Background: In humanitarian crises, reliable and accurate information about health, security and humanitarian aid can be a tool for survival. At the same time existing social structures and information systems are often disrupted, leading to uncertainty and challenges in interpreting information including information that may guide individual public health decisions, particularly as part of vaccination programmes. This study aims to systematically explore the existing literature on these dynamics. Methods: A scoping review [(1)](#ref-0001) was conducted using the key themes: misinformation, infodemic, vaccine confidence and trust with relevant synonyms and subheadings included to build the search strategy. Initial searching was conducted through Medline (Ovid), Embase (Ovid), Global Health (Ovid), PsycInfo (Ovid), Web of Science and SCOPUS, and through handsearching reference lists. Articles were screened and data extracted using Covidence software [(2)](#ref-0002). A content analysis was used to elucidate common and overlapping themes [(3)](#ref-0003). Findings: In total, 41 studies from 14 specific country contexts as well as four from regional and global analyses met the inclusion criteria. The themes identified were (1) the drivers of mistrust (2) the complexity of misinformation and vaccine confidence and (3) equity and programming with communities. Conclusion: The scoping review concluded that trust is essential for vaccine confidence in crisis contexts. However, trust is a complex process shaped by various factors including historical injustices, political dynamics, power dynamics and information. The synthesized evidence demonstrates the importance of community-driven interventions, equitable vaccine distribution and culturally sensitive communications strategies. A consistent finding was that critical knowledge gaps remain about the interplay of trust, information and vaccine confidence in crisis settings to support humanitarian response.

Background: Adequate knowledge, attitude, and safe practice of infection prevention among healthcare providers are vital to prevent nosocomial infections. This study examined the level of knowledge, attitude, and practice of healthcare providers on infection prevention and its associated factors among health professionals working in Public Hospitals of Rwanda. Methods: Institution based cross-sectional study was conducted among 715 healthcare providers who were selected by convenient technique. Data were collected using interviewer-administered questionnaire. Multivariate logistic regression was performed to identify factors associated with practice of infection prevention and variables with a p-value < 0.05 were considered statistically significant. Results: More than half 70.8, 69, and 56.9 of healthcare providers had satisfactory knowledge positive attitude and satisfactory practice of infection prevention, respectively. Referral hospitals (AOR= 2.1, CI at 95% [= 1.5 – 2.9], p-value = 0.01] , Region (AOR = 1.4, CI at 95% [1.2 – 2.0], p – value = 0.04);(AOR = 1.54, CI at 95 % [1.01 -2.70], p – value < 0.01) , Education (AOR = 0.44, CI at 95%, [0.38 – 1.08], p-value 0.04) ; (AOR = 0.63, CI at 95% [0.37 – 0.87], p – value < 0.01) , attending a course (AOR = 1.54, CI at 95 % [1.02 – 1.68], p – value < 0.01), receiving HBV (AOR = 1.03, CI at 95% [0.49 – 1.12], p-value = 0.02) , working experience ≥ 10 years , and Positive overall attitude (AOR = 2.07, CI at 95% [1.01 – 3.42], p-value = 0.01) were positively associated with satisfactory practice of infection prevention. Conclusion: A considerable proportion of healthcare providers had satisfactory knowledge, attitude, and satisfactory practice of infection prevention. There is a need to improve training in health facilities.

Africa faces a growing mental health crisis, characterized by limited resources, pervasive stigma, and restricted access to mental health services. Cultural beliefs often hinder individuals from seeking help, exacerbating the situation. Mental Health First Aid (MHFA) programmes present a culturally sensitive approach to addressing these issues, highlighting the urgent need for action. Integrating MHFA into existing mental health frameworks across African communities has shown promise in enhancing public understanding and the ability to provide timely support to those experiencing mental health challenges. This integration improves access to mental health services, reduces stigma, fosters inclusivity in healthcare, and encourages greater tolerance and compassion for individuals facing mental health issues. To achieve these outcomes, advocacy efforts must focus on widespread MHFA training within communities, government partnerships to fund primary healthcare systems incorporating MHFA, and media campaigns aimed at de-stigmatizing mental health conditions. By embedding MHFA into mental health strategies, Africa can address its mental health crisis more effectively, creating a more inclusive, community-driven, and sustainable framework for improved mental health outcomes.

Objective: In response to the urgent need for COVID-19 vaccination clinics for vulnerable populations in Kentucky (12.2% live in poverty; 5.6% lack healthcare coverage), nurse leaders received training through a standardized training program to prevent COVID-19 vaccine administration errors (VAE). This project aimed to evaluate the process effectiveness of the training program as perceived by the trainees (Team Leaders) and to assess the number and types of vaccination errors that occurred during mobile vaccination clinics during the mobile clinics in Kentucky. Design: A program evaluation. Sample: A total of 12 Nurse Team Leaders underwent the standardized training program. Measurement: The Logic-Model-based, 7-item, 4-point Likert scale (α=. 84) was used to evaluate training effectiveness. VAE rates were calculated. Intervention: The Kentucky Nurses Association (KNA) developed a standardized COVID-19 vaccination training program for Team Leaders to prevent VAE during the mobile clinics. Components of the training program (program development, training protocols, and error monitoring) were based on the CDC’s (2022) recommendation that all healthcare providers need to know how to store, handle, prepare, and administer each COVID-19 vaccine product. Results: Team Leaders strongly agreed on the effectiveness of the training (e.g., the importance of training, staying updated, and feeling prepared). VAE was 0.001% (9/8086 administrations over 16 months). Conclusion: Findings suggest that the training program successfully prevented vaccination errors, and that Nurse Team Leaders collectively perceived the training program as effective. Widespread adoption of similar programs is recommended to prevent VAE during public health emergencies, including future pandemics.

The Urgent Need to Address Neonatal Mortality in NigeriaKehinde Precious Fadelea Igwe Stephen Chukwuemekab Deborah Shomuyiwac Don Eliseo Lucero-Prisno IIId,e,fAffiliationsa. Department of Medicine and Surgery, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu. 0000-0002-0464-4167b. Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria. 0000-0001-6443-261Xc. Faculty of Pharmacy, University of Lagos, Nigeria 0000-0001-6665-9439d. Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.0000-0002-2179-6365e. Office for Research, Innovation and Extension Services, Southern Leyte State University, Sogod, Southern Leyte, Philippinesf. Research and Innovation Office, Biliran Province State University, Naval, Biliran Province, Philippines

Introduction: Timely commencement of antenatal care (ANC) improves maternal outcomes by reducing complications that often result in death. According to the World Health Organization, 800 women died daily in 2020 from preventable complications related to pregnancy and childbirth, with 95% occurring in developing countries. Despite efforts by the Rwandan government to promote maternal health, delayed ANC visits remain prevalent in rural areas. This study aimed to determine the prevalence and predictors of delayed first ANC visits in rural Rwanda . Methods: This cross-sectional study used Rwanda Demographic and Health Survey (RDHS) data, enrolling 4039 women who had been pregnant within five years before the survey. Logistic regression modeling identified socio-demographic and maternal characteristics associated with delayed first ANC visits . Results: The prevalence of delayed first ANC visits was 40.2%. After adjustment in a multivariate regression model, factors associated with delay included low wealth index, marital status, maternal age (25-34 and 35-49), having 2-4 or more than 4 children, and occupation. Health insurance coverage was a protective factor against delays . Conclusion: The findings highlight the need for interventions at multiple levels to increase timely uptake of first antenatal care visit, as the study revealed that socio-demographic and maternal factors significantly influence delays in initiating ANC .

Institutional delivery, defined as giving birth in a health facility with skilled delivery assistants, is essential for reducing maternal mortality in low- and middle-income countries. This study aimed to assess wealth-related disparities in the use of institutional delivery services in Bangladesh using data from the Multiple Indicator Cluster Survey (MICS) 2019. Multiple logistic regression was used to identify factors associated with institutional delivery, and a concentration index (CIX) measured wealth-related disparities. Decomposition analysis helped identify key contributors to these disparities. Results showed that 52% of deliveries were institutional. Women from rich and middle-income households had a 94% (AOR=1.94; 95% CI: 1.62-2.34) and 32% (AOR=1.32; 95% CI: 1.12-1.56) higher likelihood, respectively, of delivering in a health institution compared to poor women. The CIX value of 0.170 indicated institutional delivery was more common among wealthier women. Decomposition analysis revealed that prenatal care visits (33.11%), parity (11.79%), and wealth index (11.07%) were significant contributors to wealth-related disparities. In conclusion, this study highlights the urgent need for pro-poor strategies, particularly in rural and underserved areas like Mymensingh, to reduce socio-economic disparities in access to institutional delivery services, with a focus on improving education and healthcare access for women.

The Coronavirus disease (COVID-19) pandemic has led to unprecedented restrictions on movement potentially affecting daily physical activity levels, raising concerns about possible negative health outcomes associated with physical inactivity. This study aimed to assess physical activity levels among adults in Kuwait during the COVID-19 pandemic. 679 adults residing in Kuwait completed the International Physical Activity Questionnaire short form (IPAQ) online between June and July of 2020. Participants were recruited via social media. Results indicated that within the sample, 28.9% were classified as highly active, 35.8% as moderately active, and 35.3% as having low physical activity levels. No significant differences in physical activity levels were observed between genders (P=0.460); however, physical activity levels were significantly associated with age (P=0.022), physical activity levels were reduced with increasing age. These findings suggest the necessity of promotion of physical activity during pandemics, particularly for adults over the age of 45.

Interaction between humans, livestock, and wildlife plays an important role in zoonotic disease transmission. The emergence of Leptospira in humans, rodents, and cattle remains relatively understudied. A cross-sectional study was conducted between February and May 2023 in Muheza to determine evidence of Leptospira infection and associated risk factors in rodents, cattle, and humans. A total of 479 serum samples from rodents (n=201), humans (n=198), and cattle (n=80) were examined by using the Microscopic Agglutination Test (MAT) to detect antibodies against six live Leptospira stock culture serovars, including Pomona, Hebdomadis, Canicola, Grippotyphosa, Sokoine, and Lora. Additionally, a questionnaire survey was conducted on 140 respondents to establish potential risk factors for transmission of Leptospira. The overall Leptospira seroprevalence in rodents, cattle and humans was 6.0% (12/201; 95% CI: 3.12%-10.20 %), 12.5% (10/80; 95% CI: 6.16%-21.79%) and 13.13% (26/198; 95% CI: 8.76%-18.65%), respectively and the most predominant serovars were Grippotyphosa, Sokoine, and Hebdomadis. A significant difference in the seroprevalence was observed in the occupation category, with farmers likelier to be infected with leptospirosis than those in other categories (χ 2= 9.19, df = 3, p = 0.027). This study showed co-agglutination between rodents, cattle, and humans with serovars Hebdomadis, Sokoine, and Grippotyphosa. People aged 36-59 had the highest seropositivity, suggesting they are the most at-risk group. Our study shed light on pathogenic serovars circulating among humans, rodents, and cattle and their associated risk factors. It also highlights the importance of employing a One Heath approach in controlling zoonotic disease.

Objectives: Global oral health is a crucial topic since this (largely preventable) burden affects 3.5 million people worldwide, disproportionately impacting disadvantaged groups and exacerbating in low and middle-income countries like Cabo Verde. This exploratory study aimed to understand the oral health landscape for children in Cabo Verde. With this knowledge, we hope to provide guidance for oral health promotion and disease prevention in similar resource-constrained settings. Methods: Purposive sampling identified 38 stakeholders, including 20 schoolchildren and 8 parents. Data were collected through semi-structured interviews and focus groups. All interviews were transcribed and analyzed using an inductive thematic approach. Results: Four main themes emerged from the data: oral health knowledge, oral health practices, dietary habits, and dental service accessibility. As main challenges were identified: time constraints hindering comprehensive oral health education in schools, parental struggles in managing children’s habits and the pervasive availability of sugar-rich foods driven by affordability and influence, limiting access to healthier alternatives. Public dental facilities face severe issues; professional oral health accessibility is currently a significant challenge. Discussion: The study reveals complex oral health challenges for Cabo Verdean children, highlighting systemic obstacles. Despite government claims of free dental care, service absence and high costs impede prevention. The financial barrier aligns with global trends, but Cabo Verde’s unique factors complicate this. Tourism’s impact on oral health, particularly sweets provision, is underexplored. These results emphasize the necessity of addressing oral health services in Cabo Verde, where schools and parents show initiative, but broad population-level improvement necessitates accessible dental care and dietary changes.

Background: Despite well-documented relationships between climate and malaria transmission, there is a lack of information on how precipitation and temperature as climatic factors specifically impact malaria burden among different age groups in high-transmission areas in western Kenya. Current models often overlook the time-lagged effects of climate variables, such as precipitation and temperature, on age-group specific malaria burden. Methods: This study utilized monthly malaria positivity data from three health centers, along with climate data from western Kenya by applying Negative Binomial mixed effects models with both current and lagged climate variables. Interaction plots, analysis of deviance, and goodness-of-fit tests were used to assess the significance of some relationships or choose a model with a better fit. Results: The study revealed that lagged precipitation (Lag2) and temperature were significant predictors of malaria positivity, with older age groups showing higher susceptibility. Site-to-site and year-to-year variations were also identified as important sources of variation to be considered. Conclusions: The study highlights the importance of considering both age-specific vulnerability and climatic influences in malaria control strategies, suggesting the need for targeted interventions for malaria risk in age-specific groups following the period of precipitation.

Nigeria has seen outbreaks of multiple infectious diseases, a major public health concern, in the past ten years, including the Ebola virus in 2014, monkeypox in 2017, COVID-19 in 2020, Lassa fever in 2022, measles in 2023, diphtheria in 2023, and the current cholera outbreak in 2024. This emphasizes the importance of implementing a robust infectious disease surveillance system for illness response, prevention, and control. This review examines the current status of infectious disease surveillance system in Nigeria and its usefulness in preparing for future outbreaks. A network of laboratories, community health workers, health facilities, and epidemiology units was established during the COVID-19 epidemic by the Nigeria Centre for Disease Control (NCDC), which is essential to disease surveillance. One of the surveillance system’s tiers, state epidemiology units, was in charge of overseeing the gathering and reporting of regional data. Community health workers also carried out contact tracing and public health education as a grassroots method of disease surveillance. The NCDC adopted the Surveillance Outbreak Response Management and Analysis Systems as a primary digital surveillance platform for implementing the Integrated Disease Surveillance and Response system, which is specifically tailored for the surveillance of priority diseases of public health importance in Nigeria. This was done to effectively improve the surveillance capacity and data management. It is critical to enhance the current surveillance system’s ability to monitor, anticipate, and quickly respond to disease outbreaks. The COVID-19 outbreak highlighted the need for surveillance system improvement, particularly gaps that need to be closed to monitor future outbreaks or resurgences. In order to fortify the surveillance system for infectious diseases, it is imperative to continue utilizing the knowledge gained from prior outbreaks, enhance data collection, enhance national and sub-national surveillance systems, and enhance laboratory surveillance systems with precise data gathering and dissemination.

Background: Hypertension is the leading cause of preventable deaths globally, yet reports on its burden and risk factors in rural Sub-Saharan Africa have been inconsistent. This study aimed to assess the prevalence, awareness, and factors associated with hypertension among adults in a rural community in southwestern Uganda. Methods: A baseline survey was conducted in Ngango, Mbarara district, involving adults aged 18-79 from eleven villages. Research assistants and community health workers enrolled consenting participants from their homes using the WHO STEPS questionnaire, gathering demographic, behavioral characteristics (e.g., tobacco and alcohol use), and lifestyle factors including dietary habits and physical activity. Blood pressure (BP) readings were taken three times. Hypertension was defined as BP ≥140/90 mmHg or self-reported use of antihypertensive medication. We used logistic regression to identify factors associated with hypertension. Results: A total of 953 adults were enrolled, with a median (IQR) age of 43 (30-57) years, 61.5% female and only 43.5% recalled ever having a BP measure. The prevalence of hypertension was found to be 27.3% with 61.5% unaware of their condition. Only 27.7% receiving treatment and 65.3% had controlled BP. Despite 66.8% reporting good physical activity, 63.7% were overweight. Key factors associated with hypertension included being over 40 years old (OR 2.26), consuming fewer than three servings of fruits or vegetables weekly (OR 1.62), and being overweight or obese (OR 1.57 and OR 2.73, respectively). Conclusion: The prevalence of hypertension in rural southwestern Uganda is high, highlighting the need for targeted interventions, particularly in a relatively young and physically active population

A document by Asad Allana. Click on the document to view its contents.

Objective: Insufficient physical activity (PA) is a well-known risk factor for many non-communicable diseases. This study aimed to develop a screening tool to identify physically inactive people at the population level and to help social and health care professionals promote physical activity among people at risk. Methods: Eighty-five healthy adults wore a hip-worn accelerometer for seven days, after which they completed several PA questionnaires. These included some novel and several validated questions on PA. The reliability of individual questions to identify physically inactive people was assessed by correlation analysis. Logistic regression analysis was used to find the combination of questions which best identified physically inactive people. Results: The highest correlation of the screening questionnaire with the accelerometer was 0.46 (p < 0.001) for sedentary behavior and 0.42 (p < 0.001) for total physical activity, respectively. The best pair of questions on total physical activity identified 64% of all inactive subjects (MVPA < 150 min/week) based on accelerometer data. Conclusions: The questionnaires developed for screening PA have a poor correlation with the accelerometer data. The screening questionnaires roughly describe PA level among middle-aged participants, but if a more sensitive or specific method is needed, device-based measurements are recommended.

Introduction: Cervical cancer is the leading cause of cancer deaths among women in Russia. This high early-age mortality emphasizes the need to strengthen the human papillomavirus (HPV) vaccination program among adolescent girls and include it in Russia’s national immunization schedule. Methods: Using data from the Moscow Department of Health, we analyzed the economic burden of cervical cancer, estimated girls’ 2022 vaccination coverage, explored challenges and approaches to improve coverage, and compared the cost-effectiveness of strategies to improve coverage scenarios and reduce HPV vaccine costs. Conversations with healthcare workers at healthcare facilities validated coverage estimates from procurement data based on previous trends and 2020 demographic data. Results: In 2022, we estimated that 24% of girls aged 12-13 years were vaccinated. The total cost for a two-dose vaccination per girl was USD 226.86. HPV vaccination gains 215 quality-adjusted life years (QALYs) per 100,000 females. The discounted cost of treating cervical cancer per patient over 29 years is USD 4,889. Comparing the costs of the HPV program and cervical cancer treatment per 100,000 females, the program proves to be cost-effective and cost-saving even with costs over USD 200 per fully vaccinated girl. This study provides evidence for expanding the HPV vaccination program to other regions of Russia. The study seeks to reduce cervical cancer morbidity and mortality and achieve 50% coverage by 2030. We recommend shifting to a one-dose HPV vaccination strategy and including HPV in the national immunization schedule.

Type 2 diabetes (T2D) is an escalating public health issue in Nigeria, driven by rapid urbanization, lifestyle changes, and inadequate healthcare infrastructure. The disease affects 5.8% of the adult population, with millions requiring ongoing care. However, significant barriers prevent many from accessing the clinical care they need. These challenges include geographical disparities, with rural areas lacking essential healthcare services, and economic constraints, as many Nigerians cannot afford the high out-of-pocket costs associated with diabetes management. Cultural factors, such as reliance on traditional medicine and low health literacy, further complicate the effective management of T2D. The healthcare system is also hampered by a shortage of trained professionals and inadequate facilities, particularly in rural areas where most of the population resides. This review identifies these critical barriers and offers targeted solutions, including strengthening primary healthcare systems through investment in infrastructure and training, expanding health insurance coverage to reduce the economic burden, and enhancing public health education to improve health literacy and promote early diagnosis. Addressing these multifaceted challenges is crucial for improving access to care, reducing complications, and managing the growing burden of T2D in Nigeria. The findings of this study aim to inform policy and guide future research to develop effective diabetes management strategies in the region.

Service-learning is one way to engage students in health professions and promote health literacy in the community. This paper describes developing and delivering a service-learning course designed to improve diabetes literacy and diabetes outcomes among a medically underserved population. The didactic component of the course introduced topics such as health literacy, health education techniques, and diabetes pathophysiology, prevention, and treatment. Later, students designed and delivered community diabetes education classes at a local free clinic. After the classes were offered, diabetes knowledge and self-efficacy scores improved for community members and students leading the classes. A subset of community members also had lower body mass index at a 6-month follow-up. Though COVID-19 interfered with student's ability to offer in-person education sessions in the last semester this course was offered, it provided an opportunity to examine differences in diabetes knowledge and self-efficacy scores between students who offered in-person courses versus those who were unable to go out to the community and developed an online class instead. Self-efficacy was significantly higher at the end of the semester compared to at the end of the didactic component of the class for only those students who delivered in-person community education and not for those who developed the online class, providing further evidence of the benefit of engaging with community members on student outcomes. Community members and students alike were delighted with the program. Student-led community classes can be a financially sustainable solution to improving health literacy that benefits community members and students alike.