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Neonatal and Child Growth Monitoring: A Renewed Call for Uptake and Application of International Growth Standards.
Get PDFOBJECTIVE: The Guidance for International Growth Standards (GIGS) project aims to improve and promote appropriate application of international growth standards across clinical, research and public health settings.
DESIGN: A guidance document providing historical and conceptual context to support the appropriate application of international growth standards.
SETTING: Global; applicable across public health, clinical, research and epidemiological contexts where child growth monitoring is key.
POPULATION OR SAMPLE: Neonates and children under 5 years.
METHODS: Narrative synthesis of key growth monitoring approaches, historical evolution of growth charts and a renewed call for a standardised assessment of child growth using a suite of international standards. MAIN
OUTCOME MEASURES: Not applicable. This paper does not report original outcomes, but highlights intended use and application of growth standards.
RESULTS: Presents a historical overview of growth chart development, clarifies distinctions between descriptive, prescriptive and customised standards and introduces the rationale and a suite of statistical tools provided by the GIGS project. The paper presents insights from three companion papers, providing a structured guide to growth standard application.
CONCLUSIONS: The appropriate and correct application of international growth standards offers the opportunity to improve early identification of at-risk infants and children and reduce global disparities in child health outcomes. The GIGS project provides a structured framework and set of tools to operationalise these standards, supporting consistent application across diverse settings and facilitating progress towards global child health goals
Can behavioral science advance breastfeeding-friendly primary care? Key findings from an evaluation in Kosovo.
Get PDFBreastfeeding is a cost-effective intervention vital to child health, yet rates remain suboptimal, especially in fragile settings. Primary care providers are critical to improving breastfeeding outcomes but face multilevel barriers. While hospital-based interventions have shown success, adaptations to primary care are limited, and understanding of the mechanisms driving provider behavior change remains insufficient. In Kosovo, where exclusive breastfeeding is declining alongside increasing infant mortality, we piloted a behavioral science intervention to improve primary care provider practices. A before-and-after design (baseline June-July 2019; endline June-July 2021) using mixed-methods assessed changes in provider behavior, maternal experience, and the institutional environment across five municipalities. Validation compared maternal reports with clinical observations. The intervention targeted provider behavior with emotionally engaging activities, job aids and institutional strategies, and was co-designed with system actors. Data sources included direct observation of consultations, exit interviews with mothers, provider interviews and facility assessments. Across 609 consultations with matched exit interviews, we recorded a 14.9 percentage point increase in the mean frequency of breastfeeding-friendly clinical behaviors by providers (95% CI: 6.4-23.4) and a 13.3 percentage point increase in interpersonal behaviors (95% CI: 5.2-21.3) after versus before intervention. Gains were strongest for providers explaining ability to breastfeed (+39.0 points), inviting mother to ask questions (+21.8 points) and explaining follow-up required (+18.7 points). Gaps between observer and maternal reports narrowed across most indicators, indicating stronger alignment between care delivered and perceived. Mothers reported greater confidence and better care experiences. Providers' knowledge and attitudes improved and shifts in leadership engagement and facility norms were seen, though broader system integration was limited. A behaviorally informed, co-designed intervention can measurably improve breastfeeding counseling behaviors and maternal experiences in Kosovo's primary care settings. Findings underscore the value of targeting deeper behavioral drivers, not just knowledge gaps, within fragile health systems
Building an appraisal framework for radiotherapy innovations in a value-based context: The ESTRO-Value-based radiation oncology categorisation system.
Get PDFAim: There is no consistent appraisal strategy for radiotherapy innovations supporting their clinical implementation or regulatory decision-making, thus hampering access to high-value care. This study presents the development of a categorisation system as a first step towards a value-based appraisal framework for radiotherapy innovations within the ESTRO Value-Based Radiation Oncology (VBRO) project.
Methods: A mixed-method development process in four phases integrated qualitative and quantitative data in multiple rounds of revision, improvement and validation; and was supported by multidisciplinary stakeholders representing the European radiation oncology community.
Results: Four distinct categories of radiotherapy interventions are defined: Drug-centred, Radiation-centred, Radiation-enabling and Operational radiation interventions. Innovations are categorised based on their primary aim, focussing on either patient-level or organisational level; their technological characteristics; and their radiotherapy-specific characteristics such as therapeutic ratio, biological or dosimetric properties or radiotherapy-drug combinations. To support categorisation choices, a sequence of decision-making questions was arranged in a decision algorithm and presented as a decision tree. The categories and categorisation algorithm were validated using qualitative and quantitative methods by representative stakeholders of the European radiation oncology community, by a bibliometrical data analysis, and finally by the VBRO steering committee.
Conclusion: A correct definition of the different radiotherapy categories is essential to study their interrelation with optimum study design, outcomes, and magnitude of benefit, in view of optimising evidence generation and tailored appraisals. This categorisation system forms the basis to create a value-based appraisal framework within the ESTRO-VBRO project, aimed to support implementation and authorisation regulations for each category of radiotherapy innovation
Immunogenicity of a trivalent haemorrhagic fever vaccine candidate against Sudan virus, Marburg virus and Lassa virus in an mpox vaccine.
Get PDFA multivalent vaccine targeting high-consequence infectious diseases in Sub-Saharan Africa (SSA), which are linked to high mortality, morbidity and overlapping clinical manifestations, would significantly improve health security and economic stability in this region. Trivalent vector vaccines were devised to deliver digitally optimized versions of Orthoebolavirus, Orthomarburgvirus glycoproteins (GPs) and a Lassa mammarenavirus (LASV) nucleoprotein (NP) by a single Modified Vaccinia Ankara (MVA) known to protect against mpox virus (MPXV) along with a matched DNA vaccine. Three immunizations in mice and Hartley guinea pigs with MVA only or a DNA prime followed by two MVA administrations induced comparable levels of binding antibodies and LASV-specific T-cells, respectively. While DNA priming mitigated MVA-specific antibody responses, GP- and NP-specific antibodies developed already after a single MVA vaccination. Although a post-outbreak Ebola virus vaccine is available, outbreaks by other filoviruses, annual LASV epidemics and increased incidence of MPXV infections support the rationale for an MVA-based trivalent haemorrhagic fever vaccine for endemic and high-risk human populations in SSA
Traditional medicine practices for Cutaneous Leishmaniasis in Kalu District, South Wollo, Ethiopia.
Get PDFBACKGROUND: Cutaneous leishmaniasis is a neglected tropical disease of public health importance in Ethiopia, with an estimated 40,000 new cases per year. Access to allopathic diagnostic and treatment facilities is limited. Traditional healthcare is an accessible option in many communities, but there is limited evidence on the types of traditional treatments utilized for cutaneous leishmaniasis in Ethiopia. OBJECTIVE: To explore the traditional treatment practices used for cutaneous leishmaniasis in Kalu district, South Wollo, Ethiopia. METHODS: We conducted an ethnographic study from April to August 2023 in Kalu district, Amhara region. Interviews with ten cutaneous leishmaniasis affected individuals, five traditional healers, and three local opinion leaders were conducted to understand their experiences, treatment choices, and perceptions. In addition, observations at three traditional healers were used to document traditional treatment procedures, materials used, and healer-client interactions. The interviews were transcribed verbatim in Amharic and translated to English and thematically analyzed alongside observation notes. RESULTS: Cutaneous leishmaniasis affected individuals reported using traditional treatments to manage cutaneous leishmaniasis. The factors influencing this choice were lack of awareness about the availability of allopathic treatments, limited access to healthcare facilities, the long duration and high cost of allopathic treatment, trust in traditional healers, and recommendations from community members. Plant-based remedies were commonly applied to lesions, while other treatments included honey, dried bat meat, application of heated metallic objects, and spiritual practices. Traditional healers recommended various behavioral modifications as part of the therapeutic process to facilitate healing, which included dietary restrictions, limiting farm work and cooking, celibacy, and social isolation. CONCLUSION: In Kalu, traditional medicines are the primary source of treatment for cutaneous leishmaniasis. With limited access to allopathic care, cost of services, and trust in local healers, traditional healing of cutaneous leishmaniasis is widely recognized. While further research may help to evaluate the safety and effectiveness of traditional healing practices, there is a need to find ways of engaging healers to support interventions tackling skin diseases
The Mental Health of Farmers and Farmworkers Impacted by Flooding and Drought: Protocol for a Mixed Methods Study.
Get PDFBACKGROUND: Farmers and farmworkers in England are a population group who are particularly vulnerable to the mental health impacts of environmental stressors, including flooding and droughts. While international studies, particularly from Australia, have examined these impacts, there is a critical gap in understanding the mental health consequences of such events for England's farming community. This gap is particularly concerning given the increase in frequency and severity of flooding and drought events due to climate change, which will have significant repercussions for the mental well-being of those whose livelihoods depend on affected land. OBJECTIVE: This study aims to investigate the mental health impacts of flooding and drought events on farmers and farmworkers in England. It will examine how these events affect their livelihoods and explore both compounding and mitigating factors associated with mental health challenges. METHODS: A mixed methods approach will be used, beginning with a national online survey distributed via trusted intermediary agricultural organizations from January 2025 to March 2025. The survey will include the Warwick-Edinburgh Mental Wellbeing Scale to assess participants' mental well-being. A subset of respondents will be selected for follow-up semistructured interviews in late 2025 to early 2026 to gather more in-depth data. Data will be thematically analyzed, allowing for the identification of key patterns in mental health impacts, coping mechanisms, and resilience-building strategies. RESULTS: Survey and interview data will be analyzed during 2025 and 2026 to identify themes and patterns related to the mental health challenges faced by the farming community. This will include exploring coping mechanisms, support networks, and resilience-building strategies, with findings used to inform national interventions. Data obtained from the Warwick-Edinburgh Mental Wellbeing Scale component will be assessed against results from existing studies that have used the scale for other population groups to provide comparative results. CONCLUSIONS: Findings from this study will inform the development of health protection interventions, supporting the farming community in building resilience to future flooding and drought events. This study will also provide valuable insights into the mental health impacts of flooding and droughts in England, contributing to the growing international research on the mental health effects of climate change. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/73827
Household sanitation access before and after an extreme weather event: Tropical Cyclone Freddy in rural Malawi
Get PDFThis study is embedded within the Water, Sanitation, and Hygiene for Everyone programme in Chiradzulu District, Malawi, where one programme area achieved Open Defecation Free (ODF) status in December 2022 following a Community-Led Total Sanitation (CLTS) intervention. In March 2023, Tropical Cyclone Freddy made landfall in Chiradzulu District, causing widespread damage to essential infrastructure. This study compares household sanitation access, classified according to the WHO/UNICEF Joint Monitoring Programme (JMP) sanitation ladder, before and after the cyclone in a rural area of southern Malawi. Household surveys were administered in the same 311 households at programme baseline in April 2022, prior to CLTS implementation, and at 10-month follow-up in June 2023, three months after Cyclone Freddy. ODF status verification data were also used to estimate pre-cyclone sanitation access. These data were used to estimate the proportion of household sanitation facilities that collapsed and became unusable due to the cyclone. The types of JMP sanitation facilities most prone to collapse and those most likely to be reconstructed three months after the cyclone are also reported. Of the 311 households surveyed, 5% had access to basic sanitation, 3% to limited sanitation, and 92% relied on unimproved sanitation prior to Cyclone Freddy. Following the cyclone, 68% of households reported that their sanitation facility, primarily unimproved, had collapsed. Three months later, 36% of surveyed households had no sanitation facility at all, while 50% relied on unimproved sanitation. Among the 211 households whose facility collapsed, 43% rebuilt an unimproved facility. These findings underscore the vulnerability of sanitation infrastructure to tropical cyclones, which can cause affected communities to resort to unsafe sanitation practices or rebuild facilities that remain vulnerable to future cyclones. Improving the resilience of household sanitation infrastructure to extreme weather is critical to protecting public health, particularly in the context of climate change
Initial health assessments of children and young people seeking asylum and refugees in Europe: insights from a qualitative study of health care providers.
Get PDFIn 2023, the number of people seeking asylum globally reached a record high, with 38% aged under 18. Over the past three decades, Europe has experienced the largest increase in international migration since records began. However, research focused on the health of migrant children remains limited. While European guidelines for their care exist, evidence regarding the implementation of these recommendations is limited. This study explores practices and experiences of health care professionals in Europe who conduct initial health assessments (IHAs) for children and young people seeking asylum and refugees (CYPSAR). A qualitative study was conducted (between July and August 2022), using questionnaires and semi-structured interviews to explore perspectives of health care providers WHO care for migrant children in Europe. Participants were recruited through snowball sampling from European expert networks, with 16 clinicians from eight European countries taking part. Data were analysed thematically using NVivo12. We found considerable variation in the content and delivery of IHAs, particularly with regard to screening for communicable and non-communicable diseases. Although immunisation was prioritised, some services lacked vaccination capabilities. Mental health services were limited, with minimal standardised screening. Key barriers to care included insufficient documentation, limited funding, staffing, patient relocation, and inadequate infrastructure to support migrant health. Access to professional translators and the involvement of multidisciplinary teams were considered the main facilitators.
CONCLUSION: Care delivery for migrant children across Europe remains variable despite existing guidelines. Significant barriers to delivery of equitable, quality care exist. There is a need for resources tailored to address challenges in migrant health. Further research is needed to inform evidence-based practice and achieve high-quality equitable care for migrant children in Europe.
WHAT IS KNOWN: • Children seeking asylum and refugees face particular health challenges shaped by experiences before, during and after migration. • Recommendations for initial health assessments upon arrival in European host countries exist, but their implementation across different settings remains variable.
WHAT IS NEW: • While the content and delivery of initial health assessments for children and young people seeking asylum and refugees vary across Europe, clinicians consistently identify common barriers and facilitators to health care. • Our findings emphasise the need for an evidence-based approach to support effective, consistent delivery of services to this vulnerable group and provide insight into factors which may influence this
From Insult to Injury: Exploring the Associations Between Severe Malnutrition in Childhood, Rehabilitation Weight Gain and Adult Adiposity in a Prospective Cohort Study.
Get PDFThe relationships between severe malnutrition (SM), rehabilitation weight gain, and cardiometabolic risk in adult survivors have not been fully elucidated. We utilised a previously collected data set to explore these associations in a cohort of adults who were hospitalised for SM as children from 1963 to 1995. We studied 278 adult SM survivors: 60% male; median age (IQR) 26.5(11.3) years; mean BMI 23.6(5.2) kg/m2). Children's minimum weight-for-age z scores after hospitalisation (minWAZ) were analysed against adiposity as adults in sex-disaggregated regression models. Higher minWAZ was associated with greater adult waist circumference (mean difference:1.8 cm, 95%CI 0.7, 2.9, p = 0.001), fat mass (difference:2.4 kg, 95%CI 0.17,1.06, p = 0.007) and android fat mass (difference:0.19 kg, 95%CI 0.09, 0.29, p 12.9 g/kg/day was associated with greater adult fat mass (difference:5 kg, 95%CI 2, 9, p = 0.006) and android fat (difference:0.5 kg, 95%CI 0.1, 0.8, p = 0.006). Female sex was the strongest predictor of adult fat mass (difference:12.7 kg, 95%CI 9.6, 15.7, p < 0.001) and android fat mass (difference:0.9 kg, 95%CI 0.6, 1.2 p < 0.001) and adult age the strongest predictor of adult waist circumference (difference:0.67 cm, 95%CI 0.39, 0.94, p < 0.001). Faster rehabilitation weight gain as an independent, causal risk factor for adiposity in male SM survivors requires further exploration and more modest weight gain targets may contribute to reducing their risk of adult cardiometabolic disease
Experiences of disrespect and abuse during childbirth in the World Health Organization European region: A mixed-method study among 22 countries.
Get PDFOBJECTIVE: Despite advancements in maternity quality care worldwide, mistreatment of women during childbirth persists. Currently, there is a gap of knowledge on the occurrence of disrespect and abuse during childbirth in the World Health Organization (WHO) European region. METHODS: Within the IMAgiNE EURO (Improving Maternal Newborn Care in the WHO European Region During COVID-19 Pandemic) study, women 18 years and older who gave birth in healthcare facilities in the WHO European region, were invited to complete an online validated questionnaire regarding quality of maternity care. Data were collected between March 2020 and May 2023, declared as the COVID-19 pandemic. A mixed-method analysis was conducted on women's experiences of abuse, involving descriptives and multivariate logistic regression for quantitative data and thematic analysis for qualitative data. RESULTS: Of 50 617 participants among 22 countries, 7683 (15.2%) reported experiences of abuse ranging from 6.4% in Israel to 30.7% in Bosnia-Herzegovina, with significant differences by country, age, and birth mode. Emotional, verbal, and physical abuses were reported by 10.3%, 7.3%, and 2.4%, respectively. The thematic analysis, including 737 responses, identified several shortcomings in care that women perceived as abusive, the experience associated with abuse, and the elicited emotions. Experiences of disrespect and abuse were often linked to a sequence of actions, resulting in women feeling violated and treated as an object. CONCLUSION: Disrespectful maternity care was common during the COVID-19 pandemic in the WHO European region. Efforts are needed to improve communication, implementation of evidence-based practices, and respect for women's rights. Constant monitoring of disrespect and abuse indicators is needed. A paradigm shift must happen, ensuring safe and respectful care for all