BMJ public health最新文献

{"title":"Early detection of oropharyngeal dysphagia in rehabilitation and long-term care sectors: the EDOR-Care cross-sectional study protocol.","authors":"Giulia Krethlow, Valentin Oestreicher, Igor Leuchter, Léa Burgniard, Eric Ménétré, Christophe Graf, Marie-José Roulin","doi":"10.1136/bmjph-2025-004740","DOIUrl":"https://doi.org/10.1136/bmjph-2025-004740","url":null,"abstract":"<p><strong>Introduction: </strong>Oropharyngeal dysphagia (OD), or difficulty swallowing, is a common yet frequently underdiagnosed condition that can lead to serious complications, reduced quality of life and increased healthcare costs. Early identification of at-risk patients is therefore essential. Although screening tools such as the Volume-Viscosity Swallow Test (V-VST) are widely used, they remain time-consuming, require trained staff and are often validated only in specific populations (eg, patients who had a post-stroke). This study aims first to establish the prevalence of OD risk in rehabilitation and long-term care units; second, to quantify the agreement between bedside nurses and specially trained nurses using the same institutional screening tools; and third, to estimate the criterion validity of two institutional tools less time-consuming and easier to use against the V-VST, used as the comparator standard. Clinical risk factors and patient characteristics associated with OD will be identified to develop a simple, rapid and reliable predictive risk score. Designed for use by non-specialised staff at admission, this tool should support early detection and optimise resource allocation across diverse care settings.</p><p><strong>Methods and analysis: </strong>This cross-sectional study will screen for OD all adult inpatients admitted to rehabilitation units and long-term care sectors of the Departments of Clinical Neurosciences and Rehabilitation & Geriatrics, that is, an expected total of 457-487 patients recruited consecutively and exhaustively without random sampling. The primary outcome is the prevalence of OD, which will be compared with published estimates. Secondary outcomes will include identifying risk factors and clinical characteristics, assessing the agreement between bedside nurses and specially trained nurses, validating two institutional screening tools against the V-VST and developing a predictive risk score for early detection at admission. Analyses will comprise proportions with 95% CIs, multivariable logistic regression, percentage agreement and Cohen's kappa, sensitivity, specificity, predictive values and likelihood ratios, and development of a points-based risk score with internal validation by bootstrapping.</p><p><strong>Ethics and dissemination: </strong>The study has received ethics committee approval (2025-00401). This manuscript reports the study protocol: at the time of submission, no participant had been screened, and no data had been collected. Inclusions are planned from 4 January 2027 to 30 June 2027. Findings will be disseminated through peer-reviewed scientific journals and conferences. If internally validated, the predictive score could inform early identification of patients at risk of OD within the study institution; any broader clinical use would require independent external validation and compliance with the applicable medical device regulations.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e004740"},"PeriodicalIF":1.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General practitioners' willingness and perceived barriers and facilitators to 'prescribing' potassium-enriched salt in China: an explanatory sequential mixed methods study.","authors":"Shuangjie Peng, Yuze Xin, Rui Jiang, Kathy Trieu, Katrina Kissock, Bruce Neal, Xuejun Yin, Yongchen Wang, Maoyi Tian","doi":"10.1136/bmjph-2026-005169","DOIUrl":"https://doi.org/10.1136/bmjph-2026-005169","url":null,"abstract":"<p><strong>Introduction: </strong>Replacing regular salt with potassium-enriched salt has been identified as a promising strategy to reduce blood pressure and prevent cardiovascular diseases. However, its implementation in clinical practice remains limited. To address this implementation gap, this study aimed to examine general practitioners' (GPs) self-reported awareness, perceptions, personal use and willingness to 'prescribe' potassium-enriched salt and to identify perceived barriers and facilitators to its future implementation in routine primary care.</p><p><strong>Methods: </strong>This explanatory sequential mixed methods study combined a cross-sectional survey of GPs across mainland China with semi-structured qualitative interviews with GPs and patients.</p><p><strong>Key results: </strong>A total of 7134 survey responses were received, of which 7116 were included in the quantitative analysis after 18 internally inconsistent responses were excluded. The qualitative phase included 51 participants (19 GPs and 32 patients). Among the 7116 GPs included in the quantitative analysis, 82.6% reported having heard of potassium-enriched salt, 48.6% reported currently using it, 78.7% perceived it to be safe and 79.5% expressed willingness to 'prescribe' it. Among those unwilling to 'prescribe' it (n=1456), the most frequently reported reason was perceived low patient awareness (44.7%). Qualitative findings indicated that willingness was influenced by uncertainty about appropriate use, concerns about potential safety risks, the lack of clinical guidelines and perceived gaps in understanding of long-term benefits and risks. Consumer adoption was influenced by taste preferences, cost and limited awareness of potential health benefits. Strong GP-patient trust emerged as a key facilitator.</p><p><strong>Conclusions: </strong>This study highlights the potential role of GPs in recommending potassium-enriched salt. Future implementation will require addressing gaps in awareness and understanding, providing formal training and developing standardised guidelines to support safer and more consistent implementation in routine primary care.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e005169"},"PeriodicalIF":1.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Outsourced oxygen to the bedside' in five countries: a qualitative implementation assessment.","authors":"Celia Blaas, Pius Mukisa, Mattias Schedwin, Hamish R Graham, Tim Baker, Ayobami Adebayo Bakare, Deepa Bishit, Elibariki Mkumbo, Jacquie Oliwa, Jacinta Nzinga, Sophie Namasopo, Máire Ruane, Aishat Adeniji, Michael T Hawkes, Amarpreet Rai, Michael Njuguna, Carina King, Freddy Eric Kitutu","doi":"10.1136/bmjph-2026-005433","DOIUrl":"https://doi.org/10.1136/bmjph-2026-005433","url":null,"abstract":"<p><strong>Introduction: </strong>Access to medical oxygen remains a challenge, with 60% of the world's population lacking access to quality oxygen services. We explored whether 'outsourced oxygen to the bedside' (O2B), where private providers offer bundles of oxygen services to health facilities, could be adopted and scaled across diverse health systems, to improve patient access to oxygen.</p><p><strong>Methods: </strong>Qualitative interviews were conducted with healthcare workers (HCWs), facility management staff and district medical officers in India, Nigeria, Tanzania, Kenya and Uganda, who had taken part in an O2B pilot. Interviews were conducted between 19 November 2024 and 25 January 2025 and explored the feasibility, fidelity, acceptability, perceived benefits and weaknesses of five O2B models. Analysis used a pragmatic codebook approach, with inductive and deductive coding, informed by implementation science frameworks.</p><p><strong>Results: </strong>We conducted 59 interviews across 20 health facilities. We identified five themes relating to the potential for O2B pilots to be adopted within the health system: a positive effect on oxygen culture, feasibility of whole of facility solutions, promotion of local ownership, lack of feasible payment schemes and the desire for hybrid tailored service models. HCWs and facility staff raised several positive factors within these themes but highlighted that understanding local facility needs and tailoring the services to embed within existing structures were important for sustainability.</p><p><strong>Conclusions: </strong>Overall, the O2B service approach was feasible and perceived positively by health facility managers and HCWs. However, the effective scale of O2B services will require intentional tailoring to individual facility needs and improved strategies for financial affordability and sustainability.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e005433"},"PeriodicalIF":1.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing a peer learning strategy for health systems strengthening in Ghana: a qualitative study.","authors":"Janet A Y Tiah, Essi Edjodjinam Kpegba-Fiaboe, Adriana A E Biney, Pearl S Kyei, Samuel Amon, Mawuli K Kushitor, Patrick O Asuming, Caesar Agula, Arhizah Blay-Abiti, S Patrick Kachur, John Koku Awoonor-Williams, Ayaga A Bawah","doi":"10.1136/bmjph-2026-004995","DOIUrl":"https://doi.org/10.1136/bmjph-2026-004995","url":null,"abstract":"<p><strong>Introduction: </strong>Primary healthcare, through community-based care provision, is a pathway to achieving universal health coverage (UHC). Ghana adopted the Community-based Health Planning and Services (CHPS) initiative as a national health strategy to drive UHC. Challenges with the national scale-up led to strengthening CHPS in the Upper East Region through the Ghana Essential Health Interventions Programme (GEHIP). Subsequently, CHPS+ was implemented to further strengthen CHPS and sustain the gains of GEHIP. CHPS+ adopted a peer learning implementation strategy through health personnel visits to Upper East. This study reports on health personnel's experiences with the CHPS+ peer learning exchange and their perceptions of how lessons from the exchange informed healthcare services.</p><p><strong>Methods: </strong>This qualitative systems appraisal used a descriptive design comprising in-depth interviews and focus group discussions. Study participants consisted of 51 health personnel, including district health management team members, subdistrict leaders and community health officers, recruited from four systems learning districts. The data were analysed thematically, both manually and using the Dedoose software.</p><p><strong>Results: </strong>Peer-to-peer learning strengthened CHPS implementation by improving subdistrict supervision, standardising monitoring and feedback, enhancing community engagement and supporting the use of practical tools such as community health action plans, movement wheels, community maps and profiling charts. Greater involvement of chiefs, community health committees, volunteers and local government actors was reported after the exchange. However, implementation remained uneven, with some districts reporting concrete changes and others describing early-stage actions. Continued mentorship, adequate resources, routine monitoring and stronger local leadership were recommended to sustain and institutionalise the lessons learnt.</p><p><strong>Conclusions: </strong>Peer-to-peer learning offers a feasible strategy for strengthening CHPS+ implementation across districts by translating established practices into locally adaptable action. Its long-term value will depend on institutionalising follow-up mentorship, ensuring adequate resources and embedding shared learning within routine health-system structures to strengthen primary healthcare in Ghana.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e004995"},"PeriodicalIF":1.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondhand smoke exposure and current tobacco and/or nicotine use among adolescents in Kenya and Nigeria: a survey-weighted inverse probability weighting analysis.","authors":"Grace Kyule, Shukri F Mohamed, Lyagamula Kisia, Olatunbosun Abolarin, Uche Okezie, Nelson Mbaya, Akinsewa Akiode, Thompson Ademola, James Kavai, Franklin Koech, Bosco Okumu, Damazo T Kadengye, Samuel Iddi","doi":"10.1136/bmjph-2025-004773","DOIUrl":"https://doi.org/10.1136/bmjph-2025-004773","url":null,"abstract":"<p><strong>Introduction: </strong>Secondhand smoke (SHS) exposure is associated with adolescent tobacco and nicotine use but nationally representative evidence from sub-Saharan Africa is limited. We examined this association among adolescents in Kenya and Nigeria using survey-weighted inverse probability weighting.</p><p><strong>Methods: </strong>We analysed cross-sectional data from the 2024 Data on Youth Tobacco in Africa household survey of adolescents aged 10-17 years in Kenya (n=6435) and Nigeria (n=7502). SHS exposure was self-reported. Current use of any tobacco and/or nicotine product was self-reported past-30-day use of cigarettes, roll-your-own tobacco, shisha, smokeless tobacco, heated tobacco products, e-cigarettes or nicotine pouches. We estimated the average treatment effect (ATE) and average treatment effect on the treated (ATT), adjusting for age, sex, residence, school attendance, adolescent employment, household head education, household size, wealth and country in pooled analyses. We assessed effect modification by country and conducted regression, location-specific and E-value sensitivity analyses.</p><p><strong>Results: </strong>Overall, 38.2% reported SHS exposure and 3.1% reported current use; 72.1% of current users were boys. Current use was more common among SHS-exposed than unexposed adolescents (4.4% vs 2.4%). In pooled analyses, SHS exposure was associated with a 2.65 percentage-point higher probability of current use (ATE: +2.65 pp; 95% CI 1.46 to 3.83); the ATT was 2.42 percentage points (95% CI 1.35 to 3.49). The ATE was larger in Nigeria (+3.94 pp; 95% CI 1.95 to 5.93) than Kenya (+1.32 pp; 95% CI 0.19 to 2.45), with evidence of effect modification (interaction p=0.019). Sensitivity analyses were consistent, although unmeasured confounding remains possible.</p><p><strong>Conclusions: </strong>SHS exposure was associated with a higher probability of adolescent tobacco and/or nicotine use. Because exposure and outcome were measured cross-sectionally, temporality and causality cannot be established. Strengthening smoke-free policies may help reduce adolescent SHS exposure and tobacco and/or nicotine use.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e004773"},"PeriodicalIF":1.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Viral load measurements and viral suppression in a cohort of acutely treated people living with HIV during the COVID-19 pandemic in Bangkok, Thailand: a longitudinal cohort analysis.","authors":"Nitiya Chomchey, Carlo Sacdalan, Tyler Hamby, Roger Ying, Julius Tonzel, Eugène Kroon, Ferron Ocampo, Pathariya Promsena, Peeriya Prueksakaew, Somchai Sriplienchan, Nittaya Phanuphak, Lydie Trautmann, Sandhya Vasan, Trevor A Crowell","doi":"10.1136/bmjph-2025-003196","DOIUrl":"10.1136/bmjph-2025-003196","url":null,"abstract":"<p><strong>Introduction: </strong>Lockdowns during the COVID-19 pandemic decreased disease transmission by reducing social interactions but also potentially hindered access to medical care. For individuals who face social and structural barriers to healthcare, such as people with HIV, the overall effect on medical care is unclear.</p><p><strong>Methods: </strong>Using data from the RV254/SEARCH010 study, a cohort of people with acutely treated HIV, we examined changes in HIV care during the COVID-19 pandemic. Participants with at least one suppressed viral load measurement (≤1000 copies/mL) after 24 weeks on antiretroviral therapy (ART) between 1 January 2018 and 30 September 2023 were included to assess maintenance of HIV care. Time periods were defined as pre-COVID-19, COVID-19 and post-lockdown. COVID-19 was further divided into lockdown 1 (16 March to 3 May 2020), lockdown 2 (1 May to 6 June 2021) and the open inter-lockdown period. Generalised estimating equations were used to calculate prevalence ratios (PRs) of measurements/year and ORs of viral suppression, with 95% CIs. Analyses were adjusted for demographic factors, ART regimen and enrolment status (newly enrolled or established in care).</p><p><strong>Results: </strong>Among 606 participants, 591 (97.5%) were male with a median age of 26.9 years. Participants had 3.50 measurements/year in the pre-COVID-19 period, which decreased to 2.36/year (aPR 0.67 (95% CI 0.65 to 0.70)) during the COVID-19 period and 2.56/year (aPR 0.73 (0.71-0.75)) in the post-lockdown period. Older participants also had fewer measurements/year compared with those 18-19 years of age (20-29 years, aPR 0.90 (0.82-0.98); ≥30 years, aPR 0.88 (0.80-0.97)), as did sex workers (aPR 0.91 (0.85-0.96)). Viral suppression remained unchanged during the COVID-19 (aOR 0.95 (0.43-2.07)) and post-lockdown (aOR 0.95 (0.48-1.88)) periods compared with pre-COVID-19. During the COVID-19 period, there were fewer measurements in lockdowns 1 and 2 (0.34/year and 0.14/year) than the inter-lockdown period (2.82/year).</p><p><strong>Conclusions: </strong>Lockdowns during COVID-19 reduced HIV care engagement, particularly among participants established in care, without affecting viral suppression.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e003196"},"PeriodicalIF":1.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, patterns and factors associated with over-the-counter antibiotic purchase: a cross-sectional study in private pharmacies in Montserrado County, Liberia.","authors":"Bode Ireti Shobayo, Cecilia Stalsby Lundborg, Helena Nordenstedt, Tamba Fayiah, Mosoka Fallah, Megha Sharma","doi":"10.1136/bmjph-2025-004154","DOIUrl":"https://doi.org/10.1136/bmjph-2025-004154","url":null,"abstract":"<p><strong>Introduction: </strong>Antibiotics are prescription-only medicines, but their over-the-counter (OTC) purchase is common in low-income countries such as Liberia. Private pharmacies are an important source for OTC purchases. This study investigates the prevalence, patterns and factors affecting the OTC purchase of antibiotics from private retail pharmacies in Liberia.</p><p><strong>Methods: </strong>14 private pharmacies were selected through stratified random sampling in Montserrado County, Liberia, for the cross-sectional study conducted in 2023. Exit interviews were conducted among adult clients who consented and purchased antibiotics using a validated, semi-structured questionnaire. The demographic information, prescription availability, antibiotic use and antibiotic resistance (AR) knowledge were recorded. The Access, Watch and Reserve classifications were employed.</p><p><strong>Results: </strong>Of 600 clients approached, 584 (97%) purchased antibiotics, while 96% (562/584) purchased without-prescription. Access and Watch categories accounted for 56% (313/562) and 33% (183/562) OTC purchases, respectively. Most participants (465/584, 80%) had low awareness of AR. Previous experience with an antibiotic was the most common reason for OTC purchase (38%). Keeping antibiotics as reserve medicine (adjusted OR (aOR)=2.2, 95% CI 1.1 to 4.8), no information about AR (aOR=4.4, 95% CI 2.08 to 9.60) and affordability of purchasing antibiotics without-prescription instead of with-prescription (no doctor visit, aOR=3.2, 95% CI 1.5 to 6.6) showed a significant association with OTC purchases.</p><p><strong>Conclusion: </strong>A majority of the clients in Montserrado County purchased antibiotics without a prescription. Watch antibiotics, labelled as reserved for health facilities, accounted for one-third of total OTC purchases. Low awareness of AR and purchasing antibiotics based on prior experiences were prevalent. OTC purchases were significantly associated with antibiotic affordability, awareness level and the preservation of antibiotics for future use. Our study underlines an urgent need for implementing community-focused and pharmacy-focused antibiotic stewardship with contextual mass awareness campaigns on AR and microbial diseases and regular surveillance to rationalise antibiotic use in the community.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e004154"},"PeriodicalIF":1.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What factors are associated with contraceptive method choice during social marketing campaigns in Kinshasa, Democratic Republic of the Congo? A mixed-methods cross-sectional study.","authors":"Lionel Muyuku, Harry César Kayembe, Glody-Nickel Mbaa, Tesky Koba, Valentin Mbumba, Paul Samson D Lusamba","doi":"10.1136/bmjph-2026-005019","DOIUrl":"https://doi.org/10.1136/bmjph-2026-005019","url":null,"abstract":"<p><strong>Introduction: </strong>The Democratic Republic of the Congo (DRC) has one of the highest maternal mortality ratios worldwide (746 per 100 000 live births), alongside limited access to contraception. Modern contraceptive prevalence remains low, estimated at 11% among women in union. This situation is compounded by insufficient funding and limited government commitment. In this context, social marketing has been considered a strategic response to these challenges.This study aimed to identify factors associated with contraceptive method choice during social marketing family planning campaigns and to explore the perceptions and attitudes of healthcare providers and women users towards these campaigns. The quantitative component included only women who adopted a contraceptive method during campaigns, which limits inference on overall uptake.</p><p><strong>Methods: </strong>Sequential explanatory mixed-methods study combining an analytical cross-sectional survey with an exploratory qualitative component, conducted in health facilities implementing social marketing campaigns between January 2022 and December 2023 in Kinshasa, DRC.Participants were healthcare providers and 339 women who adopted a contraceptive method during the campaigns.Study variables included sociodemographic characteristics, contraceptive method choice and providers' and users' perceptions.</p><p><strong>Results: </strong>Most women (81.7%) opted for implants. Contraceptive method choice was significantly associated with educational level, marital status and exposure to media as a source of campaign information. Implant adoption followed a curvilinear pattern across educational levels, peaking among women with secondary education, and was markedly higher among married women. Rumours and cost were identified as barriers to contraceptive use and access.</p><p><strong>Conclusions: </strong>These findings support the continued use of social marketing as a viable strategy to expand contraceptive access. Although social marketing campaigns facilitated access to contraception, substantial challenges persist in the context of the Democratic Republic of Congo, underscoring the need for sustained family planning efforts.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e005019"},"PeriodicalIF":1.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large-scale COVID-19 asymptomatic testing using lateral flow devices (LFDs) in reducing nosocomial infections and healthcare worker absenteeism: an observational study and cost-effectiveness analysis in NHS acute trusts in England.","authors":"Siyu Chen, Rachel Hounsell, Liberty Cantrell, Lok Hei Tsui, Reshania Naidoo, Prabin Dahal, Richard Creswell, Sumali Bajaj, Jennifer A Flegg, Tom Fowler, Susan Hopkins, Ben Lambert, Merryn Voysey, Lisa White, Kasia Stepniewska, Rima Shretta","doi":"10.1136/bmjph-2024-001618","DOIUrl":"https://doi.org/10.1136/bmjph-2024-001618","url":null,"abstract":"<p><strong>Introduction: </strong>Twice-weekly lateral flow device (LFD) testing for asymptomatic healthcare workers (HCWs) was introduced in the National Health Service (NHS) in England in November 2020. We retrospectively examine associations between LFD testing, nosocomial infections and HCW absenteeism at NHS acute trusts.</p><p><strong>Methods: </strong>We collected 16 million LFD testing results reported by NHS acute trusts from 1 October 2020 to 30 March 2022 and estimated the prevalence of nosocomial COVID-19 infections in NHS acute trusts using data from the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC). We used a mixed-effects linear model to examine the association between full-time equivalent (FTE) days lost due to COVID-19 and LFD test coverage. The relationship between weekly prevalence of nosocomial infections and LFD test coverage in the previous week was modelled using logistic regression weighted by the number of new COVID-19 cases reported in the ISARIC dataset for that week. We conducted an analysis of cost-effectiveness of testing for nosocomial infections.</p><p><strong>Results: </strong>Increased LFD test coverage was associated with decreases in FTE days lost due to COVID-19 from November 2020 to July 2021, with no association observed from August 2021 to March 2022. The proportion of nosocomial infections among new weekly cases in hospitalised patients was negatively associated with reported LFD testing levels.</p><p><strong>Conclusions: </strong>Higher LFD test coverage was associated with lower HCW absenteeism (November 2020-July 2021) and with a lower proportion of nosocomial infections among hospitalised patients. Given the retrospective, ecological design, these are associations rather than causal effects, and the cost-effectiveness estimates are valid only if the observed association reflects a causal effect of testing rather than confounding by co-occurring interventions or temporal trends in the pandemic. Under that assumption, LFD testing would have been a cost-effective measure for reducing nosocomial infections in NHS acute trusts.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e001618"},"PeriodicalIF":1.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infant vaccination coverage trajectories and immunisation system archetypes in the WHO African region, 2019-2024: a longitudinal analysis of 47 countries.","authors":"Abdu A Adamu, Aschalew Teka Bekele, Balcha Girma Masresha, Lynda Rey, Sidy Ndiaye, Michael R Adjei, Ado Mpia Bwaka, Rabiu I Jalo, Charles Shey Wiysonge","doi":"10.1136/bmjph-2025-004748","DOIUrl":"10.1136/bmjph-2025-004748","url":null,"abstract":"<p><strong>Introduction: </strong>COVID-19 disrupted childhood vaccination, but country-specific heterogeneity in diphtheria-tetanus-pertussis-containing vaccines (DTP3) coverage across the WHO African region remains poorly understood. This study addressed this gap by quantifying temporal trajectories and identifying latent structural patterns in DTP3 coverage across all 47 countries in the WHO African region from 2019 to 2024, spanning the onset and recovery phases of the COVID-19 pandemic.</p><p><strong>Methods: </strong>Country-level DTP3 coverage data from 2019 to 2024 were extracted from the WHO/United Nations Children's Fund Estimates of National Immunisation Coverage, published in July 2025. Country-specific ordinary least squares regression models estimated annual rates of change (slopes) in DTP3 coverage, while linear mixed-effects modelling decomposed within-country and between-country variance components. Principal component (PC) analysis (PCA) was then applied to the 6-year coverage matrix to derive two dominant, uncorrelated components capturing coverage level (PC1) and temporal trajectory (PC2). K-means clustering of PC scores grouped countries into empirically distinct immunisation system archetypes.</p><p><strong>Results: </strong>Between 2019 and 2024, the estimated annual rate of change in DTP3 coverage was positive in 21 countries and negative in 24; Eritrea and Burkina Faso showed no evidence of a linear trend. The fixed-effect slope was 0.07 percentage points per year (95% CI -0.34 to 0.47; p=0.75), indicating no statistically significant net regional change, while between-country heterogeneity was substantial (random-intercept variance, 188.18; random-slope variance, 1.18). PCA showed that PC1 dominated, explaining 93% of variance (capturing sustained coverage level), with PC2 contributing an additional 3% (capturing temporal trajectory). K-means clustering of PC scores yielded four archetypes: cluster 1 (high coverage, consolidating; n=15), cluster 2 (chronically low coverage, divergent trajectories; n=9), cluster 3 (mid-low coverage, predominantly improving; n=11) and cluster 4 (mid-high coverage, erosion risk; n=12).</p><p><strong>Conclusion: </strong>This study generated an empirically derived, model-driven typology of immunisation system performance across the WHO African region, characterised by four distinct DTP3 coverage archetypes. The typology provides decision-makers with a granular basis for differentiating programmatic strategies, prioritising resource deployment and designing cluster-specific implementation research rather than applying uniform regional solutions.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 Suppl 1","pages":"e004748"},"PeriodicalIF":1.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}