BMJ Global Health最新文献

{"title":"Optimising care for uncomplicated type 2 diabetes mellitus in Lagos, Nigeria: cost and benefit estimates using real-world data.","authors":"Martilord Ifeanyichi, Gloria P Gómez-Pérez, Bolanle Banigbe, Ibironke Dada, Adedamola A Dada, Emmanuella Zamba, Judith van Andel, Tobias F Rinke de Wit, Charlotte Dieteren","doi":"10.1136/bmjgh-2025-019477","DOIUrl":"10.1136/bmjgh-2025-019477","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes mellitus accounts for a significant share of morbidity and mortality in ages 30-70 years worldwide. In sub-Saharan Africa, diabetes care is often suboptimal for reasons ranging from health system weaknesses to patient illiteracy and non-compliance with recommendations. This study explores the potential costs and health benefits of optimising care for uncomplicated type 2 diabetes in Lagos State, Nigeria.</p><p><strong>Methods: </strong>Longitudinal data on medical care patterns and resource use (consultations, medications, diagnostics and lifestyle counselling) over a 1-year period were collected retrospectively from 84 health facilities in Lagos. Medical resource prices were obtained from a subsample of 26 facilities. Patient care gaps were assessed by comparing actual journeys to official diabetes management guidelines. Mixed-effect regression analyses were employed to explore the impact of care elements on blood glucose control and model the potential complications averted if all patients received recommended care, with extrapolation to the entire Lagos population.</p><p><strong>Results: </strong>Data from 642 patients with uncomplicated type 2 diabetes were analysed. A one-unit increase in consultation score (a measure of the adequacy of consultation visits) and having health insurance coverage were linked to 47-unit and 29-unit lower blood glucose levels, respectively. Optimising diabetes care requires US$3716 per patient annually, totalling US$2.1 billion statewide, with medications comprising 97% of costs. Enhanced care could reduce stroke and myocardial infarction by 2% (12 675 cases) and 4% (22 282 cases) over 7 years, respectively, at a cost of US$61 492 per complication averted.</p><p><strong>Conclusions: </strong>The investment required to optimise diabetes care in Lagos is currently unfeasible in the existing approaches. There is a need to explore innovative financing and delivery options, including digital value-based care interventions and cost-saving care approaches such as pooled medication procurement, while also investing in local medicines production capacity and expansion of the health insurance coverage.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833440","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":"Are parenting programmes effective at scale? Associations with violence against adolescent girls, parenting and mental health in real-world delivery across eight African countries: a meta-analysis of pre-post surveys.","authors":"Lucie Cluver, Catherine L Ward, Francesca Little, Inge Vallance, Genevieve Haupt Ronnie, Yulia Shenderovich, Hlengiwe Gwebu, Kufre Joseph Okop, Frances Gardner, Lindokuhle L Ngcobo, Mark Tomlinson, Daniel Oliver, Zuyi Fang, Natalie Davidson, Roselinde Janowski, Heiletjé Van Zyl, Anna Booij, Nyasha Manjengenja, Sibongile Tsoanyane, Muhubiri Kabuyaya, Mukondi Nethavhakone, Tendai Mutembedza, Alison Koler, Amon Exavery, Anne Schley, Charles Bibuya, Daisy Kisyombe, Esther Nydetabura, Farai Charasika, Gideon Mavise, Henry Mbuyi, Jack Ngangula, Jeldau Rieff, Joyce Wamoyi, Lisa Jamu, Nomsa Monare, Richard Savo, Samuel Bojo, Styn Jamu, Thomas Kipingili, Vengai MacGerald Mujuru, Jamie Lachman","doi":"10.1136/bmjgh-2025-020422","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-020422","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence-based parenting programmes are widely used to prevent violence against children and improve parenting and mental health. Despite hundreds of randomised trials, little is known about their outcomes when delivered at scale within routine delivery. This study assesses the WHO-endorsed and UNICEF-endorsed Parenting for Lifelong Health programme for caregivers and adolescents, delivered through non-governmental organisation and government in Botswana, the Democratic Republic of the Congo, Eswatini, South Africa, South Sudan, Tanzania, Zambia and Zimbabwe, with support from the President's Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID) and the European Union.</p><p><strong>Methods: </strong>Pre-post surveys for caregivers and adolescents were integrated into service data collection between 2016 and 2022. Abbreviated standardised measures of physical abuse, emotional abuse, approval of corporal punishment, positive involved parenting, monitoring/supervision, caregiver depressive symptoms, parenting stress and adolescent depressive symptoms and externalising behaviour were used. Individual country scores were analysed separately for caregivers and adolescents using generalised linear mixed-effects models, and cross-country data were combined using a random-effects meta-analytic model.</p><p><strong>Results: </strong>123 050 participants were included (93% retention, 57 908 adolescents (96% female), 56 423 caregivers at follow-up). In all-country meta-analyses, estimates showed reduced physical abuse (-65%; 95% CI 51% to 74%), emotional abuse (-59%; 95% CI 48% to 68%) and approval of corporal punishment (-55%; 95% CI 48% to 60%). Positive involved parenting increased (+52%; 95% CI 24% to 87%) and poor supervision/monitoring decreased (-48%; 95% CI 34% to 58%). Caregiver depressive symptoms (-25%; 95% CI 8% to 48%), parenting stress (-46%; 95% CI 41% to 52%), adolescent depressive symptoms (-22%; 95% CI 1% to 38%) and adolescent externalising behaviour problems (-43%; 95% CI 29% to 54%) all declined. There was heterogeneity in pre-intervention scores and extent of change between humanitarian and development settings, and between different target groups, but strong consistency across caregiver and adolescent reports.</p><p><strong>Conclusion: </strong>In eight African countries, including humanitarian and pandemic-affected contexts, an evidence-based parenting programme showed consistent associations with reduced violence against adolescent girls and improved parenting and mental health.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833423","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":"Whose crisis is it? Local experiences and health governance in the era of polycrisis.","authors":"Jacinta Mwikali Nzinga, Maryse Kok, Joanna Raven, Miriam Taegtmeyer","doi":"10.1136/bmjgh-2026-023610","DOIUrl":"10.1136/bmjgh-2026-023610","url":null,"abstract":"<p><p>The concept of polycrisis has gained traction to describe the interconnected shocks-pandemics, climate-related disasters, conflict and economic instability-shaping global risk. Yet for many communities in low-income settings, such entanglements are not new but reflect long-standing conditions of permacrisis. We advance a situated perspective that examines how global shocks intersect with pre-existing local vulnerabilities, drawing on examples from Somalia, northern Kenya, Zimbabwe and Lebanon. These cases show that crises are experienced unevenly and simultaneously across systems of food, water, livelihoods, health and security, raising the question: whose crisis is it?We argue that responding to polycrisis requires moving beyond siloed notions of 'health systems' towards integrated systems for health, supported by multisectoral governance at national and especially local levels. Practical components include shared early-warning triggers, clear cross-sector roles, flexible local financing and co-produced planning with communities. For research, this perspective redirects attention to how interconnected systems shape risk, resilience and equity, and how coordinated arrangements can be designed, tested and strengthened. A systems-for-health approach offers a more realistic and context-grounded pathway for navigating overlapping crises in settings where disruptions have become the norm.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833369","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":"Sustainable surgical financing through philanthropy: an analysis of contributions to low- and middle-income countries (LMICs).","authors":"Dawn Celine Siaw Chern Poh, Nardos Getachew Bulfeta, Ruben Ayala, David Barash, Simon Fabry, Gabriella Yael Hyman, Walter D Johnson, Piper Tingleaf, Kee B Park","doi":"10.1136/bmjgh-2025-021114","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-021114","url":null,"abstract":"<p><strong>Background: </strong>Surgery is an indispensable component of a health system, yet financing its delivery faces significant financing challenges. This study seeks to address the research question: What is the financial contribution of philanthropy to the delivery of surgical care in low and middle-income countries (LMICs)?</p><p><strong>Methodology: </strong>This study combines a qualitative and a quantitative component to examine the magnitude of philanthropic contributions in surgical care. The qualitative analysis is composed of a narrative review of peer-reviewed and gray literature that was conducted and synthesised through thematic analysis to identify patterns of philanthropic engagement. To quantify philanthropic contributions, a cross-sectional analysis was employed by using the Organization for Economic Cooperation and Development Creditor Reporting System, to identify philanthropic funding for surgical projects between 2014 and 2022.</p><p><strong>Results: </strong>Four thematic domains were identified from the narrative review: (1) an overview of philanthropy, highlighting its role in filling critical funding gaps in financing health systems; (2) the modes of engagement in philanthropic giving, including partnerships with multilateral organisations, corporate social responsibility, domestic philanthropy, crowdfunding and remittances; (3) recipient channels such as non-profit, non-government organisations, faith-based organisations, non-profit private hospitals and academic institutions who more often contribute to surgical service delivery, research and capacity building; (4) facilitators include flexibility and risk tolerance, contrasted by barriers such as weak policy environments and donor dependency. Quantitatively, 10 philanthropic organisations collectively funded a total of $124.8 million to surgical care from 2014 to 2022. East Asia and the Pacific received the largest share totalling $38.02 million (30.5%). Pediatric surgery received the most amount of funding at $49.07 million (39.3%), with 95.3% contributed by the UBS Optimus Foundation.</p><p><strong>Conclusion: </strong>Global surgery remains chronically underfunded despite its substantial burden of disease. Amid shifting financial aid landscapes, renewed philanthropic investment in global surgery is urgent. Philanthropy often focuses resources where perceived need is greatest. Although modest in scale, it has the potential to seed and catalyse surgical systems, advancing the expansion of access to surgical care in LMICs.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 Suppl 2","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833173","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":"Fragmented geographies and trauma pathways in the Middle East.","authors":"Mac Skelton, Ghassan Abu Sittah, Zahi Abdul Sater, Anas Ismail, Hannah B Wild, Rasheed M Fakhri, Gemma Bowsher, Richard Sullivan, Craig Jones","doi":"10.1136/bmjgh-2025-021217","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-021217","url":null,"abstract":"<p><p>Enduring and interlocking conflicts across the Middle East over the last 25 years have generated injuries on a large scale. While civilian injuries in the region have been widely documented, very little is known about civilian trauma pathways-the system designed to manage patients from the moment of injury through to rehabilitation. Military trauma pathways are premised on rapid evacuation, coordinated referral and timely access to treatment, but replicating these systems for civilians, under conditions of active and ongoing conflict, presents many challenges. Civilians can be injured almost anywhere-far away from hospitals, without access to ambulances, emergency and other services-and in absence of a clear trauma pathway, their care trajectory in the weeks and years after sustaining injury is highly inequitable and geographically fragmented. This analysis examines some of the problems posed by the geographical fragmentation of civilian trauma pathways and reflects on what might be done to rebuild and improve them.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833403","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":"Cost-effectiveness of in-kind nutritional support for impoverished persons with tuberculosis to reduce mortality and disengagement from care in India: a modelling study.","authors":"Julia Gallini, Urvashi B Singh, Madolyn Dauphinais, Sonali Sarkar, Madeline Carwile, Rakesh Kumar, Raghuram Rao, Aparna Chaudhary, C Finn McQuaid, Kimberly Maloomian, Srishti Sinha, Saurabh Mehta, David W Dowdy, Anne F Liu, Benjamin P Linas, C Robert Horsburgh, Laura F White, Pranay Sinha","doi":"10.1136/bmjgh-2025-020335","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-020335","url":null,"abstract":"<p><strong>Background: </strong>Undernutrition is a leading risk factor for tuberculosis (TB) mortality and poor treatment outcomes. We evaluated the cost-effectiveness of providing in-kind nutritional support to impoverished persons with TB (PWTB) in India.</p><p><strong>Methods: </strong>We developed a Markov model comparing standard care with a household-level nutritional food-basket intervention. Model parameters were informed from systematic reviews and a recent cluster-randomised study. We estimated TB mortality, disability-adjusted life years (DALYs) and costs from the healthcare perspective. We calculated incremental cost-effectiveness ratios (ICERs), and parameter uncertainty was quantified through deterministic and probabilistic sensitivity analyses. We estimated uncertainty intervals (UIs) with 10 000 Monte Carlo iterations.</p><p><strong>Findings: </strong>Nutritional support was projected to avert 10 470 DALYs per 10 000 PWTB (95% UI 1 775 to 33 255). When scaled to India's 2.8 million annual TB cases, this corresponds to approximately 120 120 TB deaths averted nationwide (95% UI 60 760 to 162 960) under full coverage. The ICER was US$141 per DALY averted (95% UI US$44 to 836). The ICER was most sensitive to the mortality reduction achieved through nutritional support but remained below India's willingness-to-pay threshold (US$550 per DALY averted) as long as the intervention achieved at least a 13% relative reduction in mortality. Nutritional support was cost-effective in 94% of simulations.</p><p><strong>Interpretation: </strong>In-kind nutritional support for PWTB is highly cost-effective and could substantially reduce TB mortality and disengagement from care. Scaling up such interventions could meaningfully improve TB outcomes nationwide and accelerate progress towards the end TB strategy targets.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833391","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":"Transforming reproductive healthcare delivery through telemedicine services expansion: evidence from a mixed-methods pilot evaluation in rural Ghana.","authors":"Ernest Afriyie Owusu, Matthea Roemer, Ernestina Monney, Prince Dugbazah, Ellis Nutifafa Attah, George Akanlu, Chris Fofie","doi":"10.1136/bmjgh-2024-018762","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-018762","url":null,"abstract":"<p><strong>Background: </strong>In 2021, Ghana's National Comprehensive Abortion Care Standards and Protocols recognised telemedicine as an approved delivery model for early medical abortion (EMA). Following a successful pilot in Accra, MSI Reproductive Choices Ghana expanded their telemedicine model to more rural areas and broadened their package of sexual and reproductive health (SRH) services to include fertility evaluation. This study evaluates the expanded model.</p><p><strong>Methods: </strong>A mixed-methods evaluation (January 2024 to March 2025) drew on routine clinical data, courier and call centre tracking, client feedback surveys, and qualitative, individual in-depth interviews with telemedicine clients to assess clinical safety, service utilisation and user experience. Quantitative analysis included descriptive statistics and unadjusted logistic and ordinal regression. Qualitative interviews with clients explored feasibility, acceptability and implementation challenges. A deductive, thematic analysis was conducted with the support of Delve qualitative research software and guided by the Consolidated Framework for Implementation Research.</p><p><strong>Results: </strong>A total of 2721 clients accessed telemedicine services, with 70.0% receiving EMA and 29.5% short-term contraceptive methods. Among EMA clients reached for follow-up, 96.9% reported complete abortion with no further intervention. Satisfaction was high: 89.4% would recommend the service, and 78.2% would use it again. Qualitative findings highlighted that clients valued privacy, convenience and autonomy, particularly in stigmatised or crowded spaces. Barriers to accessing services included unclear eligibility criteria, limited digital access and misperceptions that the service was for abortion only. Most clients contacted the service between 4 and 6 weeks' gestation. Post-abortion contraception uptake was 24.8%, with no significant variation by age or location. Nearly half of clients reported having no other way to access care.</p><p><strong>Conclusions: </strong>Telemedicine is a feasible, safe and acceptable model for SRH delivery in Ghana. Findings will inform national scale-up and strategies to strengthen equity, communication and service integration.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 6","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833162","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":"The need to strengthen Australian health and social policy to support survivors of the Stolen Generations.","authors":"Shakeel Mahmood, Colin MacDougall, Phil Naden, Subash Thapa, Peter Gibbs, Anayochukwu E Anyasodor, Kedir Ahmed, M Mamun Huda, Damien Little, Feleke H Astawesegn, Allen G Ross","doi":"10.1136/bmjgh-2025-018903","DOIUrl":"10.1136/bmjgh-2025-018903","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811171","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":"Climate, geography and socioeconomic vulnerability and emergency care accessibility in Nepal, 2022: a high-resolution geospatial analysis of inequalities.","authors":"Aldina Mesic, Andrea Davis, Carlos Ochoa, Shyam Sundar Budhathoki, Raslina Shrestha, Barclay T Stewart, Christopher Millett, Thomas Hone","doi":"10.1136/bmjgh-2025-021150","DOIUrl":"10.1136/bmjgh-2025-021150","url":null,"abstract":"<p><strong>Background: </strong>Strengthening emergency care systems could reduce death and disability in low- and middle-income countries (LMICs), yet many struggle to provide timely, high-quality care. LMICs also face growing risks from climate-related shocks and mass casualty events. This study identifies unmet emergency care needs in Nepal-one of the world's most climate-vulnerable countries-using high-resolution geospatial data to estimate socioeconomic and climate-related inequalities.</p><p><strong>Methods: </strong>We conducted a cross-sectional geospatial analysis using data from the 2022 Nepal Demographic and Health Survey (DHS), the 2021 DHS Service Provision Assessment and publicly available climate vulnerability data. Government hospitals were classified into three emergency care levels using World Health Organzation criteria: A (basic 24-hour services), B (A plus resuscitative capabilities) and C (B plus ≥50 beds and a surgeon). Household location and injury data were obtained from the DHS. Accessibility was defined as the proportion of the population within 1-hour and 2-hour travel times, estimated using AccessMod 5.8, incorporating road networks, rivers, land cover and elevation.</p><p><strong>Findings: </strong>Most public hospitals (77.7%) met Level A criteria but only 49.3% met Level B and 10.8% met Level C. Nationally, 78.7% of households had 1-hour access to Level A care, 71.8% to Level B and 44.6% to Level C. Adjusted logistic regression showed rural, poorer and climate-vulnerable households had significantly lower 1-hour access compared with urban households, rural households had lower odds of access: Level A OR: 0.33 (95%CI 0.30 to 0.37), Level B OR: 0.33 (95%CI 0.30 to 0.36), Level C OR: 0.56 (95%CI 0.51 to 0.61). Households in high climate vulnerability areas had reduced access across all levels.</p><p><strong>Conclusions: </strong>Substantial gaps and inequities in timely access to high-quality emergency care exist in Nepal. Rural, poorer and climate-vulnerable populations experience markedly lower access. Targeted, decentralised strengthening of emergency care capacity is essential both in Nepal and in other LMICs facing similar constraints.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 4","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811199","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":"Aid withdrawal: an event study of mortality, vaccine coverage and DALY following transitioning from Gavi support.","authors":"Kit Ming Isabel Yan, Jinfeng Liu, Ishwara Hegde, Eran Bendavid","doi":"10.1136/bmjgh-2025-020781","DOIUrl":"10.1136/bmjgh-2025-020781","url":null,"abstract":"<p><p>This study investigates the health impacts of transitioning from Gavi, the Vaccine Alliance, on vaccination coverage, infant and under-5 mortality, and disability-adjusted life years (DALYs) in low and middle-income countries between 2000 and 2021. As Gavi plays a critical role in supporting immunisation programmes for some of the world's most vulnerable populations, understanding the consequences of funding withdrawal is vital for ensuring the sustainability of health gains. Using a quasi-experimental event study design, we leverage Gavi's eligibility criteria and transition policy to compare countries phasing out of Gavi support with those continuing to receive assistance. Our analysis reveals significant short-term and medium-term negative effects of reduced Gavi support: the prevalence of children receiving no basic vaccines increased by 1.94 percentage points, infant mortality rose by 7.59 per 1000 live births, and under-5 mortality increased by 17.31 per 1000 live births. DALYs also rose by 1264 units per 100 000 population, with the most pronounced effects occurring during the accelerated transition phase. Although these adverse effects diminish several years after the transition, our findings provide robust evidence of the heightened vulnerability of health systems during the withdrawal of external aid. This study contributes to the literature by quantifying the health impacts of Gavi's transition process and underscores the need for strengthening transition policies. Policymakers should consider a more gradual and tailored approach to aid withdrawal to ensure the continuity of critical health services and protect long-term health outcomes in transitioning countries.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 4","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811153","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}