Sexually transmitted infections (STIs) have emerged as significant public health concerns, imposing a substantial burden on both individuals and the healthcare system of the country. Additionally, STIs may also result in major extensive psychological consequences that profoundly affect individuals with STIs. Despite the government’s implementation of different initiatives aimed at addressing STI-related challenges, these conditions are associated with shame and stigma which act as barriers to the effective utilisation of healthcare services. The purpose of the present study is to generate evidence on barriers and facilitators to service utilisation and management of STIs in India.

Indian Council of Medical Research, New Delhi, is conducting a multi-centre study employing a mixed-method approach. The study involves different levels of healthcare systems, including both government and private healthcare facilities across seven sites in several states of India, including Maharashtra, Rajasthan, Punjab, Bihar, Uttar Pradesh and New Delhi. For the quantitative data, individuals seeking healthcare services related to STIs will be enrolled and assessed using a semi-structured pilot-tested questionnaire. In-depth interviews and focus group discussions will also be conducted with different stakeholders as per the standard guidelines of the qualitative method by the designated trained project staff. Descriptive and inferential statistics will be applied to the quantitative data, while the qualitative data will be analysed using a deductive approach with thematic content analysis.

The study protocol has been approved by the ethics review committees of all the participating sites individually. The findings from this study will be published in peer-reviewed journals and disseminated through scientific conferences and meetings among policy-makers and government agencies. AIIMS/IEC/2024/609; AIIMS/Pat/IEC/2024/1205; F. 7/BIOETHICS/AIIMS-RBL/APPROEM/2021/1; KIMSDU/IEC/11/2022; LHMC/IEC/2024/11; IEC/02/EX/2024; PGI/IEC/2024EIC000373.

Irrational prescribing is a major global health concern, contributing significantly to increased morbidity, mortality and antimicrobial resistance (AMR). Despite existing knowledge and awareness, irrational antibiotic use remains prevalent among healthcare professionals.

This qualitative study aimed to explore the contributing factors to irrational antibiotic prescribing, understand healthcare professionals’ perceptions, identify barriers to rational use and gather suggestions for improving rational antibiotic use.

A qualitative study using semi-structured interviews was conducted with participants. A total of 60 healthcare professionals (20 physicians, 20 pharmacists and 20 nurses) participated after providing verbal consent.

Semi-structured interviews were conducted with healthcare professionals across various clinical settings in Pakistan until data saturation was reached. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to ensure transparent reporting. An inductive thematic analysis approach was employed and themes and subthemes were developed from the data.

The findings revealed a generally good understanding of irrational prescribing. Contributing factors included prescriber-related issues, patient expectations, weak regulatory oversight and underutilisation of pharmacists. Key barriers identified were financial constraints, lack of awareness and insufficient resources. Suggestions for improvement included regular audits, public awareness campaigns, an integrated healthcare system, interprofessional collaboration, drug utilisation reviews, adverse drug reaction reporting, standardising hospital policies and strengthening regulatory frameworks.

This study highlights critical factors and barriers contributing to irrational antibiotic prescribing and presents practical suggestions to improve rational use. Implementing evidence-based approaches, updating clinical guidelines, and promoting awareness among healthcare professionals are essential steps toward improving prescribing practices and combating AMR.

Patient engagement is the practice of "meaningful and active collaboration [of patient partners] in governance, priority setting, conducting research and knowledge translation." Patient engagement has been implemented in various settings including clinical, research, and quality improvement, with varying levels of patient contributions and decision-making responsibility. However, little is known about the experiences of patient partners who are in leadership roles in patient-led events. For Patients, By Patients (PxP) is an annual, virtual, patient-led conference that focuses on topics important to patient partners in research. Each year’s PxP steering committee is comprised of those with patient experiences and consequently, offers an opportunity for our research team to explore patient leadership within a conference setting. Understanding more about the intricacies of patient-led events is necessary if we wish to support patient leadership as a valuable form of patient engagement.

The aim of this study was to explore (1) the benefits and challenges experienced by PxP steering committee members in a patient-led event and (2) how to better support patient leadership.

We conducted a qualitative descriptive study of semi-structured virtual interviews with PxP conference steering committee members. Thematic analysis was used to identify core themes that were salient to the data.

The Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis in Vancouver, Canada, and an international virtual setting via Zoom from January 2025 to April 2025.

Purposive sampling was used to conduct interviews with thirteen PxP patient partner steering committee members.

Four core themes were identified in the data: (1) institutional support: how institutions can support patient leadership, (2) steering committee environmental characteristics: what characteristics are conducive to patient leadership, (3) personal growth: how patient leadership promotes growth among patient partners and (4) new possibilities: how patient-led events foster future expansion and opportunities. Power dynamics, intersectionality, and accessibility were also identified as central to supporting patient leadership and building safe and supportive environments.

Patient partners are capable of leading events which promote interpersonal relationships and advance patient engagement practices and governance. Important facilitators include institutional support and governance that considers power dynamics, accessibility and intersectionality.

To assess the burden of diabetes and prediabetes in the educational sector in Bahawalpur City, Pakistan.

Cross-sectional study.

Teaching institutes of Bahawalpur, Pakistan, during January 2024 to December 2024.

A total of 955 participants from 15 universities, colleges and schools were included. Eligible participants were aged 18–75 years and employed as teachers or academic staff and enrolled using a non-probability consecutive sampling technique. Primary anthropometric measurements, blood pressure, smoking status and HbA1c levels were recorded. Prediabetes was defined as HbA1c 5.7–6.4% and type 2 diabetes mellitus (T2DM) as HbA1c ≥6.5%.

Among 955 participants, 622 (65.1%) were male and 713 (74.7%) were teaching staff. The median age was 42 years, and median BMI was 27.3 kg/m². The prevalence of prediabetes and T2DM was 31.7% and 15.4%, respectively, with 8.5% newly diagnosed cases of T2DM. Multivariate binary logistic regression analysis found that age (p=0.006), BMI (p=0.008) and family history of diabetes (p

This study highlights a significant prevalence of T2DM and prediabetes in the educational sector of Bahawalpur, Pakistan. Increasing age, BMI and positive family history of diabetes were independent predictors of prediabetes/T2DM.

Frostbite is a common reason for emergency department (ED) presentations in Canada. Iloprost, a prostacyclin analogue, has been investigated to reduce the risk of amputation with its use expanding. Two Canadian cities implemented iloprost over different times leading to a practice variation that allowed for treatment comparison. Our objective is to evaluate the effectiveness of iloprost compared with non-iloprost treatment. Secondary objectives include assessing the impact of iloprost dosage and homelessness.

A retrospective cohort study was conducted on adult severe frostbite cases presenting to EDs in Calgary and Edmonton between November 2021 and April 2024. Data were abstracted from clinical databases and analysed for demographic and injury characteristics, treatment and amputation outcomes.

Of 1812 total ED encounters for frostbite, 257 patients with grades 2–4 extremity frostbite were included for analysis. Logistic regression found that overall patients receiving iloprost were associated with reduced likelihood of any amputation (OR=0.49, 95% CI 0.25 to 0.96) and fewer digit amputations (p

Iloprost infusion was associated with a reduction in amputation rates in grade 3 and 4 frostbite with the greatest association seen in grade 3 cases. Greater iloprost dosage was associated with improved digit salvage. Homelessness was associated with delayed ED presentation.

Anxiety and depression are common and associated with higher use of general healthcare services. The aims of this systematic review were to (1) estimate the prevalence of anxiety and depression in adults who are high or costly users of general healthcare services in comparison to routine users and (2) estimate the magnitude of healthcare costs associated with the presence of anxiety and depression.

Systematic review of the available literature.

MEDLINE, PsycINFO, EMBASE, CINAHL, PROSPERO and Cochrane Library were systematically searched without language restriction from inception to 1 April 2019 and updated on 25 October 2022, 16 October 2024 and 18 February 2026.

Eligible studies described adults aged ≥18 years who were defined as high or costly general healthcare users and where the prevalence and/or associated costs of anxiety and/or depression were quantified.

Three reviewers independently extracted information on study characteristics, exposure and outcomes.

From the 38 412 identified articles, 27 studies from 10 countries (in Europe, North America and Asia) involving 6 145 907 participants met eligibility criteria and were included. There were wide variations in the estimated prevalence of anxiety (3.8–67.2%) and depression (4.7–77.9%) among high healthcare users. The prevalence of both disorders was higher among high healthcare users than routine users in all studies with non-high user comparator groups. Only four studies investigated healthcare costs associated with depression. These uniformly reported that general healthcare costs are higher for those with depression than those without. No studies investigated costs associated with anxiety.

Anxiety and depression are over-represented among high or costly healthcare users, although accurate quantification of the magnitude of difference is precluded by significant methodological heterogeneity and variability in definitions used. Improved identification of covert mental health problems is essential for the provision of effective interventions for patients and healthcare expenditure reduction. Future research should prioritise a standardised approach, with agreed definitions for high and/or costly healthcare use in different contexts.

CRD42018102628.

Primary hyperparathyroidism (PHPT) increases the risk of renal stones and progressive renal dysfunction. Parathyroidectomy is recommended for patients with renal involvement, yet whether surgery improves renal outcomes compared with non-surgical management remains unclear. Prior reviews have focused mainly on biochemical or skeletal outcomes, included few renal events and largely predate recent large cohort studies using contemporary methods to evaluate renal stones, chronic kidney disease (CKD) progression and long-term estimated glomerular filtration rate (eGFR) decline. A contemporary renal-focused synthesis is needed to clarify the true renal benefits of parathyroidectomy. We aim to evaluate the effect of parathyroidectomy versus non-surgical management on renal stones and broader renal outcomes in adults with PHPT.

This Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P)-aligned protocol describes a systematic review and meta-analysis comparing parathyroidectomy with non-surgical management in adults (≥18 years) with PHPT. MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials will be searched from inception to 5 November 2025. Eligible studies include randomised trials, non-randomised interventional studies and observational comparative designs. Studies without a comparator, those focused exclusively on secondary or normocalcaemic hyperparathyroidism and case reports or series will be excluded. Primary outcomes are renal stones and renal functional outcomes (eg, CKD progression, ≥30% decline in eGFR, dialysis initiation). Secondary outcomes include health-related quality of life and adverse events. Two reviewers will independently screen records, extract data and assess risk of bias (Cochrane Risk-of-Bias 2 and Risk Of Bias In Non-randomised Studies of Interventions). Random-effects models will be used where appropriate, and heterogeneity assessed using I². Publication bias will be assessed using appropriate quantitative or qualitative methods based on the available evidence.

Ethics approval is not required as only published data will be used. Findings will be disseminated through peer-reviewed publication and conference presentations.

CRD420251240480.

Scabies is a common skin condition and poses a substantial disease burden in resource-poor tropical settings. The Rohingya refugee camps in Cox’s Bazar, Bangladesh represent one of the world’s largest and most protracted humanitarian crises. Using 3 years of data from 2021 to 2023, this study analysed the seasonality of scabies and examined its association with climatic factors.

This is a retrospective observational study conducted in the Rohingya refugee camps and adjacent host communities in Ukhiya and Teknaf, Cox’s Bazar. All patients clinically diagnosed with scabies and who received treatment at 35 International Organization for Migration (IOM)-supported health facilities between 1 January 2021 and 31 December 2023 were included. Climate data, including daily mean, minimum and maximum temperature and total and maximum rainfall, were obtained from the Bangladesh Meteorological Department. Seasonal–Trend decomposition using LOESS (locally estimated scatterplot smoothing) (STL) was applied. Associations between climatic variables and the decomposed seasonal component of scabies cases and corresponding attack rate, as well as overall scabies case counts and overall attack rate, were assessed using Pearson’s correlation tests.

A total of 323 106 new scabies cases were reported from IOM-supported health facilities between January 2021 and December 2023. Children aged under 5 years and 6–18 years accounted for the highest proportion of cases (32.08% and 38.95%, respectively). The average monthly number of scabies cases was highest in November (12 625) and lowest in May (5862). Case numbers increased from November to February (high season), with a peak between October and November, and declined between April and June (low season). An inverse relationship was observed between temperature and scabies incidence, with higher case numbers during cooler months and lower numbers during warmer months. Pearson’s correlation analysis demonstrated a strong and significant negative correlation between the seasonal components of both scabies cases and attack rate and temperature variables, including maximum (cases: r=–0.492, p=0.002; attack rate: r=–0.484, p=0.003), minimum (cases: r=–0.506, p=0.002; attack rate: r=–0.489, p=0.002) and mean temperature (cases: r=–0.525, p=0.001; attack rate: r=–0.511, p=0.001). No significant association was observed between the seasonal component of scabies cases or attack rate and humidity or rainfall.

This study identified a distinct seasonal pattern of scabies, with higher caseloads and attack rate during late autumn and winter (October to February) and lower caseloads and attack rate during summer months (April to June). Temperature showed a strong negative association with the seasonal component of scabies burden. These findings may inform the timing of public health strategies, including mass drug administration, intensified case management and social and behavioural change communication, in humanitarian settings.

The National Health Service (NHS) faces mounting pressure from an ageing population and the backlog of care following the COVID-19 pandemic. The NHS Long Term Workforce Plan sets out a strategic framework to address these pressures through three priorities: train, retain and reform. The plan outlines a range of measures, including the doubling of medical school places over the next decade. Realisation of these ambitions is constrained by limited training capacity, as existing educators face significant pressures due to clinical demands. Clinical Teaching Fellow (CTF) programmes provide resident doctors with protected time for education and may help expand capacity and alleviate workforce pressures on established educators. Despite their rapid growth, CTF programmes remain under-described, and their contribution to NHS workforce priorities has not been systematically examined. To address this gap, this scoping review will map published and unpublished evidence on UK-based CTF programmes, engaging knowledge users to ensure findings are relevant to practice and workforce priorities.

The review will follow the Joanna Briggs Institute methodology for scoping reviews and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. Evidence will be identified from academic databases (British Education Index, EMBASE, ERIC, MEDLINE, Scopus, Web of Science) and grey literature sources (Google Scholar, NHS and medical school websites, deanery pages and job-advertising platforms). Two reviewers will independently screen and extract data using a piloted form, with discrepancies resolved by discussion or a third reviewer. Extracted data will undergo descriptive analysis and narrative synthesis, guided by a Theory of Change framework to identify how CTF programme inputs, activities and outcomes relate to NHS workforce priorities. Knowledge users will be engaged throughout the review to refine research questions, inform source selection, interpret findings, and shape dissemination.

Ethical approval has been granted. All participants will provide informed consent. Participant contributions will be pseudonymised, and data will be managed in accordance with UK data protection legislation. Dissemination will be informed by knowledge users to ensure that findings on CTF programmes, including reported outcomes and identified gaps, are shared with those involved in delivering or supporting CTF programmes and with NHS stakeholders responsible for workforce priorities in training, retention and reform.

To systematically identify and synthesise dengue management strategies, levels of implementation, management dimensions, key challenges and proposed solutions across health systems worldwide.

A scoping review following the Arksey and O’Malley framework and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.

PubMed, Scopus, Web of Science, Embase and the Cochrane Library were searched for studies published between January 2003 and December 2024. Reference lists of included studies were also manually screened.

English-language, peer-reviewed articles and reviews focusing on dengue management strategies, challenges and solutions at any health system level were included. Studies without full-text access or outside the scope of dengue management were excluded.

Two reviewers independently screened studies and extracted data using a structured form. Extracted data were charted and synthesised using an inductive thematic approach to identify core strategy domains, implementation levels, challenges and solutions.

Of 4822 records identified, 34 studies met the eligibility criteria. Dengue management strategies were categorised into six domains: vector and environmental control; surveillance and early warning systems; vaccination; enhancement of diagnostic and treatment services; community participation and education; and governance with intersectoral coordination. Implementation occurred at community, municipal, national, regional and international levels. Key challenges were grouped into five domains: structural and resource-related; sociocultural; governance and policy; scientific and technological; and climate- and urbanisation-related factors.

Global dengue management is increasingly adopting integrated, multi-sectoral approaches. Effective dengue control requires strengthening health system infrastructure, institutionalising community engagement and leveraging scientific and technological innovations. Sustained political commitment, stable financing mechanisms and coordinated governance across sectors are essential for resilient and sustainable dengue control.

Sepsis is a global health priority with nearly 50 million cases annually. Cardiovascular dysfunction is common, frequently manifesting as hypotension that persists despite fluid resuscitation. Most affected patients require the use of intravenous (IV) vasoactive agents, typically necessitating intensive care unit (ICU)-level monitoring, invasive interventions and contributing substantially to healthcare costs. Midodrine, an oral alpha-1 agonist approved for orthostatic hypotension, has increasingly been used off-label as a vasopressor-sparing (reducing IV vasopressor use) strategy in sepsis, despite limited and inconsistent evidence. This pragmatic, randomised, open-label trial evaluates the efficacy and safety of midodrine in patients with sepsis-associated hypotension. We hypothesise that, compared with standard care, midodrine administration will reduce the duration of IV vasopressor use.

A total of 308 adult patients with sepsis-associated hypotension will be enrolled (154 per arm). The intervention group will, in addition to standard of care, receive enteral midodrine 10 mg three times daily. Outcomes will be ascertained pragmatically via electronic health record-based data retrieval and adjudicated by research coordinators blinded to treatment assignment. The primary outcome is time alive and off IV vasopressors in the first 28 days (in hours) after randomisation. Secondary outcomes include cumulative vasopressor exposure; use and duration of central venous access; cumulative fluid balance over the first 48 hours and up to 7 days of ICU stay; ICU and hospital length of stay; and ICU-, hospital-, and organ support-free days through day 28. Safety outcomes include adverse events potentially attributable to midodrine during hospitalisation including acute kidney injury. Primary analyses will follow an intention-to-treat framework, including all randomised participants according to their assigned treatment groups. Primary and secondary outcomes will be compared using a van Elteren test stratified by randomisation factors. A predefined secondary Bayesian analysis of the primary outcome will provide complementary estimates of treatment effect. Safety outcomes will be summarised descriptively without formal between-arm hypothesis testing.

The Mayo Clinic Institutional Review Board approved this protocol and required written informed consent from all participants (IRB# 24–0 00 121). Findings will be disseminated through peer-reviewed publications and international conference presentations.

NCT06319248.

To determine the prevalence of presbyopia and associated risk factors among Bangladeshi recipients of elderly social safety net payments who were not currently using mobile financial services (MFS) and demonstrated numeracy, dexterity and cognitive prerequisites for smartphone use during eligibility screening for the Transforming Households with Refraction and Innovative Financial Technology (THRIFT) trial. Accessing these payments requires use of online banking, as with a smartphone.

Cross-sectional analysis of trial eligibility screening data.

Community-based screening conducted in two rural subdistricts in Kurigram District, Bangladesh.

Among 13 944 Old Age Allowance and Widows’ Allowance (WA) beneficiaries screened, 953 met trial eligibility criteria, including passing a smartphone readiness assessment and completing near vision examinations.

Presbyopia, defined as binocular presenting near visual acuity of N6.3 or worse, correctable to at least N5 with near vision glasses and with distance vision of ≥6/12 in both eyes.

Among 953 participants (mean age 61.4±7.2 years, 62.6% women), presbyopia prevalence was 62.6% (95% CI 59.5 to 65.7). Presbyopia was significantly positively associated with female gender (adjusted prevalence ratio (APR)=1.19, 95% CI 1.02 to 1.41) and receiving WA (APR=1.20, 95% CI 1.04 to 1.38) in multivariable analyses.

This study highlights a substantial burden of uncorrected presbyopia among a prescreened, randomised control trial-eligible subgroup of social safety net beneficiaries in rural Bangladesh, who were not currently using MFS but demonstrated cognitive and functional capacity to use mobile phones, potentially hampering their ability to carry out online banking. Delivery of reading glasses may improve digital financial access and facilitate broader financial inclusion, a hypothesis currently being tested in the parent THRIFT trial.

NCT05510687.

While health research about persons of South Asian ancestry has been conducted for decades in Canada, it often uses pathologising approaches that fail to consider historical, social and political factors shaping health disparities. Further, this research rarely engages South Asian communities in meaningful ways, reinforcing feelings of disconnect and longstanding mistrust. Greater collaboration and transparency are needed to build trust and generate credible findings. The aims of this research protocol are to (1) examine how community engagement has been implemented in health research involving South Asian populations, (2) explore the experiences of both South Asian community members and academics involved in community-engaged research and (3) develop a framework guiding health research with and for South Asian communities in Canada, titled PRinciples to Operationalize Community Engagement, Equity, and Sustainability in South Asian Health Research in Canada (PROCESS).

This ongoing codesigned concurrent multimethods study is being conducted with community partners across Canadian provinces. First, the scoping review is examining how community engagement has been operationalised in health research involving South Asian populations in Canada. We are performing a search in Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Web of Science, Scopus and PsycINFO databases for articles published between 2003 and 2024 referring to the concept of community engagement in South Asian health research. Two reviewers are independently completing abstract and full-text reviews based on preselected eligibility criteria. Data are being extracted from peer-reviewed studies using a data extraction framework. Findings will be aggregated and synthesised using descriptive content analyses. Second, a qualitative descriptive study is being conducted to explore the experiences of diverse stakeholders, including academics and community partners who are partaking in academic health research focused on South Asians. Semistructured interviews are being analysed using an inductive thematic content analysis. Results from the scoping review and qualitative interviews will be triangulated to detect emerging themes and patterns, which will enable the identification of principles to be incorporated within a draft of the PROCESS framework. In the final phase, we will use a modified Delphi process to iteratively codevelop the PROCESS framework with community partners and researchers across Canada.

The Faculty of Medicine and Health Sciences Institutional Review Board at McGill University approved the study’s protocol (24-05-080). Results will be submitted for publication in peer-reviewed journals and presented in academic and community forums. Results will also be shared with diverse audiences across Canada through multiple formats, including articles, conferences, infographics and social media, with the aim of raising awareness and promoting the adoption of research principles and practices for engaging South Asian communities in health research. This research received funding from the Canadian Institutes of Health Research (Grant #507768).

Equitable access to healthcare is a critical determinant of health that significantly impacts individual health and wellness. Beyond addressing immediate medical needs, it enables preventive care, closes critical service gaps and enhances patient autonomy, ultimately reducing health disparities faced by disadvantaged groups. Migrants encounter numerous challenges in accessing healthcare in their adopted countries, and these challenges...

To assess the mental health status and identify associated factors among rural adult women in Bangladesh.

Cross-sectional study using face-to-face interviews with a semistructured questionnaire.

Data were collected between January and February 2025 in three rural upazilas (Dhamrai, Nawabganj and Sreepur) using multistage systematic sampling. The semistructured questionnaire included sociodemographic characteristics, household assets and the Depression Anxiety Stress Scale-21 (DASS-21). The wealth index was calculated using principal component analysis. Cases with mild to extreme levels of depression, anxiety and stress were grouped together to indicate the presence of any level of the three mental health problems. Statistical analyses included descriptive statistics, bivariate analyses using ², Fisher’s exact test and Welch two-sample t-test, and multivariable binary logistic regression to identify predictive factors of mental problems. A Venn diagram was generated to display the proportion of patients with anxiety, depression and stress. Data analysis was performed using SPSS (V.26) and R Studio (V.2025.05) with a significance level of p

A total of 1350 women aged 18 years or older who were available at home during the data collection period and gave consent to participate. Women who were unable to participate due to illness were excluded.

Participants had a mean (±SD) age of 36.35 (±12.58) years. The prevalence of depression, anxiety and stress was 47.7%, 60.7% and 23.2%, respectively. Moderate severity was most common among patients with depression (20.34%), anxiety (24.20%) and stress (8.03%). 20% of participants experienced all three conditions simultaneously, with 22% having both depression and anxiety. Multivariable analysis revealed that factors associated with an increased odds of depression, anxiety and stress were chronic diseases (ORs (95% CIs): 2.02 (1.50 to 2.73), 1.44 (1.05 to 1.99) and 1.91 (1.35 to 2.71), respectively) and history of abuse (1.84 (1.28 to 2.66); 3.15 (2.06 to 4.93) and 1.91 (1.28 to 2.83), respectively). Family history of mental illness was associated with an increased odds of anxiety (1.71 (95% CI 1.12 to 2.87)) and stress (1.61 (95% CI 1.01 to 2.52)). So was the presence of a caregiving role (1.68 (95% CI 1.18 to 2.42) and 1.50 (95% CI 1.02 to 2.19) for anxiety and stress, respectively). Having a financial problem was associated with an increased odds of anxiety (1.52 (95% CI 1.16 to 2.00)). A happy family relationship was associated with decreased odds of depression (0.28 (95% CI 0.20 to 0.93)), anxiety (0.22 (95% CI 0.06 to 0.60)) and stress (0.50 (95% CI 0.25 to 1.00)). Conjugal satisfaction was protective against anxiety (0.42 (95% CI 0.18 to 0.80) and stress (0.32 (95% CI 0.17 to 0.59)). Unexpectedly, higher wealth status (being rich) increased depression (1.56 (95% CI 1.04 to 2.34) and anxiety (1.57 (95% CI 1.03 to 2.41) risk.

A major segment of rural adult women of Bangladesh experiences mental health problems. The findings recommend community-based comprehensive mental health screening programmes, interventions and integration of mental healthcare into primary health systems to address this critical public health challenge.