BMJ Global Health最新文献

{"title":"Responsible governance of genomics data and biospecimens in the context of broad consent: experiences of a pioneering access committee in Africa.","authors":"Ahmed Rebai, Akin Abayomi, P Andanda, R Kerr, Kobus Herbst, J Mabuka, R Wamuyu, Daima Bukini, C Dandara","doi":"10.1136/bmjgh-2024-016026","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-016026","url":null,"abstract":"<p><p>International collaboration in genomic research is gaining momentum in African countries and is often supported by external funding. Over the last decade, there has been an increased interest in African genomic data. The contribution of this rich data resource in understanding diseases predominant in both African and global populations has been limited to date. There has been some non-governmental funding dedicated to the advancement of genomic research and innovation by African-based and African-led research groups, but the impact of these initiatives is hard to quantify. However, there is now an opportunity for the global research community to leverage decades of genomic data and biospecimens originating from African populations. The experience we describe in this paper is of an access governance framework established under the Human, Heredity, and Health in Africa (H3A) consortium, given the task of managing wider access to the data and biospecimen resources collected via its various projects. The function of the Data and Biospecimen Access Committee (DBAC) is to facilitate the advancement of medicine and health while fostering the development of bioinformatics capabilities at Africa-based institutions or regional hubs. Our collective experiences and lessons learnt as a committee provide examples of nuanced considerations when evaluating access to African data. The committee was semi-autonomous in its establishment and had independence in decision-making. The DBAC continually advocates for the responsible use of genomic data and biospecimens that were obtained from African research participants, under broad consent, by primary researchers who no longer have oversight over the future use of these resources.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373595","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":"A qualitative study of community perceptions and practices relating to blood donation in Cameroon.","authors":"Constantine T Asahngwa, Ghyslaine Bruna Djeunang Dongho, Wilfred Ngwa, Regina Sinsai, Solange Dabou, Evrard Kepgang, Odette D Kibu, Ngo Valery Ngo, Ronald Mbua Gobina, Denis Alemka Foretia","doi":"10.1136/bmjgh-2024-017825","DOIUrl":"10.1136/bmjgh-2024-017825","url":null,"abstract":"<p><strong>Introduction: </strong>Blood and blood products are essential for patients in need of transfusion therapy, especially those undergoing surgical procedures, childbirth and other injuries. In Cameroon, there is an annual deficit of over 270 000 pints of blood, with a coverage rate of only 17%. This qualitative study investigates the barriers and motivators to blood donation among Cameroonian adults, with the aim of better understanding community perceptions and practices.</p><p><strong>Methods: </strong>This ethnographic study was performed using a purposive sampling strategy. Focus group discussions and in-depth interviews were conducted with community members to understand perceptions and practices that serve as motivators and deterrents to blood donation in Yaoundé, Cameroon. Data were transcribed verbatim and analysed thematically to identify emerging themes.</p><p><strong>Results: </strong>A total of 25 Cameroonian adults were interviewed. Some participants believed that donating blood is: (1) a humanitarian and life-saving gesture, (2) an act of social and religious responsibility and (3) a means for donors to access health services. Some people do not want to donate blood due to: (1) fear of needles, donor-site pain or possible ritualistic use of donated blood, (2) certain religious beliefs, such as those held by Jehovah's Witnesses, (3) local and cultural beliefs, (4) the perception that blood donation is a commercial activity for many health personnel and (5) lack of transparency from health personnel. The practice of free and voluntary donation, as well as donations specifically to family and friends, was common. Occasionally, requests for financial remuneration prior to blood donation also emerged.</p><p><strong>Conclusions: </strong>Community members displayed both favourable and unfavourable perceptions as well as both safe and risky practices related to blood donation. The positive aspects highlighted the potential for creating a supportive environment for blood donation, while the negative aspects presented the significant challenges facing the development of high-quality blood donation and transfusion services. Efforts to reduce apathy toward blood donation and expand the pool of regular, repeat donors must carefully address the diverse perceptions and practices identified in this study.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363653","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":"Understanding experiences of neglected tropical diseases of the skin: a mixed-methods study to inform intervention development in Ethiopia.","authors":"Mirgissa Kaba, Yohannes Hailemichael, Abebaw Yeshambel Alemu, Teklu Cherkose, Getachew Kebebew, Fikregabrail Aberra Kassa, Galana Mamo Ayana, Tedros Nigusse, Kibur Engedawork, Zenebu Begna, Abay Waday, Tara B Mtuy, Saba Lambert, Katherine Elizabeth Halliday, Maria Zuurmond, Rachel L Pullan, Stephen L Walker, Catherine Pitt, Endalamaw Gadisa, Michael Marks, Jennifer Palmer","doi":"10.1136/bmjgh-2024-016650","DOIUrl":"10.1136/bmjgh-2024-016650","url":null,"abstract":"<p><strong>Background: </strong>The WHO and Ethiopia's Ministry of Health have developed strategies to expand and integrate services for co-endemic neglected tropical diseases (NTDs) which manifest in the skin. To inform these strategies, we aimed to understand the social, economic and health system context of skin NTD care in Kalu woreda, Amhara region, Ethiopia, where cutaneous leishmaniasis (CL) and leprosy are endemic.</p><p><strong>Methods: </strong>Between October 2020 and May 2022, we surveyed and reviewed records of 41 primary healthcare facilities and explored common disease experiences in focus group discussions (n=40) and interviews with people affected by leprosy (n=37) and CL (n=33), health workers (n=23), kebele authorities and opinion leaders (n=33) and traditional healers (n=7). Opportunities for integrated skin NTD service provision were explored through policy document review, interviews with health officials (n=25), and stakeholder meetings.</p><p><strong>Results: </strong>Availability of diagnostic supplies and health worker competence to provide skin care was very limited across primary healthcare facilities, particularly for CL. People with leprosy commonly sought care from healthcare facilities, while people with CL administered self-care or sought help from traditional healers. Travel and costs of care at specialised facilities outside the district inhibited timely care-seeking for both diseases. Transmission discourses shaped different understandings of who was affected by leprosy and CL and expectations of behaviour during and after treatment. Many policy actors felt that existing supply chain interventions, decentralised treatment approaches and community engagement initiatives for leprosy could also benefit CL, but others also warned against increasing care-seeking unless CL treatment could be provided on a scale commensurate with the large burden they perceived.</p><p><strong>Conclusion: </strong>Our findings demonstrate significant gaps in the provision of care for skin NTDs within primary healthcare, very different health-seeking patterns for leprosy and CL, and a need to develop new models of care, especially for CL.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363655","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":"Decision-making under epistemic, strategic and institutional uncertainty during COVID-19: findings from a six-country empirical study.","authors":"Sumegha Asthana, Sanjana Mukherjee, Alexandra L Phelan, Ibrahim B Gobir, J J Woo, Clare Wenham, Mohammad Mushtuq Husain, Tahmina Shirin, Nevashan Govender, Mohannad Al Nsour, Winifred Ukponu, Adachioma Chinonso Ihueze, Roujia Lin, Sumit Asthana, Renee Vongai Mutare, Claire J Standley","doi":"10.1136/bmjgh-2024-018124","DOIUrl":"10.1136/bmjgh-2024-018124","url":null,"abstract":"<p><strong>Background: </strong>Uncertainty is defined as limited knowledge or lack of predictability about past, present or future events. The COVID-19 pandemic management was significantly impacted by uncertainty, as the gaps between existing information and the necessary knowledge hindered decision-making. Current uncertainty literature primarily focuses on natural disasters, leaving a gap in understanding decision-making under uncertainty in times of public health emergencies. Analysing strategies for making decisions under uncertainty during the pandemic is crucial for future pandemic preparedness.</p><p><strong>Methods: </strong>Using a comparative research design, we study the strategies governments used to make decisions under uncertainty during the COVID-19 pandemic. We collected data through desk reviews, stakeholder interviews and focus group discussions with stakeholders from government, academia and civil society from six purposefully selected countries: Nigeria, Singapore, South Africa, Bangladesh, Jordan and the UK.</p><p><strong>Results: </strong>Regardless of political, geographic and economic context, all six countries adopted common strategies to make decisions under three types of uncertainties. Decision-making under epistemic uncertainty involved seeking expert advice and collecting evidence from other countries and international organisations. Decision-making under strategic uncertainty involved coordination, collaboration and communication. Decision-making under institutional uncertainty involved using or adapting pre-existing experiences, structures and relationships and establishing new institutions and processes.</p><p><strong>Conclusions: </strong>We contribute to the theory and practice of public health crisis decision-making by presenting a unified national-level applied decision-making framework for events involving uncertainty. We provide practical guidance for approaches to enhance decision-making in future health crises that could also be used for other emergencies.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363654","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 scoping review on the impact of women's global leadership: evidence to inform health leadership.","authors":"Anna Kalbarczyk, Katherine Banchoff, Kelly E Perry, Charlotte Pram Nielsen, Anju Malhotra, Rosemary Morgan","doi":"10.1136/bmjgh-2024-015982","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-015982","url":null,"abstract":"<p><strong>Introduction: </strong>The documented benefits of gender parity in leadership are emerging-women leaders have been shown to have a positive impact on maternal and health care policies, strengthen health facilities, and reduce health inequalities. More research is needed, however, to document their impact on global health. We go beyond the well-documented barriers that uphold the lack of gender parity by identifying areas where women leaders are making an impact to inform investment, programming, and policy.</p><p><strong>Methods: </strong>We conducted a scoping review of peer-reviewed literature, following Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, to map evidence on the impact of women's leadership in organisations in low- and middle-income countries. As many leadership outcomes are cross-disciplinary, outcomes were explored across sectors with particular attention paid to the relevance of these outcomes for global health.</p><p><strong>Results: </strong>137 articles were included in the review. Studies found women leaders' positive influence on six areas of impact: (1) financial performance, risk, and stability, (2) innovation, (3) engagement with ethical initiatives, (4) health, (5) organisational culture and climate outcomes, and (6) influence on other women's careers and aspirations. Articles reporting mixed results focused on multiple indicators and still largely pointed to positive results, particularly when modified by other factors including increased education, increased experience, and opportunities to work with other women across the organisation. In all sectors, across leadership roles, and across geographies, women's leadership can produce positive results. Women leaders' success, however, cannot be separated from the contexts in which they work, and unsupportive environments can affect the extent to which women leaders can have an impact.</p><p><strong>Conclusion: </strong>Increased and sustained investment in women's leadership within the health sector can lead to improved outcomes for organisations and their clients. Such investments must not only target individual women, but also seek to foster organisational cultures that promote and retain women leaders and support their independent decision-making.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187770","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":"Acceptability of the R21/Matrix-M malaria vaccine alongside existing malaria interventions in the trial context.","authors":"Halimatou Diawara, Jane Grant, Alassane Dicko, Seydou Traore, Djibrilla Issiaka, Fatoumata Koita, Mehreen Datoo, Mala Sylla, Abdrahmane Boncane Dicko, Issaka Sagara, Daniel Chandramohan, Adrian Vs Hill, Brian Greenwood, Jayne Webster","doi":"10.1136/bmjgh-2024-015524","DOIUrl":"10.1136/bmjgh-2024-015524","url":null,"abstract":"<p><strong>Background: </strong>The R21/Matrix-M malaria vaccine has been shown to provide high protective efficacy against malaria in a phase III trial, and has been recommended for use by WHO. The vaccine will soon be deployed at scale in sub-Saharan Africa. This study aimed to understand the caregiver and community acceptability of the R21/Matrix-M vaccine alongside existing malaria prevention interventions, according to the communities of participants in the seasonal R21/Matrix-M phase III trial in Mali.</p><p><strong>Methods: </strong>Qualitative data were collected to assess the acceptability of the R21/Matrix-M vaccine alongside the three R21/Matrix-M or control vaccine priming injections given in the first year of the trial. A total of 33 in-depth interviews (IDIs), 12 focus group discussions (FGDs) and 45 exit interviews at the trial clinics were conducted with caregivers of trial participants, 18 IDIs and 8 FGDs were conducted with community members, 13 IDIs with community health workers and 8 IDIs with trial field staff. Data were coded using the constructs from Sekhon's theoretical framework on acceptability.</p><p><strong>Results: </strong>Acceptability of the R21/Matrix-M vaccine was driven mainly by the high burden of malaria in the highly seasonal study area and consequent demand for a malaria vaccine, a perceived high efficacy of the R21/Matrix-M vaccine, and a high level of trust and confidence in the trial and trial team. These perceptions of the acceptability of the R21/Matrix-M vaccine led to a reduced perceived importance of seasonal malaria chemoprevention (SMC) among some caregivers, while others viewed R21/Matrix-M, SMC and insecticide-treated nets as complementary.</p><p><strong>Conclusions: </strong>The R21/Matrix-M vaccine was acceptable to caregivers and communities of participants in the R21/Matrix-M phase III trial in Mali. Implementation research is needed to evaluate and ensure co-coverage of complementary malaria control interventions, including SMC in seasonal settings, in the face of the scale-up of R21/Matrix-M and other malaria vaccines.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122131","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":"Evaluation of oral cholera vaccine (Euvichol-Plus) effectiveness against <i>Vibrio cholerae</i> in Bangladesh: an interim analysis.","authors":"Farhana Khanam, Md Taufiqul Islam, Faisal Ahmmed, Md Nazmul Hasan Rajib, Md Ismail Hossen, Fahima Chowdhury, Ashraful Islam Khan, Md Taufiqur Rahman Bhuiyan, Shahinur Haque, Prasanta Kumar Biswas, Amirul Islam Bhuiyan, Zahid Hasan Khan, Mohammad Ashraful Amin, Aninda Rahman, S M Shahriar Rizvi, Tahmina Shirin, Md Nazmul Islam, Amanda Tiffany, Lucy Breakwell, Firdausi Qadri, John D Clemens","doi":"10.1136/bmjgh-2024-016571","DOIUrl":"10.1136/bmjgh-2024-016571","url":null,"abstract":"<p><strong>Introduction: </strong>Millions of Euvichol-Plus doses have been deployed from the global oral cholera vaccine stockpile in over 20 cholera-affected countries. However, information on Euvichol-Plus's effectiveness is limited. Using this vaccine in a cholera epidemic in Dhaka, Bangladesh, provided the opportunity to evaluate the vaccine effectiveness (VE) using a test-negative design.</p><p><strong>Methods: </strong>A two-dose regimen of Euvichol-Plus was administered to individuals aged >1 year in a population of ca. 900 000 in two campaign rounds between June and August 2022, with prospective registration of all persons who received at least one dose. We conducted systematic surveillance in two key facilities, enrolling patients with acute watery diarrhoea who were eligible for vaccination from the campaign's start and who presented for care between 21 August 2022 and 20 August 2023. Faecal culture-positive cholera cases were matched to up to four faecal culture-negative controls by age, presentation date and facility. Vaccination status was documented without knowledge of culture results. Conditional logistic regression models estimated the OR for the vaccination-cholera association, and the VE of the two-dose regimen was calculated as [(1-OR) × 100].</p><p><strong>Results: </strong>The analysis included 226 cases and 552 matched controls. The adjusted VE of two doses of the Euvichol-Plus vaccine against medically attended cholera was 66% (99.5% CI: 30 to 83) for all recipients. Limited protection (12%; 95% CI: -95 to 60) was observed for children aged 1-4 years; whereas, protection was 79% (95% CI: 60 to 89) for those aged ≥5 years. VE against cholera with moderate to severe dehydration was 69% (95% CI: 44 to 83) overall but 6% (95% CI: -206 to 71) for children aged 1-4 years.</p><p><strong>Conclusion: </strong>Euvichol-Plus provided significant protection against medically attended cholera of any severity as well as cholera with moderate to severe dehydration. However, significant levels of protection were only observed for those aged ≥5 years.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122132","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":"Risk factors associated with human Mpox infection: a systematic review and meta-analysis.","authors":"Chigozie Louisa Jane Ugwu, Nicola Luigi Bragazzi, Jianhong Wu, Jude Dzevela Kong, Ali Asgary, James Orbinski, Woldegebriel Assefa Woldegerima","doi":"10.1136/bmjgh-2024-016937","DOIUrl":"10.1136/bmjgh-2024-016937","url":null,"abstract":"<p><strong>Background: </strong>Mpox emerged as a significant global public health concern during the 2022-2023 outbreak, impacting populations in both endemic and non-endemic countries. This study reviews and synthesises evidence on the risk factors associated with human Mpox transmission across these regions.</p><p><strong>Methods: </strong>A systematic search of peer-reviewed original studies was conducted across Scopus, Embase, Web of Science and PubMed databases, covering publications up to 31 March 2024. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two authors independently screened the articles by title, abstract and full text. The Newcastle-Ottawa Scale used to assess the risk of bias for included articles. Fixed- or random-effects meta-analysis was conducted when at least two studies reported ORs or relative risks, with 95% CIs. Heterogeneity was assessed using the [Formula: see text] statistic. This study was registered on PROSPERO (ID: <i>CRD42023459895</i>).</p><p><strong>Results: </strong>The systematic review identified 947 articles through database searches, of which 31 met our inclusion criteria. The meta-analysis revealed significant risk factors associated with Mpox infection. Interaction with infected animals (OR=5.61, 95% CI 2.83, 11.13), HIV infection (OR=4.46, 95% CI 3.27, 6.08), other sexually transmitted infections (OR=1.76, 95% CI 1.42, 2.19), unprotected sexual activities (OR=1.53, 95% CI 1.13, 2.07), contact with an infected person (OR=2.39, 95% CI 1.87, 3.05), identification as men who have sex with men (OR=2.18, 95% CI 1.88, 2.51) and having multiple sexual partners (OR=1.61, 95% CI 1.24, 2.09) were associated with increased Mpox infection risk. Conversely, smallpox vaccination was associated with a significantly reduced risk of Mpox infection (OR=0.24, 95% CI 0.11, 0.55).</p><p><strong>Conclusion: </strong>Identification of risk factors associated with Mpox provides insights for strategic public health planning, enabling targeted interventions for high-risk groups and optimising resource allocation to strengthen Mpox control efforts.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122135","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":"Modelling the health, financial protection and equity impacts of upscaling the ACT NOW early intervention breast cancer pilot program in the Philippines: an extended cost-effectiveness analysis.","authors":"Alexander Chye, Stephen Jan, Nirmala Bhoo Pathy, Herdee Gloriane C Luna, Soledad B Lim, Merel Kimman, Mark Woodward, Sanne Peters, Helen Monaghan, Corazon A Ngelangel, Blake Angell","doi":"10.1136/bmjgh-2024-016402","DOIUrl":"10.1136/bmjgh-2024-016402","url":null,"abstract":"<p><strong>Introduction: </strong>Women in the Philippines experience significant health and economic burdens of breast cancer. The Philippines has reformed financial protection for breast cancer but does not have a national early detection and treatment programme. This study aims to model the health and economic impacts of ACT NOW (a pilot breast cancer programme that navigates women through free early detection to treatment) through an extended cost-effectiveness analysis.</p><p><strong>Methods: </strong>A microsimulation decision tree model was used to model the ACT NOW intervention (including annual clinical breast examination (CBE) and biannual breast ultrasound for women at high risk of breast cancer) over 5 years for healthy women 40-69 years old. Outcomes included health gains (breast cancer deaths saved), financial protection (financial catastrophes saved) and incremental cost-effectiveness ratios (ICER) (cost per disability-adjusted life year (DALY) saved). Outcomes were stratified by income group. Probabilistic, one-way sensitivity and scenario analyses explored uncertainty.</p><p><strong>Results: </strong>Over 5 years, the ACT NOW intervention is cost-effective with an ICER of PHP60 711 (USD1098) (average incremental cost PHP743 [95% UI 424-960] and DALYs saved 0.01 [95% UI 0.01-0.02], below Philippines 2022 gross domestic product per capita PHP178 751). Per 100 000 women, 57 deaths and eight financial catastrophes were saved. Cost-effectiveness did not vary significantly by income, but higher income groups incurred greater costs and lower DALYs. Results were sensitive to proportion of late-stage breast cancers post intervention, treatment adherence, intervention costs and downstaging effectiveness. Trade-offs are apparent between government contributions to financial protection and rates of financial catastrophe.</p><p><strong>Conclusions: </strong>Early detection interventions (annual CBE, biannual breast ultrasound if at high risk of breast cancer) are likely to be cost-effective, reduce breast cancer-related mortality through detection at earlier stages and modestly effective in reducing the incidence of financial catastrophe. Further research is required to establish the best implementation model to pursue full implementation and ways of designing equity-based screening interventions.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122133","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":"Essential newborn care practices in selected public health facilities using observation of 2603 normal deliveries in Uttar Pradesh, India.","authors":"Shajy Isac, Bidyadhar Dehury, Ravi Prakash, Nihal Hasan, John Anthony, Banadakoppa Manjappa Ramesh, Prakash P Javalkar, Vasanthakumar Namasivayam, Marissa L Becker, James Blanchard, Ties Boerma","doi":"10.1136/bmjgh-2024-017117","DOIUrl":"10.1136/bmjgh-2024-017117","url":null,"abstract":"<p><strong>Introduction: </strong>Essential newborn care (ENBC) practices are recommended for all births to improve neonatal survival. This paper aims to understand the facility-level variations and factors associated with the essential newborn care practices by providers in higher-level public health facilities in 25 high priority districts (HPDs) of Uttar Pradesh (UP).</p><p><strong>Methods: </strong>We used observational cross-sectional quantitative data from 48 selected public health facilities (23 district hospitals (DH) and 25 community health centres (CHC)-first referral units (FRU)) implemented in 25 HPDs of UP from February 2020 to May 2021. We defined ENBC practice as both cord care and initiation of breastfeeding within 1 hour of birth were practiced in normal deliveries by the staff nurse. Descriptive analysis was done based on data from 2603 newborns attended by 318 providers. A stratified analysis was done by DH and CHC-FRU.</p><p><strong>Results: </strong>Overall, essential newborn care was practiced among 26.1% of the newborns (26.2% in DH and 35.0% in CHC-FRU). The ENBC practice varied across facilities from 3.0% to 64.1% in DH and from 0% to 91.0% in CHC-FRU. The ENBC practice was about 2.3 times higher in facilities with a high level of skill and knowledge of the providers (39.0%) compared with the facilities with a low level of skill and knowledge (16.9%). Similar patterns of association between providers' skills and knowledge of ENBC practices were observed in DH and CHC-FRU.</p><p><strong>Conclusion: </strong>Skill and knowledge on ENBC components are significantly associated with the clinical practices of providers, with a high level of variability across facilities. This suggests a focused facility-based assessment and enhancement of the clinical competencies of the providers to improve the quality of care in public health facilities in UP.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073602","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}