The role of puppetry in mental health promotion: A scoping review of its efficacy and applications

Puppetry-based interventions have gained recognition as a potential tool in therapeutic, educational, and social contexts, offering unique benefits in emotional expression, anxiety reduction, and social skills development, thereby contributing to mental health promotion. This review aims to bridge the gap between practice and theory, providing a comprehensive understanding of the role of puppetry in therapeutic and educational settings for promoting mental health. A scoping review was conducted using the PICOS framework and PRISMA-ScR guidelines, examining studies across 16 databases up to August 2024. This review evaluated 30 studies to assess the effectiveness of puppetry-based interventions across diverse populations, including children, adolescents, and vulnerable groups such as refugees and the elderly. The findings demonstrate significant improvements in emotional regulation, anxiety management, and social interaction, particularly in pediatric and educational settings. However, the review also identifies critical gaps in the literature, including the limited use of large-scale randomized controlled trials, a scarcity of longitudinal studies, and inconsistent application of theoretical frameworks. These gaps highlight the need for more rigorous and theoretically grounded research to fully optimize the benefits of puppetry-based interventions. This review consolidates existing evidence and offers a roadmap for future research, emphasizing the importance of standardized protocols and long-term outcome evaluations. The findings contribute to the growing recognition of puppetry as a valuable tool in therapeutic and educational practices, offering insights into how these interventions can be effectively tailored to meet the needs of diverse populations

Harnessing artificial intelligence for predictive modeling in combating antimicrobial resistance: a call for integration and innovation

Antimicrobial resistance (AMR) represents a critical global health challenge with profound socioeconomic and public health implications. The rise of resistant microorganisms undermines the effectiveness of antibiotics, antivirals, antifungals, and other antimicrobial agents, leading to increased mortality, prolonged illnesses, and escalating medical costs. This study underscores the urgent need for innovative solutions, focusing on the integration of artificial intelligence (AI) to combat AMR. AI, with its rapid data processing, predictive modeling capabilities, and cost-effectiveness, emerges as a transformative tool in mitigating this global crisis. AI-driven predictive models have demonstrated remarkable accuracy in identifying AMR patterns by analyzing vast datasets encompassing patient demographics, antibiotic usage, and environmental factors. These models enhance the precision of antibiotic therapy, guide antimicrobial stewardship programs, and provide early warnings for resistance outbreaks. Furthermore, AI facilitates the development of novel antimicrobial agents, accelerates drug discovery, and supports precision medicine by tailoring treatments to individual patients' profiles. The effective application of AI in addressing AMR necessitates interdisciplinary collaboration among healthcare professionals, microbiologists, policymakers, and AI specialists. This paper calls for robust policy frameworks, dedicated funding, and global partnerships to integrate AI into healthcare systems for AMR surveillance, prevention, and control. Embracing AI innovation is pivotal to safeguarding global public health and ensuring a sustainable future free from the threat of antimicrobial resistance

Projected uptake of sulfadoxine-pyrimethamine for perennial malaria chemoprevention in children under 2 years of age in nine sub-Saharan African countries: an epidemiologically-based 5-year forecast analysis.

BACKGROUND: Perennial malaria chemoprevention (PMC) with sulfadoxine-pyrimethamine (SP) is recommended for children under 2 years of age living in areas of perennial malaria transmission. Initially delivered through the Expanded Programme of Immunization (EPI), recent pilot studies explored PMC delivery via the vitamin A supplementation programme or community health workers (CHWs). Understanding SP demand across the various delivery channels is key to implementing PMC. METHODS: A 5-year epidemiologically-based forecasting model was developed to estimate SP volumes required for nine sub-Saharan countries based on seven different scenarios considering the EPI, vitamin A or CHWs delivery channels, alone or in combination. Model inputs were secondary data sources, enhanced with information from a field survey conducted among 40 national decision-makers and 176 healthcare providers. Projected SP volumes were estimated based on expected coverage and uptake within the eligible population. The efficiency of meeting the need versus demand was calculated for each scenario. A sensitivity analysis was performed for base, low and high estimates of the coverage and uptake rates. The forecasting period was 2023 to 2027. RESULTS: The eligible population in the study countries was estimated at 21 million children in 2023. Estimated demand in 2027 ranged from 17.8 million SP doses for EPI to 49.6 million when combining all delivery channels. These results were highly dependent on the coverage and uptake rate of each delivery channel. The sensitivity analysis showed that uncertainty around the estimates ranged from twofold (Vitamin A), to 3.4-fold (CHWs). EPI was the most efficient channel overall (53%), but the efficiency of each scenario varied by country depending on local contexts. CONCLUSIONS: The model provides a tool to anticipate SP needs and demand for PMC under various scenarios, aiding manufacturers, donors, partners, governments, and procurement organizations in effective planning for PMC implementation

Sexual and Reproductive Health Education Interventions Conducted across the League of Arab States: A Regional Scoping Review

Purpose of Review: Women and men in the League of Arab States (LAS) face significant barriers in accessing comprehensive sexual and reproductive health (SRH) information due to cultural taboos, gender inequality, and structural limitations within health and education systems. Despite increasing global recognition of the importance of SRH education, interventions in the LAS remain fragmented and under-evaluated. This scoping review aims to identify, describe, and appraise existing interventions addressing SRH education-related outcomes across LAS countries, with a focus on assessing their effectiveness, limitations, and areas for future research and policy development. Recent Findings: Fourteen studies met inclusion criteria, representing diverse interventions including school-based, community-led, peer-supported, mHealth, and clinical-provider-based approaches. While many interventions demonstrated improvements in SRH knowledge and attitudes, significant barriers such as provider stigma, lack of parental and community support, and gender-based restrictions persist. Gaps remain in addressing the needs of marginalized populations, including refugees and LGBTQ + youth, and few studies report long-term behavioral outcomes. Summary: Effective SRH education interventions in the LAS require culturally sensitive, inclusive, and sustainable models integrated within health and education systems. Future research and policy should prioritize long-term evaluations and target underserved populations to ensure equitable access to SRH education and services

How inclusive were strategies to prevent the spread of COVID-19 for people with disabilities? Evidence from qualitative research in eight low- and middle-income countries.

BACKGROUND: From the outset of the pandemic there were calls to ensure people with disabilities were included in prevention and response measures, given their increased risk of health consequences from COVID-19 infection. This study sought to explore people with disabilities' experiences of inclusion in the response to the COVID-19 pandemic, to understand how such responses can be more inclusive in the future. METHODS: Qualitative interviews were conducted with 372 people with disabilities and their caregivers in Bangladesh, Ghana, India, Peru, Thailand, Türkiye (with Syrian refugees), Viet Nam, and Zimbabwe between 1 December 2020 and 28 February 2023, and analysed using thematic analysis. RESULTS: The study found that people with disabilities demonstrated high levels of knowledge about COVID-19 and were willing to adhere to prevention measures. However, participants noted that countries' COVID-19 responses were largely not inclusive of people with disabilities; that pandemic information was seldom available in accessible formats; and that adhering to social distancing and other mandates was challenging and incurred personal and economic costs. CONCLUSIONS: Consequently, the pandemic compounded existing barriers and inaccessibility experienced by people with disabilities and contributed to inequality

Inclusive policy development from the ground up: Insights from the household water-energy-food nexus

Despite substantial contemporary research and a growing trend in exploring the water-energy-food (WEF) nexus, most research efforts have been invested in macro-level supply-side infrastructure and policies. However, prioritizing demand-side management policies can provide new opportunities and untapped potential for addressing interconnected resource challenges. Demand management inherently encompasses users’ consumption patterns, behaviors, socio-economic conditions, and choices, thereby necessitating active engagement and participation. Understanding household-level demands is fundamental to assess the demand for and consumption of water, energy, and food, as well as to inform policy decisions. In this context, our study investigated household consumption patterns within the interconnected WEF nexus, including daily practices such as cooking and washing, conservation measures, household governance, and their cross-cutting relationships with climate change. As a case study, we conducted our research in the Jabal Al Natheef neighborhood of Amman City, Jordan. Our findings reveal that households can propose and enact climate-friendly decisions. Significant gender-related differences were also observed in decisions made across WEF household practices. Additionally, households’ perspectives highlighted governance issues and revealed gaps in policy implementation along with the need for more inclusive decision-making processes. Our results underscore the importance of understanding household-level WEF nexus dynamics and daily practices in informing environmental policies, particularly those related to climate action. Such policies are best developed from the bottom-up by incorporating household insights, rather than relying solely on top-down, one-size-fits-all solutions

Intermittent suppressive posaconazole therapy is ineffective at mitigating cardiac and digestive tract pathologies in an experimental model of chronic Chagas disease.

Infections with Trypanosoma cruzi cause Chagas disease, a chronic condition that can give rise to debilitating cardiac and/or gastrointestinal damage. However, it is unclear why only ~30% of individuals progress to symptomatic pathology, why this can take decades to become apparent, and why there is such a wide range of disease outcomes. Disease pathology is a long-term cumulative process resulting from collateral damage caused by inflammatory immune responses that continually eliminate transient parasite infections in the heart and/or gastrointestinal tract. The guiding principle behind anti-parasitic drug development is that a sterile cure is required to prevent progression to symptomatic pathology. Evidence suggests that the cumulative damage required to reach the symptomatic threshold is determined by a number of factors, including host and parasite genetics, which govern the intensity and location(s) of infection. Therefore, an alternative therapeutic strategy could involve long-term intermittent treatment, which may not confer sterile cure but is able to suppress the parasite burden to a level where the disease does not become symptomatic within the lifetime of the infected individual. To test this hypothesis, we used an experimental murine model that displays both cardiac and digestive tract pathologies. Mice were given intermittent treatment with posaconazole under conditions that initially reduced the parasite burden by >99% but did not confer sterile clearance. Our results show that this did not provide long-term protection against the key cardiac or gastrointestinal manifestations of Chagas disease, and that sterile cure should remain the single goal of the drug development community

Does enhanced HIV prevention, diagnosis, and linkage to care reduce hospitalisation in high HIV-burden communities in Zambia and South Africa? findings from the HPTN 071 (PopART) randomised trial.

ClinicalTrials.gov NCT01900977

Comparison of an Open versus List-Based Dietary Recall Method to Assess Unhealthy Feeding Practices among Infants and Young Children.

BACKGROUND: Collecting accurate dietary data is critical for assessing infant and young child feeding practices, identifying populations at risk, and using evidence to inform policy. In 2021, World Health Organization/United Nations Children's Fund released new indicators of unhealthy food and beverage consumption and recommended that survey administrators use either an open or list-based method. OBJECTIVES: This study compared infants' and young children' unhealthy food consumption estimated using an open 24-h recall (24HR) compared with list-based 24HR among young children living in peri-urban Cambodia and explored the effect of social desirability bias on respondents' responses. METHODS: We conducted a secondary analysis of unhealthy food consumption estimated in a longitudinal cohort study implemented from June 2021 through January 2022 in the rural/peri-urban district of Khsach Kandal, Kandal Province, Cambodia (567 children aged 10-13.9 mo at baseline). Each month, for 5 mo, data were collected via an open 24HR. At the 6th month, half of the children were randomly assigned to also receive a list-based 24HR to collect data on unhealthy food consumption. RESULTS: The prevalence of sweet beverage and unhealthy food consumption and zero fruit and vegetable consumption among young children was high. We observed that the percentage of children consuming sweet foods was significantly higher when estimated using the list-based compared with an open 24HR method (61.6% compared with 43.8%; P = 0.012). An association between social desirability bias and reported consumption of salty/fried foods was also observed across both groups; however, this relationship was more pronounced among caregivers who received the list-based 24HR than the open 24HR (P = 0.004). CONCLUSIONS: Researchers must carefully consider the method used for 24HR because this may have implications for respondents' recall and memory. As more evidence is collected on the rising consumption of unhealthy food and beverages among young children, researchers should take into consideration the effects of caregiver's susceptibility to social desirability bias when analyzing these consumption patterns

The first BILGENSA Research Network workshop in Zambia: identifying research priorities, challenges and needs in genital bilharzia in Southern Africa [version 2; peer review: 3 approved, 1 approved with reservations]

Female genital schistosomiasis (FGS) and male genital schistosomiasis (MGS) are gender-specific manifestations of urogenital schistosomiasis. Morbidity is a consequence of prolonged inflammation in the human genital tract caused by the entrapped eggs of the waterborne parasite, Schistosoma (S.) haematobium.Both diseases affect the sexual and reproductive health (SRH) of millions of people globally, especially in sub-Sahara Africa (SSA). Awareness and knowledge of these diseases is largely absent among affected communities and healthcare workers in endemic countries. Accurate burden of FGS and MGS disease estimates, single and combined, are absent, mostly due to lack of awareness of both diseases and absence of standardized methods for individual or population-based screening and diagnosis. In addition, there are disparities in country-specific FGS and MGS knowledge, research and implementation approaches, and diagnosis and treatment. There are currently no WHO guidelines to inform practice. The BILGENSA (Genital Bilharzia in Southern Africa) Research Network aimed to create a collaborative multidisciplinary network to advance clinical research of FGS and MGS across Southern African endemic countries. The workshop was held in Lusaka, Zambia over two days in November 2022. Over 150 researchers and stakeholders from different schistosomiasis endemic settings attended. Attendees identified challenges and research priorities around FGS and MGS from their respective countries. Key research themes identified across settings included: 1) To increase the knowledge about the local burden of FGS and MGS; 2) To raise awareness among local communities and healthcare workers; 3) To develop effective and scalable guidelines for disease diagnosis and management; 4) To understand the effect of treatment interventions on disease progression, and 5) To integrate FGS and MGS within other existing sexual and reproductive health (SRH) services. In its first meeting, the BILGENSA Network set forth a common research agenda across S. haematobium endemic countries for the control of FGS and MGS