Research Articles (School of Public Health)

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Unravelling dual violence against women in Ethiopia: experiences of obstetric violence and postpartum intimate partner violence
(Elsevier B.V., 2026) Makandi, Millicent; Benová, Lenka; Gebremedhin, Samson; Mohammed, Zemzem; Votruba, Nicole; Tabana, Hanani; Dadi, Abel Fekadu; Asefa, Anteneh
ObjectiveTo examine the prevalence of dual violence—experience of obstetric violence (OV) and postpartum intimate partner violence (IPV)—and factors associated with it among women in Addis Ababa, Ethiopia.MethodsAs part of a broader longitudinal study, we surveyed 354 postpartum women six to sixteen weeks after childbirth. OV was assessed across seven domains (e.g., verbal abuse, non-consented care, lack of privacy), and IPV across three (physical, sexual, emotional). Dual violence was defined as experiencing at least one form of both OV and IPV. We used logistic regression to identify factors associated with dual violence.ResultsExperience of OV was reported by 87.0% (95% CI: 82.9%-90.2%) of the participants, while 31.2% (95% CI: 26.1–36.0%) reported experiencing postpartum IPV. The prevalence of dual violence was 29.4% (95% CI: 24.9%–34.2%). Most prevalent OV forms were: lack of privacy, confidentiality, or access to information (65.5%) and non-consented care (61.6%), whereas emotional violence was the most experienced form of postpartum IPV (29.4%). Dual violence was significantly associated with unemployment (AOR: 2.31, 95% CI: 1.20–4.54), lack of postnatal check (AOR: 2.23; 95% CI: 1.06–4.72), and experience of IPV during pregnancy (AOR: 6.91, 95% CI: 3.92–12.55). Conversely, women who gave birth in private facilities had lower odds of experiencing dual violence (AOR: 0.41, 95% CI: 0.15–0.99).ConclusionThe high prevalence of dual violence identified by our study underscores the need for integrated interventions to strengthen OV and IPV prevention and response actions.
The healthy hard worker: a critical analysis of young adult South Africans’ discursive constructions of health
(SAGE Publications Ltd, 2025) De Jong, Michelle; Plüg, Simóne; Collins, Anthony
This qualitative study explores how a small group of young adult South Africans discursively construct health during in-depth semi-structured interviews, and the ways in which these discourses are used to construct subjectivity. Data was collected from 20 mostly white, university educated participants and were analysed using Foucauldian discourse analysis. One of the discourses identified, ‘health and work’, is discussed with a specific focus on the construction of subject positions and the possible implications these have. We explore the personal implications of how the use of ‘health and work’ discourses construct participants as in alignment with moral norms. However, we also argue that these discourses individualise the responsibility for (ill)health and deploy the association between good health and virtue to perpetuate capitalist notions of the work ethic and neoliberal ideologies which are implicated in the perpetuation of health inequities.
Transition of adolescents from paediatric to adult HIV care in South Africa: a policy review
(AOSIS (pty) Ltd, 2025) Petinger, Charné; Crowley, Talitha; van Wyk, Brian
The successful roll-out and improved delivery of antiretroviral therapy (ART) services has led to paediatric HIV patients surviving to reach adolescence. Adolescents living with HIV (ALHIV) are challenged when transitioning to adult HIV care programmes where they must negotiate new care pathways, changes in healthcare providers and self-manage their chronic condition, in addition to dealing with the psychological and physiological developmental changes of adolescence. The transition process needs to be well guided, to ensure that ALHIV on ART maintain optimal adherence and remain engaged in care. Viral suppression and retention in care are significantly lower for older adolescents (15–19 years) compared to children and younger adolescents under 15 years – coinciding with the post-transition period. Comprehensive and structured transition protocols may have a significant impact on positive health outcomes. In sub-Saharan Africa, there is a dearth of policies and implementation guidelines for ALHIV who are transitioning to adult HIV care. The current review reports on policies and guidelines for transitioning ALHIV to adult HIV care in South Africa. Eight policies were identified, which were developed at global (n = 2), national (n = 2) and provincial levels (n = 1), and guided implementation (n = 3). Current national and provincial policies provide guidance on when to transition a patient clinically to facilitate the switch to adult ART regimens. Although global policies and implementation guidelines emphasise specific and comprehensive care for ALHIV on ART, these are not carried over to national and provincial policies in South Africa. Further development of policies is required to guide comprehensive, adolescent-friendly transition processes for ALHIV on ART in South Africa.
Drivers of food choice in three urban communities in South Africa
(Taylor and Francis Ltd., 2026) Sayed, Nazeeia; Swart, Elizabeth Catherina
Background: With South Africa's high burden of disease, increasing attention has been given to improving food environments to facilitate healthier food access. An understanding of the main drivers of food choice and barriers in consuming healthier foods can assist in the formulation of nudge strategies to improve the quality of diets consumed. Objectives: To explore the drivers of food choice among adults in three urban communities in South Africa. Design: Qualitative descriptive phenomenological study using focus-group discussions. Setting: Three urban sites in the Eastern Cape, KwaZulu Natal, and Western Cape provinces in South Africa. Subjects: Adults (male and female, 21 to 59 years of age). Outcome measures: Self-administered sociodemographic questionnaire and focus-group discussions. Findings: Nine focus groups with 68 participants were completed. Financial considerations, household/family factors, and shop/food retail factors were the key drivers of food choice identified. Health considerations were present, but not prevalent. Enablers of healthy food consumption included: cost, recognised health/nutrition benefits, and good taste. Barriers were unavailability, unknown preparation, beliefs, and disliked taste. Conclusions: This study found that financial considerations, household/family factors, and the retail food environment were key influences on food choice in three urban South African communities. The research contributes to qualitative evidence on consumer perspectives in urban contexts. Recommendations include exploring retail interventions and pricing strategies to improve access to healthy foods. The study limitations include limited transferability beyond the study sites, but findings remain valuable for guiding future research and public health nutrition policy.
“If there is no data, how do we improve?” exploring health workers’ perspective on stillbirth recording in the ashanti region of ghana
(BioMed Central Ltd, 2026) Mensah-Abrampah, Nana Afriyie; Okwaraji, Yemisrach Behailu; Oteng, Kenneth Fosu; Asiedu, Ernest Konadu; Larsen-Reindorf, Rita; Blencowe, Hannah K.; Jackson, Debra J.
Background: Health workers play a critical role in documenting the estimated 2 million stillbirths that occur annually. From the moment a stillbirth occurs, a health worker is responsible for recording the birth outcome. The reliability of stillbirth data for informing global and national-level strategies on stillbirths depends on the information recorded by the health worker at the point of care. This study aimed to gain insights into the health worker practices and challenges related to stillbirth recording and reporting. Methods: The qualitative study explored three objectives using an a priori framework: 1) experiences, perceptions, and attitudes; 2) barriers; and 3) support mechanisms available to health workers for stillbirth recording and reporting. Semi-structured interviews were conducted with 28 health workers, including midwives, medical officers, physician assistants, and health information officers. The study was conducted across four secondary and four primary care facilities in the Ashanti Region of Ghana. All health facilities are government owned. Thematic analysis was performed. Results: Under experiences, perceptions, and attitudes, inconsistent definitions were used to describe stillbirths. Health workers described stillbirths using various gestational age thresholds, including 24-,28-,36-, and 38-weeks. Some health workers did not reference gestational age when describing stillbirths. Pre-service education shaped knowledge on stillbirths and its recording, with limited opportunities for in-service training. The motivation to record stillbirths was influenced by both intrinsic, driven by the moral imperative to do what is right, and extrinsic factors, influenced by district-level standards. Misclassifications and omissions of stillbirths occurred due to a higher workload, a large volume of forms requiring completion, limited knowledge and experience, and a deliberate effort to minimize facility mortality rates, especially in cases of macerated stillbirths. For barriers to stillbirth recording, midwives reported that blame was evident at three levels: blame from the broader health system, blame within the organizational facility-level, and individual-level blame. The failure to implement audit recommendations was identified as a bottleneck perpetuating negative attitudes toward collecting stillbirth data. The engagement of clinical staff in audit reviews and training was identified as support available to health workers. Conclusion: We need to understand the health worker experiences, perceptions, and attitudes that underpin stillbirth data to reduce the stillbirth burden. The study suggests several recommendations, including socializing the national stillbirth definition, and reviewing audit protocols. © The Author(s) 2026.
Unravelling dual violence against women in ethiopia: experiences of obstetric violence and postpartum intimate partner violence
(Elsevier B.V., 2026) Makandi, Millicent; Benová, Lenka; Gebremedhin, Samson; Mohammed, Zemzem; Votruba, Nicole; Tabana, Hanani; Dadi, Abel Fekadu; Asefa, Anteneh
Objective: To examine the prevalence of dual violence—experience of obstetric violence (OV) and postpartum intimate partner violence (IPV)—and factors associated with it among women in Addis Ababa, Ethiopia. Methods: As part of a broader longitudinal study, we surveyed 354 postpartum women six to sixteen weeks after childbirth. OV was assessed across seven domains (e.g., verbal abuse, non-consented care, lack of privacy), and IPV across three (physical, sexual, emotional). Dual violence was defined as experiencing at least one form of both OV and IPV. We used logistic regression to identify factors associated with dual violence. Results: Experience of OV was reported by 87.0% (95% CI: 82.9%-90.2%) of the participants, while 31.2% (95% CI: 26.1–36.0%) reported experiencing postpartum IPV. The prevalence of dual violence was 29.4% (95% CI: 24.9%–34.2%). Most prevalent OV forms were: lack of privacy, confidentiality, or access to information (65.5%) and non-consented care (61.6%), whereas emotional violence was the most experienced form of postpartum IPV (29.4%). Dual violence was significantly associated with unemployment (AOR: 2.31, 95% CI: 1.20–4.54), lack of postnatal check (AOR: 2.23; 95% CI: 1.06–4.72), and experience of IPV during pregnancy (AOR: 6.91, 95% CI: 3.92–12.55). Conversely, women who gave birth in private facilities had lower odds of experiencing dual violence (AOR: 0.41, 95% CI: 0.15–0.99). Conclusion: The high prevalence of dual violence identified by our study underscores the need for integrated interventions to strengthen OV and IPV prevention and response actions.
School health initiatives in low-income and middle-income countries: a scoping review protocol
(BMJ Publishing Group, 2026) Hibusu Ladislas; Mianda Solange Z; Akintola Olagoke
Background: Schools are key settings for implementing school health initiatives to prevent health problems facing learners. Initiatives exist to help learners build health literacy, adopt positive behaviors and improve their health and academic outcomes. Yet, school health outcomes have not been achieved in many settings, particularly in low-income and middle-income countries. This failure is attributed to mismatches between the initiatives and the problems being addressed, or the ill implementation of school health initiatives. Mapping these initiatives to school health problems and other school health characteristics is essential to fully understand and achieve the desired school health outcomes. Methods and analysis: This study will map literature on school health initiatives with other characteristics from 2013 to 2025. We will search articles in PubMed, Scopus, Web of Science and Google Scholar databases. Two reviewers will independently screen records and chart data; disagreements will be resolved by consensus and, when needed, adjudicated by a third reviewer. Analysis will include a qualitative review of key concepts in school health and a quantitative analysis of all included studies based on the main text categories and themes from the qualitative phase. Ethics and dissemination: Ethics approval is not required because this study is a scoping review of published literature and does not involve human participants. The results will be published as an article in a peer-reviewed journal and presented to stakeholders involved in implementing school health initiatives.
Unwrapping the global financing facility: understanding implications for women’s children’s and adolescent’s health through layered policy analysis
(Taylor and Francis Ltd, 2025) Kinney, Mary V; Kwesiga, Doris; Lawn, Joy E; Walmisley, Ulla; Kumar, Meghan Bruce; Kiendrébéogo, Joël Arthur; Wanduru, Phillip; Waiswa, Peter; Shamba, Donat; Baraka, Jitihada; Chivangue, Andes; Msemo, Georgina; Steege, Rosie; George, Asha Sara
The Global Financing Facility (GFF), launched in 2015, aims to catalyse funding for reproductive, maternal, newborn, child, and adolescent health, and nutrition. Few independent assessments have evaluated its processes and impact. We conducted a multi-layered policy analysis of GFF documents–the Investment Cases (ICs) and the GFF-linked World Bank Project Appraisal Documents (PADs)–examining the content of GFF documents for 28 countries, comparing four tracer themes (maternal and newborn health, adolescent health, community health, and quality), and analysing the policy processes in four country studies (Burkina Faso, Mozambique, Tanzania, and Uganda). From 2015 to 2022, GFF-linked PADs reported US$ 14.5 billion of funding across 26 countries through 30 PADs, with GFF contributing 4% to this value. GFF investments primarily focused on service delivery, governance, and performance-based financing. Countries received more targeted investments for maternal and newborn health and adolescent health linked to their burden of these tracer themes. Attention to community health and quality varied. ICs were broader than PADs and more inclusive in their development. Local contexts shaped policy processes. GFF supported priority-setting and learning; however, translating priorities into resourced actions proved challenging. Power dynamics influenced country ownership, donor coordination and resource mobilisation. The GFF is a significant opportunity to advance health for vulnerable populations. Progress in transparency and data use is evident, but accountability gaps, power imbalances, and limited engagement with civil society and private sector hinder national ownership. Further research is needed to determine GFF’s attribution to catalytic resource mobilization.
Comparison of treatment outcomes of adolescents on HIV treatment before and during the coronavirus disease 2019 pandemic in Cape Town, South Africa: a retrospective cohort study
(AOSIS (pty) Ltd, 2026) Khan, Nazreen; van Wyk, Brian; Crowley, Talitha
Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare systems, posing risks for adolescents living with HIV (ALHIV) in resource-limited, high HIV-prevalence settings. These disruptions threatened antiretroviral therapy (ART) adherence, viral load suppression (VLS) and retention in care (RiC). Aim: This study aimed to compare treatment outcomes of ALHIV on ART in the Khayelitsha and Eastern Substructure (KESS) before and during the COVID-19 pandemic. Setting: The study was performed in KESS, Cape Town, South Africa. Methods: A retrospective cohort analysis was conducted among ALHIV aged 10–19 years receiving ART at public health facilities, pre-COVID-19 (before 01 March 2020) and during COVID-19 (01 March 2020–31 December 2021). Sociodemographic, clinical, and treatment data were analysed. Descriptive and inferential statistics compared outcomes and determined factors associated with VLS (< 1000 copies/mL) using SPSS v.30. Results: Data from 1702 ALHIV (pre-COVID-19) and 2733 ALHIV (during COVID-19) were analysed. Viral load suppression declined from 82.1% to 64.8%, while full VLS (< 50 copies/mL) from 70.8% to 53.7% (p = 0.065). Antiretroviral therapy adherence fell from 96.4% to 70.0% (p < 0.001), and RiC 80.3% to 76.3% (p < 0.001). In multivariate analysis, higher CD4 count, and consistent ART adherence predicted VLS. Conclusion: Antiretroviral therapy adherence and VLS rates among ALHIV declined during COVID-19. Adolescent-centred healthcare delivery models are needed to ensure continuity of HIV treatment during public health emergencies. Contribution: This study provides local evidence on the pandemic's impact in a high-burden South African context. By quantifying declines in ART adherence, RiC, and VLS, it highlights ALHIV vulnerabilities and the need to strengthen adolescent-responsive, resilient healthcare systems.
Health services and programmatic responses to improving adolescent HIV care in Lusaka, Zambia: A descriptive qualitative study
(AOSIS (pty) Ltd, 2026) Moomba, Kaala; Crowley, Talitha; van Wyk, Brian
Background: Adolescents living with human immunodeficiency virus (HIV) face disproportionately poor treatment outcomes because of a combination of psychosocial, structural and health systems challenges. Despite efforts to implement adolescent-friendly and differentiated service delivery models in Zambia, gaps remain in the organisation and delivery of care. Aim: This study aimed to explore how HIV services for adolescents are delivered and experienced by healthcare workers and programme managers in Lusaka District. Setting: The study was conducted across six health facilities in Lusaka District, Zambia, representing different levels of the health system and providing HIV care to adolescents. Methods: A descriptive qualitative design was employed. Thirty purposively selected participants (24 healthcare workers and six HIV programme managers) participated in individual in-depth interviews (IDIs) conducted between 20 February 2025 and 30 April 2025 using a semi-structured interview guide. Data were audio-recorded, transcribed verbatim and analysed using inductive content analysis. Results: Inductive content analysis identified three themes: programmatic responses, highlighting strategic leadership, policy direction, adolescent-focused service delivery and workforce capacity building; implementation challenges, including inadequate infrastructure, health system limitations and individual-level barriers; and opportunities for improved programmatic response and service delivery, emphasising improvements in policy, health systems, infrastructure and service delivery. Conclusion: Although notable progress has been made in expanding adolescent HIV services in Lusaka, gaps in infrastructure, workforce and social support continue to affect programme effectiveness. Strengthening adolescent-responsive and sustainable care is essential to improve retention, viral suppression and Zambia’s progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets in the adolescent HIV cascade. Contribution: This study highlights barriers and opportunities in adolescent HIV programming in Lusaka, emphasising leadership, policy, service delivery and workforce capacity, while noting ongoing system and individual challenges. The findings can inform policy and practice to strengthen adolescent-responsive HIV care in Zambia and similar contexts.
Irrational medicine use and its associated factors in conflict-affected areas in Mali: a cross-sectional study
(Taylor and Francis Ltd., 2025) Ahmed, Mohamed Ali Ag; Seydou, Alassane; Coulibaly, Issa; Kielmann, Karina; Ravinetto, Raffaella
Background: Rational use of essential medicines is a critical step towards prevention and treatment of many illnesses. However, it represents a significant challenge worldwide, and particularly for under-resourced health systems in conflict-affected areas. Objective: To assess barriers to rational use of essential medicines at primary healthcare level in conflict-affected areas of Mali. Methods: We conducted a cross-sectional study in twenty randomly selected community health centres (CHCs) in four health districts, by applying the World Health Organisation and International Network on Rational Use of Drugs core forms for the rational use of medicines. Seven hundred eighty-nine (789) prescriptions were retrospectively selected and analysed; four hundred forty-three (443) patients were interviewed: and health facility-related indicators were collected prospectively from the 20 CHCs. Results: The average number of medicines per prescription was 3.89 ± 1.83; out of these, 94.0% were prescribed by generic name, and 91.0% belonged to Mali’s National List of Essential Medicines. Overall, 68% of the assessed prescriptions included antibiotics; 58% included injectables; and 75.79% were characterized by polypharmacy, i.e. more than two medicines per prescription. In multivariate analysis, the study area and prescriber’s sex were significantly associated with polypharmacy; prescriber’s seniority and training were associated with antibiotic overprescription; the study area, prescriber’s sex and seniority were associated with overprescription of injectables. Moreover, the average price of prescriptions was high in relation to average local income, likely making these unaffordable for many households. Conclusion: Excessive polypharmacy and overprescription of antibiotics and injectables undermine the performance of the local health system and the achievement of intended therapeutic outcomes. Our findings provide a solid basis for more targeted and multidisciplinary research, to further inform relevant stakeholders on how best to mitigate the impact of conflict on the rational use of medicines.
Contextual constraints and dilemmas influencing health providers' prescription practices in a conflict-affected area: qualitative insights from Mopti, Mali
(Public Library of Science, 2025) Coulibaly, Issa; Diarra, Yacouba; Ahmed, Mohamed Ali Ag; Ravinetto, Raffaella; Doumbia, Seydou O.; Kielmann, Karina
Armed conflicts present complex, multidimensional challenges that severely compromise both access to and the quality of healthcare, including the adequate prescription of essential medicines. This study aimed to identify and understand the factors underlying the irrational prescribing of medicine in areas affected by armed conflict in the Mopti region in Mali. An exploratory qualitative study was conducted using a semi-structured interview guide to collect data from 30 participants, including health professionals from three health districts, representatives of the regional health directorate, members of community health associations, and staff from non-governmental organisations (NGOs) working in health sector. Interviews were recorded, transcribed, and subjected to thematic content analysis, using NVIVO 14 (2023 version) to support coding and data retrieval. Study participants reported a range of health system- and patient-related factors contributing to irrational prescribing practices in these conflict-affected areas. Health systems factors included: an imbalance between workload and the availability of qualified staff; limited access to professional training and training resources; poor adherence to prescription guidelines and procedures -often a consequence of contextual constraints; and coercion from armed terrorist groups. Administrative and political challenges were also highlighted, including weak monitoring and supervision mechanisms within the local health system; a lack of oversight by health and regulatory authorities in blockaded areas; the development of an informal pharmaceutical sector to compensate for deficiencies in the formal system; and overprescription of medicines linked to insurance schemes. Patient-related factors included delayed care-seeking linked to regional insecurity and contributing to increased morbidity and worsened health outcomes. Our results show that the multiple contextual factors influencing prescribing of medicines are deeply interlinked. Efforts to improve the quality of prescribing in conflict zones must recognise that practices often deemed ‘irrational’ are shaped by complex contextual constraints. A coordinated and comprehensive approach involving all health systems stakeholders is required.
‘The not talking is actually what kills you’– young South African women’s communication barriers about sexual health
(Routledge, 2026) Hartley, Felicity; Trappler, Jill; Gill, Katherine; Bekker, Linda-Gail; MacKenny, Virginia; Knight, Lucia; Passmore, Jo-Ann
Conversations about sex and sexual health are often stigmatised and shaped by socio-cultural influences. For young women, lack of adequate communication can influence access to information, knowledge and behaviour and therefore increase vulnerability to negative outcomes such as sexually transmitted infections (STIs) and unintended pregnancy. This qualitative study investigated the barriers young women face when seeking dialogue about sex, their sexual health and relationships. Seven isiXhosa-speaking young women (aged 21–25) participated in a six-session art-based engagement, creating large-format paintings reflecting their sexual health experiences. Data collection included in-depth interviews and a focus group discussion, which were transcribed, translated and thematically analysed. Findings revealed that communication about sex and sexual health was hindered by the attitudes of family, partners, communities and health care providers. The need to please and retain partners also restricted young women’s ability to express their sexual health needs and desires. Young women felt that with age and maturity they gained confidence, agency and capacity to navigate difficult conversations. Empowering tools and strategies to improve communication could enhance young women’s agency, enabling them to overcome barriers for communication and actively seek sexual health information and services.
Availability of essential medicines in 14 remaining health facilities in Gaza
(Elsevier B.V., 2025) Aljadeeah, Saleh; Satheesh, Gautam; Hafez, Sali; Naguib, Mina; Neilson, Amy; Alaloul, Asil; Ooms, Gorik; Shellah, Duha; Abu Shammala, Bissan Ismail; Ravinetto, Raffaella
Multiple human rights and UN officials have raised grave concerns over violations of international law in the Gaza Strip (or Gaza) that have amounted to extermination and genocide. The Israeli military blockade and violence are causing severe medicine shortages. Between May 21 and July 9, 2025, we measured the availability of 25 essential medicines across 14 functioning facilities in Gaza (six in northern Gaza and eight in southern Gaza), comprising three public hospitals, five humanitarian and relief centres, and six private pharmacies. Only functional facilities were included. Data were collected remotely following the WHO/Health Action International (HAI) methodology, which we adapted for conflict settings on the basis of preprint research conducted in northern Syria. Availability was defined as the proportion of facilities stocking each medicine on the day of data collection; more details are available in the appendix (pp 1–2). Availability was considered very low if it was less than 30%, low if it was 30–49%, somewhat high if it was 50–80%, and high if it was more than 80%.
“If there is no data, how do we improve?” Exploring health workers’ perspective on stillbirth recording in the Ashanti Region of Ghana
(BioMed Central Ltd, 2026) Mensah Abrampah, Nana A; Okwaraji, Yemisrach B; Oteng, Kenneth Fosu; Asiedu, Ernest Konadu; Larsen-Reindorf, Rita; Blencowe, Hannah; Jackson, Debra
Background: Health workers play a critical role in documenting the estimated 2 million stillbirths that occur annually. From the moment a stillbirth occurs, a health worker is responsible for recording the birth outcome. The reliability of stillbirth data for informing global and national-level strategies on stillbirths depends on the information recorded by the health worker at the point of care. This study aimed to gain insights into the health worker practices and challenges related to stillbirth recording and reporting. Methods: The qualitative study explored three objectives using an a priori framework: 1) experiences, perceptions, and attitudes; 2) barriers; and 3) support mechanisms available to health workers for stillbirth recording and reporting. Semi-structured interviews were conducted with 28 health workers, including midwives, medical officers, physician assistants, and health information officers. The study was conducted across four secondary and four primary care facilities in the Ashanti Region of Ghana. All health facilities are government owned. Thematic analysis was performed. Results: Under experiences, perceptions, and attitudes, inconsistent definitions were used to describe stillbirths. Health workers described stillbirths using various gestational age thresholds, including 24-,28-,36-, and 38-weeks. Some health workers did not reference gestational age when describing stillbirths. Pre-service education shaped knowledge on stillbirths and its recording, with limited opportunities for in-service training. The motivation to record stillbirths was influenced by both intrinsic, driven by the moral imperative to do what is right, and extrinsic factors, influenced by district-level standards. Misclassifications and omissions of stillbirths occurred due to a higher workload, a large volume of forms requiring completion, limited knowledge and experience, and a deliberate effort to minimize facility mortality rates, especially in cases of macerated stillbirths. For barriers to stillbirth recording, midwives reported that blame was evident at three levels: blame from the broader health system, blame within the organizational facility-level, and individual-level blame. The failure to implement audit recommendations was identified as a bottleneck perpetuating negative attitudes toward collecting stillbirth data. The engagement of clinical staff in audit reviews and training was identified as support available to health workers. Conclusion: We need to understand the health worker experiences, perceptions, and attitudes that underpin stillbirth data to reduce the stillbirth burden. The study suggests several recommendations, including socializing the national stillbirth definition, and reviewing audit protocols.
Born too soon: accelerating change to 2030 and beyond
(BioMed Central Ltd, 2025) Kinney, Mary; Lawn, Joy; Khosla, Rajat
Progress needed Preterm birth rates have “flatlined” for a decade with major loss of human capital, hindering progress for many Sustainable Development Goals. Progress on the reduction of maternal, newborn and child mortality needs to accelerate by between 3 and 11-fold to reach national and global targets by 2030. Priorities Actions are required on two tracks: (1) prevention of preterm birth, including better management for women in preterm labour, and (2) provision of high-quality care to vulnerable newborns, including those born into fragile and conflict-affected settings. Together these tracks have potential for high impact in terms of millions of lives saved, and socioeconomic returns on investment. We can and must do more to provide quality and respectful reproductive, antenatal and birth care for all adolescent girls and women, everywhere, and close unacceptable survival gaps for small and sick newborns. New focus is essential on threats beyond the health sector, notably conflict and the climate crisis. Pivots The cost of inaction is too high in every country. Four pivots are central to accelerating action: invest, implement, integrate, and innovate. More specifically these pivots include investments in systems including more skilled human resources; implementation of high-impact interventions with data used for quality improvement and accountability; innovations including new health technologies and also systems and social innovations; plus, integration with levels of the health sector and across sectors and the life-course, with families at the centre. Everyone has a role to play. Increasing speed now, and sustaining progress, requires multi-level leadership including from grassroots movements led by parents and affected people through to heads of state. Some countries provide examples of such change: The United States of America in data identified inequalities by state and ethnicity for preterm birth. Importantly noting drops in donor aid, India has made ambitious investment in the health sector and beyond, and United Republic of Tanzania in multi-level leadership. Changing gears requires the ambition and energy witnessed a generation ago for HIV/AIDS. We have the ability now to ensure that every baby born too soon – and their mothers – can survive and thrive. Our next generation depends on us acting now for more healthy starts and hopeful futures.
The health system’s response strategies to the effects of climate change extreme weather events in Malawi: “a policy analysis”
(BioMed Central Ltd, 2025) Chimatiro, Chancy Skenard; Mianda, Solange; Lembani, Martina
Introduction: The effects of climate change and extreme weather events on the health system are becoming unbearable globally. We conducted a health policy analysis to understand the health system’s response strategies to the effects of climate change extreme weather events in Malawi and identified implementation response challenges for improvement. Methods: The policy triangle model was used to analyze health system policies. A list of policies was obtained from the Department of Policy, Planning, and Development at the Ministry of Health. We retrieved the policies from the Ministry of Health Website, and hard copies were obtained for those not published online. A data extraction form was created to capture all climate change-related issues, which were grouped according to the policy triangle model, including context, content, process, and actors. We further identified implementation challenges to climate change. Results: In total, we obtained 32 health policy documents from the Department of Planning at the Ministry of Health that were screened for climate change-related issues. Out of these, only three had climate change-related themes and strategies. Guided by the policy triangle framework, we present our findings under five themes: policy context, policy contents, policy process, actors, and the implementation gaps. Contextually, the policies were aligned with both local and international goals. The contents of the analyzed policies have climate change thematic areas and strategies not specific to health system improvement. The process involved situation analysis and consultations with both national and international stakeholders. The actors involved included government ministries, local councils, development partners, community leaders, and global organizations. Some of the implementation challenges include a lack of health system-specific climate change strategies and guidelines, a lack of clear funding mechanisms, limited consideration of local knowledge, and a lack of capacity building strategies among health workers. Conclusion: The health system in Malawi is moving in the right direction to minimize the effects of climate change extreme weather events on health. The availability of climate change thematic areas, objectives, and strategies in the analyzed health policies shows that some efforts are being made to address the effects climate change extreme weather events in the country. We recommend developing climate change-specific health policies with clear strategies and financing mechanisms.
HIV viral re-suppression on second-line ART in Southern Zimbabwe
(Multidisciplinary Digital Publishing Institute (MDPI), 2025) van Wyk, Brian; Musomekwa, Kudakwashe
The national prevalence of HIV among adults in Zimbabwe was 10.4% in 2023, while the HIV prevalence in Bulawayo Metropolitan Province was 11.7%. The country achieved the UNAIDS Fast Track goals of 95-95-95 ahead of the 2030 target, by reporting an ART coverage of 97.0% and a viral suppression rate of 95.0%. As the number of people on ART continues to grow, it is expected that the number of patients failing current first-line non-nucleoside treatment will increase. However, access to second-line treatment regimens remains very limited in resource-poor settings such as Zimbabwe. It is therefore imperative to review treatment success for persons on second-line treatment. A retrospective cohort analysis was conducted using routinely collected clinical and demographic data from 315 participants who had been on a second-line ART regimen in Bulawayo for at least six months between 2015 and 2020. Statistical analyses were conducted to identify risk factors for viral suppression using SPSS version 28. Viral suppression (68.6%) for adults was far below the target of 95%. After accounting for all other variables, baseline CD4 count (>200 c/µL) [AOR = 1.94 (1.05–3.61)], having no history of non-adherence on first-line ART [AOR = 3.88 (1.91–7.85)], drug switch within 12 months of failure [AOR = 4.13 (1.98–8.60)] and retention in care at 5 years [AOR = 6.35 (2.56–15.76)] predicted viral re-suppression. The second-line (rescue) regimen has not achieved the expected success in reversing initial viral non-suppression (due to late presentation and poor adherence), despite enhanced adherence counselling. Timely switching is effective when done within 12 months and coupled with persistent engagement in care. We recommend improved methods, such as enhanced adherence counselling for behaviour change to improve viral re-suppression rates, especially for those on with a history of poor adherence and virologic non-suppression.
Knowledge and perceptions of uterine fibroids: a descriptive cross-sectional survey among women of childbearing age in Kwa-Zulu Natal, South Africa
(Women's Health and Action Research Centre, 2025) Nxumalo, Celenkosini Thembelenkosini; Dlamini, Amanda; Mpofana, Nomakhosi
Uterine fibroids are the leading cause of hysterectomies among women of childbearing age. This study aimed to elicit the knowledge and perceptions of childbearing women towards uterine fibroids. A quantitative, cross-sectional descriptive design was used and data were collected from a sample of 362 women of reproductive age residing in a selected township in KwaZulu-Natal, South Africa. Ethical approval to conduct the study was obtained from the Durban University of Technology’s Institutional Research Ethics Committee (IREC – Ref No. BIREC 014/21). A pre-tested survey was conducted to collect data for this study. SPSS version 27 was used to analyze data and further employed descriptive statistics. Inferential statistics were also conducted to investigate relationships between important variables and respondents who self-reported being diagnosed with uterine fibroids. Most participants, 73.8% (n=267), had no awareness of uterine fibroids. Participants also demonstrated poor knowledge regarding the aetiology and symptoms of the condition. However, nearly half of the participants, 49.2% (n=178), perceived uterine fibroids to be of spiritual origin, citing evil spirits and witchcraft as the cause. The study findings suggest that women in the selected township lack accurate knowledge about uterine fibroids. Despite the limitations related to the use of a convenience sampling approach for data collection and the subsequently low levels of education observed among certain participants, the study findings provide useful baseline information to inform the development of tailored educational interventions for the condition
Political economy of adolescent mental health and well-being globally
(BioMed Central Ltd, 2026) Biermann, Olivia; Shawar, Yusra Ribhi; Shiffman, Jeremy; Brown, Seika L; Bain, Miranda; Shire, Ismahan; Baird, Sarah; Baird, Sarah; Collins, Pamela Y; Requejo, Jennifer H; Mensa-Kwao, Augustina; Tomlinson, Mark; George, Asha; Kumar, Manasi; Aranda, Zeus; Tamambang, Rita; Omigbodun, Olayinka; Peterson, Stefan Swartling; Claeson, Mariam
Background: The current generation of 1.3 billion adolescents (10–19-year-olds), most of whom live in low- and middle-income countries, face large and growing mental health problems. Collective action that could lead to significant improvement in adolescent mental health and well-being (AMH) remains limited. We analyse the factors shaping the global prioritization of AMH for funding and action and reflect on a way forward. Methods: We triangulate data from interviews with key informants knowledgeable in AMH; focus group discussions with youth representatives who are mental health advocates, some with lived experience of mental ill-health; and document review. We collected the qualitative data from 2021 to 2023, followed by thematic analysis and stakeholder consultations. Results: We identify four themes which shape the global prioritization of AMH. First, prevailing interpersonal and institutional stigma and discrimination directed against adolescents with mental health problems hamper attention to AMH. Second, limited data on the burden of mental health problems and evidence of what works have led to the perception among decision-makers that AMH is an intractable problem. Third, diverse ways of framing AMH are often viewed as a sign of weak alignment rather than as opportunities for coalition-building. Fourth, a wide variety and increasing number of stakeholders are involved in AMH, while the stakeholder landscape remains fragmented, inhibiting coalition-building for AMH. Conclusions: To overcome the barriers that currently impede the prioritization of AMH, we recommend that (1) stakeholders conduct an adolescent-led consultative process to develop an “umbrella framing”, supported by common metrics, (2) advocates use existing global platforms to shape the political priority for AMH, (3) decision-makers, funders and research partners invest in meaningful engagement of adolescents (with lived experience), researchers and implementing partners (4) identify a leadership, governance and accountability structure for a global coalition that could transform AMH and (5) conduct context-specific analyses to inform coalition-building nationally.

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