Expressway construction has caused a significant threat to the ecological environment in developing countries, and therefore the variation characteristics of ecological resilience along the expressway in developing countries are of major importance. This empirical study focuses on a typical area within a 2-km range of the Phnom Penh-Sihanoukville Expressway in Cambodia and uses remote sensing and geographic information systems (GIS) technology to analyze the variation characteristics of ecological resilience along the expressway. The results of the study reveal that due to the construction of expressways, the land use types transferred into or out of the land use types increase and furthermore the land use types show a trend of decreasing natural attributes and increasing human attributes. It is found that expressway construction has an observed effect on the transfer rate of the center of gravity of land use type, and the direction of the center of gravity shifts in the direction of expressway construction. The impact of construction on the ecological resilience of the western region with higher vegetation coverage was higher than that of the eastern region with higher urbanization. The research develops a theoretical evaluation model based on land use type of the variation characteristics of ecological resilience along the expressway, which can be used to enable the sustainability of expressway construction and maintain the regional ecological environment.

Community health projects have played a crucial role in improving health issues. Listening to communities\' voices and achieving community ownership are essential for conducting effective health projects. However, there are limited studies on the frameworks for collecting, aggregating, and operationalizing community preferences and values. In this study, we selected two cases of community field surveys from Japan and Cambodia to discuss who may represent a community and propose a practical approach to achieving community ownership. Both cases involved various stakeholders. From the insights of these two cases, we suggested the following three key components in the community project: the community representative, the communicator, and the institute outside the community. Notably, the community representative\'s role as the community\'s direct voice should be properly recognized and institutionalised to establish community ownership. We proposed the following key terms of the qualifications of community representatives: they should be able to represent voices from the community, should have extensive experience to decide the project direction and manage the project, and should be independent of outside actors. Our theoretical model of the structure of different stakeholder groups in community-based projects will be helpful to accelerate community capacity strengthening; moreover, it can help build the appropriate community institution and process, including multi-stakeholder groups to promote community ownership in health programs.

BACKGROUND: In Cambodia, stillbirths and their underlying factors have not been systematically studied. This study aimed to assess the proportion and trends in stillbirths between 2017 and 2020 in a large maternity referral hospital in the country and identify their key determinants to inform future prevention efforts.
METHODS: This was a retrospective cross-sectional analysis with a nested case-control study of women giving birth at the National Maternal and Child Health Centre (NMCHC) in Phnom Penh, 2017-2020. We calculated percentages of singleton births at ≥ 22 weeks\' gestation resulting in stillbirth and annual stillbirth rates by timing: intrapartum (fresh) or antepartum (macerated). Multivariable logistic regression was used to explore factors associated with stillbirth, where cases were all women who gave birth to a singleton stillborn baby in the 4-year period. One singleton live birth immediately following each case served as an unmatched control. Multiple imputation was used to handle missing data for gestational age.
RESULTS: Between 2017 and 2020, 3.2% of singleton births ended in stillbirth (938/29,742). The stillbirth rate increased from 24.8 per 1000 births in 2017 to 38.1 per 1000 births in 2020, largely due to an increase in intrapartum stillbirth rates which rose from 18.8 to 27.4 per 1000 births in the same period. The case-control study included 938 cases (stillbirth) and 938 controls (livebirths). Factors independently associated with stillbirth were maternal age ≥ 35 years compared to < 20 years (aOR: 1.82, 95%CI: 1.39, 2.38), extreme (aOR: 3.29, 95%CI: 2.37, 4.55) or moderate (aOR: 2.45, 95%CI: 1.74, 3.46) prematurity compared with full term, and small-for-gestational age (SGA) (aOR: 2.32, 1.71, 3.14) compared to average size-for-age. Breech/transverse births had nearly four times greater odds of stillbirth (aOR: 3.84, 95%CI: 2.78, 5.29), while caesarean section reduced the odds by half compared with vaginal birth (aOR: 0.50, 95%CI: 0.39, 0.64). A history of abnormal vaginal discharge increased odds of stillbirth (aOR: 1.42, 95%CI: 1.11, 1.81) as did a history of stillbirth (aOR: 3.08, 95%CI: 1.5, 6.5).
CONCLUSIONS: Stillbirth prevention in this maternity referral hospital in Cambodia requires strengthening preterm birth detection and management of SGA, intrapartum care, monitoring women with stillbirth history, management of breech births, and further investigation of high-risk referral cases.
In Cambodia, there is very little information published on stillbirths to know precisely how many there are and to understand the underlying reasons they occur so they can be prevented in the future. Our study aimed to quantify the number of stillborn babies and identify some underlying risk factors from one of the largest maternity referral hospitals in Phnom Penh, Cambodia. We examined data from almost 30,000 health facility medical files of women who gave birth between 2017 and 2020 which included 938 stillbirths. We found that about 3.2% of births ended in a stillbirth and that this percentage increased between 2017 and 2020. Women who had preterm babies, or whose babies were small in weight for their gestational age, and babies that were born breech had a higher chance of being stillborn. Women who had abnormal vaginal discharge, which can indicate a possible infection, also had a higher odds of having a stillbirth. We also found that women who had a stillbirth previously had almost three times higher chance of having another stillborn baby. Having a caesarean section reduced the likelihood of having a stillborn baby by about half. These findings suggest that efforts are needed to better identify and manage women with preterm births and monitor fetal growth as well as ensure breech births are managed adequately.

BACKGROUND: In the last decade, nursing education has begun to reform to competency-based education worldwide, including in low-and middle-income countries. Case-Based Learning (CBL), an approach to delivering competency-based education, contributes to acquiring critical thinking competency, problem-solving, higher knowledge, professional value and attitude. However, it needs to be taught in a culturally appropriate manner. In Cambodia, CBL was initiated in a classroom and clinical practicum by faculty and preceptors who graduated from the upgrading course. This study examined the factors associated with the competency level of nursing students, explored the practice and perceptions of teaching-learning activities among students, faculty members and preceptors and assessed the coherence of qualitative and quantitative findings.
METHODS: This was a convergent, mixed methods study. Data were collected from eight educational institutions for quantitative and qualitative studies and seven hospitals for qualitative studies. From June to September 2019, a cross-sectional survey of nursing students in the third year of the three-year programme (n = 719), eight focus group discussions (FGDs; n = 55) with 6-8 members and 15 FGDs with faculty (n = 38) and clinical preceptors (n = 37) with 4-7 members were conducted to elicit the teaching-learning experience and perceptions. Multiple linear regression was performed to investigate the factors associated with student competency. Moreover, the study conducted thematic content analysis on the qualitative data. The integrated analysis was presented as side-by-side joint displays.
RESULTS: First, the quantitative and qualitative findings confirmed each other \'s CBL learning experiences. Students had higher levels of nursing competencies if they had CBL experiences, both in the classroom and clinical practicum, both in a group manner. Next, the quantitative and qualitative findings complemented students\' academic satisfaction with the teaching by faculty members and preceptors. Finally, the quantitative and qualitative findings were expanded to explain students\' academic satisfaction with the programme.
CONCLUSIONS: The finding of CBL experiences in a group and students\' satisfaction with faculty members\' and preceptors\' teaching improved nursing students\' competency development. Meanwhile, students\' satisfaction with the design and delivery of the educational programme provides implications for policy level to narrow the theory and practice gaps in low- and middle-income countries.

Cambodia has exhibited great progress in achieving high coverage in nationally recommended immunizations. As vaccination program managers plan interventions to reach last-mile children, it is important to consider issues of equity immunization priority setting. In this analysis, we apply the VERSE Equity Tool to Cambodia\'s Demographic and Health Survey for the years 2004, 2010, and 2014 to evaluate multivariate equity in vaccine coverage for 11 vaccination statuses, emphasizing the results of the 2014 survey for MCV1, DTP3, fully immunized for age (FULL), and zero dose (ZERO). The largest drivers of vaccination inequity are socioeconomic status and the educational attainment of the child\'s mother. MCV1, DTP3, and FULL exhibit increasing levels of both coverage and equity with increasing survey years. The national composite Wagstaff concentration index values from the 2014 survey for DTP3, MCV1, ZERO, and FULL are 0.089, 0.068, 0.573, and 0.087, respectively. The difference in vaccination status coverage between the most and least advantaged quintiles of Cambodia\'s population, using multivariate ranking criteria, is 23.5% for DTP3, 19.5% for MCV1, 9.1% for ZERO, and 30.3% for FULL. By utilizing these VERSE Equity Tool outputs, immunization program leaders in Cambodia can identify subnational regions in need of targeted interventions.

Cambodia has achieved great success in tuberculosis (TB) control in the past decade. Nevertheless, people with TB are missed by the health systems at different stages of the care pathway. This programme review corroborated the care-seeking behaviours of people with TB and TB services availability and estimated the number of people completing each step of the TB disease and TB preventive treatment (TPT) care cascade.
Patient pathways and the care cascades for TB disease and TPT were constructed using data from the latest national TB prevalence survey, routine surveillance and programme, the global TB database and published studies. We also randomly selected TB survivors in the 2019 cohort to assess recurrence-free survival 1-year post-treatment. TPT care cascade was constructed for people living with HIV (PLHIV) and household contacts (children <5 years and all ages) of persons with bacteriologically-confirmed TB in 2019 and 2020.
Nationally, 54% of those who exhibited TB symptoms sought initial care in the private sector. Overall, 93% and 58% of people with presumptive TB did not access a facility with TB diagnostic and treatment services, respectively, at the first point of care-seeking. Approximately 56% (95% CI 52% to 57%) of the 47 000 (95% CI 31 000 to 68 000) estimated TB cases in 2019 achieved recurrence-free survival. Among the estimated PLHIV in Cambodia, <30% completed TPT. Among children <5 years, 53% (95% CI 29% to 65%) (2019) and 67% (95% CI 36% to 80%) (2020) of those eligible for TPT completed the regimen successfully. In 2019 and 2020, 23% (95% CI 22% to 25%) and 54% (95% CI 50% to 58%) of the estimated household contacts (all ages) eligible for TPT completed the regimen successfully.
There are significant gaps in care-seeking, coverage and access to TB services and TPT in Cambodia. Action plans to improve TB response have been co-developed with local stakeholders to address the gaps throughout the care cascades.

BACKGROUND: Diagnosis and treatment of tuberculosis (TB) in children remain challenging, particularly in resource-limited settings. Healthcare providers and caregivers are critical in improving childhood TB screening and treatment. This study aimed to determine the barriers to childhood TB detection and management from the perspectives of healthcare providers and caregivers in Cambodia.
METHODS: We conducted this qualitative study between November and December 2020. Data collection included in-depth interviews with 16 healthcare providers purposively selected from four operational districts and 28 caregivers of children with TB and children in close contact with bacteriologically confirmed pulmonary TB residing in the catchment areas of the selected health centers. Data were analyzed using thematic analyses.
RESULTS: Mean ages of healthcare providers and caregivers were 40.2 years (standard deviation [SD] 11.9) and 47.9 years (SD 14.6), respectively. Male was predominant among healthcare providers (93.8%). Three-fourths of caregivers were female, and 28.6% were grandparents. Inadequate TB staff, limited knowledge on childhood TB, poor collaboration among healthcare providers in different units on TB screening and management, limited quality of TB diagnostic tools, and interruption of supplies of childhood TB medicines due to maldistribution from higher levels to health facilities were the key barriers to childhood TB case detection and management. Caregivers reported transportation costs to and from health facilities, out-of-pocket expenditure, time-consuming, and no clear explanation from healthcare providers as barriers to childhood TB care-seeking. Aging caregivers with poor physical conditions, lack of collaboration from caregivers, ignorance of healthcare provider\'s advice, and parent movement were also identified as barriers to childhood TB case detection and management.
CONCLUSIONS: The national TB program should further invest in staff development for TB, scale-up appropriate TB diagnostic tools and ensure its functionalities, such as rapid molecular diagnostic systems and X-ray machines, and strengthen childhood TB drug management at all levels. These may include drug forecasting, precise drug distribution and monitoring mechanism, and increasing community awareness about TB to increase community engagement.

Rivers are critical, but often overlooked, parts of food systems. They have multiple functions that support the food security, nutrition, health and livelihoods of the communities surrounding them. However, given current unsustainable food system practices, damming and climate change, the majority of the world\'s largest rivers are increasingly susceptible to environmental degradation, with negative implications for the communities that rely on them. Here we describe the dynamism and multifaceted nature of rivers as food environments (i.e. the place within food systems where people obtain their food) and their role in securing food security including improved diets and overall health. We also provide a conceptual framework that explain rivers as food environments within the broader food system and describe approaches to characterizing these food environments to better inform our understanding of how they influence food security and nutrition outcomes. Applying this framework to the Mekong River in Cambodia, we describe rivers as multifaceted wild food environments embedded within ecosystems, sociocultural and political environments and sectors of influence. We also explain the ways in which individual factors might influence how communities interact with this food environment. Developing and articulating food-related, ecosystem-specific frameworks and their constructs can guide implementation of policies aimed to improve specific public health or environmental sustainability outcomes. Our conceptual framework incorporates the multiple dimensions of rivers, which will aid future work and public health policy framing to better describe, understand and intervene to ensure protection of rivers\' biodiversity and ecosystems as well as food security, health and livelihoods.
Souvent négligés, les cours d\'eau jouent pourtant un rôle vital dans les systèmes alimentaires. Ils remplissent de nombreuses fonctions qui contribuent à la sécurité alimentaire, à la nutrition, à la santé et aux moyens de subsistance des communautés avoisinantes. Toutefois, en raison d\'un système alimentaire actuel aux pratiques non durables, de la construction de barrages et du changement climatique, la plupart des grands fleuves et rivières du monde sont de plus en plus exposés aux dégradations environnementales, avec des conséquences néfastes pour les communautés qui en dépendent. Dans le présent document, nous évoquons le dynamisme et les multiples facettes des cours d\'eau en tant qu\'environnements alimentaires (c\'est-à-dire l\'endroit où les gens se procurent de la nourriture au sein d\'un système alimentaire), ainsi que la manière dont ils favorisent la sécurité alimentaire, notamment par le biais d\'un régime plus équilibré et d\'une meilleure santé en général. Nous fournissons également un cadre conceptuel qui définit les cours d\'eau comme environnements alimentaires au sein d\'un système plus vaste et décrit les approches caractérisant ces environnements, afin que nous puissions mieux comprendre l\'influence qu\'ils exercent sur la sécurité alimentaire et la nutrition. En appliquant ce cadre au fleuve Mékong, au Cambodge, nous dévoilons les multiples facettes de ces environnements alimentaires naturels variés qui font partie intégrante des écosystèmes, des milieux politiques et socioculturels, mais aussi des sphères d\'influence. Nous expliquons en outre la façon dont certains facteurs individuels sont susceptibles d\'interférer dans les interactions que les communautés entretiennent avec cet environnement alimentaire. Développer et formuler des cadres et structures liés à l\'alimentation, propres à chaque écosystème, peut orienter la mise en œuvre de mesures visant à améliorer des résultats spécifiques dans le domaine de la santé publique ou de la préservation de l\'environnement. Notre cadre conceptuel inclut les différents aspects des cours d\'eau, ce qui aidera à mener de futurs travaux et à élaborer des politiques de santé publique pour mieux les qualifier, les appréhender et intervenir en vue d\'assurer la protection de la biodiversité et des écosystèmes fluviaux ainsi que la sécurité alimentaire, la santé et les moyens de subsistance.
Los ríos son partes fundamentales de los sistemas alimentarios, pero con frecuencia se ignoran. Tienen múltiples funciones que favorecen la seguridad alimentaria, la nutrición, la salud y los medios de vida de las comunidades que los rodean. Sin embargo, dadas las actuales prácticas insostenibles del sistema alimentario, la construcción de embalses y el cambio climático, la mayoría de los ríos más grandes del mundo son cada vez más susceptibles a la degradación medioambiental, con implicaciones negativas para las comunidades que dependen de ellos. En este documento, se describe el dinamismo y la naturaleza polifacética de los ríos como entornos alimentarios (es decir, el lugar dentro de los sistemas alimentarios donde las personas obtienen sus alimentos) y su función para garantizar la seguridad alimentaria, incluida la mejora de los hábitos alimentarios y la salud en general. Asimismo, se proporciona un marco conceptual que explica los ríos como entornos alimentarios dentro del sistema alimentario en su conjunto y se describen enfoques para caracterizar estos entornos alimentarios con el fin de comprender mejor cómo influyen en los resultados de la seguridad alimentaria y la nutrición. Mediante la aplicación de este marco al río Mekong en Camboya, se describen los ríos como entornos alimentarios silvestres multifacéticos integrados en ecosistemas, entornos socioculturales y políticos y sectores de influencia. Además, se explican cómo los factores individuales pueden influir en la interacción de las comunidades con este entorno alimentario. El desarrollo y la articulación de marcos específicos de los ecosistemas relacionados con la alimentación y sus constructos pueden orientar la aplicación de políticas destinadas a mejorar determinados resultados en materia de salud pública o sostenibilidad medioambiental. El marco conceptual que se presenta incorpora las múltiples dimensiones de los ríos, lo que ayudará en futuros trabajos y en la formulación de políticas de salud pública a describir, comprender e intervenir mejor para asegurar la protección de la biodiversidad y los ecosistemas fluviales, así como la seguridad alimentaria, la salud y los medios de subsistencia.
تمثل الأنهار أجزاءً مهمة من النظم الغذائية، ولكن غالبًا ما يتم تجاهلها. فيوجد لديها وظائف متعددة تدعم الأمن الغذائي، والتغذية، والصحة، وسبل العيش في المجتمعات المحيطة بها. إلا أنه نظرًا لممارسات النظام الغذائي غير المستدامة الحالية، وبناء السدود، وتغير المناخ، فإن غالبية أكبر أنهار العالم معرضة بشكل متزايد للتدهور البيئي، مع ما يترتب على ذلك من آثار سلبية على المجتمعات التي تعتمد عليها. نحن هنا نصف الديناميكية والطبيعة المتعددة الأوجه للأنهار كبيئات غذائية (أي المكان الموجود في النظم الغذائية حيث يحصل الناس منه على طعامهم)، ودورها في تأمين الأمن الغذائي بما في ذلك النظم الغذائية المحسنة، والصحة العامة. نحن نقدم أيضًا إطار عمل مفاهيمي يشرح الأنهار على أنها بيئات غذائية ضمن نظام غذائي أوسع، ويشرح أساليب لتوصيف هذه البيئات الغذائية لتوعية فهمنا بشكل أفضل لكيفية تأثيرها على الأمن الغذائي ونتائج التغذية. بتطبيق إطار العمل هذا على نهر ميكونج في كمبوديا، نحن نصف الأنهار على أنها بيئات غذائية برية متعددة الأوجه، مدمجة في النظم البيئية، والبيئات الاجتماعية والثقافية والسياسية، وقطاعات التأثير. نحن نوضح أيضًا الطرق التي قد تؤثر بها العوامل الفردية على كيفية تفاعل المجتمعات مع هذه البيئة الغذائية. يمكن أن يؤدي تطوير وتوضيح الأطر المتعلقة بالأغذية والخاصة بالنظم الإيكولوجية وبنياتها إلى توجيه تنفيذ السياسات الهادفة إلى تحسين نتائج محددة تتعلق بالصحة العامة أو الاستدامة البيئية. يشتمل إطار العمل المفاهيمي لدينا على الأبعاد المتعددة للأنهار، والتي سوف تساعد العمل المستقبلي وتأطير سياسات الصحة العامة من أجل وصف وفهم وتدخل أفضل، لضمان حماية التنوع البيولوجي والنظم البيئية للأنهار، وكذلك الأمن الغذائي، والصحة، وسبل العيش.
河流是食物系统的重要组成部分，但往往被人们忽视。它们具有维持周围社区的食物安全、营养、健康和生计的多种功能。然而，鉴于目前不可持续的食物系统实践、筑坝和气候变化，世界上大多数大河越来越容易受到环境退化的影响，对依赖这些河流的社区产生了负面的影响。在这里，我们介绍了河流作为食物环境（即食物系统中人们获取食物的地方）的活力和多方面性，以及它们在确保食物安全（包括改善人们饮食和总体健康）方面所起的作用。我们还提供了一个概念框架，解释了河流在更广泛的食物系统中作为食物环境的作用，并介绍了描述这些食物环境的方法，以更好地了解它们如何影响食物安全和营养状况。将此框架应用于柬埔寨的湄公河流域，我们将河流定义为嵌入生态系统、社会文化和政治环境及其所影响部门的多面性野生食物环境。我们还解释了个别因素可能如何影响社区与食物环境相互作用的方式。制定和阐明与食物相关的特定生态系统框架及其结构，可以指导旨在改善特定公共卫生或环境可持续发展状况的实践。我们的概念框架纳入了河流的多个维度，这将有助于未来开展工作和制定公共卫生政策的框架，以便更好地描述、理解和实施干预，确保河流的生物多样性和生态系统以及食物安全、人类的健康和生计得到保护。.
Реки являются важнейшей, но часто упускаемой из виду частью продовольственных систем. Они выполняют множество функций, способствующих обеспечению продовольственной безопасности, питания, здоровья и средств к существованию окружающих их сообществ. Однако в условиях существующих неэкологичных практик в продовольственной системе, зарегулирования стока плотинами и изменения климата экологическое состояние большинства крупнейших рек мира постоянно ухудшается, что негативно сказывается на зависящих от них сообществах. В этой статье описывается динамизм и многогранность рек как продовольственной среды (то есть как места в продовольственных системах, откуда люди получают пищу) и их роль в обеспечении продовольственной безопасности, включая улучшение рациона питания и общего состояния здоровья. Также представлена концептуальная схема, в которой реки рассматриваются как продовольственная среда в рамках более широкой продовольственной системы, и описаны подходы к определению характеристик этой продовольственной среды для лучшего понимания ее влияния на продовольственную безопасность и результаты в сфере питания. Применяя эту схему к реке Меконг в Камбодже, авторы описывают реки как многогранную среду обитания диких продовольственных ресурсов, встроенную в экосистемы, социокультурную и политическую среду и секторы влияния. Авторы также объясняют, каким образом отдельные факторы могут влиять на то, как сообщества взаимодействуют с этой продовольственной средой. Разработка и разъяснение схем и концепций, связанных с продуктами питания в конкретных экосистемах, могут определять реализацию политики, направленной на улучшение конкретных результатов в области общественного здравоохранения или экологической устойчивости. Разработанная концептуальная схема включает в себя многочисленные показатели состояния рек, что поможет в ходе дальнейшей работы и разработки политики в области общественного здравоохранения добиться лучшего описания, понимания и вмешательства в целях обеспечения защиты биоразнообразия и экосистем рек, а также обеспечения продовольственной безопасности, здоровья и средств к существованию.

BACKGROUND: In Cambodia, economic development accompanied by health reforms has led to a rapidly ageing population and an increasing incidence and prevalence of noncommunicable diseases. National strategic plans recognize primary care health centres as the focal points of care for treating and managing chronic conditions, particularly hypertension and type 2 diabetes. However, health centres have limited experience in providing such services. This case study describes the process of developing a toolkit to facilitate the use of evidence-based guidelines to manage hypertension and type 2 diabetes at the health-centre level.
METHODS: We developed and revised a preliminary toolkit based on the feedback received from key stakeholders. We gathered feedback through an iterative process of group and one-to-one consultations with representatives of the Ministry of Health, provincial health department, health centres and nongovernmental organizations between April 2019 and March 2021.
RESULTS: A toolkit was developed and organized according to the core tasks required to treat and manage hypertension and type 2 diabetes patients. The main tools included patient identification and treatment cards, risk screening forms, a treatment flowchart, referral forms, and patient education material on risk factors and lifestyle recommendations on diet, exercise, and smoking cessation. The toolkit supplements existing guidelines by incorporating context-specific features, including drug availability and the types of medication and dosage guidelines recommended by the Ministry of Health. Referral forms can be extended to incorporate engagement with community health workers and patient education material adapted to the local context. All tools were translated into Khmer and can be modified as needed based on available resources and arrangements with other institutions.
CONCLUSIONS: Our study demonstrates how a toolkit can be developed through iterative engagement with relevant stakeholders individually and in groups to support the implementation of evidence-based guidelines. Such toolkits can help strengthen the function and capacity of the primary care system to provide care for noncommunicable diseases, serving as the first step towards developing a more comprehensive and sustainable health system in the context of population ageing and caring for patients with chronic diseases.

Building on the value of engaging with and enabling the participation of marginalised young people in research, the aim of this article was to profile practical and procedural issues faced when conducting studies with young people who experience some form of marginalisation. Drawing on observations and research experiences from four diverse case studies involving young people who were either imprisoned in Cambodia, living in informal urban communities in North India, residing in rural northern Sweden or attending school in rural Zambia, learnings were identified under three thematic areas. Firstly, a need exists to develop trusting relationships with stakeholders, and especially the participating young people, through multiple interactions. Secondly, the value of research methods that are creative and context sensitive are required to make the process equitable and meaningful for young people. Thirdly, it is important to flatten power relations between adults and young people, researchers and the researched, to maximise participation. These findings can inform future youth research in the field of global public health by detailing opportunities and challenges of engaging in research with young people on the margins to promote their participation.