PLOS Global Public Health

BackgroundCommunity health workers (CHWs) are central to primary health care delivery in Madagascar, yet their perspectives on what enables effective work are rarely centered in programme design and implementation. Evidence is needed on the support CHWs receive in practice and the priorities they identify to strengthen effectiveness and equity. MethodsWe conducted a qualitative study nested within the formative phase of a participatory action research initiative aimed at strengthening Madagasca...

Northern Ghana faces a significant shortage of family planning (FP) services, leading to high rates of unplanned pregnancies and unsafe abortions that contribute to regional maternal mortality. Through the Academic Model Providing Access to Healthcare (AMPATH) Ghana, a partnership between Tamale Teaching Hospital (TTH), the University for Development Studies School of Medicine (UDS-SoM), and New York University Grossman School of Medicine (NYUGSOM), key stakeholders began strengthening regional ...

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 ...

BackgroundAdolescent sexual and reproductive health (ASRH) remains a critical public health priority in Ethiopia, where adolescents face persistent barriers to accessing responsive and high-quality sexual and reproductive health (SRH) services. Conventional top-down interventions often fail to address adolescents lived experiences and local contexts. Human-centered design (HCD) offers a participatory and context-sensitive approach for developing adolescent-responsive interventions. As part of th...

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...

Low public awareness and inappropriate antibiotic use contribute to the growing Antimicrobial Resistance (AMR) burden, especially in low- and middle-income countries (LMICs). The aim of Responsive Dialogues is to engage communities and key stakeholders to share information, galvanize action and create local solutions to reduce the burden of AMR. RDs promote collaborative problem-solving and have been identified as a potential tool for engaging diverse stakeholders in addressing AMR. However, RDs...

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...

IntroductionIn Bangladesh, growth monitoring and promotion (GMP) is delivered through both facility-based (FGMP) and non-government organisation (NGO)-supported home-plus-facility approaches (HGMP+FGMP). The COVID-19 pandemic disrupted health services, but little is known about the resilience of GMP delivery in rural community clinics (CCs) during this health system crisis. This study examined facilitators and barriers to GMP utilisation and implementation before and during COVID-19. MethodsWe ...

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...

IntroductionIntegrated, people-centred, high-quality services are essential to achieving universal health coverage. Traditional health facility assessments, while valuable, often focus on structural inputs and are resource-intensive, limiting their frequency and programmatic utility. The Global Fund to Fight AIDS, Tuberculosis (TB), and Malaria, developed the Targeted Health Facility Assessment (tHFA) to inform country plans and monitor progress on the Global Fund Strategy (2023-2028) of maximiz...

IntroductionPersistent infection with high-risk Human Papillomavirus (hr-HPV) in women is a leading cause of cervical cancer, and its co-infection among people living with HIV (PLHIV) increases the risk of HPV-associated cancer, including oropharyngeal and anogenital cancers. In sub-Saharan Africa, awareness of HPV is limited, screening and vaccine adoption are critically low, undermining efforts toward sexually transmitted infection (STI) elimination. MethodsFrom Awareness to ACTion (FACT) stu...

BackgroundHigh-risk fertility behaviors (HRFB) remain a public health concern in Zambia due to their association with maternal and newborn complications. Despite improvements in reproductive health services, updated national evidence on the magnitude and determinants of HRFB is limited. This study used data from the 2024 Zambia Demographic and Health Survey (ZDHS) to estimate the prevalence of HRFB and identify associated factors among women of reproductive age. MethodsA cross-sectional analysi...

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...