BMJ Global Health最新文献

{"title":"Process and feasibility of implementing guideline recommendations for the care of osteoarthritis in West Africa.","authors":"Opeyemi O Babatunde, Oladapo Adetunji, Ibidunni Alonge, Tolulope Owoyemi, Ebunoluwa Ayinmode, Adebimpe Ogunbanjo, Simon White, Adewale Adebajo Adebajo, Christian Mallen, Krysia Dziedzic","doi":"10.1136/bmjgh-2024-018714","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-018714","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the feasibility of a guideline-informed model of care for osteoarthritis in primary healthcare and community pharmacy settings in the West African context.</p><p><strong>Methods: </strong>The 4-phase mixed-methods programme of research undertaken in Southwest Nigeria, West Africa. Phases 1-2 involved contextual adaptation of guideline-informed care<b>-</b>Joint Implementation of Guidelines for OSteoArthritis in West-Africa (JIGSAW-A): (1) focus groups (n=4) with patients, community pharmacists and healthcare professionals (HCPs) to identify patient preferences and support needs of HCPs; (2) stakeholders resource contextualisation/codesign (ie, osteoarthritis guidebook in local languages, HCPs training/support package). Iterative codesign workshops (n=3) using participatory approaches, model osteoarthritis consultation simulations and consensus agreement.Phase 3: following training and a 12-week pilot implementation period, patient-reported quality of care was assessed by the OsteoArthritis Quality Indicator questionnaire (modified 9-item scale 0%-100%, 100%=best), and implementation of the JIGSAW-A model of care was evaluated using the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. Patient and HCP interviews explored barriers and facilitators, usefulness and acceptability. In phase 4, recommendations for further scale-up and wider implementation of integrated osteoarthritis care were specified.</p><p><strong>Results: </strong>Phases 1-2 highlight the burden and impact of everyday living with joint pain and misinformation which affects help-seeking. Participants expressed the need for a broad information and education campaign and access to self-management support, which informed iterative contextualisation of osteoarthritis care and patient information resources used to support pilot implementation in phase 3.Over 12 weeks, 12 HCPs (community pharmacies, physiotherapists and doctors) were involved in evaluation across nine sites. Of 369 patient consultations that were reported, high rates of quality indicator achievement were found for self-management advice (97%), topical analgesic use (89%) and exercise recommendations (87%). Compliance with full patient assessment in line with the protocol was poor (17%).</p><p><strong>Conclusions: </strong>We found that evidence-based care for osteoarthritis, involving community pharmacies (as a usual first point of call) and other primary care clinicians, is feasible and may improve aspects of care in low-resource settings. Further research is needed to ascertain long-term sustainability and cost-effectiveness.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The global economic burden of antibiotic-resistant infections and the potential impact of bacterial vaccines: a modelling study.","authors":"Nichola R Naylor, Mateusz Hasso-Agopsowicz, Chaelin Kim, Yixuan Ma, Isabel Frost, Kaja Abbas, Gisela Aguilar, Naomi Fuller, Julie V Robotham, Mark Jit","doi":"10.1136/bmjgh-2024-016249","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-016249","url":null,"abstract":"<p><strong>Introduction: </strong>Antibiotic resistance (ABR) may increase hospital costs, utility loss and mortality risk per patient. Understanding these losses at national, regional and global scales is necessary for efficiently tackling ABR. Our aim is to estimate the global economic burden of antibiotic-resistant infections and the potential for bacterial vaccines to mitigate this burden.</p><p><strong>Methods: </strong>We take healthcare system and labour productivity perspectives. Hospital cost-per-case and length-of-stay estimates were calculated through meta-analyses and reviewing published systematic reviews. Unit labour productivity losses were estimated through a human capital approach. Modelled estimates were used where secondary data were missing. Death and incidence data were combined with unit cost data to estimate the economic burden associated with ABR in 2019, and the potential costs averted (in 2019 US$) based on uptake scenarios of vaccines that currently exist or are likely to be developed.</p><p><strong>Results: </strong>Multidrug-resistant tuberculosis had the highest mean hospital cost attributable to ABR per patient, the range was US$3000 in lower-income settings to US$41 000 in high-income settings, with carbapenem-resistant infections associated with a high cost-per-case of US$3000-US$7000 depending on syndrome. ABR was associated with a median value of US$693 billion (IQR: US$627 bn-US$768 bn) in hospital costs globally, with US$207 bn (IQR: US$186 bn-US$229 bn) potentially avertable by vaccines. Productivity losses were quantified at almost US$194 billion, with US$76 bn avertable by vaccines.</p><p><strong>Conclusions: </strong>The economic burden of ABR is associated with high levels of hospital bed-days occupied, hospital spending and labour productivity losses globally and should, therefore, remain high on national and international policy agendas. Vaccines against <i>Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae</i> would avert a substantial portion of the economic burden associated with ABR. More robust evidence, particularly in low-income countries, on the hospital costs, associated with and attributable to ABR, is needed.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diaspora as partners: strengthening resilience of health systems and communities amidst aid volatility.","authors":"Alaa Dafallah, Sophie Witter","doi":"10.1136/bmjgh-2025-019622","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-019622","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the effect of nearby armed conflict on access to maternal and child health services in Burkina Faso's primary healthcare facilities.","authors":"Felix Amberg, Karl Blanchet, Neha S Singh, Valéry Ridde, Emmanuel Bonnet, Pierre Yaméogo, Ali Sie, Mariam Seynou, Julia Lohmann, Manuela De Allegri","doi":"10.1136/bmjgh-2024-015507","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-015507","url":null,"abstract":"<p><strong>Background: </strong>Armed conflict is increasing in sub-Saharan Africa, impacting access to vital health services. However, scant evidence exists on the effects of the recently escalated conflict in Burkina Faso, a country severely affected by rising violence.</p><p><strong>Methods: </strong>We conducted a longitudinal study, aligning conflict event data from the Uppsala Conflict Data Program with Burkina Faso's Health Management Information System data spanning from 2013 to 2021. Applying negative binomial regression models with health facility fixed effects, we assessed the impact of nearby armed conflict events (within 25 km of primary healthcare centres) on access to six essential maternal and child health services. We investigated effect heterogeneity by varying conflict intensity and duration, and facility characteristics.</p><p><strong>Results: </strong>Any nearby armed conflict significantly reduced the incidence of all examined health services, except for non-significant caesarean section declines. Specifically, antenatal care 4 visits decreased by 3.9%, facility-based deliveries by 7.2%, caesarean sections by 9.4%, postnatal care 1 visits by 4.3% and outpatient care visits for children under 5 and aged 5-14 by 7.2% and 12.0%, respectively. High-intensity conflict events significantly amplified the negative effects across all health services. We observed less pronounced effects on children under 5 compared with those aged 5-14 not encompassed by existing fee removal policies. Prolonged conflicts did not adversely affect outpatient care visits for children. Rural facilities bore a more pronounced effect than urban facilities.</p><p><strong>Conclusions: </strong>Our findings show a significant disruption of health services due to contemporaneous conflict in Burkina Faso. However, child curative care services seem to exhibit a stabilisation trend in prolonged conflicts, and the mitigating effects of existing fee removal policies were evident. This underscores the need for nuanced policy interventions that consider varying conflict intensities, service types and financing schemes and highlights the importance of detailed, fine-scale analyses during conflict scenarios.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of enhancing nutrition and antenatal infection treatment on birth outcomes in Amhara, Ethiopia: a pragmatic factorial, cluster-randomised clinical effectiveness study.","authors":"Anne Cc Lee, Firehiwot Workneh, Yunhee Kang, Kalkidan Yibeltal, Nebiyou Fasil, Sitota Tsegaye, Estifanos Baye, Workagegnehu Tarekegn Kidane, Yoseph Yemane Berhane, Mulatu Melese Derebe, Fred Van Dyk, Michelle Eglovitch, Ingrid Olson, Mandefro M Mengistie, Fisseha Shiferie, Tigest Shifraw, Chunling Lu, Krysten North, Grace J Chan, Sheila Isanaka, Rose L Molina, Amare Worku Tadesse, Blair J Wylie, Parul Christian, Luke C Mullany, Alemayehu Worku, Yemane Berhane","doi":"10.1136/bmjgh-2024-016264","DOIUrl":"10.1136/bmjgh-2024-016264","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to determine the impact of antenatal interventions to optimise maternal nutrition and infection management on birth outcomes in Ethiopia.</p><p><strong>Methods: </strong>We conducted a pragmatic, open-label, 2×2 factorial randomised clinical effectiveness study among pregnant women enrolled <24 weeks gestation in 12 rural health centres in Amhara, Ethiopia. Eligible health centres were randomised to deliver an enhanced nutrition package (ENP) (iron-folic acid, iodised salt and targeted micronutrient fortified balanced energy protein (BEP) supplementation for undernourished women) or routine nutrition care (iron-folic acid only). Individual women were randomised to receive an enhanced infection management package (EIMP) (genitourinary tract infection screening-treatment and enhanced deworming) or routine infection care (syndromic management). The primary outcomes were birth weight and length; secondary outcomes were gestational age, preterm delivery, small-for-gestational-age, low birth weight, stillbirth, newborn weight-for-age and length-for-age z-scores, newborn head circumference, and maternal anemia. Analysis was intention to treat.</p><p><strong>Results: </strong>From August 2020 to December 2021, 2392 women were randomised (604 ENP+EIMP, 600 ENP alone, 593 EIMP alone and 595 neither package) and followed until June 2022, with 2170 pregnancy outcomes analysed (565 ENP+EIMP, 549 ENP, 525 EIMP, 531 neither). In the ENP arm, 427 (36%) women were eligible for BEP and consumed on average 74 days. The prevalence of genitourinary tract infection was low (4.9%), while parasitic stool infections were common (31%). There was no difference in birth weight (ENP vs not-ENP: adjusted mean difference -4 g (-83 to 75); EIMP vs not-EIMP: 18 g (-35 to 70); ENP+EIMP vs neither: 14 g (-81 to 109)) or birth length (ENP: -0.3 cm (-1.1 to 0.5); EIMP: 0.2 cm (-0.1 to 0.5); ENP+EIMP: -0.1 cm (-1.2 to 1.1)) between study arms. In the ENP+EIMP group, the stillbirth rate was lower compared with the arm receiving neither package (7.1/1000 vs 24.7/1000 births; adjusted relative risk: 0.29 (0.09 to 0.94)). The packages did not significantly affect other secondary outcomes.</p><p><strong>Conclusions: </strong>In this pragmatic study implemented within the Ethiopian health system, enhanced nutrition and infection packages did not affect birth weight or length. While stillbirth rates were lower in the group receiving both packages, these findings need to be supported by additional studies.</p><p><strong>Trial registration number: </strong>ISRCTN15116516.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menopause: a midlife crisis for women in India.","authors":"Nikita Haresh Rajput","doi":"10.1136/bmjgh-2024-017863","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-017863","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The global health workforce crisis: are task-shifting strategies sustainable?","authors":"Saeed Anwar","doi":"10.1136/bmjgh-2025-019264","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-019264","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in low birth weight across 36 states and union territories in India, 1993-2021.","authors":"Omar Karlsson, Akhil Kumar, Rockli Kim, S V Subramanian","doi":"10.1136/bmjgh-2024-016732","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-016732","url":null,"abstract":"<p><strong>Introduction: </strong>Low birth weight is an important measure of the health of pregnant women and newborns. We investigated the prevalence of low birth weights in India over nearly three decades to assess trends and convergence across states.</p><p><strong>Methods: </strong>Data came from five waves of the National Family Health Survey (1992-93 to 2019-21). The prevalence of low birth weight was estimated. To explore the sensitivity of our results to missing birth weight data-since the completeness of birth weight information has changed drastically-we also estimated prevalence from multiple imputation models, Heckman selection models, and by reweighting the data so that socioeconomic characteristics of children with birth weight data matched across surveys.</p><p><strong>Results: </strong>The overall prevalence of low birth weight in India declined from 26% to 18% during the period. The 2019-21 survey revealed that four states, Uttar Pradesh, Bihar, Maharashtra, and West Bengal accounted for almost half of all low-birth-weight births in India. The Pearson's correlation between the prevalence of low birth weight in 1992-93 and percentage point change across the period was -0.85, suggesting convergence between states, where states with greater prevalence in 1992-93 had faster declines. Convergence was robust across sensitivity specifications.</p><p><strong>Conclusion: </strong>State-level convergence indicates a potential 'catch-up' phenomenon, where states with initially higher prevalence have experienced greater declines. This finding suggested a possible impact of interventions prompted by dire figures in the earliest surveys, yet also stresses the necessity for continued interventions across all states to maintain and further progress. Our analysis, however, warrants a cautious interpretation due to data limitations. However, we observed convergence in the prevalence of low birth weight across states in all sensitivity specifications.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why should we be concerned by internalised racism in global health?","authors":"Bipin Adhikari, Chanaki Amaratunga, Ferdinand C Mukumbang, Shiva R Mishra","doi":"10.1136/bmjgh-2024-016740","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-016740","url":null,"abstract":"<p><p>Internalised racism constitutes an adoption of beliefs about one's inferiority, weaknesses or shortcomings as a function of racial hierarchy affecting one's identity and self-worth, thoughts, emotions and behaviours. Internalised racism stems from widely known and discussed institutional racial discrimination, which perpetuates epistemic injustice, social injustice and health inequities in global health. In this article, reflecting on our experiential knowledge from working on global health, we engage with relevant literature to (1) highlight the concepts associated with internalised racism, (2) explore the potential impacts of internalised racism on individuals, organisations and global health and (3) propose strategies to redress and mitigate its impact on global health practice.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Connecting environment, health and livelihoods: how community experiences inform integrated programming in Rukiga District, Uganda.","authors":"Richard Muhumuza, Gift Namanya, Phiona Orishaba, Sarah Uwimbabazi, Gilbert Mateeka, Adalbert Aine-Omucunguzi, Kathryn Lloyd, Janet Seeley, Susannah Mayhew","doi":"10.1136/bmjgh-2023-014406","DOIUrl":"https://doi.org/10.1136/bmjgh-2023-014406","url":null,"abstract":"<p><strong>Introduction: </strong>The climate crisis has profound effects on people's lives, particularly those reliant on subsistence agriculture and ecosystem goods for their livelihoods and health. There is growing recognition of the interconnections between human health, environmental degradation and climate change, but little research on the pathways of these interconnections that could inform programme development and little attention given to community experiences and perspectives that provide essential insights into how cross-sector programmes could better address health, livelihoods and environmental needs.</p><p><strong>Methods: </strong>Between April and June 2021, we conducted in-depth interviews and focus group discussions with residents across eight parishes affected by climate change in Rukiga District, Uganda. We investigated peoples' perceptions and experiences concerning health, climate, environment and livelihoods, then codeveloped integrated cross-sector solutions with non-governmental partners to respond to identified challenges. We analysed data using thematic content analysis.</p><p><strong>Results: </strong>Community members articulated how increasingly unpredictable seasons and rainfall patterns lead to crop failures, soil erosion and flooding exacerbated by widespread practices of tree cutting and growing non-native plants. The burning of upland and wetland vegetation caused further degradation, reducing access to clean water. These led to inadequate nutritious food and malnutrition. Respondents noted that large family size puts pressure on available land, yet they have poor family planning services and information. Men who could not provide for their families reportedly spent money on alcohol; behaviour which was associated with gender-based violence.Community experiences and viewpoints were discussed at workshops and meetings with non-governmental organisations and health partners to identify key evidence-based interventions and develop integrated messaging to address the interconnected needs articulated by community members.</p><p><strong>Conclusion: </strong>Listening to the experiences and views of community members is essential to designing impactful, sustainable programmes to address interconnected health, environment and livelihood needs. Researchers can broker this through formative research and cocreation workshops with local responders.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"8 Suppl 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}