Subjects -> MEDICAL SCIENCES (Total: 8669 journals)
    - ANAESTHESIOLOGY (120 journals)
    - CARDIOVASCULAR DISEASES (338 journals)
    - DENTISTRY (294 journals)
    - ENDOCRINOLOGY (151 journals)
    - FORENSIC SCIENCES (42 journals)
    - HEMATOLOGY (157 journals)
    - HYPNOSIS (4 journals)
    - INTERNAL MEDICINE (176 journals)
    - MEDICAL GENETICS (58 journals)
    - MEDICAL SCIENCES (2406 journals)
    - NURSES AND NURSING (367 journals)
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    - PEDIATRICS (275 journals)
    - PSYCHIATRY AND NEUROLOGY (833 journals)
    - RESPIRATORY DISEASES (104 journals)
    - RHEUMATOLOGY (79 journals)
    - SPORTS MEDICINE (81 journals)
    - SURGERY (406 journals)

MEDICAL SCIENCES (2406 journals)            First | 1 2 3 4 5 6 7 8 | Last

Showing 201 - 400 of 3562 Journals sorted alphabetically
Asian Biomedicine     Open Access   (Followers: 2)
Asian Journal of Cell Biology     Open Access   (Followers: 6)
Asian Journal of Health     Open Access   (Followers: 3)
Asian Journal of Medical and Biological Research     Open Access   (Followers: 5)
Asian Journal of Medical and Pharmaceutical Researches     Open Access   (Followers: 2)
Asian Journal of Medical Sciences     Open Access   (Followers: 2)
Asian Journal of Medicine and Health     Open Access   (Followers: 1)
Asian Journal of Research in Medical and Pharmaceutical Sciences     Open Access   (Followers: 1)
Asian Journal of Scientific Research     Open Access   (Followers: 3)
Asian Journal of Transfusion Science     Open Access   (Followers: 1)
Asian Medicine     Hybrid Journal   (Followers: 5)
Asian Pacific Journal of Cancer Prevention     Open Access  
Asian Pacific Journal of Health Sciences     Open Access   (Followers: 10)
ASPIRATOR : Journal of Vector-borne Disease Studies     Open Access  
Astrocyte     Open Access  
Atención Familiar     Open Access  
Atención Primaria     Open Access   (Followers: 2)
Atención Primaria Práctica     Open Access   (Followers: 1)
Atti della Accademia Peloritana dei Pericolanti - Classe di Scienze Medico-Biologiche     Open Access  
Audiology - Communication Research     Open Access   (Followers: 10)
AUP Advances     Open Access   (Followers: 7)
Auris Nasus Larynx     Full-text available via subscription  
Australasian Journal of Ultrasound in Medicine (AJUM)     Hybrid Journal   (Followers: 1)
Australian Coeliac     Full-text available via subscription   (Followers: 2)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Journal of Medical Science     Full-text available via subscription   (Followers: 3)
Autopsy and Case Reports     Open Access  
Avicenna     Open Access   (Followers: 3)
Avicenna Journal of Clinical Medicine     Open Access  
Avicenna Journal of Medicine     Open Access   (Followers: 1)
Bangabandhu Sheikh Mujib Medical University Journal     Open Access   (Followers: 1)
Bangladesh Journal of Anatomy     Open Access   (Followers: 2)
Bangladesh Journal of Bioethics     Open Access  
Bangladesh Journal of Medical Biochemistry     Open Access   (Followers: 4)
Bangladesh Journal of Medical Education     Open Access   (Followers: 2)
Bangladesh Journal of Medical Microbiology     Open Access   (Followers: 4)
Bangladesh Journal of Medical Physics     Open Access   (Followers: 1)
Bangladesh Journal of Medical Science     Open Access  
Bangladesh Journal of Medicine     Open Access   (Followers: 1)
Bangladesh Journal of Physiology and Pharmacology     Open Access  
Bangladesh Journal of Scientific Research     Open Access   (Followers: 1)
Bangladesh Medical Journal     Open Access  
Bangladesh Medical Journal Khulna     Open Access  
Basal Ganglia     Hybrid Journal  
Basic Sciences of Medicine     Open Access   (Followers: 1)
Batı Karadeniz Tıp Dergisi / Medical Journal of Western Black Sea     Open Access  
Baylor University Medical Center Proceedings     Hybrid Journal  
BBA Clinical     Open Access  
BC Medical Journal     Free  
Benha Medical Journal     Open Access  
Beni-Suef University Journal of Basic and Applied Sciences     Open Access   (Followers: 3)
Bijblijven     Hybrid Journal  
Bijzijn     Hybrid Journal   (Followers: 1)
Bijzijn XL     Hybrid Journal  
Bio-Algorithms and Med-Systems     Hybrid Journal   (Followers: 2)
BioDiscovery     Open Access   (Followers: 2)
Bioelectromagnetics     Hybrid Journal   (Followers: 2)
Bioelectronic Medicine     Open Access   (Followers: 1)
Bioengineering & Translational Medicine     Open Access  
Bioethics     Hybrid Journal   (Followers: 19)
Bioethics Research Notes     Full-text available via subscription   (Followers: 15)
Biologics in Therapy     Open Access  
Biology of Sex Differences     Open Access   (Followers: 2)
Biomarker Research     Open Access   (Followers: 3)
Biomarkers in Medicine     Hybrid Journal   (Followers: 2)
BioMed Research International     Open Access   (Followers: 5)
Biomédica     Open Access  
Biomedical & Life Sciences Collection     Full-text available via subscription   (Followers: 3)
Biomedical and Biotechnology Research Journal     Open Access   (Followers: 1)
Biomedical Engineering     Hybrid Journal   (Followers: 16)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 13)
Biomedical Engineering Letters     Hybrid Journal   (Followers: 6)
Biomedical Engineering Research     Open Access   (Followers: 7)
Biomedical Informatics Insights     Open Access   (Followers: 9)
Biomedical Journal     Open Access   (Followers: 4)
Biomedical Materials     Hybrid Journal   (Followers: 7)
Biomedical Microdevices     Hybrid Journal   (Followers: 9)
Biomedical Optics Express     Open Access   (Followers: 6)
Biomedical Photonics     Open Access  
Biomedical Reports     Full-text available via subscription  
Biomedical Research Reports     Full-text available via subscription   (Followers: 2)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 9)
Biomedical Science and Engineering     Open Access   (Followers: 7)
BioMedicine     Open Access  
Biomedicine Hub     Open Access  
Biomedicines     Open Access   (Followers: 1)
Biomedika     Open Access  
Biomolecular and Health Science Journal     Open Access   (Followers: 1)
Biophysics Reports     Open Access  
BioPsychoSocial Medicine     Open Access   (Followers: 8)
Biosafety and Health     Open Access   (Followers: 2)
Biosalud     Open Access   (Followers: 1)
Biostatistics & Epidemiology     Hybrid Journal   (Followers: 2)
Birat Journal of Health Sciences     Open Access  
BIRDEM Medical Journal     Open Access   (Followers: 1)
Birth Defects Research     Hybrid Journal  
Birth Defects Research Part A : Clinical and Molecular Teratology     Hybrid Journal   (Followers: 3)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal  
BJR|Open     Open Access   (Followers: 1)
BJS Open     Open Access   (Followers: 1)
Black Sea Journal of Health Science     Open Access  
BLDE University Journal of Health Sciences     Open Access  
Blickpunkt Medizin     Hybrid Journal  
BMC Biomedical Engineering     Open Access  
BMC Medical Ethics     Open Access   (Followers: 22)
BMC Medical Research Methodology     Open Access   (Followers: 9)
BMC Medicine     Open Access   (Followers: 14)
BMC Obesity     Open Access   (Followers: 7)
BMC Proceedings     Full-text available via subscription   (Followers: 2)
BMC Research Notes     Open Access   (Followers: 4)
BMC Sports Science, Medicine and Rehabilitation     Open Access   (Followers: 34)
BMH Medical Journal     Open Access   (Followers: 2)
BMI Journal : Bariátrica & Metabólica Iberoamericana     Open Access  
BMJ     Hybrid Journal   (Followers: 1884)
BMJ Case Reports     Hybrid Journal   (Followers: 28)
BMJ Evidence-Based Medicine     Hybrid Journal   (Followers: 4)
BMJ Global Health     Open Access   (Followers: 3)
BMJ Innovations     Hybrid Journal   (Followers: 6)
BMJ Leader     Hybrid Journal  
BMJ Open     Open Access   (Followers: 44)
BMJ Open Quality     Open Access   (Followers: 19)
BMJ Open Science     Open Access   (Followers: 1)
BMJ Sexual & Reproductive Health     Hybrid Journal   (Followers: 2)
BMJ Surgery, Interventions, & Health Technologies     Open Access  
Bodine Journal     Open Access  
Boletín del Consejo Académico de Ética en Medicina     Open Access  
Boletín del ECEMC     Open Access  
Boletin Médico de Postgrado     Open Access  
Boletín Médico del Hospital Infantil de México     Open Access  
Bone     Hybrid Journal   (Followers: 18)
Bone and Tissue Regeneration Insights     Open Access   (Followers: 2)
Bone Marrow Research     Open Access   (Followers: 2)
Bone Reports     Open Access  
Bosnian Journal of Basic Medical Sciences     Open Access  
Bozok Tıp Dergisi / Bozok Medical Journal     Open Access  
Brachytherapy     Full-text available via subscription   (Followers: 6)
Brain and Development     Full-text available via subscription   (Followers: 5)
Brain Communications     Open Access   (Followers: 2)
Brain Connectivity     Hybrid Journal   (Followers: 5)
Brain Impairment     Full-text available via subscription   (Followers: 2)
Brazilian Journal of Medical and Biological Research     Open Access  
Brazilian Journal of Medicine and Human Health     Open Access  
Brazilian Journal of Pain (BrJP)     Open Access  
Brazilian Journal of Physical Therapy     Open Access   (Followers: 2)
Breastfeeding Review     Full-text available via subscription   (Followers: 19)
British Journal of Biomedical Science     Full-text available via subscription   (Followers: 7)
British Journal of General Practice     Full-text available via subscription   (Followers: 39)
British Journal of Hospital Medicine     Full-text available via subscription   (Followers: 16)
British Medical Bulletin     Hybrid Journal   (Followers: 6)
Buddhachinaraj Medical Journal     Open Access  
Bulletin Amades     Open Access  
Bulletin de la Société de pathologie exotique     Hybrid Journal   (Followers: 1)
Bulletin of Legal Medicine     Open Access  
Bulletin of Medical Sciences     Open Access  
Bulletin of the History of Medicine     Full-text available via subscription   (Followers: 21)
Bulletin of the Menninger Clinic     Full-text available via subscription  
Bulletin of The Royal College of Surgeons of England     Free  
Bulletin of the Scientific Centre for Expert Evaluation of Medicinal Products     Open Access  
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz     Hybrid Journal   (Followers: 6)
Burapha Journal of Medicine     Open Access  
Burns     Hybrid Journal   (Followers: 10)
Cadernos de Naturologia e Terapias Complementares     Open Access   (Followers: 1)
Calcified Tissue International     Hybrid Journal   (Followers: 2)
Canadian Bulletin of Medical History     Hybrid Journal  
Canadian Family Physician     Partially Free   (Followers: 13)
Canadian Journal of Pain     Open Access   (Followers: 2)
Canadian Journal of Rural Medicine     Full-text available via subscription   (Followers: 1)
Canadian Medical Association Journal     Open Access   (Followers: 18)
Canadian Medical Education Journal     Open Access   (Followers: 10)
Canadian Prosthetics & Orthotics Journal     Open Access  
Cannabis and Cannabinoid Research     Hybrid Journal   (Followers: 1)
Cardiac Electrophysiology Clinics     Full-text available via subscription   (Followers: 1)
Care Management Journals     Hybrid Journal   (Followers: 5)
Case Reports     Open Access  
Case Reports in Acute Medicine     Open Access   (Followers: 2)
Case Reports in Clinical Medicine     Open Access   (Followers: 2)
Case Reports in Clinical Nutrition     Open Access   (Followers: 1)
Case Reports in Clinical Pathology     Open Access   (Followers: 1)
Case Reports in Medicine     Open Access   (Followers: 3)
Case Reports in Transplantation     Open Access  
Case Reports in Vascular Medicine     Open Access  
Case Reports in Women's Health     Open Access   (Followers: 4)
Case Study and Case Report     Open Access   (Followers: 5)
CASUS : Revista de Investigación y Casos en Salud     Open Access   (Followers: 1)
CBU International Conference Proceedings     Open Access   (Followers: 3)
Cell & Bioscience     Open Access   (Followers: 6)
Cell Adhesion & Migration     Open Access   (Followers: 9)
Cell and Molecular Response to Stress     Full-text available via subscription   (Followers: 2)
Cell and Tissue Transplantation and Therapy     Open Access   (Followers: 2)
Cell Cycle     Full-text available via subscription   (Followers: 6)
Cell Death and Differentiation     Hybrid Journal   (Followers: 8)
Cell Death Discovery     Open Access   (Followers: 1)
Cell Health and Cytoskeleton     Open Access   (Followers: 1)
Cell Medicine     Open Access   (Followers: 6)
Cell Research     Hybrid Journal   (Followers: 8)
Cell Transplantation     Open Access   (Followers: 4)
CEN Case Reports     Hybrid Journal  
Central African Journal of Medicine     Full-text available via subscription  
Cephalalgia Reports     Open Access   (Followers: 2)
Ceylon Journal of Medical Science     Open Access  

  First | 1 2 3 4 5 6 7 8 | Last

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BMJ Global Health
Number of Followers: 3  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2059-7908
Published by BMJ Publishing Group Homepage  [68 journals]
  • Potential challenges of implementing the Community Health Extension Worker
           programme in Uganda

    • Authors: ODonovan, J; Stiles, C. E, Sekimpi, D, Ddumba, I, Winters, N, ONeil Jr, E.
      Keywords: Open access
      PubDate: 2018-08-10T07:11:29-07:00
      DOI: 10.1136/bmjgh-2018-000960
      Issue No: Vol. 3, No. 4 (2018)
  • Drug-resistant tuberculosis: is India ready for the challenge'

    • Authors: Chatterjee, S; Poonawala, H, Jain, Y.
      Keywords: Open access
      PubDate: 2018-08-10T07:11:29-07:00
      DOI: 10.1136/bmjgh-2018-000971
      Issue No: Vol. 3, No. 4 (2018)
  • Prepared for the 'unexpected' Lessons from the 2014-2016 Ebola
           epidemic in West Africa on integrating emergent theory designs into
           outbreak response

    • Authors: Graham, J. E; Lees, S, Le Marcis, F, Faye, S. L, Lorway, R. R, Ronse, M, Abramowitz, S, Peeters Grietens, K.
      Keywords: Open access
      PubDate: 2018-08-10T07:11:29-07:00
      DOI: 10.1136/bmjgh-2018-000990
      Issue No: Vol. 3, No. 4 (2018)
  • Correction: Equity in access to non-communicable disease medicines: a
           cross-sectional study in Kenya

    • Keywords: Open access
      PubDate: 2018-08-10T07:11:29-07:00
      DOI: 10.1136/bmjgh-2018-000828corr1
      Issue No: Vol. 3, No. 4 (2018)
  • Making diagnostic tests as essential as medicines

    • Authors: Velazquez Berumen, A; Garner, S, Hill, S. R, Swaminathan, S.
      Keywords: Open access
      PubDate: 2018-08-03T23:30:16-07:00
      DOI: 10.1136/bmjgh-2018-001033
      Issue No: Vol. 3, No. 4 (2018)
  • Prevalence, incidence and predictors of volunteer community health worker
           attrition in Kwale County, Kenya

    • Authors: Ngugi, A. K; Nyaga, L. W, Lakhani, A, Agoi, F, Hanselman, M, Lugogo, G, Mehta, K. M.
      Abstract: IntroductionIn underserved populations, the contribution of community health workers (CHWs) is vital to the healthcare systems. Attrition of these workers causes critical breakdowns in the delivery of essential services to these populations. Literature on reasons for attrition is limited, although some have been identified in studies on sustainability of CHW programmes. These factors are, however, likely to be influenced by context. We measured CHW attrition and its predictors in a rural area in Kenya.MethodsWe conducted a nested case–control study and focus group discussions among CHWs involved in a maternal and child health project. A training register of 1005 CHWs was used to sample and follow CHWs for attrition. Incidence of CHW attrition was calculated using a Poisson model. Separately, we used logistic regression to determine predictors of CHW attrition.ResultsOf the 1005 CHWs, 498 (49.6%) had left the project by the time of the study. The incidence of attrition was 46.8/1000 person-years (95% CI 38.7 to 56.5). In the case–control study, lack of interest in peer organisation membership (OR 5.3; 95% CI 1.3 to 20.6) was associated with attrition. Absence of refresher training (OR 4.0; 95% CI 2.2 to 7.1) and receiving no feedback from supervisors (OR 2.0; 95% CI 1.0 to 3.9) were also associated with attrition. Discordance in expectations and perceived heavy workload were also identified as key reasons for attrition in the qualitative study.ConclusionThis study estimates high prevalence and incidence of CHW attrition in Kwale County, Kenya. Ongoing training, feedback and peer support are also important in enhancing retention of CHWs. Additionally, expectations regarding the roles and benefits of involvement in CHW work should be communicated clearly, and workload should be kept reasonable or negotiated with the CHWs.
      Keywords: Open access
      PubDate: 2018-07-31T06:01:53-07:00
      DOI: 10.1136/bmjgh-2018-000750
      Issue No: Vol. 3, No. 4 (2018)
  • Sex and gender reporting in global health: new editorial policies

    • Authors: Peters, S. A. E; Norton, R.
      Keywords: Open access
      PubDate: 2018-07-26T21:20:55-07:00
      DOI: 10.1136/bmjgh-2018-001038
      Issue No: Vol. 3, No. 4 (2018)
  • Lifetime prevalence, correlates and health consequences of gender-based
           violence victimisation and perpetration among men and women in Somalia

    • Authors: Wirtz, A. L; Perrin, N. A, Desgroppes, A, Phipps, V, Abdi, A. A, Ross, B, Kaburu, F, Kajue, I, Kutto, E, Taniguchi, E, Glass, N.
      Abstract: BackgroundHumanitarian emergencies increase the risk of gender-based violence (GBV). We estimated the prevalence of GBV victimisation and perpetration among women and men in urban settings across Somalia, which has faced decades of war and natural disasters that have resulted in massive population displacements.MethodsA population-based survey was conducted in 14 urban areas across Somalia between December 2014 and November 2015.ResultsA total of 2376 women and 2257 men participated in the survey. One in five men (22.2%, 95% CI 20.5 to 23.9) and one in seven (15.5%; 95% CI 14.1 to 17.0) women reported physical or sexual violence victimisation during childhood. Among women, 35.6% (95% CI 33.4 to 37.9) reported adult lifetime experiences of physical or sexual intimate partner violence (IPV) and 16.5% (95% CI 15.1 to 18.1) reported adult lifetime experience of physical or sexual non-partner violence (NPV). Almost one-third of men (31.2%; 95% CI 29.4 to 33.1) reported victimisation as an adult, the majority of which was physical violence. Twenty-two per cent (21.7%; 95% CI 19.5 to 24.1) of men reported lifetime sexual or physical IPV perpetration and 8.1% (95% CI 7.1 to 9.3) reported lifetime sexual or physical NPV perpetration. Minority clan membership, displacement, exposure to parental violence and violence during childhood were common correlates of IPV and NPV victimisation and perpetration among women and men. Victimisation and perpetration were also strongly associated with recent depression and experiences of miscarriage or stillbirth.ConclusionGBV is prevalent and spans all regions of Somalia. Programmes that support nurturing environments for children and provide health and psychosocial support for women and men are critical to prevent and respond to GBV.
      Keywords: Open access
      PubDate: 2018-07-25T07:30:05-07:00
      DOI: 10.1136/bmjgh-2018-000773
      Issue No: Vol. 3, No. 4 (2018)
  • International research and guidelines on post-tuberculosis chronic lung
           disorders: a systematic scoping review

    • Authors: van Kampen, S. C; Wanner, A, Edwards, M, Harries, A. D, Kirenga, B. J, Chakaya, J, Jones, R.
      Abstract: IntroductionPulmonary tuberculosis (TB) is an important risk factor for chronic respiratory disease due to residual lung damage. Yet, the WHO End TB strategy does not mention post-TB chronic lung disorders (PTBLDs) and programmatic interventions to address PTBLD are lacking. This study assessed the scope of current guidelines and evidence on PTBLD to inform policy and research action.MethodsA systematic literature search was conducted following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Eight databases (TRIP, International Guideline Library, MEDLINE/PubMed, EMBASE, Web of Science, Global Health, Cochrane Library) were searched for records on PTBLD published between 1 January 1990 and 1 December 2017. Non-English records, case series, conference abstracts and letters to editors were excluded. Data were extracted and charted on publication year, location, PTBLD condition(s) and main study outcome.ResultsA total of 212 guidelines and 3661 articles were retrieved. After screening, only three international TB guidelines mentioned TB sequelae, but none described how to identify or manage the condition. A total of 156 articles addressed PTBLD: 54 (35%) mentioned unspecified TB sequelae; 47 (30%) specific post-TB conditions including aspergillosis, bronchial stenosis or bronchiectasis; 52 (33%) post-TB obstructive disorders or lung function impairment; and 20 (13%) post-TB respiratory symptoms or chest X-ray abnormalities. The first two groups mostly assessed surgery or ventilation techniques for patient management, while the last two groups typically assessed prevalence or predictors of disease.ConclusionThis is the first review to provide a comprehensive overview of the current literature on PTBLD. The scope of evidence around the burden of PTBLD warrants inclusion and recognition of the problem in international TB guidelines. Research is now needed on early detection of PTBLD and patient management options that are suitable for high-burden TB countries.
      Keywords: Open access
      PubDate: 2018-07-23T03:33:01-07:00
      DOI: 10.1136/bmjgh-2018-000745
      Issue No: Vol. 3, No. 4 (2018)
  • Early childhood cognitive development is affected by interactions among
           illness, diet, enteropathogens and the home environment: findings from the
           MAL-ED birth cohort study

    • Authors: MAL-ED Network Investigators
      Abstract: BackgroundMillions of children in low-income and middle-income countries (LMICs) are at risk of not reaching their full cognitive potential. Malnutrition and enteric infections in early life are implicated as risk factors; however, most studies on these risks and their associations with cognitive development have failed to adequately account for confounding factors or the accumulation of putative insults. Here, we examine the interaction between infections and illness on cognitive development in LMIC community settings.MethodsAs part of the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) longitudinal birth cohort study, children from eight LMICs were followed from birth to 24 months to understand the influence of repeated enteric infections on child growth and development. Here, data from six sites were employed to evaluate associations between infection, illness, the home environment, micronutrient intake and status, maternal reasoning, and cognitive development at 24 months.ResultsHigher rates of enteropathogen detection and days with illness were associated with lower haemoglobin concentrations, which in turn were associated with lower cognitive scores at 24 months. Children with lower environmental health/safety scores and lower intakes of vitamin B6 and folate had more enteropathogen detections and illness. Strength of associations varied by weight-for-age in the first 17 days of life; lower weight infants were more susceptible to the negative effects of enteropathogens and illness.ConclusionsEnteropathogens were negatively related to child cognitive development. However, other factors were more strongly associated with child cognition. Targeting of interventions to improve cognitive development should include a focus on reducing frequency of illness, improving the safety and healthfulness of the child’s environment, and improving dietary intake.
      Keywords: Open access
      PubDate: 2018-07-23T03:33:01-07:00
      DOI: 10.1136/bmjgh-2018-000752
      Issue No: Vol. 3, No. 4 (2018)
  • Diabetes knowledge and care practices among adults in rural Bangladesh: a
           cross-sectional survey

    • Authors: Fottrell, E; Ahmed, N, Shaha, S. K, Jennings, H, Kuddus, A, Morrison, J, Akter, K, Nahar, B, Nahar, T, Haghparast-Bidgoli, H, Khan, A. K. A, Costello, A, Azad, K.
      Abstract: BackgroundPopulation knowledge of how to prevent, detect and control diabetes is critical to public health initiatives to tackle the disease. We undertook a cross-sectional survey of adults in rural Bangladesh to estimate knowledge and practices related to diabetes.MethodsIn 96 villages in Faridpur district, trained fieldworkers surveyed 12 140 randomly selected men and women aged ≥30. They collected data on sociodemographic status, knowledge of diabetes and history of blood and urine glucose testing. Fasting and 2-hour post-glucose load capillary blood tests ascertained the diabetic status of respondents. Levels of knowledge and practices were analysed by sociodemographic characteristics and diabetic status.ResultsThe population showed low levels of diabetes knowledge overall, with only one in three adults able to report any valid causes of the disease. Knowledge of diabetes causes, symptoms, complications, prevention and control was significantly associated with age, education, wealth and employment. Only 14% of respondents reported ever having had a blood glucose test and strong associations with wealth were observed (least poor relative to most poor 2.91 (2.32–3.66)). 78.4% of known diabetics (ie, with a prior diagnosis) reported that they did not monitor their blood glucose levels on at least a monthly basis. However, they had better knowledge of the causes (odds relative to normoglycaemic individuals 1.62 (1.23–2.09)), symptoms (5.17 (3.41–7.82)), complications (5.18 (3.75–7.14)), prevention (4.18 (3.04–5.74)) and control (8.43 (4.83–14.71)).ConclusionKnowledge of diabetes among rural adults in Faridpur is extremely poor. Levels of diabetes testing are low and monitoring of blood glucose among known diabetics infrequent. Diabetes prevention and control efforts in this population must include large-scale awareness initiatives which focus not only on high-risk individuals but the whole population.Trial registration number ISRCTN 41083256; Pre-results.
      Keywords: Open access
      PubDate: 2018-07-23T03:33:01-07:00
      DOI: 10.1136/bmjgh-2018-000891
      Issue No: Vol. 3, No. 4 (2018)
  • Is sex ratio at birth an appropriate measure of prenatal sex
           selection' Findings of a theoretical model and its application to

    • Authors: Dubuc, S; Sivia, D. S.
      Abstract: Son preference and prenatal sex selection against females have resulted in significant sex ratio at birth (SRB) imbalances well documented in several Asian countries, including India and China. The SRB bias is generally used as indicator for the extent and trends of prenatal sex selection against females. Decreasing fertility levels are expected to increase sex selection and thus SRB bias, since desiring fewer children increases the risk for families to remain sonless (fertility squeeze effect). We developed and employ mathematical models linking family size, birth order and childbearing strategies with population SRB bias. We show that SRB bias can increase despite fewer sex selection interventions occurring, inconsistent with the expectation of the fertility squeeze effect. We show that a disproportionality effect of fertility reduction amplifies SRB bias, in addition to the fertility squeeze effect, making SRB bias an inaccurate indicator for changes in sex selection practices within a population. We propose to use sex selection propensity (proportion of couples intervening) to measure behavioural change and evaluate policies targeting sex selection practices. We apply our findings to India, showing for instance that sex selection propensity in Punjab and Delhi was lower than in Rajasthan or Uttar Pradesh, despite significantly higher SRB bias in the former. While we observe a continuous overall increase in the SRB over the 2005–2010 period in India, our results indicate that prenatal sex selection propensity started declining during that period.
      Keywords: Open access
      PubDate: 2018-07-19T23:52:26-07:00
      DOI: 10.1136/bmjgh-2017-000675
      Issue No: Vol. 3, No. 4 (2018)
  • Modelling the effect of a mass radio campaign on child mortality using
           facility utilisation data and the Lives Saved Tool (LiST): findings from a
           cluster randomised trial in Burkina Faso

    • Authors: Murray, J; Head, R, Sarrassat, S, Hollowell, J, Remes, P, Lavoie, M, Borghi, J, Kasteng, F, Meda, N, Badolo, H, Ouedraogo, M, Bambara, R, Cousens, S.
      Abstract: BackgroundA cluster randomised trial (CRT) in Burkina Faso was the first to demonstrate that a radio campaign increased health-seeking behaviours, specifically antenatal care attendance, health facility deliveries and primary care consultations for children under 5 years.MethodsUnder-five consultation data by diagnosis was obtained from primary health facilities in trial clusters, from January 2011 to December 2014. Interrupted time-series analyses were conducted to assess the intervention effect by time period on under-five consultations for separate diagnosis categories that were targeted by the media campaign. The Lives Saved Tool was used to estimate the number of under-five lives saved and the per cent reduction in child mortality that might have resulted from increased health service utilisation. Scenarios were generated to estimate the effect of the intervention in the CRT study areas, as well as a national scale-up in Burkina Faso and future scale-up scenarios for national media campaigns in five African countries from 2018 to 2020.ResultsConsultations for malaria symptoms increased by 56% in the first year (95% CI 30% to 88%; p
      Keywords: Open access
      PubDate: 2018-07-16T17:09:40-07:00
      DOI: 10.1136/bmjgh-2018-000808
      Issue No: Vol. 3, No. 4 (2018)
  • Cost-effectiveness and economies of scale of a mass radio campaign to
           promote household life-saving practices in Burkina Faso

    • Authors: Kasteng, F; Murray, J, Cousens, S, Sarrassat, S, Steel, J, Meda, N, Ouedraogo, M, Head, R, Borghi, J.
      Abstract: IntroductionChild health promotion through mass media has not been rigorously evaluated for cost-effectiveness in low-income and middle-income countries. We assessed the cost-effectiveness of a mass radio campaign on health-seeking behaviours for child survival within a trial in Burkina Faso and at national scale.MethodsWe collected provider cost data prospectively alongside a 35-month cluster randomised trial in rural Burkina Faso in 2012–2015. Out-of-pocket costs of care-seeking were estimated through a household survey. We modelled intervention effects on child survival based on increased care-seeking and estimated the intervention’s incremental cost-effectiveness ratio (ICER) in terms of the cost per disability-adjusted life year (DALY) averted versus current practice. Model uncertainty was gauged using one-way and probabilistic sensitivity analyses. We projected the ICER of national-scale implementation in five sub-Saharan countries with differing media structures. All costs are in 2015 USD.ResultsThe provider cost of the campaign was $7 749 128 ($9 146 101 including household costs). The campaign broadcast radio spots 74 480 times and 4610 2-hour shows through seven local radio stations, reaching approximately 2.4 million people including 620 000 direct beneficiaries (pregnant women and children under five). It resulted in an average estimated 24% increase in care-seeking for children under five and a 7% reduction in child mortality per year. The ICER was estimated at $94 ($111 including household costs (95% CI –38 to 320)). The projected provider cost per DALY averted of a national level campaign in Burkina Faso, Burundi, Malawi, Mozambique and Niger in 2018–2020, varied between $7 in Malawi to $27 in Burundi.ConclusionThis study suggests that mass-media campaigns can be very cost-effective in improving child survival in areas with high media penetration and can potentially benefit from considerable economies of scale.Trial registration number NCT01517230; Results.
      Keywords: Open access
      PubDate: 2018-07-16T17:09:40-07:00
      DOI: 10.1136/bmjgh-2018-000809
      Issue No: Vol. 3, No. 4 (2018)
  • Epidemiology and outcomes of Clostridium difficile infection among
           hospitalised patients: results of a multicentre retrospective study in
           South Africa

    • Authors: Legenza, L; Barnett, S, Rose, W, Bianchini, M, Safdar, N, Coetzee, R.
      Abstract: IntroductionLimited data exist on Clostridium difficile infection (CDI) in low-resource settings and settings with high prevalence of HIV. We aimed to determine baseline CDI patient characteristics and management and their contribution to mortality.MethodsWe reviewed adult patients hospitalised with diarrhoea and a C. difficile test result in 2015 from four public district hospitals in the Western Cape, South Africa. The primary outcome measures were risk factors for mortality. Secondary outcomes were C. difficile risk factors (positive vs negative) and CDI treatment.ResultsCharts of patients with diarrhoea tested for C. difficile (n=250; 112 C. difficile positive, 138 C. difficile negative) were reviewed. The study population included more women (65%). C. difficile-positive patients were older (46.5 vs 40.7 years, p
      Keywords: Open access
      PubDate: 2018-07-15T23:13:16-07:00
      DOI: 10.1136/bmjgh-2018-000889
      Issue No: Vol. 3, No. 4 (2018)
  • Addressing the tensions and complexities involved in commissioning and
           undertaking implementation research in low- and middle-income countries

    • Authors: Doherty, T; Lewin, S, Kinney, M, Sanders, D, Mathews, C, Daviaud, E, Goga, A, Bhana, A, Besada, D, Vanleeuw, L, Loveday, M, Odendaal, W, Leon, N.
      Keywords: Open access
      PubDate: 2018-07-12T05:45:21-07:00
      DOI: 10.1136/bmjgh-2018-000741
      Issue No: Vol. 3, No. 4 (2018)
  • Risk factors and risk factor cascades for communicable disease outbreaks
           in complex humanitarian emergencies: a qualitative systematic review

    • Authors: Hammer, C. C; Brainard, J, Hunter, P. R.
      Abstract: BackgroundCommunicable diseases are a major concern during complex humanitarian emergencies (CHEs). Descriptions of risk factors for outbreaks are often non-specific and not easily generalisable to similar situations. This review attempts to capture relevant evidence and explore whether it is possible to better generalise the role of risk factors and risk factor cascades these factors may form.MethodsA systematic search of the key databases and websites was conducted. Search terms included terms for CHEs (United Nations Office for the Coordination of Humanitarian Affairs definition) and terms for communicable diseases. Due to the types of evidence found, a thematic synthesis was conducted.Results26 articles met inclusion criteria. Key risk factors include crowded conditions, forced displacement, poor quality shelter, poor water, sanitation and hygiene, lack of healthcare facilities and lack of adequate surveillance. Most identified risk factors do not relate to specific diseases, or are specific to a group of diseases such as diarrhoeal diseases and not to a particular disease within that group. Risk factors are often listed in general terms but are poorly evidenced, not contextualised and not considered with respect to interaction effects in individual publications. The high level of the inter-relatedness of risk factors became evident, demonstrating risk factor cascades that are triggered by individual risk factors or clusters of risk factors.ConclusionsCHEs pose a significant threat to public health. More rigorous research on the risk of disease outbreaks in CHEs is needed, from a practitioner and from an academic point of view.
      Keywords: Open access
      PubDate: 2018-07-06T23:37:57-07:00
      DOI: 10.1136/bmjgh-2017-000647
      Issue No: Vol. 3, No. 4 (2018)
  • Accountability mechanisms and the value of relationships: experiences of
           front-line managers at subnational level in Kenya and South Africa

    • Authors: Nxumalo, N; Gilson, L, Goudge, J, Tsofa, B, Cleary, S, Barasa, E, Molyneux, S.
      Abstract: Resource constraints, value for money debates and concerns about provider behaviour have placed accountability ‘front and centre stage’ in health system improvement initiatives and policy prescriptions. There are a myriad of accountability relationships within health systems, all of which can be transformed by decentralisation of health system decision-making from national to subnational level. Many potential benefits of decentralisation depend critically on the accountability processes and practices of front-line health facility providers and managers, who play a central role in policy implementation at province, county, district and facility levels. However, few studies have examined these responsibilities and practices in detail, including their implications for service delivery. In this paper we contribute to filling this gap through presenting data drawn from broader ongoing research collaborations between researchers and health managers in Kenya and South Africa. These collaborations are aimed at understanding and strengthening day-to-day micropractices of health system governance, including accountability processes. We illuminate the multiple directions and forms of accountability operating at the subnational level across three sites. Through detailed illustrative examples we highlight some of the unintended consequences of bureaucratic forms of accountability, the importance of relational elements in enabling effective bureaucratic accountability, and the ways in which front-line managers can sometimes creatively draw upon one set of accountability requirements to challenge another set to meet their goals. Overall, we argue that interpersonal interactions are key to appropriate functioning of many accountability mechanisms, and that policies and interventions supportive of positive relationships should complement target-based and/or audit-style mechanisms to achieve their intended effects. Where this is done systematically and across key elements and actors of the health system, this offers potential to build everyday health system resilience.
      Keywords: Open access
      PubDate: 2018-07-06T23:37:57-07:00
      DOI: 10.1136/bmjgh-2018-000842
      Issue No: Vol. 3, No. 4 (2018)
  • Correction: Measuring progress towards Sustainable Development Goal 3.8 on
           universal health coverage in Kenya

    • Keywords: Open access
      PubDate: 2018-07-06T23:37:57-07:00
      DOI: 10.1136/bmjgh-2018-000904corr1
      Issue No: Vol. 3, No. 4 (2018)
  • The Brazilian health system at crossroads: progress, crisis and resilience

    • Authors: Massuda, A; Hone, T, Leles, F. A. G, de Castro, M. C, Atun, R.
      Abstract: The Unified Health System (Sistema Único de Saúde (SUS)) has enabled substantial progress towards Universal Health Coverage (UHC) in Brazil. However, structural weakness, economic and political crises and austerity policies that have capped public expenditure growth are threatening its sustainability and outcomes. This paper analyses the Brazilian health system progress since 2000 and the current and potential effects of the coalescing economic and political crises and the subsequent austerity policies. We use literature review, policy analysis and secondary data from governmental sources in 2000–2017 to examine changes in political and economic context, health financing, health resources and healthcare service coverage in SUS. We find that, despite a favourable context, which enabled expansion of UHC from 2003 to 2014, structural problems persist in SUS, including gaps in organisation and governance, low public funding and suboptimal resource allocation. Consequently, large regional disparities exist in access to healthcare services and health outcomes, with poorer regions and lower socioeconomic population groups disadvantaged the most. These structural problems and disparities will likely worsen with the austerity measures introduced by the current government, and risk reversing the achievements of SUS in improving population health outcomes. The speed at which adverse effects of the current and political crises are manifested in the Brazilian health system underscores the importance of enhancing health system resilience to counteract external shocks (such as economic and political crises) and internal shocks (such as sector-specific austerity policies and rapid ageing leading to rise in disease burden) to protect hard-achieved progress towards UHC.
      Keywords: Open access
      PubDate: 2018-07-03T23:30:02-07:00
      DOI: 10.1136/bmjgh-2018-000829
      Issue No: Vol. 3, No. 4 (2018)
  • Performance of verbal autopsy methods in estimating HIV-associated
           mortality among adults in South Africa

    • Authors: Karat, A. S; Maraba, N, Tlali, M, Charalambous, S, Chihota, V. N, Churchyard, G. J, Fielding, K. L, Hanifa, Y, Johnson, S, McCarthy, K. M, Kahn, K, Chandramohan, D, Grant, A. D.
      Abstract: IntroductionVerbal autopsy (VA) can be integrated into civil registration and vital statistics systems, but its accuracy in determining HIV-associated causes of death (CoD) is uncertain. We assessed the sensitivity and specificity of VA questions in determining HIV status and antiretroviral therapy (ART) initiation and compared HIV-associated mortality fractions assigned by different VA interpretation methods.MethodsUsing the WHO 2012 instrument with added ART questions, VA was conducted for deaths among adults with known HIV status (356 HIV positive and 103 HIV negative) in South Africa. CoD were assigned using physician-certified VA (PCVA) and computer-coded VA (CCVA) methods and compared with documented HIV status.ResultsThe sensitivity of VA questions in detecting HIV status and ART initiation was 84.3% (95% CI 80 to 88) and 91.0% (95% CI 86 to 95); 283/356 (79.5%) HIV-positive individuals were assigned HIV-associated CoD by PCVA, 166 (46.6%) by InterVA-4.03, 201 (56.5%) by InterVA-5, and 80 (22.5%) and 289 (81.2%) by SmartVA-Analyze V.1.1.1 and V.1.2.1. Agreement between PCVA and older CCVA methods was poor (chance-corrected concordance [CCC]
      Keywords: Open access
      PubDate: 2018-07-03T23:30:02-07:00
      DOI: 10.1136/bmjgh-2018-000833
      Issue No: Vol. 3, No. 4 (2018)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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