BMJ Global Health最新文献

{"title":"Research agenda for ending preventable maternal deaths from postpartum haemorrhage: a WHO research prioritisation exercise.","authors":"Caitlin R Williams, Guervan Adnet, Ioannis D Gallos, Arri Coomarasamy, Ahmet Metin Gülmezoglu, Md Asiful Islam, Sara Rushwan, Mariana Widmer, Fernando Althabe, Olufemi T Oladapo","doi":"10.1136/bmjgh-2024-015342","DOIUrl":"10.1136/bmjgh-2024-015342","url":null,"abstract":"<p><strong>Introduction: </strong>Postpartum haemorrhage (PPH) remains the leading cause of maternal death. Yet there is a lack of clarity around what research is needed to determine what works and how best to deliver proven PPH interventions. This article describes a WHO-led effort to develop a global PPH research agenda for 2023-2030, to reinvigorate research and innovation while avoiding duplication and waste.</p><p><strong>Methods: </strong>Potential questions were culled from evidence gaps in a forthcoming Lancet PPH series, a pipeline analysis on PPH medicines and devices, international PPH guidelines, previous research prioritisation efforts and submissions from a reference group of PPH experts and stakeholders. Questions were deduplicated and consolidated, categorised into three tracks (innovation, implementation and cross-cutting) and subjected to an online prioritisation survey. Survey participants (n=120) assessed these questions using five criteria (answerability, effectiveness, deliverability, maximum potential for disease burden reduction and equity) following the Child Health and Nutrition Research Initiative methodology. The outcome of this exercise was complemented by an in-person consensus meeting (Global PPH Summit from 7 March 2023 to 10 March 2023 in Dubai, United Arab Emirates) to finalise the research agenda.</p><p><strong>Results: </strong>Fifteen research questions (five per track) were identified as top priority. The top question per track called for research on the comparative effectiveness and safety of alternative routes of administration (other than the intravenous route) of tranexamic acid in the treatment of PPH (innovation); identifying barriers and facilitators affecting the adoption and use of evidence-based recommendations for PPH management (implementation) and the effectiveness of a strategy of early detection and first response treatment using a bundle of recommended interventions for improving PPH-related outcomes (cross-cutting).</p><p><strong>Conclusion: </strong>This shared research agenda should guide future investments into PPH studies with high potential to transform policy and clinical practice in the near term to medium term. Funding for the new research priorities is urgently needed.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 11","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603347","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":"Strengthening health systems through surgery.","authors":"Dion G Morton, Abdul Ghaffar","doi":"10.1136/bmjgh-2024-017782","DOIUrl":"10.1136/bmjgh-2024-017782","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 Suppl 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603351","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":"Environmentally sustainable surgical systems.","authors":"Virginia Ledda, Adewale Adisa, Fareeda Agyei, Lucy Caton, Christina George, Abdul Ghaffar, Dhruva Ghosh, Nadine Hachach-Haram, Parvez David Haque, J C Allen Ingabire, Laura Kudrna, Elizabeth Li, Craig McClain, Dmitri Nepogodiev, Faustin Ntirenganya, Mark G Shrime, Iestyn Williams, Aneel Bhangu","doi":"10.1136/bmjgh-2024-015066","DOIUrl":"10.1136/bmjgh-2024-015066","url":null,"abstract":"<p><p>Surgeons, anaesthetists, wider surgical teams and hospital managers are a large global group that has the capacity and power to play a leadership role to contribute to change. Hospitals are a good target for improvement since they are centres of communities, linking together surrounding healthcare facilities and influencing wider determinants of the environment. District and rural hospitals are good sites to start since they serve large populations, have the least sustained energy and clean water supplies and will benefit most from quality improvement. Within hospitals, surgeons and surgical pathways are the ideal places to start decarbonising healthcare. Surgery is a high-resource activity, but it focuses on one patient at a time, allowing measures to be introduced, and their effects closely monitored. Through a mass movement, surgical teams should be able to influence policy-makers for healthcare and industry supply chains, amplifying their effect. This article describes how we can make personal, professional and organisational changes to start creating impact. Change can be hard, especially in healthcare, so this new community needs to blend carbon literacy and behavioural change techniques for success. The article is focused on the front-line team and written by clinician experts in behavioural change and sustainable practice. As such, it will not tackle the technicalities of sustainability and carbon accounting. It intends to challenge individual readers to start making changes now, and to challenge systems leaders to start making larger-scale changes urgently.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 Suppl 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603349","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":"Structures, processes and outcomes between first referral and referral hospitals in low-income and middle-income countries: a secondary preplanned analysis of the FALCON and ChEETAh randomised trials.","authors":"Sivesh Kathir Kamarajah, Philip Alexander","doi":"10.1136/bmjgh-2024-015599","DOIUrl":"10.1136/bmjgh-2024-015599","url":null,"abstract":"<p><p>First referral hospitals, often known as district hospitals, are neglected in the discourse on universal health coverage in low-income and middle-income countries (LMICs). However, these hospitals are important for delivering safe surgery for 313 million people. This study aims to understand the structures, processes and outcomes of patients undergoing surgery in these centres in LMICs. This is a preplanned secondary analysis using data from two high-quality randomised controlled trials undergoing major abdominal surgery across six LMICs. Type of hospital was the main explanatory variable, defined according to the WHO taxonomy as first referral (ie, district or rural) and referral (ie, secondary or tertiary). Of the included 15 657 patients across 80 hospitals from 6 countries, 3562 patients underwent surgery in first referral and 12 149 patients underwent surgery in referral centres. First referral centres have lower full-time surgeons (median: 1 vs 20, p<0.001) and medically trained anaesthetists (28.6% vs 87.1%, p<0.001) compared with referral centres. Patients undergoing surgery in first referral centres were more likely to have lower rates of American Society of Anaesthesiologist (ASA) grades III-V (8.1% vs 22.7%, p<0.001), but higher rates of emergency procedures (65.1% vs 56.6%, p<0.001). In first referral centres, there was a significantly higher use of WHO surgical safety checklist (99.4% vs 93.3%, p<0.001) compared with referral centres. In adjusted analyses, there were no differences in 30-day mortality (OR 1.09, 95% CI 0.73 to 1.62) and surgical site infection (OR 1.30, 95% CI 0.89 to 1.90) between first referral and referral centres. Postoperative mortality and surgical site infection remain similar between first referral and referral centres in LMICs. There may be a clear need to upscale surgical volume safely in first referral centres to meet global surgical needs. High-quality research is needed to drive safe expansion of surgical workforce and strengthen referral pathways within these surgical health systems in LMICs.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 Suppl 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603353","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":"Building resilient surgical systems that can withstand external shocks.","authors":"James C Glasbey, Adesoji O Ademuyiwa, Kathryn Chu, Anna Dare, Ewen Harrison, Peter Hutchinson, Gabriella Hyman, Ismail Lawani, Janet Martin, Laura Martinez, John Meara, K Srinath Reddy, Richard Sullivan","doi":"10.1136/bmjgh-2024-015280","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-015280","url":null,"abstract":"<p><p>When surgical systems fail, there is the major collateral impact on patients, society and economies. While short-term impact on patient outcomes during periods of high system stress is easy to measure, the long-term repercussions of global crises are harder to quantify and require modelling studies with inherent uncertainty. When external stressors such as high-threat infectious disease, forced migration or climate-change-related events occur, there is a resulting surge in healthcare demand. This, directly and indirectly, affects perioperative pathways, increasing pressure on emergency, critical and operative care areas. While different stressors have different effects on healthcare systems, they share the common feature of exposing the weakest areas, at which point care pathways breakdown. Surgery has been identified as a highly vulnerable area for early failure. Despite efforts by the WHO to improve preparedness in the wake of the SARS-CoV-2 pandemic, measurement of healthcare investment and surgical preparedness metrics suggests that surgical care is not yet being prioritised by policy-makers. Investment in the 'response' phase of health system recovery without investment in the 'readiness' phase will not mitigate long-term health effects for patients as new stressors arise. This analysis aims to explore how surgical preparedness can be measured, identify emerging threats and explore their potential impact on surgical services. Finally, it aims to highlight the role of high-quality research in developing resilient surgical systems.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 Suppl 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603348","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":"Health systems strengthening through surgical and perioperative care pathways: a changing paradigm.","authors":"Sivesh Kamarajah, Adesoji O Ademuyiwa, Rifat Atun, Alarcos Cieza, Fareeda Agyei, Dhruva Ghosh, Jaymie Claire Ang Henry, Souliath Lawani, John Meara, Ben Morton, Kee B Park, Dion G Morton, Teri Reynolds, Abdul Ghaffar","doi":"10.1136/bmjgh-2024-015058","DOIUrl":"10.1136/bmjgh-2024-015058","url":null,"abstract":"<p><p>Global health has traditionally focused on the primary health development with disease-specific focus such as HIV, malaria and non-communicable diseases (NCDs). As such, surgery has traditionally been neglected in global health as investment in them is often expensive, relative to these other priorities. Therefore, efforts to improve surgical care have remained on the periphery of initiatives in health system strengthening. However, today, many would argue that global health should focus on universal health coverage with primary health and surgery and perioperative care integrated as a part of this. In this article, we discuss the past developments and future-looking solutions on how surgery can contribute to the delivery of effective and equitable healthcare across the world. These include bidirectional integration of surgical and chronic disease pathways and better understanding financing initiatives. Specifically, we focus on access to safe elective and emergency surgery for NCDs and an integrated approach towards the rising multimorbidity from chronic disease in the population. Underpinning these, data-driven solutions from high-quality research from clinical trials and cohort studies through established surgical research networks are needed. Although challenges will remain around financing, we propose that development of surgical services will strengthen and improve performance of whole health systems and contribute to improvement in population health across the world.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 Suppl 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603350","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":"Shifting official development assistance during COVID-19: earmarking, donor concentration and loans.","authors":"Liana Woskie, Clare Wenham","doi":"10.1136/bmjgh-2024-015527","DOIUrl":"10.1136/bmjgh-2024-015527","url":null,"abstract":"<p><strong>Context: </strong>In contrast to bilateral aid, aid disbursed from multilateral institutions increased significantly at the onset of the COVID-19 pandemic. Yet, at a time when a coherent and effective multilateral response is needed most, the COVID-19 pandemic revealed a shifting landscape of donor agencies that struggle with basic functions, such as cross-national coordination. While multilaterals are uniquely positioned to transcend national priorities and respond to pandemics, functionally we find official development assistance (ODA) from these entities may increasingly mimic the attributes of bilateral aid. We explore three important, but not comprehensive, attributes of aid leading up to and during the COVID-19 pandemic: (1) earmarking, (2) donor concentration and (3) aid modality.</p><p><strong>Methods: </strong>We examine ODA disbursements over time in 2020 constant prices from 2010 to 2021 and plot share of inflow that is earmarked against each United Nations multilateral against their average annual financing volume. We then assess market diversity with two measures: the Shannon-Weiner Function and Gini-Simpson Index. Finally, we examine financing vehicles used to disburse and look at 'grant share' of total ODA from all formal donors over time.</p><p><strong>Findings: </strong>We find that while the absolute number of formal multilateral actors and market diversity have been increasing since 2011, there has been a concurrent market consolidation led by the World Bank Group at 37% of market share in 2021. This coincides with an increasing prevalence of earmarking of aid inflows to the multilateral system and, unique to multilaterals but concerning given increasing debt risk, a rise in loan-based ODA disbursements.</p><p><strong>Conclusions: </strong>In theory, this consolidation may streamline revenue pooling and allow for a more collective approach to mitigating pandemic risk but, paired with increased earmarking, has the potential to sideline both collective goals (eg, the Sustainable Development Goals) and counties' core mandates (such as the pursuit of universal health coverage).</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 11","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582055","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":"Benefit equity of social health insurance in China and its provinces (2014-2020): implications for universal health coverage.","authors":"Yaoyun Zhang, Anne Mills, Jin Xu","doi":"10.1136/bmjgh-2023-014806","DOIUrl":"10.1136/bmjgh-2023-014806","url":null,"abstract":"<p><strong>Introduction: </strong>China has increased fiscal input into social health insurance (SHI) schemes to achieve universal health coverage. Our study aimed to examine the equity of SHI benefits in the country and five representative provinces over the period of 2014-2020.</p><p><strong>Methods: </strong>We analysed nationally and subnationally representative data from four waves (2014, 2016, 2018 and 2020) of the China Family Panel Studies. Benefit relative to consumption was assessed using concentration indices and concentration curves. We compared benefit distribution against health need across consumption quintiles. We further decomposed the change in the concentration index from 2014 to 2020.</p><p><strong>Results: </strong>The national concentration index for SHI benefit was pro-rich but became substantially less so over time, falling from 0.262 in 2014 to 0.133 in 2020. Poorer quintiles suffered more ill health but received a smaller share of SHI benefits compared with the richer quintiles. All five provinces improved in benefit equity to varying degrees. Reduced disparity between employee and resident schemes, and use of hospitals as the usual source of care, accounted for 44.47% and 14.70%, respectively, of the national improvement in SHI benefit equity.</p><p><strong>Conclusion: </strong>The benefit equity of SHI in China has improved, likely influenced by the narrowing funding gap between resident and employee scheme benefits. However, benefits remained skewed towards the richer groups with lower health need, revealing the resilience of an 'Inverse Benefit Law'. We suggest risk-equalisation of SHI funds and coordinated reform in health financing and service delivery towards a greater focus on primary care.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 11","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575189","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 curriculum to clinic: a qualitative study of junior doctors' perceptions of global health and sustainable development.","authors":"Charlotte Agardh, Julia Bielik, Anna-Theresia Ekman, Lotta Velin, Sibylle Herzig van Wees","doi":"10.1136/bmjgh-2024-015107","DOIUrl":"10.1136/bmjgh-2024-015107","url":null,"abstract":"<p><strong>Introduction: </strong>The role of global health and sustainable development in medical education is often debated. However, research regarding medical doctors' views on the application of their global health knowledge in the clinical setting remains scarce. This study aimed to explore junior doctors' perceptions of global health and sustainable development, the education they have received on these issues and the relevance of this knowledge in their current and future work.</p><p><strong>Methods: </strong>This was a qualitative study based on individual interviews conducted between May and June 2022. 16 junior doctors, in mandatory clinical training after completing medical school, were purposively sampled from five Swedish hospitals. Transcripts were analysed using qualitative content analysis.</p><p><strong>Results: </strong>Three themes were identified. The first theme (1) 'medical doctors have a role in the transition to a sustainable society', shows that sustainable development is increasingly perceived as relevant for junior doctors' clinical work. The second theme (2) 'global health and sustainable development teaching is inconsistent and somewhat outdated', highlights that there is an assumption that global health and sustainable development can be self-taught. A discrepancy between what is being taught in medical school and the clinical reality is also recognised. This causes challenges in applying global health interest and knowledge in the clinical setting, which is described in the third theme (3) 'application of global health and sustainable development is difficult'. This theme also highlights opportunities for continued engagement, with the perceived benefit of becoming a more versatile doctor.</p><p><strong>Conclusion: </strong>This study emphasises the need for conceptual clarity regarding global health in medical education and raises the need for clarification regarding the level of responsibility for integrating sustainable practices in Swedish healthcare settings.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 11","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575194","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":"In the margins of stigma: health inequalities among Bulgarian Roma in a post-COVID-19 UK.","authors":"Iliana Sarafian, Alice Robinson, Assen Christov, Aleksandra Tarchini","doi":"10.1136/bmjgh-2024-015686","DOIUrl":"10.1136/bmjgh-2024-015686","url":null,"abstract":"<p><p>The COVID-19 pandemic had a disproportionate impact on minoritised ethnic groups in the UK, including newly arrived Roma communities. Employing ethnographic and participatory methods, this study illustrates how systemic barriers, including precarious employment and overcrowded housing, coupled with strategies of identity concealment to avoid stigma, severely restrict access to healthcare among Bulgarian Roma communities in the UK. Drawing from fieldwork in Leicester and London, the research reveals how the pandemic amplified the vulnerabilities of Roma populations, directly linking the effects of the pandemic with broader sociopolitical dynamics, including the uncertainties and discrimination associated with Brexit. The findings point to the critical role of community, mutual and familial support networks as essential survival strategies. However, these social networks are also increasingly depleted, revealing the fragility and limits of informal communal resources. The study calls for the development of inclusive health strategies sensitive to the socio-economic and political complexities affecting marginalised communities in the UK and beyond.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 11","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575254","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}