Background As in many other countries across sub-Saharan Africa, Malawi’s commercial gambling sector has grown considerably in recent years. Driven by the widespread availability of internet through mobile devices, the industry has penetrated both urban and rural settings. In Malawi the model commonly implemented by gambling companies is similar to that used by mobile phone operators. Agents equipped with cellular devices connect to providers’ servers to place wagers for customers and print receipts using simple printers attached to their devices. This has produced lucrative returns for providers. While increasing attention is being paid to this trend, most research focusses on sports betting and there is a deficit of papers that document gambling-related harms. Methods Here we present a narrative case report of a 16-year-old boy, ‘Wati’ (pseudonym), who lived in rural Malawi and took his own life after gambling and losing money that did not belong to him. As his community is part of a demographic surveillance site, a verbal autopsy was conducted, later supplemented with interviews with Wati’s close friend and uncle, to whom his mother referred us. We triangulated data from these three sources to create a narrative case report of Wati’s suicide and its relationship to his gambling practices. Results We found that the gambling harms leading up to Wati’s suicide were recurrent, that his gambling practices were diverse (lottery, football betting, digital games and cards) and that signs of distress were apparent before his suicide. Conclusions From this case report, we learn that underage individuals participate in gambling in Malawi, can develop harmful habits and that their gambling is not confined to sports betting. We also learn that there is a lack of accessible services for people who develop harmful gambling practices. Wati could have benefited from such services and they may have saved his life.

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Background:The HIV prevalence and incidence among the general population in Rwanda have decreased significantly in the past decade, with only about 3% prevalence as of 2019. However, opposite trends are seen among the key populations (KP). The prevalence among commercial sex workers is as high as 51%, and the HIV rates among this group continue to rise. While the prevalence among key populations remains high, their adherence to HIV treatment is low compared to the general population. Healthcare providers play a vital role in ensuring key populations’ access to HIV treatment, adherence, and program retention. This study aimed to explore the experiences of healthcare providers in providing HIV services to key populations in Rwanda.Methods:A qualitative phenomenological study was conducted with nurses, doctors, social workers, and psychologists who provide HIV services in health facilities in Rwanda. In-depth interviews were conducted using a semi-structured interview guide. Transcribed and translated data were coded according to a structured code book. All data were organized and analyzed using Dedoose software (version 8.3.35).Results: Interviews with 18 healthcare providers were conducted; participants included 1 doctor (5.6%), 5 social workers (27.8%), and 12 nurses (66.7%). All participants had worked with key populations, especially commercial sex workers and men who have sex with men. Three overarching themes emerged from the interviews: healthcare providers’ intrinsic feelings affect the ways they provide HIV services to key populations, key populations face a multitude of challenges related to accessing treatment and preventing the spread of HIV, and a more comprehensive and sensitive approach should be used to improve HIV services for key populations. Conclusion: Healthcare providers expressed difficulties in providing services to key populations as they tend not to adhere to treatment and prevention guidelines, caused by some structural barriers, their lack of trust in the system, and the discrimination and abuse they have faced. More comprehensive services including clinical, financial, and psychosocial support from trusted sources are needed. Some important policy changes may be needed to allow KPs to purchase community-based health insurance.

Background: The overall HIV prevalence and incidence in Rwanda have decreased significantly in the past decade. However, opposite trends are seen among key populations (KP). The HIV prevalence among sex workers is as high as 51% and continues to rise. While the HIV prevalence among KP remains high, their adherence to treatment is low. Healthcare providers play a vital role in KP's access and adherence to HIV treatment. This study aimed to explore the perspectives of healthcare providers on providing HIV services to key populations in Rwanda. Methods: An exploratory qualitative study was conducted with nurses, doctors, social workers, and psychologists who provide HIV services to KP in public health facilities in Rwanda. In-depth interviews were conducted using a semi-structured interview guide. All data were analyzed thematically using Dedoose. Results: Interviews were conducted with 18 healthcare providers. Three overarching themes emerged from the interviews: healthcare providers' intrinsic feelings affect the ways they provide HIV services to key populations, key populations face a multitude of challenges related to accessing treatment and preventing the spread of HIV, and a more comprehensive and sensitive approach should be used to improve HIV services for key populations. Conclusion: Healthcare providers expressed difficulties in providing services to key populations and identified a lack of adherence to treatment and prevention guidelines, structural barriers, KP's lack of trust in the healthcare system, and the discrimination and abuse KP face as challenges to effective HIV prevention and treatment. More comprehensive services including clinical, financial, and psychosocial support from trusted sources are needed. Some important policy changes are essential to facilitate access to HIV services for KP.

Introduction The Syrian Civil War is one of the most significant humanitarian crises in modern times. Since 2011, over 5 million Syrians have fled the country in search of safety. Around 650,000 Syrian refugees are registered in Jordan, 48% of whom are children. The impact of forced displacement on children's wellbeing is poorly understood and requires further investigation. Methods This is a secondary analysis of a cross-sectional qualitative study consisting of 85 semi-structured interviews, conducted with Syrian refugees living in Jordan in 2017, to understand the impact of forced displacement on child refugees' wellbeing. A four-member research team developed a new Code Structure and analyzed the data thematically. Results Education, social integration, behavioral change and mental health, the effect of father's absence, and child marriage, were key areas of consideration. Children not being in school was found to play a big role in child wellbeing because many families had to choose between subsistence and education, with children required to work to earn money for their families. Many parents were afraid to let children out of the house other than for school, resulting in minimal social integration outside the school setting. Children's behavioral changes correlate with the father's absence, and girls were at higher risk of child marriage due to the living conditions of the families. Conclusions Education was a major priority for families, but some children were unable to attend school. A novel finding from this research is that many children faced limited social integration outside of school, significantly affecting wellbeing. Thus, providing school buses, prior English classes, as well as the provision of safe spaces where children can socially interact outside of school, needs to be prioritized. Financial difficulty also needs to be addressed so that children are not pushed into child marriage or made to work for their families' survival. Key messages Safe spaces that parents trust should be provided where children can socially interact outside the school setting. Financial difficulty needs to be addressed so that children are not forced to work for their families’ survival.