Essential Services Research Articles

Influence of Insecticide Application on Pollinators and Predatory Arthropods in Watermelon Agroecosystem

This study, conducted from January to April 2021 in Kandavara village, Karnataka, examined the effects of various insecticides on honeybees, spiders, and coccinellids in watermelon crops. Using a randomized complete block design, watermelon plants were treated with insecticides when pest populations reached economic thresholds. Honeybee foraging activity and populations of spiders and coccinellids were monitored before treatment and at 3,7 and 10 days post-application. Results showed that untreated control plots consistently had the highest activity of all beneficial insects. Among the insecticides tested, Spinosad 45 SC was the least harmful, with relatively higher levels of honeybee and natural enemy activity. In contrast, Imidacloprid 17.8 SL and Acephate 75 SP were the most detrimental, resulting in significantly lower activity levels for honeybees, spiders, and coccinellids. These findings highlight the importance of selecting insecticides that minimize harm to beneficial insects, emphasizing the need for integrated pest management practices that balance effective pest control with the preservation of essential ecosystem services.

Co-Designing Digital Health Intervention for Monitoring Medication and Consultation Among Transgender People in Underserved Communities: Collaborative Approach.

In many parts of the world, men who have sex with men and transgender individuals face criminalization and discrimination. As a result, they are less likely to seek medical help, despite experiencing higher rates of HIV/AIDS, mental health issues, and other health problems. Reaching key populations (KPs) with essential testing, care, and treatment services can be challenging, as they often have a higher likelihood of contracting and spreading the virus. They have limited access to antiretroviral (ARV) therapy (ART) services, which means that KPs may continue to serve as reservoirs for new HIV infections if they do not receive effective HIV programming. This ongoing issue complicates efforts to control the epidemic. Therefore, modeling a digital health system to track ARV medication access and use is crucial. This paper advocates for the use of digital interventions to manage the health of KPs in underserved regions, using Nigeria as a case study. This study aims to assess digital health interventions for monitoring medication and consultations among transgender people in underserved communities. It also sought to determine whether a system exists that could support ART adherence in Nigeria. Additionally, the study evaluated design strategies to address privacy and confidentiality concerns, aiming to reduce nonadherence to ARV medications among KPs in Nigeria. A qualitative approach was adopted for this research, involving a thematic analysis of information collected from interviews with clinicians and other health practitioners who work directly with these communities, as well as from an interactive (virtual) workshop. The findings from the thematic analysis indicate a need to increase attendance at ART therapy sessions through the implementation of an intensive care web app. Unlike previous solutions, this study highlights the importance of incorporating a reminder feature that integrates with an in-app telemedicine consultancy platform. This platform would facilitate discussions about client challenges, such as adverse drug effects, counseling sessions with clinical psychologists, and the impact of identity discrimination on mental health. Other data-driven health needs identified in the study are unique drug request nodes, client-led viral load calculators, remote requests, and drug delivery features within the web app. Participants also emphasized the importance of monitoring medication compliance and incorporating user feedback mechanisms, such as ratings and encouragement symbols (eg, stars, checkmarks), to motivate adherence. The study concludes that technology-driven solutions could enhance ART adherence and reduce HIV transmission among transgender people. It also recommends that local governments and international organizations collaborate and invest in health management services that prioritize health needs over identity.

Violation of Economic, Social, Cultural, and Environmental Rights as Seen Through the Eyes of Displaced Women in the Northern Zone of Colombia.

Forced displacement results in social inequalities negatively affecting the well-being of displaced women. Addressing the economic, social, cultural, and environmental dimensions of their vulnerability is crucial. This article examines the perspectives of 59 displaced women in informal settlements in northern Colombia on violations of their rights. Interpretative phenomenological analysis reveals economic hurdles, such as limited access to decent work and workplace discrimination. Social barriers, like stigmatization and discrimination, impede integration and access to essential services. Despite challenges, increasing awareness and implementing inclusive policies can enhance the living conditions of displaced women.

Do not forget about transplant patients during disasters.

The frequency of natural disasters and man-made conflicts has risen significantly in the past two decades, coinciding with an increase in kidney transplant recipients globally. This review addresses the critical need for disaster preparedness to mitigate the severe impacts on this vulnerable patient cohort. Kidney transplant recipients are highly dependent on robust healthcare infrastructures for ongoing care, including specialized medical staff, advanced diagnostics, and a consistent supply of immunosuppressive medications. Disasters disrupt these essential services, leading to increased risks of organ rejection, infections, and other medical complications. Strategies at various levels, from government to individual patients, can help maintain care continuity during such crises. Effective disaster preparedness plans involving strategic medication stockpiling, emergency communication systems, and patient education are crucial to support kidney transplant recipients. By implementing these measures, healthcare systems can better protect the health and well being of transplant patients during and after disasters.

Global acute malnutrition is associated with geography, season and malaria incidence in the conflict-affected regions of Ouham and Ouham Pendé prefectures, Central African Republic

BackgroundOngoing conflict between multiple armed groups, including pastoralist herders in the Central African Republic (CAR) causes frequent population displacements, food insecurity and scarcity of healthcare services. The inaccessibility and insecurity of many areas of CAR limit data collection and assessments from national nutritional surveys. Community health workers (CHWs) trained by an international non-governmental organisation, The MENTOR Initiative, deliver basic healthcare to children under 5 years old living in hard-to-reach and conflict-affected areas in eight subprefectures of north-west CAR. Their nutritional status and its associations with geography, malaria, season and conflict are unknown.MethodsCHW monthly records (October 2015–August 2021), Armed Conflict Location and Event Data project conflict data and The World Bank Group meteorological data for eight subprefectures of north-west CAR were analysed. Associations between counts of global acute malnutrition (GAM) assessed by mid-upper arm circumference and malaria, season and conflict were investigated using negative binomial regression.ResultsOf the 457,325 consultations with children aged 6–59 months, 6.2% and 0.4% were classified as moderately or severely malnourished, respectively. The negative binomial model demonstrated differences in counts of GAM by subprefecture. Counts of GAM were positively associated with the case rate of severe malaria (IRR = 1.045; 95% CI: 1.04–1.06) and the rainy season (July–September) (IRR = 1.10; 95% CI: 1.03–1.17). Conflict events coded as Battles in ACLED were associated with lower counts of GAM (IRR = 0.78; 95% CI: 0.62–0.97).ConclusionsThis analysis shows geographical differences in levels of malnutrition in north-west CAR and demonstrates clear associations between malnutrition, season and malaria. It provides evidence that levels of GAM may be underestimated in north-west CAR in areas experiencing conflict. These findings highlight the need for targeted nutritional support to reach children most at risk of malnutrition. CHWs are a proven effective means of delivering essential primary healthcare services in hard-to-reach, conflict-affected areas.

Impacts of commercial and subsistence fishing on marine and cultural ecosystem services important to the wellbeing of an Indigenous community in Hawai'i

Marine ecosystems provide essential services to coastal residents, particularly for indigenous fishing communities that have strong ties to the environment and obtain multiple benefits from their use and management of ocean spaces. However, understanding of how these are impacted by fisheries, external pressures, and ocean management, remains limited due to a focus on economic valuation and aggregated metrics. This study explores the importance of select marine ecosystem services to the wellbeing of an indigenous community in West Hawaiˈi and the observed impacts on these ecosystem services by commercial and subsistence fishing. We used a mixed-methods approach that combined a workshop with an online survey of community perceptions regarding community important marine resources and cultural values. We find that both fish and non-fish species are important to all four well-being categories, including food security, culture, mental wellbeing, and income, though the least importance was given to the economic value. This study also found that commercial fishing is perceived to have a higher negative impact on marine resources and cultural values than subsistence fishing, but a generally lower impact on non-fish than fish species. The lack of community input into legislation development and a lack of enforcement capacity were perceived to aggravate these further, whereas the integration of place-based knowledge, values and rules of the environment was seen as beneficial to both marine and cultural ecosystem services. Overall, this study shows that non-economic and disaggregated valuation approaches are critical for revealing the variable ecosystem services that marine environments provide to local communities and the importance of more inclusive resource management approaches to manage impacts on these services.

Interplay of Environmental Shifts and Anthropogenic Factors with Vegetation Dynamics in the Ulan Buh Desert over the Past Three Decades

In arid and semiarid regions, vegetation provides essential ecosystem services, especially retarding the desertification process. Vegetation assessment through remote sensing data is crucial in understanding ecosystem responses to climatic factors and large-scale human activities. This study analyzed vegetation cover changes in the Ulan Buh Desert from 1989 to 2019, focusing on the impacts of human activities and key meteorological factors. The results showed that both climatic and human activities contributed to an increasing trend in vegetation cover (normalized difference vegetation index (NDVI)) over the 30-year period. Temperature and precipitation significantly affected the NDVI in the desert, with temperature having a more substantial influence. The combined impact of average temperature and precipitation on the NDVI was notable. Human activities and meteorological factors caused the vegetation restoration area in the desert to be approximately 35% from 1989 to 2019. Human activities were the primary influencers, responsible for about 60% of vegetation restoration across the study area. Especially from 2004 to 2019, the conversion to farmland driven by human activities dominated the region’s NDVI increase. The research underscores the importance of considering both climatic and human factors in understanding and managing ecosystem dynamics in arid areas like the Ulan Buh Desert. By integrating these factors, policymakers and land managers can develop more effective strategies for sustainable ecosystem management and combating desertification.

Challenges Experienced by Health Care Workers During Service Delivery in the Geographically Challenging Terrains of North-East India: Study Involving a Thematic Analysis.

The public health landscape in North-East India is marked by the foundational principle of equitable health care provision, a critical endeavor considering the region's intricate geography and proximity to international borders. Health care workers grapple with challenges, such as treacherous routes, limited infrastructure, and diverse cultural nuances, when delivering essential medical services. Despite improvements since the National Rural Health Mission in 2005, challenges persist, prompting a study to identify health care workers' challenges and alternative strategies in Manipur and Nagaland. This study aims to document the challenges experienced by health care workers during service delivery in the geographically challenging terrains of North-East India. This study is part of the i-DRONE (Indian Council of Medical Research's Drone Response and Outreach for North East) project, which aims to assess the feasibility of drone-mediated vaccine and medical delivery. This study addresses the secondary objective of the i-DRONE project. In-depth interviews of 29 health care workers were conducted using semistructured questionnaires in 5 districts (Mokokchung and Tuensang in Nagaland, and Imphal West, Bishnupur, and Churachandpur in Manipur). Nineteen health facilities, including primary health care centers, community health centers, and district hospitals, were selected. The study considered all levels of health care professionals who were in active employment for the past 6 months without a significant vacation and those who were engaged in ground-level implementation, policy, and maintenance activities. Data were recorded, transcribed, and translated, and subsequently, codes, themes, and subthemes were developed using NVivo 14 (QSR International) for thematic analysis. Five themes were generated from the data: (1) general challenges (challenges due to being an international borderline district, human resource constraints, logistical challenges for medical supply, infrastructural issues, and transportation challenges); (2) challenges during the COVID-19 pandemic (increased workload, lack of diagnostic centers, mental health challenges and family issues, routine health care facilities affected, stigma and fear of infection, and vaccine hesitancy and misinformation); (3) perception and awareness regarding COVID-19 vaccination; (4) alternative actions or strategies adopted by health care workers to address the challenges; and (5) suggestions provided by health care workers. Health care workers demonstrated adaptability by overcoming these challenges and provided suggestions for addressing these challenges in the future. Health care workers in Manipur and Nagaland have shown remarkable resilience in the face of numerous challenges exacerbated by the pandemic. Despite infrastructural limitations, communication barriers, and inadequate medical supply distribution in remote areas, they have demonstrated adaptability through innovative solutions like efficient data management, vaccination awareness campaigns, and leveraging technology for improved care delivery. The findings are pertinent for not only health care practitioners and policymakers but also the broader scientific and public health communities. However, the findings may have limited generalizability beyond Manipur and Nagaland.

Peningkatan Ekonomi Desa melalui Pariwisata: Memahami Regulasi dan Manfaatnya

The Smart Village program aims to enhance community welfare through the application of technology and innovation. In Curahdami village, low literacy and competency levels, particularly among ex-ODGJ (people with mental disorders), are due to low productivity and insufficient skill development support. Social stigma, lack of motivation, and minimal family attention exacerbate this situation, while social disparities limit access to essential services. To address these issues, an empowerment program for ex-ODGJ was designed through the "Rumah Kreasi Budaya Desa," a center for developing creative products based on local wisdom. The program seeks to enhance artistic skills and market creative products to support the growth of the creative industry and create new jobs. This research employs a participatory-action approach, engaging the community in the planning, implementation, and evaluation of the program. Data collection methods included participatory observation, in-depth interviews, and documentation of activities. From June to August 2024, the program targeted 40 beneficiaries, including 35 ex-ODGJ from several villages and some individuals with disabilities. Of these, 62.5% showed significant improvement in artistic skills, while 37.5% demonstrated increased interest in creative activities. Nevertheless, challenges such as limited resources, low community capacity, and insufficient policy support persist. Therefore, it is crucial to improve human resource capacity, develop strategic partnerships, and strengthen stakeholder support to ensure the program's success

Regional differences in beef cattle trade and movements associated with the COVID-19 pandemic in Australia

Context The COVID-19 pandemic caused mandated restrictions on movements and distancing of people with implications for meat supply chains. Despite the COVID restrictions, agricultural activities were permitted to continue as essential services in Australia. However, there were reported shortages of meat on the shelves of supermarkets and a general increase in the price of meat in Australia during the COVID period. Hence, there is a need to establish whether the restrictions affected upstream activities in Australia’s beef supply chain. Aim This study aims to examine the impact of the COVID-19 pandemic and confounding factors including rainfall and export bans on beef cattle trade and movement in Australia. Methods Using annual data on beef cattle sold, purchased, transferred off-farm and transferred onto farms sourced from the database of the Australian Bureau of Agricultural and Resource Economics and Sciences, a t-test analysis was conducted to establish the significant changes in cattle movement and trade for the pre-COVID (2014–2019) and COVID (2020–2022) periods. Additionally, a flexible least squares model augmented with a flexible generalised least squares model was used to assess the impact of confounding factors on cattle trade and movement. Key results The results indicate no significant change in the proportion of beef cattle sold nationwide. Tasmania, New South Wales, and Western Australia (WA) recorded significant changes (1.4% increase, 3.6% increase, and 3.8% decrease, respectively) in the proportion of beef cattle purchased. For WA, these changes were localised to changes that occurred in WA Central and Southern Wheat Belt and WA Southwest Coastal regions. Moreover, rainfall did not significantly impact cattle trade but did affect cattle movements. The export ban only significantly impacted beef cattle sold in Queensland. Conclusions Overall, the findings suggest that most regions in Australia did not experience significant changes in farm-level decisions regarding beef cattle movement and trade during the COVID period. Instead, minor adjustments were made to address the demand changes. Implications The findings imply that adopted policies that facilitated the implementation of biosecurity bubbles and the movements of animal transport workers for breeding facilities and abattoirs during the COVID period were effective in normalising farm-level operations.

Colocation of COVID-19 Vaccination Services at Syringe Service Programs for People Who Inject Drugs and People Experiencing Houselessness in Oregon.

Integrating vaccination services with other essential health services could increase vaccination rates among socially marginalized populations. We examined the associations between colocation of vaccines at syringe service programs and COVID-19 vaccination status among people who inject drugs and people experiencing houselessness. This study included 1891 participants aged ≥18 years at 9 sites in Oregon from July 2021 through March 2022. Participants self-reported whether they had ever received ≥1 dose of a COVID-19 vaccine. We calculated site-level COVID-19 vaccine availability and overall vaccination rates. We compared site-level vaccination rates and analyzed the association between vaccine availability and vaccination status. We found no significant difference in vaccination rates between sites that did and did not offer COVID-19 vaccines (t7 = -0.33; P = .75). We also found no significant association between vaccine availability and vaccination status. However, the odds of having received a COVID-19 vaccine were 2.79 times higher for each additional site visit during which COVID-19 vaccines were available (odds ratio [OR] = 2.79; 95% CI, 2.18-3.58; P < .001). The association between vaccine availability and vaccine status was not moderated by participant age (OR = 1.03; 95% CI, 0.99-1.07; P = .13) or housing instability (OR = 0.59; 95% CI, 0.13-2.60; P = .48). Colocating COVID-19 vaccines at syringe service programs was only positively associated with vaccination status if vaccines were offered frequently on-site. Future work should examine whether the frequency of offering vaccination services increases willingness to engage in vaccination and examine trust and convenience as potential mechanisms.

Challenging exclusion: bringing the human rights to water and sanitation to Europe

ABSTRACT Research and advocacy on water and sanitation in low-income countries often consider the human rights to water and sanitation as the basis for improving access to these essential services. But how often is the spotlight turned on high-income countries? Do the predominantly Global North researchers, advocates, donors and development partners who explore failures to meet the human rights in Accra or Jakarta ever ask if the same rights are realized at home in Berlin, London or Paris? Exclusion and marginalization similar to that faced by various populations in low-income countries are present in the lived experiences of individuals and groups in Europe, including homeless people, Roma communities, incarcerated people and refugees. Yet, the same human rights that are invoked in low-income countries are all too often ignored in Europe. Meanwhile, high-income countries cannot point to insufficient financial resources to justify failures in human rights realization. Against this background, this short communication outlines some of the inequalities in access to water and sanitation that exist and persist in high-income countries through the lens of human rights, and proposes that invoking these human rights can support the ideals of equity and justice contributing to re-imagining universal access to services across Europe.

Comprehensive review of smart city cybersecurity strategies

With cities rapidly advancing technologically, the rise of smart cities brings innovative solutions to urban challenges. However, this integration of technologies within urban infrastructures introduces new cybersecurity risks. This review explores the cybersecurity issues that smart cities face and discusses strategies to address these threats. Smart cities rely on interconnected networks of devices and systems to enhance efficiency, sustainability, and citizen services. Yet, this connectivity also creates a complex environment that is vulnerable to cyberattacks. A key concern is the wide array of IoT devices deployed across smart city infrastructures, which often lack robust security mechanisms, making them susceptible to exploitation by cybercriminals. The interconnected nature of these systems heightens the potential impact of cyberattacks, posing significant risks to critical infrastructure, public safety, and privacy. Threat actors can exploit vulnerabilities in interconnected systems, disrupting essential services, manipulating data, or even causing physical harm. Since smart cities heavily depend on data-driven decision-making, ensuring data integrity and confidentiality is a top priority. To mitigate these risks, various cybersecurity strategies have been proposed and implemented. These include technical solutions, regulatory frameworks, and collaboration among stakeholders. Technical measures like encryption, authentication mechanisms, intrusion detection systems, and secure software development practices are essential. Additionally, strong access controls and network segmentation can limit the scope of potential attacks. Regulatory initiatives also play a crucial role in improving cybersecurity standards and ensuring compliance among stakeholders. Establishing clear guidelines for data protection, privacy rights, and incident response protocols is vital for safeguarding citizens' interests. Collaborative efforts between government agencies, the private sector, academia, and cybersecurity experts are crucial in sharing information and collectively defending against emerging threats. Securing smart cities requires a comprehensive approach that integrates technical measures, regulatory frameworks, and collaborative efforts to create a resilient and secure urban environment for all citizens. Keywords: Cybersecurity, Smart City, AI, Technology, Security.

Palynological characterization of a diverse desertic ecosystem: the Peruvian Lomas

The Pacific coastal Peruvian landscapes are dominated by desert and dry-forest biomes, which have undergone shifts in extent and floral composition in response to Plio–Pleistocene climatic fluctuations. Within this context, the coastal Lomas develop as seasonal vegetation patches, renowned for their high endemism, rich floral diversity, and essential ecosystem services. Despite growing within the desert biome, the Lomas exhibit characteristic elements and vegetation structure typical of a dry-forest biome, evidencing an active species migration between xeric biomes. However, assessing the historical evolution of this arid flora and, by extension, the coastal desert landscape, presents challenges. The scarcity of continental sedimentary records and a lack of extended and well-described palynological references impede these efforts. In response to this, our study offers a thorough morphological review of the Lomas palynoflora, encompassing over 194 genera from 76 families, representing approximately 80% of the known Lomas flora. Our review includes at least one species per reviewed genus, featuring 37 palynomorphs from endemic species (18.5% of the studied flora). This palynological characterization is intended to serve as accessible reference material for investigating the historical and long-term evolution of the coastal dry flora. Furthermore, these findings facilitate the analysis of honeys and bee floral foraging patterns, as well as the study of animal–plant or human–plant interactions from middens and archaeological remains.

Genetic Variability in Mediterranean Coastal Ecosystems: Insights into Ostrea spp. (Bivalvia: Ostreidae).

Oysters are sessile, filter-feeding bivalve molluscs widely distributed in estuarine and coastal habitats worldwide. They constitute a valuable resource for fisheries and extensive aquaculture and provide essential ecological services. Yet, their genetic diversity and distribution remain understudied. The variability in shell morphology complicates species classification, which is influenced by environmental and genetic factors. Although molecular phylogenetics research has refined oyster taxonomy and identified approximately 100 extant species, numerous taxonomic uncertainties persist. In the present study, we aimed to document the occurrence of small flat oysters of the genus Ostrea along the Mediterranean coastal areas of Liguria and Sardinia (Italy). Specifically, 16S rRNA sequence data were used to identify Ostrea species. Our findings offer novel insights into the O. stentina species complex and O. neostentina, a new species in the Mediterranean coastal areas of Italy. The study data further our understanding of Ostrea species diversity, distribution, and evolutionary patterns.

Wealth disparities in maternal health service utilization among women of reproductive age in Ethiopia: findings from the mini-EDHS 2019

BackgroundEthiopia has made strides in reducing maternal mortality, but significant discrepancies in maternal health service utilization exist across socioeconomic levels. According to studies, women from higher-income households are far more likely to use essential services such as antenatal care, delivery care, and postnatal care than poorer women. This wealth disparity is a primary contributor to persistently high maternal mortality, particularly among poor populations. The study’s goal was to assess wealth disparities in maternal health service uptake and identify contributing factors.Methods and materialsWe used the Ethiopian Mini Demographic Health Survey (EMDHS), conducted in 2019 on women aged 15–49 living in selected census areas, with a weighted sample size of 3,909. The Erreygers Concentration Index (ECI) was used to measure wealth inequalities in maternal health care, and the ECI decomposition was used to identify factors contributing to inequality in maternal health services.ResultsMaternal health service utilization was pro-rich among women in Ethiopia. The prevalence of antenatal care service (ANC), delivery, and postnatal care (PNC) service utilization showed a pro-rich distribution among Ethiopian women, with ECI = 0.115 (95% CI: 0.091–0.137), ECI = 0.223 (95% CI: 0.191–0.276), and ECI = 0.121 (95% CI: 0.041-0.200), respectively. The ECI indices were decomposed to examine the contributing factors to disparities in maternal service utilization in Ethiopia. Mother’s current age, household family size, region, birth order, and parity were contributors to maternal health service utilization.ConclusionThe ANC service, delivery service and PNC service utilization showed a pro-rich distribution among Ethiopian women. Mother’s current age, household family size, region, birth order, and parity are important contributors of maternal health service inequality. To improve access and usage among low-income women, policymakers can develop programs including increasing the number of free or subsidized services and providing transportation.

Association between pregnancy intention and completion of newborn and infant continuum of care in Sub-Saharan Africa: systematic review and meta-analysis

BackgroundThe newborn and infant continuum of care such as essential newborn care, early initiation and exclusive breastfeeding, and immunisation are highly recommended for improving the quality of life and survival of infants. However, newborn and infant mortality remains high across Sub-Saharan African countries. While unintended pregnancies are associated with adverse newborn and infant health outcomes, there is inconclusive evidence on whether pregnancy intention influences newborn and infant continuum of care completion. Therefore, this review aimed to pool findings reported in the literature on the association between pregnancy intention and newborn and infant health care across the continuum of care in Sub-Saharan Africa.MethodsWe searched MEDLINE Complete, EMBASE, CINAHL Complete, and Global Health databases for studies potentially eligible for this systematic review and meta-analysis. Two researchers independently screened the identified articles by abstract and title, and then full-text using Covidence. We used the Newcastle–Ottawa Scale to assess the quality of the included studies. The Cochran’s Q test and I2 were executed to detect and quantify the presence of statistical heterogeneity in the studies. Meta-analysis was done for each outcome when more than one original study reported relevant data, using Stata statistical software version 18.ResultsEleven studies were included from a total of 235 articles identified by the search. The odds of completing essential newborn care (pooled odds ratio: 3.04, 95% CI: 1.56, 5.90), early initiation of breastfeeding (pooled odds ratio: 1.30, 95% CI: 1.13, 1.52), exclusive breastfeeding (pooled odds ratio: 2.21, 95% CI: 1.68, 2.89), and being fully immunised (pooled odds ratio: 2.73, 95% CI: 1.16, 6.40) were higher among infants born to women with intended pregnancies as compared to women with unintended pregnancies.ConclusionIntended pregnancy was positively associated with essential newborn care completion, early initiation and exclusive breastfeeding, and full immunisation of infants in SSA countries. Thus, policy-makers and stakeholders should strengthen the provision of quality family planning services to prevent unintended pregnancy. Furthermore, follow-up of women with unintended pregnancies is needed to increase women’s opportunity to access essential newborn health care services that further reduce the risk of newborn and infant morbidity and mortality.Systematic review registrationPROSPERO registration number CRD42023409148.

Sexual and Reproductive Health Rights and Service Use among Undocumented Migrants in the EU: A Systematic Literature Review.

Most EU member states fail to provide essential sexual and reproductive health services to undocumented migrants, a vulnerable population facing limited access, utilization, and worse health-related outcomes. This study systematically reviewed the literature on access to and use of these services, as well as related health, economic, and migratory outcomes for undocumented migrants in the EU-EFTA region. The systematic review is reported based on the PRISMA 2020 checklist and includes 37 studies published between 2017 and 2024. Included studies were based upon original quantitative, qualitative, or mixed-methods data; conducted in one or more European countries; and published in one or more of the following languages: English, Spanish, French, Portuguese, or Romanian. A quality assessment was conducted using the CASP checklist for qualitative studies and the NHLBI Study Quality Assessment Tools for quantitative studies. The findings revealed numerous access barriers, including refusal of care, lack of knowledge about national healthcare schemes, bureaucratic hurdles, and affordability issues. Even when care was available, stigma, fear of deportation, socio-economic precarity, and abuse further hindered utilization. These barriers contributed to generally worse reproductive health outcomes for undocumented migrants in Europe, though the findings may not generalize to all EU-EFTA countries.

Readiness for non-communicable disease service delivery in Ethiopia: an empirical analysis

BackgroundEthiopia’s health system is overwhelmed by the growing burden of non-communicable diseases (NCDs). In this study, we assessed the availability of and readiness for NCD services and the interaction of NCD services with other essential and non-NCD services.MethodsThe analysis focused on four main NCD services: diabetes mellitus, cardiovascular diseases, chronic respiratory diseases, and cancer screening. We used data from the 2018 Ethiopian Service Availability and Readiness Assessment (SARA) survey. As defined by the World Health Organization, readiness, both general and service-specific, was measured based on the mean percentage availability of the tracer indicators, such as trained staff and guidelines, equipment, diagnostic capacity, and essential medicines and commodities needed for delivering essential health services and NCD-specific services, respectively. The survey comprised 632 nationally representative healthcare facilities, and we applied mixed-effects linear and ordered logit models to identify factors affecting NCD service availability and readiness.ResultsOnly 8% of facilities provided all four NCD services. Availability varied for specific services, with cervical cancer screening being the least available service in the country: less than 10% of facilities, primarily higher-level hospitals, provided cervical cancer screening. General service readiness was a strong predictor of NCD service availability. Differences in NCD service availability and readiness between regions and facility types were significant. Increased readiness for specific NCD services was significantly associated with increased readiness for communicable disease services and interacted with the readiness for other NCD services.ConclusionNCD service availability has considerable regional variation and is positively associated with general and communicable disease services readiness. Readiness for specific NCD services interacted with one another. The findings suggest an integrated approach to service delivery, focussing holistically on all disease services, is needed. There also needs to be increased attention to reducing resource allocation variation between facility types and locations.

The critical elements of the health system that could make for resilience in the World Health Organization African Region: a scoping review.

Unpredictable events, such as the outbreak of infectious diseases and humanitarian crises, are putting a strain on health care systems. As a result, African countries will need to prepare themselves with appropriate strategies to withstand such occurrences. Therefore, the purpose of this scoping review was to map available evidence about what type and what components of health systems are needed to help countries cope with health emergencies and to foster health system resilience in the WHO African Region. A systematic search was performed independently in Scopus and PubMed electronic databases as well as grey literature. Studies were selected based on set eligibility criteria based on the Joanna Brigg's Institute (JBI) methodology for scoping reviews. The key findings were focused on health system resilience and were mapped based on the WHO's core health system components. Our data were tabulated, and a narrative synthesis was conducted. A total of 28 studies were included in this scoping review, mostly conducted in the WHO African Region and region of the Americas. Studies focused on a variety of strategies, such as the continuous delivery of essential services, the strengthening of the health workforce, including community health care workers, community engagement, the provision of protective mechanisms for the health workforce, and flexible leadership and governance measures. Our findings suggest that strategies to improve health system resilience must include all areas of the healthcare delivery process, including primary care. A resilient health system should be ready for a crisis and have adaptable policies in place to offer adequate response at all levels, as well as post-recovery planning. Such health systems should also seek for continuous improvement. More research is needed to assess the efficacy of initiatives for improving health system resilience, particularly in vulnerable African health systems.