Health Policy Research Articles

Factors associated with depressive symptoms among 1,502 couples in the immediate puerperium.

Historically, perinatal depression has predominantly focussed on the mother-baby dyad, often neglecting the crucial role of fathers. To determine the prevalence and associated factors of depressive symptoms in the immediate puerperium (PDS) in both mothers and fathers, individually and concurrently. This study employed a cross-sectional design. The presence of PDS was assessed using the Edinburgh Postnatal Depression Scale (EPDS), with a cut-off score of ⩾11 for mothers and ⩾9 for fathers. Logistic regression analyses were conducted to identify factors independently associated with PDS. Robustness of findings was verified through sensitivity analyses among participants without prior psychiatric conditions. Among 1,502 partnered mothers and fathers aged ⩾18 years who met the inclusion criteria, PDS were present in 13.0% of mothers, 10.5% of fathers and 3.5% of both parents. Mother-baby skin-to-skin contact and the father's pregnancy planning were associated with a lower likelihood of PDS in mothers. For fathers, financial difficulties increased the likelihood of experiencing PDS threefold. The presence of PDS in mothers quadrupled the likelihood of PDS in fathers, and vice versa; their EPDS scores demonstrated a moderate correlation (rs = .38). Among participants without prior psychiatric conditions, the odds of co-occurring PDS nearly tripled if the mother had a history of abortion or miscarriage. Fathers who had increased potentially addictive behaviours showed a six-fold increase in the likelihood of experiencing PDS. Identifying depressive symptoms in both parents and incorporating fathers into clinical practice, research and health policy could enhance mental health outcomes in vulnerable populations.

Public and participant involvement as a pathway to inclusive dementia research.

The field of Alzheimer's disease and related dementias (ADRD) urgently requires inclusive research to ensure the priorities and outcomes of research apply to those most impacted. We postulate public and participant involvement (PPI) as a pathway to achieving the best science, both in research that informs health and social policy as well as in therapeutic studies to treat and prevent ADRD. This position paper aims to provide dementia researchers with evidence to understand how to apply PPI. We begin by highlighting the disparities experienced by people with dementia, including ageism, stigma of cognitive impairment, and health disparities for minoritized communities. We then provide examples of PPI in ADRD across the research lifecycle, from defining research topics of priority to those impacted by ADRD, through the design, analysis, dissemination, and translation to policy and practice. We also provide recommendations to create and maintain collaboration between researchers and communities through PPI. HIGHLIGHTS: A central premise of public and participant involvement (PPI) is collaborative relationships between researchers and community members. To build equitable partnerships, researchers must acknowledge and understand the context of research. This includes ageism, the stigma of dementia, and ongoing discrimination for many minoritized communities. Meaningful partnerships include choice, respect, shared decision making, access, inclusion, and representation. Notably, we recommend that researchers begin partnerships early in the research process and share the impact of PPI on research.

Sex differences in pneumonia risk during COVID-19 in Mexico.

This study aimed to evaluate the pneumonia risk based on the patient's sex during the COVID-19 pandemic and the early months of the endemic phase of the disease in Mexico. A retrospective cohort study was conducted using a dataset resulting from the epidemiological surveillance of COVID-19 (February 2020 to August 2023). Data from 1.6million adults with laboratory-positive disease, were analyzed. Risk ratios (RR) and 95% confidence intervals (CI), computed through generalized linear regression models, were used. The overall risk of pneumonia was 9.3% (95% CI 9.2-9.4%), with sex-specific estimates of 7.0% (95% CI 6.9-7.1%) for women and 12.0% (95% CI 11.9-12.1%) for men. This disparity was consistently observed throughout all phases of the pandemic, including the endemic phase of the disease. After adjusting for age, predominant viral genotype at illness onset and preexisting medical conditions, men had a 3.3% higher risk of severe manifestations when compared to women (RR = 1.033, 95% CI 1.032-1.034). Our research highlights the potential role of patients' sex as a factor influencing pneumonia risk during and after the COVID-19 pandemic in Mexico. These findings may provide useful considerations for healthcare planning and policy development focused on addressing the impact of the disease on vulnerable populations.

Innovative diagnostic technologies: navigating regulatory frameworks through advances, challenges, and future prospects.

Diagnostic tools are key to guiding patient management and informing public health policies to control infectious diseases. However, many diseases still do not have effective diagnostics and much of the global population faces restricted access to reliable, affordable testing. This limitation underscores the urgent need for innovation to enhance diagnostic availability and effectiveness. Developing diagnostics presents distinct challenges, especially for innovators and regulators. Unlike medicines, regulatory pathways for diagnostics are often less defined and more complex due to their diverse risk profiles and wide range of products. These challenges are amplified in low-income and middle-income countries, which often do not have regulatory frameworks for this specific purpose. In the UK, initiatives aim to support innovation by providing clearer regulatory pathways and ensuring that diagnostics are safe and effective. Regulators are also collaborating internationally to expedite diagnostics for high-need regions. Harmonised standards, regulatory frameworks, and approval processes are essential to ensure consistent quality and safety across regions and facilitate faster development and global access. This Series paper explores the regulatory challenges in infectious disease and antimicrobial resistance diagnostics, focusing on the UK's response and the broader global efforts to address these issues.

Medical disasters or disastrous medicine? Dutch medical care in the Dutch East Indies/Indonesia (1870–1949) – three examples

ABSTRACT The author argues that medical care in the Dutch East Indies, should be re-evaluated from successful to disastrous. The author first defines a medical disaster as one in which medical care has fallen short due to its own shortcomings– or even intentionally. This contrasts with a disaster for humankind, in which also many are to be regretted, but for which healthcare is not to blame, because of, for instance, a lack of resources, manpower or knowledge. The author then looks at three different types of medical care: Red Cross aid; the public health policy to eradicate leprosy; and the military medical aid given to the Indonesian population (1946–1949). In all these colonial interests were a priority, if not the driving force. Medical humanitarianism came second at best. This produced outcomes that should be called medically disastrous. Partly this is not new: medical historians have identified colonial medicine as a tool of empire before. But what it nevertheless had achieved, defined as the medical ‘good’, was seldom questioned, cutting off medical acts and their results from their context. The question must be asked if it isn’t it time to call Dutch medical care in Indonesia disastrous in itself?

Are there differences in low-acuity emergency department visits between culturally and linguistically diverse migrants and people with English-speaking background: a population-based linkage study of adults over 45

BackgroundGrowing numbers of avoidable low-acuity visits to emergency departments (ED) are a major health policy concern globally and are thought to contribute to ED crowding. This study explores the differences...

Widely Integrated Services in Home (WISH) for homebound older adults: a study protocol for a randomized encouragement trial.

Home-based primary care (HBPC) is an emerging patient-centered, interprofessional healthcare service model that can address unmet medical needs and care burdens for homebound older adults. In December 2022, the Ministry of Health and Welfare in South Korea launched the Home-Based Medical Center Demonstration project to provide a new bundle payment for physician home visits. In this study, we seek to determine whether the recently introduced HBPC services in South Korea have been associated with a reduction in long-term care (LTC) facility admissions and acute hospitalizations among homebound older adults. The study is a community-based, multicenter, two-arm, randomized encouragement design trial with a 12-month follow-up period (n = 600). Eligible study participants are community-dwelling LTC recipients with multimorbidity and functional deterioration. Study participants are recruited from five HBPC centers located in urban areas (Northeast Seoul, West Seoul, Daejeon, Wonju, and Paju). The study participants are randomly assigned to either the HBPC group or the usual care group with a 1:1 allocation ratio. Those assigned to the HBPC group receive longitudinal home visits at least once a month by an interprofessional HBPC team according to the Widely Integrated Services in Home (WISH) intervention protocol. This protocol adheres to the Integrated Care for Older People principles, which call for a person-centered assessment and broader integration of health and LTC services at the micro-, meso- and macro-levels. Primary outcomes of the trial are 1) between-group community survival days and 2) between-group potentially avoidable hospitalizations. Results of the treatment are estimated by both modified intention-to-treat and complier average causal effect analytic methods. This study aims to investigate the real-world effectiveness of HBPC on the reduction of LTC facility admissions and acute care hospitalizations in the community setting. The findings may inform healthcare policy decisions to expand HBPC services in South Korea and other countries. CRIS KCT0007921.

Incommensurability and democratic deliberation in bioethics

AbstractOften, a health resource distribution (or, more generally, a health policy) ranks higher than another on one value, say, on promoting total population health; and lower on another, say, on promoting that of the worst off. Then, some opine, there need not be a rational determination as to which of the multiple distributions that partially fulfill both one ought to choose. Sometimes, reason determines only partially, intransitively, or contentiously which of the many “compromises” between these two values is best or most choiceworthy. Norman Daniels, Ruth Chang, Martijn Boot, and Anders Herlitz affirm this opinion, which I shall call “value incommensurability,” “rational underdeterminacy,” or “reasonable disagreement.” To decide between the multiple reasonable compromises on health resource distribution, these philosophers recommend a deliberative democratic process, on two main grounds. First, in such situations, deliberation can produce the determinacy needed for decisionmaking. Second, by treating respectfully and justly even those patients or communities for whom the distributive compromise selected is bad, deliberation shields the legitimacy of that policy. Increasingly, practically-oriented bioethics recommends democratic deliberation even more expansively than these philosophers do—for nearly every decision on health resource distribution and not only when values are incommensurate—on these two grounds and on others. And one could propose a more modest variant on this expansive move as the justification of democratic deliberation. I argue that none of these moves warrants democratic deliberation on health policy.

Coming out of isolation: impacts of COVID-19 on physical activity, diet, mental well-being, and sleep over time

IntroductionThe COVID-19 pandemic lockdown significantly disrupted daily routines and impacted physical activity, diet, mental well-being, and sleep. This mixed-methods study investigates these changes over three periods—pre-pandemic, pandemic onset, and one-year post-onset—to understand their causes and inform public health policy for improved resilience during future crises.MethodsA mixed-methods study was conducted with 34 US participants who completed open-ended qualitative questions and quantitative assessments in May 2020 and May 2021. Participants were recruited via social media from 10 states with high COVID-19 cases. Quantitative data categorized health changes (positive, negative, or no change), while qualitative data were analyzed thematically to explore reasons for these changes and uncover interrelationships among health behaviors.ResultsQuantitative results showed that, during the pandemic onset, most participants experienced negative changes in diet, mental well-being, and sleep, while physical activity varied. By one-year post-onset, improvements were noted across all health pillars, with mental well-being and sleep showing the most significant positive changes. Thematic analysis of qualitative data revealed stress, anxiety, and personal motivations as key drivers of health behaviors. Participants’ narratives provided a deeper understanding of these shifts that a Likert-style survey alone could not capture, highlighting the interconnectedness of health pillars.DiscussionThe findings demonstrate the importance of addressing mental well-being to improve overall health resilience. Public health interventions should prioritize mental health and consider the interrelated nature of health behaviors. The mixed-methods approach combined quantitative trends with qualitative insights, offering a comprehensive understanding of why health changes occurred, providing actionable guidance for future public health policy.

Baseline assessment of microplastics and biochemical response of Anadara antiquata as a sentinel species for biomonitoring in Fiji

Context Microplastics are a concern for maritime nations such as Fiji, which rely heavily on seafood, such as bivalves, which can transfer pollutants through the food chain. The lack of biomonitoring studies in the Pacific region highlights the necessity of researching microplastic pollution in seafood. Aims This study quantifies microplastics in Anadara antiquata, a commonly consumed shellfish in Fiji, and evaluates its general biochemical responses. As a baseline, this study is not to draw an association between the two endpoints (microplastics and biochemical responses), rather present these as baselines for future studies. Methods A total of 58 specimens from Ba River Delta, Rakiraki Bay and Vueti Navakavu were examined, where differences in potential sources or pathways for microplastics, including anthropogenic pollutants with the potential to induce stress on marine animals, were considered (rivers, industrial zones, stormwater outlets, sewerage outfalls and mining area). Specific hepatopancreatic enzyme activities associated with detoxification (glutathione-S transferase, GST) and oxidative stress (glutathione peroxidase, GPX, and glutathione reductase, GR) were measured. Key results Microplastics were extracted, classified by morphology and quantified. The study found that 64% of specimens had microplastics, <1.0 mm being more prevalent. Ba River Delta showed significant biochemical stress (Kruskal–Wallis test; P < 0.05) with GST (χ2 = 40.28, d.f. = 2, P-value < 0.001), GPX (χ2 = 38.38, d.f. = 2, P-value < 0.001) and GR χ2 = 45.14, d.f. = 2, P-value < 0.001) being considered as likely to be responding to pollution. Conclusion As a baseline, the study underlines the need for biomonitoring as a result of varying and concerning levels of pollution and biochemical stress responses found across the study areas. Integrating biomonitoring methods into risk-assessment protocols in Fiji may support establishment of opportunities or considerations for health guidelines and policy interventions to minimise human exposure to microplastics, and regulate environmental pollution. Implications These measures are crucial for protecting public health and monitoring pollution impacts.

The Paradox of Digital Health: Why Middle-Aged Adults Outperform Young Adults in Health Management Utilization via Technology

Background/Objectives: Globally, life expectancy has been increasing with South Korea focusing on improving health to enhance quality of life. The COVID-19 pandemic further emphasized the need for digital transformation in healthcare, accelerating digital health adoption. This study explores the digital divide between ‘Digital Natives (20–39 Y)’ and ‘Digital Immigrants (40–69 Y)’, focusing on digital device usage and confidence. Methods: This study utilized national survey data from the Digital Health Literacy Survey Results and Policy Implications, focusing on differences in digital device use and confidence between young adults (20–39 Y) and middle-aged adults (40–69 Y). The participants comprised 1000 adults aged 20 to 69 in the Republic of Korea. Respondents were queried about their use of digital health tools, such as wearable devices and mobile apps. Confidence in using digital systems and managing health via digital tools was assessed using a five-point Likert scale. Results: The findings indicated that while young adults have lower rates of using digital devices for healthcare, they exhibit higher confidence in using such devices. In contrast, middle-aged adults, despite having lower confidence, report higher usage of digital devices for healthcare purposes. Conclusions: This study explored differences in digital confidence and healthcare usage between age groups and aimed to propose effective health management strategies based on digital accessibility.

Impact of Nutritional Minerals Biomarkers on Cognitive Performance Among Bangladeshi Rural Adolescents—A Pilot Study

Background: Nutritional metals (NM) are essential for neurodevelopment and cognitive performance during growth. Nevertheless, epidemiological evidence regarding the associations between NM and brain function remains understudied, particularly among adolescents. Therefore, the objective of this pilot study was to examine the effects of NM biomarkers such as iron (Fe), selenium (Se), zinc (Zn), magnesium (Mg), and copper (Cu) on neurobehavioral functions among a group of rural Bangladeshi adolescents. Methodology: We conducted a cross-sectional study involving 105 adolescents aged 13–17 from Araihazar, Bangladesh. Cognitive function was assessed using the computer-based Behavioral Assessment and Research System (BARS), focusing attention, memory, and executive function, and blood NM levels (Fe, Se, Zn, Mg, and Cu) were measured. Associations between individual minerals, NM composite scores, and cognition were analyzed using multiple linear regressions. Results: This study included 47 boys and 58 girls with an average age of 15 years. Fe levels were correlated with Continuous Performance Test (CPT) latency (r = −0.42, p < 0.05) and Se levels correlated with Match-to-Sample (MTS) correct count (r = 0.32, p < 0.01). Linear regressions showed that Se was associated with MTS correct count (b = 0.02, 95%CI: 0.01, −0.04), reflecting visual memory, and Fe was associated with CPT latency (b = −0.68, 95%CI: −1.11, −0.26), reflecting improved attention. The same BARS measures were also significantly associated with the 3-NM composite score. Conclusions: Our findings suggest that NM, particularly Fe, Se, and NM mixtures, could play a crucial role in brain development and neurocognitive function during adolescence. Further studies will help design national public health policies and strategies to address and mitigate brain health deficiencies among adolescents.

OVERVIEW OF HEALTHCARE INNOVATION AND ENTREPRENEURSHIP

The healthcare system is under constant pressure from a growing and aging population, escalating healthcare costs, limited resources and increasing demand. Achieving the triple aim of healthcare – improving care, improving health and reducing costs – requires innovation. According to the World Health Organization (WHO), health innovation is the development of new or improved health policies, systems, products and technologies, services and delivery methods that improve people’s health, with a particular focus on the needs of vulnerable populations. Health innovations have both technological (innovative products, services or processes) and non-technological (organizational, policy, educational and social innovations) dimensions and play a critical role in improving the productivity, effi ciency, reliability, sustainability, safety and cost-eff ectiveness of health care. This article is the fi rst in a series of publications on innovation and entrepreneurship in health care. The paper examines the main types and categories of innovation and entrepreneurship, analyzes current innovation trends and directions in healthcare, factors that infl uence the adoption of innovative technologies in medical practice, and the characteristics of a human- centered approach to design thinking in healthcare. The article also discusses the concept of value- based healthcare, which focuses on providing the best possible care to achieve the best possible outcomes for each patient, using available resources effi ciently, and how innovation can improve the cost, quality, and access to healthcare.

The environmental and social opportunities of reducing sugar intake

Sugar is the largest agricultural crop by mass and has seen a rapid increase in consumption around the world. There are widespread public health efforts to curb sugar intake through targeted policies given its association with noncommunicable diseases. Although curbing sugar intake aligns with sustainable diets that meet essential environmental and health targets, such a shift may be challenging from a political economy perspective. Utilizing sugar for other purposes such as the production of microbial protein, biofuels, and bioplastics, or using sugar lands to grow other food items, or rewilding could provide health and environmental win–wins that could be more politically palatable. Here, we explore several potential scenarios to illustrate the option space from which national and international stakeholders could choose locally appropriate pathways for alternative utilization of sugar or its lands. While beneficial, such alternative pathways would require the integration of environmental, economic, and health policies to provide a smoother diet transition that reduces stakeholder tensions. Given the trade in sugar as a commodity crop, international approaches that compensate sugar producers for avoided production or incentivize them for redirecting sugars to other uses will be needed. Such approaches could borrow concepts from Just Transition Partnerships that have been applied to energy system transitions in ensuring a transition for major exporters of sugar cash crops across low- and middle-income nations.

Disease Pattern and Clinical Profile of Admitted Patients in Pediatric Intensive Care Unit of a Tertiary Care Hospital in Chattogram

Background: The care of critically ill children remains one of the most demanding and challenging aspects in the field of pediatrics. Pediatric Intensive Care Unit (PICU) aims at promoting early intervention and quality care for achieving good results and better prognosis. With the advancement in intensive care facilities, there is a dramatic increase in survival of critically ill children. It is usually offered to patients whose condition is potentially reversible and who have a good chance of surviving with intensive care support. Since these patients are critically ill, the outcome of intervention is sometimes difficult to predict. This study is aimed to assess the clinical profile of critically ill children presenting to the pediatric emergency room and then their admission pattern to the pediatric intensive care unit. This may help to assist intensivist and planners to pay due attention for better utilization of healthcare facilities. Better understanding leads to better management. Materials and methods: This is a cross-sectional study, conducted at the Pediatric Intensive Care Unit of Chattagram Maa Shishu-O-General Hospital from January to June of 2019. A total of 100 admitted cases were recruited and their symptoms and signs, clinical findings and diagnosis were recorded accordingly. All the patients were aged within 28 days to below 14 years. Results: Among the 100 study subjects, 66 were male and 34 were female. The mean age was 1.73 ± 2.6 years. Most children were admitted with respiratory distress though there were other accompanying signs and symptoms. The symptoms subjects commonly presented with were respiratory distress(76%), tachycardia(70%), lung crepitations (69%), tachypnea (68%), fever (67%), lethargy (59%), feeding difficulty (59%), convulsions (48%), low blood pressure (24%), hepatomegaly (19%), cyanosis (14%), edema (6%), congenital anomalies (4%). The clinical findings that led them to PICU admissions were bronchiolitis (4%), bronchopneumonia (42%), respiratory failure of any cause (4%), heart failure (7%), cyanotic congenital heart disease (8%), acyanoticcongenital heart disease (7%), meningitis (13%), encephalitis (12%), cerebral palsy with seizure disorder (21%), status epilepticus (2%), Gullein Barre Syndrome (3%), hyponatremic dehydration (6%), acute kidney injury (2%), acute leukemia (2%).In this study, neurological disorders such as cerebral palsy with seizure disorder and encephalitis and meningitis were among the top five in the diagnosis list. Septicemia with shock was also a very common finding promoting admission to PICU. GCS was found to be significantly lower in the above-mentioned disease conditions making admission to the ICU quite plausible. Conclusion: Children admitted to PICU may have multiple clinical findings and disease patterns. However, some diseases predominate the patient population admitted to PICU.The knowledge of clinical spectrum and epidemiological profile of critically ill children plays a significant role in the planning of health policies that would mitigate various factors related to the evolution of diseases prevalent in these sectors. Descriptive epidemiology focuses on identifying and reporting the pattern and frequency of events related to the health of a population. IAHS Medical Journal Vol 7(1), June 2024; 44-49

The burden and trends of heart failure caused by ischemic heart disease at the global, regional, and national levels from 1990 to 2021.

Ischemic heart disease (IHD) is a major cause of heart failure (HF), a condition expected to increasingly affect global health and economics. This study evaluates the global burden, trends, and disparities of HF linked to IHD, aiming to inform health policy development. Data from the Global Burden of Disease Study 2021 (GBD2021) is analyzed using Joinpoint regression, decomposition analysis, and Bayesian age-period-cohort analysis (BAPC). Health disparities are assessed through the Socio-demographic Index (SDI) via the Slope Index of Inequality (SII) and the Concentration Index (CI), with future trends projected from 2022 to 2045. In 2021, global HF cases due to IHD were over 19.16 million, with an age-standardized prevalence rate (ASPR) of 228.31 per 100 000 [95% UI, 188.18 to 279.55] and age-standardized years lived with disability (ASYLDs) rate of 20.43 per 100 000 [95% UI, 13.55 to 28.7].In 2021, there was a 2.87% increase in ASPR and ASYLDs compared to 1990, primarily driven by population growth and aging.Significant reductions in global ASPR and ASYLDs disparities are observed, though the disease burden has intensified in countries with lower SDI levels. Projections indicate that by 2045, while the prevalence and YLDs for HF caused by IHD will increase, while the ASPR and ASYLDs are expected to decrease. The global burden of HF from IHD remains a significant concern. Urgent improvements in the allocation of medical resources and the implementation of effective prevention and management strategies are necessary to address this issue.

Exploring practice staffs' perspectives regarding professional roles, confidence, and motivations in delivering mental health care within rural general practice: a qualitative exploration.

General practice is pivotal in delivering mental health care within communities, yet the attitudes and professional factors influencing this provision remain underexplored. This study seeks to understand the perspective of general practice staff around the professional factors that influence the provision of primary mental health care. A qualitative study was conducted with semi-structured interviews of 14 general practice staff involved in mental health care. Participants included receptionists (n = 3), nurses (n = 4), practice managers (n = 3), and general practitioners (n = 4), recruited via purposive sampling. The Theoretical Domains Framework (TDF) guided the interviews, and thematic analysis was used to identify themes and subthemes. Three themes were identified. The first, 'Role identity, skills, and leadership in mental health care,' included subthemes of distinct role recognition with overlap, essential relational and practical skills, and leadership valued among experienced GPs. The second theme, 'Confidence and involvement in mental health care,' covered variability in confidence levels, differing perceptions of involvement, and attitudes towards further involvement. The third theme, 'Drivers for and outcomes of delivering mental health care,' revealed intrinsic motivations and acknowledged both benefits and serious consequences. This study explored general practice staff beliefs about role identity, skills, leadership, confidence, involvement, motivations, and perceptions of benefits in mental health care provision. The findings offer valuable insights into the complexities of mental health care in general practice, with significant implications for practice management and healthcare policy development.

Insights on health policies from a political philosophy perspective

Health policies play a crucial role in shaping people’s well-being. While public health often relies on evidence-based policy to improve health outcomes, many non-scientific factors determine the health policy-making process....

Measuring influencing factors affecting mortality rates during the COVID-19 pandemic

ABSTRACT Background The COVID-19 pandemic has revealed clear deficiencies in global public health policies and healthcare systems when confronted with the emergence of a novel and deadly infectious disease. Objectives With 4 years elapsed since the onset of the pandemic, ample data now exist to analyse the associations between the implementation of diverse public health policies, sociodemographic factors and COVID-19 mortality rates. Methods This study utilised the dataset compiled by ‘Our World in Data’ spanning the period of the COVID-19 pandemic from 2020 to 2022. Stochastic frontier analysis was employed to assess the influencing factors and their relationship with mortality rates resulting from COVID-19 infections across 156 countries or regions. Results This study yielded several key findings: (1) There remains a 33% margin for improvement in the global mortality rate concerning the COVID-19 pandemic; (2) During the initial stage of the pandemic, when an effective vaccine was not yet available, implementing public health control policies could reduce both the infection and mortality rates; (3) Areas characterised by higher population densities, a greater proportion of individuals aged 65 and over, and elevated prevalence rates of diabetes demonstrated higher mortality rates; and (4) Increasing vaccination coverage emerged as an effective strategy for reducing mortality rates. Conclusions As our understanding of the COVID-19 virus improves, global economies and social interactions have gradually returned to normality. It is anticipated that the findings of this study can serve as a valuable reference in combating potential future pandemics caused by unknown viruses.

Mobile outreach clinics for improving health care services accessibility in vulnerable populations of the Diffa Region in Niger: a descriptive study.

Niger is a large country with many distant locations that can be difficult to access because the Sahara Desert covers 80% of the country's land. In Niger, just 49% of residents have access to a health centre within 5km of their house. Health care may be difficult to access in the Diffa region of Niger, as non-state armed groups strike on a regular basis and floods cause a high rate of vulnerability. This study looked at how mobile clinics can improve healthcare accessibility for vulnerable populations in the Diffa region. This was a descriptive-comparative study conducted over the period from 15 August 2022 to 15 October 2022, using three months' mobile outreach clinic to improve health outcomes in five districts of the Diffa region, including Bosso, Diffa, Goudoumaria, Mainé Soroa, and N'guigmi. During the three months of mobile outreach clinic, 42,251 people were sensitized about mobile outreaches and 12,004 were treated. A total of 18,708 vaccine doses were delivered to children aged 0-11months, with Maine Soroa, Goudoumaria, Bosso, Diffa, and N'guigmi districts accounting for 29.24%, 24.62%, 18.54%, 18.05%, and 9.5%, respectively. In the same line, Goudoumaria, Bosso, and Maine Soroa districts recorded relatively high antenatal clinic (ANC) attendance percentages of 27.85%, 25.62%, and 21.89%, respectively. Furthermore, mobile clinic outreach provided a variety of healthcare treatments, both curative and preventative. Mobile Clinic 2 increased vaccine dose received among children aged 0-11months by 1.11% (95%CI: 0.15%-2.06%, P = 0.023) when compared to Mobile Clinic 1. In the same line, mobile clinic showed a statistically significant increase of ANC between the three clinical rotations (P = 0001), showing an increased ANC update over time. This study found that mobile outreach clinic can play an important role in improving healthcare access for vulnerable populations in the Diffa region. However, well-designed, and frequent mobile clinic outreach should be planned and included in the country's public health policy.