PLOS Global Public Health

IntroductionThe long-standing disconnection of abortion legislation in Nigeria with the estimated incidence of 1.8 million terminations a year has contributed to systematic gaps in reliable abortion data for health policy. Any subnational monitoring under conditions of legal restraint tends to remain hidden beneath under-reporting and spatial instability such that policy makers are not left with a clear picture of where and why these decisions are being made. Methods and AnalysisTo address this...

IntroductionChildhood immunization is highly cost-effective, yet uptake is shaped by sociocultural and religious influences. In Bauchi State, Nigeria, coverage remains low (Penta3 58.2%; fully vaccinated according to the national schedule 22.5% among children aged 12-23 months; Nigeria Demographic and Health Survey (NDHS) 2024). Religious leaders shape community norms, but their perspectives on immunization in Bauchi are not well characterized. Guided by Omans model of religion/spirituality and ...

High-risk sexual behaviour has been shown to be influenced by interpersonal, social, and economic factors in different situations and been linked to food insecurity. This study therefore investigated the individual, household and community factors associated with high-risk sexual behaviour among women age 18-49 in Zambia, paying particular attention to food insecurity status. It was anchored on the Socio-Ecological Model and used a cross-sectional non-intervention study design. We fitted survey ...

Seasonal Malaria Chemoprevention (SMC) is a promising intervention for Turkana, Northern Kenya, where malaria transmission is highly seasonal. Traditional malaria control methods, such as indoor residual spraying (IRS) and insecticide-treated nets (ITNs), are impractical due to the populations semi-nomadic lifestyle, temporary dwellings, sparse settlements, and limited access to health facilities. In 2024, following the WHOs updated guidance on SMC use, this intervention was implemented in Turka...

BackgroundThe COVID-19 pandemic disrupted access to sexual and reproductive health (SRH) services, including contraception. Understanding contraceptive use during this period is critical for strengthening health system resilience in small developing states. ObjectiveTo identify factors associated with contraceptive use among reproductive-age women during the COVID-19 pandemic in Barbados. MethodsA cross-sectional online survey was conducted in Barbados between April 28 and May 3, 2020 among ad...

BackgroundPerformance-based financing (PBF) aims to improve healthcare quality by offering financial incentives to service providers. This study evaluated PBFs impact on obstetric care quality in Nkambe Health District, Cameroon. MethodsWe employed a cross-sectional mixed-methods study from December 2016-July 2017 in PBF-implementing facilities. We surveyed 315 women attending prenatal and postnatal visits and 23 service providers using structured questionnaires. Quantitative data were analyzed...

BackgroundMaternal anaemia remains a leading cause of maternal morbidity and mortality in low- and middle-income countries (LMICs), with Nigeria bearing a disproportionate burden. Although treatment with intravenous (IV) iron formulations such as ferric carboxymaltose offer clinical advantages over oral iron, their uptake in routine maternal care in LMICs is limited. ObjectiveThis study critically assessed organisational readiness and identified context-specific facilitators and barriers to the...

BackgroundDelays in tuberculosis (TB) diagnosis and treatment continue to compromise control efforts, particularly in high-burden settings such as Kenya. These delays increase transmission, worsen clinical outcomes, and elevate mortality. The post-COVID-19 period has further strained health-care systems, influencing patient health-seeking behaviour and diagnostic efficiency. Objective: To quantify patient-related and health-system-related delays in TB diagnosis and treatment and to identify key ...

IntroductionYouth are challenged globally by sexual and reproductive health problems such as unwanted pregnancy, unsafe abortion and sexually transmitted infections. While family planning methods are a safe and effective way for individuals to responsibly control their sexual and reproductive needs, their use amongst sexually active youth is very low. Of urgency, is to understand factors influencing youth to adopt family planning methods so as to inform future strategies aiming at increasing the...

As programs for azithromycin mass drug administration to reduce child mortality have begun in some parts of West Africa, it is imperative to understand their financial costs. We combined a micro-costing framework and observations from an implementation-focused sub-study within the AVENIR trials in 80 communities in the Dosso region of Niger to estimate the national health sector costs of a scaled-up programmatic approach for azithromycin biannual distribution to children aged 1-59 months of age ...

Despite the existence of strong global and national human rights frameworks that support disability inclusion, women with disabilities in Kenya are still heavily discriminated against and stigmatised due to the negative perceptions of the community. This study examined community attitudes toward the sexuality of women with disabilities in Kibra Sub-County, Nairobi, and investigated demographic factors influencing these views. Using a quantitative cross-sectional design, a stratified multistage r...

Background Persistent inequities in immunisation coverage, particularly among zero-dose and under-immunised children, continue to challenge Pakistan's Expanded Programme on Immunization. Weak feedback loop, inconsistent data quality, and limited real-time monitoring impede effective decision-making. This Implementation Research was conducted under the MAINSTREAM Initiative funded by Alliance for Health Policy and Systems Research (AHPSR) and supported by the Aga Khan Community Health Services De...

Healthcare inequality remains a major challenge for health systems globally. While previous studies have examined inequalities in specific healthcare services or sub-domains of care, evidence on disparities in access across formal inpatient healthcare settings in Nigeria remains limited. This study examines income-related inequalities and inequities in access to inpatient healthcare among rural households in Nigeria. The study used cross-sectional data from 624 rural households collected in 2022...

The Global Polio Eradication Initiative (GPEI) is known to be one of the most successful disease eradication initiatives with massive reductions in polio transmission as well as its contributions to strengthening health systems and capacity building. Existing analyses provide limited insight into how capacity was developed, which forms of capacity were strengthened or neglected, and how these efforts were experienced by implementers. Understanding these factors can be helpful as GPEI accelerates...

IntroductionAccess to medical oxygen remains a challenge, with 60% of the worlds population lacking access to quality oxygen services. We explored whether outsourced oxygen to the bedside (O2B), where private providers offer bundles of oxygen services, could be adopted and scaled across diverse health systems, to improve patient access to oxygen. MethodsQualitative interviews were conducted with healthcare workers (HCWs), facility management staff and district medical officers in India, Nigeri...

IntroductionNational surveys in Pakistan are typically representative only at national or provincial levels, leaving large uncertainties in district-level contraceptive prevalence. This obscures local heterogeneity and limits data-driven program planning. Administrative data, although more frequent and detailed, are often underused due to reporting and measurement challenges. This study develops a multi-source small area estimation (SAE) framework to generate district-level estimates of contrace...

BackgroundTuberculosis (TB) incidence peaks in women during their reproductive years and is a leading cause of maternal mortality. Pregnant women with TB have a high risk of failure to initiate TB treatment and poor TB treatment and pregnancy outcomes. We determined the time to treatment initiation in pregnant women diagnosed with TB in a routine programmatic setting. MethodsUsing routine linked electronic data, we identified women 15-45 years of age with laboratory-confirmed and/or clinically ...

Despite numerous reforms and initiatives within the healthcare system, Nigerias performance on universal health coverage (UHC) indicators remains sub-optimal. This study aims to empirically examines multidimensional access to healthcare and identifies the key determinants influencing levels of access among rural households in Nigeria. We utilize cross-sectional data from 625 rural households collected between June and October 2022. Multidimensional access to healthcare was measured using a 10-it...

India carries a high burden of neglected tropical diseases (NTDs), yet the extent to which essential diagnostic services align with local disease burden across public health facilities remains unclear. We conducted a cross-sectional assessment of diagnostic availability for major NTDs in 332 public health facilities across seven states and one union territory, including sub-centers, primary health centers, community health centers, and district hospitals. Diagnostic availability for malaria, den...

BackgroundEmergency Departments (EDs) are crucial to managing non-communicable diseases (NCDs), a leading cause of death, yet there is limited information about the capacity and accessibility of emergency care in Kenya. MethodsUsing data from Project 47, a national dataset on EDs, we conducted a secondary analysis to assess capacity for NCD care, as guided by the WHO Package for Essential NCD Interventions for Primary Care (WHO PEN). ResultsOf the 186 facilities included in the assessment, 45....