Global Health Action最新文献

Background: Electronic medical record (EMR) systems are increasingly used to improve disease management. However, the impact on data quality, quality of care and clinical outcomes for type 1 diabetes (T1D) in sub-Saharan Africa (SSA) has not yet been explored.

Objective: The aim was to evaluate the effect of implementing an EMR system on the quality of care and clinical outcomes for T1D individuals in Rwanda.

Methods: The Rwanda Diabetes Association collected data during quarterly district hospital visits. We evaluated the effect of a newly developed and implemented EMR system by assessing differences in clinical attendance and outcomes 2 years before (pre-EMR: February 2020-February 2022) and after (post-EMR: February 2022-February 2024) the deployment of the EMR system.

Results: We found an increase in the number of individuals examined and the number of consultations conducted post-EMR. There was an increase in data completeness on all parameters; however, we also found that more people did not monitor their blood glucose post-EMR. We found a significant increase in clinical attendance, and a reduction in median HbA_1c levels from 81.4 mmol/mol pre-EMR to 63.9 mmol/mol post-EMR (p < 0.001).

Conclusion: Several quality and clinical indicators improved after the integration of the EMR system in T1D management. To the best of our knowledge, this is the first study evaluating the impact of using an EMR system on the quality of care and clinical outcomes for T1D individuals in an SSA context. The long-term effect and implications are yet to be explored.

Background: The Karamoja region in the East African drylands is a rural, impoverished setting where pastoralism is increasingly replaced by other livelihood strategies. Understanding the socioeconomic contexts as well as their local variations is key for sustainable development of communities.

Objective: The aim of the present paper is to describe the baseline survey of the Drylands Transform project, its setting, methods and key findings.

Methods: In June 2022, a survey was conducted with 944 randomly selected households at four study sites in the Karamoja border region of Kenya and Uganda. Data were analyzed using descriptive statistics.

Results: Main livelihood forms were pastoralism and agropastoralism, while many households also relied on other sources of income. At some study sites, livestock keeping was abandoned by many residents due to cattle raiding and droughts. Only 4% of households were rated as food secure. The proportion of malnutrition among children aged 6-59 months varied across sites between 3% and 17% and was considerably higher among women.

Conclusions: Climate change, water shortage, social conflicts and marginalization pose barriers to food security and wellbeing for rural populations in the East African drylands. There are, however, opportunities for development through income diversification, the improvement of land health, the promotion of kitchen gardens and other measures of sustainable agriculture.

Globally, Latin America and the Caribbean (LAC) has one of the lowest rates of equitable access to safely managed drinking water. This systematic literature review assessed the effectiveness of infrastructure interventions to provide equitable access to safely managed drinking water in LAC on the burden of diarrhoea in children <5 years. The review was conducted in February 2024 using Ovid MEDLINE, Embase, Global Health, and the Cochrane Library with inclusion criteria: quantitative study designs of intervention effectiveness on burden of diarrhoea in children; conducted in LAC; studies published since 1 January 2000; and full-text available in English. Study quality was assessed via the US Agency for Healthcare Research and Quality scale. Reported quantitative data for diarrhoea burden of disease were extracted, and thematic analysis informed a narrative synthesis. Six studies from three countries in LAC with >110,000 data-points were included. Water supply infrastructure interventions were effective at reducing the burden of diarrhoea in children <5 years. Household level, rather than community level, access to a piped water supply, a continuous reliable service with <1 day of service interruption per month, and cash transfer programs for environmental public health programs, were identified as key contributors to water infrastructure intervention effectiveness. Previous water supply infrastructure interventions which include the provision of a safe drinking water supply are effective in reducing burden of diarrhoea in children. Future studies are needed to develop a comprehensive understanding of the unique features which contribute to water infrastructure effectiveness.

Background: Many African countries have increased the dispensing duration of antiretroviral therapy (ART) from 3 months to 6 months for established HIV treatment clients.

Objective: To assess South African healthcare providers' views on the benefits and challenges of the current maximum ART dispensing duration (3-month, 3MMD) and of potential 6-month dispensing (6MMD) to help inform South Africa about whether to move from 3MMD to 6MMD.

Methods: We conducted a cross-sectional survey of healthcare providers at 24 primary healthcare clinics in South Africa from May to September 2024. We used descriptive analysis for quantitative data and analysed open-ended responses using conventional qualitative content analysis methods.

Results: A total of 182 providers were enrolled from four provinces (median age 44, 88% female). Most (>70%) respondents said that 3MMD offered multiple benefits for providers and patients, and most (64%) also said there were no challenges in implementing 3MMD. More than 80% of respondents across all cadres reported that they would be comfortable dispensing 6 months of ART at a time, believing that it would reduce the facility overcrowding, lighten staff workloads, and be advantageous to clients by decreasing their visit burden and travel costs. Two thirds (63%) of participating nurses, who provide the largest share of direct ART care, were also in favour of resuming 12-month scripting for ART; the remaining 37% expressed concerns about decreases in treatment adherence and clinical monitoring of clients.

Conclusion: Most healthcare providers at primary healthcare clinics in South Africa are in favour of allowing 6-month dispensing and 12-month prescriptions as options for established ART clients.

Background: Emerging infectious respiratory diseases present significant challenges to public health systems worldwide. The recent COVID-19 pandemic has revealed critical weaknesses in Iran's healthcare infrastructure, particularly regarding surveillance and testing capabilities. During the pandemic, Iran faced severe consequences, including a high death toll and overwhelming demands on its healthcare system. This situation highlights the urgent need for a stronger public health system in the country.

Objective: This study identifies interventions implemented in Iran's public health system during respiratory disease pandemics, their context, mechanisms and outcome.

Methods: A qualitative realist study was conducted using semi-structured interviews with 21 public health experts across various sectors. Data were analyzed through content-directed analysis using the CIMO (Context-Intervention-Mechanism-Outcome) approach and the SPRP (Strategic Preparedness and Response Plan) framework. Data collection occurred from March to June 2024.

Results: Analysis revealed that factors such as individual behaviors, social capital, institutional settings, and political pressures significantly influenced intervention outcomes. Key interventions included enhanced risk communication strategies and the establishment of specialized respiratory disease centers. However, bureaucratic inefficiencies and resource limitations hindered effective responses. Additionally, continued investment in local diagnostic production is essential for maintaining national laboratory and vaccination capabilities.

Conclusions: The findings underscore the necessity for systemic reforms in Iran's public health framework to enhance preparedness for future pandemics. The realist approach provided insights into the complexities of intervention effectiveness, emphasizing the importance of context in shaping health outcomes. Strengthening primary healthcare and fostering inter-sectoral collaboration are essential for building a more resilient public health system capable of addressing emerging respiratory diseases effectively.

Job satisfaction among healthcare workers is essential for maintaining high-quality care. Previous research has shown different levels of job satisfaction, but there is no comprehensive list of determinants of job satisfaction among healthcare workers. This study aims to provide a comprehensive list of determinants of job satisfaction in Gulf Cooperation Council (GCC) countries (Saudi Arabia, UAE, Bahrain, Kuwait, Oman, and Qatar). A systematic review was conducted following PRISMA guidelines across five databases: PubMed, CINAHL, Web of Science, Cochrane, and Scopus. Two independent reviewers performed data extraction and review using the Critical Appraisal Skills Programme (CASP) quality assessment checklist. The review was undertaken between 1 January 2012 and 4 November 2022. Five hundred titles and abstracts were screened, yielding 73 eligible studies for inclusion in this review. Of the included studies, 60 were carried out in Saudi Arabia (82.2%), six in Oman (8.2%), three in Qatar (4.1%), two in the United Arab Emirates (2.7%), one in Kuwait (1.4%), and one in the Kingdom of Saudi Arabia and the United Arab Emirates (1.4%). The analysis identified 14 key determinants of job satisfaction among healthcare workers in GCC: pay, promotion, co-workers, supervision, fringe benefits, contingent rewards, operating conditions, nature of work, communication, workload, leadership style, relation with patients, demographic variables, and others, such as hospital type. Thus, our study expands on Spector's nine determinants model of job satisfaction, hence providing a wider and more detail insight into job satisfaction in workplace.

The ongoing conflict in Gaza has resulted in a catastrophic humanitarian crisis, displacing over 1.7 million people and causing widespread damage to infrastructure, which has severely limited access to adequate shelter, clean water, and healthcare. With summer temperatures exceeding 38°C (100 °F), conflict has heightened the population's vulnerability to heat-related health risks, compounded by a combination of environmental, individual, and conflict-induced factors. Gaza's dense population, high numbers of vulnerable groups (e.g. infants, pregnant women, the elderly), and widespread pre-existing health conditions further amplify susceptibility to heat stress. Overcrowded shelters foster rapid dehydration and the spread of infectious diseases, while the destruction of Gaza's power grid has led to widespread electricity shortages, depriving families of fans, air conditioning, and refrigeration, which are critical for cooling. Immediate global intervention is required to implement emergency public health measures and establish long-term resilience to extreme heat. Proposed actions include the provision of solar-powered cooling shelters, ensuring access to clean drinking water, distributing essential supplies such as solar-powered fans and hydration kits, and investing in climate-resilient infrastructure. Without urgent action, the convergence of extreme heat and the ongoing conflict in Gaza threatens to trigger a devastating heat-related health crisis that disproportionately affects the most vulnerable segments of the population.

Background: Gestational diabetes mellitus (GDM) increases adverse neonatal and maternal outcomes. Understanding the prevalence and risk factors of GDM is necessary to plan health care interventions and policy.

Objective: To determine the prevalence and risk factors of GDM in Thai Binh, Vietnam.

Methods: A cross-sectional study was conducted in two health facilities in Thai Binh, Vietnam, with the participation of 1,106 pregnant women. Women were recruited at their first antenatal care visit where face-to-face interviews about socioeconomic and reproductive factors were performed. A 2-hour 75 g oral glucose tolerance test was conducted at 24-28 weeks of gestation. GDM was diagnosed according to the World Health Organization 2013 criteria. Logistic regression analyses were used to assess the factors associated with GDM.

Results: The prevalence rate of GDM was 27.1%. Multivariate logistic regression analysis showed maternal age from 25 to 34 (adjusted OR 2.0; 95%CI 1.3-2.9), maternal age ≥ 35 (adjusted OR 3.0; 95%CI 1.7-5.4), pregestational body mass index ≥ 23 (adjusted OR 1.6; 95%CI 1.1-2.3), family history of diabetes (adjusted OR 1.9; 95%CI 1.3-2.9), fertility treatment (adjusted OR 2.3; 95%CI 1.3-3.8), and previous GDM (adjusted OR 3.1; 95%CI 1.4-6.9) were associated with increased odds of GDM.

Conclusions: More than one-fourth of pregnant women in Thai Binh, Vietnam, may have GDM. Advanced maternal age, high pregestational body mass index, family history of diabetes, and previous GDM were associated with increased risk of GDM. Additionally, fertility treatment appears to be strongly associated with an increased risk of GDM.

Background: In low- and middle-income countries like Bangladesh, inadequate water, sanitation, and hygiene (WASH) practices lead to a higher disease burden among children and hinder their academic performance. However, there have been efforts to improve WASH between 2014 and 2018.

Objectives: The study aimed to investigate changes in WASH facilities and practices in Bangladeshi schools from 2014 to 2018.

Methods: We analyzed pooled data from Bangladesh National Hygiene Survey 2014 and 2018. We performed descriptive analysis, bivariate analysis, and multivariate Generalized Estimating Equation (GEE) to analyze the changes over the four years time period.

Results: Results showed that basic drinking water services increased from 78% in 2014 to 90% in 2018. Schools showed a significant increase in basic sanitation services from 19% in 2014 to 52% in 2018. We discovered that students' access to water and soap increased from 2014 to 2018, from 21% to 35%. In the GEE model, we found that change in time, non govt urban schools were associated factors with improved basic drinking water services. For basic sanitation services, changes in time, school type and area type were significantly associated higher services. And for basic hygiene services, the associated factors were: schools having hygiene promotion visits, and availability of hygiene brigades at schools managed by students.

Conclusion: WASH services in Bangladeshi schools have improved significantly, yet disparities exist, particularly in government and rural schools. Although students' knowledge improved, their practices still need improvements through training on proper WASH practices.

Background: Little is known about the psychological wellbeing and the potential moral distress faced by female carers of children with disabilities living in low-resource settings in East Africa. In such environments, caregiving often requires resilience and resourcefulness, yet can also increase the vulnerability of caregivers and their children.

Objective: The objective of this study is to identify factors affecting female caregivers' psychological well-being, and to suggest ways healthcare workers can support these caregivers' psychological well-being to alleviate moral distress.

Methods: Employing an intersectional convergent parallel mixed-methods approach, the research explores the factors affecting the psychological wellbeing of caregivers in one urban and one rural low-resource setting in Kenya.

Results: The study identifies strengthening and inhibiting factors, across three dimensions, that moderate caregivers' experiences of moral distress, and puts forward suggestions for healthcare workers on how to support caregivers' psychological wellbeing.

Conclusions: Female carers of children with disabilities in low-resource settings in Kenya face numerous psychological, social and systemic challenges which jeopardize their caregiving, leading to moral distress. Paediatricians and nurses can contribute to enhance the caregivers' coping-strategies and psychological well-being through simple changes, like explaining a child's condition in non-technical language. Community health workers can help strengthen the caregivers' already existing resources by accompanying them in the day-to-day care of their children and by helping them establish self-support groups. Consequently, improved training of healthcare- and community health workers in the field of childhood disability is needed to strengthen health systems, and to support these caregivers and their children.