Background:Although combined first trimester screening is effective at detecting fetal chromosomal anomalies which are trisomy 21, 18 and 13, there is scarce data on its practice and practice in low-income countries. This study presents data on clinical use of combined first trimester prenatal screening tests among pregnant women in a Sub-Saharan setting. Methods:This retrospective study was conducted over 7 years between July 2016 and June 2023 at St. Paul's Hospital Millennium Medical College (Ethiopia). Risk assessment was done with Snibe 2000 software using maternal age, nuchal translucency, PAPP-A, β-hCG and other maternal characteristics. Statistical analysis was done using SPSS version 22. Fishers exact and Man Whitney U test were done as appropriate, and P-value less than 0.05 was used to present significance of the results. Results:A total of 141 patients were included in the final analysis. Overall high-risk cases for aneuploidy based on the combined test was 24.8%. Screening positive for aneuploidy had an association with increased nuchal translucency [median (IQR) = 2.1 (1.7, 2.5) for screening negative vs 2.9 (2.4, 2.9) for screening positive test, p-value = 0.021] and low PAPP-A values ≤ 0.05 MoM (1 (5%) for negative and 5 (56%) for positive, p-value = 0.005). Conclusion:The prevalence of screening positive for high-risk aneuploidy in this study was higher than in previous reports which may be due to the fact that the study population is primary high-risk women. Nuchal translucency and low PAPP-A values were associated with screening positive for aneuploidy. Combined first trimester screening is feasible and effective for detecting fetal chromosomal anomalies in low-income settings. Laboratory capacity for performing serum analytes and genetic testing, and availability of nuchal translucency ultrasound services should acted up on for creating a wider access to such vital prenatal genetic screening and testing services.

BackgroundThe E-MOTIVE bundle that includes objective measurement of early blood loss has been found to be effective in the early detection and management of PPH and the reduction of maternal mortality because of PPH. The aim of this study was to determine the perception of trained health professionals toward the E-MOTIVE bundle intervention for PPH as well as to explore perceived barriers to its implementation in Ethiopia.MethodsThis mixed-methods study was conducted at Saint Paul's Hospital in Addis Ababa, Ethiopia, from February 1, 2024, to May 31, 2024. Data were collected from 80 health professionals using a structured questionnaire for the quantitative component, and seven in-depth interviews (IDIs) were conducted for the qualitative component with stakeholders working in maternal health. Quantitative data analysis was performed using SPSS Version 23.1, whereas qualitative data were analyzed thematically using ATLAS.ti Version 7.0.71. Written consent was obtained from study participants.ResultsOnly 21% of the health professionals had heard of E-MOTIVE prior to the training. More than 90% of the health professionals and all of the participants of the IDIs believed that the E-MOTIVE bundle comes with a novel approach for early detection of PPH and is feasible and acceptable. Most perceived that the E-MOTIVE approach is easy to understand and motivating for staff. The major perceived barriers to the implementation of the bundle were as follows: the huge resource implications of the bundle (85% of respondents), the need for increased clinical engagement (66%), increased labor ward stays of mothers (35%), and the need for more clinical documentation (38%). Other barriers cited by IDI participants were as follows: the potential for creating a displeasing labor and delivery setup, unavailability of the blood collection drapes and challenges with their local production, concern about the cultural acceptability of the drapes, and the need to align with national guidelines on PPH management.ConclusionsThe E-MOTIVE bundle approach for PPH management is feasible and acceptable. However, its successful implementation hinges on coordinated efforts to incorporate it into guidelines, overcome resource limitations, and implement behavior change strategies targeted toward healthcare professionals and delivering mothers.

October 5, 2025, saw the launch of first-ever consolidated postpartum hemorrhage (PPH) management guidelines issued by three global health agencies-World Health Organization (WHO), Federation International of Gynecologists and Obstetricians (FIGO), and International Confederation of Midwives (ICM)-at the FIGO congress in Cape Town, South Africa. This landmark XXV FIGO 2025 congress also hosted inauguration of two vital pledge walls-"End PPH" and "Safe abortion saves women. Denial takes them." These pledge walls represent a commitment to initiatives of end two leading causes of maternal mortality at global level, which are PPH and unsafe abortion. We call on WHO and FIGO-in collaboration with Society of Family Planning (SFP) and other guideline-setting bodies-to convene a similar harmonization and process and issue a consolidated, consistent abortion care guidelines to reduce contradictory recommendations and improve uptake of evidence-based recommendations.

Social media has emerged as a valuable source of patient-generated data, offering insights into the lived experiences of individuals with endometriosis. While social listening research provides important perspectives on pain, treatment decisions, and community support, the interpretation of online narratives requires careful consideration. Experiences shared publicly may not fully represent the broader endometriosis community, as individuals with particularly distressing or positive experiences may be more likely to post, while others may remain silent because of privacy concerns, stigma, or personal preference. Furthermore, peer narratives can complement clinical expertise but may also contribute to the dissemination of incomplete or non-evidence-based health information, potentially influencing treatment decisions and disease management. The role of social media algorithms also warrants attention, as algorithmic amplification may increase the visibility of emotionally engaging or controversial narratives over nuanced medical information. Nevertheless, social media remains an important space for understanding how patients articulate symptoms, interpret medical advice, and navigate chronic illness while reducing isolation and stigma. We propose viewing social media as both a source of patient experience and a dynamic environment where experiences and health information are negotiated. Triangulation with qualitative interviews, clinical data, and participatory methods may strengthen its contribution to patient-centered endometriosis research.

Although the South-South Cooperation has been recognized as a vital component of the sustainable development goals, there are too few articles that document the benefits of such a collaboration with most of them focused on research and none of them focused on describing capacity building among health professionals nor on health system strengthening through South-South Cooperation. This article covers the importance of healthcare professionals' educational and capacity building exchange programs in the global South.

The world has recently celebrated the International Conference on Population and Development (ICPD) 1994 in Cario, which transformed global thinking on population and development issues by prioritizing inclusion of reproductive rights; empowering women and girls; and addressing inequalities in nations’ development agenda. A Joint Statement at the UN General Assembly Meeting marking the 30th Anniversary of this vital conference called that the march towards a peaceful, equitable, just, and sustainable future continues by ensuring no one is left behind. Today, youth engagement in sexual and reproductive health (SRH) in developing countries remains low in spite of the call for nations to meet the educational and service needs of adolescents and youth to enable them to deal in a positive and responsible way with their sexuality and health (one of the bold layouts of the landmark ICPD). Current evidence on youth engagement in SRH shows that there are some effective interventions implemented in African countries so far that appear creative and encouraging, but they are also fragmented and poorly documented in terms of research. There are too few studies that looked into implementation of effective and pragmatic approaches on this topic. Africa should improve its investments in youth sexual and reproductive health interventions with their full participation.

Ultra-processed foods (UPFs), operationalized primarily via the NOVA classification, can be treated as a planetary nutrition “nexus exposure” because they are measurable at population level, show recurring observational associations with common mental disorder-related outcomes, and are plausibly linked to food-system externalities through shared upstream drivers such as industrial formulation, marketing power, and value chains optimized for shelf stability and high turnover. This narrative review integrates evidence across three domains: (1) UPF consumption and mental health outcomes, (2) UPF-related environmental footprints with explicit attention to system boundaries and post-farm stages, and (3) policy levers capable of shifting exposure environments while centering equity and monitorability. Across observational syntheses, higher UPF intake is consistently associated with worse profiles for depressive outcomes, anxiety-related outcomes, and non-specific psychological distress, with prospective cohorts strengthening temporal ordering for depressive outcomes while residual confounding and reverse causality remain plausible. Mechanistic interpretation is therefore framed as plausibility rather than proof, with convergent pathways including diet quality displacement, food structure and satiety dynamics that promote overconsumption and metabolic shifts, gut-related pathways, and inflammatory phenotypes, while UPF-specific mediation evidence in humans remains limited. Environmental evidence suggests UPF-rich diets are often linked to higher dietary footprints in unadjusted comparisons, but conclusions depend on total energy intake, substitution patterns, and whether footprint accounting includes post-farm stages such as processing and packaging, which can materially change inferences. Policy implications favor coordinated packages that shift defaults and incentives, including fiscal measures, marketing restrictions, interpretive front-of-pack labeling supported by nutrient profiling, and procurement standards, implemented with equity safeguards and accountability systems that track substitution pathways, distributional effects, mental health indicators where feasible, and multi-indicator environmental outcomes using transparent value-chain boundaries. This integrated framing supports precautionary action to reduce default UPF exposure while strengthening evaluation systems designed to detect trade-offs and real-world co-benefits.

Background : Infertility is a global health concern, often requiring in vitro fertilization (IVF). A key decision in IVF is choosing between fresh embryo transfer (ET) and frozen embryo transfer (FET). Advances in cryopreservation have shifted preference towards FET, yet debates about its comparative effectiveness persist. This study compares the success rates of IVF following fresh versus frozen ET at a Center for Fertility and reproductive medicine in Sub-Saharan Africa setting. Methods : This was a retrospective cohort study conducted at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Data from women undergoing fresh and frozen ET between January 1 and December 31, 2023, were analyzed. Variables included sociodemographic factors, infertility causes, treatment protocols, and pregnancy outcomes. The primary outcomes measured were biochemical pregnancy rates, clinical pregnancy rates, and live birth rates. Results : A total of 292 women were included, with 149 undergoing fresh ET and 143 undergoing frozen ET. The mean age of women in fresh cycles was 32.6 years, compared to 31.7 years in frozen cycles. Female factor infertility was the most common cause in both groups, with higher prevalence in the frozen group (55.9% vs. 45.6%, p = 0.013). FET cycles showed better outcomes, with 74.1% of embryos graded as "best" compared to 61.1% in fresh cycles (p = 0.014). FET also required less gonadotropin (2558.2 IU vs. 3030.7 IU, p = 0.024) and yielded more mature follicles and oocytes (p < 0.001). Positive biochemical pregnancy rates were higher in the frozen group (61.3%, p < 0.001). Conclusions : FET is associated with higher pregnancy rates, improved embryo quality, and reduced gonadotropin requirements compared to fresh ET. These findings support FET as a preferred approach in IVF, particularly for high responders and those at risk of ovarian hyperstimulation syndrome. Further research is needed on its long-term outcomes.

The WHO World Malaria Report 2025 highlights growing artemisinin resistance, with Nigeria bearing the world’s highest malaria burden at risk. Although no validated resistance markers were found, non-canonical mutations correlate with delayed parasite clearance. The report urges Nigeria to implement multiple first-line therapies, expand surveillance, and diversify policy urgently.

Background:Global surgery is intended to guarantee that all people can access safe, timely, and affordable surgical, obstetric, and anesthesia care, but wide disparities remain, mostly in low- and middle-income countries (LMICs). When the 17.9 million annual preventable deaths from surgical conditions are considered, the LDCS face a debilitating deficit of personnel, infrastructure, and policy-required backing. Mitigating these disparities calls for a comprehensive approach, which includes education, research, and policy. Methods:This perspective article reviews findings distilled from the global health literature, policy papers and reports, and leading initiatives such as the Lancet Commission on Global Surgery, National Surgical, Obstetric, and Anesthesia Plans (NSOAPs), and academic partnerships. It reviews pressing issues and solutions aimed at workforce development, research equity, and systems-level policy change. Results:Despite emerging awareness of the importance of surgery in universal health coverage, major gaps remain. Over 20% of public health practitioners lack fundamental knowledge of global surgery, and LMICs produce a minority of surgical research, reinforcing dependence on high-income country (HIC) frameworks. Successful interventions include integrating global surgery into public health curricula, fostering academic "twinning" partnerships, supporting South-South collaborations, and leveraging digital innovations like tele-mentoring and AI-based tools. NSOAPs have shown promise in driving national reforms but remain underfunded and unevenly implemented. However, integrated approaches also face practical challenges, including variable political commitment, competing health priorities, and limited absorptive capacity within under-resourced systems. Conclusion:Bridging global surgical inequities demands a coordinated, decolonial approach linking education, research, and policy. Building local capacity, prioritizing LMIC leadership, and embedding surgical care within broader health systems are essential to achieving sustainable, equitable progress. Global surgery must evolve from fragmented efforts into a cohesive movement that views surgical care as a fundamental human right. Future work should articulate clearer stakeholder-specific strategies, particularly for governments, academic institutions, NGOs, and funders, to ensure that integrated approaches translate into actionable, context-appropriate reforms.

Background:Nonepithelial ovarian cancers (NEOCs) comprise a group of uncommon malignancies which can be challenging to treat. This broad term includes germ cell tumors, sex cord-stromal tumors, and rare types of ovarian cancer, such as small-cell carcinomas and sarcomas. It is imperative that these rare tumors are managed with accurate diagnosis, staging, and treatment in order to optimize patient outcomes. The aim of this study was to describe the prevalence, pathology, and therapeutic interventions for NEOC in a Sub-Saharan African setting. Methods:This is a 5-year retrospective review of NEOC cases managed at St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia, from September 2016 to September 2020. Data on NEOCs including clinical presentation, pathology, therapeutic interventions, staging status, type of surgery, histological subtype, and current disease status were extracted from patients' records. Data were collected using a structured data extraction format. Data were analyzed using Stata release 15 (College Station, TX: StataCorp LLC). Results:The prevalence of NEOC was 17.3% (80 out of 264 cases of ovarian cancer). Among the types of NEOC, sex cord-stromal tumors were most common (46.2%) followed by germ cell tumors (43.8%). Of the germ cell tumors, yolk-sac tumor was the common histologic subtype, representing 15% of all NEOC cases. Sixty-five percent of cases were managed with staging surgery while 27% underwent fertility sparing surgery. There was no statistically significant association between patients' age and type of tumor (p = 0.08). Conclusion:In this study, the prevalence of NEOC was 17.3%, which is higher than in other previous reports in the literature. Yolk-sac tumor was the most common histologic subtype among germ cell tumors.

ABSTRACT Background Achievement of an efficient and equitable health care system through coverage of health insurance is an important instrument to break up the vicious circle of poverty and ill health. This study sought to determine the impact of community‐based health insurance (CBHI) on catastrophic health care expenditure in Addis Ababa region of Ethiopia. Methods We conducted a cross‐sectional study on the impact of utilizing community‐based health insurance (CBHI) among patients who received care at a tertiary institution in Ethiopia over 2 months (April and May 2023). Data were collected using a structured questionnaire. Data were analyzed using SPSS version 20. Simple descriptive statistics, Chi‐squared test, and multivariate regression analysis were employed as appropriate. P‐value less than 0.05 and Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI) were used to determine statistical significance. Results Among 260 study participants included in the study, two‐thirds (168, 64.6%) were enrolled in CBHI, while about one‐third were not (92, 35.4%). Compared to CBHI non‐members, members of CBHI had less catastrophic health care expenditure (68.8% vs. 53.5% CBHI for CBHI non‐members and CBHI members respectively, p‐value = 0.039). Multivariate regression analysis revealed that community‐based health insurance (CBHI) members (AOR = 0.4, 95% CI = 0.25–0.83) were 60 percent less likely to have catastrophic health care expenditure compared to those that are CBHI non‐members. Conclusion In this study, utilization of community‐based health insurance was found to be protective against catastrophic health care expenditure to a certain extent, which requires further justification whether this is true at the country level by conducting a similar large multicenter study.

Community-based health insurance (CBHI) has been shown to improve access to essential health services, including maternal and child care, in low- and middle-income countries. However, its implementation across Africa remains limited. This commentary examines the role of CBHI in advancing universal health coverage in Africa, identifies barriers to its wider adoption, and proposes strategies to overcome them.

[This corrects the article DOI: 10.1016/j.xagr.2025.100588.].

Background:Despite existing overwhelming evidence on the effectiveness and safety of vasectomy as a permanent method of family planning, its use worldwide has been declining over the last 5 decades. Currently, there are several studies on knowledge and acceptance of vasectomy in Ethiopia from the client-side (men). In this study, we investigated knowledge, attitude, and practice of vasectomy among family planning providers in Ethiopia. Methods:We conducted a descriptive survey study on knowledge, attitude, and practice of vasectomy among family planning providers in Ethiopia at St. Paul's Hospital Millennium Medical College over 2 months (from September 1, 2024, to October 30, 2024). Data were collected prospectively using a structured self-administered questionnaire. Data were analyzed using SPSS version 23. Simple descriptive statistics were employed to analyze the data. Results:We approached 100 family planning providers, and 90 of them completed the response, making a response rate of 90%. Majority of the participants were obstetrics and gynecology resident physicians constituting 70% (63/90) followed by midwives who accounted for 13.3% (12/90). Seventy-eight (86.7%) and 46 (51.1%) out of the 90 participants had good knowledge and favorable attitude towards vasectomy, respectively. Only 7 (7.8%) out of the total had good practice. The mean scores for knowledge, attitude, and practice were 80%, 50%, and 20%, respectively. Conclusion:Despite good knowledge and favorable attitude of family providers towards vasectomy in our study, significant gap was identified in the practice of vasectomy (less than 1 in 10 of the providers included in the study had good practice of vasectomy).

The world has recently celebrated the 1994 International Conference on Population and Development in Cario, which transformed global thinking on population and development issues by prioritizing the inclusion of reproductive rights, empowering women and girls, and addressing inequalities in nations’ development agenda. A joint statement at the United Nations General Assembly meeting marking the 30th anniversary of this crucial conference called that the march toward a peaceful, equitable, just, and sustainable future continues by ensuring no one is left behind. To date, youth engagement in sexual and reproductive health in developing countries remains low despite the call for nations to meet the educational and service needs of adolescents and youth to enable them to deal in a positive and responsible way with their sexuality and health (one of the bold layouts of the landmark International Conference on Population and Development). Current evidence on youth engagement in sexual and reproductive health shows that there are some effective interventions implemented in African countries that seem creative and encouraging. However, in terms of research, the interventions are fragmented and poorly documented. There are too few studies that looked into the implementation of effective and pragmatic approaches on this topic. Africa should improve its investments in youth sexual and reproductive health interventions with their full participation.

BACKGROUND: Postpartum hemorrhage continues to be a leading cause of maternal mortality globally. Although the E-MOTIVE bundle is an innovative approach for the early detection and management of postpartum hemorrhage that reduces maternal mortality by as high as 60%, its universal implementation in clinical practice in low-middle-income countries remains low. OBJECTIVE: This study aimed to determine the effectiveness and acceptability of the E-MOTIVE bundle intervention in Ethiopia. STUDY DESIGN: This was an implementation research on the E-MOTIVE bundle intervention for the early detection and treatment of postpartum hemorrhage using a mixed-method study design (pre- and postintervention quantitative study and cross-sectional qualitative study) in Ethiopia for over 22 months (June 2023 to February 2025). The primary outcome of the study was the rate of severe postpartum hemorrhage. The secondary outcomes were the detection of postpartum hemorrhage complications (such as blood transfusion, maternal death, admission to a high-dependency unit, and estimated blood loss) and the acceptability of the E-MOTIVE bundle approach. The participants of the quantitative study included pregnant women who delivered vaginally at St. Paul’s Hospital during the study period. Participants of the qualitative data were postpartum women who had the E-MOTIVE bundle approach applied during delivery, obstetrical care providers, maternity care coordinators, and representatives of nongovernmental organizations who focused on maternal care delivery. Quantitative data (including the characteristics of the E-MOTIVE bundle approach, occurrence of postpartum hemorrhage, and postpartum hemorrhage complication) were collected using a structured questionnaire, and qualitative data were collected using key informant interviews and focus group discussions (in-depth interviews and focused discussions focusing on the E-MOTIVE experience, attitude, and practice were conducted). Quantitative data were analyzed using simple descriptive statistics on IBM SPSS Statistics (version 23; IBM Corporation, Armonk, NY), and qualitative data were analyzed using thematic analysis on Scientific Software (ATLAS.ti.9.Ink; ATLAS.ti Scientific Software Development GmbH, Berlin, Germany). RESULTS: There were a total of 2500 and 2225 vaginal deliveries during the preintervention and postintervention periods, respectively. Compared with the preintervention period, there was a significant reduction in severe postpartum hemorrhage (25.0% in the preintervention period vs 13.5% in the postintervention period) and complications of postpartum hemorrhage, including maternal death (laparotomy: 5.0% in the preintervention period vs 1.0% in the postintervention period; maternal death: one maternal death in the preintervention period vs no encounter of maternal death in the postintervention period) in the postintervention period. From the qualitative data analysis, 3 overarching themes emerged: game-changer approach for the objective diagnosis of postpartum hemorrhage, opportunities for the scale-up of E-MOTIVE bundle intervention, and acceptability of the E-MOTIVE drape. CONCLUSION: The E-MOTIVE bundle intervention resulted in the reduction of severe postpartum hemorrhage and postpartum hemorrhage complications: no encounter of maternal death and few instances of surgical intervention to stop hemorrhage. It is feasible and has good acceptability by providers and mothers. Scale-up of the E-MOTIVE bundle intervention across low-middle-income countries is recommended.