To describe the prevalence and spatial distribution of anaemia among children aged 6–59 months in Madagascar and to explore individual-level and community-level correlates using data from the 2021 Madagascar Demographic and Health Survey.

A population-based cross-sectional study using secondary data from the 2021 Madagascar Demographic and Health Survey. Spatial statistical methods were used to assess geographic clustering and hotspot areas of anaemia.

The study was conducted across community and household levels throughout Madagascar, covering both rural and urban populations within the primary and secondary healthcare delivery contexts.

A weighted sample of 10 683 children aged 6–59 months was included. Sampling followed demographic health survey procedures, and only children with complete haemoglobin data were analysed.

No interventions were applied.

The primary outcome was anaemia, defined as haemoglobin

The overall point prevalence of anaemia was 47% (95% CI 45.60 to 48.36), showing significant spatial clustering (Global Moran’s I=0.136, p

Anaemia among Malagasy children remains a major public health concern and shows clear geographic variation. The findings describe important differences in prevalence across regions and population subgroups, providing useful evidence for public health planning and for generating hypotheses for future analytical research.

Microbiome composition across multiple body sites, including the vagina, gut, urinary tract and semen, has been implicated in reproductive health and infertility. Vaginal dysbiosis and reduced Lactobacillus abundance have previously been associated with poorer outcomes in assisted reproductive technologies, yet few studies have simultaneously characterised microbiomes of both partners or compared infertile couples with healthy population controls. The BIOME study, a prospective cohort study, aims to characterise multisite microbiomes in infertile and healthy Danish couples and examine their association with long-term fertility outcomes.

The BIOME study is a multicentre, prospective observational cohort study including 100 couples undergoing fertility treatment following ≥12 months of unsuccessful pregnancy attempts and 100 healthy control couples. Participants provide biological samples from multiple body sites (vaginal swab or semen, faeces, urine and blood) prior to initiation of fertility treatment. Samples will undergo microbial sequencing, quantitative PCR, culture-based analyses, proteomics, metabolomics and microRNA profiling. Questionnaire data, clinical information and electronic medical record data will be collected. Participants will be followed for 5 years after sample collection to assess fertility outcomes. No intervention, randomisation or blinding is performed. Recruitment is planned over 24 months.

The study has been approved by the Danish Ethics Committee (#SJ-1033), and all participants provide written informed consent. Data are processed according to the General Data Protection Regulation and the Danish Data Protection Act, with pseudonymisation and restricted-access procedures. Results will be disseminated through peer-reviewed publications and scientific conferences. Sequencing data will be deposited in a public repository (eg, European Nucleotide Archive) with personal identifiers removed, and curated metadata will be available on reasonable request.

To explore patient experiences with the RELEASE (Redressing long-term antidepressant use) toolkit resources, including antidepressant hyperbolic tapering plans designed to minimise withdrawal symptoms as part of the RELEASE trial’s implementation evaluation to understand what aspects of the toolkit work well and identify areas where refinement could enhance future implementation. The RELEASE intervention, a multistrategy intervention codesigned with general practitioners (GPs) and patients to prompt and support stopping long-term (>12 months) antidepressants, is being evaluated in an effectiveness-implementation hybrid type-1 cluster randomised controlled trial in general practice.

One-to-one semistructured qualitative interviews using reflexive thematic analysis to identify patterns of shared meaning.

General practice, south-east Queensland, Australia.

Adult participants (aged 18 years or older) taking an antidepressant long-term allocated to the intervention arm of the RELEASE trial.

31 participants with an average duration of antidepressant use of 16.5 years (range 1–30 years) were interviewed. Seven themes were identified. Across seven themes, participants described how the RELEASE toolkit resources prompted reflection on their antidepressant use, supported informed conversations with GPs, and offered tapering plans that were both structured enough to instil confidence and flexible enough to help participants feel in control of their tapering journey. They also identified barriers, including beliefs that very small tapering doses were unnecessary, difficulty accessing the mini-doses required for hyperbolic tapering and the challenge of managing withdrawal symptoms. For those who successfully stopped, the transition was associated with a renewed sense of autonomy. Participants also offered practical suggestions to strengthen the toolkit and its broader implementation.

The RELEASE toolkit resources played a meaningful role in prompting and supporting informed shared decision-making and guiding attempts to stop antidepressants. Clearer messaging about the potential for withdrawal symptoms and access to mini-doses for tapering are needed to support patients to safely stop antidepressants.

ACTRN12622001379707p; Pre-results.

Institutional delivery under skilled care is essential for reducing maternal mortality. Ghana has expanded maternal health services through policies such as the National Health Insurance Scheme and the free maternal healthcare policy. Inequalities in access to facility-based delivery, however, remain across socioeconomic groups. This study examined wealth-based inequities in institutional delivery and identified maternal and socioeconomic factors associated with facility delivery in Ghana.

A cross-sectional analysis of nationally representative survey data.

Ghana.

Data were drawn from the 2022 Ghana Demographic and Health Survey. The analysis included 5855 women aged 15–49 years who had at least one live birth in the 5 years preceding the survey.

Descriptive statistics were used to summarise participant characteristics, and weighted logistic regression models were applied to identify factors associated with institutional delivery.

84.3% of women delivered in a health facility. Wealth showed a strong gradient effect. Women in the richest wealth quintile had significantly higher odds of institutional delivery compared with those in the poorest quintile (odds ratio (OR) 2.71, p

Socioeconomic and geographic disparities in institutional delivery remain evident in Ghana. Wealth, education, antenatal care attendance and health insurance coverage influence access to facility-based childbirth. Targeted interventions are needed to improve equitable access to skilled delivery services.

The goal of this study was to identify strategies and assess priorities to increase human papillomavirus (HPV) vaccination among unvaccinated young adults using a concept mapping approach.

The concept mapping process was conducted in two phases. In phase 1, eligible participants generated qualitative statements in response to a topic prompt. In phase 2, participants organised and grouped the statements by perceived similarity, and then rated each statement on a scale of perceived effectiveness. Multidimensional scaling and hierarchical cluster analysis were conducted to develop a conceptual map of the data.

This study was conducted at a university in the southwestern USA.

Eligibility criteria for participation included individuals (1) aged 18–26, (2) who had not received any dose of the HPV vaccine or were unsure if they had received the vaccine and (3) who were enrolled students at the study site institution. 24 participants engaged in the concept mapping process; five participated in phase 1 only, five participated in phase 2 only and 14 participated in both phases.

The 41 statements generated were organised into five cluster concepts: media and messaging, information and education, promotion, legal and accessibility. Accessibility was the highest-rated cluster for effectiveness followed by information and education. Exploratory trends across participant demographics were also identified. Differences in perceived effectiveness of the cluster concepts were observed by gender, race, political affiliation and vaccination status.

This study provides valuable preliminary insights into strategies and factors perceived influential in enhancing HPV vaccination from the perspective of unvaccinated young adults. Using concept mapping, multiple factors were identified that varied in their degree of perceived effectiveness across different groups. Future HPV vaccination interventions should consider multi-component elements to ensure their success and reduce the burden of HPV-related disease.

Despite limited evidence of efficacy, opioid analgesics are frequently used by patients for chronic pain while awaiting total hip or knee arthroplasty (THA or TKA). Preoperative use of opioids is problematic as it increases the likelihood of postoperative opioid-related adverse drug events and postoperative complications and is the strongest predictor of persistent opioid use post surgery. Opioid tapering prior to elective surgery has been proposed as a strategy for mitigating harms and improving postoperative outcomes. This protocol describes a randomised clinical trial, which aims to determine the effectiveness of a preoperative pharmacist-partnered opioid tapering programme compared with standard care for patients awaiting elective THA or TKA on postoperative outcomes including persistent opioid use.

Eligible participants must be aged ≥18 years; awaiting elective unilateral or bilateral THA or TKA; speak and read English; use prescription opioid analgesics at least 4 days a week and have access to internet or telephone. The participants will be excluded if they are undergoing a repeat surgery (same procedure within 6 months), are using opioids for cancer, palliative care or substance use disorder; have previously or are currently undergoing an opioid tapering programme or active medication review or have cognitive impairment. Enrolled participants will be randomised in a 1:1 ratio in permuted blocks of two and four to: (1) intervention or (2) standard care. A total of 314 participants will be recruited into the study. The intervention will include a pharmacist-partnered opioid tapering programme in which a pharmacist will work with participants to reduce their opioid dose over a 3-month period before surgery. Standard care will involve review by the hospital preadmission clinic multidisciplinary team to assess medical, physical and psychological health prior to surgery and education sessions for preoperative and postoperative care. The primary outcome assessed is persistent opioid use 3 months post surgery. The key secondary outcome is total Western Ontario and McMaster Universities Arthritis Index score. Data analysis will be performed using an estimand framework, with a generalised estimating equation model for the primary outcome from 1 day to 3 days presurgery to 3 months post surgery and a multilevel model for the main secondary outcome from baseline to 3 months after surgery. Cost-effectiveness and cost-utility analyses will be conducted to determine whether the intervention is cost-effective from the healthcare system perspective.

Ethics approval for this study was granted by a Human Research Ethics Committee (approval number: 2023/ETH01042). Results will be disseminated in peer reviewed journals, at international scientific meetings as well as meetings with key stakeholders and via the media.

ACTRN12623000685617.

To systematically evaluate associations between comorbidities and differences in treatment decisions, outcomes, health-related quality of life (HRQoL), healthcare resource utilisation and costs, in patients with colon or rectal cancer.

Systematic review.

PubMed (Medline) and Embase databases were searched for studies published from January 2000 until January 2024.

We included articles that compared the presence and absence of comorbidities, evaluated multiple comorbid conditions or used the Charlson Comorbidity Index, or variations such as the Charlson-Deyo Index. Primary and secondary outcome measures included cancer treatments, outcomes (including complications from treatments, survival and mortality rates), HRQoL, healthcare resource use and costs.

Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Joanna Briggs Institute checklists to ensure the quality of data. Findings were summarised narratively.

After duplicates were removed, 15 394 hits were screened and 31 studies were selected for inclusion in this systematic review. Comorbidities were associated with a lower likelihood of receiving treatment and lower survival rates and HRQoL, alongside a higher likelihood of complications following treatment, higher mortality rates and higher healthcare resource use. There were very limited studies that reported on HRQoL and resource use, and none reporting data directly relating to the impact of comorbidities on costs. These results were consistent across North America, Europe, Australia and New Zealand.

For patients with colon and rectal cancer, comorbidities are associated with a lower likelihood of receiving treatments and poorer health outcomes. With global populations ageing, there is likely to be an increase in patients with colon and rectal cancer with comorbidities. Therefore, further research is necessary, especially to inform decisions regarding patient management and treatment, and to understand the implications on healthcare resource allocation, costs and HRQoL.

Healthcare services are mainly organised around single health conditions and need reconfiguration to meet the needs of people with multiple long-term conditions (multimorbidity). Typically, people are offered annual reviews for each of their long-term conditions separately. In a randomised controlled trial, a comprehensive computerised template based on a personalised care model increased the person-centredness of multimorbidity reviews in primary care, but there were implementation challenges. We sought to understand and address the challenges of implementing a template to support personalised primary care for people with multimorbidity (PP4M).

To explore the extent of implementation and factors influencing uptake of the PP4M intervention. To understand factors influencing implementation and normalisation of the template.

Convergent parallel mixed methods within a non-randomised hybrid implementation-effectiveness study. Normalisation Process Theory (NPT) informed design, data collection and analysis.

Primary care (general practices) in three English regions.

Quantitative: Patients aged 18 years or over and had at least three types of long-term conditions (routine data collection); staff involved in using the template in implementation practices (Normalisation MeAsure Development (NoMAD) questionnaire).

Qualitative: Staff at implementation practices.

A multimorbidity computerised template to support personalised annual reviews. NPT-informed implementation package delivered to implementation practices included: process mapping, software support and training.

Routine medical record data; NoMAD questionnaires and qualitative interviews in implementation practices.

Measures of reach, fidelity, acceptability and sustainability.

Quantitative data: descriptive statistics, logistic regression and difference-in-difference models. Qualitative data analysis conducted using NPT coding manual.

In practices that received an NPT-informed implementation package, use of the template increased more, across patients with a range of demographics and health conditions, than in those that did not receive the implementation package (OR 2.86 (95% CI 2.34 to 3.49)). The implementation package successfully triggered NPT processes of coherence and cognitive participation, and, to a lesser extent, collective action and reflexive monitoring. Contextual factors, including a lack of staff generalist skills and disease-specific incentives, impeded engagement and sustained implementation.

Focusing on the processes of normalisation as mechanisms of implementation facilitated development of an implementation strategy with potential to trigger those mechanisms, but did not sufficiently address contextual factors. Implementation strategies to support personalised care must consider wider system and practice level contextual factors, such as incentives and staff training.

https://doi.org/10.1186/ISRCTN40295449 (2022–08-03, retrospectively registered.)

To describe (1) the proportion of deaths that were in recently hospitalised children and (2) causes of mortality among deceased children aged 0–59 months with preceding hospitalisations who enrolled in a mortality surveillance programme.

Descriptive study using prospectively collected data.

Eight Child Health and Mortality Prevention Surveillance (CHAMPS) community and healthcare sites in sub-Saharan Africa and South Asia.

Deaths among children aged 0–59 months enrolled in CHAMPS 2016–2023.

None.

Deaths with antecedent hospitalisations within 180 days of death. Causes of death determined by expert panels who reviewed clinical data and histopathologic and microbiologic results from postmortem minimally invasive tissue sampling.

CHAMPS enrolled 8548 deaths; we excluded 3688 neonates who died before discharge or ≤24 hours of birth and 482 with unclear information on antecedent hospitalisations. Out of the 4378 remaining deaths, 16.7% (95% CI 15.7% to 17.9%) were deaths that occurred within 180 days of a hospitalisation (n=733/4378). Of these, 55.7% (95% CI 52.0% to 59.3%) occurred outside healthcare facilities. Among included deaths with minimally invasive tissue sampling completed (n=337), lower respiratory tract infections (41.2%, 95% CI 36.0% to 46.7%), sepsis (39.8%, 95% CI 34.5% to 45.2%) and undernutrition (n=92, 27.3%, 95% CI 22.7% to 32.4%) were most common causes of death among cases with antecedent hospitalisations. The greatest proportion of deaths with antecedent hospital admissions occurred among cases aged 1–11 months (48.0%, 95% CI 44.4% to 51.7%), compared with those aged 0–1 months (21.7%, 95% CI 18.8% to 24.9%) and those aged 1–5 years (30.3%, 95% CI 27.0% to 33.8%). Moreover, the greatest proportion of deaths with antecedent hospital admissions occurred among infants/children with weight-for-age Z-score of

We observed a high proportion of deaths with antecedent hospitalisations within 180 days among young children across eight sites in sub-Saharan Africa and Asia. Among those deaths, children aged 1–11 months and undernourished infants were over-represented, suggesting early follow-up as a potential point to focus targeted support and future research.

The aim of this study was to assess the level of continuum of maternal, newborn, childand reproductive health coverage using the composite coverage index (CCI) and to identify its determinants, including socioeconomic, community context, individual and family, and health service-related factors, among postpartum women one year after childbirth in Ethiopia.

This study was a secondary analysis of longitudinal data from the second cohort of the performance monitoring for action (PMA) Ethiopia survey, which was conducted from 2021 to 2023. Data were collected at four intervals: a baseline survey, a 6 week postpartum survey, a 6 month postpartum survey and a 1 year postpartum survey to track reproductive, maternal, newborn, and child health indicators.

The study was conducted from the major regions of Ethiopia, namely Amhara, Oromia, Southern Nations, Nationalities and Peoples’ and the city administration of Addis Ababa.

A total of 2297 women enrolled in cohort two of PMA Ethiopia. Of these, 2072 completed the 6 week, 1874 the 6 month and 1858 (along with their 1800 children) the 1 year postpartum follow-up surveys. The final analysis was based on a weighted sample of 1793 participants.

The outcome variable for this study was the continuum of maternal, newborn, child and reproductive health services, assessed using the CCI. We applied quantile regression analyses at the 10th, 25th, 50th, 75th and 90th quantiles of the outcome variable. Statistical significance of predictors was determined based on p values

The findings revealed that the mean CCI was 56.2% (95 % CI 52.5% to 59.8%), indicating the proportion of maternal, newborn, child, and reproductive health services received. Notably, only 4% of women received all 12 maternal, newborn, child, and reproductive health services as part of the continuum of care, while 1.1% did not receive any intervention. The study identified several factors significantly associated with CCI across different quantile levels, including maternal age, maternal education level, household wealth index, first antenatal care visit (ANC1), parity, previous facility delivery, partner encouragement, use of maternity waiting homes, and administrative regions.

Based on the findings of this study, the coverage of continuum of maternal, newborn, child and reproductive health services in Ethiopia remains low. This highlights a substantial gap in Ethiopia’s progress toward the 2030 sustainable development goal target. Ethiopia must significantly accelerate efforts to improve maternal, newborn, child and reproductive health services in order to achieve the set goals. Policymakers and programme implementers should carefully consider the identified determinants when designing policies and programmes aimed at enhancing maternal, newborn, child and reproductive health outcomes.

Recently, drug-coated balloons (DCB) have emerged as a promising alternative for side branch treatment in coronary bifurcation lesions, in combination with drug-eluting stent (DES) implantation in the main vessel, the hybrid DCB approach. We aimed to evaluate clinical outcomes in patients treated with the hybrid DCB approach and to compare this strategy with other bifurcation techniques.

A systematic review and meta-analysis.

MEDLINE and EMBASE were searched up until January 2025.

We included randomised controlled trials and observational studies investigating clinical outcomes in patients treated with the hybrid DCB approach for coronary bifurcation lesions.

Two independent reviewers extracted data and assessed the risk of bias. The outcome of interest was the combined endpoint of cardiac death, myocardial infarction (MI) or target lesion revascularisation (TLR) at the longest available follow-up. Crude event rates, stratified by treatment strategy, were provided for the overall incidence of the primary endpoint. Furthermore, we conducted meta-analyses on the combined endpoint, comparing different bifurcation percutaneous coronary intervention (PCI) strategies. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool.

13 studies, consisting of 2393 patients, were included in our systematic review. Investigated techniques were the hybrid DCB approach in all studies, and a two-stent strategy or the combination of DES in main vessel and balloon angioplasty (BA) in the side branch as potential comparators. Median follow-up duration was 12 months (IQR 7.5–12). The combined endpoint of cardiac death, MI or TLR was found in 5.6% in the hybrid DCB group, 15.4% in the two-stent group and in 10.0% in the BA group. The pooled analyses, including three and two studies, respectively, showed that the hybrid DCB approach was associated with a lower risk of the composite endpoint of cardiac death, MI or TLR when compared with a two-stent strategy (7.9% vs 15.4%; risk ratio (RR): 0.53; 95% CI 0.33 to 0.85) and compared with BA in the side branch (5.6% vs 10.0%; RR: 0.57; 95% CI 0.37 to 0.88). The certainty of the evidence was graded as very low.

The results of this systematic review and meta-analysis suggest that the hybrid DCB approach is a feasible and promising treatment approach for bifurcation lesions, when compared with other bifurcation PCI strategies. However, the results should be interpreted cautiously as the certainty of evidence was graded as very low, underlining the importance of larger trials to confirm these findings.

CRD420250651469.

HIV/sexually transmitted infection (STI) prevention interventions are only modestly successful among youth, particularly for young people of colour and sexual and gender minority (SGM) youth. Even among disparate intervention modalities delivered with high fidelity, differences between intervention types have been minimal. One consistent theme has emerged: the role of the youth:provider relationship in predicting intervention response. In line with calls for examination of relational factors, the next essential step is a harmonised analysis to evaluate connections between the youth:provider relationship and co-occurrence of alcohol and cannabis use, in youth HIV/STI prevention intervention response.

Our team has completed six sizeable HIV/STI behavioural prevention studies, generating n=1136 independent youth (baseline M_age=17, range=13–24; 43% female; 21% SGM; 54% Hispanic; 9% African American; 7% Native American/Alaska Native) who received prevention programming and were followed at 1-, 3-, 6-, and/or 12 months. We will harmonise these studies and build a longitudinal mixed-effects machine learning model, with youth:provider relationship as a predictor of intervention response. Participant factors, provider factors and their interaction will be included in the model. Given high rates of alcohol and cannabis comorbidity, we will also examine syndemic outcomes (co-occurring HIV/STI risk behaviours, alcohol use and cannabis use). These data are crucial to informing next step HIV/STI and syndemic intervention programming with this age group.

This secondary analysis study is exempt from human subjects regulations under category 4(iii) as determined by the Institutional Review Board at UConn Health. Results will be disseminated via presentations at annual scientific conferences, submissions to peer-reviewed journals, to mental health and substance use providers, as well as community programmes for youth at high risk for HIV/STI and substance use.

Stroke is one of the top causes of disability in Malaysia, yet caregivers have limited access to structured, culturally tailored education to support poststroke care.

To develop and validate the CaknaStrok Education Package (CEP), a blended learning intervention comprising a printed guidebook and a trilingual mobile health application for informal stroke caregivers in Malaysia.

Methodological study involving the development and validation of a caregiver education programme guided by the Analyse, Design, Develop, Implement, Evaluate (ADDIE) instructional design framework.

Development and validation were conducted in Malaysia between January 2022 and December 2023. Both experts and caregivers were recruited from two tertiary hospitals on the East Coast of Malaysia, with caregivers identified from inpatient wards and outpatient clinics at these hospitals.

Content validation involved 10 multidisciplinary experts. Face validation involved 14 informal stroke caregivers who met eligibility criteria, and all completed the study.

CEP was developed based on prior needs assessment and expert input. Content validation was undertaken using the Content Validity Index (CVI) and face validation using the Face Validity Index (FVI), both assessed on a four-point Likert scale. Qualitative feedback was also obtained from the participants.

CEP consists of six modules delivered via a printed guidebook and a trilingual app with videos, assessment tools and local resources. Experts rated the content highly valid (Scale-level (S)-CVI/the average method (Ave): 0.97–0.99 across domains). Caregivers reported strong acceptability (S-FVI/Ave: 0.95–0.99). Qualitative feedback from experts and caregivers informed refinements to content clarity, usability and presentation, including improved navigation, consistent language use and enhanced visual design. Suggestions requiring substantial structural changes were documented for future iterations.

The CEP shows strong content and face validity as a blended caregiver education tool. By combining printed and digital formats, CEP addresses cultural and access challenges and provides a scalable model for stroke caregiver education in Malaysia. Further pilot or feasibility studies are warranted to evaluate usability, engagement and implementation in real-world settings prior to effectiveness evaluation.

To examine outcomes from respiratory pathogens containment strategies focused on international travellers.

We developed a compartmental model generalisable to respiratory infectious diseases, in which international travellers interact with each other and airline/airport workers during transit. We used SARS-CoV-2 Omicron surge data (basic reproduction number (R₀): 9.5) as a case example and performed sensitivity and scenario analyses, including varying the R₀ for different respiratory pathogens.

A US high-volume airport.

Simulated international travellers and airline/airport workers.

Projection of new and imported SARS-CoV-2 infections without intervention (No Intervention); pre-travel screening for travellers who intend to travel (intended travellers) with PCR (Pre-travel PCR); or antigen testing (Pre-travel Ag); mask-wearing guidance for travellers and workers (Mask-wearing); and a Combined strategy (Pre-travel PCR & Mask-wearing).

The number of new and imported respiratory disease infections over the 90-day simulation period.

Over the 90-day simulation, the number of infected travellers entering the USA would be: 1 155 580 (27.2% of 4.2 million (M) intended travellers) with No Intervention; 709 560/4.2M (16.7%) with Pre-travel PCR; 862 330/4.2M (20.3%) with Pre-travel Ag; 1033 820/4.2M (24.4%) with Mask-wearing; and 650 480/4.2M (15.3%) with Combined. The number of new infections among airline/airport workers would be: 25 670 (73.3% of 35 000 workers) with No Intervention; 25 260 (72.2%) in Pre-travel PCR; 25 590 (73.1%) in Pre-travel Ag; 24 630 (70.4%) in Mask-wearing; and 18 770 (53.6%) in Combined. In scenario analyses, the most impactful parameters were R₀ of the respiratory pathogen and population immunity level.

A Combined strategy of pre-travel PCR testing and mask-wearing would most effectively reduce respiratory infection among international travellers and airline/airport workers, but would still allow a substantial number of infections to enter the USA, especially when the pathogen is highly transmissible.

To assess malaria service readiness and its associated factors among health facilities that provide antenatal care (ANC) services in Ethiopia.

Nationally representative cross-sectional facility-based study.

A total of 1156 public and private health facilities that reported providing ANC services at the time of the survey.

Health facilities across nine regions and two city administrations of Ethiopia based on data from the 2021/2022 Ethiopia Service Provision Assessment survey.

Only 15.7% (95% CI 13.8 to 18.0) of facilities demonstrated full malaria service readiness, while 14.3% had none of the key components. Substantial regional variation was observed: facilities in Somali region were more likely to be ready (adjusted OR (AOR)=1.53; 95% CI 1.19 to 1.95), whereas readiness was significantly lower in several regions, including Amhara, Oromia, Gambella, Harari, Addis Ababa, Dire Dawa and Sidama, compared with Southern Nations, Nationalities and Peoples’ Region. Governance-related factors were strong predictors of readiness—the presence of a client suggestion box (AOR=1.60; 95% CI 1.12 to 2.29), recent report submission (AOR=2.79; 95% CI 1.15 to 6.76) and monthly staff meetings (AOR=1.64; 95% CI 1.26 to 2.14) were associated with higher readiness.

Malaria service readiness in Ethiopian health facilities providing ANC services is low and unevenly distributed across regions. Strengthening supply chains, staff training and governance systems may improve facility preparedness and support more effective malaria service delivery for pregnant women.

Persistent postsurgical pain (PPSP) affects up to 15% of patients after major surgery, impairing physical function, quality of life and increasing risk for long-term opioid use. Current PPSP prediction models rely on static or retrospective data and fail to incorporate dynamic perioperative factors. The Personalised Prediction of Persistent Postsurgical Pain (P5) study aims to develop individualised, multimodal prediction models by integrating preoperative behavioural, psychophysical and neurocognitive assessments and high-frequency symptom monitoring.

P5 is a prospective, single-centre cohort study enrolling 2500 adults aged 18–75 undergoing major surgery at a tertiary academic hospital. Participants complete baseline surveys, cognitive testing and quantitative sensory testing preoperatively. Ecological momentary assessments (EMAs) are collected via smartphone three times per day through 30 days postoperatively, capturing pain, mood, catastrophising and medication use. Participants are assessed on postoperative day 1 and complete online surveys at 3 and 6 months, evaluating pain persistence, interference, neuropathic symptoms and related outcomes. Clinical and perioperative data are extracted from the electronic health record. The primary outcome is PPSP at 3 months. Predictive models will be developed using supervised machine learning and dynamic structural equation modelling to extract latent features from EMA data. Model performance will be assessed using area under the receiver operating characteristic curve, area under the precision-recall curve and SHapley Additive exPlanations for interpretability.

This study has received ethics approval from the Washington University School of Medicine Institutional Review Board #202101123. Informed consent is required. Results will be submitted for publication in peer-reviewed journals and presented at research conferences.

NCT04864275.

Involuntary sterilisation, the non-consensual medical control of an individual’s fertility, is recognised by the WHO, United Nations High Commissioner for Refugees and UN Women as a serious human rights violation and form of gender-based violence. Survivors of involuntary sterilisation who can prove they were sterilised in their countries of origin have a legal path to asylum in the USA. This study aims to describe the experiences of women seeking asylum in the USA who were subjected to involuntary sterilisation in their countries of origin.

Semistructured, first-person interviews.

A New York City-based medical human rights programme.

14 adult women who experienced involuntary sterilisation at an average age of 27 years old in their countries of origin (79% from Honduras, 14% from Guatemala, 7% from Mexico) before applying for protected immigration status in the USA.

Inductive qualitative analysis identified common themes across participants including shared experiences of discrimination due to race/ethnicity, exposure to lifelong violence in women’s home countries, involuntary sterilisation during antepartum and intrapartum care, lack of informed consent, psychological symptoms, delayed discovery, an appreciation for more responsive healthcare in the USA and a desire to have additional children. Of note, only 43% of participants were aware that they had been sterilised and were therefore eligible for asylum when they entered the USA. 71% of participants had been granted protected status in the USA at the time of interview; 29% were engaged in the asylum process.

The results of the study can inform clinicians about the impact of involuntary sterilisation, heighten awareness of this violation in the context of gender-based violence as a nexus for asylum and advance advocacy in healthcare and policy. Results suggest women would benefit from more comprehensive screening for involuntary sterilisation before and during the asylum process, as well as culturally-responsive and trauma-informed support.

Respiratory tract infections (RTIs) cause significant child morbidity and mortality. Periodical influenza vaccination and respiratory syncytial virus (RSV) prophylaxis can reduce this burden in risk groups. However, in the Caribbean, the optimal timing of these interventions is unclear due to a lack of epidemiological data. We aimed to investigate pathogens associated with RTI disease burden and pathogen specific seasonality in the Caribbean in the context of COVID-19 to achieve optimal timing of preventive measures.

We conducted a retrospective study using patient records and pathogen detection data from St. Maarten Medical Center from 1 September 2018 to 1 September 2023. We performed regression to associate pathogens with outcomes and seasonality.

RTI diagnoses accounted for 50.8% (N=7380) of outpatient cases and 28.0% (N=508) of inpatient cases. RSV and rhino/enterovirus were associated with more frequent oxygen requirement (OR 5.1 (95% CI 2.3 to 11) and OR 2.3 (95% CI 1.2 to 4.3), respectively) and tachypnoea/dyspnoea (OR 4.9 (95% CI 2.0 to 13) and OR 2.8 (95% CI 1.6 to 5.2), respectively) than other pathogens post-COVID-19. RSV consistently peaked during June/July and September/October, preceding RSV prophylaxis administration in October.

The overall burden on the healthcare system due to RTI visits and admissions was high. Higher disease severity was associated with RSV and rhino/enterovirus infections; therefore, universal RSV prophylaxis should be considered, and timing should be optimised based on seasonality.

Health cadres, who assist midwives in supporting pregnant women in community settings, need to enhance their competencies in identifying risk factors and referring high-risk pregnant women to midwives for further care. Since the capabilities of these health cadres are influenced by maternal complications, an educational programme was implemented to strengthen their skills. Therefore, this study aimed to evaluate the competency of health cadres by providing a researcher-developed educational programme.

An open-label, cluster non-randomised controlled trial.

Health cadres with at least 1 year of work experience were recruited at six public health centres (PHCs) in Banjarnegara Regency, Indonesia.

Six PHCs were selected and allocated into intervention group (IG=3 PHCs) and control group (CG=3 PHCs) groups. A total of 133 female health cadres were enrolled across the selected PHCs. At each PHC, a systematic random sampling method was used to select the participants. The researchers and health professionals provided a 3-week period of theoretical and scenario-based simulations to the IG, while the CG received no education.

Researcher-developed questionnaires and checklists were used to assess the knowledge, skills (health assessment, communication, attitude) and confidence. The primary endpoint was competency, a total score of knowledge and skills. The outcome domains were compared between the two groups, and a linear mixed-effect model was used to account for cluster-level variation.

A total of 130 (97.7%) completed the study (IG:64, CG:66). The competency score showed significant improvement at endline (CG=49.5 and IG=52.5; p=0.002). The median scores for health assessment skills (CG=12 vs IG=14; p

Education effectively increased the competency of health cadres. A well-structured education programme is necessary for health cadres to improve and maintain their competencies in monitoring high-risk pregnant women.

NCT06134518.

Binge drinking in the previous month was reported in 23.5% of US adults, and 28.1 million adults met criteria for Alcohol Use Disorder (AUD) in 2023. Individuals with AUD face increased risks of oral health problems, including caries, periodontal disease and mucosal lesions. Poor oral hygiene, nutrition and dental care all contribute to these conditions, but individuals with AUD are often under-represented in oral health surveys. Understanding relationships between oral health behaviours, attitudes and general health is crucial for designing future interventions. This pilot aims to explore the relationship between oral and systemic health in subjects with AUD, focusing on oral health behaviours, salivary biomarkers and clinical phenotype, including systemic biomarkers of inflammation, to inform future research on oral–systemic interactions in AUD.

This protocol has two parts. Part 1 involves cognitive interviews to assess the content validity and interpretability of the Oral Health Behaviours Assessment (OHBA) questionnaire. Part 2 will collect biological and behavioural data from treatment-seeking patients with AUD and matched controls (age, sex and smoking status), including saliva, blood, dental exams, and health behaviour and symptom measures. Inpatients with AUD will provide biospecimens and answer symptom severity questionnaires at admission and again at the dental exam visit (7–12 days later), while controls will provide a single set of measures at their dental exam visit. Oral health will be assessed through structured dental and periodontal examinations, radiographs and validated questionnaires (including the OHBA). Additional data will include alcohol use history, psychiatric and medical history assessments, dietary recall, and measures of stress, sleep and mood to capture potential moderators of oral–systemic relationships. Biomarkers of inflammation and stress will be quantified from saliva and blood using immunoassays. Primary outcomes will compare oral health, salivary biomarkers and clinical measures between AUD and controls, while secondary outcomes will evaluate within-subject changes in patients with AUD during inpatient treatment and early abstinence.

This clinical protocol was approved by the National Institutes of Health Institutional Review Board (IRB #002005). Prior to enrolling, participants will be informed of the study purpose, risks and benefits, and study procedures, and evaluated for understanding prior to signing consent. Part 1 of the protocol is currently active and recruiting participants for cognitive interviews. The study findings will be disseminated through journals and conferences related to addiction medicine, psychology, immunology, neuroscience and dentistry. We expect the results of the pilot study will inform future research on oral health and salivary bioscience while also providing treatment-seeking patients with AUD targeted information on the importance of oral health behaviours for maintaining oral and systemic health.

NCT06684483; preresults.