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Algorithmic bias has emerged as a critical challenge in the age of responsible production of artificial intelligence (AI). This paper reviews recent research on algorithmic bias and proposes increased engagement of psychological and social science research to understand antecedents and consequences of algorithmic bias. Through the lens of the 3-D Dependable AI Framework, this article explores how social science disciplines, such as psychology, can contribute to identifying and mitigating bias at the Design, Develop, and Deploy stages of the AI life cycle. Finally, we propose future research directions to further address the complexities of algorithmic bias and its societal implications.

Abstract Background Indigenous peoples worldwide experience inequitable cancer outcomes, and it is unclear if this is underpinned by differences in or inadequate use of endocrine treatment (ET), often used in conjunction with other cancer treatments. Previous studies examining ET use in Indigenous peoples have predominately focused on the sub-national level, often resulting in small sample sizes with limited statistical power. This systematic review aimed to collate the findings ofarticles on ET utilisation for Indigenous cancer patients and describe relevant factors that may influence ET use. Methods We conducted a systematic review and meta-analysis of studies reporting ET use for cancer among Indigenous populations worldwide. PubMed, Scopus, CINAHL, Web of Science, and Embase were searched for relevant articles. A random-effect meta-analysis was used to pool proportions of ET use. We also performed a subgroup analysis (such as with sample sizes) and a meta-regression to explore the potential sources of heterogeneity. A socio-ecological model was used to present relevant factors that could impact ET use. Results Thirteen articles reported ET utilisation among Indigenous populations, yielding a pooled estimate of 67% (95% CI:54 − 80), which is comparable to that of Indigenous populations 67% (95% CI: 53 − 81). However, among studies with sufficiently sized study sample/cohorts (≥ 500), Indigenous populations had a 14% (62%; 95% CI:43 − 82) lower ET utilisation than non-Indigenous populations (76%; 95% CI: 60 − 92). The ET rate in Indigenous peoples of the USA (e.g., American Indian) and New Zealand (e.g., Māori) was 72% (95% CI:56–88) and 60% (95% CI:49–71), respectively. Compared to non-Indigenous populations, a higher proportion of Indigenous populations were diagnosed with advanced cancer, at younger age, had limited access to health services, lower socio-economic status, and a higher prevalence of comorbidities. Conclusions Indigenous cancer patients have lower ET utilisation than non-Indigenous cancer patients, despite the higher rate of advanced cancer at diagnosis. While reasons for these disparities are unclear, they are likely reflecting, at least to some degree, inequitable access to cancer treatment services. Strengthening the provision of and access to culturally appropriate cancer care and treatment services may enhance ET utilisation in Indigenous population. This study protocol was registered on Prospero (CRD42023403562).

Indigenous people have applied their expert knowledge systems and research practices since time immemorial; however, the academy is still largely controlled by non-Indigenous people and favours Eurocentric Western methods. Indigenous people have continued to show strength and resilience despite these systems and continue to thrive through upholding sovereign knowing and wisdom. Indigenous knowledge systems are critical in driving meaningful evidence to improve health outcomes. This paper draws on our collective sovereign knowing as Aboriginal and Torres Strait Islander women to articulate the development of a smoking and vaping cessation group-based programme: Which Way, acknowledging the rights for our women to have culturally responsive and safe care. As such, we describe our approach to research, and how we reposition power and centre indigenous knowledges in our work to deliver meaningful outcomes that move beyond the usual application of Euro-Western co-designed research approaches which have become prevalent in the field. This is not to offer a methodological approach to research, but rather, to continue to validate and give space to indigenous researchers, students and community members ontological practices and in public health research.

Background While ear, nose, and throat (ENT) diseases are a substantial threat to global health, comprehensive reviews of ENT services in Southern Africa remain scarce. Objective This scoping review provides a decade-long overview of ENT services in Southern Africa and identifies gaps in healthcare provision. From the current literature, we hope to provide evidence-based recommendations to mitigate the challenges faced by the resource-limited ENT service. Data Sources PubMed, Web of Science, EBSCOhost, Cochrane Library, Cochrane Library, and Scopus. Review Methods On several databases, we conducted a comprehensive literature search on both quantitative and qualitative studies on ENT services in Southern Africa, published between 1 January 2014 and 27 February 2024. The extracted data from the analyzed studies was summarized into themes. Results Four themes in the fourteen studies included in the final analysis described the existing ENT services in Southern Africa: 1. Workforce scarcity and knowledge inadequacies, 2. Deficiencies in ENT infrastructure, equipment, and medication, 3. Inadequate ENT disease screening, management, and rehabilitation and 4. A lack of telehealth technology. Conclusion The Southern African ENT health service faces many disease screening, treatment, and rehabilitation challenges, including critical shortages of workforce, equipment, and medication. These challenges, impeding patient access to ENT healthcare, could be effectively addressed by implementing deliberate policies to train a larger workforce, increase ENT funding for equipment and medication, promote telehealth, and reduce the patient cost of care.

Despite the numerous advantages of soil fertility management (SFM) practices and substantial investments to promote adoption, uptake of these technologies remains low across sub-Saharan Africa. We study the adoption and intensity of key SFM practices - improved fallow, animal manure, compost, crop residue retention, minimum tillage, inorganic fertilizer, and intercropping among rural farmers in Zambia. Data from 1234 rural farms and the multivariate probit (MVP) and generalized Poisson regression models are used. The MVP model highlights interconnections among practices, emphasizing the need for integrated interventions. Socio-demographics like gender, age, education, and household labor availability significantly influence adoption of SFM practices. Farm characteristics including experience, land ownership, livestock, and off-farm income also play pivotal roles. Accessibility of information via phones, radio, and farmer groups emerged as a crucial enabler, while extension services, credit, and proximity to markets and roads shape adoption decisions. Results indicate education, household labor, off-farm income, and group membership drive intensity of adoption. Extension contacts, training, and agro-ecological region location also affect intensity with regional variations. Key policy implications emerge. First, the complementarities among practices underscore the need for holistic strategies recognizing these synergies. Second, enhancing education specifically for younger farmers can promote adoption of SFM technologies by increasing knowledge. Third, spurring farmer groups facilitates knowledge exchange, input access, and collaborative adoption. Fourth, strategic extension services and training programs are vital to address knowledge gaps for sustained adoption. Overall, this study provides insights to guide policies for promoting SFM practices among rural farms.

INTRODUCTION & RESEARCH OBJECTIVES: The COVID-19 pandemic significantly disrupted daily travel. This paper contrasts 51 US cities responses, namely street reallocation criteria and messaging related to physical activity (PA) and active transportation (AT) during the early months of the pandemic. This study can be utilized by cities for aiding in the creation of locally responsive policies that acknowledge and remedy a lack of safe active transportation. METHODS: A content analysis review was conducted of city orders and documents related to PA or AT for the largest city by population in all 50 US states and the District of Columbia. Authoritative documents issued from each citys public health declaration (ca. March 2020) to September 2020 were reviewed. The study obtained documents from two crowdsourced datasets and municipal websites. Descriptive statistics were used to compare policies and strategies, with a focus on reallocation of street space. RESULTS: A total of 631 documents were coded. Considerable variation existed in city responses to COVID-19 that impacted PA and AT. Most cities stay-at-home orders explicitly permitted outdoor PA (63%) and many encouraged PA (47%). As the pandemic continued, 23 cities (45%) had pilot programs that reallocated street space for non-motorized road users to recreate and travel. Most cities explicitly mentioned a rationale for the programs (e.g., to provide space for exercise (96%) and to alleviate crowding or provide safe AT routes (57%)). Cities used public feedback to guide placement decisions (35%) and several welcomed public input to adjust initial actions. Geographic equity was a criterion in 35% of programs and 57% considered inadequately sized infrastructure in decision-making. CONCLUSIONS: If cities want to emphasize AT and the health of their citizens, safe access to dedicated infrastructure needs to be prioritized. More than half of study cities did not instate new programs within the first 6 months of the pandemic. Cities should study peer responses and innovations to inform and create locally responsive policies that can acknowledge and remedy a lack of safe AT.

As statistical reviewers and editors for BMJ Paediatrics Open (BMJPO), we frequently see methodological and statistical errors in articles submitted to our journal. To make a list of these common errors and propose suitable corrections, and inspired by similar efforts at other leading journals, we surveyed the statistical reviewers and editors at BMJPO to collect their ‘pet peeves’ and examples of best practices.(1, 2) We have divided these into seven sections: graphics; statistical significance and related issues; presentation, vocabulary, textual and tabular presentation; causality; model building, regression and choice of methods; meta-analysis; and miscellaneous. Here, we present the common errors, with brief explanations. We hope that the guidance provided here will help guide authors as they prepare their submissions to the journal, leading to higher quality and more robust research reporting.

Schistosomiasis, a neglected tropical disease caused by parasitic worms, poses a major public health challenge in economically disadvantaged regions, especially in Sub-Saharan Africa. Climate factors, such as temperature and rainfall patterns, play a crucial role in the transmission dynamics of the disease. This study presents a deterministic model that aims to evaluate the temporal and seasonal transmission dynamics of schistosomiasis by examining the influence of temperature and rainfall over time. Equilibrium states are examined to ascertain their existence and stability employing the center manifold theory, while the basic reproduction number is calculated using the next-generation technique. To validate the model's applicability, demographic and climatological data from Uganda, Kenya, and Tanzania, which are endemic East African countries situated in the tropical region, are utilized as a case study region. The findings of this study provide evidence that the transmission of schistosomiasis in human populations is significantly influenced by seasonal and monthly variations, with incidence rates varying across countries depending on the frequency of temperature and rainfall. Consequently, the region is marked by both schistosomiasis emergencies and re-emergences. Specifically, it is observed that monthly mean temperatures within the range of 22–27 °C create favorable conditions for the development of schistosomiasis and have a positive impact on the reproduction numbers. On the other hand, monthly maximum temperatures ranging from 27 to 33 °C have an adverse effect on transmission. Furthermore, through sensitivity analysis, it is projected that by the year 2050, factors such as the recruitment rate of snails, the presence of parasite egg-containing stools, and the rate of miracidia shedding per parasite egg will contribute significantly to the occurrence and control of schistosomiasis infections. This study highlights the significant influence of seasonal and monthly variations, driven by temperature and rainfall patterns, on the transmission dynamics of schistosomiasis. These findings underscore the importance of considering climate factors in the control and prevention strategies of schistosomiasis. Additionally, the projected impact of various factors on schistosomiasis infections by 2050 emphasizes the need for proactive measures to mitigate the disease's impact on vulnerable populations. Overall, this research provides valuable insights to anticipate future challenges and devise adaptive measures to address schistosomiasis transmission patterns.

Abstract Background Addressing childhood stunting is a priority and an important step in the attainment of Global Nutrition Targets for 2025 and Sustainable Development Goals (SDGs). In Rwanda, the prevalence of child stunting remains high despite concerted efforts to reduce it. Methods Utilizing the United Nations International Children’s Emergency Fund (UNICEF) framework on maternal and child nutrition, this study systematically evaluated the determinants of child stunting in Rwanda and identified available gaps. Twenty-five peer-reviewed papers and five Demographic and Health Surveys (DHS) reports were included in the final selection of our review, which allowed us to identify determinants such as governance and norms including wealth index, marital status, and maternal education, while underlying determinants were maternal health and nutrition factors, early initiation of breastfeeding, water treatment and sanitation, and immediate factors included infections. Results A total of 75% of the overall inequality in stunting was due to the difference in the social determinants of stunting between poor and nonpoor households. Maternal education (17%) and intergenerational transfer (31%) accounted for most of the inequalities in stunting, and an increase in gross domestic product per capita contributed to a reduction in its prevalence. There is a paucity of information on the impact of sociocultural norms, early life exposures, maternal health and nutrition, and Rwandan topography. Conclusion The findings of this study suggest that improving women’s status, particularly maternal education and health; access to improved water, sanitation, and hygiene-related factors; and the socioeconomic status of communities, especially those in rural areas, will lay a sound foundation for reducing stunting among under-5 children.

This research examines how school choice impacts school segregation. Specifically, this work demonstrates that even if parents do not take the racial demographics of schools into account, preference differences between Black and White parents for other school attributes can still result in segregation. These preference differences stem from motivational differences in pursuit of social status. Given that the de facto US racial hierarchy assigns Black people to a lower social status, Black parents are more motivated to seek schools that signal that they can improve their children's status. Simulations of parental school decisions at scale show that preference differences under an unmitigated school-choice policy lead to more segregated schools, impacting more than half a million US children for every 3-percentage-point increase in school-choice availability. In contrast, if Black and White parents have similar preferences, unmitigated school choice would reduce racial segregation. This research may inform public policy concerning school choice and school segregation.

Abstract Background Same-day initiation (SDI) of antiretroviral therapy (ART) increases ART uptake, however retention in care after ART initiation remains a challenge. Public health behaviours, such as retention in HIV care and adherence to antiretroviral therapy (ART) pose major challenges to reducing new Human Immunodeficiency Virus (HIV) transmission and improving health outcomes among HIV patients. Methods We evaluated 6-month retention in care, and clinical outcomes of an ART cohort comprising of SDI and delayed ART initiators. We conducted a 6 months’ observational prospective cohort study of 403 patients who had been initiated on ART. A structured questionnaire was used to abstract data from patient record review which comprised the medical charts, laboratory databases, and Three Interlinked Electronic Registers.Net (TIER.Net). Treatment adherence was ascertained by patient visit constancy for the clinic scheduled visit dates. Retention in care was determined by status at 6 months after ART initiation. Results Among the 403 participants enrolled in the study and followed up, 286 (70.97%) and 267 (66.25%) complied with scheduled clinics visits at 3 months and 6 months, respectively. One hundred and thirteen (28.04%) had been loss to follow-up. 17/403 (4.22%) had died and had been out of care after 6 months. 6 (1.49%) had been transferred to other health facilities and 113 (28.04%) had been loss to follow-up. Among those that had been lost to follow-up, 30 (33.63%) deferred SDI while 75 (66.37%) initiated ART under SDI. One hundred and eighty-nine (70.79%) participants who had remained in care were SDI patients while 78 (29.21%) were SDI deferred patients. In the bivariate analysis; gender (OR: 1.672; 95% CI: 1.002–2.791), number of sexual partners (OR: 2.092; 95% CI: 1.07–4.061), age (OR: 0.941; 95% CI: 0.734–2.791), ART start date (OR: 0.078; 95% CI: 0.042–0.141), partner HIV status (OR: 0.621; 95% CI: 0.387–0.995) and the number of hospitalizations after HIV diagnosis (OR: 0.173; 95% CI: 0.092–0.326). were significantly associated with viral load detection. Furthermore, SDI patients who defaulted treatment were 2.4 (95% CI: 1.165–4.928) times more likely to have increased viral load than those who had been returned in care. Conclusion Viral suppression under SDI proved higher but with poor retention in care. However, the results also emphasise a vital need, to not only streamline processes to increase immediate ART uptake further, but also to ensure retention in care.

BackgroundStunting among children under five years of age is a global public health concern, especially in low-and middle-income settings. Emerging evidence suggests a gradual reduction in the overall prevalence of stunting in Rwanda, necessitating a qualitative understanding of the contributing drivers to help develop targeted and effective strategies. This qualitative study explored the lived experiences of women and men to identify key issues that influence childhood nutrition and stunting as well as possible solutions to address the problem.MethodsTen (10) focus group discussions (FGDs) were conducted with fathers and mothers of children under five years of age from five districts, supplemented by forty (40) in-depth interviews (IDIs) with Nurses and Community Health Workers (CHWs). Transcripts were coded inductively and analysed thematically using Dedoose (version 9.0.86).ResultsThree themes emerged: (1) Awareness of a healthy diet for pregnant women, infants, and children with subthemes Knowledge about maternal and child nutrition and feeding practices; (2) Personal and food hygiene is crucial while handling, preparing, and eating food with subthemes, food preparation practices and the feeding environment (3) factors influencing healthy eating among pregnant women, infants, and children with subthemes; Barriers and facilitators to healthy eating among pregnant women and children.ConclusionSeveral factors influence child stunting, and strategies to address them should recognise the cultural and social contexts of the problem. Prioritisation of nutrition-based strategies is vital and should be done using a multifaceted approach, incorporating economic opportunities and health education, especially among women, and allowing CHWs to counsel households with conflicts.

Abstract Background Patients’ views and experiences in healthcare institutions provide a means of assessing the quality of services patients receive from healthcare workers (HCWs). However, the views of patients on the health promotion (HP) and disease prevention (DP) services offered by HCWs and the delivery mode have not been adequately studied. Aim This study assessed the views of patients on HP and DP services provided by various categories of HCWs. Setting The study was conducted at a tertiary hospital in the Nelson Mandela Bay Municipality, South Africa. Method An exploratory cross-sectional study was conducted among 500 patients. The questionnaire elicited responses from patients regarding the HP and DP services received from the different cadres of HCWs at three different admission phases: pre-admission phase (PAP), admission phase (ADP), and post-admission phase (POP). Descriptive, bivariate, and multivariate analysis was conducted. Results In the PAP, most patients (83.33%, n = 5; 87.85%, n = 217; and 76.14%, n = 150) seen by the rehabilitation health workers, medical doctors, and nurses respectively were empowered to manage their health. Patients attended to by nurses were 0.45 (95% CI 0.27–0.74) times less likely than those attended to by medical doctors to receive information that that will help them address the physical and environmental needs. In the ADP, patients attended to by nurses were less likely, compared to those attended to by medical doctors to be empowered to have good control over their health. In the POP, patients attended to by nurses are more likely to have their health behaviours change for better compared to those not seen by any HCW. Conclusion Patients attending tertiary hospital received greater HP and DP services during the PAP and ADP of patient care. Greatest influence for behavioural change of patients on HP and DP were achieved from the medical doctors, nurses and rehabilitation service staff. Improving structural factors may prove beneficial in enhancing patients’ experience from all HCW groups and phases of patient care.

Background: Zambia is one of the countries in sub-Saharan Africa with a high prevalence of human immunodeficiency virus among women of reproductive age. Notably, the literature shows that human immunodeficiency virus status is one of the factors that influence fertility intention among women of reproductive age. With increased access, uptake and coverage of anti retroviral therapy, there is a need to understand the influence of human immunodeficiency virus status on fertility intentions of women of reproductive age in Zambia. Objectives: The purpose of this study was to determine the fertility intentions of both mothers living with human immunodeficiency virus and mothers living without human immunodeficiency virus in Zambia. Design: This study adopted a cross-sectional design using data collected by the Zambia Demographic and Health Survey conducted in 2018. The study sample comprised 7983 mothers in the reproductive age (15–49 years), of which 6704 were mothers living without human immunodeficiency virus and 1279 were mothers living with human immunodeficiency virus. Methods: Here, we determined the fertility intentions of mothers living with human immunodeficiency virus and mothers living without human immunodeficiency virus using secondary data. Multivariable logistic regression models were used to determine the association of individual and household socio-demographic factors on fertility intentions of mothers living with human immunodeficiency virus and mothers living without human immunodeficiency virus in Zambia. Results: Fertility intention among mothers living with human immunodeficiency virus was 42.1% while that on mothers living without human immunodeficiency virus was 55.5%. Regardless of human immunodeficiency virus status, fertility intention reduced with increasing age. Mothers aged 35–49 years who were living with human immunodeficiency virus (adjusted odds ratio = 0.12, 95% confidence interval = 0.06–0.24) and mothers aged 35–49 years who were living without human immunodeficiency virus (adjusted odds ratio = 0.18, 95% confidence interval = 0.13–0.26) had lower odds of intention to have another child compared to mothers aged 15–24 years. Furthermore, married mothers living with human immunodeficiency virus and those living without human immunodeficiency virus had increased odds of intention of having another child (adjusted odds ratio = 2.52, 95% confidence interval = 1.36–4.66) and (adjusted odds ratio = 3.21, 95% confidence interval = 2.36–4.36), respectively. Conclusion: The study has established that age, marital status, parity and employment status were associated with fertility intention among women living with and without human immunodeficiency virus. The results necessitate the need for enhanced maternal health education for mothers regardless of human immunodeficiency virus status. Furthermore, there is a need for continuous counselling for both women living with human immunodeficiency virus and without human immunodeficiency virus during their routine human immunodeficiency virus care, to improve and enhance pregnancy outcomes.

BackgroundThe impact of climate change has led to variations in various biological processes, leading to altered transmission dynamics of infectious diseases, including snail-borne diseases (SBDs). Fascioliasis is one of the neglected zoonotic tropical snail-borne diseases caused by the trematode of the genus Fasciola. This review focused on laboratory experimental and model studies that evaluate the potential effect of temperature change on the ecology and biology of the intermediate host snails (IHS) of Fasciola.MethodsA literature search was conducted on Google Scholar, EBSCOhost, and PubMed databases using predefined medical subject heading terms, Boolean operators, and truncation symbols in combination with direct keywords: Fasciolosis AND Temperature, Lymnaea OR Austropeplea OR Radix OR Galba OR Fossaria OR Pseudosuccinea AND growth, fecundity, AND survival at the global scale. Other search terms used were (Fascioliasis AND Temperature), (Lymnaea AND Temperature), (Austropeplea AND Temperature), (Fossaria AND Temperature), (Galba AND Temperature), (Pseudosuccinea AND Temperature), and (Radix AND Temperature).ResultsThe final synthesis included thirty-five published articles. The studies reviewed indicated that temperature rise may alter the distribution, and optimal conditions for breeding, growth, and survival of IHS, ultimately resulting in changing the transmission dynamics of fascioliasis. The literature also confirmed that the life history traits of IHS and their interaction with the liver fluke parasites are driven by temperature, and hence climate change may have profound outcomes on the population size of snails, parasite density, and disease epidemiology.ConclusionWe concluded that understanding the impact of temperature on the growth, fecundity, and survival of IHS may broaden our knowledge of the possible effects of climate change and hence inform fascioliasis control programs.

The World Health Organization (WHO) recom‑ mends same‑day initiation (SDI) of antiretroviral therapy (ART) for all individuals diagnosed with HIV irrespective of CD4+ count or clinical stage. Implementation of program is still far from reaching its goals. This study assessed the level of implementation of same day ART initiation. A longitudinal study was conducted at four primary healthcare clinics in eThekwini municipality KwaZulu‑Natal. Data was collected between June 2020 to October 2020 using a data extrac‑ tion form. Data on individuals tested HIV positive, number of SDI of ART; and clinicians working on UTT program were compiled from clinic registers, and Three Interlinked Electronic Registers.Net (TIER.Net). Non‑governmental organisations (NGO) supporting the facility and services information was collected. Among the 403 individuals who tested HIV positive, 279 (69.2%) were initiated on ART on the same day of HIV diagnosis from the four facilities. There was a significant association between health facility and number of HIV positive individuals initiated on SDI (chi‑square=10.59; P‑value=0.008). There was a significant association between facilities with support from all NGOs and ART SDI (chi‑square=10.18; P‑value=0.015. There was a significant association between staff provision in a facility and SDI (chi‑square=7.51; P‑value=0.006). Urban areas clinics were more likely to have high uptake of SDI compared to rural clinics (chi‑square=11,29; P‑value=0.003). Implementation of the Universal Test and Treat program varies by facility indi‑ cating the need for the government to monitor and standardize implementation of the policy if the program is to yield success.

Abstract Background Closing the gap of unmet needs for family planning (FP) in sub-Saharan Africa remains critical in improving maternal and child health outcomes. Determining the prevalence of unmet needs for family planning among married women in the reproductive age is vital for designing effective sexual reproductive health interventions and programmes. Here, we use nationally representative data drawn from sub-Saharan countries to estimate and examine heterogeneity of unmet needs for family planning among currently married women of reproductive age. Methods This study used secondary data from Demographic and Health Surveys (DHS) conducted between January 1, 1995 to December 31, 2020 from 37 countries in sub-Saharan African. An Inverse Heterogeneity model (IVhet) in MetaXL application was used to estimate country and sub-regional level pooled estimates and confidence intervals of unmet needs for FP in SSA. Results The overall prevalence of unmet need for family planning among married women of reproductive age in the sub-region for the period under study was 22.9% (95% CI: 20.9–25.0). The prevalence varied across countries from 10% (95% CI: 10–11%) in Zimbabwe to 38% (95% CI: 35–40) and 38 (95% CI: 37–39) (I2 = 99.8% and p-value

Abstract Systematic reviews (SR) and meta-analyses (MA) have become important in addressing specific questions of clinical importance and presenting evidence from an in-depth analysis of literature and aiding clinical decision-making. The “Systematic Reviews on infectious diseases” collection will address several important questions by summarizing large bodies of evidence in a reproducible and concise approach to advance our knowledge and understanding of infectious diseases.

Plain Language Summary Modern contraceptive use has been observed to improve the health of women and accelerate the attainment of health rights and gender equity. Sustaining and enhancing the uptake of modern contraceptives is essential in designing sexual reproductive health programs for all sexually active women to reduce the risks of unplanned pregnancies. This paper identified and reports changes in modern contraceptives among all sexually active women aged between 15 and 49 years old for the period 2010–2020. The manuscript used Rwanda Demographic and Health Survey (RDHS) data that is collected every after five years to track changes in the health and demographics of the citizens. The study found that a change in the behaviour of women towards contraceptive use is key to improving modern contraceptive use among sexually active women. Therefore, focusing on these behavioural components will enhance modern contraceptive use and contribute to improving women’s sexual and reproductive health.

Abstract Childhood stunting in its moderate and severe forms is a major global problem and an important indicator of child health. Rwanda has made progress in reducing the prevalence of stunting. However, the burden of stunting and its geographical disparities have precipitated the need to investigate its spatial clusters and attributable factors. Here, we assessed the determinants of under‐5 stunting and mapped its prevalence to identify areas where interventions can be directed. Using three combined rounds of the nationally representative Rwanda Demographic and Health Surveys of 2010, 2015 and 2020, we employed the Blinder‐Oaxaca decomposition analysis and the hotspot and cluster analyses to quantify the contributions of key determinants of stunting. Overall, there was a 7.9% and 10.3% points reduction in moderate stunting among urban and rural areas, respectively, and a 2.8% and 8.3% points reduction in severe stunting in urban and rural areas, respectively. Child age, wealth index, maternal education and the number of antenatal care visits were key determinants for the reduction of moderate and severe stunting. Over time, persistent statistically significant hotspots for moderate and severe stunting were observed in Northern and Western parts of the country. There is a need for an adaptive scaling approach when implementing national nutritional interventions by targeting high‐burden regions. Stunting hotspots in Western and Northern provinces underscore the need for coordinated subnational initiatives and strategies such as empowering the rural poor, enhancing antenatal health care, and improving maternal health and education levels to sustain the gains made in reducing childhood stunting.