BMJ Global Health最新文献

{"title":"Costs of surgeries in low- and middle-income countries: a systematic literature review.","authors":"Martilord Ifeanyichi, Phyllis Tenkorang, Esther Matey, Chizowa Okwuchukwu Ezeaku, Oluwayemisi Ekor, George Duke Mukoro, Soham Bandyopadhyay, Jose Luis Mosso-Lara, Pedra Rabiee, Danyal Zaman Khan, Maeve Bognini, Meskerem Aleka Kebede, Rachel Hargest, Rocco Friebel","doi":"10.1136/bmjgh-2025-020596","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-020596","url":null,"abstract":"<p><strong>Background: </strong>Surgical care is essential for achieving global health equity, yet low- and middle-income countries (LMICs) face major gaps in access and planning, partly due to limited evidence on the costs and resource requirements of surgical interventions. Understanding these costs is vital for designing efficient and equitable health systems.</p><p><strong>Methods: </strong>We conducted a systematic literature review (covering MEDLINE, EMBASE, Global Health, EconLit and grey literature) to identify studies reporting the costs of surgeries in LMICs from January 2000 to June 2023. Minor and major surgical procedures were considered, focusing on therapeutic procedures (excluding diagnostic interventions). Studies that clearly identified, quantified and costed hospital resources and services deployed in the provision of surgical care, and included at least two of the surgical production factors (ie, consumables, diagnostics, personnel, infrastructure and overhead) in the costing were included. Costs were standardised to 2023 International dollars (I$) for comparability.</p><p><strong>Results: </strong>A total of 74 studies from 29 countries met the inclusion criteria, with 210 cost estimates across 65 procedure groups. Costs varied widely: from I$1.54 for a caesarean section in Tanzania to I$618 098 for paediatric cataract surgery in Zambia. Full costing studies reported higher estimates than partial costing studies. Most studies (60%) originated from upper-middle-income countries, with limited data (10%) from low-income settings.</p><p><strong>Conclusion: </strong>This review provides a reference list of surgical procedure costs across LMICs, highlighting considerable cost variation by procedure, specialty and country. The findings underscore the need for better-quality, standardised cost data-especially from low-income countries-to inform national surgical plans, universal health coverage benefit packages and reimbursement policies.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891110","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 new conceptual framework for evaluating healthcare quality: shifting from reactive treatment to proactive health preservation.","authors":"Keisuke Kanda","doi":"10.1136/bmjgh-2025-020678","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-020678","url":null,"abstract":"<p><p>Healthcare quality is commonly assessed using clinical outcomes and service-based metrics that begin after illness has occurred. While such measures are important, they often overlook healthcare's fundamental purpose: to preserve health, prevent disease and minimise reliance on medical intervention. Drawing from global definitions of healthcare and quality-and philosophical insights from Sunzi's Art of War-this paper proposes a new framework that shifts evaluation from reactive treatment to proactive health preservation. A two-dimensional model is introduced, plotting age-standardised healthy life expectancy on the vertical (Y) axis against purchasing power parity adjusted per capita healthcare expenditure on the horizontal (X) axis. To enable standardised comparison across countries, both indicators are converted into z-scores, allowing the positioning of healthcare systems within a normalised, intuitive visual space. The ideal health system occupies the upper-left corner of this graph, where long, healthy lives are achieved with minimal spending. By examining relative positions on this graph, the model enables strategic policy discussions about value-based trade-offs between health outcomes and spending. The model also highlights a structural tension between the goals of healthcare and the incentives of capitalist systems, where prevention may paradoxically reduce profitability. By redefining quality in terms of sustained wellbeing rather than service provision, the framework offers a timely, intuitive tool for evaluating system performance. It invites policymakers, researchers and the public to reconsider what constitutes progress in health systems-emphasising that the best healthcare may not be the one that delivers the most care, but the one that is least needed.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886548","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":"Lives saved and financial risk protectionfrom scaling up kangaroo mother care in India: an extended cost -effectivenessanalysis.","authors":"Tarun Shankar Choudhary, Sarmila Mazumder, Oystein A Haaland, Sunita Taneja, Halvor Sommerfelt, Ole F Norheim, Nita Bhandari, Kjell Arne Johansson","doi":"10.1136/bmjgh-2025-021719","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-021719","url":null,"abstract":"<p><strong>Introduction: </strong>Kangaroo mother care (KMC) is a proven, low-cost intervention to reduce neonatal mortality, yet its coverage remains limited in most low- and middle-income countries (LMICs), including India. In this study, we examined the impact of scaling up KMC in India on distribution of health and financial outcomes using an extended cost-effectiveness analysis (ECEA) framework.</p><p><strong>Methods: </strong>Building on primary data from a randomised controlled trial (RCT), we modelled the health and financial outcomes of scaling up KMC to 95% coverage nationally. We estimated lives saved, disability-adjusted life-years (DALYs) averted, out-of-pocket expenditure (OOPE) averted and cases of catastrophic healthcare expenditure prevented. Estimates were disaggregated by socioeconomic quintiles and geography. We used deterministic and probabilistic sensitivity analyses to assess the robustness of our findings.</p><p><strong>Results: </strong>Scaling up KMC in India could save around 26 000 neonatal lives annually, avert approximately 1.6 million DALYs, reduce OOPE by around US$13 million and prevent an estimated 57 000 households from experiencing catastrophic health expenditures. Three-fourths of the benefits would be concentrated in the lowest two socioeconomic quintiles. Six high-burden states, including Uttar Pradesh, Bihar and Madhya Pradesh, accounted for 90% of the health and financial gains. The incremental cost-effectiveness ratio ranged from 0.08 to 0.17 times gross domestic product per capita for India across different quintiles. Probabilistic sensitivity analysis showed scaling up KMC would be cost-effective in 97.8% of simulations.</p><p><strong>Conclusion: </strong>Our findings suggest that scaling up KMC is cost-effective and can reduce health inequities, particularly benefiting the lowest socioeconomic groups and high-burden states. Incorporating geographical disaggregation and using primary RCT data into ECEA enhance its utility for informing evidence-based, equity-focused health policies in LMICs.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879130","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":"Geographical accessibility to hospital care amid armed conflict in Myanmar: a population-weighted analysis of compounding health inequality, 2021-2024.","authors":"Hein Thu, Kaung Khant Tin, Aung Thura Htoo","doi":"10.1136/bmjgh-2026-024615","DOIUrl":"10.1136/bmjgh-2026-024615","url":null,"abstract":"<p><strong>Introduction: </strong>Armed conflict disrupts health systems, but whether it compounds pre-existing geographical barriers to hospital care has not been quantified. We aimed to estimate population-weighted travel time to public hospital care across Myanmar's 330 townships; test whether conflict following the February 2021 coup concentrated in populations with the worst baseline access, and whether attacks on health facilities followed the same pattern; and measure the cumulative person-year burden of simultaneous poor access and intense conflict.</p><p><strong>Methods: </strong>We conducted a longitudinal ecological analysis of 330 townships over 16 quarters from 2021 to 2024. Travel time from each populated square kilometre to the nearest of 68 general hospitals, representing the surgical-care tier, was estimated using the pre-coup facility registry, OpenStreetMap road data and WorldPop 2020 population estimates. Townships were classified by population-weighted median travel time. Quarterly conflict intensity was calculated from 35 647 Armed Conflict Location and Event Data Project battle and explosion or remote-violence events; 655 Safeguarding Health in Conflict Coalition-reported facility attacks were analysed separately. The concentration index assessed whether conflict events, fatalities and facility attacks were disproportionately concentrated among populations with worse baseline access. Double-burden exposure (poor or very poor access combined with high or extreme conflict) was accumulated in person-years. Because access was held at pre-coup baseline, estimates should be read as optimistic bounds.</p><p><strong>Results: </strong>Before the coup, 5.8 million people (12%) lived over 2 hours from a general hospital. Double-burden exposure grew from 0.4 million (Q1 2021) to 3.1 million (Q1 2024). Conflict was significantly concentrated in worse-access populations: concentration index 0.126 (95% CI 0.053 to 0.199) for events, 0.169 (95% CI 0.078 to 0.263) for fatalities. Facility attacks showed no significant concentration (0.049, 95% CI -0.041 to 0.145), as remote townships lack targetable facilities. An estimated 8.4 million person-years of double-burden exposure accumulated over 2021-2024, rising roughly eightfold quarterly, from about 100 000 (Q1 2021) to 780 000 (Q1 2024).</p><p><strong>Conclusion: </strong>Conflict in Myanmar has compounded pre-existing geographical inequality in hospital access, with populations furthest from surgical care bearing a disproportionate burden. The concentration curve framework used is transferable to other conflict-affected settings.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872644","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":"Projections of human papillomavirus (HPV) vaccination impact on non-cervical cancer outcomes among women in 117 low- and middle-income countries: a modelling study.","authors":"Aarushi Tuli, Mark Jit, Kaja Abbas, Allison Portnoy","doi":"10.1136/bmjgh-2025-021127","DOIUrl":"10.1136/bmjgh-2025-021127","url":null,"abstract":"<p><strong>Introduction: </strong>Human papillomavirus (HPV) is a leading cause of both cervical and non-cervical cancers, including anal, oropharyngeal, vaginal and vulvar cancers. While most HPV vaccination impact assessments have focused on preventing cervical cancer among women, the broader benefits of vaccination against other HPV-attributable cancers in low- and middle-income countries (LMICs) remain less explored.</p><p><strong>Methods: </strong>We used a static cohort model to assess the potential health impact of bivalent HPV vaccination on HPV-attributable female non-cervical cancers in 117 LMICs from 2030 to 2100. The model incorporated country-specific data on cancer mortality, HPV type distribution, demographic projections and vaccine coverage. Sensitivity analyses were performed to account for uncertainties in cancer incidence, cancer mortality and HPV type distribution.</p><p><strong>Results: </strong>Our projections suggest that HPV vaccination could contribute to prevention of approximately five 90 000 cases of anal, 880 000 cases of oropharyngeal, 1.27 million cases of vaginal and 2.18 million cases of vulvar cancers over the analytic period. In total, 3.02 million deaths from these non-cervical cancers among women could be averted by 2100. The African region is expected to see the largest relative reductions in both cases and deaths while the European region showed the smallest gains. By the end of the century, 58 countries are projected to reach at least a 25% reduction in anal cancer mortality compared with just 25 countries for oropharyngeal cancer. These findings reflect substantial regional disparities in both burden and vaccination impact.</p><p><strong>Conclusion: </strong>HPV vaccination holds considerable promise in reducing the burden of non-cervical cancers among women in LMICs, especially in regions with high incidence and limited access to care. Recognising and harnessing these broader benefits can strengthen the public health case for scaling up vaccine access, implementing region-specific strategies and investing in equitable healthcare systems to decrease global disparities.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863198","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":"New article types at <i>BMJ Global Health</i>, and a statement on the use of artificial intelligence in global health research.","authors":"Mark G Shrime","doi":"10.1136/bmjgh-2026-025873","DOIUrl":"10.1136/bmjgh-2026-025873","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863259","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":"Correction: Optimising care for uncomplicated type 2 diabetes mellitus in Lagos, Nigeria: cost and benefit estimates using real-world data.","authors":"","doi":"10.1136/bmjgh-2025-019477corr1","DOIUrl":"10.1136/bmjgh-2025-019477corr1","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863093","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":"Combining statistical and dynamical modelling to guide the design of cluster randomised trials for malaria.","authors":"Joseph D Challenger, Joseph Biggs, Janetta Skarp, Jackie Cook, Thomas S Churcher","doi":"10.1136/bmjgh-2026-024344","DOIUrl":"10.1136/bmjgh-2026-024344","url":null,"abstract":"<p><p>Cluster randomised trials (CRTs) remain key for evaluating the community-wide impact of interventions against infectious diseases such as malaria. Randomising by cluster prevents contamination and enables both the direct and indirect effects of the intervention to be estimated. Although these trials are extremely informative, they can be logistically demanding and costly to carry out, which means it is important that these trials are well powered. Here, we present a framework for planning CRTs that measure malaria prevalence as the outcome using an established mathematical model of malaria transmission. In this way, we explicitly consider the epidemiology of the individual trial clusters. The framework can be used alongside a baseline prevalence survey to help inform the sample size calculations for the trial. We use a case study to illustrate the framework, where we simulate a CRT in which a next-generation pyrethroid-pyrrole insecticide-treated net (ITN) is compared against a standard pyrethroid-only ITN. We show how the malaria endemicity of the trial location and timing of the follow-up surveys can affect the results obtained. We also highlight how other active interventions against malaria can reduce study power by increasing the amount of between-cluster heterogeneity in malaria prevalence.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849817","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":"Performance in reducing child stunting in Africa: a stochastic frontier analysis of 54 countries over the past two decades (2000-2022).","authors":"Brice Ulrich Foudjo Saha, Ismael Teta, Dia Sanou","doi":"10.1136/bmjgh-2026-024101","DOIUrl":"10.1136/bmjgh-2026-024101","url":null,"abstract":"<p><strong>Introduction: </strong>Africa remains off-track to meet 2030 stunting targets despite relative economic growth. We aimed to quantify the 'nutrition conversion gap', the efficiency with which national resources are translated into stunting reduction, and examine factors associated with technical inefficiency across 54 African nations.</p><p><strong>Methods: </strong>This longitudinal panel study (2000-2022; N=1134 country-years) used stochastic frontier analysis to estimate a health production frontier, defined as the maximum achievable health production score (100-stunting prevalence). Inputs (gross domestic product (GDP) per capita, dietary adequacy and maternal education) were modelled as 3-year weighted moving averages. Technical inefficiency was modelled as a function of lagged diarrhoea incidence, electrification, urbanisation and political stability.</p><p><strong>Results: </strong>Significant performance heterogeneity exists across the continent. High technical inefficiency (γ=0.976, λ=6.33) accounted for 97.6% of the observed nutritional disparities. Low GDP elasticity (β=0.042, p<0.001) suggests economic growth alone is an insufficient standalone strategy for stunting eradication. Senegal and Somalia achieved near-optimal efficiency despite low national wealth, whereas nations like Equatorial Guinea and Botswana exhibited high systemic inefficiency despite significant economic resources. Electricity access was significantly associated with a narrower conversion gap (p<0.001). Furthermore, political stability in the absence of institutional reform correlated with increased inefficiency (δ=0.39, p<0.001).</p><p><strong>Conclusion: </strong>Nutritional progress is profoundly decoupled from national wealth. Policy must pivot from aggregate resource accumulation towards mitigating systemic bottlenecks, specifically infection control and electrification. Strengthening health system efficiency through decentralised, community-led models represents a more potent roadmap for human capital development than simple macroeconomic expansion.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849824","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":"Overcoming the last mile: practical strategies for leprosy elimination in Pakistan.","authors":"Anil Fastenau, Abdul Salam, Bushra Nadeem, Alexandra Asboeck, Muhammad Adnan Ali, Matthew Willis, Sophie C W Unterkircher, Fabian Schlumberger, Hamideh Ebrahimi","doi":"10.1136/bmjgh-2025-022490","DOIUrl":"10.1136/bmjgh-2025-022490","url":null,"abstract":"<p><p>Leprosy, a neglected tropical disease (NTD) caused by <i>Mycobacterium leprae</i>, continues to affect vulnerable populations in low-endemic countries like Pakistan despite its official elimination as a public health problem in 1996. With 236 new cases reported in 2023, including 16 among children, ongoing transmission highlights significant gaps in Pakistan's leprosy elimination strategy. This paper explores key challenges, including diagnostic delays, limited retrospective contact tracing and resource constraints, which hinder progress towards Zero Leprosy. Drawing on decades of field experience from Pakistan's specialised leprosy services, including the Marie Adelaide Leprosy Centre and Aid to Leprosy Patients, we propose practical, evidence-informed strategies to overcome these barriers. These include scaling up active case finding initiatives, implementing single-dose rifampicin as post-exposure prophylaxis, leveraging Geographic Information System technology for hotspot identification and integrating leprosy services with other skin-related NTDs. Additionally, we emphasise the importance of strengthening non-governmental organisation collaboration and broader multistakeholder partnerships, enhancing healthcare worker training and addressing social stigma through community engagement. By presenting actionable lessons from Pakistan, this perspective aims to inform global efforts to eliminate leprosy and other NTDs, particularly in similar low-endemic settings. Achieving Zero Leprosy requires sustained political commitment, increased resource allocation and a multifaceted approach that addresses both medical and social dimensions of the disease.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839284","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}