Artificial intelligence (AI) is increasingly being integrated into healthcare systems and has the potential to improve health outcomes. In Sub-Saharan Africa (SSA), however, concerns remain that AI may either reduce or exacerbate existing health inequities depending on how it is developed, governed, and implemented. This scoping review aimed to map and synthesise the existing evidence on the implications of AI for health equity among marginalised populations in Sub-Saharan Africa. PubMed, Web of Science, Scopus, and selected grey literature sources were searched between February and March 2026. Peer-reviewed and grey literature examining AI applications, governance, or implementation in healthcare involving marginalised populations or health systems within SSA were eligible for inclusion. The review followed the Arksey and O'Malley methodological framework and the PRISMA-ScR reporting guideline. Two reviewers independently screened sources of evidence and extracted data using a standardised charting form, and findings were synthesised thematically. Twenty-three sources of evidence met the inclusion criteria. Two dominant narratives emerged. AI may reinforce existing inequities through digital infrastructure gaps, algorithmic bias, under-representation of African datasets, weak governance, and data colonialism. Conversely, AI has the potential to improve health equity by expanding healthcare access, strengthening disease surveillance, supporting health system planning, and improving access to specialised services. Across the literature, AI's impact consistently depended on equitable infrastructure, inclusive governance, and context-specific implementation. AI has considerable potential to advance health equity in SSA. However, achieving equitable benefits requires investment in digital infrastructure, representative data systems, ethical governance, and inclusive policies. This paper situates AI within the context of health equity in Sub-Saharan Africa.Main findings: Artificial intelligence in African health systems presents both opportunities to expand healthcare access and risks of reinforcing existing inequalities driven by infrastructure gaps, data bias, and governance challenges.Added knowledge: This review provides a focused synthesis of how artificial intelligence specifically affects marginalised populations in Sub-Saharan Africa, highlighting the structural conditions that shape equitable or inequitable outcomes.Global health impact for policy and action: The findings emphasise the need for deliberate policy action on inclusive data systems, digital infrastructure investment, and contextually grounded governance to ensure artificial intelligence advances health equity rather than deepening disparities.
Chronic kidney disease (CKD) is a growing global health issue that significantly impairs quality of life (QoL), particularly among patients undergoing dialysis. This study examines the relationships between e-health literacy, self-efficacy, and QoL in this vulnerable population. To examine associations among e-health literacy, self-efficacy, and health-related quality of life (HRQoL) among patients receiving hemodialysis in Northern Jordan. A cross-sectional study was conducted among 184 adult HD patients recruited from four hospitals in Northern Jordan. Data were collected using validated Arabic versions of the eHealth Literacy Scale (eHEALS), the Self-Efficacy for Managing Chronic Disease Scale (SEMCD-6), and the Kidney Disease Quality of Life-36 (KDQOL-36). Spearman correlation was used to examine associations between variables. Multiple linear regression was performed to identify independent predictors of KDQOL-36 total scores. Among 184 participants (mean age 49.9 years, 65% male), the mean self-efficacy score was 25.52 (SD = 1.8) and the mean e-health literacy score was 3.62 (SD = 0.58). The mean KDQOL‑36 total score was 105 ± 17, with domain scores of 39 ± 7 for Symptoms/Problems, 25 ± 6 for Effects of Kidney Disease, 11 ± 3 for Burden of Kidney Disease, 29 ± 5 for Social Function, 12 ± 3 for the Physical Component Summary, and 21 ± 4 for the Mental Component Summary. Multivariable regression identified independent predictors of higher quality of life: graduate-level education (B = 8.06, 95% CI: 2.32-13.80, p = 0.006) and employment (B = 7.14, 95% CI: 2.10-12.20, p = 0.006). Diabetes was independently associated with lower quality of life (B = -5.92, 95% CI: -10.90 to -0.95, p = 0.020). Although significant in unadjusted analyses, e-health literacy and self-efficacy were not independent predictors after adjustment for socioeconomic and clinical factors. Health-related quality of life among HD patients appears to be influenced primarily by socioeconomic and clinical factors, particularly educational attainment, employment status, and diabetes mellitus. Although e-health literacy and self-efficacy were associated with HRQoL in unadjusted analyses, these associations were attenuated after adjusting for socioeconomic and clinical characteristics. Interventions that address educational disparities, support patient engagement, and optimize comorbidity management may improve health outcomes among patients receiving hemodialysis.
Drawing on data from the Global Burden of Disease (GBD) 2021 study, this research provides the first systematic assessment of the burden and trends of chronic kidney disease (CKD) among the global population aged 75 years and over between 1990 and 2021. Unlike previous studies covering the entire age spectrum, this study focuses on the age group with the highest concentration of disease burden and the greatest health vulnerability, with the aim of revealing the unique epidemiological patterns specific to this population. The study methodology involved extracting data on the prevalence, incidence, mortality and disability-adjusted life years (DALYs) for chronic kidney disease (CKD) among people aged 75 years and over in 204 countries and territories from the GBD 2021 database. All reported rates are age-standardized. We calculated estimated annual percentage changes (EAPCs) to analyze trends and examined the association between the disease burden and the Sociodemographic Index (SDI). The study found that in 2021, approximately 127 million people aged 75 years and over worldwide were living with CKD. Between 1990 and 2021, the age-standardized prevalence declined slightly (EAPC = -0.06%; 95% UI: -0.09% - -0.03%), whilst incidence, mortality and DALY rates all rose significantly (EAPCs of 0.50%; 95% UI: 0.47%-0.53%, 1.55%; 95% UI: 1.48%-1.61% and 1.07%; 95% UI: 1.02%-1.12%, respectively), demonstrating the key phenomenon of 'prevalence-mortality trend divergence'. The relationship between the burden of disease and socio-economic development is complex: regions with low SDI bear the heaviest burden of mortality, whilst regions with high SDI have experienced the fastest growth in mortality rates. The study also revealed significant heterogeneity in the burden across age, gender and geographical regions. The burden of chronic kidney disease (CKD) among the global older adult population is rapidly shifting from a pattern of 'high prevalence' to one characterised by 'high incidence, high mortality and high disability', with the underlying drivers exhibiting fundamental differences across regions at various stages of development. This necessitates that public health strategies move beyond a 'one-size-fits-all' approach and instead develop highly age-specific and contextually tailored interventions. This study provides a detailed map for understanding the epidemiology of CKD in the context of extreme population ageing, and offers crucial evidence for the allocation of resources and the formulation of policies.
Worldwide, around 1.9 million babies are stillborn, and 2.5 million newborns die soon after birth annually, the overwhelming majority occur in low- and middle-income countries (LMICs). Perinatal death has devastating impacts for families and communities, but not all parents receive adequate respectful bereavement support. Healthcare workers in LMICs often report that bereavement support is challenging, but few studies have explored factors that impact their confidence to deliver optimal care. To explore healthcare worker's views and experiences of factors impacting their confidence to provide bereavement support to parents after stillbirth or neonatal death in Malawi and Zimbabwe. Using qualitative approaches, a purposive sample of healthcare workers in four maternity facilities in Malawi and Zimbabwe was recruited. Guided by the principles of information power, six dual-moderated focus groups supplemented with eight individual in-depth interviews were conducted. The focus group discussions and interviews were audio-recorded and transcribed verbatim. Data were analyzed using the framework method. Sixty-six healthcare workers, including midwives, nurses, service managers, nurse educators, and doctors, participated. Two main themes were identified: (1) 'at least we tried our best' reflecting individual factors including feelings of inadequacy and insufficient education, and (2) 'as a facility we are not quite there yet' characterized by a lack of organizational support, feeling unsupported and a lack of continuing professional development. Findings highlight the need to address the individual and environmental barriers to providing support to bereaved women and families. Improving access to pre- and in-service education and training, mentorship and management support are potential solutions. Main Findings: Healthcare workers in LMICs lack confidence to provide support to women and families following stillbirths or neonatal deaths.Added knowledge: Sub-optimal working environments with lack of explicit clinical guidance, unavailability of education and lack of management priority and support are an important influence on lack of confidence.Global health impact for policy and action: Interventions targeting the enhancement of healthcare worker education and skills through context-specific guidelines and training provide a basis for increasing healthcare worker confidence.
To reduce perinatal deaths, identification of their causes is paramount. 'The WHO application of ICD-10 to deaths during the perinatal period' (ICD-PM) was developed to improve the quality of perinatal death data. To determine stillbirth and very early neonatal death rates across 16 hospitals in Benin, Malawi, Tanzania, and Uganda, examine causes of death and associated maternal conditions applying the ICD-PM, and assess how a clinical perinatal e-registry performed when applying the ICD-PM. We used cross-sectional data collected between 1st July 2021 and 29th February 2024 of babies weighing ≥1000 g or ≥28 weeks of gestational age, born to women aged 13-50 years in the participating hospitals. After analyzing 143,105 births, the stillbirth rate was 36.9 per 1,000 births and very early neonatal death rate was 7.7 per 1,000 live births. Nine in ten antepartum stillbirths could not be assigned a cause of death. Among intrapartum stillbirths, the most common cause of death was 'disorders of fetal growth' and for very early neonatal death it was 'complications of intrapartum events'. The e-registry provided information to report on 17 out of the 24 ICD-PM categories. Collecting high-quality clinical data through an e-registry allowed the identification of a cause of death for most intrapartum stillbirths and very early neonatal deaths. A specifically designed clinical questionnaire and simple diagnostic procedures could enable the application of the ICD-PM in settings with limited diagnostic resources and high mortality rates. Main findings: After applying the International Classification of Diseases to Perinatal Mortality classification system to a clinical dataset, a cause of death or an associated maternal condition was established for the majority of perinatal deaths, while most intrapartum stillbirths were a consequence of disorders of fetal growth, complications of intrapartum events were the main cause of very early neonatal deaths.Added knowledge: This study reveals that collecting basic clinical information through a structured questionnaire in high-burden and resource-limited settings can support the application of the International Classification of Diseases to Perinatal Mortality.Global health impact for policy and action: This study highlights that despite revisions and updates are needed, the International Classification of Diseases to Perinatal Mortality is still a valuable instrument that could help better understand the pathways to perinatal death, thus contributing to the development of targeted prevention strategies.
In super-aged societies such as Japan, achieving "healthy longevity with well-being" requires not only medical and long-term care services but also a seamless continuum that integrates health promotion, frailty prevention, and community-based support, along with age-friendly physical and social environments that support functional ability, social participation, and independent living. Within this framework, oral frailty (OF)-defined as the accumulation of slight declines in oral function, including tooth loss, chewing and swallowing difficulties, oral dryness, and low articulatory oral motor skills-has emerged as a key indicator linking oral health to systemic frailty, disability, and mortality. Originating in Japan, the concept of OF emphasizes early detection and reversibility through multidisciplinary collaboration. The 2024 Consensus Statement issued by three academic societies (the Japan Geriatrics Society, the Japanese Society of Gerodontology, and the Japanese Association on Sarcopenia and Frailty) proposed a definition, conceptual model, and assessment using the Oral Frailty 5-item Checklist (OF-5). This review summarizes the development of OF initiatives within Japan's Community-Based Integrated Care System and discusses recent international trends, including the WHO Global Oral Health Action Plan (2023-2030), the FDI policy statement "Oral Health for Healthy Ageing," and emerging global research evidence. Practical examples, such as a community-wide campaign in Hiratsuka City, illustrate multisectoral collaboration to prevent and raise awareness of OF. Finally, we highlight future directions, including integration of oral health into community development, strengthening interprofessional collaboration, and leveraging digital technologies for monitoring and education. By integrating clinical, community, and policy perspectives, the Japanese concept of OF offers a promising, implementable model for global healthy aging.
Like many others, Malawi's healthcare system faces significant health workforce shortages largely due to budget constraints that limit training, recruitment and retention of staff. A crucial question is how to best allocate a limited incremental budget to expand different healthcare workers (HCW) cadres so that the potential health gains are maximised, which is more important now than ever considering recent withdrawal and reduction in donor funding. This research aims to provide a practical answer to this question. We designed a range of budget allocation scenarios for HCW expansion across cadres and used the 'all diseases-whole healthcare system' Thanzi La Onse (TLO) model to estimate the resulting population health outcomes. We find that, indeed, how to allocate the incremental budget among cadres is an important determinant of the potential health impact. Concentrating all of the budget on expanding a single cadre-such as clinical, pharmacy or nursing and midwifery-is not the most effective use of the resources, even when that cadre currently faces the greatest staffing shortages. Similarly, allocating the budget in a manner that mirrors the current distribution of spending and results in a uniform expansion across cadres does not generate the greatest possible gains. Instead, an allocation that uplifts staffing for multiple cadres, accounting for the additional time and costs required to meet the future healthcare needs, yields the greatest benefits. We conclude that, in the context of complex interplay between demography, epidemiology, treatment scope and effectiveness and health resource constraints, human resources for health (HRH) bottlenecks in achieving health gains are multifactorial and a needs-based balanced mix of cadres and skills is required for future HRH expansion. As such, health system models such as the TLO that capture this interplay can make potential contributions to strengthening HRH planning.
Somalia has one of the highest maternal mortality ratios and low coverage of maternal health services. Evidence on socioeconomic and geographic inequalities across maternal care continuum remains limited. This study examined wealth-related inequalities and determinants of maternal health service utilisation in Somalia. We analysed data from the 2020 Somali Health and Demographic Survey (SHDS), including 8,598 ever-married women aged 15-49 years with a recent live birth. Outcomes were at least one antenatal care visit (ANC), health facility childbirth, and postnatal care (PNC) within 2 days of birth. Multilevel mixed-effects logistic regression examined associations with socioeconomic, geographic, and empowerment-related factors, while Erreygers Concentration Indices (ECIs) assessed wealth-related inequalities. Results are presented as adjusted odds ratios (aORs), ECIs, and 95% confidence intervals (CIs). Coverage was low: 32.4% attended at least one ANC visit, 24.2% delivered in a health facility, and 10.9% received PNC. Nomadic women were less likely to deliver in a health facility (aOR = 0.45; 95% CI: 0.35, 0.58) and receive early PNC (aOR = 0.49; 95% CI: 0.32, 0.75). Rural residence, the Northeastern and Southcentral zones, and higher parity were associated with lower service utilisation, whereas higher education, mobile phone ownership, household wealth, and media exposure increased utilisation. Pro-rich inequalities were observed for ANC (ECI: 0.40), health facility childbirth (ECI: 0.38), and early PNC (ECI: 0.19). Maternal health service utilisation remains critically low with socioeconomic and geographic inequalities. Equity-focused strategies targeting rural, remote, and nomadic populations are needed to accelerate universal health coverage. Main findings: Coverage of antenatal care, facility childbirth, and early postnatal care in Somalia remains critically low, with substantial inequalities by wealth, geography, and community type.Added knowledge: Using nationally representative survey data, this study shows that women from nomadic, and poorer remote communities are consistently less likely to access essential maternal health services across the maternal care continuum.Global health impact for policy and action: Reducing maternal health inequalities in fragile settings will require targeted outreach, financial protection, stronger primary health care, and sustained investment in women’s education and empowerment.
Hypertension is a leading global cause of morbidity and mortality, especially in low- and middle-income countries, where low healthcare access limits diagnosis and treatment. Community health workers (CHWs) supported by mobile health (mHealth) clinical decision support (CDS) tools may help. This study evaluated the feasibility of CHW-led hypertension management using an mHealth CDS application in rural Guatemala. We conducted a single-group feasibility study in San Lucas Tolimán, Guatemala. Trained CHWs assisted by a CommCare-based CDS application provided direct patient care. Application algorithms were based on World Health Organization guidelines and assisted with medication titration, lifestyle counselling, and physician consultation. Adults (≥18 years) with diagnosed hypertension were followed monthly for six months. The primary feasibility outcome was prescribing agreement between CHWs and supervising physicians with application of antihypertensive recommendations (minimum acceptable agreement was 90%). Primary clinical outcomes were changes in systolic (SBP) and diastolic (DBP) blood pressure. Secondary outcomes included retention, patient satisfaction, and safety. In total 32 participants were enrolled and 30 (93.8%) completed six-month follow-up, with 96.4% of possible visits completed. CHW-physician agreement with application recommendations was 98.9%. The median decrease in SBP was 7.5 mm Hg (95% confidence interval (CI) = 1.0, 12.0), and the mean decrease in DBP was 3.1 mm Hg (95% CI = 0.1, 6.1). The proportion of patients with controlled SBP (<140 mm Hg) increased from 66.7% to 76.7% (P = 0.505). A total of 11 application errors (5.0% of 217 visits) occurred, none of which resulted in adverse events. Only three patients experienced significant adverse events, none of which required hospitalisation. Patient satisfaction remained high. In this pilot, CHWs supported by an mHealth CDS application safely managed hypertension with high physician agreement, patient retention, and blood pressure improvement. These findings demonstrate the feasibility of CHW task-sharing hypertension management in low-resource settings and support evaluation of this approach in larger trials. ClinicalTrials.gov: NCT05479097.
Sudden death (SD) poses great health and social challenges worldwide. There are a few studies investigating the epidemiological characteristics and disease burden of SD globally. The study aimed to assess the epidemiological characteristics and global burden of SD in different population and regional groups, and to determine the incidence of SD and its influencing factors. We conducted a systematic review and spatiotemporal analysis to estimate global, regional, and national SD incidence. A comprehensive search was conducted across four databases, including PubMed, Embase, the Cochrane Library and Web of Science, between 1 July 2003 and 30 June 2023. The included studies reported the incidence of SD in the general population of a country or region, or provided data on which the incidence could be calculated. We utilised a Bayesian hierarchical linear mixed model to estimate global, regional, and national SD incidence and to describe the characteristics. Our search identified 9797 records, with 108 studies meeting our inclusion criteria. The incidence of SD was significantly different among super-regions. South Asia was estimated to have the highest incidence for 4.01 cases (95% confidence interval (CI) = 1.40, 7.51) per 100 000 person-years on a log-transformed basis, followed by South East Asia, East Asia, and Oceania. Among them, Guyana showed the highest estimated incidence of 5.06 cases (95% CI = 2.78, 8.20) per 100 000 person-years, followed by India of 4.89 cases (95% CI = 2.08, 7.76) per 100 000. Sub-Saharan Africa had the lowest estimated incidence, at 1.79 cases (95% CI = -1.83, 3.98) per 100 000 person-years. The temporal trends in SD incidence rates exhibited remarkable heterogeneity across regions. The downward trend was most pronounced in high-income countries, while Sub-Saharan Africa maintained a stable high incidence rate. Conversely, Latin America and the Caribbean exhibited continuous growth, with the Andean sub-region showing the most striking trend. Risk factors associated with SD include diabetes, hypertension, hyperlipidaemia, and heart disease. This study provides a comprehensive assessment of the global incidence of SD. The findings emphasise the need for targeted strategies to effectively reduce the burden of SD. PROSPERO: CRD42023432992.
Objective To systematically assess the global,regional,and national burdens of rheumatic heart disease (RHD) from 1990 to 2021 and to examine their associations with the sociodemographic index (SDI). Methods Data were obtained from the Global Burden of Disease Study 2021 (GBD 2021).We analyzed RHD-related deaths,prevalent cases,age-standardized death rates (ASDRs),and age-standardized prevalence rates (ASPRs),stratified by age,sex,region,and SDI.Estimated annual percentage changes (EAPCs) were calculated to evaluate temporal trends.Spearman correlation analysis was performed to explore the associations between EAPCs and baseline burden in 1990,as well as SDI in 2021.An autoregressive integrated moving average (ARIMA) model was employed to project the future trend of RHD through 2030. Results In 2021,the global ASDR and ASPR of RHD were estimated at 4.47 (95%UI:3.89-5.31) and 488.19 (95%UI:442.57-539.76) per 100 000 population,respectively.Females exhibited higher ASDR and ASPR than males,and the burden was more pronounced among older age groups.From 1990 to 2021,global deaths due to RHD declined by 10.8%,and ASDR decreased by 56.2%,with an EAPC of -2.71% (95%CI=-2.75--2.67).The ARIMA model projected a continued decline in both the number of deaths and ASDR through 2030.In contrast,the number of prevalent cases and ASPR increased by 69.4% and 12.6%,respectively.The highest absolute numbers of deaths and prevalent cases were observed in populous countries,notably India and China.From 1990 to 2021,ASDR and ASPR declined in most countries,while the disease burden in some countries in Africa,the Middle East,and South Asia experienced increasing trends.Both ASDR and ASPR were negatively correlated with SDI (r=-0.511 and -0.762,respectively,both P<0.001).The EAPCs of ASDR and ASPR were associated with both baseline burden in 1990 and SDI in 2021.Countries with higher SDI experienced more substantial declines in RHD burden.However,the declines were limited in areas with high baseline prevalence,and some regions even showed upward trends. Conclusions Between 1990 and 2021,although the global mortality of RHD steadily declined,the prevalence slightly increased,with females and older adults bearing a disproportionate burden.Significant regional disparities in disease burden were observed.More pronounced declines occurred in countries with a high SDI,whereas some low-SDI and high-baseline-burden regions showed little or no decline,which suggested the need for sustained and targeted comprehensive prevention and control strategies in key areas. 目的 系统评估1990—2021年风湿性心脏病(RHD)在全球、地区和国家层面的疾病负担,分析其与社会人口学指数(SDI)之间的关系。方法 研究数据来源于全球疾病负担研究2021(GBD 2021)。分析了RHD相关的死亡人数、患病人数、年龄标准化死亡率(ASDR)和年龄标准化患病率(ASPR),按年龄、性别、地区和SDI进行分层。采用估计年变化百分比(EAPC)评估其时间趋势,并通过斯皮尔曼等级相关性分析探讨EAPC与1990年基线负担及2021年SDI的关系。采用自回归积分滑动平均模型(ARIMA)预测2030年RHD的未来趋势。结果 2021年,全球RHD的年龄标化患病率和死亡率分别估计为488.19/10万(95% UI=442.57/10万~539.76/10万)和4.47/10万(95% UI=3.89/10万~5.31/10万)。其中,女性的年龄标化患病率、死亡率均高于男性,老年人群负担更重。1990—2021年,全球RHD的死亡人数下降约10.8%,ASDR下降约56.2%,对应EAPC为-2.71%(95% CI=-2.75~-2.67),预测至2030年,全球RHD死亡人数和ASDR将进一步下降,而患病人数和患病率分别上升约69.4%和12.6%。死亡和患病人数主要集中在印度、中国等高人口国家。1990—2021年,大多数国家ASDR和ASPR呈下降趋势,但部分非洲、中东和南亚国家负担仍持续上升。ASDR和ASPR与SDI均呈显著负相关(r=-0.511,r=-0.762,P均<0.001)。1990—2021年,ASDR和ASPR的EAPC受基线负担和SDI影响,SDI高的国家其疾病负担下降更为显著,而高基线患病区负担下降幅度有限,部分地区甚至呈上升趋势。结论 1990—2021年,尽管全球RHD的死亡率持续下降,但其患病率仍略微增高,女性和老年人群负担尤重。疾病负担的地区差异显著,高SDI国家下降更为显著,而部分低SDI和高基线负担地区负担未见改善,提示未来需针对重点区域持续加强综合防控策略。.
 The nasal mucosa is the primary defense mechanism of the upper respiratory tract. Its functionality relies heavily on the intricate balance of mucociliary clearance (MCC), mucosal hydration, epithelial tight junction integrity, and local immunological responses. While the detrimental physiological effects of low humidity and cold temperatures on nasal function are extensively documented in the literature, the physiological and pathological impacts of chronic exposure to high relative humidity (RH) and high temperatures-the defining characteristics of tropical and equatorial climates-remain significantly underrepresented and poorly synthesised. Given that approximately 40% of the global population lives in these climate zones, understanding these mechanisms is of paramount importance to global health. This evidence gap is particularly critical for sub-Saharan Africa, where sinonasal disorders constitute a significant and underappreciated component of the otolaryngological disease burden, yet region-specific clinical guidelines remain largely absent. Compounding this, rapid urbanisation across African and Asian tropical cities is accelerating the adoption of air-conditioning, creating novel patterns of indoor-outdoor micro-climatic exposure that may be fundamentally altering the epidemiology of chronic rhinitis. This systematic review aims to comprehensively evaluate the correlation between high ambient humidity in tropical climates and nasal mucosal function. The primary endpoints include mucociliary clearance times, ciliary beat frequency (CBF), mucus rheology (viscoelasticity), epithelial barrier integrity, and the epidemiological prevalence of specific sinonasal disorders such as tropical allergic rhinitis and non-allergic vasomotor rhinitis. A rigorous systematic literature search was conducted in strict adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search spanned PubMed, Scopus, Web of Science, and the Cochrane Library for peer-reviewed articles published between January 1, 2000, and January 1, 2025. Inclusion criteria mandated studies evaluating human nasal mucosal physiology, MCC time, CBF, and humidity levels exceeding 70%. Risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for randomised trials. Out of 1,420 initially identified records, 45 studies met the stringent inclusion criteria for qualitative synthesis. The aggregated data indicate a complex, non-linear, U-shaped relationship between ambient RH and MCC efficiency: optimal MCC occurs between 40% and 60% RH, while chronic exposure to tropical humidity (>70% RH) combined with high ambient temperatures (>28°C) is associated with mucosal engorgement, altered mucus rheology characterised by decreased viscosity and elasticity, and a paradoxical slowing of ciliary beat frequency (CBF). Furthermore, the modern tropical lifestyle involves frequent, abrupt transitions between highly humid outdoor environments and cold, desiccating air-conditioned indoor spaces. This 'micro-climatic shock' may contribute to reactive turbinate hypertrophy, disrupted osmotic gradients, and increased susceptibility to perennial aeroallergens such as house dust mites and fungal spores. High ambient humidity in tropical climates is associated with altered nasal mucosal function, including impaired MCC and changes in mucus rheology. These findings highlight the need for climate-specific approaches to the management of sinonasal disorders. Keywords: Nasal mucosa; humidity; tropical climate; mucociliary clearance; rhinitis; air-conditioning.
Epilepsy is a major public health challenge affecting individuals of all ages, especially in low- and middle-income countries (LMICs). Reliable prevalence projections are critical for healthcare planning and resource allocation. This study aimed to forecast the prevalence of epilepsy and its trends in LMICs by age, sex, year, and income level by 2050. Using data from the Global Burden of Disease Study (GBD) 2023, we projected the prevalence and number of idiopathic and secondary epilepsy cases in LMICs from 2024 to 2050. We developed a hybrid deep neural network (DNN)-Transformer framework that integrates Poisson regression and Autoregressive Integrated Moving Average (ARIMA) models for prevalence projection. Decomposition analysis was applied to quantify the contributions of population growth, aging, and prevalence change to the increase in epilepsy cases. Dementia-attributable epilepsy was independently projected to address secondary causes not included in GBD 2023. By 2050, the age-standardized prevalence rate (ASPR) of epilepsy in LMICs was projected to reach 907.22 per 100,000 [95% uncertainty interval (UI) 731.01-1083.56], a 33.32% increase from 2023, with cases rising to 72.04 million (95% UI 57.86-86.23), a 58.68% increase. The ASPRs of idiopathic and secondary epilepsy were estimated at 323.11 and 584.10 per 100,000 in 2050, respectively, with the increase in secondary epilepsy being more than 7-fold that of idiopathic epilepsy since 2023. The ASPR of secondary epilepsy due to neonatal disorders was projected to rise by 65.76%. Model validation demonstrated good predictive performance (root mean squared error <0.001). From 2023 to 2050, the increases in idiopathic and secondary epilepsy cases were forecast to be highest in low-income countries (LICs; 76.12% and 241.50%, respectively), with growth declining as income levels increased. Population growth (21.40%) primarily drove the increase in idiopathic epilepsy cases, whereas changes in prevalence (59.89%) predominantly drove the rise in secondary epilepsy cases. Dementia-attributable secondary epilepsy was projected to reach 3.40 million cases by 2050. We forecast a continuous increase in the prevalence and number of epilepsy cases in LMICs through 2050, with secondary epilepsy increasing more rapidly than idiopathic epilepsy. LICs may exhibit the greatest increases over the next three decades, necessitating targeted interventions and further investigation.
Migraine is a major cause of disability globally, yet its epidemiological impact on postmenopausal women (aged ≥55 years) is not well understood. This study aims to fill this knowledge gap by analyzing long-term trends in migraine burden from 1990 to 2021. Data from the Global Burden of Disease (GBD) 2021 study were utilized to estimate prevalence, incidence, and disability-adjusted life years (DALYs), stratified by age group, Socio-demographic Index (SDI), and geographical region. Temporal trends were assessed using the estimated annual percentage change (EAPC), while socioeconomic inequalities were evaluated through the Slope Index of Inequality (SII) and Concentration Index (CIX). The number of prevalent cases of migraine among postmenopausal women increased by 118.3% globally, rising from 55.29 million to 120.68 million between 1990 and 2021. Age-standardized rates (ASRs) in this population displayed contrasting trends: while age-standardized prevalence and incidence rates experienced slight increases (EAPC: 0.07-0.17), the age-standardized DALY rate (ASDR) remained stable. Middle-SDI regions faced the highest absolute burden of migraine in postmenopausal women and showed the most rapid growth in ASRs. Inequality analyses highlighted persistent socioeconomic disparities, revealing significant efficiency gaps in health resource utilization in high-SDI countries. This study highlights the increasing absolute burden of migraine among postmenopausal women, despite stable age-standardized rates. This underscores the need for context-specific interventions across SDI strata to reduce health inequities and optimize resource allocation in migraine care.
Post-COVID syndrome (PCS) is an ongoing legacy of the SARS-CoV-2 pandemic. Defined as symptoms persisting beyond 12 weeks following SARS-CoV-2 infection unexplained by an alternative diagnosis, many individuals continue to experience symptoms for months post-infection. Fatigue, breathlessness, cognitive difficulties and sleep disturbances are all commonly reported, frequently impairing daily functioning and quality of life. Acceptance and commitment therapy (ACT), which enhances psychological flexibility and supports values-based behaviour change, has shown effectiveness across long-term health conditions. This protocol describes the evaluation of Balance-ACT as a novel, adapted ACT-based intervention to address the complex physical and psychological needs of people with PCS. A randomised controlled trial (RCT), co-developed with people with PCS, will evaluate the efficacy and cost-effectiveness of Balance-ACT for PCS. A total of 196 adults with PCS will be recruited from specialist long COVID services within secondary care across NHS organisations in England and randomised 1:1 to Balance-ACT or treatment as usual (TAU). Balance-ACT consists of 10 therapist-delivered sessions delivered over 13 weeks. TAU comprises brief educational videos and a self-help leaflet for COVID-19 recovery. Outcomes will be assessed at 7, 14 and 20 weeks post-randomisation. The primary outcome is health-related quality of life, measured using the SF-36 Physical Component Score at 14 weeks post randomisation. Secondary outcomes include physical health-related quality of life at 20 weeks, perceived fatigue, clinical global improvement, sleep disturbance, cognitive functioning, depressive symptoms, anxiety symptoms, post-exertional malaise, breathlessness, muscle strength, muscle fatigue and heart-rate variability. Mediation analyses will examine whether the intervention leads to changes in psychological flexibility, fear-avoidance beliefs, damage beliefs, embarrassment-avoidance, symptom focusing, muscle strength and physical activity and whether these changes are associated with physical health outcomes. We will also conduct a nested qualitative study to explore participants' views of the intervention. Cost-effectiveness will be assessed by comparing health and social care service costs and quality of life outcomes between Balance-ACT and TAU at 20 weeks. Ethical approval has been granted by the NHS Camberwell St Giles Research Ethics Committee (reference 23/LO/0941). The study results will be disseminated in peer-reviewed journals and presented at international conferences. NCT06231238.
Learning curves are critical to the safe adoption and standardized training of robot-assisted urological surgery, yet the evolution of proficiency assessment from technical experience toward surgical safety and functional recovery remains unclear. Records indexed in the Web of Science Core Collection were quantitatively mapped to examine publication dynamics, research partnerships, the underlying knowledge base, and shifts in major topics over time. A total of 346 publications, including 252 articles and 94 reviews, were analyzed. Scientific output increased markedly, with an annual growth rate of 21.33%. The United States was the leading contributor, while Vita-Salute San Raffaele University and Alexandre Mottrie were the most productive institution and author, respectively. Highly co-cited literature primarily focused on standardized complication assessment, procedure-specific learning curves, and perioperative outcomes. Keyword and temporal analyses revealed a gradual shift from initial experience and technical adaptation toward outcome-based evaluation of surgical proficiency. Perioperative outcomes, complications, and surgical experience dominated the research landscape, whereas functional recovery, quality of life, and other patient-centered outcomes remained comparatively underrepresented. Overall, learning curve research in robot-assisted urological surgery has progressed toward multidimensional assessment of clinical performance, but current frameworks remain strongly weighted toward perioperative safety. Future studies should establish procedure-specific, outcome-oriented models incorporating patient characteristics, procedural complexity, functional recovery, and multidisciplinary team performance to define more clinically meaningful standards of robotic surgical proficiency.
Occupational arsenic exposure (OEA), mainly through inhalation in workplace settings, is an established carcinogenic hazard associated with lung, skin, and bladder cancers. However, long-term trends and the global cancer burden attributable to OEA remain insufficiently characterized. Data from the Global Burden of Disease Study 2021 were used to analyze the cancer burden attributable to OEA from 1990 to 2021. Indicators included summary exposure values (SEVs), deaths, years lived with disability (YLDs), and disability-adjusted life years (DALYs) at global, regional, and national levels. Estimates were reported with 95% uncertainty intervals (UIs) generated from 1000 Monte Carlo simulations. Age-standardized indicators, Joinpoint regression, inequality analysis, decomposition analysis, and frontier analysis were used to assess spatiotemporal trends, drivers, and disparities. Seven forecasting models were evaluated to predict trends from 2022 to 2036. Between 1990 and 2021, global OEA SEV increased from 0.408% to 0.496% (average annual percentage change [AAPC] = 0.288). Cancer deaths rose from 5.5 to 10.5 thousand, YLD from 1.5 to 3.3 thousand, and DALYs from 169.6 to 298.7 thousand. In contrast, age-standardized death rate (AAPC = -0.300) and DALYs rate (AAPC = -0.531) declined. Men bore higher overall burdens, but women experienced faster increases (AAPC 0.428 vs 0.171). High-socio-demographic index (SDI) countries showed continuous improvement, whereas middle- and low-SDI regions-particularly East, South, and Southeast Asia-experienced substantial increases. In East Asia, the AAPCs for age-standardized SEVs, age-standardized death rates, age-standardized YLDs rates, and DALYs rates were 0.953, 1.067, 1.849, and 0.809, respectively. Inequality analysis indicated stable absolute gaps but reduced relative disparities, with burdens still concentrated in low-SDI countries. Decomposition suggested that population growth was the main driver of global burden increases, and frontier analysis highlighted limited improvement potential in low-SDI regions. Forecasting models indicated that the absolute burden of occupational arsenic exposure will continue to rise over the next 15 years. The cancer burden attributable to OEA is still increasing globally, with persistent prevention gaps and socioeconomic disparities. Focused interventions in low- and middle-SDI countries and rapidly industrializing regions are needed, including strengthened occupational exposure regulations, improved workplace arsenic monitoring, engineering controls, personal protective equipment, and regular health surveillance for workers in high-risk industries, to reduce inequalities and mitigate public health threats.
Gastric cancer (GC) is a leading contributor to cancer-related illness and death globally, presenting a significant public health concern in Iran. There is a lack of extensive data regarding long-term trends at both national and regional levels for GC incidence and its anticipated future impact. This research aimed to investigate the changes in gastric cancer rates in Iran from 1990 to 2021 and to forecast incidence rates through 2030 by gender, age groups, and provinces. This research used secondary ecological data from the GBD 2021 research to investigate the incidence of GC in Iran from 1990 to 2021. Temporal trends were assessed with Joinpoint Regression to determine the Average Annual Percent Change (AAPC). Also, a Bayesian age-period-cohort model was then applied to project new cases and incidence rates up to 2030. We used from R and Joinpoint software for all analyses. From 1990 to 2021, Iran saw nearly a twofold increase in new GC instances; however, the age-standardized incidence rate (ASIR) significantly fell from 23.12 to 14.37 per 100,000 individuals. The most significant decreases were observed in the northwestern provinces and among females. Forecasts for 2030 show that the absolute number of cases will likely increase to around 12,070, yet the ASIR is predicted to see a slight drop to 13.44, with a stagnation in decrease for individuals over 80 years old, suggesting a gradual slowdown in the overall trend. Although there has been a persistent reduction in the age-standardized incidence rate of GC in Iran over the last thirty years, the sheer number of cases is still increasing owing to demographic growth and an aging population. To combat this rising challenge, future initiatives should focus on implementing targeted screening in high-risk areas and for elderly populations, improving geriatric healthcare, and addressing inequalities in healthcare access through better collaboration across sectors.
Mental disorders are leading causes of disability worldwide but remain underprioritized in many low- and middle-income countries, including sub-Saharan Africa (SSA), where access to care, workforce capacity, and mental health infrastructure remain limited. This study quantified the burden of mental and substance use disorders (SUDs) in SSA from 1990 to 2023 using Global Burden of Disease (GBD) 2023 estimates, with attention to long-term trends, late-period changes, country-level heterogeneity, sex differences, and risk-factor attribution. We analyzed GBD 2023 estimates for 46 SSA countries from 1990 to 2023, including prevalence, disability-adjusted life years (DALYs), age-standardized rates, sex-specific estimates, country-level burden, and selected risk factors. Percentage changes were calculated for 1990-2023, with sensitivity analyses for 1990-2019 and 2019-2023 and segmented log-linear trend models using 2019 as the breakpoint. From 1990 to 2023, the age-standardized prevalence rate of mental disorders increased from 11,138.8 to 14,841.0 per 100,000 (+33.24%), while the age-standardized DALY rate increased from 1634.9 to 2218.9 per 100,000 (+35.73%). Anxiety disorders showed the largest relative increases in age-standardized prevalence (+90.99%) and DALY rates (+92.11%). Depressive disorders also increased, while ADHD age-standardized rates remained largely stable. SUDs showed rising absolute burden despite declining age-standardized prevalence and DALY rates. Late-period analyses showed larger increases after 2019, particularly for anxiety disorders. Females had higher age-standardized rates and larger relative increases for anxiety and depressive disorders, whereas males had higher rates of ADHD and SUDs. Among selected risk factors, sexual violence against children had the highest age-standardized attributable DALY rate in 2023, while bullying victimization and intimate partner violence showed the largest relative increases. Mental and SUDs represent a growing public health challenge in SSA. Strengthening mental health systems, integrating services into primary and general healthcare platforms, expanding SUD prevention and treatment, addressing violence-related risk factors, and reducing stigma are essential to improving mental health outcomes across the region.
During childbirth, no woman should lose a child. However, perinatal mortality remains a global concern. The recent South African Saving Mothers and Babies report revealed a notable 20% increase in perinatal mortality in Mpumalanga province. This excess of perinatal mortality was due to hypertensive disorders and unexplained causes. Thus, this paper explores and describes the voices of midwives on the causes of perinatal mortality in the resource-limited setting of the Mpumalanga province. A qualitative, exploratory and descriptive design was carried out to explore the views and perceptions of midwives on the causes of perinatal mortality. Purposive sampling was adopted to select midwives with experience in midwifery care, and data saturation was reached with the 20th participant. The data was collected through semi-structured interviews and analysed using thematic analysis. The study revealed that issues such as delayed interventions and poor monitoring by healthcare personnel, lack of triaging, shortage of staff, variations in implementation of health education and compliance were the concerning issues contributing to perinatal mortality. The study highlights that health education is a crucial element in the prevention of perinatal mortality. Therefore, more initiatives should be directed at educating patients about the importance of antenatal care, treatment adherence, and the use of unsafe traditional medicines for the induction of labour. Aucune femme ne devrait perdre son enfant lors de l'accouchement. Pourtant, la mortalité périnatale demeure une préoccupation mondiale. Le récent rapport sud-africain intitulé *Saving Mothers and Babies* (Sauver les mères et les bébés) a révélé une augmentation notable de 20 % de la mortalité périnatale dans la province de Mpumalanga. Cette surmortalité périnatale était imputable à des troubles hypertensifs et à des causes inexpliquées. Ainsi, cet article explore et décrit le point de vue des sages-femmes sur les causes de la mortalité périnatale dans le contexte de ressources limitées de la province de Mpumalanga. Une approche qualitative, exploratoire et descriptive a été adoptée pour étudier les opinions et les perceptions des sages-femmes concernant les causes de la mortalité périnatale. Un échantillonnage raisonné a permis de sélectionner des sages-femmes expérimentées dans les soins obstétricaux, et la saturation des données a été atteinte avec la vingtième participante. Les données ont été recueillies par le biais d'entretiens semi-directifs et analysées selon une méthode thématique. L'étude a révélé que des problèmes tels que les retards d'intervention et une surveillance insuffisante de la part du personnel soignant, l'absence de tri, le manque de personnel, ainsi que les disparités dans la mise en œuvre de l'éducation à la santé et dans l'observance des soins, constituaient des facteurs préoccupants contribuant à la mortalité périnatale. L'étude souligne que l'éducation à la santé est un élément crucial de la prévention de la mortalité périnatale. Par conséquent, davantage d'initiatives devraient viser à sensibiliser les patientes à l'importance des soins prénatals, à l'observance du traitement et aux risques liés à l'utilisation de médecines traditionnelles dangereuses pour le déclenchement du travail.