Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People’s Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26–96% declines). Total outpatient visits declined by 9–40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.

Childhood overweight is not restricted to developed countries: a number of lower- and middle-income countries are struggling with the double burden of underweight and overweight. Another public health problem that concerns both developing and, to a lesser extent, developed countries is food insecurity. This study presents a comparative gender-based analysis of the association between household food insecurity and overweight among 10-to-11-year-old children living in the Canadian province of Québec and in the country of Jamaica.

Introduction. Pyelonephritis is a common complication of pregnancy. It is also exacerbated by immunocompromised states and also the sickle cell gene. We reviewed this condition in Jamaican women.Method. We did a six year hospital database docket review. We found 102 confirmed cases.Results. Pyelonephritis was found in 0.7% of deliveries. The mean maternal age was years with 51% primiparity. Most (58.8%) occurred in the second trimester. The main symptoms were loin pain (96.2%) and abdominal pain (84.6%). It was more common on the right side in 67% of cases. On urinalysis, 81.4% had pyuria. The commonest organism wasEscherichia coli, in 61% of cases. Patients given Antibiotics prior to admission had quicker resolution, . Haemoglobin S was found in 16% cases (general population 10%; . However diabetes was only found in 1.3% cases (1.5% expected). 61.3% had positive urine culture after treatment showed that 61.3% and 25% had recurrent pyelonephritis. Complications included 32% threatened preterm labour and 17% preterm delivery. About 6% of neonates had intrauterine growth restriction. There were no ICU admissions and no deaths.Conclusion. Early recognition and treatment of pyelonephritis result in good outcome. The condition is more prevalent in patients with the sickle cell gene and recurrence is high.

Introduction. Noni (Morinda citrifolia) has been used for many years as an anti-inflammatory agent. We tested the efficacy of Noni in women with dysmenorrhea.Method. We did a prospective randomized double-blind placebo-controlled trial in 100 university students of 18 years and older over three menstrual cycles. Patients were invited to participate and randomly assigned to receive 400 mg Noni capsules or placebo. They were assessed for baseline demographic variables such as age, parity, and BMI. They were also assessed before and after treatment, for pain, menstrual blood loss, and laboratory variables: ESR, hemoglobin, and packed cell volume.Results. Of the 1027 women screened, 100 eligible women were randomized. Of the women completing the study, 42 women were randomized to Noni and 38 to placebo. There were no significant differences in any of the variables at randomization. There were also no significant differences in mean bleeding score or pain score at randomization. Both bleeding and pain scores gradually improved in both groups as the women were observed over three menstrual cycles; however, the improvement was not significantly different in the Noni group when compared to the controls.Conclusion. Noni did not show a reduction in menstrual pain or bleeding when compared to placebo.

Water resources, whether exceeding per capita water abundance thresholds or below water scarcity thresholds, are health determinants within small island developing states (SIDS). Thresholds indicate water stress vulnerability in SIDS, but underestimate the physicality associated with a lack of water. The objectives of this study were to capture the main challenges of consistently meeting water demand in SIDS and to present their intersection with certain diseases or factors associated with specific health conditions like dengue fever, gastrointestinal disorders, dehydration, and malnutrition. This review utilized archival evidence to categorize the challenges undermining water availability in SIDS with the view that these issues present or exacerbate health outcomes. Seasonal rainfall variations (73%), inadequate distribution infrastructure (64%), saltwater intrusion (61%), contamination (58%), human-induced watershed change (19%), and sea level rise (17%) were identified from 108 country-specific sources as challenges to consistently meeting water demand by 59 SIDS. Any water stress indicator must consider that it is contingent on its human burden. These challenges affect food security through agricultural drought and soil salinization, and the proliferation of vector-borne and sanitation-related diseases across SIDS. This review is the first step in determining the human health burden of water insecurity in SIDS.