Public Health in Practice

Background: Sickle cell anaemia (SCA) is characterised by chronic haemolysis, inflammation, platelet activation, and recurrent vaso-occlusive complications. Mean platelet volume (MPV) is a readily available platelet index, but evidence regarding its relationship with disease severity in paediatric SCA remains limited and inconsistent, particularly in African populations. Objective: To evaluate the relationship between MPV and disease severity among children with SCA in Kwara State, North-Central Nigeria. Methods: This hospital-based cross-sectional study included 51 clinically stable children with confirmed SCA consecutively recruited from the paediatric haematology clinic of Children Emergency Specialist Hospital, Ilorin. Complete blood count, including MPV, was performed using a Rayto RT-7600 automated haematology analyser. Disease severity was assessed using a composite clinical and laboratory scoring system based on a previously described method. Pearson's correlation, Spearman's rank correlation, simple linear regression, and the Kruskal-Wallis test were used as appropriate. Statistical significance was set at p < 0.05. Results: Of 51 participants, 14 (27.5%) had mild, 33 (64.7%) moderate, and 4 (7.8%) severe disease. Mean MPV was 9.34 +/- 0.76 fL (range, 8.0-11.2). Pearson's correlation showed a weak positive, non-significant linear relationship with severity score (r = 0.231, p = 0.103), whereas Spearman's analysis showed a weak positive monotonic association (rho = 0.286, p = 0.042). Regression explained 5.3% of severity-score variation (R2 = 0.053, p = 0.103). MPV did not differ significantly across severity categories (H = 2.163, p = 0.339). MPV correlated inversely with haemoglobin (r = -0.556, p < 0.001) and positively with platelet count (r = 0.307, p = 0.029). Conclusion: MPV showed a weak relationship with disease severity but inconsistent statistical evidence across analyses. The limited explained variance and absence of significant differences between severity categories do not support MPV as a standalone severity marker. Larger longitudinal studies are warranted. Keywords: Sickle cell anaemia; Mean platelet volume; Disease severity; Platelet indices; Paediatric haematology; Cross-sectional study; Nigeria.

Background: Immigrant patients with limited dominant-language proficiency may face intersecting challenges when navigating cancer care and long-term oral anticancer treatment. Although studies have reported lower medication adherence among migrant and ethnic minority populations, less is known about how migration-related, linguistic, experiential and contextual factors shape treatment engagement from patients own perspectives. This study explored how immigrant patients experience illness, navigate treatment and engage with oral anticancer medication within the broader context of cancer care. Methods: Thirteen immigrant patients with limited dominant-language proficiency receiving oral anticancer medication for haematological malignancies were recruited from the haematology outpatient clinic of a Belgian university hospital. Semi-structured interviews were conducted in participants native languages using an adapted version of the McGill Illness Narrative Interview, with professional interpreters or intercultural mediators. Interviews were analysed using inductive reflexive thematic analysis within an interpretivist framework. Results: Analysis of patients illness narratives generated five experiential dimensions: 1) bodily, biographical and identity rupture; 2) temporal disruption and uncertainty; 3) linguistic vulnerability shaping the illness experience; 4) meaning-making and explanatory frameworks; and 5) resources sustaining treatment engagement. Linguistic vulnerability shaped access to biomedical knowledge, participation in healthcare encounters and patient autonomy, while patients mobilised personal, relational, existential, linguistic and institutional resources to sustain treatment continuity. Treatment engagement emerged as a dynamic and relational process embedded within broader migration-related, linguistic and healthcare contexts. Rather than representing fixed determinants or sequential stages, the five dimensions formed an evolving configuration whose relative salience varied throughout the illness trajectory. Conclusion: This study proposes a multidimensional interpretive model of engagement with oral anticancer medication among immigrant patients with limited dominant-language proficiency. Rather than conceptualising adherence as an isolated individual behaviour, the findings show how migration-related contexts shape the conditions under which treatment engagement becomes possible, difficult or fragile. By foregrounding immigrant patients lived experiences, the study identifies experiential, linguistic, relational and structural dimensions of cancer care that are difficult to capture through behavioural adherence measures alone and offers insights for more equitable, context-sensitive and patient-centred oncology care.

Background Floods are among the most devastating natural disasters worldwide and are increasingly associated with adverse mental health outcomes, particularly Post-Traumatic Stress Disorder (PTSD). In December 2023, Hanang District in northern Tanzania experienced catastrophic mud floods that resulted in extensive loss of life, destruction of property, displacement of households, and disruption of livelihoods. While emergency humanitarian responses focused primarily on physical needs, limited evidence exists regarding the long-term psychological consequences among survivors. Therefore, this study aimed to determine the patterns of PTSD manifestations and assess cognitive factors associated with PTSD symptoms among flood victims in Hanang District, Tanzania. Methods A community-based cross-sectional study was conducted among 360 flood victims one year after the disaster. PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5). Descriptive statistics summarized PTSD severity, while chi-square tests and regression analyses examined associations between socio-demographic characteristics and PTSD manifestations. Cognitive factors were assessed based on participants' exposure to traumatic experiences and perceptions of traumatic events. Results The mean PCL-5 score was 39.2 (SD = 20.6), indicating a high burden of psychological distress. Approximately 45% of respondents had severe PTSD symptoms (PCL-5 [&ge;]45), while another substantial proportion demonstrated moderate symptom severity. PTSD manifestations varied significantly by geographical location (p < 0.001), household income (p = 0.011), and marital status (p = 0.002). Age positively predicted PTSD severity ({beta} = 0.019, p = 0.001), whereas household income negatively predicted symptom severity ({beta} = -0.297, p = 0.001). Exposure to natural disasters constituted the predominant cognitive factor, with 45% directly experiencing the flood and 38.3% witnessing the event. Exposure to secondary traumatic experiences through witnessing or learning about violent events was also common. Cognitive trauma exposure demonstrated a significant association with PTSD symptoms ({chi}2, p < 0.001). Conclusion PTSD remains highly prevalent among flood survivors in Hanang district. Both direct and indirect trauma exposure significantly contributed to PTSD manifestations. Comprehensive disaster recovery programmes should integrate trauma-focused psychological services, cognitive behavioural interventions, routine PTSD screening, and community-based psychosocial support alongside socioeconomic recovery initiatives.

Introduction: Clinical students are a future health workforce, yet their roles during outbreaks of highly infectious diseases remain uncertain because of safety, training, supervision and welfare concerns. Ugandas 2022 outbreak of Ebola disease caused by Sudan ebolavirus highlighted the need to understand how clinical students perceive outbreak-related care. Aim: This study explored willingness to care for patients with Ebola virus disease among clinical students at a Ugandan medical school and examined how perceived risks, perceived benefits and support needs shaped that willingness. Methods: An exploratory descriptive qualitative study was conducted among clinical students of Makerere University in Kampala, Uganda. Fifteen undergraduate medical and nursing students in the later years of training were purposively selected. Data were collected through in-depth interviews, audio-recorded with consent, transcribed verbatim, de-identified and analysed using latent content analysis. The Health Belief Model sensitised interpretation, and reporting was strengthened using the COREQ guidance. Results: Five interrelated themes emerged, showing that willingness to care was conditional rather than simply present or absent. Students described an initial willingness grounded in professional duty, devotion to patients and the desire to save life. This willingness was restrained by perceived risks of contracting Ebola virus disease, dying, transmitting infection to family members or colleagues, emotional distress, lack of epidemic-readiness in the curriculum, inadequate preparedness and weak welfare support. Perceived benefits, including patient survival, professional learning, outbreak experience and personal fulfilment, strengthened willingness but did not override safety concerns. Students identified reliable personal protective equipment, epidemic-ready curricula, practical infection-prevention and control training, simulation, clear protocols, close supervision, psychosocial support, insurance and fair compensation as cues to action that could convert willingness into safe participation. Conclusions: Clinical students in this Ugandan teaching hospital expressed a strong sense of professional responsibility, but their willingness to participate in Ebola care was conditional upon preparedness, protection, epidemic-ready education and institutional trust. Professional duty and learning opportunities promoted participation, whereas perceived risks and inadequate support limited it. Medical education programmes and outbreak-response systems should develop ethical, supervised, competency-based student roles supported by practical curricula, reliable protective equipment and psychosocial and welfare safeguards.

Background: Though progress has been made towards universal access to diagnosis and treatment, inequalities in HIV testing are a major obstacle to HIV care in the world, as not everyone has enough access to HIV testing services. Progress is being made towards universal HIV testing and treatment, but inequalities in HIV testing are also an important hurdle to HIV care. Design: Cross-sectional secondary analysis Setting: Nationally representative survey across all 16 administrative regions of Ghana. Participants: 22,058 respondents (15,014 women aged 15-49 and 7,044 men aged 15-59) from the 2022 Ghana Demographic and Health Survey. Primary outcome measure: HIV testing uptake, defined as ever having been tested for HIV and received results (binary: yes/no). Aim: The aim of this study was to examine socioeconomic inequalities and spatial clustering in uptake of HIV testing in Ghana in the 2022 Ghana Demographic and Health Survey (GDHS). Specifically, it considered the level of inequality in wealth, the factors related to these inequalities, and the spatial distribution of HIV testing and factors associated with uptake of HIV testing. Methods: The secondary analysis of cross sectional data was done on 22,058 respondents from all 16 administrative regions of Ghana by using descriptive statistics, Erreygers concentration index, Wagstaff decomposition, spatial autocorrelation techniques, and multilevel logistic regression. Results: The findings showed that there was significant pro-rich inequality in HIV testing, with the majority of inequalities observable not being accounted for by the difference in wealth, but in education level. There was a significant geographic clustering with hotspots in the south, and coldspots in the north. HIV testing uptake was significantly predicted by wealth, education, and the age, sex, marital status and being covered by health insurance Conclusion: The study revealed that socioeconomic and geographical inequalities still exist and have significant impacts on uptake of HIV testing in Ghana. It suggests specific programs such as those aimed at disadvantaged communities, geographic areas, greater access to health insurance, and improved community-based HIV testing services to help ensure equitable access.

Introduction Safe and timely blood availability remains a major global health challenge, especially in low- and middle-income countries. Digital tools may accelerate donor contact, but digital reachability alone does not ensure that people will notice, trust and act on urgent requests to support blood donation efforts. We examined factors associated with anticipated engagement in digitally coordinated urgent blood-donor mobilisation among digitally reachable adults in Ghana. Methods We conducted a cross-sectional online survey from September 2025 to January 2026 across Ghana's 16 regions. Participants were recruited via Facebook advertising and snowball sampling. Factors associated with urgent blood-donor mobilisability were assessed under four criteria: high future-donation willingness; high willingness to install a trusted donation app; high willingness to respond to a trusted urgent-request; and high practical flexibility to leave current activities. Descriptive analyses and multivariable logistic regression examined prevalence and associated factors. Results Among 1,067 participants, 577 (54.1%) met all four criteria. Future-donation willingness (91.8%), trusted-app installation willingness (83.2%) and trusted-request response willingness (82.7%) were common, whereas practical flexibility was lower (66.6%). In the adjusted model, high formal health-system trust (adjusted OR (AOR) 3.95, 95% CI 2.08-7.50), high digital-response readiness (AOR 2.26, 1.66-3.08), previous donation (AOR 1.47, 1.08-2.01), high donation knowledge (AOR 1.42, 1.03-1.97) and willingness to donate to strangers were positively associated with high mobilisability. Women (AOR 0.60, 0.43-0.83), participants reporting a work-schedule barrier (AOR 0.43, 0.29-0.66) and those travelling over 30 min to the nearest healthcare facility at night (AOR 0.66, 0.45-0.96) had lower adjusted odds. Conclusions Digital reachability and stated donation willingness may overestimate the population pool available for emergency donation. Digital blood-donor solutions should consider verifiable health-system requests, account for response readiness and current availability, and connect willing individuals with accessible collection options and transport support where needed.

Introduction People with severe mental illness (SMI) and learning disabilities (LD) experience significant health inequalities, with diet-related conditions contributing substantially to early and preventable death. Despite high levels of nutritional risk, the presence and effectiveness of nutritional screening in mental health (MH) and LD settings remains under-researched. This study aimed to investigate nutritional screening practices in UK inpatient MH and LD services from the perspectives of dietitians. Methods A cross-sectional mixed-methods study was conducted using a novel 22-question online survey. Data was collected via the British Dietetic Association Mental Health Specialist Group (April-June 2025). Quantitative data was analysed descriptively and qualitative data by reflexive thematic analysis. Findings were integrated and presented thematically. Ethical approval was granted by Teesside University (2025Mar26544). Results Forty-seven dietitians participated, most with substantial dietetic experience, from a range of MH settings. Screening practices were widely established and supported by policy and audit. However, participants reported low confidence in screening translating into meaningful patient care. Barriers to screening included appropriateness of available tools, time constraints, difficulty engaging distressed patients and poor prioritisation of physical health. Digital integration and wider infrastructure were also important. Dietitians rarely undertook screening directly, instead holding secondary or leadership roles, while screening was most often completed by nursing staff who were often perceived to place limited importance on the process. Existing tools, particularly the Malnutrition Universal Screening Tool (MUST), were viewed as insufficiently capturing the broader nutritional risks relevant to MH/LD populations, leading some services to adopt bespoke, unvalidated tools. Conclusion Concerns regarding the suitability of existing nutritional screening tools in MH/LD settings are consistent with previous literature. However, we suggest cautious use of unvalidated bespoke tools. Whilst there was no clear front runner, MH specific tools such as the St Andrews Nutrition Screening Instrument (SANSI) and the NutriMental Screener warrant further evaluation. Importantly, findings indicate that optimising tool choice alone is unlikely to improve screening effectiveness. Nutritional screening must be embedded within clear care pathways, supported by organisational leadership, digital infrastructure, and multiprofessional engagement to move beyond procedural completion and support meaningful clinical action to improve patient care.

Background: The Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS) remain a major public health concern in Ghana. Despite sustained progress in treatment and prevention, regional prevalence variations persist, driven by healthcare access, urbanization, and socio-economic factors. This study identifies trends and hotspots to guide effective HIV surveillance and control strategies in Ghana. Methods: A retrospective ecological study was conducted using secondary HIV data confirmed by laboratory testing, from the Ghana District Health Information Management System (DHIMS2) for the period 2020 to 2024. HIV prevalence was calculated as the number of confirmed cases per 100,000 population, using denominators from the Ghana Statistical Service 2021 Population and Housing Census. Spatiotemporal variation in prevalence was visualized using choropleth maps. Global Morans Index examined whether overall spatial dependency existed, followed by local indicators of spatial association (LISA), comprising local Morans I and the Getis-Ord Gi* statistic, to identify local clusters, outliers, and hotspots or coldspots. Results: National HIV prevalence per 100,000 population rose from 0.68 in 2020 to 0.84 in 2024. The highest burden was in the southern and middle belt regions: Western North (2.16), Bono East (1.71), Eastern (1.30), Volta (1.06), and Ahafo (1.01). Northern regions remained consistently low throughout the study period, with Northern (0.32), Upper East (0.26), and Savannah (0.30) recording averages below 0.50 per 100,000. Global Morans Index indicated a dispersed pattern in 2020 (I = -0.43), spatially random pattern between 2021 and 2023, and weak positive spatial association in 2024 (I = 0.22). Conclusions: Regional disparity in HIV prevalence in Ghana is widening, with greater burden concentrated in the more urbanized southern regions. Interventions guided by surveillance data and tailored to specific regions, including strengthened testing infrastructure and a more equitable distribution of health resources, are needed to curb transmission and support HIV in Ghana and the AIDS control programme. Keywords: HIV, AIDS, spatiotemporal analysis, Morans I, Getis-Ord Gi*, Ghana

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.

Objective: To investigate the distribution frequencies of Rh blood group antigens (C, c, D, E, e) and phenotypes in the population of Hengyang, Hunan Province, and to analyze the production of Rh alloantibodies in repeatedly transfused patients, thereby providing a basis for developing precise transfusion strategies. Methods: Rh phenotyping, antibody screening, and antibody identification were performed on 3,635 hospitalized patients and 5,326 blood donors using Rh blood group typing cards. A blood transfusion management system was used to identify and track patients' historical specific antibodies, with automatic alerts for inconsistent results. Results: The antigen frequency distribution in patients was D (99.56%) > e (94.69%) > C (91.64%) > c (48.06%) > E (38.79%). The phenotypic distribution frequencies among Rh(D)-positive patients were as follows: CCDee (51.31%) > CcDEe (30.01%) > CcDee (9.37%) > ccDEE (5.00%) > ccDEe (2.79%) > CCDEe (0.80%) > ccDee (0.39%) > CcDEE (0.28%) > CCDEE (0.05%). From March to October 2023, after implementing Rh phenotyping and antigen-matched compatible transfusions for five antigens, the antibody screening positivity rate decreased to 0.97%, compared to 1.14% during the same period in 2022 (p < 0.05). Antibody identification in 276 antibody-positive samples revealed that alloantibodies against the Rh system accounted for the highest proportion (46.01%, 127/276), which was lower than the 55.21% observed in 2022 (p < 0.05). Unexpected antibodies in the Rh system were the primary cause of crossmatch incompatibility in clinical transfusions, accounting for 46.01%. Conclusion: Rh phenotyping and sustained antigen-matched compatible transfusions in repeatedly transfused patients can effectively prevent and reduce alloantibody production. Continuous tracking of specific antibodies and transfusion efficacy evaluation can be achieved through an efficient blood transfusion management system.

Communities exposed to flooding can experience markedly different mental health outcomes, yet conventional resilience indicators capture only part of the social and contextual conditions that may explain this variation. This study develops a multilevel and predictive framework for examining community resilience and depressive symptoms following flood exposure in Indonesia. Data were drawn from 20,303 respondents aged 15 years and older nested within 312 communities in the Indonesia Family Life Survey (IFLS-5). Depressive symptoms were assessed using the 10-item Centre for Epidemiologic Studies Depression Scale (CES-D-10), with Rasch Partial Credit Model calibration used to examine measurement properties. Bayesian multilevel models quantified between-community heterogeneity and assessed how far observable structural resources accounted for this variation. Community resilience was represented through two complementary constructs: structural resilience, based on observable socioeconomic and social-capital resources, and Latent Community Protective Capacity (LCPC), a model-derived proxy for residual contextual variation in depressive-symptom risk. Approximately 6 percent of variation was attributable to between-community differences, while observable structural resources explained only part of this heterogeneity. Structural resilience and LCPC were weakly correlated (r = 0.155). Moderation analyses provided no clear evidence that structural resilience altered the flood-depression association, while LCPC showed a directionally consistent but uncertain buffering pattern. Predictive models incorporating community-level information improved discrimination, with the best-performing model reaching an ROC-AUC of approximately 0.71. The findings suggest that observable resource-based indices provide an incomplete account of community-level mental health vulnerability and that residual contextual measures may provide complementary information, while requiring cautious interpretation and independent validation.

Introduction: Antenatal depression is a major public health concern linked to adverse maternal and neonatal outcomes, including preterm birth, impaired fetal growth, low birth weight, infant malnutrition, and increased episodes of childhood illness. This study assessed the magnitude and factors associated with antenatal depression among pregnant women attending public health centers in Shire town, Tigray, Ethiopia. Methods: This facility-based cross-sectional study allocated the sample proportionally across health centers based on November-December 2025 antenatal care caseloads. After selecting the first participant by lottery, every third eligible attendee was enrolled through systematic sampling. Variables with p[&le;]0.25 in bivariable analysis were entered into a multivariable logistic regression model to identify factors associated with antenatal depression among pregnant women in post-war Shire Town, Tigray, Ethiopia. Results: All 463 participants were included (response rate: 100%). The magnitude of antenatal depression was 34.3% (95% CI: 30-38.7%). Increased odds of depression were observed among age group 25-34 years (AOR = 3.43; 95% CI: 1.7-7.2), those with unplanned pregnancies (AOR=2.2; 95% CI: 1.25-3.87), exposure to conflict-related traumatic events (AOR=2.6; 95% CI: 1.41-4.81), Internally displaced people (AOR=2.02; 95% CI: 1.05-3.92), experience of intimate partner violence (AOR=2.22; 95% CI: 1.31-3.8), poor partner relationship (AOR=2.17; 95% CI: 1.2-3.96), and low perceived neighborhood safety (AOR=2.7; 95% CI: 1.5-5.08). Protective factors included middle income (AOR=0.54;(95% CI:0.31-0.93), higher income (AOR=0.15; 95% CI: 0.065-0.33), and very good pre-war economic status (AOR=0.4; 95% CI: 0.16-0.94). Conclusion: Antenatal depression was common among pregnant women in this post-war population, with internally displaced women experiencing higher odds. Integrating mental health and psychosocial support into antenatal care, alongside interventions addressing conflict-related trauma, intimate partner violence, socioeconomic vulnerability, and community safety, is warranted.

BACKGROUND: Undernutrition is the leading risk factor for tuberculosis (TB), yet evidence on programmatic nutritional support during treatment is limited. Benin and Togo are neighboring West African counties. Benin provides in-kind food support to all people with drug-susceptible TB; neighbouring Togo does not. This created the opportunity for a natural experiment. METHODS: We conducted a prospective cohort study at 13 sites in Benin and Togo (September 2023-June 2024). We compared recipients of nutritional support with non-recipients, using Beninese non-recipients as an internal comparison. Primary outcomes were [&ge;]5% weight gain at month 2, change in 6-minute walk test (6MWT) distance, and pill-count adherence. We used multivariable regression adjusted for pre-specified covariates. RESULTS: Of 769 participants, 450 received nutritional support and 319 did not. Recipients had higher odds of [&ge;]5% weight gain at month 2 (adjusted odds ratio [aOR] 1.57, 95% CI 1.13-2.19) and [&ge;]10% at month 6 (aOR 1.92, 1.35-2.74), greater 6MWT improvement (adjusted {beta} 40.6 m, 26.5-54.6), and higher adherence (aOR 3.43, 1.81-6.51). Mortality was lower among recipients (aOR 0.32, 0.11-0.93). Sputum conversion and treatment success did not differ. Beninese non-recipients resembled Togolese participants across outcomes. CONCLUSION: Programmatic nutritional support was associated with improved weight gain, functional recovery, adherence, and lower mortality during TB treatment, supporting its integration into national TB programmes.

Background: Ebola virus disease is a life-threatening illness caused by the Ebolavirus, with symptoms manifesting two to twenty-one days after infection. Although Uganda has faced multiple Ebola outbreaks, many patients survive only to encounter persistent challenges. Therefore, this study explored the post-discharge experiences of survivors following the 2022 Ebola Virus Disease outbreak in Uganda. Methods: An exploratory qualitative study comprising of in-depth participant interviews was conducted at Mubende Regional Referral Hospital in central Uganda. Interviews were face-to-face and data were analyzed manually by inductive content analysis. Ten male and female participants were Ebola Virus Disease survivors in Mubende district who had lived in the community for at least six months post-discharge from the Ebola Treatment Unit. Results: Four themes emerged: (i) Psychosocial Burdens and Social Exclusion, (ii) Economic Hardship and Loss of Financial Stability, (iii) Chronic Physical and Health Burdens Post-Recovery and (iv) Rebuilding Lives: Psychological, Social, and Medical Pathways to Recovery. Survivors faced significant emotional burdens such as survivor guilt, grief, trauma from loss, and anxiety about transmission risks. They experienced social isolation, stigma, and discrimination, which often led to their exclusion from community activities. Financially, they struggled with debt and the loss of livelihoods, compounded by ongoing health issues. Additionally, survivors endured chronic physical complications, including pain and fatigue, which hindered their recovery. Despite these challenges, survivors sought psychological, social, and medical pathways to recovery, including confirmation of their recovery, support from family and organizations, and health maintenance practices. Supportive medical care and community assistance were crucial in their physical and emotional rehabilitation. Conclusion: Ebola Virus Disease survivors in Uganda face significant psychosocial, health, social, and economic challenges post-discharge. The findings highlight the critical need for comprehensive medical and community-based support systems to aid survivors' recovery and well-being. Further research on long-term neurological effects and community reintegration programmes is needed to inform targeted interventions that support Ebola survivors and reduce stigma and discrimination.

Introduction: Veterinary Professionals are at risk of contracting zoonoses, including potential emerging infections. Personal Protective Equipment (PPE) could reduce infection transmission risk, but use of it in the profession is low. Understanding Veterinary Professionals experiences with PPE could help identify facilitators and barriers, therefore informing a future strategy to improve usage. Methods: Two focus group discussion with veterinary nurses and two with veterinarians took place at a tertiary small animal teaching hospital. With an interpretivist epistemology, transcriptions were inductively coded and analysed using thematic analysis. Results: Veterinary Professionals frequently reported underusing PPE, despite significant zoonotic risk. Friction in interdisciplinary relationships negatively impacted veterinary professionals experiences with PPE: differing views on risk, policy and PPE, contrasting perceptions of each other, and challenges with communication impacted PPE decision-making. Barriers included an absence of initial recognition of risk, a staff culture of prioritising patient health over risk to self, friction in response to others PPE use or lack thereof, an overly complex policy, and a lack of cultural and institutional reaction to occupationally contracted zoonoses. Facilitators included effective inter and intradisciplinary communication and previous personal experience with serious zoonoses. Conclusion: Veterinary Professionals experiences with PPE, are shaped by social and professional factors, such as interdisciplinary friction, perceptions of self and others, of risk and policy. Recommendations are for the findings to be used locally to embed PPE use into everyday practice. At a national level, the United Kingdom Health Security Agency (UKHSA) should use the findings to evaluate current policies regarding PPE and zoonoses in veterinary practice and produce a simplified national guidance, in collaboration with veterinary professionals with lived experience. Further research into General Practice Veterinary Professionals experiences and the interdisciplinary social dynamics is recommended.

Introduction After U.S. foreign assistance was frozen in January 2025, empirical data on the status of the HIV response has been limited. To better understand the ongoing impacts of changes in U.S. foreign assistance, we launched an open survey to assess disruptions in HIV-related care among clinics and programs in low- and middle-income countries (LMICs). Methods Conducted from August to December 2025, the survey explored U.S. foreign assistance-related disruptions in HIV service delivery, medication availability, laboratory services and clinic operations; whether disruptions were fully resolved at the survey timepoint; and the introduction of clinic mitigation strategies. Data on other impacts of U.S. funding changes were explored through an open-ended question. A convergent mixed-methods design, involving parallel quantitative and qualitative analyses and merging of findings from each, was used to examine the impacts of U.S. funding freezes on HIV-related care. Results We received 158 responses from 38 LMICs, including 30 countries supported by the U.S. President's Emergency Fund for AIDS Relief (PEPFAR) at the beginning of 2025 (n=123 responses) and eight non-PEPFAR countries (n=35 responses). Respondents represented health centers (25%), hospitals (31%), dedicated HIV clinics and drop-in centers (39%), and multi-site programs (4%), with a majority (59%) in the non-governmental/private sector. Overall, 81% reported disruptions in at least one HIV-related service since January 2025 because of changes in U.S. foreign assistance, with most also reporting disruptions in medication availability, laboratory services, and clinic operations. The largest reported disruptions were in the areas of pre-exposure prophylaxis (67%) and HIV testing (63%), along with patient tracing (67%), adherence support (63%) and services to key populations (64%). Disruptions were more prevalent in PEPFAR-supported countries and were more likely to be "not fully resolved" by time of survey completion. Qualitative data highlighted the impact of U.S. foreign assistance disruptions on the erosion of client trust in the health system and strains on staff morale. Conclusions Substantial and sustained disruptions in HIV prevention and care reported by diverse clinics in LMICs reinforce concerns that recent funding shifts could reverse progress in ending the HIV epidemic, particularly for vulnerable and key populations.

This study investigated the prevalence of physical and non-physical disciplining methods used by mothers of young children in Rwanda and examined their association with child stunting. The role of disciplining practices in child linear growth remains largely overlooked in interventions across low- and middle-income countries, including Rwanda, despite growing attention to psychosocial factors. This cross-sectional study, conducted between November 15 and December 31, 2021, included 601 mother-child pairs selected through systematic random sampling. Child disciplining practices were assessed using the UNICEF Multiple Indicator Cluster Surveys questionnaire. Stunting, defined as chronic undernutrition during critical growth periods that leads to impaired growth and development, was measured using WHO standards (height-for-age Z score <-2 SD). Child disciplining methods were categorized into two types: physical (e.g., hitting or spanking) and non-physical (e.g., shouting or yelling). Multivariable logistic regression assessed the association between disciplining methods and stunting, adjusting for socioeconomic factors, IPV, and social support. The study included predominantly low-income, married mothers, >30 years old, with low educational attainment, and working in unskilled jobs as defined by the national occupational classification. Physical disciplining methods were used by 76.5% (n=449) of mothers, while 38.3% (n=225) used non-physical methods. Younger mothers used physical methods more than older ones (p=0.002). Mothers exposed to physical and sexual intimate partner violence (IPV) had a higher likelihood of using physical methods (p<0.001 and p=0.036, respectively). Exposure to psychological IPV was significantly associated with both non-physical (p=0.025) and physical methods (p=0.004). Of the 601 children, 27.1% (n=163) were stunted; 88.3% (n=144) were >1 year old. The odds of stunting were higher in older children subjected to both physical and non-physical methods (odds ratio [OR], 1.92; 95% confidence interval, 1.08-3.41). Using both disciplining methods was most strongly associated with stunting, with adjusted ORs ranging from 1.96 to 2.04.Findings suggest disciplining methods may contribute to the risk of stunting, especially in older children in Rwanda. These findings highlight the urgent need for positive parenting education, child abuse prevention, and the integration of child protection screening into routine healthcare services in Rwanda.

Abstract Background Breast and cervical cancer screening in Ghana remains low, and several analyses of the Ghana Demographic and Health Survey (GDHS) have already shown that wealth, education, and place of residence pattern who gets screened [1-3]. Whether this patterning clusters geographically below the level of administrative region has not been tested for this population, and whether cluster-aware machine learning adds anything to the standard regression approach used so far remains open. Methods We analyzed the 2022 Ghana Demographic and Health Survey women's file (N = 15,014; primary sample of women aged 25-49 years, n = 9,510) linked to cluster geographic coordinates for 618 enumeration areas. Clinical breast examination and cervical cancer testing were the two outcomes. We estimated survey-weighted prevalence across demographic and socioeconomic strata, tested global spatial autocorrelation with Moran's I, mapped local clustering with Getis-Ord Gi* statistics, and separately fitted gradient-boosted classifiers on individual-level socioeconomic covariates, validated under cluster-held-out five-fold cross-validation to prevent within-cluster information leakage. Feature contributions to the breast-screening model were interpreted with an additive, feature-level explanation technique, and socioeconomic inequality was quantified with both the ordinary and Erreygers-corrected concentration index. The predictive models did not include geographic coordinates or survey weights; both are noted as limitations. Results Weighted prevalence among women aged 25-49 years was 22.5% (standard error 0.77) for breast examination and 6.9% (standard error 0.46) for cervical testing. Both rose with education and wealth and were roughly double in urban areas relative to rural ones. Moran's I was positive and significant for both outcomes (breast: 0.217, z = 11.69, p < 0.001; cervical: 0.125, z = 6.77, p < 0.001), and local cluster statistics located discrete hotspots around Greater Accra and parts of Ashanti and Bono, with coldspots concentrated across the north, though these local tests were not adjusted for multiple comparisons. Cross-validated discrimination reached an area under the curve of 0.716 for breast examination and 0.730 for cervical testing, without confidence intervals or calibration assessment; education, wealth, and age were the dominant predictors for both. The Erreygers index put breast examination as the more wealth-concentrated outcome (0.231 versus 0.095 for cervical testing), reversing the ranking implied by the uncorrected index. Conclusions Screening uptake in Ghana is spatially clustered at a resolution that regional reporting cannot show, and this clustering is compositionally associated with, though not formally shown to be mediated by, the socioeconomic makeup of individual clusters. Cluster-level spatial analysis and a model-based risk ranking may offer a useful complement to regional targeting, but calibration, external geographic validation, and comparison against a regional-allocation baseline are needed before any operational use.

Background: Trauma-informed approaches (TIAs) are increasingly implemented across public-sector settings to improve support for young people affected by adverse childhood experiences (ACEs). However, practitioners often report difficulties translating broad trauma-informed principles into everyday practice, and young people are rarely involved in developing resources intended to support implementation. Aim: To co-design, implement and undertake a preliminary evaluation of a youth-led trauma-informed resource for professionals working with young people in public-sector settings in England. Methods: The study formed part of the UKRI-funded Attune programme and employed Accelerated Experience-Based Co-Design (AEBCD). Eighteen adolescents with lived experience of ACEs and 16 professionals from nine public-sector settings participated in three regional co-design workshops. Findings from a prior arts-based lived experience study informed the workshops. Participants collaboratively developed Validating Voices, a low-cost resource designed to increase validating interactions between professionals and young people. The resource was subsequently introduced into nine organisations and evaluated using staff surveys and semi-structured interviews. Results: Co-design participants identified professional invalidation of young peoples experiences, identities, needs and emotions as an under-recognised contributor to mental health. The resulting resource combined discussion cards, creative activities, role-play and organisational reflection exercises to promote validating practices. Five organisations implemented the resource and reported it to be feasible. Flexible local adaptation was common, while more participatory role-play elements proved harder to implement consistently. Staff observed increased opportunities for disclosure, reflection, peer connection and professional curiosity about young peoples experiences. Staff reported listening differently to young people and, in some settings, implementing changes in response to young people's recommendations. Conclusions: Youth-led co-design identified validation as a practical and meaningful mechanism for operationalising trauma-informed principles in everyday professional practice. With refinements, Validating Voices shows promise as a resource to support more relational, collaborative and trauma-informed responses to young people in public sector settings.

Background Early recognition of presentations consistent with the deliberate release of a Category A bioterrorism agent is essential for rapid isolation, public health notification, and containment. The ability of UK clinicians-in-training to recognise these syndromes is unstudied. This pilot assessed final-year UK medical students' ability to recognise these syndromes. Methods A pilot cross-sectional online survey of final-year UK medical students used single-best-answer clinical vignettes depicting syndromes associated with Category A bioterrorism agents (BT vignettes) and clinically overlapping non-bioterrorism syndromes (NBT vignettes). Performance was summarised as the proportion of vignettes correctly identified, with primary analysis comparing within-participant BT and NBT performance. Results Twenty-five participants completed the survey. Participants performed worse on BT vignettes (M = 0.55) than on NBT vignettes (M = 0.81), with a within-participant difference of -0.26 (95% CI [-0.35, -0.18]; t(24) = -6.33, p < 0.001; Cohen's dz = -1.27). Botulism (96.0%) and Ebola virus disease (88.0%) were recognised by most participants, while anthrax (40.0%), pneumonic plague (28.0%), and smallpox (24.0%) were recognised by fewer than half. Conclusion This pilot provides the first UK evidence of a substantial diagnostic deficit in final-year medical students' recognition of Category A bioterrorism agent syndromes.