Global Health Action

Background Concurrent wasting and stunting (WaSt) is a severe form of child undernutrition, linked to higher mortality and long-term negative health outcomes. Malnutrition is a significant challenge in Yemen, where the country is experiencing a long-standing conflict, food insecurity, and socioeconomic deprivation. But there is still limited evidence on the burden and determinants of WaSt in Yemen on a national level. This study aimed to estimate the prevalence and identify factors associated with WaSt among children under 5 years in Yemen. Methods We conducted a cross-sectional analysis using nationally representative data from the 2022-2023 Yemen Multiple Indicator Cluster Survey (MICS). A significantly large dataset of 17,734 children aged 0-59 months from all the 22 governorates of Yemen was analyzed. Concurrent wasting and stunting (WaSt) was defined as the coexistence of a weight-for-height z-score (WHZ) below -2 standard deviations and a height-for-age z-score (HAZ) below -2 standard deviations from the WHO Child Growth Standards in the same child. Survey-weighted logistic regression was performed to analyze the factors associated with WaSt among the under 5 children in Yemen. Results The national prevalence of WaSt was 8.4% (95% CI: 7.6-9.2). The highest prevalence of WaSt was found in children aged 12-23 months (12.0%) and in the Western Coastal region (11.6%). After adjustment, male sex (AOR 1.52, 95% CI: 1.30-1.80), residence in the Western Coastal (AOR 2.00, 95% CI: 1.60-2.40), Eastern (AOR 2.00, 95% CI: 1.50-2.70), and Southern regions (AOR 1.60, 95% CI: 1.20-2.10), poorest household wealth (AOR 1.96, 95% CI: 1.30-2.90), moderate (AOR 1.51, 95% CI: 1.13-1.94) and severe food insecurity (AOR 1.94, 95% CI: 1.40-2.60), and recent diarrhoea (AOR 1.22, 95% CI: 1.02-1.44) were associated with higher odds of WaSt. Having a handwashing facility and improved sanitation were protective. Conclusion At least 1 in every 12 under-five children in Yemen was affected by WaSt, and there were significant socioeconomic, geographic, food-security and WASH-related factors influencing this devastating outcome. Instead of simple, one-dimensional approaches, multi-sectoral interventions are needed to address this adversity. And those efforts must be integrated into the system, interconnected with each other and specifically targeted to vulnerable children and households.

Background Micronutrient deficiencies are a major public health problem for women of reproductive age (WRA), especially in conflict settings, such as Yemen. However, there is little information on knowledge, attitudes and practices (KAP) toward micronutrient-rich foods among WRA in Aden Governorate. This study aimed to assess knowledge, attitude and practices of WRA toward micronutrient rich foods attending health facilities in Aden Governorate, Yemen. Methods A facility based descriptive cross-sectional study was conducted among 348 WRA aged 15-49 years who visited selected primary health care and maternal and child health facilities in the eight districts of Aden governorate, Yemen. Data were collected using structured interviewer administered questionnaire which was adapted from guidelines of Food and Agriculture Organization and World Health Organization. Chi-square test and Pearson correlation were used to assess the association between the KAP indicators and sociodemographic characteristics. Results The mean age of the participants was 26.3 {+/-} 8.8 years and 73.9% had high-grade education. In general, 77.9% identified micronutrients as essential for health and 92.8% correctly identified liver/red meat as micronutrient-rich food. However, only 29.6% identified iodized salt as a source of iodine. Although 95.7% perceived supplementation as important, only 9.8% reported regular supplement use. The most commonly reported barrier to access to nutritious food was high food cost (43.4%) and 70.6% perceived healthy foods as too expensive. Restriction in daily consumption was observed for eggs (36.2%), meat/poultry/fish (32.2%) and fruits (13.2%). Education was moderately positively correlated with micronutrient knowledge (r = 0.514, p < 0.001) and age was weakly positively correlated (r = 0.162, p = 0.002). Conclusion WRA in Aden had good knowledge and positive perceptions about micronutrients and supplementation but major gaps in dietary practices and access to affordable nutritious foods. Integrated, culturally appropriate interventions that include nutrition education and improved access to affordable micronutrient-rich foods and appropriate supplementation are needed.

BackgroundModern contraceptive use remains low in many sub-Saharan African countries, including Mozambique, limiting progress towards sexual and reproductive health and Sustainable Development Goals (SDGs). Understanding the prevalence, determinants, and inequalities in modern contraceptive use based on Mozambique-wide national survey is critical to informing effective family planning interventions. MethodWe analyzed the most recent data from the Mozambique Demographic and Health Survey (DHS), 2022-2023, focusing on a total of 11,783 reproductive-aged women (15-49 years). The outcome variable was current use of modern contraceptives. Several individual, household-related and community determinants of modern contraceptives were examined employing multivariable logistic regression. Adjusted odds ratio with corresponding confidence intervals and p-values were reported. Erreygers Concentration Index (ECI) and concentration curves were used to assess wealth-and empowerment-related inequalities. All analyses were conducted on weighted data. ResultOverall, 27.6% of women reported current use of modern contraceptive methods. Younger age, higher education, being employed, higher parity, greater wealth, and a partner with higher education were positively associated with modern contraceptive use. Significant wealth-related (ECI = 0.32, p < 0.001) and womens empowerment-related (ECI = 0.26, p < 0.001) inequalities were observed, indicating that wealthier and more empowered women had higher use of modern contraceptive methods. ConclusionModern contraceptive use in Mozambique is suboptimal and influenced by a combination of individual, household, and contextual factors, with marked socioeconomic and empowerment-related disparities. Policy interventions should focus on improving access to and encouraging use of contraceptives for economically disadvantaged and women with low-empowerment, promoting womens autonomy, enhancing male involvement, and leveraging media and community-based programs to increase awareness and uptake. Equity-focused strategies are essential to achieving national and global family planning targets.

Abstract Immunisation system performance depends on effective service delivery and the generation of high-quality data to support planning and decision-making. With the recent scaling down of external health funding, Kenya must identify sustainable strategies to strengthen the resilience of its immunisation programme. We conducted a three-part qualitative study comprising thematic analysis, application of complex adaptive systems (CAS) theory, and the Meadows leverage-points framework. Thematic key personnel interviews were conducted with selected Essential Programme on Immunisation (EPI) personnel from 14 counties and sub-counties in Kenya to explore factors influencing immunisation system performance. Vaccine distribution, health workforce shortages and immunisation financing emerged as the dominant themes affecting immunisation performance. Analysis through a CAS lens revealed that reinforcing feedback loops were more dominant than balancing loops, suggesting that system dysfunctions were more influential than adaptive self-correcting mechanisms, resulting in a tendency toward negative system behaviour. Application of the Meadows framework showed that existing interventions were largely concentrated at lower leverage levels, which are more likely to generate short-term operational improvements, while higher-leverage interventions with the potential for long-term system transformation remained underutilised. We concluded that systems-thinking approaches offer a powerful framework for understanding and improving immunisation system performance. They facilitate the identification of vulnerabilities and bottlenecks, while informing the design of higher-leverage interventions capable of producing sustainable and transformative improvements across the system.

Background Despite substantial improvements in maternal and child health over the past two decades, preventable maternal and neonatal morbidity and mortality remain major public health concerns in rural Bangladesh. Community-based interventions involving Community Volunteers (CVs), Community Groups (CGs), and Community Support Groups (CSGs) have been introduced to strengthen maternal and child health (MCH) services through health promotion, community engagement, and improved linkage with primary healthcare facilities. This study explored the roles, challenges, and opportunities of these community-based platforms in improving maternal and child health services. Methods A qualitative study was conducted in Kalaroa Upazila of Satkhira District, Bangladesh, between July and October 2020. Data were collected through focus group discussions and in-depth interviews with mothers, Community Volunteers, Community Group members, and Community Support Group members. Participants were purposively selected to capture diverse experiences from intervention and comparison areas. Interviews were conducted using semi-structured guides, audio-recorded with informed consent, transcribed verbatim, translated into English, and analyzed thematically using an inductive approach. Results Participants from intervention areas demonstrated greater knowledge of birth preparedness, antenatal care, pregnancy danger signs, institutional delivery, postnatal care, and newborn care than those from comparison areas. Community Volunteers, CGs, and CSGs played important roles in identifying pregnant women, conducting household counselling, promoting skilled maternal healthcare, facilitating referrals, and strengthening community participation. Participants perceived that these activities increased maternal awareness, improved health-seeking behaviour, and enhanced utilization of maternal and newborn health services. However, persistent barriers, including socio-cultural beliefs, financial constraints, transportation difficulties, shortages of skilled healthcare providers, and inadequate logistical support for community volunteers, continued to limit equitable access to quality services. Participants recommended strengthening community awareness programmes, improving community clinic readiness, enhancing referral systems, and providing regular training and supportive supervision for community-based health workers. Conclusions Community-based maternal health interventions involving Community Volunteers, Community Groups, and Community Support Groups contribute to improved maternal knowledge, health-seeking behaviour, and utilization of essential maternal and newborn health services in rural Bangladesh. Sustaining these gains will require stronger primary healthcare services, continued community engagement, and targeted strategies to address persistent health system and socio-cultural barriers. These findings provide important evidence for strengthening community-based maternal and child health programmes in Bangladesh and similar resource-constrained settings.

Introduction Literacy is a determinant of mental health, wellbeing, and social participation. Although literacy interventions improve educational and socioeconomic outcomes, their effects on mental health and social participation are poorly evidenced. We aimed to assess the feasibility and acceptability of a group-based literacy and numeracy intervention and explore its effects on literacy, mental health, numeracy, wellbeing, and social participation. We also estimated implementation costs. Methods We conducted a mixed-methods study using an uncontrolled pre-post design among women in low-income urban communities in Lucknow, India. A total of 115 women were recruited to a 17-week group literacy intervention using the Accelerating Learning for All literacy intervention. Outcomes measured at baseline, midline, and endline used literacy and numeracy assessments and validated scales of mental distress, wellbeing, and social participation. Quantitative data were analysed using multilevel mixed-effects models. Qualitative interviews and focus groups were analysed thematically. Costs were calculated per participant. Results The intervention was feasible and acceptable with functional recruitment of 71% (82/115), 74/82 participants (90%) completed it (retention), and mean attendance of 69% of scheduled sessions. In multilevel mixed-effects models, mean literacy scores increased by 29.5 (95% CI: 23.6, 35.3) between baseline and endline, while mean mental distress (SRQ20) decreased by 3.4 (95% CI: 2.2, 4.6), mean mental wellbeing (WEMWBS) improved by 2.6 (95% CI: 0.1, 5.1), while social exclusion (P scale) declined by 4.1 (95% CI: 1.6, 6.5). Qualitatively, participants described greater confidence, autonomy, financial literacy, and social support. Implementation enablers included local facilitators. Implementation cost was US$25 per participant. Conclusion This low-cost literacy intervention was feasible and acceptable for women in low-income urban communities in India. Findings provide preliminary evidence of improvements in literacy, mental health, and social participation. Controlled studies are needed to establish causal effects, long-term outcomes, and scalability.

Menstrual health remains a neglected public health challenge in India, where persistent stigma, incomplete education, inadequate sanitation, and limited access to menstrual health resources can adversely affect health and social participation. Institution-based educational programs represent an underexplored opportunity to improve menstrual health literacy while promoting more inclusive discussions surrounding menstruation. Bridging this gap, an exploratory, prospective educational evaluation was conducted at a hospital in Coimbatore, Tamil Nadu and an engineering college in Wayanad, Kerala. Anonymous pre- and post-course surveys assessed menstrual health knowledge, attitudes, practices, perceived barriers, and perspectives on emerging digital health technologies. Quantitative responses were summarized descriptively, and open-ended responses were reviewed to identify recurring perspectives that contextualized the quantitative findings. The standardized educational program integrated evidence-based menstrual health education with discussions of bioengineering and wearable technologies. Eighty-three participants completed the pre-course survey, 68 attended the educational program, and 20 completed the post-course survey. Because responses could not be linked at the individual level, the survey cohorts were compared descriptively. At baseline, 80 of 82 respondents (97.6%) recognized menstruation as a biological process, yet only 38 of 82 (46.3%) indicated that it was not solely a woman's issue. The mean agreement that menstruation remained taboo was 7.44 of 10 (SD 1.99; n=78), and 51 of 77 respondents (66.2%) reported that they or others avoided activities during menstruation. Painful periods were identified as a barrier by 56 of 67 respondents (83.6%), and 18 of 67 (26.9%) considered institutional or community toilets insufficiently clean and private for menstrual management. Open-ended responses illustrated how pain, fear of leakage, stigma, and inadequate facilities constrained participation in school, physical activity, and social life. These findings document a marked gap between basic biological recognition and the social normalization and practical support of menstruation in two South Indian institutions, and support further evaluation of gender-inclusive, context-responsive menstrual health education using paired assessments, stronger follow-up, comparison groups, and long-term outcomes.

ABSTRACT Background: Poliomyelitis remains a major public health concern where population immunity is incomplete and circulating vaccine-derived poliovirus (cVDPV) persists. Although Nigeria interrupted wild poliovirus (WPV) transmission in 2020, cVDPV cases continue to pose challenges, particularly in parts of northern Nigeria. Modern control strategies require a synergy of routine immunization, supplementary campaigns, disease surveillance, and community trust. Methods: This multicentre descriptive cross-sectional study evaluated community knowledge and attitudes towards polio immunization across 37 Local Government Areas (LGAs) in 20 states and the Federal Capital Territory (FCT). A multistage sampling strategy was utilized to select 1,850 adult respondents (50 per LGA) spanning rural, semi-urban, and urban settlements. Results: Overall, 40.4% (n = 747) of respondents demonstrated good knowledge, while 58.4% (n = 1,080) displayed positive attitudes towards polio immunization. A striking disparity was observed across residence classifications: respondents in urban/semi-urban LGAs exhibited significantly higher levels of good knowledge (51.7%, 569/1,100) compared to those in rural LGAs (23.7%, 178/750; {chi} = 144.00, df = 1, p < 0.001). Main sources of information were Questionnaire responses (53.6%) and community and Traditional leaders(17.2%). Conclusion & Recommendations: Substantial knowledge deficits persist in rural northern Nigerian communities despite generally favorable attitudes. Interventions must prioritize localized risk communication, involvement of traditional/religious leaders, strengthening routine primary healthcare integration, and targeting zero-dose children in hard-to-reach areas. Keywords: Poliomyelitis, Oral Polio Vaccine, Vaccine Hesitancy, Northern Nigeria, Community Health, Routine Immunization.

Background Chronic diseases are the leading causes of illness, disability, and death worldwide, with a disproportionate burden in low- and middle-income countries. Hospitalization is a critical outcome in chronic disease management, reflecting disease severity, treatment failure, and healthcare utilization. However, data on hospitalization burden and its associated factors among chronic disease patients in Ethiopia, are limited. This study aimed to determine the rate of hospitalization and its associated factors among patients with chronic diseases attending a tertiary hospital in Wolaita Zone, South Ethiopia. Methods A facility-based cross-sectional study was conducted among 321 patients with chronic diseases attending the chronic follow-up clinic at Wolaita Sodo University Comprehensive Specialized Hospital from November to December 2022. Consecutive recruitment was used, with unique medical record numbers tracked to prevent double recruitment. Data were collected through structured questionnaires and medical record review. Negative binomial regression was used to identify factors associated with hospitalization rate, with incidence rate ratios (IRR) and 95% confidence intervals (CI) reported. A p-value < 0.05 was considered statistically significant. Results Of the 321 participants, 66% reported at least one hospitalization while on treatment, with a mean of 1.70 {+/-} 1.81 hospitalizations per patient. Drug discontinuation was the most frequently documented reason for hospitalization (39.5%), followed by disease complications (22.3%) and infections (11.7%). Multimorbidity was prevalent, with the majority (59.8%) had 2-3 conditions, and a mean of 2.40 {+/-} 1.02 chronic diseases per patient. Male sex was associated with a higher hospitalization rate, while regular physical exercise was associated with a lower number of hospitalizations. Conclusion This study found a high burden of hospitalization among chronic disease patients, with drug discontinuation being the leading documented reason. Male sex and regular physical exercise were significantly associated highlighting the need for medication adherence support programs and structured exercise programs integrated into routine chronic disease care, as well as gender-sensitive interventions.

Modern contraceptive use in Nigeria remains low and unequally distributed. Existing research has extensively examined socioeconomic and demographic determinants, but less is known about how multiple dimensions of disadvantage coexist and relate to contraceptive use. This study identified distinct profiles of cumulative vulnerability among Nigerian women, examined inequalities in modern contraceptive use across these profiles, and assessed changes between 2018 and 2024. We analyzed pooled cross-sectional data from the 2018 and 2024 Nigeria Demographic and Health Surveys, comprising 80,871 women aged 15-49 years. Latent class analysis was used to identify vulnerability profiles based on six indicators of socioeconomic, informational and empowerment-related disadvantage. Survey-weighted and multilevel logistic regression models were used to examine associations between vulnerability profiles and modern contraceptive use, including differences by survey year. Average marginal effects and adjusted predicted probabilities were estimated. Five vulnerability profiles were identified. The extreme vulnerability profile, characterized by predominantly rural residence, limited education, minimal internet and media access, and low decision-making autonomy, was the largest, accounting for 39.2% of women. Its prevalence increased from 38.3% in 2018 to 40.1% in 2024, while the proportion of women in the most advantaged profile increased from 10.4% to 15.7%. Compared with women in the most advantaged profile, those in the extreme vulnerability profile had a 30.9-percentage-point lower adjusted probability of modern contraceptive use (95% confidence interval: -32.8 to -29.0). This difference was 26.5 percentage points (95% confidence interval: -28.4 to -24.7) after accounting for variation between survey clusters. Adjusted contraceptive use increased across all profiles between 2018 and 2024, but substantial inequalities persisted. Evidence of a differential change for the extreme vulnerability profile was present in the survey-weighted model but not in the multilevel model. Modern contraceptive use in Nigeria is strongly associated with cumulative vulnerability. Despite improvements between 2018 and 2024, substantial inequalities persisted across vulnerability profiles. These findings underscore the importance of addressing overlapping socioeconomic, informational and empowerment-related barriers and monitoring contraceptive-use inequalities across population groups.

Background Circadian eating patterns, referring to the timing and regularity of meal intake relative to the body's internal clock, are increasingly recognized as important determinants of metabolic health among university students. However, empirical evidence on how the university food environment influences circadian eating patterns remains scarce, particularly within Nigerian tertiary institutions. This study assessed the influence of the university food environment on the circadian eating patterns of undergraduate students at the University of Medical Sciences, Ondo (UNIMED). Methods A descriptive cross-sectional study was conducted among 302 undergraduate students selected through a multistage sampling technique. Data were collected using a structured, facilitator-administered questionnaire assessing socio-demographic characteristics, the university food environment (UNI-FOOD, across six domains), circadian eating patterns, influencing factors, and anthropometric measurements. Data were analysed using SPSS version 27, employing descriptive statistics, chi-square tests, and univariable and multivariable binary logistic regression, with significance set at p < 0.05. Results The mean age of respondents was 20.03 {+/-} 2.58 years, and the majority were female (68.9%). Students generally perceived the university food environment as moderate, with affordability rated the weakest domain (mean 2.65 {+/-} 0.51) and food promotion/visibility the strongest (3.27 {+/-} 0.52). Most respondents (71.9%) exhibited moderate circadian eating patterns, while 21.2% had poor patterns. A significant association was found between the overall food environment and circadian eating patterns ({chi}2 = 44.369, p < 0.001). After adjustment, poor physical food accessibility (AOR = 6.44, 95% CI: 2.00-20.72, p = 0.002) and a poor food policy environment (AOR = 9.53, 95% CI: 3.51-25.87, p < 0.001) were independent predictors of poor circadian eating patterns. Circadian eating pattern was also significantly associated with BMI category ({chi}2 = 7.346, p = 0.025). Conclusion The university food environment, particularly physical accessibility and food policy, significantly influences circadian eating patterns among undergraduate students. Improving campus food accessibility and implementing supportive food policies may promote healthier meal timing and nutritional outcomes.

Aim: This study aimed to estimate the prevalence and distribution of minimum dietary diversity for women (MDD-W) and underweight/thinness and examine sociodemographic and dietary factors associated with underweight/thinness among Cambodian women aged 15-49 years. Methods: We conducted a cross-sectional analysis of 9,181 women aged 15-49 years (9,262.5 weighted) from the 2021-22 Cambodia Demographic and Health Survey. Survey-weighted descriptive statistics and provincial mapping were used to describe MDD-W, food-group consumption and underweight/thinness. Rao-Scott chi-square tests assessed group differences, and survey-weighted logistic regression estimated factors associated with underweight/thinness. MDD-W and household wealth were retained a priori in the adjusted model, while other covariates with an overall crude Wald P value <0.20 were included. Results: The analysis included 9,181 women (9,262.5 weighted). Overall, 57.2% achieved MDD-W, and 6.7% had underweight/thinness; 22.8% were overweight, and 5.7% had obesity. Underweight/thinness was highest among women aged 20-24 years (17.7%). Achieving MDD-W was not associated with underweight/thinness in crude analysis (OR 0.93, 95% CI 0.74 to 1.17; P=0.545). In the adjusted analysis, the association remained imprecise (aOR 0.86, 95% CI 0.67 to 1.09; P=0.219). Provincial estimates showed geographic variation in both MDD-W and underweight/thinness. Conclusion: More than half of Cambodian women achieved MDD-W, while underweight/thinness coexisted with overweight and obesity. MDD-W was not clearly associated with underweight/thinness. These findings support monitoring dietary diversity, anthropometric status, and socioeconomic inequalities together in women's nutrition.

Abstract Background: The risk of developmental delays among infants in the refugee camps is high due to prolonged exposure to adverse situations such as poverty, violence, lack of access to basic necessities, safety, poor maternal mental health and inadequate access to healthcare. To reduce the risk of developmental delays, a contextualized early child development and maternal mental health care package, was implemented through enabling and engaging the refugee women as community-based care providers. Methods: The process evaluation study was conducted using a mix-method design to explore the acceptability, feasibility, appropriateness, adoption, and cost of the Early Child Development (ECD) and maternal mental health care package in refugee camps, by applying Proctor et al framework. Data on quantitative indicators was reviewed for 348 mother-child dyads in the intervention arm. Qualitative interviews were conducted with 12 mothers, 5 community health workers, and 2 members of the implementing research team. Incremental Cost-Effectiveness Ratio (ICER) was calculated using the healthcare provider perspective to estimate the incremental cost-effectiveness of the ECD care package in reducing proportion of children with two or more developmental delays. Results: Home-based delivery of counselling sessions was a key facilitator in ensuring the successful implementation of intervention. The delivery of intervention by modestly educated refugee women reduced cultural and language barriers and facilitated the home-based delivery of sessions. Mothers found the recommended activities feasible to do in routine as they were culturally appropriate, and did not require maternal literacy or additional resources. The intervention was cost-effective with an ICER of 63 USD in reducing the proportion of children with two or more developmental delays by one percentage point. Conclusion: Contextualized ECD and maternal health care package is a potentially replicable and scalable intervention for refugee healthcare systems.

Background: A responsive and resilient health system that is informed by community needs and guided by evidence-based interventions is fundamental to delivering quality essential health services and achieving Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs). Ethiopia committed to improve access to and quality of essential health services through the Health Extension Program Optimization (HEPO) roadmap, which restructured primary healthcare facilities into three categories i.e., Basic Health Posts (BHPs), Comprehensive Health Posts (CHPs), and Health Extension Program units imbedded within Health Centers (HCs). However, evidence on the reproductive, maternal, newborn, and child health (RMNCH) service availability and readiness of these restructured primary health-care facilities remains limited. Methods: This multi-region cross-sectional facility based study was conducted between December 2024 and February 2025. A structured questionnaire adapted from the World Health Organization Service Availability and Readiness Assessment (SARA) was used to measure service availability, general facility readiness, and RMNCH service-specific readiness using predefined domains and tracer items. Differences across facility types were assessed using Kruskal-Wallis or categorical association tests, with Benjamini-Hochberg adjustment for multiple comparisons. Multivariable linear regression estimated the adjusted differences in overall RMNCH readiness, controlling for region, urban-rural residence, and log-transformed catchment population, with robust standard errors clustered at woreda level. Results: A total of 305 primary health care facilities were assessed, including 107 BHPs (35.1%), 142 CHPs (46.6%), and 56 HCs (18.4%). Nearly all BHPs were located in rural settings (99.1%), compared with 86.6% of CHPs and 71.4% of HCs. The median general health facility readiness were increased significantly across facility levels, from 33.1% (IQR: 24.4-40.7) in BHPs to 62.9% (IQR: 54.1-71.4) in CHPs and 89.6% (IQR: 81.3-93.6) in HCs (p<0.001). And the median overall RMNCH service readiness was 67.9%, 77.8%, and 91.1% for BHPs, CHPs, and HCs, respectively (p<0.001). skilled Birth Attendance readiness was demonstrated the largest gap between facility types. Compared with CHPs, BHPs scored 9.9 percentage points lower in adjusted RMNCH service readiness (95% CI: -14.7 to -5.1; p<0.001), while HCs scored 8.7 points higher (95% CI: 1.7-15.8; p=0.015). Conclusions: The restructured primary healthcare facilities expanded access to essential services, particularly through CHPs, which occupy an intermediate position between BHPs and HCs through substantial expansion of RMNCH service packages for underserved communities. Nevertheless, significant gaps remain in staffing, infrastructure, commodities, diagnostics, and childbirth readiness. Future HEPO scale-up should prioritize strengthening childbirth-readiness packages and ensuring reliable supply chains for essential medicines and diagnostics.

Background Urban inequities are often masked by the misleading notion of an urban advantage, despite persistent unequal access to quality healthcare services. Moreover, negative perceptions about the urban poor and slum-dwellers persist, despite their substantial role in driving and holding up the urban economy. It is thus essential to work with the media to bring visibility to these realities, raise public awareness, and inform more equitable health policies. In low- and middle-income countries (LMICs), evidence remains scarce on how health-related information from media outlets influences policy decisions. This study aimed to understand how journalists get information, engage with stakeholders in the health systems, and contribute to influencing urban health discourse in Bangladesh and Nepal. Methods We conducted a cross-country exploratory qualitative study comprising 30 key informant interviews from Bangladesh and Nepal, including 17 journalists, 10 health policymakers, and 3 public health advocates. Participants were purposively selected to ensure diversity across media types, gender, and professional roles. Interviews were conducted between September 2024 and March 2025. Data were transcribed, translated, and analyzed thematically using NVivo software. Cross-country comparative analysis was carried out to identify common themes and contextual differences. Findings Across both countries, participants relied on multiple and diverse information sources. Government data were often prioritized as a primary source of information, although they were shaped by political influences and accessibility constraints. Research evidence was valued but underutilized due to difficulties in interpreting scientific articles. Urban health issues received limited priority in health news reporting due to journalists constraints in covering multiple issues and financial constraints for in-depth coverage. Additional challenges included inadequate health and urban health-related training, limited fellowship opportunities for investigative reporting, and restricted access to data, while health policymakers and public health advocates frequently questioned the credibility and use of media-reported information. Media engagement in policymaking largely remained indirect and issue-focused or event-driven. However, consistent media coverage raised public awareness and generated public pressure and, at times, indirectly influenced health policy decisions such as immediate inspection after reporting on pesticides, installation of oxygen plants during the pandemic, dengue surveillance, and tobacco control measures and actions. Conclusion In Bangladesh and Nepal, news media play a significant but indirect role in shaping urban health policy decisions. Enhancing journalists capacity, improving access to credible information and data, and continuous engagement of stakeholders could strengthen evidence-informed urban health policymaking. Furthermore, establishing greater independence of journalists and government and community recognition of their responsible health reporting could help and motivate the media to contribute more meaningfully to public debate and policy reform processes.

Introduction:Although the COVID-19 pandemic clearly showed the potential consequences of a world without vaccinations, vaccine hesitancy is likely to be more pronounced in the post-COVID-19 era. The introduction of human papillomavirus (HPV) vaccines in this context is likely to raise particular concerns. In Tunisia, decision-makers have prioritized the introduction of HPV vaccine into the immunization schedule. This study assessed individual barriers and facilitators to HPV vaccine acceptability in Tunisia, with the aim of guiding an effective communication strategy for HPV vaccination campaigns in Tunisia and neighboring countries in a post-pandemic context.Methods: Using a qualitative design, we conducted 14 focus groups (FG) with healthcare professionals (HCP) (N=32) and community representatives (CR) (N=89) in five regions of the country. The discussion followed a semi-structured guide designed on the basis of vaccine hesitancy determinants matrix. Transcripts were deductively analyzed according to the 'social processes' and 'thinking and feeling' of the behavioural and social drivers (BeSD) Framework. Inductive approach was used to analyze participants suggestions for promoting HPV vaccination.Results:The FG analysis demonstrated that the historically strong trust in vaccination in Tunisia has weakened after the COVID-19 pandemic. Mistrust of health system and experts, the pandemic management and vaccine mandates measures had negative influence on the vaccine attitudes in a post pandemic Tunisian context. Persistent concerns about COVID-19 vaccines safety were frequently intertwined with widespread distrust of pharmaceutical companies and their profit motives, perceived as imposing inequitable access and lower-quality vaccines on countries in the Global South. These concerns fueled confusion about vaccines side effects. The weakening of immunity was recurring, as well as memory issues, impacts on fertility, and sudden deaths. Regarding information, our research revealed that although digital platforms were perceived as widely used, a significant part of the population interviewed considered public TV channel, as the most reliable source of health information.Conclusions: Emphasizing how the pandemic has shaped individual and collective perceptions and attitudes toward vaccination, our findings underline the importance of leveraging lessons learned from the pandemic to develop a context tailored and coherent communication strategy for successful HPV vaccine implementation.

Background: Access to maternal healthcare services is essential for improving maternal and neonatal health outcomes. Health insurance can reduce financial barriers to healthcare access and may facilitate utilisation of maternal health services, and contextualized evidence can further support policy development and implementation. This study assessed the association between health insurance coverage and utilisation of antenatal care (ANC), institutional delivery, skilled birth attendance and postnatal care (PNC) services among women in Nepal. Methods: This study used data from the 2022 Nepal Demographic and Health Survey (NDHS), a nationally representative cross-sectional survey. The analysis included women aged 15-49 years who had a live birth within the 24 months preceding the survey. Inverse probability of treatment weighting (IPTW) based on propensity scores was applied to balance measured socioeconomic and demographic characteristics between insured and uninsured women. Weighted marginal structural models were used to estimate the association between health insurance coverage and maternal healthcare utilisation outcomes. Robustness was assessed using alternative propensity score specifications and E-values for unmeasured confounding. Results: Among 14,845 women interviewed, 2,078 reported a recent live birth and were included in the analysis (unweighted; 1,998 when survey-weighted). Of these, 201 (9.7%) had health insurance coverage and 1,877 (90.3%) were uninsured. After adjustment using IPTW, health insurance coverage was associated with significantly higher utilisation of maternal healthcare services. Insured women had more than twice the odds of attending at least four ANC visits compared with uninsured women (AOR 2.14; 95% CI 1.15-3.98). Similarly, insured women had higher odds of receiving a PNC check-up within two days of delivery (AOR 2.05; 95% CI 1.28-3.27) and receiving PNC from a skilled provider (AOR 1.94; 95% CI 1.23-3.06). Although insurance coverage was positively associated with institutional delivery (AOR 1.55; 95% CI 0.91-2.62) and skilled birth attendance (AOR 1.57; 95% CI 0.90-2.72), these associations did not reach statistical significance. Conclusion: Health insurance coverage was associated with greater utilisation of antenatal and postnatal healthcare services among women in Nepal. However, no significant association was observed for institutional delivery or skilled birth attendance. Expanding health insurance coverage, particularly among underserved populations, may help improve maternal healthcare utilisation and support progress towards universal health coverage and maternal health-related Sustainable Development Goals.

High calorie intake of unhealthy foods are the main factor of overweight and obesity. In food environment, food retailers are the biggest player in shapping consumers purchase pattern. In this South East Asia Obesogenic Food Environment (SEAOFE) study, we aimed to to explore retailer perspectives on stocking decisions and barriers to stocking healthy food products in urban poor areas of Kuala Lumpur, Malaysia. The study was conducted using purposive sampling at three parliaments which have the highest urban poor population. 35 retailers who involved in procurement, retail operations, and product placement, with at least one year of experience, were selected as participants of this study. The interview were conducted face-to-face and been transcribed verbatim for data analysis. Nine key themes emerged regarding factors affecting stocking decisions: 1) consumer demand, 2) consumer satisfaction and feedback, 3) profitability, 4) forecast software, 5) fast-moving products, 6) product healthiness, 7) availability, 8) seasonality, and 9) e-commerce; while four key barriers in stocking healthy food products included 1) price, 2) shelf life, 3) consumer demand and preferences, and 4) availability of supply. This study showed that the urgency of targeted interventions to improve healthy food supply through collaboration from retailers, suppliers and policymakers. By addresing the issue will help to increase consumption of healthy foods and improve the health of the residents within the urban poor areas of Kuala Lumpur.

Background: The mothers of children with autism spectrum disorder (ASD) are more stressed than those of neurotypical or any other children with special needs. There remains a notable lack of contextually grounded evidence on the experiences of mothers raising children with autism in resource-constrained settings of a lower middle-income country (LMIC). Methodology: A qualitative phenomenological study was carried out at a government-run autism rehabilitation center over a period of six months. The main purpose of the study was to explore the lived experiences of the mothers of autistic children in a setting like Karachi, Pakistan. Twenty-five mothers of 3-18 years old children enrolled in the selected facility participated in two focus group discussions (FGD) and seven In-depth interviews (IDIs) until data saturation was achieved. Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines and Guba s constructs of trustworthiness were followed. Results: Several themes were derived, corresponding to the different layers of the Ecological Systems Theory. Themes included maternal emotional journey, interpersonal relationships, societal perceptions, access to support services and adaptation over time. Conclusion: Mothers of children with Autism in Pakistan face significant challenges at the personal, family, societal, and support systems levels. Removing misconceptions and improving access and quality of services to children with Autism and their families is essential for easing their burden.

Bangladeshi immigrants are a rapidly growing U.S. immigrant population, yet little is known about how pre-migration healthcare experiences shape healthcare use after migration. This qualitative study explored how healthcare norms from Bangladesh influence the health-seeking behaviors of Bangladeshi immigrants in the U.S., the barriers and facilitators they encounter, and their perceptions of care quality. Semi-structured interviews were conducted with 29 Bangladeshi-born adults living in the U.S. from September 2020 to January 2021 and analyzed using the constant comparative method. Participants described healthcare expectations shaped by the healthcare system of Bangladesh, which is mostly out-of-pocket and resource-limited, including symptom-driven rather than preventive care, self-treatment, and family-based caregiving. In the U.S., they faced barriers such as insurance confusion, long waits, difficulty establishing care, coverage disruptions, financial concerns, and language challenges. While participants valued culturally and linguistically concordant care, preferences for Bangla-speaking or co-ethnic providers varied, especially when perceived quality was low. Community networks, online information, self-education, and self-advocacy helped facilitate care. Provider communication strongly shaped perceptions of U.S. healthcare: feeling heard, respected, and well-informed promoted trust, while dismissal or delayed diagnosis led to skepticism and avoidance. These findings suggest that healthcare engagement of Bangldeshi immigrants is shaped by both structural barriers and pre-migration norms. Improving access will require attention to subgroup-specific histories, insurance navigation, language access, and the relational quality of care.