Global Health Action最新文献

Non-communicable diseases are increasingly prevalent in sub-Saharan Africa, and goal setting is often used to promote healthy self-management behaviours. In this review, we aimed to synthesise literature around how goal setting is used, for application in future interventions in the region. A systematic search was conducted in six databases and results screened for eligibility. Study characteristics, intervention details, goal setting components, feedback from participants and facilitators were extracted. Data were analysed using narrative synthesis and thematic analysis. The Mixed Methods Appraisal Tool was used to assess study quality. We included 24 publications describing 18 unique interventions. Included studies were of high to moderate methodological quality. Goal setting intervention components were informed by a variety of frameworks and involved a range of tasks. Interventions were often facilitator-led; many were conducted in group settings. Participants reported goal setting as useful for putting self-management into practice but encountered challenges related to language and literacy levels. Adequate detail on goal setting intervention components was not always present. Through this review, we provide a comprehensive picture of the variability of goal setting approaches in chronic disease prevention and management in sub-Saharan Africa and recommend more standardised use and reporting of goal setting intervention components.

Background: Pre-lacteal feeding, the provision of foods or liquids other than breast milk before breastfeeding, undermines optimal infant feeding and increases neonatal morbidity. Evidence from pastoralist settings in Ethiopia is limited.

Objective: This study aimed to assess the prevalence, determinants, and early health outcomes of pre-lacteal feeding among children aged 2 years in the Nogob Zone, Somali Region, Ethiopia.

Methods: A facility-based cross-sectional study was conducted from June to December 2025 among 609 mother - infant pairs attending seven health centers and one primary hospital. Stratified and systematic sampling were applied. Data were collected via structured questionnaires and analyzed using multivariate logistic regression. Adjusted odds ratios with 95% confidence intervals identified determinants and associated neonatal outcomes.

Results: Pre-lacteal feeding prevalence was 40.1% (95% CI: 36.2%-44.0%), with plain water, sugar water, and animal milk being the most common. Determinants included rural residence (AOR = 2.05; 95% CI: 1.30-3.22), no antenatal care (AOR = 2.10; 95% CI: 1.28-3.45), birth order ≥5 (AOR = 2.05; 95% CI: 1.25-3.35), maternal illiteracy (AOR = 2.90; 95% CI: 1.65-5.10), and cesarean delivery (AOR = 4.55; 95% CI: 1.72-12.10). Pre-lacteal feeding increased the odds of neonatal complications (AOR = 2.30; 95% CI: 1.35-3.95).

Conclusions: Pre-lacteal feeding is common in the Nogob zone and is linked to adverse neonatal outcomes. Maternal education, antenatal care promotion, early breastfeeding initiation, and culturally sensitive community interventions are essential to reduce pre-lacteal feeding and improve neonatal health in pastoralist settings.

Background: While many studies have explored the drivers of health-worker emigration, there is limited understanding of the factors that potentially encourage them to remain or return after migration.

Objectives: We explored three interrelated questions: what factors encouraged some members of the study population to remain in Nigeria?; what circumstances might encourage those intending to migrate to reconsider their plans?; and what conditions could encourage those who have already emigrated to consider returning?

Methods: We conducted a sequential explanatory mixed-methods study among a cohort of Nigerian-trained doctors and dentists. In the quantitative phase, 274 cohort members completed a structured survey assessing drivers of migration. In the qualitative phase, 50 participants across three migration status groups (emigrated, intending to migrate, and not intending to migrate) were interviewed. Thematic analysis was conducted.

Results: Overall, 49.3% (135/274) of the cohort had already migrated within 15 years of qualifying, while 63.6% (82/139) of those still in Nigeria expressed an intention to migrate. Qualitative findings reinforced the quantitative results, highlighting shared potential enablers of staying (among those intending to migrate) or returning (among already migrated), including improved security, economic stability, better remuneration, stronger healthcare infrastructure, and enhanced training opportunities. Most of those who had already migrated expressed a willingness to return, though often as a long-term plan. Those with no intention to migrate cited a sense of duty and patriotism, family responsibilities, thriving businesses, and professional or age-related factors as reasons for staying back.

Conclusion: This study offers actionable insights to inform policies on health-worker migration.

Artificial intelligence (AI) is increasingly integrated into audiology and hearing health, yet evidence from across the health sciences shows that AI systems routinely embed structural biases that can exacerbate inequities, particularly for African and other low- and middle-income country (LMIC) populations. This review identified and analysed bias types in AI applications relevant to audiology and examined their ethical, cultural, and linguistic implications for LMIC settings. A narrative review design was adopted to accommodate the heterogeneity of available evidence, where thematic saturation was more appropriate than effect-size aggregation. Peer-reviewed articles published between 2015 and 2025 were retrieved from PubMed, Scopus, Web of Science, and IEEE Xplore, with inclusion requiring explicit engagement with AI and bias or equity. Rigour was assessed using a six-domain quality rubric, and data were extracted into structured evidence tables for thematic synthesis. Thirty-three studies met inclusion criteria: six were audiology-specific empirical studies (all small scale), and the remainder were reviews or conceptual analyses. No study presented empirical African audiogram, auditory brainstem response (ABR), or speech data. Six recurrent bias types were identified; representation, measurement, algorithmic, evaluation, deployment, and intersectional, with representation bias most frequent, exemplified by English-only corpora that underperform on tonal or indigenous languages. These biases manifest as misclassified hearing loss, reduced ABR accuracy, inequitable hearing-aid personalisation, and poor cochlear-implant algorithm transferability. Advancing equitable AI in audiology requires multilingual, paediatric-inclusive, locally governed datasets; fairness-aware model design with stratified reporting; and African-led governance and capacity-building to support future validation and implementation research.

Background: Severe chronic noncommunicable diseases (SC-NCDs) globally present a challenge for health systems, particularly in rural settings of low- and lower-middle-income countries (LLMICs). The Package of Essential NCD Interventions-Plus (PEN-Plus) is a strategy currently used in 14 LLMICs to effectively manage people living with SC-NCDs (PLWSC-NCDs), including in Nhamatanda, Sofala Province, Mozambique.

Objectives: We are conducting a cohort study of PLWSC-NCDs, enrolled at Nhamatanda PEN-Plus clinic, to understand their experiences in care and clinic evolution. Here, we describe our methods and the cohort at baseline.

Methods: An 18th month cohort study was initiated shortly after the launch of the PEN-Plus clinic. At baseline, PLWSC-NCD and healthcare providers were enrolled in the study. Qualitative interviews and quantitative measurements including diabetes distress for patients and provider shadowing and task mapping were conducted at baseline and will be carried out semiannually for 18 months.

Results: Twenty-three PLWSC-NCDs and five healthcare providers were enrolled. Most provider training occurred formally pre-service or in service or less formally on job, and providers self-reported varying levels of task proficiencies. Other than personal achievement, we found generally low provider burnout at baseline. We gained insight into patients journey to diagnosis: most patients described a lengthy journey, resulting in unique clinical presentations and associated costs reflected by patients' borrowing money or selling assets.

Conclusion: There are health systems challenges associated with diagnosis and treatment of SC-NCDs in LLMICs. PEN-Plus is a strategy designed to provide mid-level healthcare workers with the necessary training and tools. This 18-month study will examine the evolution of care at the Nhamatanda clinic.

Background: All-cause mortality among people with HIV (PWH) in sub-Saharan Africa declined after antiretroviral therapy's introduction, but data in rural settings on evolving causes of death as this population age remain limited.

Objectives: To compare all-cause and cause-specific mortality trends among PWH and people without HIV (PWOH) in western Kenya using a prospective cohort study.

Methods: Data from the Siaya Health and Demographic Surveillance System were used to estimate mortality rates from 2011 to 2018 among persons aged 15-64 years, with the study population (PWH/PWOH) determined through HIV testing. InterVA-4 was used to ascertain the cause of death.

Results: 45,581 individuals with an HIV test result contributed 209,078 person-years (py) of follow-up. The HIV prevalence was 14.5%. Median age among PWH increased from 37 to 42 years from 2011 to 2018. For PWOH, this was between 29 and 31 years. 1386 individuals died, 48.8% were PWH. HIV/AIDS/tuberculosis (319 deaths; 58.2%) was the leading mortality cause for PWH and non-communicable diseases (NCDs) (235; 40.9%) for PWOH. From 2011 to 2017, HIV/AIDS/tuberculosis mortality rates declined among PWH from 19.0 to 7.0 deaths/1,000py, and mortality due to NCDs increased from 3.7 in 2014 to 5.1/1,000py in 2017. For PWOH, cause-specific mortality trends were stable over time.

Conclusion: Among PWH, HIV/AIDS/tuberculosis mortality decreased from 2011 to 2017, while mortality rates due to NCDs rose over time as the population aged. Among PWOH, NCDs were the leading cause of death. Managing HIV and the increasing burden of NCDs in this community requires education on prevention, active screening, and delivery of treatment and palliative care services.

Background: Cervical cancer causes morbidity and mortality among women worldwide, particularly in low- and middle-income countries (LMICs). Human Papillomavirus (HPV) vaccine is crucial for cervical cancer prevention, yet the vaccination rates remain suboptimal in Ethiopia. Studies identified cultural and religious factors as key barriers. While evidence suggests that faith leaders can effectively promote public health interventions, their potential role in HPV vaccination efforts has largely been overlooked and remains inadequately understood.

Objective: This study aimed to explore the perspectives of faith leaders in Addis Ababa to identify factors influencing HPV vaccination among girls.

Methods: This study employed qualitative methods, using in-depth interviews with purposively selected faith leaders. The faith leaders employed by the Inter-Religious Counsel of Ethiopia (IRCE) were excluded. A total of 13 faith leaders participated in the interviews. The 5C framework informed the data collection tool, and data analysis was conducted using inductive reflexive thematic analysis (RTA).

Result: Faith leaders are navigating between modern medicine and their religious beliefs, face distrust of Western vaccine aid intentions and local HPV vaccine providers, and receive fragmented or inconsistent information. These challenges make it difficult for them to act as champions for the vaccination, but with clear, well-organized information, there is an opportunity to involve them more effectively.

Conclusion: Faith leaders face several challenges that limit their role in promoting HPV vaccination. This study recommends providing clear, culturally relevant materials and communication strategies to support faith leaders and their communities. With these tools, faith leaders have the opportunity to engage and become effective advocates for the elimination of cervical cancer.

Background: Adolescent sexual and reproductive health and rights (ASRHR) policy has strengthened globally over the last three decades, but country-level barriers to implementation perpetuate health inequities for adolescent girls. In Vietnam, implementation of ASRHR policy remains challenged by persisting structural and socio-cultural issues and has yet to reduce the high prevalence of adolescent pregnancy in ethnic minority communities.

Objective(s): To explore the perspectives of policy makers and service providers in Vietnam regarding the factors influencing the delivery of ASRHR policy for ethnic minority adolescent girls. The research examined professional opinions related to: (1) socio-cultural factors influencing the lives of adolescent girls in Vietnam; (2) current implementation of ASRHR policy for ethnic minority girls; and (3) strengthening ASRHR policy and service delivery for this population.

Methods: Eleven key informant interviews were conducted across government and civil society, using semi-structured interviews via an online platform. Critical qualitative inquiry guided a reflexive approach to thematic analysis.

Results: Three themes were constructed. First, conservative patriarchal values, parenting, and particular vulnerabilities of ethnic minority girls underpin health inequities. Second, universal responses to ASRHR policy weaken delivery of services and education in ethnic minority communities and are not responsive to emerging complexities. Third, strengthening ASRHR policy in Vietnam includes provincial level enhancements and better use of civil society resources.

Conclusion: Key informants strongly supported ASRHR policy in Vietnam and called for improved policy level action to contextualize complexities and better use of available local resources. The recommendations could contribute to strengthening ASRHR policy in Vietnam.

Background: Against the backdrop of accelerating climate change and more frequent extreme weather events, typhoon disasters have become a major challenge to mental health. Based on the Social Determinants of Health theory and integrating the Cumulative Disadvantage Model with Structural Causal Influence analysis, this study evaluates how typhoon exposure affects the burden of mental health disorders and how these effects vary with social structural differences.

Objective: To investigate the mechanisms linking typhoon exposure to the burden of mental health disorders, and to quantify the moderating roles of macro-level social structural variables.

Methods: By constructing both main effect and year-on-year difference models, combined with structural equation modelling and multinational panel data, this research quantifies the moderating roles of macro-level social variables, including gross national income, Human Development Index, Gini coefficient, government health expenditure, out-of-pocket health spending, educational attainment, and life expectancy.

Results: Typhoons were found to increase prevalence, incidence, and disability-adjusted life years (DALYs) related to mental disorders, with the strongest impact in the 25-34 age group. High income, education, HDI, and public health investment were linked to greater resilience, while low income, high OOP, and high inequality indicated vulnerability. Secondary disaster frequency and the number of people affected acted as mediators, forming a pathway from 'typhoon' to 'social stress' to 'mental disorders.'

Conclusions: Typhoon impacts on mental health are shaped by both direct exposure and structural inequalities. Improving socioeconomic conditions, lowering OOP costs, reducing inequality, and increasing public health investment can strengthen psychological resilience and disaster response capacity.

This scoping review aims to systematically explore the extent, nature, and gaps in the existing literature on self-care practices among adolescents and young adults aged 10-24 years living with type 1 diabetes mellitus (T1D) in Sub-Saharan Africa. The review will examine self-care knowledge, attitudes, practices, perceived barriers and facilitators, and interventions developed to support self-care. Type 1 diabetes mellitus accounts for approximately 5-10% of all diabetes cases globally and disproportionately affects children and young people in low- and middle-income countries. Adolescence and young adulthood are critical developmental periods during which self-care behaviours are established and may influence long-term health outcomes. In Sub-Saharan Africa, adolescents and young adults with T1D face challenges including limited healthcare infrastructure, inadequate disease awareness, restricted access to insulin and diabetes supplies, and high out-of-pocket costs. This scoping review will include quantitative and qualitative studies, systematic reviews, and grey literature published in English from January 2004 onwards. The review will follow the Joanna Briggs Institute methodology for scoping reviews. A three-step search strategy will be applied across PubMed, MEDLINE, Web of Science, CINAHL, and Embase. Two independent reviewers will screen titles, abstracts, and full texts. Data will be extracted using a structured tool and synthesised using narrative, tabular, graphical, and thematic approaches.