BMJ Global Health最新文献

{"title":"Enhancing global health security responses through greater inclusion of the global south in infectious disease modelling.","authors":"Kathy Leung, Alex R Cook, Joseph T Wu, Jodie McVernon, Kiesha Prem, Mark Jit, Pritaporn Kingkaew, Siuli Mukhopadhyay, Wanrudee Isaranuwatchai, Wirichada Pan-Ngum, Yot Teerawattananon, Angkana Huang, Bimandra Djaafara, Jarawee Sukmanee, Thinh Ong Phuc, Saranyu Laemlak, Vera W Chua, Waranya Rattanavipapong, Saudamini Vishwanath Dabak","doi":"10.1136/bmjgh-2025-019111","DOIUrl":"10.1136/bmjgh-2025-019111","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 8","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882060","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 call to strengthen clinical trials capacity in resource-limited settings.","authors":"Lulu Mussa Muhe, Simon G Anderson, Paul Brown, Michael Campbell, Yuri Clement, Damian Cohall, M Reid, Donald Simeon, Marshall K Tulloch-Reid, Helen Trotman, Haileyesus Getahun","doi":"10.1136/bmjgh-2025-020170","DOIUrl":"10.1136/bmjgh-2025-020170","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 8","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882059","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":"Uncovering systemic barriers related to equity, diversity and inclusion in child health research: a scoping review addressing marginalised communities.","authors":"Ulises Charles-Rodriguez, Deliwe P Ngwezi, Suha Damag, Nicole Johnson, Aleem Bharwani, Tehseen Ladha, Oluwabukola Salami","doi":"10.1136/bmjgh-2024-015824","DOIUrl":"10.1136/bmjgh-2024-015824","url":null,"abstract":"<p><strong>Introduction: </strong>Despite abundant evidence illustrating the impact of social determinants of health on children and youth from marginalised communities, their continued marginalisation in research contributes to a negative feedback loop that perpetuates health inequities. Previous reviews have identified barriers in marginalised adult communities. However, no comprehensive review outlines the scope of barriers to equity, diversity and inclusion (EDI) in child health research across multiple marginalised communities, particularly as they are defined in Canada.</p><p><strong>Methods: </strong>The purpose of this review is to scope and summarise research discussing systemic barriers influencing EDI in child health research, focusing on racialised and black individuals, 2SLGBTQIA+ individuals, Indigenous peoples, women and girls and individuals with disabilities (identified as priority communities in the Canadian government's research policy). Our team followed the steps proposed by Arksey and O'Malley for scoping reviews.</p><p><strong>Results: </strong>From 3336 identified records, 53 publications met the inclusion criteria. Most studies were based in the USA (n=40) and/or other English-speaking countries (n=14), emphasising the need for global perspectives. Some publications were based in more than one country; others addressed more than one marginalised community. We identified more publications discussing racialised individuals (n=30) and black individuals (n=20) than women and girls (n=10), Indigenous peoples (n=9), children with disabilities (n=7) or 2SLGBTQIA+ individuals (n=4). Publications increased from 3 in 2020 to 15 in 2022, reflecting heightened awareness of structural racism and health inequities during the COVID-19 pandemic. Our findings suggest systemic under-recruitment and tokenism. Other factors in the research ecosystem include misleading conceptualisations of race and other social categories, power dynamics, lack of cultural safety and discrimination. Finally, we recommend applying the socio-ecological model to systematically map barriers and develop tailored, multilevel solutions that promote equity and inclusivity in research.</p><p><strong>Conclusion: </strong>To foster a more equitable and impactful child health research ecosystem, institutions must address individual, interpersonal, organisational and policy-level barriers by embedding community-driven priorities, promoting diverse and inclusive practices, and ensuring long-term, reciprocal relationships with historically marginalised communities.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 8","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871484","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 brief international screening tool for traumatic birth and childbirth-related PTSD: the city BiTS-short form.","authors":"Susan Ayers, Dan Brooks Wright, Rafael A Caparros-Gonzalez, Giulia Ciuffo, Georgina Constantinou, Pelin Dikmen-Yildiz, Susan Garthus-Niegel, Hanna Grundström, Jonathan Handelzalts, Antje Horsch, Chiara Ionio, Sandra Nakić Radoš, Flávia L Osório, Valentine Rattaz, Olga Riklikiene, Lara Seefeld, Valgerður Lísa Sigurðardóttir, Rebecca Webb","doi":"10.1136/bmjgh-2025-019216","DOIUrl":"10.1136/bmjgh-2025-019216","url":null,"abstract":"<p><strong>Introduction: </strong>Screening to identify traumatic births and childbirth-related post-traumatic stress disorder (CB-PTSD) is critical for reducing the global burden of maternal mental health challenges. Despite this, no brief, validated tools exist for international use. This study therefore developed and validated a short version of the City Birth Trauma Scale (City BiTS) to provide a brief, globally relevant screening tool.</p><p><strong>Methods: </strong>The City BiTS-Short was developed in three stages. In stage 1, exclusive lasso statistical analyses were conducted on survey data of 11 302 postpartum women in 31 countries to identify the most effective items for the City BiTS-Short, ensuring all four CB-PTSD symptom domains were represented. In stage 2, stakeholder reviews were conducted with researchers, health professionals (midwives, health visitors, psychiatrist, psychologist) and representatives of women who experienced traumatic birth. In stage 3, the City BiTS-Short was finalised and psychometric properties examined across diverse geographical settings.</p><p><strong>Results: </strong>The City BiTS-Short comprises one item assessing traumatic birth and four items assessing CB-PTSD symptoms: re-experiencing, avoidance, negative cognitions and mood and hyperarousal. The scale had strong psychometric properties, including good internal consistency (α=0.78) and high correlations with the original City BiTS (r=0.90), birth trauma ratings (r=0.50), distress (r=0.56), impairment (r=0.47) and CB-PTSD diagnoses (r=0.54). It identified 90% of participants with a CB-PTSD diagnosis. Women who had operative births (F(3,2174)=127.38, p<0.001), maternal complications (F(2,2163)=212.84, p<0.001), infant complications (F(2,1100)=138.93, p<0.001) or depression (t(3209.5)=-30.96, p<0.001) had higher scores. Psychometric properties were consistent across most international contexts, with stakeholders affirming its utility.</p><p><strong>Conclusion: </strong>The City BiTS-Short offers a brief, validated screening tool for identifying birth trauma and CB-PTSD symptoms. Its widespread adoption can enhance early detection and support for women, potentially reducing the global burden of birth trauma and improving maternal mental health outcomes worldwide. Further research is needed to explore its use in specific contexts.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 8","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942716","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":"Single low-dose primaquine for malaria control in Africa: a systematic review of safety, efficacy and implementation barriers.","authors":"Tianle Ye, Emmanuelle Caspar, Denis Niyomwungere, Alphonse Ouedraogo, Lucas Thiebaut, Pierre-Emeric Strubel, Omega Raobela, Joseph Nyandwi, Rianasoambolanoro Rakotosaona, Arsène Ratsimbasoa, Sodiomon Bienvenu Sirima, Didier Menard","doi":"10.1136/bmjgh-2025-020264","DOIUrl":"10.1136/bmjgh-2025-020264","url":null,"abstract":"<p><p>Since 2012, the WHO has recommended a single low dose of primaquine (SLDPQ, 0.25 mg/kg) alongside artemisinin-based combination therapies (ACTs) to block <i>Plasmodium falciparum</i> transmission and combat artemisinin resistance. Despite its proven benefits, SLDPQ adoption in African malaria policies remains limited. We conducted a systematic review of studies published between 2012 and 2023 on the safety, efficacy and implementation of SLDPQ in Africa. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched 7 databases and screened 819 records. Eligible studies focused on SLDPQ co-administered with ACTs for treating uncomplicated <i>P. falciparum</i> malaria in African contexts. Data were extracted and analysed from 41 studies, including 15 randomised controlled trials (RCTs) and 26 non-trial studies. SLDPQ was found to be safe and well-tolerated, including in glucose-6-phosphate dehydrogenase deficiency individuals and children under 5. Eight RCTs confirmed significant reductions in gametocyte carriage, validating SLDPQ's individual-level efficacy. However, evidence on community-level impact remains limited. Key implementation barriers include persistent misconceptions about primaquine toxicity, absence of paediatric formulations and operational challenges in health systems. Most studies used the WHO-recommended dose (0.25 mg/kg), but higher doses and age-based regimens were also investigated. This review supports SLDPQ as a safe and effective tool for malaria transmission reduction in Africa. Addressing barriers to implementation, through health worker training, community sensitisation and operational research, is essential to accelerate its adoption. The ongoing Implementing Primaquine Single Low Dose in Africa project aims to generate real-world evidence across three countries, with a focus on paediatric use and health system integration. SLDPQ scale-up should be prioritised within malaria elimination strategies across sub-Saharan Africa.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 8","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854587","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":"Corticosteroids for reducing tuberculosis mortality in persons living with HIV: a systematic review and meta-analysis using reconstructed individual patient data.","authors":"Alhassane Diallo, Boubacar Djelo Diallo, Oumou Hawa Diallo, Miguel Carlos-Bolumbu, Mohamed Camara, Sidibe Sidikiba","doi":"10.1136/bmjgh-2024-017923","DOIUrl":"10.1136/bmjgh-2024-017923","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effect of adjunctive corticosteroids on mortality in persons living with HIV (PLHIV) being treated for tuberculosis (TB).</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources: </strong>PubMed, CENTRAL and EMBASE through 31 December 2023 STUDY SELECTION: Randomised placebo-controlled trials (RCTs) with published Kaplan-Meier survival curves comparing corticosteroids versus placebo in PLHIV receiving TB treatment.</p><p><strong>Quality assessment, data extraction and analysis: </strong>Three reviewers independently assessed study quality and extracted data. Reconstructed individual patient data were derived from published Kaplan-Meier survival curves, and a one-stage mixed-effects Cox regression model was used to estimate HRs for all-cause mortality.</p><p><strong>Results: </strong>Four trials involving 873 PLHIV with three forms of TB (618 meningitis, 197 pleural and 58 pericarditis) were included. Over a median follow-up of 19.3 months (IQR, 15.1-30.2), 367 (42%) participants died. At 12 months after randomisation, corticosteroids were associated with a 67% reduction in mortality (HR 0.33, 95% CI 0.26 to 0.41; p<0.0001) compared with placebo. This benefit was maintained during the full follow-up period, with a 17% reduction in mortality (0.83, 0.68-0.99; p=0.0477). In subgroup analyses, a non-significant trend towards benefit was seen for TB meningitis (HR 0.84, 0.67-1.05; p=0.061, two trials), with unclear effect for pleural (HR 0.90, 0.57-1.41; p=0.643, one trial) and TB pericarditis (HR 0.40, 0.15-1.17; p=0.100, one trial).</p><p><strong>Conclusion: </strong>Adjunctive corticosteroids were associated with reduced mortality among PLHIV treated for TB in this meta-analysis of four RCTs. Further clinical trials are needed to confirm this finding and inform guidelines on the use of adjunctive corticosteroid in this population.</p><p><strong>Prospero registration number: </strong>CRD42024500865.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 8","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854518","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":"Equity in protection: bridging global data gaps for an EBV vaccine-a systematic review and meta-analysis.","authors":"Marisa D Muckian, Ting Shi, Vesa Qarkaxhija, Simran Kapoor, Tomos Morgan, Helen R Stagg","doi":"10.1136/bmjgh-2024-015534","DOIUrl":"10.1136/bmjgh-2024-015534","url":null,"abstract":"<p><strong>Introduction: </strong>Epstein-Barr virus (EBV) is linked to multiple malignancies and autoimmune conditions, with different disease burdens globally. Pharmaceutical companies and researchers are placing substantial investment in the development of EBV vaccines. To ensure optimal vaccine roll-out, particularly in resource-limited settings, it is essential to have data on the age at acquisition of EBV. This study aimed to systematically review and meta-analyse seroprevalence by age and country, WHO region and country income level, identify knowledge gaps, and determine an approach to bridge these gaps.</p><p><strong>Methods: </strong>MEDLINE, Embase and Web of Science were searched on 22 March 2022 for studies that measured EBV seroprevalence by age. An updated search was conducted on 22 October 2022. There were no language restrictions. Papers were assessed for quality using an adapted version of the Downs and Black checklist. Seroprevalence by age was estimated using a fixed-effect (country) or random-effects (WHO region and income) meta-analysis. This review has been registered on PROSPERO (CRD42022349900).</p><p><strong>Results: </strong>Only one country (USA) had enough data for a country meta-analysis. WHO regional analyses revealed the Western Pacific region to have a higher seroprevalence in younger age groups than other WHO regions. Country income level better explained seroprevalence trends per age. Middle-income countries displayed a quicker rise to balance seroprevalence than high-income countries, with a 30% absolute increase in 0- to 4-year-olds in middle-income than in high-income countries (59% [95% CI 28 to 91%, I²=99%] vs 29% [95% CI 16 to 41%, I²=99%]).</p><p><strong>Conclusion: </strong>This first meta-analysis producing estimates of EBV seroprevalence by age provides crucial information to guide governments when using a vaccine for EBV. However, data variability and limited consistency of methodologies and EBV seroprevalence measurements hindered comprehensive meta-analyses across all WHO regions and countries. This study provides an interim framework for the extrapolation of seroprevalence using country-specific income levels to aid vaccine roll-out decisions.</p><p><strong>Prospero registration number: </strong>CRD42022349900.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 8","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854519","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":"Social and geographical inequalities in prenatal care coverage in Colombia: a multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).","authors":"Merida Rodriguez-Lopez, Daniela Botero Jaramillo, Sergio Prada, Juan Merlo, George Leckie","doi":"10.1136/bmjgh-2025-019608","DOIUrl":"10.1136/bmjgh-2025-019608","url":null,"abstract":"<p><strong>Background: </strong>Access to adequate antenatal care (ANC) is crucial for improving maternal and neonatal health outcomes. Despite high national ANC coverage, Colombia still faces regional and socioeconomic disparities. This study aims to estimate geographical and intersectional inequalities in ANC coverage and evaluate the contribution of social determinants to these disparities.</p><p><strong>Methods: </strong>We conducted a cross-sectional observational study using data from live birth certificates of singleton pregnancies in Colombia during 2022. Multilevel analysis of individual heterogeneity and discriminatory accuracy was performed using logistic regression models. Two approaches were applied: (1) geographical, with departments as the second level and (2) intersectional, with strata as the second level, defined by the combination of health insurance, area of residency, ethnicity and maternal age. The variance partition coefficients (VPCs) from the random-intercept versions of the models were used as the disparity measure. Random slopes were included to allow for variations in the effects of ethnicity and insurance across departments.</p><p><strong>Results: </strong>A total of 552 284 singleton pregnancies were analysed. National ANC coverage was 95.96%. However, 15 of the 33 departments and 24 of the 36 intersectional strata reported ANC coverage below the national average. For the geographical analysis, the VPC dropped from 24.45% to 10.02%, after accounting for population compositional effects. For the intersectional analysis, the VPC dropped from 39.43% to 3.64%, after adjusting for the additive effects of the individual characteristics used to define the strata. Ethnicity and health insurance were the most significant determinants of both geographical and intersectional heterogeneity. The effect of both factors varied significantly across departments.</p><p><strong>Conclusions: </strong>Colombia faces significant geographical and intersectional inequalities, primarily driven by inequities in ethnicity and health insurance coverage. Policies targeting these social determinants are needed to ensure equitable access to maternal health services.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 8","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854588","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":"Mind the 'inequality' gap: intersectionality-informed scoping review of inequalities and adverse experiences of health and care workers globally.","authors":"Roomi Aziz, Anuj Kapilashrami, Reza Majdzadeh","doi":"10.1136/bmjgh-2024-016795","DOIUrl":"10.1136/bmjgh-2024-016795","url":null,"abstract":"<p><strong>Context: </strong>Health and care workers' well-being is critical for comprehensive human resources for health (HRH) planning. However, system-wide factors such as wage disparities and career advancement barriers remain underexplored, while most existing planning frameworks focus on gender, ignoring other interactions shaping the HRH experiences.</p><p><strong>Objective: </strong>To systematically map literature on adverse HRH experiences, underlying inequalities and the resulting impact using an intersectional equity lens.</p><p><strong>Methods: </strong>A rigorous scoping protocol was developed which guided the search in four bibliographic databases (SCOPUS, Web of Science, PubMed and CINAHL Ultimate). Literature was screened by two reviewers independently, charted and thematically analysed.</p><p><strong>Results: </strong>From 21 184 records, 511 articles were included. 76% of the excluded articles were duplicates, while the rest were ineligible (non-English, grey literature, irrelevant publication type, etc). The review unpacked six types of adverse experiences (invisibilisation, disproportionate scrutiny, denial of opportunities, verbal abuse, physical abuse and sexual harassment) across 72 countries. 20 social locations, such as gender, race, ethnicity, cadre and their interactions shaped these experiences.55% of these studies were based in high-income countries and only 2% in low-income countries. 45% of articles studied these experiences across only two or more social locations, with the most common combinations being race-sex. Adverse manifestations included wage disparities, career advancement barriers, poor mental health and high turnover. The existing literature lacked an equity gaze, missing the underlying systematic drivers and rarely exploring intersecting unique positionalities of health and care workers.</p><p><strong>Implications: </strong>Using an intersectionality lens, this scoping review identifies three key gaps: regional evidence imbalances, lack of an explicit intersectional equity focus and absence of translation of the scant intersectional evidence into HRH policy tools. These gaps restrict global HRH planning and hinder the development of inclusive, context-specific strategies-especially in low- and middle-income countries facing the most severe workforce challenges.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 8","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854586","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":"From poverty to health: intraurban inequalities in child health indicators in low-income and middle-income countries during the SDG era.","authors":"Tsion Mulat Tebeje, Mekonnen Birhanie Aregu, Yordanos Sisay Asgedom, Amanuel Yosef Gebrekidan, Mesfin Abebe","doi":"10.1136/bmjgh-2025-019134","DOIUrl":"10.1136/bmjgh-2025-019134","url":null,"abstract":"<p><strong>Introduction: </strong>Urban areas are generally associated with better health outcomes. However, in many low-income and middle-income countries (LMICs), rapid urbanisation has led to significant health disparities. These inequalities, especially those affecting the urban poor, are often overlooked in studies focused solely on rural-urban differences. This study aimed to assess the overall and country-specific intraurban inequalities in under-5 and neonatal mortality rates, immunisation coverage, care-seeking for acute respiratory infections (ARIs), coverage of diarrhoea treatment, and stunting, wasting and overweight in children under 5.</p><p><strong>Methods: </strong>Demographic and Health Survey datasets collected since 2015 from 48 LMICs were analysed. We constructed an urban poor cluster using the United Nations Human Settlements Programme definition for slums and categorised them as urban poor and urban non-poor clusters. The Wagstaff normalised concentration index (WCI) and concentration curve were used to assess urban poverty-related inequalities in child health indicators.</p><p><strong>Results: </strong>In LMICs, 13.7% (95% CI: 13.6% to 13.9%) of urban children lived in poor clusters, with over 65% of urban clusters classified as poor in Chad, Ethiopia and Afghanistan. All child health indicators, except neonatal mortality, exhibited significant inequality between the urban poor and non-poor. Despite some inconsistencies across countries, there were pro-urban poor inequalities in under-5 mortality (WCI=-0.069), stunting (WCI=-0.121) and wasting (WCI=-0.088). Full vaccination coverage (WCI=0.078), overweight (WCI=0.087), care-seeking for children with acute respiratory infections (WCI=0.131) and receiving oral rehydration salts and zinc for diarrhoea (WCI=0.127) showed pro-urban non-poor inequality in LMICs.</p><p><strong>Conclusions: </strong>Substantial intraurban inequalities were observed in child health indicators. Under-5 mortality, stunting and wasting were concentrated among urban poor children, while health service utilisation and overweight were concentrated among urban non-poor children. Improving access to clean water, sanitation, quality healthcare and education in underserved urban areas, along with combating urban poverty and promoting healthy lifestyles, is essential for achieving better health outcomes.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 8","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854585","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}