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The use of oral human immunodeficiency virus pre-exposure prophylaxis in pregnant and lactating women in sub-Saharan Africa:considerations,barriers,and recommendations

Moyo ENOS ; Murewanhema GRANT ; Moyo PERSEVERANCE ; Dzinamarira TAFADZWA ; Ross ANDREW

Global Health Journal.2024;8(2):41-45. doi:10.1016/j.glohj.2024.04.002

In sub-Saharan Africa(SSA),63％of new human immunodeficiency virus(HIV)infections in 2021 were among women,particularly adolescent girls,and young women.There is a high incidence of HIV among pregnant and lactating women(PLW)in SSA.It is estimated that the risk of HIV-acquisition during pregnancy and the postpar-tum period more than doubles.In this article,we discuss the safety and effectiveness of drugs used for oral HIV pre-exposure prophylaxis(PrEP),considerations for initiating PrEP in PLW,the barriers to initiating and adher-ing to PrEP among them and suggest recommendations to address these barriers.Tenofovir/emtricitabine,the most widely used combination in SSA,is safe,clinically effective,and cost-effective among PLW.Any PLW who requests PrEP and has no medical contraindications should receive it.PrEP users who are pregnant or lactating may experience barriers to starting and adhering for a variety of reasons,including personal,pill-related,and healthcare facility-related issues.To address the barriers,we recommend an increased provision of information on PrEP to the women and the communities,increasing and/or facilitating access to PrEP among the PLW,and developing strategies to increase adherence.

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Time trends and disparities of obesity and related national policies and programs in Nepal:a systematic review

Wei JUNXIANG ; Nie PENG ; Gao LIWANG ; Mi YANG ; Wang YOUFA

Global Health Journal.2024;8(2):46-57. doi:10.1016/j.glohj.2024.05.006

Objective:Overweight and obesity prevalence has increased in low-income countries.This study systematically reviewed the obesity trend,disparities,and prevention and control efforts in Nepal. Methods:We searched PubMed and Google Scholar for articles and reports published between January 1,2004 and December 31,2022.Additional information on National policies and programs related to obesity prevention was retrieved from governmental websites and consultation with relevant experts.Overweight and obesity were defined using the World Health Organization body mass index cut points.Thirty-two studies and reports were included. Results:Overall,overweight and obesity rates increased in all groups in Nepal although nationally representative data remained limited.The combined overweight and obesity(OW/OB)and obesity rates in women aged 15-49 years increased from 8.5％to 22.2％and from 0.9％to 5.1％between 2006 and 2016,respectively.OW/OB and obesity rates in men were 17.1％and 2.5％based on data from the 2016 Demographic and Health Survey.OW/OB rate in under-five children increased from 0.6％to 2.8％between 2006 and 2016.Obesity rates for school-age(5-9 years)boys and girls in 2016 were 2.4％and 2.8％,respectively,and were 1.1％and 1.4％for male and female adolescents aged 10-19 years,respectively.OW/OB prevalence was much higher among women,residents in urban areas and central provinces,and in higher socioeconomic status groups.Projected prevalence of OW/OB and obesity for 2030 in adults aged 15-49 was 44.7％and 8.3％,respectively,while it was 2.2％for OW/OB in preschool children.Policies and direct interventions that specifically focused on obesity prevention and control are limited. Conclusions:OW/OB prevalence in Nepal has increased during the past 1.8 decades,disproportionately affecting population groups.Existing interventions mostly focused on undernutrition with some indirect implications for obesity prevention.In the future,Nepal needs to develop population-based programs for obesity prevention.

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Charting the course:India's health expenditure projections for 2035

Sahoo Monalisa PRAGYAN ; Rout Sekhar HIMANSHU

Global Health Journal.2024;8(2):58-66. doi:10.1016/j.glohj.2024.05.001

Objectives:Understanding past trends and forecasting future changes in health spending is vital for planning and reducing reliance on out-of-pocket(OOP)expenses.The current study analyzed health expenditure patterns in India and forecasted future trends and patterns until 2035. Methods:Data on health expenditure in India from 2000 to 2019 was collected from the Organisation for Eco-nomic Co-operation and Development(OECD)iLibrary and National Health Accounts 2019 databases.Gross do-mestic product(GDP)data from the World Bank was also utilized.Descriptive statistics analyzed the composition and pattern,while the exponential smoothing model forecasted future health expenditures. Results:The findings revealed that expenditure made by OOP is the primary health financing source,followed by government and pre-paid private spending.The percentage of GDP allocated to total health expenditure remains stable,while the per capita health expenditure fluctuates.Variations in expenditure among states are observed,with Karnataka relying heavily on pre-paid private coverage.Future projections suggest a decline in per capita and total health expenditure as a share of GDP,with a slight increase in the government's share.Pre-paid private expenditure per capita and OOP health expenditure as a share of the total is projected to remain relatively constant but still high in absolute terms. Conclusion:The study highlights variations in health spending in India,characterized by high OOP spending,limited public coverage,and a need for investments,and reforms to improve healthcare access and equity.

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Community-led total sanitation(CLTS)implementation in West Mamprusi Municipal Assembly in Ghana.What do communities think eleven years on?

Adam ELIJAH ; Badu EMMANUEL

Global Health Journal.2024;8(2):67-73. doi:10.1016/j.glohj.2024.05.003

Objective:Access to improved sanitation is a fundamental human right and an important aspect of Public Health.However,an estimated thousands of people in Ghana especially,the West Mamprusi Municipal Assembly(WMMA)still have no access to adequate toilet facilities.This has brought untold health repercussions to the inhabitants,the community,and the environment at large.To address this menace,the community-led total san-itation(CLTS)was implemented.This study aimed to assess communities'perspectives on the implementation of CLTS and to understand the factors influencing its success and failures. Methods:A mixed-method approach involving sequential qualitative and quantitative methods was employed in this study.Participants for the quantitative study were randomly selected and surveyed using questionnaires.The qualitative study employed focus group discussion involving purposively sampled participants including assembly members,opinion leaders,and assembly staff. Results:The CLTS program in WMMA realized an apparent use of construction and proper use of household latrines leading to a reduction of open defecation free(ODF)and two communities achieving sanitized status in the history of the study area,enabling the training of latrine artisans and natural leaders to facilitate the CLTS expansion and sustainability,improved sanitation and hygiene,strengthened the enforcement of community rules and regulations and many others. Conclusion:The CLTS program has received more widespread acceptance in the study area than the previous government policy of constructing public toilets,which was greeted with massive failures due to poor imple-mentation.To ensure that gains achieved through CLTS implementation are sustained longer,it is recommended that chiefs and opinion leaders should be involved in the CLTS programs to ensure checks and enforcement.The entrenchment of bylaws and more education to address enduring myths and misconceptions will sustain the program.Subsidies in the form of sanitation loans for latrine construction materials by the government and supporting non-governmental organizations(NGOs)will be paramount in sustaining ODF.

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Knowledge and discriminatory attitudes towards HIV/AIDS among the women of reproductive age group of Pakistan using the Multiple Indicator Cluster Survey(MICS)

Hussain REMSHA ; Kabir RUSSELL

Global Health Journal.2024;8(2):74-82. doi:10.1016/j.glohj.2024.05.004

Background:Human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)has become a major worldwide public health issue,with a focus on developing nations.Despite having a very low HIV prevalence,South Asia faces serious issues with stigma and false information because of a lack of awareness.This stigma highlights significant gaps in popular awareness while also sustaining unfavorable attitudes towards those living with HIV/AIDS.Pakistan is ranked second in South Asia for the rapidly increasing AIDS epidemic.Thorough information and optimistic outlooks are essential for successful HIV/AIDS prevention,control,and treatment.But false beliefs about how HIV/AIDS spreads lead to negative perceptions,which highlights the need to look into how women's knowledge and attitudes about HIV/AIDS in Pakistan are influenced by sociodemographic traits and autonomy. Methods:The purpose of this study is to evaluate Pakistani women's discriminatory attitudes and level of aware-ness on HIV/AIDS.This study used data(the women in reproductive age 15-49 years'dataset)from the Pakistan Multiple Indicator Cluster Survey to conduct an analytical cross-sectional analysis.To represent the respondents'attitudes and knowledge towards people living with HIV(PLHIV),two composite variables were developed and composite scored.Binary logistics regression was used to identify predictor variables and chi-square was used for bivariate analysis. Results:The findings reveal that almost 90％of Pakistani women have poor knowledge and attitude with HIV/AIDS.In Punjab,72.8％of rural residents have low knowledge,whereas only 20.6％of young individu-als(15-＜25 years old)show the least amount of ignorance.Education is shown to be crucial,and"Higher"education is associated with superior knowledge.Urban dwellers in Khyber Pakhtunkhwa typically have more expertise.Knowledge of HIV is positively correlated with education;those with higher education levels know a lot more(odds ratio[OR]=5.419).Similarly,quintiles with greater incomes show a higher likelihood of know-ing about HIV(OR=6.745).The study identifies age,wealth index,place of residence,educational attainment,and exposure to contemporary media as significant predictors influencing HIV knowledge and attitudes among women in these provinces. Conclusion:The majority of respondents had negative opinions regarding the virus,and the majority of women in the study knew very little about HIV.Individuals who live in metropolitan areas,have higher incomes,are better educated,are exposed to contemporary media,and are generally more aware of HIV and have more positive attitudes towards HIV/AIDS,or PLHIV.The study found that,in comparison to those living in urban environments,those from rural areas with low socioeconomic level have a negative attitude and inadequate understanding.

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Does community-based health insurance affect lifestyle and timing of treatment seeking behavior?Evidence from Ethiopia

Anteneh Fetene ZECHARIAS ; D.Mebratie ANAGAW ; Shigute ZEMZEM ; Alemu GETNET ; S.Bedi ARJUN

Global Health Journal.2024;8(2):83-90. doi:10.1016/j.glohj.2024.05.005

Objectives:This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance(CBHI)scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms.There is growing concern about the financial sustainability of CBHI schemes in developing countries.However,few empirical studies have identified potential contributors,including ex-ante and ex-post moral hazards. Methods:We implement a household fixed-effect panel data regression model,drawing on three rounds of house-hold survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia. Results:The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals.However,CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms.Particularly,on average,we estimate about 4-6 h delay for malaria symptoms,a little above 4 h for tetanus,and 10-11 h for tuberculosis among the insured households. Conclusions:While there is evidence that CBHI improve the utilization of outpatient or primary care services,our study suggests that insured members may wait longer before visiting health facilities.This delay could be partly due to moral hazard problems,as insured households,particularly those from rural areas,may consider the opportunity costs associated with visiting health facilities for minor symptoms.Overall,it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.

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Shaping global health promotion:a comprehensive analysis of the 10 Global Conferences on Health Promotion Conferences(1986-2021)

Liu SHIYU ; Sun MEICHEN ; Zhang NA ; Sun ZHAOZHANG ; Tian XIANGYANG ; Li LIMING ; Wang YOUFA

Global Health Journal.2024;8(2):91-96. doi:10.1016/j.glohj.2024.05.002

Objective:This study analyzed how the 10 Global Conferences on Health Promotion have played a significant role in shaping and promoting a worldwide consensus and actions on health promotion,effectively addressing diverse health challenges that evolved over different periods. Methods:The textual analysis method was used in this study and text encoding was conducted to systematically examine the declarations and reports presented by the 10 Global Conferences on Health Promotion held during 1986-2021.We summarized the themes and key achievements,and key vocabulary in the conference declarations was extracted and analyzed to construct the global health promotion consensus and actions. Results:The fundamental principles of the conferences are to foster consensus and initiate actions in the realm of health promotion on a global scale.The primary purpose and goal are to promote health from regional to global.Significantly,our findings highlight a transition in the primary actors driving health promotion.It underscores a shift in health promotion from being driven primarily by organizations like the World Health Organization,governments,and international bodies,to a more inclusive approach involving non-governmental organizations and the general public.This development implies that health promotion has evolved into a collective global en-deavor,demanding the proactive involvement of various stakeholders,and forging new alliances in public health.Meanwhile,the coronavirus disease 2019(COVID-19)pandemic has further shaped the landscape of health pro-motion,underscoring the need for intensified focus on areas including disease prevention,health education,and the integration of digital health technologies,and emphasizing the importance of a multidimensional,responsive approach in public health initiatives. Conclusions:Sustained collaboration and innovative strategies are pivotal to advancing health promotion globally.Countries,together with public and private entities,should intensify cooperation.Multisectoral collaboration among partners such as healthcare,education,social security,and the industry is vital for health promotion and achieving global health goals.

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Building a transdisciplinary science of One Health with a global vision

Zhou XIAONONG ; Zheng JINXIN

Global Health Journal.2024;8(3):99-102. doi:10.1016/j.glohj.2024.08.004

One Health has been recognized as a cost-effectiveness approach that intricate connections between human health,animal health,and ecosystem health.This holistic perspective is crucial for addressing complex health challenges that arise at the intersection of these domains,such as emerging infectious diseases,antimicrobial resistance,food safety & food security,and environmental degradation.The beneficiaries of the One Health ap-proach have been demonstrated by many case studies worldwide,and summarized by The World Bank that not only support poverty alleviation in developing countries,but also can reduce pandemic risk globally.It is essential for us to understand the means of promoting the initiatives in building the transdisciplinary science of One Health that requires a global vision with integration of various disciplines,stakeholders,and resources.Therefore,we introduce the role of the transdisciplinary science of One Health,and the key steps and strategies necessary to implement One Health approach in the real world.We also propose three research priorities,including empha-sizing climate change and health,enhancing global health security,and promoting equity and inclusivity which is crucial for the success of One Health initiatives.Hence,building a transdisciplinary science of One Health will not only improve holistic health between human,animal,and environmental domains,but also contribute to the global health security and sustainable development.

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Mobile health interventions for improving maternal and child health outcomes in South Africa:a systematic review

Mbunge ELLIOT ; Sibiya Nokuthula MAUREEN

Global Health Journal.2024;8(3):103-112. doi:10.1016/j.glohj.2024.08.002

Background:Maternal and child health(MCH)remains a significant public health concern globally despite pre-vious efforts made to improve MCH services.Initiatives such as antenatal care,postnatal care services exclusive breastfeeding,child vaccination and supplements have been rolled out to improve MCH outcomes.However,inadequate maternal healthcare,socioeconomic factors,obstetric haemorrhaging,complications of hypertension during pregnancy,lack of maternal information,poor universal health coverage and uptake of MCH services exac-erbate maternal mortality and child mortality rates,especially in resource-constrained areas in many sub-Saharan African countries including South Africa. Objective:This study aimed to review mobile health(mHealth)interventions deployed to improve maternal and child health outcomes. Methods:The study adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses model to search and retrieve relevant literature from reputable,prominent electronic databases(Google Scholar,Scopus,PubMed,Embase,CINAHL,Web of Science,etc.).A total of 26 papers were selected and analyzed. Results:The findings revealed several mHealth interventions such as MomConnect,Mobile Alliance for Maternal Action,NurseConnect,ChildConnect,CommCare,Road to Health Application and Philani Mobile Video Interven-tion for Exclusive Breastfeeding have been utilized by healthcare workers and women to improve access to MCH services.However,inadequate digital infrastructure,digital divide,resistance to change,inadequate funding,language barriers,short message service and data costs,lack of digital skills and support,compatibility,scalabil-ity and interoperability issues,legislative and policy compliance,lack of mHealth awareness,data security and privacy concerns hinder uptake and utilisation of mHealth interventions.There is a need to scale up and sustain mHealth interventions and update existing regulatory framework,policies and strategies. Conclusion:mHealth interventions offer unprecedented opportunities to improve access to maternal information and substantially improve maternal and child health services.Stakeholder engagement and the development of sustainable funding strategies are important for successfully implementing and scaling mHealth projects while addressing existing and emerging key issues.

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Plain language in the healthcare of Japan:a systematic review of"plain Japanese"

Kido HATSUNE ; Saeki SOICHIRO ; Hiraiwa MAYU ; Yasunaga MASASHI ; Tomizawa RIE ; Honda CHIKA ; Fukuoka TOSHIO ; Minamitani KAORI

Global Health Journal.2024;8(3):113-118. doi:10.1016/j.glohj.2024.08.007

Objective:Despite the decrease in the number of foreign visitors and residents in Japan due to the coronavirus dis-ease 2019,a resurgence is remarkable from 2022.However,Japan's medical support system for foreign patients,especially residents,is inadequate,with language barriers potentially causing health disparities.Comprehen-sive interpretation and translation services are challenging,but"plain Japanese"may be a viable alternative for foreign patients with basic Japanese language skills.This study explores the application and obstacles of plain Japanese in the medical sector. Methods:A literature review was performed across these databases:Web of Science,PubMed,Google Scholar,Scopus,CINAHL Plus,Springer Link and Ichushi-Web(Japanese medical literature).The search covered themes related to healthcare,care for foreign patients,and scholarly articles,and was conducted in July 2023. Results:The study incorporated five papers.Each paper emphasized the language barriers foreign residents in Japan face when accessing healthcare,highlighting the critical role and necessity of plain Japanese in medical environments.Most of the reports focused on the challenges of delivering medical care to foreign patients and the training of healthcare professionals in using plain Japanese for communication. Conclusion:The knowledge and application of plain Japanese among healthcare professionals are inadequate,and literature also remains scarce.With the increasing number of foreign residents in Japan,the establishment of a healthcare system that effectively uses plain Japanese is essential.However,plain Japanese may not be the optimal linguistic assistance in certain situations,thus it is imperative to encourage more research and reports on healthcare services using plain Japanese.

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