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Background Emerging evidence from China suggests that coronavirus disease 2019 (COVID-19) is deadlier for infected men than women with a 2.8% fatality rate being reported in Chinese men versus 1.7% in women. Further, sex-disaggregated data for COVID-19 in several European countries show a similar number of cases between the sexes, but more severe outcomes in aged men. Case fatality is highest in men with pre-existing cardiovascular conditions. The mechanisms accounting for the reduced case fatality rate in women are currently unclear but may offer potential to develop novel risk stratification tools and therapeutic options for women and men. Content The present review summarizes latest clinical and epidemiological evidence for gender and sex differences in COVID-19 from Europe and China. We discuss potential sex-specific mechanisms modulating the course of disease, such as hormone-regulated expression of genes encoding for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) entry receptors angiotensin converting enzyme (ACE) 2 receptor and TMPRSS2 as well as sex hormone-driven innate and adaptive immune responses and immunoaging. Finally, we elucidate the impact of gender-specific lifestyle, health behavior, psychological stress, and socioeconomic conditions on COVID-19 and discuss sex specific aspects of antiviral therapies. Conclusion The sex and gender disparities observed in COVID-19 vulnerability emphasize the need to better understand the impact of sex and gender on incidence and case fatality of the disease and to tailor treatment according to sex and gender. The ongoing and planned prophylactic and therapeutic treatment studies must include prospective sex- and gender-sensitive analyses.

Oral candidiasis is a common opportunistic infection of the oral cavity caused by an overgrowth of Candida species, the commonest being Candida albicans. The incidence varies depending on age and certain predisposing factors. There are three broad groupings consisting of acute candidiasis, chronic candidiasis, and angular cheilitis. Risk factors include impaired salivary gland function, drugs, dentures, high carbohydrate diet, and extremes of life, smoking, diabetes mellitus, Cushing’s syndrome, malignancies, and immunosuppressive conditions. Management involves taking a history, an examination, and appropriate antifungal treatment with a few requiring samples to be taken for laboratory analysis. In certain high risk groups antifungal prophylaxis reduces the incidence and severity of infections. The prognosis is good in the great majority of cases.

Gender-the socially constructed roles, behaviours, activities and attributes that a given society considers appropriate for males, females and other genders-affects how people live, work and relate to each other at all levels, including in relation to the health system. Health systems research (HSR) aims to inform more strategic, effective and equitable health systems interventions, programs and policies; and the inclusion of gender analysis into HSR is a core part of that endeavour. We outline what gender analysis is and how gender analysis can be incorporated into HSR content, process and outcomes Starting with HSR content, i.e. the substantive focus of HSR, we recommend exploring whether and how gender power relations affect females and males in health systems through the use of sex disaggregated data, gender frameworks and questions. Sex disaggregation flags female-male differences or similarities that warrant further analysis; and further analysis is guided by gender frameworks and questions to understand how gender power relations are constituted and negotiated in health systems. Critical aspects of understanding gender power relations include examining who has what (access to resources); who does what (the division of labour and everyday practices); how values are defined (social norms) and who decides (rules and decision-making). Secondly, we examine gender in HSR process by reflecting on how the research process itself is imbued with power relations. We focus on data collection and analysis by reviewing who participates as respondents; when data is collected and where; who is present; who collects data and who analyses data. Thirdly, we consider gender and HSR outcomes by considering who is empowered and disempowered as a result of HSR, including the extent to which HSR outcomes progressively transform gender power relations in health systems, or at least do not further exacerbate them.

ContributorsKH and AR led conceptualisation and drafting of the paper. AD led the study on nurses in Uttar Pradesh, ND the study on accredited social health activists in Uttar Pradesh, HW and JR the study on community health workers and community health worker policy in Sierra Leone, LM, JK, and AR the study on gender parity in the global physician workforce, and KH, YA, and NS the study on selfhelp groups in India. FS and RF-M led development of the case on the nurse from eSwatini. VP, RH, and EBa did the systematic literature review on health systems models. JGS and AR led the systematic review on gender transformative clinical interventions. KH, LM, JK, FS, RF-M, AD, YA, JY, EBl, NB, JGS, and AR did the critical reviews of the literature on gender inequalities and gender norms affecting health and helped draft pieces of those reviews, with consideration of diverse geographic contexts. All authors offered critical inputs and reviews of this work, contributed intellectual and substantive revisions to the writing, and provided final approval of the submitted version.

Women are affected more than men by the social and economic effects of infectious-disease outbreaks. They bear the brunt of care responsibilities as schools close and family members fall ill 1,2 . They are at greater risk of domestic violence 3 and are disproportionately disadvantaged by reduced access to sexual-and reproductive-health services. Because women are more likely than men to have fewer hours of employed work and be on insecure or zero-hour contracts, they are more affected by job losses in times of economic instability 2 .There has been a "horrifying global surge in domestic violence" since the start of the COVID-19 lockdowns, said United Nations secretary-general António Guterres in early April. Malaysia, for example, reported 57% more calls to domestic-abuse helplines between 18 March and 26 March. Moreover, sexualand reproductive-health clinics are closing worldwide. Some US states have restricted access to abortions 4 .It is all too familiar. During outbreaks of Ebola and Zika viruses in the past few years,The social and economic impacts of COVID-19 fall harder on women than on men. Governments need to gather data and target policy to keep all citizens equally safe, sheltered and secure.

While the private sector is an important health care provider in many low and middle income countries (LMICs), its role in relation to progress towards Universal Health Coverage (UHC) varies. Drawing on a review of the published and grey literature, we explore the factors that affect private sector contribution to UHC: i.e. we are interested in the overall impact on system outcomes such as . Evidence on the performance of both the private and public healthcare sectors is used to examine the characteristics of private providers that are associated with their performance, and the implications for how these factors might interrelate to influence progress towards UHC. Studies of private sector performance have focused on three main dimensions: quality, equity of access, and efficiency. We found that the characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers including their size, objectives, and technical competence the interaction of these factors influences how the sector performs within different contexts. Changing the performance of the private sector will require interventions which target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector appears to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health sector requires a regulatory response focused on the health sector as a whole. Key messages The critical policy relevant question about the private sector is not its performance in isolation, or relative to the public sector, but the extent to which it supports or detracts from progress towards Universal Health Coverage  There is a dearth of evidence on factors affecting system level performance, reflecting the complexity and heterogeneity of the private health sector and the difficulty in exploring the inter-relationships of factors at the system level, and their effect on overall performance.  Deriving population benefit from the private health sector will require interventions which target the sector as a whole, rather than individual providers alone.

Despite its reduction over the last decade, the maternal mortality rate in Uganda remains high, due to in part a lack of access to maternal health care. In an effort to increase access to care, a quasi-experimental trial using vouchers was implemented in Eastern Uganda between 2009 and 2011. Findings from the trial reported a dramatic increase in pregnant women’s access to institutional delivery. Sustainability of such interventions, however, is an important challenge. While such interventions are able to successfully address immediate access barriers, such as lack of financial resources and transportation, they are reliant on external resources to sustain them and are not designed to address the underlying causes contributing to women’s lack of access, including those related to gender. In an effort to examine ways to sustain the intervention beyond external financial resources, project implementers conducted a follow-up qualitative study to explore the root causes of women’s lack of maternal health care access and utilization. Based on emergent findings, a gender analysis of the data was conducted to identify key gender dynamics affecting maternal health and maternal health care. This paper reports the key gender dynamics identified during the analysis, by detailing how gender power relations affect maternal health care access and utilization in relation to: access to resources; division of labour, including women’s workload during and after pregnancy and lack of male involvement at health facilities; social norms, including perceptions of women’s attitudes and behaviour during pregnancy, men’s attitudes towards fatherhood, attitudes towards domestic violence, and health worker attitudes and behaviour; and decision-making. It concludes by discussing the need for integrating gender into maternal health care interventions if they are to address the root causes of barriers to maternal health access and utilization and improve access to and use of maternal health care in the long term.