Bulletin of the World Health Organization最新文献

{"title":"Capacity for national health policy modelling, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates.","authors":"Abdullah Alibrahim, Fadi El-Jardali","doi":"10.2471/BLT.25.294844","DOIUrl":"https://doi.org/10.2471/BLT.25.294844","url":null,"abstract":"<p><p>Gulf Cooperation Council countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates) have similar governance structures, economic profiles and health system organization, creating an opportunity for collective action on health. Similarly, these countries have the same challenges including ageing populations, climate and heat risks, immigration, service delivery and disease profiles. We argue for the need to shift from opinion-driven policy discourse to computer-based, decision-focused policy analysis that is participatory, aware of inherent uncertainties surrounding decisions and context-specific. Despite areas of excellence, modelling capacity in these countries is fragmented and underresourced and models are rarely used to guide decision-making. The coronavirus disease 2019 pandemic saw very few decision-oriented models tied to local data from Gulf Cooperation Council countries. Gulf Cooperation Council models rely on outside modellers, which limits both the relevance and ownership of the findings. The coming decade will bring challenges that demand a change in how evidence is generated and applied. A structured, regionally anchored policy-modelling system can help governments test reforms, prioritize investments and engage in scenario planning before crises force reactive measures. Our paper outlines pragmatic steps towards effective health policy modelling based on four supporting pillars: (i) a regional co-produced modelling and knowledge translation strategy tied to priority decisions; (ii) embedded capacity-building across ministries, public health institutes and universities; (iii) a viable modelling stack that allows transparency, speed and reproducibility; and (iv) explicit communication and evaluation of the uncertainty of models to reduce risks within the choices made.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"104 10","pages":"682-689"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104417","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":"Improvements to pharmaceutical manufacturing capacity, Ethiopia.","authors":"Kedir Tahir Hagos, Tsige Gebre-Mariam, David Woo, Abraham Gebregiorgis Kahsay, Mengistab Woldearegay Teferi, Jicui Dong","doi":"10.2471/BLT.25.295594","DOIUrl":"https://doi.org/10.2471/BLT.25.295594","url":null,"abstract":"<p><strong>Problem: </strong>Ethiopia's heavy dependence on imported pharmaceuticals created public health vulnerabilities, foreign exchange pressures and recurrent medicine stock-outs.</p><p><strong>Approach: </strong>In 2015, Ethiopia launched a 10-year National Strategy and Plan of Action for Pharmaceutical Manufacturing Development to improve access to quality-assured medicines. The strategy, overseen by a Joint Steering Committee co-chaired by the Ministries of Health and Industry with technical assistance from the World Health Organization (WHO), combined industrial incentives, preferential centralized procurement and regulatory strengthening.</p><p><strong>Local setting: </strong>Before strategy implementation, Ethiopia had limited manufacturing capacity. Local manufacturers supplied approximately 20% of national generic medicine demand, while supply chain fragmentation and foreign exchange constraints compromised access to imported medicines.</p><p><strong>Relevant changes: </strong>By 2025, six facilities had achieved national good manufacturing practice compliance, 11 manufacturers were operational and the Ethiopian Food and Drug Authority reached WHO Maturity Level 3. Locally produced coverage of the National Essential Medicines List increased from 90 to 140 chemical entities, across 167 dosage forms, and a vaccine manufacturing initiative was launched. However, domestic supply only increased to 23% against a 60% public procurement target; active pharmaceutical ingredient production and WHO prequalification remained unachieved, and export and workforce targets were missed.</p><p><strong>Lessons learnt: </strong>Combined, the strategy's cross-sectoral governance, regulatory strengthening, preferential centralized procurement and industrial incentives advanced local production. However, foreign exchange constraints, dependence on imported raw materials and financing and capacity gaps limited progress. Future efforts should prioritize WHO prequalification, upstream manufacturing, skilled workforce development, export competitiveness and sustainable financing while maintaining patient-centred objectives.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"104 10","pages":"705-710"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104444","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 health round-up.","authors":"","doi":"10.2471/BLT.26.011026","DOIUrl":"https://doi.org/10.2471/BLT.26.011026","url":null,"abstract":"","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"104 10","pages":"660-661"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104483","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":"Epistemic injustice in climate health research.","authors":"Verina Wild, Anthony Capon, Jan-Christoph Heilinger, Cristian Timmermann, Mujahid Torwali, Jakelin Troy","doi":"10.2471/BLT.25.294374","DOIUrl":"https://doi.org/10.2471/BLT.25.294374","url":null,"abstract":"","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"104 10","pages":"711-713"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104439","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":"Accountability for large language models in health care.","authors":"Carlos Fernando Mourão, Luiz Eduardo Juliasse","doi":"10.2471/BLT.26.296186","DOIUrl":"https://doi.org/10.2471/BLT.26.296186","url":null,"abstract":"<p><p>Large language models are entering clinical workflows faster than health-care institutions can assign responsibility for their failures. This situation is creating governance gaps with consequences that extend beyond individual patients to public health systems. The result is an accountability vacuum in which responsibility for harm mediated by large language models can be spread across clinicians, institutions and vendors. This responsibility gap distributes harm inequitably, particularly in low- and middle-income countries where regulatory infrastructure for digital health is still developing. We propose earned delegation as a predeployment standard: authority should be delegated only when evidence is proportionate to clinical risk, substantive human oversight is integrated and resourced, and responsibility for foreseeable failure modes is assigned in advance. To operationalize this standard, health systems should adopt a predeployment accountability charter specifying intended use, excluded use, validation evidence, oversight design, escalation pathways, auditability, subgroup performance review and named accountable parties. The charter should be integrated into existing institutional review, accreditation and procurement structures. Earned delegation provides a governance framework that health ministries, regulators and institutional leaders can adopt to ensure that use of large language models serves public health goals without outpacing them.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"104 10","pages":"698-704"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104408","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":"How a 10-minute bout requirement for physical activity affects guideline adherence estimates, Germany.","authors":"Julian Brummer, Michael J Stein, Hansjörg Baurecht, Mirko Brandes, Christoph Buck, Antje Hebestreit, Lilian Krist, Michael Leitzmann, Andrea Weber, Volker Harth, Jana-Kristin Heise, Verena Katzke, Thomas Keil, Alexander Kluttig, Claudia Meinke-Franze, Rafael Mikolajczyk, Ute Mons, Katharina Nimptsch, Nadia Obi, Cara Övermöhle, Annette Peters, Tobias Pischon, Börge Schmidt, Matthias B Schulze, Henry Völzke, Stefan N Willich, Florian Herbolsheimer, Karen Steindorf","doi":"10.2471/BLT.25.295087","DOIUrl":"https://doi.org/10.2471/BLT.25.295087","url":null,"abstract":"<p><strong>Objective: </strong>To examine how adherence to the World Health Organization's (WHO) physical activity guidelines changes with and without the application of a 10-minute bout requirement.</p><p><strong>Methods: </strong>We analysed accelerometry data from the baseline assessment of the German National Cohort, NAKO. Using predefined acceleration thresholds, we classified each participant's volumes of moderate and vigorous intensity physical activity and compared these values with WHO guidelines. We analysed data with and without the 10-minute bout requirement. We used Welch's analysis of variance and equal proportions tests to compare demographic and health characteristics between participants who met the activity guidelines and those who did not.</p><p><strong>Findings: </strong>Of 63 134 participants, 22 226 (35.2%) met the guidelines with the bout requirement, while 62 532 (99.0%) met the guidelines without it. Participants who met the guidelines under each condition differed in demographic and health-related characteristics. For example, mean age was 48.6 years (SD: 13.0) among participants meeting the guidelines with the bout, 50.8 years (SD: 12.2) among those meeting only the guidelines without the bout and 60.8 years (SD: 10.4) among those meeting neither guidelines. Participants meeting the guidelines with the bout had a lower body mass index (25.2 kg/m²; SD: 4.0) than those meeting only the guidelines without the bout (27.0 kg/m²; SD: 5.1) and those meeting neither guidelines (30.6 kg/m²; SD: 7.1).</p><p><strong>Conclusion: </strong>Removing the 10-minute bout requirement for accelerometry-measured activity volumes substantially increased estimated guideline adherence. The change has implications for interpreting time trends in guideline adherence and alters conclusions about which population subgroups meet the guidelines.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"104 10","pages":"673-681"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104428","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":"Seasonal malaria chemoprevention effectiveness and drug resistance in Plasmodium falciparum: a matched parallel cohort study, Kenya.","authors":"Beatrice Rotich, Emmah Kimachas, Joseph Kipkoech, Erastus Kirwa, Christine Markwalter, David Ekai, Ann Mwangi, Suzanne Van Hulle, Diana Menya, Wendy Prudhomme O'Meara","doi":"10.2471/BLT.25.294889","DOIUrl":"https://doi.org/10.2471/BLT.25.294889","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate seasonal malaria chemoprevention with sulfadoxine-pyrimethamine and amodiaquine in a semi-nomadic community in north-western Kenya, and to examine the relationship between parasite resistance and breakthrough infections.</p><p><strong>Methods: </strong>A parallel cohort study conducted during the peak malaria season in 2024 involved 10 randomly selected villages in Turkana Central subcounty, where children younger than 5 years received seasonal malaria chemoprevention, and 10 matched villages in Turkana North subcounty (non-intervention cohort). We conducted surveillance of malaria symptoms weekly. The primary outcome was malaria-like symptoms plus a positive rapid diagnostic test result. We analysed <i>Plasmodium falciparum</i> genomic DNA in dried blood spot samples from children with symptomatic infections to identify <i>pfdhfr</i> and <i>pfdhps</i> gene substitutions associated with sulfadoxine-pyrimethamine resistance.</p><p><strong>Findings: </strong>Children (198 in the intervention cohort and 200 in the non-intervention cohort) were followed until four weeks after the last chemoprevention cycle. In the intervention cohort, 72% (143/198) completed all five cycles. The incidence of malaria was significantly lower in the intervention than non-intervention cohort (adjusted incidence rate ratio 0.29; 95% confidence interval: 0.13-0.67). <i>Plasmodium falciparum</i> genomic DNA analysis of samples from 68 infected children showed that <i>pfdhps</i> gene mutations were more common in the intervention than non-intervention cohort and became more frequent as the number of treatment cycles increased.</p><p><strong>Conclusion: </strong>Seasonal malaria chemoprevention with sulfadoxine-pyrimethamine and amodiaquine was associated with substantial protection against malaria in children in an area where sulfadoxine-pyrimethamine resistance was common. Treated children were more likely to harbour resistant parasites.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"104 10","pages":"662-672"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104509","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 plastics treaty negotiations and health-care system use of plastics, WHO African Region.","authors":"Oluwaseyi Muyiwa Egbewande, Oladotun Erastus Okediji, Adedayo Samsondeen Adeboye","doi":"10.2471/BLT.26.295879","DOIUrl":"https://doi.org/10.2471/BLT.26.295879","url":null,"abstract":"","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"104 10","pages":"659-659A"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case for eliminating Widal testing for enteric fever, India.","authors":"Kamini Walia, Ram Gopalakrishnan, Priscilla Rupali, Camilla Rodrigues, V Ramasubramanian, Veeraraghavan Balaji, Vinod Ohri, Navin Dang, Chand Wattal, Himanshu Reddy, Nitin Bansal, Hina Singh","doi":"10.2471/BLT.26.295696","DOIUrl":"https://doi.org/10.2471/BLT.26.295696","url":null,"abstract":"","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"104 10","pages":"714-716"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104396","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":"An oral health module for use in noncommunicable disease risk factor surveys.","authors":"Nicole Rendell, Habib Benzian, Richard G Watt, Leanne Riley, Eugenio Beltrán, Eduardo Bernabe, Jonathan Broadbent, Moréniké O Foláyan, Heba Fouad, Nicolas Giraudeau, Nalika Gunawardena, Yuriko Harada, Anja Heilmann, Carolina Hommes, Yuka Makino, Ricardo Martinez, Sudeshni Naidoo, Marco A Peres, Waranuch Pitiphat, Maha El Tantawi, Georgios Tsakos, Elena Tsoy, Renato Venturelli, Benoit Varenne","doi":"10.2471/BLT.25.295572","DOIUrl":"https://doi.org/10.2471/BLT.25.295572","url":null,"abstract":"<p><p>The World Health Organization (WHO) <i>Global strategy and action plan on oral health 2023-2030</i> emphasizes the need to strengthen oral health information systems, including surveillance, to support public health action. Objective 5 of the <i>Global strategy and action plan on oral health 2023-2030</i> calls for reliable, timely and policy-relevant data to inform decision-making, promote accountability and monitor progress, in other words, surveillance of oral diseases. However, most countries face challenges in identifying and applying practical tools to generate such population-level data. Until recently, the WHO STEPwise approach to noncommunicable disease risk factor surveillance (STEPS) included an oral health module that relied on self-reported data on perceived oral health and oral health-seeking behaviour. However, this module is outdated. In response to growing global demand and policy needs, the new STEPS oral health module updated the self-reported questionnaire and added a clinical assessment component that can be done by oral or non-oral care workers after a short training. This paper presents the rationale, development process, structure and policy implications of the updated module. The paper provides an outline of the updated module and evidence to support this new approach as a practical, scalable and aligned solution to one of the most persistent gaps in noncommunicable disease surveillance. As countries move towards universal health coverage and integration of oral health into broader noncommunicable disease strategies, the updated WHO STEPS oral health module is a timely and necessary improvement in surveillance of noncommunicable diseases and their risk factors.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"104 10","pages":"690-697"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104488","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}