Background In sub-Saharan Africa (SSA), there is a heavy burden on the health-related quality of life (HRQoL) of both people living with cleft lip and/or palate (CL/P) and their families. In these places, there is little to no utility data for cost-effectiveness analysis. The existing condition-specific patient-reported outcome measures (PROMs) and utility instruments were developed and validated in high-income countries (HIC). Therefore, there is a question on the effectiveness of these tools in SSA. This study systematically maps and appraises the utility measurement tools and HRQoL instruments applied in CL/P care across SSA, characterises their psychometric properties, and identifies gaps to inform instrument adaptation and development. Methods The Population-Concept-Context framework was used to conduct a systematic review. Searches were performed across four databases. The inclusion criteria were a peer-reviewed quantitative study conducted in SSA with a CL/P population with a named, validated QoL or utility instrument. Results Twelve studies from five SSA countries were included. While fourteen distinct HRQoL instruments were identified, only one study used a direct utility method. There were three condition-specific PROMs but none was formally validated in SSA. After quality appraisal, five studies were rated low, five were moderate and two had a high risk of bias. Across studies, CL/P had a significant association with low HRQoL. Conclusions There is a paucity of utility data and SSA-validated HRQoL instruments for CL/P. The existing instruments when applied, are done without formal cultural adaptation. This is likely to lead to ineffective application, and uninformed conclusions and decision making.
Background Road traffic accidents (RTAs) are a leading cause of mortality and disability in Nepal. Despite the scale of the problem, comprehensive province-level analyses covering recent years remain limited. This study describes the pattern of RTAs across all seven provinces of Nepal over four fiscal years. Design and methods A cross-sectional record review was conducted using RTA records obtained from Nepal Traffic Police departments across all provinces. Records spanning fiscal years 2020/21-2023/24 AD were analysed. Variables extracted included province and year of incident, urban/rural classification, driver age group, and vehicle type. Descriptive statistics were computed using SPSS version 20. Data for 2023/24 cover only the first five months of the fiscal year and should be interpreted with caution. Results A total of 74,929 RTAs were recorded over the study period. Annual totals increased from 20,640 in 2020/21 to a peak of 24,537 in 2021/22, before declining modestly to 23,597 in 2022/23. The Kathmandu Valley consistently recorded the highest accident burden (10,733 in 2021/22; 10,675 in 2022/23). Drivers aged 25–40 years accounted for the largest proportion of recorded driver involvements with known age (58,614; 50.2%), followed by those aged 16-25 years (34,886; 29.9%). Motorcycles and scooters were the most commonly involved vehicle type. Urban areas accounted for 30,401 accidents (59.0% of accidents with known location), though rural predominance was observed in Madhesh and Koshi provinces. Conclusions RTAs in Nepal are concentrated among young and middle-aged adult drivers, predominantly involve two-wheeled vehicles, and exhibit marked urban-rural variation across provinces. These findings support age-targeted safety interventions, strengthened motorcycle helmet enforcement, and geographically differentiated road safety strategies.
Background Spinal anesthesia is a type of regional anesthesia that has been practiced for obstetric anesthesia since the beginning of the 20th century. Despite the simplicity and lower maternal mortality risk, compared to general anesthesia, spinal anesthesia is linked to different adverse effects, of which hypotension is the most common complication. Comprehensive data are scarce on hypotension during spinal anesthesia and its associated factors in this study area. Objective This study aimed to determine the prevalence and factors associated with spinal anesthesia-induced hypotension during cesarean section at Hiwot Fana Comprehensive Specialized University Hospital and Jugal General Hospital, Harar, Ethiopia, November 20, 2024- January 20, 2025. Method An institution-based cross-sectional study was conducted among 389 mothers who underwent cesarean section. Participants were selected using simple random sampling. Data were collected using a pretested structured questionnaire and supplemented by medical record review. Data were entered into EpiData 3.1 and analyzed using SPSS version 26. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with hypotension. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported, with variables having a p-value <0.05 in the multivariable analysis considered statistically significant. Result Data from 388 participants were analyzed. The overall prevalence of spinal anesthesia-induced hypotension was 59.28% (95% CI: 54.40%–64.20%). In the multivariable logistic regression analysis, the odds of developing post-spinal hypotension were significantly higher among mothers delivering newborns weighing ≥2.5 kg (AOR=6.89; 95% CI: 2.99–15.91), those experiencing an intraoperative estimated blood loss between 500 and 1000 mL (AOR=2.87; 95% CI: 1.53–5.40), patients maintained in a supine position immediately before anesthetic induction (AOR=2.02; 95% CI: 1.24–3.27), and procedures with a total surgical duration exceeding 1 hour (AOR=1.97; 95% CI: 1.25–3.11). Conclusion The prevalence of spinal anesthesia-induced hypotension during cesarean section among pregnant mothers was high. Newborn weight, being positioned supine before spinal anesthesia, greater than 1 hr duration of surgery, and estimated blood loss are factors associated with hypotension after spinal anesthesia. Recognizing these high-risk profiles and optimizing perioperative care protocols, such as managing surgical timelines, monitoring fluid volume, and utilizing left-lateral positioning, may serve as valuable supportive considerations for managing maternal hemodynamic stability.
Background Cutaneous leishmaniasis (CL) is a neglected tropical disease transmitted through the bites of infected female phlebotomine sandflies. With an evolving epidemiology in tropical countries, this study assessed the knowledge, attitude and perception about CL disease in endemic communities of the Oti region, Ghana. Methods A cross-sectional study was carried out in six communities in the Oti region, Ghana. A structured questionnaire was administered to 254 participants to evaluate CL associated knowledge, attitude, perceptions (KAPs) and health beliefs. Bivariate and multivariate logistic regression analyses and Sankey plots were performed to determine the association between KAPs about CL and sociodemographic characteristics. Principal findings Thirty-seven participants with chronic skin ulcerations were identified with 21.6% confirmed CL cases. Of the 254 respondents, 97.6% (n=248) had poor knowledge about CL disease while all participants (100%, n=254) had poor knowledge about CL sandfly vector. The participants had good attitude (84%) towards CL and also exhibited good perceptive health beliefs about CL disease with positive perception index scores of 0.68 (CL disease awareness), 0.78 (perceived susceptibility), 0.91 (perceived severity) and 0.81 (perceived response efficiency). Conclusion Cutaneous leishmaniasis remains a major healthcare issue in communities in the Oti region with critical deficits in disease and vector knowledge. This requires continued surveillance and targeted health education in vector biology, disease aetiology and dynamics.
Objective Increasing evidence supports the benefits of physical activity (PA) in lowering the risk of type 2 diabetes mellitus (T2DM) among middle-aged women. Despite the increased risk for T2DM at a younger age, South Asian (SA) women in the United States (U.S.) have lower PA than men and have been studied to a lesser extent. This study explored the culturally bound attitudes, behaviors, beliefs, and barriers related to PA among middle-aged SA women at risk for T2DM. Design A descriptive qualitative study involving focus group discussions (FGDs) with SA women (N=25) at risk for T2DM was conducted. Participants were recruited from SA religious/faith communities and professional organizations in Houston, Texas, using purposive and snowball sampling. FGDs were audio-recorded and transcribed. Data were analyzed using Braun and Clarke’s reflexive thematic analysis in MAXQDA. Results Most participants were married, college-educated, employed, and first-generation immigrants. Two overarching themes—barriers to PA and facilitators/motivators of PA—emerged, comprising six subthemes. Barriers included balancing roles and responsibilities and cultural attitudes and norms, while facilitators/motivators included support systems, personal drives, role models, and exercise as enjoyable. Conclusion Cultural attitudes and gender norms strongly influence PA behavior among SA women in the U.S. Collectivism expressed through bonding, accountability, enjoyment, and mutual encouragement is a key strength among SA women that shapes their PA experiences. Culturally appropriate intervention strategies may include offering peer-based, socially supported PA programs and targeted education to increase SA women’s awareness of PA benefits across life stages.
Background Rural Comprehensive Health Centers (RCHCs) constitute a cornerstone of primary healthcare delivery and possess substantial capacity to provide essential services that enhance the health and quality of life of individuals living with chronic non-communicable diseases (NCDs). The present study aimed to explore the experiences and perceived of patients with chronic NCDs and identify the perceived barriers influencing their utilization of Rural Comprehensive Health Centers in Fars Province, southern Iran. Design and methods A qualitative study grounded in conventional content analysis was conducted. Data were collected through 25 semi-structured, in-depth interviews with patients diagnosed with chronic conditions. The data were analyzed using the methodological framework proposed by Graneheim and Lundman. Results Analysis of the interview data yielded three overarching themes and seven subthemes. The principal themes included Structural and service accessibility barriers (distance, service hours, workforce shortages, and lack of equipment), Trust-related barriers (belief in traditional remedies and self-treatment, and Negative attitude and experiences to the utilization of rural comprehensive health centers (RCHCs)), and Health literacy and illness perception barriers (insufficient knowledge of self-care and disease management, and low perceived severity of illness). Conclusion The findings indicate that access to and utilization of rural comprehensive health services among individuals living with chronic non-communicable diseases are influenced by a combination of organizational, sociocultural, and individual factors. These insights provide valuable guidance for healthcare policymakers and senior administrators seeking to develop effective strategies and targeted interventions to address barriers that hinder the optimal utilization of RCHCs.
Objective Understanding multiple determinants of health and their contributions to premature mortality is essential for policymaking in population health. As an exploratory forecasting exercise, we aimed to analyze the associations between multiple determinants of health and improvement in premature mortality in U.S. counties. Methods Using County Health Rankings data on health determinants from 2010-2014, we predicted changes in premature mortality from 2015 to 2019. We used Extreme Gradient Boosting, which allows for flexible functional estimates of a multi-dimensional health production function, to assess the association between improvement in premature mortality and pre-period health determinants. We made Accumulated Local Effects plots to illustrate these associations and conducted a conventional spatial regression as a robustness check. Results We find a negative association between the baseline some-college rate (percentage of adults aged 25-44 with some post-secondary education) and change in premature mortality. A one-percentage-point increase in the baseline some-college rate in 2010-2014 is associated with a reduction of premature mortality by 9.57 years of potential life lost per 100,000 population from 2015 to 2019. The magnitude of the association for each county varied based on each county’s baseline some-college rate. Conclusions Our findings reveal that improvements in post-secondary education are associated with relatively large, yet variable, gains in population health across U.S. counties. Applying machine learning methods to estimate a county-level health production function can inform tailored policies to improve local population health.
Anemia remains a major global public health problem, affecting an estimated 1.93 billion people worldwide. Pregnant women in sub-Saharan Africa (SSA) are disproportionately affected, placing them at greater risk of adverse maternal and neonatal outcomes. This study used machine learning to predict anemia and identify key predictors among pregnant women in SSA. We analyzed the most recent Demographic and Health Survey (DHS) data from 24 SSA countries, including a weighted sample of 14,569 pregnant women. Data were prepared in SPSS version 27 and analyzed in Python version 3.12. An Extreme Gradient Boosting (XGBoost) classifier was developed to predict anemia, while Shapley Additive Explanations (SHAP) identified influential predictors and improved model interpretability. Model performance was assessed using accuracy, recall, F1 score, and area under the receiver operating characteristic curve (AUC). The XGBoost model achieved 87% accuracy, 85% recall, a 73% F1 score, and an AUC of 95%, indicating excellent predictive performance. SHAP analysis identified unimproved water sources, lack of antenatal care visits, absence of mobile phone ownership, older maternal age, financial barriers to healthcare, cigarette smoking, khat chewing, limited media exposure, urban residence, home delivery, and use of unimproved cooking fuel as the most influential predictors of anemia. These findings demonstrate that machine learning can accurately identify pregnant women at high risk of anemia using routinely collected sociodemographic, behavioral, and maternal health data. Integrating ML-based prediction models into antenatal care and digital maternal health platforms could support timely risk identification, personalized interventions, and targeted strategies to reduce maternal anemia across SSA.
This cross-sectional study investigated the association between smoking status and serum vitamin B12 concentrations in a Jordanian adult population, using plasma cotinine as a validated biomarker of tobacco exposure. Tobacco use remains a major public health concern in Jordan, where smoking prevalence is among the highest globally. Although previous studies have explored the link between smoking and vitamin B12 status, findings have been inconsistent, and the effects of passive smoke exposure are not well understood. A total of 251 Jordanian adults from Amman and Madaba governorates were categorized as active smokers (n=125), passive smokers (n=63), or non-smokers (n=63). Non-parametric tests (Kruskal–Wallis and Mann–Whitney U) were used to compare group differences, and multiple linear regression was performed on log-transformed vitamin B12 concentrations to identify independent predictors. Vitamin B12 levels differed significantly across groups (p=0.021), with passive smokers showing the highest median concentrations (373.0 pg/mL) compared with active smokers (327.0 pg/mL) and non-smokers (295.0 pg/mL). In the regression model, passive smoking was independently associated with higher vitamin B12 concentrations (B=0.168, p = 0.027), while higher BMI was associated with lower concentrations (B=−0.011, p = 0.039). No significant correlation was observed between cotinine and vitamin B12 levels within any group. These findings suggest a possible compensatory metabolic response in passive smokers. Should these findings be validated, they could have clinical implications for evaluating vitamin B12 status in individuals exposed to tobacco smoke and highlight the urgency of enforcing smoke-free environments. Further investigation is needed to elucidate the mechanisms involved.
Introduction Retention into Active Antiretroviral Therapy (ART) care is critical indicator of HIV treatment success, enabling long and healthy lives. However, adolescents face unique challenges, including low retention rates, high new infection rates, and higher AIDS-related morbidity and mortality. This study investigated factors affecting retention in HIV care among adolescents in two selected districts in the Copperbelt Province in Zambia. Methods A cross-sectional study was carried out in two public health facilities, one in Ndola and the other in Masaiti District, in the Copperbelt Province of Zambia between July 2023 and May 2024. Data were collected using a pre-tested, validated questionnaire administered to adolescents living with HIV aged 10 to 19 years, and their responses were linked to their medical records. Multivariable logistic regression was used to identify factors associated with retention in HIV care. All analyses were conducted using Stata version 16. Results Out of 237 participants, majority were females (55.3%). Retention in HIV care was 91.1%, with Ndola district at 94.2% and Masaiti district at 88.0%. Key factors associated with retention included suppressed viral load (AOR 10.41, 95% CI:1.83, 59.01) and having a treatment supporter (AOR 10.91, 95% CI:1.71, 69.55). Conclusions Adolescent retention on ART in the Copperbelt Province was 91.1%, indicating generally strong program performance, though some gaps remain. Adolescents in rural areas faced greater barriers and showed higher levels of attrition. Retention was higher among those with treatment supporters and among those with sustained viral suppression, underscoring the value of strong adherence support systems. To build on these gains, there is a need to strengthen adolescent-centred, context-specific interventions; particularly in rural settings where health system challenges are more pronounced. Improving support for adherence and engagement in care will be key to sustaining viral suppression and advancing broader HIV control efforts by 2030.
Introduction Diabetes mellitus associated with urinary tract infections. This study aimed to determine the prevalence of bacterial infection of urinary tract, assess antimicrobial resistance, and associated factors among asymptomatic diabetic patients attending Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, northwestern Ethiopia. Methods An institution-based cross-sectional study was conducted from January to March 2025 among 248 diabetic patients. Sociodemographic and clinical data were collected using a structured questionnaire. Data were entered into EPI data 3.1 and exported to SPSS v.26. Bivariate and multivariable logistic regression analyses were used to identify factors associated with bacterial infection of urinary tract, with p < 0.05 considered statistically significant. Results Of the 248 study participants, 63 (25.4%) had bacterial infection of urinary tract. Gram-negative bacteria predominated, with Escherichia coli (38.1%), Klebsiella pneumoniae (20.6%), and Acinetobacter baumannii (11.1%) being the most common isolates. High resistance was observed to commonly used antibiotics, including ampicillin, amoxicillin–clavulanate, chloramphenicol, and co-trimoxazole . In multivariable analysis, age 19–60 years (AOR = 3.95; 95% CI: 1.55–10.08), divorced marital status (AOR = 3.05; 95% CI: 1.02–9.09), prior history of UTI (AOR = 2.20; 95% CI: 1.12–4.33), and longer duration of diabetes (6–10 years: AOR = 3.85; >10 years: AOR = 5.50) were significantly associated with bacterial infection of urinary tract. Conclusion The findings of this study showed bacterial infection of urinary tract is common among asymptomatic diabetic patients, with a high burden of antimicrobial resistance. Antimicrobial stewardship programs, rational antibiotic use guided by culture and sensitivity testing are essential to reduce infection-related morbidity.
Background Cabenuva (cabotegravir/rilpivirine) is the first complete long-acting injectable regimen for HIV-1 treatment. As its use expands, post-marketing surveillance should address not only conventional adverse reactions, but also therapeutic failure and product-use or administration-related issues. This study aimed to characterize Cabenuva-associated reports submitted to the FDA Adverse Event Reporting System (FAERS) from Q4 2019 to Q3 2024. Methods Cabenuva-associated FAERS reports were extracted and coded using MedDRA v27.1. Disproportionality analysis and Bayesian models were applied for signal detection. Subgroup analyses by sex and age were conducted using reporting odds ratios and interpreted as exploratory. Time-to-onset (TTO) was calculated from treatment start date to event onset date when valid dates were available. Results A total of 3,497 reports including 22,738 Cabenuva-associated event records were identified. The detected PTs included established adverse reactions, therapeutic failure or disease-progression terms, product-use and administration issues, exposure circumstances, and sparse unexpected findings. Frequently reported clinically relevant events included injection-site pain, injection-site nodule, and depression. Prominent implementation-related terms included product dose omission issue, inappropriate schedule of product administration, and product administration error. Sparse unexpected PTs were interpreted as hypothesis-generating observations rather than established adverse reactions. Conclusions This study provides a broad post-marketing signal-screening profile of Cabenuva, highlighting both known safety concerns and real-world implementation issues such as missed doses, administration problems, product issues, and therapeutic failure. The findings support careful clinical monitoring, adherence to administration guidance, staff training, and further validation of sparse unexpected signals.
Background Smartphone addiction is an emerging public health concern, particularly among caregivers experiencing chronic stress. Caregivers of children with physical disabilities may be especially vulnerable, yet research on this topic in low-resource settings like Nepal is scarce. This study aimed to determine the prevalence of smartphone addiction and identify its sociodemographic, psychological, and social determinants among caregivers of children with physical disabilities. Methods A quantitative, cross-sectional, descriptive study was conducted at the country’s only specialized pediatric rehabilitation center in Nepal, a national referral hub providing comprehensive care for children with physical disabilities. Consecutive sampling was used to recruit 227 primary caregivers. Inclusion criteria were: age ≥18 years, primary responsibility for the child’s daily care, and ability to complete a structured questionnaire. Exclusion criteria included caregivers with severe cognitive impairments or acute illness preventing participation. Data were collected using a structured questionnaire incorporating the Smartphone Addiction Scale–Short Version (SAS-SV). Descriptive statistics, Chi-square tests, t-tests, and multivariable logistic regression were used to examine associations between smartphone addiction and participant characteristics. Results In this sample of 227 caregivers, 62.1% (n=141) screened above the SAS-SV risk threshold for problematic smartphone use. Significant determinants identified in multivariable logistic regression included female gender (AOR=5.83, 95% CI 1.58–21.45, p=0.008), unemployment (AOR=19.17, 95% CI 1.14–323.85, p=0.041), ethnicity (Brahmin/Chhetri: AOR=0.009, 95% CI 0.000–0.234, p=0.005; Janajati: AOR=0.015, 95% CI 0.001–0.420, p=0.014), chronic illness (AOR=0.009, 95% CI 0.000–0.514, p=0.022), frequent headaches (AOR=0.004, 95% CI 0.000–0.093, p<0.001), and occasional eye strain (AOR=0.081, 95% CI 0.009–0.748, p=0.027). Conclusion In this sample, a high proportion of caregivers screened at risk for problematic smartphone use, with female gender and unemployment associated with higher adjusted odds. Given the cross-sectional design, these findings are preliminary and hypothesis-generating, and further longitudinal research is needed before screening or intervention strategies can be recommended.
Background Type 2 diabetes (T2D) is a major global health issue. Many Asian individuals with T2D are non-obese, suggesting that factors beyond body mass index (BMI) may be relevant. Design and methods This ecological cross-sectional study examined correlations between diabetes prevalence and lifestyle-related factors using age-standardized, prefecture-level data from the 2021 National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data. Variables included diabetes prevalence (glycated hemoglobin [HbA1c] ≥ 6.5%), obesity (BMI ≥ 25 kg/m 2 ), other obesity-related indicators, and self-reported dietary habits. Associations were assessed using Spearman’s rank correlation coefficients with Benjamini–Hochberg false discovery rate (FDR) correction. Results After FDR correction, prefecture-level diabetes prevalence was positively correlated with BMI ≥ 25 kg/m 2 , elevated waist circumference, and weight gain in both sexes, and with alanine aminotransferase in women. Among dietary variables, the proportion of individuals with impaired masticatory function was positively correlated with diabetes prevalence in both sexes, whereas daily snacking was inversely correlated only in women; breakfast skipping, late-night dinner, and fast eating were not significantly correlated in either sex. However, after adjustment for BMI ≥ 25 kg/m 2 , none of the dietary habit variables showed a significant association with diabetes prevalence in either sex. Conclusions Prefecture-level diabetes prevalence in Japan correlated with several obesity-related indicators and impaired masticatory function in both sexes, although impaired masticatory function was not robust to BMI adjustment. Sex-specific patterns included a positive correlation with alanine aminotransferase and an inverse correlation with daily snacking in women. These findings warrant future individual-level studies.
The 2025 Myanmar earthquake caused extensive destruction. Beyond 3,800 direct disaster-related deaths (direct DRDs) and 5,100 injuries, indirect disaster-related deaths (indirect DRDs) remain a persistent concern. Indirect DRDs are deaths caused by secondary health effects after a disaster, rather than by the direct physical impact of the hazard itself. They may arise through disrupted healthcare delivery, deteriorating living and evacuation environments, interruptions to chronic-disease management, and psychosocial stress. Evidence from Japan, including the 2011 Great East Japan Earthquake and the 2024 Noto Peninsula Earthquake, shows that prolonged displacement and repeated disruptions in health and social systems can sustain mortality risk over time. Based on these insights, this Perspective synthesizes publicly available United Nations and humanitarian reports to identify risks of indirect DRDs in Myanmar. Months after the earthquake, many survivors remain in fragile shelters with degraded water, sanitation, and hygiene conditions. Health facilities were damaged or closed, healthcare access remains constrained, and vulnerable groups—including children, pregnant women, older adults, persons with disabilities, and patients with chronic diseases—face sustained risks. These conditions increase the likelihood of infectious disease outbreaks, chronic disease decompensation, heat illness, and psychosocial distress. Priorities include continuity of essential services, access to noncommunicable disease medicines, maternal–child health and psychosocial support, improved shelter and WASH conditions, standardized documentation of disaster relevance in medical records and death certification, and sustained, coordinated recovery. Framing indirect DRDs as preventable and measurable can strengthen protection of vulnerable groups, resilience, accountability, and dignity.
Background The world appears to be experiencing more than its fair share of shocks: climatic disasters, pandemics, wars and political events that have far-reaching consequences for vulnerable populations globally. One such example was the COVID-19 pandemic, which resulted in both direct and indirect impacts on older women, especially those residing in Sub-Saharan Africa, due to the already fragile economic and health care systems in place, as well as the lack of infrastructure for public services. While substantial literature now exists documenting the impact of COVID-19 on vulnerable populations, less attention has been paid to building back better. Design and Methods Using the feminist political ecology of health framework, this research investigated the impacts of the COVID-19 pandemic on health and wellbeing among older women residing in Kenya (n=231) and Uganda (n=211) and how they are ‘building back better’. Using survey data, we used a generalized linear model with a complementary loglog link function to identify factors associated with wellbeing, emotional distress and self-reported health status. Results Only 17.7% of older women in Kenya and 14.7% in Uganda experienced an improvement in wellbeing post-COVID compared to during the pandemic. Further, there remains a sustained impact on emotional distress levels. Several factors, such as WASH insecurity and no health insurance, negatively impacted wellbeing, emotional distress and self-reported health status. Conclusion Overall, this research documents how older women in Uganda and Kenya have been and continue to be impacted by the COVID-19 pandemic, despite declining case counts. Several policy recommendations have been outlined.
Background:We assessed whether two consecutively recruited cohorts of medical students were sufficiently comparable to support pooled analyses of quality of life (QoL) and health outcomes. Design and methods:A total of 892 first-year students from a single medical school in Poland, recruited in 2021/2022 (cohort A) and 2022/2023 (cohort B) academic years, were evaluated with standardized instruments (WHOQOL-BREF, AUDIT, GHQ-28). Cohorts were compared using the chi-square and Mann-Whitney U tests for sociodemographic, lifestyle, and health parameters; longitudinal changes were tested with paired Wilcoxon tests. Results:Most baseline characteristics were similar between the two cohorts, with significant differences observed only for relationship status, residence, and smoking. Between the first and second academic years, a statistically significant deterioration was observed in the somatic and psychological domains of the WHOQOL-BREF (52.28→45.16 and 61.32→55.63, respectively), whereas GHQ-28 scores improved (32.73→29.69) (all p<0.001). Limitations include self-report bias, single-site sampling, and short follow-up. Conclusions:When baseline comparability is demonstrated, pooling consecutive student cohorts may be reasonable and may support more precise monitoring of QoL and mental health over time. Future research should consider advanced longitudinal methods to examine age and cohort effects over extended follow-up.
Background The school food environment critically shapes child nutrition, yet the role of informal food vendors, individuals selling food on school premises without formal government-issued business licenses, remains understudied in Ghana. Objective This study explored the dual role of informal food vendors as potential gatekeepers to healthy eating and examined the barriers they face in offering nutritious options. Methods Six focus group discussions were conducted with 38 purposively selected informal food vendors (37 female, 1 male) across six public basic schools in the Cape Coast Metropolitan Area (three farming and three fishing communities). Data were analyzed thematically using NVivo 12. Results Vendors demonstrated good knowledge of nutrition and hygiene practices (81.6% had food safety training) but operated under severe constraints: intense price sensitivity among students (meals often purchased for 1-2 Ghana cedis), competition from unauthorized external vendors, lack of infrastructure (shelter, storage, water), and weak policy enforcement. These factors forced vendors to prioritize cheap, calorie-dense foods over nutritious alternatives. Conclusions Vendors are not inherent barriers to healthy eating but constrained entrepreneurs. Their strong accountability (e.g., “We eat the same food we sell”) and willingness to collaborate with schools represent untapped opportunities for intervention. Recommendations Multi-level strategies including enforced school food policies, vendor subsidies or micro-loans, infrastructure investment, and teacher-vendor partnerships are urgently needed.
