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Background In the face of rapid urbanization, developing countries like Nigeria are witnessing a surge in rural-urban migration, with a predominant concentration in low-income neighborhoods known as slums. The provision of appropriate health services in slums is limited due to their unplanned nature. Similarly, access and utilization of health services are constrained by many factors, especially the unavailability of formal healthcare providers in urban slums. This study investigated challenges and opportunities to the provision and use of health services in urban slums in two states in southeast Nigeria. The study is anchored in Andersen’s Behavioral Model of Health Services Use (1995). Methods A cross-sectional survey was conducted in four urban slums in Onitsha in Anambra state, and Enugu in Enugu state. Eligible formal and informal health providers and householders were randomly selected for the interviews. A total of 255 health providers and 1025 primary caregivers in households were randomly selected from the households and interviewed using different structured pre-tested questionnaires for the consumers and providers, respectively. Univariate, bivariate, and multiple regression analyses were used to analyze the data. Results The major perceived challenge to accessing healthcare was poverty, since many people stated that they were unable to pay for health services (80%). Other challenges were health system factors such as the lack of drugs in government facilities (52%) and the high cost of treatment (76%). The major challenge to the provision of health services was poor availability of quality medicines (14.9%) and lack of supportive supervision of health workers (9.4%). In multiple regression analysis, the type of health provider’s facility (OR -1.69, CI 0.07–0.51) and training received on the type of health services they provide (OR -0.91, CI 0.21–0.79) were significantly associated with health workers’ provision of healthcare services. The consumers’ utilization of healthcare services was explained by employment status (OR 0.53, CI 1.02–2.83). Respondents suggested that subsidizing or providing free healthcare services, improving the capacity of informal health providers, and the quality of health services provided by the existing health facilities are opportunities for improving health service utilization by urban slum dwellers. Conclusion The provision and utilization of appropriate health services in urban slums is severely constrained by multiple, interconnected barriers. Addressing these through targeted financial protection, provider regulation, slum-specific infrastructure and improving the capacity of informal healthcare providers is essential to bridge the gap between demand and supply gap and improve healthcare access and quality in these underserved communities.

Urbanization, armed conflict, and deforestation in African countries have increased the risk of zoonotic infections, which requires a One Health approach focused on the environment, animal health and human health.

June 24th, 2022, a day that will be etched in today and future generations’ textbooks as a historic day, the United States of America revoked the constitutional right to seek safe abortion care. Overturning Roe v Wade allowed the divided individual states to independently decide the legal parameters regarding abortion care. A decision that disproportionately effects the reproductive lives of women residing on the land of America. Given the systemic impacts of racism, neoliberalism and white supremacy, it is the Black, racialized and poor women who suffer terrible repercussions. In this commentary the authors begin by discussing the historical biopolitical perspective, colonial systems and longstanding impacts on racialized women’s bodies in America. The discussion transitions to the implications of geopolitics at play nationally and cascading impacts globally, focusing on humanitarian and emergency settings. Using a medical humanities perspective, authors highlight the collision between politics and reproductive health policy and its implications on social determinants of health, such as women’s education, employment, housing, racial and gender equity and wellbeing. Long standing advocates, community leaders and healers, leading scientists, birth attendants, doctors, nurses, allied health professionals/providers and humanitarian workers – and many others - are reminded and live the weight of the continuous battle of population control, stemming from the oppressive history of control and exploitation.

Probiotics are live microorganisms recognized as natural candidates to substitute antibiotic substances, usually used to treat bacterial infections responsible for numerous human and animal diseases. Antibiotics are mostly prescribed for treating infections caused by bacteria. However, their excessive and inappropriate use has resulted in the increase of bacterial antimicrobial resistance (AMR) and host microbiota imbalance or dysbiosis phenomena. Even though antibiotics are the most well-known lifesaving substances, the AMR within the bacterial community has become a growing threat to global health, with the potential to cause millions of deaths each year in the future. Faced with these worldwide issues, it is high time to discover and develop antibiotic alternatives. There exists some evidence of probiotic roles in antagonizing pathogens, modulating immune systems, and maintaining general host health by restoring the gut microbiota balance. The multi-antimicrobial action mechanisms of such beneficial living microorganisms are one approach to practicing the “prevention is better than cure” concept to avoid antibiotics. The current review proposes a comprehensive description of antibiotic-related AMR issues and the potential of probiotics as antibiotic alternatives, while discussing pros and cons, as well as some evidence of beneficial uses of probiotics for human and animal health protection through recent results of experimental models and clinical trials.

Physical activity (PA) interventions help people with advanced incurable diseases to manage symptoms and improve their quality of life. However, little is known about the extent to which PA is currently delivered in hospice care in England. To determine the extent of and intervention features of PA service provision in hospice care in England alongside barriers and facilitators to their delivery. An embedded mixed-methods design using (1) a nationwide online survey of 70 adult hospices in England and (2) focus groups and individual interviews with health professionals from 18 hospices. Analysis of the data involved applying descriptive statistics to the numeric items and thematic analysis to the open-ended questions. Quantitative and qualitative data were collected and analyzed separately. The majority of responding hospices (  = 47/70, 67%) promoted PA in routine care. Sessions were most often delivered by a physiotherapist (  = 40/47, 85%) using a personalized approach (  = 41/47, 87%) and included resistance/thera bands, Tai Chi/Chi Qong, circuit exercises, and yoga. The following qualitative findings were revealed: (1) variation among hospices in their capacity to deliver PA, (2) a desire to embed a hospice culture of PA, and (3) a need for an organizational commitment to PA service provision. While many hospices in England deliver PA, there is considerable variation in its delivery across sites. Funding and policy action may be needed to support hospices to initiate or scale up services and address inequity in access to high-quality interventions.

To review and synthesize the existing evidence on bereavement care, within the United Kingdom (UK), for ethnic minority communities in terms of barriers and facilitators to access; models of care; outcomes from, and satisfaction with, service provision. A systematic review adopting a framework synthesis approach was conducted. An electronic search of the literature was undertaken in MEDLINE, Embase, PsycINFO, Social Work Abstract and CINAHL via EBSCO, Global Health, Cochrane library, the Trip database and ProQuest between 1995 and 2020. Search terms included bereavement care, ethnic minority populations and the UK setting. From 3,185 initial records, following screening for eligibility, and full-text review of 164 articles, seven studies were identified. There was no research literature outlining the role of family, friends and existing networks; and a real absence of evidence about outcomes and levels of satisfaction for those from an ethnic minority background who receive bereavement care. From the limited literature, the overarching theme for barriers to bereavement care was 'unfamiliarity and irregularities'. Four identified subthemes were 'lack of awareness'; 'variability in support'; 'type and format of support'; and 'culturally specific beliefs'. The overarching theme for facilitators for bereavement care was 'accessibility' with the two subthemes being 'readily available information' and 'inclusive approaches'. Three studies reported on examples of different models of care provision. This review reveals a stark lack of evidence about bereavement care for ethnic minority populations. In particular, understanding more about the role of family, friends and existing support systems, alongside outcomes and satisfaction will begin to develop the evidence base underpinning current provision. Direct user-representation through proactive engagement and co-design approaches may begin to determine the most appropriate models and format of bereavement care for ethnic minority communities to inform service design and delivery.

Background The low demand for maternal and child health services is a significant factor in Nigeria's high maternal death rate. This paper explores demand and supply-side determinants at the primary healthcare level, highlighting factors affecting provision and utilization. Methods This qualitative study was undertaken in Anambra state, southeast Nigeria. Anambra state was purposively chosen because a maternal and child health programme had just been implemented in the state. The three-delay model was used to analyze supply and demand factors that affect MCH services and improve access to care for pregnant women/mothers and newborns/infants. Result The findings show that there were problems with both the demand and supply aspects of the programme and both were interlinked. For service users, their delays were connected to the constraints on the supply side. On the demand side, the delays include poor conditions of the facilities, the roads to the facilities are inaccessible, and equipment were lacking in the facilities. These delayed the utilisation of facilities. On the supply side, the delays include the absence of security (fence, security guard), poor citing of the facilities, inadequate accommodation, no emergency transport for referrals, and lack of trained staff to man equipment. These delayed the provision of services. Conclusion Our findings show that there were problems with both the demand and supply aspects of the programme, and both were interlinked. For service users, their delays were connected to the constraints on the supply side.

Over the last two decades, Nepal has experienced substantial urbanization, with an increasing number of people choosing to move to cities. Although cities offer a wealth of opportunities, it also provides significant challenges. Many of those migrating to and living in cities contend with poor conditions and live in poverty. Defining and measuring urban deprivation is challenging due to its multi-dimensional nature, encompassing various dimensions such as housing, employment, living expenses, education, healthcare, and other unique challenges associated with city life. This study draws on the 'Domains of Urban Deprivation Framework' and evaluates the availability, commonness, and applicability of these domains. It measures multiple urban deprivation indices relevant to the context of Nepal. The research will commence with a review of the availability of data covering the urban domains listed in the Urban Deprivation Framework within routine data collected in Nepal at the province, district, and municipal levels. This will involve examining existing datasets and identifying any gaps or limitations in the data that could impact the construction of the local urban deprivation indices. To understand the commonness of different urban deprivation within different urban contexts in Nepal, a Delphi survey will be conducted in two municipalities and nationally with government policymakers, community representatives, data experts/researchers, and civil society actors. In the three urban contexts, stakeholders will prioritize and weigh the indicators according to their respective urban contexts and rank domains that reflects the priorities across different geographical areas and stakeholder communities. We will compare responses across these groups of stakeholders and explore contextual differences. The composite score for each domain will be calculated by summing the weighted scores of all indices and normalizing the results to ensure that they fall within a defined range. We will then plot the deprivation indices in urban areas at the provincial, district, and municipal levels. The urban deprivation index in Nepal will provide granular data that will enable policymakers and stakeholders to explore the urban deprivation index visually and access key insights for informed decision-making and resource allocation. Ethical approval was obtained from the Ethical Review Board of Nepal Health Research Council (Reference number: 213/2024) and the School of Medicine Research Ethics Committee at the University of Leeds, UK. The findings will be disseminated in a peer-reviewed journal and presented at conferences.