Alinane Linda Nyondo-Mipando

Background: Non-communicable diseases (NCDs) such as diabetes, hypertension, and obesity are increasingly recognised important causes of adverse pregnancy outcomes in low- and middle-income countries (LMICs). Despite this growing burden, few large-scale programmes exist to tackle NCDs in pregnancy in these settings. Identification of complex interventions that may be transferable to similar contexts is an important component of future intervention development. Methods: We conducted a systematic review to characterise interventions addressing NCDs in pregnancy across LMICs. We included experimental, quasi-experimental, and pre-experimental studies targeting diabetes, hypertension, obesity and chronic kidney disease, or related gestational syndromes among pregnant women or those in the pre-conception or postpartum periods. Searches were conducted in Scopus, MEDLINE, CINAHL, PubMed and Cochrane CENTRAL from 1 January 1990 to 14 June 2024. Two reviewers independently screened studies and extracted using COVIDENCE software. Intervention complexity was assessed using the Cochrane iCAT_SR tool. Complex interventions underwent risk of bias assessment, and all studies underwent credibility checks using open-source databases. Review conducted in accordance with PRISMA guidelines. Results: Of 3,477 records screened, 135 studies were included. Most were small, single site trials conducted in tertiary care facilities. Leading contributors were Iran (27%), China (16%) and India (13%), whilst only ten studies (7%) originated from sub-Saharan Africa. Less than one quarter (31/135, 23%) targeted women with underlying NCDs; most focussed on gestational syndromes such as gestational diabetes or pre-eclampsia. Interventions primarily targeted individual participants rather than wider health systems, commonly using educational or pharmacological approaches. Approximately one quarter (37/135, 27%) of studies reported formal intervention design processes or stakeholder involvement. Seventeen studies were classified as complex interventions (iCAT_SR ≥ 12/18), of which 59% (10/17) were judged at high risk of bias. Compared with simple interventions, complex interventions more frequently reported implementation outcomes (41% vs 8%), stakeholder involvement (65% vs 14%), and intervention design processes (82% vs 19%). Conclusions: We demonstrate a marked shortage of complex, system-level interventions addressing NCDs in pregnancy across LMICs. Future intervention design should prioritise co-designed, multi-level interventions with embedded implementation outcomes, particularly in under-represented regions such as sub-Saharan Africa. This review provides a practical resource for researchers and policy makers seeking adaptable and scalable interventions for use in comparable settings. Trial registration: PROSPERO CRD42025643691

A high-quality health system is a core component for achieving universal health coverage [1]. It is estimated that poor quality of care accounts for 5.7–8.4 million deaths each year in low- and middle-income countries (LMICs) [2]. Newborns represent some of the most vulnerable users of the health system, with an estimated 2.3 million neonatal […]

Background: The Early Infant Diagnosis (EID) Program exists to improve the identification of HIV-exposed infants(HEIs) to accelerate linkage to care. The trends of retention in EID have been 88%, 91% and 93% retention at 24 ^th month age cohort in the last quarter of 2022, 2023 and 2024 respectively. However, these rates varied across health facilities, with some reporting much lower retention. This study explored factors influencing the retention of HEIs within the program. Methods: We conducted a barrier analysis study at four facilities. We recruited 90 HIV-exposed infants 0-24 months of age purposively: 45 doers (retained in care) and 45non-doers (not retained in care). The independent variables were self-efficacy, social norms, access, culture, and religion. The dependent variable was retention. Results: Distance to the health facility ( p = 0.001), mothers'/caregivers’ willingness to seek services ( p = 0.006), absence of a life partner ( p = 0.004), and approval and support from partners, family members, and the community ( p = 0.049) were significant determinants of clients’ utilization of early infant diagnosis (EID) program services. These findings suggest that both structural factors (e.g., distance to health facilities) and social factors (e.g., life partner, family and community support) play important roles in influencing the uptake of EID services. Conclusion: These findings highlight the need for multifaceted interventions that address health system, behavioral, and social determinants simultaneously to improve retention in EID services.

Background: Malawi has one of the highest incidences and mortality due to cervical cancer, which is caused by the human papillomavirus (HPV). Achieving high HPV vaccination coverage is critical for advancing the World Health Organization (WHO) cervical cancer elimination strategy. This study aims to describe the spatio-temporal uptake of the first and second doses of the HPV vaccine in Malawi and to investigate the covariates associated with the uptake. Methods: We analysed HPV vaccination coverage data from routinely collected administrative data across 28 districts in Malawi from 2019 to 2024. We used spatio-temporal Bayesian models in R-INLA to investigate the association between environmental factors, such as urbanization and climatic conditions, and vaccination uptake. Results: HPV vaccine uptake was 46.83% (95% Credible interval, CrI: 46.52%, 47.21%) for the first dose, and 32.44% (95% CrI: 32.09%, 32.96%) for the second dose, across the study period, with distinctive subnational heterogeneity. A negative relationship was observed between nighttime light intensity and vaccination coverage (first dose: posterior mean: -0.599, (95% CrI: -1.160, -0.040); second dose: posterior mean: -2.164, (95% CrI: -3.415, -0.967)). Conclusions: HPV vaccination uptake in Malawian districts remains below the WHO 90% vaccination target. These findings emphasise the need for decentralised planning to improve coverage. Targeted interventions, mobile outreach programmes, and strengthened community engagement, particularly in urban settings, may help close coverage gaps and accelerate progress toward cervical cancer elimination in Malawi.

The 2013 World Health Organization (WHO) guidelines for cervical pre-cancer screening recommended screening women aged 30–49 and women living with HI

Repeat HIV testing during pregnancy is significant to detect new maternal HIV infections and mitigate the risk of mother-to-child HIV transmission. Despite

Among the estimated 12,500 new HIV infections in Malawi among people aged 15-24 each year, 70 percent occur in Adolescent Girls and Young Women (AGYW). The Ministry of Health (MoH) in Malawi rolled out an oral Pre-Exposure Prophylaxis (PrEP) prevention program targeting populations at elevated risk of HIV acquisition, including AGYW, in 2021. Since PrEP roll-out, there has been limited research exploring the factors that influence uptake of PrEP among AGYW. This study explored the barriers and facilitators to the uptake of PrEP among AGYW at elevated risk of HIV acquisition. it was an exploratory qualitative study conducted at Kawale Health Center in Lilongwe, Malawi, in February 2023, which employed a phenomenological design. Data were collected using semi-structured in-depth interviews and vignettes from purposively sampled 20 AGYW and 10 health care workers (HCWs) based on their PrEP status (on PrEP versus not on PrEP) and involvement in PrEP provision, respectively. The data were digitally recorded, managed using NVivo software and analysed using a thematic approach guided by the Consolidated Framework for Implementation Research (CFIR). AGYW identified perceived HIV risk and vulnerability and PrEP knowledge as facilitators. HCWs identified AGYW perceived HIV risk, HCW altitudes, and availability of youth friendly service center and resources as facilitators to PrEP uptake. Barriers identified by AGYW included PrEP side effects, limited PrEP information, lack of privacy, stigma, and lack of transportation. HCWs identified limited resources and burden of work as barriers. In conclusion, PrEP’s full potential as an HIV prevention tool for AGYW requires a holistic approach that considers their particular requirements, removes systemic hurdles, and guarantees access to high-quality services. In addition, there is a need to create demand to increase the uptake of PrEP.

Many studies in infectious diseases struggle to recruit participants. The SARS-CoV-2 infection, transmission dynamics, and household impact in Malawi (SCATHIM) study reported a refusal rate of 57.2%. Adequate publicity can lead to more people participating in studies. This study explored the reasons for participating in the SCATHIM study. A descriptive qualitative study informed by the theory of reasoned action was conducted in Blantyre between January 2022 and March 2022 to assess factors that influence participation in a COVID-19 study among 10 index cases, 10 caregivers, 10 study decliners, and 5 research staff. The data were collected via in-depth interview guides, audio recorded, transcribed, managed via NVIVO and analysed via a thematic approach. The factors that motivated participation in the study included one’s knowledge of COVID-19; potential access to medical services, including free COVID-19 tests for members of the household; financial reimbursements; and the ability to contribute scientific knowledge. The barriers to participation included minimal publicity of the study amidst a novel condition, perceived stigma and discrimination, perceived invasion of privacy, discomfort with the testing procedures, and suboptimal financial reimbursements. Effective publicity and outreach strategies have the potential to decrease refusal rates in study participation, especially if a condition is novel. Studies on infectious diseases should address stigma and discrimination to promote participation and ensure participant safety.