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....

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...

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...

IntroductionIntegrated, people-centred, high-quality services are essential to achieving universal health coverage. Traditional health facility assessments, while valuable, often focus on structural inputs and are resource-intensive, limiting their frequency and programmatic utility. The Global Fund to Fight AIDS, Tuberculosis (TB), and Malaria, developed the Targeted Health Facility Assessment (tHFA) to inform country plans and monitor progress on the Global Fund Strategy (2023-2028) of maximiz...

BackgroundUnderstanding hospital admission and mortality trends is essential for enhancing health system performance in low- and middle-income countries. In Ghana, systemic challenges such as unequal access to care, workforce shortages, and changing disease patterns - exacerbated by the COVID-19 pandemic - underscore the need for comprehensive health data analysis. This study examines national hospital morbidity and mortality trends from 2019 to 2023, identifying demographic and clinical factors...

The growing threat to health systems posed by extreme weather events (EWEs) disproportionately affects people living with HIV (PLHIV) and tuberculosis (TB) in high-burden, low-resource settings. In Zimbabwe, for example, the 2023/2024 El Nino-induced drought intensified food insecurity and reduced access to clinics and medication for vulnerable populations. We conducted a formative evaluation to assess how recent EWEs in Zimbabwe have impacted HIV and TB care in this community and to identify po...

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...

Spatially detailed estimates of childhood vaccination coverage are crucial to guide program design, targeting interventions, and evaluating progress within countries. In settings where substantial geographic inequities persist, high-resolution vaccination coverage and corresponding zero-dose maps can be helpful for understanding local patterns and informing strategies to reach underserved or missed populations. In this study, we produce annual 1x1 km and district level estimates of coverage for ...

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...

IntroductionIt is estimated that there were 263 million malaria cases and 597,000 deaths in 2023 globally, a substantial proportion of which are attributable to inadequate access to good-quality and efficacious antimalarials. Africa bears the highest malaria burden. Yet despite the high prevalence of substandard and falsified (SF) antimalarials in some African regions, their prevalence across space and time remains poorly understood. MethodsWe extracted data from the Infectious Disease Data Obs...

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...

BackgroundShort birth intervals raise maternal, perinatal, and child health risks. Sub-Saharan Africa (SSA) has the worlds highest fertility and elevated child mortality. While short intervals effects on child mortality are well established, the reverse link is less studied. The child replacement effect posits that early child death shortens subsequent birth intervals. This study examines and quantifies this association across 26 SSA countries. MethodsThis study pooled recent DHS data from 26 S...

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 ...

BackgroundSouth Africas National Tuberculosis (TB) Programme aims to achieve targets set by the World Health Organizations End TB Strategy, including an 80% reduction in TB incidence and a 90% reduction in TB mortality by 2030, compared to 2015 levels. We were tasked to evaluate 1) the impact on TB incidence and mortality of scaling up individual interventions focusing on TB preventive therapy, screening, testing and linkage to treatment as included in the 2023-2028 National Strategic Plan for T...

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 ...

IntroductionMultidimensional poverty (deprivations in education, health, and living standards) affects people with and without HIV. We compared poverty levels by HIV status in Eastern and Southern Africa and identified indicators driving deprivations. MethodWe analysed the 2020-22 Population HIV Impact Assessment data from Eswatini, Lesotho, Malawi, Mozambique, Tanzania, Uganda, and Zimbabwe using the Alkire-Foster method, calculating the multidimensional poverty index (MPI), headcount ratio, a...

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...

Routine childhood immunization is still a critical topic for global public health, since it prevents an estimated 3.5 to 5 million deaths annually. However, its access remains uneven, especially in low-income countries, where structural inequalities limit the reach of immunization programs, and the Covid-19 pandemic disrupted routine services, worsening the existing disparities. This ecological study (2010-2023) examined associations between vaccine coverage and infant mortality using the WHO/UN...