Purpose Bilateral choanal atresia is a life-threatening neonatal emergency requiring prompt airway intervention. In resource-limited settings, diagnosis and management are often delayed due to systemic constraints. This case report describes the successful management of a neonate with bilateral choanal atresia in a low-resource environment and highlights the adaptive strategies used, with the aim of advocating for improved global pediatric surgical equity. Methods A full-term female neonate presenting with severe respiratory distress immediately after birth was diagnosed with bilateral choanal atresia using bedside catheter testing and contrast radiography, as computed tomography (CT) was initially unavailable. Stabilization was achieved with an improvised oral airway fashioned from an endotracheal tube. Definitive surgery was performed at a tertiary center after a 5-day delay due to financial and logistical barriers. Results Transnasal endoscopic puncture and dilation were performed using urethral dilators due to unavailability of balloon catheters. Custom stents were fashioned from silastic tubing. The neonate was discharged on postoperative day 5 with normal oxygen saturation and established oral feeding. Stents were removed at 6 months. Serial endoscopic follow-up over 3 years demonstrated sustained bilateral patency (>5 mm anteroposterior diameter) and age-appropriate growth and development. Conclusion This case demonstrates that favorable long-term outcomes for bilateral choanal atresia are achievable in resource-limited settings through clinical innovation and sustained follow-up. However, significant delays and financial hardship underscore the urgent need for systemic investments in infrastructure, workforce training, and financing to ensure equitable access to life-saving neonatal surgical care globally.
Purpose To examine how reported changes in Sierra Leone's eye health system may help interpret limited change in avoidable blindness, cataract surgical coverage, and gender equity between repeated population eye health surveys. Methods We reviewed four national reports: RAABs from 2010 and 2021 and EHSAs from 2013 and 2025. We extracted findings on governance, financing, workforce, service delivery, medical products, and information systems. We compared what changed and what persisted across the two EHSAs, assessed how comparable the reports were, and linked system themes to RAAB outcomes as plausible interpretations rather than direct causal effects. Results Blindness among adults aged 50 years and older changed little, from about 4.9% in 2010 to 5.4% in 2021. Cataract surgical coverage rose from about 40.5% to 50.5%, but coverage fell slightly among women while rising among men. By 2025, eye health had stronger coordination, more district eye units, a larger workforce, wider equipment distribution, and eye indicators in DHIS2. These gains matched the modest rise in coverage. However, donor dependence, weak domestic financing, uneven workforce deployment, fragile procurement and maintenance, and weak routine data use remained. Conclusion Repeated EHSAs can help explain why visible service expansion may not lead quickly to better population outcomes. In Sierra Leone, progress was real but too uneven and fragile to shift blindness more clearly or close the gender gap. Future gains will depend on stronger domestic financing, fairer workforce deployment, reliable supplies and maintenance, and routine equity monitoring.
Background Treatment switching in the oncology trials introduced time-dependent confounding and informative censoring, which complicated the unbiased estimation of treatment effects in evidence synthesis. Objectives To systematically assess the meta-analytical practices that are used for adjusting treatment switching in oncology, with an emphasis on handling time-dependent confounding, censoring bias, as well as patient-level variability. Methods A systematic review was conducted using PRISMA 2020 guidelines. The databases searched systematically are MEDLINE, Embase, Cochrane Library and Web of Science, and the studies published between 2015 and the last search date were included (provide exact search date). The review was conducted with the reporting standards from the PRISMA 2020 statement, and because there was methodological heterogeneity, an analysis of the findings was conducted using a structured narrative synthesis. The eligible studies included randomized trials, simulation studies, observational studies, and health technology assessments, with the application of formal statistical methods to adjust for treatment switching. Results Six studies had met the inclusion criteria. Common methods involved rank-preserving structural failure time models (RPSFTM), marginal structural models (MSMs), and inverse probability of censoring weighting (IPCW). The modeling assumptions, the specification of the model, the switching mechanisms, the method of dealing with time-dependent confounders, and the method of dealing with censoring were shown to vary across the included studies and affect the results and estimates of the treatment effects. The reporting practices were varying, and there was limited integration into the meta-analytical frameworks. Conclusion Adjustment regarding the treatment switching is methodologically complex, having no universally optimal approach. Enhanced level of transparency, methodological standardization, along with the consideration of patient-level heterogeneity, is important to improve the validity of the oncology evidence synthesis.
Ambient heat is an escalating climate-related hazard, yet its implications for menstruation and adolescent and young adult mental health remain understudied. Menstruating individuals face unique physiological and psychosocial challenges that may be intensified in the presence of heat stress. These challenges can be further shaped by stigma, period poverty, and developmental vulnerability, with potential implications for depression, anxiety, and psychological wellbeing. Heat exposure may disrupt thermoregulation, exacerbate menstrual symptoms, and heighten psychological stress, but the combined effects of these processes remain poorly understood. In this critical narrative review, we: draw together evidence from multiple disciplines on biological, psychological, and structural pathways linking heat exposure, menstruation, and mental health. We identify important research gaps and propose a conceptual framework and gender-responsive research agenda to inform equitable climate-resilient health strategies.
Purpose Hypertension-related end-organ damage disproportionately affects Black populations, with earlier onset, greater severity, and higher rates of heart failure and chronic kidney disease despite treatment. Because structural injury may persist even when blood-pressure (BP) targets are met, this review examines aldosterone–mineralocorticoid receptor (MR) signaling as a driver of residual tissue injury and develops a hypothesis-generating framework for earlier, risk-stratified MR antagonism. Methods This is a narrative review. We searched PubMed/MEDLINE and the Cochrane Library (inception–July 2026) using terms including mineralocorticoid receptor antagonist, aldosterone, spironolactone, eplerenone, finerenone, hypertension, resistant hypertension, end-organ damage, fibrosis, hyperkalemia, chronic kidney disease, heart failure, and health disparities. We prioritized randomized controlled trials, prespecified pooled analyses, mechanistic studies, and current guidelines, and hand-searched reference lists. No quantitative synthesis was performed. Findings Aldosterone–MR signaling promotes fibrosis, inflammation, oxidative stress, and adverse remodeling across cardiovascular and renal tissues, and may be particularly relevant in low-renin, salt-sensitive phenotypes observed more frequently, on average, among Black patients. Randomized trials support MR antagonists (MRAs) in resistant hypertension, heart failure, and diabetic CKD; however, MRAs are often introduced late, when reduced renal function raises hyperkalemia risk and limits preventive benefit. Conclusion In selected higher-risk patients with preserved renal function and controlled potassium, earlier MR antagonism may warrant prospective evaluation as a tissue-protective, disparity-reducing strategy. This framework is hypothesis-generating and is intended to stimulate research, not to alter current guideline-directed therapy.
Health literacy supports people, communities, and organisations in addressing noncommunicable diseases and their determinants, taking meaningful action to reduce risk factors, and support health and wellbeing for all. Addressing the issue of low health literacy has the potential to increase health, health equity and health system effectiveness by building citizens' capacities for health. The Sláintecare Healthy Communities programme was launched in 2021 in Ireland focussing specifically on promoting health and wellbeing at the community level, and improving health literacy is a key area of focus for this programme. This study aimed to work with stakeholders, in two Sláintecare Healthy Community areas, through a four-stage reflective process to discover, define, develop, and deliver innovative recommendations to improve health literacy within their communities. Two co-design workshops, adopting an adapted double diamond design approach (DDDA) took place in Spring 2024, one in each case study area. Sixty-eight stakeholders engaged in two DDDA workshops, undertaking tasks in same stakeholder and mixed stakeholder groups. A series of recommendations were co-created, with stakeholders voting for their preferred recommendations to refine this list in each area. These recommendations highlighted the need for effective early intervention, improved health infrastructure, and engaging with the community to connect, support, and sustain existing health literacy related initiatives. This is a novel example of health literacy stakeholder engagement in Ireland, and critically, it provides a tangible example of the process and outcomes of a collaboration between stakeholders and researchers which can be applied beyond these contexts.
Background:Heart failure (HF) affects 64 million individuals globally and accounts for one quarter of non-communicable disease deaths in the Western Pacific Region (WPR). Indigenous populations, including Māori and Pacific Islander peoples, experience disproportionately higher HF morbidity and premature mortality. Evidence on HF management systems across Pacific Island Countries remains critically limited. Objective:This rapid scoping review aimed to map and synthesise existing evidence on HF management systems across the WPR, including healthcare infrastructure, diagnostic and treatment modalities, guideline adherence, and patient outcomes. Methods:A comprehensive search was conducted in PubMed, CINAHL, Web of Science, and Scopus for English-language articles published between 2000 and 2024. Grey literature from the WHO Western Pacific Regional Office and Pacific Island Ministries of Health was also searched. The review followed the PRISMA-ScR framework. Results:Two studies met all inclusion criteria. One study, from Papua New Guinea, identified critical deficits in guideline-directed pharmacological therapy, provider training, and pharmaceutical access for HF with reduced ejection fraction. The second study, from Aotearoa New Zealand, documented widening ethnic inequities in HF hospitalisation rates among Māori and Pacific Islander peoples between 2006 and 2018, with rates more than six times higher in those aged under 50 years compared to European counterparts. Conclusion:No formalised HF management guidelines were identified across the WPR. Significant evidence gaps, health inequities, and implementation deficits persist across both resource-limited and higher-income settings. Urgent investment in primary research, culturally responsive policy development, and alignment with WHO HEARTS frameworks is needed to improve HF outcomes for Pacific peoples.
Purpose Cultural Humility is vital for effective healthcare delivery as it fosters trust, open communication, and addresses health disparities. By engaging in ongoing reflection and recognizing patients' cultural identities, providers can create more equitable and inclusive care. Despite its importance, Cultural Humility is rarely taught systematically in healthcare systems, and even when introduced, it is often not assessed, making accountability and consistent practice difficult. These challenges arise from its focus on attitudes and interpersonal dynamics, which are less tangible and harder to evaluate than clinical skills. Method To address these gaps, the authors developed a Cultural Humility educational module (S.E.L.F.) for 30,000 employees across a health system. This program provides insights into its development, content, and implementation. The evaluation aimed to demonstrate the effectiveness of the module's delivery, assess participant confidence and comfort, measure commitment to Cultural Humility, and explore scalability across healthcare systems. Results The findings indicate positive outcomes, including improved attitudes, knowledge, and satisfaction. Qualitative analysis highlighted the program's utility and impact, emphasizing that ongoing education is essential for professional growth and advancing health equity. Contrary to the belief that a single training is sufficient, this evaluation underscores the importance of continuous learning and dialogue to enact institutional culture change. Conclusions The S.E.L.F. model demonstrates how large healthcare systems can implement accessible training to promote Cultural Humility. By adopting these practices, institutions can model equity-driven behaviors and hold themselves accountable for advancing health equity at all organizational levels.
Purpose:This study evaluated the transition of disease surveillance in Bihar, India, from paper-based reporting to the digital Integrated Health Information Platform (IHIP) portal. The operational strategies and system-level governance mechanisms deployed to strengthen surveillance performance in a resource-constrained public health setting was examined. Methods:A program implementation evaluation was conducted using routine indicators from the IHIP-IDSP portal between 2021 and 2024. The intervention integrated systematic mapping of reporting units with a "Training of Trainers" cascade for frontline workers, real-time troubleshooting via formalized WhatsApp groups, and robust accountability frameworks. Results:The transition was associated with a fundamental expansion of active surveillance infrastructure. Between 2021 and 2023, the number of active Syndromic (S) form reporting units increased from 2148 to 10,633, while Presumptive (P) form units rose from 93 to 1650. Laboratory (L) form reporting completeness surged from baseline levels of 0.57% to over 90% within the same period. These gains were sustained by state-level governance structures, including weekly block-level performance reviews, daily automated portal checks, and a constant reward mechanism utilizing public recognition and certificates for high-performing units. The overall state reporting score improved from 8.4/100 (2021) to 85.4/100 by late 2023. Conclusion:Bihar's experience demonstrates that combining need-based training with real-time feedback and administrative accountability can significantly modernize surveillance systems. These results suggest that digital transformation in LMICs is achievable when technological tools are paired with strong governance and institutionalized motivation strategies.
Noncommunicable diseases demand community programs that are meaningful, feasible, and sustainable. This qualitative process evaluation examined a university-led public health and wellness extension program implemented in Philippine local communities. It documented how participants define health, wellness, and engagement; describe perceived benefits and prevention relevance; identify barriers and facilitators to participation; and articulate improvement priorities. Data were generated from semi-structured interviews with community beneficiaries (n = 10) and documentary testimonials from faculty extensionists (n = 4) and student extensionists (n = 7). Reflexive thematic analysis showed that participants framed health as holistic (physical and mental) and linked wellness to practical routines including stress regulation, self-care, nutrition-related skills, and movement. Engagement reflected belonging and psychological safety that supported sharing and sustained attendance, alongside diffusion of learning to others. Perceived benefits included increased health knowledge, coping and stress relief, practical lifestyle skills, and accessible prevention supports. Barriers included limited slots, scheduling constraints, fatigue, and contextual stressors, while facilitators included continuity, adequate resources, and community cooperation. The study proposes a contextually grounded process model linking activities, participant meanings, perceived benefits, implementation conditions, and improvement priorities to support iterative refinement of community wellness programming in similar university-extension settings.
Authors and consumers of epidemiology research need to understand just how imprecise the results of epidemiology studies are. As a start on this, authors need to stop implicitly claiming orders-of-magnitude more precision than is warranted by their methods and data. The present paper briefly summarizes why everyone should understand this, and provides a bit of advice to authors about reducing incorrect and potentially harmful claims of precision.
Non-alcoholic fatty liver disease (NAFLD) is a growing public health concern associated with obesity, diabetes, and metabolic syndromes. However, awareness and preventive behaviors remain understudied among young adults in low- and middle-income countries. This cross-sectional study assesses knowledge, attitudes, and practices related to NAFLD. This study is carried out among 343 university students (predominantly undergraduate students, mean age 24.6 years) at the Islamic University of Technology(IUT), Bangladesh. Even with 76.1% awareness, knowledge was very poor (39.1%) or moderate (40.2%). This shows significant gaps in understanding risk factors, treatment, prevention, and a strong dependence on informal information sources. Knowledge was particularly associated with age, region, and educational level. Preventive measures were extremely low, with only 11.1% followed by dieting restrictions and 31.2% making lifestyle changes. In an exploratory analysis limited to the 59 students who self-reported a prior NAFLD diagnosis (a figure likely inflated by over-reporting and not clinically confirmed), nearly half (47.5%) showed poor management practices. These findings reveal significant gaps in NAFLD literacy and health behaviors among university students in Bangladesh. This underscores the urgent need for institution-based and evidence-based educational programs and awareness campaigns to promote early prevention and effective self management of NAFLD.
Background:Long waiting times at outpatient pharmacies negatively affect patient satisfaction, medication adherence, and healthcare efficiency. In South Africa, tertiary hospital pharmacies face mounting pressure from high patient volumes, staffing shortages, and growing demand for chronic medication services. The SkipTheQ (STQ) mobile and web-based appointment system was implemented at a tertiary hospital in Gauteng province, South Africa, to reduce waiting times and improve service delivery. This study evaluates the impact of STQ on patient waiting times, satisfaction levels, and implementation challenges. Methodology:A descriptive, cross-sectional, quantitative study was conducted among 297 adult STQ users at a tertiary hospital outpatient pharmacy in Gauteng province. Data were collected over five weeks (April-May 2025) using structured questionnaires covering socio-demographics, digital connectivity, booking experiences, and satisfaction (12-item scale, 0-4 Likert). Waiting times were recorded manually and compared with pre-implementation hospital data. Statistical analysis included descriptive statistics, Mann-Whitney U and Kruskal-Wallis tests, and multiple linear regression (p ≤ 0.05). Results:Participants were predominantly female (68.4%), aged 51-65 years (34.3%), with secondary education (63.6%). Most owned smartphones (89.9%) had internet access (82.8%) and could afford mobile data (76.4%). Website access (94.3%), booking confirmation (98.7%), and preferred slot allocation (93.9%) were high. Satisfaction scores ranged from 3.05 to 3.38 (mean), with the highest ratings for packaging/labelling and likelihood to recommend. Affordability of data, employment status, successful booking confirmation, and preferred time slot significantly predicted satisfaction (p < 0.05). Average waiting time decreased from 87 min (pre-STQ) to 29 min (post-STQ). However, 25% of users reported delays, with challenges including system downtime (21.8%), unprepared medication (18.8%), and fully booked slots (12.5%). Conclusion:STQ significantly reduced outpatient pharmacy waiting times and achieved high patient satisfaction. Digital connectivity, particularly data affordability and reliable booking confirmation, was a key driver of satisfaction. However, operational challenges (staffing, system reliability, and digital literacy) must be addressed to ensure scalability and equitable access. Future implementation should prioritise strengthening infrastructure and implementing digital inclusion strategies to maximise public health impact.
Ethics committees are not yet fully integrated into the response to climate change, whether they are national ethics committees (NECs) that issue advisory opinions or research ethics committees (RECs) that review research protocols. This article took this observation as its starting point to consider how ethics committees could support to more accurately assess the consequences of climate change on health, through a lens that focuses on the health of younger and future generations yet within the wider context of ecosystems. From November 2024 to November 2025, the R(H)OPE- The Right To An Open Future - project brought together eight partners based in six countries across four continents. An analysis of the literature and the case studies written by selected partners has led to the formulation of eight recommendations to guide ethics committees, international regulators (WHO, CIOMS, etc.) and ethicists towards adapting the biomedical model. These recommendations add intergenerational responsibility to the consideration of current intragenerational inequalities (Global Ethics) in order to preserve the right to an open future for young people and future generations.
Background:Sex and gender influence infectious disease outcomes through biological and social mechanisms. Gender norms, roles, and behaviors affect exposure, care-seeking, and service access, yet many infectious disease models overlook these factors. Methods:To provide guidance to researchers considering sex/gender in epidemiological models, we propose structured guidelines for developing gender-responsive infectious disease models, adapted from an established monitoring and evaluation framework. Recommendations include: 1) using sex/gender-disaggregated or sex/gender-specific populations; 2) incorporating an additional social stratifier (e.g., age, race/ethnicity); 3) maintaining stratification in results; 4) addressing the needs, rights, and preferences of gender groups; and 5) grounding models in context with participation from target groups. To provide examples, we conducted a scoping review using these criteria, drawing from HIV, COVID-19, and malaria literature. Findings:Of 7303 studies screened, 45 met inclusion criteria. Most modeled HIV (96%), used compartmental (73%) or agent-based (22%) approaches, and included sexual orientation or occupation as an additional stratifier. Studies contextualized their models by discussing local healthcare systems, unequal access to care, stigma, gender norms in partnership dynamics, and occupational risk. Interpretation:Gender-responsive modeling is feasible but uncommon beyond sexually transmitted infections. Applying intersectional, context-specific approaches can reveal disparities and inform equitable, efficient interventions. These guidelines can be adapted to address other health disparities.
Purpose Recognizing normal and abnormal menstrual features is essential for the early detection of gynecologic conditions, facilitating timely medical care and preventing associated biopsychosocial impacts. However, there is limited information on menstrual cycle characteristics, clinical profiles, and education among menstruating adolescents in Puerto Rico, as well as how these factors relate to sociodemographic factors such as age, school type (public/private), region of residence (metropolitan/non-metropolitan and residential zone (urban/rural). Methods This cross-sectional study was designed to assess the menstrual cycle characteristics, symptoms and dysregulations, self-reported menstrual conditions, and sources of menstrual education available to menstruating adolescents across Puerto Rico. An anonymous online survey designed by the study team was disseminated via social media, text messaging, and in collaboration with the Department of Education of Puerto Rico. Differences in the likelihood of receiving education, sources, trusted figures, and level of understanding and comfort regarding menstrual health topics and clinical outcomes (moderate-severe menstrual pain, emergency room (ER) utilization) based on sociodemographics factors were assessed by logistic regressions. Results Analysis of data from 1094 menstruating adolescents showed high rates of menstrual symptoms, particularly severe dysmenorrhea and cycle irregularities, with substantial impacts on daily life. Participants living in urban areas had higher odds of reporting prior menstrual health education. Older participants were more likely to receive information through school classes, social media, and physicians. Students in public schools had lower odds of reporting media and physicians as key sources or trusted contacts. Comfort discussing menstrual health topics increased with age, while perceived understanding of the menstrual cycle did not differ significantly across sociodemographic groups. Moderate to severe menstrual pain was not associated with sociodemographic factors, whereas ER visits varied by age, region, and school type that may determine access to care. Conclusion This study revealed high prevalence of menstrual irregularities and pain among menstruating adolescents, emphasizing the need for improved menstrual health education and implementation of early intervention strategies. Significant disparities in education, trusted figures, comfort and ER utilization across demographics demonstrate the importance of tailoring menstrual health initiatives to address the unique needs of this population.
Purpose:Child survival remains central to achieving Sustainable Development Goals (SDGs) 3 and 10, particularly in sub-Saharan Africa where inequalities in health outcomes persist. This study aimed to predict under-five survival in Southern Africa using advanced machine learning survival models and to examine the influence of household composition, maternal care giving, and unobserved community-level heterogeneity on child mortality outcomes. Methods:A retrospective cohort was constructed using Demographic and Health Survey (DHS) birth-history data from Malawi, South Africa, Zambia, and Zimbabwe. Survival time was measured from birth until death before age five or censoring at the time of interview, with a maximum follow-up period of 59 months. Three survival modelling approaches were evaluated: Random Survival Forests (RSF), DeepHit, and DeepFrailty. The DeepFrailty model incorporated DHS cluster identifiers to account for unobserved community-level heterogeneity. Model performance was assessed using the concordance index (C-index) and Integrated Brier Score (IBS), while calibration analyses and five-fold cross-validation were used to evaluate predictive reliability and model robustness. Results:Survival probabilities remained consistently high across all four countries, exceeding 0.97 throughout the follow-up period. South Africa generally demonstrated the most favourable survival outcomes and lowest mortality risk, whereas Zambia showed comparatively lower survival probabilities and higher cumulative hazard levels over time. Among the evaluated models, RSF achieved the strongest predictive performance across countries, with C-index values ranging from 0.8890 to 0.9458 and IBS values ranging from 0.0062 to 0.0097. DeepHit demonstrated slightly lower predictive performance (C-index: 0.5889-0.8943; IBS: 0.0085-0.0140), while DeepFrailty produced comparatively lower predictive accuracy (C-index: 0.8385-0.9159; IBS: 0.0164-0.0212). However, DeepFrailty provided clearer separation of survival and cumulative hazard curves across countries by capturing latent community-level heterogeneity through the frailty component. Important predictors of under-five survival included "births in the past year", "total number of living children", "total children ever born", "currently breastfeeding", and "birth order", highlighting the importance of household composition, fertility behaviour, and maternal caregiving practices in child survival. Conclusion:The findings demonstrate the potential of machine learning survival models for improving under-five mortality prediction and risk stratification in Southern Africa. RSF emerged as the most accurate and robust predictive model, while DeepFrailty provided valuable insights into unobserved socioeconomic and community-level heterogeneity influencing child survival. The results further emphasise the importance of targeted, context-specific interventions focusing on maternal healthcare, family planning, breastfeeding promotion, and household-level support to improve child survival outcomes. Future work should focus on improving the interpretability of deep learning survival models and incorporating additional contextual information to support evidence-based public health interventions aligned with SDGs 3 and 10.
Background:The rising incidence of diabetes and its complications, particularly diabetic retinopathy (DR), in sub-Saharan Africa presents a significant public health challenge, compounded by a lack of skilled human resources. Artificial intelligence (AI)-based screening offers a promising way to address this burden. Understanding the integration of such complex interventions from research to routine clinical practice is crucial for sustainability. Methods:A qualitative study design was employed using the Normalization Process Theory (NPT) framework, which supports the evaluation of whether an innovation will be sustainable in everyday practice by analysing how new practices become embedded into routine work. Clinical staff and patients involved in AI-based DR screening at three clinics in Kigali, Rwanda were interviewed using an NPT-based questionnaire through semi-structured interviews and focus groups. Verbal consent was obtained for recording and transcription. Interview data were thematically analysed, with codes generated to align with the four NPT constructs: coherence, cognitive participation, collective action, and reflexive monitoring. Findings:In total, nine clinical staff members and 67 patient participants were interviewed. Participants reported a coherent understanding of the program's purpose, value, and benefits. They valued the technology for its ability to address the gap between the scarcity of competent healthcare providers and the growing burden of DR. Challenges identified related to workload, division of labour, initial patient distrust of AI, and restrictive organizational policies regarding operator access. Interpretation:The NPT framework proved valuable for analysing the implementation of this complex intervention, providing insights into user perceptions and generating actionable recommendations for enhancement. While positive adoption was observed, further research is needed to fully understand the intervention's long-term impact on health outcomes such as visual preservation and treatment success. Funding:Fundus cameras were donated by Topcon. The company had no input into the design and/or analysis of the study.
Background:Diabetes mellitus is an important public health challenge worldwide, particularly in low-resource settings where health literacy may be limited. This study assessed perceptions regarding the causes, symptoms, complications, and prevention of diabetes among adult market vendors in Butembo, Democratic Republic of Congo. Methods:A descriptive cross-sectional survey was conducted between March and April 2025 among adult market vendors recruited from seven major markets in Butembo, Democratic Republic of Congo. Data were collected using a pre-tested structured questionnaire administered face-to-face in French or Swahili using KoboCollect software and analyzed using descriptive statistics in IBM SPSS version 20. Results:A total of 433 adults participated in the study. Among them, 334 (77.1%) reported having previously heard of diabetes and were included in the perception analyses. Commonly perceived signs of diabetes included weight loss (64.4%) and chronic fatigue (49.4%). High blood pressure (50.3%) and death (48.5%) were frequently perceived as complications. Healthy diet (49.1%) and regular exercise (37.4%) were commonly identified as preventive measures; however, some respondents also reported spiritual or cultural beliefs such as prayer (28.4%) and poisoning-related beliefs. Most respondents (73.7%) reported knowing someone with diabetes, while 52.1% stated that consulting a doctor would be the preferred response if diabetes was suspected. Conclusion:Participants demonstrated mixed perceptions regarding diabetes, combining biomedical explanations with cultural and spiritual beliefs. These findings highlight the importance of culturally adapted community health education interventions in Butembo.
Purpose:Natural disasters such as earthquakes, cyclones, and volcanic eruptions directly and indirectly impact health and wellbeing. This work aimed to understand how access to, and use of, peripartum health services were impacted following a large 7.3 magnitude earthquake in Vanuatu in the context of an ongoing field trial looking at the effectiveness of universal peripartum antiviral prophylaxis for pregnant women living with hepatitis B to prevent mother-to-child transmission. Methods:Participants were pregnant women enrolled in the intervention-arm of a field trial at sites in the earthquake-affected area. During routine monitoring calls, we asked additional questions about the impact of the earthquake on continued access to health services and continued use of daily hepatitis B antiviral prophylaxis with tenofovir disoproxil fumarate. Results:Seventeen participants of 26 women enrolled in the trial could be contacted and answered all questions from early-February to early-March 2025. Self-reported continued use of tenofovir disoproxil fumarate was high, with only two of 17 participants reporting interruptions to use in the weeks following the earthquake. Seven participants (41%) reported missing at least one routine antenatal or postnatal appointment in the three months following the earthquake. Conclusions:In natural disaster-prone settings, it is critical that field research take an adaptive approach that can adjust and respond to health emergencies. While natural disasters are inevitable, health systems must implement risk mitigation strategies to limit interruptions to routine health services to reduce negative short-, medium-, and long-term health impacts of natural disasters.
