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To classify Italian home care models based on structural characteristics, process factors and stakeholder perceptions.
This is a secondary analysis of the AIDOMUS-IT multicentre cross-sectional study, conducted in Italy between July 2022 and December 2023.
Data were collected via online surveys completed by 33 Local Health Authority Nursing Directors, home care nurses and patients. Hierarchical cluster analysis was used to classify different organisational models based on structural and process-related factors. Nurses' and patients' perceptions of care were described for each identified cluster.
The analysis identified three distinct organisational home care models: The ‘multidisciplinary model’, in which nurses reported high dissatisfaction due to organisational complexity and excessive workloads. In the ‘nurse-centred model’, characterised by publicly employed nurses, strong leadership, and a supportive work environment, patients reported high levels of satisfaction. The ‘performance-based model’, which operated with a lower nurse-to-patient ratio, reduced service hours, and greater reliance on external professionals. Nurses in this model reported high job satisfaction but also a greater intention to leave, while patient satisfaction was lower.
This study underscores the importance of leadership, resource management, and a supportive work environment in influencing both job satisfaction and patient outcomes in home care settings.
Policymakers could use these findings to refine care models and improve service delivery.
Limited research has examined the organisational structures of home care services, which are important for professionals' organisational well-being, patient safety, and quality of care. This study identified three distinct organisational home care models that could be used to refine care approaches and improve service delivery.
This study respects the EQUATOR guideline for observational studies (STROBE).
This study did not include patient or public involvement in its design, conduct, or reporting.
Most adolescents fail to achieve recommended levels of vigorous-intensity physical activity, despite the established benefits for cardiorespiratory fitness and vascular health. Supervised interventions can be effective, but are resource-intensive and lack scalability. Mobile health (mHealth) technologies may provide a cost-effective and accessible approach to support structured, individualised training for adolescents. The Motivating Adolescent Fitness (MOTAFIT) trial will assess the feasibility and acceptability of an mHealth-supported exercise intervention for adolescents to inform the design of a definitive randomised controlled trial (RCT).
MOTAFIT is a three-arm feasibility RCT targeting 120 adolescents aged 13–16 years from the Okanagan Valley, British Columbia. Participants will be randomised (1:1:1) to: (1) MOTAFIT, (2) active control or (3) control group. The 12-week intervention targets ≥40 min/week of vigorous-intensity exercise (≥80% HRmax), co-designed with an exercise specialist and supported by mHealth technology. Primary outcomes for feasibility, including recruitment, retention, adherence, fidelity and acceptability, will be assessed as part of a process evaluation. Secondary measures (cardiorespiratory fitness, vascular health and blood pressure) will provide preliminary estimates to guide future sample size calculations.
The study has received approval from the University of British Columbia Clinical Research Ethics Board (H22-03183) and the University of Victoria Human Research Ethics Board. Parental consent and adolescent assent will be obtained prior to participation. Findings will be disseminated via peer-reviewed publications, conferences and community engagement.
Explore the care escalation process initiated by parents concerned about their hospitalised child's deterioration and healthcare providers' response to parental concerns.
A qualitative study using Charmaz's constructivist grounded theory.
Participants included healthcare providers, cultural mediators and parents of children hospitalized for ≥ 3 days, who had experienced previous urgent intensive care admission or parental concern during hospitalization, in a tertiary pediatric hospital. Data were collected through focus groups, and analyzed using a grounded theory methodology with NVivo Software.
A total of 13 parents, 7 cultural mediators and 68 healthcare providers participated in 16 focus groups. Two main categories were identified: (1) Parents navigating the uncertainty of the escalation system to get a response; (2) Healthcare providers balancing parents' concerns, their own situation awareness, escalation processes and team relations. We developed a Grounded theory called ‘Parents Supporting Timely Escalation Processes’ (P-STEP). By monitoring their children, parents identify early signs of deterioration and advocate for escalation. Reasons for concern are their child's behaviour, communication failure and admission on an off-service ward. Parents escalate by contacting ward providers, their child's specialist or the most trusted staff and, only selected parents, the Rapid Response Team. Staff escalate parents' concern according to their own situation awareness, parent evaluation and ward escalation practices. Parent's emotions and trust are influenced by the timeliness and type of staff response.
While some parents effectively advocate for their child, others face obstacles due to unclear and lack of formal care escalation systems. Understanding how parents escalate care and healthcare providers respond is essential to identify facilitators, barriers, key stakeholders, and implement a formal system for parent-initiated escalation of care.
Integrating parents into processes of escalation and rapid response systems could optimise early recognition and improve responsiveness in paediatric deterioration.
The study adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines.
Parents and HCPs participated as interview respondents.
To identify the pain assessment scales with the best psychometric properties to be used by nurses in an inpatient setting.
Umbrella review.
A comprehensive search of four databases was conducted for systematic reviews published from July 2013 to November 2024, focusing on psychometric properties of pain scales used in inpatient settings. Inclusion criteria required scales to assess subjective or behavioural pain and be nurse-administered, while reviews without detailed psychometric data were excluded. Screening, quality appraisal (JBI checklist), and data extraction were performed independently by two researchers. Data synthesis combined qualitative and quantitative approaches, with psychometric properties evaluated using the COSMIN checklist. The study was reported in accordance with the Preferred Reporting Items for Overviews of Reviews (PRIOR) statement.
Seventeen articles met the inclusion criteria, identifying 41 scales used across various patient populations, including critical care, paediatric, postoperative, cancer, cerebral palsy, disorders of consciousness, low back and neck pain, stroke and verbal communication disorders. The Paediatric Pain Profile, the Breakthrough Pain Assessment Tool and the Questionnaire on Pain caused by Spasticity demonstrated adequate psychometric properties, although the positive findings for the latter two should be confirmed by at least one additional study. Most of the scales (n = 36) require further studies to validate their use in clinical practice. For two scales, their clinical use remains questionable.
The Paediatric Pain Profile, the Breakthrough Pain Assessment Tool, and the Questionnaire on Pain caused by Spasticity can be recommended for use. Unidimensional scales should complement, rather than replace, multidimensional scales to ensure a comprehensive pain assessment. Standardising documentation with validated scales enhances clinical decision-making, care quality, research usability, and reduces documentation burden.
by Laura Sánchez-Bermejo, Pedro Jesús Milla-Ortega, José Manuel Pérez-Mármol
ObjectiveTo cross-cultural adapt the ADL Observation Scale and evaluate its psychometric properties in a sample of Spanish-speaking patients with stroke.
MethodsA validation study that included cross-cultural adaptation, structural validity assessment, reliability, and diagnostic accuracy analysis. The study followed COSMIN and STARD criteria. Translation and cross-cultural adaptation of the ADL Observation Scale followed a backward translation process. Structural validity was assessed with confirmatory factor analysis, and internal consistency was analyzed using Cronbach’s alpha and McDonald’s omega coefficient. Cut-off points were estimated using ROC analysis, and diagnostic accuracy was evaluated using sensitivity, specificity, and positive and negative predictive values. Internal consistency, cut-off points, and diagnostic accuracy were calculated for two different age groups (≥65 years; > 65 years).
ResultsThe Spanish version of the ADL Observation Scale was obtained after cross-cultural adaptation. The psychometric properties were tested in a sample of 180 patients with stroke. Structural validity showed a four-factor structure of the scale (RMSEA = 0.078; CFI = 0.952; TLI = 0.934). Internal consistency for each factor indicated Omega values between 0.641, 95% CI [0.495, 0.753], and 0.915, 95% CI [0.882, 0.936]. Cut-off points, also calculated for each factor, ranged from ≥1 to ≥4 points. Sensitivity, specificity, and positive and negative predictive values showed high values, indicating the scale’s discriminatory capacity for correctly classifying patients with praxis deficits.
ConclusionThe ADL Observation Scale has a four-factor structure, and it is a reliable instrument for evaluating the levels of praxis function in daily living among Spanish-speaking patients with stroke. The scale also has adequate diagnostic accuracy in detecting patients with praxis deficits.
RESUMEN
Se pretende describir la Enfermería del Hospital de San Hermenegildo (1455-1837), aplicar una visión enfermera actual, a la obra iconográfica de El Tránsito de San Hermenegildo y relacionar Enfermería, iconografía y musicoterapia atendiendo a la obra pictórica del extinguido Hospital de San Hermenegildo. Para realizar este trabajo se ha utilizado el método histórico descriptivo, la recogida de información se ha realizado a través de fuentes primarias y secundarias. Como resultados, resaltar la Enfermería en el Hospital de San Hermenegildo, pieza clave en la atención sanitaria, indicando sus funciones e intervenciones, así como la descripción del cuadro de “El Tránsito de San Hermenegildo”, situado en el extinguido Hospital de San Hermenegildo de Sevilla, así como aplicar una Mirada Enfermera a esta obra pictórica, resumiendo un Plan de Cuidados utilizando la nomenclatura NANDA-NIC-NOC. relacionando dicha iconografía con la Terapia Musical.
La Fundación del Hospital de San Hermenegildo en 1455, conocido popularmente como hospital del Cardenal, supuso un cambio, un avance en la Medicina, en la Enfermería, en los Cuidados, en las formas de curar, siguiendo una metodología diferente e innovadora.
Dar a conocer el extinguido hospital de San Hermenegildo, describir la Enfermería del Hospital de San Hermenegildo (1455-1837), aplicar una visión enfermera actual, a la obra iconográfica de El Tránsito de San Hermenegildo, así como relacionar Enfermería, iconografía y musicoterapia/terapia musical atendiendo a la obra pictórica del extinguido Hospital de San Hermenegildo de Sevilla.
Palabras clave: Enfermería; hospital de San Hermenegildo; Sevilla; iconografía; plan de cuidados de enfermería; musicoterapia; terapia musical; historia de la enfermería.
La enfermería es una disciplina con un futuro prometedor, pero con bases epistemológicas débiles y con una cientificidad por consolidar en gran medida. A pesar de los avances en su teorización, sigue existiendo una dependencia de otras ciencias, especialmente la medicina, fruto del desequilibrio existente entre la teorización y la práctica enfermera. La distorsión del ejercicio práctico de la profesión en detrimento de una consideración epistemológica produce un abismo difícil de saltar. El artículo destaca el dominio casi absoluto de la investigación cuantitativa sobre la cualitativa, lo que limita una visión más integral del cuidado. Se identifican varias paradojas dentro de la enfermería, como la desconexión entre teoría y práctica, el uso poco riguroso de conceptos filosóficos y la falta de autonomía disciplinaria. Se enfatiza la necesidad de una filosofía propia de la enfermería que permita su consolidación como ciencia independiente, superando su papel subordinado dentro del ámbito de la salud.
To assess the impact of a nurse-led remote secondary cardiovascular prevention programme versus usual follow-up in patients who have suffered an acute coronary syndrome in terms of major adverse clinical events (MACE), diet, physical exercise, smoking, emotional state, adherence to medical treatment, cardiometabolic profile and anthropometric parameters within one year of discharge.
Prospective, randomised, open-label, evaluator-blinded, multicentre trial.
Between October 17, 2017, and February 5, 2023, patients were randomly assigned to either a usual follow-up of two cardiology visits over 12 months or the nurse-led remote secondary cardiovascular prevention programme, which also included 5 nursing visits (one face-to-face and four remote).
At 12 months, the nurse-led remote prevention programme group (interventional group) had lower smoking rates, greater adherence to medication, greater adherence to the Mediterranean diet, more physical activity, and better perceived health status compared to the usual follow-up group. The interventional group demonstrated a reduction in major adverse clinical events (20.7%) compared to the usual follow-up group (12.4%). This reduction was observed particularly in Acute Coronary Syndrome recurrence, all-cause hospitalisation, and hospitalisation for cardiovascular causes.
Patients randomised to the nurse-led remote prevention programme showed a significant reduction of the MACE, improved lifestyle, and medication adherence at 12 months compared to the usual follow-up group.
This study illustrates the feasibility and efficacy of a remote secondary cardiovascular prevention programme led by advanced practice nurses in patients who have suffered an Acute Coronary Syndrome.
CONSORT.
None.
The study was prospectively registered at www.clinicaltrials.gov: NCT03234023
To assess the care needs of older adults living in poverty in a high-income country and to analyse their relationship with other outcome variables.
A cross-sectional study.
Data were collected between September 2022 and February 2024 from 384 older adults in southeastern Spain. Descriptive statistics were calculated to assess older adults' care needs. A multiple linear regression analysis was carried out to determine the percentage by which the socio-demographic or outcome variables could explain the number of met care needs among older adults in poverty.
Around 20% of the care needs amongst older adults living in poverty were unmet. The most frequently unmet care need was related to money (53.6%). Almost 30% of participants were at risk of malnutrition, 18% felt lonely, and 80% perceived a low level of social support. Age, history of falls, emergency room visits, functionality, perceived social support, quality of life and nutritional status significantly predicted the number of needs met.
The health conditions of older adults living in poverty are suboptimal and may negatively influence their care needs. Nurses should consider these factors when designing, implementing and evaluating interventions to promote the biopsychosocial health of this population.
Nursing interventions to promote health amongst older adults living in poverty should focus on identifying unmet care needs, particularly those related to financial and social support. Interventions should prioritise improving nutritional status, enhancing social support networks and addressing loneliness.
Living in poverty increases older adults' vulnerability due to unmet financial, nutritional and social support needs. These unmet needs can negatively affect older adults' physical and mental health.
The study has been reported following the STROBE guidelines.
The study's participants only participated in the data collection process.
The substantial case detection gap in the field of child tuberculosis (TB) disease is largely driven by inadequate diagnostic tools and approaches. Chest radiographs (CXRs) remain a key component in the evaluation of children and young adolescents (0–15 years) with presumptive TB, aiding clinicians in making the diagnosis and discriminating children with TB from those with other diseases. Widespread use and optimal interpretation of CXR is hampered by a lack of access to well-trained specialists to interpret images. Artificial intelligence CXR interpretation software, termed computer-aided detection (CAD), is now well developed for adults, yet few products have been evaluated in children. The CXR features of child TB are different from those of adults, and as a result, the performance of these CAD algorithms, largely developed for use in adults, will be suboptimal when used in children. Adapting, or fine-tuning adult CAD algorithms, using CXR images from children with presumptive TB, could allow optimisation of these products for use in children. We, therefore, set out to develop a large image and data repository collected from children evaluated for TB (called Catalysing Artificial Intelligence for Paediatric Tuberculosis Research, CAPTURE) with the purpose of evaluating current CAD products and then working with developers and other partners to optimise CAD algorithms for use in children.
We identified approximately 20 studies, from which potentially up to 11 000 CXRs could be used for the proposed project. CXRs and data were eligible for inclusion in the CAPTURE repository if collected from high-quality child TB diagnostic studies that enrolled children with presumptive TB and if CXRs were obtained as part of the baseline assessment. All lead investigators of these studies are members of the CAPTURE consortium. The images and metadata contributed are centrally collated and the key variable of TB case classification as confirmed, unconfirmed or unlikely TB, using an established consensus case definition, is available. All CXRs included in the CAPTURE repository have a consensus radiological interpretation allocated by a panel of independent expert child TB CXR readers who have classified them as ‘unreadable’, ‘normal’, ‘abnormal typical of TB’ or ‘abnormal not typical of TB’. To determine diagnostic performance of existing CAD products, we will evaluate these against a primary composite clinical reference standard (confirmed TB and unconfirmed TB vs unlikely TB), as well as other secondary microbiological and radiological reference standards. A subset of images will be subsequently allocated to a ‘training set’ and made available to developers, academic groups or other parties to either develop novel paediatric CAD products or fine-tune existing adult ones, which will then be re-evaluated by the CAPTURE team using an image subset (‘validation set’) that is independent of the training set.
The CAPTURE study has been approved by Stellenbosch University Health Research Ethics Committee (N22/09/113), with additional ethics approval or waivers by relevant local authorities obtained by consortium members contributing data if required. The final pooled, harmonised and cleaned dataset, as well as the deidentified, renamed CXR images, is stored on a secure cloud-based server. All analyses of existing CAD products, as well as the paediatric-optimised products, will be published in peer-reviewed publications and shared with other stakeholders like the WHO and donor and procurement organisations to guide policy updates and procurement pathways to ensure widespread uptake.
by Roberto Germano, Owen Alexander Higgins, Emanuela Cristiani, Alessia Galbusera, Carmen Esposito, Dulce Neves, Carmine Pellegrino, Alessandra Sperduti, Giorgio Manzi, Luca Bondioli, Alessia Nava
This study investigates health, dental development, diet, and human-environment interactions in individuals buried in the necropolises of Pontecagnano (Campania, Italy, 7th-6th century BCE), using an integrated approach merging dental histomorphometry and calculus micro-residue analysis. The sample consists of 30 permanent teeth (canines, first and second molars) from 10 individuals. Histomorphometric analysis of dental thin sections allowed the estimation of crown formation times, initial cusp formation, crown completion, and enamel extension rates. The prevalence of Accentuated Lines, marking physiological stress events, was analyzed chronologically across tooth classes. Dental calculus analysis was performed on five individuals, identifying plant micro-remains and fungal spores. Crown formation times varied by tooth class, with canines forming the longest (mean = 1,977 ± 295 days), followed by second molars (mean = 1,176 ± 179 days) and first molars (mean = 1,094 ± 154 days). Initial cusp formation values, estimated through chronological overlap between teeth, allowed for a more accurate reconstruction of crown completion timing. Accentuated Lines prevalence peaked at 12 and 44 months, likely reflecting early childhood dietary transitions and the differential recording of stress events across different crown regions. Calculus analysis identified starch granules from cereals (Triticeae) and legumes (Fabaceae), fungal spores (Saccharomyces), and plant fibers, indicating diverse dietary practices, food processing, and extra-masticatory activities. This interdisciplinary approach reinforces the validity of combining histomorphometric and micro-residue analyses to reconstruct childhood health, adult diet, and lifestyle. Our findings align with previous research while emphasizing population-specific variations. This study enhances understanding of Iron Age biocultural adaptations, offering insights into developmental and dietary behaviors in this ancient Italian community.
by Wendy C. Hernández-Mazariegos, Felipe I. Torres, Manuel Rodríguez, Christian M. Ibáñez, Luis E. Escobar, Federico J. Villatoro
Cockroaches are vectors of pathogens and parasites that pose public health risks, especially in developing countries with poor hygiene and inadequate infrastructure. This study aimed to identify the household factors associated with the occurrence of cockroaches and the helminth parasites they carry in a rural community. Data on household infrastructure, presence of domestic animals, and insect control methods were collected from 70 households in rural Guatemala. Cockroaches were captured using traps and manually. A Generalized Linear Mixed Model revealed that households with concrete roofs had 94% lower abundance of cockroaches than those with metal sheet roofs, while the presence of cats increased cockroach abundance by 2.6 times (p Moniliformis moniliformis, were identified, marking the first report of such parasites in household cockroaches in Guatemala. These results highlight the need for improved housing infrastructure and integrated pest management strategies to mitigate the risks associated with cockroach-borne parasites in vulnerable communities.
To explore the relationship between social determinants of health and adherence to lifestyle recommendations, and how these determinants can help explain contextual and interpersonal factors contributing to adherence among individuals with prediabetes.
Explanatory sequential mixed methods study integrating a cross-sectional quantitative analysis with an ethnomethodological qualitative approach grounded in critical social paradigm.
The quantitative phase used data from the intervention arm (n = 86) of the PREDIPHONE trial, a randomised controlled study evaluating the effectiveness of a nurse-led telephone intervention for lifestyle changes in glycaemic control. Adherence was measured using a composite index, analysed as both a continuous and categorical variable. Correlation analysis examined adherence and age. Chi-square and ANOVA tests were used to analyse differences in participant characteristics across adherence quartiles. The qualitative phase included individual semi-structured interviews and a focus group with participants showing high or low adherence. Thematic content and discourse analysis were employed, ensuring validity through triangulation, reflexivity and discourse saturation.
Employment status was identified as a significant factor, with unemployed or retired participants showing better adherence. Although no statistical differences in adherence were found by social class or gender, lower social class participants reported financial barriers to healthy eating and time constraints limiting physical activity (PA). Women reported facing greater challenges due to caregiving responsibilities, whereas men benefited from household support.
Employment status emerged as a determinant of time availability for self-care, alongside social class and gender in adherence to lifestyle modifications. Women, especially those from lower social classes, experienced heightened barriers to adherence, underscoring the need for tailored, gender-sensitive and equity-focused interventions.
Addressing social determinants is essential for effective lifestyle advice among individuals with prediabetes.
The study highlights the role of social class and gender in adherence.
STROBE and COREQ guidelines.
Through interviews and focus group.
To assess the effectiveness of fresh frozen plasma (FFP) as an adjunctive treatment to anti-snake venom (ASV) for resolving venom-induced consumption coagulopathy (VICC) in patients with hemotoxic snakebites.
Systematic review and meta-analysis, reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
MEDLINE, ScienceDirect, Embase, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Europe PubMed Central, Directory of Open Access Journals, Google Scholar, ClinicalTrials.gov and WHO ICTRP were searched from inception to 30 July 2025 using multiple terms, including ‘fresh frozen plasma’, ‘plasma transfusion’, ‘hemotoxic snakebite’, ‘vasculotoxic snakebite’, ‘coagulopathy in snake bite’ and ‘venom-induced consumption coagulopathy’.
We included randomised controlled trials and observational studies in the English language comparing antivenom alone with antivenom with FFP in patients with hemotoxic snakebite-induced coagulopathy. Studies must have reported coagulopathy resolution as measured by international normalised ratio (INR) normalisation or 20 min whole blood clotting test (WBCT) correction. Non-English publications, case reports, case series, reviews, conference abstracts, preclinical studies and studies lacking full-text availability or without quantitative INR or WBCT outcome data were excluded.
Two independent reviewers extracted data using standardised extraction forms and assessed risk of bias using the Cochrane Risk of Bias 2 tool for randomised controlled trials and the Newcastle–Ottawa scale for observational studies. Data were pooled using random-effects meta-analysis and expressed as ORs with 95% CIs. Statistical heterogeneity was assessed using I² statistics, and the certainty of evidence was evaluated using the Grades of Recommendation, Assessment, Development and Evaluation approach.
Four studies involving 370 patients were included (two randomised controlled trials and two prospective observational studies). The pooled analysis demonstrated that adjunctive FFP significantly increased the likelihood of coagulopathy resolution compared with antivenom alone (OR=7.71, 95% CI 2.20 to 27.04, p=0.001). No evidence of a significant difference in mortality was observed between groups (OR=4.96, 95% CI 0.55 to 44.60, p=0.15). High heterogeneity was noted among the four studies (I² = 67%), but a subgroup analysis of three studies, which used INR as the outcome assessment method, showed lower heterogeneity (I² = 25%). Adverse events were inconsistently reported across studies.
FFP as an adjunct to antivenom significantly improves coagulopathy resolution in patients with hemotoxic snakebite-induced coagulopathy. However, the certainty of evidence is very low because of methodological limitations, small sample sizes and significant heterogeneity. Although FFP shows promise for rapid coagulopathy correction, mortality benefits are not established, and it should not replace timely antivenom administration or comprehensive supportive care.
PROSPERO, CRD42023483336.
by Helena Tinnerholm Ljungberg, Martina Wallberg, Emmanuel Aboagye, Gunnar Bergström, Christina Björklund, Lydia Kwak, Susanna Toivanen, Irene Jensen
The prevalence of telework increased dramatically during the COVID-19 pandemic, and today it is not uncommon to refer to hybrid work as “the new normal” in work life. Leadership plays a pivotal role in hybrid work transitions, underscoring the need for research on post-pandemic managerial practices. This qualitative interview study with 15 professional service managers at a Swedish medical university, working in either central administration or a research department, provides a nuanced understanding of the experiences of implementing hybrid work in a higher education setting. The qualitative content analysis resulted in three main themes and six sub-themes: New ways of organising work (sub-themes: Hybrid work brings new opportunities and needs, and Hybrid work as an ongoing process of change); Changes for employees (sub-themes: Social interaction and sense of community, and Increased work-life balance); and Changes in leadership (sub-themes: Communication with employees and New expectations on managers). The findings of this study provide a more fine-grained understanding of how managers experienced both challenges and opportunities in implementing and managing hybrid working arrangements. Challenges included managing employee expectations and relations, while opportunities included potential improvements in work-life balance. A key conclusion of this study is that managers in hybrid work environments adjust their leadership, especially when communicating and managing relationships within teams and across the organization. Despite the identified challenges and despite managers’ wish to see their employees in person and on site, the interviewed managers are generally optimistic about hybrid work and see it as the future. To address the identified challenges, managers may benefit from networking and exchanging information with other managers in similar situations, as well as support from their organisation.
by Emelia Konadu Danso, Prince Asare, Amanda Yaa Tetteh, Phillip Tetteh, Augustine Asare Boadu, Ivy Naa Koshie Lamptey, Augustina Angelina Sylverken, Kwasi Obiri-Danso, Jane Sandra Afriyie-Mensah, Abraham Adjei, Dorothy Yeboah-Manu
Drug-resistant (DR) tuberculosis (TB) and diabetes mellitus (DM) are intersecting epidemics that complicate management of both diseases and worsen patient outcomes. We conducted a prospective cohort study of 758 GeneXpert-confirmed pulmonary TB patients, of whom 75 had DM. Demographic, clinical, radiographic, and anthropometric data were collected at baseline. Sputum samples were cultured for mycobacterial isolation, and the obtained isolates were characterized for Mycobacterium tuberculosis complex (MTBC) lineage and drug-susceptibility testing using spoligotyping and microplate alamar blue assay. The TB-diabetes (TB-DM) comorbid cohort was older [TB-DM: 53/75 (70.7%) vs. 241/683 (35.3%) aged 41–60 years) (p
by Bwambale Jonani, Emmanuel Charles Kasule, Bwire Roman Herman, Joel Fredrick Arturo, Mwesigwa Calvin Mugambwa, Ssebulime Stephen, John Bosco Mundaka, Richard Kwizera, Gerald Mboowa, Felix Bongomin
IntroductionSickle Cell Anemia (SCA) is a significant genetic disorder in Africa; however, comprehensive data on its prevalence and geographic distribution remain limited. We aimed to estimate the pooled prevalence of SCA (HbSS) in African populations and examine regional, demographic, and temporal variations from 1994–2024.
MethodsWe systematically searched PubMed, Scopus, Google Scholar, and BASE databases for studies reporting SCA prevalence in African populations. Screening and quality assessments were performed using JBI tools. A random-effects meta-analysis with logit transformation was performed, with subgroup analyses by region, age, sex, and study design. Meta-regression explored heterogeneity sources, including geographic region, age category, diagnostic method, study design, and publication year.
ResultsFrom 115 studies with 1,203,839 participants and 17,458 confirmed HbSS cases, the pooled prevalence was 1.43% (95% CI: 1.08%–1.88%), with substantial heterogeneity (I2 = 99.1%) and a prediction interval of 0.21%–8.91%. Central Africa showed the highest prevalence (1.99%), and Southern Africa showed the lowest (0.59%). Children exhibited a higher prevalence (1.65%) than adults (0.45%), while sex differences were non-significant (males 2.71%, females 1.74%; p = 0.694). The prevalence has remained stable over three decades despite a six-fold increase in research output, although wide prediction intervals indicated substantial between-study variability. Electrophoretic techniques predominated (86.4% of cases). Diagnostic method (χ² = 16.73, p = 0.033) and age category (χ² = 33.66, p 2 = 98.6%). Leave-one-out sensitivity analysis showed that no single study significantly impacted the pooled estimates.
ConclusionSCA represents a substantial and geographically variable public health challenge across Africa. These findings highlight the need for region-specific interventions, expanded newborn screening programs, improved diagnostic accessibility with quality assurance for point-of-care technologies, and continued surveillance to address geographic gaps.
by Emmanuel O. Adewuyi, Asa Auta, Olumuyiwa Omonaiye, Mary I. Adewuyi, Victory Olutuase, Kazeem Adefemi, Olumide A. Odeyemi, Yun Zhao, Gizachew A. Tessema, Gavin Pereira
IntroductionNigeria currently has the highest maternal mortality ratio and one of the highest neonatal mortality rates worldwide. Home birth—childbirth outside health facilities, often without skilled attendance or timely access to emergency obstetric care—may contribute to these disproportionate and avoidable adverse maternal and neonatal outcomes. National estimates often mask substantial sub-national disparities. This study examines the prevalence of home birth and associated factors across national, rural, and urban settings in Nigeria.
MethodsWe analysed data from the nationally representative cross-sectional Nigeria Demographic and Health Survey 2018, guided by Andersen’s Behavioural Model. Multivariable logistic regression was used to examine the associations between home birth and various predictor variables at the national level, as well as separately for rural and urban areas in Nigeria.
ResultsNationally, 58.1% (95% CI: 56.5, 59.7) of mothers gave birth at home, with prevalence twice as high in rural areas (72.4%, 95% CI: 70.7, 74.0) compared to urban areas (36.1%, 95% CI: 33.6, 38.7) (p Conclusion
Home birth remains highly prevalent in Nigeria, particularly in rural settings and in the northern and South-South regions, where prevalence is disproportionately high. Reducing home births requires a comprehensive approach that addresses the interplay of factors identified in this study. From a social justice and health determinants perspective, these factors are interconnected and can influence both access to and use of services. In rural areas, policies should enhance women’s decision-making autonomy, reduce distance barriers, and address region-specific challenges (e.g., insecurity in northern regions). In urban areas, it is essential to address financial barriers, support young mothers, and provide culturally and religiously sensitive care. Nationally, efforts should focus on improving education, expanding and strengthening antenatal care, and increasing access to media and the internet. From an equity perspective, interventions must be tailored to specific contexts to reduce unsafe home births and ensure that all mothers, regardless of location, have equitable access to skilled, respectful, and high-quality childbirth care.
by Emmanuel Timmy Donkoh, Iddrisu Wahab Abdul, Abraham Kwadzo Ahiakpa, Isaac Williams, Rita Nyaaba Akologo, Stephen Danyo, Chrysantus Kubio, Kofi Effah, Joseph Emmanuel Amuah
BackgroundCervical cancer, though preventable, remains the second most diagnosed cancer and the primary cause of cancer-related deaths among females in Sub-Saharan Africa. The significance of coordinated screening programmes for reducing the burden of cervical cancer in Africa is not well documented. This systematic review will summarize published reports from key databases, grey literature and programme reports to assess the performance of cervical cancer prevention programmes in Ghana.
MethodsTo be eligible for inclusion, interventions must target Ghanaian women with cervical cancer screening and prevention strategies using methods such as visual inspection with acetic acid (VIA), mobile colposcopy, HPV DNA testing, cytology (Pap smear), and treatment approaches such as cryotherapy, thermal ablation, loop electrosurgical excision procedure (LEEP). A comprehensive electronic search strategy will be used to identify studies published since database inception, and indexed in MEDLINE, EMBASE, CINAHL and Web of Science. The search strategy will include MeSH terms (and synonyms) relevant to cervical cancer, screening/treatment methods, geographic focus and implementing institution. We will include searches for grey literature, recognizing the value of programmatic and governmental reports that might not appear in traditional databases. Search results will be summarized in line with PRISMA guidelines. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach will be used to evaluate and document evidence certainty for all outcomes, internal validity of included reports, inconsistency, indirectness, imprecision, and publication bias. Where sufficient homogeneity exists among included studies in terms of interventions, study designs, populations, and outcome measures, we will perform a meta-analysis to calculate pooled effect estimates and their corresponding 95% confidence intervals.
SignificanceThis systematic review will assess the performance and impact of cervical cancer screening and prevention programmes conducted in Ghana to date and identify what contextual strategies have delivered the most impact as well as highlight what gaps remain in our understanding of how a nationwide screening programme can be properly construed for maximum impact.
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