Healthcare utilisation (HU) is key to improving the health of residents in urban informal settlements. This study aimed to explore household-level factors influencing HU among informal settlement households in Freetown, Sierra Leone.

Cross-sectional survey.

Three informal settlements (Cockle Bay, Dwarzark and Moyiba) in Freetown, Sierra Leone.

Primary data from 4871 households were collected during the Health and Wellbeing survey conducted between April and May 2023, targeting households with adults aged 18 years and older.

The primary outcomes were households HU both within and outside informal settlements. Household-level predisposing and enabling explanatory variables were derived from Andersen’s Behavioural Model of HU.

Disability in households increases HU within settlements (especially in Dwarzark, 13% and Moyiba, 10%) but is less likely outside. Households engaged in income-generating activities are more likely to seek healthcare within settlements, but 12% less likely outside in Cockle Bay and Dwarzark. Food insecurity decreases HU within Dwarzark (9%) and increases HU outside by 174% in Moyiba. Longer water fetching times and water shortages were associated with higher HU (between 6% and 16%) within settlements, especially in Cockle Bay and Dwarzark. Clean water sources (eg, piped dwelling, bowser, surface, bottled) were consistently associated with higher HU both within and outside settlements. Shared sanitation facilities (such as shared toilets) were positively associated with HU both within and outside settlements, particularly in Dwarzark and Moyiba. Households with income from fishing, informal salaried work and bike riding showed higher HU both within and outside settlements, especially in Dwarzark and Moyiba.

We identified strong settlement-specific patterns of household-level factors that influence HU both within and outside Freetown’s informal settlements. These findings provide a foundation for developing targeted policies such as strengthening local services, addressing affordability and accessibility barriers and supporting vulnerable occupation groups.

Temporary childbirth migration (TCM), where women return to their natal homes for pregnancy, delivery or postpartum for a limited duration, is a long-standing sociocultural practice in India. While often motivated by familial support and traditional norms, its implications for maternal and child health and health system engagement remain poorly understood. This study aims to quantify the impact of TCM on maternal and newborn outcomes and to explore how continuity of perinatal care and social support mediate these relationships.

We are conducting a three-site, community-based, prospective cohort study across the Health and Demographic Surveillance System sites of Vadu (Maharashtra), Sevagram (Maharashtra) and DEESHA (Delhi). A total of 3000 pregnant women will be enrolled in pregnancy (

This study has been approved by the Ethics committees at the KEM Hospital Research Centre Pune (KEMHRC/RVM/EC/1931), Society for Applied Studies (SAS/ERC/TCM Study/2024), Mahatma Gandhi Institute of Medical Sciences (MGIMS/lEC/COMMED/8412023) and University of California San Francisco (22-36484). All research activities are conducted in accordance with Indian Council of Medical Research Guidelines for biomedical research and the Declaration of Helsinki. On study completion, findings will be disseminated to diverse local, national and global stakeholders and published in academic journals.

CTRI/2024/02/062881.

Women who use drugs in Tanzania face a disproportionately high burden of HIV and mental health disorders. Despite the availability of pre-exposure prophylaxis (PrEP), uptake remains low, highlighting the need for integrated, scalable interventions that address co-occurring substance use and mental health challenges. Motivational interviewing (MI) and cognitive-behavioural approaches, such as the Common Elements Treatment Approach (CETA), show promise for enhancing HIV prevention outcomes in this population. This study presents the protocol for a pilot feasibility trial assessing the acceptability, feasibility and preliminary efficacy of MI for PrEP (MI-PrEP) and a combined CETA and MI-PrEP intervention (CETA + MI-PrEP) to improve PrEP engagement among women who use drugs in Tanzania.

This individually randomised, parallel-group pilot trial will be conducted in Dar es Salaam, Tanzania, guided by the situated Information, Motivation and Behavioral Skills model. Eligible participants are adult women who use heroin, report recent drug-related or sex-related HIV risk behaviours, are HIV-negative and exhibit symptoms of depression, anxiety or post-traumatic stress disorder. Participants are randomised to one of three arms: MI-PrEP, CETA + MI-PrEP or enhanced treatment as usual. Interventions are delivered face-to-face by trained counsellors. Feasibility and acceptability will be assessed using recruitment and retention data, surveys and qualitative interviews. Preliminary effects will be measured for PrEP initiation, symptoms of common mental disorders and substance use.

Ethical approval has been obtained from the Johns Hopkins Bloomberg School of Public Health Institutional Review Board (25580), the Muhimbili University of Health and Allied Sciences Ethics Review Committee (MUHAS-REC-12-2023-1994) and the National Health Research Ethics Committee at the National Institute for Medical Research in Tanzania (NIMR/HQ/R.8a/Vol.IX/4830). Results will be disseminated through ClinicalTrials.gov, peer-reviewed publications, conferences, presentations and research briefings to community stakeholders.

ClinicalTrials.gov ID: NCT06835751. Initially registered 14 February 2025, https://clinicaltrials.gov/study/NCT06835751, last updated 5 December 2025.

COVID-19 pandemic affected physical, psychological and social well-being of many individuals, including healthcare workers, who were at the forefront of the pandemic. Thus, the pandemic may have reduced the sexual quality of life of frontline healthcare workers, which in turn could compromise their ability to provide quality healthcare to patients. This scoping review aims to gather and synthesise current available global evidence on the interactions among COVID-19, sexual quality of life and healthcare delivery among healthcare workers.

The JBI framework for performing scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Reviews (PRISMA-ScR) guided the conduct of this scoping review. A search strategy was developed and will be implemented in five major databases, including PubMed, SCOPUS, JSTOR, Dimensions AI and CENTRAL. Additional records will be obtained via Google, Google Scholar, WHO IRIS, ProQuest Dissertations and Theses Global, as well as reference lists of selected full-text studies, ending in January 2026. Eligible studies will include original peer-reviewed articles conducted among healthcare workers that examine how COVID-19 affected their sexual health and how this, in turn, influenced their healthcare delivery. The data will be extracted and charted using predetermined criteria to completely understand the relationship between COVID-19-induced psychological distress and sexual health among healthcare workers. Using a narrative synthesis and thematic analysis, the findings from the selected studies will then be summarised and synthesised.

Since primary data would not be collected for this study, ethical approval will not be needed. The study’s findings will be derived from publicly accessible documents and previously published articles. The findings of the review will be submitted for publication in a peer-reviewed journal and presented at conferences and workshops.

The scoping review protocol has been registered with the Open Science Framework (https://osf.io/2yjkx).

The impact of poor nutritional health on maternal and infant morbidity and mortality remains high in low- and middle-income countries (LMICs), exacerbated by climate change-linked disasters. Maternal nutritional health, as a modifiable factor, is influenced by various social, political, economic and environmental factors, as well as cultural practices. Identifying climate change-related interventions, adaptive strategies and best practices targeting maternal nutritional health and well-being in LMICs within a cultural context helps inform the co-production of sustainable, culturally sensitive interventions to improve health outcomes for mothers and babies.

We will undertake a systematic review of the literature employing the six steps of the Protocol, Search, Appraisal, Synthesis, Analysis and Report (PSALSAR) framework, including both peer-reviewed and grey literature. The Population, Concept and Context approach will be used to formulate the review question and the inclusion and exclusion criteria. We will include primary research comprising all study designs published in English from 2007 onwards. We will conduct searches in online academic databases, including CINAHL, MEDLINE, Global Health (CABI), AGRIS (FAO) and SCOPUS, as well as defined grey literature sources (ie, Google Scholar). Titles, abstracts and later full-text articles will be independently accessed and screened for eligibility criteria by four researchers. Following the integrative review methodology, we will present findings narratively, organised around the components of the PSALSAR framework to provide a comprehensive synthesis of the available evidence.

As no primary data will be collected, the systematic review does not require formal ethics approval. However, we will give attention to ethical considerations within the identified studies. Findings will be published in a peer-reviewed journal and presented at relevant conferences. The findings of our systematic review and the ethnographic component of our research project will inform the development of appropriate maternal nutritional health interventions using co-production methodology in Pakistan.

CRD420251080897.

To evaluate the diagnostic accuracy of CT in identifying small and large bowel obstruction and associated complications, including ischaemia and perforation, in adult patients.

Systematic review and meta-analysis reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy reporting guidelines.

Ovid MEDLINE and Embase were searched from 1946 to 20 February 2025.

The study included randomised controlled trials, cohort studies and case–control studies evaluating the diagnostic accuracy of CT for bowel obstruction in adults (aged ≥18 years). Only studies published in English were included. Conversely, case reports, editorials, conference abstracts without full data and studies focusing exclusively on paediatric populations or animal models were excluded.

Three reviewers independently extracted data on study characteristics, CT modality, diagnostic accuracy metrics (sensitivity, specificity and predictive values) and complications. Risk of bias was assessed using the QUADAS-2 tool. A random-effects meta-analysis was conducted. Heterogeneity was assessed using I² and Tau² statistics.

Sixty-five studies with 9418 patients were included. The pooled sensitivity and specificity of CT for bowel obstruction were 90% (95% CI 78 to 96; I²=56%, Tau²=0.36) and 88.8% (95% CI 78.0 to 94.8; I²=65%, Tau²=0.35), respectively. For bowel ischaemia, CT showed a pooled sensitivity of 47.0% (95% CI 32.4 to 59.9; I²=0%, Tau²=0.00) and specificity of 85.3% (95% CI 77.9 to 89.5; I²=1%, Tau²=0.45). Multidetector CT (MDCT) outperformed older modalities across all endpoints. Ischaemia was present in 22.05% of all cases, with higher rates in small bowel obstruction. Perforation and mortality rates were 3.98% and 4.40%, respectively. No significant publication bias was detected, and the certainty of evidence was graded as moderate for most diagnostic accuracy outcomes.

CT, particularly MDCT, offers high diagnostic accuracy for bowel obstruction and is a critical tool for detecting serious complications such as ischaemia and perforation. However, sensitivity for ischaemia remains modest. Standardised protocols and prospective studies are needed to enhance early identification and optimise care pathways.

The aim of this study was to assess the time to live birth following fertility treatments among couples attending fertility centres in Addis Ababa, Ethiopia, and to identify associated factors that could contribute to improving fertility treatment outcomes.

A retrospective record review

Treatment centres that are found in Addis Ababa, Ethiopia.

411 infertile couples who have undergone fertility treatment at St. Paul’s Hospital Millennium Medical College (SPHMMC) and Ethio Fertility and IVF Center in Addis Ababa from 2021 to 2023.

A retrospective record review was conducted using data from patient charts among 411 couples who received fertility treatments at SPHMMC and the Ethio Fertility and IVF Center in Addis Ababa. A simple random sampling technique was used to select samples from participants who started fertility treatments from March 2021 to February 2023. Data were collected by three nurses who work at the facilities using the data abstraction format under close supervision. Kaplan-Meier, life table, log-rank test and Cox regression were used to analyse the time-to-live birth and associated factors.

Among the 411 couples who underwent fertility treatments, 33.1% achieved live birth, with most occurring between 8 and 12 months after treatment initiation. Women aged ≥35 years had a 63% lower adjusted hazard of live birth compared with those aged

Younger women and couples undergoing multiple treatment cycles achieve higher live birth rates, and assisted reproductive technology in Addis Ababa attains outcomes comparable to international standards. Expanding early infertility intervention, ensuring access to repeated treatment cycles nationwide and raising public awareness are essential.

With the rapid increase in the number of older adults living with chronic diseases and disabilities, there is a growing need to prepare nurses with positive attitudes and a willingness to work with older adults. This study aims to examine attitudes towards and willingness to work with older adults among nurses.

A cross-sectional survey was conducted among a purposive sample of 267 nurses at the University Hospital of Kotelawala Defence University, Sri Lanka. Participants completed a self-administered questionnaire consisting of socio-demographic variables, Kogan’s Attitudes Toward Old People Scale and questions related to willingness to work with older adults. Descriptive statistics and linear and logistic regression analyses were used in data analysis.

The majority were female nurses (71.9%, n=192) and held slightly negative (58%, n=155) or slightly positive (41.9%, n=122) attitudes towards working with older adults. Only 35.2% (n=94) were willing to work with older adults in this study. A male nurse (beta coefficient (β)=4.644, CI 2.392 to 6.896, p

Most nurses express slightly negative to positive attitudes and have little interest in working with older adults. Various socio-demographic factors have an impact on attitudes towards and willingness to work with older adults. Since nurses play a significant role in providing care for older adults, the development of positive attitudes is essential, and interventions and strategies are crucial to increasing their willingness to work with older adults.

South Asia carries the burden of a rapidly changing climate with floods and extreme heat. These disasters further translate into mental health distress, financial stress and detrimental effects on well-being, with women being the most vulnerable. This study aims to demonstrate that mental health screening, referral and resilience-building group sessions can be successfully administered by community health workers and primary health facility staff in a flood-affected rural population of women in Pakistan and provide evidence on the effectiveness of this approach for improving their mental health status.

A quasi-experimental design with a comparison group will be used for the study, preceded by a formative phase. The formative phase evaluated the feasibility of mental health screening by Lady Health Workers (LHWs) in flood-affected areas using a qualitative approach such as focus group discussions and in-depth interviews. Manuals developed by the study team of mPareshan will be used to train LHWs, Lady Health Supervisors (LHS) and health facility staff. Following this, LHWs will briefly screen women aged 18 to 49 years, administer awareness-raising and resilience-building sessions and refer women who screen positive for depression or anxiety to a primary health facility. Physicians at the health facility will confirm the diagnosis and provide counselling to mild-moderate cases, while severe cases would be referred to specialists. Statistical evaluation of quantitative data and thematic content analysis of qualitative data will be conducted to assess the feasibility and impact of the intervention. This trial is registered at clinicaltrials.gov with number NCT06756165.

The study acquired ethical approval from the Ethical Review Committee at Aga Khan University (2024-10475-30776) and the National Bioethics Committee (4-87/NBC-1158/23/481) in Islamabad. Approval was obtained from relevant provincial authorities. The trial will adhere to the ethical principles of autonomy, anonymity, confidentiality, equity and respect. All eligible participants will be provided with informed consent, details regarding the purpose and procedure of the study, and the right to withdraw at any time. Data and information will be anonymised and stored securely. Dissemination of the results of the trial will occur after its completion to stakeholders, participants and the public.

NCT06756165.

Giant cell arteritis (GCA) is a large-vessel vasculitis occurring in people aged over 50 years. Recent studies have shown that tocilizumab (TCZ), an anti-IL-6 receptor monoclonal antibody, is remarkably effective in treating GCA and allows significant dose sparing of glucocorticoids. However, it makes it difficult to monitor disease activity. Furthermore, treatment is often prolonged over 1 year due to the fear of relapse after stopping TCZ and/or the absence of an optimal discontinuation scheme.

This study aims at comparing two discontinuation regimens in a population of GCA patients who have been treated with TCZ for 12–36 months and have discontinued glucocorticoids for at least 12 weeks. Patients will be randomised with a 1:1 ratio between two arms: immediate discontinuation (cessation) versus gradual discontinuation of TCZ (162 mg subcutaneously every 2 weeks for 12 weeks and then every 4 weeks for 12 additional weeks). Patients will be followed up for 78 weeks. The primary endpoint is relapse-free survival after 26 weeks of follow-up. A total of 120 patients will be randomised (60 in each group) for a period of 3 years.

The trial was approved by an independent ethics committee (CPP Sud Ouest et Outre Mer IV) and the French health authority (French National Agency for Medicines and Health Products Safety—ANSM) through the Clinical Trials Information System (CTIS) provided by the European Medicines Agency (EMA). The informed consent complies with the ICH GCP guideline and regulatory requirements. Eligible patients may only be included in the study after providing informed consent. Findings will be published in peer-reviewed journals and conference presentations.

NCT06037460.

The gig economy is a promising arena to reduce unemployment and provide other benefits such as the opportunity to earn supplemental income. Like all other forms of work, the gig space also presents occupational health issues for those working in it. This proposed review is aimed at identifying and describing the common occupational health outcomes reported within this workforce; second, to examine the risk factors that contribute to the development of these health issues; and third, to assess the interventions and support systems currently in place to promote the occupational health of gig workers.

A systematic review will be undertaken according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (2009). A search from 2015 to 2025 will be conducted on four global databases (Web of Science, SCOPUS, Academic Source Complete and Business Source Complete). Only records in English, full text and peer-reviewed journal articles will be included. Book chapters, thesis, reports and systematic reviews will be excluded. The Joanna Briggs Institute Critical Appraisal Tools will be used to assess the methodological rigour of various studies prior to inclusion for the final analysis. The extracted data will be synthesised using a narrative synthesis approach, integrating findings from both quantitative and qualitative studies.

This research is exempt from ethics approval because the work will be carried out on published documents. We will disseminate this protocol in a related peer-reviewed journal.

CRD420250654059.

The improved survival rates of children with cancer have heightened concerns about treatment-related chronic health conditions, including platinum-induced hearing loss (PIHL). Cisplatin and carboplatin, widely used in paediatric cancer therapies, frequently cause irreversible sensorineural hearing loss. PIHL affects 1.7–90.1% of patients exposed to these drugs, yet known risk factors—including age, cisplatin dosage, cranial radiation and co-treatment with ototoxic drugs—fail to fully explain interindividual variability. Genetic factors likely play a role in susceptibility to PIHL. Since genetic susceptibility in children may differ from adults, and given the critical window of auditory development, a focused investigation of paediatric genetic factors using quantitative methods is warranted to detect small to moderate effects and understand the polygenic nature of PIHL.

In this study, we will systematically review and conduct a meta-analysis of genetic polymorphisms associated with PIHL in individuals diagnosed before the age of 21 years. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, the review will include randomised controlled trials, cohort, case-control and cross-sectional studies that analyse the genetic influence on PIHL in paediatric populations treated with cisplatin and carboplatin. A comprehensive search of PubMed, EMBASE and Cochrane databases will be conducted, supplemented by backward citation searching. Data will be extracted on study design, treatment details, hearing loss assessment methods, genetic findings and covariates. We will use forest plots to present the results, and both Mantel-Haenszel fixed-effects model and random-effects model will be used for meta-analysis. Heterogeneity will be assessed with the I² index. The study will address potential heterogeneity, individual study quality, proportion of missing data and meta-analysis bias. The quality of the evidence of the meta-analysis will be assessed using the Grading quality of evidence and strength of Recommendations (GRADE) approach.

This systematic review will enhance our understanding of the genetic contribution to PIHL in children and serve as a basis for further research for improvement of personalised treatment strategies for paediatric cancer care.

CRD42024532664.

All the included patient’s data are already published with an ethics approval for each study, respectively. No original data will be collected.

In critical care, intensive care unit (ICU) staff and physicians often estimate patients' height and weight visually, impacting calculations for cardiac function, ventilation, medication, nutrition and renal function. However, accurate assessment is challenging in critically ill patients. This study evaluates the accuracy of visual estimations by ICU staff.

Descriptive cross-sectional study.

National Institute of Cardiovascular Diseases, Karachi, Pakistan.

We included a convenient sample of adult (≥18 years) cardiac patients admitted to the critical care unit in this study. Patients who refused to give consent, trauma/surgery of lower limbs or patients with below-knee or above-knee amputation were excluded to avoid bias.

A convenient sample of cardiac ICU patients was included. Measured weight (kg) and height (cm) were compared with visual estimations by senior ICU nurse, senior non-ICU nurse, ICU consultants, fellows and residents. Correlation and agreement were analysed using Bland–Altman plots and 95% agreement limits.

A total of 356 patients were evaluated, of whom 204 (57.3%) were male, with a mean age of 55.2 ± 14.3 years. The median SOFA score was 3 [2–5], and 101 patients (28.4%) were on mechanical ventilation. The mean difference between measured and estimated weight by senior non-ICU nurse was 4.7±9.2 [–13.38–22.83] kg, senior ICU nurse was 7.8±9.9 [–11.56–27.12] kg, ICU consultants was 3.0±6.6 [–9.89–15.79] kg, ICU fellow was 3.0±7.1 [–10.88–16.92] kg and ICU resident was 8.0±9.6 [–10.83–26.79] kg. Similarly, the mean difference between measured and estimated height by senior non-ICU nurse was 2.0±7.3 [-12.36–16.34] cm, senior ICU nurse was 2.4±7.5 [–12.19–17.00] cm, ICU consultants was 1.5±5.6 [–9.51–12.48] cm, ICU fellow was 1.1±5.5 [–9.68–11.95] cm and ICU resident was 2.3±8.5 [–14.40–19.01] cm.

The findings indicate that healthcare professionals tend to overestimate both weight and height. The accuracy of these estimations varied among professional groups, underscoring the potential clinical consequences of such errors. This emphasises the need for objective measurements in clinical decision-making.

Using the community-based participatory research (CBPR) methodology, sustained peer group treatment has effectively improved medication adherence. Although many studies investigate the effectiveness of peer group therapy, there is a lack of evidence addressing the cost-effectiveness of CBPR models in low- and middle-income countries. This protocol outlines the methods for the economic evaluation of the PArticipatory Research model for medicaTIon adherenCe In People with diAbetes and hyperTEnsion (PARTICIPATE) trial to determine whether the CBPR approach to enhance medication adherence among patients with diabetes and/or hypertension is cost-effective in India.

A within-trial cost-effectiveness analysis (CEA) from a societal perspective will be conducted alongside a multicentre cluster randomised controlled trial to identify, measure and evaluate the key resource and outcome impacts of a CBPR model compared with usual care aimed at improving medication adherence in adult rural Indian patients with diabetes and/or hypertension. The CEA will provide results in terms of the cost per improvement in medication adherence score, and a cost-utility analysis (CUA) will express the findings as the cost per disability-adjusted life year (DALY) or quality-adjusted life year (QALY) gained. Intervention costs and effects will be projected for the population of Indian adults with diabetes and/or hypertension who are on medication, analysed over the cohort’s lifetime. Results from the modelled CUA will detail incremental costs, costs per death averted and costs per DALY averted/QALY gained for the interventions relative to the comparator. Incremental cost-effectiveness ratios will be computed by dividing the cost difference between the intervention and comparator by the difference in benefits. Health economic evaluation methods, including a lifetime horizon, a 3% discount rate for costs and benefits and a societal perspective, will be followed. The effects of sampling uncertainty on estimated incremental costs and effectiveness parameters, as well as the influence of methodological assumptions (such as the discount rate and study perspective), will be examined through both deterministic and probabilistic sensitivity analyses. Relevant differences in costs, outcomes or cost-effectiveness disparities among subgroups of patients with varying baseline characteristics will also be reported. Results will be illustrated using cost-effectiveness acceptability curves across a range of willingness-to-pay thresholds. Modelled CUA will broaden the target population and time frame to offer decision-makers insights into the cost-effectiveness of the CBPR approach for enhancing medication adherence. Furthermore, a return on investment analysis will be performed to express benefits in monetary terms relative to investments made, allowing for a comprehensive expression of both costs and the full spectrum of intervention benefits in monetary units.

The Institutional Ethics Committee of Sri Aurobindo Medical College and PGI, Indore, provided ethics approval. The results of the main trial and economic evaluation will be submitted for publication in a peer-reviewed journal and disseminated through reports to Indian Council of Medical Research and conference presentations.

Clinical Trial Registry of India (CTRI) CTRI/2024/01/061939.