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Abstract Background Raising the quality of health services is key to continued progress in improving child health, however, data on service quality are limited and difficult to interpret. The relationship between facility readiness and the quality of care is complex. Methods Using publicly available data sets from five low- and middle-income countries (LMICs), we assessed the relationship between structural factors and the clinical quality of care for managing sick children. We developed indices for readiness and quality accounting for available indicators, expert opinion, and alignment with integrated management of childhood illness (IMCI) guidelines. In each country, we assessed the association between readiness and quality, with and without adjusting for other factors. We considered associations overall, by domain, and by provider type, explored non-linear associations, and compared associations at the individual and facility-level. Results The analysis included data from 3,149 health facilities and 11,159 sick child observations. In four of the five countries included in the analysis, we observed for every 10%-point increase in readiness, quality increased by about 1% point after adjusting for facility type and managing authority. There was little evidence of a non-linear relationship or a threshold effect altering the relationship between readiness and quality of care. Beyond readiness, younger child age, higher cost of care, and having a respiratory, digestive, or febrile diagnosis were most often associated with a higher quality of care. Higher “human resources” readiness domain scores were most consistently associated with better quality of care, while the quality of care domain of “treatment” was the least influenced by readiness. Facility-level associations did not vary greatly from individual-level associations. Conclusions The weak correlation observed suggests readiness plays an important role in quality but as currently measured cannot be used to characterize clinical quality of care. Data for assessing quality of health services are limited, presenting challenges for understanding impediments, assessing interventions, and gauging changes in the quality of care over time. We need better data to assess the quality of care being delivered in LMICs to understand what factors drive quality, with the goal of improving the management of sick children.

Sub-Saharan Africa has fewer medical workers per capita than any region of the world, and that shortage has been highlighted consistently as a critical constraint to improving health outcomes in the region. This paper draws on newly available, systematic, comparable data from 10 countries in the region to explore the dimensions of this shortage. We find wide variation in human resources performance metrics, both within and across countries. Many facilities are barely staffed, and effective staffing levels fall further when adjusted for health worker absences. However, caseloads—while also varying widely within and across countries—are also low in many settings, suggesting that even within countries, deployment rather than shortages, together with barriers to demand, may be the principal challenges. Beyond raw numbers, we observe significant proportions of health workers with very low levels of clinical knowledge on standard maternal and child health conditions. This study highlights that countries may need to invest broadly in health workforce deployment, improvements in capacity and performance of the health workforce, and on addressing demand constraints, rather than focusing narrowly on increases in staffing numbers. [ABSTRACT FROM AUTHOR]

Following the World Health Organization's declaration of the new coronavirus as a pandemic, nations had to act swiftly to draft effective strategies for the prevention and containment of COVID-19. International literature highlights a range of approaches taken by countries, with varying degrees of success, as measured by the quality and responsiveness of their public health systems. This brief perspective proposes a critical-gerontological reflection on the Central American countries, highlighting the divergent regional approaches to the pandemic that resulted in unequal figures between nations. Despite the intention to face the health challenge collectively, varying governmental positions had a direct impact on the health of the older population. Costa Rica and Panama responded similarly to the crisis, showcasing their better social and health scenarios compared to their peers. The Central American approach to public health was tailored to the political ideology of each country, rather than adhering to the common objectives set by the regional integration scheme in place. Despite the pandemic posing a challenge, the region remains committed to building universal, equitable, and comprehensive public health for older people. [ABSTRACT FROM AUTHOR]

Resumen: La entrevista clínica a pacientes inmigrantes requiere una competencia cultural que garantice una buena comprensión y una correcta comunicación, además de recoger información específica diferente a pacientes autóctonos, como origen y ruta migratoria o identidad cultural.Se recomienda el cribado de infección tuberculosa latente (ITL) en ciertos casos, y el cribado de otras infecciones, tanto cosmopolitas con mayor prevalencia en migrantes (VIH, lúes, VHB, VHC), como importadas (Chagas, parásitos intestinales, estrongiloidiasis, esquistosomiasis), según procedencia.Es clave comprobar el estado de vacunación y completar la pauta vacunal adaptándola al calendario vigente, priorizando vacunas como sarampión, rubéola y poliomielitis.Proponemos actividades preventivas a realizar ante viajes a países de origen, por sus características y riesgos especiales: consejos generales, explorar riesgo de malaria, valorar vacunaciones específicas, consejo respecto a infecciones de transmisión sexual (ITS) y consideraciones especiales si tienen enfermedades crónicas; y abordaje, si es pertinente, de riesgos de mutilación genital femenina (MGF). Abstract: The clinical interview of immigrant patients requires cultural competence to ensure good understanding and correct communication, in addition to collecting specific information that differs from that of native patients, such as origin and migratory route or cultural identity.Screening for latent tuberculosis infection is recommended in certain cases and screening for other infections, both cosmopolitan with a higher prevalence in migrants (HIV, syphilis, hepatitis B and C) and imported (Chagas, intestinal parasites, strongyloidiasis, schistosomiasis), depending on origin.It is essential to check the vaccination status and complete the vaccination schedule, adapting it to the current calendar, prioritizing vaccines such as measles, rubella and poliomyelitis.We propose preventive activities to be carried out when traveling to countries of origin, due to their special characteristics and risks: general advice, exploring the risk of malaria, assessing specific vaccinations, advice regarding sexually transmitted infections and special considerations if they have chronic diseases; and addressing, if appropriate, the risks of female genital mutilation.

BACKGROUND: The COVID-19 pandemic has adversely affected health care systems and dialysis access care in the US and across the globe. Beyond the initial challenges posed by the pandemic and despite the actions taken by health care leaders/organizations/professional societies such as the Maintaining Lifelines for ESKD Patients joint statement, there continues to be delays in providing timely care and performing elective and emergent dialysis access procedures worldwide. The aim of this study was to assess the global challenges associated with providing dialysis vascular access care across the international vascular access community during the pandemic. METHODS: The American Society of Diagnostic and Interventional Nephrology (ASDIN) conducted an online survey in 2021, that was administered to an expert panel of dialysis vascular access specialists and global leaders spanning across the international community. The respondents who are members of ASDIN, Association of Vascular Access and InTerventionAl Renal physicians (AVATAR), Asia Pacific Society of Dialysis Access (APSDA), Peruvian Vascular Access Society (APDAV), and Australia/New Zealand Society of Interventional Nephrology (ANZSIN) reported their experiences in the care of dialysis vascular access, practice patterns, and challenges faced during the COVID pandemic. RESULTS: Of the 53 individual surveys sent, 16 were opened and 11 (69%) responses were received from across the world and from different practice settings. The survey revealed the continued challenges facing the international community, the stark disparities in care delivery, supply chain disruption and logistical, regulatory, and financial issues that the global community continues to face in the ongoing pandemic. CONCLUSIONS: The COVID19 pandemic is far from over, and the challenges and barriers to providing dialysis access care seen on the initial ASDIN survey in the US seem to extend across the globe. We describe those results and discuss options, opportunities, and innovative tools to provide dialysis and access care during these trying times.

Aim: To explore the International Network for Child and Family Centred Care (INCFCC) members' experiences and views on the long‐term impact of COVID‐19 on the nursing workforce. Background: On the 11 March 2020, the World Health Organization declared COVID‐19 a global pandemic. While some countries adopted a herd immunity approach, others imposed stricter measures to reduce the transmission of the virus. Hospitals in some countries faced an avalanche of extremely sick admissions, whereas others experienced an early surge in cases or were able to control the spread. Design: Discursive paper. Methods: A web‐based survey was e‐mailed to 63 INCFCC members from 28 March to 30 April 2022, as an invitation to share their experience concerning the long‐term impact of COVID‐19 on their role as a nurse educator, clinician or researcher. Results: Sixteen members responded, and the responses were grouped under the themes stress and anxiety, safe staffing and pay, doing things differently, impact on research, impact on teaching and learning, impact on clinical practice, nursing made visible and lessons for the future. Conclusion: The INCFCC members provided their views and highlighted the impact on their role in nursing education, administration, research and/or practice. This discussion of international perspectives on the similarities and differences imposed by COVID‐19 found that the impact was wide‐ranging and prolonged. The overarching theme revealed the resilience of the participating members in the face of COVID‐19. Relevance to Clinical Practice: This study highlights the importance of all areas of nursing, be it in academia or in clinical practice, to work together to learn from the present and to plan for the future. Future work should focus on supporting organizational and personal resiliency and effective interventions to support the nursing workforce both during a disaster and in the recovery phase. Nursing workforce resilience in the face of COVID‐19. [ABSTRACT FROM AUTHOR]

Abstract Background Despite the importance of baseline health data for evidence-informed decision-making, these data are rarely available for displaced populations. At the height of the European refugee crisis, most of those seeking asylum in Europe were from regions with high prevalences of communicable and non-communicable diseases. To create an epidemiologic profile for refugees in camps on mainland Greece, this study assessed the prevalence of 11 communicable and non-communicable diseases among refugees utilizing Médecins du Monde (MdM) in-camp clinics. Methods The proportional morbidity of selected diseases among individuals utilizing MdM services were determined from data collected at refugee camp clinics on mainland Greece from April 2016 - July 2017. Overall and age-specific proportional morbidities were reported. Differences in disease burden among refugees from the largest sending countries - Afghanistan and Syria - were compared using proportional morbidity ratios and 95% confidence intervals. Patterns in results were compared with disease burden estimates in sending countries and with findings from comparable settings. Results Respiratory tract infections (RTIs) were the most prevalent outcome. Among RTIs, upper RTIs were most common, with a proportional morbidity of nearly 40%; throughout the study period, over 46% of children under 18 years had at least one upper RTI consultation. Musculoskeletal conditions (3.64%), were the most prevalent non-communicable outcome, followed by hypertension (2.21%) and asthma (1.28%). Afghans were 31.68% more likely than Syrians to have a consultation for at least one condition (PR: 1.32; 95% CI: 1.25, 1.39). The proportional morbidity of RTIs was comparable to sending countries, but there was a comparatively lower burden of other conditions among refugees than literature estimates from sending countries. Conclusion Refugees utilizing MdM clinics in camps had higher burdens of communicable diseases - predominantly RTIs - relative to non-communicable diseases. Non-communicable disease burdens were comparatively lower than reported prevalences from in-country populations. These findings can be attributed to a range of considerations including differences in demographic profiles between sending countries and refugee populations and missed opportunities for utilizing clinical care. Further investment is needed to capture the health profiles of displaced populations to support evidence-informed decision-making processes in humanitarian emergency responses.

Community health workers (CHWs) are a vital part of the health infrastructure in Uganda and in many other low- and middle-income countries. While the need for CHWs is clear, it is less clear how they should dispense health products to maximize the health benefits to their community. In this study, we assess the cost-effectiveness of several competing CHW distribution strategies in the context of treatment for child diarrhoea. We used data from a four-armed cluster-randomized controlled trial to assess the cost-effectiveness of (1) free distribution of oral rehydration salts (ORS) via home deliveries prior to diarrhoea onset (free delivery arm), (2) free distribution via vouchers where households retrieved the treatment from a central location (voucher arm), (3) a door-to-door sales model (home sales arm) and (4) a control arm where CHWs carried out their activities as normal. We assessed the cost-effectiveness from the implementors perspective and a societal perspective in terms of cost per case treated with ORS and cost per disability-adjusted life year (DALY) averted. Free delivery was the most effective strategy and the cheapest from a societal perspective. Although implementor costs were highest in this arm, cost savings comes from households using fewer resources to seek treatment outside the home (transport, doctor fees and treatment costs). From the implementors perspective, free delivery costs $2.19 per additional case treated and $56 per DALY averted relative to the control. Free delivery was also extremely cost-effective relative to home sales and vouchers, but there was a large degree of uncertainty around the comparison with vouchers. Free distribution of ORS by CHWs prior to diarrhoea onset is extremely cost-effective compared to other CHW distribution models. Implementers of CHW programmes should consider free home delivery of ORS.

Abstract Transnational public and global health programs in China have rapidly expanded over the past 20 years, and have potential to make important contributions to China’s global health workforce. However, there has been sparse if any literature specific to transnational public and global health higher education in China. In response, this perspective article aims to: (1) outline current transnational public and global health programs in China, and (2) delineate opportunities and challenges for transnational public and global health programs to enhance China’s global health workforce. Based on internet searches, eight active transnational public and global health programs in China were identified in September 2022 (one Bachelors; four Masters; three doctorate). Degree awarding institutions are located in Australia, Portugal, the United Kingdom, and the United States. Courses for stand-alone transnational programs were co-delivered by faculty from the Chinese and foreign sponsoring institutions. The earliest and latest programs were respectively established in 2001 and 2022, and the average year of establishment was 2013. The endurance of some programs (three programs operating ≥ 10 years) indicates the potential sustainability of transnational public and global health programs in China. However, opportunities for cross-cultural engagement appear to be constrained by lack of English (or other language) requirements in some programs, limited recruitment of international students, pandemic travel restrictions, and a dearth of funding for global health research outside China. In addition, students enrolled at transnational universities in China are currently ineligible for China Scholarship Council funding. As China’s need for global health capacity grows amid a rapidly shrinking population of younger citizens, strategic investments in transnational public and global health programs may be of increasing value.

Background: Despite growing interest in monitoring improvements in quality of care, data on service quality in low-income and middle-income countries (LMICs) is limited. While health systems researchers have hypothesized the relationship between facility readiness and provision of care, there have been few attempts to quantify this relationship in LMICs. This study assesses the association between facility readiness and provision of care for antenatal care at the client level and facility level. Methods: To assess the association between provision of care and various facility readiness indices for antenatal care, we used multilevel, multivariable random-effects linear regression models. We tested an inflection point on readiness scores by fitting linear spline models. To compare the coefficients between models, we used a bootstrapping approach and calculated the mean difference between all pairwise comparisons. Analyses were conducted at client and facility levels. Results: Our results showed a small, but significant association between facility readiness and provision of care across countries and most index constructions. The association was most evident in the client-level analyses that had a larger sample size and were adjusted for factors at the facility, health worker, and individual levels. In addition, spline models at a facility readiness score of 50 better fit the data, indicating a plausible threshold effect. Conclusions: The results of this study suggest that facility readiness is not a proxy for provision of care, but that there is an important association between facility readiness and provision of care. Data on facility readiness is necessary for understanding the foundations of health systems particularly in countries with the lowest levels of service quality. However, a comprehensive view of quality of care should include both facility readiness and provision of care measures. [ABSTRACT FROM AUTHOR]

Abstract Background Mainstream medical education remains largely focused on national health issues. Therefore, in order to expose medical students to international health issues, it is beneficial to facilitate international medical electives. Methods This article describes the Junior Project Officer (JPO) program, a medical experience based on clinical electives in Sub-Saharan Africa, supported by a Non-Governmental Organisation (NGO). Residents spend 6 months as part of a multidisciplinary medical team in Africa. A post-elective online survey was administered to all who participated in the program in the period 2002–2020. The questionnaire comprised three domains: (i) general and pre-departure information; (ii) the experience; (iii) the post-experience. Results Questionnaires were received from 157/241 subjects, a response rate of 65%. The most common specialties were pediatrics, public health, and internal medicine. Of all, 87% carried out clinical activities; 45% also worked in the management of health services, and 60% carried out research activities. About 64% reported difficulties linked to a lack of equipment, different ways of working (57%), and exposure to situations for which they did not feel technically prepared (56%). In 25% of cases, residents reported that their school’s attitude to their doing the elective was not positive: upon their return, over 50% felt that their experience was not sufficiently valued by their institution. Respondents considered the experience important for professional and personal growth (93% and 80% respectively ). Forty-two participants (27%) reported that the experience had a significant impact on their future career choices. Conclusion Despite the difficulties encountered, a well-structured experience in international health can have a positive impact on residents, professionally and personally. Key factors behind the positive outcomes are the substantial length (6 months) of the experience, and the long term working relationships between the sending and receiving institutions. The schools in Italy that provide the students for the electives need to see more evidence that international electives are worth the investment.

The article discusses the innovative health financing mechanisms implemented in Africa for vaccine acquisition, particularly during the COVID-19 pandemic. Africa has historically relied on donor-driven funding models for vaccine procurement, but during the pandemic, the continent took a more autonomous approach. African institutions designed and implemented financing models that reduced costs, fragmentation, and the unpredictability of external aid. The article emphasizes the importance of Africa's institution-driven approach, strategic collaborations, high political engagement, and collective finance management for financing vaccines and achieving vaccine self-reliance. The article also highlights the need for more predictable public funding, joint procurement mechanisms, and increased domestic health investments to reduce reliance on external aid. [Extracted from the article]

BackgroundAbout 80% of the nearly 2 billion people experiencing psychiatric conditions worldwide do not have access to quality, affordable mental health care. In Africa, there are 0.004 psychiatrists per 10,000 people, with the shortage exacerbated by a limited number of postgraduate psychiatry training opportunities. As of 2018, there were only two psychiatrists in Liberia.MethodsThis paper aims to offer a framework for developing postgraduate (i.e., residency) psychiatry training in resource-constrained settings to disseminate best practices and lessons learned. This article describes the approach to developing the formal global academic partnership that supported the initiation of Liberia’s first postgraduate psychiatry training program in July 2019.ResultsAuthors describe strengths, challenges, and opportunities for improvement in the planning and initiation stages of the postgraduate program. Key strengths of the program planning process include: (1) collaboration with a coalition of local and national stakeholders committed to improving mental health care in Liberia; (2) early procurement of quality video conferencing equipment and internet service to facilitate remote learning and broaden access to digital materials; and (3) leveraging of intra-continental partnerships for subspecialty training. Challenges experienced include: (1) navigating the intricacies of local political and administrative processes; (2) recruiting candidates to a medical specialty with historically lower salaries; and (3) the added burden placed on the limited number of local specialists. Identified opportunities include building a monitoring, evaluation, and learning (MEL) framework, further diversifying subspecialty areas of psychiatric and neurological training, and obtaining full accreditation of the postgraduate psychiatry program through the West African College of Physicians (WACP).ConclusionThe successful launch of the postgraduate psychiatry training program in Liberia is attributed to several factors, including a long-standing academic collaboration of over 10 years and support for mental health capacity-building efforts at national and local levels.

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for health care providers skilled in rapid and flexible decision making, effective and anticipatory leadership, and in dealing with trauma and moral distress. Palliative care (PC) workers have been an essential part of the COVID-19 response in advising on goals of care, symptom management and difficult decision making, and in supporting distressed health care workers, patients, and families. We describe Global Palliative Education Collaborative (GPEC), a training partnership between Harvard, University of California San Francisco, and Tulane medical schools in the U.S.; and two international PC programs in Uganda and India. GPEC offers U.S.-based PC fellows participation in an international elective to learn about resource-limited PC provision, gain perspective on global challenges to caring for patients at the end of life, and cultivate resiliency. International PC colleagues have much to teach about practicing compassionate PC amidst resource constraints and humanitarian crisis. We also describe a novel educational project that our GPEC faculty and fellows are participating in-the Resilience Inspiration Storytelling Empathy Project-and discuss positive outcomes of the project.

Introduction: International emergency medicine is a new subspecialty within emergency medicine. International emergency medicine (EM) fellowships have been in existence for more than 10 years, but data is limited on the experiences of the fellows. Our goal in this study was to understand the fellowship experience.Methods: The study employed a cross-sectional survey in which participants were asked about their demographics, fellowship program, and advanced degree. Participants consisted of former fellows who completed the fellowship between 2010-19. The survey consisted of both closed and open-ended questions to allow for further explanation of former fellows’ experience. Descriptive analysis was conducted on the quantitative survey data while content analysis was conducted to ascertain salient themes from the open-ended questions.Results: We contacted 71 former fellows, of whom 40 started and 36 completed surveys, for a 51% response rate (55.6% women). Two-year fellowships predominated, with 69.4% of respondents. Prior to fellowship, a subset of fellows spoke the native languages of their service sites: French, Spanish, Haitian Creole, Mandarin, or Kiswahili. Half the respondents spent 26-50% of their fellowship in field work, with 83.3% of institutions providing direct funding for this component. Many respondents stated a need for further institutional support (money or infrastructure) for fieldwork and mentoring. Non-governmental organizations comprised 29.7% of respondents’ work partners, while 28.6% were with academic institutions in country, focused mostly on education, health systems development, and research. The vast majority (92%) of respondents continued working in global EM, with the majority based in American academic institutions. Those who did not cited finances and lack of institutional support as main reasons.Conclusion: This study describes the fellow experience in international EM. The majority of fellows completed a two-year fellowship with 26-50% of their time spent in fieldwork with 83.3% of institutions providing funding. The challenges in pursuing a long-term career in global EM included the cost of international work, inadequate mentorship, and departmental funding.

BackgroundLeisure-time and transport activity domains are studied most often because they are considered more amenable to intervention, but to date evidence on these domains is limited. The aim of the present study was to examine patterns of socio-demographic correlates of adults' leisure-time and transport physical activity and how these associations varied across 17 cities in 12 countries.MethodsParticipants (N = 13,745) aged 18-66 years in the IPEN Adult study and with complete data on socio-demographic and self-reported physical activity characteristics were included. Participants reported frequency and duration of leisure-time and transport activities in the last 7 days using the self-administered International Physical Activity Questionnaire-Long Form. Six physical activity outcomes were examined in relation with age, education, and sex, and analyses explored variations by city and curvilinear associations.ResultsSex had the most consistent results, with five of six physical activity outcomes showing females were less active than males. Age had the most complex associations with self-report transport and leisure-time physical activity. Compared to older people, younger adults were less likely to engage in transport physical activity, but among those who did, younger people were likely to engage in more active minutes. Curvilinear associations were found between age and all three leisure-time physical activity outcomes, with the youngest and the oldest being more active. Positive associations with education were found for leisure-time physical activity only. There were significant interactions of city with sex and education for multiple physical activity outcomes.ConclusionsAlthough socio-demographic correlates of physical activity are widely studied, the present results provide new information. City-specific findings suggest there will be value in conducting more detailed case studies. The curvilinear associations of age with leisure-time physical activity as well as significant interactions of leisure-time activity with sex and education should be further investigated. The findings of lower leisure-time physical activity among females as well as people with low education suggest that greater and continued efforts in physical activity policies and programs tailored to these high-risk groups are needed internationally.

When we look at world history, we can easily say that the process of globalization has caused significant changes and transformations. First and foremost, globalization, which has caused “economic” changes, has had a significant impact on all societies and human life. One of the areas where the significant changes and transformations brought by globalization are clearly observed is undoubtedly healthcare. In this regard, our research will discuss to what extent the risks that may arise in the healthcare sector due to globalization will be effective. [ABSTRACT FROM AUTHOR]

In the 2022 mpox (monkeypox) outbreak, 79,000 global cases have been reported. Yet, limited dermatologic data have been published regarding lesion morphology and progression. The objective of this study was to characterize skin lesion morphology, symptomatology, and outcomes of mpox infection over time. The American Academy of Dermatology/International League of Dermatological Societies Dermatology COVID-19, Mpox, and Emerging Infections Registry captured deidentified patient cases of mpox entered by health care professionals. From August 4 to November 13, 2022, 101 cases from 13 countries were entered, primarily by dermatologists (92%). Thirty-nine percent had fewer than 5 lesions. In 54% of cases, skin lesions were the first sign of infection. In the first 1-5 days of infection, papules (36%), vesicles (17%), and pustules (20%) predominated. By days 6-10, pustules (36%) were most common, followed by erosions/ulcers (27%) and crusts/scabs (24%). Crusts/scabs were the predominant morphology after day 11. Ten cases of morbilliform rash were reported. Scarring occurred in 13% of the cases. Registry-reported data cannot address incidence. There is a potential reporting bias from the predilection to report cases with greater clinical severity. These findings highlight differences in skin findings compared to historical outbreaks, notably the presence of skin lesions prior to systemic symptoms and low overall lesion counts. Scarring emerged as a major possible sequela. [ABSTRACT FROM AUTHOR]

Global Health Informatics (GHI) as a branch of health informatics has been established for 2 decades now. During that time, great strides have been made in the creation and implementation of informatics tools to improve healthcare delivery and outcomes in the most vulnerable and remote communities worldwide. In many of the most successful projects, innovation has been shared between teams in high- and low- or middle-income countries (LMICs). In this perspective, we review the state of the academic field of GHI and the work published in JAMIA in the last 6 1/2 years. We apply criteria for articles about LMICs, those on international health, and on indigenous and refugee population, and subtypes of research. For comparison, we apply those criteria to JAMIA Open and 3 other health informatics journals which publish articles on GHI. We make recommendations for future directions and the role that journals like JAMIA can play in strengthening this work worldwide. [ABSTRACT FROM AUTHOR]

Background: Mainstream medical education remains largely focused on national health issues. Therefore, in order to expose medical students to international health issues, it is beneficial to facilitate international medical electives. Methods: This article describes the Junior Project Officer (JPO) program, a medical experience based on clinical electives in Sub-Saharan Africa, supported by a Non-Governmental Organisation (NGO). Residents spend 6 months as part of a multidisciplinary medical team in Africa. A post-elective online survey was administered to all who participated in the program in the period 2002–2020. The questionnaire comprised three domains: (i) general and pre-departure information; (ii) the experience; (iii) the post-experience. Results: Questionnaires were received from 157/241 subjects, a response rate of 65%. The most common specialties were pediatrics, public health, and internal medicine. Of all, 87% carried out clinical activities; 45% also worked in the management of health services, and 60% carried out research activities. About 64% reported difficulties linked to a lack of equipment, different ways of working (57%), and exposure to situations for which they did not feel technically prepared (56%). In 25% of cases, residents reported that their school's attitude to their doing the elective was not positive: upon their return, over 50% felt that their experience was not sufficiently valued by their institution. Respondents considered the experience important for professional and personal growth (93% and 80% respectively). Forty-two participants (27%) reported that the experience had a significant impact on their future career choices. Conclusion: Despite the difficulties encountered, a well-structured experience in international health can have a positive impact on residents, professionally and personally. Key factors behind the positive outcomes are the substantial length (6 months) of the experience, and the long term working relationships between the sending and receiving institutions. The schools in Italy that provide the students for the electives need to see more evidence that international electives are worth the investment. [ABSTRACT FROM AUTHOR]

Abstract Background This research examines the ways in which higher education institutions (HEIs) across the tropEd Network for Education in International Health (tropEd) began to adapt their teaching and learning approaches in response to the COVID-19 pandemic in 2020. Already during this early phase of the pandemic HEIs’ responses demonstrate global health approaches emphasising cooperation and communication, rather than national health driven strategies that emphasise quarantine and control. Key lessons learnt for multiple dimensions of teaching and learning in global health are thus identified, and challenges and opportunities discussed. Methods Data collection includes a cross-sectional online survey among tropEd member institutions (n = 19) in mid-2020, and a complementary set of open-ended questions generating free-text responses (n = 9). Quantitative data were analysed using descriptive statistics, textual data were analysed using a Framework Analysis approach. Results While early on in the pandemic the focus was on a quick emergency switch to online teaching formats to ensure short-term continuity, and developing the administrative and didactic competence and confidence in digital teaching, there is already recognition among HEIs of the necessity for more fundamental quality and longer-term reforms in higher education in global health. Alongside practical concerns about the limitations of digital teaching, and declines in student numbers, there is a growing awareness of opportunities in terms of inclusivity, the necessity of cross-border cooperation, and a global health approach. The extent to which the lack of physical mobility impacts HEI programmes in global health is debated. Conclusion The COVID-19 pandemic has brought about preventive measures that have had a considerable impact on various dimensions of academic teaching in global health. Going forward, international HEIs’ experiences and response strategies can help generate important lessons for academic institutions across different settings worldwide.

Broad and aspirational targets to meet health service needs are useful for advocacy, but setting measurable, time-defined targets for accelerated yet feasible progress is necessary for national monitoring and planning purposes. Information from probabilistic projections of health outcomes and service coverage can be used to set country-specific targets that reflect different starting points and rates of change. We show the utility of this approach in an application to contraceptive coverage in 131 low- and middle-income countries (LMICs) and the related cost and impact of different coverage scenarios. We use the sustainable development goal (SDG) indicator of the proportion of women who have their need for family planning satisfied with modern contraception. The results show that accelerated progress targets would collectively result in 83% of the need satisfied in 2030 for LMICs, which is 5% points higher than the projected level based on the current pace of progress. This translated into 41 million fewer women with an unmet need for modern methods and 14 million fewer unintended pregnancies. Annual direct costs would be $480 million more in 2030 to support contraceptive services compared with costs in 2030 based on the current pace of progress. As governments plan and budget for expanded health service coverage, information from probabilistic projections can guide them in setting measurable, ambitious yet realistic targets that are relevant to their particular contexts. [ABSTRACT FROM AUTHOR]

Objective: To describe the use of point‐of‐care ultrasound (POCUS) in an acute‐care paediatric setting in Malawi, including clinical indications, types of examinations and frequency of positive findings. Methods: Retrospective, cross‐sectional study of a convenience sample of POCUS examinations performed in one tertiary referral hospital in Lilongwe, Malawi over 1 year. POCUS examinations were performed by Paediatric Emergency Medicine physician consultants as part of routine clinical practice and at the request of local clinicians. Images were saved along with the clinical indication and physician interpretation for quality review. Ultrasounds performed by the radiology department and those examinations that were technically faulty, missing clinical application or interpretation were excluded. Results: In total, 225 ultrasounds of 142 patients were analysed. The most common clinical indications for which examinations were completed were respiratory distress (23%), oedema (11.7%) and shock/arrest (6.2%). The most common examinations performed were cardiac (41.8%) and lung (15.1%), focused assessment with sonography in trauma (FAST; 12.9%) and ultrasound‐guided procedural examinations (9.8%). Pathology was identified in 68% of non‐procedural examinations. Cardiac examinations demonstrated significant pathology, including reduced cardiac function (12.8%), gross cardiac structural abnormality (11.8%) and pericardial effusion (10.3%). Conclusions: POCUS was used for both clinical decision‐making and procedural guidance, and a significant number of POCUS examinations yielded positive findings. Thus, we propose that cardiopulmonary, FAST and procedural examinations should be considered in future for the POCUS curriculum in this setting. [ABSTRACT FROM AUTHOR]

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In February and March 1953, a WHO Visiting Team of Medical Scientists worked in India, collaborating with local medical students and professionals. This article studies the complexities of early postcolonial international health work and the relations between the young WHO and the newly independent countries, from the position of the team's vice chairman, Norwegian doctor Karl Evang. While the WHO aimed to create dialogue and interaction, also learning from the host country, the article finds that an equal exchange of views between visitors and hosts was not achieved. The topic pertains to discussions on power and influence in international organisations and governance, development and health work, within a South Asian setting. Studying intellectual exchanges between Evang and his Indian interlocutors sheds light on India's role as both receptive and generative site of ideas and political practice, contributing to broader debates on the appropriation, refashioning and application of political ideas in independent India. Also, at a time of new directions in international health, and considering Evang's social medicine conviction, an additional question concerns the role of social medicine. The article underlines the existence of multiple, parallel tracks in international health work, and argues the need to portray international health as a complex mosaic, rather than a step-by-step development. The case has relevance as historians endeavour to make international and global history more diverse, as through Evang we capture parts of a broader international involvement of people and nation states in the WHO and its work in the early post-war period. [ABSTRACT FROM AUTHOR]

Background: Health research teams increasingly partner with stakeholders to produce research that is relevant, accessible, and widely used. Previous work has covered stakeholder group identification.Objective: We aimed to develop factors for health research teams to consider during identification and invitation of individual representatives in a multi-stakeholder research partnership, with the aim of forming equitable and informed teams.Design: Consensus development.Participants: We involved 16 stakeholders from the international Multi-Stakeholder Engagement (MuSE) Consortium, including patients and the public, providers, payers of health services/purchasers, policy makers, programme managers, peer review editors, and principal investigators.Approach: We engaged stakeholders in factor development and as co-authors of this manuscript. Using a modified Delphi approach, we gathered stakeholder views concerning a preliminary list of 18 factors. Over two feedback rounds, using qualitative and quantitative analysis, we concentrated these into ten factors.Key Results: We present seven highly desirable factors: 'expertise or experience', 'ability and willingness to represent the stakeholder group', 'inclusivity (equity, diversity and intersectionality)', 'communication skills', 'commitment and time capacity', 'financial and non-financial relationships and activities, and conflict of interest', 'training support and funding needs'. Additionally, three factors are desirable: 'influence', 'research relevant values', 'previous stakeholder engagement'.Conclusions: We present factors for research teams to consider during identification and invitation of individual representatives in a multi-stakeholder research partnership. Policy makers and guideline developers may benefit from considering the factors in stakeholder identification and invitation. Research funders may consider stipulating consideration of the factors in funding applications. We outline how these factors can be implemented and exemplify how their use has the potential to improve the quality and relevancy of health research. [ABSTRACT FROM AUTHOR]

Background: Medical tourism provides Effective economic, political and social profits to the countries active in the field, which should be taken into account in a competitive market. This study aimed to evaluate the relationship between foreign patients' satisfaction and other aspects of health tourism in educational and medical centers of the Iran University of Medical Sciences (IUMS). Methods: This was a descriptive correlational study with a researcher-made questionnaire. The first part of the questionnaire contained the demographic characteristics of the participants, and the second part included 30 questions about the components that affect receiving medical services by foreign nations. The reliability coefficient of the questionnaire was determined by using Cronbach's alpha (0.980). Expert judgment was used to assess the validity of the questionnaire. Out of 70 hospitals affiliated with the University of Iran in 2019, 10 hospitals from 35 licensed centers in the field of international health were randomly selected, and 300 questionnaires were delivered to foreign patients who were willing to complete the questionnaire. The received information was from Random sampling recorded in SPSS25 software. Descriptive Statistics was used to determine the effective factors. Results: The largest numbers of foreign patients in this study were from Iraq (64 %) and Kuwait (24 %), respectively. In correlation review, there was a significant relationship between satisfaction of foreign patients and financial dimension (0.785), quality of treatment dimension (0.914), medical facilities dimension (0.799) and tourism facilities dimension (0.918) in hospitals. Conclusion: This study demonstrates that there is a significant relationship between satisfaction of foreign patients and other aspects of health tourism (such as financial dimension, treatment quality, treatment and tourism facilities) in hospitals, Which needs to be given special attention by health tourism managers for short-term and long-term planning for its development.

Introduction: A bi-institutional partnership between physicians at Addis Ababa University, Ethiopia and the University of Toronto, Canada led the development and implementation of a novel emergency medicine (EM) postgraduate training program at Addis Ababa University (AAU). Subsequently, the first three cohorts of trainees were invited to participate in the evaluation of the curricular components devised and delivered by Toronto EM physicians as part of the Toronto Addis Ababa Academic Collaboration in EM (TAAAC-EM). We sought to characterise the strengths and weaknesses of the curriculum to improve it for future trainee cohorts. Methods: This curriculum assessment used semi-structured, in-depth individual interviews to evaluate components of the TAAAC-EM program curriculum. Interviews were conducted with a purposive sampling of graduates from the first three cohorts of the TAAAC-EM program. Results: Twelve participants were interviewed. The following themes were identified; The TAAAC-EM program built a novel EM culture at AAU and shifted teaching from didactic to learner-centered strategies where teachers serve as role models; The curriculum content of the EM resident program, including didactic and practical sessions, was well received by the graduates interviewed; Challenges identified included lack of continuity in training, and difficulties transitioning to practice in a locally nascent field; Participants evaluated the TAAAC-EM program model as very positive overall, and supported replicating the model by expanding within Ethiopia and beyond. Conclusions: The challenges identified in the program, including lack of continuity of clinical teaching and meeting the local educational resource needs of new graduates, helped inform program adaptations and improvements. TAAAC-EM, currently in its eleventh year, is now focused on transitioning full teaching responsibilities to local faculty and continuing to support a positive EM teaching culture. We believe that this thriving partnership can serve as a model for future north-south and south-south collaborations in postgraduate medical education.

Background Diaspora communities are a growing source of external aid and resources to address unmet needs of health systems of their homelands. Although numerous articles have been published, these endeavors as a whole have not been systematically assessed. Objective Examine the available literature to assess activities through which diasporas engage with the health system in their origin country and what barriers they face in their interventions. Methods This is a scoping review from 1990–2018 using the PRISMA-Scr framework to examine both peer-reviewed and gray literature on (1) specific activities through which diasporas contribute to the health system in their origin country; (2) major health needs diasporas have tried to address; and (3) barriers faced by diaspora healthcare efforts. Results The initial search identified 119 articles, of which 45 were eligible after excluding non-relevant studies. These were case studies of diaspora contributions to health systems in their origin country (13), interviews (13), literature reviews (9), general articles on the topic (4), and correspondences or presentations (6). The healthcare needs diasporas have sought to address include health workforce emigration (‘brain drain’) (10), capacity building for research and training (10), inadequate infrastructure (5), and finances (4). Specific activities included short-term missions (11), establishing partnerships (9), emigration back to country of origin (8), specific research and training programs (8), and financial remittances (5). Specific barriers identified were most commonly financial need within the origin country (8), lack of sustainability (6), communication issues (6), lack of intention to return to the origin country (5), infrastructure (4), and political concerns (3). Conclusion Further research on how to expand the scope of and reduce barriers to diaspora engagement is needed to optimize the effectiveness of diaspora contributions to their origin countries. Metrics and standards should be developed for assessing impact of diaspora engagement and interventions.

BackgroundTo more accurately quantify the potential impact of the neighbourhood environment on adults' physical activity (PA), it is important to compare environment-PA associations between periods of the day or week when adults are more versus less likely to be in their neighbourhood and utilise its PA resources. We examined whether, among adults from 10 countries, associations between objectively-assessed neighbourhood environment attributes and moderate-to-vigorous physical activity (MVPA) varied by time of the day and day of the week. The secondary aim was to examine whether such associations varied by employment status, gender and city.MethodsThis cross-sectional study included 6,712 adults from 14 cities across 10 countries with ≥1 day of valid accelerometer-assessed MVPA and complete information on socio-demographic and objectively-assessed environmental characteristics within 0.5 and 1 km street-network buffers around the home. Accelerometer measures (MVPA min/h) were created for six time periods from early morning until late evening/night, for weekdays and weekend days separately. Associations were estimated using generalized additive mixed models.ResultsTime of the day, day of week, gender and employment status were significant moderators of environment-MVPA associations. Land use mix was positively associated with MVPA in women who were employed and in men irrespective of their employment status. The positive associations between MVPA and net residential density, intersection density and land use mix were stronger in the mornings of weekdays and the afternoon/evening periods of both weekdays and weekend days. Associations between number of parks and MVPA were stronger in the mornings and afternoon/evenings irrespective of day of the week. Public transport density showed consistent positive associations with MVPA during weekends, while stronger effects on weekdays were observed in the morning and early evenings.ConclusionsThis study suggests that space and time constraints in adults' daily activities are important factors that determine the impact of neighbourhood attributes on PA. Consideration of time-specific associations is important to better characterise the magnitude of the effects of the neighbourhood environment on PA. Future research will need to examine the contribution of built environment characteristics of areas surrounding other types of daily life centres (e.g., workplaces) to explaining adults' PA at specific times of the day.

The emerging field of global oral and maxillofacial surgery (OMS) aims to improve worldwide access to safe, timely, and affordable OMS care. However, there exists a dearth of literature thoroughly detailing the scope of academic global OMS collaborations between high-income countries (HICs) and low- and/or lower middle-income countries (LICs/LMICs). This scoping review was performed to characterize the landscape of global academic OMS collaborations between HICs and LICs/LMICs. A five-stage methodological framework was used. Academic global OMS collaborations from 1996 to 2020 were identified via an electronic database and grey literature review. A total 1318 articles were identified on December 17, 2020. Following the application of inclusion and exclusion criteria, 71 articles describing 81 unique global OMS academic collaborations were included in the final analysis. The most common HIC was the United States (44.4%); the majority of LIC/LMICs were within Africa (45.8%). Of the total interventions, 89.6% improved LIC/LMIC capacity development, and surgical (43.8%) interventions were the most common. By serving as a central report on current and past academic collaborations in global OMS, this review helps identify areas in need of surgical capacity building, lays the foundation for future research efforts on the topic, and serves as a resource for individuals aiming to become involved in global OMS. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this systematic review was to synthesize the existing global literature examining the relationship between altitude and suicide. Method: Using the electronic databases PubMed, CINAHL, EMBASE, and PsychInfo published articles in English that addressed the relationship between altitude and suicide as a primary or secondary aim, and included human subjects, where identified. Studies were assessed for quality based on methodological approach and data relevance on a three-point scale (strong, moderate, or weak). Results: Of the 19 studies related to the purpose and aims, 17 reported evidence of a positive correlation between altitude and increased suicide. Vast design differences were employed within the literature, individual-level suicide data was identified as the preferred level of analysis. Discussion: The relationship between altitude and suicide is an evolving science with a small but growing body of literature suggesting altitude is associated with an increased risk of suicide. This review identifies the need for additional studies examining both individual-level suicide data and improving geographic precision. Public health nurses have a responsibility to carefully examine the quality of studies and the strength of the evidence when addressing variables associated with suicide. [ABSTRACT FROM AUTHOR]

Aim: To explore the resources supporting current nurse practice in the post‐emergency country of Liberia, using the nursing intellectual capital framework, as nurses work to meet the targets set by Government of Liberia's Essential Package of Health Services. Design: Case study. Methods: Data were collected in Liberia February–June 2019. Direct observation, semi‐structured interviews and photographs were used to investigate how nurse practice is supported. Field notes, transcripts and photographs were coded using both directed and conventional content analysis. Reports were then generated by code to triangulate the data. Results: Thirty‐seven nurses at 12 health facilities participated. The intellectual capital supporting inpatient and outpatient nurse practice differs in important ways. Inpatient nurse practice is more likely to be supported by facility‐based protocols and trainings, whereas outpatient nurse practice is more likely to be supported by external protocols and trainings, often developed by the Liberian government or non‐governmental organizations. This can lead to uneven provision of inpatient protocols and trainings, often favouring private facilities. Similarly, inpatient nurses rely primarily on other nurses at their facilities for clinical support while outpatient nurses often have external professional relationships that provided them with clinical guidance. Conclusion: Much has been accomplished to enable outpatient nurses to provide the primary‐ and secondary‐care target services in the Essential Package of Health Services. However, as the Liberian government and its partners continue to work towards providing certain tertiary care services, developing analogous protocols, trainings and clinical mentorship networks for inpatient nurses will likely be fruitful, and will decrease the burden on individual facilities. Impact Nurses are often expected to meet new service provision targets in post‐emergency states. Further research into how best to support nurses as they work to meet those targets has the potential to strengthen health systems. [ABSTRACT FROM AUTHOR]

IntroductionIn this study, we developed a simplified artificial intelligence to support the clinical decision-making of medical personnel in a resource-limited setting.MethodsWe selected seven infectious disease categories that impose a heavy disease burden in the central Vietnam region: mosquito-borne disease, acute gastroenteritis, respiratory tract infection, pulmonary tuberculosis, sepsis, primary nervous system infection, and viral hepatitis. We developed a set of questionnaires to collect information on the current symptoms and history of patients suspected to have infectious diseases. We used data collected from 1,129 patients to develop and test a diagnostic model. We used XGBoost, LightGBM, and CatBoost algorithms to create artificial intelligence for clinical decision support. We used a 4-fold cross-validation method to validate the artificial intelligence model. After 4-fold cross-validation, we tested artificial intelligence models on a separate test dataset and estimated diagnostic accuracy for each model.ResultsWe recruited 1,129 patients for final analyses. Artificial intelligence developed by the CatBoost algorithm showed the best performance, with 87.61% accuracy and an F1-score of 87.71. The F1-score of the CatBoost model by disease entity ranged from 0.80 to 0.97. Diagnostic accuracy was the lowest for sepsis and the highest for central nervous system infection.ConclusionSimplified artificial intelligence could be helpful in clinical decision support in settings with limited resources.

ABSTRACT: Strongyloidiasis, a disease caused by the helminth Strongyloides stercoralis, has been identified as a life-threatening parasitic infection among immunocompromised patients. In the most severe cases, which include hyperinfection syndrome and dissemination of larvae throughout multiple organ sites, there is typically a history of immunosuppression among the infected. Herein, we describe a fatal case of S. stercoralis hyperinfection in an immigrant from rural Ecuador presenting with diarrhea along with Clostridium difficile colitis after the use of a prolonged course of steroids. Despite the appropriate administration of ivermectin, living Strongyloides larvae were discovered in a tracheal lavage. The patient ultimately developed a multiorgan failure requiring life-supporting measures in the intensive care unit and later succumbed to his condition. This case of S. stercoralis hyperinfection emphasizes the importance of screening for this parasite in the appropriate clinical scenarios. The diagnosis of S. stercoralis can be made more accessible to practitioners through the use of methods such as the modified Baermann technique, agar-plate culture, and serologic antibody testing.

NPs are an essential resource in the organization and creation of capacity-building efforts to improve healthcare across the globe. There are limited data to guide the creation of effective supplementary education projects. Recent evidence highlights the essential components of sustainability, curriculum development, and program evaluation. [ABSTRACT FROM AUTHOR]

Whereas the effect of performance-based financing (PBF) on improving the quantity and quality of health services has been established, little is known about what matters for health facilities to improve performance under a PBF scheme. This study examined the associations between management practices and the performance of primary healthcare centres (PHCCs) under a PBF scheme in Nigeria. This study utilized longitudinal data on monthly institutional deliveries and outpatient visits collected between December 2011 and March 2016 from 111 randomly selected PHCCs in Adamawa, Ondo and Nasarawa states of Nigeria. A management practices scorecard, based on a health facility survey conducted in April/May 2016, was used to derive management practices scores for the 111 PHCCs. The management practices examined included activities to recruit and retain clients, staff's attention to performance targets, listening and responding to client feedback, teamwork building and addressing low-performing staff. A multilevel, multilinear regression model was used to investigate the associations between health facility performance (monthly number of institutional deliveries and outpatient visits) and management practices at the PHCCs, adjusting for key control variables (number of skilled health workers, the size of PHCC catchment population, PHCC quality score, seasonality and states). Following PBF introduction, PHCCs with medium management scores had 0.42 (95% CI 0.18-0.65; P < 0.001) and 9.93 (95% CI 6.15-13.71; P < 0.001) higher monthly improvement rates for institutional delivery and outpatient visits, respectively, compared to the PHCCs with low management scores. Also, the PHCCs with high management scores had 0.49 (95% CI 0.28-0.70; P < 0.001) and 5.10 (95% CI 1.76-8.44; P < 0.003) higher monthly improvement rates for institutional delivery and outpatient visits compared to the PHCCs with low management scores. These findings suggest the importance of management practices in facilitating the effect of PBF on health facility performance and the need to strengthen PHCC management practices in low- and middle-income countries. [ABSTRACT FROM AUTHOR]