Middle-income countries

  • 文章类型: Journal Article
    在过去的二十年里,研究发现,人们对调查精神障碍的兴趣显著增加,以及低收入和中等收入国家在精神卫生领域面临的挑战.在高收入国家,各种类型的普遍基本收入(UBI)计划已经对个人的心理健康产生了重大影响。因此,本综述侧重于低收入和中等收入国家的情况。使用七个电子数据库进行了文献综述。搜索了在中低收入国家实施不同类型的UBI干预措施并应用任何类型的心理健康措施的任何设计的实证研究。在系统地审阅6822篇文章后,确定了13项实证研究,研究了发展中国家各种类型的UBI干预措施与心理健康的不同方面之间的关系。这些研究的集体结果表明,UBI计划对发展中国家个人的心理健康有显著的积极影响,无条件性和支付频率的潜在中介作用值得注意。然而,由于在这一领域进行的研究数量很少,以及方法学上的限制,这些影响是有限的。需要进行严格设计的进一步研究,特别是侧重于实验控制和随访期的长度。
    In the past two decades, a significant surge in interest in investigating mental disorders and challenges faced by low- and middle-income countries in the realm of mental health has been observed. Various types of universal basic income (UBI) programs have already demonstrated significant impacts on individuals\' mental health in high-income countries. Therefore, this review focuses on the situation in low- and middle-income countries. A literature review was conducted using seven electronic databases. Empirical studies of any design that implemented different types of UBI interventions in middle- and low-income countries and applied any type of mental health measures were searched for. After systematically reviewing 6822 articles, 13 empirical studies examining the relationship between various types of UBI interventions and different aspects of mental health in developing countries were identified. The collective findings of the studies suggest that UBI programs have significant positive effects on the mental health of individuals from developing countries, with the potential mediating role of unconditionality and payment frequency being noteworthy. However, these implications are limited due to the small number of studies conducted in this area and their methodological constraints. Further research with rigorous design is needed, particularly focusing on experimental control and length of follow-up periods.
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  • 文章类型: Journal Article
    尽管过去几十年来孕产妇死亡率的下降取得了重大进展,但孕产妇死亡率仍然是一个持续存在的公共卫生问题。到2020年,全球孕产妇死亡率(MMR)为每100,000例活产中223例死亡,表明在20年内下降了34.3%,低收入国家(LICs)和中低收入国家(LMICs)承担了主要负担。有效实施基于设施的未遂病例审查(NMCR),由世界卫生组织(WHO)批准,面临阻碍进步的挑战,通过范围审查探索实施战略至关重要。本范围审查旨在确定和描述低收入和中低收入国家采用的实施战略,以促进基于设施的NMCR的实施。
    范围审查将遵循Arksey和O'Malley的方法论框架,涉及五个阶段:确定研究问题,选择相关研究,选择数据,绘制图表,并总结结果。像PubMed这样的电子数据库,Embase,WebofScience,EBSCOhost-CINAHLUltimate,OvidMEDLINE将被搜索,辅以引文跟踪。Rayyan将用于筛选和删除重复项,使用Google表格进行数据图表。两名独立审稿人将进行盲检,资格评估,和包容阶段。审稿人将使用试点表格独立进行系统数据提取,通过团队讨论和共识解决差异。
    审查将确定和描述所采用的实施策略,以促进在LIC和LMIC中实施基于设施的未遂病例审查。
    本次审查的结果将有助于理解LIC和LMIC中基于设施的NMCR的实施策略。该审查可以帮助设计干预措施/计划,以降低孕产妇死亡率和知识产品。
    UNASSIGNED: Maternal mortality remains a persistent public health concern despite significant strides in reduction over the past few decades, with a global maternal mortality ratio (MMR) of 223 deaths per 100,000 live births in 2020, indicating a 34.3% decline over 20 years, with Low income countries (LICs) and Lower Middle-Income Countries (LMICs) bearing the major burden. Effective implementation of facility-based near-miss case reviews (NMCR), endorsed by the World Health Organization (WHO), faces challenges hindering progress, making exploring implementation strategies through a scoping review essential. This scoping review aims to identify and characterize implementation strategies employed in Low and Lower Middle- Income Countries to facilitate the implementation of facility-based NMCR.
    UNASSIGNED: The scoping review will follow Arksey and O\'Malley\'s methodological framework, involving five stages: identifying the research question, selecting relevant studies, selecting data, charting, and summarizing the results. Electronic databases like PubMed, Embase, Web of Science, EBSCOhost - CINAHL Ultimate, and Ovid MEDLINE will be searched, supplemented by citation tracking. Rayyan will be used to screen and remove duplicates, with data charting conducted using Google Sheets. Two independent reviewers will conduct blinded screening, eligibility assessment, and inclusion phases. Reviewers will conduct Systematic data extraction independently using piloted forms, with discrepancies resolved through team discussion and consensus.
    UNASSIGNED: The review will identify and characterize implementation strategies employed to facilitate the implementation of facility-based near-miss case reviews in LICs and LMICs.
    UNASSIGNED: The findings of this review will contribute to the understanding of implementing strategies for facility-based NMCR in LICs and LMICs. The review can help in designing interventions/programs to reduce maternal mortality and knowledge products.
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  • 文章类型: Journal Article
    先天性心脏病(CHD)患儿的治疗方法的改进导致对长期功能结果(如与健康相关的生活质量(HRQOL))的兴趣与日俱增。对CHD儿童HRQOL的研究得出了矛盾的结果。在这项研究中,我们旨在进行系统评价和荟萃分析,分析低收入和中等收入国家的CHD患儿手术对HRQOL结局的影响.
    使用Medline(PubMed)对文章进行了全面搜索,Scopus,和Embase数据库从成立到2023年9月5日。包括报告18岁以下儿童生活质量结果并以英文发表的研究。
    在筛选的1239条记录中,10研究,包括1721名参与者,包括在研究中。对照组的总体生活质量明显优于接受冠心病手术的儿童(P=0.04,标准平均差为-0.62,95%CI:-1.2至-0.04),冠心病患儿手术后的总体生活质量明显优于手术前(P=0.05,标准均差-0.56,95%CI:-1.11至-0.01)。
    接受冠心病手术的低收入和中等收入国家儿童的生活质量在除情感领域外的所有方面都明显低于对照组。同时,手术对改善CHD患儿术后体质的影响最大。应进一步研究改善此亚组患者HRQOL的策略。
    UNASSIGNED: Improved treatments for children with congenital heart disease (CHD) have led to a growing interest in long-term functional outcomes such as health-related quality of life (HRQOL). Studies on HRQOL in children with CHD have yielded contradictory results. In this study, we aimed to perform a systematic review and meta-analysis to analyze the effect of surgery on HRQOL outcomes in children with CHD in low-income and middle-income countries.
    UNASSIGNED: A comprehensive search for articles was performed using the Medline (PubMed), Scopus, and Embase databases from their inception to September 5, 2023. Studies reporting QOL outcomes in children <18 years and published in English were included.
    UNASSIGNED: Of the 1239 records screened, 10 studies, including 1721 participants, were included in the study. The overall QOL was significantly better in the control group than in the children who underwent surgery for CHD (P=0.04, standard mean difference of -0.62, 95% CI: -1.2 to -0.04), and the overall QOL was significantly better in the children with CHD after surgery than before surgery (P=0.05, standard mean difference of -0.56, 95% CI: -1.11 to -0.01).
    UNASSIGNED: The QOL of children from low-income and middle-income countries who undergo surgery for CHD is significantly poorer than that of controls in all dimensions except the emotional domain. Meanwhile, surgery has the greatest impact on improving the physical domain in children with CHD after surgery. Strategies to improve HRQOL in this subgroup of patients should be further investigated.
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  • 文章类型: Systematic Review
    背景:迈向全民健康覆盖(UHC)的努力旨在以提高效率的方式重新平衡卫生筹资,股本,和质量。资源约束要求从被动采购转变为战略采购(SP)。在本文中,我们报告了9个中等收入国家公共部门健康保险计划中SP的经验,以了解SP的建立程度,挑战和促进者,以及它如何帮助各国实现其UHC目标。
    方法:我们进行了系统的搜索,以确定有关SP的论文。选择了9个国家进行案例研究分析。我们从129篇文章中提取数据。我们使用了一个通用框架来比较不同方案中的采购安排和关键特征。证据是定性合成的。
    结果:五个国家有卫生技术评估(HTA)部门来研究购买哪些服务。大多数计划都有补偿机制,可以在一定程度上控制成本。然而,我们发现仅在泰国和中国对报销机制进行了基于证据的改变.所有国家都有某种形式的卫生设施认证机制,尽管所做的事情有很大的不同。所有国家都有一些监控索赔的策略,但它们的复杂性和实施程度各不相同;三个国家实施了电子索赔处理,从而能够实现更高水平的监测。只有四个国家有独立的治理结构来提供监督。我们发现延迟偿还(六个国家),未能在福利包中提供服务(四个国家),以及除泰国和印度尼西亚以外的所有国家的高额自付(OOP)付款,暗示这些计划让他们的成员失望了。
    结论:我们建议对购买者和研究能力进行投资,并专注于强大的治理,包括买方之间的定期约定,提供者和公民,为了建立信任关系以更充分地利用SP的潜力,并扩大金融保护和实现UHC的进展。
    BACKGROUND: Efforts to move towards universal health coverage (UHC) aim to rebalance health financing in ways that increase efficiency, equity, and quality. Resource constraints require a shift from passive to strategic purchasing (SP). In this paper, we report on the experiences of SP in public sector health insurance schemes in nine middle-income countries to understand what extent SP has been established, the challenges and facilitators, and how it is helping countries achieve their UHC goals.
    METHODS: We conducted a systematic search to identify papers on SP. Nine countries were selected for case study analysis. We extracted data from 129 articles. We used a common framework to compare the purchasing arrangements and key features in the different schemes. The evidence was synthesised qualitatively.
    RESULTS: Five countries had health technology assessment (HTA) units to research what services to buy. Most schemes had reimbursement mechanisms that enabled some degree of cost control. However, we found evidenced-based changes to the reimbursement mechanisms only in Thailand and China. All countries have some form of mechanism for accreditation of health facilities, although there was considerable variation in what is done. All countries had some strategy for monitoring claims, but they vary in complexity and the extent of implementation; three countries have implemented e-claim processing enabling a greater level of monitoring. Only four countries had independent governance structures to provide oversight. We found delayed reimbursement (six countries), failure to provide services in the benefits package (four countries), and high out-of-pocket (OOP) payments in all countries except Thailand and Indonesia, suggesting the schemes were failing their members.
    CONCLUSIONS: We recommend investment in purchaser and research capacity and a focus on strong governance, including regular engagement between the purchaser, provider and citizens, to build trusting relationships to leverage the potential of SP more fully, and expand financial protection and progress towards UHC.
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  • 文章类型: Journal Article
    在全球范围内,对姑息治疗的需求正在上升,有需要的人中有76%生活在低收入和中等收入国家(LMICs)。数字健康干预(DHIs)已被确定为使姑息治疗更广泛获得的一种手段。这篇综述总结了在LMIC中用于提供姑息治疗的DHI的范围和特征,并试图确定影响其实施和利用的因素。
    这篇综述旨在总结用于在LMIC中提供姑息治疗的DHI的范围和特征,并确定影响其实施和利用的因素。
    包含定量和定性数据的混合方法系统综述。
    所有针对中低收入国家中需要姑息治疗的患者(成人/儿童)及其照顾者(以患者和照顾者为中心)的DHI的研究均通过对MEDLINE的系统搜索确定,EMBASE,PsycINFO和CINAHL数据库。数据综合和分析是根据JoannaBriggs研究所(JBI)的混合方法进行系统综述的融合集成方法进行的。
    包括15项研究(三项定性,四种混合方法和八项定量研究)。远程医疗/移动健康是LMICs中报告最多的DHI,用于提供姑息治疗。患者和护理人员在许多方面受益于使用DHIs,包括增加获得护理的机会,减少不适,旅行时间和卫生保健相关感染的风险。卫生保健提供者还报告说,使用DHI如远程医疗使他们能够以更有效和高效的方式提供护理。四个因素被确定为实施的主要障碍:资源限制;识字,培训和技能;治理,运营和沟通问题以及技术问题。
    DHIs,比如远程医疗,有可能提高低收入国家姑息治疗的可及性,特别是在农村地区。需要全面的使用策略来解决已确定的障碍。
    UNASSIGNED: The need for palliative care is rising globally with 76% of those who are in need living in low- and middle-income countries (LMICs). Digital health interventions (DHIs) have been identified as a means of making palliative care more widely accessible. This review summarizes the range and characteristics of DHIs used to deliver palliative care in LMICs and sought to identify factors that influence their implementation and utilization.
    UNASSIGNED: This review aims to summarize the range and characteristics of DHIs used to deliver palliative care in LMICs and identify factors that influence their implementation and utilization.
    UNASSIGNED: Mixed-method systematic review incorporating both quantitative and qualitative data.
    UNASSIGNED: All studies focusing on DHIs for patients who need palliative care (adults/children) and their caregivers (patient and caregiver centred) in LMICs and published in English were identified through a systematic search of MEDLINE, EMBASE, PsycINFO and CINAHL databases. Data synthesis and analysis were carried out following the convergent integrated approach based on the Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews.
    UNASSIGNED: Fifteen studies were included (three qualitative, four mixed-methods and eight quantitative studies). Telemedicine/mHealth was the most reported DHI utilized in LMICs in delivering palliative care. Patients and caregivers benefited from using DHIs in many ways including increased access to care with reduced discomfort, travel time and risk of health care-associated infections. Health care providers also reported that using DHI such as telemedicine enables them to provide care in a more effective and efficient way. Four factors were identified as the main barriers to implementation: resource constraints; literacy, training and skills; governance, operational and communication issues and technical issues.
    UNASSIGNED: DHIs, such as telemedicine, have the potential to enhance accessibility to palliative care in LMICs, particularly in rural areas. Comprehensive strategies for their use are required to address the identified barriers.
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  • 文章类型: Journal Article
    背景:去骨瓣减压术(DC)是一种广泛用于缓解高颅内压的手术。多学科团队设计并实施了外部医疗原型,以提高患者的生活质量,并避免等待颅骨修补术(CP)的患者在DC后出现并发症。包括3D打印和石膏原型。
    目的:本范围审查旨在了解在等待CP期间接受DC的患者的创新外部原型证据的范围和类型。
    方法:此范围审查将使用JoannaBriggsInstitute方法进行范围审查。此范围审查将包括等待CP时接受DC的成年患者的非侵入性医疗设备。搜索策略将在MEDLINE中实施,Embase,WebofScience,Scielo,Scopus,和世界卫生组织(世卫组织)全球健康指数药物。专利文件也在Espacenet中分配,谷歌专利,和世界知识产权组织(WIPO)数据库。
    结果:此范围审查不受伦理批准,因为不会涉及患者。传播计划包括在同行评审的期刊上发表评论结果,并在与创新和神经外科最相关的利益相关者互动的会议上展示结果。
    结论:这项范围审查将作为基线,为目前设计这些非侵入性创新的多学科团队提供证据,以降低DC后相关并发症的风险,希望能够实施更具成本效益的模式,特别是在低收入和中等收入国家。
    DERR1-10.2196/50647。
    BACKGROUND: Decompressive craniectomy (DC) is a widely used procedure to alleviate high intracranial pressure. Multidisciplinary teams have designed and implemented external medical prototypes to improve patient life quality and avoid complications following DC in patients awaiting cranioplasty (CP), including 3D printing and plaster prototypes when available.
    OBJECTIVE: This scoping review aims to understand the extent and type of evidence about innovative external prototypes for patients who undergo DC while awaiting CP.
    METHODS: This scoping review will use the Joanna Briggs Institute methodology for scoping reviews. This scoping review will include noninvasive medical devices for adult patients who undergo DC while waiting for CP. The search strategy will be implemented in MEDLINE, Embase, Web of Science, Scielo, Scopus, and the World Health Organization (WHO) Global Health Index Medicus. Patent documents were also allocated in Espacenet, Google Patents, and the World Intellectual Property Organization (WIPO) database.
    RESULTS: This scoping review is not subject to ethical approval as there will be no involvement of patients. The dissemination plan includes publishing the review findings in a peer-reviewed journal and presenting results at conferences that engage the most pertinent stakeholders in innovation and neurosurgery.
    CONCLUSIONS: This scoping review will serve as a baseline to provide evidence for multidisciplinary teams currently designing these noninvasive innovations to reduce the risk of associated complications after DC, hoping that more cost-effective models can be implemented, especially in low- and middle-income countries.
    UNASSIGNED: DERR1-10.2196/50647.
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  • 文章类型: Systematic Review
    背景:不断增长的城市人口给低收入和中等收入国家(LMICs)的卫生系统带来了额外的挑战。我们探讨了整个贫民窟的经济负担和医疗保健利用的不平等,低收入国家城市居民的非贫民窟和财富水平。
    方法:本范围综述对在LMICs城市地区进行的研究进行了叙述性综合和描述性分析。我们将研究归类为仅在贫民窟进行,在贫民窟和非贫民窟定居点进行的城市范围内的财富测量研究。我们估计了获得医疗保健的平均成本,灾难性卫生支出(CHE)的发生率以及卫生支出的先进性和公平性。研究中使用的贫民窟定义与2018年人居署的定义相对应。我们开发了一张证据图,以确定LMIC中医疗保健获取经济学的研究差距。
    结果:我们确定了64项纳入研究,其中大部分来自东南亚(59%),归类为全市(58%)。我们发现整个健康状况都有严重的经济负担,财富五分位数和研究类型。与全市范围的研究相比,贫民窟研究报告说,急性疾病获得医疗保健的直接费用较高,慢性和未指明的健康状况的费用较低。在贫民窟研究中,慢性病的医疗保健支出在最富有的财富五分之一中最高,而在全市范围的研究中,在所有财富五分之一中平均分配得更多。在贫民窟研究中,所有财富五分位数的CHE发生率相似,在全市范围的研究中,CHE的发生率集中在最贫穷的居民中。使用的贫民窟定义没有一个涵盖人居署提出的所有特征。证据地图显示整个城市的研究,在印度进行的研究和对未指明的健康状况的研究主导了当前关于医疗保健获取经济学的证据。大多数证据被归类为质量差。
    结论:我们的研究结果表明,城市和贫民窟居民在获得医疗保健时有不同的支出模式。金融保护计划必须考虑城市背景下医疗保健供应的复杂性。需要进行进一步的研究,以了解LMIC快速扩张和发展的城市中医疗保健支出不平等的原因。
    The growing urban population imposes additional challenges for health systems in low- and middle-income countries (LMICs). We explored the economic burden and inequities in healthcare utilisation across slum, non-slum and levels of wealth among urban residents in LMICs.
    This scoping review presents a narrative synthesis and descriptive analysis of studies conducted in urban areas of LMICs. We categorised studies as conducted only in slums, city-wide studies with measures of wealth and conducted in both slums and non-slums settlements. We estimated the mean costs of accessing healthcare, the incidence of catastrophic health expenditures (CHE) and the progressiveness and equity of health expenditures. The definitions of slums used in the studies were mapped against the 2018 UN-Habitat definition. We developed an evidence map to identify research gaps on the economics of healthcare access in LMICs.
    We identified 64 studies for inclusion, the majority of which were from South-East Asia (59%) and classified as city-wide (58%). We found severe economic burden across health conditions, wealth quintiles and study types. Compared with city-wide studies, slum studies reported higher direct costs of accessing health care for acute conditions and lower costs for chronic and unspecified health conditions. Healthcare expenditures for chronic conditions were highest amongst the richest wealth quintiles for slum studies and more equally distributed across all wealth quintiles for city-wide studies. The incidence of CHE was similar across all wealth quintiles in slum studies and concentrated among the poorest residents in city-wide studies. None of the definitions of slums used covered all characteristics proposed by UN-Habitat. The evidence map showed that city-wide studies, studies conducted in India and studies on unspecified health conditions dominated the current evidence on the economics of healthcare access. Most of the evidence was classified as poor quality.
    Our findings indicated that city-wide and slums residents have different expenditure patterns when accessing healthcare. Financial protection schemes must consider the complexity of healthcare provision in the urban context. Further research is needed to understand the causes of inequities in healthcare expenditure in rapidly expanding and evolving cities in LMICs.
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  • 文章类型: Meta-Analysis
    抗菌素耐药性(AMR)对公众健康构成重大风险。在低收入和中等收入(LMICs)国家,AMR的影响明显更为严重。缺乏低收入国家(LMICs)的数据导致这一主题经常被忽视。此外,COVID-19大流行可能会使AMR问题变得更糟。早期的指南建议COVID-19患者使用抗生素,即使是没有细菌合并感染的患者。这项研究旨在调查2019年有和无冠状病毒病(COVID-19)患者中LMIC中抗生素处方的比例,不适当抗生素的比例,和多种抗生素处方。我们遵循系统评价和荟萃分析(PRISMA)的首选报告项目。我们通过在线数据库检索数据,包括PubMed,Scopus,和科学直接。在COVID-19患者中,抗生素处方的荟萃分析估计为0.80(95%CI:0.72-0.88),而非COVID-19感染患者的抗生素使用为0.54(95%CI:0.49~0.58).这些处方抗生素的一半(0.52,95%CI:0.32-0.72)是不适当的处方。此外,我们发现,三分之一的抗生素处方包含一种以上的抗生素(0.32,95%CI:0.21~0.43).总之,抗生素在LMIC中被高度处方,并且它们在COVID-19患者中的使用增加。在这些处方中,不适当和多次使用并不少见。这项研究有几个局限性,因为它包括在门诊环境中的两项研究,分析中包含的一些研究是小规模进行的。然而,我们的研究结果表明,采取紧急行动改善处方实践至关重要.
    Antimicrobial resistance (AMR) poses a substantial risk to public health. In low-income and middle-income (LMICs) nations, the impact of AMR is significantly more severe. The absence of data from low-income countries (LMICs) causes this topic to be frequently overlooked. Additionally, the COVID-19 pandemic could make the AMR issue even worse. Earlier guidelines recommended antibiotic use in patients with COVID-19, even in those without bacterial coinfection. This study aims to investigate the proportion of antibiotic prescriptions in LMICs among patients with and without coronavirus disease-2019 (COVID-19), the proportion of inappropriate antibiotics, and multi-antibiotic prescribing. We followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA). We retrieved data through online databases, including PubMed, Scopus, and ScienceDirect. Amongst COVID-19 patients, the meta-analytic estimate of antibiotic prescription was 0.80 (95% CI: 0.72-0.88), whereas antibiotic use among patients with non-COVID-19 infections was 0.54 (95% CI: 0.49-0.58). Half of those prescribed antibiotics (0.52, 95% CI: 0.32-0.72) are inappropriate prescriptions. In addition, we found that one-third of antibiotics prescriptions consisted of more than one antibiotic (0.32, 95% CI: 0.21-0.43). In conclusion, antibiotics are highly prescribed across LMICs, and their use is increased in patients with COVID-19. Amongst those prescriptions, inappropriate and multiple use was not uncommon. This study has several limitations, as it included two studies in an ambulatory setting, and some of the studies included in the analysis were conducted on a small scale. Nevertheless, our findings suggest that urgent action to improve prescribing practices is essential.
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  • 文章类型: Journal Article
    背景:随着国家从低收入状态逐渐过渡到中等收入状态,许多人面临健康发展援助的损失,并且必须“过渡”到更多的国内卫生应对资金。如果管理不当,中等收入国家(MICs)的捐助者过渡可能对全球卫生进步构成重大挑战。没有现有的知识综合全面调查捐助者的转变如何影响中等收入国家的卫生系统。
    方法:我们对1990年1月至2018年10月期间发表的5个学术数据库和37个全球健康捐献者和智囊团网站的文献使用结构化搜索策略进行了范围审查。我们使用世卫组织卫生系统“构建模块”框架来专题综合和构建分析。
    结果:独立筛查后,11236份出版物中有89份用于数据提取和综合。大多数证据检查了与艾滋病毒/艾滋病(n=45,50%)和免疫计划(n=14,16%)有关的转变,重点关注全球抗击艾滋病基金等捐助者,结核病和疟疾(n=26,29%),和Gavi,疫苗联盟(n=15,17%)。捐助者的过渡受到捐助者和国家政府行动的影响,对卫生系统的每个组成部分都有影响。成功的转型经验表明,规划,以及转型前对一国金融的投资,技术,后勤能力对于确保平稳过渡至关重要。如果没有这种措施,财政资源短缺,医疗产品和供应库存,服务中断,人力资源短缺很普遍,由此产生的影响不仅对程序的延续,也是为了人口健康。
    结论:捐赠者的转变可以以不同的和相互关联的方式影响卫生系统的不同组成部分。对捐助者过渡如何影响中等收入国家的卫生系统进行更严格的评估,将使人们更好地了解捐助者退出带来的风险和机会。
    BACKGROUND: As countries graduate from low-income to middle-income status, many face losses in development assistance for health, and must \"transition\" to greater domestic funding of their health response. If improperly managed, donor transitions in middle-income countries (MICs) could present significant challenges to global health progress. No prior knowledge synthesis has comprehensively surveyed how donor transitions can affect health systems in MICs.
    METHODS: We conducted a scoping review using a structured search strategy across five academic databases and 37 global health donor and think tank websites for literature published between January 1990 and October 2018. We used the WHO health system \"building blocks\" framework to thematically synthesize and structure the analysis.
    RESULTS: Following independent screening, 89 publications out of 11,236 were included for data extraction and synthesis. Most of this evidence examines transitions related to HIV/AIDS (n=45, 50%) and immunization programs (n=14, 16%), with a focus on donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (n=26, 29%), and Gavi, the Vaccine Alliance (n=15, 17%). Donor transitions are influenced by the actions of both donors and country governments, with impacts on every component of the health system. Successful transition experiences show that leadership, planning, and pre-transition investments in a country\'s financial, technical, and logistical capacity are vital to ensuring smooth transition. In the absence of such measures, shortages in financial resources, medical product and supply stockouts, service disruptions, and shortages in human resources were common, with resulting implications not only for program continuation, but also for population health.
    CONCLUSIONS: Donor transitions can affect different components of the health system in varying and interconnected ways. More rigorous evaluation of how donor transitions can affect health systems in MICs will create an improved understanding of the risks and opportunities posed by donor exits.
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  • 文章类型: Journal Article
    《2030年可持续发展议程》明确要求终止儿童,早期,强迫婚姻,全球6.5亿女孩和妇女经历了这种有害的做法。COVID-19大流行有可能阻止实现这一目标的进展,并强调需要评估研究进展,并将新兴知识与预防和应对童婚的努力联系起来。我们对涵盖四种语言(英语,西班牙语,葡萄牙语,和法语),涵盖20年(2000年1月1日至2019年12月31日),包括世界所有主要地理区域的同行评审和灰色文献。我们的评论从最初筛选的4,081份摘要中识别并分析了1,068份出版物,发现对患病率的研究,决定因素,童婚的后果占总出版物的大部分。包括西班牙文和葡萄牙文的出版物产生了拉丁美洲和加勒比的成果,莫桑比克,和欧洲,包括法语出版物在内,西非和马格里布的成果,除了涵盖这些和其他部分的英语出版物。我们对研究在时间和空间上的演变和分布的审查要求更加关注预防童婚和应对儿童结婚的个人需求的干预措施,知识交流的多语言方法,以及在被忽视的高患病率环境中进行的研究。
    The 2030 Agenda for Sustainable Development explicitly calls for an end to child, early, and forced marriages, a harmful practice that has been experienced by 650 million girls and women globally. The COVID-19 pandemic threatens to halt progress toward this goal and highlights the need to assess research progress and link emerging knowledge with efforts to prevent and respond to child marriage. We conducted a systematic search of publications focused on child marriage covering four languages (English, Spanish, Portuguese, and French), encompassing a 20-year period (1 January 2000-31 December 2019) and including peer-reviewed and gray literature across all major geographic regions of the world. Our review identified and analyzed 1,068 publications from an initial number of 4,081 abstracts screened, finding that studies on the prevalence, determinants, and consequences of child marriage represented a majority of the total publications. Including publications in Spanish and Portuguese yielded results from Latin America and the Caribbean, Mozambique, and Europe, and including publications in French yielded results from West Africa and the Maghreb, in addition to English language publications covering both these and other parts of the word. Our review of the evolution and distribution of research over time and space calls for a greater focus of research on interventions preventing child marriage and responding to the needs of individuals married as children, a multilinguistic approach to knowledge exchange, and for research to be conducted in neglected high-prevalence settings.
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