BMJ Global Health最新文献

{"title":"Peru's front-of-package warning label policy and changes in the healthfulness of the food supply: a pre-post observational study.","authors":"Jonathan Lara-Arevalo, Lorena Saavedra-Garcia, Francisco Diez-Canseco, Natalia Rebolledo, Donna R Miles, Bridget Hollingsworth, J Jaime Miranda, Lindsey Smith Taillie","doi":"10.1136/bmjgh-2025-020809","DOIUrl":"10.1136/bmjgh-2025-020809","url":null,"abstract":"<p><strong>Introduction: </strong>In 2019, Peru implemented the first phase of a front-of-package warning label (FOPWL) policy requiring packaged foods and beverages exceeding thresholds for total sugars, sodium, saturated fats or containing trans fats to display warning labels. While intended to inform consumers, such policies may also incentivise product reformulation. This study assessed differences in the proportion and nutrient content of regulated ('high in') products in the Peruvian food supply after FOPWL policy implementation.</p><p><strong>Methods: </strong>Product-level nutritional information was collected from packaged foods and beverages during two periods: pre-implementation (T0: March-June 2019; n=2481) and post implementation (T1: March 2020-February 2021; n=3018). The proportion of products exceeding thresholds for nutrients of concern (sugars, sodium and saturated fats) and shifts in nutrient distributions across quartiles were compared pre-implementation and post implementation of the law in repeated cross-sectional samples and a longitudinal subsample (products collected in both periods, n=1694). Generalized estimating equations and logistic regression assessed differences in the proportion of 'high in' products, while quantile regression evaluated shifts in nutrient distributions.</p><p><strong>Results: </strong>In cross-sectional analyses over T1-T0 period, the proportion of 'high in' products declined by 6 percentage points (61% to 55%) among foods and by 11 percentage points (31% to 19%) among beverages. Relative reductions were observed in products 'high in' sugars (10% among foods; 37% among beverages), sodium (16% among foods) and saturated fats (7% among foods). Reductions varied across product categories and were greatest in those where thresholds were set below the prepolicy 75th percentile of baseline nutrient distributions. Longitudinal results were largely consistent with cross-sectional findings.</p><p><strong>Conclusion: </strong>Peru's first FOPWL policy phase was associated with reductions in the proportion of products 'high in' nutrients of concern, suggesting reformulation occurred across diverse product categories. These findings highlight the potential of mandatory FOPWL policies to improve the nutritional quality of the food supply and support efforts to reduce diet-related diseases.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677030","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":"Mapping the conceptualisation, contributing factors and interventions of moral distress among healthcare providers in Africa: a scoping review.","authors":"Joyline Jepkosgei, Dorothy Oluoch, Jacinta Nzinga, Kate McNeil, Yingxi Zhao, Sassy Molyneux","doi":"10.1136/bmjgh-2025-023358","DOIUrl":"10.1136/bmjgh-2025-023358","url":null,"abstract":"<p><strong>Introduction: </strong>Moral distress is the psychological discomfort experienced by healthcare providers when prevented from acting on their ethical values. Although extensively studied in high-income settings, it remains relatively unexplored in Africa, where chronic resource limitations and systemic constraints shape clinical practice. This scoping review mapped African literature examining how moral distress is conceptualised and discussed, its drivers and interventions implemented to address it with a particular focus on the balance between individual and organisational perspectives.</p><p><strong>Methods: </strong>A systematic search of databases identified papers on moral distress and related concepts among healthcare providers in Africa. Data extracted included: publication year, geographical focus, study design, participants, healthcare setting, conceptual framing, definitions, factors contributing to moral distress and descriptions of interventions and their evaluations. The results were analysed thematically considering individual and organisational perspectives.</p><p><strong>Results: </strong>30 papers published between 1999 and 2025 across 11 African countries were included. Of these, 14 were qualitative, 10 quantitative, 2 mixed methods, 1 review, 2 commentaries and 1 book chapter. Moral distress was commonly framed as an individual psychological burden, yet its primary drivers were identified as organisational including staff shortages, excessive workloads, inadequate resources and limited institutional support. Quantitative papers explicitly referred to 'moral distress', while qualitative papers generally described ethical and moral challenges more widely. Reported interventions were mainly proposed: counselling, debriefing, ethics committees and better staffing were recommended but rarely implemented or evaluated. In practice, healthcare workers relied on informal coping strategies such as peer support, prayer and improvisation.</p><p><strong>Conclusion: </strong>Moral distress is increasingly explored in the literature on African health systems but remains inconsistently defined and inadequately addressed at the organisational level. Despite widespread acknowledgement of its organisational and systemic origins, responsibility for managing its effects falls largely on individuals. This review supports a systems-level understanding of moral distress and highlights the need for organisational and policy change processes. Future research should move beyond description to identifying and evaluating team-based and organisational strategies that effectively reduce or manage moral distress.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697039","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":"Optimising screening for recurrent tuberculosis: a microsimulation-based study.","authors":"Emily A Kendall, Samyra R Cox, Abhay Kadam, Aye Hnin Moe, Gayatri Lele, Nikhil Gupte, Madhusudan Barthwal, Mandar S Paradkar, Mithun K Mitra, Hojoon Sohn, Shreeya Wasunkar, Ryan R Thompson, Amita Gupta, Sanjay Gaikwad, Jonathan E Golub, Vidya Mave","doi":"10.1136/bmjgh-2026-024146","DOIUrl":"https://doi.org/10.1136/bmjgh-2026-024146","url":null,"abstract":"<p><strong>Background: </strong>People recently treated for tuberculosis (TB) (TB survivors) face substantial risk of recurrence. The optimal implementation and expected impact of active case-finding are uncertain.</p><p><strong>Methods: </strong>We developed an individual-level stochastic simulation model of TB recurrence among recently treated people in India, informed by empirical data on the cumulative incidence and timing of TB recurrence, the extent and durations of symptoms and bacteriological positivity and screening-related costs. We modelled post-treatment symptom screening at quarterly or semiannual intervals, with or without universal near-point-of-care bacteriological testing at the first screening encounter. We estimated months of symptomatic TB and of potentially infectious (bacteriologically positive, regardless of symptom status) TB averted over a 2-year period after treatment, along with corresponding screening programme costs, estimated as medians and 95% uncertainty ranges across simulations.</p><p><strong>Results: </strong>Symptomatic TB recurred within 2 years post-treatment in 10% (8%-12%) of recent TB survivors and undiagnosed prevalence peaked in month 2 (1-3). Symptom screening 6, 12 and 18 months post-treatment (as per Indian guidelines) averted 16% (8%-32%) of symptomatic and 8% (5%-17%) of infectious time. An 'early' screening schedule (3, 6 and 9 months post-treatment) increased case detection and health impact (26% (15%-43%) of symptomatic and 16% (9%-27%) of infectious time averted). Adding 'universal bacteriologic testing' at the 3-month encounter doubled the impact on transmission potential (34% (21%-55%) of symptomatic and 37% (22%-62%) of infectious time averted). In this context, 'early' symptom screening cost $190 ($100-$350) per case detected, and adding universal bacteriological testing cost an additional $520 ($240-$1070) per case incrementally detected by the screening programme.</p><p><strong>Conclusions: </strong>Screening for recurrent TB in high-risk settings such as India could reduce morbidity and time spent with potentially infectious TB. Concentrating screening within the first year has greatest yield. Symptom-based screening is most affordable, but testing for asymptomatic recurrence could further reduce transmission potential.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health impacts of expanding the health workforce across cadres under an incremental budget in Malawi.","authors":"Bingling She, Sakshi Mohan, Rachel E Murray-Waston, Sangeeta Bhatia, Martin Chalkley, Tim Colbourn, Joseph H Collins, Emilia Connolly, Eva Janoušková, Dominic Nkhoma, Paul Revill, Asif U Tamuri, Pakwanja Desiree Twea, Tara D Mangal, Joseph Mfutso-Bengo, Timothy B Hallett, Margherita Molaro","doi":"10.1136/bmjgh-2025-022167","DOIUrl":"10.1136/bmjgh-2025-022167","url":null,"abstract":"<p><p>Like many others, Malawi's healthcare system faces significant health workforce shortages largely due to budget constraints that limit training, recruitment and retention of staff. A crucial question is how to best allocate a limited incremental budget to expand different healthcare workers (HCW) cadres so that the potential health gains are maximised, which is more important now than ever considering recent withdrawal and reduction in donor funding. This research aims to provide a practical answer to this question. We designed a range of budget allocation scenarios for HCW expansion across cadres and used the 'all diseases-whole healthcare system' <i>Thanzi La Onse</i> (TLO) model to estimate the resulting population health outcomes. We find that, indeed, how to allocate the incremental budget among cadres is an important determinant of the potential health impact. Concentrating all of the budget on expanding a single cadre-such as clinical, pharmacy or nursing and midwifery-is not the most effective use of the resources, even when that cadre currently faces the greatest staffing shortages. Similarly, allocating the budget in a manner that mirrors the current distribution of spending and results in a uniform expansion across cadres does not generate the greatest possible gains. Instead, an allocation that uplifts staffing for multiple cadres, accounting for the additional time and costs required to meet the future healthcare needs, yields the greatest benefits. We conclude that, in the context of complex interplay between demography, epidemiology, treatment scope and effectiveness and health resource constraints, human resources for health (HRH) bottlenecks in achieving health gains are multifactorial and a needs-based balanced mix of cadres and skills is required for future HRH expansion. As such, health system models such as the TLO that capture this interplay can make potential contributions to strengthening HRH planning.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700806","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":"Spatial exploration of the impact of cattle on risk of malarial infection using data from a cluster randomised trial.","authors":"Almudena Sanz Gutierrez, Rachel Otuko, Kexin Xie, Isaiah Omondi, Mercy Kariukiu, Paula Ruiz-Castillo, Caroline Wanjiku, Aurelia Brazeal, Mwanajuma Ngama, Truphena Onyango, Karisa Kazungu, Mary Mael, Winnie Wangari, Khadija Nuru, Isaac Ringera, Jamal Mbarak, Shadrack Mramba, Yegon Kibet, Naomi Nyambura, Scholastica Wanjiru, Felix Hammann, Francisco Saute, Joseph Mwangangi, N Regina Rabinovich, Marta Maia, Cassidy Rist, Carlos Chaccour","doi":"10.1136/bmjgh-2025-022607","DOIUrl":"10.1136/bmjgh-2025-022607","url":null,"abstract":"<p><strong>Introduction: </strong>In the context of stalled progress in reducing malaria burden and ongoing efforts to develop novel vector control methods, there is ongoing debate about the impact of livestock on malaria transmission. Zooprophylaxis refers to the use of livestock as an alternate source of blood that diverts mosquito vectors away from humans, potentially reducing malaria transmission. However, conflicting evidence highlights the concept of zoopotentiation, where livestock may instead increase vector populations and enhance malaria transmission. Prior studies that explore these concepts have examined livestock as a household asset, which does not account for the geospatial effect of animals owned by neighbours around the home.</p><p><strong>Methods: </strong>We implemented a novel spatial approach to explore the impact of cattle on the risk of malarial infection in coastal Kenya. Using data with high granularity from a recent randomised controlled trial, we measured the presence of animals at increasing concentric areas around the household. We fit binomial regression models with generalised estimating equations to explore how cattle density and cattle-to-human-ratio measures were related to malaria prevalence in children 5-15 years old, accounting for relevant environmental and socio-economic variables.</p><p><strong>Results: </strong>Our findings show that cattle density measured at 400, 500, and 600 m around the household (ORs: 1.63, 95% CI 1.20 to 2.21; 1.84, 95% CI 1.21 to 2.80 and 2.04, 95% CI 1.13 to 3.67, respectively) and cattle-to-human ratio at 500 and 600 m (ORs: 2.73, 95% CI 1.45 to 5.41 and 2.32, 95% CI 1.11 to 4.86, respectively) are significantly related to higher odds of testing positive for malaria. We did not find a significant association at closer distances (<400 m) or when cattle were evaluated only as a household asset.</p><p><strong>Conclusion: </strong>To better understand the impact of livestock on malaria transmission and potentially develop vector control strategies that account for these impacts, future research should consider animals as an environmental exposure and not only as a household asset.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668351","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":"Determinants of trust among ethnic minority community members towards community-based organisations and leaders during pandemics and other emergencies in Australia.","authors":"Holly Seale, Pippa McDermid, Danielle H Heinrichs, Helen Bromhead, Katrina Blazek, Michael Camit, Nadia Chaves, Mitchell Smith, Cliff Goddard, Abdullah Masud, Lisa Woodland, Jim Macnamara, Mashreka Sarwar, Harris-Roxas Ben","doi":"10.1136/bmjgh-2025-019445","DOIUrl":"10.1136/bmjgh-2025-019445","url":null,"abstract":"<p><strong>Background: </strong>Effective pandemic plans must be applicable to all members of our communities. However, people from multicultural communities with diverse language needs often engage with a wide range of organisations and individuals when seeking information during a pandemic or health emergency. Despite this, there is limited evidence on levels of trust and the influence of these sources on promoting community engagement with pandemic preparedness activities in high-income settings.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among members of ethnic minority communities in Australia who self-identified with one or more of six selected language or cultural groups. The survey, available in translated online and paper formats, incorporated several validated instruments and included both closed and open-ended items. Cross-tabulation analyses were used to examine associations between participant characteristics and levels of trust in community organisations and community leaders during the COVID-19 pandemic.</p><p><strong>Results: </strong>590 completed responses were included in the study. Participants were aged between 18 and ≥95 years old and identified as: Arabic (28.7%), Chinese (24.7%), Bangladeshi (22.3%), Pasifika (10%), Nepalese (8.2%) or Ezidi (6.1%). Predictors of moderate-to-very high trust in community-based organisations (CBOs) included participants who had arrived in Australia ≥20 years ago and had previously sought information from community groups, local councils and community workers. Likewise, moderate-to-very high trust in community leaders was more common among those who were more willing to seek assistance, arrived in Australia ≥20 years ago, were aged between 35 and 44 and had higher trust in community groups.</p><p><strong>Conclusions: </strong>Results indicated that trust in CBOs and community leaders was associated with willingness to seek assistance, satisfaction with communication efforts, trusted local councils and longer settlement in Australia; however, these associations may not reflect the reach or influence of community organisations and leaders across all ethnic minority groups.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668423","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 five-step methodology for South-South Learning Exchanges to scale up family planning services to achieve Sustainable Development Goals and universal health coverage.","authors":"Rita Kabra, Komal Preet Allagh, Agnes Chidanyika, James Kiarie","doi":"10.1136/bmjgh-2025-019530","DOIUrl":"10.1136/bmjgh-2025-019530","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668340","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":"Prevalence and uptake of HIV services among men who have sex with men in Northern Nigeria.","authors":"Ismaeel Mohammed Yahaya, Agie Muhmmad Auwal, Godwin Omokhagbo Emmanuel, Paul Umoh, Olaniyi Felix Sanni, Roger Abang, Ochonye Bartholomew Boniface, Paul Amechi","doi":"10.1136/bmjgh-2024-017862","DOIUrl":"10.1136/bmjgh-2024-017862","url":null,"abstract":"<p><p>HIV/AIDS has posed continuous public health challenges for decades, impacting both physical health and socioeconomic development in sub-Saharan Africa, particularly among key populations like men who have sex with men (MSM). This study aims to determine the key factors associated with the prevalence and willingness to take HIV services among MSM in a Northern Nigeria state.</p><p><strong>Methodology: </strong>The study used a cross-sectional survey of MSM in three local government areas in Kano state. HIV prevalence was measured with self-test kits, and willingness to use services was assessed via a 17-item questionnaire. Snowball sampling was used, with data collected by trained assistants and community leaders. Data were analysed using bivariate and multivariate logistic regression in IBM SPSS V.28.0.</p><p><strong>Results: </strong>HIV prevalence was 12.3%; MSM in Fagge (adjusted OR (AOR) 4.173; 95% CI 1.193 to 14.595, p=0.025), those not abusing drugs (AOR 5.969; 95% CI 2.412 to 14.770, p<0.001) and those engaging in vaginal sex in the last 3 months (AOR 4.140; 95% CI (1.402 to 12.224), p=0.010) had higher odds to contract HIV. The major reason for taking HIV tests was to know their status (84.0%), while the major obstacle stopping them from assessing HIV services was stigmatisation by providers (25.1%). Similarly, willingness to uptake HIV services was 47.4%; MSM in Tarauni (AOR 92.453, 95% CI 30.541 to 279.876, p<0.001), those who inject drugs (AOR 3.592, 95% CI 1.207 to 10.695, p=0.030), engage in anal sex (AOR 0.075, 95% CI 0.051 to 0.302, p<0.001) and use condoms regularly (AOR 2.731, 95% CI 1.279 to 5.829, p=0.009) had higher odds of accessing HIV services.</p><p><strong>Conclusion: </strong>This study emphasises the critical need to address barriers and improve HIV prevention and treatment services for MSM in northern states of Nigeria.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 7","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648083","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 Sierra Leone and the Mano River Union: an epidemic unfolding in real time.","authors":"Nelson Aghogho Evaborhene, Sulaiman Lakoh, Darlinda Jiba, Chizaram Onyeaghala","doi":"10.1136/bmjgh-2025-021192","DOIUrl":"10.1136/bmjgh-2025-021192","url":null,"abstract":"<p><p>The 2025 mpox outbreak in Sierra Leone represents an unprecedented public health crisis, escalating rapidly from minimal prior cases to over 4400 confirmed infections within 6 months. This surge challenges previous assumptions about mpox epidemiology in West Africa and highlights critical vulnerabilities in disease surveillance, diagnostics and health system preparedness-challenges shared across the Mano River Union (MRU) region, including Liberia, Guinea and Côte d'Ivoire. Despite global commitments to equitable vaccine access, Sierra Leone and its neighbours have faced significant delays and fragmented mpox vaccine deployment, reflecting systemic failures in global health financing, vaccine ecosystems and governance. In this analysis, we examine the demographic and geographic features of the outbreak within Sierra Leone and the MRU, operational challenges and the urgent need for a coordinated equity-driven regional response. In doing so, we call for targeted vaccination, decentralised testing, the integration of mpox control into sexual health programmes and the strengthening of African vaccine manufacturing capacity. The outbreak underscores the necessity of rethinking global health governance to ensure timely sustained support for endemic and interconnected regions.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 7","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648149","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":"Return-on-investment for interventions to reduce adolescent pregnancy and child marriage in Southeast Asia: a five-country modelling study.","authors":"Tharindu Wickramaarachchi, Marie Habito, Davide De Beni, Federica Maurizio, Sylvia Wong, Elissa Kennedy, Nick Scott","doi":"10.1136/bmjgh-2025-020106","DOIUrl":"10.1136/bmjgh-2025-020106","url":null,"abstract":"<p><strong>Introduction: </strong>Adolescent pregnancy remains a concern in Southeast Asia, with pregnancy both a driver and an outcome of child marriage or union. For Cambodia, Indonesia, the Philippines, Lao People's Democratic Republic (PDR) and Malaysia, this study aimed to calculate the benefit-cost ratio of investing in evidence-based interventions to prevent adolescent pregnancy and child marriage, considering their complex interdependencies.</p><p><strong>Methods: </strong>The population of girls aged 15-19 years was modelled at a national level, stratified by marriage, poverty and school enrolment status (known risk factors for pregnancy). Time-varying inputs for sociodemographics, contraception use, pregnancy and marriage were taken from population surveys (eg, Demographic and Health Survey [DHS]) and census data. A targeted review identified interventions with sufficient cost and effectiveness evidence for inclusion in modelling. A baseline scenario (constant intervention coverage over 2024-2030) was compared with investment scenarios, with interventions scaled up to reach an aspirational 95% coverage by 2030.</p><p><strong>Results: </strong>Evidence-based interventions included in-school comprehensive sexuality education, cash transfers, educational support, life skills training, livelihood training and community dialogue. Across the five countries, baseline scenario intervention costs were US$1.4 billion over 2024-2030, with a projected 2.4 million unintended adolescent pregnancies and 2.1 million child marriages among girls 15-19 years. Scale-up of all interventions to reach 95% coverage by 2030 would cost an additional US$5.0 billion and, in return, avert 1.3 million unintended pregnancies and 1.1 million child marriages. This was estimated to generate US$13.2 billion in economic benefits by 2050 with a benefit-cost ratio of 2.7, increasing to 9.7 if interventions were maintained to 2050 and lifetime benefits considered. Achieving a more modest 50% intervention coverage by 2030 produced similar benefit-cost ratios but with reduced total impact.</p><p><strong>Conclusion: </strong>For every US$1 invested to scale up and maintain high coverage of evidence-based interventions to reduce child marriages and adolescent pregnancies in Cambodia, Indonesia, the Philippines, Lao PDR and Malaysia, US$9.7 could be returned to the economy in the longer term.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 7","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629474","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}