Background: Artificial intelligence is increasingly influencing health care and policy, yet the global research landscape linking artificial intelligence and health care policy remains underexplored. This study aimed to map publication trends, major contributors, collaboration networks, citation structures, and emerging themes in this field. Methods: A bibliometric analysis was conducted using the Web of Science Core Collection. The search was performed on 3 May 2026, and covered publications from 2000 to 3 May 2026. The final dataset included 347 peer-reviewed English-language original research and review articles. Biblioshiny, VOSviewer, and CiteSpace were used to analyze publication trends, country and institutional contributions, author and journal productivity, collaboration networks, citation and co-citation structures, keyword patterns, and thematic evolution. Results: Publications increased markedly after 2020 and reached their highest annual output in 2025. The 2026 publication count was lower because data for that year were partial at the time of database retrieval. Researchers from 82 countries and 900 institutions contributed to the field, with the United States leading in output, followed by China, England, Canada, and India. Harvard Medical School was the most productive institution, whereas Harvard University had the highest institutional centrality. Frontiers in Public Health published the most articles, and PLOS ONE was the most frequently co-cited journal. The most cited article was "Artificial intelligence and the future of global health." Key research themes included machine learning, COVID-19, health policy, risk, large language models, interpretable machine learning, neural network-assisted screening, socioeconomic perspectives, and public health applications. Conclusions: Research on artificial intelligence and health care policy has expanded rapidly, particularly in recent years, and is increasingly centered on predictive modeling, public health decision-making, and emerging artificial intelligence technologies. These findings highlight influential contributors, evolving themes, and future directions for researchers, policymakers, and health care leaders.
Visa inequities in global health have moved from the margins of academic discourse to the centre of a growing reform agenda. While recent literature has established that visa regimes function as structural determinants of global health participation, a critical gap remains: the solution pathways proposed to date remain dispersed across commentaries, editorials and toolkits rather than consolidated into a coordinated operational framework that institutions, conference bodies and funders can act on at scale. This Essay consolidates and builds on that emerging consensus to propose a Global Mobility Equity Framework comprising four interdependent and scalable domains: equitable convening, inclusive participation infrastructure, institutional accountability and distributed visa support systems. Drawing on documented cases spanning the International AIDS Conference, the World Health Summit, the Consortium of Universities for Global Health, and clinical training pathways for foreign medical graduates, we demonstrate that visa barriers impose cascading professional, financial and institutional costs that are systemic in pattern rather than exceptional in nature. We further show that virtual and hybrid conferencing, while promising, does not independently resolve underlying inequities related to connectivity, time zones, language access and the networking disparities that shape career trajectories. The framework we propose is not a restatement of the structural critique as that ground has been well covered. It is a citable, implementable operational response designed to guide coordinated action across global health's institutional landscape. Adopting this framework is a necessary condition for a more representative and effective global health system.
Anemia is a prevalent global public health issue, especially among pregnant women in developing countries. Limited research exists on anemia in pregnant women in Somalia, particularly in Garowe City. This study aims to determine the prevalence of anemia and its associated factors among pregnant women attending antenatal care in public health facilities in Garowe City, Puntland, Somalia, from December 1, 2023, to January 1, 2024. An institution-based cross-sectional study was conducted with 422 randomly selected pregnant women in public health facilities. Data were collected using EpiData version 4.6 and analyzed with SPSS version 25. Bivariate and multivariable logistic regression analyses identified factors associated with anemia, with statistical significance set at P < 0.05. The prevalence of anemia among pregnant women was 38.6% (95% CI: 33.9%, 43.6%). Significant associated factors included: rural residence (AOR = 2.58, 95% CI: 1.18-5.64), multigravidity (AOR = 2.01, 95% CI: 1.03-3.89), lack of nutritional counseling (AOR = 1.65, 95% CI: 1.09-2.52), positive malaria test (AOR = 3.58, 95% CI: 1.08-11.98), and not consuming one extra meal (AOR = 2.19, 95% CI: 1.15-4.19). Anemia in pregnant women in Garowe City is a moderate public health concern according to WHO standards. Factors such as residence, gravidity, nutritional counseling, malaria status, and dietary habits significantly correlate with anemia. Public health measures should focus on enhancing nutritional counseling, promoting extra meal consumption, and preventing malaria during pregnancy.
Pregnancy provides an opportunity to assess women's health needs and engage them in appropriate healthcare services. This study explored how noncommunicable disease (NCD) prevention has been integrated into maternal health services in Vietnam and identified the barriers and facilitators influencing this process. We conducted in-depth interviews with 30 stakeholders, including policymakers, health managers, and providers in maternal healthcare services across different levels of care. Data were analyzed thematically using a conceptual framework. Recurring themes were identified and refined through discussions among investigators and technical advisors. Integrated NCD prevention and screening services were available before, during, and after pregnancy, particularly at higher-level public and private facilities, although mental health services remained limited. Limited primary healthcare capacity for maternal health and NCD prevention contributed to greater reliance on higher-level and private facilities. Most services packages relied on out-of-pocket payments rather than social health insurance coverage. Participants also identified gaps in service quality assurance, including counseling and continuity of care for women with NCDs, which may lead to inefficient service utilization and increased healthcare costs. NCD prevention services were integrated into maternal healthcare primarily at higher-level public and private facilities, whereas mental health care remained limited. Reliance on out-of-pocket payments, limited primary health care capacity, and gaps in continuity and quality of care may influence NCD prevention utilization and healthcare costs.
Task-sharing with non-physician health workers (NPHWs), supported by digital health, has emerged as a critical strategy to address workforce shortage and improve the delivery of health services. The use of digital health shows promise in supporting task-sharing for the prevention and management of non-communicable diseases (NCDs) elsewhere; however, the evidence from Africa remains limited. This study aims to review the use of digital health in task-sharing for the prevention and management of NCDs in Africa. The review described the types of digital health technologies used, their functions, effectiveness, and what affects optimal use. The Joanna Briggs Institute (JBI) protocol for scoping reviews was employed, and searches were conducted across three databases-PubMed, Scopus, and Google Scholar-for studies published up to August 2025. The search identified 4,857 citations, of which 71 full texts were screened. Fifteen studies from eight African countries were included in the review, with the largest proportion (26.7%; 4/15) originating from South Africa. mHealth was the most frequently used digital health technology in 46.7% (7/15) of studies, with community health workers as the primary users. The review found that NPHWs utilized digital health technologies for prevention, screening, treatment delivery, and supervision. Digital health, particularly mHealth, supports NPHWs in task-sharing for NCD prevention and management in Africa, despite the limited types of technologies and functions. The use of digital health was limited by low digital literacy, poor internet connectivity, and inadequate electricity supply. Effective implementation requires governance, sustainable funding, infrastructure, workforce development, and robust data systems tailored to the specific contexts of African countries. PROTOCOL REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/Q2XF9.
Equity in health service utilization refers to equal treatment for equal health needs, regardless of socioeconomic status. In low- and middle-income countries, inequity in maternal health service use remains a pressing issue in the pursuit of universal health coverage by 2030. This study examines whether socioeconomic equity in the use of key maternal health services-antenatal care (ANC) from a medically trained provider, facility delivery, and management of complications-improved faster in districts with high facility readiness than elsewhere in Bangladesh between 2001 and 2016. We analyzed data from three rounds of the Bangladesh Maternal Mortality and Health Care Survey and corresponding Bangladesh Health Facility Survey rounds. These datasets were linked at the district level and pooled for the years 2001, 2010, and 2016. Using an adaptation of the Difference-in-Differences (DID) model based on linear probability models, we estimated whether poor-nonpoor gaps in maternal health service utilization changed differently over time in districts with high facility readiness than in districts with lower readiness. Bangladesh achieved substantial improvements in overall maternal health service use during the study period. However, these gains were not equitably distributed. Socioeconomic equity improved modestly for ANC and complication management but worsened significantly for facility deliveries. The gap between nonpoor and poor women widened more in high facility readiness districts than in low readiness districts (p < 0.05). Additionally, equity in ANC use improved among women living within one hour of a private facility (p < 0.05). This is the first systematic investigation of the role of facility readiness in maternal health equity in Bangladesh using nationally representative data. Despite overall progress, persistent and, in some cases, widening socioeconomic inequities were observed-especially in facility-based delivery. These findings highlight the need for targeted policy action to ensure that improvements in service readiness translate into more equitable maternal healthcare access and outcomes.
Frontline health workers in humanitarian settings play a critical role in pandemic response, yet evidence on what sustains response readiness beyond the emergency is limited. This study examined factors associated with primary healthcare workers' sustained self-reported knowledge, skills, and confidence to respond to future outbreaks or pandemics, with the configurational analysis focused on confidence. A retrospective cross-sectional survey was conducted among 118 health workers in Honduras, Syria, and South Sudan who received COVID-19 training. Coincidence analysis was applied with a set of associated predictors to identify combinations of conditions linked to high sustained confidence. COVID-19 training that covered five or more core topics was associated with high sustained self-rated capacities; topics included proper use of personal protective equipment, transmission routes, procedures for case screening, and facility infection prevention and control. Continuity of primary healthcare services after emergency funding ended, fewer disruptions from conflict or natural disasters, and supportive team structures were linked to confidence. Coincidence analysis indicated multiple sufficient causal pathways to sustained confidence, the first being very high self-rated post-training knowledge as a standalone pathway (consistency: 0.66, coverage: 0.62). Other pathways included health workers with higher education combined with either case-screening training or working in facilities that continued services post-funding (consistency: 0.604, coverage: 0.64). Applying COVID-19 practices to other outbreaks (e.g., dengue, cholera) further reinforced capacities and illustrated the pathogen-agnostic value of core infection prevention and response competencies. Results underscore that durable preparedness at the primary healthcare level in fragile contexts depends on comprehensive, practice-oriented training for all types of frontline health workers, as well as enabling conditions that maintain service delivery. This study contributes to emerging literature using implementation science frameworks and coincidence analysis to understand complex causal pathways. The findings should inform global health security investments, including in the world's most fragile health systems.
Elevated low-density lipoprotein cholesterol (LDL-C) is a modifiable risk factor for cardiovascular disease, the leading cause of premature death worldwide. Assessing the LDL-C-related burden is critical for guiding prevention and treatment strategies. To estimate the global, regional, and national burden of ischemic heart disease and ischemic stroke attributable to elevated LDL-C (relative to 35-54 mg/dL) from 1990 to 2023 and to quantify the contributions of population growth, aging, risk-deleted burden, and exposure changes to burden trends. This comparative risk assessment, part of the Global Burden of Disease Study 2023, estimated population-level LDL-C exposure and associated health loss in 204 countries and territories. Mean LDL-C levels were estimated using spatiotemporal gaussian process regression based on 806 studies across 161 countries. Relative risks were derived from meta-analyses of 38 randomized clinical trials. Population-attributable fractions for deaths and disability-adjusted life-years (DALYs) were estimated by age and sex for adults aged 25 years or older from 1990 to 2023, with 95% uncertainty intervals. Population-level LDL-C concentrations. Population-attributable fractions, counts, and rates (all ages and age standardized per 100 000) of LDL-C-attributable deaths and DALYs from ischemic heart disease and ischemic stroke, with uncertainty intervals. In 2023, elevated LDL-C accounted for 3.6 million deaths (95% uncertainty interval, 2.2-5.4 million; 6.0% of global mortality) and 90.7 million DALYs (95% uncertainty interval, 58.9-123.3 million; 3.2% of DALYs). Although global all-ages rates remained stable, age-standardized death and DALY rates decreased by 45.6% and 39.5%, respectively, since 1990. In 2023, age-standardized LDL-C-attributable DALY rates were highest in Eastern Europe and lowest in high-income Asia-Pacific. One-third of the global LDL-C burden occurred in India and China. Population growth and aging drove the increasing burden, with notable regional disparities in LDL-C exposure and risk-deleted DALY rates shifting toward middle-sociodemographic settings. Despite declining age-standardized rates, the absolute LDL-C burden has increased since 1990 due to demographic changes and has shifted toward middle-sociodemographic countries. Measurement and surveillance gaps persist. Strengthened prevention, diagnosis, and treatment access strategies are essential to mitigate the health burden of LDL-C.
Drawing on data from the Global Burden of Disease (GBD) 2021 study, this research provides the first systematic assessment of the burden and trends of chronic kidney disease (CKD) among the global population aged 75 years and over between 1990 and 2021. Unlike previous studies covering the entire age spectrum, this study focuses on the age group with the highest concentration of disease burden and the greatest health vulnerability, with the aim of revealing the unique epidemiological patterns specific to this population. The study methodology involved extracting data on the prevalence, incidence, mortality and disability-adjusted life years (DALYs) for chronic kidney disease (CKD) among people aged 75 years and over in 204 countries and territories from the GBD 2021 database. All reported rates are age-standardized. We calculated estimated annual percentage changes (EAPCs) to analyze trends and examined the association between the disease burden and the Sociodemographic Index (SDI). The study found that in 2021, approximately 127 million people aged 75 years and over worldwide were living with CKD. Between 1990 and 2021, the age-standardized prevalence declined slightly (EAPC = -0.06%; 95% UI: -0.09% - -0.03%), whilst incidence, mortality and DALY rates all rose significantly (EAPCs of 0.50%; 95% UI: 0.47%-0.53%, 1.55%; 95% UI: 1.48%-1.61% and 1.07%; 95% UI: 1.02%-1.12%, respectively), demonstrating the key phenomenon of 'prevalence-mortality trend divergence'. The relationship between the burden of disease and socio-economic development is complex: regions with low SDI bear the heaviest burden of mortality, whilst regions with high SDI have experienced the fastest growth in mortality rates. The study also revealed significant heterogeneity in the burden across age, gender and geographical regions. The burden of chronic kidney disease (CKD) among the global older adult population is rapidly shifting from a pattern of 'high prevalence' to one characterised by 'high incidence, high mortality and high disability', with the underlying drivers exhibiting fundamental differences across regions at various stages of development. This necessitates that public health strategies move beyond a 'one-size-fits-all' approach and instead develop highly age-specific and contextually tailored interventions. This study provides a detailed map for understanding the epidemiology of CKD in the context of extreme population ageing, and offers crucial evidence for the allocation of resources and the formulation of policies.
Migration to Peru from Venezuela has reshaped engagement in informal labour for many women who turn to sex work as a survival strategy amid legal precarity and systemic exclusion. Yet little is known about how migrant sex workers navigate sexual and reproductive health (SRH) in this context. In 2023, we conducted 34 semi-structured interviews with Venezuelan migrant cisgender women sex workers living in Lima, Peru. Interviews explored migration trajectories, working conditions, SRH needs, and experiences seeking care. Analysis was guided by the Structural Vulnerability Framework, contextualizing how institutional framings and public health logics structure SRH access, exclusion, and women's adaptive strategies. Participants described access to SRH services in Peru as narrowly restricted to HIV and sexually transmitted infection (STI) testing and condom distribution, with accessibility to those services often contingent upon disclosing involvement in sex work, thereby reinforcing surveillance, stigma, and experiences of mistreatment in healthcare settings. Comprehensive SRH needs-including contraception, cervical and breast cancer screening, management of menstrual disorders, and responses to condom breakage or occupational injuries-were frequently unaffordable, unavailable, or dismissed, even as these conditions directly affected women's capacity to work. Responding to structural gaps in care, participants exercised agency within constrained landscapes, organizing peer networks and relying on community-based organizations to access SRH information, emotional support, and care. The normalization of out-of-pocket payments further illustrated how health decisions were made within constrained economic and bureaucratic contexts. Urgent and structural action is needed to close bureaucratic barriers to access to health insurance for migrants, implement non-stigmatizing models of care, and support partnerships with peer networks and community organizations.
Depression remains a critical mental health challenge among young people in low-resource settings, where financial, structural, and social barriers frequently limit care access. Digital approaches, including Tele-Support Psychotherapy (TSP), have emerged as promising, scalable alternatives to Standard in-person Mental Health Services (SMHS), yet evidence comparing their implementation remains limited. This study explored facilitators and barriers influencing the feasibility, acceptability and engagement of youths with TSP versus SMHS for depression treatment in Kampala District, Uganda. A qualitative phenomenological study was conducted among youth aged 15-30 years enrolled in a randomized controlled trial evaluating both interventions. Data were collected through semi-structured key informant interviews and focus group discussions with participants and lay counselors and analyzed using deductive thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR). In the parent trial, 95 of 154 participants (61.69%) in the TSP arm and 15 of 146 (10.27%) in the SMHS arm engaged with their assigned intervention; these figures provide contextual background for these qualitative findings. Key facilitators for both interventions included strong social support networks and higher income levels. Technological challenges, such as unreliable mobile phone connectivity, hindered TSP, while high costs and limited awareness were barriers to SMHS. Government policies both supported trust in digital interventions and, in some cases, constrained access while lay-counselor attributes, including on-phone session flexible scheduling and rapport-building skills facilitated TSP. TSP presents a viable alternative to SMHS, particularly for youth facing financial and logistical barriers to accessing facility-based mental health services. However, optimizing its delivery requires addressing technological constraints, ensuring consistent government support, and integrating mental health literacy initiatives. Findings underscore the need for flexible and contextually tailored models that leverage technology and address individual and systemic barriers to enhance mental health service access in resource-constrained settings.
Mental disorders impose a disproportionate burden on populations in low- to middle-income countries (LMICs) and low-income countries (LICs), yet longitudinal assessments across these settings remain limited. Using the Global Burden of Disease Study 2023, we investigated prevalence and disability-adjusted life years (DALYs) for 10 mental disorder subcategories across 76 LMICs and LICs from 1990 to 2023 and projected trends through 2050 via a generalized ensemble modeling approach. Age-standardized prevalence rose markedly between 1990 and 2023, from 10,759.9 (95% uncertainty interval, 9,560.1-12,088.6) to 13,929.3 (12,512.5-15,829.0) per 100,000 in LMICs and from 11,723.6 (10,577.7-12,987.5) to 14,979.1 (13,512.9-16,770.7) in LICs, accompanied by corresponding increases in age-standardized DALY rates. The most pronounced increases in both age-standardized prevalence and DALYs were observed during the COVID-19 pandemic. Anxiety disorders (total percentage change: 102.3% in LMICs; 67.3% in LICs), eating disorders (40.7% in LMICs; 4.8% in LICs), depressive disorders (28.6% in LMICs; 29.8% in LICs), and autism spectrum disorders (14.9% in LMICs; 22.5% in LICs) showed the largest increases in prevalence. Under a reference scenario where past trends persist, age-standardized prevalence is projected to reach 17,155.8 (14,449.5-20,212.5) per 100,000 in LMICs and 17,968.4 (15,109.8-21,090.9) in LICs by 2050. These findings reveal persistent and widening disparities in mental health burden across resource-limited settings, substantially exacerbated by the pandemic. Without targeted, scalable, and sustained policy interventions, the burden in LMICs and LICs will continue to worsen, underscoring the critical need for context-specific public health action. This study was funded by the Gates Foundation.
Opioid use disorder (OUD) is a global public health crisis that has steadily worsened despite significant efforts. Maladaptive opioid use can have significant negative impacts, yet a minority receive evidence-based treatments. Leveraging common personal technologies like smartphones and computers may help extend access to such services. The current study aims to describe the landscape of personal technology use in opioid use recovery by combining an academic scoping review with a review of commercially available smartphone apps and devices. The scoping review provides an overview of research examining feasibility and efficacy, whereas the commercial review investigates whether available technology is supported by peer-reviewed research or regulatory approval. Four databases were searched for the scoping review (i.e., PubMed, PsychINFO, EMBASE, and MEDLINE) alongside Apple and Google Play stores for the commercial review. Two independent reviewers evaluated the studies. The academic search yielded 937 articles, of which 34 were included, and the commercial review found 21 apps and devices. The included studies show good acceptance and feasibility; however, research reporting on efficacy outcomes is mixed and nascent. Of the commercially available interventions, only eight underwent peer-reviewed evaluation, and only three had received healthcare body approval at the time of the search. Thus, more research is needed to ascertain the efficacy of such interventions, especially in underrepresented groups such as women, minority groups, and insecurely housed people. Additionally, given the limited data identified and the legal and medical risks associated with OUD, further consideration of safety and privacy is warranted. Further, since commercialization has vastly outpaced peer-reviewed research, we suggest amendments to regulatory procedures that consider the risks associated with the intended population, rather than just the intended use. Lastly, we offer suggestions to guide clinical decision-making regarding the use of digital tools in their practice.
Aedes aegypti (Ae. aegypti) is the primary vector for dengue, Zika and chikungunya, which represent major global public health concerns. The use of Wolbachia as a biological control agent in Ae. aegypti has gained significant international attention following the successful establishment of field-released mosquitoes in Australia, Malaysia, Brazil, Indonesia and Singapore. This study presents a comprehensive scientometric analysis of the research landscape of Wolbachia and Ae. aegypti. Data comprising 662 English-language publications from 2000 to 2025 were extracted from the Scopus database. Analytic tools, including VOSviewer and R-based Biblioshiny, were employed to quantify author productivity, transcontinental collaboration networks, thematic evolution, research gaps and future directions, while Bradford's Law of Scattering was used to identify core dissemination channels. Publications have shown a steady upward trajectory since 2000, with an overall relative growth rate of 0.3%, while annual citations peaked in 2009 and 2011 (3337 and 3460 citations, respectively). The dataset strictly conformed to Bradford's distribution (0.16% error), identifying PLOS Neglected Tropical Diseases (11.9%) and Parasites and Vectors (5.6%) as the core journals. Global research networks are predominantly led by Australia and the United States, supported primarily by the National Institutes of Health (14.8%) and the National Health and Medical Research Council (14.2%). Crucially, thematic analysis using a methodological triangulation approach demonstrates a progressive maturation in the field, shifting from foundational laboratory mechanisms toward large-scale deployment logistics and microbiome dynamics. Overall, this study highlights the intellectual landscape, underscores the vital role of global collaboration, and provides strategic insights to guide future evidence-based policies in Wolbachia-Aedes aegypti research.
Asthma is a major chronic respiratory disease with substantial health and economic consequences worldwide; however, there is little evidence for the long-term macroeconomic effects of asthma across countries. We aimed to estimate the global economic burden attributable to asthma from 2025 to 2050 across 154 countries and territories. We estimated the long-term economic burden of asthma using a health-augmented macroeconomic model covering 154 countries and territories from 2025 to 2050. Projected labour losses were captured through reductions in the workforce due to premature death and reduced labour force participation due to disability. Physical capital accumulation was affected by asthma-related medical spending, which reduces savings and investment, measured as asthma-attributable health expenditure. In the model, this spending reduced disposable income and savings, thereby lowering investment and slowing capital accumulation over time FINDINGS: Between 2025 and 2050, our model predicted that asthma would incur costs of approximately US$863 billion (95% uncertainty interval [UI] 615-1396; 2024 US$), corresponding to an annual gross domestic product (GDP) decline of 0·036% (0·026-0·058). The projected economic burden differed markedly across the 154 countries. The USA bore the largest burden (US$471 billion [371-655]), followed by the UK (US$45 billion [28-84]) and China (US$44 billion [27-81]). Across income groups, high-income countries accounted for the greatest absolute losses (US$712 billion [525-1105]) and highest proportional GDP losses (0·054% [0·039-0·083]), whereas low-income countries incurred absolute losses of US$5 billion (2-11). In low-income and middle-income countries (LMICs), labour-related losses accounted for a larger share of total costs and declines in disease burden were slower. Our findings suggest that asthma imposes a substantial and uneven macroeconomic burden across countries, with differences by income level and region. Productivity reductions dominate in LMICs, whereas physical capital-related effects are more important in high-income settings. Improving asthma prevention and control could yield economic gain. Noncommunicable Chronic Diseases-National Science and Technology Major Project; Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences; European Commission Horizon Europe.
Problematic smartphone use (PSU) has become a growing public health concern among adolescents, with global prevalence estimates ranging from 10% to 30%. Sleep dissatisfaction has been identified as a potential risk factor for PSU. However, the psychological mechanisms underlying this association remain unclear. This study examined the relationship between sleep satisfaction and PSU among Korean adolescents, and investigated the mediating roles of anxiety and loneliness. Data were collected from 48,829 adolescents who were categorized into three groups: general users (72.1%), potential-risk users (24.8%), and high-risk users (3.1%). Group differences were examined using chi-square tests and one-way analysis of variance (ANOVA). Multivariate logistic regression analyses were conducted to identify the factors associated with PSU risk. Mediation analyses were conducted using a counterfactual framework to estimate the total, natural direct, and natural indirect effects of sleep satisfaction on PSU risk through anxiety and loneliness. Increased PSU risk was significantly associated with being female, high smartphone usage time (≥4 hours/day), and reporting poor perceived health. High-risk users reported markedly longer daily smartphone use (7.01 ± 0.12 hours) and significantly higher anxiety and loneliness scores compared to other groups (p < .001). Poor sleep satisfaction and insufficient physical activity were also significantly associated with higher PSU risk. Mediation analyses indicated significant natural indirect effects through anxiety and loneliness, with proportions mediated of 30.0% and 15.2%, respectively. Sleep dissatisfaction is significantly associated with problematic smartphone use among adolescents, and this relationship is partly explained by heightened anxiety and loneliness. Interventions aimed at improving sleep satisfaction and addressing emotional vulnerability may be effective strategies for reducing the PSU risk in this population.
Heart failure (HF) remains a major public health challenge in Asia, with rising prevalence and disability burden. This study analyzed data from the 2021 Global Burden of Disease study (GBD 2021) to assess HF trends across 48 Asian countries from 1990 to 2021. In 2021, there were 29.5 million HF cases in Asia, a 155% increase since 1990, with an age-standardized prevalence rate rising from 583.62 to 633.76 per 100,000. Years lived with disability (YLDs) also surged by 155%, reaching 2.86 million in 2021. China accounted for 44.34% of Asia's HF cases, with the highest YLDs. Treated HF cases were most common, but severe HF contributed most to YLDs. The middle-high socio-demographic index (SDI) region had the highest age-standardized prevalence rate, while most SDI regions saw increasing trends, except Japan and Cyprus. The findings highlight the growing HF burden in Asia, urging targeted interventions to address this escalating health crisis.
Primary healthcare (PHC) services provided by multi-disciplinary teams is essential for delivering comprehensive, integrated health services. PHC policies in many low- and middle-income countries emphasize team-based approaches. While competencies (knowledge, skills, and attitudes) of specific health worker cadres have been identified, collective competencies of PHC teams have not been examined. Knowing these competencies will inform development of capacity building initiatives to strengthen PHC team functioning and performance. This study presents findings from an exercise to identify key competencies of PHC teams in Bhavnagar district, Gujarat, India. Team competencies were derived through a multi-step process. We searched the literature to develop an initial list of PHC team functions. We held consultations with technical experts and PHC team members where participants reviewed, edited, and developed a list of PHC team functions and identified corresponding knowledge, skills, and attitudes the PHC team must possess. Participant responses were analyzed and PHC team competencies clustered thematically. PHC team functions comprised taskwork and teamwork activities at community and facility levels. PHC team members viewed their functions through a cadre-specific lens. Identified team competencies were clustered under six themes: technical and clinical, which included use of data and digital tools and ability to implement clinical and technical protocols; communication; shared leadership and accountability; problem-solving; conflict management; and team values. While recognizing the importance of technical and clinical competencies, participants prioritized the "softer" competencies. Findings of this study suggest the importance of training PHC team members on competencies beyond the technical and clinical competencies, that strengthen ways in which teams work together. Further, teams should be trained as a unit to reinforce these competencies. The study also suggests a need for policy and organizational reforms to support team-based care. Strengthening PHC team competencies can enable the team to perform its functions better, contributing to improved service delivery.
The Sustainable Development Goal 3.2 targets reducing the neonatal mortality rate (NMR) to <12 per 1,000 live births by 2030; however, 65 countries, including Tanzania, remain off track. The 2022/23 Tanzania Demographic and Health Survey (TDHS) reported an NMR of 24 per 1,000 live births, equivalent to 48,000 neonatal deaths annually. Neonatal deaths were extracted from the District Health Information System (DHIS2) for 28 Regional Referral Hospitals (RRHs) and seven tertiary hospitals from 2015 to 2024. Data quality was assessed by: (1) completeness, as the proportion of months each hospital reported neonatal deaths; (2) internal consistency, comparing mean NMR for 2021-2023 with 2024 following WHO guidance; and (3) external plausibility, comparing DHIS2 with DHS and UN estimates. For seven hospitals implementing NEST360 program, NMRs from DHIS2 were compared with the Neonatal Inpatient Dataset (NID) for 2021 and 2024. Between 2015 and 2024, DHIS2 recorded an average of >8,500 neonatal deaths annually versus 48,000 expected. RRHs accounted for 30-40% of reported deaths, and tertiary hospitals for 4-11%. Overall monthly reporting completeness was 58.3%, higher in RRHs (median 61.7%, IQR 8.3-95.0%) than in tertiary hospitals (median 50%, IQR 0.8-73.3%), with only 8 RRHs (28.5%) and no tertiary hospital achieving >75% reporting. Only 28.6% of hospitals had internal consistency (NMR within ±33% of the mean) for 2021-2023. The DHIS2 NMR for 2024 was 5.9 per 1,000 (adjusted for ~20% home births), compared to 24 per 1,000 in DHS 2022/23. Compared with NEST360 NID, one tertiary hospital reported lower DHIS2 NMRs, and three RRHs reported higher (ratio >1). Neonatal mortality reporting in Tanzania's DHIS2 remains substantially under-captured, with notable variations across facilities. Although RRHs perform better than tertiary hospitals, overall data quality remains low. Improving reporting in underperforming facilities and leveraging high-performing RRHs can strengthen national neonatal mortality monitoring.
Across Africa, the average age of the population is increasing, leading to a rise in health challenges such as hip fractures. Surgical fixation is the standard of care for hip fracture in older adults. In The Gambia, traditional bone setters (TBS) remain an important source of fracture care, though concerns exist regarding complications. In resource-constrained settings, system constraints may also result in post-operative complications. Currently treatment-seeking decisions are poorly understood. We aimed to map hip fracture care pathways to understand factors affecting engagement with TBS and biomedical care. Ethnographic case studies, comprising interviews with 38 patients and 37 caregivers, were complemented by contextual observations of care provision. The social ecological model informed analyses. The model distinguishes five inter-related components influencing illness behaviour: (i) intrapersonal, (ii) interpersonal, (iii) organisational or institutional, (iv) socio-cultural factors, and (v) public policies. Findings showed the complexity of hip fracture care pathways, with most patients moving between TBS, public and private healthcare facilities. Intrapersonal: patients often delayed seeking care because they did not think low-trauma injuries were serious. After visiting TBS, experiences of pain and dependency motivated biomedical care seeking. Some older people avoided surgery because they lacked the "strength" to survive an operation. Interpersonal: decisions about treatment largely rested with caregivers, strongly influenced by finances. Organisational factors favouring TBS included convenience, affordability and prolonged waiting times for operations. Ambiguous terminologies used by healthcare professionals to describe fractures were influential. Socio-cultural factors included beliefs about the causes of fractures, traditions around visiting TBS and fears of biomedical care. Public policy: healthcare financing requiring patients to pay before accessing care encouraged many to seek TBS for timely treatment. Findings highlight the need to co-develop interventions with TBS to help patients navigate complex care pathways and address organisational barriers within biomedical services, whilst respecting local perceptions of TBS.