Health Sector Research Articles

Quantifying cost-savings in the treatment of neovascular age-related macular degeneration in Aotearoa New Zealand.

To estimate the cost-impact if faricimab were approved for the treatment of neovascular age-related macular degeneration (nAMD) in New Zealand. A retrospective, single-centre cost-analysis study. Data on intravitreal agent and injection intervals were obtained and statistically compared. Cost estimates were based on internal facility and publicly available data. The current costs of care were compared to two scenarios: one where all eyes receive faricimab, and another where eyes receiving aflibercept switch to faricimab. A total of 352 eyes from 292 patients were analysed. Present values locally over 10 years were estimated at -$6,776,340 for the first scenario and $5,015,922 for the second, releasing 252 and 176 hours of clinical time per year, respectively. Nationally, the savings extrapolated to -$187,925,737 and $139,104,706, respectively. The analysis indicates significant direct cost savings for the health sector and potential reductions in patient harm due to fewer injections. The approval of faricimab for the treatment of nAMD could result in substantial direct cost savings for the health sector. Additional benefits include reducing patient harm and improving ophthalmic health inequalities for Māori and Pacific peoples. Further research in diverse patient populations across multiple centres is needed to estimate the magnitude of cost savings more accurately. This study highlights the potential of faricimab to alleviate the treatment burden and provide a more sustainable healthcare option for nAMD in New Zealand, especially in cases of recalcitrant nAMD, if used in a tailored and patient-specific manner alongside the existing armamentarium of treatments.

Intimate Partner Violence and Mental Health Problems in Married Women in Rural Central India: A Community-based Cross-sectional Study

Intimate partner violence (IPV) is a significant social issue affecting women in rural India, with deleterious consequences for their physical and mental health. The “mental health problems and psychosocial factors associated with IPV” is an under-researched topic in Central India. The cross-sectional observational descriptive study was part of a project aimed at strengthening the health sector response to gender-based violence. Eighty consenting women from 19 villages in a district in Central India, who acknowledged experiencing IPV, participated in the study. A predesigned and pretested sociodemographic questionnaire, the WHO multicountry women’s questionnaire, and self-report scales for depression, anxiety, stress, and post-traumatic stress disorder (PTSD) were used to interview the women. The mean age of the respondents was 31.13 ± 6.96 years. The majority of the women (95%) experienced severe physical violence. In addition, a majority of these women simultaneously faced emotional abuse, whereas more than one-third suffered from sexual abuse from their partners. Self-reporting measures showed that nearly two-thirds of the participants had PTSD and moderate-to-severe depression and anxiety. A substantial number of study participants believed that IPV is a private matter for a couple and justified violence if the wife was unfaithful, disobedient, or neglectful of children and household duties. The under-reporting of IPV, presence of misconceptions, and high prevalence of associated mental health problems among IPV-affected women highlight the need for interventions tailored to the needs of battered women.

Sustainable Management Strategies for Enhancing Commercial Growth in the Public Health Sector

This study investigates sustainable management strategies for enhancing commercial growth in the public health sector, focusing on the interrelationship between sustainability practices and organizational performance. With the increasing pressure on healthcare systems to reduce costs while improving service quality, sustainable management has emerged as a critical approach to achieving these objectives. The research employs a mixed-methods design, combining quantitative analyses, including descriptive statistics, ANOVA, and structural equation modeling, to evaluate the effectiveness of sustainability initiatives such as waste reduction, energy efficiency, and community engagement.Findings reveal that organizations that implement comprehensive sustainability practices not only experience enhanced operational efficiency but also achieve significant cost savings and improved financial performance. This study contributes to the existing literature by highlighting the tangible benefits of sustainability in the public health sector, providing a framework for organizations to adopt effective strategies that align with environmental goals while driving commercial growth. The recommendations from this research emphasize the importance of leadership commitment, employee engagement, and ongoing training in sustainability practices. As the global emphasis on sustainability continues to rise, this study positions sustainable management as a vital component for the future success of public health organizations.

Corticosteroids and glaucoma: How do treatments trigger ocular nerve damage? - A systematic literature review

Corticosteroids are steroid hormone derivatives produced by the adrenal glands. Corticosteroids in the health sector have been widely utilized as anti-inflammatory agents because of their strong and rapid effects. This study aimed to identify the impact of long-term corticosteroid use on eye damage. This study uses a systematic literature review, which is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to the article screening process. The data of this study, in the form of demographic variables, route of administration, steroid type, comorbidities, and patient risk factors, were descriptively analyzed. As a result, 15 of the 22 articles were selected for analysis. Chronic corticosteroid administration may precipitate optic neuropathy, manifesting as glaucoma, which is characterized by progressive structural degeneration of retinal ganglion cells (RGCs) and concomitant visual function deterioration. The locus of primary pathological insult in glaucomatous conditions is the optic nerve head, specifically at the optic disc. This anatomical site is notable for the abrupt 90-degree angular deviation of RGC axons as they transition from the retinal nerve fiber layer to their trajectory within the optic nerve proper. The use of corticosteroids can damage ocular nerve tissue through an increase in intraocular pressure (IOP) beyond 21 mmHg. This increase in IOP is due to changes in the microstructure of the trabeculum webbing, resulting in increased obstruction to the outflow of aqueous humor.

Proposals for the Prevention Health Consequences of Heat Stress as a Cross-sectional Task in the Health Care System

Climate change is the greatest threat to human health in the 21st century. Climate change poses a significant threat to human health in Germany, with increasing heatwaves causing high mortality rates. In recent years, the German medical profession has become increasingly concerned with the consequences of climate change, particularly extreme temperatures and heat, for human health. Although the Deutscher Wetterdienst (DWD) issues heat warnings, there is a lack of comprehensive heat action plans (HAPs). Initiatives such as the "Berlin Heat Protection Action Alliance" offer sector-specific plans for healthcare facilities. There is an urgent need for action in the healthcare sector, as doctors play a key role in implementing heat protection measures and advocating for action against climate change. In addition to initiatives such as signing the "Climate Pact for Health" and raising awareness among stakeholders in the healthcare sector, increased education about heat-related health risks is essential. The results emphasise the urgency of measures in the healthcare sector in the face of advancing climate change. The medical profession plays a key role in the implementation of heat protection measures and should be actively involved in the planning and implementation of HAPs. Education and training on heat and health is essential in the health sector. Registration for heat warnings from the DWD (www.hitzewarnungen.de) is recommended, followed by sensitisation of decision-makers and employees in healthcare facilities. The medical profession has a crucial responsibility in the implementation of heat protection measures and should actively position itself and contribute to the political discussion on heat and climate change.

Factors influencing human papillomavirus vaccine uptake among parents and teachers of schoolgirls in Saudi Arabia: a cross-sectional study

IntroductionCervical cancer is a highly prevalent disease among women worldwide. However, the advent of a vaccine against HPV, the main cause of the disease, has prevented its spread. The acceptability of the HPV vaccine to different sectors of the Saudi community has yet to be clarified. Since parents and teachers are major influencers in the decision-making process of vaccination for HPV, this study aimed to assess the knowledge and attitudes of teachers and parents toward cervical cancer, HPV, and the HPV vaccine, and unraveled the factors that would influence recommending the vaccine.MethodsA cross sectional study was done among 927 individuals (373 teachers and 356 parents). A newly developed validated questionnaire was used to collect data on knowledge, attitude, and factors influencing cervical cancer, HPV, HPV vaccine. The relationship between different factors with knowledge and attitude were assessed using univariate and multivariate analysis.ResultsOf the study participants, 94% were females, with a median (Interquartile range) age of 38(31–44) years, 12.2% were teachers, 38.7% were parents and 49.1% were parents and teachers. The majority (78.5%) were married, and 75.6% had at least one child. Among those with children, 88.6% had at least one girl, and among those with girls, 72.2% had at least one girl aged between 10 and 18 years. The total median (IQR) knowledge score was 9 [(−5)–(−26)] and the total median (IQR) attitude score was 49 (43–56). The knowledge score significantly increased by receiving postgraduate education, working in the health or education sectors, if a person knew someone diagnosed with cervical cancer, having girls in the age group of 10–18 years, reading about medical issues or having previously heard about the HPV vaccine. The attitude score significantly increased by high knowledge score and decreased if the person has previously diagnosed with cervical cancer.ConclusionPhysician’s recommendation and the amount of information on the HPV vaccine, opinions about vaccines in general, and government decrees are the main factors influencing decision on HPV vaccine Uptake. This study emphasizes the role of healthcare providers, awareness of cervical cancer, HPV and its vaccine, and social status, in favoring vaccine uptake in Saudi Arabia.

Health and Economic Outcomes of Offering Buprenorphine in Homeless Shelters in Massachusetts

Overdose is the leading cause of death among people experiencing homelessness (PEH), but engagement in medication treatment is low in this population. Shelter-based buprenorphine may be a strategy for increasing initiation and retention on lifesaving medications. To estimate clinical outcomes and conduct an economic analysis of statewide shelter-based opioid treatment in Massachusetts. This economic evaluation study in Massachusetts used a cohort state-transition simulation model. Two cohorts were modeled starting in 2013, including (1) a closed cohort of a fixed population of PEH with history of high-risk opioid use over their lifetimes and (2) an open cohort in which membership could change over time, allowing assessment of population-level trends over a 10-year period. Data analysis occurred from January 2023 to April 2024. Model exposures included (1) no shelter-based buprenorphine (status quo) and (2) offering buprenorphine in shelters statewide. Outcomes included overdose deaths, quality-adjusted life-years (QALYs) gained, and health care and modified societal perspective costs. Sensitivity analyses were conducted on key parameters. In the closed cohort analysis of 13 800 PEH (mean [SD] age, 40.4 [13.1] years; 8749 male [63.4%]), shelter-based buprenorphine was associated with an additional 65.4 person-weeks taking buprenorphine over an individual's lifetime compared with status quo. Shelter-based buprenorphine was cost saving when compared with the status quo, with a discounted lifetime cost savings from the health sector perspective of $1300 per person, and 0.2 additional discounted QALYs per person and 0.9 additional life-years per person. In the population-level simulation, 254 overdose deaths were averted over the 10-year period with the shelter-based buprenorphine strategy compared with the status quo (a 9.2% reduction of overdose deaths among PEH in Massachusetts). Overdose-related and other health care utilization undiscounted costs decreased by $3.0 million and $66.4 million, respectively. Shelter-based opioid treatment generated $44.7 million in additional medication and clinical costs, but saved $69.4 million in overdose and other health costs. In this economic evaluation of clinical and economic outcomes among PEH, shelter-based buprenorphine was associated with fewer overdose deaths and was cost saving. These findings suggest that broad rollout of shelter-based buprenorphine may be an important tool in addressing the overdose crisis.

Effectiveness of health partners coordination for COVID-19 pandemic response in Nepal.

Nepal established the health partner coordination for COVID-19 response based on national and international plans and framework to support information-sharing for decision- making and course correction. This paper aims to assess the performance of COVID-19 Health Partner Coordination response in Nepal by adopting coordination best practices and tools from the international humanitarian cluster system. Secondary data from unpublished documents on health partner coordination for COVID-19 response in Nepal was collected and analysed from April 2023 to May 2023. The secondary data were from the review of the health partner coordination meetings conducted for COVID-19 response using a researcher-developed document review tool, responses of health partners on a survey tool adapted from the cluster coordination performance monitoring tool from the Global Health Cluster, and transcript of Focused Group Discussion among health partners. Descriptive analysis of quantitative information and thematic analysis with predefined themes of qualitative information were performed using MS Excel and MS Word respectively. A written approval from the Ministry of Health and Population and an ethical clearance from the Nepal Health Research Council was obtained before conducting the study. More than three-fifths of the meetings showed good results in conduction, process, participation, and documentation of meeting action points with improvement required for follow-up (22.2%). Assessment of health partner coordination subfunctions resulted in either 'good' (>75.0%) or 'satisfactory' (50.1%-75.0%) except for prioritization based on analyses, which was 'unsatisfactory' (<50%). Partners admired good practices of health partner coordination, pointed out some issues, and provided recommendations. COVID-19 has highlighted the importance of effective coordination of health sector for response to a pandemic. Continuation of this practice after addressing the areas for improvement will contribute to health preparedness and readiness for future disasters or public health emergencies.

The Comparison of Stock Price Before and After Pandemic to Identify The Health of Sector Company

At the beginning of the Covid-19 outbreak in Indonesia, almost all activities in this country weredisrupted and economic activity was no exception. Indonesia's current economic growth is down2.07% in 2020 due to the Covid-19 pandemic which has caused it to be reduced to a low and middleincome country. Based on the gross domestic product (GDP), most sectors of the Indonesian economyexperienced a decline in growth in 2020. Only 5 economic sectors showed positive growth. The sectorwith the largest positive growth was the health services sector and social activities, which amountedto 11.60%. This growth affects the stock price of health sector companies. Grounded on the IDXIndustry category (IDXHEALTH) from 2018-2022, there was an increase of 41.28%. The HealthSector which continues to grow is driven by the payment of Covid- 19 incentives. This study wasconducted to identify the Difference in Stock prices of Health Sector Companies before and afterCovid- 19 with the supposition that the Covid- 19 pandemic occurred in March 2020 by observingstock price fluctuations two years before and after the Covid- 19 Pandemic. Based on the PairedSample T-test, the stock prices of 3 companies from 6 companies have significant differences in thespecified sample period, namely DVLA, PRDA, and MERK companies where the stock prices ofDVLA and PRDA have increased. In addition, PRDA's stock price has the largest stock price amongother health sector companies, meaning that PRDA companies have good performance.

Exploring the prevalence of chlamydial and gonorrheal infections in pregnant women: a multicenter study in Egypt

BackgroundChlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are widespread, treatable sexually transmitted infections (STIs) of global significance, affecting millions annually. Left untreated, they pose significant risks, including pelvic inflammatory disease (PID), infertility, and complications during pregnancy. The U.S. Centers for Disease Control recommends annual chlamydial screening for sexually active women to address these risks. Responding to this global challenge, the World Health Organization (WHO) has formulated a global health sector strategy on sexually transmitted infections, outlining priority actions to strengthen STI responses in countries. However, STI epidemiological studies encounter challenges in developing nations like Egypt due to socio-cultural factors, poverty, and limited diagnostic facilities. In Egypt, STI diagnosis primarily relies on clinical presentations, lacking structured screening programs for CT and NG. This study’s main objective is to estimate the prevalence of Chlamydial and gonorrheal infections, advocating for supportive STI strategies in Egypt. Additionally, the study aims to provide a foundation for national prevalence estimates of CT and NG infections.MethodsA cross-sectional study encompassed five antenatal clinics in different regions of Egypt. A total of 1040 pregnant women attending these clinics were consecutively sampled. Data collection involved structured questionnaires, and urine samples were subjected to the GeneXpert CT/NG qualitative real-time PCR test.ResultsThe prevalence of CT infections was 0.29% (95% CI, 0.10–0.86%), with no detected NG infections. The three CT-positive cases were distributed across different recruitment centers, with no statistically significant differences observed between infected and non-infected participants. Notably, 40.3% of recruited women reported gynecological symptoms, primarily discharge. Additionally, 9.6% had undergone previous testing for sexually transmitted infections, with 8.2% receiving positive results.ConclusionsThis study provides valuable data on the prevalence of CT and NG infections among pregnant women attending ANC clinics in Egypt. The findings underscore the importance of ongoing surveillance, routine screening, and targeted interventions to ensure the reproductive health and well-being of pregnant women and their infants. Further research is warranted to explore the broader implications of STIs in different populations and to inform evidence-based guidelines for screening and management in diverse settings. Trial registration: IRB no.: 17,400,017; WHO ERC Protocol Id. A66005.

A Retrospective Comparative Analysis of Chest Radiograph Findings Among Patients in a Tertiary Hospital in Rivers State, Nigeria

Background: Chest radiograph is an imaging modality that uses ionizing radiation used for the evaluation of the thorax and its content. It is readily available, accessible, cheap and greatly employed in the health sector for various reasons. Objective: Chest radiographs serve as an indispensable diagnostic instrument when it comes to evaluating cardiac and respiratory ailments. The purpose of this study is to examine and compare chest radiograph findings in a tertiary institution, over a two-year period retrospectively. Methods: A retrospective analysis of 6,223 chest radiographs was performed at the University of Port Harcourt Teaching Hospital. From patient records, demographic and clinical data were extracted and analysed with SPSS version 21.0, setting the level of statistical significance at p&lt;0.05. Results: The mean age of the study population was 38.14±20.25 years, and the female gender comprised the majority (54.93%). Cardiomegaly was the most frequently observed indication (20.48%), whereas pleural effusion/collection was the least frequent (4.04%). A statistically significant disparity was identified among all clinical parameters across years: cardiomegaly and aortic unfolding exhibited a higher prevalence in 2019, whereas atheromatous plaques demonstrated a greater prevalence in 2020. Conclusion: The prevalence of cardiomegaly highlights the possible necessity for routine chest radiographs among the ageing adult population in Nigeria. This research emphasises the significance of ongoing radiographic monitoring for the early detection of cardiothoracic conditions and offers valuable epidemiological insights.

Critique of Legislation in the Health Sector: A Review of Medical Waste Regulation in Indonesia

Medical waste management in Indonesia has become a critical issue in the health sector, especially with the increasing volume of medical waste during the COVID-19 pandemic. Although there are regulations governing medical waste management, such as Law no. 32 of 2009 concerning Environmental Protection and Management and Minister of Health Regulation no. 18 of 2020, its implementation still faces various obstacles. This research aims to criticize legal regulations related to medical waste in Indonesia, by highlighting regulatory weaknesses, implementation challenges in the field, and their impact on public health and the environment. The research methods used are normative juridical studies and case studies in several health facilities in Indonesia. The research results show that there is a gap between regulations and practice in the field, which is caused by limited infrastructure, weak supervision, and high operational costs. This research recommends that the government tighten supervision, provide incentives for health facilities, and develop more detailed technical guidelines regarding medical waste management.

Leadership Empathy and Employee Retention in Health Sector NGOs in Kenya

Employee turnover undermines the achievement of organizational goals. Retaining talented employees is a significant challenge for many health sector non-governmental organizations (NGOs), and it threatens their sustainability. Previous studies have been conducted to determine the causes of employee turnover in Kenya; however, there is inadequate empirical evidence regarding the correlation between emotional intelligence competencies and employee retention. This study aimed to determine the impact of leadership empathy on employee retention in health sector NGOs in Kenya. The study was conducted based on Bar-On’s Emotional Intelligence Competencies Model. Positivism was the philosophical foundation of this descriptive design study. The analysis unit included 30 health sector NGOs in Kenya, while the observation unit included 1,500 management-level employees. The Yamane formula was used to determine the study sample size, which consisted of 316 respondents. A stratified random sampling technique was implemented to determine the sample. A semi-structured questionnaire was used to collect the study data. Statistical Package for the Social Sciences software (version 26) was used for data analysis, where descriptive and inferential statistics were computed. The findings are presented in tables and figures and prose form. We found a positive influence, indicating that increased empathy enhanced employee retention. Therefore, we concluded that leadership empathy is positively and significantly correlated with employee retention in health sector NGOs in Kenya. Managers and supervisors in health sector NGOs should receive training and development programs to enhance their empathy skills. Additionally, health sector NGOs should provide workshops, seminars, and coaching sessions that emphasize developing leadership empathy skills through active listening, perspective-taking, and genuine concern for others

The Impact of Unfair Compensation on Employee Morale, Job Satisfaction, and Performance: A Quantitative Analysis in Pakistan’s Health Sector

The main aim of this article is to investigate how the unjust compensation structure affects the motivation, contentment, and performance of Pakistani healthcare professionals working for different healthcare institutions. The theoretical foundation of this study is based on equity theory. The authors administered a self-completed structured questionnaire survey to 381 employees from a variety of organizational sectors, using a PLS-SEM technique to analyze the relationships between variables. The outcomes from this research show that perceived unfair compensation decreases organizational commitment, organizational citizenship behavior, job satisfaction, and performance. The findings contribute to the theoretical understanding of compensation equity and offer practical recommendations for human resource managers to improve organizational success through the correction of pay disparities. It highlights the broader importance of equitable remuneration practices in all businesses. A future study could broaden its scope by incorporating longitudinal and cross-national studies to further corroborate the findings.

Impact of Inflation and Financial Ratios on Dividend Distribution in Healthcare Sector Companies Listed on the Indonesia Stock Exchange (2020-2022)

Objective: To examined the influence of inflation, current ratio, debt to equity ratio, and return on equity on dividend distribution in health sector companies during the 2020 to 2022 period, because this period includes the COVID-19 pandemic. Study Design: This kind of research is quantitative and depends on the Indonesia Stock Exchange for the acquisition of secondary data. Study Location and Duration: 2020–2022 listings of health sector firms on the Indonesia Stock Exchange. Methodology: Purposive sampling was used in this study to identify 10 companies that met the objectives of the investigation. The analysis technique used is panel data regression, the analysis tool EViews 12. Results: Research findings show that inflation, DER, and ROE do not have a significant negative impact on dividend distribution, while CR shows a significant positive impact. This shows that liquidity plays an important role in dividend distribution decisions during the Covid 19 pandemic. TImplication: This study underscores the importance of maintaining adequate levels of liquidity for healthy companies when determining dividend policy, especially during the Covid 19 pandemic. Investors and policymakers are advised to consider these factors when evaluating a company's financial health and dividend prospects.

Ecological-level factors associated with tuberculosis incidence and mortality: A systematic review and meta-analysis.

Globally, tuberculosis (TB) is the leading infectious cause of morbidity and mortality, with the risk of infection affected by both individual and ecological-level factors. While systematic reviews on individual-level factors exist, there are currently limited studies examining ecological-level factors associated with TB incidence and mortality. This study was conducted to identify ecological factors associated with TB incidence and mortality. A systematic search for analytical studies reporting ecological factors associated with TB incidence or mortality was conducted across electronic databases such as PubMed, Embase, Scopus, and Web of Science, from each database's inception to October 30, 2023. A narrative synthesis of evidence on factors associated with TB incidence and mortality from all included studies, alongside random-effects meta-analysis where applicable, estimated the effects of each factor on TB incidence. A total of 52 articles were included in the analysis, and one study analysed two outcomes, giving 53 studies. Narrative synthesis revealed predominantly positive associations between TB incidence and factors such as temperature (10/18 studies), precipitation (4/6), nitrogen dioxide (6/9), poverty (4/4), immigrant population (3/4), urban population (3/8), and male population (2/4). Conversely, air pressure (3/5), sunshine duration (3/8), altitude (2/4), gross domestic product (4/9), wealth index (2/8), and TB treatment success rate (2/2) mostly showed negative associations. Particulate matter (1/1), social deprivation (1/1), and population density (1/1) were positively associated with TB mortality, while household income (2/2) exhibited a negative association. In the meta-analysis, higher relative humidity (%) (relative risk (RR) = 1.45, 95%CI:1.12, 1.77), greater rainfall (mm) (RR = 1.56, 95%CI: 1.11, 2.02), elevated sulphur dioxide (μg m-3) (RR = 1.04, 95% CI:1.01, 1.08), increased fine particulate matter concentration (PM2.5) (μg/ m3) (RR = 1.33, 95% CI: 1.18, 1.49), and higher population density (people/km2) (RR = 1.01,95%CI:1.01-1.02) were associated with increased TB incidence. Conversely, higher average wind speed (m/s) (RR = 0.89, 95%CI: 0.82,0.96) was associated with decreased TB incidence. TB incidence and mortality rates were significantly associated with various climatic, socioeconomic, and air quality-related factors. Intersectoral collaboration across health, environment, housing, social welfare and economic sectors is imperative for developing integrated approaches that address the risk factors associated with TB incidence and mortality.

Climate change impacts on maternal health and pregnancy outcomes in Africa

ABSTRACT The review examines how climate change adversely affects maternal health and pregnancy outcomes in Africa, a region particularly vulnerable to climate-related disasters. It highlights the increased incidence of tropical and waterborne illnesses due to climate change, disproportionately impacting expectant mothers. The study thoroughly evaluates the effects of extreme weather events like heatwaves and floods on maternal health, both directly and indirectly. It underscores significant gaps in policy and research within African health sectors regarding these issues. Key findings reveal that maternal death rates remain alarmingly high, with risks like preterm birth, stillbirth, and maternal hypertension exacerbated by climate change. The review calls for urgent action, including enhanced research, increased funding for climate adaptation, and the integration of maternal health into broader climate resilience strategies. Additionally, it emphasizes the need for greater awareness and international collaboration to strengthen health systems in Africa, particularly addressing the vulnerabilities of pregnant women. This work aims to enhance understanding among policymakers and researchers about the critical health impacts of climate change on pregnant women in Africa.

Creative health in the urban Global South: barriers and facilitators in the cases of Cochabamba and Salvador.

The Global South has some of the world's largest cities, where rapid, ad hoc development of urban centres and 'megacities' has fuelled major socio-economic, environmental, and public health concerns. These urban environments can generate feelings of loneliness, with multiple barriers for access and participation in socio-cultural infrastructures. An inclusive future agenda for global creative health must, therefore, consider how urbanisation impacts social public health, what creative health approaches can do to alleviate this, and what the barriers are to access. This article explores barriers and facilitators to accessing socio-cultural urban infrastructures in two case-study cities: Salvador in Brazil and Cochabamba in Bolivia. Data were collected as part of a survey examining access to, and engagement in, arts and cultural activities undertaken between 25 January and 1 May 2023. This article focuses on two questions: What helps you to access artistic and cultural events in your city? and What barriers do you face in accessing artistic and cultural events in your city? 239 open responses from adults, in Portuguese and Spanish, were analysed using descriptive thematic analysis. Findings highlight how emergent issues around existing economic inequality, safety, and accessibility can limit residents' capacity to engage in creative health activities. While preliminary in scope, this raises wider public health implications for how creative health approaches may be leveraged within urban, Global South contexts. Findings highlight how greater dialogue is needed between the urban development, public health, and creative health sectors. Given the emerging evidence of the role of creative engagement to alleviate loneliness, integrating creative health approaches within urban public health may further strengthen connections with the most vulnerable communities, and help to build healthier cities. The article ends by outlining an approach that incorporates both local and city-wide creative encounters, highlighting how future interventions could be appropriately designed that gradually scale these types of interventions from tailored local offerings to larger, city-wide activities.

The role of indigenous healers in treating surgical conditions in the rural Eastern Cape of South Africa.

Indigenous knowledge healers (IKHs) provide alternative healthcare to formal health services in rural South Africa, but there is a gap in knowledge regarding their treatment of surgical conditions. This study evaluated IKH surgical care and described their perspective of the dual health system. A cross sectional survey of IKHs in the Madwaleni Hospital catchment of the Eastern Cape, South Africa was conducted. Topics included the training and experience of IKHs, treatment of nine common surgical conditions, referral patterns, disease origin beliefs, benefits and limitations of care, and collaborative opportunities between the two health systems. Thirty-five IKHs completed the survey. IKHs were consulted by persons with all nine surgical conditions. The most common forms of treatment were application of an ointment on the affected site (88%) and oral medication (82%). Operative treatment was only done for abscess. Referrals to the formal healthcare sector were made for all surgical conditions. IKHs reported that they were limited by their lack of training and resources to perform operations. On the other hand, they perceived the treatment of the spiritual aspect of surgical disease as a benefit of their care. Thirty-five (100%) IKHs were interested in closer collaboration with the formal health sector. IKHs treat surgical conditions but refer to the formal health sector when diagnostic and operative services are needed. More research is needed to determine the potential advantages and disadvantages between the formal health sector and IKH collaboration.

Towards women's digital health equity: A qualitative inquiry into attitude and adoption of reproductive mHealth services in Bangladesh.

Health equity in Bangladesh faces a large chasm over the economic conditions, socio-cultural factors and geographic location despite the push for digitalization of the health sector. While some research has been conducted assessing the viability of digital health solutions in Bangladesh, gender dynamics of digital healthcare have been absent. This study dived into healthcare equity for women with a focus on reproductive health services delivered through mobile devices. This paper reported the findings of a qualitative study employing in-depth interviews conducted among 26 women about their behavioral intention to use mHealth services for reproductive health and the underlying factors influencing this intention with the help of the Integrative Model of Planned Behavior (IMPB). A snowball sampling technique were used to interview those university educated women, aged 21-31, based on their familiarity and exposure of mHealth services from seven universities in Bangladesh. The findings suggested that users of mHealth services find it more convenient and secure compared to visiting healthcare facilities, especially for trivial issues and inquiries regarding their reproductive health. Although promoting such services is lagging behind traditional healthcare, the attitude toward reproductive health services in Bangladesh is generally favorable resulting increasing adoption and use. Because such information-related mobile services (apps, websites, and social media) served as a first base of knowledge on reproductive health among many young girls and women in Bangladesh, who are generally shy to share or talk about their menstruation or personal health problems with family members, peers, or even health professionals due to socio-cultural factors and stigmatization. Conversely, urban centric services, availability of experts, quality management, security of privacy, authenticity of the information, digital divide, lack of campaign initiatives, lack of equipment and technology, lack of sex education, and outdated apps and websites were identified as obstacles that constrain the widespread use of reproductive mHealth services in Bangladesh. This study also concluded that promotion will be crucial in reforming conservative norms, taboos, and misconceptions about women's health and recommended such endeavors to be initiated by the policy makers as there is a substantive need for a specific policy regulating emerging digital health market in Bangladesh. Notwithstanding, women-only sample, low sample size, narrow focus on mHealth users and absence of perspectives from healthcare providers were among shortcomings of this study which could be addressed in future research. Further quantitative explorations are must to determine the usage patterns of reproductive mHealth services and their effectiveness that would identify implementation challenges in terms of customization and personalization in reproductive healthcare in a developing country like Bangladesh.