BACKGROUND:Cigarette smoking remains a major preventable cause of disease and mortality. Comparable sex-disaggregated estimates are needed to describe smoking patterns across African countries and support tobacco control planning. OBJECTIVE:To provide a multi-country descriptive summary of the current prevalence of cigarette smoking disaggregated by sex among people aged ≥ 15 years in 39 African countries. METHODS:This cross-sectional descriptive analysis used non-age-standardized WHO Global Health Observatory modelled estimates for 2022, accessed through Health Equity Assessment Toolkit version 6.0. Current cigarette smoking prevalence (M_Est_cig_curr) was disaggregated by sex and exported for 39 countries. Absolute differences were calculated as female minus male prevalence. Male-to-female prevalence ratios were derived from the exported point estimates for supplementary analysis. The dataset comprised modelled estimates rather than directly observed survey data. RESULTS:The overall prevalence ranged from 1.7% in Ghana to 18.2% in Seychelles. The prevalence of males exceeded that of females in all 39 countries. The male-minus-female gap ranged from 3.3 pp in Ghana to 36.4 pp in Lesotho; gaps also exceeded 25 pp in Mauritius, Algeria, Madagascar, and Seychelles. The prevalence in females was highest in South Africa (5.1%) and Seychelles (4.5%). CONCLUSION:This study shows substantial sex differences in current cigarette smoking across the included African countries, driven mainly by a higher prevalence among men. These findings support strengthened sex-disaggregated surveillance and tobacco control responses tailored to observed country patterns. Explanations involving social norms, marketing, or policy context should be treated as hypotheses because these factors were not measured in this study.
School-based nutrition interventions are widely used to improve nutrition among children and adolescents in low- and middle-income countries. This scoping review examined implementation strategies, theories, models, frameworks, and implementation outcomes reported for school-based nutrition interventions in these settings. We included English-language primary studies conducted in school settings in low- and middle-income countries if they reported implementation strategies, implementation outcomes, theories, models or frameworks, barriers, facilitators, adaptation, sustainability, scale-up, or implementation processes. PubMed and Scopus were searched, and reference lists of included studies and relevant reviews were screened. Records were screened independently by two reviewers, and data were synthesized descriptively and thematically. The search identified 1,985 records, and eight studies met the inclusion criteria. The studies were conducted in Nepal, Ghana, Pakistan, Tanzania, and India. Implementation strategies included teacher-led delivery, training, stakeholder and community engagement, external partnership support, and integration into school systems. Reported barriers included limited funding, inadequate infrastructure, staff workload, weak coordination, limited monitoring, and dependence on external or parent contributions. Separately, implementation reporting was incomplete, particularly for reach, fidelity, and sustainability. Because the search was restricted to two databases and English-language publications, some relevant evidence may have been missed. Future studies should report implementation processes and outcomes more clearly to support adaptation, scale-up, and long-term delivery.
BACKGROUND:Poor access to water, sanitation and hygiene exacerbates the spread of infections among newborns. The BabyGel cluster randomised trial assessed the effectiveness of a community-level alcohol-based hand rub with a training component in reducing infection or death rates among newborns in Uganda. OBJECTIVE:Nested in the BabyGel trial, this study investigated the acceptability of the BabyGel intervention among mothers and household members in Eastern Uganda, using the Theoretical Framework of Acceptability. METHODS:In 2022, we conducted individual semistructured interviews with mothers, and group interviews with mothers and other household members, all recruited from intervention-arm clusters. Thematic analysis combined inductive and deductive coding, structured by the framework's seven constructs: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness and self-efficacy. RESULTS:Twenty mothers and 14 household members participated in 10 individual and 10 small group interviews. Participants found the intervention generally acceptable, appreciating its convenience and perceived protection against infection. Many described hand hygiene changes that persisted beyond the intervention period. However, concerns related to its harmful effects, spiritual beliefs and social tensions with visitors occasionally influenced its use. CONCLUSION:Alcohol-based hand rub combined with a training component was generally well accepted, driven by perceived health and practical benefits, although concerns related to safety, belief systems and social dynamics remained. Because data collection coincided with the COVID-19 pandemic, a period of heightened hygiene awareness, the acceptability observed could differ in nonpandemic periods. Culturally adapted education, community engagement and reinforcement of correct use may enhance acceptability and sustainability in similar settings.
BACKGROUND:Marketing of nutrient-poor foods is a recognized driver of unhealthy dietary behaviors and childhood obesity. In Senegal, the triple burden of malnutrition persists, while regulations restricting unhealthy food marketing to children remain limited. OBJECTIVE:To assess the extent and nature of food advertising around schools and on television in Senegal and to explore children's and parents' perceptions of food marketing. METHODS:A cross-sectional mixed-methods study was conducted across four regions in Senegal (Dakar, Kaolack, Saint-Louis, Ziguinchor). Food advertising was mapped within a 250-m radius of 40 selected urban/peri-urban schools, and inventoried on four national television channels. Advertised foods were evaluated using the WHO-NPM AFRO and Nutri-Score systems and classified as 'permitted' or 'non-permitted' foods. Focus group discussions with children and in-depth interviews with parents were conducted to explore food marketing perceptions. Quantitative data were analyzed using descriptive and inferential statistical analysis, and qualitative data were analyzed using thematic analysis. RESULTS:Overall, 79% (n = 438) of food advertisements around schools and 75% (n = 366) on television were for 'non-permitted' foods. Non-permitted food advertisements were more frequent during peak viewing times and used persuasive marketing techniques. Children demonstrated brand recall and reported requesting advertised products following exposure. Parents expressed concerns about poor nutritional quality of foods advertised to children and supported stricter regulatory measures. CONCLUSIONS:Children were exposed to 'non-permitted' food advertising across physical and virtual environments in Senegal. The predominance of nutrient-poor food promotion underscores the urgent need for mandatory policies to restrict unhealthy food marketing to children.
Armed conflict profoundly affects women's sexual and reproductive health and rights, yet the pathways through which conflict shapes family planning and abortion uptake and decision-making remain insufficiently understood. This scoping review aimed to identify and map the available evidence on how armed conflict influences women's use of, access to, and decisions about family planning and abortion in conflict-affected settings. Following JBI guidance and -ScR reporting standards, searches were conducted in Web of Science, Scopus, PubMed and Embase for peer-reviewed articles published in English between 2014 and 2024. Studies were eligible if they included primary data on women living in conflict-affected settings or internally displaced populations, treated conflict as an exposure or shaping condition, and addressed family planning, contraception, sterilisation, abortion or post-abortion care. Thirty studies were included, and the data were synthesised using a thematic synthesis approach. Relevant findings from each article were organised into subcategories based on their commonalities under two main themes: a) Factors shaping the uptake of and decision-making about family planning, including contraception and sterilisation, and b) Factors shaping the uptake of and decision-making about abortion. The results highlight that armed conflict does not automatically affect reproductive health in a single direction; rather, its effects depend on how violence, service availability, gendered power relations, social norms and social conditions interact. This study calls for further research to better understand the effects of conflict on women's reproductive health and autonomy, and inform tailored humanitarian interventions to address these needs.
BACKGROUND:Midwife-led continuous labour support is a woman-centered approach that has been shown to improve childbirth outcomes. Despite strong global recommendations, it has yet been implemented in Ethiopia. OBJECTIVE:This study aimed to explore the experiences of primiparous women with midwife-led continuous labour support in northwest Ethiopia. METHODS:A qualitative exploratory design was used from July to December 2024. In-depth interviews were conducted with 16 primiparous women who received midwife-led continuous labour support in four primary hospitals. Interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed using latent content analysis. RESULTS:Four sub-categories emerged: emotional empowerment and mindset transformation; compassionate, respectful, and welcoming care; physical and informational support enabling coping and comfort; and a desire for expanded support and system strengthening. Participants considered this model superior to routine care for achieving a positive birth experience, and they advocated its wider adoption, family involvement, and investment in midwives. CONCLUSION:Midwife-led continuous labour support fostered positive birth experiences and strengthened relationships between women and midwives. As the mothers reported, the support enhanced their confidence, emotional empowerment, and development of strategies to cope with labor pain. This approach has clear clinical and policy implications for improving maternal and newborn care. This approach is superior to routine care and is strongly recommended by these mothers as standard practice, offering opportunities for family involvement and institutional investment in midwives.
BACKGROUND:Armed conflict can disrupt medication access through damaged infrastructure, supply shortages, service disruption, transport barriers, and financial hardship. Community-level evidence remains limited in post-war Syria. OBJECTIVE:To assess medication accessibility, perceived barriers and consequences, and factors independently associated with greater barriers among residents of Homs. METHODS:A cross-sectional study using convenience sampling included 1,042 participants in Homs between 29 March and 22 April 2026. Data were collected using an adapted, Arabic-translated, pilot-tested questionnaire. A seven-item medication access barrier score was calculated (range, 7-35). Descriptive analyses, nonparametric bivariate tests, and multivariable linear regression with robust standard errors were performed. RESULTS:Median age was 26 years (IQR, 22-42), and 62.0% were female. Self-reported poor economic status increased from 10.8% before the war to 30.3% during the war, and only 10.9% reported easy medication access during the war. The median barrier score was 22 (IQR, 20-26). High medication prices were the most frequently endorsed barrier (69.7%). Perceived consequences included health deterioration due to inability to access medications (68.5%) and deaths attributed to medication shortages (53.2%). In adjusted analysis, self-reported poor wartime economic status, student status, and greater distance to the nearest medication provider were associated with higher barrier scores, whereas less than high-school education was associated with lower scores. CONCLUSIONS:Medication access problems were commonly reported and were associated with socioeconomic and geographic factors. These findings may inform post-conflict strategies addressing medicine affordability, supply continuity, and access to care.
BACKGROUND:Mental health is a neglected public health issue in post-conflict zones like Somalia. OBJECTIVE(S):Given the absence of community-based data in Somalia, this study sought to determine the prevalence and associated factors with Self-Reported Mental Health Difficulties among individuals aged 10 years and older by utilizing a nationally representative sample. METHODS:We analyzed secondary data from the 2020 Somali Health and Demographic Survey of 49,389 individuals aged 10 years and older. We used descriptive statistics and multilevel logistic regression models to estimate prevalence and pinpoint socioeconomic and clinical factors. RESULTS:The overall prevalence of Self-Reported Mental Health Difficulties among Somali individuals aged 10 years and older was 0.83%. Multilevel analysis revealed that advanced age was a primary correlate, individuals aged 55 years and older had 14.30 times higher odds of reporting self-reported mental health difficulties compared with those aged 10-19 years. Significant clinical correlates included a history of stroke (AOR = 4.07), chronic back pain (AOR = 2.76), and high blood pressure (AOR = 2.57). CONCLUSIONS:While reported prevalence is relatively low, likely reflecting severe impairment and cultural under-reporting, the burden is disproportionately high among elderly individuals and those with physical comorbidities. Policy interventions should focus on secondary prevention by integrating mental health screening into primary care for chronic diseases and developing specialized geriatric support services to bridge the treatment gap in Somalia.
BACKGROUND:Nearly half of India's urban population lives in informal settlements, facing substandard living conditions due to overcrowding, poor infrastructure, and limited access to basic amenities. These conditions critically affect the psychosocial well-being of mothers, yet limited research exists on how the built environment impacts maternal psychosocial health in urban poor settings in India. OBJECTIVE:To explore the influence of housing conditions and neighborhood environments on maternal psychosocial health among mothers of children under five residing in urban slums and in-situ slum rehabilitation colonies in Bhopal, India. METHODS:A qualitative study using a phenomenological approach was conducted through focus group discussions and in-depth interviews with mothers from both slum and in-situ slum rehabilitation settings. Thematic analysis was employed to identify emerging patterns and interpretive themes reflecting shared and lived experiences. RESULTS:Women residing in slum areas were particularly vulnerable due to overcrowded and poorly constructed dwellings. Inadequate infrastructure and environmental stressors contributed to persistent fears of accidents and safety risks. In both slum and BSUP rehabilitation contexts, social isolation and limited community cohesion heightened fears of crime, adversely affecting psychosocial health. Uncertainty surrounding potential relocation, combined with caregiving-related health concerns, further intensified emotional stress and psychosocial burden. CONCLUSIONS:The findings highlight the need to improve housing quality, ensure reliable access to essential amenities, and strengthen community support systems. Developing comprehensive, context-sensitive strategies that enhance resilience and psychosocial well-being is essential for promoting inclusive and sustainable urban development among vulnerable populations.
Drones are changing healthcare delivery, particularly in sub-Saharan Africa (SSA), where traditional logistics face geographical, infrastructural, and resource limitations. This review maps where drones have been used in SSA, how they have been used, the outcomes and challenges, and the potential to expand drone systems to address other healthcare problems. A rapid scoping review methodology was employed, sourcing literature from Google Scholar, PubMed, SCOPUS, Web of Science, Cairn.info, and grey literature using targeted keywords such as 'drones,' 'medicine delivery,' and 'sub-Saharan Africa' to build a search query. Twenty-nine papers met the inclusion criteria, covering 12 countries, although the evidence base was heavily concentrated in Ghana and included a mix of peer-reviewed articles, technical reports, and media or organisational sources. Drone delivery systems have improved healthcare logistics across SSA by reducing delivery times, addressing rural access issues, improving maternal, neonatal, infectious disease, and emergency outcomes, and optimising supply chains. However, challenges such as payload limitations, dependency on donor funding, regulatory and policy restrictions, and workforce shortages hinder scalability. Drones have great potential for healthcare delivery in SSA, offering rapid, efficient, and cost-effective solutions that are transferable to non-communicable diseases (NCDs) and to potential and emerging applications such as vector surveillance and public health messaging. While their contributions to improving maternal health and emergency response are notable, addressing systemic issues is crucial. Drones show promise for improving healthcare logistics in underserved settings, but their long-term value depends on resolving regulatory, infrastructural, workforce, and financing constraints, and on generating stronger comparative generalisable evidence.
BACKGROUND:Unsafe medication practices among older adults are an important global health concern, particularly in low- and middle-income countries where multimorbidity, fragmented care, self-medication, and informal healthcare provision intersect. OBJECTIVE(S):To synthesize direct evidence on medication safety among older adults in India and contextual evidence on deprescribing and community-level provider interventions relevant to safer medication use. METHODS:This PhD synthesis integrates four studies: a record-based cross-sectional study on polypharmacy and cardiovascular autonomic function in Kolkata; a six-city community study of 600 Indian older adults; a systematic review and meta-analysis on deprescribing preventive medications in frail or end-of-life older adults; and a systematic review of informal healthcare provider interventions in low- and middle-income countries. Studies I-II provided direct Indian older-adult evidence, while Studies III-IV provided indirect contextual evidence for their optimization and implementation. RESULTS:Polypharmacy was associated with higher anticholinergic burden and numerically higher cardiac autonomic neuropathy although residual confounding limits causal interpretation. In the multicity study, one-third had polypharmacy, while potentially inappropriate medications, prescribing omissions, and self-medication were common. Risks were higher with multimorbidity, recent hospitalization, care transitions, or living alone. Deprescribing showed no statistically significant increase in mortality, hospitalization, or major cardiovascular events, but heterogeneity was high and certainty low to very low. Informal-provider interventions showed the potential to improve knowledge, referral, case management, and medication-related practices. CONCLUSIONS:Medication safety among older adults in India requires an integrated continuum approach, but direct evidence supports only some components and implementation strategies that need prospective evaluation.
Background: Spinal cord injury (SCI) requires long-term, multidisciplinary rehabilitation to optimize functioning and participation. In fragile health systems, however, rehabilitation services are often fragmented, under-resourced, and inconsistently accessible. This Current Debate paper examines SCI rehabilitation in Lebanon as an example of how health system fragility constrains rehabilitation delivery and disability inclusion.Methods: Using an International Classification of Functioning, Disability and Health (ICF)-informed approach, we developed a multi-level conceptual framework through structured narrative synthesis of 35 studies, contextual analysis of 10 policy documents, and iterative expert interpretation by a multidisciplinary team. The framework integrates evidence from rehabilitation systems literature with contextual analysis of the Lebanese healthcare system; its structure and prioritization reflect the authors' interpretive synthesis and professional experience rather than a fully systematic or validated methodology.Results: The proposed framework is organized across three interconnected levels: macro-level governance and financing, meso-level health system organization and workforce capacity, and micro-level functioning, self-management, and community participation. Health system fragility is conceptualized as a cross-cutting determinant influencing rehabilitation access, continuity of care, implementation capacity, and long-term outcomes. We argue that rehabilitation in crisis-affected settings cannot rely solely on incremental service expansion. Instead, rehabilitation should be reframed as a systems-level, disability-inclusive intervention addressing structural and contextual determinants of functioning.Conclusion: The framework provides a context-sensitive starting point for strengthening rehabilitation systems in comparable low- and middle-income settings; its broader scalability and generalizability beyond Lebanon remain conceptual at this stage and require empirical and stakeholder validation.
Non-communicable diseases (NCDs), including cardiovascular diseases, cancers, diabetes and chronic respiratory diseases, represent a growing inpatient burden worldwide. Yet hospital-based cross-national mixed-methods comparisons remain scarce, and the factors shaping inpatient NCD care are poorly understood. This protocol describes an explanatory sequential mixed-methods study examining inpatient NCD characteristics, disease patterns and hospitalisation indicators in tertiary hospitals in New Zealand and China, and exploring multilevel influences on NCD care. Guided by the Social Ecological Model, the study will be conducted at Waikato Hospital and the Third People's Hospital of Yibin. In the quantitative phase, de-identified discharge records of adult inpatients aged ≥ 16 years with a primary diagnosis of one of the major NCDs will be extracted for 2023-2025. Analyses will be stratified by NCD category, and multivariable regression models with site as a fixed effect will examine variations in hospitalisation outcomes. In the qualitative phase, semi-structured interviews will be conducted with approximately 30-40 healthcare professionals across both settings. Interview data will be analysed thematically and integrated with quantitative findings using joint displays. To our knowledge, this is the first mixed-methods comparison of inpatient NCD care between tertiary hospitals in China and New Zealand. Findings are expected to support cross-cultural learning and inform evidence-based strategies to improve inpatient NCD management across diverse healthcare systems. This protocol is reported in accordance with the GRAMMS, STROBE and COREQ guidelines.
BACKGROUND:Noncommunicable diseases (NCDs) are the leading cause of mortality in Iran, driven by behavioral and metabolic risk factors that frequently co-occur. OBJECTIVE:To identify patterns of co-occurring behavioral and metabolic NCD risk factors among Iranian adults and characterize their demographic and socioeconomic correlates. METHODS:This cross-sectional study analyzed data from 16,618 adults aged ≥25 years who participated in Iran's 2021 nationally representative STEPS survey. Thirteen behavioral and metabolic variables, including physical activity, nutrition score, smoking frequency, alcohol intake, salt intake, body mass index, blood pressure, fasting plasma glucose, and lipid markers, were entered into a K-means clustering analysis. Clusters were characterized by their risk profiles and demographic/socioeconomic attributes. Multinomial logistic regression examined associations between cluster membership and sociodemographic factors. RESULTS:Five distinct behavioral-metabolic clusters emerged. The smokers-drinkers (SD) cluster (3.1%) comprised mostly older, less-educated men with high smoking and alcohol use. The healthy-low-risk (HLR) cluster (40.3%) showed favorable profiles and included younger, more educated individuals. The physically active (PA) cluster (6.6%) was characterized mainly by younger men with markedly high physical activity levels. The dyslipidemic (DLP) cluster (26.0%) exhibited high dyslipidemia and overweight prevalence, while the hypertensive-diabetic (HTD) cluster (24.0%) had the highest obesity, hypertension, and diabetes rates, common among older urban adults. CONCLUSION:Behavioral and metabolic NCD risk factors in Iran formed five distinct co-occurrence patterns. Nearly half of adults belonged to metabolically high-risk clusters, highlighting the need for targeted prevention strategies that combine lifestyle interventions with screening and management of obesity, hypertension, diabetes, and dyslipidemia.
BACKGROUND:Preterm birth complications remain a leading cause of neonatal mortality in Sierra Leone, despite recent health system gains. Evidence on long-term sex-specific disparities in mortality due to preterm birth complications is limited, constraining equitable neonatal care planning. OBJECTIVE:To examine two‑decade trends in sex‑stratified mortality from preterm birth complications using standardized equity indicators. METHODS:We conducted a retrospective longitudinal analysis of sex-disaggregated mortality estimates from the World Health Organization (WHO) Global Health Estimates (GHE), accessed through the WHO Health Equity Assessment Toolkit (HEAT), Built-in Database Edition (Version 6.0). Mortality rates per 100,000 population were extracted for 2001, 2006, 2011, 2016, and 2021. Inequality was assessed using absolute difference (D), relative ratio (R), population attributable risk (PAR), and population attributable fraction (PAF). RESULTS:Mortality declined substantially between 2001 and 2021 for both males (85.1-49.3 per 100,000) and females (71.2-39.9 per 100,000). Male mortality remained consistently higher across all years, with relative ratios indicating approximately 20-25% excess mortality among male neonates. Absolute inequalities narrowed modestly over time, whereas relative inequalities remained largely unchanged. PAR and PAF remained close to zero throughout the study period. Wider uncertainty intervals in earlier years reflected limited empirical data availability. CONCLUSION:Although preterm mortality declined over two decades, a persistent male disadvantage remained in Sierra Leone. These findings highlight the importance of integrating sex-disaggregated equity monitoring into neonatal policies and programmes. Future research should evaluate strategies to reduce the persistent excess mortality among male neonates while sustaining overall improvements in neonatal survival and progress toward Sustainable Development Goal 3.2.
BACKGROUND:Type 2 Diabetes Mellitus (T2DM) management requires integrated and continuous care; however, service fragmentation remains prevalent in universal health coverage (UHC) systems. OBJECTIVES:This study examines how governance arrangements influence service integration and patient-reported experiences in T2DM care in Indonesia, to develop strategic recommendations for strengthening integrated governance. METHODS:A concurrent mixed-methods design, qualitative driven, was employed. Qualitative data were collected through in-depth interviews with policymakers, insurance representatives, hospital managers, clinicians, and primary care providers Quantitative data were collected from 107 adults with T2DM using structured questionnaires assessing knowledge, medication adherence, perceived service quality, and health-related quality of life. Findings were integrated using a joint display guided by Green's PRECEDE framework; strategic positioning was assessed through a SWOT and Internal-External matrix, and a TOWS matrix was developed to formulate recommendations. RESULTS:Qualitative findings identified four governance barriers: fragmented primary-referral care pathways, misaligned financing arrangements, uneven facility and workforce capacity, and weak coordination and monitoring mechanisms. Quantitative findings indicated high patient knowledge (median 86.7%) and medication adherence (76.6% highly adherent), yet generally positive service quality perceptions, though reliability showed the largest gap. Physical quality of life remained suboptimal, particularly in energy and general health. Strategic positioning placed current T2DM governance in the grow-and-build quadrant, indicating capacity for proactive reform. CONCLUSION:The development of an integrated governance strategy emphasizing structured referral pathways, aligned financing with chronic care needs, institutionalized diabetes educator roles, and accelerated health information system interoperability - offering actionable lessons for universal health coverage systems in low-and middle-income countries.
BACKGROUND:Somalia has one of the highest maternal mortality ratios and low coverage of maternal health services. Evidence on socioeconomic and geographic inequalities across maternal care continuum remains limited. OBJECTIVE:This study examined wealth-related inequalities and determinants of maternal health service utilisation in Somalia. METHODS:We analysed data from the 2020 Somali Health and Demographic Survey (SHDS), including 8,598 ever-married women aged 15-49 years with a recent live birth. Outcomes were at least one antenatal care visit (ANC), health facility childbirth, and postnatal care (PNC) within 2 days of birth. Multilevel mixed-effects logistic regression examined associations with socioeconomic, geographic, and empowerment-related factors, while Erreygers Concentration Indices (ECIs) assessed wealth-related inequalities. Results are presented as adjusted odds ratios (aORs), ECIs, and 95% confidence intervals (CIs). RESULTS:Coverage was low: 32.4% attended at least one ANC visit, 24.2% delivered in a health facility, and 10.9% received PNC. Nomadic women were less likely to deliver in a health facility (aOR = 0.45; 95% CI: 0.35, 0.58) and receive early PNC (aOR = 0.49; 95% CI: 0.32, 0.75). Rural residence, the Northeastern and Southcentral zones, and higher parity were associated with lower service utilisation, whereas higher education, mobile phone ownership, household wealth, and media exposure increased utilisation. Pro-rich inequalities were observed for ANC (ECI: 0.40), health facility childbirth (ECI: 0.38), and early PNC (ECI: 0.19). CONCLUSIONS:Maternal health service utilisation remains critically low with socioeconomic and geographic inequalities. Equity-focused strategies targeting rural, remote, and nomadic populations are needed to accelerate universal health coverage.
BACKGROUND:To reduce perinatal deaths, identification of their causes is paramount. 'The WHO application of ICD-10 to deaths during the perinatal period' (ICD-PM) was developed to improve the quality of perinatal death data. OBJECTIVES:To determine stillbirth and very early neonatal death rates across 16 hospitals in Benin, Malawi, Tanzania, and Uganda, examine causes of death and associated maternal conditions applying the ICD-PM, and assess how a clinical perinatal e-registry performed when applying the ICD-PM. METHODS:We used cross-sectional data collected between 1st July 2021 and 29th February 2024 of babies weighing ≥1000 g or ≥28 weeks of gestational age, born to women aged 13-50 years in the participating hospitals. RESULTS:After analyzing 143,105 births, the stillbirth rate was 36.9 per 1,000 births and very early neonatal death rate was 7.7 per 1,000 live births. Nine in ten antepartum stillbirths could not be assigned a cause of death. Among intrapartum stillbirths, the most common cause of death was 'disorders of fetal growth' and for very early neonatal death it was 'complications of intrapartum events'. The e-registry provided information to report on 17 out of the 24 ICD-PM categories. CONCLUSIONS:Collecting high-quality clinical data through an e-registry allowed the identification of a cause of death for most intrapartum stillbirths and very early neonatal deaths. A specifically designed clinical questionnaire and simple diagnostic procedures could enable the application of the ICD-PM in settings with limited diagnostic resources and high mortality rates.
Artificial intelligence (AI) is increasingly being integrated into healthcare systems and has the potential to improve health outcomes. In Sub-Saharan Africa (SSA), however, concerns remain that AI may either reduce or exacerbate existing health inequities depending on how it is developed, governed, and implemented. This scoping review aimed to map and synthesise the existing evidence on the implications of AI for health equity among marginalised populations in Sub-Saharan Africa. PubMed, Web of Science, Scopus, and selected grey literature sources were searched between February and March 2026. Peer-reviewed and grey literature examining AI applications, governance, or implementation in healthcare involving marginalised populations or health systems within SSA were eligible for inclusion. The review followed the Arksey and O’Malley methodological framework and the PRISMA-ScR reporting guideline. Two reviewers independently screened sources of evidence and extracted data using a standardised charting form, and findings were synthesised thematically. Twenty-three sources of evidence met the inclusion criteria. Two dominant narratives emerged. AI may reinforce existing inequities through digital infrastructure gaps, algorithmic bias, under-representation of African datasets, weak governance, and data colonialism. Conversely, AI has the potential to improve health equity by expanding healthcare access, strengthening disease surveillance, supporting health system planning, and improving access to specialised services. Across the literature, AI’s impact consistently depended on equitable infrastructure, inclusive governance, and context-specific implementation. AI has considerable potential to advance health equity in SSA. However, achieving equitable benefits requires investment in digital infrastructure, representative data systems, ethical governance, and inclusive policies.
Background Worldwide, around 1.9 million babies are stillborn, and 2.5 million newborns die soon after birth annually, the overwhelming majority occur in low- and middle-income countries (LMICs). Perinatal death has devastating impacts for families and communities, but not all parents receive adequate respectful bereavement support. Healthcare workers in LMICs often report that bereavement support is challenging, but few studies have explored factors that impact their confidence to deliver optimal care. Objective To explore healthcare worker’s views and experiences of factors impacting their confidence to provide bereavement support to parents after stillbirth or neonatal death in Malawi and Zimbabwe. Methods Using qualitative approaches, a purposive sample of healthcare workers in four maternity facilities in Malawi and Zimbabwe was recruited. Guided by the principles of information power, six dual-moderated focus groups supplemented with eight individual in-depth interviews were conducted. The focus group discussions and interviews were audio-recorded and transcribed verbatim. Data were analyzed using the framework method. Results Sixty-six healthcare workers, including midwives, nurses, service managers, nurse educators, and doctors, participated. Two main themes were identified: (1) ‘at least we tried our best’ reflecting individual factors including feelings of inadequacy and insufficient education, and (2) ‘as a facility we are not quite there yet’ characterized by a lack of organizational support, feeling unsupported and a lack of continuing professional development. Conclusion Findings highlight the need to address the individual and environmental barriers to providing support to bereaved women and families. Improving access to pre- and in-service education and training, mentorship and management support are potential solutions.
