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Expert stakeholders on the role of qualitative research in World Health Organisation guidelines.
Get PDFQualitative research findings are sometimes used in guideline development, but usually in an ad hoc manner. We sought to explore how qualitative research could contribute to guideline development, identify examples of qualitative research being used to inform guideline development, and gather suggestions for how qualitative research might be incorporated more systematically in guideline development. Using a topic guide, in 2022-24, we interviewed experts who had participated in World Health Organization (WHO) guideline development. We used purposeful sampling, including qualitative researchers, guideline developers, guideline panel members, and implementation researchers. We interviewed 16 participants, and identified three themes: (i) respondents endorsed using qualitative research findings in developing WHO guidelines, and highlighted examples where this approach had been useful; (ii) recommendation questions in the guideline process are built on clinical decision-making, which can sometimes be too detached from social contexts for broader health problems; (iii) using qualitative research findings to help delineate context has a greater potential role in guidelines. We interpret these findings to indicate that qualitative research could be used more systematically, particularly to inform a broader framing of a health problem, or later in recommendations, to tailor to particular contexts
The Lancet Commission on improving population health post-COVID-19.
Get PDFAn ever-growing number of national and international commitments have failed –sometimes spectacularly - to reduce three intimately interconnected major global threats to population health: non-communicable diseases, the risk of infectious disease pandemics, and environmental degradation.
Non-communicable diseases cause over 40 million deaths every year, of which 17 million are in people under 70 years of age, over 80% of whom live in low- and middle-income countries. At the time of writing the official toll of COVID-19 is of over 630 million cases and more than 6.6 million deaths, although the true figures are far higher due to under-reporting. Environmental degradation is unravelling complex ecosystems, setting the world on a path to mass extinction, and the climate crisis creates an existential threat to human survival.
These three threats are driven by many shared and interacting factors. One example is the clearance of vast areas of land globally to support high levels of red meat consumption. The resulting clearance reduces the capacity of the land to retain carbon while the livestock emit methane, a potent greenhouse gas. Excessive consumption of meat contributes to non communicable diseases, which are major risk factors for morbidity and mortality from infectious diseases including COVID-19. At the same time, the destruction of ecosystems and the loss of habitats increases the likelihood of interactions between wild animals and humans, in turn increasing the risk of new zoonotic diseases developing, while global heating drives increases in disease vectors such as those for malaria and dengue, and air pollution is creating an epidemic of respiratory disease.
The drivers of these three threats are underpinned by political systems which privilege economic growth over population health and the natural environment, undermining economies through increased healthcare costs and reduced human productivity. Across all these threats it is the poorest people, and the poorest countries, that experience the greatest harms.
Reducing these threats requires a global shift in the behaviour of most populations including eating healthier and more sustainable diets, drinking less alcohol, not smoking, and increasing levels of physical activity. These behaviours are largely cued, reinforced and maintained by physical, economic, digital and social environments over which populations have little control. Exhorting individuals to change their behaviour is therefore an ineffective strategy for change of the magnitude and at the scale required. Changing these behaviours necessitates changes in the environments that shape them, requiring action largely by governments and business actors, and also by citizens, in order to transform the conditions that determine population health and the natural environment
A machine learning approach for quantifying crop water stress in smallholder farms using unmanned aerial vehicle multispectral imagery
Get PDFWater stress significantly threatens sugarcane production, particularly among smallholder farmers in South Africa, where spatially explicit assessments remain limited. This study aimed to improve the quantification of crop water stress by developing a machine learning (ML) model to predict the Normalised Difference Water Index (NDWI), a proxy for vegetation water content. An ML approach was adopted to capture complex, non-linear relationships between structural vegetation indices (SVIs) and NDWI. Sentinel-2 satellite data and UAV-acquired multispectral imagery were integrated, with the model trained using satellite-derived SVIs and NDWI, and then applied to UAV-derived SVIs to predict NDWI. The model achieved high predictive accuracy (R² = 0.95, RMSE = 0.03, MAE = 0.02) and effectively captured temporal variations in sugarcane water status, including post-rainfall stress recovery and increased water retention during early maturation—aligning with changes in leaf area index (LAI), chlorophyll content (CC), and Total Soil Water Profile (TSWP). NDWI also showed a positive correlation with actual evapotranspiration (ETa; R² = 0.60) and a negative correlation with the Water Deficit Index (WDI; R² = 0.62), suggesting its potential to reflect crop water status under certain conditions. When interpreted in conjunction with in situ measurements of precipitation, TSWP, and WDI, the predicted NDWI provides valuable insights into crop water dynamics. This approach demonstrates the potential of ML-driven NDWI estimation to support site-specific irrigation scheduling, enhance resource use efficiency, and promote sustainable sugarcane cultivation. The findings contribute to climate-resilient water management practices tailored to the needs of smallholder systems in water-scarce regions
Combining professionalization and personalization in English long-term care: analyzing stakeholder views through a workforce lens.
Get PDFINTRODUCTION: Professionalizing the long-term care workforce, defined as improving the quality of care jobs, has been proposed as part of a solution to workforce challenges in long-term care. However, professionalization is argued to be in tension with personalization, a policy at the center of English long-term care. This article explores tensions and complementarities between the two policies through a workforce lens. METHODS: We conducted qualitative group (n = 2) and one-to-one interviews (n = 7) with long-term care stakeholders (n = 25) representing a wide range of organizations in England. We have adopted the method of thematic analysis to explore stakeholders' views on the relationship between the professionalization of the hands-on care workforce and the personalization of care and support services. RESULTS: We have identified three points of intersection between professionalization and personalization in stakeholders' narratives: care workers' autonomy, training and registration. Autonomy is defined here as care workers' discretion to make practical decisions in a care situation without the immediate approval of a manager or care professional. We have found that narratives reflected a complex relationship between the two policies. Stakeholders viewed care workers' autonomy and training as directly supporting the goals of personalization but they perceived personal assistants' formal training and registration as being in tension with personalization. DISCUSSION: Care workers' practical autonomy emerged from our analysis of stakeholder narratives as a key aspect of improving care jobs (professionalization). This supports research findings that a higher degree of autonomy improves job satisfaction and it is a source of dignity in an undervalued occupation. Yet, autonomy is not explicitly included in definitions of professionalization in the context of English long-term care. This article contributes to the literature by conceptualizing care workers' autonomy as a dimension of professionalization, along with pay, terms and conditions of employment, training and registration. Secondly, the results contribute to the literature and to policy debates about the relationship between professionalization and personalization, two mechanisms of reforming long-term care systems globally. Our results demonstrate that there is a complex relationship between the two policy areas, characterized by synergies and tensions
Diagnostic accuracy of an enzyme-based point-of-care test versus Nugent score for bacterial vaginosis among pregnant women attending routine antenatal care in Zambia.
Get PDFBACKGROUND: Bacterial vaginosis (BV) is associated with adverse pregnancy outcomes. OSOM® BVBlue® is a chromogenic point-of-care (POC) test that detects sialidase, an enzyme produced by Gardnerella vaginalis and some other anaerobic bacteria associated with BV. This study, part of the World Health Organization’s global ProSPeRo study, aimed to evaluate the performance of this POC test compared with the Nugent score reference standard among pregnant women in Zambia. Additionally, the operational characteristics and patient acceptability of the POC test were evaluated. METHODS: Pregnant women attending four health centres in Nchelenge, Zambia, for antenatal care between 15 February and 26 May 2023 participated. Clinician-collected vaginal swabs for OSOM® BVBlue® and Nugent scoring were obtained from each participant. POC test results were read independently by two staff members. Study staff completed a questionnaire on the operational characteristics of the POC test, whereas participants were asked about the length of time that they would be willing to wait for POC test results. RESULTS: Paired POC and reference test vaginal swabs from 999 participants were analysed. Overall, 23.1% (231/999) tested positive for BV by Nugent score. Overall sensitivity and specificity of OSOM® BVBlue® were 41.3% (95% confidence interval [CI] 25.4–59.2%) and 93.1% (95% CI 89.8–95.4%), respectively. Inter-rater agreement was 99.6% (Cohen’s Kappa 0.984). Most pregnant women, 97.9% (978/999), were willing to wait up to 20 min for a POC test result, and 59.2% (591/999) up to 30 min. Of 14 study staff members, all found the POC test easy to use and instructions clear, 13 felt the results were easy to interpret, with 12 reporting test results were available within 25 min. Cold-chain requirements and short shelf life were perceived as significant challenges. CONCLUSION: Overall, OSOM® BVBlue® yielded sub-optimal sensitivity. The findings from this study are valuable for the development of minimal and optimal product profiles for POC tests for BV. These profiles, in turn, may guide future research and development for this prevalent condition with important sexual and reproductive health consequences. Logistical challenges need to be addressed for effective implementation of POC testing in resource-limited settings. TRIAL REGISTRATION: PACTR202302766902029. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-026-12714-y
“It’s Not Secret—It’s Not Advertised” – Content, Format, and Platform Preferences to Promote PrEP Use in the Southern United States
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Gay, bisexual, and other men who have sex with men (GBM) in the Southern United States (US) experience high HIV incidence yet have relatively lower HIV pre-exposure prophylaxis (PrEP) uptake, especially among GBM of color. Despite awareness, PrEP use remains insufficient to meaningfully impact the HIV epidemic in the Southern US. PrEP promotions largely focus on PrEP messaging, especially product awareness. Theory-based health promotion research has not explored how to develop promotions that drive PrEP uptake. To close this gap, we explored preferences among GBM in the Southern US for promotion content, format, and platform. Grounded in Andersen’s Model, we conducted semi-structured interviews with HIV-negative GBM, aged 18–39 years, and used inductive and deductive coding for thematic analysis to develop themes and sub-themes to understand promotion preferences. Forty GBM (68% Black, 10% Latino, 53% not using PrEP) completed interviews. Three major themes emerged: (1) content beyond promoting PrEP awareness, (2) using digital devices and media access for promoting PrEP, and (3) platforms for PrEP promotion. GBM in this study preferred digital promotion of PrEP, focusing on access, safety, and effectiveness that is delivered discreetly; promotion in the non-digital space could normalize PrEP use. Creating promotions that address these themes will make promotions more relevant to drive uptake of PrEP in the Southern US
Consumption and expenditure on fidaxomicin and oral vancomycin for Clostridioides difficile infection: A 12-year longitudinal study of 43 countries and regions.
Get PDFBACKGROUND: Current treatment guidelines recommend fidaxomicin and oral vancomycin as first-line treatments for Clostridioides difficile infection (CDI). Disparities in the prevalence of CDI and the availability of novel treatments necessitate understanding the contemporary trends in their consumption at the global level. METHODS: This longitudinal study used global pharmaceutical sales from IQVIA-MIDAS for fidaxomicin and oral vancomycin in 43 countries from 2012 to 2023. We measured defined daily doses per 100,000 inhabitants per year (DDD/100K) and manufacture-level prices, calculating changes using compound annual growth rates (CAGR). We conducted interrupted time-series analyses to assess the impact of guideline updates by Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America (IDSA/SHEA) on quarterly consumption. RESULTS: Overall fidaxomicin consumption increased from 21.68 DDD/100K in 2012 to 126.86 DDD/100K in 2023 (CAGR = 17.42%) and similar increases in expenditure (0.07-0.34 USD/capita; CAGR = 14.96%). Oral vancomycin consumption increased from 71.61 to 120.82 DDD/100K (CAGR = 4.87%), although with a decreasing trend in expenditure (0.20-0.03 USD/capita; CAGR = -15.16%). The earliest adoption of fidaxomicin in middle-income economies occurred five years later than in high-income economies. Despite higher CAGRs, consumption of fidaxomicin and oral vancomycin in middle-income economies was only 1.9% and 2.3%, respectively, of that in high-income economies in 2023. Following the IDSA/SHEA guideline updates, fidaxomicin consumption in Northern America increased immediately. CONCLUSION: Consumption of fidaxomicin and oral vancomycin continues to increase globally; however, significant economic and geographical disparities in utilization highlight inequitable access to first-line CDI treatments
Children’s views of obesity, body size and weight: systematic review of UK qualitative evidence
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Understanding views about body size and weight is key to addressing both obesity and weight stigma. The views of younger children are not well understood and may differ in important ways from those of adults and young people. This review aimed to fill this gap.
Methods
Systematic review of qualitative evidence. We searched 19 database sources in February 2025 and included qualitative studies from the UK published since 2008 reporting data on children’s (4–12 years) views of obesity, body size, body shape or weight. We assessed study quality using the Critical Appraisal Skills Programme checklist and conducted a thematic synthesis of the data.
Results
We included 34 studies. Study quality overall was fairly high. Children reported a range of perceived impacts of body weight, including health impacts, limitations on activities, bullying and teasing, which generated negative perceptions of overweight and fear of fatness. Ideas about body shape may be influenced by family members and by media or social media content. Children identified diet and physical activity as the main influences on body weight. There may be differences in views between girls and boys at older ages, although both are concerned about weight. We found very little data on differences relating to ethnicity or socioeconomic status. Children with overweight or obesity reported a pervasive experience of negative attitudes and bullying, which could be a barrier to participating in activities.
Conclusion
Children, including very young children, generally hold very negative views of overweight and obesity. Overweight is seen to be linked with unhealthiness, limited agency and with being bullied. These links may influence how children understand messages about weight and health.
PROSPERO registration number
CRD42025650306
Heat and its effects on maternal and neonatal health care: Evidence from Burkina Faso.
No full textOBJECTIVES: Climate change has a wide range of adverse consequences for human health. The effects of extreme weather on maternal and newborn health, as well as the availability and quality of health services, remain under-researched in the sub-Saharan region. The aim of this study is to examine the effects of heat on pregnant women's use of health services, the health facility working environment and the impact of heat on the quality of care in Burkina Faso, a limited resource country. STUDY DESIGN: We adopted a qualitative approach to address the research objectives. METHODS: This study was conducted in the primary health care centers of Wemtenga in Ouagadougou and Delga in Kaya, Burkina Faso, from September 30th to October 30th, 2020. The study included individual interviews and focus group discussions (FGD) with pregnant women, postpartum women, health providers and community leaders, women of reproductive age, as well as relatives and male spouses of women who recently had given birth. The interviews were transcribed into French and coded using NVivo11 software. RESULTS: Forty pregnant and postpartum women, aged 20-40 years, were interviewed, and 31 women of childbearing age, aged 21-39 years, participated in the FGDs; 29 spouses also participated in the FDGs. Interviews indicated that extreme heat was reported to reduce the attendance and use of health services by pregnant and postpartum women. The women's choice of delivery center depended on the quality of the health centers, notably whether they were equipped with cooling systems, as lack of cooling could adversely affect the care of women and newborns, and the number of managed patients. The conveniences offered by health centers, notably the presence of fans or air conditioners, were important factors influencing women's decisions on where to give birth. All stakeholders agreed that extreme heat affected the relationship between caregivers and patients, especially facilities with inadequate infrastructures, such as the lack of a cooling system and cramped spaces. CONCLUSIONS: Extreme ambient heat negatively impacts the use of maternal and child health services, the performance and quality of care provided by health professionals, and the relationship between carer and patient. This is particularly concerning as worsening heat could undermine the progress made in maternal and child health in Burkina Faso and other similar settings. It is crucial for healthcare systems to adapt to the effects of climate change, particularly to extreme heat and heatwaves, which are becoming increasingly intense, frequent and long-lasting
Extreme weather effects on health services and communities in low and lower-middle income countries: a thematic systematic review.
Get PDFMost previous research about the dangers of extreme weather events was applicable to populations in high-income countries. Data summarising harms related to extreme weather events in low-income settings are lacking. A systematic review thematically summarising evidence about weather event-linked harms and responses in low- and lower-middle-income countries was conducted. Peer-reviewed and grey literature was systematically searched and selected. Data were extracted about harms, responses and outcomes relevant to six WHO building blocks of healthcare systems. Framework analysis was used to identify predominant themes related to harms, responses and the WHO building blocks. In total, 183 reports were included. Flooding and high winds were the most common types of extreme weather events documented. The main community experience themes identified were the displacement of populations and disruption. The main themes identified for health service delivery were vulnerability, disruption and resilience. Documented examples of resilience or recovery were far fewer for all six WHO healthcare system building blocks than descriptions of vulnerability and disruption. Extreme weather events can be highly disruptive and harmful to healthcare systems and communities in LMIC settings that are often already highly vulnerable