BMJ Global Health最新文献

{"title":"Preferences for characteristics of contraceptive methods: a large, multi-country discrete choice experiment.","authors":"Hae-Young Kim, Fred Church, LinChiat Chang, Della Berhanu, John Kinuthia, Anna Bershteyn","doi":"10.1136/bmjgh-2025-023196","DOIUrl":"10.1136/bmjgh-2025-023196","url":null,"abstract":"<p><strong>Background: </strong>Nearly half of global pregnancies are unintended. Contraceptive use is preference-sensitive, including concerns about convenience, privacy and side effects (eg, irregular bleeding, weight gain). We conducted a multi-country study examining women's preferences for attributes of current and potential future modern hormonal contraceptives using a discrete choice experiment (DCE).</p><p><strong>Methods: </strong>Between April and October 2022, we recruited nationally representative samples of women of reproductive age from seven countries (Burkina Faso, Nigeria, Ethiopia, Kenya, Zambia, Pakistan and the USA) using multi-stage random cluster sampling from national census enumeration areas. The DCE comprised six attributes of hormonal contraceptives: format (ie, mode of administration: injection, implant, etc), dosing interval, provider-administration versus self-administration, effect on menstruation, effect on weight and time from discontinuation until return to fertility. Mixed logit models were fitted separately by country to estimate the relative preference weights (β) for each attribute level.</p><p><strong>Results: </strong>Across 20 068 participants, format was the strongest driver of preferences. Injectables were most preferred in Kenya (β=0.44, 95% CI 0.25 to 0.63), Pakistan (β=0.55, 95% CI 0.29 to 0.81), Ethiopia (β=0.64, 95% CI 0.38 to 0.90) and Zambia (β=0.39, 95% CI 0.20 to 0.58). Oral pills were most preferred in the USA (β=0.78, 95% CI 0.58 to 0.98), Burkina Faso (β=0.43, 95% CI 0.27 to 0.59) and Nigeria (β=0.55, 95% CI 0.40 to 0.70). Intrauterine devices and vaginal rings were less preferred in all countries. Menstrual bleeding changes and dosing interval were secondary drivers, with longer-acting methods modestly preferred and ongoing irregular bleeding modestly non-preferred. Avoiding weight gain was significantly preferred in several countries, most strongly in Pakistan (β=0.56, 95% CI 0.44 to 0.67) and the USA (β=0.42, 95% CI 0.31 to 0.53).</p><p><strong>Conclusions: </strong>In this large, multi-country study, reproductive-age participants expressed strong, heterogeneous preferences for contraceptive format, and in some settings, avoiding weight gain side effects. These findings can support preference-aligned contraceptive product development.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811969","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":"Dynamics of global mpox epidemics, 1970-2025: a systematic review and meta-analysis of evolving transmissibility and intervention effects.","authors":"Yin-Chien Lin, Tzai-Hung Wen, Wei-Liang Shih, Chia-Wei Liao, Sten H Vermund, Chi-Tai Fang","doi":"10.1136/bmjgh-2025-022252","DOIUrl":"10.1136/bmjgh-2025-022252","url":null,"abstract":"<p><strong>Background: </strong>The 2022 global mpox epidemic declined before modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccines were widely deployed, contributing to the perception that transmission was self-limiting within a small high-risk population. This may have delayed global vaccine allocation and weakened responses to the resurgence that has disproportionately affected Africa since 2024. The reasons for the 2022 decline remain uncertain, and prior studies have reported widely divergent estimates of vaccination impact. We systematically reviewed and meta-analysed the evolving transmissibility of mpox clades and the effects of interventions.</p><p><strong>Methods: </strong>We searched GenBank, PubMed and Embase through 18 May 2025, for mpox virus sequences, reproduction number (R) estimates and modelling studies evaluating intervention effectiveness. Two reviewers independently assessed eligibility, extracted data and evaluated risk of bias using a validated tool. Random-effects meta-analyses were performed.</p><p><strong>Results: </strong>Fifty-two studies reporting R estimates and 40 studies evaluating intervention effectiveness met eligibility criteria. For clade I mpox, pooled R increased from 0.71 (95% CI 0.26 to 1.17) during 1970-2017 to 1.23 (1.12-1.33) for subclades Ib/Ia after 2023 (p=0.0303). For clade II mpox, pooled R was 1.11 (0.90-1.32) during 2017-2021 and increased to 2.66 (2.31-3.00) for subclade IIb in 2022-2023 (p<0.0001). During the 2022 subclade IIb outbreak, empirical modelling studies estimated that behaviour change and vaccination together were associated with a substantial reduction in mpox cases (55%, 95% CI 37 to 73; I^²=81.2%), although effect sizes varied across settings according to the extent of behaviour change and the timing and coverage of vaccine rollout.</p><p><strong>Conclusions: </strong>Behaviour change and vaccination likely played important roles in the decline of the 2022 mpox epidemic in many studied settings. Given the stepwise increase in human-to-human transmissibility associated with the emergence of new subclades, effective mpox epidemic control requires proactive, rapid and equitable vaccine rollout supported by culturally tailored risk communication.</p><p><strong>Prospero registration number: </strong>CRD420250653072.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788068","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 race against time': a photovoice study on priorities for quality of injury care with patients, health workers and policymakers in four low- and middle-income countries.","authors":"Lucia D'Ambruoso","doi":"10.1136/bmjgh-2026-024260","DOIUrl":"10.1136/bmjgh-2026-024260","url":null,"abstract":"<p><strong>Introduction: </strong>The Lancet Commission on High Quality Health Systems called for quality measures grounded in user experience. Studies of how stakeholders interpret and prioritise these frameworks are rare for injury care in low- and middle-income countries (LMICs).</p><p><strong>Objectives: </strong>The objective was to identify how patients, healthcare providers and policymakers in four LMICs prioritise quality of care after injury using Institute of Medicine (IoM) quality domains (safety, effectiveness, patient-centredness, timeliness and equity).</p><p><strong>Methods: </strong>We conducted a Photovoice study across eight urban and rural sites in Ghana, Pakistan, Rwanda and South Africa. Focus group discussions (n=39) convened patients/community members, healthcare providers and policymakers (n=116), supplemented by policymaker interviews (n=6). Participants photographed aspects of injury care, developed captions and used deliberative dialogue to rank these against the IoM domains.</p><p><strong>Results: </strong>Stakeholders prioritised timeliness, safety and effectiveness, with rankings varying by local system capability. In settings with significant trauma system gaps (Ghana, Pakistan), timeliness ranked highest: immediate survival, getting to care quickly across transport, referral and facility processes. Safety was also emphasised: avoiding additional harm from unsafe and unreliable environments and resources. In settings with more established access to basic emergency care (Rwanda, South Africa), priorities shifted towards effectiveness, understood in terms of clinical, functional and psychosocial recovery. Across all contexts, equity (fair access and financial protection) was interpreted as foundational rather than as a discrete domain, shaping delays, access, treatment continuity and catastrophic costs. Overall, quality was considered cumulative and relational: early failures in care pathways amplified avoidable downstream complications including disability and impoverishment.</p><p><strong>Conclusions: </strong>Stakeholders shared systems understandings of injury care quality, with priorities varying by local capabilities. Timeliness and safety were seen as necessary for survival, enabling effectiveness in clinical and recovery outcomes, while equity operated across care pathways. The findings support aligning emergency quality indicators and improvement strategies with context-specific stakeholder priorities.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788083","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":"Long-acting reversible contraception, condom use and sexually transmitted infections in developing countries: a multi-country serial cross-sectional analysis using demographic and health surveys.","authors":"Nan Zhang, Luyao Xie, Yingxuan Wang, Zihao Guo, Cheng Su, Qiaoge Chi, Salihu S Musa, Kailu Wang, Kai Wang, Ka Chun Chong, Nafiu Hussaini, Yuantao Hao, Abdulrazaq G Habib, Yang Ge, Shi Zhao","doi":"10.1136/bmjgh-2025-022849","DOIUrl":"10.1136/bmjgh-2025-022849","url":null,"abstract":"<p><strong>Introduction: </strong>Unintended pregnancy and sexually transmitted infections (STIs) are major public health issues in developing countries. While long-acting reversible contraception (LARC) effectively prevents unintended pregnancy, there is limited evidence from large multinational studies on its association with condom use and STI-related outcomes. This study aimed to investigate the association between LARC use, condom use and STIs among women in developing countries.</p><p><strong>Methods: </strong>This serial cross-sectional study extracted data from Demographic and Health Surveys (DHS), a series of nationally representative household surveys conducted in developing countries. The analysis included women aged 15 to 49 years, with data on contraceptive methods and demographics. Generalised linear mixed effect models (GLMMs) were used to estimate adjusted prevalence ratios (aPRs) for condom use and self-reported STI-related outcomes, comparing LARC users with both non-LARC users and oral contraceptive users. Subgroup analyses were conducted at the individual level and at the country level.</p><p><strong>Results: </strong>Data from 2 171 884 women across 31 countries were analysed. Overall, the prevalence of self-reported STI-related outcomes was 7.4%, 3.9% of participants used LARC, and 7.5% of participants reported consistent condom use. LARC users were significantly less likely to use condoms compared with non-LARC users (aPR=0.40, 95% CI 0.30 to 0.53) and compared with oral contraceptive users (aPR=0.61, 95% CI 0.48 to 0.78). LARC use was associated with a higher prevalence of STI-related outcomes compared with non-LARC users (aPR=1.19, 95% CI 1.10 to 1.28) and compared with oral contraceptives users (aPR=1.14, 95% CI 1.05 to 1.24). Associations were stronger in low-Human Development Index (HDI) countries, especially among younger women (15-19 years), but were not significant in high-HDI countries. Country-level heterogeneity was observed.</p><p><strong>Conclusions: </strong>LARC use is associated with reduced condom use and higher self-reported STI prevalence, particularly among younger women and in lower HDI developing countries. These findings support integrating STI prevention into LARC services and promoting dual-method use to prevent both unintended pregnancies and STIs.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788167","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":"Domestic resources for surgical care financing: a descriptive analysis of global health expenditure trends and illustrative case studies on fiscal mechanisms in LMICs.","authors":"Ramya Reddy, Gabriella Yael Hyman, Simon Fabry, Walter D Johnson, Hao Yi Tan, Roman Macaya, Noor Hisham Abdullah, Lia Tadesse Gebremedhin, Kee B Park","doi":"10.1136/bmjgh-2025-021113","DOIUrl":"10.1136/bmjgh-2025-021113","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical care is essential to achieving universal health coverage (UHC) and addressing 30% of the global disease burden, including non-communicable diseases (NCDs), maternal health and injuries. However, low and middle-income countries (LMICs) face significant challenges providing equitable access to surgical services, with 5 billion people lacking access and US$20 trillion in associated global economic losses, emphasising the need for sustainable domestic financing strategies.</p><p><strong>Methods: </strong>A multifaceted approach combined quantitative analysis of domestic health spending trends (2000-2021) using the WHO Global Health Expenditure Database with illustrative case studies examining fiscal mechanisms. The quantitative analysis assessed government health expenditure (GHE), current health expenditure (CHE) and resource allocation. Illustrative case studies examined fiscal mechanisms, including taxes, subsidies, levies and public health insurance, drawn from published literature and policy reports in selected LMICs. A surgical expenditure surrogate (SES), defined as the proportion of health expenditure allocated to NCDs, reproductive, maternal, neonatal, child and adolescent health and trauma and injuries, was used as a proxy to estimate spending on surgical care.</p><p><strong>Results: </strong>In 2021, global CHE totalled US$9.84 trillion, with GHE contributing a global median of 53.66%. LMICs allocated only 34.88% of CHE to domestic resources, relying heavily on external funding and out-of-pocket payments. Using the SES as a proxy for surgical spending, spending on communicable diseases (CDs) outpaced SES in LMICs (median SES: 40.17% vs CD: 49.38% of CHE). Mechanisms like taxes, subsidies and public health insurance show potential to expand fiscal space but face challenges such as inequities, sustainability concerns and limited allocation to surgical care.</p><p><strong>Conclusion: </strong>Strengthening domestic financing through targeted fiscal policies and improved resource allocation can enhance access to surgical care and health system independence in LMICs. National surgical plans and better reporting metrics are critical to integrating surgical care into UHC strategies.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 Suppl 2","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788117","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 African Cancer Leaders Institute: a decade of strategic development of the African next generation leaders in cancer care, research, education and advocacy.","authors":"Yosr Hamdi, Achille Manirakiza, Gad Murenzi, Violet Kayamba, Nahla Gafer, Prisca Adejumo, Lauren N Singh, Verna Vanderpuye, Paul Ndom, Serigne Magueye, Isaac Adewole, Timothy R Rebbeck, Olufunmilayo I Olopade","doi":"10.1136/bmjgh-2025-020918","DOIUrl":"10.1136/bmjgh-2025-020918","url":null,"abstract":"<p><p>Leadership and mentorship play an important role in supporting the career development of health professionals. In many African countries, supervision activities focus on technical and operational aspects rather than catalysing career and leadership development. Thus, mentorship and coaching interventions need to be implemented in African healthcare institutions as components of health systems strengthening strategies. Due to its holistic nature, cancer care involves interprofessional collaborations to develop and provide a problem-solving mindset. It is therefore an area that would benefit from leadership and mentorship, mainly in a limited-resources context. The identified benefits from leadership development in cancer care in Africa led to the creation of the African Cancer Leaders Institute (ACLI) of the African Organization for Research and Training in Cancer (AORTIC), consisting of mentors and trainees from Africa and the USA. ACLI trainees are selected through a competitive application process. During the ACLI biennial meetings, coinciding with the AORTIC conference, trainees, including early-stage/mid-career investigators, oncologists, nurses, advocates and other health professionals, meet to learn about best practices in cancer research, grant writing, scientific reporting, mentor relationships, academic pressures and professional-personal life balance. This paper describes the goals of the ACLI, its mission and achievements, the vision behind creating such important programmes and the benefits of its participants in leadership, coaching and mentorship in improving cancer care in Africa.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788134","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 has mental health impacted the HIV epidemic and how has the HIV epidemic impacted mental health in Western Kenya? A mathematical modelling study.","authors":"Daniel Citron, Hae-Young Kim, Roscoe Kasujja, Samuel Mwalili, Duncan Gathungu, Chikumbi Chambwe, Ingrida Platais, Frey B Assefa, R Scott Braithwaite, Anna Bershteyn","doi":"10.1136/bmjgh-2025-020217","DOIUrl":"10.1136/bmjgh-2025-020217","url":null,"abstract":"<p><strong>Background: </strong>In eastern and southern Africa, HIV and depression lead to substantial morbidity and mortality. Each condition affects the other: people living with HIV (PLHIV) have higher depression rates, while depression increases HIV acquisition and hinders treatment. The combined impact of HIV-depression interactions on HIV and mental health remains poorly understood.</p><p><strong>Methods: </strong>We adapted the EMOD-HIV simulation model to incorporate depression incidence, recovery and relapse. We modelled a bidirectional scenario between HIV and depression: HIV increased depression incidence; depression increased HIV incidence and reduced HIV care outcomes. In a counterfactual scenario, all HIV-depression interactions were removed. We estimated how interactions impacted depression episodes, HIV acquisitions, HIV-related deaths and HIV treatment benefits in a high-prevalence region of Western Kenya, 1985-2035.</p><p><strong>Results: </strong>Without interactions, the model projected 1.23 million (95% CI 1.21M to 1.24M) HIV acquisitions, 658 000 (95% CI 650 000 to 666 000) HIV deaths and 12.88 million (95% CI 12.87M to 12.89M) depression episodes. HIV-depression interactions increased depression episodes by 9.76% (95% CI 9.67% to 9.87%), HIV acquisitions by 12.3% (95% CI 12.0% to 12.6%) and HIV deaths by 12.5% (95% CI 12.2% to 12.9%). These interactions also diminished HIV treatment benefits, with 7.72% (95% CI 7.39% to 8.07%) fewer HIV acquisitions and 3.88% (95% CI 3.71% to 4.05%) fewer deaths averted per person-year on treatment. In secondary analyses, increased depression incidence among PLHIV had the greatest effect on HIV outcomes, contributing 7.26% of acquisitions and 7.55% of deaths.</p><p><strong>Conclusion: </strong>HIV-depression interactions have worsened both epidemics. Depression's effects on HIV incidence have been especially deleterious, while its effect on HIV care engagement is increasingly important.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of surgical and conservative interventions for orthopaedic injuries in Malawi: a modelling study.","authors":"Pakwanja Desiree Twea, Peter Hangoma, Ole Frithjof Norheim, Sven Young, Levison Chiwaula, Boston Munthali, David Watkins","doi":"10.1136/bmjgh-2025-022014","DOIUrl":"10.1136/bmjgh-2025-022014","url":null,"abstract":"<p><strong>Background: </strong>Orthopaedic injuries are a major contributor to morbidity and mortality in low-income settings, driven by rising urbanisation and inadequate road safety measures. This study evaluates the cost-effectiveness of treatment for four common orthopaedic injuries in Malawi: femoral shaft fractures, patellar fractures, humeral shaft fractures and paediatric supracondylar humeral fractures (PSCHF).</p><p><strong>Methods: </strong>We developed a dynamic state-transition model to simulate fatal and non-fatal outcomes from a healthcare perspective from 2021 to 2031, informed by cost, epidemiological and population estimates. We estimated incremental cost-effectiveness ratios (ICER) for conservative and surgical management versus no treatment and each other, conducting one-way and probabilistic sensitivity analyses. We then modelled the population impact of scaling up the most cost-effective intervention under two scenarios.</p><p><strong>Findings: </strong>For femoral shaft fractures, surgical, conservative and no treatment resulted in disability-adjusted life years (DALYs) of 0.10, 0.21 and 0.23, with ICERs of approximately US$3000 and US$60 000 for surgical and conservative treatment. For patellar fractures, DALYs were 0.20, 0.22 and 0.32, with similar cost-effectiveness (ICERs of US$1400). For humeral shaft fractures, DALYs were 0.041, 0.056 and 0.11, with ICERs of US$3000 and US$1400. For PSCHF, DALYs were 0.04, 0.086 and 0.14, with ICERs of US$1600 and US$2600. Comparison of surgical and conservative strategies shows surgery was cost-saving for femoral shaft fractures, similar for patellar fractures, less efficient for humeral shaft fractures and more cost-effective for PSCHF. At Malawi's willingness-to-pay threshold of US$65 per DALY averted, the probability of cost-effectiveness was low. Under the ambitious scale-up scenario, approximately 1800 DALYs (a 10% reduction relative to the baseline) were averted at an incremental cost of US$5 million.</p><p><strong>Conclusion: </strong>In Malawi, surgery is more cost-effective for femoral shaft and PSCHF fractures, whereas conservative care is more cost-effective for humeral shaft fractures. For patella fractures with an intact extensor mechanism, both treatments are similarly cost-effective. Targeted scale-up could yield substantial health gains, underscoring the importance of context-specific data for prioritising orthopaedic services in low-resource settings.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757484","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":"Assessing the quality of care in low- and middle-income countries: a rapid review of the landscape of assessment tools.","authors":"Nukunté David Lionel Togbenon, Sarah Cooper, Armelle Akouavi Vigan, Sorel Edgard Lokossou, Rémi Danhoundo, Nihad Jessica Eyitayo Agoligan Tometin, Mahugnon Christian Urlyss Agossou, Rosette Sègbévi Liebe Dossou, Jean-Paul Dossou, Bart Criel, Kéfilath Bello","doi":"10.1136/bmjgh-2025-019738","DOIUrl":"10.1136/bmjgh-2025-019738","url":null,"abstract":"<p><strong>Background: </strong>Despite its broad conceptual scope, the Donabedian model (input-process-outcome) remains one of the most widely used frameworks for evaluating quality of care globally. Numerous tools have been developed to operationalise this model, yet no synthesis has focused specifically on those applied in low-resource settings or examined their validity and applicability in real-world settings.</p><p><strong>Objective: </strong>This study sought to review the landscape of tools used to assess each component of quality of care-according to Donabedian's model-in low- and middle-income countries (LMICs), and to evaluate their reported validity and applicability in routine health system settings.</p><p><strong>Method: </strong>A rapid review was conducted from June to November 2023. The following databases were searched using English and/or French keywords with no time limitation: Google Scholar and PubMed.</p><p><strong>Results: </strong>A total of 1451 articles were retrieved from PubMed (n=1164) and Google Scholar (n=287), with an additional 74 articles identified through Google. After title, abstract and full-text screening, 85 studies met the inclusion criteria. The review identified a wide range of tools used to assess quality of care in LMICs, characterised by considerable variation in the aspects of quality of care covered, the types of tools and the assessment techniques applied. These tools were categorised as institutional-such as Services Availability and Readiness Assessment, Demographic and Health Surveys (DHS) and Patient Satisfaction with Nursing Care Quality Questionnaire-or investigator-developed, often tailored to particular contexts. While most tools focused on input and process components, outcome measures-especially objective health outcomes-were under-represented. Gaps were also noted in the reporting of tool validation and cost-effectiveness, with few tools integrated into routine health system practices.</p><p><strong>Conclusions: </strong>This review highlights the need for context-appropriate, validated and cost-effective tools for assessing quality of care in LMICs. Tools should be user-friendly and embedded within routine monitoring systems to better support continuous quality improvement.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758780","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":"Where are the non-sovereign islands in health policy and systems research?","authors":"Robert A J Borst","doi":"10.1136/bmjgh-2026-025304","DOIUrl":"10.1136/bmjgh-2026-025304","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148719655","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}