Sickle cell disease places a significant burden on health systems in sub-Saharan Africa, including Ghana, where access to high-quality, patient-centred care remains limited. This study evaluated patient-perceived quality of sickle cell disease care at a tertiary-level facility in Ghana and explored process factors influencing perceived quality of care.

Cross-sectional, questionnaire-based study.

A tertiary-level healthcare facility in Accra, Ghana.

A total of 424 individuals with sickle cell disease were recruited using convenience sampling. Data were collected between 4 September and 16 October 2023 using pretested, interviewer-administered questionnaires. First-time clinic attendees and those requiring urgent medical intervention were excluded.

Primary outcome was patient-perceived quality of care. Secondary outcome measures included socio-demographic and process-related factors influencing patient-perceived care quality.

Participants’ ages ranged from 15 to 66 years, with a median (IQR) age of 32 (27–42) years. Most were female (67.4%), had the SS genotype (51.9%) and 68.6% were on hydroxyurea. Overall, 81.8% of respondents reported receiving good-quality care. Predictors of higher perceived care quality included age (adjusted OR (AOR)=8.9, (95% CI 3.3 to 24.3), p=0.001), hydroxyurea use (AOR=2.3, (95% CI 1.2 to 4.2), p=0.008), good health worker-patient communication (AOR=3.2, (95% CI 1.7 to 6.0), p=0.001), positive provider attitudes (AOR=3.1, (95% CI 1.7 to 5.7), p=0.001), receipt of health education (AOR=2.1, (95% CI 1.1 to 3.9), p=0.030) and shorter waiting times for emergency care (AOR=0.2, (95% CI 0.1 to 0.6), p=0.001).

This study provides context-specific evidence on process-level determinants of quality of sickle cell disease care in Ghana. Interventions to improve provider communication, enhance provider attitudes, strengthen patient education and reduce waiting times may improve patient experience and contribute to progress towards Universal Health Coverage in resource-limited settings.

To assess HIV knowledge, stigma and perceived adequacy of HIV curricular coverage among medical students in Egypt and to identify factors associated with HIV stigma.

An online-based cross-sectional study.

Medical schools across Egypt. Data were collected in August 2025 using a bilingual (Arabic/English) online questionnaire using convenience sampling.

First- through fifth-year students enrolled in Egyptian medical schools.

HIV knowledge was assessed using the Brief HIV Knowledge Questionnaire (HIV-KQ-18); HIV-related stigma was assessed using the Healthcare Providers HIV/AIDS Stigma Scale (HPASS) and perceived adequacy of HIV curricular coverage.

A total of 1503 students participated (mean age 20.6 years; 57.4% female), half of whom (48.9%) rated curricular coverage of stigma and psychosocial aspects of HIV as inadequate. The mean HIV-KQ-18 score was 8.96/18 (SD 4.26). Only 39.9% recognised that HIV cannot be transmitted through kissing, 47% believed washing after sex is protective and just 41.3% knew that not all infants born to mothers with HIV will have AIDS. The mean HPASS score was 60.1/108 (SD 17.6). Most students (76.8%) worried about contracting HIV from patients, 52% believed patients acquired HIV through risky behaviours and 43.6% endorsed a right to refuse providing care. Knowledge and stigma were inversely but weakly correlated (r = –0.17, p<0.001), and higher knowledge was independently associated with lower stigma on multivariable regression (B=–0.16, p<0.001). Despite higher knowledge, males reported significantly higher stigma (B=0.25, p<0.001) compared with their female counterparts. Similarly, participants who completed the Arabic form had significantly lower knowledge and higher stigma (B=0.24, p<0.001).

HIV stigma is prevalent among medical students in Egypt, with significant variations observed across gender, survey language and levels of HIV knowledge. These findings call for multifaceted interventions and curriculum reform to reduce stigma among future clinicians.

Pakistan is one of the countries most affected by climate change, where peak temperatures in certain areas frequently exceed 40°C. Despite evidence that vernacular designs and behavioural adjustments can reduce indoor temperatures, heat-adaptation efforts remain concentrated in urban or high-resource settings, with limited evidence for vulnerable rural populations in low- and middle-income countries, including Pakistan.

This trial aims to evaluate the effectiveness of a comprehensive Resilience and Heat Adaptation Bundle (ReHAB) that integrates behavioural and structural interventions to reduce heat-related morbidity and mortality and improve internal ambient conditions in rural settings of Pakistan. This study is a prospective, cluster-randomised trial, comprising 22 clusters allocated to intervention and control arms in a 1:1 ratio. The ReHAB intervention combines community education and awareness with targeted structural improvements, including roof and wall treatments, enhanced shading, improved ventilation, sustainable energy installations and communal outdoor shelters. Health and behavioural data will be collected through household surveys, while wearable devices and environmental sensors will measure individual heat exposure and record indoor and outdoor thermal conditions.

The study has received ethical approval from the Aga Khan University (AKU) (ref: 2025–11559-35625) and National Bioethics Committee (ref: 4-87/NBCR-1065/23/1736). Written informed consent will be obtained from all participants before enrolment. Referral pathways to healthcare facilities will be established to ensure timely management of complications. Findings will be disseminated through peer-reviewed publications, scientific conferences and engagement with policymakers and public health stakeholders. Results will also be shared with participants and communities through meetings and informal sessions to raise awareness and support evidence-based heat adaptation.

NCT06983483.

To describe the proportion, demographic profile, mechanisms, temporal distribution, injury patterns and in-hospital outcomes of adults with major work-related trauma admitted to hospitals in Abu Dhabi.

Retrospective cohort study using prospectively collected trauma registry data.

Seven trauma-receiving hospitals in the Emirate of Abu Dhabi, United Arab Emirates, from 2014 to 2023.

Adults aged 18 years or older with injuries coded as work-related in the Abu Dhabi Trauma Registry and an Injury Severity Score (ISS) of 12 or greater.

Proportion of adult trauma admissions with ISS≥12 that were work-related; mechanisms of injury; anatomical injury pattern; intensive care unit (ICU) use; hospital and ICU length of stay; discharge disposition; and in-hospital mortality.

Among 7019 adults with ISS≥12, 1318 (18.8%) had work-related injuries. Patients were predominantly young, with a median age of 33 years (IQR 27–42), male (98.6%) and non-local (98.8%). Falls from more than 1 meter were the leading mechanism (52.7%), followed by struck-by-object injuries (17.9%) and road traffic collisions (8.8%). Head and neck (53.1%), extremity (49.4%) and chest (48.3%) injuries were common, with a median of 2 injured body regions (IQR 2–3). Median ISS was 22 (IQR 17–29). ICU admission was required in 43.0%; median ICU length of stay was 5 days (IQR 3–12), median hospital length of stay was 8 days (IQR 3–16) and in-hospital mortality was 8.9%. Burns had the highest mortality (31.0%). 76% of all trauma patients were discharged home; however around 14% required transfer, long-term care or rehabilitation.

Major work-related trauma in Abu Dhabi occurs predominantly among young non-local men, is caused mainly by falls from height and struck-by events and places a substantial burden on trauma and critical care services. Prevention should prioritise control of high-energy workplace hazards, especially falls from height, while service planning should account for rehabilitation and longer-term recovery needs.

Extreme heat events are intensifying worldwide due to climate change, posing significant health risks and economic challenges. The urban heat island effect poses extra challenges to the inhabitants of cities, especially in the global South.

This trial aims to evaluate the effectiveness of a comprehensive resilience and heat adaptation bundle (ReHAB) that integrates behavioural and structural interventions to reduce heat-related morbidity and mortality and improve internal ambient conditions in urban settings of Pakistan. This would be a cluster randomised controlled trial where 22 clusters comprising approximately 70–80 households per cluster will be randomly assigned to intervention and control arms in a 1:1 ratio. The intervention ReHAB is a combination of community education and awareness and targeted structural modifications, including reflective paints, shading, sustained energy/power, improved ventilation, and community shaded spaces. Data on health and behaviours will be collected via wearable devices and household surveys and environmental sensors will be used to capture indoor and outdoor thermal conditions.

The findings from this trial will provide evidence for the effectiveness of the ReHAB bundle on indoor ambient environments and health and help policy recommendations for urban areas, especially for the global south.

The study has received ethical approval from the Aga Khan University (AKU) (Ref: 2025-11548-35626) and the Pakistan National Bioethics Committee (Ref: 4–87/NBCR-1065/23/1736). Written informed consent will be obtained from all participants before enrolment. Referral pathways to healthcare facilities will be established to ensure timely management of complications. Findings will be disseminated through peer-reviewed publications, scientific conferences and engagement with policymakers and public health stakeholders. Results will also be shared with participants and communities through meetings and informal sessions to raise awareness and support evidence-based heat adaptation.

NCT06991543.

To identify risk factors associated with inpatient mortality among under-five children admitted with complicated severe acute malnutrition (cSAM) at Woldia Comprehensive Specialized Hospital, Ethiopia.

Hospital-based unmatched case–control study conducted from 1 January 2016 to 30 December 2022. Data were extracted from 588 medical records (147 cases and 441 controls). Bivariable and multivariable logistic regression analyses were performed to identify predictors of mortality. Adjusted ORs (AORs) with 95% CIs were used to measure associations and statistical significance was set at p

Stabilisation centre of Woldia Comprehensive Specialized Hospital, Northeastern Ethiopia.

Under-five children admitted with cSAM.

Inpatient mortality among under-five children with cSAM.

A total of 588 records were included in the analysis. In multivariable logistic regression, grade I nutritional oedema (AOR 13.70; 95% CI 1.09 to 172.76), history of bottle feeding (AOR 5.43; 95% CI 1.09 to 26.98), vomiting (AOR 7.96; 95% CI 1.97 to 32.17), pale conjunctiva (AOR 8.68; 95% CI 2.47 to 30.53), shock (AOR 6.11; 95% CI 1.44 to 25.88), no vaccination history (AOR 11.83; 95% CI 3.09 to 45.29) and intravenous fluid administration (AOR 5.55; 95% CI 1.33 to 23.10) were independent predictors of mortality. Children in the first treatment phase had lower odds of death compared with those in later phases (AOR 0.017; 95% CI 0.003 to 0.098).

Bottle feeding history, grade I nutritional oedema, shock, intravenous fluid administration, pale conjunctiva, lack of vaccination and treatment phase were independent predictors of mortality among under-five children with cSAM. Strengthening adherence to cSAM management protocols and improving routine immunisation coverage may reduce inpatient mortality.

Pathology of the long head of the biceps tendon (LHBT) is commonly treated with either tenotomy or tenodesis, which provide comparable clinical outcomes but have distinct disadvantages. A novel self-locking biceps tenodesis aims to combine the benefits of both techniques. Comparative evidence in patients without full-thickness rotator cuff tears is limited. This study aims to compare the clinical outcomes and complications of self-locking biceps tenodesis and biceps tenodesis with 360° suture anchor in patients without full-thickness rotator cuff tears.

This single-centre, double-blinded non-inferiority randomised controlled trial will include 98 patients aged≥40 years with symptomatic LHBT pathology in the absence of full-thickness rotator cuff tears. Participants will be recruited between January 2025 and January 2030 and randomly allocated to self-locking biceps tenodesis or biceps tenodesis with 360° suture anchor. The primary outcome is the Constant score at 1 year postoperatively, with a predefined non-inferiority margin of 10 points.

This study received approval from the French Committee of Person Protection North-West II (national registration number 2024-A02217-40). Furthermore, the trial is registered at ClinicalTrials.gov (NCT06772103). Results will be disseminated through publication in peer-reviewed journals and presentation at scientific conferences.

NCT06772103.

Short peripheral catheters (SPCs) are the most frequently used vascular access devices in neonates but are associated with complications and limited dwell times. International guidelines recommend using the smallest appropriate catheter gauge, yet 24G SPCs remain the default choice in many neonatal intensive care units (NICUs) while 26G SPCs are less often used because of concerns about flow adequacy particularly during blood transfusions. Evidence directly comparing these gauges in neonates is limited.

We conducted a retrospective cohort study in a tertiary NICU and national referral centre for high-risk neonatal care in Doha, Qatar. Data were collected between 1 August 2018 and 31 December 2023. Eligible participants were neonates (0–28 days) who received at least one SPC insertion. Data extracted included demographics, catheter characteristics, dwell time, complications and reasons for removal. Analyses were performed at the catheter episode level. Dwell times were analysed using Kaplan–Meier survival curves with log-rank testing, and group comparisons were performed with parametric or non-parametric tests as appropriate.

A total of 45 753 SPC episodes were analysed: 10 531 (23.0%) 24G and 35 222 (77.0%) 26G. Baseline characteristics were comparable between the groups. The mean dwell time was slightly longer for 26G than for 24G (35.1 vs 32.6 hours, pp

In this large neonatal cohort, 26G SPCs were associated with a statistically longer dwell time than 24G SPCs, although the absolute difference was small. Therapy completion and complication rates were comparable between the groups, whereas first-attempt insertion success rates were higher with 26G SPCs.

To understand pregnant women’s perception of the quality of antenatal care (ANC) services in terms of service provision and experience in Sudan, a country with one of the highest rates of maternal deaths worldwide.

A cross-sectional facility-based study.

Public primary healthcare centres in Khartoum state, Sudan.

473 pregnant women attending ANC visits. Data were collected through face-to-face interviews using a standardised questionnaire.

The perceived quality of ANC services assessed across two continuous domains: service provision score and care experience score.

The mean score for service provision was 19.96±3.03 out of 56. The great majority of the participants did not have their height or weight measured at any ANC visits 85% and 64.5%, respectively. About 87.1% and 82.5% of the participants, respectively, had blood and urine tests during each ANC visit. However, only 52.6% of the women reported receiving tetanus injections. The percentage of women receiving ultrasound examination at each visit was 88.4%. The mean score of care experience was 58.68±8.22 out of 84. Three-quarters of the women (74%) understood the purpose of the tests performed. The majority felt free to ask questions (87.3%). But only half and a third of the women were told about the signs of pregnancy complications and where to go in case any complications occurred, respectively. In linear regression, being married and older age had significant positive effects on women’s perception of care provision (p=0.004 and p=0.003, respectively). Regarding the experience of care, older age affected care experience positively (p=0.038), while rural residency (p=0.044), being illiterate (p

Women’s perception of the quality of ANC in terms of service provision and care experience was below average. Several factors were associated with their negative perceptions. These factors need to be further investigated and addressed to improve the quality of ANC provided.

Reducing stunting remains a pressing global challenge, particularly in low and middle-income countries (LMICs), where nutrition insecurity and limited access to health services persist. With its large-scale national social assistance and health programmes, Indonesia offers valuable insights into implementing integrated strategies for stunting prevention. This study examines the substantive elements of food and social assistance interventions as well as the contextual and structural factors that influence their implementation. It also assesses how multisectoral collaboration contributes to the implementation process of nutrition-specific efforts aimed at reducing stunting.

We conducted a qualitative case study in two districts of West Java Province, representing contrasting urban and rural contexts. Data were collected through 78 in-depth interviews with policymakers, implementers and primary beneficiaries. The policy implementation framework developed by Edward was used as a guide for the thematic analysis.

We identified key factors influencing programme delivery, including communication, resource availability, commitment of implementers and bureaucratic structure. Urban settings demonstrated better outreach, service utilisation and intersectoral coordination while rural areas faced logistical and administrative barriers. Innovative local practices, such as digital health monitoring and women’s farmer groups helped bridge implementation gaps. However, structural constraints, such as inflexible eligibility criteria, poor data integration and fiscal dependency on the central government, limited the programme’s reach.

Indonesia’s experience demonstrates that effective stunting reduction requires national policy frameworks and locally adapted, multisectoral approaches that address system-level barriers. The practical lessons from this study can empower LMICs aiming to scale up integrated nutrition, health and social protection programmes, equipping them with the necessary knowledge and insights.

Trauma, obstetric haemorrhage and severe anaemia lead to millions of deaths every year. Many of these deaths occur in regions known as ‘blood deserts’ where there is virtually no access to blood transfusions. A community or civilian walking blood bank (CWBB) is a low-resource strategy that can provide just-in-time, point-of-care tested blood transfusions in blood deserts when banked blood is not readily available and the alternative is almost-certain death. This protocol is designed to evaluate the effectiveness and implementation of a CWBB at Lodwar County Referral Hospital located in a blood desert in rural north-west Kenya.

We will use a mixed-methods approach relying on an implementation science design to evaluate effectiveness, acceptability, applicability and impact of a CWBB. The study will be conducted over 1 year in two parts: pre-emergency and post-emergency transfusion protocol (ETP) implementation. First, a previously developed ETP will be validated and finalised by key hospital stakeholders. Effectiveness will be assessed quantitatively and qualitatively. Prospective laboratory-based data collection will measure changes in blood ordering practices. We expect a sample size of approximately 140 (20/month) unmet blood transfusion requests, with 40 (5/month) of those being emergent (requiring blood in less than 2 hours). These cohorts will be compared pre-implementation and post implementation. Qualitatively, key informant interviews of hospital staff and the community will explore clinical blood demand and general understanding and perceptions about blood donation and transfusion. Lastly, we will determine the adaptability and scalability of a CWBB to other low-resource settings with in-depth interviews and a modified Delphi approach to achieve consensus regarding key components of a CWBB and its transferability to other settings.

Ethical approval was granted by the Strathmore University Institutional Scientific and Ethics Review Committee (SU-ISERC2234/24) and the Mass General Brigham (MGB) Hospital’s Institutional Review Board (#2024P001878; #2024P001879; #2024P001885; #2024P001887). The study team also secured a research licence from the National Commission for Science, Technology and Innovation (#168094) before initiating the study. Interviews will be voluntary and consent will be obtained prior to participation. Blood transfusion consent will be collected as per standard hospital process. The findings will be disseminated through academic publications, conference presentations and workshops, contributing valuable insights into emergency blood transfusion protocols. These findings will also be conveyed to Lodwar County Referral Hospital in order to facilitate quality improvement.

This study aimed to explore the experiences, perceptions and expressed needs of adolescents living with obesity (ALOs) and their mothers.

Data were collected through ALOs’ diary journals, short-term ethnographic fieldwork at ALOs’ schools and semi-structured individual interviews with both ALOs and their mothers. Reflexive thematic analysis was conducted using an inductive approach with two independent coders.

The study was conducted at one paediatric outpatient clinic at Dr Sardjito Tertiary Referral Hospital and in three selected junior and one senior high schools in urban and suburban areas of Yogyakarta and Sleman, Indonesia.

Twelve participants including 6 ALOs and 6 of their mothers. Data were collected through diary journals, a week of school-based observation and individual in-depth interviews with both ALOs and their mothers.

Five key themes emerged: (1) Recognition, emotional responses and perception to obesity, (2) Awareness and desire for change, (3) Self-control and coping strategies, (4) Challenges in adopting a healthy lifestyle and (5) Support systems and weight management preferences. ALOs experienced bullying, shame and physical discomfort. They struggled with physical activity and diet due to social pressures and a lack of healthy food options at school. They believed that parental support, better nutrition literacy and regular reminders were crucial for improving their body weight. The adolescents’ commitment to weight loss was driven by both internal motivations (eg, masculinity, family medical history) and external factors (eg, social and cultural pressures on body image).

This study highlights the diverse psychosocial and emotional experiences associated with living with obesity, offering important insight into how ALOs and their mothers experience and navigate everyday life. These findings are essential for developing future human-centred obesity interventions that are both effective and empathetic.

Spondyloarthritis (SpA) comprises a heterogeneous group of chronic inflammatory diseases. Axial SpA (axSpA) predominantly involves the sacroiliac joints and the spine and typically presents with back pain and stiffness. Modern imaging techniques, especially MRI, allow earlier detection of axSpA compared to conventional radiography, but imaging findings still need cautious interpretation to facilitate a clinical diagnosis.

This cohort study of patients with suspected SpA is designed to (1) compare demographic, clinical, laboratory, imaging data and patient-reported outcomes (PROs) of patients diagnosed with or without axSpA (2) to identify prognostic factors for the diagnosis of axSpA and high disease activity (3) to compare performance of different imaging modalities for establishing a diagnosis of axSpA.

The study is a 2-year prospective observational cohort study of consecutive patients with low back pain ≥3 months and ≤3 years and symptom onset at age 18–45 years, suspected of axSpA.

Clinical visits are conducted at baseline, week 6, 12 (telephone consultation), 24, 48, 72 and 96. Demographics, clinical data, laboratory findings and PROs are collected. Radiography (only at baseline), MRI, low-dose computed tomography (ldCT) and dual-energy CT (DECT) are performed at baseline and prior to the last study visit. Clinical, laboratory and imaging data are prior to visits at week 6 and week 96 assessed at a multidisciplinary team (MDT) conference involving a musculoskeletal radiologist and a rheumatologist, where a diagnosis of axSpA or not will be determined.

Descriptive statistics are used to summarise clinical, PROs and imaging data. Comparisons between axSpA patients and non-axSpA patients are made cross-sectionally at baseline and week 96. We want to investigate and compare the diagnostic performance, the ability to detect structural and inflammatory lesions and the incremental diagnostic value of ldCT and DECT compared to MRI and radiography.

The ethical committee of the Region of Southern Denmark (S-20230055) has approved the study. The study is registered at clinicaltrials.gov (NCT06337513). Results will be presented at both national and international conferences, as well as published in peer-reviewed journals.

Suicide is a major global health challenge, accounting for a significant proportion of psychiatric emergencies. Early detection and intervention are crucial to reducing mortality, yet the unstructured nature of clinical data, particularly psychiatric admission notes, poses challenges for scalable analysis. Recent advancements in artificial intelligence (AI), specifically large language models (LLMs), present opportunities to analyse such data. By capturing nuances...

This study aimed to investigate the association and potential causal relationship between ischaemic stroke/transient ischaemic attack (TIA) and oral anticoagulant (OAC) adherence using Bradford Hill’s criteria and to determine the factors influencing OAC adherence following ischaemic stroke in atrial fibrillation (AF) patients.

We conducted a scoping review.

MEDLINE, Embase and Web of Science from inception up to March 2026.

The analysis included 43 studies on OAC adherence across different phases: initiation (n=1), implementation (n=15), implementation and discontinuation (n=7) and persistence (n=20). Of these, 26 studies showed a positive association between ischaemic stroke history and OAC adherence while one showed a negative association. The evaluation of the body of evidence suggests a mixed association between ischaemic stroke and subsequent OAC adherence. While causality is not definitively established due to the observational nature of the included studies, they fulfil several of the classic Bradford Hill criteria, including temporality, consistency, biological gradient, coherence and plausibility. Factors like age, chronic obstructive pulmonary disease, cancer, heart failure, hypertension, myocardial infarction, anaemia, dementia, smoking, prior warfarin use, education level, stroke severity and recurrence were associated with decreased OAC adherence, whereas experiencing a first stroke was associated with increased adherence.

Existing evidence shows mixed associations between ischaemic stroke and OAC adherence and causality also remains inconclusive. There are multiple factors that modify this relationship. Further observational studies using causality methods are needed to definitively confirm this relationship.

To estimate the prevalence of rheumatic heart disease (RHD) and identify associated factors among school-aged children in Taiz Governorate, Yemen.

Cross-sectional, school-based echocardiographic screening study.

Public schools in urban and rural areas of Taiz Governorate, Yemen.

A total of 4135 school-aged children (5–15 years) were screened using a purposive stratified sampling approach to ensure representation by sex and place of residence.

RHD status (definite and borderline) was determined using echocardiography based on the World Heart Federation criteria. Socio-economic status was assessed using a modified Water/Sanitation, Assets, Maternal Education and Income index and nutritional status using body mass index-for-age Z-scores. Multinomial logistic regression was used to identify factors associated with RHD.

The overall RHD prevalence was 55.9 per 1000 children, including 9.9 per 1000 definite cases and 45.9 per 1000 borderline cases. Prevalence was higher among females (63.8 vs 45.9 per 1000; p=0.013), rural children (63.1 vs 47.3 per 1000; p=0.022) and undernourished children (69.9 per 1000). Caregiver awareness of RHD was low (36%).

In multivariable analysis, definite RHD was associated with older age (relative risk ratio (RRR)=1.22, 95% CI 1.10 to 1.36), female sex (RRR=3.21, 95% CI 1.51 to 6.86) and rural residence (RRR=2.21, 95% CI 1.16 to 4.20). Borderline RHD was associated with increasing age (RRR=1.07; 95% CI 1.01 to 1.14), while moderate socio-economic status was protective (RRR=0.71, 95% CI 0.52 to 0.97).

The burden of RHD among schoolchildren in Taiz is high, with borderline disease substantially exceeding definite cases. Higher risk among girls, rural populations and socio-economically disadvantaged groups highlights important health inequities. These findings support the need for a national RHD control strategy in Yemen, including school-based screening, improved access to penicillin prophylaxis, strengthened referral systems and community awareness programmes.

Unsafe abortion remains a major public health concern in Africa, contributing substantially to maternal morbidity and mortality across the continent. Although legal restrictions, stigma and socio-cultural factors are well-documented barriers to safe abortion access, health systems-related barriers are not adequately explored. This systematic review aims to examine how health systems-related barriers hinder access to safe abortion in clinic settings in Africa over the past decade.

A comprehensive search strategy will be employed to retrieve relevant studies from electronic databases, including PubMed, Web of Science and African Journals Online. Search terms such as "health system barriers", "structural barriers", "healthcare financing", "healthcare governance", "healthcare leadership", "poor referral systems" and "conscientious objection" will be combined with "abortion access" and "abortion provision" using Boolean operators. The review will include empirical studies, with designs such as cross-sectional, longitudinal, experimental and exploratory on abortion barriers in Africa that are linked to the WHO’s health system building blocks. Non-empirical publications (eg, literature reviews and commentaries) will be excluded. Titles, abstracts and full texts will be screened independently by reviewers according to predefined inclusion and exclusion criteria, with discrepancies resolved by consensus. The primary outcome of interest is how health system-related barriers affect access to safe abortion in clinics. The quality of studies will be evaluated using the Mixed Methods Appraisal Tool and data will be synthesised narratively.

Ethical approval is not required for this study, as it involves analysis of data from published literature and does not include any primary data collection. Results for the main review will be submitted for publication in a journal. Additionally, the results will be disseminated by the African Coalition for Research and Communication on Abortion.

PROSPERO 2025 CRD420251156948.

To estimate the pooled prevalence and associated factors of gastro-oesophageal reflux disease (GERD) in Saudi Arabia and other Gulf Cooperation Council (GCC) countries.

Systematic review and meta-analysis

Searches were carried out in Web of Science, Scopus, PubMed, Google Scholar and Dimensions AI with no date or language filters.

Cross-sectional studies that reported estimates of GERD prevalence from Saudi Arabia and other GCC countries were included.

Two reviewers independently extracted the data, and the accuracy and clarity of the final extracted data were cross-checked by another two reviewers. Study quality was assessed using JBI Critical Appraisal Tool for Prevalence Studies. Random-effects model was used for meta-analyses.

Fourteen studies from Saudi Arabia met the inclusion criteria (total participants=17 927); from the other GCC countries, only one study from Bahrain and none from Qatar, United Arab Emirates, Kuwait or Oman met the inclusion criteria, and thus were not included in the pooled analysis. The pooled prevalence of GERD from Saudi Arabia was 32% (95% CI 22% to 44%); however, there was substantial heterogeneity (I² = 99.4%). In subgroup analysis to account for heterogeneity, the prevalence was found to be significantly lower when endoscopy findings were used as the diagnostic criteria (13% (95% CI 10% to 16%); ²=0.028; I² = 93.4%) compared with Gerd-Q questionnaire (33% (95% CI 24% to 43%); ²=0.54; I² = 98.6%) (p²=0.87, I² = 99.3%) (p=0.0185). Factors that increased the odds of GERD were non-steroidal anti-inflammatory drugs/analgesics use (OR: 1.78, 95% CI 1.14 to 2.79; p=0.01; ²=0.09, I² = 59%) and smoking (OR: 1.59, 95% CI 1.28 to 1.99; p²=0.03, I² = 33%).

The pooled prevalence of GERD in Saudi Arabia is 32%. However, given the high heterogeneity, there is a need to standardise methods for better contextualisation of such epidemiological data. Notably, GERD prevalence was significantly lower in high-quality studies and when endoscopy findings were used as the diagnostic criteria. Finally, the lack of GERD prevalence studies from other GCC countries highlights the need for studies to fill this gap.

PROSPERO (ID: CRD42023453031)

To examine trends and factors associated with isoniazid preventive therapy (IPT) initiation among people living with HIV (PLHIV) aged ≥15 years who initiated antiretroviral therapy (ART) in mainland Tanzania between 2015 and 2020.

A retrospective observational study using routinely collected data. Multilevel logistic regression analysis was used to identify factors associated with IPT initiation.

HIV care and treatment clinics across mainland Tanzania.

The study included PLHIV aged ≥15 years who initiated ART between 2015 and 2020.

The primary outcome was IPT initiation among eligible PLHIV. Secondary outcomes included trends in IPT initiation from 2015 to 2020 and factors associated with IPT initiation.

Among 124 846 PLHIV (mean age 35.8±11.40 years), cumulative IPT initiation was 59.8% (10.50% at first visit; 21.70% within 3 months). Initiation trend increased from 52.70% in 2015 to 68.30% in 2020 (2.05, p

Although IPT initiation among PLHIV in mainland Tanzania improved between 2015 and 2020, coverage remained suboptimal. Strengthened efforts are needed to ensure all PLHIV initiating ART are appropriately screened for tuberculosis (TB), initiated on IPT if eligible and promptly treated if diagnosed with active TB.