A scoping review of the health and health-related sustainable development goals (HHSDGs) in Ghana: progress and challenges

Background: Sustainable Development Goal (SDG) 3 prioritises the promotion of equitable health outcomes and universal health coverage. In Ghana, there is limited information on the current implementation progress and challenges of the health and health-related SDGs (HHSDGs). The aim of this review was to conduct a situational analysis of the HHSDGs in Ghana whilst providing in-depth and updated literature on their implementation progress and challenges.Methods: We conducted a scoping review guided by the Arksey and O’Malley framework. The Population, Concept and Context (PCC) framework was used to select literature. Peer-reviewed and grey literature with data collected between September 2015 and October 2022 were used. Exclusion criteria included non-HHSDG topics and studies outside the timeframe. Data were retrieved from Scopus, PubMed, Medline, CINAHL, EBSCOhost and grey literature sources. The process yielded 37 peer-reviewed articles and 14 grey literature records, comprising 11 organisational reports from websites, 2 theses, and 1 blog post. Systematic screening, guided by the PRISMA-ScR, and quality appraisal, using the Mixed Methods Appraisal Tool, were performed. Thematic synthesis was employed for the analysis of the data.Results: Health and wellbeing (SDG 3), climate change and climate action (SDG 13), gender equality (SDG 5), zero hunger (SDG 2), and clean water and sanitation (SDG 6) were the identified HHSDGs. Mental health emerged as a key HHSDG, although not a stand-alone SDG. Our review indicates that Ghana has made progress in meeting some critical HHSDG targets, with further work needed to meet all targets. Ghana has made important progress toward the HHSDGs, including improvements in infectious disease control, access to clean water, gender equality initiatives, and the adoption of health innovations. Also, Ghana has significantly reduced the prevalence of overweight in children underfive. However, significant gaps remain in maternal and child health, mental health, sanitation, universal health coverage, and food security. These gapsare driven by persistent structural and socioeconomic barriers.Conclusions: These findings highlight the need for strengthened policies and targeted interventions to accelerate Ghana’s progress toward achieving the HHSDGs by 2030

Mediating democracy: Political communication, disinformation, and electoral contestation in Kenya

The role of the media, both traditional and digital, proves pivotal in Kenya’s elections, yet it operates within a highly politicised and sometimes repressive environment. This chapter explores the challenges posed to mainstream media houses and their alignment with power elites, due to the emergence of social media platforms as robust alternative spaces for political engagement. The analysis notes that these platforms offer space for greater public interaction and interventions into the information environment. However, there are also significant downsides due to the proliferation of misinformation, disinformation, and mal-information. The analysis also finds that whereas the internet has been celebrated as a more liberal and egalitarian information platform, there remains evidence of the normalisation of power relations. In Kenya we find the interests of the power elites still hold sway as they have the wherewithal to dominate the online information environment and appropriate divergent voices through orthodox and unorthodox means

Why do cesarean delivery rates persistently rise despite evidence-based efforts to reduce them?

Background Globally, cesarean delivery rates have increased steadily over the past 3 decades, beyond medically indicated limits. Research in the area tends to analyze clinical indications, with little attention to the nonclinical factors that are drivers of these increasing rates. This integrative review systematically synthesizes evidence on the structural, systemic, and sociocultural contributors to the global increase in cesarean delivery rates. Objective Critically identify the nonclinical determinants of global cesarean section overuse. Study Design A comprehensive integrative review of 144 article studies published between January 1990 and May 2025 that employed a hybrid deductive-inductive thematic synthesis approach was conducted. Articles were sourced from 6 databases and evaluated using the Critical Appraisal Skills Programme, the Mixed Methods Appraisal Tool, and a combined Authority, Accuracy, Coverage, Objectivity, Date, and Significance checklist with a policy relevance lens. Retained studies were categorized according to region, methodological design, and thematic focus. Deductive coding was used to develop a priori frameworks on legal, economic, health system, and rights-based drivers, whereas inductive coding was used to reveal emergent themes not explicitly theorized in previous literature. Results Of note, 5 core nonclinical drivers were identified: (1) medicolegal anxieties and defensive medicine; (2) financial and insurance-based incentives; (3) sociocultural preferences and aesthetic motivations; (4) health system weaknesses, including staffing and service delivery inefficiencies; and (5) reproductive rights and informed consent violations. These drivers intersected with 3 emergent themes: (1) media influence and digital normalization; (2) provider convenience and scheduling practices; and (3) patient mistrust, particularly among marginalized women. Studies revealed stark regional asymmetries: Latin America displayed the highest cesarean delivery rates, linked to private sector incentives and cultural constructs, and Africa and South Asia highlighted underuse or coerced use in public systems. Methodologically, most studies lacked intersectional or longitudinal designs, limiting insights into disparities and policy evolution. Conclusion Increasing cesarean delivery rates are the cumulative result of multiple drivers, such as structural imbalances, commodification of care, and institutional accountability gaps, and not just due to clinical processes. The interplay of profit, litigation fears, and social narratives drives unnecessary cesarean deliveries, whereas rights violations and systemic mistrust disproportionately affect vulnerable women and girls. Addressing these drivers will require multisectoral reforms, such as bundled payment models, consent safeguards, legal frameworks protecting both patients and providers, and regulation of digital health content. Future research should integrate intersectional and implementation science frameworks to generate actionable, equity-sensitive solutions for the sustainable reduction of cesarean delivery rates

Dietary diversity, undernutrition and anemia among rural adolescents in Sindh, Pakistan

Background: Adolescence is the second window of opportunity to catch-up growth, and children can attain their full physical growth potential. However, optimum dietary intake is essential for this. In this study, we aimed to estimate dietary diversity, stunting, thinness, and anemia among unmarried adolescent boys and girls in selected communities of rural Sindh, Pakistan.Methods: A cross-sectional survey of 788 unmarried 10-19-year-old adolescents in rural Sindh was conducted. Adolescents were interviewed using a food frequency questionnaire. Daily intake of at least 5 out of 10 food groups was labelled as having minimum dietary diversity following the Minimum Dietary Diversity for Women (MDDS-W) guide. Less than 2 standard deviations for z-scores of height for age and BMI for age were labelled as stunting and thinness, respectively. Anemia was defined as Hb less than 12 gm/dl for girls and for boys between the ages of 10–15 years. Cut-off of \u3c 13 gm/dl was used for anemia in boys more than 15 years of age. The Cox-proportional algorithm was used to analyze the associated factors of stunting, thinness, and anemia and prevalence ratios with 95% confidence interval were estimated.Results: Our study found that \u3c 1% of adolescents achieved minimum dietary diversity (MDD). There was a higher daily intake of sugar-sweetened beverages (SSB) and bread, and daily intake of meat, eggs, and nuts was among \u3c 1% of the participants. The sub-optimum dietary intake was reflected as high rates of stunting 31.9%, thinness 18.0%, and anemia 68.2% in our sample. Stunting and anemia were significantly higher among girls compared to boys (35.8% vs. 28.0%; 82.1% vs. 54.7% respectively). In sex-stratified analysis, the age of the adolescent and wealth quintiles were associated with stunting among girls. No other variables were associated with stunting, thinness, or anemia among girls and boys.Conclusion: The prevalence of low dietary diversity and anemia was alarmingly high in adolescents and calls for immediate attention. The high burden of stunting shows chronic undernutrition and missing the second window of opportunity during adolescence to gain potential adult height

Evaluating the safety and diagnostic performance of endoscopic ultrasound-guided fine-needle biopsy in the geriatric population

Background: Endoscopic ultrasound (EUS) has emerged as a key diagnostic and therapeutic modality due to its minimally invasive nature and high success rates. It is widely used for diagnosing and staging gastrointestinal (GI), pancreatobiliary, and lung malignancies. EUS-guided fine needle biopsy (EUS-FNB) provides preserved tissue architecture, improving histological diagnosis for such conditions. The elderly are at significantly higher risk of GI lesions, being ten times more prone to malignancy and experiencing higher mortality, thereby requiring safer and less invasive diagnostic approaches. Despite its increasing use, evidence on EUS-FNB safety and diagnostic yield in geriatric population, particularly from resource-limited settings, remains limited.Aim: To assess the indications, diagnostic efficacy, and safety profile of EUS-FNB in the geriatric population.Methods: This single-centre retrospective study included patients aged 65 years or above who underwent EUS-guided biopsy between June 2020 and June 2022 at Aga Khan University Hospital, a tertiary care centre in Karachi, Pakistan. Patient demographics, procedural details including lesion site, number of needle passes, needle type, and tissue acquisition technique, along with histopathological diagnosis, were extracted from medical records. Data were analysed using SPSS, with categorical variables reported as frequencies and percentages, and continuous variables as mean ± SD.Results: A total of 67 elderly patients were included, with a mean age of 72.7 ± 6.33 years; most were male (72%). The median duration of the EUS procedure was 19 (23) minutes. Most patients underwent biopsy for pancreatic lesions (40.3%), followed by mediastinal (16.4%) and gallbladder/common bile duct lesions (13.4%). In 31.4% cases, the specimen was obtained with 2 needle passes, while 41.4% required 1 pass and 22.9% required 3 passes. Multi-targeted biopsies using a single pass were performed in 7.5% cases. A Franseen-design needle was used in all cases, with 22G utilized in 92.5% and 25G in 7.5%. Diagnostic adequacy was 100%, with no procedure-related complications. Histopathology revealed pancreatic cancer (34.3%), benign lesions (28.4%), and metastatic renal carcinoma (6%).Conclusion: EUS-FNB is an effective minimally invasive diagnostic tool in elderly, demonstrating high diagnostic adequacy without complications. Future studies are warranted to further validate its safety and effectiveness in this population

Research NEXUS : Volume 35 – 2026

Researcher Spotlight Research Milestones & News Grant Writing Support Programme Catalyst for Funding Initiative Capacity Building Initiatives Unlocking Horizon Europe Understanding the Grant Lifecyle New Additions to the Team NIH Updates and Other Resources Explore New Funding Opportunitieshttps://ecommons.aku.edu/research_outlook/1034/thumbnail.jp

Acceptability of ambulance-based telemedicine (ABT) for paediatric emergencies in Karachi, Pakistan

Introduction: Globally, half of all 6.2 million deaths in children are caused by acute illnesses which can be prevented if diagnosed and treated in time. We hypothesise that long elapsed travel time and delay in care can be tackled using telemedicine. The objective of this study is to determine the acceptability of linking ambulances that transport acutely ill children to a remote paediatric emergency physician using a simple audiovisual device.Methods: We conducted a qualitative study to determine the acceptability of ambulance-based teleconsultation for the emergency care of acutely ill children informed by the Theoretical Framework of Acceptability. We developed semistructured guides using this framework and conducted five interviews with telemedicine physicians (TMPs), 18 interviews with parents of children who recently needed an ambulance and four focused groups with emergency medical technicians (EMTs) who transport children.Results: All participants were supportive of using the telemedicine consultation during ambulance transport in the proposed trial as they felt that having access to a video-based physician would offer prompt intervention, particularly for critically ill children in crowded cities and remote regions with scarce resources. Parents believed that ambulance-based telemedicine would enhance their trust in EMTs and reduce their stress. The concerns related to the intervention included parental reluctance in using video cameras due to privacy issues, doubts about doctors\u27 treatment reliability, risk of miscommunication and inadequate parental education. To address these challenges, the groups proposed solutions such as joint training for EMTs and TMPs, educating parents about intervention processes, improving telecommunication infrastructure and promoting public awareness.Conclusion: Parents, EMTs and TMPs mutually agreed that the use of telemedicine during ambulance transport can be successfully implemented through proper training and is acceptable in our population. All participants agreed that this intervention holds great potential to improve the survival of critically ill children

INSPIRE : Vol 9 Issue 1

Message from the Chair Neurology Trainee session Service Awards 2025 Dr Moiz Salahuddin & Dr Sajid Hameed in full swing Sections in action Poem - The New Year What academics are readinghttps://ecommons.aku.edu/inspire/1105/thumbnail.jp

In memoriam: Professor Dan J. Stein (1962-2025) — a global pioneer with an African heart

With profound sadness we mark the passing of Professor Dan J. Stein—clinician, scientist, philosopher, and friend. A pioneer of International and African psychiatry, and a central figure in global neuropsychopharmacology, he devoted his life to understanding and relieving the burden of mental disorders in South Africa, across the African continent, and worldwide. In his death, we have lost a true giant

Two-decade trends in colorectal cancer and cardiovascular disease-related mortality in the US adult population, 1999 to 2019

Background: Recent data report individuals with colorectal cancer (CRC) to be 2 to 4 times more likely to develop cardiovascular disease (CVD), while established CVD risk factors are linked with an elevated risk of CRC. This study aimed to evaluate national trends in combined CRC and CVD mortality in the United States and assess variations by demographic and geographic characteristics.Methods: Combined mortality-related deaths in the United States were extracted using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER). The Multiple Cause-of-Death Public Use record death certificates were studied to identify records in which both CRC and CVD were mentioned as either contributing or underlying causes of death on nationwide death certificates.Results: Between 1999 and 2019, a total of 1,303,016 CRC-related deaths occurred in individuals aged ≥25 years, of which 394,871 (31.8%) deaths also noted CVD. The overall CRC+CVD-related age-adjusted mortality rate per 100 000 declined from 12.06 in 1999 to 6.69 in 2019. The age-adjusted mortality rates were higher in men (11.1) versus women (7.2). Among young adults aged 35 to 44 years, the crude mortality rates increased annually by 1.8% from 1999 to 2019. The age-adjusted mortality rates were highest for non-Hispanic Black or African American individuals and lowest for non-Hispanic Asian or Pacific Island people (12.22 versus 6.19). The rates were higher in nonmetropolitan (9.77) than metropolitan (8.58) counties and varied by region, being highest in the Northeast (10.6), followed by the West (9.0), Midwest (8.4), and South (7.9).Conclusions: Nearly one-third of CRC-related deaths also involved CVD. Although combined mortality has declined overall, it remains disproportionately high among men, Black or African American individuals, and rural populations. Notably, mortality is increasing among adults aged 35 to 44 years, highlighting persistent disparities and the urgent need for integrated cardiometabolic prevention strategies in patients with cancer