Isotta Triulzi

The use of traditional medicinal plants in therapeutic settings has gained increasing attention for their potential in mental health and addiction treatment. This study explores the ethnomedical use of Brunfelsia grandiflora (chiric sanango) within the therapeutic framework of the Takiwasi Center in the Peruvian Amazon, where it is integrated into strict plant-based dietary regimens ("dietas") to support addiction recovery and psychological well-being. The research combines data from semi-structured interviews with therapists, traditional healers, and other staff members, along with patient-reported experience data from the institution's database. A total of 74 case reports were analyzed to assess both the physiological and psychological effects of chiric. Findings indicate that the plant induces notable physical effects, including numbness, tingling, dizziness, and cold sensations, while also facilitating deep psychological introspection, emotional processing, and enhanced social engagement. Participants frequently reported shifts from distressing emotions to states of clarity, acceptance, and resilience. These effects suggest that chiric sanango may serve as an important adjunct in psychotherapy and addiction treatment. This study highlights the intersection of Amazonian ethnomedicine and modern therapeutic practices, emphasizing the need for further pharmacological and clinical investigations into the psychoactive properties of B. grandiflora and its potential role in mental health interventions.

Malawi ranks 142 out of 170 countries on the UN’s Gender Inequality Index (GII). Women and men in Malawi have unequal access to and control over resources. Previous research has primarily examined gender roles and norms from a women’s perspective, but few studies have investigated men’s attitudes and behaviors regarding gender equality. This study fills this gap by investigating the social factors that influence attitudes towards gender-equality and exploring the association between behaviors and attitudes in south-eastern Malawi. A cross-sectional survey was administered to adult males during a health education program (male-friendly clinics) in four healthcare facilities from August 2022 to November 2022. The validated Gender-Equitable Men (GEM) scale, was employed to quantify men’s attitudes towards gender norms. Univariate and multivariable analyses were used to identify the social determinants of and the behaviors associated with gender-equitable attitudes. A total of 422 men, with a median age of 46 years (IQR = 34, 55), were included in this study. The participants reported a median score of 0.53 for gender attitudes, where 0 represents the minimum score and 1 the maximum. A higher GEM score was associated with a higher educational grade and living in an urban area. In terms of decision-making, 64% and 56% of men reported that they had the final say in matters concerning women’s and children’s health, respectively. Higher GEM scores were associated with joint decision-making in relation to women’s (0.55 vs. 0.49; p = 0.008) and children’s health (0.54 vs. 0.48; p = 0.012), and spending on food and clothing (0.56 vs. 0.49; p < 0.001). On the other hand, certain activities, such as cleaning the house (64% of men reported unequal participation), and cooking (70%) were not shared among partners. An equal or greater participation from men (70%) compared to women was reported for activities related to childcare. Men who participated in the previously mentioned tasks had higher GEM scores than those who did not. The findings of this study shed light on the significant role of educational grade and living in an urban area as determinants of gender-equitable attitudes among men in south-eastern Malawi. More equitable perspectives towards gender norms were associated with being more involved in tasks typically assigned to women and in joint decision-making. Incorporating gender in research can contribute to the advancement of a more inclusive healthcare system.

Background South-South learning exchange (SSLE) refers to an interactive learning process where peers exchange knowledge and experience to work towards a beneficial change. Despite organizations having recently increased the opportunity to run SSLEs, the SSLE support mechanisms and processes are not well documented in the scientific literature. This study explored experts’ perspectives on SSLEs, strengths, weaknesses and mechanisms leading to sustainable outcomes. Methods We conducted a qualitative study using semi-structured interviews on experiences of participants and organizers of SSLEs. Data were collected between 1st September 2021 to 26th November 2021. All data were digitally recorded, transcribed verbatim, and analysed. In the analysis, we adopted an inductive approach derived from thematic analysis. Results Sixteen experts, who have participated in or facilitated one or more SSLE, were interviewed. The experts’ accounts demonstrated an appreciation of participants’ empowerment, positive peer-to-peer “mind change” and convincing and powerful hands-on learning of this approach as strengths in the implementation of the SSLE. Being resource heavy, participant and donor reluctance and absence of a validated methodology emerged as main weaknesses of the South-South learning approach, which could impair the effectiveness of this scheme. Conclusions The strengths of SSLEs are anchored in the theories of experiential and social learning, highlighting SSLE's potential to create an environment that enhances knowledge exchange. the study highlights the challenges SSLE initiatives face. In particular, these include limited commitment and funds, limited evidence of impact, disparate approaches, and the absence of standardized guidelines and evaluation practices.

This study investigated the health economic evaluations of predictive biomarker testing in solid tumours treated with immune checkpoint inhibitors (ICIs). Searching PubMed, EMBASE, and Web of Science from June 2010 to February 2022, 58 relevant articles were reviewed out of the 730 screened. The focus was predominantly on non-small cell lung cancer (NSCLC) (65%) and other solid tumours (40%). Among the NSCLC studies, 21 out of 35 demonstrated cost-effectiveness, notably for pembrolizumab as first-line treatment when preceded by PD-L1 assessment, cost-effective at a threshold of $100,000/QALY compared to the standard of care. However, for bladder, cervical, and triple-negative breast cancers (TNBCs), no economic evaluations met the affordability threshold of $100,000/QALY. Overall, the review highlights a certain degree of uncertainty about the cost-effectiveness of ICI. In particular, we found PD-L1 expression associated with ICI treatment to be a cost-effective strategy, particularly in NSCLC, urothelial, and renal cell carcinoma. The findings suggest the potential value of predictive biomarker testing, specifically with pembrolizumab in NSCLC, while indicating challenges in achieving cost-effectiveness for certain other solid tumours.

Background Gender is a social determinant of health. Gender power dynamics can impact women’s and children’s health outcomes. The Demographic and Health Survey (2015) showed that 68% of women participated in decisions about their own healthcare in Malawi, but there is a lack of information on the socio-determinants and gender attitudes associated with primary health decision-making. This study aims to examine these factors during the male clinic days (health education activities) in four healthcare facilities in Southern Malawi. Methods We included men who participated in the male clinic days between August and November 2022. The main outcome of interest was the extent of women’s participation in their own healthcare. We designed a questionnaire that included the Gender-equitable Men Scale (GEM), which measures attitudes toward gender equality on a scale of 0 to 1. In addition, we collected socio-demographic, relationship, and family-related variables. Univariable and multivariable analyses revealed the association between the main and the other variables. Results 422 men were included in this study. The average GEM score was 0.53 (0.37–0.67; 95% CI: 0.004). Among the participants, 64.2% (271/422) reported that their female partners did not have the final say in healthcare decisions. When female partners assumed primary decision-making roles (35.8%, 151/422), men reported higher levels of gender-equitable attitudes compared to cases where men were the primary decision-makers (0.57 vs 0.47, p=0.004). Factors such as higher education level, location, formal employment, and male village chiefs emerged as the main socio-determinants associated with women’s decision-making role in health. Conclusion This study emphasizes the significance of socio-economic factors and gender-equitable attitudes in healthcare decision-making. This suggests the need for targeted interventions involving both men and women in discussions about healthcare decisions.

Background: Malawi ranks 173 out of 188 on the UN's Gender Inequality Index (GII) and Malawi has the eighth highest child marriage rate in the world. While previous research has mostly focused on understanding gender roles and norms from women's viewpoints, there has been limited exploration of men's attitudes and behaviors towards gender equality. This study seeks to address this gap by examining the social determinants that shape gender-equitable attitudes and investigating the relationship between behaviors and attitudes in Southern Malawi. Methods: Between August 2022 and November 2022, we conducted an observational study in four healthcare facilities located in Balaka, Phalula, Namandanje, and Kapire. The study focused on men who participated in a health education program specifically designed for them, known as male-friendly clinics. We interviewed these men using a structured questionnaire based on the International Men and Gender Equality Survey (IMAGES), which includes the Gender-Equitable Men (GEM) scale. To identify the factors influencing gender-equitable attitudes and explore the associated behaviors, we employed both univariate and multivariable analyses. Results: We included a total of 422 men in this study, with a median age of 46 years (IQR= 34, 55). Men reported a median score of 0.53 on the Gender Equality Attitudes (GEM) scale, where 1 represents the higher GEM scores and indicates more equitable attitudes. Higher gender-equitable attitudes were associated with higher education, urban areas and with various behaviours, such as joint decision-making in couples in women's (0.55 vs 0.49; p= 0.008) and children's health (0.54 vs 0.48; p=0.012), and in spending on food and clothing (0.56 vs 0.49; p<0.001). Conclusions: This study showed that education and location are the two leading social determinants that affect attitudes toward gender in Southern Malawi. This study confirmed that more gender-equitable attitudes reflect less power imbalance in couples. Key messages: • Higer education grade and urban areas affect attitudes toward gender equality in Southern Malawi. • Gender-equitable attitudes reflect equal distritution of power in couples.

Background: South-South learning exchange (SSLE) refers to an interactive learning process where peers exchange knowledge and experience to work towards a beneficial change. Despite organizations having recently increased the opportunity to run SSLEs, the SSLE processes are not well documented in the scientific literature. This study explored experts’ perspectives on SSLEs’ strengths, weaknesses and mechanisms leading to outcomes. Methods: We conducted a qualitative study using semi-structured interviews on the experience of participants and organizers of SSLEs. Data were collected between 1st September 2021 to 26th November 2021. All data were digitally recorded, transcribed verbatim, and analysed. In the analysis, we adopted an inductive approach derived from thematic analysis. Results: Sixteen experts who have participated in or facilitated one or more SSLEs were interviewed. Experts’ accounts demonstrated an appreciation of participants’ empowerment, positive peer-to-peer “mind change” and convincing and powerful hands-on learning of this approach as strengths in the successful implementation of the SSLE. Being resource-heavy, participant reluctance and the absence of a validated methodology emerged as the main weaknesses of the South-South learning approach, which could impair the effectiveness of this scheme. Conclusions: The SSLE is a promising approach to exchange knowledge and experience to work toward a desired change. However, to enhance its effectiveness and credibility, it would benefit from adopting a validated and systematic methodology that supports all stages of the exchange process, including monitoring and evaluation (M&E). Key messages: • South-South learning exchange is a promising approach to exchanging knowledge and experience among countries from the Global South. • A robust and systematic methodology is likely to increase evidence on SSLE and demonstrate its success.

Background: South-South learning exchange (SSLE) refers to an interactive learning process where peers exchange knowledge and experience to work towards a beneficial change. Despite organizations having recently increased the opportunity to run SSLEs, the SSLE support mechanisms and processes are not well documented in the scientific literature. This study explored experts’ perspective on SSLEs, strengths, weaknesses and mechanisms leading to outcomes. Methods: We conducted a qualitative study using semi-structured interviews on experience of participants and organizers of SSLEs. Data were collected between 1st September 2021 to 26th November 2021. All data were digitally recorded, transcribed verbatim, and analysed. In the analysis, we adopted an inductive approach derived from thematic analysis. Results: Sixteen experts who have participated in or facilitated one or more SSLE were interviewed. Experts’ accounts demonstrated an appreciation of participants’ empowerment, positive peer-to-peer “mind change” and convincing and powerful hands-on learning of this approach as strengths in the successful implementation of the SSLE. Being resource heavy, participant reluctance and absence of a validated methodology emerged as main weaknesses of the South-South learning approach, which could impair the effectiveness of this scheme. Conclusions: The SSLE is a promising approach to exchange knowledge and experience to work toward a desired change. This study suggested that this approach could gain robustness and credibility adopting a validated and systematic methodology. Furthermore, national and international funds improve availability of and accessibility to learning on the SSLE.

Background: South-South learning exchange (SSLE) is an interactive learning process where teams from low-income and middle-income countries exchange knowledge and experience to support one or both team’s work towards a change in policies, programmes or practices. SSLE has been used by countries to improve family planning (FP) outcomes such as increased contraceptive prevalence rate and reduced unmet need for FP, but at present, there are no reviews that summarise its use. We conducted a scoping review with stakeholder consultations to summarise the use of SSLE to change FP outcomes. Objective: To systematically identify and map the purposes, approaches, outputs, outcomes, enablers and barriers to using SSLE in FP. Methods: A search was conducted on electronic databases, grey literature sources, websites and the reference list of included studies. The scoping review is based on an adapted version of Arksey and O’Malley’s scoping review framework suggested by Levac et al. Experts were interviewed on their experiences in SSLE. Results: The initial search yielded 1483 articles; however, only 29 were selected in the final analysis. The articles were published between 2008 and 2022. Most of the articles were reports, case studies or press releases, only two were peer-reviewed publications. Capacity building of FP providers, policy-makers and community was the most commonly reported purpose of SSLE, with study tours (57%) being the most common approach. Policy dialogue was the most common (45%) output and improved contraceptive prevalence was the most frequently reported outcome. The experiences of the 16 interviewed experts aligned with the scoping review findings. Conclusion: The evidence on the effectiveness of SSLE for addressing FP outcomes is very limited and of very low quality. We call on stakeholders conducting SSLE to document their experiences in detail, including the outcomes achieved.

Emerging infectious diseases are a growing threat in sub-Saharan African countries, but the human and technical capacity to quickly respond to outbreaks remains limited. Here, we describe the experience and lessons learned from a joint project with the WHO Regional Office for Africa (WHO AFRO) to support the sub-Saharan African COVID-19 response.In June 2020, WHO AFRO contracted a number of consultants to reinforce the COVID-19 response in member states by providing actionable epidemiological analysis. Given the urgency of the situation and the magnitude of work required, we recruited a worldwide network of field experts, academics and students in the areas of public health, data science and social science to support the effort. Most analyses were performed on a merged line list of COVID-19 cases using a reverse engineering model (line listing built using data extracted from national situation reports shared by countries with the Regional Office for Africa as per the IHR (2005) obligations). The data analysis platform The Renku Project (https://renkulab.io) provided secure data storage and permitted collaborative coding.Over a period of 6 months, 63 contributors from 32 nations (including 17 African countries) participated in the project. A total of 45 in-depth country-specific epidemiological reports and data quality reports were prepared for 28 countries. Spatial transmission and mortality risk indices were developed for 23 countries. Text and video-based training modules were developed to integrate and mentor new members. The team also began to develop EpiGraph Hub, a web application that automates the generation of reports similar to those we created, and includes more advanced data analyses features (e.g. mathematical models, geospatial analyses) to deliver real-time, actionable results to decision-makers.Within a short period, we implemented a global collaborative approach to health data management and analyses to advance national responses to health emergencies and outbreaks. The interdisciplinary team, the hands-on training and mentoring, and the participation of local researchers were key to the success of this initiative.