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Abstract Background In the past few decades, there has been a significant increase in the number of refugees worldwide. Every individual deserves access to the fundamental right to health, and migration can have a substantial beneficial or detrimental effect on one’s health. Foreign invasions and political instability in Afghanistan affected neighboring countries with the large influx of refugees. Discrepancies in quality of life between the host and refugee populations may lead to health inequalities. Investigations in Pakistan on the quality of life of Afghan refugees were scarce despite more than four decades of refugee status. Therefore, this study was initiated to assess the sociocultural determinants influencing health-associated quality of life among Afghan refugees in Pakistan. Methods The Punjab province and Khyber Pakhtunkhwa province refugee populations were selected as the study population for cross-sectional research based on the inclusion criteria of majority refugee representation and female participation. Quantitative research methodology with pre-validated WHOQOL-BREF questionnaires was used for data collection via multi-stage probability sampling techniques. We collected data from 1,185 study participants and applied univariate and bivariate analyses. Inferential analyses included independent t-tests and ANOVA. Results The average scores for the entire sample of Afghan refugees were highest for the social domain (58.78 ± 22.74), followed by the physical domain (53.29 ± 19.46), the general health domain (50.44 ± 20.10), the environmental domain (48.43 ± 16.30), and the psychological domain (46.52 ± 14.78). Age, marital status, family setup, mother language, number of years in the host country, residence type, family monthly income, access to health care, current health status, chronic health illness, substance abuse (smoking), cultural compatibility, linguistic barriers, and social inclusion were non-significant with all the subdomains in the inferential analysis using the independent t-test and analysis of variance. Conclusion The Afghan refugees’ average scores across all health-associated quality-of-life domains were lower than Pakistan’s host population and the standard cutoff criteria (

Abstract Background Despite being included in the Millennium Development Goals (MDGs) and now the Sustainable Development Goals (SDGs), stillbirths remain overlooked with limited regional research, highlighting an ongoing gap in addressing this issue. However, a staggering 2 million stillbirths occur each year, equivalent to one every 16 s. Furthermore, approximately 98% of these stillbirths take place in developing countries, particularly in sub-Saharan Africa (SSA). In light of these statistics and the need to address the lack of data, methodological approaches, and population gaps, this study aims to assess the prevalence and determinants of stillbirths in SSA from 2016 to 2023, aligning with the SDGs. Methods This study used data from the Demographic and Health Survey (DHS) conducted in SSA. The analysis included a weighted sample of 212,194 pregnancies of at least 28 weeks' gestation collected from 2016 to 2023, using R-4.4.0 software. Descriptive data, such as frequencies, were performed. Stillbirth prevalence was visualized using a forest plot. A multilevel modeling analysis was used by considering individual-level factors and community level factors. The multilevel model was employed to account for clustering within countries and allow for the examination of both fixed and random effects that influence stillbirths. For the multivariable analysis, variables with a p value ≤ 0.2 in the bivariate analysis were considered. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) and a p value

Abstract Background Ensuring comprehensive and quality healthcare access is necessary to promote good health and well-being and to secure health equity. Barriers to healthcare access result in unmet health needs. Moreover, there is limited empirical evidence on specific types of barriers to women’s general health-seeking in India. This study investigates women’s perceived household-level, logistic, and facility-level barriers to healthcare access and its individual, household, and community-level determinants. Methods The study used data from the fifth round of the National Family Health Survey (NFHS-5), with a total sample of 108,785 women aged 15–49 drawn from the state module of the survey. The primary outcome variables were household, logistic, and facility-level barriers to healthcare access. A set of individual, household, and community-level predictors was assessed using multivariate binary logistic regression due to the dichotomous nature of the outcome variables. The adjusted odds ratio (AOR) with the corresponding 95% confidence intervals (CI) was used to present the regression results. The Hosmer-Lemeshow test and ROC curve statistics were carried out to enhance the robustness of the analysis and validity of the model. Results The study found a considerable proportion of women (84%) with at least one perceived barrier to accessing healthcare, with significant inter-state variations. Facility-level (55%) and logistic barriers (51%) were the predominant obstacles to healthcare access. Women aged 35–49, with higher education levels, exposed to mass media, working in professional/technical/managerial/clerical jobs, access to bank accounts, having mobile phones, and from rich households had lower odds of perceived household, logistic, and facility-level barriers to healthcare access. Conclusion Most women perceive barriers to healthcare access, though a wide inter-state variation exists. Facility-level barriers such as the unavailability of drugs and healthcare providers are major concerns to healthcare access. Distance to health facilities continues to be a logistic barrier, along with getting money for treatment at the household level. Illiteracy, non-exposure to mass media, working in the agricultural sector, no access to a bank account and a mobile phone, rural residency, and poor wealth status are significant factors adversely affecting the perceived barriers to healthcare access. The findings recommend strengthening the existing health system and increasing health literacy among poor, less educated, and rural women to reduce disparity in healthcare access.

Abstract Background Undernutrition is a serious public health concern that, despite numerous efforts to overcome, continues to persist. An integrated nutrition-specific and nutrition-sensitive intervention was implemented in Rwanda over a period of 5 years to combat undernutrition. Following this intervention, quasi-experimental quantitative studies revealed improvements in mothers’ practice regarding Infant and Young Child Feeding (IYCF), resulting in increased achievement of the Minimum Acceptable Diet (MAD). The purpose of this study was to provide qualitative data on mothers’ perceptions of the determinants of undernutrition to identify whether they understand what the determinants of undernutrition are, and what the possible barriers experienced are. By obtaining this information, the authors plan to use it to improve the integrated nutrition-specific and nutrition-sensitive intervention and to re implement this improved intervention in future. This qualitative study aimed to explore mothers’ perceived understandings of the determinants of undernutrition and identify mothers’ perceived barriers in addressing it. Methods This was a qualitative study carried out in four Districts, namely, Nyarugenge, Gasabo, Nyabihu and Ngororero. Data was obtained through Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs). Overall six FGDs with ten mothers each and thirty KIIs were considered. Both deductive and inductive approaches were utilized to identify codes, with Atlas ti 7.5.18 as the software. Results Two themes were generated from the data namely, mothers’ perceived understandings of the determinants of undernutrition and mothers’ perceived barriers related to the determinants of undernutrition. (1) Mothers had a good understanding of the determinants of undernutrition. (2) Knowledge was lacking in terms of practices related to IYCF, specifically complementary feeding initiation and practice. (3) Mothers were unsure of the association between hygiene and vaccination with undernutrition. (4) Participants from FGDs were likely less knowledgeable on the determinants of undernutrition. (5) Perceived barriers: poverty, ignorance, negative beliefs, maternal and child health issues, illnesses and inappropriate parental care practices. Conclusion Nutrition education programme is needed to address knowledge gaps, and barriers identified should guide the improvement of nutrition interventions.

Abstract Background Irreversible blindness is the natural history of untreated glaucoma; however, a significant proportion of those receiving treatment are still blind. This study sought to identify the determinant factors responsible for blindness from glaucoma among those receiving treatment. Method This retrospective cohort study collected data via chart review of glaucoma patients (N = 231) who attended eye clinics at a large government-owned or a privately owned health facility in Enugu, Nigeria, between October and December 2023. Visual acuity was used to determine whether the eyes met the criteria for blindness. The sociodemographic and clinical characteristics of glaucoma patients who were blind (105) and patients without blindness (126) were compared. Data analysis was performed via the statistical package for social sciences (SPSS) version 26. Binary logistic regression was used to identify determinants of blindness. Results The records of a total of 231 glaucoma patients were reviewed. One hundred and five (45.5%) patients were blind in at least one eye. The mean age was 61.1 ± 13.9 years (patients without blindness) and 63.6 ± 10.6 years (blind patients). Those living in urban areas (AOR = 0.49, 95%CI = 0.24–0.99), those with no visual impairment at presentation (AOR = 0.005, 95% CI = 0.000–0.055, p 22 mmHg, and being non-hypertensive increased the risk of blindness. Improving access to glaucoma care in non-urban areas, increasing awareness creation on screening for early detection and patient counseling may be profitable steps towards reducing vision loss from glaucoma.

Abstract Introduction The number of lifetime sexual partners is a critical factor in public health, influencing the transmission of sexually transmitted infections and HIV/AIDS. This study aims to explore the distribution, determinants, and geographical mapping of lifetime sexual partners among three generational cohorts in India—Generation X, Generation Y/ Millennials, and Generation Z—using data from the National Family Health Survey (NFHS-5). Methods Data were analysed from 149,665 participants (67,352 men and 80,313 women) from the NFHS-5 (2019–2021). Participants were categorized into Generation X (born 1981–1996), Millennials (born 1997–2010), and Generation Z (born 2010–2024). The primary outcome was the total number of lifetime sexual partners, with explanatory variables including demographic, socioeconomic, health-related, and behavioural factors. Hierarchical linear regression models were employed to assess associations and generate geographical mapping across Indian states and union territories. Results The mean number of lifetime sexual partners was higher in males (3.29) compared to females (2.40), with significant regional and generational variations. Males in the North-East regions reported the highest averages, particularly among Generation X. Significant determinants included religion, caste, employment status, and health insurance. Risky behaviours, such as smoking and alcohol consumption, were positively associated with the number of sexual partners in males, while comprehensive HIV/AIDS knowledge was linked to fewer partners across genders. Conclusion This study highlights significant generational, gender, and regional disparities in sexual behaviour across India. The findings suggest the need for targeted public health interventions that address specific cultural and socioeconomic contexts, promote health awareness, and integrate sexual health education with broader efforts to reduce risky behaviours and gender-based violence.

Abstract Background Sexual violence, a global concern, disproportionately affects women. In Kenya, over 40% of women experience intimate partner violence, reflecting a pressing need for understanding and addressing this issue. Sub-Saharan Africa faces a 18.7% prevalence with deep-rooted determinants like unequal power relations and cultural practices. Consequences from unwanted pregnancy to trauma hinder development goals. This study focuses on sexual violence among Kenyan women aged 15–49, aiming to inform policies and contribute to a safer, more equitable society. Methods This study analyzed 2022 Kenya Demographic Health Survey data. It used a two-stage cluster sampling method, surveyed 32,156 women aged 15–49, examined determinants of sexual violence, and employed statistical analysis to identify significant predictors. Results This study revealed several significant factors associated with the risk of sexual violence among women in Kenya. Educational attainment emerged as a key determinant, with women holding primary or secondary education showing higher odds of experiencing sexual violence compared to those with higher education. Desire for children also played a significant role; women whose partners desired more children had higher odds of experiencing sexual violence compared to those with mutual or differing desires for children. Domestic violence exposure was strongly associated with sexual violence, as women who experienced domestic violence had 8.69 times the odds of experiencing sexual violence. Additionally, partner alcohol consumption increased the likelihood of sexual violence, as did cultural attitudes, with women who believed that a wife’s refusal of sex justified physical violence facing higher odds of sexual violence. Conclusions and recommendations This study identifies key factors, including education, domestic violence, alcohol consumption, and cultural attitudes, that increase sexual violence risk. Recommendations include education, addressing domestic violence, promoting healthy relationships, and challenging harmful norms.

Abstract Context The world has experienced many global shocks in recent years, especially affecting vulnerable countries, people and groups. The analysis of recent impacts helps us to better understand how to build more sustainable agri-food systems. Objectives This paper aims to analyse the situation and main determinants of food security in the Western Balkans in light of the recent crises to ensure higher resilience for the future. Methods It follows a threefold approach. First, the food security situation in the different countries was analysed quantitatively using descriptive statistics of the main indicators on a time-series basis and the main determinants of food security. Second, the results of the semi-structured interviews with local experts were presented to understand the reasons for the changing patterns of food security. Third, results were validated during a hybrid workshop. Results Our findings suggest that food security and food supply were stable in most cases, while a large number of small farms, rural depopulation, climate change and harmonisation of food systems were cited as the main challenges. The COVID-19 pandemic did not appear to have a serious impacted on food security, although it has certainly accelerated the restructuring within the agri-food sectors. However, the war in Ukraine has had a greater impact, particularly in terms of high price inflation and rising prices for agricultural inputs. Conclusions This paper analysed the food security situation in the Western Balkans in the light of recent crises. Although the region has made good progress in reducing poverty and inequality in recent decades, the COVID-19 pandemic and the war in Ukraine appear to have stalled or, in some cases, even reversed this progress. This paper provides a number of policy recommendations based on the results to shape future policies of the region towards higher resilience.

Abstract Background and objective Temporary abstinence campaigns (TAC) are a promising approach to reduce alcohol consumption. This study examined changes in (at-risk) alcohol consumption and determinants of alcohol consumption among Belgian adults participating in the Tournée Minérale Campaign (TMC, Belgian TAC). In addition, moderating effects of age, sex, education level, successfully refraining from alcohol during TMC, risk drinking, drinking levels and binge drinking were investigated. Methods TMC is a fully automated mass media prevention campaign challenging Belgian adults to refrain from alcohol during the month February. This study includes a baseline, post- (four weeks after TMC) and follow-up (six months after TMC) test using online recruitment and an online questionnaire. Participants were self-selected by signing up on the TMC website. Repeated measures ANCOVAs were used to examine changes over time in alcohol consumption (log transformed due to skewness) and determinants among TMC participants (n = 8,730, 48.4 ± 12.9 years old, 37.4% males) who filled in all three measurements. Moderation effects were assessed for age, sex, education level, successfully refraining from alcohol during TMC, risk drinking, drinking levels and binge drinking at baseline. McNemar tests were used to examine the change in prevalence of risk drinking and binge drinking. Results TMC participants showed a significant decrease in weekly alcohol consumption (mean exp(x)-1) and CI) from baseline (6.2 [6.4,6.7]) to post (4.2 [4.1,4.3], F = 22.0, p 10 to ≤ 17 glasses) and highest (> 17 glasses) drinking level at baseline. A reduction in the proportion of risk drinkers and binge drinkers and changes in determinants of alcohol consumption (e.g. attitudes towards drinking less alcohol and habit of drinking alcohol) were observed among TMC participants. Conclusions TMC participants reported favourable changes in (the underlying determinants of) alcohol consumption in the short and medium term. Higher level drinkers appear to be especially attracted to participate in TMC and to experience the strongest decreases in alcohol consumption. However, without comparison with a control group of non-participants or comparison points, we cannot simply attribute the changes over time to participation in TMC. Future research with a stronger study design is needed to rule out possible bias (e.g., selection bias, seasonal effects or regression to the mean) and to examine mechanisms and longer term effects of TACs.

Abstract The study investigated the prevalence and determinants of family planning services uptake among women of reproductive age (15 to 49 years) in the Yendi municipality in the northern region of Ghana. A health facility-based cross-sectional study was conducted among 396 reproductive-aged women, sampled from 6 randomly selected health facilities in the Yendi municipality. The child welfare clinic (CWC) served as the point for the sampling of study respondents. Data was collected with questionnaires adapted from previously validated tools. Data was analysed using SPSS v27 in descriptive and inferential statistics. More than half of the respondents (54.3%) said they had ever used a family planning method and almost half of them said they were still using a family planning method. The desire to control pregnancy was a key factor for wanting family planning (79.3%). Most respondents (80.6%) had high knowledge of family planning services and injectables (37.1%) and condoms (24.7%) were the preferred family planning methods. The significant sociodemographic determinants of family planning uptake were religion (Christians (aOR: 7.51; 95%CI: 1.48–38.00:; p = 0.015), traditionalist (aOR: 12.1; 95%CI: 1.90–78.36; p = 0.009)), education (secondary education (aOR: 84.99; 95%CI: 20.02–360.84:; p = 0.000), tertiary education (aOR: 158.74; 95%CI: 33.71–747.52; p = 0.000), no formal education (aOR: 11.83; 95%CI: 2.10–46.76:; p = 0.000)), occupation (farmers (aOR: 12.30; 95%CI: 3.21–47.03; p = 0.000)), and marital status (married (aOR: 0.13; 95%CI: 0.03–0.57; p = 0.007)). Factors that made women less likely to use family planning were unfriendly service providers (aOR: 2.33; 95%CI: 1.28–4.21; p = 0.005), fear of side effects (aOR: 2.19; 95%CI: 1.19–4.05; p = 0.012), and lack of knowledge about available FP services (aOR: 0.45; 95%CI: 0.26–0.77; p = 0.004). Though the knowledge of family planning was high, current uptake of family planning services was modest and there are still sociodemographic and health-related barriers to family planning utilization. Highlighting the need for training programs and policy interventions to improve uptake, reduce financial barriers, and foster a supportive environment.

Abstract Background Infertility defined as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Globally, infertility affects 15% of couples in the reproductive age. Purpose To identify determinants of infertility among married women who attend care at public health facilities of Gamo Zone and South Omo Zone, Southern Ethiopia. Patients and methods An Institution-based un-matched case–control study was conducted from May 1, 2022-May 30, 2023G.C. Participants were selected by systematic random sampling method after allocating the sample size proportionally to the health facilities. The data was collected by using the Open Data Kit (ODK) app through face-to-face interviews and exported to SPSS version 25 for analysis. The chi-square test and multivariable logistic regression model were used to identify determinants (P value

Abstract Background Occupational injuries (OI) remains a global health issue, claiming approximately 1000 lives daily. More needs to be known about OI burdens among artisans in low-income settings. Therefore, this study assessed the factors influencing OIs among carpenters and bricklayers, who are informal artisans in Nigeria. Methods This mixed-methods survey was conducted in Osun state, Nigeria. The quantitative component entailed a comparative cross-sectional study of 421 bricklayers and 425 carpenters selected via simple random sampling. Information on socio-demographics and OI prevalence was obtained using a semi-structured questionnaire. The qualitative aspect comprised 12 focus group discussions (FGD) among artisans who did not participate in the quantitative aspect of the study. Thematic analysis of the qualitative data was conducted to identify pertinent themes and subthemes. Binary logistic regression analysis was conducted to assess the factors influencing OIs, p-value less than 0.05 was taken as statistically significant. Results All respondents were male. The mean age was 51.3.7 ± 14.7 years for bricklayers and 50.0 ± 11.5 years for carpenters. The 3-month prevalence of OI was 39.9% for bricklayers and 51.8% for carpenters. Factors associated with OI among bricklayers included being aged 20–39 years (AOR:6.9, 95% CI:3.1–15.3) and 40–59 years (AOR:2.9, 95% CI:1.5–5.6), earning less than N50,000 (US$67) monthly (OR:2.3, 95% CI:1.2–4.7), earning N50,000-N99,000 (US$67-US$133) monthly (AOR:2.5, 95% CI: 1.2–5.2), and handling ≥ 200 kg per day at work (AOR:2.1, 95% CI:1.3–3.5). For carpenters, factors associated with OI were being aged 20–39 years (AOR:4.1, 95% CI:2.0-8.5), age 40–59 years (AOR:2.1, 95% CI:1.2–3.6) and handling 100–199 kg per day at work (AOR:1.9, 95% CI:1.02–3.4). FGD findings revealed that the use of substandard building materials, poor use of personal protective equipment and working at heights may predispose to OIs. Conclusion The burden of OI is high among informal construction artisans in Nigeria. Safety interventions should target persons 100 kg) and bricklayers earning

Abstract Background Female sex workers (FSWs) have the highest HIV prevalence in Uganda. Pre-exposure prophylaxis (PrEP) has been recommended as a key component of the HIV combination prevention strategy. Although patient initiation of PrEP has improved, continuation rates remain low. This study evaluated PrEP continuation among FSWs and explored potential determinants of PrEP adherence within a public referral hospital in urban Uganda. Methods We conducted an explanatory sequential mixed method study at Kiruddu National referral hospital in Uganda. Secondary data on socio demographic characteristics and follow up outcomes of at least one year was collected for all FSWs who were initiated PrEP between May 2020 and April 2021 and data analyzed on July 15,2023. We used Kaplan–Meier survival analysis to evaluate continuation on PrEP from time of initiation and follow-up period. The capability, opportunity, and motivation to change behaviour model was used to explore perspectives and practices of FSWs (n = 24) and health care providers (n = 8) on continuation on PrEP among FSWs, using semi structured interviews. The qualitative data was deductively coded and analyzed thematically, categorizing the themes related to PrEP continuation as facilitators and barriers. Results Of the 292 FSWs initiated on PrEP, median age was 26 years (interquartile range, 21–29), 101 (34.6) % were active on PrEP, 137 (46.9%) were lost to follow-up, 45 (15.4%) were no longer eligible to continue PrEP, eight (2.7%) were transferred out and one (0.3%) had died. Median survival time on PrEP was 15 months (Interquartile range IQR, 3–21). The continuation rates on PrEP at six (6) and 12 months were 61.1% and 53.1%, respectively. Facilitators of PrEP continuation included awareness of risk associated with sex work, integration of PrEP with other HIV prevention services, presence of PrEP Peer support and use of Drop-in centers. The barriers included low community awareness about PrEP, high mobility of sex workers, substance abuse, and the unfavorable daytime clinic schedules. However, the quantitative findings from the multivariable Cox Proportional Hazards Model did not align with the reported findings for the qualitative evaluation. Conclusion Continuation on PrEP remains low among FSWs. Interventions for PrEP continuation should address barriers such as low community awareness of PrEP, substance abuse and restrictive health facility policies for scale of the PrEP program among FSWs in Uganda. Integration of PrEP with other services and scale up of community PrEP delivery structures may improve its continuation.

Abstract Background The WHO considers anemia in pregnancy a severe public health issue when prevalence surpasses 40%. In response, we conducted a systematic review and meta-analysis to examine anemia among pregnant women in Egypt, focusing on its prevalence, determinants, and associated complications. Methods We conducted a systematic literature search for studies published between January 1, 2010, and August 18, 2024, to identify studies from Egypt reporting on anemia in pregnant women, including its prevalence, associated determinants, and complications. A meta-analysis was conducted using a random-effects model to estimate pooled prevalence, odds ratios (OR), and standardized mean differences (SMD). Sensitivity analyses and publication bias were performed. All statistical analyses were conducted using R software. Results Eighteen studies met the eligibility criteria with a total sample size of 14,548. The overall prevalence of anemia among pregnant women was 49% (95% CI: 42–57), with no significant difference between Upper and Lower Egypt (P = 0.66). The sensitivity analysis demonstrated the absence of influential outliers and Egger’s test indicated no evidence of publication bias (P = 0.17). Anemia prevalence was significantly higher in the third trimester (65%) compared to the second trimester (47%) (P = 0.03). Among anemic pregnant women, most cases were mild (47%) and moderate (47%). The determinants of anemia among pregnant women included being over 30 years old (OR: 1.95), residing in rural areas (OR: 1.76), illiteracy (OR: 1.93), birth spacing

Abstract Introduction Existing evidence suggests a lower uptake of cervical cancer screening among Indian women. Coverage is lower in rural than urban women, but such disparities are less explored. So, the present study was conducted to explore the self-reported coverage of cervical cancer screening in urban and rural areas stratified by socio-demographic characteristics, determine the spatial patterns and identify any regional variations, ascertain the factors contributing to urban-rural disparities and those influencing the likelihood of screening among women aged 30–49 years factors residing in urban, rural, and overall Indian settings. Methods We did a secondary analysis of the fifth round of the National Family Health Survey in India (2019-21) data with a sample size of 3,48,882 women. The coverage of cervical cancer screening was estimated using sampling weights. Urban-rural differences were compared using the chi-square test. Spatial patterns were analysed using aggregated district-level data, and the contribution of different independent variables to the urban-rural disparities was estimated using multivariate decomposition analysis. Multivariable logistic regression was conducted using STATA 17 to obtain the significant factors of reported screening in urban and rural areas. Results The nationwide coverage of cervical cancer screening was 2.0% (95% CI: 1.9-2.0). The urban (2.4%; 2.3–2.5) participants had higher screening coverage than their rural (1.8%; 1.7–1.8) counterparts. Moran’s I statistic confirmed the presence of spatial dependence and geographical gradient. Decomposition analysis depicted small urban-rural differences in the screening coverage of 0.60% (0.4–0.8). Endowment and coefficient contributed to 88.15% and 11.85% of the disparities. Compositional changes were contributed majorly by regional differences, low education, scheduled tribes, and having living children > 2. Higher odds of having screening were associated with older age (AOR 1.45, 95% CI: 1.03–1.28), higher education (1.32; 1.13–1.55), higher age of first intercourse (1.60; 1.43–1.79), married (1.25; 1.08–1.45) and diabetic (1.39; 1.17–1.65) women, and those from South India (6.76; 5.90–7.75). The odds were lower among Muslims, scheduled tribes and participants using hormonal contraceptives. Conclusion There are significant urban-rural disparities in cervical cancer screening uptake that can be attributed to regional variation, educational inequalities, tribal groups, socio-economic inequalities and parity, necessitating the need to comprehensively design tailor-made advocacy initiatives and simultaneously address the broader determinants of health.

Abstract Background Access to healthcare is a major challenge in South Sudan, but evidence on the factors influencing health seeking behaviour (HSB) and the magnitude of their effect is limited. This study aims to identify which determinants are associated with seeking care for perceived health needs and with seeking care at private or public healthcare facilities in South Sudan. Methods A cross-sectional household survey was conducted in three purposefully-selected states (Central Equatoria, Western Equatoria and Warrap). A multi-stage, cluster sampling design was used. Univariable and multivariable logistic regression models were computed to explore the relationships between seeking care for perceived health needs and choice of facility, and individual and household characteristics based on an adapted Levesque framework. Results We identified that individuals who obtained medication (OR 2.45, 95% CI 1.15–5.23), obtained and paid for medication (OR 4.26, 95% CI 2.08–8.74), lived in Western-Equatoria (OR 9.05, 95% CI 2.35–34.54), and were aware of community health workers (CHWs) (OR 1.70, 95% CI 1.08–2.67), were significantly more likely to seek care for a perceived health need. Individuals who obtained and paid for medication (OR 3.03, 95% CI 1.59–5.81) and who lived further from a public health centre (OR 1.19, 95% CI 1.09–1.31) were more likely to seek care at a private facility, while individuals who had used the provider before (OR 0.52, 95% CI 0.34–0.78), lived in Western Equatoria (OR 0.24, 95% CI 0.13–0.46), lived in a rural household (OR 0.40, 95% CI 0.23–0.70) and had a longer travel time to the visited health facility, were less likely to seek care at a private facility. Conclusions Survey respondents’ state of residence and awareness of CHWs were associated with health seeking, while their state of residence, age, whether they paid for medication or not, travel time and distance to facilities were associated with choice of facility. Our results suggest differences in patterns of HSB between states, but studies with larger sample sizes are needed to analyse this. Furthermore, qualitative studies into access to healthcare in South Sudan could help characterise the nature of determinants and their relationship.

Abstract Background Maternal and child health remains a global priority, with antenatal care (ANC) recognized as essential for ensuring positive pregnancy outcomes. Despite significant improvements, in low- and middle-income countries, ANC service utilization remains low in Sub-Saharan Africa. This paper contributes to the understanding of the evolution and determinants of ANC service utilization among women of reproductive age in Rwanda. Methods This review focused on studies published between 2010 and 2024 and examined the factors associated with ANC utilization in Rwanda. Two reviewers independently performed screening of the abstracts and full texts and conducted data extraction and synthesis. The aggregated odds ratios for various factors associated with ANC service utilization were presented in forest plots, created using GraphPad Prism version 10. Results The review included 11 studies and 1 report on ANC service utilization in Rwanda. By 2019–2020, 47% of women had received ANC in the first trimester, and 59% had four or more visits. Higher education levels, better wealth status, health insurance coverage, and small household size are associated with adequate ANC service utilization. Conversely, a significant distance from health facilities and unwanted pregnancies were associated with lower odds of adequate ANC utilization. Delayed ANC was more likely among women with higher parity, those who lacked social support, and those with no or only primary education. Conclusion Rwanda has made considerable strides in improving ANC services. Addressing barriers such as distance to healthcare facilities, education, and economic disparities is crucial for enhancing maternal and child health outcomes. This review underscores the need for targeted interventions to achieve the World Health Organization recommendations of 8 antenatal care visits and sustainable development goals related to maternal and child health in Rwanda.

Abstract Background In many Asian jurisdictions, patients are required to obtain referrals from registered doctors before consulting physiotherapists. In contrast, countries such as the United States, the United Kingdom, and Australia have a direct access model for physiotherapists designed across different healthcare settings and under prescribed conditions. While research has demonstrated the benefits of direct access, issues remain on the appropriate policy design for direct access in the context of patient safety and organizational challenges in the implementation. Recently the policy to allow direct access in primary care context is being considered in Hong Kong. This study aims to examine the intervention design options for the policy of direct access to physiotherapists and identify corresponding implementation strategies, to inform the appropriate intervention design for direct access to physiotherapists and the implementation strategies. Methods We adopt a systematic process for developing the design of the policy and the implementation strategies using an Implementation Mapping approach informed by Consolidated Framework for Implementation Research (CFIR). We will conduct literature reviews to understand the different aspects of policy intervention design and employ qualitative in-depth interviews and focus group discussions to understand key stakeholders’ perspectives related to the direct access model. The identified barriers and facilitators associated with policy implementation of an acceptable intervention design will inform the development of an effective implementation strategy tailored to the implementation context. Our approach will involve mapping the research evidence and the subsequent findings from the stakeholders’ deliberations into the CFIR domains and referencing the Expert Recommendations for Implementing Change (ERIC) to develop the acceptable intervention characteristics and the corresponding implementation strategies. These insights will be further validated in a Delphi Expert Survey, for a consensus-based approach. Discussion This study employs a sequential mixed-method approach to explore the intervention characteristics for an acceptable intervention design in the policy formulation and the corresponding implementation strategy for direct access to physiotherapists. Integrating research insights into actionable policy recommendations and refining these recommendations in a Delphi Survey will inform the appropriate policy intervention design and implementation strategy for direct access to physiotherapy services.

Abstract Background Despite the integration of iron supplementation into routine antenatal care programs as a nutritional intervention to prevent anemia in pregnant women, the use of this supplement for the recommended duration remains low in sub-Saharan Africa (SSA). Evidence on maternal compliance with iron supplementation at the SSA level is lacking and most of the previous studies have been limited to specific geographic areas. Therefore, the current study used large population survey data from 35 SSA countries to estimate the pooled prevalence of non-adherence and its determinants. Methods A secondary analysis was conducted using data from the demographic and health surveys across 35 SSA countries. After excluding women with missing data on the outcome variable, a weighted sample of 158,941 women who received iron supplementation during their recent pregnancy was included in the analysis. Forest plot was used to present the pooled and country-level rates of non-adherence to antenatal iron supplementation. A multilevel mixed-effects Poisson regression with robust variance was done to identify determinants of non-adherence. Results The pooled prevalence of non-compliance to iron supplementation in SSA was 65.1% [95% CI: 64.9 − 65.3%], with the lowest level in Zambia (18%) and the highest in Burundi (97%). The analysis revealed that living in rural areas (aPR: 1.16, 95% CI: 1.13–1.19), lack of access to mass media (aPR: 1.10, 95% CI: 1.09–1.12), low household wealth (aPR: 1.11, 95% CI: 1.09–1.14), late (aPR: 1.19, 95% CI: 1.17–1.20) and frequent ANC visit (aPR: 1.28, 95% CI: 1.26, 1.29), women’s employment status (aPR: 1.05, 95% CI: 1.03–1.06), husband illiteracy (aPR: 1.12, 95% CI: 1.10–1.13), and distance to a health facilities (aPR: 1.03, 95% CI: 1.01–1.05) were associated higher prevalence of non-adherence. Conversely, older maternal age was associated lower prevalence of non-compliance (aPR: 0.96, 95% CI: 0.94–0.97). Conclusion More than six out of ten pregnant women in SSA do not take iron supplements for the recommended period, with substantial variations across the countries. The level of non-adherence was significantly varied by women’s sociodemographic and reproductive characteristics. This urges the need for strengthening community health interventions and other existing programs to reach women in rural and economically disadvantaged settings. Furthermore, promoting antenatal care services through mass media and community-based health education strategies is key for scaling up the utilization of the supplement. Our results also suggest the importance of establishing the community-based distribution of iron supplements to address women with limited access to the healthcare system.

Abstract Introduction HIV/AIDS is a global public health concern that is closely related to other sociocultural problems. The prevention of mother to child transmission cascade often begins with and is integrated into antenatal care in order to ensure a high rate of case detection and optimal treatment coverage. Although guidelines suggest that all pregnant women should have HIV testing as part of their regular screening checks during antenatal care, a significant proportion of pregnant women were not tested for HIV during antenatal care follow-up in sub-Saharan Africa. Hence, this study was aimed at assessing the determinants of women not tested for HIV during antenatal care follow-up in sub-Saharan Africa. Method A cross-sectional study was conducted to assess the determinants of non-testing for HIV among women as part of antenatal care in sub-Saharan Africa, utilizing secondary data from the 2015–2022 Demographic and Health Surveys. The study included a weighted sample of 788,421 women who had antenatal care follow-up during their most recent pregnancy within five years preceding the survey. A multilevel mixed effect logistic regression analysis was employed to identify the determinants of non-testing for HIV among these women. The adjusted odds ratios with 95% confidence intervals were calculated to determine the associations between the outcome and explanatory variables. Statistical significance was determined using a p-value of less than 0.05. Result The hierarchical analysis of this study identified several significant factors associated with women not being tested for HIV during antenatal care in sub-Saharan Africa. These factors include young age, low or no education, not being in a union, unemployment, and low household wealth index. Additionally, limited media exposure, stigmatizing attitudes towards people living with HIV, male-headed households, and rural residence were significant at the individual and household levels. At the community level, low media exposure and high illiteracy rates were significant, while at the country level, high fertility rates and low literacy rates were also associated with lower rates of HIV testing during antenatal care. Conclusion This study identified significant individual, community, and country-level factors associated with women not testing for HIV during antenatal care in sub-Saharan Africa. Key factors include young age, low education, unemployment, not being in a union, low household wealth, limited media exposure, stigmatizing attitudes towards people living with HIV, male household head, rural residence, low community media exposure, high community illiteracy, high fertility rates, and low literacy rates. These findings highlight the need for targeted, context-specific interventions to improve HIV testing rates and enhance maternal and child health outcomes in the region.

Abstract Background We aimed to investigate how self-reported physical and cognitive limitations (challenges), self-efficacy, and social support interacted with life satisfaction in adolescents and young adults with congenital heart disease (CHD) or acquired heart disease, among whom life satisfaction may be impaired. Methods “Adolescence with Heart Disease” was a cross-sectional, nationwide survey of patients with CHD or early acquired heart disease aged 15–25. Structural equation modeling was used to test the implied latent variable mediation model between the main outcome of interest (life satisfaction) and challenges, social support, and self-efficacy. The correlation factors between life satisfaction and the latent variables with 95% confidence intervals (CIs) were calculated. Results A total of 1691 patients were included: 72% had CHD, 52% were females, the median age at response was 20 years [interquartile range: 18;23], and 69% reported high life satisfaction. In the univariate models, high life satisfaction was significantly associated with low challenges (-0.5 [CI: -0.6;-0.5]), high self-efficacy (0.8 [CI: 0.7; 0.8]), and high social support (0.4 [CI: 0.3; 0.5]). In the multivariate model, only self-efficacy remained significantly associated with life satisfaction (0.8 [CI: 0.7; 0.9]). Furthermore, there was a significant negative covariance between challenges and both self-efficacy (-0.67) and social support (-0.4), while the two latter variables had a positive covariance (0.55). Conclusions In adolescents with heart disease, high life satisfaction was associated with high levels of self-efficacy. High levels of self-efficacy and social support attenuated the association between physical and cognitive challenges and life satisfaction. In this group that may face higher challenges than their peers, future interventions should aim to increase their self-efficacy to improve their life satisfaction, potentially through promoting social support.

Abstract Background The operationalization of universal health insurance in Burkina Faso represents a significant challenge for health coverage. The willingness of households to pay is a crucial aspect of the process. This highlights the necessity of examining the factors that may explain their willingness to pay. The objective of this study is to analyze the determinants of households’ willingness to pay for health insurance in Burkina Faso. Methods The data used in this study were collected between March and September 2017 in the territory of Burkina Faso, covering six administrative regions. A total of 211 households were surveyed, 71 in urban areas and 140 in rural areas. The Tobit model was employed to analyze the determinants of willingness to pay, with the contingent valuation method used to obtain willingness to pay. Results The results of the descriptive analysis indicate that households are willing to pay approximately 7,600 F CFA on average for health insurance. The estimation results demonstrate that income has a positive effect on households’ willingness to pay. Additionally, the occupation of the head of household and the insurance reimbursement rate are identified as determinants of willingness to pay. Conclusion The findings of this study indicate that income, the rate of repayment and the occupation of the head of household are the primary determinants of willingness to pay. In terms of implications, it is essential to ensure that the rate of protection is high, which could encourage households to pay the premium. Furthermore, the results of the evaluation suggest that interventions to increase household income may be beneficial.

Abstract Background Macrosomia is a forgotten health problem that directly or indirectly affects maternal and neonatal health outcomes. There is a lack of evidence on the factors that affect macrosomia in eastern Ethiopia. This study aimed to assess the determinants of macrosomia among newborns delivered in Jigjiga City, Eastern Ethiopia. Methods An institutional-based case-control study was conducted among 82 cases and 164 controls in Jigjiga City from June 25 to August 24, 2023. Bivariable and multivariable logistic regression were used to identify the determinants of macrosomia. An adjusted odds ratio (AOR) with a 95% confidence interval was used to report the strength of the association, and the statistical significance was declared at a p-value

Abstract Introduction Retroplacental hematoma is a paroxysmal accident that threatens maternal and fetal prognosis. It is a major emergency in obstetric pathology. The objective of this study was to identify the factors associated with retroplacental hematomas at the Maradi Mother and Child Health Center in 2022. Methods This was a case‒control cross-sectional analytical study that used patient records for the year 2022 from September 20 to October 20, 2023. The presence of a retropl placental hematoma was the outcome variable and was measured by a case (yes) or control (no) response. The exposure variables included sociodemographic characteristics, obstetric characteristics, care, progression of patients and neonatal characteristics. Pearson’s chi-square tests at the 5% significance level were used to analyze differences between categorical variables. All variables that had a bilateral p value

Abstract Aim To assess food and nutrition literacy status and its determinants among elementary school students in El-Beheira Governorate, Egypt. Background Developing strategies to enhance food and nutrition literacy necessitates a deeper understanding of the food and nutrition literacy situation among elementary school students and associated factors. Design A cross-sectional descriptive research design was adopted. Methods A final sample of 400 primary school students (aged 6–12 years) at Itay El Barud public elementary schools in El-Beheira Governorate were administered (1) a socio-demographic characteristics and anthropometric measurements questionnaire developed by the researchers, and (2) the Food and Nutrition Literacy Scale. The derived data were analyzed using descriptive and non-parametric tests. Results The majority (61%) of students had low food and nutrition literacy scores. The results have shown that overall socio-demographic variables were significant in predicting understanding food and nutrition information, nutritional health knowledge, interactive functional and nutritional literacy, critical food and nutritional literacy, and food labeling. Conclusion The study reveals that elementary school students in Egypt have poor knowledge and skills in food and nutrition literacy, largely due to a lack of nutrition education and family awareness. Factors like residential location, income, and education level also contribute to this disparity. Implications for the profession To improve nutrition literacy among students, a nursing approach involving community stakeholders and school nurses is recommended. This includes integrating nutrition-related topics into the school curriculum, organizing workshops, and conducting age-appropriate health education sessions. Active engagement between community health and school nurses is crucial for raising awareness about healthy nutritional choices. Impact These findings hold an important impact on the education system and those designing curricula, emphasizing the need for significant incorporation of knowledge and skills related to food and nutrition within schools. Reporting method Compliance with the STROBE checklist for cross-sectional studies was maintained throughout the research. Patient or public contribution No Patient or Public Contribution.

Abstract Background Despite the positive impact of adhering to the new antenatal care model on pregnancy outcomes and maternal health service uptake, women in resource-limited settings exhibit low levels of compliance with this recommendation. Previous studies on women’s adherence to the new antenatal care recommendation have been limited to individual countries, with no evidence available at Sub-Saharan Africa (SSA) level. Therefore, this study sought to investigate compliance with the 2016 WHO’s recommendation of at least eight antenatal care contacts among women in SSA countries and identify its determinants. Methods The study utilized a weighted sample of 101,983 women who had received antenatal care during their index pregnancy, drawn from recent DHS data of sixteen SSA countries. A multilevel mixed-effect analysis was conducted to identify factors that influence compliance with new antenatal care recommendations. Model comparison was performed using deviance and log-likelihood values, and statistical significance was determined at a P-value of less than 0.05. Results The level of compliance with the recommended antenatal care contacts among women in SSA was 9.9% (95% CI: 9.7-10.1%), with the highest rate in Sierra Leone (26.1%) and lowest in Rwanda (

Abstract Background Blended learning, a pedagogical approach combining traditional classroom instruction with online components, has gained prominence in nursing education. While offering numerous benefits, student satisfaction with blended learning remains a critical concern. This study contributes to the existing literature by providing a comprehensive evaluation of the determinants influencing nursing students’ satisfaction with this innovative educational modality. By examining a wide range of factors, including sociodemographic characteristics, academic factors, and environmental influences, this research offers valuable insights for educators to optimize blended learning experiences in nursing education. Methods A descriptive cross-sectional research design was conducted. This study investigates the factors influencing nursing students’ satisfaction with blended learning at Alexandria University, Egypt, where blended learning programs have been integrated into the curriculum primarily through the Microsoft Teams platform. A convenient sample of 1266 nursing students from both bachelor and technical educational institutions participated in the study from September 2023 to the end of December 2023. Data were collected using an online survey containing two measurement tools: the Blended Learning Satisfaction Scale and the Environmental Facilitators and Barriers to Student Persistence in Online Courses scale. Statistical analyses, including descriptive statistics and backward multiple linear regression, were conducted to identify factors that are associated with the satisfaction of nursing students’ with blended learning. Results Findings indicate that factors such as age, gender, income, employment status, access to suitable internet sources, academic year, computer literacy, preferred learning method, and perceptions of environmental facilitators significantly influence satisfaction scores (all p

Abstract Background Meconium-stained amniotic fluid (MSAF) is a condition in which meconium is present in the uterus during ante-natal and complicates 10–15% of all live births. Scanty information is known about the determinants of meconium-stained amniotic fluid. Hence, this study aimed to identify determinants of meconium-stained amniotic fluid among women delivered at southwestern referral hospitals in southwest Ethiopia, in 2024. Methods An institutional-based case-control study was employed from January 1, 2024, to June 30, 2024. The study was conducted in four southwestern referral hospitals in southwest Ethiopia. The final sample size includes 321(107 cases and 214 controls). The sample size was proportionally allocated for cases and controls for each referral hospital. Simple random sampling was used to select patient charts and data was collected from the chart using questions/tools developed after reviewing relevant literature. Data were entered using Epi-data version 3.1 and analyzed using SPSS version 25. Data was analyzed using binary logistic regression. All independent variables with P- the value of

Abstract Background The unprecedented COVID-19 pandemic has become an endemic disease of global public health importance. Mass COVID-19 vaccination has been an essential global control strategy amidst challenges of limited acceptance. Because of globalization, COVID-19/similar diseases vaccination acceptance and the determinants in any particular setting are important global public health issues. Using a novel and pragmatic framework, this study explored determinants of COVID-19 vaccination acceptance among community members during the pandemic in Ebonyi state, Nigeria, and made policy-relevant recommendations on how to increase vaccination acceptance in subsequent outbreaks/pandemics. Methods This qualitative study was based on the novel and pragmatic Individual Experiences and Perceptions and Complacency, Confidence, Convenience, and Compulsion (Four ‘Cis’) Determinants of Vaccination Acceptance Conceptual Framework – Omale INDEPT FORCIS Framework. On April 26 and 27, 2022, 20 semi-structured face-to-face focus group discussions were conducted in local language and pidgin English with 100 purposively selected consenting/assenting community members aged 15 years and above who had resided in the community for at least one year. Data was analysed using deductive (with some inductive) thematic analytic approach. Results The many, diverse, and significant determinants of COVID-19 vaccination acceptance found were factors that were individual-related (individual experiences and perceptions and knowledge about COVID-19, COVID-19 vaccine/vaccination, and the vaccination process/system, sociodemographic, individual’s condition (e.g. pregnancy)); COVID-19-related (factuality, transmissibility, frequency, severity, fatality); COVID-19 vaccine/vaccination-related (safety/side-effects, effectiveness, speedy production); COVID-19 vaccination process/system-related (real availability/accessibility); family, group, and other individual-related (experiences and perceptions and actions); and broader local, national, international, and global (LONING) context-related (socio-political, economic, historic, health system factors). The broader LONING contextual factors included the unprecedented disinformation/conspiracy theories, non-sustained COVID-19 risk/behaviour change communication, enforcement and non-enforcement or termination of peculiar control policies/measures (lockdowns, social/physical distancing, use of face mask etc.), mandatory COVID-19 vaccination policies, provision of incentives, past experiences regarding the Ebola viral disease outbreak, (un)trustworthiness of the Nigerian health system and her international/global partners, and the (un)trustworthiness of the governments in Nigeria and bad/good governance, inclusive of the failure of the Ebonyi state government to distribute the COVID-19 palliatives to the people during the lockdowns. Conclusion The evidence illuminates complex and interrelated, specific underlying, and peculiar policy-relevant LONING determinants of COVID-19 vaccination acceptance and emphasizes the need for concerted and comprehensive LONING strategies (involving all the relevant LONING stakeholders/policy makers) in addressing these determinants to increase vaccination acceptance among community members in subsequent outbreaks/pandemics in Ebonyi state/Nigeria and similar settings.

Abstract Background Many patients with post COVID-19 condition (PCC) require healthcare services. However, qualitative studies indicate that patients with PCC encounter many barriers to healthcare access. This cross-sectional study aimed to determine how many PCC patients report barriers to healthcare access and which barriers are reported, and to explore differences between subgroups. Methods Data were collected via an online survey from 10,462 adult patients with a confirmed or suspected COVID-19 infection in the Netherlands, who experienced persisting symptoms ≥ 3 months after the initial infection. To study self-perceived barriers, a list of eleven possible barriers was used, covering multiple aspects of healthcare access. Differences between subgroups based on sociodemographic characteristics, medical characteristics, PCC symptoms (fatigue, dyspnoea, cognitive problems, anxiety and depression), and healthcare use (general practitioner, paramedical professional, medical specialist, occupational physician and mental health professional) were studied through multivariable multinomial (0 vs. 1 vs. > 1 barrier) and binomial regression analyses (for each individual barrier). Results A total of 83.2% of respondents reported at least one barrier to healthcare access. Respondents reported a median of 2.0 (IQR = 3.0) barriers. The barriers “I didn’t know who to turn to for help” (50.9%) and “No one with the right knowledge/skills was available” (36.8%) were most frequently reported. Respondents with younger age, higher educational level, not hospitalized during acute COVID-19 infection, longer disease duration, who had more severe PCC symptoms, and who did not consult an occupational physician or paramedical professional, were more likely to report barriers. Analyses per barrier showed that women were more likely to report financial and help-seeking barriers, while men were more likely to report barriers related to availability of care. Hospitalized respondents were less likely to report barriers related to availability of care, but not less likely to report financial or help-seeking barriers. Conclusions This study shows that the majority of patients with PCC experiences barriers to healthcare access. Particular attention should be paid to younger, non-hospitalized patients with a long disease duration and severe PCC symptoms. Efforts to remove barriers should focus not only on improving availability of care, but also on helping patients navigate care pathways.

Abstract Background Diarrhea diseases continue to present a significant threat to the well-being of children under the age of five in Africa, thereby contributing substantially to both morbidity and mortality rates. The period spanning between January 2013 and December 2023 has witnessed persistent challenges in the fight against these diseases, thereby necessitating a thorough investigation into the factors that determine their occurrence. It is important to note that the burden of diarrhea diseases is not evenly distributed across the continent, with residence, socioeconomic, and environmental factors playing pivotal roles in shaping the prevalence and incidence rates. Consequently, this systematic review aimed to consolidate and analyze the existing body of literature on the determinants of diarrhea diseases among children under the age of five in Africa between January 2013 and December 2023. Method The systematic review employed a rigorous methodological approach to examine the determinants of diarrhea diseases among children under the age of five in Africa between January 2013 and December 2023. A comprehensive search strategy was implemented, utilizing databases such as PubMed, Scopus, and Web of Science, and incorporating relevant keywords. The inclusion criteria focused on studies published within the specified timeframe, with a specific focus on the determinants of diarrhea disease among children under the age of five in Africa. The study selection process involved a two-stage screening, with independent reviewers evaluating titles, abstracts, and full texts to determine eligibility. The quality assessment, employing a standardized tool, ensured the inclusion of studies with robust methodologies. Data extraction encompassed key study details, including demographics, residence factors, socioeconomic influences, environmental variables, and intervention outcomes. Results The search yielded a total of 12,580 articles across 25 African countries; however, only 97 of these articles met the inclusion criteria and were ultimately included in the systematic review. The systematic review revealed geographic and seasonal disparities in the prevalence of diarrhoeal diseases across different countries in Africa. Factors such as age-related vulnerabilities, gender disparities, maternal occupation, disposal of young children’s stools, and economic status were identified as significant determinants of the prevalence of diarrhea disease. Conclusion This systematic review provides a comprehensive understanding of the determinants of diarrhea diseases among children under the age of five in Africa between January 2013 and December 2023. The nuanced analysis of residence variations, socioeconomic influences, environmental factors, and intervention outcomes underscores the complex nature of this issue. The findings highlight the necessity for region-specific and context-sensitive interventions to address the unique challenges faced by diverse communities. This review serves as a valuable resource for policymakers, healthcare professionals, and researchers, guiding the development of evidence-based strategies aimed at reducing the burden of diarrhea diseases and improving child health outcomes in Africa.

Abstract Background Childbirth among adolescents and young mothers has been linked to various complications, including perinatal mortality, preterm births, low birth weight, and infections, which collectively contribute to the high burden of neonatal and maternal mortality. Despite some progress, the prevalence of skilled birth attendance, proven to improve maternal and newborn health outcomes, remains consistently low in Northern Nigeria. This study assessed the prevalence and determinants of Skilled Birth Attendance (SBA) among young women ages 15–24 years in Northern Nigeria. Methods This pooled cross-sectional study included 6,461 young women aged 15–24 years from 2011, 2016 and 2021 multiple indicator cluster surveys in Nigeria. We used a binary logistic regression model to assess the factors associated with skilled birth attendance at 95% confidence intervals (CIs) with computed adjusted odds ratios (aORs). Results The prevalence of skilled birth attendance among young women in Northern Nigeria increased from 25.6% in 2011 to 33.1% in 2021. Women who were atleast 18 years of age at first marriage had 2.48 higher odds of SBA (aOR 2.48, 95% CI = 1.54–4.00) compared those less than 18 years of age at first marriage after controlling for confounders. Young women from rich household wealth quintile were more likely to utilize SBA (aOR 1.84, 95% CI = 1.11–3.14) compared to young women from poor household wealth quintile. In terms of education, those women who had secondary (aOR = 2.52, 95% CI = 1.77–3.56) and higher education (aOR = 10.01, 95% CI = 2.21–49.31) had higher odds of SBA compared to those with no education. Individual women with media exposure had 59% higher likelihood (aOR = 1.59, 95% CI = 1.16–2.19), women who attended 4 or more antenatal care visits during their last pregnancy demonstrated 2.28 times higher odds (aOR = 2.28, 95% CI = 1.67–3.09), while those who reported no intention for their last pregnancy were 37% less likely (aOR = 0.63, 95% CI = 0.42–0.96) to utilize SBA. Conclusion A slight increase in the prevalence of skilled birth attendance was observed over the 10-year period. For a significant boost in skilled birth attendance among young women in Northern Nigeria, particular attention needs to be paid to girls’ child education, delay in marriage, economic empowerment of young women, and strategic ways of leveraging trained community health workers (CHIPs) to bring reproductive healthcare close to young women living in rural areas.

Abstract Background Women living with HIV (WLWH) in low- middle-income countries (LMICs) face increased mortality risks from comorbidities despite progress in antiretroviral therapy. Palliative care (PC) is vital for these patients, yet its integration in LMICs, such as Nigeria, is suboptimal due to unique challenges. Objective This study investigated the knowledge, perceived barriers, and facilitators influencing PC integration into routine HIV care within healthcare (HC) settings. Methodology A cross-sectional survey was conducted among WLWH in twelve HC facilities throughout Nigeria. Data collection involved surveys focused on PC knowledge, attitudes, facilitators, and barriers. Logistic regression analyses were employed to examine the data. Results This study revealed significant gaps in knowledge and attitudes towards PC among HIV + women at NISA-MIRCs. Over 90% were unaware of PC services, but many saw its potential to offer hope (55%) and improve quality of life (56.5%). The key predictors of PC knowledge included education, occupation, religion, having fewer children, urban residence, type of residence, and having a high income (p

Abstract Introduction The increasing rates of HIV among Latino men who have sex with men (MSM) necessitate innovative and rigorous studies to evaluate prevention and treatment strategies. Pre-exposure prophylaxis (PrEP) is a highly effective tool in preventing HIV acquisition and plays a crucial role in the Ending the HIV Epidemic in the U.S. initiative. However, there is a scarcity of PrEP research specifically focused on Latino MSM, and the factors influencing its implementation remain largely unknown. Methods To address this gap, we conducted a comprehensive review exploring the determinants (barriers and facilitators) of PrEP implementation among Latino MSM, as well as the change methods (implementation strategies and adjunctive interventions) that have been evaluated to promote its adoption. Our review encompassed 43 peer-reviewed articles examining determinants and four articles assessing change methods. Determinants were coded using the updated Consolidated Framework for Implementation Research (CFIR 2.0) to understand the multilevel barriers and facilitators associated with implementation. Results The majority of research has focused on PrEP recipients (i.e., patients), primarily examining their awareness and willingness to use PrEP. Fewer studies have explored the factors influencing clinicians and service delivery systems. Additionally, the evaluation of change methods to enhance clinician adoption and adherence to PrEP and recipient adherence to PrEP has been limited. Conclusion It is evident that there is a need for culturally adapted strategies tailored specifically for Latino MSM, as the current literature remains largely unexplored in this regard. By incorporating principles from implementation science, we can gain a clearer understanding of the knowledge, skills, and roles necessary for effective cultural adaptations. Future research should emphasize factors influencing implementation from a clinician standpoint and focus on innovative change methods to increase PrEP awareness, reach, adoption, and sustained adherence among Latino MSM.

Abstract Background Implementation science scholars have made significant progress identifying factors that enable or obstruct the implementation of evidence-based interventions, and testing strategies that may modify those factors. However, little research sheds light on how or why strategies work, in what contexts, and for whom. Studying implementation mechanisms—the processes responsible for change—is crucial for advancing the field of implementation science and enhancing its value in facilitating equitable policy and practice change. The Agency for Healthcare Research and Quality funded a conference series to achieve two aims: (1) develop a research agenda on implementation mechanisms, and (2) actively disseminate the research agenda to research, policy, and practice audiences. This article presents the resulting research agenda, including priorities and actions to encourage its execution. Method Building on prior concept mapping work, in a semi-structured, 3-day, in-person working meeting, 23 US-based researchers used a modified nominal group process to generate priorities and actions for addressing challenges to studying implementation mechanisms. During each of the three 120-min sessions, small groups responded to the prompt: “What actions need to be taken to move this research forward?” The groups brainstormed actions, which were then shared with the full group and discussed with the support of facilitators trained in structured group processes. Facilitators grouped critical and novel ideas into themes. Attendees voted on six themes they prioritized to discuss in a fourth, 120-min session, during which small groups operationalized prioritized actions. Subsequently, all ideas were collated, combined, and revised for clarity by a subset of the authorship team. Results From this multistep process, 150 actions emerged across 10 priority areas, which together constitute the research agenda. Actions included discrete activities, projects, or products, and ways to shift how research is conducted to strengthen the study of implementation mechanisms. Conclusions This research agenda elevates actions to guide the selection, design, and evaluation of implementation mechanisms. By delineating recommended actions to address the challenges of studying implementation mechanisms, this research agenda facilitates expanding the field of implementation science, beyond studying what works to how and why strategies work, in what contexts, for whom, and with which interventions.

Abstract Background The implementation of youth care guidelines remains a complex process. Several evidence–based frameworks aid the identification and specification of implementation determinants and strategies. However, the influence of specific strategies on certain determinants remains unclear. Therefore, we need to clarify which active ingredients of strategies, known as behaviour change techniques (BCTs), elicit behaviour change and improve implementation outcomes. With this knowledge, we are able to formulate evidence–based implementation hypotheses. An implementation hypothesis details how determinants and in turn, implementation outcomes might be influenced by specific implementation strategies and their BCTs. We aimed to identify (1) determinants relevant to the implementation of youth care guidelines and (2) feasible and potentially effective implementation hypotheses. Methods A four–round online modified Delphi study was conducted. In the first round, experts rated the implementation determinants based on their relevance. Next, experts formulated implementation hypotheses by connecting BCTs and implementation strategies to determinants and were asked to provide a rationale for their choices. In round three, the experts reconsidered and finalised their hypotheses based on an anonymous overview of all formulated hypotheses, including rationales. Finally, the experts rated the implementation hypotheses based on their potential effectiveness and feasibility. Results Fourteen experts completed the first, second, and third rounds, with 11 completed the final round. Guideline promotion, mandatory education, presence of an implementation leader, poor management support, knowledge regarding guideline use, and a lack of communication skills were reported as most relevant determinants. In total, 46 hypotheses were formulated, ranging from 6 to 9 per determinant. For each determinant, we provide an overview of the implementation hypotheses that were most commonly deemed feasible and potentially effective. Conclusion This study offers valuable insights into youth care guideline implementation by systematically identifying relevant determinants and formulating hypotheses based on expert input. Determinants related to engagement and to knowledge and skills were found to be relevant to youth care guideline implementation. This study offers a set of hypotheses that could help organisations, policymakers, and professionals guide the implementation process of youth care guidelines to ultimately improve implementation outcomes. The effectiveness of these hypotheses in practice remains to be assessed.

Abstract Background Subjective wellbeing (SWB) and health are important facets of any person’s life, and they tend to influence each other. This importance is reflected in the vastness of literature aiming to explore this association. However, most of this literature is based on sampling national population which may present different population characteristics to those of a province. Thus, the paper aims to investigate if the association between perceived health and SWB is moderated by population characteristics at a provincial level. We intend to add value to subjective wellbeing and health literature by reviewing the relationship between SWB and health in the Eastern Cape stratified by age, gender, rural and urban and different income classifications. Methods Different population characteristics tend to associate to subjective wellbeing and health differently, therefore influencing how these two variables influence each other. Thus, the paper aims to investigate if the association between perceived health and SWB is moderated by population characteristics at a provincial level. Utilising the South African National Income Dynamics Survey from 2008 to 2017, this study examined the relationship between subjective wellbeing and health using a random effects model stratified according to aforementioned population characteristics. Results A better perceived health status is associated with higher subjective wellbeing. A better subjective wellbeing is also associated with a higher health status. Determinants of subjective wellbeing and health associate with these variables differently besides income and employment which led to higher subjective wellbeing and health. Health associates to subjective wellbeing different across populations characteristics. Conclusion Subjective wellbeing and health are interdependent as reflected in the World Health Organisation (WHO) and United Nation (UN) statements. Higher income and level of education and being employed is associated with both higher SWB and health. Therefore, improving these economic outcomes maybe associated with an improvement in well-being and health as desired by WHO and UN. Provinces differ, and different population characteristics tend to associate with subjective wellbeing and health differently, therefore influencing how these two variables influence each other. Health improvement policies must consider subjective wellbeing. Well-being improvement policies need to be cognisant of the differences in provincial and population characteristics.

Abstract Recent research has established existence of a correlation between women’s education and fertility, suggesting that they share similar risk factors. However, in many studies, the two variables were analysed separately, which could bias the conclusions by undermining the apparent correlations of such paired outcomes. In this article, the univariate and bivariate Poisson regression models were applied to nationally representative sample of 24,562 women from the 2015-16 Malawi demographic and health survey to examine the risk factors of women’s education levels and fertility. The R software version 4.1.2 was used for the analyses. The results showed that estimates from the bivariate Poisson model were consistent with those obtained from the separate univariate Poisson models. The sizes of estimates of coefficients, their standard errors, p-values, and directions were comparable in both bivariate and univariate Poisson models. Using either the univariate or bivariate Poisson model, it was found that the age of a woman at first sexual experience, her current age, household wealth index, and contraceptive usage were significantly associated with both the woman’s schooling and fertility. The study further revealed that ethnicity, religion, and region of residence impacted education level only and not fertility. Similarly, marital status and occupation impacted fertility only and not education. The study also found that higher education levels were linked to a lower number of children, with a strong negative correlation of -0.62 between the two variables. The study recommends using bivariate Poisson regression for analysing paired count response data, when there is an apparent covariance between the outcome variables. The results suggest that efforts by policymakers to achieve the desired women’s sexual and reproductive health in sub-Saharan Africa should be intertwined with improving women’s and girls’ education attainment in the region.

Abstract Background Older cancer patients are vulnerable to poorer health outcomes during cancer treatment. Although the Thai elderly had their own preferences towards future medical care and advance care planning (ACP) could help cancer patients make informed decisions, Thai physicians report a low ACP engagement rate. Thus, this study aimed to explore the perceptions of older cancer patients and their families towards ACP engagement. Method We used a qualitative approach to explore the perceptions of non-haematological cancer patients aged ≥ 60 years old and their primary caregivers. The study was conducted at the Oncology Radiotherapy Referral Center, Songklagarind Hospital in Southern Thailand. Semi-structured in-depth interviews were conducted with the patients and their caregivers. Thematic analysis was used to identify and analyze recurring patterns and themes of perceptions regarding ACP engagement within the interview transcripts. Results Among the 138 families approached, 32 interviews were conducted. Three themes were found: (1) Advantageous opportunity: the patients believed ACP would help them realize their life values, and ensure that their preference would be respected; (2) contemplation and barriers to ACP: ACP is unfamiliar and unnecessary, might have low utility, worry patients and family members, take away optimism, would not be a proper activity for the patient at the current health situation; and (3) Cues for ACP initiation: perceived conformity with one’s religion, awareness of the current cancer state, having multiple comorbidity or experience suffering related with medical care, wishing not to burden family, having close family members, and trust in physicians. Conclusion ACP engagement could be hindered or promoted by perceptions of older patients and/ or their family members, as well as the communication skills of the care providers. Care professionals who aim to initiate ACP should minimize the potential barriers, make the ACP benefits salient, and watch for cues indicating a propitious time to start the ACP conversation.

Abstract Background Cervical cancer screening is the primary goal in 90-70-90 targets to reduce cervical cancer incidence and mortality by identifying and treating women with precancerous lesions. Although several studies have been conducted in Sub-Saharan African (SSA) countries on cervical cancer screening, their coverage was limited to the regional or national level, and/or did not address individual- and community-level determinants, with existing evidence gaps to the wider SSA region using the most recent data. Hence, this study aimed to assess the pooled prevalence and multilevel correlates of cervical cancer screening among women with SSA. Methods This study was conducted using the Demographic Health Survey data (2015–2022) from 11 countries, and a total weighted sample of 124,787 women was considered in the analysis. Using multilevel mixed-effects logistic regression, the influence of each factor on cervical cancer screening uptake was investigated, and significant predictors were reported using the adjusted odds ratio (aOR) with their respective 95% confidence intervals (95% CI). Results The overall weighted prevalence of cervical cancer screening was 10.29 (95% CI: 7.77, 11.26), with the highest and lowest screening rates detected in Namibia and Benin at 39.3% (95% CI: 38.05, 40.54) and 0.5% (95% CI: 0.36, 0.69), respectively. Higher cervical screening uptake was observed among women aged 35–49 [aOR = 4.11; 95% CI: 3.69, 4.58] compared to 15–24 years, attending higher education [aOR = 2.71; 95% CI: 2.35, 3.23] than no formal education, being in the richest wealth quintile [aOR = 1.45; 95% CI: 1.26, 1.67], having a recent visit to a health facility [aOR = 1.83; 95% CI: 1.71, 1.95], using contraception [aOR = 1.54; 95% CI: 1.45, 1.64], recent sexual activity [aOR = 3.59; 95% CI: 2.97, 4.34], and listening to the radio [aOR = 1.78; 95%CI: 1.60, 2.15]. Conclusion The overall prevalence of cervical cancer screening in SSA countries was found to be low; only one in every ten women has been screened. Strengthening universal health coverage, and promoting screening programs with an emphasis on rural areas and low socioeconomic status are key to improving screening rates and equity. Additionally, integrating cervical cancer screening with existing reproductive health programs, e.g. contraceptive service would be important.

Abstract Background In Morocco, much progress has been made in breast cancer treatment. However, there is limited information on survival outcomes of breast cancer patients according to their therapeutic management. Methods A pattern-of-care study was conducted in Morocco’s two main oncology centres: Rabat and Casablanca and has shown that major progress has been made in the quality of care with survival rates comparable to those in developed countries. The present study focuses on the different therapeutic strategies used in breast cancer and their impact on prognosis. Patients were classified into two categories: those considered as appropriately managed and those who were not. Results A total of 1901 women with stage I to III breast cancer were included in this study, the majority (53%) were adequately managed and had better disease-free survival (DFS) rates than those who were not: DFS at 3 years (88% versus 62%) and at 5 years (80% versus 50%). Potential significant determinants of better management were: treatment in Rabat’s oncology centre, treatment between 2008 and 2012, being aged younger than 60 years, and early TN stage. Conclusion This study demonstrated the value of proper integrated and coordinated management in a comprehensive cancer centre, to improve breast cancer survival.

Abstract Background When common mental disorders (CMD) co-occur with HIV/AIDS, they can complicate patient diagnosis, help-seeking behaviors, quality of life, treatment outcomes, and drug adherence. Thus, estimating the pooled prevalence of CMD and its association with perceived stigma and social support among people living with HIV/AIDS (PLWHA) in Ethiopia could potentially support policymakers and health professionals to understand the disease burden and set a solution to improve the mental well-being of PLWHA. Methods Popular databases such as PubMed, SCOPUS, EMBASE, and Psych-INFO as well as Google Scholar, AJOL, CINAHL, PILOTS and Web of Science were searched for the relevant articles conducted in Ethiopia. We included cross-sectional, case–control, and cohort studies in the review. The Comprehensive Meta-Analysis software version 3.0 was used to pool the results of the included studies. The Q- and I2-statistics were used to assess the heterogeneity between the included studies. We employed a random-effects meta-analysis model to estimate the pooled prevalence of CMD and to account for heterogeneity among the included studies. We also conducted a leave-one-out analyses, and stratified meta-analyses by gender (male and female). Results The studies included in this systematic review and meta-analysis were published between 2009 and 2021, recruiting a total of 5625 participants. The pooled estimated prevalence of CMD among PLWHA in Ethiopia was 26.1% (95% CI 18.1–36.0). The pooled estimated prevalence of CMD was significantly higher among females, at 39.5% (95% CI 21.2–39.0), compared to males, 26.9% (95% CI 15.6–31.7). Moreover, the pooled estimated prevalence of CMD in PLWHA ranged from 23.5 to 28.9% in the leave-one-out sensitivity analysis, indicating that the removal of any single study did not significantly affect the pooled estimate. The pooled effects (AOR) of Perceived HIV stigma and poor perceived social support on common mental disorder were 2.91, 95% CI (1.35–6.29) and 5.56, 95% CI (1.89–16.39), respectively. Conclusion People living with HIV/AIDS (PLWHA) who received poor social support and those with HIV-related perceived stigma were found to have strong association with CMD. Therefore, it is advisable that all PLWHA attending ART clinic should be screened for CMD, social support and HIV-related perceived stigma.

Abstract Background Labor pain is uniquely experienced and described by the woman giving birth, and it is often considered one of the most excruciating experiences for many women. This study aimed to evaluate factors associated with the willingness to receive labor analgesia among women attending the antenatal clinic at Dr. Bogalech Gebre Memorial General Hospital Central Ethiopia in 2022. Methods An institution-based, cross-sectional study was conducted from January to March 2022. Data were collected using semi-structured questionnaires by a convenience sampling technique. Data was entered in EpiData 4.2 and exported to SPSS version 20 for analysis. Both Bivariable and multivariable logistic regressions were conducted to determine factors associated with pregnant women’s willingness to choose labor analgesia. Crude odds ratio (COR) and adjusted odds ratio (AOR) were computed to assess the association between variables. Results A total of 398 pregnant women have participated in the study with a response rate of 94%. Nearly 30%, (29.4%) of the pregnant women had a willingness to practice labor pain management. Being a housewife (AOR: 8.35, 95% CI: 2.07, 33.63). Women who live in urban (AOR: 2.60, 95% CI: 1.29, 5.29). Having had awareness about labor analgesia (AOR: 1.70, 95% CI: 1.00, 2.60) and the short duration of labor time (AOR: 1.84, 95% CI: 1.15, 2.96) were statistically significant with a willingness to practice labor analgesia. Conclusion We conclude that the willingness of pregnant mothers’ toward obstetric analgesia practice was low in the study area. Being a housewife, urban residence, awareness about labor analgesia, and short duration of labor were statistically significant with the willingness of the mothers to practice labor analgesia. To increase willingness to use labor analgesia, authorities should prioritize delivering health education on pain management choices to address concerns and promote effective methods and practices.

Abstract Background To appreciate dental care utilization in ‌the context of socio-economic inequalities, it is imperative to identify sources of inequalities and evaluate the extent to which dental care utilization is still related to socio-economic status. This study aimed to quantify the influence of contributed determinants on dental care utilization in the context of socio-economic inequalities amongst adults residing in Tehran metropolis. Methods In this cross-sectional community-based study, a stratified random sample of 1,510 subjects aged over 18 years was investigated by the zero-inflated Poisson analysis to measure the effect of determinants on utilization of dental care, and concentration index as well as the decomposition approach to identify the contributions of deterministic variables to the socio-economic inequality. Data was obtained by employing a phone interview survey. Individuals who were not willing or able to answer the questions in the telephone interview due to hearing or neurological problems did not participate in the interview. Dental care utilization was measured using the number of dental appointments. Results Gender (male), oral health-related behaviors (such as brushing and dental flossing), experience of toothache, and concern about dental appearance were associated with an increased likelihood of utilizing dental care. Individuals who belonged to advanced age groups and lived alone significantly underutilized dental care. The concentration index equaling 0.05 (SE = 0.05) corroborates a pro-rich inequality. Decomposition analysis demonstrated the impact of oral health-related behaviors (i.e. dental brushing and use of dental flossing), concern about dental appearance, toothache, gender (male), insurance coverage of dental care, and smoking habit on the poor-rich gap in the dental care utilization. Conclusions The influence of socio-economic inequalities on dental care utilization is discernable along the entire spectrum of socio-economic status. Individuals with lower socio-economic status experience more underutilization of dental care. Community subgroups, particularly the more deprived bracket, require consideration from key stakeholders, including policymakers and health professionals for the enhancement of dental care utilization as revealed by underlying determinants.

Abstract Background It is recognized that pain related to adult individuals with idiopathic scoliosis (IS) substantially impacts individuals’ daily activities and quality of life. The objective of this study was to identify the possible predictors of pain intensity in non‑surgically treated adults with IS. Methods This cross-sectional study included 58 adults individuals with Lenke type 1 IS. Participants’ sociodemographic characteristics were recorded, and pain severity, curvature severity, trunk rotation angle, disability, spinal mobility, cosmetic deformity perception, and quality of life were assessed. Regression analyses with various models were performed to determine the predictors of pain severity and the best model was selected based on performance criteria. Results Strong associations were found between pain severity with curvature severity, spinal mobility, trunk rotation angle, perception of cosmetic deformity, disability, and quality of life (p

Abstract Background Over the last 20 years, global healthcare has placed a major focus on improving the survival rates of mothers and children, recognizing the potential to prevent a significant number of deaths resulting from pregnancy and childbirth. Nevertheless, there remains an ongoing obstacle to the insufficient utilization of critical obstetric services to achieve optimal health outcomes for pregnant women. This study aimed to assess the magnitude and determinants of maternal healthcare use in the Jimma Zone, Ethiopia. Methods Data were obtained from a household survey as part of the baseline assessment of a cluster randomized controlled trial. The study participants comprised 588 women in early pregnancy, specifically those with a gestational age of less than 20 weeks. Logistic regression analysis was employed to identify factors associated with the use of maternal health services. Adjusted odds ratios (AORs) were used to assess the strength of the associations, with significance level set at a p-value ≤ 0.05. Results The overall prevalence of maternal health service utilization was 87.9% (CI: 85.1, 90.4) for antenatal care, 74.7% (CI: 73.2, 79.9) for health facility delivery, and 60.4% (CI: 56.4, 64.3) for postnatal care. Multivariable logistic analysis revealed that maternal health service use was significantly influenced by access to health facilities (AOR: 6.6; 95% CI: 2.39, 18.16), financial hardship (AOR: 3; 95% CI: 1.97, 4.61), perceived respectful care (AOR: 2.3; 95% CI: 1.07, 5.11), perceived privacy of service provisions (AOR: 2.4; 95% CI: 1.47, 4.06), and attitudes toward maternal service use (AOR: 2.2; 95% CI: 1.48, 3.24). Conclusions The study revealed slightly higher rates of antenatal care, facility delivery, and postpartum care utilization. However, there was a low proportion of early antenatal care initiation, and high rates of antenatal care dropout. Mobile phone-based messaging intervention may enhance maternal health service use by addressing factors such as lack of access, economic challenges, disrespectful care, no privacy of procedures, and unfavorable attitudes.

ABSTRACT Background Globally, 2.6 million stillbirths are estimated to occur each year. The causes of stillbirth are often unknown but can be attributed to various causes. Therefore, identifying the determinants of stillbirth is quite important for applying further meaningful interventions. The purpose of this study was to identify the determinants of stillbirth among deliveries conducted at selected public hospitals in the West Shoa Zone, Oromia, Ethiopia. Methods A hospital-based unmatched case‒control study with a 1:4 ratio was conducted. A total of 431 (87 cases and 344 controls) participants were involved. A systematic random sampling method was used for control selection. Data were collected using interview administered questionnaire and analysed using SPSS version 26 software. Binary logistic regression analyses were performed for the independent variables and outcome variables. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated to assess the strength of the associations, and statistical significance was declared at P value

Abstract Introduction Child undernutrition is a major public health problem in sub-Saharan Africa. Children who eat animal-based foods have higher intakes of various nutrients that are important for optimal linear growth. However, the prevalence of animal-source food consumption was low across many countries. Therefore, this study aimed to determine the prevalence of good consumption of animal-source foods and its determinants among children aged 6 to 23 months in sub-Saharan African countries. Methods A cross-sectional pooled dataset using recent demographic and health surveys from 19 sub-Saharan African countries was employed. A total weighted sample of 65,742 children aged 6 to 23 months was included in the study. Data extracted from the recent DHS data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Descriptive analysis was carried out to present both individual and community-level variables using frequencies and percentages. A multilevel mixed-effects logistic regression was used to determine the factors associated with the outcome variable. Finally, variables with a p-value less than 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant. Results In this study, 43.1% (95% CI: 42.7–43.5%) of children aged 6 to 23 months consumed animal-source foods. Factors like maternal education [AOR = 1.36; 95% CI (1.28, 1.44)], maternal occupation [AOR = 1.24; 95% CI (1.18, 1.31)], exposure to media [AOR = 1.30; 95% CI (1.24, 1.36)], wealth index [AOR = 1.16; 95% CI (1.10, 1.23)] & [AOR = 1.28; 95% CI (1.21, 1.36)], owned a mobile telephone [AOR = 1.23; 95% CI (1.17, 1.29)], ANC visits [AOR = 1.20; 95% CI (1.15, 1.25)], place of delivery [AOR = 1.09; 95% CI (1.04, 1.14)], PNC checkup [AOR = 1.34; 95% CI (1.28, 1.39)], the current age of the child [AOR = 1.99; 95% CI (1.85, 2.14)], [AOR = 3.34; 95% CI (3.14, 3.56)], & [AOR = 4.3; 95% CI (4.10, 4.66)], birth interval [AOR = 0.92; 95% CI (0.87, 0.97)], residence [AOR = 1.43; 95% CI (1.35, 1.50)], community illiteracy [AOR = 0.91; 95% CI (0.86, 0.96)], and community poverty [AOR = 1.07; 95% CI (1.01, 1.14)] were significantly associated with consumption of animal-source foods. Conclusion Less than half of children aged 6 to 23 months consumed any type of animal-source foods in sub-Saharan African countries. Higher educational level, non-agricultural work, exposure to media, high economic status, having a mobile telephone, attending 4 + ANC visits, health facility delivery, PNC checkups, older children, a birth interval of 24 months, urban residency, community literacy, and low community poverty were determinates of good consumption of animal source foods. Women empowerment, dissemination of nutrition-related information through mass media, promotion of health facility delivery, and improving utilization of maternal health services are recommended to improve infant and child feeding practices.

Abstract Background Identification of neonatal danger signs and immediate access to health care are two global efforts aimed at enhancing newborn and child survival by preventing 75% of neonatal deaths. Despite various small-scale studies on women’s awareness of neonatal danger signs in Ethiopia, little is known about the level of receiving health information on those danger signs during the immediate postpartum period at the national level. Hence, this study aimed at assessing the level, and its determinants of the service uptake in Ethiopia. Methods The data for this study was taken from the Ethiopian Demographic and Health Survey (EDHS), which took place from January to June 2016 and covered all administrative regions of Ethiopia. A weighted sample of 7,589.8 women was analyzed using STATA version 16. To account for data clustering, a multivariable multilevel mixed-effect logistic regression analysis was employed to determine the effects of each predictor on the outcome variable. Adjusted odds ratio with its corresponding 95% confidence interval was used to declare the statistical significance of the explanatory variables. Results The receipt of health information on neonatal danger signs during the immediate postpartum period was 10.70% [95% CI:10.01, 11.40]. Variables namely living in Metropolitans [AOR = 2.06; 95%CI: 1.48, 2.88] and Large central [AOR = 1.83; 95%CI: 1.38, 2.42] regions, being in the highest wealth quintile [AOR = 1.87; 95% CI: 1.23, 2.84], being nulliparous [AOR = 0.27; 95% CI: 0.08, 0.87] and primiparous[AOR = 0.61;95% CI: 0.46, 0.79], getting adequate antenatal visits [AOR = 2.42; 95% CI: 1.75, 3.33], institutional delivery [AOR = 5.91; 95% CI: 4.66, 7.53], and receipt of postnatal visits [AOR = 3.52; 95% CI: 2.84, 4.38] were identified as significant determinants of receiving health information on newborn danger signs. Conclusion The findings revealed that unacceptably low uptake of health information on newborn danger signs during the immediate postpartum period in Ethiopia. A concerted effort is needed from all stakeholders in the health sector to enhance the uptake of maternal health services (antenatal care, skilled delivery service, and postnatal care). Healthcare providers should pay special attention to nulliparous and primiparous women during and after delivery, and the government should also focus on women of peripheral regions, who make up a large portion of the low coverage.

Abstract Background Burnout syndrome attributable to cumulative stressors is highly prevalent among teachers. Despite this, knowledge of burnout syndrome among schoolteachers in lower-middle-income countries are limited, therefore we aimed to investigate self-reported occupational burnout syndrome and associated factors among schoolteachers in Nepal. Methods A survey was conducted among randomly selected 37 community schools in Kathmandu, Nepal in 2022, with a total sample of 218 schoolteachers (70% male). Occupational burnout was assessed using the Nepali version of the validated Maslach Burnout Inventory (MBI-ES). MBI-ES consists of 22 items assessing occupational burnout, which were classified into emotional exhaustion (EE, 9 items, score range: 0–45), depersonalization (DP, 5 items, 0–23), and personal accomplishment (PA, 8 items; 3–48). The greater score in EE and DP and the lower score in PA indicate a higher level of burnout. Various socio-demographic, lifestyle, and work-related factors were examined as determinants of occupational burnout using ANOVA and multivariable linear regression models. Results The mean scores of EE, DP, and PA were 14.99 (Standard Deviation, SD = 9.79), 4.18 (SD = 4.57), and 42.11 (SD = 6.82) respectively. Poor/moderate work ability contributed to poorer ratings of all three dimensions. Teaching special needs students contributed to EE and DP, whereas low physical activity and alcohol intake were associated with PA only. Younger age, being married, language of teaching, having a disability, sub-optimal physical fitness, poor sleep quality, and ever smoking contributed to EE only. Conclusion Occupational burnout among schoolteachers was relatively high. Marital status, lifestyle behavioral, and work-related factors were associated especially with EE and workability was a strong determinant of all three dimensions. Clinical trial registration number NCT05626543.