Anemia remains a significant public health concern among women of reproductive age (WRA) in Ghana, contributing to adverse health and socioeconomic outcomes. Despite national nutrition and malaria control interventions, progress has been modest with persistent regional disparities. This study assessed national and regional trends in anemia prevalence among WRA from 2000 to 2019, quantified regional inequalities, and forecasted national prevalence to 2030 to measure progress toward global reduction targets. Population-representative estimates of anemia among WRA were obtained from the WHO Health Equity Assessment Toolkit (HEAT) database. National and regional prevalence were analyzed using four inequality measures: difference (D), ratio (R), population attributable risk (PAR), and population attributable fraction (PAF). Time-series forecasting was conducted using an ARIMA (1, 1, 0) model to project prevalence from 2020 to 2030. Anemia prevalence among WRA declined modestly from 47.8% in 2000 to 44.3% in 2019, a 3.5%-point reduction. The Ashanti region recorded the greatest decline (43.3% to 37.3%), while the Upper West region observed the highest increase (41.0% to 45.2%). Regional inequalities widened from 2000 to 2019 across several measures: D (18.1 to 22.2), R (1.5 to 1.6), and PAF (- 16.2 to - 18.4). ARIMA forecasting suggests a plateauing effect, with national prevalence projected to reach 43.6% (95% CI: 40.4-46.9) by 2030. The modest decline in prevalence, coupled with widening regional inequalities and a projected plateau through 2030, indicates that current progress is insufficient to achieve WHO global targets. Addressing these gaps requires geographically targeted, multi-sectoral interventions, such as improving food storage infrastructure and integrating malaria control with nutritional counseling, to accelerate progress and ensure equitable health outcomes for WRA across all regions of Ghana.

While rates of unintended pregnancy are declining among adolescents and young adults in the United States (US), rates remain higher than other industrialized nations and are associated with both educational and economic challenges. Studies examining young adult contraceptive practices are dated and limited in scope. Understanding current contraceptive use of young adults is critical to ensure intentional pregnancies. We used the American College Health Association-National College Health Assessment III 2022-2023 national dataset to examine contraceptive use patterns among 30,568 sexually active 18- to 24-year-old college students at 4-year institutions. Differences based on students' biological sex, race/ethnicity, year in school and number of sexual partners in the last 12 months were examined. Prevalence estimates with confidence intervals were calculated; chi-square tests were used to assess initial bivariate differences and t-tests were used to determine significant pairwise comparisons. Bonferroni correction set the significance level to p<.001219. Most sexually active college students were using contraception (87.6%); however, there were significant differences among students based on demographic characteristics. Black, Latinx, and multiracial students and students with more than one sexual partner in the last 12 months were less likely to use contraception (ps < 0.001). There were also differences in the types of single and dual contraceptive methods used among students based on demographics. Significant differences based on race/ethnicity occurred across all methods and combinations of methods. Results indicated less consistent patterns of differences for sex, year in school, and number of sexual partners for single and dual use. This study provides a critical update on contraceptive use among US college students. The findings indicate which subgroups may be more at risk for an unintended pregnancy due to lower overall contraceptive use and use of methods that are less effective. Differences in race/ethnicity regarding contraceptive use continue to exist, and students with fewer years of education emerged as another essential group deserving attention. Improved awareness of methods and access to birth control are potential strategies to increase uptake. College health professionals and other clinical providers who work with US college students can use these findings to inform discussions with students who may need additional information about all available options.

Collecting reliable sexual behaviour data remains a major challenge in conservative, low-literacy contexts such as The Gambia, where stigma, privacy concerns, and social desirability bias influence responses. The Prevalence of Human Papillomavirus, Antimicrobial resistance, and Sexually transmitted infection Estimation (PHASE) survey sought to address this challenge by introducing Audio Computer-Assisted Self-Interviewing (ACASI) for the first time in The Gambia. This paper documents the design, development, and piloting of the ACASI tool, highlighting key lessons for similar settings in sub-Saharan Africa.A Community Advisory Board (CAB) was central to the tool's development, ensuring cultural sensitivity, acceptability, and linguistic accuracy. CAB members guided the drafting and adaptation of sexual behaviour questions, advised on culturally relevant response categories, and reviewed translations into four local languages (Mandinka, Serahule, Fula, Wolof). They also oversaw the design of non-threatening, familiar images to accompany response options and ensured accurate, context-appropriate audio recordings. Technical implementation was achieved using the SurveyCTO platform, allowing offline use, encryption, and integration of multilingual audio and images. Privacy safeguards were embedded, including screen codes replacing text to prevent disclosure in shared settings and restricted staff access to individual responses.Pilot testing revealed critical operational considerations. Many women lacked prior experience with digital tools and required extra support during the introductory phase. Adjustments included re-recording unclear questions, reordering items to reduce priming effects, and randomising response lists to enhance validity. Additional measures, such as repeating select questions at different points, improved internal consistency checks. Despite these challenges, participants demonstrated increasing confidence with the tool, and CAB feedback confirmed that ACASI was more acceptable for sensitive questions than face-to-face interviewing.Our experience demonstrates that ACASI is a feasible and culturally appropriate method to collect sexual behaviour data in The Gambia, even within low-literacy, conservative populations. The use of familiar images, validated translations, and community engagement enhanced usability, while technical refinements addressed privacy and confidentiality concerns. Key challenges related to computer literacy and dialect variation were addressed through training, piloting, and iterative refinement. This process illustrates that by prioritizing community involvement, technical adaptation, and cultural sensitivity, ACASI offers a promising framework to enhance the acceptability and potentially the accuracy of sexual behaviour reporting in large-scale epidemiological surveys. These lessons can be applied to similar sub-Saharan African contexts seeking to generate high-quality data to inform HPV (human papillomavirus), STI (sexually transmitted infection), and sexual health research.

Current studies reporting the status of fertility preservation in oncology patients mostly focus on patients with breast cancer and adult patients. Few studies have focused on blood disorders or pediatric and adolescent patients. To investigate the current status of fertility preservation and its influencing factors in pediatric and adolescent patients with hematological disease who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in China. Adolescent and pediatric (< 18 years at diagnosis) patients who completed allo-HSCT at our center were investigated. A questionnaire was developed to collect patients’ sociodemographic information and fertility preservation status. A logistic regression model was applied to explore the factors influencing the current status of fertility preservation. A total of 190 subjects were investigated, including 78 (41%) females and 109 (56%) acute leukemia patients. The median age at diagnosis was 7 (0, 17) years. A total of 54% and 66% of patients were aware of and concerned about fertility preservation, respectively. A total of 20% and 4% of patients were counseled and underwent fertility preservation, respectively. Female sex (Odds Ratio, OR = 2.0, p = 0.031) and annual household income of ¥ (Chinese Yuan) 100,000-500,000 (OR = 3.7, p = 0.003, annual income<¥100,000 as the reference group) were significantly associated with higher awareness rates. Having health insurance (OR = 5.0, p = 0.004) and predisease fertility intentions (OR = 12, p < 0.001) were significantly associated with higher concern rates. Urban residence (OR = 3.3, p = 0.005) and annual household income of ¥100,000-500,000 (OR = 2.8, p = 0.021) were significantly associated with higher counseling rates. Aplastic anemia (OR = 8.2, p = 0.023, acute leukemia as the reference group) was significantly associated with higher rates of undergoing fertility preservation. The high rates of concern about fertility preservation are inconsistent with the low rates of awareness, consultation and actual use of fertility preservation methods. The fertility preservation status is unevenly distributed among patients of different genders, diseases, ages, regions, incomes, and health insurance statuses. The urgency of initiating therapy for hematological disorders is an important reason for the suboptimal status of fertility preservation.

Pregnancy loss represents a significant public health concern within the realm of female reproductive health. In the current landscape of research, post-traumatic stress disorder (PTSD), anxiety, and depression are often investigated as an undifferentiated whole. However, this approach overlooks the unique symptomatic relationships and nuances that may exist among these mental health conditions in women who have endured pregnancy loss. This study aimed to dissect the symptomatic interconnections among PTSD, anxiety, and depression in women who have experienced pregnancy loss. A cross-sectional study was carried out at a tertiary hospital in Zhengzhou, China. Women with pregnancy loss were surveyed using a general information questionnaire, the Posttraumatic Stress Disorder Checklist-Civilian Version, and the Hospital Anxiety and Depression Scale. Network analysis was performed using R software to examine pairwise associations among symptoms, identify core symptoms (i.e., key nodes with the strongest connectivity within the network), and detect bridge symptoms (i.e., symptoms that link post-traumatic stress, anxiety, and depressive symptom clusters). We also evaluated the accuracy and stability of the estimated network structure. Of the 691 women with pregnancy loss included in the analyses, PTSD entry 6 (Try to avoid thoughts and feelings that remind you of it) and PTSD entry 7 (Make an effort to avoid conversations, people, places and activities that remind you of the matter) had the strongest association, with a regularized partial correlation coefficient of 0.485. PTSD entry 7 was the most central symptom in the network, with a centrality strength of 1.748. Entry 5 (Muscle tension, shortness of breath, rapid heartbeat, dry mouth, and stomach cramps) had the strongest bridging effect. The accuracy and stability of the network was tested to be better, and the network model was more reliable. Through the innovative application of network analysis, this study successfully explored the associations between PTSD items and symptoms of anxiety and depression in women with pregnancy loss. By identifying the core and bridging symptoms, it provides valuable insights into the underlying mechanisms of these co-occurring mental health conditions.

Young people in Nigeria face significant barriers in accessing sexual and reproductive health (SRH) services, resulting in unmet needs. This study explores the perspectives of young people and SRH service providers on the delivery of these services to young people at primary health centres (PHCs) in Ebonyi State, Southeast Nigeria. A qualitative research approach was used, involving 20 in-depth interviews with SRH service providers and 10 focus group discussions with young people (ages 15–24) across six communities. Data collection was guided by semi-structured interview guides that focused on the types of SRH services available and the processes involved in their delivery. Transcripts were coded and analysed thematically using NVivo. Three key themes emerged: (1) Types of services – including sex education, counselling, contraception, sexually transmitted infections prevention and treatment, maternal and childcare, and support services for survivors of gender-based violence; (2) Attributes of providers and users - highlighting, respectful, empathetic, and support for informed choices and privacy, while also noting challenges such as limited provider availability and young people’s reluctance to seek care; and (3) Processes of service delivery - describing structured stage including reception, registration and payment, consultation, waiting time, operating hours and relational aspects within the health system. Despite efforts to offer youth-friendly SRH services, delivery remains constrained by workforce shortages, inadequate infrastructure, high service costs, and judgmental attitudes from health workers. While PHCs provide essential SRH services, systemic barriers hinder young people’s access to youth-friendly care. Policy reforms are needed to strengthen youth-centred service delivery, including expanding the healthcare workforce through employment and task shifting, upgrading health infrastructure, and subsidising SRH services by integrating them into basic healthcare packages. These actions are essential to advancing young people’s SRH rights and improving service delivery.

In recent decades, international organisations have advocated for comprehensive sexuality education (CSE) in school curricula, emphasising its role in equipping children with knowledge, skills, and values for informed, healthy, and respectful decisions about sexuality. Despite this, CSE programmes often focus on adolescence, adopting a preventive approach centred on risks like HIV and unintended pregnancies, while neglecting topics such as pleasure, gender diversity, and decision-making. This study explores the interests and questions of primary school children (aged 9-11) in Spain regarding sexuality, aiming to inform CSE programmes that address their real needs. A qualitative study was conducted with 331 children from eight primary schools in Catalonia, Spain, between 2021 and 2024. Data were co-produced through anonymous written questions (237 submissions), 32 focus groups and group drawings. Through integrating these three techniques, we sought to capture the plurality of children's voices: Anonymous questions enabled individual expression, focus groups facilitated collective narratives, and drawings served as a bridge between the material and the discursive. We conducted a thematic content analysis (Braun and Clarke, Qual Res Psychol 3:77-101, 2006), followed by a narrative analysis (Riessman, Narratives methos for human sciences, 2008). Ethical considerations included informed consent from parents and assent from participants. Participants' questions clustered around four main thematic areas: adult sexual practices (27%), childhood bodily experiences related to sexuality (23%), reproduction (16%), and pleasure (8%). While adult sexual practices and reproduction dominated the anonymous questions, focus group narratives revealed how these topics were negotiated through gendered, heteronormative, and age-based norms. Reproduction functioned as a socially legitimate entry point from which children explored broader and more ambiguous dimensions of sexuality, including pleasure, diversity, and bodily change. Children's questions about menstruation and semen revealed fragmented knowledge, uncertainty, and affective responses such as fear, discomfort, and shame, alongside limited opportunities for collective discussion. Topics related to pleasure and masturbation were present but strongly regulated by moral discourses that positioned sexuality as appropriate only for adolescents or adults. Differences emerged across methods and group compositions, highlighting how what children express varies according to the space and conditions of participation. This study shows that participants actively engaged with questions about sexuality that go beyond reproduction and risk, including bodily experiences, pleasure, and moral norms. However, their interests are produced through intra-actions (Barad, Meeting the universe halfway: quantum physics and the entanglement of matter and meaning, 2007) within adult-centred, reproductive, and age-regulated assemblages, which define possibilities for knowing, feeling and speaking about sexuality. The findings highlight a persistent gap between children's lived experiences and current approaches to CSE, which often overlook affective dimensions, embodied knowledge, and children's own meaning-making processes. Advancing a rights-based CSE requires recognising children as sexual subjects, and creating diverse, safe spaces that allow them to explore sexuality in ways that are inclusive and grounded in their everyday realities.