BMJ Global Health最新文献

{"title":"Immunisation health workforce capacity building in Southeast Asia: reflections from training programme implementation in Cambodia and Lao PDR.","authors":"Gemma Saravanos, Alvin Kuo Jing Teo, Esabelle Lo Yan Yam, Sok Chamreun Chou, Niramonh Chanlivong, Phorng Chanthorn, Chhit Thy, Souphon Sayavong, Julie Leask, Siyan Yi, Margie Danchin, Chris Morgan, Kylie Jenkins, Martyn Kirk, Kristine Macartney, Ben Coghlan, Michelle Apostol, Dinesh Arora, Darren Gray, Tracy Smart, Meru Sheel","doi":"10.1136/bmjgh-2024-018007","DOIUrl":"10.1136/bmjgh-2024-018007","url":null,"abstract":"<p><p>The Immunization Agenda 2030 emphasises the need for a motivated, skilled and knowledgeable workforce equipped to plan, manage, implement and monitor immunisation programmes at all levels. The rapid introduction of COVID-19 vaccines during the pandemic highlighted the adaptability of the health workforce but also exposed gaps in professional development and learning.This practice paper describes the implementation of an immunisation training programme in the Kingdom of Cambodia and the Lao People's Democratic Republic. The programme was developed and delivered by the project team in partnership with local stakeholders and technical experts. A country-centric approach ensured that training programmes met each country's needs, while input from technical experts ensured an evidence-based programme that aligned with international standards. There were 445 training participants from professional groups across various levels and sectors of the health system. Training curricula included a range of differentiated training modules which aimed to build knowledge and skills to drive increased vaccine demand, improve service delivery and optimise monitoring and evaluation of programmes.The Gavi Learning and Performance Management framework supported a structured reflection of programme strengths, limitations and opportunities. Strengths were the country-centric and learner-centric approach and the high technical quality of the programme. The pandemic context necessitated agility and adaptation to meet changing country needs and priorities, however, this introduced some limitations. Future training programmes should undertake an enhanced assessment of training needs, workforce and digital capabilities and learning and performance management systems, alongside the development of country-driven immunisation workforce training roadmaps to ensure optimal impact and sustainability.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456912","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":"Adherence to mask-wearing and its impact on the incidence and deaths of viral respiratory infectious diseases: a systematic review, meta-analysis and modelling study.","authors":"Can Chen, Wenkai Zhou, Jiaxing Qi, Mengsha Chen, Zhenglin Yuan, Jiani Miao, Mengya Yang, Jiaxin Chen, Fang Shen, Kexin Cao, Rongrong Qu, Daixi Jiang, Yuxia Du, Xiaoyue Wu, Yue You, Rui Yan, Changtai Zhu, Shigui Yang","doi":"10.1136/bmjgh-2024-017087","DOIUrl":"10.1136/bmjgh-2024-017087","url":null,"abstract":"<p><strong>Background: </strong>This study systematically analysed global and regional adherence to mask-wearing and its impact on the incidence and deaths of viral respiratory infectious diseases (VRIDs).</p><p><strong>Methods: </strong>Relevant studies were sourced from PubMed, Web of Science, Embase and Scopus. We included observational studies with available raw data on mask-wearing adherence (rates of acceptability of mask-wearing, mask-wearing in public settings and correct mask-wearing) during VRID pandemics/epidemics. The COVID-19-related incidence and deaths were sourced from Global Burden of Diseases 2021. The quality of each study was assessed using the Agency for Healthcare Research and Quality Scale. Pooled rates and effects of mask-wearing were calculated using random effects models and generalised linear models.</p><p><strong>Results: </strong>We included 448 studies from 70 countries/regions. During the VRID pandemics/epidemics, global pooled rates for the acceptability of mask-wearing, mask-wearing in public settings and correct mask-wearing were 65.27% (95% CI 60.34% to 70.05%), 74.67% (95% CI 69.17% to 79.8%) and 63.63% (95% CI 59.28% to 67.87%), respectively. In individuals with chronic diseases/elderly/pregnant women, the rates of acceptability (42.54%) and correct mask-wearing (60.56%) were both low. Among the general population, the rates of mask-wearing in public settings (68.2%) and correct mask-wearing (57.45%) were the lowest. During the COVID-19 pandemic, countries with a requirement for mask-wearing exhibited a higher rate in public settings (76.10% vs 58.32%), especially in regions with more stringent containment and health measures (β=0.86, p=0.008). The mask-wearing in public settings has been found to significantly reduce the COVID-19 incidence (β=-265.26, p=0.004), COVID-19 deaths (β=-2.04, p<0.001) and other COVID-19 pandemic-related deaths (β=-0.83, p<0.001).</p><p><strong>Conclusion: </strong>During the VRID pandemics/epidemics, adherence to mask-wearing was relatively low. Implementing policies requiring mask-wearing during the pandemic could enhance the mask-wearing rate, potentially leading to a significant reduction in VRID-related incidence and deaths.</p><p><strong>Trial registration number: </strong>CRD42024496464.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456926","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":"Evaluating geographic accessibility to COVID-19 vaccination across 54 countries/regions.","authors":"Yanjia Cao, Tianyu Li, Huanfa Chen, Qunshan Zhao, Jiashuo Sun, Karen Ann Grépin, Jeon-Young Kang","doi":"10.1136/bmjgh-2024-017761","DOIUrl":"10.1136/bmjgh-2024-017761","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has revealed significant disparities in global vaccine accessibility, particularly affecting low and middle-income countries (LMICs). However, current research on COVID-19 vaccine accessibility primarily focuses on individual countries or high-income countries (HIC). We aimed to evaluate geographic accessibility to COVID-19 vaccination on a multicountry scale, covering comparisons across LMICs and HICs. Additionally, we explored the potential economic factors related to accessibility and their impacts on health outcomes.</p><p><strong>Methods: </strong>We collected population data at a 1 km resolution and geocoded all vaccination sites across the selected countries/regions. Four measures were used to evaluate vaccine accessibility from different perspectives: population coverage with varying travel time thresholds, driving time to vaccination sites, the number of sites within a 30-min threshold and a geographic accessibility index using enhanced two-step floating catchment area method. Finally, we explored the relationships between geographic accessibility and several factors: gross domestic product per capita, vaccination uptake and mortality.</p><p><strong>Findings: </strong>We found substantial disparities in vaccine accessibility across the selected countries/regions. In 24.07% of these countries/regions, over 95% of the population can access the nearest vaccination services within 15 min. In contrast, in countries/regions such as Manitoba (Canada), Zimbabwe and Bhutan, less than 30% of the population can reach these sites within 60 min. Underserved areas, termed 'vaccine deserts', were identified in both HICs and LMICs. We found that countries/regions with higher vaccine accessibility tend to achieve higher vaccination rates, whereas those with lower vaccine accessibility are likely to experience substantial increases in COVID-19 mortality rates.</p><p><strong>Conclusion: </strong>LMICs require enhanced attention to improve geographic accessibility to vaccination. Additionally, there are internal disparities in accessibility within both HICs and LMICs. National public health officials and global health initiatives are suggested to prioritize 'vaccine deserts' and to ensure equitable vaccine access in future pandemics.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456702","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 impact of the social media industry as a commercial determinant of health on the digital food environment for children and adolescents: a scoping review.","authors":"Jesse Lafontaine, Isabel Hanson, Cervantée Wild","doi":"10.1136/bmjgh-2023-014667","DOIUrl":"10.1136/bmjgh-2023-014667","url":null,"abstract":"<p><strong>Introduction: </strong>There is emerging evidence that the social media industry contributes to adverse health outcomes by shaping the digital food environment for children and adolescents (aged 0-18). The aim of this scoping review was to determine the extent of research on how the social media industry, including the broader online landscape, influences the digital food environment and affects child and adolescent health.</p><p><strong>Methods: </strong>A scoping review was conducted in the electronic databases of PubMed, Scopus and PsycINFO, along with forward and reverse citation searching for peer-reviewed articles published in English between 2000 and May 2023. A qualitative descriptive synthesis of the included articles was performed to identify trends, themes and research gaps in the current literature.</p><p><strong>Results: </strong>The review identified 36 articles for inclusion. Most research was conducted in high-income countries and publications have increased since 2021. The review found most children and adolescents are exposed to food advertisements on social media and most advertised food is ultra-processed. Heightened by a lack of social media advertising awareness, digital food marketing influences children and youth's consumption and food behaviour. Voluntary children's food marketing regulations are ineffective for the online environment. Countering unhealthy food marketing will require media literacy and government regulation.</p><p><strong>Conclusion: </strong>The social media industry may act as a commercial determinant of health to shape the digital food environment as an extension of the obesogenic environment. Further research should explore approaches to monitor unhealthy food marketing practices and understand social media's role in the digital food environment.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456873","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 burden of mpox among MSM in South Africa.","authors":"Ruth McCabe, Leigh F Johnson, Lilith K Whittles","doi":"10.1136/bmjgh-2024-017268","DOIUrl":"10.1136/bmjgh-2024-017268","url":null,"abstract":"<p><p>Despite seeing few cases during the 2022-2023 mpox global outbreak, reports in May-July 2024 of 22 cases among men-who-have-sex-with-men (MSM) in South Africa, including three deaths, have raised concerns about under-reported community transmission. We used a Monte Carlo simulation model to estimate the true epidemic size, considering the increased severity of mpox among MSM living with advanced HIV, documented over-representation of people living with HIV among mpox cases and HIV prevalence in South Africa. We estimate that there have been between 220 and 450 cases among MSM LHIV in South Africa, with a total of 290-560 cases among all MSM. We provide an upper bound of 750-1600 cases as a sensitivity analysis where the prevalence of HIV among mpox patients is the same as population prevalence among MSM in South Africa. Estimates in both scenarios suggest a substantial number of undetected cases, with case ascertainment rates estimated between 1% and 8%. Our findings underscore the need for enhanced surveillance, targeted public health interventions and awareness campaigns to mitigate the outbreak's impact at a population level.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456667","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 health insurance among women engaged in transactional sex and impacts on HIV transmission in Cameroon: a mathematical model.","authors":"Kasim Allel, Henry Cust, Iliassou Mfochive, Sandie Szawlowski, Emile Nitcheu, Eric Defo Tamgno, Stephanie Moyoum, Julienne Noo, Serge Billong, Ubald Tamoufe, Aurelia Lepine","doi":"10.1136/bmjgh-2024-017870","DOIUrl":"10.1136/bmjgh-2024-017870","url":null,"abstract":"<p><strong>Introduction: </strong>HIV prevalence disproportionately affects high-risk populations, particularly female sex workers in Africa. Women and girls engaging in transactional sex (WGTS) face similar health risks from unsafe practices, economic vulnerabilities and stigma. However, they are not recognised.</p><p><strong>Methods: </strong>Using existing literature and data from the POWER randomised controlled trial, we developed a deterministic compartmental model to assess HIV dynamics among WGTS, their sugar daddies and low-risk populations. We evaluated the cost-effectiveness of a new structural intervention to prevent HIV among WGTS in urban Cameroon by reducing the financial need to engage in transactional sex in the case of illness and injury shocks to the household. The intervention provided free healthcare to WGTS and their economic dependents through a zero-cost health insurance package. We explored the cost-effectiveness of this intervention considering various population coverage levels (0%, 25%, 50%, 75% and 100%). We calculated the incremental cost-effectiveness ratio (ICER) per disability-adjusted life-year (DALY) and HIV infections averted, employing both univariable and global sensitivity analyses. Probabilistic sensitivity analyses considered all parameters, including the insurance effect in reducing HIV, comparing simulated ICERs to willingness-to-pay thresholds. We also compared the health insurance strategy with expanding pre-exposure prophylaxis (PrEP) coverage. All costs were evaluated in 2023 UK pounds (£) using a 3% discount rate, with Cameroon's gross domestic product (GDP) per capita recorded at £1239.</p><p><strong>Results: </strong>Implementing health insurance coverage levels of 25%, 50%, 75% and 100% yielded ICERs/DALY averted of £2795 (£2483-£2824), £2541 (£2370-£2592), £2263 (£2156-£2316) and £1952 (£1891-£1998), respectively, compared with 0% coverage. Probabilistic sensitivity analysis indicated an ICER=£2128/DALY averted at 100% coverage, with 58% of simulations showing ICERs<GDP per capita. Maintaining health insurance's effect in reducing HIV above 70% could provide significant health and economic benefits. However, antiretroviral therapy (ART) efficacy significantly impacted HIV infection prevention (partial rank correlation coefficient=-0.62, p<0.001) in global sensitivity analyses; expanding ART could reduce the cost-effectiveness of health insurance. While PrEP alone is not cost-effective, combining 20% PrEP coverage with 75%-100% health insurance for WGTS maximises DALYs averted (ICER/DALY averted=£2436-£2102) and reduces infections.</p><p><strong>Conclusion: </strong>A comprehensive health insurance scheme for women in Cameroon could significantly reduce HIV infections and DALYs, promoting a more inclusive and targeted healthcare policy for women at high risk of HIV.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448125","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":"Public patient forwarding to private pharmacies: an analysis of data linking patients, facilities and pharmacies in the state of Odisha, India.","authors":"Annie Haakenstad, Anuska Kalita, Bijetri Bose, Arpita Chakraborty, Kirti Gupta, Sian Hsiang-Te Tsuei, Liana Rosenkrantz Woskie, Winnie Yip","doi":"10.1136/bmjgh-2024-017788","DOIUrl":"10.1136/bmjgh-2024-017788","url":null,"abstract":"<p><strong>Introduction: </strong>In India, public sector patients purchase drugs from private pharmacies instead of obtaining them for free from public pharmacies-a phenomenon we call public patient forwarding to private pharmacies. This behaviour results in substantial financial hardship. We examine whether low public drug stocks, patient preferences for private drugs or the presence of private pharmacies nearby explain this behaviour.</p><p><strong>Methods: </strong>We collected cross-sectional data from 7567 households, 523 health facilities and 1036 private pharmacies in Odisha, India. We linked 917 outpatient visits to facilities based on patient reports and linked public facilities to the nearest private pharmacy using Global Positioning System coordinates. We used ordinary least squares regression to assess whether the behaviour of facilities and patients was associated with drug stocks and pharmacy proximity, and whether patient satisfaction was associated with private drug purchases.</p><p><strong>Results: </strong>Among public patients prescribed drugs, more than 70% purchased private drugs. In hospitals, for each 10% increase in drug stocks, 4.8% fewer patients purchased private drugs (p=0.047). In primary facilities, the same share of patients purchased private drugs across stock levels. Regardless of facility level, when more than 75% of drugs were in stock, 60% or more of patients still obtained drugs from the private sector. Patients were more likely to purchase private drugs when private pharmacies were near public facilities, but were not more satisfied with their visit when they obtained private drugs.</p><p><strong>Conclusion: </strong>The results suggest that private pharmacies are both secondary and complementary suppliers of drugs for hospitals, but may act more like substitutes for primary facilities, consistent with evidence that private pharmacies provide advice and other services akin to primary care in Odisha. Improving public facility drug stocks alone is unlikely to fully address drug-driven financial hardship in India. Provider prescribing practices should be investigated to identify additional policy options.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448126","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":"Embedding risk monitoring in infectious disease surveillance for timely and effective outbreak prevention and control.","authors":"Brecht Ingelbeen, Esther van Kleef, Placide Mbala, Kostas Danis, Ivalda Macicame, Niel Hens, Eveline Cleynen, Marianne A B van der Sande","doi":"10.1136/bmjgh-2024-016870","DOIUrl":"10.1136/bmjgh-2024-016870","url":null,"abstract":"<p><p>Epidemic intelligence efforts aim to predict, timely detect and assess (re-)emerging pathogens, guide and evaluate infectious disease prevention or control. We emphasise the underused potential of integrating the monitoring of risks related to exposure, disease or death, particularly in settings where limited diagnostic capacity and access to healthcare hamper timely prevention/control measures. Monitoring One Health exposures, human behaviour, immunity, comorbidities, uptake of control measures or pathogen characteristics can complement facility-based surveillance in generating signals of imminent or ongoing outbreaks, and in targeting preventive/control interventions or epidemic preparedness to high-risk areas or subpopulations. Low-cost risk data sources include electronic medical records, existing household/patient/environmental surveys, Health and Demographic Surveillance Systems, medicine distribution and programmatic data. Public health authorities need to identify and prioritise risk data that effectively fill gaps in intelligence that facility-based surveillance can not timely or accurately answer, determine indicators to generate from the data, ensure data availability, regular analysis and dissemination.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440024","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":"Effective coverage for reproductive, maternal, neonatal and newborn health: an analysis of geographical and socioeconomic inequalities in 39 low- and middle-income countries.","authors":"Tiara Marthias, Kanya Anindya, Nurmala Selly Saputri, Likke Prawidya Putri, Rifat Atun, John Tayu Lee","doi":"10.1136/bmjgh-2024-016549","DOIUrl":"10.1136/bmjgh-2024-016549","url":null,"abstract":"<p><strong>Background: </strong>Inadequate access to quality maternal and child health services leads to poor health outcomes for millions of women, particularly in low- and middle-income countries (LMICs). This study aims to explore the effective coverage of reproductive, maternal, neonatal and newborn health (RMNCH) services and examines socioeconomic and rural and urban disparities in 39 LMICs.</p><p><strong>Methods: </strong>Using Demographic and Health Surveys (DHS) data, the research assesses RMNCH service quality by applying an effective coverage framework, which measures service contact, crude coverage, quality-adjusted coverage and user adherence-adjusted coverage. We applied weighted analyses to investigate the rural-urban differences in service coverage based on countries' Human Development Index (HDI) levels as well as crude coverage and socioeconomic levels.</p><p><strong>Findings: </strong>Urban areas generally exhibit better effective coverage across all RMNCH services compared with rural areas, with significant disparities in antenatal, childbirth and postnatal care. For instance, 85% (95% CI=85-86%) of urban women received skilled birth attendance compared with 64% (95% CI=64-65%) in rural areas. High-HDI countries show smaller rural-urban gaps in service coverage than low-HDI countries. Socioeconomic inequalities are more pronounced in rural areas, particularly in services that require higher quality and adherence to standards. Socioeconomic disparities are significant in LMICs with lower HDI and are more evident in harder-to-achieve quality indicators, such as user adherence to recommended practices or treatment. For example, in medium-HDI countries, the relative inequality index (RII) for antenatal care user adherence coverage is 3.6 (95% CI=3.4-3.8) in rural areas compared with 1.9 (95% CI=1.8-2.1) in urban areas.</p><p><strong>Interpretation: </strong>The research underscores the need for targeted interventions and policies to address these disparities. The evidence supports the need for a shift from focusing solely on access to care to improve the quality of care to address rural-urban and socioeconomic inequalities in RMNCH outcomes.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440011","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":"Implications for developing global health education in China: evidence from an undergraduate teamwork with role-play.","authors":"Yi Cai, Hong Chen, Chenkai Wu, Taufique Joarder, Junxiong Pang, Chen Chen","doi":"10.1136/bmjgh-2024-017407","DOIUrl":"10.1136/bmjgh-2024-017407","url":null,"abstract":"<p><strong>Background: </strong>Since 2012, China has had one degreed undergraduate programme in global health for domestic students. The International Health Project Management course is a core component of this programme's curriculum, bridging theoretical knowledge to practice in global health engagement. This study aims to evaluate whether introducing a teamwork and role-play module would meet the learning objectives, including improving students' perception of global health, enhancing their understanding of the management processes for global health projects, and eventually developing competencies for effective global health involvement.</p><p><strong>Methods: </strong>The teamwork role-play module was used in a scenario assuming that all students played a specific role in project management in the 'Health System Enhancement for Pandemic Preparedness in Southeast and South Asian Countries' programme. This programme called for proposals to implement a project in at least one country in Southeast or South Asia. We conducted a content analysis using two types of materials from the students: (1) concept note and proposal presentations and (2) students' responses to the open-question feedback survey with four questions.</p><p><strong>Results: </strong>Students addressed the colonial origins of global health and its evolving definition, emphasising the need for a broader interdisciplinary approach. They perceived China's role in global health as evolving from a recipient to a donor, collaborator or participator, with a focus on enhancing soft power. However, their inadequate background knowledge of global health issues hindered their ability to undertake the tasks in depth. Students provided positive feedback on the teamwork with the role-play module, highlighting improved efficiency, broader and deeper learning through communication, increased participation, etc. Challenges such as poor leadership in teamwork, communication breakdowns and unequal workload distribution were identified.</p><p><strong>Conclusions: </strong>Students showed a comprehensive understanding of managing a global health project through their teamwork tasks. Introducing teaching assistants to support teamwork, providing more hands-on opportunities, and integrating a broader range of disciplines into the curriculum will be crucial for the continued development of effective global health education programmes.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439538","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}