Introduction Human papillomavirus(HPV)vaccination is a cornerstone of cervical cancer prevention,particularly in low-and middle-income countries(LMICs),where the burden of disease remains high~1.The World Health Organ...Introduction Human papillomavirus(HPV)vaccination is a cornerstone of cervical cancer prevention,particularly in low-and middle-income countries(LMICs),where the burden of disease remains high~1.The World Health Organization(WHO)HPV Vaccine Introduction Clearing House reported that 147 countries(of 194 reporting)had fully introduced the HPV vaccine into their national schedules as of 20242.After COVID-19 pandemic disruptions,global coverage is again increasing.展开更多
In order to evaluate the performance of a molecular Hain line probe assay （Hain LPA） for rapid detection of rifampicin and isoniazid resistance of Mycobocterium tuberculosis in China, 1612 smear positive patients we...In order to evaluate the performance of a molecular Hain line probe assay （Hain LPA） for rapid detection of rifampicin and isoniazid resistance of Mycobocterium tuberculosis in China, 1612 smear positive patients were consecutively enrolled in this study. Smear positive sputum specimens were collected for Hain LPA and conventional drug susceptibility testing （DST）. The sensitivity and specificity of Hain LPA were analyzed by using conventional DST as golden reference. The sensitivity, specificity, positive predictive value {PPV） and negative predictive value （NPV） for rifampicin resistance detection were 88.33%, 97.66%, 81.54%, and 98.62%, respectively. The sensitivity, specificity, PPV and NPV for isoniazid resistance detection were 80.25%, 98.07%, 87.25%, and 96.78%, respectively. These findings suggested that Hain LPA can be an effective method worthy of broader use in China.展开更多
Background: Behind every great system is an organized team;this is especially true in the healthcare industry, where a dedicated human resources team can effectively recruit employees, train staff, and implement safet...Background: Behind every great system is an organized team;this is especially true in the healthcare industry, where a dedicated human resources team can effectively recruit employees, train staff, and implement safety measures in the workplace. The importance of human resources in the healthcare industry cannot be overstated, with benefits ranging from providing an orderly and effectively run facility to equipping staff with the most accurate and up-to-date training. Proper human resources management is critical in providing high-quality health care. A refocus on human resources management in healthcare requires more research to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes and access to health care worldwide. Methods: This study leveraged NOI Polls census data on Health Facility Assessment for Lagos State. One thousand two hundred fifty-six health care facilities were assessed in Lagos State;numbers of Health workers were documented alongside their area of specialization. Also, demographic characterizations of the facilities, such as LGA, Ownership type, Facility Level Care, and Category of the facility, were also documented. Descriptive statistics alongside cross tabulation was done to present the various area of specialization of the health workers. Multiple response analysis was done to understand the distribution of human resources across the health facilities. At the same time, Chi-square and correlation tests were conducted to test the independence of various categories recorded while understanding the relationships among selected specialties. Results: The study revealed that Nurses were the most common health specialist in the Lagos State health facilities. At the same time, Gynecologists and General surgeons are the two medical specialists mostly common in health facilities. Midwives are the second most common health specialist working full time, while Generalist medical doctors make up the top three health specialists working full time. Nurses and Midwives had the highest number in Lagos State, while Pulmonologists were currently the lowest human resource available in Lagos State health care system. It was also noted that health facility distribution across Lagos’s urban and rural areas was even. In contrast, distribution based on other factors such as ownership type, Facility level of care, and facility category was slightly skewed. Conclusion: The distribution of health workers in health facility across LGA in Lagos State depend on Ownership type, Facility level of care, and category of the facility.展开更多
Background:One Health is an integrated concept of health that aims to optimize the health of humans,animals,plants,and the environment.Identifying research gaps and specific expertise areas is important for understand...Background:One Health is an integrated concept of health that aims to optimize the health of humans,animals,plants,and the environment.Identifying research gaps and specific expertise areas is important for understanding the role of One Health in practice.This information on One Health could be used to promote collaboration and research,inspire innovative ideas,and accelerate the translation of evidence-based practices into policies.Methods:We searched the Scopus database for publications related to One Health between 2012 and 2021 to extract bibliometric information and investigate the possibility of establishing a dedicated expertise database.We matched scholarly information using SciVal to exclude duplicate information and identify scholars’affiliations,countries,and academic profiles.Individual academic contributions to One Health were evaluated according to their citations,publication impact,publication type,and author contributions.Results:A total of 8,313 publications on One Health over a ten-year period were identified,with the number of publications increasing over time.The largest number of publications came from the United States and the United Kingdom.These countries also had the highest number of experts and a high level of international collaboration.We identified 500 scholars from 53 countries and 313 affiliations with a median Hirsch Index of 20 who could be included in a One Health expert database.These scientists had a median of six publications on One Health,with topics mostly focusing on dengue and antimicrobial resistance.Conclusion:A One Health information database could be used as a third-party reference for scholars,a source to track the ongoing academic progress,and support for active scholars in this field of research.展开更多
Following publication of the original article[1],it was found the number of countries with identified One Health publications was incorrectly shown in Table 2,Supplementary data-Multimedia component 3(Table-S2),corres...Following publication of the original article[1],it was found the number of countries with identified One Health publications was incorrectly shown in Table 2,Supplementary data-Multimedia component 3(Table-S2),corresponding text and Fig.3,which should be corrected to 178.The number of countries with 500 One Health experts identified should be corrected to 53 in the abstract.展开更多
Background: Waste generation and its disposal is an essential issue in the sustainability of the environment and the planet’s future. Waste management is essential across sectors, likewise the health sector. Therefor...Background: Waste generation and its disposal is an essential issue in the sustainability of the environment and the planet’s future. Waste management is essential across sectors, likewise the health sector. Therefore, there is a need to employ extra care and attention to handling waste generated from healthcare facilities to avoid the dangers of poor biomedical waste management. We carried out this study to examine the waste management practice in healthcare facilities in Lagos State. Methods: The study was a descriptive survey carried out in one-thousand two hundred and fifty-six (1256) healthcare facilities in Lagos State. Nine hundred sixty-nine (969) of these facilities are located in urban areas, while two hundred and eighty-seven (287) are rural. The facilities studied are government/public health facilities (15.45%), private-for-profit facilities (82.88%), NGOs, Mission/Faith-Based medical facilities (1.67%). The data collected were analyzed using descriptive statistics. Specifically, we utilized bar charts, frequency, and percentage. Result: The result shows that 98.4% (1236) of the studied facilities are registered with the Lagos State Waste Management Authority (LAWMA), while 1.6% (20) are not registered. 98.5% (191) of the 194 government-owned facilities, 98.5% (1025) of the 1041 private-for-profit facilities, and 98.2% (20) of the 21 NGOs/faith-based health facilities are registered with Lagos State Waste Management Authority. The result also shows that 94% of the healthcare facilities studied in Lagos State use color-coded waste bags to segregate waste at the point of origin. 58.7% of the facilities use red-colored bags, 33.3% use yellow-colored bags, 10.7% use black-colored bags, and 1.3% use brown biohazard bags for segregating Infectious waste. Also, 34.2% of the health facilities in Lagos state use red-colored bags, 36.9% use yellow-colored bags, 11% use black-colored bags, and 4.1% use brown-colored bags to segregate their hazardous waste. Conclusion: Some healthcare facilities in Lagos State do not follow the recommended guidelines for medical waste segregation. Waste generated is not appropriately segregated at the point of origin into the recommended colored bags/bins in some facilities. Thus, a policy and procedure regulating healthcare waste are mandatory. It is important to regularly train healthcare workers on proper waste management practices and encourage staff to read and apply WHO rules in managing healthcare waste. Healthcare personnel should realize that hazardous material is a potential cause of a public disaster.展开更多
Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge...Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.展开更多
While economists talk about Africa＇s demographic dividend, Bill Gates, Co-chair of the Bill ＆ Melinda Gates Foundation, regards the continent＇s young population as vital for its growth because of their power to inn...While economists talk about Africa＇s demographic dividend, Bill Gates, Co-chair of the Bill ＆ Melinda Gates Foundation, regards the continent＇s young population as vital for its growth because of their power to innovate without being bogged down by the limits of the past. At the 14th Nelson Mandela Annual Lecture in Pretoria on July 17, he spoke about how Africa can harness its youth dynamism. An exclusive excerpt of his remarks follows：展开更多
Diarrheal disease is a leading cause of morbidity and mortality in young children.Water,sanitation,and hygiene(WASH)improvements have historically been responsible for major public health gains,but many individual int...Diarrheal disease is a leading cause of morbidity and mortality in young children.Water,sanitation,and hygiene(WASH)improvements have historically been responsible for major public health gains,but many individual interventions have failed to consistently reduce diarrheal disease burden.Analytical tools that can estimate the potential impacts of individual WASH improvements in specific contexts would support program managers and policymakers to set targets that would yield health gains.We developed a disease transmission model to simulate an intervention trial with a single intervention.We accounted for contextual factors,including preexisting WASH conditions and baseline disease prevalence,as well as intervention WASH factors,including community coverage,compliance,efficacy,and the intervenable fraction of transmission.We illustrated the sensitivity of intervention effectiveness to the contextual and intervention factors in each of two plausible disease transmission scenarios with the same disease transmission potential and intervention effectiveness but differing baseline disease burden and contextual/intervention factors.Whether disease elimination could be achieved through a single factor depended on the values of the other factors,so that changes that could achieve disease elimination in one scenario could be ineffective in the other scenario.Community coverage interacted strongly with both the contextual and the intervention factors.For example,the positive impact of increasing intervention community coverage increased non-linearly with increasing intervention compliance.With lower baseline disease prevalence in Scenario 1(among other differences),our models predicted substantial reductions could be achieved with relatively low coverage.In contrast,in Scenario 2,where baseline disease prevalence was higher,high coverage and compliance were necessary to achieve strong intervention effectiveness.When developing interventions,it is important to account for both contextual conditions and the intervention parameters.Our mechanistic modeling approach can provide guidance for developing locally specific policy recommendations.展开更多
This paper introduces the background,aim and objectives of the project entitled“China—the Gates Foundation Collaboration on TB Control in China”that has been underway for many years.It also summarizes the key findi...This paper introduces the background,aim and objectives of the project entitled“China—the Gates Foundation Collaboration on TB Control in China”that has been underway for many years.It also summarizes the key findings of the nine papers included in this special issue,which used data from the baseline survey of Phase II of the project.Data were collected from the survey of TB and MDR-TB patients,from designated hospitals,health insurance agencies and the routine health information systems,as well as key informant interviews and focus group discussions with relevant key stakeholders.Key issues discussed in this series of papers include the uses of TB services and anti-TB medicines and their determining factors related to socio-economic and health systems development;expenditures on TB care and the financial burden incurred on TB patients;and the impact of health insurance schemes implemented in China on financial protection.展开更多
Background:China has recently adopted the“TB designated hospital model”to improve the quality of tuberculosis(TB)treatment and patient management.Considering that inpatient service often results in high patient fina...Background:China has recently adopted the“TB designated hospital model”to improve the quality of tuberculosis(TB)treatment and patient management.Considering that inpatient service often results in high patient financial burden,and therefore influences patient adherence to treatment,it is critical to better understand the TB patient admission rate and TB inpatient service cost,as well as their influential factors in this new model.Methods:Quantitative and qualitative studies were conducted in two cities,Hanzhong in Shaanxi Province and Zhenjiang in Jiangsu Province,in China.Quantitative data were obtained from a sample survey of 533 TB patients and TB inpatient records from 2010–2012 in six county designated hospitals.Qualitative information was obtained through interviews with key stakeholders(40 key informant interviews,14 focus group discussions)and reviews of health policy documents in study areas.Both univariate and multivariate statistical analyses were applied for the quantitative analysis,and the thematic framework approach was applied for the qualitative analysis.Results:The TB patient admission rates in Zhenjiang and Hanzhong were 54.8 and 55.9%,respectively.Qualitative analyses revealed that financial incentives,misunderstanding of infectious disease control and failure of health insurance regulations were the key factors associated with the admission rates and medical costs.Quantitative analyses found differences in hospitalization rate existed among patients with different health insurance and patients from different counties.Average medical costs for TB inpatients in Jurong and Zhenba were 7,215 CNY and 4,644 CNY,which was higher than the 5,500 CNY and 3,800 CNY limits set by the New Rural Cooperative Medical System.No differences in medical cost or length of stay were found between patients with and without comorbidities in county-level hospitals.Conclusions:TB patient admission rates and inpatient service costs were relatively high.Studies of related factors indicated that a package of interventions,including health education programs,reform of health insurance regulations and improvement of TB treatment guidelines,are urgently required to ensure that TB patients receive appropriate care.展开更多
Summary What is already known on this topic?The coronavirus disease 2019(COVID-19)pandemic has disrupted the tuberculosis(TB)service system.However,the impact on TB patients in China remains unknown.What is added by t...Summary What is already known on this topic?The coronavirus disease 2019(COVID-19)pandemic has disrupted the tuberculosis(TB)service system.However,the impact on TB patients in China remains unknown.What is added by this report?This report firstly addressed the impact of COVID-19 on TB patients in China.About half of TB patients did not revisit the hospital due to personal reasons.The reasons for irregular medication and postponing or cancelling examination after full treatment course were different.展开更多
Background:In response to the high financial burden of health services facing tuberculosis(TB)patients in China,the China-Gates TB project,PhaseⅡ,has implemented a new financing and payment model as an important comp...Background:In response to the high financial burden of health services facing tuberculosis(TB)patients in China,the China-Gates TB project,PhaseⅡ,has implemented a new financing and payment model as an important component of the overall project in three cities in eastern,central and western China.The model focuses on increasing the reimbursement rate for TB patients and reforming provider payment methods by replacing fee-for-service with a case-based payment approach.This study investigated changes in out-of-pocket(OOP)health expenditure and the financial burden on TB patients before and after the interventions,with a focus on potential differential impacts on patients from different income groups.Methods:Three sample counties in each of the three prefectures:Zhenjiang,Yichang and Hanzhong were chosen as study sites.TB patients who started and completed treatment before,and during the intervention period,were randomly sampled and surveyed at the baseline in 2013 and final evaluation in 2015 respectively.OOP health expenditure and percentage of patients incurring catastrophic health expenditure(CHE)were calculated for different income groups.OLS regression and Iogit regression were conducted to explore the intervention's impacts on patient OOP health expenditure and financial burden after adjusting for other covariates.Key-informant interviews and focus group discussions were conducted to understand the reasons for any observed changes.Results:Data from 738(baseline)and 735(evaluation)patients were available for analysis.Patient mean OOP health expenditure increased from RMB 3576 to RMB 5791,and the percentage of patients incurring CHE also increased after intervention.The percentage increase in OOP health expenditure and the likelihood of incurring CHE were significantly lower for patients from the highest income group as compared to the lowest.Qualitative findings indicated that increased use of health services not covered by the standard package of the model was likely to have caused the increase in financial burden.Conclusions:The implementation of the new financing and payment model did not protect patients,especially those from the lowest income group,from financial difficulty,due partly to their increased use of health service.More financial resources should be mobilized to increase financial protection,particularly for poor patients,while cost containment strategies need to be developed and effectively implemented to improve the effective coverage of essential healthcare in China.展开更多
Background:China’s national tuberculosis control program(NTP)provides free,first-line anti-tuberculosis(TB)drugs to pulmonary TB patients.This treatment regimen follows the World Health Organization’s(WHO)guideline....Background:China’s national tuberculosis control program(NTP)provides free,first-line anti-tuberculosis(TB)drugs to pulmonary TB patients.This treatment regimen follows the World Health Organization’s(WHO)guideline.The objective of this paper is to evaluate the current status of anti-TB drug use for newly diagnosed pulmonary TB inpatients treated in prefecture-and county-level designated hospitals.Methods:Three prefecture-level hospitals and nine county-level hospitals were selected for the study.All newly diagnosed pulmonary TB inpatient medical records from 2012 were reviewed and doubly examined by two national senior physicians.The rational use of anti-TB drugs was evaluated based on criteria in line with WHO’s guideline.Results:Of the 2,060 total treatment regimens for TB,53.1%were found to be rational(1093/2060).The percentages in prefecture-level and county-level hospitals were 50.3%(761/1513)and 60.7%(332/547),respectively.The difference between the two levels of hospitals was statistically significant(Chi-square value=17.44,P<0.01).The percentages of rational treatment regimens for first-time hospitalizations and for two or more hospitalizations were 59.5%(983/1653)and 27.0%(110/407),respectively,with a statistically significant difference(Chi-square value=138.00,P<0.01).The overall use of second-line drugs(SLD)was 54.9%(1131/2060).The percentages for prefecture-level and county-level hospitals were 50.6%(766/1513)and 66.7%(365/547),respectively.A statistically significant difference was found(Chi-square value=42.06,P<0.01).The use of SLD for inpatients hospitalized once and inpatients hospitalized twice or more was 58.4%(966/1653)and 40.5%(165/407),respectively,with a statistically significant difference(Chi-square value=42.26,P<0.01).Conclusions:Half of inpatients might be treated with irrational regimens,and the use of SLD was more appropriately dispensed in city-level hospitals than in county-level hospitals.Trainings and guidelines for health personnel,supervision led by health authorities and increased investment to designated hospitals may help to improve the rational use of anti-TB drugs.展开更多
One of the best kept secrets in global public health ishow China achieved the tuberculosis(TB)targets inthe United Nation’s Millennium Development Goals(MDG).The MDG’s TB targets were to reduce theprevalence and mor...One of the best kept secrets in global public health ishow China achieved the tuberculosis(TB)targets inthe United Nation’s Millennium Development Goals(MDG).The MDG’s TB targets were to reduce theprevalence and mortality of TB by 50%between 1990and 2015.By 2010,China had reduced its TBprevalence and mortality by 65%and 80%,(1−2)which meant China exceeded the MDG targets 5 yearsbefore the MDG deadline.展开更多
What is already known about this topic?China’s national health information system provides important support and means for deepening the country’s medical and health reform,for improving relevant delivery services,f...What is already known about this topic?China’s national health information system provides important support and means for deepening the country’s medical and health reform,for improving relevant delivery services,for enhancing the level of scientific management of health,and for promoting the goal of basic medical and health services for everyone in China.What is added by this report?To further the construction of the national health information system,the National Center for Tuberculosis Control and Prevention of China CDC,started a pilot project for a new tuberculosis(TB)integrated health(iHealth)surveillance system,which was integrated with regional health information platforms.The goal was to explore automatic data exchange between hospitals and disease control facilities to reduce the workload of data-entry.What are the implications for public health practice?This pilot proved that data sharing and automatic exchanges between different information systems can be achieved through a unified surveillance dataset,which could provide a reference point for the construction of surveillance systems for other infectious diseases or for the entire public health information system.展开更多
Tuberculosis(TB)is one of the main infectious diseases to simultaneously cause poverty and be caused by poverty.Reducing the economic burden of TB patients in China is essential to improving patient compliance and red...Tuberculosis(TB)is one of the main infectious diseases to simultaneously cause poverty and be caused by poverty.Reducing the economic burden of TB patients in China is essential to improving patient compliance and reducing the impact of the TB epidemic.In accordance with the national reform of the medical and health system and the current status of the country’s TB prevention and treatment service system,representatives of the government proposed the concept of a multichannel financing mechanism.展开更多
Background Immunization is a cornerstone of public health.Despite great success,China’s National Immunization Program(NIP)faces challenges,such as the integration of several World Health Organization-recommended vacc...Background Immunization is a cornerstone of public health.Despite great success,China’s National Immunization Program(NIP)faces challenges,such as the integration of several World Health Organization-recommended vaccines and other systemic issues.The Innovation Laboratory for Vaccine Delivery Research(VaxLab),supported by the Bill&Melinda Gates Foundation and established in 2021 at Duke Kunshan University,focuses on enhancing China’s NIP through research and policy advocacy.This editorial aims to summarize the key findings of the manuscripts published in the collection contributed by VaxLab team and set the future research agenda.Key findings The collection contains eleven manuscripts discussing China’s immunization landscape and strategies to improve coverage,particularly for non-NIP vaccines like human papillomavirus vaccine(HPV),pneumococcal conjugate vaccine(PCV),Haemophilus influenzae type b vaccine(Hib),and rotavirus vaccines.Key findings include:(i)The COVID-19 vaccination campaign demonstrated China’s capacity for rapid,large-scale immunization efforts,suggesting potential for broader vaccine coverage improvements;(ii)Efforts in combating cervical cancer through the HPV vaccine indicate progress but also highlight challenges like vaccine supply and equitable access;(iii)The lag in adopting higher-valent paediatric combination vaccines in China needs attention to address regulatory and health system hurdles;(iv)Disparities in access to non-NIP vaccines underscore the need for government initiatives to improve vaccine coverage,especially for remote areas and marginalized populations;(v)Original studies emphasize the influence of caregivers’knowledge,health workers’financial incentives,and concerns about vaccine efficacy on immunization rates;(vi)Case studies from the Weifang City of China and Indonesia to introduce PCV offer insights on successful vaccine introduction strategies and the impact of innovative financing and government support.Conclusion The articles emphasize the need for government leadership,strategic policymaking,and public awareness to enhance vaccine coverage and equity.The VaxLab will continue strengthening China’s NIP by focusing on vaccine financing,emphasizing diversity,equity,and inclusion,and improving maternal vaccination coverage.Research will extend to Southeast Asian and Western Pacific regions,especially in middle-income countries facing challenges in vaccine financing and delivery.The collective efforts outlined in this collection show a commitment to evolving and adapting immunization strategies to meet global health goals and to provide equitable access to vaccines for all.展开更多
This paper uses Covasim,an agent-based model(ABM)of COVID-19,to evaluate and scenarios of epidemic spread in New York State(USA)and the UK.Epidemiological parameters such as contagiousness(virus transmission rate),ini...This paper uses Covasim,an agent-based model(ABM)of COVID-19,to evaluate and scenarios of epidemic spread in New York State(USA)and the UK.Epidemiological parameters such as contagiousness(virus transmission rate),initial number of infected people,and probability of being tested depend on the region's demographic and geographical features,the containment measures introduced;they are calibrated to data about COVID-19 spread in the region of interest.At the first stage of our study,epidemiological data(numbers of people tested,diagnoses,critical cases,hospitalizations,and deaths)for each of the mentioned regions were analyzed.The data were characterized in terms of seasonality,stationarity,and dependency spaces,and were extrapolated using machine learning techniques to specify unknown epidemiological parameters of the model.At the second stage,the Optuna optimizer based on the tree Parzen estimation method for objective function minimization was applied to determine the model's unknown parameters.The model was validated with the historical data of 2020.The modeled results of COVID-19 spread in New York State and the UK have demonstrated that if the level of testing and containment measures is preserved,the number of positive cases in New York State remain the same during March of 2021,while in the UK it will reduce.展开更多
文摘Introduction Human papillomavirus(HPV)vaccination is a cornerstone of cervical cancer prevention,particularly in low-and middle-income countries(LMICs),where the burden of disease remains high~1.The World Health Organization(WHO)HPV Vaccine Introduction Clearing House reported that 147 countries(of 194 reporting)had fully introduced the HPV vaccine into their national schedules as of 20242.After COVID-19 pandemic disruptions,global coverage is again increasing.
基金supported by Bill&Melinda Gates Foundation Tuberculosis Prevention and Control Project(2009-04-01)
文摘In order to evaluate the performance of a molecular Hain line probe assay （Hain LPA） for rapid detection of rifampicin and isoniazid resistance of Mycobocterium tuberculosis in China, 1612 smear positive patients were consecutively enrolled in this study. Smear positive sputum specimens were collected for Hain LPA and conventional drug susceptibility testing （DST）. The sensitivity and specificity of Hain LPA were analyzed by using conventional DST as golden reference. The sensitivity, specificity, positive predictive value {PPV） and negative predictive value （NPV） for rifampicin resistance detection were 88.33%, 97.66%, 81.54%, and 98.62%, respectively. The sensitivity, specificity, PPV and NPV for isoniazid resistance detection were 80.25%, 98.07%, 87.25%, and 96.78%, respectively. These findings suggested that Hain LPA can be an effective method worthy of broader use in China.
文摘Background: Behind every great system is an organized team;this is especially true in the healthcare industry, where a dedicated human resources team can effectively recruit employees, train staff, and implement safety measures in the workplace. The importance of human resources in the healthcare industry cannot be overstated, with benefits ranging from providing an orderly and effectively run facility to equipping staff with the most accurate and up-to-date training. Proper human resources management is critical in providing high-quality health care. A refocus on human resources management in healthcare requires more research to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes and access to health care worldwide. Methods: This study leveraged NOI Polls census data on Health Facility Assessment for Lagos State. One thousand two hundred fifty-six health care facilities were assessed in Lagos State;numbers of Health workers were documented alongside their area of specialization. Also, demographic characterizations of the facilities, such as LGA, Ownership type, Facility Level Care, and Category of the facility, were also documented. Descriptive statistics alongside cross tabulation was done to present the various area of specialization of the health workers. Multiple response analysis was done to understand the distribution of human resources across the health facilities. At the same time, Chi-square and correlation tests were conducted to test the independence of various categories recorded while understanding the relationships among selected specialties. Results: The study revealed that Nurses were the most common health specialist in the Lagos State health facilities. At the same time, Gynecologists and General surgeons are the two medical specialists mostly common in health facilities. Midwives are the second most common health specialist working full time, while Generalist medical doctors make up the top three health specialists working full time. Nurses and Midwives had the highest number in Lagos State, while Pulmonologists were currently the lowest human resource available in Lagos State health care system. It was also noted that health facility distribution across Lagos’s urban and rural areas was even. In contrast, distribution based on other factors such as ownership type, Facility level of care, and facility category was slightly skewed. Conclusion: The distribution of health workers in health facility across LGA in Lagos State depend on Ownership type, Facility level of care, and category of the facility.
基金supported by Bill&Melinda Gates Foundation(No.INV-046218).
文摘Background:One Health is an integrated concept of health that aims to optimize the health of humans,animals,plants,and the environment.Identifying research gaps and specific expertise areas is important for understanding the role of One Health in practice.This information on One Health could be used to promote collaboration and research,inspire innovative ideas,and accelerate the translation of evidence-based practices into policies.Methods:We searched the Scopus database for publications related to One Health between 2012 and 2021 to extract bibliometric information and investigate the possibility of establishing a dedicated expertise database.We matched scholarly information using SciVal to exclude duplicate information and identify scholars’affiliations,countries,and academic profiles.Individual academic contributions to One Health were evaluated according to their citations,publication impact,publication type,and author contributions.Results:A total of 8,313 publications on One Health over a ten-year period were identified,with the number of publications increasing over time.The largest number of publications came from the United States and the United Kingdom.These countries also had the highest number of experts and a high level of international collaboration.We identified 500 scholars from 53 countries and 313 affiliations with a median Hirsch Index of 20 who could be included in a One Health expert database.These scientists had a median of six publications on One Health,with topics mostly focusing on dengue and antimicrobial resistance.Conclusion:A One Health information database could be used as a third-party reference for scholars,a source to track the ongoing academic progress,and support for active scholars in this field of research.
文摘Following publication of the original article[1],it was found the number of countries with identified One Health publications was incorrectly shown in Table 2,Supplementary data-Multimedia component 3(Table-S2),corresponding text and Fig.3,which should be corrected to 178.The number of countries with 500 One Health experts identified should be corrected to 53 in the abstract.
文摘Background: Waste generation and its disposal is an essential issue in the sustainability of the environment and the planet’s future. Waste management is essential across sectors, likewise the health sector. Therefore, there is a need to employ extra care and attention to handling waste generated from healthcare facilities to avoid the dangers of poor biomedical waste management. We carried out this study to examine the waste management practice in healthcare facilities in Lagos State. Methods: The study was a descriptive survey carried out in one-thousand two hundred and fifty-six (1256) healthcare facilities in Lagos State. Nine hundred sixty-nine (969) of these facilities are located in urban areas, while two hundred and eighty-seven (287) are rural. The facilities studied are government/public health facilities (15.45%), private-for-profit facilities (82.88%), NGOs, Mission/Faith-Based medical facilities (1.67%). The data collected were analyzed using descriptive statistics. Specifically, we utilized bar charts, frequency, and percentage. Result: The result shows that 98.4% (1236) of the studied facilities are registered with the Lagos State Waste Management Authority (LAWMA), while 1.6% (20) are not registered. 98.5% (191) of the 194 government-owned facilities, 98.5% (1025) of the 1041 private-for-profit facilities, and 98.2% (20) of the 21 NGOs/faith-based health facilities are registered with Lagos State Waste Management Authority. The result also shows that 94% of the healthcare facilities studied in Lagos State use color-coded waste bags to segregate waste at the point of origin. 58.7% of the facilities use red-colored bags, 33.3% use yellow-colored bags, 10.7% use black-colored bags, and 1.3% use brown biohazard bags for segregating Infectious waste. Also, 34.2% of the health facilities in Lagos state use red-colored bags, 36.9% use yellow-colored bags, 11% use black-colored bags, and 4.1% use brown-colored bags to segregate their hazardous waste. Conclusion: Some healthcare facilities in Lagos State do not follow the recommended guidelines for medical waste segregation. Waste generated is not appropriately segregated at the point of origin into the recommended colored bags/bins in some facilities. Thus, a policy and procedure regulating healthcare waste are mandatory. It is important to regularly train healthcare workers on proper waste management practices and encourage staff to read and apply WHO rules in managing healthcare waste. Healthcare personnel should realize that hazardous material is a potential cause of a public disaster.
文摘Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.
文摘While economists talk about Africa＇s demographic dividend, Bill Gates, Co-chair of the Bill ＆ Melinda Gates Foundation, regards the continent＇s young population as vital for its growth because of their power to innovate without being bogged down by the limits of the past. At the 14th Nelson Mandela Annual Lecture in Pretoria on July 17, he spoke about how Africa can harness its youth dynamism. An exclusive excerpt of his remarks follows：
基金funded by the Bill&Melinda Gates Foundation(grant INV-005081)the National Science Foundation(grant DMS-1853032).
文摘Diarrheal disease is a leading cause of morbidity and mortality in young children.Water,sanitation,and hygiene(WASH)improvements have historically been responsible for major public health gains,but many individual interventions have failed to consistently reduce diarrheal disease burden.Analytical tools that can estimate the potential impacts of individual WASH improvements in specific contexts would support program managers and policymakers to set targets that would yield health gains.We developed a disease transmission model to simulate an intervention trial with a single intervention.We accounted for contextual factors,including preexisting WASH conditions and baseline disease prevalence,as well as intervention WASH factors,including community coverage,compliance,efficacy,and the intervenable fraction of transmission.We illustrated the sensitivity of intervention effectiveness to the contextual and intervention factors in each of two plausible disease transmission scenarios with the same disease transmission potential and intervention effectiveness but differing baseline disease burden and contextual/intervention factors.Whether disease elimination could be achieved through a single factor depended on the values of the other factors,so that changes that could achieve disease elimination in one scenario could be ineffective in the other scenario.Community coverage interacted strongly with both the contextual and the intervention factors.For example,the positive impact of increasing intervention community coverage increased non-linearly with increasing intervention compliance.With lower baseline disease prevalence in Scenario 1(among other differences),our models predicted substantial reductions could be achieved with relatively low coverage.In contrast,in Scenario 2,where baseline disease prevalence was higher,high coverage and compliance were necessary to achieve strong intervention effectiveness.When developing interventions,it is important to account for both contextual conditions and the intervention parameters.Our mechanistic modeling approach can provide guidance for developing locally specific policy recommendations.
基金The study based on which this paper was written is part of the program entitled“China National Health and Family Planning Commission and the Gates Foundation TB Project”-a collaboration between the Government of China and the Melinda and Bill Gates Foundation(Grant No.51914)implemented by the China Center of Disease Control and Prevention(CDC).
文摘This paper introduces the background,aim and objectives of the project entitled“China—the Gates Foundation Collaboration on TB Control in China”that has been underway for many years.It also summarizes the key findings of the nine papers included in this special issue,which used data from the baseline survey of Phase II of the project.Data were collected from the survey of TB and MDR-TB patients,from designated hospitals,health insurance agencies and the routine health information systems,as well as key informant interviews and focus group discussions with relevant key stakeholders.Key issues discussed in this series of papers include the uses of TB services and anti-TB medicines and their determining factors related to socio-economic and health systems development;expenditures on TB care and the financial burden incurred on TB patients;and the impact of health insurance schemes implemented in China on financial protection.
基金The study upon which this paper was written is part of the large program entitled“China National Health and Family Planning Commission and the Gates Foundation TB Project”-a collaboration between the Government of China and the Melinda and Bill Gates Foundation(Grant No.51914)implemented by the China Center for Disease Control and Prevention(CDC)。
文摘Background:China has recently adopted the“TB designated hospital model”to improve the quality of tuberculosis(TB)treatment and patient management.Considering that inpatient service often results in high patient financial burden,and therefore influences patient adherence to treatment,it is critical to better understand the TB patient admission rate and TB inpatient service cost,as well as their influential factors in this new model.Methods:Quantitative and qualitative studies were conducted in two cities,Hanzhong in Shaanxi Province and Zhenjiang in Jiangsu Province,in China.Quantitative data were obtained from a sample survey of 533 TB patients and TB inpatient records from 2010–2012 in six county designated hospitals.Qualitative information was obtained through interviews with key stakeholders(40 key informant interviews,14 focus group discussions)and reviews of health policy documents in study areas.Both univariate and multivariate statistical analyses were applied for the quantitative analysis,and the thematic framework approach was applied for the qualitative analysis.Results:The TB patient admission rates in Zhenjiang and Hanzhong were 54.8 and 55.9%,respectively.Qualitative analyses revealed that financial incentives,misunderstanding of infectious disease control and failure of health insurance regulations were the key factors associated with the admission rates and medical costs.Quantitative analyses found differences in hospitalization rate existed among patients with different health insurance and patients from different counties.Average medical costs for TB inpatients in Jurong and Zhenba were 7,215 CNY and 4,644 CNY,which was higher than the 5,500 CNY and 3,800 CNY limits set by the New Rural Cooperative Medical System.No differences in medical cost or length of stay were found between patients with and without comorbidities in county-level hospitals.Conclusions:TB patient admission rates and inpatient service costs were relatively high.Studies of related factors indicated that a package of interventions,including health education programs,reform of health insurance regulations and improvement of TB treatment guidelines,are urgently required to ensure that TB patients receive appropriate care.
基金The National Health Commission of China–Bill&Melinda Gates Foundation TB Collaboration Project(OPP1137180).
文摘Summary What is already known on this topic?The coronavirus disease 2019(COVID-19)pandemic has disrupted the tuberculosis(TB)service system.However,the impact on TB patients in China remains unknown.What is added by this report?This report firstly addressed the impact of COVID-19 on TB patients in China.About half of TB patients did not revisit the hospital due to personal reasons.The reasons for irregular medication and postponing or cancelling examination after full treatment course were different.
基金The whole study was funded by the Bill and Melinda Gates Foundation.
文摘Background:In response to the high financial burden of health services facing tuberculosis(TB)patients in China,the China-Gates TB project,PhaseⅡ,has implemented a new financing and payment model as an important component of the overall project in three cities in eastern,central and western China.The model focuses on increasing the reimbursement rate for TB patients and reforming provider payment methods by replacing fee-for-service with a case-based payment approach.This study investigated changes in out-of-pocket(OOP)health expenditure and the financial burden on TB patients before and after the interventions,with a focus on potential differential impacts on patients from different income groups.Methods:Three sample counties in each of the three prefectures:Zhenjiang,Yichang and Hanzhong were chosen as study sites.TB patients who started and completed treatment before,and during the intervention period,were randomly sampled and surveyed at the baseline in 2013 and final evaluation in 2015 respectively.OOP health expenditure and percentage of patients incurring catastrophic health expenditure(CHE)were calculated for different income groups.OLS regression and Iogit regression were conducted to explore the intervention's impacts on patient OOP health expenditure and financial burden after adjusting for other covariates.Key-informant interviews and focus group discussions were conducted to understand the reasons for any observed changes.Results:Data from 738(baseline)and 735(evaluation)patients were available for analysis.Patient mean OOP health expenditure increased from RMB 3576 to RMB 5791,and the percentage of patients incurring CHE also increased after intervention.The percentage increase in OOP health expenditure and the likelihood of incurring CHE were significantly lower for patients from the highest income group as compared to the lowest.Qualitative findings indicated that increased use of health services not covered by the standard package of the model was likely to have caused the increase in financial burden.Conclusions:The implementation of the new financing and payment model did not protect patients,especially those from the lowest income group,from financial difficulty,due partly to their increased use of health service.More financial resources should be mobilized to increase financial protection,particularly for poor patients,while cost containment strategies need to be developed and effectively implemented to improve the effective coverage of essential healthcare in China.
基金paper was written is part of the large program entitled“China National Health and Family Planning Commission and the Gates Foundation TB Project”-a collaboration between the Government of China and the Bill and Melinda Gates Foundation(Grant No.51914),and implemented by the China Center of Disease Control and Prevention(CDC).
文摘Background:China’s national tuberculosis control program(NTP)provides free,first-line anti-tuberculosis(TB)drugs to pulmonary TB patients.This treatment regimen follows the World Health Organization’s(WHO)guideline.The objective of this paper is to evaluate the current status of anti-TB drug use for newly diagnosed pulmonary TB inpatients treated in prefecture-and county-level designated hospitals.Methods:Three prefecture-level hospitals and nine county-level hospitals were selected for the study.All newly diagnosed pulmonary TB inpatient medical records from 2012 were reviewed and doubly examined by two national senior physicians.The rational use of anti-TB drugs was evaluated based on criteria in line with WHO’s guideline.Results:Of the 2,060 total treatment regimens for TB,53.1%were found to be rational(1093/2060).The percentages in prefecture-level and county-level hospitals were 50.3%(761/1513)and 60.7%(332/547),respectively.The difference between the two levels of hospitals was statistically significant(Chi-square value=17.44,P<0.01).The percentages of rational treatment regimens for first-time hospitalizations and for two or more hospitalizations were 59.5%(983/1653)and 27.0%(110/407),respectively,with a statistically significant difference(Chi-square value=138.00,P<0.01).The overall use of second-line drugs(SLD)was 54.9%(1131/2060).The percentages for prefecture-level and county-level hospitals were 50.6%(766/1513)and 66.7%(365/547),respectively.A statistically significant difference was found(Chi-square value=42.06,P<0.01).The use of SLD for inpatients hospitalized once and inpatients hospitalized twice or more was 58.4%(966/1653)and 40.5%(165/407),respectively,with a statistically significant difference(Chi-square value=42.26,P<0.01).Conclusions:Half of inpatients might be treated with irrational regimens,and the use of SLD was more appropriately dispensed in city-level hospitals than in county-level hospitals.Trainings and guidelines for health personnel,supervision led by health authorities and increased investment to designated hospitals may help to improve the rational use of anti-TB drugs.
文摘One of the best kept secrets in global public health ishow China achieved the tuberculosis(TB)targets inthe United Nation’s Millennium Development Goals(MDG).The MDG’s TB targets were to reduce theprevalence and mortality of TB by 50%between 1990and 2015.By 2010,China had reduced its TBprevalence and mortality by 65%and 80%,(1−2)which meant China exceeded the MDG targets 5 yearsbefore the MDG deadline.
基金funded by the National Health Commission of China-Bill&Melinda Gates Foundation TB Collaboration project(OPP1137180).
文摘What is already known about this topic?China’s national health information system provides important support and means for deepening the country’s medical and health reform,for improving relevant delivery services,for enhancing the level of scientific management of health,and for promoting the goal of basic medical and health services for everyone in China.What is added by this report?To further the construction of the national health information system,the National Center for Tuberculosis Control and Prevention of China CDC,started a pilot project for a new tuberculosis(TB)integrated health(iHealth)surveillance system,which was integrated with regional health information platforms.The goal was to explore automatic data exchange between hospitals and disease control facilities to reduce the workload of data-entry.What are the implications for public health practice?This pilot proved that data sharing and automatic exchanges between different information systems can be achieved through a unified surveillance dataset,which could provide a reference point for the construction of surveillance systems for other infectious diseases or for the entire public health information system.
基金funded by the National Health Commission of China-Bill&Melinda Gates Foundation TB Collaboration project(OPP1137180).
文摘Tuberculosis(TB)is one of the main infectious diseases to simultaneously cause poverty and be caused by poverty.Reducing the economic burden of TB patients in China is essential to improving patient compliance and reducing the impact of the TB epidemic.In accordance with the national reform of the medical and health system and the current status of the country’s TB prevention and treatment service system,representatives of the government proposed the concept of a multichannel financing mechanism.
文摘Background Immunization is a cornerstone of public health.Despite great success,China’s National Immunization Program(NIP)faces challenges,such as the integration of several World Health Organization-recommended vaccines and other systemic issues.The Innovation Laboratory for Vaccine Delivery Research(VaxLab),supported by the Bill&Melinda Gates Foundation and established in 2021 at Duke Kunshan University,focuses on enhancing China’s NIP through research and policy advocacy.This editorial aims to summarize the key findings of the manuscripts published in the collection contributed by VaxLab team and set the future research agenda.Key findings The collection contains eleven manuscripts discussing China’s immunization landscape and strategies to improve coverage,particularly for non-NIP vaccines like human papillomavirus vaccine(HPV),pneumococcal conjugate vaccine(PCV),Haemophilus influenzae type b vaccine(Hib),and rotavirus vaccines.Key findings include:(i)The COVID-19 vaccination campaign demonstrated China’s capacity for rapid,large-scale immunization efforts,suggesting potential for broader vaccine coverage improvements;(ii)Efforts in combating cervical cancer through the HPV vaccine indicate progress but also highlight challenges like vaccine supply and equitable access;(iii)The lag in adopting higher-valent paediatric combination vaccines in China needs attention to address regulatory and health system hurdles;(iv)Disparities in access to non-NIP vaccines underscore the need for government initiatives to improve vaccine coverage,especially for remote areas and marginalized populations;(v)Original studies emphasize the influence of caregivers’knowledge,health workers’financial incentives,and concerns about vaccine efficacy on immunization rates;(vi)Case studies from the Weifang City of China and Indonesia to introduce PCV offer insights on successful vaccine introduction strategies and the impact of innovative financing and government support.Conclusion The articles emphasize the need for government leadership,strategic policymaking,and public awareness to enhance vaccine coverage and equity.The VaxLab will continue strengthening China’s NIP by focusing on vaccine financing,emphasizing diversity,equity,and inclusion,and improving maternal vaccination coverage.Research will extend to Southeast Asian and Western Pacific regions,especially in middle-income countries facing challenges in vaccine financing and delivery.The collective efforts outlined in this collection show a commitment to evolving and adapting immunization strategies to meet global health goals and to provide equitable access to vaccines for all.
基金supported by the Russian Foundation for Basic Research and Royal Society(project no.21-51-10003)The agent-based mathematical model construction and analysis of numerical results(sections 3,4,5)+1 种基金supported by the Russian Science Foundation(project no.18-71-10044)the Royal Society IECyR2y202020 e International Exchanges 2020 Cost Share between UK and Russia.
文摘This paper uses Covasim,an agent-based model(ABM)of COVID-19,to evaluate and scenarios of epidemic spread in New York State(USA)and the UK.Epidemiological parameters such as contagiousness(virus transmission rate),initial number of infected people,and probability of being tested depend on the region's demographic and geographical features,the containment measures introduced;they are calibrated to data about COVID-19 spread in the region of interest.At the first stage of our study,epidemiological data(numbers of people tested,diagnoses,critical cases,hospitalizations,and deaths)for each of the mentioned regions were analyzed.The data were characterized in terms of seasonality,stationarity,and dependency spaces,and were extrapolated using machine learning techniques to specify unknown epidemiological parameters of the model.At the second stage,the Optuna optimizer based on the tree Parzen estimation method for objective function minimization was applied to determine the model's unknown parameters.The model was validated with the historical data of 2020.The modeled results of COVID-19 spread in New York State and the UK have demonstrated that if the level of testing and containment measures is preserved,the number of positive cases in New York State remain the same during March of 2021,while in the UK it will reduce.
