Tag Archives: #medical services

Breaking the Silence: Why Chronic Kidney Disease Awareness Needs Better Communication

Chronic kidney disease (CKD) is often called ‘silent killer’ as most people live with it for years without symptoms. In resource-limited settings, up to 9 out of 10 individuals with CKD are unaware of their condition, delaying crucial interventions.1 Despite being a growing global health crisis, kidney disease remains widely misunderstood and under-communicated, leading to severe health and economic consequences. Kidney Awareness Month serves as a critical opportunity to amplify education and encourage early detection.

A Growing Global Crisis

CKD affects approximately 850 million people worldwide and is the third fastest-growing cause of death. By 2040, it is projected to become the fifth leading cause of premature mortality.1 Modern lifestyle diseases—such as diabetes and hypertension significantly contribute to this burden, with 1 in 3 adults and 1 in 5 adults at risk of developing this disease, respectively.2

Additionally, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) poses a growing threat. Around 30 million people globally consume NSAIDs daily,3 and unmonitored long-term use can worsen kidney function, further increasing CKD prevalence.

The Economic Toll of CKD

Beyond health risks, CKD imposes a profound economic burden. By 2027, the direct annual costs of diagnosed CKD and kidney replacement therapy (KRT) are expected to reach $406.7 billion.4

The challenge is particularly severe in low- and middle-income countries, where about 78% of patients with CKD reside, and health systems struggle with limited resources and systemic inequalities.5 The financial burden frequently falls on families, leading to catastrophic health expenditures. Patients often lose their ability to work, further impacting household income and national productivity.

Unawareness and the Problem of Late Diagnosis

More than 90% of people with early-stage CKD are unaware of their condition.1 The disease progresses silently, often overlooked until symptoms appear increasing risk for serious health complications such as heart attack, stroke, and kidney failure. Understanding the stages of kidney disease is crucial in recognizing progression and taking necessary preventive measures. Early detection through screening and risk stratification could significantly reduce morbidity and mortality. However, at present, there is no accepted systematic strategy for CKD screening and treatment.

For example, in the United States, over 20% of individuals with hypertension have increased albuminuria, yet only 7% have tested for it.6 Delayed diagnoses also raises treatment cost by 19% compared to early detection.7 Additionally, Late-stage CKD often requires dialysis or transplants, both costly and with limited accessibility.

In contrast, early-stage CKD can often be managed effectively through medication, lifestyle changes, and controlling underlying conditions like diabetes and hypertension. But this is only possible when the disease is identified in time.

Treatment Affordability and Accessibility

Kidney disease is not just a health issue—it’s a socioeconomic challenge. In many countries, dialysis centres are concentrated in urban areas, leaving rural populations underserved. Even when available, treatment is expensive, with annual costs reaching $19,380 for dialysis and up to $26,903 for the first year of a kidney transplant.8 Many patients delay or forgo treatment due to financial constraints, worsening outcomes.

Strengthening Awareness, Early detection, and Communication

Kidney Awareness Month is a key initiative that seeks to promote education, encourage early screening, and advocate for health policies that support kidney patients. World Kidney Day, led by the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF), also aims to enhance kidney health education and drive policy changes.

Incorporating CKD screening into public health initiatives enhances cost efficiency and resource utilization. Successful examples include Thailand’s Screening and Early Evaluation of Kidney Disease program and South Africa’s HIV Treatment Program, which has integrated serum creatinine testing to monitor kidney function.5

Digital and mobile platforms offer scalable CKD screening solutions. In rural India, telehealth programs and point-of-care (POC) testing for creatinine and urine albumin have improved risk assessment and diagnostic accuracy at the primary care level.5

Public health messaging should emphasize kidney health through lifestyle choices—nutrition, hydration, exercise, and routine screening. Stronger communication strategies, including public education campaigns, HCP engagement, social media outreach, and community initiatives, are crucial, especially for underserved groups. Addressing the emotional and social aspects of CKD can empower patients, reduce stigma, and encourage timely care-seeking.

Conclusion: Early Action Saves Lives

Kidney disease is a growing global health threat, but it is also one that can be detected early, managed effectively, and even prevented—provided the right information reaches the right people at the right time.

Enhancing communication about kidney disease is not just a public health priority but a moral responsibility. With better education, awareness, and timely intervention, we can help millions avoid the severe consequences of this silent epidemic.

References:

  1. Francis A, Harhay MN, Ong ACM, et al. Chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol. 2024;20(7):473-485.
  2. Preventing Chronic Kidney Disease. Available at: https://www.cdc.gov/kidney-disease/prevention/index.html#:~:text=Manage%20CKD%20risk%20factors,Family%20history%20of%20CKD. Last accessed: March 2025.
  3. Montuori P, Shojaeian SZ, Pennino F, et al. Consumer awareness and knowledge regarding use of non-steroidal anti-inflammatory drugs (NSAIDs) in a metropolitan area. Front Pharmacol. 2024;15:1362632.
  4. Chadban S, Arıcı M, Power A, et al. Projecting the economic burden of chronic kidney disease at the patient level (Inside CKD): a microsimulation modelling study. EClinicalMedicine. 2024;72:102615.
  5. Wijewickrama E and Kalyesubula R. World Kidney Day: Detecting Kidney Disease in Low- and Middle-Income Countries. Kidney Int Rep. 2025;10:637–640.
  6. Shlipak MG, Tummalapalli SL, Boulware LE, et al. The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2021;99(1):34-47.
  7. Spencer D, Dunning S, McPheeters J, St Clair Russell J, Hane C. Health care costs associated with unrecognized progression to late-stage kidney disease. Am J Manag Care. 2023;29(2):e64-e68.

Bello AK, Okpechi IG, Levin A, et al. An update on the global disparities in kidney disease burden and care across world countries and regions. Lancet Glob Health. 2024;1

Bridging the Gap: How Women’s Empowerment Drives Global Health Improvements

Imagine a world where every woman has the power to make decisions about her health, future, and family’s well-being. A world where women are not just patients but policymakers, not just caregivers but change-makers. This isn’t just an ideal—it’s a necessity. Women’s empowerment is not only about fairness; it is a fundamental driver of global health and economic progress. When women have access to education, financial resources, and quality healthcare, they uplift entire communities. Yet, despite undeniable progress, many women still face barriers that prevent them from achieving optimal health and well-being. Addressing these challenges through policy, advocacy, and leadership opportunities is essential for fostering a healthier, more equitable world.

Women as pillars of global health

Women play a fundamental role in health systems—not only as caregivers in their families but also as healthcare professionals, policymakers, and advocates. Studies have shown that societies with stronger female leadership representation experience improved health outcomes. For instance, Rwanda, where women hold over 60% of parliamentary seats, has seen notable progress in reducing maternal and child mortality rates.1,2

Moreover, female-led health initiatives tend to prioritize community well-being, increasing access to essential services such as vaccinations, maternal healthcare, and family planning. Women leaders are more likely to invest in equitable healthcare solutions that address the unique needs of women and children.3

Bridging the gap: Gender disparities in health

Despite their critical role, women often face disproportionate barriers to healthcare access. Gender inequalities manifest in various ways, including restricted access to reproductive health services, economic dependency that limits medical decision-making, and cultural norms that discourage seeking care. The World Health Organization (WHO) has identified gender-based violence and inadequate access to sexual and reproductive health services as key issues affecting women’s overall health.4

Furthermore, the intersection of gender and economic status exacerbates health disparities. Women in low-income settings are less likely to receive preventive care, leading to higher incidences of maternal mortality and untreated chronic illnesses.

Empowering women through healthcare access

Ensuring universal health coverage for women requires a multifaceted approach that includes:

  • Expanding access to reproductive health services: Family planning, maternal health programs, and reproductive rights are crucial for reducing unintended pregnancies and maternal mortality.
  • Addressing gender-based violence: Implementing survivor-centered healthcare responses and prevention strategies in high-prevalence regions is necessary to mitigate health consequences of violence against women.
  • Investing in women’s health leadership: Increasing female representation in health policymaking ensures that gender-specific health concerns are adequately addressed.
  • Economic empowerment programs: Cash transfer programs directed at women have shown positive impacts on family health outcomes, reinforcing the connection between financial independence and improved well-being.

Women as agents of change

Numerous examples highlight the transformative power of women’s leadership in health.

Dr. Soumya Swaminathan, former Chief Scientist at WHO, has been instrumental in global health policy, particularly in tackling tuberculosis, infectious diseases, and pandemic preparedness.

Dr. Kiran Mazumdar-Shaw, founder of Biocon, has revolutionized India’s biotechnology sector by pioneering affordable insulin and cancer treatments. Through her innovations, she has ensured greater access to life-saving medicines, particularly for low-income communities, and has championed women’s leadership in STEM and healthcare innovation.

Furthermore, grassroots movements led by women in developing nations have been instrumental in tackling health crises. Community-driven initiatives focusing on malaria prevention, maternal health, and child nutrition have significantly reduced disease burdens in low-resource settings. For example, the Self-Employed Women’s Association (SEWA) in India has improved access to healthcare for informal workers, helping women take charge of their own health.

A call to action

Empowering women in health is not just about fairness—it is about effectiveness. The evidence is clear: when women have control over their health and economic resources, societies thrive.

  • Support female-led health initiatives by advocating for policies that increase women’s leadership in healthcare and research.
  • Encourage education and training for women in medicine, public health, and policymaking.
  • Challenge harmful gender norms that limit women’s access to healthcare and economic independence.

By prioritizing gender-inclusive health policies and investing in women as decision-makers, we can move closer to a world where health equity is a reality for all.

What role will you play in empowering women for better global health?

References

  1. UN Women. Rwanda – Women, peace and security [Internet]. 2024 [cited 2025 Mar 3]. Available from: https://data.unwomen.org/country/rwanda
  2. UN Women. Beijing +30 Report: Rwanda – Advancing gender equality and women’s empowerment [Internet]. 2024 [cited 2025 Mar 3]. Available from: https://www.unwomen.org/sites/default/files/2024-09/b30_report_rwanda_en.pdf
  3. Gender-equitable families and health systems are better for children [Internet]. 2024 [cited 2025 Mar 3]. Available from: https://www.defeatdd.org/campaign/gender-equitable-families-and-health-systems-are-better-children/
  4. World Health Organization. Violence against women and girls [Internet]. 2024 [cited 2025 Mar 3]. Available from: https://www.who.int/teams/sexual-and-reproductive-health-and-research-%28srh%29/areas-of-work/violence-against-women-and-girls

Empowering Women Through Health: The Importance of Preventive Care at Every Stage of Life

Recently, while working on a project about preeclampsia during pregnancy, our team was startled to learn that preeclampsia is one of the most common hypertensive disorders of pregnancy, accounting for 2%–8% of pregnancy-related complications, more than 50,000 maternal deaths, and over 500,000 fetal deaths worldwide.1 Yet, many women are unaware that early diagnosis and prompt symptomatic management can help prevent such maternal and neonatal complications. The need of the hour is to empower women with knowledge and awareness about their health so that they can proactively prioritize their well-being while juggling multiple responsibilities.
Below are ten essential steps all women should undertake to keep all diseases at bay for themselves and their families.

Understand the food labels before buying food items

According to the World Health Organization (WHO), the increased consumption of processed foods high in salt, sugar, and fat is a key driver of a global obesity crisis. Currently, more than a billion people live with obesity,2 and an estimated 17 million early deaths occur every year due to noncommunicable diseases such as diabetes and heart disease.3 Studies have shown that some of the most frequently present additives in children’s food include bisphenols, phthalates, perfluoroalkyl chemicals, perchlorates, pesticides, nitrates and nitrites, artificial food colors, monosodium glutamate, and aspartame—all of which can be harmful to a child’s growth and development. As women are more involved in feeding their families, they must understand the nutritional labels and their implications. The next time you pick up a packet of your favorite snack, do not blindly trust the brand—read the fine print carefully.

Stay physically active

A recent study involving 5000 postmenopausal women in California supports the importance of regular physical activity and reduced sedentary time in lowering mortality risk, regardless of their genetic predisposition for longevity. Women who do strength training exercises 2–3 times a week are more likely to live longer and have a 30% lower risk of death from heart disease compared to those who do not exercise.4

Get screened for common cancers

According to the American Cancer Society, breast cancer is the second leading cause of cancer-related deaths in women, with the lifetime risk of 1 in 43.5 Young women are more likely to develop aggressive forms of breast cancer, often linked to genetic factors such as inherited mutations in the BRCA genes, highlighting the importance of undergoing BRCA testing. Studies have demonstrated that early detection of breast cancer can lead to a 100% survival rate, especially when the cancer is localized.6 Another major cancer affecting women is cervical cancer, which the WHO ranks as the fourth leading cause of cancer-related deaths among women, causing 350,000 deaths in 2022.7 Persistent HPV infections are the primary cause of cervical cancer, and vaccination between the ages of 9 and 14 is an effective preventive measure. Studies indicate that unvaccinated women are ten times more likely to develop cervical cancer than those who are vaccinated.8 Therefore, to maintain good health and a high quality of life, women should prioritize regular checkups, early detection screenings, and staying up to date with vaccinations.

Test your blood sugar regularly

Recent studies have demonstrated that 10.5% of the adult population has diabetes,9 with nearly half unaware of their condition, leading to untreated diabetes and increasing the risk of cardiovascular (CV), renal, and neurological complications.10 Research has shown that early detection and treatment of type 2 diabetes can reduce the risk of CV complications by 29%–38%, emphasizing the importance of early detection. Regular blood sugar testing plays a vital role in this process.11 With glucometers now widely available, women can easily monitor their own and their family’s blood sugar levels, even with their busy schedules, and promptly seek medical attention if any irregularities are detected.

Mental health matters

Women are three times more likely to experience mental health issues than men.12 Poor mental health not only impacts physical well-being but also decreases workplace productivity by nearly 13%,13 with twelve billion working days lost annually due to depression and anxiety.14 Furthermore, about 10% of pregnant women and 13% of postpartum women experience mental health disorders, primarily depression, which can negatively affect both the mother’s well-being and the child’s growth and development.15 These statistics are concerning and highlight the importance of prioritizing mental health. Women can support their well-being by adopting healthy habits such as regular exercise, balanced diet, self-care, and maintaining social connections.

Understand the needs of your changing body

Menopause, marking the end of reproductive years, often lacks the attention it deserves despite its significant impact. It leads to a decline in estrogen, causing symptoms like irregular periods, hot flashes, night sweats, insomnia, vaginal dryness, and mental health challenges like mood swings, anxiety, and depression. Menopause is also a major risk factor for osteoporosis, affecting 1 in 3 women.16 Hormone replacement therapy (HRT) is most effective when started within 10 years of menopause or before age 60. HRT helps relieve menopausal symptoms, prevents bone loss, and reduces the risk of fractures by 20%–40%.17 Hence, women should consult their doctor early for best results. Additionally, calcium and vitamin D supplements, a healthy diet, an active lifestyle, and cognitive behavioral therapy can help manage symptoms further.

Keep your weight under control

PCOS, hypothyroidism, Cushing’s syndrome, insulin resistance, stress, and emotional eating are the common health issues that can lead to weight gain in women. Studies show that 38%–88% of women with PCOS are either overweight or obese, which can negatively impact their menstrual and reproductive health.18 However, even a modest weight loss of 5% in obese women with PCOS can help alleviate symptoms.19 Regarding hypothyroidism, women are 8–9 times more likely to develop the condition, with the highest incidence between the ages of 30 and 50.20 Gaining a few pant sizes can be a key symptom of hypothyroidism. Women experiencing this should seek prompt medical advice and undergo appropriate treatment, as weight gain can lead to additional complications such as cardiovascular disease (CVD), joint issues, sleep apnea, and psychological distress.

Rely on nutrition for healthy skin and hair

The quest for healthy skin and hair often leads women to explore a wide range of cosmetic products. However, emerging research suggests that nutrition plays a far more significant role in maintaining and enhancing skin and hair health. Rather than relying on topical treatments, proper nutrition addresses the root causes of skin and hair concerns by supplying the body with essential nutrients. Many common chemicals found in skincare products, such as sodium lauryl sulfate, phthalates, fragrances, mineral oils, lead, and formaldehyde, can have harmful effects on the skin and other organs. In contrast, studies have shown that consuming antioxidant-rich foods can reduce photoaging by 10% over 15 years compared to diets low in antioxidants.21 Similarly, for hair health, research reveals that incorporating omega-3 fatty acids into the diet can improve scalp hydration and increase hair shine. These findings highlight how nutrition offers a safer and more effective approach to achieving and maintaining healthy skin and hair, as opposed to relying on potentially harmful cosmetics.

Relax and sleep well

Research shows that inadequate sleep negatively affects women’s mental, physical, and reproductive health, along with daily functioning. Studies reveal concerning patterns that underscore the importance of adequate sleep. Chronic sleep deprivation (less than 6 hours per night) is correlated with a higher body mass index, 22 15% increased risk of CVD, 23% higher risk of coronary heart disease,23 and increased likelihood of developing diabetes.24 .26 By adhering to a consistent good sleep routine, women may mitigate these health risks.

Avoid smoking and alcohol consumption

According to WHO data, tobacco use causes more than eight million deaths each year, whereas alcohol consumption is responsible for 2.6 million deaths.27,28 Research has shown that alcohol misuse and smoking are rising among women, posing serious health risks not only for them but also for their babies. Studies indicate that babies born to mothers who smoke are twice as likely to have a lower birth weight compared to those born to nonsmoking mothers.29 In fact, 14% of all deaths due to low birth weight are linked to tobacco use during pregnancy.29 Moreover, heavy alcohol consumption in women is associated with a more rapid onset of health conditions such as CVD, obesity, and various cancers. These findings highlight the importance of cutting back or abstaining from these habits. To stay on track, it is essential to recognize triggers, avoid situations that tempt you, find healthier coping mechanisms such as exercising or picking up new hobbies, and seek support from friends and family.

In conclusion, discipline is the key to a healthy life. By incorporating a few simple healthy habits into your daily routine, you set yourself up for a future filled with health and happiness. Take charge of your life—stay vigilant, act quickly when needed, do not hesitate to ask for help, and stay strong. Everything will fall into place. Remember, prioritizing your health and scheduling regular checkups is not just about taking care of your body, it is about empowering yourself. Staying up to date with the latest health information and educating yourself on wellness is just as important, as it helps you make informed choices and stay ahead. By prioritizing your well-being, you truly embody the strength of an empowered woman.

  1. Karrar SA, Martingano DJ, Hong PL. [Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK570611/.
  2. One in eight people are now living with obesity. Available at: https://www.who.int/news/item/01-03-2024-one-in-eight-people-are-now-living-with-obesity. Last accessed: March 2025.
  3. Cardiovascular disease. Available at: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)#:~:text=In%202013%2C%20WHO%20Member%20States,on%20preventing%20and%20controlling%20CVDs . Last accessed: March 2025.
  4. Study: Women who do strength training live significantly longer. Available at: https://globalwellnessinstitute.org/global-wellness-institute-blog/2024/05/28/study-women-who-do-strength-training-live-significantly-longer/#:~:text=Study:%20Women%20Who%20D,Access%20this%20study%20on%20exercise. Last accessed: March 2025.
  5. Key statistics for breast cancer. Available at: https://www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html#:~:text=Breast%20cancer%20is%20the%20second,decline%20of%2044%25%20through%202022. Last accessed: March 2025.
  6. Li J, Guan X, Fan Z, et al. Non-Invasive Biomarkers for Early Detection of Breast Cancer. Cancers (Basel). 2020;12(10):2767.
  7. Cervical cancer. Available at: https://www.who.int/news-room/fact-sheets/detail/cervical-cancer#:~:text=Cervical%20cancer%20is%20the%20fourth,compared%20to%20women%20without%20HIV. Last accessed: March 2025.
  8. Naslazi E, Hontelez JAC, Naber SK, et al. The Differential Risk of Cervical Cancer in HPV-Vaccinated and -Unvaccinated Women: A Mathematical Modeling Study. Cancer Epidemiol Biomarkers Prev. 2021;30(5):912-919.
  9. Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045 [published correction appears in Diabetes Res Clin Pract. 2023;204:110945.
  10. Hossain MJ, Al-Mamun M, Islam MR. Diabetes mellitus, the fastest growing global public health concern: Early detection should be focused. Health Sci Rep. 2024;7(3):e2004.
  11. Herman WH, Ye W, Griffin SJ, et al. Early Detection and Treatment of Type 2 Diabetes Reduce Cardiovascular Morbidity and Mortality: A Simulation of the Results of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Europe). Diabetes Care. 2015;38(8):1449-1455.
  12. Men and women: Statistics. Available at: https://www.mentalhealth.org.uk/explore-mental-health/statistics/men-women-statistics#:~:text=Women%20between%20the%20ages%20of,the%20same%20age%20(9%25).&text=Women%20are%20twice%20as%20likely%20to%20be%20diagnosed%20with%20anxiety%20as%20men. Last accessed: March 2025.
  13. Happy workers are 13% more productive. Available at: https://www.ox.ac.uk/news/2019-10-24-happy-workers-are-13-more-productive. Last accessed: March 2025.
  14. Mental health at work. Available at: https://www.who.int/news-room/fact-sheets/detail/mental-health-at-work. Last accessed: March 2025.
  15. Perinatal mental health. Available at: https://www.who.int/teams/mental-health-and-substance-use/promotion-prevention/maternal-mental-health. Last accessed: March 2025.
  16. Prevention and treatment of osteoporosis in postmenopausal women. Available at: https://thebms.org.uk/wp-content/uploads/2023/10/06-BMS-ConsensusStatement-Prevention-and-treatment-of-osteoporosis-in-women-SEPT2023-A.pdf. Last accessed: March 2025.
  17. Gosset A, Pouillès JM, Trémollieres F. Menopausal hormone therapy for the management of osteoporosis. Best Pract Res Clin Endocrinol Metab. 2021;35(6):101551.
  18. Barber TM. Why are women with polycystic ovary syndrome obese? Br Med Bull. 2022;143(1):4-15.
  19. Treatment, polycystic ovary syndrome. Available at: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/treatment/#:~:text=In%20overweight%20women%2C%20the%20symptoms,a%20significant%20improvement%20in%20PCOS. Last accessed: March 2025.
  20. Chiovato L, Magri F, Carlé A. Hypothyroidism in Context: Where We’ve Been and Where We’re Going. Adv Ther. 2019;36(2):47-58.
  21. Hughes MCB, Williams GM, Pageon H, et al. Dietary Antioxidant Capacity and Skin Photoaging: A 15-Year Longitudinal Study. J Invest Dermatol. 2021;141(4S):1111-1118.e2.
  22. Papatriantafyllou E, Efthymiou D, Zoumbaneas E, et al. Sleep Deprivation: Effects on Weight Loss and Weight Loss Maintenance. Nutrients. 2022;14(8):1549.
  23. Hoevenaar-Blom MP, Spijkerman AM, Kromhout D, et al. Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: The MORGEN study. Sleep. 2011;34(11):1487-1492.
  24. Darraj A. The Link Between Sleeping and Type 2 Diabetes: A Systematic Review. Cureus. 2023;15(11):e48228.
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  26. Beroukhim G, Esencan E, Seifer DB. Impact of sleep patterns upon female neuroendocrinology and reproductive outcomes: A comprehensive review. Reprod Biol Endocrinol. 2022;20(1):16.
  27. Available at: https://www.who.int/news-room/fact-sheets/detail/alcohol#:~:text=Worldwide%2C%202.6%20million%20deaths%20were,per%20100%20000%20people%2C%20respectively. Last accessed: March 2025.
  28. Available at: https://www.who.int/news-room/fact-sheets/detail/tobacco#:~:text=Tobacco%20kills%20up%20to%20half,are%20Parties%20to%20this%20treaty. Last accessed: March 2025.
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