BMJ Global Health

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....

The Global Polio Eradication Initiative (GPEI) is known to be one of the most successful disease eradication initiatives with massive reductions in polio transmission as well as its contributions to strengthening health systems and capacity building. Existing analyses provide limited insight into how capacity was developed, which forms of capacity were strengthened or neglected, and how these efforts were experienced by implementers. Understanding these factors can be helpful as GPEI accelerates...

BackgroundMaternal immunization (MI) can prevent major infectious diseases in mothers and children by boosting the immunity of pregnant women. Antenatal care (ANC) delivery platforms could be leveraged to effectively provide MI. Adding MIs into ANC could potentially enhance ANC services, positively influencing both maternal and infant health outcomes and yielding broader benefits. We model these potential ANC-mediated health benefits in five low- and middle-income countries: Ethiopia, Ghana, Ken...

The Sepsis Prevention in Neonates in Zambia (SPINZ) trial was a prospective observational cohort study conducted in the neonatal intensive care unit of the University Teaching Hospital in Lusaka, Zambia. Introduction of an infection prevention and control (IPC) bundle reduced hospital-associated mortality, total mortality, suspected sepsis, and confirmed bloodstream infections. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness in this low-resource settin...

BackgroundMalaria transmission in Uganda is heterogenous, so the national malaria program needs information about the distribution of malaria to develop appropriate policies. While population-based community surveys estimate Plasmodium falciparum parasite rate (PfPR), they are too infrequent and sparse for routine malaria management. Health facility data is routinely collected and covers a large geographic scope, but the data is collected passively, variable in quality, and potentially highly bi...

India carries a high burden of neglected tropical diseases (NTDs), yet the extent to which essential diagnostic services align with local disease burden across public health facilities remains unclear. We conducted a cross-sectional assessment of diagnostic availability for major NTDs in 332 public health facilities across seven states and one union territory, including sub-centers, primary health centers, community health centers, and district hospitals. Diagnostic availability for malaria, den...

BackgroundDelays in tuberculosis (TB) diagnosis and treatment continue to compromise control efforts, particularly in high-burden settings such as Kenya. These delays increase transmission, worsen clinical outcomes, and elevate mortality. The post-COVID-19 period has further strained health-care systems, influencing patient health-seeking behaviour and diagnostic efficiency. Objective: To quantify patient-related and health-system-related delays in TB diagnosis and treatment and to identify key ...

BackgroundRotavirus remains a leading cause of childhood diarrhoeal hospitalisation globally. Malawi introduced the monovalent G1P8 rotavirus vaccine (Rotarix(R)) in October 2012 and in April 2016 switched from trivalent to bivalent oral poliovirus vaccine (tOPV to bOPV). More than a decade after Rotarix(R) introduction, evidence on sustained vaccine effectiveness and population-level impact in high-transmission, low-income settings remains limited, and it is uncertain whether programme changes ...

IntroductionAccess to medical oxygen remains a challenge, with 60% of the worlds population lacking access to quality oxygen services. We explored whether outsourced oxygen to the bedside (O2B), where private providers offer bundles of oxygen services, could be adopted and scaled across diverse health systems, to improve patient access to oxygen. MethodsQualitative interviews were conducted with healthcare workers (HCWs), facility management staff and district medical officers in India, Nigeri...

AbstractO_ST_ABSObjectiveC_ST_ABSTo describe the existing status and associated factors influencing the utilization of four WHO-recommended essential newborn care among mothers of infants aged 45 days to one year in rural Sidama, Ethiopia. DesignA community-based cross-sectional household survey was conducted in June and July 2023. Data were collected through interviewing mothers of infants using pretested questionnaire. Participants were selected through a multi-stage sampling. Data were analy...

BackgroundZero-dose children, defined as those who have not received a first dose of a diphtheria-pertussis-tetanus (DPT)-containing vaccine, represent one of the sharpest manifestations of inequity in immunisation systems. Nigeria remains one of the largest contributors to the global zero-dose burden, with North-East Nigeria facing intersecting crises of conflict, population displacement, governance fragility, and weakened primary health care. Existing research has largely focused on structural...

BackgroundNewborns requiring inpatient care, particularly small and sick newborns (SSNBs), face high risk of mortality. Newborns referred from other facilities may experience worse outcomes than those born and managed within the same hospital (inborn newborns). Understanding factors contributing to this disparity in outcomes could support efforts to scale-up care and accelerate progress towards achieving Sustainable Development Goals target 3.2. MethodsData on 130,773 newborns admitted to 13 ho...

This study examines the impact of the Drugs for Neglected Diseases initiative (DNDi) on health research capacity and health system strengthening in the Democratic Republic of Congo (DRC) from 2005 to 2023. Using a qualitative approach with semi-structured interviews, stakeholders and beneficiaries shared their perceptions of DNDis interventions. The analysis, grounded in an integrative model of organizational performance, found that DNDis efforts significantly enhanced clinical and operational r...

BackgroundMost births worldwide (>80%) occur in health care facilities, yet 2.3 million newborns die annually. If the know-do gap between evidence and implementation was closed, an estimated 752,000 newborn deaths could be prevented per year. To bridge this gap, we describe the co-design of the Implementation Toolkit for Small and Sick Newborn Care (Newborn Toolkit), a web platform and linked community of global implementers, facilitated by NEST360 and UNICEF. The Newborn Toolkit enables access ...

Seasonal Malaria Chemoprevention (SMC) is a promising intervention for Turkana, Northern Kenya, where malaria transmission is highly seasonal. Traditional malaria control methods, such as indoor residual spraying (IRS) and insecticide-treated nets (ITNs), are impractical due to the populations semi-nomadic lifestyle, temporary dwellings, sparse settlements, and limited access to health facilities. In 2024, following the WHOs updated guidance on SMC use, this intervention was implemented in Turka...

Low participation in public health testing can lead to biased estimates of disease prevalence and inefficient allocation of public health resources. We evaluated the impact of monetary incentives and revisits on participation in door-to-door COVID testing in rural western Kenya. We conducted a cross-sectional study of all residents in 12 villages in rural western Kenya. We offered an incentive of KSh 200 (1.85 USD), KSh 350 (3.23 USD), or KSh 700 (6.47 USD), randomized at the household level, fo...

BackgroundMaternal anaemia remains a leading cause of maternal morbidity and mortality in low- and middle-income countries (LMICs), with Nigeria bearing a disproportionate burden. Although treatment with intravenous (IV) iron formulations such as ferric carboxymaltose offer clinical advantages over oral iron, their uptake in routine maternal care in LMICs is limited. ObjectiveThis study critically assessed organisational readiness and identified context-specific facilitators and barriers to the...

BackgroundAcute respiratory infection (ARI) remains a leading cause of morbidity and mortality among children under five in Nigeria. Although polluting cooking fuels are widely considered a key risk factor, their effects may be shaped by broader socioeconomic and geographic conditions. This study examined both individual and structural determinants of ARI and assessed how these factors intersect to pattern risk. MethodsWe analysed data from 28,728 children under five in the 2024 Nigeria Demogra...

IntroductionDespite being curable, leprosy-related stigma in Pakistan persists, undermining dignity, delaying care, and hindering progress toward zero-leprosy targets. Empowerment is critical in counteracting stigma and restoring agency among affected persons. Participatory, contact-based storytelling has potential to reduce stigma and strengthen empowerment, but evidence remains limited. This study evaluates a participatory storytelling intervention involving persons affected by leprosy in Kara...

As programs for azithromycin mass drug administration to reduce child mortality have begun in some parts of West Africa, it is imperative to understand their financial costs. We combined a micro-costing framework and observations from an implementation-focused sub-study within the AVENIR trials in 80 communities in the Dosso region of Niger to estimate the national health sector costs of a scaled-up programmatic approach for azithromycin biannual distribution to children aged 1-59 months of age ...