Sex Workers and the Mpox Response in Africa.

The ongoing mpox outbreak in Africa, now classified as a Public Health Emergency of International Concern by the World Health Organization, presents a severe challenge, particularly for vulnerable populations like sex workers. Despite the endemic presence of mpox in Africa since the 1970s, recent developments, including the emergence of a new clade Ib strain with increased transmissibility, have exacerbated the situation. Sex workers are at heightened risk due to their occupational exposure, compounded by stigma, criminalization, and limited access to healthcare. These factors significantly impede efforts to control the spread of the virus, leading to underreporting and inadequate intervention. This article highlights the urgent need for an inclusive public health response that prioritizes the health and safety of sex workers. Such a response should involve tailored health services, legal protections, and community engagement to ensure that this marginalized group is not overlooked. The decriminalization of sex work is also proposed as a critical public health measure to improve access to care and reduce stigma, ultimately curbing the spread of mpox in Africa.

Prevalence, demographic, socio-economic, and lifestyle factors associated with cigarette, e-cigarette, and dual use: evidence from the 2017-2021 Scottish Health Survey.

Understanding the correlation between demographic, socio-economic, and lifestyle factors with e-cigarette use, cigarette smoking, and dual use is essential for targeted public health interventions. This study examines the prevalence of these behaviors in Scotland and identifies the associated factors. We conducted a repeated cross-sectional analysis of the Scottish Health Survey data from 2017 to 2021, leveraging data from 12,644 participants aged 16 and older: 2271 cigarette smokers, 687 e-cigarette users, 428 dual users, and 9258 never users. Weighted prevalences were calculated by age group, sex, and survey year, followed by weighted multinomial logistic regression to explore associated factors. The overall prevalences were 72.0% (95% CI 70.9-73.1) for never users, 18.9% (95% CI 17.9-19.9) for cigarette smokers, 5.5% (95% CI 5.0-6.1) for e-cigarette users, and 3.6% (95% CI 3.2-4.0) for dual users. From 2017 to 2021, cigarette smoking declined from 21.7% (95% CI 19.6-23.9) to 13.1% (95% CI 11.5-15.0), e-cigarette use from 6.5% (95% CI 5.4-7.8) to 4.8% (95% CI 3.6-6.4), and dual use from 3.7% (95% CI 2.9-4.6) to 2.7% (95% CI 1.9-3.7). Age was a critical factor, with the 25-34 age group more likely to use e-cigarettes (p = 0.007) and the 35-44 age group more likely to engage in dual use (p = 0.006) compared to the 16-24 age group. Males had higher odds of e-cigarette use than females (p = 0.031). White individuals had higher odds of using e-cigarettes (p = 0.023) and being dual users (p = 0.017) compared to non-whites. Previously married individuals had higher odds of dual use than singles (p = 0.031). Larger household sizes were linked to reduced odds of all three behaviors (p = 0.001). Rural residents were less likely to use e-cigarettes compared to urban residents (p = 0.025). Higher education correlated with lower odds of all three behaviors (p = 0.001). Manual occupation increased the likelihood of dual use (p = 0.042). Lower income and higher deprivation significantly increased the odds of all three behaviors (p < 0.001). Excessive alcohol consumption was associated with increased odds of the three behaviors (p < 0.001). Poor sleep quality correlated with increased odds of dual use (p = 0.002) and cigarette smoking (p < 0.001). Adherence to physical activity guidelines was associated with reduced odds of all three behaviors (cigarette smoking p < 0.001, e-cigarette use p = 0.031, dual use p = 0.016). In conclusion, this study showed a decline in the prevalence of cigarette smoking, e-cigarette use, and dual usage from 2017 to 2021 in Scotland. Significant associations with demographic, socio-economic, and lifestyle factors highlight the need for targeted public health interventions.

Prevalence and Determinants of Current Cigarette Smoking Among Adolescents in Thailand: Evidence From 2021 Global School-Based Health Survey.

BACKGROUND: Adolescent cigarette smoking remains a concern globally, including in Thailand. This research aimed to elucidate the prevalence and determinants of cigarette smoking among Thai adolescents. Study Design: A cross-sectional study. METHODS: A cross-sectional analysis of data from the 2021 Thailand Global School-Based Health Survey with 5545 adolescents aged 13-17 with complete information was conducted on their cigarette smoking status. Bivariate analysis and multivariable logistic regression were performed to discern the determinants of tobacco smoking among adolescents. RESULTS: The overall weighted prevalence of cigarette smoking was 11.5% (95% confidence interval [CI]=9.7%, 13.5%), with adolescent males at 18.2% (95% CI=15.3%, 21.4%) and adolescent females at 5.6% (95% CI=4.2%, 7.4%). The multivariable logistic regression also revealed that males were more likely to be smokers (Adjusted Odd Ratio [AOR]=1.58; 95% CI=1.02, 2.45, P=0.040) compared to females. The presence of smokers in their vicinity significantly increased the odds of smoking (AOR=2.21, 95% CI=1.46, 3.36, P<0.001). Current alcohol use (AOR=3.37, 95% CI=2.21-5.14, P<0.001) and current marijuana use (AOR=4.53, 95% CI=2.06, 9.99, P<0.001) were both significant determinants of smoking. Notably, early initiation of cigarette use (before age 14) was associated with a lower likelihood of current smoking (AOR=0.54, 95% CI=0.33, 0.92, P=0.022). CONCLUSION: With an overall prevalence of smoking among adolescents at 11.5%, our study highlights a significant public health concern. The positive determinants of the identified tobacco smoking include being male, having smokers in their vicinity, and currently using alcohol, and marijuana, while early initiation of cigarette use before age 14 is identified as an inverse determinant.

Leaving no one behind: addressing the sexuality of people with disabilities.

Addressing the sexuality of individuals with disabilities is important within the framework of global health and societal inclusivity. Despite comprising 16% of the world's population, this demographic faces sexual autonomy inequality. Acknowledging this intersection is pertinent for achieving inclusive healthcare and upholding the commitments of the 1994 International Conference on Population and Development and the 2006 United Nations Convention on the Rights of Persons with Disabilities. Dispelling stereotypes and promoting dialogue are key to empowering individuals with disabilities and ensuring equitable access to sexual health resources. Integrating sexual health and rights into broader healthcare systems is vital for creating an inclusive society where no one is left behind. This article advocates for the need to address the specific sexual health needs and rights of individuals with disabilities, to implement inclusive policies, and to foster a healthcare environment that respects and supports their autonomy and dignity.

Predictors and Prevalence of Alcohol and Cannabis Co-use Among Filipino Adolescents: Evidence From a School-based Student Health Survey.

OBJECTIVES: This study explored the prevalence and predictors of alcohol and cannabis co-use among 9263 Filipino adolescents, using data from the 2019 Global School-based Student Health Survey (GSHS). METHODS: We conducted a cross-sectional secondary analysis of the GSHS, targeting adolescents aged 13-17 years and excluding cases with incomplete data on alcohol and cannabis use. Our analysis employed the bivariate chi-square test of independence and multivariable logistic regression using Stata version 18 to identify significant predictors of co-use, with a p-value threshold set at 0.05. RESULTS: The weighted prevalence of co-users was 4.2% (95% confidence interval [CI], 3.4 to 5.3). Significant predictors included male sex (adjusted odds ratio [aOR], 4.50; 95% CI, 3.31 to 6.10; p<0.001) and being in a lower academic year, specifically grade 7 (aOR, 4.08; 95% CI, 2.39 to 6.99; p<0.001) and grade 8 (aOR, 2.20; 95% CI, 1.30 to 3.72; p=0.003). Poor sleep quality was also a significant predictor (aOR, 1.77; 95% CI, 1.29 to 2.44; p<0.001), as was a history of attempted suicide (aOR, 5.31; 95% CI, 4.00 to 7.06; p<0.001). Physical inactivity was associated with lower odds of co-use (aOR, 0.45; 95% CI, 0.33 to 0.62; p<0.001). Additionally, non-attendance of physical education classes (aOR, 1.48; 95% CI, 1.06 to 2.05; p=0.021), infrequent unapproved parental checks (aOR, 1.37; 95% CI, 1.04 to 1.80; p=0.024), and lower parental awareness of free-time activities (aOR, 0.63; 95% CI, 0.45 to 0.87; p=0.005) were associated with higher odds of co-use. Factors not significantly linked to co-use included age group, being in grade 9, always feeling lonely, having no close friends, being bullied outside school, and whether a parent or guardian understood the adolescent's worries. CONCLUSIONS: The findings highlight the critical need for comprehensive interventions in the Philippines, addressing not only physical inactivity and parental monitoring but also focusing on sex, academic grade, participation in physical education classes, sleep quality, and suicide attempt history, to effectively reduce alcohol and cannabis co-use among adolescents.

Harnessing the potential of African youth for transforming health research in Africa.

Africa faces a significant burden of infectious diseases, including Malaria and HIV/AIDS, along with an increasing prevalence of non-infectious diseases such as diabetes and cancer. This dual health challenge is amplified by socioeconomic difficulties, restricted access to healthcare, and lifestyle changes, thus present unique scientific needs. Effectively addressing these issues requires a skilled scientific workforce adept in comprehensive healthcare strategies. This analysis explores the critical landscape of health research in Africa, emphasizing the unique opportunity presented by the continent's youthful population, projected to reach almost 1 billion by 2050. The youth's innovative potential and fresh perspectives offer a chance to overcome development barriers in health research. Nevertheless, challenges such as under-resourced education, limited research training, inadequate mentorship, and funding difficulties persist. This paper urgently calls upon African leaders, international partners, and stakeholders to prioritize health research, mobilize funding, forge strategic partnerships, and empower the youth as essential steps to capitalize on the continent's dynamic youth for breakthrough health outcomes. Such investments are vital not just for health but for the overall economic, social, and strategic growth of the continent. Through shared responsibility and a united effort, the potential of African youth can be harnessed, leading to transformative research, improved health outcomes, and a prosperous future. This perspective represents the collective voice of passionate young researchers and advocates across Africa, calling for a new era of health research on the continent.

Exploring electronic cigarette portrayals: a content and thematic analysis of African online news coverage.

BACKGROUND: Electronic cigarette use has surged internationally in recent years, with numerous countries noting an uptick in users. Despite this, the portrayal of e-cigarette usage in African news remains unclear. METHODS: This research investigates the subject, employing a mixed-methodology approach. The study units were news articles on electronic cigarette use retrieved from AllAfrica, an online African news archive. A total of 38 online news and opinion articles published between June 2017 and June 2022 qualified the exclusion and inclusion criteria. A content analysis revealed prevalent codes and themes, while a thematic analysis explored the association between news sources and framing. RESULTS: The results indicate that articles and arguments presenting e-cigarettes positively outnumber those with a negative slant. The health impacts of electronic cigarettes emerged as the most discussed topic, with health authorities frequently cited as news sources. However, these health authorities often lacked a unified stance on e-cigarette safety. CONCLUSION: The lack of consensus among health officials could have public health consequences, possibly resulting in the formulation of uninformed policies.

Decolonizing Epidemiological Research: A Critical Perspective.

Decolonizing epidemiological research is a crucial endeavor. Historically, colonial and imperialistic ideologies have pervaded epidemiology, leading to an emphasis on Western perspectives and the neglect of indigenous and other marginalized communities' needs and experiences. To effectively address health disparities and promote justice and equality, acknowledging and addressing these power imbalances are imperative. In this article, I highlight the need of decolonizing epidemiological research and make recommendations. These include increasing the representation of researchers from underrepresented communities, ensuring that epidemiological research is contextually relevant and responsive to the experiences of these communities, and collaborating with policymakers and advocacy groups to inform policies and practices that benefit all populations. Moreover, I underscore the importance of recognizing and valuing the knowledge and skills of marginalized populations, and integrating traditional knowledge-the distinct, culturally specific understanding unique to a particular group-into research efforts. I also emphasize the need of capacity building and equitable research collaborations and authorship as well as epidemiological journal editorship. Decolonizing epidemiology research is a continual process that requires continuing discourse, collaboration, and education.

The global antimicrobial resistance response effort must not exclude marginalised populations.

Antimicrobial resistance (AMR), a rising global health crisis causing about 700,000 deaths annually and potentially 10 million deaths by 2050, disproportionately impacts marginalised populations. Due to socioeconomic, ethnic, geographic, and other barriers, these communities often have restricted healthcare access, compounding the AMR threat. Unequal access to effective antibiotics, inadequate living conditions, and a lack of awareness exacerbate the crisis in marginalised communities, making them more susceptible to AMR. A broader, inclusive response is needed to ensure equitable access to antibiotics, improved living conditions, education, and policy changes to challenge the root socio-economic disparities. Ignoring marginalised populations in the fight against AMR is both a moral and strategic failure. Therefore, inclusivity must be a central tenet in combating AMR. This article not only critically dissects this prevailing oversight but also urgently calls for comprehensive action to address this significant shortcoming in our response efforts.

Balancing the risks and benefits of antibiotic use in a globalized world: the ethics of antimicrobial resistance.

Antimicrobial resistance (AMR) is a "silent pandemic" that threatens the efficacy of antibiotics and other antimicrobials. It is imperative to take into account the ethical implications of how these resources are used and distributed as the world deals with this silent pandemic. This commentary discusses the ethical considerations surrounding the use and distribution of antibiotics in the age of resistance, including issues of equity and access, responsibility for antimicrobial stewardship, the environmental impact of antibiotic use, and the development and promotion of these drugs. The ethical implications of unequal access to antibiotics and the role of social determinants of health in shaping this access are considered, as well as the globalization of AMR and the need for multiple stakeholders to be involved in addressing this issue. The opportunities of antimicrobial stewardship programmes for optimising antibiotic use and reducing the emergence and spread of resistant bacteria, as well as the ethical implications of implementing such programmes, are examined. The potential environmental outcomes of antibiotic use and the ethical implications of these impacts are also discussed, as well as the role of the pharmaceutical industry in the development and promotion of these drugs, the potential conflicts of interest that may arise and the ethical dimension of resource transfer from Global North to Global South. This paper emphasises the significance of a holistic strategy to AMR that considers these ethical components, as well as the importance of preserving antibiotic efficacy for future generations.

The Pandemic Treaty, the Pandemic Fund, and the Global Commons: our scepticism.

The call to strengthen global health governance against future outbreaks through a binding treaty on pandemics has attracted global attention and opinion. Yet, few of these perspectives have reflected the voices from early career global health professionals in Africa. We share our perspectives on the Pandemic Treaty, and specifically our scepticism on the limitations of the current top-down approach of the treaty, and the need for the treaty to centre equity, transparency and fairness to ensure equitable and effective cooperation in response to global health emergencies. We also highlight the challenges intergovernmental organisations for health faced in coordinating nation states during the COVID-19 crisis and how a Pandemic Treaty would address these challenges. We argue that lessons from the COVID-19 pandemic provide a critical opportunity to strengthen regional institutions in Africa-particularly in a multipolar world with huge disparities in power and resources. However, addressing these challenges and achieving this transformation may not be easy. Fiscal space in many countries remains constrained now more than ever. New tools such as the Pandemic Fund should be designed in ways that consider the specific needs and capacities of countries. Therefore, strengthening countries' capacities overall requires an increase in domestic investment. This paper calls for wider structural reforms such as debt restructuring among other tools to strengthen countries' capacities.

The COVID-19 pandemic and health workforce brain drain in Nigeria.

Over the years, the Nigerian healthcare workforce, including doctors, nurses, and pharmacists have always been known to emigrate to developed countries to practice. However, the recent dramatic increase in this trend is worrisome. There has been a mass emigration of Nigerian healthcare workers to developed countries during the COVID-19 pandemic. While the push factors have been found to include the inadequate provision of personal protective equipment, low monthly hazard allowance, and inconsistent payment of COVID-19 inducement allowance on top of worsening insecurity, the pull factors are higher salaries as well as a safe and healthy working environment. We also discuss how healthcare workers can be retained in Nigeria through increment in remunerations and prompt payment of allowances, and how the brain drain can be turned into a brain gain via the use of electronic data collection tools for Nigerian health workers abroad, implementation of the Bhagwati's tax system, and establishment of a global skill partnership with developed countries.

Bibliometric analysis of contributions to COVID-19 research in Malaysia.

Introduction: The advent of COVID-19 has led to an exponential rise in related publications to provide a knowledge driven approach to tame the tide of infection and impact in all spheres. This study gives an insight into COVID-19 research publication pattern in Malaysia using bibliometric analysis. Method: COVID-19 publications on Scopus database between January 1, 2020, and August 26, 2022, were extracted using predetermined search strings. Inclusion and exclusion criteria were set, and data was extracted from the database. Descriptive statistics was used to summarize our findings. Results: A total of 3,553 COVID-19 related papers were retrieved out of global count of 392,613 and 16,466 for Southeast Asia (SEA). This implies that 0.9% and 21.6% is contributed globally and SEA respectively. Indonesia, Malaysia and Singapore are the three top countries with highest research outputs in the region. This may be correlated to high GDP per capita, research and development, and research and development expenditure. Most of the publications are article/original research (n = 2832, 67%). Ministry of Higher education is the top funding sponsor and Universiti Malaya is the highest contributor and the most cited (n = 466, 4920 citations). The majority of publications are from physical sciences (30.3%), but medicine subcategory produced the highest number of papers (1,586). The top journal was International Journal of Environmental and Public Health (n = 96 publications). Most active collaborating country was the United Kingdom and most active author was from Monash University. Conclusion: Malaysian institutions have made profound contributions to COVID-19 research globally and in SEA. However, there is a need for continuous efforts to improve research outputs on the topic.

Medical Use of Cannabis in Africa: The Pharmacists' Perspective.

Cannabis is indigenous to many African countries. Despite this, the legalization of cannabis for industrial, medical, and economic purposes is not uniform. However, there is a growing interest in cannabis use for medical purposes in Africa. Pharmacists are best equipped to provide clinical advice and oversight in the safe management, production, and dispensing of medical cannabis on the continent. In this article, we share our perception as pharmacists regarding the medical use of cannabis and the possible roles of pharmacists in maximizing its use in Africa.

Self-medication practices among seafarers: a bibliometric review.

Self-medication could be a public health concern if done inappropriately, and additional research is required to better comprehend the population-wide nature of the problem. Seafarers are more inclined to self-medicate due to the nature of their work. We performed a rapid bibliometric analysis to determine the volume of research on self-medication habits among seafarers. Our analysis revealed a major knowledge gap regarding self-medication practices among seafarers. There is an urgent need to address this paucity of data and formulate appropriate interventions.