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Integration of oral health into primary health care in Somalia: opportunities, barriers, and system-level implications for universal health coverage

Background Oral diseases are among the most common noncommunicable conditions globally, yet oral health remains poorly integrated into primary health care (PHC) and universal health coverage, especially in fragile, low-limited settings. As Somalia rebuilds its health system through the Health Sector Strategic Plan III 2022–2026, the Essential Package of Health Services 2020, the Investment Case for the Somali Health Sector 2022–2027, and community health reforms, this study examined the place of oral health within national health policies. It identified barriers to integration and explored feasible pathways for strengthening PHC-based oral health. Methods The study used a qualitative policy and health-systems analysis combining documentary review with 13 key-informant interviews. Participants represented national policymakers, health-system technical advisers, regulators, academics, professional associations, and providers at public hospital, and private dental settings. Data were analyzed thematically and mapped against the WHO health-system building blocks, PHC principles, and the WHO Global Strategy and Action Plan on Oral Health 2023–2030. Results Somalia's policy environment offers opportunities for oral health integration, but stakeholders highlighted a persistent gap between policy recognition and implementation within routine PHC. Seven interrelated themes were identified: (1) policy recognition without operationalization; (2) fragmented governance, weak regulation, and limited coordination; (3) reliance on out-of-pocket financing and private-sector; (4) workforce, education, and task-sharing constraints; (5) predominantly curative, urban, hospital-based service with weak linkage to maternal and child health (MCH) and PHC; (6) limited oral health data and evidence generation; and (7) opportunities for phased integration through PHC, MCH, school health, community health workers, and NCD platforms Policymakers emphasized the need for stronger policy implementation, financing, regulation, standards, and data systems, while service providers highlighted unaffordable care, delayed care-seeking, workforce and infrastructure shortages, and missed opportunities for prevention. Conclusion Oral health integration in Somalia is a broader health system challenge rather than solely a dental-service issue. The most feasible approach is a phased, system-based model that prioritizes strengthened governance, a defined minimum oral health within PHC, workforce task-sharing, screening, counselling, referral pathways, private-sector regulation, essential commodities, and oral health indicators in District Health Information System 2 (DHIS2), followed by the gradual expansion of curative and rehabilitative services.

Saido Gedi, Salma Ali Ossoble, Mohamoud M. Dahir et al.

“I Put Her in the Baby Stroller and Left”: The Escape Route From Violence to a Domestic Violence Shelter for Mothers and Children

Little is known about mothers’ and children's escape from violence and its aftermath when living in secure accommodation, especially with regard to children. The aim is to investigate mothers’ experiences of their escape, and their considerations regarding the well-being of their young children before or during their escape, based on 14 interviews. Using a narrative thematic analysis, the results show that the escape was often planned, but that the planning horizon varies. In many cases, the mothers’ social network served as a stepping-stone during the escape, before they continued by moving to a domestic violence shelter (DVS). Implications for policy and practice are offered.

Sara Thunberg, Linda Arnell

Walking together and leading change: Shaping global solutions to end violence against children

The Baobab Research Programme Consortium (Baobab) is an Africa- based, African-led consortium, spearheaded by the Population Council, Inc., in partnership with the Population Council–Kenya and the African Population and Health Research Centre (APHRC), that is reshaping the narrative around sexual and reproductive health and rights (SRHR) research in refugee settings. Across Africa’s most challenging humanitarian landscapes, Baobab is proving that evidence can ignite action. Starting with the first-ever Humanitarian Violence Against Children and Youth Surveys in Uganda and Ethiopia, Baobab turned data into solutions—co-designing a school-based sexual violence screening model with governments, UNHCR, and civil society. By embedding trained para-social workers (PSWs) in schools, this approach ensures proactive identification, on the spot psychological first aid, rapid referral (where needed), and consistent care for child survivors of sexual violence, all while strengthening existing systems. Uganda’s Ministry of Gender, Labour and Social Development co-designed the model, building upon its existing National PSW Programme, and integrating it into national training and guidance manuals, a bold step toward systemic change. With a proven model now embedded in national systems, Baobab is helping translate frontline success into wider policy influence by elevating Africa-led solutions onto the global stage. Baobab has partnered with the African Child Policy Forum to amplify Africa’s voice globally, shaping commitments from the first-ever Global Ministerial Conference to End Violence Against Children held in Bogota, to ARISE Africa: Accelerating Action to End Violence Against Children. This case study is a blueprint for scalable, replicable interventions that transform crises into opportunities for protection, accountability, and African leadership on the world stage.

Stella Muthuri

Knowledge and practices regarding postoperative neonatal pain assessment among healthcare professionals in Kinshasa: a multicenter cross-sectional survey

Background Neonatal pain remains inconsistently assessed, particularly in resource-limited settings. We assessed healthcare professionals’ knowledge and reported practices regarding postoperative neonatal pain assessment in Kinshasa, Democratic Republic of the Congo (DRC). Methods We conducted a multicenter cross-sectional survey from August 2025 to May 2026 in ten hospitals with pediatric surgical activity. Healthcare professionals completed a 20-item questionnaire developed through expert content review and pretesting. The primary outcome was self-reported use of a standardized neonatal pain-assessment tool. A four-item knowledge score (0–4) was constructed, with ≥3 indicating high knowledge as a pragmatic study-specific threshold. Multivariable logistic regression used hospital-level cluster-robust standard errors. Results Of 580 healthcare professionals approached, 536 returned the questionnaire; six were excluded because of >30% missing data, leaving 530 complete questionnaires for analysis. Although 86.8% recognized neonatal pain, only 10.0% reported using a standardized pain-assessment tool, and 15.3% reported postoperative pain assessment at regular intervals. Nearly all participants (99.8%) reported no dedicated neonatal pain training. The mean knowledge score was 2.16 ± 0.84, and 34.7% had high knowledge. Higher knowledge was independently associated with reported standardized tool use (adjusted OR 4.90, 95% CI 3.10–7.70; p < 0.001). In the prespecified sensitivity analysis using the reduced three-item knowledge score, the association remained significant but was attenuated (adjusted OR 1.93, 95% CI 1.23–3.03; p = 0.004). Conclusion Reported use of standardized neonatal pain-assessment tools and regular postoperative pain assessment were low despite widespread recognition of neonatal pain. Higher knowledge was associated with reported tool use, although the association was attenuated after excluding scale recognition from the knowledge score. These findings highlight gaps in neonatal pain assessment and training, while the cross-sectional design precludes causal interpretation.

Eriksson Landu, Joseph Nsiala, Arriel Makembi Bunkete et al.

Abducting Children Abroad: Gender, Power, and Transnational Mobility in Immigrant Family Conflicts

Utilizing life story interviews of immigrant women whose children were abducted by abusive (ex-)husbands, the article unpacks a three-part pattern of transnational mobility: first, husbands apply strategies of coercive control to dominate wives in Denmark; second, wives draw on Scandinavian “woman-friendly” state support to challenge men and seek divorce; and third, men try to regain control through abducting children to the Middle East, seeking to blackmail mothers into leaving Denmark and resubmitting themselves to male control. While some wives accede to their husband’s demands, others skillfully manage to “re-abduct” children back to Denmark, thereby belying the trope of the victimized immigrant woman.

Anika Liversage

A narrative review of school-based preventive interventions on mental disorders and addictions

In recent years, there has been considerable concern about the deterioration of mental health in children and adolescents, and there is a coincidence between mental disorders and addictive disorders. In view of this situation, it is important to review preventive interventions from the educational field, since it is considered an area of socialization par excellence of the subjects that can avoid or reduce exposure to adversities at an early age. For this purpose, a narrative review was carried out. The databases PubMed, PsycINFO and ERIC were searched. A total of 2096 records were retrieved from which 16 studies were selected. Most of the interventions reviewed adopted a universal approach. Most of the articles reviewed refer to interventions around 13–15 years of age and, in general terms, no specific actions are specified by groups according to their needs or risks. The intervention is usually applied by teachers in collaboration with other health experts. The focus is mainly on depression, anxiety, alcohol, cannabis and tobacco, but mental health is also promoted with reinforcement of emotional competence and training in social skills. Also, there is a scarce presence of programs on non-substance addictions and long-term follow-up studies. Based on what has been studied in this research, preventive initiatives are at a point of unquestionable reflection that requires redirecting efforts based on solid scientific evidence that determines approaches adjusted to the realities of the target populations and that helps to make decisions on when to carry out universal or specific interventions.

Remedios Aguilar-Moya, Raquel Ibáñez-Martínez, David Melero-Fuentes

Establishing the Social and Legal Categories for “ Girls ” and “ Girl Children ”

This article examines whether a clearer lexical and conceptual distinction between the various stages of development, from birth to adulthood, is required to better recognize and protect the needs of the young female population affected by armed conflict. Using intersectional feminist theory, this analysis proposes a reflection on the use of a more precise definition and conceptualization of the term girls and girl children, as two distinct age stages with distinct physical and psychological development.

Laura Guercio

Regional Status Report 2020: Preventing and Responding to Violence against Children in the Americas

Violence against children is widespread in the Region of the Americas and it takes many different, equally unacceptable forms. This report is a major milestone for the Region, because it is the first of its kind. It specifically builds on and is informed by the momentum of INSPIRE: Seven Strategies to End Violence Against Children, a technical package of seven strategies based on the best available evidence and with the highest potential to end violence against all children. The report provides a more in-depth analysis of strategies and approaches to prevent and respond to violence against children in the Americas. Being in line with the commitment made by Member States to the Sustainable Development Goals (SDGs) and multiple regional and global strategies, attention to this topic is timely. Its importance is further underlined by the fact that it is the first time that governments are self-reporting on their work to address violence against children in line with the evidence-based strategies of INSPIRE. The report comes at unprecedented times, as the COVID-19 pandemic has created a new urgency for action on violence against children. This report offers a baseline of effort in the Region to prevent and respond to violence against all children everywhere.

Introduction: Against Youth Violence and Against ‘Youth Violence’

This chapter introduces the key themes of Against Youth Violence, laying out the three senses in which the authors are against youth violence: against the perpetration of violence between young people – advocating for a reduction in this violence; against the misleading connotations of the label ‘youth violence’ – advocating for more fruitful framings of the issue; and against the commodification of ‘youth violence’ – advocating for less exploitation of young people’s suffering. As well as outlining the contents and structure of Against Youth Violence, the introductory chapter articulates the need to shift away from narrow and distorting portrayals of and perspectives on violence between young people. The chapter critiques ideas of ‘youth violence’ which are stigmatizing, patronizing and counterproductive, and suggests ways of looking at the issue which are more constructive, and which are explained at greater length through the course of Against Youth Violence.

Luke Billingham, Keir Irwin-Rogers