Service-learning is one way to engage students in health professions and promote health literacy in the community. This paper describes developing and delivering a service-learning course designed to improve diabetes literacy and diabetes outcomes among a medically underserved population. The didactic component of the course introduced topics such as health literacy, health education techniques, and diabetes pathophysiology, prevention, and treatment. Later, students designed and delivered community diabetes education classes at a local free clinic. After the classes were offered, diabetes knowledge and self-efficacy scores improved for community members and students leading the classes. A subset of community members also had lower body mass index at a 6-month follow-up. Though COVID-19 interfered with student's ability to offer in-person education sessions in the last semester this course was offered, it provided an opportunity to examine differences in diabetes knowledge and self-efficacy scores between students who offered in-person courses versus those who were unable to go out to the community and developed an online class instead. Self-efficacy was significantly higher at the end of the semester compared to at the end of the didactic component of the class for only those students who delivered in-person community education and not for those who developed the online class, providing further evidence of the benefit of engaging with community members on student outcomes. Community members and students alike were delighted with the program. Student-led community classes can be a financially sustainable solution to improving health literacy that benefits community members and students alike.

India faces significant obstetrics related morbidity and mortality. This burden is largely addressed through the healthcare delivery via Primary Health Centres (PHCs). This scoping review aims to identify challenges in delivering obstetrics care within PHCs in India, using the WHO healthcare building blocks. A literature search covered PubMed, MEDLINE databases, and Google Scholar. Studies published from 2012 to 2022 were included based on predefined criteria. Study screenings were conducted using Covidence. Data extraction of included studies were done by 4 authors. Twenty-two studies were included for final review, mostly cross-sectional (59%), mainly from the state of Bihar (23%). Service delivery (77%) and health workforce (73%) were the most extensively discussed building blocks. Leadership and governance were the least discussed (14%). Challenges in service delivery encompassed limited antenatal care uptake, inadequate emergency obstetrics care and adjunct services, inadequate infrastructure, equipment and space and poor transport, and onward referral services. Health workforce issues included staffing levels and competency and training deficiencies in existing staff. This review highlights challenges in obstetrics care delivery within PHCs in India, primarily related to service delivery and health workforce. PHCs play a crucial role in the delivery of obstetrics services. Developing obstetrics healthcare strategy or policy needs to acknowledge the role of PHCs and address the challenges faced by PHCs in order to improve maternal health outcomes.

The COVID-19 pandemic, originating in Wuhan, China, in late 2019, swiftly escalated into a global health crisis by March 2020, severely impacting nations worldwide. The World Health Organization (WHO) faced criticism for delayed responses and underreporting, particularly from China, compounded by geopolitical tensions and funding shortages. This constrained the WHO’s ability to effectively manage the pandemic. Additionally, national responses varied significantly, influencing outcomes. Key factors contributing to the state’s failure to address COVID-19 effectively include delayed government actions, governance and leadership failures, poor communication, and inadequate economic support. Early and stringent measures, as demonstrated by New Zealand, resulted in better outcomes compared to countries like Italy and the United States, which experienced severe outbreaks due to delayed responses and inconsistent communication. Governance issues, such as the lack of cohesive strategies and leadership coordination, were evident in countries like Indonesia and Japan, leading to inconsistent policy implementation and poor outcomes. Economic support measures played a critical role in public compliance and economic stability. Countries like the UK provided substantial financial aid, yet disparities in support led to ongoing struggles for low-income families. In contrast, countries in the Global South faced significant challenges in providing adequate economic support, exacerbating existing inequalities and complicating pandemic management. Recommendations for future responses include improving targeted health interventions, enhancing community engagement in policy-making, increasing international financial and technical support, and revising global health treaties to ensure equitable resource access. These steps are essential to build more resilient health systems capable of effectively managing future global health crises.

Sierra Leone and neighbouring countries are prone to the proliferation of illicit drugs due to porous borders, weak regulatory frameworks, and the activities of transnational criminal syndicates. Among the emerging drug threats in the region is the synthetic cannabinoid known as "Kush," which has gained immense popularity. The use of this drug has surged in recent years, particularly among Sierra Leonean youths, leading to the declaration of a national state of emergency by the government. The Ministry of Health and Sanitation has been tasked with establishing a National Task Force on drugs and substance abuse to identify treatment and mitigation measures to combat Kush addiction among affected individuals. This commentary highlights the current situation of Kush abuse among youths, its usage patterns, and socioeconomic implications for Sierra Leone and the surrounding countries with key recommendations that will inform strategies for prevention, treatment, and regulation.

Public health transformation aims to instigate enduring changes in healthcare services, staff roles, and patient involvement, fostering heightened satisfaction among patients and staff while bolstering financial sustainability. This scoping review maps evidence of public health transformation. Searches encompassed databases including EBSCOHost, Academic Search Complete, Africa-Wide Information, Dentistry & Oral Sciences Source, Health Source - Consumer Edition, Health Source: Nursing/Academic Edition, PUBMED, and Scopus. Abstracts and full-text articles were screened by two independent reviewers against predefined criteria. Inclusion criteria spanned peer-reviewed articles in all languages published between 2013 and 2023. The quality of the included studies was assessed using the 2018 version of the mixed method appraisal tool. Screening results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA ScR) guidelines. Of 9509 articles retrieved, 808 duplicates were excluded, leaving 8692 for title and abstract screening. Following title and abstract screening, 105 articles were deemed relevant and underwent full article screening, which resulted in 20 that became eligible for data extraction. Emergent themes included: 1) Transformation in Public Healthcare; 2) Evaluation of Health Transformation Programs; 3) Financial Implications; 4) Public Health Access; and 5) Job Satisfaction. Theme 4 featured a subtheme addressing healthcare access for minority groups. Overall, the review highlights a dearth of evidence guiding policymakers in decision-making on public health transformation, oversight of vulnerable populations, financial implications, and healthcare accessibility. Solutions should prioritize a people-centered approach in both practice and research to effectively address these gaps.

Background Toxoplasmosis has public health importance, particularly in immunocompromised individuals such as pregnant women leading to congenital abnormalities and fetal losses. In this study, we aimed to determine the sero-prevalence of toxoplasmosis in sheep at Mandeeq Slaughter House in Hargiesa and pregnant women attending antenatal care at Hargiesa Group Hospital. Methods Cross-sectional study design with systematic random sampling method and Questionnaire surveys were used for the collection data from sheep and pregnant women. Sera were collected and examined for anti- Toxoplasma gondii antibodies using latex agglutination test. Results The overall prevalences of toxoplasmosis were 25.5% and 28% in sheep and human, respectively. Multivariable logistic regression analysis indicated that female (AOR = 2.18; 95% CI: 1.38 - 3.47; p = 0.001) and young age groups of sheep (AOR = 3.04; 95% CI: 1.04-8.86; p = 0.041) were significantly associated with Toxoplasma gondii sero-positivity. In pregnant women, age groups between 25-34 (AOR = 2. 76; 95% CI: 1.07 - 7.14; P = 0.037), pregnant women who have cats in their home (AOR = 6.45; 95% CI: 2.37-17.52; P = 0.000), women who have close contact with garden soil (AOR = 6.74; 95% CI: 2.55-17.81; P = 0.000), poor hand washing practices before food eating (AOR = 29.5; 95% CI: 5.41– 161.11; P= 0.000) and drinking tap water (AOR = 8.4; 95% CI: 2.54 – 28.08; P = 0.000) were significantly associated with Toxoplasma gondii sero-positivity. Conclusion This is the first report regarding to toxoplasmosis in Hargeisa, where pregnant women should avoid eating uncooked mutton and close contact with cats besides good hygienic practices related to food handling.

Background and Aims: The primary healthcare (PHC) system is a comprehensive, equitable, and efficient approach to supporting health and social well-being by offering prevention, treatment, and rehabilitation services close to living environments. The PHC system in Iraq is currently facing issues that limit its effectiveness and efficiency. This research aims to discover strategies to enhance the PHC system in Iraq. Methods: We conducted a systematic search for articles on initiatives aimed at enhancing the PHC system, covering the period from 1980 to June 2024, using eight databases and Google Scholar. We included articles that met the criteria and analyzed them using the framework analysis approach with RevMan 5.3 software. Results: A total of 18,705 articles were extracted. After removing duplicates and items without full text, 15,971 studies remained for title and abstract review, of which 14,175 were removed. Finally, 18 research articles related to PHC strengthening were used. Data collection methods included checking databases (12 studies), interviews (6 studies), focus groups (3 studies), questionnaires, and archival data (15 studies). The majority of research (44.45%) was conducted in Baghdad. Conclusion: In the context of Society 5.0, smart technology’s practical applications in healthcare aim to enhance decision-making, patient care, and service delivery. Smart technologies can help nurses make clinical decisions in complex care situations and streamline procedures like paperwork. When rebuilding and strengthening the PHC system, addressing the historical, social, cultural, and economic variables is important.

Introduction. Cardiovascular disease (CVD) is the leading cause of mortality in Kyrgyzstan. The study aimed at exploring the CVD prevalence depending on various risk factors across diverse ethnic groups in Kyrgyzstan Materials and Methods.A cross-sectional study was carried out among six ethnic groups in Kyrgyzstan, aged 18 years and above. The sample was stratified for age, education, family status, and income. We used a questionnaire with 47 questions to explore the health status, behaviour and lifestyle determinants and prevalence of CVD. We used Chi-Square Test to investigate differences between groups, and ANCOVA to determine differences between mean scores on analysed variable. Logistic regression was used to analyse the relationship between independent and dependent variables. Confounding variables were only included if they correlated with both the independent and dependent variables. Interaction analyses were conducted with logistic regression to investigate if there were any differences between the nationalities in the relationships between the independent and dependent variables. Results. Our study confirmed that the CVD prevalence across diverse ethnic groups can be significantly different: In Kyrgyzstan, the most disadvantaged group in this context were East European and the least – Western Asian. There was no difference between studied groups found in the ethnicity-stratified prevalence of such CVD risk factors as low fruit and vegetable consumption, alcohol intake, smoking, and BMI. There was no statistically significant association between educational attainment and CVD risk markers within the studied ethnic groups. The analysis of ethnicity-stratified prevalence of CVD risk markers resulted in a significant difference in physical activity across ethnicity groups. Conclusion. The study results provided an understanding of the ethnicity-stratified prevalence of CVD risk markers in the population in Kyrgyzstan. They could serve as instrumental in tailoring targeted public health interventions to address the burden of CVDs in specific subpopulations.

According to the Centers for Disease Control and Prevention (CDC), people living with HIV are at higher risk of smoking consequences than persons without HIV. Eswatini has put efforts in place to curb smoking in the country such as restriction of smoking in designated areas, prohibition of tobacco advertising and promotion, restrictions on tobacco packaging and labelling, but there is a dearth of literature to provide evidence on available smoking cessation programs in the country. This study aims to review and analyze the current state of smoking cessation programs in the country particularly for people living with HIV, and provide recommendations for a smoking cessation and tobacco harm reduction framework for persons living with HIV. Official documents including the National Multisectoral HIV and AIDS Strategic Framework (2018 - 2023) and the Eswatini Integrated HIV Management Guidelines (2022) provide recommendations for the screening of lifestyle factors including smoking and advice for quitting. However, sufficient light is not shed on the processes for caring for PLHIV who also smoke. The study concludes that smoking cessation and harm reduction programs for persons who smoke have not been effectively incorporated into national guidelines and programs for persons living with HIV, and thus the development of a prototype framework to guide healthcare professionals in delivering care for PLHIV who smoke across the different care models for ART delivery, including the use of Safer Nicotine products (SNPs) when necessary, can be discussed in the review of national HIV care documents.

Background: Although preventable, occupational heat-related illness (HRI) is problematic in the United States. Farmworkers are disproportionately affected by HRI compared to other workers. Uncovering barriers that farmworkers face to the prevention of HRI is crucial to reducing HRI-associated morbidity and mortality. This integrative review aimed to understand U.S. farmworkers’ barriers to preventing HRI. Methods: An integrative review occurred following Whittemore and Knafl guidelines. Literature searches occurred on PubMed, Medline, and Agricola. After applying inclusion and exclusion criteria and removing duplicates, nine articles remained for review. Results: The reviewed articles revealed several themes related to prevention barriers: access, education and training, culture, and compensation. Conclusion/implications: This review indicates the need for more research to understand the barriers farmworkers face to HRI prevention. Providing prevention measures without considering obstacles to their use is ineffective in reducing HRI. Because many farmworkers lack oversight and regulation of prevention measures, focusing on barriers and areas over which farmworkers have more control could have a significant impact.

A document by Abdulmumin Ibrahim. Click on the document to view its contents.

A document by Kenneth Egwu. Click on the document to view its contents.

Throughout the COVID-19 pandemic, effective risk communication emerged as pivotal in fostering positive behavioral changes that aligned with the evolving evidence and stages of the pandemic. It stood alongside key strategies like enhanced surveillance, extensive testing, stringent quarantine, and strategic case management in Bhutan's response. Over the past three years of the pandemic, we have gained profound insights into risk communication's impact. This article aims to illuminate diverse approaches in managing public information during the pandemic. The authors also suggest potential research agendas, and policy and system-level reforms in the realm of risk communication.

There has been a pressing necessity to tax Sugar-Sweetened Beverages (SSB) taxation in Indonesia. Despite the rising prevalence of obesity and diabetes, past attempts at introducing SSB excise taxes have been repeatedly rejected or delayed. Reflecting on other similar policies in other countries, this commentary highlights the potential of SSB taxation as a public health intervention to curb consumption and mitigate associated health risks. It examines historical legislative efforts, current challenges, and the pivotal role of political commitment in overcoming industry lobbying. The commentary outlines strategic steps for advancing SSB taxation policy, including policy design, stakeholder engagement, and robust enforcement mechanisms. Emphasis is placed on evidence-based policymaking, cross-sector collaboration, and the allocation of excise revenue towards public health initiatives. The article concludes with a call for decisive action to address Indonesia’s burgeoning public health crisis through effective SSB taxation implementation.

The soaring brain drain in the healthcare sector constitutes a pressing and formidable threat to public health in third-world countries. The increasing interconnectedness of the world has facilitated sharing of ideas and collaborations across borders, benefiting the global population. However, this has also led to the migration of skilled healthcare professionals from low-income countries to more developed nations. This is due to push factors such as the lack of proper healthcare infrastructure, low income, poor working conditions, and limited career opportunities which push healthcare workers to seek better prospects in more developed countries. Pull factors such as better remuneration, working conditions, and career advancement entice them to migrate to these countries. Consequently, the delivery of adequate healthcare services becomes severely compromised, exacerbating existing challenges in achieving public health goals. The impact of this phenomenon extends beyond mere workforce loss. It stifles local education, hinders advancements in medical research, and undermines the overall capacity to combat prevalent health issues. Urgent action is imperative to address this silent crisis. By prioritizing the improvement of domestic healthcare systems, offering competitive incentives for healthcare professionals, and fostering international collaboration, we can effectively mitigate brain drain and strengthen the foundation of public health in third-world countries. This Paper aims to identify the drivers behind brain drain, highlight implications for public health and proffer potential solutions and actionable plans to address this growing concern.

Background: The Patient Voice Program and Citizen Voice and Action models use scorecard meetings for community-provider-government dialogue to improve health services. This study evaluates the responsiveness of leaders and providers to concerns voiced by citizens through these scorecard meetings at the health center and district office levels in Rwanda. Methods: We conducted a cross-sectional study from July to September 2022 in 325 Rwandan health centers across 20 districts. Responsiveness was measured by comparing resolved issues to raised issues. Logistic regression identified predictors of issue resolution, with a p-value less than 0.05 considered significant. Median responsiveness turnaround time was also analyzed. Results: In total, 59.4% (1,163) of the identified gaps were resolved. Facility-level issues experienced a higher resolution rate (65.9%) than district-level issues (35.4%). Gaps at the facility level were 3.24 times more likely to be resolved than those at the district level (OR: 3.24, p<0.001, 95% CI: [2.48,4.25]). Integrated gaps had 1.46 times higher odds of resolution compared to issues stemming from reproductive, maternal, newborn, and child health services (OR: 1.46, p<0.05, 95% CI: [1.13,1.88]). The median responsiveness turnaround time for resolving a gap was approximately 15.4 months (IQR: 6.7-25.8). Conclusions: The study shows that Patient Voice Program and Citizen Voice and Action models are effective in addressing healthcare service gaps. By promoting collaboration among communities, healthcare providers, and governments, these models facilitate targeted, locally-supported solutions that significantly improve the resolution of health service delivery issues.

Introduction: Disrespect and abuse during childbirth represents a pervasive issue worldwide. In Rwanda, however, research in this area remains scarce. This study evaluated the factors linked to disrespect and abuse during labor and delivery in two Rwandan district hospitals. Methods: Employing a mixed method, cross-sectional design, we studied 280 women giving birth at Kabutare and Kibagabaga hospitals. Analysis was conducted with SPSS version 22, using the Chi-square test to identify factors correlated with childbirth-related disrespect and abuse. Results: Our findings revealed that 27% of women reported verbal abuse and 27.5% reported abandonment by healthcare providers, with 12% experiencing physical abuse during childbirth. Factors increasing the likelihood of experiencing disrespect and abuse included residing in rural areas [AOR=4.06, 95% CI (1.12, 14.7); p=0.03], having only primary education [AOR=2.9, 95% CI: 1.10-8.9, p=0.04], and night-time delivery [AOR=2.23, 95% CI (1.34, 3.03); p=0.03]. However, having a cesarean delivery [AOR=0.23, 95% CI: 0.09-0.59, p=0.002] or having attended antenatal care [AOR=0.28, 95% CI: 0.13-0.81, p=0.029] significantly reduced the risk of such experiences. Conclusion: The study uncovers a high incidence of disrespect and abuse during labor and delivery in Rwanda. The identified risk factors, namely rural residence, lower education, and night-time delivery, highlight specific areas requiring targeted intervention. The results advocate for effective measures to ensure dignified and equitable maternity care for all women.

This study is novel in that it quantitatively exams the impact of human brucellosis, an endemic zoonotic disease in Malta from 1919 until 1954, and the impact on reproductive loss through stillbirths. Based on regression analysis, brucellosis had a statistically significant effect (t = 2.8986, p = 0.0039) on stillbirth rate for males, but the effect of brucellosis on stillbirths is not statistically significant for females (p = 0.9103). This paper points to the importance of brucellosis, one of the most common zoonotic diseases, as having implications for health burden in women and fetuses in the contemporary context; this relationship has been largely ignored in the literature.