Factors associated with adolescent pregnancy and public health interventions to address in Nigeria: a scoping review.

BACKGROUND: Adolescent pregnancy is a global public health and social problem that affects both developed and developing countries. Reducing adolescent pregnancy is central to achieving sustainable development goals. In 2021 Nigeria's Adolescent pregnancy was 106 per 1000 and showed an increasing rate. This study, therefore, aims to explore the literature to map the risk factors and interventions against adolescent pregnancy in Nigeria. METHOD: A scoping review of studies published between January 2007 and December 2022 using PubMed, Web of Science and Africa Journals Online were searched using the keywords' adolescent pregnancy' AND 'Nigeria'. Studies were screened using the eligibility criteria. RESULTS: A total of 241 articles, of which 229 were identified through the databases and 12 were identified through hand search. After the full-text review, 28 studies met the inclusion criteria and were included in the final review. In Nigeria, the prevalence of adolescent pregnancy is between 7.5 and 49.5%. Associated factors for adolescent pregnancy in Nigeria are multifactorial, including individual, community, societal, school, family, and peer factors. Policies on adolescent sexual and reproductive health exist in Nigeria. Still, the policies need more sponsorship, implementation, and monitoring, while only some interventions on adolescent pregnancy majorly based on contraceptives and education of health providers are available in Nigeria. CONCLUSION: Associated factors for adolescent Pregnancy in Nigeria are multidimensional, with educational attainment and wealth index being the highest associated factor. Intervention strategies aimed at the educational level have been identified as a critical factor in curbing adolescent pregnancy. Thus, policies on sexual, reproductive, and mental health development specifically targeting adolescents to reduce the cycle of societal dependence by empowering this group economically and educationally are justifiably warranted.

Developing a national undergraduate standardized curriculum for future healthcare professionals on "Making Every Contact Count" for chronic disease prevention in the Republic of Ireland.

This report describes the development of the first national undergraduate interprofessional standardized curriculum in chronic disease prevention for healthcare professionals in the Republic of Ireland. This project brought together for the first time all higher education institutions nationwide in a novel collaboration with the national health service i.e. the Health Service Executive (HSE), to develop a standardized national curriculum for undergraduate health care professions. The curriculum sits within the framework of Making Every Contact Count, the goal of which is to re-orientate health services to embed the ethos of prevention through lifestyle behavior change as part of the routine care of health professionals. The core focus of Making Every Contact Count is chronic disease prevention, targeting four main lifestyle risk factors for chronic disease; tobacco use, alcohol consumption, physical inactivity and unhealthy eating. Making Every Contact Count is a key component of Healthy Ireland, the Irish national framework for health and wellbeing. The aim of the curriculum is to prepare newly qualified health professionals with the skills needed to support patients to achieve lifestyle behavior change delivered as part of routine clinical care.

Measuring social exclusion in healthcare settings: a scoping review.

BACKGROUND: Social exclusion is a concept that has been widely debated in recent years; a particular focus of the discussion has been its significance in relation to health. The meanings of the phrase "social exclusion", and the closely associated term "social inclusion", are contested in the literature. Both of these concepts are important in relation to health and the area of primary healthcare in particular. Thus, several tools for the measurement of social exclusion or social inclusion status in health care settings have been developed. METHODS: A scoping review of the peer-reviewed and grey literature was conducted to examine tools developed since 2000 that measure social exclusion or social inclusion. We focused on those measurement tools developed for use with individual patients in healthcare settings. Efforts were made to obtain a copy of each of the original tools, and all relevant background literature. All tools retrieved were compared in tables, and the specific domains that were included in each measure were tabulated. RESULTS: Twenty-two measurement tools were included in the final scoping review. The majority of these had been specifically developed for the measurement of social inclusion or social exclusion, but a small number were created for the measurement of other closely aligned concepts. The majority of the tools included were constructed for engaging with patients in mental health settings. The tools varied greatly in their design, the scoring systems and the ways they were administered. The domains covered by these tools varied widely and some of the tools were quite narrow in the areas of focus. A review of the definitions of both social inclusion and social exclusion also revealed the variations among the explanations of these complex concepts. CONCLUSIONS: There are several definitions of both social inclusion and social exclusion in use and they differ greatly in scope. While there are many tools that have been developed for measuring these concepts in healthcare settings, these do not have a primary healthcare focus. There is a need for the development of a tool for measuring social inclusion or social exclusion in primary healthcare settings.

Barriers to progressing through a methadone maintenance treatment programme: perspectives of the clients in the Mid-West of Ireland's drug and alcohol services.

BACKGROUND: The 'perfect' journey through an Irish Methadone Maintenance Treatment Programme (MMTP) would have a client engage appropriately with all relevant services available to them, inclusive of psychiatry, counselling, out-reach support, nursing and psychology. Concurrently, a client would ideally adhere to their prescribed methadone-dosing regimen, until a client is stabilised allowing them to function optimally. At this point, a client should transfer to the GP community setting. Unfortunately, this fails to occur. To date, very few studies have specifically investigated the reasons why a cohort of clients remain 'trapped' in the high risk, specialist clinical setting. METHODS: Qualitative detailed semi-structured interviews were undertaken with 17 clients of one of Ireland's Health Service Executive (HSE) Drug and Alcohol Services, entitled 'HSE Mid-West Limerick Drug and Alcohol Service'. Each client had a severe Opioid Use Disorder (OUD) and clients had spent on average 7.5 years engaging with the MMTP. RESULTS: Participants' life journey prior to an OUD included Adverse Childhood Experiences (ACEs) and early exposure to illicit drug use. Shared life events resulting in their initiating and sustaining an OUD involved continuous hardship into adulthood, mental illness and concurrent benzodiazepine use disorder, often resulting in harrowing accounts of participants' loneliness and lack of life purpose. Their living environments, an erroneous understanding of their illness and poor communication with allied health professionals further perpetuated their OUD. Positive factors influencing periods of abstinence were familial incentives and a belief in the efficacy of methadone. Clients own suggestions for improving their journeys included employing a multi-sectorial approach to managing OUD and educating themselves and others on opioid agonist treatments. If clients were not progressing appropriately, they themselves suggested enforcing a 'time-limit' on clients to engage with the programme or indeed for their treatment to be postponed. CONCLUSIONS: To optimise the functioning of the MMTP, three tasks need to be fulfilled: 1) Reduce the incidences of ACEs, 2) Diagnose and treat clients with a dual diagnosis 3) Educate clients, their families, the public and allied health care professionals on all aspects of OUD. A cross- departmental, inter-governmental approach is needed to address opioid misuse as a societal issue as a whole.

Social and traditional practices and their implications for family planning: a participatory ethnographic study in Renk, South Sudan.

BACKGROUND: Understanding what determines family size is crucial for programmes that aim to provide family planning services during and after conflicts. Recent research found that development agents in post conflict settings do not necessarily take time to understand the context adequately, translate their context understanding into programming, or adjust programming in the light of changes. South Sudan, a country that has been suffering from war for almost 50 years, has one of the highest maternal death rates and the lowest contraceptive utilization rates in the world. METHODS: This research used Participatory Ethnographic Evaluation and Research (PEER) to provide a contextualised understanding of social and traditional practices and their implications for family planning. Fourteen women were recruited from 14 villages in Renk County in South Sudan in the period 2010-2012. They were trained to design research instruments, conduct interviews, collect narratives and stories and analyse data to identify, prioritize and address their maternal health concerns. RESULTS: As a result of wars, people are under pressure to increase their family sizes and thus increase the nation's population. This is to compensate for the men perished in war and the high child death rates. Large family size is regarded as a national obligation. Women are caught up in a vicious cycle of high fertility and a high rate of child mortality. Determinants of large family size include: 1) Social and cultural practices, 2) Clan lineage and 3) Compensation for loss of family members. Three strategies are used to increase family size: 1) Marry several women, 2) Husbands taking care of women, and 3) Financial stability. Consequences of big families include: 1) Financial burden, 2) Fear of losing children, 3) Borrowing children and 4) Husband shirking responsibility. CONCLUSION: The desire to have a big family will remain in South Sudan until families realise that their children will live longer, that their men will not be taken by the war, and that the costs of living will be met. In order to generate demand for family planning in South Sudan, priority should be given first to improve infant and child health.

From local to global: a qualitative review of the multi-leveled impact of a multi-country health research capacity development partnership on maternal health in Sudan.

BACKGROUND: There is a substantial body of literature on the principles of good partnerships and the rationale for such partnerships in research capacity strengthening. This paper illustrates the long term effects of a multi-country (8 countries) global partnership for health systems research capacity development (Connecting health Research in Africa and Ireland Consortium - ChRAIC) in relation to its contribution to capacity strengthening, public advocacy and policy influence at different levels and its practical achievements in Sudan in addressing access to maternal health services. METHODS: The authors (all members of the global partnership) reflect on the project in one of its' partner countries, Sudan, over its' five year duration. This reflection is supported by specific project data collected over the period of the project (2008-2014). The data collected included: (i) 6 monthly and annual donor reports; (ii) a mid-term internal and end of project independent evaluation of the entire project, and; (ii) a Ph.D study conducted by a member of the Sudanese research team. RESULTS: The ChRAIC project in Sudan achieved the deliverables set out at the beginning of the project. These included a national knowledge synthesis report on Sudan's health system; identification of country level health systems research priorities; research capacity assessment and skills training, and; the training and graduation of a Sudanese team member with a Ph.D. Mechanisms established in Sudan to facilitate these achievements included the adoption of culturally sensitive and locally specific research and capacity strengthening methods at district level; the signing of a Memorandum of Understanding at country level between the Ministry of Health, research and academic institutions in Sudan, and; the establishment of country level initiatives and a research unit. The latter being recognized globally through awards and membership in global health forums. CONCLUSION: We surmise that the 'network of action' approach adopted to partnership formation facilitated the benefits gained, but that adopting such an approach is not sufficient. More local and contextual factors influenced the extent of the benefits and the sustainability of the network.

Community challenges when using large plastic bottles for Solar Energy Disinfection of Water (SODIS).

BACKGROUND: Communities living in developing countries as well as populations affected by natural or man-made disasters can be left at great risk from water related diseases, especially those spread through the faecal-oral route. Conventional water treatments such as boiling and chlorination can be effective but may prove costly for impoverished communities. Solar water disinfection (SODIS) has been shown to be a cheap and effective way for communities to treat their water. The exposure to sunlight is typically carried out in small volume plastic beverage bottles (up to 2 l). Given the water requirements of consumption and basic personal hygiene, this may not always meet the needs of communities. Recent work has shown 19-L plastic water dispenser containers to be effective SODIS reactors, comparable in efficacy to PET bottles. In this paper we outline the need for studying SODIS in large volumes and discuss 4 main associated challenges. DISCUSSION: Apart from clean water needed for consumption, access to adequate water is essential for sanitation and hygiene. Contamination of treated water through unwashed hands or vessels contributes heavily to the spread of water borne pathogens in communities. Traditional water treatments such as boiling and chlorination can be effective but may prove financially burdensome for low income communities. SODIS in large vessels could be used as a simple method to meet water requirements in low income and disaster affected populations. However, there have been some concerns associated with the conventional SODIS method; we identify the main ones to be: (1) cold or cloudy weather; (2) the fear of leaching in plastic bottles; (3) water turbidity, and; (4) community acceptance. The application of SODIS in large bottles like WDCs has the potential to be an efficient and cost effective method of disinfecting water, either for consumption until more rigorous water treatments can be put in place, or for sanitation and hygiene to curb the spread of fecal contamination. Further research is needed that can address some of the limitations and challenges associated with the use of large bottles for SODIS.

Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed.

BACKGROUND: Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective. DISCUSSION: Common demand side strategies can be grouped into three categories:(i) Financial incentives/subsidies; (ii) Enhancing patient transfer, and; (iii) Community involvement. The main challenges in assessing the effectiveness or efficacy of these interventions or strategies are the lack of quality evidence on their outcome and impact and interventions not integrated into existing health or community systems. However, what is highlighted in this review and overlooked in most of the published literature on this topic is the lack of knowledge about the context in which these strategies are to be implemented. We suggest three challenges that need to be addressed to create a supportive environment in which these demand-side strategies can effectively improve access to maternal health services. These include: addressing decision-making norms, engaging in intergenerational dialogue, and designing contextually appropriate communication strategies.

Economics of primary healthcare: cost estimation of clinical services at primary care facilities in the six countries of the Gulf Cooperation Council.

OBJECTIVE: While the Gulf Cooperation Council (GCC) countries have demonstrated a strong commitment to strengthening primary healthcare (PHC), the costs of delivering these services in this region remain relatively unexplored. Understanding the costs of PHC delivery is essential for effective resource allocation and health system efficiency. DESIGN: We used an ingredient-based method to estimate the cost of delivering a selection of services at PHC facilities in the six GCC countries in 2019. Services were categorised into eight programmes: immunisation; non-communicable diseases (NCDs); oral and dental care; child health; nutrition; mental health; reproductive, maternal, neonatal and child health and general practice. The cost estimation focused on two key ingredients: the costs of drugs and supplies and the healthcare workforce cost. The coverage rates of specific types of health services, including screening and mental health services, were also estimated. Data for the analysis were obtained from ministries of health, health statistics reports, online databases, national surveys and scientific literature. RESULTS: The estimated costs of delivering the selected services at public PHC facilities in the six GCC countries totalled US$5.7 billion in 2019, representing 0.34% of the combined 2019 GDP. The per capita costs varied from US$69 to US$272. General practice and NCD programmes constituted 79% of the total costs modelled while mental health ranged between 0.0% and 0.3%. Over 8 million individuals did not receive NCD screening services, and over 30 million did not receive needed mental health services in public PHC facilities across the region. CONCLUSIONS: To our knowledge, this is the first study to estimate the costs of services delivered at PHC facilities in the GCC countries. Identifying the main cost drivers and the services which individuals did not receive can be used to help strengthen PHC to improve efficiency and scale up needed services for better health outcomes.

Design and Evaluation of Interprofessional Training Program for Healthcare Students from Collectivistic Culture.

Background: Healthcare is team-based, and with increased mobility of healthcare workers, most of them will work with team members from all over the globe. Interprofessional education (IPE) research has mostly focused on specially designed programs in academic health institutions to prepare students for multidisciplinary work. Few IPE programs aim to integrate students with mixed disciplines from collectivist cultures. Methods: This mixed-methods study was conducted between June and August 2019. Surveys and an e-portfolio were recorded of 33 final-year and graduated health professional students' participation in an 8-week IPE summer program at a medical school in Ireland. Survey results are described, and the content of portfolios was analyzed based on the deductive analysis of qualitative data derived from questions. Results: Students reported the greatest improvement in presentation skills (63.6%), followed by communication (54.5%), team working skills (93.9%), and interprofessional learning (42.4%), respectively. Qualitative findings highlighted challenges for students from a collectivist culture adapting to an IPE: uncomfortable verbally expressing themselves in problem-based learning (PBL) and how to work with other sex. Positive themes about IPE that emerged were enjoyment in sharing ideas and building trust with PBL groups. We learned that the program had to be flexible enough to meet the educational requirements of a target community with mixed English language ability and adaptability to IPE. Conclusion: The authors propose that an international PBL-based summer program is effective in improving healthcare students' attitudes towards IPE. This study provides valuable insights to facilitate the development of further IPE programs to increased collaboration between students across various healthcare disciplines. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01536-7.

The case for investing in the prevention and control of non-communicable diseases in the six countries of the Gulf Cooperation Council: an economic evaluation.

BACKGROUND: While the non-communicable disease (NCD) burden in the countries of the Gulf Cooperation Council (GCC) (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates) has surged over the past decades, the costs and return on investment (ROI) of implementing cost-effective, WHO-recommended NCD interventions have not been established. METHODS: We performed an economic analysis to estimate the ROI from scaling up four sets of NCD interventions over 15 years. We estimated the direct costs of the four main NCDs (cancer, diabetes, cardiovascular diseases and chronic respiratory diseases) using a prevalence-based, bottom-up cost-of-illness approach. We estimated indirect costs based on productivity loss due to absenteeism, presenteeism and premature deaths. We costed the scaling up of interventions using the WHO Costing Tool and assessed the health impact of interventions using the OneHealth Tool. We calculated ROI by comparing productivity and social benefits with the total costs of implementing the interventions. RESULTS: The four main NCDs cost the GCC economy nearly US$50 billion in 2019, equal to 3.3% of its gross domestic product. The indirect costs are estimated at US$20 billion or 40% of the total burden. Implementing the four modelled intervention packages in the six GCC countries over 15 years will cost US$14 billion, with an ROI of US$4.9 for every US$1 invested and significant health and social benefits, including 290 000 averted premature deaths. CONCLUSION: Based on the results of these six investment cases, we recommend actions to scale up current WHO-recommended cost-effective interventions, strengthen whole-of-government action, drive the NCD legislative agenda, build out the evidence base, generate additional advocacy material, and increase regional collaboration and data-sharing to establish best practices and monitor impact.

Public health practicum: a scoping review of current practice in graduate public health education.

OBJECTIVES: The objectives of this study are to (1) identify Graduate Public Health (GPH) programmes with an integrated practicum, (2) determine current practice for practicum design and (3) use the information to make recommendations to inform the design of Public Health Graduate programme practicums. DESIGN: Scoping review. DATA SOURCES: Academic Ranking World Universities 2019 was used to identify top 10 institutions in each geographical hub offering GPH programmes. Each GPH programme website was searched for practicum information. ELIGIBILITY CRITERIA: GPH programmes offering a practice-based component as a requirement in their curriculum. DATA EXTRACTION AND SYNTHESIS: One reviewer screened GPH websites for eligibility and extracted data. Verification of data for accuracy and completeness was done on 10% of the sample by the second author. Data were compiled into an Excel file and were analysed to describe the duration, timing, credit, contact hours, preceptor requirements, prerequisites, objectives, deliverables and methods of evaluation of the practice-based component. RESULTS: Out of the 108 GPH programmes screened, a total of 35 programmes were included. There was a significant variation in required practicum duration ranging from 4 to 16 weeks. Only 31% specifically outlined prerequisites to be completed before the initiation of the practicum. More than half (57%) had a published list of core competencies. A majority of practicum did not provide criteria for appropriate preceptors (63%) and their responsibilities (66%). All programmes listed assessment criteria however the majority (57%) did not specify if the practicum was graded or a for-credit component. CONCLUSIONS: The integration of practical components into curricula is inconsistent. This research resulted in 14 recommendations intended to guide GPH practicum design. We propose that this study be used as a tool to spark a global dialogue about best practices in GPH education through the identification of common practices and opportunities for improvement.

"There is people like us and there is people like them, and we are not like them." Understating social exclusion - a qualitative study.

Social exclusion is a complex concept that is relevant in terms of the health of vulnerable groups. Attempts have been made in the past to measure it, both at the population and the individual level. The aim of this research was to engage with a broad range of relevant stakeholders in Ireland in order to learn how they defined and conceptualised social exclusion. Semi-structured interviews were carried out with 24 participants selected using maximum variation sampling. One quarter of the interviewees were experts by experience. Participants included academic experts, the heads of organisations working nationally with socially excluded groups, politicians, clinicians, support workers and health service managers all with experience of working with socially excluded groups. The resulting definition of social exclusion was "the experience of lack of opportunity, or the inability to make use of available opportunities, thereby preventing full participation in society." From this, we developed a new model of the concept comprising three elements; Opportunities, Influencing factors and Social outcomes. Opportunities are the fundamental needs that are required to be met for a person to begin leaving social exclusion. Influencing factors are a mixture of the personal characteristics and more complex problems such as the intergenerational effects of disadvantage. Social outcomes include a person being accepted by wider society, and subsequently being able to participate. The conceptual framework we developed can contribute to a better understanding of the concept of social exclusion. The traditional policy focus on improving the needs of excluded people at the Opportunities level must continue, but must be complemented by tackling the problems at the levels of the Influencing factors and Social outcomes also. In terms of changes to practice, the measurement of the social exclusion status of people engaging with primary care and other services would be an important start in order to better understand the magnitude of the work required.

Social inclusion in the Irish health context: Policy and stakeholder mapping.

BACKGROUND: Social inclusion is a complex concept, and its relationship to health has been widely debated. Across the European Union, there has been a move towards policies promoting social inclusion. Despite this, there has been a limited analysis of how the concept of social inclusion is operationalised in Irish policy. The aim of this research was to document and map the development of social inclusion policies in the Irish context. The objectives were to identify all the relevant stakeholders and policies and to describe the relevance of social inclusion policy in the domain of health. METHODS: We utilised a widely recognised policy analysis framework. We conducted a systematic search of relevant government policies, grey literature databases, statutory agencies and stakeholders in the Irish context since 2006. The researchers initially identified a total of 954 results. RESULTS: The relevant stakeholders discovered were the research community, service providers, civil society organisations, policy makers and government, philanthropists and socially excluded people. Most policy documents included refer to one of two national policies created to drive social inclusion activities. Social inclusion was being operationalised in the context of health, but the relationship between policymakers and those planning and providing services was unclear. CONCLUSIONS: The concept of social inclusion was being operationalised in the Irish policy context. A multitude of stakeholders were involved, reflecting the wide reach of this concept in society. Social inclusion was a particularly important concept in the realm of health, and in the primary care domain in particular.

Legislation targeting head shops selling new psychoactive substances and changes in drug-related psychiatric admissions: A national database study.

AIM: New psychoactive substance (NPS) use can negatively impact mental health and may result in drug-related psychiatric admissions (DRPA). Irish youth reported very high rates of NPS use by international standards, the most common being synthetic cannabinoids and cathinones. This occurred in the context of a rapid expansion in specialist high street shops, called head shops, selling NPS in 2010. Government responded to public protests about head shops by enacting legislation in May and August 2010 to end this trade. Many academics argued that such actions were futile. We sought to determine if changes in head shop activity coincided with changes in DRPA. METHOD: The national database on psychiatric admissions was examined focusing on young adults admitted from 2008 to 2012. Joinpoint regression analysis was utilized to examine for the presence of trend changes in DRPA. RESULTS: The monthly rate of DRPA was higher in 2010 than 2008, 2009 and 2012 (P < 0.01). Joinpoint regression analysis identified a significant downward trend change which occurred in July 2010 (95% CI Feb 2010 to April 2011). Young males aged 18 to 24 years showed evidence of greatest change, DRPA falling by 1.4% per month (95% CI 0.7 to 3.7% decline) from May 2010 to December 2012. CONCLUSIONS: Cessation of NPS sale by head shops coincided with a reversal in the upward trend of DRPA, this change being most evident in young men. While correlation does not imply causation, legislation which successfully targets the sale of NPS may result in reduced drug-related mental disorders.

Social exclusion in primary healthcare settings: the time for measurement has come / Exclusão social em ambientes de atenção primária: chegou a hora da medição

Social exclusion is a concept that has been discussed and debated in many disciplines in recent decades. In 2006 the WHO Social Exclusion Knowledge Network published a report detailing their work explaining the relevance of social exclusion to the domain of health. As part of that work, the authors formulated a complex definition of social exclusion that has proven difficult to adapt or operationalize in healthcare settings. We looked at this WHO work, and at other published evidence, and decided that social exclusion is a concept that is worth measuring at the individual level in healthcare settings. We suggest that the primary healthcare space, in particular, is an ideal setting in which to do that measurement. We have examined existing social exclusion measurement tools, and scrutinised the approaches taken by their authors, and the various domains they measured. We now propose to develop and validate such a tool for use in primary healthcare settings.

A exclusão social é um conceito que tem sido discutido e debatido em muitas disciplinas nas últimas décadas. Em 2006, a Rede de Conhecimento de Exclusão Social da OMS publicou um relatório detalhando seu trabalho explicando a relevância da exclusão social para o domínio da saúde. Como parte desse trabalho, os autores formularam uma definição complexa de exclusão social que se mostrou difícil de adaptar ou operacionalizar nos contextos de saúde. Analisamos esse trabalho da OMS e outras evidências publicadas, e decidimos que a exclusão social é um conceito que vale a pena medir no nível individual nos contextos de saúde. Sugerimos que o espaço da atenção primária à saúde, em particular, seja um cenário ideal para fazer essa medição. Examinamos as ferramentas de medição de exclusão social existentes e examinamos as abordagens adotadas por seus autores e os vários domínios que mediram. Propomos agora desenvolver e validar essa ferramenta para uso em ambientes de atenção primária.

Do we really know who are left behind and who are at risk of being left behind? / Sabemos realmente quem é deixado para trás e quem corre o risco de ficar para trás?

There is enough evidence to show the importance of the first 1000 days of life for child survival and development, and the next 8000 days for a child to reach adulthood. Yet discrimination, place of residence, socio-economic status, and inequalities within and between countries contribute to earlier mortality and significant morbidities for mothers and their children, particularly in settings with limited resources. Therefore, many children and adolescents and their families were left behind. JHGD has been raising public health issues related to inequalities and right to health. In this issue, articles generate debate around human dignity and health disparities. Several articles discuss a verity of health issues particularly in Amazon and Northeast region. School health was also discussed in this issue. Three studies were conducted in schools in Rio Grande do Sul, Brazil. Research indicate that many children and adolescents are left behind. We are missing many opportunities to bridge the gap of inequality. Actions need to be taken now to make sure no one is left behind.

Há evidências para mostrar a importância dos primeiros 1000 dias de vida para a sobrevivência e o desenvolvimento da criança e dos próximos 8000 dias para a criança atingir a idade adulta. Entretanto, o local de residência, o status socioeconômico, a discriminação e as desigualdades dentro e entre os países contribuem para a mortalidade precoce e morbidades significativas para as mães e seus filhos, particularmente em ambientes com recursos limitados, sendo que muitas crianças, adolescentes e suas famílias estão em situação de vulnerabilidade. Como contribuição ao campo da saúde pública, o Journal of Human Growth and Development (JHGD) tem promovido discussões acerca das questões de saúde pública relacionadas às desigualdades e direito à saúde. Nesta edição, os artigos geram debate em torno da dignidade humana e das disparidades de saúde. Diversos artigos discutem a veracidade das questões de saúde, particularmente na região amazônica e nordeste. Além de saúde escolar, que também foi discutida nesta edição. Três estudos foram conduzidos em escolas do Rio Grande do Sul, Brasil. Pesquisas indicam que muitas crianças e adolescentes são negligenciados. Estamos perdendo muitas oportunidades para preencher a lacuna da desigualdade. Ações precisam ser tomadas agora para garantir que ninguém seja deixado para trás.