Journal of Environmental Management

BackgroundEvidence on the long-term impact of urban green and blue spaces (UGBS) interventions remains limited. This study is a 15-year evaluation of an urban greenway development in Belfast (United Kingdom), assessing the potential effects of this UGBS intervention on physical activity (PA), mental wellbeing and co-benefits. MethodsUsing quasi-experimental design, a repeated cross-sectional survey was conducted in 2010 (baseline), 2017 (post-opening) and 2023 (long-term follow-up) with about 1,200 adults participated each wave. Outcomes included PA, mental wellbeing, general health, quality of life, social capital and environmental perception. Multilevel mixed-effect regressions were performed to examine within-group changes at long-term follow-up. Difference-in-differences analysis investigated the between-group changes that might be attributed to the greenway. Additional comparative analyses included distance-decay analysis and comparison with population trends in Northern Ireland. ResultsAt six years after completion, the greenway intervention appears to buffer a decline in duration of PA - mainly from moderate-intensity activity (decline lower by 118.6 min/week, 95%CI: 3.9-232.2) but with no significant impact on the proportion of the population meeting the recommended PA level. The intervention is associated with a smaller decline in self-rated health (4.98 units; 95%CI: 0.62-9.34) relative to control group. Intervention association with mental wellbeing was positive but not significant (p=0.30). The greenway also showed positive effects on social capital and environmental perceptions, with impacts most evident in improving safety and trust in the local area. ConclusionThis study provides evidence to support the public health impact of UGBS and its long-term health and social benefits.

Respiratory infections caused by bacterial pathogens like Mycobacterium tuberculosis and Bordetella pertussis have increased since the COVID 19 pandemic, yet clinical surveillance of both suffers from underreporting and delayed diagnoses. Wastewater monitoring is a valuable public health surveillance tool that can help fill gaps in clinical data yet has rarely been applied to respiratory bacterial pathogens despite evidence of bacterial shedding via excretion types that enter wastewater. In this study, we investigated the possibility for wastewater monitoring of two bacterial respiratory diseases, tuberculosis and pertussis, using two case studies of wastewater monitoring for M. tuberculosis and B. pertussis. We retrospectively measured concentrations of these pathogens in wastewater samples collected longitudinally from communities with and without known outbreaks of these diseases. We designed and validated a novel B. pertussis specific assay for the NAD(P) gene; B. pertussis nucleic acids were detected sporadically in wastewater during an identified outbreak. We used a highly specific, established assay for M. tuberculosis nucleic acids, and found low concentrations of the marker in wastewater that were lag-correlated with clinical incidence rates 5 weeks later. Findings support the potential of wastewater monitoring for M. tuberculosis and B. pertussis to enable identification of communities with outbreaks of tuberculosis and pertussis and provide early warning for tuberculosis.

Military aviation training noise remains understudied despite its widespread impacts across urban, rural, and wilderness areas. The predominance of low-frequency noise and repetitive training can create pervasive noise pollution, yet past research often fails to capture the full range of health and quality-of-life effects. This study analyzed two complaint datasets related to Whidbey Island Naval Air Station noise: U.S. Navy records (2017-2020) and Quiet Skies Over San Juan County data (2021-2023). We analyzed and mapped sentiment intensity from noise complaints relative to modeled annual noise exposure, developed a typology to classify impacts, and modeled the environmental and operational factors influencing complaints. Findings revealed widespread negative sentiment and anger, often beyond the bounds of estimated noise contours, suggesting that annual cumulative noise models inadequately estimate community impacts. Complaints consistently highlighted sleep disturbance, hearing and health concerns, and compromised home environments due to shaking, vibration, and disruption of daily life. Residents also reported significant social, recreational, and work disruptions, along with feelings of fear, helplessness, and concern for children's well-being. The number of complaints were strongly associated with training schedules, with late-night sessions being the strongest predictor. A delayed response pattern suggests residents reach a frustration threshold before filing complaints. Overall, our findings demonstrate persistent negative sentiment and diverse impacts from military aviation noise. Results highlight the need for improved noise metrics, modeling and operational adjustments to mitigate the most disruptive effects.

HighlightsO_LIHealth inequalities have widened over 15 years, favouring high-income groups C_LIO_LIInequality in physical activity & mental health widened the most pre-intervention C_LIO_LIPost-intervention, inequalities persisted but stayed relatively unchanged. C_LIO_LILong-term illness and unemployment were key drivers of inequality C_LIO_LIThe greenway may have slowed down the inequality widening but the impact is limited C_LI BackgroundEvidence concerning health inequalities following urban green and blue space UGBS) interventions is limited. This study examined the changes in health inequalities after a major urban regeneration project, the Connswater Community Greenway (CCG), in Belfast, UK. MethodCross-sectional household surveys were conducted in 2010/11 (baseline), 2017/18 (immediately after completion), and 2023/24 (long-term follow-up) with a sample of approximately 1,000 adults each wave. Using concentration indices (CI), income-related health inequalities for three outcomes (physical activity, mental wellbeing and quality of life) were measured. A regression-based decomposition of concentration index examined the contribution of sociodemographic factors to the observed inequalities underpinning each outcome over time. ResultsAcross three waves, there was widening of inequalities over the 15-year period across all three health outcomes, with those from high-income groups reported higher levels of physical activity (CI=0.33, SE=0.026), better mental wellbeing (CI=0.03, SE=0.003), and better quality of life (CI=0.09, SE=0.008). The widening inequalities mainly occurred during the construction phase of CCG (2010-2017) and remained stable post-intervention (2017-2023). Decomposition analysis revealed that the pro-poor concentration of long-term illness and unemployment was the key driver that together explained approximately 51%-76% of the inequalities. ConclusionThe CCG was limited in reducing health inequalities which were mainly driven by long-term illness and unemployment - factors beyond the direct scope of the UGBS intervention - resulting in low-income groups likely to fall further behind the wealthier groups. The widening of inequality is consistent with findings from other public interventions that did not have a primary equity focus.

Benzalkonium chloride (BAC) is widely used as a disinfectant in cleaning products and is frequently detected in indoor dust. In this study, we assessed dust samples, along with information on cleaning product use, from 24 pregnant participants. Dust samples were analyzed for BAC concentration and microbial tolerance. Different chain lengths of BAC (C12, C14, and C16) were quantified using LC-MS/MS, and bacterial isolates were tested for BAC tolerance using minimum inhibitory concentration (MIC) assays. BAC was ubiquitously detected, with C12 and C14 being dominant. Higher BAC concentrations were associated with reported disinfectant use and increased microbial tolerance. These findings suggest that indoor antimicrobial use may promote microbial resistance, highlighting potential exposure risks in indoor environments and the need for further investigation into health and ecological impacts.

Aims Indoor air pollution resulting from combustion of unclean cooking fuels has been linked to adverse health outcomes, but evidence regarding its association with mental health in low- and middle-income countries remains limited. We investigated the association between household use of unclean cooking fuels, as a proxy for indoor air pollution, and depression symptoms among adults aged 45 years and older in India, and assessed effect modification by age, sex, caste, and rural/urban residence. Methods We conducted a cross-sectional analysis of the first wave (2017-2018) of data from the Longitudinal Aging Study in India (LASI), a nationally representative survey of adults aged [≥]45 years. Cooking fuel type was classified as clean or unclean, and depression symptoms were assessed using the 10-item Centre for Epidemiologic Studies Depression (CES-D-10) scale. We used logistic regression to estimate odds ratios for depression symptoms, and linear regression to compare mean CES-D-10 scores by cooking fuel type, adjusting for sociodemographic and housing characteristics. Results We included 62,650 respondents. Median age was 57 years (IQR: 50-65), 46.7% were women, 47.6% reported using unclean cooking fuels, and 27.6% screened positive on the CES-D-10. After adjusting for sociodemographic and housing characteristics, use of unclean cooking fuels was associated with higher odds of screening positive on the CES-D-10 (aOR: 1.08; 95% CI: 1.02, 1.15), and higher mean CES-D-10 scores (adjusted mean difference: 0.34; 95% CI: 0.24, 0.44). The association was more pronounced among individuals living in urban areas (aOR: 1.36; 95% CI: 1.21, 1.53). Conclusion Use of unclean cooking fuels was associated with depression symptoms among older adults in India, and especially among those living in urban areas.

Objectives: Longer lifespans lead to longer time on retirement, despite the efforts to raise the retirement age. Therefore, it is important to study how the retirement years can be spent without diseases. This study examined socioeconomic and sociodemographic differences in healthy years spent on retirement. Methods: We followed a cohort of retired Finnish municipal employees (N=4231, average follow-up 15.4 years) on national administrative registers for major chronic diseases: cancer, coronary heart disease, cerebrovascular disease, diabetes, asthma or chronic obstructive pulmonary disease, dementia, mental disorders, and alcohol-related disorders. Median healthy years on retirement and age at first occurrence of illness (ICD-10 and ATC-based) in each combination of sex, occupational class, and age of retirement were predicted using Royston-Parmar models. Prevalence rates for each diagnostic group were calculated. Results: Most healthy years on retirement were spent by women having worked in semi-professional jobs who retired at age 60-62 (median predicted healthy years 11.6, 95% CI 10.4-12.7). The least healthy years on retirement were spent by men having worked in routine non-manual jobs who retired after age 62 (median predicted healthy years 6.5, 95% CI 4.4-9.5). Diabetes was slightly more common among lower occupational class women, and dementia among manual working women having retired at age 60-62. Discussion: Healthy years on retirement are not enjoyed equally by women and men and those who retire early or later. Policies aiming to increase the retirement age should consider the effects of these gaps on retirees and the equitability of those effects.

This study investigated retirement adjustment in retired police officers in the UK (N = 289), examining how time since leaving the service moderates the relationship between perceived organisational support and retirement adjustment while accounting for resilience. Results indicated a developmental trend: organisational support remains stable initially but becomes increasingly influential in later life. Using Johnson-Neyman analysis, a threshold of 32.07 years was identified, after which the association reaches statistical significance. These findings suggest an organisational legacy effect; for the older generation, the retrospective perception of being valued by the service acts as a durable psychological resource. This study offers a novel conceptualisation of long-term organisational influence by identifying a temporally delayed legacy effect that extends beyond existing models of retirement adjustment. The study advocate for lifelong wellbeing strategies that extend, recognising that the organisational relationship continues to shape adjustment outcomes decades after the conclusion of active duty.

This study evaluates the feasibility of implementing artificial intelligence (AI)-driven disease surveillance systems at Julius Nyerere International Airport (JNIA) in Tanzania, a key hub for regional and international travel. Through a mixed-methods approach combining qualitative interviews and quantitative surveys, the research assesses the infrastructure, human resource capacity, and regulatory frameworks necessary for AI integration. Findings indicate that while Port Health Officers are strongly optimistic about AIs potential to enhance disease detection, the airport faces significant barriers, including outdated infrastructure, insufficient technical resources, and a lack of trained personnel. Ethical and privacy concerns, particularly surrounding data security, also emerged as key challenges, compounded by limited public awareness and the socio-cultural acceptability of AI systems. Furthermore, the study identifies gaps in national policies and inter-agency coordination that hinder the effective implementation of AI technologies. The research concludes that while current conditions render AI adoption infeasible, strategic investments in infrastructure, workforce training, and policy development could pave the way for future integration, enhancing public health surveillance at JNIA and potentially other airports in low- and middle-income countries. This study contributes critical insights into the barriers and opportunities for AI-driven disease surveillance in low-resource settings, specifically focusing on a high-priority transit point, international airports. It emphasizes the importance of region-specific solutions to enhance health security in East Africa and supports the broader global health agenda by advocating for international collaboration and the development of scalable disease surveillance systems. Future research should explore pilot AI implementations at other airports to evaluate real-world challenges and refine AI systems for broader applicability, including cost-effectiveness analyses and integration of public perspectives on AI.

BackgroundCommercial motorcycle riders are among the most vulnerable road users in low- and middle-income countries and contribute substantially to the burden of road traffic injuries. The use of personal protective equipment (PPE), including helmets and protective clothing, reduces injury severity; however, uptake remains suboptimal. This study evaluated the effectiveness of a theory-driven health education intervention in improving knowledge, attitudes, and use of PPE among commercial motorcycle riders in Cameroon. MethodsA quasi-experimental, non-randomized controlled before-and-after study was conducted in Limbe (intervention) and Tiko (control) Health Districts between August 4, 2024, and April 6, 2025. Participants were recruited from a cohort of commercial motorcycle riders and followed over an eight-month intervention period. The intervention, guided by the Health Belief Model and developed using the Intervention Mapping framework, combined face-to-face sensitization sessions with mobile phone-based educational messaging adapted to participants literacy levels and communication preferences. Data were collected at baseline and endline using structured questionnaires and direct observation checklists. Intervention effects were estimated using difference-in-differences analysis with generalized estimating equations, adjusting for socio-demographic factors. ResultsA total of 313 riders were enrolled at baseline (183 intervention, 130 control), with 249 retained at endline (149 intervention, 100 control). The intervention was associated with significant improvements in PPE knowledge ({beta} = 2.91; 95% CI: 2.14-3.68; p < 0.001) and attitudes ({beta} = 5.76; 95% CI: 4.32-7.21; p < 0.001) compared with the control group. No statistically significant effect was observed for PPE practice scores ({beta} = 0.21; 95% CI: -0.09-0.52; p = 0.171). Among individual PPE items, helmet use increased significantly in the intervention group relative to the control group (AOR = 2.38; 95% CI: 1.19-9.45; p = 0.036), while no significant effects were observed for gloves, trousers, eyeglasses, or closed-toe shoes. ConclusionThe theory-driven health education intervention significantly improved knowledge and attitudes toward PPE and increased helmet use among commercial motorcycle riders but did not lead to broader improvements in the uptake of other protective equipment. These findings highlight the need for complementary structural and policy interventions to address persistent barriers to PPE use in similar low-resource settings. Trial registrationClinicalTrials.gov Identifier: NCT07087444 (registered July 28, 2025, retrospectively)

BackgroundThis study aimed to assess caregiver knowledge of Infant and Young Child Feeding (IYCF), child health, severe acute malnutrition (SAM) screening, and Community-Based Management of Acute Malnutrition (CMAM), its determinants, and associations with IYCF/ WaSH (water, sanitation, and hygiene) practices among caregivers of children 6-59 months with SAM in Ethiopian agrarian and pastoralist settings. MethodData were from the baseline survey of the R-SWITCH Ethiopia cluster-randomized controlled trial (cRCT), which screened [~]28,000 children aged 6-59 months and identified 686 SAM cases. Caregiver knowledge was evaluated using a validated 32-item questionnaire (Cronbachs for internal reliability) and analyzed via linear mixed-effects and Poisson regression models in Stata 17. ResultsCaregiver knowledge was positively associated with improved IYCF/WaSH practices among children aged 6-23 months with SAM, including higher minimum dietary diversity (MDD: IRR=1.50), minimum acceptable diet (MAD: IRR=1.63), and reduced zero vegetable/fruit intake (IRR=0.77), as well as MDD in children aged 24-59 months, improved water access (IRR=1.19), water treatment (IRR=2.02), and handwashing stations (IRR=1.41). Literate ({beta} = 4.1; 95% CI:1.5-6.6, p= 0.016), pregnant({beta} = 4.4; 95% CI:0.9-7.8, 0.018), having child weighing at a health post/ health center ({beta} = 8.9;95% CI:3.5-14.2,p [&le;] 0.001), and higher household wealth index ({beta} = 11.8;95% CI:3.6-20.1,p= 0.005) were associated with higher knowledge, while possible depression ({beta} = -0.3;95% CI: -0.5 to 0.0, p= 0.015) was associated with lower knowledge. ConclusionCaregiver knowledge determines better IYCF/WaSH practices among children aged 6-59 months with SAM. Literacy, pregnancy, having child weighing at a health post or health center, and greater household wealth were associated with caregivers knowledge, whereas possible depression was associated with lower knowledge. Integrating context-specific caregiver education and mental health support into CMAM, GMP(Growth monitoring and promotion), and primary care services could enhance feeding/WaSH practices in Ethiopia.

BackgroundProspective studies of pregnant adolescents are essencial to effectively address this global health priority. They help answer vital questions about their health, but such studies are uncommon due to the difficulty in retaining adolescents. This paper describes the successes and challenges of the research strategies used to ensure sufficient recruitment and retention of pregnant adolescents in a longitudinal study about adolescent childbearing in an under-resourced setting. MethodsThe Adolescence and Motherhood Research project was conducted in a rural region of Northeast Brazil in 2017-2019 and assessed 50 primigravids between 13-18 years (adolescents) and 50 primigravids between 23-28 years (young adults) during the first 16 weeks of pregnancy with two follow-ups (third trimester of pregnancy, and 4-6 weeks postpartum). Recruitment strategies involved engagement of health sector and community, as well as referrals from health care professionals and dissemination of the project in different locations. Retention strategies included maintaining contact with the participants between assessments and providing transportation for them to attend the follow-up procedures. ResultsRecruitment took 10 months to complete. A total of 78% of the participants were recruited from the primary health care units, mainly after referral from a health care provider. Retention reached 95% of the sample throughout the study (90%: adolescents; 98%: adults). ConclusionA combination of approaches is necessary to successfully recruit and retain youth in longitudinal studies and engaging local stakeholders may help to increase community-perceived legitimacy of the research. Working closely with front-line staff is essential when conducting research in rural low-income communities.

Wastewater surveillance (WWS) is established as a vital tool for monitoring polio and SARS-CoV-2 with potential to improve surveillance for many other infectious diseases. This study evaluated the feasibility of detecting measles virus (MeV) RNA in wastewater as part of a national WS preparedness trial in Brisbane, Australia, from March to June 2025. Composite and passive sampling methods were employed in parallel at three wastewater treatment plants serving populations between 230,000 and 584,000. Nucleic acids were extracted and analyzed using RT-qPCR targeting MeV N and M genes to distinguish wild-type and vaccine strains. MeV RNA were detected in both 24-hour composite and passive samples on May 26 to 27, 2025 from the largest catchment of 584,000 which also included an international airport. No measles cases were reported in this city or region within 4 weeks of the WS detections. These were confirmed as vaccine-derived measles virus (MeVV) strain via specific RT-qPCR assay. Extraction recoveries varied (11.5% to 70.5%), with passive sampling showing higher efficiency. This is the first report of use of passive samples for detection of MeV. These findings are consistent with other studies reporting WWS results of both MeVV genotype A and wild type genotype B and/or D. It demonstrates the potential for sensitive MeV WWS with rapid differentiation of MeVV from wild type MeV shedding, including in airport transport hubs and with different sample types. Use of WWS could strengthen measles surveillance by enabling rapid detection of MeV RNA and supporting outbreak preparedness and response. This requires optimised methods which are specific to or differentiate wild-type MeV from MeVV. Furthermore, the successful detection of MeV using passive sampling in this study highlights its potential for deployment in diverse global contexts which may include non-sewered settings.

Introduction Access to safe water, sanitation, and hygiene (WASH) in schools is critical for child health, learning, and gender equity. In Kenya, the Kenya School Health Policy and the Basic Education Act outline standards for school WASH; however, implementation remains uneven due to inadequate infrastructure, weak inter-sectoral coordination, and limited financing. This study aimed to identify priority components for strengthening school WASH implementation and generate policy-relevant recommendations based on expert consensus in Uasin Gishu County, Kenya. Methods and Results A Delphi technique consisting of two iterative rounds was used to reach expert consensus. In Round 1, 20 purposively selected experts including head teachers, county education officials, public health officers, water and public works officers, and NGO representatives participated in key informant interviews. Emergent themes informed development of a structured Round 2 questionnaire administered through CommCare online app. Quantitative data were analyzed using descriptive statistics (means, standard deviations, percentage agreement), while qualitative responses underwent thematic coding using NVivo 12. Experts reached strong consensus on essential components required for strengthening school WASH implementation. Key priorities included clear governance structures, designated budget lines, inclusive infrastructure, menstrual hygiene management (MHM), curriculum integration, sustained capacity building, and systematic monitoring. Multi-sectoral collaboration and recognition of best-performing schools were also emphasized as important motivators for compliance and sustainability. Equity considerations particularly the need for disability-friendly facilities and school-community outreach were highlighted as critical. Agreement levels ranged from 74% to 100%, with most items scoring mean values between 4.5 and 4.8 on a 5-point Likert scale, indicating strong consensus among experts. Conclusion strengthening implementation of school WASH in Kenya requires coordinated governance, predictable funding, reliable water systems, inclusive sanitation, strengthened MHM, and consistent monitoring beyond infrastructure investment alone. Integrating these expert-validated priorities within existing national policies offers a practical pathway to improving learner health, reducing absenteeism especially among girls and promoting equitable educational outcomes.

Background Comprehensive sexuality education (CSE) is essential to the health and well-being of young people. In the Democratic Republic of Congo (DRC), where more than 65% of the population is under the age of 25, access to interpersonal CSE remains limited owing to sociocultural and structural barriers. This exposes young people to persistent socio-sanitary vulnerabilities. In this context, mobile health apps (MHAs) constitute a promising solution, supported by the growing use of smartphones among young Congolese. However, this group's intention to use MHAs for CSE has been the subject of little research to date. Objective The aim of this study was to identify predictors of intention to use MHAs among young Congolese, based on the extended Unified Theory of Acceptance and Use of Technology (UTAUT2). Methods A predictive correlational study was conducted in eight public secondary schools in Bukavu (DRC) with a stratified random sample of 859 students. Predictors of intention to use--performance expectancy (PE), effort expectancy (EE), social influence (SI), facilitating conditions (FC), and perceived risk (PR)--and moderators--age, gender, and past MHA experience--were measured from data collected through a self-administered UTAUT questionnaire. Descriptive and multivariate analyses were run on SPSS version 28. Results Mean age of participants was 16.3 years (SD = 1.5). Boys made up 55.1% of the sample. Overall, 51.0% of the sample owned a smartphone, of which 62.3% reported having easy access to mobile data and 16.2% were already using MHAs to learn about sexual health. Intention to use MHAs was positively influenced by PE ({beta} = 0.523, p < 0.001), EE ({beta} = 0.115, p < 0.001), and SI ({beta} = 0.113, p < 0.001). FC (p = 0.260) and PR (p = 0.631), however, had no significant influence. Age moderated all of the relationships tested (F (1, 849-854) = 9.97-20.82; p [&le;] 0.002), with more marked effects observed among younger participants 14-15 years old. The final model explained 44% of the variance, indicating good predictive power. Conclusion Intention to use digital CSE was explained primarily by PE, EE, and SI and moderated by age. To strengthen this intention, stakeholders will need to promote e-interventions that are pertinent, easy to use, socially valorized, and tailored to young people's needs and to the local context.

BackgroundDespite their potential to serve as a reduced-harm alternative to combustible tobacco, e-cigarette take-up remains low among older (45+) adult smokers, especially in the U.S. While social media is a known driver of vaping attitudes and behaviors in younger populations, its influence on older smokers is poorly understood. This paper provides the first focused analysis of e-cigarette-related social media exposure in this population, documenting its prevalence, characteristics, and attitudinal correlates. MethodsData come from an opt-in survey of U.S. adults (N = 974) recruited via Prolific, comprising three groups: (i) non-vaping smokers aged 45+ (N = 484), (ii) former-smoking vapers aged 45+ (N = 149), and (iii) any-vaping-status smokers aged 18-35 (N = 341). Descriptive statistics, weighted to U.S. population benchmarks, characterize self-reported exposure to e-cigarette-related content on social media. Logistic regressions estimate associations between exposure and intentions for future e-cigarette use, e-cigarette harm perceptions, and related attitudes. ResultsOlder smokers (35.3%) reported exposure to e-cigarette-related content on social media less frequently than both older vapers (44.0%) and younger smokers (72.0%). For older smokers, e-cigarette health risks were the most frequently reported topic of content viewed, followed by youth vaping and e-cigarette addiction. Among this group, exposure was positively associated with stated intentions for future e-cigarette use. Exposure was not significantly associated with perceived e-cigarette harms for any group. ConclusionsFindings provide suggestive evidence that social media exposure may promote e-cigarette adoption among older smokers. However, the cross-sectional design limits causal inference, and the observed associations may reflect selection bias or reverse causality. If a causal relationship exists, the patterns observed suggest that exposure influences e-cigarette adoption through mechanisms other than updating beliefs about e-cigarette risks. While these results tentatively support the potential of social media as a channel for older-smoker harm reduction, any policy applications must carefully weigh privacy concerns and risks to youth. Rigorous experimental studies are needed to confirm these findings and clarify how social media might be leveraged to improve public health outcomes among older smokers.

BackgroundSexual violence (SV) is a major public health problem with far-reaching consequences; however, adolescent survivors rarely seek help. This underestimates the prevalence of SV and undermines prevention and response efforts. This study was conducted to determine the prevalence and reporting of sexual violence among adolescents in Ibadan, Nigeria. MethodsBetween September and October 2021, a cross-sectional study was conducted among 360 in-school adolescents in Ibadan South-West local government area, Nigeria. Adolescents were selected using multi-stage sampling. Information on experience and reporting of sexual violence was obtained with the aid of an interviewer-administered questionnaire. Data were analysed using descriptive and inferential statistics at p[&le;]0.05 level. ResultsRespondents mean age was 14.6{+/-}1.7 years, and 50% were female. Thirty-five per cent reported at least one incident within the past 12 months. Forms of sexual violence experienced included unwanted sexual touch (25.6%), forced sex (19.2%), attempted rape (15.2%), and suggestive comments (9.6%). Seventy per cent of adolescents who experienced sexual violence did not report to anyone; reasons included fear of getting in trouble (46.6%), thinking it was not a problem (31.8%), feeling it was their fault (30.7%), and embarrassment for self/family (27.3%). Adolescents who were closer to their mothers and younger adolescents were more likely to report their experience of sexual violence (p=0.006 and p=0.038, respectively). ConclusionSexual violence is common among in-school adolescents in Ibadan, yet reporting remains low. This study highlights the need to strengthen prevention and address barriers to reporting among adolescent survivors. Key MessageO_ST_ABSWhat is already known on this topicC_ST_ABSSexual violence has physical, psychological, and social consequences on the health and well-being of adolescent survivors, and low levels of reporting and help-seeking contribute to these consequences. What this study addsThis study provides evidence on the prevalence and reporting patterns of sexual violence among adolescents in Ibadan, Nigeria. It highlights key barriers and facilitators of reporting. How this study might affect research, practice, or policyThis study provides information about factors at individual, relationship, societal and policy levels that are associated with reporting and help-seeking among adolescent survivors of sexual violence in Ibadan, Nigeria. This highlights the importance of training stakeholders, such as parents, teachers, health workers, other caregivers and the adolescents themselves, on responding to sexual violence experience and reporting. It underscores the need for improved adolescent-friendly services, policy implementation and collaboration across families, schools, communities and states to address sexual violence.

PurposeAntibiotic use (ABU) is a major driver of antimicrobial resistance (AMR), but ABU patterns are poorly understood in low-income countries where the burden of AMR is great and ABU is insufficiently regulated. Here, we report ABU from ten sites ranging from rural villages to small cities in Madagascar, a country with high AMR levels, and present results from modeling to identify factors that may be associated with ABU in this setting. MethodsWe conducted surveys of 290 individuals from ten sites in the SAVA Region of northeast Madagascar to gather data on sociodemographic characteristics, agricultural and animal husbandry practices, recent antibiotic use, the antibiotics that participants recalled using in their lifetimes, and the sources of their antibiotics. Using these data, we conducted statistical analyses with a mixed-effects logistic model to determine which characteristics were associated with recent antibiotic use. ResultsNearly all respondents (N=283, 97.6%) reported ABU in their lifetimes, with amoxicillin being the most widely reported antibiotic (N=255, 90.1% of those reporting ABU). All recalled antibiotics were classified as frontline drugs except for ciprofloxacin. Most respondents who reported antibiotic use also reported obtaining antibiotics without prescriptions from local stores (N=273, 96.5%), while only 52.3% (N=148) reported obtaining antibiotics through a prescriptive route, such as from a health clinic or private doctor. Of the 127 individuals (44.9%) who reported recent ABU, men were found to be significantly less likely to have recently taken antibiotics than women. ConclusionsOur findings provide new insights into ABU in agricultural settings in low-income countries, which have historically been understudied in AMR and pharmacoepidemiologic research. Knowledge of ABU patterns supports understanding of AMR dynamics and AMR control efforts in these contexts, such as interventions on inappropriate antibiotic dispensing. Key pointsO_LIAntibiotic use (ABU) in Madagascar is largely unstudied despite its role in antimicrobial resistance (AMR), which Madagascar faces a high burden of. C_LIO_LIABU was widespread among livestock owners in northeast Madagascar, with the majority of study participants reporting ABU in their lifetimes and most people reporting ABU also having taken antibiotics in the previous three months. C_LIO_LIMost respondents reported obtaining their antibiotics from non-pharmaceutical stores, indicating high levels of unregulated ABU, though more than half also reported sourcing their antibiotics through prescriptive means (like doctors and health clinics). C_LIO_LIMen were less likely than women to have taken antibiotics in the previous three months. C_LIO_LIThese findings support the development of interventions to mitigate the burden of AMR in Madagascar and similar contexts while underscoring the need for more comprehensive research on the drivers and patterns of ABU. C_LI Plain language summaryIn this study, we provide basic information on antibiotic use (ABU) patterns in Madagascar, a country that experiences high levels of resistance but has been particularly understudied in AMR and pharmacological research. We surveyed 290 farmers with livestock from ten sites across northeast Madagascar about their ABU and found that nearly all study participants (N=283, 97.6%) have used antibiotics in their lifetimes, while a little under half of those who reported ABU also reported using antibiotics in the previous three months (N=127, 44.9%). The most used antibiotic was amoxicillin (N=255, 90.1%). Most people obtained their antibiotics from sources that do not require prescriptions, like general stores, indicating that most ABU is unregulated. Through modeling, we also found that men were less likely than women to have taken antibiotics in the previous three months (OR=0.50, CI 0.30-0.82). These findings help us better understand the dynamics of ABU in low-income countries, which have historically been understudied in AMR and pharmacological research. They also support efforts to mitigate the burden of AMR by revealing ABU dynamics that may contribute to the emergence and spread of AMR, as well as identifying targets for intervention to curb inappropriate ABU.

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

Background: The enterotype concept proposed that gut microbiomes cluster into discrete types, but subsequent critiques demonstrated that such clustering depends on methodological choices, that the number of clusters is not fixed, and that faecal samples cannot capture spatial heterogeneity along the gastrointestinal tract. The stomach remains particularly understudied, and no systematic classification exists for gastric microbial community types. Methods: We assembled a multi-cohort dataset of 566 gastric mucosal samples spanning healthy controls to gastric cancer, with both Helicobacter pylori (HP)-negative and HP-positive individuals. Critically, we applied the key methodological lessons of the enterotype debate: we used a variational autoencoder (VAE) for dimensionality reduction to learn a continuous latent representation without forcing discrete structure, determined the optimal number of clusters using the Silhouette index (an absolute validation measure) across K=2 to K=10 rather than arbitrarily selecting a cluster number, and performed transparent evaluation of multiple clustering solutions. This VAE-plus-silhouette workflow directly addresses the critiques leveled against the original enterotype analysis. Results: Four gastotypes were identified, with K=4 achieving the highest mean silhouette score, indicating good cluster cohesion and separation. Two gastotypes (Variovorax-type and Trabulsiella-type) were significantly enriched in HP-positive samples, while two gastotypes (Bacteroides-type and Streptococcus-type) were significantly enriched in HP-negative samples. Random Forest and Gradient Boosting achieved excellent baseline performance for predicting HP infection (AUC = 0.990 and 0.993). Conclusions: The VAE-plus-silhouette workflow provides a robust, data-driven approach for identifying gastotypes without forcing discrete structure or arbitrarily fixing cluster numbers. Using this framework, we identified four gastotypes with significantly different HP infection rates. Variovorax-type and Trabulsiella-type showed strong HP-positive enrichment, while Bacteroides-type and Streptococcus-type showed strong HP-negative enrichment. These findings demonstrate that methodological advances from the enterotype controversy can be successfully transferred to the stomach, offering a reproducible taxonomy for stratifying HP infection status with potential clinical utility.