Background Virtual care was widely adopted during the COVID‐19 pandemic following a dramatic decline in in‐person appointments. Despite rapid uptake of virtual care during the pandemic there was uncertainty about the impact of this transition on virtual care quality and patient experience especially among the mental health outpatient population. Methods Our study aimed to describe experiences of using virtual care among a cohort of mental health outpatients who accessed virtual care during the COVID‐19 pandemic. The 48‐item online questionnaire was completed by eligible adults ( n = 41) with a virtual care visit in their electronic health record between September 1, 2020, and March 15, 2022. The survey included questions related to effectiveness, quality, accessibility, and safety assessed on a Likert scale. Results Respondents reported high levels of satisfaction with virtual care (86.2%), including perceived compassionate (86.2%) and safe care (79.3%), and would use virtual care again if offered in the future (86.2%). Conclusion Our findings highlight positive responses to virtual care and suggest the need for further examination of the benefits of virtual mental health care across other mental health services and jurisdictions.
Background Teenage pregnancy remains a major public health challenge in fragile and conflict‐affected settings such as Somalia. While recent nationally representative studies have examined teenage pregnancy among adolescents, evidence on the lifetime prevalence and sociodemographic correlates of teenage pregnancy among women who have completed the adolescent risk period remains scarce. This study estimated the lifetime prevalence of teenage pregnancy and identified its sociodemographic correlates among women aged 20–49 years in Somalia. Methods This cross‐sectional study used secondary data from the 2020 Somalia Health and Demographic Survey (SHDS), a nationally representative survey conducted across all Federal Member States and the Banadir region. The analysis included 38,433 women aged 20–49 years who had completed the adolescent risk period. Teenage pregnancy was defined as having experienced at least one pregnancy before the age of 20 years. Survey‐weighted bivariable and multivariable logistic regression models were fitted to estimate crude and adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results Overall, 53.3% of women reported having experienced teenage pregnancy. In the adjusted analysis, women with higher education had significantly lower odds of teenage pregnancy than those with no formal education (AOR = 0.41, 95% CI: 0.18–0.91). Women who did not own a mobile phone also had lower odds of reporting a history of teenage pregnancy than those who owned a mobile phone (AOR = 0.83, 95% CI: 0.69–0.99). Region, place of residence, household wealth quintile, and primary or secondary education were not independently associated with teenage pregnancy after adjustment. Conclusion More than half of adult women in Somalia reported experiencing teenage pregnancy before the age of 20 years. Higher educational attainment was independently associated with lower odds of teenage pregnancy. These findings provide nationally representative evidence on the lifetime burden of teenage pregnancy among Somali women and may inform adolescent sexual and reproductive health policies and future research in fragile settings.
Background The five most commonly diagnosed types of cancer among males and females in South Africa include colorectal cancer. South Africa was the fourth leading African countries in terms of estimated disability‐adjusted life years (DALYs). Most DALYs arise mostly from years of life lost (YLLs). It is possible that there is an underestimation of colorectal cancer burden in South Africa due to underreporting. Several risk factors contribute to an increased risk of colorectal cancer development and mortality. We aimed to quantify the burden of colorectal cancer in South Africa and investigate the risk factors of colorectal cancer mortality. Methods The mortality data for the year 2016 obtained from Statistics South Africa (Stats SA) was used to determine YLLs due to colon cancer. YLLs were computed by multiplication of the number of colon cancer deaths by age with a standard life expectancy at that age. A case–control study was conducted using cases and controls registered between 2015 and 2020 at the Wits Donald Gordon Medical Centre (WDGMC). Multivariate logistic analysis was employed to obtain adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for each risk factor. Results A total of 1863 deaths were due to colon cancer, of which 954 (51.2%) and 909 (48.8%) colon cancer deaths occurred among males and females, respectively. More years of life were lost by females who died due to colon cancer compared to males. Approximately 29,639.7 years were estimated to be lost, where YLLs were 15,544.6 in females and 14,095.1 in males, which suggest low survival rate. Of the 341 eligible cases and controls, 114 cases were defined as females who died from colorectal cancer and 227 controls were females diagnosed with colorectal cancer who were alive. On multivariate analysis, processed meat consumption (OR 1.59, 95% CI: 0.99–2.58, p = 0.057) was statistically significantly associated with colorectal cancer mortality in females. Conclusions The burden of colorectal cancer has risen due to several factors. Preventive strategies such as addressing the contribution of risk factors are needed to reduce the burden of colorectal cancer.
Young women living in informal settlements in low- and middle-income countries (LMICs) face disproportionately high levels of socioeconomic and health inequities. In Kampala, Uganda, these inequities are intensified by intersecting social, environmental, and economic stressors that threaten health and well-being. This study used a complexity-sensitive and intersectional lens to examine proximal drivers of stress among young women in Kampala’s informal settlements. We conducted six focus group discussions with 60 women aged 18–24, recruited from three informal settlement sites. Discussions explored perceptions of stress, its sources, and coping strategies. Transcripts were analyzed thematically to identify stressors at individual, family, community, and structural levels, with attention to their intersections and impacts. Participants described a deeply interconnected web of stressors across social domains including gender-based violence, sexual abuse, misogyny, and family abuse; economic domains including unemployment, informal work without protections, and survival sex; environmental domains including overcrowding, inadequate sanitation, unsafe water, and flood hazards; and behavioral and psychological domains including substance use, depression, suicidality, shame, and exhaustion. These stressors were mutually reinforcing, with economic dependence increasing vulnerability to sexual exploitation and psychological distress contributing to substance use, both of which exacerbated health inequities. Participants linked these conditions to limited education, constrained healthcare access, and chronic insecurity, underscoring systemic barriers to equity. Addressing these inequities requires multisector interventions that target structural leverage points while centering young women as key stakeholders in decision-making.
This study explores the health and psychosocial impacts of homestay hosting on displaced Ukrainian women resettled in Toronto, Canada. As homestay hosting gains prominence as an alternative to traditional refugee accommodation, understanding its emotional, social, and health dimensions becomes increasingly critical. Using a secondary analysis of qualitative photovoice interviews with 18 displaced Ukrainian women, this research applies an intersectionality framework to examine how host–guest dynamics influence emotional well-being, health access, social belonging, and adaptation processes. Thematic analysis revealed four key themes: emotional landscapes of displacement and hosting, uncertainty within homestay environments as sites of healing or harm, experiences of social belonging and isolation, and navigating health in a new context. While homestay hosting offered many women emotional refuge, opportunities for connection, and temporary stability, it also introduced new emotional burdens, relational tensions, and barriers to health care access. Power imbalances, cultural dissonance, and limited autonomy within some homestay arrangements compounded psychological vulnerability. The study highlights the duality of homestay experiences: while they can foster healing and community integration, they also risk exacerbating trauma when adequate support structures are absent. Findings emphasize the need for trauma-informed, culturally responsive hosting practices, improved health navigation support, and community-based interventions to promote long-term well-being and resilience among displaced populations. Policies must move beyond logistical housing solutions to recognize the relational, emotional, and health dimensions of displacement. This study calls for integrated, holistic resettlement strategies, and best practices that prioritize dignity, cultural safety, sustainable health, and social support for both guests and hosts. Future research should expand to different contexts and include host perspectives to better understand the evolving psychosocial dynamics of homestay hosting over time.
Background Access to healthcare is vital to health outcomes. However, equitable healthcare delivery is contingent upon structural factors, including financial affordability, geographic proximity, availability of healthcare professionals and culturally appropriate services. Guided by Andersen’s behavioural model of health services use, this study examined the prevalence of men’s healthcare utilisation and the factors influencing their access to healthcare services. Methods This study is a secondary analysis of the 2022 Ghana Demographic and Health Survey (GDHS), which involved 7044 men aged 15−59 years. Descriptive and inferential (Pearson’s chi‐square test and binary logistic regression) statistics were performed to analyse the data. Results In total, 19.6% of men utilised healthcare services in the past 6 months prior to the survey. This study found that men’s healthcare utilisation is shaped by predisposing (educational level, residency, ecological zone, religion and employment status), enabling (wealth status and health insurance status) and need (self‐perceived health) factors. Men with higher educational attainment (aOR = 2.01, 95% confidence interval [CI]: 1.46–2.45), those residing in the middle belt (aOR = 1.32, 95% CI: 1.13–1.52) and rural areas (aOR = 1.19, 95% CI: 1.02–1.38), those with high‐wealth status (aOR = 1.58, 95% CI: 1.30–1.92), those of Muslim faith (aOR = 1.55, 95% CI: 1.09–2.22) and traditionalists (aOR = 1.70, 95% CI: 1.10–2.63), those employed (aOR = 1.23, 95% CI: 1.01–1.50) and those with valid health insurance (aOR = 1.84, 95% CI: 1.61–2.08) were more likely to utilise healthcare services. Conversely, men who perceived their health as ‘very good’ (aOR = 0.35, 95% CI: 0.26–0.47) or ‘good’ (aOR = 0.55, 95% CI: 0.40–0.70) were less likely to utilise healthcare services. Conclusion This study revealed that men’s healthcare utilisation was generally low (19.6%). It highlights the need for targeted policies and interventions to address the specific barriers men face in accessing healthcare in Ghana.
Background and Aims Respiratory diseases contribute significantly to morbidity and mortality rates in Bangladesh, especially in urban areas. This study aimed to estimate the prevalence of respiratory symptoms and identify the key risk factors associated with respiratory problems among adults in a community in Kaliakair, Gazipur, Bangladesh. Methods This cross‐sectional study was conducted from January 10, 2019, to December 9, 2019, in Kaliakair, Gazipur, Bangladesh. A convenient sampling technique was employed to select the households. From each selected household, one adult meeting the predefined inclusion and exclusion criteria was selected using a lottery method. Data on demographic variables (age, sex, marital status, and educational status), environmental factors (indoor tobacco smoke exposure), smoking status, and the presence of respiratory symptoms were collected via face‐to‐face interviews using a structured questionnaire. Statistical associations between respiratory symptoms and studied variables were analyzed using the chi‐square test and independent t ‐tests. Results The overall prevalence of respiratory symptoms among the study population was 22.4%. Symptomatic adults were significantly older than asymptomatic individuals (48.67 ± 15.47 vs. 39.66 ± 15.86 years; p < 0.001). The prevalence of respiratory symptoms was significantly higher in males than in females (67.9% vs. 32.1%; p < 0.001). Smoking was strongly associated with respiratory symptoms, with 37.9% of symptomatic participants identifying as current smokers ( p < 0.001). Regarding domestic exposures, 87.5% of symptomatic individuals did not utilize modern cooking methods. Wood and rice bran constituted the primary fuel types used by the symptomatic individuals (67.0%), followed by dung (13.4%). The most predominant respiratory symptoms reported were dry cough (74.1%), cold and dust allergies (61.2%), and productive cough (54.0%). Conclusions The study underscores a substantial prevalence of respiratory symptoms among adults in Kaliakair, Bangladesh. Advanced age, active cigarette smoking, and the use of traditional polluting cooking methods were identified as significant risk factors exacerbating respiratory morbidity. Given these findings, targeted public health interventions are urgently required. Implementing robust smoking cessation programs and facilitating a transition toward cleaner, modern cooking technologies are critical steps to mitigate the regional burden of respiratory diseases and improve overall population health.
Background In South Africa between 1998 and 2016, hypertension (HTN) rates in young adults (15–34 years) more than doubled calling for preventive interventions. However, with a large proportion of South Africa’s younger population not in employment, education or training (NEET), and unemployment known to be a strong determinant of health, it is not clear if taking part in health‐focused youth employment initiatives changes young adults’ perception of risk or intention for health behaviours. Objective This study aimed to explore young adults’ intention to change health behaviour by comparing HTN‐related risk perceptions and beliefs between NEET ( n = 20) and previously NEET young adults ( n = 20) on a community health worker (CHW) training programme. Methods A cross‐sectional study was performed. Data were collected through six focus group discussions (FGDs) from August to October 2021, utilising the health belief model (HBM) as the conceptual framework. Results All young adults viewed HTN as life‐threatening leading to cardiovascular disease (CVD) or death, especially if left untreated, however, only young adults undertaking CHW training felt empowered to implement healthy behaviours for disease prevention. These young adults reported BP self‐checks and the practical application of their knowledge as motivating factors for preventive behaviour, making it personally important for them. In contrast, NEET young adults felt HTN was inevitable and described negative experiences at clinics and fear of being diagnosed with HTN as reasons not to be screened. The fear of lifelong medication use was expressed by all young adults. Conclusion Our results suggest that socioeconomic interventions that intersect with structured CHW training programmes, exposing young adults to practical self‐testing and HTN in real‐world settings, are essential for engaging this population in health promotion messaging around HTN and preventive health behaviour for chronic disease.
Background An estimated 3 in 20 of all live births are born low birth weight (LBW), with the majority in low‐ and middle‐income countries (LMICs). Despite a plausible association between LBW and undernutrition, the relative contribution of LBW to the national burden of stunting, wasting and underweight has not been adequately explored in Ghana. Therefore, this study sought to determine the proportion of variance in childhood undernutrition that is attributable to LBW. Methods This was a cross‐sectional secondary analysis of the 2022 Ghana Demographic and Health Survey (DHS) dataset. Overall, 2234 mother–child pairs aged 0–23 months remained for analysis after exclusions. Survey weights, clustering and stratification were applied to account for the complex design of the DHS using R version 4.5.0. A variance decomposition analysis was conducted to quantify the contribution of LBW to each form of undernutrition, with 95% confidence interval and statistical significance set at p < 0.05. Results The mean child age was 11.68 ± 0.16 months. The prevalence of LBW was 14.5% (12.4–16.9), with the prevalence of stunting, underweight and wasting being 16.1% (13.9–18.6), 14.8% (12.9–17.0) and 9.9% (8.2–11.9), respectively. At the variance decomposition, the inclusion of LBW significantly increased the McFadden pseudo‐ R 2 of all undernutrition models (all p < 0.001). LBW accounted for 12.01% explained variance in stunting, 11.47% in underweight and 10.92% in wasting in absolute terms. Conclusion This study demonstrated that LBW alone accounts for more than a tenth of the actual explained variance in each undernutrition outcome in Ghana. Therefore, antenatal care (ANC) needs improvement to ensure that children do not have a predisposition to undernutrition at the very start of life.
Background Most existing data on childhood undernutrition in Uganda are derived from surveys at national and regional levels that overlook local variations in risk factors. This study assessed undernutrition levels and associated factors among children aged 6‒59 months in Napak District, Karamoja sub‐region. Methods A cross‐sectional study was conducted between April 24 and May 5, 2024. Multistage sampling was used to obtain 524 children from Lopei and Lotome sub‐counties. Data collection involved semi‐structured questionnaires and anthropometry. Anthropometric data were used to generate Z scores. Descriptive statistics, chi‐square tests and adjusted odds ratio (AOR) with a 95% confidence interval (CI) from logistic regressions were reported. Statistical significance was considered for p < 0.05. Results The minimum dietary diversity (MDD) was met by 4.0% and 6.3% of children in Lopei and Lotome, respectively. None of the assessed children met the minimum acceptable diet (MAD). The prevalence of wasting was 15.5%; moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) were 9.2% and 6.3%, respectively. Underweight and stunting rates were 26.0% and 30.9%, respectively. Children from households earning at least United States dollars 8–10 per day had lower odds of SAM (AOR = 0.15, 95% CI: 0.03–0.65, p = 0.011). The odds for being underweight were higher among children aged 24 months and above (AOR = 4.81, 95% CI: 3.03–7.63; p < 0.001), and among males (AOR = 1.77, 95% CI: 1.15–2.71; p = 0.009). Similarly, children aged 24 months and above had higher odds of stunting (AOR = 3.21, 95% CI: 2.13–4.86; p < 0.001). Conclusion Children in the Napak District face a severe undernutrition burden exceeding national prevalence, with no child meeting MAD. Low income, older age and male sex were associated with poorer nutritional outcomes. Urgent, locally targeted nutrition‐sensitive interventions and income‐support programmes are needed in this drought‐prone sub‐region.
Background Obesity in adults is defined as an individual with a body mass index (BMI) of 30 kg/m 2 or higher. The disease is one of the leading risk factors for noncommunicable diseases (NCDs), which accounts for 2.8 million deaths per year globally. Despite efforts to reduce obesity, the levels are still high, particularly in low‐ and middle‐income countries. In Ghana, obesity has been on the rise over the past few decades, especially among women. The health and economic burden of obesity cannot be underestimated, and efforts must be made to identify factors that are associated with the condition. This study sought to determine the levels, trends, and factors associated with obesity among women in Ghana. Methods Data for the study came from four waves of the Ghana Demographic and Health Survey (GDHS) from 2003 to 2022. The analysis involved women aged 15–49 years. Their obesity status was categorized into a binary outcome of “1” for those who are obese (BMI = 30+ kg/m 2 ) and “0” otherwise (BMI <30 kg/m 2 ). Binary logistic regression was performed on the data to ascertain the factors that are associated with obesity among women for each of the years separately. Results In all, 15,467 women, aged 15–49 years, were included in the analysis. Out of this, 13.7% were obese (BMI = 30+ kg/m 2 ). In terms of trends in obesity prevalence across the various years, the results showed an increase in obesity from 9.9% in 2003 to 23.0% in 2022. From the regression results, the common factors associated with obesity for each of the years included being an urban resident, having a tertiary education, and being in the richest household. Conclusions The results showed that being an urban dweller, having a tertiary level of education, being in the richest household, and being a resident of regions in the north of Ghana are associated with obesity. Therefore, policies aimed at reducing obesity in Ghana should intensify public health education, particularly among urban dwellers and wealthy individuals, to engage in healthy lifestyles. The less educated members of the population should also be educated to avoid behaviors that will put them at risk of obesity. Local authorities should create an environment, particularly in high‐class neighborhoods, that offers easy access to healthy foods and places for physical activities.
Africa’s medical device industry is undergoing exponential growth. It was valued at about $4.26 billion (USD) in 2025, with projections that it will grow to $7.14 billion by 2032, significantly outpacing global averages. The increased technological advancements in medical devices, driven by artificial intelligence (AI) and the continent’s desire to increase access to treatment have provided fertile ground for this growth and expansion, with diagnostics and digital health devices showing the fastest growth. The increasing integration of AI into medical devices presents significant opportunities as well as regulatory challenges. As AI-enabled medical devices continue to evolve and be integrated into healthcare, safeguarding safety, performance and security becomes increasingly critical. However, the regulatory landscape for medical devices in Africa is lagging. While regulation in many high-income countries has advanced to deal emerging changes in the industry, such as software as a medical device (SaMD), in vitro diagnostics, and AI as a medical device (AIaMD), this is not the case in most of Africa. The 2016 African Union (AU) Model Law on medical product regulation, which was designed to strengthen oversight of medical products, promote regulatory harmonisation and strengthen national regulatory systems, faces several limitations which have constrained its implementation and impact. Without a harmonised legal framework among African states, many countries depend on outdated, drug‑focused legislation or must adopt external regulatory models. This raises concerns about Africa’s ability to develop competitive, context‑appropriate systems for medical‑device oversight in the era of AIaMD. Against this background, the paper analyses medical device regulation (MDR) in Africa. Using Uganda as a case study, it demonstrates that the current regulatory framework is not equipped to handle the complexity and pace of innovation in health technologies, specifically, AIaMD. It highlights the current deficiencies and explores the potential for regulatory sandboxes for AIaMD. Drawing on an example from the United Kingdom’s AI Airlock sandbox, the paper proposes the adoption of a regulatory sandbox framework as a vital bridge to foster innovation and experimentation in Africa pending regulatory reform.
Obesity, largely driven by poor dietary and lifestyle practices, elevates the risk of cardiovascular diseases (CVDs) and metabolic syndrome. While body mass index (BMI) is a common tool for assessing obesity, it has limitations. Measures like fat mass (FM) and body fat percentage (BF%) may provide more accurate evaluations, especially in identifying normal weight obesity (NWO) individuals who carry elevated cardiometabolic risk. NWO people means persons with normal BMI and higher levels of adiposity and cardiometabolic risk. This study aimed to compare FM and BF% as predictors of obesity-related risk in normal-weight individuals and to assess their association with cardiometabolic outcomes. A cross-sectional study was conducted among 363 healthy individuals aged 18–40 years from two universities in Lahore. Participants were classified on the basis of FM index (FMI) and BMI. Data collection included anthropometrics, cardiometabolic markers, and lifestyle behaviors. Data from 363 participants with a male/female ratio of 40:60 (mean age 22.19 ± 4.13 years) were analyzed. Although BMI correlated with blood pressure and fasting glucose levels, the association lacked statistical significance; BMI and gender significantly predicted on the basis of variation in BF% (R2 = 0.475, p <0.001), while age had no impact (p=0.602). No significant correlation was found between BF% and abdominal circumference (p=0.363). Significant gender differences existed in body composition parameters (p <0.001). BF% and FM showed stronger associations with body composition differences than BMI. BMI failed to significantly predict blood pressure or fasting glucose levels. Thus, body composition metrics may offer more reliable insights into cardio metabolic risk among NWO individuals.
Background Syphilis is a sexually transmitted infection (STI) that can leave lasting consequences if left untreated. It’s a problem found in prisons, and upon release, measures are needed to ensure continuity of care, a challenge that remains. The objective of this study was to analyze the continuity of post‐release care for incarcerated women diagnosed with syphilis from the perspective of healthcare professionals. Methods This is an exploratory qualitative study that uses the theoretical framework of Brazilian Public Health. It was conducted in Belo Horizonte, Minas Gerais, Brazil. Primary data were collected through interviews. The data were analyzed using Bardin’s content analysis. All six health professionals involved in prison care and three managers participated in the study. Results Through the analysis of the interviews, three axes were identified: “the perceptions of the health professionals involved in caring for women deprived of their liberty,” “the post‐release referrals,” and “the medical records.” Conclusions Care for people deprived of liberty has been fragmented and focused on drug treatment, resulting in women deprived of liberty not completing their treatment. The results demonstrate a discontinuity of care. A review of work organization, intersectoral care actions, and ongoing education initiatives is necessary. Patients or the public were not involved in the conceptualization or research design of this study.
Objectives The research’s main aim is to explain the correlation between the adiponectin level and the onset of gestational diabetes mellitus (GDM), as well as to assess the predictive significance of adiponectin for GDM. Methods The research comprised a cohort of 584 single pregnant women in Korea and was a retrospective study. The correlation between adiponectin and GDM risk was analyzed through logistic regression analysis, smooth curve fitting, and subgroup analysis. The change in the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, the enhanced value of net weight classification (net reclassification improvement [NRI]) as well as the integrated discrimination improvement (IDI) were measured to determine the additional prediction value of adiponectin to GDM. Results GDM occurred in 36 (6.16%) patients who took part in the study. Adiponectin levels had a negative correlation with the risk of getting GDM once all potential confounders were adjusted (odds ratio [OR] = 0.25, 95% confidence interval [CI] = 0.1–0.65, p = 0.004). Analyses of sensitivity and subgroups confirmed a robust correlation between adiponectin and GDM. Furthermore, when adiponectin was added to the multivariable model, AUCs increased slightly, but not significantly. Incorporating adiponectin increased the NRI for almost all models (all p < 0.05) and increased IDI in Models 1–4 (all p < 0.05). Conclusion A decrease in adiponectin levels between 10 and 14 weeks of pregnancy was directly linked to a higher risk of GDM. Adding adiponectin to the GDM prediction model may improve its prediction accuracy. Trial Registration ClinicalTrials.gov identifier: NCT02276144
Aim This systematic review aims to synthesise the available evidence on the impact of climate variability and meteorological factors—including temperature, rainfall, humidity and extreme weather events—on the incidence of diarrhoea among children under 5 years of age. Methods A comprehensive search of three databases was conducted in Web of Science, PubMed and Scopus. This systematic review followed the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guideline. The quality assessment was conducted with the Joanna Briggs Institute (JBI) critical appraisal tools. Data synthesis was made using narrative synthesis. Results A total of 852 records were identified, of which 43 quantitative studies met the inclusion criteria. Most studies were conducted in low‐ and middle‐income countries (LMICs), particularly in sub‐Saharan Africa and South Asia. The findings were grouped into seven domains: temperature, drought, rainfall, humidity, El Niño/La Niña events, monsoon periods and water sources. Overall, climate variability was consistently associated with increased diarrhoea incidence; however, the magnitude and direction of effects varied across settings. Key mechanisms included (i) contamination of drinking water following heavy rainfall and flooding, (ii) reduced water availability and compromised hygiene during drought periods and (iii) enhanced pathogen survival and transmission under elevated temperature and humidity conditions. These effects were amplified in settings characterised by poverty, inadequate water and sanitation infrastructure and limited adaptive capacity. Conclusion The present systematic review provided evidence for better understanding of climate change on diarrhoea among under 5 years of age. In order to reduce the impacts of climate variability on health, access to clean water, improvement of hygiene conditions, education and strengthening of health systems should be prioritised. Beyond being an environmental problem, this struggle is a critical public health priority for child health.
Background The Developmental Origins of Health and Disease (DOHaD) framework links maternal stress to adverse offspring outcomes. Whether stress before pregnancy carries risk independent of stress during pregnancy is uncertain, and evidence from sub‐Saharan Africa, where chronic stressors are common, is sparse. This study examined the association between maternal stress in each period and adverse birth outcomes in a West African population, and assessed whether the timing of stress could be distinguished. Methods A cross‐sectional study was conducted among 504 mother–child dyads in The Gambia, with maternal stress before and during pregnancy ascertained retrospectively using a 16‐item checklist for each period. The primary outcome was an adverse birth outcome, defined as low birth weight (<2500 g) or preterm birth (<37 weeks), both fixed at delivery and therefore ascertainable for every child irrespective of age at interview. Multivariable logistic regression estimated adjusted odds ratios (aORs) per one‐standard‐deviation increase in stress, adjusting for maternal age, education, household income, co‐wife presence, parity, antenatal care (ANC) attendance, residence, and the interval between birth and interview. Dose–response across stress quartiles and the contribution of individual stressor domains were examined. Results The prevalence of an adverse birth outcome was 23.6% (119/504; low birth weight 18.5%, preterm birth 8.5%). Mean stress scores were 2.8 ± 2.3 before pregnancy and 2.9 ± 2.4 during pregnancy, and the two were strongly correlated ( r = 0.85, p < 0.001). Each one‐standard‐deviation increase in stress was associated with raised odds of an adverse birth outcome, both before pregnancy (aOR: 1.50, 95% confidence interval [CI]: 1.20–1.88) and during pregnancy (aOR: 1.53, 95% CI: 1.22–1.92). Because stress in the two periods was highly collinear, the two exposures could not be separated when modeled together, and the data did not support a differential effect of one window over the other. A dose–response gradient was evident across quartiles of during‐pregnancy stress, from 12.1% in the lowest quartile to 35.5% in the highest ( p for trend < 0.001). Women reporting high stress in both periods had higher odds of an adverse outcome than those with low stress throughout (aOR 2.79, 95% CI 1.65–4.69). Stressor domains most strongly associated with adverse outcomes were residential instability, pregnancy‐related problems, and violence exposure; reported family support was associated with lower risk. Conclusions Maternal stress in the period surrounding conception was associated with adverse birth outcomes in this Gambian sample, with a graded relationship between accumulated stress and risk. The strong correlation between the two periods meant that a window‐specific effect could not be isolated, so the findings are best read as evidence of cumulative perinatal stress burden rather than of a single critical window. The stressor domains identified and the dose–response pattern offer plausible targets for psychosocial support within maternal health programs in resource‐limited settings, though the cross‐sectional design with retrospective exposure assessment precludes causal inference.
Introduction The coronavirus disease (COVID‐19) pandemic has significantly impacted the economic, health, educational, and general living conditions of the global population. The economic loss, while still unfolding, is projected to be quite huge, particularly if a sudden outbreak, as was observed in India, subsequently develops in African countries. Widespread acceptance and uptake of COVID‐19 vaccines is currently the only effective approach to limit infection and reduce mortality from the disease. Knowledge, attitude, and perception (KAP) of the COVID‐19 vaccine are important as they influence its acceptability and uptake, especially given its quick turnaround. This study determined the KAP of sub‐Saharan African (SSA) respondents towards the COVID‐19 vaccination. Methods A validated self‐administered web‐based questionnaire was disseminated via emails and social media platforms to SSA countries, including Cameroon, Ghana, Kenya, Nigeria, South Africa, Tanzania, and Uganda. The mean KAP scores were calculated and summarized. Linear regression analyses were conducted to assess the unadjusted ( B ) and adjusted ( β ) coefficients at a 95% confidence interval (CI). Results Of the 2572 respondents aged 34.6 (SD, 11.8), 54% were males, 80% had bachelor’s or higher degree, and the majority (82.3%) were previously vaccinated for other diseases. KAP of the COVID‐19 vaccine were low across the four sub‐Saharan regions of Central (16.6 ± 6.2), Eastern (18.6 ± 6.0), Southern (19.0 ± 5.5), and Western Africa (19.1 ± 5.7). Multiple linear regression analysis revealed that respondents who worked in the healthcare sector, had previous vaccination history, experienced symptoms of COVID‐19, and relied on mainstream media for their information, those that believe that the virus is real, Southern African and West African respondents reported higher COVID‐19 vaccine knowledge. Central African respondents, non‐Christians, respondents with bachelor’s degrees or lower education, and those who had a previous history of vaccination had higher attitude scores towards COVID‐19 vaccination, while healthcare workers, those with a pre‐existing health condition, those who believe that COVID‐19 virus is real, and respondents who had been tested for the virus had higher risk perception scores. Conclusion Most respondents were willing to be vaccinated despite inadequate knowledge about the COVID‐19 vaccine. Targeted education campaigns are needed to improve uptake of COVID‐19 vaccines.
Background and Aim Community pharmacies are gaining recognition as key access points for primary healthcare. Incorporating point‐of‐care (POC) diagnostic services in these environments has the potential to enhance early disease detection. However, regulatory and operational obstacles might impede their implementation. This study aimed at identifying and ranking the factors that facilitate and hinder the introduction of POC diagnostic services in South African community pharmacies. Methods A nominal group technique (NGT) workshop was conducted with eight stakeholders, including pharmacists, academics, and diagnostic specialists. The stakeholders generated, discussed, and ranked ideas on a seven‐point Likert scale. Quantitative rankings were analyzed descriptively, and qualitative data underwent thematic analysis. Theme scores are reported as a percentage of the maximum possible score (number of scorers × 7), not as a proportion of participants endorsing a theme. Results The key facilitators included accessibility and convenience (94%), professional training and competence (88%), cost and time savings (82%), patient demand and public health initiatives (80%), and stakeholder engagement (78%). The corresponding barriers included infrastructure and space constraints (88%), training gaps (94%), affordability and reimbursement challenges (80%), patient mistrust (71%), regulatory ambiguities (78%), and system‐level challenges (78%). Conclusion Pharmacies seem ideally situated to offer POC diagnostic services; however, structural and regulatory challenges need resolution for effective integration. Establishing clear policy frameworks, investing in pharmacist education, and fostering stakeholder collaboration have been identified as key priorities for sustainable implementation. Due to the exploratory nature of the study and the limited stakeholder sample, these findings should guide further research and policy discussions rather than serve as conclusive implementation advice.
