Global Health Action

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.

Introduction: Nutritional challenges are a global public health concern, especially among children under five in sub-Saharan African countries. The coexistence of an overweight/obese mother and an underweight child in the same household is recognized as a dual burden of malnutrition (DBM). Our study aimed to examine the prevalence and associated factors of DBM among mother-child dyads in Mozambique. Methods: We used nationally representative, cross-sectional data from the Mozambique Demographic and Health Survey 2022-2023 (n=3,605 mother-child dyads). The children's undernutrition condition and maternal BMI status were calculated using the WHO standard reference guidelines. The outcome variable, dual burden of malnutrition, was then created if the children had any undernutrition condition (stunting, wasting, or undernutrition) and the corresponding mother was overweight/obese. Multivariable binary logistic regression, Erreygers's concentration index, and concentration curve were analyzed to determine associated factors and social inequalities. Results: The prevalence of the dual burden of malnutrition was about 5.51%. Mothers aged [&ge;]34 years [aOR (95% CI): 4.01(1.44, 11.14); p<0.05] and mothers with four or more children [aOR (95% CI): 2.68(1.29, 5.57); p<0.05] had higher odds of DBM. Rural residence and using unimproved toilet facilities (latter an indicator) were also significantly associated with experiencing DBM. Additionally, maternal age modified the association between women's empowerment and mother-child DBM. Women aged 15-19 years at the lowest and highest empowerment levels were more likely to experience DBM compared to women 20 years or older. A positive and statistically significant concentration index indicates that wealth-related inequalities exist, with DBM more concentrated among wealthier mother-child dyads. Conclusion: Our study highlights the persistence of household-level DBM in Mozambique. These findings emphasize the need for targeted interventions addressing social and economic inequalities, including poor sanitation marker of broader household deprivation. Prioritizing integrated maternal-child nutrition interventions within national strategies is essential to improving equity in nutrition and health outcomes.

ObjectiveThis study aimed to examine the association of regional disparity and socioeconomic determinants with acute malnutrition among children aged 6-59 months attending selected public hospitals in Karachi. MethodsA hospital-based unmatched case-control study was conducted on 394 participants with 197 cases and 197 controls. After developing a self-structured questionnaire based on maternal and child components, wealth quintiles were made using principal component analysis. A univariate and then a binary logistic regression was applied. ResultsThe odds of acute malnutrition were 1.2 times higher in male children. The variables significantly associated with childhood acute malnutrition were regional disparity [AOR=2.3, 95%, C. I (1.4-3.8), p-value <0.01], mothers illiteracy [AOR = 3.6, 95% C. I (1.9-7), p-value <0.001], mothers primary education [AOR =1.1, 95% C. I (0.5-2.2), p-value <0.01], fathers illiteracy [AOR= 2.4, 95% C. I (0.8-4.4), p-value 0.03], fathers primary education [AOR =1.1, 95% C. I (0.4-1.9), p-value <0.01], poorest households [AOR= 2.2, 95% C. I (1.07-4.7), p-value <0.01], and childs age [AOR =0.945, 95% C. I (0.92-0.96), p-value <0.01]. ConclusionRegional disparity was found to be significantly associated with acute malnutrition among children along with household wealth status, mothers illiteracy, and fathers illiteracy. Hence there is a need to direct the focus of policy makers to work on these factors to eradicate acute malnutrition among children.

BackgroundThe COVID-19 pandemic impacted diabetes mellitus clinical outcomes and chronic care globally. However, little is known about its impact in low-resource settings such as sub-Saharan Africa. Hence, to address this, we systematically conducted a scoping review to explore the COVID-19 impact on diabetes outcomes and care in countries of sub-Saharan Africa. MethodsWe applied our search strategy to PubMed, Web of Science, CINAHL, African Index Medicus, Google Scholar, Cochrane Library, Scopus, Science Direct, ERIC and Embase to obtain relevant articles published from January 2020 to March 2023. Two independent reviewers were involved in the screening of retrieved articles. Data from eligible articles were extracted from quantitative, qualitative and mixed methods studies. Numerical data were summarised using descriptive statistics, while a thematic framework was used to categorise and identify themes for qualitative data. ResultsWe found 42 of the retrieved 360 articles eligible, mainly from South Africa, Ethiopia and Ghana (73.4%). COVID-19 increased the risk of death (OR 1.30 - 9.0, 95% CI), hospitalisation (OR 3.30 - 3.73: 95% CI), and severity (OR: 1.30-4.05, 95% CI) in persons with diabetes mellitus. COVID-19 also increased the risk of developing diabetes mellitus in hospitalised cases. The pandemic, on the other hand, was associated with disruptions in patient self-management routine and diabetes mellitus care service delivery. Three major themes emerged, namely, (i) patient-related health management challenges, (ii) diabetes mellitus care service delivery challenges, and (iii) reorganisation of diabetes mellitus care delivery. ConclusionCOVID-19 increased mortality and morbidity among people living with diabetes mellitus. In addition, the COVID-19 pandemic worsened diabetes mellitus care management. Sub-Saharan African countries should, therefore, institute appropriate policy considerations for persons with diabetes mellitus during widespread emergencies.

BackgroundFood insecurity poses a threat to adolescent nutrition and health, especially in low- and middle-income countries (LMICs), with potential lifelong consequences. This study assessed the prevalence and drivers of adolescent food insecurity in Ghanas Volta and Oti regions. ObjectivesTo assess the prevalence and predictors of food insecurity among adolescents in the Volta and Oti regions of Ghana. MethodsO_ST_ABSDesignC_ST_ABSA community-based cross-sectional study SettingThe study was conducted in the Volta and Oti regions of Ghana. ParticipantsThe sample included 667 adolescents aged 10-19 years. Outcome MeasureWe measured food insecurity using the Household Food Insecurity Access Scale (HFIAS). Data were collected using a two-stage sampling approach. Adolescents food insecurity status was categorised into food secure, mildly, moderately, or severely food insecure. Multivariable logistic regression analysis was employed to identify the risk factors associated with food insecurity. ResultsApproximately 47.5% of the surveyed adolescents reported experiencing periods of inadequate food intake during the 12 months preceding the survey. Among adolescents experiencing food scarcity, the periods from January to March (32.2%) and April to June (28.8%) were identified as the peak times of limited food availability. In total, 61% of adolescents in the Volta and Oti regions experienced food insecurity, with 23.5% classified as severely food insecure, 47.7% worried about not having enough food, and 54% could not access preferred foods due to limited resources. Approximately 50.1% consumed a monotonous diet and 44.1% consumed foods they perceived as socially unacceptable. Urban residence (aOR = 0.67; CI=0.46-0.97), higher maternal education (aOR=0.41; CI=0.22-0.78), and higher wealth (aOR=0.02; CI=0.0-0.09) were associated with reduced odds of food insecurity. ConclusionThere was a high prevalence of adolescent food insecurity in the Volta and Oti regions of Ghana. This has profound implications for adolescent nutrition, health, and overall well-being. Peak periods of food scarcity align with the broader seasonal food scarcity patterns and lean seasons in Ghana. The high rates of food insecurity directly impede the goal of achieving SDG 2 and 3. Key predictors include urban-rural differences, maternal education, and wealth. Urgent action is needed to address these factors and ensure consistent access to nutritious food. Strengths and limitations of this studyO_LIWe used the widely accepted Household Food Insecurity Access Scale (HFIAS), a standardized and comprehensive tool for assessment of food insecurity. C_LIO_LIWe employed multistage systematic sampling, enhancing representativeness and generalizability within the Volta and Oti regions. C_LIO_LIA cross-sectional design limits the ability to establish causal relationships. C_LIO_LIPotential self-reporting bias may affect data accuracy due to socially desirable or inaccurate responses. C_LIO_LIFindings may not be generalisable beyond the studied regions because of socioeconomic and cultural differences. C_LI

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.

Sub-Saharan Africa (SSA) continues to bear a disproportionate global disease burden while also facing significant disparities in research productivity and impact. As such, strengthening the research capacity in SSA is an urgent priority, necessitating a multifaceted assessment of the current landscape, the role of international collaboration, and the alignment of research efforts with health needs. In this study, we conducted a macro-level bibliometric analysis to assess research capacity, thematic alignment, and structural autonomy in SSA. We found that SSA accounted for approximately 15% of the global population and 21% of the global disease burden, yet it received only 2.7% of global citations in 2021. Despite increasing the research output over time, academic impact and leadership remain limited. Higher international collaboration rates were positively associated with a higher research impact, but also with a markedly greater proportion of publications without SSA researchers in key authorship positions, indicating persistent structural dependency. Researcher autonomy in SSA was substantially lower than in other regions, though slight improvements were observed during the COVID-19 period. Meanwhile, the Burden-Adjusted Research Intensity analysis showed a disproportionate concentration of research on HIV/AIDS, tuberculosis, and malaria, a focus that was sustained--and even intensified--in SSA during the pandemic, while many other high-burden diseases, including neglected tropical diseases, remained severely under-researched. In conclusion, this study provides quantitative evidence of persistent academic dependency and misaligned research priorities in SSA, with our analyses revealing how structural inequities in international collaborations and externally driven research agendas limit local research leadership and potentially hinder effective responses to regional health needs. Achieving a more just global research ecosystem demands active decolonization efforts centered on empowering Global South ownership, necessitating the fostering of genuinely equitable partnerships, reforming of funding mechanisms to prioritize locally led research, and sustained investment in developing the local research and leadership capacity. Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSO_LISub-Saharan Africa (SSA) bears a disproportionate share of the global disease burden but has historically lagged in research output and scientific capacity. C_LIO_LIStructural and systemic barriers have long hindered the development of robust research ecosystems in SSA. C_LI What this study addsO_LISSA faces a critical mismatch between its high disease burden and its limited capacity to generate scientific research needed to address local health challenges. C_LIO_LIHigher international collaboration in SSA is correlated with both greater citation impact and diminished local leadership. C_LIO_LIThere are persistent inequities in research in SSA in relation to the COVID-19 pandemic. C_LI How this study might affect research, practice or policyO_LIOur results underscore the need to focus on structural equity, in addition to the quantity and quality, in global health research. C_LIO_LITo decolonize knowledge production, international partnerships must prioritize local leadership, long-term investment, and alignment with regional health needs. RSI and BARI offer practical tools to monitor these goals and guide policy reform. C_LIO_LIEquitable research ecosystems will require both capacity building in SSA and behavioral shifts in high-income country funders and institutions. C_LI

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.

BackgroundSocioeconomic status (SES) is essential for determining a person or communitys position about certain social and economic characteristics. This is particularly important in sub-Saharan Africa, where health disparities are pronounced. We conducted a scoping review to explore approaches used in health studies to measure socio-economic status in the sub-Saharan region. MethodsA comprehensive literature search covering January 2012 to June 2024 was conducted in five databases: PubMed, EMBASE, CIHNAL, Web of Science, and African Index Medicus. All studies in sub-Saharan Africa focused on health-related socioeconomic status were included, regardless of study methodology. Three peer reviewers independently evaluated the selected articles according to inclusion and exclusion criteria. Discrepancies between reviewers were resolved through a consensus meeting. The review protocol was registered on the Open Science Framework (OSF, OSF.IO/7NGX3). ResultsThe initial search yielded 19,669 articles. At the end of the screening process, 65 articles were analysed. Cross-sectional studies have been widely used. South Africa (13.4%) and Kenya (11%) were the most represented countries. Maternal, neonatal, and infant/juvenile health was the most covered theme (31%). The review identified 12 categories of SES measurement methods, with the asset-based wealth index being the most widespread (61.9%). Principal component analysis (PCA) is the primary analytical method used to calculate this index (57.7%). ConclusionsThis scoping review identified the asset-based wealth index as the most frequently used and provided essential elements for pooling different SES calculation methodologies to reach a consensus. Using SES to improve interventions is important to limit African health disparities.

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.

Socioeconomic inequalities in the double burden of child malnutrition threatens global nutrition targets 2025, especially in Eastern and Southern Africa. We aimed to quantify these inequalities from nationally representative household surveys in 13 Eastern and Southern African countries between 2000 and 2018. 13 of the latest Demographic and Health Surveys including 72,231 children under five year olds were studied. Prevalence of stunting, wasting and overweight (including obesity) were disagregated by wealth quintiles, maternal education categories and urban-rural residence for visual inspection of inequalities, and the slope index of inequality (SII) and the relative index of inequality (RII) were estimated for each country. Country-specific estimates were pooled using random-effects meta-analyses. Regional stunting and wasting prevalence was higher among children living in the poorest households, with mothers with the lowest educational level and in rural areas. In contrast, regional overweight (including obesity) prevalence was higher among children living in the richest households, with mothers with the highest educational level and urban areas. Tackling social inequalities in the distribution of the double burden of malnutrition among children in the Eastern and Southern African region will require strategies that address the reasons socially disadvantaged children become more exposed to stunting or wasting.

Objetive:This study aimed to describe the scientific output of specialized health institutes in Peru from 1991 to 2021. Method: A bibliometric analysis was conducted to evaluate the scientific production, collaboration, and impact of nine specialized health institutes in Peru. An exploratory analysis of associations was performed for highly cited articles and publications in Q1 journals. Results: A total of 3,020 articles were analyzed, with the majority published in English (61.39%). The institutes with the highest scientific output were the Instituto Nacional de Salud, Instituto Nacional de Enfermedades Neoplasicas, and Instituto Nacional de Salud del Nino - Brena. Instituto Nacional de Salud collaborated with the other institutes at least once, while Instituto Nacional de Oftalmologia had the least collaboration. The three institutes with the highest bibliometric impact were the Instituto Nacional de Salud, Instituto Nacional de Enfermedades Neoplasicas, and Instituto Nacional de Ciencias Neurologicas. Notably, the Instituto Nacional de Ciencias Neurologicas had half of its articles (50.12%) highly cited (more than 10 citations). Foreign collaboration and publication in Q1 journals were associated with a higher likelihood of being highly cited. Additionally, publishing in English, conducting interventional research, receiving funding, foreign collaboration, and having male authors as last authors increased the likelihood of publication in Q1 journals. Conclusion: The scientific output of specialized institutes in Peru is heterogeneous and growing, although none of the institutes exceeded 100 articles per year. Moreover, collaboration among the institutes is limited. Reference values should be established to enhance the performance of specialized institutes in Peru.

IntroductionExcessive body weight and problematic eating behaviours, such as emotional and binge eating, have become major public health concerns. Mindful eating and intuitive eating offer alternative approaches to traditional dieting by encouraging individuals to focus on internal hunger and satiety cues. This study aims to analyse research trends and metrics related to mindful eating and intuitive eating publications over the past twenty years. MethodsWe used Scopus to identify mindful and intuitive eating related studies from 2004 to 2024. VOSviewer and Bibliometrix were used to extract relevant data and run the bibliometric analysis. ResultsA total of 1922 articles and reviews published in English were identified. After screening titles and abstract for relevance, 1064 documents were left for analysis. The number of studies on mindful and intuitive eating increased most years, with 2023 (n=143, 13.44%) and 2024 (n=146, 13.72%) producing the most articles, and a total citation count of 32,245 over the twenty-year period. High-income countries such as the United States (n=497), United Kingdom (n=131), and Canada (n=88) produced the most scientific articles. Leading researchers were Mantzios, M. (n=26) and Tylka, T. L. (n=25). The most cited articles focused on mindfulness or meditation-based therapies in managing psychological stress and the influence of taste on food choices. Keyword and trend analyses highlight emerging research areas such as mindfulness and intuitive eating. ConclusionThis bibliometric analysis provides valuable insights to the research trends in the mindful and intuitive eating fields. Strengthening interdisciplinary research and expanding collaborations between countries and authors could enhance the research impact in these fields as well as exploring emerging topics such as body perceptions (e.g., body image, body positivity, body dissatisfaction).

IntroductionDomestic violence is a prevalent global health issue that causes incredibly adverse consequences for an individuals physical and psychological health. The rates of physical and sexual violence in developing countries are thought to be some of the highest in the world, where up to 44% of women in Sub-Saharan Africa have experienced domestic violence. However, this has not been explored systematically. We present the first study to estimate the incidence and prevalence of physical and sexual violence across Africa. MethodsPoisson meta-regression analysis on demographic health survey data from 482,670 women from 442,507 households in 30 countries across Africa. Hotspot analysis using the Getis-ORD Gi approach at the sub-regional level. ResultsOf 482,670 women, those who were divorced or separated were approximately 7 times more likely to experience physical violence and 6 times more likely to experience sexual violence compared to those who were never married (Risk Ratio: RRs:7.35, 95%CI 7.16-7.54 and 5.89, 95%CI 5.75-6.02 respectively). Likewise, wealth index and education level were inversely related to the incidence and prevalence of sexual and physical violence. Hotspots of sexual and physical violence were identified in Congo and surrounding areas. ConclusionsInterventions should be designed to address the high levels of physical and sexual violence in Congo and surrounding areas, especially in those who are less educated, have lower wealth indices, and are divorced or separated. Key QuestionsO_ST_ABSWhat is already known?C_ST_ABSExperiencing domestic violence can increase the likelihood of experiencing poorer health outcomes. Previous research has shown that the rates of domestic violence is higher in developing countries, specifically in countries located in sub-Saharan Africa. What are the new findings?This is the first study to estimate the incidence and prevalence of physical and sexual violence across regions in Africa. Geospatial analysis illustrated hot-spots near Congo that have a higher prevalence of domestic violence. This study also solidified the association between income, education, and marital status, and domestic violence. Those who are less educated and are of lower socioeconomic status are more likely to experience domestic violence in comparison to their educated, wealthy counterparts. What do the new findings imply?Our findings further promote the importance of tailoring appropriate interventions that strive to reduce domestic violence across Africa, while also protecting domestic violence victims against the adverse psychological and physical health outcomes that may occur as a result of their exposure.

IntroductionSierra Leone is one of the worst affected by hunger and food insecurity, but data to understand the impact of public health emergencies on nutrition indicators is limited. In this study, we sought to describe nutrition service delivery and nutritional health among children under age five before and during the Ebola epidemic, the inter-epidemic period, and during the COVID-19 pandemic (2021) in Sierra Leone. MethodsWe conducted a descriptive study using secondary data from five serial cross-sectional surveys conducted using representative sampling as part of programmatic monitoring and evaluation: 2010 (N=14027, before Ebola); 2014 (N=10,975, during Ebola); 2017 and 2019 (N=9059, N=4,870, respectively, inter-pandemic period); 2021 (N=10,165, during COVID-19). We described and compared the prevalence of each of the following indicator at each time-point: shunting, global acute malnutrition, breastfeeding and underweight. ResultsThe prevalence of stunting was 34.1% before the Ebola epidemic, 28.8% during the Ebola epidemic, 31.3% after the Ebola epidemic, 25.9% before the COVID-19 epidemic, and 26.2% during the COVID-19 epidemic. The prevalence of global acute malnutrition was: 6.9% before the Ebola epidemic, 4.7% during the Ebola epidemic, 5.1% after the Ebola epidemic, 5.0% before the COVID-19 epidemic, and 5.2% during the COVID-19 epidemic. Finally, the report showed that the proportion of breastfeeding for up to 23 months was 84.0% (before the Ebola epidemic), 86.0% (during the Ebola epidemic), 85.0% (after the Ebola epidemic), 61.8% (before the COVID-19 epidemic), and 53.1% (during the COVID-19 epidemic). ConclusionWe found a variable effect of the Ebola epidemic and COVID-19 on nutrition health and nutrition indicators. Findings highlight the importance of continuing to strengthen the implementation of nutrition programs during and after public health emergencies.

Objective: Malnutrition and micronutrient deficiency are significant public health problems affecting the well-being of both the mother and her offspring. It is important to first quantify their burden in underserved communities and then to tackle this problem. The objective of this study was to assess the nutritional status, micronutrient deficiency profile, and associated determinants among pregnant women attending antenatal care clinics under PMSMA in selected government health facilities across three districts of Jharkhand, India. Design: The study employed a cross-sectional study design to assess the burden of malnutrition and micronutrient deficiency among pregnant women. Setting: The study was conducted in 4 health facilities in 3 districts of Jharkhand. The selected facilities were Rajendra Institute of Medical Sciences (RIMS), Ranchi; District Hospital (Sadar), Ranchi; District Hospital (Sadar), Godda; and Community Health Centre (Gamharia, Saraikela) under RHTC, Department of Community Medicine, Manipal Tata Medical College, Jamshedpur. The study was conducted during the period of September to December, 2022. Participant: Eligible pregnant women attending ANC clinics under PMSMA in the selected health facilities were enrolled until the required sample size of 977 was achieved. Pregnant women who were critically ill or those who presented with some emergency conditions were excluded from the study. Result: Based on BMI assessment, 38.6% of participants were malnourished, with 17.7% being underweight and 20.9% overweight or obese. Anaemia affected 69.3% of women, while clinical features suggestive of iron deficiency were observed among 21.1% of the participants. Vitamin A deficiency, iodine deficiency, and fluoride excess were also identified among a smaller proportion of women. Conclusion: The present study highlights a substantial burden of both malnutrition and micronutrient deficiency among pregnant women in Jharkhand and justifies the need for integrated maternal nutrition strategies during antenatal care.

School feeding program is one of the worlds most popular interventions for school-age children. Under-investment in this age group is a major obstacle to human capital development. This study aims to provide evidence on the impact of school meals on student survival, nutrition and education. This study is based on the method of dynamic micro-simulation of the behavior of schoolchildren consuming school canteen meals. The statistical software R was used to process both the individual data and to write the model. A cohort of 1,000 beneficiary schoolchildren was used to observe the impact of this canteen during the primary cycle. Simulation at 100% coverage of the school year shows a cost USD 18,489 per year and per beneficiary, and over the six years of the primary cycle: i) saves three lives out of every 1,000 pupils, ii) gives each pupil around 3 months more life, iii) saves 121 pupils from dropping out of school, and iv) reduces the level of stunted growth from 18.5% to 9.8%, i.e. a reduction of 8.7% in six years. The results indicate the higher the level of school feeding coverage, the greater its impact on human capital development in Burkina Faso.

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.