Non-communicable diseases (NCDs) have become the leading cause of mortality globally, with a sharp rise in Iran due to lifestyle changes and urbanisation. Although many NCD risk factors are modifiable, limited understanding of their determinants hinders effective prevention. To address this, the Prospective Epidemiological Research Studies in Iran (PERSIAN) Cohort was established in 2014 to study NCDs nationwide. The Sabzevar PERSIAN Cohort Study (SPECS) is the first in northeastern Iran, aiming to investigate environmental and social factors influencing NCDs in a unique regional context.

SPECS enrolled 5174 adults (aged 35–70 years) in northeastern Iran between January 2018 and January 2019 through a census and an online registration process. The baseline data collection included demographic verification, informed consent, health questionnaires, anthropometric measurements and biological samples (blood, urine, hair, nails). The annual follow-up began in April 2019, with full reassessments every 5 years over a 15-year period. The data is gathered via an active and passive follow-up, supported by trained staff and registry linkages.

Of the 5174 participants, 4241 (81%) remained in the study. Among the cohort, 54.5% were female, with a mean age of 50.5 years. The majority were married (93.5%), and nearly half had at least high-school education (46.5%) and moderate socioeconomic status (49.4%). Drug abuse history (smoking/drugs) was reported by about 15% of the sample. The mean body mass index was 26.9 kg/m², and the average blood pressure was higher in males (118.1/74.0 mm Hg) than in females (111.5/70.2 mm Hg). The common conditions included hypertension (22.8%), kidney stones (22.4%), fatty liver (15.4%) and diabetes (13.8%). Cancer had the highest treatment rate (100%), while fatty liver had the lowest (70.1%). Stroke had the highest mean age of onset (51.2 years), and epilepsy the lowest (23.7 years). All health data were self-reported.

SPECS, part of the national PERSIAN cohort initiative, is the only adult NCD-focused study in Khorasan Razavi. Its 15-year follow-up aims to generate region-specific insights into the incidence of NCDs and their risk factors. The ethnically homogeneous sample enhances statistical power, and the findings may inform culturally tailored health policies. While self-reported data have limitations due to bias, high initial participation and access to free healthcare support long-term engagement, especially among lower-income groups.

This study aims to estimate the prevalence of long-lasting severe fatigue and identify possible risk factors in a 2-year follow-up of patients with predominantly mild-to-moderate SARS-CoV-2 infection.

Prospective cohort study.

A community-based cohort from Telemark and Agder Counties, Norway.

A total of 159 PCR-confirmed SARS-CoV-2 positive individuals in the period between 28 February and 17 December 2020 were included at 12 months after SARS-CoV-2 infection, and 93 responded at 24 months follow-up.

Fatigue was assessed using the Fatigue Severity Scale (FSS), and health-related quality of life using the RAND version of health-related quality of life Short Form 36 (SF-36), developed by the RAND Corporation. SARS-CoV-2 antibodies were measured at 12 and 24 months.

Severe fatigue (FSS ≥5) was reported by 36% at 12 months and 31% at 24 months. A higher proportion of women than men reported severe fatigue at 12 months (p=0.08). The number of acute-phase symptoms was associated with severe fatigue. No association was found between severe fatigue and anti-SARS-CoV-2 antibody levels, demographic variables or reinfection status. The severe fatigue group scored significantly lower on all domains of SF-36.

In this cohort, severe fatigue was common, greatly impacted quality of life and persisted for up to 2 years following SARS-CoV-2 infection. Fatigue severity was associated with symptom burden in the acute phase but not with antibody levels or other demographic variables. These findings underscore the need for long-term follow-up and support for affected individuals.

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.

Antenatal care (ANC) plays a critical role in improving maternal and neonatal health outcomes. However, incomplete ANC attendance in Somaliland is associated with adverse maternal and birth outcomes. Barriers to ANC attendance may increase the risk of pregnancy-related complications, including maternal morbidity, mortality and poor neonatal health outcomes. Understanding the effect of ANC attendance on maternal and birth outcomes is crucial for informing policies and interventions aimed at reducing these risks. Hence, this study aimed to assess the effect of ANC attendance on maternal and birth outcomes in Somaliland.

A prospective cohort study was conducted among 1205 pregnant women enrolled by systematic sampling method.

The study was conducted in the Republic of Somaliland, which is situated in the Horn of Africa. Baseline data were collected at recruitment, and participants were followed up to delivery for the collection of outcome variables. The number of ANCs was considered to be a dichotomous independent variable; incomplete attendance (≤ 3 visits) and complete attendance (≥4 visits). The risk of pregnancy outcome among those with incomplete ANC was assessed using multi-variable logistic regression.

The outcome variables of the study were the maternal and birth outcomes. The independent variables included socio-demographic characteristics, such as age, residence, educational status, occupation, family size, wealth index and marital status, and reproductive factors, such as parity, gestational age at first ANC visit, current pregnancy desirability and previous pregnancy history.

Out of the total participants, 43.3% of women had complete attendance. The incidence of postpartum haemorrhage was 10.0% (95% CI 8.6 to 12.3); antepartum haemorrhage, 3.6% (95% CI 2.6 to 4.7); caesarean section, 14.8% (95% CI 12.9 to 16.8); preterm delivery, 13.7% (95% CI 11.7 to 15.4); low birth weight, 25.8% (95% CI 23.4 to 28.1); and stillbirth, 3.2% (95% CI 2.3 to 4.2). Complete attendance to ANC significantly reduced the risk of antepartum haemorrhage, caesarean section, preterm delivery and admission to the neonatal intensive care unit and stillbirth.

Nearly more than half of women in Somaliland had less than four ANC visits. The incidence of maternal and birth complications is higher among pregnant women who attended

To determine individual and community-level predictors associated with timely initiation of breastfeeding among women in Tanzania.

Analytical cross-sectional study.

This was an analytical cross-sectional study that used the 2022 Tanzania Demographic and Health Survey, which was conducted across all regions of Tanzania.

Data from 4308 women were included.

The outcome variable was timely initiation of breastfeeding, defined as starting breastfeeding within the first hour after birth, coded as 1 if timely and 0 otherwise. Mixed-effects generalised linear model (family- Binomial and link-logit) approach was used to account for the hierarchical structure of the data. Four models were constructed to assess individual and community-level predictors. Adjusted prevalence ratios (APRs) with 95% CIs were reported.

Women aged 25–34 years were significantly more likely to initiate breastfeeding within 1 hour (APR=1.40; 95% CI 1.18 to 1.65). Vaginal delivery was strongly associated with the timely initiation of breastfeeding (TIBF) (APR=10.13; 95% CI 7.84 to 13.09), whereas home delivery (APR=0.29; 95% CI 0.24 to 0.36) was negatively associated with TIBF. Multiparity (APR=1.22; 95% CI 1.04 to 1.43) increased the likelihood of TIBF. Women in the richest wealth category were less likely to practise TIBF (APR=0.70; 95% CI 0.51 to 0.96). Approximately 12.3% of the variation in TIBF was explained by cluster-level differences.

Both individual and community-level factors influence TIBF in Tanzania, highlighting the need for strong communication between mothers and healthcare providers to consistently promote its importance across all ages and wealth groups.

Adolescent tobacco use (ATU) is a global public health concern, causing significant morbidity and premature death. This study aimed to assess trends in the prevalence of ATU in Indonesia between 2009 and 2019 and to identify factors contributing to the observed changes.

This study performed secondary data analysis of three consecutive waves (2009, 2014, and 2019) of the Indonesian Global Youth Tobacco Survey (IGYTS). Weighted prevalence estimates and complex survey data analysed using multivariate logistic regression were established across the three-wave surveys. A pooled IGYTS data set was explored to determine the risk factors of the ATU. A multivariate decomposition analysis (MDA) was used to determine factors contributing to the prevalence change in male adolescents over the last two surveys.

The prevalence of ATUs was 21.1% (38.2% in males; 6.4% in females), 18.6% (32.7% in males; 3.9% in females) and 19.8% (36.8% in males; 3.5% in females) for the three consecutive surveys, respectively. Being older adolescents, male, exposed to SHS (secondhand smoke) at home, tobacco industry promotion, not knowledgeable of the dangers of tobacco smoke and SHS, and against banning smoking in public places were associated with ATU consistently across the surveys. In addition, inadequate anti-cigarette media and not being knowledgeable of the difficulty of quitting smoking were also identified as risk factors in the pooled data. MDA showed that 88.94% of the explained change was due to differences in the composition of explanatory variables between the last two surveys.

This study suggests that social influence and tobacco industry promotion significantly impact ATU in Indonesia. Governments should emphasise these factors in their tobacco control interventions.

Geriatric patients often face issues related to polypharmacy and adverse drug events. Re-evaluating prescribed medications and considering deprescribing is critical. Medication discrepancies (MDs) during care transitions can compromise patient safety, as over 60% of medication errors occur at these points. This study aimed to assess the magnitude of MDs and their contributing factors through the medication reconciliation (MedRec) process among geriatric patients in emergency departments of comprehensive specialised hospitals in northwest Ethiopia, as well as to determine the acceptance of pharmaceutical interventions.

In this multicentre prospective observational study, the best possible medication history (BPMH) was obtained within 24 hours of emergency department admission from at least two sources. A comparison of the BPMH list with medication orders from treating physicians revealed discrepancies. Data were analysed using STATA V.17.0, using multivariable logistic regression to assess variable associations.

Adult emergency departments of comprehensive specialised hospitals in northwest Ethiopia.

Overall, 384 geriatric patients with chronic conditions and current medication use who visited the adult emergency department of the hospital from 10 January 2025 to 30 March 2025 were involved in this study.

Magnitude and types of MDs, acceptance of pharmacist interventions, and factors associated with MDs.

In total, 384 patients with chronic diseases visiting the hospital emergency department were recruited in the present study. Out of 384 patients involved in the study, 218 (56.77%) had encountered at least one MD. Omission error 190 (45.24%) was the most common type of MD, followed by wrong dose 82 (19.50%). Among 420 interventions, 80.48% of the total cases were accepted. Number of previous/home medications (≥5 medicines; adjusted OR (AOR)=3.12; 95% CI 1.190 to 8.151), older age (≥75 years; AOR=1.62; 95% CI 1.054 to 2.495), and number of comorbidities (≥3; AOR=1.65; 95% CI 1.066 to 2.546) were associated factors with MDs.

This study revealed a high prevalence of MDs in the emergency department. Polypharmacy, comorbidities and older age were factors associated with MDs. The study findings show the need for a clinical pharmacist-led MedRec implementation to enhance patient safety.

To examine the association between spinal mobility, disease activity, frailty and cardiorespiratory fitness (maximal oxygen uptake (VO₂max)) in patients with ankylosing spondylitis (AS).

A cross-sectional comparative study was conducted at the University of Lahore and seven government hospitals (March–August 2025) including 74 patients with AS (40–55 years, modified New York criteria) and 77 age-matched and sex-matched healthy controls. Assessments included disease activity (Bath Ankylosing Spondylitis Disease Activity Index), functional limitation (Bath Ankylosing Spondylitis Functional Index), spinal mobility (Bath Ankylosing Spondylitis Metrology Index (BASMI)), chest expansion, frailty (Fatigue, Resistance, Ambulation, Illnesses, Loss of weight scale), pulmonary function and cardiorespiratory fitness (VO₂max) via symptom-limited cardiopulmonary exercise testing. Functional performance was measured with the 6 min walk test (6MWT), and physical activity with the International Physical Activity Questionnaire (IPAQ). Data were analysed using t-tests, ² tests, correlations and regression models to examine associations between clinical measures and cardiorespiratory fitness.

Among 151 participants (74 AS, 77 controls), AS patients showed significantly reduced pulmonary function (forced expiratory volume in one second 83.5% vs 91.2%, forced vital capacity 85.1% vs 93.0%), lower VO₂max (27.8 vs 33.4 mL/kg/min), impaired spinal mobility (BASMI 5.1 vs 1.2) and decreased chest expansion (2.8 vs 5.6 cm; all p2max was inversely correlated with disease activity, spinal stiffness, frailty and structural damage and positively correlated with chest expansion, 6MWT and activity levels. AS status, higher disease activity, greater spinal stiffness and reduced chest expansion independently predicted low physical activity.

AS is associated with impaired pulmonary function, reduced spinal mobility and lower cardiorespiratory fitness, with disease activity, stiffness and restricted chest expansion potentially influencing physical activity and overall functional capacity.

National cross-sectional survey.

Hospitals delivering orthopaedic and trauma services across all levels of care and ownership categories in Tanzania.

Licensed orthopaedic and trauma surgeons practising in Tanzania served as key informants for their respective hospitals. A total of 171 surgeons provided data on 92 unique hospitals nationwide.

Primary outcomes included orthopaedic departmental structural capacity, availability of multidisciplinary specialist support, external support mechanisms and in-hospital orthopaedic training activities.

A response rate of 77.7% yielded data on 92 hospitals delivering orthopaedic and trauma services nationwide. Structural capacity varied widely, with only 19.6% of hospitals reporting more than 50 orthopaedic beds, 43.5% relying on a single orthopaedic surgeon, and 47.8% operating with one or two functional theatres. Access to specialist support was limited, with vascular trauma surgeons available in 9.8% of hospitals and plastic and reconstructive surgeons in 8.7%. Intensivists were available in 41.3% of facilities and anaesthesiologists in 57.6%, while physiotherapists were present in 90.2% of hospitals but occupational therapists in only 28.3%. External dependence was common, with 41.3% of hospitals relying on donated implants and 29.3% participating in outreach programmes. In-hospital orthopaedic training opportunities were limited, with seminars or workshops available in 25.0% of hospitals. Across domains, higher-tier hospitals demonstrated significantly greater structural capacity and specialist availability.

Orthopaedic and trauma services in Tanzania are available across multiple levels of the health system but are characterised by inequitable workforce distribution, limited capacity at lower-tier hospitals and substantial reliance on external assistance. Integrated strategies linking infrastructure development, multidisciplinary workforce expansion, sustainable procurement and decentralised training are essential to strengthen the organisation and resilience of orthopaedic and trauma services nationwide.

Despite anatomical correction, people born with oesophageal atresia±tracheoesophageal fistula (OA-TOF) experience lifelong morbidity. Core outcome sets (COSs) are recognised as a means of improving research quality and, as a consequence, improving patient outcomes; one was not available for this population.

The scope of the study was to develop a COS for people born with OA-TOF that would be applicable regardless of age or geographic location.

Patient input was paramount to this study. For long-list generation, in addition to the systematic review (SR), patients and representatives were invited to participate in focus groups, interviews or complete activity packs to ascertain outcomes that matter most to them. International consensus was then sought using a two-step Delphi survey followed by an online consensus meeting.

Eight outcomes were identified through patient events that had not been picked up from SR. 175 people completed the Delphi survey from 26 countries and health care professionals from 13 different disciplines. 24 outcomes met predefined criteria for inclusion and following discussion and voting in the consensus meeting, and 14/24 outcomes were agreed for inclusion in the COS.

14 outcomes have been agreed on to form the COS. 12 of these outcomes are relevant to people of all ages, 1 to paediatric population and 1 to adult cohorts. The COS is, therefore, truly applicable lifelong, which was the scope of the project. This COS will help reduce research heterogeneity, enabling better quality research outcomes and more comparable data.

To assess the impact of a National Enhanced Service (NES) incentive for weight management that financially rewarded practices for each eligible patient referred to a weight management programme.

Interrupted time-series analysis to examine the rate of weight management referral and weight management advice.

Primary healthcare records from January 2018 to December 2024 in the Oxford Clinical Informatics Digital Hub, covering 8.3 million patients in 1198 primary care clinics around England.

NES payments to practices for weight management were introduced in April 2021.

The rate of referral increased from 1 referral per 1000 patients per month before the incentive to around 4 referrals per 1000 patients per month afterwards. There was no evidence that the increase differed by age, gender, ethnic group or socioeconomic status. The occurrence of weight management advice was unchanged by the introduction of the NES and was at least three times more common than referral to weight management services.

The NES was associated with a fourfold increase in referrals to weight management services. However, clinicians are much more likely to offer advice rather than a referral to a weight management programme. There is a clear opportunity to improve outcomes for patients by encouraging greater use of referrals to effective weight management services in place of advice.

To investigate associations between body composition indices and metabolic status among normal-weight adults.

Cross-sectional study using data from the Tehran Lipid and Glucose Study (phaseVII: 2019–2021).

Primary care and community health services in an urban Tehran population.

1298 adults (40.5% men, 59.5% women), aged 18–80years, body mass index (BMI) 18.5–24.9 kg/m². Exclusions: known diabetes, cardiovascular disease, kidney failure, malignancy, pregnancy or lactation, diuretic or glucocorticoid use. Participants were classified as metabolically healthy normal weight (MHNW) or unhealthy (MUHNW).

The primary outcome was the association between body composition and anthropometric indices with metabolic status. The secondary outcome was identification of the strongest predictors of MUHNW. Body composition was assessed by bioelectrical impedance analysis to obtain fat mass (FM), body fat percentage (BFP), skeletal muscle mass percentage (SMM%), fat mass index (FMI), fat-free mass index, skeletal muscle indices and the fat-to-muscle mass ratio (FMR). Anthropometric measures included waist circumference (WC) and waist-to-hip ratio (WHR). Associations were examined using logistic regression adjusted for age, smoking and physical activity.

Mean age: 37.5±12.8 y; MUHNW participants were older than MHNW (44.5±13.2 vs 35.8±12.1 years, p

BMI, WC, WHR and body fat indices were positively associated with metabolically unhealthy status among normal-weight adults of both sexes. WHR was the strongest predictor, highlighting its value for identifying at-risk individuals where advanced body composition tools are unavailable.

To identify the individual and community-level factors associated with barriers to accessing healthcare services among currently married women in Somalia.

A cross-sectional analysis using data from the 2020 Somalia Demographic and Health Survey.

Somalia.

A nationally representative sample of 30 311 currently married women aged 15–49 years with complete data on outcome and explanatory variables.

The primary outcome was ‘reporting at least one barrier to accessing healthcare’, a composite binary variable based on four specific problems: obtaining permission to go for treatment, getting money for treatment, distance to the health facility and not wanting to go alone.

A substantial majority (77.06%) of married women reported experiencing at least one barrier to accessing healthcare. Financial cost was the most common barrier (69.91%), followed by distance to health facilities (65.95%), reluctance to go alone (49.64%) and the requirement for permission (46.03%). Multilevel analysis confirmed that higher household wealth was strongly protective (richest vs poorest: adjusted OR (aOR)=0.27, 95% CI 0.24 to 0.32). Paradoxically, factors typically considered protective were associated with increased barriers: women with secondary education (aOR=1.19, 95% CI 1.00 to 1.41) and those with educated husbands (aOR=1.23, 95% CI 1.14 to 1.33) reported more obstacles. Similarly, urban residents faced higher odds of barriers than their nomadic counterparts (aOR=1.40, 95% CI 1.27 to 1.55). Significant regional disparities were evident, with community-level context explaining 26.30% of the total variance in reporting barriers.

Access to healthcare for married women in Somalia is predominantly hindered by economic, educational and community-level constraints. Targeted interventions addressing socioeconomic disparities, infrastructural deficits and specific community contexts are essential to alleviate these barriers.

This study investigated perinatal depressive symptoms among pregnant and postpartum Filipino women.

Cross-sectional survey.

The Philippines.

Participants were recruited online and face-to-face from maternal care facilities.

Perinatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) score, with prevalence calculated based on ≥13 cut-off, indicating clinically significant symptoms of depression. Patterns of depressive symptoms were examined by demographics, perinatal time period and other obstetric information using adjusted regression coefficients (ab) and risk ratios (aRR).

A total of 856 women participated in the study, comprising 356 pregnant and 500 postpartum women. EPDS scores were, on average, similar between pregnant (14.4) and postpartum women (14.1). Using the locally validated cut-off of ≥13 revealed that 69.1% of pregnant and 62.0% of postpartum women reported clinically significant depressive symptoms. Consistent EPDS scores and prevalence were observed across pregnancy trimesters and within 12 months postpartum and beyond. Women who received adequate prenatal care were less likely to experience antenatal (ab=–1.59, 95% CI –3.13 to –0.05) and postpartum (ab=–1.30, 95% CI –2.48 to –0.12) depressive symptoms. Postpartum EPDS scores and depressive symptom prevalence (EPDS score ≥13) were higher among 18–24-year olds (ab=1.96, 95% CI 0.30 to 3.61; aRR=1.23, 95% CI 1.03 to 1.47) and single mothers (ab=3.46, 95% CI 0.22 to 6.71; aRR=1.42, 95% CI 1.07 to 1.90), compared with older and married mothers, respectively.

At least 60% Filipino mothers experienced clinically significant perinatal depressive symptoms, which exceeds the established global average of 25%. Younger and single postpartum women were at greater risk, while pregnant and postpartum women who attended adequate prenatal visits were less likely to report depressive symptoms. Our study underscores the need for further research to uncover the true burden of poor perinatal mental health and calls for targeted early interventions and integrative public health strategies to support at-risk mothers, particularly those from socially disadvantaged backgrounds.

To assess health-related quality of life (HRQoL), treatment satisfaction and associated factors among older adults with acute heart failure in Northwest Ethiopia.

Prospective, multicentre observational study.

Three tertiary hospitals in Northwest Ethiopia provide secondary and tertiary care services.

A total of 422 patients aged ≥60 years with a confirmed diagnosis of acute heart failure were consecutively enrolled between December 2024 and April 2025. Patients with unstable psychiatric conditions or advanced kidney disease were excluded.

HRQoL was assessed using the WHO Quality of Life – Brief Version questionnaire, and treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM). Multiple linear regression identified factors associated with HRQoL and treatment satisfaction.

95% of participants reported moderate HRQoL, and 3% reported poor HRQoL. Weight loss was positively associated with HRQoL (β=1.52; 95% CI 0.04 to 3.07; p=0.021), whereas asthma was negatively associated with HRQoL (β = –3.28; 95% CI 6.94 to 0.37; p=0.001). Regarding treatment satisfaction, 65% of patients were moderately satisfied, with notable concerns regarding medication safety and overall experience. Rural residents reported lower satisfaction than urban residents (β = –0.20; 95% CI 0.34 to 0.05; p=0.007). Patients with New York Heart Association (NYHA) class III had higher satisfaction (β=0.25; 95% CI 0.05 to 0.45; p=0.016). Effective hypertension management was linked to increased satisfaction (β=0.20; 95% CI 0.02 to 0.37; p=0.026), whereas coronary heart disease was associated with lower satisfaction (β = –0.40; 95% CI 0.64 to 0.88; p=0.012).

Among older adults with heart failure in Northwest Ethiopia, 98% reported moderate to low HRQoL. Asthma and polypharmacy negatively affected HRQoL, whereas weight loss was positively associated with HRQoL. An NYHA class III status and well-managed hypertension improved treatment satisfaction, whereas rural residency and coronary heart disease were associated with lower satisfaction. These findings underscore the need for targeted interventions to enhance outcomes and QoL in this vulnerable population.

Cystic fibrosis (CF) is a life-shortening genetic disorder traditionally mischaracterised as affecting only populations of European descent. This framing has contributed to under-recognition of CF in African populations, despite emerging evidence of both common and region-specific cystic fibrosis transmembrane conductance regulator mutations across the continent. Diagnostic barriers, structural inequities and lack of surveillance further exacerbate disparities in care and visibility.

This scoping review aims to characterise CF in African populations by synthesising evidence on clinical presentation, diagnostic practices, genotypic diversity, prevalence and structural barriers to care. We will include case reports, cohort studies, registry analyses and other primary data sources involving individuals of African descent with suspected or confirmed CF. Key outcomes include clinical phenotype, age at diagnosis, mutation profile, diagnostic testing access and mortality. Data sources include Ovid Medline, Embase, Ebsco Global Health, CAB Abstracts and Web of Science Core Collection. Multiple-reviewer screening and extraction will be conducted. We will use narrative synthesis, thematic analysis and meta-analysis for prevalence where feasible.

No ethical approval is required as the review uses published data. Results will be shared with clinicians, researchers and CF networks in Africa and globally to inform diagnostic strategies and policy.

The number of people living with obesity is increasing rapidly worldwide, and the WHO estimates approximately 5 million deaths yearly from non-communicable diseases related to elevated body mass index (BMI). The most effective treatment for weight loss is bariatric surgery, but due to the associated risks and the need for lifelong care, this is not a viable treatment for every patient. With the advent of gut-hormone-based medications to treat obesity, the effectiveness of non-surgical treatment is approaching that of surgical interventions. We therefore aim to investigate the beneficial and harmful effects of laparoscopic bariatric surgery versus any non-surgical treatment.

We will conduct a systematic review with meta-analysis applying our eight-step procedure to assess thresholds for clinical significance and trial sequential analysis to mitigate the risk of random errors. To identify relevant trials, we will search for both published and unpublished trials, without any language restriction, in major medical databases (CENTRAL, MEDLINE, EMBASE, LILACS, SCI-EXPANDED and CPCI-S) and trial registries. The date range covered by the search is from database inception until final search date—within 3 months prior to submission of final results manuscript. Two review authors will independently screen references, extract data and perform risk-of-bias assessment using the Cochrane Risk of Bias Tool 2 and the Grading of Recommendations, Assessment, Development and Evaluations. We will include randomised clinical trials comparing laparoscopic surgery currently in use with any non-surgical comparator in adults or adolescents with BMI >30 kg/m². Quasi-randomised studies or non-randomised studies will not be included. Our critical outcomes are all-cause mortality, serious adverse events and quality of life, and our important outcomes are major cardiovascular events, weight at follow-up, physical function and glycaemic control. In addition, we have two explorative outcomes: metabolic syndrome or Z-score and reported incident of alcohol abuse or other addictive disorder or self-inflicted harm.

This review will collect and perform secondary analysis of data from publicly available sources and ethical approval is therefore not required. The findings will be published in peer-reviewed journals and presented at relevant scientific conferences. We will strive to publish with open access. Awareness will be made through social media platforms. This review aims to help clinicians in identifying best practices in the wide-spanning field of obesity treatment.

CRD420251135341.

Premature birth is the leading cause of neonatal morbidity and mortality. Understanding perceptions, beliefs and attitudes towards preterm births, and how these factors influence care provision at health facilities and at home is crucial for improving preterm newborns’ health outcomes.

We conducted an exploratory qualitative study at Batu and Meki communities in the East Shewa Zone of Oromia Region, Ethiopia. We conducted in-depth interviews (n=81) and focus group discussions (n=8) using semistructured guides. The study participants included women who had preterm births, family members, community members, healthcare workers and expert stakeholders. We audio-recorded, transcribed the interviews and coded the transcripts. We employed the socioecological model to present perceptions, beliefs and attitudes towards preterm birth at individual, interpersonal, organisational and societal levels.

Giving birth to a preterm newborn is often associated with fear, stress, unhappiness, concern and worry. At the individual level, preterm newborns’ mothers often feel guilt and self-blame. Families tend to keep preterm birth a secret due to perceptions of ‘incompleteness’. At the interpersonal level, preterm newborns are often stigmatised and families are disappointed by mothers who give birth prematurely. However, some believe that preterm newborns are accepted within the community. At the organisational level, healthcare providers find the causes of preterm birth unpredictable, they do not consider preterm births prevalent, and consider some of them as abortion. There is also a common belief that preterm infants have a low survival rate, leading to the deprioritisation of their care. At the societal level, some believe preterm births are caused by divine will as punishment for sins committed by the mother, while others think they occur naturally. Preterm newborn’s death is often not acknowledged as true loss and families are discouraged from grieving.

Our study found that the beliefs, perceptions and attitudes surrounding preterm birth, held by families, communities, healthcare providers and society at large, influence the care that preterm newborn–mother dyads receive both at home and within health facilities. Addressing these requires a multifaceted approach targeted at deeply ingrained attitudes and perceptions.

This study aimed to investigate the prevalence and associated factors of anaemia and its association with the academic performance of schoolchildren in Kandahar, Afghanistan.

This was a cross-sectional analytical study.

This was a school-based study conducted among 1866 schoolchildren aged 6–14 years in Kandahar city from September to December 2023. Haemoglobin concentration was measured using a portable HemoCue Hb 301 analyser, while the WHO age-adjusted cut-off for haemoglobin was used to classify anaemia. Data were analysed by using descriptive statistics, the ² test and multivariate logistic regression.

In this study, the mean age of the children was 9.1 years, 61.1% (1138/1866) were boys, 83.6% (1560/1866) had illiterate mothers, and 81.3% (1517/1866) belonged to poor families. Prevalence of anaemia among schoolchildren was 64.1% (1196/1866), while 20.8% (388/1866), 41.7% (778/1866), and 1.6% (30/1866) were suffering from mild, moderate and severe anaemia, respectively. Main associated factors of anaemia were being male (adjusted OR (AOR) 1.4, 95% CI 1.1 to 1.7, p=0.003), unemployed father (AOR 1.5, 95% CI 1.1 to 2.2, p=0.020), poor family (AOR 2.3, 95% CI 1.8 to 2.9, p

Prevalence of anaemia was very high and is a severe public health problem in schoolchildren of Kandahar. Based on the known consequences of anaemia on academic performance, the education and health authorities of Afghanistan should take serious steps to alleviate this problem. Periodic iron supplementation and deworming, as well as daily iron-rich mid-day meal programmes, should be started for both boys and girls in schools.

Pregnancy and childbirth among adolescents have a higher risk of adverse outcomes than among older women. Adolescent mothers often lack physiological, psychological, social and financial capabilities, risking adverse birth outcomes such as preterm birth (PTB), low birth weight (LBW), asphyxia and stillbirth. We investigated birth outcomes and associated factors among adolescent mothers in the Nabdam District of Ghana.

Retrospective, health facility-based, cross-sectional study.

12 health facilities in Nabdam District, January 2021 to December 2022.

Census of all 373 births recorded in the maternity registers of the selected health facilities.

The main outcome measure was adverse birth outcome, a composite outcome measured as the presence of at least one of PTB, LBW, asphyxia and stillbirth. The data collected were analysed using SPSS V.22. Proportion, mean, ² and binary logistic regression models were used.

141 (37.8%) of the adolescent mothers in the selected health facilities had at least one adverse birth outcome: PTB (78, 20.9%), newborn with asphyxia (56, 15.0%), LBW (55, 14.7%) and stillbirth (1, 0.3%). Adolescents in the Pelungu subdistrict were 2.95 times (95% CI 1.44 to 6.05) more likely to have an adverse birth outcome compared with those in the Zanlerigu subdistrict. Lower odds of adverse birth outcomes were found among adolescents aged 16–19 years (adjusted OR (aOR) 0.26, 95% CI 0.08 to 0.89) and those with eight or more antenatal care (ANC) visits (aOR 0.30, 95% CI 0.10 to 0.96) compared with those younger than 16 years and those with fewer than eight ANC visits, respectively.

Adverse birth outcomes were common among adolescent mothers in the district and were more likely among younger adolescents, those living in disadvantaged subdistricts and those with fewer ANC visits. These findings indicate the urgent need for targeted interventions and support for this vulnerable population, as well as those directed towards improving access to comprehensive prenatal care, promoting proper nutrition during pregnancy and enhancing the overall well-being of adolescent mothers in resource-limited settings, in order to facilitate the attainment of Sustainable Development Goals 3.1 and 3.2 on reducing maternal mortality and improving foetal health outcomes.