PLOS global public health最新文献

{"title":"Sensitivity and specificity of tuberculosis screening tools in people with diabetes.","authors":"Neha Janrode, Yohhei Hamada, Arshad Taliep, Lauren Barron, Walter Chabaya, Rene T Goliath, Trinh Duong, Amanda Jackson, Shireen Galant, Nashreen Omar-Davies, Louise Lai Sai, Lillian Twentiey, Robert J Wilkinson, Molebogeng X Rangaka","doi":"10.1371/journal.pgph.0006479","DOIUrl":"https://doi.org/10.1371/journal.pgph.0006479","url":null,"abstract":"<p><p>Systematic screening for tuberculosis (TB) is recommended in people with diabetes; however, data on the accuracy of screening tools in this population are lacking. We assessed the accuracy of symptom and chest X-ray screening among people with diabetes. We consecutively enrolled adults with diabetes attending routine care in South Africa. All participants underwent symptom screening and chest X-ray. A single sputum specimen was collected from all participants and tested by Xpert Ultra. A positive Xpert Ultra result was used as the reference standard. We enrolled 673 participants. The median age was 54 years (interquartile range 47-60 years), and 63.8% were female. HIV prevalence was 17.2%. Prevalent TB was diagnosed in nine participants (1.33%). Any cough had a sensitivity of 22.2% (95% confidence interval [CI] 2.1-60.0%) and a specificity of 97.5% (95%CI 96.0-98.6%). Expanding the symptom definition to include any of cough, fever, weight loss, or night sweats did not improve sensitivity (22.2%, 95% CI 2.1-60.0) and slightly reduced specificity to 96.0% (95% CI 94.2-97.0). Chest X-ray abnormalities suggestive of TB demonstrated a sensitivity of 55.6% (95%CI 21.2-86.3%) and a specificity of 95.4% (95%CI 93.4-97.0%). The specificity of chest X-ray was significantly lower in participants with prior TB (87.6%, 95% CI: 79.8-90.6%), compared to 97.2% (95% CI: 95.2-98.5%) in those without (p < 0.01). Symptom-based TB screening has poor sensitivity in people with diabetes. Although chest X-ray improved the sensitivity, it remained suboptimal, with a reduced specificity in people with previous TB.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 9","pages":"e0006479"},"PeriodicalIF":2.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119853","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":"Rethinking wellbeing measurement: Learning from a scale development study with adolescents living with HIV in Zimbabwe.","authors":"Webster Mavhu, Jermaine M Dambi, Victoria Simms, Faith Martin, Joni Lariat, Rufaro Mbundure, Leviticus Makoni, Laura Kafata, Carol Wogrin, Vivian Chitiyo, Abigail Mutsinze, Frances M Cowan, Nicola Willis, Sarah Bernays","doi":"10.1371/journal.pgph.0006845","DOIUrl":"https://doi.org/10.1371/journal.pgph.0006845","url":null,"abstract":"<p><p>Adolescents living with HIV (ALHIV) in Eastern and Southern Africa experience challenges around medication adherence, mental health and wellbeing. Although interventions such as Zvandiri aim to strengthen mental health and wellbeing to impact HIV treatment outcomes, available measures often focus on negative outcomes or rely on positive psychology instruments developed in high-income settings. These tools may not adequately capture culturally embedded and relational dimensions of wellbeing. We describe the development of the Zvandiri Character Strength (ZCS) scale and draw methodological lessons for culturally grounded wellbeing measurement. The multi-stage scale-development process (2022-2025) comprised a scoping and systematic review, qualitative discussions, expert panel input, construct and item prioritisation, cognitive interviews, iterative item reduction, and exploratory factor and Rasch analyses. We reduced an initial item bank to a 53-item candidate scale, then to the ZCS 38 (38 items) and finally, the ZCS 25 (25 items), based on quantitative analyses and participant feedback. We subsequently assessed the ZCS 25 using retrospective pretest, post-test and follow-up administration. The review identified conceptually overlapping positive psychological constructs, many of which are measured using instruments developed in high-income settings and not adequately validated for ALHIV in Africa. Qualitative work highlighted connectedness, hope, self-acceptance, self-efficacy, purpose, and flourishing as key. Discussions also highlighted that wellbeing was relational, contextually situated, and often co-occurring with distress. Quantitative testing showed highly positive responses, disordered thresholds, ceiling effects, weak internal structure, and fluctuating retrospective ratings. Participant feedback suggested that positive responses likely reflected affirmations, and were partly linked to social desirability. In conclusion, the ZCS scale did not support a single interpretable total score, but its development offers important methodological lessons. Future measurement should begin with clearer construct definition, response-process validation, domain-level testing and explicit decisions about whether the measure aims to capture lived wellbeing, domain-specific positive outcomes or intervention-relevant change.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 9","pages":"e0006845"},"PeriodicalIF":2.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119856","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 and correlates of underweight among lactating mothers aged 20-49 years living in the Urban Slums of Kampala City, Uganda: A mixed-methods cross-sectional study.","authors":"Saharu Magona Nerima, Jireh Kirabo, Edirisa Juniour Nsubuga, Grace Nanyombi, Joel J Komakech, Latiffu Musisi, Joseph Mbabazi, John Bosco Ddamulira","doi":"10.1371/journal.pgph.0007389","DOIUrl":"10.1371/journal.pgph.0007389","url":null,"abstract":"<p><p>Suboptimal nutrient intake during lactation contributes to maternal underweight and reduced breastmilk quantity and quality, with potentially severe consequences for maternal and infant health. Although underweight prevalence among lactating mothers in urban slums is presumed higher compared to other areas, empirical data from Kampala's slums remains limited. This study examined the prevalence and correlates of underweight among lactating mothers aged 20-49 years in Kampala's slums. A convergent mixed methods cross-sectional study was conducted among 285 lactating mothers in Kampala's slums. Multivariable modified Poisson regression generated adjusted prevalence ratios (aPRs), with statistical significance at p < 0.05. A prespecified multivariable modified Poisson regression model guided by the UNICEF conceptual framework and literature was fitted to identify correlates of underweight among lactating mothers. Model robustness was assessed through sensitivity analyses using three distinct covariate blocks. Ten key informant interviews with health workers explored perceptions of factors associated with higher and lower prevalence of maternal underweight. Inductive thematic content analysis was used for the qualitative data whose findings were triangulated with quantitative results for a comprehensive and better contextual understanding of findings. The average age of the lactating mothers was 29 years (standard deviation = 5). Underweight (13.7%) among lactating mothers was moderately prevalent. Correlates of underweight among lactating mothers were household food insecurity (aPR = 1.4[1.2-1.6]), household size of <5 members (aPR = 0.94[0.89-0.99]), meal frequency of ≥3 meals/day (aPR = 0.74[0.66-0.83]), and minimum dietary diversity for women (MDD‑W) (aPR = 0.91[0.84-0.96]). Results from sensitivity analyses supported robustness of the findings. Factors perceived to be associated with higher prevalence of maternal underweight included household food insecurity and working mothers. Factors perceived to be associated with lower prevalence of maternal underweight included higher meal frequency, meeting MDD‑W and fewer household members. Community sensitization on family planning, household food security, meal frequency, and dietary diversity through integrated community outreaches could improve nutritional status of lactating mothers.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 9","pages":"e0007389"},"PeriodicalIF":2.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082975","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 of person-centered maternity care during childbirth and its predictors among women who gave birth in health facilities of East Africa: A systematic review and meta-analysis.","authors":"Yaregal Admasu Alelign, Chernet Getnet, Alemitu Ayele, Derese Eshetu Debela, Degefa Gomora, Aynamaw Embiale, Yordanos Sintayehu, Neway Ejigu","doi":"10.1371/journal.pgph.0005909","DOIUrl":"10.1371/journal.pgph.0005909","url":null,"abstract":"<p><p>Poor quality care significantly contributes to preventable maternal morbidity and mortality in sub-Saharan Africa, where respectful and responsive childbirth care remains variable. Person-centered maternity care (PCMC) is a crucial element of the WHO maternal and newborn quality-of-care framework; however, region-specific synthesis is lacking. This review aimed to estimate the pooled mean PCMC score and identify its predictors among postpartum women in East Africa. We systematically searched PubMed, Research4Life, ScienceDirect, DOAJ, and Google Scholar for observational studies conducted from 2017 to 2025. Study quality was appraised using the Joanna Briggs Institute critical appraisal checklist. Random-effects meta-analysis using the DerSimonian-Laird estimator was performed, and subgroup and meta-regression analyses were used to explore heterogeneity. Twenty three studies involving 15,325 women were included. The pooled mean PCMC score in East Africa was 63.08% (95% CI: 59.19, 66.97). Domain-specific scores were highest for dignity and respect (78.05%; 95% CI: 74.43-81.67), followed by supportive care (62.59%; 95% CI: 59.44-65.73), and lowest for communication and autonomy (55.29%; 95% CI: 48.66-61.92), demonstrating significant gaps in provider-patient communication and shared decision-making. Lower PCMC scores were associated with nighttime delivery (β = -2.23; 95% CI: -3.35, -1.11), third-trimester antenatal care initiation (β = -4.06; 95% CI: -7.74, -0.38), and rural residence (β = -1.61; 95% CI: -2.60, -0.61), while higher maternal education was positively associated with PCMC. PCMC in East Africa remains suboptimal, predominantly in the communication, autonomy, and supportive care domains. Reinforcing provider communication and shared decision-making skills, improving night-shift staffing and supervision, integrating PCMC indicators into quality monitoring systems, and expanding community-level interventions through task-shifting and community engagement strategies are recommended. Future research should prioritize implementation and intervention studies targeting identified gaps. The protocol has been registered in PROSPERO (CRD42024576229).</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 9","pages":"e0005909"},"PeriodicalIF":2.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083093","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":"Disparities in treatment burden in Peru among people with multiple long-term conditions by geography and healthcare facility: A cross-sectional study.","authors":"Silvana Perez-Leon, Daniel Mendoza-Quispe, Maria Sofia Cuba-Fuentes, Juan Carlos Bazo-Alvarez, M Amalia Pesantes, Andrea Gaspar, Joseph R Zunt, Victor M Montori, Jose Armando Castillo, Eduardo Carcausto, Nelson Diaz, Keveen Salirrosas, Pilar Cornejo, J Jaime Miranda","doi":"10.1371/journal.pgph.0007355","DOIUrl":"10.1371/journal.pgph.0007355","url":null,"abstract":"<p><p>People with multiple long-term conditions (MLTC) in low-resource settings face high treatment burdens, influenced by healthcare access and quality disparities. The study aimed to compare the treatment burden among patients with MLTC across geographical locations and healthcare providers in Peru. We conducted a cross-sectional study conducted between June-October 2023 among outpatients aged ≥40 years with type 2 diabetes and ≥1 additional chronic condition, recruited from public and private healthcare facilities in urban Lima and semi-urban Tumbes, Peru. Treatment burden was assessed using the Multimorbidity Treatment Burden Questionnaire (MTBQ). Differences in median MTBQ scores by setting and healthcare provider were analyzed using regression models adjusting for capacity- and workload-related variables. Among 555 participants (55% female, mean age 62.4 ± 10.5 years), median MTBQ score was 27.1 (IQR 14.6-41.7). After adjustment, patients in semi-urban Tumbes had higher treatment burden than those in urban Lima (adjusted median difference 6.1 points; 95% CI 2.9 to 9.3), while patients receiving care in private facilities had lower treatment burden than those in public settings (-6.6 points; 95% CI -9.3 to -3.9). These findings highlight substantial inequalities in treatment burden by place and provider type, with implications for efforts to improve care delivery and reduce disparities for people living with MLTC.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 9","pages":"e0007355"},"PeriodicalIF":2.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082963","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":"Combined nutrition and physical activity education for early adolescents with malnutrition: A systematic review of overweight interventions and the undernutrition evidence gap.","authors":"Radiet Kidane Alemu, Tefera Belachew, Beyene Wondefrashe, Eugène Rameckers, Kenneth Verboven, Evi Verbecque","doi":"10.1371/journal.pgph.0007280","DOIUrl":"10.1371/journal.pgph.0007280","url":null,"abstract":"<p><p>Early adolescence represents a pivotal stage of growth and development, characterized by profound changes in dietary patterns and physical activity behaviors. Yet, despite the well-documented consequences of both undernutrition and overnutrition, this age group remains largely overlooked in low- and middle-income country settings where the double burden of malnutrition is rapidly intensifying. The primary objective of this systematic review is to determine the effect of combined physical activity and nutrition education interventions among early adolescents experiencing either underweight or overweight, living in socio-economically disadvantaged circumstances. PubMed, Web of Science, Scopus, and LILACS Plus collection were systematically searched and last updated on June18th 2026. The methodological quality of the studies was assessed using the revised Cochrane Risk of Bias tool for randomized trials. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the quality of evidence.Five studies comprising 960 adolescents all classified as overweight or obese met the inclusion criteria; no studies involving underweight adolescents were identified. Risk of bias was generally low to some concerns. Overall, the evidence suggests that combined physical activity and nutrition education interventions may improve anthropometric indicators, dietary behaviors, physical activity levels and sedentary behaviors among overweight and obese early adolescents. However, the overall certainty of evidence was very low primarily because of substantial heterogeneity and the limited number of available studies.Given the very low certainty of evidence, the effectiveness of combined nutrition and physical activity education interventions among overweight and obese early adolescents living in resource-constrained settings remains uncertain. While positive trends were noted, the highly inconsistent data across a limited number of studies indicate the data should be interpreted with caution. Furthermore, a substantial gap exists regarding underweight early adolescents. To address this, further high-quality trials, are needed particularly in low-income settings. Protocol registration: PROSPERO (CRD42024569008).</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 9","pages":"e0007280"},"PeriodicalIF":2.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083026","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":"Identifying barriers and facilitators to implementing triage systems in low- and middle-income countries: A scoping review.","authors":"Ghada Elhadari, Sarah Aly, Alexandria Brackett, Hani Mowafi","doi":"10.1371/journal.pgph.0007378","DOIUrl":"10.1371/journal.pgph.0007378","url":null,"abstract":"<p><p>More than 50% of mortality and one-third of disabilities associated with a range of medical and surgical conditions may be prevented by a well-established Emergency Care System (ECS). The World Health Organization (WHO) has developed a framework that defines the essential ECS functions, including facility-based triage. This scoping review aims to identify the barriers and facilitators to facility-based triage implementation in low- and middle-income countries (LMICs) within peer-reviewed literature and map them to the Consolidated Framework for Implementation Research (CFIR). We searched Scopus, Web of Science-Core Collection, Ovid MEDLINE, Embase, Cochrane CENTRAL, CINAHL, AfricaWide, and Global Health for original research articles, with one or more barriers or facilitators to triage implementation in an LMIC facility. Two reviewers independently screened studies in Covidence. A third reviewer resolved conflicts at each stage. Data was extracted in Covidence by one reviewer and verified by a second. We conducted thematic content analysis of barriers and facilitators and mapped them to the Consolidated Framework for Implementation Research (CFIR). We also conducted quality appraisals of each study using Joanna-Briggs Institute (JBI) tools and the Mixed Method Appraisal tool (MMAT). Our search yielded 1,586 articles, including 839 unique articles. After applying inclusion/exclusion criteria, we included 57 studies. 42 (73.7%) studies were mapped to the Innovation domain; 19 (33.3%) studies were mapped to the Outer Setting domain; 50 (87.8%) studies were mapped to the Inner Setting domain; 51 (89.5%) studies were mapped to the Characteristics of Individuals domain; 53 (93.0%) studies were mapped to the Implementation Process domain. Several barriers and facilitators to triage implementation in LMIC settings are reported in the literature. Our analysis provides a comprehensive framework for emergency care leaders planning to implement or scale triage implementation in LMICs.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 9","pages":"e0007378"},"PeriodicalIF":2.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083024","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":"Correction: Top ten research priorities for Essential Emergency and Critical Care: A modified Delphi process.","authors":"Ryan Rhys Ellis, Wurry Ayuningtyas, Alexandra Wharton Smith, Martin Gerdin Wärnberg, Carl Otto Schell, Tim Baker","doi":"10.1371/journal.pgph.0007403","DOIUrl":"10.1371/journal.pgph.0007403","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1371/journal.pgph.0005262.].</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 9","pages":"e0007403"},"PeriodicalIF":2.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082933","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":"Correction: Relationship of rotating-shift work with lifestyle and health status of hospital employees.","authors":"Maria Antonia Alou-Soler, Aina M Galmes-Panades, Ángel Arturo López-González, Aina M Yañez, Miquel Bennasar-Veny","doi":"10.1371/journal.pgph.0007404","DOIUrl":"10.1371/journal.pgph.0007404","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1371/journal.pgph.0006956.].</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 9","pages":"e0007404"},"PeriodicalIF":2.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082987","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":"Towards gender parity: An analysis of leadership management teams in Tanzania's health sector.","authors":"Henry Mollel, Sara Dada, Anosisye Kesale, Brynne Gilmore, Eilish McAuliffe, Magreth Thadei Mwakilasa, Ntuli Kapologwe, Ziada Sellah, Agnes Mpinga","doi":"10.1371/journal.pgph.0006813","DOIUrl":"10.1371/journal.pgph.0006813","url":null,"abstract":"<p><p>Women constitute the majority of the health workforce globally and in Tanzania, yet remain underrepresented in leadership roles, particularly at higher levels. Despite national commitments to gender equality and various supportive policies, analysis of gender representation in health sector leadership in Tanzania is limited. This study presents the analysis of gender representation in leadership across three healthcare levels of Tanzania's health system, Regional Health Management Teams (RHMTs), Council Health Management Teams (CHMTs), and Health Facility Management Teams (HFMTs). This study used secondary data collected by a government ministry in 2022 from 20 out of 26 regions of mainland Tanzania, representing over two-thirds of the country's regions. The analysis examined 9,120 leadership positions. Descriptive statistics were done using Excel. Results show that while gender representation is nearing parity overall for less powerful roles, notable disparities remain based on role and level of seniority. The highest proportion of women is found in HFMTs at 48.9%, followed by a decline at the CHMTs level to 41.5%, and further to 39.5% in the RHMTs. This trend is similarly evident in leadership roles such as Medical Officers In-Charge, where women represent 29.8% at the HFMT level, but their presence drops to 17.6% among District Medical Officers and just 11.1% among Regional Medical Officers. Gender representation also varies geographically and by facility type, with lower-level facilities generally showing more equitable gender distributions. The findings reflect the ongoing need for gender-transformative leadership strategies, including targeted mentorship, equitable promotion practices, and inclusive workplace cultures.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 9","pages":"e0006813"},"PeriodicalIF":2.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083074","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}