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Supply-side and demand-side factors affecting allopathic primary care service delivery in low-income and middle-income country cities

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The Lancet Global health 2025年第5期13卷 e942-e953页

作者： Lilford, Richard J Daniels, Benjamin McPake, Barbara Bhutta, Zulfiqar A Mash, Robert Griffiths, Frances Omigbodun, Akinyinka Pinto, Elzo Pereira Jain, Radhika Asiki, Gershim Webb, Eika Scandrett, Katie Chilton, Peter J Sartori, Jo Chen, Yen-Fu Waiswa, Peter Ezeh, Alex Kyobutungi, Catherine Leung, Gabriel M Machado, Cristani Sheikh, Kabir Watson, Sam I Das, Jishnu Institute of Applied Health Research University of Birmingham Edgbaston United Kingdom Department of Global Health and Population Harvard T H Chan School of Public Health Boston MA United States The University of Melbourne Parkville VIC Australia Institute for Global Health & Development The Aga Khan University South-Central Asia East Africa and UK Karachi Pakistan Centre for Global Child Health The Hospital for Sick Children Toronto ON Canada Department of Family & Emergency Medicine University of Stellenbosch Cape Town South Africa Warwick Medical School University of Warwick Coventry United Kingdom Centre for Health Policy School of Public Health University of the Witwatersrand Johannesburg South Africa College of Medicine University of Ibadan Ibadan Nigeria Center of Data and Knowledge Integration for Health Oswaldo Cruz Foundation–Brazil Salvador Brazil Global Business School for Health University College London London United Kingdom African Population and Health Research Center Nairobi Kenya University Hospitals Birmingham NHS Foundation Trust Birmingham United Kingdom School of Public Health College of Health Sciences Makerere University Kampala Uganda Dornsife School of Public Health Drexel University Philadelphia PA United States School of Public Health Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong Special Administrative Region Hong Kong Sergio Arouca National School of Public Health Oswaldo Cruz Foundation Rio de Janeiro Brazil McCourt School of Public Policy and the Walsh School of Foreign Service Georgetown University Washington DC United States

Most people in low-income and middle-income countries (LMICs) now live in cities, as opposed to rural areas where access to care and provider choice is limited. Urban health-care provision is organised on very different patterns to those of rural care. We synthesise global evidence to show that health-care clinics are plentiful and easily accessible in LMIC cities and that they are seldom overcrowded. The costs that patients incur when they seek care are highly variable and driven mostly by drugs and diagnostics. We show that citizens have agency, often bypassing cheaper facilities to access preferred providers. Primary care service delivery in cities is thus best characterised as a market with a diverse range of private and public providers, where patients make active choices based on price, quality, and access. However, this market does not deliver high-quality consultations on average and does not provide continuity or integration of services for preventive care or long-term conditions. Since prices play a key role in accessing care, the most vulnerable groups of the urban population often remain unprotected. © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

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Policy and service delivery proposals to improve primary care services in low-income and middle-income country cities

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The Lancet Global health 2025年第5期13卷 e954-e966页

作者： Lilford, Richard J Daniels, Benjamin McPake, Barbara Bhutta, Zulfiqar A Mash, Robert Griffiths, Frances Omigbodun, Akinyinka Pinto, Elzo Pereira Jain, Radhika Asiki, Gershim Webb, Eika Scandrett, Katie Chilton, Peter J Sartori, Jo Chen, Yen-Fu Waiswa, Peter Ezeh, Alex Kyobutungi, Catherine Leung, Gabriel M Machado, Cristiani Sheikh, Kabir Watson, Sam I Das, Jishnu Institute of Applied Health Research University of Birmingham Edgbaston United Kingdom Department of Global Health and Population Harvard T H Chan School of Public Health Boston MA United States The University of Melbourne Parkville VIC Australia Institute for Global Health & Development The Aga Khan University South-Central Asia East Africa and UK Karachi Pakistan Centre for Global Child Health The Hospital for Sick Children Toronto ON Canada Department of Family & Emergency Medicine University of Stellenbosch Cape Town South Africa Warwick Medical School University of Warwick Coventry United Kingdom Centre for Health Policy School of Public Health University of the Witwatersrand Johannesburg South Africa College of Medicine University of Ibadan Ibadan Nigeria Center of Data and Knowledge Integration for Health Oswaldo Cruz Foundation–Brazil Salvador Brazil Global Business School for Health University College London London United Kingdom African Population and Health Research Center Nairobi Kenya University Hospitals Birmingham NHS Foundation Trust Birmingham United Kingdom School of Public Health College of Health Sciences Makerere University Kampala Uganda Dornsife School of Public Health Drexel University Philadelphia PA United States School of Public Health Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong Special Administrative Region China Sergio Arouca National School of Public Health Oswaldo Cruz Foundation Rio de Janeiro Brazil McCourt School of Public Policy and the Walsh School of Foreign Service Georgetown University Washington DC United States

The landscape of primary care services in low-income and middle-income country cities is diverse and dynamic, yet the quality of care received is too often low and the financial cost to the patient high. In the second Paper in this Series, we argue that shaping the primary care market is likely to provide larger returns to scale than individual quality improvement initiatives. Among other things, the market can be shaped by regulation and targeted public investment to crowd out poor providers and motivate those that remain to improve. Additional supply-side initiatives for which there is evidence include measures to educate and motivate the workforce, skill substitution and formation of clinical primary care teams, information technology, and improving the supply of medicines and diagnostics. Demand-side measures include reducing out-of-pocket expenses and promoting health literacy and user advocacy. Research is urgently needed into access for people who are unregistered (eg, those who sleep on the streets), those in peri-urban areas and towns, and on cost-effectiveness, and sustainability of beneficial interventions. © 2025 Elsevier Ltd

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Inequality and income segregation in Brazilian cities: a nationwide analysis

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SN Social Sciences 2022年第9期2卷 1-22页

作者： de Sousa Filho, José Firmino dos Santos, Gervásio F. Andrade, Roberto F. Silva Paiva, Aureliano S. Freitas, Anderson Castro, Caio Porto de Lima Friche, Amélia A. Barber, Sharrelle Caiaffa, Waleska T. Barreto, Maurício L. Center of Data and Knowledge Integration for Health (CIDACS) Salvador Brazil School of Economics (PPGE) Federal University of Bahia Salvador Brazil Institute of Public Health (ISC) Federal University of Bahia Salvador Brazil Observatory for Urban Health in Belo Horizonte (OSUBH) Federal University of Minas Gerais Belo Horizonte Brazil Department of Epidemiology and Biostatistics Drexel University Dornsife School of Public Health Philadelphia United States Institute of Physics Federal University of Bahia Salvador Brazil

Residential segregation has brought significant challenges to cities worldwide and has important implications for health. This study aimed to assess income segregation in the 152 largest Brazilian cities in the SALURBAL Project. We identify specific socioeconomic characteristics related to residential segregation by income using the Brazilian demographic census of 2010 and calculated the income dissimilarity index (IDI) at the census tract level for each city, subsequently comparing it with Gini and other local socioeconomic variables. We evaluated our results’ robustness using a bootstrap correction to the IDI to examine the consequences of using different income cut-offs in substantial urban and regional inequalities. We identified a two minimum wage cut-off as the most appropriate. We found little evidence of upward bias in the calculation of the IDI regardless of the cut-off used. Among the ten most segregated cities, nine are in the Northeast region, with Brazil's highest income inequality and poverty. Our results indicate that the Gini index and poverty are the main variables associated with residential segregation. © The Author(s) 2022.

关键词： Brazil Income dissimilarity index Segregation Urban inequality

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Improving primary health-care services in LMIC cities

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The Lancet Global health 2025年第5期13卷 e795-e796页

作者： Richard J Lilford Benjamin Daniels Barbara McPake Zulfiqar A Bhutta Robert Mash Frances Griffiths Akinyinka Omigbodun Elzo Pereira Pinto Radhika Jain Gershim Asiki Eika Webb Katie Scandrett Peter J Chilton Jo Sartori Yen-Fu Chen Peter Waiswa Alex Ezeh Catherine Kyobutungi Gabriel M Leung Cristiani Machado Jishnu Das Institute of Applied Health Research University of Birmingham Birmingham B15 2TT UK Department of Global Health and Population Harvard TH Chan School of Public Health Boston MA USA The University of Melbourne Parkville VIC Australia Institute for Global Health & Development The Aga Khan University South-Central Asia East Africa and UK Karachi Pakistan Centre for Global Child Health The Hospital for Sick Children Toronto ON Canada Department of Family & Emergency Medicine University of Stellenbosch Stellenbosch South Africa Warwick Medical School University of Warwick Coventry UK Centre for Health Policy School of Public Health University of the Witwatersrand Johannesburg South Africa College of Medicine University of Ibadan Ibadan Nigeria Center of Data and Knowledge Integration for Health Fiocruz-Brazil Salvador Brazil Global Business School for Health University College London London UK African Population and Health Research Center Nairobi Kenya University Hospitals Birmingham NHS Foundation Trust Birmingham UK School of Public Health College of Health Sciences Makerere University Kampala Uganda Dornsife School of Public Health Drexel University Philadelphia PA USA School of Public Health LKS Faculty of Medicine The University of Hong Kong Hong Kong Special Administrative Region China Sergio Arouca National School of Public Health—Oswaldo Cruz Foundation Rio de Janeiro Brazil McCourt School of Public Policy and the Walsh School of Foreign Service Georgetown University Washington DC USA

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Vaccination in a two-strain model with cross-immunity and antibody-dependent enhancement

arXiv

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arXiv 2023年

作者： Bulhosa, Lorena C. Oliveira, Juliane F. Institute for Pure and Applied Mathematics Rio de Janeiro22460-320 Brazil Center for Data and Knowledge Integration for Health Gonçalo Moniz Institute Oswaldo Cruz Foundation Bahia Salvador40296-710 Brazil

Dengue and Zika incidence data and the latest research have raised questions about how dengue vaccine strategies might be impacted by the emergence of Zika virus. Existing antibodies to one virus might temporarily protect or promote infection by the other through antibody-dependent enhancement (ADE). With this condition, understanding the dynamics of propagation of these two viruses is of great importance when implementing vaccines. In this work, we analyze the effect of vaccination against one strain, in a two-strain model that accounts for cross-immunity and ADE. Using basic and invasion reproductive numbers, we examined the dynamics of the model and provide conditions to ensure the stability of the disease-free equilibrium. We provide conditions on cross-immunity, ADE and vaccination rate under which the vaccination could ensure the global stability of the disease-free equilibrium. The results indicate scenarios in which vaccination against one strain may improve or worsen the control of the other, as well as contribute to the eradication or persistence of one or both viruses in the population. © 2023, CC BY-NC-SA.

关键词： Vaccines

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data challenges for international health emergencies: lessons learned from ten international COVID-19 driver projects

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The Lancet Digital health 2024年第5期6卷 e354-e366页

作者： Boylan, Sally Arsenault, Catherine Barreto, Marcos Bozza, Fernando A Fonseca, Adalton Forde, Eoghan Hookham, Lauren Humphreys, Georgina S Ichihara, Maria Yury Le Doare, Kirsty Liu, Xiao Fan McNamara, Edel Mugunga, Jean Claude Oliveira, Juliane F Ouma, Joseph Postlethwaite, Neil Retford, Matthew Reyes, Luis Felipe Morris, Andrew D Wozencraft, Anne Health Data Research UK London United Kingdom Department of Global Health Milken Institute School of Public Health George Washington University WashingtonDC United States Center for Data and Knowledge Integration for Health Gonçalo Moniz Institute Oswaldo Cruz Foundation Salvador Brazil Evandro Chagas National Institute of Infectious Disease Oswaldo Cruz Foundation Rio de Janeiro Brazil Aridhia Informatics Glasgow United Kingdom St George's University of London London United Kingdom Green Templeton College University of Oxford Oxford United Kingdom Nuffield School of Medicine University of Oxford Oxford United Kingdom Makerere University John's Hopkins University Research Collaboration Kampala Uganda Department of Media and Communication City University of Hong Kong Hong Kong Special Administrative Region Hong Kong Partners in Health BostonMA United States Department of Global Health and Social Medicine Harvard Medical School BostonMA United States Division of Global Health Equity Brigham and Women's Hospital BostonMA United States Department of Mathematics Centre of Mathematics of the University of Porto Porto Portugal Universidad de La Sabana Chia Colombia

The COVID-19 pandemic highlighted the importance of international data sharing and access to improve health outcomes for all. The International COVID-19 data Alliance (ICODA) programme enabled 12 exemplar or driver projects to use existing health-related data to address major research questions relating to the pandemic, and developed data science approaches that helped each research team to overcome challenges, accelerate the data research cycle, and produce rapid insights and outputs. These approaches also sought to address inequity in data access and use, test approaches to ethical health data use, and make summary datasets and outputs accessible to a wider group of researchers. This health Policy paper focuses on the challenges and lessons learned from ten of the ICODA driver projects, involving researchers from 19 countries and a range of health-related datasets. The ICODA programme reviewed the time taken for each project to complete stages of the health data research cycle and identified common challenges in areas such as data sharing agreements and data curation. Solutions included provision of standard data sharing templates, additional data curation expertise at an early stage, and a trusted research environment that facilitated data sharing across national boundaries and reduced risk. These approaches enabled the driver projects to rapidly produce research outputs, including publications, shared code, dashboards, and innovative resources, which can all be accessed and used by other research teams to address global health challenges. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

关键词： COVID-19

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Expansion of primary healthcare and emergency hospital admissions among the urban poor in Rio de Janeiro Brazil: A cohort analysis

LANCET REGIONAL HEALTH-AMERICAS

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LANCET REGIONAL health-AMERICAS 2022年 15卷 100363-100363页

作者： [Anonymous] Public Health Policy Evaluation Unit Imperial College London London United Kingdom Departments of Health Policy and Management and Community Health Sciences Jonathan and Karin Fielding School of Public Health University of California Los Angeles United States Federal University of Rio de Janeiro Brazil Department of Public Health University “Federico II” of Naples Italy Instituto de Estudos em Saúde Coletiva Universidade Federal do Rio de Janeiro Rio de Janeiro Brazil Secretaria Municipal de Saúde do Rio de Janeiro Rio de Janeiro Brazil ISGlobal Hospital Clinic - Universitat de Barcelona Barcelona Spain Center of Data and Knowledge Integration for Health (CIDACS) Instituto Gonçalo Muniz Fundação Oswaldo Cruz Salvador Brazil Comprehensive Health Research Center and Public Health Research Centre NOVA National School of Public Health NOVA University of Lisbon Lisbon Portugal

Background Robust evidence on the relationship between primary care and emergency admissions is lacking in low-and middle-income countries. This study evaluates how the phased roll out of the family health strategy (FHS) to the urban poor in Rio de Janeiro Brazil affected emergency hospital admissions and readmissions from ambulatory-care sensitives conditions (ACSCs).Methods A cohort of 1.2 million adults in Rio de Janeiro city were followed for five years (Jan 2012 to Dec 2016). The association between FHS use and the likelihood of emergency hospital admissions and 30-day readmissions were evaluated using multilevel Poisson regression models with inverse probability treatment weighting and regression adjustment (IPTW-RA) for socioeconomic and household characteristics. Inequalities in associations were examined across groups of causes and by key socioeconomic *** Records from 2,551,934 primary care consultations and 15,627 admissions were analysed. In IPTW-RA analyses, each additional FHS consultation was associated with a 3% lower rate of ACSC admission (RR: 0.97;95%CI: 0.95, 0.98), a 63% lower rate of 30-day readmissions from any non-birth cause (RR: 0.37;95%CI: 0.30, 0.46), and an 57% lower rate of 30-day readmissions from ACSCs (RR: 0.43;95%CI: 0.33, 0.55). Individuals who were older, had the lowest educational attainment, were unemployed, and had higher incomes had larger reductions in ACSC admissions associated with FHS *** Investment in primary care is important for reducing emergency hospital admissions and their associated costs in LMICs.

关键词： Brazil Primary care Hospitalisations Admissions

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Corrigendum to "Recent changes in growth trajectories: a population-based cohort study of over 5 million Brazilian children born between 2001 and 2014" [The Lancet Regional health-Americas 2024;Volume 32, 100721, Published: March 27, 2024]

Lancet regional health. Americas

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Lancet regional health. Americas 2024年 34卷 100787页

作者： Carolina Santiago-Vieira Gustavo Velasquez-Melendez Rita de Cássia Ribeiro Silva Elizabete de Jesus Pinto Maurício L Barreto Leah Li School of Nursing Universidade Federal de Minas Gerais Belo Horizonte Brazil. Center of Data and Knowledge Integration for Health (CIDACS) Fiocruz Bahia Salvador Brazil. Population Policy and Practice Research and Teaching Department Great Ormond Street Institute of Child Health University College London London UK. School of Nutrition Federal University of Bahia Salvador Brazil. Health Sciences Center Federal University of Recôncavo da Bahia Santo Antônio de Jesus Brazil.

[This corrects the article DOI: 10.1016/***.2024.100721.].

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Early-childhood linear growth faltering in low- and middle-income countries (

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NATURE 2023年第7985期623卷 E2-E2页

作者： Benjamin-Chung, Jade Mertens, Andrew Colford, John M., Jr. Hubbard, Alan E. van der Laan, Mark J. Coyle, Jeremy Sofrygin, Oleg Cai, Wilson Nguyen, Anna Pokpongkiat, Nolan N. Djajadi, Stephanie Seth, Anmol Jilek, Wendy Jung, Esther Chung, Esther O. Rosete, Sonali Hejazi, Nima Malenica, Ivana Li, Haodong Hafen, Ryan Subramoney, Vishak Haggstrom, Jonas Norman, Thea Brown, Kenneth H. Christian, Parul Arnold, Benjamin F. Department of Epidemiology & Population Health Stanford University Stanford CA USA Division of Epidemiology & Biostatistics University of California Berkeley Berkeley CA USA Chan Zuckerberg Biohub San Francisco CA USA Hafen Consulting LLC West Richland WA USA DVPL Tech Dubai United Arab Emirates Cytel Inc. Waltham MA USA Quantitative Sciences Bill & Melinda Gates Foundation Seattle WA USA Department of Nutrition University of California Davis Davis CA USA Center for Human Nutrition Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA Francis I. Proctor Foundation University of California San Francisco San Francisco CA USA Department of Ophthalmology University of California San Francisco San Francisco CA USA Department of Public Health and Primary Care Ghent University Ghent Belgium Department of Nutrition University of North Carolina at Chapel Hill Chapel Hill NC USA International Centre for Diarrhoeal Disease Research Bangladesh Dhaka Bangladesh Department of Pediatrics and Child Health The Aga Khan University Karachi Pakistan University of Virginia Charlottesville VA USA JiVitA Project John Hopkins Bangladesh Rangpur Bangladesh Center for Child Adolescent and Maternal Health Research Department of Medicine and Health Technology Tampere University Tampere Finland Tampere University Hospital Tampere Finland World Health Organization Geneva Switzerland Center of Data and Knowledge Integration for Health Fundação Oswaldo Cruz Salvador Brazil UNICEF New York NY USA HIV/AIDS & Global Health Research Programme University of Venda Thohoyandou South Africa Indian Institute of Technology New Delhi India Centre for Health Research and Development Society for Applied Studies New Delhi India Sunder Lal Jain Hospital New Delhi India Centre of Excellence in Women & Child Health Institute for Global Health & Development The Aga Khan University Karachi Pakistan Johns Hopkins University Bl

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Correction to: health data collection methods and procedures across EU member states: findings from the InfAct Joint Action on health information

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Archives of public health = Archives belges de sante publique 2022年第1期80卷 51页

作者： Brigid Unim Eugenio Mattei Flavia Carle Hanna Tolonen Enrique Bernal-Delgado Peter Achterberg Metka Zaletel Stefanie Seeling Romana Haneef Anne-Charlotte Lorcy Herman Van Oyen Luigi Palmieri Department of Cardiovascular Endocrine-metabolic Diseases and Aging Istituto Superiore di Sanità Via Giano della Bella 34 00162 Rome Italy. brigid.unim@iss.it. Department of Cardiovascular Endocrine-metabolic Diseases and Aging Istituto Superiore di Sanità Via Giano della Bella 34 00162 Rome Italy. Center of Epidemiology Biostatistics and Medical Information Marche Polytechnic University Ancona Italy. Department of Public Health and Welfare Finnish Institute for Health and Welfare (THL) Helsinki Finland. Data Sciences for Health Services and Policy Research Group Institute for Health Sciences in Aragon (IACS) Zaragoza Spain. Centre for Health Knowledge Integration National Institute for Public Health and the Environment (RIVM) Bilthoven Netherlands. Health Data Centre National Institute of Public Health Ljubljana Slovenia. Department of Epidemiology and Health Monitoring Robert Koch Institute Berlin Germany. Department of Non-Communicable Diseases and Injuries Santé Publique France 94415 Saint-Maurice France. Directorate of Health Luxembourg Luxembourg. Epidemiology and Public Health Sciensano Brussels Belgium.

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