Despite the benefits of early diagnosis, most cancers in sub-Saharan African (SSA) countries are diagnosed at an advanced stage due to late presentation of symptoms, inadequate referral systems and poor diagnostic capacity. Health communication interventions have been used extensively in high-income countries to increase people’s awareness of cancer symptoms and encourage timely help-seeking. However, in SSA, there is still limited evidence on the effectiveness of these interventions and existing evaluations are mainly focused on communicable diseases rather than cancer.

A randomised, multisite, controlled community trial will evaluate a culturally tailored health infographic toolkit delivered in rural and urban settings in the Western Cape Province in South Africa and Harare and surrounding provinces in Zimbabwe. Participants will be randomised to receive one of three African aWAreness of CANcer and Early Diagnosis (AWACAN-ED) cancer awareness tools, coproduced with local communities, comprising health communication infographics with descriptions of breast, cervical and colorectal cancer symptoms plus messages to encourage consultation with primary care providers if symptoms occur, all presented in English and four local languages. We will recruit 144 participants in each of the three intervention groups (N=432). The primary outcome will be recall of symptoms and the secondary outcomes will be (1) intention to seek help, (2) emotional impact and (3) acceptability of the toolkit. Outcomes will be measured preintervention and at two points postintervention: after 15 min and 1 month.

Ethical approval was obtained in both participating countries, South Africa (148/2025) and Zimbabwe (363/2021). All participants will be required to provide written informed consent prior to participation. Findings will be disseminated through peer-reviewed publications, conference presentations and the AWACAN-ED programme website.

PACTR202505475803308.

Gestational weight gain (GWG) is an important indicator of maternal nutrition to be monitored during pregnancy. However, there is no evidence-based tool that can be used to monitor it across all geographic locations and pre-pregnancy body mass index (BMI) categories. The WHO is undertaking a project to develop GWG charts by pre-pregnancy BMI category, and to identify GWG ranges associated with the lowest risks of adverse maternal and infant outcomes. This protocol describes all the steps that will be used to accomplish the development of these GWG charts.

This project will involve the analysis of individual participant data (researcher-collected or administrative). To identify eligible datasets with GWG data, a literature review will be conducted and a global call for data will be launched by the WHO. Eligible individual datasets obtained from multiple sources will be harmonised into a pooled database. The database will undergo steps of cleaning, data quality assessment and application of individual-level inclusion criteria. Heterogeneity of maternal weight and GWG will be assessed to verify the possibility of combining datasets from multiple sources and regions into a single database. Generalized Additive Models for Location, Scale and Shape will be applied for the construction of the centile curves. Diagnostic measures, internal and external validation procedures will also be performed.

This project will include an analysis of existing study de-identified data. To be included in the pooled database, each included study should have received ethics approvals from relevant committees. Manuscripts will be submitted to open-access journals and a WHO document will be published, including the GWG charts and cut-offs for application in antenatal care.

This study aims to assess travel time, associated costs, challenges and factors influencing healthcare facility choices among persons with cancer in Southern India.

An explanatory sequential mixed methods study.

The study was conducted in the cancer care outpatient department at a tertiary care centre in Puducherry, Southern India.

A total of 192 persons with cancer aged 18 to 65 years, diagnosed with breast, lip and oral cavity, cervical, lung or upper gastrointestinal cancers, and attending the cancer care centre between 2023 and 2024, were enrolled in the study through systematic random sampling. Additionally, 10 in-depth interviews were conducted using purposive sampling.

Of the 192 participants, 89 (46.4%) belonged to a lower socioeconomic group, and 178 (92.7%) reported experiencing financial hardship while undergoing cancer treatment. The median travel time to a tertiary care centre was 4.3 hours (IQR: 2.07–7.3), with a median direct non-medical cost of Indian Rupees (INR) 453 (IQR: 200–987). Median expenditures for travel, food and accommodation were INR 200 (IQR: 123–400), INR 360 (IQR: 150–613) and INR 30 (IQR: 20–60), respectively, per single visit. A significant proportion of participants (n=146, 76%) were unaware of nearby cancer treatment centres and relied on peer recommendations when choosing their place of treatment. Key challenges identified included long-distance travel, financial burden due to high food and transportation costs and limited affordability for accommodation.

The study highlights that prolonged travel time and associated costs pose substantial financial strain on cancer-affected families. Enhancing awareness of available healthcare facilities, implementing patient-friendly travel and accommodation support systems and decentralising cancer care services can improve accessibility and mitigate both travel and financial burdens.

Type 2 diabetes is a growing global health challenge that requires effective prevention strategies. Public health and community-based approaches play an essential role in reaching vulnerable populations and addressing broader determinants of health. This protocol outlines a scoping review aimed at systematically mapping the existing evidence on lifestyle-based diabetes prevention interventions implemented in public health and community contexts.

A systematic literature search will be conducted to identify relevant studies published in English or German from 1 January 2014 onwards. The following databases will be searched: PubMed, Web of Science Core Collection, CINAHL (via EBSCO), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews (via OVID) and ClinicalTrials.gov. Relevant websites and grey literature sources will be searched to identify further eligible studies. (Cluster-)randomised controlled trials, non-randomised controlled trials and clinical trials will be included. These must examine nutrition-based, physical activity-based or lifestyle-based interventions aimed at preventing type 2 diabetes in healthy adults or individuals with pre-diabetes, implemented in public health or community settings. Case reports and studies involving medical therapies or pharmacological interventions will be excluded. The literature search started in May 2025 and is expected to be completed by the end of December 2025.

As this scoping review is based on the secondary analysis of publicly available data, no ethical approval is required. Our dissemination strategy includes publication in peer-reviewed journals, presentations at academic conferences and targeted dissemination to relevant interest holders.

This project has been registered at Open Science Framework (https://osf.io/zafg5/), as PROSPERO does not accept registrations for scoping reviews.

To systematically review data-driven modelling studies that evaluated the effectiveness of interventions implemented during the COVID-19 pandemic and to identify which measures were most frequently reported as effective in controlling disease spread.

Systematic review of modelling studies focused on data-driven, model-informed decision-making for COVID-19 interventions.

A comprehensive literature search was conducted in PubMed, Web of Science and Embase, covering publications from 1 January 2020 to 16 October 2024.

Studies were included if they: (1) used real-world data; (2) had sufficient sample sizes and (3) assessed at least one intervention with measurable outcomes.

Meta-analyses and purely theoretical modelling studies were excluded. Papers were further filtered using a structured screening process to ensure empirical and intervention-based modelling.

Data were extracted from eligible studies and categorised according to modelling approaches, data sources, intervention types and reported effectiveness. Descriptive synthesis was performed to summarise modelling trends and intervention performance. Studies were classified into major intervention categories, including tracing, testing and isolation (TTI); physical and social distancing (PSD); vaccination; lockdowns; mask-wearing; home office or stay-at-home (HOSH) and health infrastructure enhancement (HIE).

Out of 2297 studies identified, 126 met inclusion criteria. Compartmental models were the most frequently used approach, primarily relying on case and death counts to assess intervention impact. The most commonly reported effective interventions were TTI, PSD, vaccination, lockdowns, mask-wearing and HOSH. When considering effectiveness relative to study frequency, the top six interventions were TTI, HOSH, mask-wearing, HIE, PSD and lockdowns. The relatively lower representation of vaccination reflects that most included studies were conducted during the early stages of the pandemic, before widespread vaccine rollout and availability of empirical vaccination data.

This review highlights the critical role of data-driven models in guiding COVID-19 response strategies. Evidence supports the combined effectiveness of non-pharmaceutical interventions, robust testing and tracing systems and health infrastructure strengthening. Real-world impact, however, remains dependent on local healthcare capacity, socioeconomic conditions and cultural contexts. Continued research is essential to refine adaptive modelling approaches and strengthen preparedness for future public health emergencies.

Non-communicable diseases (NCDs) currently contribute to over 50% of the global disease burden. Digital tools bear the potential to mitigate the risk of NCDs by facilitating personalised, preventive healthcare. It is therefore pertinent to examine the specific components that contribute to the success or constrain the impact of digital health interventions (DHIs), with particular attention to the sustainability of their long-term effects. Additionally, it is important to provide an up-to-date perspective on emerging interventions and technologies that have not yet been comprehensively addressed in the literature. This protocol defines the methodology for an umbrella review to synthesise the available high-quality evidence from systematic reviews and meta-analyses regarding effectiveness of DHIs in influencing the primary prevention of NCDs.

Using a rigorous search strategy, the subsequent databases will be searched in December 2025: MEDLINE, Web of Science, CINAHL, Embase, Scopus and Epistemonikos. Following the Joanna Briggs Institute (JBI) methodology, the selected literature will be screened based on predefined inclusion criteria. This includes systematic reviews and meta-analyses published within the last 5 years, without restrictions on country or language, that evaluate the effectiveness of any DHI aimed at the primary prevention of NCDs. Suitable full-text articles will be extracted by four researchers and independently assessed for methodological quality by two researchers using the AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) tool. The results will be presented in a summary table aligned with the review question and subquestions, accompanied by a narrative synthesis that explores the findings and their relevance to the research aims.

Ethical approval is not required as no primary data will be collected. The findings of this umbrella review will be published in a peer-reviewed journal and presented at academic conferences.

CRD420251139744.

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.

To identify stakeholder perceived challenges and facilitators for implementing a clean fuel and clean stove intervention to reduce household air pollution and hypertension in Lagos, Nigeria.

Qualitative study guided by the Exploration and Preparation phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, using focus group discussions and in-depth semi-structured interviews with inductive and deductive thematic analysis.

Peri-urban communities across the five administrative divisions of Lagos State, Nigeria.

128 stakeholders from 32 communities, including community, religious, market and youth leaders, primary healthcare staff, and household decision makers. Approximately half were female.

This was a pre-implementation needs assessment that included demonstrations of the clean stove and fuel.

Thematic domains describing barriers and enablers to adoption and implementation, mapped to EPIS inner, outer, and bridging factors.

Stakeholders reported barriers that included stove stacking, upfront stove cost, concerns about long-term fuel price and availability, equipment durability and maintenance, safety, mistrust of new technology, and uncertainty about stove performance for dishes requiring high heat and long cooking times. Reported facilitators included payment flexibility and subsidies, opportunities to test the stove, perceived benefits of cleaner and faster cooking with less soot, endorsement by community leaders, and interest in local retail and distribution to improve access.

Implementation planning for clean fuel and clean stove programmes should address affordability, reliable fuel supply chains, durability and service, culturally relevant cooking needs, and trust building through community leadership. These findings inform adaptation strategies for scale-up in similar low-resource settings.

NCT05048147.

Pre-exposure prophylaxis (PrEP) use among cisgender female sex workers (FSWs), a population at disproportionately high HIV acquisition risk in Uganda, remains suboptimal. Uptake and continued use are constrained by barriers, such as limited clinical hours, long distances to access facility-based PrEP services, and high mobility among FSWs. Community pharmacies may offer a more accessible PrEP delivery model due to extended operating hours and convenient locations. This study aims to evaluate the accessibility and capacity of pharmacies in Kampala, Uganda, to serve as potential sites for PrEP delivery.

We will conduct a concurrent mixed-methods study combining geospatial mapping, structured surveys, a discrete choice experiment (DCE), and in-depth interviews (IDIs). First, the study will compare the reach and accessibility of PrEP services through community pharmacies versus public healthcare facilities. To highlight PrEP service reach, we will use geospatial analysis to map pharmacies, PrEP clinics, FSW hotspots (i.e., areas where sex is exchanged), and HIV incidence. We will also calculate a PrEP facility needs ratio (number of PrEP facilities/HIV incidence) for each of Kampala’s administrative divisions and estimate travel distance and time to access PrEP services using cost–distance analysis. Perceived accessibility of PrEP services will be assessed through FSW surveys (n=50) and IDIs (n=20–30), guided by Levesque’s framework. Then, we will evaluate pharmacy capacity via surveys (n=274) and IDIs (n=20–30), exploring infrastructure, resources, and staff perspectives, informed by the Consolidated Framework for Implementation Research. Additionally, a DCE will be embedded in the pharmacy survey to elicit staff preferences for delivery approaches and analysed using mixed logit models. Finally, we will integrate quantitative and qualitative findings to provide a broad assessment of whether pharmacies are suitable venues for PrEP delivery to FSWs in Kampala. Enrolment will begin by April 2026 for FSWs and July 2026 for pharmacy staff.

Ethical approval has been obtained from the Infectious Diseases Institute Research Ethics Committee (IDI-REC-2025-175) and the Uganda National Council for Science and Technology (HS6178ES). Written informed consent will be obtained from all participants. We will disseminate study findings through stakeholder meetings, scientific conferences, and peer-reviewed publications.

Early screening for autism spectrum disorder (ASD) can enhance educational and health outcomes for affected children. This narrative systematic review explores school-based screening tools used around the world to identify children with ASD and explore the differences across socio-demographic groups.

Systematic review of electronic databases (EMBASE, MEDLINE, PsycINFO, Cochrane and Scopus) in October 2024 of papers published between 2011 and 2024.

Mainstream school-based settings globally.

Children aged 4–16 years old attending mainstream school.

School-based screening tools for ASD, including all types of informant and format of tools reported in eligible studies.

Primary outcomes included prevalence of screen positives, sensitivity and specificity of the screening tools. Secondary outcomes included participants’ sex, socioeconomic status and ethnicity, and the relation of this to the primary outcomes.

Of 7765 eligible articles, 14 studies were included in this review. We identified eight different school-based ASD screening tools. Study populations ranged from 103 to 16 556 children, with sensitivity and specificity varying by screening tool used, age group, setting and ASD prevalence. The percentage of children screening positive for ASD ranged from 0.7% to 8.5%. Studies were conducted in Europe (n=6), Western Pacific (n=4), the Americas (n=3) and Eastern Mediterranean (n=1) regions. No studies explicitly explored accuracy or validity outcomes based on ethnicity or socioeconomic status. Half of the 14 studies (n=7) reported the sensitivity and specificity of the screening tools; sensitivity ranged from 58% to 94% and specificity from 61% to 100%. There was insufficient evidence to recommend any single ASD screening tool.

ASD screening tools vary widely across the globe, with limited standardisation. Evidence is lacking on how ethnicity and socioeconomic status affect their effectiveness in schools. Given the dearth of scientific evidence in this field, collaboration among educators, researchers and policymakers is needed to establish the evidence base for universal screening, identify optimal tools, coordinate their use and ensure their validation for specific populations.

Human papillomavirus (HPV) vaccines have been introduced in the Chinese market since 2016. However, the HPV vaccine coverage is still remarkably low among adolescent girls in China. This study will employ discrete choice experiments (DCEs) to elicit the preferences of Chinese caregivers for HPV vaccine-related profile characteristics and service delivery methods for adolescent girls.

Two DCEs will be conducted with caregivers of girls aged 9–18 in China. The first DCE will focus on caregivers’ preferences regarding the HPV vaccine-related profile for girls aged 9–18, with potential attributes including level of protection against cervical cancer, level of protection against genital warts, risk of severe side effects, number of dose(s), place of manufacture, waiting time and cost for one dose. The second DCE will assess Chinese caregivers’ preferences for vaccination service delivery methods, with the potential attributes including source of recommendation, information channel, message framing, how to make an appointment, location for receiving the vaccine and incentives. A total of 300 participants will be recruited to complete the DCEs. We will summarise the key socio-demographic characteristics of participants and use latent class and mixed logit models to assess preferences and preference heterogeneity in HPV vaccination services.

Ethical approval was obtained from the Research and Ethics Committee at Nanjing Medical University. Findings from this study will be disseminated widely to relevant stakeholders via scheduled meetings, webinars, presentations at conferences and in peer-reviewed journal manuscripts.

To develop and validate the Internalised Stigma Scale for Gestational Diabetes Mellitus (ISS-GDM), a questionnaire measuring self-reported internalised stigma among women with prior gestational diabetes mellitus (GDM). We hypothesised that internalised GDM stigma could be reliably and validly assessed through a short psychometric instrument.

Cross-sectional validation study.

Follow-up data from the Danish, multicentre Face-it trial for women with prior GDM and their families.

In total, 248 women completed the ISS-GDM approximately 1 year after their GDM affected pregnancy.

The primary outcome was psychometric properties of the ISS-GDM, assessed using Cronbach’s alpha, confirmatory factor analysis (CFA) and Rasch analysis (RA). Secondary outcomes included identification of item anomalies (local response dependence, differential item functioning).

A large proportion of respondents endorsed statements reflecting self-disappointment, self-blame and an altered self-perception. Less endorsed statements included feeling inferior to other mothers or guilt towards family members due to GDM. The ISS-GDM demonstrated satisfactory psychometric properties. CFA indicated that item 2 assessing self-perceived capabilities as a mother did not load onto the main factor, while CFA and RA identified local response dependence and differential item functioning by body mass index. After adjustments, a two-factor solution supported calculating a sum score of items 1 and 3–11, with item 2 retained as a stand-alone indicator of perceived parenting capabilities. The 10-item scale demonstrated acceptable reliability (Cronbach’s alpha=0.78).

The ISS-GDM is a reliable and valid tool for assessing internalised stigma among women with prior GDM. Our findings further suggest that a substantial proportion of women with prior GDM experience self-blame and an altered self-perception due to their diagnosis. The ISS-GDM scale enables research into its prevalence, severity and consequences.

To examine the association between birth intervals and perinatal mortality in Indonesia.

Cross-sectional study using reproductive calendar data from the 2017 Indonesia Demographic and Health Survey.

Nationally representative households in Indonesia.

A total of 17 171 women aged 15–49 with pregnancies in the 5 years preceding the survey. Women with missing data or multiple births were excluded.

Perinatal mortality, defined as stillbirths and early neonatal deaths.

The perinatal mortality rate was 22 per 1000 births. Short birth intervals (

Short and long birth intervals were associated with higher perinatal mortality in Indonesia, with additional associations observed for antenatal care visits, maternal age and newborn sex. These findings underscore the importance of promoting healthy birth spacing within maternal and child health programmes and integrating postpartum family planning into routine care. Further longitudinal research is needed to confirm causal pathways and inform targeted interventions.

In Indonesia, the second most natural disaster-prone country in the world, the tobacco industry exploits such crises via corporate social responsibility. The objective of this study was to map existing evidence on natural disasters and tobacco use in order to understand how tobacco control policies could be optimised in disaster-prone regions.

Scoping review.

ScienceDirect, PubMed and Google Scholar, with searches conducted twice: between January and April 2024 and again in August 2025.

All studies examining natural disasters, smoking behaviours and the tobacco industry.

Studies were assessed primarily on reports of tobacco use change, tobacco control policy enforcement, tobacco industry interference and mention of the role of stress. Data on country, disaster type, type of research study and sample details were also collated.

27 of the 611 identified studies were included in the final analysis. Two-thirds of studies reported an increase in smoking rates following disasters. No studies mentioned tobacco control policy enforcement or tobacco industry interference during disasters. Most of the studies (74%) which examined the relationship between disaster-related stress and smoking found a positive association. About half (51.9%) of the studies described disasters in the Americas.

Smoking rates often rise after stress-inducing disasters. More evidence is urgently required to assist countries like Indonesia in enforcing tobacco control and preventing tobacco industry interference.

This study aims to identify factors associated with early antenatal care (ANC) initiation using a survival analysis approach applied to nationally representative data.

This study used a cross-sectional design based on data from the nationally representative 2022 Bangladesh Demographic and Health Survey. The survey was conducted at the community level across all administrative divisions of Bangladesh. A total of 5128 ever-married women aged 15–49 years who had a live birth within 5 years prior to the survey were included in the analysis. Women with missing or incomplete information regarding the timing of their first ANC visit were excluded from the study.

The primary outcome was early initiation of ANC, defined as the first ANC contact within the first trimester.

The study applied survival analysis methods, including Kaplan-Meier survival curves, log-rank tests and an Accelerated Failure Time model, to assess the determinants of early ANC initiation.

Only 37.9% (95% CI 36.0% to 39.9%) of women in Bangladesh initiated ANC within the first trimester. Early ANC initiation was associated with higher maternal age, education, skilled employment, wealthier households, media exposure, higher decision-making autonomy, higher husband’s education and urban residence. Women who reported that distance to a health facility was not a big problem had initiated ANC earlier than those who considered distance a major barrier. Regional disparities were also evident, with women from Barishal, Chattogram, Rajshahi, Khulna and Rangpur accessing ANC later than those in Dhaka.

Persistent inequalities in early ANC initiation highlight the need for targeted policies to reduce financial barriers, improve healthcare accessibility and strengthen awareness campaigns to ensure equitable maternal healthcare in Bangladesh.

Antimicrobial resistance (AMR) is a critical public health issue in Bangladesh, exacerbated by the widespread practice of non-prescribed antibiotic dispensing. This study seeks to assess their knowledge and attitudes, particularly how these factors influence non-prescribed antibiotic dispensing practices in Bangladesh.

A total of 287 pharmacy staff across four regions of Bangladesh were included in the study. Data were collected using a structured questionnaire assessing knowledge, attitudes and practices regarding non-prescribed antibiotic dispensing.

The study found that 92.4% of respondents dispensed antibiotics without prescriptions. The practice was significantly more prevalent among those with poor knowledge (99.28% in below-average vs 86.09% in above-average knowledge groups, p

These findings highlight knowledge and attitude towards antibiotic dispensing play a vital role where weak regulation, education and economic incentives further worsen the situation. Urgent interventions, including improved pharmacist training, prescription monitoring and public awareness campaigns, are essential to reduce non-prescribed antibiotic dispensing and align practices with Bangladesh’s National Action Plan on AMR.

To determine the prevalence of undiagnosed diabetes and identify associated factors using a two-step diagnostic method combining fasting blood sugar with confirmatory glycated haemoglobin A1c (HbA1c) testing among adults 45 years and above in rural Sidama, Ethiopia.

A community-based cross-sectional design was conducted from 1 April to 31 July 2024. Data were collected through a census of adults aged 45 years and above using a pretested WHO-STEPwise questionnaire. Physical and biochemical tests were performed following standard protocols. Data were analysed using Stata V.17.

Selected rural kebeles of Shebedino district, Sidama, Ethiopia.

2875 adults aged 45 years and above.

Undiagnosed diabetes confirmed by HbA1c levels (≥48 mmol/mol or ≥6.5%).

The prevalence of undiagnosed diabetes confirmed by HbA1c was 1.2% (35 of 2871; 95% CI: 0.9% to 1.7%). Previously diagnosed diabetes was found in 0.5% (14 of 2875; 95% CI: 0.3% to 0.8%). The total diabetes prevalence, confirmed by HbA1c or prior diagnosis, was 1.7% (49 of 2871; 95% CI: 1.3% to 2.3%). A total of 1327 out of 2875 (46%) participants were undernourished. Advanced age (β=0.21; 95% CI: 0.08 to 0.32, p=0.001), and estimated annual income (β=0.15; 95% CI: 0.02 to 0.28; p=0.029) were significantly associated with elevated fasting blood sugar levels.

The prevalence of undiagnosed diabetes among rural adult population was low. Older age and higher income were significantly associated with elevated fasting blood sugar. Routine community-based diabetes screening among older population, health education and nutrition-focused interventions are recommended to sustain the low burden and address undernutrition.

Bangladesh is facing a growing obesity epidemic; however, evidence on sex-specific patterns and socioeconomic determinants is limited.

We aimed to investigate sex differences in obesity prevalence and to assess how socioeconomic and demographic factors influence obesity risk among adult men and women.

We analysed data from the Bangladesh Demographic and Health Survey 2022. Prevalence of obesity (body mass index ≥25.0 kg/m²) among men and women was estimated by sociodemographic characteristics. Two multinomial logistic regression models were fitted: first, to quantify sex-specific odds of obesity with socio-demographic variables as interaction terms for effect modification; and second, adjusted sex-stratified models to assess determinants of obesity separately in men and women.

Overall, 30% of our participants had obesity, with women more affected than men (36% vs 20%; adjusted OR (aOR) 2.75, 95% CI 2.53 to 3.00). Interaction analyses showed attenuation of the female-male difference among those with higher education (interaction aOR 0.57, 95% CI 0.43 to 0.74), richest quintile (interaction aOR 0.63, 95% CI 0.47 to 0.83) and urban residence (interaction aOR 0.81, 95% CI 0.68 to 0.96). Obesity was positively associated with age, education, wealth and urban residence, with stronger effects in men, except for higher education (interaction aOR 0.65, 95% CI 0.47 to 0.89), richest quintile (interaction aOR 0.72, 95% CI 0.54 to 0.98) and urban residence (interaction aOR 0.84, 95% CI 0.70 to 0.98).

Obesity disproportionately affected women, although association with socio-demographic factors was stronger in men. Targeted sex-specific interventions that address socioeconomic and contextual determinants are needed to mitigate obesity burden in Bangladesh.

Self-efficacy is a major factor in enabling individuals to follow behavioural goals. This applies to health behaviours including physical activity and exercise behaviour, a health topic especially important for persons suffering from health conditions. In subjects with already existing conditions, self-efficacy in exercise behaviour is a research field with a high volume of published articles, yet it has never been charted in its entirety. This systematic evidence map (SEM) provides a comprehensive overview of the current state in published empirical research.

Collecting, categorising and visualising the breadth of evidence via SEM following the Methods of Evidence Mapping by Schmucker et al.

Medline (via PubMed) and PsycINFO (via EbscoHost).

We searched for the terms ‘self-efficacy’ and any of the search terms ‘sport’ and ‘exercise’ in titles and abstracts. We included all empirical research studies published until 2022 that measured self-efficacy in relation to exercise. This SEM includes all studies on humans with a pre-existing condition. We extracted the data points authors, title, year, sample size (N), age groups, pre-existing condition(s), surveyed sport and method of measuring self-efficacy.

We extracted the data points from the full text (if available). In addition to a data table, we created a freely accessible evidence map in the form of graphs in this article.

The number of publications grew over time from single publications per year in the 1980s to over 100 per year in the beginning of the 2020s, adding up to 1342 included studies. Most research focuses on middle-aged and older adults. Research covers a wide variety of conditions, with endocrine, nutritional and metabolic diseases (22%) as well as diseases of the circulatory system (19%) being the most common disease groups. Most included studies (71%) do not specify a sport. Most (55%) papers used validated scales to measure self-efficacy, and we discovered 235 individually named scales among them.

This paper offers the first ever comprehensive list of empirical publications on self-efficacy in exercise behaviour in persons with pre-existing conditions in the form of a SEM. The research field was as wide as anticipated concerning total numbers, number of individual scales for measuring self-efficacy, as well as range in diagnosed conditions. Most research focusing on advanced age may be due to many diseases only manifesting later in life, and the lack of specification in types of sport points to the choice of sport being less important than getting enough exercise in general. Future research should examine the strength of evidence and the robustness and comparability of self-efficacy scales as well as underrepresented disease groups for public health considerations.

Since no primary data was collected, an ethics approval is not required for the presented work. In addition to the result being disseminated via the publication at hand, the data is being shared in detail via the Open Science Framework platform.

The term ‘culture of care’ began to be used following the Francis Report in the UK in 2013. This concept involves three dimensions: personal care, leadership care and co-worker care. Personal care focuses on employees’ attitudes and behaviours. Co-worker care relates to a sense of community, and leadership care relates to how employees perceive leaders and managers as caring individuals dedicated to ensuring the well-being of others. Previous studies investigating culture assessment tools used in the healthcare system reported that although organisations are increasingly using culture assessment instruments, there is a focus on assessing safety and quality cultures rather than on caring perspectives. This scoping review aims to map existing studies related to the assessment of culture of care.

This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. The search strategy will include four indexed databases (PubMed, EMBASE, Cochrane Library and Latin American and Caribbean Literature in Health Sciences) and additional sources not retrieved with the adopted search strategy. The search strategy will be constructed using the controlled vocabulary in Health Sciences Descriptors, Medical Subject Headings and Emtree. Relevant articles in all languages, without restrictions related to date of publication, will be considered eligible for inclusion. Two independent researchers will select articles based on the inclusion criteria, and a third author will be consulted to establish consensus, if necessary. Data extraction will involve a form with information on the study characteristics, methodological issues and main results from the evidence sources. The extracted data will be analysed using descriptive and content analysis.

Ethics approval is not required, as this review will use data from publicly available bibliographic sources. The results will be disseminated through publications in scientific journals and presentation of the evidence to interested parties.

The protocol was registered in the Open Science Framework (DOI: 10.17605/OSF.IO/U9Q53).