Abstract: Early Intervention (EI) for children with neurodevelopmental disabilities is seen as es-sential in ameliorating the impact of the impairments on their development. Providing integrated, family-centred, culturally appropriate and socially inclusive EI services is complex. Service delivery needs to be informed by those who use them and underpinned by theories that support EI practice. In total, 31 interviews were included, and data were collected with children, parents and professionals and interpreted in a coherent, sys-tematic and rigorous way. This research used a Grounded Theory methodology and developed a substantive theory, which is represented by a conceptual model of facilitating and hindering constructs for EI practice. This article describes how a synthesis of different theories informed the development of the model. The factors that influence the relationship are discussed: each person, investment, alternative services, comparison, interaction process, and relationship stages. It adds to current thinking and demonstrates synergy across different theoretical frames grounding family systems theory, social ex-change theory and social penetration theory within the context of EI. The conceptual model can be used can be used tool to facilitate best practice in EI service provision in Western Countries and beyond.

Abstract: Background: A good understanding of the demand for health services requires not only an analysis of the current and historical volume of health care provided but also relies on accurate forecasting of trends in the future. Such trends provide invaluable information for needs assessment, resource planning, facility evaluation and policy formulation. We set the task of assessing the load on the healthcare system of Kazakhstan in the next decade using indicators of general morbidity, outpatient visits, the need for medical personnel and financial costs of medical care. Methods: This study applies a dynamic Markov chain model to forecast population dynamics and ARIMAX method for healthcare demand forecasting. Results: In the next decade, the population of Kazakhstan is expected to grow by an average of 1.4% per year, reaching 23,334,397 people by 2033. The population growth will lead to an increase in the overall morbidity of the population in absolute values. The growth rate for children will be 1.6%, for adults - 0.8% per year. In this regard, the number of visits to medical specialists will increase by approximately 1.5% per year. Therefore, the demand for internists will increase by an average of 4.7% per year. The need for labour and material resources will entail an increase in financial costs. Total costs by 2033 will increase by 11.6% compared to 2023. Conclusions: Understanding the demand for health services requires not only the analysis of past and current health data but also relies on accurate forecasting of future trends. Assessing such trends provides invaluable information for identifying needs, planning resources, evaluating facilities, and formulating policies.

Abstract: This study presents a comprehensive analysis of tuberculosis (TB) epidemiology, with particular emphasis on elucidating the determinants that differentiate TB infection from fatal outcomes. Through systematic examination of demographic, clinical, socioeconomic, and healthcare system factors, this research illuminates the complex, multifactorial nature of TB mortality. Our findings demonstrate pronounced disparities in mortality across age demographics, with individuals above 55 years experiencing disproportionately elevated fatality rates (case-fatality ratio nearly three times that of younger adults, p<0.001) despite peak incidence occurring in younger cohorts. Clinical comorbidities, particularly HIV co-infection (45% mortality rate; RR 3.0, 95% CI 2.8-3.2), malnutrition (62% mortality rate), and drug resistance (37% mortality rate), emerged as significant mortality risk modifiers. Analysis of healthcare system factors revealed that delayed diagnosis (OR 3.8, 95% CI 3.5-4.1), limited access to drug susceptibility testing, and treatment adherence challenges substantially influence mortality outcomes. Perhaps most notably, socioeconomic determinants—including healthcare access, food security, housing quality, and income level—demonstrated marked gradients between surviving and deceased tuberculosis patients. The geographical distribution of TB mortality exhibits striking regional concentration, with South-East Asia and Africa collectively accounting for approximately 69% of global TB deaths. Building upon these findings, we propose a comprehensive framework for TB elimination that transcends traditional biomedical paradigms to address the fundamental social and economic determinants of TB transmission, progression, and mortality.

Abstract: Gender-based violence (GBV) remains a critical public health and human rights concern in Timor-Leste, deeply rooted in intersecting social, economic, cultural, and institutional factors. Grounded in intersectionality theory, this narrative review explores how multiple dimensions such as gender, poverty, geographic isolation, health status, and customary norms exacerbate women’s vulnerability to GBV. Drawing on recent literature, national reports, and policy documents, the paper identifies key determinants that sustain violence, including entrenched patriarchal attitudes, weak law enforcement, limited access to healthcare and legal aid, and persistent stigma—particularly for women with disabilities or chronic illnesses such as HIV or tuberculosis. While legislative frameworks like the 2010 Law Against Domestic Violence exist, their implementation is constrained by cultural resistance and limited institutional capacity. The review synthesizes findings from national and regional reports, including the 2016 and 2022 Demographic and Health Survey (DHS), to highlight structural and institutional gaps that perpetuate violence and challenging effective response. This contributes to the existing literature by synthesizing fragmented data, identifying policy and service gaps, and aligning national challenges with global goals, particularly Sustainable Development Goals (SDG) 3 (health) and 5 (gender equality). It calls for stronger coordination between stakeholders to ensure comprehensive and contextually relevant GBV prevention and response strategies.

Abstract: Background: Obstetric fistula remains a major, yet preventable, maternal public health issue affecting tens of thousands of women annually—primarily in low- and middle-income countries (LMICs). It is intricately linked to health system failures, socio-economic inequality, and political instability. While advancements in maternal care have dramatically reduced maternal morbidity and mortality in high-income countries, progress has been inconsistent or stagnant across LMICs. The burden of obstetric fistula is exacerbated by ongoing conflict, reduced global aid, and weakened reproductive rights in many regions. Methods: This study explored historical and contemporary trends in maternal mortality and obstetric fistula, focusing on how geopolitical instability and global health policy shifts have shaped service delivery in low- and middle-income countries (LMICS). It assessed the effectiveness of international campaigns and training programmes while identifying systemic barriers and proposing evidence-based strategies to improve outcomes. A narrative review and policy analysis were conducted, drawing from peer-reviewed literature, global health databases (WHO, UNFPA, and World Bank), and grey literature spanning 1990–2025. Data included maternal mortality, fistula incidence, service models, and geopolitical events impacting healthcare systems. Key informant insights and case studies from conflict-affected regions—including Sudan, Afghanistan, and the DRC—were used to contextualise and strengthen the analysis. Results: Findings demonstrate a persistent and disproportionate burden of maternal mortality and obstetric fistula in sub-Saharan Africa and South Asia. Despite global campaigns (e.g., the UNFPA Campaign to End Fistula), the prevalence of untreated fistula remains high. Geopolitical instability, such as civil conflicts and forced migration, has directly undermined maternal healthcare infrastructure. Furthermore, structural adjustment policies, funding shifts toward disease-specific programmes, and the erosion of reproductive rights in several nations have hindered comprehensive maternal health provision. Capacity-building efforts, such as competency-based fistula surgery training endorsed by FIGO, have had localised success but are insufficiently scaled. Conclusion: Obstetric fistula is both a public health failure and a gender-based human rights issue, deeply rooted in structural inequities and geopolitical dynamics. Reductions in foreign aid, conflict-related health system collapse, and restrictive reproductive policies have collectively stalled progress. A multifaceted, rights-based approach—emphasising health system strengthening, midwifery-led care, patient empowerment, and geopolitical accountability—is urgently required. With coordinated investment and political will, the global community can reverse current trends and eliminate obstetric fistula as a public health problem.

Abstract: Objectives: Trauma patients often cannot communicate a preferred hospital destination to emergency medical services (EMS) due to injuries or impaired consciousness. EMS teams, therefore, determine hospital destinations, potentially influencing access to care. This study examines differences in Level 1 trauma admissions between a county hospital (CH) and an academic health center (AHC) within two miles of each other, focusing on transport patterns and their association with patient demographics. Methods: We conducted a retrospective review of patient charts and EMS transport records, analyzing demographic data, hospital destinations, EMS pickup locations, and documented reasons for hospital selection. Results: Among 1520 patients transported to CH and 625 to AHC, significant differences in transport patterns were observed. White patients were more likely than minority patients to be taken to the nearest hospital (53.1% vs. 46.4%, p=0.003) and less likely to bypass it (21.2% vs. 33.0%, p< 0.001). Minority patients disproportionately bypassed AHC for CH (46.6% vs. 24.6%, p< 0.001), while only 3.8% bypassed CH for AHC. AHC admitted more Black patients (47.4% vs. 37.1%, p< 0.001), while CH admitted more Hispanic patients (10.1% vs. 5.6%, p< 0.001). AHC patients had higher Medicare and Medicaid coverage, whereas CH had more uninsured patients. Conclusion: EMS transport patterns reveal disparities in trauma care access linked to race, ethnicity, and insurance status, underscoring the need for equitable EMS protocols and resource allocation.

Abstract: This study highlights critical training, classification, and support gaps for PHIs under climate pressure. It introduces the Adamopoulos-Valamontes Classification and Assessment (AV-CA) Model, a novel framework for classifying environmental, psychosocial, and organizational risks. Results support policy reform and targeted OSH training to enhance resilience in frontline public health systems amid global climate disruption.

Abstract: Long-term intravenous therapies often necessitate the use of peripherally inserted central catheters (PICCs), and antimicrobial-coated PICCs have been introduced to minimize catheter-related infections. A decision-analytic cost-effectiveness model was developed from a societal perspective utilizing real-world data concerning PICC-related complications and costs from Class 3A hospitals and community hospital settings in China. The analysis compared the quality-adjusted life years (QALYs) for patients receiving antimicrobial-coated PICCs versus standard PICCs, with catheter-associated costs included. Incremental cost-effectiveness ratios (ICERs) were calculated in Chinese Yuan (¥) per QALY gained.Patients with antimicrobial-coated PICCs experienced slightly fewer complication-related events, leading to significantly lower costs for managing complications. In the Class 3A hospital setting, the average total cost per patient was lower with antimicrobial-coated PICCs (¥62,800) compared to standard PICCs (¥102,900), primarily due to reduced expenses for treating CLABSI and related unknown fever. The ICER demonstrated that the coated PICC was the dominant option, showing a negative ICER (cost-saving of approximately ¥4 million per QALY gained in the base-case Class 3A hospital scenario). In community hospital care scenarios, the cost advantage of antimicrobial-coated PICCs remained. Thus, the antimicrobial-coated PICC strategy was cost-saving, providing equal or improved health outcomes at lower costs in China's medical center and community hospital settings, making it a more efficient choice for long-term vascular access.

Abstract: Background: The COVID virus was recognized in January 2020 and it started almost immediately the most controversial epidemic of our history there the combination of a somatic disease and the weaknesses of human rationalism literally stopped the World and turned our life upside-down. Objective: Specifying and measuring the major errors in the interpretation and communicating epidemic data, that violated the rules of evidence based medicine and rational respect for the objective reality. Methods: 1. The maximal possible number of “true” COVID deaths were estimated from the frequency of viral test positivity in the tested general population. The difference between the reported and theoretical maximum of COVID deaths were the result of “hearsay” determinations of the UCOD (not supported by laboratory test) i.e. highly questionable. 2. The number of statistically expected “regular deaths” (from the Actuary tables) provided an estimate how many persons died “with” COVID infection but not “due to” of the virus disease. Only the excess deaths could have been the result of the virus contribution, with statistical certainty. All original data in this study were collected from publicly available, official databases and evaluated by using simple well known statistical methods. A “political score” was used to characterize the states on a continuous left (democrat) to right (republican) scale based on the political attitude of the citizens as determined and available from published opinion research. 1) COVID as the Underlying Cause of Death (UCOD) haven’t been verified by specific laboratory viral test in ca. 40.3% of reported causes. These, exclusively HEARSAY information based cases violated the WHO guidelines for reporting COVID related deaths.(Use of U07.1 code); 2) Large number of natural, age related, expected deaths have been reported as COVID related deaths even if the virus reasonably couldn’t play any causative role as UCOD. These PSEUDO COVID deaths were ca 46% of all reported COVID deaths. The oldest persons in this group were 85+ years old and comprised as much as 28% to all allegedly COVID fatalities (the GERONTO COVID deaths). These errors significantly inflated the number of COVID deaths and the related mortality statistic. Conclusions: The number of correctly identified COVID related deaths in our study is about 32% of the officially published number [171K instead of 533K, respectively]. The average FATALITY of COVID stays at ~0.54% and the MORTALITY 53/100K (On May 2021).

Abstract: The work presented herein focuses on the development and characterization of a transdermal caffeine platform fabricated from ultrathin micro- and submicron fibers produced via electrospinning. The formulations incorporated caffeine encapsulated in a polyethylene oxide (PEO) matrix, combined with various permeation enhancers. A backing layer made of annealed electrospun polycaprolactone (PCL) facilitated the lamination of the two layers to form the final patch. Comprehensive characterization was conducted, utilizing scanning electron microscopy (SEM) to assess fiber morphology, attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) for chemical detection and stability of the caffeine, and differential scanning calorimetry (DSC) along with wide-angle X-ray scattering (WAXS) to analyze the physical state of caffeine within the fibers of the active layer. Additionally, Franz cell permeation studies were performed using both synthetic membranes (Strat-M) and ex vivo human stratum corneum (SC) to evaluate and model the permeation kinetics. These experiments demonstrated the significant role of enhancers in modulating caffeine permeation rates from the patch, achieving permeation rates of up to 0.73 mg/cm² within 24 hours. This work highlights the potential of the electro-hydrodynamic processing technology to develop innovative transdermal delivery systems for drugs, offering a promising strategy for enhanced efficacy and innovative therapeutic direct plasma administration.

Abstract: The number of people with disabilities in the world and in Poland is constantly increasing. Social inclusion, anti-discrimination and social integration is one of the Sustainable Development Goals, which includes inclusive tourism. Fostering inclusion in the tourism industry contributes to improving the quality of life among marginalised communities, community involvement in tourism development planning and ethical activities related to the production and consumption of tourism services. Making attractions accessible to the people with disabilities also contributes to enriching the region's tourist offer. The aim of this study is to assess the accessibility of tourist attractions in the Świętokrzyskie region, located in central Poland. The natural, cultural and historical attractions here create potential for the development of various forms of tourism. The accessibility of 20 major tourist attractions for people with mobility, sight and hearing impairments was examined. The results indicate a varying level of adaptation of facilities to the needs of the surveyed groups of people. Recreation and entertainment facilities are the best adapted, while sacred and historical facilities are the least adapted. Most adaptations were directed towards people with mobility impairments, with blind and partially sighted people and deaf and partially hearing people often overlooked. Barriers to adaptation identified included the excessive cost of adaptation and the limitations of the historic nature of the building. The inadequate preparation of attraction staff to deal with people with disabilities was also highlighted, as well as the importance of modern technology in creating accessibility and the need to promote inclusion among attraction managers and in regional policy. The article also includes an analysis of the local government's measures for social inclusion.

Abstract: This study analyzes the comparative performance of ten hospitals in the Kadutu Health Zone in the Democratic Republic of Congo, using the EGIPSS model. The study was carried out in the height of the COVID-19 pandemic in August and September 2021, in a changing global context where health systems are called upon to improve their resilience capacity while remaining high-performing. The study was descriptive and observational, using documentary review, interviews with 85 key informants and participatory observation of the ten hospitals selected on the basis of several criteria including the organization of a complete complementary package of activities assigned to a hospital in the DR Congo. It mainly reveals three facts, namely: (i) university hospitals show the best performance, (ii) adaptive capacity considerably influences the other dimensions of the EGIPSS model and along the way the overall performance of the hospital and (iii) to adapt, hospitals need resources and good management and governance. Adapting hospitals in the Kadutu Health Zone to the changing context requires a holistic approach that combines clinical work with research, investments in infrastructure (often dilapidated and not modern), training, technology and governance. It also involves learning from practices implemented in more efficient hospitals.

Abstract: Psychotherapy incorporating horses (PIH) is often provided for veterans, though research is limited. Investigations are needed to explore how these services might be implemented and utilized. This study evaluated the safety, implementation and utilization of an PIH program. In addition to the overall program, data were collected for a specific PIH intervention, Whispers with Horses (WwH). This was a retrospective study of the first 46 months of implementation. Three hundred and forty veterans were referred to the program and 230 (68%) were enrolled. Seven hundred and nine sessions of PIH (637 individual and 74 group) were provided to veterans without any adverse effects to participants, staff or equines. Regarding WwH, 125 veterans were enrolled. The mean number of sessions attended was 3.64 (out of 6) and 66% were considered completers (attended &gt; 50% of sessions). Additionally, 26% attended all sessions and the no show rate was 11%. These results indicate that it is feasible and safe to implement an EAS program within a VHA medical center. Treatment engagement was superior to VHA conventional mental health services with no-show and completion rates of 40% and 9.1% respectively. Thus, these results also suggest that a RCT of WwH is warranted.

Abstract:

The health and social care needs of children and adults with disabilities are often neglected in many low and middle income countries. International opinion favours the creation of community-based supports rather than the institutional and clinic-based care that has dominated to date. However models of care that are reliant on community leadership have been slow to develop within and across less affluent countries. Moreover, the managerial models inherent in institutional based care are likely to be inadequate in such settings. The study aimed to explore the leadership qualities required in initiating and sustaining community-based supports. Face-to-face interviews were conducted with a purposeful sample of 16 leaders of projects in Africa, Asia and South America. They included people with sensorial, physical and intellectual disabilities as well as non-disabled leaders of local and national projects plus others whose leadership was at a regional or international level. Two main questions were addressed: what are the qualities required to function as a community leaders and how can these qualities be nurtured in low resourced settings. Thematic content analysis identified three core themes: first, personal qualities such as empathy with an understanding of the personal circumstances of persons in need of support, second, communicating clearly the vision and values informing their work, and thirdly, building and mobilising community support from families and neighbours. The nurturing of leadership comes through mentoring and coaching, the empowerment of others, networking opportunities and the development of inter-personal and communication skills. These themes were commonly expressed across the 16 leaders from all the participating nations and at all levels of responsibility which validates their universality. The findings are in marked contrast to current practices in health and social care that have valued professional expertise over lived experience, knowledge and technical skills over compassion and empathy, and the provision of person-centred ‘treatments’ over developing community and personal self-reliance. Nonetheless the challenges involved in establishing and sustaining new styles of leadership are many and will not be quickly resolved.

Abstract:

Background Women globally spend a significant portion of their lives experiencing perimenopausal and menopausal symptoms, which can severely affect their quality of life. Hormone Replacement Therapy (HRT) has proven effective in alleviating symptoms such as hot flushes, sleep disturbances, and mood disorders. However, disparities in access to HRT exist, especially in low- and middle-income countries (LMICs), where socioeconomic factors and healthcare availability may limit treatment access.AimWe aimed to explore economic barriers and disparities to access to HRT across Brazil, Ghana, Malaysia, Nepal, Nigeria and Sri Lanka. Methods An exploratory study was conducted using publicly available data from national healthcare databases, pharmacies, and hospital formularies from Brazil, Ghana, Malaysia, Nepal, Nigeria, and Sri Lanka. The availability and cost of common HRT medicines, including oral and transdermal therapies, were analysed alongside of surgical procedures. Affordability was assessed by comparing the cost of a two-month HRT supply to the number of days of minimum wage work required to cover the cost. Additionally, Gross National income (GNI) per capita was also collected to contextualise these findings.Findings The availability of HRT medicines varied widely across the six countries, with Brazil and Nigeria offering a broader range of options compared to Ghana and Nepal. Pricing disparities were significant, with the cost of medicines such as the Mirena Coil requiring over 21 days of minimum wage work in Brazil and more than 260 days in Nigeria for Angeliq. Affordability remained a critical issue across LMICs, with high out-of-pocket costs restricting access to essential menopausal treatments.Conclusion This study reveals substantial economic barriers to accessing HRT in LMICs, driven by high costs and limited availability. Healthcare policy reforms to improve access and affordability of HRT in these regions are urgently needed. These findings can inform strategies to reduce healthcare inequalities and enhance women’s health outcomes globally.

Abstract:

Clinical research is a cornerstone of medical advancement, requiring efficient data management and coordination across multiple stakeholders. This study explores the implementation of a digital research management system at the Faculty of Medicine of the University of Porto (FMUP) to address the challenges posed by its extensive and diverse clinical research portfolio. Given the institution's need to centralize research activities, improve efficiency, and ensure regulatory compliance, the CR-Digital project was launched to integrate a comprehensive database management system. Over a two-year period, FUNDANET was selected and implemented due to its adaptability to FMUP’s research framework, its ability to enhance collaboration, and its alignment with legal and financial requirements. The implementation process was structured into seven key phases, with the primary challenge being the alignment of diverse departmental objectives and preferences. These ranged from ensuring seamless interoperability with electronic health records to meeting the usability needs of researchers and administrators. Despite these complexities, FUNDANET successfully provided a robust platform encompassing digital research management, clinical study tools, and advanced data analytics, streamlining research workflows and optimizing decision-making processes. This study highlights the lessons learned during the system’s deployment, demonstrating the importance of selecting adaptable technological solutions, fostering stakeholder engagement, and implementing structured change management strategies. The insights gained from this project can inform other institutions seeking to modernize their clinical research infrastructure, ultimately contributing to more efficient, transparent, and data-driven research environments.

Abstract: Aim: To determine the evolving rehabilitation needs in Brazil, considering five main impairment categories for nationwide health-service planning, and stratified per age groups as well as Brazilian regions with inequitable development. Methods: Secondary analysis of the Global Burden of Disease study (1990-2019), using Years Lived with Disability (YLD) rates, including for all ages and age-standardized metrics. The set of health conditions amenable to rehabilitation were selected and organized based on the five impairment types, derived from the Brazil’s public-based Care Network for People with Disabilities. Results: A Brazil-wide 24% growth (1990-2019) in overall rehabilitation needs per capita (i.e., YLD rates per 100,000 population) was observed, in addition to a 6% negative growth for age-standardized YLD rates. “Physical” impairments accounted for 77% of the Brazilian rehabilitation needs in 2019; 69% of these impairments come from musculoskeletal conditions. Rehabilitation-need growths were also observed across the five Brazilian regions, ranging from 16% to 25%. Conclusion: Rehabilitation needs are growing Brazil-wide and across its regions, as a result of the population ageing and epidemiological transition. Brazilian regions with lower income and lower population density (e.g. with more rural or remote populations) also had growths in rehabilitation needs even though often underserved by rehabilitation professionals.

Abstract:

Background: Television (TV), video games, PC and devices such as tablets and smart phones have become part of everyday life at an ever-younger age. Increased screen time correlates with unhealthy eating habits and reduced sleep duration among children. Methods: 374 children aged 9-12 years and their parents (n=159), from 3 schools in Lemnos and 5 schools in Thessaloniki, Greece, took part in this cross-sectional study. The children completed the KIDMED score and a questionnaire about their physical activity, time spent watching TV, PC and playing electronic games, the frequency of cooking or shopping with their parents, the frequency of eating fast food and soft drinks. Statistical analysis was performed with SPSSS-29.0, using One Way ANOVA, T-test, Cross Tabulation, Reliability Statistics, Bivariate, Bonferoni, Post-hoc, Kolmogorov – Smirnov and Pearson chi-square. Results: There was a statistically significant difference between soft drinks consumption and hours of television viewing (p=0.03). A statistically significant difference detected between television (p=0,024), video games (p=0,028), all screen categories (p=0,011) and fast-food consumption. The more hours children spent in front of screens, the less adherence they had to the Mediterranean Diet. Sleep hours and screen time were correlated (p=0.002). Conclusions: The results suggest that screen time seem to be interrelated and affect children’s eating behaviors and sleep duration. The study concluded that the longer the screen time the unhealthier dietary habits and lifestyle profile have schoolchildren. Future research should focus on reducing screen time, as a means of improving dietary patterns, sleeping and potentially reducing childhood obesity.

Abstract:

In dementia care, access to effective psychosocial interventions is often addressed by evidence-based guidelines for care providers. However, it is unclear if current guidelines consider personal characteristics that may impact intervention effectiveness. This study investigates if, and within what framing, dementia care guidelines in Europe address what is effective and for whom. A review of 47 guidelines from 12 European countries was conducted. Content analysis focused on: i) if guidelines recommended specific psychosocial interventions, and how guidelines referred to ii) social health, iii) intersection of social positioning, and iv) inequities in care or outcomes. Thirty-five guidelines (74%) recommended specific psychosocial interventions. Around half referenced aspects of social health and of intersectionality. Thirteen guidelines (28%) referenced inequities. Social health was not explicitly recognised as a mechanism of psychosocial interventions. Only age and comorbidity were consistently considered to impact interventions’ effectiveness. Inequities were acknowledged to arise from within-country regional variations and individual economic status but not linked to (intersectional) individual societal positions such as sex and/or gender, sexuality, and/or religion. Results between European countries were heterogeneous. Current guidelines offer little insight into what works for whom. Policymakers and guideline developers should work with researchers, generating and translating evidence into policy.

Abstract: The sound level of knowledge, positive attitudes, and good practices of learners towards COVID-19 guidelines play a pivotal role in minimising the spread of COVID-19 and ensuring safe, healthy learning environments. The present study aimed to investigate learners' knowledge, attitudes, and practices towards COVID-19 guidelines at Bushbuckridge Local Municipality, Mpumalanga Province. This study employed a quantitative cross-sectional descriptive design. Two-stage cluster sampling and systematic sampling were used to select respondents in each sampled school cluster. Data was gathered using a questionnaire that was administered to sampled respondents. It was discovered that the majority of secondary school learners have a good level of knowledge towards COVID-19 guidelines. The study also found that the majority of secondary school learners, 77,60% have positive attitudes towards COVID-19 guidelines. The study also discovered that most secondary school learners, 72,26%, have proactive practices towards COVID-19 guidelines. The Department of Basic Education should emphasise integrating health education in schools to enhance the knowledge base of learners on COVID-19 guidelines and COVID-19 in general. Learners need to be continuously educated about hygiene practices and COVID-19 guidelines for readiness and be able to comply during future pandemics.