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Venzor Strader A, Sotz M, Gilbert HN, Miller AC, Lee AC, Rohloff P. A biosocial analysis of perinatal and late neonatal mortality among Indigenous Maya Kaqchikel communities in Tecpán, Guatemala: a mixed-methods study. BMJ Glob Health 2024; 9:e013940. [PMID: 38631704 PMCID: PMC11029291 DOI: 10.1136/bmjgh-2023-013940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Neonatal mortality is a global public health challenge. Guatemala has the fifth highest neonatal mortality rate in Latin America, and Indigenous communities are particularly impacted. This study aims to understand factors driving neonatal mortality rates among Maya Kaqchikel communities. METHODS We used sequential explanatory mixed methods. The quantitative phase was a secondary analysis of 2014-2016 data from the Global Maternal and Newborn Health Registry from Chimaltenango, Guatemala. Multivariate logistic regression models identified factors associated with perinatal and late neonatal mortality. A number of 33 in-depth interviews were conducted with mothers, traditional Maya midwives and local healthcare professionals to explain quantitative findings. RESULTS Of 33 759 observations, 351 were lost to follow-up. There were 32 559 live births, 670 stillbirths (20/1000 births), 1265 (38/1000 births) perinatal deaths and 409 (12/1000 live births) late neonatal deaths. Factors identified to have statistically significant associations with a higher risk of perinatal or late neonatal mortality include lack of maternal education, maternal height <140 cm, maternal age under 20 or above 35, attending less than four antenatal visits, delivering without a skilled attendant, delivering at a health facility, preterm birth, congenital anomalies and presence of other obstetrical complications. Qualitative participants linked severe mental and emotional distress and inadequate maternal nutrition to heightened neonatal vulnerability. They also highlighted that mistrust in the healthcare system-fueled by language barriers and healthcare workers' use of coercive authority-delayed hospital presentations. They provided examples of cooperative relationships between traditional midwives and healthcare staff that resulted in positive outcomes. CONCLUSION Structural social forces influence neonatal vulnerability in rural Guatemala. When coupled with healthcare system shortcomings, these forces increase mistrust and mortality. Collaborative relationships among healthcare staff, traditional midwives and families may disrupt this cycle.
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Affiliation(s)
- Anahí Venzor Strader
- Department of Global Health and Social Medicine "Blavatnik Institute", Harvard Medical School, Boston, Massachusetts, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Center for Indigenous Health Research, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| | - Magda Sotz
- Center for Indigenous Health Research, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| | - Hannah N Gilbert
- Department of Global Health and Social Medicine "Blavatnik Institute", Harvard Medical School, Boston, Massachusetts, USA
| | - Ann C Miller
- Department of Global Health and Social Medicine "Blavatnik Institute", Harvard Medical School, Boston, Massachusetts, USA
| | - Anne Cc Lee
- Department of Pediatrics, Global Advancement of Infants and Mothers, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Rohloff
- Center for Indigenous Health Research, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Nassiri-Ansari T, Rhule ELM. Missing in action: a scoping review of gender as the overlooked component in decolonial discourses. BMJ Glob Health 2024; 9:e014235. [PMID: 38604753 PMCID: PMC11015240 DOI: 10.1136/bmjgh-2023-014235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
INTRODUCTION Race and gender were intimately intertwined aspects of the colonial project, used as key categories of hierarchisation within both colonial and modern societies. As such, true decolonisation is only possible when both are addressed equally; failure to address the colonial root causes of gender-based inequalities will allow for the perpetuation of racialised notions of gender to persist across the global health ecosystem. However, the authors note with concern the relative sidelining of gender within the decolonising global health discourse, especially as it navigates the critical transition from rhetoric to action. METHODS A scoping review was conducted to locate where gender does, or does not, appear within the decolonising global health literature. The authors reviewed the decolonising global health literature available on Scopus and PubMed online databases to identify peer-reviewed papers with the search terms "(decoloni* or de-coloni*) OR (neocolonial or neo-colonial) AND 'global health'" in their title, abstract or keywords published by December 2022. RESULTS Out of 167 papers on decolonising global health, only 53 (32%) had any reference to gender and only 26 (16%) explicitly engaged with gender as it intersects with (de)coloniality. Four key themes emerged from these 26 papers: an examination of coloniality's racialised and gendered nature; how this shaped and continues to shape hierarchies of knowledge; how these intertwining forces drive gendered impacts on health programmes and policies; and how a decolonial gender analysis can inform action for change. CONCLUSION Historical legacies of colonisation continue to shape contemporary global health practice. The authors call for the integration of a decolonial gender analysis in actions and initiatives that aim to decolonise global health, as well as within allied movements which seek to confront the root causes of power asymmetries and inequities.
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Affiliation(s)
- Tiffany Nassiri-Ansari
- United Nations University International Institute for Global Health, Cheras, WP Kuala Lumpur, Malaysia
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Konu YR, Dogo F, Dagnra CA, Atcha-Oubou T, Gbeasor-Komlanvi FA, Afanvi KA, Diallo FBT, Teouri M, Mijiyawa M, Ekouevi DK. Effect of the COVID-19 pandemic on HIV, malaria and tuberculosis indicators in Togo: an interrupted time series analysis. BMJ Glob Health 2024; 9:e013679. [PMID: 38569659 PMCID: PMC11002417 DOI: 10.1136/bmjgh-2023-013679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Limited data are available on the effects of the COVID-19 pandemic on health-related indicators in sub-Saharan Africa. This study aimed to estimate the effect of the COVID-19 pandemic on nine indicators of HIV, malaria and tuberculosis (TB) in Togo. METHODS For this interrupted time series analysis, national health information system data from January 2019 to December 2021 and TB programmatic data from the first quarter of 2018 to the fourth quarter of 2022 were analysed. Nine indicators were included. We used Poisson segmented regression to estimate the immediate impact of the pandemic and per-pandemic period trends through incidence rate ratios (IRRs) with 95% CIs. RESULTS Overall, there was a decrease in six of the nine indicators, ranging from 19.3% (IRR 0.807, 95% CI 0.682 to 0.955, p=0.024) for the hospitalisation of patients for malaria to 36.9% (IRR 0.631, 95% CI 0.457 to 0.871, p=0.013) for TB diagnosis by Mycobacterium tuberculosis Xpert immediately after the declaration of the COVID-19 pandemic. A comparison of the observed and predicted trends showed that the trend remained constant between the prepandemic and pandemic periods of COVID-19 for all malaria indicators. A significant downward monthly trend was observed in antiretroviral therapy initiation (IRR 0.909, 95% CI 0.892 to 0.926, p<0.001) and positive TB microscopy (IRR 0.919, 95% CI 0.880 to 0.960, p=0.002). CONCLUSION HIV, malaria and TB services were generally maintained over time in Togo despite the COVID-19 pandemic. However, given the decline in levels immediately after the onset of the pandemic, there is an urgent need to improve the preparedness of the healthcare system.
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Affiliation(s)
- Yao Rodion Konu
- Département de Santé Publique, Université de Lomé, Lome, Togo
- Centre Africain de Recherche en Epidemiologie et en Santé Publique (CARESP), Lomé, Togo
- Global Health in the Global South (Inserm UMR 1219, IRD EMR 271), Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
| | - Fall Dogo
- Programme national de lutte contre la tuberculose (PNLT), Lomé, Togo
| | - Claver Anoumou Dagnra
- Programme national de lutte contre le sida, les hépatites virales et les infections sexuellement transmissibles (PNLS-HV-IST), Lomé, Togo
| | | | - Fifonsi Adjidossi Gbeasor-Komlanvi
- Département de Santé Publique, Université de Lomé, Lome, Togo
- Centre Africain de Recherche en Epidemiologie et en Santé Publique (CARESP), Lomé, Togo
| | | | | | - Mahmoud Teouri
- Direction du système national d'information sanitaire et l'informatique (DSNSI), Lomé, Togo
| | - Moustafa Mijiyawa
- Ministère de la Santé, de l'Hygiène Publique et de l'Accès Universel aux Soins, Lomé, Togo
| | - Didier Koumavi Ekouevi
- Département de Santé Publique, Université de Lomé, Lome, Togo
- Centre Africain de Recherche en Epidemiologie et en Santé Publique (CARESP), Lomé, Togo
- Global Health in the Global South (Inserm UMR 1219, IRD EMR 271), Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
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Boufkhed S, Thorogood N, Ariti C, Durand MA. 'They treat us like machines': migrant workers' conceptual framework of labour exploitation for health research and policy. BMJ Glob Health 2024; 9:e013521. [PMID: 38316464 PMCID: PMC10860016 DOI: 10.1136/bmjgh-2023-013521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/25/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The exploitation of migrant workers ranks high on global political agendas including the Sustainable Development Goals. Research on exploited workers, using assessment tools where exploitation is defined by professional experts, indicates serious health concerns and needs. Yet, migrant workers are rarely asked about their understanding of a phenomenon they may experience. Our study aimed to conceptualise 'labour exploitation' from the perspective of migrant workers employed in manual low-skilled jobs. METHODS Twenty-seven Latin Americans working in London (UK) participated in Group Concept Mapping; a participatory mixed-method where qualitative data are collected to define a concept's content and then analysed using quantitative methods to generate a structured conceptual framework. Participants generated statements describing the concept content during brainstorming sessions, and structured them during sorting-rating exercises. Multi-Dimensional Scaling and Cluster Analysis were performed, generating a conceptual framework that clarified the dimensions, subdimensions and constituent statements of the concept of labour exploitation from migrant workers' perspectives. RESULTS Three key dimensions were identified: 'poor employment conditions and lack of protection', covering contractual arrangements and employment relations; 'disposability and abuse of power' (or 'dehumanisation') covering mechanisms or means which make migrant workers feel disposable and abused; and 'health and safety and psychosocial hazards' encompassing issues from physical and psychosocial hazards to a lack of health and social protection. 'Dehumanisation' has not been included in mainstream tools assessing exploitation, despite its importance for study participants who also described harsh situations at work including sexual, physical and verbal abuse. CONCLUSION Our study provides a conceptual framework of labour exploitation that gives voice to migrant workers and can be operationalised into a measure of migrant labour exploitation. It also calls for the dimension 'dehumanisation' and structural forms of coercion to be integrated into mainstream conceptualisations, and their workplace hazards to be urgently addressed.
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Affiliation(s)
- Sabah Boufkhed
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Humanitarian and Conflict Response Institute, The University of Manchester, Manchester, UK
| | - Nicki Thorogood
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Cono Ariti
- Centre for Trials Research, Cardiff University School of Medicine, Cardiff, UK
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mary Alison Durand
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Ngwenya N, Dziva Chikwari C, Seeley J, Ferrand RA. Are concepts of adolescence from the Global North appropriate for Africa? A debate. BMJ Glob Health 2023; 8:e012614. [PMID: 38164704 PMCID: PMC10729106 DOI: 10.1136/bmjgh-2023-012614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Nothando Ngwenya
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Chido Dziva Chikwari
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Janet Seeley
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Rashida Abbas Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Loewenson R, Mukumba C. Recovering lost tax to meet the health financing gap for universal public sector health systems in East and Southern Africa. BMJ Glob Health 2023; 8:e011820. [PMID: 37813446 PMCID: PMC10565176 DOI: 10.1136/bmjgh-2023-011820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/21/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Universal healthcare services funded through taxation and free at point-of-access are the most equitable ways of funding healthcare rights. This paper examines key public sector health financing measures in 17 East and Southern African (ESA) countries, estimates the funding gap for basic and comprehensive services and relates this to sources of lost tax revenue. METHODS Health financing and tax data for 2018 (the most recent year available) were extracted from international databases for each ESA country, and analysed collectively for the region, comparing against intergovernmental estimates of optimal funding and tax capacity. Despite limitations noted, the scale of the health financing gap and tax losses informed policy recommendations. RESULTS The annual average per capita financing gap ranged from $28 to $84 for basic to comprehensive services, respectively, applying estimates of funding needs. Many innovative financing measures being explored do not meet this scale of deficit. Annual ESA per capita tax losses were estimated as: US$34.20 from shortfalls in domestic tax capacity and US$13.80 from illicit financial flows largely due to commercial practices. A proposed 25% minimum effective tax rate on multinationals in a fairer global tax system would yield an additional annual collection US$26.20 in the region. CONCLUSIONS Addressing a total annual tax loss of US$34 billion from these three sources alone would almost completely finance the region's US$36 billion financing gap for a comprehensive public sector health system. The COVID-19 pandemic's exposure of the need for investment in public sector services suggests an opportunity for an alliance between health and finance sectors to ensure progressive taxation as the core funding for an equitable, universal health system. This implies costing the health funding demands and gap in ESA countries; strengthening domestic tax capacity, expanding wealth taxes, curbing illicit outflows and providing health evidence to ongoing African diplomacy for a fairer global tax system.
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Affiliation(s)
| | - Chenai Mukumba
- Policy Research and Advocacy, Tax Justice Network Africa, Nairobi, Kenya
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Kumah E, Boateng R, Agyei E. Strategic purchasing in times of public health emergency: lessons from COVID-19. BMJ Glob Health 2023; 8:e013938. [PMID: 37793809 PMCID: PMC10551923 DOI: 10.1136/bmjgh-2023-013938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Emmanuel Kumah
- Department of Health Administration and Education, University of Education Winneba, Winneba, Ghana
| | - Richard Boateng
- Department of Health Administration and Education, University of Education Winneba, Winneba, Ghana
| | - Eunice Agyei
- Department of Health Administration and Education, University of Education Winneba, Winneba, Ghana
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Chattopadhyay S, de Kok B. Making research ethics work for global health: towards a more agile and collaborative approach. BMJ Glob Health 2023; 8:e011415. [PMID: 37451687 PMCID: PMC10351231 DOI: 10.1136/bmjgh-2022-011415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/06/2023] [Indexed: 07/18/2023] Open
Abstract
In this reflective essay, we seek to engage in a constructive dialogue with scholars across medicine, public health and anthropology on research ethics practices. Drawing on anthropological research and ethical dilemmas that our colleagues and we encountered as medical anthropologists, we reflect on presumed and institutionalised 'best' practices such as mandatory written informed consent, and problematise how they are implemented in interdisciplinary global health research projects. We demonstrate that mandatory, individualised, written, informed consent may be unsuitable in many contexts and also identify reasons why tensions between professionals in interdisciplinary teams may arise when decisions about ethics procedures are taken. We propose alternatives to written informed consent that acknowledge research governance requirements and contextual realities and leave more room for ethnographic approaches. Beyond informed consent, we also explore the situatedness of ethical practices when working in contexts where decision-making around health is clearly a shared concern. We use vignettes based on our own and colleagues' experiences to illustrate our arguments, using the collective 'we' instead of 'I' in our vignettes to protect our research participants, partners and interlocutors. We propose a decolonial, plural and vernacular approach to informed consent specifically, and research ethics more broadly. We contend that ethics procedures and frameworks need to become more agile, decolonial, pluralised and vernacularised to enable achieving congruence between communities' ideas of social justice and institutional ethics. We argue that global health research can benefit from anthropology's engagement with situated ethics and consent that is relational, negotiated and processual; and accountability that is not only bureaucratic but also constructive. In doing so, we hope to broaden ethical praxis so that the best outcomes that are also just, fair and equitable can be achieved for all stakeholders.
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Affiliation(s)
| | - Bregje de Kok
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
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Wright K, Ali J, Davies A, Glasziou P, Gobat N, Kuchenmüller T, Littler K, Modlin C, Pascoe LA, Reis A, Singh JA. Ethical priorities for international collaborative adaptive platform trials for public health emergencies. BMJ Glob Health 2023; 8:e012930. [PMID: 37524503 PMCID: PMC10391826 DOI: 10.1136/bmjgh-2023-012930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 08/02/2023] Open
Affiliation(s)
| | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alun Davies
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Nina Gobat
- Community Readiness and Resilience Unit, World Health Organization, Geneva, Switzerland
| | - Tanja Kuchenmüller
- Evidence to Policy and Impact Unit, World Health Organization, Geneva, Switzerland
| | | | - Chelsea Modlin
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lee-Anne Pascoe
- Health Ethics and Governance Unit, WHO, Geneva, GE, Switzerland
| | - Andreas Reis
- Health Ethics and Governance Unit, WHO, Geneva, GE, Switzerland
| | - Jerome Amir Singh
- Howard College School of Law, University of KwaZulu Natal, Durban, South Africa
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AlKnawy B, Kozlakidis Z, Tarkoma S, Bates D, Honkela A, Crooks G, Rhee K, McKillop M. Digital public health leadership in the global fight for health security. BMJ Glob Health 2023; 8:bmjgh-2022-011454. [PMID: 36792230 PMCID: PMC9933676 DOI: 10.1136/bmjgh-2022-011454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023] Open
Abstract
The COVID-19 pandemic highlighted the need to prioritise mature digital health and data governance at both national and supranational levels to guarantee future health security. The Riyadh Declaration on Digital Health was a call to action to create the infrastructure needed to share effective digital health evidence-based practices and high-quality, real-time data locally and globally to provide actionable information to more health systems and countries. The declaration proposed nine key recommendations for data and digital health that need to be adopted by the global health community to address future pandemics and health threats. Here, we expand on each recommendation and provide an evidence-based roadmap for their implementation. This policy document serves as a resource and toolkit that all stakeholders in digital health and disaster preparedness can follow to develop digital infrastructure and protocols in readiness for future health threats through robust digital public health leadership.
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Affiliation(s)
- Bandar AlKnawy
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Sasu Tarkoma
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - David Bates
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Antti Honkela
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - George Crooks
- Digital Health and Care Innovation Centre, Glasgow, UK
| | - Kyu Rhee
- CVS Health Corp, Woonsocket, Rhode Island, USA
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McCray G, McCoy D, Kariger P, Janus M, Black MM, Chang SM, Tofail F, Eekhout I, Waldman M, van Buuren S, Khanam R, Sazawal S, Nizar A, Schönbeck Y, Zongo A, Brentani A, Zhang Y, Dua T, Cavallera V, Raikes A, Weber AM, Bromley K, Baqui A, Dutta A, Nisar I, Detmar SB, Anago R, Mercadante P, Jiang F, Kaur R, Hepworth K, Rubio-Codina M, Kembou SN, Ahmed S, Lancaster GA, Gladstone M. The creation of the Global Scales for Early Development (GSED) for children aged 0-3 years: combining subject matter expert judgements with big data. BMJ Glob Health 2023; 8:bmjgh-2022-009827. [PMID: 36650017 PMCID: PMC9853147 DOI: 10.1136/bmjgh-2022-009827] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/02/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION With the ratification of the Sustainable Development Goals, there is an increased emphasis on early childhood development (ECD) and well-being. The WHO led Global Scales for Early Development (GSED) project aims to provide population and programmatic level measures of ECD for 0-3 years that are valid, reliable and have psychometrically stable performance across geographical, cultural and language contexts. This paper reports on the creation of two measures: (1) the GSED Short Form (GSED-SF)-a caregiver reported measure for population-evaluation-self-administered with no training required and (2) the GSED Long Form (GSED-LF)-a directly administered/observed measure for programmatic evaluation-administered by a trained professional. METHODS We selected 807 psychometrically best-performing items using a Rasch measurement model from an ECD measurement databank which comprised 66 075 children assessed on 2211 items from 18 ECD measures in 32 countries. From 766 of these items, in-depth subject matter expert judgements were gathered to inform final item selection. Specifically collected were data on (1) conceptual matches between pairs of items originating from different measures, (2) developmental domain(s) measured by each item and (3) perceptions of feasibility of administration of each item in diverse contexts. Prototypes were finalised through a combination of psychometric performance evaluation and expert consensus to optimally identify items. RESULTS We created the GSED-SF (139 items) and GSED-LF (157 items) for tablet-based and paper-based assessments, with an optimal set of items that fit the Rasch model, met subject matter expert criteria, avoided conceptual overlap, covered multiple domains of child development and were feasible to implement across diverse settings. CONCLUSIONS State-of-the-art quantitative and qualitative procedures were used to select of theoretically relevant and globally feasible items representing child development for children aged 0-3 years. GSED-SF and GSED-LF will be piloted and validated in children across diverse cultural, demographic, social and language contexts for global use.
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Affiliation(s)
| | - Dana McCoy
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | | | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA,RTI International, Research Triangle Park, North Carolina, USA
| | - Susan M Chang
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Iris Eekhout
- Department of Child Health, TNO, Leiden, The Netherlands
| | - Marcus Waldman
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Rasheda Khanam
- Department of International Health, Johns Hopkins, Baltimore, Maryland, USA
| | - Sunil Sazawal
- Center for Public Health Kinetics, New Delhi, New Delhi, India
| | - Ambreen Nizar
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | | | - Arsène Zongo
- Innovations for Poverty Action, Washington, District of Columbia, USA
| | - Alexandra Brentani
- Pediatrics, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Yunting Zhang
- Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, Shanghai, China,National Children's Medical Center, Shanghai Children's Medical Center affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tarun Dua
- Brain Health Unit, Mental Health and Substance Use Department, World Health Organization, Geneve, Switzerland
| | - Vanessa Cavallera
- Brain Health Unit, Mental Health and Substance Use Department, World Health Organization, Geneve, Switzerland
| | - Abbie Raikes
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ann M Weber
- School of Public Health, University of Nevada Reno, Reno, Nevada, USA
| | | | - Abdullah Baqui
- International Center for Maternal and Newborn Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Imran Nisar
- Paediatrics, Aga Khan University, Karrachi, Pakistan
| | | | - Romuald Anago
- Innovations for Poverty Action, Washington, District of Columbia, USA
| | - Pacifico Mercadante
- Pediatrics, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Fan Jiang
- Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, Shanghai, China
| | - Raghbir Kaur
- Brain Health Unit, Mental Health and Substance Use Department, World Health Organization, Geneve, Switzerland
| | - Katelyn Hepworth
- University of Nebraska-Lincoln College of Education and Human Sciences, Lincoln, Nebraska, USA
| | | | - Samuel N Kembou
- Innovations for Poverty Action, Washington, District of Columbia, USA
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Hou X, Liu L, Cain J. Can higher spending on primary healthcare mitigate the impact of ageing and non-communicable diseases on health expenditure? BMJ Glob Health 2022; 7:bmjgh-2022-010513. [PMID: 36564087 PMCID: PMC9791382 DOI: 10.1136/bmjgh-2022-010513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Financing healthcare for ageing populations has become an increasingly urgent policy concern. Primary healthcare (PHC) has been viewed as the cornerstone of health systems. While most research has examined the effects of PHC on population health, there is still a relative paucity of analysis on the effects of PHC on health expenditures, particularly, in low-income and middle-income countries. Knowledge on PHC's potential role in mitigating the impact of ageing and non-communicable diseases (NCDs) on health expenditure remains limited. METHODS Using publicly accessible secondary data at country level, this paper examines the impact of ageing and the NCD burden on health expenditures. Regression with the interaction terms is used to explore whether greater expenditures on PHC can mitigate the growing fiscal pressure from ageing and the NCD burden. RESULTS The empirical evidence shows that a higher share of PHC spending is correlated with lower per capita non-PHC spending, after controlling for population aged 60 and over and NCD burden, and gross domestic product per capita. However, the mitigating effects of PHC spending to reduce non-PHC expenditure caused by ageing and NCDs are not significant. CONCLUSIONS The findings suggest that more PHC spending can potentially lower total health expenditure. However, higher primary health spending cannot fulfil that potential without scrupulous attention to the way it is delivered. More spending on PHC, together with changes in PHC service delivery, highlighting its coordination and referring roles, will put nations on a pathway to achieving universal health coverage more sustainably.
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Affiliation(s)
- Xiaohui Hou
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, District of Columbia, USA
| | - Lingrui Liu
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | - Jewelwayne Cain
- Health Nutrition and Population Global Practice, World Bank Group, Washington, District of Columbia, USA
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Stelmach R, Kocher EL, Kataria I, Jackson-Morris AM, Saxena S, Nugent R. The global return on investment from preventing and treating adolescent mental disorders and suicide: a modelling study. BMJ Glob Health 2022; 7:bmjgh-2021-007759. [PMID: 35705224 PMCID: PMC9240828 DOI: 10.1136/bmjgh-2021-007759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/02/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite the high burden of mental disorders among adolescents and the potentially lifelong consequences of these conditions, access to mental health services remains insufficient for adolescents in low-income and middle-income countries. We conducted an economic modelling study to quantify the potential costs and benefits of mental health interventions to prevent or treat anxiety, depression, bipolar disorder, and suicide among adolescents. METHODS We developed a Markov model that followed cohorts of adolescents (ages 10-19) from 36 countries to assess the impact of addressing anxiety, depression, bipolar disorder, and suicide during adolescence on health and non-health outcomes through their lives. We estimated the costs of interventions using an ingredients-based approach and modelled impacts on education and employment and the resulting economic, morbidity, and mortality benefits. RESULTS Implementing the selected interventions offers a return on investment of 23.6 and a cost of $102.9 per disability adjusted life year (DALY) averted over 80 years. The high return on investment and low cost per DALY averted is observed across regions and country income levels, with the highest return on investment arising from treating mild depression with group-based cognitive behavioural therapy, prevention of suicide attempts among high-risk adolescents, and universal prevention of combined anxiety and depression in low-income and lower-middle income countries. CONCLUSIONS The high return on investment and low cost per DALY averted suggests the importance and value of addressing mental disorders among adolescents worldwide. Intervening to prevent and treat these mental disorders even only during adolescence can have lifelong health and economic benefits.
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Affiliation(s)
- Rachel Stelmach
- International Development Group, RTI International, Washington, District of Columbia, USA
| | - Erica L Kocher
- Center for Global NCDs, RTI International, Research Triangle Park, North Carolina, USA
| | - Ishu Kataria
- Center for Global NCDs, RTI International, Research Triangle Park, North Carolina, USA
| | | | - Shekhar Saxena
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Rachel Nugent
- Center for Global NCDs, RTI International, Research Triangle Park, North Carolina, USA
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Davis SLM. Towards digital justice: participatory action research in global digital health. BMJ Glob Health 2022; 7:bmjgh-2022-009351. [PMID: 35580914 PMCID: PMC9114965 DOI: 10.1136/bmjgh-2022-009351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/23/2022] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Sara L M Davis
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
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Murdoch J, Curran R, Cornick R, Picken S, Bachmann M, Bateman E, Simelane ML, Fairall L. Addressing the quality and scope of paediatric primary care in South Africa: evaluating contextual impacts of the introduction of the Practical Approach to Care Kit for children (PACK Child). BMC Health Serv Res 2020; 20:479. [PMID: 32471431 PMCID: PMC7257217 DOI: 10.1186/s12913-020-05201-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/08/2020] [Indexed: 12/05/2022] Open
Abstract
Background Despite significant reductions in mortality, preventable and treatable conditions remain leading causes of death and illness in children in South Africa. The PACK Child intervention, comprising clinical decision support tool (guide), training strategy and health systems strengthening components, was developed to expand on WHO’s Integrated Management of Childhood Illness programme, extending care of children under 5 years to those aged 0–13 years, those with chronic conditions needing regular follow-up, integration of curative and preventive measures and routine care of the well child. In 2017–2018, PACK Child was piloted in 10 primary healthcare facilities in the Western Cape Province. Here we report findings from an investigation into the contextual features of South African primary care that shaped how clinicians delivered the PACK Child intervention within clinical consultations. Methods Process evaluation using linguistic ethnographic methodology which provides analytical tools for investigating human behaviour, and the shifting meaning of talk and text within context. Methods included semi-structured interviews, focus groups, ethnographic observation, audio-recorded consultations and documentary analysis. Analysis focused on how mapped contextual features structured clinician-caregiver interactions. Results Primary healthcare facilities demonstrated an institutionalised orientation to minimising risk upheld by provincial documentation, providing curative episodic care to children presenting with acute symptoms, and preventive care including immunisations, feeding and growth monitoring, all in children 5 years or younger. Children with chronic illnesses such as asthma rarely receive routine care. These contextual features constrained the ability of clinicians to use the PACK Child guide to facilitate diagnosis of long-term conditions, elicit and manage psychosocial issues, and navigate use of the guide alongside provincial documentation. Conclusion Our findings provide evidence that PACK Child is catalysing a transition to an approach that strikes a balance between assessing and minimising risk on the day of acute presentation and a larger remit of care for children over time. However, optimising success of the intervention requires reviewing priorities for paediatric care which will facilitate enhanced skills, knowledge and deployment of clinical staff to better address acute illnesses and long-term health conditions of children of all ages, as well as complex psychosocial issues surrounding the child.
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Affiliation(s)
- Jamie Murdoch
- School of Health Sciences, University of East Anglia, Edith Cavell Building, Colney Lane, Norwich, NR4 7TJ, UK.
| | - Robyn Curran
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa
| | - Ruth Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa.,Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Sandy Picken
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa
| | - Max Bachmann
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Eric Bateman
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa
| | - Makhosazana Lungile Simelane
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa.,Department of Medicine, University of Cape Town, Observatory, 7925, South Africa.,King's Global Health Institute, King's College London, London, SE1 9NH, UK
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Jahagirdar D, Harper S, Heymann J, Swaminathan H, Mukherji A, Nandi A. The effect of paid maternity leave on early childhood growth in low-income and middle-income countries. BMJ Glob Health 2017; 2:e000294. [PMID: 29988584 PMCID: PMC6027064 DOI: 10.1136/bmjgh-2017-000294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/06/2017] [Accepted: 06/14/2017] [Indexed: 01/05/2023] Open
Abstract
Background Despite recent improvements, low height-for-age, a key indicator of inadequate child nutrition, is an ongoing public health issue in low-income and middle-income countries. Paid maternity leave has the potential to improve child nutrition, but few studies have estimated its impact. Methods We used data from 583 227 children younger than 5 years in 37 countries surveyed as part of the Demographic and Health Surveys (2000–2014) to compare the change in children’s height-for-age z score in five countries that increased their legislated duration of paid maternity leave (Uganda, Zambia, Zimbabwe, Bangladesh and Lesotho) relative to 32 other countries that did not. A quasiexperimental difference-in-difference design involving a linear regression of height-for-age z score on the number of weeks of legislated paid maternity leave was used. We included fixed effects for country and birth year to control for, respectively, fixed country characteristics and shared trends in height-for-age, and adjusted for time-varying covariates such as gross domestic product per capita and the female labour force participation rate. Results The mean height-for-age z scores in the pretreatment period were -1.91 (SD=1.44) and –1.47 (SD=1.57) in countries that did and did not change their policies, respectively. The scores increased in treated and control countries over time. A 1-month increase in legislated paid maternity leave was associated with a decrease of 0.08(95% CI −0.20 to 0.04) in child height-for-age z score. Sensitivity analyses did not support a robust association between paid maternity leave policies and height-for-age z score. Conclusion We found little evidence that recent changes in legislated paid maternity leave have been sufficient to affect child height-for-age z scores. The relatively short durations of leave, the potential for low coverage and the strong increasing trend in children’s growth may explain our findings. Future studies considering longer durations or combined interventions may reveal further insight to support policy.
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Affiliation(s)
- Deepa Jahagirdar
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Jody Heymann
- Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Hema Swaminathan
- Indian Institute of Management Bangalore, Centre for Public Policy, Bangalore, India
| | - Arnab Mukherji
- Indian Institute of Management Bangalore, Centre for Public Policy, Bangalore, India
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health, Institute for Health and Social Policy, McGill University, Montreal, Canada
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