The association of dental caries and periapical lesions with anthropometric measurements in postpartum women in Mangochi, Malawi

Background: Obesity, stunting, malnutrition and dental diseases are major public health challenges globally. Dental diseases and anthropometrics are of multifactorial nature and share the same risk factors; diet, socioeconomic status and education. People who have dental caries or periapiacl lesions suffer pain and discomfort during eating which might be associated with less food intake and low anthropometrics. No previous studies, that investigated the association of dental diseases (dental caries and periapiacl lesions) with anthropometric measurements (body mass index BMI and middle upper arm circumference MUAC) among post-partum women or in a rural Sub-Saharan Africa has been published before. Objective: The objective of this study was to investigate the association of dental caries and periapiapical lesions with anthropometric measurements (BMI and MUAC) among post partum women in rural Mangochi, Malawi. The study's hypothesis was that dental caries and periapiacl lesions are associated with low anthropometrics in this low resource setting in Sub-Saharan Africa. Methods: The study had cross-sectional design. The study used secondary data from larger nutrition interventional trial iLiNS-DYAD (www.ilins.org). The sample size of this study was 1016 participants. The anthropometric measures (BMI and MUAC), age, gestational age at enrolment and the number of previous pregnancies were collected during early pregnancy of maximum twenty weeks at the study enrolment. The dental data (periapical lesions and dental caries) and the gestational age at delivery were collected postpartum within maximum 6 weeks of delivery. Unadjusted multinomial logistic regression was performed to investigate the association among variables. Results: 1016 women were enrolled in the study, with the age range of 14-49 years and the mean age of 25.5 years. Of the study participants, 580 (57.1%) had one or more carious teeth and 240 (23.6%) had one of more periapical lesions. For the anthropometrics, 54 participants (5.3%) had low BMI, 844 (83.1%) had moderate BMI and 118 (11.6%) had high BMI. Measuring the MUAC, 71 participants (7%) had low MUAC, 603 (59.4%) had moderate MUAC and 342 (33.6%) had high MUAC. The study did not find statistically significant association of dental caries and periapical lesions with BMI (low or high) or low MUAC. Nevertheless, there was a statistically significant association between caries and high MUAC (OR= 1.3, 95% CI 1.0 - 1.7, p=0.046) and stronger significant association between periapical lesions and high MUAC (OR=1.6, 95% CI 1.2 - 2.2, p= 0.002). Conclusion: The study results suggest rejecting the hypothesis that dental caries and periapical lesions are associated with low anthropometric measurements (BMI and MUAC) among the study participants. Further studies are recommended to investigate whether the association of dental caries and periapical lesions with high MUAC is causal or could be better explained by the common risk factors

Strengthening health systems and peacebuilding through women's leadership: a qualitative study.

BACKGROUND: Active and protracted conflict settings demonstrate the need to prioritise the peace through health agenda. This can be achieved by reorienting attention toward gender diverse leadership and more effective governance within health systems. This approach may enable women to have a greater voice in the decision-making of health and social interventions, thereby enabling the community led and context specific knowledge required to address the root causes of persistent inequalities and inequities in systems and societies. METHODS: We conducted a qualitative study, which included semi-structured interviews with 25 key informants, two focus group discussions and one workshop with humanitarian workers in local and international non-governmental organisations (NGOs), United Nations (UN) agencies, health practitioners, and academics, from Sub-Saharan Africa, Middle East and North Africa (MENA), and Latin America. Findings were then applied to the peacebuilding pyramid designed by John Paul Lederach which provides a practical framework for mediation and conflict resolution in several conflict-affected settings. The purpose of the framework was to propose an adapted conceptualisation of leadership to include women's leadership in the health system and be more applicable in protracted conflict settings. RESULTS: Five interrelated themes emerged. First, perceptions of terms such as gender equality, equity, mainstreaming, and leadership varied across participants and contexts. Second, armed conflict is both a barrier and an enabler for advancing women's leadership in health systems. Third, health systems themselves are critical in advancing the nexus between women's leadership, health systems and peacebuilding. Fourth, across all contexts we found strong evidence of an instrumental relationship between women's leadership in health systems in conflict-affected settings and peacebuilding. Lastly, the role of donors emerged as a critical obstacle to advance women's leadership. CONCLUSION: Continuing to empower women against social, cultural, and institutional barriers is crucial, as the emerging correlation between women's leadership, health systems, and peacebuilding is essential for long-term stability, the right to health, and health system responsiveness

Israeli necropolitics and the pursuit of health justice in Palestine.

We abhor the continuation and acceleration of the Israeli state's systemic violence against the Palestinian people. We reassert that resolution of the settler colonial root causes of violence in Palestine is central to the pursuit of justice and peace. The moral foundations of global health and medical practice require us to prioritise and foreground oppressed realities, and to practise epistemic resistance. Framing Palestinian violence on October 7 as provocation and Israeli violence as response is ahistoric and indicates indifference to the everyday violence experienced by Palestinians. The Israeli state practises both fast violence against Palestinians, while simultaneously creating the conditions for their ‘slow death’. The systematic targeting and destruction of the health system and healthcare workers in Gaza has been central to Israel's military strategy, while many Israeli officials have expressed clear genocidal intent. The occupation of Palestine demonstrates the horrors of Israeli necropolitics, which leads to the creation of 'death-worlds' in which people survive and resist in perpetual proximity to death

Community interventions for pandemic preparedness: A scoping review of pandemic preparedness lessons from HIV, COVID-19, and other public health emergencies of international concern.

Community action is broadly recognised as central to comprehensive and effective system responses to pandemics. However, there is uncertainty about how and where communities can be best supported to bolster long-term resilience and preparedness. We applied a typology of community interventions (Community Informing, Consulting, Involving, Collaborating or Empowering-or CICICE) to cover the diverse range of interventions identified across the literature and used this to structure a scoping review addressing three linked topics: (i) how CICICE interventions have been understood and applied in the literature on epidemic and pandemic preparedness; (ii) the spectrum of interventions that have been implemented to strengthen CICICE and (iii) what evidence is available on their effectiveness in influencing preparedness for current and future emergencies. We drew on peer-reviewed and grey literature from the HIV (from 2000) and COVID-19 pandemics and recent public health emergencies of international concern (from 2008), identified through systematic searches in MEDLINE, Scopus, the Cochrane Collaboration database, supplemented by keyword-structured searches in GoogleScholar and websites of relevant global health organisations. Following screening and extraction, key themes were identified using a combined inductive/deductive approach. 130 papers met the criteria for inclusion. Interventions for preparedness were identified across the spectrum of CICICE. Most work on COVID-19 focused on informing and consulting rather than capacity building and empowerment. The literature on HIV was more likely to report interventions emphasising human rights perspectives and empowerment. There was little robust evidence on the role of CICICE interventions in building preparedness. Evidence of effect was most robust for multi-component interventions for HIV prevention and control. Much of the reporting focused on intermediate outcomes, including measures of health service utilisation. We put forward a series of recommendations to help address evidence shortfalls, including clarifying definitions, organising and stratifying interventions by several parameters and strengthening evaluation methods for CICICE

Examining the Gender Imbalance in the National Community Health Assistant Program in Liberia: A Qualitative Analysis of Policy and Program Implementation.

The Revised National Community Health Services Policy (2016-2021) (RNCHSP) and its program implementation, the Liberian National Community Health Assistant Program (NCHAP), exhibit a critical gender imbalance among the Community Health Assistants (CHAs) as only 17% are women (MOH, 2016). This study was designed to assess the gender responsiveness of the RNCHSP and its program implementation in five counties across Liberia to identify opportunities to improve gender equity in the program. Using qualitative methods, 16 semi structured interviews were conducted with policymakers and 32 with CHAs, other members of the community health workforce and community members. The study found that despite the Government of Liberia's intention to prioritise women in the recruitment and selection of CHAs, the planning and implementation of the RNCHSP were not gender responsive. While the role of community structures, such as Community Health Committees, in the nomination and selection of CHAs is central to community ownership of the program, unfavourable gender norms influenced women's nomination to become CHAs. Cultural, social and religious perceptions and practices of gender created inequitable expectations that negatively influenced the recruitment of women CHAs. In particular, the education requirement for CHAs posed a significant barrier to women's nomination and selection as CHAs, due to disparities in access to education for girls in Liberia. The inequitable gender balance of CHAs has impacted the accessibility, acceptability, and affordability of community healthcare services, particularly among women. Strengthening the gender responsiveness within the RNCHSP and its program implementation is key to fostering gender equity among the health workforce and strengthening a key pillar of the health system. Employing gender responsive policies and programs will likely increase the effectiveness of community healthcare services

The association of dental caries and periapical lesions with anthropometric measurements in postpartum women in Mangochi, Malawi

Background: Obesity, stunting, malnutrition and dental diseases are major public health challenges globally. Dental diseases and anthropometrics are of multifactorial nature and share the same risk factors; diet, socioeconomic status and education. People who have dental caries or periapiacl lesions suffer pain and discomfort during eating which might be associated with less food intake and low anthropometrics. No previous studies, that investigated the association of dental diseases (dental caries and periapiacl lesions) with anthropometric measurements (body mass index BMI and middle upper arm circumference MUAC) among post-partum women or in a rural Sub-Saharan Africa has been published before. Objective: The objective of this study was to investigate the association of dental caries and periapiapical lesions with anthropometric measurements (BMI and MUAC) among post partum women in rural Mangochi, Malawi. The study's hypothesis was that dental caries and periapiacl lesions are associated with low anthropometrics in this low resource setting in Sub-Saharan Africa. Methods: The study had cross-sectional design. The study used secondary data from larger nutrition interventional trial iLiNS-DYAD (www.ilins.org). The sample size of this study was 1016 participants. The anthropometric measures (BMI and MUAC), age, gestational age at enrolment and the number of previous pregnancies were collected during early pregnancy of maximum twenty weeks at the study enrolment. The dental data (periapical lesions and dental caries) and the gestational age at delivery were collected postpartum within maximum 6 weeks of delivery. Unadjusted multinomial logistic regression was performed to investigate the association among variables. Results: 1016 women were enrolled in the study, with the age range of 14-49 years and the mean age of 25.5 years. Of the study participants, 580 (57.1%) had one or more carious teeth and 240 (23.6%) had one of more periapical lesions. For the anthropometrics, 54 participants (5.3%) had low BMI, 844 (83.1%) had moderate BMI and 118 (11.6%) had high BMI. Measuring the MUAC, 71 participants (7%) had low MUAC, 603 (59.4%) had moderate MUAC and 342 (33.6%) had high MUAC. The study did not find statistically significant association of dental caries and periapical lesions with BMI (low or high) or low MUAC. Nevertheless, there was a statistically significant association between caries and high MUAC (OR= 1.3, 95% CI 1.0 - 1.7, p=0.046) and stronger significant association between periapical lesions and high MUAC (OR=1.6, 95% CI 1.2 - 2.2, p= 0.002). Conclusion: The study results suggest rejecting the hypothesis that dental caries and periapical lesions are associated with low anthropometric measurements (BMI and MUAC) among the study participants. Further studies are recommended to investigate whether the association of dental caries and periapical lesions with high MUAC is causal or could be better explained by the common risk factors

Self care for maternal and reproductive health in conflict settings: qualitative case study in Nuba mountains, Sudan

Introduction: Self-care is a critical component of Reproductive, Maternal, and Neonatal Health (RMNH), offering women the knowledge, skills, and autonomy needed for well-being throughout the reproductive cycle. This paper explores the significance of self-care in conflict-affected regions, where access to formal healthcare is limited. Such areas place pregnant women at higher risk due to increased incidents of adverse events during pregnancy and childbirth. Self-care interventions have the potential to enhance access to quality healthcare services. Methods: Employing a qualitative approach, this study explores RMNH self-care practices among pregnant and post-natal women in the Nuba Mountains. The methods included in-depth semi-structured interviews with 24 participants, comprising pregnant women, recent mothers, and healthcare providers. Purposive sampling was used to capture the experiences of mothers, and thematic analysis identified key patterns and themes in self-care practices. The perspectives of healthcare professionals were included to understand the context of RMNH care in conflict settings. Results: The study revealed the crucial role of community cohesion in providing emotional and practical support in pregnancy, childbirth, and in the post-natal period. Limited healthcare infrastructure and ongoing conflict-related challenges provided important drivers for self-care practices. A spectrum of self-care interventions ranged from personal hygiene practices to community-supported childbirth and postnatal care. Significant reliance on elder women's wisdom and traditional midwifery was observed, particularly in the absence of formal healthcare facilities. Some women moved to live with family close to the hospital in the weeks before their due dates in order to mitigate the risks of early deliveries, complications, or general insecurity in their home areas. Discussion: The findings present a compelling narrative of communal self-care, challenging the conventional notion of self-care as solely individualistic. In this setting, the community's role is fundamental, with knowledge sharing and mutual support forming the bedrock of maternal health practices. Elder women, embodying repositories of perceived traditional wisdom, emerge as central figures, guiding pregnant and postpartum women through shared experiences and practices. This collective approach is not merely a cultural characteristic but a necessity born out of the region's limited healthcare infrastructure and ongoing conflict. The study underscores the need to recognize and integrate these communal self-care strategies into broader health interventions

Decolonising humanitarian health: A scoping review of practical guidance

Despite growing calls and efforts to decolonise global and humanitarian health, there is limited practical guidance for researchers, educators and practitioners on how to do so. This paper fills this gap by offering a narrative exploration of key recommendations on decolonising global/humanitarian health research, partnerships, teaching, organisational structures and other practices. We present concrete guidelines to support humanitarian actors in decolonising their work. We used a scoping review method. The search strategy was built on three overarching themes: decolonising, global health/health and humanitarian crises. We combined a MEDLINE and Web of Science database search with a grey literature search. In total, we screened abstracts and titles of 533 documents, excluding records that did not specifically refer to ‘decolonising,’ humanitarian and/or global health. We assessed full texts of 58 documents for eligibility, excluding documents that did not include practical recommendations. In total, 15 documents were included in this review. We identified five key themes: organisational structure, strategy and engagement; research partnerships and conceptualisations; funding for research and projects; the research lifecycle; and teaching and the curriculum. The principal finding is that humanitarian actors can decolonise their work by decentralising power, redistributing resources, critically reflecting on their work in the context of the broader socio-political landscape and recovering, centring and valuing marginalised Global South perspectives. Race was not a central analytical category in the reviewed literature, despite being an integral part of historical background narratives. Future research should reflect on practical steps towards racial justice in global/humanitarian health and be focused on ensuring that efforts towards “localisation” or “equitable partnerships” in global health are linked to decolonisation efforts, including in humanitarian health research. Our review underscores the importance of drawing on knowledge created by and for actors based in the Global South