Maternal and newborn morbidity and mortality are a global concern. Understanding the epidemiology of post-discharge complications could identify opportunities for interventions. We aimed to quantify mortality, care-seeking events and readmission among mothers and newborns in Uganda following facility-based delivery.

This prospective observational study (Apr 2022-Sep 2023) enrolled women presenting for delivery at two regional referral hospitals in Uganda. Data were collected during admission and 6 weeks after delivery by phone.

Overall, 7131 women delivered 7359 newborns, of whom 7129 (99%) women and 6968 (94%) newborns were discharged alive. The newborn mortality rate was 2.7% and 32% of deaths occurred post-discharge. Following discharge, 230 (3%) women and 287 (4%) newborns were readmitted. Suspected sepsis and infections were the most common reasons for readmission among mothers (62.2%) and newborns (89.9%). Caesarean delivery (OR:2·26 (1·75-2·93)) and perinatal death (OR:3·18 (2·09-4·69)) were associated with post-discharge maternal readmission. Both maternal and newborn readmission were associated with household food insecurity during pregnancy (maternal OR:1·56 (1·15-2·08); newborn OR: 1·73 (1·31-2·25)). Newborn resuscitation with oxygen was associated with maternal readmission (OR:2.24 (1.24–3·78)), newborn readmission (OR: 2·74 (1·54-4·56)) and newborn death (OR: 4·01 (1·73-8·21)). Although >99% of women had ≥1 antenatal care visit, only 511 (7%) had ≥1 routine postnatal care visit. There were no routine postnatal care visits among 211 (91·7%) readmitted mothers, 276 (96·2%) newborns and 57 (91·9%) newborns who died.

Post-discharge complications occur in a context of low routine postnatal care use. Risk-informed discharge planning, postnatal care and health education strategies may improve outcomes in mothers, newborns and their families.

To explore barriers and facilitators to midwifery practice of intermittent auscultation according to national guidance in the UK.

Multisite ethnographic study using observations of practice, semistructured interviews and informal conversations. Framework analysis using the Consolidated Framework for Implementation Research (CFIR).

11 maternity units across seven NHS maternity services in England and Wales in 2024.

Midwives and other maternity care professionals involved in fetal monitoring during labour.

‘Intermittent auscultation’ (IA), or listening to the fetal heart rate at regular intervals, to monitor fetal well-being during active labour.

Not applicable.

IA monitoring was frequently observed to be marginalised due to national and local pressures. IA is a complex skill that requires expertise and practice to develop and maintain. However, lack of a robust evidence base for IA methods is a further barrier to implementation. The study uncovered examples of facilitators that include: leadership engagement, access to knowledge and information supported in mentorship programmes and peer support models. These features created micro-environments where IA was valued, supported and integrated into care.

Our study highlights the significant impact of multilevel factors on the implementation of IA within UK maternity care. However, when organisational readiness, strong leadership engagement and supportive conditions are present, IA can be delivered in accordance with guidance. These findings underscore the need to align policy, infrastructure and organisational culture to sustain evidence-based, woman-centred practices such as IA.

Adolescents in Kenya face a high burden of sexual and reproductive health (SRH) challenges, including early pregnancy, sexually transmitted infections and limited access to accurate sexuality education. While school-based comprehensive sexuality education (SBCSE) has shown promise globally, its implementation in Kenya has faced significant barriers, including cultural resistance and lack of trained personnel. To address these gaps, the Afya Kesho (‘Health for Tomorrow’) programme introduces an innovative, animation-based, school-integrated and community-integrated comprehensive sexuality education curriculum aimed at enhancing adolescent SRH knowledge, attitudes and behaviours in rural and periurban Kenya. This manuscript presents the protocol of the Afya Kesho programme.

This quasiexperimental study will employ a preintervention and postintervention design to evaluate the effectiveness of the Afya Kesho programme. The intervention, delivered in three schools across Nairobi and Kiambu counties, includes 17 animated episodes structured into eight interactive SBCSE sessions facilitated by trained school health teachers and community health promoters. A total of 422 adolescents aged 10–19 will be recruited using multistage sampling. Quantitative data will be collected at baseline and endline using a structured questionnaire adapted from the Global School-based Student Health Survey and the Global Diet Quality Score. Primary outcomes include SRH knowledge, gender norms and intimacy, while secondary outcomes include physical and mental health, dietary behaviours and healthcare utilisation. Statistical analysis using STATA V.17 will include descriptive, inferential and multivariate regression analyses. The final protocol is available on Open Science Forum (https://osf.io/fx38c).

Ethical approval has been granted by the Kenyatta National Hospital-University of Nairobi Ethics and Research Committee (P854/12/2024). Informed consent will be obtained from all participants and their guardians. The study prioritises minimal disruption and adheres to ethical standards of adolescent research. Findings will be disseminated through open-access publications, infographics, school-based brochures and digital platforms. Anonymised datasets will be made publicly available on the Innovation for Health Equity in Africa website on completion.

Ebola disease stigma hinders outbreak control and recovery by deterring care-seeking and driving social exclusion. Although this phenomenon is well recognised, gaps remain in understanding how stigma emerges and operates in outbreak settings, limiting the development of effective reduction strategies. The objective of this study was to examine the drivers, manifestations and public health impacts of stigma following the 2022–2023 Sudan ebolavirus outbreak in central Uganda.

We conducted a cross-sectional, mixed-methods survey to assess Ebola disease stigma in June 2024.

The study was conducted in the Ugandan districts of Mubende, Kassanda and Kyegegwa, which were heavily affected by the outbreak.

A total of 302 respondents completed the survey. Respondents included all 51 eligible adult Ebola survivors in the districts known to the research team, as well as household members, healthcare workers, outbreak support staff and the general public.

The interviewer-administered survey explored personal experiences of stigma, community attitudes and impacts on outbreak control. We used a pillar integration process to identify themes across quantitative and qualitative data in three domains (drivers, manifestations and impacts of stigma).

Participants identified several perceived drivers of stigma, including fear, hygiene-focused public health messaging, distrust in public services and criminal connotations inferred from the outbreak response. Manifestations, including self-stigma and associative stigma, endured beyond the outbreak and across contexts. Nearly all survivors interviewed (n=48, 94%) reported multiple experiences of stigmatisation since discharge, with almost half (n=25, 49%) reporting physical harm or threats. Stigma was reported to affect care-seeking, healthcare worker morale and community socioeconomic well-being.

Stigma remains a major barrier to Ebola disease outbreak control and recovery. The high levels of stigma reported by survivors and anticipated by community members highlight the urgent need for targeted interventions in future outbreaks. We specifically show there are opportunities to address misinformation, avoid criminal connotations in outbreak control efforts and enable peer support.

Depressive symptoms are common in the growing geriatric surgical population and are associated with important patient-centred surgical outcomes, including postoperative delirium, discharge to postacute care facility and decline in functional status. Few interventions have been developed to address depressive symptoms in the perioperative setting.

We designed a feasibility and acceptability study of a nine-session problem-solving therapy (PST) telehealth perioperative intervention aimed at reducing postoperative functional decline and depressive symptoms among at-risk older adults undergoing major surgical procedures. Acceptability will be evaluated using a patient-centred five-question survey, assessing participant satisfaction and perceived usefulness of the perioperative intervention. A feasibility assessment will rely on objective measures including ease of participant recruitment, frequency and timing of delivery of intervention sessions and retention of participants throughout the duration of the intervention. With respect to the efficacy of the proposed PST intervention, the primary outcome of interest is postoperative functional status, as measured by the WHO Disability Assessment Schedule 2.0 at the 6-month postoperative time point. The secondary outcome of interest is the degree of depressive symptoms as assessed by the Patient Health Questionnaire-9 at both 3 months and 6 months postoperatively. The broader goals of this study include: (1) assessing the feasibility of implementing a PST perioperative intervention for older surgical patients at risk of postoperative functional decline, (2) demonstrating the acceptability of the PST intervention and (3) assessing the preliminary impact of the PST intervention on postoperative functional status and depressive symptoms.

The study received ethical approval from the University of California San Francisco Institutional Review Board. Results of this study will be published in peer-reviewed scientific journals with further dissemination at local institutional meetings and professional conferences.

NCT06174701.

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).