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Exposure to pornographic material and perpetration of intimate partner violence among young men in Mwanza Tanzania.
Get PDFAIM: Intimate partner violence (IPV) is a public health concern that negatively impacts women's health. Preliminary evidence from high-income countries suggests that IPV is linked with exposure to pornographic materials among men, by encouraging negative norms of masculinity. To generate evidence from low and middle-income countries, we examined the relationship between frequent exposure to pornography and IPV perpetration among young men in Mwanza, Tanzania.
SUBJECT AND METHODS: We conducted a cross-sectional survey among 1002 randomly selected young men aged 18 to 24 living in Mwanza, Tanzania.
RESULTS: Of the 828 ever-partnered young men included in the study, 396 (47.8%) reported viewing pornography in the past 12 months, with 14.1% viewing it at least once a week. In the last 12 months, 21.4% of participants reported perpetrating sexual IPV, while 43.2% and 15% reported to have perpetrated emotional and physical IPV respectively. After adjusting for covariates, exposure to pornography was significantly associated with sexual (aOR = 2.77 95% CI 1.51 - 5.08), emotional (aOR = 1.84 95% CI: 1.01 - 3.37) and physical (aOR = 1.65 95% CI 1.00 - 2.74) IPV perpetration.
CONCLUSION: Frequent exposure to pornography was associated with sexual, emotional, and physical IPV perpetration. Interventions to prevent violence against women therefore need to address men's exposure to pornography
Ethnic differences in Long COVID diagnosed in primary care in England (2020-2022): an observational cohort study using OpenSAFELY.
Get PDFBACKGROUND: Long COVID continues to affect millions of adults and contribute to substantial economic burden across Europe. Ethnic inequalities in Long COVID, and the reasons underlying these, are poorly understood. We aimed to investigate ethnic differences in the incidence of diagnosed Long COVID in England using linked national primary care data. METHODS: With approval from NHS England, we used linked health record data from England, 2020-2022, accessed through the OpenSAFELY platform. We applied Cox regression to compare incidence of diagnosed Long COVID in primary care across self-reported ethnicity in five groups. We explored potential explanations for these differences by 1) adjusting for sociodemographic and health-related factors, 2) restricting to those tested or hospitalised with COVID-19, 3) stratifying into 16 ethnic sub-groups. FINDINGS: Our sample comprised 17,848,825 adults, of whom 16,970 (0.1%) had a diagnosis of Long COVID recorded in primary care. Hazard ratios (95% confidence intervals) for Long COVID compared with the white group were 1.04 (0.98-1.11) for the South Asian group, 0.84 (0.75-0.94) for the Black group, 0.97 (0.84-1.13) for the Mixed Ethnicity group, and 0.63 (0.55-0.72) for Other ethnic groups, which remained similar when adjusting for sociodemographic and health-related factors and among those tested or hospitalised for COVID-19. Disaggregating into 16 ethnic sub-groups revealed heterogeneity within groups, for example, compared with the White British group, hazard ratios were 1.21 (1.00-1.47) for the Bangladeshi group and 1.09 (0.99-1.21) for the Pakistani group, but 0.77 (0.70-0.86) for the Indian group; and 1.15 (0.95-1.40) for the Black Caribbean group but 0.61 (0.51-0.72) for the Black African group. INTERPRETATION: Differences in Long COVID diagnoses across broad ethnic groups mask important sub-group inequalities, offering insight into underlying mechanisms and approaches to better target Long COVID services. FUNDING: The OpenSAFELY platform is principally funded by grants from: NHS England [2023-2025]; The Wellcome Trust (222097/Z/20/Z) [2020-2024]; MRC (MR/V015737/1) [2020-2021]. Additional contributions to OpenSAFELY and this analysis have been funded by grants from: MRC via the National Core Study programme, Longitudinal Health and Wellbeing strand (MC_PC_20030, MC_PC_20059) [2020-2022] and the Data and Connectivity strand (MC_PC_20058) [2021-2022]; NHS England via the Primary Care Medicines Analytics Unit [2021-2024]; NIHR and MRC via the CONVALESCENCE programme (COV-LT-0009, MC_PC_20051) [2021-2024] and MRC (MR/V040235/1) [2021-24]
Prevalence of death in people with vision impairment from cataracts before treatment: a case study from Kenya.
Get PDFBACKGROUND: Cataract remains the leading cause of blindness globally, which substantially affects quality of life and economic productivity. Despite being a highly cost-effective intervention, cataract surgery remains inaccessible to many, especially in low-resource settings. This study presents a dynamic model that aims to estimate the number of people who will die before receiving cataract surgery, using Kenya as a case study. METHODS: We developed a dynamic simulation model to project the national cataract backlog, surgical interventions, and mortality over a 50-year period (1990-2040). The model integrates demographic and epidemiological data, alongside key parameters including age-specific cataract incidence, severity progression, mortality risk, and surgical throughput. Sensitivity analysis was done to estimate the effect of different cataract surgical rates. FINDINGS: At current surgical capacity, the model estimates that 280 400 (77%) of 360 000 individuals on Kenya's cataract backlog in 2025 will die before receiving surgery, with 236 400 (66%) dying before 2030. Sensitivity analysis shows that doubling cataract surgical rates could enable an additional 24 000 people to receive treatment before death, representing a 16% reduction in untreated mortality. A ten-fold increase (cataract surgical rates of 7020 surgeries per million people per year) would nearly eliminate deaths among those awaiting surgery. INTERPRETATION: This model provides a comprehensive view of the national cataract burden by incorporating incidence, surgical capacity, and mortality estimates for untreated cases. It underscores the urgent need for expanded cataract surgery capacity and improved access to care. The model offers actionable insights for policy makers and health system planners aiming to reduce avoidable blindness and prevent premature deaths from treatable conditions. FUNDING: The Wellcome Trust and Fred Hollows Foundation
Teaching Guide for Health Training Institutions on Stigma-Free Care
Get PDFThis guide represents a huge leap forward in the work towards reducing stigma in health facilities. It is a handbook for nursing tutors and lecturers to enable the integration of stigma reduction education into the national nursing curriculum and has been created as part of the Expanded Total Facility Approach project.
The content has been developed alongside the Nursing and Midwifery Councils in Ghana and Zambia, and with tutors, lecturers and student nurses, to ensure that the participatory exercises, which include case studies, pictures, stories and role-plays, are relevant, accessible and easy to teach in a training institution setting.
The over-riding purpose of the Guide is a commitment to making health facilities more sensitive and empathetic to the needs of people affected by HIV, and other groups who often face stigma, across sub-Saharan Africa.
We hope other countries will follow the example of Ghana, Zambia, and Tanzania by incorporating stigma and discrimination reduction into medical training curricula. This training guide is offered as a resource to support such efforts and to advance stigma-free health care for all
Prescribing of high-cost targeted therapies in England is diverging by region.
Get PDFOBJECTIVES: To examine regional variation in the prescribing of targeted therapies for chronic inflammatory disorders in England between 2019 and 2025. STUDY DESIGN: Retrospective observational study. METHODS: This study analysed Secondary Care Medicines Data from all NHS hospitals in England to evaluate time-trends in prescribing rates of targeted therapies by Integrated Care Board (ICB). RESULTS: Substantial and increasing regional variation in prescribing rates for targeted therapies was observed between 2019 and 2025. The disparity between the highest and lowest prescribing ICBs increased over time, with rates ranging from 2.0 to 6.5 per 1000 people in 2019 and 3.4 to 14.2 per 1000 people in 2025. CONCLUSIONS: There is marked and growing regional variation in the prescribing of targeted therapies across England. Further research should explore the reasons for this divergence to ensure equitable access to these highly effective treatments for patients with chronic inflammatory disorders, irrespective of geography
Cervical cancer in Bulgaria since EU accession in 2007: a struggle in the face of political instability.
Get PDFBACKGROUND: Bulgaria has one of the highest cervical cancer incidence rates in the EU, driven by persistently low screening uptake and HPV vaccination coverage. Despite the preventable nature of the disease, efforts to implement effective prevention strategies have been undermined by political instability, fragmented governance, and systemic health system weaknesses.
REFORM CONTENT: Since EU accession in 2007, Bulgaria has launched several initiatives, including the "Stop and Get Checked" programme and the National Program for Primary Prevention of Cervical Cancer. These efforts were supported by EU policy frameworks and funding. The 2023 National Plan for Combating Cancer aims to align with Europe's Beating Cancer Plan, proposing organised screening, expanded HPV vaccination (including boys), and improved public awareness. A new HPV prevention programme (2025-2030) sets ambitious coverage targets and introduces gender-neutral vaccination.
EXPECTED RESULTS: If implemented effectively, these reforms could significantly reduce cervical cancer incidence and mortality. Key expected outcomes include increased screening coverage, higher HPV vaccination rates, improved access for underserved populations, and better data collection and monitoring. The integration of EU-supported strategies offers a pathway to more consistent and sustainable progress.
CONCLUSIONS: Bulgaria's experience highlights the challenges of implementing cancer prevention in politically unstable settings. While recent reforms show promise, success depends on sustained political commitment, adequate funding, and coordinated implementation. Lessons from Bulgaria may inform other countries facing similar governance challenges, underscoring the value of external policy frameworks and targeted, system-wide approaches
Impact and cost-effectiveness of maternal vaccine and short and long-acting monoclonal antibodies against respiratory syncytial virus among children in Japan: A modeling study
Get PDFBackground Respiratory syncytial virus (RSV) infection is one of the most common causes of lower respiratory infection globally. Three prevention measures—short-acting monoclonal antibody (sa-mAb) and long-acting monoclonal antibody (la-mAb) for infants, and RSV prefusion F protein vaccine maternal vaccine (MV) for pregnant women—are approved for use in Japan. We aim to evaluate the cost-effectiveness of multiple interventions to lower RSV disease burden among under-2-year-old children in Japan. Methods We assessed the cost-effectiveness of six strategies for preventing RSV infection in comparison to no immunization intervention; (i) sa-mAb for high-risk infants, (ii) MV for all pregnant women, (iii) la-mAb for high-risk infants, (iv) la-mAb seasonal administration to all infants who were born between September and March, (v) la-mAb seasonal administration with catch-up administration in September for infants who were born between April and August, and (vi) la-mAb year-round administration to all infants. We also assessed the cost-effectiveness of MV combined with mAb for high-risk infants in comparison to-only MV. We conducted threshold analyses to identify the maximum price of MV and la-mAb at which they are cost-effective. Results We estimated the incremental cost-effectiveness ratio (ICER) for the maternal vaccine at JPY 6.7 million per quality-adjusted life year (QALY) gained, which exceeded the willingness-to-pay threshold in Japan of JPY 5 million per QALY gained. For la-mAb, the most cost-effective strategy was seasonal administration, although the ICER was over 180 million JPY per QALY gained with the current market price. A combination strategy of MV and mAb for high-risk infants was not cost-effective regardless of the prices of mAb. We estimated the threshold prices of MV at JPY 17,251 and la-mAb at JPY 11,443–14,143. Conclusion Among the RSV preventive interventions, MV was closest to being cost-effective. However, the price would have to be lowered for it to be cost-effective in Japan
Mapping policies and evidence addressing childhood malnutrition in India: a global scoping review of systematic reviews and India policy gap map.
Get PDFBACKGROUND: Child undernutrition remains a leading contributor to mortality, morbidity and impaired development in low-income and middle-income countries, particularly in India where rates of stunting and underweight persist despite broad policy and programme investments. The critical window for intervention is the first 1000 days, from conception to age 2, when both maternal and child factors influence lifelong outcomes. OBJECTIVES: To map the review level evidence on interventions to prevent and reduce child and maternal malnutrition across health, education, environment and engineering sectors in India, and assess the degree of alignment with current policy strategies targeting the first 1000 days. ELIGIBILITY CRITERIA: Included sources were systematic reviews, meta-analyses and WHO guidelines published in English, addressing interventions for pregnant women, mothers of infants and children under 5 in India or other low-income/middle-income country settings. SOURCES OF EVIDENCE: Evidence was identified via searches of MEDLINE, Cochrane Library, CINAHL, ERIC, GEOBASE, Engineering Village, and relevant policy reports and guidelines, up to July 2025. CHARTING METHODS: Reviews were screened, and data were extracted on intervention design, implementation context, sectoral focus, population, outcomes, strength of evidence and evidence gaps. RESULTS: A total of 155 reviews met eligibility. Multisectoral approaches integrating nutrition, Water, Sanitation and Hygiene(WASH), education and social support showed the strongest impact for preventing stunting and improving child growth, particularly when targeted early. Intervention coverage and effectiveness were limited by gaps in cross-sector coordination, infrastructural constraints, poor supervision and exclusion of the youngest and poorest populations. Prevention in the first 1000 days yielded greatest benefits, but implementation challenges persist. CONCLUSIONS: India's efforts against childhood malnutrition require integrated, context-specific and prevention-focused strategies. Mapping review evidence to policy reveals strengths and gaps, with lessons relevant for improving child and maternal nutrition in other high-burden regions
Sex differences and gender bias on memory tests in older adults.
Get PDFOBJECTIVE: Females typically perform slightly better than males on memory tests, but this may be partially explained by gender-related biases in remembering the test content. Sex/gender-related differences are underexplored on tests designed to detect subtle Alzheimer's disease-related memory impairment. We studied sex differences on memory tests among older adults, particularly focusing on the Face-Name test (FNAME-12). Specifically, we investigated whether participants were biased toward remembering stimuli that matched their own sex.
METHOD: Cognitively normal participants (n = 452) completed cognitive tests including FNAME-12 at baseline (aged ∼70 years) and follow-up (aged ∼73). FNAME-12 stimuli comprise male and female faces, with names and occupations. Recall and recognition were tested with delays of up to 7 days. We investigated how FNAME-12 outcomes were affected by stimulus gender and participant sex. We examined correlations between "gender bias scores" at baseline and follow-up.
RESULTS: Women outperformed men on memory tests including FNAME-12. Men and women recalled more male than female stimuli, with this discrepancy being two to three times greater among men (baseline: men d = 0.52, women d = 0.15; follow-up: men d = 0.58, women d = 0.25). Seven-day retention rates for male stimuli were higher (recall d = 0.32; recognition d = 0.41). Baseline and follow-up "gender bias scores" were weakly to moderately correlated.
CONCLUSIONS: We observed a gender bias on FNAME-12-particularly among male participants-where male stimuli were better remembered than female stimuli. This bias showed some consistency over ∼2.5 years. Sex differences on memory tests require careful interpretation, as they may be partially explained by gender-related bias in the learning and recall of test content. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Kinetics of antimalarial antibodies in children with common haemoglobinopathies in a Tanzanian population.
Get PDFINTRODUCTION: Haemoglobin gene mutations have long been associated with protection against malaria, as evidenced by the concordant geographic distribution of these mutations with malaria parasite prevalence and by the reduced risk of severe disease among individuals carrying thalassaemia or sickle cell trait alleles. However, the mechanisms underlying this protection remain poorly understood. Although the precise correlates of immunity to malaria are still debated, antibody-mediated responses are widely considered to play a critical role. In this study, we investigated changes in putatively protective anti-malarial antibody titres in relation to age, malaria infection, and protection in Tanzanian children with and without α+-thalassaemia.
METHODS: Antibody responses were quantified using a multiplex assay targeting sporozoite antigens (CSP), merozoite antigens (AMA1, MSP119, MSP3, GLURP R0 and R2), and infected red blood cell surface antigens (PfEMP1 groups A, B, and E). A linear mixed-effects modelling framework, assuming a multivariate normal distribution of residuals, was applied to determine whether antibody responses to specific antigens or antigen groups differed by haemoglobinopathy status or were associated with protection from malaria.
RESULTS: In age-adjusted analyses, antibody levels to MSP3 and Group B PfEMP1 exhibited opposing associations with inherited red blood cell disorders: responses were negatively associated with α+-thalassaemia and positively associated with sickle cell trait, respectively.
CONCLUSION: These findings suggest that sickle cell trait may modulate PfEMP1 expression, thereby weakening the adhesion of Plasmodium falciparum-infected red blood cells to microvascular endothelial cells, while α⁺-thalassaemia may interfere with the shedding of parasite surface proteins involved in erythrocyte invasion. Collectively, these results provide further insight into the immunological and cellular mechanisms by which haemoglobinopathies confer protection against malaria