To describe antibacterial consumption (ABC) in four paediatric inpatient facilities in Sri Lanka in 2023.

Descriptive cross-sectional study, adapted from the WHO Global Antimicrobial Resistance and Use Surveillance System methodology.

Paediatric inpatient facilities in two tertiary and two secondary care government hospitals located across three provinces.

Data on antibacterials for systemic use, J01 in the Anatomical Therapeutic Chemical (ATC) classification issued to these paediatric inpatient facilities in 2023 by their respective hospital pharmacies.

(1) ABC at ATC third and fifth levels expressed as defined daily doses (DDDs)/100 admissions, (2) ABC as per WHO ‘Access, Watch and Reserve’ category, (3) choice of antibacterials within a class, (4) DU 75% for oral and parenteral dosage forms, (5) quality indicators such as amoxicillin index and broad:narrow spectrum ratio.

In 2023, total antibacterial (J01) consumption across the four paediatric inpatient facilities was 94.49 DDDs/100 admissions. Together, non-penicillin beta-lactams, penicillins and macrolides/lincosamides/streptogramins accounted for 90–98%. Co-amoxiclav was the most consumed antibacterial, and six agents (co-amoxiclav, cefotaxime, clarithromycin, azithromycin, cefuroxime and meropenem) collectively accounted for 70–90%. Aminoglycosides, tetracyclines, sulfonamides and trimethoprim, and quinolones contributed minimally. Access and Watch group antibacterials accounted for 34 and 65%. Quality indicators demonstrated disproportionately higher use of broad-spectrum and Watch group antibacterials.

High use of broad-spectrum and Watch-group antibacterials was observed across the four paediatric inpatient facilities. The findings highlight targets for antibacterial stewardship programmes and demonstrate the feasibility of ABC surveillance in Sri Lanka.

This study explored perspectives of practitioners providing weight management support for urban-dwelling young adults (18–35 years) with obesity in Sri Lanka, addressing an important evidence gap in understanding obesity management from a provider perspective.

This descriptive qualitative study employed face-to-face semi-structured interviews, and the data were analysed using a framework approach within thematic analysis.

Eight purposively selected practitioners involved in weight management in the Colombo District, Sri Lanka, were interviewed. Participants represented key domains of comprehensive obesity management, including dietary, physical activity, behaviour and medical management. Recruitment continued until thematic saturation was achieved.

Two key themes emerged from the data: (1) Barriers to effective weight management and (2) Strategies to improve weight management. Within the first theme, five subthemes emerged, including limited knowledge and confidence among practitioners, provider attitudes towards clients, resource and service limitations, client motivation and adherence challenges and cultural and religious influences and myths. The second theme comprised four subthemes: early detection with a proper referral system, comprehensive and individualised care approach, continuous follow-up and self-monitoring and supportive social environment.

The findings indicate that obesity management is hindered by fragmented care, with provider, client and system-level factors constraining practitioners’ weight management efforts and limiting opportunities for improved care. These findings suggest the potential value of strengthening interdisciplinary referral pathways and targeted training to support more coordinated care.

Tobacco use treatment (TUT) remains largely absent from Lebanon’s primary healthcare system, even though smoking prevalence ranks among the highest in the region. Although Lebanon has ratified the WHO Framework Convention on Tobacco Control, TUT has not been integrated into routine care. This study describes the adaptation of evidence-based, phone-delivered TUT strategies for integration within Lebanon’s primary healthcare network.

We conducted an explanatory sequential mixed-methods study. Data sources included surveys (n=107) and semistructured interviews (n=24) with healthcare providers, focus group discussions with patients who smoke (n=61) and workflow assessments of 24 primary healthcare centres. Quantitative data were analysed descriptively, and qualitative data underwent rapid framework analysis. We coded adaptations using the Framework for Reporting Adaptations and Modifications to Evidence-based Interventions (FRAME).

Adaptations were informed by contextual determinants, including gaps in electronic health record infrastructure, patients’ mental health needs, and misconceptions and social norms surrounding waterpipe use. Additional considerations included provider-level constraints, such as limited time to promote tobacco cessation (47% of providers reported having sufficient time), limited cessation training (42% reported sufficient knowledge of pharmacotherapy and 15% reported knowledge of how to prescribe cessation medications) and low confidence in counselling patients about the risks and benefits of these medications (50%). Adaptations included adding paper-based reminders to address variability in electronic health record systems; providing concise, role-specific materials and nicotine replacement therapy guidance for providers; incorporating mental health referral pathways and strengthening counselling content on the harms of waterpipe use; substituting nicotine patches with nicotine gum due to product availability; and developing instructional videos and self-help materials to support implementation.

Tailoring implementation strategies to contextual realities in Lebanon aimed to improve the relevance, feasibility and potential uptake of TUT. This formative study provides an example of a data-driven, stakeholder-engaged approach to adapting evidence-based TUT for low-resource primary healthcare settings.

NCT05628389.

The transition from chronic homelessness to being housed is a period of increased mortality risk. Examining the post-housing period is important for improving our understanding of this increased risk.

To investigate, in a retrospective cohort study, the mortality rate of people who had been chronically homeless and who moved into supported housing and to identify risk factors associated with mortality.

Retrospective cohort study with eligible records reviewed from 1 October 2017 until 14 June 2024.

Three supported housing units in Ottawa, Ontario, Canada.

Participants were any individual, alive or deceased, who moved into one of the eligible supported housing units within 6 months of their opening date. 123 participants were included in the study. The mean age was 41.3 (SD 11.9) years, and 76 (62%) were male.

The primary outcome was all-cause and cause-specific mortality following transition to supported housing. Differences in demographics and morbidity were also compared between people who were alive as of 14 June 2024 and those who were deceased as of 14 June 2024.

During a mean follow-up of 2.6 years, there were 27 deaths recorded (22% of those who moved into supported housing). Most, 11 (40%), died from ‘other causes’, where the cause of death was unclear or unknown and where they were found dead in their room, seven (26%) died of ‘natural causes’ usually in hospital after a medical event, seven (26%) of an opioid overdose and two (8%) where we have suppressed cause of death for privacy. There were no statistically significant differences in psychiatric diagnoses, substance use, medical diagnoses or opioid agonist therapy between those who died and those still alive at the end of the study period. Survival differed significantly across age groups (log-rank ²=11.05, p=0.011), with residents aged 31–45 years demonstrating better survival than older age groups. No significant differences in survival were observed by sex.

There is a high mortality rate in people who are chronically homeless who move into supported housing. As our findings do not identify any clear baseline risk factor, it supports the idea that the transition into housing must be complemented with comprehensive health and well-being services that can meet this population’s complex needs to reduce the mortality risk.

Knee osteoarthritis (OA) is a prevalent and debilitating condition, with nearly 50% of patients experiencing bilateral symptoms. Persistent contralateral knee pain after unilateral total knee arthroplasty (TKA) is a common contributor to suboptimal functional recovery and patient dissatisfaction. An intra-articular corticosteroid injection is a safe and widely used non-operative treatment for OA, but its perioperative utility in the contralateral (non-operative) knee to improve TKA recovery (operative side) remains underexplored. The COntralateral CorticoSTeroid Injection in Total Knee Arthroplasty (COSTI) trial is designed to investigate whether a single contralateral corticosteroid injection administered perioperatively improves patient-reported outcomes following unilateral TKA.

The COSTI trial is a multi-centre, triple-blinded, randomised controlled superiority trial. An embedded pilot of 60 patients will first be used to assess the feasibility of the definitive trial. To preserve the integrity of the definitive trial, the pilot phase will focus on feasibility outcomes rather than treatment efficacy and no formal between-group analyses of clinical outcomes will be conducted prior to the progression decision. Treatment allocation will remain concealed from investigators and the study statistician throughout the pilot phase. The preliminary planned sample of the definitive trial will consist of 154 patients undergoing unilateral TKA for primary OA with symptomatic contralateral knee OA. Patients will be randomised 1:1 to receive either an ultrasound-guided contralateral intra-articular corticosteroid injection (80 mg methylprednisolone+0.5% bupivacaine/10 cc volume) or placebo (band-aid application) following the administration of spinal regional anaesthesia on the day of surgery. The primary outcome is change in Oxford Knee Score (OKS) from baseline to 4, 8 and 12 weeks and 1 year postoperatively. Secondary outcomes include contralateral knee pain (Visual Analogue Scale), EuroQol five-dimensional descriptive system, Timed Up and Go performance, range of motion, complications, readmissions and adverse events. The study is powered to detect a 5-point between-group difference in OKS with 90% power.

This trial has received approval from the Unity Health Toronto Research Ethics Board (Protocol #24-158) and is registered at ClinicalTrials.gov (NCT06809998). All participants will provide written informed consent. Findings will be disseminated through peer-reviewed publications and academic conferences, and pseudonymised data will be made available upon reasonable request.

NCT06809998.

Language and communication difficulties are common across a range of dementias including primary progressive aphasia (PPA). Better Conversations with PPA (BCPPA) is a co-designed communication partner training intervention that aims to improve the experience of conversations for a person with communication difficulties. An NHS-based pilot study of face-to-face BCPPA demonstrated positive outcomes but also raised questions about when and where this intervention should be delivered (at diagnosis or later; face to face and/or remotely), how to best measure the effectiveness of the intervention in line with participant’s priorities and whether BCPPA might be acceptable and useful to people with a range of dementia types. We also had questions about the possible economic implications of BCPPA. In preparation for a future full effectiveness study, the present study will address the following questions:

What is the optimal schedule and dosage of BCPPA versus treatment as usual?

What are the eligibility criteria for the BCPPA intervention? Is remote delivery of BCPPA acceptable to people with PPA and other dementias? Can the BCPPA be delivered remotely as intended? Do planned outcome measures show sensitivity to change pre-/post-/3 months post BCPPA? What are the barriers and facilitators to implementation of BCPPA in an NHS setting? What is the most appropriate perspective of analysis and way of measuring costs and outcomes in a future cost-effectiveness analysis of BCPPA versus usual care?

In line with Medical Research Council guidance on development and management of complex interventions, Skivington et al, 2021 this protocol paper describes a phase II mixed-methods process evaluation and health economic study. This protocol for a randomised controlled pilot feasibility study compares the BCPPA communication partner training intervention with a deferred entry group for people with PPA and other rare dementias and their communication partners. Participants will be recruited at diagnosis and review appointments from two NHS trusts. Participants who have completed a repeated baseline measure will be randomised to either the BCPPA intervention or a deferred entry group. The intervention will be delivered remotely, via teletherapy, over 4–6 weeks depending on goal achievement. The deferred entry group will receive the intervention after a 6-week waiting period, and all participants will be assessed immediately post intervention and again at 3 months post intervention. Outcome measures have been selected in line with the current recommendations for a core outcome set for PPA and to address questions of implementation and health economic evaluation. Qualitative and quantitative analysis methods will be used to explore the data.

Ethical approval for this study was granted by the Health Research Authority for England and Wales IRAS (Project ID: 341322 REC REF 24-NI-0123). Results from this study will be published in peer-reviewed journal articles and shared with participants and patient and public involvement advisors in accessible formats.

ISRCTN16268666.

To assess levels of and trends in knowledge that smoking and secondhand smoke (SHS) cause lung cancer and cardiovascular disease (CVD) in 46 countries over two decades.

Longitudinal cohort and repeat cross-sectional surveys.

Nationally representative surveys in 26 International Tobacco Control (ITC) Project countries (2002–2022) and 32 Global Adult Tobacco Survey (GATS) countries (2008–2020).

Adults (aged 18+ years) who smoke tobacco (26 ITC countries: n=133 410; 32 GATS countries: n=110 537).

Current use of cigarettes at least monthly (all ITC countries) and/or bidis at least monthly (ITC India, Bangladesh and Zambia) and current use of any combustible tobacco products (all GATS countries). We conducted individual-level analyses of the ITC and GATS data separately, without combining the datasets or analysing previously published summary statistics. Generalised estimating equations and weighted multinomial regression models assessed country-level prevalence of knowledge for three smoking and two SHS outcomes. Multilevel models estimated mean prevalence across all countries and tested within-country linear trends over time for five disease indicators by survey. Across 12 countries with data from both surveys, correlations between ITC and GATS assessed consistency across indicators.

Knowledge that smoking causes lung cancer was highest (ITC=92.2%, GATS=91.9%), followed by heart disease (ITC=84.7%)/heart attack (GATS=80.0%) and stroke (ITC=75.0%, GATS=66.1%). Knowledge that SHS causes lung cancer (ITC=77.3%, GATS=82.1%) was highest, followed by heart attack (ITC=61.8%)/heart disease (GATS=72.5%) (all p

There is a need to improve and sustain people’s knowledge of diseases caused by smoking and SHS, especially CVD risks.

Idiopathic intracranial hypertension (IIH) is characterised by raised intracranial pressure (ICP) and typically affects young women with obesity. Patients are at risk of permanent visual loss due to papilloedema. Some require emergency intervention to rapidly reduce papilloedema and preserve vision. The international standard of care for patients with sight-threatening IIH is cerebrospinal fluid (CSF) shunting. However, dural venous sinus stenting (DVSS) is an emerging procedure that is offered at many neuroscience centres internationally as the primary intervention. Currently, there are no randomised controlled trial data supporting the efficacy of any interventional approach for preserving vision in sight-threatening IIH.

IIH Intervention is a UK-based two-arm, open-label, multicentre, randomised controlled phase IIb clinical trial with integrated health economic evaluation to compare CSF shunting with DVSS in patients who have confirmed IIH and are at risk of permanent visual loss due to severe papilloedema. The primary outcome is the global thickness of the peripapillary retinal nerve fibre layer (RNFL), an indicator of papilloedema, measured by optical coherence tomography (OCT) over a 6-month period. Secondary outcomes are global thickness of the RNFL over 12 and 24 months, as well as macular ganglion cell layer volume, perimetric mean deviation, headache outcomes, intervention reporting measures (including complications and revisions) and patient-reported outcomes over 6, 12 and 24 months.

The protocol was approved initially on 12 December 2022 by West Midlands-South Birmingham Research Ethics Committee (ref: 22/WM/0230). Participants will be required to provide written informed consent. The results of this trial will be disseminated through national and international presentations and peer-reviewed publications.

ISRCTN57142415.

Approximately 15 million people in the UK live with obesity and at least 5 million of these are people with severe obesity (PWSO). Severe obesity significantly compromises health, well-being and quality of life and reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Several studies suggest the potential of group-based intervention in Specialist Weight Management Services (SWMS), but PWSO remain underrepresented in research, and evidence on optimal design and outcomes is limited. The success of the PROGROUP feasibility randomised controlled trial (RCT) (ISRCTN22088800) informed the development of this study and additional adjustments have been made in response to the rollout of obesity management medication in the National Health Service (NHS). This study aims to assess the effectiveness and cost-effectiveness of PROGROUP in SWMS and primary care.

The RCT will be conducted in SWMS, alongside an implementation study in primary care. The RCT will recruit cohorts of 30 participants to be randomised 1:1 within-cohort to PROGROUP (intervention) or usual care (control). The implementation arm will recruit cohorts of 15 to PROGROUP. The primary objectives for the study are to undertake a process evaluation and economic evaluation of PROGROUP in the RCT and to assess its implementation in primary care. Baseline data and outcome differences at 6 months will be analysed. These will include weight, other clinical measures and patient-reported outcomes, including social and life-satisfaction measures.

This study is approved by an NHS Research Ethics Committee (REC reference: 23/WS/0101). Results will be reported in a manuscript that will be submitted to a peer-reviewed medical journal as open access. A lay summary of the findings will be published online, and participants and sites will be signposted to this.

ISRCTN13721429.

To review how statistically non-significant indirect treatment comparison (ITC) results are interpreted within National Institute for Health and Care Excellence (NICE) cost-comparison evaluations (CCEs) and develop a framework to support interpretations of these results from Bayesian network meta-analyses (NMAs).

A systematic review of CCEs between 2017 (first introduced) and April 2025. A framework (point-and-density plots) was developed to better interpret statistically non-significant NMA results for CCEs.

CCEs were identified through NICE website searches, references of similar reviews and communications with NICE.

NICE technology appraisals (from 2017) that followed a CCE approach ab initio, had final guidance available and used non-statistically significant ITC results were included.

A single reviewer performed screening and data extraction with validation by a second reviewer. Narrative syntheses were performed separately for company, External Assessment Group (EAG) and committee perspectives. Point-and-density plots combine elements of forest plots and density plots alongside reporting the probability that a treatment is non-inferior relative to a comparator. These were applied to a recent CCE (TA1019) for crovalimab for patients with paroxysmal nocturnal haemoglobinuria.

Among 41 CCEs, EAGs raised concerns about statistically non-significant ITC results while companies relied heavily on them. Only ~32% of CCEs applied formal methods to explore ITC result uncertainty.

For the example framework analysis, comparisons of crovalimab to eculizumab (mean difference (MD): 0.018; 95% CIs –0.22 to 0.25) and ravulizumab (MD: 0.079; 95% CIs –0.25 to 0.41) were statistically non-significant, with non-inferiority not demonstrated. However, point-and-density plots indicated a 95.9% and 86.3% probability of non-inferiority of crovalimab versus eculizumab and ravulizumab.

Interpretations of statistically non-significant ITC results are inconsistent within individual CCEs and across appraisals. Implementation of the presented recommendations and framework would improve the consistency and robustness of CCEs.

CRD420251034143.

To measure differences in hospital use between homeless adults using the homeless health peer advocacy (HHPA) service (clients) and non-clients in London.

We conducted a cohort study with linkage to Hospital Episode Statistics (HES) 1 year prior and postenrolment.

London, UK.

People who are homeless in London aged over 18 years residing in a hostel, attending a day centre or being referred by a homelessness service; experiencing difficulties accessing healthcare; and speaking either English or Polish. Participants were required to provide consent for linkage to HES. To be classified as a client, individuals must have used the HHPA service at least once between January and July 2021; non-clients were those who had never used the service.

Peer advocacy is the provision of support by volunteer-trained advocates with lived experience of homelessness to individuals to overcome barriers to accessing health services.

The primary outcome was not attending a scheduled outpatient appointment (‘did-not-attend’) over 12 months postrecruitment, commencing from their baseline interview date. Secondary outcomes included the number of accident and emergency (A&E) and inpatient admissions (all and planned admissions) during that same period.

We estimated the probability of non-attendance using Poisson regression and the number of inpatient admissions and A&E visits using negative binomial regression models. Models included: (1) propensity score weights and (2) propensity score weights and imbalanced confounders. Sensitivity analyses assumed that participants who did not link to HES had no hospital attendance. Exploratory analyses examined differential effects of peer advocacy by clients’ type of peer advocacy engagement (new vs ongoing clients; supported vs unsupported) and by clients’ anxiety or depression symptom scores measured with the Patient Health Questionnaire-4 (PHQ4).

153 clients and 158 non-clients were recruited between July and December 2021. Most were male (77.5%) with a median age of 48 years. Weighted regression models suggested no evidence of effect of peer advocacy on non-attendance (rate ratio (RR) 0.97 (95% CI 0.67 to 1.42)), no difference in the mean number of A&E visits (2.59 95% CI 1.93, 3.24 vs 1.76 95% CI 1.13, 2.40) but more inpatient admissions (1.65 95% CI 1.10, 2.20 vs. 0.53 95% CI 0.27, 0.82) for HHPA clients vs non-clients respectively. This was supported in sensitivity analyses. In exploratory analyses, clients with PHQ4 scores of 9–12 had greater probability of non-attendance at outpatient appointments (RR 1.98 (95% CI 1.0 to 3.89)) compared to non-clients. Those with scores of 6–8 had 5.86 (95% CI 2.73 to 9.0) completed appointments versus 1.87 (95% CI 0.41 to 3.34) among non-clients and 1.13 (95% CI 0.01 to 0.27) inpatient admissions compared with 0.13 (95% CI –0.01 to –0.27) among non-clients.

Following COVID-related disruptions to the work of peer advocates and health services, we found mixed evidence on the effect of peer advocacy: with no evidence of impact on outpatient appointments or use of emergency services; but increased inpatient admissions.

People experiencing homelessness (PEH) face multiple barriers to seeking healthcare and have poorer health outcomes. Point of care tests (POCTs) provide a potential solution to improving access to diagnostics for this population. This survey aimed to understand if these technologies could address unmet needs in primary care for PEH.

An online survey was circulated via dedicated inclusion healthcare newsletters to professionals providing community-based care for PEH in England. The survey focused on experiences of diagnostics and opinions on the use of POCTs for this population.

Thirty-two healthcare workers participated, including GPs, nurses and other allied practitioners from 13 different Integrated Care Boards across England.

Descriptive analyses were performed using standard statistical parameters. A reflexive thematic analysis was performed on free-text responses.

There was evidence of current POCT use but with marked variation across services as to which tests are available. Healthcare workers were overwhelmingly positive about the potential for POCTs, with rapid results facilitating prompt diagnosis and management, increasing likelihood of engagement. C reactive protein testing was considered as the test, which could confer the most benefit to acute care, with renal function and troponin also being discussed, whereas tests to determine cardiometabolic risk were thought to have the most patient benefit in chronic care. Point of care ultrasound for diagnosis of respiratory pathologies and deep vein thrombosis and POCTs for malnutrition were suggested as potential future technologies to address unmet healthcare needs.

The majority of responders expressed that enhancing the provision of POCTs would be beneficial, both in acute and chronic care scenarios, due to the benefits of getting rapid results and reducing the need for repeat appointments or onward referral for diagnostics.

Local public health organisations require information about local variations in healthy life expectancy (HLE) and associated risks to inform decisions about how and where to intervene to improve HLE, a key indicator of population health. We aimed to estimate both HLE and levels of risk in small areas and quantify associations between them.

Cross-sectional population-based study.

Norfolk and Waveney Integrated Care System.

128 Middle Layer Super Output Areas and eight Lower Tier Local Authority Areas.

HLE (estimated using self-reported health status from the 2021 UK Census) in each Middle layer Super Output Area and levels of 10 risk factors (selected based on existing evidence of association with lower life expectancy or self-reported health and availability of local risk information): index of multiple deprivation; weekly net income; urban area; diet not meeting five portions of fruit and vegetables on a usual day; physical inactivity; older person living alone; falls admissions rate; alcohol mortality rate; road casualties and air pollution.

HLE in 2021 was 66.5 years for men (range 52–73) and 67.5 years for women (range 56–74). The difference between areas was 21 years for men and 18 years for women. Higher income was strongly associated with all healthy life expectancies: £100 higher weekly income was associated with 4.4 (95% confidence limits 3.5 to 5.2) and 4.6 (3.8 to 5.4) years greater HLE at birth in males and females respectively and with 1.7 (1.3 to 2.2) and 2.0 (1.5 to 2.5) greater HLE at age 65. Higher percentage of older adults living alone was associated with lower HLE at birth in males and females. Physical inactivity was associated with lower HLE at 65 in males and at birth in females.

This approach uses standard methods and publicly available data to estimate both HLE and risk exposures in small areas to find areas with low life expectancy and high risks, where local organisations may prioritise the implementation of cost-effective interventions. It could be replicated in other areas to target interventions and inequalities. More accurate data on risk exposures in small areas would allow a broader range of risk factors, including smoking, to be considered.

To inform the adaptation of an existing tobacco use treatment (TUT) programme into a contextually appropriate service for Lebanon’s safety-net primary care system.

In-person focus group discussions with an in-depth thematic analysis.

Two primary healthcare centres in Beirut, Lebanon

61 individuals who smoked cigarettes (n=36) and waterpipe (n=25).

The analysis revealed four primary themes: 1) smoking as a coping mechanism for national crisis, 2) lack of perceived fit of the programme with the Lebanese context, 3) differing perceptions of harm and addiction by tobacco product, 4) perceived effectiveness of programme components. Participants reported that smoking helped them cope with stress resulting from the national crisis and felt that patient education material did not reflect local norms around tobacco use. Participants’ views on the relative harm and addictiveness of cigarettes and waterpipe were often discussed in the context of differing use patterns. Addressing mental health, using competent and non-judgmental counsellors, and sharing real-life success stories were recommended to improve engagement in TUT.

Tobacco is embedded within the Lebanese social and cultural life. Our findings inform implementation efforts by identifying contextual needs specific to the Lebanese population that smokes. Tailoring TUTs can increase acceptability, effectiveness and sustainability of smoking cessation efforts in Lebanon and similar low-resource contexts.

Aboriginal and Torres Strait Islander children are the future custodians of country, culture and community for the world’s oldest living cultures. However, they continue to experience significant disadvantage as a legacy of British colonisation. Failure to address the systemic inequities experienced by Aboriginal and Torres Strait Islander children infringes on their rights to health, education, safety and cultural identity. Despite this, there has been limited focus on recognising and measuring the cultural and personal strengths that support their well-being. This study aims to co-design a culturally grounded, illustrated self-report well-being measure for Aboriginal and Torres Strait Islander children aged 5–11 years, focusing on the aspects of life that nurture their strength and well-being.

The project will employ a five-phase mixed methods design, guided by principles of co-design and best practices to develop culturally and developmentally responsive measures with Aboriginal and Torres Strait Islander children. Extending existing methods, we will pioneer a new approach to develop measures enhanced with culturally-responsive pictures co-designed with Aboriginal and Torres Strait Islander communities.

Ethics approvals have been obtained from the University of Queensland Human Research Ethics Committee (2023/HE000607), Western Australian Aboriginal Health Ethics Committee (WAHREC1260), Far North Queensland Human Research Ethics Committee (2023/QCH/99346), Aboriginal Health and Medical Research Council of New South Wales (2140/23), Aboriginal Health Council of South Australia (04–23-1063), Menzies School of Health Research and Northern Territory Department of Health Human Research Ethics Committee (HREC 2023–4608) and the Australian National University Human Research Ethics Committee (H/2024/0914), as well as relevant Departments of Education. The final WM2K (What Matters 2 Kids) results will be published in peer-reviewed journals, presented at conferences and disseminated to partner organisations and the broader sector via strategic networks with Aboriginal and Torres Strait Islander organisations, government bodies and non-government agencies. Children will receive study communications via partner organisations in age-appropriate formats.

To estimate the global, regional and national burden of maternal haemorrhage (2000–2021) and its 2050 projections in 204 countries and territories.

This study systematic analysis of the burden of maternal haemorrhage sourced data from the Global Burden of Disease (GBD) 2021 study. We estimated the incidence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs) and years of life lost (YLLs) due to maternal haemorrhage. Changes in the burden from 2000 to 2021 were computed using AAPC. To detect statistically notable changes in the trends of maternal haemorrhage metrics between 2000 and 2021, Joinpoint regression analysis using the Joinpoint Regression Programme was conducted. We also projected mortality rates, YLDs and YLLs through to 2050 using maps and trends generated by the GBD Foresight visualisation tool.

Globally, the incidence of maternal haemorrhage among women aged 15–49 years declined from 881.98 per 100 000 reproductive aged women (95% uncertainty interval (UI) 687.01 to –1150.23) in 2000 to 714.00 (95% UI 556.97 o t908.54) in 2021, with an average annual percentage change (AAPC) of –0.91 (–1.37 to –0.49). Similar downward trends were observed for maternal deaths, DALYs, YLDs and YLLs attributable to maternal haemorrhage, with AAPCs of –3.78 (–4.39 to –3.18), –4.68 (–4.83 to –4.55), –1.21 (–1.54 to –0.89) and –4.80 (–5.10 to –4.52), respectively. Sub-Saharan Africa, particularly Western Sub-Saharan Africa, recorded the highest burden in 2021, which is almost 300 times higher than in Western Europe. Elevated rates of mortality, DALYs and YLDs were also evident in Sierra Leone, Chad, Niger, Mali, Nigeria, Burkina Faso, Central African Republic, Somalia and South Sudan in 2021 and projections for 2050. However, the high-income Asia Pacific region had the lowest incidence, DALYs and YLDs at 151.32 (109.63–203.68), 2.21 (1.72–2.86) and 0.87 (0.46–1.38) per 1 00 000 women, respectively. Australasia recorded the lowest maternal death count and YLLs attributed to maternal haemorrhage at 0.69 (0.50–0.90) and 0.56 (0.41–0.74) per 1 00 000 women, respectively.

While the global burden of maternal haemorrhage has declined over time, significant regional and national inequities persist. Even though the 2050 projections show improvement in the burden of maternal haemorrhage, there is also regional and national variation in the rate of decrease in maternal haemorrhage burden. Targeted, context-specific interventions are urgently needed to reduce maternal haemorrhage-related mortality and morbidity.