Military coups are not uncommon occurrences, particularly in developing nations where political systems might be less firmly entrenched or still evolving. Developments of this nature can often have profound implications for the affected nation’s healthcare systems, both in the immediate aftermath and over the longer term. This paper narrates some notable consequences of political instability on the national health system, particularly placing them in the context of the military coup in October 2021 – emphasizing the context behind the political turbulence, its acute and direct consequences, and the possible long-term legacies of political shocks on the already overwhelmed health system. As a descriptive piece, this narrative does not only look at the impact of the military coup on hospitals, but considers the implications for the healthcare system as defined by the WHO, with particular emphasis on the impact of the coup on health funding from multi-laterals, service delivery, human resource availability, and supply chains in Sudan.

The World We WanT Covid-19 as a long multiwave event: implications for responses to safeguard younger generationsMandeep Dhaliwal and colleagues call for urgent correction of the response to covid-19 to safeguard the development of children and young people

The three main Nile Delta wetland ecosystems, Manzala, Burullus and Edku lagoons, are among the most ecologically important and productive habitats in Egypt. We studied the area degradation and the human health risks associated with trace metal accumulation in Tilapia zillii harvested from these lakes. The area of Manzala lagoon has shrunken from about 3035 km2 in 1800 to about 288 km2 in 2015, the area of Edku has shrunken from about 336 km2 in 1824 to about 18 km2 in 2014, and the area of Burullus has shrunken from about 1116 km2 in 1949 to about 546 km2 in 2014. This area degradation is attributed to drying for housing, land reclamation and fish farming. As a result, the concentration of pollutants and nutrients has subsequently increased, and large parts of the lakes have been overgrown with aquatic vegetation, which increased the rate of degradation and land transformation. Metal pollution was detected in water, sediment and edible fish harvested from the lakes. The hazard index, an indicator of human health risks associated with fish consumption, showed adverse health effects of zinc and lead metals for habitual fish consumers. The impact of the high dam on the lakes was discussed.

Introduction Adolescent girls and young women, including adolescent mothers, in Southern Africa have high HIV seroconversion and transmission. We need to know which risks drive HIV infections, and what can reduce these risks. Methods We interviewed 1712 adolescent girls and young women (11–23 years), including 1024 adolescent mothers who had conceived before age 20 and had a living child, from two health municipalities of South Africa's Eastern Cape Province between March 2018 and July 2019. Recruitment was through multiple community, school and health facility channels. Associations between adolescent motherhood and seven HIV risk behaviours (multiple sexual partners, transactional sex, age‐disparate sex, condomless sex, sex on substances, alcohol use and not in education or employment) were investigated using the generalized estimating equations method for multiple outcomes specified with a logit link and adjusting for nine covariates. Using the same model, we investigated associations between having enough food at home every day in the past week (food security) and the same seven HIV risk behaviours. When we found evidence of moderation by HIV status, we report stratum‐specific odds ratios. Results Mean age was 17.51 years (SD: 2.54), 46% participants were living with HIV. Compared to non‐mothers, adolescent mothers had lower odds of alcohol use (AOR = 0.47, 95% CI = 0.29–0.75), but higher odds of multiple sexual partners (AOR = 1.93, 95% CI = 1.35–2.74), age‐disparate sex (HIV‐uninfected AOR = 1.73, 95% CI = 1.03–2.91; living with HIV AOR = 5.10, 95% CI = 2.98–8.73), condomless sex (AOR = 8.20, 95% CI = 6.03–11.13), sex on substances (AOR = 1.88, 95% CI = 1.10–3.21) and not in education/employment (HIV‐uninfected AOR = 1.83, 95% CI = 1.19–2.83; living with HIV AOR = 6.30, 95% CI = 4.09–9.69). Among non‐mothers, food security was associated with lower odds of multiple sexual partners (AOR = 0.45, 95% CI = 0.26–0.78), transactional sex (AOR = 0.32, 95% CI = 0.13–0.82) and not in education/employment (AOR = 0.48, 95% CI = 0.29–0.77). Among adolescent mothers, food security was associated with lower odds of transactional sex (AOR = 0.17, 95% CI = 0.10–0.28), age‐disparate sex (AOR = 0.66, 95% CI = 0.47–0.92), sex on substances (AOR = 0.51, 95% CI = 0.32–0.82), alcohol use (AOR = 0.45, 95% CI = 0.25–0.79) and not in education/employment (AOR = 0.56, 95% CI = 0.40–0.78). Conclusions Adolescent motherhood is associated with multiple vulnerabilities to HIV infection and transmission. Social protection measures that increase food security are likely to reduce HIV risk pathways for adolescent girls and young women, especially adolescent mothers.