This systematic review examined the prevalence of postpartum family planning (PPFP) uptake and its association with spousal discussion and husband’s support.

Systematic review and meta-analysis.

A comprehensive literature search was conducted across PubMed (NLM), Scopus (Elsevier), Web of Science (Clarivate) and Cochrane Library (Wiley).

The review included primary observational studies published in English between January 2014 and March 2024. Eligible studies reported prevalence and association between spousal discussion, support, approval or contraceptive use by the husband in PPFP within 12 months of childbirth.

Two reviewers independently screened the articles, performed data extraction and assessed the risk of bias using the Newcastle-Ottawa Scale and Appraisal Tool for Cross-Sectional Studies. Discrepancies were resolved through consensus. Random-effects meta-analysis estimated pooled prevalence, and pooled ORs of log odds were reported for the association between spousal discussion and partner approval and PPFP uptake.

Six cross-sectional studies involving 2856 postpartum women were included. The pooled prevalence of PPFP uptake was 35% (95% CI 19% to 52%). Meta-analysis showed that spousal discussion was associated with PPFP uptake (log OR=1.39 (95% CI 0.65 to 2.13), however, partner’s approval was not associated with PPFP uptake (log OR=1.49, 95% CI –0.08 to 3.06). Two studies assessed partner support, with one reporting a significant association (log OR: 1.45); joint decision-making was assessed in two studies but showed no significant association with PPFP.

In conclusion, the overall prevalence of PPFP uptake is low. Spousal discussion plays a critical role in enhancing PPFP uptake. These findings highlight the need for policy initiatives and programmatic interventions that promote couple communication for PPFP decision-making to improve reproductive health outcomes in low–middle-income countries.

CRD42024505801.

Advanced maternal age (AMA), defined as giving birth at age 35 or older, is an increasingly significant public health concern worldwide. This study aimed to identify the socio-demographic and economic determinants of giving birth at AMA among women in Ethiopia and to explore the resulting health consequences for both mothers and children.

This study is a secondary analysis of data from 5517 women extracted from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS), a nationally representative cross-sectional survey. The data were cleaned, weighted using STATA V. 17 and analysed using ArcGIS 10.8 to map AMA. Global and local Moran’s Index methods were used to assess clustering and a multilevel binary logistic regression model was fitted to identify predictors of giving birth at AMA.

The prevalence of giving birth at AMA was 12.7%, with a Global Moran’s I of 0.9964, indicating significant clustering across Ethiopian zones (p

This study found a high prevalence of giving birth at AMA among women with a lifetime birth history, with a spatially non-random distribution, indicated by a positive Moran’s Index. Individual and community-level factors such as having a previous male child, small family size, being Catholic or Protestant and residing in Addis Ababa or the Amhara region were positively associated with AMA. Conversely, factors including lower education level (no or primary education), contraceptive use, media access, rural residence adherence to postnatal check-ups and residing in the Afar region were negatively associated with AMA. All community-level factors were significantly associated with the outcome.

Sexually transmitted infections (STIs) pose a huge public health challenge in sub-Saharan Africa, where prevalence rates are among the highest globally. Barriers such as limited healthcare access, stigma and inadequate diagnostic facilities impede timely detection and treatment. Self-sampling for STI testing offers a potential solution to these challenges. This scoping review will systematically map the available evidence on self-sampling for STIs in sub-Saharan Africa, focusing on its feasibility, acceptability, implementation and outcomes.

The scoping review will be guided by the Arksey and O’Malley framework. The review will include a comprehensive search of peer-reviewed and grey literature from various repositories and databases. The following databases will be searched: PubMed, Scopus and Global Health. Studies that will be included will meet specific criteria. The results of the review will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist.

The methodology used for this study is a scoping review of existing literature; therefore, ethical approval is not required. Findings of this study will be shared at national, regional and international conferences and published in a peer-reviewed journal.

We registered the protocol with the Open Science Framework.

Human papillomavirus (HPV) is a major global health concern linked to cancers. Although a safe and effective vaccine exists, HPV vaccination rates are still low among Asian American and Pacific Islander (AAPI) populations. Barriers such as limited awareness, cultural stigma and systemic inequities contribute to this gap. This systematic review and meta-analysis aims to compile current evidence on HPV vaccination behaviours and related factors among AAPIs to help develop culturally tailored interventions and public health strategies.

This review will include descriptive and correlational studies (quantitative, qualitative and mixed methods), examining HPV vaccination intention or uptake among AAPI populations in the USA from inception to December 2024. Randomised controlled trials and intervention studies will be excluded. Databases to be searched include PubMed, CINAHL, PsycINFO and Cochrane. Study screening, data extraction and quality assessment will be conducted independently by three reviewers using standardised tools. Risk of bias in non-randomised studies will be assessed using Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I), and the Critical Appraisal Skills Programme (CASP) checklist will be used for qualitative studies. Quantitative findings will be synthesised narratively and, where appropriate, through meta-analysis using random-effects models. Qualitative themes will be synthesised to contextualise quantitative results.

Ethics approval is not required for this protocol as it does not involve primary data collection. Findings will be disseminated via peer-reviewed publications and conference presentations. Findings of this systematic review and meta-analysis will provide critical insights for promoting HPV vaccination and reducing HPV-related cancer disparities among AAPIs.

CRD420251008431.

Adolescents and young adults (AYAs) in low- and middle-income countries (LMICs) are at high risk of harmful sexual and reproductive health (SRH) practices due to limited knowledge, low availability or acceptability of modern contraceptives, gender inequality and cultural practices like child marriage. Preventive and educational interventions by lay health workers or through technological means are a cost-effective and scalable solution. Unfortunately, too little is currently known about the scope, content and conditions of the effectiveness and sustainability of these approaches and synthetic evidence on this topic is scarce. To help fill this knowledge gap and to identify where further research is needed, we will conduct a scoping review of technology-based or lay health-worker delivered preventive and educational SRH interventions targeting AYAs in LMICs. This information is valuable to both policymakers and researchers as it provides a synthesis of existing interventions, highlights best practices for their implementation and identifies potential avenues for future research.

This review will include studies on SRH preventive and educational interventions targeting AYAs aged 10–24 years in LMICs. It encompasses interventions delivered by lay health workers or via technological means, assessing various outcomes including but not limited to SRH literacy, sexual risk behaviours, pregnancies, sexually transmitted infections and gender-based violence. Key databases, including PubMed via MEDLINE and Embase, will be searched from 1 January 2000 up to 23 January 2024, using a comprehensive search strategy. Screening will be conducted using Covidence software. Data extraction will cover study details, methods, intervention strategies, outcomes and findings. A narrative synthesis will be conducted following synthesis without meta-analysis guidelines.

The scope of this scoping review is limited to publicly accessible databases that do not require prior ethical approval for access. The findings will be disseminated through peer-reviewed journal publications, as well as presentations at national and international conferences and stakeholder meetings in LMICs.

The final protocol is prospectively registered with the Open Science Framework on 7 May 2024 (osf.io/vna2z).

Adverse prognostic events (APE) of neurosyphilis include ongoing syphilitic meningitis, meningovascular syphilis, parenchymatous neurosyphilis and death. Its complexity and rarity have the potential to result in the underestimated true burden of neurosyphilis worldwide, due to lack of recognition and under-reporting. The unmet need for a modern method of refined and targeted treatment of neurosyphilis is strengthened by the currently various distinct diagnostic criteria. The DEep learning Framework for pErsonalized prediction of Adverse prognosTic events in NeuroSyphilis study will develop and validate prediction models for personalised prediction of APE after initial diagnosis in neurosyphilis to aid shared decision-making and stratify care of patients with neurosyphilis at high risk of severe prognostic course.

We conducted formative research to conceptualise and design a robust and clinically acceptable deep learning framework. We will conduct a deep learning framework development and validation study using a retrospective, multicentre, longitudinal cohort design and applying unsupervised, semi-supervised machine learning and deep learning. It will be conducted following expert guidance for model development and validation and our previous research experience. This study design consists of six parts: development, calibration, validation, subgroup bias evaluation, clinical utility evaluation and explanation.

This study will be conducted according to the Declaration of Helsinki and the Harmonised Tripartite Guideline for Good Clinical Practice of the International Conference on Harmonisation. No patient will be directly involved in developing the study’s research question, design and implementation. This study will be a retrospective analysis of already anonymised data; therefore, ethical approval and informed consent were waived by the institutional review board of School of Public Health (Shenzhen), Sun Yat-sen University. The results will be disseminated through a peer-reviewed publication.

This study was carried out to identify individual-level and community-level factors influencing the number of antenatal care (ANC) visits in Ethiopia’s emerging regions (Afar, Somali, Benishangul-Gumuz and Gambella).

Cross-sectional study design.

Ethiopia’s emerging regions (Afar, Somali, Benishangul-Gumuz and Gambella) from the 2016 Ethiopian Demographic and Health Survey (EDHS).

The analysis included a total weighted sample of 441 women from the EDHS dataset who had given birth within the 5 years before the survey.

The number of ANC visits.

In this study, 20.5% (95% CI: 16.7%, 24.5%) of pregnant women received four minimum recommended visits. Women with secondary (incidence rate ratio, IRR 1.3; 95% CI: 1.1, 1.5), and higher (IRR 1.3; 95% CI: 1.1, 1.5) education, terminated pregnancy (IRR 2.3; 95% CI: 1.9, 3.1), wanted pregnancy (IRR 1.4; 95% CI: 1.3, 2.3), high community poverty (IRR 0.5; 95% CI: 0.4, 0.7), community media exposure (IRR 1.3; 95% CI: 1.3, 1.8) and high community illiteracy (IRR 0.6; 95% CI: 0.5, 0.9) were significant predictors of many ANC visits in Ethiopia’s emerging regions.

According to the findings of our study, more than three-quarters of pregnant mothers in Ethiopia’s emerging region did not receive the adequate number of visits recommended by the WHO. Pregnancy desirability, history of a terminated pregnancy, maternal education, community poverty level, community literacy and community media exposure were significantly associated with the number of ANC visits. Therefore, promoting interpectoral actions would be vital in improving maternal health.

Non-specific symptoms of testosterone deficiency (TD) and lack of awareness impact diagnosis and appropriate treatment. This study aimed to characterise the awareness of key symptoms of TD in community-dwelling men and contextualise this against the reported prevalence of these symptoms.

Cross-sectional survey comprising 54 questions (including assessment of symptoms as per the qADAM questionnaire and where relevant, men’s experiences while on TD treatment). The survey was distributed through online media channels, Prolific and academic networks.

Community-dwelling men in the UK.

Associations between age, participant demographics and a ‘positive’ qADAM score were assessed using logistic regression. A positive qADAM score was defined as self-rated ‘poor’ or ‘terrible’ libido or erection strength or rating 3 of the other questionnaire domains as ‘poor’ or ‘terrible’.

Of 973 men, 49% indicated high likelihood of TD using qADAM scores—5% were formally diagnosed. Men over 50 years of age had 1.54–2.0 times higher odds of TD compared with men aged

Almost half of the responders exhibited a burden of TD-associated symptoms, but under 5% had a formal diagnosis. These findings suggest significant gaps between symptom awareness and access to treatment options.

Gender-based violence (GBV) is a pervasive global issue that transcends cultural, economic and educational boundaries, with an exceptionally high prevalence among refugees. Despite extensive research on GBV in Ethiopia, evidence of its occurrence in refugee settings remains limited.

To examine the prevalence and contributing factors of GBV among reproductive-age women in the Okugu Refugee Camp, Gambella, Ethiopia.

A facility-based cross-sectional study.

This study analysed 416 reproductive-age women living in Okugu Refugee Camp.

The study was conducted in the Okugu Refugee Camp from 15 March to 30 May 2023.

The study’s primary outcome was gender-based violence, while the secondary outcome focused on the factors influencing it.

A total of 422 reproductive-age women participated in the study, with a response rate of 98.6%. The prevalence of gender-based violence was 64.4% (95% CI: 59% to 69%). Among the participants, 51.9% experienced physical violence, while 34.9% had a history of sexual violence. Factors, illiterate women (AOR=2.73, 95% CI: 1.509 to 4.942), those who had lived in the camp for more than 4 years (AOR=3.24, 95% CI: 1.964 to 5.372), women who did not discuss sexual intercourse with their family or intimate partner (AOR=4.7, 95% CI: 2.83 to 7.80) and women who consumed alcohol (AOR=2.19, 95% CI: 1.30 to 3.69) were at significantly higher risk of experiencing gender-based violence.

Gender-based violence in the study area was highly prevalent. Key determinants included illiteracy, alcohol consumption, lack of discussion and prolonged stay in the camp. Stakeholders should prioritise interventions such as promoting female education, fostering open discussions and addressing substance use to mitigate gender-based violence in the refugee camp.

Most people who have experienced sexual violence (SV) will disclose the event(s) to someone. Key recipients of disclosure are those working in healthcare, and using sexual and reproductive health services can be an important step in accessing necessary medical care and being signposted to other services. Accessing this care and disclosing SV can be challenging. Evidence is lacking about how best to create a safe environment for disclosure to take place, how services can make changes to better facilitate this experience and what changes matter most.

Realist evaluation.

Sexual and reproductive health settings.

1-1 interviews with service users who have disclosed SV (n=18), three focus groups with healthcare professionals and survey respondents (n=2007).

Initial programme theories of what works, for whom and in what context were tested and refined with empirical data from a national survey, 1-1 interviews and focus groups. The final steps are presented here, bringing strands of the study together and informed using substantive theory.

The key steps in using healthcare on disclosure of SV relate to self-identification as a worthy candidate irrespective of background or presentation, ensuring empowerment during navigation of services, initial access to sexual healthcare made straightforward, validation by healthcare professionals when receiving disclosures, choice and control for service users during a collaborative interaction with healthcare professionals and aftercare that reflects needs particularly of minoritised groups.

We propose a novel way of considering Dixon-Woods’ candidacy theory seen through a trauma-informed lens for healthcare following SV, and how, by holding a trauma-informed lens to candidacy, steps of healthcare access and utilisation can be framed to ensure a safer environment for disclosure. This modified substantive theory marks the chosen endpoint of the realist evaluation and provides a transferable programme theory that can be considered in other settings.

Adolescent Sexual and Reproductive Health encompasses their physical and emotional well-being, including their ability to avoid unwanted pregnancies, unsafe abortions, sexually transmitted infections (STIs) and any type of sexual violence and coercion. However, these risks may be mitigated through improved knowledge, encouraging positive attitudes, and adopting better practices. This study aimed to identify the factors associated with knowledge, attitudes and practices (KAP) related to HIV, STI, family planning and pregnancy among adolescents residing in rural Thatta.

A cross-sectional study.

62 villages from Thatta, Gharo and Jungshahi registered under the Global Network Maternal and Newborn Health Registry in Thatta, Pakistan.

632 adolescents aged 14–19 years.

The association between sociodemographic factors and KAP was assessed using a modified version of the ‘Asking Young People about Sexual and Reproductive Behaviors’ tool. Statistical analysis was performed on Stata V.15.0 using multiple linear regression.

Among 632 adolescents, 82.7% were females. No significant differences were found in mean scores of knowledge and attitudes between males and females. However, a difference of 0.13 (95% CI 0.005, 0.24) in practice scores was observed. In design-based multivariable analysis, adolescents’ marital status (β 5.13; 95% CI 1.34, 8.91) and father’s occupation (β 3.41; 95% CI 0.90, 5.93) were associated with knowledge. Marital status (β 1.34; 95% CI 0.82, 1.86), household income (β –2.36; 95% CI –4.64, –0.07), father’s occupation (β –1.42; 95% CI –2.52, –0.33) and mother’s education (β –1.41; 95% CI –2.71, –0.11) were associated with attitudes. Moreover, marital status (β 0.24; 95% CI 0.06, 0.41) and mother’s occupation (β 0.64; 95% CI 0.38, 0.90) were associated with practices.

No differences in knowledge and attitudes between male and female adolescents were found. These findings suggest that community awareness programmes should be implemented to improve sexual and reproductive health KAP for both male and female adolescents in Thatta.