학술 — 오픈뉴스백과

PLOS Global Public Health

The Right to Development and disparities in healthcare access: Qualitative study from rural Ontario, Canada

by Amal Jawad, Bonny Ibhawoh, Lisa Schwartz, Andrew Kapoor The Right to Development is the UN-recognised principle that frames development as a human right, emphasising equitable access to resources and opportunities. As enshrined in the UN Declaration on Human Rights, it affirms that all individuals should be able to participate in, contribute to, and benefit from development processes, including healthcare. This study examines how ethnic minorities in Oxford County, rural Ontario, perceive their healthcare access and identify barriers to their right to development. Using a qualitative interpretive approach, in-depth semi-structured interviews were conducted with 25 participants, 16 men and 9 women, between January and April 2025. Data were analysed through Braun and Clarke’s six-step method for thematic analysis, revealing two central themes: constraints on social support and equity and inclusion policy. The first theme highlights compounded challenges, including ethnoracial stratification, social isolation, and limited social support. The second theme reflects participants’ views on accessibility, resource allocation, and inclusivity of healthcare, pointing to the need for targeted policy interventions. Findings demonstrate that while participation is critical, meaningful healthcare equity requires more substantial commitments to universality and accessibility. Applying the right to development framework advances understanding of healthcare disparities by linking inclusive participation with the practical delivery of equitable services. This study carries significant policy implications, underscoring the importance of addressing structural and cultural barriers, strengthening community support systems, and ensuring fair distribution of healthcare resources. Situating the rural Ontario case within broader global debates, the research offers insights applicable to rural and underserved populations worldwide.

PLOS Global Public Health

Migration and its impact on universal HIV testing and treatment in the HPTN 071 (PopART) study communities

by David Macleod, Sian Floyd, Kwame Shanaube, William Probert, Justin Bwalya, Ab Schaap, Timothy Skalland, Ayana Moore, Estelle Piwowar-Manning, Graeme Hoddinott, Virginia Bond, Musonda Simwinga, Nomtha Mandla, Deborah Donnell, Peter Bock, Helen Ayles, Sarah Fidler, Richard Hayes, on behalf of the PopART study team Migrants have been identified as a population left behind by the AIDS (Acquired Immune Deficiency Syndrome) response, with evidence showing poorer HIV (Human Immunodeficiency Virus) outcomes and reduced intervention effectiveness in mobile populations. We used data from the HPTN 071 (PopART) trial (ClinicalTrials.gov number, NCT01900977) to investigate migration and HIV-related indicators, assessing whether community migration influenced PopART trial results and whether migration was associated with HIV status and position on the care continuum. The PopART trial, conducted in Zambia and South Africa (SA) from November 2013 to June 2018, evaluated a universal testing and treatment intervention using a three-arm design. A cohort of 18–44-year-olds was followed annually to estimate HIV incidence, with migration out of trial communities tracked using this cohort. migration into and within the community was tracked using intervention delivery data in community members aged 18 + . HIV-related indicators were HIV status, knowledge of HIV-positive status and ART use. Migration’s influence on the trial HIV incidence results was analysed using a two-stage approach for cluster-randomised trials, adjusting for community-level migration. Associations between HIV-related indicators and both out-migration (Poisson regression using cohort data) and in-migration (logistic regression using cross-sectional data) were also estimated. While migration differed between trial arms, there was no evidence that it confounded the intervention effect on HIV incidence. There was evidence out-migration was higher among HIV-positive individuals who did not know (or did not disclose) their HIV-positive status compared to those HIV-negative (adjusted rate ratio: Zambia 1.28, 95%CI 1.17-1.39; SA 1.27, 95%CI 1.17-1.38). Residents who had moved into the community within the previous year were less likely to be aware of their HIV-positive status than longer-term residents (adjusted odds ratio: Zambia 0.18, 95%CI 0.16-0.19; SA 0.23, 95%CI 0.20-0.28) and contributed to approximately one in four of the newly identified HIV infections. Following intervention delivery the gap in knowledge of HIV status and ART treatment coverage between recent in-migrants and longer-term residents closed. Countries with high HIV burden should aim to ensure a sustained delivery of HIV services in areas with high levels of population mobility and in areas with moderate to high HIV prevalence.

PLOS Global Public Health

“Getting pregnant at a young age doesn’t mean your life’s going to end”: A qualitative inquiry with older AI/AN youth participants of an evidence-based teen pregnancy prevention program

by Gabrielle S. Evans-Mitchell, Abagail Edwards, Barbara Harvey, Christopher G. Kemp, Abagail Walsh, Jennifer Richards AI/AN youth experience inequities in sexual health outcomes, including higher rates of sexually transmitted infections (STIs) and teen pregnancies, that are compounded by barriers to healthcare access and a lack of culturally competent services. Navajo Nation youth follow the same trends of overall AI/AN youth with high rates of STIs, teen pregnancies, and behaviors that predict such outcomes, such as early sexual initiation and early substance use initiation. These alarming reproductive health inequities call for urgent and culturally tailored sexual health education for Navajo and AI/AN youth. Respecting the Circle of Life (RCL) is one of the first sexual and reproductive health programs to be developed and rigorously evaluated with AI/AN youth. Previous evaluations of RCL on the Navajo Nation found the program to be most effective with younger youth, aged 11–14. To better understand how the program can serve older youth, we investigated the experiences of youth aged 15–19 on the Navajo Nation who had previously participated in the RCL program as part of a demonstration study during and after the COVID-19 pandemic. A purposive sample of AI/AN youth participants (n = 6) was interviewed to solicit feedback and experiences from the program. Our thematic analysis revealed four key themes that reflect the experiences of older youth (ages 15 – 19) who previously participated in the RCL program: (1) interactive and group-based learning, (2) peer and facilitator dynamics, (3) balanced and culturally relevant content, and (4) shifts in knowledge and attitudes. Youth reported meaningful shifts in knowledge, confidence, and perspective regarding their sexual health. They also expressed a clear need for deeper cultural alignment and age-relevant content. As Indigenous communities continue to reclaim and revitalize their approaches to sexual and reproductive health, programs like RCL must evolve to reflect the realities, resilience, and aspirations of all youth.

PLOS Global Public Health

Implementation research for advancing health equity: Design and competency-based assessment of a short-term implementation research training program focused on health equity in global health

by Anna Helova, Kevin Owuor, Camryn Durham, Erin Tech, Olakunle Alonge Implementation research (IR) provides tools to address health inequities and complex global health issues, facilitating real-world health impact at scale. Limited training opportunities exist for applying IR to health inequities. The 2024 Sparkman Center for Global Health Summer Institute (SI) in the School of Public Health, University of Alabama at Birmingham, provided a one-week intensive workshop that introduced concepts, methodologies, and applications of IR in global health settings, explicitly targeting health inequities. This paper describes a competency-based assessment of SI. We utilized the reliability- and validity-tested Self-evaluation of Implementation Research Competencies and Objective Assessment questionnaires. Analyses included pre/post-SI comparisons of self-assessed knowledge, self-efficacy, and objective knowledge scores; associations between participant characteristics and changes in knowledge/self-efficacy scores; and explored psychometric properties of the objective assessment tool to estimate item difficulty and discrimination parameters. Open-ended questions were analyzed thematically to reveal participant experiences, perceived relevance of the training, and suggestions for future improvement. SI was completed by 28 participants from 12 countries working on various global health topics. Equity considerations within projects focused on social/structural barriers, differentiating outcomes, and strategies to target disadvantaged groups within IR. Significant improvements were observed across IR domains, with the mean self-assessed knowledge increasing from 57.67% [Confidence interval (CI):43.78; 71.55] to 87.68% (CI: 76.96;98.41), p = 0.003, and the largest improvements in competencies related to stakeholder engagement, scientific inquiry, and the application of IR strategies to real-world problems. Objective assessment scores demonstrated modest, nonsignificant improvement, increasing from 65.35% (CI: 61.28;69.41) to 68.18% (CI: 64.38;71.97), p = 0.324). Participants reported high satisfaction with SI’s structure, content, and delivery, highlighting its practical focus on stakeholder engagement, real-world case studies, mentorship, networking, calling for continued mentorship engagement and further training. This evaluation will be used to improve the impact of IR training in global health settings, emphasizing importance of hands-on application of IR concepts in tackling health inequities.

PLOS Global Public Health

The Epidemiology of colorectal cancer in Guangzhou, China: A cross-sectional and age-period-cohort study

by Di Wu, Ke Tang, Yinru Liang, Huan Xu, Yuanyuan Chen, Suixiang Wang, Dedong Wang, Boheng Liang, Lei Yang To explore the epidemiological features and trends of colorectal cancer (CRC) incidence and mortality in Guangzhou, and offering scientific evidence for its prevention and control. Cross-sectional study with Joinpoint regression analysis was utilized to analyze CRC incidence and mortality trends. The age-period-cohort model was applied to evaluate the impacts of age, period, and birth cohort on CRC incidence and mortality. 36086 CRC cases and 15557 deaths were reported, 2011–2020. The age-standardized incidence rate increased from 23.20/100,000 in 2011 to 27.10/100,000 in 2020 (AAPC = 1.90%, 95% CI: 1.04% - 2.77%, P < 0.01), with significant rises in both the 0–49 age group and those aged 50 and above. The age-standardized mortality rate changed from 8.97/ 100,000 in 2011 to 9.55/100,000 in 2020, showing a stable, non - significant trend. The 5-year survival rate for CRC patients in Guangzhou was 46.27%. The APC model showed that CRC incidence and mortality generally increased with age. The period effect had an initial rise then a decline in risk, and CRC incidence risk increased with birth cohort while mortality risk first rose, peaked in the late 1950s, and then decreased. During 2011–2020, CRC incidence in Guangzhou showed an upward trend, while mortality was stable. Men had higher incidence and mortality than women. Rates were higher in those aged 50 and above, and there was a rising trend among those under 50. Promoting CRC prevention awareness, enhancing early diagnosis, and advocating healthy lifestyles are crucial.

PLOS Global Public Health

Barriers and facilitators to pre-exposure prophylaxis uptake among high-risk women and men who have sex with men in Georgia: A pre-implementation mixed-methods study using nominal group technique and the COM-B model

by Tamar Mgebrishvili, Irma Kirtadze, David Otiashvili, Mariam Sherozia, David Oliveros, Frederick L. Altice While pre-exposure prophylaxis (PrEP) research predominantly focuses on men who have sex with men (MSM), PrEP uptake among women who use drugs (WWUD), female sex workers (FSWs), and female partners of people who inject drugs (PWID) is limited. This study fills a critical gap in the literature by examining the unique barriers and facilitators to PrEP uptake among these under-researched female populations, relative to MSM. This pre-implementation study employed a human-centered design approach guided by the Capability, Opportunity, and Motivation-Behavior (COM-B) model. Five focus group sessions using nominal group technique (NGT) were conducted with 66 participants from key populations (MSM, WWUD, FSWs, and female partners of PWID) across three cities (Tbilisi, Kutaisi, and Batumi) to systematically generate and prioritize barriers and facilitators. This study applied the Behavior Change Wheel (BCW) framework to map identified barriers and facilitators to specific intervention functions, highlighting actionable strategies to improve PrEP uptake. Semi-structured interviews with healthcare providers were conducted to contextualize system-level factors. Participants prioritized 15 distinct barriers, with clear differences between groups. MSM most often identified opportunity-related barriers, such as rigid clinic hours, confidentiality concerns, and prior negative healthcare experiences. In contrast, women primarily reported informational and social barriers, including lack of accurate information about PrEP and eligibility, anticipated stigma, and fear of being seen at AIDS centers. Other top barriers included low perceived HIV risk and fear of social stigma. Key facilitators included providing PrEP in neutral, non-stigmatizing delivery settings (i.e., separate from AIDS centers or MSM-specific venues) and offering tele-PrEP and injectable options. Provider insights aligned with participant findings. Findings highlight the need for better access to information and alternative PrEP delivery strategies that decouple PrEP from AIDS centers and MSM-identified venues, including neutral access points, tele-PrEP models, pharmacy or primary care delivery to improve acceptability and reach among at-risk women.

PLOS Global Public Health

Experiences and understanding of diagnosis and treatment among drug-resistant extrapulmonary tuberculosis patients: A qualitative study from Central India

by Gautam Bhagwat, Pavan Asalampuram, Arti Julka, Cecilia Stålsby Lundborg, Manju Purohit Extrapulmonary tuberculosis (EPTB) accounts for 15–20% of tuberculosis (TB) cases in immunocompetent individuals and over 50% in people living with Human immunodeficiency virus (HIV). Drug-resistant EPTB presents unique diagnostic and treatment challenges, yet patient experiences remain poorly understood. This study explores how patients with drug-resistant-EPTB perceive and navigate disease acquisition, diagnosis, and treatment within the Indian context. A qualitative study was conducted between January 2022 and July 2024 using in-depth individual interviews with 18 patients diagnosed with drug-resistant-EPTB at a tertiary care centre in Central India. Participants were purposively selected to ensure variation in age, gender, and disease site. Interviews were audio-recorded, transcribed verbatim, and analysed thematically following a structured coding framework. Reporting adhered to COREQ guidelines. Patient experiences were characterized by a “pathway of uncertainty” spanning disease understanding, diagnosis, and treatment. Three major themes emerged. First, limited understanding of EPTB and drug resistance, with misconceptions regarding disease presentation and confusion about the origins of drug resistance, including limited awareness of primary transmission. Second, fragmented diagnostic pathways, marked by delayed diagnosis, multiple healthcare encounters, and reliance on informal care, often compounded by non-specific clinical presentations. Third, uncertainty during treatment, driven by adverse drug effects, lack of clear monitoring indicators, and inadequate communication. These challenges were accompanied by significant socioeconomic and psychosocial impacts, including financial strain, stigma, and gendered vulnerabilities, with some effects persisting beyond treatment. Drug-resistant -EPTB patient experiences reflect interconnected challenges that extend beyond clinical management, forming a continuum of uncertainty across the care pathway. Addressing these requires improved patient-centered communication, strengthened diagnostic pathways, and greater attention to the specific needs of drug-resistant -EPTB within TB control programmes.

PLOS Global Public Health

Health issues and needs among adolescents in Ethiopia: A cross-sectional study

by Adamu Amanu Asari, Ameyu Godesso, Zewdie Birhanu Adolescence, which is a critical foundation for lifelong health, comes with distinct health challenges and needs. Understanding these is crucial for timely and effective measures. This study therefore examines adolescent health issues and needs and identifies unmet health information and service needs, including differences by sex, grade level, and school type, to inform tailored and effective interventions. The study employed a cross-sectional design involving school adolescents. Respondents were randomly selected after stratification by sex at grade level. Data were collected using a self-administered questionnaire that was informed by qualitative findings. Descriptive statistics were used to summarize the data, and Pearson’s chi-square tests evaluated differences by sex, grade level, and school type, in SPSS 27.0. Of the 722 adolescents participated in this study, 27.6% reported recent health problems related to mental health, reproductive health, and other issues. Respondents identified risky sexual behaviors, substance use, mental health issues, and social media addiction as major health concerns among adolescents, with sex-based differences in perceived priorities. About 73% of the respondents reported seeking health information and services for various reasons, with females were more likely to do so than males (p = 0.025). They reported often consulting parents, friends, the Internet, and health professionals, in that order, while seeking health information, with variations by school type and grade level. However, they trusted health professionals most, followed by the Internet, television/radio, and family. Only 32.7% of the respondents reported that they could access health service when needed. Adolescents from private schools were significantly more likely than those from public schools to do so (p < 0.001). Overall, the study shows that adolescent health challenges and needs are multifaceted, demanding tailored interventions, including effective multichannel health communication, promotion of health literacy, strong parental and community involvement, and accessible adolescent-friendly health services.

PLOS Global Public Health

Food purchase patterns in Nairobi before, during, and after the COVID-19 pandemic lockdown measures

by Reinpeter Momanyi, Tatenda Duncan Kavu, Daniel Mtai Mwanga, Caroline H. Karugu, Steve Cygu, Gershim Asiki, Agnes Kiragga The nationwide lockdown measures implemented during the coronavirus disease 2019 (COVID-19) pandemic disrupted food supply systems, potentially altering consumer purchasing behaviour. There is limited evidence quantifying these changes in low- and middle-income settings. This study aimed to examine the impact of COVID-19 on grocery purchase patterns among consumers in Nairobi. Using generalized least squares (GLS), we conducted an interrupted time series (ITS) analysis of weekly food purchase data from 2018 to 2023. The analysis considered three periods: pre-COVID (12th January 2018–26th March 2020), COVID (27th March 2020–21st October 2021), and post-COVID (22nd October 2021–31st December 2023). A total of 11,105,974 transactions from two supermarkets in Nairobi were classified using the NOVA food classification and linked with nutrient composition data. Compared to the pre-COVID period, characterized by declining purchases of processed culinary, unprocessed/minimally processed foods, and increasing ultra-processed food (UPF) purchases, the COVID period was associated with a short-term change toward healthier purchasing patterns, including reduced UPF, with increased processed and unprocessed/minimally processed food purchases. Nutritionally, pre-COVID trends of rising energy and carbohydrate purchases and declining proteins, calcium, iron, magnesium, potassium, and sodium, were contrasted by short-term increases during COVID in fibre, iron, magnesium, phosphorus, potassium, and sodium, alongside a long-term decline in carbohydrates. Proteins showed consistent short- and long-term increases, while calcium rose sharply at COVID onset but declined over time. In comparison, the post-COVID period reflected a reversal of these changes. While processed food purchases increased briefly before declining, longer-term trends showed increases in calcium, sodium, and carbohydrate purchases and decreases in energy and fat. These findings shed light on how populations adapt their food purchasing behaviors during and after global crises, offering insights that can inform future policies aimed at curbing unhealthy food purchases and strengthening food security.

PLOS Global Public Health

Target product profiles of laboratory and data analytical frameworks for genotyping to monitor antimalarial efficacy

by Mateusz M. Plucinski, Amy Wesolowski, Inna Gerlovina, Aimee R. Taylor, Jessica Briggs, Andrés Aranda-Díaz, Monica Golumbeanu, Marko Bajic, Jeffrey A. Bailey, Joel L. N. Barratt, Caroline Buckee, Awa B. Deme, Ingrid Felger, Anita Ghansah, Ian Hastings, Johanna Helena Kattenberg, Alfredo Mayor, Didier Menard, Leah F. Moriarty, Daniel Neafsey, Lucy Okell, Isabella Oyier, Jaishree Raman, Philip J. Rosenthal, Anna Rosanas-Urgell, Robert Verity, Sarah K. Volkman, Christian Nsanzabana, Bryan Greenhouse Therapeutic efficacy studies (TESs) are the standard to evaluate antimalarial drug efficacy and guide malaria treatment policy. TESs are particularly relevant now, with resistance to first-line regimens emerging in sub-Saharan Africa. For TESs, a range of parasite genotyping and data analyses are available for genotype correction, a process to distinguish whether recurrent parasitemia after therapy is due to recrudescence of initially infecting parasites (treatment failure) or a new infection. The choice of methods for laboratory genotyping and data analyses can have a large effect on how outcomes are classified, and thereby on trial results. The currently recommended and most widely used laboratory and analytical methods for TES genotyping do not incorporate recent methodological advances and can produce biased results. As such current TES results can be difficult to interpret, especially in areas with high malaria transmission, such as much of sub-Saharan Africa. Thus, improving the accuracy and reliability of TES genotyping and data analysis are a major priority. To that end, we present target product profiles that outline key specifications for genetic data generation, processing, and data analysis, with the goal of creating rigorous and consistent community standards. Primary recommended specifications for laboratory methods include high sensitivity, specificity, and reproducibility, and guidance on the number and genetic diversity of targets; criteria which are best and likely only met by amplicon sequencing. Primary recommendations for data analysis methods include high classification accuracy, accounting for errors in genotyping, and accounting for alleles matching by chance. All laboratory and data analysis methods used should be systematically validated and publicly documented so that TES results, which have major policy implications, can be relied upon for sound programmatic decision making.

PLOS Global Public Health

Converting donor dependence to domestic ownership: The realignment of tuberculosis financing for sustainability

by William A. Wells, Sarah Scheening, Saba Waseem, Amanda Schulhofer, Yemelaknesh Wolde, Guy Stallworthy The financing of tuberculosis (TB) programs in high burden countries (HBCs) requires an overhaul. Donor funding for TB has often bypassed domestic channels, decreased the incentive for engagement between national TB programs and national budget holders, and provided minimal assistance to improve domestic TB budgeting processes. The result is local budgeting and financial management processes that do not efficiently and effectively meet both curative and public health TB needs. Meanwhile, donor TB funding has become less certain. Our analysis suggests that, in almost three quarters of high TB burden countries, increases in health budgets and in the proportion of health budgets dedicated to TB could compensate financially for a complete withdrawal of donor funding for TB. However, marginalized populations may be left behind and, in countries with less resources, major gaps will remain. Ministries of Health and Finance should assess whether the country can pay for more of its own TB response; this includes defining TB-specific financing needs, and assigning these needs to specific domestic financing sources. They should also demand that future TB donor funds flow through domestic channels, and prioritise TB in their engagement with Multilateral Development Banks (MDBs). Donors and MDBs should: renew their commitment to funding TB; ensure that TB donor funds and TB loans flow through domestic systems; communicate more clearly around transition; provide assistance related to advocacy, accountability, and the raising, allocation and more efficient use of domestic TB funding; and target TB implementation funding to lower-income countries where it is most urgently needed. The end result would be national TB programs that are system-aligned, with donor support that is more clearly differentiated between implementation and system building in lower-income countries and addressing health system constraints in middle-income countries.

PLOS Global Public Health

A reliable and inclusive method for assessing failure-causing mechanical wear in prosthetic feet

by Michael A. Berthaume, Sikandar Qayyum, Ryley Ofoedu, Taosif Mohammad, Reza Hematti, Nana Akosua Asamoa-Bonsu, Someya Ali, Gemma Ranson Wear assessment of prosthetic feet is critical for monitoring device performance and replacement, especially in rural or resource constrained areas where clinical follow-ups can be infrequent. Standardised, reliable methods for wear evaluation are limited. This study investigates the inter-observer reliability of a method for quantifying patterns and relative magnitudes of plantar surface wear of prosthetic feet and presents preliminary results for intra-observer error. Sixty-two plantar images of used SACH feet from Sri Lanka were scored by four independent groups a published method for quantifying prosthetic foot wear. A 20x10 grid was applied to each image, and wear was scored from 0–9 per cell based on visual indicators. Interobserver agreement was assessed on full (48 feet, 4 raters) and reduced (62 feet, 3 raters) datasets. Intraobserver reliability was tested by 2 raters re-scoring five images after 5 + days. Kendall’s W evaluated agreement, and a modified scoring method was developed and evaluated. Interobserver agreement ranged from fair to excellent and was higher in the reduced dataset. Intraobserver agreement appears high, especially in central, less-worn areas of the foot. The modified method showed reduced intraobserver variability but lower interobserver agreement, largely due to increased ties affecting Kendall’s W, not increased disagreement. The original and modified methods for wear qualification demonstrate high reliability, supporting their use as a low-cost, field-appropriate tool for monitoring prosthetic foot wear to enhance the evaluation and design of prosthetic feet, particularly in resource-limited settings. While the full method provides higher resolution data, the reduced method is more broadly applicable to different foot types. Clinically, this method offers a reliable, scalable approach to assessing prosthetic foot wear, potentially supporting community-based monitoring. Further testing and methodological alterations to encompass additional foot designs are required for clinical use.

PLOS Global Public Health

Assessment of knowledge on self-management and level of asthma control among patients attending a tertiary care center in Nepal: A cross-sectional study

by Swojay Maharjan, Rajesh Khatri Chhetri, Ashok Basnet, Sirapa Maharjan, Kushal Shrestha, Shashwot Sedhain, Helina Singh, Kiran Dhonju Asthma is a major public health challenge globally and is characterized by recurrent attacks of breathlessness and wheezing that vary in severity and frequency from person to person. With a notable burden in Nepal, where prevalence ranges from 4.2% to 8.9%, effective asthma management requires both updated pharmacological treatments and robust self-management practices, which involve monitoring symptoms and preventing exacerbations. In settings like Nepal, where asthma prevalence and resource limitations are concerns, enhancing patient education and behavioral interventions is crucial for better disease control. An analytical cross-sectional study was conducted to find the relationship between asthma control levels and asthma self-management at a tertiary care center from 25th May 2024 to 15th November 2024 in Nepal. The convenience sampling method was used. To evaluate differences in asthma self-management knowledge, a non-parametric statistical test was applied to the scores from the Asthma Self-Management Knowledge Questionnaire (ASMQ), which were categorized by independent variables. A p-value of < 0.05 was considered as statistically significant. A total of 145 patients had participated in our study. The mean (SD) transformed ASMQ score was 26.22 (13.32). Based on ACT scores, asthma control levels were classified as uncontrolled (40%), partially controlled (54.5%), and controlled (5%). The Kruskal-Wallis H test revealed a statistically significant difference in ASMQ scores across education levels (p = 0.047), occupation (p = 0.015) and subgroups of the asthma control test (p = 0.011). Post hoc analysis using the Dunn-Bonferroni test indicated a statistically significant difference in ASMQ scores between individuals with uncontrolled asthma and partially controlled asthma. The findings of our study suggest that asthma self-management knowledge is suboptimal and correlates with asthma control levels, emphasizing the critical importance of effective patient education and assessment in achieving optimal disease management.

PLOS Global Public Health

Assessing the levels of utilisation of WHO-recommended healthcare waste disposal practices at healthcare service delivery points in Uganda

by Shafik Senkubuge, Lydia Kabwijamu, Sarah Nabukeera, Andrew K. Tusubira, Timothy Kasule, Fredrick E. Makumbi, Samuel Etajak, Christine Nalwadda Kayemba Inadequate healthcare waste management (HCWM) poses substantial challenges to public health, environmental sustainability and community wellbeing. Safe healthcare waste disposal practices (HWDP) at healthcare facilities are essential to protect staff, patients, caregivers, and the wider public. Achieving this requires consistent use of appropriate final waste disposal practices at each healthcare facility. This study assessed the level of utilisation of World Health Organisation (WHO) - recommended healthcare waste disposal practices at healthcare service delivery points (HSDP) in Uganda. A cross-sectional survey was conducted among 681 randomly selected HSDP from 15 sub-regions of Uganda between September and December 2023. Facilities were categorised into primary, secondary and tertiary levels. The sample was drawn from a national sampling frame of 6,929 HSDP reported through the District Health Information System platform in 2020. At each HSDP, the study assessed the extent to which WHO-recommended HWDP were utilised. Findings showed that over 70% of the surveyed HSDP utilised WHO non-recommended HWDP such as on-site burning, burial, and disposal with general waste. Among primary-level facilities, 30.2% disposed of healthcare waste with regular garbage, 17.3% burnt the waste, and 24.3% buried it within facility grounds. In contrast, 31.7% of secondary-level facilities reported using centralised collection services by specialised agencies. Over half of tertiary facilities (58.3%) disposed of waste with regular garbage, while only 12.5% used incinerators. Regional differences were evident, with disposal alongside general garbage particularly high in Kampala (92.7%) compared to Karamoja (5.3%). Urban HSDP were also more likely to use this method (59.4%) than rural facilities (19.5%). Overall, the nation-wide assessment presents critical gaps in the availability and utilization of WHO-recommended healthcare waste disposal practices across HSDP levels, management types, residence settings, and regions. Addressing these gaps requires targeted interventions, including strengthening guideline enforcement, improving infrastructure, and enhancing compliance with healthcare waste management regulations.

PLOS Global Public Health

Perception of artificial intelligence and machine learning applications in the Nigerian healthcare sector: A cross-sectional study

by Obi Peter Adigwe, Godspower Onavbavba Artificial intelligence (AI) has significant benefits across various facets of healthcare delivery, notably in personalised pharmacotherapy and the development of targeted health interventions for specific demographic groups. This study aimed to comprehensively evaluate the applications of AI and machine learning (ML) from the perspectives of healthcare professionals in Nigeria. A cross-sectional study design was adopted, and responses were obtained from healthcare professionals across the six geopolitical zones in Nigeria. Data were collected with the aid of a well-structured questionnaire, and a stratified multistage sampling method was employed. Statistical Package for Social Sciences (SPSS) software version 25 was used to analyse the data generated. The results of descriptive analysis and inferential analysis were generated and discussed appropriately. Pharmacists (27.7%), physicians (24.5%), and nurses (19.3%) comprised the largest professional groups, with females representing 55.7% of participants. Most respondents (68.3%) were aged 18–30 years. Two-thirds (67.3%) agreed that ML algorithms can enhance research processes, and a similar proportion (69.5%) believed AI could accelerate drug discovery. Regarding clinical decision-making, 66.6% indicated that AI can support physicians by processing unstructured data, while 77% felt AI and ML could improve pharmaceutical manufacturing. This study revealed positive perceptions from healthcare professionals regarding the applications of AI and ML in the Nigerian health sector. The findings from this study indicate the readiness of the health workforce for a large-scale implementation of AI technologies in the sector.

PLOS Global Public Health

Characterizing acute and persistent symptoms of COVID-19 among adults and children in rural Zambia, 2020–2022

by Catherine G. Sutcliffe, Pamela Sinywimaanzi, Mutinta Hamahuwa, Juliet Morales, Adriana van de Guchte, Morris Sianyanda, Zain Khalil, Passwell Munachoonga, Ana Silvia Gonzalez-Reiche, Mathias Muleka, Katherine Z. J. Fenstermacher, Mwaka Monze, Harm van Bakel, Richard E. Rothman, Andrew Pekosz, Edgar Simulundu Since emerging in December 2019, SARS-CoV-2 has led to significant morbidity and mortality globally. While much is known about SARS-CoV-2 infection and sequelae, fewer studies have been conducted in sub-Saharan Africa. This study was conducted to characterize acute and persistent symptoms of COVID-19 among adults and children in rural Zambia. From December 2020 to March 2022, individuals of all ages with acute SARS-CoV-2 infection (n = 132) were recruited into a cohort study. For comparison, individuals with acute influenza infection (n = 56) were also recruited. Participants were followed at 30, 90, 180, and 365 days. Most adult COVID-19 participants (median age: 36 years; 54% male; 11% had received the COVID-19 vaccine) were symptomatic at enrollment (92%), but few were hospitalized (9%). The most common symptoms were cough, headache, fever, and body aches. Most symptoms resolved by 30 days; the proportion reporting symptoms at follow-up visits ranged from 11% to 19%. Common symptoms at follow-up visits included cough, runny nose, headache, body aches, and fatigue. Similarly, most child COVID-19 participants (86%) were symptomatic at enrollment (median age: 13 years; 57% male; none had received the COVID-19 vaccine) and none were hospitalized. The most common symptoms were cough, fever, headache, and runny nose with most symptoms resolving by 30 days. The proportion reporting symptoms at follow-up visits ranged from 13% to 20%. Common symptoms included cough, fever, headache and runny nose. For comparison, adult and child participants with influenza virus infection were evaluated. The proportion reporting symptoms at follow-up visits ranged from 16% to 32%. This study adds to the literature on the clinical characteristics of acute SARS-CoV-2 infection and persistent symptoms in the first two years of the pandemic in an underrepresented region.

PLOS Global Public Health

Probation as a targeted entry point for scaling up opioid agonist therapies in Moldova using a modified screening, brief intervention and referral to treatment strategy

by Matthew N. Ponticiello, Daniel J. Bromberg, Lyu Azbel, Sergiu Cugut, Svetlana Doltu, Frederick L. Altice People with HIV and opioid use disorder (OUD) are concentrated in criminal legal settings. Consequently, decarceration efforts in Moldova have shifted many people in prisons to community supervision in probation. Probation differs from prisons as they have no mandate to screen and treat for medical conditions like OUD and link to evidence-based treatments like methadone or buprenorphine, otherwise known as medications for opioid use disorder (MOUD). We hypothesized that probation settings are a missed opportunity to screen and link to treatment for HIV and OUD. From November 2019 to April 2023, 900 consecutive entrants to 10 probation centers across Moldova underwent a modified screening, brief intervention, and referral to treatment (SBIRT) strategy to identify people on probation with OUD and link them to MOUD; testing for HIV, HCV, HBV, and syphilis was bundled for efficiency. Among those screening positive for OUD, interest in MOUD was assessed before and after the brief intervention. For those interested in MOUD, they were referred to treatment. MOUD interest was assessed using a single-item screening instrument, where higher scores were associated with greater interest in starting MOUD. Overall (N = 900), 15.1% (N = 136) participants met screening criteria for OUD, of which 119 (87.5%) were eligible for and enrolled in the brief intervention. Interest in MOUD after the brief intervention increased modestly, but significantly (p < 0.001). Overall, 33 (27.7%) of 119 participants initiated MOUD, and 32 (97%) of these were retained on treatment over 6-months. Predictors of initiating MOUD were perceiving MOUD to be an important treatment for OUD and having HCV and HIV. Twenty-seven (22.7%) tested positive for HIV, with 7 (25.9%) being newly diagnosed during the screening procedures. Rapid screening strategies can identify and provide opportunities for treatment for multiple interrelated chronic conditions. Implementation opportunities, however, will require aligning public safety mandates in probation with public health.

PLOS Global Public Health

Organization-level determinants for low secondary traumatic stress in lay counselors delivering trauma-focused cognitive behavioral therapy in Kenya

by Priya Dahiya, Clara Johnson, Rashed AlRasheed, Christine L. Gray, Rosemary Meza, Kathryn Whetten, Daisy Anyango Okoth, Omariba Anne Nyaboke, Shannon Dorsey Eighty percent of the world’s youth live in low- and middle-income countries (LMICs), yet access to trauma-focused mental health care in these settings remains limited despite a high burden of mental health disorders and trauma exposure among youth. Task-shifting models that train lay counselors to deliver evidence-based treatments can expand access to care, yet delivering trauma-focused treatment may increase counselors’ vulnerability to secondary traumatic stress (STS). Organization-level support may play an important role in sustaining counselor well-being, yet little is known about which organizational factors are protective (i.e., contribute to low STS) in resource-limited settings. Data came from an implementation-effectiveness trial for an adapted trauma-focused cognitive behavioral therapy in western Kenya, to examine organizational factors linked to low STS among two groups of lay counselors: community health volunteers (CHVs; N = 120) and teachers (N = 117). Counselors completed surveys following training and treatment delivery that assessed supervisory relationships, leadership, implementation climate, feasibility, and organizational climate. We applied Coincidence Analysis, a configurational method, to identify organization-level determinants of low STS. Among CHVs, a solution with three pathways was identified for low STS: high supervision relationship; high implementation climate with high implementation leadership; and high feasibility with high transactional leadership. Among teachers, a different solution with three pathways emerged: high implementation climate; high supervisory relationship with a positive organizational climate via perceived work environment; and low transactional leadership with high transformational leadership. No single organizational factor was necessary for low STS. Instead, multiple configurations were sufficient, and these differed across provider roles and their organizational contexts. These findings suggest that organizational strategies to prevent or mitigate STS should be tailored to provider roles and settings. As task-shifting models expand in LMICs, centering lay counselors’ well-being within organizational management and treatment development will be critical to sustaining the workforce and ensuring quality trauma-focused care.

PLOS Global Public Health

Targeting a future generation free from female genital mutilation: A mixed-methods quasi-experimental study of an awareness intervention in central Tanzania

by Leah Barthalome Kimario, Manji Nyaganya Isack, Beatrice Zakaria Temba, Agnes Cyril Msoka, Blandina Theophil Mmbaga Female genital mutilation (FGM) persists in Tanzania, with the Dodoma Region having the country’s second-highest prevalence. This study evaluated a community-based educational intervention aimed at increasing FGM awareness and encouraging its abandonment among young adults (15–19 years) in Chamwino District, Dodoma, an important yet often overlooked group for fostering intergenerational change. We conducted a mixed-methods study with a primary quasi-experimental component: a single-arm, baseline-to-endline survey with a multi-stage cluster sample of 452 young adults who completed follow-up from schools and hospitals. Secondary components included a clinical audit of 3,770 delivering mothers to determine FGM prevalence and in-depth interviews with ten young adult mothers who had undergone FGM. The primary outcome was the change in the mean awareness score, analyzed using a paired t-test, with linear regression estimating associations with participants’ demographics. Changes in binary secondary outcome measures were analyzed using McNemar’s test, and the association between them was assessed with the chi-square test. The mean awareness score increased by 15.04 percentage points from 44.08% (SD = 15.85) at baseline to 59.12% (SD = 16.85), p < .001. At endline, 96.5% believed FGM is harmful, 50.9% reported its continuation, 97.6% knew it violates the human rights of girls and women, and 95.8% expressed a desire for abandonment. About 7.3% of women self-reported positive FGM status at baseline, while 16.6% were observed in 9-months. Qualitative analysis yielded three themes: 1) The hidden system, 2) Blood and lies, and 3) Intergenerational revolt. This theory-informed, community-engaged intervention significantly improved awareness and attitudes among more than 1,700 community members. However, qualitative findings revealed a persistent “hidden system” and a “critical power gap” among young adults, indicating awareness alone is insufficient. Sustainable abandonment requires integrating awareness campaigns with strategies that address structural power dynamics.

PLOS Global Public Health

Prevalence, severity and correlates of dysmenorrhea among postpartum women in Western Kenya: A cross-sectional study

by Madalitso Khwepeya, Jillian Pintye, Felix Abuna, Amritha Bhat, Daniel A. Enquobahrie, Lauren Gomez, Grace John-Stewart, John Kinuthia, Mary Marwa, Nancy Ngumbau, Ben Odhiambo, Salphine Watoyi, Joshua Stern, Anna Larsen Dysmenorrhea is the most common menstrual disorder globally, contributing the highest disease burden of any gynecological issue in low- and middle-income countries (LMICs). Yet, limited data exist on dysmenorrhea among women in LMICs, particularly in Sub-Saharan Africa, including countries like Kenya. We conducted a cross-sectional analysis using data from the PrIMA-Extension Study, a large prospective cohort study that enrolled women during pregnancy and followed mother-child pairs up to 60 months post-delivery in four clinics in Western Kenya. At 24 months post-delivery, we assessed prevalence, severity, and correlates of dysmenorrhea using the Cox Menstrual Symptom Scale. Moderate-to-severe dysmenorrhea was defined as ≥1 symptom that was moderately to very severely bothersome. Poisson regression models identified correlates of moderate-to-severe dysmenorrhea. Among 277 women (median age: 27 years, IQR: 24–31), 24% (n = 67) had moderate-to-severe dysmenorrhea. Women predominantly reported cramps (46%), abdominal pain (34%), headaches (13%), weakness (8%), and dizziness (8%), lasting 3–7 hours or longer. Severe symptoms of dysmenorrhea most often reported were cramps (17%), abdominal pain (12%), headaches (4%), and weakness (3%). In a multivariate analysis adjusted for age and current breastfeeding status, moderate-to-severe dysmenorrhea was associated with high scores of adverse childhood experiences (ACEs; adjusted PR [aPR]=1.71, 95% CI: 1.04–2.79, p = 0.03), spending time in bed due to menstrual problems (aPR = 3.11, 95% CI: 1.88–5.14, p < 0.001), and taking painkillers (aPR = 4.12, 95% CI: 2.52–6.73, p < 0.001). Adjusting for age, current breastfeeding was associated with a higher frequency of moderate-to-severe dysmenorrhea (aPR = 1.66, 95% CI: 1.02–2.71, p = 0.04). At 2 years postpartum, nearly 1 in 4 women reported moderate-to-severe dysmenorrhea, associated with ACEs and resulting in daily functional interruptions. These findings underscore the need for routine menstrual health assessment during care and integrated approaches addressing pain management and psychosocial support.