With the continuous increase in morbidity among older adults and the rapid progression of population aging, the demand for healthcare services and older adults care services has grown rapidly. However, the traditional model characterized by the separation of healthcare and older adults care has become increasingly inadequate in meeting the diverse and expanding needs of the aging population. Therefore, promoting the coordinated development of healthcare services and older adults care services has emerged as an urgent and critical issue. Based on panel data from 31 provinces (including municipalities and autonomous regions) in China from 2014 to 2023, this study employs the entropy method, the coupling coordination degree model, and the geographic detector model to analyze the level of coordinated development and its key influencing factors between community-level healthcare services and older adults care services at the provincial scale. Specifically, the entropy method is used to determine indicator weights, the coupling coordination degree model is applied to evaluate the coordination level, and the geographic detector model is utilized to identify the main influencing factors. (1)The coupling coordination level between community healthcare services and older adults care services in China shows an overall upward trend, although the growth rate is uneven, exhibiting a dynamic evolution characterized by "rapid development-gradual slowdown-bottoming out and rebound-fluctuating advancement."(2)Significant spatial disparities are observed in the coupling coordination level, gradually forming a diversified spatial pattern in which coastal regions take the lead, inland regions rise rapidly, and remote regions demonstrate substantial development potential.(3)The coupling coordination development of community healthcare services and older adults care services in China is jointly influenced by infrastructure, workforce, and service capacity. Among these factors, the number of healthcare institutions, the number of technical staff, the number of outpatient visits, the number of older adults care institutions, the number of certified social workers, and the number of community-based daytime care recipients play a dominant promoting role. Based on the findings, this study recommends implementing dynamic regulatory strategies aligned with different development stages, formulating region-specific policies that account for spatial heterogeneity, and adopting targeted interventions focusing on key influencing factors, in order to systematically promote the high-quality coordinated development of healthcare services and older adults care services in China.
BackgroundAlthough perceived distance is a key factor in deciding and reaching healthcare, its impact on antenatal care (ANC) utilisation remains underexplored.ObjectiveThis study aims to examine the effect of perceived distance on ANC uptake, stratified by key maternal characteristics.DesignCross-sectional analysis based on demographic and health survey data (DHS).MethodsThis study analysed the demographic and health survey data of 26 sub-Saharan African countries, comprising 186,873 women who had given birth within the five years preceding the surveys. The exposure variable was perceived distance to a healthcare facility, categorised as "a big problem" or "not a big problem." Whereas the outcome variable was the number of ANC contacts, classified as no, one to three, four to seven and eight or more contacts. A Generalised Structural Equation Model (GSEM) with a multinomial logit link was employed to examine the association. Analyses were further stratified by socio-demographic characteristics.ResultsThe analysis revealed that women who perceived the distance as a major problem had 15% higher odds of receiving only 1-3 contacts (aOR = 1.15, 95% CI: 1.05, 1.25, p = 0.002), and 51% higher odds of receiving no ANC (aOR = 1.51, 95% CI: 1.35, 1.66, p < 0.001), compared to those receiving eight or more contacts. These associations were particularly pronounced among women with lower educational status (aOR=1.48, 95%CI: 1.29, 1.64), rural residents (aOR=1.55, 95%CI: 1.37, 1.74), low household income (aOR=1.47, 95%CI: 1.27,1.68), and younger age (aOR=1.55, 95%CI: 1.31, 1.80).ConclusionPerceived distance remains a significant barrier to the utilisation of antenatal care services in resource-limited settings. Strengthening health system responsiveness and addressing structural barriers, such as transportation infrastructures, through innovations like mobile antenatal care is vital to improving maternal health outcomes and advancing global health equity. Ensuring access to high-quality antenatal care (ANC) is essential for improving maternal and newborn health outcomes. However, evidence on the effect of geographical distance on ANC use in sub-Saharan Africa remains limited and inconclusive. This study examined the relationship between perceived distance to a health facility and ANC utilisation across 26 sub-Saharan African countries. We analysed the Demographic and Health Survey (DHS) data from 186,873 women who had given birth in the five years preceding the survey. Women who reported that distance to a health facility was a major problem had 15% higher odds of attending only 1-3 ANC contacts and 51% higher odds of receiving no ANC, compared with women who attended at least eight contacts. These associations were stronger among women with lower levels of education, those living in rural areas, women from low-income households, and younger women. These findings underscore the importance of addressing perceived distance-related barriers to improve uptake of the WHO-recommended number of ANC contacts and to promote equitable access to maternal health services in sub-Saharan Africa.
Climate change is now regarded as a global health challenge of the 21st century, posing a negative health risk to the population. Sub-Saharan Africa is disproportionately affected more than any other region worldwide. Mapping strategies and responses in Sub-Saharan Africa to address the impact of climate change on health systems is a starting point for understanding evidence-based decision-making and informing best practices. We conducted a scoping review to identify health systems strategies and responses to the effects of climate change in Sub-Saharan Africa. Electronic database searches were conducted on African Index Medicus, PubMed, CINAHL, and Scopus. Covidence software was used to remove duplicates, blind study selection, and data extraction. We included peer-reviewed articles (original quantitative and qualitative studies, mixed methods studies, reviews, editorials, and commentaries) published between 2011 and 2025. All book chapters and grey literature publications (dissertations, conference proceedings, abstracts, and reports) that primarily focus on climate change strategies and responses without effects on health systems were excluded. The results were analysed using descriptive thematic analysis. Out of 11459 articles, 8 studies met our inclusion criteria. Most studies provided strategies and responses centered on service delivery, health workforce, health information, leadership and governance, with few on health financing and medicinal products. No study was identified that had outlined strategies and responses across all of the six World Health Organisation building blocks for the health systems. Implementation challenges identified include inadequate funding, lack of knowledge among health workers on climate change and health, inadequate surveillance and reporting structures, and low prioritization of climate change activities among health workers. This scoping review has identified some health system strategies and responses to the effects of climate change within the Sub-Saharan African region. The review has revealed that existing strategies and responses are fragmented and hindered by some implementation challenges. As climate change continues to pose health threats to the global population, urgent and effective interventions are required to minimize its impacts. It is essential to understand the unique vulnerabilities of the health systems, particularly those in the Sub-Saharan African region. The time is now to develop strategies and responses that can improve and strengthen health systems as it protects health of the population from the effects of climate change.
General service readiness in health facilities often fails to predict the quality of care for sick child health services. This study aims to describe the specific service readiness in 8 low- and middle-income countries (LMICs) and examine its relationship with quality of care and user experience. Data was drawn from the Service Provision Assessment surveys, comprehensive national health system assessments conducted within the last decade across Afghanistan, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Nepal, Senegal, and Tanzania. Specific service readiness was identified using the World Health Organization's Service Availability and Readiness Assessment, calculated as the mean preparedness across facilities. Quality of care was assessed by the number of actions in international guidelines that health providers performed. User experience was measured by reported client issues during visits. Multilevel linear regression models were performed testing the relationship between specific service readiness and quality of care and user experience. A total of 5,311 facilities and 20,880 sick child visits were analyzed. The mean score for specific service readiness was 0.57, with the staff and guidelines being the scarcest at 0.34. Health providers completed an average of 5.77 out of 20 recommended actions, indicating suboptimal quality. Interestingly, clients reported a higher user experience. Specific service readiness was positively related to the quality of care, but showed no correlation with user experience. Specific service readiness shows a notable association with the clinical quality of sick child health services in LMICs. Key strategies include staff training, improved availability of equipment and medications. Addressing these prerequisites may be associated with better health outcomes in sick child health services. Not applicable.
Experience-based co-design (EBCD) seeks to bring together people with lived experience of healthcare with other interest holders to collaboratively generate creative solutions. A cluster randomised controlled trial is planned to assess the feasibility, acceptability and effectiveness of a co-designed multicomponent intervention to improve communication in aged care services. This paper describes a nested process evaluation design for the EBCD and implementation of the intervention with the aim of understanding the role of co-design and other factors in achieving impact. Primary data sources will include surveys, interviews, focus groups, field notes and observations of co-design activities. Secondary sources will include data collected and materials produced by the researchers developing the intervention. Aged care recipients; family members and significant others; direct care workers; managers; and other healthcare professionals will be engaged as co-designers of the intervention, and as research participants in the evaluation of its co-design and implementation. Evaluation findings will compare experiences of co-design, within and across informant groups, with an explanatory theoretical model of change described in previous research employing EBCD. Additionally, the role of the co-design and other contextual factors in the intervention's impact will be organised using the RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) framework. The involvement of people who use and deliver health services in the development of complex interventions is increasingly recommended as a means to improve impact and health outcomes. However, research evidence supporting the mechanisms of impact of co-design and related approaches in healthcare is limited. Nested process evaluations of co-design are needed to support the continued theoretical and methodological development and resourcing of co-design in healthcare. A lived experience advisory group (LEAG) of older people receiving aged care services and family or other informal supporters of those receiving aged care services has provided input to the evaluation design described in this manuscript, and a member of this group has co-authored this article. LEAG members will continue to contribute to the conduct of the evaluation as well as the analysis and dissemination of the evaluation findings.
Frailty is a common condition in older adults which becomes more prevalent and more severe with age. Health and care services designed to meet the needs of older adults living with frailty are expanding in number and scope, but information on the workforce needed to deliver services both now and in the future is lacking. To understand the service design and staffing configurations for frailty services through gathering data on the setting and purpose of services; target population; referral methods into the service; specific activities delivered; frailty assessment tools; key service and patient outcomes; staff involved; future service priorities and anticipated future workforce requirements. National survey, circulated electronically via national networks and organisations involved in the care of patients with frailty (n=26). England health and care settings. Health and care professionals delivering services for people living with frailty. There were 93 survey responses from frailty services across England, of which 82 contained usable information. Respondents included clinicians and managers in a range of health and care sectors and the voluntary sector. Frailty services across settings commonly prioritised reducing frailty-associated risks but few focused on prevention. Staff teams included representation across professions, with specialists in older people's care (eg, geriatricians, advanced practitioners) present in most teams, but non-specialist team members (eg, therapists, social workers and care co-ordinators) comprised a large proportion of the total workforce. All respondents identified similar priorities for their service in future, including reducing frailty progression, and specified needs for additional staff which broadly reflected the current team configurations. However, staff vacancies or unmet patient need due to low capacity was highlighted, and all respondents identified the need for additional staff in future. Services designed to identify and manage people with frailty are complex and require a workforce with specialist training to assess, plan and deliver care. Current services are understaffed with insufficient capability to prevent frailty onset or slow progression, thereby failing to address unmet need. Workforce planning and resourcing to address frailty-related needs is urgently required.
Primary healthcare (PHC) systems in Sub-Saharan Africa (SSA) continue to prioritise reactive, curative models of care, despite the region's pressing need for health-promotive and preventative strategies. Instead of disrupting the existing curative model, the expansion of digital health often automates old, treatment-oriented systems with a limited focus on creating new tools for preventive and health-promoting functions. While there is no shortage of reviews on digital health and telemedicine in SSA, these predominantly focus on curative care and service delivery within the walls of healthcare facilities. An understanding of how remotely provided preventive and health-promoting services can be implemented by PHC facilities to strengthen the PHC overall is currently lacking. Addressing this gap is critical for guiding research, policy and practice towards designing more preventive and proactive PHC service models. This protocol details a scoping review that will identify and establish what is currently known about the implementation and feasibility of remote preventive and digital health-promoting services as potential levers to strengthen PHC in SSA. The review will consolidate evidence on digital health initiatives for prevention and identify key opportunities, barriers and gaps in the current knowledge. Results will be analysed using quantitative summaries and qualitative thematic analysis. Ethical approval is not required as this study uses publicly available literature. The findings could guide policymakers, programme implementers and researchers in reorienting PHCs towards more preventive approaches. The findings of the proposed scoping review will be disseminated through publication in a peer-reviewed journal. The protocol is registered with the Open Science Framework (OSF: https://osf.io/8whkc/) to comply with methodological transparency and accountability.
This study examines the role of blockchain-based accounting mechanisms in improving the governance of reproductive health supply chains in low- and middle-income countries (LMICs). With a focus on countries in sub-Saharan Africa and South Asia, this research investigates how digital accountability can address common challenges in reproductive health programs, such as commodity leakage, inventory discrepancies, and weak transparency. Using structural equation modeling (SEM), the study analyzes data from stakeholders involved in reproductive health commodity supply chains, including supply chain managers, healthcare administrators, and program coordinators. The findings reveal that blockchain-based accounting significantly enhances supply chain transparency, reduces commodity leakage, and strengthens governance accountability. These improvements lead to better availability and continuity of reproductive health commodities, which are critical for maternal health and family planning services. The study highlights the potential of digital health governance tools to strengthen supply chain operations and foster institutional trust, ultimately improving service delivery outcomes in resource-constrained settings. By integrating blockchain technology, reproductive health supply chains can achieve greater efficiency, transparency, and sustainability, contributing to the achievement of global reproductive health goals. L'accès aux produits de santé reproductive essentiels demeure un obstacle majeur à l'amélioration des résultats en matière de santé maternelle et de planification familiale dans les pays à revenu faible et intermédiaire. Les ruptures de stock causées par les fuites dans la chaîne d'approvisionnement, la faible responsabilisation et les systèmes de rapport fragmentés perturbent fréquemment la prestation des services et contribuent aux besoins non satisfaits en santé reproductive. Cette étude examine comment les mécanismes de responsabilité numérique, en particulier la comptabilité de la chaîne d'approvisionnement basée sur la blockchain, peuvent améliorer la disponibilité des produits de santé reproductive et renforcer les systèmes de prestation de services. En utilisant une synthèse intégrative des preuves sur les applications de la blockchain dans la santé et la littérature sur les chaînes d'approvisionnement en santé reproductive, l'étude évalue les relations entre la transparence numérique, la réduction des fuites, la responsabilité de la gouvernance et la disponibilité des produits. Les résultats indiquent que les systèmes de responsabilité numérique améliorent significativement la transparence de l'approvisionnement, réduisent les pertes de produits et améliorent la continuité des stocks, ce qui peut renforcer l'utilisation des services de santé reproductive. Une gouvernance améliorée et une confiance institutionnelle renforcent davantage l'approvisionnement durable en produits. L'étude met en lumière la transparence numérique comme une intervention prometteuse de gouvernance pour renforcer les systèmes de santé reproductive et réaliser l'accès universel aux services de santé maternelle et de planification familiale dans les milieux à ressources limitées.
The widespread mobilisation to improve maternal health over recent decades has led to increased prenatal consultations and assisted deliveries, resulting in a significant reduction in maternal mortality in many sub-Saharan African countries. This paper examines the progress made in basic obstetric care in four sub-Saharan African countries (Burkina Faso, Côte d'Ivoire, Ghana and Senegal), and investigates the sources of this progress to better inform future policy actions that will help achieve the Sustainable Development Goal 3 targets related to maternal and child health. We used data from two Demographic and Health Surveys (DHSs) conducted in each of the four countries in the early 2010s and 2020s by their respective national statistical offices. Specifically, we relied on the 2010 and 2021 DHS for Burkina Faso, the 2011 and 2021 DHS for Côte d'Ivoire, the 2014 and 2022 DHS for Ghana and the 2010 and 2023 DHS for Senegal. We first estimated coverage rates for various components of maternity care using descriptive statistics with CIs to assess significant differences. Associations were examined using a multivariate decomposition analysis based on the Oaxaca-Blinder method adapted for binary outcomes. The results show a substantial increase in coverage of antenatal care (ANC) and postnatal care services over the past decade in all four countries. While progress in ANC4+ coverage is evident, the situation becomes more complex when considering more comprehensive quality indicators such as ANC8+ and its individual components. Decomposition results suggest that the factors driving progress are largely not fully captured by conventional socio-economic variables, pointing instead to changes in women's health-seeking behaviour and broader improvements in health system performance. This study highlights a marked gap between the high frequency of antenatal consultations and the quality of services delivered, particularly with respect to ANC8+ coverage and the full set of ANC components. Sustaining and deepening progress will require greater emphasis on improving service quality and expanding behaviour-change communication strategies tailored to local contexts, alongside continued health system strengthening.
Health insurance coverage in sub-Saharan Africa (SSA) remains low and digital premium payment systems have been suggested as a potential solution to increase enrolment and retention. This systematic review will collate and distill empirical evidence on the impact of digital premium payment in scaling health insurance coverage and retention and access to health service delivery in SSA. This systematic review protocol has been prepared following robust methods, and it is reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will conduct searches through relevant databases, including PubMed, CINAHL, LILACS, HINARI, African Journals Online, Google Scholar, Scopus, Web of Science, Trip Pro and TOXNET from 2007 to 30 June 2026, without language restriction for studies that evaluated digital premium payment systems and reported health insurance enrolment or retention rates. The search terms and concepts include: 'national health insurance', 'health insurance coverage', 'insurance enrolment', 'digital premium', 'e-payment', 'online payment', 'electronic payment', 'mobile payment', 'telepayment' and 'cashless payment', together with their alternate terms and synonyms, singular and plural forms as well as British and American spelling. The names of the countries in SSA will be included as search terms. Grey literature including dissertation repositories, national health insurance databases and conference proceedings will be searched. Reference list of retrieved articles will be reviewed, and where necessary, experts working in the field of national health insurance will be contacted for knowledge about completed studies not captured by our searches. Two reviewers will independently screen studies, extract data (using pretested data extraction form developed from Microsoft Excel) and assess risk of bias in the included studies using the quality assessment tool for Risk Of Bias In Non-randomized Studies - of Exposures. Any disagreements will be resolved through discussion between the reviewers. Heterogeneity will be explored graphically for overlapping CIs and statistically using the [Formula: see text]-statistic. We will combine dichotomous outcomes using risk ratio and for continuous data mean difference employing random-effects meta-analysis and presenting weighted effect estimates with their 95% (CIs). Subgroup analysis will be performed to assess the impact of heterogeneity and sensitivity analyses to test the robustness of the pooled effect estimates. The overall level or certainty of evidence will be assessed using Grading of Recommendations, Assessment, Development, and Evaluation. This systematic review will collate empirical data on publicly available published and unpublished primary studies and no ethical approval is required. However, an eligible study with serious ethical issues will be excluded from the analysis and the reasons for exclusion documented. The review findings will be shared with key stakeholders and health authorities, agencies involved in digital premium health insurance and policymakers. The review results will be presented at scientific conferences and symposia, and a manuscript will be submitted for publication in a high impact factor journal. CRD42024576134.
Adolescents living with HIV (ALHIV) in sub-Saharan Africa (SSA) are a vulnerable population disproportionately affected by mental health disorders due to the combined burden of chronic illness, stigma and socioeconomic challenges. In response, numerous mental health interventions have been implemented to support ALHIV. However, the COVID-19 pandemic significantly disrupted health systems, particularly in-person services, potentially undermining the delivery and efficacy of these interventions. This protocol describes the methodology for a systematic review that will assess the impact of the COVID-19 pandemic on the implementation of mental health interventions for ALHIV in SSA and to explore the emergence or adaptation of interventions during this period. Data will be collected, analysed and reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will search PubMed, Web of Science, APA PsycINFO and Scopus for literature published from 2020 to 2025. Eligible studies will include both qualitative and quantitative designs that assess mental health interventions for ALHIV in SSA or explore pandemic-related implementation impacts. Both peer-reviewed and grey literature will be included. The primary outcomes of interest are implementation-related outcomes, including service disruptions, adaptations, feasibility, acceptability and barriers or facilitators influencing intervention delivery during the COVID-19 pandemic. Data, including study design, methodology and results, will be extracted and synthesised using an Excel spreadsheet. Specific inclusion and exclusion criteria will be used during literature screening and will include study type, location and language. This review uses only publicly accessible data from previously published studies and does not involve the collection of primary data or identifiable human subjects. Therefore, ethical approval is not required. The results of the review will be disseminated through publication in a peer-reviewed journal and shared with stakeholders working in adolescent HIV and mental health services in SSA. CRD420251147822.
The aim of this review was to explore the unmet healthcare needs of community-dwelling older adults living in rural areas, to identify barriers and facilitators in accessing services and examine the supply and demand of community-based care. A scoping review was conducted following the Arksey and O'Malley framework and adhering to PRISMA-ScR guidelines. A systematic search and selection process identified peer-reviewed articles and grey literature published from 2014 to 2025. Data were extracted, organised and analysed using Covidence to map key findings and identify thematic patterns. Ovid MEDLINE, CINAHL Plus with Full Text, Scopus, Informit, and ProQuest Health and Medicine databases were searched for primary research studies. A search specifically for grey literature focusing on the current Australian context was undertaken separately. The 23 resources included in the review highlight significant rural healthcare disparities, including workforce shortages, high service costs and limited availability of aged care resources. While family and community networks remain vital sources of support, they are increasingly strained due to demographic shifts, such as the outmigration of younger populations. Older people consistently expressed a strong preference for home-based care; however, environmental and systemic barriers, such as inadequate transportation and service fragmentation, hinder their ability to age in place. Social participation was found to be linked to wellbeing, yet many older adults in rural communities experience isolation due to geographic, infrastructure and service-related constraints. This review identified persistent and multifaceted inequities in healthcare services available to community-dwelling older adults. Rural health workforce shortages, limited community support service availability, transport barriers, fragmented care systems and reliance on informal caregiving were key factors influencing the capacity to age in place. These findings highlight the need for more coordinated, context and culturally responsive rural health services and support systems.
Older people living in care homes are at increased risk of harm during acute hospital admissions. In England, care home residents have more than twice as many emergency department (ED) attendances as people of the same age living at home. Up to 40% of emergency hospital admissions of older care home residents may be avoidable with different models of care within their homes.In 2023, National Health Service England introduced the updated Enhanced Health in Care Homes (EHCH) framework, a set of recommendations to support 'joined up' and enhanced care for people living in care homes. A stated aim of the framework is to reduce ED attendances and inpatient admissions of residents. There is limited available evidence regarding how implementation of the EHCH framework differs regionally and whether variation in implementation may impact on hospitalisations of care home residents. We aim to explore regional differences in care elements developed from the EHCH framework and assess how these differences may contribute to variation in hospitalisations of care home residents over the age of 65. This is a comparative qualitative case study of six care home-containing postcode districts in England embedded within three Integrated Care Boards (ICBs). ICBs are regional organisations responsible for commissioning healthcare services in England. Case study districts and ICBs were selected due to contrasting case-mix adjusted admission rates and other characteristics (eg, deprivation). Data will be collected through semistructured interviews. We will interview health and social care professionals who are responsible for commissioning, overseeing and delivering enhanced care in care homes, care home professionals, residents over the age of 65 and their family and friends. Interview data will be analysed through a framework approach, with comparisons drawn within cases, across cases and across ICBs. Through our analysis, we will characterise the EHCH framework care elements and identify differences in implementation that may cause variation in hospital admissions. We will also identify perceived appropriate, effective and replicable enhanced care models.Patients and the public have informed the design of this study, and will advise the research practice, support the analysis of data and guide dissemination plans. This study has received Social Care Research Ethics and Health Research Authority Approval (25/IEC08/0014). All participants will be required to provide informed consent. The findings will inform a national survey of ICBs to map appropriate and effective enhanced care in England. Findings will be shared with key stakeholders and academic audiences.
Older adults living in residential aged care facilities (RACFs), particularly in regional and rural areas, experience a high burden of untreated dental caries, tooth sensitivity, and oral pain. Workforce shortages, limited access to dental services, and competing health priorities make the delivery of timely oral health care challenging in these settings. Poor oral health contributes to pain, impaired nutrition, reduced quality of life, and increased health service use. There is an urgent need for context-appropriate, accessible, and cost-effective interventions for RACF residents. Aqueous silver fluoride (AgF), a minimally invasive topical agent with caries-arresting and desensitizing properties, offers a pragmatic approach suitable for aged care settings. This protocol aims to test the effectiveness of an AgF intervention package in reducing tooth sensitivity and tooth pain, arresting caries, and improving oral health and well-being in older adults living in regional and rural RACFs. This study is a 2-arm, parallel-group cluster randomized controlled trial, with RACFs as the unit of randomization. The trial is conducted in public and private RACFs across regional and rural Queensland and New South Wales, Australia. Eligible participants are residents with at least 1 natural tooth. At baseline, calibrated examiners perform standardized oral examinations to assess dental caries status, lesion activity, and dentin hypersensitivity. AgF is applied to eligible carious lesions and sensitive tooth surfaces following a standardized clinical protocol. Follow-up assessments at 3 months include a repeat clinical examination to assess caries arrest and changes in hypersensitivity, along with resident-reported measures of oral pain and oral health-related quality of life collected using validated instruments. Outcomes include change in tooth sensitivity and oral pain at the 3-month follow-up, caries arrest rates, and change in oral health-related quality of life. Analyses will follow intention-to-treat principles and account for clustering using mixed-effects regression models with facility-level random effects. Models will adjust for baseline covariates and prespecified confounders. Sensitivity analyses will examine the robustness of the findings. The trial will also inform a planned economic evaluation embedded within the broader research program. This trial forms part of a broader program funded by the Medical Research Future Fund Dementia, Aging and Aged Care Grant (2024439). Recruitment and data collection commenced in May 2025 and are expected to conclude in June 2026. Recruitment is ongoing across participating RACFs. Data analysis is expected to commence in mid-2026, with primary findings anticipated for publication in early 2027. This protocol outlines a rigorous evaluation of a minimally invasive, scalable oral health intervention tailored to RACF settings. The findings will provide high-quality evidence on effectiveness to inform policy, service delivery, and economic evaluation aimed at improving oral health and well-being among older adults in residential aged care.
Diarrheal disease remains a leading cause of morbidity among children under 5 years of age in sub-Saharan Africa, yet many estimates rely on outdated data. Using the most recent Demographic and Health Survey (DHS) datasets, this study is aimed at providing updated estimates of childhood diarrheal morbidity and at identifying associated factors to inform monitoring and targeted interventions. This study analyzed pooled DHS data collected between 2021 and 2024 from 11 sub-Saharan African countries, focusing on diarrheal morbidity among 124,167 children under 5 years of age. A multilevel modified Poisson regression model was employed to estimate adjusted prevalence ratios (APRs) and corresponding 95% confidence intervals (CIs), accounting for the hierarchical structure of the data, including clustering at household and community levels. Statistical significance was declared at p < 0.05. The prevalence of diarrheal morbidity among children under 5 years of age was 13.8% (95% CI: 13.6%-14.0%), with significant variation across the included sub-Saharan African countries. Lower prevalence was observed among children born to mothers aged 25-34 years (APR = 0.89; 95% CI: 0.85-0.92) and 35-49 years (APR = 0.82; 95% CI: 0.78-0.86), female children (APR = 0.93; 95% CI: 0.91-0.96), children aged 37-59 months (APR = 0.42; 95% CI: 0.40-0.44), children of literate mothers (APR = 0.86; 95% CI: 0.82-0.89), those from wealthier households (APR = 0.84; 95% CI: 0.79-0.88), children covered by health insurance (APR = 0.89; 95% CI: 0.83-0.95), and those who had received measles vaccination (APR = 0.95; 95% CI: 0.90-0.99). Conversely, distance to health facilities as a big problem (APR = 1.09; 95% CI: 1.05-1.13), underweight status (APR = 1.17; 95% CI: 1.10-1.24), and wasting (APR = 1.17; 95% CI: 1.09-1.26) were associated with a higher prevalence of diarrheal morbidity. Positive associations were also observed for media exposure, improved toilet facilities, four or more antenatal care visits, postnatal checkups, vitamin A supplementation, rotavirus vaccination, and deworming treatment. These associations should be interpreted cautiously, as they are unlikely to be causal and may reflect reverse causation, residual confounding, or reporting and detection bias. Childhood diarrhea remains a major public health concern in sub-Saharan Africa, with substantial variation across the included countries. Diarrheal morbidity among children under 5 years of age was associated with a range of biological, socioeconomic, nutritional, and health service-related factors. Lower diarrheal morbidity was associated with older maternal age, female sex, older child age, maternal literacy, higher household wealth, health insurance coverage, and measles vaccination, whereas undernutrition and barriers to healthcare access were associated with higher morbidity. Counterintuitive associations observed for several health service and infrastructure variables likely reflect reverse causation and reporting bias rather than harmful effects. These findings underscore the need for integrated interventions aimed at improving child nutrition, reducing socioeconomic inequalities, and expanding equitable access to quality healthcare services.
Adolescents in Sub-Saharan Africa (SSA) continue to face significant barriers to accessing contraceptive services, despite global and regional commitments to improve sexual and reproductive health (SRH) outcomes. This scoping review synthesises current evidence on the barriers adolescents encounter when seeking contraceptive services across SSA. Following the Arksey and O'Malley framework and the Joanna Briggs Institute guidelines, a comprehensive literature search of peer-reviewed and grey literature published between January 2010 and January 2025 across multiple databases was conducted. A total of 30 studies met the inclusion criteria. Thematic synthesis revealed five major categories of barriers: individual-level [limited knowledge, fear of side effects, misconceptions], sociocultural [stigma, religious beliefs, parental disapproval], economic [cost of services and transportation], health system-related [provider attitudes, confidentiality concerns, facility accessibility], and policy/legal [age restrictions, mandatory parental consent, poor coordination among agencies]. The findings highlight how these multi-level barriers intersect to impede adolescents' access to contraception, contributing to high rates of early pregnancy, unsafe abortion, and sexually transmitted infections. Notably, research gaps remain regarding marginalised groups such as LGBTQ+ youth and adolescents with disabilities. The review emphasises the need for adolescent-centred policy reforms, improved provider training, expanded community engagement, and equitable financing mechanisms to support adolescent access to contraception. These findings can inform strategies for achieving the Sustainable Development Goals (SDGs) related to health and gender equality in Sub-Saharan Africa. Main findings: There exist persistent individual, sociocultural, economic, policy and legal restrictions, and health system barriers that reinforce adolescents’ resistance to accessing contraceptive services in Sub-Saharan Africa.Added knowledge: This review provides consolidated evidence on the barriers that reinforce adolescents’ resistance to accessing contraceptive services in Sub-Saharan Africa, by providing a structured overview to guide research, practice, and policy discussions.Global health impact for policy and action: By consolidating current knowledge, the review guides global health strategies and policy actions to strengthen adolescent-centred contraceptive service delivery and advance sexual and reproductive health equity across low-resource settings.
Intermediate Care (IMC) provides intensive rehabilitation to prevent long-term disability among partially dependent individuals. Demand for IMC in Thailand is rising, yet governance frameworks remain underdeveloped. The Seamless Health and Social Services Provision for Elderly Persons (S-TOP) project, a Japan International Cooperation Agency (JICA) pilot, aimed to strengthen IMC governance by improving service delivery for older adults. To explore and compare the governance models of IMC in two pilot sites in Thailand from the viewpoints of health and social service providers. We explored IMC governance within JICA pilot sites through a qualitative comparative case design. We gathered data from 13 in-depth interviews, site visits, and document reviews. Using thematic analysis, we compared different governance patterns from the provider's perspective to understand how local contexts shape implementation, transdisciplinary teamwork, and overall governance. Two distinct governance models emerged, both perceived by stakeholders as having achieved integration of health and social care. The lead organization model enabled direct service creation and flexible resource allocation, while the shared governance model leveraged strong health care networks and community altruism to coordinate care within the national framework. Despite differing in seniority structures, with one based on position and the other on age, both models enhanced service accessibility and promoted health equity through tailored, community-based systems. Community-based IMC governance succeeds when aligned with local structural and cultural contexts. The integration of health and social care requires adaptable mechanisms, whether through local government leadership or collaborative health care networks, while respecting culturally embedded decision-making norms. The lead organization model suits decentralized settings with strong local government. The shared governance model suits centralized settings with robust health care networks and cultural assets like age-based seniority and altruism. Health administrators should cultivate transdisciplinary teams that integrate professional expertise with community knowledge and respect local decision-making norms.
Under the initiative of China's "Internet+" strategy, smart elderly care reflects the government's capacity to bridge the digital divide and provide inclusive care services for older adults. Though studies have identified positive associations between smart elderly care and health outcomes, empirical research examining its impact on older adults' subjective well-being remains limited. This study utilizes data from the 2021 Chinese Longitudinal Healthy Longevity Survey (CLHLS, N = 8,950), which includes multifaceted information on individuals aged 65 and above, covering their personal characteristics, health status, family information, and community elderly care services. A logit model is employed to investigate the association between smart elderly care and SWB. The mediating effects are tested using the bootstrap resampling method. To address endogeneity concerns, instrumental variable (IV) approaches including IV-Probit and 2SLS are applied as robustness checks. The results reveal a positive correlation between smart elderly care and older adults' subjective well-being (β = 0.101, p < 0.01). This association is partially mediated by both health status (proportion mediated: 38.47%) and social activities (proportion mediated: 2.65%). Heterogeneity analyses show that this positive association holds consistently across both rural and urban older adults, and is more pronounced among those with lower digital literacy. This study challenges the prevailing assumption that the "digital divide inevitably isolates the older adults from participating in a digitized society." By integrating digital technologies into older adults care services, we demonstrate that smart elderly care is positively associated with bridging technological barriers and addressing the unmet needs of aging populations. These findings further propose a synergistic mechanism-policy innovation, technological adaptation, and service optimization, to build an inclusive older adults care ecosystem, offering evidence-based insights for policymakers in aging societies to balance equity and efficiency in digital transformation.
With ageing populations and increasing demand for aged care, quality of life (QoL) has become a central focus of recent policy reforms in Australia and other countries. The Quality of Life-Aged Care Consumer (QOL-ACC), a preference-based measure, was introduced as a mandatory national quality indicator across Australia in 2023 to support assessment and public reporting of variation in QoL across long term aged care facilities (LTCFs). While its national implementation is a significant step forward, further guidance is needed to support the interpretation of QOL-ACC scores in practice. Therefore, this study aimed to identify an empirical reference point on the QOL-ACC to aid interpretation of scores in LTCFs. Data were collected through self-reports from LTCFs residents and proxy reports from informal carers. An anchor-based method was used, comparing QOL-ACC summative scores (range: 0 to 24; higher scores indicate better QoL) against two global items of health and QoL. Receiver Operating Characteristic (ROC) curve analysis assessed the discriminative ability of different QOL-ACC scores in identifying residents who rated their global health or quality of life as "good" or better. Sensitivity, specificity, and area under the curve (AUC) were calculated. Of the total 316 care recipients included (200 [62.5%] self-reports and 116 [37.5%] proxy-reports), the majority were female (64.2%) with a mean age of 84 ± 8.2 years. A QOL-ACC summative score of ≥ 18 was identified as the optimal reference threshold for indicating good quality of life, with a sensitivity of 76%, specificity of 78%, and an AUC of 0.83 (95% CI 0.78-0.87), indicating good discriminative ability. This study provides a practical and evidence-based interpretive reference point for QOL-ACC scores in long-term care facilities. The identified cut-off may support interpretation of QOL-ACC outcomes in routine quality monitoring and inform care planning, service evaluation, and quality improvement interventions. As the population ages, improving quality of life (QoL) in aged care has become a major priority in Australia and other countries. The QOL-ACC is a national quality indicator introduced in 2023 to measure the quality of life of people living in aged care facilities. However, staff and policymakers need clearer guidance on how to understand and use these scores in practice. This study aimed to identify a practical reference point on the QOL-ACC scale. We analysed survey data from 316 long-term care residents and compared QOL-ACC scores with residents’ overall ratings of their health and quality of life. We found that a score of 18 provides a practical reference threshold for interpreting QOL-ACC results. Scores above this level may reflect a good standard of quality of life, while lower scores may indicate poorer QoL. This reference point may help aged care providers and policymakers better understand quality of life outcomes and support improvements in care. This threshold should be used with caution and alongside other quality of life information.
The development and integration of geriatric medicine into national health care systems vary widely across countries. While a robust care workforce requires providers from several disciplines, including nursing, social sector, rehabilitation, psychiatry, neurology, and others, a strong core of highly qualified geriatricians is essential to delivering older person-centred and integrated care. The number and professional profile of geriatricians, along with the status of the specialty, are important to informing efforts to reshape health care systems in response to the global ageing scenario. WHO developed and distributed a structured questionnaire to representatives of national geriatrics and gerontology societies beginning in March 2025. The survey collected data on the status of the geriatric medicine specialty, including its formal recognition at the country level, the estimated number of practising geriatricians, and information on training curricula, professional environments, and systemic challenges. A total of 48 national societies completed the survey. Recognition of geriatric medicine ranged widely, from full specialty status in some countries to subspecialty or non-recognition in others. The number of practicing geriatricians per 100,000 persons aged 60 years and older ranged from <0.1 to >30 across countries, illustrating marked workforce disparities and some severe shortages. Where the geriatric medicine specialty is formally available, pre-service training durations ranged from 24 to 96 months. Geriatricians worked in diverse settings, though integration into primary care and public health was limited. Training in and exposure to geriatric medicine principles during undergraduate and postgraduate medical training were minimal in many countries. Key challenges included workforce shortages, fragmentation of care, and undervaluation of the speciality's role in informing health care for older people. Strategic priorities reported by respondents included investment in training, policy development, and institutional support. The survey highlights disparities in geriatric medicine across countries and identifies several challenges and priorities. Strengthening education, policy, and workforce development is essential to meet the needs of ageing populations and support healthy ageing worldwide. At the same time, countries should also think of innovative approaches and building capacity of existing other health occupations to improve geriatric care. Future updates of this survey will provide longitudinal insights into workforce evolution. These findings provide a global evidence base to guide workforce planning and policy under the United Nations Decade of Healthy Ageing (2021-2030).