optimal diagnostic cut-offs. The iron-deficient group showed significantly lower MCV (75.3 vs. 84.5 fL, p < 0.001), MCH (24.3 vs. 28.1 pg, p < 0.001), and median Hb (10.9 vs. 12.0 g/dL, p < 0.01) compared to iron-sufficient girls. RDW was higher (16.3% vs. 14.9%, p < 0.01) and serum ferritin lower (6.8 vs. 30.95 μg/L, p < 0.01) in IDA cases. ROC analysis revealed an AUC of 65% for RDW alone, with optimal cut-off >16.9% (sensitivity 39.5%, specificity 82%). Lowering the cut-off to >16.7% improved sensitivity to 44%. The combined Hb ≤ 10.3 g/dL and RDW ≥ 16.4% showed superior performance with 93% sensitivity, 75% specificity, and 89% accuracy (AUC 72%), though not significantly different from RDW alone. While RDW alone has moderate diagnostic value, its combination with Hb significantly enhances IDA detection in adolescent girls. This simple, cost-effective two-parameter approach (Hb ≤ 10.3 g/dL + RDW ≥ 16.4%) offers an efficient screening tool for resource-limited rural settings, where advanced diagnostics are often unavailable. The findings support using routine hematological parameters for early IDA identification in vulnerable populations.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0005108"},"PeriodicalIF":2.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12478879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194172","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 role of seasonal malaria chemoprevention in the effect of azithromycin on child mortality: A secondary analysis of the CHAT cluster randomized clinical trial.","authors":"Elisabeth A Gebreegziabher, Mamadou Ouattara, Mamadou Bountogo, Boubacar Coulibaly, Valentin Boudo, Thierry Ouedraogo, Elodie Lebas, Huiyu Hu, Kieran S O'Brien, Michelle S Hsiang, David V Glidden, Benjamin F Arnold, Thomas M Lietman, Ali Sié, Catherine E Oldenburg","doi":"10.1371/journal.pgph.0004653","DOIUrl":"10.1371/journal.pgph.0004653","url":null,"abstract":"<p><p>The objective of this study was to examine whether the effect of mass Azithromycin (AZ) distribution on all-cause mortality among children under 5 varies with seasonal malaria chemoprevention (SMC) administration season or coverage. This was a secondary analysis of the Community Health with Azithromycin Trial (CHAT), a cluster-randomized, placebo-controlled trial of twice-yearly AZ treatment in 341 communities in the Nouna District, Burkina Faso. All communities received SMC as standard-of-care. SMC administration and coverage data were provided from National Malaria Control Program. SMC season was defined as the period during and following SMC (July-December) versus the no SMC season (January-June). SMC coverage was assessed as proportion of the population covered and by whether it was below or above a threshold of 80%. We used Poisson regression models with person-time at risk as an offset and robust standard error to analyze mortality rates by treatment group and SMC subgroups and assessed interaction on both multiplicative and additive scales. Mortality was higher in SMC seasons for both arms. Compared to placebo, the mortality rate in AZ clusters was 0.77 (95% CI: 0.60 to 0.98) during SMC season, while it was 0.89 (95% CI: 0.68 to 1.15) during the non-SMC seasons. In clusters with <80% SMC coverage, the effect of AZ was 0.73 95%CI (0.56 to 0.96) and in clusters with ≥80% SMC coverage, it was 1.0 95%CI (0.59 to 1.69). The interaction between AZ and SMC season or coverage was not statistically significant on the additive or multiplicative scales. While our findings did not reach statistical significance, they raise the question of whether prioritizing MDA AZ during high transmission periods or in regions with low SMC coverage could be beneficial. Further research is needed to determine if targeting these periods or areas could further reduce child mortality.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0004653"},"PeriodicalIF":2.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12478956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194118","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":"Opportunities and barriers arising from the COVID-19 pandemic for health campaign integration across immunizations, neglected tropical diseases, insecticide-treated bed nets, and vitamin A supplementation: A qualitative key informant interview study.","authors":"Alison Krentel, Afzaa Rajabali, Olumide Ogundahunsi, Tuoyo Okorosobo, Eva Bazant, Carol McPhillips-Tangum, Aashka Sethi Sood, Kristin Saarlas, Margaret Gyapong","doi":"10.1371/journal.pgph.0005186","DOIUrl":"10.1371/journal.pgph.0005186","url":null,"abstract":"<p><p>In low- and middle-income countries, health campaigns play a crucial role in addressing high-priority health concerns such as neglected tropical diseases (NTDs), malaria, vaccine-preventable diseases and nutrition (vitamin A supplementation). Many health campaigns are conducted throughout the calendar year, resulting in multiple campaigns annually in some communities. Campaign integration offers an opportunity to increase efficiencies across programs and limit the strain on healthcare workers, communities, and health systems. The response to the COVID-19 pandemic provided opportunities for campaign integration to mitigate losses from missed campaign deliveries. As the interest in integration grows, there is a need to understand existing barriers, bottlenecks, and opportunities for better integration, whether through co-delivery or increased collaboration. This qualitative study aimed to understand the opportunities and barriers to campaign co-delivery and collaboration from the perspective of 26 stakeholders involved in vaccine-preventable diseases, vitamin A supplementation, NTDs, and malaria programs. Key informants included campaign managers, implementing partners, donors, and decision-makers at the country and state levels in five countries: Côte d'Ivoire, Ethiopia, Guyana, Indonesia, and Nigeria. Results indicated that campaigns were integrated at various levels, from partial integration and co-delivery to fully integrated delivery within existing health services. Most emerging factors were categorized as either facilitating or hindering campaign integration. Enablers to campaign integration included joint planning and appreciation for human resources, while target population variation, prioritization of one intervention by another, and overburdening of healthcare workers, community health workers and community drug distributors were identified as specific barriers. An emerging theme was the importance of leadership, reinforcing the need for country ownership, political will, and positive stakeholder relationships. Further research is warranted to identify optimal combinations of campaign commodities, strategies to ensure stakeholder engagement throughout the integration process, methods to factor in local community context, and the expansion of lessons learned from the COVID-19 pandemic.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0005186"},"PeriodicalIF":2.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12478929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194153","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":"Left behind in primary healthcare: A qualitative exploration of healthcare experiences of people with disabilities in Ethiopia.","authors":"Desta Debalkie Atnafu, Hannah Kuper, Femke Bannink Mbazzi","doi":"10.1371/journal.pgph.0005147","DOIUrl":"10.1371/journal.pgph.0005147","url":null,"abstract":"<p><p>People with disabilities, who make up 1.3 billion globally, frequently face systemic exclusion from healthcare due to a range of barriers. This qualitative study explored the healthcare access experiences of 30 adults with disabilities in Bahir Dar City, Ethiopia, aiming to identify barriers, facilitators, and context-driven solutions. Both purposive and snowball sampling was conducted to identify participants. In-depth interviews were conducted in the local language. Data were analysed using reflexive thematic analysis in NVivo 14, guided by the Missing Billion Health System Framework service delivery components. The study identified five key themes each for barriers, facilitators, and coping strategies. Major barriers included low health literacy, unaffordable care, negative provider attitudes, inaccessible infrastructure, and lack of assistive technologies and rehabilitation services. Facilitators included family support, community-based health insurance, disability-sensitive training of healthcare workers, presence of a rehabilitation centre, and initiation of renovation infrastructure in model facilities. Participants proposed actionable strategies such as increasing awareness, insurance coverage, local production of assistive technologies, assigning personal assistants in health facilities, improving accessibility, and establishing disability units within governance structures. People with disabilities experienced persistent, intersecting barriers to healthcare access in Ethiopia. However, scaling disability-inclusive training, infrastructure improvemnts, and governance reforms-rooted in lived experience and aligned with human rights of people with disabilities-can help drive progress toward Universal Health Coverage.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0005147"},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180845","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}