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Women's self-employment, business acumen, and emotional IPV: a longitudinal study in Tanzania.
Get PDFBackground: Emotional intimate partner violence (IPV) is the most prevalent form of IPV and is associated with severe health consequences for women. Despite its widespread occurrence, emotional IPV remains under-researched, particularly in relation to women’s economic empowerment. While prior studies have examined the role of cash transfers and microfinance, less is known about the possible protective effects of self-employment and business acumen on emotional IPV.
Methods: Using data from the MAISHA longitudinal study, we examined how indicators of business acumen - including business ownership, leadership, working hours, and reinvestment of earnings - relate to women’s experiences of emotional IPV, measured via a composite index in Mwanza, Tanzania. In a mixed‑effects logistic regression model, we include business acumen and emotional IPV measures at each of four waves (N = 1,004 at Wave 1 & N = 836 (83%) at Wave 4), adjusting for sociodemographic covariates.
Results: Across all waves, approximately 80% of economically active women were self-employed. Emotional IPV was commonly reported, with an increasing trend over time, rising from 44.8% at Wave 1 to 52.7% at Wave 4. The intra-class correlation (ICC) of 35% indicated stability in IPV experiences between women, while 65% reflects within-woman variability over time. In adjusted models, women who held leadership roles within their businesses (AOR = 0.69; 95% CI: 0.49–0.97) and those who reinvested earnings (AOR = 0.66; 95% CI: 0.53–0.82) had significantly lower odds of experiencing emotional IPV.
Conclusion: Findings suggest that among self-employed women, business leadership and financial reinvestment may serve as protective factors against emotional IPV. Enhancing women’s business capacity may strengthen their agency and reduce IPV risk in contexts with high female labour force participation
Segmented filamentous bacteria are worldwide human gut commensals.
Get PDFSegmented filamentous bacteria (SFB) describe morphologically similar gut commensals found in mammals, fish and birds. In mice, SFB intimately colonizes the ileal epithelium at the time of weaning and elicits a strong pleiotropic immune activation that fosters colonization resistance while augmenting disease severity in various disease models. SFB is therefore critical in both health and disease but information regarding SFB in humans remains limited. Here, we first identify and characterize a human SFB species with SFB-specific morphology, including the hook-like tip structure that mediates attachment, and unique genome features, including a starch and glycogen degradation module. This species, which we name Anisomitus miae and establish as the nomenclature type for the SFB genus, is common across Africa. We then bioinformatically identify, based on the 16S rRNA gene V3-V4 variable region sequence, four major, and two minor, human SFB lineages in forty-four countries distributed across all six inhabited continents. We provide evidence towards the co-colonization potential of the SFB lineages and their colonization dynamics, including a potent but short-lived colonization peak in children between one to five years of age. This study establishes the presence of multiple SFB species in the human population and SFB as a minor but wide-spread group of commensals in humans
Leptospirosis Incidence at Four Sites in Sub-Saharan Africa and South East Asia: An International Multi-Site Hybrid Surveillance Study.
Get PDFBACKGROUND: There are few leptospirosis incidence studies despite such estimates being central to accurate burden of disease estimation. We used data from the multicenter Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE) study to make leptospirosis incidence estimates from new sites. METHODS: Febrile patients aged ≥2 months in Laos, Malawi, Mozambique, and Zimbabwe were enrolled and underwent standardized clinical and exposure assessment. Acute and convalescent sera were tested by Leptospira microscopic agglutination test and acute plasma by lfb1 polymerase chain reaction (PCR). Participants with ≥4-fold rise in antibody titer between acute and convalescent sample, or Leptospira PCR positive for the lfb1, had confirmed leptospirosis. Leptospirosis incidence was estimated after adjusting for incomplete enrollment of febrile patients, availability of paired sera, and use of study healthcare facilities by febrile patients based on healthcare utilization data from community controls. RESULTS: Leptospirosis incidence (95% CI) per 100 000 population per year was 1302 (1011, 1677) in Laos, 1337 (874, 2044) in Malawi, 187 (85, 409) in Mozambique, and could not be calculated for Zimbabwe. Sensitivity analysis restricted to pre-COVID years of 2018 and 2019 produced similar estimates of incidence to that of the whole study period. CONCLUSIONS: Leptospirosis incidence was high at the Laos, Malawi, and Mozambique sites and at the upper end of published incidence estimates from the Asia and Africa regions. We recommend more leptospirosis incidence studies be done in areas lacking data to strengthen leptospirosis global burden of disease estimates and to stimulate progress on diagnosis, management, and control
The adaptation process of the Brazilian National Health System to the effects of climate change.
Get PDFThe term “climate change” refers to alterations in long-term temperature and weather patterns, mostly driven by human activities such as the burning of fossil fuels. Climate change manifests through rising global temperatures, changes in precipitation cycles, and the increasing frequency of extreme weather events, such as floods, droughts, heat waves, land and rockslides, strong winds, storms, and wildfires (1).
The health impacts of climate change are unevenly distributed and disproportionately affect countries and populations that have historically contributed less to greenhouse gas emissions (2). In Brazil, socially vulnerable groups-including Indigenous peoples, riverside communities, quilombola populations, and residents of peripheral urban areas-face a compounded burden arising both from climate risks and from systemic barriers to health care access. This dual exposure highlights an urgent scenario of climate injustice and a potential public health crisis (3)
The Psychometric Properties of Scales Assessing Family Context Stigma in Severe Mental Illness: A Systematic Review.
Get PDFStigma experienced and/or conveyed by family members of individuals with mental health conditions may impact on their health and wellbeing, and on the quality of care and health outcomes of people with lived experience of mental illness. However, most of the research on stigma and mental illness has been on public attitudes and behaviors of patients rather than what is expressed by or experienced within families. We aimed to identify scales that assess stigma in the context of family life, and to evaluate their psychometric properties. A literature search across Web of Science, PsycINFO, Medline, Scopus, and ProQuest Social Science (up to August 2025) yielded 14 eligible studies, reported via PRISMA. None of the 14 scales directly or solely assesses family-context stigma, but includes dimensions of self or public stigma, especially related to schizophrenia, possibly neglecting other forms of severe mental illness (SMI). In addition, existing tools often overlook the full range of family relationships and diverse caregiving experiences. There is a need for measures that more adequately and comprehensively capture the often complex and nuanced experience of mental illness stigma within families
Facilitators' experiences of co-designing an intrapartum care intervention in four sub-Saharan African countries: a qualitative study.
Get PDFOBJECTIVE: The aim is to explore co-design facilitators' perspectives and experiences of using co-design to improve intrapartum care in four sub-Saharan African settings. The inquiry focuses particularly on how they fostered engagement, built trust and mitigated unintended consequences during the co-design process.
DESIGN: Qualitative interview study with reflexive thematic analysis.
SETTING: Sixteen public and private not-for-profit hospital-based maternity units in Benin, Malawi, Tanzania and Uganda (four per country).
PARTICIPANTS: A total population sample of 10 co-design facilitators involved in a hospital-based co-design project implemented in maternity units in Benin, Malawi, Tanzania and Uganda were interviewed. Semistructured interviews were conducted between December 2022 and January 2023.
RESULTS: Co-design facilitators viewed co-design as a collaborative process to develop contextually relevant solutions. Our findings elucidate their role in facilitating consensus-building and fostering stakeholder ownership amidst significant power divides. They described approaches co-design facilitators take to maintain ongoing stakeholder engagement and manage misaligned expectations in a trusting and collaborative environment, while being mindful of existing tensions and power imbalances. They also highlighted key challenges faced, including navigating norms, power imbalances and unintended consequences.
CONCLUSIONS: This study underscores the importance of power-sharing, fostering ownership and engaging end users equitably and continuously in co-design efforts, while also being aware of how to address its potential unintended consequences. Further research is needed to understand co-design facilitators' impact on co-design and how to address unintended consequences for stakeholders during and after co-design activities in intrapartum interventions in low-resource settings
Extreme weather and sanitation in Bangladesh: a mixed-methods study of lived experiences of people with disabilities
Get PDFBackground Climate change exacerbates weather extremes, damaging sanitation infrastructure and undermining personal hygiene. Disasters disproportionately impact people with disabilities. This study explored how flooding and cyclones affect the sanitation experiences of people with disabilities in Bangladesh. Methods This mixed-methods study comprised a cross-sectional survey, in-depth interviews, and photovoice. Survey data was collected from 1021 people with disabilities and 909 without disabilities. Purposive sampling selected 28 people with disabilities and 16 caregivers for qualitative data collection. Data were analysed using descriptive statistics, multi-level Poisson regression, and thematic analysis. Findings People with disabilities had a modestly higher risk of experiencing sanitation damage by cyclones or floods compared to people without disabilities (adjusted risk ratio [aRR] 1.28, 95% CI 1.00–1.63). Among people with disabilities, those in the wealthiest quintile were 88% less likely to experience sanitation facility damage than those in the poorest quintile. Qualitative findings showed that muddy, inaccessible paths caused injuries to people with disabilities and their caregivers. Accessing alternative facilities during flooding was difficult for persons with disabilities, with some experiencing verbal abuse. Some reported resorting to open defecation. People with disabilities with incontinence often could not reach facilities in time, resulting in soiled clothing and bedding. Privacy concerns and reliance on caregivers led many, especially women, to restrict toileting, while both women and men adjusted food and water intake, increasing health risks. Interpretation Flooding and storms worsen sanitation challenges for people with disabilities and caregivers, increasing injury risk, dependence, and exposure to human waste. Climate-resilient sanitation must prioritise inclusive sanitation to protect dignity, health, and well-being, and prevent the deepening of health inequalities. Funding Australian Government's Water for Women (WfW) Fund
Household transmission of mpox in Africa: limited in adults but more prevalent in children.
Get PDFIn the transmission of infectious diseases, epidemiological and social context is key, and mpox is a perfect example. Before 2022, transmission was largely believed to be zoonotic, with only limited human-to-human transmission chains.(1,2) In 2022, an outbreak of clade-IIb mpox spread rapidly across Europe and the Americas, mainly through sexual networks among men who have sex with men.(1,3) In that setting, household transmission was rare
The potential impact of reduced international donor funding on the household economic burden of tuberculosis in low- and middle-income countries: A modeling study.
Get PDFBACKGROUND: Recent shifts in the global health funding landscape-most notably the dismantling of the United States Agency for International Development (USAID) and possible reduced contributions to the Global Fund to Fight AIDS, TB, and Malaria (Global Fund)-threaten essential tuberculosis (TB) services in low- and middle-income countries (LMICs). We quantified the potential impact on the household economic burden of TB.
METHODS AND FINDINGS: We used linked epidemiological and economic models, calibrated to 79 LMICs, to estimate future TB patient costs under six scenarios: continuation of 2024 funding levels (baseline), termination of USAID, termination of USAID plus announced reductions in Global Fund contributions from the USA alone, termination of USAID plus complete termination of Global Fund contributions from the USA alone, termination of USAID plus announced reductions in Global Fund contributions from all donor countries contributing 1% or more to the budget, and full elimination of external funding for TB. Outcomes included total TB-attributable household costs and numbers of households experiencing catastrophic costs (disease-related costs >20% of annual income). USAID termination was projected to produce US6.1-8.9) billion in additional patient-incurred costs and 3.9 (3.1-4.6) million additional households experiencing catastrophic costs over 2025-2050. The worst-case scenario (elimination of all external funding) resulted in 60.0-99.2) billion in additional patient-incurred costs and 40.5 (30.9-50.7) million additional households experiencing catastrophic costs-a 32% increase over baseline. Impacts were greatest for poorer households, with over 50% of additional catastrophic costs occurring in the poorest 20% of households. This analysis is limited by substantial uncertainty regarding costs faced by untreated patients and assumptions of constant patient costs and uniform treatment reductions over time.
CONCLUSIONS: Abrupt reductions in international donor funding for TB may reverse recent progress toward financial risk protection and health equity in LMICs. Strategies to reduce the disruption caused by funding cuts and protect vulnerable populations are urgently needed
Impact of cannabidiol on myocardial recovery in patients with acute myocarditis: primary results of the ARCHER study.
Get PDFINTRODUCTION: Cannabidiol has been shown to exert significant anti-inflammatory effects and has demonstrated efficacy in murine models of autoimmune myocarditis, pericarditis, and heart failure. The ARCHER Study assessed whether a pharmaceutically produced cannabidiol formulation showed beneficial effects on cardiac magnetic resonance (CMR) endpoints known to predict prognosis in this patient population.
METHODS: In a multicentre international double-blind placebo-controlled phase 2 study, we randomly assigned 109 patients within 10 days of CMR confirmed diagnosis of acute myocarditis to 12 weeks of pharmaceutically produced oral cannabidiol (active) or placebo. Dose was titrated up to 10 mg/kg of body weight twice daily. Primary endpoints were the difference in extracellular volume (ECV) and global longitudinal strain (GLS) measured by CMR at week 12. Other CMR endpoints included left-ventricular ejection fraction (LVEF), LV mass, intracellular volume (ICV), LV end-diastolic and end-systolic volumes (LVEDV, LVESV), and left-atrial end-systolic volume (LAESV).
RESULTS: All randomized patients (56 active/53 placebo) completed the study with no loss to follow-up. Study drug appeared safe and well tolerated. Baseline mean ECV 38.9 ± 10.9 ml, GLS -15.3 ± 3.6%, and LVEF 60.6 ± 9.9% were consistent with mild to moderate myocarditis and predominantly intact LV function. Week 12 mean ECV was 33.6 ml in the active group and 37.3 ml in the placebo group, a difference of -3.7 ml, confidence interval (CI): -7.4 to 0.1; P = .0538; GLS was -16.0% in the active group and -15.9% in the placebo group, difference of -0.1, CI: -1.2 to 1.1; P = .90. Left ventricular mass was significantly reduced in the active group at 121.1 g compared to placebo 130.3 g, a difference of -9.2, CI: -16.4 to -2.1; P = .0117. In terms of remodelling, LAESV was significantly reduced in the active group (-8.1 ml; P = .0376) while the reduction in LVEDV failed to reach significance (-7.4 ml; P = .098).
CONCLUSION: In mild-to-moderate acute myocarditis, treatment with pharmaceutically manufactured cannabidiol was not associated with a statistically significant change in myocardial ECV or GLS, although a trend towards reduction in ECV was observed. In addition, improvement in other potential markers of myocardial recovery, including a significant reduction in LV mass, was seen in the active treatment group. Further investigation of the therapeutic potential of this therapy in inflammatory cardiac conditions is warranted