Background Despite induced abortion being highly legally restricted in Pakistan, studies in 2002 and 2012 showed that many women rely on abortion when faced with an unintended pregnancy. Following the 2012 study, concerted efforts were made to improve contraceptive services and to strengthen postabortion care. The availability and use of misoprostol also expanded in the past decade. Our primary objective was to provide new evidence on the rates of unintended pregnancy, induced abortion and postabortion care in 2023 and to assess trends in these outcomes since 2012.Methods This is a cross-sectional study based on a Health Professional Survey, and a nationally representative Health Facilities Survey, conducted in 2023. A widely applied methodology is used to estimate rates of abortion and unintended pregnancy. Data sources and methods are comparable across the 2012 and 2023 studies.Results In 2023, an estimated six million unintended pregnancies occurred and 64% of them or 3.8 (95% CI 2.

The Sahel region is a geographical belt in Africa that stretches from the Atlantic Ocean to the Red Sea, between the Sahara Desert in the north and the Savannah in the south. It is characterised by challenging environmental crises and conflicts. This analysis highlights the potential implications of conflict on vaccination across five Sahel countries, including Burkina Faso, Chad, Mali, Niger and Sudan, from 2019 to 2023. It also presents recommendations to improve vaccination coverage in these settings. The WHO Immunisation Data Portal was used to extract data about vaccination coverage and disease outbreaks. With the increasing complexity of humanitarian access in the Sahel, there has been an accumulation of the number of zero-dose and underimmunised children. In 2023 alone, most of these countries had a significant proportion of zero-dose children, particularly Sudan (43%), Mali (22%) and Chad (16%). Nearly half of children in Sudan (49%), 33% in Chad and 23% in Mali are underimmuni

Introduction Faced with a backdrop of an increasing chronic disease burden from an ageing global population compounded with rising healthcare costs, health systems are required to implement cost-effective, safe and equitable care through efficient service delivery models. One approach to achieving this is through Starfield’s 4Cs of primary healthcare (PHC), which delineates the key attributes of a high-performing PHC system that upholds the pillars of care coordination, first contact of care, continuity of care and comprehensive care. Therefore, this study aims to explore and elucidate the key themes and subthemes related to and extending beyond Starfield’s 4Cs of PHC by integrating findings from a comprehensive literature review and a qualitative study.Methods In this case study analysis, case studies of PHC systems from 19 countries were purposefully selected to represent a range of income levels and diversity in health systems and PHC landscapes. A review of existing literature of p

The poor management of public health risks associated with travel by most countries proved among the most contentious issue areas during the COVID-19 pandemic. Evidence from previous outbreaks suggested travel restrictions were largely unnecessary and counterproductive to timely reporting. This led to initial WHO recommendations against the use of travel restrictions. Substantial evidence of the role of human travel in spreading SARS-CoV-2 worldwide throughout the evolving pandemic supported new thinking about the use of different types of travel measures (ie, screening, restrictions, quarantine, immunity documentation) to limit the introduction of SARS-CoV-2 into jurisdictions with low incidence and onward transmission. However, governments failed to work together, undermining public health goals. In addition, profound secondary impacts were caused by uncoordinated, frequently changing and poorly evidenced use of travel measures. Alongside the need to better understand what, when and

Introduction National malaria programmes must weigh the relative benefits of different vector control and elimination tools to prioritise resource allocation with the greatest impact. This study assesses the epidemiological and entomological impacts of piperonyl butoxide insecticide-treated nets (PBO ITN-only arm) compared with the combination of two annual non-pyrethroid indoor residual spraying (IRS) campaigns and standard pyrethroid ITNs (IRS+Standard Pyrethroid ITN arm) in the Amhara region of Ethiopia.Methods An open-label, stratified block-cluster randomised trial was designed to compare the impacts of the two intervention arms. ITN distribution took place from June to July 2021. IRS campaigns took place from June to July 2021 and again in June 2022. Confirmed malaria cases reported during the high transmission season (September to December) were compared in the 2 years before (2019 and 2020) vs the 2 years after (2021 and 2022) the 2021 campaigns. The difference in An. gambiae s

Despite progress in healthcare services for individuals living with sickle cell disease (SCD) in Africa, substantial gaps remain in advanced treatments for SCD. To help address this burden, Tanzania has established one of the largest single-centre SCD programmes in the world and developed an advanced therapy programme for SCD focused on patient engagement and advocacy, clinical activities involving exchange blood transfusion (ExBT) and haematopoietic stem cell transplant (HSCT), gene therapy (GT) preparedness, and enabling partnerships. This report describes the programme’s genesis, structure and progress achieved. Patient engagement camps and patient-focused workshops conducted since early 2021 have involved more than 150 patients, family caregivers and healthcare providers. A patient registry was established by screening 1500 patients eligible for advanced therapies with 157 identified to benefit from advanced treatments for SCD. Out of which 22 patients received ExBT, and human leuc

Introduction Climate change is shaping adolescent and young people’s (AYP) transitions to adulthood with significant and often compounding effects on their physical and mental health. The climate crisis is an intergenerational inequity, with the current generation of young people exposed to more climate events over their lifetime than any previous one. Despite this injustice, research and policy to date lacks AYP’s perspectives and active engagement.Methods Participatory, youth co-led qualitative focus group discussions were held in Bangladesh, Guatemala and Nigeria in mid-2023. A total of 196 AYP ages 12–25 years participated. Open-ended questions elicited responses regarding AYP knowledge, experiences and perceptions of climate change. Using NVivo software, translated transcripts were coded to explore and synthesise key thematic areas.Results Respondents discussed varied climate exposures and associated health risks, for example, how flooding events were impeding access to sexual and

High-burden cholera outbreaks, spreading beyond the traditional cholera-endemic countries, have been reported since 2021 in the WHO African region. Member states in the region have committed to the global goal of cholera elimination by 2030. To track progress towards this goal, WHO-African countries adopted a regional cholera prevention and control framework in 2018. This study reports on 27 countries’ 5-year achievements in implementing the cholera regional framework for cholera prevention, and control. Data collected through a web-based self-assessment tool were analysed and visualised through Power BI. Data were provided by national teams of experts on cholera based on the milestones of the framework. Countries’ specific progress and regional progress were calculated. The overall regional progress was 53%, ranging from 19% in Mauritania to 76% in Ethiopia. Out of the 27 countries, 3 had made good progress while 14 had fair and 10 had insufficient progress. At the regional level, 4 m

Introduction The WHO endorsed the Xpert MTB/RIF (Xpert) technique since 2011 as initial test to diagnose rifampicin-resistant tuberculosis (RR-TB). No systematic review has quantified the proportion of pretreatment attrition in RR-TB patients diagnosed with Xpert in high TB burden countries.Pretreatment attrition for RR-TB represents the gap between patients diagnosed and those who effectively started anti-TB treatment regardless of the reasons (which include pretreatment mortality (death of a diagnosed RR-TB patient before starting adequate treatment) and/or pretreatment loss to follow-up (PTLFU) (drop-out of a diagnosed RR-TB patient before initiation of anti-TB treatment).Methods In this systematic review and meta-analysis, we queried EMBASE, PubMed and Web of science to retrieve studies published between 2011 and 22 July 2024, that described pretreatment attrition for RR-TB using Xpert in high TB burden countries. Data on RR-TB patients who did not start treatment after diagnosis a