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This chapter describes the Mental Health Gap Action Programme (mhGAP) and the mhGAP-Intervention Guide (mhGAP-IG) developed by the World Health Organization (WHO), aimed at scaling up suicide prevention and management services to bridge unmet need.The mhGAP-IG is an evidence-based tool for mental disorders with structured and operationalised guidelines for clinical decision-making targeting non-specialist community and primary care workers in low and middle-income countries (LMICs).
Groundwater iron varies geographically and iron intake through drinking water can minimise iron deficiency (ID). Rice, a major share of daily meals (∼70% of total energy) in Bangladesh, absorbs a substantial amount of water. This study aimed to estimate the contribution of groundwater iron entrapped in cooked rice and its implications on the recommended iron intake. A cross-sectional study was conducted among 25 households, selected by the iron content of their drinking groundwater source in Sirajganj district, Bangladesh. Each household pre-supplied with 600 g of raw rice (300 g for each cooking), was instructed to cook ‘water-draining rice’ (WDR) and ‘water-sitting rice’ (WSR). Using atomic absorption spectrophotometry, iron content in filtered and non-filtered water was measured as 0.4 ± 0.2 mg/L and 6.1 ± 2.0 mg/L, respectively. After adjusting for water filtration, the weighted mean of total iron content in WDR and WSR was 6.18 mg and 5.70 mg, respectively. Assuming the average rice intake, iron content in WDR and WSR fulfilled approximately 98.15% and 90.62% of the average requirement for non-pregnant and non-lactating women (NPNL). The water-entrapped iron in cooked WDR and WSR fulfilled about 23.77% and 20.4% of Recommended Dietary Allowances, and 52.83% and 45.30% of Estimated Average Requirements, respectively in NPNL women, suggesting that groundwater entrapped in cooked rice is an influential dietary iron source. The substantial amount of iron from cooked rice can make an additional layer to the environmental contribution of iron in this setting with the potential to contribute ID prevention.
This article considers the history of Emergency Health Kits established by United Nations agencies and the larger medical non-governmental organizations of the 1980s to analyse the significance of standardized responses in humanitarian emergencies. We argue that, far from being a rigid and immutable response, the kits reflected a (not universally realized) desire to standardize and control both supplies and medical care from international organizations. As such, humanitarian medical practice remained a disputed field in which each object or drug was negotiated at the risk of creating innovation traps. Coming at a time of increasingly global logistics capacities, the Emergency Health Kits became a central feature of a more coordinated global marketplace of humanitarian aid. The kits’ promise to provide rapid transport of emergency supplies to crisis settings across the world was often experienced as a construct, with long delays and logjams in certain regions. Even so, humanitarian organizations were agents of globalization because they imagined a system of centralized production in the Global North and supply to isolated and/or insecure locations across the world.
This chapter traces debates on progress and social justice as of the late 1980s. The critique of a medical marketplace, the perceived need to challenge an autonomy-based notion of progress, and a certain sociopolitical optimism all contributed to reimagining medical progress by placing left-wing sensibilities front and center. The rise of the health model underpinning this view of progress emphasized nonhealth factors – including income, education, and housing – that influence the health of communities. Effectively, the idea of health progress lost its narrower “medical” focus and became associated with ambitious projects for achieving social equality. But here too, a single-minded commitment to the notion of progress as health justice comes replete with trade-offs and unresolved tensions. I end the chapter with a case study of the COVID-19 pandemic, the way in which it furthered a vision of health as occurring in a much larger ecosystem than previously thought, and corresponding ideas of progress as social justice.
This scoping review provides an overview of the impact of fruit and vegetable (FAV) consumption on cognitive function in adolescents and young adults between January 2014 and February 2024. A comprehensive search across six databases, CINAHL, PubMed-MEDLINE, ProQuest, Web of Science, Scopus, and Embase, identified 5,181 articles, of which six met the inclusion criteria after deduplication and screening. This scoping review focused on individuals aged 11–35 years in schools, colleges, universities, and communities. Following a descriptive and narrative synthesis of the data, tables and figures were used to present the findings. Across the six included studies, most consistently demonstrated a positive association between higher fruit and vegetable (FAV) intake and improved cognitive performance among adolescents and young adults. This association was evident in both cross-sectional and longitudinal studies, with stronger effects observed for whole fruits and vegetables high in fibre and polyphenols. Cognitive domains positively impacted included psychomotor speed, memory, attention, and mood. However, findings varied by type of food and cognitive domain; while whole FAVs were generally beneficial, results for fruit juice were mixed—some studies showed acute benefits. Differences in study designs, dietary assessment tools, and cognitive measures contributed to variability. Despite these inconsistencies, the overall trend supports a beneficial role of FAV consumption in promoting cognitive health during adolescence and early adulthood. This review demonstrates that increased fruit and vegetable consumption is consistently linked to improved cognitive function in adolescents and young adults. However, further research is needed to establish its long-term effects on cognitive ageing and disease prevention
The multilevel dimensions of sustainable diets associating food systems, public health, environmental sustainability, and culture are presented in this paper. It begins by defining sustainable diets as those that are healthful, have low environmental impacts, are affordable, and culturally acceptable. The discussion includes the history of research on sustainable diets, from initial studies focused on environmental impacts to more recent, comprehensive frameworks that integrate affordability, cultural relevance, and nutritional adequacy as key dimensions of diet sustainability. In addition, the paper highlights recent innovations, such as the Planetary Health Diet of EAT–Lancet and the SHARP model, and the conflicts and optimum trade-offs between sustainability and nutrition, particularly within low- and middle-income countries. Case descriptions of Mediterranean Diet with a focus on Traditional Lebanese Diet, and African Indigenous Foods demonstrate culturally confined dietary patterns associated with sustainability objectives. These examples show that sustainable diets are not a single set of prescriptions, but a series of multiple pathways that are shaped by local food environments, ecological belts, and sociocultural heritages. The paper also describes major policy and governance activities necessary to promote sustainable diets. Finally, the paper addresses measurement challenges and advocates for better indicator options to measure sustainable food systems in all their facets and for participatory and context-specific approaches. The discussion concludes that fairer and culturally diverse inclusion strategies, system change, and political determination are imperative in achieving sustainable diets. Diets able to sustain are posited as agents capable of driving the 2030 agenda, enhancing planetary health and social integrity.
Sebastián MachadoThe activities of international organizations have been traditionally analysed through categories which rely on classical notions of subjectivity and contractual relativity. International organizations, however, routinely engage the world beyond their own internal structure through a variety of actions. This presents a choice for their theorization, as we can characterize the relationship in ways that go beyond conventional legal types and can include broader themes such as markets, effects or costs and benefits. Within this context, this chapter takes the World Health Organization’s handling of the A1H1 Pandemic as a case-study for a (re)conceptualization that can account for the political economy of international institutional decision-making. While this opens up some research possibilities and brings the cost-and-benefit redistribution to the forefront, the reality is that international organizations have a powerful capacity to affect third parties even through non-conventional and unpredictable ways. The organization’s officials regularly engage in a balancing act where institutional activity must be seen to fit within their mission. Considering the sensibility of the different external and relevant markets, this chapter concludes by suggesting that international organizations and their officials must remain highly aware of their redistributive potential.
In the wake of the COVID-19 pandemic, member states of the World Health Organisation (WHO) agreed to ‘draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response’ (Pandemic Treaty).
Proposals for a Pathogen Access and Benefit-Sharing (PABS) System were included from the earliest drafts of the Pandemic Treaty. Access and Benefit-Sharing (ABS) is a transactional mechanism with its origins in international environmental law, where access to genetic resources for use in research and development is provided in exchange for a share of the benefits associated with their use. The purpose is to generate benefits that can be channelled into environmental conservation and sustainable use activities in countries where the genetic resources originate.
The PABS System could be a mechanism for incorporating One Health considerations into the Pandemic Treaty, but this will depend on its design and implementation. This chapter analyses the proposed PABS System in the Pandemic Treaty negotiating texts to determine whether it constitutes a genuine attempt to apply a One Health approach to pathogen ABS.
Adolescents from low-income households are at increased risk of growth failures due to inadequate food intake. This cross-sectional study assessed dietary practices and nutritional status according to FANTA measurement standards. Among 610 randomly selected adolescents attending public primary schools in rural and semi-urban Kuyu district. Dietary diversity and anthropometric measurements (height, weight, and Body Mass Index) were collected and analysed using SPSS version 26 and WHO Anthro Plus software. The study population included 36% females and 69% semi-urban residents. Dietary analysis revealed that most adolescents consumed two or fewer daily meals, primarily cereals and legumes. Over 90% of the households consumed less than four food groups during the 7-day recall period. The anthropometric assessment showed significant undernutrition: 19% of early adolescent girls and 34% of late adolescent boys were underweight; 27.5% were stunted; 8% and 5.9% had moderate and severe undernutrition, respectively; and 13.8% exhibited thinness, with boys more affected (35%) than girls (10%). Additionally, 7% were overweight, and 64% presented single, double, or triple growth failures. Regression analysis showed that Children in female-headed households had 1.7 times higher odds of stunting, adolescent girls had 1.8 times higher odds of thinness, late adolescents had 70% lower odds of being overweight, and adolescents from households with off-farm activities had 4.5 times higher odds of being overweight. Inadequate meal frequency and limited dietary diversity contribute to the high prevalence of undernutrition among Kuyu district adolescents. A school feeding programme is strongly recommended.
Cross-cutting issues like nutrition have not been adequately addressed for children with severe visual impairment studying in integrated schools of Nepal. To support advocacy, this study aimed to determine the nutritional status of this vulnerable group, using a descriptive cross-sectional design involving 101 students aged 5–19 years from two integrated public schools near Kathmandu Valley and two in western Nepal. The weight-for-age z-score (WAZ), height-for-age z-score (HAZ), and body mass index-for-age z-score (BAZ) were computed and categorised using World Health Organization cut-off values (overnutrition: z-score > +2.0 standard deviations (SD), healthy weight: z-score −2.0SD to +2.0SD, moderate undernutrition: z-score ≥ −3.0SD to <−2.0SD, severe undernutrition: z-score < −3.0 SD) to assess nutritional status. A child was considered to have undernutrition for any z-scores <−2.0SD. Multivariate logistic regression was used to analyse variables linked to undernutrition. The mean age of participants was 11.86 ± 3.66 years, and the male-to-female ratio was nearly 2:1. Among the participants, 71.29% had blindness, and 28.71% had low vision. The mean BAZ and HAZ scores decreased with age. The WAZ, HAZ, and BAZ scores indicated that 6.46% were underweight, 20.79% were stunted, and 5.94% were thin, respectively. Overall, 23.76% of students had undernutrition and 7.92% had overnutrition. More than three in ten students had malnutrition and stunting was found to be prevalent. Older students and females were more likely to have undernutrition. These findings highlight the need for nutrition interventions within inclusive education settings, particularly targeting girls with visual impairments who may face compounded vulnerabilities.
The Nordic Nutrition Recommendations 2023 (NNR2023) serve as the scientific foundation for national dietary guidelines and nutrient recommendations across the Nordic and Baltic countries. We reviewed how NNR2023 was adapted into national food-based dietary guidelines (FBDG) in the Nordic countries and Estonia, focusing specifically on sustainability considerations and policy implications. National FBDG integrated both health and environmental aspects in all countries, except Norway, which addressed environmental aspects only in a separate report. Health impacts served as the primary principle in all countries. Additionally, national policy perspectives, such as domestic food security, were addressed in some countries, while the integration of social and economic sustainability remained very limited. In adopting NNR2023, all countries modelled how implementation would affect nutrient adequacy or health within their food environments, making minor adjustments based on these findings. Guidelines for animal source food groups showed the most variation between countries; Estonia and Denmark established the strictest recommended limits for red meat and total meat, respectively, while Norway was most liberal regarding milk products. Stakeholders participated in the consultation process. The agricultural sector and meat industry primarily maintained pro-meat discourse, which was particularly intense in Norway and Sweden. Transition towards healthy and sustainable diets demands multiple policy instruments – FBDG being just one – alongside a supportive environment and participation from all food system actors.
Infants born at high altitudes, such as in the Puno region, typically exhibit higher birthweights than those born at low altitudes; however, the influence of ethnicity on childhood anthropometric patterns in high-altitude settings remains poorly understood. This study aimed to characterise the nutritional status, body composition and indices, and somatotype of Quechua and Aymara children aged 6–10 years. A cross-sectional, descriptive, and comparative design was employed, with a simple random sampling of children from six provinces representative of the Puno region, including 1,289 children of both sexes. Twenty-nine anthropometric measurements were taken, and fat, muscle, and bone components were assessed using bioelectrical impedance analysis. Standardised equations were applied to determine body indices. Among the findings, most children presented normal nutritional status according to BMI-for-age and height-for-age Z-scores. However, high rates of overweight and obesity were observed in Aymara (39%) and Quechua (28.4%) children, with differences in fat content between ethnic groups at the 5th, 10th, 50th, and 75th percentiles. Both groups were characterised by brachytypy and brachybrachial proportions; Quechua children were mesoskelic and Aymara brachyskelic, with macrocormic proportions, rectangular trunks, and broad backs. The predominant somatotype was mesomorphic, with a stronger endomorphic tendency among Aymara. It is concluded that both groups exhibit normal nutritional status; however, Aymara children show a greater tendency towards fat accumulation and notable morphological differences. Differences were also observed in limb proportions, particularly a relatively shorter lower limb.
Modern conflicts are characterized by wide-spread use of conventional explosive ordnance (EO), improvised explosive devices (IEDs), and other air-launched explosives. In contrast to advances in military medicine and high-income civilian trauma systems since the United States-led wars in Afghanistan and Iraq, the mortality rate among civilian EO casualties has not decreased in decades. Although humanitarian mine action (HMA) stakeholders have extensive presence and medical capabilities in EO-affected settings, coordination between HMA and health actors has not been leveraged systematically.
Methods:
Data from a prior systematic review of emergency care interventions feasible within the context of HMA activities and low-resource health care systems were used to model mortality reduction among EO victims. Interventions were categorized using the World Health Organization (WHO) Emergency Care System Framework sites of “scene,” “transport,” and “facility.” The cumulative impact of the interventions on EO-related mortality was estimated using pooled effect estimates and simulation modeling.
Results:
The meta-analysis included 16 reports from 13 countries, representing 127,505 injured persons. Pooled effect estimates across subcategories of emergency care interventions were 0.42 for layperson transportation (95%CI, 0.24-0.74), 0.79 for prehospital notification systems (95%CI, 0.51-1.19), 0.52 for prehospital trauma care training courses (95%CI, 0.46-0.59), 0.67 for facility-based trauma care training courses (95%CI, 0.48-0.92), and 0.66 for facility-based trauma team organization and activation protocols (95%CI, 0.45-0.97). A 68% reduction in mortality (95%UI, 57%-79%) was observed when implementing the full set of interventions in a region with no prior implemented interventions.
Conclusion:
Enhanced coordination between HMA and health actors to implement a structured set of emergency care interventions holds potential to significantly reduce preventable death among civilian EO casualties.
The adoption of the main text of the Pandemic Agreement at the 2025 World Health Assembly is a milestone in global health law. The adopted text makes several key contributions, but there were several missed opportunities in the negotiating process, and key roadblocks remain for the future of the Pandemic Agreement.
We aimed to compare the mean sodium content of New Zealand (NZ) packaged breads in 2013 and 2023 and assess compliance with the NZ Heart Foundation (HF) and World Health Organization (WHO) sodium reduction benchmarks. Sodium data were obtained from a supermarket food composition database. Mean differences between years were assessed using independent samples t-tests and chi-square tests. There was a significant reduction in the sodium content of all bread from 2013 (n=345) to 2023 (n=309) of 46 mg/100g (p<0.001). In 2013, 20% (n=70/345) of breads met the HF benchmarks, and 10% (33/345) met the WHO benchmarks; corresponding values for 2023 were 45% (n=138/309) and 18% (n=57/309) (p<0.001 for both). If continued, the modest reduction in sodium content and increase in the percentage of NZ breads meeting relevant sodium reduction benchmarks could positively affect public health, particularly if extended across the packaged food supply.
Blast injuries can occur by a multitude of mechanisms, including improvised explosive devices (IEDs), military munitions, and accidental detonation of chemical or petroleum stores. These injuries disproportionately affect people in low- and middle-income countries (LMICs), where there are often fewer resources to manage complex injuries and mass-casualty events.
Study Objective:
The aim of this systematic review is to describe the literature on the acute facility-based management of blast injuries in LMICs to aid hospitals and organizations preparing to respond to conflict- and non-conflict-related blast events.
Methods:
A search of Ovid MEDLINE, Scopus, Global Index Medicus, Web of Science, CINAHL, and Cochrane databases was used to identify relevant citations from January 1998 through July 2024. This systematic review was conducted in adherence with PRISMA guidelines. Data were extracted and analyzed descriptively. A meta-analysis calculated the pooled proportions of mortality, hospital admission, intensive care unit (ICU) admission, intubation and mechanical ventilation, and emergency surgery.
Results:
Reviewers screened 3,731 titles and abstracts and 173 full texts. Seventy-five articles from 22 countries were included for analysis. Only 14.7% of included articles came from low-income countries (LICs). Sixty percent of studies were conducted in tertiary care hospitals. The mean proportion of patients who were admitted was 52.1% (95% CI, 0.376 to 0.664). Among all in-patients, 20.0% (95% CI, 0.124 to 0.288) were admitted to an ICU. Overall, 38.0% (95% CI, 0.256 to 0.513) of in-patients underwent emergency surgery and 13.8% (95% CI, 0.023 to 0.315) were intubated. Pooled in-patient mortality was 9.5% (95% CI, 0.046 to 0.156) and total hospital mortality (including emergency department [ED] mortality) was 7.4% (95% CI, 0.034 to 0.124). There were no significant differences in mortality when stratified by country income level or hospital setting.
Conclusion:
Findings from this systematic review can be used to guide preparedness and resource allocation for acute care facilities. Pooled proportions for mortality and other outcomes described in the meta-analysis offer a metric by which future researchers can assess the impact of blast events. Under-representation of LICs and non-tertiary care medical facilities and significant heterogeneity in data reporting among published studies limited the analysis.
Women and children are priority populations in Cambodia, however no dietary intake information exists on breastfeeding women for informing nutritional intervention. The aim was to assess nutritional adequacy of dietary intakes of Cambodian women, by breastfeeding status and locality. A cross-sectional assessment of dietary intake was conducted with non-pregnant women ≥18 years of age with at least one child under 5 years in rural, semi-rural and urban locations in Siem Reap province, Cambodia. Women used a bespoke smartphone application to capture three-day image-voice records on two occasions. Data were analysed using a semi-automated web platform incorporating a tailored Cambodian food composition database. Estimated Average Requirements were used to assess adequacy of nutrient intakes. Of 119 women included in the analysis, 58% were breastfeeding, and 63% were rural or semi-rural. Protein, carbohydrate, vitamin B12, iron, and sodium were adequate for over 65% of women. Less than 10% of women had adequate vitamin A, vitamin C, thiamine, calcium, and zinc intakes, in contrast to low deficiency rates reported for Cambodian women. Despite breastfeeding women recording higher dietary intakes, adequate intakes of protein, carbohydrate, vitamin A, thiamine, and zinc were lower than non-breastfeeding women due to higher requirements. Rural women generally had higher nutrient intakes, and urban women had inadequate folate intake. This study indicates dietary intakes of Cambodian women in Siem Reap province, particularly breastfeeding women, are not nutritionally adequate. Data collected using image-voice dietary assessment could inform nutrition interventions and policies in Cambodia to improve dietary intakes and nutrition-related health outcomes.
Social medicine, as it was conceived of by left-wing medical doctors in Scandinavia from the 1930s became influential in the creation of a new role for medicine in the making of “the good society” and the political radicalism of social medicine was assimilated into the dominant, social democratic ideology. Several of the pioneers of the left-wing social medicine that had previously aimed for a disruption of the power balances in society, acquired hegemonic positions within the state medical bureaucracy. They constituted an expertise that, by and large, was responsible for the shaping of the national health policies in the “golden age” of the Scandinavian social democratic welfare states (1940s–70s). In this chapter, we discuss the coming into being and passing away of social medicine in the Scandinavian welfare states, exploring how it unfolded in the late twentieth century, in the clinic, in academia, and in health policy. We argue that in spite of its dominance within the central health bureaucracy, social medicine never managed to penetrate mainstream medicine and it left perhaps its strongest footprint abroad, in the field of international health.
This cross-sectional study aimed to investigate the correlation between magnesium consumption and periodontitis in different body mass index (BMI) and waist circumference (WC) groups. 8385 adults who participated in the National Health and Nutrition Examination Survey during 2009–2014 were included. The correlation between dietary magnesium intake and periodontitis was first tested for statistical significance by descriptive statistics and weighted binary logistic regression. Subgroup analysis and interaction tests were performed to investigate whether the association was stable in different BMI and WC groups. There was a statistical difference in magnesium intake between periodontitis and non-periodontitis populations. In model 3, participants with the highest magnesium consumption had an odds ratio of 0.72 (0.57-0.92) for periodontitis compared to those with the lowest magnesium consumption. However, in subgroup analysis, the relationship between magnesium intake and periodontitis remained significant only in the non-general obese (BMI ≤ 30 kg/m2) and non-abdominal obese populations (WC ≤ 102 cm in men and ≤ 88 cm in women). Dietary magnesium intake might decrease the periodontitis prevalence in the American population, and this beneficial periodontal health role of magnesium consumption might only be evident in non-general obese and non-abdominal obese populations.
Attacks on health care – which are potential war crimes – are increasingly observed in contemporary armed conflicts. The full-scale Russian invasion of Ukraine is no exception to this worrisome trend. War crime prosecutions of suspected deliberate attacks on health care facilities require proof that they were the intended target, which is extremely challenging. If health care facilities are attacked more than once, this may increase the likelihood of intent. The Ukrainian Healthcare Center (UHC) began documenting attacks on health infrastructure since the start of the full-scale Russian invasion of Ukraine. In this study, the aim was to assess repetitive attacks on Ukrainian health care facilities from February 24, 2022 through October 24, 2023.
Methods:
The Berkeley Protocol on Digital Open Source Investigations was used to identify and document health care attacks. Data collection for this study included temporal factors, location and type of facility, attack and weapon type, the number of health care personnel and civilians killed and injured, and whether the afflicted facilities were damaged, destroyed, and/or repeatedly attacked.
Results:
During the study period, there were 397 attacks on 281 Ukrainian health care facilities, damaging 237 facilities and destroying another 44. Fifty-three facilities (18.9%) were attacked more than once (total: 163 attacks; mean 3.1; median 2; range 2-10 attacks), and 27.7% of all health care attacks (110/397) concerned repeat attacks. The median time between attacks was 18 days (range: 0-289 days).
Conclusions:
From February 24, 2022 through October 24, 2023, one-in-five targeted health care facilities in Ukraine experienced repetitive attacks. Furthermore, one-in-four attacks on health care involved recurrent attacks. This observed pattern raises the possibility that health care facilities in Ukraine are being intentionally targeted.