Background: Cervical cancer (CC) remains a significant global public health issue, with over 90% of related deaths occurring in low- and middle-income countries (LMICs). Women living with HIV (WLHIV) face a sixfold increased risk of developing CC due to immunosuppression. Despite the World Health Organization’s recommendations for regular cervical screening, adherence to these guidelines remains low in LMICs including Ghana. Human papillomavirus (HPV) Self-sampling (HPVSS) has the potential to enhance screening uptake. However, its acceptability among key stakeholders, including WLHIV, healthcare workers (HCWs), and community members (CMs) in Ghana remains underexplored. We examined these stakeholders’ perceptions of HPVSS to better understand the barriers and facilitators regarding the implementation of HPVSS in Ghana.

Methods: We conducted three focus group discussions (FGDs) with a purposive sample of 36 stakeholders; WLHIV (n=14) and HCWs (n=11) from the Cape Coast Teaching Hospital, and CMs (n=11) from the Cape Coast Metropolis. WLHIV were identified through patient electronic records and face-to-face verbal invitation, and snowball methods were used to recruit participants. A semi-structured questionnaire, informed by the PRECEDE-PROCEED model, guided 90-minute discussions. Discussions were recorded, transcribed, and analyzed using a deductive-inductive approach with NVivo software.

Results: Social assessment themes derived from the FGDs highlighted stigma associated with HIV and CC, fear of discrimination, and limited spousal and community support as barriers, while community-based education and advocacy were identified as facilitators of screening uptake. Epidemiological assessment themes revealed limited knowledge of CC risk factors, screening misconceptions, and unawareness of the etiology and prevalence of CC in Ghana. Participants expressed willingness to screen with education and access and availability of screening materials. Ecological assessment themes identified misinformation, fear, and cultural beliefs as barriers, while peer support and incentives were potential motivators. Administrative assessment themes pointed to systemic challenges like inadequate policies, infrastructure gaps, and resource limitations. Participants emphasized the need for structured screening programs, streamlined protocols, and HCW training to enhance screening uptake.

Conclusion: HPVSS offers a promising solution for improving CC screening among WLHIV in Ghana. Addressing barriers through policy, education, and HCW training, alongside community-driven solutions, can enhance WLHIV’s acceptance and utilization of HPVSS in Ghana

Context: Tobacco use is associated with various health risks. Extant literature explored contemporaneous association between tobacco consumption and various sociodemographic factors. Investigation of tobacco-use initiation, i.e., the age when tobacco-use was initiated, has been limited in the developing country context. This study aims to assess the demographic, socioeconomic and life-course determinants of the age at regular tobacco-use among Indian women using a time-to-event analysis.

Methods: Our sample comprised of 600,436 women aged 20-49 years from the 5th wave (2019-2021) of National Family Health Survey of India. Respondents were asked for how long they have been regularly using tobacco (smokeless and/or smoking) products. Incorporating this information with respondents’ age at the time of the survey, we obtained the age (in years) when regular tobacco-use was initiated. We estimated non-parametric Kaplan-Meyer survivor functions and parametric stratified Cox proportional hazard models for the event of regular tobacco-use initiation. We assessed two life-course events – child marriage and adolescent childbearing; three demographic factors – birth cohort, religion, and caste; and three socioeconomic factors – education, household wealth, and urban/rural residence. Proportional hazard assumption for respective factors was checked by examining the log-log plots.

Results: Around 6.5% women reported regular tobacco-use and median age of regular tobacco-use initiation was 25 years. The Kaplan-Meyer analysis suggested that getting married as children, giving birth during adolescent age, living in rural areas, and lower household wealth were associated with lower survival rates of regular tobacco-use initiation. Proportional hazard assumption was not met for education, religion, caste, and birth cohort. These factors, along with state of residence were adjusted in the Cox model though stratification. The Adjusted odds ratios (AORs) of regular tobacco-use for child marriage and adolescent childbearing were 1.15 (95% CI: 1.12–1.19) and 1.13 (95% CI: 1.10–1.16), respectively. The AOR was 3.16 and 2.40 for the women in the poorest and poorer households, respectively. The AOR for rural residence, however, 0.89, a deviation of the Kaplan-Meyer estimates.

Conclusion and discussion: Life-course events and household wealth emerged as critical factors of regular tobacco-use initiation among Indian women. This knowledge may be utilized for targeted campaigns against tobacco-use.

Context:
Presently, Chronic Kidney Disease (CKD) affects over 20 million Nigerians, with prevalence estimates ranging from 7.6 to 27%, driven by hypertension, diabetes, and nephrotoxic exposures. As Nigeria faces a rapidly rising CKD burden, systemic gaps in screening, diagnosis, and treatment continue to jeopardize efforts aimed at managing the disease, thus exacerbating morbidity and mortality. This review explores the spectrum of CKD management in Nigeria, highlighting challenges and opportunities within its healthcare system that can help improve health outcomes and the overall management of NCDs in Nigeria and similar contexts.

Methods:
A comprehensive narrative literature review was conducted, synthesizing peer-reviewed studies, reports, and grey literature from 2003–2024. Sources were identified via PubMed, Google Scholar, and Nigerian health databases, focusing on CKD epidemiology, prevention, screening, diagnosis, treatment, and health system interactions. Key insights were extracted on CKD prevalence, risk factors, management practices, and barriers/opportunities, as well as on the role of primary care and the socioeconomic impact of the disease in Nigeria.

Results:
CKD prevalence varies widely, from 7.6–24.3% regionally. While there are approximately 20,000 new end-stage cases yearly, only 3,000 received hemodialysis in 2018. Screening targets high-risk groups (e.g., hypertensive patients), but low awareness and poor healthcare access limit early detection. Presently, CKD diagnosis relies on clinical evaluations of eGFR and proteinuria, and advanced tools like renal biopsies are scarce. Treatment with antihypertensives and dialysis is inconsistent and problematic due to costs (e.g., $150 per dialysis session vs. $41 monthly wage) and disparities in access to renal care facilities due to the concentration of clinics in urban centers. Opportunities for addressing the disease burden include community education, affordable alternative options for renal replacement therapy, digital health innovations, and the establishment of a national CKD registry.

Conclusion and Discussion:
Nigeria’s CKD crisis is fueled by inadequate infrastructure, workforce shortages, and financial barriers to care. Unfortunately, rural and poor patients fare the worst. Strengthening primary care for screening and education, scaling cost-effective models like opt-out peritoneal dialysis, and leveraging technology could curb progression. Policymakers must prioritize making improvements in renal care access, insurance coverage, and awareness to align with global NCD goals.

Introduction

Childhood zinc supplementation offers substantial benefits on reducing stunting, diarrhea, and infections. However, its potential to reduce long-term non-communicable disease (NCD) risks through improved linear growth remains underexplored. We estimated the population-level impact of scaling up childhood zinc supplementation on delaying cause-specific NCD mortality in 132 LMICs, through its effect on childhood and adult height.

Methods

We developed a population-based simulation model using the generalized population impact fraction estimator. We first estimated childhood height gains from zinc supplementation (10 mg/day for 24 weeks), followed by corresponding changes in attained adult height, and subsequently, its impact on NCD outcomes. We obtained effect sizes by conducting scoping reviews of high-quality meta-analyses of randomized trials, birth cohorts and prospective studies. We used the latest demographic and cause-specific disease data (by age, sex, and country) from the UN population division and the Global Burden of Disease study. Key outcomes were delayed cause-specific NCD deaths, attributable proportion of NCD deaths, and years of life gained (YLG). Future benefits were discounted at 3% annually. Four scaling-up scenarios were analyzed: 90, 75, 50 and 25% coverage.

Results

Scaling up childhood zinc supplementation coverage to 90% in 132 LMICs could delay 0.024% of annual NCD deaths (4,950 deaths annually) and yield 51,340 years of life gained. This includes 6,385 delayed cardiovascular deaths — 3,665 from IHD and 2,720 from stroke. However, these gains were partially offset by increased risk of cancer which would translate to 1,432 additional cancer deaths, mainly from lung (400), breast (362), and colon (352) cancers. Notable variations were observed across regions: Southeast Asia had the largest reduction in NCD deaths (1,910) and YLG (17,800), and Latin America had the lowest benefits. Benefits were slightly higher among males due to higher NCD death rates.

Discussion

Scaling up zinc supplementation could modestly reduce later-life NCD mortality, primarily by delaying cardiovascular deaths. Addressing early-life zinc deficiency through scaling up supplementation could disrupt the pathway from growth deficits to increased adult NCD risk, offering promising strategy to reduce the dual burden of malnutrition and NCDs prevailing in LMICs.

Cervical cancer is the second leading cause of cancer-related deaths among reproductive-age women in Guatemala. Despite being preventable and treatable when detected early, Pap tests remain inaccessible or unacceptable for many, which may explain a higher cervical cancer burden among rural and indigenous women. The recent innovation of HPV self-testing offers a more effective and acceptable alternative for early detection and early pilot programs suggest broad acceptability of self-testing either in a clinic or at home with a community health worker. We assessed barriers and facilitators to the integration of HPV self-testing into Guatemala’s health system and developed and pilot tested a health education intervention for women at risk and their healthcare providers using community-engaged mixed methods. We used the RE-AIM framework, Diffusion of Innovation Theory, and Guatemala’s National Strategic Plan to Reduce Cervical Cancer to frame the study and the design of qualitative topic guides and provider and community questionnaire. A purposive sample of national and local healthcare and public health experts, healthcare providers, laboratory scientists, and community health workers were recruited for in-depth interviews. Online surveys were conducted with providers and women at risk were recruited for focus group discussions and the survey. Findings highlighted implementation challenges, including fear, stigma, health literacy and needing partner permission among women at risk. Challenges from the macro and systems levels included lack of funding, inequitable access, challenges with scaling up prevention and referral efforts, and workforce training gaps. Opportunities included leveraging CHWs for home visits, health education through social media, and policy changes that may accelerate adoption of HPV self-testing. Our community-engaged approach resulted in the establishment of a professionally, geographically, and culturally diverse community advisory board and local participation and pilot testing of information, education, and communication materials and interventions for women and health providers.

Cardiovascular disease is responsible for 10% of all deaths in Uganda, making it the leading cause of death among non-communicable diseases (NCD) in the country. Uganda is among the world's most rapidly growing and urbanizing countries, with a hypertension prevalence that exceeds 25%. Across sub-Saharan Africa, urban market vendors serve as key participants in the informal workforce and represent a vulnerable population at high risk for cardiovascular diseases. In Uganda, 65% of market vendors are women, many of whom face high poverty rates, have low education levels, and work long, sedentary hours. These conditions, along with limited healthcare access and unhealthy eating habits, contribute to a high prevalence of obesity and hypertension, making market vendors a high-risk population for cardiovascular diseases (CVD).

Despite limited literature on this high-risk population and many evidence-based interventions known to reduce CVD risk, no targeted implementation strategies have been developed to date. We are conducting a cross-sectional quantitative study that surveys market vendors in two large urban markets in Kampala and Mbarara through a stratified random sampling approach using a comprehensive questionnaire adapted from the World Health Organization (WHO) STEPwise approach to NCD risk factor surveillance (STEPS). Our analysis focuses on identifying CVD risk factors, such as hypertension, physical inactivity, unhealthy diet, and poor sleep, and explores the barriers to healthcare access that may hinder vendors' ability to mitigate these risks. Multivariate logistic regression will be used to identify factors that are significantly associated with poor health outcomes and barriers to healthcare access. In addition to blood pressure readings and basic anthropometric measurements, data is collected to estimate 10-year CVD risk using a non-laboratory-based CVD risk estimate instrument. This study provides novel formative quantitative research data about a vulnerable population at high risk for CVD to identify opportunities to co-create implementation strategies along with vendors and other stakeholders in order to mitigate this risk.

Background: Health behaviors significantly influence the risk of cardiovascular diseases (CVDs), particularly inadequate diet, physical inactivity, tobacco use, and alcohol consumption. CVDs are the leading cause of death worldwide, accounting for 17.9 million deaths annually. In the Dominican Republic, 72.3% of deaths are due to noncommunicable diseases, with cardiovascular diseases being the most prevalent (34.9%). Adopting healthier behaviors could prevent millions of deaths each year.

Methods: We conducted a secondary analysis of data from the Second National Initiative on Arterial Hypertension: Prevention of Overweight, Obesity, Diabetes, and Hypertension (SODHIP) in the Dominican Republic (May–July 2022). The study assessed variables including sex, age, alcohol consumption, tobacco use, fruit and vegetable intake, and physical activity. Descriptive and inferential statistical analyses were performed using SPSS v19.

Results: We analyzed data from 20,074 adults; 58.2% were women, and 44.2% were aged 25–44 years. Only 9.3% consumed fruits and 11% vegetables daily. Physical activity (≥3 times per week) was reported by 32.1%, while 42.1% consumed alcohol and 9.2% used tobacco at least once a week. Alcohol and tobacco use were more prevalent in men and young adults aged 18–24 years (p<0.001). Physical activity was more frequent in men and individuals aged 45–64 years (p<0.001). Adults aged 45–64 and women had higher fruit and vegetable consumption (p<0.05).

Conclusions: The adoption of healthy behaviors among Dominican adults remains low, particularly regarding fruit and vegetable intake and regular physical activity. Public policies should be implemented to promote healthy lifestyles, strengthen targeted educational campaigns, create healthier food environments, and further investigate the barriers to adopting healthier behaviors.

Background: Gut microbiota diversity and richness have been linked to metabolic and mental health. Recently, several groups have shown that microbiota divergence is positively linked to healthier aging. Therefore, in this study, we will review the role and mechanisms of gut microbiota in promoting healthy aging and longevity. Additionally, we will provide recommendations to preserve the gut microbiota and protect against geriatric diseases.

Methods: Using PubMed, we conducted a literature search with the terms “Gut microbiota and aging”, “Gut microbiota and healthy aging”, and “Gut microbiota and longevity”. Our search yielded 660 publications; however, we reviewed and assessed 20 articles, relevant to our objective, to support our abstract.

Results: Divergence and richness of gut microbiota are proven to be essential for the individual’s well-being and protection from metabolic diseases such as obesity, diabetes mellitus, and atherosclerosis. It has been shown that older adults who have diverse gut microbiota tend to be healthier and live longer than older adults who have less divergence in gut microbiota. Lower blood levels of LDL, higher Vitamin D levels and indole (an anti-inflammatory metabolites) were further reported in healthy older adults. Several mechanisms explain the role of gut microbiota in healthy aging and longevity. Healthy long-lived adults showed high levels of anti-inflammatory metabolites of gut microbiota such as short-chain fatty acids (SCFAs), and lower levels of pro-inflammatory metabolites such as trimethylamine-N-oxide (TMAO). A study has shown that Chinese long-lived individuals have high serum levels of an anti-inflammatory analogue of thromboxane A2. The divergence of gut microbiota protects older adults from neuropsychiatric and neurodegenerative disorders through the regulation of neuro-immune signaling, control of neuroendocrine function, and production of neuroactive compounds, and SCFAs. Finally, probiotics (healthy gut microbiota), prebiotics (dietary fibers), synbiotics (pre-and probiotics) showed positive health effects in older adults. Thus, gut microbiota represents a promising target to promote healthy aging and longevity.

Conclusion: Our findings suggest that the composition of gut microbiota has a major impact on the health of humans as they age. Strategies aiming at preserving the diversity and health of gut microbiota would be beneficial in ensuring healthy aging and longevity.

Introduction: Non-communicable diseases such as hypertension (HBP) continue to be a public health burden globally; however, morbidity, disability and mortality indicators due to these conditions are higher in developing countries. There is interesting evidence about the relevance of the ecosocial model to explain the complexity of diabetes and hypertension. We aim to explore whether biological, behavioral, socioeconomic, and environmental factors may explain the presence of hypertension among Dominican adults.

Methods: We conducted data-based research from a cross-sectional, two-stage clustered-sampled survey that included adults (18 years and older) from two of the main provinces in the Dominican Republic. An inform consent was signed for all participants (n=651). Measurements included biological (sex and age), behavioral (food security and physical activity), socioeconomic (literacy), and environmental (geographical location) factors. Descriptive and inferential statistics were calculated. Chi-square and T-test were calculated to estimate bivariate analysis. Logistic regression was used to model the presence of hypertension according to the variables chosen as proxies for ecosocial levels. Odd ratios and 95%CI were reported.

Results: HBP was reported in the 39.5% of the participants; mainly among women (28.3%). The mean age for those with HBP was significantly higher (63.0 vs. 48.4; p<0,05). In comparison to women, men were 2.27 more likely to have HBP, holding age constant (95%CI=1.69-3.04; p<0.01 For those who reported doing sports or exercise in the last week, the likelihood of HBP decreased by 52% (OR=.48; 95%CI=.32 - .71; p<0.01); however, food security preoccupation was significantly associated. Having access to health care significantly increases the likelihood of having HBP in comparison with those with no insurance (OR=2.22, 95%CI=1.31-3.78; p=0.03). Literacy (know how to read) reduced the likelihood of HBP (p<0.002), but geographical location (Santiago vs. Distrito Nacional) was not found to have a significant impact.

Conclusions: The ecosocial model offers a suitable framework to understand the complexity of hypertension among adults. However, a deeper approach is needed to redefine adequate proxies to measure each level from a more holistic perspective. These findings support comprehensive, theory grounded statistical modeling to provide evidence for multilevel interventions to prevent and control non-transmissible diseases in the Dominican Republic.