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Developing and pretesting a sexual reproductive health (SRH) school health promotion intervention (Safer Choices program) in rural South Africa: Study Protocol
Get PDFBackground Young people remain at highest risk of HIV, sexually transmitted infections (STIs) and early pregnancy. The WHO Global School Health Initiative acknowledges the opportunity to promote effective health interventions within the sustainable infrastructure of schools. Safer Choices is a school-based multiple-component whole-school intervention effective in reducing sexual risk behaviours and preventing HIV, STIs and pregnancy among high-school learners. The overall aim of this study is to adapt and evaluate a Safer Choices program to improve uptake of sexual reproductive health (SRH) and HIV-prevention amongst 15-19-year-old learners in rural KwaZulu-Natal, South Africa. Methods This study will use a mixed-method study design guided by the MRC-framework for development and evaluation of complex interventions. We will use the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) to document modifications to Safer Choices. The study will be conducted across six purposively selected high schools in uMkhanyakude district. The study will be divided into three work-packages (WP): WP1 to adapt and refine Safer Choices to context using participatory research methods; WP2 to pilot and assess acceptability and feasibility of the adapted intervention followed by a process evaluation to understand reach, uptake, acceptability and feasibility of intervention. We will conduct pre/post intervention surveys with 390 randomly selected learners aged 15-19 to measure exposure, satisfaction, changes in self-reported SRH and HIV-risk behaviours. WP3 will include collection of exploratory data on the effect of the intervention on improving resilience and uptake of HIV-prevention and SRH services 60-days post-intervention delivery. Discussion This study protocol paper reports the details of our design for adaptation and evaluation of Safer Choices, with the aim of informing efforts elsewhere and scale-up of this evidence-based intervention. Integrating Safer Choices with SRH and HIV services will likely amplify its effectiveness, offering a holistic framework that addresses the multifaceted nature of HIV prevention.</ns3:p
Considerations for epidemiological studies investigating emerging post-acute infection syndromes: Long Covid as a case study
Get PDFEpidemiological research studies into Long Covid, currently defined by prolonged symptoms after SARS-CoV-2 infection, have reported widely varying prevalence estimates. As well as rapidly evolving scientific knowledge of Long Covid, these differences are partly driven by substantial methodological heterogeneity between studies, including the outcome definition of Long Covid; duration of follow-up; study design, period and population; sampling frame; data source; and the statistical techniques employed. Having a robust understanding of the prevalence of and risk factors for Long Covid is essential for informing treatment pathways, service provision and policy decisions. In preparation for the public health response to future epidemics and pandemics, this review outlines key epidemiological and statistical considerations and recommendations when designing studies of emerging post-acute infection syndromes, focussing on Long Covid as a case study
The Impact of Community-Based Health Insurance on Catastrophic Health Care Expenditure: A Cross-Sectional Study From Ethiopia.
Get PDFBACKGROUND: Achievement of an efficient and equitable health care system through coverage of health insurance is an important instrument to break up the vicious circle of poverty and ill health. This study sought to determine the impact of community-based health insurance (CBHI) on catastrophic health care expenditure in Addis Ababa region of Ethiopia.
METHODS: We conducted a cross-sectional study on the impact of utilizing community-based health insurance (CBHI) among patients who received care at a tertiary institution in Ethiopia over 2 months (April and May 2023). Data were collected using a structured questionnaire. Data were analyzed using SPSS version 20. Simple descriptive statistics, Chi-squared test, and multivariate regression analysis were employed as appropriate. P-value less than 0.05 and Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI) were used to determine statistical significance.
RESULTS: Among 260 study participants included in the study, two-thirds (168, 64.6%) were enrolled in CBHI, while about one-third were not (92, 35.4%). Compared to CBHI non-members, members of CBHI had less catastrophic health care expenditure (68.8% vs. 53.5% CBHI for CBHI non-members and CBHI members respectively, p-value = 0.039). Multivariate regression analysis revealed that community-based health insurance (CBHI) members (AOR = 0.4, 95% CI = 0.25-0.83) were 60 percent less likely to have catastrophic health care expenditure compared to those that are CBHI non-members.
CONCLUSION: In this study, utilization of community-based health insurance was found to be protective against catastrophic health care expenditure to a certain extent, which requires further justification whether this is true at the country level by conducting a similar large multicenter study
Prevalence of suicidal behavior in nigeria: a systematic review and meta-analysis.
Get PDFSuicidal behaviors are a major public health concern, yet their burden remains poorly defined in Nigeria, a country with a predominantly young population. This study aimed to comprehensively assess the prevalence and correlates of suicidal ideation, planning, and attempt in Nigeria. We systematically searched medical literature databases for studies published up to November 2025 that reported the prevalence of suicidal behaviors in the Nigerian general population or specific subgroups, using diagnoses or validated screening tools. Random-effects meta-analysis were conducted, with heterogeneity explored using meta-regression and subgroup analysis. Overall, 53 studies comprising 132,514 individuals were included. The prevalence of suicidal ideation in the general population was 7.9% (95%CI: 4.6, 13.4), while suicidal planning and attempts were estimated at 1.9% (95%CI: 0.9, 4.0) and 1.3% (95%CI: 0.4, 4.3), respectively. Suicidal ideation was associated with sociodemographic factors, including marital status, educational attainment, and employment status, and was more common in conflict-prone regions. Compared with the general population, suicidal behaviors were more prevalent among adolescents and young people, people living with HIV, and pregnant women. Notably, the prevalence also increased over time. These findings indicate that suicidal behaviors are common in Nigeria and highlight the need for targeted intervention strategies for high-risk populations
Nanoenabled smart drug delivery in One Health: advances in targeted therapy and theranostics
Get PDFVector-borne and zoonotic diseases (VBZDs) remain a critical global health challenge, disproportionately affecting low- and middle-income countries and driving significant morbidity, mortality, and economic loss. This review synthesizes emerging evidence on nano-enabled smart drug delivery system (SDDS) within the One Health framework, emphasizing their role in advancing targeted therapy, controlled release, and theranostics for VBZD management. Nano-enabled platforms such as liposomes, polymeric nanoparticles, nanogels, metal–organic frameworks, and biomimetic carriers are designed for stimuli-responsive and site-specific delivery, enhancing therapeutic precision, lowering dosing frequency, and reducing the risk of drug resistance. Controlled-release formulations of agents such as artemisinin derivatives, amphotericin B, and ivermectin have demonstrated superior efficacy in the treatment of malaria and leishmaniasis, and in vector control applications. Targeted delivery strategies extend beyond human therapies to address viral reservoirs, infected macrophages, and arthropod vectors, highlighting the cross-species applications central to One Health. Theranostic innovations combine imaging and therapy to enable early disease detection, real-time monitoring, and the design of adaptive treatment strategies. Applications span human, animal, and environmental domains, from nanovaccines and veterinary antimicrobials to nanoparticle-based larvicides and biosensors for vector surveillance. Future directions underscore the integration of AI-driven nanodesign, scalable and eco-friendly synthesis, and harmonized regulatory frameworks to increase accessibility in resource-limited settings. Although clinical trials are limited, ongoing translational efforts indicate the transformative potential of nanomedicine in VBZD control. Ultimately, integrating nano-enabled SDDS into a One Health framework provides a sustainable and collaborative approach to reduce the global burden of zoonotic and vector-borne diseases
Age distribution of respiratory syncytial virus disease in children younger than 5 years in low-income and middle-income countries: a systematic review and meta-analysis
Get PDFBackground: Low-income and middle-income countries (LMICs) bear the greatest burden of respiratory syncytial virus (RSV) disease. WHO recommends passive immunisation to protect infants younger than 6 months and, in some strategies, infants up to age 12 months, but detailed age data are needed to determine optimal timing and impact. Our study estimates age distributions for the full range of RSV outcomes among children younger than 5 years in LMICs.
Methods: We conducted a systematic review and meta-analysis of RSV age distributions for seven health or health-care outcomes (hereafter, RSV outcomes): community cases, outpatient or clinic visits, emergency room visits, inpatient ward admissions, intensive care unit (ICU) admissions, facility deaths, and non-facility deaths. Inclusion required at least 30 laboratory-confirmed counts of RSV disease in children younger than 5 years, for a single RSV outcome from a single LMIC in the pre-COVID-19 decade (Jan 1, 2010, to Dec 31, 2019). We invited authors of included studies to share RSV counts by week or month of age. Using a Bayesian hierarchical model, we fitted parametric age distributions (by week for children <5 years) to each dataset, and derived pooled estimates of the mode, median, and mean age for each RSV outcome. The study was registered with PROSPERO (CRD42023435080).
Findings: We included 160 datasets with 131 124 RSV counts in children younger than 5 years. The mode (peak) age was 3 weeks (95% credible interval 1–6) for non-facility deaths (57% <6 months), 4 weeks (1–8) for facility deaths (57% <6 months), 7 weeks (6–8) for ICU admissions (60% <6 months), 17 weeks (14–19) for inpatient ward admissions (41% <6 months), 10 weeks (5–17) for emergency room visits (40% <6 months), 28 weeks (22–32) for outpatient or clinic visits (19% <6 months), and 22 weeks (17–28) for community cases (26% <6 months). Considering the most severe RSV outcomes, 20% of ICU admissions and 23% of facility deaths were in infants younger than 8 weeks.
Interpretation: Our findings reaffirm the importance of immunising the youngest infants who bear the greatest burden of severe RSV outcomes. Our estimates should allow more precise quantification of the potential impact of RSV prevention strategies across the full range of RSV disease severity in children younger than 5 years.
Funding: WHO
Implementation-relevant characteristics of midwifery-led cognitive behavioural therapy-based interventions for perinatal mental health in primary care: a scoping review.
No full textINTRODUCTION: Cognitive behavioural therapy (CBT) is an evidence-based approach for perinatal mental health, yet its integration into perinatal primary care remains limited. Midwifery-led CBT-based interventions may enhance continuity, accessibility, and acceptability within primary healthcare. To address the gap between evidence and practice, this scoping review mapped existing research on midwifery-led CBT-based interventions and synthesised implementation-relevant characteristics that facilitate their integration into primary care settings.
METHODS: We conducted a scoping review following the Arksey and O'Malley framework and PRISMA-ScR guidelines. Five databases, MEDLINE, CINAHL Complete, EMBASE, Web of Science, and Scopus, were searched for studies published between 2004 and 2024. We synthesised data narratively across three domains: contextual, provider-related, and intervention-specific characteristics. Study quality was appraised using the SIGN checklist.
RESULTS: Ten studies met the inclusion criteria. Recurring implementation-relevant characteristics were observed in target population selection, intervention timing, provider configuration, and delivery formats, while substantial heterogeneity was observed in baseline symptom severity, intervention intensity, and evaluation approaches across contexts.
DISCUSSION: The recurring patterns identified across studies are likely to reflect pragmatic considerations related to feasibility within routine maternity care settings. In contrast, heterogeneity across the literature appears to reflect differences in intervention aims and care contexts, particularly preventive versus treatment-oriented approaches.
CONCLUSION: This review provides a foundation for future research to support the integration of midwifery-led CBT-based interventions into perinatal primary care. It highlights the importance of clearly defining intervention intent, developing feasibility-informed implementation strategies, and improving reporting practices to enhance interpretability and comparability across studies
Understanding the Humanistic Burden of Metabolic Dysfunction-Associated Steatohepatitis Liver Disease in the US Population: Age/Sex Stratified Analysis of Morbidity and Mortality.
Get PDFBACKGROUND AND AIMS: Metabolic dysfunction-associated steatohepatitis (MASH) is defined by a buildup of fat in the liver and signs of inflammation and liver damage (fibrosis). Eventually, subjects with MASH may develop cirrhosis, leading to more serious consequences of decompensation, liver cancer, and liver failure. In this manuscript, a population-level burden-of-disease model for MASH in the USA is constructed that may form a novel framework to assess the value of new population-level diagnostic and treatment strategies for MASH as they emerge. METHODS: We develop an underlying model of MASH, similar to published models in literature, nested within a population model. Using this model, we estimate the likely incidence of MASH at the stage at which it is most indolent and difficult to detect through calibration techniques and published prevalence of later disease stages. We then present a graphical analysis of disease burden, including disaggregating this burden by age and sex, and into the relative contribution of morbidity and mortality. RESULTS: From the model, we realised that MASH has a higher burden if acquired earlier in life, and the decade in which burden is greatest for patients with MASH is dependent on the age at which they contracted the disease: aged 40: ninth decade (80-89 years). The model also found that the burden was higher for women owing to their longevity. Similarly at the population level, the greatest burden of MASH is expected to fall in the 70-79-year-old age group (6.46 million years of quality-adjusted life-expectancy [QALE]) and the 60-69-year-old age band (5.49 million years of QALE). Approximately 19.34 million years of QALE are lost in the US population (334 million) over their lifetime. CONCLUSIONS: The analysis shows that mortality is a greater burden than morbidity for MASH, and that owing to the insidious nature of the disease, burden is likely to be concentrated in the seventh to eighth decade of life (60-79-year-olds). The burden for females is higher than for males, without differential incidence, owing to women's longevity. The incidence of MASH is expected to rise owing to the increasing prevalence of obesity and diabetes in the population
Point-of-care testing to strengthen sexually transmitted infection case management in resource-constrained settings.
No full textThe WHO estimated in 2020 that 374 million new cases of curable sexually transmitted infections (STIs) occur globally each year.(1) The highest incidence is observed in low-resource settings, where syndromic management is the standard of care. Introduced by WHO in 1984, syndromic management is a clinical approach that uses algorithms to guide empirical antimicrobial treatment based on signs and symptoms—such as vaginal discharge and urethral discharge—without diagnostic testing. Availability and implementation of rapid diagnostic tests for STIs will improve quality of care, reduce overtreatment and missed infections and mitigate against antimicrobial resistance.(2)
This overview covers advances towards implementation of STI diagnostics in low-resource settings, as presented at a symposium co-organised by WHO and the Gates Foundation at the STI & HIV World Congress in Montreal, Canada (29 July 2025)
Estimated effect of correcting inequalities in minimally invasive surgical resection in patients with colon cancer in England: a population-based study.
Get PDFBACKGROUND: Minimally invasive surgical resection offers advantages over open surgical resection in elective management of colon cancer. However, patients who are older, have comorbidities, or live in socioeconomically deprived areas are less likely to receive minimally invasive surgical resection. We aimed to estimate the potential effect on outcomes of correcting inequalities in minimally invasive surgical resection for colon cancer. METHODS: In this population-based study, we studied adult patients (aged 15-99 years) diagnosed with stage I-III carcinoma of the colon between Jan 1 and Dec 31, 2022, and followed up to Dec 31, 2023, who underwent elective resection as recorded in linked cancer registration data in England. We excluded patients diagnosed through an emergency route, diagnosed with metastatic disease (stage IV), with missing stage, not resected, and who underwent colon cancer surgery in a private hospital or in a UK National Health Service (NHS) Trust that recorded ten or fewer colon cancer resections in 2022. Only Trusts doing both minimally invasive surgical and open surgical resections were included to ensure correct modelling of the effect of correcting inequalities in minimally invasive surgical resections within each Trust. We designed scenarios to correct inequalities in minimally invasive surgical resection in each UK NHS Trust, targeting four suboptimal uptake groups (patients who were aged 65 years and older, patients with frailty, patients with comorbidities, and patients with high levels of socioeconomic deprivation). We used a potential outcomes framework and contrasted observed and potential outcomes to estimate the effect of reducing inequalities in use of minimally invasive surgical resection on four primary outcomes: the lengths of index stay and total hospital stay, the probability of readmission within 30 days of resection, and 1-year mortality after resection. FINDINGS: All analyses included data for 10 603 elective colon resections done in 123 NHS Trusts. The median follow-up time was 1·47 years (IQR 1·22-1·74). The mean age at diagnosis was 70·3 years (SD 11·4). 5487 (51·7%) patients were male and 5116 (48·3%) were female. Minimally invasive surgical resection was attempted in 8909 (84·0%) and completed in 7951 (75·0%), among whom there were substantial inequalities in the proportion of minimally invasive surgical resections among the four suboptimal uptake groups defined by age at diagnosis of 65 years and older (5495 [73·8%] vs 2456 [77·8%] in those younger than 65 years), most deprived quintiles (quintiles 3-5: 4114 [73·9%] vs 3837 [76·2%] in the least deprived quintiles), comorbidity (2348 [70·8%] vs 5603 [76·9%] in those without comorbidities), and a moderate or high frailty score (695 [64·1%] vs 7256 [76·2%] in those with a low frailty score). Patients with minimally invasive surgical resection had 3-day to 4-day shorter lengths of hospital stay than patients with open surgical resection. Proportions of 30-day readmission and 1-year mortality were lower in patients with minimally invasive surgical resection than in patients with open surgical resection (13·1% vs 18·1% and 2·9% vs 7·9%, respectively). Correcting inequalities in minimally invasive surgical resection resulted in reductions in total hospital stay of 1567 days, 975 days, 912 days, and 682 days following the corrective scenarios on age, deprivation, comorbidity, and frailty, respectively, and reductions in 1-year mortality for the whole cohort. INTERPRETATION: Correcting inequalities in implementation of minimally invasive surgical resection has the potential to reduce inequalities in colon cancer outcomes. FUNDING: Cancer Research UK