Search

The historical and contemporary alignment of medical and health journals with colonial practices needs elucidation. Colonialism, which sought to exploit colonised people and places, was justified by the prejudice that colonised people's ways of knowing and being are inferior to those of the colonisers. Institutions for knowledge production and dissemination, including academic journals, were therefore central to sustaining colonialism and its legacies today. This invited Viewpoint focuses on The Lancet, following its 200th anniversary, and is especially important given the extent of The Lancet's global influence. We illuminate links between The Lancet and colonialism, with examples from the past and present, showing how the journal legitimised and continues to promote specific types of knowers, knowledge, perspectives, and interpretations in health and medicine. The Lancet's role in colonialism is not unique; other institutions and publications across the British empire cooperated with empire-building through colonisation. We therefore propose investigations and raise questions to encourage broader contestation on the practices, audience, positionality, and ownership of journals claiming leadership in global knowledge production., Competing Interests: Declaration of interests MSK is on the editorial boards of PLoS Global Public Health and Health Policy and Planning and was a member of the London School of Hygiene and Tropical Medicine's governing council (August, 2020–July, 2023). TN is an associate editor on PLOS Global Public Health. IT is a member of the International Council of the Global Society on Migration, Ethnicity, Race and Health and strategic advisor at the Inter-American Institute for Global Change Research. SA is Editor in Chief of BMJ Global Health and on the editorial board of PLoS Global Public Health. JBB is on the editorial board of Health Systems & Reform, and is also a board member of Aidspan. MNN has received royalties from Spinger Nature to write a book on the homeless youth of Pakistan and received financial support from Aga Khan University to attend the 7th Global Symposium on Health Systems Research in Bogota, Colombia., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: India has one of the highest burden of burns. The health systems response to burn care is sometimes patchy and highly influenced by social determinants. Delay in access to acute care and rehabilitation adversely affects recovery outcomes. Evidence on underlying factors for delays in care are limited. In this study, we aim to explore patients' journeys to analyse their experiences in accessing burn care in Uttar Pradesh, India., Methods: We conducted qualitative inquiry using the patient journey mapping approach and in-depth interviews (IDI). We purposively selected a referral burn centre in Uttar Pradesh, India and included a diverse group of patients. A chronological plot of the patient's journey was drawn and confirmed with respondents at the end of the interview. A detailed patient journey map was drawn for each patient based on interview transcripts and notes. Further analysis was done in NVivo 12 using a combination of inductive and deductive coding. Similar codes were categorised into sub-themes, which were distributed to one of the major themes of the 'three delays' framework., Results: Six major burns patients (4 female and 2 males) aged between 2 and 43 years were included in the study. Two patients had flame burns, and one had chemical, electric, hot liquid, and blast injury, respectively. Delay in seeking care (delay 1) was less common for acute care but was a concern for rehabilitation. Accessibility and availability of services, costs of care and lack of financial support influenced delay (1) for rehabilitation. Delay in reaching an appropriate facility (delay 2) was common due to multiple referrals before reaching an appropriate burn facility. Lack of clarity on referral systems and proper triaging influenced this delay. Delay in getting adequate care (delay 3) was mainly due to inadequate infrastructure at various levels of health facilities, shortage of skilled health providers, and high costs of care. COVID-19-related protocols and restrictions influenced all three delays., Conclusions: Burn care pathways are adversely affected by barriers to timely access. We propose using the modified 3-delays framework to analyse delays in burns care. There is a need to strengthen referral linkage systems, ensure financial risk protection, and integrate burn care at all levels of health care delivery systems., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.)

Background: Population-level health and mortality data are crucial for evidence-informed policy but scarce in Nigeria. To fill this gap, we undertook a comprehensive assessment of the burden of disease in Nigeria and compared outcomes to other west African countries., Methods: In this systematic analysis, using data and results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we analysed patterns of mortality, years of life lost (YLLs), years lived with disability (YLDs), life expectancy, healthy life expectancy (HALE), and health system coverage for Nigeria and 15 other west African countries by gender in 1998 and 2019. Estimates of all-age and age-standardised disability-adjusted life-years for 369 diseases and injuries and 87 risk factors are presented for Nigeria. Health expenditure per person and gross domestic product were extracted from the World Bank repository., Findings: Between 1998 and 2019, life expectancy and HALE increased in Nigeria by 18% to 64·3 years (95% uncertainty interval [UI] 62·2-66·6), mortality reduced for all age groups for both male and female individuals, and health expenditure per person increased from the 11th to third highest in west Africa by 2018 (US$18·6 in 2001 to $83·75 in 2018). Nonetheless, relative outcomes remained poor; Nigeria ranked sixth in west Africa for age-standardised mortality, seventh for HALE, tenth for YLLs, 12th for health system coverage, and 14th for YLDs in 2019. Malaria (5176·3 YLLs per 100 000 people, 95% UI 2464·0-9591·1) and neonatal disorders (4818·8 YLLs per 100 000, 3865·9-6064·2) were the leading causes of YLLs in Nigeria in 2019. Nigeria had the fourth-highest under-five mortality rate for male individuals (2491·8 deaths per 100 000, 95% UI 1986·1-3140·1) and female individuals (2117·7 deaths per 100 000, 1756·7-2569·1), but among the lowest mortality for men older than 55 years. There was evidence of a growing non-communicable disease burden facing older Nigerians., Interpretation: Health outcomes remain poor in Nigeria despite higher expenditure since 2001. Better outcomes in countries with equivalent or lower health expenditure suggest health system strengthening and targeted intervention to address unsafe water sources, poor sanitation, malnutrition, and exposure to air pollution could substantially improve population health., Funding: The Bill & Melinda Gates Foundation., Competing Interests: Declaration of interests GA is a current head of the National Agency for the Control of AIDS. CI and SA held leadership roles in the Nigerian Government during the period of writing of this paper. SA is editor in chief of BMJ Global Health. IA was a scientific and technical adviser to the Nigerian Government Presidential Task Force on COVID-19 and ZI is chair of the Nigerian national ethics committee. IA, FO, GA, SA, and IMOA are members of the Presidential Health Reform Committee. All other authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: Declaration of interests FS, MNS, GA, and BLS are current heads of Nigerian Government health agencies. CI and SHA held leadership roles in the Nigerian Government during the period of writing of this Commission. SA is editor-in-chief of BMJ Global Health. IA was a Scientific and Technical Adviser to the Nigerian Government Presidential Task Force on COVID-19 and ZI is chair of the Nigerian national ethics committee. All other authors declare no competing interests.

Background: Despite the proliferation of learning collaborations such as innovation platforms, the factors contributing to their success or failure are rarely documented. The Agency for Healthcare Research and Quality learning collaboratives taxonomy provides a framework for understanding how such collaborations work in different settings according to four primary elements: innovation, communication, time, and social systems. This study applied the taxonomy to assess an innovation platform and the utility of applying the taxonomy., Methods: The study focus was a five-year national research collaboration operating as an innovation platform to strengthen primary health care quality improvement efforts for Indigenous Australians. The study team analyzed project records, reports and publications, and interviews that were conducted with 35 stakeholders. Data were mapped retrospectively against the taxonomy domains and thematically analyzed., Results: The taxonomy proved useful in understanding how and why the innovation platform generated innovations. It revealed that time was particularly important, both to see innovations through and to establish a social system that enabled interconnectivity between members. However, the taxonomy did not provide useful guidance on identifying the types of innovations from the collaboration or the importance of a culture of continuous adaptation and learning. The study also found that the primary and secondary elements of the taxonomy were not discrete, which meant that it was difficult to align themes with only one element., Conclusion: To improve the utility of the taxonomy, several elaborations are proposed, including reconfiguring it to a more dynamic form that recognizes the interconnections and links between the elements., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Knowledge that older people are vulnerable to develop tuberculosis is rarely considered in developing country settings. According to 2010 Global Burden of Disease estimates, the majority of tuberculosis-related deaths occurred among people older than 50; most in those aged 65 and above. Older people also contribute a large proportion of Disability-Adjusted Life Years (DALYs); 51% of tuberculosis DALYs occurred in patients aged 50 years and older in East Asia. Tuberculosis age distributions in Africa have been severely skewed by the human immunodeficiency virus (HIV) epidemic, but emerging data suggest increasing disease burdens among older people. Older adults are more likely to develop extra-pulmonary and atypical forms of disease that are often harder to diagnose than conventional sputum smear-positive pulmonary tuberculosis. Their care is complicated by more frequent drug-related adverse events and increased co-morbidity, which may prove difficult to manage in regions where health resources are already constrained. Health systems will have to confront the challenge of an ageing global population and the integrated services required to address their health needs., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)