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Climate change is the greatest global health threat of the 21st century, but little is known about well-being in climate vulnerable populations. We investigate how well-being is shaped by common and unique stressors in an area of climate vulnerability in Bangladesh. We present findings from 60 semi-structured in-depth interviews. We inductively analyzed our data following a Reflexive Thematic Analysis approach and then applied a Relational Well-being (RWB) framework. We found that well-being was influenced negatively by factors such as financial worries, forced migration, social pressure, and natural disasters. Well-being was influenced positively by factors such as financial satisfaction, voluntary migration, social support, and place attachment. Using relational well-being as a conceptual lens allowed us to explore the dynamism and complexity of factors shaping well-being that were partly specific to the local context and partly rooted in wider societal and global structures. Policies which aim to improve the well-being of climate vulnerable populations should consider relational well-being as a conceptual tool to leverage locally available informal resources, such as suppotive reciprocal relationships.

Despite the effort to eradicate rabies in the Philippines, human rabies cases have not decreased in the past decade. Rabid dogs pose the most significant hazard in the countries with the highest burden of rabies, and 70% rabies vaccine coverage is recommended for dogs in high-risk areas. Ascertaining the owned dog population and community knowledge on rabies can help improve vaccine coverage and information campaigns. We conducted a cross-sectional survey in six randomly selected communities (five urban, one rural) in Central Luzon, Philippines. We first conducted the complete mapping of 9,173 households and then randomly selected 727 households. More than half (54.1%) of the households owned dogs (1.21 dogs/household). In the 727 households, we identified 878 owned dogs and 3256 humans. According to these results, the dog-to-human ratio was approximately 1:3.7. Only 8.8% of households reported a history of dog bite in 2019. Among dog-owning households, 31% reported that they allow their dogs to roam freely. Of the recorded dogs, 35.9% have never been vaccinated, and only 3.5% were spayed or castrated. Factors associated with lower rabies knowledge include (1) no education aOR: 0.30 (0.16-0.59), and (2) only primary school education aOR: 0.33 (0.22-0.49). In contrast, factors associated with higher knowledge include (1) owning a dog and not allowing them to roam freely aOR: 2.01 (1.41-2.87) and (2) owning a dog and allowing them to roam freely aOR: 1.84 (1.17-2.92), when compared to those with no dogs. We identified a larger dog population in the community than the usual estimates (1:10), suggesting that annual vaccine needs in the Philippines must be reassessed. Our survey shows a relatively good understanding of rabies; however, awareness of the concept of rabies as a disease, and how animals and humans can acquire it, is lacking.

The first reported case of Coronavirus Disease 2019 (COVID-19) in Rwanda occurred on March 14 2020. By the end of July 2024, a total of 133,518 individuals had tested positive for the infection, resulting in 1,468 deaths and 132,039 had fully recovered. The success of COVID-19 elimination in Rwanda hinges on the public’s level of acceptance of the COVID-19 vaccination. Although COVID-19 is no longer a pandemic anymore, the World Health Organisation recommends countries vaccinate their populations to protect them from COVID-19 and its variants. Globally, COVID-19 has affected 704,753,890 people, caused 7,010,681 deaths and 675,619,811 have recovered. This study aimed to assess the acceptability of COVID-19 vaccines among adults aged 18 years and above in Rwanda. A cross-sectional study was conducted from January to March 2022 to determine the associations between COVID-19 vaccine acceptance (VA) with respondents’ characteristics, using logistic regression analysis. This study enrolled 2,126 respondents with a mean age of 31 years, the majority of whom were females (82.2%), 51.4% had completed primary education, and 78.7% were married. Most respondents recognized the importance of COVID-19 vaccination for both personal health and community well-being. The study found a high rate of COVID-19 vaccine acceptance, with 91.6% of respondents expressing VA and an overall VA rate of 98.2%. Having a relationship with the child(ren) was the only characteristic associated with COVID-19 vaccine acceptance (p; 3.2 × 10 − 3 , OR; 2.9, 95% C.I; 1.4–5.9). In conclusion, the study found a high rate of COVID-19 vaccine acceptance among adults in Rwanda, with COVID-19 associated with having a relationship with the child(ren). The study recommends the need for mass educational campaigns and awareness-raising efforts to understand of COVID-19 vaccines.

Background Care-seeking during antenatal and intrapartum periods has remained persistently low in Madagascar, largely due to financial barriers. To bolster both care-seeking and health financing, a Mobile Maternal Health Wallet (MMHW) was developed and implemented in the Analamanga region, Madagascar. The MMHW, a service based on mobile money, enabled users to digitally save and pay for services at participating public health facilities. Here, we compare perspectives of those who enrolled (doers) and those who did not enroll (non-doers) in the MMHW to understand decision-making processes, interpersonal dynamics, and other factors that informed enrollment. Methods In this mixed methods study, we analyzed data from a quantitative survey ( n  = 477) examining predictors of enrollment using logistic probability models, followed by applying Reflexive Thematic Analysis to qualitative in-depth interviews ( n  = 29) to gain insights from 11 doers, 12 non-doers, three family members, and three MMHW outreach team members. Results Quantitatively, significant predictors of enrollment included: learning about the MMHW from a midwife, having a pre-existing maternal medical risk factor, and residing in the Avaradrano district of Antananarivo. Predictors of non-enrollment included: learning about the MMHW from family or friends, having a higher salary, and being diagnosed with medical warning signs during pregnancy. Qualitative findings mostly mirrored the quantitative data, revealing that women enrolled due to early, comprehensive information from trusted sources (e.g., midwives) and because they found the offer of financial benefits and expanded medical services meaningful and reliable. Women sometimes reported that peer influence played a role as driver of enrollment, though not uniformly. Women who were non-doers described a sense of incredulity about the MMHW (often citing rumors or others’ negative experiences), incomplete information, spousal disagreements about enrolling, and implementation-related barriers (e.g., lacking an ID card, which was needed for enrollment). Conclusion This study underscores the importance of evaluating sensitization activities among target populations. Our findings highlight a critical need to identify trusted information sources (individuals and channels) and to convey innovative programs via these sources. Effective communication and the elimination of implementation barriers remain essential to bolster care-seeking and improve maternal health outcomes in Madagascar and beyond. Trial registration This study is a component of the 4MOTHERS trial, which was registered on March 12, 2021, in the German Clinical Trials Register (DRKS), identifier: DRKS00014928, https://drks.de/search/en/trial/DRKS00014928 .

Soil-transmitted helminths (STH) are the most common parasitic infections in impoverished communities, particularly among children. Current STH control is through school-based mass drug administration (MDA), which in the Philippines is done twice annually. As expected, MDA has decreased the intensity and prevalence of STH over time. As a result, the common Kato Katz (KK) thick smear method of detecting STH is less effective because it lacks sensitivity in low intensity infections, making it difficult to measure the impact of deworming programs. A cross-sectional study was carried out over a four-week period from October 27, 2014 until November 20, 2014 in Laguna province, the Philippines. Stool samples were collected from 263 schoolchildren, to determine the prevalence of STH and compare diagnostic accuracy of multiplex quantitative polymerase chain reaction (qPCR) with the KK. A large discrepancy in the prevalence between the two techniques was noted for the detection of at least one type of STH infection (33.8% by KK vs. 78.3% by qPCR), Ascaris lumbricoides (20.5% by KK vs. 60.8% by qPCR) and Trichuris trichiura (23.6% by KK vs. 38.8% by qPCR). Considering the combined results of both methods, the prevalence of at least one type of helminth infection, A. lumbricoides, and T. trichiura were 83.3%, 67.7%, and 53.6%, respectively. Sensitivity of the qPCR for detecting at least one type of STH infection, A. lumbricoides, and T. trichiura were 94.1%, 89.9%, and 72.3% respectively; whereas KK sensitivity was 40.6%, 30.3%, and 44.0%, respectively. The qPCR method also detected infections with Ancylostoma spp. (4.6%), Necator americanus (2.3%), and Strongyloides stercoralis (0.8%) that were missed by KK. qPCR may provide new and important diagnostic information to improve assessment of the effectiveness and impact of integrated control strategies particularly in areas where large-scale STH control has led to low prevalence and/or intensity of infection.

Background Studies focusing on the Integrated Management of Childhood Illness (IMCI) program in the Philippines are limited, and perspectives of frontline health care workers (HCWs) are largely absent in relation to the introduction and current implementation of the program. Here, we describe the operational challenges and opportunities described by HCWs implementing IMCI in five regions of the Philippines. These perspectives can provide insights into how IMCI can be strengthened as the program matures, in the Philippines and beyond. Methods In-depth interviews (IDIs) were conducted with HCWs ( n  = 46) in five provinces (Ilocos Sur, Quezon, National Capital Region, Bohol and Davao), with full transcription and translation as necessary. In parallel, data collectors observed the status (availability and placement) of IMCI-related materials in facilities. All data were coded using NVivo 12 software and arranged along a Social Ecological Model. Results HCWs spoke of the benefits of IMCI and discussed how they developed workarounds to ensure that integral components of the program could be delivered in frontline facilities. Five key challenges emerged in relation to IMCI implementation in primary health care (PHC) facilities: 1) insufficient financial resources to fund program activities, 2) inadequate training, mentoring and supervision among and for providers, 3) fragmented leadership and governance, 4) substandard access to IMCI relevant written documents, and 5) professional hierarchies that challenge fidelity to IMCI protocols. Conclusion Although the IMCI program was viewed by HCWs as holistic and as providing substantial benefits to the community, more viable implementation processes are needed to bolster acceptability in PHC facilities.

Human-centred design (HCD) is an approach to problem-solving that prioritises understanding and meeting the needs of the end-users. Researchers and designers practice empathic listening as users share their perspectives, thereby enabling a variety of stakeholders to cocreate effective solutions. While a valuable and, in theory, straightforward process, HCD in practice can be chaotic: Practitioners often struggle to navigate an excess of (often conflicting) ideas and to strike a balance between problem-understanding and problem-solving. In this practice paper, we outline our own experiences with HCD, which ultimately resulted in the development of a successful video-based intervention to bolster vaccine confidence in the Philippines. We highlight the use of ‘radical circles’ to overcome roadblocks and navigate tensions. Radical circles entail groups of individuals with divergent opinions and identities engaging in critical analysis of a given idea, actively challenging standard ways of thinking, and ultimately, generating solutions. Employing radical circles enabled us to innovate and adapt to new perspectives that emerged along the non-linear HCD pathway. Our incorporation of radical circles into HCD methodology demonstrates its potential as a powerful complementary step in the meaning-making process. In our view, radical circles could enrich HCD processes and provide a solution to design overcrowding, leading to meaningful, transformative and successful interventions.

Background Tuberculosis (TB) poses a considerable challenge for people with HIV (PWH), especially in low- and middle-income countries. Even with the availability of effective preventive strategies such as tuberculosis preventive therapy (TPT), the implementation of these measures continues to fall short. Our study explores the perceptions of healthcare workers (HCWs) regarding the barriers and facilitators to TPT implementation in the Philippines and Indonesia. Methods We performed 10 focus group discussions and four in-depth interviews with HCWs from June to December 2023. Each discussion and interview lasted between 45 and 120 min. Discussions explored HCWs’ perspectives on the policies, logistics, and prescribing practices related to TPT, as well as their personal experiences, concerns, and suggested improvements. Data were coded using MAXQDA24 qualitative software informed by the tenets of constructivist grounded theory. We organized themes using the Consolidated Framework for Implementation Research (CFIR), while contextualizing implementation determinants most pertinent to the local contexts. Results Our findings revealed nuanced barriers and facilitators—marked by paradoxes—organized across three CFIR domains: the outer, inner, and individual domains of HIV-TB care. In the outer setting, barriers include limited patient knowledge and drug shortages, while facilitators involved national policies and external pressures from mass media and peer imitation. The inner setting was shaped by structural gaps—such as poor documentation, staff turnover, and procedural challenges in ruling out active TB—that affected patient trust, whereas open communication and role clarity supported TPT implementation. At the individual level, HCWs expressed high motivation but cited limited capacity due to lack of training and information to deliver effective TPT care. Conclusions Our findings highlight implementation determinants to TPT implementation across outer, inner, and individual domains of HIV-TB care. Understanding how structural gaps, provider capacity, and patient trust intersect with supportive policies, and peer and mass media influences offer insights into the complex dynamics shaping TPT uptake and integration. Our study insights may inform policy adjustments and guide strategies to better integrate TPT into national health frameworks.

BackgroundThe public’s confidence in vaccinations has eroded, and anti-vaccination movements have gained traction around the world, including in the Philippines. ‘Salubong’, a Filipino term, refers to welcoming someone back into one’s life and elicits ideas about friendship and family relationships. We extended this concept to vaccines in efforts to design an intervention that would re-welcome vaccines into homes.MethodsUsing human-centred design, we developed and refined a story-based intervention that engages Filipino families, community leaders and community health workers. We conducted a randomised controlled trial among 719 caregivers of small children to test the developed intervention against a control video. We assessed the binary improvement (improvement vs no improvement) and the amount of improvement in vaccine attitudes and intentions after intervention exposure.ResultsAlthough the intervention group began with marginally higher baseline vaccine attitude scores, we found that 62% of the intervention group improved their vaccine attitude scores versus 37% of the control group (Fisher’s exact, p<0.001). Among individuals whose scores improved after watching the assigned video, the intervention group saw higher mean attitude score improvements on the 5-point scale (Cohen’s d=0.32 with 95% CI 0.10 to 0.54, two-sided t-test, p<0.01). We observed similar patterns among participants who stated that they had previously delayed or refused a vaccine for their child: 67% of 74 in the intervention group improved their vaccine attitude scores versus 42% of 54 in the control group (Fisher’s exact, p<0.001). Among the subset of these individuals whose scores improved after watching the assigned video, the intervention group saw higher mean attitude score improvements on the 5-point scale that were marginally significant (Cohen’s d=0.35 with 95% CI −0.01 to 0.70, two-sided t-test, p=0.06).ConclusionsOur results provide solid evidence for the potential of co-designed vaccine confidence campaigns and regulations.

BackgroundVaccine hesitancy (VH) and the global decline of vaccine coverage are a major global health threat, and novel approaches for increasing vaccine confidence and uptake are urgently needed. ‘Nudging’, defined as altering the environmental context in which a decision is made or a certain behaviour is enacted, has shown promising results in several health promotion strategies. We present a comprehensive synthesis of evidence regarding the value and impact of nudges to address VH.MethodsWe conducted a systematic review to determine if nudging can mitigate VH and improve vaccine uptake. Our search strategy used Medical Subject Headings (MeSH) and non-MeSH terms to identify articles related to nudging and vaccination in nine research databases. 15 177 titles were extracted and assessed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The final list of included articles was evaluated using the Mixed Methods Appraisal Tool and the Grading of Recommendations, Assessment, Development and Evaluations framework.FindingsIdentified interventions are presented according to a framework for behaviour change, MINDSPACE. Articles (n=48) from 10 primarily high-income countries were included in the review. Nudging-based interventions identified include using reminders and recall, changing the way information is framed and delivered to an intended audience, changing the messenger delivering information, invoking social norms and emotional affect (eg, through storytelling, dramatic narratives and graphical presentations), and offering incentives or changing defaults. The most promising evidence exists for nudges that offer incentives to parents and healthcare workers, that make information more salient or that use trusted messengers to deliver information. The effectiveness of nudging interventions and the direction of the effect varies substantially by context. Evidence for some approaches is mixed, highlighting a need for further research, including how successful interventions can be adapted across settings.ConclusionNudging-based interventions show potential to increase vaccine confidence and uptake, but further evidence is needed for the development of clear recommendations. The ongoing COVID-19 pandemic increases the urgency of undertaking nudging-focused research.PROSPERO registration numberCRD42020185817.