Global Public Health最新文献

Breast cancer is the most common type of cancer among Saudi women. Despite this prominence, the lack of data on the association between intimate partner violence (IPV) and breast cancer among Saudi women has presented significant obstacles for both academics and practitioners. This study sought to determine the prevalence, consequences, and types of IPV-including physical, emotional, and verbal abuse as well as controlling behavior-among Saudi breast cancer patients and survivors (BCPS). A cross-sectional study was conducted in Saudi Arabia (SA) among 146 BCPS. The frequency of IPV among BCPS varied by IPV type. The most prevalent forms of IPV were verbal and emotional (26%). All BCPS who were exposed to emotional and verbal IPV had at least one emotional issue. IPV was found to be significantly associated with both participants and their partners being unemployed and having a lower level of education. IPV can adversely impact the health and well-being of BCPS as well as that of their children and families. Therefore, future research and practice must prioritize enhancing IPV awareness among patients with cancer and their families due to its profound effect on the health and well-being of those affected.

Pakistan faces a substantial burden of tuberculosis (TB) and comorbid depression. Although the TB control programme has made progress, it lacks personalised care for patients with both conditions. Therefore, we aim to explore the health system's readiness and challenges in effectively addressing TB-depression comorbidity. We conducted a multi-site focused ethnography in TB centres in Peshawar and Haripur, Khyber Pakhtunkhwa, Pakistan, involving observations and semi-structured interviews (SSIs). We purposively selected 15 TB centres for observation. For 29 SSIs, we recruited seven TB healthcare providers, 12 patients, and 10 caregivers. An inductive-deductive thematic analysis was performed using the framework method. We identified factors within Pakistan's TB care framework that influence the system's capacity to address TB-depression comorbidity. We organised findings into four themes: the first focusing on accessibility, location, and infrastructure of TB centres; the second highlighting patients' fears, psychological distress, and their past and current experiences; the third examining the working environment of healthcare providers, their behaviour, and interactions with patients; and the final theme emphasising opportunities to address TB-depression comorbidity within the system. Integrating mental health services into Pakistan's TB care is crucial. Training providers, fostering patient engagement, and involving stakeholders can enhance support systems and help address TB-depression comorbidity.

Novel point-of-care tools tailored to contextual needs are critical for improving sexually transmitted infection (STI) management. The genital inflammation test (GIFT) is a point-of-care test under development to detect genital inflammation. A potential use of GIFT is as a screening tool to identify asymptomatic women who may have a sexually transmitted infection (STI) or bacterial vaginosis (BV), followed by confirmatory STI- testing if GIFT-positive. This study assessed the prospective acceptability of GIFT within national healthcare sectors in South Africa and Zimbabwe, where STI diagnostics are limited. In-depth interviews were conducted with women (n = 33), healthcare professionals (HCPs; n = 20) and decision-makers (n = 12) alongside seven focus group discussions (FGDs) with women (n = 16) and HCPs (n = 35). Thematic analysis was guided by Sekhon's framework of acceptability. Women showed a strong desire for devices to support sexual health and viewed diagnostic testing positively. However, acceptability declined when GIFT was explained as a screening tool requiring follow-up diagnostics, due to cost and limited availability of STI tests. HCPs and decision-makers similarly questioned its utility in constrained settings, despite recognising its potential as a potential catalyst for cheaper, point-of-care, infrastructure-light STI diagnostics. GIFT's acceptability is shaped by health system limitations, underscoring the need for clear communication, affordable diagnostics, and co-designed care pathways.

To conduct a systematic review and meta-analysis on the observed test positivity rates, risk factors, clinical manifestations and management of Mpox in paediatric populations globally. We searched relevant articles from databases, including PubMed, the Cochrane Library, Scopus, Web of Science and ProQuest, as well as gray literature sources, for studies published between 2023 and 2024. The inclusion criteria encompassed primary studies (including case reports) focused on paediatric mpox, with an emphasis on epidemiology, clinical manifestations and management. Data extraction was performed independently by two reviewers. We calculated pooled positivity rates and identified and reported risk factors and clinical manifestations (PROSPERO id: CRD42024600945). Among the 1414 records from databases and 24 from gray literature, 22 studies met the inclusion criteria. Paediatric mpox cases show considerable variability in PCR positivity rates, ranging from 6.95% in non-endemic regions to 35.6% in endemic areas. The clinical manifestations include progressive skin lesions and fever, with younger children being more susceptible to severe complications. The key risk factors included close household contact, coinfections and socioeconomic factors. Paediatric Mpox poses significant challenges, particularly in endemic regions. The observed frequency of infection and severity of complications emphasise the need for age-specific public health interventions, improved diagnostic capabilities and harmonised clinical guidelines to reduce morbidity and improve clinical outcomes.

This commentary examines the use of trade tariffs embedded in U.S. executive orders issued during the Trump administration as a strategy to address the fentanyl crisis. The key issue is whether it will be effective to curb the opioid epidemic or would rather mean more of the same. By combining quantitative classification of executive orders with exploratory discourse analysis, the article demonstrates that fentanyl is predominantly framed as a problem of trade, border security, and economic coercion rather than as a public health challenge. Our findings indicate a strong overlap between fentanyl-related orders and tariff measures, revealing a policy logic that prioritizes supply-side control through international economic pressure. The paper argues that this approach reflects a continuity of the U.S. war on drugs under a new trade-centered rhetoric, raising concerns about its effectiveness and potential risks for health systems, medical supply chains, and evidence-based public health responses.

Accredited Social Health Activist (ASHA) workers, India's community health workers (CHWs), serve as the primary link between households and the health system. They perform essential maternal and child health tasks while absorbing administrative and programmatic responsibilities. However, research on ASHAs and CHWs remains fragmented, often siloed into separate discussions of labor conditions, workplace hierarchies, and surveillance. This paper integrates these perspectives to examine how health systems rely on low-cost, flexible labor to sustain themselves. Drawing on ethnographic fieldwork in India, including participant observation and in-depth interviews, this analysis shows that ASHAs' constrained autonomy is not only the result of systemic inefficiencies, but is shaped by governance arrangements that produce and reinforce disempowerment. Findings reveal that hierarchical task delegation, economic precarity, and routine surveillance work in tandem to constrain autonomy among ASHAs. These conditions limit their capacity to resist expanding responsibilities, while simultaneously enabling the health system to function without structural reform. This analysis offers conceptual tools for understanding how informal health labor is governed, disciplined, and constrained across CHW programs in low- and middle-income countries.

Extreme heat is among the most severe climate hazards, driving substantial preventable morbidity and mortality worldwide, yet autistic and disabled people remain largely invisible within adaptation and health policy. Differences in thermoregulation, interoception, and sensory processing can mute awareness of heat stress, while poverty, inaccessible housing, and exclusion from emergency planning amplify danger. Historical heatwaves reveal how disability invisibility turns preventable stress into tragedy, and these inequities are even sharper in low-resource settings where cooling infrastructure is scarce. This commentary argues that climate resilience must include disabled embodiment as a dimension of global justice. Disability-inclusive heat adaptation-co-designed with autistic and disabled communities and grounded in universal design and human rights-offers a feasible path toward equitable survival in a warming world.

Access to safe sanitation is a human right, yet millions in Africa practice open defecation, risking disease and environmental harm. Despite global efforts, rural-urban disparities remain, especially in low-income countries. This study examines these disparities to inform policies for equitable sanitation access. To assess rural-urban disparities in open defecation across 47 African countries using WHO and HEAT data, identifying patterns for equitable sanitation policies and SDG 6 progress. This study assessed disparities using WHO and HEAT data, focusing on open defecation prevalence, defined as the population without sanitation facilities. The main inequality measure was the absolute prevalence difference between rural and urban populations. In 2022, South Africa, Mauritius, and Rwanda had near-universal access, with prevalence below 3%. Eritrea, Chad, and South Sudan exceeded 40%, some over 60%. Disparities were pronounced, with rural rates higher. Largest differences were in Niger (66.7 percentage points), Chad (62.2), and South Sudan (65.2). Some countries had minimal disparities, nearly eliminating open defecation in both areas. The study highlights significant sanitation inequalities, with rural areas most affected. It calls for targeted rural interventions, continued urban progress, and equity-focused policies to achieve SDG 6 and improve public health across Africa.

This study centres the voices of providers currently working with the child and adolescent population to analyse social and structural factors that facilitate or impede access and service utilisation among children and adolescents. We conducted semistructured interviews with 15 psychological health care providers across 4 metropolitan cities in India. Thematic analysis was guided by an immersion-crystallization study design. Following this modified grounded theory approach, structural stigma emerged as a salient factor. Participant narratives revealed interconnecting forms of stigma encountered by adolescents. There was a preference for therapy over pharmacological interventions. Providers indicate the need for institutional and policy support for schools to promote mental health and well-being among children. Training lay counsellors, and initiating tele-mental health services in a large-scale manner could be effective ways to distribute caseloads and reach vulnerable populations without access to high-quality mental healthcare in their geographic vicinity.

The displaced Rohingya population residing in Cox's Bazar, Bangladesh, must navigate their reproductive lives in this fragile context. This study examines the knowledge, attitudes and use of menstrual regulation/pregnancy termination services in four displaced persons' camps to understand women's engagement with these services and barriers to safe services using Bandura's social cognitive theory. We conducted a household, community-based survey with women of reproductive age in 2022 (n = 1173). Ninety-two percent of respondents knew that health facilities provide pregnancy terminations, yet knowledge about when access is permissible is incomplete. Only one-third knew that this service could be provided 11-12 weeks after last menstrual period, with most respondents believing that the cutoff was earlier. The respondents believed that menstrual regulation was provided only under certain conditions, and 99% stated that a husband's consent should be required for a woman to end a pregnancy (always or sometimes). One in five respondents (n = 223) knew someone who had ended a pregnancy since arriving in the camps. While knowledge about and support for pregnancy termination services are high, there is room for improvement in education about the conditions under which it can be accessed. The results fill a knowledge gap regarding the acceptability and use of pregnancy termination in the Bangladesh camps of displaced Rohingya.