BMJ Global Health最新文献

{"title":"Efficacy and effectiveness of hand hygiene-related practices used in community settings for removal of organisms from hands: a systematic review.","authors":"Stephen P Hilton, Nick H An, Lilly A O'Brien, Jedidiah S Snyder, Hannah K Rogers, Oliver Cumming, Joanna Esteves Mills, Bruce Gordon, Matthew C Freeman, Bethany A Caruso, Marlene K Wolfe","doi":"10.1136/bmjgh-2025-018925","DOIUrl":"10.1136/bmjgh-2025-018925","url":null,"abstract":"<p><strong>Background: </strong>This systematic review collected and synthesised evidence on the efficacy and effectiveness of commonly used hand hygiene materials and methods for removing or inactivating pathogens on hands in community settings. The evidence was generated to support the development of the WHO Guidelines for Hand Hygiene in Community Settings.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, EMBASE, CINAHL, Global Health, Cochrane Library, Global Index Medicus, Scopus, PAIS Index, WHO IRIS, UN Digital Library and World Bank eLibrary, and consulted experts in March 2023 for studies published between 1 January 1980 and 29 March 2023. Eligible studies included laboratory and field studies measuring reduction in organisms on hands after washing as intended in community settings; healthcare settings were excluded. Two reviewers independently extracted data from each study; risk of bias was assessed using the Mixed Method Appraisal Tool and a laboratory-based quality assessment tool. Summary results in terms of log₁₀ reduction in organisms on hands were calculated for categories with five or more data points from two or more studies.</p><p><strong>Results: </strong>Of 177 studies that met inclusion criteria, the majority focused on alcohol-based hand sanitiser (111, 63%) and handwashing with soap and water (110, 62%). Most evidence (119, 67%) assessed bacterial reductions and only 7 (4%) studies addressed enveloped viruses. Across studies, there was a >2 log₁₀ reduction in bacteria after handwashing with soap and water (2.19 (95% CI 1.5 to 2.87)) or alcohol-based sanitisers (3.13 (95% CI 2.7 to 3.56)), and for viruses after handwashing with soap and water (2.03 (95% CI 1.45 to 2.62)). However, there was a <2 log₁₀ reduction for viruses with alcohol-based sanitisers (1.86 (95% CI 1.37 to 2.35)).</p><p><strong>Conclusions: </strong>The ability to compare efficacy across materials and methods was limited due to the focus on bacteria and soap and water and alcohol-based sanitisers. Additional evidence quantifying the impact of handwashing on viruses (especially enveloped viruses), handwashing alternatives other than alcohol-based sanitisers, drying methods and microbial water quality, as well as the effectiveness of many of these products in the field would support more evidence-based recommendations.</p><p><strong>Prospero registration number: </strong>CRD42023429145.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074420","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":"Interventions to improve hand hygiene in community settings: a systematic review of theories, barriers and enablers, behaviour change techniques and hand hygiene station design features.","authors":"Sridevi K Prasad, Jedidiah S Snyder, Erin LaFon, Lilly A O'Brien, Hannah K Rogers, Oliver Cumming, Joanna Esteves Mills, Bruce Gordon, Marlene K Wolfe, Matthew C Freeman, Bethany A Caruso","doi":"10.1136/bmjgh-2025-018928","DOIUrl":"10.1136/bmjgh-2025-018928","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review identified and examined the theories, barriers and enablers, behaviour change techniques (BCTs), and design features of interventions that have been leveraged to improve and sustain hand hygiene in community settings. It was conducted to support the development of the WHO Guidelines for Hand Hygiene in Community Settings.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, EMBASE, CINAHL, Global Health, Cochrane Library, Global Index Medicus, Scopus, PAIS Index, WHO IRIS, UN Digital Library and World Bank eLibrary for studies published through 29 March 2023, and consulted experts. Eligible studies had an intervention targeting hand hygiene behaviour, quantitatively measured hand hygiene practice, were published in English after 1 January 1980 and were set in non-healthcare community settings. Studies in healthcare settings, nursing homes or long-term care facilities were excluded. Two reviewers independently extracted data from each study and appraised study quality (Mixed Method Appraisal Tool).</p><p><strong>Results: </strong>223 eligible studies (including 247 398 participants) met inclusion criteria, 82% of which were reported to be effective at improving hand hygiene. A minority (28%) used theory to inform intervention design. Interventions did not always address identified barriers or enablers. Most interventions addressed 'action knowledge' (eg, handwashing instruction), which was not a widely reported barrier or enabler. Interventions did not extensively address the physical environment (eg, resource availability) despite its importance for hand hygiene. Interventions leveraged a variety of BCT combinations, limiting comparability. We did not conduct a meta-analysis on effectiveness due to heterogeneity across studies. 10 studies evaluated hand hygiene station design adaptation, six examined variations in frequency or intensity of intervention delivery, and four focused on people with disabilities, revealing gaps in evidence.</p><p><strong>Conclusions: </strong>Findings are limited by inconsistent intervention reporting but more consistent identification and leveraging of barriers and enablers would improve alignment of hand hygiene interventions to local context.</p><p><strong>Prospero registration number: </strong>CRD42023429145.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074392","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":"We have the evidence but governments must now build the systems to deliver on hand hygiene.","authors":"Joanna Esteves Mills, Bruce Gordon, Lindsay Denny, Ann Thomas, Arnold Oredola Cole, Andrea Lee-Llacer, Sophie Hickling, Alemu Kejela Ababu, Akosua Kwakye, Alyaa Mohamed, Aarin Palomares, Nathaniel Paynter, Om Prasad-Gautam, Siddhi Shrestha, Precious Kalubula, Bethany A Caruso, Matthew C Freeman, Marlene K Wolfe, Sudan Raj Panthi, Marysol Astrea Liwanag Balane, Jon Michael Villasenor, Kidist Bartolomeus, Anthony Eshofonie, Bonifacio Magtibay, Sory Bouare, Doussou Doumbia, Kachusha Nkosha, Rajit Ojha, Suzzy Abaidoo, Waltaji Kutane, Mahamane Toure, Issaka Sangare, Sanjani Limbu, Ahammadul Kabir, Seema Ranjouria, Doreen Mulemba, Suzan Alzubaidy, Olga Kokshagina, Leah Heiss, Elisabetta Minelli, Charles Nachinab, Oliver Cumming","doi":"10.1136/bmjgh-2025-018930","DOIUrl":"10.1136/bmjgh-2025-018930","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074417","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":"Minimum material requirements for hand hygiene in community settings: a systematic review.","authors":"Lilly A O'Brien, Kennedy Files, Jedidiah S Snyder, Hannah K Rogers, Oliver Cumming, Joanna Esteves Mills, Bruce Gordon, Matthew C Freeman, Bethany A Caruso, Marlene K Wolfe","doi":"10.1136/bmjgh-2025-018926","DOIUrl":"10.1136/bmjgh-2025-018926","url":null,"abstract":"<p><strong>Background: </strong>This systematic review assessed the minimum requirements necessary to create an enabling environment for sustained hand hygiene practices: quantity of water and soap, and number, spacing, location, and design of hand hygiene facilities.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, EMBASE, CINAHL, Global Health, Cochrane Library, Global Index Medicus, Scopus, PAIS Index, WHO IRIS, UN Digital Library and World Bank eLibrary, and consulted experts. Eligible studies were published through 29 March 2023, observational, in non-healthcare community settings, and reported on at least one of the five categories: (1) quantity of water, (2) quantity of soap, (3) location of hand hygiene materials, (4) number of users or spacing of facilities and (5) considerations for equitable access. Two reviewers independently extracted data from each study and assessed risk of bias using the Mixed Method Appraisal Tool.</p><p><strong>Results: </strong>This review identified 37 studies that met inclusion criteria from 27 countries, representing 4 of the 6 WHO regions (Africa, South-East Asia, the Americas and Europe). Household settings were the most represented (59% of studies), followed by institutional or school settings (41%) and public establishments (27%). Of the 37 studies, 12 (32%) assessed the relationship between a material requirement and hand hygiene practices. Despite extensive global research on hand hygiene, we found a lack of evidence linking material requirements with handwashing practices in community settings.</p><p><strong>Conclusions: </strong>This review was limited to observational studies, and more data could be derived from experimental studies. Important evidence gaps include the quantity of water and soap needed, the influence of facility location and design on hand hygiene practice, and material needs providing equitable access. Further research is needed to strengthen the evidence base for hand hygiene recommendations and supplement the expert opinion on which many recommendations are currently based.</p><p><strong>Prospero registration number: </strong>CRD42023429145.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074475","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-creating community engagement and involvement strategies: understanding challenges and needs of people living with multiple long-term conditions and stakeholders' perspectives in India and Nepal.","authors":"Monika Arora, Mansi Chopra, Radhika Shrivastav, Nikhil Srinivasapura Venkateshmurthy, Natalia Oli, Niharika Rao, Mansi Gupta, Shabana Cassambai, Patrick Highton, Abhinav Vaidya, Kuldeep Singh, Amanda Crompton, Sailesh Mohan, Kamlesh Khunti, Dorairaj Prabhakaran","doi":"10.1136/bmjgh-2025-018968","DOIUrl":"10.1136/bmjgh-2025-018968","url":null,"abstract":"<p><p>Living with multiple long-term conditions (MLTCs) presents significant healthcare and patient-level challenges, which are further compounded by fragmented and poorly coordinated healthcare systems, leading to difficulties in access, dissatisfaction with quality of services, non-engagement with treatment protocols and poor outcomes. Overcoming these barriers requires a strong and equitable primary healthcare system that prioritises people-centred care and fosters meaningful community engagement. We aimed to understand how individuals with MLTCs navigate healthcare systems and co-create strategies to support community engagement.10 community conversations (n=90 respondents) were held in New Delhi, Jodhpur, Visakhapatnam (India), Duwakot and Bhaktapur (Nepal) between October-November 2021. These structured discussions explored experiences, beliefs, needs and perceptions of people living with MLTCs, caregivers and healthcare providers. Participants included adults aged 30-75 years, with an equal distribution of men and women. Respondents living with MLTCs reported conditions such as diabetes, hypertension, cardiovascular disease, chronic respiratory diseases and mental health conditions. Using a six-step inductive thematic analysis, we examined access, availability, affordability of healthcare services, continuity of care, expectations of health system interventions-electronic decision support system, assisted telemedicine, patient-facing services and community engagement and involvement (CEI).Six key themes emerged: (1) definition of community; (2) disease labelling, identity, social stigma, discrimination and coping mechanisms among people living with MLTCs; (3) access, availability and affordability of medications and healthcare services and associated challenges in receiving care; (4) role of local leaders, decision makers and healthcare professionals; (5) uptake, acceptability and building capacity on use of digital interventions such as telemedicine for healthcare service delivery; (6) community engagement methods, including the need for creation of community champions and innovative approaches to improve healthcare service delivery.The findings highlight significant barriers to accessing care yet also demonstrate the community's readiness to embrace digital tools, especially when guided and supported by trusted local leaders. These insights have key implications for health policy and programme design. Meaningfully engaging people with lived experiences as community champions can improve trust, screening, early diagnosis and self-management, while also bridging gaps between communities and health systems. Digital health interventions such as telemedicine should be embedded within primary care systems through culturally resonant and locally tailored approaches that build digital literacy and foster acceptance. Co-created CEI strategies can help design more equitable, people-centred and scalable health interventions.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069147","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":"It is time to increase Africa's governmental representation on the governing board of the global fund to fight AIDS, tuberculosis and malaria.","authors":"Reginald Maudlin Nalugala, Josephat Kakoma, Gemma Bridge, Jean Merlin von Agris, Robyn Hayes Badenhorst, Lieve Fransen, Garrett Wallace Brown","doi":"10.1136/bmjgh-2024-018252","DOIUrl":"10.1136/bmjgh-2024-018252","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069184","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 upstream-downstream tension in the global health classroom.","authors":"Neha Faruqui, Edward Jegasothy, Javier M Rodriguez, Seye Abimbola","doi":"10.1136/bmjgh-2025-019131","DOIUrl":"10.1136/bmjgh-2025-019131","url":null,"abstract":"<p><p>In this practice paper, we reflect on our practices, experiences and observations of teaching global and public health, with a focus on navigating the upstream-downstream tension. The concept of upstream determination of health encompasses how the social, structural and systemic drivers shape health and well-being. This paper discusses the challenges of foregrounding this concept in pedagogy through four key themes: (1) a lack of uniformity in integrating upstream concepts across disciplines related to health, and the ways in which it could be better integrated specifically into global health curricula; (2) helping students navigate the upstream-downstream tension by reflecting on why downstream solutions are more prevalent and how to better understand the structural responses, which are needed for achieving health equity; (3) why upstream thinking is hard to teach and learn, given that upstream determination can be complex, less familiar and abstract (we outline conceptual barriers and pedagogical challenges, common missteps and potential strategies to overcome them); (4) looking upstream in global health roles; how future graduates may consider ways to work upstream in their role as global health professionals, given that many job opportunities tend to focus downstream. This paper highlights the challenges of teaching upstream determination in global health, with a call to more uniformly integrate its concepts into curricula and offers potential strategies for teachers to meaningfully and collectively foreground such concepts within pedagogical delivery.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069115","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":"National IHR authorities in the 2024 amendments to WHO's International Health Regulations: transforming the opportunity into reality.","authors":"Cedric Aperce, Roojin Habibi","doi":"10.1136/bmjgh-2025-019284","DOIUrl":"10.1136/bmjgh-2025-019284","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069096","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":"Japan's emerging role in bridging immunisation gap and supporting global health.","authors":"Aomi Katagiri, Yuka Iijima, Yoshiki Tanaka, Hikari Ohyama, Takuya Nakazawa, Hayase Hakariya","doi":"10.1136/bmjgh-2025-020316","DOIUrl":"10.1136/bmjgh-2025-020316","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069128","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 health at a crossroads: WHO's 2025 Emergency Response to outbreaks, conflicts and humanitarian crises.","authors":"Abdullahi Hassan Elmi","doi":"10.1136/bmjgh-2025-020703","DOIUrl":"10.1136/bmjgh-2025-020703","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069163","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}