BMJ Global Health

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...

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...

Background Persistent inequities in immunisation coverage, particularly among zero-dose and under-immunised children, continue to challenge Pakistan's Expanded Programme on Immunization. Weak feedback loop, inconsistent data quality, and limited real-time monitoring impede effective decision-making. This Implementation Research was conducted under the MAINSTREAM Initiative funded by Alliance for Health Policy and Systems Research (AHPSR) and supported by the Aga Khan Community Health Services De...

BackgroundPostnatal care is crucial for assessing and improving the health of both mothers and newborns, yet its coverage remains low in Ethiopia. Timely, high-quality postnatal care, especially within the first week after birth, is essential to reduce maternal and neonatal mortality. Family-led postnatal care is an innovative model for reaching postnatal mothers and newborns during the first week after birth. Leveraging self-care principles, mothers, with the support from family and guided by a...

Sepsis caused by drug-resistant pathogens remains a major contributor to under-five mortality in low- and middle-income countries, threatening progress toward Sustainable Development Goal (SDG) 3.2. Blood culture, the gold standard for sepsis diagnosis and antimicrobial stewardship, remains underutilised in routine pediatric care. This study assessed the extent and determinants of blood culture utilisation among hospitalised children under five years with suspected sepsis at four antimicrobial r...

BackgroundPerformance-based financing (PBF) aims to improve healthcare quality by offering financial incentives to service providers. This study evaluated PBFs impact on obstetric care quality in Nkambe Health District, Cameroon. MethodsWe employed a cross-sectional mixed-methods study from December 2016-July 2017 in PBF-implementing facilities. We surveyed 315 women attending prenatal and postnatal visits and 23 service providers using structured questionnaires. Quantitative data were analyzed...

BackgroundText messages are a low-cost digital health solution that can provide information directly to mothers. We aimed to evaluate a text message program, called Essential Coaching for Every Mother Tanzania (ECEM-TZ), designed to improve maternal access to essential newborn care education during the immediate 6-week postnatal period. MethodsA randomized controlled trial was conducted in Dar es Salaam, Tanzania. ECEM-TZ consists of standardized text messages from birth to 6 weeks postpartum t...

The recent Lancet Commission on Nigerias health system highlighted high out of pocket expenditures on health and underfunding of the public health sector as major obstacles to Nigerias achievement of the Sustainable Development Goals. Nigeria has sought to address these gaps by extending health insurance coverage. This paper measures health insurance coverage and access to care in Nigeria circa 2023, using the first round of the Peoples Voice Survey (PVS). We analyze health insurance coverage by...

Background Acute malnutrition remains a major public health challenge among children under five in Malawi due to undetected and untreated cases. While several policies and programmes are in place, they face significant resource input and implementation constraints. In this study, we evaluate the potential health impact and cost-effectiveness of three interventions designed to address constraints along the care pathway in childhood acute malnutrition management. These include improving early reco...

BackgroundIn trials, three-month weekly rifapentine and isoniazid (3HP) showed higher adherence and completion than the six-month daily isoniazid (6H) regimen for TB preventive treatment (TPT). However, programmatic outcome data remain limited. MethodologyWe evaluated the TPT cascade among people with HIV (PWH) aged >15 years newly enrolled in HIV care in western Kenya. Initiation and completion of 6H (Jan to Sept 2022) were compared to 3HP (Oct 2022-Sept 2023) using Chi-square tests. Correlate...

BackgroundLarval source management (LSM) was once central to malaria control before insecticide-treated nets and indoor residual spraying dominated. Renewed interest in LSM raises questions about its effectiveness in rural Africa, where habitats are dispersed, and vector species contribute unequally, and whether species-targeted larviciding could offer greater gains than broadcast approaches. MethodsThis modelling study quantified the potential impact of larviciding in African settings where mu...

The spread of Anopheles stephensi into the Horn of Africa represents one of the main challenges for malaria control, given the species ecological plasticity and resistance to multiple insecticides. In response to the World Health Organizations 2022 vector alert, an adaptive, model-based spatial surveillance framework was developed and evaluated to improve detection, mapping accuracy, and operational responsiveness during invasion. Adaptive surveillance utilises initial observations to guide subs...

Because of its recent regulatory approval in southern and eastern Africa, CAB PrEP represents a scientific advancement with unknown implementation costs in most African countries. To our knowledge, this paper is the first study comparing PrEP costs in health facilities where clients had a choice between three PrEP methods. We collected and analyzed the direct service delivery costs for each method using the same costing approach and assumptions at three facilities in Lesotho and six facilities i...

BackgroundHelmet use is a proven safety measure that reduces the risk of head injury among cyclists and e-scooter riders. Despite legal requirements for pedal bikes and e-bikes in Australia, compliance varies, particularly among users of electric vehicles. The growing popularity of e-bikes and e-scooters in urban areas presents new public health challenges, yet observational data on helmet use, behavioural determinants, and the effectiveness of safety interventions remain limited. AimPhase 3 of...

BackgroundSustained retention in HIV care is essential for achieving durable viral suppression and controlling the HIV epidemic. Loss to follow-up (LTFU) remains a persistent challenge in sub-Saharan Africa and shows substantial geographic variation. However, nationally representative analyses of routine monitoring data remain limited. Pharmacy refill data provide a scalable and objective approach for identifying individuals at risk of disengaging from care. We assessed the magnitude, spatial di...

BackgroundArtemisinin-based combination therapies (ACTs) are the most widely used treatment for Plasmodium falciparum malaria. Kelch 13 mutations associated with artemisinin partial resistance (ART-R) have emerged in Sub-Saharan Africa (SSA) and are now reported in an increasing number of countries. ACT treatment failure rates are at risk of unprecedented increase. To summarise existing surveillance data and guide future surveillance, we produce modelled estimates of the spatiotemporal distribut...

Despite the relevance of spatial mapping in analyzing the health situation and understanding the risk factors and determinants of leptospirosis, peripheral urban communities often remain invisible on maps, which tend to use data and methods that do not express community contribution nor promote local participation. Furthermore, in the implementation of sanitation interventions, the same happens: there is limited user participation, and a lack of identification of intervention needs based on the...

Background Antibiotic pricing is a key determinant of access and stewardship in low- and middle-income countries (LMICs), yet empirical evidence on how prices are formed within pharmaceutical markets remains limited. However, there is little longitudinal evidence on how antibiotic prices behave within national pharmaceutical supply systems. This study evaluated the patterns and determinants of systemic antibiotic pricing in Tanzania using national regulatory import permit data. Methods We conduc...

Background: Type 2 diabetes is a growing challenge in low- and middle-income countries, where health systems face major capacity gaps. Participatory learning and action (PLA) has shown effectiveness in preventing type 2 diabetes in Bangladesh, but little is known about its use in other LMICs for diabetes. The EMPOWER-D (Engagement of community through Participatory learning and action for cOntrol and prevention of type 2 diabetes) trial is testing PLA for diabetes prevention in communities in Pa...