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Paternity leave, mental health and wellbeing for new parents: evidence from a national survey in the UK.
Get PDFPaternity leave has the potential to help parents by enabling new fathers to spend time with their families. However, existing evidence about its association with parental mental health and wellbeing is mixed. This study used data from Understanding Society, a national UK household survey, to examine uptake of paternity leave and its association with measures of mental health and wellbeing for fathers (n = 1385) and mothers (n = 1384) of infants born 2009-2019. We used logistic regression to explore paternity leave uptake and inverse probability weighted regression adjustment (IPWRA) to estimate the association between paternity leave uptake and the mental wellbeing (Short Form-12 Mental Component Score (SF-12 MCS)) and mental health (General Health Questionnaire-12 (GHQ-12) caseness) of fathers and mothers in the months after the birth of their child. Odds of taking paternity leave were higher for more educated fathers and those born in the UK. After adjusting for potential confounders, we found no strong evidence of association between paternity leave and mental wellbeing or mental health of mothers or fathers in our overall sample. This finding was robust to a range of sensitivity analyses including alternative model specifications, imputation of missing data, and weighting. However, subgroup analysis showed that fathers with above median household incomes had better mental wellbeing if they took paternity leave (1.43-point difference in SF-12 MCS; 95 % CI 0.25,2.62; p = 0.02). Improved policies are needed to ensure parental leave reduces inequalities in mental health and wellbeing
What Can We Learn From Qualitative Impact Evaluations About the Effectiveness of Lobby and Advocacy? A Meta-Evaluation of Dutch aid Programmes and Assessment Tool.
Get PDFOfficial development agencies are increasingly supporting civil society lobby and advocacy (L&A) to address poverty and human rights. However, there are challenges in evaluating L&A. As programme objectives are often to change policies or practices in a single institution like a Government Ministry, L&A programmes are often not amenable to large-n impact evaluation methods. They often work in strategic partnerships to foster change; hence, contribution may be a more relevant evaluation question than attribution. Small-n qualitative approaches are available to measure the effectiveness of L&A which use the theory of change as their analytical framework. We conducted a meta-evaluation of 36 evaluations of multi-component international programmes to support civil society L&A across Asia, Africa and Latin America, comprising the majority of programmatic support from one international donor. We assessed the confidence in causal claims in the evaluations using a new tool that we developed. Assessments of the contribution of the programmes to the changes in outcomes were not provided in many of the evaluations, nor were predictable sources of bias addressed. Given that L&A programmes are likely to adopt an influencing approach where many different inside-track and outside-track engagement objectives, opportunities and strategies are attempted, many of which might be expected to fail, there appeared to be a clear bias in the evaluations towards reporting outcomes that were achieved, ignoring those that were not. We provide guidance on how to improve the design, conduct and reporting of small-n qualitative evaluations of aid effectiveness
Feasibility, acceptability and preliminary effectiveness of the Hospital to Home discharge and follow-up programme in rural Uganda: a mixed-methods intervention study.
Get PDFINTRODUCTION: Over 60% of premature infants are born in Africa or South Asia. Infants born early, small or who become sick after birth have a higher risk of death, poor growth and developmental impairments. Innovative interventions tailored for low- and middle-income countries are essential to help these newborns survive and develop optimally. This study evaluated the feasibility, acceptability and preliminary effectiveness of Hospital to Home (H2H), a discharge and follow-up programme for small and sick newborns in rural Uganda. METHODS: We compared two cohorts of high-risk hospitalised neonates in Uganda: a historical-comparison cohort receiving standard facility-based care and an intervention cohort that received the H2H programme, a hospital and community spanning package of interventions designed to improve neurodevelopmental outcomes. We compared 6-month corrected neurodevelopmental, growth, nutritional and vaccination outcomes between the cohorts complemented by qualitative interviews of caregivers, community health workers and health facility staff. RESULTS: We recruited 191 participants: 91 historical-comparison cohort (born between July and September 2018), and 100 intervention cohort (born July 2019 to February 2020). No statistically significant difference was seen in neurodevelopmental outcomes (adjusted OR 0.68; 95% CI: 0.32 to 1.46). Improved vaccination completion (88.5% intervention vs 76.9% comparison, p=0.041), and exclusive breastfeeding rates (42% vs 6.6%, p<0.001) were seen. Caregivers and healthcare workers reported the intervention to be acceptable and feasible in this rural Ugandan setting. CONCLUSION: The H2H programme was feasible and acceptable to caregivers and healthcare providers. Improved vaccination and exclusive breastfeeding rates were seen in the intervention group when compared with a historical comparison cohort in this rural Ugandan setting. Further investigation on the short and long-term effectiveness of the H2H programme in a government health services setting is warranted. TRIAL REGISTRATION NUMBER: ISRCTN51636372
The unfolded protein response is a critical mediator in Campylobacter jejuni pathogenesis and host defence.
Get PDFCampylobacter jejuni is the major bacterial cause of foodborne gastroenteritis worldwide. How this pathogen interacts with the host defence machinery of human intestinal epithelial cells (IECs) and is involved in pathogenesis remains elusive. Bacterial pathogens utilise strategies to gain access to the eukaryotic cell machinery that can involve subversion of biological processes in host. Unfolded protein response (UPR) is a highly conserved host cell stress response to the accumulation of misfolded proteins in the endoplasmic reticulum (ER) and is a conserved evolutionary response against invading pathogens. Several bacterial pathogens can induce the UPR for their own survival and thus design a dual scenario where UPR can both protect and facilitate pathogen evasion. Herein, we investigated whether UPR represents a virulence mechanism exploited by C. jejuni during bacterial invasion in human IECs. Our data show that following C. jejuni infection, we observe consistent upregulation of protein kinase R-like ER kinase (PERK), inositol-requiring enzyme 1α and (IRE1α), with activating transcription factor 6 (ATF6) activation occurring in a strain- and cell line-dependent manner. Chemical induction of UPR by thapsigargin in host cells reduced intracellular survival of C. jejuni while conversely pretreatment with UPR inhibitors increased intracellular survival of C. jejuni and attenuated IL-8 release. Finally, we show using C. jejuni mutants that the capsular polysaccharide and flagella contribute to UPR activation in IECs. Collectively, these findings provide observational insights into UPR activation during infections and how C. jejuni infection leads to UPR activation and inflammation, potentially contributing to downstream C. jejuni-mediated damage
UAV-supported mangrove restoration: nature-based solutions for controlling vector-borne disease incidence.
Get PDFMangrove ecosystems provide essential services, acting as natural barriers that help to curb the spread of vector-borne diseases. This article examines how restoring mangroves can play a key role in reducing such disease transmission by enhancing habitats of the natural predators of disease vectors and creating ecological conditions that hinder vector populations, particularly mosquitoes. Herein, we leverage the advancement of UAV (unmanned aerial vehicle) technology and propose ten strategies-including (1) identification and restoration of hydrological connectivity, (2) diverse planting methods, (3) community involvement and visualizations, (4) restoration monitoring and maintenance, (5) integrated vector management, (6) optimal site selection based on vector habitats, (7) early detection of tree mortality, (8) tracking wildlife populations and movement, (9) real-time data collection and analysis, and (10) management and predictive modeling under climate change-through which targeted mangrove restoration can serve as a nature-based solution (NbS) for disease control. Our goal is to facilitate the integration of public health objectives into mangrove ecosystem management with the support of low-cost and widely available UAVs. Ultimately, effective mangrove restoration could offer a sustainable approach to reducing the growing threat of vector-borne diseases in coastal areas, safeguarding the environment, wildlife, and human health
Cancer risks and trends between 1997 and 2018, and effects of restored immunity in people living with HIV: Results from the ANRS CO4 French hospital database on HIV.
Get PDFWe assessed long-term trends in cancer incidence among people with HIV (PWH) in France between 1997 and 2018, focusing on AIDS-defining cancers (ADC) (Kaposi's sarcoma, non-Hodgkin's lymphoma, and cervical cancer), three virus-related non-AIDS-defining cancers (Hodgkin lymphoma, liver, and anal cancer), and four virus-unrelated cancers (lung, colorectal, prostate, and breast cancer). Using data from the ANRS CO4-French Hospital Database on HIV and cancer registries in the general population, we calculated age-standardized incidence rates and standardized incidence ratios (SIRs) across four time periods. Special attention was given to PWH with controlled viral load and restored CD4 during 2008-2018. Among 154,733 individuals contributing nearly 2 million person-years, 9572 cancers were diagnosed. Incidence rates of ADC and virus-related non-ADC declined over time but remained significantly higher than in the general population, with SIRs ranging from 3 to 420, even in recent years. Rates of prostate and colorectal cancers increased overtime, while breast cancer incidence remained stable. For these three cancers, the relative risk compared to the general population remained close to 1. In PWH with CD4 ≥ 500/mm3 for at least 2 years and with recent viral load ≤50 copies/mL, risks of virus-related cancers (KS, NHL, HL, liver, and anal cancer) remained significantly higher relative to the general population, albeit to a lesser extent than in PWH overall, while risks of lung and cervical cancers were similar. Over 20 years, the incidence of all virus-related cancers continued to fall but in the most recent period, the risks still remained higher than in the general population
Health-seeking behaviour, health service delivery and its perceived impact among stroke survivors in Sierra Leone: a longitudinal qualitative study embedded in the SISLE project.
No full textBACKGROUND: Stroke is a leading cause of disability and mortality globally. Despite growing awareness of the stroke epidemic, there is limited understanding of the lived experiences and perspectives of stroke care within resource-constrained health systems. This study explored the experiences and perspectives of stroke survivors, primary caregivers and healthcare providers on stroke care in Sierra Leone.
METHODS: This qualitative descriptive study involved face-to-face semi-structured interviews with stroke survivors, informal caregivers, and healthcare providers between December 2020 and August 2021 in Sierra Leone. We purposively sampled participants to capture diverse experiences across the care continuum. Data were analysed thematically using a constant comparative approach and interpretative phenomenological analysis, triangulating perspectives across participant groups.
RESULTS: Five interconnected themes emerged and are grouped into three categories: (1) Health-seeking behaviour: delayed hospital presentation, financial burden and out-of-pocket costs; (2) Health service delivery: hospital care experiences, access to and continuity of physiotherapy and; (3) Perceived impact and recommendation: recommendations for systemic improvements. Stroke survivors and caregivers reported a lack of knowledge of stroke symptoms, considering traditional treatment or religious consultation as the first point of contact, resulted in considerable delay in seeking hospitalisation. Other major barriers were related to challenges in accessing physiotherapy services and the financial hardship associated with stroke care. The dependence of stroke survivors on their caregivers as a result of staffing shortages and frequent communication breakdowns was frequently reported during hospitalisation. National health policies on stroke care, dedicated stroke units, community physiotherapy programmes and funding support were recommended.
CONCLUSION: Stroke care in Sierra Leone is limited by systemic barriers that include infrastructure, cost, and accessibility. To bridge these gaps, community-based stroke education, health insurance schemes, workforce stroke-care training, and organised stroke-care delivery are needed. These results offer actionable recommendations for improving stroke care and service delivery in resource-constrained settings.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-025-13836-w
Hepcidin is low in children with moderate acute malnutrition and asymptomatic malaria: secondary analysis of a 2×2×3 factorial randomised trial in Burkina Faso.
Get PDFChildren with moderate acute malnutrition (MAM) have an increased risk of iron deficiency, anaemia and death from infectious diseases. The iron-regulating hormone hepcidin is increased in inflammation and may be important in regulating iron metabolism in children with MAM. Asymptomatic malaria has previously been associated with elevated s-hepcidin. We assessed the association between inflammation, iron status, anthropometry and malaria and serum hepcidin (s-hepcidin) and evaluated the effect of food supplementation on s-hepcidin in a secondary analysis in 1019 children with MAM from a randomised intervention trial in Burkina Faso. Children received 12 weeks of supplementation of 500 kcal/d as either corn-soy blend (CSB) or lipid-based nutritional supplements (LNS). S-hepcidin was measured at baseline and after 12 weeks. At baseline, correlates of s-hepcidin were determined using Tobit regression. The effect of supplementation was determined using mixed effects Tobit regression. Children with iron deficiency had 82 % (95 % CI 76, 87) lower s-hepcidin than those without, whereas children with acute infection and inflammation had elevated s-hepcidin. Children with symptomatic malaria had 103 % (95 % CI 32, 210) higher s-hepcidin than afebrile children without detectable malaria, while children with recent or asymptomatic malaria had 51 % (95 % CI 35, 63) lower s-hepcidin. S-hepcidin increased 61 % (95 % CI 38, 87) after 12 weeks of food supplementation with 22 % higher (95 % CI 2, 45) concentration in those who received LNS compared with CSB. Expectedly, morbidity and inflammation were associated with higher, and iron deficiency with lower, s-hepcidin. Further studies are needed to corroborate the finding of decreased s-hepcidin in malnourished children with asymptomatic malaria
Why, how and in what circumstances do school-based gender-based violence interventions work in LMICs? A realist review.
No full textBACKGROUND: Gender-based violence (GBV), a human rights violation, disproportionately affects women and girls in low- and middle-income countries (LMICs). School settings are important platforms for GBV prevention interventions. OBJECTIVE: This paper employs realist synthesis to understand the mechanisms underlying how and why school-based interventions in LMICs generate GBV-related outcomes. METHODS: Database searches yielded 6235 papers - 31 were included, describing 28 different interventions, mostly multilevel and mixed-sex interventions. Grounded theory was used to analyse important contexts, mechanisms, outcomes, and to create explanatory configurations. RESULTS: The predominant contexts are fixed patriarchal sociocultural norms condoning violence, resource availability, and organisational partnerships. Mechanisms, the underpinning forces of the interventions that lead to outcomes, are interdependent and commonly involve knowledgeable facilitators, safe spaces, and enhancing individuals' "power to" and "power within". Changes in GBV knowledge and attitudes are the most frequently reported outcomes. Whilst knowledgeable facilitators are the main vehicle to triggering other enabling mechanisms, the context in terms of sociocultural norms, resource availability, and organisational support needs to be assessed for its capacity to trigger other mechanisms that enable intervention goals. The facilitator mechanism can then trigger individual-level "power to" or "power within" mechanisms; however, these alone are insufficient to improve outcomes. CONCLUSIONS: Multilevel, mixed-sex interventions with increased access to and distribution of resources are important for improving GBV outcomes, particularly those with family and community involvement
Interplay between the gut microbiome and typhoid fever: insights from endemic countries and a controlled human infection model.
Get PDFBACKGROUND: Typhoid fever is a systemic infection caused by Salmonella enterica serovar Typhi (S. Typhi) invasion from the gut lumen. Transmission between people occurs through ingestion of contaminated food and water, particularly in settings with poor water and sanitation infrastructure, resulting in over 10 million illnesses annually. As the pathogen invades via the gastrointestinal tract, it is plausible that the gut microbiome may influence the outcome of S. Typhi exposure. There is some evidence that bacteria producing short-chain fatty acids (SCFAs) may create an environment unfavourable to invasive Salmonella, but data from humans is limited. METHODS: To investigate the association between the gut microbiome and typhoid fever, we analysed samples collected from three all-age cohorts enrolled in a prospective surveillance study conducted across three settings where typhoid fever is endemic (Dhaka, Bangladesh; Blantyre, Malawi; and Kathmandu, Nepal). Cohorts consisted of acute typhoid fever patients (n = 92), asymptomatic household contacts of typhoid fever patients (representing individuals who were likely exposed to S. Typhi but did not develop the disease, n = 97) and asymptomatic serosurvey participants with high Vi antibody titres (representing individuals who were exposed to S. Typhi and may be carriers, n = 69). The stool microbiomes of each cohort were characterised using shotgun metagenomics, and bacterial diversity, composition and function were compared. RESULTS: We identified 4 bacterial species that were significantly lower in abundance in typhoid fever patients compared with household contacts (i.e. probably exposed), in two of the three participant populations (Bangladesh and Malawi). These bacteria may represent taxa that provide protection against the development of clinical infection upon exposure to S. Typhi and include the inflammation-associated species Prevotella copri clade A and Haemophilus parainfluenzae. Our functional analysis identified 28 specific metabolic gene clusters (MGCs) negatively associated with typhoid fever in Bangladesh and Malawi, including seven MGCs involved in SCFA metabolism. The putative protection provided by microbiome SCFA metabolism was supported by data from a controlled human infection model conducted in a UK population, in which participants who did not develop typhoid fever following ingestion of S. Typhi had a higher abundance of a putative SCFA-metabolising MGC (q-value = 0.22). CONCLUSIONS: This study identified the same protective associations between taxonomic and functional microbiota characteristics and non-susceptibility to typhoid fever across multiple human populations. Future research should explore the potential functional role of SCFAs and inflammation-associated bacteria in resistance to S. Typhi and other enteric infections. Video Abstract