Public Health

Objectives Concerns about COVID-19 were a key driver of infection-prevention behaviour during the pandemic. The aim of this study was to gain an in-depth longitudinal understanding of the type and frequency of concerns experienced throughout the first two years of the COVID-19 pandemic. Design Content analysis of qualitative descriptions provided in a prospective longitudinal online survey as part of the COVID-19 UK Public Experiences (COPE) Study. Method At baseline (March/April 2020), when the UK entered its first national lockdown, 11,113 adults completed the COPE survey. Follow-up surveys were conducted at 3, 12, 18 and 24 months. Participants were recruited via the HealthWise Wales research registry and social media. Baseline surveys collected demographic and health data, and all waves included an open-ended question about COVID-19 concerns. Content analysis was used to identify the type and frequency of concerns at each time point. Results A total of 41,564 open-text responses were coded into six categories: personal harm (n=16,353), harm to others (n=11,464), social/economic impact (n=6,433), preventing transmission (n=4,843), government/media (n=1,048), and general concerns (n=1,423). The proportion of respondents reporting any concern declined from 75.3% at baseline to 65.8% at 24 months. Over time, concerns about personal harm increased (baseline 41.8% vs. 24-months 52.7%) whereas concerns about harm to others decreased (baseline 48.5% vs. 24-months 28.6%). Concerns about harm were also expressed in relation to clinical vulnerability, lack of trust in government/media, and perceived lack of adherence by others. These were balanced against concerns about wider social and economic impacts of restrictions. Conclusions Public concerns about COVID-19 evolved substantially over the first two years of the pandemic, reflecting changing perceptions of risk and responsibility. Monitoring concerns longitudinally is vital to help guide effective communication and behavioural interventions during future pandemics.

BackgroundAvian Influenza (AI) is a potential pandemic threat, specifically when human-to-human transmission occurs. For outbreak management testing is essential. Current knowledge on testing behaviour is mostly derived from other infectious diseases such as COVID-19. It is necessary to identify determinants of testing behaviour for AI in an early phase. Therefore, this interview study aims to identify a wide range of behavioural determinants of testing during a hypothetical human-to-human transmissible AI outbreak. MethodsSemi-structured in-depth interviews, based on the Theoretical Domains Framework, were carried out between May 2024 and February 2025. Participants were included through purposive and convenience sampling. During the interviews an animation was shown illustrating a hypothetical AI outbreak. Verbatim transcripts were thematically analysed. ResultsWe included seventeen participants (median age 44, range 20-81; 71% women) with diverse backgrounds in terms of age, gender, educational level and country of birth. We found that having the freedom to decide to test would make testing more acceptable, whereas a decreased sense of autonomy would discourage testing. Most themes included individual rather than population-level benefits as drivers of testing behaviour. These included protecting loved ones, ones own health and gaining psychological reassurance. External conditions like being unable to go to work or an event would generally encourage testing behaviour. Lower trust in governmental authorities could hamper testing behaviour. Previous experiences from the COVID-19 pandemic shaped participants answers about AI testing behaviour. ConclusionKey considerations include balancing peoples need for autonomy with the external measures imposed by employers or the government, rebuilding trust in institutions and acknowledging how prior experiences with testing may shape testing behaviour in future AI outbreaks. Further research is needed to determine how these findings can be translated into effective communication and how trust in authorities can be build.

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.

ObjectiveExplore self-reported racial discrimination in healthcare. MethodsRepresentative population sample, Switzerland, repeated cross-sectional data 2016 to 2024 (N=15,525). ResultsContrary to expectation, respondents from the migration-related population (foreign citizens, foreign born, migration background, first/second generation) report less racial discrimination than members of the majority population. Over time, we see an increase in the non migration-related population reporting (racial) discrimination in healthcare, while the share for the migration-related population is constant. The validity of the instrument is demonstrated with reported discrimination at work and in housing and the results are reliable across specifications and statistical controls. ConclusionWe speculate that in some cases, reported racial discrimination may express unmet expectations in healthcare more generally.

BackgroundMalnutrition among children remains a significant public health concern in countries with stunting, wasting, and underweight as key indicators. Rotavirus accounts for approximately 40% of moderate to severe diarrhea cases in children under five, highlighting the potential role of rotavirus vaccination in mitigating diarrhea-associated malnutrition. This study investigated the association between the Rotavirus vaccine (RVV) and malnutrition among children in India. MethodsThe study examined data from the National Family Health Survey-5. The sample included 67,369 children aged 12 to 35 months. Outcomes included stunting, underweight, and wasting, along with their severe form of malnutrition. Adjusted regression, sensitivity analyses, and Inverse Probability Weighting Regression Adjustment assessed the association between receiving RVV and malnutrition. ResultsChildren receiving all three RVV doses had a lower prevalence of stunting (37% vs 41%), underweight (28% vs 33%), and wasting (17% vs 20%) compared to the unvaccinated. Full RVV coverage was significantly associated with reduced odds of stunting (aOR: 0.88; 95% CI: 0.85-0.92), underweight (aOR: 0.86; 95% CI: 0.83-0.89), and wasting (aOR: 0.85; 95% CI: 0.82-0.89). ConclusionReceiving RVV is associated with a reduced risk of malnutrition in children, highlighting the indirect effect (Herd Immunity) and the role of the vaccine beyond preventing diarrheal disease.

BackgroundWorking while sick (presenteeism) with an infectious disease contributes to the spread of infections and is detrimental to productivity. Respiratory illnesses are a common cause of sickness in the working population and understanding the prevalence of presenteeism linked to respiratory illness is therefore important. MethodsWinter Covid Infection Study (WCIS) panel members in work aged 18-64 were surveyed in February - March 2024 and asked about presenteeism in the previous 28 days. Multilevel regression and poststratification was used to estimate the prevalence and length of presenteeism and its effect on productivity in the English workforce, as approximated using the WCIS survey sample calibrated to census proportions. Differences by demographic groups and work sector were also analysed. ResultsAround one in six working adults in England worked while sick with a respiratory infection during the study period, and one in ten attended a non-home workplace. Overall, around one day per adult was spent working while sick with a respiratory infection, approximately half of which was non-home working. Respondents felt they were able to work at around three-quarters of their usual capacity while sick. Presenteeism was more common among respondents who were younger, White, worked in a hybrid pattern, lived in larger households, had Long COVID-19, or worked in teaching and education. ConclusionWorking while sick with a respiratory infection is relatively common, including among those who primarily work away from the home. Key messagesAround one in six working-age adults in employment worked while sick with a respiratory infection during the study period (Feb-Mar 2024). - The likelihood of working while sick with a respiratory infection varied by demographic group and work sector. - On average, survey respondents said they could work at around three quarters their normal effectiveness while sick with a respiratory infection.

IntroductionDuring the COVID-19 pandemic, incarcerated populations faced heightened risk of exposure due to healthcare barriers, restrictive environments, and pre-existing health conditions. Consequently, Correctional Officers (COs) faced increased risk of COVID-19 exposure. Given the health benefits of COVID-19 vaccination and the rise in vaccine hesitancy, this study examined the relationship between COs health beliefs and COVID-19 vaccine uptake. MethodsA health beliefs survey was administered to Massachusetts-based COs (n=118). Chi-squared Automatic Interaction Detection modeling and logistic regression was utilized to analyze the survey data. ResultsCOs with higher trust in vaccines and a prior positive COVID-19 test were most likely to get vaccinated voluntarily. Those with low trust in vaccines and no previous positive COVID-19 test were least likely to receive the vaccine. ConclusionDespite the severe impact of COVID-19 in correctional settings, and the evidence of vaccine efficacy against hospitalization and death, vaccine uptake among COs remains low.

Abstract Background Musculoskeletal conditions, such as back pain and osteoarthritis, are common and disabling disorders. Musculoskeletal conditions are closely related to chronic disease risk factors like smoking/vaping, poor nutrition, alcohol misuse and physical inactivity and impact a person's risk of falling (SNAPF). Preventive care for SNAPF risks is often overlooked. Online delivery of preventive care may increase the provision of this care. We aimed to assess if an online tool for SNAPF risks would be used by and acceptable to patients waiting for an orthopaedic consultation. Methods We completed a multi-method study to test an online health risk self-assessment tool. A random sample of 300 people on the orthopaedic outpatient waiting list aged 18-64 years were sent the tool in batches of 20-50. The tool assessed SNAPF risks and provided feedback against national guidelines. After each batch, we completed feedback interviews with participants to assess acceptability and updated the tool. We summarised quantitative data using descriptive statistics and qualitative data using thematic analysis. Results Of the 300 participants sent the tool, 51.3% were female, 8.6% identified as Aboriginal and/or Torres Strait Islander, with a mean (SD) age of 52.0 years (11.2). There were 170 participants (59.2%) who completed the tool, 117 who did not complete it, and 13 participants who were excluded from analysis because they did not receive the SMS. We conducted 184 feedback interviews, including 125 'completers' and 59 'non-completers'. The percentage of participants who felt that SMS was an appropriate way to receive the tool was 84.7% of 'completers' and 50% of 'non-completers'. The two most common reasons for not completing the tool were due to perceived risk (13/59, 22.0%), and the SMS was received at an inconvenient time (11/59, 18.6%). Qualitative data from the feedback interviews captured three enablers: i) design, ii) high importance, and iii) engagement with health service, along with four barriers: i) design, ii) risk, iii) relevance, and iv) engagement with health service. Conclusion Our study found that an online health risk self-assessment tool appears to be an acceptable way to assess chronic disease and falls risk factors for people on an orthopaedic waitlist.

BackgroundWomens autonomy in healthcare decision-making has become one of the most critical yet inequitably distributed determinants of health outcomes, gender equity, and sustainable development worldwide. In Northern Nigeria, the presence of ethnic and socio-cultural inequality is frequently concealed by the aggregated statistics of a region. MethodsThis cross-sectional secondary analysis utilized the 2024 Nigeria Demographic and Health Survey. The sample included 9,998 married women (15-49 years) identifying as Hausa, Fulani, or Kanuri in Northern Nigeria. Healthcare autonomy was categorized as husband/partner alone, respondent alone, or joint decision-making. Analysis included weighted descriptive statistics, Rao-Scott adjusted chi-square tests for residential associations, and complex sample multinomial logistic regression to identify multivariable correlates while adjusting for sampling weights, strata, and clusters. ResultsMean age was 30.38 years. Most participants lacked formal education (69.6%) and resided in rural areas (72.0%). Husband-only decision-making predominated (72.6%), while 22.5% reported joint and 4.9% independent autonomy. Joint decision-making was significantly higher in urban (33.3%) than rural areas (18.3%; Adjusted F=50.892, p<0.001). In adjusted models (Reference: Kanuri), Hausa and Fulani women had substantially lower odds of joint decision-making relative to husband-only outcomes. Rural residence correlated with lower odds of both independent and joint agency. Notably, wealth status was not a significant predictor after adjustment (p > 0.05). ConclusionsEthnicity and residence are robust determinants of healthcare autonomy among women in Northern Nigeria, persisting regardless of education or wealth. This "socio-cultural paradox" suggests that economic interventions alone are insufficient. Policies must complement socioeconomic approaches with culturally responsive strategies addressing household power dynamics and entrenched social norms.

Background: Understanding the underlying mechanisms for differences in vaccine uptake between migrants and non-migrants is crucial in order to design targeted interventions encouraging vaccination and to ensure vaccine-related equity. Therefore, this study examined to what extent migration-related disparities in COVID-19 vaccination were associated with psychological factors, based on the established 5C model of vaccine behaviour (Confidence, Complacency, Constraints, Calculation, Collective Responsibility). Methods: Data were obtained from the German study "Corona Monitoring Nationwide - Wave 2" (RKI-SOEP-2 study), which was carried out between November 2021 and March 2022. The association between COVID-19 vaccination and migration status, while considering the psychological factors, was investigated using multivariable binary logistic regressions. A decomposition analysis (Karlson-Holm-Breen method) was conducted to examine the extent to which migration-related disparities in vaccine uptake were associated with the psychological factors of the 5C framework. Results: Migrants were less likely to be vaccinated against COVID-19 compared to non-migrants, especially participants from the Middle East and North Africa (MENA) region. Our decomposition showed that almost two-thirds of the disparities in COVID-19 vaccine uptake between migrants and non-migrants were associated with the psychological factors (first-generation: 61.2%, second-generation: 64.2%). Confidence in safety of the vaccine was the most relevant factor in the 5C framework. Furthermore, the results highlighted the importance of a differentiated analysis regarding country of origin: While the 5C model accounted for only 19.4% of the difference between participants from the MENA region and non-migrants, the proportion for participants from Eastern Europe was 73.5%, suggesting that the underlying mechanisms for the lower uptake in the MENA group need further investigation. Conclusions: Overall, migration-related disparities in COVID-19 vaccination were significantly associated with differences in psychological factors of vaccine behaviour. To increase vaccine acceptance within the heterogeneous group of migrants in general, tailored and proactive health communication interventions are needed.

BackgroundOut-of-hospital cardiac arrest (OHCA) survival depends on timely bystander cardiopulmonary resuscitation (CPR) and quick defibrillation via automated external defibrillator (AED). However, access to CPR education and willingness to intervene are not equitably distributed. Within the Muslim community, intersecting religious identity, language, immigration-related concerns, and other social determinants of health may affect CPR/AED education, bystander response, and ultimately OHCA outcomes, underscoring the need for culturally responsive, faith-based training models. MethodsA survey based cross sectional study was conducted to evaluate the perceived barriers to emergency response and lay rescuer cardiopulmonary resuscitation (CPR). Individuals aged 13 years and older were recruited between January and June 2025 through convenience sampling at free, non-certification public CPR/AED classes, where participants self-reported demographic characteristics and barriers to calling 9-1-1 or initiating CPR. Analyses compared Muslim and non-Muslim participants using Fisher exact tests and multivariable logistic regression models adjusted for demographic and socioeconomic factors, with results reported as odds ratios (OR) and 95% confidence intervals (CI). ResultsOf the 651 surveys collected, 33% of participants identified as Muslim, and 46% reported no prior CPR/AED training, with a higher proportion among Muslim respondents (57% vs 41%). Religion was significantly associated with some perceived barriers, with Muslim participants more likely to report law enforcement as a barrier to calling 9-1-1 (OR: 0.53 for non-Muslims vs Muslims, p=0.04) and less likely to report "no problem" starting CPR (OR: 0.91, p=0.04). Race and gender also influenced barriers, with non-white and female participants more likely to report immigration status, language, cost, and concern for violence as barriers to initiating CPR or calling 9-1-1. ConclusionMuslim participants were more confident in performing CPR, but reported less confidence in calling 9-1-1, revealing gaps in emergency response readiness. This emphasizes the importance of culturally adapted CPR/AED training that addresses specific barriers within faith-based communities and to strengthen all links of the chain of survival.

BackgroundPopulation ageing is accelerating, with the fastest growth occurring in low-and middle-income countries. Adequate nutrition is central to healthy ageing, yet little is known about the factors shaping dietary behaviours among older adults in rural African settings, where structural constraints may strongly influence dietary choice. This study explored the facilitators and barriers influencing the dietary choices among older adults aged 60 years and above living in rural communities of Edo Central, Nigeria. MethodsThis exploratory qualitative study was guided by the Socio-Ecological Model (SEM). Semi-structured, in-depth interviews were conducted with 22 older adults. Interview transcripts were analysed thematically using NVivo 14, with findings mapped across individual, environmental, community, and policy/system levels of the SEM. ResultsFourteen subthemes were identified and organised into four overacting SEM domains. Individual drivers identified included a deep knowledge of nutrient-rich diets and a preference for natural, minimally processed foods, as well as community drivers, including cultural and traditional norms and market access, which were the facilitators. Environmental drivers, including physical and economic access, and policy/system drivers, including government policies/subsidies, food prices and inflation, were identified as the main barriers. ConclusionDietary choices among older adults in rural Nigeria are shaped predominantly by structural and food-system constraints rather than by individual knowledge alone. Policies aimed at improving nutrition in ageing populations should prioritise strengthening rural food systems, supporting smallholder agriculture, stabilising food prices, and developing targeted social protection programmes for older adults.

IntroductionFamily Constellation Therapy (FCT) has been widely disseminated in clinical, public health, and judicial settings despite persistent concerns regarding its theoretical basis, safety, and the limited availability of rigorous randomised evidence supporting its clinical use. ObjectiveThe aim of this systematic review is to assess the effects of FCT across all clinical conditions, explicitly considering both benefits and harms; and summarise the characteristics of studies and intervention settings used in randomised controlled trials of FCT. MethodsFollowing a prospectively registered protocol (CRD420251136190), we conducted a systematic search of seven databases (PubMed, EMBASE, APA PsycInfo, CENTRAL, BVS, Web of Science, and CINAHL) and grey literature (ICTRP and ProQuest database) without language or date restrictions to identify published and unpublished randomised controlled trials of FCT. Study selection, data extraction, risk of bias (RoB 2), and certainty of evidence (GRADE) were performed in duplicate. Statistical analyses followed a prospectively registered analysis plan with prespecified criteria for data pooling and for handling analytical limitations. ResultsNo reliable evidence was found to support the use of FCT for any condition across both clinical and non-clinical samples. All trials included were judged to be at high risk of bias and all comparisons were rated as very low-certainty evidence. Concerns regarding potential adverse effects were identified, and the available data was insufficient to establish the effectiveness of the intervention, precluding any clinical recommendation. ConclusionClinicians, policymakers, and consumers should reconsider adopting FCT while reliable evidence is not available.

Aim: To explore RSV knowledge and awareness, RSV vaccination perceptions and acceptability, and preferences for maternal vaccine delivery and communication amongst pregnant women and mothers of infants and toddlers in England. Methods: Between July and November 2024, semi-structured qualitative interviews were performed with 30 mothers (youngest child under 2 years), two of whom were pregnant with a subsequent child. The study was conducted as a follow-on to a UK Health Security Agency survey of attitudes towards RSV vaccination amongst pregnant and post-partum women in England. Findings: Although most mothers had heard of RSV, mothers with experience in health roles were more likely to understand the potential severity of RSV in infants. Likelihood of maternal RSV acceptance was reported as high, with most mothers considering RSV vaccination as beneficial in protecting infants. Most mothers preferred a hybrid approach to vaccine communication, with information available online (e.g. through the NHS website), via written sources (e.g. NHS produced leaflet), and through talking with midwives. For convenience, most mothers preferred the option of fitting vaccinations within the antenatal midwifery appointment schedule rather than going to general practice for a separate appointment. Conclusion: To support maternal RSV vaccination decision-making and access, women need vaccine information early in pregnancy; information provision through a range of different sources (i.e. online, paper, in-person); and vaccination delivery in a convenient location (i.e. as part of antenatal appointments).

ObjectivesTo evaluate the effect of surgical hubs on the volume of surgeries, patient waiting times, and length of hospital stay for elective hip and knee replacements in the English NHS. DesignA retrospective longitudinal study using a difference-in-differences approach to compare changes in outcomes at NHS trusts that opened surgical hubs with those that did not. SettingThe study was set in the English NHS, using administrative data from NHS acute trusts providing elective hip and knee replacements between April 2014 and September 2024. ParticipantsThe study included 76 NHS trusts. The treatment group consisted of 29 trusts that opened a surgical hub for trauma and orthopaedic surgery during the study period. The control group consisted of 47 trusts that did not. 48 trusts that performed fewer than 1,000 relevant procedures over the ten-year period or that reported data for fewer than 41 of the 42 quarters in the sample period were excluded. InterventionThe phased introduction of surgical hubs dedicated to elective procedures at 29 NHS trusts between Q1 2020 and Q3 2024. Main outcome measuresThe three main outcomes were, measured at the trust-quarter level: the total number of elective primary hip and knee replacements (surgical volume), the average length of stay in hospital, and the average waiting time from being added to the waiting list to hospital admission. ResultsThe opening of a surgical hub was associated with an increase of 43.75 hip and knee replacement surgeries per quarter (95% CI: 22.22 to 65.28), which represents a 19.1% increase compared to the pre-hub mean. Length of stay was reduced by 0.32 days (95% CI: - 0.48 to -0.16), a 7.8% reduction. There was no statistically significant effect on average waiting times (-14.96 days, 95% CI: -33.11 to 3.19). ConclusionsSurgical hubs appear to be effective at increasing the number of hip and knee replacements and reducing the time patients spend in hospital. However, in this study, they did not lead to a statistically significant reduction in waiting times overall.

Large-scale epidemics are consistently associated with increased psychological distress and substantial changes in human mobility, yet the relationship between mental health responses and effective population mobility remains overlooked. During the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) such as lockdowns and travel restrictions altered daily movement patterns while simultaneously affecting psychological well-being. Importantly, formal policy stringency alone does not fully capture realized mobility behavior, which also reflects spontaneous adaptation and adherence fatigue over time. In this study, we examine the association between self-reported mental distress and mobility recovery across the United States during the first wave of the COVID-19 pandemic. We combine state-level human mobility data derived from anonymized mobile phone records with large-scale survey data on self-reported anxiety and depression. Our analysis focuses on the U.S. states and territories from April 1 to September 1, 2020. Using fixed-effects regression models, we assess how variations in mental distress relate to deviations from pre-pandemic mobility levels, while controlling for reported COVID-19 mortality and the stringency of NPIs. We find a negative and statistically significant association between mental distress and mobility recovery: higher levels of self-reported anxiety and depression are associated with lower recovery of pre-pandemic mobility. These results indicate that psychological distress is associated with population mobility beyond what is explained by formal restrictions alone. Our findings highlight the relevance of mental health as a factor linked to behavioral responses during public health crises. Incorporating psychological well-being into the evaluation of mobility dynamics may inform more balanced public health strategies in future emergencies. Author summaryDuring the COVID-19 pandemic, governments introduced restrictions on movement, such as stay-at-home orders and travel limits, to slow the spread of the virus. At the same time, many people experienced increased anxiety and depression. In this study, we ask whether changes in mental well-being were linked to how quickly people returned to their usual patterns of movement. Here, we focus on the first wave of the pandemic in the United States and combine mobility data and large-scale digital survey data to study the association between self-reported mental health indicators and effective mobility at the population level. By comparing states over time, we explore whether changes in mental distress were associated with changes in mobility, beyond what can be explained by public restrictions or reported deaths alone. We find that states with higher levels of reported anxiety and depression tended to show slower recovery toward normal mobility levels. This suggests that psychological well-being played an important role in shaping individual and collective responses to the pandemic, with implications for the design of future public health interventions.

BackgroundSex workers struggled to adhere to isolation guidelines following COVID-19 diagnosis because of financial pressure to keep working. We co-developed and evaluated for feasibility, acceptability, and cost an intervention for promoting isolation and community-based self-monitoring for COVID-19. MethodsSex workers testing positive for COVID-19 received the following co-developed intervention: i) risk-differentiated support, including immediate hospitalization and/or treatment for serious illness, and community-based self-monitoring for those at risk of progressing to severe illness, ii) food packs lasting two weeks. Using Proctors Framework, we interviewed purposively selected health-workers and sex workers before intervention implementation (26 sex workers and 24 health workers) and during implementation (8 sex workers of whom 5 tested positive, and 5 health workers) to evaluate the intervention. We determined intervention development and implementation costs using program data. ResultsThe intervention was implemented between March-June 2023. Sex workers and health workers reported that the intervention was highly acceptable and was implemented with fidelity. Food packs were highly appreciated; participants said they promoted isolation although vulnerability to non-food financial pressures persisted. Unanticipated impacts were increased testing uptake following introduction of food packs. Self-monitoring at home was acceptable although fear of stigma prevented some participants from seeking the needed support. The cost per sex worker testing positive was $49 and $54 respectively excluding/including intervention co-development costs. ConclusionA co-developed intervention for promoting isolation and community-based self-monitoring for COVID-19 was feasible and acceptable, with costs comparing favorably with similar interventions. Addressing stigma could optimise implementation and potential for future pandemics.

BackgroundRisk communication is critical in shaping public response during infectious disease outbreaks. This study quantitatively examined whether Nigerian media coverage during the 2024 cholera outbreak reflected a proactive or reactive risk communication pattern. MethodsA Python-based systematic content analysis was conducted on 352 unique news articles published by major Nigerian media sources in 2024. K-Means was used to cluster and quantify thematic patterns, TextBlob for sentiment polarity, and time-series analysis to determine the features of media engagement. ResultsThe analysis identified a dominant reactive, crisis-driven communication pattern with media coverage surging by over 400% in June, matching the peak of reported cholera cases. Thematic analysis portrayed a severe reporting imbalance focused on Outbreak Reports and Mortality (41.5% of articles), while structural and preventive themes such as WASH and Health Education received marginal attention (less than 25% of coverage). Furthermore, communication was overwhelmingly neutral (76.4%) in sentiment, potentially limiting the perceived urgency required for public action. ConclusionsMedia reporting on the 2024 cholera outbreak in Nigeria was reactive and focused disproportionately on threat rather than solutions. These findings support the need for a strategic dual-focus communication model that shifts from crisis-driven coverage to sustained, year-round preventive messaging centered on WASH accountability and community resilience.

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.

BackgroundSocioeconomic status is an important driver of health outcomes, but the drivers of change in household status over time are often overlooked in favor of cross-sectional metrics of convenience. This is especially challenging in remote populations in low- and middle-income settings. We report changes in socioeconomic status over two decades. MethodsDuring two studies on childhood health outcomes (1989-1996 and 2011-2014), socioeconomic data were collected through surveys and interviews in Oshikhandass village, a remote population in northern Pakistan. Observations included metrics of population demography, occupation and incomes, household structure and self-reported adult illness. Individual measurements are reported with summary statistics comparing the two time periods and multi-dimensional socioeconomic constructs are constructed from factor analyses to compare changes in relative household socioeconomic position over time. ResultsThe population had substantial investment during the early 1990s that specifically targeted suspected causes of poverty (electrification, clean water and female education). Within one generation, the village approximately doubled in population, was fully electrified, maternal illiteracy rates dropped from 70% to 27% and jobs opportunities proliferated from primarily agricultural to include a large number of service sectors. Simultaneously the population demography has transformed from stage 1 to stage 3 unlike the national trend that remains in stage 2. Despite secular trends to improved status, there has been approximately equal decline in relative position in the population due to small changes in access to resources. ConclusionThe transformation in human capital in this population is a testament to targeted investments to improve education and childhood health. In a single generation the population has transitioned faster than the national average, exemplified, for example, by individuals achieving higher education, including international, and the village becoming a magnet for migration from the surrounding population. The transition has not been evenly distributed, however, and access to land and resources have led to some households rising in relative position while others have fallen.