PLOS global public health最新文献

{"title":"Advancing gender equality in global health: What can we learn from successful gender integration across five UN agencies?","authors":"Johanna Riha, T K Sundari Ravindran, George A Atiim, Renu Khanna, Michelle Remme","doi":"10.1371/journal.pgph.0004697","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004697","url":null,"abstract":"<p><p>The global nature of on-going crises - climate, economic, social, political - and their impact on health means more than ever a response supported via an effective multilateral system is needed. Not only have these crises worsened health inequities but they have also eroded strides advancing gender equality, with detrimental impacts in the health sector and beyond. Despite recent attacks against multilateralism, the United Nations (UN) and its agencies remain strategically well-placed to provide direction and lead the agenda of gender equality in health, drawing on lessons from the past. Through a collaborative practice-based multi-agency study, 14 case studies from across five UN agencies were documented and analysed to identify what has worked institutionally and programmatically to promote gender equality in health over the last 25 years. The outcomes observed reflected the different levels that UN agencies work at and showcased the capabilities and strengths of the UN system in promoting gender equality in health through its operational functions, global agenda-setting work, and institutional processes and structures. In addition, across the case studies five key factors - feminist civil society, robust evidence, leadership support and gender technical expertise, and institutional structures - consistently stood out as necessary elements to leverage opportunities and produce substantial and sustained advances in gender equality in health. These findings offer important lessons of what to foster more of in multilateral and bilateral health organisations as we seek to continue advancing gender equality in health.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004697"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the pill: Understanding barriers and enablers to oral and long-acting injectable PrEP among women in sex work in Zambia.","authors":"Ramya Kumar, Chisomo Mwale, Patricia Maritim, Jamia Phiri, Wendy Barrington, Ruth Zyambo, Martin Zimba, Kenneth Mugwanya, Michael Herce, Maurice Musheke, Deepa Rao, Anjali Sharma","doi":"10.1371/journal.pgph.0004461","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004461","url":null,"abstract":"<p><p>Women engaging in sex work (WESW) in low- and middle-income countries face a disproportionately high risk of HIV infection. This study explores enablers and barriers to the uptake and persistence of oral pre-exposure prophylaxis (PrEP) and long-acting injectable PrEP (LAI-PrEP) among WESW in Lusaka, Zambia. We evaluated Capability, Opportunity, and Motivation behavioral domains, using the COM-B model, which affectied behavioral engagement with PrEP services among newly-initiated WESW from community-based safe spaces. Participants were recruited from July-October 2023 and interviewed using a semi-structured guide to explore barriers and enablers to engagement with HIV prevention. We used a rapid analysis approach-a two-step qualitative method-to identify themes aligned with COM-B domains. Interviews were conducted in English, ChiNyanja, or IchiBemba, audio-recorded, translated into English when necessary, and transcribed verbatim. Among 18 participants with a median age of 28 years (IQR:23-33) and 5 years in sex work (IQR:2,7), education during outreach by peer navigators and program staff was crucial to building trust and demystifying PrEP. Persistent knowledge gaps and misconceptions, especially about daily adherence and alcohol use, were significant barriers. Trustworthy program staff and reliable service provision facilitated continued PrEP use, and women preferring that drugs be delivered to them. Social support systems were mixed, offering both aid and competition. Personal empowerment and health protection motivated PrEP use, with LAI-PrEP preferred for eliminating daily pill burdens and associated stigma. However, inconsistent supply and misconceptions about LAI-PrEP were potential barriers. This study underscores the importance of person-centered care in addressing the complex interplay of individual, community, and programmatic factors influencing PrEP engagement among WESW in Zambia. A holistic focus, and adaptive health service delivery approach are both crucial to ensure that advances in HIV prevention translate into tangible benefits for WESW. Reliable, respectful healthcare programs that provide accurate, and trusted information are essential for improving PrEP uptake and persistence.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004461"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The economic impacts of COVID-19 hospitalizations, intensive care unit admissions, and deaths related to overweight and obesity.","authors":"Adeyemi Okunogbe, Donal Bisanzio, Garrison Spencer, Shradha Chhabria, Jaynaide Powis, Rachel Nugent","doi":"10.1371/journal.pgph.0001445","DOIUrl":"https://doi.org/10.1371/journal.pgph.0001445","url":null,"abstract":"<p><p>During the COVID-19 pandemic, it quickly became clear that people living with overweight and obesity (OAO) have a higher risk for more severe health outcomes. The objective of this study is to investigate how the health and economic impacts of COVID-19 are exacerbated by OAO. We estimated economic impacts of COVID-19 associated with OAO for eight countries using a cost-of-illness approach from a limited societal perspective. Direct medical costs and premature mortality costs between 2020 and 2030 were estimated. Country-specific data were sourced from published studies and global databases. Additional COVID-19 hospitalizations, ICU admissions, and deaths among the population with OAO accounted for approximately 20% of hospitalizations, 43% of ICU admissions, and 17% of deaths from COVID-19 in 2020 and 2021 on average across the eight countries. As a percent of GDP, additional treatment and premature mortality costs ranged from between 0.0003% in Thailand to 0.62% in Brazil in 2020 and between 0.009% in Australia to 0.56% in Brazil in 2021. In future COVID-19 prevalence scenarios, keeping OAO prevalence at 2019 levels or reducing it by 50% will translate into average annual reductions of 17.4%-18.5% and 40.8%-41.4% in additional costs respectively between 2022 and 2030 across the eight countries. This study provides initial evidence on the significant economic impacts of COVID-19 on populations with OAO. Our findings support the need for strengthened political commitment and adequate prioritization of OAO prevention and reduction interventions to help increase resilience to public health emergencies in these and other countries.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0001445"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the Covid-19 pandemic on mental health of persons with disabilities: Insights from the 2021 Canadian Housing Survey.","authors":"Sulemana Ansumah Saaka, Roger Antabe, Isaac Luginaah","doi":"10.1371/journal.pgph.0004728","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004728","url":null,"abstract":"<p><p>Mental health (MH) remains a major public health concern in Canada and has been exacerbated by the unprecedented challenges of the COVID-19 pandemic and the associated restrictions on physical movement. While considerable work has been done on the impact of COVID-19 on the physical and MH of the general population, relatively less work has focused on the MH of persons with disabilities (PWDs). Although the COVID-19 containment measures including lockdowns, social distancing, quarantine, and closure of nonessential services were intended to reduce the direct risks of COVID-19, the socioeconomic consequences of those restrictions and the uncertainties surrounding the virus, inadvertently had adverse impact on the MH and well-being of Canadian residents, particularly, among already marginalized groups such as PWDs. Moreover, PWDs were identified as disproportionately vulnerable to the psychological impacts of the pandemic containment measures which compromised their overall Positive Mental Health (PMH): a state of well-being where individuals can realize their full potential, manage life's stresses, work productively, and contribute to society. This study addresses the research gap by examining the effect of the pandemic on the MH of PWDs in Canada using a cross-sectional analysis of the 2021 Canadian Housing Survey (N = 15,626), a subset of people who reported disabilities. Logistic regression models were employed for this cross-sectional analysis. The results show that females (OR = 0.789; P < 0.001), those who experienced COVID-19 economic hardship (OR = 0.703; P < 0.001), and dwelling dissatisfaction (OR = 0.585; P < 0.001), significantly reported about 0.79, 0.70, and 0.59 times lower odds of positive Mental Health (PMH), respectively. On the other hand, those who had post-secondary educational attainment (OR = 1.210; P < 0.001), strong sense of community belonging (OR = 2.056; P < 0.001), and civic engagement with their communities (OR = 1.204; P < 0.001), were significantly associated with 1.21, 2.06, and 1.20 times higher odds of PMH, respectively. Additionally, immigration status, household type, the province of residence, and neighborhood-specific challenges such as race-based harassments, and drug use/dealings emerged as significant predictors of PMH. The findings underscore the positive impacts of empowering elements such as strong community ties on the MH of PWDs during public health crisis. Also, the findings prompt the pressing need for identifying and addressing the unique challenges of PWDs in Canada, particularly, the less educated and socioeconomically disadvantaged, as part of effort to foster PMH in the country. Overall, these findings suggest the need to prioritize and strengthen disability-inclusive MH programs for future public health crises.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004728"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harnessing HIV clinics to deliver integrated hypertension care for People living with HIV in Uganda: A formative mixed methods study.","authors":"Fred C Semitala, Florence Ayebare, John Baptist Kiggundu, Christine Kiwala, Joel Senfuma, Gerald N Mutungi, Isaac Ssinabulya, James Kayima, Martin Muddu, Donna Spiegelman, Jeremy I Schwartz, Chris T Longenecker, Anne R Katahoire","doi":"10.1371/journal.pgph.0004701","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004701","url":null,"abstract":"<p><p>Access to antiretroviral therapy has led to better treatment outcomes for aging people living with HIV worldwide. However, in Uganda and other parts of sub-Saharan Africa, PLHIV with comorbidities like hypertension experience fragmented healthcare access, despite existing guidelines for the integration of non-communicable diseases into HIV care. We assessed knowledge, attitudes, and practices of PLHIV regarding hypertension care, and their perceptions of integrated hypertension-HIV care. We used a parallel convergent-mixed methods approach to collect quantitative and qualitative data from HIV clinics in urban and peri-urban Uganda. We surveyed PLHIV with hypertension to explore their knowledge, attitudes, and practices related to HTN. We selected a sub-sample from survey participants for qualitative interviews, to explore their perceptions of hypertension care and integrated HTN and HIV services. We analyzed quantitative data using STATA 14.1 and analyzed qualitative data deductively mapping it onto the Consolidated Framework for Implementation Research. A total of 394 PLHIV (325 in Kampala and 69 in neighboring Wakiso district) were enrolled in the study. Their median age was 52 years (IQR 44-59), and 300 (76%) were female. Only 32% of the participants correctly identified the normal range for systolic blood pressure (BP) (80-140 mmHg) and 24% diastolic BP (60-90 mmHg). Although 87% of the participants recognized that hypertension was treatable, only 62% knew that the treatment was lifelong. Barriers identified through interviews included fragmented care delivery, frequent hypertension medication shortages, interruptions due to side effects, high out of pocket costs of hypertension drugs, use of herbal remedies, and PLHIV discontinuing medication upon feeling better. Integrating chronic care for co-morbidities like hypertension in HIV clinics in Uganda offers an opportunity to address key barriers, including knowledge gaps, inconsistent medication access, and fragmented care delivery. The findings of this formative assessment informed the development of strategies to integrate hypertension-HIV care in Uganda.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004701"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organizational models and patient-reported outcomes for palliative care across five tertiary hospitals in Nigeria: An environmental scan.","authors":"Ann Abiola Ogbenna, Matthew Caputo, Tonia C Onyeka, Debora O Ohanete, Lyra S Johnson, Nadia A Sam-Agudu, Chisom Obiezu-Umeh, Babatunde Akodu, Denise Drane, Charlesnika T Evans, Mukaila O Akinwale, Geraldine U Ndukwu, Israel K Kolawole, Saheed A Ayilara, Gracia K Eke, Adeseye M Akinsete, Adeboye Ogunseitan, Ashti Doobay-Persaud","doi":"10.1371/journal.pgph.0004638","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004638","url":null,"abstract":"<p><p>Palliative care (PC) is an essential, effective, and affordable component of health care. Global need is rising, with the greatest burden in low-and-middle-income countries. This is especially true in Nigeria where the need is growing rapidly, as are PC services; however, current organizational models have not yet been examined. This was a cross-sectional, descriptive study of five PC sites at tertiary hospitals in four of Nigeria's six geopolitical zones. Surveys, informed by a Centre for Palliative Care, Nigeria (CPCN) needs assessment checklist and the Consolidated Framework for Implementation Research (CFIR), were administered at each site to leadership, frontline workers, patients, and caregivers. Surveys varied by participant group and inquired about organizational models and personal experiences of both providers and recipients of care. Across five sites, there was a total of 282 survey respondents: five leaders, nine frontline workers, 132 patients, and 136 caregivers. The most common diagnoses of PC patients were cancer, sickle cell disease, and HIV. Most sites reported sub-optimal administrative support (80%), hospital management support (60%), and building space (60%). Leadership responses highlighted variations in PC training requirements and opportunities. Frontline workers desired additional training, sponsorship, and governmental support. Most patients and their caregivers reported satisfaction with PC, though high levels of worry and hopelessness were reported. Increased organizational support appears necessary to facilitate improvements in administrative resources, staffing, and training. Emotional and spiritual wellbeing likely require prioritization when designing palliative care delivery services in Nigeria. Further research is needed to refine current services and inform implementation efforts.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004638"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iron deficiency prevalence among pregnant women in Cambodia varies widely by trimester, inflammation adjustments, and across different ferritin thresholds.","authors":"Stella C Mlewa, Lulu X Pei, Cassandra Sauer, Colleen C Farrell, Hou Kroeun, Mam Borath, Tim J Green, Kyly C Whitfield, Crystal D Karakochuk","doi":"10.1371/journal.pgph.0004650","DOIUrl":"10.1371/journal.pgph.0004650","url":null,"abstract":"<p><p>Iron deficiency (ID) prevalence has been consistently reported as low among non-pregnant women in Cambodia, but less is known about iron status during pregnancy. Assessing iron status during pregnancy is critical, as deficiency can increase the risk of adverse pregnancy outcomes. We assessed anemia, ID, and inflammation prevalence in a cohort of pregnant women in Cambodia. Venous blood from 90 pregnant women (12-32 weeks' gestation) was collected before the start of a 2016 trial conducted in Prey Veng province. Gestational age was recorded on the same day as blood collection. Hemoglobin was measured on a hematology autoanalyzer, and ferritin, α-1 acid glycoprotein (AGP), and C-reactive protein (CRP) concentrations were measured with a sandwich-ELISA. Ferritin concentrations are presented as unadjusted and inflammation-adjusted (based on AGP and CRP concentrations). ANOVA and post-hoc pairwise t-tests were used to compare variables across trimesters of pregnancy. Mean±SD age of women was 26 ± 5 years. Most women (94%) reported consumption of iron and folic acid (IFA) tablets during pregnancy (mean±SD: 85 ± 19 tablets), and 72% received deworming treatment. Overall, 49% of women had anemia (hemoglobin <110 g/L for first and third trimesters; < 105 g/L for second trimester); with 43%, 34%, and 64% in the first, second and third trimester, respectively. ID prevalence (unadjusted ferritin <30 µg/L) ranged widely by trimester: 0%, 17% and 76% in the first, second and third trimester, as well as with use of a lower ferritin threshold (0-52%; < 15 µg/L), and whether ferritin was inflammation-adjusted (61% with and 43% without adjustment; < 30 µg/L). ID prevalence was high among women in third trimester, despite high IFA compliance. These findings underscore the need to consider the trimester of pregnancy in anemia and ID assessment. More research is needed to determine if trimester-specific thresholds for ferritin in pregnant populations are warranted and whether ferritin should be adjusted for inflammation in pregnancy.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004650"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227865","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":"Providers perspectives on a team-based maternal health care delivery in Ghana: A qualitative study.","authors":"Veronica Millicent Dzomeku, Ebenezer Dassah, Ebenezer Mensah Gyimah, Abigael Omowumi Emikpe, Lydia Boampong Owusu, Catherine Kroamah Dwumfour, Oluwatoyin Abayomi Ogunyewo, Thomas Peprah Agyekum, Eric Adjei Boadu, Emmanuel Kweku Nakua","doi":"10.1371/journal.pgph.0004246","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004246","url":null,"abstract":"<p><p>Interprofessional team-based care is crucial in ensuring respectful and dignified maternal services. However, there is limited research that explores this issue from the perspectives of health care providers in Ghana. The study sought to explore the perspectives and experiences of health care providers working in a collaborative team-based setting at a health in Ghana, with the aim to improve respectful and dignified maternal care. We used a descriptive qualitative study and conducted semi-structured interviews with 35 participants from diverse cadre of health care providers, including Midwives, Nurses, Nutritionists, Pharmacists, Physicians, Radiographers and Sonographers. The data were subsequently transcribed and analysed thematically. The findings revealed four overarching themes namely roles, facilitators, barriers and strategies to overcome barriers experienced by healthcare professionals within an interprofessional team-based setting providing respectful and dignified maternal services. Providers' primary roles in enhancing respectful and dignified maternal services within interprofessional team-based setting included enhancing patients' outcome, improving healthcare professionals' outcomes and optimizing facility outcomes. The facilitators to respectful and dignified maternal care were clear role definitions, transparent communication, personal empathy and professional competence. Conversely, barriers to the delivery of respectful and dignified maternal services within a team-based setting noted in participants' responses included infrastructural deficiencies, inadequate staffing, discrimination and negative professional attitudes. Participants' proposed strategies to overcome these barriers included investments in infrastructure, enhanced professional competence among staff and improved interprofessional communication within and between teams. Addressing these barriers could inform the development of policies and clinical practices aimed at advancing respectful and dignified maternal care. The study can also contribute to the design and formulation of an operational manual required to shape interprofessional team-based respectful and dignified maternal care in Ghana and other similar contexts.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004246"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seroprevalence and associated factors of Hepatitis B virus infection among pregnant women attending Antenatal care clinic in public hospitals in the Central Ethiopia region: A cross-sectional study.","authors":"Yilma Markos Larebo, Abebe Alemu Anshebo, Sujit Kumar Behera, Natarajan Gopalan","doi":"10.1371/journal.pgph.0003921","DOIUrl":"10.1371/journal.pgph.0003921","url":null,"abstract":"<p><p>Hepatitis B virus infection poses a significant public health challenge among pregnant women in sub-Saharan Africa, including Ethiopia, where it is often underdiagnosed and underreported. This study aimed to determine the seroprevalence and associated factors of hepatitis B virus infection among pregnant women attending antenatal care in public hospitals in the Central Ethiopian region. A hospital-based cross-sectional study was conducted from October 1, 2023, to March 1, 2024, among 482 pregnant women selected using systematic random sampling. Blood samples were collected and tested for hepatitis B surface antigen, and data were gathered using a structured, interviewer-administered questionnaire. Data were entered into Epi Data version 3.1 and analyzed using SPSS version 26. Logistic regression analysis identified factors associated with hepatitis B infection, with significance at p < 0.05. The response rate was 98.8%. Most participants (66.2%) were aged 18-28 years, with a mean age of 28. The overall seroprevalence of hepatitis B virus infection was 12.8% (95% CI: 10.1, 16.2). A maternal educational level of diploma and above (AOR: 0.23; 95% CI: 0.09, 0.62) and no history of hospital admission (AOR: 0.23; 95% CI: 0.10, 0.53) were linked to a lower risk. In contrast, being unable to read and write (AOR: 2.67; 95% CI: 1.14, 6.26), having a medium (4-6) or large (≥7) family size (AOR: 2.34; 95% CI: 1.15, 4.78) and (AOR: 3.65; 95% CI: 1.33, 10.04), respectively, history of traditional delivery care (AOR: 2.46; 95% CI: 1.04, 5.84), and history of abortion (AOR: 2.90; 95% CI: 1.37, 6.11) were associated with higher risk. Hepatitis B virus infection remains highly prevalent among pregnant women in the study area. Strengthening family-centered healthcare, improving screening and vaccination coverage, and enhancing community-based awareness and prevention initiatives are essential to reduce the burden of infection.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0003921"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12132948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217750","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":"The older the injured, the worse the outcomes: A comparison of injury patterns and in-hospital outcomes between younger and older adult trauma patients at a tertiary hospital in Northern Tanzania.","authors":"Edwin Joseph Shewiyo, Rosalia Njau, Natan Nascimento de Oliveira, Frijenia G Sumbai, Paige O'Leary, Frida Shayo, João Vitor Perez Souza, João Ricardo Nickenig Vissoci, Blandina T Mmbaga, Catherine A Staton","doi":"10.1371/journal.pgph.0004547","DOIUrl":"10.1371/journal.pgph.0004547","url":null,"abstract":"<p><p>The number of older adults (>60 years) in Sub-Saharan Africa (SSA) is expected to double by 2050. This demographic shift has led to a rise in traumatic injuries among this population, with one in ten trauma patients in Tanzania being an older adult. Yet, geriatric specialization remains largely absent in many low- and middle-income countries (LMICs), including Tanzania. To inform strategies for optimizing care in this vulnerable group, we conducted a cross-sectional secondary analysis using data from the adult trauma registry at Kilimanjaro Christian Medical Centre (KCMC), a tertiary hospital serving over 15 million people in northern Tanzania. The study included all injured adults (>18 years) from 2020 to 2024. We compared socio-demographic, clinical characteristics, injury patterns, and in-hospital outcomes between older (≥60 years) and younger adults. The main outcomes were length of hospital stay and in-hospital mortality. A total of 3,296 adult trauma patients were included, of whom 13.3% were older adults. Older adults took 4 hours longer to reach care (p < 0.001) and were more likely to be injured by falls (56% vs. 17%), while younger adults were more commonly involved in road traffic crashes (67% vs. 33%) (p < 0.001). Although most older adults sustained mild injuries (86%), they were more often hospitalized (91%) and required surgery (66%) compared to younger adults (85%, 58%) (p = 0.002). Comorbidities were more prevalent in older adults, notably diabetes (12%) and hypertension (26%) (p < 0.001). Older adults also experienced 4 days longer hospital stays and higher in-hospital mortality (9% vs. 4%) than younger adults (p < 0.001).Our study demonstrates significant differences between the injured older adult patients and the younger adult patients, highlighting the differences in care required for older adult trauma patients and providing evidence to support the next steps of adoption and implementation of older adult-specific clinical practice guidelines to improve outcomes.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004547"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210443","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}