69832 research outputs found
Sort by
Anti-abortion politics and changes in abortion, miscarriage, and stillbirth across time and social strata in Turkey
Get PDFAbortion has been legal without restriction in Turkey since 1983. However, the government’s anti-abortion campaign in 2012 has resulted in significant restrictions on abortion services, particularly in public hospitals. Using six waves of the Turkish Demographic and Health Survey (TDHS), which was administered every five years from 1993 to 2018 (n=32,990), we investigated the trends in abortion, miscarriage, and stillbirth rates among ever-married women. We found that, compared to wave 2008, women in wave 2013 were seven percentage points less likely to report an abortion, while they were three percentage points more likely to report an experience of a miscarriage. This pattern continued largely also in the 2018 wave. This unprecedented decline in abortion was observed across all socioeconomic groups, with the strongest decline among lower educated and poorer women. Moreover, the increase in miscarriages was primarily driven by lower educated women and those outside of the richest wealth quintile. Our findings suggest that the government’s anti-abortion campaign led to reduced access to abortion services, and potential misreporting of abortions as miscarriages by reinforcing stigma towards both abortion seekers and providers. The findings underscore how an anti-abortion political climate can exacerbate existing social inequalities, even when abortion remains legal
TAP-I Deficiency Presenting With Chronic Granulomatous Rubella Virus-Driven Cutaneous Ulceration: A Case Report and Scoping Literature Review.
Get PDFAutosomal recessive mutations in TAP1, TAP2, TAPBP, or B2M, are associated with major histocompatibility complex (MHC) class I deficiency. Individuals may present with granulomatous skin ulceration, but the underlying antigenic triggers remain largely unknown. We identified TAP1 deficiency in a 32-year-old female referred with a 7-year history of localized skin ulceration. Histologic immunofluorescence revealed that rubella virus (RuV) infection was a likely driver of the associated inflammation, and modest clinical improvement was observed following topical calcineurin inhibition. To better define the natural history, clinical, and immunological manifestations of this condition, we also performed a scoping literature review. We identified 45 unique individuals from 36 reports with a combined follow-up duration of 1,184 patient years. Chronic necrotizing granulomatous skin lesions and childhood-onset bronchiectasis were common. Five deaths were reported (median age 36 years), typically linked to respiratory complications. Phenotypic heterogeneity was evident, with at least four individuals reaching adulthood without clinical symptoms. Diagnostic delay frequently exceeded a decade amongst symptomatic individuals, with misdiagnosis of granulomatous disease prompting systemic immunosuppression and infection-related morbidity. The presence of an abnormal CD8+ T-cell count or a history of consanguinity offered low sensitivity for MHC I deficiency (~ 50%), indicating a low threshold for further investigation is required for correct diagnosis. Graphical review of case reports identified morphologically similar lesions in other MHC I-deficient individuals. These findings suggest that the phenomenon of MHC I deficiency is underreported and that diagnosis should prompt testing for RuV
Evaluating the cost of malaria elimination by Anopheles gambiae precision guided SIT in the Upper River region, The Gambia.
Get PDFMosquito control has successfully reduced the burden of malaria globally, but current vector control technologies cannot achieve malaria elimination. Precision guided sterile insect technique (pgSIT) is one of the most promising interventions being developed for malaria elimination. Mass release of genetically sterile males can act as a chemical-free species-specific insecticide. Before translating pgSIT from the bench to the field, however, it is essential to understand the potential costs and capabilities of this technology in a malaria-endemic region to determine if further investment into research and development of this technology is worthwhile. Therefore, we estimated the health outcomes and costs of a pgSIT program working jointly with current interventions to control the Anopheles gambiae malaria vector in the Upper River region of The Gambia. The pgSIT intervention in this region is predicted to prevent approximately 230 deaths and about 48,000 sick days per year. We have provided a range of costs that include risks associated with research and development, the facility, mass rearing efficiency, and distribution. This intervention should save disability-adjusted life years (DALY) at 11-94 USD per year and will prevent cases at 10-86 USD per infection. These estimates predict that pgSIT will cost 0.36-3.03 USD per person in the treated region annually. The cost per DALY shows life-saving at a cost comparable to current interventions in the Upper River region
The role of health workers in Kenya's Net-Zero transition: a Mixed-Methods study on healthcare system climate change mitigation and adaptation.
Get PDFClimate change presents a critical challenge to healthcare systems, particularly in low- and middle-income countries like Kenya. Health workers are key to leading the transition toward a sustainable, climate-resilient healthcare system. This mixed-methods study explores the perceptions, knowledge, and roles of Kenyan health workers in mitigation and adaptation in healthcare. An online questionnaire, completed by 118 health workers, explored their understanding of climate change's impacts on health, the healthcare system's role in emissions reduction and adaptation, and current practices. A subsequent focus group discussion delved deeper into the identified themes, with a particular focus on education of health workers to support climate action. The findings reveal that while health workers are aware of the health risks posed by climate change, financial limitations and insufficient training present significant barriers to the implementation of sustainable practices. The focus group emphasized the need for practical, context-specific education to equip health workers with actionable knowledge and skills, alongside fostering emotional resilience and ethical leadership. Key recommendations include co-creating educational programs with communities and health workers, integrating climate-health modules into curricula, and leveraging innovative approaches such as peer-led workshops and social media campaigns. These insights underscore the transformative potential of education in empowering health workers to lead Kenya's transition to a sustainable, climate-resilient healthcare system
Improving the reporting on health equity in observational research (STROBE-Equity): extension checklist and elaboration.
Get PDFData on health equity to inform societally relevant evidence based decisions and policy making are lacking in the research literature. Observational studies have the potential to provide data on health equity. Yet, guidance on how to report health equity data and considerations in observational research is inadequate. The STROBE-Equity extension addresses this gap by providing a structured set of criteria to enhance the reporting of health equity data and considerations
Impact assessment of Benazir Nashonuma Programme (BNP) on maternal, child health and nutritional status in Pakistan: a quasi-experimental study protocol.
Get PDFINTRODUCTION: Maternal and child malnutrition is a significant public health concern in Pakistan, with 40% of children under five being stunted. In response, the Government of Pakistan initiated the Benazir Nashonuma Programme (BNP), a nutritional supplementation programme for pregnant women, mothers of children aged 0 to 23 months and children aged 6 to 24 months. This study aims to evaluate the effectiveness of the BNP in reducing childhood stunting and improving maternal and child health outcomes.
METHODS AND ANALYSIS: A quasi-experimental longitudinal study comprising baseline, midline and endline surveys will be conducted across 18 districts (9 intervention and 9 control) in Pakistan. The surveys will use a two-stage cluster sampling method to enrol 13 200 children aged 0-59 months and their mothers from the Benazir Income Support Programme households. The primary outcome of interest is the prevalence of under-five stunting. We will use a difference-in-differences approach to estimate the impact by comparing the documented changes over time between the intervention and control groups.
ETHICS AND DISSEMINATION: This study will provide critical insights into the effectiveness of the BNP in addressing childhood undernutrition in Pakistan. The findings will inform policy and programmatic decisions aimed at reducing undernutrition in resource-constrained settings. Ethical approval has been obtained from the Ethics Review Committee of Aga Khan University and the Pakistan National Bioethics Committee.
TRIAL REGISTRATION NUMBER: NCT06025786
Identifying women with poor experience of post-abortion care: a cross-sectional study in two African hospitals in humanitarian settings.
Get PDFBACKGROUND: High quality post-abortion care (PAC) is essential to reducing abortion-related morbidity and mortality. However, the experience of receiving PAC, a key component of care quality, remains understudied in humanitarian settings. We assessed the experience of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic, CAR) and identified characteristics associated with poor experience of PAC. METHODS: We analyzed data from two components of a multi-methods cross-sectional study: a prospective medical records review and a survey of women hospitalized for abortion complications in the Nigerian (n = 360) and CAR (n = 362) hospitals. We measured women’s experience of PAC with two questions related to communication with health providers (explanations received and ability to ask questions) and five questions related to respect and preservation of dignity (privacy, waiting times, health provider’s kindness, painkillers provision and overall care assessment). Association between women’s characteristics and the two communication outcomes were investigated using multivariate logistic regressions. A latent variable was constructed using the five respect and dignity questions and its association with women’s characteristics was assessed using multivariate linear regression. RESULTS: Nearly 51% in Nigeria hospital and 41% in CAR hospital reported receiving no explanation of their care, and over 80% in both hospitals said they felt unable to ask questions during examination and treatment. Less than 20% of women in Nigeria reported a lack of respect and preservation of their dignity. In CAR, almost 63% of women said that their privacy was not always respected during the physical examination and 38% said waiting times were long or very long before seeing a health provider. We found associations between low education level and poor experience of communication in both settings. Being adolescent was associated with one poor communication outcome in CAR and poor experience of respect and preservation of dignity in Nigeria. CONCLUSION: A non-negligible proportion of PAC patients faced poor communication and mixed experiences of respect, with poorer experiences in women with low education and adolescents. Socio-demographic inequalities in PAC experiences must not be overlooked in humanitarian settings, and further research is critical to identify and support the most vulnerable women. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-25558-z
Comparing methods for aggregating indoor air pollutant concentration over space and time.
Get PDFThis paper explores the impact of different approaches to aggregating the indoor concentration of fine particulate matter (PM2.5) in a case study home. Indoor- and outdoor-sourced PM2.5 was modelled in CONTAM-EnergyPlus for a bungalow occupied by a family of four in Plymouth, England. Simulations were conducted assuming energy efficiency levels typical of a 1950s home and following retrofit. Pollutants were modelled at a 5-min temporal resolution in bedrooms, kitchen and living room and aggregated according to four metrics: (i) household arithmetic mean concentration, (ii) household time-weighted mean concentration, (iii) arithmetic mean of individual exposure, and (iv) household arithmetic mean exposure. Comparing the household metrics revealed differences of up to 50.0 % (3.6 μg/m3) for the pre-retrofit model, which remained largely consistent following retrofit. When comparing against individual exposure, differences were observed for all three metrics and reached 55.6% (9.1 μg/m3) for the pre-retrofit model, and 50.6% (8.7 μg/m3) for the post-retrofit model. Approaches (i) and (ii) consistently underpredicted individual exposure. Further, the differences were greatest for the time-weighted mean method, suggesting that taking into consideration the total time that each room is occupied but not when it is occupied will not necessarily provide a more accurate description of occupant exposure compared to the simple arithmetic mean. To better represent individual exposure, data on occupant presence is required
Glaucoma detection training of community healthcare workers using portable devices in Nigeria.
Get PDFBACKGROUND: Glaucoma, an irreversible blinding eye disease caused by optic nerve damage, remains a major public health challenge in sub-Saharan Africa, where it occurs earlier and progresses more aggressively than in other regions. Accessibility and affordability remain major barriers to timely diagnosis and treatment in low- and middle-income countries (LMICs). PURPOSE: To assess the ability of community health workers (CHWs) without prior ophthalmic training to use portable diagnostic tools for early detection and referral of possible glaucoma cases in Abuja, Nigeria. METHODS: This feasibility study was conducted from June to September 2024 in three community health centres in Abuja. Fifteen CHWs (14 females, 1 male) were trained over 3 days using didactic lectures, practical demonstrations, and hands-on sessions on four portable devices: PEEK Acuity, iCare tonometer, Eyecatcher visual field analyser, and Remidio handheld fundus camera. Pre- and post-training assessments were conducted, with an 80% pass mark required. A simplified scoring system based on test findings guided referral decisions. RESULTS: All CHWs achieved scores of 80% or higher post-training, showing significant improvement in glaucoma knowledge and testing proficiency. Initial challenges with the iCare tonometer and fundus camera improved with practice. CONCLUSION: Community health workers can effectively use portable diagnostic tools for glaucoma screening and referral in primary care settings. Their involvement could enhance early detection and contribute substantially to reducing glaucoma-related blindness in resource-limited settings
Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India.
Get PDFOBJECTIVE: To investigate whether induction/augmentation of labor in pregnant women with anemia increases the risk of postpartum hemorrhage (PPH) and whether this risk varied by indications for labor induction/augmentation and by anemia severity in pregnancy.
METHODS: In a prospective cohort study of 9420 pregnant women from 13 hospitals across India, we measured hemoglobin concentrations at recruitment (≥28 weeks of gestation) and blood loss after childbirth during follow-up and collected clinical information about PPH. Clinical obstetric and childbirth information at both visits were extracted from medical records. Anemia severity in the third trimester was categorized using hemoglobin concentrations (no/mild anemia: hemoglobin ≥10 g/dL; moderate: hemoglobin 7 to 9.9 g/dL; severe: hemoglobin <7 g/dL), while PPH was defined based on blood loss volume (vaginal births: ≥500 mL or cesarean sections: ≥1000 mL) and clinical diagnosis. Indications for labor induction/augmentation were classified as clinically indicated and elective as per guidelines. We performed multivariable modified Poisson regression analyses to investigate the associations of anemia severity and indications for labor induction/augmentation, including their interaction, with PPH, adjusted for potential confounders.
RESULTS: PPH was associated with anemia but not with indications for labor induction/augmentation. However, there was a significant interaction between the two factors in relation to PPH (P = 0.003). Among pregnant women with severe anemia, a higher risk of PPH was associated with elective (adjusted risk ratio, 3.44 [95% confidence interval, 1.29-9.18]) but not with clinically indicated (adjusted risk ratio, 1.22 [95% confidence interval, 0.42-3.55]) labor induction/augmentation. No associations were observed among pregnant women with no/mild and moderate anemia.
CONCLUSION: The risk of PPH is higher in women who have moderate-severe anemia in late pregnancy. Induction/augmentation of labor is generally safe for women with anemia, but it can increase the risk of PPH in women with severe anemia if performed electively