BMJ Global Health最新文献

{"title":"Tuberculosis and the climate crisis in Latin America: a predicament of poverty, migration and displacement.","authors":"Lara Goscé, Julia M Pescarini, Rein M G J Houben, Christopher Finn McQuaid","doi":"10.1136/bmjgh-2024-018674","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-018674","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980238","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":"Impact of increasing CD4 count threshold eligibility for antiretroviral therapy initiation on advanced HIV disease and tuberculosis prevalence and incidence in South Africa: an interrupted time series analysis.","authors":"Kwabena Asare, Lara Lewis, Johan van der Molen, Yukteshwar Sookrajh, Thokozani Khubone, Thulani Ngwenya, Ntokozo Siyabonga Mkhize, Richard John Lessells, Kogieleum Naidoo, Phelelani Sosibo, Christian Bottomley, Nigel Garrett, Jienchi Dorward","doi":"10.1136/bmjgh-2024-016631","DOIUrl":"10.1136/bmjgh-2024-016631","url":null,"abstract":"<p><strong>Introduction: </strong>We investigated the impact of increasing CD4 count eligibility for antiretroviral therapy (ART) initiation on advanced HIV disease (AHD) and tuberculosis (TB) prevalence and incidence among people living with HIV (PLHIV) in South Africa.</p><p><strong>Methods: </strong>We conducted an interrupted time series analysis with de-identified data of PLHIV aged ≥15 years initiating ART between April 2012 and February 2020 at 65 primary healthcare clinics in KwaZulu-Natal, South Africa. Outcomes included monthly proportions of new ART initiators presenting with AHD (CD4 count <200 cells/µL) and TB disease. We created a cohort of monthly ART initiators without TB and evaluated the cumulative incidence of TB within 12 months follow-up. We used segmented binomial regression models to estimate relative risks (RR) of outcomes, allowing for a step and slope change after expanding the ART initiation CD4 count eligibility from <350 to <500 cells/µL in January 2015 and following Universal Test and Treat (UTT) implementation in September 2016.</p><p><strong>Results: </strong>Among 209 984 participants, median age was 32 (range: 26-38), and 141 499 (67.4%) were female. After January 2015, the risk of AHD at initiation decreased in step by 25.0% (RR=0.750, 95% CI 0.688 to 0.812) and further reduced by 26.9% following UTT implementation (RR=0.731, 95% CI 0.681 to 0.781). The risk of TB at initiation also decreased in step by 27.6% after January 2015 (RR=0.724, 95% CI 0.651 to 0.797) and further decreased by 17.4% after UTT implementation (RR=0.826, 95% CI 0.711 to 0.941) but remained stable among initiators with AHD. Among the incidence cohort, we saw a step decrease in the risk of new TB by 31.4% (RR=0.686, 95% CI 0.465 to 0.907) following UTT implementation. Among the incidence cohort with AHD, there was weak evidence of a step decrease in the risk of new TB (RR=0.755, 95% CI 0.489 to 1.021), but the slope decreased by 9.7% per month (RR=0.903, 95% CI 0.872 to 0.934) following UTT implementation.</p><p><strong>Conclusions: </strong>Our data support the added benefit of decreased TB co-burden with expanded ART access. Early diagnosis and immediate linkage to care should be prioritised among PLHIV.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958700","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":"Estimating the effects of interventions on increasing vaccination: systematic review and meta-analysis.","authors":"Jiayan Liu, Yingli Zhang, Haochun Zhang, Hao Tan","doi":"10.1136/bmjgh-2024-017142","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-017142","url":null,"abstract":"<p><p>As global vaccination rates have reached their lowest point in nearly 15 years, effective interventions are being required globally to promote vaccination; however, there is a lack of rigorous evaluation of the effect of various interventions. Through a global synthesis, we analysed data from approximately 6 125 795 participants across 319 studies in 41 countries to reveal the global landscape of four intervention themes and to assess their effectiveness in increasing vaccination rates. We found an overall positive effect of the interventions across four main themes on improving vaccination. Specifically, dialogue-based interventions increased vaccination rates by 43.1% (95% CI: 29.8 to 57.9%, with effect sizes measured as relative risks (RRs)), though they may not always be effective in adolescents or in the sample with a higher percentage of male participants. Incentive-based interventions, whether implemented alone or combined with other intervention themes, failed to demonstrate a significant effect in children. Reminder/recall-based interventions were also effective for promoting vaccination (38.5% increase, 95% CI: 28.9 to 48.9%), particularly for completing vaccine series. Multi-component interventions exhibited excellent effectiveness in vaccination (54.3% increase, 95% CI: 40.5 to 69.6%), with the combination of dialogue, incentive and reminder/recall proving more effective than other multi-component interventions, but showing no significant effects in populations with high initial vaccination rates. However, we found that in most cases combining additional interventions with a single intervention may not significantly improve their effectiveness, especially for incentive-based interventions, but dialogue-based and reminder/recall-based interventions appear to be beneficial in some specific combinations. These findings underscore the importance of governments, public health officials and advocacy groups implementing appropriate vaccine interventions by selecting interventions tailored to specific populations, strategically promoting the completion of vaccine series and effectively combining interventions to promote global vaccination and save more lives.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973789","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":"Clinical prediction models to diagnose neonatal sepsis in low-income and middle-income countries: a scoping review.","authors":"Samuel R Neal, Sarah S Sturrock, David Musorowegomo, Hannah Gannon, Michele Zaman, Mario Cortina-Borja, Kirsty Le Doare, Michelle Heys, Gwendoline Chimhini, Felicity Fitzgerald","doi":"10.1136/bmjgh-2024-017582","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-017582","url":null,"abstract":"<p><strong>Introduction: </strong>Neonatal sepsis causes significant morbidity and mortality worldwide but is difficult to diagnose clinically. Clinical prediction models (CPMs) could improve diagnostic accuracy, facilitating earlier treatment for cases and avoiding antibiotic overuse. Neonates in low-income and middle-income countries (LMICs) are disproportionately affected by sepsis, yet no review has comprehensively synthesised evidence for CPMs validated in this setting.</p><p><strong>Methods: </strong>We performed a scoping review of CPMs to diagnose neonatal sepsis using Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, Global Index Medicus and the Cochrane Library. The most recent searches were performed on 16 June 2024. We included studies published in English or Spanish that validated a new or existing CPM for neonatal sepsis in any healthcare setting in an LMIC. Studies were excluded if they validated a prognostic model or where data for neonates could not be separated from a larger paediatric population. Studies were selected by two independent reviewers and summarised by narrative synthesis.</p><p><strong>Results: </strong>From 4598 unique records, we included 82 studies validating 44 distinct models in 24 252 neonates. Most studies were set in neonatal intensive or special care units (n=64, 78%) in middle-income countries (n=81, 99%) and included neonates already suspected of sepsis (n=58, 71%). Only four studies (5%) were set in the WHO African region, and only one study included data from a low-income country. Two-thirds of CPMs (n=30) required laboratory parameters, and three-quarters (n=34) were only validated in one study.</p><p><strong>Conclusion: </strong>Our review highlights several literature gaps, particularly a paucity of studies validating models in the lowest-income countries where neonatal sepsis is most prevalent, and models for the undifferentiated neonatal population that do not rely on laboratory tests. Furthermore, heterogeneity in study populations, definitions of sepsis and reporting of models inhibits meaningful comparison between studies and may hinder progress towards useful diagnostic tools.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974452","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":"Developing a framework for monitoring the stages towards achieving effective coverage and equity for maternal, newborn, child health and nutrition interventions.","authors":"Patricia S Coffey, Megan E Parker, Katharine D Shelley, Elan Ebeling, Lydia Nguti, Sophia Knudson, Nesibu Agonafir, Sali Ahmed, Savitha Subramanian, Kimberly Mansen, Sadaf Khan, Cyril Engmann, Jessica C Shearer","doi":"10.1136/bmjgh-2024-016494","DOIUrl":"10.1136/bmjgh-2024-016494","url":null,"abstract":"<p><p>Reaching the Sustainable Development Goal 2030 global mortality and morbidity targets will require increased access to essential health services. Scaling high-impact health interventions within the public sector is complex; delineation of the pathway to scale for each intervention within each distinct geography is important for prioritising actions to advance interventions towards effective coverage. Following a review of 38 theoretical frameworks describing pathways for scaling health system interventions, we developed, tested and refined a new schema-the Stages of Achieving Effective Coverage and Equity Framework-for use to describe the status of policy adoption, implementation and coverage of key maternal, newborn, child health and nutrition (MNCHN) interventions. We propose a framework with six domains (global, national, systems, implementation, availability and coverage) covering 26 critical milestones with identified corresponding, intervention-specific indicators. Our framework was validated by the alignment of over 83 000 data points sourced from document review, interviews and global or country surveys. Visualisations are presented to highlight how the framework is operationalised to assess scale-up progress. We outline our process of conceptualising and developing a new framework and articulate its use case for action-oriented monitoring of progress towards effective coverage through applied examples in key geographies. Our framework offers an easy-to-follow implementation pathway and a set of common policy and implementation indicators to monitor scale-up towards effective coverage that uses existing secondary data sources where available. Achieving prioritised maternal, newborn and child health targets requires scalable implementation strategies for lifesaving interventions, alongside monitoring progress towards achieving scale.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964390","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":"Intersectional forces of urban inequality and the global HIV pandemic: a retrospective analysis.","authors":"Ingrid T Katz, Dana Renee Thomson, Sindhu Ravishankar, Kennedy Otwombe, Erlyn Rachelle Macarayan, Carissa Novak, Alison R Schulte, Sidney Atwood, Liana Rosenkrantz Woskie, Zoe Siegel, Bruce D Agins, Janan Dietrich, Blair T Johnson, Erva-Jean Stevens, Lisa M Butler, Matthew Kavanagh","doi":"10.1136/bmjgh-2023-014750","DOIUrl":"https://doi.org/10.1136/bmjgh-2023-014750","url":null,"abstract":"<p><p>To determine how the intersection of increased urban growth and poverty has impacted HIV incidence and prevalence, given growing HIV inequalities globally. Retrospective analysis using combined data from five publicly available, population-level datasets to determine city- and within-urban countrywide estimates of 95-95-95 treatment targets, prevalence and incidence rates from 2015 to 2019. For city-level estimates, we analysed combined data from: Fast-Track City (FTC), SINAN from Brazil and UNAIDS Naomi-Spectrum. Countrywide estimates of HIV prevalence in the urban slum versus non-slum since 2012 were compiled from Population-Based HIV Impact Assessment (PHIA) surveys in 12 countries and Demographic Health Surveys (DHS) in 28 countries. HIV prevalence is generally higher among the urban slum, compared to their non-slum counterparts, thus resulting in national HIV estimates masking nuances in HIV inequalities between the urban slum and non-slum. Specifically, national and city-level HIV estimates mask inequalities within and between cities, with secondary cities often having higher HIV prevalence and incidence rates than capital cities and large urban areas. The urban divide between slum and non-slum populations is a contributor to HIV inequality, often with poorer outcomes in smaller cities than their larger counterparts. Interventions tailored to cities, and particularly those considering local nuances in subpopulations (eg, different genders, ages, roles), are necessary to reduce HIV inequality. Focused HIV programming accounting for structural drivers of inequalities between urban slum and non-slum populations such as inequalities in wealth, education, employment and housing are crucial to closing gaps driving HIV inequalities globally.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958664","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":"Epidemiology of sepsis in hospitalised neonates in Indonesia: high burden of multidrug-resistant infections reveals poor coverage provided by recommended antibiotic regimens.","authors":"Nina Dwi Putri, Benjamin Fr Dickson, Riyadi Adrizain, Leny Kartina, Jannah Baker, Distiayu Sukarja, Fabiola Cathleen, Dominicus Husada, Martono T Utomo, Tetty Yuniati, Adhi K Suginali, Michelle Harrison, Michael Sharland, Phoebe Cm Williams","doi":"10.1136/bmjgh-2024-016272","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-016272","url":null,"abstract":"<p><strong>Background: </strong>Neonatal sepsis is a leading cause of child mortality, and this burden is rising secondary to increasing antimicrobial resistance worldwide. There are marked global disparities in the burden of antimicrobial resistance, with Southeast Asia identified as a region of particular concern. Indonesia is the world's fourth most populous country, with 4.2 million babies born each year. Despite this, there remains limited published data on the burden of neonatal sepsis and antimicrobial resistance in the country.</p><p><strong>Methods: </strong>We conducted a 2-year analysis of the epidemiology of neonatal sepsis across three high-burden clinical settings in Indonesia, alongside an antibiotic point prevalence prescribing survey.</p><p><strong>Results: </strong>Of 5439 blood cultures analysed, gram-negative bacteria predominated as causative pathogens for neonatal sepsis in Indonesia, with <i>Klebsiella</i> spp and <i>Acinetobacter</i> spp most common (prevalence 35% and 19%, respectively). Overall, the pathogens causing neonatal sepsis exhibit very low susceptibility to WHO-recommended antibiotic regimens for the treatment of neonatal sepsis, with only 25% coverage provided by aminopenicillins plus gentamicin (95% credible interval (CI) 22% to 29%) and 20% by third-generation cephalosporins (95% CI 17% to 23%). Almost half of all antibiotics prescribed to treat neonatal sepsis across the clinical settings included in our study were Watch and Reserve antibiotics.</p><p><strong>Conclusion: </strong>Our multicentre study across three sites in Indonesia revealed neonatal sepsis is predominantly caused by Gram-negative pathogens, with very poor coverage provided by currently recommended empiric regimens. A high burden of multidrug-resistant pathogens drives empirical use of broad-spectrum antibiotics. There is an urgent need for new antibiotic regimens and infection prevention and control strategies to treat neonatal sepsis in regions with a high prevalence of multidrug-resistant infections.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972202","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":"Impact of all-oral bedaquiline-based shorter regimens in the treatment of drug-resistant tuberculosis: a systematic review and meta-analysis.","authors":"Ginenus Fekadu, Tadesse Tolossa, Firomsa Bekele, Xiaohan Chen, Yan He, Jing Yu, Xinyao Yi, Ming Liu, Getahun Fetensa, Dinka Dugassa, Ebisa Turi, Tesfaye Regassa Feyissa, Nathorn Chaiyakunapruk, Lianping Yang, Shanquan Chen, Wai-Kit Ming","doi":"10.1136/bmjgh-2024-018220","DOIUrl":"10.1136/bmjgh-2024-018220","url":null,"abstract":"<p><strong>Background: </strong>Drug-resistant tuberculosis (DR-TB) presents a significant global obstacle to TB control efforts, necessitating improved intervention strategies. The introduction of potent drugs, such as bedaquiline (Bdq), has led to the development of shorter treatment regimens. This systematic review and meta-analysis aimed to examine the impact of these regimens, synthesising data from recent clinical trials and observational studies.</p><p><strong>Methods: </strong>We searched multiple databases, including Medline and Scopus, for studies published from 2012 to February 2024. Eligible studies included clinical trials and cohort studies involving adults diagnosed with DR-TB treated with Bdq-based all-oral regimens lasting up to 12 months. Primary outcomes were treatment success rate (TSR) and incidence of serious adverse events (SAEs). We also compared efficacy and safety with longer oral or injectable regimens in control groups. Meta-analyses were conducted to pool event rates and risk ratios (RRs). Subgroup analyses and meta-regression were performed to identify potential sources of heterogeneity.</p><p><strong>Results: </strong>Data from 12 studies involving 1902 DR-TB patients across 11 countries were analysed. The pooled TSR was 83% (95% CI 77% to 89%), with mortality, treatment failure and loss to follow-up (LTFU) rates of 5% (3-8), 4% (2-6) and 4% (2-6), respectively. Subgroup analyses showed no significant differences in TSR by DR-TB type or HIV status. The incidence rate of SAE was 19% (13-24), with prolonged corrected QT interval (QTc) in 5% (2-8) of cases. Compared with the control regimens, all-oral Bdq-based shorter regimens significantly improved treatment success (RR 1.22, 1.04-1.43) but reduced mortality (RR 0.73, 0.69-0.99), treatment failure (RR 0.33, 0.32-0.62) and QTc prolongation (RR 0.39, 0.21-0.73).</p><p><strong>Conclusions: </strong>All-oral Bdq-based shorter regimens have improved treatment outcomes and significantly advanced DR-TB management. We urge policymakers, clinicians and stakeholders to expand access to and expedite the implementation of these regimens.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802530","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, regional and national disparities and temporal trends of common autoimmune disease burdens among children and adolescents from 1990 to 2019.","authors":"Chen Chen, Fan Yang, Paul Lodder, Xiaohan Liu, Ning Huang, Mingyu Zhang, Shan Zhang, Jing Guo","doi":"10.1136/bmjgh-2024-017187","DOIUrl":"10.1136/bmjgh-2024-017187","url":null,"abstract":"<p><strong>Introduction: </strong>Previous evidence lacked a thorough review of the disparities of autoimmune diseases (AD) burdens among countries and regions, which led to an insufficient basis for developing country-specific developmental level relevant preventive measures. This study aimed to analyse disparities and trends of global, regional and national burden of common ADs in children and adolescents from 1990 to 2019 and to investigate the associations between specific ADs and varied country indexes.</p><p><strong>Methods: </strong>All data for four major ADs were obtained from the Global Burden of Diseases Study 2019. Age period-cohort modelling was conducted to disentangle age, period and birth cohort effects on AD incidence from 1990 to 2019. Local regression smoothing models were used to fit the correlation between AD burdens and sociodemographic index (SDI). Pearson's correlation was used to investigate varied country-level risk factors for disease burden.</p><p><strong>Results: </strong>A global increase in four common ADs incidence was observed from 1.57 million to 1.63 million between 1990 and 2019 in the 0-24 age group. The age-standardised incidence rate of overall four ADs showed substantial regional and global variation with the highest incidence in high SDI regions. The age, period and cohort distributions of AD incidence varied significantly, especially in high SDI countries. Relative to the expected level of age-standardised incidence associated with SDI, the distribution varied by regions depending on the specific ADs. Countries with higher levels of socioeconomic development, better quality of life and easier access to healthcare and the healthcare system showed lower disease burdens of ADs.</p><p><strong>Conclusions: </strong>The incidence patterns and disease burdens of ADs varied considerably according to age, time period and generational cohort, across the world between 1990 and 2019. Incidences of ADs in children and adolescents were significantly correlated with indexes involving risks of the environment, human rights and health safety and quality of life.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787832","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":"Beyond proximity: an observational study of stillbirth rates and emergency obstetric and newborn care accessibility in The Gambia.","authors":"Oghenebrume Wariri, Winfred Dotse-Gborgbortsi, Schadrac C Agbla, Hawanatu Jah, Mamady Cham, Ba Foday Jawara, Mustapha Bittaye, Momodou T Nyassi, Musa Marena, Sainey Sanneh, Mariama Janneh, Beate Kampmann, Aduragbemi Banke-Thomas, Joy E Lawn, Uduak Okomo","doi":"10.1136/bmjgh-2024-016579","DOIUrl":"10.1136/bmjgh-2024-016579","url":null,"abstract":"<p><strong>Introduction: </strong>Stillbirths are disproportionately concentrated in sub-Saharan Africa, where geographical accessibility to basic/comprehensive emergency obstetric and newborn care (BEmONC and CEmONC) significantly influences maternal and perinatal outcomes. This study describes stillbirth rates within healthcare facilities in The Gambia and examines their distribution in relation to the geographical accessibility of these facilities.</p><p><strong>Methods: </strong>We analysed 97 276 births recorded between 1 January 2013 and 31 December 2018, from 10 major public healthcare facilities in The Gambia. To standardise definitions, stillbirths were defined as fetal deaths with a birth weight of ≥500 g. Fresh stillbirths were reclassified as intrapartum, and macerated stillbirths were reclassified as antepartum. Linear regression with cubic splines was used to model trends, and AccessMod software estimated travel times to facilities.</p><p><strong>Results: </strong>Among recorded births, 5.1% (4873) were stillbirths, with an overall stillbirth rate of 51.3 per 1000 births (95% CI: 27.5 to 93.6). Intrapartum stillbirths accounted for 53.8% (27.6 per 1000 births; 95% CI: 14.4 to 49.8). Fully functional CEmONC facilities reported the highest stillbirth rates, including the National Teaching Hospital (101.7 per 1000 births, 95% CI: 96.8 to 106.8). Approximately 42.8%, 58.9% and 68.3% of women aged 15-49 lived within a 10, 20 and 30 min travel time, respectively, to fully functional CEmONC facilities, where high stillbirth rates were concentrated.</p><p><strong>Conclusions: </strong>In The Gambia, intrapartum stillbirth rates remain alarmingly high, even in geographically accessible CEmONC facilities. Inadequate documentation of fetal heart rate on admission hampers accurate classification, complicating targeted interventions. Ensuring that EmONC-designated facilities-particularly those providing BEmONC services-are fully functional with essential equipment, trained staff and robust referral systems, while enhancing the timeliness and quality of obstetric care, is crucial to reducing stillbirth rates.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787829","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}