This paper explored in October 2024 community and healthcare workers’ perspectives on the impacts of climate change and related extreme weather events on reproductive, maternal, and child health outcomes in Kilwa District, Tanzania through 10 focus group discussions with women and 15 key informant interviews with healthcare workers in 10 flood-prone villages in Kilwa District. High temperature, floods, and prolonged dry spells were perceived by community and healthcare workers to have direct and indirect impacts on reproductive, maternal, and child health outcomes, including limited accessibility to health facilities during the flooding season, a surge in climate-sensitive diseases such as malaria and diarrhoea in the aftermath of floods, and increased food insecurity leading to malnutrition. The increased frequency of climate-related disasters has driven changes in fertility intentions, as women have expressed a desire to have smaller families, fearing that climate-related extreme weather events would further strain their financial capacity to support larger families. Participants described that women faced heightened vulnerabilities due to patriarchal gender norms. Travelling long distances searching for water, increased burden of household chores, and climate-induced economic instability were reported to put women and girls at increased risk of experiencing sexual and gender-based violence. In response to these impacts, the community has implemented several adaptation measures such as utilizing maternity waiting homes during the flooding season, provision of psychosocial support for disaster victims, and relocation of vulnerable populations from flood-prone areas. The findings underscore the urgency to ensure the continuity of healthcare service provision during and after climate-related disasters and to take into account the differential vulnerability and impacts of climate change.
Equity in Health
This paper estimated the survival probability and determine predictors of under-five mortality in Siaya County, Kenya, using secondary data from the Siaya Health Demographic Surveillance System from 2015 to 2020 and semi-annual population-based longitudinal surveillance. The cumulative survival probability among children under five was 92% with children of younger age being at increased risk of death. The risk of under-five mortality increased with decreasing maternal education and number of Antenatal Clinic visits. Delivery at home/way to the hospital, maternal age less than 18 years, no latrine and male gender were associated with reduced survival. Under-five mortality in Siaya was 63/1000 live births, higher than the national average of 41.6/1000 live births. Gender, maternal education, number of anti-natal care visits, maternal age, delivery in hospital, and availability of toilets at home were the main predictors of under-five mortality.
This health equity-oriented scoping review examines transition in care interventions for refugee, immigrant, and migrant (RIM) populations, analyzing 42 studies evaluating 38 unique interventions from databases including MEDLINE, Embase, and Scopus for studies published from 2000 onward. The systematic search identified interventions delivered across various healthcare sectors and professionals, with some programs enlisting non-medical personnel to provide health-related education and support, with the most promising programs involving health navigation or providing public health education for RIM populations. Results showed that language, education, and cultural background were the most common equity-relevant characteristics targeted. Three types of continuity of care: informational, management, and relational were found, with interventions addressing challenges including linguistic and cultural barriers, unfamiliarity with healthcare systems, and complex health needs such as untreated chronic conditions or trauma-related mental health issues. The authors conclude that future research should target transitions to digital health technologies, public health, hospital-to-home, and paediatric to adult care gaps to ensure smoother transitions for equity-deserving populations navigating new healthcare systems, while emphasizing the need for culturally appropriate and contextually responsive interventions for diverse subgroups within the broader migrant population.
This systematic review mapped how social, commercial, political, and digital determinants of health have evolved during society's digital transformation. Analyzing 204 studies from 13,804 records (MEDLINE, Embase, Web of Science) published since 2018, supplemented by expert recommendations and recent literature searches, researchers identified 127 related health determinants across four domains: digital (37), social (33), commercial/economic (33), and political (24). Through thematic analysis and a two-round consensus process, 30 determinants (23.6%) were identified as requiring urgent policy attention. The findings provide a comprehensive framework for understanding how digitalization influences health outcomes through policy decisions, individual behaviours, and broader societal factors, offering insights for addressing these complex, interconnected determinants within the modern digital ecosystem. The study highlights the need for targeted policy interventions to address emerging health challenges in an increasingly digitalized society.
This cross-sectional study examined the combined effects of smoking and alcohol consumption on hypertension among 4,372 adults in rural Uganda's Mukono and Buikwe districts. Among participants, 23% had high blood pressure. Results showed smokers had 1.36 times higher risk of hypertension than non-smokers, while moderate drinkers had 1.45 times and heavy drinkers 2.53 times higher risk than non-drinkers. Notably, the combination of smoking and heavy drinking produced an additive effect, with combined users showing 45% higher odds of hypertension than the sum of individual risks. These findings suggest the need for integrated interventions targeting both smoking and heavy drinking to reduce hypertension in rural Uganda.
This paper compared, using network analysis, the network structures of Internet addiction and mental health symptoms among university students in China and Malawi, to provide insights into culturally sensitive prevention and intervention strategies. The prevalence of internet addiction and mental health was significantly higher in China than Malawi. In Malawi, the strongest edges were school work, job performance and a sense of worthlessness. The central nodes were daily work, suffering, fantasizing and loss of interest. In China, the strongest edges were neglected household, neglected partner and difficulties with daily work suffering. The central nodes were trouble thinking, unhappiness, and inability to 'play a useful part'. Bridge symptoms varied between the countries, with functional impairments being more prominent in Malawi and emotional disturbances in China. The study highlights significant differences in the network structures of internet addiction and mental health between China and Malawi. This underscores the importance of culturally sensitive mental health interventions. In Malawi, addressing functional impairments related to academic and work performance is crucial, while in China, interventions should focus on emotional and relational aspects.
This mixed-methods study compared health districts with and without armed conflict exposure in South Kivu, DRC, using the Kruk index framework. Through document review, stakeholder interviews, and Likert scale questionnaires, researchers identified essential resilience components including prior knowledge of strengths/weaknesses and crisis risks, plus community and non-health actor involvement. The conflict-affected district implemented additional mechanisms including armed forces involvement, mobile clinics, warning systems, and displaced persons monitoring. Findings emphasize that health districts need better resourcing during stable periods to build capacity for crisis resilience, enabling improved care quality and disturbance management.
This study analyzed child malnutrition trends and determinants using Kenya Demographic Health Survey data (2014-2022), examining stunting, underweight, and wasting in children under five. Analysis showed increased socioeconomic inequality in malnutrition between 2014-2022, particularly affecting the poorest households. Key risk factors for stunting included child's age, household poverty, and sex, while underweight and wasting were associated with mother's age, child's sex, and socioeconomic status. Residence specifically influenced wasting risk. Socioeconomic status proved the strongest predictor of health inequality, though its effectiveness as a screening tool for stunting was moderate (sensitivity 67.4%, specificity 50.6%). Findings highlight the need for interventions that address both immediate health risks and underlying socioeconomic factors to improve child nutrition outcomes equitably.
When global outbreaks of disease are declared ‘over’, what, when and for whom is an end ‘the end’ and what happens after? How do declarations of ends shape personal experiences of crises, ongoing access to care, health and obligations? Global health is defined by narratives of a clearly discernible and singular end. Official announcements of ‘the end’, however, are often arbitrary and unstable. Furthermore, they can distract from important counter-narratives and undermine social, environmental, political and epistemic justice when those ‘left behind’ are excluded from discussions of whether the end has been achieved, or is achievable, and if so when and how. Today, uncertain trajectories, the ‘slow violence’ of environmental degradation, passive attrition of many diseases, and drug resistances question ideas of a singular extinction event and finality. Drawing on an interdisciplinary approach involving historians, sociologists, epidemiologists, psychologists, bioethicists, literary and legal scholars, philosophers and policymakers, this research has two synergistic empirical and normative aims: 1. to explore lived experiences of time and temporality of endings of crises, to capture counter-narratives and their implications for future practices, responses and policies, and 2. to provide an account of the moral and ethical obligations and responsibilities of global health institutions in the aftermaths of crises to health. From detailed comparative research in three countries, including ethnographic, cognitive time-perception and archival methodologies, the authors foreground the people, places, processes and policies to capture everyday experiences of endings and aftermaths in context.
This community-based case-control study identified determinants of teenage pregnancy in Malawi. It used secondary data from the 2015-16 Malawi Demographic and Health Survey from all 28 districts of Malawi. Data on 3435 participants 20-24 years old were analysed. In multivariable analyses: no teenage marriage; secondary education; higher education; richest category of wealth index, use of contraception, domestic violence by father or mother were found to be significant factors in teenage pregnancy. The authors recommend that the government sustain and expand initiatives that increase protection from teenage pregnancy, reinforce the implementation of amended marriage legislation, introduce policies to improve the socioeconomic status of vulnerable girls and increase contraceptive use among adolescent girls before their first pregnancy.