BACKGROUND:Vision-related quality of life (VRQoL)-vision's impact on one's social, emotional and economic well-being-has not been extensively studied in patients living in middle-income countries. The aim of this study was to compare the VRQoL among age-related macular degeneration (AMD), primary open-angle glaucoma (POAG) and normal subjects in Brazil. METHODS:This was a case-control, cross-sectional study. Patients with AMD or POAG and normal controls underwent a complete eye examination; all participants answered the Brazilian-Portuguese version of the Visual Function Questionnaire 25 (VFQ-25). Each item was scored and an overall composite score was calculated and compared among groups with an analysis of variance test. RESULTS:The sample included 60 patients with AMD, 64 with POAG and 60 controls. All groups were matched for age, gender, ethnic distribution and comorbidities. The VFQ-25 total score was lower in both AMD (50.6±20.9) and POAG (61.8±20.4) as compared with controls (89.2±9.1, p<0.001); scores for AMD patients were lower than for POAG patients (p<0.001). CONCLUSIONS:Brazilian patients with POAG, and especially AMD, presented significantly lower VRQoL scores, underscoring the need to improve the care of patients with visual impairment in Brazil.
BACKGROUND:Climate change is increasingly recognised as a major threat to health in Uganda, yet gaps in implementation, financing and coordination may limit the country's climate-health response. This study aimed to understand how national-level interest-holders perceive the availability, adequacy and functioning of policy, governance and financing mechanisms for integrating health into climate action. METHODS:In-depth interviews were conducted with nine key interest-holders purposively selected from ministries, departments and agencies responsible for health, climate change, planning and finance and from academic institutions engaged in climate and health programming and research. A total of 14 individuals were approached and 9 agreed to participate. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Saturation was assessed iteratively by monitoring whether successive interviews yielded new codes or substantively new themes. RESULTS:Interest-holders described a relatively strong climate policy and legal framework that increasingly recognises health but does not fully operationalise climate-health action. Implementation was reported to be constrained by underfunding, fragmented and siloed governance and weak subnational capacity. Climate-related hazards were reported to be damaging health facilities, disrupting access to care and increasing climate-sensitive disease burdens, while local innovations and emerging climate-smart practices remain too limited to guide implementation at scale. Major gaps in evidence for effective health-focused adaptation and mitigation and in climate-health training and public education were identified as limiting the ability of decision-makers, health workers and communities to anticipate and respond to climate risks. CONCLUSIONS:Uganda's relatively robust climate policy framework is undermined by incomplete implementation, driven by constrained financing, limited evaluation and fragmented delivery systems. Strengthening climate-resilient health systems will require embedding climate-health policies into routine health planning and financing, empowering local action using climate information and investing in research, training and public education. Cross-sectoral actions grounded in whole-government and multisectoral governance approaches are also essential to address climate-health challenges.
Malaria remains a leading cause of morbidity and mortality among children under five in Africa. Chemoprevention strategies, including perennial malaria chemoprevention (PMC), seasonal malaria chemoprevention (SMC), together with other control measures, constitute a cornerstone of current preventive approaches. This scoping review aimed to synthesize evidence on the effectiveness of malaria chemoprevention strategies and to examine factors influencing their implementation across diverse epidemiological contexts. We systematically searched PubMed, Scopus, the Cochrane Database of Systematic Reviews, and Google Scholar for peer-reviewed quantitative studies published from 2002 to October 2025. Two reviewers independently screened records and extracted data using a standardized extraction form. Of 386 records identified, 42 met the inclusion criteria. Coverage across all doses ranged from 50% to 60% for both PMC and SMC, with adherence to the first dose consistently higher than for later doses. PMC showed a protective efficacy ranging from 20% to 87.5%, while SMC's protective efficacy reached 88.2%. Protection was markedly enhanced when chemoprevention was combined with malaria vaccination (RTS, S/AS01E). Effectiveness was modulated by transmission seasonality, prevalence of asymptomatic parasitemia, and local transmission intensity. Malaria chemoprevention is an effective strategy for reducing malaria burden in children under five, with the greatest impact observed when combined with vaccination.
BACKGROUND:Humanitarian settings face elevated extreme weather events (EWEs), yet few studies with refugees have examined EWE-related risks and associations with human immunodeficiency virus (HIV) vulnerabilities. METHODS:Among refugee youth ages 16-24 y in a Ugandan refugee settlement, we conducted latent class analysis to examine EWE-related risk classes (resource insecurities [water, food, sanitation], EWE exposure, mobility) and multivariable regression to assess associations between class membership and HIV vulnerabilities (sexual relationship power [SRP], intimate partner violence [IPV], condom use self-efficacy [CUSE], reproductive autonomy). RESULTS:Participants' (n=400, 50% women; mean age 19.49 y [standard deviation 2.3]) class profiles included Class-1 (moderate resource insecurity, high mobility, high EWE), Class-2 (water insecurity, low mobility, low EWE) and Class-3 (severe resource insecurity, moderate mobility, high EWE). Compared with Class-2, Class-1 and Class-3 reported lower SRP (Class-1: adjusted beta coefficient (aβ)=-3.63 [95% confidence interval {CI} -6.27 to -0.98]; Class-3: aβ=-4.24 [95% CI -6.80 to -1.68]) and CUSE (Class-1: aβ=-2.55 [95% CI -4.21 to -0.90]; Class-3: aβ=-3.09 [95% CI -4.69 to -1.48]) and higher IPV (Class-1: odds ratio [OR] 4.81 [95% CI 1.00 to 23.03]; Class-3: OR 5.59 [95% CI 1.19 to 26.36]), and Class-1 reported lower reproductive autonomy (aβ=-0.27 [95% CI -0.54 to -0.01]). CONCLUSION:Converging EWE, mobility and resource insecurities increase refugee youths' HIV vulnerabilities, requiring urgent attention.
BACKGROUND:Vaccine hesitancy is a serious public health problem that contributes to poor vaccine uptake with associated poor health outcomes among the population. This study assessed the level of hesitancy of coronavirus disease 2019 (COVID-19) vaccination among pregnant women in Jos, Plateau State, Nigeria. METHODS:A hospital-based cross-sectional study involving 104 pregnant women was conducted at a specialist hospital antenatal clinic. COVID-19 vaccine hesitancy was assessed using a 10-item tool. Descriptive statistics and binary logistic regression were performed, with statistical significance set at p<0.05. RESULTS:The mean age of the participants was 30.3 y (standard deviation 6.3), with 49% ages 25-34 y. Most were married (96.2%), resided in urban areas (84.6%) and were employed (64.4%). About 72% of the participants had more than one child, were healthy (55.8%) and had no family members or friends who had been vaccinated against COVID-19 (70.2%). Overall, about 58% of the participants were hesitant regarding COVID-19 vaccine. Participants' parity, health status, social influence and negative perceptions towards vaccination influenced vaccine hesitancy. CONCLUSION:Pregnant women were likely to be hesitant about the COVID-19 vaccines if they felt their health was good and had a family member who had received a COVID-19 shot. Public health efforts and education campaigns for pregnant women are needed to change their perception patterns to promote vaccination uptake and participation in vaccine trials.
OBJECTIVES:Niger in West Africa reduced maternal mortality by 34.5% among 1 380 799 health-facility births over 72 months through 2020 by more than halving postpartum haemorrhage (PPH) mortality in health facilities nationwide, using low-cost obstetrics technologies and 11 public health disease-eradication tools. Monthly support ended in December 2020 because of a lack of funding. Sustainability of innovations is important, given declining external funding and expectations that even very poor countries fund health from domestic taxes. Therefore, the current study assessed for PPH mortality rebound, also because 2015-20 results had been better than expected. METHODS:Routinely collected government maternal mortality data during the 2015-20 project period and the 2021-4 post-project period were tested using Poisson regression models, and the Cochran-Armitage test for trend. RESULTS:Among 2 158 021 health-facility births from 2021 to 2024, no significant change was seen in the proportion of maternal deaths caused by PPH, PPH case fatality, PPH cases per 100 000 births, or PPH deaths/1000 births compared with the preceding 4 years. CONCLUSIONS:Niger's >50% PPH mortality reduction was sustained for 4 years without external attention to its implementation. Given sustained success emanating from capacity-strengthening, the strategy should be tested in other settings where maternal mortality remains high.
Two large studies published in 2023 report more rapid reductions in postpartum haemorrhage (PPH) mortality after health-facility births than many would think possible in a low- or middle-income country, using very different study designs yet broadly similar interventions. In this commentary and the accompanying study, we report on how Niger is sustaining its nationwide results through four subsequent years among over 2 million health-facility births with little external support. In an era of greatly reduced external funding for health, these studies provide strong justification for testing elsewhere too, to determine whether these approaches should be scaled globally.
OBJECTIVES:Smoking is a major cause of preventable morbidity and mortality worldwide. Despite global tobacco control efforts, smoking prevalence remains high in many regions. This study aimed to determine the prevalence of smoking and its associated factors in the Kurdistan Region of Iraq. METHODS:A community-based, cross-sectional study was conducted in 2025, consisting of 1132 individuals aged ≥18 years selected through multistage random sampling from 12 districts of Duhok City. Data were collected using a structured questionnaire and anthropometric measurements. Descriptive statistics and logistic regression analyses were performed to identify factors associated with smoking. RESULTS:The mean age of participants was 37.5 ± 14.8 years. The overall prevalence of smoking was 33.6%, with a marked gender disparity (50.9% in men vs 5.7% in women). In univariate analysis, smoking was significantly associated with gender, education, marital status, employment status, physical activity, hypertension, waist circumference, and body mass index. Multivariate logistic regression showed that gender, education level, and employment status remained independently associated with smoking. CONCLUSIONS:Smoking prevalence in the Kurdistan Region of Iraq is alarmingly high, particularly among men, individuals with lower education, and employed adults. These findings highlight the urgent need for strengthened tobacco control policies and targeted public health interventions in the region.
This study estimated the pooled prevalence of visual acuity (VA) outcomes and potentially blinding cataract surgery complications in Nigeria. Ethical clearance was waived by the Ethical Review Board of the Kano State Ministry of Health. We searched PubMed, African journals online, Embase, MEDLINE and Google Scholar to identify relevant studies from January 1990 to February 2025. Data on presenting and best-corrected visual acuities at ≥6 weeks after cataract surgery, intraoperative posterior capsular rupture with vitreous loss and postoperative endophthalmitis were extracted from included studies. I2 statistics were used to assess heterogeneity across studies. Articles were systematically reviewed and a random effects meta-analysis model was applied to estimate the pooled effect size across studies. All statistical analyses were performed using Stata version 17.0 software. Sixteen studies, with a total of 3631 cataract-operated eyes, were included in the review. A total of 80.0% of all operated eyes had a preoperative VA of <3/60. At ≥4 weeks the percentage with good presenting VA ranged from 8% to 86%, with evidence of improved outcomes over time (95% confidence interval [CI] 45.0 to 67.0, I2=96.7%). With the best correction, 75% (95% CI 66.0 to 83.0, I2=98%) had a good outcome at ≥6 weeks postoperatively. The pooled prevalence of posterior capsular ruptures with vitreous loss was 4.0%, while 1.0% had postoperative endophthalmitis. In this review, the VA outcome after cataract surgery in Nigeria is well below the World Health Organization-recommended benchmark of >90% for a good result, with a higher rate of potentially blinding complications. The findings of this review suggest the need for improvement in modern surgical techniques, quality biometry and stocking of intraocular lenses of different powers and types to improve visual outcome and reduce complication rates.
OBJECTIVES:The need for rapid, point-of-need screening of pesticide residues in resource-limited settings requires moving beyond subjective visual interpretation of colorimetric tests. Organophosphate pesticides pose significant public health risks, especially in low- and middle-income countries, where laboratory-based detection methods are often inaccessible. METHODS:We developed an integrated system combining paper-based microfluidics, smartphone imaging, and chemometric modeling. A three-zone paper microfluidic card was engineered to incorporate an acetylcholinesterase inhibition assay, along with internal positive and negative controls. A 3D-printed imaging enclosure with controlled LED lighting standardizes smartphone image capture. Images were processed via an automated pipeline to extract CIELAB color features, and a partial least squares regression (PLSR) model was calibrated to predict chlorpyrifos concentration. RESULTS:The system achieved a limit of detection of 0.35 mg/L and a limit of quantification of 1.06 mg/L. Validation on an independent set yielded a root-mean-square error of prediction of 0.82 mg/L and a mean absolute error of 12.7%. Recovery rates in spiked lettuce extract ranged from 89% to 110%. The a* channel in CIELAB space showed the strongest correlation with concentration, and the PLSR model performed robustly for semiquantitative screening. CONCLUSIONS:This smartphone-based system transforms a qualitative enzymatic assay into a reliable, semiquantitative screening of organophosphate (chlorpyrifos) residues in resource-limited settings such as Sierra Leone. As a laboratory-validated prototype, it requires future field testing before operational deployment and validated system performance in terms of detection limits, accuracy, precision, and robustness against matrix effects in a representative vegetable matrix (lettuce extract).
OBJECTIVES:Trachoma elimination progress is hampered in some districts by persistent or recrudescent trachomatous inflammation-follicular (TF). In Sokoto State, Nigeria, two local government areas (LGAs) have been classified as having persistent TF. We aimed to determine whether there was ongoing, programmatically significant conjunctival Chlamydia trachomatis (Ct) community transmission in these LGAs. METHODS:In addition to examination for trachoma clinical signs, we took conjunctival swabs (for Ct nucleic acid amplification testing) from children aged 1-5 years, and dried blood spots [for estimation of anti-chlamydial plasmid gene protein 3 seroconversion rates (SCRs)] from children aged 1-9 years. RESULTS:In Binji LGA, TF prevalence (4.1%) was below the elimination threshold, SCR was 1.1 per 100 child years in 1-5-year-olds, and Ct infection prevalence was 0.1%. In Silame LGA, TF prevalence (5.6%) was above the elimination threshold, but SCR was 1.6, and Ct infection prevalence was 0.2%. CONCLUSION:Binji has attained the active trachoma elimination threshold, thus transitioning to surveillance. In Silame, despite the TF prevalence remaining slightly above threshold, the low Ct infection prevalence and low SCR suggest Ct transmission is minimal, and mass drug administration will not be conducted. Silame can therefore also transition to the surveillance phase. Complementary trachoma survey indicators help ensure appropriate and cost-efficient programmatic decisions.
BACKGROUND:Adequate dietary diversity is crucial for maternal nutrition, yet many pregnant women in Somaliland suffer from poor nutrient intake. However, evidence of influencing factors of pregnant women's dietary diversity, particularly the role of husband involvement in maternal dietary practices, remains limited in Somaliland. Therefore, this study examines the association between husband involvement and dietary diversity among pregnant women attending maternal and child health centres (MCHCs) in Hargeisa, Somaliland. METHODS:A facility-based cross-sectional study was conducted from November to December 2024 in five MCHCs in Hargeisa. Data on sociodemographics, antenatal care (ANC), husband involvement and supplementation were collected via interviewer-administered questionnaires. SPSS version 29.0 was used for data cleaning and analysis, with bivariate and multivariable logistic regression (p<0.05 significance). RESULTS:The overall prevalence of adequate dietary diversity was 64%. Significant predictors of adequate dietary diversity include greater husband involvement, higher maternal education, multigravidity, attending ANC for four or more visits and participation in nutrition counselling sessions. In contrast, logistic barriers, limited healthcare access and insufficient healthcare professionals were negatively associated with adequate dietary diversity among pregnant women attending MCHCs. CONCLUSIONS:Pregnant women's dietary diversity is suboptimal in Hargeisa. Strengthening husband involvement in care, maternal education and access to care in integrating nutrition counselling into ANC services were recommended.
OBJECTIVES:Establishing effective systems that enable informal healthcare providers (IHPs) to refer complicated cases and share service data with the formal health system is essential for improving quality services and coordination. METHODS:This qualitative study explored the motivations of IHPs to refer patients and share health information in eight urban informal settlements in two eastern states, Enugu and Anambra in Nigeria. Data were collected through 32 in-depth interviews with purposively selected IHPs. RESULTS:Findings revealed that IHPs refer patients and share some patient information. However, the recording and sharing of patients' data was uncommon among most IHPs. Altruism was reported by IHPs as a motivator for improving care and linking with the formal sector to save lives. However, there are ad hoc and unsystematic links between formal and informal providers. CONCLUSION:Understanding these motivations is vital for designing strategies to strengthen collaboration and establish sustainable referral and data-sharing systems within Nigeria's mixed health system.
Corporate social responsibility has received substantial attention from researchers in the business and organizational literature. However, this concept is equally desirable in nursing care, as nurses must realize their responsibility towards society in the effective delivery of healthcare services. Employing the concept analysis method of Walker and Avant, 128 journal articles published in the PubMed journal during 2000 to 2025 were selected based on the inclusion criteria. Based on this model, the study proposes a framework for nurses' social responsibility (NSR), especially in the context of developing countries. This framework coins three important dimensions of social responsibility that include NSR towards their profession, community, and patients. Based on the three dimensions of the NSR, this study proposes six major principles that govern this framework. It also presents four strategies for successful implementation of this framework. This framework also outlines certain challenges and mitigation strategies to effectively counter these challenges. Potential outcomes of the proposed framework are discussed, followed by a call for action to nurses, nursing organizations, governments, and the community at large.
Objectives Kenya's 2024 heavy rains and flooding resulted in agricultural devastation and displacement. We assessed resource insecurity, sexual health, and mental health differences across two time points, during this heavy rain/flooding and at 6-month follow-up under dry conditions, among adolescent girls and young women (AGYW) in Kenya.Methods We conducted surveys at Time 1 (T1) (heavy rains/flooding, June 2024) and Time 2 (T2) (dry conditions, November 2024) with a non-random sample of AGYW aged 16-24 years in Nairobi and Kisumu. We conducted longitudinal analyses using generalized estimating equations to assess differences over time in resource insecurities (food, water, sanitation, menstruation), sexual health (transactional sex, sexual relationship power (SRP), condom use self-efficacy (CUSE)), and mental health (depression, eco-anxiety), adjusting for sociodemographics and baseline scores, and tested motherhood and traumatic exposure severity as moderators.Results Among 586 participants (mean age 20.13 (SD 2.5) years) at follow-up (98.2% retention) vs baseline across sites we found significant resource insecurity reductions (food, sanitation), sexual health improvements (reduced transactional sex, increased SRP), and reduced eco-anxiety. Depression and CUSE changes varied across sites.Conclusion Participants reported differences over time in resource insecurity and sexual and mental health. The findings signal the importance of weather-informed health research with AGYW in Nairobi and Kisumu.
African governments must regulate fast-growing digital health and artificial intelligence technologies while building the continent's planned digital single market. Regulatory sandboxes are increasingly promoted as a solution, but most sandbox experience comes from finance, where the primary concern is market risk, not clinical safety or public health harm. Healthtech is not fintech, and failure carries very different consequences. We argue that the Global System for Mobile Communications (GSM) standards model offers a more appropriate template. Drawing on the V-Model framework, we propose that regional bodies verify technical interoperability while national regulators validate clinical and ethical suitability. Simulation-based exercises can test governance before technologies go live, building a cautious, collectively owned approach to digital health innovation on African terms.
Large language models (LLMs) are proposed as scalable solutions for health workforce gaps in low- and middle-income countries, yet deployment risks deepening inequities. LLM evaluation remains disproportionately centered on English-language resources, and current reporting standards do not operationalize linguistic parity, data sovereignty, or accountability for specific language communities, care pathways, and regulatory arrangements. We propose three minimum governance commitments: parity before scale, requiring pre-specified performance thresholds or non-inferiority margins by language and care setting before deployment; local ownership before extraction; and accountability before integration. Systems failing these thresholds should be restricted, redesigned, or subject to additional oversight before scale-up.
BACKGROUND:Investing in adolescents' sexual and reproductive health (SRH) yields great benefits, as this period marks a crucial transition from childhood to adulthood. Many young people face SRH challenges due to limited knowledge and inability to make informed decisions about their sexual and reproductive health rights (SRHR). This study aimed to assess the effectiveness of digital health interventions in improving SRH among school adolescents and youths in Jimma, Ethiopia. METHODS:A quasi-experimental design was employed and data were collected from school youths. Analysis was conducted using EpiData version 4.6 and Stata version 17.0. Propensity score matching was applied to estimate average treatment effects and sensitivity analysis was conducted using a difference-in-differences approach. RESULTS:There was a significant improvement in SRH outcomes between baseline and the end line. Knowledge of SRHR increased by 26.8 percentage points (95% confidence interval [CI] 14.5 to 38.6), knowledge of SRH by 11.5 percentage points (95% CI 1.7 to 21.4) and positive attitudes toward SRHR by 27.4 percentage points (95% CI 17.5 to 37.3) following the digital intervention. CONCLUSIONS:The digital health intervention significantly enhanced knowledge and attitudes related to SRHR among school adolescents. Further studies should explore whether improvements in knowledge and attitudes translate into longer-term reproductive health outcomes, such as contraceptive uptake, teenage pregnancy and unmet need for family planning.
