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The continuum of care (CoC) throughout pregnancy, delivery and post-delivery has recently been highlighted as an integrated intervention programme for maternal, new-born, and child health. Existing literature suggests the importance of continuum of care (CoC) for improved maternal and child health outcomes. However due to unavailability of data at the lowest administrative levels, literature on spatial pattern of uptake of full CoC is lacking. The present study attempts to focus on the spatial analysis of CoC in maternal health care in India. The study is based on the fourth round of National Family Health Survey data conducted in 2015-16 in India. The outcome variable used is maternal health continuum of care which includes- at least 4 ANC visits, delivery through skilled birth attendant and postnatal check-up within 48 hours of delivery. Univariate and bivariate Local Indicator of Spatial Association (LISA) maps have been generated to show the spatial pattern of CoC across 640 districts in India. We also employed spatial regression techniques to explore the determinants of CoC. Percentage of women who followed full CoC was observed to be least for East Kameng (0.0%) district of Arunachal Pradesh and highest in North Goa district (90.4%). Majority of districts where uptake of full CoC was more than 80 percent were found concentrated in southern region on India. Equivalently, findings indicated a strong spatial clustering of full CoC with high-high clusters mostly concentrated in southern districts. Low-low district clusters are concentrated in the states of Uttar Pradesh, Bihar and Madhya Pradesh. For complete CoC the global Moran's I is 0.73 indicating the spatial dependence. The spatial regression analysis suggested that modern contraceptive use, meeting with health worker, urbanization and secondary or above education for women have positive impact on the utilisation of CoC. The spatial pattern indicates district level clustering in uptake of CoC among women. The study suggests policymakers and stakeholders to implement comprehensive interventions at sub-regional levels for ensuring the completion of CoC for women which acts as a preventive measure for adverse outcomes such as-maternal and child mortality.

The impact of ill-health on labour force participation is a well-recognized concern in both developed and developing countries. However, previous studies have often overlooked age differentials in this relationship, assuming uniform effects across age groups. This study aims to fill this gap by examining how ill-health affects labour outcomes among different age segments in India. Utilizing data from the Longitudinal Ageing Study in India (LASI) Wave 1, which covers over 72,000 individuals aged 45 and above, this research investigates the linkage between health and labour force outcomes. The labour outcomes in this study includes labour force participation, labour earnings and hours worked. Present study used instrumental variable approach to mitigate endogeneity issues and establish causal relationships between health and labour outcomes. The Heckman selection model is utilized to address selection bias in analysing wage and hours worked. The study reveals several key findings. Firstly, ill-health consistently leads to a decline in labour force participation among both middle-aged (28 percent) and elderly (36 percent) individuals in India. This underscores the pervasive impact of health on workforce engagement, particularly in a context with limited social security measures. Secondly, the research identifies significant variations in the effects of ill-health on wages and hours worked based on age. Among elderly individuals, there is a pronounced reduction in both wages and hours worked due to ill-health. However, this effect is less pronounced among middle-aged adults. Furthermore, socioeconomic factors play a pivotal role in shaping how ill-health influences labour outcomes among different age groups. This study underscores the importance of considering age differentials in the impact of ill-health on labour outcomes, offering valuable insights for policymakers, practitioners, and researchers seeking to address this critical issue in India’s dynamic socio-economic landscape.

The World Health Organization (WHO) continues to experience immense financial stress. The precarious financial situation of the WHO has given rise to extensive dialogue and debate. This dialogue has generated diverse technical proposals to remedy the financial woes of the WHO and is intimately tied to existential questions about the future of the WHO in global health governance. In this paper, we review, categorize, and synthesize the proposals for financial reform of the WHO. It appears that less contentious issues, such as convening financing dialogue and establishing a health emergency programme, received consensus from member states. However, member states are reluctant to increase the assessed annual contributions to the WHO, which weakens the prospect for greater autonomy for the organisation. The WHO remains largely supported by earmarked voluntary contributions from states and non-state actors. We argue that while financial reform requires institutional changes to enhance transparency, accountability and efficiency, it is also deeply tied to the political economy of state sovereignty and ideas about the leadership role of the WHO in a crowded global health governance context.

The world energy crisis and increased greenhouse gas emissions have driven the search for alternative and environmentally friendly renewable energy sources. According to life cycle analysis, microalgae biofuel is identified as one of the major renewable energy sources for sustainable development, with potential to replace the fossil-based fuels. Microalgae biofuel was devoid of the major drawbacks associated with oil crops and lignocelluloses-based biofuels. Algae-based biofuels are technically and economically viable and cost competitive, require no additional lands, require minimal water use, and mitigate atmospheric CO2. However, commercial production of microalgae biodiesel is still not feasible due to the low biomass concentration and costly downstream processes. The viability of microalgae biodiesel production can be achieved by designing advanced photobioreactors, developing low cost technologies for biomass harvesting, drying, and oil extraction. Commercial production can also be accomplished by improving the genetic engineering strategies to control environmental stress conditions and by engineering metabolic pathways for high lipid production. In addition, new emerging technologies such as algal-bacterial interactions for enhancement of microalgae growth and lipid production are also explored. This review focuses mainly on the problems encountered in the commercial production of microalgae biofuels and the possible techniques to overcome these difficulties.

Background: CXCL12 (SDF1) is reported to promote cancer progression in several preclinical models and this is corroborated by the analysis of human tissue specimens. However, the relationship between CXCL12 expression and cancer survival has not been systematically assessed. Methods: We conducted a systematic review and meta-analysis of studies that evaluated the association between CXCL12 expression and cancer survival. Results: Thirty-eight studies inclusive of 5807 patients were included in the analysis of overall, recurrence-free or cancer-specific survival, the majority of which were retrospective. The pooled hazard ratios (HRs) for overall and recurrence-free survival in patients with high CXCL12 expression were 1.39 (95% CI: 1.17–1.65, P =0.0002) and 1.12 (95% CI: 0.82–1.53, P =0.48) respectively, but with significant heterogeneity between studies. On subgroup analysis by cancer type, high CXCL12 expression was associated with reduced overall survival in patients with oesophagogastric (HR 2.08; 95% CI: 1.31–3.33, P =0.002), pancreatic (HR 1.54; 95% CI: 1.21–1.97, P =0.0005) and lung cancer (HR 1.37; 95% CI: 1.08–1.75, P =0.01), whereas in breast cancer patients high CXCL12 expression conferred an overall survival advantage (HR 0.5; 95% CI: 0.38–0.66, P <0.00001). Conclusions: Determination of CXCL12 expression has the potential to be of use as a cancer biomarker and adds prognostic information in various cancer types. Prospective or prospective–retrospective analyses of CXCL12 expression in clearly defined cancer cohorts are now required to advance our understanding of the relationship between CXCL12 expression and cancer outcome.

Background: The World Health Assembly (WHA), on 1st December 2021, unanimously agreed to launch a global process to draft and negotiate a convention, agreement, or other international instrument under the World Health Organization’s (WHO’s) constitution to strengthen pandemic prevention, preparedness, and response. We aimed to explore the role of global health diplomacy (GHD) in pandemic treaty negotiations by providing deep insight into the ongoing drafting process under the WHO leadership. Methods: We conducted a narrative review by searching Scopus, Web of Sciences, PubMed, MEDLINE, and Google Scholar search engine using the keywords \"Pandemic Treaty,\" OR \"International Health Regulations,\" OR \"International conventions,\" OR \"International treaties\" in the context of recent COVID-19 pandemic. Besides, we included articles recommending the need for GHD, leadership and governance mechanisms for this international treaty drafting approved by the WHA. Results: Amid the COVID-19 pandemic, the concept of GHD bolstered the international system and remained high on the agendas of many national, regional and global platforms. As per Article 19 of the WHO constitution, the Assembly established an intergovernmental negotiating body (INB) to draft and negotiate this convention/ agreement to protect the world from disease outbreaks of pandemic potential. Since GHD has helped to strengthen international cooperation in health systems and address inequities in achieving health-related global targets, there is a great scope for the successful drafting of this pandemic treaty. Conclusion: The pandemic treaty is a defining moment in global health governance, particularly the pandemic governance reforms. However, the treaty’s purpose will only be served if the equity considerations are optimized, accountability mechanisms are established, and a sense of shared responsibility is embraced. While fulfilling treaty commitments might be complex and challenging, it provides an opportunity to rethink and build resilient systems for pandemic preparedness and response in the future.

Agricultural field experiments are costly and time-consuming, and often struggling to capture spatial and temporal variability. Mechanistic crop growth models offer a solution to understand intricate crop-soil-weather system, aiding farm-level management decisions throughout the growing season. The objective of this study was to calibrate and the Crop Environment Resource Synthesis CERES-Maize (DSSAT v 4.8) model to simulate crop growth, yield, and nitrogen dynamics in a long-term conservation agriculture (CA) based maize system. The model was also used to investigate the relationship between, temperature, nitrate and ammoniacal concentration in soil, and nitrogen uptake by the crop. Additionally, the study explored the impact of contrasting tillage practices and fertilizer nitrogen management options on maize yields. Using field data from 2019 and 2020, the DSSAT-CERES-Maize model was calibrated for plant growth stages, leaf area index-LAI, biomass, and yield. Data from 2021 were used to evaluate the model's performance. The treatments consisted of four nitrogen management options, viz., N0 (without nitrogen), N150 (150 kg N/ha through urea), GS (Green seeker-based urea application) and USG (urea super granules @150kg N/ha) in two contrasting tillage systems, i.e., CA-based zero tillage-ZT and conventional tillage-CT. The model accurately simulated maize cultivar’s anthesis and physiological maturity, with observed value falling within 5% of the model’s predictions range. LAI predictions by the model aligned well with measured values (RMSE 0.57 and nRMSE 10.33%), with a 14.6% prediction error at 60 days. The simulated grain yields generally matched with measured values (with prediction error ranging from 0 to 3%), except for plots without nitrogen application, where the model overestimated yields by 9–16%. The study also demonstrated the model's ability to accurately capture soil nitrate–N levels (RMSE 12.63 kg/ha and nRMSE 12.84%). The study concludes that the DSSAT-CERES-Maize model accurately assessed the impacts of tillage and nitrogen management practices on maize crop’s growth, yield, and soil nitrogen dynamics. By providing reliable simulations during the growing season, this modelling approach can facilitate better planning and more efficient resource management. Future research should focus on expanding the model's capabilities and improving its predictions further.

Health expenditure is indicative of the financial burden of health care and serves as a yardstick of health system performance. However, health expenditure may be shaped by multiple factors such as prevalence of morbidity, income inequality and above all, unobserved heterogeneity such as disease severity. This study uses finite mixture models (FMM) to analyze health expenditure distribution based on a National Sample Survey (NSS) which is a nationally representative dataset. This exercise identifies three different class of health care users, acknowledging the heterogeneity within the expenditure distribution. The classes demonstrate variations in spending behavior and associated characteristics. It is observed that health spending is influenced by disease severity, age, gender, education, social group, and economic status. Notably, health expenditure for similar diseases varies significantly across three classes, with the highest expenditure observed in the third latent class. It also reaffirms the gender disparities in health spending irrespective of the class. Additionally, socio-economic status consistently affects health expenditure across classes. These findings underscore the importance of recognizing unobserved heterogeneity in health expenditure for the design of effective healthcare policies. In conclusion, there is a need to recognize the unobserved heterogeneity in health expenditure data and such a recognition that distinct classes within may have greater significance in designing better health care policies. Beyond health expenditure, this analytical framework can be adopted to other medical and public health research to identify the latent classes, thus offering a broader methodological value.

Tobacco control norms have gained momentum over the past decade. To date 43 of 47 Sub-Saharan African countries are party to the Framework Convention on Tobacco Control (FCTC). The near universal adoption of the FCTC illustrates the increasing strength of these norms, although the level of commitment to implement the provisions varies widely. However, tobacco control is enmeshed in a web of international norms that has bearing on how governments implement and strengthen tobacco control measures. Given that economic arguments in favor of tobacco production remain a prominent barrier to tobacco control efforts, there is a continued need to examine how economic sectors frame and mobilize their policy commitments to tobacco production. This study explores the proposition that divergence of international norms fosters policy divergence within governments. This study was conducted in three African countries: Kenya, Malawi, and Zambia. These countries represent a continuum of tobacco control policy, whereby Kenya is one of the most advanced countries in Africa in this respect, whereas Malawi is one of the few countries that is not a party to the FCTC and has implemented few measures. We conducted 55 key informant interviews (Zambia = 23; Kenya = 17; Malawi = 15). Data analysis involved deductive coding of interview transcripts and notes to identify reference to international norms (i.e. commitments, agreements, institutions), coupled with an inductive analysis that sought to interpret the meaning participants ascribe to these norms. Our analysis suggests that commitments to tobacco control have yet to penetrate non-health sectors, who perceive tobacco control as largely in conflict with international economic norms. The reasons for this perceived conflict seems to include: (1) an entrenched and narrow conceptualization of economic development norms, (2) the power of economic interests to shape policy discourses, and (3) a structural divide between sectors in the form of bureaucratic silos. Les normes de contrôle du tabagisme ont pris de l’ampleur au cours de la dernière décennie. À ce jour, 43 des 47 pays de l’Afrique subsaharienne sont parties à la Conventioncadre pour la lutte antitabac (CCLAT). L’adoption quasi universelle de la CCLAT illustre la force croissante de cette réglementation, bien que le degré d’engagement en faveur de la mise en œuvre de ces dispositions varie considérablement. Cependant, la lutte antitabac est liée à un réseau de règles internationales qui influent sur la manière dont les gouvernements mettent en œuvre et renforcent les mesures de lutte antitabac. Étant donné que les arguments économiques en faveur de la production du tabac demeurent un obstacle majeur aux efforts de lutte antitabac, il est nécessaire de continuer à examiner l’apport des secteurs économiques dans l’encadrement et la mobilisation des engagements politiques en faveur de la production du tabac. La présente étude explore la proposition selon laquelle la divergence des règles internationales favorise la divergence des stratégies politiques au sein des gouvernements. L’étude a été réalisée dans trois pays africains: le Kenya, le Malawi et la Zambie. Ces pays représentent un continuum de la politique de lutte antitabac; en effet, le Kenya est l’un des pays africains les plus avancés à cet égard, alors que le Malawi est l’un des rares pays à ne pas avoir adhéré à la CCLAT et à n’avoir mis que peu de mesures en place. Nous avons mené 55 entretiens avec des informateurs clés (Zambie = 23, Kenya = 17, Malawi = 15). L’analyse des données impliquait un codage déductif de la transcription des entretiens et des notes afin d’identifier la référence aux normes internationales (engagements, accords, institutions), associé à une analyse inductive visant à interpréter le sens que les participants attribuaient à ces normes. Notre analyse suggère que les engagements en matière de lutte contre le tabagisme n’ont pas encore investi les secteurs non sanitaires, qui considèrent que la lutte antitabac est dans une large mesure en conflit avec les normes économiques internationales. Les raisons de ce conflit apparent semblent inclure: 1) une conceptualisation étroite bien ancrée des normes de développement économique, 2) la faculté des intérêts économiques à façonner les discours politiques, et 3) une division structurelle entre les secteurs sous la forme de cloisonnements bureaucratiques. 烟草控制规范在过去十年加速发展。目前47个撒哈拉以南非 洲国家中, 有43个签署了hh烟草控制框架公约ii （FCTC） 。 几 乎所有国家都加入了FCTC, 显示了烟草控制规范日益增强的 势头, 尽管履行规定的程度不一。然而, 烟草控制处在国家规 范网络之中, 这一网络会影响政府的控烟措施。有鉴于支持烟 草生产的经济论据仍然是烟草控制的主要障碍, 需要持续研究 经济部门如何建构和削弱对烟草控制的政治承诺。本研究探 讨的问题是, 国际规范的分歧产生政府内的政策分歧。研究涉 及3个非洲国家：肯尼亚、马拉维和赞比亚。这些国家代表了 3种不同强度的控烟政策：肯尼亚是非洲烟草控制力度最强的 国家之一, 而马拉维是少数未加入FCTC的国家之一, 几乎未实 施控烟措施。我们进行了55次关键知情人访谈（赞比亚23, 肯 尼亚17, 马拉维15）。数据分析包括对访谈记录和笔记采用演 绎法编码, 发现提及国际规范的内容（即承诺、协议和制 度）, 同时采用归纳法分析受访者赋予这些规范的意义。我们 的分析显示, 对烟草控制的承诺还未渗透至卫生以外部门, 这 些部门认为烟草控制与国际经济规范相冲突。这种观点的原 因包括： （1） 对经济发展规范的理解狭隘, 根深蒂固； （2） 经济利益对政策话语有强烈影响力； （3） 结构划分导致部门 相互隔绝。 Las normas de control del tabaco han ganado impulso en la última década. Hasta la fecha, 43 de los 47 países del África Sub-Sahariana son parte del Convenio Marco para el Control del Tabaco (CMCT). La adopción casi universal del CMCT ilustra la fuerza creciente de estas normas, aunque el nivel de compromiso de implementación varía ampliamente. Sin embargo, el control del tabaco está enlazado en una red de normas internacionales que se relacionan con la forma cómo los gobiernos implementan y fortalecen las medidas de control del tabaco. Dado que los argumentos económicos en favor de la producción de tabaco continúan siendo una barrera importante para los esfuerzos de control del tabaco, existe una necesidad continua de examinar cómo los sectores económicos enmarcan y movilizan sus compromisos de política con la producción de tabaco. Este estudio explora la idea que la divergencia de las normas internacionales fomenta la divergencia de políticas dentro de los gobiernos. Este estudio se realizó en tres países africanos: Kenia, Malawi y Zambia. Estos países representan un continuo de políticas de control del tabaco. Kenia es uno de los países más avanzados de África en este aspecto, mientras que Malawi es uno de los pocos países que no es parte del CMCT y ha implementado pocas medidas. Llevamos a cabo 55 entrevistas con informantes claves (Zambia=23, Kenia=17 y Malawi=15). El análisis de datos implicó la codificación deductiva de transcripciones de entrevistas y anotaciones para identificar referencias a normas internacionales (es decir, compromisos, acuerdos, instituciones), junto con un análisis inductivo que buscaba interpretar el significado que los participantes atribuyen a estas normas. Nuestro análisis sugiere que los compromisos con el control del tabaco aún no han penetrado los sectores no relacionados con la salud, los cuales perciben que el control del tabaco está en gran parte en conflicto con las normas económicas internacionales. Las razones de este conflicto percibido parecen incluir: (1) una conceptualización arraigada y estrecha de las normas de desarrollo económico, (2) el poder de los intereses económicos para dar forma a los discursos políticos y (3) una división estructural entre sectores en forma de silos burocráticos.

Background The media play a critical role in informing the public about the COVID-19 pandemic. Throughout the pandemic, international travel has been a highly contested subject at both the international and national levels. We examined Canadian media reporting on international travel restrictions during the pandemic, how these restrictions aligned with the International Health Regulations (IHR 2005), and how the narrative around international travel evolved over time. Methods We analysed articles from Canada’s top three national newspapers by circulation – The Globe and Mail, The National Post and The Toronto Star - published between Jan 1, 2020 - May 31, 2020. Our search yielded a total of 378 articles across the three newspapers. After removing duplicates and screening the remaining articles, we included a total of 62 articles for the analysis. We conducted a qualitative media content analysis by using an inductive coding approach. Results Three major themes were identified within the articles. These included: 1) The role of scientific and expert evidence in implementing travel restrictions; 2) Federal legislation, regulation and enforcement of international travel measures; and 3) Compliance with World Health Organization (WHO) guidelines in travel restriction policy- and decision-making. The federal government relied primarily on scientific evidence for implementing international travel restrictions and fully exercised its powers under the Quarantine Act to enforce travel regulations and comply with the IHR 2005. The government embraced a rules-based international order by following WHO recommendations on international travel, contributing to a delay in border closure and travel restrictions until mid-March. Conclusion The media focussed significantly on international travel-related issues during the early phase of the pandemic. The dominant media narrative surrounded the need for earlier travel restrictions against international travel.