PLOS global public health最新文献

{"title":"Sex-specific hemostatic responses and alterations of Platelet Distribution Width (PDW) and D-dimer in mild COVID-19, Malaria, and co-infection in a tropical setting: A case-control study in Port Harcourt, Nigeria.","authors":"Erens Spiff Ekprikpo, Stella Urekweru Ken-Ezihuo, Zaccheaus Awortu Jeremiah","doi":"10.1371/journal.pgph.0007465","DOIUrl":"10.1371/journal.pgph.0007465","url":null,"abstract":"<p><p>In malaria-endemic tropical regions, overlapping coagulopathy in COVID-19 and malaria poses management challenges with potential sex differences. This STROBE-compliant case-control study evaluated sex-specific variations in platelet indices and assessed alterations of platelet distribution width (PDW) and D-dimer in mild cases. We studied 220 participants, 55 per group: healthy controls, malaria-positive, COVID-19-positive, and COVID-19 plus malaria co-infected, aged 20-65 years, balanced by sex (22 females and 33 males per group), conducted in Port Harcourt, Nigeria between November 2021 and March 2022. Platelet indices were measured using Sysmex XP-300 and D-dimer and fibrinogen by sandwich-ELISA. Data were analyzed using SAS 9.4 and JMP 14.3. PDW was significantly elevated in all infected groups versus controls: malaria 15.19 ± 1.47 fL, COVID-19 15.17 ± 1.51 fL, co-infection 15.58 ± 1.45 fL versus control 13.27 ± 1.20 fL; F = 25.850, p < 0.001. D-dimer was highest in co-infected group 552.80 ± 402.46 ng/mL; F = 2.816, p = 0.040. Two-way ANOVA showed no significant group×sex interaction for platelet indices but significant interactions for fibrinogen F = 18.42, p < 0.001 and D-dimer F = 3.14, p = 0.026. Sex-stratified analysis showed PDW higher in females in malaria p = 0.012 and co-infection p = 0.033, and D-dimer higher in males only in malaria p = 0.021. No significant correlations were observed between platelet indices and fibrinolytic markers. PDW was consistently elevated across mild infections and sex significantly modified fibrinolytic markers, indicating PDW and D-dimer are accessible indicators of hemostatic alterations in resource-limited tropical settings.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007465"},"PeriodicalIF":2.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139558","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":"National burden of disabilities in Bangladesh and its socio-demographic correlates: A 2021 cross-sectional analysis.","authors":"Mizanur Rahman, Md Shohel Rana, Gulam Khandaker, Md Mostafizur Rahman, Md Nuruzzaman Khan","doi":"10.1371/journal.pgph.0007463","DOIUrl":"10.1371/journal.pgph.0007463","url":null,"abstract":"<p><p>Disability remains an important public health and social challenge, particularly in low- and middle-income countries (LMICs), including Bangladesh. However, nationally representative evidence on its burden, distribution, and associated factors remains limited. This study estimated the national prevalence and patterns of disability in Bangladesh and examined their sociodemographic correlates. This cross-sectional study analysed data from 155,025 participants in the 2021 National Survey on Persons with Disabilities (NSPD). Disability status (yes or no) was the primary outcome. Explanatory variables were measured at the individual, household, and community levels. Multilevel mixed-effects logistic regression models, stratified by age group (0-17 years [children] and 18-95 years [adults]), were used to examine factors associated with disability. The prevalence of disability was 2.79% (95% CI 2.69-2.91). Physical disability (42.44%) and visual impairment (14.11%) were the most commonly reported types, and 11.60% of persons with disabilities reported multiple disabilities. Overall, disability was more prevalent among males, although sex-specific patterns differed by age. Among children, girls had 31% higher adjusted odds of disability than boys (adjusted odds ratio [aOR] 1.31, 95% CI 1.13-1.52), whereas no significant sex was observed among adults (aOR 1.06, 95% CI 0.95-1.19). In both age groups, the odds of disability increased with years of schooling and household wealth. Among adults, housewives, students, and blue-collar workers had higher odds of disability than agriculture workers. Higher community-level literacy was associated with higher odds of disability among adults, whereas the association was reversed among children. The findings support strengthening community-based disability identification and referral in Bangladesh through existing primary health-care services, particularly in underserved populations and areas. Coordination between the Ministry of Health and Family Welfare and the Department of Social Services could improve access to existing social protection, rehabilitation, and assistive-device services.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007463"},"PeriodicalIF":2.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139563","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":"Stakeholder perspectives on telemedicine acceptance and experiences in Uganda: A qualitative study.","authors":"Irene Semakula, Sande Slivesteri, Benjamin Mwesige, Mukooza Edward, Benedict Akimana, Vincent Micheal Kiberu","doi":"10.1371/journal.pgph.0007047","DOIUrl":"10.1371/journal.pgph.0007047","url":null,"abstract":"<p><p>In Uganda and other low- and middle-income countries, access to healthcare is constrained by shortages of health workers, long travel distances, and inadequate infrastructure. Telemedicine offers a potential solution, but its effectiveness depends on how key stakeholders perceive, accept, and experience it. This study explored the acceptance and experiences of telemedicine by policymakers, healthcare providers, and service users in Kampala, Uganda. An exploratory qualitative study was conducted between November 2024 and February 2025 at four sites in Kampala: Rocket Health, Uganda Cancer Institute, Butabika National Referral Mental Hospital, and the Ministry of Health. Participants were purposively selected to ensure direct experience with telemedicine. Data was collected through 15 key informant interviews with policymakers and healthcare providers and three focus group discussions with service users (patients and caregivers) who had accessed telemedicine within the previous year. Interviews and discussions were conducted in English or Luganda, audio-recorded with consent, and transcribed verbatim. Data were analyzed thematically using Braun and Clarke's six-phase approach, supported by NVivo 12 software. Three main themes emerged: perceived benefits, perceived challenges, and recommendations for improving telemedicine. Participants described telemedicine as convenient, reducing travel and contributing to cost and time savings. It also enhanced continuity of care, flexibility, privacy, and autonomy. These benefits were particularly evident among people with disabilities and digitally literate urban users. However, challenges included poor internet connectivity, limited infrastructure, low digital literacy, concerns about diagnostic accuracy without physical examination, and variable levels of trust, with some participants preferring in-person interaction. Telemedicine was perceived as acceptable and useful. However, its broader adoption is limited by structural, technical, and trust-related barriers. Addressing these challenges will require investment in infrastructure, strengthened digital literacy, provider training, increased public awareness, and a robust national telemedicine policy to support equitable and sustainable integration into healthcare delivery in Uganda.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007047"},"PeriodicalIF":2.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129456","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":"Spatiotemporal patterns of antimicrobial resistance in shared human-animal waterpoints in the Maasai Mara Ecosystem, Kenya.","authors":"Brian Marvis Waswala-Olewe, George Paul Omondi, Monica Adhiambo Olewe, Brian Njuguna, Yvonne Nyararai, Nyamai Mutono, Mwangi Thumbi, Paul W Webala, Romulus Abila","doi":"10.1371/journal.pgph.0007393","DOIUrl":"10.1371/journal.pgph.0007393","url":null,"abstract":"<p><p>Antimicrobial resistance (AMR) presents an existential One Health threat. The spread of AMR in arid and semi-arid landscapes is modulated by ecological interactions and exacerbated by endemicity of livestock diseases and poor sanitation in shared human-animal systems leading to misuse of antibiotics. This study characterized the prevalence, resistance patterns, and spatiotemporal variations of AMR in surface water sources in the Maasai Mara Ecosystem (MME), a rapidly changing water-stressed socio-ecological landscape. Employing cross-sectional study design, water samples were collected from 28 water points between April 2024 and May 2025. Cultured Escherichia coli isolates were evaluated for resistance to eight antibiotics, following CLSI susceptibility testing protocols. AMR prevalence was calculated as proportions, with associations between sampling sites and seasons assessed using chi-square. Local clustering of resistant isolates was evaluated using spatial multinomial modelling, while cost-distance analysis against water points identified the proportion of the MME population with limited access to potable water. E. coli was detected in 92.9% water sources, with all isolates resistant to at least one antibiotic. High resistance rates were observed for Penicillin (100%), Amoxicillin (92.6%), Nitrofurantoin (78.6%), and Ceftazidime (52.9%). River samples exhibited higher resistance (51.4%) than open water pans (40.4%). AMR peaked during short-wet and short-dry seasons (51.3%; 51.5% respectively), with seasonal variations being significant (p = 0.04). Multi-drug-resistant isolates (MDR: resistant to ≥3 antibiotic classes) were detected across all seasons, peaking in the short-wet season. MDR relationship between water sources was insignificant across all sampling sites and seasons (p > 0.05). Spatial analysis (p > 0.05) identified two exploratory clusters: Cluster 1 near dense human areas (RR = 0.78) while Cluster 2 in human-livestock-wildlife zones (RR = 1.26). Cost-distance analysis (p < 0.05) revealed one-third of the MME population is at risk of AMR due to limited access to potable water. Our findings reveal widespread distribution of AMR isolates in shared waterpoints, necessitating targeted One Health Quadripartite interventions.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007393"},"PeriodicalIF":2.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129438","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":"Measurement of Tuberculosis treatment adherence: A methodological scoping review of observational studies.","authors":"João Pedro Ramos, Catarina Simas, Mariana Vieira, Ana Aguiar, Ana Rute Costa, Marta Pinto, Raquel Duarte","doi":"10.1371/journal.pgph.0007422","DOIUrl":"10.1371/journal.pgph.0007422","url":null,"abstract":"<p><p>Despite extensive conceptual development, the definition and measurement of Tuberculosis (TB) treatment adherence remain inconsistent. This ambiguity obscures what is being assessed and compared across studies. This scoping review examined how adherence is labelled, defined, and operationalised in observational studies of drug-susceptible TB, assessed consistency with contemporary frameworks, and identified methodological gaps. We conducted a scoping review of observational studies on drug-susceptible TB identified from eight databases up to February 2026. Data were extracted on terminology, measurement approaches, and operational definitions. Content analysis was used to map labels and indicators to the constructs they implicitly presuppose. One hundred and three studies were included. Treatment-taking behaviour was mostly assessed through clinician assessment or self-report. Explicit definitions were uncommon, and operational criteria served as de facto definitions. Multidimensional measures were frequently reduced to binary or ordinal outcomes, and most studies relied on cross-sectional designs, reinforcing static representations of a dynamic process. Thus, TB adherence research faces a fundamental problem of construct conflation: the same label is used to describe behaviours that are conceptually distinct, limiting comparability and weakening the interventions' evidence base. Standardising reporting requirements would strengthen the evidence base for programmes addressing structural and social drivers of adherence.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007422"},"PeriodicalIF":2.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129469","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":"Dementia care gaps in Sub-Saharan Africa: A scoping review of technology, environmental, community perspectives, and financial constraints.","authors":"Soarov Chakra Borty, Maiya G Block Ngaybe, Angela E Apeagyei, Divya Bhagianadh, Monica H Swahn, Nazmus Sakib","doi":"10.1371/journal.pgph.0007265","DOIUrl":"10.1371/journal.pgph.0007265","url":null,"abstract":"<p><p>Dementia is a growing public health challenge in Sub-Saharan Africa (SSA), where population aging is expected to substantially increase the regional burden of dementia in the coming decades. Rapidly changing demographics, underdeveloped health infrastructure, and limited awareness of dementia symptoms and care pathways contribute to delayed diagnosis, treatment, and care. This scoping review examined literature published from 2021 to 2025 to identify gaps in dementia care across four key domains: environmental and social factors, technological capacity, community-based caregiving, and financial and economic factors. First, social and ecological factors, including low health literacy, rural residence, and weak primary care infrastructure, influence disease diagnosis and access to care. Second, technological capacity remains limited, including scarce access to neuroimaging and diagnostic tools, limited telemedicine coverage, weak electronic health information systems, and insufficient digital health solutions for early detection, management, and monitoring. Third, evidence from community-based care highlights heavy reliance on informal caregivers who often lack training and institutional support, resulting in substantial emotional, physical, and financial burden. Finally, inadequate public financing for dementia care, coupled with limited insurance coverage, further restricts access to dementia care services and support. Overall, this review highlights critical gaps in policy, evidence generation, cost-effective technology investment, caregiver support, and health systems strengthening across all levels of care. Addressing these multidimensional challenges is crucial to improving the quality of life for people living with dementia and their caregivers across SSA.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007265"},"PeriodicalIF":2.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119843","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":"Caregivers' willingness and factors influencing uptake of the malaria vaccine among under-five children at Masaka Regional Referral Hospital, Uganda.","authors":"Annet Mary Namusisi, Richard Migisha, Dominic Kizza, Benon Kwesiga, Lilian Bulage, Valeria Tusuubira, Lucy Maria Nakayiza, Sophia Tageya, Fred Nsubuga, Rita Atugonza, Michael Baganizi, Alex Riolexus Ario","doi":"10.1371/journal.pgph.0005764","DOIUrl":"10.1371/journal.pgph.0005764","url":null,"abstract":"<p><p>Uganda ranks third with the highest malaria cases globally, highlighting limitations in existing prevention efforts. Malaria vaccination is a key promising strategy to reduce both morbidity and severity among children under 5 (U5) years. In April 2025, Uganda introduced a four-dose R21 malaria vaccine for U5s. We assessed willingness to vaccinate with the malaria vaccine and associated factors among caregivers of U5s to support vaccine rollout in the targeted population. In March 2025, we conducted a cross-sectional study at the Maternal and Child Health unit of Masaka Regional Referral Hospital among 292 caretakers. We generated caretaker attendance lists daily to serve as sampling frames and developed a sampling interval. We used systematic sampling to obtain the total sample size. We administered a questionnaire assessing caregivers' willingness to vaccinate, and identified associated factors using modified Poisson regression. We interviewed 292 caretakers, 250(86%) were female and 249(85%) indicated willingness to vaccinate their children. Prior experience with adverse events following immunization (AEFIs) (adjusted prevalence ratio [aPR]=0.2,95%Confidence Interval [CI]0.05-0.5), having other relatives than biological parents as main decision makers (aPR 0.2, 95%CI0.04-0.9) and having tertiary education (aPR 0.14, 95%CI0.04-0.6) were associated with reduced willingness to vaccinate, while receipt of malaria Intermittent Preventive Treatment in pregnancy (IPTp) (aPR 6.2, 95%CI1.6-23) and trust in vaccine safety (aPR 13, 95%CI4.0-43) were associated with increased willingness to vaccinate. Majority of the caretakers were not aware of the malaria vaccine butwere willing to vaccinate their children when oriented. AEFI history, household decision-making roles, and education level were associated with reduced willingness, while having received malaria IPTp and trust in vaccine safety were associated with increased willingness to vaccinate. We recommended providing malaria vaccine information through antenatal care, preparing health workers to address the AEFI history and vaccine-safety concerns and prioritizing safety-focused messaging over general awareness messaging.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0005764"},"PeriodicalIF":2.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119872","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":"Perceived changes in mothers' outcomes following a pilot parenting program for couples with young children in Mwanza, Tanzania: A longitudinal qualitative study.","authors":"Valencia J Lambert, Alina Bhojani, Gabriel Sangarara, Julieth Joseph, Nathan T Yang, Damas Joachim, Joshua Jeong","doi":"10.1371/journal.pgph.0006203","DOIUrl":"10.1371/journal.pgph.0006203","url":null,"abstract":"<p><p>There is growing interest in engaging not only mothers but also fathers in parenting programs to improve nurturing care, psychosocial support, and early childhood development. However, few studies have explored how mothers perceive and benefit from participating in parenting interventions alongside their partners. This study explored mothers' experiences during the pilot implementation of Familia Bora, a couples-based parenting program delivered in six communities in Mwanza, Tanzania (July-November 2024). In-depth interviews were conducted with mothers at baseline, midline, and endline using both random and purposive sampling. A total of 22 mothers participated in endline interviews, of whom 15 (68%) were purposively re-interviewed from the baseline sample to enable longitudinal qualitative analysis of perceived changes over time. Interviews explored mothers' perceptions of changes in parenting practices, gender roles and attitudes, couples' relationships, maternal mental health, and complementary feeding practices. Mothers commonly reported improvements across all domains. They described increased use of responsive caregiving and early learning activities, reduced harsh discipline, and improved nutrition knowledge and child feeding practices. Mothers also highlighted greater father involvement in childcare and more supportive couples' relationship dynamics, which they perceived as reducing their caregiving burden and supporting their mental health. Overall, engaging fathers through couples-based parenting interventions may catalyze shifts within households that benefit mothers through improved caregiving practices, stronger partner relationships, and more nurturing family environments. These findings highlight the potential of father-inclusive parenting programs to support maternal, child, and family well-being.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0006203"},"PeriodicalIF":2.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119690","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":"Access to and use of improved water and sanitation facilities in Sub-Saharan Africa: Analysis of Demographic and Health Survey Data from 30 countries.","authors":"Joyce Aputere Ndago, Paul Adjorlolo, Martin Nyaaba Adokiya, Micheal Boah","doi":"10.1371/journal.pgph.0006195","DOIUrl":"10.1371/journal.pgph.0006195","url":null,"abstract":"<p><p>Access to and use of improved water sources and sanitation facilities in Sub-Saharan Africa (SSA) remains a significant public health concern, with notable variations across countries. Achieving the Sustainable Development Goals related to water and sanitation require evidence on current levels of access and factors that shape them. This study examined household access to and use of improved water sources and sanitation facilities, as well as the determinants of their use in SSA. Demographic and Health Survey data from 465,208 households across 30 SSA countries conducted between 2014 and 2025 was used for this study. Descriptive analyses examined access levels. Multivariable Poisson regression with robust variance was used to identify the factors associated with reported use. Overall, 76.3% of households had access to and use of improved water sources, 56.7% had access to improved toilets, and 35.4% had access to basic sanitation facilities (unshared improved toilet facilities), with wide variations across countries. Significant factors associated with access and use of improved toilet and sanitation facilities included wealth and residence, while educational attainment was significantly associated with access to and use of improved water sources. The findings highlight that disparities in access to water and sanitation exist in the SSA region, with household wealth, place of residence, and education significantly associated with households' access and use of improved water sources and sanitation facilities. Governments in SSA should prioritize improving access to water and sanitation, particularly in underserved areas. Additionally, targeted strategies are needed to address disparities driven by socioeconomic and demographic factors.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0006195"},"PeriodicalIF":2.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119825","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":"\"My feet are no longer swollen\": Testing a co-designed podoconiosis protective footwear among rural female farmers in Rwanda.","authors":"Gloria Igihozo, Leila Dusabe, Jeanne Uwizeyimana, Jamie Boiles, Tonya Huston, Janna M Schurer","doi":"10.1371/journal.pgph.0007114","DOIUrl":"10.1371/journal.pgph.0007114","url":null,"abstract":"<p><p>Podoconiosis is a disabling neglected tropical disease (NTD) caused by prolonged occupational exposure to alkaline red clay soil, disproportionately affecting female farmers in Rwanda. Although preventable through the consistent use of protective footwear, such as farming boots, high costs and limited availability at local markets impede rural farmers' access to appropriate footwear. Among female farmers, gender norms and cultural expectations further constrain their ability to access and wear farming boots. This qualitative community-based participatory project aimed to test a women-centered farming boot, co-designed by participants and the research team, to address previously identified barriers to protective footwear access among rural Rwandan farmers. Boots were distributed for testing, to male and female farmers, in four villages with the highest podoconiosis prevalence across Rwanda. This was paired with education campaigns and other informational materials. Sixteen audio-recorded focus group discussions were subsequently conducted to explore farmers' experiences with the boots. Farmers reported that receiving the footwear encouraged a more consistent use of farming boots, with female participants expressing feelings of pride and an emerging sense of empowerment associated with owning and wearing the boots. While community reactions to the boots varied, most female farmers noted that restrictive gender norms and expectations related to boot wearing persist but do not deter them from wearing the boots. Findings reiterate the importance of gender-sensitive, culturally tailored, and locally driven solutions in preventing podoconiosis and other skin NTDs. Future podoconiosis eradication strategies should strive to prioritize equitable access to protective footwear and address underlying social norms that limit women's access to preventive tools.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007114"},"PeriodicalIF":2.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119874","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}