This cross-sectional study examines differentials in age at marriage, collecting data from 665 ever-married women in Howrah district, West Bengal, using a mixed-methods approach across three generational cohorts. Quantitative analyses included ANOVA and multinomial logistic regression, complemented by qualitative interviews to contextualize marriage timing. Results revealed a non-linear trajectory of marriage age across generations. Mean age at marriage was 21.4 years, 23.2 years, and 19.5 years in Generation I, Generation II, and Generation III, respectively, with significant differences. MLR results showed respondents in Generation II had higher odds of marrying at ages 19-24 (RRR = 1.5, CI = 0.6-2.7) and ≥25 years (RRR = 1.4, CI = 0.9-4.0), whereas Generation III women had lower odds at ages 19-24 (RRR = 0.3, CI = 0.2-0.9) and ≥25 years (RRR = 0.6, CI = 0.1-0.9), compared to Generation I. Urban women showed delayed marriage at ages 19-24 (RRR = 3.1, CI = 2.6-11.5) and ≥25 years (RRR = 4.5, CI = 2.2-15.5). Higher educated women increased the likelihood of delaying marriage at ages 19-24 (RRR = 1.6, CI = 0.4-1.9) and ≥25 years (RRR = 1.2, CI = 0.8-1.6). Fathers' secondary education was associated with marriage at ages 19-24 (RRR = 1.5, CI = 1.0-2.3) and ≥25 years (RRR = 4.6, CI = 1.3-15.8), and fathers' higher education was associated with marriage at ≥25 years (RRR = 2.6, CI = 1.3-12.8); mothers' secondary education was associated with marriage at ages 19-24 (RRR = 1.7, CI = 1.0-2.9) and ≥25 years (RRR = 3.1, CI = 1.9-12.3), and mothers' higher education was associated with marriage at ≥25 years (RRR = 3.2, CI = 1.6-10.4). Respondents in white-collar jobs were more likely to delay marriage at 19-24 (RRR = 1.5, CI = 0.3-2.0) and ≥25 years (RRR = 1.6, CI = 0.8-3.4). White-collar employment of fathers increased the odds of marriage at ages 19-24 (RRR = 1.7, CI = 0.7-2.1) and ≥25 years (RRR = 1.6, CI = 0.4-2.6) and of mothers at ages 19-24 (RRR = 1.2, CI = 0.4-1.6) and ≥25 years (RRR = 1.1, CI = 0.3-1.9). Women from the upper wealth quintile were more likely to marry at ≥25 years (RRR = 1.2, CI = 0.5-2.8). Muslim women showed significantly less likelihood to marry at ≥25 years (RRR = 0.2, CI = 0.1-0.6). Ethnographic narratives revealed tensions between aspirations for daughters' education and parental anxieties related to employment insecurity, dowry, and premarital relationships, shaping marriage decisions.

Social isolation and loneliness have been linked to adverse health outcomes such as depression in old age. However, limited data exist on the association of loneliness and social isolation with probable depression (PD) in low- and middle-income countries (LMICs), while psychosocial mediators are largely unknown. This study investigates the individual and joint associations of social isolation and loneliness with PD among older adults in Ghana. It quantifies the extent to which psychosocial factors mediate the associations. Cross-sectional data from the Aging, Health, Well-being, and Health-seeking Behaviour Study were analyzed. PD was defined as moderate to severe depressive symptoms with the Center for Epidemiologic Studies Depression (CES-D-9) scale. Loneliness and social isolation were assessed with the University of California, Los Angeles 3-item loneliness scale and the Berkman-Syme Social Network Index, respectively. Multivariable logistic models and PROCESS macro bootstrapping mediation analyses were performed. Among the 1,201 adults aged ≥50 years (Mage = 66.1 ± 11.9 years, 63.3% women), 29.5% PD cases were found. The prevalence of social isolation and loneliness was 27.3% and 17.7%, respectively. Loneliness (OR = 3.15, 95% CI = 3.26-5.28) and social isolation (OR = 1.24, 95% CI = 1.10-1.41) were independently associated with higher odds of PD. The loneliness and PD association was modified by spatial location (Pinteraction = 0.021); thus, the association was more pronounced in rural areas (OR = 7.06) than in urban areas (OR = 3.43). Psychosocial factors (e.g. sleep problems) mediated the loneliness/social isolation and PD association. Loneliness and social isolation were independently associated with a higher likelihood of PD, and psychosocial factors mediated the associations. Interventions to reduce PD in later life should also consider addressing loneliness and social isolation, as well as sleep problems.

The deliberations for the Pandemic Accord have opened an important moment of reflection on future approaches to pandemic preparedness. The concept had been increasingly prominent in global health discourse for several years before the pandemic and had concretised into a set of standardised mainstream approaches to the prediction of threats. Since 2019, the authors and the wider research team have led a research project on the meanings and practices of preparedness. At its close, the authors undertook 25 interviews to capture reflections of regional and global health actors' ideas about preparedness, and how and to what extent these were influenced by Covid-19. Here, an analysis of interview responses is presented, with attention to (dis)connections between the views of those occupying positions in regional and global institutions. The interviews revealed that preparedness means different things to different people and institutions. Analysis revealed several domains of preparedness with distinct conceptualisations of what preparedness is, its purposes, and scope. Overall, there appear to be some changes in thinking due to Covid-19, but also strong continuities, especially with respect to a technical focus and an underplaying of the inequities that became evident (in terms of biosocial vulnerabilities but also global-regional disparities) and, related to this, the importance of power and politics. Here, the analysis has revealed three elements, cutting across the domains but particularly strong within the dominant framing of preparedness, which act to sideline direct engagement with power and politics in the meanings and practices of preparedness. These are an emphasis on urgent action, a focus on universal or standardised approaches, and a resort to technical interventions as solutions. A rethinking of pandemic preparedness needs to enable better interconnections across scales and attention to financing that enables more equitable partnerships between states and regions. Such transformation in established hierarchies will require explicit attention to power dynamics and the political nature of preparedness.

Biosocial birth cohort studies are uniquely positioned to be novel sites of interdisciplinary research. Their enduring commitment to specific field sites and populations, recurring grant renewal cycles, ability to ask prospective questions while drawing on long-standing data repositories, and more ensure ongoing collaboration and allow research to remain responsive to the evolving needs and timelines of multiple disciplines. However, it is widely recognised that interdisciplinary work is often easier imagined than achieved, and additional conditions are required to facilitate it beyond assembling teams of varied experts. This piece offers mediating practices as a concept that refers to the practical, multi-directional, and relational processes that attempt to resolve tensions that interdisciplinary teams often confront. Mediating practices bridge gaps among different disciplines' data and methods, often relying on pragmatic strategies, like re-designing data infrastructures or planning action items after a meeting, to do so. As such, mediating practices are crucial to conducting successful interdisciplinary research. Further, the concept of mediating practices foregrounds the actions of junior team members who often perform these practices, highlighting the need to foster epistemic humility and models of horizontal knowledge production in interdisciplinary teams. Here, the authors discuss their experiences and insights as members of interdisciplinary projects and outline how mediating practices emerged in these projects and enabled interdisciplinary success.

Quality of care during childbirth is crucial to maternal health outcomes. Studies from India that report on women's experiences of disrespect and abuse by healthcare providers during facility-based childbirth are limited to high-fertility states and predominantly focus on public hospitals. However, the quality of maternal care in states with low fertility rates like West Bengal needs further examination. This study aimed to understand women's experiences of disrespect and abuse and their perceptions of facility-based childbirth. The study focused on public, private, and charitable hospitals in Kolkata district of West Bengal that presents a higher institutional birth rate than the national average. The findings derive from a qualitative study using in-depth interviews with 17 postpartum women who had facility-based births within one year before data collection in May 2019. Grounded theory approach was used to iteratively code the interview transcripts, identify reappearing categories, and generate themes through abstraction. The participants' narratives revealed experiences of verbal abuse, neglect and abandonment, poor rapport between providers and women, improper conduct of procedures, health facility conditions and constraints, and instances of overlapping forms of disrespect and abuse. The findings demonstrate the nature of disrespect and abuse across different hospital types in a major metropolis of India. Normalisation of poor-quality care manifested in women's lack of expectations of patient education and attention from providers. Health system conditions and constraints can impact the quality of care that problematise the push for institutional deliveries as a panacea for poor maternal health outcomes. The findings add to long-standing calls for improving maternal experiences of birth with an emphasis on promoting autonomy. National and state guidelines related to maternal health need to be aligned with accepted standards of care. West Bengal must establish ways to assess the implementation of such guidelines on the ground.

Contraceptive side effects are consistently given as the main reason why women are dissatisfied with contraception or choose not to use it. However, why some women suffer more from side effects remains unknown. Through inductive analysis of in-depth interviews and focus group discussions with 40 contraceptive users and 3 key informants in Central Oromia, Ethiopia, we explored women's rationales for variation in side-effect experiences. The data first reveal the wide diversity in type and severity of side-effect experiences reported by users of contraception. Second, we found that women's rationales for why some individuals suffer more side effects from contraception invoke economic and physical hardship (food insecurity and heavy workloads), as well as interindividual differences in biology (one's blood must 'fit' with contraception). Finally, the analysis revealed the tension many women face in trying to negotiate the trade-off between the consequences of these side effects and those of an unwanted pregnancy. The results show the value of using a biosocial approach, which centres women's voices and experiences, for informing the measurement of contraceptive side effects within population health surveys and clinical trials. Additionally, the findings helpgain an understanding of how an individual's social, biological, and cultural contexts drive variation in when and why different side effects manifest.

Investing in the sexual and reproductive health of young adults can directly and indirectly contribute to accelerated economic growth. Looking beyond individual determinants of sexual behaviours and focusing on cultural factors such as ethnic affiliation are crucial for interventions and programme planning, particularly in a context like Nigeria. Using a concurrent triangulation mixed-methods design, this article explores the associations between ethnic affiliations and protective sexual behaviours of young adults in Nigeria. The quantitative data was derived from a representative sample of 1,393 male and female youth aged 16-24 years in three states purposively selected from three regions in Nigeria, while qualitative data was based on 18 focus groups and 36 in-depth interviews. The quantitative data was analysed using frequency distributions and regressions, while content analysis was employed to analyse qualitative data. Descriptive results showed that abstinence was higher for Hausa (80%) young adults compared with Yoruba (72%) and Igbo (68%) young adults. Condom use was lowest for Hausa (56%) young adults compared with Igbo (80%) and Yoruba (81%) young adults. The effect of education on abstinence differed by ethnicity and living with two parents was associated with a higher likelihood of abstinence among youth in all ethnic groups. Fear of early fatherhood and unplanned pregnancy was a prominent reason for protective sexual behaviour among Yoruba, Igbo, and Hausa young adults. The findings from this study show that young adults who engage in protective sexual behaviours may identify different rationales for this behaviour based on their ethnic background. Programme planners interested in promoting and encouraging protective sexual behaviours should recognize these multiple reasons across different ethnic affiliations to scale up and sustain existing interventions.

Anaemia severely impacts physical and mental abilities, raises health risks, and diminishes the quality of life and work capacity. It is a leading cause of adverse pregnancy outcomes and maternal mortality, especially in developing nations like India, where recent data on anaemia from National Family and Health Survey (NFHS-4) (2015-16) and NFHS-5 (2019-21) indicate a tremendous rise. Anaemia is a marker of poor nutrition and health, and socio-economic factors such as gender norms, race, income, and living conditions influence its impact. As a result, there are disparities in how anaemia affects different segments of society. However, existing research on health inequity and anaemia often employs a single-axis analytical framework of social power. These studies operate under the assumption that gender, economic class, ethnicity, and caste are inherently distinct and mutually exclusive categories and fail to provide a comprehensive understanding of anaemia prevalence. Therefore, the study has adopted the theoretical framework of intersectionality and analysed the NFHS-5 (2019-21) data using bivariate cross-tabulations and binary logistic regression models to understand how gender, class, caste, and place of residence are associated with the prevalence of anaemia. The results suggest that the women of Scheduled Tribes (ST) and Scheduled Castes (SC) share a disproportionate burden of anaemia. This study confirms that economic class and gender, geographical location, level of education, and body mass index significantly determine the prevalence of anaemia. The ST and SC women who are economically marginalised and reside in rural areas with high levels of poverty, exclusion, and poor nutritional status have a higher prevalence of anaemia than other population groups. Thus, the study suggests that intersections of multiple factors such as caste, class, gender, and place of residence significantly determine 'who is anaemic in India'.

This paper compares community responses to Ebola and Covid-19 in two regions of southern and eastern Sierra Leone with reference to the theory of institutional dynamics proposed by the anthropologist Mary Douglas. Institutions, Douglas argued, are conveyed by styles of thought, shaped by the ways human communities, through everyday practices, reinforce systems of classification and denotation. Pandemic advice to 'follow the science' proved problematic, since there is no single institution of science, and institutions never stand alone but are bundled with other institutions, reflecting the manifold and intertwined practices of human social life. The paper explores some of the ways a traumatic epidemic of Ebola Virus Disease in Sierra Leone shaped a distinctive local response to this deadly infectious disease in the absence of an effective vaccine. This local approach emphasised social rules based on ideas about sequestration and testing. Communities then proposed to continue this rules-based approach to the pandemic of Covid-19 and showed little initial enthusiasm for vaccination. With Ebola, the adoption of rules resulted in dramatic drops in infection rates. But Covid-19 spreads in different ways, and good results from the application of social rules were much less apparent. The paper shows how communities began to grapple with this new situation. In some cases, vaccine hesitation was overcome by treating the requirement for vaccination as a new form of social discipline. More generally, it is concluded that epidemiologists need to pay specific attention to institutions and institutional dynamics in order to better understand and anticipate public reactions to new disease threats.

Existing research on human growth in Mexico is regionally focused, creating a gap in the understanding of growth patterns of children and adolescents at national level and regional variation. The objective of the present study was to characterize the height growth curve of the Mexican population by geographic area and to cluster the states of the Mexican Republic according to their somatic maturation characteristics, based on a national representative sample of boys. Data on age, height, socioeconomic level, and geographic area of 18,219 boys were obtained from the National Health and Nutrition Survey 2012 (ENSANUT) and ENSANUT 2018, carried out in 32 Mexican states. Both surveys had representative samples. Preece-Baines 1 model was applied to fit height growth curves. Biological parameters were estimated; principal component analysis and cluster analysis were performed to group Mexican states based on these biological parameters. The estimated age at peak height velocity (PHV) was 12.3 years in the sample. Significant regional differences in the timing and tempo of PHV among Mexican boys were observed. Boys in the northern region experienced PHV at an earlier age and had a shorter duration of growth compared with boys in the central and southern regions. Boys in the central region had a longer duration of growth and a later age of PHV compared with the boys in the southern region. The cluster that included the southern states of the country showed estimated lower adult height and earlier somatic maturation. A lower height was found in the low and low-middle socioeconomic levels compared with the medium-high and high socioeconomic levels. Future research in Mexico should focus on longitudinal studies to analyse the timing and tempo of growth and maturation, considering the impacts of environmental and genetic factors. Public health strategies should account for geographic variations.