Health seeking behaviour is a key determinant of health outcomes and health system performance, particularly in low- and middle-income countries. Despite Tanzania’s commitment to Universal Health Coverage (UHC), timely and appropriate use of formal healthcare services remains suboptimal. This study assessed patterns and determinants of health seeking behaviour among adults attending health facilities in Ifakara, Tanzania. An analytical cross-sectional study was conducted among 300 adult patients attending St. Francis Regional Referral Hospital and Kibaoni Health Center. Data were collected using interviewer-administered structured questionnaires. Descriptive statistics were used to summarize participant characteristics. Bivariate and multivariable logistic regression analyses were performed to identify factors independently associated with good health seeking behaviour. Statistical significance was set at p < 0.05. Overall, 39.7
Abstract In early 2026, Somalia reached a critical threshold in pediatric malnutrition, with admissions hitting five-year highs. This surge is exacerbated by the simultaneous closure of nearly 500 nutrition clinics due to international funding cuts and a sharp, conflict-driven rise in fuel costs, which has fundamentally severed healthcare access for rural and displaced populations. This perspective examines the “empty shell” syndrome of Somalia’s aid-driven health system, which stems from reliance on off-budget, vertical programming. We analyze the combined mortality rates resulting from the interaction of severe acute malnutrition (SAM) with preventable infectious diseases such as measles and cholera. Addressing the largely overlooked child survival emergency requires a strategic shift from emergency handouts to comprehensive health system integration. We propose urgent interventions, including transport subsidies and the decentralization of stabilization centers, as immediate measures to save lives.
Hepatitis C virus (HCV) infection remains a major public health challenge globally and in South Africa, particularly among key populations such as people who inject drugs (PWID), men who have sex with men (MSM), and sex workers. Despite the availability of curative direct-acting antivirals and point-of-care testing, HCV testing uptake remains suboptimal due to stigma, limited access to services, and ineffective risk communication. Evidence-informed, contextually relevant risk communication strategies are crucial to improve HCV testing uptake among priority populations. This study aims to co-design risk communication strategies to promote HCV testing among key populations in the Johannesburg District, Gauteng Province, South Africa. This study will employ a multi-phase, mixed-methods design guided by the Socio-Ecological Model and principles of Community-Based Participatory Research. Phase 1 will involve a scoping review to map evidence on barriers and facilitators to effective risk communication and HCV testing uptake. Phase 2 will use a cross-sectional design with a crowdsourcing approach to identify existing communication channels and tools. Phase 3 will apply participatory mapping with key stakeholders to co-design tailored HCV risk communication strategies. Phase 4 will use a discrete choice experiment to determine the most acceptable strategies. Data will be analysed thematically in ATLAS.ti and quantitatively in STATA. Ethical approval was obtained from the University of Pretoria’s Faculty of Health Sciences Research Ethics Committee, and permission was granted by the Johannesburg Health District Research Committee. Findings will be disseminated through peer-reviewed publications, policy briefs, conference presentations, and community-friendly outputs.
Abstract This study examines the determinants of socioeconomic status (SES) and their implications for the well-being of structurally vulnerable groups in post-conflict Tigray, Ethiopia, following the 2020–2022 armed conflict. Grounded in a multidimensional SES framework encompassing occupation, livelihood, health, and education, the study adopts a cross-sectional explanatory mixed-methods design. Quantitative data were collected from 590 respondents using multistage sampling with proportional stratification across six severely affected areas. In addition, qualitative data were obtained from 24 key informant interviews, 24 in-depth interviews, and 12 focus group discussions, and were analyzed thematically to support interpretation of statistical findings. Composite SES indices and multiple linear regression were used to identify key predictors of post-conflict socioeconomic outcomes. The results indicate that vulnerability category is the most significant predictor of SES, surpassing the explanatory contribution of demographic factors such as age, sex, and location. Persons with physical disabilities experience the lowest SES outcomes, reflecting long-standing exclusion and mobility constraints. Orphans exhibit mixed outcomes, with partial health improvements linked to humanitarian assistance but declining livelihoods due to household disruption. Older adults face persistent disadvantages associated with cumulative life-course deprivation, while destitute female-headed households show moderate but fragile resilience supported by informal livelihoods and social networks. From a capability-oriented perspective, the findings demonstrate that entrenched structural constraints continue to shape post-conflict inequalities in well-being. The study underscores the importance of targeted, capability-enhancing recovery strategies to improve socioeconomic security and promote inclusive recovery in conflict-affected settings.
This study investigates the relationship between life expectancy (LE) and per capita income (PCI) across 16 major Indian states during 1991–2022. Both variables display steady upward trajectories, with Preston curves confirming their co-movement. Panel econometric analysis using the Westerlund error-correction cointegration test and the CS-ARDL model establishes a stable long-run equilibrium, showing that a one-year increase in LE raises PCI by approximately Rs. 1978.88 in the short-run and Rs. 3139.27 in the long-run. The negative and highly significant error-correction term (− 0.76) indicates rapid adjustment toward equilibrium, while Dumitrescu-Hurlin panel Granger causality tests confirm bidirectional causality between LE and PCI. To capture heterogeneity, the analysis divides the panel into two income-based subgroups. Results reveal that in higher-income states, LE significantly enhances PCI in both horizons, whereas no such effect is observed in lower-income states. These findings underscore the need for differentiated policy action: sustaining the virtuous cycle in richer states through advanced healthcare systems, preventive programs, and social protection, while in poorer states prioritizing equitable access to medical services, effective school-based nutrition programs, and strengthened primary healthcare networks supported by state-level monitoring of centrally sponsored schemes. These operational measures provide concrete pathways for translating longevity gains into inclusive and sustainable economic development across Indian states.
The increasing burden of unintentional injuries among older adults in India poses a serious public health concern. Understanding their magnitude and underlying determinants is essential for developing effective preventive and intervention strategies. This research aims to study the prevalence of unintentional injuries and identify factors associated with unintentional injuries among older adults in India, using the Longitudinal Aging Study in India (LASI) Wave 1. The main data source is LASI, a population-based longitudinal survey. Unintentional injuries, socio-demographic profile, co-morbidity, and medical disorders were used in this study. The analysis methods include logistic regression, Chi-square analysis, and descriptive statistics. Out of the 31,902 older adults analyzed, 12.91
Abstract Background Oral health disparities represent a major but under-prioritized public health challenge in Cameroon. Despite a growing burden of caries, periodontal disease, and tooth loss, oral health remains marginalized within national policy. Understanding the social determinants driving inequities is essential to designing effective, equitable interventions. Objective This scoping review aimed to synthesize available evidence on oral health disparities and their social determinants in Cameroon, highlighting population-level inequities, systemic gaps, and policy implications. Methods Following the PRISMA-ScR guidelines, a comprehensive search was conducted in PubMed and Google Scholar for studies published between 2000 and 2024. Search terms included “oral health”, “dental care”, “Cameroon”, “disparities”, “inequities”, “rural,” “urban” and “socioeconomic”. Eligible studies addressed determinants or inequities in oral health within Cameroon. Data were extracted using a standardized charting framework that covered study design, populations, socioeconomic factors, and key findings. The findings were then synthesized narratively. Results Fifteen studies (2011–2023) were included, spanning urban, rural, semi-urban, indigenous, refugee, and elderly populations, with sample sizes ranging from 73 to 2287 participants. The majority (87%) were cross-sectional. Findings revealed a consistent urban-rural divide, with 93% of dentists concentrated in Yaoundé and Douala, leaving the rest underserved. Financial hardship, long distances, cultural reliance on traditional healers, and lack of insurance were key barriers. Preventive services were rarely accessed, while extractions and symptomatic care dominated treatment. Mid-level providers and NGOs played a critical role in filling service gaps. Policy frameworks remain fragmented, with weak enforcement of Law No. 80 − 09 (1980) and limited integration of oral health into primary health care. Conclusion The review identified consistent patterns of oral health disparities associated with socioeconomic, geographic, and health system factors. Vulnerable groups, including rural children, refugees, and the elderly, face the greatest unmet needs. Addressing these challenges requires expanding insurance coverage, scaling up training for mid-level providers, integrating oral health into primary health care, and implementing context-specific, equity-driven policies aligned with the WHO Global Oral Health Action Plan.
This study investigates the intertwined demographic and epidemiological transitions across Asia’s five regions and empirically examines the association of demographic shifts on the epidemiological transition across 44 Asian nations. Data from 44 Asian nations from 1991 to 2023 was used and retrieved from the World Bank, UN DESA (World Population Prospects 2024), and Global Burden of Disease (1991–2023). Regional aggregates of demographic and epidemiological transitions were visualised using choropleth maps, pyramids, and descriptive statistics (Excel). Lastly, the fixed effects (FE) model was preferred over the random effects (RE) model based on the “Hausman test”. East Asia shows sub-replacement fertility (< 1.3) and ageing pyramids; Central Asia retains high fertility, whereas South Asia faces rapid population growth. Epidemiologically, non-communicable diseases (NCDs) dominate in East and South Asia, with communicable diseases (CDs) declining in South Asia. Injuries show an erratic trend: transport deaths fell in the East Asia region, but self-harm rose in South and Western Asia. Results from the fixed-effects (FE) model indicate that the size of the older population (65+) and GDP per capita (gdppc) are positively and significantly associated with the share of deaths due to NCDs (ncdm), whereas the coefficient of the crude death rate is negative and significant. This integrated regional and panel data analysis reveals Asia’s non-linear transitions, underscoring dual burdens in South Asia and ageing-NCD synergies in East Asia, urging tailored policies for primary care, NCD prevention, and demographic dividends.
Diabetes mellitus is a growing public health concern requiring self-management strategies that extend beyond pharmacological treatment. Food insecurity, limited access to culturally appropriate health services, and broader social determinants of health can undermine diabetes self-management, particularly among marginalized and racialized populations. Although community-based interventions integrating nutritional support, health education, and physical activity have shown promise, limited research has examined participant experiences with culturally tailored diabetes support programs in Canada. Informed by the Social Ecological Model (SEM), this study explored participant experiences with Type Diabeat-it, a Black-led charitable organization addressing diabetes-related health inequities through culturally responsive community-based supports, and examined how its food, fitness, and educational initiatives influenced diabetes self-management and well-being among individuals living with or at risk of diabetes. This qualitative exploratory study utilized interviews (n = 12) and focus group discussions (n = 45), involving 57 participants. Participants included individuals living with Type 1 diabetes, Type 2 diabetes, gestational diabetes, prediabetes, caregivers, and community members without diabetes. Data were analyzed using reflexive thematic analysis supported by NVivo. Six themes emerged. Participants reported improved access to diabetes-appropriate foods, healthier eating practices, increased physical activity, enhanced diabetes knowledge, and stronger motivation for self-management. Consistent with the SEM, participants valued the program’s cultural relevance, sense of belonging, supportive relationships, and community-based resources as important contributors to diabetes self-management. Community organizations like Type Diabeat-it support diabetes self-management by tackling social, behavioral, and structural health factors. Culturally responsive interventions can lower health disparities and prevent chronic diseases.
Infection prevention and control (IPC) is critical in healthcare, yet the unique risks in audiology practice remain underexplored in Ghana. This study investigated the microbial contamination of audiological clinical environment and corresponding knowledge, attitudes, and practices (KAP) of practitioners. A cross-sectional, multi-method design was employed. A KAP questionnaire was distributed to licensed audiologists nationwide via REDCap through the Speech Therapists and Audiologists Association of Ghana (STAAG) WhatsApp platform. Direct observations of seven audiologists were conducted in three selected facilities (two public, one private) in the Greater Accra Region. Using STATA MP14, descriptive analysis was conducted. Swab samples were collected from audiologists’ palms, clothing, work surfaces, and equipment at the selected facilities for microbial culture. Contamination levels were compared using z-test for proportions. The KAP survey of 57 audiologists demonstrated a strong IPC knowledge and positive attitudes. However, direct observations revealed non‑compliance with hand hygiene, PPE use, and disinfection protocols. A weak but significant negative correlation existed between self‑reported and observed practices (r = − 0.263, p = 0.048). Concurrently, microbial analysis of 72 samples identified fifty‑four Bacillus spp. and forty Staphylococcus spp. isolates across both private and public facilities. Mixed bacterial contamination was found on clinicians’ hands (22
Adverse childhood experiences (ACEs) are recognized as a major public health concern due to their long-term impact on health. While global evidence has established strong associations between ACEs and adverse outcomes, research in India remains limited and fragmented. This scoping review aimed to map the prevalence of ACEs in India, identify sociocultural and demographic factors associated with ACEs, and examine their relationship with health outcomes. Following PRISMA guidelines and Arksey O’Malley’s scoping review framework, a systematic search was conducted across PubMed, Scopus, Web of Science, PsycINFO, and Google Scholar for studies published between 2016 and 2026. A total of 52 articles were identified, of which 17 met the inclusion criteria. Data were extracted and synthesized using a narrative approach to identify key themes. The reviewed studies revealed a high prevalence of ACEs across diverse regions and populations in India. Sociocultural and demographic factors were found to increase ACE risk. Boys reported higher physical abuse, violent behavior and substance use, while girls reported more neglect and suicidal thoughts. ACEs were consistently associated with poor developmental, mental, physical and behavioral health outcomes. Moreover, the protective factors were found to moderate the negative impact of ACEs. ACEs are highly prevalent in India and strongly associated with adverse health outcomes, shaped by sociocultural and demographic contexts. There is a need to address research gaps and provide recommendations for public health strategies to reduce childhood adversities in India.
Clinical students face hazards, such as needlestick injuries and blood spills. While healthcare workers’ exposure to such hazards is well-documented, there is limited data on medical students, particularly in Uganda. We explored the prevalence and factors associated with biological occupational hazards among clinical university students. This cross-sectional study examined biological occupational hazards among 384 randomly selected undergraduate clinical medical students at a university in Southwestern Uganda. Data were collected using a structured self-administered questionnaire. Categorical and numerical data were summarised descriptively using frequencies and means. Multivariable logistic regression identified factors independently associated with hazard exposure. Adjusted odds ratios with 95
Fruit consumption plays a critical role in supporting dietary diversity, growth, immune function, and healthy development in children. To meet increasing consumer demand and reduce post-harvest losses, artificial ripening technologies are widely employed in fruit production and distribution. While approved ripening agents such as food-grade ethylene and appropriately applied ethephon can accelerate ripening safely, unauthorized practices—particularly the use of industrial-grade calcium carbide and other non-food-grade chemicals—may introduce contaminants that compromise fruit safety. These contaminants include endocrine-disrupting chemicals, volatile and semi-volatile by-products, heavy metals, quaternary ammonium compounds, microplastics, and polycyclic aromatic hydrocarbons through contaminated ripening agents, food-contact materials, equipment, and post-harvest handling practices. Children are particularly susceptible to these contaminants because of their higher food intake relative to body weight, immature detoxification systems, and critical stages of neurological, endocrine, immune, and reproductive development. This review critically synthesizes current evidence on contaminants associated with artificial fruit ripening, their occurrence, exposure pathways, mechanisms of toxicity, and potential health implications for children. It also examines the effects of unauthorized ripening practices on the nutritional, physicochemical, biochemical, and sensory quality of fruits and discusses strategies to reduce dietary exposure through improved regulation, safer ripening technologies, routine surveillance, and consumer education. The available evidence highlights the need for strengthened regulatory oversight, comprehensive exposure assessment, human biomonitoring, and multidisciplinary research to better characterize cumulative health risks and support evidence-based policies that safeguard children's health while preserving the nutritional benefits of fruit consumption.
Abstract Background Managerial competencies shape how hospitals plan, execute and evaluate care processes, and in this study performance management is understood as the organizational cycle of planning, monitoring, evaluating and developing individual and team performance, whereas managerial competencies are treated as the individual-level attributes that enable managers to operate that cycle. In Brazilian institutional settings, however, the competencies that hospital managers require remain insufficiently characterized in empirical mixed methods studies. Objective To map the technical and behavioral competencies required for healthcare manager positions in a large private Brazilian hospital and to discuss the implications of the resulting profile for performance management practice and workforce development at the organizational level. Methods A mixed methods, exploratory, single-center design combined documentary analysis of internal hospital regulations with a structured questionnaire administered to a convenience sample of 112 healthcare professionals using a four-point Likert-type scale. Institutional documents were selected by predefined criteria and analyzed by both researchers through thematic content analysis, with themes retained by consensus and converted into competency indicators organized according to the Knowledge, Skill and Attitude (KSA) framework. Behavioral competencies were grouped by similarity through the same consensus procedure. An 85% cut-off of the highest score obtained within each KSA dimension was applied to identify core indicators. Results Documentary analysis identified ten institutional attributions of the healthcare manager position. Six core technical knowledge competencies, six core technical skill competencies and six core behavioral competencies were identified, and behavioral competencies were organized into three clusters oriented toward patient care, leadership and team management, and organizational results. Conclusions The study provides a competency profile for healthcare managers that is specific to the studied institution and is not proposed as an externally validated or generalizable measurement instrument. It supports the design of institutional training, recruitment and performance evaluation, and it offers a mapping procedure that comparable hospitals can repeat.
Abstract Depression has been associated with cardiovascular disorders, including stroke. Although, the graded association and the role of antidepressant medication use continue to be uncertain. To examine the link between depression severity (PHQ-9) and stroke, comprising nonlinear effects and interaction with the use of antidepressant. In this study, data was analysed from NHANES 2007–2018 ( n = 35,162), of whom 32,040 participants with complete data were incorporated in the final analysis. Severity of depression was evaluated by using PHQ-9. Self-reported prevalent stroke was the outcome. Odds ratios (ORs) were estimated by survey weighted logistic regression models. Nonlinear associations were evaluated by using natural cubic splines. Greater PHQ-9 scores were significantly linked with augmented odds of self-reported stroke (OR 1.07, 95% CI 1.05–1.09, p < 0.001). Use of antidepressant was independently linked with self-reported stroke (OR 1.74, 95% CI 1.27–2.39). No statistically significant interaction was observed between PHQ-9 score and antidepressant use ( p = 0.061). Natural cubic spline analysis demonstrated a significant overall association between PHQ-9 score and self-reported stroke, with no statistically significant evidence of nonlinearity. Both hypertension and diabetes were strong independent predictors of self-reported stroke, while higher income (PIR) was protective. Severity of depression was independently associated with higher odds of self-reported stroke. These findings highlight an association between depression severity and self-reported stroke history.
Voluntary Medical Male Circumcision (VMMC) is endorsed as an effective HIV prevention strategy. Despite scale-up efforts in Tanzania, uptake remains low in traditional non-circumcising communities, highlighting the need to understand context-specific drivers influencing VMMC uptake. This study aimed to explore facilitators and barriers to VMMC uptake among adult males aged 15–49 years in Bariadi District Council, Tanzania, guided by the Social Ecological Model. A qualitative study design was employed with purposive sampling used to recruit adult men (both circumcised and uncircumcised), VMMC healthcare providers, and a community leader. Data were collected through in-depth and key informant interviews and analyzed using content analysis with the NVivo software. The findings were categorized into individual, community, and facility levels. Key facilitators included knowledge of VMMC’s health benefits, autonomy in decision-making, peer advocacy, community mobilization, positive attitudes of providers, and consistent service availability. Barriers included fear and misconceptions regarding sexual function and fertility, concerns about healing and disruption of daily responsibilities, perceived provider incompetence, time constraints, inconsistent service provision, staff shortages, and lack of age-sensitive services. This study highlights the complex interplay of individual, community, and facility-level facilitators and barriers to VMMC uptake, indicating that effective programs must address these multi-level barriers through accurate information, supportive social environments, and improved service delivery. By applying the Social Ecological Model in the underexplored, predominantly rural Bariadi District, this study fills an important gap in VMMC research, as prior literature has seldom used a comprehensive theoretical framework to examine multilevel determinants or addressed the specific cultural and contextual factors present in such settings. The findings therefore offer transferable, context-sensitive evidence to guide VMMC program design including community mobilization, peer advocacy, provider training, and age-sensitive services in similar low-uptake, non-circumcising communities across sub-Saharan Africa.
The rising burden of abdominal obesity (AO) has emerged as a significant global public health concern. Three commonly used measures for assessing AO are waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). This raises an important question: which of these indicators provides the most reliable assessment of abdominal obesity? This commentary addresses this issue from two key perspectives: (a) comparative evaluation of the strengths and limitations, and (b) understanding the predictive power in assessing cardiometabolic risk of these three indicators. The available evidence suggests that, due to conceptual and clinical limitations, WHR is the least robust indicator of AO among the three. Furthermore, a comparative analysis indicates that WHtR not only overcomes several limitations associated with WC and WHR in estimating AO, but also serves as a more consistent and reliable predictor of cardiovascular risk across children, adolescents, and adults globally.
Infection Prevention and Control (IPC) is essential for resilient health systems and emergency preparedness. In Sierra Leone, inadequate IPC practices during the 2014–2016 West Africa Ebola epidemic catalysed the establishment of a national IPC programme. This review examines a decade of IPC implementation lessons, progress, challenges, and policy implications. We conducted a structured narrative review with targeted literature search (2015–2025). Evidence was drawn from peer-reviewed and grey literature and national reports, including the International Health Regulations (IHR, 2005) core capacity monitoring reports. Searches were conducted in PubMed, Scopus, organisational databases/libraries, Ministry of Health archives, and Google. Quantitative performance scores were benchmarked against regional and global averages, while qualitative data were synthesised thematically to identify lessons learned. The IPC programme demonstrates strong national foundation and achievements that compare favourably with global trends, particularly in similar low- and middle-income countries (LMICs). Policy reforms included expansion of IPC structures, enhanced partnership, integration, and updated policies/strategies and guidelines. Practice improvements were evident in rising IPC performance scores, outbreak response, workforce training, innovation and operational research. Though disparities exist at the healthcare facility level with critical gaps in financing and healthcare-associated infection surveillance, progress has been internationally recognised. Its critical functions during public health emergencies underscored resilience and need to extend IPC beyond health facilities to communities through culturally appropriate risk communication. Important lessons along with key policy implications were systematically reported. This decade review of IPC programme rooted in lessons from the Ebola epidemic, has shown evidence of progressive and sustainable implementation. Providing testament that IPC can be established and scaled even in resource-constrained and vulnerable settings when political commitment and international partnerships align. By embedding both policy reforms and practice improvements, it offers a solid foundation for strengthening healthcare across the continuum with transferable lessons for other LMICs.
Smokeless tobacco use remains a significant public health concern in Pakistan, particularly in rural settings where prevention and cessation efforts remain limited. Existing literature has largely emphasized social normalization, dependence, and barriers to quitting, but does not fully capture the structural drivers of use. This commentary examines the roles of food insecurity and livelihood stress in sustaining smokeless tobacco use in rural Sindh. Evidence suggests that products such as gutka may have appetite-suppressing effects that interact with dietary compromise in food-insecure settings, alongside wider structural pressures including chronic poverty, weak rural health outreach, and climate-related livelihood instability. Prevention strategies focused solely on awareness or regulation are unlikely to be sufficient. More effective responses will require integrating smokeless tobacco screening and brief counselling into primary healthcare and aligning tobacco control with nutrition and social protection interventions.
Cervical malignancy remains a major public health challenge in low- and middle-income countries, with sub-Saharan Africa bearing a disproportionate burden of disease. In Ghana, cervical cancer incidence and mortality remain high despite the availability of effective preventive measures, including human papillomavirus (HPV) vaccination and screening. Knowledge, perceptions, and attitudes influence uptake of cervical cancer prevention services, yet evidence from Ghana remains limited. This scoping review aims to map and synthesize available evidence on knowledge, perceptions, and attitudes toward cervical cancer among Ghanaians. The review will follow the methodological framework outlined by Arksey and O’Malley, enhanced by the Joanna Briggs Institute guidelines for scoping reviews, which will help to strengthen the methodological rigor of the review. A literature search will be undertaken in PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, and African Journals Online (AJOL). Studies published in English between January 2016 and January 2026 will be eligible for inclusion. Search terms: ‘Cervical cancer’, ‘knowledge’, ‘attitudes’, ‘perceptions’, ‘Ghana’ and related syntax will be used to identify literature. Two reviewers will independently screen titles, abstracts, and full texts, with disagreements resolved through consensus. The Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for Scoping Reviews will be used to report the results of this study. Ethical approval is not required for this review, as it will use publicly available data. Findings will be disseminated through peer-reviewed publications, conference presentations, and stakeholder engagement to inform cervical cancer prevention strategies and support progress toward the World Health Organization’s cervical cancer elimination targets in Ghana.
