Journal Article > ResearchFull Text
BMJ Glob Health. 19 January 2025; Volume 10 (Issue 1); e015900.; DOI:10.1136/bmjgh-2024-015900
Gales M, Yonally Phillips EL, Zilversmit Pao L, Dubray C, Rodriguez Ribas Elizalde C, et al.
BMJ Glob Health. 19 January 2025; Volume 10 (Issue 1); e015900.; DOI:10.1136/bmjgh-2024-015900
INTRODUCTION
Understanding sex and gender differences during outbreaks is critical to delivering an effective response. Although recommendations and minimum requirements exist, the incorporation of sex-disaggregated data and gender analysis into outbreak analytics and response for informed decision-making remains infrequent. A scoping review was conducted to provide an overview of the extent of sex-disaggregated data and gender analysis in outbreak response within low- and middle-income countries (LMICs).
METHODS
Five databases were searched for peer-reviewed literature examining sex- and gender-specific outcomes for communicable disease outbreaks published in English between 1 January 2012 and 12 April 2022. An adapted version of the WHO’s Gender Analysis Matrix was used to synthesise evidence, which was then mapped across four phases of the outbreak timeline: prevention, detection, treatment/management and recovery.
RESULTS
71 articles met inclusion criteria and were included in this review. Sex-, gender-, and pregnancy-related disparities were identified throughout all four phases of the outbreak timeline. These disparities encompassed a wide range of risk factors for disease, vulnerability, access to and use of services, health-seeking behaviour, healthcare options, as well as experiences in healthcare settings and health and social outcomes and consequences.
CONCLUSION
Significant gender-evidence gaps remain in outbreak response. Evidence that is available illustrates that sex and gender disparities in outbreaks vary by disease, setting and population, and these differences play significant roles in shaping outbreak dynamics. As such, failing to collect, analyse or use sex-disaggregated data and gendered data during outbreaks results in less effective responses, differential adverse health outcomes, increased vulnerability among certain groups and insufficient evidence for effective prevention and response efforts. Systematic sex- and gender-based analyses to ensure gender-responsive outbreak prevention, detection, treatment/management and recovery are urgently needed.
Journal Article > CommentaryFull Text
Critical failings in humanitarian response: a cholera outbreak in Kumer Refugee Camp, Ethiopia, 2023
BMJ Glob Health. 1 December 2024; Volume 9 (Issue 12); e015585.; DOI:10.1136/bmjgh-2024-015585
Winkler NE, Muhie JM, Demlie YW, Berneh AA, Demessie BS, et al.
BMJ Glob Health. 1 December 2024; Volume 9 (Issue 12); e015585.; DOI:10.1136/bmjgh-2024-015585
Journal Article > CommentaryFull Text
BMJ Glob Health. 1 November 2024; Volume 9 (Issue 11); e017090.; DOI:10.1136/bmjgh-2024-017090
Evaborhene NA, Oga JO, Adebayo YA, Runyowa N, Okorie CE, et al.
BMJ Glob Health. 1 November 2024; Volume 9 (Issue 11); e017090.; DOI:10.1136/bmjgh-2024-017090
Journal Article > CommentaryFull Text
BMJ Glob Health. 10 September 2024; Volume 9 (Issue 9); e015862.; DOI:10.1136/bmjgh-2024-015862
Gleeson B, Ferreyra C, Palamountain K, Jacob ST, Spotswood N, et al.
BMJ Glob Health. 10 September 2024; Volume 9 (Issue 9); e015862.; DOI:10.1136/bmjgh-2024-015862
Journal Article > ReviewFull Text
BMJ Glob Health. 1 February 2023; Volume 8 (Issue 2); e011431.; DOI:10.1136/bmjgh-2022-011431
Evaborhene NA, Udokanma EE, Adebisi YA, Okorie CE, Kafuko Z, et al.
BMJ Glob Health. 1 February 2023; Volume 8 (Issue 2); e011431.; DOI:10.1136/bmjgh-2022-011431
The call to strengthen global health governance against future outbreaks through a binding treaty on pandemics has attracted global attention and opinion. Yet, few of these perspectives have reflected the voices from early career global health professionals in Africa. We share our perspectives on the Pandemic Treaty, and specifically our scepticism on the limitations of the current top-down approach of the treaty, and the need for the treaty to centre equity, transparency and fairness to ensure equitable and effective cooperation in response to global health emergencies. We also highlight the challenges intergovernmental organisations for health faced in coordinating nation states during the COVID-19 crisis and how a Pandemic Treaty would address these challenges. We argue that lessons from the COVID-19 pandemic provide a critical opportunity to strengthen regional institutions in Africa—particularly in a multipolar world with huge disparities in power and resources. However, addressing these challenges and achieving this transformation may not be easy. Fiscal space in many countries remains constrained now more than ever. New tools such as the Pandemic Fund should be designed in ways that consider the specific needs and capacities of countries. Therefore, strengthening countries’ capacities overall requires an increase in domestic investment. This paper calls for wider structural reforms such as debt restructuring among other tools to strengthen countries’ capacities.
Journal Article > ResearchFull Text
BMJ Glob Health. 1 December 2022; Volume 7 (Issue 12); e009674.; DOI:10.1136/bmjgh-2022-009674
Van Bortel W, Mariën J, Jacobs BKM, Sinzinkayo D, Sinarinzi P, et al.
BMJ Glob Health. 1 December 2022; Volume 7 (Issue 12); e009674.; DOI:10.1136/bmjgh-2022-009674
BACKGROUND
Long-lasting insecticidal nets (LLINs) are one of the key interventions in the global fight against malaria. Since 2014, mass distribution campaigns of LLINs aim for universal access by all citizens of Burundi. In this context, we assess the impact of LLINs mass distribution campaigns on malaria incidence, focusing on the endemic highland health districts. We also explored the possible correlation between observed trends in malaria incidence with any variations in climate conditions.
METHODS
Malaria cases for 2011—2019 were obtained from the National Health Information System. We developed a generalised additive model based on a time series of routinely collected data with malaria incidence as the response variable and timing of LLIN distribution as an explanatory variable to investigate the duration and magnitude of the LLIN effect on malaria incidence. We added a seasonal and continuous-time component as further explanatory variables, and health district as a random effect to account for random natural variation in malaria cases between districts.
RESULTS
Malaria transmission in Burundian highlands was clearly seasonal and increased non-linearly over the study period. Further, a fast and steep decline of malaria incidence was noted during the first year after mass LLIN distribution (p<0.0001). In years 2 and 3 after distribution, malaria cases started to rise again to levels higher than before the control intervention.
CONCLUSION
This study highlights that LLINs did reduce the incidence in the first year after a mass distribution campaign, but in the context of Burundi, LLINs lost their impact after only 1 year.
Long-lasting insecticidal nets (LLINs) are one of the key interventions in the global fight against malaria. Since 2014, mass distribution campaigns of LLINs aim for universal access by all citizens of Burundi. In this context, we assess the impact of LLINs mass distribution campaigns on malaria incidence, focusing on the endemic highland health districts. We also explored the possible correlation between observed trends in malaria incidence with any variations in climate conditions.
METHODS
Malaria cases for 2011—2019 were obtained from the National Health Information System. We developed a generalised additive model based on a time series of routinely collected data with malaria incidence as the response variable and timing of LLIN distribution as an explanatory variable to investigate the duration and magnitude of the LLIN effect on malaria incidence. We added a seasonal and continuous-time component as further explanatory variables, and health district as a random effect to account for random natural variation in malaria cases between districts.
RESULTS
Malaria transmission in Burundian highlands was clearly seasonal and increased non-linearly over the study period. Further, a fast and steep decline of malaria incidence was noted during the first year after mass LLIN distribution (p<0.0001). In years 2 and 3 after distribution, malaria cases started to rise again to levels higher than before the control intervention.
CONCLUSION
This study highlights that LLINs did reduce the incidence in the first year after a mass distribution campaign, but in the context of Burundi, LLINs lost their impact after only 1 year.
Journal Article > CommentaryFull Text
BMJ Glob Health. 15 July 2022; Volume 7 (Issue 7); e009709.; DOI:10.1136/bmjgh-2022-009709
Perehudoff K, 't Hoen E, Mara K, Balasubramaniam T, Abbott F, et al.
BMJ Glob Health. 15 July 2022; Volume 7 (Issue 7); e009709.; DOI:10.1136/bmjgh-2022-009709
SUMMARY BOX
⇒ The COVID-19 pandemic highlighted how current international laws and practices fail to ensure medical countermeasures (i.e., vaccines, therapeutics, diagnostics and personal protective equipment) are
equitably distributed in a global health crisis.
⇒ In 2021, the 194 Member States of the World Health Organization agreed to begin negotiations towards an international instrument that would better position the world to prevent, respond and prepare for future pandemics (often called a ‘pandemic treaty’.)
⇒ A pandemic treaty presents an opportunity to address these challenges in international law, and craft a better system, based on solidarity, for the global development and distribution of medical countermeasures.
⇒ We recommend that a pandemic treaty ensure sufficient financing for biomedical research and development (R&D), creates conditions for licensing government-funded R&D, mandates technology transfer, shares intellectual property, data and knowledge needed for the production and supply of products, and streamlines regulatory standards and procedures to market medical countermeasures.
⇒ We also recommend that a pandemic treaty ensures greater transparency and inclusive governance of these systems.
⇒ The aim of these components in a pandemic treaty should be to craft a better collective response to global health threats, consistent with existing international law, political commitments and sound public health practice.
⇒ The COVID-19 pandemic highlighted how current international laws and practices fail to ensure medical countermeasures (i.e., vaccines, therapeutics, diagnostics and personal protective equipment) are
equitably distributed in a global health crisis.
⇒ In 2021, the 194 Member States of the World Health Organization agreed to begin negotiations towards an international instrument that would better position the world to prevent, respond and prepare for future pandemics (often called a ‘pandemic treaty’.)
⇒ A pandemic treaty presents an opportunity to address these challenges in international law, and craft a better system, based on solidarity, for the global development and distribution of medical countermeasures.
⇒ We recommend that a pandemic treaty ensure sufficient financing for biomedical research and development (R&D), creates conditions for licensing government-funded R&D, mandates technology transfer, shares intellectual property, data and knowledge needed for the production and supply of products, and streamlines regulatory standards and procedures to market medical countermeasures.
⇒ We also recommend that a pandemic treaty ensures greater transparency and inclusive governance of these systems.
⇒ The aim of these components in a pandemic treaty should be to craft a better collective response to global health threats, consistent with existing international law, political commitments and sound public health practice.
Journal Article > ResearchFull Text
BMJ Glob Health. 12 July 2022; Volume 7 (Issue 7); e008821.; DOI:10.1136/bmjgh-2022-008821
Baobeid A, Faghani-Hamadani T, Sauer SM, Boum Y II, Hedt-Gauthier BL, et al.
BMJ Glob Health. 12 July 2022; Volume 7 (Issue 7); e008821.; DOI:10.1136/bmjgh-2022-008821
INTRODUCTION
Women researchers find it more difficult to publish in academic journals than men, an inequity that affects women's careers and was exacerbated during the pandemic, particularly for women in low-income and middle-income countries. We measured publishing by sub-Saharan African (SSA) women in prestigious authorship positions (first or last author, or single author) during the time frame 2014-2016. We also examined policies and practices at journals publishing high rates of women scientists from sub-Saharan Africa, to identify potential structural enablers affecting these women in publishing.
METHODS
The study used Namsor V.2, an application programming interface, to conduct a secondary analysis of a bibliometric database. We also analysed policies and practices of ten journals with the highest number of SSA women publishing in first authorship positions.
RESULTS
Based on regional analyses, the greatest magnitude of authorship inequity is in papers from sub-Saharan Africa, where men comprised 61% of first authors, 65% of last authors and 66% of single authors. Women from South Africa and Nigeria had greater success in publishing than those from other SSA countries, though women represented at least 20% of last authors in 25 SSA countries. The journals that published the most SSA women as prominent authors are journals based in SSA. Journals with overwhelmingly male leadership are also among those publishing the highest number of SSA women.
CONCLUSION
Women scholars in SSA face substantial gender inequities in publishing in prestigious authorship positions in academic journals, though there is a cadre of women research leaders across the region. Journals in SSA are important for local women scholars and the inequities SSA women researchers face are not necessarily attributable to gender discrepancy in journals' editorial leadership.
Women researchers find it more difficult to publish in academic journals than men, an inequity that affects women's careers and was exacerbated during the pandemic, particularly for women in low-income and middle-income countries. We measured publishing by sub-Saharan African (SSA) women in prestigious authorship positions (first or last author, or single author) during the time frame 2014-2016. We also examined policies and practices at journals publishing high rates of women scientists from sub-Saharan Africa, to identify potential structural enablers affecting these women in publishing.
METHODS
The study used Namsor V.2, an application programming interface, to conduct a secondary analysis of a bibliometric database. We also analysed policies and practices of ten journals with the highest number of SSA women publishing in first authorship positions.
RESULTS
Based on regional analyses, the greatest magnitude of authorship inequity is in papers from sub-Saharan Africa, where men comprised 61% of first authors, 65% of last authors and 66% of single authors. Women from South Africa and Nigeria had greater success in publishing than those from other SSA countries, though women represented at least 20% of last authors in 25 SSA countries. The journals that published the most SSA women as prominent authors are journals based in SSA. Journals with overwhelmingly male leadership are also among those publishing the highest number of SSA women.
CONCLUSION
Women scholars in SSA face substantial gender inequities in publishing in prestigious authorship positions in academic journals, though there is a cadre of women research leaders across the region. Journals in SSA are important for local women scholars and the inequities SSA women researchers face are not necessarily attributable to gender discrepancy in journals' editorial leadership.
Journal Article > CommentaryFull Text
BMJ Glob Health. 19 April 2022; Volume 7 (Issue 4); e007490.; DOI:10.1136/bmjgh-2021-007490
Perrin C, Athersuch K, Elder G, Martin M, Alsalhani A
BMJ Glob Health. 19 April 2022; Volume 7 (Issue 4); e007490.; DOI:10.1136/bmjgh-2021-007490
Two drugs with novel mechanisms of action, the diarylquinoline bedaquiline and the nitroimidazole delamanid—as well as pretomanid from the same class of drugs as delamanid—have recently become available to treat drug-resistant tuberculosis (DR-TB) after many decades of little innovation in the field of DR-TB treatment. Despite evidence of improved efficacy and reduced toxicity of multidrug regimens including the two agents, access to bedaquiline and delamanid has been limited in many settings with a high burden of DR-TB and consistently poor treatment outcomes. Aside from regulatory, logistic and cost barriers at country level, uptake of the novel agents was complicated by gaps in knowledge for optimal use in clinical practice after initial market approval. The main incentives of the current pharmaceutical research and development paradigm are structured around obtaining regulatory approval, which in turn requires efficacy and safety data generated by clinical trials. Recently completed and ongoing clinical trials did not answer critical questions of how to provide shorter, less toxic treatment DR-TB treatment regimens containing bedaquiline and delamanid and improve patient outcomes. Voluntary generation of evidence that is not part of this process—yet essential from a clinical or policy perspective—has been left to non-sponsor partners and researchers, often without collaborative efforts to improve post-regulatory approval access to life-saving drugs. Additionally, these efforts are currently not recognised in the value chain of the research and development process, and there are no incentives to make this critical research happen in a coordinated way.
Journal Article > CommentaryFull Text
BMJ Glob Health. 31 August 2019; Volume 4 (Issue 4); e001593.; DOI:10.1136/
bmjgh-2019-001593
McDiarmid M, Crestani R
BMJ Glob Health. 31 August 2019; Volume 4 (Issue 4); e001593.; DOI:10.1136/
bmjgh-2019-001593
Health workers were differentially infected during the 2014 to 2016 Ebola outbreak with an incidence rate of 30 to 44/1000 depending on their job duties, compared to the wider population’s rate of 1.4/1000, according to the WHO.
Médecins Sans Frontières (MSF) health workers had a much lower incidence rate of 4.3/1000, explained as the result of MSF’s ‘duty of care’ toward staff safety.
Duty of care is defined as an obligation to conform to certain standards of conduct for the protection of others against an unreasonable risk of harm.
The duty of care was operationalised through four actions: performing risk assessments prior to deployment, organising work and work practices to minimise exposure, providing extensive risk communication and training of staff and providing medical follow-up for staff exposures.
Adopting and consistently enforcing these broader, duty of care safety policies in deployed teams augments and fortifies standard infection prevention practices, creating a more protective, comprehensive safety programme.
Prioritising staff safety by taking such actions will help avoid the catastrophic loss of the health work force and assist in building resilient health systems.
Médecins Sans Frontières (MSF) health workers had a much lower incidence rate of 4.3/1000, explained as the result of MSF’s ‘duty of care’ toward staff safety.
Duty of care is defined as an obligation to conform to certain standards of conduct for the protection of others against an unreasonable risk of harm.
The duty of care was operationalised through four actions: performing risk assessments prior to deployment, organising work and work practices to minimise exposure, providing extensive risk communication and training of staff and providing medical follow-up for staff exposures.
Adopting and consistently enforcing these broader, duty of care safety policies in deployed teams augments and fortifies standard infection prevention practices, creating a more protective, comprehensive safety programme.
Prioritising staff safety by taking such actions will help avoid the catastrophic loss of the health work force and assist in building resilient health systems.