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Approximately 1.33 million pregnancies are recorded in South Africa annually. About 30% of all pregnant women are HIV positive, posing a serious risk to unborn children. However, effective interventions such as prevention of mother-to-child transmissions (PMTCT) services have been shown to significantly reduce the risk of mother-to-child or vertical transmission. Migrant women in South Africa face challenges in accessing [free] healthcare services. This study aims to assess the cost-effectiveness of providing free PMTCT services to migrant women living in South Africa. We employed cost-effectiveness analysis methodology to establish the cost and outcomes (averted pediatric infections and averted disability-adjusted life years (DALYs)) associated with free PMTCT services for migrant women. The comparator was provision of only antenatal care (ANC) while the intervention was ANC + PMTCT services. A Microsoft Excel-based decision tree model was designed to achieve the study objectives. Data on costs and health outcomes for each intervention was sourced from the literature on HIV/AIDS. The prevalence-based study is conducted from a public sector healthcare payer perspective. Provision of ANC + PMTCT services to migrants will prevent 14 562 new infections among 52 762 HIV positive pregnant women. The estimated total expected cost of ANC + PMTCT service was US$52 889 per 1000 live births compared to US$191 000 for ANC only per 1000 live births. The expected cost for the do-nothing scenario was US$73 535 per 1000 live births. The expected health benefit (ie, averted DALYs) associated with do-nothing scenario, ANC, and ANC + PMTCT were 277, 265 and 76 DALYs, respectively. ANC + PMTCT service provision produces the lowest DALYs at lower cost thereby producing cost-saving of US$733/DALY averted per 1000 live births. Further, an average of US$1.5 million would be required annually to achieve 100% coverage of HIV+ migrant women. Therefore, provision of ANC and PMTCT services to migrant women is cost-effective when compared to not offering PMTCT services and allows the government to avoid the long-term cost of antiretroviral therapy (ART) provision.

Background: Zimbabwe lacks information on physical activity levels, the available information is based on estimates.

Aim: This study compared physical activity levels in rural and urban settings. The relationship between the level of physical activity and metabolic risk factors for non-communicable diseases was also analysed.

Setting: The study took place in Bulawayo city (urban) and Mashonaland East province (rural).

Methods: Multi-stage probability-based sampling was used to select 200 male respondents from Bulawayo Province (urban) and 200 male respondents from Mashonaland East Province (rural). The study used the enumeration areas (EAs) used during the 2012 census and represented wards. In total, 10 enumeration areas were randomly selected, and 40 households were randomly selected in each of these enumeration areas. Logistic regression was used for all statistical analyses.

Results: Rural respondents were 62% more likely to meet the World Health Organisation (WHO) required physical activity level than urban respondents. The rural group was 158% more likely to have intermediate physical activity levels (600-2999 METs) than the urban group. Those meeting the WHO recommended physical activity level were 51% less likely to have elevated blood glucose. Facilities to promote physical health are not being used.

Conclusions: The rural group was more physically active than the urban group. High physical activity reduces the risk of metabolic risk factors for non-communicable diseases such as diabetes.

Contribution: Promotion of good health by reducing risk factors for non-communicable diseases.

Addressing the mental healthcare needs of the population at the Primary Health Care (PHC) level has gained global consensus as a key strategy to realising the mental health targets of the United Nations (UN) Sustainable Development Goals (SDGs), especially SDG3. This research explored the question 'What is the nature and level of community participation and ownership in the development and integration of mental healthcare service provision at the PHC, especially at Community Health Planning and Services Centre (CHPS) level(s) in Ghana?'. A cross-sectional study that adopted concurrent mixed quantitative and qualitative research methods was undertaken to explore and answer the question. The quantitative data of the study was collected through a survey questionnaire. Key informant interviews and focus group discussions were used to collect the qualitative data. Thematic analysis with the use of NVivo 12 was applied for the qualitative field data and Stata SE16 used for quantitative data. Data triangulation strategy was used to report both the qualitative and quantitative data sets. The study findings show that community participation and ownership was low, requiring more concerted efforts to engender that into mental health care policy and services development and implementation to realise the seamless integration of mental healthcare into general healthcare at the PHC level. Community participation and ownership will substantially enhance the (re-)organisation and resourcing of mental health services in Ghana to make them more responsive and inclusive.

Cholera remains a major healthcare issue in the Democratic Republic of the Congo with recurrent cholera outbreaks in its eastern provinces since 1994. Cholera cases and deaths increased from 18 403 and 302 in 2022 to 52 570 and 470 in 2023. From October 1st to December 31st, 2022, we conducted a mixed descriptive study to analyze the management process underpinning the cholera vaccination campaign in the Katana health district, South Kivu province, DRC. The survey targeted households (n = 404) with 1 adult person per household responding on behalf of all the members of the household and key informants (KI) who were health workers (n = 6) in 5 health areas of the Katana health district. The overall cholera prevalence in the surveyed households was 4.7% (95% CI 2.9-7.3), and the overall vaccination rate was 25.0% (95% CI 20.9-29.5). Most interviewed household respondents (54.5%) were eager for their household members to get vaccinated, and 61% had to walk for more than 1 hour to reach the vaccination center. Cholera vaccine for children under 2 years was available in all the 5 health areas investigated, only 2 out of 5 health areas had enough vaccine stockpiles. Only 33.3% of KI administering vaccines were trained at least once during the past 3 years. All the KI (100%) complained about delays or absence of payment for their services which negatively impacted their implication. Our findings highlight weaknesses in the planning of the last cholera vaccination campaign in the health district of Katana.

Background/objectives: Mental health issues are prevalent among healthcare workers, but help-seeking behavior in this groups remains under-researched. The purpose of this study was to explore predictors of and barriers to mental health help-seeking among healthcare workers in Canada, compared to workers from other sectors.

Design: This quantitative study analyzed cross-sectional data from Mental Health Research Canada (MHRC) from October 2022 to January 2024.

Methods: The total sample consisted of 8,191 workers from various sectors, including 419 healthcare workers. We examined prevalence of help-seeking, barriers to accessing mental health support, and predictors of help seeking using descriptive and inferential statistics. A multivariate logistic regression analysis was performed to explore the relationship between sociodemographic factors and help-seeking.

Results: Healthcare workers were more likely to seek mental help support compared to workers from other sectors (OR 1.73, 95% CI: 1.35, 2.20). Healthcare workers least likely to seek mental health support were male (OR 0.58, CI 0.52, 0.66), residing in Quebec (OR 0.49, 95% CI: 0.41, 0.59), or of older age (OR 0.40, 95% CI: 0.30, 0.52). Key barriers to mental health help-seeking identified among healthcare workers included concerns about exposure to COVID-19 (33%), preference for self-management (25%), concerns about the safety of care options (18%), and lack of knowledge on how or where to seek help (13%).

Conclusions: This study provides valuable insight into the barriers and predictors of mental help-seeking behavior among healthcare workers. Findings underscore the need for workplaces to foster safe, supportive, and inclusive environments to better support healthcare workers facing mental health challenges.

Background: Protecting healthcare employees and preventing infection transmission are paramount concerns during epidemics. Predicting healthcare employees' behavior regarding the use of personal protective equipment (PPE) and identifying the related effective factors can guide educational and administrative strategies and enable timely interventions during outbreaks. This study aimed to predict factors affecting the healthcare employees' behavior in the use of PPE at Shiraz University of Medical Sciences in Iran, based on Godin et al's model.

Methods: This was a cross-sectional and descriptive-analytical study. After reviewing the related articles and interviewing the experts and based on the model of Godin et al. (2008), a questionnaire was developed, validated, and tested for reliability using face and content validity as well as Cronbach's alpha. Collected data were analyzed using SPSS v.21 and modeled by Structural Equation Modeling (SEM) via SPSS v.21 and Smart PLS v.3 software.

Results: The questionnaire was valid (CVI = 86.42, CVR = 81.71) and reliable (α = .85). The model exhibited appropriate measurement, structural, and overall fit. Beliefs about consequences, social influences, habits/past behavior, role and identity, characteristics of employees, moral norms, and beliefs about capabilities indirectly and significantly influenced behavior (P < .001). Additionally, beliefs about capabilities (P < .001), habits/past behavior (P = .001), and intention (P = .001) directly and significantly influenced PPE use behavior during epidemics.

Conclusion: The results emphasized the necessity of targeted interventions based on the studied model constructs within healthcare organizations. By promoting positive beliefs about PPE effectiveness and encouraging appropriate intentions and behaviors, healthcare organizations can significantly improve employee's adherence to PPE use during pandemics.

Background: Preoperative anxiety is commonly characterized as a feeling of tension, apprehension, nervousness, distressing fear, and emotional discomfort preceding surgery. Different studies across the countries indicated an inconsistent prevalence of preoperative anxiety and its associated factors. Therefore, this study aimed to determine the pooled prevalence of preoperative anxiety and associated factors among surgical patients in Ethiopia.

Methods: In this study, all observational study designs conducted in Ethiopia were included while studies that did not report our main outcome of interest or did not meet the quality criteria by Joanna Briggs Institute (JBI) critical appraisal techniques were excluded. Electronic databases (PubMed, SCOPUS, Web of Science Core Collection, CAB Abstract, EMBASE, and CINHAL (EBSCO)), Google Scholar, and lists of references were used to search works of literature in Ethiopia. STATA version 17 was used for analysis, and the odds ratios of the outcome variable were determined using the random-effects model. Computing values assessed heterogeneity among the studies for I ² and P-values. Also, sensitivity analysis and funnel plot were done to assess the stability of pooled values to outliers and publication bias respectively.

Results: A total of 10 studies were included with a total of 3054 participants. The pooled prevalence of preoperative anxiety among surgical patients in Ethiopia was 60% (95% CI: 55-66, P < .001, I ² = 90.00%). The overall prevalence among non-obstetric patients was 59% (95% CI: 53-66) while among obstetric 66% (95% CI: 62-69). Fear of complication (AOR = 2.32, 95% CI: 1.23, 3.41, P = .62, I ² = 0.00%), postoperative pain (AOR = 1.92, 95% CI: 1.29, 2.56, P = .37, I ² = 0.00%), and fear of death (AOR = 2.27, 95% CI: 1.53, 3.00, P = .70, I ² = 0.00%) were significantly associated with preoperative anxiety.

Conclusion: This study revealed a high pooled prevalence of preoperative anxiety among surgical patients in Ethiopia. The findings showed that fear of complication, postoperative pain, and fear of death were significantly associated with preoperative anxiety. This implies that a multidisciplinary approach involving various healthcare professionals is essential to optimize patient care and outcomes by addressing postoperative pain through pain management, counselling on fear of death, and complications to reduce the level of preoperative anxiety.

Background: While the importance of women's participation in household decision making in enhancing access to healthcare services is widely acknowledged, limited evidence exists on the link between women's participation in household decision making and skilled birth attendants (SBA) supervised delivery. This study aims to fill this gap by examining the effects of women's participation in household decision making on SBA supervised delivery in Bangladesh.

Methods: Data of 3607 mothers who had given birth within 2 years of the survey date were extracted from the 2022 Bangladesh Demographic and Health Survey (BDHS) and analyzed. The outcome variable considered was SBA supervised delivery, and the primary explanatory variable was a composite index of women's participation in household decision making generated from their responses regarding decision-making on own healthcare, large household purchases, and visits to their family or relatives. Multi-level mixed-effects logistic regression was used to explore the effects of women's participation in household decision making on SBA supervised delivery, adjusted for potential confounders.

Results: The reported prevalence of SBA supervised delivery was 70%. Women lacking participation power and moderately empowerment in household decision-making were 15% (aOR= 0.85, 95% CI: 0.66-1.08) and 20% less likely to had SBA supervised delivery (aOR = 0.80, 95% CI: 0.64-0.99) compared to those with high participation power, respectively. This association remained consistent across all 3 empowerment domains, with lower likelihoods of SBA supervised delivery among women lacking empowerment.

Conclusion: The findings of this research affirm the positive effects of women's participation in household decision making on SBA supervised delivery in Bangladesh. Recommendations include increasing women's empowerment in household decision making and raising awareness and education about the importance of SBA supervised delivery.

Background: Quality improvement initiatives in the acute care setting often target reduction of mortality and length of stay (LOS). Unplanned care escalations are associated with increased mortality risk and prolonged LOS, but may be precipitated by different factors, including appropriate triage, bed availability, and post-admission deterioration.

Objectives: This work evaluates different transfer timeframes to quantify the impact of deterioration-associated unplanned transfers to intensive care (ICU) on mortality and LOS, informing evidence-based interventions to improve patient care.

Design: This retrospective analysis examined 519 181 adult inpatients discharged from 15 hospitals in the United States. A propensity matched cohort analysis compared mortality and overall hospital LOS for patients admitted to routine and intermediate care units who did and did not have an unplanned ICU transfer within 12, 12-48, or ⩾48 hours from admission.

Methods: Population cohorts were matched on age, sex, admitting unit type, admission type, and admission acuity. Multivariable regression analysis was used to estimate the impact of unplanned transfer on mortality and LOS. Sensitivity sub-analyses compared direct ICU admissions to unplanned ICU transfers using the same transfer timeframes and endpoints.

Results: Patients with unplanned transfers in each of three timeframes had statistically higher mortality rates and longer LOS than matched cohorts without unplanned transfer. Differences between cohorts was greatest in patients transferring ⩾48 hours post-admission for both mortality (25.1% vs 1.9%, P < .0001) and LOS (x¯ = 14.7 vs 5.3, P < .0001). Multivariate analysis showed unplanned ICU transfer significantly increased odds of mortality and prolonged LOS, with later transfers having the most profound influence (19-fold increase in mortality and 2-fold increase in LOS). Sensitivity analyses found a statistically significant increase in mortality and LOS associated with unplanned ICU transfer across all three timeframes.

Conclusion: The association of later transfers with elevated mortality and LOS underscores the importance of timely intervention on patient deterioration.

Background: Afghan refugees in Pakistan, particularly in Quetta, Balochistan, encounter formidable barriers in accessing maternal, newborn, and child health (MNCH) services. These challenges have been intensified by the COVID-19 pandemic and entrenched systemic health inequities.

Methods: This qualitative study, conducted from February to April 2023, aimed to assess the obstacles within health systems and community environments that hinder MNCH service access among Afghan refugees. The study involved 20 key informants through in-depth interviews and focus group discussions, including Afghan refugee women, community elders, health workers, and representatives from non-governmental organizations and government agencies. The research focused on experiences during the initial four waves of the COVID-19 pandemic (2020-2021), utilizing a conceptual framework integrating Health Emergency Disaster Risk Management (Health-EDRM) with primary health care.

Findings: The study identified significant systemic barriers to accessing MNCH services, such as insufficient funding, inadequate health infrastructure, and discriminatory practices within the healthcare workforce. Additionally, community-level obstacles were prominent, including cultural and language differences, geographical isolation, and economic constraints. The integration of Health-EDRM into local health systems was minimal, with many stakeholders either needing to be made aware of or unengaged with the framework.

Conclusion: The findings highlight a critical need for comprehensive policy reforms, infrastructure enhancement, and community-centered approaches to address Afghan refugees' health needs effectively. Strengthening the integration of health-EDRM into health systems is crucial for enhancing resilience and ensuring continuous care during health emergencies. The study calls for concerted efforts to implement culturally sensitive health interventions that include disaster risk management components to improve MNCH outcomes among Afghan refugees in crisis-affected settings. Addressing systemic and community-level barriers makes creating a more resilient and equitable health system for vulnerable populations possible.