BMJ Global Health

ObjectiveThe purpose of this analysis was to describe national critical care capacity shortages for 52 African countries and to outline needs for each country to adequately respond to the COVID-19 pandemic. MethodsA modified SECIR compartment model was used to estimate the number of severe COVID-19 cases at the peak of the outbreak. Projections of the number of hospital beds, ICU beds, and ventilators needed at outbreak peak were generated for four scenarios - if 30, 50, 70, or 100% of patients...

The geographical area around a health facility characterizing the population that utilizes some or all of its services - a health facility catchment area (HFCA)-, forms the fundamental basis of estimating reliable population denominator for disease mapping and routine healthcare planning. Consequently, the approaches used to delineate the catchment area have a direct impact on the health of a population. To date, there is no systematic literature review documenting different approaches that have...

BackgroundEmergency Departments (EDs) are crucial to managing non-communicable diseases (NCDs), a leading cause of death, yet there is limited information about the capacity and accessibility of emergency care in Kenya. MethodsUsing data from Project 47, a national dataset on EDs, we conducted a secondary analysis to assess capacity for NCD care, as guided by the WHO Package for Essential NCD Interventions for Primary Care (WHO PEN). ResultsOf the 186 facilities included in the assessment, 45....

IntroductionThe COVID-19 pandemic will test the capacity of health systems worldwide. Health systems will need surge capacity to absorb acute increases in caseload due to the pandemic. We assessed the capacity of the Kenyan health system to absorb surges in the number of people that will need hospitalization and critical care because of the COVID-19. MethodsWe assumed that 2% of the Kenyan population get symptomatic infection by SARS-Cov-2 based on modelled estimates for Kenya and determined th...

BackgroundThe COVID-19 pandemic severely impacted health systems in several countries, including Sierra Leone, which was recovering from the 2014-2016 Ebola Virus Disease epidemic. The National Referral Service was established in 2017 followed by launching of the National Emergency Medical Services (NEMS) in 2018 to strengthen the countrys referral system as part of the post-Ebola recovery strategy. This study examined the impact of COVID-19 on the referral system and hospital bed occupancy in S...

Typhoid remains endemic in many low and middle-income countries, with the highest incidence reported in children under 15 years. No published study has estimated the cost of hospitalized paediatric typhoid cases in Kenya. This analysis estimated the direct medical, direct non-medical, and indirect costs from the healthcare provider and societal perspectives and assessed the proportion of households that would experience catastrophic health expenditure (CHE) due to the disease. Patient-level dat...

This observational cohort study explores the association between maternal, newborn and child health care implementation strength and child survival in rural Tanzania from 2011-2015. We used data from a 2011 service availability and readiness assessment that quantified primary health care facilities ability to implement maternal, newborn and child health services and a population-level household survey that measured the utilization of such services to develop domain-specific summary measures of t...

BackgroundHuman-caused climate change is already increasing the intensity and frequency of extreme weather events, such as droughts. The health and economic consequences of these events are expected to be particularly severe for populations in low-income settings whose livelihoods rely on rain-fed agriculture. Within these populations, children are an especially vulnerable group, as undernutrition is linked to 45% of all child deaths across the globe. Despite progress, adaptation gaps exist. We ...

BackgroundThe Covid-19 pandemic led to widespread changes to health and social institutions. The effects of the pandemic on neonatal and infant health outcomes in low- and middle-income countries (LMICs) are poorly understood, and nationally representative data characterizing changes to health care and outcomes is only now emerging. MethodsWe used nationally representative survey data with vital status and perinatal care information on 2,959,203 children born in India, Madagascar, Cambodia, Nep...

BackgroundRecent shifts in the global health funding landscape--most notably the dismantling of the United States Agency for International Development (USAID) and possible reduced contributions to the Global Fund to Fight AIDS, TB and Malaria (Global Fund)-- threaten essential tuberculosis (TB) services in low- and middle-income countries (LMICs). We quantified the potential impact on the household economic burden of TB. MethodsWe used linked epidemiological and economic models, calibrated to 7...

BackgroundThe first case of COVID-19 in sub-Saharan Africa (SSA) was reported by Nigeria on February 27, 2020. While case counts in the entire region remain considerably less than those being reported by individual countries in Europe, Asia, and the Americas, SSA countries remain vulnerable to COVID morbidity and mortality due to systemic healthcare weaknesses, less financial resources and infrastructure to address the new crisis, and untreated comorbidities. Variation in preparedness and respon...

BackgroundVulnerable children from poor communities with high HIV and Tuberculosis(TB) burdens were impacted by COVID-19 lockdowns. Concern was raised about the extent of this impact and anticipated post-pandemic surges in mortality. MethodsInterrupted time series segmented regression analyses were done using routinely collected facility-level data of children admitted for medical conditions at four South African referral hospitals. Monthly admission and mortality data over a 60-month period fr...

Measles is endemic in Kenya, mainly affecting young children, with low vaccination coverage leading to recurrent outbreaks. No published study has estimated the cost of treating hospitalised paediatric measles patients in Kenya. This study quantified the cost of treating measles from the healthcare provider and societal perspectives, identified the main cost drivers, and assessed the proportion of households likely to experience catastrophic health expenditure due to the disease. A retrospectiv...

BackgroundAs one of the worlds most powerful international financial organisations, the International Monetary Fund (IMF) is uniquely positioned to shape global developmental trajectories by influencing domestic policy arrangements. However, its role in shaping population health is understudied. MethodsWe use previously unavailable cross-national time-series data and an instrumental-variables method to examine the causal impact of the IMFs structural adjustment programmes on age-standardised al...

BackgroundHalf of global child deaths occur in sub-Saharan Africa. Understanding child mortality patterns and risk factors will help inform interventions to reduce this heavy toll. The Nanoro Health and Demographic Surveillance System (HDSS), Burkina Faso was described previously, but spatial patterns of child mortality in the district had not been studied. Similar studies in other districts indicated accessibility to health facilities as a risk factor, usually without distinction between facili...

BackgroundAfricas changing climate heightens risk of disease outbreaks with impacts on vulnerable demographics already encumbered by health and socioeconomic burdens. Health preparedness policies to address disease outbreaks rely on integrated information systems and value-for-cost analysis to facilitate sound decision-making during a public health emergency. This rapid scoping review protocol describes the a priori objectives and methods to conduct a synthesis of the evidence on economic evalua...

BackgroundThe Kilifi Health and Demographic Surveillance System (KHDSS) was established in 2000 to define the incidence and prevalence of local diseases and evaluate the impact of community-based interventions. KHDSS morbidity data have been reported comprehensively but mortality has not been described. This analysis describes mortality in the KHDSS over 16 years. MethodsWe calculated mortality rates from 2003-2018 in four intervals of equal duration and assessed differences in mortality across...

BackgroundCoronavirus disease 2019 (COVID-19) epidemics strain health systems and households. Health systems in Africa and South Asia may be particularly at risk due to potential high prevalence of risk factors for severe disease, large household sizes and limited healthcare capacity. MethodsWe investigated the impact of an unmitigated COVID-19 epidemic on health system resources and costs, and household costs, in Karachi, Delhi, Nairobi, Addis Ababa and Johannesburg. We adapted a dynamic model...

During outbreaks women struggle with access to essential health services, including for violence. Services may be disrupted or deprioritised, or women may avoid clinical settings. We conducted a scoping review to understand how health services for violence against women (VAW) were affected in low- and middle-income (LMIC) settings during recent outbreaks, and womens help-seeking for violence. We reviewed published academic literature reporting on primary research from LMIC settings during recent...

Much attention has focussed in recent months on the impact that COVID-19 has on health sector capacity, including critical care bed capacity and resources such as personal protective equipment. However, much less attention has focussed on the overall cost to health sectors, including the full human resource costs and the health system costs to address the pandemic. Here we present estimates of the total costs of COVID-19 response in low- and middle-income countries for different scenarios of COV...