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The Lancet Countdown on health and plastics.
Get PDFPlastics are a grave, growing, and under-recognised danger to human and planetary health. Plastics cause disease and death from infancy to old age and are responsible for health-related economic losses exceeding US$1·5 trillion annually. These impacts fall disproportionately upon low-income and at-risk populations. The principal driver of this crisis is accelerating growth in plastic production-from 2 megatonnes (Mt) in 1950, to 475 Mt in 2022 that is projected to be 1200 Mt by 2060. Plastic pollution has also worsened, and 8000 Mt of plastic waste now pollute the planet. Less than 10% of plastic is recycled. Yet, continued worsening of plastics' harms is not inevitable. Similar to air pollution and lead, plastics' harms can be mitigated cost-effectively by evidence-based, transparently tracked, effectively implemented, and adequately financed laws and policies. To address plastics' harms globally, UN member states unanimously resolved in 2022 to develop a comprehensive, legally binding instrument on plastic pollution, namely the Global Plastics Treaty covering the full lifecycle of plastic. Coincident with the expected finalisation of this treaty, we are launching an independent, indicator-based global monitoring system: the Lancet Countdown on health and plastics. This Countdown will identify, track, and regularly report on a suite of geographically and temporally representative indicators that monitor progress toward reducing plastic exposures and mitigating plastics' harms to human and planetary health
How social norms influence processes of change related to an economic intervention in Bangladesh
Get PDFIntimate partner violence (IPV) occurs due to multiple factors at the individual, relational, community and societal levels. Previous research has shown that a cash, food and behaviour change communication programme called the Transfer Modality Research Initiative (TMRI) implemented from 2012 to 2014 in Bangladesh had sustained effects on IPV. We collected qualitative data among former TMRI participants in 2023 that allows exploring how social norms may have played a role in shaping the changes related to IPV along four pathways through which TMRI influenced IPV: 1) economic security, 2) family relationships, 3) women's empowerment, and 4) social support and community relationships. We conducted nine focus group discussions (FGDs) with 49 women TMRI participants, nine FGDs with 52 husbands of women TMRI participants, 54 in-depth interviews (IDIs) with women TMRI participants, and 10 IDIs with women who did not participate in TMRI. We find: along 1) women's economic contributions may facilitate weakening of IPV norms, however norms on gender roles and seclusion constrain change; along 2) norms related to family reputation could influence IPV condemnation, however norms on female submission and obedience to in-laws constrain change; along 3) norms on female submission constrain female empowerment but could be weakened if women display knowledge aligning with gender roles; and, along 4) linkages to reduced IPV were less clear, with female seclusion norms constraining change, highlighting the importance of group activities. Our findings draw attention to the potential for economic interventions layered with context-specific norms interventions to achieve longer-term changes in IPV and gender inequalities
Bridging communities of practice: lessons from the Humanitarian Health Research Forum on climate, crisis, and collaboration.
Get PDFUnveiling masturbatory sexual behaviours in Nigeria: insights into the prevalence and factors associated with self- and mutual masturbation among the sexually active population.
Get PDFBACKGROUND: Masturbation is a common practice across various demographics worldwide. However, its prevalence among the general population in Nigeria remains unknown. This study investigates the prevalence of self- and mutual masturbation and their associated factors among sexually active Nigerians. METHODS: Data were obtained from the Sexual Behaviour and HPV Infection in Nigerians in Ibadan cross-sectional study, including males and females aged 18-45 years. After obtaining consent, participants were asked during face-to-face interviews whether they had ever touched their genitals or inserted fingers into the vagina or anus for sexual pleasure (self-masturbation) or whether they and their sexual partners had ever touched each other's genitals by hand for sexual pleasure (mutual masturbation). The prevalence of self- and mutual masturbation was reported using percentages, while their associations with participants' demographic, lifestyle, and biological characteristics were examined using chi-square tests. Poisson regression with robust variance was performed to identify associated factors. Statistical significance was set at p < 0.05. RESULTS: Mutual masturbation (83.7%) was more common than self-masturbation (64.9%) among participants. The prevalence of self-masturbation was significantly higher among males than females (69.9% vs. 62.4%, p = 0.022), while mutual masturbation was significantly higher among females than males (86.6% vs. 78.1%, p = 0.001). Occupation, smartphone ownership, and alcohol consumption were significantly associated with self-masturbation, while ethnicity, location, number of penile-vaginal sex partners, and receiving oral sex were associated with mutual masturbation. CONCLUSION: Self- and mutual masturbation are highly prevalent among sexually active Nigerians, with distinct factors influencing each behaviour
Age, sex and sexual orientation effects in the Safetxt trial: secondary data analysis of a randomised controlled trial.
Get PDFBACKGROUND: Increasing rates of sexually transmitted infections (STIs) and antimicrobial resistance among young people underscore the urgent need for preventative interventions. Interventions should be evidence-based and tailored to the unique risks and needs associated with varying age, sex and sexual orientation. We used data from the Safetxt trial to explore whether young people's age, sex and sexual orientation influence (1) their risk of STI reinfection and condom use and (2) the effect of the Safetxt intervention on STI reinfection and condom use. METHODS: We conducted exploratory secondary analyses of data from the Safetxt trial that evaluated a theory-based digital sexual health intervention tailored according to sex and sexual orientation. We recruited 6248 young people with STIs from 92 UK sexual health clinics and assessed outcomes after 1 year, including the cumulative incidence of STI reinfection and condom use at last sex. We used adjusted logistic regression and margins plots to visualise effect modification. RESULTS: There were differences in STI reinfection and condom use by age, sex and sexuality. Age was associated with STI reinfection (OR 0.90, 95% CI 0.87 to 0.94) with evidence for interaction between age and sexuality (p<0.001). Our findings suggest that the risk of STI reinfection decreases with age among young heterosexuals but increases among men-who-have-sex-with-men (MSM). Overall, MSM had the highest likelihood of reinfection (OR 3.53, 95% CI 2.66 to 4.68) despite being more likely to use condoms (OR 1.50, 95% CI 1.18 to 1.91).Among MSM, age modified the intervention effect on condom use at 1 year with highest benefits among participants aged 16-18, moderate to minor benefits among those aged 18-21 and no effect among participants aged 22-24 years. CONCLUSIONS: Future digital health interventions tailored for diverse sexuality groups need to target young people early enough to have an impact on sexual behaviour. Specific novel interventions are needed for older MSM. TRIAL REGISTRATION NUMBER: ISRCTN64390461
The Impact of Culture in Weight Loss Intervention Effectiveness Among Hispanic American Women with Overweight or Obesity: A Systematic Scoping Review
Get PDFIntroduction: U.S Hispanic women bear a disproportionate burden of overweight and obesity. This review aims to examine and appraise the effectiveness of culturally tailored lifestyle modification interventions in this population.
Methods: A review was conducted using seven databases for published studies between 2004 and July 2024 using PRISMA-ScR guidelines. The quality of studies was evaluated using the Effective Public Health Practice Project (EPHPP) tool.
Results: Fourteen articles met criteria for inclusion. Interventions were delivered in-person in group and community settings, but varied in length, sample size, reporting of outcomes, and tailoring methods. All interventions were found to produce weight loss. Seven studies reported significant reductions in weight, eight in body mass index (BMI), and three in waist circumference. Across studies, the mean weight loss was -8.73 pounds, mean reduction in BMI units -1.85, and mean reduction in waist circumference -3.89 inches. Effective interventions included a bilingual and bicultural delivery, cultural modification of materials, incorporation of traditional Hispanic foods, and encouraged peer participation.
Conclusions: Evidence demonstrates that culturally tailored lifestyle interventions are feasible, acceptable, and effective in producing weight loss and promoting healthier lifestyle practices among Hispanic American women. The findings of this review should be used to develop culturally relevant community programs and initiatives for the prevention and management of obesity among the population, providing rationale for further research to build upon the examined intervention strategies
Prevalence and risk of adverse intrapartum-related outcomes in Uganda: a cross-sectional study with nested case-control
Get PDFINTRODUCTION: Intrapartum-related complications are a leading cause of adverse perinatal outcomes, including stillbirths, neonatal deaths and intrapartum-related neonatal encephalopathy (IP-NE). We assessed the prevalence of adverse intrapartum-related outcomes, evaluated the association between IP-NE and obstetric and fetal risk factors, and examined whether emergency referral and emergency caesarean section (CS) modified this association through interaction effects.
DESIGN: Cross-sectional with a nested case-control study.
SETTING: Two hospitals in rural Eastern Uganda.
POPULATION: Women giving birth to a live or stillborn baby weighing >2000 g between June and December 2022.
METHODS: We used prospectively collected perinatal e-registry data to assess the prevalence of adverse perinatal outcomes. Logistic regression with interaction with postregression margins analysis was used to determine the association between IP-NE and emergency referral and emergency CS across risk groups of hypertensive disorders, antepartum haemorrhage, prolonged/obstructed labour and birth weight.
MAIN OUTCOME MEASURES: Adverse perinatal outcomes were stillbirths, 24-hour neonatal deaths and IP-NE (defined as Apgar score <7 at 5 min, cord blood lactate ≥5.5 mmol/L and Thompson score ≥5).
RESULTS: Of 6550 births, 10.2% had an adverse perinatal outcome: 3.8% stillbirths, 0.6% neonatal deaths and 5.7% IP-NE. Adverse outcomes were higher among neonates whose mothers had antepartum haemorrhage (31.3%) or prolonged/obstructed labour (27.2%) compared with those whose mothers had no complications. Emergency referral and CS did not change the association between IP-NE and obstetric risk, except in prolonged/obstructed labour. Without emergency CS, the predicted probability of IP-NE was 0.73 (95% CI 0.51 to 0.95); with CS, it decreased to 0.45 (95% CI 0.39 to 0.50).
CONCLUSIONS: Neonates born to mothers with obstetric complications had low healthy survival rates. Emergency referral and CS did not alter the risks of IP-NE in women with obstetric complications except for obstructed or prolonged labour, highlighting that these interventions may not be implemented with sufficient timeliness or quality, and/or that additional, more targeted strategies beyond referral and CS are needed to address
IP-NE
Growth Monitoring of Children Under Five Years Using National Reference Charts Versus International Growth Standards, 2007-2023: A Systematic Review.
Get PDFBACKGROUND: Growth charts are commonly used for monitoring attained size at a specified age relative to a population average considered to represent expected growth. OBJECTIVES: To evaluate the impact of the application of international growth charts for children under five on common growth metrics when compared to national reference charts. SEARCH STRATEGY: We conducted a systematic literature search across five electronic databases: CINAHL Complete (EBSCOhost), EMBASE (Ovid), MEDLINE (PubMed), Scopus, and Web of Science. SELECTION CRITERIA: Studies published in English between 2007 and 2023 that made comparisons between national reference charts and either INTERGROWTH-21st (IG-21st) or WHO Child Growth (WHO CGS) charts. DATA COLLECTION AND ANALYSIS: Common growth metrics were compared using either z-scores or centiles. The prevalence of small- and large-for-gestational age, stunting, wasting, underweight, overweight, and obesity was compared when calculated using international standards versus national charts. MAIN RESULTS: We identified 1556 records, of which 314 were excluded as they were duplicates, 1069 after reading the title and abstract, 90 after reading the full texts, and 7 we could not retrieve the full texts. Z-score or centile values of local references were more often reported to be higher than values of WHO CGS when evaluating weight-, length-, or head circumference- for- age. Seven of 11 studies reported higher rates of small-for-gestational age, while four of five studies reported lower rates of large-for-gestational age using local references compared to IG-21st standards. CONCLUSIONS: Meaningful differences exist in growth assessment between national and international charts that have implications for identifying at-risk infants
Implementing oral (event-driven and daily) and long-acting pre-exposure prophylaxis in mobile men in sub-Saharan Africa: a phase 3b, open-label, hybrid type 2 implementation and effectiveness trial (MOBILE MEN).
Get PDFBACKGROUND: Men who are mobile for work are a key population at high risk of acquiring HIV. Flexible pre-exposure prophylaxis (PrEP) options, including event-driven (ED) oral PrEP and long-acting injectable cabotegravir (CAB-LA), may offer increased access and acceptability for these men. However, limited data exist on the effectiveness and implementation of CAB-LA and ED PrEP among mobile men in Africa. Our study aims to assess the effectiveness and implementation of CAB-LA and oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) (both daily and ED) through comparison of uptake, retention in care, coital coverage, and participant choice. METHODS: We will conduct a mixed0method, phase 3b, open-label, hybrid type 2 implementation and effectiveness randomised controlled trial (RCT). The trial will be carried out in 400 HIV-negative men aged 18 years or older in South Africa and Uganda. Men will be randomised 1:1 to either Group A: oral TDF/FTC PrEP (ED or daily) or Group B: CAB-LA over 9 months. After 9 months, participants from both groups will be offered a choice of PrEP (oral TDF/FTC or CAB-LA) for a further 9 months, with the ability to change their choice as required. Various strategies to support PrEP adoption, initiation, and persistence will be implemented, monitored, and reported on using a RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) implementation science framework. DISCUSSION: This study will provide critical data to inform scalable delivery models for both oral and injectable PrEP among mobile men at high risk for HIV acquisition. Findings will also highlight the potential of PrEP choice delivery and its benefits, offering evidence for governments to consider in the rollout of injectable PrEP in public health systems. Trial registration NCT06133686. Registered on 14 November 2023. PACTR202409632006463. Registered on 2 September 2024
The association between residential segregation and stillbirths in Brazil-a cross-sectional study.
Get PDFBACKGROUND: Segregation is the degree to which two or more groups live separately. While US research has linked segregation to increased stillbirth risk, studies from Latin America have yet to explore this. This study investigated the association between the racial and income segregation index (SI) and stillbirth prevalence in Brazil. METHODS: We used nationwide birth data from Brazil in 2018 (live births from Live Birth Information System, SINASC, and stillbirths from Mortality Information System, SIM). Income and racial SI were calculated using the 2010 national census and analyzed as quintiles with the least segregated group as the reference. Odds ratios were calculated using a logistic regression model, adjusting for infant sex, maternal age, education, previous fetal loss, and the municipal level percentage of the population earning less than half the minimum wage. The sub-analysis was stratified by city size, area-level stillbirth prevalence, and stillbirth type (intrapartum or antepartum). RESULTS: Two million seven hundred seventy-one thousand two hundred seventy-two live-born and stillborn in 2018 were included in the analysis. Women in municipalities with high income and racial SI were older, had more education, and had more previous fetal loss. Women in municipalities with the highest income SI had a 25.1% higher risk of delivering a stillbirth (95% CI: 1.202-1.303). Those in the highest racial SI municipalities had a 5.5% lower risk of delivering a stillbirth compared to those in the quintile with the lowest racial SI (95% CI: 0.908-0.984). In regions with low stillbirth prevalence, a dose-response relationship was observed between income segregation and stillbirth, with the risk of stillbirth among those with the highest income SI being more than twice that of the least segregated (OR 2.086, 95% CI: 1.494-2.911). In larger cities, racial and income segregation were associated with reduced odds of stillbirth. The effect of income SI was larger for intrapartum stillbirths. CONCLUSIONS: We observed that income segregation increases the odds of stillbirth, especially in municipalities with low stillbirth prevalence, while the association for racial segregation was less consistent