Jennifer Dunne

Despite notable improvement in maternal survival between 2000 and 2015, progress plateaued during the early years of the Sustainable Development Goal (SDG) period [1]. By 2023, the global maternal ...

Dementia prevalence in the Middle East and North Africa (MENA) is projected to rise exponentially, with estimates suggesting increases of 367% by 2050. This region faces distinctive challenges, including rapid demographic transition, high rates of modifiable risk factors, and fragmented health systems. This paper examines region-specific risk factors and pooled prevalence rates of dementia across the MENA region. We conducted a narrative review of dementia risk factors in the MENA region, including analysis of population-attributable risk (PAR) estimates and pooled estimates of dementia prevalence among adults aged 50 years and older. Dementia prevalence was estimated at 1.84% among individuals aged 50 years and older, increasing to 3.81% among those aged 60 years and older, with substantial variability across countries. Smoking (>30%), physical inactivity ( ~ 50%), and high burdens of diabetes, hypertension, and obesity were consistently associated with increased dementia risk. Additional region-specific drivers include nutritional transitions, gut dysbiosis, consanguinity, and environmental risk factors such as air pollution and climate-related heat stress. Critical barriers to prevention and care include limited research infrastructure, low health literacy, stigma, and inequitable health care access. Dementia prevalence in MENA is rising rapidly, driven by demographic change and high exposure to modifiable risk factors that are relatively region-specific in terms of their contribution. Strengthening prevention, early detection, and equitable access to care should be regional health priorities.

Background Skilled maternal health services, including antenatal care (ANC) services, childbirth services and postnatal care (PNC) services, can save the lives of women and newborns. However, women in resource-limited countries, such as Ethiopia, tend to have a relatively lower uptake, partly because current services may not align with their preferences. This study assessed the stated preferences ofwomen for maternal health services in the Sidama region, Ethiopia. Methods A multi-stage sampling technique was used to select reproductive-aged women (15–49 years) from the Central Sidama Zone, Sidama region, Ethiopia. A D-efficient discrete choice experiment (DCE) with two blocks of 24 choice tasks was designed. Six attributes, including healthcare provider attitude, availability of medication and supplies, distance to the health facility, privacy, waiting times, and service cost, were identified through literature reviews, focus group discussions and in-depth interviews with women and other stakeholders. Respondents were randomly assigned to one of the three interrelated but distinct maternal health services (ANC, childbirth and PNC). A latent class analysis (LCA) model was used to estimate preferences and estimate the relative importance of attributes, uptake probability, and willingness-to-pay (WTP). The association between individual sociodemographic characteristics and latent classes was examined using a class membership model. Result A total of 1558 women, including 526 for ANC services, 537 for childbirth services and 495 for PNC services, were included in the analysis. For each service, three classes were identified, and notable differences in preferences were observed across the classes within each maternal health service. For ANC services, Class 1 was a medication-sensitive group (34.3%) that prioritised the availability of essential medications. In contrast, Class 2 was a price-sensitive group (21.9%), exhibiting high disutility for costly services (7500 ETB ≈ US$137). For childbirth services, Class 1 was a time-sensitive group (21.1%) exhibiting strong aversion to long waiting times (24 hours), while Class 2 was a price-sensitive group (19.3%). For PNC services, Class 1 was a medication-sensitive group (48%), whereas Class 3 was a price-sensitive group (25%). The predicted uptake probability in ideal conditions was above 96% across all maternal health services; however, it ranged from 60% for class 2 PNC services to 99% for class 2 childbirth services in average conditions. Overall, women showed a higher willingness to pay (WTP) approximately 8604 ETB (US$159) and 5118 ETB (US$95 ), to avoid childbirth services that lacked medications and supplies or had long waiting times, respectively. Sociodemographic factors, including age, residence, and education level, significantly shaped women's preferences for maternal health services. Conclusion The cost of service, availability of medication and supplies, and waiting time were the most important attributes influencing maternal health service preferences for most of the classes of all services, while privacy and distance to the health facility were frequently the least important. Maternal health services should address the specific needs of women, such as subsidising costs, ensuring sustainable medication supply, and optimising service efficiency to enhance maternal healthcare uptake and outcomes in resource-limited settings, including Ethiopia and similar contexts. The findings will provide policymakers with valuable insights and inform future research on maternal health services in other contexts, including the Afar and Somali regions, where nomadic lifestyles are common, and data are sparse.

Introduction: The increasing inequality and multifaceted barriers to accessing maternal healthcare services play a significant role in the observed high maternal mortality ratios in sub-Saharan African (SSA) countries compared with other regions. Evidence is required to understand the relationship between barriers to healthcare access and the utilisation of maternal healthcare services. This study aims to assess the role of healthcare access barriers in the uptake of maternal health services in SSA. Methods: We used a cross-sectional, demographic and health survey data from 14 SSA countries. We included 31 940 (31 553 weighted) reproductive-age women who had given birth in the year preceding the survey. Healthcare access barrier was an exposure variable and considered when a woman reported at least one of the following four concerns limiting access to healthcare services during illness: (1) difficulty obtaining permission to visit health facility, (2) financial challenges in covering healthcare expenses or treatment costs, (3) having significant travel distance to reach a health facility and (4) reluctance not wanting to visit facilities alone. We used χ ² tests to select covariates and logistic regression to assess the association between healthcare access barriers and maternal healthcare service uptake. Propensity score matching (PSM) reduced selection bias by balancing observed characteristics between women with and without reported barriers. A one-to-one logit nearest neighbour matching method with bootstrap was used to estimate the average treatment effect on the treated (ATT) (women with access barriers) to antenatal care (ANC), health facility birth and postnatal care (PNC) services utilisation. Maternal education level, household wealth status, access to media, parity, COVID-19 pandemic period, geographical residence and country of residence were covariates used for matching. Post-matching sensitivity analysis and balance tests were conducted to assess the robustness of our PSM analysis. Results: Almost three-fifths (60.2%) of women in the SSA (95% CI; 53.7% to 66.7%) reported barriers to accessing healthcare services. Barriers to accessing healthcare were associated with an 8-percentage point reduction in the likelihood of having a health facility childbirth (ATT: −0.08; SE: 0.016). However, there was insufficient evidence for differences in the uptake of ANC visit and PNC visit between the treatment (women with access barriers) and control groups. Post-matching tests confirmed that covariates were well balanced, and hidden biases were substantially reduced. Conclusion: The presence of barriers to healthcare access is negatively associated with the utilisation of health facility childbirth in SSA countries. These findings underscore the need for public health programmes that address the primary barriers to healthcare access, including financial constraints and physical accessibility, to enhance childbirth outcomes in health facilities.

BACKGROUND: Effective treatments for neurodegenerative diseases remain elusive, underscoring the importance of preventive strategies. Probucol, a cholesterol lowering and antioxidant drug with established cardiovascular use, has shown neuroprotective effects in preclinical models of dementia by modulating peripheral lipoprotein amyloid metabolism and preserving capillary integrity. However, no large-scale human studies have examined its association with dementia risk. OBJECTIVE: To examine the association between probucol use and incident dementia in older adults. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used the Japan Medical Data Centre claims database from 2014 to 2023. Adults aged 50 years or older prescribed probucol or statins were included, excluding those with prior dementia or recent drug exposure. Participants were categorized as probucol monotherapy users, statin monotherapy users, or combination users (≥2 prescriptions). Propensity score matching was used to balance baseline comorbidities. EXPOSURES: Probucol or statin therapy. MAIN OUTCOMES AND MEASURES: The primary outcome was incident all cause dementia. Secondary outcomes included Alzheimer’s disease and mixed Alzheimer’s and vascular dementia. Odds ratios (ORs) with 95% CIs were calculated using logistic regression adjusted for age and sex. RESULTS: Among 57 231 individuals (52.6% female) followed for up to 10 years (median, 3 years), 7 387 (12.9%) developed dementia. The cohort included 2 896 probucol users (5.1%) and 54 335 statin users (94.9%). Dementia incidence was higher among females (14.7%) than males (10.9%). Dementia incidence was lower in probucol users (5.6%, 162/2 896) than in statin users overall (13.2%, 8 248/62 519), with individual statins ranging from 11.4% (fluvastatin) to 16.7% (pravastatin). Probucol use was associated with a 62% lower adjusted risk of dementia compared with all statin users combined (adjusted OR, 0.38; 95% CI, 0.37-0.38). Protective associations were consistent across individual statin comparisons, with adjusted ORs ranging from 0.30 (pitavastatin) to 0.57 (fluvastatin). CONCLUSIONS AND RELEVANCE: In this large national cohort of Japanese adults, probucol use was associated with a substantially lower risk of incident dementia compared with statins. These findings provide the first large-scale human evidence linking probucol exposure with reduced dementia risk, supporting its further evaluation as a preventive therapy in prospective clinical trials. Key Points: Question: Is use of the lipid-lowering and antioxidant agent probucol associated with a reduced risk of incident dementia compared with statin therapy in older adults? Findings: In this nationwide cohort study of 57 231 Japanese adults aged 50 years and older, dementia incidence was nearly halved in probucol users (5.6%) compared with statin users overall (13.2%), corresponding to 62% lower adjusted odds of dementia. Protective associations were consistent across dementia subtypes and individual statins. Meaning: These findings suggest that probucol, a long-standing and well-tolerated cardiovascular drug, may offer a mechanistically distinct and potentially scalable strategy for dementia prevention, warranting confirmation in prospective intervention trials.