BMJ Global Health最新文献

{"title":"Profit over woman-centred care? A commentary on drivers of high rates of caesarean birth in Indonesia.","authors":"Rana Islamiah Zahroh, Ana Pilar Betrán, Alya Hazfiarini, Marc Cheong, Fitriana Murriya Ekawati, Ova Emilia, Caroline Homer, Meghan A Bohren","doi":"10.1136/bmjgh-2026-023873","DOIUrl":"https://doi.org/10.1136/bmjgh-2026-023873","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 10","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health economic evaluation of hip fracture care pathways in The Gambia.","authors":"Nyashadzaishe Mafirakureva, Kebba S Marenah, Anya Burton, Tafadzwa Madanhire, Hannah Wilson, Momodou K Jallow, Awa Touray, Lucy Gates, Bintou Trawally, Simon Matthew Graham, James Masters, Matthew L Costa, Kate A Ward, Celia L Gregson, Sian M Noble","doi":"10.1136/bmjgh-2025-022219","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-022219","url":null,"abstract":"<p><p>Hip fractures cause substantial morbidity, mortality and healthcare costs among older adults. While advances in surgical and postoperative care have improved outcomes in high-income countries, these interventions are often inaccessible in low-income and middle-income countries due to cost constraints. This study assessed the costs and outcomes of surgical versus non-surgical management of hip fractures to inform resource allocation in a resource-limited setting. Data from a prospective cohort study of patients with acute hip fractures over a 12-month postfracture follow-up period were used. Outcomes included quality-adjusted life years (QALYs), healthcare resource use and costs in 2024 US$. Differences in costs and QALYs were estimated using multivariable regression analysis, while a range of sensitivity analyses assessed the impact of different assumptions. The analysis included 137 patients with a mean age of 70 years (SD: 13.4); 60% (n=82) were female and 81.8% (n=112) had fragility fractures. Fewer than half (47%, n=64) had surgery. Surgical management incurred US$988 higher costs (95% CI US$843 to US$1132) and generated 0.122 additional QALYs (95% CI -0.034 to 0.277) compared with non-surgical care, yielding an incremental cost-effectiveness ratio (ICER) of US$8117 per QALY gained. The probability of surgery being cost-effective exceeded 50% at willingness-to-pay thresholds of US$8200 per QALY gained or higher. The results were sensitive to surgical timing: operating within 3 days of admission more than doubled health gains to 0.247 QALYs (95% CI 0.056 to 0.439) and reduced the ICER to $4974 per QALY gained compared with no surgery. In this resource-limited setting, surgical management of hip fractures is more expensive but delivers clinically meaningful benefit for patients; a gain of 0.12 QALYs per patient translating to an extra 44 days in good health. Health systems in resource-limited settings should prioritise expanding surgical access while optimising early intervention and postoperative care to maximise benefits.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104240","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":"Care under attack: a qualitative study of healthcare system disruption and health worker resilience during airstrikes on Lebanon.","authors":"Samar Al-Hajj, Rakan Nassereldine, Noor Srour, Michelle E Bauer, Danielle Poole, Ibrahim Issa, Rami Zurayk, Hani Mowafi","doi":"10.1136/bmjgh-2026-025384","DOIUrl":"10.1136/bmjgh-2026-025384","url":null,"abstract":"<p><strong>Introduction: </strong>War severely disrupts healthcare systems by damaging infrastructure, limiting access to care and placing healthcare workers (HCWs) at physical and psychological risk. During the 2024 Israeli war on Lebanon, repeated airstrikes created major challenges for healthcare delivery. This study explored HCWs' experiences and examined the impact of conflict on healthcare system functioning and service continuity.</p><p><strong>Methods: </strong>A qualitative study was conducted using semi-structured interviews with 19 HCWs involved in emergency response and patient care, including nurses, paramedics and ambulance staff affected during the conflict. Data were analysed using reflexive thematic analysis informed by a critical health systems framework.</p><p><strong>Results: </strong>Two overarching themes emerged: (1) operational disruption and failures in preparedness and accountability and (2) workforce resilience and professional commitment during crisis. Participants described attacks on healthcare facilities, ambulances and infrastructure that disrupted services, caused shortages of staff and medical supplies and reduced access to care. HCWs described a substantial psychological toll, including fear, anxiety, burnout and emotional exhaustion, alongside moral distress arising from having to weigh patient care against their own safety and from being unable to provide the standard of care they were committed to. Despite these conditions, participants demonstrated resilience through teamwork, rapid adaptation and strong professional dedication, helping sustain essential healthcare services during the conflict.</p><p><strong>Conclusions: </strong>The findings highlight the vulnerability and resilience of healthcare systems in conflict settings, as well as the considerable psychological and moral burden borne by HCWs. Strengthening emergency preparedness, protecting HCWs and facilities and improving accountability for attacks on healthcare are essential to maintaining healthcare delivery and safeguarding workforce well-being during armed conflict.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104221","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":"Beyond resilience frontline healthcare workers and structural fragility in African epidemic response.","authors":"Oluwaseun Ayoola Ojomo, Tayechalem Moges, Corrado Cancedda, Philip Cotton","doi":"10.1136/bmjgh-2026-025630","DOIUrl":"https://doi.org/10.1136/bmjgh-2026-025630","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104299","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":"Wings of access: a cluster RCT on drone-based medical commodity delivery in remote Madagascar.","authors":"Katherine Tumlinson, Andry Rabemanantsoa, Sandrah Rahantanirina, Kanto Jude Ramanamahefa, Erica Felker-Kantor, Daniel Crapper, Eunice Kioko, Emilia Goland, Stephanie R Chung, Brooke W Bullington, Sean Sylvia, Tara Templin","doi":"10.1136/bmjgh-2025-021965","DOIUrl":"10.1136/bmjgh-2025-021965","url":null,"abstract":"<p><strong>Background: </strong>Stockouts of essential medicines remain a persistent challenge across the Global South, undermining healthcare access. Unmanned aerial vehicles or drones have emerged as a promising solution to improve delivery.</p><p><strong>Methods: </strong>We implemented a two-arm cluster randomised trial in eastern Madagascar. Hard-to-reach public-sector facilities were randomised to drone delivery or standard land-based delivery of medical commodities. Preintervention and postintervention data included audits, provider and client interviews and population-based surveys of reproductive-age women. Our primary outcomes were (1) current modern contraceptive use and (2) the probability of stockouts. Secondary outcomes included aligned and preferred contraceptive use, vaccine and malaria outcomes and perceived quality. For each outcome, we compared intervention and control clusters using analysis of covariance (ANCOVA) regressions. Facilities randomised to drone delivery received continuous service from September 2023 to October 2024; outcomes were measured at baseline (June-August 2023) and endline (October 2024-March 2025).</p><p><strong>Results: </strong>Between June and August 2023, 109 facilities were randomised to drone intervention (n=55) or control (n=54). Within the corresponding communities, a representative sample of 1199 reproductive-age women (n=605 treatment, 594 control) completed a baseline survey. In primary ANCOVA analyses, drone delivery had no measurable impact on current modern contraceptive use, stockouts of most commodities, malaria rapid diagnostic test stockouts or most client-reported quality measures. Supporting difference-in-difference analyses suggested possible reductions in malaria rapid diagnostic test stockouts and modest improvements in aligned and preferred contraceptive use, but these findings were not consistently replicated in the primary specification.</p><p><strong>Conclusion: </strong>In this cluster randomised trial, drone delivery did not measurably improve most stockout, service readiness, utilisation or client-reported quality outcomes. These findings suggest that drone delivery alone may be insufficient to improve commodity availability where upstream supply-chain constraints remain binding. Prior estimates of drone impact across a broad range of supplies may have been inflated by methodological limitations. Rigorousstudies in additional settings are needed before further integration of drones into national health systems in the Global South.</p><p><strong>Trial registration number: </strong>AEARCTR-0011710.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13636326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079815","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":"From research <i>on</i> to research <i>with</i>: a bottom-up participatory approach for setting research agenda at a rural health research unit.","authors":"Anoop C Choolayil, Vijesh Sreedhar Kuttiatt, Manju Rahi","doi":"10.1136/bmjgh-2025-019341","DOIUrl":"10.1136/bmjgh-2025-019341","url":null,"abstract":"<p><p>Public health research often relies on top-down approaches that do not adequately address local needs or engage end-users as active participants. This article narrates the implementation of a bottom-up health research approach at the Model Rural Health Research Unit (MRHRU) in Puducherry, India, aimed at prioritising community participation in health research. The model leverages a participatory approach to integrate local stakeholders into the research process. The study outlines a structured, democratic process for stakeholder engagement, beginning with the identification and network-building of stakeholders and progressing through collaborative brainstorming, priority setting and project development. By aligning research initiatives with these 'felt needs', the MRHRU facilitates relevant and impactful health interventions. This approach, while grounded in the local context, provides a model for setting health priorities based on community perceptions, adaptable to other regions and settings, underscoring the benefits of participatory health research in eliminating health disparities and achieving health equity.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079760","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":"How mistrust emerged in real time in the Bundibugyo virus disease outbreak: 'Ebola business', social media and the history of mistrust in Ebola epidemics in eastern Congo.","authors":"Sung Joon Park, Vinh-Kim Nguyen, Freddy Lorima Dz'bo, Emmanuel Bachweki Basia, Kennedy Muhindo Wema, Gloire Mumbesa, Martin Doevenspeck, Jules Villa, Nene Morisho Mwanabiningo","doi":"10.1136/bmjgh-2026-025522","DOIUrl":"10.1136/bmjgh-2026-025522","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global challenges and perspectives in acute and emergency general surgery in low and middle-income countries: a scoping review.","authors":"Mahmoud Diaa Hindawi, Arda Isik, Fausto Rosa, Diego Visconti, Taras Nechay, Sharfuddin Chowdhury, Abdourahmane Ndong, Tushar S Mishra, Stefano Piero Bernardo Cioffi, Abd-Elfattah Kalmoush, Francesco Piscioneri, Walter L Biffl, Edward C T H Tan","doi":"10.1136/bmjgh-2025-021056","DOIUrl":"10.1136/bmjgh-2025-021056","url":null,"abstract":"<p><strong>Background: </strong>Acute and emergency general surgery in low and middle-income countries (LMICs) faces critical disparities. Despite global and regional initiatives, surgical inequities persist due to fragile healthcare infrastructure, workforce shortages and insufficient policy integration. This study explores the systemic challenges and perspectives in acute and emergency surgical care in LMICs while evaluating global efforts to bridge these gaps.</p><p><strong>Methods: </strong>We searched seven databases from inception to 26 November 2024, with an updated search through 12 June 2025. Records were screened in duplicate according to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidance, and included studies were charted across major health-system domains, including workforce/training, infrastructure, prehospital and emergency response systems, financing, governance/policy and regional capacity-building initiatives.</p><p><strong>Results: </strong>A total of 160 studies were included. The evidence was geographically diverse and was mapped across overlapping thematic domains rather than assigned to single mutually exclusive categories because many studies addressed more than one health-system component. The main recurrent domains were workforce shortages and training gaps, infrastructure andIntensive Care Unit limitations, fragmented prehospital and emergency response systems, financial barriers, weak policy enforcement and emerging capacity-building strategies. Across these domains, access to timely, safe and affordable acute and emergency surgical care remained limited, particularly in rural and underserved LMIC settings.</p><p><strong>Conclusion: </strong>While international efforts have made progress, more attention is needed on locally driven solutions, structured training and broader healthcare system investment. The next step is conducting multicentre surveys to identify key challenges and create evidence-based protocols. Future research should focus on context-specific solutions, innovative funding and scalable strategies to strengthen surgical care. This study is a first step in identifying challenges for future policies aimed at ensuring universal access to safe, timely surgical care in LMICs.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073544","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 2026 Ebola outbreak and the politics of forgetting: why global health keeps relearning the same lessons.","authors":"Justin Onyebuchi Nwofe, Dickson Adeolu Adetoye, Kingsley Chukwuemeka Onugwu, Femi Emmanuel Owolagba, Daniel Chinenyeike Offie, Babatope O Adebiyi","doi":"10.1136/bmjgh-2026-025747","DOIUrl":"10.1136/bmjgh-2026-025747","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073457","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":"Eliminating 'slum' from urban health research.","authors":"Achsah Dorsey","doi":"10.1136/bmjgh-2024-018609","DOIUrl":"10.1136/bmjgh-2024-018609","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073488","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}