Journal of Global Health

Background: Maternal mortality remains uneven globally, and the COVID-19 pandemic disrupted maternal health services through direct infection-related risks and indirect health-system pathways. We estimated country-level deviations in maternal deaths and maternal mortality ratios (MMR) during 2020-2023 relative to pre-pandemic trends. Methods: We used WHO/UN MMEIG model-based country-level estimates of maternal deaths and MMR from 2000-2019 to fit an ensemble n-sub-epidemic forecasting model. We generated no-pandemic counterfactual projections for 2020-2023 and compared them with WHO/UN MMEIG estimates for the same years. Excess was defined as the positive difference between the WHO/UN MMEIG estimate and the counterfactual prediction; uncertainty was quantified using bootstrap-based prediction intervals. Results: Globally, estimated cumulative excess maternal deaths were 68,489 (95% UI 34,706-147,118) during 2020-2023, and the aggregate excess MMR was 10,154 (95% UI 4,568-23,744). The largest regional excess death burdens were observed in the South-East Asia Region, Eastern Mediterranean Region, and African Region. Among the eight illustrative high-burden countries, Afghanistan and Somalia had statistically detectable excess maternal deaths, with totals of 2,335 (95% UI 1,148-4,350) and 1,815 (639-3,401), respectively. Liberia had a positive median estimate of 265 excess maternal deaths, but its interval included zero (0-990). Nigeria, Chad, and South Sudan had median totals of zero, although uncertainty intervals indicated that nonzero excess could not be excluded in Chad and South Sudan. Conclusion: Pandemic-period WHO/UN MMEIG estimates deviated heterogeneously from pre-pandemic counterfactual trends. These findings should be interpreted as modeled excess relative to a no-pandemic baseline and may reflect pandemic-related disruptions together with other contemporaneous health-system, political, and social shocks, rather than directly observed deaths or causal effects attributable solely to COVID-19.

Background Bangladesh has experienced a rapid increase in cesarean section (CS) utilization over the past two decades. While previous studies have documented socioeconomic disparities in CS use, evidence on how wealth-related inequalities differ between public and private healthcare facilities remains limited. This study assessed the magnitude and drivers of socioeconomic inequality in CS utilization among facility-based births in Bangladesh. Methods We analyzed data from 3,008 facility-based births reported in the 2022 Bangladesh Demographic and Health Survey (BDHS). Survey-weighted multivariable logistic regression was used to identify factors associated with CS utilization. Wealth-related inequality was assessed using concentration curves and the Erreygers-corrected concentration index (ECCI). Regression-based decomposition of the standard concentration index was performed to quantify the contribution of socioeconomic, demographic, and healthcare-related factors to observed inequalities overall and separately for public and private facilities. Results Overall, 71.2% of facility-based births were delivered by CS, with substantially higher prevalence in private facilities (84.2%) than in public facilities (35.9%). Women delivering in private facilities had markedly higher odds of CS than those delivering in public facilities (adjusted odds ratio [AOR]: 9.07; 95% confidence interval [CI]: 7.17-11.47). Significant pro-rich inequality was observed overall (ECCI: 0.154; 95% CI: 0.117-0.191), with inequality substantially greater in public facilities (ECCI: 0.189; 95% CI: 0.114-0.264) than in private facilities (ECCI: 0.049; 95% CI: 0.014-0.084). Decomposition analysis showed that household wealth was the dominant contributor to inequality, particularly the richest wealth quintile, accounting for 81.5% of overall inequality, 63.8% in public facilities, and 109.7% in private facilities. Conclusions Wealth-related inequalities in CS utilization remain substantial in Bangladesh despite widespread use of the procedure. Although pro-rich inequality exists across both sectors, inequality is considerably greater in public facilities and is driven by different mechanisms across facility types. Policies should simultaneously improve equitable access to medically necessary CS and reduce unnecessary procedures, particularly within the private sector.

Background For children at risk of acute malnutrition, being able to predict and forecast dietary intakes and/or nutritional evolution would support decision-making, particularly in crisis settings where ground data collection is unfeasible or scant. We explored whether statistical models could offer accurate predictions of caloric intake or anthropometric (weight-for-height Z score, WHZ) changes, given intake, household food insecurity and other plausible predictors. Methods We reanalysed data from the Malnutrition and Enteric Disease (MAL-ED) multi-country (Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa, Tanzania) birth cohort (2009-2014), which consistently tracked household food insecurity experience, dietary intake, anthropometry, infectious disease symptoms, breastfeeding and other variables among children 9 to 35 months old. We quantified the performance on cross-validation of three models: (M1) change in WHZ as a function of household food insecurity; (M2) change in WHZ as a function of caloric intake; (M3) caloric intake as a function of household food insecurity. We compared random forests, lasso regressions, additive models and generalised boosted regressions. All models included age, sex, birth weight, urban versus rural residence, breastfeeding status and the longitudinal prevalence of diarrhoea, acute respiratory infection and fever as additional predictors. Results Altogether, M1, M2 and M3 leveraged 2957, 23,651 and 2013 longitudinal child observations, respectively. Both at country and individual level, there was low correlation among the key variables of interest. All three models featured low performance and moderate to extreme regression dilution, even when fitted to each country cohort separately. Discussion This secondary analysis based on data from a rigorous observational study suggests that statistical prediction of key variables along the causal pathway to childhood acute malnutrition may not be feasible. These negative findings may in part be explained by error in predictor measurement and the narrow range of both predictor and outcome values in the MAL-ED cohort, relative to the more extreme scenarios common to crisis settings. They also imply that mechanistic models requiring caloric intake as an input cannot rely on a statistical shortcut of this kind and must instead depend on empirical data or scenario assumptions.

Introduction: Low and middle-income countries suffer from a high burden of undernutrition. Fetal malnutrition negatively impacts a newborn's body composition, metabolism, and enzymatic processes, predisposing the newborn to malnutrition during childhood period. This study aims to assess the magnitude of fetal malnutrition and its predictors in southern Ethiopia. Methods: A facility-based cross-sectional study was conducted among 423 pairs of mother and term newborn delivered from February 1- 28, 2025, at five randomly selected public hospitals in southern Ethiopia. The Clinical Assessment of Nutrition (CAN) Score is used to assess fetal malnutrition. Logistic regression was employed to identify predictors of fetal malnutrition. Statistical significance of the association was declared at p < 0.05. Results: Among 423 newborns included in the study, 60 (14.1%) had fetal malnutrition. Newborns born to women with a placental weight of 519 grams or less had ten times higher odds of fetal malnutrition compared to their counterparts (AOR=9.795, 95% CI: 4.881-19.657). Dietary counselling during pregnancy reduced odds of fetal malnutrition by 62.3% (AOR=0.377, 95% CI: 0.162-0.877); similarly, an extra meal during pregnancy was associated with reduced odds of fetal malnutrition by 71.6% (AOR=0.284, 95% CI: 0.131-0.616). Newborns delivered from women who had a MUAC (Mid Upper Arm Circumference) >22 cm had 75.7% lower odds of fetal malnutrition (AOR=0.243, 95% CI 0.074 -0.797), whereas maternal chronic medical illness increased the odds by threefold (AOR=3.419, 95% CI: 1.269-9.153). Conclusion: There is a high magnitude of fetal malnutrition in the study area. Placental weight, dietary counselling, extra meals during pregnancy, MUAC and chronic medical illness were predictors of fetal malnutrition, signifying the need for a comprehensive approach targeting maternal nutrition during pregnancy

Abstract Background: Maternal disability can reduce the ability to provide adequate care and increase the likelihood of undernutrition among children. In Malawi, over one third of under-five children are affected by stunting. There has been no study that assessed the association between maternal functional difficulty and undernutrition among children in Malawi. The objective was to assess if maternal functional difficulty is associated with stunting, underweight, and wasting in children in Malawi. Methods: Data were extracted from the nationally representative cross-sectional Malawi 2024 Demographic and Health Survey (MDHS). Mother-child dyads were included for mothers aged 15-49 years and children aged [&le;] 59 months, with valid anthropometric z-scores. Maternal functional difficulty was assessed using the Washington Group Short Set on six domains (seeing, hearing, walking, cognition, self-care, communication) and classified as severe vs. no difficulty. Child undernutrition was defined as height-for-age z-score (HAZ) < -2 (stunting), weight-for-age z-score (WAZ) < -2 (underweight), and weight-for-height z-score (WHZ) < -2 (wasting). Survey-adjusted multivariable logistic regression models were fitted, accounting for complex sampling design whilst population attributable fraction was calculated. Results: A total of 4,361 mother-child dyads were analyzed for this study. The overall weighted prevalence of maternal functional difficulty was 3.74% (SE 0.35). There was a reported 36.4% prevalence for child stunting, 8.7% for underweight and 1.7% for wasting. Maternal functional difficulty was not associated with child stunting (AOR 0.85, 95% CI: 0.55-1.33), underweight (AOR 1.06, 95% CI: 0.55-2.02) and wasting (AOR 0.96, 95% CI: 0.26-3.53) after adjustments for confounders. The population-attributable fractions were also found to be negligible for all three nutrition outcomes. Maternal height [&ge;] 150 cm showed strong protective effect against child stunting (AOR 0.29, 95% CI: 0.16-0.54) as well as belonging to the richest wealth quintile (AOR 0.61, 95% CI: 0.42-0.89). In conclusion, there was no statistically significant association between maternal functional difficulty and child undernutrition in Malawi. The family and community support networks in Malawi may be buffering the nutritional effects of maternal disability on children. To reduce child undernutrition in Malawi, efforts should focus on maternal height, household wealth and the first 1,000 days interventions.

Background Global labor migration from LMIC to higher-income destinations has expanded rapidly, placing increasing pressure on destination-country health. Existing research on cross-border migrant workers has focused largely on occupational health, general healthcare utilization, and disease-specific risks, while there is considerably less evidence on their sexual and reproductive health. This study contributes to this understudied field by examining the policy and health-system factors that shape the sexual and reproductive health services for migrant workers in Taiwan. Methods A qualitative study was conducted in Taiwan between November 2025 and August 2026. 22 stakeholders were purposively recruited from academia, healthcare, nongovernmental organizations, government, labor brokerage, and employers. Data were collected through semi-structured interviews and small focus groups. Interviews were conducted in Mandarin Chinese, transcribed verbatim, and translated into English. Data were analyzed using framework analysis combining deductive coding based on the AAAQ framework with inductive coding of implementation and contextual themes. Results Gaps were identified across all four AAAQ dimensions. Participants described limited migrant-responsive SRH programming; physical, financial, administrative, social, and information barriers; shortcomings in linguistic and cultural responsiveness; and weaknesses in interpretation, coordination, and continuity of care, despite generally favorable views of Taiwan's clinical quality. Conclusions Our findings show that broad insurance coverage and strong clinical capacity do not by themselves ensure the realization of migrant workers' SRHR. In Taiwan, rights were mediated through labor brokerage, gendered live-in work arrangements, and fragmented governance across health, labor, immigration, and social-welfare systems. Improving migrant SRHR therefore requires stronger implementation of existing protections, reduced dependence on informal intermediaries, and more integrated institutional responsibility for cross-sector migrant health needs.

Introduction: District-level estimates of fertility are required by policymakers and programme planners in sub-Saharan Africa (SSA) to guide decision making at the local level. Existing approaches to produce fertility estimates at the district level use age-structures or total fertility trends over time from higher administrative levels which prevents representation of district-level heterogeneity in fertility estimates. Methods: We extracted observed numbers of births and person-years stratified by five-year age group, single calendar year, and district from 194 nationally-representative household surveys. We constructed a spatiotemporal Bayesian hierarchical model that reconciles point and areal data and adjusts for non-sampling biases to estimate age-specific (ASFR) and total fertility rates (TFR) in 36 countries between 2000-2025. Results: Fertility rates were calibrated to three million births from two million women over fifteen million person-years. TFR declined in the majority of countries 2000-2020 (median -15%, interquartile range (IQR) -3 to -24%). Substantial subnational heterogeneity in TFR levels was observed in most countries, exceeding that of differences between national fertility levels. ASFR heterogeneity was observed, though to a lesser degree than variation in total fertility. Teenage fertility was unchanged in several countries, with fertility declines driven by older age groups. Conclusion: District-level fertility dynamics can differ greatly from national TFR trends and age-patterns of fertility. Use of national fertility rates will produce inaccurate estimates of births in the majority of SSA districts, leading to inappropriate resource management for key global public health objectives.

Background and aims: Maternal overweight and obesity are increasing worldwide, including Nepal. This study assessed BMI trajectories from early pregnancy to one year postpartum and trends in overweight and obesity over the past two decades in Bhaktapur, Nepal. Methods: In the most recent study, BMI was measured in 800 Nepalese women at three time points: at early pregnancy, 6 and 12 months postpartum (2017-2021). The prevalence of undernutrition, overweight, and obesity was estimated using the World Health Organization and the Asian specific cut-offs. Long-term trends were assessed by comparing these findings with three population-based studies conducted in Bhaktapur between 2001 and 2021 among 2400 women at similar life stages. Results: Mean (SD) BMI increased from 23.7 (3.0) kg/m^2 in early pregnancy to 26.1 (3.3) kg/meter squre at 6 and 25.2 (3.3) kg/m^2 and 12 months. The prevalence of overweight increased from 32.9% in early pregnancy to 48% at 6 months. Using the Asia-specific cut-offs, the prevalences were higher. Results from the three previous population-based studies demonstrated an upward trend where postpartum overweight increased from 11.4% in 2001- 2002 to 44.6% in 2017- 2021. The obesity prevalence rose from 1.8% to 10.9% during this period. Conclusion: Overweight and obesity among Nepalese women have risen dramatically over the past two decades, with postpartum overweight increasing nearly fourfold and obesity more than sixfold. These findings highlight the need for interventions to prevent excessive weight retention and reduce adverse health outcomes.

This study focuses on the relationship between access to Advanced Neonatal Care (ANC) and fertility across the regions in Ghana between 1988 and 2022. It builds on previous studies focused on inequity in maternal health across subnational levels and incorporates spatial analytics, machine learning, and a welfare-adjusted fertility care metric. Nine waves of the Ghana Demographic and Health Survey (DHS) were analyzed, with 94 region-by-year units across 8 to 16 regions in each survey wave in the 16 Ghana administrative regions. Skilled ANC along with the Total Fertility Rate (TFR) and demographic control variables were extracted for the analysis. The methodologies employed include decomposition of the Gini coefficient of inequality, bivariate z-score risk stratification, Random Forest (RF), and Decision Tree (DT) regression, partial dependence, Local Indicators of Spatial Association (LISA), global Moran's I with permutation inference and a novel Care Efficiency Index (CEI = ANC% / TFR). Care for the outcomes employed region aggregations along with district boundary geometries for the display of the choropleth maps. National skilled ANC coverage increased from 83.1% (1988) to 97.7% (2022), with inter-regional Gini declining 87.9% (0.070 to 0.008). The North-South gap narrowed from 32.4 to 0.9 percentage points. Northern region showed the greatest absolute gain (+43.0pp). Machine learning identified an exploratory RF partial-dependence inflection near TFR=5.90, above which predicted ANC coverage declined in the historical data. Survey year was the dominant RF predictor (43.7%), followed by TFR (38.8%). TFR spatial clustering intensified by 2022 (Moran's I=0.606, p=0.001). Greater Accra led the Care Efficiency Index (CEI=31.9); Northern Belt regions lagged (CEI=14.5-16.5). Risk stratification classified 23 observations as Critical (Low ANC/High TFR), predominantly from Northern Belt regions in earlier survey waves. ANC coverage converged substantially, yet fertility-related spatial inequities persisted, especially in the Northern Belt. The Care Efficiency Index and exploratory TFR inflection provide hypothesis-generating tools for targeting health-system investment. They should not be interpreted as causal thresholds.

Abstract Background The continuum of maternal healthcare utilization is crucial for enhancing maternal and child health outcomes. Despite high individual service utilization, completion of the continuum of care among many women in Kenya remains suboptimal, with significant attrition across the stages of care. This study examined socioeconomic and sociodemographic inequalities in the continuum of maternal healthcare utilization in Kenya. Methods This study used the 2022 Kenya Demographic and Health Survey, specifically the womens file. A total of 13,612 women aged 15-49 years who had a live birth within 5 years before the survey were included in the analysis. Continuum of care was categorized as no, partial, or complete. A multivariable multinomial logistic regression model was used to estimate inequalities across the continuum of care, with no continuum as the reference category. Results were expressed as adjusted Relative Risk Ratios (aRRR) with 95% confidence intervals. Results Overall, approximately 36.6% (95% CI: 35.1-38.0) achieved a complete continuum, while a majority, 60.8% (95% CI: 59.3 - 62.2), achieved a partial continuum. In terms of individual service utilization, 67% of women had 4 or more antenatal care contacts, 62% had a skilled delivery, and 54% had a postnatal visit within 48 hours of delivery. We observed inequalities across parity, age, wealth quintiles, education, pregnancy intention, place of residence, and media exposure that influenced both the partial and complete continuum of maternal healthcare utilization. Conclusion Approximately one-third of women in Kenya received a complete continuum of care during the prenatal and postnatal periods. The government and stakeholders should prioritize targeted, equity-focused interventions for women with no education and those from low-income households to increase service utilization. Non-governmental organizations and the Ministry of Health should also intensify media sensitization and expand access to family planning services.

Background Neural tube defects (NTDs) are preventable congenital malformations that disproportionately affect low and middle income countries and contribute to disability and mortality. Evidence on the long-term outcomes of children and adolescents with NTDs in Eastern Africa has not been comprehensively synthesised. We conducted a systematic review and meta-analysis to assess survival, complications, and functional outcomes among children with NTDs in this region. Methods We searched PubMed, MEDLINE (Ovid), Cochrane Library, Web of Science, and Africa Index Medicus from the earliest records to April 2025. Two reviewers independently screened studies, assessed quality, and extracted data. We included studies reporting outcomes beyond one year of age, except mortality, which was assessed from birth onwards. Random-effects meta-analyses were undertaken when at least two sufficiently studies were available; otherwise, findings were synthesised narratively. Results Of 597 articles screened, 16 studies involving 2,340 children with NTDs met the inclusion criteria. Pooled cumulative mortality was 23% (95% CI: 12 - 36%) in the neonatal period, 9% (95% CI: 2 - 33%) during infancy, 22% (95% CI: 16 - 28%) in toddlers, 37% (95% CI: 30 - 44%) in pre school aged children and 45% (95% CI: 36 - 54%) in school-aged children. The pooled prevalence of hydrocephalus was 41% (95% CI: 34 - 48%) with little variation by age. Neurogenic bladder increased from 53% (95% CI 49 - 81%) in toddlers to 83% (95 % CI 72 - 91%) in adolescents, while impaired mobility affected about 61% (95% CI 48 - 72%) of adolescents. School enrolment was 53% (95% CI: 39 - 67%), with 9% (95% CI: 4% - 19%) in specialized education. Speech, hearing, and bowel dysfunction were understudied (< 2 studies each). Conclusion Many children with NTDs in the Eastern African region survive beyond infancy but frequently experience hydrocephalus, neurogenic bladder and motor impairment. Longitudinal studies, context-specific guidelines, and follow-up systems are urgently needed to improve care and long-term outcomes.

Background: Neonatal mortality remains a significant public health challenge in Sub Saharan Africa (SSA). The continuum of maternal care (COC), spanning antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC) represents an integrated pathway to improving neonatal survival. Multi-country evidence on how adherence to this full continuum affects neonatal outcomes across SSA is limited. Objectives: This study aimed to: (1) construct a composite COC indicator and describe its sociodemographic distribution; (2) estimate its association with neonatal mortality; (3) conduct a counterfactual analysis; and (4) examine cross country heterogeneity in the COC effect on neonatal mortality. Methods: Pooled Demographic and Health Survey (DHS) data from 35 SSA countries (2010 to 2026) were analyzed (N = 867,984 live births). A binary CoC indicator (coc1 = 1 if mother received [&ge;]4 ANC visits, skilled birth attendance, and PNC within 48 hours) was constructed. Survey-weighted logistic regression adjusted for wealth, education, residence, parity, maternal age, child sex, child age, and country. Counterfactual predictive margins and a COC and country interaction model were estimated in Stata 18. Results: Only 13.47% of mothers met the full COC threshold. COC completion was higher among wealthier, urban, more educated, and lower-parity women. After adjustment, CoC receipt was associated with significantly lower odds of neonatal death (aOR = 0.638, 95% CI: 0.577 - 0.706, p < 0.001). Counterfactual analysis showed the predicted neonatal mortality probability would fall from 3.15% (no CoC) to 2.04% (full CoC), an absolute risk reduction of 1.11 percentage points. Cross-country interaction terms were largely non-significant; only Namibia reached significance (p = 0.036). Conclusion: Completion of the full continuum of maternal care is independently associated with reduced neonatal mortality across SSA. Equity focused policies should prioritize integrated service delivery for rural, poor, and less educated women.

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.

Background: Evidence regarding the double burden of malnutrition (DBM) among hospitalized patients in Vietnam remains limited. This study examined nutritional status at admission and its association with length of hospital stay among adults in Hanoi. Methods: This prospective observational cohort study was conducted in eight public hospitals in Hanoi between September 2018 and November 2019. Adults aged 18-60 years were assessed within 48 hours of admission using interviews, physical examination, anthropometric measurements, and medical records. Nutritional status was classified using the Subjective Global Assessment (SGA) and body mass index (BMI): undernourished (SGA-B or SGA-C or BMI <18.5 kg/m2) and overnourished (SGA-A and BMI [&ge;]25.0 kg/m2). Length of stay was compared across nutritional-status groups using the Kruskal-Wallis test. Results: Among 1,183 registered patients, 1,115 had sufficient data for analysis. Overall, 24% were undernourished and 16% overnourished. Weight loss during the preceding six months was reported by 54%, although most losses were <5%. SGA-B or SGA-C was identified in 20%, whereas 11% had BMI <18.5 kg/m2. The median hospital stay was 8 days, with no significant difference across nutritional status groups. Conclusions DBM was prevalent among hospitalized adults in Hanoi. Indicators of recent nutritional deterioration were more common than low BMI, suggesting that BMI alone may overlook early disease-related nutritional decline. Nutritional status was not associated with length of stay in this relatively young, predominantly mild-to-moderate patient population. Hospital nutritional screening should therefore assess recent nutritional changes across the full BMI spectrum.

Background: Neonatal mortality remains disproportionately high in sub-Saharan Africa (SSA), accounting for nearly half of all deaths in children under five. Although antenatal care, skilled birth attendance, and postnatal care are individually associated with improved newborn survival, few studies have examined whether their integrated receipt as a continuum of care (CoC) confers additional protection against neonatal death, particularly after accounting for sociodemographic confounding and heterogeneity across country contexts. Methods: A pooled cross-sectional analysis was conducted using DHS-8 Births Recode files from five countries: Nigeria (2024), Mali (2023-2024), Congo DRC (2023-2024), Kenya (2022), and Lesotho (2023-2024). The analytical sample comprised 37,351 births within the 36-month postnatal care reference window. Complete CoC was defined as receipt of adequate antenatal care ([&ge;]4 visits with first-trimester initiation), skilled birth attendance, and postnatal care within 48 hours for the mother or newborn. Neonatal mortality was defined as death within 27 days of birth. Survey-weighted logistic and log-Poisson regression models estimated adjusted odds ratios (aOR) and adjusted prevalence ratios (aPR). G-computation quantified the population attributable fraction (PAF). Country-specific heterogeneity was examined through random-effects meta-analysis (DerSimonian-Laird method) and a two-level multilevel logistic regression model. Results: The overall neonatal mortality rate was 29.3 per 1,000 live births (95% CI: 27.6-31.0). Complete CoC prevalence was 19.2% (95% CI: 18.5-19.9%), ranging from 7.8% in Congo DRC to 47.8% in Lesotho. In unadjusted analysis, complete CoC was associated with a 24% reduction in neonatal death odds (cOR: 0.764, 95% CI: 0.583-1.000, p = 0.050). After adjustment for wealth, education, residence, parity, maternal age, child sex, and country, the association was substantially attenuated and non-significant (aOR: 0.961, 95% CI: 0.717-1.289; aPR: 0.962, 95% CI: 0.722-1.282). The PAF under universal complete CoC was 3.2%. The pooled meta-analytic estimate was aOR 0.718 (95% CI: 0.447-1.152), with moderate heterogeneity (I{superscript 2} = 38.9%; {tau}{superscript 2} = 0.089). Country-specific estimates ranged from aOR 0.455 (95% CI: 0.256-0.810) in Kenya to 1.447 (95% CI: 0.496-4.220) in Lesotho. Conclusion: Complete continuity of maternal healthcare was not independently associated with reduced neonatal mortality after full adjustment, suggesting that the unadjusted benefit was attributable to sociodemographic selection rather than a direct causal pathway. These findings underscore the insufficiency of service utilisation metrics in isolation and highlight the need to address the structural and contextual determinants that simultaneously constrain both care access and neonatal survival. Country-level heterogeneity in the CoC-mortality relationship points to the importance of tailored, context-specific interventions.

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.

Abstract Background Evaluating antenatal care (ANC) quality is critical to reducing maternal and neonatal mortality. In Zambia, despite high basic ANC attendance, comprehensive national evidence on the clinical content and quality of services remains limited. This study assessed the coverage of WHO-recommended ANC interventions and identified factors associated with care quality using the latest national data. Methods A cross-sectional analysis was conducted using data from the 2024 Zambia Demographic and Health Survey. The final analytic sample comprised 4,829 women aged 15-49 with a live birth in the preceding 5 years. A composite index of 15 selected, equally weighted WHO-recommended components evaluated clinical assessment, counseling/screening, preventive interventions, and utilization. Survey-weighted Poisson regression estimated adjusted incidence rate ratios (aIRRs) for the count of ANC components received. Results The mean ANC quality score was 12.5 out of 15 (95% CI: 12.4-12.6), and 78.5% (95% CI: 77.0-80.0) of women achieved adequate ANC ([&ge;] 12/15 components). While individual clinical and counseling coverage generally exceeded 90%, only 47.2% (95% CI: 45.3-49.0) of women initiated care during the first trimester, and just 4.8% (95% CI: 4.1-5.6) achieved [&ge;] 8 ANC contacts. Maternal education was the strongest and most stable predictor of quality across all models. Compared to no education, higher education was associated with an 8.0% higher expected quality score (aIRR = 1.080, 95% CI: 1.051-1.110). Lower ANC quality was significantly associated with unwanted pregnancies (aIRR = 0.970, 95% CI: 0.956-0.993) and with residence in Western (aIRR = 0.923, 95% CI: 0.897-0.951) and North Western (aIRR = 0.966, 95% CI: 0.937-0.996) provinces. Absence of distance barriers and residence in Eastern, Luapula, and Copperbelt provinces were associated with higher quality scores. Conclusion While average ANC component coverage in Zambia is high, critical gaps persist in early initiation and total contact frequency. Care adequacy is strongly influenced by maternal education, relationship status, pregnancy intention, and regional inequities. These findings underscore the need for interventions targeted at uneducated women, preventing unintended pregnancies, and underserved regions such as Western and North Western Provinces. Keywords: Antenatal care quality, ANC content, Zambia, maternal education.

Abstract Objective: This study aimed to assess the magnitude of undernutrition and associated factors among pregnant women attending public health facilities in the Goba district, Bale zone, Oromia Region, Ethiopia, 2022. Design: Institution-based, cross-sectional study design was used. Setting: The study was conducted in selected public health facilities from May to June 2022. Participants: The study population consisted of pregnant women who lived for at least 6 months in the study area and who attended antenatal care follow-up at selected public health facilities during the study period. Pregnant women who lived for less than six months in the study area and those who were critically ill were excluded from the study. Results: 487 respondents participated in this study with a 100% response rate. More than half (50.7%) of pregnant mothers were undernourished. The significant factors associated with maternal undernutrition during pregnancy in this study were mothers with no formal education (AOR = 5.050; 95% CI: 1.470- 17.346), a history of illness during pregnancy (AOR = 2.089; 95% CI: 1.246-3.504), and eating frequency of meals less than or equal to three times per day (AOR = 3.292; 95% CI: 1.040- 10.42). Poor nutritional knowledge (AOR = 5.588; 95% CI: 2.921-10.689), poor household (HH) wealth status (AOR = 4.774; 95% CI: 2.216- 10.285), and mothers who had >= 4 pregnancies were included (AOR = 0.852; 95% CI: 342-0.989). Conclusion: The magnitude of Undernutrition among pregnant women was 50.7%. Significant associations with Undernutrition were found in mothers with no formal education, poor dietary knowledge, a meal frequency of three or fewer times per day, a history of illness during pregnancy, lower and medium household wealth status, and those who had experienced four or more pregnancies while attending antenatal care (ANC) services at public health facilities.

The Gaza Strip is facing unprecedented levels of destruction to its healthcare system--including the provision of rehabilitation services--since the Israeli Defense Forces began its most recent military operation in October 2023. The Rehabilitation Task Force (RTF) is the governing body tasked with overseeing the provision of these services, including prosthetics and orthotics (P&O), in Gaza. Using the RTFs published documents--including reports on the state of P&O services, technical reports, and manuals/guidelines for various forms of rehabilitation services--this study aims to assess the capacity of Gazas P&O sector to meet the needs of Palestinians seeking P&O services. The study team analyzed the RTFs documents on P&O capacity and generated ratings according to the World Health Organizations Standards for Prosthetics and Orthotics. The results of our study demonstrate that, despite the extremely challenging circumstances, Gazas P&O sector excels in the domain of Policy. The targeted destruction of the rehabilitation sector and intentional withholding of resources preclude the Gaza Ministry of Health from meeting the standards in the domains of Products, Personnel, and Provision of Services. This systemic erosion of rehabilitative medical care translates into a reduced capacity to restore function and mobility to the tens of thousands of people in Gaza currently in need of such care. As such, urgent measures are required to restore, uphold, and expand the capacity of the P&O sector to serve the rights of persons with disabilities in Gaza.

Background: Indonesia, as an upper-middle-income country, is undergoing a nutrition transition. The persistent problem of undernutrition is now accompanied by rising overnutrition, creating a double burden of malnutrition. The Human Development Index (HDI) that measures socio-economic development, has shown steady improvements in Indonesia, yet nutritional disparities remain across provinces with varying HDI levels. Objective: This study aims to map the relationship between HDI and nutritional status by analyzing the prevalence of stunting, wasting, underweight, and overweight across different HDI categories and provinces in Indonesia. Additionally, this study explores the determinants of malnutrition to provide a deeper understanding of the factors influencing child nutrition status. Methods: This ecological study utilizes data from 2023 Indonesian Nutrition Status Study, Central Bureau of Statistics and Indonesian Demographic and Health Survey and creates provincial level dataset with malnutrition prevalence, HDI, and other health indicators. The analysis employs spatial relationship, descriptive statistics, and correlation analysis to assess the determinants of malnutrition. This ecological study used 2023 provincial-level data from the Indonesian Health Survey (SKI) and the Human Development Index (HDI) published by the Central Bureau of Statistics. Nutritional indicators (stunting, underweight, wasting, and overweight) were analyzed in relation to HDI and other determinants. Spearmans correlation and Mann-Whitney U tests were used for statistical analysis. Spatial patterns were visualized through GIS mapping to explore geographic relationships between HDI levels and nutritional status. Results: Provinces with high to very high HDI had significantly lower prevalence of stunting (21.36% vs. 31.80%), underweight (16.60% vs. 21.89%), and wasting (9.49% vs. 13.00%) compared to those with low to medium HDI (p < 0.05). No significant difference was found for overweight. Significant negative correlations were observed between stunting, underweight, and wasting with several key determinants, including exclusive breastfeeding, proper infant and young child feeding practices, adequate vitamin A intake, proper handwashing and sanitation practices, parental education, immunization coverage, and HDI. However, no significant correlations were found between these determinants and overweight. Conclusion: This study highlights the complex relationship between HDI and nutritional status, emphasizing the need for region-specific interventions. While improving HDI can help to reduce undernutrition, rising overweight prevalence requires targeted public health strategies. These findings offer valuable insights for policymakers to design holistic, multi-dimensional approaches to combat malnutrition in Indonesia. Keywords: Human Development Index, Nutritional Status, Spatial Analysis, Malnutrition, Indonesia