BMJ Global Health最新文献

{"title":"Physical activity policies in the six Gulf Cooperation Council countries: a qualitative study with document analysis.","authors":"Ali Ahmed Alzahrani, Peter Gelius, Anne Grunseit, Adrian Bauman, Klaus Gebel","doi":"10.1136/bmjgh-2024-017627","DOIUrl":"10.1136/bmjgh-2024-017627","url":null,"abstract":"<p><strong>Background: </strong>The Gulf states have some of the lowest physical activity levels and some of the highest obesity rates globally. Understanding physical activity policies is important but under-researched in this region.</p><p><strong>Purpose: </strong>To analyse physical activity policies in terms of structures, formulation, implementation and evaluation in the six Gulf Cooperation Council (GCC) member countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates (UAE)).</p><p><strong>Methods: </strong>We systematically searched the websites of the Ministries of Health, Education, Sport, Transport, Tourism and Municipal Affairs of the GCC countries between March 2023 and February 2024 for documents related to physical activity policy. Experts from Saudi Arabia, Oman and Bahrain were consulted to identify unpublished documents. Desk research questions from the Health-Enhancing Physical Activity Policy Audit Tool were used to evaluate the content of these documents in terms of the policy cycle model.</p><p><strong>Results: </strong>We identified 39 policy documents from the six countries. Comparative analysis revealed centralised governance across GCC nations, except for the UAE's federal monarchy system. Policy formulation typically involves collaboration among health, sports and education ministries, although responsibilities vary. There were no sedentary behaviour reduction policies. Policy implementation lacks funding, especially for marginalised groups such as individuals with disabilities and immigrants. Evaluation lacks economic assessment.</p><p><strong>Conclusions: </strong>Our study revealed a lack of implementation of physical activity policies and a general dearth of policies aimed at reducing sedentary behaviour within the GCC. Enhancing transparency, inclusion and evaluation mechanisms are essential for fostering effective physical activity policies in GCC countries.</p><p><strong>Practical implications: </strong>Our study provides impetus for policy-makers in the Gulf region to develop policies addressing sedentary behaviour and improving the evaluation framework. Additionally, it serves as a foundation for researchers to identify and address gaps in future policy analysis, contributing to the advancement of effective strategies for promoting physical activity.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779058","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":"Unintended pregnancy and gender inequality worldwide: an ecological analysis.","authors":"Gilda Sedgh, Jonathan Marc Bearak","doi":"10.1136/bmjgh-2024-016573","DOIUrl":"10.1136/bmjgh-2024-016573","url":null,"abstract":"<p><p>Unintended pregnancy compromises many women's and girls' ability to pursue the lives that they want. The conditional unintended pregnancy rate (CUPR) is a measure of unintended pregnancy among women who wish to avoid getting pregnant. Using the CUPR, we explore the relationship between gender inequality and unintended pregnancy across 132 countries. We used gender inequality indicators from the UNDP Human Development Report and estimates of the incidence of unintended pregnancy published by the Guttmacher Institute and WHO. We regressed the CUPR on several measures of gender inequality using least squares with a percentile bootstrap to account for sampling error and the additional uncertainty in the model-based unintended pregnancy estimates. We find that unintended pregnancy is positively correlated with multiple composite measures of gender inequality, even after controlling for countries' levels of economic development. Of the components of gender inequality, gender disparities in educational attainment were most strongly correlated with unintended pregnancy in multivariable regressions. We also find that female educational attainment is a stronger predictor of the CUPR than male educational attainment. Analyses with the standard unintended pregnancy rate, a measure that does not take into account differences across settings in the proportion of women who wish to avoid getting pregnant, obscured the strength of the observed relationships. Further exploration of the factors underlying this relationship can inform policies to improve the quality of women's lives.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751090","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":"Health system effectiveness of symptomatic malaria case management in Papua New Guinea.","authors":"Vincent Minconetti, Clara Champagne, Michah Muri, Clara Are, Philemon Goi, Yangta Ura, Melvin Kualawi, Diana Timbi, Joseph Giduthuri, Myo Minn Oo, Leo Makita, Osama Seidahmed, Amanda Ross, William Pomat, Manuel W Hetzel","doi":"10.1136/bmjgh-2024-016825","DOIUrl":"10.1136/bmjgh-2024-016825","url":null,"abstract":"<p><p>Effective case management is crucial for malaria control efforts and is a cornerstone of malaria control programmes. Yet, although efficacious treatments exist, malaria case management often faces challenges, such as poor access to treatment providers, supply-chain issues, non-compliance with guidelines or substandard medication. In Papua New Guinea (PNG), progress in control efforts has stagnated in recent years. This study identifies barriers to and areas for improvement in malaria case management in PNG.A cascade of care model was used to estimate the health system effectiveness of malaria case management. Data from nationwide surveys conducted between 2013 and 2021 were used to quantify steps along a symptomatic case management pathway. Potential risk factors for cascade decay, including demographic, socioeconomic and health system characteristics, were investigated using mixed-effect logistic regression.The main bottleneck along the case management cascade was treatment-seeking, with only 40% (95% CI: 37% to 46%) of symptomatic malaria cases attending a formal health facility. A further important bottleneck was confirmatory parasitological diagnosis, provided to 77% (95% CI: 68% to 80%) of patients attending a health facility. Younger patients and those living in high transmission regions were more likely to receive a diagnostic test.Measures to improve the effectiveness of malaria case management in PNG should include increasing access to, utilisation and quality of formal health services. Further investigations to elucidate local determinants of treatment-seeking may support the National Malaria Strategic Plan's emphasis to optimise the delivery of proven interventions within the existing system.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742352","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":"Global clubfoot treatment in 2023: an overview of advances and outcomes.","authors":"Tracey Smythe, Rosalind M Owen, Adam Aspden, Jennifer Everhart, Endashawu Abera, Peace Amaraegbulam, Rosalyn Flores, Liza Valdez, Chris Lavy","doi":"10.1136/bmjgh-2024-017861","DOIUrl":"10.1136/bmjgh-2024-017861","url":null,"abstract":"<p><strong>Introduction: </strong>Approximately 200 000 children are born each year with clubfoot, the majority of whom live in low-income and middle-income countries (LMICs). If untreated, clubfoot causes pain and reduced mobility, leading to activity limitations and disability. The Ponseti method is a highly effective and minimally invasive treatment. This observational study aims to quantify the countries providing clubfoot services and the children receiving treatment in 2023 and compares progress since data were first collected in 2005.</p><p><strong>Methods: </strong>In January and February 2024, data on clubfoot treatment in 2023 were collected from 70 countries. Informants completed a survey about new cases enrolled, treatment outcomes and health system integration. Data were analysed using descriptive statistics, with adjustments made for duplicates, and included clinic locations, the number and ages of children starting treatment, types of support available and Ministry of Health involvement. We compared coverage trends over time and used a cartogram to visualise the extent of clubfoot programme coverage across countries.</p><p><strong>Results: </strong>Responding countries accounted for 83% of all expected cases in LMICs. There was an increase in enrolment numbers, to 40 382, in 2023. Despite this progress, treatment coverage remained low at approximately 22% across respondent countries. While integration of clubfoot services into national healthcare systems varied widely, strong public-private partnerships in many countries suggest a foundation for sustainable, long-term treatment programmes. However, quality care remained a challenge, with only 67% of children receiving their first foot abduction brace, indicating gaps in ensuring comprehensive treatment necessary for successful clubfoot management. Lingering effects of COVID-19 restrictions include a higher percentage of cases enrolled after 1 year of age.</p><p><strong>Conclusions: </strong>A larger proportion of children in LMICs received Ponseti treatment in 2023 compared with 2005. However, more work is needed to expand national programmes, build sustainable, high-quality treatment capacity and ensure all children get the care they need to avoid lifelong disability.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742349","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":"Seasonality of underweight among infants 1-11 months old in Niger: an exploratory analysis of data from a cluster-randomised trial.","authors":"Brittany Peterson, Ahmed Mamane Arzika, Ramatou Maliki, Amza Abdou, Bawa Aichatou, Ismael Sara, Diallo Beidi, Nasser Galo, Nasser Harouna, Alio Karamba Mankara, Sani Mahamadou, Moustapha Abarchi, Almou Ibrahim, Elodie Lebas, Jeremy David Keenan, Catherine E Oldenburg, Travis C Porco, Benjamin Arnold, Thomas M Lietman, Kieran S O'Brien","doi":"10.1136/bmjgh-2024-017643","DOIUrl":"10.1136/bmjgh-2024-017643","url":null,"abstract":"<p><strong>Introduction: </strong>Malnutrition is a risk factor for child mortality, with around 45% of deaths in children under 5 globally linked to malnutrition. Seasonality of malnutrition has important implications for the timing of child health programme activities, but evidence is mixed on the nature of such patterns. Moreover, the bulk of the existing evidence is focused on wasting and stunting in children 6-59 months, despite increasing evidence that younger children also face a high risk, and that underweight alone is an important predictor of mortality.</p><p><strong>Methods: </strong>This study used data from the cluster-randomised AVENIR trial which compared the effect of biannual distribution of azithromycin vs placebo on mortality in children 1-59 months old in Niger. AVENIR included a biannual census conducted on a rolling basis over 2 years. A subset of 133 781 infants aged 1-11 months from 2904 communities were included in this study, and weight-for-age z-score (WAZ) was calculated at each census. The exposure for this analysis is the day of the year weight was captured. Harmonic regression was used to determine primary and secondary peaks and nadirs of WAZ over time.</p><p><strong>Results: </strong>Overall, the primary peak of WAZ occurred in late February and the primary nadir occurred in mid-May, aligning with a seasonal temperature increase before the rainy season. A secondary peak in August and a secondary nadir in November were also seen, aligning with the postrainy season.</p><p><strong>Conclusion: </strong>The seasonality of WAZ of infants 1-11 months in Niger may have implications for the timing of programmes aiming to decrease malnutrition.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742363","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":"Towards building climate-resilient health systems and communities: a clarion call to increase investments in public health disaster risk reduction in Africa.","authors":"Olushayo Oluseun Olu","doi":"10.1136/bmjgh-2024-016232","DOIUrl":"10.1136/bmjgh-2024-016232","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742404","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":"Cumulative population blood lead levels.","authors":"Richard Fuller, Kate Porterfield, David Hanrahan, Howard Hu","doi":"10.1136/bmjgh-2024-018145","DOIUrl":"10.1136/bmjgh-2024-018145","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728653","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":"Balancing short-term and long-term climate-health equity strategies: a framework for supporting faster, fairer joint action on climate change and health equity.","authors":"Kirsty Wild, Kumanan Rasanathan, Sudhvir Singh, Alistair Woodward","doi":"10.1136/bmjgh-2024-016094","DOIUrl":"10.1136/bmjgh-2024-016094","url":null,"abstract":"<p><p>In this conceptual paper, we propose an integrated framework to support and accelerate joint action on climate change and health equity. We introduce a 'healthy climate, healthy people' framework, designed to support the complex task of synchronising these two significant justice challenges. The framework includes four domains for joint action: (1) Health in all climate mitigation policies; (2) Mitigation with health equity 'co-benefits'; (3) Pro-poor climate adaptation and (4) Greening health equity. We discuss practical implications for policy-makers, including the importance of attending to the health equity dimensions of both climate change and climate action; the value of increasing the use of rapid health equity assessment tools and harm-reducing (redistributive and compensatory) policy measures; the importance of community knowledge and the critical role of 'fair effort sharing' and tackling the emissions of the wealthy.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 Suppl 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728576","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":"Optimising adolescents and young adults' utilisation of sexual and reproductive health and HIV services in Chad: a sensemaking approach.","authors":"Esias Bedingar, Ferdinan Paningar, Ngarossorang Bedingar, Eric Mbaidoum, Naortangar Ngaradoum, Rifat Atun, Aisha Yousafzai","doi":"10.1136/bmjgh-2024-017763","DOIUrl":"10.1136/bmjgh-2024-017763","url":null,"abstract":"<p><strong>Background: </strong>Adolescents and young adults (AYA) aged 15-24 years account for nearly half of all new HIV infections globally, with over 80% residing in sub-Saharan Africa, where AIDS is a leading cause of death. In Chad, HIV/AIDS significantly impacts AYA, despite a reduction in national prevalence from 1.6% in 2010 to 1.0% in 2022. AYA still contribute to 26.3% of new infections, with young women facing four times the risk compared with young men. Barriers throughout the care continuum, including transitions from paediatric to adult services, contribute to an overall antiretroviral therapy (ART) coverage of 47% in 2023, with only 27% of males compared with 58% of females receiving treatment. These challenges impact access to sexual and reproductive health services and effective help-seeking.</p><p><strong>Methods: </strong>This study used participatory action research with a sensemaking theoretical lens. From December 2021 to March 2024, data were collected from 52 AYA (aged 15-24, both HIV-positive and HIV-negative) in focus group discussions. Data were analysed using a modified grounded theory approach, with coding and category development guided by the constant comparison method.</p><p><strong>Results: </strong>Findings indicate that empowering AYA in health decision-making requires an adaptable approach considering individual experiences, interpersonal influences and systemic factors. Such an approach can enhance engagement with healthcare services, increase service utilisation and treatment adherence and inform policy redesign for more effective service delivery.</p><p><strong>Conclusion: </strong>This study advances the understanding of sensemaking in healthcare, illustrating how AYA in Chad navigate and interpret the healthcare system. It highlights the need for AYA-friendly services that foster clear communication, trust and responsive care. Strengthening health systems through adolescent-responsive policies, workforce training and decentralised service delivery can enhance AYA engagement, service utilisation and retention in care. Aligning services with AYA perspectives through community-driven approaches and system reforms can improve healthcare accessibility and outcomes in similar contexts.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728573","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":"Knowledge, attitudes and barriers to uptake of COVID-19 vaccine in Uganda, February 2021.","authors":"Bob Omoda Amodan, Patricia Thiwe Okumu, John Kamulegeya, Alex Ndyabakira, Geoffrey Amanya, Daniel Jacob Emong, Aggrey Byaruhanga, Job Morukileng, Alex Riolexus Ario","doi":"10.1136/bmjgh-2024-016959","DOIUrl":"10.1136/bmjgh-2024-016959","url":null,"abstract":"<p><strong>Introduction: </strong>Uganda planned to start its COVID-19 vaccination campaign in March 2021, prioritising healthcare workers, security personnel, elderly and people with comorbidities. However, the willingness to receive the vaccine and potential barriers and hindrances were unknown. To understand the barriers to uptake of the COVID-19 vaccine prior to its rollout, we explored the communities' knowledge, attitudes and barriers.</p><p><strong>Methods: </strong>We conducted a mixed-methods cross-sectional study in Kampala and Ankole subregions in February 2021. For the household survey, we used three-stage sampling to select three districts in each subregion and, thereafter, 12 villages per district. One adult in each household was interviewed. Additionally, we conducted focus group discussions and key informant interviews to explore knowledge, attitudes and barriers to COVID-19 vaccination. Modified Poisson regression was used to identify factors associated with willingness to receive to COVID-19 vaccine RESULTS: Among 1728 respondents, 52% were under 40 years old, and 67% were female. Fifty-nine percent of those who had heard of the vaccine primarly obtained information from radio and television (TV). Despite one-quarter reporting that they had heard that the vaccine could cause death or genetic changes, 85% were willing to receive it. Persons in the Kampala subregion were less willing than those in the Ankole subregion to take the vaccine (76% vs 94%, adjusted prevalence ratio (aPR)=0.85, 95% CI: 0.81 to 0.89). Trust in the effectiveness of non-vaccine COVID-19 preventive measures (aPR=0.89, 95% CI: 0.80 to 0.99), living in urban areas (aPR=0.84, 95% CI: 0.76 to 0.91) and lack of information on vaccine safety (aPR=0.91, 95% CI: 0.83 to 0.93) reduced interest in taking the vaccine.</p><p><strong>Conclusions: </strong>Vaccine willingness was high despite some misinformation and safety concerns, which more prevalent in Kampala than in the Ankole subregion. While radio and TV were major sources of COVID-19 vaccine information, social media was the biggest propagator of COVID-19 vaccine misinformation. Therefore, providing credible information about vaccine safety could reinforce uptake, especially among urban residents. Additionally, local and national leaders should publicise their acceptance of vaccines and debunk misinformation.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728656","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}