Risultati per: Babylon Health: il servizio anglosassone di Medicina Generale privato basato su app

‘Necessario un modello organizzativo dipartimentale’

Objective
This study aimed to assess the prevalence of early discharge among women who gave vaginal delivery in health facilities.

Design
Cross-sectional study.

Setting
Four African countries.

Participants
A total weighted sample of 14 942 women who delivered vaginally in health facilities.

Methods
In this study, data were obtained from the recent Demographic and Health Survey data from four African countries. A total weighted sample of 14 942 women who delivered vaginally in a health facility was included. A multilevel mixed effect binary logistic regression model was fitted to identify significant factors associated with early discharge following health facility vaginal delivery. Statistical significance was determined using adjusted OR (odd ratio) with a 95% CI.

Results
The overall prevalence of early discharge following health facility vaginal delivery in four African countries was 30.91% (95% CI: 30.18% to 31.66%). Overall, first-born babies (AOR=0.7; 95% CI: 0.57 to 0.85), women with a high maternal body mass index (AOR=0.8; 95% CI: 0.71 to 0.89), women with multiple pregnancies (AOR=0.48; 95% CI: 0.31 to 0.74), women who reside in Burkina Faso (AOR=0.15; 95% CI: 0.12 to 0.18) and women who reside in Ghana (AOR=0.28; 95% CI: 0.24 to 0.33) had lower odds of early discharge following health facility vaginal delivery. On the other hand, women having no difficulty accessing health facilities (AOR=1.18; 95% CI: 1.05 to 1.33) and women delivering in private health facilities (AOR=1.46; 95% CI: 1.08 to 1.99) had higher odds of early discharge following health facility vaginal delivery.

Conclusion
Overall, in four African countries, a higher proportion of women who gave birth vaginally in health facilities were discharged home early without optimum immediate postpartum care. As a result, legislators, programmers and other stakeholders should make every effort to lessen the burden of early discharge, with a special focus on women who deliver in private health institutions.

Objective
Uric acid (UA) and obesity are significant risk factors for new-onset atrial fibrillation (AF). Based on the pathogenesis mechanisms of new-onset AF involving obesity and UA, it is possible that UA and weight gain may interact with each other. We investigated the impact of UA and weight gain on new-onset AF using a simple measure of weight change over time, ‘weight gain of ≥10 kg after age 20’.

Design
A retrospective cohort study.

Setting and participants
We retrospectively analysed 16 444 Japanese aged over 30 without AF from a cohort of employees undergoing annual health check-up from 2 April 2013 to 30 April 2022. We conducted a landmark survival analysis to assess the impact of longitudinal changes in UA and obesity on new-onset AF. Weight gain was defined as ‘weight gain of≥10 kg after age 20’ using a standardised self-administered questionnaire.

Primary outcome measure
Subjects were diagnosed with AF when AF was present in the electrocardiogram or when indicated in a patient interview.

Result
During a median follow-up period of 3.91 years, 69 new-onset AF occurred (incidence; 1.12/1000 person-years). UA levels were 5.76 (±1.37) in the weight gain group and 4.87 (±1.31) in the no weight gain group, both within normal limits. A multivariable landmark survival analysis including interaction term showed that new-onset AF was significantly associated with age, sex, baseline systolic blood pressure, baseline UA and the interaction term between UA change and weight gain. The interaction term between weight gain and UA change indicates that HR for every UA 1 mg/dL increase was 1.96 (95% CI 1.38 to 2.77) in subjects with weight gain and 0.95 (95% CI 0.61 to 1.48) in those without.

Conclusion
Even if UA levels are within the normal range, subsequent UA change and weight gain in adulthood have an interactive effect on new-onset AF.

Objective
In Papua New Guinea (PNG), antenatal clinic attendance averaged 50% for one or more visits, and 30% for four visits in the last decade. In 2016, the WHO revised its focused antenatal care (ANC) model recommending eight rather than four visits. If implemented, this new model would require additional resources. This study estimated provider costs of ANC in PNG, including the expected cost of scaling up to universal ANC coverage as well as recommending eight visits.

Design and setting
Cross-sectional estimation of ANC costs collected from nine health facilities, which were part of a cluster randomised trial. Costs were estimated using both top-down and bottom-up approaches. The cost of the first and follow-up visits were estimated per woman, at the health facility level. Health system and scale-up costs of four visits were calculated by multiplying the aggregate cost of four visits by ANC utilisation rates. A budget impact analysis estimated the expected costs of delivering eight visits over 5 years. Univariate sensitivity analysis was conducted. Discounted costs are reported in local currency and 2019 international dollars using purchasing power parity data.

Results
The average cost of the first and follow-up visits were $17.66–$30.58 (K42.94–K74.34) in Madang and $11.26–$35.61 (K27.37–K86.56) in East New Britain. Four visits per woman cost $70.65–$122.33 (K171.76–K297.36) in Madang and $45.02–$142.45 (K109.50–K346.4) in East New Britain; and salaries represented the largest share of costs. The annual health system cost was $6.9 million (K16.9 million), the expected cost of scaling up to the universal coverage of four visits was $22.7 million (K55.2 million), and $45.4 million (K110.3 million) over 5 years for eight visits.

Conclusion
Costs varied with the number of clinicians, infrastructure and ANC coverage, suggesting scaling up requires increasing the financial investment in ANC services. These results provide a template to strengthen health systems by improving the quality of care.

Introduction
Many Americans fail to receive equitable access to or positive outcomes from rehabilitation services. These disparities result from broader societal inequities that disproportionately affect certain groups of people due to non-medical factors such as race, gender, education and living status. This scoping review aims to describe research papers that examine social determinants of health (SDOH) that underlie disparities in access to, use of, or outcomes related to rehabilitation (in occupational therapy, physical therapy, recreational therapy, rehabilitation medicine/physiatry and speech-language pathology) among adults in the USA. Identifying SDOH-related factors that drive inequities in rehabilitation will inform the development of potential solutions to improve access, professional education and patient outcomes.

Methods and analysis
The Joanna Briggs Institute methodological framework will be used to conduct this scoping review. To meet the inclusion criteria, articles will need to be published in English since 2013, be classified as full-length original research, include at least 100 sampled adults, be conducted in the USA or its territories, and investigate SDOH-related disparities in rehabilitation. Search terms will include SDOH, rehabilitation and disparities. Five databases (Embase, PubMed, Scopus, Sociological Abstracts and Web of Science: Core Collection) will be searched for articles published in English between 2013 and 2023. Records from these databases as well as reference lists of included papers and review papers will be screened for eligibility. Two people will independently review each record during title and abstract screening and full-text screening, and three people will independently extract data. Screening and data extraction processes will be piloted. The results will be presented in tables, graphs and narrative summaries.

Ethics and dissemination
Findings will be disseminated through scientific conferences, professional networks, stakeholder meetings, invited workshops and webinars, email listservs of professional associations, academic social media and in a peer-reviewed journal. Ethics approval is not required as the review will only include previously published data.

Background
Plain language summaries (PLSs) are easy-to-understand summaries of research articles that should follow principles of plain language and health literacy. PLS author instructions from health journals help guide authors on word count/PLS length, structure and the use of jargon. However, it is unclear whether published PLSs currently adhere to author instructions.

Objectives
This study aims to determine (1) the degree of compliance of published PLSs against the PLS author instructions in health journals and (2) the extent to which PLSs meet health literacy principles.

Study design
We conducted a three-part systematic environmental scan.

Methods
We examined 26 health journals identified from a previous review. In part 1, we assessed the inclusion frequency of PLSs in the 26 journals; in part 2, we assessed the level of compliance of PLSs with PLS author instructions; and in part 3, we conducted a health literacy assessment of the PLSs.

Results
Part 1: we found PLSs for 20/26 (76.9%) included journals. Part 2: no journal achieved 100% compliance with PLS author instructions. The highest level was 86% and the lowest was 0%. Part 3: no PLS was written at a readability level suitable for a general audience. The mean reading level was grade 15.8 (range 10.2–21.2and mean percentage of complex words, 31% (range 8.5%–49.8%).

Discussion
PLSs are an important means through which consumers can access research findings. We found a lack of compliance between PLS author instructions and PLSs published in health journals that may impede access and use by consumers. This study highlights the need for better ways to support authors adhere to PLS instructions and improved monitoring by journals.

Objectives
The potential and expected benefits of digital health interventions (DHI) have long been discussed, yet substantial challenges are associated with deploying DHI at scale. Insights are presented concerning the implementation of a DHI consisting of a patient-facing app and a digital dashboard for clinicians providing supported self-management for long COVID to support both clinicians and patients.

Design
Qualitative reflexive thematic analysis, mapped against Normalisation Process Theory.

Setting
Fifty-five and a half hours of zoom recordings of meetings between clinicians in community and secondary care long COVID clinics and members of the research team.

Participants
Allied health professionals, service delivery managers and members of the core team, including representatives from industry partners.

Results
The DHI fitted with contextual circumstances and the design supported flexibility to suit circumstances in different trusts. The DHI also aligned with existing ways of working.
Healthcare professionals worked together to support the implementation of the DHI, requiring flexibility to take account of local circumstances. The DHI was appraised in both positive and negative terms by healthcare professionals. Using DHIs was said to have the potential to complement care but not be a replacement for face-to-face clinical input. The DHI was judged to have demonstrated the potential to affect long-established patterns and organisational structures of engagement between healthcare professionals and patients in terms of access to care.

Conclusions
NPT provided a framework for considering both individual agency and the organisation context, enabling reflections to be made at the level of the structure of services as well as people’s experiences. The discipline of considering first the context, then the work and finally the practical effects helped place order on the ‘mess’ involved in the rapid cycle of developing, refining and implementing a DHI in an atypical environment (a pandemic).

Objective
To understand barriers and facilitators for strengthening health systems for person-centred care of people with multiple long-term conditions-multimorbidity (MLTC-M) at the primary healthcare (PHC) level in low-income and middle-income countries (LMICs).

Design
A scoping review.

Methods
We adopted a systematic scoping review approach to chart literature guided by Arksey and O’Malley’s methodological framework. The review focused on studies conducted in LMICs’ PHC settings from January 2010 to December 2023. Papers were extracted from the following databases: PubMed, EBSCOhost and Google Scholar. Framework analysis was undertaken to identify barriers and facilitators for strengthening MLTC-M primary care according to the five health system pillars in the Lancet Global Health Commission on High-Quality Health Systems Framework.

Results
The literature search yielded 4322 citations, evaluated 202 studies and identified 36 for inclusion. Key barriers within the people pillar included poverty, low health education and low health literacy; within the platform pillar, fragmented services and lack of multimorbid care guidelines were mentioned; within the workforce pillar, lack of required skills and insufficient health workers; and in the tools pillar: a shortage of essential medicines and adverse polypharmacy effects were prominent. A lack of political will and the absence of relevant national health policies were identified under the governance pillar. Facilitators within the people pillar included enhancing self-management support; within the platforms, pillar included integration of services; within the tools pillar, included embracing emerging technologies and information and communication technology services; and governance issues included upscaling interventions to respond to multimorbid care needs through enhanced political commitment and financial support.

Conclusions
Potential solutions to strengthening the healthcare system to be more responsive to people with MLTC-M include empowering service users to self-manage, developing multimorbid care guidelines, incorporating community health workers into multimorbid care efforts and advocating for integrated person-centred care services across sectors. The need for policies and procedures in LMICs to meet the person-centred care needs of people with MLTC-M was highlighted.

Background
Birth preparedness and complication readiness (BPCR) are essential components of maternal health that encourage proactive planning and decision-making during pregnancy and childbirth. However, there is limited information available regarding the status of BPCR, particularly in our study area. Therefore, this study aimed to assess birth preparedness, complication readiness and associated factors among pregnant women attending public health facilities in the Chelia District.

Methods
A facility-based cross-sectional study was conducted among 410 pregnant women at public health facilities, using a systematic random sampling method. Descriptive statistics, such as frequencies, and summary statistics were calculated for the relevant variables. Bivariate and multivariate binary logistic regression analyses were performed to evaluate the relationship between dependent and independent variables. The strength of the association was measured using an OR with a 95% CI. Statistical significance was determined at a p value of 0.05.

Results
A total of 406 mothers participated in the study, resulting in a 99% response rate. The study found that 245 (60.3%) respondents were well-prepared for birth and complication readiness. Several factors such as: family size (adjusted odds ratios (AOR)=0.18; 95% CI (0.09 to 0.35)), decision-making with husbands (AOR=2.43, 95% CI (1.44 to 3.32)), parity (AOR=0.32; 95% CI (0.16 to 0.62)), lack of awareness about birth preparedness (AOR=0.30; 95% CI (0.16 to 0.57)), not knowing about the existence of a waiting home (AOR=0.31; 95% CI (0.19 to 0.48)) and not participating in a pregnant women’s conference (AOR=0.50; 95% CI (0.32 to 0.79)) were significantly associated with BPCR.

Conclusion
The study found that the level of BPCR is low in the study area. Family size, decision-making with husbands, awareness of maternity waiting homes, participation in pregnant women’s conferences, knowledge about BPCR and parity were significantly associated with BPCR. Therefore, strengthening pregnant women’s conferences, encouraging husband involvement in decision-making and ensuring maternity waiting homes at health facilities are important.

Objectives
To evaluate acceptability and effectiveness of midwives as trainers for NoviGuide, a neonatal clinical decision support system (CDSS).

Design
A 20-months, mixed-methods open cohort study.

Settings and participants
Nurse-midwives at four rural health facilities in eastern Uganda.

Methods
We developed a midwife-led trainer programme and instructed two midwives as NoviGuide Trainers in three 3-hour-long sessions. Trainers trained all nurse-midwives at each site in single 3-hour-long sessions. Using the Kirkpatrick model, we evaluated acceptability at level 1 for participant’s reaction and level 3 for participant’s attitudes towards the programme. We evaluated effectiveness at level 2 for newly learnt skills, and level 3 for participant’s uptake of NoviGuide and perception of newborn care practices. We used surveys and focus groups at baseline, 3 months and 6 months and viewed usage data from September 2020 through May 2022.

Results
All 49 participants were female, 23 (46.9%) owned smartphones, 12 (24.5%) accessed the internet daily and 17 (34.7%) were present by study end following staff changes. All participants perceived the use of midwives as NoviGuide Trainers to be an acceptable approach to introduce NoviGuide (mean 5.9 out of 6, SD 0.37). Participants reported gaining new skills and confidence to use NoviGuide; some, in turn, trained others. Participants reported improvement in newborn care. Uptake of NoviGuide was high. Of 49 trained participants, 48 (98%) used NoviGuide. A total of 4045 assessments of newborns were made. Of these, 13.8% (558/4045) were preterm, 17.5% (709/4045) weighed under 2.5 kg and 21.1% (855/4045) had a temperature

Objective
People living with HIV (PLHIV) are often recruited from primary healthcare clinics (PHC) into clinical trials. On trial completion, they are transferred back to the facility for continued care and support in managing their condition, potentially leading to better health outcomes. Because transferring PLHIV back to PHCs post-clinical trials may result in decreased access to specialised care or resources that were available during the trial, this study explored insights into challenges faced during reintegration from clinical trial settings into PHCs and antiretroviral therapy (ART) adherence post-clinical trials.

Design
This cross-sectional study was conducted using a qualitative research approach. Participants were recruited using purposive sampling.

Setting
The study was conducted at the Ezintsha Research Centre in Johannesburg, South Africa, between November 2022 and February 2023.

Participants
The study population consisted of PLHIV who had participated in two clinical trials (DORA and ADVANCE) at the Ezintsha Research Centre in Johannesburg, South Africa.

Methods
Using a semistructured guide, 12 in-depth interviews were conducted with PLHIV until data saturation was reached. Data were then transcribed verbatim and analysed thematically with MAXQDA software.

Results
The majority (n=8, 67%) of participants were female, and the average age of all participants was 40 (SD 7.2) years. Two main themes emerged: reintegration from clinical trials to public healthcare and barriers to ART adherence. These themes were further separated into seven subthemes, namely, negative attitude of healthcare workers, poor healthcare service delivery, poor communication to patients, waiting time at healthcare facilities, lack of privacy and confidentiality, mistakes in ART dispensing and bad reception at facilities post-clinical trials.

Conclusion
Clinical trial sites should cultivate better stakeholder engagement with PHCs to facilitate a smoother transition of research participants, especially PLHIV, back into public healthcare for continued care.

Objective
To assess community awareness of cutaneous leishmaniasis (CL) in a disease-endemic district in Sri Lanka.

Design
Population-based cross-sectional study.

Setting
This study was conducted in selected 158 Grama Niladhari divisions covering all the 22 Divisional Secretariat areas of the Anuradhapura district, Sri Lanka.

Sampling technique and participants
A probability sample of households was selected using multistage cluster sampling. Adults (≥18 years) who resided permanently in the Anuradhapura district during the data collection period were eligible, and individuals who could not comprehend or respond to the questions were excluded. The primary or secondary healthcare-related decision-maker of 1555 households participated in the study, in which 1479 (95.1%) were Sinhalese in ethnicity, including 1157 (74.4%) females.

Primary and secondary outcome measures
The primary outcome measure was ‘CL awareness,’ operationalised by awareness of the disease name, transmission mode and the primary disease characteristic based on a systematic expert consensus approach. Secondary outcome measures included awareness and perceptions of CL curability, treatment centres and perceived susceptibility.

Results
Only 3.6% (n=56) demonstrated CL awareness based on the definition. We observed low disease awareness even among people who claimed having CL or previously had the disease (n=6, 27.3%). While 1065 (68.5%) had heard the correct name (‘leishmaniasis’) or the local name (‘wæli mæssāgē ledē’) for the disease, only 224 (21.0%) out of that knew the mode of transmission and 128 (12.0%) the chronic nature of CL skin lesions, respectively. Among the respondents with CL awareness (n=56), 42 (75.0%), 54 (96.4%) and 44 (88.0%) perceived CL as curable, were aware of treatment centres and expressed self-perceived susceptibility, respectively. Despite 423 (46.4%) who claimed to know more beyond the disease name, only 35 (8.3%) demonstrated actual CL awareness.

Conclusion
Findings highlight significantly low CL awareness in the disease-endemic Anuradhapura district, and we recommend developing evidence-based, context-specific public health interventions targeting CL awareness gaps.

Objective
In this scoping review, we aim to consolidate the evidence on inequalities in service coverage in Africa using a comprehensive set of stratifiers. These stratifiers include place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status and social capital. Our approach provides a more holistic understanding of the different dimensions of inequality in the context of universal health coverage (UHC).

Design
We conducted a scoping review following the Joanna Briggs Institute Manual for Evidence Synthesis.

Data sources
We searched MEDLINE, Embase, Web of Science, CINAHL, PyscINFO, Cochrane Library, Google Scholar and Global Index Medicus for articles published between 1 January 2005 and 29 August 2022 examining inequalities in utilisation of health services for reproductive, maternal, newborn and child health (RMNCH), infectious or non-communicable diseases in Africa.

Eligibility criteria for selecting studies
We included any empirical research that assessed inequalities in relation to services for RMNCH (eg, family planning), infectious diseases (eg, tuberculosis treatment) and non-communicable diseases (eg, cervical cancer screening) in Africa.

Data extraction and synthesis
The data abstraction process followed a stepwise approach. A pilot-tested form capturing study setting, inequality assessment and service coverage indicators was developed and finalised. Data were extracted by one reviewer and cross-checked by another, with discrepancies resolved through consensus meetings. If a consensus was not reached, senior reviewers made the final decision. We used a narrative approach to describe the study characteristics and mapped findings against PROGRESS-Plus stratifiers and health service indicators. Quantitative findings were categorised as ‘proequity’, ‘antiequity’ or ‘equal’ based on service utilisation across social groups.

Results
We included 178 studies in our review, most studies published within the last 5 years (61.1%). Most studies assessed inequality using socioeconomic status (70.6%), followed by age (62.4%), education (60.7%) and place of residence (59.0%). Few studies focused on disability, social capital and ethnicity/race and intersectionality of stratifiers. Most studies were on RMNCH services (53.4%) and infectious disease services (43.3%). Few studies were qualitative or behavioural analyses. Results highlight significant inequalities across different equity stratifiers and services with inconsistent trends of inequalities over time after the implementation of strategies to increase demand of services and strengthen health systems.

Conclusion
There is a need to examine equity in service coverage for a variety of health conditions among various populations beyond the traditional classification of social groups. This also requires using diverse research methods identifying disparities in service use and various barriers to care. By addressing these knowledge gaps, future research and health system reforms can support countries in moving closer to achievement of UHC targets.

Introduction
Research with urban refugee youth in Uganda has documented co-occurring social (e.g., poverty) and health (e.g., depression) disparities associated with HIV vulnerabilities. Benefits of HIV self-testing (HIVST) in increasing HIV testing uptake among youth are well established, yet limited interventions have examined if combining HIVST with mental health promotion, or with mental health promotion alongside poverty reduction, is associated with greater improvements in HIV prevention and testing outcomes.

Methods and analysis
The aim is to evaluate the effectiveness of: (1) HIVST alone (standard of care); (2) mobile health (mHealth) and graphic medicine (comic) programme for mental health alongside HIVST; and (3) the combination of HIVST, a livelihoods programme, and mHealth mental health programme, in advancing the primary outcome of HIV testing uptake and secondary outcomes (HIV status knowledge, linkage to confirmatory testing and HIV care, HIV knowledge, consistent condom use, condom use self-efficacy, sexual risk) with urban refugee youth in Kampala, Uganda. A three-arm randomised controlled trial will be implemented from 8 April 2024 to 31 October 2024 with youth across five informal settlements in Kampala, grouped into three sites based on proximity, and randomised in a 1:1:1 design. Approximately 330 participants (110 per arm) are enrolled and data collection will occur at three time points (baseline enrolment, 3-month follow-up and 6-month follow-up).

Ethics and dissemination
The study received ethical approval from the University of Toronto (#37496), Mildmay Uganda Research Ethics Committee (#MUREC-2021-41) and Uganda National Council for Science & Technology (#SS1021ES). The trial is registered at ClinicalTrials.gov (NCT06270160). Study findings will produce new knowledge of the impacts of a mental health programme, and a combined mental health and livelihoods programme, on improving HIV prevention outcomes among urban refugee youth in Kampala. Findings will be shared in peer-reviewed publications, conference presentations and in community dissemination.

Trial registration number
NCT06270160 (date of registration: 13 February 2024).

Trial sponsor
Dr. Carmen Logie, carmen.logie@utoronto.ca.

Introduction
People with intellectual disability are at risk of poor physical and mental health. Risks to health are compounded by poor health literacy, that is, reduced capacity to access health services, respond quickly to changes in health status and navigate care pathways. Building health literacy skills is a strength-based way to increase health and optimise the use of healthcare services. The internet is a primary source of health information for many people, including people with intellectual disability and their families. This scoping review will aim to identify and collate online lay healthcare resources available to and developed for people with intellectual disability and their families and evaluate whether domains of health literacy are addressed.

Methods and analysis
This review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. The proposed search strategy has three components. Resources will be identified by (1) reviewing disability organisation websites, (2) searching key disability and health terms in the Google search engine and (3) snowball sampling to identify additional resources through links in identified websites and resources. Resources will be selected if they are freely available, presented in or translatable into English, provide health information and are directed to people with intellectual disability or their family members. Extracted data will include descriptors of the source, format, area of health and targeted age range. Content relevant to domains of health literacy will be documented and gaps in available health information will be identified. Study findings will be presented in narrative, tabular and visual forms.

Ethics and dissemination
Ethical approval will not be sought because primary data will not be collected. The results will be disseminated in peer-reviewed literature, as conference presentations, as a synthesised resource for people with intellectual disability and their families and in summary documents for health service managers and policymakers.

Introduction
Global Health Initiatives (GHIs) have significantly improved access to healthcare globally. However, high maternal mortality rates persist in low- and middle-income countries (LMICs) such as Uganda. Despite heavy investment from the GHIs, there is insufficient evidence on the effects of GHIs on the quality of care of maternal health services and yet this significantly impacts maternal outcomes. Available evidence has focused on outputs such as facility deliveries and utilisation of services. These outputs alone are not a reflection of the quality of care, which is crucial in improving maternal outcomes. Given the inadequate information available, we will conduct a scoping review to collate available evidence on the effects of GHIs on the quality of care of maternal health services. The protocol outlined here describes the scoping review aimed at examining the available evidence on the effects of GHIs on maternal health services quality in Sub-Saharan Africa. The information gathered will be used to inform subsequent studies on the effects of GHI on the quality of care of maternal health services in Uganda and later inform policymakers, programmers and health workers on how best to maximise investments from GHIs through improved quality of care. The findings from this study will mainly be used to inform policy on maternal health services in Uganda.

Methods and analysis
The study will use Arksey and O’Malley’s enhanced six-stage framework for conducting scoping reviews. The core research question for this review is ‘what is the available evidence on the effects of global health initiatives on the quality of healthcare provided for maternal health services in health facilities of Sub-Saharan Africa’. We will consider peer-reviewed and non-peer-reviewed articles, reports and policy documents discussing the effects of GHIs on maternal health services from 2010 to 2023 available in all languages. Relevant databases including Ovid Medline, Embase, Cochrane Library, Centre for Agriculture and Biosciences International Global Health (Ovid), Cumulated Index to Nursing and Allied Health Literature, Scopus and the Joanna Briggs Institute Evidence Synthesis will be used for the search. Grey literature from various sources will also be included. Data on the study design, results and methodology will be extracted using a Google Form. This review’s report will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We will employ specific inclusion and exclusion criteria for evidence during the literature screening and mapping process, including study types, focus, timeframe, language and location. The quality of included studies will be assessed using the Critical Appraisal Skills Programme tool and the Mixed Methods Appraisal Tool where applicable. Subsequently, the identified data will be subjected to descriptive analysis and visual representation.

Ethics and dissemination
Ethical approval is not required for this review as it only uses literature available in the public domain. The results will be shared via a peer-reviewed journal, conference presentations and stakeholder consultations.