The co-occurrence of multiple long-term conditions, that is, multimorbidity, is increasing globally and is associated with lower quality of life and increased risk of death. The risk and prevalence of multimorbidity are higher among women compared with men, but currently, evidence focusing on women’s multiple long-term conditions during the perinatal period is limited. Existing evidence needs to be examined to determine the extent to which maternal multimorbidity or women’s multiple health needs related to pregnancy have been addressed, especially for women living in low-income and middle-income countries (LMICs) where this burden of disease is the highest. The objective of this scoping review is to map existing evidence in LMICs on (a) Study designs and data sources, (b) Context-relevant definitions and descriptions, (c) Associated risk and protective factors, (d) Relevant maternal and infant health outcomes and (e) Treatments and interventions used to manage multiple long-term conditions before, during and after pregnancy.

This scoping review will be conducted using Joanna Briggs Institute methodology and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement extension for scoping reviews. This review will include observational, experimental or quasi-experimental studies, as well as systematic or umbrella reviews, on multimorbidity in women of reproductive age (15–49 years) in prepregnancy, pregnancy or up to 6 weeks after childbirth in LMICs. The studies will focus on definitions, risk and protective factors and management strategies for multiple long-term conditions before, during and after pregnancy. Studies of morbidity in women with a single index condition or conditions that are not related to pregnancy or childbirth will be excluded. A search strategy will be developed using thesaurus (including MeSH) and free-text terms for ‘maternal morbidity’ or ‘multiple long-term conditions’ and associated keywords such as multimorbidity, co-morbidity and unmet health needs related to pregnancy and/or childbirth for women living in LMICs. Electronic (EBSCOhost (CINAHL Ultimate, STM Source, Medline Ultimate), Cochrane Library, Web of Science or Scopus and Google Scholar) and grey literature databases will be searched from database inception. Reference lists and bibliographies of key topic articles will also be searched, and any additional papers that meet the inclusion criteria will be obtained. There will be no limitations on dates or languages. Records will be independently screened, selected and extracted by two researchers. Data will be presented in tables and narrative summaries.

Ethics approval is not required as this scoping review will summarise previously published data. Findings from the review will be disseminated through various platforms, including peer-reviewed journals, conferences and community meetings.

Open Science Framework (https://doi.org/10.17605/OSF.IO/FYCR8).

Sexually transmitted infections (STIs) pose a huge public health challenge in sub-Saharan Africa, where prevalence rates are among the highest globally. Barriers such as limited healthcare access, stigma and inadequate diagnostic facilities impede timely detection and treatment. Self-sampling for STI testing offers a potential solution to these challenges. This scoping review will systematically map the available evidence on self-sampling for STIs in sub-Saharan Africa, focusing on its feasibility, acceptability, implementation and outcomes.

The scoping review will be guided by the Arksey and O’Malley framework. The review will include a comprehensive search of peer-reviewed and grey literature from various repositories and databases. The following databases will be searched: PubMed, Scopus and Global Health. Studies that will be included will meet specific criteria. The results of the review will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist.

The methodology used for this study is a scoping review of existing literature; therefore, ethical approval is not required. Findings of this study will be shared at national, regional and international conferences and published in a peer-reviewed journal.

We registered the protocol with the Open Science Framework.

This study aimed to investigate the relationship between coping strategies and compassion fatigue among healthcare professionals in Central Uganda.

A facility-based cross-sectional study conducted between June and July 2023. Three tools were used for data collection: a socio-demographic survey, the Professional Quality of Life Scale (ProQOL-5) and the Brief-Coping, Orientation to Problem Experienced tool. Participants were asked to recall experiences from the previous 30 days.

The study was conducted in five prominent hospitals in Central Uganda.

A total of 548 healthcare providers, including 191 physicians, 256 nurses and 103 technicians.

Compassion fatigue scores.

Most participants were under 29 years old (50.9%) and women (62.0%). High levels of compassion fatigue were reported by 37.8% of participants. Active coping, self-distraction and denial were associated with higher compassion fatigue, while informational support, positive reframing and venting were linked to lower fatigue levels. Seeking social support effectively reduced compassion fatigue.

The findings highlight significant compassion fatigue among healthcare providers in Central Uganda, impacting their well-being and patient care. Coping strategies like active problem-solving and social support are promising in mitigating compassion fatigue. Interventions should focus on reducing self-distraction, enhancing problem-solving skills and fostering supportive work environments to improve healthcare workers’ well-being and patient care quality.

The study evaluated healthcare professionals’ adherence to guidelines on quality neonatal resuscitation practices in Ghana.

This study employed an observational design. A validated observational checklist for neonatal resuscitation was used to assess the adherence to quality neonatal resuscitation guidelines among healthcare professionals.

The study was conducted among healthcare professionals in six healthcare facilities, consisting of five government-owned healthcare facilities and a private non-profit health facility across the northern, middle and coastal belts of Ghana.

The study participants were 75 healthcare professionals across the six sampled healthcare facilities.

Outcome measures of interest are: initial preparation prior to resuscitation; stimulation and airway maintenance; positive pressure ventilation; coordinated positive pressure ventilation with chest compression and postresuscitation infection prevention and control measures.

The results revealed that 53% of the healthcare professionals demonstrated good (scored 80%–100%) adherence to guidelines on quality neonatal resuscitation practices; the remaining scored moderate 36% (scored 50%–79%) and 11% (scored 0%–49%) poor adherence. Binary logistic regression analysis revealed that increased staffing levels and a bachelor’s degree or higher were positively associated with the performance of positive pressure ventilation (adjusted OR (aOR) 19.3 (95% CI 2.430799, 152.8657), p=0.005) and (aOR 9.9 (95% CI 1.070278, 92.38303), p=0.043), respectively. Furthermore, professional nurses and medical practitioners were more likely to adhere to coordinated positive pressure ventilation with chest compressions than auxiliary nursing staff (aOR 13.2 (95% CI 1.917858, 92.61999), p=0.009) and (aOR 15.7 (95% CI 1.227859, 200.1105), p=0.034).

The results showed that 53% of healthcare professionals demonstrated good adherence for neonatal resuscitation practices. Addressing the identified gaps and inequalities in neonatal resuscitation practice will improve healthcare professionals’ knowledge and skills in neonatal resuscitation, which ultimately helps to reduce neonatal deaths among babies in Ghana.

Many people with psychosis find the world very frightening. It can be difficult for them to do everyday things—for example, walking down a busy street, travelling on a bus or going to the shops. Sometimes, the fears are so great that individuals rarely leave their homes. gameChange virtual reality therapy is designed to reduce this agoraphobic avoidance. In gameChange, users practise going into computerised immersive versions of ordinary situations. A virtual therapist guides users through the programme. A mental health worker also supports people. People normally do six sessions of gameChange, but now they can do more as headsets can be left with many people. We originally tested gameChange with 346 patients with psychosis. People saw a significant reduction in their fears. People with the most severe problems made the biggest improvements. This led to gameChange receiving National Institute for Health and Care Excellence (NICE) Early Value Assessment (EVA) approval for its use with patients with psychosis who have severe agoraphobic avoidance. NICE EVA approval is conditional on further evidence generation. We aim to carry out a real-world trial of gameChange used in the NHS. The overall aim is to gather evidence on the four essential areas (clinical benefits on agoraphobia, level of engagement and adherence, healthcare resource use, adverse effects) and the two further supporting areas (health-related quality of life, generalisability) identified in the NICE evidence generation plan for gameChange.

200 patients with psychosis and severe agoraphobic avoidance will be randomised (1:1) to receive gameChange in addition to treatment as usual (TAU) or to a waitlist control group receiving TAU. Assessments will be conducted blind to group allocation at baseline, 8 weeks (end of treatment) and 26 weeks (follow-up). The trial will be embedded in services in at least seven National Health Service (NHS) trusts across England. The primary outcome is agoraphobic avoidance at 26 weeks assessed with the Oxford Agoraphobic Avoidance Scale. The secondary clinical outcomes are agoraphobic distress, paranoia and social contacts. There will be tests of moderation of the main clinical outcome. Treatment acceptability, adverse effects and cost-effectiveness will also be assessed. The target estimand is the treatment policy estimand and all primary and secondary analyses will be carried out incorporating data from all participants including those who do not complete treatment.

The trial has received ethical approval from the NHS Health Research Authority and Health and Care Research Wales (25/WA/0081). A key output will be the evidence needed for a NICE guidance update on gameChange and a clear recommendation concerning future routine use in the NHS.

ISRCTN79060696.

The open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort is the first study to comprehensively investigate socioeconomic indicators, common chronic diseases and their risk factors in a remote rural setting in Lesotho. It serves as a platform for implementing nested trials using the Trials within Cohorts (TwiCs) design to assess community-based chronic care interventions. In this study, we present the cohort’s sociodemographic and chronic disease risk factor profile, including self-reported HIV prevalence and hypertension and diabetes care cascades.

Since February 2023, community health worker (CHWs) supported by a clinical decision support and data collection application have enrolled inhabitants from 103 randomly selected rural villages in Butha-Buthe and Mokhotlong districts in Northeast Lesotho. As of 31 May 2024, the cohort includes 5008 households with 14 735 participants (55% female, median age 19 years). The cohort’s socioeconomic status is low with an International Wealth Index of 26, a monthly household income of US$42.4 and low levels of formal education. Among the 7917 adult participants, 42.5% are overweight or obese, with higher rates among women, and 33.1% smoke tobacco, with higher rates among men. Self-reported HIV prevalence is 15.1% with a 98.4% treatment rate. Hypertension prevalence is 17% with a 56% control rate and diabetes prevalence is 4% with a 39% control rate.

The cohort’s low socioeconomic status is linked to multiple health risks including insufficient access to clean energy, essential healthcare services, adequate sanitary facilities and secure food supply. Besides the expected high HIV prevalence, we found significant hypertension, diabetes and cardiovascular risk factor prevalences. While treatment and control rates for diabetes and hypertension are higher than in similar settings, they remain below global targets.

Ongoing cluster-randomised TwiCs, which will be completed in 2025, are assessing the effectiveness of community-based, CHW-led care interventions for diabetes and hypertension. CHWs will continue to closely monitor the cohort and integrate additional measurements such as HIV testing. This will provide further insights into the dynamics and interactions of chronic diseases and inform the development of future nested trials on innovative community-based prevention and care interventions.

NCT05596773.

Predictive scoring systems support clinicians in decision-making by estimating the prognosis of patients in intensive care units (ICUs). However, there is limited evidence on the accuracy of these systems in predicting mortality and organ dysfunction in special populations. The aim of this review is to assess the performance of predictive scoring systems in forecasting mortality in adult ICU patients in relation to baseline kidney function. It is anticipated that the assessment of predictive scoring systems’ performance and patient outcomes in this review may reveal information that will contribute to improve the quality of care and outcomes for special or under-represented ICU patient populations. It might also inform future research and contribute to the development of novel risk prediction models to address identified gaps or unanswered questions.

This review will include only observational studies, as these allow us to assess the real-world performance of predictive scoring systems in ICU settings by examining the original validation studies. By excluding randomised trials, paediatric studies, case reports and machine learning-derived models, this review focuses on the direct practical use of the scoring systems in adult ICU patients. A comprehensive search of MEDLINE, Embase and Scopus was conducted from database inception to 10 October 2024. The data will be extracted on study characteristics, patient outcomes and performance metrics.

This review will analyse data from previously published studies; no ethical approval is required. All data that will be included in the analysis will be publicly available and will be included in the final manuscript. Results will be disseminated through publication in a peer-reviewed journal and will also be presented at seminars and conferences.

CRD42024611547.

Persecutory delusions are very common in severe mental health disorders such as schizophrenia. Existing treatments often do not work well enough. We developed a face-to-face theory-driven psychological intervention, called Feeling Safe, that produces very large reductions in persistent persecutory delusions. The challenge now is to make Feeling Safe widely available. So, we developed a 6-month supported online version, called Feeling Safer. The aim is an intervention that patients can easily access and use, reduces persecutory delusions and can be supported by a range of mental health professionals in less contact time than face-to-face therapy. Initial proof of concept testing of Feeling Safer was very encouraging. In a randomised controlled trial, we now plan to test whether Feeling Safer is efficacious for patients and can be successfully delivered by any of three different mental health staff groups (peer-support workers, graduate psychologists and cognitive behavioural therapy (CBT) therapists). We will also test whether Feeling Safer works equally across gender, age, ethnicity and cognitive functioning (moderation) and whether Feeling Safer works via the targeted psychological processes (mediation).

The study design is a multicentre, single-blind (outcome assessor), parallel, four-arm randomised controlled trial; 484 patients with persistent persecutory delusions will be randomised to one of the four conditions (1:1:1:1): Feeling Safer (added to treatment as usual (TAU)) supported by peer-support workers, or Feeling Safer (added to TAU) supported by graduate mental health workers including assistant psychologists, or Feeling Safer (added to TAU) supported by CBT therapists or TAU. Feeling Safer will be provided for 6 months with a staff member. Assessments will be conducted at 0, 3, 6 and 9 months by research assistants blind to group allocation. The primary outcome is severity of persecutory delusions at 6 months rated with the Psychotic Symptoms Rating Scale—Delusions. The secondary outcomes are other psychiatric symptoms (depression, anxiety, insomnia, agoraphobia and paranoia), psychological well-being, recovery, activity and health-related quality of life. Analysis will be conducted under a treatment policy strategy following the intention-to-treat principle, incorporating data from all participants including those who do not complete treatment. Moderation and mediation will be tested. A within-trial cost-effectiveness analysis will be conducted of Feeling Safer compared with TAU.

The trial has received ethical approval from the NHS Health Research Authority (23/LO/0951). Informed consent will be obtained from all participants. A key output will be an open-access publication in a peer-reviewed journal reporting on the clinical effectiveness of a high-quality supported online programme for the treatment of persecutory delusions that has the potential to be used at scale in mental health services.

ISRCTN93974770.

Adolescent girls living in low-income urban informal settlements face unique challenges that elevate their susceptibility to early childbearing. However, there has been limited research attention, especially qualitative studies, on their use or non-use of antenatal care (ANC) services. Informed by the socioecological theory, we examined the obstacles to and facilitators of ANC services use among pregnant adolescent girls in a low-income urban informal settlement in Kenya.

The study adopted a qualitative explanatory design. We purposively selected 22 adolescent girls aged 13–19 who were either pregnant or had given birth, 10 parents and three health providers to participate in individual interviews. We employed inductive and deductive thematic analyses informed by socioecological theory to explain the barriers to enablers of antenatal services use among pregnant adolescent girls in low-income informal settlements.

Most adolescent girls interviewed faced barriers at multiple socioecological levels, resulting in delayed ANC initiation and fragmented engagement with services. At the intrapersonal level, girls grappled with internalised stigma and late pregnancy recognition and acceptance, often dismissing early signs due to fear or denial. Their young age and limited knowledge of maternal health left them terrified in fear, caught between societal judgement and the daunting prospect of confronting their condition. At the interpersonal level, societal stigma and discrimination pushed many into secrecy, hindering their access to antenatal services. However, parents, other family members, and health providers played a key role in enabling access to care by offering various forms of support to pregnant girls, including offering counselling and accompanying girls to clinics. At the organisational level, user fees and condescending health providers’ attitudes hindered ANC use. Yet, good patient-provider communication, privacy and confidentiality played a key role in enabling ANC attendance.

Pregnant adolescent girls face unique challenges that prevent them from accessing ANC early and completing the recommended number of visits. These challenges range from intrapersonal factors to interpersonal and organisational factors. Programmes to improve early initiation of ANC for pregnant adolescents should include interventions that address the social stigma associated with early and unintended pregnancy, promote family support and make health facilities responsive to the needs of pregnant girls.

Uncertainty exists as to what extent common risk factors are involved in the associations of unemployment with major health outcomes and mortality.

A retrospective and prospective observational study.

A large population-based French cohort (CONSTANCES).

99 430 adults at baseline who have been exposed to unemployment during their lifetime and 54 679 of them who were followed for 7 years after baseline.

Testing the mediating roles of several risk factors at baseline in the associations of lifetime unemployment exposure with cardiovascular disease, cancer and mortality rates during a 7-year follow-up. Direct and indirect effects were calculated for each risk factor and all together using logistic regression models adjusted for major confounders including sex, age, parental histories of cardiovascular disease and cancer, social position and working conditions.

Estimates (95% CIs) of the direct and indirect effects for smoking are 0.0083 (0.0044 to 0.0122), p

These analyses show that common risk factors such as smoking, alcohol consumption, depressive symptoms, leisure-time physical inactivity and blood triglycerides mediate up to 10% of the associations of lifetime unemployment exposure with cardiovascular disease, cancer and mortality rates when tested separately and approximately 20% when tested all together. This highlights the existence of other major mediating pathways that have yet to be identified.

Unintended pregnancies pose significant public health challenges globally, particularly in the Middle East and North Africa (MENA) region, where cultural, religious and societal factors play the most substantial role. This systematic review and meta-analysis investigated the pooled prevalence and factors associated with unintended pregnancies in the MENA region.

We conducted a systematic review to identify relevant studies in Medical Literature Analysis and Retriaval System (MEDLINE), Embase and Scopus published on unintended pregnancies until July 2024. We included studies that were conducted on unintended pregnancy prevalence within MENA countries and employed suitable measurement tools. We analysed data from 40 studies involving 34 837 participants across the region, including Egypt, Iran, Saudi Arabia and Qatar. We used a random-effects model to estimate the pooled prevalence of unintended pregnancy.

In this meta-analysis, we found that the overall prevalence of unintended pregnancy was 27.0% (95% CI 25.0% to 30.0%) in the MENA region, and the certainty of the evidence was moderate. Saudi Arabia had the highest prevalence of unintended pregnancy at 32.0% (95% CI 27.0% to 38.0%). A lower prevalence, 10.0% (95% CI 8.0% to 14.0%), was found in the studies that used validated tools compared with non-validated tools to measure unintended pregnancy. Between 2006 and 2010, the prevalence was 34.0% (95% CI 28.0% to 40.0%), the highest compared to other time periods . Age, rural areas, education, employment, economic status, parity, gravidity, history of miscarriage, previous pregnancies or abortion, non-use or failure of contraception methods, limited antenatal care, were associated with unintended pregnancies.

Our findings suggest that the MENA region faces a substantial burden of unintended pregnancies, with variations among countries and over time. The results emphasise the need for evidence-based interventions to address this issue, focusing on factors associated with unintended pregnancy.

Chronic health conditions are the leading causes of morbidity and mortality worldwide, with a disproportionately high burden in low-income and middle-income countries. The burden arising from these conditions presents immense challenges to countries with dysfunctional public healthcare systems, such as South Africa. This necessitates patients to have a good understanding of the conditions and optimal self-management approaches. We explored patients’ understanding of chronic health conditions and self-management practices, including self-monitoring, in the rural South African community of Agincourt in the subdistrict of Bushbuckridge, Mpumalanga Province.

We randomly selected patients receiving routine care for chronic health conditions in primary healthcare facilities who were linked to the Agincourt Health and Demographic Surveillance System to participate in focus group discussions. Six focus groups (three with men and three with women) were conducted, with 17 male and 19 female participants (n=35) living with different chronic health conditions. Data were collected using body mapping exercises and semistructured focus group discussions facilitated by two experienced qualitative research assistants. An inclusive thematic approach was used for analysis.

Participants identified most chronic health conditions and their progression. Participants expressed that some consequences of chronic health conditions were unavoidable and some were attributed to medications. Three themes emerged on the management of chronic health conditions: (1) individual-level management, where participants actively changed or managed lifestyle factors associated with the conditions; (2) clinic-level management and support, where participants believed that following instructions from healthcare providers facilitates better management of their condition(s); and (3) prevention and screening, to prevent disease progression and development of complications. Participants also highlighted the role of religion in the control of chronic disease risk factors and traditional treatments for uncommon conditions such as epilepsy. Costs associated with lifestyle changes and equipment to manage and monitor health were highlighted as barriers to self-management of chronic health conditions.

Our findings contribute to emerging research on chronic health conditions and self-management approaches. Participants in our study demonstrated a good understanding of various chronic health conditions but lacked knowledge of self-management practices and faced barriers to self-management. There is a need for further studies on self-management of chronic health conditions, including self-monitoring among patients in rural sub-Saharan settings.