BMJ Global Health最新文献

{"title":"Missed opportunities in health sector responses to violence against women and girls: a comparative mixed-methods study in Albania and Brazil.","authors":"Carmen Sant Fruchtman, Isabella Vitral Pinto, Hugo André da Rocha, Kenia Araújo, Camila Alves Bahia, Rebeca Becedas Revenga, Daniel Cardoso Portela Câmara, Júlia Costa de Oliveira, Salime Cristina Hadad, Eliete Guizilini Moreira de Carvalho, Elira Jorgoni, Sônia Lansky, Joan Muela Ribera, Ejnxh Pepa, Ana Pereira Dos Santos, Genta Qirjako, Rudina Rama, Kate Rocha Lacerda, Mayara Santos, Sindi Shahu, Marinela Sota, Lívia de Souza, Alban Ylli, Paula Dias Bevilacqua, Daniel Cobos Muñoz","doi":"10.1136/bmjgh-2025-022311","DOIUrl":"10.1136/bmjgh-2025-022311","url":null,"abstract":"<p><strong>Background: </strong>Violence against women and girls (VAWG) is a global public health crisis, affecting one in three women worldwide. Survivors of VAWG access health services more frequently due to the direct and indirect consequences of violence. Despite the health system's potential lifesaving role, these visits often result in missed opportunities.</p><p><strong>Methods: </strong>The Missed Opportunities to Respond to Violence Against Women and Girls in the Health Sector (MISSOP) study investigated the nature, scale and determinants of missed opportunities in responding to VAWG within primary care and emergency departments in Tirana, Albania and Belo Horizonte, Brazil. Using a triangulated mixed-methods design with an intersectional systems thinking lens, we built a retrospective cohort of women affected by VAWG, analysed their health service use and conducted focused ethnography through observations and interviews with health professionals and survivors to understand why missed opportunities occur.</p><p><strong>Results: </strong>Missed opportunities emerged as a discontinuum of care. In both settings, failures occurred across the continuum, ranging from access, detection, care and referral to statistics. In each municipality, 42% of women had not accessed any public healthcare facility in the 5 years investigated. Among the 58% who accessed public healthcare services, missed detection rates ranged from 68% in Belo Horizonte to 100% in Tirana's primary care system.These gaps were shaped by a complex interplay of factors, the biomedical orientation of health systems and by intersecting systems of discrimination, such as racism, sexism and classism, that shaped provider attitudes and institutional responses. Although protocols for responding to VAWG existed in both settings, they were poorly implemented or unknown to providers.</p><p><strong>Conclusion: </strong>Despite contextual differences, both health systems showed a similar pattern of systemic neglect. By conceptualising missed opportunities as a reinforcing cycle, our study introduces a novel framework to understand and address institutional failures. This approach highlights the complexity of VAWG as a health system challenge and identifies leverage points for structural and cultural reform.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058370","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-utility analysis of pre-exposure prophylaxis rabies vaccine in 5-year-old children in Thailand.","authors":"Sutinee Soopairin, Parnnaphat Luksameesate, Nattiya Arthonchaikul, Suda Punrin, Terapong Tantawichien, Suthira Taychakhoonavudh","doi":"10.1136/bmjgh-2025-022168","DOIUrl":"10.1136/bmjgh-2025-022168","url":null,"abstract":"<p><strong>Introduction: </strong>Rabies remains a life-threatening disease affecting children in endemic regions including Thailand. The cost-effectiveness of pre-exposure prophylaxis (PrEP) rabies vaccination in the Thai context is unclear. This study analysed the cost-utility of adding PrEP rabies vaccination to post-exposure prophylaxis (PEP) rabies vaccination compared with PEP alone in 5-year-old children.</p><p><strong>Methods: </strong>A decision tree model compared eight strategies (four PEP alone and four PrEP+PEP), classified by route of administration (intradermal (ID) or intramuscular (IM)) and vaccine product (purified chick embryo cell vaccine (PCEC) or chromatographically purified Vero cell vaccine (CPRV)/purified Vero cell rabies vaccine (PVRV)). Costs and outcomes were derived from published literature and discounted at 3% annually. The analysis was conducted from a societal perspective over a 20-year horizon. Incremental cost-effectiveness ratios (ICERs) were evaluated against Thailand's willingness-to-pay threshold of THB 160 000 per quality-adjusted life year (QALY).</p><p><strong>Results: </strong>PrEP+PEP ID using PCEC was cost-effective, with an ICER of THB 40 977 (US$1160.8) per QALY versus PEP alone ID using PCEC; the remaining strategies were dominated. The one-way sensitivity analysis identified annual bite incidence as the most influential parameter, with the ICER ranging from cost-saving to not cost-effective (THB 454 265 (US$12 868.7) per QALY). The results were robust to variation in all other parameters.</p><p><strong>Conclusion: </strong>PrEP+PEP ID using PCEC is cost-effective for children in Thailand, reducing reliance on equine rabies immunoglobulin and disease-related QALY losses. These findings support integrating PrEP into Thailand's National Immunization Program for children in high-risk areas, prioritising early vaccination in high-risk populations to advance the goal of eliminating rabies by 2030.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13636331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058419","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":"Co-adapting a school-based mental health literacy intervention for adolescents in Cambodia and Vietnam.","authors":"Aisling Murray, Nashwa Mohammed, Vân Vũ, Nil Ean, Sovandara Kao, Sareth Khann, Đào Kieu, Mengleang Kong, Khang Lê Hữu Minh, Phuong Hong Ngoc Nguyen, Phuong Nguyen, Bunna Phoeun, Thearom Ret, Phuong Tran Thi Mai, Francois van Loggerenberg, Channith Yeun, Hoang-Minh Dang, Fiona Samuels","doi":"10.1136/bmjgh-2026-024547","DOIUrl":"10.1136/bmjgh-2026-024547","url":null,"abstract":"<p><strong>Introduction: </strong>Given rising rates of mental health difficulties among young people, early intervention is crucial to mitigate personal and societal costs. Interventions should be locally adapted to ensure acceptability and sustainability, particularly in low- and middle-income countries (LMICs), where health systems are often under-resourced. Vietnam and Cambodia are LMICs with young populations, recent histories of conflict and ongoing vulnerabilities, including poverty and urban-rural inequality. While many adolescents experience common mental disorders, access to care is limited by stigma, low mental health literacy and reliance on urban, medicalised services. Community-based interventions are therefore needed; however, evidence on adapting such interventions in LMICs remains limited. This article describes the co-adaptation of a school-based mental health literacy intervention in Vietnam and Cambodia.</p><p><strong>Methods: </strong>The intervention, within the Mental health capacity Building and stRengthening In Global HealTh systems study, was adapted from the co-created Adolescent Mental Health Promotion intervention implemented in Vietnam and Tanzania. Adaptations to content and delivery were developed through workshops across four study sites (two in each country). Facilitated by local research teams, the workshops engaged adolescents alongside parents, teachers and other stakeholders. Activities included topic ranking, workbook exercises and group discussions. Adaptations were synthesised across sites using spreadsheets, and feedback from stakeholder advisory groups informed the final intervention design.</p><p><strong>Results: </strong>Key adaptations included delivery by two trained facilitators per session (one teacher, one external provider, with an additional back-up teacher in Cambodia), inclusion of peer-led co-facilitation of some sessions and the addition of new topics: 'the Internet', 'Eating disorders and body image' and 'Self-harm and suicide'.</p><p><strong>Conclusion: </strong>Co-adaptation was strengthened by early and diverse stakeholder engagement and participatory workshops that enabled all stakeholders, including adolescents, to voice their views. Responsive adaptations will likely continue throughout delivery via participant input, research team discussions and consultations with stakeholder advisory groups.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058434","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":"More than a lack of resources: a mixed-methods assessment of the barriers and facilitators to infection prevention practices in three low-resource maternity units in Malawi.","authors":"Jennifer M Riches, Chimwemwe Kachiwaya, Marthe Onrust, Linda Nyondo-Mipando, Catriona Waitt, Abi Merriel, David Lissauer","doi":"10.1136/bmjgh-2025-020210","DOIUrl":"10.1136/bmjgh-2025-020210","url":null,"abstract":"<p><strong>Background: </strong>Maternal sepsis is a leading cause of maternal mortality and morbidity. Caesarean section is a risk factor for infection, particularly in low-resource settings. This study aimed to identify barriers and facilitators to recommended infection prevention (IP) practices prior to implementation of a complex intervention to improve IP during caesarean section in a low-resource setting.</p><p><strong>Methods: </strong>This was a mixed methods study conducted in three semi-rural maternity hospitals in Malawi between June and December 2022. Participants were healthcare workers (HCWs) and women undergoing caesarean section. Data collection included case note review, weekly surveys and ethnographic participant observation to assess resource availability for IP and adherence to recommended IP practice. Preliminary data were integrated and used to inform in-depth interviews with HCWs to further explain findings. Inductively coded themes from interviews were mapped to the Communication-Opportunity-Motivation-Behaviour (COM-B)/Theoretical Domains Framework (TDF) model.</p><p><strong>Results: </strong>We found a lack of resources and suboptimal infrastructure for IP across the facilities, with many basic items available only intermittently. Observation revealed significant gaps in recommended IP practices, including hand hygiene, aseptic technique during vaginal examination, surgical scrubbing and sterile practice in the operating theatre. Scarcity of resources and infrastructure functioned as both direct and indirect barriers to IP due to their impact on staff motivation (reflective and automatic). Having 'passion' for patients, regular senior supervision and 'reminders' acted as facilitators to recommended IP practice.</p><p><strong>Conclusion: </strong>Our study demonstrates that adherence to recommended IP practice is determined by more than the availability of resources; the indirect impact of scarcity on staff motivation also played an important role. The study identified further barriers and facilitators to general IP practices, the understanding of which was subsequently used in the selection and development of a complex behaviour change intervention to improve IP practices in the same facilities.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975821","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":"Mpox in Africa: one year continental response outcomes and way forward.","authors":"Michel K Muteba, Kyeng Mercy, Yap Boum, Nebiyu Dereje, Merawi Aragaw Tegegne, Patrick Chanda Kabwe, Anthony Twyman, Yao S Atrah, Hieronyma Nelisiwe Gumede-Moeletsi, Charles Ugochukwu Ibeneme, Wazih Nji Cho, Laura Ambe, Beryl Njeba, John Masina, Joseph Armachie, Mamadou Saliou Kalifa Diallo, Sheillah Nsasiirwe, Polydor Mutombo, Denis Bunyoga, Deogratias Kakule, Olaniyi F Sanni, Rose Mary Nakame, Ibrahim Mamadu, Elizabeth Gonese, Viviane Kuissi, Priscilla Kusena, Linda Meta Mobula, Viviane N Fossouo, Usman Shehu, Selamawit Kebede, Bibi Kenta, Aurore Virayie, Emilio Hornsey, Cat Makisonbooth, Victor J Del Rio-Vilas, Natalie Fischer, Masresha Worku, Aarunima Bhatnagar, Eve Matthews, Abbie Harrison, Mosoka Papa Fallah, Gervais Folefack, Abou B Gaye, Mory Keita, Shanelle Hall, Otim Ramadan, Fiona Braka, Abdou Salam Gueye, Ngashi Ngongo, Jean Kaseya","doi":"10.1136/bmjgh-2025-023050","DOIUrl":"10.1136/bmjgh-2025-023050","url":null,"abstract":"<p><strong>Background: </strong>Following the declaration of mpox as both a global and continental public health emergency in August 2024, the Joint Incident Management Support Team (IMST), co-led by the Africa Centres for Disease Control and Prevention (Africa CDC) and the WHO, was activated in Kinshasa, DRC to coordinate the continental mpox response. This article highlights the first year's epidemiological and operational findings.</p><p><strong>Methods: </strong>Key performance indicators across eight IMST pillars (coordination, surveillance, laboratory, case management, infection prevention and control, risk communication and community engagement (RCCE), vaccination and research) were descriptively analysed using data from 28 African Union Member States from January 2024 to August 2025.</p><p><strong>Results: </strong>A total of 49 803 confirmed cases and 240 deaths (CFR 0.5%) were recorded across 28 countries. The response was supported with US$977 million as tracked by the IMST. Operational achievements included 87% surveillance completeness, 72% contact tracing completeness and improved average laboratory turnaround time from >5 days to 2 days. Laboratory testing capacity expanded from 2 to 27 sites in the DRC and from 1 to 56 decentralised sites in Burundi. RCCE activities reached 50 million people in 21 countries, with vaccine acceptance among high-risk groups rising from 44% to 87%. Operational research achievements included a responsive and functional research coordination mechanism, 24 (92%, 24/26) multi-country clinical and operational research studies implemented and 60% completion rate of the research data and material sharing framework for Africa. Only 938 000 doses (32%) of the 3.1 million vaccine doses delivered were administered.</p><p><strong>Conclusion: </strong>The joint continental IMST is a new benchmark for response governance, successfully mobilising resources and scaling up diagnostics under unified co-leadership. On the other hand, the evaluation revealed persistent structural challenges in last-mile vaccine delivery, contact tracing (due to stigma/funding) and weak regional collaborative research including fragmented regional research priorities. Future focus must shift from emergency action to durable, sustained investment in national and sub-national health security architecture using a multisectoral whole of government approach.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975795","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":"Disability inclusion as a missing pillar of Africa's non-communicable disease response.","authors":"Abdul-Aziz Seidu, Augustus Osborne, Pascal Agbadi, John Kuumuori Ganle, Leonard Baatiema, Agustina Naami, Usman Malabu, Charles Agyemang, Francis Sambah, Theophilus I Emeto","doi":"10.1136/bmjgh-2026-025577","DOIUrl":"10.1136/bmjgh-2026-025577","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975751","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":"Trajectories of child undernutrition in Ethiopia: a multivariate GEE approach.","authors":"Getnet Bogale Begashaw, Temesgen Zewotir, Haile Mekonnen Fenta","doi":"10.1136/bmjgh-2025-020133","DOIUrl":"10.1136/bmjgh-2025-020133","url":null,"abstract":"<p><strong>Background and objectives: </strong>Child undernutrition remains a significant public health issue in Ethiopia despite Millennium Development Goal efforts. Most prior Ethiopian studies have relied on cross-sectional designs or have modelled underweight, stunting and wasting as separate independent outcomes, limiting insight into their longitudinal interplay. This study employs a multivariate longitudinal framework to jointly examine trajectories, co-occurrence and shared determinants of all three anthropometric outcomes from infancy through adolescence.</p><p><strong>Methods: </strong>We utilised the Young Lives Cohort Survey (YLCS), collecting data from ~1997 Ethiopian children across five time points (2002-2016). A multivariate generalised estimating equations (GEE) model with a logit link function and exchangeable working correlation structure assessed associations between covariates and three undernutrition outcomes (underweight, stunting and wasting) defined by WHO z-scores (<-2 SD=undernutrition; ≥-2 SD=normal). Covariate effects were estimated with ORs and 95% CIs.</p><p><strong>Results: </strong>Undernutrition prevalence varied over time: underweight peaked at 52.1% at age 12, stunting was highest at 42.5% at age 1 (persisting at 25.6% by age 15), and wasting reached 41.2% at age 12. Overall, 37.2% of measurements showed underweight, 30.2% stunting and 24.7% wasting. The GEE model showed that higher wealth was associated with lower odds of underweight (OR=0.05, 95% CI: 0.02 to 0.11), stunting (OR=0.20, 95% CI 0.10 to 0.38) and wasting (OR=0.17, 95% CI 0.07 to 0.41). Females had lower odds (eg, underweight OR=0.61, 95% CI 0.53 to 0.70), while lack of safe water was associated with higher wasting odds (OR=1.40, 95% CI 1.16 to 1.69). Wasting odds surged by age 12 (OR=3.65, 95% CI 3.19 to 4.19).</p><p><strong>Conclusion: </strong>Undernutrition burden shifted across childhood, with stunting predominating in early years, underweight peaking in preadolescence and wasting escalating in later childhood. Wealth-targeted economic support programmes, poverty reduction strategies and improved water purification may help to address these disparities.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975774","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":"Uptake and feasibility of task-shifting of Xpert MTB/RIF Ultra testing from laboratory technicians to nurses to increase access and reduce time to results: a multicountry mixed method research.","authors":"Eden Masama Ngu, Joshi Basant, Bandana Bhatta, Minh Huyen Ton Nu Nguyet, Manon Lounnas, Rodney Munyaradzi Kaitano, Marcelle Sandrine N'Guessan, Kunda Mabuuku Kasakwa, Emelva Maria Alexandre Manhiça, Song Yin, Jacob Ross Mugisha, Timothée Dieudonné Ouassa, Jean-Voisin Taguebue, Raoul Moh, Guillaume Breton, Juliet Mwanga-Amumpere, Laurence Borand, Chishala Chabala, Celso Khosa, Eric Wobudeya, Olivier Marcy, Joanna Orne-Gliemann, Maryline Bonnet","doi":"10.1136/bmjgh-2025-019948","DOIUrl":"10.1136/bmjgh-2025-019948","url":null,"abstract":"<p><strong>Introduction: </strong>Task-shifting tuberculosis (TB) rapid molecular testing from laboratory technicians to nurses could help decentralise TB diagnosis at primary health centres (PHCs) and allow in-ward testing to shorten treatment decision for very sick patients. We assessed the feasibility of Xpert MTB/RIF Ultra (Ultra) testing on nasopharyngeal aspirate (NPA) by nurses in children with presumptive TB at PHCs and in hospitalised children with severe pneumonia within the TB-Speed project in seven countries.</p><p><strong>Methods: </strong>Of 23 PHCs and 15 paediatric wards, 9 and 4 respectively had nurses trained to perform Ultra using the battery-operated GeneXpert Edge. Laboratory technicians performed testing in the other sites. We compared the proportion of samples tested, invalid or error results, TB detection yield, turnaround time (TAT) between sample reception and result at PHC and time to clinician between sample collection and result delivery to clinicians in paediatric wards between nurses and laboratory technicians. External quality assessment (EQA) and site support supervision assessed performance. Self-administered questionnaire and semistructured individual interviews assessed nurses' perceptions.</p><p><strong>Results: </strong>Ultra was done in 253/254 (99.6%) and 258/258 (100%) samples for PHC and hospital nurses versus 895/897 (99.8%) and 874/874 (100%) for laboratory technicians, respectively. At PHC, TAT was below 1 hour 30 min for 158/252 (62.7%) samples tested by nurses versus 677/893 (75.8%) by laboratory technicians, p<0.001. Ultra results were available to clinicians within 3 hours in 201/258 (77.9%) samples for nurses versus 464/874 (53.1%) for laboratory technicians in hospitals, p<0.001. EQA results <87.5% was more common for PHC nurses than PHC laboratory technicians or hospital nurses. Technical difficulties, lack of practice and workload were the main challenges, and training and supervision the main facilitators reported by nurses.</p><p><strong>Conclusion: </strong>Task shifting of Ultra testing from laboratory technicians to nurses under close supervision could support decentralisation of TB diagnosis and shorten time to treatment decision for very sick patients.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944248","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":"Costs of surgeries in low- and middle-income countries: a systematic literature review.","authors":"Martilord Ifeanyichi, Phyllis Tenkorang, Esther Matey, Chizowa Okwuchukwu Ezeaku, Oluwayemisi Ekor, George Duke Mukoro, Soham Bandyopadhyay, Jose Luis Mosso-Lara, Pedra Rabiee, Danyal Zaman Khan, Maeve Bognini, Meskerem Aleka Kebede, Rachel Hargest, Rocco Friebel","doi":"10.1136/bmjgh-2025-020596","DOIUrl":"10.1136/bmjgh-2025-020596","url":null,"abstract":"<p><strong>Background: </strong>Surgical care is essential for achieving global health equity, yet low- and middle-income countries (LMICs) face major gaps in access and planning, partly due to limited evidence on the costs and resource requirements of surgical interventions. Understanding these costs is vital for designing efficient and equitable health systems.</p><p><strong>Methods: </strong>We conducted a systematic literature review (covering MEDLINE, EMBASE, Global Health, EconLit and grey literature) to identify studies reporting the costs of surgeries in LMICs from January 2000 to June 2023. Minor and major surgical procedures were considered, focusing on therapeutic procedures (excluding diagnostic interventions). Studies that clearly identified, quantified and costed hospital resources and services deployed in the provision of surgical care, and included at least two of the surgical production factors (ie, consumables, diagnostics, personnel, infrastructure and overhead) in the costing were included. Costs were standardised to 2023 International dollars (I$) for comparability.</p><p><strong>Results: </strong>A total of 74 studies from 29 countries met the inclusion criteria, with 210 cost estimates across 65 procedure groups. Costs varied widely: from I$1.54 for a caesarean section in Tanzania to I$618 098 for paediatric cataract surgery in Zambia. Full costing studies reported higher estimates than partial costing studies. Most studies (60%) originated from upper-middle-income countries, with limited data (10%) from low-income settings.</p><p><strong>Conclusion: </strong>This review provides a reference list of surgical procedure costs across LMICs, highlighting considerable cost variation by procedure, specialty and country. The findings underscore the need for better-quality, standardised cost data-especially from low-income countries-to inform national surgical plans, universal health coverage benefit packages and reimbursement policies.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891110","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":"A new conceptual framework for evaluating healthcare quality: shifting from reactive treatment to proactive health preservation.","authors":"Keisuke Kanda","doi":"10.1136/bmjgh-2025-020678","DOIUrl":"10.1136/bmjgh-2025-020678","url":null,"abstract":"<p><p>Healthcare quality is commonly assessed using clinical outcomes and service-based metrics that begin after illness has occurred. While such measures are important, they often overlook healthcare's fundamental purpose: to preserve health, prevent disease and minimise reliance on medical intervention. Drawing from global definitions of healthcare and quality-and philosophical insights from Sunzi's Art of War-this paper proposes a new framework that shifts evaluation from reactive treatment to proactive health preservation. A two-dimensional model is introduced, plotting age-standardised healthy life expectancy on the vertical (Y) axis against purchasing power parity adjusted per capita healthcare expenditure on the horizontal (X) axis. To enable standardised comparison across countries, both indicators are converted into z-scores, allowing the positioning of healthcare systems within a normalised, intuitive visual space. The ideal health system occupies the upper-left corner of this graph, where long, healthy lives are achieved with minimal spending. By examining relative positions on this graph, the model enables strategic policy discussions about value-based trade-offs between health outcomes and spending. The model also highlights a structural tension between the goals of healthcare and the incentives of capitalist systems, where prevention may paradoxically reduce profitability. By redefining quality in terms of sustained wellbeing rather than service provision, the framework offers a timely, intuitive tool for evaluating system performance. It invites policymakers, researchers and the public to reconsider what constitutes progress in health systems-emphasising that the best healthcare may not be the one that delivers the most care, but the one that is least needed.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 9","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886548","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}