Background Low vaccination coverage among children in slum areas is a global concern, particularly in Asian countries. Despite several reported studies, systematic reviews are lacking. This systematic review aimed to identify interventions that effectively improve vaccination coverage among children aged 12–23 months in slum areas in Asia. Methods We searched the Embase, PubMed, and Cochrane databases using specific search terms for articles published between 2010 and January 2026. Two investigators independently extracted the data and assessed the methodological quality of the identified studies. Biases in non-randomized and randomized studies were assessed using the Risk of Bias In Non-randomized Studies of Interventions and Risk of Bias 2 tools, respectively. The quality of the evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluations tool. Heterogeneity was assessed using I2, and subgroup analysis was performed when substantial heterogeneity was identified. The effect measure was estimated using odds ratios (ORs) and 95% confidence intervals (CIs). Results The nine included studies ranged from quasi-experimental to randomized controlled studies (RCTs) conducted in Bangladesh, India, Indonesia, and Pakistan, involving 37,405 children. The included studies demonstrated a moderate to high or serious level of bias. The full vaccination coverage probably improved in only one RCT (OR 6.42, 95% CI 4.63 to 8.90) and from three quasi-experimental studies (OR 9.68, 95% CI 3.91 to 23.95) with high heterogeneity. DPT3 vaccine coverage significantly improved in two RCTs (OR 2.68, 95% CI 2.17–3.31; 1,872 participants; I²=0%), whereas quasi-experimental studies showed uncertain effects with high heterogeneity (OR 3.58, 95% CI 2.99–4.28; 31,817 participants; I² = 78%). Compared to the control groups, single or multicomponent strategies significantly increased vaccination coverage. However, the certainty of the evidence was moderate in RCTs and very low in quasi-experimental studies owing to methodological limitations. Conclusion Owing to the methodological biases of the included studies and the limited sustainability of the implemented interventions, further studies are needed to improve vaccination coverage in children aged 12–23 months, particularly in slum areas of Asia.
Colonial legacies in global health have entrenched structural inequities through unequal resource distribution, Western epistemic dominance, and the marginalization of Global South voices. Although implementation science aims to close the evidence–practice gap, its dominant frameworks often reinforce these hierarchies rather than dismantle them. Current approaches insufficiently consider communities’ positionality within global power structures, emphasize provider-level factors over social determinants, and overlook colonial histories and epistemic hierarchies. To advance decolonization, we propose a community-centred and equity-oriented recalibration of established implementation science frameworks. Specifically, CREAIM is presented as an adaptation of the RE-AIM framework, adding “Community” as a cross-cutting foundation that contextualizes Reach, Effectiveness, Adoption, Implementation, and Maintenance through explicit reflection on power, agency, and justice. In parallel, a decolonial recalibration of CFIR emphasizes political economy analysis, locally led adaptation, equitable resource control, and co-created implementation processes. Together, these adaptations reposition implementation science from a technical instrument for intervention delivery into a vehicle for structural change. Embedding decolonial principles within implementation frameworks can reorient the field toward community leadership, epistemic justice, and sustainable global health equity.
Background Routine childhood immunization has reduced vaccine-preventable disease burden, yet inequalities in DPT-related outcomes persist in the WHO Western Pacific Region. This study examined whether DPT3 vaccination coverage was associated with DPT-related disease burden and inequality, and whether this association varied with systemic capacity, defined as the governance, health service coverage, and logistics environment in which immunization programs operate. Methods We constructed a 2000–2023 country–year panel for 32 countries and areas using Global Burden of Disease 2023 estimates, WHO–UNICEF DPT3 coverage data, and World Bank indicators. A composite DiseaseIndex for under-five DPT-related incidence, mortality, and DALYs was derived using principal component analysis; the first component explained 74.5% of total variance. Cross-country inequality was measured using Theil and Gini indices. We estimated mean and distributional associations using fixed-effects and distributional regression models, and used counterfactual simulations and decomposition analyses to explore model-based inequality patterns. A restricted mechanism analysis of 17 countries and areas examined modification by systemic capacity. Results Higher DPT3 coverage was associated with lower average DiseaseIndex and lower cross-country inequality. In two-way fixed-effects distributional models, DPT3 coverage was negatively associated with RIF-Theil inequality (β = –6.130, 95% CI: –8.260 to –4.000) and RIF-Gini inequality (β = –2.941, 95% CI: –3.841 to –2.041). Exploratory counterfactual simulations suggested that model-implied inequality patterns varied across coverage-improvement scenarios, with convergence-oriented changes showing more consistent reductions than uniform or threshold-based increases. Decomposition analyses showed that observable characteristics explained 13.3% of the Theil gap and 15.9% of the Gini gap between low- and high-coverage settings, leaving a large unexplained component. In the 17-country mechanism sample, the association between DPT3 coverage and lower inequality was stronger in lower-SystemIndex settings, possibly reflecting larger marginal gains where baseline disease burden or coverage gaps were greater. Conclusions Higher DPT3 coverage was associated with lower DPT-related disease burden and inequality, but coverage alone did not fully account for persistent disparities. These ecological observational findings suggest that systemic capacity may condition how vaccination coverage is translated into equitable health gains, and should be interpreted as associative rather than causal.
Background Despite recent calls for change, the field of global health continues to perpetuate unequal power dynamics due to colonization and disparate resource access. While there is research on the history of colonization in global health and a current push towards ‘decolonization,’ more research is needed to explore how global health partnerships between high-income countries (HICs) and low-middle-income countries (LMICs) can decolonize. Methods We conducted a scoping review of peer-reviewed literature published between 2011-2024 focused on global health decolonization in collaborative partnerships between HICs and LMICs by searching Web of Science, PubMed, Embase, ProQuest databases, and JSTOR. Primary outcomes included descriptive information on models of decolonized global health in collaborative research partnerships, progress made in decolonizing collaborative research partnerships, barriers to decolonization in collaborative research partnerships, and roles of different contemporary stakeholders in the decolonization of collaborative research partnerships. Results We included 56 studies in this review. Primary themes were identified, including: 1) Decolonized global health should be equitable, including fair and equal recognition of work and cultural humility should be centered; 2) Progress has been made in the decolonizing global health movement through increased acknowledgement of the topic in education and leadership; 3) Significant barriers persist, such as implicit bias, different standards, poverty imbalance, and a lack of authority held by persons from LMICs; and 4) Individual researchers, academic institutions, and structural level stakeholder can work to combat these barriers by shifting paradigms or current structures and methods. Conclusion Findings from this review highlight the importance of equitable, participatory, and culturally humble approaches to global health research partnerships. These findings can inform future reform efforts by supporting the development of a practical checklist for decolonized global health practice to guide stakeholders in implementing these principles.
Vaccination is a cornerstone of public health and a critical enabler of universal health coverage, yet Ethiopia’s immunization system remains largely oriented toward early childhood. Although childhood coverage for key antigens has improved substantially, recent evidence shows persistent zero-dose and under-immunization among children, uneven uptake of vaccines for adolescents, pregnant women, adults, and older adults, and missed opportunities even among populations living near health facilities. Life course immunization (LCI), defined by Immunization Agenda 2030 as vaccination across all ages and life stages through integrated health systems, offers a policy pathway to close these gaps. This policy brief argues that Ethiopia should institutionalize LCI as a routine primary health care function rather than relying on fragmented campaigns or childhood-focused platforms alone. The evidence points to interacting demand-side, supply-side, and health-system barriers, including limited awareness of vaccines beyond childhood, low perceived risk, concerns about side effects, gender-related decision-making constraints, weak adolescent and adult service platforms, and insufficient age-disaggregated monitoring. By embedding LCI into national immunization policy, Ethiopia can create repeated vaccination contact points, strengthen risk communication, improve accountability across age and risk groups, and reposition vaccination as a lifelong public good for equity and universal health coverage.
This commentary examines the ongoing shift from multilateral to bilateral health development aid in Africa and its implications for regional public health governance. Multilateral institutions, such as the World Health Organization (WHO) and the Africa Centre for Disease Control and Prevention (AfCDC), have fostered coordination and regional integration in Africa. However, recent geopolitical fragmentation, donor realignment, and pandemic-era disruptions, including vaccine nationalism and bilateral vaccine diplomacy, have shifted coordination structures, weakened harmonization, and increased political conditionalities, thereby challenging Africa's public health resilience. We explore the key drivers and consequences of this transition and propose seven policy recommendations, including revisiting regional coordination models, strengthening global health diplomacy, enhancing sustainable domestic financing, investing in local production, and fostering an enabling environment for regional knowledge generation. The implementation of these measures has grown particularly urgent, considering the recent shifts in development assistance priorities and the restructuring of major donor agencies and other multilateral and international non-governmental organizations that previously supported African governments with technical assistance, thereby increasing vulnerabilities. These findings suggest the importance of facilitating the adoption of a recalibrated, context-specific governance model to build resilient national health systems and safeguard continental health security amid current changes in development aid.
Background Medication non-adherence is a critical determinant of poor outcomes in heart failure, a condition posing a significant public health burden across Africa. Unique regional challenges such as healthcare resource constraints, economic disparities, and diverse healthcare systems exacerbate this issue. However, a consolidated estimate of non-adherence prevalence and its associated factors across the continent remains unknown. Method This systematic review and meta-analysis followed PRISMA guidelines (PROSPERO: CRD420251139486). A comprehensive search of databases (PubMed/MEDLINE, African Journal Online, and Google Scholar) was conducted for studies published between 2000 and 2025. Observational studies reporting non-adherence prevalence or associated factors among African heart failure patients were included. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists for cross-sectional and cohort studies. Data were extracted and pooled using a random-effects model in STATA 17. Result Seventeen studies (n=6,276 patients) from multiple African regions were included. The pooled prevalence of medication non-adherence among heart failure patients in Africa was 41.88% (95% CI: 25.43-58.34). Extreme heterogeneity (I² = 99.7%) was explored via subgroup analyses, revealing significant regional variation with Western Africa showing the highest prevalence (77.59%). Meta-analysis of associated factors identified lack of health insurance as the strongest predictor (OR = 4.27, 95% CI: 1.62-11.26). Other significant factors included polypharmacy (OR = 2.58, 95% CI: 2.00-3.33) and presence of comorbidities (OR = 1.76, 95% CI: 1.31-2.35). No publication bias was detected (Egger's test: p=0.267). Conclusion Approximately two in five heart failure patients in Africa are non-adherent to their medication, with prevalence rates varying significantly by region. This rate is exacerbated by financial, clinical, and therapy-related factors. Concerted multi-faceted interventions are urgently needed across the continent. Recommendations include expanding health insurance coverage, implementing medication subsidy programs, strengthening therapy simplification strategies, and developing context-specific adherence support strategies tailored to regional healthcare contexts and patient populations.
The recent withdrawal of major U.S. funding from global health initiatives has created a critical turning point for research and public health in Africa. These cuts threaten decades of progress in combating HIV, tuberculosis, and other infectious diseases, exposing the vulnerability of Africa’s research landscape, which relies heavily on a single donor source. This perspective argues for a fundamental reimagining of research financing and partnerships to secure Africa’s scientific and health futures. It identifies three key strategic priorities: (1) strengthening public–private partnerships to mobilize sustainable resources, drive innovation, and enhance accountability; (2) deepening South–South collaborations to promote knowledge exchange, build research capacity, and advance African research sovereignty; and (3) fostering public engagement and science advocacy to cultivate societal support and diversify funding mechanisms, including crowdfunding and institutional investment. Additionally, the paper highlights the need to embed research within resilient, integrated health systems that align with local priorities and regional development goals. Collectively, these strategies may offer a promising path toward reshaping the continent's research ecosystem — one that moves away from dependency and toward greater autonomy, while striving to sustain innovation, nurture local capacity, and foster more equitable partnerships as global funding landscapes continue to shift in uncertain ways.
Child malnutrition persists globally, reflecting structural failures when externally conceived interventions lack contextual adaptability and local agency. The Ying Yang Bao programme reflects principles aligned with calls for more locally led and adaptive global health practice. It was developed through participatory pilots grounded in local diets and caregiver input, then scaled nationally through domestic financing, cross-sector collaboration, and adaptive health system integration. Reaching over 19 million children in China’s poverty-designated counties, YYB not only reduced malnutrition but also supported caregivers’ informed participation, strengthened community health capacity, and institutionalised data-informed decision-making. These outcomes demonstrate that implementation science, when redirected through local leadership and iterative co-creation, can achieve sustainable and equitable nutrition improvements. YYB’s evolution from field trials to nationally embedded policy illustrates a transferable framework—rooted in equity, ownership, and contextual innovation—that low- and middle-income countries can adapt to advance ownership and leadership in global health implementation.
Background:Undernutrition is a major driver of common infectious morbidity among children under five; however, the relationship between different forms of undernutrition and childhood infectious morbidity remains poorly understood. This study examined variations in the association between different forms of undernutrition measured according to the Composite Index of Anthropometric Failure (CIAF) and common infectious morbidity among children under the age of five in sub-Saharan Africa (SSA). Methods:We performed a multilevel binary logistic regression analysis using country and community clusters as random effects. Our study utilised demographic and health survey (DHS) data collected between 2016 and 2024 in 27 SSA countries. A total weighted sample of 157, 800 under-five children whose nutritional status was assessed based on the World Health Organization (WHO) anthropometric techniques and data on Acute Respiratory tract Infection (ARI) and diarrhea recorded were included. An adjusted odds ratio (AOR) with a 95% Confidence Interval (CI) was reported, and variables' effects with a p-value less than 0.05 were declared significant determinants of common infectious morbidity. Results:The prevalence of common infectious morbidity among children under five in SSA was 30.20% (95% CI: 27.34, 33.06). The lowest and highest prevalences were reported in Mozambique (16.96%; 95% CI: 16.94, 16.98) and Uganda (53.26%; 95% CI: 53.24, 53.28), respectively. The odds of infectious morbidity significantly differs between children with standalone, double and triple forms of undernutrition. Children with double (AOR: 1.25; 95% CI: 1.16, 1.34 for stunting-underweight; AOR: 1.36; 95% CI: 1.22, 1.51 for wasting-underweight) and triple undernutrition (AOR: 1.51; 95% CI: 1.36, 1.68) were more susceptible to common infectious morbidity. Conclusions:Children with coexisting undernutrition were more likely to experience common infectious morbidity, and those affected by the coexistence of stunting-wasting-underweight experienced the highest odds of infectious morbidity. Among the standalone forms, only underweight children were more likely to experience common infectious morbidity. Therefore, to mitigate the burden of childhood infectious morbidity, it is crucial for policymakers to implement targeted nutritional interventions for children experiencing coexisting undernutrition.
Background:As population aging accelerates, the escalating prevalence of comorbidity of chronic diseases (CCD) necessitates evidence-based preventive strategies. This study aims to examine associations between continuous participation in health examinations and the long-term CCD trajectories among Chinese adults aged 45 and older, providing evidence to optimize targeted prevention. Methods:This study used data from four waves of China Health and Retirement Longitudinal Study (CHARLS), specifically 2013, 2015, 2018, and 2020. Latent class growth analysis was used to classify trajectories of CCD. Chi-square tests and multivariate logistic regression were conducted to examine the relationship between CCD and health examination behaviors. A regression discontinuity design was also implemented to assess the impact of China's free health examination policy. Results:A total of 12,510 participants data were categorized into six latent classes. In the unadjusted model, continuous health examination participants were significantly more likely to be classified into the Health Risk (Relative risk ratio (RRR) = 2.249; 95% CI: 1.780-2.842) and Multiple Chronic Diseases Worsening groups (RRR = 7.124; 95% CI: 5.454-9.305) compared to non-participants. After adjusting for baseline burden, individuals with a low baseline burden who participated in health examination had a lower likelihood of unfavorable CCD trajectories (RRR = 0.456; 95% CI: 0.278-0.748; P < 0.01) than non-participants. Older adults were more likely to participate in continuous examinations (OR = 21.571; 95% CI: 11.732-39.662). After controlling for sociodemographic factors, the association between continuous health examinations and CCD trajectories varied by baseline burden, showing stronger effects in individuals with lower baseline burden and weaker effects in those with higher burden (P < 0.01). Conclusions:Continuous health examinations are significantly associated with CCD trajectories. However, their effectiveness remains moderated by baseline disease burden. The current free health examination policy effectively fosters CCD management, yet this association is contingent upon age and socioeconomic determinants. The extension of eligibility to individuals below 65 could maximize the potential for early chronic disease control. This may also serve as a valuable blueprint for other low- and middle-income countries for optimizing cost-effectiveness of their preventive healthcare systems before populations age into high-burden morbidity.
The persistent "know-do gap"—the lag between the development of evidence-based practices (EBPs) and their routine use in health systems—remains a barrier to achieving global health equity. Implementation science offers a pathway to bridge this gap, but without an explicit equity focus, it risks reinforcing existing disparities. In this perspective, we propose an equity-centered adaptation of the PEDALs model (Problem, Evidence-based practice, Determinants, Action, Long-term use, and Scale) to guide more just and context-sensitive implementation efforts in global health. We describe how each stage of PEDALs can be used to embed equity considerations in implementation research and practice. These include identifying root causes of inequity-linked health problems (P), using both scientific and practice-based evidence while adapting or de-implementing interventions (E), engaging marginalized voices when analyzing barriers and facilitators (D), co-designing contextually grounded implementation strategies (A), and measuring long-term implementation outcomes through an equity lens (L), including attention to scalability, iterative learning, and proper design and methods (s).We highlight methodological considerations—such as hybrid designs, embedded and workflow-based research, and rapid and participatory methods—that support timely, relevant, and equitable implementation. Our model builds on the concept of “radical incrementalism” to emphasize steady, equity-driven change that is responsive to diverse settings, especially in low- and middle-income countries. This modified PEDALs-based approach offers a practical structure for design and methodological considerations in advancing equity-centered implementation science.
Background:Surgical site infections (SSIs) are significant complications following cesarean delivery, and preoperative antibiotic prophylaxis (PAP) is crucial for prevention. Limited data exist on PAP compliance in low- to middle-income countries such as Jordan. This study aimed to assess the compliance with PAP guidelines in women undergoing cesarean delivery in Jordan and evaluate its impact on the incidence of SSIs. Methods:A retrospective cross-sectional study was conducted using electronic health records from 60,212 women who underwent cesarean delivery between 2015 and 2022 in 20 Ministry of Health hospitals in Jordan. PAP compliance was defined as the administration of cefazolin (1-2 g) within one hour before surgery for patients without penicillin allergy, or appropriate alternatives for those with an allergy, following USAID and MOH protocols. Multilevel logistic regression models with hospital code as a random effect were used to identify factors associated with PAP compliance and SSIs. Results:Only 19.4% of patients received PAP as recommended. The monthly rate of women who received antibiotics increased slightly over time by an average of almost 1.0% per month (95% CI: 0.07-0.09; p < 0.001). Factors positively associated with receiving PAP included age, undergoing elective cesarean delivery (adjusted odds ratio [aOR]: 2.60; 95% CI: 2.43-2.79; p < 0.001), and longer time between admission and surgery (aOR per hour: 1.02; 95% CI: 1.02-1.02; p < 0.001). Patients who received PAP had 41% lower odds of readmission due to SSIs (aOR: 0.59; 95% CI: 0.39-0.89; p = 0.012). The monthly rate of SSIs decreased by approximately 1.6% over the study period (incidence rate ratio: 0.984; 95% CI: 0.979-0.989; p < 0.001). Conclusion:PAP compliance in women undergoing cesarean delivery in Jordan is suboptimal, with less than one-fifth receiving prophylaxis per guidelines. Compliance with PAP is significantly associated with reduced SSIs. Interventions to improve PAP compliance, such as enhancing guideline awareness, implementing antibiotic stewardship programs, and improving preoperative planning, are urgently needed to enhance patient outcomes and reduce postoperative complications.
Global displacement has increased reliance on private and homestay hosting as community-based responses to humanitarian crises. While these arrangements provide immediate shelter and opportunities for social integration, they also create complex and often unequal dynamics, particularly for displaced women. This policy brief draws on emerging evidence and lived experiences from displaced Ukrainian women in Canada to highlight how homestay hosting operates at the intersection of housing, health, and social care systems. Hosting functions as both refuge and risk: it can foster safety, connection, and temporary stability, while also creating challenges related to limited privacy, unclear expectations, dependency, and unequal power relations. Gendered caregiving roles and emotional labor further shape women's well-being, access to healthcare, and integration trajectories. Structural gaps, including fragmented policy frameworks and limited coordination with health and social services, contribute to ongoing vulnerabilities. Homestay hosting is therefore positioned as a critical yet under-recognized social determinant of health. To address these challenges, this policy brief calls for the development of a coordinated national framework that integrates hosting within health and social care systems, ensures access to trauma-informed and culturally responsive supports, and strengthens guidance for both hosts and guests. Establishing monitoring mechanisms and linking hosting to long-term housing and integration pathways are essential to promote equity, safety, and sustainable outcomes for displaced women.
Background:Global mpox outbreaks have exposed healthcare inequities in testing accessibility. Socioeconomic disparities and medical discrimination and distrust influence testing service utilization among vulnerable populations. We examined how medical discrimination and distrust affect testing intention across socioeconomic strata among men who have sex with men (MSM) in China. Methods:We conducted a nationwide cross-sectional study across six regions of China (November 2023 to March 2024). MSM aged ≥ 18 years who reported male sexual partners within previous six months were recruited through local Centers for Disease Control and Prevention and community-based organizations. Participants completed anonymous questionnaires measuring medical discrimination and distrust (DS), structural determinants, behavioral factors, psychosocial factors, and mpox testing intention. Path analysis was used to examine the effects of medical discrimination and distrust on testing intention, stratified by socioeconomic status (SES). Results:50.7% of 2403 participants reported high testing intention. Path analysis revealed that medical discrimination and distrust were associated with testing intention through distinct mechanisms across SES groups. For high-SES participants, positive indirect associations were found between medical discrimination and distrust and testing intention (β = 0.061, P < 0.001) mediated by voluntary HIV counseling and testing services, social support and depression. For low-SES participants, medical discrimination and distrust demonstrated a negative direct effect (β = -0.218, P < 0.001) and indirect effects through social support, depression, and mpox prevention-related self-efficacy (β = -0.028, P < 0.001). Social support emerged as a crucial mediator among low-SES groups, while depression served as the crucial mediator among high-SES groups. Conclusions:Healthcare inequities manifest through socioeconomically patterned pathways affecting mpox testing intention. Our findings suggest differentiated intervention strategies: integrating services with existing healthcare infrastructure for high-SES populations while strengthening community-based support for low-SES groups. These insights inform efforts to address healthcare disparities in infectious disease responses, particularly in resource-limited settings.
Background:Respiratory infections pose a major global health burden. While green spaces are generally thought to benefit respiratory health, research often overlooks the roles of private gardens and the interaction between environmental exposures and lifestyle behaviors. This study uses UK Biobank data to examine the integrated associations of environmental exposures, lifestyle habits, and respiratory infections. Methods:We conducted a large-scale cohort analysis based on UK Biobank data. Environmental exposures were assessed using geospatial data linked to residential addresses, including green space and domestic garden percentage (within 300 m and 1000 m buffers), natural environment accessibility, and coastal proximity. Cox proportional hazards regression models were used to estimate hazard ratios (HRs), adjusting for demographic characteristics (sex, age, BMI), socioeconomic status, and lifestyle behaviors (insomnia, smoking status, alcohol consumption, and physical activity). Results:A total of 46,288 healthy individuals and 21,602 patients with respiratory infection were included. Results revealed a scale-dependent "dual effect" of green space: higher greenspace percentage within a 300 m buffer was protective (HR=0.93, 95% CI: 0.88-0.99), whereas within a 1000 m buffer, it was associated with an increased risk (HR=1.10, 95% CI: 1.02-1.19). Domestic gardens and natural environments at 1000 m were generally protective. Greater distance to the coast was associated with a lower risk of most respiratory infections but a potentially higher risk of tuberculosis. Male gender, older age, higher BMI, smoking, and insomnia were risk factors, while physical activity and alcohol consumption were associated with lower risks. Conclusions:This study provides novel insights into the complex interplay between environmental exposures and lifestyle factors. The divergence between the protective effects of immediate greenness (300 m) and the risks associated with broader vegetation coverage (1000 m) suggests a trade-off between accessibility benefits and potential exposure to aeroallergens. Public health strategies should prioritize "low-allergen" urban planning and promote healthy lifestyles-particularly physical activity and smoking cessation-to mitigate respiratory infection risks.
Background:Road traffic injury is a significant global health challenge, and timely available data are significant to monitor this trend. We aimed to develop a cost-effective approach in resource-limited settings to estimate the number of road traffic crashes at the national level by utilizing media-reported data. Methods:Media-reported data about road traffic crashes were extracted from the Automated Road Traffic Crash Data Platform (ARTCDP) and augmented based on the available police reports with limited free-access. Besides, crash data were approximated according to the national disease surveillance point (DSP). We then fitted four common machine learning models (linear regression, artificial neural network, support vector machine, classification and regression tree) with six predictors to determine the best predictive model for road traffic crashes in China and correct underestimation of police-reported data. Results:Of the 50,850 media outlets indexed by the ARTCDP, 379 media outlets reporting road traffic crash news quarterly were determined as the most reliable media-reported data sources. Of the four machine learning methods, artificial neural network performed best, yielding an R 2 of 0.93 for training data, 0.92 for validation data, and 0.88 for testing. The number of road traffic crashes estimated by the approach closely matched actual trends in national number of crashes from official statistics. Conclusions:Our approach based on ARTCDP-collected media outlets demonstrated excellent predictive performance and has potential to be used for estimating national road traffic crash statistics in resource-limited locations where official statistics are absent, not freely accessible, not reliable, or not yet released.
Background:Coronary artery disease (CAD) remains a leading cause of global mortality and disability. CAD patients face tradeoffs between antithrombotic therapy benefits and bleeding risks, underscoring the need to incorporate patient values and preferences into clinical guidelines. Establishing minimal important differences (MIDs) for patient-important outcomes supports clinical guideline development by determining the smallest change in outcomes that patients consider important. However, directly conducting patient surveys to establish MIDs presents several methodological challenges. Methods:We established a multidisciplinary working group to guide the MID investigation. Using a three-phase process, we identified key outcomes through literature review and discussion. We will develop draft health outcome descriptions by synthesizing evidence from clinical guidelines and qualitative studies, supplemented with patient interviews, and refine the drafts through iterative cognitive interviews. We then designed outcome-specific draft MID questionnaires and will employ cognitive interviews to assess clarity and comprehensibility. Discussion:This study will develop standard materials for surveying patient values and determining MIDs in Chinese CAD patients. The resulting methodology will support future investigations into patient-important outcomes and provide critical evidence for clinical guideline development.
Background:Given the lack of legal status, stateless persons often live in precarious situations that put them at risk of mental health problems, especially in urban settings. Moreover, pathways to citizenship may involve navigating different legal statuses over a lifetime, posing additional challenges. Yet, research on the nexus between legal status and mental health remains scant. This study examines the factors that influence the mental health of persons with different legal statuses in a Thai urban context. Methods:This study employed a qualitative design. Data were collected through 47 in-depth interviews in Northern Thailand's largest city in July 2023 using purposive and snowball sampling strategies. The interviews were recorded and transcribed verbatim. Thematic analysis, based on a social determinants of mental health framework, was used to analyse the data. Results:Legal status was related to multiple and interdependent conditions of precarity in the city. Together they created a compounding effect that threatened mental health. The more restricted the rights attached to a legal status, the greater the effect. Past negative life events, adversed employment conditions, and discrimination were key factors that led to mental health challenges. Obtaining permanent legal status, on the other hand, alleviated legal uncertainty and provided immediate benefits by enhancing access to fundamental rights, with positive effects on mental health. Yet, it cannot reverse pernicious long-term effects of past deprivations, such as foregone opportunities for education and employment, as well as past traumatic events on mental health. Conclusions:The 2024 landmark move of Thailand's Cabinet to accelerate progress in resolving citizenship problems for almost 500,000 persons should be accompanied by multi-pronged interventions aimed at improving the social determinants of mental health. In addition, access to mental healthcare should be facilitated.
