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 A persistent gap between motivation and action threatens voluntary blood supply. This study examined the publics knowledge, attitudes, and practices (KAP) regarding blood donation, with a particular focus on identifying the different determinants of past blood donation behavior and future willingness to donate. Methods Convenience sampling was used to conduct a cross-sectional survey among 1,058 eligible people in Qingdao, China, between July and November 2025. Data were collected via a self-designed KAP questionnaire. To find independent characteristics linked to previous behavior and future intention, respectively, multivariable binary logistic regression was used. Results Overall, 37.0% of participants (n=391) had a lifetime donation history, while 39.2% (n=415) intended to donate in the next 12 months. Past behavior was positively associated with older age (36-45 years: OR=6.84; 95% CI: 3.21-14.58), higher education (OR=2.06; 95% CI: 1.33-3.17), and interpersonal interaction channels (OR=1.45; 95% CI: 1.01-2.09) but hindered by safety concerns (OR=0.23; 95% CI: 0.16-0.34). Conversely, future intention was positively correlated with male sex (OR=1.69; 95% CI: 1.24-2.29), prior donation history (OR=2.69; 95% CI: 1.87-3.86), having family members or friends in need of blood (OR=2.75; 95% CI: 1.96-3.85), and traditional media exposure (OR=3.33; 95% CI: 2.18-5.10). Higher education was adversely correlated with future intention (OR=0.55; 95% CI: 0.38-0.79). Conclusion There is a substantial disparity between donation motivation and action. The determinants of past behavior and future intention are asymmetric, suggesting that stage-specific interventions are required, using social mobilization for initiating first-time donations, while employing family reciprocity and authoritative communication to sustain long-term engagement.

This study examines the effects of rural out-migration and remittance inflows on food consumption outcomes among rural households in the Tigray region of Ethiopia. Utilizing household survey data collected from 521 rural households across three distinct Weredas (districts) (Tahtay Maichew, Kola Tembien, and Kilte-awlaelo). A Binary Probit model was employed to identify factors influencing migration decisions, while an Endogenous Switching Regression (ESR) model was used to estimate the impact of migration on food consumption outcomes while controlling for selection bias and unobserved heterogeneity. Food security was measured using the Food Consumption Score (FCS) and dietary diversity indicators. The empirical results reveal that severe food insecurity is widespread, with over 60% of all surveyed households falling into the "Poor" food consumption category. Descriptive baseline comparisons show that migration and remittance transfers marginally shift the raw average FCS upward from 23.86 to 25.48. However, this impact is profoundly nuanced: remittances serve as an immediate consumption-smoothing safety net but run parallel to a "labor-lost" constraint that reduces own-production capacities, forcing households to rely increasingly on market purchases for staple foods. The findings reveal that migration creates short-term labor shortages in agricultural production; however, remittance inflows substantially improve household food consumption frequencies, particularly for pulses, vegetables, and other nutrient-rich foods. After accounting for self-selection bias and unobserved traits, the rigorous ESR estimates indicate that migration increases the Food Consumption Score of participating households by an average Treatment Effect on the Treated (ATT) of 10.75 points, shifting them into more secure dietary tiers. Moreover, remittances help households mitigate the adverse effects of drought and other shocks by relaxing liquidity constraints and supporting both food purchases and agricultural investments. The study recommends establishing target food security safety nets for non-remittance households, promoting scale-appropriate labor-saving agricultural technologies, expanding traditional communal labor-sharing innovations, and boosting irrigation and agricultural input support programs to enhance rural food security and livelihood resilience.

Background: In malaria-endemic tropical regions, the overlapping coagulopathy in COVID-19 and malaria poses diagnostic and prognostic challenges, particularly with potential sex differences. This study evaluated sex-specific variations in platelet indices and fibrinolytic markers and assessed the utility of Platelet Distribution Width (PDW) and D-dimer in mild/asymptomatic cases. Methods: A case-control study was conducted with 220 participants (55 each in healthy controls, malaria-positive, COVID-19-positive, and COVID-19+malaria co-infected groups), aged 20-65 years, in Port Harcourt, Nigeria. Platelet indices were analysed using Sysmex XP-300 haematology analyser, while D-dimer and fibrinogen were measured by ELISA. Data were analysed using SAS 9.4 with ANOVA, Tukey's HSD, Pearson correlation, and sex-stratified comparisons. Results: PDW was significantly elevated in all infected groups compared to controls (malaria: 15.21 +/- 0.22 fL; COVID-19: 15.21 +/- 0.22 fL; co-infection: 15.61 +/- 0.21 fL vs. control: 13.26 +/- 0.17 fL; F=25.850, p < 0.001). D-dimer levels were highest in the co-infected group (553.42 +/- 59.74 ng/ml, F=2.816, p = 0.040). No significant changes were observed in other platelet indices or fibrinogen across groups. No significant correlation existed between platelet indices and the fibrinolytic markers. Males exhibited significantly higher D-dimer levels across all infected groups (p < 0.05) and higher fibrinogen in COVID-19 subjects (p = 0.036). Sex exerted a stronger influence on parameters than age. Conclusion: Males show heightened fibrinolytic activation in COVID-19 and malaria co-infection. PDW and D-dimer are promising, cost-effective biomarkers for screening mild infections in resource-limited tropical settings.

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.

Background Child marriage/cohabitation before 18 years of age disproportionately affects girls worldwide, but its impacts on mental health are poorly understood. Existing research is mostly cross-sectional, hence unable to estimate causal impacts or longer-term outcomes of child marriage. Methods We analysed longitudinal cohort data across Ethiopia, India, Peru, and Vietnam from Young Lives to investigate the relationship between child marriage/cohabitation and life satisfaction and emotional symptoms. We used linear regression, difference-in-differences estimation (DiD), and propensity score matching (PSM) to examine short and longer-term impacts from age 19 to 29. Findings Across countries 5% (Peru) to 20% (India) of girls were child brides. Child marriage/cohabitation predicted lower life satisfaction -- pooled estimates at age 19 (-0.25 [95%CI=0.40,-0.10]), across 19-29 (-0.22 [95%CI=-0.32,-0.13]), and heterogeneity estimates suggest consistently negative impacts across countries. However, child brides have lower life satisfaction at age 8 even before marriage occurs, likely due to pre-existing disadvantages such as poverty that increase child marriage likelihood. DiD and PSM analyses confirm that most of the differences are due to pre-existing vulnerability and there is a small additional impact of child marriage on worse life satisfaction at age 19 (pooled matched estimate -0.09 [95%CI=-0.19, 0.00]). No differences in emotional symptoms were observed, nor any differences by age of marriage within the child-married sample. Interpretation Child brides have lower life satisfaction from childhood through to early adulthood, which is mostly explained by prior disadvantages and risk factors, with a small additional impact of child marriage itself.

Objectives To identify research priorities for improving the mental health of neurodivergent higher education (HE) students by exploring the perspectives of individuals with lived experience. Design Qualitative study using an online survey. Data was analysed using a deductive-inductive, hybrid semantic thematic analysis. Setting UK higher education institutions. Participants 104 current and former neurodivergent HE students with diverse neurodivergent profiles and intersecting identities. Main outcome measures Participant recommendations regarding priorities for future research on neurodivergent student mental health. Results Six themes were identified and were grouped into (1) general recommendations for research and (2) recommendations specific to neurodivergence within a HE context. Participants prioritised a shift away from medical model approaches towards research informed by social and strengths-based perspectives. Key priorities included improving understanding of diagnostic barriers and misdiagnosis, reducing stigma, investigating institutional barriers within HE, evaluating the effectiveness of support and accommodations and examining the experiences of underrepresented and intersectional groups. Participants emphasised the need for research on more flexible teaching practices, sensory-friendly learning environments, integrated mental health and educational support and alternatives to diagnosis-dependent access to services. Conclusions Future research should move beyond descriptive accounts towards evaluating interventions and current support provision to understand if they improve the mental health of neurodivergent students. Adopting intersectional approaches, moving beyond binary deficit- or strengths-based frameworks and focusing on inclusive, needs-based support rather than diagnosis-led systems are likely to produce more equitable and effective outcomes for neurodivergent students in higher education.

Background: Returnee migrants in Nigeria often face significant psychosocial and economic challenges during reintegration, necessitating resilience to adapt and recover. This study examined factors influencing resilience among returnee migrants in Nigeria. Methodology: A mixed methods design was employed, involving 1316 returnees selected through multistage sampling across Nigeria six geopolitical zones. Quantitative data were collected using the Connor Davidson Resilience Scale and analyzed using SPSS version 28. Qualitative data was obtained through eight focus group discussions and analyzed thematically. Result: Social support from family and friends was inconsistent (70.8% reported occasional support), while community support was largely absent (85.9%). Financial insecurity was widespread (gt 90%). Male gender (AOR = 6.092, plt 0.001), ethnicity, and higher education were significant predictors of resilience. Qualitative findings highlighted the role of family support, faith, adaptive coping, and skill acquisition in strengthening resilience. Conclusion: Resilience among returnee migrants in Nigeria is limited by weak structural and economic support, despite moderate personal coping capacity. Strengthening economic opportunities, community integration, and access to mental health services is essential for sustainable reintegration. Keywords: Returnee migrants, resilience, Reintegration, and psychosocial factors.

Improving minority ethnic student retention is a global higher education priority. This mixed-methods study investigated how institutional belonging and socioeconomic status interact to shape dropout intentions among minority university students in the UK (N = 182). Quantitative results revealed that perceived course difficulty and lower subjective socioeconomic status were the strongest predictors of dropout intent. While the interaction between socioeconomic status and difficulty was non-significant, qualitative accounts showed distinct structural vulnerabilities. Financial strain restricted social integration, turning socioeconomic disparities into campus isolation. Conversely, representative curricula, diverse peer networks, and stable cultural in-groups (e.g., religious affiliations, living in the parental home) functioned as essential psychological buffers against academic exhaustion and alienation. Universities must shift from transactional models to sustained structural equity to protect vulnerable student groups.

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.

Objective: To examine railway suicide trends and change points in Australia and across states/territories. Methods: We identified railway suicides that occurred in Australia between 2001 and 2023, using data from the National Coronial Information System. We performed negative binomial regression analysis to examine railway suicide trends and joinpoint regression analysis to identify potential change points at both national and state/territory levels. Results: Between 2001 and 2023, railway suicide in Australia declined by 54% (Incidence rate ratio [IRR] 0.98, 95% Confidence Interval [CI] 0.97 to 0.99). Substantial declines were observed in Victoria (-62%, IRR 0.97, 95% CI 0.96 to 0.99) and New South Wales (-67%, IRR 0.97, 95% CI 0.96 to 0.99), and, to a lesser extent, in Queensland (-25%, IRR 0.97, 95% CI 0.95 to 0.99). Nationally, one change point was identified. Between 2017 and 2023, the annual percent change was -8.8% (95% CI -24.5 to -3.3). In Victoria, railway suicide rates decreased annually by 13.6% between 2018 and 2023 (95% CI -38.5 to -4.3). In Western Australia, railway suicide rates increased annually by 10.3% between 2002 and 2010 (95% CI 1.5 to 58.8) and decreased annually by 5.4% between 2010 and 2023 (95% CI -19.8 to -1.8). No change point was identified for other states/territories. Conclusion: Australian railway suicides have declined substantially, with this trend largely driven by reductions in Victoria and New South Wales. These findings demonstrate that railway suicide is preventable through multisectoral initiatives and suggest that interventions should be continued to reduce railway suicide.

The relationship between obesity and specific autoimmune diseases haas been well-established, specifically due to obesity's role in promoting pro-inflammatory states. Although not much literature has been documented regarding obesity association with AIHA. As such, this study aims to assess any correlations in patients with elevated body mass index (BMI) and autoimmune hemolytic anemia (AIHA). Here we present a retrospective cross-sectional study conducted over a four-year period, across four medical centers during which a new electronic medical record was implemented. The study included 25 patients who had a previously documented history of AIHA from another facility, DAT positive with indicators of hemolysis, or DAT positive with monomer specific antisera. The patients BMI was recorded at the time of presentation to the hospital. However, for patients with a prior history of AIHA or those transferred from another facility, the BMI that was closest to the time period of when the patient was diagnosed with AIHA was used as an adjunct. Our results show that there is an association of patients with elevated BMI (>25) and AIHA; however, various other confounding variables should be taken into consideration, and further research should be done to establish a causal relationship.

Background: Medical students face significant mental health challenges, yet psychological distress and post-traumatic stress remain insufficiently characterized in lower-resource settings like Vietnam. Among potential stressors, sexual violence (SV) exposure represents a critical but understudied risk factor. This study evaluated the severity of psychological distress (PD) and post-traumatic stress symptoms (PTSS) among medical students in Northern Vietnam and examined their associations with past-year non-contact and contact SV exposure. Methods: A cross-sectional survey was conducted in May 2025 using REDCap among a probability sample of 555 medical students (years 2 to 5). Mental health outcomes were evaluated using validated instruments: the 21-item Depression, Anxiety, and Stress Scales (DASS-21) for past-week PD and the PTSD Checklist for DSM-5 (PCL-5) for past-month PTSS. Past-year non-contact and contact SV exposures were measured using the Sexual Experiences Survey-Victimization (SES-V). Multivariable linear regression modeled adjusted associations between SV exposure types and mental health symptom severity, testing for sex-specific differences. Results: Overall mental health symptom scores escalated significantly with SV exposure. Median PTSS scores increased from 11 among unexposed students to 20 for non-contact SV and 30 for contact SV (p < 0.001). Similarly, median PD scores increased from 7 (unexposed) to 11.5 (non-contact SV) and 21 (contact SV) (p < 0.001). Adjusted linear models demonstrated robust associations where both non-contact and contact SV exposure were strong independent predictors of heightened PD and PTSS severity, with no significant moderation by sex. In terms of exposure prevalence, 21.26% of students reported non-contact SV (higher in females: 26.24% vs. males: 16.12%) and 10.66% reported contact SV. Conclusions: Vietnamese medical students exposed to sexual violence experience a heavy mental health burden marked by elevated psychological distress and post-traumatic stress symptoms. To protect student mental health in lower resource settings, medical institutions must establish comprehensive trauma-informed psychological support, confidential counseling services, and targeted intervention strategies addressing both contact and non-contact stress exposures. Keywords: psychological distress, post-traumatic stress, non-contact sexual violence, contact sexual violence, university students, Vietnam

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.

Background: Travellers visiting friends and relatives (VFRs) experience a disproportionate burden of travel-associated infectious diseases, yet little is known about the complexity of pre-travel consultations required to support their care. We compared enquiries relating to VFR travellers and tourists received by the UK National Travel Health Network and Centre (NaTHNaC) specialist Advice Line to identify differences in traveller characteristics, destinations and clinical complexity. Methods: We conducted a retrospective observational study of enquiries to the NaTHNaC Advice Line between 1 January 2019 and 31 December 2025. Enquiries relating to VFR travellers and tourists were compared using descriptive statistics and appropriate statistical tests. Traveller demographics, travel characteristics, destinations and enquiry management were analysed. Results: Of 16,367 enquiries relating to specific travellers, 3,090 (18.9%) concerned VFR travellers and 7,237 (44.2%) concerned tourists. Compared with tourists, VFR travellers were younger (median age 24 vs 52 years, P<0.001), more likely to undertake long-stay (8.4% vs 1.8%, P<0.001) and last-minute travel (5.0% vs 1.1%, P<0.001), and more frequently travelled to the WHO African Region (56.6% vs 29.2%, P<0.001) and Eastern Mediterranean Region (12.7% vs 2.8%, P<0.001). Pregnancy was substantially more common among VFR travellers (11.6% vs 4.3%, P<0.001). Enquiries concerning VFR travellers were more likely to require a call-back (16.1% vs 13.8%, P=0.012) and escalation to a specialist doctor (13.1% vs 10.5%, P<0.001), indicating greater consultation complexity. General practice generated a higher proportion of VFR-related enquiries than tourist enquiries (69.5% vs 63.9%, P<0.001). Conclusions: VFR travellers generate disproportionately complex pre-travel consultations characterised by higher rates of specialist escalation, distinct travel patterns and travel to destinations associated with the greatest burden of imported infectious diseases. These findings highlight the importance of specialist travel medicine support for healthcare professionals managing VFR travellers and reinforce the need for equitable access to timely, high-quality pre-travel healthcare for this high-risk population.

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.

Background Deconfliction is a central pillar of humanitarian risk mitigation in contemporary armed conflicts. Intended as a notification system through which parties to a conflict can mitigate against harm to humanitarian personnel and infrastructure, its effectiveness is dependent on respect for humanitarian protections. Since October 2023, repeated Israeli attacks on deconflicted sites and routes in Gaza, alongside increasing restrictions on humanitarian movement as notification-based coordination was replaced by a permission-based system, have raised fundamental questions about the utility and function of deconfliction. This study examines how deconfliction shaped humanitarian access, healthcare delivery, and Palestinian health infrastructure from the perspective of international healthcare workers in Gaza since 2023. Methods We conducted semi-structured interviews with 18 international healthcare providers who worked in Gaza between January 2024 and December 2025. Participants completed 31 deployments across 16 healthcare facilities. Interviews were analyzed using inductive thematic analysis. Results Two major themes emerged. First, participants described deconfliction as an unstable and ineffective means of ensuring humanitarian protection or access. They reported delays, denials, sudden revocations of movement permissions, and strikes on deconflicted sites. These conditions disrupted clinical care, delayed transfers and evacuations, limited facility access, and exposed both patients and providers to ongoing risk. Second, participants described deconfliction as a mechanism of control that shifted responsibility for protection from parties to a conflict to humanitarian actors and redirected resources and personnel away from Palestinian hospitals toward NGO (Non-Governmental Organization) facilities, eroding Palestinian healthcare autonomy. Conclusion Rather than a neutral protection mechanism, deconfliction operated as a conditional authorization regime through which Israel regulated humanitarian movement, medical supply chains, and healthcare delivery. This mechanism rendered protection contingent on compliance, allowing Israel to reframe attacks as humanitarian operational failures rather than violations of international law by military actors. Deconfliction also facilitated the substitution of Palestinian healthcare with internationally managed structures that were dependent on Israeli approval. By undermining local health system autonomy, deconfliction was instrumentalized within a broader Israeli strategy to deliberately inflict conditions to bring about the physical destruction of life in Gaza. These findings raise urgent questions about humanitarian actors obligations when operating within non-neutral systems and underscore the need to prioritize direct support for local healthcare institutions.

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