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Global trends in antibiotic expenditure: Analysis of pharmaceutical sales data, 2013 to 2023
No full textBackground: Human antibiotic consumption is a major contributing factor to antimicrobial resistance. Understanding the dynamics of the antibiotic market can help improve antibiotic stewardship efforts and encourage innovation. Methods: We used quarterly pharmaceutical sales value and volume data from IQVIA MIDAS to estimate aggregate and per capita real annual spending (inflation adjusted) on antibiotics in 62 countries from 2013 to 2023, with unit values defined by the ratio of sales value and quantity. We evaluated trends by broad classes of antibiotics and country income groups and conducted multivariate regression analyses to identify associations with factors such as income and health spending. Results: Between 2013 and 2023, aggregate and per capita real spending on antibiotics decreased from 30.68 billion and from 7.92, respectively. Real spending per unit of antibiotic, which is an indicator of price but not necessarily the final consumer price, also declined from 0.45 (2023). Spending decreased across country income groups and converged, driven by more rapid reductions in high-income countries as compared with other regions. In 2020, spending decreased sharply due to the COVID-19 pandemic, followed by a small rebound. In multivariate analysis, income, health spending, median age, and clean water access were associated positively with spending on antibiotics per 1000 people, while schooling attainment, availability of doctors, and higher state capacity were associated negatively. Conclusions: Global spending on antibiotics declined and overall converged among countries from 2013 to 2023. More investment is necessary toward reducing antibiotic use and developing new effective antibiotics
National Training Manual for Para Social Workers
No full textPara social workers have become an integral part of Uganda’s social support system. Operating at the grassroots level, often in remote and underserved communities, these individuals provide critical services to vulnerable children, youth, families, and communities in need of support. In the face of limited professional human resources in the social welfare sector, Para Social Workers fill a vital gap, extending the reach of formal systems and ensuring that no one is left behind. This revised edition of the manual reflects the evolving nature of community and social work practice in Uganda. It incorporates new practical tools, and evidence-based approaches to empower Para Social Workers with the knowledge and skills necessary to deliver quality services at the grassroots level. It integrates the Baobab project\u27s sexual violence screening intervention and promotes inclusive practices that recognize the diverse needs of children and youth, including those living with disabilities, those in conflict with the law, and those affected by poverty or displacement
Dataset: Measuring abortion incidence, severity of complications, and health facilities’ capacity to provide abortion care in refugee settings in Uganda, Baobab Study
No full textBackground: Sparse evidence is available to support improved programming and reporting on SRHR in refugee settings in the East and Horn of Africa, where unsafe abortion is one of the major causes of maternal mortality and morbidity. It is important to design studies that explicitly investigate the sexual and reproductive health needs and outcomes of refugee populations, as it is likely that these factors differ among refugee populations as compared to the general population. Understanding the state of abortion in a given context, including abortion incidence, safety, and outcomes, is challenging due to the limitations of currently available methodologies. Objectives: To determine the incidence of induced abortions and the severity of abortion-related complications in refugee settings in Uganda. Methods: The study employed a quantitative cross-sectional design. The study components included three separate surveys. Although the study was not nationally representative, efforts were made to ensure representativeness at the refugee settlement/camp level : i) representative Health Facility Survey (HFS) to estimate the number of women who receive post-abortion care (PAC) following abortion complications, ii) a Knowledgeable Informants Survey (KIS) to capture information on the proportion of all women having abortions who receive facility-based treatment for abortion-related complications, and iv) a Prospective Morbidity Survey (PMS) to capture information necessary to describe characteristics of women receiving treatment for abortion complications, the severity of complications, the type of treatment received, and the delays in access to PAC. The PMS also included clinical data abstraction from the medical records. Potential Impact: This will help host governments, humanitarian partners, and donors to seek long-term, innovative, cost-effective SRHR development solutions to bring about change in the health and lives of refugee women and girls
Baobab Research Programme Consortium: Generating Evidence to Enhance SRHR in Refugee Settings
No full textThe Population Council leads the Baobab Research Programme Consortium in partnership with Population Council Kenya and the African Population and Health Research Center. Situated in the East and Horn of Africa, this Africa-based and African-led consortium focuses on filling critical evidence gaps and fostering evidence use.
For nearly a decade, the Council has worked in refugee settings to strengthen Sexual and Reproductive Health and Rights (SRHR) programming, providing research and technical support to UNHCR and its implementing partners through a technical cooperation agreement with the UNHCR Regional Bureau for the East and Horn of Africa and Great Lakes region. Building on this long-standing collaboration, the Baobab consortium is bringing selected, rigorous SRHR surveys into refugee settings in Uganda and Ethiopia for the first time. These large-scale surveys on violence against children and adolescents, unsafe abortion, and unintended pregnancy draw upon existing robust, well-regarded, and well-known global tools
No change in key HIV target cell markers following initiation of three progestin-based hormonal contraception methods: Findings from the CHIME study
No full textIntroduction: Depot medroxyprogesterone acetate (DMPA) injectable, etonogestrel subdermal implant (ENG-implant), and levonorgestrel intrauterine device (LNG-IUD) are effective, widely used female hormonal contraceptives (HC). Observational studies, but not a randomized trial, suggest increased risk of HIV acquisition with HC use, particularly DMPA. Sexual acquisition of HIV occurs via CD4+ T cells expressing C-C chemokine receptor type 5 (CCR5), though other immunologic cells play a role. This study examined longitudinal changes in CCR5+ T cells and other immunologic cells in the female genital tract following HC initiation. Methods: HIV negative participants aged 18–45 years, not using HC, were recruited in Atlanta, Georgia. After two pre-HC visits, participants initiated DMPA, ENG-implant, or LNG-IUD and completed visits every three months for one year. Specimens (peripheral blood, endocervical cells, cervical tissue biopsy, and cervicovaginal lavage [CVL]) were analyzed for immune cellular markers (CD45, CD3, CD4, CCR5, CD69, HLA-DR, CD38, α4β7, CD103, Fox-P3, and Ki-67) using flow cytometry. Effects of CVL on HIV infection of cells in vitro was assessed. Vaginal microbiome was characterized via 16S rRNA gene amplicon sequencing. Multivariable linear mixed effects models estimated association between HC and immune markers (Primary outcome: proportion of CD4+ T cells expressing CCR5; Secondary outcomes: other immune markers, in vitro HIV enhancement). A Bonferroni correction was applied. Results: Among 118 participants (mean age 25.9; 44.1% self-identified as Black race), 545 visits were completed from 2019-2023. No significant changes were observed in proportion of CCR5+ T cells in any tissue type post-HC. There were statistically significant but moderate absolute decreases in proportion of CD45+ and CD4+ T cells in CVL, and CD4+ T cells in blood, and increased proportion of CD69+ T cells in blood post-HC. Post-HC CVL vs. pre-HC enhanced HIV infection of cells in vitro for all three HC groups (p\u3c 0.01) and was modified by the vaginal microbiome. There was also evidence of interaction by time and microbiome parameters for several other immune cells. Discussion: Our findings suggest that commonly used HC methods do not result in immunologic changes that increase HIV acquisition risk. However, HIV infection enhancement with post-HC CVL in vitro warrants further study
Is economic inequality in maternal and child healthcare decreasing in India? Trends between 2005–2006, 2015–2016 and 2019–2021
No full textObjective: This study examined economic inequality in coverage of selected maternal and child healthcare (MCH) indicators in India and its states over the last 15 years. Design: The study analysed last three rounds of the National Family Health Survey data, conducted during 2005–2006, 2015–2016 and 2019–2021. Bivariate analyses, ratio of richest to poorest, slope index of inequality (SII) and multivariate binary logistic regression analyses were used to examine the coverage as well as inequalities in the outcome indicators for India and its states and at district level. Primary outcomes: The outcome variables analysed in the study were full antenatal care, institutional delivery, postnatal care of mothers within 48 hours of delivery, and full immunisation among children. Participants: Women aged 15–49 who had given a birth in the last 5 years before the surveys were unit of analysis for the maternal healthcare indicators, and children aged 12–23 months were unit of the analysis for childhood immunisation. Results: Over the last 15 years, coverage of the MCH indicators has increased in India and across socioeconomic segment of the population, and the absolute increase was higher among the worse-off segments than the better-off. This led to decline in the inequality in coverage of all the MCH indicators. For instance, the value of SII for institutional births decreased from 0.76 in 2005–2006 to 0.45 in 2015–2016 and further to 0.37 in 2019–2021. Although inequality has decreased, geographic disparities persist across states and districts. Conclusion: Though substantial improvement was observed, coverage of MCH indicators increased and the economic inequality declined; certain geographies are still characterised with the low coverage and persistent high inequality. This suggests that adding a spatial perspective to the inequality research and targeted strategies is essential for achieving universal access to reproductive healthcare services by 2030 in India
Protecting Children in Crisis: School-Based Sexual Violence Screening in Refugee Settings
Full text linkAvailability of post-abortion care in refugee settlements in Uganda: Evidence Brief
Full text linkThe Baobab Research Programme Consortium (RPC), in collaboration with the Guttmacher Institute, implemented the first-ever application of the Abortion Incidence Complications Method (AICM) in refugee settings in Uganda. The data presented herein is derived from this study, and offers critical insights into the availability of post-abortion care in these displacement settings. These findings contribute to a growing body of evidence aimed at informing policy, programming, and resource allocation for sexual and reproductive health and rights (SRHR) in refugee-hosting countries
Experiences of childhood violence and violence perpetration and the association with inequitable gender norms and violence justification in humanitarian settings in Uganda
No full textExperiences of childhood violence and violence perpetration and the association with inequitable gender norms and violence justification have been extensively studied in non-humanitarian settings, and among older populations. However, there is a gap in understanding these associations within humanitarian contexts, particularly from the perspective of children and youth. We used data from the Uganda Humanitarian Violence Against Children and Youth Survey, a representative, cross-sectional household survey of 2,265 children and youth aged 13–24 years living in refugee settlements in Uganda. We explored associations between endorsement of inequitable gender norms, intimate partner violence (IPV) justification, and experiences of violence and/or perpetration of violence in childhood. Experience of any childhood violence was significantly associated with an increase in endorsement of inequitable gender norms among females and IPV justification among males. This pattern was similar for 18-24-year-olds. Among 13-17-year-olds, IPV justification was significantly associated with experience of any childhood violence among females and perpetration of violence among males. Our findings suggest the need for gender-transformative violence prevention interventions that start early in the life course, and that address inequitable gender socialisation and power relations. School-based violence prevention interventions, community-based approaches to form gender equitable attitudes among adolescents, parenting interventions, and interventions with children and adolescents that had experienced childhood violence have shown considerable success in other settings, and could be adapted to humanitarian settlements
Celebrating 20 Years of Abriendo Oportunidades: Transforming the Lives of Indigenous Girls in Guatemala
Full text linkThis blog post originally appeared on the Population Council’s website in August 2025