BMJ Global Health最新文献

{"title":"Impact of all-oral bedaquiline-based shorter regimens in the treatment of drug-resistant tuberculosis: a systematic review and meta-analysis.","authors":"Ginenus Fekadu, Tadesse Tolossa, Firomsa Bekele, Xiaohan Chen, Yan He, Jing Yu, Xinyao Yi, Ming Liu, Getahun Fetensa, Dinka Dugassa, Ebisa Turi, Tesfaye Regassa Feyissa, Nathorn Chaiyakunapruk, Lianping Yang, Shanquan Chen, Wai-Kit Ming","doi":"10.1136/bmjgh-2024-018220","DOIUrl":"10.1136/bmjgh-2024-018220","url":null,"abstract":"<p><strong>Background: </strong>Drug-resistant tuberculosis (DR-TB) presents a significant global obstacle to TB control efforts, necessitating improved intervention strategies. The introduction of potent drugs, such as bedaquiline (Bdq), has led to the development of shorter treatment regimens. This systematic review and meta-analysis aimed to examine the impact of these regimens, synthesising data from recent clinical trials and observational studies.</p><p><strong>Methods: </strong>We searched multiple databases, including Medline and Scopus, for studies published from 2012 to February 2024. Eligible studies included clinical trials and cohort studies involving adults diagnosed with DR-TB treated with Bdq-based all-oral regimens lasting up to 12 months. Primary outcomes were treatment success rate (TSR) and incidence of serious adverse events (SAEs). We also compared efficacy and safety with longer oral or injectable regimens in control groups. Meta-analyses were conducted to pool event rates and risk ratios (RRs). Subgroup analyses and meta-regression were performed to identify potential sources of heterogeneity.</p><p><strong>Results: </strong>Data from 12 studies involving 1902 DR-TB patients across 11 countries were analysed. The pooled TSR was 83% (95% CI 77% to 89%), with mortality, treatment failure and loss to follow-up (LTFU) rates of 5% (3-8), 4% (2-6) and 4% (2-6), respectively. Subgroup analyses showed no significant differences in TSR by DR-TB type or HIV status. The incidence rate of SAE was 19% (13-24), with prolonged corrected QT interval (QTc) in 5% (2-8) of cases. Compared with the control regimens, all-oral Bdq-based shorter regimens significantly improved treatment success (RR 1.22, 1.04-1.43) but reduced mortality (RR 0.73, 0.69-0.99), treatment failure (RR 0.33, 0.32-0.62) and QTc prolongation (RR 0.39, 0.21-0.73).</p><p><strong>Conclusions: </strong>All-oral Bdq-based shorter regimens have improved treatment outcomes and significantly advanced DR-TB management. We urge policymakers, clinicians and stakeholders to expand access to and expedite the implementation of these regimens.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802530","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":"Global, regional and national disparities and temporal trends of common autoimmune disease burdens among children and adolescents from 1990 to 2019.","authors":"Chen Chen, Fan Yang, Paul Lodder, Xiaohan Liu, Ning Huang, Mingyu Zhang, Shan Zhang, Jing Guo","doi":"10.1136/bmjgh-2024-017187","DOIUrl":"10.1136/bmjgh-2024-017187","url":null,"abstract":"<p><strong>Introduction: </strong>Previous evidence lacked a thorough review of the disparities of autoimmune diseases (AD) burdens among countries and regions, which led to an insufficient basis for developing country-specific developmental level relevant preventive measures. This study aimed to analyse disparities and trends of global, regional and national burden of common ADs in children and adolescents from 1990 to 2019 and to investigate the associations between specific ADs and varied country indexes.</p><p><strong>Methods: </strong>All data for four major ADs were obtained from the Global Burden of Diseases Study 2019. Age period-cohort modelling was conducted to disentangle age, period and birth cohort effects on AD incidence from 1990 to 2019. Local regression smoothing models were used to fit the correlation between AD burdens and sociodemographic index (SDI). Pearson's correlation was used to investigate varied country-level risk factors for disease burden.</p><p><strong>Results: </strong>A global increase in four common ADs incidence was observed from 1.57 million to 1.63 million between 1990 and 2019 in the 0-24 age group. The age-standardised incidence rate of overall four ADs showed substantial regional and global variation with the highest incidence in high SDI regions. The age, period and cohort distributions of AD incidence varied significantly, especially in high SDI countries. Relative to the expected level of age-standardised incidence associated with SDI, the distribution varied by regions depending on the specific ADs. Countries with higher levels of socioeconomic development, better quality of life and easier access to healthcare and the healthcare system showed lower disease burdens of ADs.</p><p><strong>Conclusions: </strong>The incidence patterns and disease burdens of ADs varied considerably according to age, time period and generational cohort, across the world between 1990 and 2019. Incidences of ADs in children and adolescents were significantly correlated with indexes involving risks of the environment, human rights and health safety and quality of life.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787832","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":"Beyond proximity: an observational study of stillbirth rates and emergency obstetric and newborn care accessibility in The Gambia.","authors":"Oghenebrume Wariri, Winfred Dotse-Gborgbortsi, Schadrac C Agbla, Hawanatu Jah, Mamady Cham, Ba Foday Jawara, Mustapha Bittaye, Momodou T Nyassi, Musa Marena, Sainey Sanneh, Mariama Janneh, Beate Kampmann, Aduragbemi Banke-Thomas, Joy E Lawn, Uduak Okomo","doi":"10.1136/bmjgh-2024-016579","DOIUrl":"10.1136/bmjgh-2024-016579","url":null,"abstract":"<p><strong>Introduction: </strong>Stillbirths are disproportionately concentrated in sub-Saharan Africa, where geographical accessibility to basic/comprehensive emergency obstetric and newborn care (BEmONC and CEmONC) significantly influences maternal and perinatal outcomes. This study describes stillbirth rates within healthcare facilities in The Gambia and examines their distribution in relation to the geographical accessibility of these facilities.</p><p><strong>Methods: </strong>We analysed 97 276 births recorded between 1 January 2013 and 31 December 2018, from 10 major public healthcare facilities in The Gambia. To standardise definitions, stillbirths were defined as fetal deaths with a birth weight of ≥500 g. Fresh stillbirths were reclassified as intrapartum, and macerated stillbirths were reclassified as antepartum. Linear regression with cubic splines was used to model trends, and AccessMod software estimated travel times to facilities.</p><p><strong>Results: </strong>Among recorded births, 5.1% (4873) were stillbirths, with an overall stillbirth rate of 51.3 per 1000 births (95% CI: 27.5 to 93.6). Intrapartum stillbirths accounted for 53.8% (27.6 per 1000 births; 95% CI: 14.4 to 49.8). Fully functional CEmONC facilities reported the highest stillbirth rates, including the National Teaching Hospital (101.7 per 1000 births, 95% CI: 96.8 to 106.8). Approximately 42.8%, 58.9% and 68.3% of women aged 15-49 lived within a 10, 20 and 30 min travel time, respectively, to fully functional CEmONC facilities, where high stillbirth rates were concentrated.</p><p><strong>Conclusions: </strong>In The Gambia, intrapartum stillbirth rates remain alarmingly high, even in geographically accessible CEmONC facilities. Inadequate documentation of fetal heart rate on admission hampers accurate classification, complicating targeted interventions. Ensuring that EmONC-designated facilities-particularly those providing BEmONC services-are fully functional with essential equipment, trained staff and robust referral systems, while enhancing the timeliness and quality of obstetric care, is crucial to reducing stillbirth rates.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787829","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":"An unfinished agenda: insights from seven country case studies on strengthening primary health care in the Western Pacific Region.","authors":"Alexandra Edelman, Lluis Vinyals Torres, Anis Kazi, Kumanan Rasanathan, Robert Marten","doi":"10.1136/bmjgh-2024-017442","DOIUrl":"10.1136/bmjgh-2024-017442","url":null,"abstract":"<p><p>In the WHO Western Pacific Region, primary health care (PHC) is considered 'the future of health' and the key to achieving universal health coverage. However, political, economic and social forces underlying curative, hospital-centric models have eroded public, local-level health service capacity-contributing to fragmented systems and persisting health inequities. Drawing insights from seven published country case studies from East Asia examining PHC in the context of the COVID-19 pandemic, this paper discusses key factors influencing the implementation of PHC. Countries are improving service delivery through a PHC approach, but persisting governance and structural barriers to PHC reform include vertical approaches to health care planning and programme delivery, health workforce shortages and maldistribution, and market forces that have shaped health care and workforce models towards curative care. Three domains for future policy and research to strengthen PHC are proposed. First, managing the political economy of PHC reform requires mapping relationships and systematically unravelling political, social and economic factors shaping accountability, receptiveness and capacity for change. Second, strengthening participatory governance involves shifting power to communities through platforms for shared policy creation and implementation, decentralised governance and empowering community-oriented health workers. Third, improving conceptual clarity and policy guidance on PHC can use the Sustainable Development Goals to orient systems towards preventing illness and valuing good health. The case studies offer a practice model of applied health policy and systems research coproduced with policy stakeholders.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771361","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":"A pragmatic covariate-constrained cluster-randomised controlled trial of hybrid parents and health workers adaptive intervention for optimal (timely, cumulative age-appropriate) community-wide routine childhood immunisation coverage: the AGINTOPIC trial.","authors":"Ugwu I Omale, Richard L Ewah, Chidinma I Amuzie, Cordis O Ikegwuonu, Glory E Nkwo, Chimaobi C Iwegbulam, Louisa C Ekwuazi","doi":"10.1136/bmjgh-2024-017403","DOIUrl":"10.1136/bmjgh-2024-017403","url":null,"abstract":"<p><strong>Introduction: </strong>Vaccine-preventable infectious diseases (VPDs) covered by routine childhood immunisation programmes are major causes of morbidity/mortality as outbreaks continue to reoccur despite repeated efforts to increase immunisation coverage. This trial aimed at increasing optimal/timely immunisation coverage.</p><p><strong>Methods: </strong>The Adaptive Group Intervention for Optimal routine childhood Immunisation Coverage (AGINTOPIC) trial was conducted from 1 June 2022 to 31 May 2023 in Ebonyi state, Nigeria. 16 geographical clusters (where the primary healthcare facilities were providing weekly routine childhood immunisation) were covariate-constrained-randomised (1:1) to control arm (receiving no intervention) and intervention arm (receiving hybrid parents/health workers adaptive engagement to enlighten/facilitate regular communications/working relationships between them regarding optimal immunisation). The primary outcomes included the proportion of children aged 5-9 months who had optimal/timely (cumulative age-appropriate) receipt of every recommended birth to 14 weeks vaccine and the age-appropriate vaccines receipt (receipt timeliness) score. The outcomes were measured via baseline and end-of-study repeated cross-sectional surveys. All analyses were done using a cluster-level method on intention-to-treat basis, and randomisation-based inference was done via adjusted clustered permutation tests (aCPTs) to check the robustness/validity of the main findings.</p><p><strong>Results: </strong>A mean proportion of 6.0% (SD 8.1) of children aged 5-9 months in the control arm had optimal/timely receipt of every recommended birth to 14 weeks vaccine, vs 14.3% (11.7) in the intervention arm (adjusted prevalence difference 10.8%, 95% CI 0.8% to 20.9%, p=0.0376, aCPT p=0.0093). The mean age-appropriate vaccines receipt score was 75.1 (17.8) in the control arm, vs 85.5 (9.5) in the intervention arm (adjusted mean difference 9.5, 95% CI 1.0 to 17.9, p=0.0317, aCPT p=0.0155).</p><p><strong>Conclusions: </strong>The AGINTOPIC intervention significantly increased the optimal/timely (cumulative age-appropriate) community-wide routine childhood immunisation coverage, and the evidence illuminates the need for the exploration and adaptation of such pragmatic/dynamic/scalable community engagement intervention by routine childhood immunisation programmes in the global efforts to address the recurrent outbreaks of VPDs.</p><p><strong>Trial registration number: </strong>ISRCTN59811905.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779020","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":"Maternal experiences of multiple forms of intimate partner violence and associations with undernutrition among children under 5: evidence from 36 low- and middle-income countries based on demographic and health surveys.","authors":"Yifan Gao, Shuangyu Zhao, Yanan Zhou, Jiale Zhou, Kun Tang","doi":"10.1136/bmjgh-2024-017114","DOIUrl":"10.1136/bmjgh-2024-017114","url":null,"abstract":"<p><strong>Background: </strong>Intimate partner violence (IPV) is a global issue and has various negative impacts on women and their children's physical and psychological health. Although the co-occurrence of multiple forms of IPV (ie, physical, psychological and sexual IPV) against women is prevailing, its negative effects on their children's nutrition remain neglected. This study aimed to explore such effects among children under 5.</p><p><strong>Methods: </strong>We used a sample of 104 740 mother-child pairs from 36 low- and middle-income countries based on the Demographic and Health Surveys between 2005 and 2022. Pooled and income level-specific survey logistic regressions were performed to assess the associations between maternal experience of any form of IPV, multiple forms of any IPV, co-occurrence of different forms of IPV and number of IPV forms within the past 12 months, with child undernutrition.</p><p><strong>Findings: </strong>Maternal exposure to multiple forms of IPV was significantly associated with an increased risk of child wasting (OR: 1·2, 95% CI: 1·0 to 1·4) and underweight (OR: 1·2, 95% CI: 1·1 to 1·4), while no significant association was found for stunting. Significant dose-response effects of the number of IPV forms were found for child wasting (p<0·05) and underweight (p<0·05). The co-occurrence of psychological and sexual IPV showed the most significant impact on child wasting (OR: 1·4, 95% CI: 1·2 to 1·8) across subtypes of co-occurrence. Most significant results were detected in lower- and middle-income countries. Children whose mothers were shorter than average, underweight, lived in rural areas and poorer families were more vulnerable to undernutrition.</p><p><strong>Interpretation: </strong>This study highlighted the negative effect of multiple forms of maternal IPV on child wasting and underweight with a focus on the number of IPV experienced. Our findings called for enhanced policy-based efforts to end gender-based violence to protect the health and rights of both women and children.</p><p><strong>Funding: </strong>This research is supported by the National Natural Science Foundation of China (No. 72074130).</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779023","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":"Worldwide burden of cervical human papillomavirus (HPV) in women over 50 years with abnormal cytology: a systematic review and meta-analysis.","authors":"Vanesa Osmani, Michael Rossiter, Lucy Hörner, Theoneste Nkurunziza, Sophia Rank, Luana Fiengo Tanaka, Stefanie J Klug","doi":"10.1136/bmjgh-2024-017309","DOIUrl":"10.1136/bmjgh-2024-017309","url":null,"abstract":"<p><strong>Introduction: </strong>More than half of global cervical cancer cases occur among women older than 50. However, global estimates regarding the human papillomavirus (HPV) prevalence among this population are lacking, especially for women with abnormal cytology. Therefore, we conducted a systematic review and meta-analysis to estimate the worldwide HPV prevalence in women aged 50 and older with abnormal cytology.</p><p><strong>Methods: </strong>We searched PubMed, Scopus and Web of Science for quantitative studies reporting any or high-risk (HR)-HPV prevalence for women 50 years and older with abnormal cytology (atypical squamous cells of undetermined significance and higher). We extracted data on world region, subregion, cervical lesion type, recruitment setting, HPV test, year of study conduct and HPV prevalence from the included studies. We assessed the risk of bias of the included studies using a modified Newcastle-Ottawa scale. We estimated the pooled prevalence and 95% CIs of any-HPV and HR-HPV using random-effects models, considering the world regions. Additionally, we estimated the prevalence by HPV type, lesion type and age groups.</p><p><strong>Results: </strong>Overall, 113 studies met the inclusion criteria, of which 104 were included in the meta-analysis. Among women aged 50 and older with abnormal cytology, the estimated global pooled prevalence of any-HPV from 53 studies, including 14 585 women, was 54.5% (95%CI, 46.0 to 62.8%), and the HR-HPV prevalence from 85 studies, covering 33 672 women, was 43.0% (95%CI, 36.6 to 49.5%). There was a higher HR-HPV prevalence among women with high-grade lesions and women living in the African continent. No major differences in HR-HPV prevalence between the age groups of women over 50 years were found. The most common single HPV types worldwide were 16 and 52, with pooled prevalence estimates of 12.0% (95%CI, 8.0% to 17.7%) and 8.4% (95%CI, 4.4% to 15.4%), respectively.</p><p><strong>Conclusion: </strong>Our findings highlight the relevance of targeted screening interventions among women 50 years and older. To achieve the elimination of cervical cancer, age-inclusive screening strategies should be considered.</p><p><strong>Prospero registration number: </strong>CRD42021241365.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779065","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":"Nutrition and reproductive potential of women in low- and middle-income countries: a systematic review and meta-analysis.","authors":"Dongqing Wang, Christine H Nguyen, Anahita Asghari-Kamrani, Uttara Partap, Iqbal Shah, Wafaie W Fawzi","doi":"10.1136/bmjgh-2024-015713","DOIUrl":"10.1136/bmjgh-2024-015713","url":null,"abstract":"<p><strong>Introduction: </strong>Nutrition plays a critical role in key physiological processes related to reproduction. However, there is limited understanding of the impact of nutritional factors and interventions on the reproductive outcomes of women in low- and middle-income countries (LMICs).</p><p><strong>Methods: </strong>This systematic review and meta-analysis aimed to synthesise evidence regarding the impact of nutritional factors and interventions on the reproductive outcomes of women in LMICs. Outcomes of interest included fertility and fecundity, menarche and menstrual disorders, miscarriage, stillbirth and live birth. Randomised controlled trials (RCTs) and non-randomised intervention studies with nutritional interventions, and observational cohort studies with nutritional factors, were included. Study selection, data extraction and risk of bias assessment were independently completed by two reviewers. A narrative synthesis of included studies was conducted, and meta-analyses were conducted when feasible.</p><p><strong>Results: </strong>Systematic search identified 180 studies, including 47 intervention studies and 133 observational cohort studies. From RCTs, there was no clear evidence for an effect of prenatal multiple micronutrient supplementation on the risk of miscarriage (8 RCTs; risk ratio (RR): 0.87; 95% CI 0.75, 1.02; moderate certainty of evidence) or stillbirth (15 RCTs; RR: 0.86; 95% CI 0.73, 1.02; low certainty of evidence). From observational cohort studies, preconceptional obesity was associated with a greater risk of miscarriage (12 studies; RR: 1.27; 95% CI 1.10, 1.47; very low certainty of evidence) and stillbirth (4 studies; RR: 1.66; 95% CI 1.28, 2.14; very low certainty of evidence). Any anaemia during pregnancy was associated with a greater risk of stillbirth (10 studies; RR: 1.26; 95% CI 1.01, 1.58; very low certainty of evidence).</p><p><strong>Conclusion: </strong>This review highlights the importance of ensuring preconceptional nutrition and preventing anaemia during pregnancy for favourable reproductive outcomes. This review calls for randomised controlled trials to evaluate the effectiveness of preconceptional and prenatal interventions on these outcomes.</p><p><strong>Prospero registration number: </strong>CRD42023395937.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771362","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":"Expanding access to sexual and reproductive health and rights through evidence-based policy dialogue: implications for practice from a multicountry initiative.","authors":"Ulrika Rehnstrom Loi, Amy Coates, Offeibea Obubah, Frank Noij, Katy Footman, Antonella Lavelanet, Hyobum Jang, Laurence Codjia, Laurence Läser, Tesfaye Tufa, Leopold Ouedraogo, Nilmini Hemachandra, Karima Gholbzouri, Meera Upadhyay, Neena Raina, Dina Gbenou, Souleymane Zan, Thierry Tossou Boco, Theopista John Kabuteni, Maria Mugabo Mujawamariya, Priya Karna, Ram Chahar, Amrita Kansal, Ellen Thom, Qudsia Uzma, Dan Kass, Carisse Hamlet, Adam Karpati, Shambhu Acharya, Bela Ganatra","doi":"10.1136/bmjgh-2024-016587","DOIUrl":"10.1136/bmjgh-2024-016587","url":null,"abstract":"<p><strong>Introduction: </strong>Policy dialogue is an important component of evidence-based policy-making. In 2019, WHO and Ministry of Health staff in 15 countries participated in an initiative that involved training and implementation of country-level sexual and reproductive health and rights (SRHR) policy dialogues. An evaluation of the process and outcomes was subsequently undertaken in six of the countries.</p><p><strong>Methods: </strong>The three-stage policy dialogue initiative included a preparatory phase to develop stakeholder analyses and policy briefs and a 2-day workshop to develop an action plan, followed by continuous support as the national teams implemented the action plans. A participatory, multimethod approach was used to evaluate the policy dialogue initiative, including a desk review of initiative documentation and interviews with project participants.</p><p><strong>Results: </strong>Participants reported positive experiences of the policy dialogue initiative and felt it improved their knowledge, skills and confidence. The ensuing policy dialogue activities in each country contributed to some SRHR policy development and/or implementation changes. The policy dialogue initiative supported these changes through its practical approach to learning and ongoing technical support. However, the impact of policy dialogues varied depending on political factors, the scope of policy goals, alignment with existing country priorities and stakeholder engagement. Furthermore, facilitating factors included strong support networks, incremental working and preparation for backlash against SRHR.</p><p><strong>Conclusions: </strong>Our experience highlights the value of policy dialogue for progressing SRHR policy change at the national level and the need for further investments in strengthening the skills of health decision-makers required for effective policy dialogue.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"8 Suppl 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771399","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":"Neurodevelopmental screening for neonates less than 44 weeks gestation in low-income and middle-income countries: a systematic review.","authors":"Benjamin J S Al-Haddad, Elisabeth Olson, Erin Reardon, Emmanuel Bonney","doi":"10.1136/bmjgh-2024-017683","DOIUrl":"10.1136/bmjgh-2024-017683","url":null,"abstract":"<p><strong>Introduction: </strong>With global improvements in neonatal survival, more small and sick newborns in low-income and middle-income countries (LMICs) are at increased risk of neurodevelopmental disability and delay. While there is increased recognition of the importance of early identification of neurodevelopmental differences and timely initiation of therapy, little is known about standardised neonatal neurodevelopmental screening tools in these settings.</p><p><strong>Methods: </strong>We performed a systematic review to determine what standardised neurodevelopmental assessments had been used in LMICs for neonates before 44 weeks corrected gestational age and published in the literature. We excluded short-term clinical assessments designed for specific pathologies. We performed the search across seven databases, screened studies for eligibility and inclusion and extracted bibliographic data, country, patient characteristics, assessments and study aims. Results were summarised in tabular and graphical presentation.</p><p><strong>Results: </strong>There were 2477 records screened, yielding 67 studies for inclusion. Studies in Asian countries made up 65.7%, while Latin America and Africa made up 19.4% and 16.4%, respectively. Physicians and paramedical staff performed the screening assessments in only 16.4% of studies, and 92.5% of studies used inpatient recruitment. The Neonatal Behavioural Neurological Assessment (25.4%) was the most frequently used screening tool followed by the General Movements Assessment (22.4%), the Hammersmith Neonatal Neurological Examination/Dubowitz (16.4%) and the Neonatal Behavioural Assessment Scale (10.4%).</p><p><strong>Conclusions: </strong>We did not identify any one neonatal neurodevelopmental screening assessment that is rapid, globally validated, identifies targets for intervention, has high predictive prognostic value and does not require neonatal or kinesiologic expertise or uncommon equipment. Such an assessment, in concert with evidence-based intervention, therapeutic delivery platforms, established referral pathways and trained personnel would improve functional outcomes for high-risk small and sick neonates in LMICs.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779038","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}