Global Health Action

This paper explores the burdens of non-communicable diseases (NCDs) in low-income settings, and how they are shaped by structural barriers including gender inequities. As Low- and Middle-Income Countries (LMICs) face epidemiological transitions towards increased NCD burdens, the challenges faced by people living with NCDs are a priority. We employed narrative inquiries to explore the lived experiences and healthcare seeking decision making practices of 15 participants living with diabetes, hypertension, and disability related to stroke in three informal settlements in Freetown. Narrative interviews were conducted through three household visits within a period of 12 weeks. We adapted the Intersectional Gender Analysis Framework for Infectious Diseases of Poverty Research to understand how poverty, gender and other axes of inequity interact with NCD burdens in informal settlements. Findings show a strong connection between poverty, gender identities and comorbidities linked to NCDs. Womens lived experiences of NCD conditions reflected historical disadvantage and patriarchal oppression, most notably through their limited financial autonomy, barriers to healthcare decision making and treatment access, compounded by gendered impacts of conflict and migration. Mens experiences were however influenced by changes in social status, due to conflict and migration, and financial instability, limiting access to healthcare. Gender differences were also key in shaping household and healthcare decision making, as gender norms and experiences of masculinities and femininities reflected the division of roles and access to resources by men and women, which in turn shaped their ability to seek early and better healthcare interventions. In conclusion, our study has shown that for people living with NCDs, gender norms and patriarchal structures reinforce power hierarchies, worsen health outcomes and deepen poverty. Healthcare interventions must consider the full range of needs and impacts of people impacted by long term illnesses and the context in which they live.

Multimorbidity, the presence of multiple chronic conditions in one person, is a growing global health concern. Integration of chronic care services is urgently needed, especially in low-resource settings including in Southern Africa, where care has been fragmented by vertical and siloed disease approaches. Many countries share similar challenges to integration, presenting rich opportunities for shared learning. Yet, rarely are these opportunities capitalised upon, in part because of a lack of systematic knowledge about the similarities and differences in the health system contexts, challenges and current progress towards integration. As part of an inter-country collaboration, we sought to answer the questions: What are the common and distinct characteristics of the care pathways for people living with multimorbidity in Malawi and Zimbabwe, and the opportunities and challenges that emerge through such a country-level comparison? We used an iterative, qualitative research design that involved a desk review of relevant indicators, policies and strategies; key informant interviews, collaborative workshops, and the development of case studies of service integration in practice. Thematic analysis and comparison of challenges of integration across different levels of care revealed uneven funding for different diseases, a lack of both vertical and horizontal integration, frequent stockouts of drugs and diagnostic equipment, especially for noncommunicable diseases (NCDs), and inadequate training and support for clinicians. In both countries, progress towards decentralising and integrating chronic disease care at national level, has occurred through inclusion of specific NCDs into HIV programmes. This is prone to leave out comprehensive chronic care for people that are not living with HIV and reproduces verticalised programming. We suggest that a promising avenue for wider scale-up of decentralised, non-HIV-dependent integrated care lies in the expansion of an Integrated Chronic Care Clinic (IC3) model that provides comprehensive health system integration for all chronic diseases. Further cross-country learning and feasibility assessment is needed to advance this model.

BackgroundPeople with disabilities face more barriers accessing healthcare and, on average, experience worse health outcomes. Strengthening health access for people with disabilities requires coordinated action across the health system. The Missing Billion Inclusive Health System Framework is a new tool to support policy makers assess levels of disability inclusion within health systems. In this study we use the framework within the Unified Health System in Brazil. We consider the relevance and feasibility of the indicators, as part of further testing and refining the framework. MethodsInformation sources, used to complete the assessment, included Brazilian laws and policies, publically available data, published literature and interviews with people with disabilities and service providers. A workshop with stakeholders was held to co-develop key recommendations. FindingsOverall, the framework was comprehensive and feasible to complete. It highlighted key strengths in terms of disability inclusion in the Brazilian health system as well as gaps and leverage points for action. InterpretationThe Missing Billions framework can identify progress and opportunities to strengthen disability inclusion in health systems. In Brazil, key promotive factors include supportive policies, leadership and financing structures. There are also opportunities for strengthening data and evidence, healthcare worker training on disability and health service accessibility. Actions must be centered on, and informed by, people with disabilities. FundingThis work was supported by the Sao Paulo Research Foundation, Brazilian National Council for Scientific Technological Development, Federate District Research Foundation and the Medical Research Council. Hannah Kuper is supported by a NIHR Global Research Professorship.

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.

BackgroundAlthough the COVID-19 pandemic has resulted in lower reported number of cases and deaths within the paediatric population, indirect impacts on the health of children in Sub-Saharan Africa such as malnutrition are evident. Data on the socioeconomic factors affecting malnutrition in the under-age population of Sub-Saharan Africa brought by the COVID-19 pandemic remain limited. This paper assesses socioeconomic factors of malnutrition in relation with COVID-19 and potential mitigating measures. MethodsA scoping review of PubMed, Embase, and Web of Science from March 11, 2020, to May 1, 2021, was conducted. The included studies focused on COVID-19, children malnutrition, and Sub-Saharan Africa and adhered to the PRISMA guideline. ResultsAmong 73 total screened articles, 15 studies filled the inclusion criteria. The identified socioeconomic factors leading to malnutrition in children were reduction in average income or increase in unemployment rate, access to healthcare and food supplements, disrupted food supply chains and increased prices of food products, pauses in humanitarian responses, and reduced access to school-based meals. Potential mitigation measures were food subsidies, food price control measures, the identification of new vulnerable groups and the implementation of financial interventions. ConclusionMalnutrition amongst Sub-Saharan African children due to COVID-19 is a result of a combination of multiple socioeconomic factors. To stabilize household purchasing power and eventually malnutrition in children in SSA, a combined strategy of initial detection of newly developing vulnerable groups and efficient, rapid financial assistance through mobile phone transfers was suggested. These strategies were proposed in combination with other economical models.

BackgroundConfronted with the triple burden of malnutrition including in low- and middle-income country settings (LMICs), effort has been made to tackle child wasting especially to improve treatment outcomes of complicated severe acute malnutrition (cSAM). However, some children relapse after recovery and are retaken through the elaborate management criteria which not only strains the system, but also puts a toll on their health. ObjectiveWe assessed the proportion of cSAM relapses and the associated socioeconomic, anthropometric, and clinical factors. MethodThis was a comparative cross-sectional study using secondary data of children under 5 with cSAM admitted at Mwanamugimu nutrition unit between May 2015 to April 2017. Multiple logistic regression analysis was used to assess for the correlates of cSAM. ResultsWe included 1098 children with mean age 13.8 {+/-}9.8 months, over two-thirds were male, and [~]50% hailed from Kampala. On analysis, 5.7% were cSAM relapses, 0.7% were multiple relapses, and it took them [~]36 weeks on average to relapse. Increased age, number of siblings, and children with unemployed mothers had 0.05 (95%CI: 0.02; 0.08), 0.3 (95%CI: 0.09; 0.51), and 2.63 (95%CI: 0.61; 4.65) higher odds of relapsing with cSAM respectively. There was no observed association with any anthropometric or clinical factor. ConclusionDespite lack of a standard definition and set threshold, a compelling proportion of children relapse with cSAM seemingly unnoticed across CMAM programs in LMICs but this may be at a cost. Treatment programs need to ensure they establish readmissions and also reinforce their community leakages so that poor, large households are benefactors of livelihood support to cater for underlying factors and mitigate risk of cSAM relapse.

BackgroundWasting remains a major public health concern in Nepal, contributing to preventable morbidity and mortality among children under five. The Integrated Management of Acute Malnutrition (IMAM) program has been implemented in Bajura district since 2014/15, yet evidence on its coverage and accessibility has been lacking. This study assessed program coverage, identified barriers and enablers, and proposed strategies to improve reach and effectiveness. MethodsA Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) approach was employed in three stages. Stage I combined routine HMIS data review with qualitative data from key informant interviews, focus group discussions, and direct observations to identify barriers and boosters. Stage II tested the hypothesis that coverage was higher near Outpatient Therapeutic Care Centres (OTCCs) and lower in distant areas, using active and adaptive case-finding. Stage III conducted a wide-area survey, applying Bayesian analysis to estimate coverage. ResultsThe assessment identified 14 boosters, including OTCC expansion and integration of SAM screening into growth monitoring and immunization services, and 25 barriers, notably RUTF stockouts, inadequate health worker capacity, and low community awareness. Coverage was estimated at 23.5% (95% CI: 14.5-36.0%), well below the SPHERE standard of [≥]50% for rural settings. Point coverage was 11.53%, indicating very limited reach at any given time. Female children constituted the majority (69%) of uncovered cases, suggesting possible gender-related disparities. ConclusionIMAM coverage in Bajura is substantially below international benchmarks, constrained by both service delivery gaps and socio-cultural barriers. Strengthening health worker capacity, ensuring uninterrupted RUTF supply, enhancing community engagement, improving data systems, and addressing gender-related inequities are critical to expanding access and improving treatment outcomes.

BackgroundUndernutrition among HIV-positive adults in Ethiopia highlights the cycle of cause- and-effect relationships between undernutrition and HIV infection. AimThe study aimed to assess the prevalence of undernutrition and its determinants among HIV-positive adults in Ethiopia. MethodsIntensive searches were carried out utilizing PubMed, EMBASE (Elsevier), Cochrane, and and other electronic databases such as Science Direct, African Journal Online (AJOL), Google Scholar, and gray literature. Data synthesis/findingsA total sample size of 5,648 and a total number of undernourished individuals of 1,474 from 11 articles met the inclusion criteria. The study found that the pooled prevalence of 26.70% (95% CI: 21.31%, 32.10%) of HIV-positive patients in Ethiopia are undernourished. Factors determining undernutrition include having opportunistic infections (OR: 3.496, 95% CI 1.776-5.217), being at an advanced WHO clinical stage II or above (OR: 2.916, 95% CI 1.088-4.744), having a cluster differentiation (CD4) count below 200 cells (OR: 3.099, 95% CI 1.418-4.779), and food insecurity (OR: 3.352, 95% CI 1.418-5.287). ConclusionThe systematic review and meta-analysis found that Ethiopias HIV-positive population faces high undernutrition rates in comparison to studies done in sub-Saharan Africa. Opportunistic infections, advanced WHO clinical disease stage, CD4 counts below 200 cells/mm3, and food insecurity were identified as statistically significant factors determining the high prevalence of undernutrition. This suggests a cyclic link between undernutrition and health outcomes. The meta-analysis identifies factors influencing undernutrition in Ethiopias HIV-positive population, but more research is needed to determine the efficacy of interventions and address root causes.

BackgroundHIV and malnutrition act synergistically to weaken the immune system, increasing susceptibility to opportunistic infections, morbidity, and mortality. HIV destroys the body ability to fight infections, while malnutrition hinders recovery, accelerating the progression of AIDS related illnesses. This combination also undermines the adherence to and effectiveness of antiretroviral therapy (ART), particularly in resource limited settings. Accordingly, this study assessed the prevalence of malnutrition and associated factors among women attending prevention of mother to child transmission programs in public hospitals in Addis Ababa, Ethiopia, in 2024. MethodsA cross sectional study was undertaken from April 1st to 20th, 2024. The study enrolled 193 women receiving PMTCT care at six public hospitals in Addis Ababa, selected through a simple random sampling method. Data were collected via face to face interviews using a standardized, structured questionnaire. Additionally, participants mid upper arm circumference (MUAC), weight, and height were measured to assess nutritional status. Data analysis was performed using SPSS version 26. Binary logistic regression was employed to examine the strength of associations, with results expressed as odds ratios alongside 95% confidence intervals. A p value score of 0.05 was considered statistically significant. ResultsThe overall prevalence of malnutrition was 29% (19% undernutrition, 8% overweight, 2% obesity). In the adjusted analysis, younger age (25 to 34 years) was protective (AOR: 0.25), whereas experiencing eating problems (AOR: 13.70) and gastrointestinal symptoms (AOR: 3.52), immunosuppression (AOR: 8.13), anemia (AOR: 5.03), low meal frequency (AOR: 4.12), poor adherence (AOR: 3.60) were significant risk factors. ConclusionThe prevalence of malnutrition among women receiving PMTCT at public hospitals in Addis Ababa was high. Moving forward, integrating routine nutritional screening and evidence based supportive interventions, including dietary support for women with low meal frequency and targeted management for those with anemia or low CD4 counts, should be a priority to improve comprehensive care for this vulnerable population.

Food insecurity (also called, simply, FI) levels in sub-Saharan Africa are rising among its growing adolescent population, the world's fastest-growing teenage population. This study examines food insecurity and its role as a social determinant of poor mental health among African adolescents. The study utilised the Gallup World Poll data between 2014 and 2019, including adolescents aged 15 -19 (n=25,368). Poor mental health was measured using five validated responses about negative experiences. We employed a two-level binary logistic regression model to determine the associations between food insecurity and poor mental health. At the individual level, the primary explanatory variable, food insecurity, was measured using the FAO (2015) Food Insecurity Experience Scale (FIES). The odds of poor mental health exhibited a dose-response relationship with food insecurity severity, with mild (OR=1.70; 95% CI (1.57-1.84), moderate (OR=2.35; 95% CI (2.17-2.54) and severe food insecurity (OR=3.19; 95% CI (2.96-3.54) being associated with poorer mental health. Other assessed covariates showed that residing in a Francophone state increased the odds of poor mental health experiences, whereas positive experiences reduced the chances of poor mental health, as did residing in rural areas. There was no difference in the relationship between mental health and food insecurity across the two colonial origins. Food insecurity remains an important determinant of adolescent mental health in Francophone and Anglophone Africa. Investing in cost-effective agricultural and nutrition-sensitive interventions that boost food production could improve adolescent mental well-being while reducing long-term social and economic burdens on families and health systems in sub-Saharan Africa.

BackgroundAdolescence is a crucial period for growth, and adequate nutrition is essential for those living with HIV/AIDS and on antiretroviral therapy (ART). Despite declining HIV prevalence in Ethiopia, adolescents continue to face challenges that negatively impact their nutritional status. This study explored clinical, lifestyle, environmental, and dietary factors influencing the nutrition of adolescents on ART in selected Ethiopian hospitals. MethodCross-sectional surveys, clinical assessments and clinical record reviews were conducted, recruiting 384 ALHIV in receipt of ART at ten public hospitals in Addis Ababa and Oromia regions in August - December 2023. Participants were selected using proportionate random sampling for ALHIV and data were collected using a pre-tested interviewer-administered structured questionnaire and standardised assessments by trained healthcare workers. ResultsNutritional assessments revealed 24.2% of participants classified as thin, 21.7% as stunted, and 34.9% as acutely malnourished. Factors significantly determinant of malnutrition included, for thinness, male gender, household food insecurity, a history of chronic infections such as tuberculosis, and symptom levels indicative of anxiety and moderate/moderately severe depression. Significant factors for acute malnutrition included younger rather than older adolescence (aged 10-17), male gender, larger household size (four or more members), household food insecurity, delayed disclosure of HIV status, history of chronic infections, generalized anxiety disorder, and low haemoglobin levels (<11 mg/dL). Conclusion and RecommendationsFindings highlight the multifaceted challenges faced by ALHIV, inform and underscore the need for targeted nutritional and mental health interventions to address the specific challenges faced by this vulnerable group.

BackgroundAdolescents living with HIV (ALHIV) in Ethiopia face significant nutritional challenges affecting their health and ART outcomes. Increased energy needs, HIV complications, and socioeconomic barriers contribute to their vulnerability. Despite ART advancements, research on their nutritional care remains limited, and comprehensive guidance is lacking. This study assessed ALHIVs nutritional status, nutrition support in ART clinics, and strategies for improvement. MethodA two cross-sectional survey were conducted in ten public hospitals across Addis Ababa and Oromia regions, involving 384 ALHIV and 44 healthcare professionals. Healthcare workers were selected through purposive sampling, while ALHIV were recruited using proportionate random sampling. Data was collected using a pre-tested structured questionnaire with quantitative and qualitative components, administered by trained healthcare workers via the Kobo Toolbox program. ResultsNutritional assessments of ALHIV revealed that 24.2% were thin, 21.7% were stunted, and 34.9% were malnourished based on mid-upper arm circumference, with 19.4% experiencing severe acute malnutrition. Many adolescents faced food insecurity, which negatively affected their nutritional status and ART adherence. While most healthcare workers conducted basic nutritional assessments, the use of sensitive tools was limited. Only 36.4% assessed dietary intake, 27.3% evaluated food security, and 38.6% provided regular nutrition counseling. Healthcare professionals expressed dissatisfaction with the integration of nutrition services due to inadequate training and resource constraints. ConclusionThe study highlights significant gaps in nutrition support and malnutrition among ALHIV on ART in Ethiopia. Integrating nutritional assessments and counseling into routine ART care, enhancing healthcare worker training, and developing standardized nutritional guidelines are essential for improving outcomes. Addressing food insecurity and socioeconomic barriers through adequate resources and policies is also critical for better health outcomes. Further research is needed to understand the long-term nutritional needs of ALHIV.

IntroductionThe double burden of malnutrition, defined as the coexistence of undernutrition and overnutrition within the same individual, is an emerging public health challenge in low- and middle-income countries undergoing rapid urbanization. In Ghana, the rising prevalence among under-five children underscores the need for context-specific evidence. This study examined the prevalence and predictors of the double burden of malnutrition among under-five children in a selected urban area in Ghana. MethodsA hospital-based cross-sectional study was conducted among 271 mother-child pairs using a semi-structured questionnaire and standardized anthropometric measurements. Nutritional status was assessed using the World Health Organizations Child Growth Standards. The double burden of malnutrition was defined as the co-occurrence of underweight or overweight with any form of stunting within the same child. Descriptive statistics, Chi-square tests, and binary logistic regression were used to analyze the data. ResultsThe prevalence of the double burden of malnutrition among the sampled children was 31.37%. Significant predictors included childs age (OR=1.034; p=0.002), low physical activity levels (OR=6.22; p=0.001 for inactive children), lack of breastfeeding (OR=11.82; p=0.001), non-exclusive breastfeeding (OR=6.06; p=0.001), absence of formula feeding (OR=2.16; p=0.043), and early introduction of semi-solid foods (OR=0.28; p=0.019 for introduction at 6-8 months versus <6 months). Additionally, maternal tertiary education was protective against the double burden of malnutrition (OR=0.24; p=0.032). ConclusionThe findings highlight the multifactorial nature of DBM in urban Ghana, shaped by child feeding practices, physical activity, and maternal education. Addressing DBM will require integrated public health strategies that promote optimal infant feeding, physical activity, and maternal health education, particularly in urban poor communities.

Background: Severe acute malnutrition (SAM) remains a major public health problem among under-five children, particularly in low-income countries. Comorbidity, especially pneumonia and diarrhea, significantly increases the risk of morbidity and mortality among affected children. Methods: An institutional-based cross-sectional study was conducted from April 20 to May 20, 2024, among children aged 6-59 months admitted with SAM to public hospitals in North Shoa Zone, Ethiopia. A total of 394 participants were included using systematic random sampling. Data were collected through caregiver interviews and medical record reviews using a structured, pre-tested questionnaire. Data were entered into Epi Info version 7 and analyzed using Stata version 16.1. Logistic regression analyses were performed to identify factors associated with comorbidity. Statistical significance was declared at p-value < 0.05. Results: The prevalence of comorbidity (pneumonia and diarrhea) among severely acutely malnourished children was 15.48% (95% CI: 11.89-19.06). Children with low dietary diversity (<5 food groups) were twice as likely to develop comorbidity (AOR = 2.00, 95% CI: 1.09-3.98). Children of single mothers had higher odds of comorbidity (AOR = 3.00, 95% CI: 1.21-7.65). Additionally, very low perceived birth weight was strongly associated with comorbidity (AOR = 7.11, 95% CI: 1.43-35.48). Conclusions: A substantial proportion of children with SAM had comorbid pneumonia and diarrhea. Key predictors included poor dietary diversity, maternal marital status, and low birth weight. Strengthening integrated child health and nutrition interventions is essential to reduce comorbidity and improve outcomes among vulnerable children.

IntroductionMalnutrition remains a critical threat to child survival in Nigeria, especially in ecologically vulnerable states like Bayelsa. Although the Mid-Upper Arm Circumference (MUAC) tool is widely used for early detection of severe acute malnutrition (SAM), disparities in screening coverage and case detection across local government areas (LGAs) remain under-explored. This study assessed regional MUAC screening performance during the June 2025 Maternal, Newborn, and Child Health (MNCH) Week in Bayelsa State, with a focus on identifying disparities in screening distribution and SAM prevalence. MethodologyA cross-sectional quantitative design was adopted, using secondary program data from the Bayelsa State OPS Room Final Report. The dataset included MUAC screening indicators across eight LGAs. Variables analyzed included the number of children screened, Red MUAC cases identified, screening coverage percentage, and Red MUAC prevalence. Descriptive statistics and Pearson correlation analysis were conducted using Python and SPSS to examine trends and relationships. ResultsOut of 538,813 children screened, significant disparities were observed across LGAs. Ogbia LGA accounted for over 52% of screenings, while Ekeremor and Nembe contributed less than 8% combined. Red MUAC prevalence varied from 0.03% to 1.78%, with Nembe recording the highest burden. A moderate positive correlation (r {approx} 0.41) was found between screening coverage and Red MUAC detection, indicating that higher screening volume did not always equate to higher detection efficiency. ConclusionThe study revealed operational and equity gaps in MUAC screening implementation across Bayelsa State. Disparities in both screening coverage and SAM detection underscore the need for data-driven planning, targeted deployment, and health system strengthening. These findings highlight the importance of regionalized nutrition surveillance to ensure equitable service delivery, particularly for high-risk and hard-to-reach populations.

IntroductionUndernutrition remains a major public health concern in low- and middle-income countries, including Ghana, with generational consequences. This study examined the prevalence and place-based correlates of malnutrition and anaemia among children under five years old in rural Northeastern Ghana, aiming to develop effective interventions. MethodologyA community-based cross-sectional study was conducted in 10 rural communities in the East Mamprusi Municipality in June/July 2023. Anthropometric and haemoglobin measurements were taken from children under five, alongside socio-demographic, maternal health, and feeding practice data. Descriptive and logistic regression were used to identify the prevalence and determinants of child nutrition indicators. ResultsThe prevalence of malnutrition was 34.3% for stunting, 31.9% for wasting, 27.8% for underweight, and 55.2% for anaemia. Key associated factors of underweight included a lack of home healthcare provider support [AOR = 21.44, 95% CI: 3.39-135.78, p = 0.001] and non-exclusive breastfeeding [AOR = 9.53, 95% CI: 1.71-53.06, p = 0.01]. Wasting was associated with the absence of age-appropriate complementary feeding [AOR = 11.23, 95% CI: 2.35-53.74, p = 0.002] and failure to prevent iodine deficiency [AOR = 8.37, 95% CI: 1.93-36.24, p = 0.004]. Stunting was linked to lower household food expenditure [AOR = 0.97, 95% CI: 0.97-0.98, p < 0.001] and limited caregiver knowledge of exclusive breastfeeding [AOR = 0.38, 95% CI: 0.16-0.91, p = 0.03]. Anaemia was more likely in children whose mothers did not implement anaemia-preventive practices [AOR = 6.41, 95% CI: 1.31-31.32, p = 0.022], while protective factors included maternal satisfaction with health services [AOR = 0.13, 95% CI: 0.03-0.50, p = 0.003] and exclusive breastfeeding [AOR = 0.31, 95% CI: 0.10-0.93, p = 0.036]. ConclusionChild malnutrition and anaemia remain unacceptably high in rural Northeastern Ghana. Co-designed, community-specific and culturally relevant strategies are urgently needed to address these challenges sustainably.

BackgroundEvidence from high-income countries suggests that COVID-19 may adversely affect cognitive functioning, yet population-based data from African countries remain scarce. Understanding how COVID-19 symptom burden, chronic disease, and mental health intersect to shape cognitive outcomes is critical in low-resource settings disproportionately affected by structural and health system constraints. MethodsCross-sectional data were collected from 3,058 adults (M_age = 27.2 years) in Botswana, Ghana, Nigeria, and Tanzania between April 2020 and November 2022 using the Sonde Health platform. Participants self-reported sociodemographic characteristics, COVID-19 symptoms, chronic disease diagnoses, mental health symptoms, physical activity, and sedentary behavior. Executive function was assessed using the Stroop Color-Word interference score. Multivariable linear regression models estimated adjusted mean differences in executive function associated with COVID-19 symptom burden and chronic disease, controlling for sociodemographic, health, mental health, and behavioral factors. Effect modification by country was evaluated using interaction terms (p < 0.10). ResultsExecutive function declined with increasing COVID-19 symptom burden, with Stroop scores decreasing from 0.14 among participants reporting no symptoms to 0.07 among those reporting three or more symptoms (p < 0.001). Being symptom-free was associated with better executive function in Ghana (adjusted mean difference = 0.06; 95% CI: 0.00, 0.11) and Nigeria (adjusted mean difference = 0.07; 95% CI: 0.02, 0.12), but not in Botswana or Tanzania. Lower chronic disease burden was associated with better executive function in Nigeria (adjusted mean difference = 0.16; 95% CI: 0.06, 0.26). Higher educational attainment was consistently associated with better executive function across countries. ConclusionsCOVID-19 symptom burden and chronic disease were associated with poorer executive function across the four African countries studied, with substantial cross-country variation. Education emerged as a consistent protective factor. These findings highlight the importance of integrated, context-sensitive approaches that address both physical and mental health to support cognitive well-being during and beyond public health crises.

ImportanceMultimorbidity, the coexistence of multiple long-term conditions, is a growing public health challenge in South Africa. Understanding the patterns of multimorbidity and their socioeconomic determinants is crucial for developing prevention and control solutions. ObjectiveTo identify and characterize multimorbidity clusters and their socioeconomic determinants in the South African population using data from the Demographic and Health Survey (DHS). Design, Setting, and ParticipantsThis cross-sectional study used data from the recent South Africa DHS, a nationally representative household survey. The study included 5,342 individuals aged 18 years and above who participated in the adult health module of the survey. Data were collected through interviews and biomarker measurements between June and November 2016. Main Outcome and MeasuresThe primary outcome was multimorbidity, defined as the presence of two or more chronic conditions. Twelve chronic conditions were considered: tuberculosis, hypertension, stroke, high blood cholesterol, anaemia, chronic bronchitis, diabetes, asthma, cancer, heart disease, HIV, and chronic pain. Socioeconomic determinants included wealth index, education level, occupation, health insurance, marital status, age, sex, ethnicity, and media access. ResultsOf the 5,342 participants, 2,382 (44.6%) had multimorbidity. Four distinct multimorbidity clusters were identified: "Low Morbidity Group" (low prevalence of chronic conditions), "Cardiometabolic Cluster" (high prevalence of hypertension and diabetes), "Chronic Infectious Disease Cluster" (high prevalence of tuberculosis and HIV), and "Complex Chronic Disease Cluster" (high prevalence of multiple chronic conditions, including cancer, stroke, and heart attack). Multinomial logistic regression analysis revealed socioeconomic disparities in multimorbidity patterns, with lower levels of education, unemployment, and poverty associated with membership in the clusters characterized by a higher burden of chronic diseases. Conclusions and RelevanceThis study identified four distinct multimorbidity clusters in the South African population, each characterized by unique patterns of chronic disease co-occurrence and socioeconomic determinants. The findings highlight the need for tailored interventions and policies that address the specific needs of each multimorbidity cluster while also tackling the underlying social and economic determinants of health.

BackgroundPersons with disabilities (PWDs) experience persistent disparities in accessing equitable and effective healthcare, despite the existence of global human rights frameworks. Structural, financial, attitudinal, and systemic barriers continue to impede their full inclusion in healthcare systems. Over the past fifteen years, frameworks such as the UN Convention on the Rights of Persons with Disabilities (CRPD) have sought to promote inclusive health reforms. However, implementation remains uneven, and a comprehensive synthesis of interventions is lacking. ObjectiveThis scoping review aims to map and synthesise global literature (2010- 2025) on disability-inclusive healthcare systems. It focuses on structural competency, universal design, telehealth, and community-based rehabilitation (CBR), identifying key barriers and facilitators. MethodsThe review will follow Arksey and OMalleys scoping review methodology, incorporating Joanna Briggs Institute (JBI) and PRISMA-ScR guidance. Literature will be identified through searches in PubMed, Scopus, Web of Science, CINAHL, and Google Scholar. Eligibility will be guided by the Population-Concept- Context (PCC) framework, with studies screened and charted independently by two reviewers. Thematic synthesis and evidence mapping will be used to analyse findings. No meta-analysis will be conducted due to expected heterogeneity. Expected OutcomesThe review is anticipated to categorise major systemic barriers (e.g., physical inaccessibility, provider bias, financial exclusion) and identify inclusive interventions aligned with CRPD principles. These insights will support health policy reform and training in disability-responsive care. This review addresses a key gap by systematically synthesising global evidence on disability-inclusive healthcare interventions with a specific focus on structural competency, a lens rarely applied in previous reviews. Ethics and RegistrationNo ethical approval is required. This protocol is registered with the Open Science Framework (OSF) https://doi.org/10.17605/OSF.IO/PWC92.

BackgroundAcute malnutrition remains a major public health challenge among children under five in Malawi due to undetected and untreated cases. While several policies and programmes are in place, they face significant resource input and implementation constraints. In this study, we evaluate the potential health impact and cost-effectiveness of three interventions designed to address constraints along the care pathway in childhood acute malnutrition management. These include improving early recognition of symptoms by caregivers, increasing attendance at routine growth monitoring visits through community outreach, and scaling up the availability of therapeutic food supplements. Methods and FindingsWe use a newly developed model representing the natural history and management of acute malnutrition, implemented within the Thanzi La Onse (TLO) dynamic individual-based simulation framework, which captures the public health system in Malawi. Each of the three interventions is assessed both individually and in combination, translated into seven scenarios which we evaluate in comparison to the status quo. The optimal strategy combines two interventions, improved caregiver awareness of early symptoms with increased availability of therapeutic food supplements. Over five years, this strategy is predicted to avert 840,470 (95% CI: 682,057-998,883) DALYs with total incremental costs of $34 million. This corresponds to an annual health expenditure increase of $0.32 per capita. At a cost-effectiveness threshold of $76 per DALY averted, the strategy results in an incremental net health benefit of 394,252 (95% CI: 235,839-552,665) DALYs averted. ConclusionsThe cost-effective strategy for addressing constraints in childhood acute malnutrition management is simultaneously improving caregiver recognition of early symptoms and expanding therapeutic food supplement availability. Out of the seven scenarios evaluated, this integrated approach was found to be the optimal strategy within the Malawian public health system, yielding substantial health at modest costs. These findings provide critical evidence to inform national policy and guide investment prioritisation for the management of childhood acute malnutrition.