Mpox (monkeypox) poses disproportionate risks to pregnant women and children, yet evidence on immunisation and prevention in these groups remains limited. This scoping review mapped and synthesised existing evidence on vaccines and non-pharmaceutical preventive measures for mpox in pregnant women and children, to assess reported effectiveness, and to identify implementation barriers and facilitators. Peer-reviewed and Grey literature were searched in PubMed, Scopus, and Google for records published since 2008; databases were last searched on 19 September 2025. Screening and data extraction followed a pre-specified protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework. Key themes included immunisation strategies, preventive measures, effectiveness, barriers, and facilitators. Forty-eight peer-reviewed articles and 16 Grey literature sources were included. Third-generation non-replicating vaccines (MVA-BN/JYNNEOS/Imvanex/IMVAMUNE) were consistently recommended for pregnant women and children because of their favourable safety profiles. Observational and programmatic estimates of vaccine effectiveness (single dose 36-86%; two doses up to approximately 89%) came almost entirely from adults, and no effectiveness estimate specific to pregnant women or children was identified. No source reported vaccine use by trimester, and paediatric data were limited to small studies. Ring vaccination and post-exposure prophylaxis (PEP) were supported mainly by adult data. Major barriers included limited vaccine supply and cold-chain and logistical constraints in low- and middle-income countries (LMICs), vaccine hesitancy driven by safety concerns, particularly in pregnancy, and the absence of randomised trials in pregnant women and children. Few sources were centred on Africa or other LMICs. Facilitators included international coordination, targeted surveillance, flexible delivery strategies such as intradermal dosing, and integration with maternal and child health services. Priorities include prospective safety and immunogenicity studies in pregnancy and childhood, equitable vaccine access in LMICs, and tailored risk communication to address hesitancy.
Epidemic and pandemic preparedness relies on multi-sectoral coordination, a competent workforce, and well-defined preparedness functions. In the Middle East and North Africa (MENA) region, preparedness is shaped by diverse health system capacities, political contexts and recurrent crises. Despite recurrent outbreaks in the region, limited regional-level evidence exists on who is involved in preparedness and how different roles are distributed across preparedness domains, as well as countries and income settings. This cross-sectional stakeholder mapping study identified stakeholder roles, affiliations, and organizations involved in epidemic and pandemic preparedness across 22 MENA countries. Using publicly available online sources, stakeholder roles were systematically identified and categorized according to the European Centre for Disease Prevention and Control (ECDC) public health emergency preparedness framework. Records were analyzed by preparedness domain, workforce category, organizational affiliation, country, income level, and gender. A total of 3555 stakeholder roles were identified across the region. Roles were predominantly classified under coordination and communication (38.4%) and health services (32.0%), while emergency risk communication (4.1%) and policy development, adaptation, and implementation (6.6%) were the least represented domains. Emergency management roles constituted the largest workforce group (42.6%), followed by public health professionals (28.3%) and clinicians (19.4%). Significant variation was observed across country income levels, including differences in preparedness domains, workforce categories, organizational affiliation, and gender distribution. Records associated with women accounted for 31.5% of the total roles, with their representation varying across income groups. Preparedness-related roles were identified across the MENA region but vary in their distribution across domains, workforce categories, and countries. The greater representation of records in operational roles, alongside limited representation in policy development and emergency risk communication, highlights differences in the publicly identifiable preparedness landscape across functions. These findings provide a regional descriptive overview that can inform future validation, stakeholder engagement, and capacity-building efforts across the MENA region.
Shoulder injuries are prevalent among working populations and may significantly delay return to work (RTW). Identifying predictors of successful RTW is crucial for designing effective interventions. This study aimed to assess the RTW status and its determinants among patients with shoulder injuries. In this retrospective cohort study with prospective follow-up, 340 patients with shoulder injuries— such as acromioclavicular joint dislocation, clavicle fractures, and shoulder instability—treated between 2016 and 2020 were included. Data were obtained from medical records and structured telephone interviews. Demographic and clinical variables, health-related quality of life (SF-12), and perceived support from employer and colleagues were assessed. Multivariate logistic regression was used to identify predictors of RTW. Among 340 participants, 67.9% returned to their previous job, 14.1% returned with modifications, 14.4% obtained new employment, and 3.5% did not return to work. Multivariate analysis showed that coworker support (OR=1.88, p < 0.001) was positively associated with RTW, whereas lower employer support (OR=0.585, p < 0.001), lower SF‑12 scores (OR=0.895, p = 0.023), and white‑collar occupation (OR=0.015, p < 0.001) were associated with reduced likelihood of RTW. In addition, health insurance coverage and certain injury types were significantly related to RTW outcomes. RTW after shoulder injuries is mainly influenced by multiple occupational, clinical, and psychosocial factors. Workplace support, overall health status, and job characteristics play important roles in facilitating occupational reintegration. Strengthening rehabilitation programs and workplace support systems may improve RTW outcomes among injured workers.
Rotavirus vaccination (RVV) has substantially reduced childhood diarrhoeal morbidity and mortality globally. However, interest in neonatal or birth-dose schedules is increasing to provide earlier protection and potentially reduce intussusception risk. Understanding barriers and implementation challenges of current RVV and other birth-dose vaccines (BDVs), including hepatitis B birth dose, Bacillus Calmette-Guérin, and oral polio vaccine, is essential to inform this transition in low- and middle-income countries. This review therefore aims to examine the supply- and demand-side factors influencing the uptake, timeliness, and implementation of RVV and BDV in low- and middle-income countries. A scoping review was conducted across PubMed, Scopus, Cochrane, and grey literature from Portal Garuda from database inception to 5 March 2025. Original studies assessing determinants, enablers, and barriers of any BDV or RVV implementation, uptake, or timeliness were included. An analytical framework was developed inductively to classify factors as supply- or demand-side and was refined through discussions among reviewers. From 8,502 identified records, a total of 93 articles were included in the review. Identified supply-side enablers and barriers encompassed domains related to policy and governance, health system capacity, healthcare accessibility, and programmatic interventions. On the demand side, key enablers included higher caregiver education, higher socioeconomic status, health facility birth, and older maternal age, whereas major barriers included home birth, lower socioeconomic status, rural residence for BDV, and incomplete or delayed uptake of other routine vaccinations for RVV. Implementation and uptake of BDV and RVV were influenced by both supply- and demand-side factors, including policy support, health system capacity and access, targeted interventions, and socioeconomic disparities in vaccine uptake. Transitioning from infant-dose to birth-dose RVV will require addressing existing implementation challenges and ensuring timely vaccination at birth to achieve equitable coverage.
Gutka, a commercially prepared smokeless tobacco product, is widely consumed in Pakistan and poses significant public health risks, including oral cancer and other chronic conditions. Cloth shopkeepers represent a particularly vulnerable occupational group due to long working hours, affordability pressures, and high-exposure social environments. This study aimed to examine the multi-level drivers of gutka initiation and sustained use among cloth shopkeepers in Karachi using a socioecological framework and to understand participants’ perceived health impacts and perspectives on existing public health and regulatory interventions. A qualitative exploratory study was conducted with 25 male cloth shopkeepers recruited from five markets across Karachi using quota sampling. In-depth interviews were conducted within participants’ workplace settings. Data were analysed using an inductive-deductive thematic analysis approach guided by the socioecological framework. Ethical approval was obtained from the Aga Khan University Ethics Review Committee. Four overarching thematic categories emerged across 12 sub-themes. At the individual level, participants demonstrated awareness of gutka's health risks, yet continued use through cognitive rationalisation, psychological and physical dependence, early initiation in adolescence, and affordability. At the interpersonal level, peer and family influence during formative years and within the workplace drove initiation and sustained use through normalisation. At the community level, gutka use was deeply embedded in market culture, with widespread social acceptance and unrestricted accessibility through informal supply networks. At the policy and structural level, participants described a clear policy-practice gap, with regulatory bans perceived as ineffective due to systemic corruption, advance raid warnings, and adaptive supply and consumption strategies that circumvented enforcement. Gutka consumption among cloth shopkeepers in Karachi is a complex, multi-determined behaviour sustained by addiction, social normalisation, affordability, and structural failures in regulation. Effective control requires strategies that simultaneously strengthen enforcement, address informal supply networks, provide accessible cessation support, and tackle deep-rooted social norms within occupational settings.
