This study examined the mental health literacy of perinatal healthcare professionals in the United Arab Emirates (UAE) and analysed how their knowledge, attitudes and confidence impact their clinical practices in addressing perinatal mental health disorders.

A qualitative study with a descriptive phenomenological design. Data were collected via semi-structured individual interviews and focus group discussions. The data were analysed inductively using Braun and Clarke’s six-step thematic analysis.

The study was conducted in Abu Dhabi, Dubai and Al Ain in the UAE. Participants were recruited from various healthcare facilities and professional educational events.

The participants consisted of perinatal healthcare professionals from seven disciplines, including lactation consultants, midwives, nurses, obstetricians, paediatricians, family medicine practitioners and psychiatrists/psychologists. All participants were required to be actively involved in providing care to perinatal patients and to have a minimum of one year of clinical experience. The study included three focus group discussions and 28 semistructured individual interviews, culminating in a sample of 43 participants for analysis.

Three key themes emerged: (1) Knowledge and awareness, highlighting variable understanding of perinatal mental health and reliance on instinct over formal screening; (2) Navigating professional roles and realities, showing empathy and willingness to support patients, yet role ambiguity, low confidence and societal stigma influence perinatal healthcare professionals’ responses and care practices and (3) Strengthening support systems and resources, where participants called for improved training, clear policies and psychosocial resources to overcome institutional and educational gaps and to enhance perinatal mental healthcare and patient outcomes.

The study reveals gaps in mental health literacy and institutional support that hinder the delivery of effective perinatal mental healthcare. Strengthening provider training, implementing standardised screening and referral pathways, and promoting culturally sensitive, multidisciplinary approaches are essential. Such interventions can enhance early detection and improve outcomes for mothers and infants. Further research should focus on developing and evaluating the efficacy of such interventions to enhance early detection and improve outcomes for mothers and infants.

Bangladesh is highly prone to recurrent flooding that disrupts all four pillars of food security. This study aimed to explore the effect of household food insecurity on the underweight status of women in flood-affected areas of Bangladesh, which remains underexplored.

This is a cross-sectional analysis.

This study was conducted in eight sub-districts (upazilas) across eight districts in Bangladesh that experience severe to moderate river flooding, flash floods and substantial tidal surges.

A total of 532 women participated in the study. The inclusion criteria for participation were as follows: (1) being at least 18 years of age, (2) residing in the household for at least 1 year and (3) having experienced limited food access in the 4 weeks before data collection due to flood-related constraints.

Household food insecurity was measured using the U.S. Agency for International Development Household Food Insecurity Access Scale questionnaire. An underweight status was evaluated through anthropometric measurements of women. Adjusted prevalence ratios (aPRs) were estimated using robust log-linear models.

Moderate food insecurity was the most common (58.3%) among the participants. The prevalence of underweight was the highest (52.1%) in the severely food-insecure group and decreased significantly with improved food security. Severe household food insecurity was strongly associated with a higher prevalence of underweight individuals (aPR = 4.12; 95% CI, 1.60 to 10.60). An underweight status was also prevalent in women from moderately food-insecure households (aPR = 1.75; 95% CI, 0.68 to 4.55).

This study reveals a significant association between household food insecurity and underweight status, highlighting the major challenges faced by women living in flood-prone areas of Bangladesh. These findings emphasise the urgent need to address household food insecurity to improve nutritional outcomes for women in vulnerable communities.

In Bangladesh, evidence on the long-term trajectory of adolescents' sexual and reproductive health (SRH) remains limited, largely due to the lack of longitudinal data to assess the changes over time. To address this gap, the Advancing Sexual and Reproductive Health and Rights (AdSEARCH) project of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) set up an adolescent cohort study aimed at documenting changes in SRH knowledge, attitudes and practices, and identifying the factors affecting these changes. This article presents the baseline sociodemographic and SRH characteristics of this cohort as a pathway for future analyses.

This cohort study included 2713 adolescents from the Baliakandi Health and Demographic Surveillance System run by icddr,b. The cohort covered three age groups from girls and boys, giving a total of five cohorts: girls aged 12, 14 and 16 years; and boys aged 14 and 16 years. A total of seven rounds of data had been collected at 4-month intervals over 2-years follow-up period.

The majority of adolescents were attending school (90%), and school dropouts were higher among boys. Around 17% of the respondents were involved in income-generating activities, which were mostly boys. Among girls, the mean age of menarche was 12.2 years. Overall, 6% of adolescents had major depressive disorder, with prevalence increasing with age. Gender differences were evident regarding knowledge about conception and contraception. Egalitarian attitudes towards social norms and gender roles were found higher among girls (52%) compared to boys (11%). The majority of adolescents reported experiencing social/verbal bullying (43%), followed by physical violence (38%) and cyberbullying (4%).

This article presents the baseline findings only. A series of papers is in the pipeline for submission to different peer-reviewed journals. The findings from this study will be used to support data-driven policy formulation for future adolescent health programmes.

The number of people living with multiple long-term conditions (MLTCs or ‘multimorbidity’) is growing. Evidence indicates that exercise-based rehabilitation can improve health-related quality of life and reduce hospital admissions for a number of single long-term conditions. However, it is increasingly recognised that such condition-focused rehabilitation programmes do not meet the needs of people living with MLTCs. The aims for this study were to (1) evaluate the acceptability and feasibility of the newly developed Personalised Exercise Rehabilitation FOR people with Multiple long-term conditions (PERFORM) intervention; (2) assess the feasibility of study methods to inform progression to a definitive randomised controlled trial (RCT) and (3) refine our intervention programme theory.

Semi-structured qualitative interviews were conducted with patients receiving and healthcare practitioners delivering the PERFORM intervention, to seek their experiences of the intervention and taking part in the study. Interviews were analysed thematically, informed by Normalisation Process Theory and the programme theory.

Three UK sites (two acute hospital settings, one community-based healthcare setting).

18 of the 60 PERFORM participants and 6 healthcare professionals were interviewed.

The intervention consisted of 8 weeks of supervised group-based exercise rehabilitation and structured self-care symptom-based support.

All participants and staff interviewed found PERFORM useful for physical and mental well-being and noted positive impacts of participation, although some specific modifications to the intervention delivery and training and study methods were identified. Scheduling, staffing and space limitations were barriers that must be considered for future evaluation and implementation. Key intervention mechanisms identified were social support, patient education, building routines and habits, as well as support from healthcare professionals.

We found the PERFORM intervention to be acceptable and feasible, with the potential to improve the health and well-being of people with MLTCs. The findings of the process evaluation inform the future delivery of the PERFORM intervention and the design of our planned full RCT. A definitive trial is needed to assess the clinical and cost-effectiveness.

ISRCTN68786622.

Existing exercise-based rehabilitation services, such as cardiac and pulmonary rehabilitation, are traditionally commissioned around single long-term conditions (LTCs) and therefore may not meet the complex needs of adults with multiple long-term conditions (MLTCs) or multimorbidity. The aim of this study was to assess the feasibility and acceptability of the newly developed personalised exercise-rehabilitation programme for people with multiple long-term conditions (PERFORM) and the trial methods.

A parallel two-group mixed-methods feasibility randomised controlled trial (RCT) with embedded process and economic evaluation.

Three UK sites (two acute hospital settings, one community-based healthcare setting).

60 adults with MLTCs (defined as the presence of ≥2 LTCs) with at least one known to benefit from exercise therapy were randomised 2:1 to PERFORM intervention plus usual care (PERFORM group) or usual care alone (control group).

The intervention consisted of 8 weeks of supervised group-based exercise rehabilitation and structured self-care symptom-based support.

Primary feasibility outcomes included: trial recruitment (percentage of a target of 60 participants recruited within 4.5 months), retention (percentage of participants with complete EuroQol data at 3 months) and intervention adherence (percentage of intervention group attending ≥60% sessions). Other feasibility measures included completion of outcome measures at baseline (pre-randomisation), 3 months post-randomisation (including patient-reported outcomes, exercise capacity and collection of health and social care resource use) and intervention fidelity.

Target recruitment (40 PERFORM group, 20 control group) was met within the timeframe. Participants were 57% women with a mean (SD) age of 62 (13) years, body mass index of 30.8 (8.0) kg/m² and a median of 4 LTCs (most common: diabetes (41.7%), hypertension (38.3%), asthma (36.7%) and a painful condition (35.0%)). We achieved EuroQol outcome retention of 76.7% (95% CI: 65.9% to 87.1%; 46/60 participants) and intervention adherence of 72.5% (95% CI: 56.3% to 84.4%; 29/40 participants). Data completion for attendees was over 90% for 11/18 outcome measures.

Our findings support the feasibility and rationale for delivering the PERFORM comprehensive self-management and exercise-based rehabilitation intervention for people living with MLTCs and progression to a full multicentre RCT to formally assess clinical effectiveness and cost-effectiveness.

ISRCTN68786622.

This study employs structural equation modelling to explore the inter-relationships among optimal antenatal care (ANC), health facility delivery and early postnatal care (EPNC) in Ethiopia. By identifying both direct and indirect influencing factors, the study offers valuable insights to support integrated maternal health strategies and guide informed decision-making by policymakers and women alike.

The secondary analysis of the Ethiopian Demographic and Health Survey 2016 was performed to investigate inter-relationships between optimal ANC, health facility delivery and postnatal care (PNC) among women in Ethiopia. Data were analysed with R software V.4.3.2. The study used binary logistic regression to examine differences in optimal ANC, health facility delivery and EPNC, focusing on variables with a p value of 0.1 or less. Selected variables were incorporated into a generalised structural equation model (GSEM) using the LAVAAN package to explore both direct and indirect effects. The GSEM method assessed the impact of exogenous variables on endogenous variables, all binary, using a logistic link and binomial family. Missing data were handled with the multiple imputation by chained equations package, and sampling weights were applied to ensure national and regional representativeness.

The source population comprised all women of reproductive age (15–49 years) who gave birth in the 5 years preceding the survey. From 16 650 interviewed households (98% response rate), we identified 7590 eligible women with recent births. Finally, we included 2415 women who had attended four or more ANC visits.

Media exposure significantly boosts the likelihood of using ANC (OR=1.8, 95% CI (1.04 to 3.23), p=0.04), health facility delivery (OR=1.7, 95% CI (1.23 to 2.45), p=0.05) and PNC (OR=2.0, 95% CI (1.6 to 4.01), p=0.01). Urban residence and secondary education also enhance ANC (OR=1.2, 95% CI (1.01 to 2.88), p=0.022; OR=1.3, 95% CI (1.20 to 3.01), p=0.018), health facility delivery (OR=1.1, 95% CI (1.01 to 3.24), p=0.035; OR=1.5, 95% CI (1.22 to 3.45), p=0.03) and PNC (OR=1.6, 95% CI (1.01 to 4.32), p=0.03). ANC directly affects health facility delivery (OR=1.4, 95% CI (1.28 to 3.09), p=0.01) and PNC (OR=1.6, 95% CI (1.01 to 3.80), p=0.03). Additionally, women aged 20–34 years and those from male-headed households positively impact health facility delivery (OR=1.5, 95% CI (1.20 to 4.80), p=0.01; OR=1.3, 95% CI (1.07 to 3.45), p=0.014) and PNC (OR=1.4, 95% CI (1.10 to 2.90), p=0.01; OR=1.2, 95% CI (1.07 to 3.08), p=0.025).

Optimal ANC is vital for encouraging health facility delivery and EPNC. To enhance maternal and neonatal health, policies should integrate these services. Key predictors include being aged 20–34, having secondary and higher education, media exposure, male-headed households and living in urban areas. Improving education and media exposure can boost maternal healthcare service use.

The study aims to assess the magnitude of acute gastroenteritis and associated factors among under-five children visiting public hospitals in Jigjiga City, Somali Region, Ethiopia.

A hospital-based cross-sectional study design was used to carry out the study. We then employed a systematic random sampling technique through face-to-face interviews to gather the data. A structured questionnaire consisting of socio-demographic, behavioural, environmental and clinical factors was developed after reviewing relevant literature.

The study was conducted in public hospitals located in Jigjiga City, Somali Region, Ethiopia.

A total of 353 under-five children visiting public hospitals were involved in the study.

The primary outcome of the study was the prevalence of acute gastroenteritis.

The 2-week prevalence of acute gastroenteritis among under-five children was 24.6% (95% CI 23.4% to 25.9%). The study found strong links between acute gastroenteritis and having a household greater than five (adjusted OR (AOR)=2.94, 95% CI 1.55 to 5.60), an unprotected source of drinking water (AOR=2.74, 95% CI 1.29 to 5.82), unimproved latrine facilities (AOR=3.15, 95% CI 1.26 to 7.78), the presence of faeces around the latrine (AOR=3.53, 95% CI 1.77 to 7.03) and mothers or caregivers’ history of diarrhoea over the past 2 weeks (AOR=6.23, 95% CI 3.22 to 12.06).

The overall prevalence of acute gastroenteritis in Jigjiga City was relatively high in the 2-week period. Having a household greater than five, an unprotected source of drinking water and unimproved latrine facilities was a significant predictor of acute gastroenteritis. Additionally, the presence of faeces around the latrines and the history of diarrhoea in mothers or caregivers over the past 2 weeks were strongly linked to acute gastroenteritis.

A spinal cord injury (SCI) disrupts synaptic connections between the corticospinal tract and motor neurons, impairing muscle control below the injury site. Many individuals with an SCI have impaired trunk control, affecting the performance of activities of daily living and quality of life. Work has shown improvements in trunk control after home-based, unsupervised arm-crank exercise training (ACET) in people with chronic motor-incomplete SCI. However, no studies have examined ACET’s impact on trunk control in individuals with subacute SCI. This study aims to investigate ACET’s effects on trunk control in adults with subacute incomplete SCI, and its mechanisms, and its long-term benefits on neuropathic pain, psychological well-being, physical activity levels and health-related quality of life.

This multicentre, parallel-group, randomised controlled trial will evaluate self-directed ACET in 60 individuals with subacute SCI (

This study was approved by The Health Research Authority and Health and Care Research Wales (22/NS/0054). Results will be published in peer-reviewed journals. Findings will be presented at National and International conferences for researchers and clinicians. Finally, results will be disseminated to the SCI community.

ISRCTN17247972

This study aimed to assess the proportion of nutrition-related information-seeking behaviour and its associated factors among pregnant women attending antenatal care at public hospitals in Bahir Dar City, northwest Ethiopia, 2023.

A cross-sectional quantitative supplemented with qualitative study design was conducted from March to April 2023 among 406 pregnant women. Pre-tested structured interviewer-administered and semistructured open-ended questionnaires were used to collect quantitative and qualitative data, respectively. Data were collected using the Kobo toolbox, and SPSS V.25 was used for analysis. Descriptive statistics were used to describe study subjects, and multivariate logistic regression analysis was employed to investigate the associated factors. The strength of associations was described using the OR with the corresponding 95% CI.

The study included 406 pregnant mothers with a median age of 28 with an IQR of 8 and 212 (52.2%) from rural settings. Of the total respondents, 173 (42.6%; 95% CI 37.7 to 47.6) of pregnant mothers were nutrition-related information seekers. Educational status, residence, monthly income and nutrition information literacy were significantly associated with nutrition-related information-seeking behaviour.

The proportion of nutrition information seeking among pregnant mothers in Bahir Dar City public hospitals was low. Lower educational status, low nutrition information literacy level, being from a rural residence and low monthly income are significantly associated factors.

Awareness creation for pregnant mothers from rural areas and with low educational status and improving nutrition information literacy of pregnant mothers are important activities to improve their nutrition information-seeking behaviour.

Ethiopia, the second most populous country in Africa, faces significant demographic transitions, with fertility rates playing a central role in shaping economic and healthcare policies. Family planning programmes face challenges due to funding limitations. The recent suspension of the US Agency for International Development funding exacerbates these issues, highlighting the need for accurate birth forecasting to guide policy and resource allocation. This study applied time-series and advanced machine-learning models to forecast future birth trends in Ethiopia.

Secondary data from the Ethiopian Demographic and Health Survey from 2000 to 2019 were used. After data preprocessing steps, including data conversion, filtering, aggregation and transformation, stationarity was checked using the Augmented Dickey-Fuller (ADF) test. Time-series decomposition was then performed, followed by time-series splitting. Seven forecasting models, including Autoregressive Integrated Moving Average, Prophet, Generalised Linear Models with Elastic Net Regularisation (GLMNET), Random Forest and Prophet-XGBoost, were built and compared. The models’ performance was evaluated using key metrics such as root mean square error (RMSE), mean absolute error (MAE) and R-squared value.

GLMNET emerged as the best model, explaining 77% of the variance with an RMSE of 119.01. Prophet-XGBoost performed reasonably well but struggled to capture the full complexity of the data, with a lower R-squared value of 0.32 and an RMSE of 146.87. Forecasts were made for both average monthly births and average births per woman over a 10-year horizon (2025–2034). The forecast for average monthly births indicated a gradual decline over the projection period. Meanwhile, the average births per woman showed an increasing trend but fluctuated over time, influenced by demographic shifts such as changes in fertility preferences, age structure and migration patterns.

This study demonstrates the effectiveness of combining time-series models and machine learning, with GLMNET and Prophet XGBoost emerging as the most effective. While average monthly births are expected to decline due to demographic transitions and migration, the average births per woman will remain high, reflecting persistent fertility preferences within certain subpopulations. These findings underscore the need for policies addressing both population trends and sociocultural factors.

Maternal and child malnutrition is a significant public health concern in Pakistan, with 40% of children under five being stunted. In response, the Government of Pakistan initiated the Benazir Nashonuma Programme (BNP), a nutritional supplementation programme for pregnant women, mothers of children aged 0 to 23 months and children aged 6 to 24 months. This study aims to evaluate the effectiveness of the BNP in reducing childhood stunting and improving maternal and child health outcomes.

A quasi-experimental longitudinal study comprising baseline, midline and endline surveys will be conducted across 18 districts (9 intervention and 9 control) in Pakistan. The surveys will use a two-stage cluster sampling method to enrol 13 200 children aged 0–59 months and their mothers from the Benazir Income Support Programme households. The primary outcome of interest is the prevalence of under-five stunting. We will use a difference-in-differences approach to estimate the impact by comparing the documented changes over time between the intervention and control groups.

This study will provide critical insights into the effectiveness of the BNP in addressing childhood undernutrition in Pakistan. The findings will inform policy and programmatic decisions aimed at reducing undernutrition in resource-constrained settings. Ethical approval has been obtained from the Ethics Review Committee of Aga Khan University and the Pakistan National Bioethics Committee.

NCT06025786.

The WHO’s Integrated Management of Childhood Illness (IMCI) in young infants

We will create a dataset that integrates data from population-based studies globally with similar designs that have examined the presence of signs of PSBI identified by frontline health workers throughout the young infant period (days 0 to

All prior studies incorporated into our pooled analysis were approved by the independent local ethics committee/institutional review board (IRB) at each study site in each country, and all study participants provided informed consent. This project was approved by the Stanford University School of Medicine IRB protocol 74456. Study findings will be disseminated through publications in peer-reviewed journals, WHO documents, and presentations at maternal and child health meetings.

To assess the effectiveness of random capillary blood glucose as a diagnostic tool for type 2 diabetes and determine optimal cut-off values for adults in Bangladesh.

Cross-sectional diagnostic accuracy study.

16 diabetes centres were selected randomly from all eight administrative divisions of Bangladesh.

A total of 3200 adults aged 18 years and older were recruited using systematic random sampling between May and September 2022.

The primary outcome was the diagnostic accuracy of random capillary blood glucose compared to fasting plasma glucose, 2-hour plasma glucose after a 75-gram glucose load and glycated haemoglobin. Secondary outcomes included sensitivity, specificity, area under the curve and agreement with the other diagnostic tests.

Random capillary blood glucose showed a strong positive correlation and high concordance with fasting plasma glucose, 2-hour plasma glucose and glycated haemoglobin. A cut-off value of ≥8.7 mmol/L demonstrated improved diagnostic performance compared with the currently used cut-off of ≥11.1 mmol/L. This new threshold yielded higher sensitivity, specificity, area under the curve and agreement with other standard diagnostic tests. Notably, hyperglycaemic symptoms were not required for diagnosis. The number needed to screen to identify one case of type 2 diabetes using the ≥8.7 mmol/L cut-off was 2.74, lower than that for fasting plasma glucose (2.86) and random capillary blood glucose ≥11.1 mmol/L (4.68).

Random capillary blood glucose may be an effective and affordable diagnostic tool for type 2 diabetes in resource-limited settings. The proposed cut-off of ≥8.7 mmol/L offers improved diagnostic accuracy and reflects the population’s glucose distribution pattern.

The ‘Developing and evaluating an adapted behavioural activation intervention for depression and diabetes in South Asia (DiaDeM)’ trial investigates a psychological intervention, behavioural activation (BA), on people with both diabetes and depression in Bangladesh and Pakistan. This study aimed to aid the intervention and trial design.

This was a modelling study using microsimulation to assess the intervention’s cost-effectiveness. Diabetes was modelled using the UK Prospective Diabetes Study model based on Pakistani patients and depression was modelled using Patient Health Questionnaire-9 (PHQ-9) trajectories allowing for multiple depressive episodes. It was assumed that diabetes-related adverse events increased depression recurrence, while depression impacted haemoglobin A1c, increasing diabetes-related events. The model estimated (1) maximum cost of BA which would be cost-effective (headroom analysis) to inform intervention design, and (2) value of reducing uncertainty around different measures (value of information analysis) to prioritise data collection in the DiaDeM study.

Analysis was conducted from a Pakistani healthcare perspective over a lifetime with costs and outcomes discounted at 3%.

BA plus usual care was compared against usual care. BA involved six sessions by a trained (non-mental health) facilitator. The usual care comparator was the prevailing mix of pharmacological and non-pharmacological treatments used in Pakistan.

The primary outcome was disability-adjusted life-years (DALYs). Secondary outcomes included life years, healthcare costs and the rate of depression and diabetes-related events.

Over their lifetime, individuals receiving BA plus usual care avoid 3.2 (95% credible interval: 2.7 to 3.8) years of mild depression and experience fewer diabetes-related events. BA plus usual care resulted in an additional 0.27 (0.03 to 0.52) life years, 0.98 (0.45 to 1.86) DALYs averted and had incremental healthcare costs of –US$97 (–US$517 to US$142), excluding BA costs. The maximum cost per BA course at which was cost-effective is US$83 (US$9 to US$214). Value of information analysis found the most important measures to include in the trial are the impact of depression on diabetes and PHQ-9 over time.

This is the first model to jointly model depression and diabetes for South Asia and uses novel methods to reflect the diseases and inform intervention and trial design. This evidence has helped to inform the design of the DiaDeM intervention and the trial to evaluate it.

DiaDeM trial: ISRCTN40885204, DOI: ; pre-results, DOI: https://doi.org/10.1186/ISRCTN40885204, DiaDeM-NIHR200806

Developmental language disorder (DLD) is a common communication disorder that impacts children’s ability to learn, comprehend and use language effectively, yet it remains under-researched, particularly in the Arab countries. This scoping review aims to provide a comprehensive narrative summary on the epidemiology of DLD among children aged ≤10 years in the Arab countries.

A scoping review.

PubMed, Scopus and Web of Science.

We included studies that reported on the prevalence or risk factors of DLD in children aged ≤10 years from any Arab country. Only peer-reviewed publications were considered, and the study populations were required to consist of children without underlying medical conditions known to contribute to language or speech delay.

Two reviewers independently performed abstract and full-text screening and extracted relevant data. The risk factors identified as linked to DLD were grouped into maternal and perinatal factors, factors related to children and family and environmental factors.

From 4832 citations, 17 were deemed eligible and included in this review. The reviewed studies were conducted in only seven Arab countries, with the majority from Egypt (eight studies, 47.1%) and Saudi Arabia (four studies, 23.5%). The reported prevalence of DLD ranged from 3.2% in Egyptian children aged 3–6 years to 25.6% in Saudi Arabian children aged 1–5 years. Among the identified risk factors for DLD were sex, low birth weight, a history of speech and language delay in the family, parental socioeconomic status, perinatal complications, larger family size and early screen exposure.

The reported prevalence of DLD varied across the seven Arab countries. Strategies to address the preventable underlying DLD-associated risk factors are required. There is a clear gap in evidence related to the burden of DLD among children in most of the 22 Arab countries, which warrants further research.