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Authors: Arnaud Philippot, Irène Ibanez, Marine Coppens, Coralie Eeckhout, Catherine Cescutti, Alexandre Beine, Esther Meers, Tine Van Damme, Marc Francaux, Vincent Dubois, Davy Vancampfort

Introduction Physical activity interventions for adolescents with depression often show limited effectiveness due to insufficient developmental tailoring, limited autonomy support, and poor contextual feasibility. BRIDGES (Brussels Resilience and Inclusion for Depression – Guidance, Exercise, and Support) is a theory-informed and co-designed physical activity intervention integrating the COM-B model, self-determination theory and motivational interviewing to support autonomous and competence-enhancing engagement. This pilot randomized controlled trial uses a hybrid type 2 implementation–effectiveness design to examine feasibility, acceptability, implementation processes and obtain preliminary estimates of clinical effectiveness to inform a future larger-scale trial. Methods and analysis Sixty physically inactive adolescents aged 12–19 years with depression will be recruited from an outpatient mental health service in Brussels, Belgium. Participants will be randomized in waves using covariate-adaptive minimization with a biased-coin component (p=0.85), balancing baseline depression severity, physical activity level, gender and age. The intervention consists of 18 individualized physiotherapist-led counselling sessions delivered over 12 weeks, including structured support to facilitate transition to community-based physical activity. Primary feasibility, acceptability, implementation outcomes will be assessed using quantitative measures and semi-structured interviews with adolescents, caregivers and community partners, guided by the Practical, Robust Implementation and Sustainability Model (PRISM) and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Preliminary effectiveness outcomes are changes in physical activity measured using the Physical Activity Vital Sign (PAVS) and depressive symptoms measured using the Patient Health Questionnaire-9 modified for Adolescents (PHQ-A). Preliminary effectiveness will be analysed using linear mixed-effects models following an intention-to-treat approach to estimate cluster-level parameters for a future fully powered Hybrid Type 2 trial. Secondary outcomes include social support, exercise self-efficacy, cardiorespiratory fitness and waist-to-height ratio. Qualitative data will be analysed using the Qualitative Analysis Guide of Leuven. Trial registration ClinicalTrials.gov NCT07422909

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360292. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Gladness N. Mkawe, Benedicto Mgala, Neema Mawi, Salome E. Buluba, Menti Ndile, Khadija Malima, Edith Tarimo, Fatina B. Ramadhani

Cardiovascular diseases (CVDs) are a significant cause of morbidity and mortality worldwide, with lifestyle modification being a cornerstone in their management. However, qualitative evidence on the influences that facilitate or hinder lifestyle modification practices among patients attending cardiac clinics in Tanzania remains limited. Understanding these influences is important for designing feasible, context-appropriate cardiovascular risk-reduction interventions. This study aimed to explore perceived facilitators and barriers influencing lifestyle modification among adults with cardiovascular disease attending the cardiac clinic at Kilimanjaro Christian Medical Centre (KCMC). An exploratory qualitative study was conducted between May and July 2024 among adults with CVD attending the KCMC cardiac clinic. Ten (10) participants were purposively recruited to capture variation in age, sex, and cardiovascular diagnosis. The final sample was guided by thematic saturation, reached after eight interviews and confirmed through two additional interviews. Data were collected through in-depth semi-structured interviews and analyzed manually using Braun and Clarke’s six-phase thematic analysis. The analysis generated two themes supported by sub-themes: (1) facilitators of lifestyle modification, comprising perceived benefits and outcomes; social, family, and spiritual support; and medical advice and counselling; and (2) barriers to lifestyle modification, comprising lack of consistent motivation; psychological factors; physical limitations and health setbacks; social and environmental barriers; lack of guidance; misconceptions and beliefs; and financial constraints. Despite facing cultural, psychological, physical, and financial barriers, patients demonstrated willingness to adopt healthier lifestyles when supported by healthcare providers, family members, and personal motivation. These findings highlight the need for culturally sensitive, patient-centered interventions that integrate lifestyle counseling, psychosocial support, and community involvement to improve long-term cardiovascular outcomes.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0007537. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Benjamin Tsofa, Moriasi Nyanchoka, Joshua Munywoki, Fatuma Guleid, Nancy Kagwanja, Lucy Kanya, Francis Wafula, Jacinta Nzinga

Recurrent health worker strikes in Kenya since the 2013 devolution reforms reflect more than episodic labour unrest; they signal broader governance challenges that may be particularly pronounced in decentralised and resource-constrained health systems. Despite constitutional protections for labour rights and decentralised service delivery, Kenya’s health sector has experienced persistent industrial disputes, exposing gaps in legal frameworks, institutional coordination, and dispute resolution systems. We conducted a qualitative policy analysis of health worker strikes in Kenya between 2010 and 2025. Data were drawn from legal statutes, policy documents, government reports, peer-reviewed literature, and grey sources. Guided by Walt and Gilson’s policy triangle, complemented by complex adaptive systems and health governance frameworks, we analysed how institutional arrangements, stakeholder dynamics, and policy processes shape labour relations in a devolved health system. Several interrelated drivers of recurrent strikes were identified, including tensions between the constitutional rights to strike and to health, fragmented governance and weak intergovernmental coordination under devolution, persistent workforce challenges and failures to implement Collective Bargaining Agreements (CBAs) and Return-to-Work Formulae (RTWFs), ineffective dispute-resolution mechanisms, and the absence of enforceable minimum service arrangements during industrial action. Through their interaction, these factors generate recurring cycles of non-compliance, labour unrest, and institutional mistrust. Recurrent disputes over CBA and RTWF implementation suggest that the central issue lies not in the absence of legal protections or negotiated settlements, but in translating commitments into sustained action. Addressing recurrent strikes requires systemic reform beyond short-term dispute settlement to address underlying governance, accountability, and implementation challenges. Priorities include strengthening independent dispute resolution mechanisms, clarifying responsibilities across levels of government, improving accountability for negotiated commitments, harmonising human resource management systems, and institutionalising minimum service protections. Kenya’s experience offers important lessons for decentralised health systems on aligning authority, accountability, and implementation capacity to strengthen resilience and advance universal health coverage.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0006412. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Afruna Rahman, Kyu Han Lee, Shams El Arifeen, Mohammad Zahid Hossain, Atique Iqbal Chowdhury, Muntasir Alam, Afsana Afrin, Ikechukwu Udo Ogbuanu, Solomon Samura, Erick Kaluma, Julius Ojulong, Samba Sow, Adama Mamby Keita, Milagritos D. Tapia, Kiranpreet Kaur Chawla, Karen Kotloff, Shabir A. Madhi, Sana Mahtab, Yasmin Adam, Amy Wise, Ziyaad Dangor, Christopher Mugah, Elizabeth Oele, Richard Omore, Aggrey K. Igunza, Dickens Onyango, Inacio Mandomando, Quique Bassat, Sara Ajanovic, Rosauro Varo, Elisio Xerinda, Nega Assefa, J. Anthony G. Scott, Lola Madrid, Melisachew M. Yeshi, Fikremelekot Temesgen, Lucy Liu, Portia Mutevedzi, Dianna M. Blau, Victor Akelo, Robert F. Breiman, Cynthia G. Whitney, Emily S. Gurley, for the CHAMPS Consortium

Background Globally, an estimated 1.9 million stillbirths occur annually, yet significant knowledge gaps exist regarding the causes of stillbirths, particularly in high-burden regions. We investigated fetal and maternal conditions causing stillbirths in seven countries in sub-Saharan Africa and South Asia and described missed opportunities for prevention. Methods Child Health and Mortality Prevention Surveillance (CHAMPS) identified stillbirths at sites in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa. We asked families for consent to conduct minimally invasive tissue sampling (MITS) from December 2016 to December 2023. An expert panel reviewed test results, clinical information, and verbal autopsy data and assigned fetal and maternal conditions leading to stillbirths and identified missed opportunities for prevention. Findings A cause of death (fetal or maternal condition) was determined for 94% (2342/2492) of stillbirths; the most frequent condition in the fetus was intrauterine hypoxia (75%, 1864/2492) across all sites, resulting from either maternal condition (49%, 922/1864) or placental causes (33%, 610/1864). Congenital infections were determined to be the cause of 9% (228/2492) of stillbirths, accounting for the highest proportion in South Africa (31%, 96/306). Group B Streptococcus, Escherichia coli, and Enterococcus faecalis were the most common causative pathogens. Congenital birth defects caused 9% (227/2492) overall and were most common in Ethiopia (24%, 136/568). Primary maternal conditions were identified in 72%, most often placental complications (18%, 446/2492) and maternal hypertension (17%, 414/2492). Complications of placenta, cord and membranes were more common in Mali (43%, 92/212) while maternal medical and surgical conditions were most frequently observed in South Africa (40%, 121/306) and Bangladesh (39%, 158/405). Most (72%, 1808/2492) causes of stillbirth were considered preventable, with heterogeneity observed across sites on the recommended prevention strategies. Interpretation Complications of pregnancy or delivery accounted for most stillbirths across all sites, with intrauterine hypoxia identified as the predominant fetal condition highlighting widespread and persistent gaps in the timely identification and management of maternal and placental conditions during antenatal and obstetric care across sites in Africa and South Asia. At the same time, substantial geographic variation in causes and prevention opportunities, including for infections and birth defects, underscored the need for locally tailored strategies. Strengthening facility-based care alongside targeted interventions based on site-specific patterns, will be critical to reducing the stillbirth burden in these high-priority regions. Funding The Gates Foundation

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0005235. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Majed M. Aljabri, Bandar S. Alharbi, Endale Alemayehu Ali

Background Psychological stress is highly prevalent among nursing students. The clinical exposure is a major factor contributing to psychological stress, but there is a lack of consistent evidence, particularly in the context of Middle Eastern countries. The aim of this study was to quantify the association between clinical exposure and perceived stress among nursing students, and to assess whether perceived social support moderates this relationship. Methods We conducted a cross-sectional study among nursing students from King Saud University. The Perceived Stress Scale was used to measure psychological stress, and the Multidimensional Scale of Perceived Social Support was employed to measure perceived social support. The clinical exposure was quantified as the average number of hours spent per week. We employed multivariable linear regression to determine the association. The regression analysis was adjusted for age, gender, living arrangements, and employment status. Results Higher perceived social support was significantly associated with lower perceived stress (β = −0.05, 95% CI −0.09 to −0.01). Clinical exposure was not significantly associated with perceived stress. Students living alone had significantly lower levels of perceived stress (β = −0.37, 95% CI −0.63 to −0.11), as did students working part-time (β = −0.34, 95% CI −0.54 to −0.13). The interaction model revealed that perceived social support was inversely associated with perceived stress levels (β = −0.14, 95% CI −0.23 to −0.04). A statistically significant interaction was observed among students with less than 10 hours of clinical exposure per week. This exploratory finding suggests that the association between perceived social support and stress may differ among students with limited clinical exposure. However, the finding was based on a single statistically significant interaction and should be considered preliminary and hypothesis-generating. Conclusions Higher perceived social support was associated with lower levels of perceived stress among nursing students. Interventions aimed at enhancing the social support system may be beneficial in reducing stress, especially during the early clinical exposure period.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361336. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Carolina G. Downie, Heather M. Highland, Annie Green Howard, Mona Alotaibi, Tali Elfassy, Christina Cordero, Jennifer E. Below, Mercedes Carnethon, Susan Cheng, Martha Daviglus, Olga Garcia-Bedoya, Robert Kaplan, Tasneem Khambaty, Yilun Li, Adam G. Lilly, Dan-Yu Lin, Tao Long, Frank J. Penedo, Lauren E. Petty, Bharat Thyagarajan, Hsiao-Chuan Tien, Mohit Jain, Barrett M. Welch, Kari E. North, Christy L. Avery

Background Inflammation is a common pathological feature underlying type 2 diabetes (T2D) risk and progression. Determining the roles of fatty acids and bioactive lipid oxylipin inflammatory mediators could inform T2D preventative efforts and therapeutic targets. Methods Leveraging the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), we evaluated cross-sectional and prospective associations of 81 oxylipins and polyunsaturated, monounsaturated, and saturated fatty acids with T2D. We assessed whether fatty acid levels differed at visit 2 by visit 1-prevalent T2D status and prioritized likely causal metabolites using Bayesian model averaging Mendelian randomization (MR-BMA). Results Fifty-four fatty acids and oxylipins were associated with prevalent T2D at visit 1 (15,138 participants; 2,962 T2D cases), four of which (adrenic, dihomo-gamma-linolenic, tricosanoic, and lignoceric acids) were also associated with incident T2D by visit 2 (8,548 participants; 1,376 T2D events), though effects were attenuated for adrenic and dihomo-gamma-linolenic acids upon further adjustment for impaired glucose tolerance. Sixteen out of 28 fatty acids were significantly different at visit 2 between those with and without prevalent T2D at visit 1 (9,115 participants; 2,151 T2D cases), holding visit 1-measured fatty acid levels constant. MR-BMA prioritized one diHETrE oxylipin as a likely causal risk factor for T2D. Conclusions Fatty acids and oxylipins showed complex patterns of association with T2D, including more associations likely reflecting overt disease processes in prevalent T2D, than incident risk-enhancing associations.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360656. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: David E. Goldsbury, Anne E. Cust, Caroline Watts, Alison Pearce, Philip Haywood, Louisa G. Collins, Preston Ngo, Kirstie McLoughlin, Michael Caruana, Karen Canfell, Julia Steinberg, Marianne F. Weber

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361490. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Chidera M. Ejike, Rebecca Ramos, Christiana Ketema, Mackenzie Waller, Kai Glahn, Auwal Abubakar, Deborah Jean McClelland, Kacey Ernst, Huaqing Wang, Shujuan Li, Maiya Grace Block Ngaybe

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361454. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Ugochukwu Uzoechina Nwokoro, Ifeyinwa Lilian Ezenwosu, Elias Chikee Aniwada, Izuchukwu Frank Obi, Justus Uchenna Onu, Chidiebere Clifford Aniagboso, Eunice Enabulele, Chinyere Nkiruka Okafor, Chijioke Thaddeus Asogwa, John Olajide Olawepo, Chika N. Onwasigwe

Women caregivers living with HIV (WCLHIV) face a dual burden of managing their own health while caring for their families, increasing their vulnerability to mental health disorders. This study aimed to ascertain the prevalence and factors associated with common mental health disorders among WCLHIV in Enugu, Nigeria. A cross-sectional study employing a mixed method approach was conducted among 1,011 WCLHIV accessing anti-retroviral therapy in four tertiary health facilities in Enugu State, Nigeria. Quantitative data were obtained face-to-face using pre-tested, validated tools to assess the prevalence of depression, anxiety, stigma, and other psychological characteristics. Multivariate logistic regression identified significant risk factors of mental health disorders at a 95% confidence interval and p < 0.05. Four focus group discussions involving 35 WCLHIV explored factors impacting their mental well-being. Qualitative data were analyzed thematically using an inductive approach. Participants had a mean age of 44.3 (SD ± 8.44) years. The prevalence of depression and anxiety was 25.7% and 19.2%, respectively, while 79.0% reported high perceived stigma. Having primary education (AOR = 1.53; 95% CI: 1.06 –2.22), and low social support (AOR = 2.32; 95% CI: 1.11–5.07) were risk factors while low income (AOR = 0.42; 95% CI: 0.21–0.85), and low perceived stress (AOR = 0.05; 95% CI: 0.02–0.15) were protective of depression. Low perceived stress was protective of anxiety (AOR = 0.07; 95% CI: 0.02–0.22). Qualitative findings converged with quantitative data, highlighting the impact of stigma, poor social support, pill burden, fear of status disclosure, and financial strain on the mental health of WCLHIV.The prevalence of common mental health disorders was high among WCLHIV with a substantial proportion experiencing depression and anxiety, reflecting the significant impact of stigma, low social support, and stress. Targeted multi-level psychosocial interventions and community empowerment programs are needed to strengthen social support and reduce stigma among WCLHIV.

Source: PLOS Mental Health. DOI: 10.1371/journal.pmen.0000764. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Helena Mutede Cutótua Daniel, Lauro Estivalete Marchionatti, Jessica Azevedo Veronesi, André Cardoso Campello, Luis Augusto Rohde, Caio Borba Casella, Peter Raucci, Afonso Mazine Tiago Fumo, Jair Mari, Giovanni Abrahão Salum, Lidia Gouveia, Zeina Mneimneh

Mozambique is home to 18 million children and adolescents largely underrepresented in mental health research. We conducted a systematic review of evidence-based resources (prevalence estimates, assessment instruments, and interventions) on mental health-related outcomes addressing individuals aged 0–19 years in Mozambique. We searched PubMed, Web of Science, PsycINFO, CINAHL, Google Scholar, African Index Medicus, and local catalogues. Extraction followed COSMIN and Cochrane manuals (PROSPERO registration: CRD420251016208). The search yielded 81 unique publications, including 61 reports presenting prevalence estimates from 25 studies, 29 reports providing data on 42 assessment instruments, and 9 intervention reports describing 8 intervention trials. The clinical prevalence of mental disorders were estimated in two surveys, conducted in Nampula (ADHD: 13·4%; N = 748, 6–18 years) and Maputo (any mental diagnosis: 23%, anxiety disorders: 17·5%; major depression episode: 8·5%; disruptive behavior disorder: 6·6%; substance use disorders: 4·5%; ADHD: 3·3%; PTSD: 1·2%; N = 486, 12–19 years). Most research focused on psychosocial adversities, with nationally representative adolescent surveys reporting significant exposure to violence (physical/emotional violence annually: 24·86%; girls suffering intimate partner violence: 21·11%; lifetime sexual abuse: 16·55%). National suicide rates were highest among 15–19-year-olds (1·53 per 100,000). Only four instruments were cross-culturally adapted and showed reliable psychometrics (MINI-KID, GAD-7, PHQ-A, and SDQ), whilst unadapted tools performed poorly. There was a single randomized clinical trial which reported a cost-effective intervention for neurodevelopment among high-poverty preschoolers. Children and adolescents in Mozambique face significant psychosocial adversity, and available evidence suggests a substantial burden of mental disorders according to limited clinical data. There are few available instruments assessing mental conditions, and culturally sensitive approaches are warranted for strengthening local research.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0007513. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Celumusa Ndlangamandla, Musa Mamba

Adolescents living with HIV (ALWH) carry a substantial burden of mental health problems, yet summary data remain limited. Previous reviews, particularly systematic reviews, have focused mainly on diagnosed disorders among adults or broader populations of young people living with HIV, while substance use and emotional and behavioural symptoms remain understudied and often underreported. This scoping review synthesized existing evidence on common mental health problems among ALWH aged 10–19 years in sub-Saharan Africa (SSA). We searched five electronic databases (PubMed, PsycINFO, CINAHL, Embase, and Open Access for Africa) and Google Scholar, and screened the bibliographic references of selected articles for additional studies. Search terms were combined using Boolean operators and organized into four concept categories: HIV, age, mental health, and region. Eligible studies were original, peer-reviewed research published in English between 2020 and 2026, conducted in SSA, and reporting on mental health among ALWH aged 10–19 years. The search yielded 427 records, of which 29 duplicates were removed. Of the 398 articles screened, 317 were excluded at the abstract stage and a further 57 after full-text review, leaving 24 articles for inclusion. The review identified six common mental health problems among ALWH in SSA: depressive disorders and symptoms, generalized anxiety, suicidality, emotional and behavioural problems, posttraumatic stress, and substance use problems. Depression and suicidality were the most frequently reported, whereas substance use, generalized anxiety, posttraumatic stress, and emotional and behavioural problems were less frequently reported. ALWH in SSA experience a range of mental health problems that may affect their well-being and engagement in HIV care. Routine mental health screening, prevention, and psychosocial support should be integrated into HIV care for this population. Strengthening integrated mental health and HIV services may help address unmet needs and improve health outcomes among ALWH in SSA.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0006832. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Oluwatosin Nkereuwem, Jana Prauseová, Rachel Ford, Alpha Omar Jallow, Musa Marena, Gibril Jarju, Sidat Fofana, Mamady Cham, Buba Manjang, Beate Kampmann, Joanna Busza

Many low- and middle-income countries rely on paper-based maternal and child health records that are often incomplete, fragmented, and difficult to use for continuity of care and decision-making. Smart Paper Technology (SPT), a hybrid paper–digital documentation system, has been proposed as a practical alternative to fully electronic medical records in resource-constrained settings. This study explored the early implementation of SPT in maternal and infant health services in The Gambia, focusing on feasibility and acceptability. We conducted a qualitative descriptive implementation evaluation guided by Rapid Assessment Procedures (RAP) in two pilot facilities in the Western Region of The Gambia between September and December 2024. Data were collected through 30 semi-structured interviews; four focus group discussions with 30 participants spanning facility-level clinical, management, and administrative staff, Ministry of Health staff, and technical and implementing partners; and non-participant observations across key service delivery areas. Data were analysed thematically using NVivo 14. Participants described SPT as feasible and broadly acceptable because it built on familiar paper-based workflows, was introduced through a participatory process, and offered advantages in reporting, information retrieval, and maternal–infant record linkage. However, these benefits were contingent on the implementation context. Key challenges included uneven training coverage, dual documentation, limited internet connectivity, scanning and data capture errors, storage constraints, and concerns about data governance. Staff adapted through peer mentoring, remote troubleshooting, and local workarounds. Participants emphasised that successful scale-up would require sustained training, clear governance arrangements, adequate human and technical resources, and a phased transition to government ownership. SPT offers a practical pathway towards digitisation in maternal and infant health services in LMICs, but its success depends on strong organisational systems, workforce support, and implementation processes that are responsive to routine service realities.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0006244. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.