Objectives To synthesise existing evidence on perinatal health interventions implemented in Australia to improve perinatal outcomes. Study design Scoping review. Methods The scoping review followed Arksey and O'Malley's methodological framework, refined by the Joanna Briggs Institute (JBI), and was reported in accordance with the PRISMA extension for scoping reviews checklist. A systematic search was undertaken in PubMed, Embase, Scopus, Web of Science, and CINAHL for literature published from 01 January 2000 to 30 September 2025, supplemented by grey literature. Structured programs, models of care, and policy initiatives aimed at improving perinatal health outcomes in Australia were included and synthesised narratively. Results Of the 3649 records identified from five databases and grey literature, 59 studies were included. Observational cohort designs were the most common (18; 30.5%). Most studies (31; 52.5%) were conducted in New South Wales, Victoria, and Queensland, and a few (8; 13.6%) in remote settings. Midwifery continuity-of-care models were the most frequent interventions (16; 27.1%), followed by clinical and biomedical risk-targeted interventions (15; 25.4%). Preterm birth (12; 20.3%) was the most reported outcome. In 52.5% of studies, authors reported improvements in maternal and neonatal outcomes. Only (23; 39%) studies were specifically targeted at Aboriginal and Torres Strait Islander women. Implementation and sustainability plans were reported in (30: 50.8%) studies. Conclusions Continuity models of care and risk-targeted interventions were associated with improved perinatal outcomes. However, most evidence comes from metropolitan settings; evidence from remote areas, where the burden is greatest, remains uncertain. Equitable progress will require culturally appropriate and community-led models of care in regions of greatest need.
Objectives The objective of this study is to investigate urban Water, Sanitation and Hygiene (WASH) service gaps, their socio-demographic determinants, and public health and policy implications in Ethiopia Study design Cross-sectional mixed methods study design was conducted. Methods A survey of 384 purposively selected urban households across 16 cities in eight regions and one city administration was conducted using multi-stage stratified sampling. Data was collected via structured questionnaires, 38 institutional surveys of water utilities, 25 key informant interviews, and 70 focus group discussions. Quantitative data were analysed with descriptive statistics, chi-square tests, and binary logistic regression (SPSS v25); qualitative data underwent thematic analysis with methodological triangulation. Results Although 87.8% of households used piped water, 71.2% faced access barriers, 71.4% experienced intermittent supply, and 48.7% consumed <20 L/capita/day. Sanitation relied on pit latrines (80.3%), but 62.4% had never been emptied. Only 26.9% of households had both water and soap at handwashing stations. Significant associations existed between household tenure and sanitation quality (χ2 = 14.82, p = 0.001), gender and hygiene access (p = 0.013), education and handwashing facilities (OR 2.32, 95% CI 1.52–3.54, p < 0.001), and female-headed households and handwashing (OR 1.66, 95% CI 1.10–2.51, p = 0.015). Conclusions Urban WASH failures exacerbate water-washed and fecal-oral disease risks and violate constitutional rights to a clean environment. Strengthened infrastructure, equitable service delivery to informal settlements, fecal-sludge management, and hygiene subsidies are urgently required.
Objectives Adolescent pregnancy has well-documented socioeconomic consequences, yet its long-term associations with adult mental health remain underexplored. This study examines associations between adolescent pregnancy outcomes (live birth, miscarriage, abortion) and adult depressive symptoms, exploring substance use and socioeconomic attainment as potential pathways. Study design Prospective longitudinal cohort study using a nationally representative sample of US women (n = 6163) followed from adolescence into adulthood. Methods Using four waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we estimated lagged dependent variable regression models with school fixed effects to address baseline differences and unobserved school-level confounding. Cigarette smoking, binge drinking, educational attainment, and personal earnings were tested as mediators via delta-method mediation analysis. Results Adolescent miscarriage (β = 0.645, 95% CI: 0.106, 1.183) and live birth (β = 0.365, 95% CI: 0.104, 0.627) were associated with elevated adult depressive symptoms in fully adjusted models, corresponding to approximately 25% and 14% of the outcome standard deviation, respectively. The association for abortion was not statistically significant. Educational attainment and cigarette smoking emerged as statistically significant mediators. Joint indirect effects accounted for 0.091 (95% CI: 0.023, 0.160), 0.099 (95% CI: 0.032, 0.166), and 0.126 (95% CI: 0.082, 0.169) for miscarriage, abortion, and live birth, respectively, corresponding to roughly 14%, 30%, and 35% of the total effect. Conclusions Adolescent pregnancy is associated with elevated adult depressive symptoms, particularly for miscarriage and live birth. Part of these associations was accounted for by educational disruption and increased substance use. Public health efforts should prioritize prevention of social disadvantage, early identification of at-risk adolescents, and integrated reproductive and mental health services for young women who experience adolescent pregnancy.
Objectives To develop and validate a hybrid, equity-focused artificial intelligence (AI) framework for predicting and analysing postnatal care (PNC) uptake among women in Ghana, with emphasis on minority-class sensitivity, model interpretability, and actionable intervention insights. Study design Cross-sectional, secondary analysis of nationally representative survey data. Methods Using data from the 2022 Ghana Demographic and Health Survey (n = 3314), we developed a hybrid AI framework combining ensemble learning (Logistic Regression and Support Vector Machine with soft voting and threshold tuning), explainable AI (SHAP analysis), counterfactual reasoning (DiCE), and causal inference (doubly robust estimators for average and conditional average treatment effects). The Synthetic Minority Over-Sampling Technique (SMOTE) was applied to address class imbalance and stratified 5-fold cross-validation was used for model evaluation. Doubly robust causal inference was conducted using the econml library, with propensity score modelling used to account for treatment assignment, and positivity and exchangeability assumptions assessed through covariate overlap diagnostics. Results The ensemble model calibrated at a threshold of 0.45 achieved a Class 0 recall of 0.31 and an area under the precision-recall curve (AP) of 0.97, outperforming all individual baseline classifiers. SHAP analysis identified maternal age, education level, wealth status, caesarean section, and sex of household head as the most influential predictors of PNC non-utilization. Counterfactual analysis revealed that minimal, actionable changes including increased media exposure, improved educational attainment, or change of residence could shift individual predictions from non-utilization to utilization of PNC. Causal inference demonstrated significant heterogeneity in treatment responsiveness, with women aged 25–34, those with secondary education or above, urban residents, and those in female-headed households exhibiting the highest conditional average treatment effects. Conclusions This interpretable, fairness-aware AI framework advances the prediction and analysis of PNC uptake in Ghana. By prioritizing sensitivity to underserved women and integrating explainability, counterfactual reasoning, and causal inference, the framework provides empirical evidence for targeted, equitable maternal health interventions and is transferable to other low- and middle-income country settings.
