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Prevalence and Determinants of the Double Burden of Malnutrition Among Adolescents in Nine Low- and Middle-Income Countries.
No full textPURPOSE: The double burden of malnutrition (DBM)-the coexistence of undernutrition and overweight/obesity-poses a significant public health challenge among adolescents in low- and middle-income countries (LMICs). This study examines the prevalence of underweight, stunting, overweight/obesity, and DBM among adolescents in nine LMICs, and identifies key sociodemographic, behavioral, and digital access factors that shape its distribution. METHODS: We conducted a cross-sectional survey across 10 sites in nine LMICs, sampling 11,982 adolescents aged 10-19 years. Nutritional outcomes, including underweight, stunting, overweight/obesity, and DBM (defined as concurrent stunting and overweight/obesity), were assessed using height-for-age and BMI-for-age Z-scores based on the 2007 World Health Organization Growth Reference. Sex-stratified linear and logistic regression models were applied to examine associations between nutritional outcomes and individual- and household-level characteristics at both pooled and country-specific levels, adjusting for site-fixed effects. RESULTS: Overall, 9.5% of adolescents were underweight, 10.7% were stunted, 13.2% were overweight or obese, and 1.4% experienced DBM. Underweight (11.6%) and stunting (12.4%) were more prevalent among male adolescents, while overweight or obesity (16.3%) was more common among female adolescents. Female adolescents were less likely to be underweight (odds ratio [OR] = 0.5, 95% confidence interval [CI]: 0.4-0.6) or stunted (OR = 0.5, 95% CI: 0.4-0.7). Low social class was linked to higher odds of underweight (OR = 1.2, 95% CI: 1.0, 1.5) and stunting (OR = 1.4, 95% CI: 1.1, 1.7), while being out-of-school increased the risk of DBM (OR = 1.8, 95% CI: 1.0, 3.3). Among male adolescents, lack of digital exposure was associated with increased stunting risk but decreased overweight or obesity risk, and insufficient physical activity increased the risk of both outcomes. DISCUSSION: Adolescent DBM in LMICs is shaped by intersecting economic, educational, behavioral, and digital determinants, with distinct gender patterns. These findings underscore the urgency of integrated interventions-combining poverty alleviation, school retention, promotion of physical activity, and targeted online nutrition education-that are tailored to national and gender-specific contexts. Addressing these factors could reduce both undernutrition and obesity, with long-term benefits for adolescent health trajectories
Q. D. Leavis and the critique of academic culture: toward an institutional ethnography
No full textPurpose:
This article re-evaluates the work of Q. D. Leavis, repositioning her not as a secondary figure in cultural criticism but as a pioneering insider ethnographer of academic institutions.
Design/methodology/approach:
Through analysis of her foundational work Fiction and the Reading Public (1932) and essays in Scrutiny, this article applies the lens of organizational ethnography to Leavis's critiques of university life. It draws on current scholarship in ethnography and institutional analysis to frame her method as an early form of embedded, reflexive inquiry.
Findings:
Leavis's cultural diagnostics reveal a sophisticated engagement with the symbolic and gendered structures of the academy. Her writings anticipate concerns of contemporary organizational ethnography, including institutional performativity, insider critique and the use of narrative and parable as tools of analysis.
Research limitations/implications:
This study reframes Q. D. Leavis as a precursor of organizational ethnography, encouraging further archival and critical recovery of overlooked figures in the history of academic critique. It also supports integrating literary methods into organizational research frameworks.
Practical implications:
Leavis's method offers a model for examining the internal cultures of academic institutions, encouraging ethnographic and reflexive approaches in addressing organizational practices and disciplinary identities.
Social implications:
By revealing how universities function as sites of symbolic power and structural exclusion, Leavis anticipates current concerns about gender and capital in higher education. Her case histories operate as prompts for reflexive, insider critique that mobilizes archival memory, parable and narrative to inform contemporary responses to neo-liberal attacks on the university.
Originality/value:
This article is the first to interpret Q. D. Leavis's work through the lens of organizational ethnography. It repositions her criticism as a sustained institutional analysis, offering a valuable resource for debates on academic culture and values
C-reactive protein diagnostic test uptake in primary care: a qualitative study of the UK's 2019-2024 AMR National Action Plan and lessons learnt from Sweden, the Netherlands and British Columbia.
Get PDFOBJECTIVES: This study compares the implementation of C-reactive Protein (CRP) testing to distinguish between acute bacterial and viral infections in primary care in three WHO European region countries (Sweden, the Netherlands and the UK) and one WHO Americas region country (Canada) to generate insights that health services can use to guide decision-making on CRP test implementation. SETTING: Three settings were included: (1) national-level policy interviewees in England, (2) front-line antibiotic prescribers operating in primary care in England and (3) national-level policy interviewees in Canada, Sweden and the Netherlands. PARTICIPANTS: We conducted in-depth qualitative interviews with 35 UK antimicrobial resistance policy-makers, clinicians and allied medical professionals. We also interviewed 13 national-level diagnostic test experts in Canada, Sweden, the Netherlands and the UK. We transcribed, thematically coded and analysed the data, using the NASSS framework for analysing technology-supported healthcare change. RESULTS: There were multiple barriers and facilitators to CRP test implementation. The Netherlands was seen as the country with the most successful implementation of CRP, with enabling IT, financing and quality assurance infrastructure alongside strong guideline adherence to prevent overtesting. By contrast, Swedish interviewees reported 'CRP-itis', or widespread, guideline-discordant testing. UK uptake, contingent on local-level commissioning, has stalled amid mixed professional views. Canadian professional views are sceptical, and uptake plans are nearly non-existent. The NASSS themes emerging as the strongest facilitator or barrier to diagnostic uptake were the organisation and wider systems, with some reflections emerging on the limitations of NASSS to capture interface issues emerging from the analysis. CONCLUSIONS: Health services considering CRP test adoption in primary care need to be mindful that, where concerns about the value proposition of the technology exist among policy-makers and professionals, CRPs are unlikely to be implemented; where there are discordant practices between policymakers/guidelines and clinicians, adoption of CRP testing may increase both antibiotic prescribing and costs to the health system. Where there is local-level commissioning of diagnostic tests, uptake may stagnate; and where implementation succeeds, it may be to the detriment of the public purse
Mediators of the Association Between a Parent's Experience of Trauma and Their Children's Well-Being: A Systematic Review.
Get PDFAt present, our understanding of trauma's complexity is underdeveloped, particularly with regard to intergenerational effects. In this paper, we review peer-reviewed literature on parental trauma and child well-being, focusing on mediating factors. We conducted a global systematic review of longitudinal, observational studies assessing mediators between a parent's traumatic exposure and their children's well-being. The primary outcome of the review was quantitative measures of child well-being (physical and psycho-social) assessed when the child was 18 years or under. We considered the following experiences as trauma exposures: intimate partner violence, rape, sexual assault, victimization during violent crime, childhood abuse, and exposure to direct, immediate threats to personal survival during war, political unrest, natural disasters, and sudden, critical injury/illness. Thirty-two studies met our inclusion criteria. The two most common mediator categories were caregiver mental health (n = 13) and parenting behavior (n = 10). Other studies measured aspects of the parent-child relationship (n = 9), maternal stress factors (n = 5), parental physical health (n = 2), and child-level factors (n = 6) as mediators. Almost all included studies (n = 28) detected a mediation effect. The majority of studies (n = 21) cited robust theoretical frameworks to support their mediator and outcome choices. Studies varied in quality, but most used appropriate, formal mediation analyses. Several study designs could be enhanced by methods to improve precision and reduce bias. Currently, there is little consistency in how similar constructs are measured between mediation studies. We did not locate any studies in low-income countries, and few studies examined aspects of family dynamics, physical health, environmental characteristics, or paternal factors
Associations of linear growth trajectories from 0 to 5 years with cognitive function and school achievement at 10 years of age: the Ethiopian Infant Anthropometry and Body Composition birth cohort study.
No full textThis study aimed to identify linear growth trajectories from 0 to 5 years and assess their associations with cognitive function and school achievement in Ethiopian children aged 10 years. Latent class trajectory modelling was used to identify distinct height-for-age (HAZ) trajectories. Cognitive function was assessed using the Peabody Picture Vocabulary Test, while school achievement was measured by math, English and science (MES) combined scores and grade-for-age. Associations were assessed using multiple linear or logistic regressions. We identified four distinct HAZ trajectories. Decreasing trajectory (n 145, 31·9 %) started high at birth but dropped sharply. The increasing-decreasing trajectory (n 196, 43·2 %) increased up to 3 months, followed by a decrease. The stable low (n 74, 16·3 %) had low HAZ at birth, followed by a slight decrease. The rising trajectory (n 39, 8·6 %) started low but then increased to HAZ above, yet close to zero. At 10 years, children in the rising trajectory had 4·54 (95 % CI: -0·45, 9·55, P = 0·075) higher MES combined score and 2·4 times (95 % CI: 1·12, 5·15, P = 0·025) higher odds of being in the appropriate grade-for-age compared to those in the increasing-decreasing trajectory. The association between stable low and decreasing trajectory with appropriate grade-for-age had odds ratio close to null. In conclusion, we found that three of the four linear growth trajectory classes showed a declining pattern. Data suggest that greater linear growth in early childhood may be associated with higher school achievement and better cognitive function
Whole Genome Sequencing of Drug-Resistant Vibrio cholerae Serotype Ogawa from an Outbreak in Khyber Pakhtunkhwa.
Get PDFBACKGROUND: Cholera, caused by Vibrio cholerae, remains endemic in many developing countries, including Pakistan. The extensive use of antibiotics has led to the emergence of antimicrobial resistance in V. cholerae, limiting available treatment options. In this study, we performed molecular characterisation of antibiotic-resistant V. cholerae serotype Ogawa isolates from a recent cholera outbreak in Khyber Pakhtunkhwa, Pakistan. METHODOLOGY: Suspected cholera stool samples were collected from hospitalised patients at various district hospitals of Khyber Pakhtunkhwa Province (KPK), Pakistan. The samples were transported to the Public Health Reference Microbiology Laboratory at Khyber Medical University, Peshawar. V. cholerae were identified based on colonial morphology, Gram staining, and biochemical tests using EPI 10E. For serotype identification, monovalent antisera were used. Antibiotic susceptibility testing (AST) was performed using CLSI M45 and EUCAST guidelines. DNA was extracted from pure colonies of multidrug-resistant (MDR) V. cholerae and subjected to whole-genome sequencing (WGS) for genomic characterisation using an Illumina MiSeq platform. RESULTS: Of the 350 active diarrheal cases investigated, 70 were confirmed as V. cholerae. The outbreak was initially reported in Dir and was subsequently followed by a high incidence of cholera in the Peshawar district of KPK. All strains belong to the Ogawa serotype, which shows high antibiotic resistance, particularly to ampicillin (n = 62, 88.57%), Sulfamethoxazole/Trimethoprim (n = 60, 85.71%), Erythromycin (n = 59, 84.29%), and Tetracycline (n = 53, 75.71%). The lowest resistance was against Meropenem (n = 1, 1.4%), followed by amikacin (n = 7, 10.0%) and levofloxacin (n = 13, 18.57%). Furthermore, 34 (48.57%) of the isolates were MDR, while 13 (18.57%) were extensively drug-resistant. Six samples were selected for whole-genome sequencing. The selection of six V. cholerae samples for WGS was based on their drug resistance pattern and origin of isolation. At the genomic level, all sequenced V. cholerae strains harboured multiple antimicrobial resistance determinants. Quinolone resistance was associated with mutations and genes in gyrA, gyrB, parC, and parE; resistance to sulfamethoxazole-trimethoprim with folA, folP, and dfr; tetracycline resistance with tetA and tet35; chloramphenicol resistance with catB and S10p; and aminoglycoside resistance with hns, S12p, and gigB. In addition, β-lactam resistance was linked to the presence of efflux and β-lactamase genes, including blaSHV and mox-3. Mutations were identified in gyrA at positions S83I, S177A, and S202A, and in parC at positions S85L and I231V. Collectively, the presence of these resistance determinants likely enables V. cholerae to survive exposure to high concentrations of multiple antibiotics. CONCLUSIONS: Our V. cholerae isolates showed close genetic relatedness to previously sequenced strains from Pakistan (2010 and 2022), as well as to recently reported international strains from the USA, Australia, and China. These findings highlight both the long-term persistence of these lineages within Pakistan and their international dissemination, likely facilitated by globalisation
Workforce distribution and cataract surgical rates in the eastern mediterranean (EMR) and middle east north Africa (MENA) regions
Get PDFPurpose: This study analyses the distribution of ophthalmic human resources in countries of the Eastern Mediterranean Region (EMR) and the Middle East North Africa (MENA), and their productivity in relation to cataract surgery. Design: Cross-sectional, secondary data analysis.
Methods: The analysis compiled secondary data available in the public domain, on the ophthalmic workforce and Cataract Surgical Rate (CSR), defined as the number of cataract surgeries performed annually per million population, using the International Agency for the Prevention of Blindness (IAPB) Vision Atlas and the Rapid Assessment of Avoidable Blindness (RAAB) Repository. We included data from 25 countries (n = 25 data points), and performed a segmented linear correlation to account for the correlation between CSR and ophthalmologist density.
Results: The density of ophthalmologists per million population ranged from <1 per million population in Somalia and South Sudan to 70 per million in Saudi Arabia. There was a positive correlation between the number of ophthalmologists per million and CSR up to approximately 20 ophthalmologists/million, after which the association was not found. On average, ophthalmologists performed <1 to 22 cataract surgery per week in countries of the region. Iran and Pakistan showed the highest CSR values and CSRs per ophthalmologist/week among the countries analysed.
Conclusions: There are wide variations in the availability and productivity of ophthalmic personnel in terms of cataract surgeries/ophthalmologist/week between countries in the region. These findings highlight the need to strengthen efficiency, equitable access, and data quality across eye care systems in the region. Wider adoption of newer indicators, particularly the effective cataract surgical coverage (eCSC), would provide additional information on equity and quality of cataract services
Which interventions optimize antibiotic prescribing in primary care in England? A survey and Qualitative Comparative Analysis of NHS Integrated Care Boards.
Get PDFBACKGROUND: Optimizing antibiotic use is a UK Government priority. This study aimed to identify which combinations of interventions are associated with meeting primary care antibiotic prescribing targets in England's National Health Service, going beyond typical evaluations of individual interventions. METHODS: Data on interventions implemented by Integrated Care Boards (ICBs) in England were collected via an online survey (October 2023 to January 2024). The survey gathered information about 61 interventions covering data monitoring, incentives, governance, staff training, guidance, diagnostics, decision support tools and public awareness-raising activities.The survey data were linked to ICB-level antibiotic prescribing data, analysed descriptively and through a set-theoretic approach (fuzzy-set Qualitative Comparative Analysis, fsQCA). Clusters of ICBs that used a common set of interventions and met prescribing targets were identified. The average prescribing rates were calculated for each cluster and compared with ICBs that did not implement those interventions. RESULTS: Fifty-four responses were received from staff at 29 out of 42 ICBs (69%). Locally adapted prescribing guidance was used by all ICBs meeting targets. ICBs that monitored data and used incentives, guidance and/or challenged prescribers on their behaviour had the lowest prescribing. Implementing diagnostics, staff training or public awareness-raising interventions was not associated with lower prescribing. CONCLUSIONS: In a country that has been reducing antibiotic prescribing and implementing numerous antimicrobial stewardship interventions over the last decade, commissioning organizations that met policy targets were using combinations of a limited number of interventions by 2024. National and local efforts could therefore start prioritizing fewer interventions to further reduce prescribing
DNA methylation-based clocks, tobacco smoking, and lung cancer risk.
No full textBACKGROUND: Biological age, estimated by DNA methylation-based (DNAm) clocks, has been reported to be associated with lung cancer risk. However, the extent to which tobacco smoking behaviours can explain this association and the extent to which DNAm clocks and their components can inform risk assessment for lung cancer remains to be elucidated. This study aimed to evaluate the relationship between DNAm clocks, smoking, and lung cancer risk.
METHODS: We analyzed four prospective cohorts (MCCS, Australia, 324 cases/324 controls; NSHDS, Sweden, 190 cases/190 controls; EPIC, Italy, 160 cases/107 controls; and NOWAC, Norway, 115 case/70 controls) with blood samples collected before lung cancer diagnosis. Study participants were restricted to those with a history of smoking. Incidence sampling was used to match one control to each of the lung cancer cases by cohort, sex, date of blood collection, age, and smoking status in MCCS and NSHDS. The risk discriminative performance of age-adjusted DNAm clocks and their components was compared with that of the Prostate, Lung, Colorectal, and Ovarian model 2012 (PLCOm2012) lung cancer risk model.
RESULTS: We found several DNAm clocks positively associated with lung cancer risk (Hannum: OR = 1.13, 95% CI = 1.02-1.26; PhenoAge: OR = 1.25, 95% CI = 1.12-1.40; DunedinPACE: OR = 1.44, 95% CI = 1.29-1.62; PCGrimAge (a principal component-denoised GrimAge): OR = 1.79, 95% CI = 1.56-2.06), after adjustment for age and tobacco smoking. Tobacco smoking explained a modest proportion of variance in most age-adjusted DNAm clocks (R2 < 11%), except for PCGrimAge, where it accounted for ~ 30% of variance in both lung cancer cases and controls. Detailed smoking adjustments attenuated the PCGrimAge association with lung cancer risk by 13%. In a secondary analysis adjusting for PCGrimAge components and the PLCOm2012 score, DNA methylation-predicted packyears emerged as an independent predictor of lung cancer risk (OR = 2.23, 95% CI = 1.58-3.14). The area under the receiver operating characteristic curve (AUC) for the PLCOm2012 model was 0.66 (95% CI = 0.61-0.71) compared with 0.72 (95% CI = 0.67-0.77) for the PCGrimAge model (Pdifference = 0.03). Combining PCGrimAge with PLCOm2012 provided similar risk discrimination as PCGrimAge alone (AUC = 0.72, 95% CI = 0.67-0.77).
CONCLUSIONS: Methylation-based biological clocks capture epigenetic marks left by exposure to tobacco smoke, and some clocks may inform lung cancer risk assessment by complementing or replacing traditional prediction models
A qualitative exploration of perceived risks, motivations, and risk management strategies among brothel-based female sex workers in Ibadan, Nigeria.
Get PDFBACKGROUND: Female sex workers (FSWs) experience a higher burden of Human Immunodeficiency Virus (HIV), and other sexually transmitted infections (STIs) compared to the general population due to the nature of their work. In Nigeria, challenges such as poverty, stigma, and poor access to healthcare continue to heighten their vulnerability, even though prevention programmes are in place. However, limited qualitative evidence exists on how FSWs perceive sexual risks, the motivations driving unsafe practices, and the strategies used to mitigate them. This study draws from the constructs of the Health Belief Model (HBM) to examine the experiences of brothel-based FSWs on vaginal, oral, and Anogenital sexual activity. METHODS: This qualitative study was conducted in brothels located in Ibadan, Oyo State, Nigeria, as part of the SHINI Project. Two focus group. discussions (FGDs) with 19 participants and five in-depth interviews (IDIs) were held with purposively selected FSWs aged 18–45 years. Data were collected between August and October 2016, audio-recorded, transcribed, translated into English, and coded using NVivo 11. Thematic analysis was applied to identify patterns related to perceived risks, motivations, and coping strategies. RESULTS: FSWs perceived oral and Anogenital sexual activity as high-risk practices, linking them to infections such as syphilis, gonorrhoea, herpes, and human papillomavirus (HPV), as well as long-term complications including mouth cancer, faecal incontinence, and rectal trauma. Motivations for engaging in unsafe sexual behaviours included financial incentives, fear of losing clients, peer influence, and curiosity. While some participants demonstrated agency by refusing unsafe sex or negotiating safer alternatives, economic hardship, client coercion, and stigma often limited their ability to act. Coping strategies included outright refusal, condom use, negotiation for alternative styles, and frequent medical check-ups, though stigma and discriminatory health services reduced care-seeking. CONCLUSIONS: The findings highlight the complex balance between economic survival and health risk awareness among brothel-based FSWs. To reduce these risks, this study recommends the implementation of targeted interventions targeted interventions are needed, including comprehensive sexual health education, stigma-free healthcare services, improved access to condoms and lubricants, and economic empowerment initiatives. Collaboration between government agencies, NGOs, healthcare providers, and community organisations is essential to reduce vulnerabilities and improve the health outcomes of this key population. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-25625-5