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Working age adults living with adventitious blindness (occurring from age five) in Nigeria face significant challenges, including rehabilitation, depriving them of the quality of care required for successful adaptation and integration. This study aimed to explore their lived experiences to inform policy and service delivery. Dahlgren and Whitehead's socioecological model underpinned this study to highlight how institutions and society shape participants' lives. In-depth interviews were conducted with 40 participants on multi-level and multi-dimensional factors, including environmental, economic, social, and individual factors. Audio recordings were transcribed and analysed using framework analysis. The analysis yielded 14 themes, including barriers to employment, education, rehabilitation, and other essential services that undermined productivity and integration. Reports of pervasive discrimination and stigma were compounded by a long-standing history of non/poor implementation of anti-discrimination laws. To deeply understand the nature of the layers of exclusion, oppression, and subjugation faced by participants, findings were discussed using Critical Disability Theory. The findings suggest that Nigerian society is currently structured in a way that keeps people living with adventitious blindness disabled, rendering them powerless and unable to fully actualise their aspirations, career goals, and societal and civic obligations. This necessitates multi-sectoral reforms strengthened by the implementation of existing legal frameworks.

Injuries cause 6 million deaths and 40 million disabilities annually. Over 90% of deaths occur in low-and-middle-income-countries (LMICs), and nearly half are preventable. This Commentary examines the possibilities and limitations of data to support injury care in LMIC settings. We frame injury care as a wicked problem with complex causality, contested goals, unintended consequences, and an incomplete evidence base. We use critical realism (CR) to address conceptual complexity and data scarcity using depth ontology and retroduction. Using exemplars (drug-related admissions, intimate-partner violence, and ambulance delays), we apply a pragmatic approach to: (1) describe patterns/distributions; (2) identify who/what may be missing or misrepresented; (3) triangulate with frontline/community intelligence to infer mechanisms and constraints, translating interpretations into feasible actions and accountabilities. CR broadens interpretation to include institutional and structural drivers (e.g. mistrust, referral fragmentation, gender norms). Routine data are indispensable but are partial. Used uncritically, they can reproduce disparities, leaving health systems to manage complex demands with limited insight. CR supports holistic analysis of how interventions interact with actors, interests, institutions, and political-economic conditions. Focusing on why disparities persist and linking routine metrics to triangulation and dialogue, CR readings can guide service adaptation and wider structural reform.

Background: Learning platforms can strengthen primary healthcare (PHC) by integrating community knowledge with system decision-making, but evidence on how they work in low-resource settings is limited. This study presents a realist evaluation of the Verbal Autopsy with Participatory Action Research (VAPAR) learning platform in rural Mpumalanga, South Africa (2015–25). VAPAR aimed to embed participatory evidence generation and shared learning within routine district processes to support more equitable, community-linked PHC.

Methods: A realist design was used to synthesise data from five action-learning cycles (2017–23), a preceding pilot (2015–16), and an engagement and uptake phase (2023–25). Data included cycle reports, participatory outputs, verbal autopsy (VA) analyses, 22 endline interviews, policy, strategy and planning documents. Using a co-developed theory of change, qualitative data were coded to examine context-mechanism-outcome patterns. Mechanisms were identified and refined through cross-cycle comparison, triangulation, and stakeholder validation.

Results: VAPAR was contextually responsive, adapting to shocks such as COVID-19 and progressively embedding within the district health system. Through regular dialogue, the platform activated generative mechanisms of trust-building, role clarity and recognition, collective sense-making, and strengthened agency, particularly among Community Health Workers (CHWs), whose skills, confidence and legitimacy expanded. These mechanisms operated within an enabling structural context shaped by PHC reforms that strengthened the District Health System and Ward-Based Primary Health Care Outreach Teams, alongside trade-union action for CHW absorption into public service. Institutionalisation followed through Mpumalanga’s revitalised Health Promotion Programme, with adaptation to additional provinces and for outbreak response and emergency obstetric care. Outcomes were interpreted through context-mechanism-outcome patterns, illustrating how participatory learning becomes embedded in decentralised health systems.

Conclusions: Over a decade, VAPAR demonstrated how structured, participatory learning can reshape relationships, strengthen community-linked PHC, and support institutionalisation of routine, evidence-informed practice in decentralised health systems. The findings offer transferable lessons for sustaining learning platforms in resource-constrained settings.

People living with disabilities (PLWD) in Nigeria experience significant disparities in health outcomes and access to care. Among them, individuals living with visual impairment (VI) face compounded barriers due to structural inequities and social exclusion. This paper explores how the Nigerian health system serves PLWD through a socioecological lens, with a focus on those living with VI. We conducted a narrative review using databases such as Medline, Scopus, Embase and Google Scholar, along with policy repositories, to identify peer-reviewed and grey literature. Inclusion criteria focused on studies addressing disability, healthcare access, and Nigeria. Thematic analysis was guided by the Dahlgren and Whitehead‘s socioecological model to explore multilevel determinants affecting access to care for PLWD, particularly those living with VI. Findings reveal systemic failures across political, economic, sociocultural, and environmental domains that limit equitable access to care. Attitudinal barriers, inadequate infrastructure, and weak enforcement of anti-discrimination laws emerged as critical challenges. This analysis underscores the need for multisectoral reforms that address both institutional and societal barriers to inclusion. Strengthening legal frameworks, increasing budgetary allocations for inclusive services, and involving PLWD and people living with VI in policy processes are critical steps toward equitable healthcare delivery.

Introduction: Learning sites have supported intervention development and testing in health care, but studies reflecting on lessons relating to their deployment for health policy and system research (HPSR) in low- and middle-income settings are limited.

Methods: This experience report draws from learning over three continents and five research and community engagement programs—the oldest starting in 2010—to reflect on the challenges and benefits of doing embedded HPSR in learning sites, and how those have been managed. Its objective is to generate better understanding of their potential and constraints. The report draws from team members' experiential insights and program publications.

Results: Challenges relating to initial engagement in the sites included building and maintaining trust, managing partner expectations, and negotiating priority topics and stakeholders. Once the embedded research was underway, sustaining engagement, and managing power dynamics within the group, supporting all participants in developing new skills and managing rapidly changing settings were important. Finally, the complexity of reflecting on action and assessing impact are outlined, along with potential approaches to managing all of these challenges and the variety of gains that have been noted across the programs.

Conclusions: We highlight the potential of learning sites to develop relationships, capacities, and local innovations which can strengthen health systems in the long term and some lessons in relation to how to do that, including the importance of stable, long-term funding as well as developing and recognizing facilitation skills among researchers. Supporting spaces for learning is particularly important when health systems face resource constraints and everyday or acute stressors and shocks.

Introduction: People living with visual impairment (VI) have a higher prevalence of mental health challenges versus those without VI. The occurrence of clinical depression has been estimated at 10% to 40% among this population. Specifically, adults of working age (18-65 years) living with adventitious VI have a higher risk of severe psychological distress, disruption of employment status and attendant loss of income. Hence, our overall research question was: What is known from existing literature about the protective and risk factors for mental health of working age adults (18-65 years) with adventitious total bilateral blindness and low vision?

Methods: Using Joanna Briggs Institute guidance, articles in English were systematically searched across six databases: MEDLINE, PsycINFO, CINAHL, EMBASE, PsycArticles, Web of Science. Searches were also conducted in various websites such as: World Blind Union, World Vision, African Union, and Royal National Institute of Blind People. Two reviewers independently screened titles and abstracts. Full texts were then reviewed by the team. Of 4,352 identified titles, 92 were included. We thematically analysed the evidence using inductive and deductive approaches with the latter informed by Dahlgren and Whitehead’s socioecological model.

Results: Thirteen (13) risk and 10 protective themes were identified. Rehabilitation (protective) was the commonest theme in 30.4% of studies, followed by negative social support (risk) at 17.4%. Most research was conducted in the US (43.5%). Critical findings included: strong socially determined nature of mental health; coexistence of positive and negative social support and limited studies of lived experience. Our analysis also revealed layers of under and mis-representation; these included scarce research from low- and middle-income countries (LMICs), non-uniformity in definitions of blindness and incomplete reporting of participant characteristics.

Conclusion: This is the first scoping review to comprehensively explore protective and risk factors for mental health for people living with adventitious total bilateral blindness and low vision. This study reports multiple upstream drivers acting singularly and in concert to exert a profound determining influence on the mental health of our target population. It also highlights the institutional ways that the condition and related issues are reported, recorded and researched.

Promoción y protección de la salud mental de personas con ceguera adquirida y baja visión:una revisión exploratoria de factores protectores y de riesgo

Introducción: Las personas que viven con discapacidad visual (DV) presentan una mayor prevalencia de problemas de salud mental en comparación con quienes no tienen DV. Se ha estimado que la depresión clínica afecta entre el 10 y el 40% de esta población. En particular, los adultos en edad laboral (18 a 65 años) con DV adquirida tienen un mayor riesgo de sufrir malestar psicológico grave, interrupciones en su situación laboral y la consecuente pérdida de ingresos. Por ello, nuestra pregunta de investigación fue: ¿Qué se sabe, según la literatura existente, sobre los factores protectores y de riesgo para la salud mental de adultos en edad laboral (18 a 65 años) con ceguera bilateral total adquirida y baja visión?

Métodos: Siguiendo las directrices del Instituto Joanna Briggs, se realizó una búsqueda sistemática de artículos en inglés en seis bases de datos: MEDLINE, PsycINFO, CINAHL, EMBASE, PsycArticles y Web of Science. También se hicieron búsquedas en sitios web como World Blind Union, World Vision, African Union y Royal National Institute of Blind People. Dos revisores evaluaron de forma independiente los títulos y resúmenes, y luego todo el equipo revisó los textos completos. De 4.352 títulos identificados, se incluyeron 92. Analizamos la evidencia de manera temática utilizando enfoques inductivo y deductivo, este último guiado por el modelo socioecológico de Dahlgren y Whitehead.

Resultados: Se identificaron trece temas de riesgo y diez temas protectores. La rehabilitación (factor protector) fue el tema más frecuente en 30,4% de los estudios, seguida del apoyo social negativo (factor de riesgo) con 17,4%. Gran parte de la investigación se realizó en Estados Unidos (43,5%). Entre los hallazgos clave destacan: la fuerte influencia social en la salud mental, la coexistencia de apoyo social positivo y negativo, y la escasez de estudios sobre experiencias vividas. El análisis también reveló varias formas de infrarrepresentación y mala caracterización, incluida la escasa investigación en países de ingresos bajos y medianos, la falta de uniformidad en las definiciones de ceguera y la insuficiente descripción de las características de los participantes.

Conclusión: Esta es la primera revisión exploratoria que analiza de forma integral los factores protectores y de riesgo para la salud mental de personas con ceguera bilateral total adquirida y baja visión. El estudio muestra múltiples determinantes estructurales que actúan de forma individual y conjunta, influyendo de manera profunda en la salud mental de la población objetivo. También destaca las formas institucionales en que esta condición y sus temas relacionados se informan, registran y estudian.

Vision loss has been associated with mental health problems such as depression, anxiety, and post-traumatic stress disorder, which significantly impact lives of working age adults with adventitious total bilateral blindness and low vision. It is imperative, therefore, to prioritize the mental health in this population by exploring and understanding the factors that impact on their mental health. Hence, the objective of this scoping review is to identify and chart existing literature on the protective and risk factors of mental health of working age adults with adventitious total bilateral blindness and low vision. We developed this scoping review protocol in line with the Joanna Briggs Institute guidance. This scoping review will include publications in English language with no date restrictions exploring the protective and risk factors of mental health of our study population. A three-step search strategy will be employed. Searches will be carried out in the following databases: Medline, Embase, PsycInfo, PsycArticles, CINAHL and Web of Science. Search for grey literature will be conducted in Google, Google Scholar and Websites dedicated to information on visual impairment. Collated results will be imported into Endnote Basic (Clarivate) for deduplication. Two reviewers will independently conduct double screening of all the titles and abstracts in Rayyan- a web application, and full texts in Endnote while three other reviewers will conduct screening of a subset of for example 10% of titles and abstracts and full texts. Furthermore, two reviewers will independently conduct double data extraction while three other reviewers will revise, cross check, and correct any extraction errors. Extracted data will be presented in tabular formats and summarized descriptively in line with the research objectives. This scoping review will generate evidence on factors impacting the mental health of the working age adults with adventitious total bilateral blindness and low vision as well as critically highlight gaps in the literature. The findings will inform and critically underpin future empirical research which will explore the lived experiences of working age people with adventitious total bilateral blindness. Additionally, evidence from this review will inform the development of interventions in the promotion of mental health as well as assisting rehabilitation specialists and workers, public health practitioners and other relevant stakeholders in addressing the mental health needs of working age adults with adventitious total bilateral blindness and low vision.

Background: Ethiopia faces significant mental health challenges; mental disorders are the leading non-communicable condition, and many adults experience symptoms by age 14–15. We examined structural, institutional, and agentic factors affecting child and adolescent mental well-being in Ethiopia. The aims were to describe the political, economic, social and policy contexts in which mental well-being exists; analysing power, interests, and the influence and resources key stakeholders bring to bear on decision-making processes related to child and adolescent well-being.

Methods: We used a Political Economy Analysis framework to identify structural and institutional features, networks of influence, and routes for change. Using this lens, a literature review was performed, supplemented with key informant interviews (n = 9).

Results: Multiple structural drivers of mental health problems were identified: globalized urbanization and social fragmentation, and political and economic systems characterized by economic ambition but entrenched poverty, aid dependency, conflict and civil war. Despite significant policy recognition and support, there was poor coordination between federal and regional structures and sectors, vastly insufficient resources, and low coverage especially in rural areas. Service delivery was further complicated by widespread and normalised violence against children and young people, low knowledge and awareness among children and families, entrenched stigma and gender inequities, and ethnic tensions, conflict and displacement. Overall, regional resource shortages drastically limited the collective agencies of service users and providers. Meanwhile, development programmes lack context and coordination. The analysis emphasizes an urgent need to enhance implementation support through targeted, contextually relevant mental health policies and programmes, and institutional expansion of spaces and processes for multisectoral working, especially between health and education. Development partners should align with statutory bodies as a mechanism to harmonise and contextualise.

Conclusion: The government’s tendency to formulate national programs and strategies is positive, but lack of regional funding and support limit effectiveness. Schools and healthcare environments can play powerful roles supporting mental health, however, experience considerable challenges related to resourcing, and lack spaces and processes for multisectoral working. There is a pressing need to resource and support implementation and collaboration capabilities of the school community and healthcare sector to promote mental wellbeing and provide culturally engaged services.

Objectives: To use verbal autopsy (VA) data to understand health system utilisation and the potential avoidability associated with fatal injury. Then to categorise any evident barriers driving avoidable delays to care within a Three-Delays framework that considers delays to seeking (Delay 1), reaching (Delay 2) or receiving (Delay 3) quality injury care.

Design: Retrospective analysis of existing VA data routinely collected by a demographic surveillance site.

Setting: Karonga Health and Demographic Surveillance Site (HDSS) population, Northern Malawi.

Participants: Fatally injured members of the HDSS.

Primary and secondary outcome measures: The primary outcome was the proportion of fatal injury deaths that were potentially avoidable. Secondary outcomes were the delay stage and corresponding barriers associated with avoidable deaths and the health system utilisation for fatal injuries within the health system.

Results: Of the 252 deaths due to external causes, 185 injury-related deaths were analysed. Deaths were predominantly among young males (median age 30, IQR 11–48), 71.9% (133/185). 35.1% (65/185) were assessed as potentially avoidable. Delay 1 was implicated in 30.8% (20/65) of potentially avoidable deaths, Delay 2 in 61.5% (40/65) and Delay 3 in 75.4% (49/65). Within Delay 1, 'healthcare literacy' was most commonly implicated barrier in 75% (15/20). Within Delay 2, 'communication' and 'prehospital care' were the most commonly implicated in 92.5% (37/40). Within Delay 3, 'physical resources' were most commonly implicated, 85.7% (42/49).

Conclusions: VA is feasible for studying pathways to care and health system responsiveness in avoidable deaths following injury and ascertaining the delays that contribute to deaths. A large proportion of injury deaths were avoidable, and we have identified several barriers as potential targets for intervention. Refining and integrating VA with other health system assessment methods is likely necessary to holistically understand an injury care health system.

This data note provides details of the development of a Verbal Autopsy (VA) dataset produced with the South African Population Research Infrastructure Network (SAPRIN) drawing on datasets from health and socio-demographic surveillance sites' (HDSS) ' covering a population of over 250,000 in two rural provinces in South Africa for the period 2012-2019. The purpose of the data set was to refine an analytical tool within VA, which provides unique information on care seeking and utilisation at and around the time of death complementary to that of medical cause of death. On an individual basis, the dataset includes demographic data, probable cause of death data, and data on care seeking and utilisation at or around the time of death drawn from longitudinal population cohorts. The purpose of this publication is to describe both the dataset and methods in formatting and processing the data for other researchers who may be interested in similar data. The data described in this paper are available to be requested from the respective HDSS repositories.