BMJ Global Health最新文献

{"title":"Empowering African professionals to assess palliative care development: regional application of the WHO framework.","authors":"Fernanda Bastos, Vilma A Tripodoro, Alvaro Montero, Ana Cristina Béjar, Eduardo Garralda, Virginia Gathoni Gichuru, Anthelme Kouessi Agbodande, Eve Namisango, Emmanuel Luyirika, Carlos Centeno","doi":"10.1136/bmjgh-2025-020623","DOIUrl":"10.1136/bmjgh-2025-020623","url":null,"abstract":"<p><strong>Introduction: </strong>The WHO has proposed a structured framework to assess palliative care development through 14 actionable indicators across 6 dimensions. While prior applications have been limited to individual countries, this study explores the feasibility of empowering professionals across an entire region to independently evaluate palliative care development using the WHO framework.</p><p><strong>Methods: </strong>An expert-informed, participatory implementation study was conducted across the African continent. A structured survey based on the WHO indicators was developed and translated into multiple languages. A regional network of national consultants was established, and participants were trained through an asynchronous, tutored online course. Data collection involved self-assessment of national palliative care development, accompanied by narrative justifications and documentary evidence. Validation processes included peer review and, where feasible, endorsement by national associations or authorities. Empowerment was assessed through course completion, perceived impact via post-course surveys and participation in data validation.</p><p><strong>Results: </strong>National-level data from 50 African countries were included, based on 121 contributors. Most countries had at least two contributors, ensuring data triangulation. Validation processes were completed in 48 countries, with 21 reports endorsed by national associations or authorities. Post-course surveys indicated that 91% of respondents rated the course highly for professional value, and 95% expressed interest in ongoing collaboration. The data collected are already informing global comparative analyses, including the African Palliative Care Atlas (2025 edition).</p><p><strong>Conclusions: </strong>This study demonstrates that with appropriate training and support, professionals across an entire region can independently assess palliative care development using the WHO framework. The approach fosters professional empowerment and provides high-quality, context-rich data, laying the groundwork for similar initiatives in other regions and contributing to a coordinated global assessment of palliative care development.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 10","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12530404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145306972","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":"How to measure the core functions of primary care in low-income and middle-income country settings.","authors":"Robert Mash, Innocent Besigye, Kéfilath Bello, Anna Galle","doi":"10.1136/bmjgh-2025-021218","DOIUrl":"10.1136/bmjgh-2025-021218","url":null,"abstract":"<p><p>The core functions of primary care are first contact access, comprehensiveness, continuity, coordination and person-centredness. These five core functions are highlighted as essential aspects of quality by the new WHO's measurement framework. In low-income and middle-income countries, the core functions are rarely measured and routinely collected data does not support their measurement. Existing international tools to measure the quality of primary care may evaluate some aspects of these core functions, but none of the reviewed tools focused on all of them. In sub-Saharan Africa, the Primary Care Assessment Tool has been developed over the last decade and a regional version of the tool has been validated to only measure the core functions as defined by the WHO. The tool uses exit interviews with users as recommended by the WHO. The tool has been piloted in South Africa, Uganda and Benin and will now be implemented in 11 African countries. The tool can enable low-income and middle-income countries to measure the core functions and plan interventions to improve the quality of primary care.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 10","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12530417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307027","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":"Maintaining essential health services during COVID-19: cross-country lessons of health system resilience from Asia, Sub-Saharan Africa and Latin America.","authors":"Moytrayee Guha, Arielle Cohen Tanugi-Carresse, Lucia Mullen, Sara Bennett, Rhoda Kitti Wanyenze, Andrea M Prado, Piya Hanvoravongchai, Magdalena Rathe, Julius Fobil, Ravindra Prasan Rannan-Eliya, Andy A Pearson, Claudio A Mora-García, Paul Cheh, Rawlance Ndejjo, Steven Ndugwa Kabwama, Duah Dwomoh, Suzanne Kiwanuka, Wasin Laohavinij, Melanie Coates, Laura Rathe, Nilmini Wijemunige, Zachary Hennenfent, William Wang, Siobhan Lazenby, Anne Liu, Jennifer B Nuzzo","doi":"10.1136/bmjgh-2023-013392","DOIUrl":"https://doi.org/10.1136/bmjgh-2023-013392","url":null,"abstract":"<p><p>The COVID-19 pandemic severely disrupted the delivery of essential health services (EHS) worldwide, contributing to excess morbidity and mortality from preventable conditions. Some countries employed innovative strategies that may have enabled their health systems to be more resilient than others in responding to COVID-19. This cross-country analysis aimed to identify beneficial practices and policies employed by six low- and middle-income countries (LMICs) in Asia, Sub-Saharan Africa and Latin America to maintain access to EHS while responding to COVID-19. Cross-country research partners (CCRPs) led a mixed methods assessment to identify best practices and strategies for COVID-19 response and continued provision of EHS between April 2021 and September 2022. A cross-country analysis was conducted to extract and thematically code best practices that were reported as beneficial by three or more study countries based on desk reviews, key informant interviews and quantitative and qualitative analyses. Cross-cutting enablers, barriers and lessons learnt were also documented. Cross-country themes include whole-of-government approaches; multisectoral collaboration and decision-making; early outbreak control measures; partnerships with the private sector; innovations in service delivery and health financing; a robust health workforce; adaptation of existing disease response capacities; and community engagement. Long-standing investments in health systems strengthening and preparedness, integrated health systems, public trust in government, leadership and political will, prior experience in responding to epidemics, strong primary healthcare systems, existing health financing mechanisms and provision of social and economic supports were identified as cross-cutting enablers. Lack of context-specific definitions for EHS, inequitable access to technology and lack of access to real-time, high-quality data were identified as challenges in study countries. This study provides valuable insights into the practices that may be considered beneficial and worthy of pursuit by other countries wishing to strengthen health system resilience and preparedness for future health emergencies. Further research is needed to evaluate the effectiveness of these practices in different settings.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"8 Suppl 6","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285546","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":"Association between food insecurity and intimate partner violence: the role of gendered asset policies.","authors":"Faith Miller, Jenevieve Mannell, Laura Brown, Andrew Gibbs, Abigail Hatcher","doi":"10.1136/bmjgh-2024-018322","DOIUrl":"10.1136/bmjgh-2024-018322","url":null,"abstract":"<p><strong>Introduction: </strong>Intimate partner violence (IPV) affects an estimated 27% of women globally, with consequences spanning mental, physical and societal well-being. Previous research identifies individual and relational risk factors for IPV, but less is known about wider structural factors. This study examines the association between food insecurity and IPV using nationally-representative data from 156 countries, exploring gendered asset policies as a potential mediator.</p><p><strong>Methods: </strong>We used nationally representative survey data on women's experience of IPV (1993-2019) and the Food and Agriculture Organization data on moderate to severe food insecurity. Multilevel mixed-effects generalised linear models estimated the association between standardised variables for food insecurity and IPV, accounting for country-level clustering and adjusting for gross domestic product (GDP). Mediation analysis estimated the role of gendered asset policies (Women, Business and the Law Index Score). Sensitivity analyses lagged food insecurity by at least 4 years among a subset of 59 countries.</p><p><strong>Results: </strong>We examined data from 219 country-years representing 156 countries globally across the period of 1993-2019. After controlling for national GDP, models estimated an independent cross-sectional association between food insecurity and IPV (<i>b=</i>0.49; 95% CI 0.37 to 0.62). Gendered asset policies mediated 18.9% of the food insecurity-IPV relationship (indirect effect 0.099 (0.044-0.155); total effect 0.526 (0.422-0.631)). In lagged analysis, food insecurity was associated with higher IPV 2 years later (<i>b=</i>0.78; 95% CI 0.48 to 1.06), with a similar mediation effect (21.0%).</p><p><strong>Conclusion: </strong>This study is among the first to harness global data to demonstrate country-level effects of food insecurity on IPV, which countries enacting more equitable asset policies were able to mitigate a substantial proportion of. Future research should prospectively pinpoint how supportive gender policies and asset ownership can amplify the benefits of food security for women's safety and longevity.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 10","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273721","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":"Coordinated responses to maintain tuberculosis care amid climate emergencies: challenges and perspectives based on the events of Brazil.","authors":"Lucas Vinícius de Lima, Daniele Maria Pelissari, Gabriel Pavinati, Fernanda Dockhorn Costa Johansen, Edenilo Baltazar Barreira Filho, Gabriela Tavares Magnabosco, Ethel Leonor Noia Maciel","doi":"10.1136/bmjgh-2025-019123","DOIUrl":"10.1136/bmjgh-2025-019123","url":null,"abstract":"<p><p>The Unified Health System (<i>Sistema Único de Saúde</i>, SUS) is a cornerstone of Brazil's public health, offering universal care and playing a critical role during crises such as the COVID-19 pandemic and climate emergencies. Climate change poses escalating threats to public health, intensifying vulnerabilities and increasing the burden of diseases like tuberculosis. This study focuses on the analysis of events resulting from heavy rains in the state of Rio Grande do Sul, addressing the impacts of climate change, strategies for continued tuberculosis control, logistical and operational challenges and prospects for strengthening the SUS in times of climate crises. With Brazil's high tuberculosis prevalence, climate events, such as the severe 2024 floods in Rio Grande do Sul, disrupted healthcare infrastructure, delayed tuberculosis diagnosis and treatment and worsened health inequities. The floods in Rio Grande do Sul affected 96% of municipalities, displacing over 160 000 people and damaging health centres. Efforts to maintain tuberculosis care included deploying mobile units, relocating diagnostic equipment and implementing extended medication dispensing. The SUS demonstrated resilience, but gaps in real-time case monitoring and health infrastructure persist. Addressing these gaps is critical, especially as climate change exacerbates social vulnerabilities. The need for an effective tuberculosis vaccine has become urgent in mitigating climate-related health crises. Additionally, adopting the one health approach, improving cross-sector collaboration, investing in digital health technologies and empowering communities are essential for building a resilient health system. Integrated policies addressing climate change impacts can safeguard public health and equity in Brazil.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 10","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249744","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":"The economic burden of rheumatic heart disease in the Eastern Mediterranean Region.","authors":"Khalifa Elmusharaf, Sébastien Poix, Emil Basil Scaria, Mariyam Saherwala, Matilda Byström, Asmus Hammerich, Abdirahman Khalif Mohamud, Hicham El Berri, Eiman Hag","doi":"10.1136/bmjgh-2024-018277","DOIUrl":"10.1136/bmjgh-2024-018277","url":null,"abstract":"<p><strong>Introduction: </strong>Acute rheumatic fever (ARF) is an immune response triggered by group A Streptococcus (GAS) infections, predominantly affecting children aged 5-15 years. Untreated ARF can progress to rheumatic heart disease (RHD), causing complications such as valve stenosis, heart failure and stroke. Despite preventability using antibiotics, RHD persists as a major health concern in many Eastern Mediterranean Region (EMR) countries. Beyond its health implications, RHD poses a significant economic burden on societies, emphasising the need for comprehensive solutions.</p><p><strong>Methods: </strong>An economic analysis was conducted to estimate the burden of RHD in 22 countries of the EMR using data from secondary databases and existing research. The analysis modelled the future disease burden, using a scenario of inaction and considering population growth and changes in population structure. Economic losses associated with RHD were explored through five pathways, including the (a) direct healthcare costs of preventing and treating RHD and its complications, (b) cost of premature deaths, (c) cost of absenteeism in adult patients, (d) cost of absenteeism in caregivers and (e) future productivity losses due to unfulfilled potential in children.</p><p><strong>Results: </strong>The estimated economic burden of ARF, RHD and its related complications in the EMR was US$5.8 billion in 2020, amounting to 0.20% of the combined gross domestic product. Indirect costs accounted for 78% of the burden. 192 million prevalent cases and 1.5 million deaths were expected by 2050. The burden is projected to increase to US$166 billion between 2020 and 2050.</p><p><strong>Conclusion: </strong>The disease burden of RHD is rising in the EMR, widening health inequalities and straining resources. Careful planning and resource allocation based on economic evaluations are crucial to mitigate this issue. Regional governments must implement measures to address social determinants, enhance community awareness, improve surveillance and provide accessible healthcare services to effectively tackle this challenge.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 10","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249779","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":"Effect of caregiver training on knowledge and confidence of at-home clinical and anthropometric surveillance of children with uncomplicated severe acute malnutrition: analysis of a cross-over cluster randomised trial in Sokoto, Nigeria.","authors":"Nazia Binte Ali, Matt Dt Hitchings, Fatou Berthé, Philip Aruna, Ibrahim Shehu, Siméon Nanama, Chizoba Steve-Edemba, Rebecca F Grais, Sheila Isanaka","doi":"10.1136/bmjgh-2024-018559","DOIUrl":"10.1136/bmjgh-2024-018559","url":null,"abstract":"<p><strong>Introduction: </strong>Patient-centred task-shifting models may be a promising strategy in the community-based management of severe acute malnutrition (SAM) to alleviate pressure on health systems and increase access to treatment in low-resource settings. The engagement of caregivers in clinical and anthropometric surveillance has not been evaluated.</p><p><strong>Objectives: </strong>We examined the effect of caregiver training on their knowledge and confidence in at-home clinical and anthropometric surveillance of children with uncomplicated SAM in Sokoto, Nigeria.</p><p><strong>Methods: </strong>We used data from a cross-over cluster-randomised trial (n clusters=10) comparing a monthly follow-up schedule with caregiver training to standard weekly follow-up for the outpatient management of children 6-59 months with uncomplicated SAM. Caregivers in the monthly follow-up group received a one-time training on at-home clinical surveillance and mid-upper arm circumference (MUAC) measurement. Intention-to-treat analyses assessed mean differences in knowledge and confidence scores within the monthly follow-up group and between groups at enrolment, post-training, programme discharge and 3 months post-discharge. Accuracy of MUAC measurement and classification was compared in the monthly follow-up group to study staff at enrolment post-training, programme discharge and 3 months post-discharge.</p><p><strong>Results: </strong>Of 3945 enrolled children, 96% were followed to programme discharge and 91% to 3 months post-discharge. Caregivers' knowledge and confidence scores in clinical surveillance increased significantly in the monthly follow-up group post-training and remained elevated at programme discharge and 3 months post-discharge, compared with pretraining. Agreement in MUAC classification between caregiver and study staff was high (>92% agreement at all time points). Caregivers' knowledge and confidence scores in clinical surveillance were significantly greater in the monthly follow-up group compared with the weekly follow-up group at all time points.</p><p><strong>Discussion: </strong>These findings confirm caregiver training increases knowledge and confidence in at-home clinical and anthropometric surveillance in the management of children with uncomplicated SAM, encouraging the continued consideration for task-shifting models in the community-based management of SAM in similar settings.</p><p><strong>Trial registration number: </strong>NCT03140904.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 10","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243779","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":"COmmunities Facilitating incREasing Smoke-free Homes (CO-FRESH): co-developing a toolkit with local stakeholders in Indonesia and Malaysia.","authors":"Rachel O'Donnell, Bagas Suryo Bintoro, Aliya Wardana Rustandi, Zakiya Ammalia Farahdilla, Deskantari Murti Ari Sadewa, Retna Siwi Padmawati, Aidil Ikhwan Ahmad, Nur Hanisah Misban, Izzah Athirah Mohd Shu'ah, Nur Shafiqa Safee, Wan Taqiyyah Zamri, Siti Nurhasyimah Ayuni Binti Kamni, Aziemah Zulkifli, Isabelle Uny, Emilia Zainal Abidin, Yayi Suryo Prabandari, Sean Semple","doi":"10.1136/bmjgh-2024-018102","DOIUrl":"10.1136/bmjgh-2024-018102","url":null,"abstract":"<p><strong>Introduction: </strong>Exposure to secondhand tobacco smoke generates a considerable health burden globally. In South-East Asia, most of that burden falls on women and children who are exposed to secondhand smoke (SHS) from male smoking in their home. Interventions to encourage smoke-free homes have tended to target people who smoke individually or within their family unit, although some evidence suggests a community-wide approach holds promise. The aim of this study was to codevelop a toolkit to increase the uptake of smoke-free homes within small village/town communities in Indonesia and Malaysia.</p><p><strong>Methods: </strong>During 2022/3, the CO-FRESH (COmmunities Facilitating incREasing Smoke-free Homes) study engaged with local community members in three villages in central Malaysia and one subdistrict in Indonesia. This toolkit-development study co-created: (1) online training materials to equip local health professionals to tackle smoking in the home; (2) a local public information campaign on the benefits of a smoke-free home; (3) methods to provide household air quality feedback to highlight the impact of smoking in the home; and (4) information on local services to support families to create smoke-free homes.</p><p><strong>Results: </strong>Communities welcomed the concept of tackling smoking in the home; however, there was limited knowledge about how SHS moved around the home and could enter indoor spaces from outdoor smoking. There were differences in the conceptualisation of what defined a 'smoke-free' home, alongside the delineation of indoor and outdoor spaces within the home setting. In addition, findings of high background air pollution levels mean that household air quality measurement may not be suited to providing SHS information in these communities.</p><p><strong>Conclusions: </strong>Communities in Malaysia and Indonesia recognised the importance of reducing smoking in the home and welcomed the approach of co-developing community-wide methods of tackling the issue. The CO-FRESH toolkit requires evaluation to determine effectiveness and how it can be implemented at scale.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 10","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238026","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":"Tailoring malaria control interventions to suit local context: codesign of perennial malaria chemoprevention (PMC) programmes through the Plus Project.","authors":"Meredith Center, Alba Luna McGirr, Malia Skjefte, Lilly Claire Ekobika, Hans Bahibo, Elsa Nhantumbo, Bienvenu Wakpo, Aurore Ogouyemi Hounto, Colette Yah Kokrasset, Baltazar Candrinho, Kathryn Malhotra, Sian E Clarke, Roly Daniel Gosling, Jacques Kouakou","doi":"10.1136/bmjgh-2024-015207","DOIUrl":"10.1136/bmjgh-2024-015207","url":null,"abstract":"<p><p>With global malaria cases on the rise, the WHO has placed increased emphasis on National Malaria Programmes to tailor interventions to country and programmatic needs. This paper presents the Plus Project's experience of applying a codesign approach to design country-specific models of perennial malaria chemoprevention (PMC), a chemoprevention intervention aimed at reducing morbidity and mortality due to malaria and anaemia in children. Codesign workshops were held in each of the project's focus countries (Benin, Cameroon, Côte d'Ivoire and Mozambique) with the primary objective of designing the country-specific PMC model. The three-and-a-half-day workshops were adapted to each country's context and included stakeholders from national and subnational malaria, immunisation and child health programmes, as well as national and international development partners and research institutions. The meetings were iterative and collaborative, harnessing a variety of participatory methods including journey mapping and surveys to reach group consensus on the PMC models best suited to each country's specific context. The Plus Project's codesign approach resulted in four different PMC strategies, with a range from four to eight contact points and different codelivery interventions, each taking advantage of country-specific health system delivery platforms, operational logistics and political contexts. This collaborative, codesign process also helped gather additional programmatic insights to aid PMC implementation while providing an opportunity to increase stakeholder buy-in. With an emphasis on collaborative decision-making, the learnings collected through these workshops can be applied to a variety of programmatic applications, extending beyond malaria.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 10","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238096","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":"Not one but two: cross-sectional associations among repeat pregnancy, maternal mental health and child cognitive outcomes among adolescent and young mothers in South Africa.","authors":"Lorraine Sherr, Katharina Haag, Kathryn Steventon Roberts, Lucie Cluver, Janina Jochim, Wylene Saal, Nontokozo Langwenya, Camille Wittesaele, Janke Tolmay, Marguerite Marlow, Elona Toska","doi":"10.1136/bmjgh-2025-019909","DOIUrl":"10.1136/bmjgh-2025-019909","url":null,"abstract":"<p><strong>Background: </strong>Globally, adolescent mothers and their children have poorer health outcomes. However, little is known regarding having multiple children as an adolescent. Analyses explore associations between having multiple versus single children on young mothers' mental health and having a sibling and child development outcomes for their children. Furthermore, maternal age when having a second child (eg, multipara adolescent or multipara adolescent-adult pregnancy) is examined in relation to maternal and child outcomes.</p><p><strong>Methods: </strong>Data are drawn from a cohort of young mothers (n=1017; 10-24 years) and their children (0-68 months) residing in the Eastern Cape Province, South Africa. Effects of having multiple versus single children on maternal mental health and child cognitive outcomes (assessed using the Mullen Scales of Early Learning) were explored using hierarchical regression models. We examined associations among primipara adolescent motherhood, multipara adolescent motherhood and multipara adolescent-adult motherhood, and child cognitive development scores.</p><p><strong>Results: </strong>Poor maternal mental health was elevated among multipara mothers. Multipara mothers were more likely to report higher parental stress scores and lower social support scores (p=0.002-0.038). Child cognitive development scores were higher in children born to multipara mothers (those with a sibling <i>(B=</i>6.75, 95% CI 1.00 to 12.51, p=0.021)); younger child age (<i>B=</i>-0.56, 95% CI -0.68 to -0.44, p=<0.001) and formal childcare attendance (<i>B=</i>3.58, 95% CI 0.03 to 7.13, p=0.048) were also identified as positive predictors of higher cognitive development scores. First-born children of multipara adolescent mothers appeared to perform equally well to children born to primipara mothers (children without siblings), while first-born children of multipara adolescent-adult mothers seemed to benefit strongly from having siblings (<i>B</i>=14.31, 95% CI 4.18 to 24.44, p=0.006).</p><p><strong>Conclusions: </strong>Having multiple children was associated with poorer maternal mental health. Delaying a second pregnancy until adulthood may have benefits, as sibling effects were found to be positively associated with child cognitive development scores. Formal childcare support was associated with positive child outcomes. Findings highlight the need to focus on repeat adolescent pregnancy, improve social, psychological and family planning support among young mothers with a focus on birth timing and spacing, early childhood care provision and support for young families.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 10","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238061","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}