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The influence of internship training experience on Kenyan and Ugandan doctors' career intentions and decisions: a qualitative study. 实习培训经验对肯尼亚和乌干达医生职业意向和决策的影响:一项定性研究。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2023-12-31 Epub Date: 2023-11-09 DOI: 10.1080/16549716.2023.2272390
Yingxi Zhao, Daniel Mbuthia, Dos Santos Ankomisyani, Claire Blacklock, David Gathara, Sassy Molyneux, Catia Nicodemo, Tom Richard Okello, Elizeus Rutebemberwa, Raymond Tweheyo, Mike English

Background: Medical internship is a key period for doctors' individual career planning and also a transition period for the broader labour market.

Objectives: We aimed to understand the complex set of factors influencing the career intentions and decisions of junior doctors, post-internship in Kenya and Uganda.

Methods: We conducted semi-structured interviews with 54 junior medical officers and 14 consultants to understand doctors' internship experiences and subsequent employment experiences. We analysed the data using a mix of a direct content approach, informed by an internship experience and career intentions framework developed primarily from high-income country literature, alongside a more inductive thematic analysis.

Results: Echoing the internship experience and career intentions framework, we found that clinical exposure during internship, work-life balance, aspects of workplace culture such as relationships with consultants and other team members, and concerns over future job security and professional development all influenced Kenyan and Ugandan doctors' career preferences. Additionally, we added a new category to the framework to reflect our finding that interns might want to 'fill a health system gap' when they choose their future careers, based on what they witness as interns. However, often career intentions did not match career and employment decisions due to specific contextual factors, most importantly a shortage of job opportunities.

Conclusion: We have shown how internship experiences shape medical doctors' career intentions in Kenya and Uganda and highlighted the importance of job availability and context in influencing doctors' career choices.

背景:医学实习是医生个人职业规划的关键时期,也是更广泛的劳动力市场的过渡期。目的:我们旨在了解影响肯尼亚和乌干达初级医生实习后职业意向和决策的一系列复杂因素。方法:我们对54名初级医生和14名顾问进行了半结构化访谈,以了解医生的实习经历和随后的就业经历。我们采用直接内容法对数据进行了分析,主要根据高收入国家文献开发的实习经历和职业意向框架,以及更具归纳性的主题分析。结果:与实习经历和职业意向框架相呼应,我们发现实习期间的临床暴露、工作与生活的平衡、工作场所文化的各个方面,如与顾问和其他团队成员的关系,以及对未来工作保障和专业发展的担忧,都会影响肯尼亚和乌干达医生的职业偏好。此外,我们在框架中添加了一个新的类别,以反映我们的发现,即实习生在选择未来职业时,可能希望根据他们作为实习生的经历来“填补卫生系统的空白”。然而,由于特定的背景因素,最重要的是缺乏工作机会,职业意向往往与职业和就业决定不匹配。结论:我们展示了肯尼亚和乌干达的实习经历如何影响医生的职业意向,并强调了工作机会和背景在影响医生职业选择方面的重要性。
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引用次数: 0
Trends and causes of neonatal mortality from 2010 to 2017 at a Health and Demographic Surveillance site in Northern Ethiopia. 2010 年至 2017 年埃塞俄比亚北部一个健康与人口监测点的新生儿死亡率趋势和原因。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2023-12-31 Epub Date: 2023-12-21 DOI: 10.1080/16549716.2023.2289710
Mengistu Welday Gebremichael, Mache Tsadik, Haftom Temesgen Abebe, Abraha Gebreegzabiher, Selam Beyene, Abera Berhe Aregawi, Solomon Weldemariam

Background: Half of global under-five mortalities is neonatal. The highest rates are found in low-income countries such as Ethiopia. Ethiopia has made progress in reducing under-five mortality, but neonatal mortality remains high. Evidence collected continuously at the community level is crucial for understanding the trends and causes of neonatal mortality.

Objectives: To analyse the trends and causes of neonatal mortality at the Kilte-Awlelo Health and Demographic Surveillance System (KAHDSS) site in Ethiopia from 2010 to 2017.

Methods: A descriptive study was conducted using data from neonates born between 2010 and 2017 at the KAHDSS site. Data were collected using interviewer-administered questionnaires. Causes of death were examined, and neonatal mortality trends were described using simple linear regression.

Results: The overall average neonatal mortality rate was 17/1000 live births (LBs). The rate increased from 12 per 1000 LBs in 2010 to 15 per 1000 LBs in 2017. The majority of neonatal deaths occurred during the first week of life, and more than one-half died at home. The leading causes were sepsis, pre-term birth (including respiratory distress), disease related to the perinatal period, birth asphyxia, and neonatal pneumonia.

Conclusions: The high neonatal mortality in Ethiopia requires urgent attention and action. Sepsis, preterm birth, perinatal diseases, asphyxia, and neonatal pneumonia are the leading causes of death in neonates. Facility- and community-based health services should target the leading causes of neonatal deaths.

背景:全球五岁以下儿童死亡率的一半是新生儿。埃塞俄比亚等低收入国家的新生儿死亡率最高。埃塞俄比亚在降低五岁以下儿童死亡率方面取得了进展,但新生儿死亡率仍然很高。在社区层面持续收集的证据对于了解新生儿死亡率的趋势和原因至关重要:分析 2010 年至 2017 年埃塞俄比亚 Kilte-Awlelo 健康与人口监测系统(KAHDSS)站点的新生儿死亡率趋势和原因:利用KAHDSS站点2010年至2017年间出生的新生儿数据进行了描述性研究。数据是通过访谈者发放的问卷收集的。对死亡原因进行了研究,并使用简单线性回归法描述了新生儿死亡趋势:结果:新生儿总平均死亡率为 17/1000 活产(LBs)。该比率从 2010 年的每千例活产 12 例上升至 2017 年的每千例活产 15 例。大多数新生儿死亡发生在出生后的第一周,一半以上死于家中。主要原因是败血症、早产(包括呼吸窘迫)、围产期相关疾病、出生窒息和新生儿肺炎:埃塞俄比亚新生儿死亡率高,亟需关注并采取行动。脓毒症、早产、围产期疾病、窒息和新生儿肺炎是新生儿死亡的主要原因。以医疗机构和社区为基础的医疗服务应针对新生儿死亡的主要原因。
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引用次数: 0
Changes in self-reported risky sexual behaviour indicators among adults receiving regular risk reduction counselling and optional initiation of pre-exposure prophylaxis in an HIV vaccine preparedness study in Masaka, Uganda. 在乌干达马萨卡进行的一项艾滋病毒疫苗准备研究中,接受定期减少风险咨询和选择性地开始接触前预防的成年人自我报告的危险性行为指标的变化。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2023-12-31 DOI: 10.1080/16549716.2023.2242672
Jonathan Kitonsa, Sheila Kansiime, Sylvia Kusemererwa, Martin Onyango, Berna Nayiga, Anita Kabarambi, Joseph O Mugisha, Pontiano Kaleebu, Eugene Ruzagira

Background: HIV risk reduction counselling may reduce risk-taking behaviours. Yet, concerns remain about risk compensation among individuals initiating pre-exposure prophylaxis (PrEP).

Objective: We assessed changes in risky sexual behaviour indicators among HIV vaccine preparedness study participants who received regular risk reduction counselling and referral for PrEP in Masaka, Uganda.

Methods: Adults (18-39 years) at high risk of HIV infection were enrolled in the study between July 2018 and December 2021. Data were collected on socio-demographic factors (baseline) and self-reported sexual risk behaviours (baseline, six monthly). HIV testing and risk-reduction counselling and referral for PrEP were done quarterly. Participants who had completed at least 1 year of follow-up were included in the analysis. Proportional differences and McNemar chi-square tests were used to assess changes in the prevalence of self-reported risky sexual behaviour indicators between baseline and 1 year. Logistic regression was used to assess the predictors of unchanged/increased HIV risk at 1 year.

Results: Three hundred participants [132 (44%) females, 152 (51%) aged ≤24 years] were included in this analysis. Eighty-one (27%) participants initiated PrEP at 1 year. Compared to baseline, there were significant reductions in the prevalence of the following self-reported HIV risk indicators at 1 year (overall, among non-PrEP initiators, and among PrEP initiators): transactional sex, ≥6 sexual partners, unprotected sex with ≥3 partners, sex while drunk, and sexually transmitted infection diagnosis/treatment. Percentage differences ranged from 10% for individuals reporting at least six sexual partners to 30% for those reporting unprotected sex with three or fewer sexual partners. There was weak evidence of association between female gender and unchanged/increased HIV risk at 1 year (adjusted OR: 1.35, 95% CI (0.84-2.17)). No other indicators, including PrEP use, were associated with unchanged/increased HIV risk at 1 year.

Conclusion: Regular risk-reduction counselling may reduce risky sexual behaviour, while PrEP initiation may not lead to risk compensation.

背景:减少艾滋病毒风险咨询可以减少冒险行为。然而,在开始暴露前预防(PrEP)的个体中,风险补偿仍然令人担忧。目的:我们评估了在Masaka接受定期风险降低咨询和PrEP转诊的HIV疫苗准备研究参与者中风险性行为指标的变化,乌干达。方法:在2018年7月至2021年12月期间,将艾滋病毒感染高危成年人(18-39岁)纳入该研究。收集了社会人口因素(基线)和自我报告的性风险行为(基线,六个月)的数据。每季度进行一次艾滋病毒检测、降低风险咨询和PrEP转诊。已完成至少1年随访的参与者被纳入分析。使用比例差异和McNemar卡方检验来评估基线和1年之间自我报告的危险性行为指标的患病率变化。Logistic回归用于评估1年时HIV风险不变/增加的预测因素。结果:300名参与者[132名(44%)女性,152名(51%)年龄≤24岁]被纳入本分析。81名(27%)参与者在1年时开始PrEP。与基线相比,在1年时,以下自我报告的HIV风险指标的患病率显著降低(总体而言,在非PrEP发起者和PrEP发起者中):交易性行为、≥6个性伴侣、与 ≥3名伴侣,醉酒时发生性行为,以及性传播感染的诊断/治疗。百分比差异从报告至少有六个性伴侣的个人的10%到报告与三个或更少性伴侣发生无保护性行为的个人的30%不等。女性与1年时HIV风险不变/增加之间的相关性证据不足(校正OR:1.35,95%CI(0.84-2.17))。没有其他指标,包括PrEP的使用,与1年后HIV风险不变或增加相关。结论:定期的风险降低咨询可以减少危险的性行为,而PrEP的启动可能不会带来风险补偿。
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引用次数: 0
Assessing the role of depression in reducing intimate partner violence perpetration among young men living in urban informal settlements using a mediation analysis of the Stepping Stones and Creating Futures intervention. 利用垫脚石和创造未来干预的中介分析,评估抑郁在减少城市非正式住区青年男性亲密伴侣暴力行为中的作用。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2023-12-31 DOI: 10.1080/16549716.2023.2188686
Victoria Oyekunle, Andrew Gibbs, Andrew Tomita

Background: Stepping Stones and Creating Futures (SS/CF) is a gender transformative and economic empowerment intervention that has effectively reduced the perpetration of intimate partner violence (IPV) by young men living in informal settlements in South Africa.

Objective: This study examines whether depression mediated the association between SS/CF intervention and decreased IPV.

Method: Data from a two-arm cluster randomised community-based controlled trial that evaluated the effectiveness of SS/CF in lowering IPV were obtained from 674 young men aged 18-30 within urban informal settlements in South Africa. After being randomly assigned to either the experimental arm (SS/CF) or the control arm, the participants were followed up for 24 months. Logistic regression using mediation analysis was conducted to see whether changes in depressive symptoms mediated the association between the intervention and reduced IPV perpetration.

Results: Findings from the mediation analysis indicated that those assigned to the SS/CF experimental group reported lower depression (β = -0.42, p < 0.05) at 12 months, and this was subsequently associated with reduced IPV (β = 0.43, p < 0.05) at 24 months. The direct path from SS/CF to IPV was originally (β = -0.46, p < 0.01), but reduced in the mediation model to (β = -0.13, p = 0.50). Depressive symptoms mediated the association between the SS/CF intervention and decreased IPV perpetration.

Conclusion: These findings suggest that one pathway through which SS/CF decreased IPV was through improvement in mental health (i.e. depression). Future IPV prevention interventions may consider incorporating components that focus on improving mental health as a way of also reducing IPV perpetration in disadvantaged settings.

背景:垫脚石和创造未来(SS/CF)是一种性别变革和经济赋权干预措施,有效减少了南非非正规住区年轻男性实施亲密伴侣暴力(IPV)的情况来自一项评估SS/CF在降低IPV方面有效性的双臂集群随机社区对照试验,该试验来自南非城市非正规住区674名18-30岁的年轻男性。在被随机分配到实验组(SS/CF)或对照组后,参与者被随访24小时 月。使用中介分析进行Logistic回归,以了解抑郁症状的变化是否介导了干预和减少IPV实施之间的关联。结果:中介分析结果表明,那些被分配到SS/CF实验组的人报告了较低的抑郁(β=-0.42,p p p p = 0.50)。抑郁症状介导了SS/CF干预与IPV实施减少之间的关联。结论:这些发现表明,SS/CF降低IPV的一个途径是改善心理健康(即抑郁)。未来的IPV预防干预措施可能会考虑纳入侧重于改善心理健康的组成部分,以此减少在弱势环境中实施IPV的情况。
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引用次数: 0
Effects of health poverty alleviation project from the perspective of vulnerability to poverty: evidence from five Chinese prefectures. 从易受贫困影响的角度看健康扶贫项目的效果:来自中国五个州的证据。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2023-12-31 Epub Date: 2023-10-02 DOI: 10.1080/16549716.2023.2260142
Yan Wei, Zhaochi Zhang, Mingjian Zhang

Background: The Health Poverty Alleviation Project (HPAP) has received widespread attention as a primary means of preventing poverty caused by illness. However, further evidence is required to confirm the effects of HPAP.

Objective: This study examines the effectiveness and mechanisms of action of HPAP using data from a special survey conducted in five Chinese prefectures in 2018-2019.

Method: This study uses a three-step feasible generalised least-squares method to measure the farm households' vulnerability to poverty. Hierarchical linear regression and propensity score matching were employed to assess the poverty-reduction effects of HPAP. A mediating effects model was used to test how these policies alleviated poverty.

Results: The mean vulnerability to poverty among farm households was 0.367, with 11.89% experiencing both poverty and vulnerability, particularly in areas of deep poverty. This study has found that HPAP significantly reduces poverty and is more effective in reducing the vulnerability of non-poor farm households than poor farm households. Additionally, the results suggest that improving human capital stock and reducing medical expenditure are the two pathways through which HPAP can alleviate farm households' vulnerability to poverty.

Conclusions: This study suggests that the vulnerability to poverty perspective should be incorporated into poverty alleviation policy formulation. HPAP enhances differentiation and precision. Thus, a long-term mechanism of HPAP should be developed.

背景:健康扶贫项目作为预防因病致贫的主要手段,受到了广泛关注。然而,还需要进一步的证据来证实HPAP的影响。目的:本研究利用2018-2019年在中国五个都道府县进行的一项特别调查的数据,检验HPAP的有效性和作用机制。方法:本研究使用三步可行的广义最小二乘法来衡量农户的贫困脆弱性。采用层次线性回归和倾向得分匹配来评估HPAP的减贫效果。使用了一个中介效应模型来检验这些政策是如何减轻贫困的。结果:农户的平均贫困脆弱性为0.367,11.89%的农户同时经历贫困和脆弱性,特别是在深度贫困地区。这项研究发现,HPAP显著减少了贫困,在降低非贫困农户的脆弱性方面比贫困农户更有效。此外,研究结果表明,提高人力资本存量和减少医疗支出是HPAP缓解农户贫困脆弱性的两条途径。结论:本研究表明,应将易受贫困影响的观点纳入扶贫政策的制定中。HPAP可提高分化和精确度。因此,应制定HPAP的长期机制。
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引用次数: 0
"We don't trust all data coming from all facilities": factors influencing the quality of care network data quality in Ethiopia. “我们不相信来自所有设施的所有数据”:影响埃塞俄比亚护理网络数据质量的因素。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2023-12-31 Epub Date: 2023-11-29 DOI: 10.1080/16549716.2023.2279856
Asebe Amenu Tufa, Geremew Gonfa, Anene Tesfa, Theodros Getachew, Desalegn Bekele, Ftalew Dagnaw, Nehla Djellouli, Tim Colbourn, Tanya Marchant, Seblewengel Lemma

Background: Good quality data are a key to quality health care. In 2017, WHO has launched the Quality of Care Network (QCN) to reduce maternal, newborn and stillbirth mortality via learning and sharing networks. Guided by the principle of equity and dignity, the network members agreed to implement the programme in 2017-2021.

Objective: This paper seeks to explore how QCN has contributed to improving data quality and to identify factors influencing quality of data in Ethiopia.

Methods: We conducted a qualitative study in selected QCN facilities in Ethiopia using key informant interview and observation methods. We interviewed 40 people at national, sub-national and facility levels. Non-participant observations were carried out in four purposively selected health facilities; we accessed monthly reports from 41 QCN learning facilities. A codebook was prepared following a deductive and inductive analytical approach, coded using Nvivo 12 and thematically analysed.

Results: There was a general perception that QCN had improved health data documentation and use in the learning facilities, achieved through coaching, learning and building from pre-existing initiatives. QCN also enhanced the data elements available by introducing a broader set of quality indicators. However, the perception of poor data quality persisted. Factors negatively affecting data quality included a lack of integration of QCN data within routine health system activities, the perception that QCN was a pilot, plus a lack of inclusive engagement at different levels. Both individual and system capabilities needed to be strengthened.

Conclusion: There is evidence of QCN's contribution to improving data awareness. But a lack of inclusive engagement of actors, alignment and limited skill for data collection and analysis continued to affect data quality and use. In the absence of new resources, integration of new data activities within existing routine health information systems emerged as the most important potential action for positive change.

背景:高质量的数据是高质量医疗保健的关键。2017年,世卫组织启动了保健质量网络(QCN),通过学习和分享网络降低孕产妇、新生儿和死胎死亡率。在公平和尊严原则的指导下,网络成员同意在2017-2021年实施该计划。目的:本文旨在探讨QCN如何为提高数据质量做出贡献,并确定影响埃塞俄比亚数据质量的因素。方法:我们在埃塞俄比亚选定的QCN设施中进行了定性研究,采用关键线人访谈和观察方法。我们在国家、地方和机构层面采访了40人。在四个有目的地选择的卫生设施中进行了非参与性观察;我们访问了41家QCN学习机构的月度报告。根据演绎和归纳分析方法准备了一个密码本,使用Nvivo 12进行编码并进行主题分析。结果:人们普遍认为,QCN通过指导、学习和借鉴已有举措,改善了学习设施中的健康数据记录和使用。QCN还通过引入一套更广泛的质量指标,增强了可用的数据要素。然而,数据质量差的看法仍然存在。对数据质量产生负面影响的因素包括:缺乏将QCN数据整合到常规卫生系统活动中,认为QCN是一个试点项目,以及缺乏不同层面的包容性参与。个人和系统的能力都需要加强。结论:有证据表明QCN有助于提高数据意识。但是,行动者缺乏包容性参与、缺乏一致性以及数据收集和分析技能有限,继续影响数据质量和使用。在缺乏新资源的情况下,在现有常规卫生信息系统内整合新的数据活动成为促进积极变革的最重要的潜在行动。
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引用次数: 0
Achieving the UNAIDS 95-95-95 treatment target by 2025 in Ghana: a myth or a reality? 到2025年在加纳实现联合国艾滋病规划署95-95-95治疗目标:是神话还是现实?
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2023-12-31 Epub Date: 2023-11-03 DOI: 10.1080/16549716.2023.2271708
Dorothy Serwaa Boakye, Samuel Adjorlolo

The United Nations Joint Programme on HIV/AIDS (UNAIDS) has set ambitious treatment targets known as Project 95-95-95, aiming to achieve 95% of people living with HIV knowing their status, 95% of diagnosed individuals on antiretroviral therapy (ART), and 95% of those on ART achieving viral suppression by 2025. Through a comprehensive analysis of Ghana's HIV/AIDS response, we evaluate the feasibility of Ghana's efforts in realising these targets. The discussion explores Ghana's achievements in HIV testing and diagnosis, ART coverage, and viral suppression rates, as well as challenges related to stigma, limited access to healthcare services, funding constraints, and data quality. Strategies such as strengthening prevention efforts, expanding access to ART, addressing stigma, and enhancing health systems are discussed as the way forward to advance Ghana's progress towards the UNAIDS 95-95-95 treatment targets. While Ghana has made significant strides in its HIV/AIDS response, achieving the 95-95-95 targets is a challenging yet realistic goal.

联合国艾滋病毒/艾滋病联合规划署(UNAIDS)制定了名为“95-95-95项目”的雄心勃勃的治疗目标,目标是到2025年,95%的艾滋病毒感染者了解自己的状况,95%的确诊者接受抗逆转录病毒疗法,95%的抗逆转录病毒治疗者实现病毒抑制。通过对加纳艾滋病毒/艾滋病应对措施的全面分析,我们评估了加纳努力实现这些目标的可行性。讨论探讨了加纳在艾滋病毒检测和诊断、抗逆转录病毒疗法覆盖率和病毒抑制率方面取得的成就,以及与污名化、获得医疗服务的机会有限、资金限制和数据质量有关的挑战。讨论了加强预防工作、扩大抗逆转录病毒治疗的机会、消除污名和加强卫生系统等战略,以此作为推动加纳实现联合国艾滋病规划署95-95-95治疗目标的前进道路。尽管加纳在应对艾滋病毒/艾滋病方面取得了重大进展,但实现95-95-95年目标是一个具有挑战性但现实的目标。
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引用次数: 0
Closing the pneumococcal conjugate vaccine (PCV) introduction gap: an archetype analysis of last-mile countries 缩小肺炎球菌结合疫苗 (PCV) 接种差距:对 "最后一英里 "国家的典型分析
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2023-12-12 DOI: 10.1080/16549716.2023.2281065
Preetika Banerjee, Jasmine Huber, Veronica Denti, Molly Sauer, Rose Weeks, Baldeep K. Dhaliwal, Anita Shet
Pneumonia remains the leading infectious cause of global childhood deaths, despite the availability of pneumococcal conjugate vaccine (PCV) products and widespread evidence of their safety and effi...
尽管肺炎球菌结合疫苗 (PCV) 产品已经上市,而且其安全性和有效性也得到了广泛证明,但肺炎仍然是全球儿童死亡的主要传染病因。
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引用次数: 0
An assessment of immediate newborn care readiness and availability in Nepal 尼泊尔新生儿即时护理准备和可用性评估
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2023-12-12 DOI: 10.1080/16549716.2023.2289735
Ranjan Dhungana, Mala Chalise, Robert B. Clark
Global neonatal mortality necessitates access to immediate newborn care interventions. In Nepal, disparities persist in the readiness and availability of newborn care services within health facilit...
全球新生儿死亡率居高不下,因此有必要立即采取新生儿护理干预措施。在尼泊尔,医疗机构在新生儿护理服务的准备和可用性方面仍然存在差距。
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引用次数: 0
Closing the birth registration gap for Every newborn facility birth: literature review and qualitative research 缩小每个新生儿设施出生登记的差距:文献综述和定性研究
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2023-12-12 DOI: 10.1080/16549716.2023.2286073
Masudah Paleker, Dorothy Boggs, Debra Jackson, Louise-Tina Day, Joy E. Lawn
Birth registration is vital to provide legal identity and access to essential services. Worldwide, approximately 166 million children under five years (just under 25%) are unregistered, yet >80% of...
出生登记对于提供合法身份和获得基本服务至关重要。全世界约有 1.66 亿五岁以下儿童(略低于 25%)没有进行出生登记,而 80% 以上的儿童没有进行出生登记。
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引用次数: 0
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