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This article is a critique of a report, Open and Inclusive: Fair Processes for Financing Universal Health Coverage. The report proposes a framework that is meant to improve procedural fairness and how decisions in financing of health care can be fairer. The author of this article argues that while procedural fairness and the proposed framework are an important step in improving equity in health sector financing, the report falls short on several aspects of achieving the set objectives. First, the report does not place emphasis on the role of civic education as an important component of public education building on access to information. Therefore, there should be caution in assuming that improved dissemination of information will lead to increased civic action. Secondly, the author proposes that the report include principles that should guide how decisions are made in public deliberations when consensus cannot be achieved. Lastly, the framework in the report does not speak to the complexity of the trade-offs that have to be made between health and other sectors. The author argues that a key area of deliberations in health financing is understanding how practitioners in the sector can argue for better funding against other competing sector such as education and agriculture while still finding complementarities.

Commercial sodium hydroxide (NaOH) and sodium silicate (SS) have remained two of the leading alkaline activators widely used in producing geopolymer concrete, despite some identified negatives regarding their availability and additional CO2 emissions relating to the overall manufacturing process. This study reports the viability of developing geopolymer concrete using a laboratory-synthesised silica fume (SF)-derived SS solution in combination with NaOH at a molarity of 10M as an alternative binary alkali-alkaline activator to Ground Granulated Blast Furnace slag (GGBS). The use of SF in the development of geoolymer activators will pave the way for the quality usage of other high-silica content by-products from nature, industry, and agriculture. In the currently reported proof of concept, four geopolymer concrete batches were produced using different alkaline activator/precursor-A/P ratios (0.5 and 0.9) and SS to NaOH-SS/SH volume ratios (0.8/1.2 and 1.2/0.8), to establish the impact on the engineering performance. Two controls were adopted for ordinary and geopolymer concrete mixes. The engineering performance was assessed using slump and compaction index (CI) tests, while the Unconfined Compressive Strength (UCS) and tensile splitting (TS) tests were measured at different curing ages in accordance with their appropriate standards. The results indicated a reduction in slump values as the A/P ratio decreased, while the CI values showed a reversal of the identified trend in slump. Consequently, mix GC2 attained the highest UCS strength gain (62.6 MPa), displaying the superiority of the alkali activation and polymerisation process over the CSH gel. Furthermore, the impact of A/P variation on the UCS was more pronounced than SS/SH due to its vital contribution to the overall geopolymerisation process.

Geopolymer concrete (GPC) can be produced by the chemical activation of industrial by-products and processed natural minerals that contain aluminosilicates with the presence of an alkaline activator. Raw components are one of the critical parameters affecting geopolymer performance. On the other hand, the mixing procedure of geopolymer concrete is not any less important. Few demonstrative constructions have been built using GPC as a greener alternative to Portland cement concrete. Numerous variables affect GPC manufacture, such as raw material specification, activator type and dosage, and curing regimes. Despite the conventions of the building industry, the lack of proper mix design methods limits the wide acceptance of GPC in the industry. This report conducted experimental trials on GGBS-based GPC to optimize a mixing design procedure to achieve best mechanical strength and structural integrity. Geopolymer concrete properties were evaluated through slump and unconfined compressive strength tests. The laboratory trials in this report revealed that all geopolymer mixes, except SD0HV and 1W-SG, exhibited high workability values. Also, the presence of an alkaline activator was vital to attain satisfactory compressive strength values. The alkaline activator could be used when cooled and reached room temperature after two hours of preparation and was not necessary after 24 h. Mix G-(0.5W-S) with a 0.5A.A. (alkaline activator)/precursor (GGBS) ratio, SSA (sodium silicate alternative)/SH (sodium hydroxide with 10 M molarity) ratio of 1:1, and 0.55 W/B (water to binder) ratio is recommended to achieve best mechanical performance and structural integrity.

Assessing healthcare quality is pivotal for patient-centric enhancements. Employing the Gaps Model of Service Quality and SERVQUAL, this study determined patient expectations and perceptions of care quality at a national referral hospital. In this cross-sectional study, data were gathered pre and post care using a semi-structured tool with 380 participants. Statistical package for social sciences(Version 25) facilitated analysis. Quality indices, expressed as percentages of weighted averages, compared expected and perceived care. Service quality gaps, which represented the difference between perception and expectation (P - E), were assessed via paired-sample t-tests. Logistic regression were used to examine factors linked to positive service quality gaps. Median age was 34 years, 74% were female, 57% had non-formal employment, and 49% had attained secondary education. The gap index across all components was -10%. The largest gaps existed in SERVQUAL's reliability and empathy domains. Secondary education (OR = 2.13, 95% CI: 1.01-5.21,p = 0.003; aOR =  2.0, 95%CI: 1.57-7.11) and non-formal employment (OR = 1.54, 95% CI: 1.01-4.11, p = 0.01; aOR =  1.40, 95%CI: 1.08-5.12) correlated with positive health service quality gaps. Patient expectations exceeded perceptions of care quality, emphasizing the need to align service delivery and actively manage patient expectations, particularly in areas of reliability and empathy, such as timeliness and compassion.

Geopolymers are an environmentally sustainable class of low-calcium alkali-activated materials (AAMs), distinct from high-calcium C–A–S–H gel systems. Synthesized from aluminosilicate-rich precursors such as fly ash, metakaolin, slag, waste glass, and coal gasification fly ash (CGFA), geopolymers offer a significantly lower carbon footprint, valorize industrial by-products, and demonstrate superior durability in aggressive environments compared to Ordinary Portland Cement (OPC). Recent advances in thermodynamic modeling and phase chemistry, particularly in CaO–SiO2–Al2O3 systems, are improving precursor selection and mix design optimization, while Artificial Neural Network (ANN) and hybrid ML-thermodynamic approaches show promise for predictive performance assessment. This review critically evaluates geopolymer chemistry and composition, emphasizing precursor reactivity, Si/Al and other molar ratios, activator chemistry, curing regimes, and reaction mechanisms in relation to microstructure and performance. Comparative insights into alkali aluminosilicate (AAS) and aluminosilicate phosphate (ASP) systems, supported by SEM and XRD evidence, are discussed alongside durability challenges, including alkali–silica reaction (ASR) and shrinkage. Emerging applications ranging from advanced pavements and offshore scour protection to slow-release fertilizers and biomedical implants are reviewed within the framework of the United Nations Sustainable Development Goals (SDGs). Identified knowledge gaps include standardization of mix design, LCA-based evaluation of novel precursors, and variability management. Aligning geopolymer technology with circular economy principles, this review consolidates recent progress to guide sustainable construction, waste valorization, and infrastructure resilience.

This study investigates the feasibility of utilizing recycled plastic waste as a partial substitute for sand in concrete production. Reprocessing used plastic items or materials involves collecting, cleaning, shredding, and melting, resulting in reprocessed plastic particles. Incorporating these recycled plastic particles into concrete addresses environmental concerns related to plastic disposal and the growing scarcity and increasing cost of natural sand. To evaluate the sand replacement capacity of recycled plastic, four types of mixtures were created with varying levels of recycled plastic replacement (5%, 10%, 15%, and 20%). All mixtures maintained a water-to-binding ratio of 0.55 and were tested at 7, 28, and 56 days. The testing regimen encompassed determining the slump value, density, compressive strength, tensile strength, and resistance to freezing and thawing. The findings revealed that replacing sand in the concrete mix with recycled plastic enhanced workability, which was attributed to the hydrophobic nature of the plastic particles. However, both compressive and tensile strength exhibited a declining trend. Additionally, after undergoing multiple freezing and thawing cycles, the concrete mix exhibited poor durability properties and brittleness. These issues may arise due to factors such as incompatibility, non-uniformity, reduced cohesion, and the lower density of plastic particles.

Young women account for a disproportionate fraction of new HIV infections in Africa and are a priority population for HIV prevention, including implementation of preexposure prophylaxis (PrEP). The overarching goal of this project was to demonstrate the feasibility of integrating PrEP delivery within routine family planning (FP) clinics to serve as a platform to efficiently reach at-risk adolescent girls and young women (AGYW) for PrEP in HIV high-burden settings. The PrEP Implementation in Young Women and Adolescents (PrIYA) program is a real-world implementation program to demonstrate integration of PrEP delivery for at-risk AGYW in FP clinics in Kisumu, Kenya. Between November 2017 and June 2018, women aged 15 to 45 from the general population seeking FP services at 8 public health clinics were universally screened for HIV behavioral risk factors and offered PrEP following national PrEP guidelines. We evaluated PrEP uptake and continuation, and robust Poisson regression methods were used to identify correlates of uptake and early continuation of PrEP, with age included as a one-knot linear spline. Overall, 1,271 HIV-uninfected women accessing routine FP clinics were screened for PrEP; the median age was 25 years (interquartile range [IQR]: 22-29), 627 (49%) were <24 years old, 1,026 (82%) were married, more than one-third (34%) had partners of unknown HIV status, and the vast majority (n = 1,200 [94%]) reported recent condom-less sex. Of 1,271 women screened, 278 (22%) initiated PrEP, and 114 (41%) returned for at least one refill visit after initiation. PrEP uptake was independently associated with reported male-partner HIV status (HIV-positive 94%, unknown 35%, HIV-negative 8%; p < 0.001) and marital status (28% unmarried versus married 21%; p = 0.04), and a higher proportion of women ≥24 years (26%; 191/740) initiated PrEP compared to 16% (87/531) of young women <24 years (p < 0.001). There was a moderate and statistically non-significant unadjusted increase in PrEP uptake among women using oral contraception pills (OCPs) compared to women using injectable or long-acting reversible contraception methods (OCP 28% versus injectable/implants/intrauterine devices [IUDs] 18%; p = 0.06). Among women with at least one post-PrEP initiation follow-up visit (n = 278), no HIV infection was documented during the project period. Overall, continuation of PrEP use at 1, 3, and 6 months post initiation was 41%, 24%, and 15%, respectively. The likelihood for early continuation of PrEP use (i.e., return for at least one PrEP refill within 45 days post initiation) was strongly associated with reported male-partner HIV status (HIV-positive 67%, -negative 39%, unknown 31%; overall effect p = 0.001), and a higher proportion of women ≥24 years old continued PrEP at 1 month compared with young women <24 years old (47% versus 29%; p = 0.002). For women ≥24 years old, the likelihood to continue PrEP use at 1 month post initiation increased by 3% for each additional year of a woman's age (adjusted prevalence ratio [PR]: 1.03; 95% confidence interval [CI]: 1.01-1.05; p = 0.01). In contrast, for women <24 years old, the likelihood of continuing PrEP for each additional year of a woman's age was high in magnitude (approximately 6%) but statistically non-significant (adjusted PR: 1.06; 95% CI: 0.97-1.16; p = 0.18). Frequently reported reasons for discontinuing PrEP were low perceived risk of HIV (25%), knowledge that partner was HIV negative (24%), experiencing side effects (20%), and pill burden (17%). Study limitations include lack of qualitative work to provide insights into women's decision-making on PrEP uptake and continuation, the small number of measured covariates imposed by the program data, and a nonrandomized design limiting definitive ascertainment of the robustness of a PrEP-dedicated nurse-led implementation strategy. In this real-world PrEP implementation program in Kenya, integration of universal screening and counseling for PrEP in FP clinics was feasible, making this platform a potential \"one-stop\" location for FP and PrEP. There was a high drop-off in PrEP continuation, but a subset of women continued PrEP use at least through 1 month, possibly indicating further reflection or decision-making on PrEP use. Greater efforts to support PrEP normalization and persistence for African women are needed to help women navigate their decisions about HIV prevention preferences as their reproductive goals and HIV vulnerability evolve.

Disruptions of vaginal microbiota might increase women's susceptibility to HIV infection. Advances in molecular microbiology have enabled detailed examination of associations between vaginal bacteria and HIV acquisition. Therefore, this study aimed to evaluate the association between the concentrations of specific vaginal bacteria and increased risk of HIV acquisition in African women. We did a nested case-control study of participants from eastern and southern Africa. Data from five cohorts of African women (female sex workers, pregnant and post-partum women, and women in serodiscordant relationships) were used to form a nested case-control analysis between women who acquired HIV infection versus those who remained seronegative. Deep sequence analysis of broad-range 16S rRNA gene PCR products was applied to a subset of 55 cases and 55 controls. From these data, 20 taxa were selected for bacterium-specific real-time PCR assays, which were examined in the full cohort as a four-category exposure (undetectable, first tertile, second tertile, and third tertile of concentrations). Conditional logistic regression was used to generate odds ratios (ORs) and 95% CIs. Regression models were stratified by cohort, and adjusted ORs (aORs) were generated from a multivariable model controlling for confounding variables. The Shannon Diversity Index was used to measure bacterial diversity. The primary analyses were the associations between bacterial concentrations and risk of HIV acquisition. Between November, 2004, and August, 2014, we identified 87 women who acquired HIV infection (cases) and 262 controls who did not acquire HIV infection. Vaginal bacterial community diversity was higher in women who acquired HIV infection (median 1·3, IQR 0·4–2·3) than in seronegative controls (0·7, 0·1–1·5; p=0·03). Seven of the 20 taxa showed significant concentration-dependent associations with increased odds of HIV acquisition: Parvimonas species type 1 (first tertile aOR 1·67, 95% CI 0·61–4·57; second tertile 3·01, 1·13–7·99; third tertile 4·64, 1·73–12·46; p=0·005) and type 2 (first tertile 3·52, 1·63–7·61; second tertile 0·85, 0·36–2·02; third tertile 2·18, 1·01–4·72; p=0·004), Gemella asaccharolytica (first tertile 2·09, 1·01–4·36; second tertile 2·02, 0·98–4·17; third tertile 3·03, 1·46–6·30; p=0·010), Mycoplasma hominis (first tertile 1·46, 0·69–3·11; second tertile 1·40, 0·66–2·98; third tertile 2·76, 1·36–5·63; p=0·048), Leptotrichia/Sneathia (first tertile 2·04, 1·02–4·10; second tertile 1·45, 0·70–3·00; third tertile 2·59, 1·26–5·34; p=0·046), Eggerthella species type 1 (first tertile 1·79, 0·88–3·64; second tertile 2·62, 1·31–5·22; third tertile 1·53, 0·72–3·28; p=0·041), and vaginal Megasphaera species (first tertile 3·15, 1·45–6·81; second tertile 1·43, 0·65–3·14; third tertile 1·32, 0·57–3·05; p=0·038). Differences in the vaginal microbial diversity and concentrations of key bacteria were associated with greater risk of HIV acquisition in women. Defining vaginal bacterial taxa associated with HIV risk could point to mechanisms that influence HIV susceptibility and provide important targets for future prevention research. National Institute of Child Health and Human Development.

Background Persons who inject drugs (PWID) in Kenya face a high HIV burden (18% prevalence). Although oral pre-exposure prophylaxis (PrEP) is effective for HIV prevention among PWID, its awareness and use remain low. This study assessed HIV acquisition risk, oral PrEP knowledge, and uptake among PWID in Nairobi, Kenya. Methods HIV-negative PWID were recruited from four drop-in centers in Nairobi (February–March 2022). HIV risk from sexual and injection practices was measured using the National Drug and Alcohol Research Centre’s HIV Risk-Taking Behavior Scale (HRBS). Oral PrEP awareness and uptake were assessed using the Low PrEP Awareness and Use among PWID tool. Analyses included descriptive statistics, unpaired t-tests (HRBS scores), chi-square tests (PrEP awareness and use), logistic regression (factors associated with PrEP awareness), and Fisher’s exact tests (PrEP uptake), conducted in SPSS version 24. Findings Among 256 participants, 82.0% were male, 30.1% were on methadone, and 99.2% injected heroin. Mean HIV risk scores indicated moderate risk from injection practices (8.35/25) and sexual practices (11.59/30), totaling 19.94/55. HRBS scores were not associated with PrEP awareness ( P  = 0.493) or use ( P  = 0.727). Sexual HIV risk was higher among women than men (12.44/30 vs. 7.3/30; P  < 0.001), and among those aged 18–24 versus 25–55 years (23.00/55 vs. 19.35/55; P  = 0.016). PrEP awareness was 59.4%, but only 3.9% had ever used PrEP. Men were more likely than women to be aware of PrEP (84.8% vs. 53.8%; P  < 0.001) and to have used it (13.0% vs. 1.9%; P  < 0.001). Conclusion PWID in Nairobi have a moderate HIV risk, with young and female PWID disproportionately affected. Despite moderate awareness, PrEP uptake is very low. Targeted PrEP education, gender-responsive outreach, and integration of PrEP into harm reduction services are needed to improve uptake. Trial registration ClinicalTrials.gov Protocol Record STUDY0001370.

The effective use of waste materials is one of the key drivers in ensuring sustainability within the construction industry. This paper investigates the viability and efficacy of sustainably incorporating a polylactic acid-type plastic (WP) as a 10 mm natural coarse aggregate (NA) replacement in geopolymer concrete. Two types of concrete (ordinary Portland cement—OPC and geopolymer) were produced for completeness using a concrete formulation ratio of 1:2:3. The ordinary concrete binder control was prepared using 100% OPC at a water/binder ratio of 0.55, while the geopolymer concrete control used an optimum alkaline activator/precursor—A/P ratio (0.5) and sodium silicate to sodium hydroxide—SS/SH volume ratio (1.2/0.8). Using the same binder quantity as the control, four concrete batches were developed by replacing 10 mm NA with WP at 30 and 70 wt% for ordinary and geopolymer concrete. The mechanical performance of the developed concrete was assessed according to their appropriate standards, while a microstructural investigation was employed after 28 days of curing to identify any morphological changes and hydrated phases. The results illustrate the viability of incorporating WP in geopolymer concrete production at up to 70 wt% replacement despite some negative impacts on concrete performance. From a mechanical perspective, geopolymer concrete indicated a 46.7–58.3% strength development superiority over ordinary concrete with or without WP. The sample composition and texture quantified using automated scanning electron microscopy indicated that adding WP reduced the presence of pores within the microstructure of both concrete types. However, this was detrimental to the ordinary concrete due to the low interfacial zone (ITZ) between calcium silicate hydrate (CSH) gel and WP, resulting in the formation of cracks.