Conectar
To evaluate the impact of public–private mix (PPM) models for tuberculosis (TB) on health, process and system outcomes, adopting the WHO’s definition of PPM, which is a strategic partnership between national TB programmes and healthcare providers, both public and private, to deliver high-quality TB diagnosis and treatment.
Systematic review without meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.
EMBASE, MEDLINE, Health Management Information Consortium, Social Sciences Citation Index, Science Citation Index, Emerging Sources Citation Index, CENTRAL, Database of Disability and Inclusion Information Resources, WHO Library Database and 3ie.
We included all primary studies examining PPM models delivering TB services in urban health sectors in least-developed, low-income and lower–middle-income countries and territories.
17 reviewers were involved in data extraction in COVIDENCE using a prepiloted template. All extractions were completed by a single reviewer and checked by a second reviewer. Quality appraisal was carried out using the mixed-methods appraisal tool, covering mixed-methods, qualitative and quantitative study designs. Narrative synthesis was carried out by tabulating and summarising studies according to PPM models and reported in line with the synthesis without meta-analysis guidelines.
Of the 57 included studies, covering quantitative (n=41), qualitative (n=6) and mixed-method (n=10) designs, the majority were from Southeast Asia (n=37). PPM models had overall positive results on TB treatment outcomes, access and coverage and value for money. They are linked with improved TB health workers’ skills and service delivery. Most outcomes tended to favour interface models, although with considerable heterogeneity. Inconsistent implementation of national TB guidelines, uncoordinated referrals and lack of trust among partners were identified as areas of improvement. Evidence was lacking on the involvement of informal providers within PPM models.
PPM models can be effective and cost-effective for TB care in urban low- and middle-income countries contexts, particularly when levels of mistrust between public and private sectors are addressed through principles of equal partnership. The evidence indicates that this may be more achievable when an interface organisation manages the partnership.
CRD42021289509.
To identify enablers and barriers for scaling up non-communicable disease (NCD) interventions across diverse global contexts and to map these factors to the WHO’s health system building blocks.
A multi-method qualitative study applying the Consolidated Framework for Implementation Research to analyse data from multiple projects nearing or completing scale-up.
Global Alliance for Chronic Diseases-funded implementation research projects conducted across 18 low- and middle-income countries and high-income settings.
Data was derived from documents (n=77) including peer-reviewed publications, policy briefs, and reports and interviews with stakeholders (n=18) (eg, principal investigators, medical professionals, public health workers).
Various context-specific interventions targeting sustainable scale-up of NCD (eg, diabetes, hypertension, cardiovascular disease) interventions at the community, primary care or policy levels.
The primary outcome was identifying contextual enablers and barriers to intervention scale-up. Secondary outcomes included exploring how these factors aligned with health system building blocks (eg, leadership/governance, healthcare workforce).
Twenty enablers (eg, intervention adaptability, strong stakeholder engagement, local empowerment) and 25 barriers (eg, resource limitations, intervention complexity, stakeholder burnout) were identified. Contextual alignment, supportive governance and capacity building were critical for sustainability, while cultural misalignment and socio-political instability frequently hampered scaling efforts.
Tailoring interventions to local health systems, ensuring stakeholder co-ownership and incorporating strategies to mitigate stakeholder burn-out are essential to achieving sustainable, scalable NCD solutions. Future research should focus on integrating systematic cultural adaptation, sustainable financing and workforce capacity building into scale-up planning.
To estimate the treatment outcomes among individuals treated for hypertension in the public sector in 89 districts across 15 states in India and to identify the risk factors for uncontrolled blood pressure (BP).
An analysis of a cohort of people with hypertension from 2018 to 2022 from public sector health facilities.
All India Hypertension Control Initiative (IHCI) implementing districts using digital information systems across 15 states of India, namely Andhra Pradesh, Bihar, Goa, Gujarat, Jharkhand, Karnataka, Maharashtra, Nagaland, Puducherry, Punjab, Rajasthan, Sikkim, Tamil Nadu, Uttar Pradesh and West Bengal.
Individuals aged 30 years or older, who were diagnosed with hypertension or on medication at the time of registration between 1 January 2018 and 31 December 2021 were included in the study.
Treatment outcomes were controlled BP, uncontrolled BP and missed visits in the reporting quarter (1 January 2022–31 March 2022). We analysed the risk factors for uncontrolled BP.
Out of 1, 235, 453 hypertensive individuals enrolled in the IHCI project across 15 states, 1, 046, 512 remained under care, with 44% BP control. The control varied from 26% to 57% in various types of facilities. The states of Maharashtra, Punjab and Rajasthan had above 50% control, while Nagaland, Jharkhand and Bihar had below 25%. BP control declined from 68% when defined using a single recent reading to 52% when defined using the two-visit readings. Younger individuals (
We documented the implementation of IHCI strategies at scale and measured treatment outcomes in a large cohort. Overall, BP control improved with variations across states. We need focused strategies to improve control in higher-level facilities, among males and people with diabetes. Using two BP readings may support consistent treatment adherence.
by Resham B. Khatri, Rolina Dhital, Sabita Tuladhar, Nisha Joshi Bhatta, Yibeltal Assefa
BackgroundImproving maternal health is a global priority for overall socioeconomic development countries, especially in the low- and middle-income countries including Nepal. Recently, Nepal has made significant progress in enhancing access to maternal health services and in reducing maternal mortality ratio (MMR). Nonetheless, the MMR remains high (151 maternal deaths per 100,000 live births), with a slower rate of decline in recent years, particularly among disadvantaged groups. This study investigates trends and determinants of key maternal health services in Nepal.
MethodsWe conducted further analysis of secondary data from the most recent three Nepal Demographic and Health Surveys (NDHS) conducted in 2011 (n = 1,057), 2016 (n = 964), and 2022 (n = 981) among women aged 15–49 who had at least one live birth prior to each survey. The outcome variables for the trend analysis included the uptake of at least four antenatal care (4ANC) visits, institutional deliveries, first postnatal care (PNC) within 48 hours of childbirth, and completion of all these three routine visits. Determinants of institutional delivery, delivery in private health facilities (HFs), cesarian section (CS) deliveries, and uptake of maternity incentive were investigated. Independent variables included socioeconomic characteristics of women and their marginalization status, geographic factors (e.g., province), health system factors (health service use). A multivariable logistic regression analysis was conducted using data from the NDHS 2022 to investigate the associated determinants of outcome variables considering p value Results
Results showed low completion rates (59%) of all three maternity care visits and significant discontinuity of care throughout the maternity continuum (82% 4ANC, and 73% PNC visits). From 2011 to 2022, there were increased institutional deliveries overall (47% to 81%) and CS within private HFs (30% to 51%), alongside a decreasing trend in the utilization of maternity incentives (87% to 78%). Women from Karnali province and those facing multiple forms of marginalization (women form lower wealth status and who belong to marginalized ethnicities (e.g., Dalits or Janajatis), and lack of education had lower odds of institutional delivery. Conversely, women who attended at least 4ANC visits had higher odds of institutional delivery. Higher odds of childbirth in private HFs were identified in the Koshi, Bagmati, Madhesh, and Lumbini provinces, particularly among women with fewer forms of marginalization. In contrast, women who worked as manual labor or those with higher birth orders had lower odds of childbirth in private HFs. Notably, higher odds of delivery by CS were observed among older women, women who were Maithili native speakers, and in provinces where higher delivery in HFs. Furthermore, the odds of uptake of maternity incentives were lower among women who had gave births in private HFs.
ConclusionsMarginalized women experience lower uptake of routine maternity care visits and higher discontinuation along the antenatal through to ponstantal period, creating significant equity gaps in Nepal. The increasing trend of deliveries in private HFs, particularly deliveries by elective CS without maternity incentives could lead to financial hardship while seeking routine maternal health care. Health systems should adopt targeted strategies addressing specific needs, considering intersecting marginalization factors. Key interventions include improving infrastructure, hiring and training local health workers, revising maternity incentives, regulating private HFs, and conducting quality audits, including increasing trends of CS deliveries.
by Daniel Bekele Ketema, Min Jun, Sradha Kotwal, Workagegnehu Hailu, Martin Gallagher, Rohina Joshi
BackgroundChronic kidney disease (CKD) is a growing public health problem in Ethiopia. However, evidence on the health system and contextual factors influencing CKD care remains limited. This study explored the barriers and facilitators to CKD care from the perspectives of healthcare providers and other stakeholders.
MethodsA descriptive qualitative study was conducted using purposive and maximum variation sampling to recruit healthcare providers (including general practitioners, nephrologists/internists, nurse) and non-communicable disease (NCD) officers and program coordinators. Interviews were audio recorded, transcribed, and thematically analysed, underpinned by the Theoretical Domains Framework version 2.
ResultsFifteen participants (six general practitioners, five nephrologists/internists, one nurse, and three NCD program officers and coordinators) were included. About 40% of participants had over six years’ experience. Key barriers to CKD care included patient misconceptions, low patient and healthcare provider awareness, shortage of health workforce, knowledge gaps among junior healthcare providers, limited resources, high out-of-pocket costs, absence of registries for CKD, weak referral systems, inconsistent access to medicines and diagnostics, lack of structured training, and conflict-related disruptions. Facilitators included adherence to guidelines by senior staff, inclusion of CKD into national non-communicable disease strategies, and increased use of media for public health education.
ConclusionsAddressing key barriers and enhancing prioritisation of CKD by clinicians and policymakers is critical. Strengthening workforce capacity, awareness, referral systems, and integration into national strategies offers opportunities to improve CKD care.
Diabetes mellitus is a significant global health challenge, requiring innovative strategies to improve management and mitigate complications. Digital health technologies offer promising solutions to enhance diabetes self-care by providing real-time feedback, improving communication and supporting data-driven decision-making. Despite the increasing adoption of digital self-care interventions, there is a lack of comprehensive synthesis of evidence on their impact, accessibility and integration into healthcare systems. This scoping review aims to map existing research on digital self-care solutions for diabetes management, identify knowledge gaps and highlight best practices and key factors influencing adoption.
The review will follow Arksey and O’Malley’s framework and adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A systematic search will be conducted in Medline, Scopus, Embase, CINAHL and Google Scholar, focusing on studies published from January 2004 to December 2024 in English, French, Arabic, Portuguese, Spanish, Italian, Czech, Slovak and Chinese. Studies reporting on digital self-care solutions for diabetes management will be included, covering experimental and quasi-experimental study designs. Data extraction will cover study and participant characteristics, digital solution features, and barriers and facilitators to adoption. Ethical and equity considerations will also be analysed using established frameworks. Two reviewers will independently screen studies, with discrepancies resolved by a third reviewer.
This scoping review will provide a comprehensive understanding of digital self-care solutions for diabetes management, offering insights to inform future research and enhance self-care practices globally. Findings will be disseminated through peer-reviewed publications, conferences and interest holder engagements to inform clinical practice and policy development. As this study involves the review of existing literature, ethical approval is not required.
by Karishma Bhandari, Sheetal Bhandari, Manish Rajbanshi, Richa Aryal, Sagun Magar, Lokendra Oli, Mohandev Joshi, Bishnu Prasad Choulagai
Overweight is highly prevalent in lower- and middle-income countries (LMICs), including Nepal. Due to the rapid physical and mental growth among adolescents, they are nutritionally vulnerable and sensitive to environmental factors and dietary habits. This study aimed to determine the prevalence of overweight and its associated factors among adolescents of higher secondary schools in Kathmandu Metropolitan City (KMC) of Nepal. A cross-sectional study was conducted among 282 adolescents in higher secondary schools. A stratified random sampling technique was used to select the participants for data collection. The frequencies, percentages, mean, and standard deviation were used to describe the characteristics of the participants. Binary logistic regression was performed to determine the association between individual characteristics and the prevalence of overweight. All the tests were performed at a 95% Confidence Interval (CI), and variables with p-values below 0.05 were considered statistically significant. The mean (±SD) age of the participants was 16.8 ± 0.1 years. The majority of the participants (66.3%) were from private schools. Around 13.4% of the participants were overweight. Characteristics such as type of school (AOR: 2.6, CI: 1.9–8.2), father’s education (AOR: 2.1, CI: 1.7–6.5), access to physical activity at school (AOR: 1.2, CI: 1.1–4.6), and pocket money for lunch at school (AOR: 0.3, CI: 0.2–0.5) were found to be significantly associated with overweight among adolescents in this study. This study found that a notable proportion of adolescents were overweight and were influenced by socio-economic and demographical characteristics such as education, income level, school type, and level of physical activity. School-based interventions and programs should be carried out to promote healthy eating and physical activity among adolescents. A holistic approach, including parental education on nutrition, controlling pocket money to reduce unhealthy purchases, and adding physical activities to school programs, should be tailored to the school setting to reduce the risk of being overweight.
Globally, over 2.3 million people die each year as a result of diseases or injuries related to their jobs, and 313 million suffer from non-fatal ailments. Welding is one such profession, which is a hazard-prone job with several potential risks, including burns, electrocution and the potentially deadly risk of fume exposure. In Nepal, people taking the welding profession are aware of the risks associated with their jobs, but they often do not take preventive measures because of ignorance, perceived discomfort in their jobs and lack of knowledge about occupational safety laws and regulations. This increases the probability of accidents.
The objective of this study was to explore occupational health risks and safety awareness among welders and their adherence to occupational safety and health regulations in Nepal.
A qualitative, cross-sectional study employing a thematic analysis approach was adopted.
The research was conducted in small-scale welding workshops located in a semiurban area in Bhaktapur District, central Nepal, reflecting the informal industrial sector.
26 male welders, aged 18–42 years, originally from nine districts across Nepal, participated, each from a different workshop, thus reaching 26 small-scale welding workshops. All were engaged in welding work at the time of the study. Participants were selected using snowball sampling. Most had not completed secondary education and had work experience ranging from 1 to 22 years.
As a qualitative study, the primary outcome was the thematic exploration of welders’ experiences. The main themes included occupational health risks and injury management, personal protective equipment (PPE) use and barriers, access to healthcare and insurance, and awareness of occupational health and safety (OHS) policies and training opportunities.
The study revealed significant occupational health risks, including eye burns, electric shocks and physical exhaustion among the welders. Further, the participating welders reported limited access to health insurance and inadequate awareness and access to PPE. Furthermore, awareness of safety policies is also low among welders. While support groups and associations exist, their support is often insufficient, thus perpetuating challenges in workplace safety.
This study provides a glimpse of the ground reality of welding workers in small-scale industries in Nepal, showing gaps and the need for safe occupational practices that must be addressed. Further study and work are needed to establish better occupational safety practices and improve the health and safety status of welders.
Mycobacteroides abscessus (MABS) is within the non-tuberculous mycobacteria family. It inhabits soil and water, exhibits multi-antibiotic resistance and causes opportunistic lung infections, which may progress to symptomatic MABS-pulmonary disease (MABS-PD) associated with substantial morbidity, increased healthcare utilisation, impaired quality of life and increased mortality. Treatment regimens for MABS-PD are highly variable, not evidence-based and involve complex, expensive drug combinations administered for prolonged periods (>12 months) with frequent adverse effects and treatment failure. There is an urgent need for safe, efficacious and cost-effective MABS-PD therapy. Here, we describe the Master Protocol for the Finding the Optimal Regimen for Mycobacteroides abscessus Treatment (FORMaT) trial. FORMaT aims to determine the most effective and best tolerated treatment for MABS-PD as defined by MABS clearance from respiratory samples with good treatment tolerance.
FORMaT is an international multicentre, adaptive platform trial evaluating treatment combinations for MABS-PD. Participants are randomised multiple times during the trial, with assessment of the primary outcome of clearance of MABS infection with good treatment tolerance. Initially, therapies recommended in international consensus guidelines are being tested. Data obtained will eliminate therapies lacking efficacy or causing unacceptable toxicity. Novel treatments can then be added and tested against previously determined optimal approaches, leading in an iterative fashion to improved microbiological clearance and health outcomes. In parallel, an Observational cohort and several integrated and discovery studies are embedded in FORMaT to identify biomarkers of MABS-PD and MABS clearance, clinical and radiographic treatment response, drug pharmacokinetics and Mycobacteroides genomics and resistome.
The FORMaT Master Protocol and related documents are approved by regulatory authorities in each participating jurisdiction and/or site. Results will be published in peer-reviewed journals and presented at scientific meetings. De-identified, aggregated data will be shared on an approved online platform.
NCT04310930, ANZCTR12618001831279, 2020-000050-10,
Guideline-based strategies to prevent chronic kidney disease (CKD) progression and complications are available, yet their implementation in clinical practice is uncertain. We aimed to synthesise the available evidence on the concordance of CKD care with clinical guidelines to identify gaps and inform future CKD care.
Systematic review and meta-analysis.
We systematically searched MEDLINE (OVID), EMBASE (OVID) and CINAHL (EBSCOhost) (to 18 July 2025) for observational studies of adults with CKD reporting data on the quality of CKD care. We assessed data on quality indicators of CKD care across domains that related to patient monitoring (glomerular filtration rate and albuminuria), medications use (ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), statins) and treatment targets (blood pressure (BP) and HbA1c). Pooled estimates (95% CI) of the percentage of patients who met the quality indicators for CKD care were estimated using random effects model.
59 studies across 24 countries, including a total of 3 003 641 patients with CKD, were included. Across studies, 81.3% (95% CI: 75% to 87.6%) of patients received eGFR monitoring, 47.4% (95% CI: 40.0% to 54.7%) had albuminuria testing, and 90% (95% CI: 84.3% to 95.9%) had BP measured. ACEIs/ARBs were prescribed among 56.7% (95% CI: 51.5% to 62%), and statins among 56.6% (95% CI: 48.9% to 64.3%) of patients. BP (systolic BP ≤140/90 mm Hg) and HbA1c (
Current evidence shows substantial variation in CKD care quality globally. Guideline-concordant care varied according to quality measures and across patient groups, with gaps in indicators like albuminuria testing. These findings underscore the need for effective quality improvement strategies to address gaps in CKD care, including increased albuminuria testing for risk stratification, together with systematic measures for monitoring care quality.
CRD42023391749.
by Ramesh Malashi, Sunita Sharma, Srijana Adhikari, Chitra Raj Sharma, Arun Kumar Joshi, Buna Bhandari
IntroductionHypertension is a significant risk factor for cardiovascular diseases (CVDs), which remains the leading causes of morbidity and mortality globally, with a disproportionate impact on low and middle income countries. While hypertension is prevalent across various populations, government employees are particularly susceptible due to high stress levels, sedentary lifestyles, and work-related pressures. Therefore, this study was undertaken to assess the prevalence of hypertension and its associated risk factors among government employees in the Doti district of Nepal.
MethodsA cross-sectional study was carried out among 195 government employees in Dipayal Silgadhi Municipality of Doti district of Sudurpashchim province of Nepal. The data was collected through face-to-face interviews using Simple Random Sampling (SRS) technique and analysed using SPSS v25. The structured questionnaire adopted from the WHO STEPS survey tool was used for data collection. Bivariate and multivariate logistic regression model was used to assess the factors associated with hypertension.
ResultsThe prevalence of hypertension among government employee was 36.4%% ± 5.6%. Participants with age group 30–40 years [Adjusted Odd’s Ratio (AOR) 14.4, 95% Confidence Interval (CI) (1.6, 127.7)], 40–50 years [AOR 13.7, 95% CI (1.04, 180.3)] and work experience (20–30 years) [AOR 6.67, 95% CI(1.23, 35.9), and drinking alcohol [AOR 0.35, 95% CI (0.17, 0.72)] were found to be statistically significant with hypertension.
ConclusionThe study revealed the high prevalence of hypertension among government employees; significantly associated with risk factors like age group 30–50 years, work experience and alcohol consumption, indicating an alarming public health concern. These results highlight the pressing need for focused interventions to reduce the risk of hypertension and its related problems among government employees, such as lifestyle changes, workplace health programs, and routine health screenings.
To evaluate the attitudes of Indian nurses towards the importance of family involvement in nursing care and the association between nurse attitudes and sociodemographic characteristics.
Involving the family in the care process is crucial for delivering family- and patient-centred care and ensuring the best possible patient outcomes. Nevertheless, published literature revealed that the nurses may lack clarity regarding the role of family members in the patient's care, which in turn hinders families' participation in care.
Cross-sectional descriptive study. The STROBE checklist was used to report the present study.
A total of 203 Nurses participated in a prospective cross-sectional study between May 2022 and August 2022. They were recruited through convenience sampling from two tertiary care centres in India. A two-part questionnaire was used to gather the data; the first section contained questions for gathering sociodemographic information, and the second part contained the standardized FINC-NA scale.
The mean age of the nurses was (28.08 ± 4.722) years, and their median professional experience was 2.5 (1–5.5) years. Nurses' attitude regarding family's importance in patient care was found to be significantly associated (p ≤ .05) with education level, marital status, religion and hometown region.
In several items Indian nurses have positive attitudes towards family involvement in care but some of the lower scoring items can present opportunities for focused improvement. Continuing development programmes about family-centered care can constitute important strategies to improve the positive attitudes of nurses towards families in practice.
No patient or public contribution.
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