Urinary incontinence (UI) in older women in low- and middle-income countries: a rapid review and case study from Burkina Faso

The prevalence of urinary incontinence (UI) in older women in low- and middle-income countries (LMICs) is not well understood. We conducted a rapid literature review to assess the burden of UI in this population and contextualize findings from a household survey of women aged 40 and older in Nouna, in northwestern Burkina Faso. The rapid review included 21 survey articles. UI prevalence for LMIC women 40 or older varied greatly (6%–80%), with differences by socio-demographics, gynecological factors (menopausal status, birth outcomes), comorbidities (age, education, obesity, diabetes, hypertension, arthritis), behaviors (smoking status) and survey location. The studies used validated tools—the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ UI-SF) was most common (n = 4, 19%)—and bespoke tools that have not yet been validated. In Nouna, 983 (64.5%) of 1,524 women, completed the ICIQ UI-SF. Overall UI prevalence, defined as reporting leakage at least 2–3 times a week, was 2.6% (95% CI 1.73%–3.85%), descriptively increased with age from 0.5% in 40–49 year-olds to 6.6% in those 70 and over. Of those with UI, 88.5% experienced leakage daily, and 50% reported moderate or greater interference with daily life, yet most (88.5%) had not spoken to a healthcare provider. Multivariable analysis revealed that UI was more common among women who were not currently married and decreased with higher education levels. Both the rapid review and survey highlight the burden of UI among older women in LMICs, particularly as they age beyond 60. Given UI's association with physical and mental health, it is crucial to raise awareness of its burden, improve healthcare access, and integrate routine screening into basic healthcare services. Additionally, training healthcare providers and developing culturally appropriate interventions will help address stigma and ensure effective management of UI in this vulnerable population

Frailty progression in adults aged 40 years and older in rural Burkina Faso: a longitudinal, population-based study

BACKGROUND: Little is known about ageing and frailty progression in low-income settings. We aimed to describe frailty changes over time in individuals living in rural Burkina Faso and to assess which sociodemographic, disability, and multimorbidity factors are associated with frailty progression and mortality. METHODS: This longitudinal, population-based study was conducted at the Nouna Health and Demographic Surveillance Systems (HDSS) site in northwestern Burkina Faso. Eligible participants were aged 40 years or older and had been primarily resident in a household within the HDSS area for at least the past 6 months before the baseline survey and were selected from the 2015 HDSS household census using a stratified random sample of adults living in unique households within the area. Participants were interviewed in their homes in 2018 (baseline), 2021 (follow-up), or both. We derived the Fried frailty score for each participant at each timepoint using data on grip strength, gait speed, self-reported weight loss, self-reported exhaustion, and physical activity, and described changes in frailty status (no frailty, pre-frailty, or frailty) between 2018 and 2021. We used multivariate regression models to assess factors (ie, sex, age, marital status, educational attainment, wealth quintile, WHO Disability Assessment Schedule (WHODAS) score, and multimorbidity) associated with frailty progression (either worsening frailty status or dying, compared with frailty status remaining the same or improving) and with mortality, and developed sequential models: unadjusted, adjusting for sociodemographic factors (sex, age, marital status, educational attainment, and wealth quintile), and adjusting for sociodemographic factors, disability, and multimorbidity. FINDINGS: Between May 25 and July 19, 2018, and between July 1 and Aug 22, 2021, 5952 individuals were invited to participate: 1709 (28·7%) did not consent, 1054 (17·8%) participated in 2018 only and were lost to follow-up, 1214 (20·4%) participated in 2021 only, and 1975 (33·2%) were included in both years or died between years. Of 1967 participants followed up with complete demographic data, 190 (9·7%) were frail or unable to complete the frailty assessment in 2018, compared with 77 (3·9%) in 2021. Between 2018 and 2021, frailty status improved in 567 (28·8%) participants and worsened in 327 (16·6%), and 101 (5·1%) participants died. The relative risk of frailty status worsening or of dying (compared with frailty impRoving or no change) increased with age and WHODAS score, whereas female sex appeared protective. After controlling for all sociodemographic factors, multimorbidity, and WHODAS score, odds of mortality were 1·07 (odds ratio 2·07, 95% CI 1·05-4·09) times higher among pre-frail individuals and 1·1 (2·21, 0·90-5·41) times higher among frail individuals than among non-frail individuals. INTERPRETATION: Frailty status was highly dynamic in this low-income setting and appears to be modifiable. Given the rapid increase in the numbers of older adults in low-income or middle-income countries, understanding the behaviour of frailty in these settings is of high importance for the development of policies and health systems to ensure the maintenance of health and wellbeing in ageing populations. Future work should focus on designing context-appropriate interventions to improve frailty status. FUNDING: Alexander Von Humboldt Foundation, Institute for Global Innovation, University of Birmingham, and Wellcome Trust

Logistiek Biobased Economy: toekomstbeelden 2025 & agenda 2013-2017

Naast de afzetmogelijkheden van biobased producten (markten) en de technologische verwerkingsmogelijkheden, bepalen de beschikbaarheid, handel en logistiek in sterke mate de wijze waarop de biobased economy in Nederland zich zal ontwikkelen. Het is noodzakelijk in de komende jaren duurzame, economisch rendabele logistieke biomassaketens op te zetten. Op dit terrein bestaat nog veel onduidelijkheid. Het doel van het project is het vormen van: gedragen toekomstbeelden van de logistiek in de biobased economy in 2025 en een gedragen agenda met actiepunten voor 2013-2017 (ofwel waarmee moeten we starten in de eerstkomende 5 jaar om de toekomstbeelden te bereiken)

Practices and Obstacles to Provider-Initiated HIV Testing and Counseling (PITC) Among Healthcare Providers in Côte d’Ivoire

Practices of Provider-Initiated HIV Testing and Counseling (PITC) remains suboptimal in Côte d'Ivoire. The aim of this survey was to identify the practices and obstacles to PITC among healthcare professionals in Côte d'Ivoire. A nationally representative cross-sectional survey was conducted in 2018 by telephone among three separate samples of midwives, nurses and physicians practicing in Côte d'Ivoire. The number of HIV tests proposed during consultation in the month preceding the survey was collected for each professional. Factors associated with the number of proposed tests were identified through ordinal logistic regression models. A total of 298 midwives, 308 nurses and 289 physicians were interviewed. Midwives proposed the test more frequently, followed by nurses and physicians. Among midwives, a higher number of proposed tests was associated with the perception that HIV testing does not require specific consent compared to other diseases (aOR 4.00 [95% CI 1.37-14.29]). Among nurses, having received HIV training and the presence of community HIV counselors were associated with a higher number of proposed tests (aOR 2.01 [1.31-3.09] and aOR 1.75 [1.14-2.70], respectively). For physicians, the presence of a voluntary testing center was associated with a higher number of proposed tests (aOR 1.69 [1.01-2.86]). PITC practices and barriers differed across professions. Beyond improving environmental opportunities such as dedicated staff or services, strengthening the motivations and capabilities of healthcare professionals to propose testing could improve PITC coverage

Invisible geographies - the rural and coastal blind spot in UK cancer policy: A content analysis

Background The United Kingdom’s (UK) diverse geography means many people live in rural and coastal areas, where cancer outcomes are often poorer than in urban settings. Devolution means that the four nations of the UK have distinct approaches to cancer care. Scotland, Wales, and Northern Ireland have recently published national cancer strategies, while England’s new plan is expected later in 2025. This study examined UK cancer policy documents, to identify, how, and to what extent, rural or coastal issues were considered. Methods UK cancer policy documents from 2000 to 2024 were sourced via The International Cancer Control Partnership (ICCP) website (https://iccp-portal.org/), UK government sites and Google. Documents were searched for rural and coastal related terms. Results Fifty-five documents were included (England n = 17; Northern Ireland n = 10; Scotland n = 21; Wales n = 7). No recent policies included a specific section or explicit recommendations for rural or coastal cancer care. Across the policies, contextual analysis highlighted that terms to promote rural or coastal equity rarely appeared within recommendations. Northern Ireland gave more attention to rural issues than other nations, as evidenced by a rural needs impact assessment and supporting documents to inform Northern Ireland’s Cancer Strategy 2022–2032. Conclusion Despite sizeable rural and coastal populations facing specific health challenges across the UK, national cancer policies excepting Northern Ireland gave minimal guidance for delivering cancer care tailored to these communities. Other UK nations should consider adopting more rural-centric approaches like Northern Ireland. Policy summary Coastal and rural health issues have received policy attention via the Chief Medical Officer for England’s annual reports (2021; 2023) and more recently in the UK Government’s 10 Year Health Plan for England (July 2025). However, when it comes to high-level cancer policy across the UK, the needs of rural and coastal people with cancer are not being adequately or specifically recognised