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Background: Anemia is a chronic condition that disproportionately affects women and children. Anemia shows detrimental long-term impacts on maternal and child health and development, with the highest burden observed in low- and middle-income countries. In the Lao People’s Democratic Republic (PDR), anemia is prevalent in 39% of women of reproductive age, 47% of pregnant women, and 43% of children under five. Objective: Our study evaluates associations between maternal anemia at pregnancy and postpartum and infant hemoglobin (Hb) levels in early infancy. We further investigate the influence of breastfeeding practices on this association. Methods: Data from the Social Transfers for Exclusive Breastfeeding ongoing randomized control trial (RCT) (n = 298) in Vientiane, Lao PDR, was used. Maternal and infant Hb levels were assessed during pregnancy and at one, six, and twelve months postpartum. We used generalized estimating equations (GEE) for repeated measures analysis. Results: Anemic mothers at pregnancy and postpartum saw a 1.89 g/L (adjusted 95% CI: −4.48 to 0.70, p = 0.15) and 3.25 g/L (adjusted 95% CI: −7.86 to 1.36, p = 0.17) decrease in infant Hb levels compared to non-anemic mothers. Among postpartum anemic mothers who followed the World Health Organization (WHO) breastfeeding recommendations, an increase of 7.87 g/L in infant Hb levels (adjusted 95% CI: −2.21 to 17.94, p = 0.13) was observed. Conclusions: A weak negative association was found between maternal anemia during pregnancy and the first year postpartum and infant Hb levels. However, among anemic mothers at postpartum, adhering to WHO breastfeeding recommendations may help to mitigate this impact.

Background: Sub-Saharan Africa (SSA) faces the highest rate of hypertension worldwide. The high burden of elevated blood pressure (BP) in black people has been emphasized. Guidelines recommend two or more antihypertensive medications to achieve a BP control. We aimed to identify factors associated with prescription of up-titrated antihypertensive strategies in Africa. Methods: We conducted a cross-sectional study on outpatient consultations for hypertension across 12 SSA countries. Collected data included socioeconomic status, antihypertensive drugs classes, BP measures, cardiovascular risk factors and complication of hypertension. We used ordinal logistic regression to assess factors associated with prescription of up-titrated strategies. Results: The study involved 2123 treated patients with hypertension. Patients received monotherapy in 36.3 vs. 25.9%, two-drug in 42.2 vs. 45% and three and more drugs strategies in 21.5 vs. 29.1% in low (LIC) and middle (MIC) income countries, respectively. Patients with sedentary lifestyle [OR 1.4 (1.11–1.77)], complication of hypertension [OR 2.4 (1.89–3.03)], former hypertension [OR 3.12 (2.3–4.26)], good adherence [OR 1.98 (1.47–2.66)], from MIC [OR 1.38 (1.10–1.74)] and living in urban areas [OR 1.52 (1.16–1.99)] were more likely to be treated with up-titrated strategies. Stratified analysis shows that in LIC, up-titrated strategies were less frequent in rural than in urban patients (P for trend <0.01) whereas such difference was not observed in MIC. Conclusion: In this African setting, in addition to expected factors, up-titrated drug strategies were associated with country-level income, patient location and finally, the interplay between both in LIC. These results highlight the importance of developing policies that seek to make multiple drug classes accessible particularly in rural and LIC.

Background: According to the World Health Organization’s infant and young child feeding guidelines, infants should be exclusively breastfed for the first 6 months of life. Despite public health campaigns to increase exclusive breastfeeding (EBF) rates, socioeconomic inequities persist among low-income breastfeeding mothers, especially in countries with large wealth and health gaps, such as Brazil. Social transfer programs are initiatives that provide financial support to individuals or households to improve their well-being and reduce financial burdens. These may be conditional, requiring recipients to meet specific criteria to receive the transfer, or unconditional, in which recipients receive the transfer without prerequisites. Evidence suggests that conditional and unconditional social transfers may help increase EBF rates while addressing the economic challenges breastfeeding mothers face. A randomized controlled trial (RCT) conducted in Vientiane, Lao People’s Democratic Republic, found that a social transfer program significantly improved both EBF rates at 6 months and EBF duration. Building on this study, we aim to evaluate the impact of this intervention in a different socioeconomic and cultural context. Objective: This protocol aims to implement an RCT to assess whether conditional and unconditional social transfers improve EBF rates at 6 months postpartum for mothers in low-income communities in São Paulo, Brazil. Methods: A prospective RCT will be conducted among 400 mothers who gave birth in the last 72 hours and plan to exclusively breastfeed. Participants will be recruited in São Paulo at the University Hospital of São Paulo and Amparo Maternal. Participants will be randomly assigned to one of the following groups: (1) control group—no social transfer; (2) intervention group 1—an unconditional social transfer at 6 months postpartum; and (3) intervention group 2—a social transfer at 6 months postpartum, conditional upon mothers’ EBF. All groups will receive educational materials supporting EBF. The study will have visits at birth, 1 month, 6 months, 1 year, and 2 years and will include a questionnaire and biological collections of breast milk samples, infant fecal samples, and blood samples (finger pricks) from both the mother and infant. The main study outcomes are the prevalence of EBF at 6 months and the duration of EBF across the 3 groups, where we hypothesize higher rates of EBF among mothers in the conditional group. Results: Recruitment began on March 6, 2024. As of September 2025, we enrolled 204 participants. Our goal is to recruit 400 mother-infant dyads by October 2025, with study visits expected to be completed by October 2027. Conclusions: We hypothesize that the Social Transfers for Exclusive Breastfeeding in Brazil (STEBB) intervention will positively impact breastfeeding mothers in São Paulo. If successful, the program may inform national policy to enhance Brazil’s existing social transfer program for new mothers. Trial Registration: ClinicalTrials.gov NCT06157697; https://clinicaltrials.gov/study/NCT06157697 International Registered Report Identifier (IRRID): DERR1-10.2196/75796

Background The impact of COVID-19 sanitary measures on the time trends in infectious and chronic disease consultations in Sub-Saharan Africa remains unknown. Methods We conducted a cohort study on all emergency medical consultations over a five-year period, January 2016 to July 2020, from SOS Medecins in Dakar, Senegal. The consultation records provided basic demographic information such as age, ethnicity (Senegalese v. Caucasian), and sex as well as the principal diagnosis using an ICD-10 classification (‘infectious, ‘chronic’, and ‘other’). Firstly, we investigated how the pattern in emergency consultation differed from March to July 2020 compared to previous years. Secondly, we examined any potential racial/ethnic disparities in COVID-19 consultation. Findings Data on emergency medical consultations were obtained from 53,583 patients of all ethnic origins. The mean age of patients was 37.0 ± 25.2 and 30.3 ± 21.7 in 2016-2019 and 45.5 ± 24.7 and 39·5 ± 23.3 in 2020 for Senegalese and Caucasians. The type of consultations between the months of January and July were similar from 2016 and 2019; however, in 2020, there was a drop among the numbers of infectious disease consultations, particularly from April to May 2020 when sanitary measures for COVID-19 were applied (average of 366.5 and 358.25 in 2016-1019 and 133 and 125 in 2020). The prevalence of chronic conditions remained steady during the same period (average of 381 and 394.75 in 2016-2019 and 373 and 367 in 2020). In a multivariate analysis after adjusting to age and sex, infectious disease consultations were significantly more likely to occur in 2016-2019 compared to 2020 (OR for 2016= 2.39, 2017= 2.74, 2018= 2.39, 2019= 2.01). Furthermore, the trend in the number of infectious and chronic consultations were similar among Senegalese and Caucasian groups, indicating no disparities among those seeking treatment. Interpretation During the implementation of COVID-19 sanitary measures, infectious disease rates dropped as chronic disease rates stayed stagnant in Dakar. Furthermore, no racial/ethnic disparities were observed among the infectious and chronic consultations. Question How has the application of COVID-19 sanitary measures affected emergency medical consultations from March to July 2020 compared to previous years? Finding The rates of infectious diseases decreased as rates of chronic diseases stayed stagnant with the application of sanitary measures. Among the infectious and chronic disease consultations, no racial/ethnic disparities were observed. Meaning Understanding the effects of the sanitary measures against COVID-19 in Sub-Saharan Africa has helped emphasize the possibility of limiting the spread of other infectious diseases in this part of the world where they are still highly prevalent and the efficiency of controlling the spread of the virus while avoiding racial/ethnic disparities.