Public Health in Practice

BackgroundDengue outbreaks have become a severe threat to Bangladesh as the infections and mortality numbers are skyrocketing in recent years. Favorable environmental and anthropogenic conditions have established the capital of Bangladesh, Dhaka city as the epicenter of dengue outbreak. Studies have showed that climate change induced extreme weather events are exacerbating Aedes mosquito breeding and dengue virus transmission conditions. Methodology/Principal FindingsIn this study, short-term (0-6 weeks) associations of maximum temperature and heatwave days on dengue cases in Dhaka city were examined through Distributed Lag Non-linear Model (DLNM) methodology for weekly measurement of 2016-2024, taking into account relative humidity, cumulative rainfall, seasonality and hospital closure effect. Two separate negative binomial models were constructed. The maximum temperature model rendered an overall inverted U-shaped association, where the maximum temperature range of 31.5-33.2{degrees}C showed a sustained elevated dengue risk, with highest risk estimate at 33.2{degrees}C [relative risk (RR): 1.186, 95% CI: 1.002, 1.403]. Whereas, results of weekly heatwave days showed an overall protective effect (RR<1) for dengue cases. The lowest risk of infection was found at 3 heatwave days per week, with RR 0.275 (95% CI: 0.178, 0.423). Multiple sensitivity analyses were conducted for both models to evaluate their robustness. Lastly, the optimized models were analyzed under three distinct sub-periods, to capture the association of exposure variables with predominant circulating serotypes. Conclusions/SignificanceThe findings of the study aim to support public health policymakers and healthcare authorities in designing and implementing effective vector control interventions under emerging climatic emergencies. Author SummaryDengue disease is one of the most buringing issue in Bangladesh in recent years. This vector-borne disease is inherently influenced by climatic variables, i.e., temperature, rainfall, humidity, etc. Moreover, these relations are complex and non-linearly associated. Due to shift in climatic conditions, the occurance of extreme weather events are becoming frequent, with increased magnitude and longer duration. In this study, the nonlinear and delayed association of dengue infections due to the exposure of extreme temperature events were assessed in climate-change vulnerable Dhaka city. To do this, a statistical method was used, called distributed lag nonlinear methodology (DLNM). The results showed that dengue infections had an inverted U-shaped (parabolic) relationship with maximum temperature, while compared to mean maximum temperature, and a suppressive association with heatwaves relative to days without heatwaves. The findings aim to work as an early warning system, and support to policymakes and healthcare authorities to tackle the dengue surge in the changing climate.

Childhood malnutrition remains a major public health challenge in Ethiopia, where stunting and wasting co-exist but may arise from distinct spatial and etiological processes. Analyses focusing on a single outcome may overlook the interdependence of these conditions and their geographic heterogeneity. This study aimed to disentangle the determinants of stunting and wasting among children under five years of age using a Bayesian bivariate spatial modelling framework. Data from 5,405 children included in the 2019 Ethiopia Mini Demographic and Health Survey were analyzed. Stunting and wasting were modelled as correlated binary outcomes using Bayesian bivariate hierarchical geostatistical models implemented through SPDE-INLA, accounting for child, maternal, household, and environmental covariates, non-linear age effects, and spatial dependence. Model performance was assessed using the deviance information criterion, Watanabe-Akaike information criterion, and marginal log-likelihood. The bivariate model identified shared socio-economic and biological determinants. Multiple births, male sex, low maternal education, a higher number of under-five children, and household poverty were associated with increased risks of both outcomes. Female-headed households were associated with lower odds of stunting but higher odds of wasting. Spatial analysis revealed elevated residual stunting risk in the northern and central highlands, whereas wasting hotspots were concentrated in northeastern pastoralist regions. Residual spatial correlation was weak ({rho} = -0.12), indicating largely independent geographic patterns. These findings suggest that effective child nutrition policies in Ethiopia require outcome-specific and regionally tailored interventions addressing both chronic and acute forms of malnutrition.

IntroductionAnemia is a common and debilitating complication in cancer patients, affecting prognosis, quality of life, and treatment response. The burden of anemia may be higher in resource-limited settings due to nutritional deficiencies and limited healthcare access. However, data on anemia among newly diagnosed cancer patients in Ethiopia remain scarce. This study was aimed to determine the magnitude and predictors of anemia in newly diagnosed adult solid cancer patients in Hawassa, Ethiopia. MethodsA cross-sectional study was conducted among randomly selected 405 newly diagnosed adult solid cancer patients at selected public health facilities in Hawassa City, Ethiopia, from June 2021 to October 2021. Data were collected using structured face-to-face interviews and from medical records. Data were entered into EpiData version 3.1 and exported to SPSS version 26 for analysis. Descriptive statistics were computed for all variables. Binary logistic regression was performed to determine the independent effects of potential explanatory variables on the presence of anemia. Adjusted Odds ratios with 95% confidence intervals were calculated. Statistical significance was set at p-value < 0.05. ResultThe prevalence of anemia was 26.4% (95% CI: 22.1-30.7%), with normocytic anemia (56.1%) being the most common morphological type. Multivariable analysis identified a history of bleeding (AOR = 3.46, 95% CI: 1.94-6.16), advanced cancer stage (AOR = 2.01, 95% CI: 1.20-3.34), and underweight BMI (AOR = 2.14, 95% CI: 1.28-3.55) were significantly associated with anemia. Conversely, higher educational attainment (diploma and above) was protective (AOR = 0.35, 95% CI: 0.13-0.93). ConclusionAnemia affects over one-quarter of newly diagnosed solid cancer patients in Hawassa, with advanced-stage disease, bleeding history, and decreasing body mass index as significant risk factors. These findings highlight the need for routine anemia screening at diagnosis, nutritional interventions, and early bleeding management in oncology settings.

BackgroundWhile veterinary surgeons are known to have particularly high rates of injury compared to other sectors, little is known about rates of injury among veterinary students. This study aims to understand animal-related injury rates, injury context and mechanisms, attitudes to reporting injuries, and behaviour change among UK and Irish veterinary students. MethodsA survey was distributed to students across all veterinary schools operating in the UK and Ireland in 2021. Questions explored participants experience of injury through asking about their most recent and most severe injuries via quantitative and free-text questions. Data were analysed using descriptive statistics, logistic regression, and qualitative content analysis. Results533 responses were included in the analyses. Overall, 47.5% of students reported having been injured by an animal during the veterinary degree, 35.5% of students reported being injured within the last 12 months. Most recent injuries were caused by companion animals (38.0%), livestock (37.6%), and equids (23.5%). For their most severe injuries, 48.7% involved livestock, 28.7% companion animals, and 22.1% equids. The content analysis highlighted that students normalised injuries and infrequently reported injuries to the university. It was very rare for students to take time off from their studies or placements, due to course pressures. ConclusionsThese findings reflect concerningly high levels of injury, which are being under-reported and reflect a culture of injury acceptance and expectation among students. Veterinary schools should consider lessons learnt in other work environments which have been successful in changing safety culture.

Policing is one of the most rewarding occupations; however, it is stressful and demanding. This study was designed to explore stress, stress management, and coping mechanisms among Nigerian Police Officers working across four geopolitical zones in Nigeria. Using an exploratory design, forty in-depth interviews (IDIs) were conducted with police officers. Data was collected using an interview guide. The interviews were conducted in English and the participants indigenous languages (by preference), audio-recorded, and transcribed verbatim. Data were analyzed using the thematic approach. A range of contextual stressors were identified as barriers to the health and well-being of police officers in Nigeria. The police often lack the tools and equipment needed to perform their official duties effectively. This includes items like uniforms, bulletproof vests, and even operational vehicles. Shortage of manpower, lack of operational tools, poor welfare for police officers, and poor remuneration were also among their concerns. The participants were able to identify signs of stress that are common among police officers, which are majorly weaknesses, lack of sleep, dizziness, headache, anxiety, exhaustion, and anger. The common coping mechanisms include regular exercise, adequate rest, and relaxation through recreational activities, regular medical checkups, and seeking support from colleagues, among others. Nigerian police officers face many challenges that affect their health and daily routines. This analysis identifies potential opportunities to improve officers welfare in these contexts.

Anemia, particularly iron-deficiency anemia, is a critical global health concern, with a high prevalence among children under six years of age. Early and non-invasive detection can significantly improve health outcomes. This study proposes a computer vision and machine learning framework for anemia screening and hemoglobin (Hb) level prediction using palmar images from pediatric subjects. The region of interest (palm) was segmented using a U-Net model, achieving a Dice coefficient of 0.96. Images were processed across RGB, CIELab, and HSV color spaces to extract key color features, including red fraction, erythema index, and normalized a-component. For anemia classification, multiple machine learning models were evaluated, with Logistic Regression, Gradient Boosting, and a custom Convolutional Neural Network (CNN) achieving the highest test accuracies of approximately 94.5% and 95.53%, respectively. For hemoglobin regression, a Random Forest model in the CIELab color space achieved a coefficient of determination (R2) of 0.95. The Pearson correlation coefficient in the Lab color space was 0.98 for the Random Forest algorithm and 0.94 for the Linear Regression algorithm. The analysis, supported by SHAP values, identified red-related color features as the most significant predictors. The model demonstrated robust performance across different skin tones, with particularly high accuracy (R2 = 0.9926) in darker-skinned individuals, who constituted the majority of the studied Iranian population. The results confirm that pallor analysis of palmar images using artificial intelligence techniques offers a reliable, non-invasive, and effective tool for pediatric anemia screening and hemoglobin estimation, with strong potential for point-of-care applications.

Sickle cell disease (SCD) is associated with chronic systemic morbidity that extends beyond acute crises. However, data describing the clinical and laboratory adolescents and young adults with SCD at steady state in sub-Saharan Africa are limited. We described clinical and laboratory characteristics of adolescents and young adults with SCD at steady state in Uganda. We conducted a hospital-based cross-sectional study of 60 adolescents and young adults with SCD in steady state at Mulago National Referral Hospital. Descriptive statistics were used to summarize participant characteristics and medication use. The mean age was 16.5 {+/-} 3.3 years, and 34 (56.7%) participants were female. Mean hemoglobin was 9.1 {+/-} 2.2 g/dl. Mean systolic and diastolic blood pressures were 107.9 {+/-} 15.5 mmHg and 60.3 {+/-} 12.6 mmHg, respectively; mean heart rate was 89.5 {+/-} 15.5 beats/min. Fifty-two (86.7%) participants reported using hydroxyurea. These observations show that adolescents and young adults with SCD at steady state exhibit hematologic abnormalities and distinctive hemodynamic profiles that underscore substantial chronic subclinical abnormalities that extend beyond acute complications.

Engaging with stakeholders/contributors is vital to achieve a comprehensive approach to policymaking about the food (kai) system. The food system in Aotearoa New Zealand (Aotearoa NZ) is associated with high environmental impacts and inequitably distributed health consequences by ethnicity and socio-economic status. We engaged with contributors from government agencies, industry, academics, community, rural and urban M[a]ori communities to develop policy actions to support New Zealanders to eat healthy sustainable food. This paper outlines methods used to score contributor identified policies with follow-up focus groups and interviews where the highest scored policies were discussed, to understand contributor perspectives on the scope, implementation, barriers, and possible unintended consequences of these policies. Semi-structured interviews (12) and focus groups (6) were conducted. The top five scored policies among all contributors were: healthy food and drink policies in schools and kura (M[a]ori-language immersion schools); supporting m[a]ra kai (food garden) and community gardens; garden to table programmes in schools and kura; education about sustainable and healthy food; and increasing incomes. The top five policies for M[a]ori were: healthy food and drink policies in schools and kura; garden to table programmes in schools and kura; remove GST from core foods; increase incomes and make local food cheaper by supporting local growers. Considerations for policy implementation involved implementing multiple policies at once, the importance of evaluation, finding existing examples of policies, strong collaboration for long-term outcomes, and centring policies through a M[a]ori framework.

IntroductionClimate change is a global adverse phenomenon affecting the health and wellbeing of all humans, and timely awareness can help mitigate these health effects. ObjectiveTo understand the knowledge and attitudes of Sri Lankan adults towards climate change and its effects on human health. MethodsA web based cross-sectional survey was conducted using a structured, pretested, web based, self-administered questionnaire, using a respondent driven sampling technique, among Sri Lankan adults. Data was collected over three months, from 1st September 2022. Responses were automatically stored in a cloud-based database and were imported into a spreadsheet and analysed using MS Excel. ResultsMajority of the 118 respondents were young, educated, employed adults from western province, and 56.78% were females. Overall knowledge on climate change was good among 82.20%, while over 90% had a good or favourable knowledge on health effects associated with climate change. Respondents demonstrated a good awareness of climate effects on skin cancer (92.37%), mental illnesses (82.2%) and asthma (82.2%), but were less aware of the effects on diabetes (28.8%), COPD (38.1%) and heart diseases (46.6%), and vector borne diseases such as Malaria (57.6%) and Dengue (61.8%). Over 90% had a good attitude towards the need for climate change mitigation and climate friendly activities being implemented. ConclusionsUrban, educated Sri Lankan adults had a good understanding and awareness on the health effects of climate change, and the importance of mitigating it in relation to its health effects, but further studies are needed to understand the awareness levels of the less educated rural communities.

BackgroundThe COVID-19 pandemic significantly changed the daily routines of frontline health workers (FLHW), particularly those directly caring for COVID-19 patients. This study explores the lived experiences and coping strategies of FLHW at a Zonal Hospital in Kilimanjaro, Tanzania MethodThe study used a qualitative exploratory descriptive design, to retrospectively capture psychological impacts, challenges, coping strategies, and professional dilemmas faced by FLHW. Participants were purposively sampled from KCMC Hospital departments directly involved in COVID-19 patient care. FindingsThe FLHW experienced considerable fear, stress, and stigma. The fear of infection and high mortality rates among patients and colleagues heightened their anxiety. Stress was exacerbated by long working hours, uncomfortable personal protective equipment (PPE), poor remuneration, and the emotional toll of witnessing numerous deaths. FLHW also experienced being stigmatized and discriminated against, both within their workplaces, within the family and in the broader community. Some FLHW considered quitting their jobs due to the overwhelming workload, fear of being infected, and emotional strain. Additionally, absenteeism and avoidance of COVID-19 duties were common, driven by fear and inadequate hospital capacity. Coping strategies among FLHW to manage their stress and maintain resilience included acceptance, faith, family support, rest, and, the use of recreational substances. ConclusionThe FLHW experienced considerable fear, stress, and stigma. The study highlights the need for better psychological support, improved communication, adequate training, and resources to support FLHW before, during, and post-pandemic. Enhanced resilience and confidence, along with a greater appreciation for protective measures and compassion for patients, were some of the key lessons learned from their experiences during the pandemic informing more effective preparedness care in future pandemics.

Background Acute malnutrition remains a major public health challenge among children under five in Malawi due to undetected and untreated cases. While several policies and programmes are in place, they face significant resource input and implementation constraints. In this study, we evaluate the potential health impact and cost-effectiveness of three interventions designed to address constraints along the care pathway in childhood acute malnutrition management. These include improving early recognition of symptoms by caregivers, increasing attendance at routine growth monitoring visits through community outreach, and scaling up the availability of therapeutic food supplements. Methods and Findings We use a newly developed model representing the natural history and management of acute malnutrition, implemented within the Thanzi La Onse (TLO) dynamic individual-based simulation framework, which captures the public health system in Malawi. Each of the three interventions is assessed both individually and in combination, translated into seven scenarios which we evaluate in comparison to the status quo. The optimal strategy combines two interventions, improved caregiver awareness of early symptoms with increased availability of therapeutic food supplements. Over five years, this strategy is predicted to avert 840,470 (95% CI: 682,057-998,883) DALYs with total incremental costs of $34 million. This corresponds to an annual health expenditure increase of $0.32 per capita. At a cost-effectiveness threshold of $76 per DALY averted, the strategy results in an incremental net health benefit of 394,252 (95% CI: 235,839-552,665) DALYs averted. Conclusions The cost-effective strategy for addressing constraints in childhood acute malnutrition management is simultaneously improving caregiver recognition of early symptoms and expanding therapeutic food supplement availability. Out of the seven scenarios evaluated, this integrated approach was found to be the optimal strategy within the Malawian public health system, yielding substantial health at modest costs. These findings provide critical evidence to inform national policy and guide investment prioritisation for the management of childhood acute malnutrition.

BackgroundSuicide prevention has become a global public health priority, and Brief Contact Interventions (BCI) following suicide attempts (SA) are an important tool for preventing suicides. The VigilanS project was designed to generalize compounded BCIs at the entire population level., It involves resource cards, telephone calls, and mailings, following a predefined algorithm. It has been implemented progressively in France, on a region-by-region basis, since 2015. ObjectiveTo evaluate the effectiveness of VigilanS in reducing suicide attempts among patients aged 18 years and older, and to explore potential differences in effectiveness by sex, age, and geographical location. MethodsThe study used data from the French national hospitalization database, PMSI-MCO. It included all patients over age 18 who were admitted to general hospitals for suicide attempts, between 2012 and 2022. Time-to-event ("survival") analysis of a second SA after a first one was performed; patients whose first SA occurred before VigilanS implementation were compared with their after-VigilanS counterparts. Six regions, with implementation occurring between 2015 and 2017, are analyzed here. ResultsThe differences in distribution of time-to-new-SA among patients before and after VigilanS implementation were statistically significant in all six regions under scope (log-rank test: P<0.0001). The Cox regression analysis revealed that VigilanS was significantly associated with a reduced risk of reattempting suicide in all regions. Age consistently showed a negative association with reattempting suicide. ConclusionVigilanS is likely effective in reducing suicide attempts among patients aged 18 years and older in France. This suggests that implementing BCIs following SAs in general hospitals at a population-wide level can contribute to reducing suicide rates and provides real-world evidence (RWE).

BackgroundThe COVID-19 pandemic required South African public sector HIV viral load (VL) laboratories to scale up Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) testing while maintaining essential HIV services. This placed additional pressure on diagnostic services. This dual mandate introduced significant occupational and environmental challenges (OEC) for staff that remain underexplored. ObjectiveThis study aimed to investigate the OEC and effects that staff experienced during the implementation of COVID-19 testing at public sector VL laboratories in South Africa. MethodsA quantitative, cross-sectional study utilised a census approach among technical and support staff. Data were collected via a structured REDCap questionnaire using 5-point Likert scales. Pre- and post-implementation challenges were assessed across four domains: workload, environmental conditions (space, ventilation, waste), communication, and PPE availability. Statistical analyses included the Wilcoxon Signed-Rank and Spearmans correlation tests. ResultsPerceived occupational challenges increased significantly across all domains post-implementation. Staff workload saw the highest rise (mean score 3.02 to 3.53). Adverse health effects were pervasive; 80.2% of staff reported burnout/fatigue, and 76.5% reported increased anxiety/stress. A strong positive correlation was observed between post-COVID-19 challenges and adverse mental and physical health outcomes (rho = 0.449, p < 0.001). Furthermore, 35.8% of staff considered resigning due to increased job demands. ConclusionIntegrating COVID-19 testing exacerbated systemic weaknesses, causing measurable psychological injury and threatening workforce retention. Findings suggest that the diagnostic workforce requires formal crisis surge staffing models and institutionalised mental health support to safeguard personnel and maintain essential services during future health emergencies.

BackgroundExternal validations of existing risk models is an efficient step towards potential implementation, obviating the need to develop new models. However, validation in new clinical settings poses several challenges. ObjectiveTo externally validate the OxSATS tool using data from the Oxford Monitoring System for Self-harm in England. OxSATS is a validated tool to predict suicide after self-harm developed using Swedish population registers. MethodsWe selected episodes of self-harm (ICD-10 codes X60-84; Y10-34) by individuals aged 10-64 years who presented to a large regional hospital between 1 January 2000 and 31 December 2018, and were followed up until 31 December 2019. We applied the OxSATS tool to estimate each individuals suicide risk within 12 months after their index self-harm. We assessed model performance using discrimination (Harrells c-index) and calibration measures (calibration plot and the observed-to-expected events ratio, O:E). We assessed the effects of missing predictors on calibration and subsequently recalibrated the model. FindingsWe identified 16,120 individuals who presented to hospital with self-harm, of whom 101 (0.6%) died by suicide in the 12-month follow-up period. The OxSATS model showed good discrimination in external validation (c-index=0.72, 95% CI=0.67, 0.77). Recalibration was required because initial calibration reflected a lower outcome rate in the new data. After recalibration, calibration performance was excellent (O:E=1.00, 95% CI=0.80, 1.20). ConclusionsDespite differences in clinical services and outcome ascertainment, suicide risk models can maintain good predictive performance in new settings. However, recalibration should be considered when applying prediction models in new settings, and the impact of missing predictors should be assessed using sensitivity analyses. KEY MESSAGESO_ST_ABSWhat is already known on this topicC_ST_ABSSuicide risk is substantially elevated after hospital presentation for self-harm, but most existing risk assessment tools rely on rating scales or binary cut-offs, show limited predictive accuracy, and rarely report calibration. OxSATS is a prognostic model developed using Swedish register data that provides continuous risk estimates and demonstrated good discrimination and calibration in its original setting. External validation in new healthcare systems is essential before implementation, but is often complicated by differences in predictor definitions, missing variables, and outcome prevalence. What this study addsThis study provides the first external validation of OxSATS in an English clinical setting using routinely collected hospital data. The model retained good discrimination but initially overpredicted suicide risk due to a lower baseline event rate and one missing predictor, highlighting the importance of calibration assessment. How this study might affect research, practice or policyFuture research and implementation strategies should routinely incorporate external validation, sensitivity analyses for missing predictors, and local recalibration before clinical or policy adoption.

BackgroundAcute respiratory infection (ARI) remains a leading cause of morbidity and mortality among children under five in Nigeria. Although polluting cooking fuels are widely considered a key risk factor, their effects may be shaped by broader socioeconomic and geographic conditions. This study examined both individual and structural determinants of ARI and assessed how these factors intersect to pattern risk. MethodsWe analysed data from 28,728 children under five in the 2024 Nigeria Demographic and Health Survey. Three ARI definitions were applied. Survey-weighted quasibinomial logistic regression estimated associations between ARI and cooking fuel type, child age and sex, household wealth quintile, residence type, geopolitical zone, and parental education. To examine intersectional patterning, we conducted a Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), constructing strata defined by combinations of cooking fuel, wealth, residence, and geopolitical zone. The intraclass correlation coefficient (ICC) quantified between-strata variance. ResultsStrict ARI prevalence was 1.9%, and 8.3% of children had broader respiratory symptoms. In unadjusted analyses, polluting fuel use was associated with higher odds of respiratory symptoms (OR 1.85, 95% CI 1.43-2.39). After adjustment, this association was substantially attenuated, indicating confounding by structural factors. Child age was the most consistent predictor: children aged 24-59 months had about half the odds of strict ARI compared with infants (aOR 0.53, 95% CI 0.41-0.68). Geopolitical zone showed the strongest overall association. MAIHDA revealed that 9% of total ARI variance lay between intersectional strata (ICC = 0.09), and this variance was not explained by child age or sex. The population-attributable fraction for polluting fuel declined from 41.4% to 12.4% after adjustment. ConclusionsARI risk among Nigerian children is shaped more by structural and geographic inequalities than by household fuel use alone. Equity-focused, subnational policies addressing intersecting socioeconomic and regional disadvantage are needed to reduce the ARI burden.

Armed conflict in Sub-Saharan Africa has exposed millions of civilians to repeated and severe traumatic events, yet the prevalence of posttraumatic stress disorder (PTSD) and its associated determinants across the region have not been comprehensively synthesised. This study aimed to estimate the prevalence of PTSD and examine its associated factors among conflict-affected adult populations in Sub-Saharan Africa. Methodological quality was assessed using the Joanna Briggs Institute (JBI) criteria for cross-sectional and epidemiological studies A systematic search of PubMed, MEDLINE, Embase, Scopus, CINAHL, APA PsycINFO, the Cochrane Library, and the WHO Global Index Medicus (including African Index Medicus) was conducted for studies published between January 1, 2000, and May 31, 2025. Observational studies reporting PTSD prevalence among adults aged 18 years or older exposed to armed conflict were included. Study selection followed PRISMA 2020 guidelines, with independent screening by two reviewers. Random-effects meta-analyses with logit transformation were used to pool prevalence estimates, and determinants were synthesised narratively with emphasis on adjusted effect estimates. Heterogeneity was assessed using the I{superscript 2} statistic. Sixty-eight studies comprising 82,021 participants from 13 countries met inclusion criteria. The pooled prevalence of PTSD was 43% (95% CI, 35.9%-50.0%), with substantial heterogeneity (I{superscript 2} = 99.9%). Prevalence was highest among refugees (79%), followed by internally displaced persons (48%) and residents of conflict-affected communities (34%). Female sex was consistently associated with increased odds of PTSD (pooled adjusted odds ratio approximately 2.0), as were comorbid depression or depressive symptoms (AOR range 4.2-9.5). Additional correlates included cumulative trauma exposure, displacement, poor social support, and substance use. Overall, PTSD is highly prevalent among conflict-affected adults in Sub-Saharan Africa, underscoring the need for integrated, context-sensitive mental health strategies to address the enduring psychological consequences of armed conflict in the region.

Iron deficiency (ID) is the most common nutritional deficiency worldwide, often caused by insufficient dietary intakes. Oral supplementation is one of the means to improve iron status. This study evaluated the efficacy and safety of two low-dose iron supplements - >Your< Iron Forte Capsules (YIFC) and Ferrous Sulfate Capsules (FSC) - in individuals with dietary ID. One hundred and one participants (mean age 30.6 years; 98% women) with low iron stores (mean serum ferritin 16.1 {micro}g/L) were randomized to receive either YIFC or FSC once daily for 12 weeks. Changes in blood indices and iron-related parameters were assessed at four and 12 weeks of intervention relative to baseline. The primary outcome was the change in hemoglobin (Hb) after 12 weeks. Eighty-seven participants completed the study. Both supplements significantly increased Hb at 12 weeks (YIFC: mean 6.52 g/L, p<0.001; FSC: mean 5.71 g/L, p<0.001). Product-related adverse events (AEs) were few (17% of all AEs) and of mild to moderate intensity only. One participant receiving FSC withdrew due to a probable product-related AE. The frequencies of product-related AEs were similar between study arms, however, statistically significantly more AEs judged to be definitely related to the product occurred in in the FSC arm. While product-related AEs were confined to the gastrointestinal tract in the YIFC arm, they affected multiple organ systems in the FSC arm. Supplementation with either YIFC or FSC proved as an effective, well-tolerated, and safe strategy for improving iron status in non-anemic dietary iron deficiency. In terms of the AE profile, supplementation with YIFC may offer advantages over supplementation with FSC.

BackgroundAntimicrobial resistance (AMR) is a global public health threat driven significantly by antimicrobial misuse in agriculture, particularly in poultry farming. This study assessed the awareness, knowledge, practices, and associated factors related to antimicrobial resistance among poultry farmers in Osun State, Nigeria. MethodsA cross-sectional study was conducted among 289 poultry farmers selected through stratified random sampling across Osun State. The study included actively practicing poultry farmers aged 18 years and above who used antimicrobials in their operations. Farmers not using antimicrobials were excluded. Data were collected using a pre-tested, structured, interviewer-administered questionnaire and analyzed with SPSS version 27. Descriptive statistics, chi-square tests, and inferential analyses were used to examine relationships between variables. ResultsThe majority of respondents (89.6%) had heard of AMR, the majority 239 (92.3%) of the respondents heard it from veterinary doctors. The majority (77.2%) also demonstrated good knowledge. Most farmers (89.6%) used antibiotics, with 52.9% using them occasionally. Personal experience (57.8%) was the primary basis for antibiotic selection. About 71.6% implemented biosecurity measures, and 57.8% had received training on AMR. Significant associations were found between knowledge and practice (p<0.001) and between attitude and practice (p<0.001). ConclusionDespite high awareness, antibiotic misuse persists, driven by factors such as reliance on personal experience and limited veterinary consultation. There is a need for enhanced farmer education, stricter regulatory enforcement, and the implementation of targeted antimicrobial stewardship programs to mitigate AMR risks in poultry farming.

BackgroundHumanitarian settings in Pakistan face major gaps in mental health service delivery, with limited specialist resources and a high burden of untreated conditions. The WHO mhGAP-Humanitarian Intervention Guidelines (mhGAP-HIG) aim to strengthen the capacity of primary care physicians (PCPs) to identify and manage common mental health conditions in humanitarian contexts. However, the evidence for multidimensional training outcomes remains limited. This study evaluated the effectiveness of mhGAP-HIG training to improve outcomes in terms of knowledge, skills, attitudes and confidence among PCPs across different humanitarian contexts in Pakistan. MethodsAs part of implementing an evidence-based digital MHPSS service model, seven mhGAP-HIG workshops were held between September and November 2025 across two provinces and a federal area facing humanitarian contexts. We conducted a quasi-experimental, mixed-methods evaluation where a total of 149 PCPs completed standardized assessments of knowledge (mhGAP-HIG), therapeutic skills (ENACT), attitudes (MICA-4), and confidence. Paired sample t-tests and ANCOVA were used to assess within-group and between-group changes, respectively. Quantitative feedback on training quality was obtained and qualitative reflections on learning experiences were evaluated using thematic analysis. ResultsA modest improvement in attitude and significant improvements across all other domains were observed. The participants from KP showed greater gains in knowledge, while participants from GB showed greater gains in skills, as compared to other provinces. Participants expressed a high level of satisfaction in all workshops, and reported improvements in knowledge, confidence, and ability to identify, manage and refer people with common mental health conditions. ConclusionSystematic efforts to adapt and implement mhGAP-HIG may lead to significant improvements across multidimensional competencies of PCPs, including their knowledge, skills, attitudes and confidence.

IntroductionFlooding events, which are strongly linked to climate change and variability, have the potential to disrupt communities and health systems. Vaccination, a highly effective public health intervention, plays a pivotal role in preventing numerous deaths annually, particularly among children. However, the relationship between exposure to flood events and early childhood vaccination remains unexplored. MethodsThis study utilizes validated flood exposure data from the Global Flood Database (GFD) and five waves of nationally representative survey data regarding the vaccination history of children under 3 years from the Bangladesh Demographic and Health Surveys (DHS) collected between 2004 and 2018. Using the geographical coordinates of each surveyed household grouping and matching it with the spatially resolved GFD data, we determined whether children reside in a flood-prone area. We then used Generalized Estimating Equations, accounting for geographical clustering and including an inverse probability of treatment weighting (IPTW) for covariate balance, to assess the relationship between living in a flood-prone area and incomplete vaccination. Incomplete vaccination was defined as having missed at least one does of the four World Health Organization-recommended childhood vaccines: Tuberculosis (BCG), Diphtheria-Tetanus-Pertussis (DTP), Polio (OPV), and Measles (MCV). The sensitivity of the association measure to various definitions of exposure was explored. ResultsOur sample included 13,649 children, of which 16% resided in flood-prone areas and 84% were fully vaccinated. Our findings indicate that children living in a flood-prone area have a higher risk of not receiving the DTP vaccine (PR = 1.24, CI: 1.05-1.46), the BCG vaccine (PR = 1.27, 1.08-1.50), and the OPV vaccine (PR = 1.24, CI: 1.06-1.46). The direction of the relationship remained but the effect became non-significant when looking at the MCV vaccine alone (PR = 1.06, CI: 0.90-1.25), as well as the four vaccines together (PR = 1.05, CI: 0.90, 1.22). InterpretationThese findings hold critical implications for disaster management protocols, emphasizing the need to ensure uninterrupted access to routine healthcare services during floods, which are becoming increasingly more common due to climate change. Considering that populations in low- and middle-income countries are disproportionately impacted by extreme climate events such as floods and that preventable infectious diseases remain among the leading causes of child death in these regions, ensuring access to essential vaccines is critical for safeguarding public health.