This mixed-methods study compared health districts with and without armed conflict exposure in South Kivu, DRC, using the Kruk index framework. Through document review, stakeholder interviews, and Likert scale questionnaires, researchers identified essential resilience components including prior knowledge of strengths/weaknesses and crisis risks, plus community and non-health actor involvement. The conflict-affected district implemented additional mechanisms including armed forces involvement, mobile clinics, warning systems, and displaced persons monitoring. Findings emphasize that health districts need better resourcing during stable periods to build capacity for crisis resilience, enabling improved care quality and disturbance management.
Equity in Health
This study analyzed child malnutrition trends and determinants using Kenya Demographic Health Survey data (2014-2022), examining stunting, underweight, and wasting in children under five. Analysis showed increased socioeconomic inequality in malnutrition between 2014-2022, particularly affecting the poorest households. Key risk factors for stunting included child's age, household poverty, and sex, while underweight and wasting were associated with mother's age, child's sex, and socioeconomic status. Residence specifically influenced wasting risk. Socioeconomic status proved the strongest predictor of health inequality, though its effectiveness as a screening tool for stunting was moderate (sensitivity 67.4%, specificity 50.6%). Findings highlight the need for interventions that address both immediate health risks and underlying socioeconomic factors to improve child nutrition outcomes equitably.
When global outbreaks of disease are declared ‘over’, what, when and for whom is an end ‘the end’ and what happens after? How do declarations of ends shape personal experiences of crises, ongoing access to care, health and obligations? Global health is defined by narratives of a clearly discernible and singular end. Official announcements of ‘the end’, however, are often arbitrary and unstable. Furthermore, they can distract from important counter-narratives and undermine social, environmental, political and epistemic justice when those ‘left behind’ are excluded from discussions of whether the end has been achieved, or is achievable, and if so when and how. Today, uncertain trajectories, the ‘slow violence’ of environmental degradation, passive attrition of many diseases, and drug resistances question ideas of a singular extinction event and finality. Drawing on an interdisciplinary approach involving historians, sociologists, epidemiologists, psychologists, bioethicists, literary and legal scholars, philosophers and policymakers, this research has two synergistic empirical and normative aims: 1. to explore lived experiences of time and temporality of endings of crises, to capture counter-narratives and their implications for future practices, responses and policies, and 2. to provide an account of the moral and ethical obligations and responsibilities of global health institutions in the aftermaths of crises to health. From detailed comparative research in three countries, including ethnographic, cognitive time-perception and archival methodologies, the authors foreground the people, places, processes and policies to capture everyday experiences of endings and aftermaths in context.
This community-based case-control study identified determinants of teenage pregnancy in Malawi. It used secondary data from the 2015-16 Malawi Demographic and Health Survey from all 28 districts of Malawi. Data on 3435 participants 20-24 years old were analysed. In multivariable analyses: no teenage marriage; secondary education; higher education; richest category of wealth index, use of contraception, domestic violence by father or mother were found to be significant factors in teenage pregnancy. The authors recommend that the government sustain and expand initiatives that increase protection from teenage pregnancy, reinforce the implementation of amended marriage legislation, introduce policies to improve the socioeconomic status of vulnerable girls and increase contraceptive use among adolescent girls before their first pregnancy.
Equity is at the core and a fundamental principle of achieving the family planning (FP) 2030 Agenda. However, the conceptualization, definition, and measurement of equity remain inconsistent and unclear in many FP programs and policies. This paper documents the conceptualization, dimensions and implementation constraints of equity in FP policies and programs in Uganda, through. a review of literature and key informant interviews with 25 key stakeholders in 2020. A limited number of documents had an explicit definition of equity, which varied across documents and stakeholders. The definitions revolved around universal access to FP information and services, with limited focus on equity. The dimensions most commonly used to assess equity were either geographical location, or socio-demographics, or wealth quintile. Almost all the key informants noted that equity is a very important element, which needs to be part of FP programming. However, implementation, client and policy constraints were observed to continue to hinder its implementation in FP programs in Uganda.
Engaging with communities in informal settlements presents opportunities to mitigate the health impacts of climate change, but government investment is also needed. Around one third of the estimated 4.5 billion urban dwellers worldwide use pit toilets or septic tanks, which are normally the first to be overwhelmed in floods, spreading excrement and the pathogens it carries into the environment. Climate change is likely to exacerbate the challenges faced in cities. According to UN-Habitat, “cities are growing faster than governments can build the necessary institutional capacity to better plan and manage urban growth." in the absence of progress on urban investment, planning and management, one suggested way of addressing inequitable exposure to climate risk is to engage with the communities most affected. Not only are community members motivated to initiate risk mitigation measures, they also typically have the best understanding of their surroundings, including the makeup of the local population, and areas most likely to flood.
This theme issue of the Bulletin of the World Health Organization shows how health inequities affect many areas, both at national and global scale. The papers discuss health inequity and its root causes, and offer promising solutions. Challenges include national statistics not capturing health inequity among vulnerable populations such as Indigenous people, refugees and migrant workers, including migrant health workforce. However, good practices exist. For example on paper reports on local Indigenous communities successfully managing primary health-care clinics, that can be scaled up and replicated. Overall, the issue editors observe that rectifying global health inequity requires multidimensional interventions and decisive government leadership at the macro-policy level, collaboration with affected populations at the micro-operational level and accelerating progress towards UHC.
The COVID-19 pandemic, particularly from 2020 to mid-2022, debilitated the management of the HIV epidemic in Africa. The multiple effects included well-documented HIV service interruptions, curtailment of HIV prevention programmes, the associated marked increase in both the risk for HIV infection among key populations and vulnerability of sub-populations. As importantly but less well documented were the diverse negative socio-economic effects that accentuate HIV risk and vulnerability generally (e.g. loss of earnings, gender-based violence, stigma, police harassment of people during lockdowns. The global biomedical response to COVID-19 was necessary and remarkable for mitigating the bio-physical impacts of the pandemic. However, this article suggests that key lessons learnt during the HIV and AIDS and other pandemics were ignored, at least during the early stages of COVID-19. The authors critique is that better integration of the social sciences and humanities in responses to pandemics can counter the reflex tendency to uncritically adopt a biomedical paradigm and, more importantly, to enable consideration of the social determinants of health in pandemic responses.
More people from sub-Saharan Africa aged between 20 years and 60 years are affected by end-organ damage due to underlying hypertension than people in high-income countries, but we lack data on the pattern of elevated blood pressure among adolescents aged 10–19 years in sub-Saharan Africa. This study aimed to fill this gap, through systematic review and meta-analysis of studies published from Jan 2010, to Dec 2021. 36 studies comprising 37 926 participants aged 10–19 years from sub-Saharan African countries were eligible. A pooled sample of 29 696 adolescents informed meta-analyses of elevated blood pressure and 27 155 adolescents informed meta-analyses of mean blood pressure. The reported prevalence of elevated blood pressure ranged from 0·2% to 25·1% of adolescents. with 13·4% of male participants compared with 11·9% of female participants having elevated blood pressure, Although many low-income countries were not represented in the study, the findings suggest that approximately one in ten adolescents have elevated blood pressure across sub-Saharan Africa. The authors observe that there is an urgent need to improve preventive heart-health programmes in the region.
Over the past years, Mozambique has implemented several initiatives to ensure equitable coverage to health care services. While there have been some achievements in health care coverage at the population level, the effects of these initiatives on social inequalities have not been analysed. This study aimed to assess changes in socioeconomic and geographical inequalities (education, wealth, region, place of residence) in health care coverage between 2015 and 2018 in Mozambique. The study was based on analysis of measures from repeated cross-sectional surveys from nationally representative sample surveys. The non-use of insecticide-treated nets dropped, whereas the proportion of women with children who were not treated for fever and the prevalence of women who did not take the full Fansidar dose during pregnancy decreased between 2015 and 2018. The authors observed significant reductions of socioeconomic inequalities in insecticide-treated net use, but not in fever treatment of children and Fansidar prophylaxis for pregnant women. They suggest that decision-makers target underserved populations, specifically non-educated, poor people and rural women, to address inequalities in health care coverage.