BMJ Global Health最新文献

{"title":"Potential impact of increasing physical activity on NCD mortality in the EU: pathways to SDG 3.4.1 by 2030.","authors":"Abdu Nafan Aisul Muhlis, Nour Mahrouseh, Carlos Alexandre Soares Andrade, José Chen-Xu, Terje Andreas Eikemo, Mirza Balaj, Mary Economou, Enkeleint A Mechili, Brigid Unim, Carl Michael Baravelli, Andreea Badache, Jeroen Spijker, Jonila Gabrani, Rafael José Vieira, Brian Lassen, Romana Haneef, Gülcan Tecirli, Sarah Cuschieri, David Rojas-Rueda, Hanno Hoven, Ghenwa Chamouni, Gabriella Laila Tarek, Orsolya Varga","doi":"10.1136/bmjgh-2025-022998","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-022998","url":null,"abstract":"<p><strong>Background: </strong>Physical inactivity affects 36.2% of adults in the European Union (EU), contributing substantially to the burden of non-communicable diseases (NCDs). The WHO's Global Action Plan on Physical Activity 2018-2030 targets a 15% relative reduction in physical inactivity by 2030, supporting Sustainable Development Goal (SDG) 3.4.1 to achieve over 30% reduction in premature NCD mortality. This study estimates the number of averted deaths, premature deaths and cause-specific NCD deaths averted if physical activity targets are achieved across EU countries.</p><p><strong>Methods: </strong>We applied the WHO Preventable Risk Integrated ModEl using baseline physical activity and body mass index from waves 2 and 3 of the European Health Interview Survey. The counterfactual scenario modelled a 15% increase in metabolic equivalent of task hours/week of moderate-to-vigorous physical activity and a 15% relative reduction in the proportion of adults who are physically inactive across the EU.</p><p><strong>Findings: </strong>Increased physical activity is associated with an estimated 24 178 premature deaths averted by 2030 (95% uncertainty interval (UI): 23 253-25 103), equivalent to 3.3% of premature NCD mortality. Overall, 107 108 deaths (95% UI: 102 479-111 737) across all ages could be prevented, representing 4.7% of total NCD deaths in EU member states.</p><p><strong>Interpretation: </strong>Increasing physical activity alone is unlikely to achieve the SDG 3.4.1 target of reducing premature NCD deaths by 2030. However, when combined with other WHO 'best buy' interventions, such as improved diet and reduced tobacco and alcohol use, this target could be attainable across the EU.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Willingness to accept paediatric blood sample collection for clinical research purposes in Nepal: a qualitative study.","authors":"Ashata Dahal, Pratibha Oli, Mila Shakya, Shrijana Shrestha, Dikshya Pant, Sarah Kelly, Andrew J Pollard, Bipin Adhikari, Jennifer Van Nuil, Abhilasha Karkey","doi":"10.1136/bmjgh-2025-021437","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-021437","url":null,"abstract":"<p><p>Blood sample collection is essential for clinical research but can be challenging due to cultural beliefs, emotional responses, and misconceptions. This can escalate in paediatric settings. Despite the growing landscape of clinical research, evidence from South Asia remains limited. This study explores the factors influencing willingness to accept paediatric blood sample collection for clinical research in Nepal, drawing on experiences from a clinical research cohort. A qualitative study grounded in a constructivist-interpretivist paradigm, using semi-structured interviews, was conducted with 38 parents/guardians of sick children attending a study fever clinic. A purposive sampling technique was used to recruit participants attending the study fever clinic at Patan Hospital, Nepal. Additionally, interviews were conducted with six research clinicians and nurses. Interviews were conducted between May 2022 and August 2023. The six-step thematic analysis process described by Braun and Clarke was used to identify key themes and subthemes related to blood collection experiences for research purposes. Willingness to provide consent for paediatric blood sampling was shaped by three inter-related factors: personal, behavioural and environmental. Personal beliefs about blood and blood volume, its replenishment and contribution to public health encouraged participation, while fears of harm and lack of personal benefit deterred consent. Behavioural factors included prior experience of blood collection, professional background and perceived necessity of the test. Environmental influences such as trust in the hospital and research staff, effective communication and family decision-making dynamics, were also critical. Some participants equated research blood collection with altruistic donation, while others expressed concerns about misuse or wastage. Our findings underscore the need to engage with the community regarding beliefs about blood in research, transparent communication and trust-building strategies in paediatric clinical research. These findings offer practical guidance for improving participant recruitment and retention in future clinical research in similar settings.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alarming disparities of adolescent motherhood in Nigeria: results from 36 states and the Federal Capital Territory.","authors":"Anayochukwu E Anyasodor, M Mamun Huda, Md Mahmudur Rahman, Victor M Oguoma, Oyelola Adegboye, Chukwudi M Egbuche, Bright Opoku Ahinkorah, Ann Nwankwo-Eluwa, Feleke H Astawesegn, Subash Thapa, Shakeel Mahmood, Allen G Ross","doi":"10.1136/bmjgh-2025-021486","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-021486","url":null,"abstract":"<p><strong>Importance: </strong>Nigeria has a population of 233 million people and high rates of adolescent motherhood. Reduction of adolescent motherhood is a priority and primarily aligns with the sexual and reproductive health target (indicator 3.7.2) in the specific United Nations Sustainable Development Goals (SDGs).</p><p><strong>Objective: </strong>This study examined the trends and social disparities of health impacting adolescent motherhood at the state level.</p><p><strong>Design, settings and participants: </strong>The study analysed 24 668 adolescent females aged 15-19 years, drawn from 36 states and the Federal Capital Territory (FCT) using four Nigerian Demographic and Health Surveys (2003-2018). This study estimated the population-weighted prevalence of adolescent motherhood and employed the average annual rate of change (AARC) to compute the state-level trends in the prevalence. The normalised concentration index was also used to understand the sociodemographic inequalities.</p><p><strong>Results: </strong>The national prevalence of adolescent motherhood is 18.73%, with substantial variation in AARC and a normalised concentration index across states in different geopolitical zones. The highest prevalence of adolescent motherhood was observed in Bauchi State in the North-East at 40.65%, while the lowest was in Lagos in the South-West at 1.1%. The AARC in Bauchi was +1.7%, while in Lagos it was reported at -9.96%. Out of the 36 states and FCT, 15 (40.5%) either experienced an increasing prevalence of adolescent motherhood (29.7%) or a slow decline (10.8%) while 22 (59.5%) showed progress. With respect to the distribution of adolescent motherhood, most of the high-burden states had a negative normalised concentration index for wealth (92%), education (92%) and area of residence (72%). Moreover, highly statistically significant variations were observed between high-burden states in the North and low-burden states in the South for wealth, education, rurality, child marriage, age at first child and polygyny.</p><p><strong>Conclusions: </strong>Adolescent motherhood remains persistently high in Nigeria, particularly in the northern part of the country, due to early marriage, intergenerational poverty and a lack of education. This necessitates scaling up state-specific health education programmes targeting adolescent girls in schools and government policy, enforcing the legal age of marriage to achieve the SDG 3.7.2 target.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV care continuity for women in postconflict Tigray: assessing mother-to-child transmission rates, infant health and cervical cancer screening.","authors":"Hafte Kahsay Kebede, Hailay Abrha Gesesew, Lillian Mwanri, Paul Ward","doi":"10.1136/bmjgh-2025-023272","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-023272","url":null,"abstract":"<p><strong>Introduction: </strong>The Tigray War (November 2020-November 2022) caused catastrophic health system collapse in northern Ethiopia, with substantial excess mortality and near-total destruction of health infrastructure. The impact on HIV care services remains poorly documented. We comprehensively assessed HIV care continuum recovery across prevention of mother-to-child transmission (PMTCT), HIV-exposed infant care and cervical cancer screening among women living with HIV during the postconflict period.</p><p><strong>Methods: </strong>We conducted a retrospective multidomain cohort study across seven health facilities in Mekelle City, Tigray, from November 2022 to May 2025. We assessed: (1) mother-to-child transmission (MTCT) rates among 405 HIV-exposed infants using Firth's penalised logistic regression; (2) feeding practices, growth outcomes, cotrimoxazole prophylaxis coverage and retention among 2482 follow-up visits using generalised estimating equations and (3) cervical cancer screening cascade completion among 2515 women living with HIV using mixed-effects logistic regression.</p><p><strong>Results: </strong>Among 405 HIV-exposed infants, 11 were diagnosed HIV-positive, an MTCT rate of 2.72% (95% CI 1.36% to 4.81%). MTCT declined significantly from 5.56% in 2022 to 0% by early 2025 (p=0.0015). All transmissions occurred in primary-level facilities (8.27%), with none in secondary-level facilities (0%). Exclusive breastfeeding occurred in 90.9% of visits (95% CI 89.3 to 92.4%). Growth failure was rare among exclusively breastfed infants (0.48%) but markedly higher among replacement-fed infants (26.2%). Programme retention was 99.8%, mortality 0.2%, and no infants were lost to follow-up. Cervical cancer screening coverage was high (98.6% offered, 98.3% accepted), though only 76.9% completed screening.</p><p><strong>Conclusion: </strong>Despite catastrophic health system disruption, facility-based HIV services in post-war Tigray achieved near-elimination of MTCT by 2025, with exceptional retention, prophylaxis coverage and breastfeeding outcomes. Concentration of PMTCT services at secondary-level facilities was strongly associated with reduced transmission. However, these findings represent a selected population successfully accessing services; true population-level outcomes are likely substantially worse. Sustained investment in facility-based services and community outreach is essential for comprehensive HIV care recovery.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congo's conflicts, minerals and microbes: planetary health implications.","authors":"Shahul H Ebrahim, John Ditekemena, Barrak Alahmad, Ann-Christine Duhaime, Dieudonné Mwamba, Ziad A Memish","doi":"10.1136/bmjgh-2025-022261","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-022261","url":null,"abstract":"<p><p>The abrupt re-escalation of the three-decade conflict in eastern Democratic Republic of the Congo (DRC) in January 2025, the July peace deal and new mineral extraction agreements highlight the Congo Basin's global significance. Known as the world's largest rare mineral reserve, the 'second lung of the planet', and a hotspot for emerging infectious diseases, the region embodies critical planetary health challenges. The conflict intensifies sylvatic-to-human transmission of zoonoses (involving at least 15 known pathogens), undermines climate change mitigation and conservation, disrupts human development-including education-and inflicts intergenerational harm.In the Congo basin, conflict-driven displacement and close contact with forests create ideal conditions for sporadic disease spillover. These risks are magnified by ecosystem disruptions from logging, mining, agriculture, wildlife trade, firewood collection and tourism, all intersecting with demographic shifts that push communities deeper into forested areas.Global demand for DRC minerals is surging, but without parallel investments in human development, biodiversity protection and disease surveillance, exploitation could accelerate regional instability and global health threats. The June 2025 peace deal and the rise of a mineral-based economy present a critical opportunity to align extraction with peacebuilding, sustainable development and climate resilience. Investments in enhanced surveillance and preparedness systems are essential to prevent transboundary pathogen spread and preserve fragile ecosystems. As the world grows increasingly dependent on the Congo's mineral wealth, realising its benefits requires renewed global commitment to ensure that resource extraction strengthens peace, resilience and planetary health rather than deepening conflict and instability.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting access to and utilisation of intravenous iron to treat anaemia in pregnancy in Zomba, Malawi: a qualitative study.","authors":"Elisabeth Mamani-Mategula, Hana Sabanovic, Naomi Von Dinklage, Ebony Verbunt, Khic-Houy Prang, Effie Chipeta, Lucinda Manda-Taylor","doi":"10.1136/bmjgh-2025-019886","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-019886","url":null,"abstract":"<p><strong>Background: </strong>Anaemia in pregnancy significantly increases the risk of maternal and neonatal complications. Oral iron supplementation, the standard treatment, is often poorly tolerated and associated with low adherence. Intravenous iron presents a rapid alternative, and we examined the factors influencing access to and utilisation of intravenous iron in treating anaemia in pregnancy within Malawi's primary healthcare system.</p><p><strong>Methods: </strong>We conducted a qualitative study embedded with a clinical trial. We collected data through in-depth interviews (n=16) and focus group discussions (n=3) with pregnant women enrolled in the trial, those who withdrew and their husbands and caregivers. Interviews were audio-recorded, transcribed and analysed using a reflexive thematic approach in NVivo 12. Themes were mapped onto the supply and demand domains of the Patient-Centred Access to Healthcare framework.</p><p><strong>Results: </strong>Barriers to access and utilisation operated across both supply-side and demand-side domains. On the supply side, limited service awareness, logistical constraints and unclear provider communication reduced engagement with intravenous iron. On the demand side, pregnant women's knowledge about anaemia, cultural norms, personal beliefs and social support shaped decision-making and ability to access care. Facilitators across both domains included patient-centred service delivery, clear and responsive provider communication and family or peer involvement in decision-making, which enhanced trust, understanding and uptake.</p><p><strong>Conclusion: </strong>In conclusion, our study demonstrates that patient-centred approaches are critical for improving health literacy, and strong health systems are essential for the effective delivery of intravenous iron intervention. Addressing supply and demand barriers is vital for optimising uptake of intravenous iron interventions, improving health system performance and ensuring equitable access to antenatal care interventions, ultimately improving the health outcomes for mother and child.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AWaRe antibiotic prescribing for common acute infections in private primary care in low-middle-income countries: a patient-level analysis using IQVIA prescriber surveys from Pakistan, Egypt and Indonesia.","authors":"Nam Nguyen, Sherry Mangla, Peter Stephens, Aislinn Cook, Mike Thorn, Zikria Saleem, Siswanto Agus Wilopo, Elizabeth Tayler, Mike Sharland, Koen B Pouwels","doi":"10.1136/bmjgh-2025-021139","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-021139","url":null,"abstract":"<p><strong>Backgrounds: </strong>There is limited high-quality data on antibiotic prescribing in low and middle-income countries, particularly in the private sector. Here, we use large-scale healthcare surveys to assess antibiotic prescribing levels and the factors influencing prescribing decisions for common infections in primary care and outpatient settings, predominantly within the private sector, in Pakistan, Egypt and Indonesia.</p><p><strong>Methods: </strong>We analysed surveys completed by prescribers in Pakistan, Egypt and Indonesia, collected in primary care and outpatient settings, predominantly within the private sector, by IQVIA between 2017 and 2021, namely IQVIA's proprietary Medical Data Index (Medical Index of Pakistan (MIP), Egypt Medical Data Index (EMDI) and Indonesia Medical Data Index (IMDI)). IQVIA market research information reflects estimates of real-world activity and should be treated accordingly. We evaluated antibiotic prescribing categorised by WHO AWaRe and Essential Medicines List (EML) classifications for common infections. We used mixed-effects regression analyses to identify factors influencing prescribing decisions.</p><p><strong>Results: </strong>Among the 384 975 infection-related health consultation records analysed, antibiotics were prescribed in 82.0% of consultations in Pakistan, 81.2% in Egypt and 69.1% in Indonesia. Watch antibiotics accounted for 70.2% of antibiotic prescriptions in Pakistan, 52.9% in Egypt and 53.6% in Indonesia. Non-WHO EML antibiotics accounted for 26.8% of prescriptions in Pakistan, 39.9% in Egypt and 33.0% in Indonesia. Consultations for patients presenting with lower respiratory tract infections, urinary tract infections, multiple infections or differentiated fever had higher odds of receiving any or a Watch antibiotic. Consultations by respiratory-related specialists in Pakistan and Egypt and by most specialities in Indonesia were more likely to receive Watch antibiotics.</p><p><strong>Conclusions: </strong>Similar patterns of high levels of total and Watch antibiotic prescribing for common infections-including those that generally do not require any antibiotics-were identified among prescribers in primary care and outpatient settings within the private sector in Pakistan, Egypt and Indonesia.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of mass transfers of enrollees from liquidated health insurance companies on the financial sustainability of health insurance: an ecological study in the Colombian health system.","authors":"Carlos Eduardo Pinzon Florez, Ciro Gómez Ardila, Myriam Ruiz-Rodriguez","doi":"10.1136/bmjgh-2025-021359","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-021359","url":null,"abstract":"<p><strong>Background: </strong>The liquidation of health promoting entities (Entidades Promotoras de Salud (EPS)) in Colombia and the forced transfer of millions of enrollees to solvent insurers have raised concerns about the financial sustainability of the health insurance system. This study examines the impact of these uncompensated mass transfers on key financial indicators of receiving EPS.</p><p><strong>Methods: </strong>A multitemporal ecological study and a difference-in-differences (DiD) model were conducted using national administrative data. Nine continuously operating EPS that received enrollees from liquidated entities were included. Key financial indicators analysed included operating margin, capitation payment unit (Unidad de Pago por Capitación (UPC)) sufficiency, medical loss ratio, per capita medical cost and enrolment volume. Linear mixed-effects and fixed-effects DiD models were applied.</p><p><strong>Findings: </strong>Average operating margins decreased from 3.2% (2017) to -0.59% (2024). In mixed-effects models, UPC sufficiency was the strongest positive correlate of margin (β=0.28, 95% CI 0.14 to 0.41), while per capita medical cost (β=-0.43, 95% CI -0.66 to -0.21) and enrollee transfers (β=-0.014, 95% CI -0.027 to -0.002) were negatively associated. DiD estimates show that mass transfers reduced operating margins by 1.2 percentage points (95% CI -1.5 to -0.9), with the strongest effects in the first 2 years and consistent results across sensitivity analyses.</p><p><strong>Interpretation: </strong>Uncompensated mass enrollee transfers from liquidated EPS have a significant negative impact on the financial sustainability of receiving insurers. Regulatory reforms, including risk-adjusted premium adjustments and interinsurer compensation mechanisms, are urgently needed.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutrition-sensitive agriculture programme impacts women's mental health via food security in rural Bangladesh.","authors":"Thalia M Sparling, Cesar Cornejo, Claudia Offner, Axel Mayer, Jillian L Waid, Suneetha Kadiyala, Sabine Gabrysch","doi":"10.1136/bmjgh-2025-020509","DOIUrl":"10.1136/bmjgh-2025-020509","url":null,"abstract":"<p><strong>Introduction: </strong>Food insecurity and malnutrition, as well as poor mental health, negatively impact millions of people worldwide and can reinforce each other, compounded by gender inequity. Nutrition-sensitive agriculture interventions have the potential to improve these simultaneously. We analysed the impact of a homestead food production (HFP) programme on women's mental health, including pathways through food insecurity, women's empowerment and dietary diversity.</p><p><strong>Methods: </strong>The Food and Agricultural Approaches to Malnutrition cluster-randomised trial allocated 96 settlements in northeastern Bangladesh 1:1 to a HFP programme, implemented 2015-2018, and control. Data were collected at baseline in 2015, at endline in 2019/20 and continuously through a surveillance system. Depressive symptoms were assessed using the Edinburgh Postpartum Depression Scale (EPDS). We quantified the intervention's impact on depressive symptoms at endline, analysing data from 2513 women using multilevel regression. We also examined whether that effect was mediated by household food security, women's empowerment and women's dietary diversity, using sequential mediation analysis with cluster-bootstrapped standard errors, adjusting for baseline covariates.</p><p><strong>Results: </strong>At baseline, 39% of households were severely food insecure and 69% of women did not have minimally diverse diets. At endline, 38% of women in the control and 32% in the intervention arm screened positive for depressive symptoms (EPDS≥12). The intervention reduced the odds of depressive symptoms by 23% (OR 0.77, p=0.03). There was no evidence that the combined pathway reduced depression (OR 0.95, p=0.24). When decomposed, food security was responsible for one-third of the total effect (OR 0.92, p=0.01). Most of the intervention effect on depression was through other pathways (OR 0.81, p=0.08).</p><p><strong>Conclusions: </strong>On average, intervention participants had better mental health 1 year after the programme ended, with some of the effect mediated by increased food security. There are likely other pathways through which nutrition-sensitive agriculture can improve mental health, such as social protection and income, which may act synergistically.</p><p><strong>Trial registration number: </strong>NCT02505711.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of infectious disease outbreaks and violence against women and girls: changes in magnitude, mechanisms and lessons for the future.","authors":"Lindsay Stark, Douglas James Noble, Melissa Meinhart, Blake Erhardt-Ohren, Sarah Karmin, Catherine Poulton, Danielle Sarraf, Flavia Bustreo, Ilana Seff","doi":"10.1136/bmjgh-2025-020982","DOIUrl":"10.1136/bmjgh-2025-020982","url":null,"abstract":"<p><p>Infectious disease outbreaks (outbreaks) are increasing across the globe due to climate change, urbanisation and changes in land use, and many of their response measures impact risk factors for violence against women and girls (VAWG). We conducted a systematic review to consolidate existing evidence on the impact of any outbreaks, and their public health responses, on the change in magnitude of VAWG and mechanisms facilitating violence among women and girls in low-income and middle-income countries. Though our search strategy aimed to capture studies from any outbreak since 2014, all quantitative evidence on VAWG impacts, and all but one qualitative study, focused on the COVID-19 pandemic, and only three studies disaggregated outcomes for women versus girls. Overall, our synthesis of the evidence points to increased VAWG during the first year of the COVID-19 pandemic compared with pre-pandemic levels. We identified five broad mechanisms through which violence occurred against women and girls: (1) income loss due to economic shutdown, financial insecurity, and/or job loss, (2) movement restrictions, (3) changes in access to public services, (4) fear of exposure to infectious disease, and (5) a legacy of mistrust in health systems from previous outbreaks. Our study demonstrates the novelty of VAWG monitoring during outbreaks, the need for increased surveillance and the known mechanisms to date through which VAWG may be perpetrated during outbreaks. By implementing both short-term protective measures and long-term structural reforms, outbreak responses may not only break the cycle of VAWG exacerbated by public health emergencies but build resilient systems that protect women, girls and marginalised populations before, during and after crises.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}