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PurposeOut-of-school adolescent girls (OoSGs) can lack education on menstrual, sexual, reproductive, and mental health (SRMH) and be more vulnerable to SRMH harms. Targeted interventions could reduce these risks. We assessed interventions and their effectiveness among OoSGs globally.MethodsSix online databases were searched for interventional studies targeting SRMH problems in OoSGs. Two coders independently abstracted data from each eligible study, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We summarized results using forest plots.ResultsA total of 1,244 studies were screened; eight studies with sufficient information on SRMH outcomes were included (9,084 OoSGs, range 100–3,026 per study, overall study quality low-to-moderate). Six were educational programmes, and two were cash interventions; no study was directed at mental health. Participants were recruited through village census, outreach workers, and work locations. Some improvements were seen in indicators of SRMH knowledge (four studies), attitudes (one study), and risky sexual behaviors (four studies); however, no reduction was seen in human immunodeficiency virus or herpes simplex virus-2 incidence (two studies).DiscussionThis review suggests that programmes can improve OosG’s SRMH knowledge, attitudes, and practices and can be delivered in low resource contexts. Effective interventions are needed to support OoSGs, including interventions focusing on SRMH support incorporating elements of cash-transfer, and comprehensive sexual education, and to aid local policy and programming.

Introduction Rheumatic heart disease (RHD) is underdiagnosed globally resulting in missed treatment opportunities and adverse clinical outcomes. We describe the protocol for a study which aims to co-design, implement and conduct an evaluation of a task-sharing approach to echocardiographic active case finding for early detection and management of RHD in high-risk settings in Australia and Timor-Leste.Methods and analysis Echocardiograms will be obtained by trained local staff using hand-held echocardiographic devices employing the ‘Single Parasternal Long Axis view with a Sweep of the Heart’ (SPLASH) technique and interpreted by experts remote from the site of acquisition. Approximately 1500 children and pregnant women will be screened across high-risk communities in Australia and Timor-Leste over an 18-month period. The study will use a type II effectiveness-implementation hybrid design. A tailored package of implementation strategies will be co-designed with communities and health services and mapped onto a Theory of Change framework. The clinical effectiveness will be assessed as the change in the proportion of the target population that are prescribed secondary prophylaxis for RHD by the end of the study compared with baseline. The implementation will be assessed as the adoption, penetration, sustainability, fidelity and cost of the programme with a mixed-methods theory-based and economic evaluation. Data will include numbers of normal, abnormal and uninterpretable SPLASH echocardiograms obtained, numbers of participants progressing through the cascade of care, interviews with staff and programme costs.Ethics and dissemination Ethical approval has been obtained from the Human Research Ethics Committee of the NT Department of Health and Menzies School of Health Research, Darwin (HREC-2022-4479), the Western Australian Aboriginal Health Ethics Committee (HREC-1237) and the Instituto Nasional Saude Publika Timor-Leste Ethics and Technical Committee (03-UEPD/INSP-TL/V/2023). Informed consent is required to be enrolled. Study findings will be disseminated in the communities involved and submitted for publication.Trial registration number NCT06002243.

Breech presentation is a risk factor for poor birth outcomes. Guidance for safest mode of delivery in breech presenting full term pregnancies is available but there is a lack of evidence on the optimal mode of delivery in breech presenting preterm spontaneous births. The aim of this study is to evaluate the causal effect of mode of delivery on extended perinatal death (EPD) in this population using a trial emulation. Randomized experiments are the gold standard for estimating causal effects; however, previous attempts to conduct them in this context has resulted in recruitment challenges. Causal inference methods provide a framework for drawing causal conclusions from observational data. A trial emulation aims to overcome limitations common to observational studies by specifying core components of a randomized trial using observational data. Our trial emulation uses national Scottish health data to identify an eligible study sample and adjust for confounding characteristics between groups undergoing caesarean and vaginal deliveries to simulate randomized assignment of mode of delivery. We were able to estimate the per-protocol impact of caesarean delivery on EPD. Our data, containing all recorded potentially eligible births in Scotland between 1997 and 2019, was provided by eDRIS in a trusted research environment. After applying our eligibility criteria, our data contained 3,457 birth records, (2,361 c-section and 1,096 vaginal deliveries). There were 212 EPDs (1.7% (39) of c-sections and 16% (173) of vaginal deliveries). Our preliminary results suggest that caesarean delivery reduces the odds of EPD by 73% among breech presenting spontaneous preterm births.

Abstract Background Maternal morbidity and mortality related to infection is an international public health concern, but detection and assessment is often difficult as part of routine maternity care in many low- and middle-income countries due to lack of easily accessible diagnostics. Front-line healthcare providers are key for the early identification and management of the unwell woman who may have infection. We sought to investigate the knowledge, attitudes, and perceptions of the use of screening tools to detect infectious maternal morbidity during and after pregnancy as part of routine antenatal and postnatal care. Enabling factors, barriers, and potential management options for the use of early warning scores were explored. Methods Key informant interviews (n = 10) and two focus group discussions (n = 14) were conducted with healthcare providers and managers (total = 24) working in one large tertiary public hospital in Blantyre, Malawi. Transcribed interviews were coded by topic and then grouped into categories. Thematic framework analysis was undertaken to identify emerging themes. Results Most healthcare providers are aware of the importance of the early detection of infection and would seek to better identify women with infection if resources were available to do so. In current practice, an early warning score was used in the high dependency unit only. Routine screening was not in place in the antenatal or postnatal departments. Barriers to implementing routine screening included lack of trained staff and time, lack of thermometers, and difficulties with the interpretation of the early warning scores. A locally adapted early warning screening tool was considered an enabler to implementing routine screening for infectious morbidity. Local ownership and clinical leadership were considered essential for successful and sustainable implementation for clinical change. Conclusions Although healthcare providers considered infection during and after pregnancy and childbirth a danger sign and significant morbidity, standardised screening for infectious maternal morbidity was not part of routine antenatal or postnatal care. The establishment of such a service requires the availability of free and easy to access rapid diagnostic testing, training in interpretation of results, as well as affordable targeted treatment. The implementation of early warning scores and processes developed in high-income countries need careful consideration and validation when applied to women accessing care in low resource settings.