Adequate nutrition plays a vital role in maintaining women’s health and ensuring the healthy growth and development of infants and children. However, during emergencies and displacement, multiple factors can disrupt adequate maternal and child nutrition. The aim of this study was to explore the available literature reporting the prevalence and associated risk factors of undernutrition among displaced pregnant and lactating women. This review follows the PRISMA guidelines for Scoping Reviews. An electronic search was conducted in the PubMed, Web of Science, and Google Scholar databases. The Emergency Nutrition Network and ReliefWeb websites were also explored for grey literature. The prevalence of wasting among pregnant and lactating women varied widely, reaching 77% in Tigray internally displaced person (IDP) camps. The underweight prevalence ranged from 9.3% in a Nigerian IDP camp to 26.7% in a refugee camp in Bangladesh. Anemia was common, affecting up to 44.7% of pregnant Syrian refugees in Jordan. Maternal age, family size, childbirth interval, family income, and lack of education were the main factors associated with undernutrition among displaced pregnant and lactating women. Acknowledging the burden of undernutrition and identifying the most frequent risk factors, should inform the development of relevant nutrition interventions in different displacement settings.

ABSTRACT Two common consequences among persons with a physical health condition are internalised stigma associated with the physical illness and depression. Increased awareness and knowledge of both concepts might help professionals to better diagnose and deploy interventions that best suit the needs of people who experience these phenomena. Therefore, this study aimed to investigate to what extent and how internalised stigma and depression overlap. A Delphi study was conducted to create understanding and build consensus among experts. Over three survey rounds, experts in the field of stigma and depression (n = 24) were asked to determine whether signs/behaviours, symptoms/experiences, external factors and strategies or interventions were associated with internalised stigma, depression or both. Consensus was reached that internalised stigma and depression are common consequences of physical health conditions and are two separate but overlapping phenomena. The main difference between both were external factors, such as environmental (e.g. weather-driven mood fluctuations), or therapeutic (e.g. medication) aspects of depression. This study highlights the importance of raising awareness among professionals that internalised stigma and depression can co-occur, and that strategies and interventions are available for both. Improved awareness will lead to care that is more suitable to the individual’s needs, therewith improving quality of life.

Stewardship of antibiotic medicines will likely play a key role in curtailing the rise of antimicrobial resistance (AMR) globally. In East Africa, drug sellers are a critical group for interventions because they often dispense without prescription and violate regulations designed to facilitate antibiotic stewardship. Currently, measures to tackle regulatory avoidance are often rooted in individuated cognitive-behavioural approaches that label sellers’ actions as ‘irrational’. This study, part of a larger interdisciplinary investigation of AMR drivers in East Africa, conducted in-depth interviews [n = 105] with drug sellers in Kenya, Tanzania and Uganda to explore sellers’ accounts of their own behaviours. Its findings seem contradictory; sellers are aware of regulations and express a desire to comply, yet confirm non-compliance is common. The paper’s contribution is to demonstrate that such behaviour is ‘situationally rational’ when contextualised within a broader socio-material assemblage of unenforced regulation, fierce market competition, relational customer interactions and professional commitment to communities in resource-poor healthcare settings. The paper concludes that an understanding of the structural and relational dynamics driving current behaviours is a necessary precondition for the design of new interventions bringing professional and commercial motivations into closer alignment, something which could make antibiotic stewardship situationally rational for sellers and customers alike.

The displaced Rohingya population residing in Cox’s Bazar, Bangladesh, must navigate their reproductive lives in this fragile context. This study examines the knowledge, attitudes and use of menstrual regulation/pregnancy termination services in four displaced persons' camps to understand women’s engagement with these services and barriers to safe services using Bandura’s social cognitive theory. We conducted a household, community-based survey with women of reproductive age in 2022 (n = 1173). Ninety-two percent of respondents knew that health facilities provide pregnancy terminations, yet knowledge about when access is permissible is incomplete. Only one-third knew that this service could be provided 11−12 weeks after last menstrual period, with most respondents believing that the cutoff was earlier. The respondents believed that menstrual regulation was provided only under certain conditions, and 99% stated that a husband’s consent should be required for a woman to end a pregnancy (always or sometimes). One in five respondents (n = 223) knew someone who had ended a pregnancy since arriving in the camps. While knowledge about and support for pregnancy termination services are high, there is room for improvement in education about the conditions under which it can be accessed. The results fill a knowledge gap regarding the acceptability and use of pregnancy termination in the Bangladesh camps of displaced Rohingya.

ABSTRACT This study centres the voices of providers currently working with the child and adolescent population to analyse social and structural factors that facilitate or impede access and service utilisation among children and adolescents. We conducted semistructured interviews with 15 psychological health care providers across 4 metropolitan cities in India. Thematic analysis was guided by an immersion-crystallization study design. Following this modified grounded theory approach, structural stigma emerged as a salient factor. Participant narratives revealed interconnecting forms of stigma encountered by adolescents. There was a preference for therapy over pharmacological interventions. Providers indicate the need for institutional and policy support for schools to promote mental health and well-being among children. Training lay counsellors, and initiating tele-mental health services in a large-scale manner could be effective ways to distribute caseloads and reach vulnerable populations without access to high-quality mental healthcare in their geographic vicinity.

ABSTRACT The absence of reliable administrative data from many countries means that there is little global surveillance of femicide. We conducted femicide surveillance with four dedicated national retrospective mortuary-based surveys to understand its magnitude among women 14 years and older in South Africa from 1999 to 2020/21, including the first year of COVID-19. The surveys included data from police on the investigation to ascertain who perpetrated the femicide (i.e. an intimate partner or someone else). We found overall femicides declined between 1999 and 2009, but the rate of decline slowed in subsequent years. Intimate partner femicide increased during the first year of COVID-19, unlike non-intimate partner femicide. Firearm-related femicides also increased in parallel with the increased availability of firearms in the country during the same period. The data show that South Africa remains one of the countries with the highest recorded rate of intimate partner femicide globally (5.5/100,000 female population), almost five times the global average. We have shown that femicide is preventable, but the conditions of the COVID-19 response likely increased the risk for women in abusive relations. We have also shown the value of dedicated surveys in the absence of reliable information systems.

ABSTRACT Vaccines are essential for preventing infectious diseases and promoting population health; however, equitable global access to vaccines remains elusive. Regulatory approval of vaccines is a critical step on the path towards global vaccines justice, yet the resources required can impede timely decision making. Regulatory reliance, where authorities use other agencies' assessments of new vaccines to make local decisions about their benefit-risk profile, can expedite regulatory decision making. In this Commentary, we apply a critical lens inspired by ‘Third World Approaches to International Law’ to vaccine justice that challenges the dominant narratives in international pharmaceutical regulatory policy from the perspective of historically marginalised LMICs. This Commentary's main contribution is to illustrate how modern trends in regulatory reliance – namely South-South reliance and reliance on opinions by the European Medicines Agency about medicinal products for global health (rather than evaluations of medicines destined for the European Union market) – are embracing ‘third world approaches’ to vaccines justice. Strengthening capacity through international regulatory pathways can help alleviate bottlenecks in the approval of vaccines that have already been deemed safe, effective, and quality-assured by qualified regulators, thereby streamlining registration processes and accelerating global access, particularly in an emergency situation.

ABSTRACT Young people have a high burden of sexually transmitted infections (STIs) but low uptake of and high attrition from services. We adopted a positive deviance approach to explore uptake of STI screening, treatment, and partner notification within a sexual and reproductive health service. We conducted in-depth interviews with young people (aged 16–24 years) who accepted screening, treatment, and partner notification slips (n = 15), and healthcare providers who delivered the service (n = 13). We used thematic analysis to understand decisions at each stage of the STI care cascade. Young people who accepted STI screening and returned to receive their results were influenced by the friendliness and informativeness of providers, which helped overcome their anxiety. Experiencing symptoms and health being a priority were also motivators to seek treatment and overcame the inconvenience of returning to the service and the fear of the test result. While all participants accepted partner notification slips, only those in secure relationships felt able to tell their partners. This study identified both supply (positive provider attitudes, information provision, and same-day treatment provision) and demand side factors (prioritise one’s health, experiencing symptoms, and knowledge about asymptomatic infections) that STI interventions can build on to support young people’s engagement with STI services.

ABSTRACT Displaced communities face risks to quality of life and health, such as poverty, crowded living conditions, exposure to environmental contaminants, and poor access to healthcare, highlighting areas for research on the challenges they endure. However, these communities are routinely subject to extractive research practices with little regard to local participation or sustainability. To facilitate better research, there is a need for tools and frameworks that enable more effective, ethical and equitable research. In this paper, we synthesise and compare eleven research guidelines and frameworks addressing research conducted in displaced and vulnerable populations with the goal of assessing utility and applicability of frameworks for displaced populations. Overall, we found that the level of detail varied between documents, and that while many frameworks were based on expert discussion, few were co-created with community input. Additionally, the frameworks often failed to address nuances between different displaced populations in key aspects of ethics and research. Moreover, in practice, the frameworks were not widely utilised for research in settings of forced displacement. Based on our analyses, we identify recommendations to improve current and future frameworks, including adding context and community feedback, increasing flexibility and adaptability in research practices, and generating strategies to promote framework uptake.

ABSTRACT Climate-related extreme weather events (EWE) affect sexual and reproductive health and rights (SRHR) outcomes through complex and multi-level pathways. These include institutional-level effects on health systems, such as damaged health infrastructure and roads, barriers to retaining qualified health and care workers, as well as healthcare access barriers due to increased economic precarity, displacement and migration. Furthermore, EWE effects on SRHR disproportionately affect marginalised communities. Optimising SRHR in the context of climate change and EWE thus require moving beyond traditional health system approaches. Self-care interventions (e.g. HIV self-tests) and self-care actions (e.g. self-monitoring blood glucose during pregnancy), whereby affected individuals and communities have increased control and agency over their own health practices, can ensure essential SRHR needs can be maintained during crises. Yet opportunities for SRHR self-care strategies in communities affected by EWE are underexplored. When health systems collapsed during the COVID-19 pandemic in countries spanning income levels, self-care options were prioritised to maintain essential health services. In this commentary, we explore how SRHR self-care interventions and actions can be integrated into EWE emergency preparedness across dimensions of self-management, self-testing, and self-awareness to build individual, community and health systems climate resilience.