Culturally and linguistically diverse (CALD) communities have unique strengths, needs, and health seeking behaviours reflecting their cultural background. Therefore, top-down population-level health promotion initiatives with externally imposed performance indicators are frequently ineffective in CALD contexts. Accordingly, the Healthy New Communities (HNC) program implements an equity-based bottom-up commissioning model aimed at addressing socio-cultural factors impacting health seeking behaviours with people from refugee and migrant backgrounds. In the first phase of a comprehensive evaluation of the HNC program commissioning model, stakeholders involved in the implementation of commissioned activities and programs shared their experiences with this innovative funding model pioneered by the Queensland Health Metro South Hospital and Health Services, Health Equity and Access Team. Their perspectives were gathered in focus groups and interviews and analysed using an inductive approach to thematic analysis. The findings demonstrate the effectiveness of the HNC program commissioning model in engaging CALD communities in health promotion initiatives. Flexibility, responsiveness, trust, relationships, shared commitments, and cultural representation facilitated community members' participation in the commissioned activities. The impacts of the HNC program commissioning approach extend beyond the adoption of healthy lifestyles and include positive social, emotional, cultural, and physical impacts across a range of life domains and the creation of employment, training, and career pathways. The HNC program demonstrates how socio-cultural determinants of health can be influenced by commissioning models that prioritise community engagement, relationships, co-design, and the culturally shaped health-seeking behaviours of CALD individuals, families, and communities in the funding, design, and implementation of health promotion initiatives. SO WHAT?: Phase one results are promising and lay the foundation for an in-depth investigation of the potential of equity-based commissioning models for improving health and wellbeing outcomes for CALD communities across Queensland and beyond.

ObjectivesChemsex is the use of select psychoactive drugs to enhance sexual experiences and has been described among gay, bisexual, and other men who have sex with men (GBMSM). We aimed to characterise sexual risk, wellbeing and health-seeking behaviours among GBMSM and gender-diverse people reporting chemsex-associated drug use.MethodsWe analysed data from 'Reducing inequalities in Sexual Health' (RiiSH), an online community survey of 2758 UK-resident men and gender-diverse people having sex with men undertaken in November-December 2024. We compared those reporting chemsex-associated drug use with those who did not, assessing sociodemographic characteristics, well-being, sexual risk behaviours and sexual health service (SHS) engagement.ResultsOverall, 8% (218/2758) reported chemsex-associated drug use in the last year. A higher proportion of participants reporting chemsex-associated drug use in the last year also reported a composite measure of sexual risk based on self-reported behaviours in the previous 3-4 months (e.g. prior bacterial STI diagnosis, ≥5 male condomless anal sex partners) compared to those who did not (85% vs 61%, p < 0.001). They also more frequently reported attending a SHS in the last year (81% vs 57%, p < 0.001). Those reporting chemsex-associated drug use also more frequently reported a long-term limiting mental health condition (36% vs 24%, p < 0.001) and poorer personal wellbeing (e.g. reporting low life satisfaction 36% vs 20%, p < 0.001).ConclusionWhile a minority of participants in this national, community-based sample reported chemsex-associated drug use, this group had higher sexual risk and poorer indicators of wellbeing. Many participants also attended SHSs, reinforcing the key supporting role of SHSs for referral pathways to harm reduction support for those experiencing problematic drug use.

Early life social and environmental exposures and all-cause hospital visits among children under five in southern Mozambique.

A socioecological model of skilled birth attendant perspectives on gastroschisis in southwest Uganda.

Body shaming refers to the stigmatization of individuals based on body weight, shape, or appearance; it is an under-recognized determinant of women's mental health. It contributes to low self-esteem, depression, anxiety, and diminished quality of life, while discouraging health-seeking behaviors and reinforcing gender inequities. Despite growing global recognition of body shaming as a public health concern, evidence on its prevalence, cultural dynamics, and impact in African contexts remains limited. This review aims to synthesize current evidence on body shaming, examine existing interventions, and identify gaps particularly within African settings. A narrative review of published literature, global health frameworks, and advocacy reports was conducted. Sources included guidance from the World Health Organization (WHO) and the American Psychological Association (APA), evidence-based therapeutic interventions, digital advocacy movements, and policy frameworks such as the African Union's Agenda 2063. The WHO and APA now formally recognize appearance-related distress as a mental health determinant. Evidence-based interventions including Cognitive Behavioral Therapy (CBT), Compassion-Focused Therapy (CFT), and school-based programs such as the Body Project demonstrate measurable reductions in body dissatisfaction and associated psychological risks. Large-scale initiatives like the Dove Self-Esteem Project have reached millions of young women globally, while digital movements (#BodyPositivity, #DetoxYourFeed) and mobile mental health platforms continue to expand access and awareness. However, challenges persist: deeply rooted cultural norms that privilege specific body types, limited African-focused research, inadequate mental health infrastructure, the paradoxical role of social media, and weak policy enforcement. Addressing body shaming requires intersectional, culturally sensitive research, integration of screening and interventions within healthcare systems, strengthened digital literacy, and cross-sectoral policy action. Community-driven campaigns and women's empowerment are central to challenging stigma and celebrating diversity. Systemic change across healthcare, education, media, and policy is essential to promote healthier self-perceptions, enhance mental wellbeing, and advance gender equity.

The widespread mobilisation to improve maternal health over recent decades has led to increased prenatal consultations and assisted deliveries, resulting in a significant reduction in maternal mortality in many sub-Saharan African countries. This paper examines the progress made in basic obstetric care in four sub-Saharan African countries (Burkina Faso, Côte d'Ivoire, Ghana and Senegal), and investigates the sources of this progress to better inform future policy actions that will help achieve the Sustainable Development Goal 3 targets related to maternal and child health. We used data from two Demographic and Health Surveys (DHSs) conducted in each of the four countries in the early 2010s and 2020s by their respective national statistical offices. Specifically, we relied on the 2010 and 2021 DHS for Burkina Faso, the 2011 and 2021 DHS for Côte d'Ivoire, the 2014 and 2022 DHS for Ghana and the 2010 and 2023 DHS for Senegal. We first estimated coverage rates for various components of maternity care using descriptive statistics with CIs to assess significant differences. Associations were examined using a multivariate decomposition analysis based on the Oaxaca-Blinder method adapted for binary outcomes. The results show a substantial increase in coverage of antenatal care (ANC) and postnatal care services over the past decade in all four countries. While progress in ANC4+ coverage is evident, the situation becomes more complex when considering more comprehensive quality indicators such as ANC8+ and its individual components. Decomposition results suggest that the factors driving progress are largely not fully captured by conventional socio-economic variables, pointing instead to changes in women's health-seeking behaviour and broader improvements in health system performance. This study highlights a marked gap between the high frequency of antenatal consultations and the quality of services delivered, particularly with respect to ANC8+ coverage and the full set of ANC components. Sustaining and deepening progress will require greater emphasis on improving service quality and expanding behaviour-change communication strategies tailored to local contexts, alongside continued health system strengthening.

Rabies remains a fatal zoonotic disease of significant public health concern, particularly in regions where surveillance and vaccination campaigns are inconsistent. The COVID-19 pandemic disrupted routine healthcare and animal health programs worldwide, raising concerns about the continuity of rabies prevention strategies. This study evaluates the impact of the pandemic on post-exposure prophylaxis (PEP) administration in Serbia and North Macedonia, two Balkan countries historically considered at risk of rabies circulation. We conducted a retrospective analysis of medical records from the Pasteur Institute Novi Sad (PINS, Serbia) and the Clinic for Infectious Diseases in Skopje (CIDS, North Macedonia), comparing pre-pandemic (2018-2019) and post-pandemic (2022-2024) periods. A total of 5,128 patient records were included, with dog bites accounting for the majority of exposures in both countries. Findings revealed a significant increase in PEP administration in North Macedonia, rising from 6.7% to 16.4% of bite patients after the pandemic (p < 0.001), while Serbia maintained stable rates (0.98% to 1.65%, p > 0.05). Differences likely reflect disparities in rabies surveillance, information flow between veterinary and medical sectors, and the organization of national control programs. These results underscore the importance of integrated One Health approaches and real-time information exchange to optimize rabies prevention and ensure resilience against future disruptions.

The COVID-19 pandemic disrupted healthcare service utilisation, but evidence on its impact on perinatal outcomes is conflicting. We investigated the impact of the pandemic public health measures (eg, lockdowns, reduced healthcare access, altered health-seeking behaviour) on preterm birth (PTB), stillbirth, low birth weight (LBW), small for gestational age, caesarean delivery, breastfeeding initiation (BFI) and neonatal intensive care unit (NICU) admissions. Using linked administrative health databases, we conducted a population-based study of pregnancies before (January 2008-February 2020) or during (March 2020-March 2022) the pandemic; for the latter period, they were categorised by exposure duration. We conducted interrupted time series analyses using season-adjusted generalised linear models, and analyses were stratified by income. Among 222 636 pregnancies (190 694 prepandemic and 31 942 during pandemic), PTB rates increased from 8% prepandemic to 9.1% during the pandemic, with a 19.0% relative increase overall (p<0.01). In stratified analyses, PTB rose by 27.1% in the lower-income group (8.8% to 10.1%, p=0.01) and by 19.7% in the higher income group (7.3% to 8.2%, p=0.02); however, effect modification by income was statistically non-significant. Pregnancies 100% exposed during the first and second year of the pandemic experienced higher rates of PTB by 15.0% (p=0.01) and 11.6% (p<0.01) compared with the prepandemic period, respectively. The pandemic measures were associated with no changes in stillbirth (0.7‰ vs 0.61%; p=0.37) or NICU admission rates (8.3% vs 8.2%; p=0.69). LBW rates increased from 5.5% to 6.3% (13.9% relative increase, p=0.05). Pregnancies spanning the entire first year of the pandemic experienced higher rates of caesarean deliveries (24.6% relative increase, p<0.01). BFI rates decreased from 82.5% to 81.8% (3.9% relative decrease, p=0.01) compared with prepandemic, followed by a slight increase (p=0.02) during the pandemic period. The COVID-19 pandemic measures were associated with increased PTB and caesarean delivery rates, particularly among pregnancies fully exposed to pandemic measures. Over the 2-year pandemic period, stillbirth, NICU admissions and BFI rates were stable.

In many low- and middle-income countries (LMICs), older adults rely on family and community networks for health care, yet little is known about how limited familial ties shape their health-seeking behaviors. Given that Indonesia has the world's fourth-largest population that is rapidly aging, this study examines how different dimensions of limited familial ties (spousal absence, solo-living arrangements, geographical separation from adult children, parent-child disconnection) are associated with health-seeking practices among older Indonesians, and whether community engagement and trust moderate these relationships. Using data from Wave 5 of the Indonesia Family Life Survey (N = 2,809 adults aged 60+), we apply latent class analysis to identify distinct health-seeking profiles. Multinomial logistic regression models assess associations between family ties and health-seeking profiles and test interaction effects with community engagement and trust. We identify four distinct health-seeking profiles: Limited, Basic Routine, Traditional, and Comprehensive. Spousal absence is associated with lower engagement in basic routine health-seeking. Living alone with children nearby is associated with more limited health-seeking, whereas parent-child disconnection is linked to greater likelihood of comprehensive health-seeking. While community trust partially compensates for weak familial ties, community engagement may exacerbate gaps in health-seeking among older adults with varying levels of kin availability. Health-seeking behaviors in later life reflect complex interactions between kin availability, relational dynamics, and community context. Reliance on community relationships to mitigate gaps created by absent kin should be approached with caution. Policies should support inclusive, culturally grounded health interventions that account for diverse family structures and care practices.

Nigeria bears the highest burden of malaria cases in the world, and pregnant women are uniquely vulnerable to the disease. Malaria in pregnancy (MiP) may have negative implications for maternal and neonatal health. The World Health Organization (WHO)-recommended intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) helps to prevent MiP. However, due to the influence of significant others, the decision-making power regarding health may be outside the purview of pregnant women. Using the social norms theory, this study investigates the role of community factors affecting the use of IPTp-SP among pregnant women. The study adopted qualitative methods, including focus group discussions with pregnant women and in-depth interviews with significant others, including community leaders, traditional birth attendants, religious leaders, spouses and mothers-in-law. Six focus group discussions and seventeen in-depth interviews were conducted with pregnant women and stakeholders, respectively. Data were managed using NVivo (version 12) and analyzed thematically and deductively in line with the social norms theory. We found that most of the pregnant women demonstrated interest in using IPTp-SP. While they recognized the role of significant others in health decision-making, many expressed agency and resistance against social norms opposing their use of IPTp-SP. They exhibited varying degrees of defiance against domination by spouses and mothers-in-law and gave legitimacy to healthcare professionals. Pregnant women and TBAs adopted mixed approaches (traditional and orthodox medicines) to preventing MiP. Pregnant women deferred to their religious leaders than to their community leaders. For this study’s sample, descriptive norms were more critical. Most women emphasized their will to make health decisions and prioritized their health and their babies, defying the long-standing social norms that militate against women’s health-seeking behaviour.

This review maps the existing evidence regarding the Social Determinants of Health (SDH) on women with heart failure (HF) in Europe, focusing on healthcare access, diagnostic pathways, clinical management and outcomes. This review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. A systematic search of six electronic databases in September 2025 yielded 3728 articles. Articles were eligible for inclusion if they featured women (aged ≥18 years) with a diagnosis of HF, were conducted in countries within the WHO-defined European Region, and specifically examined the impacts of SDH on this population. Following a two-stage screening process, 30 papers met the inclusion criteria. Data synthesis and reporting were guided by the PAGER framework (Patterns, Advances, Gaps, Evidence, and Recommendations). Nine dominant patterns were identified, centred largely on socioeconomic status, gender disparities in clinical care, and the impact of gendered labour expectations on health-seeking behaviour. These determinants significantly delay HF diagnosis and affect treatment optimisation among European women. However, a critical gap remains in sex- and age-disaggregated data with European HF datasets and research. Evidence for practice highlights the need for equity-focused care that incorporates social context into clinical management, while research recommendations prioritise investigating the underlying mechanisms behind the SDH-HF relationship to develop targeted interventions. Social determinants are fundamental drivers of heart failure outcomes for women in Europe. Addressing the intersection of structural socioeconomic barriers and clinical management is essential to mitigating health disparities and achieving care equity and outcomes for women living with HF.

Menstrual Hygiene Management (MHM) is recognized globally as a public health concern; however, it remains a neglected issue in Bangladesh, particularly in rural communities. This study examined the self-reported prevalence and perceived severity of menstruation-related physical and psychological symptoms, their association with menstrual irregularity, and health-seeking behaviour among rural school-going adolescent girls. A cross-sectional mixed-methods study was conducted among 474 grade 9-10 school-going girls in rural Sylhet division, Bangladesh, between September and November, 2024. Participants reported menstrual cycle characteristics and self-rated the severity of their common physical and psychological symptoms as mild, moderate, or severe. Menstrual cycle regularity was assessed through self-report. Symptom prevalence and severity distributions were summarised descriptively by cycle regularity group. Chi-square tests examined associations between menstrual irregularity and symptom severity. Qualitative in-depth interviews (n = 29) were conducted with purposively selected participants to contextualise quantitative patterns within broader sociocultural and structural determinants. Of 474 participants, 111 (23.4%) reported irregular menstrual cycles. Abdominal pain or cramps (77.2%), fatigue or weakness (69.4%), and joint or muscle pain (48.5%) were the most prevalent physical symptoms. Irritability (73.4%), mood swings (64.1%), and anxiety (58.6%) were the most common psychological symptoms. Menstrual irregularity was significantly associated with higher symptom severity for both physical (χ²(2) = 157.81, p < 0.001) and psychological (χ²(2) = 100.85, p < 0.001) outcomes; 49.5% of irregular-cycle girls reported severe physical symptoms versus 3.9% of regular-cycle girls, and 27.0% reported severe psychological symptoms versus 3.0%. Qualitative findings revealed that these high symptom burdens were systematically normalised through cultural beliefs, intergenerational transmission of avoidance strategies, and stigma-mediated communication failures, resulting in very low rates of formal health-care seeking irrespective of symptom severity. This study demonstrates that menstrual symptom burden, both physical and psychological, is substantial among rural adolescent girls in Bangladesh and is disproportionately severe among those with irregular cycles. These findings highlight the importance of integrating symptom recognition, stigma reduction, and accessible care pathways into health initiatives for adolescents. Given the cross-sectional and self-reported design, the results should be interpreted as exploratory but indicative of an important area for targeted public health attention in rural contexts.

Malaria remains a major public health burden in Bangladesh, particularly in the Chittagong Hill Tracts (CHT), where indigenous and marginalized populations face persistent transmission risks. The Mass Vaccine and Drug Administration (MVDA) trial is currently being implemented to accelerate malaria elimination. MVDA is socially complex because it involves administering preventive interventions to largely asymptomatic populations in contexts where trust, prior experiences, and sociopolitical factors strongly shape acceptance. Little is known about community perspectives toward such interventions. This study explored local understandings of malaria, health-seeking behaviours, and perceptions of mass vaccine and drug administration in the CHT to inform community engagement and implementation of MVDA. A qualitative study collected data using focus group discussions (FGDs), in-depth interviews (IDIs), and key informant interviews (KIIs) in Lama and Alikadam sub-districts of Bandarban among community members with no prior exposure to formal research activities. Participants were purposively selected using a maximum variation sampling approach to capture diverse perspectives across socio-demographic and stakeholder groups. Participants included community members, village leaders, traditional healers, local pharmacists, village health workers, religious leaders, and local government representatives. A total of 105 participants from heterogeneous backgrounds participated in this study between September and October 2024. Data were transcribed, translated, and underwent primarily inductive thematic analysis led by a trained qualitative researcher, a Bengali non-native to the study site. Interpretation was conducted reflexively, considering the researcher's positionality. Malaria was recognized as a recurrent illness, particularly during the rainy season and among traditional farmers. While awareness of malaria symptoms and prevention had increased through non-governmental and government initiatives, health-seeking behaviour remained pluralistic. Communities relied on traditional healers and informal drug sellers before seeking formal care. Village health workers provided malaria diagnosis and treatment but faced challenges of inconsistent services (e.g., irregular supply of health materials). The recent COVID-19 experience seemed to shape vaccine perceptions, with mandates, and adverse event narratives contributing to mistrust. Knowledge of a malaria vaccine was limited, yet participants expressed conditional acceptance, indicating willingness to participate if interventions were perceived as safe, effective, and transparently communicated. MDAs were viewed more positively than mass vaccine administration(s) although adherence, particularly among children and adults was considered a challenge. Trust in institutions and historical political mistrust emerged as key determinants shaping community attitudes toward MVDA. These findings informed the design of community engagement strategies accompanying the MVDA intervention. The success of MVDA depends on achieving high population coverage, which is contingent on trust, legitimacy, and effective community engagement. In socially and politically complex settings such as the CHT, implementation must be grounded in context-specific strategies that are responsive to local social and cultural dynamics and informed by community perspectives.

The burden of social stressors (discrimination, prejudice, violence, and stigmatization) is disproportionately high among LGBTIQA + (Lesbian, Gay, Bisexual, Transgender, Intersex, Queer and Asexual) individuals. These stressors negatively influence the overall well-being of this population which in turn affects their health-seeking behaviours, including the disclosure of psychosocial concerns to health workers. Peer-led mental health interventions have therefore been identified as a potentially suitable and acceptable approach for this population. This protocol presents the SAATHI (Support, Advocacy, and Awareness for Trauma, Healing and Inclusion) study. The study will assess the feasibility, acceptability, and effectiveness of peer counselling, safety planning, and group-based sessions in reducing exposure to violence and psychological distress among LGBTIQA + individuals in Nepal. We will conduct a three-arm randomized controlled trial with a 1:1:1 allocation ratio. At least 1062 LGBTIQA + participants will be enrolled. Eligibility criteria include age 18-55years, a history of violence in the past 12months, and a score of ≥ 3 on the General Health Questionnaire, indicating psychological distress. Participants in the intervention arms will receive six 90-min peer-led counselling sessions and one of the arms will receive monthly peer-led group sessions for shared reflection and support. Follow-up assessments will occur at 7weeks, 18weeks, and 12months post-baseline. A qualitative process evaluation will be conducted of the intervention delivery. The primary outcomes are psychological distress and exposure to violence. The secondary outcomes include post-traumatic stress disorder, participant-reported psychological outcomes, daily functioning, self-esteem, self-compassion, perceived social support, use of personal safety strategies, and satisfaction with community resources. We will analyse quantitative data using intention-to-treat principles. For the qualitative data, our approach will be reflexive thematic analysis, which is grounded in a critical realist/contextualist ontology. This study ultimately aims to reduce health disparities and improve the health and well-being of LGBTIQA + individuals. If effective, the SAATHI intervention has potential to be sustainable through empowered peer-led networks and scalable in low- and middle-income countries due to its low-cost, community-implemented design. ClinicalTrials.gov NCT06979193. Registered on 20 May 2025, https://clinicaltrials.gov/study/NCT06979193.

Unplanned pregnancy continues to pose a major challenge to public health, frequently resulting in negative maternal outcomes and delayed healthcare utilization. In developing nations, its occurrence is influenced by restricted access to contraception, cultural and societal norms, and inadequate awareness of reproductive health. This study primarily aimed to assess the prevalence and factors associated with unplanned pregnancies with a comparative group of planned pregnancies. Secondary objectives included exploring pregnancy outcomes and health-seeking behavior in unplanned pregnancies. An analytical cross-sectional study was conducted with 430 ever-married women who conceived in the last three years, recruited using convenient sampling from rural and urban areas of Khordha District, Odisha. Data were collected via face-to-face interviews. Descriptive statistics were used to describe the sociodemographic and obstetric characteristics, and bivariate and multivariate logistic regression were used to identify associated factors, outcomes, and health-seeking behavior in unplanned pregnancies. Nearly one-fourth of women (26%) had unplanned pregnancy, 64% continued their pregnancy, while 36% opted for termination. Age at pregnancy ≥ 30 years, gravidity > 2, birth spacing ≤ 24 months, history of induced abortion, and both induced & spontaneous abortions were factors associated with unplanned pregnancies. Secondary findings indicated that unplanned pregnancies were associated with higher rates of complications during pregnancy and puerperium, as well as delayed Urine Pregnancy Test and Antenatal Care registration. Unplanned pregnancies were significantly associated with advanced maternal age, higher gravidity, short birth intervals, and a prior history of abortion. These pregnancies were more likely to result in adverse maternal outcomes and were marked by delayed healthcare utilization, including late antenatal registration and reliance on unsafe abortion methods. Enhancing access to contraception, fostering early engagement with maternal healthcare services, and strengthening reproductive health education are crucial steps toward reducing the incidence and consequences of unplanned pregnancies.

Karen and Karenni refugees from Myanmar face significant barriers to access and engagement in health services due to high levels of vulnerability and disability. Social isolation and limited access to resources have been identified as important barriers to health engagement; however, research on social inclusion programs, which might assist in overcoming poor access, have been limited in number and by methodological constraints This study examined the impact of a social inclusion program on the health-seeking behaviours of Karen and Karenni refugees in Melbourne's western suburbs, by identifying the key enablers and barriers to improving health engagement. Semi-structured interviews were conducted with both refugees and healthcare practitioners, and subsequently analysed with both deductive and inductive thematic analysis. Interviews explored refugees' understanding of their health conditions, and their engagement with the Victorian healthcare system, as well as healthcare practitioners' impressions of the above. Health practitioners (5) and refugees (14) had similar perspectives. Outcomes demonstrated partially improved engagement, specifically a greater willingness to seek help for physical compared with mental health complaints, and a clear preference for community-based over hospital care. Enablers included social connection and psychological safety, which fostered a sense of identity that enhanced functioning and health-seeking capacity. Program effectiveness was hampered by refugee-specific and systemic barriers, including cultural differences, low health literacy, social issues and inaccessible hospital systems. This research highlights the effectiveness of a community-led, culturally-sensitive intervention in empowering Karen and Karenni refugees to engage in health care. Findings support increased funding for ongoing program delivery, and can inform development of more refugee-specific health services nationwide and globally.

BackgroundMalaria remains the leading cause of morbidity and mortality in Ghana, particularly in rural high-burden communities. Mass drug administration (MDA) has re-emerged as a complementary strategy to reduce transmission, yet community acceptability and implementation challenges remain underexplored.MethodsWe conducted a cross-sectional study in the Pokrom subdistrict following pilot mass drug administration (MDA) interventions. Data were collected through eleven focus group discussions (FGDs), nine with community members and two with healthcare providers, comprising 97 participants, as well as eight in-depth interviews (IDIs) with assemblymen, healthcare providers and personnel of malaria elimination programme. Thes were complemented by field notes. Participants were purposively selected from individuals who had participated in the MDA interventions and provided informed consent. This study explored community perceptions of malaria burden, perceived MDA effectiveness, reported adverse events, health-seeking behaviour, financial implications and acceptability. Transcripts were analysed thematically using a hybrid inductive–deductive approach informed by reflexive thematic analysis.ResultsMalaria was widely identified as the most pressing health concern in the subdistrict prior to the MDA intervention, with frequent hospitalisation and substantial household expenditure on treatment reported. Following the MDA interventions, notable reductions in malaria episodes were described, with some households transitioning from frequent infections to rare or no illness. These perceived improvements were accompanied by decreased healthcare-related costs, indicating important financial and economic benefits. Though adverse events, including dizziness, abdominal pain, and weakness, were reported, they were generally perceived as mild and transient. Initial challenges included inadequate community sensitization and negative messaging from some health workers, which temporarily affected uptake. Despite these concerns, willingness to participate in future MDA rounds remained high among community members, with recommendations emphasizing continued sensitization, strengthened drug delivery systems, and enhanced monitoring of side effects.ConclusionsThe MDA interventions were widely perceived as beneficial in reducing malaria burden and associated household healthcare costs in rural Ghana. Consistent with the Theoretical Framework of Acceptability, perceived effectiveness and economic benefits outweighed the burden of transient adverse events, contributing to perceived high community acceptability. Strengthening communication, pharmacovigilance, and community engagement could be critical for sustaining uptake and supporting the potential scale-up of MDA in high-burden malaria settings.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12936-026-05979-w.

Rabies is a fatal zoonotic disease causing an estimated 59000 annual human deaths globally and approximately 523 in Kenya, with children disproportionately affected. Despite evidence that school-based educational interventions effectively increase rabies awareness and prevention among children, its implementation in Kenya is limited. This study aimed at utilizing an education programme to increase rabies awareness among primary school learners and evaluate their knowledge uptake. A quasi-experimental study was conducted among 210 learners from four primary schools (two urban, two rural). Pre-tested questionnaires assessed rabies awareness before and after rabies training sessions. Differences between urban and rural schools were assessed using χ2 tests, while Wilcoxon signed-rank test was used for pre- and post-training scores. Post-training, overall knowledge scores improved from 6.14 to 7.61(p<0.001), with significant increase in learners' knowledge on rabies transmission, zoonosis, and the importance of annual dog vaccination. Attitudes and perceptions improved from 3.23 to 4.03 (p<0.001), particularly health-seeking behaviour and reporting post dog bite. In conclusion, school-based rabies education significantly improved learners' awareness. Being the first report of such intervention in Kenya, it could serve as a model for other zoonoses.

A well-performing health workforce, defined as one that is available, competent, productive, and responsive to patient needs, is central to achieving Sustainable Development Goals SDG 3.8 on Universal Health Coverage. In Uganda, district-level health performance reports have indicated persistent challenges. Addressing health workforce performance gaps is therefore a critical health systems issue for achieving district-level health targets. This study assessed factors affecting the performance of professional nurses and midwives defined as enrolled, registered, and degree-level practitioners licensed by the Uganda Nurses and Midwives Council, in Lira District, Northern Uganda. A cross-sectional convergent parallel mixed-methods study was conducted from April 2017 to May 2018. A structured questionnaire was administered to 156 randomly selected nurses (n = 98) and midwives (n = 58) across all government (n = 24) and private-not-for-profit (n = 6) facilities. Performance was measured across four dimensions: competency, productivity, availability, and responsiveness. Principal Component Analysis (PCA) reduced independent variables. Linear regression identified predictors of performance. Qualitative data from 20 key informant interviews (KIIs) and three Focus Group Discussions (n = 30) were analyzed thematically. The majority of respondents were female (83.3%), certificate holders (72.4%), and had 1-10 years of experience (54.5%). PCA yielded six components (C1-C6) explaining 85.9% of variance. Performance levels varied across dimensions: half of the respondents (50.0%) had competency scores in the 0-50% range, while productivity (60.3%), availability (51.3%), and responsiveness (75.0%) scores were predominantly in the 51-75% range. Linear regression identified distinct predictors for each dimension: Competency was significantly predicted by C1 (Poor Clinical Practice, β=-0.010, p = 0.012), C2 (Adherence to Systems, β = 0.066, p < 0.001), C3 (Organizational Commitment, β = 0.039, p < 0.001), and C4 (Participatory Environment, β = 0.080, p < 0.001). Productivity was predicted by C1 (β=-0.029, p < 0.001), C2 (β = 0.030, p = 0.006), C3 (β = 0.044, p = 0.005), and C4 (β = 0.131, p < 0.001). Availability was predicted by C2 (β = 0.090, p < 0.001), C4 (β = 0.131, p < 0.001), C5 (Unmet Training Needs, β=-0.060, p < 0.001), and C6 (Politicized Recruitment, β=-0.020, p = 0.004). Responsiveness was predicted by C2 (β = 0.070, p < 0.001), C4 (β = 0.139, p < 0.001), and C5 (β=-0.047, p < 0.001). Qualitative findings from 20 key informant interviews and 3 FGDs revealed key contextual factors: poor health-seeking behaviors (mentioned in 85% of FGDs), political interference in recruitment/promotion (reported by 70% of key informants), lack of community ownership of health facilities (discussed in 80% of FGDs), and negative staff attitudes (raised in 85% of FGDs). Individual factors (clinical practices, motivation), organizational factors (working environment, systems adherence, resource availability), and political economy factors (political interference in recruitment/promotion) significantly predict nurse and midwife performance across all dimensions. Community-level factors (poor health-seeking behaviors, negative mutual perceptions) further undermine performance and service utilization. A multi-level intervention addressing individual capacity, organizational support, depoliticized human resource management, and community-health system linkages is urgently needed to improve workforce performance and service delivery. This requires coordinated action from national policymakers, district managers, facility leaders, and communities.

Cancer has become a major global public health threat, and individuals diagnosed with cancer and their family caregivers often seek to understand their illness experiences. Religious, spiritual, and sociocultural beliefs play a central role in shaping illness interpretations and care-seeking behaviors. However, in Ethiopia, limited attention has been paid to how these frameworks influence cancer experiences. This study explored religious narratives and interpretations of illness etiology among individuals diagnosed with cancer and their family caregivers and examined their influence on illness experiences and health-seeking practices. An interpretive phenomenological approach was employed using semi-structured, in-depth interviews with 41 participants, including individuals with cancer, family caregivers, and religious leaders. Data were transcribed, translated, and thematically analyzed to examine the processes of meaning-making. The findings showed that participants commonly conceptualized addiction as spiritually mediated rather than merely biologically determined. Illness was frequently interpreted as having a divine or supernatural origin, including punishment, a test of faith, God’s will, or spiritual affliction. These interpretations were dynamic and shaped by religious teachings, sociocultural contexts and personal reflections. Religious frameworks influence emotional responses, coping strategies, and health-seeking behaviors, providing comfort and resilience while shaping treatment decisions. They functioned not only as explanatory frameworks for illness but also as practical resources that structured participants’ responses to and negotiations with uncertainty, suffering, and responsibility. Religious meaning-making plays a central role in illness interpretations and overall experiences in cancer trajectories. Recognizing and engaging with these spiritual frameworks may enhance culturally responsive and patient-centered cancer care. Integrating spiritual sensitivity into clinical practice and collaborating with religious leaders may improve communication, trust, and psychosocial support for patients and their families.