Search Results (3,930)

Background: An estimated 25 million children globally miss routine vaccinations each year, with 14.3 million classified as zero-dose and the majority residing in low- and lower-middle-income countries (LMICs). Pharmacies are recognised as accessible healthcare delivery points, yet their role in paediatric immunisation in LMICs is not well defined. This literature review sought to evaluate pharmacist-provided vaccination services for paediatric patients in LMICs. Methods: A systematic review was conducted following Cochrane and PRISMA guidelines. Five databases and grey literature were searched for articles published between January 2005 and June 2026. Studies were reviewed by multiple authors to reduce the risk of individual bias and included if they reported original research involving pharmacists in LMICs delivering vaccination-related services to children aged 12 years and under. For each study, items intended for extraction included country, pharmacy setting, specific vaccines administered, patient age range, and specific roles for the pharmacist in the vaccination administration process. The protocol for this systematic review was registered with the Nelson Mandela University Faculty of Health Sciences Postgraduate Studies Committee and the Research Ethics Committee for Humans (H23-HEA-PHA-007). Results: Of 162 identified records, four studies from Bangladesh, Ethiopia, India, and Jordan met inclusion criteria. No study described pharmacists routinely administering paediatric vaccines. Instead, findings focused on indirect involvement, system readiness, and public perception. Significant barriers included limited infrastructure, inadequate training, and lack of regulatory authority. Study results were limited by a lack of information published and inclusion of only articles available in English. Conclusions: Evidence on pharmacist-administered paediatric vaccinations in LMICs is scarce. Expanding pharmacist roles could improve access and reduce zero-dose prevalence, but would require policy support, infrastructure investment, and further implementation research. Full article

São Paulo is the largest city in Brazil and the second in Latin America. Its domestic waste production reached 3,515,678.96 tons in 2024. Historically, the city has a low recycling rate, and several laws and policies have been implemented to reverse this situation. The objective of this study was to investigate whether there have been advances in the recycling of household solid waste in São Paulo 15 years after the National Solid Waste Policy, from municipal and intra-urban perspectives. The extended period studied and segregated data by regional administration represent the innovative approach of this manuscript. The methodology consisted of a case study with an analysis of the legislation, official data research and evaluation of goals, and socio-spatial distribution. The separate collection rate grew from 0.69% in 2006 to 2.85% in 2024, but this volume represents less than 10% of the target originally projected for the period. A socio-spatial inequality was found as well as a lack of dedicated collection for the organic fraction. It can be concluded that progress is incremental, but limited by structural barriers and urban inequities. Results indicate for São Paulo and for other large cities, mainly in low and middle-income countries, recycling success cannot depend on legislation as it is also correlated with demographic factors, such as educational level, and to the need of targeted policies for a progressive increase in source-separated recycling. Full article

Background: Candidemia carries case-fatality rates exceeding 30% in pediatric oncology cohorts from low- and middle-income countries. We describe a temporal cluster of culture-confirmed candidemia cases at King Hussein Cancer Center (KHCC), Amman, Jordan, coinciding with a novel environmental event and the multidisciplinary infection prevention and control (IPC) response undertaken. Methods: This retrospective cohort study describes seven pediatric inpatients with culture-confirmed candidemia identified between June 1 and September 30, 2025, at a 330-bed tertiary oncology center against a background rate of one confirmed case in the preceding six months. An additional five patients with clinically suspected invasive fungal infection (IFI) but negative blood cultures are described separately. Species identification was performed using the BioFire FilmArray Blood Culture Identification (BCID) panel (multiplex PCR); MALDI-TOF MS was additionally available; antifungal susceptibility was determined using the Sensititre system (Thermo Fisher Scientific, UK). Results: The seven confirmed cases comprised six males and one female (median age: 12 years; range: 1–17 years). Underlying diagnoses were predominantly leukemia (71%). All patients had a central venous catheter (CVC) in situ and recent broad-spectrum antibiotic exposure. Candida tropicalis was the predominant species (57%), with azole resistance identified in 42% of tested isolates. A plumbing infrastructure failure with an associated water leak was identified in late August 2025 during the cluster investigation; structural repair was completed in September 2025. The last confirmed case was recorded on 23 September 2025. All patients received guideline-concordant echinocandin- or amphotericin-based therapy. Candidemia-attributable mortality was 14% (1/7). Conclusions: A temporal cluster of seven culture-confirmed candidemia cases—representing a 7-fold increase above background incidence—was identified at a Jordanian pediatric oncology center. The cluster coincided with a documented environmental water leak. Individual single-room isolation, geographic ward sectioning, contact precautions, hand hygiene monitoring, expanded antifungal prophylaxis with real-time protocol adjustment, and environmental remediation were all implemented and documented with defined operational criteria. These data demonstrate that a structured, criteria-driven IPC bundle is operationally feasible at a resource-limited tertiary oncology center. Full article

Background: Adolescents in low- and middle-income countries face a disproportionate burden of dietary inadequacy, yet evidence on the determinants of overall diet quality remains scarce. This study assessed the prevalence of macro- and micronutrient inadequate intake and identified factors associated with dietary adequacy among adolescents in rural Pakistan. Methods: A cross-sectional survey was conducted among adolescents using multistage cluster sampling. Dietary intake was assessed through a single 24-hour dietary recall; nutrient adequacy was determined using age-and sex-specific Dietary Reference Intake (DRI) standards, including Estimated Average Requirements (EARs), Adequate Intakes (AIs), Estimated Energy Requirements (EERs), and Acceptable Macronutrient Distribution Ranges (AMDRs), as appropriate. Overall dietary adequacy was quantified using the Mean Adequacy Ratio (MAR), calculated as the unweighted mean of nutrient adequacy ratios for fourteen nutrients, including protein, fiber, calcium, iron, zinc, thiamin, riboflavin, niacin, vitamins A, B6, C, D, E, and folate, scaled from 0 to 100. Multivariable linear regression incorporating survey weights and clustering was used to identify independent predictors of MAR using STATA. Results: A total of 1132 adolescents were included. Most of the energy was derived from carbohydrates, and a high proportion of adolescents had energy intakes below age- and sex-specific Estimated Energy Requirement (EER) values, while very high levels of inadequacies were observed for protein, fiber, calcium, vitamin D, and vitamin A. The mean MAR score was 54.04 ± 16.51, indicating overall poor dietary adequacy. In multivariable analysis, male sex (β = 3.26; 95% CI: 1.76, 4.75), belonging to the richest wealth quintile (β = 5.81; 95% CI: 1.76, 9.86), always eating between meals (β = 6.70; 95% CI: 3.93, 9.47), and use of bar soap for handwashing (β = 4.97; 95% CI: 2.00, 7.94) were significantly associated with higher dietary adequacy. Adolescents who were underweight (β = −2.40; 95% CI: −4.81, −0.11) and those with moderate physical activity levels (β = −3.96; 95% CI: −7.62, −0.29) had significantly lower dietary adequacy scores. Conclusions: Dietary inadequacy among rural adolescents in Pakistan was highly prevalent and was associated with socioeconomic, behavioral, and nutritional factors. These findings highlight the need for interventions that address food insecurity, promote equitable food distribution, and strengthen nutrition education to support adolescent health and nutrition. However, these findings should be interpreted in light of the cross-sectional design and the use of a single 24-hour dietary recall, which may not reflect habitual dietary intake. Full article

Psychosocial job characteristics are important components of the work environment and are closely associated with occupational health, particularly among nurses working in demanding healthcare settings. However, evidence from primary healthcare settings in low- and middle-income countries remains limited. This study aimed to describe psychosocial job characteristics and job strain among nurses in urban primary healthcare centers in Vietnam and to examine factors associated with psychosocial job characteristics and job strain. A multicenter cross-sectional study was conducted among 768 nurses across four district-level healthcare centers in Ho Chi Minh City, Vietnam, using a structured questionnaire including the validated Vietnamese Job Content Questionnaire. Nurses reported moderate-to-high job demands, high social support, and limited decision latitude. Most participants reported low strain (45.6%) or active jobs (42.4%), while fewer were in the high-strain (6.3%) and passive (5.7%) categories. Sociodemographic and work-related factors were significantly associated with job strain (p < 0.001). Although the prevalence of high strain was relatively low, differences between perceived job demands and specific dimensions of decision latitude were observed. These findings highlight the importance of job control, workload, and workplace support as factors associated with psychosocial job characteristics and job strain and may help inform future workplace interventions and longitudinal research. Full article

In low- and middle-income countries, the burden of hypertension and hyperglycaemia is alarming. These conditions remain major, recurring public health concerns that demand alternative healthcare strategies. This systematic review critiques and synthesises the existing evidence on the roles of recreational activities and dietary management in treating hypertension and hyperglycaemia in adults in low- and middle-income countries. The aim is to create awareness for hypertensive and hyperglycaemic patients. A systematic search was conducted using the PRISMA guidelines across six online databases: PubMed, Scopus, Google Scholar, Cochrane Library, Web of Science, and CINAHL. The search included peer-reviewed articles published between 2015 and 2025. Of the 12,500 identified articles, only 35 met the inclusion criteria. The evidence suggests that active recreational activities and dietary interventions are the most effective strategies for managing hypertension and hyperglycaemia when implemented properly. Current studies demonstrate that aerobic recreational activity improves vascular function, lowers blood pressure, and enhances insulin sensitivity. DASH and Mediterranean diets support cardiometabolic health in hypertensive and hyperglycaemic patients. These diets help reduce hypertension, control blood sugar levels, and lower cardiovascular risk. If sustained, these intervention strategies can effectively prevent and manage hypertension and hyperglycaemia. This review recommends that healthcare systems integrate therapeutic recreational activities with the DASH and Mediterranean diets as alternative interventions for adults with hypertension and hyperglycaemia. Full article

Severe food insecurity, the level of the Food Insecurity Experience Scale at which people go an entire day without eating, remains above pre-pandemic levels: in 2024, 673 million people (8.2% of the global population) faced hunger and 2.3 billion experienced moderate or severe food insecurity. We examine whether progress in green growth is associated with reductions in severe food insecurity, and over what horizon, using a balanced panel of 78 countries from 2010 to 2024. A dynamic autoregressive model with two-way fixed effects and Driscoll-Kraay standard errors introduces the four dimensions of the Global Green Growth Index (GGGI) as lagged predictors at one, two, and three years. Severe food insecurity is highly persistent: the autoregressive coefficient is 0.941, implying a half-life of at least 11.4 years, and a bias-corrected estimate of 0.970 suggests even greater inertia. Associations with green growth emerge with a delay: Green Economic Opportunities after two years, Efficient and Sustainable Resource Use after three years, while Natural Capital Protection displays a short-run adverse association that dissipates by the third year. Heterogeneity across income levels is confirmed formally, and the protective association of Social Inclusion is confined to low-income countries. Full article

Equity is fundamental to an effective pandemic vaccination response, yet the COVID-19 pandemic demonstrated how inequitable access, driven by purchasing power and delayed supply for low- and middle-income countries (LMICs), prolonged transmission and enabled viral evolution. The Pandemic Influenza Preparedness (PIP) Framework offers a model for providing timely and equitable access to pandemic influenza vaccines. Through legally binding advance supply agreements, the PIP Framework secures real-time access by the WHO to a proportion of global vaccine production and mandates allocation based on public health risk and need. In doing so, it addresses the two axes of inequity observed in previous pandemics—distribution and timeliness—by ensuring that affected populations that do not have access, irrespective of income status, are not at the back of the queue. Full article

As extreme heat events increase in frequency, intensity, and duration due to climate change, forecasting these events has become vital for early warning systems, public health preparedness, and climate adaptation strategies, especially in parts of the world that are already subject to extreme heat, such as tropical regions. In recent years, machine learning (ML) has increasingly been applied to environmental and meteorological data to improve the prediction of heatwaves and extreme heat events. This scoping review examines global peer-reviewed literature on the application of ML techniques for extreme heat prediction using environmental variables. This includes heatwave prediction, environmental and meteorological predictors used in these models, and the geographical distribution of existing research. A total of 23 peer-reviewed studies meeting the inclusion criteria were included in the review, following the PRISMA-ScR guidelines. The findings indicate that artificial neural networks and random forest models were most frequently reported as high performing within individual studies. However, direct comparisons across studies are limited by heterogeneity in prediction targets, validation strategies, lead times, heatwave definitions, and performance metrics. Temperature-related variables, especially maximum temperature, were consistently identified as the most influential predictors across studies. Furthermore, the evidence base was heavily concentrated in Europe, Asia, and North America, with comparatively limited representation from low- and middle-income countries respective to population, despite these regions often experiencing disproportionate impacts of climate change and extreme heat exposure. By synthesising current evidence on ML-based heatwave prediction, associated environmental predictors, and geographical research trends, this review provides insights to support the development of more robust, context-aware, and globally representative heatwave forecasting frameworks. Full article

Background: Tetanus remains a life-threatening yet preventable disease, with a disproportionate burden in low- and middle-income countries. Data on non-neonatal tetanus in Somalia, particularly from referral centres managing severe cases, are limited. This study aimed to describe the clinical characteristics, management, and outcomes of patients with non-neonatal tetanus in Mogadishu, Somalia. Methods: This retrospective observational study was conducted at Madina Hospital between July 2024 and January 2026. All patients with clinically diagnosed non-neonatal tetanus presenting to the Emergency Department were included. Data on demographics, clinical features, management, complications, and outcomes were extracted from medical records. Continuous variables were summarized as mean ± standard deviation or median (interquartile range), while categorical variables were presented as frequencies and percentages. Associations were assessed using Fisher’s exact test, with p < 0.05 considered statistically significant. Results: A total of 50 patients were included (mean age 22.24 ± 15.49 years; 84.0% male). Most patients were unvaccinated (80.0%), and severe or very severe disease was present in 64.0% of cases. Generalized muscle spasm was the most common presentation (50.0%). Dysautonomia (42.0%) and respiratory failure (18.0%) were the most frequent complications. The overall in-hospital mortality rate was 26.0%, with respiratory failure accounting for 69.2% of deaths. Mortality was significantly associated with disease severity (p < 0.001), complications (p = 0.006), antibiotic category (p = 0.043), and vaccination status (p = 0.0265). Conclusions: Non-neonatal tetanus in this referral-based setting is associated with high mortality, predominantly affecting young, unvaccinated individuals presenting with advanced disease. Disease severity and complications, particularly respiratory failure, are the main drivers of outcomes. Strengthening adult immunization, improving early recognition and referral, and expanding access to critical care are essential to reduce tetanus-related mortality. Full article

South Africa attracts thousands of refugees and is regarded as a key destination for migrants on the African continent. Although the country has ratified international and regional conventions on refugees, many refugee women face enormous challenges to attain basic civil, social and economic rights. Employing a qualitative research approach, the study explored the challenges that refugee women encounter in shifting from survival to sustainable livelihood strategies. A purposive sampling technique was used to select 23 refugee women participants for the study. Data was collected through one-on-one interviews and analysed using thematic data analysis. The findings show that most refugee women find it extremely difficult to find an adequate job despite being educated or having stayed in the country for a considerable period. If they do get a job, it is mostly part-time. Due to a lack of decent work, their income remains low, which in turn influences their access to health services, further education, education for their children, adequate shelter, and food security. The study concludes that the socio-economic challenges that refugee women face keep them trapped in poverty and expose them to discrimination, violence, exclusion, and humiliation. The study recommends that strategies be developed to increase the provision of social protection and promote basic civil, social and economic rights for refugee women. Full article

Multidrug-resistant bacterial enteric pathogens such as Salmonella and Shigella have the potential to cause significant mortality and represent a major issue facing the global health community. This is particularly concerning in low-and middle-income countries where access to clean water and antimicrobials is limited. We aimed to determine the frequency, antimicrobial resistance, and presence of resistance genes among Salmonella, Shigella, Vibrioand Campylobacter recovered from patients presenting with diarrhea in an informal settlement in Nairobi, Kenya, from 2018 to 2020. Conventional bacteriologic methods were used for bacterial culture and isolation. BD Phoenix M50 technology was used for the identification and speciation of bacteria recovered from stool samples and for determining minimum inhibitory concentrations to both clinically relevant antimicrobials and agents of epidemiologic significance. PCR testing was subsequently performed to identify resistance genes. The key pathogenic bacteria recovered were: Shigella flexneri (58.3%), Salmonella enterica serovar Typhi (8.3%), Shigella dysenteriae (6.7%), Shigella boydii (6.7%), and Shigella sonnei (6.7%); no Campylobacter or Vibrio were isolated. Overall resistance among Shigella spp. and Salmonella spp. was determined to be highest to ampicillin (83%), followed by tetracycline (50%), cotrimoxazole (47%), chloramphenicol (17%), ceftriaxone (7%), gentamycin (5%), meropenem (2%), ciprofloxacin (0%) and amoxicillin-clavulanic acid (2.0%). Resistance genes detected included β-lactamases (bla_TEM and bla_SHV), aminoglycoside 3-N acetyltransferase acc(3), sulfonamide resistance genes (sul1, sul2), and tetracycline resistance genes tet(A) and tet(B). Results emphasize the critical need for active and continuous surveillance of pathogenic enteric bacteria to improve patient management and inform the development of empiric therapy guidelines. Full article

Background/Objectives: Socioeconomic inequalities continue to shape health service use in low- and middle-income countries. This study aimed to quantify socioeconomic inequalities in formal health service utilization among Peruvian adults using nationally representative data. Methods: A cross-sectional analytical study was conducted using the 2023 National Household Survey (ENAHO). The sample included 77,793 adults aged 18 years or older. Formal health service utilization was defined as self-reported use of outpatient, emergency, or hospitalization services during the preceding 12 months. Survey-weighted Poisson regression with robust variance was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Results: Overall, 15.94% of adults reported using formal health services in the previous year. In the adjusted model, utilization was higher among women (aPR: 1.47; 95% CI: 1.41–1.55) and adults aged 60 years or older (aPR: 1.74; 95% CI: 1.57–1.92). Compared with uninsured adults, service utilization was higher among those covered by SIS (aPR: 2.59; 95% CI: 2.29–2.93), EsSalud (aPR: 2.90; 95% CI: 2.56–3.29), Armed Forces/Police insurance (aPR: 3.04; 95% CI: 2.36–3.91), and private insurance (aPR: 2.32; 95% CI: 1.77–3.03). Non-extreme poverty (aPR: 0.72; 95% CI: 0.67–0.78) and extreme poverty (aPR: 0.68; 95% CI: 0.59–0.78) were associated with lower utilization. Conclusions: Formal health service utilization remains low and unequal in Peru. Insurance coverage was strongly associated with greater service use, whereas poverty was associated with lower utilization. Full article

(1) Background: Digital nature, delivered through different media, has been proposed as a scalable substitute for physical nature exposure to support psychological well-being, especially in high-income countries. This scoping review aimed to map the evidence on digital nature interventions and positive psychological outcomes. (2) Methods: Following PRISMA-ScR guidelines, we searched PubMed, ScienceDirect, and Google Scholar, supplemented by AI search and citation tracking, for studies published between 2020 and 2025. The first search was conducted between 15 November 2025 and 25 December 2025 and revisited between 5 June 2026 and 10 June 2026. We included articles published in English in peer-reviewed journals with the full text available. (3) Results: Our search yielded 67 studies from diverse cultural settings in three categories: primary studies (N = 46), review articles (N = 19) and conceptual articles (N = 2). Digital nature was associated with reduced stress and anxiety, better mood, greater restorativeness, and stronger nature connectedness, across healthy individuals, older adults, and clinical populations; reviews supported these findings at a larger scale, though some flagged mixed results for specific outcomes and technologies. Two conceptual articles explained these patterns through biophilic design and digital placemaking. (4) Conclusion: Overall, digital nature appears to be a promising approach for promoting psychological well-being, particularly where access to natural environments is limited. However, the evidence is mixed, geographically concentrated in Europe, East Asia, and North America, and methodologically heterogeneous, with no studies from low-resource settings. Further research is needed in these underrepresented regions. Full article

Traditional wet markets are critical components of Indonesia’s urban food system, yet remain largely unexamined from an occupational health and safety (OHS) perspective. This study identified and prioritized OHS risks among vendors and visitors at Nanggalo Market, a high-density traditional market in Padang, West Sumatra. This was an exclusively qualitative, descriptive, non-probability (purposive) study; no actual occupational accidents, injuries, or exposure incidents were evaluated, and risk levels reflect participants’ perceptions together with researchers’ triangulated observations rather than objective incident records. An observational qualitative design combined elicitation surveys with 45 participants (20 vendors, 20 visitors, 5 market managers), direct observation, and in-depth interviews with 7 key informants. Risk assessment followed the AS/NZS 4360:2004 matrix, classifying risks by likelihood and consequence severity based on participant- and researcher-perceived evidence rather than recorded incident data. Ten potential hazards were identified across six activity zones: traffic and parking; buying and selling; culinary activities; building structures and floor conditions; security and stray animals; and emergency access. Seven risks were classified as high-level, including slipping on wet floors, lack of evacuation routes, lack of fire extinguishers, narrow circulation paths, poor toilet conditions, crowding, and traffic injuries, while three were moderate. All high-level risks lacked adequate controls. Recommended interventions span the full hierarchy of controls, prioritizing engineering and administrative measures, and propose community-based occupational health posts as a sustainable mechanism. These findings provide an evidence base for strengthening OHS governance in traditional wet markets across Indonesia and comparable low- and middle-income country settings. Full article