Disease and Health Research: Recent Developments Vol. 1

Cultural Competency in Childbirth Services: Development and Validation of the CCMS-HSP Framework in Elgeyo-Marakwet County, Kenya

Solomon Cheboi — 2026-07-25

Cultural competency is increasingly recognised as an important component of respectful and person-centred maternity care, particularly in culturally diverse health systems. This chapter examines the role of cultural competency in shaping maternal satisfaction with childbirth services in Kenya, It presents the Cultural Competency–Maternal Satisfaction and Health Systems Performance (CCMS-HSP) Framework. The study employed a cluster randomised controlled trial (cRCT) design, with a total of 758 women receiving maternity services recruited from intervention and control facilities at baseline and endline, alongside healthcare workers from multiple professional cadres who received the structured training intervention. Quantitative data assessed changes in women’s perceptions of maternity care before and after the intervention, while qualitative interviews and focus group discussions explored women’s experiences, expectations, and perceived determinants of satisfactory childbirth care. The findings indicate that cultural competency training was associated with improvements in provider–patient communication, respect for women’s cultural beliefs and preferences, emotional support, trust in healthcare providers, and perceived quality of childbirth services. Statistically significant improvements were recorded across multiple dimensions of maternal satisfaction in intervention compared to control facilities, with the largest effect observed in staff friendliness and respect (F = 79.002, p < 0.001), followed by satisfaction with information provided (F = 11.493, p < 0.001), prompt provision of maternity services (F = 10.142, p = 0.001), and trust in healthcare providers (F = 6.395, p = 0.012). Mean satisfaction scores for consideration of cultural childbirth beliefs also improved, though the magnitude of change in this domain was more modest, suggesting that deeply embedded cultural practices require sustained engagement beyond a single training cycle. Women emphasised the importance of respectful treatment, clear information, continuous labour support, cultural responsiveness, autonomy in decision-making, and reassurance during childbirth. These findings informed the development of the CCMS-HSP Framework, which links cultural competency interventions to provider competencies, respectful maternity care processes, maternal satisfaction, healthcare utilisation, and broader health system performance. The chapter argues that cultural competency can support more responsive, respectful, and patient-centred childbirth services when integrated into health worker training, service delivery, supervision, and quality improvement systems. The framework provides a practical model for policymakers, educators, managers, and practitioners seeking to strengthen maternity care experiences in culturally diverse settings.

Etiological Spectrum of Amenorrhea: A Clinical and Cytogenetic Perspective from a Tertiary Care Center in Western India

Pritti K. Priya — 2026-07-25

Background: Amenorrhoea has heterogeneous anatomical, gonadal, endocrine and chromosomal causes, and its distribution may vary according to referral patterns and population characteristics. This chapter evaluates the aetiological profile of primary and secondary amenorrhoea among patients attending a tertiary care centre in Western India and places these observations within the broader clinical and pathophysiological framework of menstrual disorders.

Methods: A retrospective review was conducted using medical records of 170 non-pregnant patients who presented with primary or secondary amenorrhoea to the Department of Obstetrics and Gynaecology, IKDRC-ITS, Ahmedabad, Gujarat, from January 2014 to December 2022. Clinical presentation, development of secondary sexual characteristics, physical examination findings, hormonal profile, pelvic imaging and cytogenetic evaluation, including karyotyping when indicated, were reviewed.

Results: Of the 170 patients, 144 (84.70%) had primary amenorrhoea and 26 (15.29%) had secondary amenorrhoea. Most patients with primary amenorrhoea were younger than 20 years. End-organ failure or genital tract/outflow tract abnormality was the most frequent aetiological group in primary amenorrhoea, affecting 103 patients (71.49%). Mullerian agenesis was the most common individual diagnosis, reported in 77 patients (53.47%), followed by hormonal causes in 23 patients (15.97%) and gonadal failure in 11 patients (7.63%). Complete androgen insensitivity syndrome was identified in three patients. Among patients with secondary amenorrhoea, hypergonadotropic hypogonadism was reported in 13 patients (50%), hypogonadotropic hypogonadism in four patients (15.38%), premature ovarian failure in three patients (11.53%) and an unknown cause in six patients (23.07%). All patients with secondary amenorrhoea presented with infertility. Renal anomalies were documented in 25 patients with primary amenorrhoea, with a single kidney being the most frequent association.

Conclusion: Mullerian anomalies were the predominant cause of primary amenorrhoea, while hypergonadotropic hypogonadism was the leading identified cause of secondary amenorrhoea in this tertiary care setting.

Cultural Competence and Maternal Healthcare Satisfaction: Evidence from Kenya for Equitable and Person-Centred Maternal Healthcare

Solomon Cheboi — 2026-07-25

Maternal healthcare satisfaction is an important indicator of service quality because it reflects women’s experiences, expectations, and perceptions of care during pregnancy, childbirth, and the postpartum period. This chapter presents the role of cultural competence in improving satisfaction with maternal services, with particular attention to lessons from Kenya. Drawing on an integrative review of international literature, policy documents, theoretical frameworks, and Kenyan evidence, the chapter explores how culturally responsive care contributes to respectful, equitable, and person-centred maternal care services.

The chapter is guided by the Social Ecological Model, Donabedian’s Quality of Care Framework, and established models of cultural competence and cultural humility. The evidence reviewed suggests that cultural competence influences maternal satisfaction through several related pathways, including effective communication, respectful provider–patient interactions, acknowledgement of cultural beliefs and preferences, privacy, dignity, emotional support, and patient participation in decision-making. In the Kenyan context, cultural diversity and ongoing maternal health reforms provide a relevant setting for understanding how culturally responsive maternal care can strengthen women’s trust in healthcare providers and improve perceptions of service quality.

The chapter argues that cultural competence should be understood as a core dimension of quality maternal healthcare rather than an optional addition to service delivery. Integrating cultural competence into health professions education, facility-level practices, maternal health policies, and quality improvement systems may support more acceptable and respectful maternal care. The findings indicate that culturally responsive care can contribute to better maternal care experiences, especially in multicultural settings where women’s expectations and healthcare decisions are shaped by social, cultural, and community contexts.

Perceptions about Second-Hand Smoke among School-Going Adolescents of Kolar: A Cross-Sectional Study

Chanditha K. Reddy — 2026-07-25

Background: Second-hand smoke (SHS) exposure is an important public health concern among adolescents, who may encounter tobacco smoke within households and public places. This study assessed perceptions regarding SHS among school-going adolescents in Kolar, Karnataka, and examined selected sociodemographic factors associated with perception scores.

Methods: A community-based cross-sectional study was conducted among 351 adolescents aged 13-16 years studying in selected rural and urban schools of Kolar taluk. Participants were selected using a multistage sampling approach. Data were collected using a validated semi-structured questionnaire covering sociodemographic characteristics, SHS exposure, and perceptions regarding SHS. Data were analysed using descriptive statistics, an independent t-test, and one-way ANOVA, with p < 0.05 considered statistically significant.

Results: Of the 351 participants, 178 (50.7%) were male and 173 (49.3%) were female. Rural and urban students constituted 50.1% and 49.9% of the sample, respectively. A total of 127 participants (36.2%) reported living with a habitual smoker. Grandfathers (50.3%) and fathers (29.9%) were the most frequently reported household sources of SHS exposure. Shops (41.8%), bus stops (32.4%), and markets (17.3%) were common public exposure settings. Urban students had higher mean perception scores than rural students (17.8 ± 3.0 versus 16.7 ± 3.4; p = 0.001). Perception scores also differed significantly by class, with 10th-standard students recording the highest mean score (18.2 ± 3.2; p < 0.001).

Conclusion: SHS exposure was common among school-going adolescents in Kolar, particularly through household members and public places. The findings support the need for school-based awareness activities, the promotion of smoke-free homes, and strengthened implementation of tobacco-control measures.

Successful Management of a Rare Hepatic Hydatid Cyst with Multiple Fistulas: A Case Report

Yousra Rahioui — 2026-07-25

Hydatid disease is a zoonosis caused by Echinococcus granulosus, most commonly affecting the liver. The disease is prevalent in Mediterranean, Middle Eastern, and South American regions. Although hydatid cysts may remain silent for years, they can enlarge, become infected, or rupture into adjacent structures. While biliary rupture represents the most frequent complication, direct rupture into the stomach is exceptional. A cysto-gastric fistula is a rare and unusual presentation, often discovered intraoperatively or through advanced imaging. This case report describes a 34-year-old man with no previous medical history who presented with epigastric pain, fever, and vomiting of whitish membranes. Clinical examination revealed fever, jaundice, and an epigastric mass, while laboratory findings showed neutrophilic leucocytosis and mildly abnormal liver function tests. Imaging demonstrated a giant left hepatic hydatid cyst fistulised into the intrahepatic bile ducts, stomach, and duodenal bulb. The patient underwent exploratory laparotomy with resection of the protruding dome, evacuation of hydatid material, closure of the cysto-gastric and cysto-duodenal fistulas, cholecystectomy, and drainage. The patient also received adjuvant medical therapy with albendazole. The postoperative course was uneventful, with no complications during follow-up. This report synthesises recently reported cases and radiological reviews to analyse the mechanisms, diagnostic features, and surgical management of hepatic hydatid cysts complicated by multi-organ fistulation, emphasising the need for prompt management. Cysto-gastric and cysto-duodenal fistulisation represent exceptionally rare but potentially life-threatening complications of hepatic hydatid disease. Surgical management remains the cornerstone of treatment, with the objectives of cyst evacuation, fistula closure, prevention of peritoneal contamination, and management of associated biliary complications. Early diagnosis and prompt multidisciplinary management are essential for achieving favourable outcomes, even in complex presentations involving multiple gastrointestinal fistulas.

Perception of Human Papilloma Virus Vaccination among Pre-University Boys in Kolar Taluk - A Cross-Sectional Study

Raja Sutharsun S B — 2026-07-25

Background: Human papillomavirus vaccination is an important preventive strategy for reducing HPV-related diseases, including cancers affecting both females and males. Although vaccination programmes have traditionally focused more on girls, awareness and perception among adolescent boys are also important for improving acceptance of HPV vaccination and strengthening public health prevention strategies.

Objective: This study assessed perceptions of HPV vaccination among pre-university boys in Kolar Taluk.

Methods: A community-based cross-sectional study was conducted among 400 pre-university-going boys from selected pre-university colleges in Kolar Taluk. Ten colleges were selected from 80 pre-university colleges by simple random sampling. Eligible boys aged 16 to 19 years from the selected colleges were included. Data were collected using a semi-structured, pre-tested and validated questionnaire. The questionnaire included socio-demographic details and items assessing knowledge and perceptions of HPV infection and HPV vaccination. Perception scores were calculated by assigning one mark for each positive response and zero marks for incorrect or “don’t know” responses. Data were analysed using SPSS software. Descriptive statistics were used, and associations between socio-demographic factors and perception scores were assessed using one-way ANOVA; statistical significance was set at p < 0.05.

Results: Among the 400 participants, 205 (51.2%) were aged 17 years, 126 (31.5%) were aged 16 years and 69 (17.3%) were aged 18 years. Rural participants constituted 263 (65.8%), while 137 (34.3%) were from urban areas. Participants from rural areas had higher perception scores than urban participants, and this association was statistically significant (p < 0.001). Father’s educational status was also significantly associated with perception regarding HPV vaccination (p < 0.001). Age, year of study, family type, mother’s education, father’s occupation and mother’s occupation were not statistically significant.

Conclusion: The study showed poor perception regarding HPV vaccination among pre-university-going boys in Kolar Taluk. Place of residence and father’s education were significantly associated with perception scores. Strengthening school-based awareness programmes and involving parents may help improve understanding and acceptance of HPV vaccination among adolescent boys.

Emerging Trends and Risk Factors Associated with Kidney Disease: A Comprehensive Review

Okolonkwo, Benjamin Nnamdi — 2026-07-25

Kidney disease is a global health concern affecting millions of people worldwide. Early intervention is essential for reducing the economic burden associated with kidney diseases. This chapter reviews the risk factors associated with kidney diseases, specifically age, gender, race, ethnicity, family history, drug use, smoking, socio-economic status, hypertension, diabetes, and recent evidence linking other conditions and toxins to the development of kidney disease. The kidneys play a vital role in overall human health and well-being. Their ability to filter waste, reabsorb essential nutrients, and maintain fluid and electrolyte balance is essential for health. However, factors such as age-related changes, exposure to toxins, and lifestyle habits can contribute to declining kidney function and subsequent health problems. It is therefore crucial to identify risk factors for kidney damage and implement early preventive measures to slow the progression of chronic kidney disease. Raising awareness of these factors may help prevent chronic kidney disease and reduce the incidence of end-stage renal disease. Several risk factors are modifiable, and early diagnosis and treatment can prevent severe complications. Regular health checks, the identification of risk factors through panels of tests, and a proactive approach to health are important for maintaining kidney function and preventing potential health problems. In conclusion, awareness of factors that can damage the kidneys, together with a proactive approach to health, can support the maintenance of healthy kidney function and the prevention of chronic kidney disease. Prioritising healthy lifestyle habits may reduce the risk of kidney disease and support long-term health. Awareness is also increasing regarding the detrimental effects of potential nephrotoxins on kidney health in children and adults. However, high-quality epidemiological studies examining environmental exposures and multiple health outcomes, including kidney health, in both populations remain limited; therefore, further studies are required.

Antimicrobial Peptides as Immunomodulators in Combating Opportunistic Bacterial Skin Infections

Debabrata Biswas — 2026-07-25

Skin is the primary and largest protective organ of the human body and is colonised by a diverse community of microbiota, most of which are commensal. Under abnormal or perturbed conditions, these microbiota can behave as opportunistic pathogens. To defend against environmental threats and microbial invasion, the skin has evolved a sophisticated arsenal of factors, including antimicrobial peptides (AMPs). These AMPs not only kill pathogens directly but also modulate host immune responses to prevent infection. The canonical direct antimicrobial functions of AMPs have long been a focus in the development of enhanced therapeutics, especially against multidrug-resistant pathogens. However, more recently, the immunomodulatory functions performed by these peptides at sub-microbicidal concentrations have become a major focus in the field of host-directed therapeutics. Immunomodulation is a contemporary approach that manipulates the immune response to pathogen entry and infection. Its main goal is to enhance host-protective responses by ‘training’ immune cells to act efficiently against pathogens through the administration of modulators. Such strategies have the added benefit of reducing the likelihood that pathogens will develop resistance to immunomodulatory pathways, because pathogens exploit these signalling pathways to enter and survive within the host. Thus, this review summarises the potent immunomodulatory effects of AMPs on different host immune cells, with a view to providing an information platform that may support the design of studies to exploit and formulate effective host-directed adjunct therapeutic strategies that could act synergistically with drug regimens to counter the current diversity of drug-resistant opportunistic skin pathogens.

Discordant Parental Carrier Screening in Spinal Muscular Atrophy: A Prenatal Diagnostic Dilemma and Its Lessons for Reproductive Counseling

Kumari Pritti — 2026-07-25

Spinal muscular atrophy (SMA) is an inherited neuromuscular disorder in which carrier screening may be difficult when copy number findings do not correspond with family history. This chapter describes a 28-year-old woman who sought genetic counselling and prenatal diagnosis after two previous children had been affected with SMA type 1 and had died at 6 months of age. The couple was non-consanguineous. Genetic evaluation of an affected child showed no point mutation on exome sequencing, whereas multiplex ligation-dependent probe amplification identified homozygous deletion of exons 7 and 8 of the SMN1 gene. Segregation analysis showed that the mother carried a single copy of SMN1, consistent with carrier status, while the father had two SMN1 copies on dosage testing and appeared to be a non-carrier. In view of the family history, a paternal silent carrier state caused by a cis SMN1 copy configuration was suspected. During the current pregnancy, chorionic villus sampling was performed at 12 weeks. Initial foetal testing raised concern for sex chromosome aneuploidy, and amniocentesis at 16 weeks was performed for clarification. Amniotic fluid evaluation showed a 46,XY karyotype and two copies of SMN1. The pregnancy was continued, and a healthy child was delivered at term. This case highlights the need to interpret SMA carrier screening in relation to clinical history, previous affected offspring and the limitations of dosage-based assays.