Mortality trends among Indigenous peoples in Brazil remain poorly characterised. An ecological time-series study (2010–2022) was conducted, comparing Indigenous and non-Indigenous populations using nationwide open-access demographic and mortality data. Mortality was stratified by sex, age, and ICD-10 groups, populations were compared using Pearson’s chi-square test (p < 0.05), and trends were evaluated with joinpoint regression (JR) to estimate Average Annual Percentage Changes (AAPCs). Between 2010 and 2022, mortality among Indigenous peoples increased by 82.5% (from 2,927 to 5,343), compared with a 42.3% increase in the non-Indigenous population. Over 40% of deaths among Indigenous peoples occurred outside health facilities in both years, versus fewer than 30% among non-Indigenous populations. Crude mortality rates remained lower in Indigenous peoples (2010: 35.8 versus 55.9; 2022: 43.5 versus 74.8 per 10,000 population). However, age-specific differences were marked: mortality among Indigenous children and adolescents (0–19 years) was 3.3 times higher in 2010 and 3.8 times higher in 2022, while mortality among adults aged ≥40 years was approximately 2.5 times lower in both years compared with non-Indigenous populations (all p < 0.05). Mortality rates among Indigenous peoples were consistently higher for maternal, perinatal, and congenital conditions in both 2010 and 2022. JR revealed heterogeneous proportional mortality trends: significant increases in perinatal, congenital, and external causes (AAPC approximately 5.0–6.4%), as well as neoplasms, circulatory, haematological, digestive, respiratory, and endocrine/metabolic diseases (AAPC approximately 1.6–4.4%); a significant decline in infectious and parasitic diseases (AAPC −6.6%); and stability in other groups. Indigenous peoples in Brazil continued to face unfavourable mortality, particularly among children, adolescents, and maternal conditions. Many leading causes of death are preventable. Strengthening primary healthcare, expanding prenatal and perinatal services, improving vaccination and mental-health support, and adopting culturally safe, community-driven strategies to address chronic diseases are critical to reducing inequities and preventable deaths.

Loneliness and social isolation represent persisent global public health concerns, particurarly for people in later life, with extensive mental, social, and biological consequences. Both have been associated with increased risk of depression, anxiety, dementia, cardiovascular disease, premature mortality, and greater demand for health and social care services. A growing body of evidence indicates that nature-based interventions are effective in reducing loneliness, enhancing mood, and promoting overall well being, yet they still remain underutilised within health and social care strategies; particularly for older adults and those with limited mobility. One such initiative, Cycling Without Age, a grassroots programme, demonstrates the potential of nature-based interventions. Evidence across multiple contexts indicates improvements in mood, life satisfaction, and social connectedness, alongside benefits for families and care staff. Cycling Without Age illustrates a type of scalable, person-centred intervention that could be integrated into healthy ageing strategies. However, rigourous large-scale research remains scarce, which highlights the need for further evaluation to guide policy adoption and sustainable implementation. Effective responses to loneliness and social isolation require integrated support programmes that foster social connectedness and healthy ageing, delivered through coordinated efforts spanning public health, urban design, and community services.

Given the surging economic and health costs associated with childhood stunting, identifying its associated factors is crucial. This study therefore explores a key determinant of long-term nutritional status, women’s participation in household decision-making in the context of Pakistan. To empirically estimate this association, three-level modelling was employed by pooling the data from two recent nationally representative survey rounds PDHS 2012–13 and PDHS 2017–18. Multilevel analysis was better suited compared to traditional methods for robust estimates because of the hierarchical nature of the data. Women’s decision-making power was measured by formulating an index through factor analysis from the direct questions about women’s participation in household decisions. This study found a positive association between women’s decision-making power and children’s nutritional growth at the national level, with no significant changes across the survey years. However, this relationship was moderated by regional variations, which was more pronounced in Sindh and relatively modest in other regions. The sensitivity analysis showed that among the different decision-making domains, only women’s participation in large household purchases was significantly and positively associated with child linear growth. The insights of this research suggest that nutrition-oriented policies should also consider non-nutritional factors, like women’s decision-making power when designing projects for target population. Meanwhile, it is also crucial to recognize that decision-making power is a contextual factor and its effect on child nutritional growth may vary across regions.

Hypertension (HTN) is the primary cause of preventable cardiovascular-related deaths globally, representing the most important modifiable risk factor for preventing such deaths. Nearly 700 million of the 1.3 billion adults with HTN worldwide remain untreated, most of whom live in low-and middle-income countries, including East Africa. Barriers to the diagnosis of HTN also impact treatment adherence after diagnosis and the initiation of treatment. This scoping review used a qualitative synthesis method to describe studies examining the cultural and contextual factors influencing HTN treatment adherence in East Africa and the lived experiences of patients with HTN to gain a better understanding of these factors in the region. A total of 34 studies, 25 qualitative and 9 mixed-methods designs from five East African nations were included in the final review. Reported influencing factors are classified into individual, structural, and social factors. Lack of HTN literacy and limited risk perception were often cited as individual barriers to adherence, along with mental health challenges, including fear of stigma, while trust and HTN literacy enhanced adherence. Inconsistent healthcare delivery, lack of access, and financial constraints were the most reported structural factors. Social norms surrounding health behaviours and attitudes towards HTN treatment were identified as key determinants of adherence at the social level. The findings underscore the complex interplay of individual, structural, and social factors associated with HTN treatment adherence in East Africa, offering practical ways to enhance adherence in the region at all three levels.

This study presents a revised estimation of the prevalence of female genital mutilation/cutting (FGM/C) among migrant women and second-generation girls in Italy as of 1 January 2023. The study is based on an enhanced indirect estimation of the prevalence among migrants and data on first- and second-generation women legally residing in Italy as of 1 January 2023. The study estimates that approximately 88,600 women aged 15 and over have undergone FGM/C in Italy, representing 46% of migrant women from practising countries. Notably, around one-third of these women are over 50 years old, indicating that FGM/C remains a significant health concern beyond childbearing age. Among foreign-born women, 46.5% are estimated to be affected, compared to 22.5% of Italian-born women. The research also identifies approximately 16,000 girls under 15 at potential risk, with the highest numbers among those of Egyptian, Nigerian, and Senegalese descent. Methodologically, the study underscores the importance of refining indirect estimation techniques to account for the socio-demographic selectivity of migration. While the overall prevalence of FGM/C is decreasing, the persistence of the practice among specific communities calls for targeted interventions. The findings emphasise the need for culturally sensitive awareness campaigns, strengthened legal frameworks, and accessible healthcare services. Furthermore, this research contributes to the European discourse on FGM/C by providing a replicable estimation model adaptable to other non-practising countries receiving migrants from FGM/C-prevalent regions. Periodic replication of such estimates can provide valuable insights into evolving FGM/C trends, aiding policymakers in resource allocation and intervention strategies to eradicate the practice.

The objective of this study is to assess the effects of the configuration, size, and density of family and personal networks on women’s current fertility in Ouagadougou. The association between women’s reproductive histories and their social networks was evaluated using Poisson regression models and fairly original data on these networks. The study is based on three family configurations: ‘Restricted’ (children and friends), ‘Kinship’ (blood or marital relatives), and ‘Sibling’ (brothers and sisters). Results show that the type of family configuration has a significant effect on current fertility. ‘Kinship’ and ‘Sibling’ configurations are associated with higher current fertility, while the ‘Restricted’ configuration is associated with lower fertility. Regarding the size and density of the network, the findings indicate that network size and density are negatively associated with current fertility. These results highlight the need to take social networks into account in strategies aimed at controlling fertility in the city of Ouagadougou.

Family planning programmes in sub-Saharan Africa (SSA) often disseminate the proposition that birth spacing improves child survival. Yet, there are few examinations of this hypothesis that benefit from longitudinal data. This paper addresses this gap using 15 years of prospective data from three rural districts of Tanzania. The effect of birth interval durations on the risk of childhood mortality was estimated by fitting Weibull parametric hazard regression models with shared frailties to a dataset that comprised records of reproductive events and their succeeding survival trajectories of 25,762 mother-child dyads that lived in the sentinel areas of the Ifakara and Rufiji Health and Demographic Surveillance Systems from 2000 to 2015. The analysis was motivated by two hypotheses: First, that relatively short subsequent and preceding birth intervals would be associated with heightened risks of child mortality; however, that the effects of short subsequent birth intervals would be most pronounced among children between 12 and 59 months of age; and second, that the effects of short preceding birth intervals would be most acute during the neonatal and post-neonatal period. Results, which were adjusted for confounder effects at the individual, household, and contextual levels, demonstrated significant associations between subsequent and preceding birth interval durations and childhood mortality risk. Regarding subsequent birth intervals, relative to birth spacing of less than 18 months, durations 24–35 and ≥36 months were associated with 1–5-year-old mortality risks that were 0.29 and 0.21 times lower. Relative to preceding birth intervals of less than 18 months, those of 24–35 months were associated with a neonatal mortality risk that was 0.48 lower. Compared to the same referent group, preceding birth intervals of 18–23, 24–35, and ≥36 months were significantly associated with 12–23-month-old mortality risks that were 0.20, 0.39, and 0.33 times lower. The findings are compared with those from similar studies held in SSA, and the potential for family planning programmes to contribute to improved child survival in settings, such as Tanzania, is discussed.

Social isolation and loneliness have been linked to adverse health outcomes such as depression in old age. However, limited data exist on the association of loneliness and social isolation with probable depression (PD) in low- and middle-income countries (LMICs), while psychosocial mediators are largely unknown. This study investigates the individual and joint associations of social isolation and loneliness with PD among older adults in Ghana. It quantifies the extent to which psychosocial factors mediate the associations. Cross-sectional data from the Aging, Health, Well-being, and Health-seeking Behaviour Study were analyzed. PD was defined as moderate to severe depressive symptoms with the Center for Epidemiologic Studies Depression (CES-D-9) scale. Loneliness and social isolation were assessed with the University of California, Los Angeles 3-item loneliness scale and the Berkman-Syme Social Network Index, respectively. Multivariable logistic models and PROCESS macro bootstrapping mediation analyses were performed. Among the 1,201 adults aged ≥50 years (Mage = 66.1 ± 11.9 years, 63.3% women), 29.5% PD cases were found. The prevalence of social isolation and loneliness was 27.3% and 17.7%, respectively. Loneliness (OR = 3.15, 95% CI = 3.26–5.28) and social isolation (OR = 1.24, 95% CI = 1.10–1.41) were independently associated with higher odds of PD. The loneliness and PD association was modified by spatial location (Pinteraction = 0.021); thus, the association was more pronounced in rural areas (OR = 7.06) than in urban areas (OR = 3.43). Psychosocial factors (e.g. sleep problems) mediated the loneliness/social isolation and PD association. Loneliness and social isolation were independently associated with a higher likelihood of PD, and psychosocial factors mediated the associations. Interventions to reduce PD in later life should also consider addressing loneliness and social isolation, as well as sleep problems.

When traditional measures for material conditions are scarce or unreliable, body mass, height, and weight are complements to standard income and wealth measures. A persistent question in welfare studies is the 19th century’s 2nd and 3rd quarter’s stature diminution, a pattern known as the antebellum paradox. However, the question may not be well stated nor experienced equally by women and non-white male samples. The late 19th century’s political Granger, Greenback, and Populist movements may have affected farmer and non-farmer’s net nutrition. Despite 19th and early 20th century US political movements, farmers had greater BMIs, taller statures, and heavier weights than non-farmers. From the 1870s through 1890s, women’s body mass, height, and weight increased relative to men. Individuals of African or mixed European-African descent had heavier weights and greater BMIs than their taller, European-white counterparts, indicating that the traditional antebellum paradox needs to include women and non-European males and weight measures.

The deliberations for the Pandemic Accord have opened an important moment of reflection on future approaches to pandemic preparedness. The concept had been increasingly prominent in global health discourse for several years before the pandemic and had concretised into a set of standardised mainstream approaches to the prediction of threats. Since 2019, the authors and the wider research team have led a research project on the meanings and practices of preparedness. At its close, the authors undertook 25 interviews to capture reflections of regional and global health actors’ ideas about preparedness, and how and to what extent these were influenced by Covid-19. Here, an analysis of interview responses is presented, with attention to (dis)connections between the views of those occupying positions in regional and global institutions. The interviews revealed that preparedness means different things to different people and institutions. Analysis revealed several domains of preparedness with distinct conceptualisations of what preparedness is, its purposes, and scope. Overall, there appear to be some changes in thinking due to Covid-19, but also strong continuities, especially with respect to a technical focus and an underplaying of the inequities that became evident (in terms of biosocial vulnerabilities but also global-regional disparities) and, related to this, the importance of power and politics. Here, the analysis has revealed three elements, cutting across the domains but particularly strong within the dominant framing of preparedness, which act to sideline direct engagement with power and politics in the meanings and practices of preparedness. These are an emphasis on urgent action, a focus on universal or standardised approaches, and a resort to technical interventions as solutions. A rethinking of pandemic preparedness needs to enable better interconnections across scales and attention to financing that enables more equitable partnerships between states and regions. Such transformation in established hierarchies will require explicit attention to power dynamics and the political nature of preparedness.

Gestational diabetes mellitus (GDM) is a common medical condition during pregnancy and is linked to short- and long-term complications for both mothers and offspring. However, there is limited information regarding poor glycaemic control in Malaysia. This study aims to determine the predictors of poor glycaemic control among women with GDM and to explore women’s perceptions and experiences in self-managing glycaemic control. An explanatory sequential mixed methods study was conducted among women with GDM in Northern Terengganu. A proportional-to-size stratified sampling method was used in quantitative research to obtain 238 samples. Logistic regression was applied to determine associations between factors and poor glycaemic control. Then, purposive sampling was done in qualitative inquiry to obtain 12 samples. Thematic analysis was applied to identify recurring themes. The data from both quantitative and qualitative inquiry were then combined to answer research questions. Dietetic counselling (AOR = 2.95; 95% CI: 1.41, 6.17; p-value=0.004) and diet self-efficacy (AOR = 0.78; 95% CI: 0.61, 0.98; p-value=0.040) were associated with poor glycaemic control. Six themes that emerged from the interviews were: fear and worry; knowledge and motivation; dietary preferences and beliefs; family factors; occupational factors; and availability and affordability. The findings provide useful evidence for healthcare providers in delivering comprehensive health education and providing care for women with GDM.

Spousal age differences are highest in Sub-Saharan Africa, where trends in age at first marriage indicate an increase for both men and women. However, the net outcome for spousal age difference is difficult to predict without explicit analysis of these distributions. This study examines differentials in spousal age for women in first union. Further, it examines differences within population sub-groups and across countries, focusing on the influence of age at marriage and educational attainment. The analysis pools 144 survey datasets from the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 1980 and 2020 in 34 countries. OLS regression analysis was used to predict the spousal age difference at marriage with five-year cohorts used to study time trends. The analysis finds a decline of 1.7 years in the spousal age difference at first marriage between the earliest (1980–1984) and most recent (2014–2019), indicating that there has been minimal reduction in age at first marriage over four decades, despite rising ages at marriage for females. Increasing age at first marriage and educational attainment of women partly explain the decline observed over time.

Premised on the Developmental Origins of Health and Disease theory and on the limited effectiveness of antenatal interventions, interventions in the preconception period are being conducted to potentially improve intergenerational health and non-communicable disease burdens. The Healthy Life Trajectories Initiative (HeLTI) is an international health research consortium primarily investigating the intergenerational effects of behavioural interventions on obesity via a complex four-phase intervention initiated preconceptionally, through pregnancy, and into early childhood. HeLTI, in partnership with the World Health Organization, aims to generate evidence that will shape health policy focused on preconception as part of a life course approach to population health. It is necessary to ensure that a renewed public health focus on preconception prioritises justice and equity in its framing. This article presents collaborative interdisciplinary work with HeLTI-South Africa. It applies a feminist bioethics methodology, which is empirical, situated, intersectional, and fundamentally concerned with justice, to investigate what South African HeLTI community health workers, or ‘Health Helpers’, who deliver the complex behavioural intervention, think about preconception health and responsibility. Seven semi-structured interviews were conducted with HeLTI-SA Health Helpers, and data were analysed using reflexive thematic analysis. Our findings show that Health Helpers’ perceptions of preconception health and related responsibility were significantly gendered, heteronormative, and concerned with child-bearing intentionality and desires. These themes were inflected with Health Helpers’ perceptions about how attributions of responsibility are shaped by culture, demonstrating the situated nature of epistemologies. Their ideas also highlight how preconception health knowledge can distribute responsibility unjustly. Understanding the contextual impact and relevance of values around responsibility is critical to prospectively design preconception health interventions that promote equity and fairness. This understanding can then be used for effective policy translation, with the goal that public health policy is founded upon contextual responsivity and justice for the public it aims to serve.

Low birth weight (LBW) and preterm birth (PTB) are primary factors contributing to morbidity and mortality among children aged under 5, resulting in a range of short- and long-term health consequences worldwide. Among the various risk factors, ambient air pollution poses a significant environmental risk and is a key determinant of child health. The prevalence of LBW and PTB among under 5 children sampled from the NFHS-5, 2019–2021, was combined with monthly PM2.5 data (2013–2021) obtained from the Atmospheric Composition Analysis Group at Washington University. Multivariable logistic regression models were used, and a stratified analysis was applied to understand the potential effect modifiers in LBW and PTB. Further, the geographical variation of LBW and PTB spatial autocorrelation (Moran’s I) was used. Geographically weighted regression and ordinary least square spatial regression were used to identify the spatial heterogeneity associated with selected variables. The study comprises a total of 208,181 under 5 children. Out of these children, the LBW rate was 17.41%, and the rate of PTB was 12.42%. The in-utero exposure to the mean concentration of PM2.5 was 56.01 μg/m3. The odds of suffering from LBW showed a non-linear shift when PM2.5 levels rose from the first octile (<28.02 μg/m3) to the last octile (>93.84 μg/m3) (adjusted odds ratio (AOR): 1.06, 95% CI: 1.01–1.12). While comparing the first octile of exposure to PM2.5 (>93.84 μg/m3) to the last octile, there was a 52% more likelihood of having PTB (AOR: 1.52, 95% CI: 1.43–1.61) after accounting for all relevant factors. These findings highlight the urgent need for a thorough strategy to control the air quality in India. Further, to reduce adverse birth outcomes, longitudinal studies and other co-pollutants can consider assessing the possible mechanisms mediating the relationship between maternal exposure and ambient air pollution.

For the first time, a question relating to certain long-term health conditions was asked in the 2021 Australian population census. The conditions included arthritis, asthma, cancer (including remission), dementia (including Alzheimer’s), diabetes (excluding gestational diabetes), heart disease (including heart attack or angina), kidney disease, lung condition (including COPD or emphysema), mental health condition (including depression or anxiety), and stroke. Respondents could indicate either none or any number of these conditions. In this paper, the data on these conditions have been analysed to compare the self-reported prevalence of diseases among the 23.4 million Australians who responded to this question (median age 39 years), of whom 3.2% were Aboriginal and Torres Strait Islander peoples (median age 24 years). Standardised Morbidity Ratios for each disease were calculated for the Aboriginal and Torres Strait Islander peoples by using the relevant age-disease specific morbidity rates for the total population as the ‘standard’. Findings of this research revealed that the prevalence of diseases was much higher among the Aboriginal and Torres Strait Islander peoples compared to the total population. The only exception was cancer, where the rates for the two groups were not much different. Gaps in prevalence of diseases in the two groups generally increased with age. The higher rates among the Aboriginal and Torres Strait Islander peoples emphasise the need for continued action on health equity and the development of more nuanced and focused initiatives to reduce the gaps between the Aboriginal and Torres Strait Islander peoples vis-à-vis the total population of Australia. Findings in this paper were consistent with similar studies (albeit largely surveys) on health of the Indigenous peoples in Canada and the Maoris in New Zealand.

Biosocial birth cohort studies are uniquely positioned to be novel sites of interdisciplinary research. Their enduring commitment to specific field sites and populations, recurring grant renewal cycles, ability to ask prospective questions while drawing on long-standing data repositories, and more ensure ongoing collaboration and allow research to remain responsive to the evolving needs and timelines of multiple disciplines. However, it is widely recognised that interdisciplinary work is often easier imagined than achieved, and additional conditions are required to facilitate it beyond assembling teams of varied experts. This piece offers mediating practices as a concept that refers to the practical, multi-directional, and relational processes that attempt to resolve tensions that interdisciplinary teams often confront. Mediating practices bridge gaps among different disciplines’ data and methods, often relying on pragmatic strategies, like re-designing data infrastructures or planning action items after a meeting, to do so. As such, mediating practices are crucial to conducting successful interdisciplinary research. Further, the concept of mediating practices foregrounds the actions of junior team members who often perform these practices, highlighting the need to foster epistemic humility and models of horizontal knowledge production in interdisciplinary teams. Here, the authors discuss their experiences and insights as members of interdisciplinary projects and outline how mediating practices emerged in these projects and enabled interdisciplinary success.

Hypertensive disorders of pregnancy (HDP) and postpartum depression (PPD) are significant global health challenges affecting maternal and child well-being. HDP, including pre-eclampsia, gestational hypertension, and chronic hypertension, complicate up to 10% of pregnancies worldwide, with profound implications for maternal mortality, particularly in low- to middle-income countries (LMICs) like Ghana. The incidence of HDP is rising globally, contributing substantially to maternal deaths and severe perinatal outcomes such as stillbirth and low birth weight. Concurrently, perinatal mental health issues, including PPD, affect a significant proportion of women globally, with higher prevalence rates observed in LMICs. Despite the known physiological impacts of HDP, their association with maternal mental health remains underexplored, especially in LMIC contexts. A systematic review and meta-analysis were conducted to explore the association between HDP and PPD in LMICs, focusing on available literature and studies from diverse global settings. Additionally, semi-structured qualitative interviews were conducted with healthcare professionals in Ghana to gather insights into local perspectives and experiences regarding this association. The systematic review revealed a consistent association between HDP and increased risk of PPD across various LMIC settings. Meta-analysis findings indicated a significant pooled odds ratio, highlighting a robust statistical linkage between HDP severity and subsequent PPD risk. Qualitative data underscored healthcare professionals’ observations of heightened psychological distress among women with HDP, emphasizing the complex interplay between physiological complications and maternal mental health outcomes in the Ghanaian context. The study findings underscore the critical need for integrated maternal health strategies that address both physical and psychological aspects of pregnancy complications like HDP. By elucidating these connections, the study contributes to advancing evidence-based interventions and support systems tailored to LMIC settings, aiming to mitigate adverse maternal mental health outcomes and improve overall perinatal care in Ghana and similar contexts worldwide. These insights are pivotal for informing policy decisions, guiding healthcare practices, and fostering targeted interventions that enhance maternal well-being during the vulnerable perinatal period.

The promotion of menstrual health and hygiene globally, especially in lower-middle-income countries (LMICs), is a major public health imperative. The primary study objective was to ascertain the change in the patterns of menstrual hygiene practices and their sociodemographic determinants amongst adolescent girls and young women in India. The present study analyses data from the Indian National Family and Health Survey (NFHS), round 4 (2015–2016) and round 5 (2019–21). Women in the age group 15–24 years (n = 241,180) were interviewed regarding their menstrual hygiene practices. The proportion of women using sanitary napkins as absorbent during menstruation increased from 41.8% (NFHS-4) to 64.1% (NFHS-5), with more than six in ten adolescent girls and young women in India using sanitary pads during menses, although the socioeconomically vulnerable more likely to lack access. The higher age group (20–24 years), rural residence, lower wealth quintile, absence of schooling, absence of flush toilets, and lack of exposure to media were factors that were independently associated with the use of cloth as menstrual absorbent. Vaginal discharge was reportedly higher among women using unhygienic products, however, on adjusted analyses, no statistically significant association was observed with the type of absorbent used. The transition from cloth to sanitary pads has nearly doubled on average in the states implementing free and subsidised government pad distribution schemes during the same period.