BMJ Public Health

BackgroundThis study aims to describe the epidemiological trends and estimate the economic burden of genital warts (GW) in Dutch primary care. MethodsA retrospective, non-interventional, multiyear study (2011-2021) was performed using data from the Nivel Primary Care Database. Changes in incidence by age group, sex, and level of urbanisation of individuals with GW and associated healthcare resource use (general practitioner consultations, prescribed medication, and referrals) were estimated over the 11-year period. Total annual healthcare costs and cost per incident case were estimated via a bottom-up gross costing approach. ResultsBetween 2011 and 2021, GW incidence increased, which was especially seen in men (from 2.0 to 3.5 per 1 000 inhabitants) and to a lesser extent in women (from 1.9 to 2.1 per 1 000 inhabitants). GW incidence was most common in age group 20-29 years (men: 43.6%; women: 50.7%) and highly urbanised areas. Medication was prescribed in 61.4% of GW cases, and 5.4% of GW patients were referred to secondary care. Total costs in Dutch primary care increased by 108% from EUR 2.3 million in 2011 to EUR 4.9 million in 2021. The cost per incident case also showed an increasing trend from EUR 72 in 2011 to EUR 99 in 2021. Referrals to secondary care resulted in a 14-30% increase of total costs. ConclusionsThis study provides novel insights into recent epidemiological trends of GW and its associated costs in Dutch primary care. Incidence especially increased among men and total annual costs of GW in primary care doubled between 2011 and 2021.

Sexual abuse among adolescent girls is underreported in low and middle income countries including Nepal. This study aimed to estimate the prevalence of SA among school girls, examined associated sociodemographic and contextual factors describe the nature and reporting patterns of abuse and assess the relationship with nutritional status. A school based cross sectional study was conducted, among 330 female students (ages 14-19) were selected through simple random sampling from two schools. Data were collected using a validated self-administered questionnaire covering demographic characteristics, abuse experiences, psychosocial responses and reporting patterns. Anthropometric measurements were used to assess BMI-for- age and height-for-age Z scores calculated using WHO AnthroPlus. Logistic regression analysis was used to identify factors independently associated with sexual abuse and adjusted odds ratio with 95% confidence intervals were calculated. SA prevalence was 33.3%. Most perpetrators were male (61.5%) and known to the victim, 63.3% involved perpetrator use. Reporting was low (16.5%) due to fear (42.2%) and shame (22%). Significant predictors included lower maternal education (AOR=3.03) and living in joint families (AOR=2.34).After adjusting for confounders, SA was strongly associated with thinness (AOR=5.59; 95% CI; 2.54-12.26), severe thinness (AOR=18.81; 95% CI: 4.21-84.07) and stunting (AOR=3.79; 95% CI: 1.88-7.62). One in three girls experienced sexual abuse, which is strongly correlated with growth impairment and malnutrition. These findings suggest that anthropometric deficits may serve as clinical red flags for underlying trauma. Strengthening school-based nursing programs and primary care screening is essential for early identification and safeguarding.

BackgroundThe Gaza Strip, spanning approximately 365 square kilometers, has been a focal point of geopolitical tensions and humanitarian crises. The military escalation on October 7th exacerbated existing vulnerabilities, notably food security and hunger, with an estimated 85,750 deaths due to Israeli attacks, representing about 8% of the 2.34 million population. This research aims to inform policymakers and humanitarian organizations about strategies to mitigate hunger and improve food security in Gaza amidst this damaging war. MethodsA cross-sectional study was conducted from May to July 2024, assessing food insecurity and hunger among Palestinian households across the five governorates of Gaza. The study applied a quantitative research approach; the study involved 1209 households. The study utilized the Household Food Security Survey Module (HFSSM), Household Food Insecurity Access Scale (HFIAS), and Household Hunger Scale (HHS) to measure food insecurity and hunger. Self-reported anthropometric data were also collected. Data were analyzed using SPSS version 29, employing correlation tests, chi-square analysis, and logistic regression. ResultsOut of 1503 surveyed households, 1209 were included in the final analysis. The mean age of participants was 38 years, with 53.5% being female. Significant findings included high levels of food insecurity, with 100% of households experiencing some level of food insecurity according to HFSSM and 97.7% being severely food insecure per HFIAS. The results revealed a catastrophic, unprecedented, extremely high prevalence of hunger, reaching more than 95%. The HHS indicated that 88% of households experienced varying degrees of hunger. The war was associated with significant weight loss among individuals, with the average weight dropping from 74.6 kg before the war to 64.1 kg. Factors such as displacement, age, economic status, and educational level significantly impacted hunger severity. ConclusionThe study reveals a severe food insecurity and hunger crisis in the Gaza Strip, exacerbated by the ongoing damaging war by Israeli forces. The findings highlight the urgent need for coordinated efforts to address food security and support the resilience and recovery of affected communities. Policymakers and humanitarian organizations must develop targeted interventions to mitigate hunger and improve the living conditions in Gaza.

IntroductionMedical complications of malnutrition and refeeding account for approximately half of deaths in anorexia nervosa (AN). The AN Care Pathway (ANCP) was introduced at our institution in 2016 to improve quality of care of patients admitted for medical observation and management. We report results from our review of medical complications and report the impact and adoption of the ANCP. MethodsThe ANCP was developed in response to a need to improve quality of medical monitoring of patients with severe AN using Squire Guidelines and the Plan-Do-Study-Act cycle. All patients admitted to a medical hospital with AN between 2010-2020 were included after hospital inpatient enquiry and medical records were reviewed. Descriptive statistics were calculated using Stata (Statcorp). ResultsFifty-one patients (63 admissions) were included. Median BMI was 13.8 kg/m (11.9-22.5). After ANCP implementation in 2016, compliance with recommended daily ECG, thiamine and blood tests improved from 30% (n=8/27) to 86% (n=21/36). We report a high rate of medical complications of severe AN including anaemia (n=24, 47%), neutropoenia (n=18, 35%), abnormal liver bloods (n=15, 29%) and half developed refeeding syndrome. One-third patients had cardiovascular compromise including reduced cardiac contractility (n=13, 25%), pericardial effusion (n=7, 14%) and one death. Low BMI was associated with cardiovascular complications (mean BMI 13.5 kg/m vs 15.5 kg/m, p=0.01) and neutropoenia (mean BMI 13.4 kg/m vs 15.4 kg/m, p=0.02). ConclusionIntroduction of the ANCP improved quality of care during medical stabilisation. We report a high rate of medical complications of severe AN in patients admitted to a medical hospital. Use of multidisciplinary care protocols may contribute to quality improvement and improved consistency of care for this vulnerable population.

ObjectivesThis scoping review aimed to identify available tools for detecting human trafficking survivors in healthcare settings and to explore implementation strategies. MethodsA systematic search was conducted in MEDLINE/PubMed, EMBASE, BIREME-LILACS, WHO-PAHO IRIS, and other institutional repositories on August 12, 2024, with an update on January 18, 2025. ResultsOut of 2,881 records screened, 140 resources were included, mostly from the U.S. (n = 113). We identified 26 screening tools, 44 toolkits and guidelines, 23 documents on educational strategies and 24 studies on other types of strategies targeting HT detection in healthcare. Tools often addressed sexual exploitation, especially in minors, with limited focus on other forms of trafficking. Only eight tools reported having undergone validation processes. Many resources emphasized trauma-informed care, indicator use, and referral protocols. Implementation strategies included training programs, integration of screening protocols into clinical workflows, and digital tools; however, system-level barriers and limited provider confidence persist. ConclusionDespite the availability of tools and guidelines, there is no consensus on definitions or standardized methods for HT identification. Most tools focus on sexual exploitation, particularly in minors, while other trafficking forms are under-addressed. Sustained training, validated tools, and interdisciplinary collaboration are essential. Systemic barriers must be addressed through clear protocols and institutional commitment to ensure effective, survivor- centered detection and care.

Lao Peoples Democratic Republic (PDR) introduced a National Health Insurance (NHI) scheme in 2016 to all provinces except Vientiane Capital City. We describe the financial impact on households related to treatment of severe childhood illness at a hospital covered by NHI, and one without NHI. We conducted a prospective cohort study (2022-2024) in Lao PDR of children aged one month to <15 years admitted with severe illness at two hospitals: Salavan Provincial Hospital (SPH) with NHI, and National Childrens Hospital (NCH) without NHI, with two-month follow-up post-discharge. Illness-related direct and indirect costs were collected. We calculated household out-of-pocket (OOP) costs, impoverishment and catastrophic health expenditure (CHE, >10% annual household expenditure) rates and analysed relative risk (RR) of CHE by socioeconomic status. 200 participants were recruited from each hospital with demographic differences observed between hospitals in urban residence (NCH 87.0%, SPH 14.5%), maternal education (primary level: NCH 95.9%, SPH 76.3%) and wealth status (wealthiest quintile: NCH 79.0%, SPH 20.5%). Median household OOP costs were higher at NCH (USD290.6 [IQR 206.9-422.9]) compared to SPH (USD92.4 [IQR 56.3-52.9]). Impoverishment at two months post-discharge was 0.5% (95%CI 0.0-3.0) at NCH and 10.2% (95%CI 6.2-15.4) at SPH. CHE rates were 34.5% (95%CI 27.9-41.1) at NCH and 26.0% (95%CI 19.9-32.1) at SPH, with higher RR in the poorest versus wealthiest households (NCH: RR 6.6, 95%CI 4.5-9.5; SPH: RR 4.9, 95%CI 1.7-13.7) and households with no formal maternal education versus secondary education (NCH: RR 2.6, 95%CI 1.2-5.5; SPH: RR 4.6, 95%CI 1.92-11.1). Direct medical costs were lower where NHI is available, but total household OOP costs and CHE rates were high at both hospitals, particularly among disadvantaged households. Additional interventions are required to prevent severe illness and provide financial protection for socioeconomically disadvantaged groups to reduce health-related economic burden on households in Lao PDR.

BackgroundAdolescent girls in resource-constrained settings are vulnerable to sexual exploitation and gender inequities due to poverty, leading to teen motherhood, which is often characterised by stigmatization. Marginalized adolescent mothers may experience stigma in their family, school, community, health, and public services, resulting in poverty, which exacerbates food insecurity. This scoping review will explore the drivers, coping strategies, and the mental, sexual and reproductive health impacts associated with food insecurity among adolescent mothers (ages 10-19 years) in SSA. MethodsWe will apply the scoping review framework outlined by Arksey and OMalley and further developed by the Joanna Briggs Institute, and the reporting guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) (S1Table). The overall research question is: What are the drivers, coping strategies, and the mental, sexual and reproductive health impacts associated with food insecurity among adolescent mothers (10-19 years) in SSA? In collaboration with a research librarian, search strategies will be developed using text words and subject headings (eg, Medical Subject Headings (MeSH), Emtree) related to adolescent mothers and food insecurity in SSA. We will include quantitative, qualitative, mixed-methods, and review studies in our analysis. A thematic analysis will be conducted on the findings, with results presented in both narrative and tabular formats. Ethics and DisseminationFormal ethical approval is not required as we are not collecting primary data. The findings will be published in a peer-reviewed journal and disseminated at international conferences.

BackgroundThere is increasing global focus on malnutrition in infants aged under 6 months (u6m) but evidence on how best to identify and manage at-risk individuals is sparse. Our objectives were to: explore data quality of commonly used anthropometric indicators; describe prevalence and disease burden of infant u6m malnutrition; compare wasting and underweight as measures of malnutrition by determining the strength and consistency of associations with biologically plausible risk factors. MethodsWe performed a cross-sectional secondary analysis of Demographic and Health Survey (DHS) datasets, focussing on infants u6m. We calculated underweight (low weight-for-age), wasting (low weight-for-length), stunting (low length-for-age), and concurrent wasting and stunting. We explored data quality by recording extreme (flagged, as per standard criteria) or missing values. We calculated the population-weighted prevalence of each type of malnutrition and extrapolated the burden to all low- and middle-income countries (LMICs). We explored associations between infant, maternal and household risk factors with underweight and wasting using logistic regression models. ResultsWe analysed 54 DHS surveys. Data quality in terms of refusals and missingness was similar for both weight and length. There were more extreme (flagged) values for length-based measures (6.1% flagged for weight-for-length, 4.8% for length-for-age) than for weight-for-age (1.0% flagged). Overall, 20.1% of infants (95% CI: 19.5, 20.7) were underweight, 21.3% (95% CI: 20.7, 22.3) were wasted, 17.6% (95% CI: 17.0, 18.2) were stunted, and 2.0% (95% CI: 1.8, 2.2) were concurrently wasted and stunted. This corresponds to an estimated burden in LMICs of 23.8m underweight infants, 24.5m wasted infants, 21.5m stunted infants and 2.2m concurrently wasted and stunted. Logistic regression models showed that numerous risk factors were associated with wasting and underweight. Effect sizes of risk factors tended to be stronger and more consistently associated with underweight compared to wasting. ConclusionMalnutrition in infants u6m is a major problem in LMICs. This is true whether assessed by underweight, wasting or stunting. Our data build on other evidence suggesting that underweight may be a better anthropometric case definition than wasting: data quality is better when length is not involved; biologically plausible risk factors are better reflected by an infant being underweight. Future research, ideally from intervention trials, should further explore how best to identify malnourished (small and nutritionally at-risk) infants u6m. For now, treatment programmes should note that many factors might underlie problems in this age group: services should thus consider how to address maternal health and wider social circumstances as well as caring for infants themselves.

BackgroundSurgery-related (iatrogenic) obstetric fistulas are a major public health threat in sub-Saharan Africa (SSA), but the actual burden is largely unknown due to a paucity of data. This review aimed to collate empirical evidence on the magnitude and determinants of iatrogenic obstetric fistulas in SSA. MethodsPubMed, LILACS, CINAHL, SCOPUS and Google Scholar were searched from 1st January 2000 to 31st March 2025, without language restrictions, via comprehensive search terms. The Cochrane Library, African Journals Online, Data Base of African Thesis and Dissertations, including Research (DATAD-R D Space), Preprint Repositories and reference lists of relevant studies, were also searched. The retrieved studies were deduplicated in Endnote, screened and selected in Rayyan. Two authors independently selected studies, extracted data and assessed the quality of the included studies via pretested tools. Disagreements between reviewers were resolved through discussion. Weighted proportions were estimated via STATA SE 18. Heterogeneity between studies was assessed graphically and statistically, and where significant, random effects model meta-analysis was performed. Estimates are reported with 95% confidence intervals (CIs). Subgroup analysis was conducted to address heterogeneity, and sensitivity analyses were performed to test the robustness of the pooled estimates. ResultsThe proportion of surgery-related obstetric fistulas among urogenital/rectovaginal fistulas in SSA is 40% (95% CI 34-47, 60 studies, n=25825), whereas among obstetric fistulas, it is 44% (95% CI 37-51, 55 studies, n=17504). The procedures that frequently preceded obstetric fistulas were as follows: caesarean section (34%, 95% CI 28-40; 54 studies, n=17491) and instrumental vaginal deliveries (11%, 95% CI 9-13; 34 studies, n=12727). Most procedures that resulted in obstetric fistulas were performed by nonspecialists (92%, 3 studies, n=749). ConclusionsThe proportions of iatrogenic obstetric fistulas among urogenital/rectovaginal fistulas (40%) and obstetric fistulas (44%) are high and raise serious concerns about the quality of obstetric surgical care delivery in SSA. The fact that more than 92% of obstetric surgeries are performed by nonspecialists and that the incidence of iatrogenic fistulas is high calls for increased efforts towards capacity building and quality improvement across countries in SSA. RegistrationThe protocol for this systematic review was registered in the International Prospective Register for Systematic Reviews (PROSPERO) with registration ID: CRD42021277993.

AimTo explore whether children in specialist care with COVID-19 have increased post-discharge health care use when compared to children in specialist care with 1) respiratory syncytial virus (RSV) infection, and 2) other respiratory tract infections (RTIs). MethodsIn 34,214 children aged 1 month to 5 years who were registered with one or more hospital visit (outpatient or inpatient) with a diagnosis of COVID-19 (N=128), RSV infection (N=4,009), or other RTIs (N=34,458) from 2017-2021, we used a difference-in-differences study design to investigate the individual all-cause primary and specialist health care use from 12 weeks prior to 12 weeks after the hospital visit, stratified on infants (1-12 months) and children (1-5 years). ResultsWe found a slight increase in primary health care use in the first four weeks after the hospital visit for infants with COVID-19 when compared to infants with RSV infection (6 [95%CI=2 to 13] per 10,000, 0.52% relative increase). For infants diagnosed with COVID-19, we found a similar post-visit increase in inpatients when compared to infants with RSV infection, which lasted for 12 weeks. ConclusionsOur findings imply slightly increased health care use among infants after hospital visit for COVID-19 than among infants with other respiratory tract infections, for which potential etiological mechanisms deserve future clinical research. Severe COVID-19 in young children will not represent any markedly increased burden on the health services.

Female genital cutting (FGC) is identified within global health and human rights discourse as aligned with gender inequality and female disempowerment. The persistence of FGC in high-prevalence societies is assumed to reflect womens limited influence over decisions concerning their daughters. Yet anthropological research has questioned whether this interpretation adequately reflects how FGC is organized within practicing communities. Across two studies with 176,728 participants from 15 African and Asian countries, we examine whether mothers attitudes toward FGC predict daughters circumcision status and whether this relationship varies with regional FGC prevalence. Multilevel logistic regression models show that maternal attitudes strongly predict daughter circumcision status across both datasets. Contrary to expectations derived from disempowerment frameworks, the association between maternal attitudes and daughter outcomes is not weaker in high-prevalence contexts, it is stronger. These findings suggest that interpretations of FGC as reflecting female disempowerment may mischaracterize the social dynamics of societies in which FGC is common. Policy implications of the findings are discussed.

BackgroundMental health risks are high in conflict settings, but mental health research mostly focuses on non-conflict settings. Survey data from active conflict settings often suffer from low response rates, unrepresentative samples, and a lack of detailed information on the roots and implications of poor mental health. We overcome these challenges by analyzing nationally representative evidence on the prevalence, sources, and socio-economic correlates of depression, a highly disabling and costly public health issue, in an active conflict setting. MethodsWe analyze nationally and sub-nationally representative geocoded survey data from the Palestinians Psychological Conditions Survey, collected from 5,877 Palestinian individuals in West Bank and Gaza in 2022. We calculate representative depression statistics, disaggregate by sub-areas and across socio-demographic groups, and estimate the associations with geocoded violent conflict event data as well as survey-based trauma exposure across conflict types and socio-economic outcomes. Findings58 percent (SE=2{middle dot}21) of adults in Palestine exhibit depressive symptoms. Prevalence is highest in Gaza (71 percent, SE=2{middle dot}70), increases with exposure to violent conflict and traumatic events, and is associated with worse socio-economic outcomes. The associated losses for 2022 are equivalent to 732,555 Years Lost in Disability, representing 8{middle dot}9 percent of Palestines GDP. InterpretationThose exposed to violence and traumatic events are disproportionately affected by depression in conflict settings, which may fuel poverty and instability. Scalable investments in mental health in conflict settings promise to not only support well-being but also strengthen productivity and social cohesion for a given level of violence. FundingThe study received funding by the World Banks State and Peace Building Trust Fund.

ObjectivesMost research about outcomes following postpartum haemorrhage (PPH) has focused on immediate outcomes. There are fewer studies investigating longer-term maternal morbidity following PPH, resulting in a significant knowledge gap. This review aimed to synthesize the evidence about the longer-term physical and psychological consequences of primary PPH for women and their partners from high income settings. MethodsThe review was registered with PROSPERO and five electronic databases were searched. Studies were independently screened against the eligibility criteria by two reviewers and data were extracted from both quantitative and qualitative studies that reported non-immediate health outcomes of primary PPH. ResultsData were included from 24 studies, of which 16 were quantitative, five were qualitative and three used mixed-methods. The included studies were of mixed methodological quality. Of the nine studies reporting outcomes beyond five years after birth, only two quantitative studies and one qualitative study had a follow-up period longer than ten years. Seven studies reported outcomes or experiences for partners. The evidence indicated that women with PPH were more likely to have persistent physical and psychological health problems after birth compared with women who did not have a PPH. These problems, including PTSD symptoms and cardiovascular disease, may be severe and extend for many years after birth and were more pronounced after a severe PPH, as indicated by a blood transfusion or hysterectomy. There was limited evidence about outcomes for partners after PPH, but conflicting evidence of association between PTSD and PPH among partners who witnessed PPH. ConclusionThis review explored existing evidence about longer-term physical and psychological health outcomes among women who had a primary PPH in high income countries, and their partners. While the evidence about health outcomes beyond five years after PPH is limited, our findings indicate that women can experience long lasting negative impacts after primary PPH, including PTSD symptoms and cardiovascular disease, extending for many years after birth. PROSPERO registration numberCRD42020161144

During outbreaks women struggle with access to essential health services, including for violence. Services may be disrupted or deprioritised, or women may avoid clinical settings. We conducted a scoping review to understand how health services for violence against women (VAW) were affected in low- and middle-income (LMIC) settings during recent outbreaks, and womens help-seeking for violence. We reviewed published academic literature reporting on primary research from LMIC settings during recent outbreaks (Ebola, Zika and COVID-19). Four databases were searched: Medline, Embase, Global Health, and Global Index Medicus. Thirty two papers met the inclusion criteria. Data were extracted using a thematic framework focusing on both the supply and demand for services. Experiences during COVID-19 were overrepresented, with no studies identified from other outbreaks. Research spanned 20 countries including a range of services and populations. In the face of lockdowns and reorientation of the health system towards COVID-19, VAW services were restricted or closed despite being essential. Many settings reported that they moved services online or to telehealth, raising digital access issues and safety concerns for women using services from spaces that might be shared with a violent partner or others. Some in-person programme modalities were also adapted, with community volunteers used, or cash assistance provided to survivors. Help-seeking varied, with greater or fewer numbers of survivors presenting at clinical settings, likely indicating fluctuating restrictions. Women experiencing violence often sought help from informal sources (such as community leaders and family). Survivors help-seeking was affected by the economic crisis accompanying COVID-19, including food insecurity and transportation challenges. To prepare for future outbreaks research is needed to identify what services are or are not safe and accessible to deliver online, as well as a understanding a broader range of emerging practices for adapting to social distancing, movement and transport restrictions and economic stress.

BackgroundThe United States and Canada have resettled over 120,000 Afghan refugees since August 2021, but sociodemographic and health status data remains sparse with investigations often limited to refugee entrance exams, standardized health screenings, or acute health settings. MethodsThis retrospective community-engaged cohort study investigated Afghan patients who received care between January 1, 2011 and December 31, 2020 at an interdisciplinary specialized refugee clinic in Calgary, Canada that provides care to newly arrived refugees. Two reviewers independently extracted and manually verified sociodemographic factors, medical diagnoses, and clinic utilization variables from patients electronic medical records, then coded patient diagnoses into ICD-10 codes and chapter groups. Diagnosis frequencies were calculated and stratified by age group and sex. We corroborated these findings with Afghan refugee co-investigators. FindingsAmong 402 Afghan refugee patients, 228 were adults (mean age 34{middle dot}2 [SD 13] years), and 174 were children (mean age 7{middle dot}5 [SD 5{middle dot}4] years). We identified 1535 total individual diagnoses and classified them into 382 unique ICD-10 codes. Patients had a median 2 diagnoses each [IQR 0-6], 4 clinic visits across primary, specialty and multidisciplinary care annually, and an 11% appointment no-show rate. Among adults, the most frequent diagnoses were abdominal pain (26{middle dot}3%, 60/228), mechanical back pain (20{middle dot}2%, 46/228), and H. pylori infection (19{middle dot}3%, 44/228). Among children, the most frequent diagnoses were upper respiratory tract infection (12{middle dot}1%, 21/174), Giardia (10{middle dot}3%, 18/174), and short stature (7{middle dot}5%, 13/174). InterpretationRecently resettled Afghan refugees in Canada were relatively young, experienced diverse health characteristics, and had multi-specialty care engagement in their first two years after arrival. These findings may guide specialized healthcare provision to this inadequately characterized but growing population of refugee arrivals in North America and elsewhere. FundingResearch grants from the M.S.I. Foundation and University of Calgary OBrien Institute for Public Health

BackgroundDuring the pandemic and associated lockdowns, many families from around the world experienced financial and confinement stress and the reorganisation of family caregiving responsibilities. Several studies have been conducted about the impact of the pandemic on family wellbeing. The aim of this systematic review was to identify, synthesize and critique relevant studies in this field. MethodsFollowing Cochrane Collaboration and PRISMA guidelines, a systematic search was performed in databases including MEDLINE, PsycINFO, Embase, SocINDEX and PubMed. Peer-reviewed studies that examined the experiences of families during infectious disease outbreaks were included. Quality assessment was undertaken using the Mixed Methods Appraisal Tool. A narrative synthesis approach was employed. ResultsEighty-four papers were found, all conducted during the Covid-19 pandemic, with the majority from the USA and presented from the perspective of parents/caregivers. Synthesized results focused on how family experiences, the dyad relationship and parenting behaviours were impacted during Covid-19. ConclusionAlthough some families reported positive growth, socially and financially vulnerable families were more negatively impacted than others during the pandemic. The review highlights the important role of families during times of stress and possible intervention targets.

BackgroundChildren exposed to polyvictimization (exposure to multiple types of victimization), experience severe impacts on health and wellbeing across the life course. While the prevalence, risk factors, and health consequences of polyvictimization have been well documented in lower-middle-income countries, there remains a significant knowledge gap regarding the situation in humanitarian contexts, particularly in refugee settings. ObjectivesWe examined the prevalence, risk, and protective factors of polyvictimization and its association with mental health outcomes in refugee settings in Uganda and Ethiopia. Data and MethodsWe utilized data from the Uganda Humanitarian Violence Against Children and Youth Survey (HVACS) 2022, which included 1,338 females and 927 males, and the Ethiopia HVACS 2024, which comprised 1,937 females and 1,536 males. These were representative, cross-sectional household surveys of females and males aged 13 to 24 years living in refugee settlements in Uganda and Ethiopia. Analysis entailed cross-tabulation with chi-square test and estimation of a multivariate logistic regression model. ResultsIn both settings, males experienced higher rates of polyvictimization than females (49% vs.30% in Uganda and 33% vs. 29%. in Ethiopia). Several risk factors for childhood polyvictimization were identified at the individual level, including having a disability and endorsing intimate partner violence against women, and at the family level, such as having a difficult relationship with ones father and household food insecurity. Conversely, living in a female-headed household was found to be protective against childhood polyvictimization across both settings. Additionally, polyvictimization was significantly associated with higher odds of mental distress, self-harm, and suicidal ideation/attempts among females and males in both Uganda and Ethiopia refugee settings. ConclusionOur findings confirm that childhood polyvictimization is prevalent among refugee populations in Uganda and Ethiopia, with nuanced insights into the risk and protective factors. The challenging circumstances within these refugee settings may exacerbate polyvictimization and its consequences. Therefore, it is essential to prioritize preventive measures alongside response strategies in addressing polyvictimization in these contexts, starting much earlier in the life course.

BackgroundSevere acute malnutrition (SAM) is still having public health significance by attributing almost fifty percent of the estimated ten to eleven million deaths encountered in less than five-years old children, imposing nine-fold likelihood of death compared with well-nourished children of similar age group. It increases terrifyingly and become lethal during conflicts due to lack of food, compromised water supply and hygienic practices along with insufficient healthcare services. MethodsHospital-based prospective cohort study was conducted using regularly collected programme data of children admitted to the stabilization center in Suhul general hospital from January 1st, 2023 up to July 31st, 2023. To collect the data, pretested structured questionnaire was generated referring to the national SAM management protocol. Then collected data get coded and entered into Microsoft Excel spreadsheet 2016 version. All forms of analyses were done using statistical package for social sciences (SPSS) version 25. ResultsFrom the total 168 children aged 6-59 months enrolled in the study, ninety-four per cent of them were recovered and transferred to the outpatient therapeutic programme while the rest six per cent of the participants were censored. Appetite test (AHR = 1.874; 95% CI: 1.180-2.978), level of dehydration (AHR = 0.538; 95% CI: 0.361-0.800 for some/moderate dehydration and AHR = 0.250; 95% CI: 0.128-0.489 for severe dehydration or shock), diagnosis at admission (AHR = 0.452; 95% CI: 0.294-0.694), blood transfusion (AHR = 5.559; 95% CI: 2.419-12.773), type of antibiotics (AHR = 0.365; 95% CI: 0.192-0.692) and nasogastric tube feeding (AHR = 0.531; 95% CI: 0.372-0.758) were declared significant predictors of recovery time. ConclusionBottom line of the study shows the inpatient therapeutic feeding center has met the agreed indicators for nutrition interventions during humanitarian crises. We recommend the hospital leadership, the regional health bureau and other humanitarian agencies to stress on training clinical workforce directly involved in patient management and care.

Sepsis is a life-threatening condition with high mortality, especially in sub-Saharan Africa (SSA). Sepsis survivors may face long term consequences and experience poor health-related quality of life (HRQoL). By comparing HRQoL trajectories between sepsis cases and matched controls we sought to identify the longitudinal impact of sepsis on HRQoL in the SSA context. This study was nested within a longitudinal adult sepsis cohort admitted to hospital in Blantyre, Malawi. Two reference control groups matched to cases by age, sex, and geographical location were recruited: (1) hospital inpatients without sepsis and (2) community controls with no current illness. All participants were followed up to 180 days post-enrolment. HRQoL was assessed using EQ-5D-3L questionnaire and a visual analogue scale (VAS). Regression analysis was conducted to examine factors associated with HRQoL among sepsis survivors. A total of 425 participants: 225 sepsis cases, 100 hospital controls, and 100 community controls were recruited. HIV prevalence was higher among sepsis cases 143/225 (63.6%) compared to hospital controls 12/100 (12.0%) and community controls 18/100 (18.0%) p= <0.001. At baseline, sepsis cases had lower health utility scores (median 0.596, IQR: 0.365- 0.734 compared to hospital controls (0.666, IQR: 0.611 - 0.722) and community controls (0.900, IQR: 0.833 - 0.900). Over time, sepsis cases displayed fluctuating HRQoL, with a marked decline in utility scores at day 180 (0 IQR: 0 - 0) compared to relatively stable scores in both control groups. Regression analysis identified age, sex, duration of illness before admission and baseline utility score as significant predictors of HRQoL in the sepsis group. The findings reveal a severe and persistent reduction in HRQoL among patients admitted with sepsis in Malawi, suggesting a substantial post-discharge burden among survivors. These results point to a need for evidence-based prevention, early recognition of sepsis and post-sepsis support programs in SSA.

BackgroundPerinatal asphyxia (PNA) remains a leading, yet preventable, cause of neonatal death, disproportionately affecting low-resource settings like Ethiopia. Despite its significance, data on the burden and factors influencing survival among asphyxiated neonates in this region are scarce. This study aims to address this gap by investigating the time to death and its associated predictors in this vulnerable population. MethodsA retrospective cohort study was conducted at Wolaita Sodo University Comprehensive Specialized Hospitals Neonatal Intensive Care Unit (NICU) in southern Ethiopia. Medical records of 404 neonates diagnosed with PNA between January 2019 and December 2023 were reviewed. The study followed these neonates for a total of 2889 person-days to assess their survival outcomes. Kaplan-Meier analysis estimated the median time to death, and a Weibull regression model identified independent predictors of mortality. ResultsThe findings revealed the incidence density of PNA-related mortality of 30.8 per 1,000 person-days (95% CI: 25.0-37.9). Notably, nearly 72% of deaths occurred within the first critical week of life, with a median survival time of 20 days. The multivariable Weibull regression analysis identified several factors significantly associated with shorter time to death at p 0.05. These are presence of meconium-stained amniotic fluid (MSAF), low fifth-minute Apgar score (less than 7), birth weight greater than 4000gm, low admission oxygen saturation level, treatment with anticonvulsant, the use of Continuous Positive Airway Pressure (CPAP) for oxygen administration, and need for resuscitation with chest compression. ConclusionThis study highlights the significant burden of PNA-related mortality, particularly during the first week of life, in a resource-limited setting. The findings underscore the urgent need for improved PNA management strategies. Furthermore, specific treatment decisions, including the use of anticonvulsants, oxygen therapy methods, and resuscitation techniques, emerged as crucial factors influencing survival outcomes. These results call for further investigation into these specific interventions and potentially revising PNA management protocols to optimize the chances of survival for asphyxiated neonates in low-resource settings like Ethiopia.