Background Unsafe healthcare waste management in primary health care (PHC) facilities contributes to healthcare-associated infections, occupational injuries, and environmental degradation, including greenhouse gas emissions from open burning. Despite growing global emphasis on climate-smart health systems, evidence on integrating environmental sustainability into PHC waste management in sub-Saharan Africa remains sparse. As a pilot proof-of-concept, this study assessed the baseline status of climate-smart and environmentally sustainable healthcare waste management practices across four PHC facilities in Abuja, Nigeria, to test the assessment approach and inform intervention design. Methods We conducted a proof-of-concept comparative baseline assessment across four purposively selected PHC facilities (Apo PHC, Kagini PHC, EHA Clinics, and Lugbe PHC) in Abuja, Federal Capital Territory. This pilot was designed to establish the feasibility of a structured facility audit approach and to generate baseline data ahead of the ClimateSENSE intervention, rather than to produce population-level prevalence estimates. Using a structured 14-domain audit tool, data were collected through direct observation, staff interviews, and document review. Composite scores were computed for each domain, and an overall readiness score (maximum 275) was derived for each facility. Facility-level waste-related carbon dioxide (CO 2 ) emissions were estimated using a WHO-aligned approach (0.2 kg of waste per patient per day; emission factor 0.8 kg CO 2 per kg of waste). Findings are reported across all domains, with emphasis on environmental and climate practices, waste treatment, and disposal. Results Composite readiness scores ranged from 43.6% (Kagini PHC, low-to-moderate) to 84.7% (EHA Clinics, high readiness). Waste segregation was the strongest domain (75–100% across facilities), but data systems were weak: 50% of facilities did not measure waste quantities, and 75% kept no records. Half of the facilities stored waste for more than 48 hours. Environmental and climate practices were the weakest domain: only one facility (25%) used renewable energy for waste treatment, 75% did not track carbon emissions, and open burning was the primary disposal method in 75% of facilities, with all facilities (100%) using fuel accelerants. Functional autoclave capacity was limited to 50% of facilities. Estimated baseline waste-related emissions totalled approximately 7.7 tonnes CO 2 per year across the four facilities (WHO patient-load basis); self-reported waste volumes were substantially higher and internally inconsistent with patient load. Over two years, facilities reported an average of 1.5 needle-stick injuries and 1.5 staff exposure incidents, despite universal Hepatitis B vaccination coverage. Conclusions Healthcare waste management in these facilities is partially functional but uneven, with the most critical failures concentrated at treatment and disposal, where environmental sustainability remains peripheral. Open burning, absent emission tracking, and the non-use of renewable energy represent critical gaps in climate-smart practice. The ClimateSENSE intervention, which deploys solar-powered autoclaves, strengthens segregation systems, and builds frontline capacity, is well-positioned to address these gaps. These proof-of-concept findings support the feasibility of the assessment approach and motivate larger, representative studies of environmentally sustainable PHC waste management across Nigeria and comparable low- and middle-income country settings.
Background: Viral respiratory pathogens have become the leading cause of acute undifferentiated febrile illness (AFI). We determined the fraction of AFI attributable to influenza and SARS-CoV-2 in Ethiopia, along with an understanding of their epidemiological characteristics. Methods: From February 2021 to June 2022, we enrolled patients meeting an AFI case definition (age >5 years with fever >= 38 degrees C) who presented at one of four selected sentinel hospital sites in Jimma, Harari, Addis Ababa, and Gonder. Clinical and epidemiological information was collected, Nasopharyngeal swab samples were collected and analyzed using real-time PCR for respiratory viruses (influenza and SARS-CoV-2). A quasi-binomial regression model and multivariable regression were performed to compute fractions and establish associations with the agent detected. Result: A total of 737 AFI cases were enrolled. The overall proportion of SARS-CoV-2, influenza A, and influenza B among AFI patients were 7.8, 1.9, and 0.5 per 100,000 population, respectively. Among the enrolled AFI cases tested for SARS-CoV-2 and Influenza virus, SARS-CoV-2 was the most detected pathogen with a positivity rate of 13.7% (95% CI:11.3-16.4), followed by influenza A and influenza B, which have a positivity rate of 3.3% (95% CI: 2.2-5.1) and 0.8% (95% CI:0.3-1.8), respectively. The positivity rate of SARS-CoV-2 peaked at 37.4% in September 2021. Per the multivariable analysis, cases >= 65 years of age were three [AOR = 3.3,95% CI:(1.9-5.7)] times more likely to be positive for SARS-CoV-2. Conclusion: SARS-CoV-2 and influenza viruses were highly prevalent among AFI cases. The proportion of SARS-CoV-2 was higher among older adults. Further study is recommended to characterize influenza subtypes, SARS-CoV-2 variants and determine their attributable fraction among a broader panel of AFI-causing pathogens that contributes for guiding the proper diagnostics, treatment and surveillance measures.
The digital health community has taken an increased interest in climate and environmental issues. At the same time, and even though equity considerations have been central to digital health for decades, equity-focused approaches to climate and the environment have been less considered. In this commentary, we emphasize the need for equity to remain central to digital health as it shifts to address climate and environment-related challenges. We provided four case examples: electronic waste, early warning systems, digital systems infrastructure vulnerability and artificial intelligence resource use, to demonstrate the climate/environment digital health inequity nexus. We stress that, in not attending to this relationship, the digital transition may amplify rather than reduce inequities associated with climate and environmental challenges. We include a call to action for those in the digital health community to include equity considerations in the planning and designing of digital health solutions and systems aimed at addressing such climate and environmental challenges and beyond.
The incidence of early-onset colorectal cancer (eoCRC) diagnosed under age 50 years has been increasing. The causes of this trend could be multifactorial and remain to be understood. The average birth weight has been increasing in the US since 1950. Intrauterine conditions can affect health outcomes later in life. Prior studies showed a link between high birth weight and risk of certain cancers in adolescent and young adults. Here we evaluated the hypothesis that high birth weight increases risk of eoCRC in a nested case-control study. We included patients diagnosed with colorectal adenocarcinoma at age 15-49 years at Kaiser Permanente Southern California (KPSC) (2009-2021). Cancer-free controls were matched at 10:1 ratio on age, sex, and length of prior KPSC membership using incidence density sampling. Study data were collected from KPSC’s electronic health records and birth data from California Department of Public Health. Record linkage with birth certificates from 1960 to 2005 was performed using date of birth, sex, and first, last, middle, and maiden names. Conditional logistic regression was used to estimate the association between eoCRC and high birth weight, measured using (1) neonatal macrosomia (birth weight > 4,000 grams), (2) large for gestational age (LGA; defined as birth weight > 90th percentile for gestational age and sex, using population references at KPSC), and (3) LGA stratified by sex and race/ethnicity. Analyses were repeated for colon and rectal cancer. Potential confounders or intermediates were assessed in crude models using threshold p-value <0.10. Two-stage model adjustments were performed: adjusting for race/ethnicity only, then additionally adjusting for obesity and hypertension (both had crude p-value <0.10). Of 1,400 eligible eoCRC cases and 13,608 matched controls, 486 cases and 4,706 controls had linked birth certificate data (35% linked in both groups). After excluding cases without controls and vice versa, 471 cases (mean diagnosis age: 41.1 years) and 1,931 controls were included in the analysis. Of the 471 cases, 64% were male; 40% were non-Hispanic white; 64% had colon cancer, 36% had rectal cancer; and 12% had neonatal macrosomia. Both stages of models yielded similar results. In the fully adjusted model, high birth weight was associated with an elevated risk of overall eoCRC with marginal significance [odds ratio (OR)= 1.31 (95% CI: 0.94-1.82), 1.39 (0.96-2.02), and 1.38 (0.98-1.95) for neonatal macrosomia, LGA, and LGA stratified by sex and race/ethnicity, respectively]. Neonatal macrosomia and LGA were significantly associated with rectal cancer [OR= 1.80 (1.03-3.14) and 1.90 (1.04-3.48), respectively], but not with colon cancer [OR= 1.13 (0.75-1.71) and 1.17 (0.73-1.86), respectively]. We observed an association between high birth weight and risk of early-onset rectal cancer independent of adult metabolic abnormality, which should be confirmed in larger studies. Our finding suggests potentially distinct pathogenesis for rectal vs. colon cancer. Chun R. Chao, Lanfang Xu, Amrita Mukherjee, Darios Getahun, Jessica Chubak, Jane C. Figueiredo, Kimberly L. Cannavale, Alec Gilfillan, Bechien Wu. Association of high birth weight with risk of early-onset colorectal cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: The Rise in Early-Onset Cancers—Knowledge Gaps and Research Opportunities; 2025 Dec 10-13; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(23_Suppl):Abstract nr C006.
Background: Telehealth usage increased dramatically during the COVID-19 pandemic, but equitable access remains a concern. Patients lacking technology access, skills, and digital literacy may not benefit fully. Validated telehealth literacy screening instruments are lacking. This study evaluated existing tools from patient and clinician perspectives. Methods: Five telehealth literacy screening tools were identified through a literature review: 1) Digital Literacy Self-Assessment Tool (DLSA), 2) Electronic Health Literacy Scale (eHEALS), 3) Digital Health Literacy Scale (DHCLS), 4) Telehealth Literacy Screening Tool (TLST), and 5) University of Alabama-Birmingham Technology Comfort Survey (TCS). Patients (n=44) and clinicians (n=24) completed an online survey rating each tool across domains of 1) User experience, 2) Engagement, 3) Relevance, and 4) Health literacy. Results: Clinicians overall had greater technology comfort and more digital healthcare usage than patients. Patients ranked TCS highest overall, while clinicians preferred DHCLS. TLST performed well for both groups. All participants ranked eHEALS lowest. Patients valued simplicity and clarity while clinicians favored brevity and clinical focus. Conclusion: Perspectives differed between patients and clinicians regarding optimal telehealth literacy screening tools. Screening instruments should align with key engagement drivers: access, competency, digital literacy, relevancy, trust, and preferences. Tailored tools co-designed with patients and clinicians can promote equitable telehealth adoption and engagement.
