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Authors: Action Amos, Sandra Jumbe, Thiyara Bandara, Sadiya Begum, Charlotte Hanlon, Sumeet Jain, Martyn Pickersgill, Eric Umar, Robert C. Stewart

Inclusive healthcare decision-making is a cornerstone of recovery-oriented mental health services, contributing to improved outcomes, enhanced autonomy, and reduced stigma. While substantial research on mental healthcare decision-making has been conducted in high-income countries, there is limited evidence from low- and middle-income countries (LMICs), where sociocultural norms, family structures, and health system constraints may shape decision-making differently. This review sought to synthesise evidence on service user and caregiver involvement in mental healthcare decision-making in LMICs and identify contextual factors influencing these processes. A scoping review was conducted following Arksey and O’Malley’s five-stage framework. English-language studies from 2008 to 2025 were identified through databases and grey literature searches. Eligible studies extracted examined the involvement of people with mental health conditions and/or caregivers in mental healthcare decision-making within LMICs. Two reviewers independently coded descriptions of involvement using an inductive content analysis approach. Three overarching themes emerged: (1) active user involvement, reflecting service users’ participation in and co-creation of decisions about their care; (2) family dominance, where family members significantly influenced or controlled decision-making processes; and (3) drivers of decision-making, including cultural norms, stigma, economic hardship, social relationships, and health system constraints. Overall, decision-making was predominantly shaped by family authority and contextual factors, with relatively limited evidence of shared or supported decision-making approaches. The search yielded 21,830 records, with an additional 46 studies identified through grey literature searches. Following screening, 36 studies were included. Studies were conducted across Africa (n = 12), Asia (n = 22), and the Middle East (n = 2). Mental healthcare decision-making in LMICs is embedded within complex family, cultural, and structural contexts that both enable and constrain service user participation. This review contributes to promoting a contextualised understanding of mental healthcare decision-making in LMICs.

Source: PLOS Mental Health. DOI: 10.1371/journal.pmen.0000712. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Henry B. Perry, Abhay Bang, Steve Hodgins, Madeleine Ballard, Jeffrey D. Sachs, Abnet Z. Muluneh, Mushtaque Chowdhury, Mark Mwenda, Raj Panjabi

Many health systems, particularly in low- and lower middle-income countries (LMICs), are lagging in their progress in achieving Universal Health Coverage and delivering on the promise of Health for All, constrained by workforce shortages, fiscal ceilings, and inadequate outreach to those lacking basic and essential services. Stark inequities in coverage of services and in health status persist. Strengthening community health worker (CHW) programs provides the fastest and most cost-effective route for health systems to achieve their full potential. CHWs should become the backbone of primary health care (PHC) and the foundation of health systems. Evidence from more than a decade of national-scale experience demonstrates that CHWs who are appropriately trained, paid, equipped, and supervised can extend high-quality essential services to the last mile while improving the overall efficiency of the health system. We are at a point in time when donor strategies and private investment are captivated by the promise of digital health and artificial intelligence. The most reliable approach to saving more lives is still a paid, supported CHW empowered with digital tools. At the same time, the contraction of Official Development Assistance (ODA) creates both risk and opportunity. ODA must pivot from supporting services to catalytic capital: time-bound, matching investments that accelerate governments’ own proCHW policy. A “next generation” of CHW programs in LMICs would enable CHWs to visit every home monthly and provide a broad array of PHC services as a result of adequate remuneration and appropriate training, supervision, logistical support, and integration into the health system. This could yield a highly favorable economic return—through productivity gains from better health, reduced health-care expenditures, and pandemic-risk mitigation. A “next generation” of CHW programs is our best bet for accelerating progress in achieving Universal Health Coverage and Health for All sooner rather than later.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0007545. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Madura Nanthakumaran, Charles Orjiakor, Dina Balabanova

Corruption in healthcare is a pervasive global challenge that undermines equity, efficiency, and trust in health systems. Whilst its economic and governance impacts are well documented, the psychological consequences for patients, providers, and those involved in anti-corruption reform remain under-explored. Understanding these mental health effects is critical for designing anti-corruption strategies that safeguard wellbeing and strengthen health systems. An exploratory mixed-methods study was conducted to map an emerging evidence base. A scoping review of 25 peer-reviewed and grey literature sources was complemented by four key informant interviews, which were used to interpret and contextualise the review findings. Findings were synthesised into a conceptual framework mapping pathways between corruption and mental health outcomes. Corruption was reported to be associated with psychological distress among patients, providers, and anti-corruption actors. This included stress, anxiety, depressive symptoms, and moral injury. At a community level, corruption eroded trust and collective agency, whilst institutional effects included normalisation of unethical practices. Structural determinants were found to perpetuate corruption’s harms. Anti-corruption efforts produced mixed outcomes: reform targeting high-level officials improved public mental health modestly, whereas punitive measures against frontline workers exacerbated fear and demoralisation in the workforce. Protective factors such as moral agency, and robust reporting systems were found to buffer harm but were context dependent. Policy recommendations are made for practice, research and capacity building. These include framing corruption as a public mental health issue, strengthening whistleblower protections, commissioning further research, and adapting reform to local political economy and social norms. These findings indicate that corruption is a plausible but under-recognised social determinant of mental health requiring further research. Integrating mental health considerations into anti-corruption policy and health system reforms is essential to mitigate harm and strengthen resilience.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0007509. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Moses Mwale, Peter Jay Chipimo, Andrew Phiri, Patrick Sakubita, Penelope Masumbu, Bryson Musonda, Chipo Mwela, Kelvin Mwangilwa, Musole Chipoya, Priscilla Nkonde Gardner, Francis Dien Mwansa, Azmach Gebregiorgis, Muziya Chika, Kennedy Matanda, Freddie Masaninga, Jacob Sakala, Peter Clement Lugala

Despite progress in childhood immunization, Zambia retains pockets of zero-dose children (those who have not received the first dose of diphtheria-tetanus-pertussis-containing vaccine, DTP1) and under-immunised children (those missing one or more vaccines in the recommended schedule), sustaining vulnerability to vaccine-preventable diseases. Understanding the factors associated with missed vaccination is essential for achieving Immunization Agenda 2030 targets. We analysed cross-sectional data from 1,738 children aged 12–23 months identified through the 2024 Zambia Demographic and Health Survey, a nationally representative survey using a stratified two-stage cluster sampling design. Three outcomes were assessed: zero-dose status (no DTP1), under-immunization by the basic schedule (BCG, DTP1–3, OPV1–3, measles-1), and under-immunization by the national expanded schedule (basic plus PCV1–3 and rotavirus1–2). Survey-weighted multivariable regression identified associated factors. Nationally, 3.2% (95% CI: 2.1–4.3%) of children were zero-dose, 36.1% (95% CI: 33.0–39.2%) were under-immunised by the basic schedule, and 69.9% (95% CI: 67.0–72.8%) by the national schedule. Zero-dose prevalence ranged tenfold across provinces, from 0.6% in Lusaka to 6.9% in North Western. In adjusted models, children in the richest households had 93% lower odds of zero-dose than the poorest (aOR 0.07, 95% CI: 0.02–0.29). Facility delivery reduced zero-dose by 68% (aOR 0.32, 95% CI: 0.15–0.69). For basic-schedule under-immunization, secondary education (aOR 0.50, 95% CI: 0.30–0.82; prevalence ratio 0.68) and vaccination card possession (aOR 0.24, 95% CI: 0.14–0.40; prevalence ratio 0.53) were associated with lower odds. Wealth effects differed significantly by residence for all outcomes (p < 0.001). Zero-dose and under-immunization in Zambia are profoundly socioeconomically and geographically patterned. Reaching zero-dose children requires targeting the poorest households and those with home deliveries, particularly in North Western and Northern provinces. Improving vaccination card coverage may reduce broader under-immunization. Gaps in national schedule coverage are consistent with supply-side constraints requiring structural health system responses, though direct supply-side measurement was beyond the scope of this analysis.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0006618. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Sameera Mahomedy, Nosiphiwo Nzimande, Susan Goldstein

The prevalence of overweight and obesity among South African children is increasing. Unhealthy food and beverage marketing is a major contributor to this burden and has been associated with an increased risk of diet-related non-communicable diseases (DR-NCDs), unhealthy food preferences among children, and changes in household purchasing patterns. Despite these risks, South Africa primarily relies on industry self-regulation to govern advertising, raising questions about the effectiveness of existing complaint mechanisms. This study evaluated the procedural and substantive effectiveness of advertising complaint mechanisms for child-directed marketing across South African regulatory bodies. A ‘mystery shopper’ methodology was used to assess the complaint mechanisms under real-world conditions. Nine adverts were purposively selected from a broader observational sample, resulting in eleven complaints submitted to the relevant regulatory bodies. Complaints related to alcohol adverts, unhealthy food and beverage adverts, and promotional adverts across television, radio, YouTube and outdoor platforms. Complaint mechanisms were evaluated for timeliness, accessibility, jurisdictional clarity, and procedural and substantive adjudication. The current advertising framework is largely self-regulatory through the Advertising Regulatory Board (ARB), limiting the scope of enforceable oversight. Complaint procedures were frequently characterised by delays, incorrect referrals, inconsistent procedural requirements, and fragmented jurisdiction. Procedurally, nine of the eleven complaints were not satisfactorily resolved. Substantively, none were satisfactorily resolved. The ARB applied a narrow “specifically directed to children” test, despite broader evidence that children’s exposure to unhealthy product marketing can influence behaviour, particularly among adolescents. Comparison with relevant ARB decisions involving public health messaging further suggested asymmetries in evidentiary standards between commercial advertising and public health communications. These findings highlight important procedural and substantive limitations within South Africa’s current advertising complaints framework. They further support consideration of stronger statutory or co-regulatory approaches with independent oversight to better protect children from harmful commercial marketing.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0005223. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Shiferaw Birhanu, Getu Degu Alene, Yeshalem Mulugeta Demilew

Background Appropriate complementary feeding is essential for children’s growth and cognitive development. However, these practices remain inadequate in the study area. Therefore, this study aimed to evaluate the effect of nutrition counseling on complementary feeding practices among mothers with children aged 6–23 months in West Gojjam Zone, Northwest Ethiopia. Methods A two-arm, parallel, cluster-randomized controlled trial was conducted from June 2023 to December 2024 in rural districts of West Gojjam Zone. Thirty clusters (15 per arm) were assigned to either an intervention group (n = 401), which received Health Belief Model-based nutrition counseling by Women’s Development Army leaders, or to a control group (n = 401), which received routine education. The intervention was delivered monthly for nine months from infant age 6–8 months. The primary outcome was appropriate complementary feeding practices. Secondary outcomes included minimum dietary diversity, meal frequency, acceptable diet, and egg/flesh food consumption. Data were collected via interviewer-administered questionnaires. The intervention effect was analyzed using Generalized Estimating Equations with adjustment for potential confounders. Statistical significance was set at p < 0.05. Results The difference-in-differences in appropriate complementary feeding practices between groups was 13.2 percentage points. After adjustment, mothers in the intervention group were nearly 2.5 times more likely to practice appropriate complementary feeding than controls [AOR = 2.49, 95% CI: (1.40, 4.42)]. Children of counseled mothers were also more likely to achieve minimum dietary diversity [AOR = 1.75, 95% CI: (1.04, 2.93)], minimum meal frequency [AOR = 1.62, 95% CI: (1.01, 2.61)], and minimum acceptable diet [AOR = 2.13, 95% CI: (1.26, 3.59)] compared with controls. Conclusion Health Belief Model-based nutrition counseling was positively associated with improvements in appropriate complementary feeding practices, minimum dietary diversity, meal frequency, and acceptable diet. Integrating such counseling into routine maternal and child health services may strengthen child nutrition programs in similar rural settings. Trial registration ClinicalTrials.gov (NCT05871346).

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361976. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Gwangsu Lee

Rising health insurance expenditure (HIE) poses fiscal risks and challenges to the sustainability of public insurance systems. Despite growing interest in data-driven analysis, empirical evidence on the associations between macroeconomic, social, and financial conditions and national HIE remains limited, particularly across provider types. This study introduces an explainable machine-learning framework with temporal predictive validation to analyze and forecast HIE using 60 macro-financial and socioeconomic indicators. The framework is applied to three monthly expenditure series from Korea’s National Health Insurance system (2000–2023). Predictive performance and interpretability are assessed using two univariate autoregressive baselines, three regularized linear indicator-based benchmarks, and six nonlinear indicator-based ensemble models. LightGBM serves as the primary explanatory model, and SHapley Additive exPlanations (SHAP) quantifies indicator contributions and captures autoregressive persistence. Beyond associational insights, temporal predictive validation using lagged regression and Granger-type temporal predictive tests examines, within a prespecified exploratory lag window, whether SHAP-identified indicators show statistically supported exploratory lagged monitoring relevance. These results are interpreted as hypothesis-generating temporal monitoring evidence rather than as evidence of structural causal effects. Although persistence-based baselines achieved the strongest short-term forecasting accuracy, indicator-based models provided model-conditional explanatory information beyond autoregressive controls. The results indicate that shared macroeconomic pressures and provider-specific factors are associated with HIE predictions. The cost-of-living index is consistently associated with expenditure patterns across categories, whereas domestic demand and external conditions indicate provider-specific associations for medical institutions and pharmacies. Only a subset of predictors retained exploratory lagged monitoring support, underscoring the distinction between model-based predictive importance and hypothesis-generating monitoring signals. This integrated framework may inform transparent fiscal risk monitoring hypotheses and contextual review of public HIE.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361904. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Maha Aljabri, Mustafa M. H. Abd El-Wahab, Amani Mahmoud Dobeie, Mohamed El-Soda

Dissecting the genetic basis of genotype × environment interaction (G × E) is important for breeding crops with stable or responsive performance across production environments. Using previously published seed-yield data from 107 Egyptian fenugreek accessions evaluated under two contrasting field environments, we investigated whether yield potential and environmental responsiveness share a common genetic basis. Seed yield per plant was measured in Giza (SYP_G; reference environment) and Wadi El-Natrun (SYP_W; contrasting environment). Nine derived indices were calculated to characterize environmental responsiveness, productivity, and stability: relative performance index (RPI), yield plasticity index (YPI), stress tolerance index (STI), log response ratio (LRR), mean productivity (MP), harmonic mean (HM), tolerance index (TOL), stress susceptibility index (SSI), and AMMI stability value (ASV). The near-zero correlation between SYP_G and SYP_W (r = 0.107) indicated substantial genotype reranking across environments, while several response indices were closely related to SYP_W and therefore predominantly reflected environment-dependent yield expression. Phenotypic analyses also identified contrasting performance strategies, ranging from highly responsive accessions, such as G15 (RPI = 3.629), to highly stable accessions, such as G41 (YPI = 0.001). These phenotypes were integrated with 38,142 SNPs using univariate association-mapping approaches. In addition, SYP_G and SYP_W were subjected to multivariate association-mapping. Association mapping identified one genome-wide-significant SNP for STI and several suggestive loci showed concordant associations across mapping methods. Within the current panel, marker coverage, and significance thresholds, most adaptation-index associations did not overlap previously reported yield loci; however, dDocent_Contig_39939_66, previously associated with seed yield in this panel, also showed cross-method suggestive associations with RPI and TOL. Comparative genomic analysis of three legume reference genomes supported two gene-linked candidate loci associated with STI: a cation/H⁺ antiporter and an importin subunit beta-1. The same analysis classified two of the strongest statistical signals, including the sole genome-wide-significant locus, as repetitive or transposable-element sequences rather than single-copy genes. These findings demonstrate that statistical association strength does not necessarily establish a coding-gene basis for loci identified using reference-free ddRAD markers. Within the current population size and marker coverage, environmental responsiveness and productivity appeared partially distinct but biologically connected components of environment-dependent yield performance. The results provide a genomic and phenotypic framework for prioritizing fenugreek germplasm for further evaluation while emphasizing the need for independent-population, multi-season, and functional validation of the identified candidate loci.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361774. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Xiaoqian Liu, Wenxin Jiang, Yining Ren

This paper proposes a Meta-Transformer model for few-shot accurate lane-changing intention recognition in connected vehicle environment. Given the velocity, acceleration, distance headway, time headway and time to collision of a vehicle at past time steps, a transformer model is developed to recognize the lane changing intention of the vehicle at the current time step. The multi-head attention layer of the Transformer model is capable of effectively extracting features from the multivariate time serie input. This enhances the accuracy of lane-changing intention recognition. The Transformer model is combined with a model -agnostic meta-learning (MAML) algorithm to be able to perform well with small amount of training data. The meta-learning consists of meta-training and meta-testing. During the meta-training, a task is sampled from the distribution over tasks. The tasks include recognition of intention of lane-keeping, lane-changing to left lane, and lane-changing to right lane. The model is trained with few samples and feedback from the loss function defined on the tasks. The loss function is defined as the categorical cross entropy of the errors between the labels and the results generated by the proposed model. During the meta-testing, the model is tested on new data from the distribution of the transition from a feature and the label to another feature. The model is trained by minimizing the test error. Experimental results show that the proposed model can achieve 8.7 percentage points higher accuracy than a transformer model.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361594. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Dominique Guillaume, Laetitia Mélissande Amédée, Maria Alcaide, Joy Chepkorir, Ashley Gresh, Ann Augustin, Laeticia Jean Baptiste, Kamila Alexander

Haitian migrant women in the U.S. experience disproportionate rates of cervical cancer. Intravaginal practices (IVPs) are widely used among Haitian women and have been linked to an increased risk of human papillomavirus (HPV) infection. Although IVPs are well-documented in the Haitian community, little is known about Haitian migrant women’s perceptions and motivations underlying their use. This exploratory sequential mixed-methods study examined Haitian migrant women’s motivations for engaging in IVPs, products used for IVPs, and indications for their use. A convenience sample of Haitian migrant women in South Florida were recruited through active and passive recruitment approaches in community-based centers. Semi-structured qualitative interviews (n = 25) explored perceptions, motivations, and products used for IVPs. Qualitative results informed the development of survey items measuring IVPs, which were administered to participants (n = 151). Chi-square analysis with a Bonferroni adjustment examined associations between IVP products and IVP indications. All women in the qualitative sample (n = 25, 100%) confirmed IVP use compared to 68.9% (n = 104) of women in the quantitative sample. Qualitative interviews revealed that IVP preferences were rooted in cultural expectations with most women starting these practices either during puberty or after sexual debut. IVP products (e.g., plant and herbal agents, astringent washes, and antibiotics) were often chosen based on specific gynecologic indications, with this finding being consistent across both samples. Pigeon pea (pwa kongo) was the most frequently used IVP product in the quantitative sample (n = 74, 71.2%) and was associated with nearly all IVP indications (p ≤ 0.004). Given the high prevalence of IVPs in our sample, researchers and practitioners should further examine the meaningful health risks and protective effects associated with IVPs.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0007394. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Tomas Bañeras, David Jiménez-Alvarado, Hector Toledo-Padilla, Laura Camps-Lahora, José Juan Castro, Ana Espino-Ruano, Airam Guerra-Marrero, Lorena Couce-Montero, Eva K.M. Meyers, Lluís Bañeras

Shark microbiome studies offer acute insights into host health, immunity, and ecological interactions, yet remain poorly studied compared to other marine vertebrates. Shark-associated microbial communities, despite being species-specific, are influenced by environmental conditions and feeding ecology. In this study, we aimed to characterize shifts in the microbiome of the Critically Endangered angelshark (Squatina squatina) during the early stages of development and to assess how environmental factors contribute to the shaping of a specific microbiota. Samples from thirty-nine juvenile angelsharks were collected from Las Teresitas nursery area in the Canary Islands over one year. Skin, oral and cloacal microbiomes were analysed using 16S rRNA gene amplicon sequencing. The sizes of individuals ranged between 24 and 42 cm in length. The shark microbiome was clearly distinct from the surrounding environment, indicating a unique composition from early life stages. Dominant bacteria present in the shark microbiomes included Vibrionaceae (up to 96%), Pseudoalteromonas (up to 63%), Rhodobacteraceae (up to 57%) and Alteromonadaceae (up to 20%). Seawater had a greater influence than sediment on the external skin microbiome, especially in younger individuals. This was not expected due to the burial behaviour of the species. Notably, the abundance of Pseudoalteromonadaceae (assessed by qPCR) was positively correlated with shark growth but was independent of the skin mucus. This suggests a protective role of this phylotype in younger individuals and may help in the adaptation to habitat conditions. This is the first comprehensive microbiome study in angelsharks, highlighting the importance of environmental preservation for microbial integrity and juvenile fitness.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361287. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.