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Interventions to address postpartum depression in South Asian countries: a scoping review.
No full textBACKGROUND: Postpartum depression (PPD) can result in poor health outcomes in mothers, affect maternal-child bonding and have long-term effects on child development. AIMS: The aim of this review was to identify existing studies on PPD and characterise any gaps in literature. METHODS: We conducted a scoping review of 14 databases using a combination of search terms and phrases related to PPD and the respective Southern Asian countries. We applied the criteria from the PRISMA Extension for Scoping Reviews to identify relevant articles from Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka published between January 2004 and September 2024. RESULTS: We identified 20 studies conducted in only four of the South Asian countries: Pakistan, India, Bangladesh and Nepal. Fifteen were studies with clear post-intervention outcomes; five had process outcomes. Intervention studies used trained community health workers in a variety of psychosocial programs, many with culturally specific content, including adoption of language and integration of local activities. Among the 15 intervention studies, six had positive maternal mental health outcomes and three had positive pediatric-related findings. CONCLUSION: The 20 articles identified address the important problem of PPD in South Asia. The positive findings in both the large randomised control trials and small pilot studies identified in this article, combined with the studies' use of the resource of community health workers, suggest that the gap in the literature is less on identifying effective interventions and more on securing the political and policy resolution to address the problem of PPD
Community benefits of mass distribution of three types of dual-active-ingredient long-lasting insecticidal nets against malaria prevalence in Tanzania: evidence from a 3-year cluster-randomized controlled trial.
Get PDFBACKGROUND: Long-lasting insecticidal nets (LLINs) were once fully effective for the prevention of malaria; however, mosquitoes have developed resistance to pyrethroids, the main class of insecticides used on nets. Dual active ingredient LLINs (dual-AI LLINs) have been rolled out as an alternative to pyrethroid (PY)-only LLINs to counteract this. Understanding the minimum community usage at which these LLINs elicit an effect that also benefits non-users against malaria infection is important. METHODS: We conducted a secondary analysis of a 3-year randomized controlled trial (RCT) in 84 clusters in North-western Tanzania to evaluate the effectiveness of three dual-AI LLINs: pyriproxyfen and alpha(α)-cypermethrin, chlorfenapyr and α-cypermethrin, and the piperonyl-butoxide (PBO) and permethrin compared to α-cypermethrin only LLINs. We measured malaria infection prevalence using 5 cross-sectional surveys between 2020 and 2022. We assessed net usage at the cluster level and malaria infection in children aged from 6 months to 14 years in 45 households per cluster. The trial was registered as a clinical trial on www. CLINICALTRIALS: gov : ClinicalTrials.gov (NCT03554616) on 2018-06-13. RESULTS: A total of 22,479 children from 12,654 households were tested for malaria using rapid diagnostic tests in January 2020, 2021, & 2022 and July 2020 & 2021. Among non-users, community-level usage of > 40% of dual-AI LLIN was significantly associated with protection against malaria infection: chlorfenapyr arm (OR: 0.44 (95% CI: 0.27-0.71), p = 0.0009), PBO arm (OR: 0.55 (95% CI: 0.33-0.94), p = 0.0277) and pyriproxyfen arm (OR: 0.61 (95% CI: 0.37-0.99), p = 0.0470) compared with non-users in clusters with > 40% usage of pyrethroid-only LLINs. There were indications of some protection against malaria infection to non-users in the chlorfenapyr arm when community-level usage was ≤ 40% (OR: 0.65 (95% CI: 0.42-1.01), p = 0.0528) compared to those living in clusters with > 40% usage of pyrethroid-only LLINs. CONCLUSION: Our study demonstrated that at a community usage of 40% or more of dual-AI LLINs non-users benefited from the presence of these nets. Noticeably, even when usage was ≤ 40% in the chlorfenapyr arm, non-users were better protected than non-users in the higher coverage pyrethroid-only arm. The greater difference in malaria risk observed between users and non-users indicates that LLINs play a crucial role in providing personal protection against malaria infection for the people using the net
Exploring the need for overdose prevention centers in England: A qualitative community-based participatory study on the perspectives of people who use drugs in public and semi-public environments.
No full textBACKGROUND: Overdose prevention centres (OPCs) have been implemented as a harm reduction response in around 20 countries; with one just opened in the UK. In a context of rising rates of drug-related deaths, this study aimed to assess the need for an OPC in Sandwell, England, by examining the experiences and perspectives of local people who use drugs. METHODS: Qualitative data were collected through three focus groups, 20 street-based interviews with people who use drugs, and observations from four ethnographic field sessions. This was a community-based participatory project and included community consultation during study design and peer researcher participation during data collection, analysis and dissemination. RESULTS: Findings evidence how the threat of public and police interaction in semi-public drug use spaces leads to rushed injection practice, hampers poor venous access management, and increases risk of injection-related harms. Participants were enthusiastic about the concept of an OPC and its potential to reduce injecting-related risks, drug-related death, provide safety, and prevent traumatic experiences with police. Participants also highlighted concerns about negative public perceptions of their community, viewing an OPC as a potential solution to improving community relations by reducing drug-related litter. CONCLUSIONS: There is an urgent need for OPC implementation, given current risks from rushed injection practices, the lack of safe spaces, and the increasing presence of nitazenes and other unexpected contaminants in the UK drug supply. The assertion from local people who drugs that an OPC would be an appropriate and effective intervention requires prioritisation by policymakers
Barriers and facilitators of primary care management of type II diabetes mellitus in the West African sub-region: A scoping review.
Get PDFThe prevalence of diabetes is rising rapidly across West Africa, posing a significant public health challenge. Effective diabetes management through accessible and quality primary healthcare is crucial, yet multiple barriers persist. This review aimed to synthesise the available evidence on factors influencing access, utilisation, and quality of diabetes primary care in West Africa. Following Arksey and O'Malley's framework and PRISMA-ScR guidelines, we searched four electronic databases (PubMed, Scopus, Google Scholar, CAIRN Info) and grey literature sources. Eligibility criteria included: peer-reviewed studies published between 2000-2023 in English or French; primary research focusing on adult type II diabetes care in West African countries; and studies reporting on factors affecting access, utilisation, or quality of primary healthcare. Data were extracted using a standardised form and analysed through framework synthesis integrating the WHO Primary Health Care Framework, Social Determinants of Health model, and Innovative Care for Chronic Conditions model. Twelve studies were included from Nigeria (n=7), Ghana (n=4), and Senegal (n=1). Key barriers to access, utilisation, and quality were identified as health system deficiencies, including inadequate infrastructure, workforce shortages, supply gaps, fragmented coordination of care, absence of standardised guidelines, high costs of care, and inefficient leadership/governance for chronic disease management. Broader determinants of health, such as poverty, gender, cultural beliefs, reliance on traditional medicine, and health policy gaps, significantly influenced access to and utilisation of care. Individual-level barriers like psychological distress and delays in care-seeking were also significant. Family/social support systems emerged as potential facilitators of accessing and utilising PHC services. Our review identified that to improve diabetes care, West Africa needs context-specific models that align indigenous healing practices with PHC, strengthen health systems, and address sociocultural determinants. Future research should focus on developing and evaluating culturally resonant interventions that can navigate both biomedical and sociocultural factors shaping diabetes management in resource-constrained settings
Community engagement and chronic viral hepatitis public health interventions: a systematic review, meta-analysis, and complementary crowdsourcing open call.
Get PDFBACKGROUND: Chronic viral hepatitis causes a high burden of morbidity and mortality, especially in low- and middle-income countries (LMICs). While community engagement, which involves stakeholders in addressing health-related issues, has shown promise to enhance hepatitis outcomes, evidence on its impact remains limited. To summarize the current state of knowledge on this topic we performed a systematic review and a crowdsourcing open call. METHODS: A parallel mixed-methods approach was used in this study. The systematic review included publications that evaluated a community-engaged intervention, reported chronic viral hepatitis outcomes, included a comparator group, and were published in English up to 12 March 2025. A random-effects model was used to pool the overall effect of the community-engaged interventions on hepatitis outcomes. To ensure innovative ideas from LMICs were included, we organized a complementary crowdsourcing open call using the WHO/TDR practical guide. Thematic analysis identified key themes in the crowdsourced submissions. FINDINGS: 35 studies were included in the systematic review, and 28 crowdsourced submissions were analyzed. In both the systematic review and open call, community-engaged interventions included peer-based interventions, community health workers, interactive educational programs, and patient advocacy. The meta-analysis, predominantly of studies from high-income countries, found community-engaged interventions significantly improved HBV vaccine completion (RR 1.59, 95% CI 1.15-2.19; I 2 = 88.10%), HBV/HCV test uptake (RR 2.33, 95% CI 1.78-3.06; I 2 = 99.10%), HBV and HCV linkage to chronic viral hepatitis care (RR 1.96, 95% CI 1.46-2.64; I 2 = 96.20%), HBV/HCV treatment adherence (RR 1.14, 95% CI 1.03-1.27; I 2 = 0%), and HCV sustained virologic response (RR 1.50, 95% CI 1.23-1.83; I 2 = 93.90%). Open call submissions, largely from LMICs, highlighted community-led interventions where patients led community-based organizations to advocate for improved access to hepatitis care. INTERPRETATION: Findings underscored the importance of community engagement in chronic viral hepatitis service delivery across the care continuum. Implementing community-engaged interventions can enhance chronic viral hepatitis elimination efforts. FUNDING: National Natural Science Foundation of China
The TyphiNET data visualisation dashboard: unlocking Salmonella Typhi genomics data to support public health.
Get PDFBACKGROUND: Salmonella enterica subspecies enterica serovar Typhi (abbreviated as 'Typhi') is the bacterial agent of typhoid fever. Effective antimicrobial therapy reduces complications and mortality; however, antimicrobial resistance (AMR) is a major problem in many endemic countries. Prevention through vaccination is possible through recently-licensed typhoid conjugate vaccines (TCVs). National immunisation programs are currently being considered or deployed in several countries where AMR prevalence is known to be high, and the Gavi vaccine alliance has provided financial support for their introduction. Pathogen whole genome sequence data are a rich source of information on Typhi variants (genotypes or lineages), AMR prevalence, and mechanisms. However, this information is currently not readily accessible to non-genomics experts, including those driving vaccine implementation or empirical therapy guidance. RESULTS: We developed TyphiNET ( https://www.typhi.net ), an interactive online dashboard for exploring Typhi genotype and AMR distributions derived from publicly available pathogen genome sequences. TyphiNET allows users to explore country-level summaries such as the frequency of pathogen lineages, temporal trends in resistance to clinically relevant antimicrobials, and the specific variants and mechanisms underlying emergent AMR trends. User-driven plots and session reports can be downloaded for ease of sharing. Importantly, TyphiNET is populated by high-quality genome data curated by the Global Typhoid Pathogen Genomics Consortium, analysed using the Pathogenwatch platform, and identified as coming from non-targeted sampling frames that are suitable for estimating AMR prevalence amongst Typhi infections (no personal data is included in the platform). As of February 2024, data from a total of n = 11,836 genomes from 101 countries are available in TyphiNET. We outline case studies illustrating how the dashboard can be used to explore these data and gain insights of relevance to both researchers and public health policy-makers. CONCLUSIONS: The TyphiNET dashboard provides an interactive platform for accessing genome-derived data on pathogen variant frequencies to inform typhoid control and intervention strategies. The platform is extensible in terms of both data and features, and provides a model for making complex bacterial genome-derived data accessible to a wide audience
Participation in population-based eye health surveys is lower but more gender-balanced in high- compared to low- and middle-income countries
Get PDFBackground Population-based eye health surveys are an important source of evidence describing the eye health needs of a population, although differences in participation rates between population groups may lead to response bias. In some high-income settings, participation in surveys has decreased over time, although whether this has occurred for eye health surveys is unclear. The aim of this study was to compare participation in population-based eye health surveys conducted over the previous ~20 years between country income levels and different population sub-groups. Methods Participation rates were extracted from an existing database of all population-based eye health surveys undertaken anywhere in the world between 2000–2023 that estimated the prevalence of vision impairment. Overall participation and participation rates disaggregated between population groups (identified using the PROGRESS+ framework) were extracted and compared between country income levels. Results Participation was reported by 374 (86.6%) of the 432 included eye health surveys, was generally high (median=89.5%, interquartile range [IQR]: 81.1-94.6%) and did not change over the study period. Participation was lowest in high-income countries (79.2%, IQR 70.4-90.0%). Just over one-quarter of studies (n=125, 28.9%) disaggregated participation by gender/sex. In these studies, women were more likely to participate than men in low income (women: 90.5%, IQR 75.3-96.2 vs men: 86.8%, IQR 59.1-90.1%), lower-middle income (92.2%, IQR 86.1-95.5% vs 88.8%, IQR 80.1-93.4%), and upper-middle income (91.2%, IQR 85.8-94.6% vs 86.3%, IQR 77.4-90.1%) countries, but not in high-income countries where participation was similar (87.9%, IQR 80.8-95.4% vs 89.3%, IQR 79.1-92.9%). Participation rates disaggregated by age were reported by 68 surveys (15.7%) and participation was not significantly associated with age. Participation disaggregated between other population sub-groups was infrequently reported (<10% of surveys) and could not be meaningfully compared. Conclusions Researchers could consider alternative recruitment strategies that achieve better participation in high income countries and for men in low- and middle-income countries.</ns5:p
Estimating the potential health economic value of introducing universal opt-out testing for HIV in emergency departments in Italy
Get PDFAbstract
In Italy, an estimated 13 000–15 000 people have undiagnosed HIV, and in 2020, 60% of new diagnoses were late-stage (CD4 &lt; 350 cells/mm3). In hospitals, including emergency departments (EDs), testing is largely limited to indicator-condition-guided testing (IC), with written consent universally required. We developed a closed-cohort hybrid decision tree–Markov model to compare health economic values of two HIV testing strategies in the ED: (1) universal opt-out and (2) IC (Italian standard of care). Data sources included healthcare costs and HIV public health data, obtained from national reports and published studies. A lifetime time horizon and a National Health Service perspective were used. Primary outcomes were life years, quality-adjusted life years (QALYs), and costs. Universal opt-out testing resulted in better health outcomes at higher costs. For every 10 000 individuals attending ED, opt-out testing resulted in 15.78 additional new HIV diagnoses and 14.47 more people linked to HIV care compared with IC. Prevalence threshold analysis demonstrated that opt-out testing was cost-effective compared to IC when the HIV prevalence was 0.25% or higher, assuming a willingness-to-pay threshold of €30 000/QALY. Universal opt-out HIV testing in the ED could be a cost-effective way to increase the number of new HIV diagnoses and improve HIV health outcomes in Italy. The model may underestimate the full benefits of this strategy as our model did not consider disengaged patients or transmissions averted. Further research using real-world data is needed to verify our findings
Assessing family influence on adolescent healthy eating: insights from knowledge, attitudes, and practices in a cross-sectional survey in Hong Kong.
Get PDFBACKGROUND: Poor dietary habits in adolescents contribute to the development of non-communicable diseases in adulthood. While family influence by parenting style, food parenting practice and household income on adolescent eating habits has been well-established, other family factors such as parental health conditions as well as the impact on dietary knowledge and attitudes in adolescents are underexplored. This study aimed to evaluate the relative importance of family factors on adolescent healthy eating using the knowledge, attitudes, and practices (KAP) model. METHODS: A cross-sectional online survey was conducted among parent-adolescent dyads recruited from a previous cohort study and secondary schools in Hong Kong. Adolescent healthy eating was assessed by a locally developed and validated KAP of Healthy Eating Questionnaire (KAP-HEQ). It evaluated knowledge on dietary recommendations, health outcomes and food choice; attitudes on outcome expectation, food preference, and self-efficacy; and practices on meal pattern and healthy/unhealthy food consumption. Parents reported on family factors including their KAP of healthy eating (KAP-HEQ), parenting style (Parenting Style and Dimensions Questionnaire), attitudes towards adolescent eating habit, food parenting practices, and family demographic characteristics such as employment status and household income. Multivariable linear regression was used to estimate the family influence on adolescent healthy eating. RESULTS: Two hundred seven dyads of parents (mean age = 46.14 years, 85.02% mothers, 80.19% married, 60.87% attained senior secondary education or above) and adolescents (mean age = 15.21 years, 48.31% female) completed the survey. Positive associations were found between dyad knowledge (β = 0.28, p < 0.001), dyad attitudes (β = 0.22, p < 0.001), and between adolescent practices and food parenting practices (β = 0.18, p < 0.001) and parental employment status (part-time vs unemployed: β = 4.08, p < 0.05). Negative associations were identified between adolescent attitudes and authoritative parenting style (β = -0.11, p < 0.05) and household size (β = -3.19, p < 0.05), and between adolescent practices and higher parental education levels (senior secondary or above vs primary or below: β = -2.86, p < 0.05). DISCUSSION: The study found positive effects of parental dietary knowledge, attitudes, and food parenting practices on adolescent KAP of healthy eating. Interventions to enhance these three family facilitators should be included in strategies for promoting KAP of healthy eating among adolescents
Community perspectives on the risks of prescription drug misuse and awareness among young women and girls in KwaZulu-Natal, South Africa [version 1; peer review: awaiting peer review]
Get PDFBackground There has been an increase in prescription drug misuse globally, with individuals using medications in ways other than prescribed. This can cause serious health risks, including death. Gender differences in prescription drug misuse have been observed with women misusing medication more than men. Methods We conducted a qualitative study in KwaZulu-Natal, South Africa, to explore the extent of this problem providing preliminary findings for a larger study that will inform relevant interventions and health policy responses. We conducted 12 in-depth interviews, and four focus group discussions with young women and girls aged 17-25 years. Thematic content analysis was conducted. Results Our results indicated that family and peer influence contributed to prescription drug misuse, despite participants' negative attitudes toward this due to the associated health risks. Secondly, social and environmental factors such as easy access to prescription drugs within the community contributed to misuse. Conclusion Targeted awareness and intervention programs for young women and girls are needed to highlight the health risks and dangers associated with this problem