BMJ Global Health最新文献

{"title":"A scoping review on the impact of women's global leadership: evidence to inform health leadership.","authors":"Anna Kalbarczyk, Katherine Banchoff, Kelly E Perry, Charlotte Pram Nielsen, Anju Malhotra, Rosemary Morgan","doi":"10.1136/bmjgh-2024-015982","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-015982","url":null,"abstract":"<p><strong>Introduction: </strong>The documented benefits of gender parity in leadership are emerging-women leaders have been shown to have a positive impact on maternal and health care policies, strengthen health facilities, and reduce health inequalities. More research is needed, however, to document their impact on global health. We go beyond the well-documented barriers that uphold the lack of gender parity by identifying areas where women leaders are making an impact to inform investment, programming, and policy.</p><p><strong>Methods: </strong>We conducted a scoping review of peer-reviewed literature, following Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, to map evidence on the impact of women's leadership in organisations in low- and middle-income countries. As many leadership outcomes are cross-disciplinary, outcomes were explored across sectors with particular attention paid to the relevance of these outcomes for global health.</p><p><strong>Results: </strong>137 articles were included in the review. Studies found women leaders' positive influence on six areas of impact: (1) financial performance, risk, and stability, (2) innovation, (3) engagement with ethical initiatives, (4) health, (5) organisational culture and climate outcomes, and (6) influence on other women's careers and aspirations. Articles reporting mixed results focused on multiple indicators and still largely pointed to positive results, particularly when modified by other factors including increased education, increased experience, and opportunities to work with other women across the organisation. In all sectors, across leadership roles, and across geographies, women's leadership can produce positive results. Women leaders' success, however, cannot be separated from the contexts in which they work, and unsupportive environments can affect the extent to which women leaders can have an impact.</p><p><strong>Conclusion: </strong>Increased and sustained investment in women's leadership within the health sector can lead to improved outcomes for organisations and their clients. Such investments must not only target individual women, but also seek to foster organisational cultures that promote and retain women leaders and support their independent decision-making.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187770","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":"Acceptability of the R21/Matrix-M malaria vaccine alongside existing malaria interventions in the trial context.","authors":"Halimatou Diawara, Jane Grant, Alassane Dicko, Seydou Traore, Djibrilla Issiaka, Fatoumata Koita, Mehreen Datoo, Mala Sylla, Abdrahmane Boncane Dicko, Issaka Sagara, Daniel Chandramohan, Adrian Vs Hill, Brian Greenwood, Jayne Webster","doi":"10.1136/bmjgh-2024-015524","DOIUrl":"10.1136/bmjgh-2024-015524","url":null,"abstract":"<p><strong>Background: </strong>The R21/Matrix-M malaria vaccine has been shown to provide high protective efficacy against malaria in a phase III trial, and has been recommended for use by WHO. The vaccine will soon be deployed at scale in sub-Saharan Africa. This study aimed to understand the caregiver and community acceptability of the R21/Matrix-M vaccine alongside existing malaria prevention interventions, according to the communities of participants in the seasonal R21/Matrix-M phase III trial in Mali.</p><p><strong>Methods: </strong>Qualitative data were collected to assess the acceptability of the R21/Matrix-M vaccine alongside the three R21/Matrix-M or control vaccine priming injections given in the first year of the trial. A total of 33 in-depth interviews (IDIs), 12 focus group discussions (FGDs) and 45 exit interviews at the trial clinics were conducted with caregivers of trial participants, 18 IDIs and 8 FGDs were conducted with community members, 13 IDIs with community health workers and 8 IDIs with trial field staff. Data were coded using the constructs from Sekhon's theoretical framework on acceptability.</p><p><strong>Results: </strong>Acceptability of the R21/Matrix-M vaccine was driven mainly by the high burden of malaria in the highly seasonal study area and consequent demand for a malaria vaccine, a perceived high efficacy of the R21/Matrix-M vaccine, and a high level of trust and confidence in the trial and trial team. These perceptions of the acceptability of the R21/Matrix-M vaccine led to a reduced perceived importance of seasonal malaria chemoprevention (SMC) among some caregivers, while others viewed R21/Matrix-M, SMC and insecticide-treated nets as complementary.</p><p><strong>Conclusions: </strong>The R21/Matrix-M vaccine was acceptable to caregivers and communities of participants in the R21/Matrix-M phase III trial in Mali. Implementation research is needed to evaluate and ensure co-coverage of complementary malaria control interventions, including SMC in seasonal settings, in the face of the scale-up of R21/Matrix-M and other malaria vaccines.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122131","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":"Evaluation of oral cholera vaccine (Euvichol-Plus) effectiveness against <i>Vibrio cholerae</i> in Bangladesh: an interim analysis.","authors":"Farhana Khanam, Md Taufiqul Islam, Faisal Ahmmed, Md Nazmul Hasan Rajib, Md Ismail Hossen, Fahima Chowdhury, Ashraful Islam Khan, Md Taufiqur Rahman Bhuiyan, Shahinur Haque, Prasanta Kumar Biswas, Amirul Islam Bhuiyan, Zahid Hasan Khan, Mohammad Ashraful Amin, Aninda Rahman, S M Shahriar Rizvi, Tahmina Shirin, Md Nazmul Islam, Amanda Tiffany, Lucy Breakwell, Firdausi Qadri, John D Clemens","doi":"10.1136/bmjgh-2024-016571","DOIUrl":"10.1136/bmjgh-2024-016571","url":null,"abstract":"<p><strong>Introduction: </strong>Millions of Euvichol-Plus doses have been deployed from the global oral cholera vaccine stockpile in over 20 cholera-affected countries. However, information on Euvichol-Plus's effectiveness is limited. Using this vaccine in a cholera epidemic in Dhaka, Bangladesh, provided the opportunity to evaluate the vaccine effectiveness (VE) using a test-negative design.</p><p><strong>Methods: </strong>A two-dose regimen of Euvichol-Plus was administered to individuals aged >1 year in a population of ca. 900 000 in two campaign rounds between June and August 2022, with prospective registration of all persons who received at least one dose. We conducted systematic surveillance in two key facilities, enrolling patients with acute watery diarrhoea who were eligible for vaccination from the campaign's start and who presented for care between 21 August 2022 and 20 August 2023. Faecal culture-positive cholera cases were matched to up to four faecal culture-negative controls by age, presentation date and facility. Vaccination status was documented without knowledge of culture results. Conditional logistic regression models estimated the OR for the vaccination-cholera association, and the VE of the two-dose regimen was calculated as [(1-OR) × 100].</p><p><strong>Results: </strong>The analysis included 226 cases and 552 matched controls. The adjusted VE of two doses of the Euvichol-Plus vaccine against medically attended cholera was 66% (99.5% CI: 30 to 83) for all recipients. Limited protection (12%; 95% CI: -95 to 60) was observed for children aged 1-4 years; whereas, protection was 79% (95% CI: 60 to 89) for those aged ≥5 years. VE against cholera with moderate to severe dehydration was 69% (95% CI: 44 to 83) overall but 6% (95% CI: -206 to 71) for children aged 1-4 years.</p><p><strong>Conclusion: </strong>Euvichol-Plus provided significant protection against medically attended cholera of any severity as well as cholera with moderate to severe dehydration. However, significant levels of protection were only observed for those aged ≥5 years.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122132","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":"Risk factors associated with human Mpox infection: a systematic review and meta-analysis.","authors":"Chigozie Louisa Jane Ugwu, Nicola Luigi Bragazzi, Jianhong Wu, Jude Dzevela Kong, Ali Asgary, James Orbinski, Woldegebriel Assefa Woldegerima","doi":"10.1136/bmjgh-2024-016937","DOIUrl":"10.1136/bmjgh-2024-016937","url":null,"abstract":"<p><strong>Background: </strong>Mpox emerged as a significant global public health concern during the 2022-2023 outbreak, impacting populations in both endemic and non-endemic countries. This study reviews and synthesises evidence on the risk factors associated with human Mpox transmission across these regions.</p><p><strong>Methods: </strong>A systematic search of peer-reviewed original studies was conducted across Scopus, Embase, Web of Science and PubMed databases, covering publications up to 31 March 2024. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two authors independently screened the articles by title, abstract and full text. The Newcastle-Ottawa Scale used to assess the risk of bias for included articles. Fixed- or random-effects meta-analysis was conducted when at least two studies reported ORs or relative risks, with 95% CIs. Heterogeneity was assessed using the [Formula: see text] statistic. This study was registered on PROSPERO (ID: <i>CRD42023459895</i>).</p><p><strong>Results: </strong>The systematic review identified 947 articles through database searches, of which 31 met our inclusion criteria. The meta-analysis revealed significant risk factors associated with Mpox infection. Interaction with infected animals (OR=5.61, 95% CI 2.83, 11.13), HIV infection (OR=4.46, 95% CI 3.27, 6.08), other sexually transmitted infections (OR=1.76, 95% CI 1.42, 2.19), unprotected sexual activities (OR=1.53, 95% CI 1.13, 2.07), contact with an infected person (OR=2.39, 95% CI 1.87, 3.05), identification as men who have sex with men (OR=2.18, 95% CI 1.88, 2.51) and having multiple sexual partners (OR=1.61, 95% CI 1.24, 2.09) were associated with increased Mpox infection risk. Conversely, smallpox vaccination was associated with a significantly reduced risk of Mpox infection (OR=0.24, 95% CI 0.11, 0.55).</p><p><strong>Conclusion: </strong>Identification of risk factors associated with Mpox provides insights for strategic public health planning, enabling targeted interventions for high-risk groups and optimising resource allocation to strengthen Mpox control efforts.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122135","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":"Modelling the health, financial protection and equity impacts of upscaling the ACT NOW early intervention breast cancer pilot program in the Philippines: an extended cost-effectiveness analysis.","authors":"Alexander Chye, Stephen Jan, Nirmala Bhoo Pathy, Herdee Gloriane C Luna, Soledad B Lim, Merel Kimman, Mark Woodward, Sanne Peters, Helen Monaghan, Corazon A Ngelangel, Blake Angell","doi":"10.1136/bmjgh-2024-016402","DOIUrl":"10.1136/bmjgh-2024-016402","url":null,"abstract":"<p><strong>Introduction: </strong>Women in the Philippines experience significant health and economic burdens of breast cancer. The Philippines has reformed financial protection for breast cancer but does not have a national early detection and treatment programme. This study aims to model the health and economic impacts of ACT NOW (a pilot breast cancer programme that navigates women through free early detection to treatment) through an extended cost-effectiveness analysis.</p><p><strong>Methods: </strong>A microsimulation decision tree model was used to model the ACT NOW intervention (including annual clinical breast examination (CBE) and biannual breast ultrasound for women at high risk of breast cancer) over 5 years for healthy women 40-69 years old. Outcomes included health gains (breast cancer deaths saved), financial protection (financial catastrophes saved) and incremental cost-effectiveness ratios (ICER) (cost per disability-adjusted life year (DALY) saved). Outcomes were stratified by income group. Probabilistic, one-way sensitivity and scenario analyses explored uncertainty.</p><p><strong>Results: </strong>Over 5 years, the ACT NOW intervention is cost-effective with an ICER of PHP60 711 (USD1098) (average incremental cost PHP743 [95% UI 424-960] and DALYs saved 0.01 [95% UI 0.01-0.02], below Philippines 2022 gross domestic product per capita PHP178 751). Per 100 000 women, 57 deaths and eight financial catastrophes were saved. Cost-effectiveness did not vary significantly by income, but higher income groups incurred greater costs and lower DALYs. Results were sensitive to proportion of late-stage breast cancers post intervention, treatment adherence, intervention costs and downstaging effectiveness. Trade-offs are apparent between government contributions to financial protection and rates of financial catastrophe.</p><p><strong>Conclusions: </strong>Early detection interventions (annual CBE, biannual breast ultrasound if at high risk of breast cancer) are likely to be cost-effective, reduce breast cancer-related mortality through detection at earlier stages and modestly effective in reducing the incidence of financial catastrophe. Further research is required to establish the best implementation model to pursue full implementation and ways of designing equity-based screening interventions.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122133","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":"Essential newborn care practices in selected public health facilities using observation of 2603 normal deliveries in Uttar Pradesh, India.","authors":"Shajy Isac, Bidyadhar Dehury, Ravi Prakash, Nihal Hasan, John Anthony, Banadakoppa Manjappa Ramesh, Prakash P Javalkar, Vasanthakumar Namasivayam, Marissa L Becker, James Blanchard, Ties Boerma","doi":"10.1136/bmjgh-2024-017117","DOIUrl":"10.1136/bmjgh-2024-017117","url":null,"abstract":"<p><strong>Introduction: </strong>Essential newborn care (ENBC) practices are recommended for all births to improve neonatal survival. This paper aims to understand the facility-level variations and factors associated with the essential newborn care practices by providers in higher-level public health facilities in 25 high priority districts (HPDs) of Uttar Pradesh (UP).</p><p><strong>Methods: </strong>We used observational cross-sectional quantitative data from 48 selected public health facilities (23 district hospitals (DH) and 25 community health centres (CHC)-first referral units (FRU)) implemented in 25 HPDs of UP from February 2020 to May 2021. We defined ENBC practice as both cord care and initiation of breastfeeding within 1 hour of birth were practiced in normal deliveries by the staff nurse. Descriptive analysis was done based on data from 2603 newborns attended by 318 providers. A stratified analysis was done by DH and CHC-FRU.</p><p><strong>Results: </strong>Overall, essential newborn care was practiced among 26.1% of the newborns (26.2% in DH and 35.0% in CHC-FRU). The ENBC practice varied across facilities from 3.0% to 64.1% in DH and from 0% to 91.0% in CHC-FRU. The ENBC practice was about 2.3 times higher in facilities with a high level of skill and knowledge of the providers (39.0%) compared with the facilities with a low level of skill and knowledge (16.9%). Similar patterns of association between providers' skills and knowledge of ENBC practices were observed in DH and CHC-FRU.</p><p><strong>Conclusion: </strong>Skill and knowledge on ENBC components are significantly associated with the clinical practices of providers, with a high level of variability across facilities. This suggests a focused facility-based assessment and enhancement of the clinical competencies of the providers to improve the quality of care in public health facilities in UP.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073602","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":"Decoding mpox: a systematic review and meta-analysis of the transmission and severity parameters of the 2022-2023 global outbreak.","authors":"Candida Diaz Brochero, Laura Cristina Nocua-Báez, Jorge Alberto Cortes, Kelly Charniga, Adriana Buitrago-Lopez, Zulma M Cucunubá","doi":"10.1136/bmjgh-2024-016906","DOIUrl":"10.1136/bmjgh-2024-016906","url":null,"abstract":"<p><strong>Introduction: </strong>The 2022-2023 mpox outbreak has been the largest in history. We aim to synthesise the key epidemiological parameters related to the dynamics, transmission, and severity of mpox (incubation period, serial interval, generation time, infectious period, basic (R0) and effective (R(t)) reproductive number, and case fatality rate (CFR)).</p><p><strong>Methods: </strong>Systematic review of observational studies in MEDLINE, EMBASE and other sources up to September 2023 (PROSPERO: CRD42023404503). Quality assessment using the Joanna Briggs Institute Critical Appraisal for case series, cross-sectional and cohort studies, and a designed quality assessment questionnaire for mathematical models. Meta-analysis was performed using a random effects model.</p><p><strong>Results: </strong>For transmissibility parameters, we estimated a pooled incubation period of 7.60 (95% CI 7.14 to 8.10) days and a pooled serial interval of 8.30 (95% CI 6.74 to 10.23) days. One study reported a generation time of 12.5 days (95% CI 7.5 to 17.3). Three studies reported presymptomatic transmission in 27-50% of paired cases investigated. R(t) varied between 1.16 and 3.74 and R0 varied between 0.006 and 7.84. The epidemic peaked between August and September 2022 in Europe and the Americas whereas transmission has continued in African countries. For severity parameters, we estimated a pooled CFR by continent: 0.19% (95% CI 0.09% to 0.37%) for the Americas and 0.33% (95% CI 0.15% to 0.7%) for Europe. For Africa, we found that the CFRs of countries associated with group I were higher (range 17-64%) than those associated with group IIb (range 0-6%).</p><p><strong>Conclusion: </strong>Pooled mpox serial interval was slightly larger than pooled incubation period, suggesting transmission occurs mostly postsymptom onset, although presymptomatic transmission can occur in an important proportion of cases. CFR estimates varied by geographical region and were higher in Africa, in countries linked with clade I. Our results contribute to a better understanding of mpox dynamics, and the development of mathematical models to assess the impact of current and future interventions.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073585","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":"Abortion and unintended pregnancy in Pakistan: new evidence for 2023 and trends over the past decade.","authors":"Zeba Sathar, Susheela Singh, Iqbal H Shah, Muhammad Rehan Niazi, Tahira Parveen, Octavia Mulhern, Ali Mohammad Mir","doi":"10.1136/bmjgh-2024-017239","DOIUrl":"10.1136/bmjgh-2024-017239","url":null,"abstract":"<p><strong>Background: </strong>Despite induced abortion being highly legally restricted in Pakistan, studies in 2002 and 2012 showed that many women rely on abortion when faced with an unintended pregnancy. Following the 2012 study, concerted efforts were made to improve contraceptive services and to strengthen postabortion care. The availability and use of misoprostol also expanded in the past decade. Our primary objective was to provide new evidence on the rates of unintended pregnancy, induced abortion and postabortion care in 2023 and to assess trends in these outcomes since 2012.</p><p><strong>Methods: </strong>This is a cross-sectional study based on a Health Professional Survey, and a nationally representative Health Facilities Survey, conducted in 2023. A widely applied methodology is used to estimate rates of abortion and unintended pregnancy. Data sources and methods are comparable across the 2012 and 2023 studies.</p><p><strong>Results: </strong>In 2023, an estimated six million unintended pregnancies occurred and 64% of them or 3.8 (95% CI 2.2 to 6.4) million resulted in induced abortions. This corresponds to an annual unintended pregnancy rate of 100 and an induced abortion rate of 66 (95% CI 38 to 111) per 1000 women aged 15-49. There was no significant change in the unintended pregnancy rate, but the abortion rate increased by 25% between 2012 and 2023. In 2023, 697 913 women were treated for postabortion complications, corresponding to an annual rate of 12.1 (95% CI 6.4 to 16.5) per 1000 women ages 15-49. This treatment rate declined by 16% between 2012 and 2023.</p><p><strong>Conclusions: </strong>The unintended pregnancy rate has remained stable in the past decade. However, Pakistani women are increasingly relying on abortion to resolve unintended pregnancy. The treatment rate of postabortion complications has declined, owing largely to widespread access to misoprostol. This transformation of the abortion landscape calls for concerted efforts to increase contraceptive use and strengthen postabortion care.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063507","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":"Implications of conflict on vaccination in the Sahel region.","authors":"Majdi M Sabahelzain, Harriet Dwyer, Seye Abimbola, Julie Leask","doi":"10.1136/bmjgh-2024-016496","DOIUrl":"10.1136/bmjgh-2024-016496","url":null,"abstract":"<p><p>The Sahel region is a geographical belt in Africa that stretches from the Atlantic Ocean to the Red Sea, between the Sahara Desert in the north and the Savannah in the south. It is characterised by challenging environmental crises and conflicts. This analysis highlights the potential implications of conflict on vaccination across five Sahel countries, including Burkina Faso, Chad, Mali, Niger and Sudan, from 2019 to 2023. It also presents recommendations to improve vaccination coverage in these settings. The WHO Immunisation Data Portal was used to extract data about vaccination coverage and disease outbreaks. With the increasing complexity of humanitarian access in the Sahel, there has been an accumulation of the number of zero-dose and underimmunised children. In 2023 alone, most of these countries had a significant proportion of zero-dose children, particularly Sudan (43%), Mali (22%) and Chad (16%). Nearly half of children in Sudan (49%), 33% in Chad and 23% in Mali are underimmunised. Measles vaccine coverage was consistently below 90% in these countries, except for Burkina Faso. The trend of polio outbreaks (circulating vaccine-derived poliovirus) across these countries showed fluctuations in the number of cases, with Niger having reported several cases over this period, and Chad having 101 cases reported in 2020 alone. Despite relatively high coverage, there were significant outbreaks of polio in Burkina Faso, Sudan and Mali in 2020, which reflects the potential impact of the COVID-19 pandemic. Lessons can be learnt from past diplomatic and programmatic successes, while investments in innovative and flexible approaches may help increase the reach of vaccination programmes in inaccessible areas.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063666","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":"Starfield's 4Cs of NCD management in primary healthcare: a conceptual framework development from a case study of 19 countries.","authors":"Chuan De Foo, Krishaa Logan, Elliot Eu, Darius Erlangga, Juan Carlos Rivillas, Ewa Kosycarz, Aungsumalee Pholpark, Natchaya Ritthisirikul, Piya Hanvoravongchai, Likke Prawidya Putri, Tiara Marthias, Marcela Schenck, Wilson Benia, Eva Turk, Kim Bao Giang, Doan Thi Thuy Duong, Supri Shrestha, Maria Eugenia Esandi, Laura Antonietti, Shangzhi Xiong, Pami Shrestha, Jasper Tromp, Helena Legido-Quigley","doi":"10.1136/bmjgh-2024-017578","DOIUrl":"10.1136/bmjgh-2024-017578","url":null,"abstract":"<p><strong>Introduction: </strong>Faced with a backdrop of an increasing chronic disease burden from an ageing global population compounded with rising healthcare costs, health systems are required to implement cost-effective, safe and equitable care through efficient service delivery models. One approach to achieving this is through Starfield's 4Cs of primary healthcare (PHC), which delineates the key attributes of a high-performing PHC system that upholds the pillars of care coordination, first contact of care, continuity of care and comprehensive care. Therefore, this study aims to explore and elucidate the key themes and subthemes related to and extending beyond Starfield's 4Cs of PHC by integrating findings from a comprehensive literature review and a qualitative study.</p><p><strong>Methods: </strong>In this case study analysis, case studies of PHC systems from 19 countries were purposefully selected to represent a range of income levels and diversity in health systems and PHC landscapes. A review of existing literature of peer-reviewed articles, policy documents and technical reports made publicly available data on PHC was complemented with data obtained from 61 in-depth interviews with health systems experts from a larger study. The research team thematically analysed the data and organised the key themes and subthemes into a conceptual framework that is anchored on Starfield's 4Cs of PHC.</p><p><strong>Results: </strong>Broadly, we developed a conceptual framework with the 4Cs, placing providers and patients at the centre. The key subthemes that manifested from Starfield's 4Cs included maximising the use of existing fiscal resources, leveraging technology, improving accessibility to health services and task sharing. Other relevant and overarching themes were the deployment of national frameworks, equity, healthcare provider retention, service integration, emergency preparedness and community engagement.</p><p><strong>Discussion: </strong>The subthemes derived point health systems in the right direction based on the trialled and tested PHC models of various countries. Their strong points were highlighted in our case studies to depict how Starfield's 4Cs are leveraged to strengthen PHC, and the themes we identified that went beyond the 4Cs are necessary considerations for modifying PHC policies going forward.</p><p><strong>Conclusion: </strong>As the world enters an era of ageing populations and acute system shocks, PHC needs to be fortified and integrated into the more extensive system to protect the health of the population and safeguard the well-being of providers. Our conceptual framework offers health systems a glimpse of how this can be achieved.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063675","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}