Background: The Framework Convention on Tobacco Control (FCTC) requires countries to develop and implement multi-sectoral tobacco control strategies, including policies and legislation. Zambia, potentially faced by a rising problem of tobacco smoking, signed the FCTC in 2008 but has been unable to enact a tobacco policy for over a decade.

Objective: This study explores the role of 'principled engagement', a key element of the theoretical framework for collaborative governance, in Zambia's delayed success to develop a comprehensive tobacco control policy.

Methods: This was a qualitative case study of key stakeholders in the collaborative process of trying to develop a tobacco policy in Zambia. Participan-ts were sampled from across various sectors, including government departments and civil society, comprising anti-tobacco activists and researchers. A total of 27 key informant interviews were undertaken. We supplemented the interview data with a document review of relevant policies and legislation. Data were analysed using thematic analysis.

Results: Several factors hindered efforts to attain principled engagement, including the adverse legal and socioeconomic environment in which the collaborative regime evolves; poor planning of meetings and frequent changes in tobacco focal point persons; lack of active and meaningful participation; and communication challenges among the key stakeholders. These collaborative dynamics, coupled with the opposition to tobacco control efforts from within some government departments, revealed the inadequacy of the current collaborative governance regime to facilitate enactment of a comprehensive tobacco control policy in Zambia.

Conclusion: Efforts to develop a comprehensive tobacco control policy in Zambia will require addressing challenges such as disagreements, communication, and leadership at engagement level across interested sectors. We further argue that principled engagement has a greater role to play in unlocking these efforts and should therefore be embraced by those entrusted to lead the process to develop tobacco policy in Zambia.

Background: Globally, steps to revitalise programmes deploying community health workers (CHWs) on a national scale have been growing, but few economic evaluations have been done on system-integrated CHW programmes. Ghana has dual cadres of CHWs: community health officers (CHOs) and community health volunteers (CHVs). CHO plays a major role in primary health services but has suffered from chronic staff shortages. We activated CHVs in communities to mitigate the negative impact due to CHO shortages. The CHVs conducted home visits and provided health education to prevent childhood diseases.

Objective: We evaluated the cost-effectiveness and cost-benefit of activating CHVs.

Methods: In a cluster-randomised trial with 40 communities in rural Ghana, the changes in disease incidence were inferred from a statistical model using a Bayesian generalised linear multilevel model. We evaluated the total incremental cost, benefit, and effectiveness for the intervention from an economic model. In cost-effectiveness analysis, disability-adjusted life years (DALYs) were estimated using a decision tree model. In the cost-benefit analysis, the cost-benefit ratio and net present value of benefit were estimated using a decision tree model, and a standardised sensitivity analysis was conducted. The decision tree model was a one-year cycle and run over 10-years. Costs, benefits, and effectiveness were discounted at a rate of 3% per year.

Results: According to the cost-effectiveness analysis, the programme was highly likely to exceed the WHO-CHOICE threshold (1-3 times GDP per capita), but it was unlikely to exceed the conservative threshold (10-50% of GDP per capita). In the cost-benefit analysis, the mean and median cost-benefit ratios were 6.4 and 4.8, respectively.

Conclusion: We found the potential economic strengths in the cost-benefit analysis. To integrate CHW programmes with national health systems, we need more research to find the most effective scope of work for CHWs.

Vaccine hesitancy is a growing public health concern that has fueled the resurgence of vaccine-preventable diseases in several Muslim-majority countries. Although multiple factors are associated with vaccine hesitancy, certain religious deliberations are significant in determining individuals' vaccine-related decisions and attitudes. In this review article, we summarize the literature on religious factors linked to vaccine hesitancy among Muslims, thoroughly discuss the Islamic law (sharia) viewpoint on vaccination and offer recommendations to address vaccine hesitancy in Muslim communities. Halal content/labeling and the influence of religious leaders were identified as major determinants of vaccination choices among Muslims. The core concepts of sharia, such as "preservation of life," "necessities permit prohibitions," and "empowering social responsibility for the greater public benefit" promote vaccination. Engaging religious leaders in immunization programs is crucial to enhance the uptake of vaccines among Muslims.

Background: Advocacy is one of the core functions of public health and is a key tool for achieving Sustainable Development Goals. Public health associations play a key role in advocating for the development and implementation of strategies to prevent diseases and promote health and well-being.

Objective: This study aims to map out the focus of public health advocacy carried out by selected national public health associations over 4 years, between 2018 and 2021, in order to identify gaps and strengths and support associations and professionals in their advocacy efforts.

Methods: Twelve national public health associations participated in the study. Official policy documents produced between 2018 and 2021 were collected and analysed. The title and summary of the policy documents were examined line by line and coded into the main subject categories and themes. A qualitative thematic analysis was conducted. Policies were assessed from global and regional perspectives.

Results: A total of 220 policy documents were analysed. Overall, the largest number of policy documents came from high-income countries and dealt with environmental health and communicable diseases, including COVID-19, with, however, important differences among regions. In the African region, public health advocacy focused mainly on strengthening health systems; Europe and South America were mostly concerned with communicable diseases and pandemic management; and North America and the Western Pacific regions focused primarily on climate change. Limited attention was paid to international health and health as a human right in all regions.

Conclusion: Our study showed that, especially in high-income countries, public health associations actively engage in advocacy; however, more effort needs to be devoted to implementing a more international and intersectoral approach at the global level, anchored in health as a human right and aligned with the Sustainable Development Goals.

The Nordic country Faroe Islands consists of 18 mountain islands situated in the North Atlantic Sea. In the late 1800s, nursing in the Faroe Islands was behind international standards. A transition towards organised nursing commenced when Danish deaconesses arrived in 1897; their missions were to serve as nurses and train Faroese women in nursing. The overall aim of this research is to add to the history of Faroese nurses' training and work during the first decades of the 1900s, decades when Faroese nursing became visible through the presence of deaconesses and trained nurses. With historiographic and biographic approaches and in the context of Faroese history and nursing theory and research, we present accounts about four Faroese nurses' living, training and work during the three first decades of the 1900s. These years were progressive for Faroese nursing in hospital care and public health around on the islands, and a struggle to combat tuberculosis took place. We conclude by emphasising the importance of considering the beginning of professional nursing in a small faraway country where resilient nurses worked with ingenuity and often exceeded geographic and professional boundaries to help and support sick and injured compatriots, promoting their health and well-being.

Recent work in family planning has shifted from an instrumentalist perspective on quality in contraceptive counselling, which views quality as a means to encourage contraceptive uptake, to privilege quality of care as a valued end in itself. In this context of shifting narratives about quality, it is important to understand how health systems and providers navigate potential conflicts between instrumentalist definitions of quality versus a person-centred definition that considers meeting clients' contraceptive needs and preferences as an important end goal in and of itself. However, we know little about how providers and other health system stakeholders interpret the concept of quality in counselling, and how their experiences with different quality monitoring systems influence their ability to provide person-centred care. This qualitative study draws from 51 in-depth interviews with public healthcare providers and health facility administrators in Ethiopia, Mexico and India. Across all three countries, except for some cases in India, administrators were concerned with encouraging uptake of contraceptives in order to meet local and national level goals on contraceptive uptake and maternal health. In contrast, providers were more concerned with responding to client desires and needs. However, participants across all levels shared the opinion that successful counselling should end with contraceptive uptake. We conclude that the instrumentalist view of quality counselling continues to prevail across all three countries. Our findings suggest that encouraging healthcare providers and administrators to meet even relatively broad targets set by government reinforces an instrumentalist approach, as opposed to an approach that privileges person-centred care.

Background: Infections contribute significantly to neonatal mortality in Nigeria. Community health officers (CHOs) provide maternal, newborn and child health services at the primary health care level. However, newborn infection prevention and control (NB-IPC) is not included in their current training curriculum, which has little innovation in teaching methods. This study assessed the effectiveness of a blended curriculum on NB-IPC in improving the competencies of student CHOs.

Methods: This pre- and post-test study was conducted in the CHO training school of Lagos University Teaching Hospital (LUTH), which has 70 students enrolled. We developed and implemented a blended curriculum on NB-IPC using Kern's six-step framework. Twelve videos were recorded of content experts teaching various aspects of NB-IPC and were watched online or downloaded by students. Two interactive practical sessions were held in class. Pre- and post-course assessment of knowledge was with multiple choice questions, attitude with a Likert scale, and skills with an objective structured clinical examination (OSCE). Course satisfaction was also assessed with a validated scale. Paired t-test was used to determine mean differences at a significance level of 0.05.

Results: The mean knowledge score of students increased from 10.70 (95% confidence interval (CI): 10.15-11.24) pre-course out of a possible score of 20 to 13.25 (95%CI: 12.65-13.84) post-course (p < 0.001). Mean attitude score increased from 63.99 (95%CI: 62.41-65.56) out of a possible score of 70 to 65.17 (95%CI: 63.68-66.67) (p = 0.222). The mean OSCE score increased from 21.27 (95%CI: 20.20-22.34) out of a possible score of 58.5 to 34.73 (95%CI: 33.37-36.09) (p < 0.001). Mean post-course satisfaction score of students was 127.84 (95%CI: 124.97-130.89) out of a possible score of 147.

Conclusion: The new curriculum on NB-IPC improved the competencies of student CHOs in LUTH and they were highly satisfied. The blended curriculum may be a feasible addition to learning in CHO schools across Nigeria.Key messageA blended curriculum on NB-IPC involving video teaching is effective in improving the competencies of student CHOs.

Background: Experiences of long-term achievement in participants attending programs for changing health habits including diet and physical activity interventions aiming for weight reduction is lacking. This study aimed to explore how participants experienced their own achievement of healthy habits 60 months after attending a Healthy Life Centre programme in the Norwegian primary healthcare.

Methods: An explorative qualitative design with an inductive approach was employed. Individual semi-structured interviews were performed with 20 participants attending a Healthy Life Centre programme 60 months ago. They were aged 30-72 years, and 55% were females. Interviews were transcribed verbatim and analysed thematically using systematic text condensation.

Results: Two main themes emerged from the interviews with three subthemes each. The first theme "Changes over time" includes "Nutritional changes", "Physical activities adjusted to own presumptions" and "Health habits incorporated into life with manageable goals". The second theme "Barriers to fulfil changes" includes "Life circumstances with health issues influences the continuity to adjust to changes", "a busy everyday life" and "a lack of external drive when not having commitment to the Healthy Life Centre".

Conclusions: Focusing on changes adjusted to participants' own everyday lives and having an approach with small goals can facilitate long-term changes in health habits.

Purpose: This study explored the experiences of people with stress-related illness participating in a nature-based intervention programme in a northern natural setting.

Methods: A longitudinal case study was conducted with two women participating in a nature-based intervention programme on a farm. Data were collected by semi-structured interviews, diaries, rating scales, and self-assessment. Qualitative data were analysed by qualitative content analysis and quantitative data are presented descriptively.

Results: The theme of finding a source for recovery and well-being permeates all categories. The participants perceived the farm and nature to be a calming refuge; they learned to be in the present and could manage the tasks. In togetherness with each other and the facilitator on the farm they felt understood and confident, experienced joy, and found opportunities for change. They gained knowledge and positive memories and found new approaches in life. Self-assessment questionnaires indicated improvements of functioning in everyday life and reduced stress-related exhaustion at the end of the NBI programme.

Conclusions: Nature-based interventions lasting for a relatively short period seem to promote health and may be a complement to other treatments of stress-related illness. Further research is needed with a larger number of participants and in various natural settings.