School of Community and Public Health
Permanent link for this collectionhttps://hdl.handle.net/10292/10764
The School of Community and Public Health includes the following groups:
• Public Health
• Hauora Māori
• Disaster Risk Management and Development
• Pacific Health
• Violence and Trauma
• Health Law and Ethics
• Psychotherapy
• Counselling
• Mental Health & Addictions
• Lived Experience
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Item The Potential of a Rights-based Approach to Refugee-focused Mental Health Policy in Aotearoa New Zealand(Taylor & Francis Group, 2024-09-16) Vanderpyl, Lucie; Charania, Nadia; Treharne, Gareth J; Al Naasan, ZeinaIn accordance with international human rights commitments, individuals with a refugee background have the right to mental health services that are available, accessible, acceptable, and of good quality. However, refugee-background individuals living in Aotearoa New Zealand experience a myriad of barriers at the individual, community, and policy level that impede access to appropriate mental health services. This commentary puts forward the argument that the incorporation of a human rights-based approach to mental healthcare service at a policy level is essential for reducing barriers to care and increasing the accessibility of mental health services. The article provides key recommendations for reforming the current New Zealand Refugee Resettlement Strategy (NZRRS) to include rights-based indicators for children and youth, to monitor accessibility relative to geographic location, to disaggregate data, to extend the 12-month monitoring period and to extend monitoring beyond one mental health visit. Further research is needed to understand how best to implement these recommendations and develop insight into how Aotearoa New Zealand can more effectively uphold the rights of refugee-background individuals with the ultimate goal of developing a mental health system that is more inclusive and responsive to their needs.Item Chinese and Indian Migrant Mothers’ Perceptions and Experiences of Utilising Maternal and Early Childhood Healthcare Services in Aotearoa New Zealand: A Qualitative Descriptive Study(Informa UK Limited, 2024-07-14) Bhatia, Anjali; Qi, Hongxia; Charania, Nadia AAlthough the health system in Aotearoa New Zealand is based on universalism and equity, disparities exist in the uptake and quality of health care for ethnic-migrant mothers and their children. This qualitative descriptive study explored the perceptions and experiences of Chinese and Indian migrant mothers (N = 24) accessing maternal and early childhood healthcare services. Semi-structured interviews and focus groups were conducted and data were analysed using reflexive thematic analysis. Three themes were generated. Migrant mothers displayed limited awareness of services available for themselves and their children, and experienced difficulties navigating the complex and fragmented health system. Transnational ties influenced mothers’ expectations of care and health seeking practices for themselves and their children. Mothers shared suggestions for a system that is inclusive of migrants’ needs, such as offering orientation sessions to raise awareness and ease navigation challenges, having interpreters available and translated resources to support language challenges, and improve postpartum support as mothers adapt to motherhood. To improve health equity, it is important that national policy supports improvements to the health system to address the challenges faced by ethnic-migrant families when navigating health services.Item The Prevalence and Predictors of Clinical Breast Cancer Screening in Sub-saharan African Countries: A Multilevel Analysis of Demographic Health Survey(Frontiers Media SA, 2024-09-13) Hailegebireal, AH; Bizuayehu, HM; Wolde, BB; Tirore, LL; Woldegeorgis, BZ; Kassie, GA; Asgedom, YSBackground: Despite a higher rate of breast cancer in sub-Saharan Africa (SSA), efforts to treat the disease through breast cancer screening are suboptimal, resulting in late diagnosis of breast cancer and poor outcomes. Several studies have been conducted in SSA countries about screening uptake, yet they addressed country or sub-country level data and did not consider both individual and beyond-individual factors related to screening. Hence, pooled prevalence as well as multilevel correlates of screening in the region is sparse, which have been addressed by this study using the most recent data among women with SSA. Methods: This study was conducted using the Demographic Health Survey data (2013–2022) from six countries, and a total weighted sample of 95,248 women was examined. STATA version 16 was used for the data analysis. Multilevel mixed-effects logistic regression was performed and significant predictors were reported using adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). Results: The overall weighted prevalence of clinical breast cancer screening was 14.23% (95% CI: 13.97–14.75), with Namibia and Tanzania having the highest (24.5%) and lowest (5.19%) screening rates, respectively. Higher breast cancer screening uptake was observed among women of advanced age (35–49) [aOR = 1.78; 95% CI: 1.60, 1.98], had higher educational levels [aOR = 1.84; 95% CI: 1.66, 2.03], cohabited [aOR = 1.37; 95% CI: 1.21, 1.55], in the richest wealth quintile [aOR = 2.27; 95% CI: 1.95, 2.64], urban residents [aOR = 1.21; 95%CI: 1.10, 1.33], multiparous [aOR = 1.47; 95% CI: 1.30, 1.68], visited health facilities [aOR = 1.64; 95% CI: 1.52, 1.76], and read newspapers [aOR = 1.78; 95%CI: 1.60, 2.15]. Conclusion: The prevalence of clinical breast cancer screening was low (14%). Strengthening awareness campaigns, improving healthcare infrastructure, health education, universal health coverage, and screening program access, with a focus on rural areas, women who lack formal education, and low socioeconomic status, are critical to increasing breast cancer screening rates and equity. Scale-up local and regional collaborations and the involvement of media agencies in the implementation of screening programs, advocacy, dissemination of information, and integration of screening programs with their routine care, such as perinatal care, can boost the screening. The existing health service delivery points also need to focus on integrating breast cancer screening services with routine care such as perinatal care.Item Ngā Tāpiritanga: Secure Attachments from a Māori Perspective(Te Mātāpuna | AUT Library, 2018-09-24) Fleming, Anna HinehouWhile Western attachment theory has tended to focus on the interpersonal attachments between people, indigenous Māori attachment perspectives have always included connections and relationships to aspects outside of the interpersonal domain. Collective, cultural and tikanga-based extrapersonal relationships are significant in Te Ao Māori and include connection to whānau/hapū/iwi (extended family and community groups), whenua (land and the natural world), and wairua (interconnection and spirituality). Alongside vital interpersonal relationships, these extrapersonal connections are substantial to the development of an indigenous Māori self which is well and supported within a holistic framework. This article explores the extrapersonal connections outlined above, their importance to Hauora Māori and implications for the practice of psychotherapy in Aotearoa New Zealand. Whakarāpopotonga I te wā e warea ana te arotahi kaupapa piripono a te Uru ki te piringa whaiaro tangata ki te tangata, ko tā te Māori tirohanga piripono he whakauru i ngā here ngā whanaungatanga ki ngā āhuatanga i tua atu i te ao whaiaro. He take nunui te whānau kohinga ahurea o te Ao Māori whakakaohia ki tēnei te here ā-whānau, ā-hāpū, ā-iwi (whānau whānui me ngā rōpū hāpori), te whenua, te taiao me te wairua (ngā taura here, te waiuratanga). I tua atu o ngā here whaiaro he wāhanga tino nui tō ēnei kohinga ahurea ki te whanaketanga o te mana motuhake o te tangata whenua Māori e ora ana e tautokohia ana e te papa whānui nei. E wherawhera ana tēnei tuhinga i ngā here whakawaho kua whakaarahia i runga ake nei, te hira o ēnei ki te Hauora Māori me ngā whakahīrau mō ngā mahi hauora hinengaro i Aotearoa.Item Te Au Marama: Bound to the Movements of Taiao(Auckland University of Technology, 2025-11-24) Warbrick, Isaac; Heke, Deb; Johnson, TomItem Ethical Tensions in the Ethics Review of Scholarship of Teaching and Learning Projects: Revealing Values from a Health Faculty in Aotearoa New Zealand.(Georgia Southern University, 2025-11-18) Lees, Amanda B; Godbold, Rosemary; Walters, SimonThis study employed a case study approach to explore ethical conduct in Scholarship of Teaching and Learning (SoTL) research. Originating within biomedical research, the remit of ethics review bodies now commonly extends to assessing SoTL projects. Set within a health faculty at a university in Aotearoa New Zealand, we examined student and academic perspectives on ethical conduct in SoTL research to gauge how their values align with those who decide on ethical standards of research involving them. Drawing on reflexive thematic analysis, our findings reflect tensions between the relational and cultural values of SoTL and the biomedically based values of ethics review. Conflict within the dual role of the academic as both teacher and researcher, whilst of concern to ethics review bodies and academics, is not recognised as being as problematic by students, who do not feel pressure to participate. A greater focus on the learning opportunities afforded to students through SoTL research participation is warranted.Item The Nasal Ecosystem as a Sentinel Interface for One Health Surveillance in an Era of Converging Crises(Springer Science and Business Media LLC, 2025-11-21) Alao, Jude Oluwapelumi; Bamigboye, Favour OluwadaraThe interconnectedness of human, animal, and environmental health demands surveillance systems capable of predicting cross-boundary threats. We propose a solution already inside us: the nasal microbiome. Positioned at the interface of environmental exposure, zoonotic transmission, and immune regulation, the nasal microbiome could serve as an early-warning system for pandemics, antimicrobial resistance (AMR), and climate-driven health impacts. Emerging evidence supports its predictive capacity, but many applications remain conceptual and require systematic validation. We therefore outline a roadmap for standardising nasal microbiome monitoring across One Health sectors, with the potential to shift global disease surveillance from reactive to proactive and enable timely interventions before threats escalate.Item Removing Systemic Barriers to Register Overseas Trained Doctors in New Zealand While Preventing Their Mental Distress(Adjacent Digital Politics Ltd, 2025-10-03) Mpofu, Charles; Wepa, DianneDr Charles Mpofu and Dr Dianne Wepa discuss removing systemic barriers for overseas-trained doctors registering in New Zealand while also addressing mental health challenges. New Zealand (NZ) depends on internationally trained medical graduates (IMGs), yet too many remain blocked from practice by processes that are slower, costlier and less flexible than comparable jurisdictions. This article distils evidence and international practice to outline balanced, pragmatic reforms that uphold patient safety while accelerating IMG integration. It highlights solutions for experienced practitioners and refugee doctors, ensuring their mental health distress is minimised and communities can access care when and where it is needed.Item Psychological Health in Marginalised Women Living in Witches’ Camps in Ghana(Springer Science and Business Media LLC, 2025-11-10) Yakubu, Yakubu H; Siegert, Richard J; Krägeloh, Christian U; Aziato, Lydia; Holroyd, EleanorAnxiety and depression are prevalent mental health issues, particularly affecting older women in vulnerable circumstances. In Ghana, older women accused of witchcraft endure severe mental health challenges due to stigmatisation and isolation. Many are sent to live in witches’ camps for safety, where they face limited access to care. This study investigated the prevalence of anxiety and depression among marginalised women in witches’ camps compared to women in the general population, highlighting the social factors associated with their mental well-being. The researchers employed a cross-sectional quantitative study design. Data were collected from 168 women from two witches’ camps in northern Ghana and 100 women from the general population using the Dagbani version of the Hospital Anxiety and Depression Scale (HADS). Camp participants were also asked supplemental questions about their living conditions and circumstances. Anxiety and depression scores were significantly higher among camp residents (M = 14.73, SD = 1.46 for anxiety; M = 17.85, SD = 1.55 for depression) compared to the general population (M = 6.18, SD = 2.43 for anxiety; M = 4.18, SD = 3.00 for depression). Common health complaints among the women from the witches’ camps were joint pain and hypertension. Social isolation and poor living conditions may have also impacted the women’s mental well-being in the witches’ camps. Many women in the camps relied on traditional medicine for treatment, and despite desiring to return home, many remained uncertain if they could go home. Women in witches’ camps in Ghana experience significantly higher anxiety and depression as well as adverse social conditions, such as poor housing, isolation, and unemployment. The study emphasises the need for mental health interventions addressing the unique emotional needs of these women and highlights the role of social determinants in mental health policies.Item Home-insemination: The Motivations and Experiences of Same-sex and Gender Diverse Couples Using Self-insemination and Known Donors to Conceive in Aotearoa New Zealand(Informa UK Limited, 31/10/2025) Fyfe, Angela; Goedeke, Sonja; Du Preez, ElizabethDonor conception that occurs outside of clinical fertility settings is understood to be increasingly common, yet research on this practice remains limited. Drawing on interviews with eleven participants, this study explored the motivations and experiences of same-sex and gender diverse couples who used known donors and home insemination methods to conceive. While participants were parents of children conceived after the introduction of the Human Assisted Reproductive Technology [HART] Act (2004) in Aotearoa New Zealand, conception outside regulated settings meant they were not subject to the medical, ethical, or legal procedures implicit within fertility clinics. Four main themes were identified (1) Finding the ‘ideal donor’- participants sought donors who were ‘good’ people; known donors were chosen to enable relational processes and facilitate ongoing connections, (2) Home insemination - perceived as affordable, personal, and offering greater agency; though revealing potential relational awkwardness, (3) Relationship planning/envisaged relationships: not the ‘donor dad’ - participants constructed donors as ‘helping uncles’ or extended family members with ongoing, contracted roles, (4) Lack of and need for knowledge, understanding and relevant support for self-insemination using known donors. This study highlights the need for accessible, evidence-based resources and psychosocial support to benefit and protect all donor conception stakeholders.Item Tips to Maximize Learning in Large Group Teaching Sessions for Health Professions Educators: A Narrative Review(Egyptian Knowledge Bank, 2025-07-01) Kamal, Doaa; Hassan, Nahla; Hassouna, Amira; El Tarhouny, ShereenObjective: This study aims to explore effective strategies and considerations for enhancing learning outcomes in large group teaching settings for health professions educators. Methods: A comprehensive review of literature was conducted to identify key factors influencing learning effectiveness in large group teaching within health professions education. Various pedagogical approaches, technological tools, and instructional methodologies were examined to determine their impact on maximizing learning in large group settings. Results: The findings highlight the importance of incorporating active learning techniques, fostering student engagement, and utilizing artificial intelligence (AI) to optimize learning outcomes in large group teaching. Strategies such as interactive lectures, group discussions, case-based learning, and simulation exercises were identified as effective methods for promoting active participation and knowledge retention. Additionally, creating a supportive learning environment, providing timely feedback, and encouraging collaborative learning were found to enhance student satisfaction and overall learning experiences. Conclusion: To achieve optimal learning outcomes in large group teaching for health professions educators, it is essential to adopt a comprehensive approach that combines inventive teaching methods, AI learning aids, and a nurturing educational atmosphere. Further research is needed to explore long-term impact of these strategies and to identify additional approaches for enhancing learning in large group teaching settings.Item Nasal–Gut Microbiome Axis in Health and Disease(Elsevier, 2025-10-20) Alao, Jude Oluwapelumi; Bamigboye, Favour OluwadaraThe nasal and gut microbiomes are recognised as key regulators of mucosal and systemic immunity. While each has been studied extensively in isolation, evidence suggests they are connected through a bidirectional network of immune signalling, microbial metabolites, and barrier integrity, forming what may be termed “the nasal–gut microbiome axis”. This review synthesises current knowledge on the composition and function of these microbiomes, highlighting shared features, environmental influences, and patterns of dysbiosis observed in conditions such as asthma, allergic rhinitis, and chronic rhinosinusitis. We examine potential mechanisms of cross-talk, including cytokine and chemokine exchange, short-chain fatty acid mediated epigenetic regulation, and dendritic cell–driven immune priming across mucosal sites. Clinical implications are explored, with particular attention to dual-site microbiome modulation strategies, concurrent nasal–gut microbial profiling for diagnostics, and microbiome-informed precision therapies. Despite promising early evidence, knowledge gaps persist, particularly the scarcity of longitudinal, multi-omic studies and mechanistic human data. Framing the nasal and gut microbiomes as components of an integrated mucosal network, this review aims to advance understanding of their connection, and encourage research that could transform prevention and treatment strategies for immune-mediated respiratory disease.Item Reliability of a Modified 24 h Dietary Recall and Veggie Meter to Assess Fruit and Vegetable Intake in New Zealand Children(MDPI AG, 2025-10-20) Patel, Varshika V; Perera, Thalagalage Shalika Harshani; Rush, Elaine; McArley, Sarah; Wham, Carol; Rowlands, David SAdequate intake of fruits and vegetables (F + V) supports healthy growth and development in children, yet many New Zealand children do not meet national dietary recommendations, and methods to evaluate intake require good reliability. Objectives: To establish the validity and reliability of a modified 24 h multiple pass recall (MPR) for evaluating F + V and carotenoid intakes in children aged 9–13 years. The reliability of the Veggie Meter® (VM®), a non-invasive reflection spectrometer to estimate skin carotenoid scores and derive blood carotenoid concentrations, was also examined. Methods: Thirty-two children (20 boys, 12 girls) completed three 24 h MPRs and parent-assisted weighed food diaries (WFDs) on randomised weekdays and weekends. Skin carotenoid scores were assessed using the VM®. The validity of the MPR was evaluated against WFDs using log-transformed Pearson correlations and mean x-axis bias. The reliability was assessed by the coefficient of variation (CV) and Pearson correlations. Results: Participants did not meet recommended F + V intakes (5–5.5 servings/day): MPR (mean fruit 1.3 servings/day; vegetables 2.0), WFD (fruit 1.3; vegetables 1.9). The MPR was a valid tool to estimate fruit and vegetable daily servings (combined-day Pearson coefficients > 0.71) with only trivial–small standardized mean bias-offset vs. WFD; however, the reliability was poor for the MPR-estimated carotenoid intake (CV 126%) and F + V intake. In contrast, the VM® was reliable (Pearson correlation 0.97–0.99) with low measurement error (CV 4.0–5.2%). Conclusions: The modified 24 h MPR was valid but unreliable for estimating F + V and carotenoid intake. The VM® demonstrated high reliability as a biomarker of skin carotenoid status in children.Item Intersecting Challenges and Ways Forward: The Impact of the Covid-19 Pandemic on an Urban First Nations Community in Southern Ontario, Canada(Public Library of Science (PLoS), 2025-10-27) Liberda, Eric N; Ahmed, Fatima; Spence, Nicholas D; Plain, Sarah; Moriarity, Robert J; Tsuji, Leonard JS; Charania, Nadia AThe COVID-19 pandemic has had wide-ranging impacts on communities worldwide, with Indigenous communities in southern Ontario, Canada, being no exception. Partnering with Aamjiwnaang First Nation, we explored the multifaceted impacts of the pandemic and learnings for the future. This study utilized semi-structured interviews with the community’s pandemic committee and other front line essential services (N = 12) to explore the nuanced dimensions of the pandemic’s effects. Data were analysed using a template approach to codebook thematic analysis to examine various aspects of the pandemic response. Five main themes were identified, including: (i) Wellbeing and mental health, (ii) Work-life balance, (iii) Community and social factors, (iv) Organizational dynamics, and (v) Lessons learned and future planning. Our findings unveiled a multifaceted spectrum of challenges, encompassing socioeconomic, psychological, and organizational aspects, which the First Nations community encountered amidst the pandemic. Despite these challenges, the commitment to community adaptation and collaboration highlighted the resilience cultivated through strong Indigenous leadership, trusting partnerships, and transparent communication, contributing to an effective response. This research stresses the need for future pandemic preparedness efforts to prioritize Indigenous leadership and address the social and cultural determinants of Indigenous health. Additionally, to effectively address future environmental and health emergencies, there is a pressing need to adopt an all-hazards approach and develop comprehensive, yet adaptable plans tailored to meet the diverse needs of communities.Item Beyond One-Size-Fits-All: Integrating Traditional Knowledge and Addressing Historical Trauma and Health Inequities in New Zealand for South-Asian Communities(Asian Academics in Aotearoa Association (A4), 2025-09-09) Lee, Bible; Kaur-Devgun, NavneetNew Zealand is now home to approximately 350,000 South Asians, and many carry unacknowledged, intergenerational historical trauma that profoundly shapes their health experiences. The enduring legacies of the 1947 Partition, British colonisation, including famines caused by colonial policies that resulted in millions of Indian deaths to enrich the British colonial empire, have left deep psychological and other intergenerational health imprints. Currently, many South Asians in Aotearoa still actively draw upon traditional healing systems alongside Western medical treatment. Yet, these ancient and community-validated practices remain largely invisible and unacknowledged in mainstream clinical settings. Traditional South Asian health knowledge, such as Ayurveda, Unani medicine, Siddha, and spiritual healing, is often disregarded or dismissed within Aotearoa New Zealand’s clinical contexts as lacking empirical evidence. This research addresses this critical gap by exploring how traditional and historical South Asian healing knowledge can be meaningfully recognised, respected, and woven into Aotearoa’s healthcare landscape to provide more holistic care for South Asians in Aotearoa. This mixed-methods study involves semi-structured interviews with 20 South Asian adults living outside Auckland, a systematic literature review, and a demographic survey. Guided by Kaupapa Māori methodology, the project honours traditional South Asian health knowledge as taonga and upholds cultural safety and epistemic justice as central principles. This study contributes to the growing field of Asian health equity research in Aotearoa by establishing an evidence base for policymakers, clinicians, and researchers. The project highlights the importance of respecting, integrating, restoring and valuing traditional and historical South Asian health knowledge within culturally responsive and equitable healthcare systems for New Zealand’s fastest-growing population. Importantly, this project argues that Aotearoa’s public health system does not need to remain solely biomedical and Western-dominated. Instead, it should evolve to embrace pluralistic approaches and find opportunities to honour both clinical efficacy and culturally grounded methods that reflect the diversity of its people.Item Colonial Legacy and Lung Cancer Inequities Among Rural Māori Men: A Social Epidemiological Analysis(Asian Academics in Aotearoa Association (A4), 2025-09-09) Lee, Bible; Hasan, FahmidLung cancer remains one of the leading causes of cancer-related mortality in Aotearoa New Zealand, disproportionately affecting Māori communities. Data consistently show that rural Māori men experience pronounced inequities in lung-cancer incidence, access to timely screening, and quality of care. The enduring legacies of colonisation, systemic racism, geographic isolation, and cultural disconnection continue to shape these disparities. Yet, there is limited research examining the intersection of rurality, Māori identity, and structural determinants influencing lung-cancer outcomes. This study is framed by a social epidemiological lens and grounded in a Kaupapa Māori paradigm. Currently, no lung-cancer care model specifically addresses the needs of rural Māori men in Aotearoa. The project involves semi-structured interviews with 50 Māori men living in rural regions across Aotearoa, with interview questions informed by a focused literature review that incorporates both peer-reviewed and grey literature. The research questions explore equity-focused approaches to care by drawing on Māori health frameworks—Te Whare Tapa Whā, Te Pae Mahutonga, and Te Wheke—alongside international Indigenous literature and Māori-led health strategies. The project also recognises that Aotearoa’s public-health system does not need to remain solely biomedical and Western-dominated; instead, it should evolve to embrace Indigenous-led and community-driven models of care that reflect the diversity and sovereignty of Māori worldviews. As an international postgraduate student, I position this work as a contribution to cross-cultural and equity-focused dialogue in public health. The presentation offers preliminary insights to inform future community-led interventions and culturally grounded policy reform aimed at achieving lung-cancer equity in Aotearoa.Item Exploring the Meaning of "Asian" in Aotearoa and the Way Forward(Asian Academics in Aotearoa Association (A4), 2025-09-09) Lee, BibleThe category “Asian” in Aotearoa New Zealand is broad and complex. It encompasses diverse languages, histories, religions, and migration experiences - yet is often treated as a single homogenous group in the census. This raises important questions: What does it mean to be “Asian” in Aotearoa? How do we celebrate the richness of our communities while also recognising shared experiences of invisibility, marginalisation, and resilience? According to the 2023 Census, Asians now comprise 17.3% of New Zealand’s population, making them the largest non-European ethnic group and a significant demographic milestone in the nation’s evolving diversity. In a country founded on Te Tiriti o Waitangi and shaped by increasing social diversity, Asian academics, community leaders, postgraduate students, and ethnic organisations are being called upon to build visibility, belonging, and leadership pathways. This requires moving beyond narrow definitions toward a collective understanding of the term "Asian" -embracing differences while fostering solidarity. This conference offers a platform to reflect on these questions and envision the way forward. Together, we will explore how Asian peoples in Aotearoa can connect across cultures, collaborate across sectors, and create supportive structures that will empower future generations. We also acknowledge lessons from our Pacific colleagues, who have built strong cross-institutional networks to protect cultural integrity and advance equity. By coming together, we can begin shaping a future where Asian peoples of Aotearoa are visible, valued, and supported to thrive, contributing to a more just and inclusive society.Item Assessment of COVID-19 Severity Levels and Associated Factors Among Patients Admitted to the Treatment Centers in Southern Ethiopia(Frontiers Media SA, 2024-10-31) Tirore, LL; Sergindo, MT; Areba, AS; Hailegebireal, AH; Desalegn, MBackground: COVID-19, a highly impactful infectious disease, has been observed to result in psychological distress, organ impairment, and mortality. The severity and consequences of the illness appear to vary based on geographical location and individual characteristics. Understanding the disease and optimizing resource distribution through early classification depend on having data on the severity of COVID-19 patients. There is a dearth of information in this particular region regarding the severity of COVID-19 patients and related factors. Therefore, this study used an ordinal logistic regression model to determine the severity levels of COVID-19 and its associated components. Materials and methods: A retrospective follow-up study was conducted on COVID-19 patients admitted between May 30, 2020, and October 15, 2021, at care centers in southern Ethiopia. 845 patients were included in this research. The mean (standard deviation) and median (interquartile range) were used to summarize the data. A multivariable ordinal logistic regression model was used to study the association between independent variables and COVID-19 severity levels. Results: In terms of the severity of the disease, 12.07% of patients had severe COVID-19, 7.81% had critical disease, and 6.39% had moderate disease. 8.28% of the 845 patients died, while 88.88% of them made a full recovery. Older age (> = 40 years) (AOR = 5.75, 95% CI = 3.99, 8.27), comorbidities (AOR = 4.17, 95% CI = 3.03, 5.88), and low oxygen saturation (AOR = 3.44, 95% CI = 2.23, 5.56) were significantly linked to higher odds of experiencing more severe levels of COVID-19 compared to their counterparts. Conclusion: 7.81% of patients were critically ill, while more than one-tenth (12.07%) were considered severely ill. Low oxygen saturation, comorbidities, and advanced age were found to be significantly associated with COVID-19 severity. Therefore, it is crucial to manage comorbidities, provide special treatment, and provide COVID-19 patients with underlying medical issues more attention due to the higher risk of poor outcomes. To speed up their recovery, medical professionals should regularly monitor and provide specialized care to older COVID-19 patients. In order to identify patients who are more likely to experience a severe illness and to better manage their treatment, it is imperative that oxygen saturation levels in COVID-19 patients be promptly identified and monitored.Item How Organisational Dynamics Impact Decision Latitude, Social Support, Self-Identity Through Work and Job Insecurity for Nurse Practitioners(Wiley, 2025-02-24) Wright, Isabella; Vorster, Anja; Merrick, EamonAIM: To identify whether nurse practitioners (NPs) in New Zealand (NZ) have the organisational opportunities to make decisions related to performing their role. DESIGN: A cross-sectional study of self-reported decision-making, social support, psychosocial demands and identification with role in a representative population of NPs employed in a range of practice settings in NZ. METHODS: This study utilised the internationally validated Job Content Questionnaire. Reliability and construct validity were assessed using co-efficient α and confirmatory factor analysis. Linear regression analyses were conducted to understand the strength and direction of the relationships between the constructs. RESULTS: All scales demonstrated acceptable levels of internal reliability. Factor analysis supported a five-factor model, with decision latitude, psychological job demands, co-worker support, supervisor support and job insecurity as the main factors fitting the theoretical model. Regression models suggested that NPs (n = 169) have more control over their decision-making when supported by their colleagues rather than supervisors. NPs perceive improved relationships with healthcare consumers if they feel an increase in support from their colleagues; this relationship is mediated by the freedom to make decisions. NPs in rural settings had more job security when they felt valued and appreciated at work. CONCLUSION: The presence of collegial support significantly influences the freedom and autonomy of NPs in making decisions. Workforce policy, the organisation of practice and vocational training may be effective ways of helping NPs expand access to healthcare services. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Collegial and supervisory support are critical for NPs to work to their full scope. A funded, first-year-in-practice vocational training program designed to support role transition, foster collegial support and build a community of practice for newly qualified NPs. IMPACT: For the first time, nurse practitioner decision-making and autonomy determinants have been described in NZ. These findings should be considered within the context of international evidence and in global nursing workforce policies that seek to create opportunities for NPs to work to the limit of their scope. REPORTING METHOD: The authors have adhered to relevant EQUATOR guidelines-STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.Item Socioeconomic and Educational Influences on Malaria Prevention and Treatment Behaviours in Rural Nigeria(Springer Science and Business Media LLC, 2025-09-24) Alao, Jude Oluwapelumi; Olowoshile, Oluwadamilare Peter; James, Timothy Adetayo; Okezie, Chinonso Chinaza; Adebayo, Zainab Pamilerin; Ogbonna, Success Chimbuchi; Oyelayo, Emmanuel AdedejiMalaria remains a leading cause of morbidity and mortality in rural Nigeria, where socioeconomic, educational, and informational factors critically influence prevention and treatment behaviours. Methods This study is a cross-sectional analysis of the 2021 Malaria Indicator Survey (MIS) to investigate the relationships between household income, education, media exposure, and key malaria control outcomes among rural populations. Three complementary analyses were conducted: household-level associations between income and insecticide-treated net (ITN) ownership and use (n = 5,021 households); individual-level associations of education with malaria prevention awareness and ITN use among women aged 15–49 years (n = 9,546); and the influence of media exposure on malaria treatment-seeking behaviour (n = 893). Results Results indicated near-universal ITN ownership across income groups, demonstrating equitable distribution (97.7%), but usage was significantly lower (70.3%). However, ITN use varied inversely with income, with low-income households having 3.6 times higher odds of ITN use (95% CI: 3.07–4.29). Among women, education was a strong predictor of malaria prevention awareness, with higher education levels associated with increased knowledge (p < 0.001). Paradoxically, ITN use decreased as education increased, suggesting that behavioural or contextual factors modulate preventive practice despite greater awareness. Media exposure did not significantly influence the type of healthcare service accessed for malaria treatment, indicating that information access alone may not determine treatment-seeking patterns. Conclusions These findings highlight complex relationships between social determinants and malaria control behaviours. While ITN distribution efforts have achieved broad coverage, targeted behavioural interventions may be needed to improve ITN utilisation, particularly among higher-income groups who may underestimate their risk. Education is associated with increased awareness, but this does not necessarily lead to net use, highlighting the need for strategies that address barriers beyond knowledge. The limited impact of media exposure on treatment choices calls for comprehensive approaches that go beyond simply disseminating information, addressing structural and cultural factors in healthcare utilisation. Policymakers, including the Nigerian Ministry of Health (MOH) and the National Malaria Elimination Programme (NMEP), should design interventions that combine education, community engagement, and practical support to ensure sustained behaviour change. This study provides information to help optimise malaria control strategies and reduce the malaria burden in rural Nigeria by addressing both knowledge gaps and real-world barriers to prevention and treatment.