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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.

Authors: Yuanliang Dong, Chengcheng Pan, Siyu Pan, Lei Zhang

Linear cultural heritage landscapes embody the long-term coupling relationships between ecological processes and human cultural practices, yet conservation models guided by a single ecological or cultural goal fail to meet their holistic management needs. Based on the perspective of biocultural diversity, this study takes the Huizhou-Hangzhou Ancient Trail (HHAT) as a case study and constructs a comprehensive conservation framework oriented toward spatial planning. Biodiversity and cultural diversity patterns are assessed and their spatial relationships are quantified using the coupling coordination degree model. The biocultural diversity index is further integrated with the Marxan systematic conservation planning model to identify Biocultural Core Protected Areas (BCCPA) and support differentiated spatial conservation strategies. The results indicate that biodiversity and cultural diversity along the HHAT exhibit a pronounced antagonistic coupling relationship: regions with antagonistic coupling account for 98.90% of the total study area, while coordinated regions make up only 0.02%. Based on the natural and cultural context of the study area, this pattern may be jointly influenced by rigid competition for small‑scale spatial resources, the dual effects of traffic corridors, and the cumulative effects of traditional livelihood activities. In response, an integrated conservation spatial pattern of one core area and two corridors is proposed, together with four conservation strategies: Conservation-Minimal Intervention, Conservation-Appropriate Revitalization, Restoration-Minimal Intervention, and Restoration-Appropriate Revitalization-enabling an effective translation from coupling diagnosis to spatial planning responses. This study advances understanding of biocultural interactions in mountainous linear heritage landscapes and provides a transferable methodological pathway for integrated conservation planning.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360922. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Efrén Martínez-Quintana, Marta Isabel García-Suárez, María Alcántara-Castellano, Jesús María González-Martín, Fayna Rodríguez-González

Background Adults with congenital heart disease (CHD) may experience substantial psychological distress. This study evaluated whether a documented history of anxiety disorders is associated with a distinct psychosocial profile in adults with CHD. Methods In this cross-sectional study, 45 adults with CHD were included: 21 with a documented history of anxiety disorders and 24 without. Psychosocial assessment included the EuroQol-5D-3L (EQ-5D-3L), Rosenberg Self-Esteem Scale (RSES), State–Trait Anxiety Inventory (STAI), and Beck Depression Inventory-II (BDI-II). Associations between psychosocial measures and documented anxiety history were assessed using multivariable logistic regression adjusted for sex, NYHA functional class, and CHD complexity. Moderate depression was additionally assessed using univariable logistic regression. Results Mean age was 35 ± 9 years in participants with a documented history of anxiety disorders and 31 ± 11 years in those without (P = 0.230); males accounted for 33% and 62%, respectively (P = 0.052). NYHA functional class II–IV was more frequent among participants with a documented history of anxiety disorders (67% vs. 25%; P = 0.018). Compared with those without a documented anxiety history, participants with anxiety history reported greater limitations in usual activities (P = 0.021), higher anxiety/depression scores on the EQ-5D-3L (P = 0.023), poorer self-rated health (P = 0.038), higher trait anxiety (31.2 ± 5.8 vs. 26.5 ± 5.2; P = 0.008), and greater depressive symptom severity (BDI-II median 19 vs. 3; P = 0.001). Self-esteem was also higher (RSES median 27 vs. 25; P = 0.006). After adjustment, BDI-II scores were positively associated with a documented history of anxiety disorders (OR 1.14, 95% CI 1.05–1.28; P = 0.011), while EQ-5D VAS scores were inversely associated (OR 0.64, 95% CI 0.38–0.97; P = 0.048). STAI-State, STAI-Trait, and RSES scores were not significantly associated with anxiety history. None of the variables assessed in the univariable analysis was significantly associated with moderate depression. Conclusions In adults with CHD, a documented history of anxiety disorders was associated with greater depressive symptom severity and poorer self-rated health after adjustment for relevant clinical factors.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360616. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Abdulmohsen Saud Albesher

National digital health platforms are becoming fundamental components of modern healthcare delivery; however, patient experience is commonly assessed using overall ratings or sentiment analysis, providing limited understanding of the specific dimensions that influence digital healthcare quality and service improvement. This study aimed to develop a multidimensional framework for understanding patient experience in a national digital health platform, examine variation across healthcare services, investigate changes over time, and identify evidence-based improvement priorities. A qualitative analysis was conducted using 97,034 Google Play reviews of Sehhaty, the Saudi national digital health platform, posted between 2019 and 2026. Reviews were analyzed using an inductive coding approach to develop a patient experience framework, followed by comparative analyses across healthcare services and longitudinal analyses across successive stages of platform development. Nine patient experience dimensions were identified. Patient experience differed considerably across healthcare services, indicating that improvement priorities were service-specific rather than uniform across the platform. Longitudinal analyses showed a shift from predominantly technical concerns during early deployment toward challenges involving service accessibility, integration, continuity of care, as the platform matured. These findings enabled the identification of service-specific priorities for improving digital healthcare delivery. Patient experience in national digital health platforms is multidimensional, service-dependent, and evolves alongside platform maturity. The proposed framework extends approaches based primarily on ratings or sentiment by transforming large-scale patient-generated feedback into actionable evidence for healthcare quality improvement and continuous evaluation of patient-centered digital health services.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360416. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Rui Guo, Ancan Yao

The relationship between environmental heterogeneity and intangible cultural heritage (ICH) remains insufficiently explored at the regional scale. Using data from 312 ethnic minority villages and 305 ICH items in Guizhou, China, this study develops an Environmental Type–Recessiveness Cultural Adaptation (ERC) framework to examine associations between environmental conditions and ICH distribution patterns. Four environmental variables were integrated into five environmental types using K-means clustering. ICH recessiveness was operationalized as a three-dimensional composite index comprising observability, carrier explicitness, and environmental association. Expert scoring exhibited strong reliability. Results reveal clear associations between environmental settings and ICH recessiveness: moderate recessiveness predominates across the province; high-elevation, high-elevation environments with large distance to water systems tend to host more recessive forms of heritage, whereas low-relief and highly accessible landscapes are associated with lower recessiveness. These findings indicate that environmental differentiation is spatially coupled with systematic variation in ICH recessiveness. Such spatial correspondence is consistent with processes of socio-ecological adaptation rather than environmental determinism. The ERC framework provides a standardized and reproducible quantitative approach for comparative analysis of ICH across heterogeneous landscapes, offering a transferable tool for heritage research in mountainous and ethnically diverse regions. Overall, the observed west-to-east gradient in ICH recessiveness further supports the role of socio-ecological adaptation in shaping ethnic heritage patterns in mountainous environments.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360100. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.