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The effectiveness of rural community health workers in improving health outcomes during the COVID-19 pandemic: a systematic review. 在 COVID-19 大流行期间,农村社区保健员在改善健康结果方面的有效性:系统性综述。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-01-05 DOI: 10.1080/16549716.2023.2292385
Neema Kaseje, Meghna Ranganathan, Monica Magadi, Kevin Oria, Andy Haines

Background: Rural community health workers [CHWs] play a critical role in improving health outcomes during non-pandemic times, but evidence on their effectiveness during the COVID-19 pandemic is limited. There is a need to focus on rural CHWs and rural health systems as they have limited material and human resources rendering them more vulnerable than urban health systems to severe disruptions during pandemics.

Objectives: This systematic review aims to describe and appraise the current evidence on the effectiveness of rural CHWs in improving access to health services and health outcomes during the COVID-19 pandemic in low-and middle-income countries [LMICs].

Methods: We searched electronic databases for articles published from 2020 to 2023 describing rural CHW interventions during the COVID-19 pandemic in LMICs. We extracted data on study characteristics, interventions, outcome measures, and main results. We conducted a narrative synthesis of key results.

Results: Fifteen studies from 10 countries met our inclusion criteria. Most of the studies were from Asia [10 of 15 studies]. Study designs varied and included descriptive and analytical studies. The evidence suggested that rural CHW interventions led to increased household access to health services and may be effective in improving COVID-19 and non-COVID-19 health outcomes. Overall, however, the quality of evidence was poor due to methodological limitations; 14 of 15 studies had a high risk of bias.

Conclusion: Rural CHWs may have improved access to health services and health outcomes during the COVID-19 pandemic in LMICs but more rigorous studies are needed during future pandemics to evaluate their effectiveness in improving health outcomes in different settings and to assess appropriate support required to ensure their impact at scale.

背景:农村社区保健员(CHWs)在非大流行期间对改善健康结果起着至关重要的作用,但在 COVID-19 大流行期间,有关其有效性的证据却很有限。有必要关注农村社区保健员和农村医疗系统,因为他们的物质和人力资源有限,在大流行期间比城市医疗系统更容易受到严重破坏:本系统性综述旨在描述和评估在 COVID-19 大流行期间,农村社区保健员在改善中低收入国家(LMICs)卫生服务的获取和卫生结果方面的有效性的现有证据:我们在电子数据库中检索了 2020 年至 2023 年间发表的描述 COVID-19 大流行期间中低收入国家(LMICs)农村社区保健员干预措施的文章。我们提取了有关研究特征、干预措施、结果测量和主要结果的数据。我们对主要结果进行了叙述性综述:来自 10 个国家的 15 项研究符合我们的纳入标准。大多数研究来自亚洲(15 项研究中的 10 项)。研究设计各不相同,包括描述性研究和分析性研究。证据表明,农村社区保健员干预措施增加了家庭获得医疗服务的机会,并可有效改善 COVID-19 和非 COVID-19 健康结果。但总体而言,由于方法上的局限性,证据的质量较差;15 项研究中有 14 项存在较高的偏倚风险:农村社区保健员可能会在 COVID-19 大流行期间改善低收入与中等收入国家的医疗服务获取途径和医疗效果,但在未来的大流行期间还需要进行更严格的研究,以评估他们在不同环境下改善医疗效果的有效性,并评估为确保他们的大规模影响所需的适当支持。
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引用次数: 0
Electronic health record and primary care physician self-reported quality of care: a multilevel study in China. 电子健康记录与基层医生自我报告的医疗质量:中国的一项多层次研究。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-01-11 DOI: 10.1080/16549716.2023.2301195
Wenhua Wang, Mengyao Li, Katya Loban, Jinnan Zhang, Xiaolin Wei, Rebecca Mitchel

Background: Health information technology is one of the building blocks of a high-performing health system. However, the evidence regarding the influence of an electronic health record (EHR) on the quality of care remains mixed, especially in low- and middle-income countries.

Objective: This study examines the association between greater EHR functionality and primary care physician self-reported quality of care.

Methods: A total of 224 primary care physicians from 38 community health centres (CHCs) in four large Chinese cities participated in a cross-sectional survey to assess CHC care quality. Each CHC director scored their CHC's EHR functionality on the availability of ten typical features covering health information, data, results management, patient access, and clinical decision support. Data analysis utilised hierarchical linear modelling.

Results: The availability of five EHR features was positively associated with physician self-reported clinical quality: share records online with providers outside the practice (β = 0.276, p = 0.04), access records online by the patient (β = 0.325, p = 0.04), alert provider of potential prescription problems (β = 0.353, p = 0.04), send the patient reminders for care (β = 0.419, p = 0.003), and list patients by diagnosis or health risk (β = 0.282, p = 0.04). However, no association was found between specific features availability or total features score and physician self-reported preventive quality.

Conclusions: This study provides evidence that the availability of EHR systems, and specific features of these systems, was positively associated with physician self-reported quality of care in these 38 CHCs. Future longitudinal studies focused on standardised quality metrics, and designed to control known confounding variables, will further inform quality improvement efforts in primary care.

背景:医疗信息技术是高效医疗系统的基石之一。然而,有关电子健康记录(EHR)对医疗质量影响的证据仍然参差不齐,尤其是在中低收入国家:本研究探讨了增强电子病历功能与初级保健医生自我报告的保健质量之间的关系:来自中国四个大城市 38 家社区卫生中心(CHC)的 224 名初级保健医生参与了一项横断面调查,以评估社区卫生中心的医疗质量。每位社区卫生中心主任都对其社区卫生中心的电子病历功能进行了评分,评分标准包括健康信息、数据、结果管理、患者访问和临床决策支持等十项典型功能的可用性。数据分析采用分层线性模型:结果:五项电子病历功能的可用性与医生自我报告的临床质量呈正相关:与诊所外的医疗服务提供者在线共享记录(β = 0.276,p = 0.04),患者在线访问记录(β = 0.325, p = 0.04),提醒提供者潜在的处方问题(β = 0.353, p = 0.04),向患者发送护理提醒(β = 0.419, p = 0.003),按诊断或健康风险列出患者名单(β = 0.282, p = 0.04)。然而,在特定功能可用性或功能总分与医生自我报告的预防质量之间没有发现任何关联:本研究提供的证据表明,在这 38 家社区健康中心,电子病历系统的可用性以及这些系统的特定功能与医生自我报告的护理质量呈正相关。未来的纵向研究将重点关注标准化的质量指标,并旨在控制已知的混杂变量,这将为基层医疗质量改进工作提供更多信息。
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引用次数: 0
The Kenyan assistive technology ecosystem: a network analysis. 肯尼亚辅助技术生态系统:网络分析。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-01-15 DOI: 10.1080/16549716.2024.2302208
Emma M Smith, Stephanie Huff, Rose Bukania, Bernard Chiira, Catherine Holloway, Malcolm MacLachlan

Background: Assistive technology is central to the realization of the rights of persons with disabilities. However, there remains limited access to assistive technology throughout much of the world, with particularly poor access in lower- and middle-income countries. Evaluating stakeholder engagement in assistive technology networks has been used as a successful strategy to understand and address gaps in the assistive technology ecosystem.

Objective: The objective of this research was to provide an overview of the Kenyan Assistive Technology Ecosystem, including available assistive products and related services, and an understanding of the nature and strength of relationships between stakeholders.

Methods: In this study, we employed an online qualitative stakeholder survey (2021) with representatives of organizations involved in assistive technology in Kenya.

Results: The assistive technology network in Kenya is distributed, with Government Ministries and Agencies and Organizations of persons with disabilities central to the network. The strength of relationships is concentrated on awareness and communication, with fewer organizations actively collaborating. Innovation training organizations are not yet well integrated into the network.

Conclusions: Improving access to assistive technology in Kenya will benefit from greater collaboration amongst all assistive technology stakeholders.

背景:辅助技术是实现残疾人权利的核心。然而,在世界大部分地区,获得辅助技术的机会仍然有限,尤其是在中低收入国家。评估利益相关者在辅助技术网络中的参与情况已被用作了解和解决辅助技术生态系统中存在的差距的一项成功战略:本研究旨在提供肯尼亚辅助技术生态系统的概况,包括现有的辅助产品和相关服务,并了解利益相关者之间关系的性质和强度:在这项研究中,我们采用了利益相关者在线定性调查(2021 年)的方法,调查对象是肯尼亚辅助技术相关组织的代表:肯尼亚的辅助技术网络是分布式的,政府部委和机构以及残疾人组织是网络的核心。关系的优势集中在认识和沟通方面,积极合作的组织较少。创新培训组织尚未很好地融入该网络:结论:加强所有辅助技术利益相关者之间的合作将有利于改善肯尼亚辅助技术的获取。
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引用次数: 0
Changes in the menstrual hygiene management facilities and usage among Bangladeshi school girls and its effect on school absenteeism from 2014 to 2018. 2014年至2018年孟加拉国女学生月经卫生管理设施和使用情况的变化及其对旷课的影响。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-01-17 DOI: 10.1080/16549716.2023.2297512
Farjana Jahan, Noshin Sayiara Shuchi, Abul Kasham Shoab, Mahbub-Ul Alam, Sk Md Kamrul Bashar, Khairul Islam, Hasin Jahan, Mahadi Hasan, Md Masud Alam, Mahbubur Rahman

Background: The lack of menstrual hygiene management (MHM) information and facilities in schools is a major contributor to adolescent girls' school absenteeism in low- and middle-income countries like Bangladesh.

Objectives: This paper examines the changes over time in school MHM facilities, knowledge and perceptions among adolescent girls, in relation to school absenteeism between 2014 and 2018 in Bangladesh.

Methods: We examined changes in MHM and school absenteeism among schoolgirls using nationally representative data from the Bangladesh National Hygiene Baseline Survey 2014 and National Hygiene Survey 2018. Given the repetitive nature of our data and its clustering within participants, our method included performing descriptive analysis, bivariate analysis, and multivariate Generalised Estimating Equation (GEE) modelling to analyse these changes.

Results: Results showed that adolescent girls' menstruation-related absenteeism decreased between 2014 and 2018. Percentage of adolescents who missed school decreased from 25% to 14% (PD: -11; CI: -16 to -6.1), while the average number of missed days reduced from 2.8 to 2.5 (PD: -0.33; CI: -0.57 to -0.10). In the GEE model, we found that living in rural areas (coef: -5.6; CI: -10.06 to -1.14), parental restrictions on going outside (coef: 4.47; CI: 0.75 to 8.2), education levels of girls (coef: -9.48; CI: -14.17 to -4.79), girl's belief that menstruation affects school performance (coef: 23.32; CI: 19.71 to 26.93), and using old cloths (coef: -4.2; CI: -7.6 to -0.79) were significantly associated with higher absenteeism. However, participant's age, type of school, knowledge of menstruation before menarche, receiving information regarding MHM, separate place for changing absorbents, and separate latrine and urine facility were not significantly associated with the changes in absenteeism over time.

Conclusion: This paper emphasised the associations between changes in school absenteeism, parental restrictions on students, students' education levels, and menstruation-related misperceptions. Ongoing research, policy reviews, and targeted interventions to improve MHM perceptions among girls are required to provide long-term benefits for adolescent girls in Bangladesh.

背景:在孟加拉国等中低收入国家,学校缺乏月经卫生管理(MHM)信息和设施是导致少女旷课的主要原因:本文研究了孟加拉国 2014 年至 2018 年间学校 MHM 设施、知识和少女对缺课的看法随时间发生的变化:我们利用孟加拉国 2014 年国家卫生基线调查和 2018 年国家卫生调查中具有全国代表性的数据,研究了学校女生中 MHM 和旷课情况的变化。考虑到数据的重复性和参与者的聚类性,我们的方法包括进行描述性分析、双变量分析和多变量广义估计方程(GEE)建模来分析这些变化:结果显示,2014 年至 2018 年期间,少女与月经有关的旷课现象有所减少。旷课的青少年比例从25%降至14%(PD:-11;CI:-16至-6.1),平均旷课天数从2.8天降至2.5天(PD:-0.33;CI:-0.57至-0.10)。在 GEE 模型中,我们发现居住在农村地区(系数:-5.6;CI:-10.06 至-1.14)、父母限制外出(系数:4.47;CI:0.75 至 8.2)、女孩的教育水平(系数:-9.48;CI:-14.17至-4.79)、女孩认为月经会影响学习成绩(系数:23.32;CI:19.71至26.93)和使用旧布(系数:-4.2;CI:-7.6至-0.79)与旷课率较高显著相关。然而,受试者的年龄、学校类型、月经初潮前对月经的了解、接受有关产妇保健的信息、更换吸收剂的独立场所以及独立的厕所和尿液设施与旷课率随时间的变化并无明显关联:本文强调了旷课率的变化、家长对学生的限制、学生的教育水平以及与月经有关的错误观念之间的关联。为了使孟加拉国的少女长期受益,需要持续开展研究、政策审查和有针对性的干预措施,以改善女孩对 MHM 的认识。
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引用次数: 0
"Arming half-baked people with weapons!" Information enclaving among professionals and the need for a care-centred model for antibiotic use information in Uganda, Tanzania and Malawi. "用武器武装半生不熟的人!"在乌干达、坦桑尼亚和马拉维,专业人员之间的信息封闭以及以护理为中心的抗生素使用信息模式的必要性。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-03-05 DOI: 10.1080/16549716.2024.2322839
Susan Nayiga, Eleanor E MacPherson, John Mankhomwa, Fortunata Nasuwa, Raymond Pongolani, Rita Kabuleta, Mike Kesby, Russell Dacombe, Shona Hilton, Delia Grace, Nicholas Feasey, Clare I R Chandler

Background: The overuse of antimicrobial medicines is a global health concern, including as a major driver of antimicrobial resistance. In many low- and middle-income countries, a substantial proportion of antibiotics are purchased over-the-counter without a prescription. But while antibiotics are widely available, information on when and how to use them is not.

Objective: We aimed to understand the acceptability among experts and professionals of sharing information on antibiotic use with end users - patients, carers and farmers - in Uganda, Tanzania and Malawi.

Methods: Building on extended periods of fieldwork amongst end-users and antibiotic providers in the three countries, we conducted two workshops in each, with a total of 44 medical and veterinary professionals, policy makers and drug regulators, in December 2021. We carried out extensive documentary and literature reviews to characterise antibiotic information systems in each setting.

Results: Participants reported that the general public had been provided information on medicine use in all three countries by national drug authorities, health care providers and in package inserts. Participants expressed concern over the danger of sharing detailed information on antibiotic use, particularly that end-users are not equipped to determine appropriate use of medicines. Sharing of general instructions to encourage professionally-prescribed practices was preferred.

Conclusions: Without good access to prescribers, the tension between enclaving and sharing of knowledge presents an equity issue. Transitioning to a client care-centred model that begins with the needs of the patient, carer or farmer will require sharing unbiased antibiotic information at the point of care.

背景:过度使用抗菌药物是一个全球健康问题,也是抗菌药物耐药性的主要驱动因素。在许多中低收入国家,很大一部分抗生素是在没有处方的情况下非处方购买的。但是,尽管抗生素可以广泛获得,有关何时以及如何使用抗生素的信息却并不普及:我们旨在了解乌干达、坦桑尼亚和马拉维的专家和专业人士对与最终用户(患者、护理人员和农民)共享抗生素使用信息的接受程度:在对这三个国家的最终用户和抗生素供应商进行长期实地调查的基础上,我们于 2021 年 12 月在这三个国家各举办了两次研讨会,共有 44 名医疗和兽医专业人士、政策制定者和药品监管者参加。我们进行了广泛的文件和文献审查,以了解各国抗生素信息系统的特点:结果:与会者报告说,在所有三个国家,国家药品管理机构、医疗保健提供者和包装插页都向公众提供了药品使用信息。与会者对共享抗生素使用详细信息的危险性表示担忧,特别是最终用户没有能力确定药物的适当使用。他们更倾向于分享一般说明,以鼓励专业处方:结论:如果不能很好地接触处方医生,"圈地 "与知识共享之间的矛盾就会带来公平问题。要过渡到以客户护理为中心的模式,从病人、护理人员或农民的需求出发,就需要在护理点共享无偏见的抗生素信息。
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引用次数: 0
Facility capacity and provider knowledge for cholera surveillance and diarrhoea case management in cholera hotspots in the Democratic Republic of Congo - a mixed-methods study. 刚果民主共和国霍乱热点地区霍乱监测和腹泻病例管理的设施能力和提供者知识--一项混合方法研究。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-03-05 DOI: 10.1080/16549716.2024.2317774
Mattias Schedwin, Aurélie Bisumba Furaha, Kelly Elimian, Carina King, Espoir Bwenge Malembaka, Marc K Yambayamba, Thorkild Tylleskär, Tobias Alfvén, Simone E Carter, Placide Welo Okitayemba, Mala Ali Mapatano, Helena Hildenwall

Background: Wider healthcare-strengthening interventions are recommended in cholera hotspots and could benefit other types of diarrhoeal diseases which contribute to greater mortality than cholera.

Objective: Describe facility capacity and provider knowledge for case management of diarrhoea and cholera surveillance in cholera hotspots in the Democratic Republic of Congo (DRC) among health facilities, drug shops, and traditional health practitioners.

Methods: We conducted a sequential exploratory mixed-method study, using focus group discussions, facility audits, and provider knowledge questionnaires during September and October 2022 in North Kivu and Tanganyika provinces, Eastern DRC. Content analysis was used for qualitative data. Quantitative data were summarised by facility level and healthcare provider type. Audit and knowledge scores (range 0-100) were generated. Multivariable linear regression estimated association between scores and explanatory factors. Qualitative and quantitative data were triangulated during interpretation.

Results: Overall, 244 facilities and 308 providers were included. The mean audit score for health facilities was 51/100 (SD: 17). Private facilities had an -11.6 (95% CI, -16.7 to -6.6) lower adjusted mean score compared to public. Mean knowledge score was 59/100 (95% CI, 57 to 60) for health facility personnel, 46/100 (95% CI, 43 to 48) for drug shop vendors and 37/100 (95% CI, 34 to 39) for traditional health practitioners. Providers had particularly low knowledge concerning when to check for low blood sugar, use of nasogastric tubes, and dosing schedules. Knowledge about case definitions for cholera was similar between groups (range 41-58%) except for traditional health practitioners for the definition during an outbreak 15/73 (21%).

Conclusions: Increasing awareness of cholera case definitions in this context could help improve cholera surveillance and control. Increased support and supervision, especially for private providers, could help ensure facilities are equipped to provide safe care. More nuanced aspects of case management should be emphasised in provider training.

背景:建议在霍乱热点地区采取更广泛的医疗保健强化干预措施,这将使死亡率高于霍乱的其他腹泻疾病受益:建议在霍乱热点地区采取更广泛的医疗保健强化干预措施,并使死亡率高于霍乱的其他类型腹泻疾病受益:目的:描述刚果民主共和国(DRC)霍乱热点地区医疗机构、药店和传统医疗从业人员在腹泻病例管理和霍乱监测方面的能力和知识:2022 年 9 月至 10 月期间,我们在刚果民主共和国东部的北基伍省和坦噶尼喀省开展了一项顺序探索性混合方法研究,采用了焦点小组讨论、设施审计和提供者知识问卷调查等方法。定性数据采用内容分析法。定量数据按医疗机构级别和医疗服务提供者类型进行汇总。得出审计和知识评分(范围 0-100)。多变量线性回归估计了分数与解释因素之间的关联。在解释过程中,对定性和定量数据进行了三角测量:共有 244 家医疗机构和 308 名医疗服务提供者参与了研究。医疗机构的平均审计得分为 51/100(标准差:17)。与公立医疗机构相比,私立医疗机构的调整后平均得分低-11.6(95% CI,-16.7 至-6.6)分。医疗机构工作人员的平均知识得分为 59/100(95% CI,57 至 60),药店商贩为 46/100(95% CI,43 至 48),传统医疗从业人员为 37/100(95% CI,34 至 39)。医疗服务提供者对何时检查低血糖、鼻胃管的使用和用药时间表的了解程度尤其低。除了传统医疗从业者对疫情爆发期间的霍乱病例定义有 15/73 (21%)的了解外,其他群体对霍乱病例定义的了解程度相近(范围为 41-58%):结论:在这种情况下,提高对霍乱病例定义的认识有助于改善霍乱的监测和控制。加强支持和监督,尤其是对私营医疗机构的支持和监督,有助于确保医疗机构具备提供安全护理的能力。在对医疗服务提供者进行培训时,应强调病例管理的细微差别。
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引用次数: 0
China's policies: post-COVID-19 challenges for the older population. 中国的政策:COVID-19 后老年人口面临的挑战。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-05-08 DOI: 10.1080/16549716.2024.2345968
Xuezhi Wei, Guoqing Han, Quansheng Wang

On 7 December 2022, the State Council of China released 'Measures to Further Optimize the Implementation of the Prevention and Control of the New Coronavirus Epidemic'. The previous three-year dynamic zero epidemic prevention policy was then replaced with a full liberalization policy. On 5 May 2023, the World Health Organization declared that COVID-19 no longer constituted a 'public health emergency of international concern.' However, given the ongoing prevalence of coronavirus, emerging mutations, and the liberalization of restrictions, there are increased risks of vulnerable people contracting new variants. Low vaccination coverage among older people with compromised immune systems, puts them at further risk. The policy shift will increase pressure on already stretched health infrastructure and medical resources. This short article adds to the current debate arguing that the Chinese government should take commensurate preventive measures, including strengthening medical facilities and equipment and targeting ongoing vaccination in older people.

2022 年 12 月 7 日,中国国务院发布了《进一步优化新型冠状病毒疫情防控工作实施办法》。此前的三年动态零防疫政策被全面放开政策所取代。2023 年 5 月 5 日,世界卫生组织宣布 COVID-19 不再构成'国际关注的突发公共卫生事件'。然而,鉴于冠状病毒的持续流行、新出现的变异以及限制的放开,易感人群感染新变异病毒的风险增加了。免疫系统受损的老年人接种率低,使他们面临更大的风险。政策的转变将增加本已捉襟见肘的卫生基础设施和医疗资源的压力。这篇短文为当前的讨论添砖加瓦,认为中国政府应采取相应的预防措施,包括加强医疗设施和设备,并针对老年人持续接种疫苗。
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引用次数: 0
Action against birth defects: if not now, when? 应对出生缺陷的行动:此时不采取,更待何时?
IF 2.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-31 Epub Date: 2024-05-31 DOI: 10.1080/16549716.2024.2354002
Kathleen Strong, Judith Robb-McCord, Salimah Walani, Cecilia Mellado, Lorenzo D Botto, Guillermo Lay-Son, Theresa Diaz, Tahmina Banu, Kokila Lakhoo, Anshu Banerjee

Background: More children are surviving through interventions to address the infectious causes of under-5 mortality; subsequently, the proportion of deaths caused by birth defects is increasing. Prevention, diagnosis, treatment and care interventions for birth defects are available but are needed where the burden is highest, low-and-middle-income countries.

Objectives: A selection of birth defect focused publications, conferences, and World Health Assembly resolutions from 2000 to 2017 show that global efforts were made to raise the profile of birth defects in global public health. However, recent donor support and national government interest has waned. Without concerted global action to improve primary prevention and care for children born with birth defects, the Sustainable Development Goal targets for child survival will not be met.

Results: Birth defects make up 8% and 10% of global under-5 and neonatal deaths respectively, making them significant contributors to preventable loss of life for children. Survivors face long-term morbidity and lifelong disability which compounds the health and economic woes of individuals, families, communities and society as a whole. Demographic changes in sub-Saharan Africa portend a growing number of births with 1.6 billion projected from 2021 to 2050. More births and better survival without effective prevention and treatment for birth defects translates into more mortality and disability from birth defects.

Conclusions: We recommend interventions for prevention of birth defects. These are evidenced-based and affordable, but require low- and middle-income countries to strengthened their health systems. Action against birth defects now will prevent premature deaths and long-term disability, and lead to stronger, more resilient health systems.

背景:通过采取干预措施消除 5 岁以下儿童死亡的传染病病因,越来越多的儿童得以存活;随之而来的是,出生缺陷导致的死亡比例也在增加。目前已有针对出生缺陷的预防、诊断、治疗和护理干预措施,但需要在负担最重的中低收入国家采取这些措施:从 2000 年到 2017 年,一些关注出生缺陷的出版物、会议和世界卫生大会决议显示,全球都在努力提高出生缺陷在全球公共卫生中的地位。然而,最近捐助方的支持和各国政府的兴趣有所减弱。如果不采取协调一致的全球行动来改善出生缺陷儿童的初级预防和护理,可持续发展目标中有关儿童生存的具体目标将无法实现:结果:出生缺陷分别占全球 5 岁以下儿童和新生儿死亡人数的 8%和 10%,是造成可预防的儿童死亡的重要原因。幸存者面临着长期发病和终生残疾的问题,这加剧了个人、家庭、社区和整个社会的健康和经济困境。撒哈拉以南非洲的人口结构变化预示着出生人数将不断增加,预计 2021 年至 2050 年将达到 16 亿。如果不对出生缺陷进行有效的预防和治疗,出生人数越多、存活率越高,则因出生缺陷导致的死亡率和残疾率就会越高:我们建议采取干预措施预防出生缺陷。结论:我们建议采取预防出生缺陷的干预措施,这些措施以证据为基础,价格低廉,但需要中低收入国家加强卫生系统。现在就采取行动预防出生缺陷,将能防止过早死亡和长期残疾,并建立更强大、更有弹性的卫生系统。
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引用次数: 0
Analysis of Iranian health workforce emigration based on a system dynamics approach: a study protocol. 基于系统动力学方法的伊朗卫生工作者移民分析:研究方案。
IF 2.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-31 Epub Date: 2024-07-12 DOI: 10.1080/16549716.2024.2370095
Hamideh Keyvani, Reza Majdzadeh, Esmaeil Khedmati Morasae, Leila Doshmangir

Background: Emigration of health workers has emerged as a significant obstacle in Iran, compelling policymakers to implement a diverse range of interventions and reforms to enhance healthcare services. It is imperative to comprehend the efficacy of emigration control interventions. To explore the intricate dynamics of elite emigration, this study employs a system dynamics modeling approach. The objective is to scrutinize Iranian health workers' emigration, examine the relationships, and evaluate the impact of various factors involved.

Objectives: The general purpose of this study is to analyze the policy interventions affecting the emigration of human resources in the field of health in Iran based on the system's dynamic approach.

Method: The research consists of four phases including analyzing the emigration status of health workers in developing countries, studying health personnel emigration in Iran, developing a System Dynamics (SD) model, and determining evidence-based policy interventions to address health worker emigration. These phases involve realist review, document analysis, qualitative interviews, data integration, and policy scenario planning. The primary objective is to gain a profound understanding of the underlying causes, mechanisms, and consequences of migration, as well as assess the impact of policies, in order to prioritize effective interventions.

Results: It seems that the SD model developed in this study can highlight the interconnectedness of various factors that influence health worker emigration, including demographic changes, economic conditions, and characteristics of healthcare systems.

Conclusion: This study uses a systems dynamics approach to analyze health worker emigration from Iran, focusing on policies that promote retention and explore the implications of emigration on the healthcare system. By examining interrelationships and feedback loops within the healthcare system and socioeconomic factors, the study aims to identify effective policy interventions that can mitigate the negative effects of emigration.

背景:卫生工作者移民已成为伊朗的一个重大障碍,迫使政策制定者实施各种干预措施和改革,以加强医疗保健服务。当务之急是了解移民控制干预措施的效果。为探索精英移民的复杂动态,本研究采用了系统动力学建模方法。目的是仔细研究伊朗卫生工作者的移民情况,考察其中的关系,并评估各种相关因素的影响:本研究的总体目的是基于系统动力学方法,分析影响伊朗卫生领域人力资源移民的政策干预:研究分为四个阶段,包括分析发展中国家卫生工作者的移民状况、研究伊朗卫生人员的移民情况、建立系统动力学(SD)模型以及确定循证政策干预措施以解决卫生工作者移民问题。这些阶段包括现实主义审查、文件分析、定性访谈、数据整合和政策情景规划。主要目的是深刻理解移民的根本原因、机制和后果,评估政策的影响,以便优先采取有效的干预措施:结果:本研究中开发的 SD 模型似乎可以突出影响卫生工作者移民的各种因素之间的相互联系,包括人口变化、经济条件和医疗保健系统的特点:本研究采用系统动力学方法分析伊朗卫生工作者的移民情况,重点关注促进留住卫生工作者的政策,并探讨移民对医疗保健系统的影响。通过研究医疗保健系统和社会经济因素之间的相互关系和反馈回路,本研究旨在确定有效的政策干预措施,以减轻移民的负面影响。
{"title":"Analysis of Iranian health workforce emigration based on a system dynamics approach: a study protocol.","authors":"Hamideh Keyvani, Reza Majdzadeh, Esmaeil Khedmati Morasae, Leila Doshmangir","doi":"10.1080/16549716.2024.2370095","DOIUrl":"10.1080/16549716.2024.2370095","url":null,"abstract":"<p><strong>Background: </strong>Emigration of health workers has emerged as a significant obstacle in Iran, compelling policymakers to implement a diverse range of interventions and reforms to enhance healthcare services. It is imperative to comprehend the efficacy of emigration control interventions. To explore the intricate dynamics of elite emigration, this study employs a system dynamics modeling approach. The objective is to scrutinize Iranian health workers' emigration, examine the relationships, and evaluate the impact of various factors involved.</p><p><strong>Objectives: </strong>The general purpose of this study is to analyze the policy interventions affecting the emigration of human resources in the field of health in Iran based on the system's dynamic approach.</p><p><strong>Method: </strong>The research consists of four phases including analyzing the emigration status of health workers in developing countries, studying health personnel emigration in Iran, developing a System Dynamics (SD) model, and determining evidence-based policy interventions to address health worker emigration. These phases involve realist review, document analysis, qualitative interviews, data integration, and policy scenario planning. The primary objective is to gain a profound understanding of the underlying causes, mechanisms, and consequences of migration, as well as assess the impact of policies, in order to prioritize effective interventions.</p><p><strong>Results: </strong>It seems that the SD model developed in this study can highlight the interconnectedness of various factors that influence health worker emigration, including demographic changes, economic conditions, and characteristics of healthcare systems.</p><p><strong>Conclusion: </strong>This study uses a systems dynamics approach to analyze health worker emigration from Iran, focusing on policies that promote retention and explore the implications of emigration on the healthcare system. By examining interrelationships and feedback loops within the healthcare system and socioeconomic factors, the study aims to identify effective policy interventions that can mitigate the negative effects of emigration.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591868","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
Adaptive adjustment to the needs of families caring for children and adolescents with physical disabilities in north-eastern Tanzania: a grounded-theory study. 坦桑尼亚东北部照顾肢体残疾儿童和青少年的家庭对需求的适应性调整:一项基础理论研究。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-06-04 DOI: 10.1080/16549716.2024.2354009
Elia Asanterabi Swai, Haleluya Imanueli Moshi, Sia Emmanueli Msuya, Marie Lindkvist, Ann Sörlin, Klas Göran Sahlen

Background: Family interactions, which are always multi-faceted, are complicated further by family members with disabilities. In resource-poor settings, policies and programmes that address the needs of and challenges faced by families are often inaccessible or unavailable. Approximately 13% of the families in Tanzania have at least one member with a disability, yet family-centred research on caring for disabled children and adolescents is scarce in this context.

Objective: The aim is to explore the needs and challenges faced by families that care for children and adolescents with physical disabilities in the Kilimanjaro Region of north-eastern Tanzania.

Methods: This qualitative study had a constructivist grounded-theory design. In-depth interviews, using a semi-structured interview guide based on the social-capital framework, were conducted with 12 female participants aged between 24 and 80. A conceptual model of family needs, inspired by Maslow's hierarchy of needs, informed the analysis.

Results: Challenging needs were grouped into five categories, which were linked to Maslow's hierarchy of needs and related to the central concept of 'adaptive adjustment': (1) 'barely surviving'; (2) 'safety needs in jeopardy'; (3) 'sociocultural protection'; (4) 'self-esteem far beyond reach', and (5) 'dreaming of self-actualisation'.

Conclusion: Families caring for children and adolescents with physical disabilities in north-eastern Tanzania have needs that extend beyond the available and accessible resources. Families can adjust and adapt by avoiding certain situations, accepting the reality of their circumstances and exploring alternative ways of coping. A sustainable support system, including social networks, is essential for meeting basic needs and ensuring safety.

背景:家庭互动总是多方面的,而残疾家庭成员则使家庭互动更加复杂。在资源匮乏的环境中,往往无法或无法获得满足家庭需求和应对家庭挑战的政策和计划。坦桑尼亚约有 13% 的家庭至少有一名残疾成员,但在这种情况下,以家庭为中心的有关照顾残疾儿童和青少年的研究却很少:目的:旨在探讨坦桑尼亚东北部乞力马扎罗山地区照顾肢体残疾儿童和青少年的家庭所面临的需求和挑战:这项定性研究采用建构主义基础理论设计。采用基于社会资本框架的半结构化访谈指南,对 12 名年龄在 24 岁至 80 岁之间的女性参与者进行了深入访谈。受马斯洛需求层次理论的启发,对家庭需求的概念模型进行了分析:挑战性需求被分为五类,它们与马斯洛的需求层次理论相关联,并与 "适应性调整 "这一核心概念有关:(1) "勉强生存";(2) "安全需求岌岌可危";(3) "社会文化保护";(4) "自尊遥不可及",以及 (5) "梦想自我实现":结论:坦桑尼亚东北部照顾身体残疾儿童和青少年的家庭的需求超出了现有和可获得的资源范围。家庭可以通过避免某些情况、接受现实环境和探索其他应对方式来进行调整和适应。包括社会网络在内的可持续支持系统对于满足基本需求和确保安全至关重要。
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Global Health Action
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