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The health, environmental, and cost implications of providing healthy and sustainable school meals for every child by 2030: a global modelling study.
Get PDFBACKGROUND: School meal programmes are thought to improve dietary behaviour in children, with benefits sustained throughout the life course, making them important catalysts for wider food-system change. However, only one in five children globally currently receives school meals. We estimated the potential effects of extending school meal coverage to all children by 2030 for dietary health; the environmental effects related to diets; and the costs of diets at global, regional, and national levels. METHODS: We conducted health, environmental, and cost assessments of future scenarios of school meal coverage, meal frequency, meal composition, and food wastage. In the health assessment, we used statistical methods and a comparative risk assessment to estimate short-term changes in undernourishment and long-term changes in dietary risks and mortality. In the environmental assessment, we used food-related environmental footprints to analyse how changes in dietary composition and food waste affect greenhouse gas emissions, land use, and freshwater use. In the cost assessment, we used an international dataset of food prices to estimate changes in diet costs, and we used estimates of the social cost of carbon and the costs of illness to estimate changes in the costs of climate-change damages and in health-related costs. FINDINGS: Extending school meal programmes to all children globally by 2030 could be associated with substantial health and environmental benefits globally and in each country. In the model assessments, the prevalence of undernourishment in food-insecure populations was reduced by a quarter due to having an additional meal at school; more than 1 million cases of non-communicable diseases were prevented globally per year if dietary habits were partly sustained into adulthood; and food-related environmental effects were halved if meal composition adhered to recommendations for healthy and sustainable diets and food waste was reduced. Increasing school meal coverage incurred additional meal-related costs that ranged from 0·1% of gross domestic product (GDP) in high-income countries to 1·0% of GDP in low-income countries. Reductions in the external costs of climate-change damages and the costs of illness compensated for the costs of providing meals in line with health and sustainable diets. INTERPRETATION: Universal school meal coverage could make important contributions to improving children's health, the food security of their families, and the sustainability of food systems. However, dedicated policy and financial support will be required to close the gap in school meal coverage, especially in low-income countries. FUNDING: Research Consortium for School Health and Nutrition
Participatory implementation science to enhance knowledge and build the capacity to increase the uptake and sustainability of HPV vaccination among girls in Nigeria.
Get PDFBACKGROUND: Human papillomavirus (HPV) vaccination can prevent cancer in low- and middle-income countries (LMICs), but its uptake remains low, especially in Nigeria. Understanding participatory approaches can help identify local strategies to increase, build capacity for, and sustain vaccine uptake. This study evaluated the effectiveness of an innovation bootcamp in enhancing the knowledge and skills of youth implementers about HPV and cervical cancer as a strategy to increase vaccine uptake among Nigerian girls aged 9-14 years. An innovation bootcamp is an intensive training program that engages end users to build capacity and skills. METHODS: This was a five-week hybrid bootcamp guided by Youth Participatory Action Research (YPAR) and the PEN-3 cultural model at the Nigerian Institute of Medical Research in Lagos, Nigeria. Data were collected using pre- and post-training surveys to assess sociodemographic characteristics, participant preparation, motivations, support needs, baseline learning barriers, the bootcamp process, and knowledge and implementation science research skills (using 9-item and 22-item self-reported scales, respectively). We conducted descriptive analyses of quantitative data and thematic analysis for qualitative, open-ended responses, and we estimated changes in knowledge and skills using the Wilcoxon Signed-Rank test. RESULTS: Five teams comprised of 16 participants attended the bootcamp, and 13 completed the post-survey. Of the 16 participants, most were female (81%) with an average age of 22 years and resided in the following states: Osun (n = 5), Abuja (n = 4), Lagos (n = 2), Kwara (n = 2), Oyo (n = 2), and Plateau (n = 1). The PEN-3 cultural model highlighted the importance of training and enabling resources. Following the bootcamp, the median knowledge score increased from 34 (IQR 31.0-35.0) to 37 (IQR 35.0-40.0), but this change was not statistically significant (p = 0.086). In contrast, there was a significant increase in research skills score from 54 (IQR 43.0-61.0) to 82 (IQR 73.0-96.0) (p = 0.011). CONCLUSIONS: The bootcamp demonstrated that culturally structured participatory approaches can enhance engagement, knowledge, and skills while cultivating participatory learning communities. Empowering young people with appropriate resources and mentorship can propel sustainable HPV vaccination in Nigeria
Reflection or correction? A qualitative study of health manager's experience of clinical audit activities in rural maternity units in KwaZulu-Natal, South Africa.
Get PDFClinical audit aims to improve maternal and newborn care by systematically reviewing clinical practices, identifying gaps, implementing corrective actions, and monitoring progress. Audit can improve outcomes but effective implementation requires strong teamwork, communication and trust. To explore how health professionals experience audit, individual semi-structured interviews were conducted with maternity managers in 11 rural health facilities in KwaZulu-Natal, South Africa, between November 2022 and February 2023. Participants included medical managers (5) and nursing managers (11). Analysis used inductive thematic analysis supported by Nvivo v15. Managers described the maternity team working together to systematically assess care across a range of clinical areas, suggesting that reflective practice was embedded in their work. Audit activities included auditing of clinical case records, caesarean sections, and perinatal and maternal deaths. However, managers reported that clinical audit was time consuming and required high level technical and facilitation skills. Feedback was often described as didactic, emphasising teaching rather than reflection and learning, and frequently involved elements of identifying and blaming individuals. It is important that maternity managers have skills to provide feedback in a safe, blame-free environment. Inappropriate or judgemental feedback could lead to a blame culture and negatively affect communication, teamwork and collaboration across the maternity team
Rasch analysis of the self-reported PedsQL™ 4.0 Generic Core Scales by Australian children.
Get PDFPURPOSE: The Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales (PedsQL GCS), comprising 23 items covering four subscales (physical, emotional, social, and school functioning), is a widely applied generic measure of childhood health-related quality of life (HRQoL). This study aimed to assess the psychometric performance of the self-reported Child version in an Australian general population of children using psychometric criteria based on Rasch measurement theory.
METHODS: To minimise type I error, a random sample of n = 500 was drawn from 1,874 Australian children aged 11–12 years who participated in the Longitudinal Study of Australian Children and completed the PedsQL GCS Child self-report measure. The partial credit model was applied. The following properties were assessed: unidimensionality, model goodness of fit, model reliability, targeting, item fit, threshold ordering, differential item functioning (DIF), and local dependency.
RESULTS: Areas of poor performance included: weak support for unidimensionality of school functioning subscale; only emotional functioning subscale showing sufficient model goodness of fit; poor targeting, suggesting that item thresholds are limited in discriminating HRQoL differences in this cohort; seven items showing disordered thresholds; and five pairs of items being locally dependent. Only two items showed poor fit, and there was no evidence of non-uniform DIF regarding sex and age.
CONCLUSION: Not all Rasch measurement criteria were satisfied by the PedsQL GCS Child self-report measure applied in Australian children. This Rasch-based psychometric evaluation identified potential areas of improvement that can complement the known conceptual, practical, and classical psychometric strengths of the PedsQL GCS.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12955-025-02441-4
Depressed mood as a transdiagnostic target relevant to anxiety and/or psychosis: a scoping review.
Get PDFINTRODUCTION: Depressed mood is a psychological state characterised by sadness or loss of interest in activities, is a common symptom that accompanies most major mental disorders. It is therefore reasonable to consider it as a transdiagnostic target, which when addressed, may improve the functioning and quality of life of persons with lived experience of mental disorders. However, there is limited understanding of the depressed mood as a transdiagnostic target across major mental disorders. Therefore, this scoping review aims to synthesise knowledge on depressed mood, its measurement and interventions among persons with anxiety and/or psychosis.
METHODS AND ANALYSIS: This scoping review followed Arksey and O'Malley's framework. Peer-reviewed articles and grey literature published from January 1988 to April 2024 were searched in the following databases: Medline/PubMed, Scopus, Web of Science, Africa-Wide Information, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, SocINDEX, Humanities International Complete, Sabinet, Open Grey and Google Scholar. Articles were screened at title, abstract and full article levels. Data extracted were analysed using thematic analysis and reported following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. We also consulted stakeholders such as lived experience experts, clinicians and researchers to contextualise our findings.
RESULTS: We screened 245 full articles out of the 4039 hits and included 28 articles in this review. Although depressed mood is conceptually different from clinical depression, the terms are used interchangeably in the literature. The prevalence of depressed mood in psychosis was 7.3-33.3%, with no prevalence studies specific to anxiety disorders. Commonly used outcome measures included Beck's Depression Inventory (n=6) and Patient Health Questionnaire-9 (n=5). Psychosocial conservative interventions such as cognitive-behavioural therapy were the most common interventions. Other interventions, including yoga, pharmacotherapy and Ecology Momentary Interventions, were also reported. All interventions were reported to improve depressed mood, and most were implemented in high-income settings. Stakeholders, including lived experience experts, concurred on the importance of using depressed mood as a transdiagnostic target, viewing it as a 'window' for early identification and management of many common mental disorders.
DISCUSSION: There is a need to clarify the definition and diagnostic cut-off points on common outcome measures of depressed mood. There is also a need for increased research on depressed mood as a viable transdiagnostic target in anxiety and/or psychosis with a special focus on low-to-middle income countries.
CONCLUSION: Depressed mood is an important and prevalent transdiagnostic target with great promise for early management in anxiety and/or psychosis. Valid diagnostic and measurement tools are developing, and so are the targeted interventions in the context of anxiety and/or psychosis
Examining Effective Translation and Implementation Methods for Equitable Access and Scaling of Nutrition Programs-A Report From the "Biomarkers of Nutrition for Development: Knowledge Indicating Dietary Sufficiency (BOND-KIDS)" Project Working Group 4.
No full textSchool-age years (5-19 y) are a critical development period, bridging early childhood and adulthood. Nutrition during this stage is essential for supporting physical, cognitive, and socioemotional/psychological well-being. Moreover, nutritional status in these years has lasting effects on lifelong health, well-being, productivity, and human capital. In 2022, the National Institutes of Health "Biomarkers of Nutrition for Development: Knowledge Indicating Dietary Sufficiency (BOND-KIDS)" Project was launched to explore how to advance the assessment and impact of nutrition programs and policies for school-age children. The aim of this study is to use an ecological approach and available evidence to develop actionable tools for policymakers and program planners that support the design, implementation, and evaluation of equitable, effective, and scalable nutrition programs for school-age children. The BOND-KIDS project convened 4 expert working groups (WGs) to explore biological, environmental, assessment, and implementation dimensions of nutrition during school-age years. WG4 focused on translation and implementation and applied an ecological lens to identify strategies that are fair, effective, and adaptable to meet the needs of communities. WG4 developed 2 tools to support effective nutrition programming for school-age children: 1) a set of 6 overarching principles-equity, developmental relevance, transdisciplinary collaboration, contextual adaptation, sustainability, and systems thinking, and 2) the BOND-KIDS implementation framework. Together, these tools serve as resources for designing, implementing, and evaluating the process and outcomes of nutrition interventions and programs across diverse settings and populations. Strategic investment in nutrition during school-age years is necessary to secure early gains, enable catch-up growth, enhance cognitive development, promote long-term health, and optimize individual and societal productivity. Using the overarching principles and the BOND-KIDS implementation framework can ensure that programs achieve their goals-promoting early nutrition gains, supporting catch-up growth, enhancing cognitive development, and driving human capital transformation
Data science and artificial intelligence for maternal, newborn and child health: scoping review and thematic analysis.
No full textINTRODUCTION: In 2020, an estimated 287,000 women died in pregnancy or childbirth-related causes (70% in Africa), while 2.3 million newborns died in the first 28 days of life in 2022 (46% in Africa). The utility of data science and Artificial Intelligence (AI) in health has potential to contribute and accelerate innovation, improve data use for evidence-based decision making, and better planning for policy decision making.
AIM: To map the current landscape of data science and artificial intelligence applications in maternal, newborn and child health (MNCH) across Africa and identify gaps, challenges, and opportunities for future implementation.
METHODS: A scoping review was conducted following the Arksey and O'Malley framework across five databases (PubMed, Web of Science, EMBASE, SCOPUS, Ovid) and grey literature published before December 2023. Thematic analysis was conducted using previously published seven-domain framework to identify patterns in data science applications, challenges and opportunities. Additionally, projects within the maternal newborn and child health focus on the WHO's Digital Health Initiatives Atlas were reviewed.
RESULTS: Of 11,320 articles screened, 52 articles from 31 African countries met inclusion criteria. Most studies (n = 34, 65.4%) were from Eastern Africa. Most studies were research projects (n = 28, 53.8%) and demographic health surveys (n = 22, 43.1%) rather than operational implementation government programmes. Key themes identified included infrastructure challenges, data quality issues, limited workforce capacity, and heavy reliance on external funding. The WHO's Digital Health Atlas revealed 659 data science initiatives across Africa with the earliest recorded in 2002. 316 (48%) projects were focussed on MNCH and were implemented in 44 African countries.
CONCLUSION: The limited application of data science and artificial intelligence in MNCH at the national level highlights a significant gap in Africa. Our review found that 28 studies (53.8%) were research projects compared to operational implementations integrated into routine systems to inform policy. Main barriers include inadequate infrastructure, limited data stewardship capacity, and insufficient government commitment. Opportunities exist through Africa's youthful demographics, expanding mobile technology, and latecomer advantage in digital innovation
Continuing to be cautious: Japanese contact patterns during the COVID-19 pandemic and their association with public health recommendations.
Get PDFDespite implementing no lockdowns and having a large elderly population, Japan had a low mortality rate due to COVID-19 compared to Europe and North America. The extent to which policies impacted person-to-person contact remains unclear. In this study, we examined changes in contact patterns and their association with behaviors and governmental recommendations in Japan during the pandemic. Ten social contact surveys were conducted between 2021 and 2023 reaching over 1500 participants per survey in Osaka and Fukuoka prefectures where governmental recommendations were first implemented due to high COVID-19 incidence. Their contact patterns were assessed through their demographic characteristics, COVID-19 vaccination status, and individual disease mitigation measures. Generalized linear models were used to identify factors associated with increased contacts. The mean number of contacts during the pandemic declined by at least 49.8% (8.2 weekday contacts and 6.0 weekend contacts per individual, adjusted by age and sex) compared to a study conducted prior to 2020. Weekdays, occupation, larger household sizes, and mask wearing were associated with a higher number of contacts. The frequency and duration of contacts were negatively associated with the issuance of COVID-19 governmental measures, yet the relative change in contacts was not as prominent as pre- and post-lockdown situations in the United Kingdom. There was a gradual increase in contacts with time and less strict public health recommendations. Yet, contacts that did not increase with uptake of COVID-19 vaccination and continuous mask wearing depict cautious behavior across the survey population during the pandemic and into 2023. These results are in contrast with European countries where contacts largely increased among vaccinated individuals compared to the non-vaccinated. Social contacts are country and context specific, highlighting the need for data collection across different communities
Changing perspectives on corporal punishment in schools: Insights from Ugandan young people
Get PDFThis paper contributes to decolonising ways in which corporal punishment has been understood and represented in Africa, through engaging with the complex views of young Ugandans about corporal punishment in schools. Conceptualising time as non-linear, and violence as a web of power, our analysis of longitudinal, mixed method data traces how physical punishment functioned to maintain the generational order, and as a regulatory practice in schools. While young people adopted critical standpoints against corporal punishment, structural conditions and violence in schools evoked feelings of insecurity, that could generate resistance to change. Our analysis problematises assumptions that legal bans alone will create meaningful change
Facing up to reality: over-the-counter access to antibiotics in low-income and middle-income countries needs a paradigm shift in thinking.
Get PDFAlmost half of the global population do not have access to universal health coverage and the current shortfall of health-care professionals (including doctors and nurses) is estimated to reach a deficit of 11 million by 2030, disproportionately affecting low-income and middle-income countries (LMICs). Against this backdrop, of the 8 million deaths per year from bacterial sepsis worldwide, over 3 million are from treatable antibiotic-sensitive infections. This number suggests that access to antibiotics under the current model is insufficient. In many LMICs, over-the-counter antibiotic sellers that range from informal drug procurers to small-sized and medium-sized private pharmacies are the primary and most accessible care providers. Yet global health narratives, often shaped by the traditional doctor-led prescribing model, portray them as drivers of misuse rather than recognising them as politically and economically embedded actors that meet unmet health and antibiotic needs. In this Viewpoint, we argue that over-the-counter antibiotic sellers need to be integrated into a solution for antibiotic misuse and overuse, rather than being seen as part of the problem. Furthermore, we provide a framework with which to achieve integration, so that the concept of global health care for all becomes a reality