This scoping review synthesized the evidence on double-duty actions targeted at adolescents to address the double burden of malnutrition (DBM). Adolescents face unique challenges related to the DBM, including both undernutrition and overweight, obesity, or diet-related noncommunicable diseases (NCDs). Understanding effective strategies for addressing these issues is critical. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. We examined studies from MEDLINE, Embase, CENTRAL, CINAHL, and Google Scholar on double-duty actions, defined as an array of interventions, programs, and policies that aim to simultaneously reduce the risk or burden of both undernutrition (including wasting, stunting and micronutrient deficiency) and overweight, obesity or diet-related NCDs. The evidence was analyzed through narrative synthesis. Our comprehensive search of the published and gray literature identified 17 publications representing 16 studies. These included 5 cluster randomized controlled trials, 2 evaluation studies, and 10 quasi-experimental studies conducted across 10 countries, mainly in sub-Saharan Africa and Asia. The interventions varied in duration from 1 month to 5 years and incorporated multi-component approaches, such as physical activity promotion, school feeding programs, nutrition education, and water, sanitation, and hygiene (WASH) activities. While 2 studies effectively reduced both undernutrition and overweight, 9 were DBM-neutral, 4 were potentially beneficial, and 2 had potential DBM-harmful outcomes. Thirteen multi-component interventions showed improved nutritional indicators, particularly in anemia and dietary diversity, with strong engagement from the school community contributing to successful outcomes. This review emphasizes the need for multifaceted interventions to address the DBM among adolescents. The included studies showed that school-based, multi-component strategies, including physical activity promotion and nutrition education, can improve nutritional outcomes. However, variations in effectiveness highlighted the complexity of the DBM, requiring re-design of strategies to address common drivers of multiple forms of malnutrition through context-specific approaches that engage multiple sectors and local communities. Ongoing evaluation and adaptation of strategies to attain optimal nutritional status are key to success.

India accounts for the largest national proportion of global multi-drug resistant (MDR-TB) cases and TB mortality. However, evidence on the role of diet and nutrition in MDR-TB infection remains limited. This study aimed to multifacetedly evaluate and compare diet and nutrition status of MDR-TB cases and controls in high TB-burden slum areas of Mumbai. We recruited 352 pulmonary MDR-TB cases receiving domiciliary treatment, household controls, and age-, sex-, and area-matched community controls 18-60 years of age. Participants were assessed for habitual food and nutrient intake using a validated semi-quantitative food-frequency questionnaire, other food consumption-related habits, diet quality metrics, anthropometry, biochemical measurements, and diet-related non-communicable diseases. Measures of diet and nutrition status were compared within and between study arms using hypothesis tests and multiple regression. The prevalence of dietary adequacy was < 50% for 18 of 24 assessed nutrients among cases and 12/24 nutrients among controls. Compared to both household and community controls, cases had significantly (p < 0.05) higher prevalence of underweight (66% vs. 23% and 15%, respectively), anemia (22% vs. 9% and 10%), and diabetes (18% vs. 4% and 5%); lower consumption of major healthy food groups including non-tuberous vegetables, deep orange vegetables, legumes, whole grains, and nuts and seeds; lower Global Diet Quality Score (GDQS); and higher prevalence of nutrient inadequacies including protein, thiamine, folate, and vitamins A, C, and E. Women had significantly poorer adequacy of most nutrients than men in all three study arms, and intake of most nutrients declined with asset index and age in models adjusted for age, sex, study arm, and asset index. Results indicate an urgent need to improve diet and nutrition in Mumbai slum dwellers - particularly among the MDR-TB-infected population, women, the elderly, and the poorest households - and highlights the potentially key role of nutrition interventions in reducing MDR-TB burden in urban India.

Abstract Background The World Health Organization (WHO) recommends that adolescents engage in at least 60 min of moderate-to-vigorous physical activity (MVPA) daily across the week to support healthy growth and development. Despite this guideline, physical inactivity is prevalent among adolescents in South Africa. This is concerning given the increasing burden of overweight and obesity. While nutrition is a critical driver of these conditions, physical activity represents a complementary and scalable strategy to improve overall adolescent health. This study aims to assess the effect of providing a skipping rope and an informational pamphlet to adolescents aged 10–14 years in South Africa on their physical activity intentions and behaviors. Methods This study is a two-arm parallel-group, individual 1:1, unblinded randomized trial, nested within the Design and Evaluation of Adolescent Health Interventions and Policies in Sub-Saharan Africa (DASH) project. The intervention consists of providing adolescents 10–14 years old in a community setting in South Africa with a skipping rope and a pamphlet with general instructions for rope skipping and messages emphasizing the importance of regular physical activity. About 700 adolescent boys and girls are enrolled as part of this study. The intervention was administered during the first wave of data collection for the DASH study, or baseline, and outcomes will be assessed at both baseline and endline (12 months), during the second wave of data collection for DASH. As a primary outcome, the trial will test whether providing skipping ropes and pamphlets to intervention participants will increase their amount of weekly MVPA over 12 months, compared to participants in the control group, who will receive no materials. Secondary outcomes will be intention to do physical activity, assessed toward the end of the baseline interview, and meeting the WHO recommendations for physical activity, assessed at endline. The physical activity questionnaire was developed from the Physical Activity Questionnaires for Adolescents. Discussion Improving physical activity behaviors and reducing sedentary time among adolescents are critical for fostering healthy lifestyles into adulthood. Assessing the effectiveness of this intervention to enhance physical activity intention and behaviors in South Africa is particularly important given the increasing burden of overweight and obesity. Trial registration ClinicalTrials.gov NCT06516549. Registered on July 17th 2024. https://clinicaltrials.gov/study/NCT06516549 .

The growth of children is influenced by various factors, including infections like malaria, diarrhea, and respiratory tract infections (RTIs). This study aimed to assess the associations of these infections with the monthly growth velocity in Tanzanian children. We used data from 2,397 Tanzanian children enrolled in a randomized controlled trial and followed for 18 months (30,079 monthly visits). The exposure variables were infections, whereas the outcome variables were monthly height and weight velocities. Mixed-effects models were used to assess the relationships. The average height velocity was 1.58 cm per month, and average weight velocity was 358 g per month during the follow-up period. Malaria infection was association with a reduction of 0.14 cm/month in height velocity (coefficient [95% CI]: -0.14 [-0.23 to -0.05]) but not significantly associated with weight velocity. RTIs were associated with a reduction of 0.10 cm/month (coefficient [95% CI]: -0.10 [-0.15 to -0.04]) and a decrease of 37 g/month (coefficient [95% CI]: -37 [-72 to -2.6]) in height and weight velocity, respectively. Diarrhea was also inversely associated with both height and weight velocity, with reductions of 0.26 cm/month (coefficient [95% CI]: -0.26 [-0.35 to -0.17])] and 120 g/month (coefficient [95% CI]: -120 [-177 to -62]), respectively. The findings demonstrate that malaria, respiratory infections, and diarrhea are associated with slower growth velocity in children. These results underscore the importance of integrated health care strategies to address these prevalent infections, because preventing them may contribute to healthier child growth and better overall health outcomes.

Effective mentorship is essential for advancing global health research, particularly in low- and middle-income countries (LMICs). This review synthesizes expert perspectives from a highly experienced group of global health research mentors. We identify the characteristics and core competencies of effective global health mentors, emphasizing adaptability, cultural competence, and equitable collaboration. Special attention is paid to addressing barriers faced by underrepresented groups in academia, highlighting the role of mentorship in career advancement and enhancing workforce diversity. We describe a variety of mentoring models, e.g., one-to-one, peer, group, and virtual, and mentoring tools and frameworks, evaluating their relevance to diverse global health contexts. This review emphasizes their potential for customization in LMICs and provides guidance for structuring effective mentor-mentee communication. Recognizing that sustainable impact extends beyond individual relationships, we present strategies for developing institutional mentorship programs, drawing on lessons from Ethiopia and Kenya. Key recommendations include capacity-building for mentors and mentees, institutional ownership of mentoring activities, mentor-mentee matching, accessible training, and regular evaluation linked to recognition and career advancement. The transition from structured mentorship to professional independence merits special consideration, including mechanisms for fostering ongoing collegiality and long-term career support. Our findings underscore the importance of structured, intentional mentorship for building research capacity, driving academic productivity, and advancing global health equity. We advocate for sustained investment by individuals and institutions, recommending adaptable mentorship frameworks and supportive cultures to foster emerging global health leaders. By institutionalizing best practices, global health research mentorship can contribute decisively to stronger health systems worldwide.

BACKGROUND:Family planning (FP) and nutrition services are essential for the health and well-being of girls and women in low- and middle-income countries (LMICs), yet evidence on their existing and potential integration is limited. Also, little is known about relevant national programmes and the views of health officials. METHODS:An on-line survey of national health ministry officials in member states of WHO Regions for Africa (AFRO), Eastern Mediterranean (EMRO) and South-East Asia (SEARO) was conducted from 29 August 2023 to 15 December 2023, using a structured questionnaire. It covered national FP and nutrition programmes and policies, special FP programmes for vulnerable groups, task sharing in provision of services, and existing or potential for integration of FP and nutrition services. This was complemented with recent data from the UN Population Division and Global Health Observatory. RESULTS:Altogether, 64 (81%) of 79 member states' health officials responded. All countries in SEARO, 83% of countries in AFRO and 92% in EMRO reported the existence of a national nutritional programme. In 40 countries with integrated FP and nutrition programmes, integration of FP with breastfeeding counselling during the first 2 days after delivery was universal, followed by nutritional information, education and communication (98%) and nutritional counselling during pregnancy (98%). In 24 countries without an integrated FP and nutrition programme, food and/or cash assistance for nutrition and weekly iron folic acid supplement for women aged 15-49 years were reported as best suited for integration with FP. Integration with nutrition service was considered suitable by 58% of respondents. CONCLUSIONS:WHO regions vary widely in policies, programmes, provision and integration of FP and nutrition services. Officials of several countries recognise the potential values of integration, indicating the need to comprehensively explore strategies to promote integration to benefit women in LMICs.

Emerging evidence demonstrates a positive relationship between heat exposure and child maltreatment. However, mechanisms remain unclear and evidence from Africa is limited, where children face high risks from both ambient temperature and trauma. Using data from 114,051 children and adolescents across 8 sub-Saharan African countries, we identified a nonlinear, J-shaped relationship between ambient temperature and child maltreatment, with minimum risk at the 27th temperature percentile. At the 95th temperature percentile, the odds ratio for any abuse was 1.50 (95% confidence interval 1.35-1.67), with stronger effects for psychological than for physical abuse. Effect modification was significant for low maternal education, maternal acceptance of physical punishment, female-headed households, rural residence, lack of air conditioning and absence of social support. Mediation analysis suggested that occupational heat exposure among working adolescents was associated with 18.8% of the estimated indirect pathway, and household water shortage with 7.1%. These findings underscore the need to integrate child protection into climate adaptation planning.

Rising temperatures due to climate change pose significant risks to the nutritional status of under-five children, particularly in Sub-Saharan Africa (SSA). This study investigates the influence of temperature increases on nutritional status (wasting, stunting, and underweight) in SSA. Based on Demographic and Health Survey (DHS) data for under-five children and global meteorological reanalysis data, we employed multiple supervised machine learning methods to predict the impact of temperature variability on nutritional status indicators, including stunting, underweight, and wasting, while controlling for socioeconomic variables such as household income and maternal education. Different metrics were used to evaluate the forecasting performance. In addition, multivariable logistic regression was employed to test for the causal-effect relationship. A total of 345,837 participants from 22 SSA countries were analyzed using data from 2005 to 2023. Among the algorithms tested, XG Boost achieved the highest accuracy for underweight prediction (Accuracy = 0.7832), Random Forest for stunting (Accuracy = 0.7023), and logistic regression for wasting (Accuracy = 0.6634). For different countries, accuracies ranging from 0.65 to 0.90, with highest in Uganda (decision tree, Accuracy = 0.9042 for stunting) and lowest in Burundi (XG Boost, Accuracy = 0.6426 for wasting). Causal-effect analysis revealed that each 1 °C rise in average temperature increased the odds of stunting by approximately 1% (OR 1.01, 95% CI: 1.00–1.10), underweight by about 3% (OR 1.03, 95% CI: 1.01–1.06), and wasting by around 10% (OR 1.10, 95% CI: 1.08–1.12). Although the incremental increases per degree appear modest, such temperature-related risks may translate into substantial population-level impacts in climate-vulnerable settings. Higher household income and maternal education were associated with improved nutritional outcomes and attenuated the adverse effects of rising temperatures, indicating a protective socioeconomic effect. Supervised machine learning models can effectively leverage complex datasets to predict the impact of temperature variability on nutritional status, reinforcing the importance of integrated policies and climate-smart agricultural practices for safeguarding the health of under-five children in SSA.

Background:Anaemia remains a major public health challenge among adolescents in low- and middle-income countries (LMICs). However, longitudinal evidence on its incidence and remission during this critical period is limited. Most existing studies assess anaemia cross-sectionally, providing limited insight into its progression or potential reversibility. We aimed to examine the dynamics of anaemia during adolescence, estimating incidence and remission over one year and identifying sociodemographic, behavioural, nutritional, and dietary predictors of these transitions. Methods:We used data from the Africa Research, Implementation Science, and Education Network's multi-site prospective cohort in Nouna (Burkina Faso), Harar (Ethiopia), Dar es Salaam (Tanzania), and Pune (India). Baseline assessments were conducted between November 2021 and December 2023, with follow-up approximately 12 months later. The analytical sample included 3656 adolescents aged 10-19 years. Haemoglobin was measured using HemoCue® analysers and classified according to World Health Organization standards. We used Poisson regression models to estimate risk ratios (RR). Results:Anaemia prevalence was 34.4% at baseline and 32.6% at follow-up. Among 2399 adolescents who were non-anaemic at baseline, 21.2% developed anaemia, whereas 45.6% of 1257 adolescents with anaemia achieved remission. Late adolescence (RR = 0.81; 95% confidence interval (CI) = 0.70-0.95), school attendance (RR = 0.67; 95% CI = 0.57-0.80), and frequent consumption of fruits and vegetables (RR = 0.83; 95% CI = 0.73-0.95) were associated with a lower risk of incident anaemia, whereas stunting (RR = 1.61; 95% CI = 1.33-1.96) increased the risk. Remission from anaemia was more likely among school attendees (RR = 1.49; 95% CI = 1.27-1.76), adolescents living with guardians (RR = 1.19; 95% CI = 1.05-1.35), and those who frequently consumed fruits and vegetables (RR = 1.17; 95% CI = 1.06-1.29), but less likely among adolescents with depressive symptoms (RR = 0.75; 95% CI = 0.61-0.92) and stunting (RR = 0.75; 95% CI = 0.62-0.91). Conclusions:Anaemia among adolescents in LMICs is both prevalent and dynamic. Diet quality, school participation, household stability, and mental and physical health are associated with these trajectories. National nutrition and health strategies should explicitly target adolescents, integrating dietary interventions with educational and clinical platforms to accelerate anaemia reduction.

Introduction School feeding programmes reach over 466 million children globally, making them one of the largest social safety nets worldwide. Beyond providing immediate nutritional benefits, school feeding programmes increasingly aim to strengthen local food systems through procurement from smallholder farmers, support for sustainable agriculture, community kitchen involvement and broader development outcomes. However, evidence on how school feeding programmes can simultaneously improve nutrition and educational outcomes while transforming food systems in low and middle-income countries (LMICs) remains fragmented. This systematic review will synthesise evidence on the effects of school feeding interventions with explicit food system components on health, nutrition, education and food system outcomes among school-age children and adolescents in LMICs.Methods and analysis We conducted comprehensive searches in MEDLINE (PubMed), Embase (Ovid), CENTRAL (Cochrane Library), Web of Science, Google Scholar, completed on 18 February 2026, with grey literature searches ongoing and to be completed subsequently. We will include randomised controlled trials (RCTs), non-RCTs and quasi-experimental studies with comparison groups examining school feeding interventions with food system components among school-age children and adolescents (5–19 years) in LMICs. Two reviewers will independently screen titles and abstracts, review full texts, extract data and assess study quality using the Cochrane Risk of Bias tools (RoB 2 for RCTs and Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) for non-randomised studies). Certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. We will conduct narrative synthesis using the Synthesis Without Meta-analysis (SWiM) guidelines and meta-analysis where appropriate.Ethics and dissemination Ethical approval is not required for this systematic review as no primary data will be collected. Findings will be disseminated through peer-reviewed publication, conference presentations and policy briefs targeting international organisations, governments and development partners working on school feeding and food systems in LMICs.Registration: Open Science Framework https://osf.io/p83tb/

Objective:To estimate the associations between gestational weight gain and maternal immediate perinatal and postpartum outcomes by pooling data from low and middle income countries. Design:Individual participant data meta-analyses. Data sources:PubMed, Embase, Web of Science, and Cochrane Library, based on three searches (Search 1: all prospective studies published from January 2000 to May 2021; Search 2: randomized controlled trials of balanced energy and protein supplementation published until June 2021; Search 3: randomized controlled trials of anti-infectious agents published until August 2021). Eligibility criteria for selecting studies:Prospective studies (randomised controlled trials or observational cohort studies) with measured maternal weight during pregnancy and data available on maternal height, based in populations from low and middle income countries with no underlying conditions. Results:The analyses included 156 300 women from 61 studies and 23 countries, with most participants based in South Asia (n=78 454, 50.2%) and sub-Saharan Africa (n=36 327, 23.2%). Compared with women with adequate (90-125%) gestational weight gain, women with excessive (>125%) gestational weight gain had a higher risk of caesarean delivery (risk ratio 1.10, 95% confidence interval 1.06 to 1.13, τ2=0.000) and emergency caesarean delivery (risk ratio 1.22, 1.03 to 1.43, τ2=0.000). Women with moderately (70% to <90%) or severely inadequate (<70%) versus adequate gestational weight gain had lower risks for caesarean delivery (risk ratio in women with moderately inadequate gestational weight gain 0.88, 95% confidence interval 0.84 to 0.92, τ2=0.004; risk ratio in women with severely inadequate gestational weight gain 0.82, 0.77 to 0.88, τ2=0.010) and emergency caesarean delivery (risk ratio in moderately inadequate gestational weight gain 0.82, 0.71 to 0.95, τ2=0.004; risk ratio in severely inadequate gestational weight gain 0.73, 0.56 to 0.96, τ2=0.103). Excessive versus adequate gestational weight gain was associated with higher postpartum weight retained at any time point (mean difference 2.00 kg, 95% confidence interval 1.49 to 2.50, τ2=1.317), whereas moderately and severely inadequate gestational weight gain were associated with lower retained weight compared with adequate gestational weight gain. Similar trends were found for postpartum body mass index. Severely inadequate gestational weight gain was associated with lower systolic and diastolic blood pressure at any time point post partum than adequate gestational weight gain. No associations were observed for other outcomes including postpartum depressive symptoms or breastfeeding. Evidence indicating an interaction between gestational weight gain and body mass index before pregnancy was found when examining the risk of caesarean delivery and postpartum weight retention, body mass index, and systolic blood pressure as outcomes. Conclusions:These findings support the association between suboptimal gestational weight gain and adverse maternal outcomes in the immediate perinatal and postpartum periods. Further research examining the consequences of suboptimal gestational weight gain in low and middle income countries would be valuable to inform potential strategies to improve long term maternal health. Review registration:PROSPERO CRD42023432836.

Background: Tanzania has over 1.5 million people living with HIV. Understanding changes in its HIV epidemic is critical to informing interventions and policies. We aim to describe the state of Tanzania’s HIV epidemic and progress towards epidemic control by evaluating changes in population-level HIV prevalence, HIV incidence, and viremia between 2016–2017 and 2022–2023. Methods: Sequential Tanzania HIV Impact Surveys (THIS) 2016–2017 and 2022–2023 were nationally-representative, cross-sectional household-based surveys with a stratified, two-stage cluster design. Participants aged ≥15 years provided information on HIV testing and treatment histories and blood samples for HIV serology. HIV incidence was estimated using a laboratory-based algorithm (HIV-1 Limiting Antigen (Lag) avidity, viral load (VL), and antiretroviral (ARV) detection). We calculated weighted estimates of population-level HIV prevalence, HIV incidence, and viremia and compared them between surveys. Arithmetic differences and incidence rate ratios were used to assess change. Modified Poisson regression models were used to estimate adjusted prevalence ratios (aPR) for correlates of HIV prevalence and viremia. Findings: Among participants aged ≥15 years with biomarker data (n=31,579 in 2016–2017; n=33,663 in 2022–2023), 1,831 and 1,850 were living with HIV, respectively. HIV prevalence remained stable at 4.9% [95% CI: 4.5–5.2] in 2016–2017 and 4.4% [4.1–4.7] in 2022–2023. Annual HIV incidence did not significantly change (0.24% [0.15–0.34] vs. 0.18% [0.09–0.26]). Population viremia declined significantly from 2.8% [2.6–3.1] to 1.7% [1.5–1.8], with a 41% reduction between surveys (aPR: 0.59 [0.52–0.67]). Higher prevalence and viremia were observed among women and adults aged ≥25 years. Interpretation: Between 2016–2017 and 2022–2023, HIV prevalence and incidence remained stable in Tanzania, while population viremia declined substantially, indicating progress towards HIV epidemic control. Continued efforts and targeted interventions are needed to reduce viremia among women and older age groups.

Introduction Iron-folic acid (IFA) supplementation in pregnancy is recommended by the WHO, with a dose of 60 mg of iron in contexts where anaemia remains a severe public health problem. Iron-containing supplements may cause side effects that affect acceptability and adherence in a dose-response manner. Maternal multiple micronutrient supplements (MMS), which include iron and folic acid plus additional micronutrients, are also recommended in the context of rigorous research, and programmes are considering transitioning from IFA to MMS containing 30 mg of iron. We will evaluate the effect of iron dose in MMS on maternal acceptability, side effects, adherence and preferences. Methods and analysis The Multiple Micronutrient Supplementation (MMS) Iron Dose Acceptability Crossover Trial is an individually randomised, quadruple-blind, non-inferiority crossover trial of daily antenatal MMS supplementation formulations that contain 60 mg, 45 mg and 30 mg elemental iron among pregnant women in Dar es Salaam, Tanzania. A total of 156 pregnant participants will be randomised to a sequence in which they receive each of the three MMS formulations for 1 month. Participants, investigators, outcome assessors and data analysts will be blinded to the treatment sequence. The primary trial outcome is participant-reported acceptability of each MMS formulation, measured on a Likert scale. Secondary and tertiary outcomes include preferred and least preferred formulation, identification of MMS formulation, reported side effects and adherence assessed by pill count. Regression analyses will be used to assess differences between formulations and will account for sequence and period effects of the crossover trial design. Qualitative in-depth interviews from a subsample of participants will be conducted to understand women's perceptions and experiences taking the different MMS formulations. Ethics and dissemination The trial protocol was approved by Harvard T. H. Chan School of Public Health Institutional Review Board (IRB), the Ifakara Health Institute IRB, the Muhimbili University of Health and Allied Sciences IRB, the National Health Research Ethics Sub-Committee and the Tanzania Medicine and Medical Device Authority. Results will be shared through publications and presentations at the local, regional and international levels. Trial registration number ClinicalTrials.gov Identifier: NCT06069869.

INTRODUCTION:Anaemia remains a major public health concern among Indian adolescents, particularly girls. National-level and state-level initiatives led by the Government of India, such as the Weekly Iron and Folic Acid Supplementation, Anaemia Mukt Bharat and the Intensified National Iron Plus Initiative, aim to control iron-deficiency anaemia through systematic supplementation and behaviour change communication strategies. However, implementation challenges persist. Given the limited evidence on barriers, facilitators and interventions implemented to improve the outlined national schemes, we have designed a systematic review to inform future research and programmes. This review aims to systematically identify and synthesise evidence on barriers and facilitators influencing the implementation of national iron and folic acid supplementation programmes targeting adolescents aged 10-19 years in India. METHODS AND ANALYSIS:A comprehensive search will be conducted using five databases, namely PubMed, EMBASE, Web of Science, CINHAL and Scopus, from inception to 30 September 2025. To capture grey literature, we will also search government portals, international agency repositories, clinical trial registries and the Google platform. Eligible studies include experimental, observational, qualitative and implementation research conducted in school-based, community-based or combined delivery settings. Screening, data extraction and quality appraisal will be performed independently by two reviewers using the Covidence platform. The Joanna Briggs Institute tool will be used to assess methodological quality of included studies. Quantitative data will be synthesised descriptively following the Synthesis Without Meta-analysis guidelines, and qualitative data will be analysed using thematic synthesis. ETHICS AND DISSEMINATION:Ethical approval is not required as there is no human participation. The results will be published in a peer-reviewed journal and presented at scientific conferences. PROSPERO REGISTRATION NUMBER:CRD420251153248.

Alcohol use and risky alcohol use are associated with health, social, and psychological complications and may interfere with HIV/AIDS treatment. This study assessed the prevalence and factors associated with alcohol use and risky alcohol use among adults living with HIV in Dar-es-Salaam, Tanzania. This cross-sectional study included data from 771 adults living with HIV on antiretroviral therapy (ART) who were enrolled in a non-inferiority cluster randomized controlled trial. Alcohol use and risky drinking in the past 12 months were assessed using the Alcohol Use Disorders Identification Test (AUDIT-C) tool. Log-binomial regression models were applied to identify factors associated with alcohol use and risky alcohol use. Overall, 31.4

BackgroundDepression is highly prevalent among people living with HIV (PLWH). However, few studies have examined its relationship with clinical and nutritional outcomes in sub-Saharan Africa.MethodsWe conducted a cohort study of 3996 PLWH in Tanzania. Depressive symptoms were measured at antiretroviral therapy (ART) initiation with the Hopkins Symptom Checklist-25 (HSCL-25). Symptoms consistent with depression were defined using the conventional HSCL-25 (score >1.75) and Tanzania-adapted (score >1.06) cutoffs. We evaluated the association of depression defined by both cut-offs and tertiles of HSCL-25 scores with clinical and nutritional outcomes using regression models.ResultsUsing the conventional HSCL-25 cutoff, men with symptoms consistent with depression had increased risk of all-cause mortality (hazard ratio (HR): 1.68; 95% CI: 1.17-2.39) and HIV disease progression (HR: 1.59; 95% CI: 1.15-2.19). Women in the highest tertile of depressive symptom scores had increased risk of >10% weight loss (HR: 1.27; 1.05-1.55) and incident pulmonary TB (HR: 1.93, 95% CI: 1.19-3.12).ConclusionsDepressive symptoms at ART initiation were associated with poor clinical and nutritional outcomes; however, the risks appear to differ by gender and depression severity.

BackgroundSmall vulnerable newborn (SVN) types, defined by combinations of being born too soon or too small, have distinct determinants, health consequences, and prevention strategies. The effects of prenatal balanced energy and protein (BEP) supplementation on SVN types remain unknown.Methods and findingsWe conducted a systematic review and meta-analysis of individual participant data from eight randomized controlled trials of prenatal BEP supplements (N = 10,252, with 5,164 in the BEP arm and 5,088 in the control arm) in low- and middle-income countries were used. The control arms varied across studies and included context-specific standards of care, iron and folic acid supplements, or multiple micronutrient supplements. Newborns were classified into 10 groups through the combinations of preterm birth, small for gestational age (SGA) birth, and low birthweight (LBW), such as term-appropriate-for-gestational-age (AGA)-nonLBW, preterm-SGA-LBW, preterm-large-for-gestational-age-LBW, term-SGA-LBW, preterm-AGA-nonLBW, and other permutations. Newborns were also analyzed using a four-group categorization that included term-nonSGA, preterm-nonSGA, term-SGA, and preterm-SGA. Log-binomial models were used to estimate study-specific risk ratios (RRs), which were pooled using meta-analyses. Subgroup analyses were conducted by maternal age, parity, gestational age at enrollment, early pregnancy body mass index, and maternal anemia status. In the 10-group categorization of SVNs, on average, prenatal BEP supplementation led to a 30% lower risk of preterm-SGA-LBW (RR: 0.70; 95% CI [0.53, 0.91]; P = 0.009), a 25% lower risk of preterm-AGA-LBW (RR: 0.75; 95% CI [0.60, 0.93]; P = 0.009), and a 20% lower risk of term-SGA-LBW (RR: 0.80; 95% CI [0.72, 0.90]; P < 0.001). In the four-group categorization, prenatal BEP supplementation led to a 31% lower risk of preterm-SGA (RR: 0.69; 95% CI [0.52, 0.91]; P = 0.008) and a 12% lower risk of term-SGA (RR: 0.88; 95% CI [0.81, 0.96]; P = 0.005). The protective effect of prenatal BEP supplementation on preterm-SGA was stronger among multiparous women and women without anemia. The protective effects on all three SVN types under the four-group categorization were stronger among women enrolled before 20 weeks of gestation. The main limitations of the study included the absence of some BEP trials and the small event numbers for some SVN types.ConclusionsPrenatal BEP supplementation reduces the risk of SVNs to varying extents. Further research is needed to determine the optimal targeting approach for providing BEP supplements to vulnerable pregnant women who are most likely to benefit from the supplementation.

BackgroundBalanced energy protein (BEP) supplements during pregnancy have shown promise in reducing small-for-gestational-age births and low birth weight in low- and middle-income countries, but practical gaps remain in implementing this supplementation. This formative study assessed the acceptability, adherence, and sharing practices of a ready-to-use BEP supplement among pregnant women in Addis Ababa, Ethiopia.Subjects and methodFrom January to February 2023, 45 pregnant women were purposively selected from nine public health centers and provided a 4-week BEP supply with usage guidance. Thirty-nine participants completed in-depth interviews. The framework analysis focused on acceptability, adherence, and sharing. Adherence was calculated as the proportion of sachets consumed or returned empty; partially used or unopened sachets were considered unconsumed.ResultsAcceptability was high, with positive feedback on texture (32/39, 82.1%), smell (35/39, 89.7%), color (38/39, 97.4%), and ease of consumption (33/39, 84.6%). However, 23/39 participants (59%) found the taste overly sweet, which occasionally led to nausea or reduced intake. Over the one month, supplement consumption ranged from 0 to 30 sachets, with a mean intake of 21.9 (SD = 9.5). High adherence (≥80% consumption) was observed in 25/39 (64.1%) of participants. Intake was facilitated by provider counseling and family support, while fasting, travel, and weight concerns influenced consumption patterns. Sharing was minimal and discouraged through counseling. Most participants expressed willingness to continue supplementation, recommending reduced sweetness.ConclusionPregnant women demonstrated high acceptability and adherence to the BEP supplement. Findings support its feasibility for informing intervention design in the main trial.

In Tanzania, adolescents face both undernutrition and a rising prevalence of obesity. This study details the co-design and prototyping of a school-based nutrition intervention among adolescents in Dar es Salaam, Tanzania. The study followed human-centered design principles. Four co-design workshops were conducted with stakeholders to develop the intervention, which was prototyped in two schools with students aged 13–15 years and school staff. The intervention’s acceptability, appropriateness, and feasibility were assessed using mixed-methods. Workshops identified four key challenges for action: poor nutritional status, limited nutrition awareness, low physical activity, and poor sanitation and hygiene practices. The resulting intervention—COMPASS, a COMprehensive health and nutrition Program for AdolescentS in Schools—integrates twelve nutrition activities designed for delivery at whole-school, group, and individual levels by trained teachers. Qualitative feedback was positive, with students appreciating enhanced nutrition knowledge and health practices and feeling empowered as change agents. A post-intervention quantitative survey of 220 students showed high levels of enjoyment (93.6

BACKGROUND:Despite known linkages between family planning (FP) and nutrition, there is little evidence on whether and how these services are integrated for women of reproductive age (WRA; aged 15-49 years) in Burkina Faso. This study aimed to obtain an overview of FP and nutrition policies and programmes in Burkina Faso to understand the value, current efforts, gaps and opportunities for integration. METHODS:In this mixed-methods study, we analysed recent Demographic and Health Survey Demographic and Health Survey (2021) data using survey-adjusted tabulation and Poisson regression models to assess population-level FP and nutrition needs and inter-relationships. We also conducted a desk review of 27 policies and programmes targeting nutrition and/or FP and their integration, analysed using Walt and Gilson's triangular framework. Finally, we conducted a series of in-depth interviews with policy and programme leaders and focus group discussions with WRA and other community members to determine perspectives and experiences on FP and nutrition service integration (n=144), with data analysed using thematic analysis. RESULTS:We found a high prevalence of unmet need for FP (18.3%, 95% CI 17.3 to 19.3) and of indicators of poor nutrition (moderate anaemia: 29.3%, 95% CI 28.0 to 30.7) among WRA. Use of hormonal contraceptives was associated with reduced anaemia risk (risk ratio for injections: 0.72, 95% CI 0.65 to 0.80, p<0.001). Alignment of FP and nutrition was noted in 9/27 policy and programme documents, especially within the context of maternal and child healthcare services. Interviewees recognised the health-related, resource-related and logistical (to WRA) benefits of integrating FP and nutrition services particularly for maternal and child well-being, but financial, logistical and cultural barriers were emphasised. CONCLUSIONS:Integrating FP and nutrition services is a potentially valuable and impactful approach to improve health in WRA in Burkina Faso. However, this view is not universal, and effectively consolidating integration will require targeted efforts to address barriers at multiple levels.