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Great improvements in the health of newborns, children, and women in Pakistan are needed. A large body of literature has demonstrated that the majority of maternal, newborn, and child deaths are preventable with essential health strategies including immunization, nutrition interventions, and child health interventions. Despite the importance of these interventions for the health of women and children, access to services continues to be a barrier. Furthermore, demand for services also contributes to low coverage of essential health interventions. Given the emerging threat of COVID-19 coupled with already weak maternal and child health, delivering effective and feasible nutrition and immunization services to communities, and increasing demand and uptake of services is a pressing and important need. This quasi-experimental study aims to improve health service delivery and increase uptake. The study included four main intervention strategies including community mobilization, mobile health teams offering MNCH and immunization services, engagement of the private sector, and testing of a comprehensive health, nutrition, growth, and immunization app, Sehat Nishani, for a period of 12 months. The target group of the project were women of reproductive age (15-49 years) and children under-five. The project was implemented in three union councils (UCs) in Pakistan including Kharotabad-1(Quetta District, Balochistan), Bhana Mari (Peshawar District, Khyber Pakhtunkhwa) and Bakhmal Ahmedzai (Lakki Marwat district, Khyber Pakhtunkhwa). Propensity score matching based on size, location, health facilities, and key health indicators of UC was conducted to identify three matched UCs. A household baseline, midline, endline and close-out assessment will be conducted for evaluating coverage of interventions as well as the knowledge, attitude, and practices of the community in the MNCH and COVID-19 context. Descriptive and inferential statistics will be used to test hypotheses. As well, a detailed cost-effectiveness analysis will be conducted to generate costing data for these interventions to effectively inform policymakers and stakeholder on feasibility of the model. Trial registration: NCT05135637.

Pregnant South Asian immigrants (PSAI) make up a significant portion of immigrants to Canada and face a higher risk of adverse pregnancy outcomes compared to other ethnic groups. This disparity is largely due to cultural and linguistic barriers to maternity care, including language difficulties, limited cultural sensitivity in healthcare services, and a lack of awareness about culturally tailored educational resources. Despite the growing number of PSAI in Canada, there is limited understanding of how to best support their healthcare and well-being. To address this gap, we aim to conduct a priority-setting exercise to identify key research priorities and establish a patient-oriented research agenda that will drive long-term, impactful research and ultimately improve maternal health outcomes for PSAI in Canada. This project follows the James Lind Alliance (JLA) priority-setting partnership (PSP) methodology, which includes forming a steering committee, identifying and verifying uncertainties, conducting an interim priority-setting phase, and holding a final workshop. Participants will include first-generation South Asian immigrant women from Bangladesh, India, Pakistan, and Sri Lanka, as well as clinicians, researchers, and community/professional organizations from Ontario, Alberta, and British Columbia. Data will be collected through Zoom-based recorded working group sessions and an online ranking survey. Qualitative data will be analyzed using an inductive content analysis approach supported by NVivo software. Subgroup diversity (e.g., ethnicity, gender, age, and geography) will be tracked across participant groups. Consensus on top research priorities will be achieved through a structured ranking process followed by a facilitated virtual workshop. The study began in May 2025 and is expected to conclude by January 2026, a timeline consistent with similar JLA PSP initiatives. All findings will be shared through a peer-reviewed publication and conference presentations for the scientific community, a lay summary for community organizations, and a video and infographic for patient participants. Community and professional organizations will also support the dissemination of findings through their networks and social media channels.

As a framework to conceptualise well-being, the capability approach (CA) combines structural drivers with personal freedoms, making it a compelling approach for understanding women’s health and well-being (WHW). The WHW Project of the Exemplars in Global Health initiative chose the CA for its conceptual framing, while emphasising the influential role of gender and other intersecting inequalities (intersectional gender inequality) in shaping health and well-being over the life course. We discuss the Exemplars in Global Health – Women’s Health and Well-being (EGH-WHW) Framework and a scoping review that supports it.ObjectivesTo identify well-established and/or validated CA-based frameworks and measures attuned to intersectional gender inequality that analyse women’s well-being over the life course and across multiple geographies.If needed, to develop a new conceptual framework to analyse WHW over the life course through an intersectional gender inequality lens.DesignThe scoping review, which was carried out between January and May 2024 and re-run in May 2025, adhered to the methodology by Arksey and O’Malley, Levac et al and Daudt et al, and the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist. The EGH-WHW Framework was developed by a multidisciplinary Working Group comprising representatives of organisations in the WHW Project consortium.Data sourcesThe review drew upon database searches (Scopus, PubMed) and targeted online hand searches for CA-based frameworks and measures.Eligibility criteriaAll CA-based frameworks and measures of multidimensional well-being were included. CA-based empirical research was considered if it applied a framework or measure; or if it analysed multidimensional well-being across multiple geographies.Data extraction and synthesisInformation about each type of CA-based application—its choice of well-being dimensions, methods, focus on inequality, intersectionality and the life course—was recorded in a data charting form. Thematic summative syntheses of publications about each CA-based framework or measure led up to an overall evaluative synthesis of the fit between existing work and our requirements.ResultsThe review culminated in 94 publications, including six frameworks and 14 measures that met only some of the WHW Project’s requirements: multidimensionality of well-being; attention to intersectional gender inequality and the life course; as well as demonstrated and intended measurements across multiple geographies.DiscussionThe review reaffirms the need for the EGH-WHW Framework, which recognises that WHW depend on their freedom ‘to be’ and ‘to do’, and proposes three interconnected clusters of dimensions depicting key capabilities, agency and functionings that are sensitive to intersectional gender inequality and the life course. Each dimension is mapped to specific indicators to support comparative assessments of country performance and drivers of progress across low-income and middle-income countries.ConclusionThe EGH-WHW Framework distinguishes itself from other CA-based frameworks by incorporating both an intersectional gender lens and a life course perspective. The framework’s conceptualisation of multidimensional well-being allows for a rich and nuanced foundation on which to build policies and programmes that address the complex determinants of health, well-being and human rights of different groups of girls and women.

Our study describes the utility of group object narrative to understand the experiences of women affected by humanitarian crises. Drawing on a case study from the Swat Valley, Pakistan, we illustrate how objects act as an entry point to understand participants gendered experiences of the 2022 floods. Our findings demonstrate how this method can foster solidarity among participants, illuminate oft overlooked gender-specific challenges, and facilitate the development of practical solutions. By centering the voices of participants, we describe how group object narrative can disrupt existing power structures and amplify the voices of marginalized groups, especially women. This methodology provides a culturally appropriate, decolonial alternative to traditional research approaches, empowering participants to co-create narratives and pinpoint critical issues. The insights gained hold significant implications for public health research and practice. In particular, group object narrative can generate findings that directly translate into practice, and actionable change.

IntroductionFaith-based organisations (FBOs) and religious actors increase vaccine confidence and uptake among ethnoracially minoritised communities in low-income and middle-income countries. During the COVID-19 pandemic and the subsequent vaccine rollout, global organisations such as the WHO and UNICEF called for faith-based collaborations with public health agencies (PHAs). As PHA-FBO partnerships emerge to support vaccine uptake, the scoping review aims to: (1) outline intervention typologies and implementation frameworks guiding interventions; (2) describe the roles of PHAs and FBOs in the design, implementation and evaluation of strategies and (3) synthesise outcomes and evaluations of PHA-FBO vaccine uptake initiatives for ethnoracially minoritised communities.Methods and analysisWe will perform six library database searches in PROQUEST-Public Health, OVID MEDLINE, Cochrane Library, CINAHL, SCOPUS- all, PROQUEST - Policy File index; three theses repositories, four website searches, five niche journals and 11 document repositories for public health. These databases will be searched for literature that describe partnerships for vaccine confidence and uptake for ethnoracially minoritised populations, involving at least one PHA and one FBO, published in English from January 2011 to October 2023. Two reviewers will pilot-test 20 articles to refine and finalise the inclusion/exclusion criteria and data extraction template. Four reviewers will independently screen and extract the included full-text articles. An implementation science process framework outlining the design, implementation and evaluation of the interventions will be used to capture the array of partnerships and effectiveness of PHA-FBO vaccine uptake initiatives.Ethics and disseminationThis multiphase Canadian Institutes of Health Research (CIHR) project received ethics approval from the University of Toronto. Findings will be translated into a series of written materials for dissemination to CIHR, and collaborating knowledge users (ie, regional and provincial PHAs), and panel presentations at conferences to inform the development of a best-practices framework for increasing vaccine confidence and uptake.

Background Somalia has been ravaged by more than two decades of armed conflict causing immense damage to the country’s infrastructure and mass displacement and suffering among its people. An influx of humanitarian actors has sought to provide basic services, including health services for women and children, throughout the conflict. This study aimed to better understand the humanitarian health response for women and children in Somalia since 2000. Methods The study utilized a mixed-methods design. We collated intervention coverage data from publically available large-scale household surveys and we conducted 32 interviews with representatives from government, UN agencies, NGOs, and health facility staff. Qualitative data were analyzed using latent content analysis. Results The available quantitative data on intervention coverage in Somalia are extremely limited, making it difficult to discern patterns or trends over time or by region. Underlying sociocultural and other contextual factors most strongly affecting the humanitarian health response for women and children included clan dynamics and female disempowerment. The most salient operational influences included the assessment of population needs, donors’ priorities, and insufficient and inflexible funding. Key barriers to service delivery included chronic commodity and human resource shortages, poor infrastructure, and limited access to highly vulnerable populations, all against the backdrop of ongoing insecurity. Various strategies to mitigate these barriers were discussed. In-country coordination of humanitarian health actors and their activities has improved over time, with federal and state-level ministries of health playing increasingly active roles. Conclusions Emerging recommendations include further exploration of government partnerships with private-sector service providers to make services available throughout Somalia free of charge, with further research on innovative uses of technology to help reaches remote and inaccessible areas. To mitigate chronic skilled health worker shortages, more operational research is needed on the expanded use of community health workers. Persistent gaps in service provision across the continuum must be addressed, including for adolescents, for example. The is also a clear need for longer term development focus to enable the provision of health and nutrition services for women and children beyond those included in recurrent emergency response.

Background: The Ontario government launched the High Priority Communities Strategy (HPCS) in December 2020, funding community agencies operating in neighborhoods disproportionately affected by COVID-19 in Durham, Peel, Toronto, York, and Ottawa. Community-led task forces and networks also formed with the aim to increase vaccine confidence and uptake among minoritized communities. Objectives: To explore how community-led task forces, networks and agencies mobilized and engaged faith-based and ethno-racial communities in Peel Region and Toronto to improve vaccine confidence and uptake, including perceived facilitators and barriers. Design: Multi-method qualitative study. Methods: Between June 2023 and March 2024, we conducted ten online focus groups with three task forces and six HPCS-funded community agencies, as well as four key-informant interviews with representatives from two task forces and one network. We used thematic analysis to explore respondents’ perceptions and experiences. Results: Three key themes emerged. First, community-led task forces, the network and agencies used community mobilization strategies, such as tailored outreach, mitigating vaccine access barriers and leveraging trusted community voices, to improve vaccine confidence and uptake. Second, fostering a sense of community was central to their work, enabled through member engagement and power (knowledge and resource) sharing for collective impact. Third, sustaining community-led efforts was a challenge. The volunteer-driven task forces and network lacked the capacity to formally evaluate their activities or long-term infrastructure, and most disbanded post-pandemic. However, community agencies pivoted to preventative and primary care initiatives under HPCS. Conclusion: Community-led structures contributed to promoting vaccine uptake among ethno-racial and faith-based communities in hotspot areas. Facilitators included the use of trusted messengers and power sharing, while barriers included short-term funding and challenges sustaining efforts over time. Long-term sustainability of these efforts requires continued investment, sustained infrastructure, and strong community partnerships. Lessons from these findings can help strengthen community-led responses to future public health emergencies.

Background Equitable access to vaccination remains a concern, particularly among population groups made structurally vulnerable. These population groups reflect the diversity of communities that are confronted with structural barriers caused by systemic racism and oppression and result in them experiencing suffer disadvantage and discrimination based on citizenship, race, ethnicity, ancestry, religion, spiritual beliefs, and/or gender identity. In Canada, Ontario public health units (PHUs) engage with faith-based organizations (FBOs) to improve vaccine confidence among populations made structurally vulnerable. This study explores the factors that facilitate and hinder engagement in the implementation of vaccine confidence promoting interventions, and challenges associated with working with FBOs. Methods In-depth interviews were conducted with 18 of the 34 Ontario PHUs who expressed an interest. Braun and Clarke’s “experiential” approach was used to explore the realities of PHUs’ contextual experiences and perspectives. Results The results showed that receptivity and openness of PHUs to learn from FBOs, previous experience working with religious communities and FBOs, ongoing relations based on respect of different beliefs and opinions on the vaccines, leveraging the support of trusted faith leaders among communities and communications strategy adapted and sensitive to the needs of the community was facilitators to community involvement in the prevention and control of COVID-19. On the other hand, factors both internal and external to the PHUs have often posed challenges to collaboration with the FBOs. Internal factors include low operational capacity of PHU like insufficient human and financial resources, weak analytical capacity, ambiguity in the roles and responsibilities of the different actors. Some external challenges issues were related to the provincial level and the Ministry of Health, while others were related to FBOs. For example, faith-based and collective beliefs promoting vaccine hesitancy have resulted in resistance from some religious communities when PHUs have reached out to collaborate. Conclusions Engaging with faith-based communities is an ongoing process that requires time, flexibility, and patience, but it is necessary to improve vaccine confidence and equity access among population groups made structurally vulnerable. Lessons learned from this research can guide the implementation of future vaccination programs.

The objective of this study was to explore how Ontario Public Health Units (PHUs) partnered with faith-based organizations (FBOs) and other community-based organizations (CBOs) to promote COVID-19 vaccination among ethnoracial groups made structurally vulnerable during the pandemic, and to understand how PHUs perceive the effectiveness of these partnerships with these organizations. Between June to December 2022, we distributed a cross-sectional survey to 34 PHUs in Ontario to explore how PHUs were engaging and partnering with FBOs and CBOs. Responses were received from 28 of 34 (82.5%) public health units. Across Ontario, 23 (82.1%) respondent PHUs worked with FBOs during the COVID-19 vaccine rollout with activities ranging from informing FBOs of vaccine availability, to using places of worship as sites for vaccine administration and co-creating educational materials on immunization that were faith- and culturally sensitive. FBOs can be a valuable community partner as PHUs work to increase the reach and uptake of public health interventions. Ongoing monitoring and evaluation of the impact of FBO engagement on vaccine confidence and uptake among ethnoracial communities is needed to inform future community engaged vaccine programming in Ontario.

Many people with depression experience repeated episodes. Previous research into the predictors of chronic depression has focused primarily on the clinical features of the disease; however, little is known about the broader spectrum of sociodemographic and health factors inherent in its development. Our aim was to identify factors associated with a long-term negative prognosis of depression. We included 585 people aged 16 years and older who participated in the 2000/01 cycle of the National Population Health Survey and who reported experiencing a major depressive episode in 2000/01. The primary outcome was the course of depression until 2006/07. We grouped individuals into trajectories of depression using growth trajectory models. We included demographic, mental and physical health factors as predictors in the multivariable regression model to compare people with different trajectories. Participants fell into two main depression trajectories: those whose depression resolved and did not recur (44.7%) and those who experienced repeated episodes (55.3%). In the multivariable model, daily smoking (OR 2.68, 95% CI 1.54–4.67), low mastery (i.e., feeling that life circumstances are beyond one's control) (OR 1.10, 95% CI 1.03–1.18) and history of depression (OR 3.5, 95% CI 1.95–6.27) were significant predictors (p < 0.05) of repeated episodes of depression. People with major depression who were current smokers or had low levels of mastery were at an increased risk of repeated episodes of depression. Future studies are needed to confirm the predictive value of these variables and to evaluate their accuracy for diagnosis and as a guide to treatment.