BMJ Global Health最新文献

{"title":"Addressing epistemic injustice (and ongoing effects of colonisation) through the Ethiopian intellectual tradition of <i>Qiné</i>.","authors":"Dawit Wondimagegn, Cynthia Ruth Whitehead","doi":"10.1136/bmjgh-2025-019230","DOIUrl":"10.1136/bmjgh-2025-019230","url":null,"abstract":"<p><p>As global health and medical education scholars build their understanding of the historical and continuing influences of colonisation, the absence of non-western forms of thought in medical education remains a challenge. <i>Qiné</i> is an Ethiopian intellectual tradition and poetic practice dating back many centuries (predating colonialism) that continues to exist and has the potential to expand scholarly inquiry in critical spaces. The central tenet of <i>Qin</i>é is that all phenomena, subject matter, knowledge and truth are incomplete and thus open for exploration and interpretation. In introducing <i>Qiné</i> in this analysis paper, we outline key <i>Qiné</i> definitions and concepts, describe our positionality and the processes we followed to bring <i>Qiné</i> concepts into this global critical scholarly space, provide a brief background on our Ethiopian/Canadian collaborative partnership model, review some of the literature about <i>Qiné</i> written in English and provide a few examples to illustrate the potential <i>Qiné</i> holds as a theory and methodology for global health and medical education. We conclude with some suggestions for next steps in incorporating <i>Qiné</i> into the methodological and theoretical toolkit for global critical scholarship. Advancing a-colonial theories and methodologies may be one effective way for educators and scholars to decolonise global health and medical education.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641810","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":"Essential aid made fully visible: understanding the proCHW financing landscape analysing accessible donor data sources.","authors":"Cleo Baskin, Carey Carpenter Westgate, Laura Shellaby, Madeleine Ballard, Ash Rogers, Rachel Hofmann, Mallika Raghavan, Daniel Palazuelos, Sarah Lindsay, Pauline Picho Keronyai, Matthew French, Niloofar Ganjian, Stephanie Rapp, Sonia Tiedt, Carla López Castañeda, Diana Nambatya Nsubuga, Jude Aidam, Benedicte Razafinjato, James O'Donovan","doi":"10.1136/bmjgh-2024-017453","DOIUrl":"10.1136/bmjgh-2024-017453","url":null,"abstract":"<p><strong>Introduction: </strong>Community health workers (CHWs) play a critical role in extending healthcare services to underserved populations, especially in low-income and middle-income countries. Professional CHWs (proCHWs), who are salaried, skilled, supplied and supervised, are essential for achieving Universal Health Coverage and other global health goals. Despite the growing recognition of proCHWs, there is limited understanding of the global financing landscape for these workers. This study analyses the availability of data detailing the allocation of funding from major global development organisations for proCHWs.</p><p><strong>Methods: </strong>The study was conducted by the Community Health Impact Coalition (CHIC) using a two-stage approach. First, eight major global funders were selected through a consultative process with CHIC members, chosen based on their perceived influence, leadership in community health and scale of financial commitments. The second stage involved mapping and analysing the funding availability of these organisations through desk reviews, brief consultations and analysis of public funding databases. The transparency of proCHW-specific funding data was assessed using a classification system: 'yes' (full availability), 'partial' (moderate availability) and 'no' (low/no availability).</p><p><strong>Results: </strong>The analysis revealed a gap in accessible data required to quantify the funding for CHWs, particularly proCHWs, across the eight organisations. Only two organisations, The Global Fund and the President's Malaria Initiative, provided partial data visibility, while none fully disclosed specific funding amounts for proCHW programmes. Most organisations did not systematically track or report CHW investments, making it challenging to assess global funding flows.</p><p><strong>Conclusions: </strong>The study highlights gaps in the availability of data related to funding for proCHWs, hampering the ability to track and evaluate investments in proCHW programmes. The study recommends global funders improve the specificity of their data reporting and integrate proCHW indicators into standard reporting tools. Enhanced data reporting is essential for optimising investments in proCHW programmes and advancing global health equity.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641812","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":"Implementing the 7-1-7 target to improve epidemic preparedness and response in Uganda.","authors":"Lydia Nakiire, Aaron F Bochner, Maureen Nabatanzi, Anita Kisakye Kisakye, Joshua Kayiwa, Christopher Lee, Michael Coninx, Julie Wahl, Elizabeth Mgamb, Immaculate Atuhaire, Godfrey Bwire, Edson Katushabe, Jobin Abraham, Maureen Nyonyintono, Immaculate Nabukenya, Moses Rubangakene, Emmanuel Nkurunziza, Chris Columbus Opesen, Annet Alenyo Ngabirano, Allan Muruta, Alex Riolexus Ario, Francis Kakooza, Yonas Tegegn Woldemariam, Mohammed Lamorde, Issa Makumbi","doi":"10.1136/bmjgh-2024-018207","DOIUrl":"10.1136/bmjgh-2024-018207","url":null,"abstract":"<p><p>Early and effective response actions are vital to mitigate outbreaks and other public health events. The 7-1-7 target (7 days to detect, 1 day to notify and 7 days to complete early response actions) is a performance improvement approach for epidemic preparedness. 7-1-7 data were collected by rapid response teams and presented to stakeholders at National Task Force (NTF) meetings, Uganda's primary outbreak coordination platform, in the days immediately after event detection. From October 2021 to December 2022, 7-1-7 data were collected for 13 ongoing events that were presented at NTF meetings as well as 29 lower-risk events for which the NTF was not convened. Among these 42 events, 22 (52%) met the 7-day detection target, 31 (74%) met the 1-day notification target and 19 (45%) met the 7-day early response target, with 10 (24%) meeting all 7-1-7 target components. Systems bottlenecks identified across the 42 events were consolidated, shared with stakeholders and integrated into Uganda's National Action Plan for Health Security (NAPHS) Operational Plan. Of the 108 subactivities in the 2023 NAPHS Operational Plan, 17% aligned with recommended activities that emerged from 7-1-7 implementation. Uganda's experience demonstrated that real-time 7-1-7 reviews improved ongoing public health responses and that synthesising 7-1-7 data across events identified recurrent systems bottlenecks that warranted prioritisation during NAPHS operational planning. We recommend that other countries adopt WHO's 2023 guidance on incorporating the 7-1-7 approach into Early Action Reviews to improve their outbreak responses.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636101","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":"Hypertensive disorders of pregnancy and perinatal outcomes: two prospective cohort studies of nulliparous women in India and Tanzania.","authors":"Andrea B Pembe, Pratibha Dwarkanath, Amani Kikula, John Michael Raj, Nandita Perumal, Heavenlight A Paulo, Rajalakshmi M, Christopher P Duggan, Honorati M Masanja, Nandini Chopra, Mary M Sando, Tinku Thomas, Cara A Yelverton, Alfa Muhihi, Anura V Kurpad, Wafaie W Fawzi, Blair J Wylie, Christopher R Sudfeld","doi":"10.1136/bmjgh-2024-016339","DOIUrl":"10.1136/bmjgh-2024-016339","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertensive disorders of pregnancy (HDP) have been linked with increased risk for maternal and offspring complications in high-income settings. However, in resource-limited settings, studies with robust measurement of HDP, including severity and timing, and perinatal outcomes are limited.</p><p><strong>Methods: </strong>We analysed data from two prospective cohorts of nulliparous women in India (n=10 570 pregnancies) and Tanzania (n=10 299 pregnancies) who were enrolled in calcium supplementation trials and had blood pressure and proteinuria assessments throughout pregnancy and at the time of labour and delivery. Generalised estimating equations were used to assess the relationship between HDP severity categories (gestational hypertension, preeclampsia without severe features and preeclampsia with severe features) and timing of HDP onset (early-onset <34 weeks vs late-onset ≥34 weeks gestation) with adverse perinatal outcomes.</p><p><strong>Results: </strong>The cumulative incidence of HDP was 3.7% and 4.5% in the India and Tanzania cohorts, respectively. All HDP severity categories were associated with a significantly higher risk for perinatal death in both cohorts (p values<0.05). Pregnancies complicated by pre-eclampsia with severe features had the largest magnitude of increased risk for perinatal death as compared with pregnancies without an HDP (India RR 8.60; 95% CI 5.90 to 12.53; Tanzania RR 4.05; 95% CI 2.91 to 5.66). In both cohorts, pre-eclampsia with and without severe features, but not gestational hypertension, was associated with increased risks for preterm birth and low birth weight. Pregnancies with early-onset HDP had a high absolute risk of perinatal death (India 25.6% and Tanzania 36.9%), and the risk was markedly increased as compared with late-onset HDP (India RR 4.79; 95% CI 2.68 to 8.54; Tanzania RR 5.79; 95% CI 3.56 to 9.41).</p><p><strong>Conclusion: </strong>HDP were differentially associated with risks for perinatal outcomes by severity and timing of onset. Interventions that prevent, reduce the severity or delay the onset of HDP may improve perinatal outcomes in resource-limited settings.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov number, NCT03350516.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607330","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":"Equity of maternal and child health services in Afghanistan: a spatiotemporal analysis of national survey datasets.","authors":"Tim Groteclaes, Saifuddin Ahmed, Cauane Blumenberg, Aluisio J D Barros, Mickey Chopra, Nadia Akseer","doi":"10.1136/bmjgh-2024-018577","DOIUrl":"10.1136/bmjgh-2024-018577","url":null,"abstract":"<p><strong>Introduction: </strong>Afghanistan's healthcare system faces geopolitical instability and inequities in maternal and child health (MCH) services, particularly associated with a temporary collapse in funding in 2021. We analysed coverage levels and spatiotemporal trends in sociodemographic inequalities in the country using data from the 2010/2011 and 2022/2023 Afghan Multiple Indicator Cluster Surveys.</p><p><strong>Methods: </strong>The study's primary outcome was an adapted Composite Coverage Index (CCI) that combined seven essential MCH interventions with corresponding inequality measures, evaluated using Slope Indices of Inequality. These interventions included antenatal care, skilled birth attendance (SBA), Bacillus-Calmette-Guérin (BCG), diphtheria-pertussis-tetanus, and measles vaccination and treatment for suspected pneumonia and diarrhoea. Inequalities were analysed across wealth, education and urban/rural status at both national and provincial levels.</p><p><strong>Results: </strong>The analysis revealed persistent socioeconomic inequalities across all strata, with the most significant economic disparities observed in SBA and the largest educational disparities in vaccine coverage in 2022/2023. Nationally, the CCI increased by 4.2% from 42.1% (95% CI 40.3% to 44%) in 2010/2011 to 46.2% (95% CI 44.6% to 47.9%) in 2022/2023. Despite a slight increase between the two studies, severe regional disparities are masked, particularly in the eastern and southern regions, where coverage across multiple interventions significantly declined. The provinces of Nooristan and Urozgan significantly lost coverage, while Daykundi and Nimroz recorded increases in coverage and equity.</p><p><strong>Conclusion: </strong>The findings underscore the persistence of substantial inequalities in Afghanistan, with severe consequences for already vulnerable populations facing multiple hardships. The findings highlight ways in which geopolitical instability affects healthcare equity. Increasing disparities threaten to exacerbate existing challenges in accessing essential healthcare services, particularly for those of lower socioeconomic status. Urgent, targeted interventions are necessary to address these inequities, the impacts associated with funding cuts and gender marginalisation, and to mitigate their detrimental impact on Afghan women and children.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607332","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 historical impact of outbreak response immunisation programmes across 210 outbreaks in low and middle-income countries.","authors":"Dominic Delport, Alina M Muellenmeister, Gabrielle MacKechnie, Stefanie Vaccher, Tewodaj Mengistu, Dan Hogan, Romesh G Abeysuriya, Nick Scott","doi":"10.1136/bmjgh-2024-016887","DOIUrl":"10.1136/bmjgh-2024-016887","url":null,"abstract":"<p><strong>Background: </strong>Outbreaks of vaccine-preventable diseases frequently occur in low and middle-income countries (LMICs), requiring outbreak response immunisation (ORI) programmes for containment. To inform future investment decisions, this study aimed to estimate the cases, deaths, disability-adjusted life years (DALYs) and societal economic costs averted by past ORI programmes. Outbreaks of measles, Ebola, yellow fever, cholera and meningococcal meningitis in LMICs between 2000 and 2023 were considered.</p><p><strong>Methods: </strong>210 outbreaks (51 measles, 40 cholera, 88 yellow fever, 24 meningitis, 7 Ebola) across 49 LMICs were identified with sufficient data for analysis. Data were sourced from publicly available outbreak reports and literature. Agent-based models were calibrated for each disease such that after controlling for baseline vaccine coverage, response time, vaccination rate, environmental variables or endemic prevalence of the disease, observed outbreaks were within the distribution of simulated outbreaks. A status-quo and no ORI scenario were compared for each outbreak.</p><p><strong>Findings: </strong>Across 210 outbreaks, ORI programmes are estimated to have averted 5.81M (95% uncertainty interval 5.75M-5.87M) cases (4.01M measles, 283K cholera, 1.50M yellow fever, 21.3K meningitis, 820 Ebola), 327K (317K-338K) deaths (20.0K measles, 5215 cholera, 300K yellow fever, 1599 meningitis, 381 Ebola), 14.6M (14.1M-15.1M) DALYs (1.27M measles, 220K cholera, 13.0M yellow fever, 113K meningitis, 16.6K Ebola) and US$31.7B (29.0B-34.9B) (US$710M measles, US$156M cholera, US$30.7B yellow fever, US$97.6M meningitis, US$6.72M Ebola) in economic costs. Often, the more rapidly the ORI was initiated the greater impact.</p><p><strong>Interpretation: </strong>ORI programmes are critical for reducing the health and economic impacts of outbreaks of vaccine-preventable diseases.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599375","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":"Inadequate last-mile pharmaceutical waste management is a neglected threat to environmental and public health: a call to action.","authors":"Raffaella Ravinetto, Jennie Lates, Lauren Jonkman, Vulika Nangombe, Anne Hauner, Renier Coetzee, Belen Tarrafeta, Hazel Bradley, Maya Ronse, Koen Peeters Grietens, Joos Van Den Noortgate, Saleh Aljadeeah","doi":"10.1136/bmjgh-2025-019544","DOIUrl":"10.1136/bmjgh-2025-019544","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583075","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":"Patient experience with cancer care in low- and middle-income Asian countries: a cross-sectional study of patients with advanced cancer.","authors":"Ellie Bostwick Andres, Louisa Poco, Ishwarya Balasubramanian, Isha Chaudry, Thushari Hapuarachchi, Sushma Bhatnagar, Anjum Khan Joad, Lubna Mariam, Rubayat Rahman, Maria Fidelis Manalo, Pham Nguyen Tuong, Gayatri Palat, Rudi Putranto, Hamzah Shatri, Wah Wah Myint Zu, Semra Ozdemir, Chetna Malhotra","doi":"10.1136/bmjgh-2024-017153","DOIUrl":"10.1136/bmjgh-2024-017153","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the disproportionate burden of cancer morbidity and mortality in low- and middle-income countries (LMICs), little is known about patients' care experiences in these settings. This study assesses which aspects of physician communication and care coordination most influence patients' overall experience with care, and factors associated with patient experience ratings, to inform quality improvement and improve cancer care experiences in LMICs.</p><p><strong>Methods: </strong>In a cross-sectional study of 1933 patients with advanced cancer recruited at 10 major public hospitals in seven LMICs in Asia, patients rated their experience with physician communication, care coordination and overall.</p><p><strong>Results: </strong>Physician communication mattered most in patients' assessment of overall experience with care. Patient use of traditional medicine was associated with poorer physician communication ratings (β: -1.38, 95% CI: -2.11 to 0.65), while outpatient care (0.91, 95% CI: 0.24 to 1.57) was associated with higher ratings. Patients who were unsure (-0.77, 95% CI: -1.43 to -0.10) of their cancer stage (relative to aware of late-stage), or indicated financial difficulty (sufficient money to cover their daily needs fairly well (-0.77, 95% CI: -1.50 to -0.04) or poorly (-1.20, 95% CI: -2.30 to -0.09) relative to very well) rated care coordination lower. Patient experience ratings differed by minority group status and cancer severity understanding. Respondents identifying as ethnic minorities who were unsure of their cancer stage rated physician communication significantly higher (1.64, 95% CI: 0.71 to 2.58) than non-minorities aware of their advanced cancer. Non-minorities unsure of their cancer stage rated care coordination significantly lower (-1.00, 95% CI: -1.64 to -0.36) than non-minority patients aware of their cancer stage.</p><p><strong>Conclusions: </strong>This study provides new understanding of care priorities among patients with advanced cancer in LMICs. Our findings highlight the importance patients attribute to physician communication and considerations for improving patient-centred communication to support equitable and culturally appropriate care. This study also underscores the need for future work navigating prognostic discussions in LMICs.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583076","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":"Changing the narrative: visual methods can reinforce or reduce disease-related stigma.","authors":"Sofia Labbouz, Diana Timoria, Yoppy Pieter, Ragil Dien, Hana Krismawati, Claus Bogh, Hardyanto Soebono, Mary Chambers, Marlous L Grijsen","doi":"10.1136/bmjgh-2024-016532","DOIUrl":"10.1136/bmjgh-2024-016532","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583072","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":"Practical norms in emerging infectious disease control: lessons for transnational collaboration from a suspected newly emerging zoonosis outbreak in Ghana.","authors":"Freya L Jephcott, Joseph Humphrey Kofi Bonney, Kennedy Owusu Arhin-Sam, Stephen Nyarko-Ameyaw, James Wood, Andrew A Cunningham, Paul Wenzel Geissler","doi":"10.1136/bmjgh-2024-017717","DOIUrl":"10.1136/bmjgh-2024-017717","url":null,"abstract":"<p><p>Concern around the emergence of zoonoses with pandemic potential has fuelled significant foreign engagement with domestic infectious disease surveillance and response systems across Africa. These international efforts at augmentation have likely been hampered, however, by an inattention to how such systems actually manifest on the ground and the critical activities and undertakings that take place outside of official structures and protocols. Such deviations from official protocols have previously been treated as inherently detrimental to public service delivery. A growing body of anthropological scholarship arising out of west and east Africa, however, has revealed that such deviations are often crucial to realising some core function or facet of it. Further, these apparent acts of discretion can represent broadly standardised sets of practices and structures that can be elucidated through interviews and observation.In this paper, we present an ethnographic account of the investigations into a suspected outbreak of a newly emerging zoonosis in the Brong Ahafo Region of Ghana between 2010 and 2016. By following the unfolding of the responses to the Brong Ahafo Region outbreak and drawing on observations from contemporaneous zoonotic outbreaks in West Africa, we elucidate the kinds of unofficial professional practices and shared visions of public service delivery which shape, and frequently augment, national responses to suspected newly emerging infectious diseases. The paper advances recent anthropological work on practical norms by applying them to emerging infectious disease control systems and considering the role of professional ethos in coordinating their use. The paper also clarifies the nature and utility of such unofficial activities for foreign would-be reformers of domestic surveillance and response systems in Africa, potentially enabling more effective transnational engagement with, and strengthening of, these critical systems for emerging infectious disease control.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567098","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}