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Cash transfer, maternal and child health outcomes: a scoping review in sub-Saharan Africa. 现金转移、孕产妇和儿童健康成果:撒哈拉以南非洲的范围界定审查。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-02-09 DOI: 10.1080/16549716.2024.2309726
Emery L Ngamasana, Jessamyn Moxie

Background: Cash Transfer (CT) programmes can improve maternal and child health outcomes in low- and middle-income countries. However, studies assessing the effectiveness of these programmes on maternal and child health outcomes (MCH), beyond nutritional outcomes and service utilisation, remain inconclusive.

Objectives: We synthesized current empirical evidence on the effectiveness of these programmes in improving MCH outcomes and suggested a framework for reporting such outcomes. We focused on sub-Saharan Africa because of substantial operational differences between regions, and the need for MCH advancement in this region.

Methods: This review searched PubMed Central and Google Scholar and supplemented it with a backward citation search for studies conducted in sub-Saharan Africa for the period between 2000 and 2021. Only peer-reviewed studies on CT that reported health outcomes beyond nutritional outcomes and service utilisation among women of reproductive age and children below 18 years old were included.

Results: Twenty-one articles reporting studies conducted in six sub-Saharan African countries were identified. All studies reported health outcome measures, and programmes targeted women of reproductive age and children under 18 years of age. Of the 21 articles, 1 reported measures of mortality, 13 reported measures of functional status; 3 reported subjective measures of well-being, and 4 reported behavioural health outcomes. Across all categories of reported measures, evidence emerges that cash transfer programmes improved some health outcomes (e.g. improved infant and child survival, reduced incidence of illnesses, improved cognitive and motor development, improved general health, delayed sexual debut, lower transactional sex, etc.), while in some of the studies, outcomes such as depression did not show significant improvements.

Conclusion: Cash Transfer programmes are effective and cost-effective, with a real potential to improve maternal and child health outcomes in sub-Saharan African countries. However, further research is needed to address implementation challenges, which include data collection, and programme management.

背景:现金转移(CT)计划可以改善中低收入国家的母婴健康状况。然而,除营养结果和服务利用率外,评估这些计划对母婴健康结果(MCH)的有效性的研究仍未得出结论:我们综合了当前有关这些计划在改善母婴健康成果方面有效性的经验证据,并提出了报告此类成果的框架。我们将重点放在撒哈拉以南非洲地区,因为不同地区之间在操作上存在很大差异,而且该地区需要提高母婴保健水平:本综述检索了 PubMed Central 和 Google Scholar,并对 2000 年至 2021 年期间在撒哈拉以南非洲进行的研究进行了反向引文检索。只纳入了同行评审的关于 CT 的研究,这些研究报告了育龄妇女和 18 岁以下儿童营养结果和服务利用率之外的健康结果:结果:确定了 21 篇报道在 6 个撒哈拉以南非洲国家开展的研究的文章。所有研究都报告了健康结果的衡量标准,计划的目标群体是育龄妇女和 18 岁以下儿童。在这 21 篇文章中,1 篇报告了死亡率测量结果,13 篇报告了功能状态测量结果;3 篇报告了幸福感的主观测量结果,4 篇报告了行为健康结果。在所报告的各类衡量标准中,有证据表明现金转移计划改善了一些健康结果(如提高了婴幼儿存活率、降低了疾病发病率、改善了认知和运动发育、改善了总体健康状况、推迟了初次性行为、减少了性交易等),而在一些研究中,抑郁症等结果并未显示出显著改善:现金转移计划既有效又具有成本效益,确实有可能改善撒哈拉以南非洲国家的母婴健康状况。然而,还需要进一步开展研究,以解决实施过程中遇到的挑战,包括数据收集和计划管理。
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引用次数: 0
Estimation of cause-specific mortality in Rakai, Uganda, using verbal autopsy 1999-2019. 利用口头尸检估算乌干达拉卡伊地区 1999-2019 年特定病因死亡率。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-05-08 DOI: 10.1080/16549716.2024.2338635
Dorean Nabukalu, Júlia Almeida Calazans, Milly Marston, Clara Calvert, Hadijja Nakawooya, Brendah Nansereko, Robert Sekubugu, Gertrude Nakigozi, David Serwadda, Nelson Sewankambo, Godfrey Kigozi, Ronald H Gray, Fred Nalugoda, Fredrick Makumbi, Tom Lutalo, Jim Todd

Background: There are scant data on the causes of adult deaths in sub-Saharan Africa. We estimated the level and trends in adult mortality, overall and by different causes, in rural Rakai, Uganda, by age, sex, and HIV status.

Objectives: To estimate and analyse adult cause-specific mortality trends in Rakai, Uganda.

Methodology: Mortality information by cause, age, sex, and HIV status was recorded in the Rakai Community Cohort study using verbal autopsy interviews, HIV serosurveys, and residency data. We estimated the average number of years lived in adulthood. Using demographic decomposition methods, we estimated the contribution of each cause of death to adult mortality based on the average number of years lived in adulthood.

Results: Between 1999 and 2019, 63082 adults (15-60 years) were censused, with 1670 deaths registered. Of these, 1656 (99.2%) had completed cause of death data from verbal autopsy. The crude adult death rate was 5.60 (95% confidence interval (CI): 5.33-5.87) per 1000 person-years of observation (pyo). The crude death rate decreased from 11.41 (95% CI: 10.61-12.28) to 3.27 (95% CI: 2.89-3.68) per 1000 pyo between 1999-2004 and 2015-2019. The average number of years lived in adulthood increased in people living with HIV and decreased in HIV-negative individuals between 2000 and 2019. Communicable diseases, primarily HIV and Malaria, had the biggest decreases, which improved the average number of years lived by approximately extra 12 years of life in females and 6 years in males. There were increases in deaths due to non-communicable diseases and external causes, which reduced the average number of years lived in adulthood by 2.0 years and 1.5 years in females and males, respectively.

Conclusion: There has been a significant decline in overall mortality from 1999 to 2019, with the greatest decline seen in people living with HIV since the availability of antiretroviral therapy in 2004. By 2020, the predominant causes of death among females were non-communicable diseases, with external causes of death dominating in males.

背景:关于撒哈拉以南非洲成人死亡原因的数据很少。我们按年龄、性别和 HIV 感染状况估算了乌干达拉卡伊农村地区成人总死亡率和不同死因的死亡率水平和趋势:估算并分析乌干达拉卡伊地区成人因特定原因导致的死亡率趋势:方法:拉卡伊社区队列研究利用口头尸检访谈、HIV血清调查和居住地数据记录了按病因、年龄、性别和HIV感染状况分列的死亡率信息。我们估算了成年后的平均生活年限。利用人口分解方法,我们根据成年后的平均生活年限估算了每种死因对成人死亡率的贡献:1999 年至 2019 年期间,共对 63082 名成人(15-60 岁)进行了人口普查,登记死亡人数为 1670 人。其中,1656 人(99.2%)的死因数据来自口头尸检。成人粗死亡率为每千人观察年(Pyo)5.60(95% 置信区间(CI):5.33-5.87)。1999-2004 年至 2015-2019 年期间,粗死亡率从每 1000 人年 11.41 例(95% 置信区间:10.61-12.28 例)下降到 3.27 例(95% 置信区间:2.89-3.68 例)。2000 年至 2019 年间,艾滋病毒感染者的平均成年生活年数有所增加,而艾滋病毒阴性者的平均成年生活年数有所减少。传染病(主要是艾滋病毒和疟疾)的降幅最大,使女性的平均寿命增加了约 12 年,男性增加了 6 年。非传染性疾病和外部原因导致的死亡有所增加,使女性和男性的平均成年寿命分别减少了 2.0 年和 1.5 年:从 1999 年到 2019 年,总死亡率大幅下降,自 2004 年提供抗逆转录病毒疗法以来,艾滋病毒感染者的死亡率下降幅度最大。到 2020 年,女性的主要死因是非传染性疾病,而男性的主要死因是外部因素。
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引用次数: 0
Recruiting hard-to-reach populations via respondent driven sampling for mobile phone surveys in Colombia: a qualitative study. 在哥伦比亚通过受访者驱动的手机调查抽样招募难以接触到的人群:一项定性研究。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-01-11 DOI: 10.1080/16549716.2023.2297886
Camila Solorzano-Barrera, Mariana Rodriguez-Patarroyo, Angélica Tórres-Quintero, Deivis Nicolas Guzman-Tordecilla, Aixa Natalia Franco-Rodriguez, Vidhi Maniar, Prakriti Shrestha, Andrés I Vecino-Ortiz, George W Pariyo, Dustin G Gibson, Joseph Ali

Background: Uptake of mobile phone surveys (MPS) is increasing in many low- and middle-income countries, particularly within the context of data collection on non-communicable diseases (NCDs) behavioural risk factors. One barrier to collecting representative data through MPS is capturing data from older participants.Respondent driven sampling (RDS) consists of chain-referral strategies where existing study subjects recruit follow-up participants purposively based on predefined eligibility criteria. Adapting RDS strategies to MPS efforts could, theoretically, yield higher rates of participation for that age group.

Objective: To investigate factors that influence the perceived acceptability of a RDS recruitment method for MPS involving people over 45 years of age living in Colombia.

Methods: An MPS recruitment strategy deploying RDS techniques was piloted to increase participation of older populations. We conducted a qualitative study that drew from surveys with open and closed-ended items, semi-structured interviews for feedback, and focus group discussions to explore perceptions of the strategy and barriers to its application amongst MPS participants.

Results: The strategy's success is affected by factors such as cultural adaptation, institutional credibility and public trust, data protection, and challenges with mobile phone technology. These factors are relevant to individuals' willingness to facilitate RDS efforts targeting hard-to-reach people. Recruitment strategies are valuable in part because hard-to-reach populations are often most accessible through their contacts within their social network who can serve as trust liaisons and drive engagement.

Conclusions: These findings may inform future studies where similar interventions are being considered to improve access to mobile phone-based data collection amongst hard-to-reach groups.

背景:在许多中低收入国家,特别是在收集非传染性疾病(NCDs)行为风险因素数据的背景下,手机调查(MPS)的使用率正在不断提高。受访者驱动抽样(RDS)包括连锁推荐策略,即现有研究对象根据预先确定的资格标准有目的地招募后续参与者。从理论上讲,将 RDS 策略应用于 MPS 工作可提高该年龄组的参与率:调查影响哥伦比亚 45 岁以上人群对 MPS RDS 招募方法可接受性的因素:为了提高老年人群的参与率,我们试行了一种采用 RDS 技术的 MPS 招募策略。我们开展了一项定性研究,通过开放式和封闭式项目调查、半结构化反馈访谈和焦点小组讨论,探讨了医疗保险计划参与者对该策略的看法及其应用障碍:结果:该战略的成功与否受到文化适应、机构信誉和公众信任、数据保护以及手机技术挑战等因素的影响。这些因素关系到个人是否愿意为针对难以接触人群的 RDS 工作提供便利。招募策略之所以有价值,部分原因在于难以接触到的人群通常最容易通过其社交网络中的联系人接触到,这些联系人可以充当信任联络人并推动参与:这些研究结果可为今后的研究提供参考,因为今后的研究将考虑采取类似的干预措施,以改善难以接触人群使用手机收集数据的情况。
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引用次数: 0
Co-creation of a toolkit to assist risk communication and clinical decision-making in severe preeclampsia: SPOT-Impact study design. 共同创建工具包,协助重度子痫前期的风险交流和临床决策:SPOT-Impact 研究设计。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-05-08 DOI: 10.1080/16549716.2024.2336314
Hannah Brown Amoakoh, Bregje C De Kok, Linda Lucy Yevoo, Klaartje M Olde Loohuis, Emmanuel K Srofenyoh, Daniel K Arhinful, Koiwah Koi-Larbi, Kwame Adu-Bonsaffoh, Mary Amoakoh-Coleman, Joyce L Browne

Globally, the incidence of hypertensive disorders of pregnancy, especially preeclampsia, remains high, particularly in low- and middle-income countries. The burden of adverse maternal and perinatal outcomes is particularly high for women who develop a hypertensive disorder remote from term (<34 weeks). In parallel, many women have a suboptimal experience of care. To improve the quality of care in terms of provision and experience, there is a need to support the communication of risks and making of treatment decision in ways that promote respectful maternity care. Our study objective is to co-create a tool(kit) to support clinical decision-making, communication of risks and shared decision-making in preeclampsia with relevant stakeholders, incorporating respectful maternity care, justice, and equity principles. This qualitative study detailing the exploratory phase of co-creation takes place over 17 months (Nov 2021-March 2024) in the Greater Accra and Eastern Regions of Ghana. Informed by ethnographic observations of care interactions, in-depth interviews and focus group and group discussions, the tool(kit) will be developed with survivors and women with hypertensive disorders of pregnancy and their families, health professionals, policy makers, and researchers. The tool(kit) will consist of three components: quantitative predicted risk (based on external validated risk models or absolute risk of adverse outcomes), risk communication, and shared decision-making support. We expect to co-create a user-friendly tool(kit) to improve the quality of care for women with preeclampsia remote from term which will contribute to better maternal and perinatal health outcomes as well as better maternity care experience for women in Ghana.

在全球范围内,妊娠期高血压疾病,特别是子痫前期的发病率仍然很高,尤其是在中低收入国家。对于那些未足月就患上高血压疾病的妇女来说,不利的孕产妇和围产期后果所造成的负担尤其沉重。本定性研究将在加纳大阿克拉和东部地区进行,为期 17 个月(2021 年 11 月至 2024 年 3 月),详细介绍共同创造的探索阶段。在对护理互动进行人种学观察、深入访谈以及焦点小组和小组讨论的基础上,将与幸存者、妊娠高血压疾病妇女及其家人、医疗专业人员、政策制定者和研究人员共同开发工具包。工具包将由三部分组成:定量预测风险(基于外部验证的风险模型或不良后果的绝对风险)、风险交流和共同决策支持。我们希望共同创建一个用户友好型工具包,以提高对远期子痫前期妇女的护理质量,这将有助于改善孕产妇和围产期健康状况,并改善加纳妇女的产科护理体验。
{"title":"Co-creation of a toolkit to assist risk communication and clinical decision-making in severe preeclampsia: SPOT-Impact study design.","authors":"Hannah Brown Amoakoh, Bregje C De Kok, Linda Lucy Yevoo, Klaartje M Olde Loohuis, Emmanuel K Srofenyoh, Daniel K Arhinful, Koiwah Koi-Larbi, Kwame Adu-Bonsaffoh, Mary Amoakoh-Coleman, Joyce L Browne","doi":"10.1080/16549716.2024.2336314","DOIUrl":"10.1080/16549716.2024.2336314","url":null,"abstract":"<p><p>Globally, the incidence of hypertensive disorders of pregnancy, especially preeclampsia, remains high, particularly in low- and middle-income countries. The burden of adverse maternal and perinatal outcomes is particularly high for women who develop a hypertensive disorder remote from term (<34 weeks). In parallel, many women have a suboptimal experience of care. To improve the quality of care in terms of provision and experience, there is a need to support the communication of risks and making of treatment decision in ways that promote respectful maternity care. Our study objective <u>is</u> to co-create a tool(kit) to support clinical decision-making, communication of risks and shared decision-making in preeclampsia with relevant stakeholders, incorporating respectful maternity care, justice, and equity principles. This qualitative study detailing the exploratory phase of co-creation takes place over 17 months (Nov 2021-March 2024) in the Greater Accra and Eastern Regions of Ghana. Informed by ethnographic observations of care interactions, in-depth interviews and focus group and group discussions, the tool(kit) will be developed with survivors and women with hypertensive disorders of pregnancy and their families, health professionals, policy makers, and researchers. The tool(kit) will consist of three components: quantitative predicted risk (based on external validated risk models or absolute risk of adverse outcomes), risk communication, and shared decision-making support. We expect to co-create a user-friendly tool(kit) to improve the quality of care for women with preeclampsia remote from term which will contribute to better maternal and perinatal health outcomes as well as better maternity care experience for women in Ghana.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11080670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Lessons from community engagement to improve COVID-19 diagnosis and treatment in Cochabamba, Bolivia. 玻利维亚科恰班巴社区参与改善 COVID-19 诊断和治疗的经验教训。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-06-11 DOI: 10.1080/16549716.2024.2358602
Elizabeth Posada, Nilce Mendoza, Cristina Alonso-Vega, Claire Billot, Beatriz Mallén Muñoz, Leonardo de la Torre, Adalid Paiva, Luis Villarroel, Regina Rabinovich

Background: Community engagement is recognized as a vital component of health-related research and programs, particularly during infectious disease outbreaks and epidemics. Despite the importance of engaging communities in the response to COVID-19, relatively little research has examined how this was (or was not) achieved, and even less in low- and middle-income countries. This article describes the community engagement that accompanied efforts to strengthen COVID-19 diagnosis and treatment as part of the ECO Project in Cochabamba, Bolivia and highlights lessons for future pandemic response.

Methods: Community engagement involved formative assessment, co-creation to develop a health information campaign, ongoing community listening and evaluation. Qualitative data were collected during workshops, project meetings and focus groups. Questionnaire-based surveys were conducted to assess COVID-19-related attitudes, knowledge and practices.

Results: The collected data highlighted the value of working closely with well-established community health committees and involving community members with social media skills in the design of COVID-19-related messages to address on- and offline misinformation. Co-creation sessions enabled the adjustment of the information campaign in terms of content and approach based on the needs and preferences of community members and health staff. The continuous listening with community and health personnel facilitated the ongoing adaptation of project activities.

Conclusion: Through a stepped and multi-pronged approach, incorporating co-creation and community listening, the engagement could respond to emerging local challenges during the pandemic. The project created spaces for dialogue and opportunities for collaboration that strengthened links between the community and the health services.

背景:社区参与被认为是健康相关研究和计划的重要组成部分,尤其是在传染病爆发和流行期间。尽管社区参与应对 COVID-19 的重要性不言而喻,但有关如何实现(或未实现)社区参与的研究却相对较少,在中低收入国家更是如此。本文介绍了作为玻利维亚科恰班巴 ECO 项目的一部分,在加强 COVID-19 诊断和治疗的同时开展的社区参与工作,并重点介绍了未来大流行应对工作的经验教训:方法:社区参与包括形成性评估、共同制定健康信息宣传活动、持续的社区倾听和评估。在研讨会、项目会议和焦点小组期间收集了定性数据。还开展了问卷调查,以评估与 COVID-19 相关的态度、知识和实践:收集到的数据强调了与完善的社区卫生委员会密切合作以及让具有社交媒体技能的社区成员参与设计 COVID-19 相关信息以应对线上和线下错误信息的价值。共创会议使宣传活动能够根据社区成员和医务人员的需求和偏好调整内容和方法。持续倾听社区和医务人员的意见有助于不断调整项目活动:结论:通过阶梯式和多管齐下的方法,结合共同创造和社区倾听,参与能够应对大流行病期间当地新出现的挑战。该项目创造了对话空间和合作机会,加强了社区与卫生服务机构之间的联系。
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引用次数: 0
A global review of the impact on women from men's alcohol drinking: the need for responding with a gendered lens. 男性饮酒对女性影响的全球审查:需要从性别角度做出回应。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-05-03 DOI: 10.1080/16549716.2024.2341522
Ingrid M Wilson, Bree Willoughby, Amany Tanyos, Kathryn Graham, Mary Walker, Anne-Marie Laslett, Leane Ramsoomar

Background: Global evidence shows that men's harmful alcohol use contributes to intimate partner violence (IPV) and other harms. Yet, interventions that target alcohol-related harms to women are scarce. Quantitative analyses demonstrate links with physical and verbal aggression; however, the specific harms to women from men's drinking have not been well articulated, particularly from an international perspective.

Aim: To document the breadth and nature of harms and impact of men's drinking on women.

Methods: A narrative review, using inductive analysis, was conducted of peer-reviewed qualitative studies that: (a) focused on alcohol (men's drinking), (b) featured women as primary victims, (c) encompassed direct/indirect harms, and (d) explicitly featured alcohol in the qualitative results. Papers were selected following a non-time-limited systematic search of key scholarly databases.

Results: Thirty papers were included in this review. The majority of studies were conducted in low- to middle-income countries. The harms in the studies were collated and organised under three main themes: (i) harmful alcohol-related actions by men (e.g. violence, sexual coercion, economic abuse), (ii) impact on women (e.g. physical and mental health harm, relationship functioning, social harm), and (iii) how partner alcohol use was framed by women in the studies.

Conclusion: Men's drinking results in a multitude of direct, indirect and hidden harms to women that are cumulative, intersecting and entrench women's disempowerment. An explicit gendered lens is needed in prevention efforts to target men's drinking and the impact on women, to improve health and social outcomes for women worldwide.

背景:全球证据表明,男性酗酒会导致亲密伴侣暴力(IPV)和其他伤害。然而,针对酒精对女性造成伤害的干预措施却很少。定量分析显示,男性饮酒与肢体和言语攻击有关;然而,男性饮酒对女性造成的具体伤害还没有得到很好的阐述,特别是从国际视角来看:方法:采用归纳分析法,对同行评议的定性研究进行叙述性回顾,这些研究包括(方法:采用归纳分析法对同行评议的定性研究进行了叙述性综述,这些研究包括:(a)关注酒精(男性饮酒),(b)以女性为主要受害者,(c)包含直接/间接伤害,以及(d)在定性结果中明确提到酒精。在对主要学术数据库进行无时间限制的系统性检索后,对论文进行了筛选:本综述收录了 30 篇论文。大多数研究都是在中低收入国家进行的。对研究中的危害进行了整理,并将其归纳为三个主题:(i) 男性与酒精相关的有害行为(如暴力、性胁迫、经济虐待),(ii) 对女性的影响(如身心健康危害、关系功能、社会危害),(iii) 研究中女性如何看待伴侣饮酒:男性酗酒对女性造成了许多直接、间接和隐性的伤害,这些伤害是累积性的、交叉性的,并加剧了女性的失权。在针对男性饮酒及其对妇女的影响开展预防工作时,需要有明确的性别视角,以改善全世界妇女的健康和社会成果。
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引用次数: 0
Any better? A follow-up content analysis of adolescent sexual and reproductive health inclusion in Global Financing Facility country planning documents. 还有更好的吗?对全球融资机制国家规划文件中纳入青少年性健康和生殖健康内容的后续分析。
IF 2.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-31 Epub Date: 2024-06-19 DOI: 10.1080/16549716.2024.2315644
Ulla Walmisley, Mary V Kinney, Joël Arthur Kiendrébéogo, Yamba Kafando, Asha S George

Background: The Global Financing Facility (GFF) supports national reproductive, maternal, newborn, child, adolescent health, and nutrition needs. Previous analysis examined how adolescent sexual and reproductive health was represented in GFF national planning documents for 11 GFF partner countries.

Objectives: This paper furthers that analysis for 16 GFF partner countries as part of a Special Series.

Methods: Content analysis was conducted on publicly available GFF planning documents for Afghanistan, Burkina Faso, Cambodia, CAR, Côte d'Ivoire, Guinea, Haiti, Indonesia, Madagascar, Malawi, Mali, Rwanda, Senegal, Sierra Leone, Tajikistan, Vietnam. Analysis considered adolescent health content (mindset), indicators (measure) and funding (money) relative to adolescent sexual and reproductive health needs, using a tracer indicator.

Results:  Countries with higher rates of adolescent pregnancy had more content relating to adolescent reproductive health, with exceptions in fragile contexts. Investment cases had more adolescent content than project appraisal documents. Content gradually weakened from mindset to measures to money. Related conditions, such as fistula, abortion, and mental health, were insufficiently addressed. Documents from Burkina Faso and Malawi demonstrated it is possible to include adolescent programming even within a context of shifting or selective priorities.

Conclusion: Tracing prioritisation and translation of commitments into plans provides a foundation for discussing global funding for adolescents. We highlight positive aspects of programming and areas for strengthening and suggest broadening the perspective of adolescent health beyond the reproductive health to encompass issues, such as mental health. This paper forms part of a growing body of accountability literature, supporting advocacy work for adolescent programming and funding.

背景:全球筹资机制(GFF)支持各国在生殖、孕产妇、新生儿、儿童、青少年健康和营养方面的需求。之前的分析研究了 11 个全球森林筹资机制伙伴国家的青少年性健康和生殖健康在全球森林筹资机制国家规划文件中的体现情况:作为特别系列的一部分,本文进一步分析了 16 个全球森林论坛伙伴国家的情况:方法:对阿富汗、布基纳法索、柬埔寨、中非共和国、科特迪瓦、几内亚、海地、印度尼西亚、马达加斯加、马拉维、马里、卢旺达、塞内加尔、塞拉利昂、塔吉克斯坦和越南公开发表的全球森林论坛规划文件进行了内容分析。分析考虑了与青少年性健康和生殖健康需求相关的青少年健康内容(思维方式)、指标(措施)和资金(金钱),并使用了追踪指标: 结果:青少年怀孕率较高的国家与青少年生殖健康有关的内容较多,但情况脆弱的国家除外。与项目评估文件相比,投资案例中有关青少年的内容更多。从思想到措施再到资金,内容逐渐弱化。瘘管病、人工流产和心理健康等相关问题没有得到充分解决。布基纳法索和马拉维的文件表明,即使在优先事项发生变化或有所选择的情况下,也有可能纳入青少年计划:结论:追溯优先事项以及将承诺转化为计划的过程,为讨论全球青少年资助问题奠定了基础。我们强调了计划编制的积极方面和需要加强的领域,并建议将青少年健康的视角从生殖健康扩大到心理健康等问题。本文是日益增多的问责制文献的一部分,为青少年计划和资金的宣传工作提供了支持。
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引用次数: 0
Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho. 莱索托接受耐多药结核病治疗的患者中,低体重指数是痰培养转换和治疗效果的预测因素。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-02-02 DOI: 10.1080/16549716.2024.2305930
Lawrence Oyewusi, Chengbo Zeng, K J Seung, Stephanie Mpinda, Mikanda Kunda, Carole D Mitnick, Makelele Kanu, Meseret Tamirat, Joalane Makaka, Mabatloung Mofolo, Refiloe Maime, Llang Maama, Ninza Senyo, Bamidele Oguntoyinbo, Lwayi Mayombo, Molly F Franke

Background: A low body mass index (BMI) at the start of treatment for rifampicin- or multidrug-resistant tuberculosis (MDR/RR-TB) is associated with poor treatment outcomes and may contribute to delayed sputum culture conversion, thereby prolonging the period of potential transmission to others. Whether the relative importance of low BMI in predicting treatment outcomes differs by HIV status is unclear.

Objectives: We evaluated the association between low BMI and two dependent variables, sputum culture conversion and end-of-treatment outcome, among patients receiving treatment for MDR/RR-TB in Lesotho, a setting with a high prevalence of HIV infection.

Methods: Secondary data from a prospective cohort of patients initiating a longer (18-20 months) treatment containing bedaquiline and/or delamanid under routine programmatic conditions in Lesotho were analysed. Risk ratios and differences were adjusted for potential confounders using multivariable logistic regression, and estimates were stratified by HIV status.

Results: Of 264 patients, 105 and 250 were eligible for culture conversion and end-of-treatment analyses, respectively. Seventy-one per cent of patients (74/105) experienced culture conversion within six months, while 74% (184/250) experienced a favourable end-of-treatment outcome. Low BMI was associated with a lower frequency of culture conversion at six months among those who were not living with HIV (relative risk [RR]: 0.50 [95% CI: 0.21, 0.79]); this association was attenuated among those living with HIV (RR: 0.88 [95% CI: 0.68, 1.23]). A low BMI was moderately associated with a lower frequency of treatment success (RR = 0.89 [95% CI: 0.77, 1.03]), regardless of HIV status.

Conclusions: Low BMI was common and associated with the frequency of six-month culture conversion and end-of-treatment outcomes. The association with culture conversion was more pronounced among those not living with HIV. Addressing the myriad factors that drive low BMI in this setting could hasten culture conversion and improve end-of-treatment outcomes. This will require a multipronged approach focused on alleviating food insecurity and enabling prompt diagnosis and treatment of HIV and TB.

背景:开始治疗利福平或耐多药结核病(MDR/RR-TB)时体重指数(BMI)偏低与治疗效果不佳有关,并可能导致痰培养转换延迟,从而延长可能传染给他人的时间。低体重指数在预测治疗结果方面的相对重要性是否因艾滋病病毒感染状况而异,目前尚不清楚:我们评估了在莱索托接受 MDR/RR-TB 治疗的患者中,低 BMI 与两个因变量(痰培养转换和治疗结束结果)之间的关联:分析了在莱索托常规项目条件下接受贝达喹啉和/或地拉那米德较长时间(18-20 个月)治疗的前瞻性队列患者的二次数据。使用多变量逻辑回归对潜在的混杂因素进行了风险比和差异调整,并根据艾滋病病毒感染状况对估计值进行了分层:在 264 名患者中,分别有 105 人和 250 人符合培养转换和治疗结束分析的条件。71%的患者(74/105)在 6 个月内经历了培养转换,74%的患者(184/250)经历了良好的治疗结束结果。在非 HIV 感染者中,低体重指数与较低的 6 个月培养转换频率相关(相对风险 [RR]:0.50 [95% CI:0.21, 0.79]);而在 HIV 感染者中,这种相关性减弱(RR:0.88 [95% CI:0.68, 1.23])。低体重指数与较低的治疗成功率(RR = 0.89 [95% CI: 0.77, 1.03])呈中度相关,与艾滋病毒感染状况无关:结论:低体重指数很常见,并与六个月培养转换频率和治疗结束结果有关。在非艾滋病病毒感染者中,低体重指数与培养转换的关系更为明显。在这种情况下,解决导致低体重指数的各种因素可以加快培养转换并改善治疗结束后的结果。这就需要采取多管齐下的方法,重点缓解粮食不安全问题,并使艾滋病毒和结核病得到及时诊断和治疗。
{"title":"Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho.","authors":"Lawrence Oyewusi, Chengbo Zeng, K J Seung, Stephanie Mpinda, Mikanda Kunda, Carole D Mitnick, Makelele Kanu, Meseret Tamirat, Joalane Makaka, Mabatloung Mofolo, Refiloe Maime, Llang Maama, Ninza Senyo, Bamidele Oguntoyinbo, Lwayi Mayombo, Molly F Franke","doi":"10.1080/16549716.2024.2305930","DOIUrl":"10.1080/16549716.2024.2305930","url":null,"abstract":"<p><strong>Background: </strong>A low body mass index (BMI) at the start of treatment for rifampicin- or multidrug-resistant tuberculosis (MDR/RR-TB) is associated with poor treatment outcomes and may contribute to delayed sputum culture conversion, thereby prolonging the period of potential transmission to others. Whether the relative importance of low BMI in predicting treatment outcomes differs by HIV status is unclear.</p><p><strong>Objectives: </strong>We evaluated the association between low BMI and two dependent variables, sputum culture conversion and end-of-treatment outcome, among patients receiving treatment for MDR/RR-TB in Lesotho, a setting with a high prevalence of HIV infection.</p><p><strong>Methods: </strong>Secondary data from a prospective cohort of patients initiating a longer (18-20 months) treatment containing bedaquiline and/or delamanid under routine programmatic conditions in Lesotho were analysed. Risk ratios and differences were adjusted for potential confounders using multivariable logistic regression, and estimates were stratified by HIV status.</p><p><strong>Results: </strong>Of 264 patients, 105 and 250 were eligible for culture conversion and end-of-treatment analyses, respectively. Seventy-one per cent of patients (74/105) experienced culture conversion within six months, while 74% (184/250) experienced a favourable end-of-treatment outcome. Low BMI was associated with a lower frequency of culture conversion at six months among those who were not living with HIV (relative risk [RR]: 0.50 [95% CI: 0.21, 0.79]); this association was attenuated among those living with HIV (RR: 0.88 [95% CI: 0.68, 1.23]). A low BMI was moderately associated with a lower frequency of treatment success (RR = 0.89 [95% CI: 0.77, 1.03]), regardless of HIV status.</p><p><strong>Conclusions: </strong>Low BMI was common and associated with the frequency of six-month culture conversion and end-of-treatment outcomes. The association with culture conversion was more pronounced among those not living with HIV. Addressing the myriad factors that drive low BMI in this setting could hasten culture conversion and improve end-of-treatment outcomes. This will require a multipronged approach focused on alleviating food insecurity and enabling prompt diagnosis and treatment of HIV and TB.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10840591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Applying the photovoice method with adolescents in mining areas in rural Mozambique: critical reflections and lessons learned. 对莫桑比克农村矿区青少年采用摄影 "选择 "方法:重要反思与经验教训。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-02-07 DOI: 10.1080/16549716.2024.2305506
Olga Cambaco, Hermínio Cossa, Andrea Farnham, Eusébio Macete, Mirko S Winkler, Karin Gross, Khátia Munguambe

There is a recognised need for innovative methods to elicit the perspective of adolescents on public health issues, particularly when addressing sensitive topics such as the impact of mining projects on their health. Participatory approaches such as "photovoice" allow for deep engagement of vulnerable and marginalised populations, including adolescents. However, few existing studies have used the photovoice method to reflect on issues related to the environment and its impact on public health. To date, no studies have been found that have used photovoice to gain insight into adolescents' perspectives in mining areas. In this paper, we discuss the application of the photovoice method to understand adolescents' perceptions about the impact of mining on their health and well-being in rural areas in Mozambique. The study was conducted in northern and central Mozambique. Photovoice was successfully integrated into eight focus group discussions with adolescent girls and boys aged 15 to 17 years. Several lessons for guiding future research were learned. First, it provided an understanding of the perceived impacts of mining on their health and well-being. Second, photovoice promoted active engagement and interest in the study by the adolescents. Finally, compared to its ability to capture perceptions of physical and environmental aspects affecting adolescents' well-being, the method was less straightforward in revealing their concerns regarding social, relational and community aspects that are less tangible. Programs can make use of photovoice to address health issues without setting adolescents' views and priorities aside, allowing them to influence health decisions on issues that are meaningful to them. Future studies should explore strategies to minimise the role of the power dynamics that affect the engagement and contribution of adolescents in advocating for necessary and meaningful changes. Additionally, it is important to investigate how health programs and policies can help to reduce the impact of existing inequalities.

人们认识到,需要采用创新方法来征求青少年对公共卫生问题的看法,尤其是在处理采矿项目对青少年健康的影响等敏感话题时。摄影选择 "等参与式方法可以让包括青少年在内的弱势和边缘人群深入参与其中。然而,现有的研究很少使用 photovoice 方法来反思与环境有关的问题及其对公众健康的影响。迄今为止,还没有发现任何研究利用摄影选择来深入了解青少年对矿区的看法。在本文中,我们讨论了如何应用 photovoice 方法来了解莫桑比克农村地区青少年对采矿对其健康和福祉的影响的看法。研究在莫桑比克北部和中部进行。在与 15 至 17 岁的男女青少年进行的八次焦点小组讨论中,成功采用了摄影选择法。这项研究为指导今后的研究提供了几条经验。首先,它让人们了解到采矿对他们健康和福祉的影响。其次,摄影选择促进了青少年对研究的积极参与和兴趣。最后,这种方法能够捕捉到青少年对影响其福祉的物质和环境方面的看法,但在揭示他们对社会、关系和社区方面的关注方面,这种方法就不那么直接了,因为这些方面不是那么有形。计划可以利用摄影舆论来解决健康问题,同时又不会将青少年的观点和优先事项搁置一旁,让他们能够就对自己有意义的问题影响健康决策。未来的研究应探索各种策略,尽量减少影响青少年参与和促进必要而有意义的变革的权力动态因素。此外,研究健康计划和政策如何帮助减少现有不平等现象的影响也很重要。
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引用次数: 0
Organizational culture and turnover intention among primary care providers: a multilevel study in four large cities in China. 组织文化与基层医疗服务提供者的离职意向:一项在中国四个大城市开展的多层次研究。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-06-03 DOI: 10.1080/16549716.2024.2346203
Mengyao Li, Wenhua Wang, Jinnan Zhang, Ruixue Zhao, Katya Loban, Huiyun Yang, Rebecca Mitchell

Background: Primary health care plays an important role in providing populations with access to health care. However, it is currently facing unprecedented workforce shortages and high turnover worldwide.

Objective: This study examined the relationship between organizational culture and turnover intention among primary care providers in China.

Methods: A cross-sectional survey was administered in four large cities in China, Tianjin, Jinan, Shanghai, and Shenzhen, comprising 38 community health centers and 399 primary care providers. Organizational culture was measured using the Competing Value Framework model, which is divided into four culture types: group, development, hierarchy, and rational culture. Turnover intention was measured using one item assessing participants' intention to leave their current position in the following year. We compared the turnover intention among different organizational culture types using a Chi-square test, while the hierarchical logistic regression was used to examine the relationship between organizational culture and turnover intention.

Results: The study found that 32% of primary care providers indicated an intention to leave. Primary care providers working in a hierarchical culture reported higher turnover intention (43.18%) compared with those in other cultures (p < 0.05). Hierarchical culture was a predictor of turnover intention (OR = 3.453, p < 0.001), whereas rational culture had a negative effect on turnover intention (OR = 0.319, p < 0.05).

Conclusions: Our findings inform organizational management strategies to retain a healthy workforce in primary health care.

背景:初级卫生保健在为民众提供卫生保健服务方面发挥着重要作用。然而,目前它正面临着前所未有的劳动力短缺和全球范围内的高离职率:本研究探讨了中国基层医疗机构组织文化与离职意向之间的关系:方法:在天津、济南、上海和深圳四个大城市进行了一项横断面调查,调查对象包括 38 家社区卫生中心和 399 名初级医疗服务提供者。组织文化采用竞争价值框架模型进行测量,该模型分为四种文化类型:群体文化、发展文化、等级文化和理性文化。离职意向采用一个项目进行测量,评估参与者在下一年离开当前职位的意向。我们使用卡方检验比较了不同组织文化类型的离职意向,并使用层次逻辑回归检验了组织文化与离职意向之间的关系:研究发现,32% 的初级医疗服务提供者表示有离职意向。与其他文化中的医疗服务提供者相比,在等级文化中工作的医疗服务提供者离职意向更高(43.18%)(p p p 结论:我们的研究结果为组织管理策略提供了参考:我们的研究结果为组织管理策略提供了参考,以留住一支健康的初级医疗服务人员队伍。
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