BMJ Global Health最新文献

{"title":"Acceptability and feasibility of glucose-6-phosphate dehydrogenase (G6PD) testing using SD Biosensor by village malaria workers in Cambodia: a qualitative study.","authors":"Sarah A Cassidy-Seyoum, Bipin Adhikari, Keoratha Chheng, Phal Chanpheakdey, Agnes Meershoek, Michelle S Hsiang, Lorenz von Seidlein, Rupam Tripura, Benedikt Ley, Ric N Price, Lek Dysoley, Kamala Thriemer, Nora Engel","doi":"10.1136/bmjgh-2025-019615","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-019615","url":null,"abstract":"<p><strong>Introduction: </strong><i>Plasmodium vivax</i> is the predominant cause of malaria in the Greater Mekong Subregion. To ensure safe treatment with primaquine, point-of-care glucose-6-phosphate dehydrogenase (G6PD) testing was rolled out in Cambodia at the health facility level, although most malaria patients are diagnosed in the community. The current study aims to explore the acceptability and feasibility of implementing community-level G6PD testing in Cambodia.</p><p><strong>Methods: </strong>Semistructured interviews and focus group discussions (FGD) were conducted. Across eight study sites in three provinces, 142 respondents, including policymakers, programme officers, healthcare providers and patients, participated in 67 interviews and 19 FGDs in 2022 and 2023. Data were analysed thematically using an adapted framework derived from Bowen <i>et al</i>'s feasibility framework and Sekhon <i>et al</i>'s acceptability framework.</p><p><strong>Results: </strong>All stakeholders attributed value to the intervention. Acknowledging an intervention's different values can help discern policy implications for an intervention's successful implementation. Building and maintaining confidence in the device, end users, infrastructure and health systems were found to be key elements of acceptability. In general, health centre workers and village malaria workers (VMWs) had confidence that VMWs could conduct the test and administer treatment given appropriate initial training, monthly refresher training and the test's repeated use. More is required to build policymakers' confidence, while some implementation challenges, including the test's regulatory approval, stability above 30°C and cost, need to be overcome.</p><p><strong>Conclusion: </strong>Implementation of G6PD testing at the community level in Cambodia is an acceptable and potentially feasible option but requires addressing implementation challenges and building and maintaining confidence among stakeholders.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315899","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":"Supporting local ownership of transition processes: a key pathway to sustaining the HIV response.","authors":"Lindsay Moore Murphy, Deborah Valerie Stenoien, Eliza Love, Hilary Mwale, Vi Vu, Aishling Thurow, Damian Walker, Monica Jordan, Allyala Nandakumar, Sarah Konopka","doi":"10.1136/bmjgh-2024-018190","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-018190","url":null,"abstract":"<p><p>Globally, an increasing number of countries have made progress towards HIV epidemic control, yet decreasing donor funding and insufficient domestic investments threaten these strides. Within this context, the global community is interested in how to successfully transition responsibility for HIV services from donor-funded programmes to local ownership within the broader healthcare system.This analysis explores how to centre local leadership in transition processes to ensure long-term sustainability of HIV programmes, including moving from external to domestic financing. Existing frameworks show broad consensus on the core elements required to examine readiness and support transition processes; however, many of these frameworks do not address how to ensure that transitions are locally owned. An examination of HIV programmes in Vietnam and Zambia, supported by previous evidence, presented four specific lessons on promoting local ownership and local leadership of transition processes. First, sustainable transitions rely on strong locally led health systems and health system functions. Second, the prioritisation of HIV service and system integration must be locally led to ensure harmonisation with national health sector reforms and priorities. Third, capacity strengthening and consistent engagement with civil society, especially during decision-making processes, can strengthen the sustainability of transition efforts. Finally, decentralising planning and integration processes to regional platforms and actively involving subnational actors is essential in contexts with decentralised health systems. The global community can embrace these lessons to support locally led transitions and improve sustainable HIV services in the long term.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315900","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":"Do health facility governing committees improve health system performance? An ecological study of Mainland Tanzania.","authors":"Fredrika von Essen, Stephen Maluka, Kamuzora Peter, Ntuli Kapologwe, Miguel San Sebastian, Anna-Karin Hurtig, Baroudi Mazen","doi":"10.1136/bmjgh-2024-015753","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-015753","url":null,"abstract":"<p><strong>Introduction: </strong>Accountability is crucial for improved functionality of health systems and can be ensured through community participation in health governance. To engage the community in the governance of the local health system, health facility governing committees (HFGCs) have been implemented in several low-income and middle-income countries including Tanzania. However, the effect of HFGCs on health system performance is not well studied. The aim of this study was to investigate the relationship between the functionality of the HFGCs and health system performance in 180 districts of mainland Tanzania, and to assess whether this relationship varies between dispensaries, health centres and hospitals.</p><p><strong>Methods: </strong>We conducted an ecological study in which the studied outcome was health system performance. The main independent variable was functionality of HFGCs, that is, to what extent these committees reflect the concerns of and connect back to the community. Other explanatory variables included staff availability, location of the facility, gender of the manager of the facility and ownership of the facility. Data on all of the variables were retrieved from the Star Rating Assessment of 2017/2018, measured as mean proportions of all facilities in the districts. The analyses included linear regression for all facility levels combined, as well as for the levels of facility separated (dispensaries, health centres and hospitals).</p><p><strong>Results: </strong>We found a positive relationship between the functionality of the HFGCs and health system performance (β=0.53; 95% CI=0.47 to 0.60). The relationship was stronger for dispensaries (β=0.56; 95% CI=0.50 to 0.63) compared to health centres (β=0.39; 95% CI=0.33 to 0.44) and hospitals (β=0.23; 95% CI=0.15 to 0.31).</p><p><strong>Conclusions: </strong>Districts that have functional HFGCs tend to have better health system performance than others. This relationship is stronger in dispensaries compared to health centres and hospitals. Therefore, we believe the district authorities should allocate resources to strengthen the HFGCs.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301143","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":"Private finance and the threat to global health.","authors":"Benjamin M Hunter, David McCoy, Ana Carolina Cordilha, Anna Marriott, Victor Roy, Felix Stein, Benjamin Wood","doi":"10.1136/bmjgh-2025-019726","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-019726","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301144","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":"Out-of-pocket expenditure and financial risks associated with treatment of chronic kidney disease in Ethiopia: a prospective cohort costing analysis.","authors":"Solomon Tessema Memirie, Mizan Habtemichael, Hamelmal G Hailegiorgis, Leja Hamza Juhar, Tsegay Berhane, Sisay Tesfaye, Workagegnehu Hailu Bilchut, Maekel Belay Woldemariam, Lina Mohammed Ahmedtaha, Ole Frithjof Norheim","doi":"10.1136/bmjgh-2025-019074","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-019074","url":null,"abstract":"<p><strong>Introduction: </strong>In Ethiopia, most healthcare expenditures are paid out-of-pocket (OOP), while the burden of kidney disease (KD) is rapidly increasing, posing a major public health challenge in low- and middle-income countries, along with a staggering economic burden. We aimed to quantify the extent of OOP health expenditures and the magnitude of associated catastrophic and impoverishing health expenditures (CHE and IHE) for chronic KD (CKD) care in Ethiopia.</p><p><strong>Methods: </strong>We conducted a prospective costing analysis for CKD care from the patient perspective. We collected data on OOP health expenditures (2023 US$) and household consumption expenditures from a cohort of 433 patients that were followed prospectively for 6 months. Patients were recruited from six health facilities from four constituencies in Ethiopia. We estimated the burden of OOP payments as the sum of direct medical expenditures (DMEs) and direct non-medical expenditures (DNMEs). DMEs were calculated by summing OOP payments for consultations, diagnostic workups, procedures, medications and hospital stays. DNMEs were computed by totalling OOP expenses for transportation, food and lodging. Additionally, we estimated the economic value of productivity losses incurred by patients and/or caregivers due to time spent seeking care. We used descriptive statistics to measure the extent of CHE and IHE. We ran a logistic regression model to assess the drivers of CHE.</p><p><strong>Results: </strong>The mean annual OOP expenditure was US$2337 (95% CI US$2014 to US$2659) and varied by type of care: US$677 (95% CI US$511 to US$825) for outpatient care, US$2759 (95% CI US$1171 to US$4347) for inpatient care and US$5312 (95% CI US$4644 to US$5919) for haemodialysis. DMEs (particularly haemodialysis) were the major drivers of cost, accounting for 76%-85% of the total OOP expenditure. Transportation expenditures were the major contributors among the DNMEs. Among those who sought outpatient, inpatient and haemodialysis care, 36%, 67% and 90% incurred CHE, respectively, at a 10% threshold of annual consumption expenditures. Among all patients, 25.6% of households were impoverished due to OOP medical expenditures, with the rate substantially higher among those requiring haemodialysis (43.4%). Facility type and the type of visit were significantly associated with the odds of incurring CHE (p<0.05), while adjusting for wealth quintile, disease stage, area of residence (urban/rural), family size, patient age and insurance membership status.</p><p><strong>Conclusions: </strong>The household economic burden for CKD care is substantial, likely hindering access to necessary treatment and exacerbating the impoverishment, which is prevalent in Ethiopia. This would be an obstacle in achieving universal health coverage and Sustainable Development Goals in Ethiopia.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293316","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":"Time to inclusion of selected medicines for priority diseases in National Essential Medicines Lists compared with the WHO Model List.","authors":"Moska Hellamand, Tessa E Moleman, Annet P Post, Aukje K Mantel-Teeuwisse, Fatima Suleman, Hendrika A van den Ham","doi":"10.1136/bmjgh-2024-018550","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-018550","url":null,"abstract":"<p><strong>Introduction: </strong>The WHO maintains a Model List of Essential Medicines, which guides countries in developing their National Essential Medicines List (NEML) to improve access to medicines. We aimed to assess the time it took for countries to adjust their NEMLs when medicines were added or deleted from the WHO Model List and if this differed between priority diseases.</p><p><strong>Methods: </strong>We extracted medicines added or deleted from the WHO Model List (2007-2021) for selected priority diseases: diabetes, hepatitis C, HIV, oncology and tuberculosis. These medicines were compared with NEMLs from 20 countries; reimbursement lists (RLs) were used in the absence of an NEML. The time to inclusion in NEMLs/RLs and the percentage of included medicines in the most recent NEML/RL were assessed.</p><p><strong>Results: </strong>90 medicines were added, and 15 medicines were deleted from the WHO Model List. Low-income and middle-income countries (LMICs) mostly included medicines in NEMLs after their addition to the WHO Model List (median: 1 year), and high-income countries prior to addition (median: -9 years). Medicines for HIV (62%) and tuberculosis (59%) were most frequently included in the most recent NEML/RL. High-income countries included the most medicines for diabetes (86%) and oncology (67%).</p><p><strong>Conclusions: </strong>The WHO Model List may be a guiding tool for selecting medicines in LMICs, although it is applied differently between the priority diseases included in the present study. More medicines could be included in NEMLs for non-communicable diseases, which impose a large health burden on LMICs, as a first step to ensure their sustainable access.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293317","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":"Does home-based screening improve hypertension diagnosis, treatment and control? A regression discontinuity analysis in urban India.","authors":"Michaela Theilmann, Sneha Sarah Mani, Pascal Geldsetzer, Shivani A Patel, Mohammed K Ali, Harsha Thirumurthy, K M Venkat Narayan, Viswanathan Mohan, Nikhil Tandon, Dorairaj Prabhakaran, Nikkil Sudharsanan","doi":"10.1136/bmjgh-2024-017167","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-017167","url":null,"abstract":"<p><p>As part of India's efforts to expand primary healthcare services, several state governments are implementing or considering home-based hypertension screening programmes to improve population-wide diagnosis and blood pressure (BP) control rates. However, there is limited evidence on the effectiveness of home-based screening programmes in India. Using six waves of population-representative cohort data (N=15574), we estimate the causal effect of a home-based hypertension screening intervention on diagnosis, treatment, and BP using a novel application of the Regression Discontinuity Design. We find that measuring individuals' BP in their homes and providing health information and a referral to those with elevated BP did not meaningfully improve hypertension diagnosis (0.12 percentage points (pp), 95% CI -1.39 to 1.75), treatment (-0.16 pp, 95% CI -2.18 to 1.03), or change in BP (systolic: -0.96mm Hg, 95% CI -5.63 to 1.14; diastolic: 0.21, 95% CI -1.65 to 1.65). Our heterogeneity analyses suggest that home-based screening may reduce systolic BP for women with secondary education and women living in Chennai. However, we find null effects for diagnosis and treatment among these subpopulations and in all outcome variables across the other subpopulations and alternative specifications. Our findings suggest that a lack of knowledge of one's hypertension status might not be the primary reason for low diagnosis and treatment rates in India, where other structural and behavioural barriers may be more relevant. Adapting screening efforts to address these additional barriers will be essential for India's efforts to achieve universal health coverage.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293314","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":"Human papillomavirus vaccine coverage surveys in low- and middle-income countries: current efforts and future considerations for very young adolescents.","authors":"Lia Pak, Julia Rollison, Maya Rabinowitz, Laura J Faherty","doi":"10.1136/bmjgh-2024-018731","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-018731","url":null,"abstract":"<p><p>With the recent accelerated rollout of the human papillomavirus (HPV) vaccine in low- and middle-income countries (LMICs), there is a growing need for high-quality vaccination coverage measurement. Vaccine coverage surveys are a key avenue for collecting coverage data, but little is known about the current state of HPV vaccination coverage surveys of very young adolescents (VYAs)-those 10-14 years of age-in LMICs and methodological considerations for these efforts. Through an analysis of peer-reviewed and grey literature and a series of expert discussions, we identify promising approaches for these coverage surveys, such as when to sample from schools versus households and how to reduce recall bias. We also draw attention to the significant methodological gaps, such as a lack of research comparing the validity of vaccination status self-report by the VYA to a caregiver's report. Next, we describe the status of coverage surveys, finding that most LMICs with the HPV vaccine included in their national programme have not conducted a nationally representative HPV vaccination coverage survey. We also describe four existing multi-country survey efforts that include HPV vaccination coverage questions. Finally, we discuss promising approaches to strengthen survey measurement of HPV vaccination coverage among VYAs. Our findings lay the groundwork for stakeholders to expand HPV vaccination coverage measurement for VYAs in LMICs, a necessary component for reducing global HPV and cervical cancer burdens.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293315","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":"Academy, a battleground for justice: a call for prioritarian scholarship.","authors":"Mark G Shrime","doi":"10.1136/bmjgh-2025-020428","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-020428","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293303","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":"Enhancing learning from evaluations in newborn and child health.","authors":"Claire Blacklock, Andrew Clarke, Sebastian Taylor, Marion Lynch, Arooj Sahir, Stavros Petrou, Junior Mudji, Shobhana Nagraj, Katherine Kalaris, Soren Kudsk-Iversen, Adam Harnischfeger, Claire Allen, Sarah Williams, Prisca Benelli, Claire M Keene, Desire Habonimana, Neil Jefferies, Tanya Marchant, Louise Tina Day, Mike English","doi":"10.1136/bmjgh-2025-019663","DOIUrl":"10.1136/bmjgh-2025-019663","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282377","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}