BMJ Global Health最新文献

{"title":"Expanding access to sexual and reproductive health and rights through evidence-based policy dialogue: implications for practice from a multicountry initiative.","authors":"Ulrika Rehnstrom Loi, Amy Coates, Offeibea Obubah, Frank Noij, Katy Footman, Antonella Lavelanet, Hyobum Jang, Laurence Codjia, Laurence Läser, Tesfaye Tufa, Leopold Ouedraogo, Nilmini Hemachandra, Karima Gholbzouri, Meera Upadhyay, Neena Raina, Dina Gbenou, Souleymane Zan, Thierry Tossou Boco, Theopista John Kabuteni, Maria Mugabo Mujawamariya, Priya Karna, Ram Chahar, Amrita Kansal, Ellen Thom, Qudsia Uzma, Dan Kass, Carisse Hamlet, Adam Karpati, Shambhu Acharya, Bela Ganatra","doi":"10.1136/bmjgh-2024-016587","DOIUrl":"10.1136/bmjgh-2024-016587","url":null,"abstract":"<p><strong>Introduction: </strong>Policy dialogue is an important component of evidence-based policy-making. In 2019, WHO and Ministry of Health staff in 15 countries participated in an initiative that involved training and implementation of country-level sexual and reproductive health and rights (SRHR) policy dialogues. An evaluation of the process and outcomes was subsequently undertaken in six of the countries.</p><p><strong>Methods: </strong>The three-stage policy dialogue initiative included a preparatory phase to develop stakeholder analyses and policy briefs and a 2-day workshop to develop an action plan, followed by continuous support as the national teams implemented the action plans. A participatory, multimethod approach was used to evaluate the policy dialogue initiative, including a desk review of initiative documentation and interviews with project participants.</p><p><strong>Results: </strong>Participants reported positive experiences of the policy dialogue initiative and felt it improved their knowledge, skills and confidence. The ensuing policy dialogue activities in each country contributed to some SRHR policy development and/or implementation changes. The policy dialogue initiative supported these changes through its practical approach to learning and ongoing technical support. However, the impact of policy dialogues varied depending on political factors, the scope of policy goals, alignment with existing country priorities and stakeholder engagement. Furthermore, facilitating factors included strong support networks, incremental working and preparation for backlash against SRHR.</p><p><strong>Conclusions: </strong>Our experience highlights the value of policy dialogue for progressing SRHR policy change at the national level and the need for further investments in strengthening the skills of health decision-makers required for effective policy dialogue.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"8 Suppl 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771399","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":"Neurodevelopmental screening for neonates less than 44 weeks gestation in low-income and middle-income countries: a systematic review.","authors":"Benjamin J S Al-Haddad, Elisabeth Olson, Erin Reardon, Emmanuel Bonney","doi":"10.1136/bmjgh-2024-017683","DOIUrl":"10.1136/bmjgh-2024-017683","url":null,"abstract":"<p><strong>Introduction: </strong>With global improvements in neonatal survival, more small and sick newborns in low-income and middle-income countries (LMICs) are at increased risk of neurodevelopmental disability and delay. While there is increased recognition of the importance of early identification of neurodevelopmental differences and timely initiation of therapy, little is known about standardised neonatal neurodevelopmental screening tools in these settings.</p><p><strong>Methods: </strong>We performed a systematic review to determine what standardised neurodevelopmental assessments had been used in LMICs for neonates before 44 weeks corrected gestational age and published in the literature. We excluded short-term clinical assessments designed for specific pathologies. We performed the search across seven databases, screened studies for eligibility and inclusion and extracted bibliographic data, country, patient characteristics, assessments and study aims. Results were summarised in tabular and graphical presentation.</p><p><strong>Results: </strong>There were 2477 records screened, yielding 67 studies for inclusion. Studies in Asian countries made up 65.7%, while Latin America and Africa made up 19.4% and 16.4%, respectively. Physicians and paramedical staff performed the screening assessments in only 16.4% of studies, and 92.5% of studies used inpatient recruitment. The Neonatal Behavioural Neurological Assessment (25.4%) was the most frequently used screening tool followed by the General Movements Assessment (22.4%), the Hammersmith Neonatal Neurological Examination/Dubowitz (16.4%) and the Neonatal Behavioural Assessment Scale (10.4%).</p><p><strong>Conclusions: </strong>We did not identify any one neonatal neurodevelopmental screening assessment that is rapid, globally validated, identifies targets for intervention, has high predictive prognostic value and does not require neonatal or kinesiologic expertise or uncommon equipment. Such an assessment, in concert with evidence-based intervention, therapeutic delivery platforms, established referral pathways and trained personnel would improve functional outcomes for high-risk small and sick neonates in LMICs.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779038","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":"Physical activity policies in the six Gulf Cooperation Council countries: a qualitative study with document analysis.","authors":"Ali Ahmed Alzahrani, Peter Gelius, Anne Grunseit, Adrian Bauman, Klaus Gebel","doi":"10.1136/bmjgh-2024-017627","DOIUrl":"10.1136/bmjgh-2024-017627","url":null,"abstract":"<p><strong>Background: </strong>The Gulf states have some of the lowest physical activity levels and some of the highest obesity rates globally. Understanding physical activity policies is important but under-researched in this region.</p><p><strong>Purpose: </strong>To analyse physical activity policies in terms of structures, formulation, implementation and evaluation in the six Gulf Cooperation Council (GCC) member countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates (UAE)).</p><p><strong>Methods: </strong>We systematically searched the websites of the Ministries of Health, Education, Sport, Transport, Tourism and Municipal Affairs of the GCC countries between March 2023 and February 2024 for documents related to physical activity policy. Experts from Saudi Arabia, Oman and Bahrain were consulted to identify unpublished documents. Desk research questions from the Health-Enhancing Physical Activity Policy Audit Tool were used to evaluate the content of these documents in terms of the policy cycle model.</p><p><strong>Results: </strong>We identified 39 policy documents from the six countries. Comparative analysis revealed centralised governance across GCC nations, except for the UAE's federal monarchy system. Policy formulation typically involves collaboration among health, sports and education ministries, although responsibilities vary. There were no sedentary behaviour reduction policies. Policy implementation lacks funding, especially for marginalised groups such as individuals with disabilities and immigrants. Evaluation lacks economic assessment.</p><p><strong>Conclusions: </strong>Our study revealed a lack of implementation of physical activity policies and a general dearth of policies aimed at reducing sedentary behaviour within the GCC. Enhancing transparency, inclusion and evaluation mechanisms are essential for fostering effective physical activity policies in GCC countries.</p><p><strong>Practical implications: </strong>Our study provides impetus for policy-makers in the Gulf region to develop policies addressing sedentary behaviour and improving the evaluation framework. Additionally, it serves as a foundation for researchers to identify and address gaps in future policy analysis, contributing to the advancement of effective strategies for promoting physical activity.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 4","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779058","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":"Unintended pregnancy and gender inequality worldwide: an ecological analysis.","authors":"Gilda Sedgh, Jonathan Marc Bearak","doi":"10.1136/bmjgh-2024-016573","DOIUrl":"10.1136/bmjgh-2024-016573","url":null,"abstract":"<p><p>Unintended pregnancy compromises many women's and girls' ability to pursue the lives that they want. The conditional unintended pregnancy rate (CUPR) is a measure of unintended pregnancy among women who wish to avoid getting pregnant. Using the CUPR, we explore the relationship between gender inequality and unintended pregnancy across 132 countries. We used gender inequality indicators from the UNDP Human Development Report and estimates of the incidence of unintended pregnancy published by the Guttmacher Institute and WHO. We regressed the CUPR on several measures of gender inequality using least squares with a percentile bootstrap to account for sampling error and the additional uncertainty in the model-based unintended pregnancy estimates. We find that unintended pregnancy is positively correlated with multiple composite measures of gender inequality, even after controlling for countries' levels of economic development. Of the components of gender inequality, gender disparities in educational attainment were most strongly correlated with unintended pregnancy in multivariable regressions. We also find that female educational attainment is a stronger predictor of the CUPR than male educational attainment. Analyses with the standard unintended pregnancy rate, a measure that does not take into account differences across settings in the proportion of women who wish to avoid getting pregnant, obscured the strength of the observed relationships. Further exploration of the factors underlying this relationship can inform policies to improve the quality of women's lives.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751090","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 system effectiveness of symptomatic malaria case management in Papua New Guinea.","authors":"Vincent Minconetti, Clara Champagne, Michah Muri, Clara Are, Philemon Goi, Yangta Ura, Melvin Kualawi, Diana Timbi, Joseph Giduthuri, Myo Minn Oo, Leo Makita, Osama Seidahmed, Amanda Ross, William Pomat, Manuel W Hetzel","doi":"10.1136/bmjgh-2024-016825","DOIUrl":"10.1136/bmjgh-2024-016825","url":null,"abstract":"<p><p>Effective case management is crucial for malaria control efforts and is a cornerstone of malaria control programmes. Yet, although efficacious treatments exist, malaria case management often faces challenges, such as poor access to treatment providers, supply-chain issues, non-compliance with guidelines or substandard medication. In Papua New Guinea (PNG), progress in control efforts has stagnated in recent years. This study identifies barriers to and areas for improvement in malaria case management in PNG.A cascade of care model was used to estimate the health system effectiveness of malaria case management. Data from nationwide surveys conducted between 2013 and 2021 were used to quantify steps along a symptomatic case management pathway. Potential risk factors for cascade decay, including demographic, socioeconomic and health system characteristics, were investigated using mixed-effect logistic regression.The main bottleneck along the case management cascade was treatment-seeking, with only 40% (95% CI: 37% to 46%) of symptomatic malaria cases attending a formal health facility. A further important bottleneck was confirmatory parasitological diagnosis, provided to 77% (95% CI: 68% to 80%) of patients attending a health facility. Younger patients and those living in high transmission regions were more likely to receive a diagnostic test.Measures to improve the effectiveness of malaria case management in PNG should include increasing access to, utilisation and quality of formal health services. Further investigations to elucidate local determinants of treatment-seeking may support the National Malaria Strategic Plan's emphasis to optimise the delivery of proven interventions within the existing system.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742352","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 clubfoot treatment in 2023: an overview of advances and outcomes.","authors":"Tracey Smythe, Rosalind M Owen, Adam Aspden, Jennifer Everhart, Endashawu Abera, Peace Amaraegbulam, Rosalyn Flores, Liza Valdez, Chris Lavy","doi":"10.1136/bmjgh-2024-017861","DOIUrl":"10.1136/bmjgh-2024-017861","url":null,"abstract":"<p><strong>Introduction: </strong>Approximately 200 000 children are born each year with clubfoot, the majority of whom live in low-income and middle-income countries (LMICs). If untreated, clubfoot causes pain and reduced mobility, leading to activity limitations and disability. The Ponseti method is a highly effective and minimally invasive treatment. This observational study aims to quantify the countries providing clubfoot services and the children receiving treatment in 2023 and compares progress since data were first collected in 2005.</p><p><strong>Methods: </strong>In January and February 2024, data on clubfoot treatment in 2023 were collected from 70 countries. Informants completed a survey about new cases enrolled, treatment outcomes and health system integration. Data were analysed using descriptive statistics, with adjustments made for duplicates, and included clinic locations, the number and ages of children starting treatment, types of support available and Ministry of Health involvement. We compared coverage trends over time and used a cartogram to visualise the extent of clubfoot programme coverage across countries.</p><p><strong>Results: </strong>Responding countries accounted for 83% of all expected cases in LMICs. There was an increase in enrolment numbers, to 40 382, in 2023. Despite this progress, treatment coverage remained low at approximately 22% across respondent countries. While integration of clubfoot services into national healthcare systems varied widely, strong public-private partnerships in many countries suggest a foundation for sustainable, long-term treatment programmes. However, quality care remained a challenge, with only 67% of children receiving their first foot abduction brace, indicating gaps in ensuring comprehensive treatment necessary for successful clubfoot management. Lingering effects of COVID-19 restrictions include a higher percentage of cases enrolled after 1 year of age.</p><p><strong>Conclusions: </strong>A larger proportion of children in LMICs received Ponseti treatment in 2023 compared with 2005. However, more work is needed to expand national programmes, build sustainable, high-quality treatment capacity and ensure all children get the care they need to avoid lifelong disability.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742349","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":"Towards building climate-resilient health systems and communities: a clarion call to increase investments in public health disaster risk reduction in Africa.","authors":"Olushayo Oluseun Olu","doi":"10.1136/bmjgh-2024-016232","DOIUrl":"10.1136/bmjgh-2024-016232","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742404","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":"Seasonality of underweight among infants 1-11 months old in Niger: an exploratory analysis of data from a cluster-randomised trial.","authors":"Brittany Peterson, Ahmed Mamane Arzika, Ramatou Maliki, Amza Abdou, Bawa Aichatou, Ismael Sara, Diallo Beidi, Nasser Galo, Nasser Harouna, Alio Karamba Mankara, Sani Mahamadou, Moustapha Abarchi, Almou Ibrahim, Elodie Lebas, Jeremy David Keenan, Catherine E Oldenburg, Travis C Porco, Benjamin Arnold, Thomas M Lietman, Kieran S O'Brien","doi":"10.1136/bmjgh-2024-017643","DOIUrl":"10.1136/bmjgh-2024-017643","url":null,"abstract":"<p><strong>Introduction: </strong>Malnutrition is a risk factor for child mortality, with around 45% of deaths in children under 5 globally linked to malnutrition. Seasonality of malnutrition has important implications for the timing of child health programme activities, but evidence is mixed on the nature of such patterns. Moreover, the bulk of the existing evidence is focused on wasting and stunting in children 6-59 months, despite increasing evidence that younger children also face a high risk, and that underweight alone is an important predictor of mortality.</p><p><strong>Methods: </strong>This study used data from the cluster-randomised AVENIR trial which compared the effect of biannual distribution of azithromycin vs placebo on mortality in children 1-59 months old in Niger. AVENIR included a biannual census conducted on a rolling basis over 2 years. A subset of 133 781 infants aged 1-11 months from 2904 communities were included in this study, and weight-for-age z-score (WAZ) was calculated at each census. The exposure for this analysis is the day of the year weight was captured. Harmonic regression was used to determine primary and secondary peaks and nadirs of WAZ over time.</p><p><strong>Results: </strong>Overall, the primary peak of WAZ occurred in late February and the primary nadir occurred in mid-May, aligning with a seasonal temperature increase before the rainy season. A secondary peak in August and a secondary nadir in November were also seen, aligning with the postrainy season.</p><p><strong>Conclusion: </strong>The seasonality of WAZ of infants 1-11 months in Niger may have implications for the timing of programmes aiming to decrease malnutrition.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742363","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":"Cumulative population blood lead levels.","authors":"Richard Fuller, Kate Porterfield, David Hanrahan, Howard Hu","doi":"10.1136/bmjgh-2024-018145","DOIUrl":"10.1136/bmjgh-2024-018145","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728653","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":"Balancing short-term and long-term climate-health equity strategies: a framework for supporting faster, fairer joint action on climate change and health equity.","authors":"Kirsty Wild, Kumanan Rasanathan, Sudhvir Singh, Alistair Woodward","doi":"10.1136/bmjgh-2024-016094","DOIUrl":"10.1136/bmjgh-2024-016094","url":null,"abstract":"<p><p>In this conceptual paper, we propose an integrated framework to support and accelerate joint action on climate change and health equity. We introduce a 'healthy climate, healthy people' framework, designed to support the complex task of synchronising these two significant justice challenges. The framework includes four domains for joint action: (1) Health in all climate mitigation policies; (2) Mitigation with health equity 'co-benefits'; (3) Pro-poor climate adaptation and (4) Greening health equity. We discuss practical implications for policy-makers, including the importance of attending to the health equity dimensions of both climate change and climate action; the value of increasing the use of rapid health equity assessment tools and harm-reducing (redistributive and compensatory) policy measures; the importance of community knowledge and the critical role of 'fair effort sharing' and tackling the emissions of the wealthy.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 Suppl 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728576","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}