BMJ Global Health最新文献

{"title":"The multi-mechanism pathway: quantifying the mediating role of perceived barriers of healthcare access in the relationship between intimate partner violence and antenatal care adherence across 31 sub-Saharan African countries.","authors":"Shuyi Wang, Maryam Zaid, Mayassa Ally, Bruno Sunguya, Dominic Nkhoma, Richard Makurumidze, Felistar Mwakasungura, Jiayan Huang","doi":"10.1136/bmjgh-2026-024675","DOIUrl":"10.1136/bmjgh-2026-024675","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 10","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164061","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":"Association between cigarette tax and the global burden of non-communicable diseases: a longitudinal ecological study in 193 countries.","authors":"Wenyao Peng, Siqi Lin, Xuan Liu, Hao Zhang, Jiapeng Lu","doi":"10.1136/bmjgh-2026-024235","DOIUrl":"10.1136/bmjgh-2026-024235","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 10","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147106","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":"ASHA workers at the crossroads: navigating volunteerism and formalisation in the changing public health landscape.","authors":"Anoop C Choolayil, Thamizhmaran Sundararajan, Vijesh Sreedhar Kuttiatt","doi":"10.1136/bmjgh-2025-020405","DOIUrl":"10.1136/bmjgh-2025-020405","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 10","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147459","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":"Age-sex-income triad disparities in diet-attributable diabetes: a GBD 2023 analysis reveals East Asia and Pacific region's decoupling phenomenon and cost-effective solutions.","authors":"Mengting Yin, Yan Fang, Qihang Ding, Huiqin Mei, Guomiao Zhang, Qichao Sheng, Kailong Liu, Yixin Shou, Xiaoyu Zhang, Dapeng Li, Fang Shi, Qingyang Mao, Chao Zheng, Zipei Jiang, Guangyun Mao","doi":"10.1136/bmjgh-2026-023665","DOIUrl":"10.1136/bmjgh-2026-023665","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 10","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135080","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":"50 years of contraception: trends in contraception prevalence rate and unmet family planning needs in twenty Arab countries (1970-2020).","authors":"Mohamed Khalis, Oumnia Bouaddi, Baholy Ramangason, Diatta Mohamed-Wassime, Bouchra Assarag, Vincent de Brouwere, Saber Boutayeb, Lahcen Belyamani, Radouane Belouali, Annie Haakenstad, Georges Georgi","doi":"10.1136/bmjgh-2025-019089","DOIUrl":"10.1136/bmjgh-2025-019089","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 10","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135093","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":"Formalising remote consulting in primary care services for underserved populations with long-term conditions in sub-Saharan Africa: a process evaluation and stakeholder engagement.","authors":"Olufunke Fayehun, Bronwyn Harris, Titus Mashanya, Kennedy Bashan Nkhoma, Aboluwaji Daniel Ayinmoro, Ayanfeoluwa Ibrahim, Abiodun Alliu, Wendy Higman, Chinwe Onuegbu, Akinyinka Omigbodun, Senga Pemba, Jackie Sturt, Frances Griffiths","doi":"10.1136/bmjgh-2024-018780","DOIUrl":"10.1136/bmjgh-2024-018780","url":null,"abstract":"<p><strong>Introduction: </strong>Remote consulting can improve healthcare access and equity. When delivered by trained health workers, it is safe, trustworthy and efficient. Alongside two independent clinical trials, we studied the implementation of a cascaded health worker training intervention (REaCH), plus airtime, on remote consulting in primary healthcare facilities in Nigeria (n=35) and Tanzania (n=21). Additionally, we assessed health service readiness for sustainable remote consulting in Ghana, Kenya, Nigeria, Malawi, Sierra Leone, Tanzania and Uganda.</p><p><strong>Methods: </strong>We explored what worked for whom, how, and why in both health worker training in Nigeria (n=115) and Tanzania (n=136), and the implementation of remote consulting for patients with long-term conditions. We assessed REaCH training for talent, resources, alignment, implementation and nurture. We analysed system readiness with WHO's Digital Investment Guide. We undertook 82 semi-structured interviews with health workers and patients (n=40: Nigeria, n=42: Tanzania), collected text produced, engaged with stakeholders and reviewed key policies/guidelines. Data were analysed thematically.</p><p><strong>Results: </strong>Health workers were already doing informal remote consulting. REaCH training helped facilities to plan and implement remote consulting. It addressed concerns about delivering a safe and ethical service. Provision of airtime was critical. Health workers used remote consulting for patient follow-up and patients sought advice, test results, prescriptions, referrals and emergency help. Patients and health workers trusted and appreciated remote consulting as it saved time. Patients felt cared for, but some received calls at inconvenient times. Health workers reported reduced stress but noted off-duty calls could be burdensome. Stakeholders were aware of informal remote consulting and were concerned about quality. None of the study countries provided airtime for remote consulting or had guidance or recording systems for remote consulting.</p><p><strong>Conclusion: </strong>There is an appetite for remote consulting in primary healthcare. However, health systems in seven countries of sub-Saharan Africa are not yet fully prepared for this.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 10","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104216","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 the essential package of health and nutrition services for women and children and strengthening the enabling environment will be critical to save lives in Afghanistan.","authors":"Emily C Keats, Hana Tasic, Palwasha Anwari, Paata Chikvaidze, Homayoun Ludin, Farzana Maruf, Bilal Ahmad Rahimi, Catherine Todd, Nadia Akseer","doi":"10.1136/bmjgh-2025-023267","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-023267","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 3","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104282","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":"Precision immunisation: reaching zero-dose children in underserved communities in Niger State, Nigeria.","authors":"Akolade Jimoh, Stephen Olabode Asaolu, Daniel Tsado Jiya, Obiamaka Enwezor, Abubakar Usman Kpantu, Abduljalal Salisu, Grace Odey, Odira Irene Okoye, Daniel Azuka, Emmanuella Alumonah, Temitope Kassim, Yasmin Aliyu, Sidney Sampson, Hilary Okagbue","doi":"10.1136/bmjgh-2025-023058","DOIUrl":"10.1136/bmjgh-2025-023058","url":null,"abstract":"<p><p>Nigeria has one of the highest burdens of zero-dose children globally, particularly in underserved and hard-to-reach communities where routine immunisation systems face persistent barriers. In Niger state, these challenges are compounded by insecurity, seasonal flooding and dispersed populations, limiting the effectiveness of conventional facility-based approaches. We describe the implementation of the Strengthening Routine Immunization in Consequential Areas of Niger State (STRICAN) initiative, which applied a precision immunisation approach to identify and reach previously unreached children. The model combined household-level enumeration, geographical information system-enabled microplanning through a digital Micro Coverage Tracking Tool and community-based mobilisation using Community Health Influencers, Promoters, and Services agents and local leadership structures. Across 10 local government areas, the initiative generated granular data on settlements and under-five children, enabling targeted service delivery through a mix of outreach, mobile and facility-based strategies. Vaccination activities were adapted in real time to contextual challenges, including insecurity, poor network connectivity and population displacement. This implementation experience highlights the importance of integrating digital tools with trusted community systems to improve identification, tracking and service delivery for zero-dose populations. Key lessons include the value of data-driven microplanning, flexible delivery strategies in fragile settings and strong partnerships between government and implementing actors. The STRICAN model offers practical insights for policymakers and programme implementers seeking to strengthen routine immunisation systems and reach underserved populations in similar contexts.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 10","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104294","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":"5-year survival rate and determinants of decreased survival among patients with breast cancer in Africa: a systematic review and meta-analysis.","authors":"Chalie Mulugeta, Tadele Emagneneh, Getinet Kumie, Assefa Sisay, Esuyawkal Mislu, Mulat Ayele, Aynalem Yetwale, Abebaw Alamrew","doi":"10.1136/bmjgh-2024-018721","DOIUrl":"10.1136/bmjgh-2024-018721","url":null,"abstract":"<p><strong>Introduction: </strong>Breast cancer is the most commonly diagnosed cancer among women worldwide and a leading cause of cancer-related mortality. Survival varies across regions, with most deaths occurring in low- and middle-income countries due to limited early detection and treatment access. This study aimed to estimate the 5-year survival rate and identify determinants of decreased survival among patients with breast cancer in Africa.</p><p><strong>Methods: </strong>A systematic review of only retrospective cohort studies was conducted using PubMed, Hinari, EMBASE, Google Scholar, African Journals Online, African Index Medicus and Web of Science. The literature search was conducted for a 1-month duration (1-30 November 2024). We included all available articles without restriction on publication date to ensure a comprehensive review. Methodological quality was assessed using the Newcastle-Ottawa 2016 Critical Appraisal Checklist. Publication bias was evaluated using funnel plots and Egger's test, and heterogeneity was assessed with the I² test. Data were analysed with Stata V.17.</p><p><strong>Results: </strong>55 articles with 19 577 participants from 19 countries were included; 37 studies (4622 participants) were used to estimate pooled 5-year survival. The pooled 5-year survival rate of patients with breast cancer in Africa was 40.38% (95% CI 33.92 to 46.83%). Reduced survival was strongly associated with tumour characteristics, including tumour stage >2 (HR 3.06, 95% CI 2.02 to 4.09), negative oestrogen receptor status (HR 2.52, 95% CI 1.89 to 3.15), tumour size >5 cm (HR 1.62, 95% CI 1.48 to 1.76), positive nodal status (HR 1.64, 95% CI 1.58 to 1.70) and higher histological grade (HR 1.26, 95% CI 1.22 to 1.29). Treatment-related factors such as single-agent chemotherapy (HR 1.78, 95% CI 1.04 to 2.53) and patient-related factors, including comorbidities (HR 1.45, 95% CI 1.40 to 1.50) and illiteracy (HR 6.54, 95% CI 4.39 to 8.69), were also associated with reduced survival.</p><p><strong>Conclusion: </strong>This study reveals a critically low 5-year survival rate of 40.4% for breast cancer in Africa. Poor survival is linked to advanced tumour features, suboptimal treatment and patient-related factors, with comorbidities and illiteracy being the strongest patient-related factors. These results highlight the urgent need for integrated strategies focused on early diagnosis, public education, equitable access to multimodal therapies and systematic management of comorbidities across the continent.</p><p><strong>Prospero registration number: </strong>CRD420261387399.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 10","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104259","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":"Assessment of the performance of primary healthcare in eight African countries: based on the Composite Fuzzy Index.","authors":"Xiaolong Hu, Maryam Zaid, Jinkou Zhao, Mufuta Tshimanga, Gasto Frumence, Dominic Nkhoma, Jiayan Huang","doi":"10.1136/bmjgh-2026-023653","DOIUrl":"10.1136/bmjgh-2026-023653","url":null,"abstract":"<p><strong>Background: </strong>African countries face a dual burden of infectious and non-communicable diseases, placing substantial pressure on primary healthcare (PHC) systems. Existing indicator-weighting approaches are limited in addressing redundancy and non-linear relationships. In addition, conventional composite indices often rely on linear aggregation assumptions that may not adequately reflect complex relationships among PHC performance indicators. This study proposes a novel weighting method and composite index to improve facility-level assessment of PHC performance.</p><p><strong>Methods: </strong>We analysed nationally representative healthcare facility data from Service Provision Assessments conducted in eight African countries (Ethiopia, the Democratic Republic of the Congo, Tanzania, Malawi, Kenya, Namibia, Rwanda and Uganda). Based on the Primary Health Care Performance Initiative framework, we constructed an indicator system comprising 34 indicators across five subdomains within the Service Delivery domain. Two composite indices were calculated: the Arithmetic Mean Index (AMI) and the Composite Fuzzy Index (CFI). AMI was derived using a simple arithmetic mean, while CFI employed a distance-based aggregation approach with indicator weights estimated using Multivariate Adaptive Regression Splines. The associations between the composite indices and patient-reported satisfaction were examined, with patient satisfaction calculated as a weighted average across surveyed patients.</p><p><strong>Findings: </strong>A total of 6921 facilities were included. Overall performance across indicators was low, with particularly poor scores observed in community engagement within the population health management subdomain (mean=0.08). AMI ranged from 0.238 to 0.806, and CFI ranged from 0.237 to 0.705. Facility-level CFI scores showed a positive association with patient satisfaction (Spearman's ρ=0.039, p<0.01; Kendall's τ=0.027, p<0.01), whereas AMI showed no significant association.</p><p><strong>Conclusion: </strong>PHC performance in African countries remains suboptimal across multiple dimensions. The proposed weighting and aggregation approach better captures inter-relationships among indicators and provides a more plausible assessment of PHC performance than traditional composite indices.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 10","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104291","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}