Gonococcal cervicitis can contribute to reproductive tract complications and infertility, yet evidence from fertility-care settings in Uganda remains limited. This study determined its prevalence, antimicrobial susceptibility patterns, and associated factors among women seeking fertility care at three tertiary hospitals in Uganda. We conducted a multicenter cross-sectional study involving 402 women seeking fertility care at three tertiary hospitals in Uganda from 10th September 2025 and 10th January 2026. Endocervical swabs were cultured for Neisseria gonorrhoeae, and isolates underwent antimicrobial susceptibility testing. Factors associated with gonococcal cervicitis were assessed using bivariable and multivariable logistic regression. Of the 402 participants, 34 had culture-confirmed gonococcal cervicitis, for an overall prevalence of 8.5% (95% CI, 6.1%-11.6%). Site-specific prevalence was 10.4% at the Jinja Regional Referral Hospital and 7.5% at both Lira and Kayunga Regional Referral Hospitals, with no significant between-site difference (p = 0.598). Among the 34 isolates, susceptibility was highest to ceftriaxone and azithromycin (94.1% each), whereas resistance was common to penicillin (64.7%), ciprofloxacin (58.8%), and tetracycline (58.8%). Independent factors associated with gonococcal cervicitis were having three or more lifetime sexual partners (adjusted odds ratio [AOR], 5.25; 95% CI, 1.65-16.72), vaginal douching (AOR, 5.59; 95% CI, 1.83-17.03), current oral contraceptive use (AOR, 8.32; 95% CI, 2.94-23.54), HIV seropositivity (AOR, 5.00; 95% CI, 1.82-13.76), and a new sexual partner in the previous 3 months (AOR, 7.92; 95% CI, 2.68-23.41). Gonococcal cervicitis was common among women seeking fertility care at these Ugandan tertiary hospitals. The observed resistance to penicillin, ciprofloxacin, and tetracycline, together with preserved susceptibility to ceftriaxone and azithromycin, supports culture-informed treatment and targeted screening in fertility clinics.
Despite its major implications for biodiversity conservation and public health, the generality of a protective effect of biodiversity on zoonotic pathogen transmission (i.e., the dilution effect) remains strongly debated. This controversy may partly arise from the diversity of analytical approaches used, but also from the spatial scales at which studies are conducted. Here, we explicitly test whether increasing the spatial scale of analysis affects the detection of the relationship between hantavirus infection prevalence and rodent species richness, using a global dataset spanning multiple regions. Although the association between species richness and infection prevalence remains negative across all spatial scales, we show that the magnitude of the dilution effect progressively weakens as spatial aggregation increases and can become statistically non-significant at coarse spatial resolutions. These results, which are consistent across world regions, indicate that the dilution effect is likely a general feature of hantavirus-rodent systems, but that its empirical detection is highly sensitive to the spatial scale of analysis. Our findings highlight how large-scale spatial aggregation can mask underlying ecological processes and emphasize the need to carefully match spatial scale to the biological mechanisms under investigation when testing biodiversity-disease relationships. Finally, we discuss the ecological and methodological mechanisms that may obscure dilution effects and outline why scale-explicit approaches are essential for robust inference in biodiversity-disease research.
Attention-Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder that may adversely affect academic performance and well-being. Data on ADHD among Lebanese medical students are limited. This study assessed the prevalence of probable ADHD symptoms and associated factors among medical students in Lebanon. A multicenter cross-sectional study was conducted among medical students from six Lebanese universities. Participants completed an online questionnaire including the Adult ADHD Self-Report Scale (ASRS v1.1), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Pittsburgh Sleep Quality Index (PSQI). Factors associated with ADHD screening scores were identified using multivariable linear regression. A total of 306 medical students participated; 60.8% were female, and the mean age was 21.9 ± 2.1 years. Overall, 93 students screened positive for probable ADHD symptoms, corresponding to a prevalence of 30.4% (95% CI: 25.5%-35.8%). Higher ADHD screening scores were independently associated with fourth academic year (β = 0.605, 95% CI: 0.111-1.099; p = 0.017), middle socioeconomic status (β = 0.399, 95% CI: 0.022-0.777; p = 0.038), comorbidities (β = 0.624, 95% CI: 0.082-1.167; p = 0.024), birth complications (β = 0.888, 95% CI: 0.311-1.466; p = 0.003), smoking (β = 1.054, 95% CI: 0.415-1.692; p = 0.001), higher PHQ-9 scores (β = 0.089, 95% CI: 0.042-0.136; p < 0.001), and poorer sleep quality (PSQI score; β = 0.093, 95% CI: 0.029-0.157; p = 0.005). Nearly one-third of Lebanese medical students screened positive for probable ADHD symptoms. These findings suggest that ADHD symptoms may coexist with modifiable psychological and lifestyle factors, highlighting the need for integrated screening and support services within medical schools. Future longitudinal studies using clinical diagnostic assessments are warranted to clarify causal relationships and confirm ADHD diagnoses.
Community case management has been scaled up nationally in Zambia over the last decade. However, there is limited evidence on how this nationwide implementation has affected febrile patients' access to malaria diagnosis and treatment in Zambia. This study analyzed four rounds of Malaria Indicator Survey (MIS) data (2012-2021) to evaluate: 1) proportion of all-ages individuals with fever who sought treatment from a formal provider, 2) proportion of individuals going to CHWs over time, among those who sought treatment at a formal provider, 3) time duration between fever onset and treatment seeking at a formal provider, and 4) proportion of children <5 with malaria that received Artemether-Lumefantrine (AL) treatment. Mixed-effect logit models were employed to examine determinants of treatment-seeking behavior and factors affecting AL receipt among children <5 with malaria cases. The proportion of febrile patients seeking treatment remained below 60% throughout 2012-2021, and AL receipt among children with malaria cases consistently stayed below 50%. The mean interval between fever onset and initial treatment-seeking encounter decreased from 2.42 days in 2012 to 1.71 days in 2021. Among formal care seekers, CHW utilization increased from 1.5% in 2012 to 10.0% in 2018 before declining to 3.2% in 2021. Longer walking time to the nearest health facility was associated with lower odds of treatment seeking, whereas CHW density was not associated with treatment seeking or AL receipt. Children who did not go to formal providers had lower odds of AL receipt than those who sought treatment from CHWs. Despite nationwide CCM scale-up over the last decade, significant barriers persist in malaria patients' access to diagnosis and treatment in Zambia. Our results indicate that while CCM coverage should be maintained and further expanded, additional complementary interventions are also needed to overcome remaining access barriers.
Raute the last nomadic hunter-gatherer marginalized indigenous group face disproportionate and persistent barriers to reproductive health services, including family planning and safe abortion. The lack of the pre-existing population-level quantitative reproductive health data limits the ability of health authority to design cultural-sensitive health services. This census-based cross-sectional study enrolled all 192 eligible married women of reproductive age in the Raute community of Parshuram Municipality, Dadeldhura district, Sudurpaschim Province, Nepal. Data was collected through structured interviews, and analyzed in IBM SPSS version 16. Results showed more than half of participants (53.6%) currently used family planning, with injectable contraceptives being the most common method (42.7%), followed by female sterilization (33.0%) and implants (24.3%), while condom use was negligible at 1.0%. Among non-users (46.4%), 97.7% cited lack of interest as the primary reason. Knowledge of safe abortion services was reported by 61.5% of women, yet only 8.3% had ever accessed such services, and awareness of Nepal's national safe abortion policy was critically low (10.4%). The independent predictor of current family planning utilization in the adjusted logistic regression model was non-utilization of safe abortion services (AOR = 4.275; 95% CI: 1.145-15.954; p = 0.030), suggesting that contraceptive use and abortion service use represent alternative reproductive management strategies in this community. Younger age (≤30 years) and urban residence were significantly associated with safe abortion use in bivariate analysis but were attenuated after adjustment. These findings reveal critical gaps in reproductive method diversity, safe abortion policy literacy, and male partner engagement. Community-based mobile outreach tailored to nomadic movement patterns, legal literacy programs in the local language, and strategies to engage male partners are indicated as priorities; their design should be informed by qualitative, community-engaged research into the cultural and relational dynamics that a structured survey cannot capture.
Women experiencing the postpartum stage often develop psychological distress, fear of movement, and maladaptive pain coping, which is a hindrance to healing lumbopelvic pain (LPP). Traditional exercise (TE) programs are usually characterized by low adherence. Virtual reality (VR) - based exercise can be a strong immersive experience, which can positively affect emotional well-being, decrease fear of pain, and increase coping mechanisms. To determine the level of effectiveness of VR-based exercise programs as compared to TE in enhancing psychological and emotional outcomes in postpartum women with LPP. 60 postpartum women aged 20-40 years with LPP, registered between 2-12 weeks post-delivery, were enrolled in a single blind randomized controlled trial. The project followed a simple randomization process and was conducted computationally with an equal distribution (1:1) between the VR and TE groups. Both of the groups were exposed to 8 sessions of pelvic floor muscle training over a month. The VR group additionally performed immersive tasks using Meta Quest 2 headsets and Lumbar Pain Rehab software. Outcomes were measured at baseline, 4th week, and 8th week using the Depression, Anxiety, and Stress Scale (DASS), Pain Catastrophizing Scale (PCS), Coping Strategies Questionnaire (CSQ), Tampa Scale for Kinesiophobia (TSK), and Simulator Sickness Questionnaire (SSQ). The ethical approval was acquired (IRB no.0543; reference no. SMDC-IRB/AI/18-1/2023). The VR group demonstrated significantly better reductions in depression, anxiety, and stress at the 4th week, alongside improved adaptive coping strategies and decreased pain catastrophizing compared with TE. These advantages were sustained at the 8th week, with further improvement in kinesiophobia and a continued enhancement of emotional well-being. No adverse VR-related effects were reported. VR-based exercise demonstrated superior benefits over TE in enhancing psychological well-being, reducing fear of movement, and promoting adaptive coping strategies in postpartum women with LPP. ClinicalTrials.gov Identifier: NCT05921747, registered on 4/17/2023.
Adolescents' immediate environments, including their homes, schools, and neighbourhoods, have a significant impact on their behaviour, health and development. Fostering adolescents' agency and empowerment can drive environmental and behavioural changes that can lead to improved health outcomes and reduced disparities in current and future generations. The objective of the study was to pilot and evaluate the implementation of a "by the people" citizen science method (the Our Voice method), engaging adolescent high school learners in Cape Town, Western Cape, South Africa in promoting healthy and active lifestyles and environments. Sixty-six high school adolescents of both genders between the ages of 13-18 years old were purposively recruited from 6 high schools in Cape Town, located in places of low or middle/high socioeconomic areas (SEA), as citizen scientists. The citizen scientists and some caregivers were interviewed via telephone. Citizen scientists also used a mobile application to collect data in their immediate environments to identify barriers to healthy eating, physical activity, hygiene, and safety. Data were audio-recorded, downloaded, and transcribed. In facilitated workshops, citizen scientists analysed the data and proffered solutions to the barriers, advocated change, and thereafter implemented relevant health promoting changes. Demographic characteristics and anthropometric measurements of the adolescents were also collected. Overall, similar barriers were experienced by adolescents regardless of SEA. However, lower socioeconomic status areas were a significant contributor of barriers to physical inactivity and unhealthy eating, safety, and hygiene. The buy-in and participation of adolescents and the school authority in the intervention to promote healthy lifestyles and environments is imperative. The Our Voice method was found to be a promising multi-layered tool for empowering adolescents as advocates in promoting feasible healthy and active lifestyle and environmental changes.
Newborn screening (NBS) using dried blood spot (DBS) analysis is an important public health intervention to detect serious congenital disorders early, and reduce childhood mortality, and lifelong disabilities. While institutionalized for decades in high-income countries, NBS remains limited in low- and middle-income countries such as India. Despite recommendations in national child healthcare policies, few Indian states have adopted NBS. Even Karnataka, a state performing well in maternal and child health indicators and one of the first states to pilot large-scale NBS studies in the 1980s, is yet to implement a statewide program. This study presents a scoping review of the literature on NBS in Karnataka to understand the NBS efforts so far, identify gaps and provide recommendations for the future. A search of English-language peer-reviewed studies and newspaper articles on newborn/neonatal screening in Karnataka (1980-2024) was conducted using PubMed, Google Scholar, and Google News. Nineteen articles were included, charted using the ISNS framework, and thematically analysed. The results highlighted prevalent themes of research such as disease burden, awareness gaps, inconsistent diagnostic thresholds, consanguinity, lack of data, limited outreach programs, and inadequate NBS facilities. Most studies were hospital-based single-or multi-centre studies limited to the population accessing institutional delivery services. Estimation of incidence and prevalence were the most common research objectives. Diseases commonly considered for screening were inborn errors of metabolism (IEM) and congenital hypothyroidism (CH). A significant burden of CH (ranging from 1:1000) and IEMs (ranging from 1:811) were reported, with certain communities at a higher risk due to prevailing marriage practices. Limited evidence on cost suggests that universal newborn screening is economically feasible, with estimated costs of USD 6.45 per child for a single disorder. All studies support the need for NBS in Karnataka, but further health systems research is needed to inform sustainable implementation.
Maternal and neonatal mortality rates remain high in sub-Saharan Africa despite increased facility-based childbirth, reflecting persistent gaps in quality of care. We evaluated the impact of MENTORS, a facility based nurse mentorship and training program, on provider knowledge and childbirth care quality. In an unblinded parallel-arm cluster randomized controlled trial conducted between November 2021, 40 health facilities in Kenya were randomized to receive continuing medical education lectures, simulation-based drills, and in-facility mentorship to strengthen obstetric and newborn care. Baseline data included facility assessments and provider surveys; endline data included provider surveys, a standardized neonatal resuscitation simulation, and childbirth observations. Primary outcomes included provider knowledge, quality of routine maternity care, and quality of neonatal resuscitation management. All outcomes were assessed at endline. The trial was registered at ClinicalTrials.gov (NCT05110521) and the AEA RCT Registry (0008449). At baseline (November-December 2021), 357 providers were interviewed; at endline (May-August 2022), 376 providers were interviewed and 4,377 childbirths were observed. Routine maternity care quality was low across facilities, with providers performing 58.6% of essential actions in intervention facilities and 57.0% in control facilities at endline. There was no significant difference between the intervention and control facilities in provider knowledge (unadjusted domain effect 0.006, 95% CI: -0.038, 0.051) nor the quality of routine maternity care (0.018, 95% CI: -0.029, 0.065). However, providers in intervention-exposed facilities demonstrated improved quality of neonatal resuscitation in simulation-based assessments (0.094, 95% CI: 0.000, 0.188), with suggestive evidence of improved performance in standardized childbirth observations as well (0.041, 95% CI: -0.001, 0.083). Routine maternity care quality was suboptimal across both intervention and control facilities. While the facility-based mentorship program did not significantly improve provider knowledge or the quality of routine childbirth care, it showed evidence of improvements in neonatal resuscitation, although these findings were not robust across all sensitivity analyses.
Substandard and falsified (SF) medicines pose a major threat to maternal, newborn, and child health (MNCH) and malaria control in Africa, yet their true burden remains uncertain. We conducted a systematic review and meta-analysis of studies published between 2010 and 2025 that chemically tested the quality of essential MNCH and antimalarial medicines collected in African countries. Following PRISMA 2020 guidelines and a registered PROSPERO protocol, we searched PubMed, Embase, Web of Science, and WHO databases, screened 3,178 records, and included 123 studies from 34 countries reporting on 36,069 medicine samples. Studies were appraised with the MEDQUARG checklist, and random-effects meta-analyses with Freeman-Tukey transformation were used to estimate pooled SF prevalence overall and by therapeutic class, country, and subregion. Meta-regression explored study-level drivers of heterogeneity. Overall, 17.9% (95% CI 13.6-22.7) of tested medicines failed quality standards. Failure rates were highest for corticosteroids (65.0%), uterotonics (43.9%), and hematinics (34.7%); antimalarials, antihypertensives, and antibiotics ranged from 15-20%. Estimates for corticosteroids and hematinics carried wide confidence intervals, reflecting sparse underlying data. Western and Central Africa had the greatest regional burdens, whereas Southern Africa showed lower pooled estimates but with sparse data. Substandard medicines accounted for most poor-quality products (pooled prevalence 12.8%), while falsified medicines were less common (1.2%). Therapeutic category, geographic subregion, and use of mystery-client purchasing were significant predictors of heterogeneity, whereas publication year and methodological quality were not. Nearly one in five essential MNCH and antimalarial medicines tested in Africa are SF, posing a major barrier to reducing preventable maternal, neonatal, and child mortality. Strengthened regulatory systems, risk-based post-market surveillance, and priority attention to high-risk therapeutics, particularly uterotonics and antimalarials, are urgently needed. As the African Medicines Agency becomes operational, this evidence base offers a concrete foundation for directing continental regulatory investment where it is most needed.
Gender-based violence (GBV) is a major global public health and human rights issue with wide-ranging physical and mental health consequences. Physiotherapists frequently work with populations and conditions plausibly linked to violence exposure, yet little is known about their preparedness to identify and respond to GBV in Spanish-speaking contexts. We conducted a cross-sectional online convenience survey of Spanish-speaking physiotherapists from Latin America and Spain using the Spanish-language Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), originally developed and validated for intimate partner violence (IPV) and administered here with broader GBV framing (violencia basada en género) while retaining some IPV-specific items. The survey assessed self-reported preparation, self-perceived knowledge, objective knowledge, opinions, and practice issues related to GBV. Descriptive analyses were conducted across PREMIS subscales and item-level responses. A total of 719 physiotherapists from 15 countries were included in the analytic sample. Self-reported preparedness to identify and respond to GBV was low (mean preparation score 2.5/7), as was self-perceived knowledge (2.4/7). Nearly three-quarters of respondents reported not identifying any GBV cases in the previous six months, and engagement in response practices, such as risk assessment, safety planning, documentation, and referral was uncommon. Nearly half (45%) reported no formal GBV training. Respondents also reported limited awareness of institutional protocols, referral resources, and organisational supports for GBV response. Attitudes towards victim-survivors were generally supportive, with low endorsement of victim-blaming beliefs. Physiotherapists in this sample reported low preparedness, limited training, and substantial system-level barriers to responding to GBV in clinical practice. These findings suggest an underused opportunity to strengthen health-sector responses to GBV through physiotherapy education, professional training, and organisational infrastructure that supports safe identification, referral and trauma-informed care. Future research should evaluate strategies for embedding trauma-informed responses to GBV within routine physiotherapy practice.
This study aimed to assess undergraduate nursing students' knowledge and attitudes toward Primary Health Care in Jordan. This study adopted a descriptive cross-sectional design, involving 157 nursing students from two private and two public universities in the central region of Jordan. It utilized an Arabic version of a self-administered online Primary Health Care Questionnaire. The findings indicated that the majority of students exhibited high knowledge (77%) and positive attitudes (97%); however, there was a significant difference between students' knowledge, attitudes, and their socio-demographic factors. Moreover, the results revealed that demographic factors affect primary healthcare attitudes and knowledge, indicating that students' perspectives concerning PHC can be influenced by demographic factors, including gender (B = 0.173), academic performance (B = 0.044), and intent to leave nursing in the future (B = 0.122) at a significance level (<0.05). Furthermore, the findings demonstrated that these demographic and academic factors significantly predicted the attitudes of undergraduate nursing students toward PHC in Jordan. Nursing students demonstrated high knowledge and positive attitudes toward primary healthcare services. Selected demographic characteristics were significantly associated with knowledge and attitudes, as supported by the statistical analysis. These findings highlight the importance of strengthening primary healthcare content and practical learning experiences within nursing education to support students' preparedness for future community-based health promotion and disease-prevention roles.
Mental health stigma remains a major barrier due to limited mental health promotion and care among adolescents in low- and middle-income countries (LMICs), due to a lack of mental health literacy, sociocultural beliefs, and misconceptions which contribute to delayed help-seeking and poor mental health outcomes. In Ethiopia, stigma surrounding mental illness can result in social exclusion, discrimination, and abandonment by family members. This study evaluated the effectiveness of a culturally adapted, school-based mental health literacy and anti-stigma intervention among secondary school students in Addis Ababa, Ethiopia. The intervention was culturally adapted in collaboration with local mental health experts and adolescent students to ensure relevance to the Ethiopian context. Using a train-the-trainer approach, seven school nurses and health extension workers were trained to deliver the intervention to 186 students across four secondary schools. Implemented over one week, the intervention utilized three components: (1) an interactive mental health literacy curriculum delivered through PowerPoint presentations and participatory activities, (2) a contact-based session involving a person with lived experience of mental illness, and (3) mental health promotion materials, including posters and bookmarks displaying anti-stigma messages. Outcomes were assessed using self-administered questionnaires completed before the intervention and three weeks after its completion. Following the intervention, students demonstrated improved mental health knowledge and more positive attitudes toward mental illness (t(185) = 8.67, p < 0.001). Social distance, avoidance, and discomfort toward individuals with mental health problems were reduced, while intentions to seek help increased, with participants reporting greater willingness to seek support from formal and informal sources. These findings suggest that a culturally adapted, school-based mental health literacy and anti-stigma intervention was associated with improving adolescents' mental health knowledge, reduce stigmatizing attitudes, and strengthening help-seeking intentions. Such interventions represent a promising strategy for supporting adolescent mental health and addressing stigma in Ethiopia and other LMIC settings.
Chronic conditions both drive development of and are consequences of tuberculosis (TB). While there is growing awareness of chronic lung disease, data on other health conditions post-TB are limited. In this cross-sectional study in Zimbabwe, we offered adults with pulmonary TB an integrated health check at or after treatment completion, assessing uptake and yield. Members of the same households were also offered the intervention. Selecting household members without prior or current TB as a comparator, we calculated odds ratios (OR) for HIV, diabetes, hypertension, underweight, anaemia, symptoms of mental health disorders, self-reported memory difficulty, vision impairment, chronic lung disease and multimorbidity (two or more of the above); and compared health-related quality of life (HRQoL; EQ-5D value). Of 229 people with TB invited, 96 (42%) participated (median age 38 years, 54% men, median 356 days from diagnosis). Common reasons for non-participation were migration and work. Among people with TB, chronic conditions were common and, other than HIV, mostly undiagnosed. Ninety-one percent of people with recent TB had at least one chronic condition; almost two-thirds had two or more. Compared to 285 household comparators (median age 34 years, 71% female) and after adjustment for age and sex, people with recent TB were more likely to have at least one chronic condition (OR 2.30 [95% confidence interval 1.03-5.11]) but not multimorbidity (1.55 [0.86-2.78]). People with recent TB had greater odds of HIV (1.77 [1.03-3.04]), symptoms of mental health disorders (1.57 [0.96-2.56]), self-reported memory difficulty (2.13 [1.19-3.80]), impaired lung function (3.24 [1.46-7.20] among 39/92 people with TB and 155/285 household comparators with data available), and underweight (5.15 [2.28-11.61]) compared to household comparators without prior TB; hypertension was less common (0.40 [0.20-0.79]) and HRQoL was worse (p = 0.005). Uptake of chronic disease screening among people with recent TB was low, but prevalence of chronic conditions was high. Holistic approaches to treatment which identify and address these conditions are needed. The contribution of post-TB multimorbidity to morbidity and mortality among TB survivors should be included in global disease estimates. Whilst comparison to household controls aimed to reduce confounding by socio-economic status, a limitation of this approach is externality, whereby the health status of the person with TB influenced that of their household members.
The world produces enough food for all, yet it falls short of providing a nutritionally balanced diet, and what it produces is extremely unevenly distributed, with high levels of undernourishment and obesity co-existing, often within the same countries. Policy responses have achieved only limited success because they often fail to address the underlying causes of these outcomes. Drawing on Amartya Sen's entitlement framework and adapting it by making the conditions governing conversion analytically explicit, we explain food access in terms of people's endowments and the exchange, production, and transfer entitlements through which food is acquired. We examine two analytically distinct but mutually reinforcing forces: corporate power and wealth inequality. Corporate concentration can reshape production, supply chains, food environments and public policy, while wealth inequality limits access to productive assets, purchasing power and social protection. We argue that durable progress requires policies that rebuild household endowments, constrain excessive corporate and political power, strengthen conversion factors, and widen exchange, production and transfer entitlements. Priority measures include progressive taxation of income and particularly taxation of extreme wealth, social protection, competition and governance reform, secure land tenure and support for smallholders, regulation of food marketing, and investment in enabling infrastructure.
Mobile health (mHealth) technologies are increasingly used to support community-based healthcare. However, their real-world impact often remains unclear. Understanding implementation factors is essential for advancing their use and achieving meaningful health outcomes. We evaluated an mHealth tool (AitaHealth) after customising its modules and workflows for household Tuberculosis (TB) contact tracing and other community-based data collection by community health workers (CHWs). We describe the acceptability, feasibility, and implementation fidelity of this approach. We conducted a mixed-methods evaluation in two South African districts: uMkhanyakude and Ekurhuleni. We collected qualitative data through focus group discussions (FGDs) and in-depth interviews (IDIs) with CHWs, team leaders, and key stakeholders. We used deductive thematic analysis grounded in the Technology Acceptance Model (TAM) to assess the acceptability and implementation feasibility of the mHealth tool. We used quantitative data from the AitaHealth metadata to assess implementation fidelity. CHWs appreciated AitaHealth's efficiency, data security, and credibility. Across the two districts, 103 CHWs recorded data for 2,452 households and 10,649 household members. However, they reported challenges in ease of use, with unreliable devices, weak support, and safety concerns hindering data collection. These issues led to inconsistent engagement, with 48.5% of CHWs logging in fewer than 15 times during implementation. Despite these challenges, when used, AitaHealth ensured high-quality data collection and household coverage, with TB-related fields completed in over 94% of households, demonstrating its potential under better conditions. AitaHealth`s limitations stemmed from system constraints rather than user resistance. To achieve full impact, mHealth tools require reliable infrastructure and supportive environments for both the tools and their implementers.
Approximately 1.2 million Rohingya refugees currently reside among the 33 refugee camps in Cox's Bazar - Bangladesh, where the right to education remains a critical humanitarian concern. This study aimed to estimate the prevalence of Rohingya refugee children in educational need, elucidate predominant reasons among children in need, and identify factors associated with educational severity to inform targeted humanitarian relief efforts. This study utilized participant data collected during the 2023 Joint Multi-Sectoral Needs Assessment - a representative cross-sectional household survey. Education-age children (3-18) were assigned a severity score categorized as stressed, severe, or extreme based on proxy responses capturing educational access, learning conditions, and protection factors. Ordinal logistic regression examined factors associated with increasing educational severity scores. Among 8,408 education age children surveyed from 2,959 households, 29.6% were in severe educational need and 10.1% were in extreme educational need. After adjustment, increasing educational severity was significantly associated with head of household age 45-59 (aOR= 1.29 [95%CI: 1.09-1.54]), head of household age 60+ (aOR= 1.31 [95%CI: 1.07-1.60]), female headed households (aOR= 1.33 [95%CI: 1.15-1.54]), early education age boys (aOR= 3.95 [95%CI: 3.21-4.85]) and teenage boys (aOR= 4.42 [95%CI: 3.73-5.24]) relative to primary school age boys, early education age girls (aOR= 4.23 [95%CI: 3.36-5.31]) and teenage girls (aOR= 19.06 [95%CI: 15.70-23.15]) relative to primary school age girls, primary school age girls (aOR= 0.82 [95%CI: 0.68-0.99]) relative to primary school age boys, and teenage girls (aOR= 3.54 [95%CI: 3.04-4.12]) relative to teenage boys. Educational needs remain highly prevalent among Rohingya refugee children - particularly teenage girls. Local humanitarian authorities are currently providing targeted relief to those in educational need but these interventions are threatened by sweeping international funding cuts. Future longitudinal studies are required to monitor educational needs over time and further clarify causal pathways.
