Global Health Efforts Research Articles

Application of mucosal functional genomics to childhood undernutrition and stunting: Insights into mechanisms and targeted interventions.

Despite extensive global health efforts, maternal and child undernutrition continue to account for substantial morbidity and mortality in low-income and middle-income countries [1]. This includes a high rate of mortality for children hospitalized with severe acute malnutrition (SAM), and lasting effects upon cognition in those with chronic undernutrition and stunting. Efforts focused upon improved nutrition and sanitation early in life have yielded only partial benefits, suggesting a critical knowledge gap in our understanding of underlying mechanisms [1].

Changes in lifestyle, diet, and body weight during the first COVID 19 ‘lockdown’ in a student sample

Changes in lifestyle and body weight were examined retrospectively in students at a German university during the first COVID-19 lockdown period (March 12- May 3, 2020) using an online survey. Data from a total of 827 participants was used. Almost half of the students reported perceived body weight changes with about 27% gaining weight and around 22% losing weight. Regression analyses showed that consumption changes in the following food categories: fruits, sweets and cakes, bread and bakery products, pasta, savoury snacks, and meats and sausages were predictive of weight changes. Additionally, changes in the frequency of cooking with fresh ingredients, physical activity, exercise, smoking, and alcohol consumption as well as pre-lockdown BMI were all predictive of weight changes. Given the continuous global pandemic, increased and innovative public health efforts to support this population group are needed.

Paediatric surgery for congenital anomalies: the next frontier for global health

Paediatric surgery has historically been neglected in global health efforts.1,2 Estimates suggest that 6% of children worldwide are born with a congenital anomaly and 94% of these children are born in low-income and middle-income countries (LMICs).3 Surgical intervention for these children is potentially life-saving. However, many are among the two-thirds of the world's children, or an estimated 1·7 billion children, who lack access to surgical care.4 In The Lancet, the Global PaedSurg Research Collaboration report that the mortality of patients with congenital gastrointestinal anomalies in low-income countries is seven times that of children in high-income countries.

Global Review of Dairy Recommendations in Food-Based Dietary Guidelines.

At present, there are ~100 countries with national food-based dietary guidelines. While the intent of these guidelines is to inform national-level dietary recommendations, they also tie into global health and sustainable development initiatives, since diet and nutrition are linked to outcomes for all 17 United Nations Sustainable Development Goals. Therefore, key messaging in food-based dietary guidelines plays an important role in both national and global health efforts. However, this type of national-level dietary guidance is not standardized and varies considerably from country to country, and from food group to food group. The main objective of this review is to provide a novel look at dairy food group messaging within global food-based dietary guidelines, focusing specifically on nutrient-based and health-based messaging. Dairy-based messaging from 94 national food-based dietary guidelines was reviewed and grouped by region, with an emphasis on messaging regarding dairy's contribution to nutrients of public health concern for both underconsumption and overconsumption. The results showed that most nutrient-based dairy messaging relating to underconsumption was focused on calcium, followed by vitamin D, iodine, potassium, and protein; whereas messaging related to overconsumption was focused on saturated fat, added sugars, and salt. Health-based messaging specific to dairy food intake typically coalesced around three types of health outcomes: (1) bone, teeth, and muscle, (2) cardiometabolic, and (3) gut and immune. Although a fundamental concept of food-based dietary guidelines is to provide dietary guidance in a manner that is both “food-based,” and in the context of “dietary” patterns, most food-based dietary guidelines still express the health value of dairy foods (and potentially other foods groups) solely in terms of their nutrient content – and often times only in the context of a single nutrient (e.g., calcium).

Artificial intelligence in nursing: Priorities and opportunities from an international invitational think-tank of the Nursing and Artificial Intelligence Leadership Collaborative.

AimTo develop a consensus paper on the central points of an international invitational think-tank on nursing and artificial intelligence (AI).MethodsWe established the Nursing and Artificial Intelligence Leadership (NAIL) Collaborative, comprising interdisciplinary experts in AI development, biomedical ethics, AI in primary care, AI legal aspects, philosophy of AI in health, nursing practice, implementation science, leaders in health informatics practice and international health informatics groups, a representative of patients and the public, and the Chair of the ITU/WHO Focus Group on Artificial Intelligence for Health. The NAIL Collaborative convened at a 3-day invitational think tank in autumn 2019. Activities included a pre-event survey, expert presentations and working sessions to identify priority areas for action, opportunities and recommendations to address these. In this paper, we summarize the key discussion points and notes from the aforementioned activities.Implications for nursingNursing's limited current engagement with discourses on AI and health posts a risk that the profession is not part of the conversations that have potentially significant impacts on nursing practice.ConclusionThere are numerous gaps and a timely need for the nursing profession to be among the leaders and drivers of conversations around AI in health systems.ImpactWe outline crucial gaps where focused effort is required for nursing to take a leadership role in shaping AI use in health systems. Three priorities were identified that need to be addressed in the near future: (a) Nurses must understand the relationship between the data they collect and AI technologies they use; (b) Nurses need to be meaningfully involved in all stages of AI: from development to implementation; and (c) There is a substantial untapped and an unexplored potential for nursing to contribute to the development of AI technologies for global health and humanitarian efforts.

Human rights and fair access to COVID-19 vaccines: the International AIDS Society–Lancet Commission on Health and Human Rights

Human rights and fair access to COVID-19 vaccines: the International AIDS Society–Lancet Commission on Health and Human Rights

Simulation Use in Outreach Setting: A Novel Approach to Building Sustainability.

Simulation is a well-studied teaching tool for multidisciplinary teamwork, crisis resource management, and communication skills. These attributes are essential for successful international medical missions, which include healthcare providers with different familiarities with the outreach environment and each team member's role. However, immersive simulation remains underused in similar settings. Our team designed a simulation-based curriculum that focuses on multidisciplinary teamwork and crisis resource management skills. In this commentary, we describe its implementation during high-risk cleft care outreach missions conducted by the Global Smile Foundation. We discuss the importance of a simple, feasible, and flexible platform to successfully overcome the limitations of time and resources inherent to outreach mission work while addressing the clinical and geographic needs specific to each site. We highlight challenges, including unpredictability of the outreach environment, a language barrier, and the short duration of missions. Finally, we offer a roadmap for groups involved in similar global health efforts.

The Global Burden of Neural Tube Defects and Disparities in Neurosurgical Care

Despite the success of folic acid fortification programs, neural tube defects (NTDs) such as spina bifida, encephalocele, and anencephaly remain among the most substantial causes of childhood morbidity and mortality worldwide. Although these are complicated conditions that require an interdisciplinary approach to care, definitive treatment of survivable NTDs is often neurosurgical. Using Global Burden of Disease data, we examined the global burden of NTDs as related to a nation's wealth, health care quality, and access to neurosurgical care. We abstracted data for death by cause, years lived with disability (YLD), gross domestic product (GDP), United Nations geoscheme, Food Fortification Initiative participation, and Healthcare Access and Quality Index. We compared means using 1-way analysis of variance and proportions using Fisher exact tests, with statistical significance as α= 0.05. Seventeen of 20 (85%) nations with the most deaths caused by NTDs (P < 0.0001) and 15/20 (75%) nations with the highest YLD (P < 0.0001) were in the lowest GDP quartile. Deaths and YLD were negatively correlated with increasing GDP and Healthcare Access and Quality Index (P < 0.0001). The nations with the highest disease burdens also had the fewest neurosurgeons per capita. Despite the success of folic acid fortification programs, greater global public health efforts should be placed on improving access to neurosurgical care in low and middle-income nations through sustainable initiatives such as surgeon exchange programs and the establishment of neurosurgery residency training programs.

Global Fund contributions to health security in ten countries, 2014–20: mapping synergies between vertical disease programmes and capacities for preventing, detecting, and responding to public health emergencies

BackgroundThe Global Fund to Fight AIDS, Tuberculosis and Malaria is a robust vertical global health programme. The extent to which vertical programmes financially support health security has not been investigated. We, therefore, endeavoured to quantify the extent to which the budgets of this vertical programme support health security. We believe this is a crucial area of work as the global community works to combine resources for COVID-19 response and future pandemic preparedness.MethodsWe examined budgets for work in Kenya, Uganda, Vietnam, Democratic Republic of the Congo, Guatemala, Guinea, India, Indonesia, Nigeria, and Sierra Leone from January, 2014 to December, 2020. These ten countries were selected because of the robustness of investments and the availability of data. Using the International Health Regulations Joint External Evaluation (JEE) tool as a framework, we mapped budget line items to health security capacities. Two researchers independently reviewed each budget and mapped items to the JEE. Budgets were then jointly reviewed until a consensus was reached regarding if an item supported health security directly, indirectly, or not at all. The budgets for the study countries were inputted into a single Microsoft Excel spreadsheet and line items that mapped to JEE indicators were scaled up to their respective JEE capacity. Descriptive analyses were then done to determine the total amount of money budgeted for activities that support health security, how much was budgeted for each JEE capacity, and how much of the support was direct or indirect.FindingsThe research team reviewed 37 budgets. Budgets totalled US$6 927 284 966, and $2 562 063 054 (37·0%) of this mapped to JEE capacities. $1 330 942 712 (19·2%) mapped directly to JEE capacities and $1 231 120 342 (17·8%) mapped indirectly to JEE capacities. Laboratory systems, antimicrobial resistance, and the deployment of medical countermeasures and personnel received the most overall budgetary support; laboratory systems, antimicrobial resistance, and workforce development received the greatest amount of direct budgetary support.InterpretationOver one-third of the Global Fund's work also supports health security and the organisation has budgeted more than $2 500 000 000 for activities that support health security in ten countries since 2014. Although these funds were not budgeted specifically for health security purposes, recognising how vertical programmes can synergistically support other global health efforts has important implications for policy related to health systems strengthening.FundingResolve to Save Lives: An Initiative of Vital Strategies.

A bibliometric analysis of international publications and citation trends of articles in mental health produced by Chinese institutions in mainland China (1990-2019).

The recognition of the importance of mental health as a health-target to be pursued at a global level has received additional theoretical legitimacy through its inclusion in the United Nations (UN) 2030 Agenda for Sustainable development. The theoretical axiom - mental health as a development priority - is today expected to drive the focus of research efforts and orient the future policies and funds expenditures, at global and local level. According to these premises, it becomes central to track the international trajectories of mental health research and how the different countries are progressively defining their role in the global mental health effort. In this paper we have focused on China. In light of heavy burden of mental and substance use disorders affecting this country, and considering the impact of this burden at a global level, a basic research was conducted with the main aim of offering a preliminary view on the Chinese scientific activity within the context of global mental health research. This study is not intended to assess the quality of Chinese research, but merely to retrieve and measure a specific output of this research: the articles in mental-health produced by Chinese institutions based in mainland China, published in international journals. Although the publication of articles in internationally indexed journals in not exhaustive of China's scientific activity in global mental health, it is nevertheless informative of the production of new knowledge, it allows an assessment of the impact of this knowledge at the global scientific community level and it could partially reflect the Chinese capacity to benefit from research conducted globally. In consideration of the very limited number of studies assessing the collective evidence of Chinese research in mental health, we developed our analysis with the purpose of providing a preliminary picture of the Chinese contribution, in terms of scientific publications, in this field of knowledge. Our research performs a bibliometric analysis on the articles in mental-health produced by Chinese institutions based in mainland China and published in English-language SCI-E and SSCI journals from 1990 to 2019, providing a measure of the impact of this research at the global scientific community level. We performed a search on the Web of Science (WoS) using seven mental and substance use disorders according to their global prevalence, as per estimates of the Global Burden of Disease 2019. A dataset including the overall number of publications for seven diseases was created and exported in InCites. The dataset was analysed on the basis of 11 research areas (WoS categories) to which mental health topic is associated in SCI-E and SSCI journals in WoS. We further extracted publications that originated in mainland China. The citational trends over time are calculated with nonparametric test for trends across ordered groups. An evaluation of the impact of the Chinese scientific production is provided by the number of citations received at the global scientific community level, both as average and percentile. From 1990 to 2020 the overall Chinese scientific production in mental health has been generally increasing, reaching the highest growth in the last decade. A statistically significant increase (p < 0.001) is reported for articles produced by Chinese institutions in mainland China regarding 'depression*', 'bipolar disorders*' and 'schizophrenia*'. Published Chinese research is mostly included in SCI-E journals. There is a substantial overlap regarding the average number of citations for articles in mental-health produced by Chinese institutions and the rest of the world. Despite the increasing trend, the percentage of articles in mental health produced by Chinese institutions in mainland China on the overall scientific production worldwide is below 10%. Notwithstanding a substantial increase in the last decade, the volume of Chinese publications appears to be very limited, thus resulting in a relatively low impact at a global level. These results are affecting the potential contribution of Chinese research in the global mental health effort.

Air pollution and neurological development in children.

Pregnancy and early childhood are periods with high plasticity in neurological development. Environmental perturbations during these sensitive windows can have lifelong developmental consequences. This review summarizes key findings relevant to the effects of air pollution on neurological development. Mounting evidence suggests that exposure to air pollution, both during pregnancy and childhood, is associated with childhood developmental outcomes ranging from changes in brain structures to subclinical deficits in developmental test scores, and, ultimately, developmental disorders such as attention-deficit/hyperactivity disorders or autism spectrum disorders. Although the biological mechanisms of effects remain to be elucidated, multiple pathways are probably involved and include oxidative stress, inflammation, and/or endocrine disruption. Given the alarming global increase in developmental disorders in recent years, and increased human exposures to pollution, it is critical to reduce personal and community-level exposures through tight collaboration of interdisciplinary and multi-level bodies including community partners, physicians, industry partners, policy makers, public health practitioners, and researchers. WHAT THIS PAPER ADDS: Exposure to air pollution is associated with a range of childhood developmental complications. Biological mechanisms may include oxidative stress, inflammation, and endocrine disruption.

Tackling NCDs: The Need to Address Alcohol Industry Interference and Policy Incoherence Across Sectors Comment on "Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool".

Ralston et al highlight the ways that different actors in global nutrition governance conceptualise and frame the role of non-state actors in governance arrangements, including the potential for conflict of interest (COI) to undermine global health efforts. The authors argue that the World Health Organization (WHO) draft tool on managing COI in nutrition policy is an important innovation in global health, but that further research and refinement is needed for operationalising the management of COI with diverse actors in diverse contexts. In this commentary, reflecting on strategic framing and industry interference in policy-making, we argue for the urgent need for states and intergovernmental organisations to prevent alcohol industry interference in the development of national and global alcohol policy. We argue that policy incoherence remains a key barrier, where governments pursue health goals in the health sector while pursuing exports and market liberalisation of health harmful commodities in the trade sector.

Substance Use Disorders in Global Mental Health Delivery: Epidemiology, Treatment Gap, and Implementation of Evidence-Based Treatments.

After participating in this activity, learners should be better able to:• Assess the treatment gap for patients with substance use disorders• Evaluate treatments and models of implementation for substance use disorders ABSTRACT: Substance use disorders (SUDs) account for substantial global morbidity, mortality, and financial and social burden, yet the majority of those suffering with SUDs in both low- and middle-income (LMICs) and high-income countries (HICs) never receive SUD treatment. Evidence-based SUD treatments are available, but access to treatment is severely limited. Stigma and legal discrimination against persons with SUDs continue to hinder public understanding of SUDs as treatable health conditions, and to impede global health efforts to improve treatment access and to reduce SUD prevalence and costs. Implementing SUD treatment in LMICs and HICs requires developing workforce capacity for treatment delivery. Capacity building is optimized when clinical expertise is partnered with regional community stakeholders and government in the context of a unified strategy to expand SUD treatment services. Workforce expansion for SUD treatment delivery harnesses community stakeholders to participate actively as family and peer supports, and as trained lay health workers. Longitudinal supervision of the workforce and appropriate incentives for service are required components of a sustainable, community-based model for SUD treatment. Implementation would benefit from research investigating the most effective and culturally adaptable models that can be delivered in diverse settings.

Understanding COVID-19 Vaccines and Their Development.

Understanding COVID-19 Vaccines and Their Development.

Global public health efforts to address HIV and related communicable disease syndemics.

To review recent progress in public health efforts to address HIV, and the extent to which key approaches can be applied to three key epidemics that commonly co-occur with HIV: TB, viral hepatitis, and STIs. The public health approach to tackling HIV in low-income and middle-income settings relied on standardized treatment regimens and monitoring approaches, task sharing and community involvement, and decentralized and integrated service delivery. These approaches can all be applied to three key epidemics that commonly co-occur with HIV: TB, viral hepatitis, and STIs. HIV, viral hepatitis, and STIs share common routes of infection, and HIV weakens the immune system, increasing the risk of TB. A public health approach can be applied to address these syndemics.

Dengue Reemergence: The Challenges Ahead

The global expansion of competent Dengue vectors in tropical and sub-tropical areas, and the favorable conditions for disease transmission demonstrates a critical public health challenge ahead. This review provides an insight into some key underlying gaps while attempting to suggest alternatives towards the containment and hence eradication of Dengue. The non-existence of an efficient vaccine against all DENV serotypes and the rapid global emergence of COVID-19, are undermining the complexities of vaccine development and disrupting global health efforts for the management of Dengue respectively. The development of sustainable DENV control programs now requires a multifaceted approach involving the integration of the recently developed multi-platforms application in entomological surveillance, community awareness, modelling, vaccination, vector control, and also ensuring that Dengue control efforts are not hampered or neglected during COVID-19 pandemic. This approach requires active collaboration and communication of scientists from various disciplines, economic support from funding agencies and institutions as well as support from the communities, governments and public health organizations.

Twelve Tips on enhancing global health education in graduate medical training programs

Investment in healthcare infrastructure in resource-limited settings is a vital and cost-effective approach for diminishing world-wide disease burden, increasing quality of life, and lengthening life expectancy. Graduate medical trainees enthusiastically express interest in supporting global health efforts that expand healthcare access and capacity in resource-limited settings. Academic institutions are responding by developing training programs to equip graduate medical trainees with the technical, interpersonal, scholastic, and ethical skillsets necessary for the pursuit of global health efforts. Drawn from real-world experience and current literature, the following twelve tips will strengthen a global health curriculum in graduate medical training programs with dedicated global health education.

Analysis of public engagement with ten major global health topics on a social network profile and a newspaper website.

BackgroundEfforts in global health and development have broad political support and substantial financial commitment from most governments. However, this support could be greater if global health issues featured more prominently in the public debate. It has proven quite difficult to make global health issues attractive for viewing and engaging with, as compared to other forms of entertainment or public debates in the media.MethodsWithin the Massive Open Online Course “Survival: The Story of Global Health”, we created 10 educational videos on major global health topics. Between August 1 and September 30, 2017, we posted each episode with a brief background text on the Facebook profile of the narrator, who had an average of 450 friends and further 800 followers throughout the period of study. We studied the interaction of Facebook friends and followers with each posted video, tracing the number of their “likes”, “shares” and “comments”. Moreover, a popular Croatian online newspaper portal with about 250 000 daily viewers shared three of these stories after they were posted on Facebook and views, shares and comments were monitored. We recorded the effect on the number of YouTube views of the featured videos.ResultsThe 10 posts received between 65 and 274 “likes” on the Facebook profile and between 2 and 124 shares, receiving between 0 and 17 comments. The three episodes that were shared by the online newspaper portal were further shared between 164 and 2820 times, receiving between 8 and 111 comments from the general public. The effect of these two promotion channels on YouTube viewership resulted in between 107 and 9784 views of the 10 featured videos, with the number of “likes” received on YouTube ranging between 0 and 43. The video that raised the most attention and shares was the one on the history of pandemics, which also had the highest number of shares on YouTube (n=69), followed by the video on human evolution (n = 14). Topics of non-communicable diseases, ageing and dying, and the future of humanity were also popular, while the topics more specific to global health raised less interest - ie, maternal and child mortality, major infectious diseases, international organizations, inequality and equity, and the UN Millennium Development Goals.ConclusionOur study showed that the interest in “core” global health topics was, as a rule, lower than in the topics which have a more general appeal - such as pandemic threat, human origins, ageing and dying. If we aim to increase public interest in global health topics, a feasible strategy would be to adjust the language and presentation used to be of more appeal to popular culture. Linking promotional materials to other popular topics that are dominating the public debate or capturing their interest could prove to be a successful strategy to achieve this.

Coronavirus Disease 2019: A threat to global health

Due to its rapid spread, the World Health Organization characterized coronavirus disease 2019 (COVID-19) as a pandemic on March 11, 2020. Coronaviruses cause a variety of respiratory diseases, ranging from the mild common cold to the lethal Middle East Respiratory Syndrome. At the end of 2019, COVID-19 made its way onto the global stage due to its rapid human-to-human transmission and its ability to cause death secondary to respiratory failure. Symptoms of lower respiratory illness, including cough and shortness of breath, along with fever, should raise suspicion of COVID-19 infection in those who have recently traveled to high-risk areas or have had close contact with a confirmed or suspected case of COVID-19. Other symptoms include gastrointestinal distress and cardiac involvement. Polymerase chain reaction testing of respiratory specimens and computed tomographic scans of the chest can be used to confirm the disease. Preventing exposure to the disease through handwashing, surface disinfection, and avoiding contact with those who are sick is the best way to prevent transmission of the disease. Many countries and local governments have implemented stayat-home orders to decrease the rapid spread of COVID-19. Management of the disease involves symptom control, as there is currently no available treatment, but many clinical trials are underway. Global health efforts have concentrated on quick and aggressive actions to slow the transmission of the disease and identify cases as quickly as possible but with varying degrees of success.

Global health research and education at medical faculties in Germany.

BackgroundUniversities undertake the majority of publicly funded research in Germany and hence bear a responsibility to contribute to global health efforts. So far, involvement and impact of German medical faculties in global health are unknown. Our aim was to systematically asses and evaluate German medical faculties’ contribution to global health related research and education, as well as their policies and practices concerning open access publishing and equitable licensing.MethodsWe assessed the involvement in global health of all 36 publicly funded medical faculties in Germany during 2010–2014 in three areas: innovation, access and education, using the following indicators: research funding and publications focused on global health or poverty-related and neglected diseases; open access publishing and policies promoting access to medical innovations worldwide; provision of global health education. Data were gathered from public databases, university websites and questionnaires sent to individual universities for validation and triangulation.ResultsThere was a high level of variability between institutions and indicators. The proportion of research funding for poverty-related and neglected diseases research ranged between 0.0–1.1%. The top five institutions received nearly 85% of the total poverty-related and neglected diseases research funding. 20 of 36 universities had an institutional open access publishing policy, 19 had an open access publishing fund, 16 had neither. Only one university reported having used an equitable licensing policy. 22 of 36 faculties provided some global health education, but only one of them included global health in their core undergraduate medical curriculum as a compulsory course with more than just single lectures.ConclusionObtained data indicate that global health and poverty-related and neglected diseases research at German medical faculties is highly concentrated in a few institutions, open-access publishing and equitable licensing policies are mostly absent, and only little global health education exists. Universities and government should address global health strategically in both research and education at medical faculties to reflect the country’s economic and political weight and human resource potential.