COVID

Misinformation circulating through digital platforms and community networks increasingly challenges public health communication, particularly in low- and middle-income countries. Frontline health educators play a critical role in addressing misinformation and promoting accurate health information within primary health care systems; however, empirical evidence on their preparedness to manage infodemics remains limited. This study assessed the training needs and response capacity of primary health care health educators in Lagos State, Nigeria. A convergent mixed-methods design was employed across three districts. Quantitative data were collected from 95 health educators using the 30-item Health Educators Infodemic Management Training Needs Assessment Questionnaire (HEIM-TNAQ). Qualitative data were obtained through six focus group discussions involving 56 educators and 25 key informant interviews with supervisors and programme managers. Quantitative data were analysed using descriptive statistics and t-tests, while qualitative data were analysed thematically. Participants demonstrated relatively strong knowledge of health misinformation (mean = 71.5), but only moderate decision-response skills (48.6) and low confidence in addressing misinformation (42.5). Integration of misinformation response into routine practice was also limited (46.3), and no significant differences were observed between respondents with or without prior training. Qualitative findings revealed frequent exposure to vaccine rumours, spiritual explanations for illness, and misinformation circulating through social media and community networks. Strengthening infodemic management within primary health care requires practical training, behavioural communication skills, and institutional mechanisms for systematic rumour monitoring and response.

BackgroundZero-dose children, defined as those who have not received the first dose of a diphtheria-tetanus-pertussis-containing vaccine (DPT1), are a key indicator of inequitable access to immunization services. Nigeria remains one of the largest contributors to the global burden of zero-dose children. This study estimated the prevalence of zero-dose children aged 12-23 months and identified individual-and community-level determinants using the 2024 Nigeria Demographic Health Survey (NDHS). MethodsA secondary analysis of cross-sectional analysis was conducted using data from 4,711 children aged 12-23 months in the 2024 NDHS kids recode dataset. A multilevel mixed-effects logistic regression model was fitted to account for the hierarchical structure of the data. Four models were compared: null, individual-level, community-level, and combined models. Adjusted odds ratios (AORs) with 95% confidence interval (CI) were used to identify significant determinants at p<0.05. ResultsThe weighted prevalence of zero-dose children was 37.3% (95% CI: 35.1-39.6%). Significant factors included birth order, maternal age, maternal occupation, parental education, household wealth, antenatal attendance, postnatal care utilization, place of delivery, religion, distance to health facilities, and geographical region. Children whose mothers had higher educational attainment, attending antenatal care, deliver in the health facilities, and received postnatal care were significantly less likely to be zero-dose status. Conversely, children from poorer households, those facing distance barriers to health facilities, those belongings to Muslim and traditional religion group and those residing in certain geographical regions had higher odds of zero-dose children, with significant regional variations observed. Conclusionzero-dose vaccination remains highly prevalent in Nigeria and is strongly influenced by socioeconomic disadvantage, maternal healthcare utilization, religion, and regional inequities. Strengthening integrated maternal and child health services and improving access in underserved regions are essential to achieving equitable vaccination coverage.

ObjectiveThis study aimed to assess the effectiveness of SMS and voice message reminders in reducing the dropout rate in Lome-Togo, in 2026. MethodsWe conducted a cross-sectional study between October 2025 and March 2026 in the Grand Lome region. The intervention consisted of an integrated digital system used by health facilities to send automated SMS. Categorical variables were described in terms of frequency and proportion; Fishers exact test was used to compare proportions. Quantitative variables were described by their means accompanied by their standard deviation; the Wilcoxon rank-sum test was used to compare means. The significance level for statistical tests was set at 5%. ResultsA total of 30 health facilities were included. Seventy percent (70.0%) of the health facilities used messages associated with calls. Ninety percent (90.0%) of participants found the reminders useful, and 60.0% reported an improvement in Expanded Program on Immunization services related to their use. Among participants who received a reminder, 51.0% kept their vaccination appointments. The Penta 1/3 dropout rate decreased from 3.2% before the intervention to 1.3% (p < 0.001). Among the 323 parents of children included, only 20.74% reported receiving a reminder by phone. Sixty-point-five percent (60.5%) preferred to receive both text messages and voice calls. ConclusionThis study demonstrates the operational feasibility of an SMS/call-based reminder system in reducing dropout rate for childhood vaccination in Togo.

Introduction. Empirical evidence linking specific national structural policies to the provision of key HIV services in low- and middle-income settings remains scarce. This study addresses the research gap by quantifying the within-country relationships between six national structural policy indicators and the presence of the HIV prevention service component targeted at sex workers in Southeast Asia. Methods. We constructed a balanced panel dataset covering eight Southeast Asian countries from 2018 to 2025 from the UNAIDS Global AIDS Monitoring (GAM) framework. We used Fixed-Effects (FE) and Random-Effects (RE) models to analyse the relationships, with the FE model selected as the more statistically appropriate estimator. We enhanced robustness by using clustered standard errors and one-period lagged explanatory variables. Results. The primary finding from the FE model indicated a statistically significant and positive contemporaneous association between the existence of legal or administrative barriers to social protection (barriers_spi,t) and the presence of HIV prevention services for sex workers ({beta} = 0.8531; p < 0.001). However, the robustness check revealed a statistically significant negative association between the two when using the lagged barrier variable (barriers_spi,t-1), suggesting a decline in HIV prevention service availability over time ({beta} = -0.3540; p < 0.05). We did not find any other policy variable's coefficient to be statistically significant in the FE models. Conclusions. While the immediate recognition (contemporaneous effect) of structural barriers to access social protection may occur alongside prioritised HIV prevention service provision, the sustained presence of these impediments acts as a long-term constraint that undermines the effectiveness and sustainability of targeted HIV programmes. National HIV programmes must urgently prioritise the removal of structural barriers to ensure long-term service stability for key populations.

As climate change intensifies, health risks from extreme heat are rising. Accurate assessment of heat vulnerability at high spatial resolution is crucial for developing effective adaptation strategies, particularly in socioeconomically heterogeneous urban settings. However, the identification of key indicators underlying heat vulnerability remains challenging. Using Chicago, Illinois (USA) as a case study, we systematically compare different variable selection strategies in community-level heat vulnerability assessments. We take the conventional unsupervised principal component analysis (PCA)-based Heat Vulnerability Index (HVI) as a baseline, and compare it with supervised approaches that incorporate variable selection, including machine learning algorithms (Lasso regression, Random Forest, and XGBoost) as well as traditional statistical methods (simple linear regression and polynomial regression). Using the vulnerability indicator subsets identified by each variable selection method, we construct multiple HVIs and evaluate their performance against heat-related excess mortality. Our work indicates that supervised variable selection improves the performance of HVIs in capturing heat-related health risks. Among all methods, the Random Forest-based variable selection algorithm achieves the best overall results, highlighting the potential of machine learning to enhance heat vulnerability assessment tools. Our results demonstrate that poverty rate, lack of air conditioning, and proportion of residents aged 65 and above are robust determinants of heat vulnerability in Chicago.

Human diversity did not only remain restricted to their socio-cultural and linguistic domains but also have penetrated deep inside their genetic root. Africa harbors more genetic diversity than any other part of the world. Diversification of the African lineages were complex, involving long-distance gene flow. Data from Africansis needed to better understand the origin and evolution of modern humans, the genetic basis local adaptation, and the evolution of complex traits and related diseases. This analysis formed the basis for this study of determining the origin and migration of the Ameru community in Kenya. Blood samples was collected from 132 male adults of 65 year and above. DNA was extracted and analyzed for the Hyper variable region 1and 2. The sequences were sequenced using Sanger sequence alignment and analyzed using Geneious. Phylogenetic analysis was done using Mega-X while haplotype analysis was done using DNASP software. L1 haplogroup (2.9%) was found among Igembe (7%), Tharaka (6%), and Chuka (7%) and is common in West, Central, and parts of East Africa. L2 haplogroup (6.7%) was present in all subgroups except Imenti and Tigania, indicating West and Central African maternal ancestry. L1 and L2 haplotypes indicate that most Ameru subgroups share partial maternal ancestry from West and Central Africa, while Imenti and Tigania have different maternal lineages. L0-L4 haplogroups indicate predominant East, Central, and West African maternal origins, with subgroups showing variation in haplotype frequencies (e.g., L1 and L2 in Igembe, Tharaka, Chuka; L3 in Tharaka, Mwimbi, Chuka; L4 across all subgroups). Subgroup differences suggest that certain communities, particularly Imenti, have distinct maternal lineages, with less contribution from L1, L2, and L3 but potential links to Afro-Asiatic groups via L4 (found in the Middle East). Non-African haplogroups (N and R) point to historical interactions or shared ancestry with populations in Eurasia and the Horn of Africa, primarily in Tigania and Imenti. Overally, the Ameru maternal gene pool is heterogeneous, shaped by multiple migration routes and interactions across East Africa and beyond, with subgroup-specific maternal histories.

Background: The COVID-19 pandemic disrupted childhood immunization programmes in many countries worldwide. However, evidence on its impact in low and middle-income countries remains limited. This study examined the impact of the COVID-19 pandemic on childhood immunization coverage across 514 districts in Indonesia and identified district-level associated factors. Methods: We conducted a nationwide longitudinal analysis of the Expanded Programme on Immunization to compare immunization coverage before and after the pandemic. The outcome variable was the annual childhood immunization coverage (proportion of children aged 0-12 months who have received all recommended doses of childhood immunization as per the national immunization schedule). The explanatory variables include COVID-19 burden and vaccination rates, health system and human development indicators. Mixed-effect logistic regression was done to assess association between the explanatory and outcome variables. Results: At the national level, the coverage was 83.2% in pre-pandemic, 75.0% in the first year of pandemic, and 88.6%, in the second. In the first year, 69.3% of districts experienced significant decline, with a lower national coverage ratio of 0.92 (95% confidence interval 0.89-0.94). In the second year, 36.2% districts were still affected. The multivariable analysis showed that a significant decline in coverage during the first pandemic year was associated with high COVID-19 incidence (adjusted odds ratio 2.19, 95%CI 1.01-4.73 for the highest vs. lowest group), low midwife adequacy (5.84, 2.40-14.16 for the lowest vs. the highest group, 2.61, 1.26-5.40 for low-middle vs. the highest group), and a high proportion of health facility-based births (2.98, 1.49-5.98 for middle-high vs. the lowest group). Conclusions: The COVID-19 pandemic negatively and unevenly impacted childhood immunization in Indonesia, with greatest impacts in districts facing a higher COVID-19 burden and weaker health system capacity. These findings underscore the need for targeted efforts to strengthen the local health system for future health crises. Keywords: COVID-19, pandemic, immunization, vaccine preventable diseases

Influenza infection results from tightly coupled interactions between viral replication, host immune responses, and the emergence of clinical symptoms. While mathematical models have extensively characterized viral and immune dynamics, the mechanistic link between immune activity and disease severity remains poorly understood. Here, we develop an integrative within-host modeling framework that explicitly connects infection dynamics, immune responses, and symptom manifestation through a unified dynamical system. Using murine influenza data, we incorporate key immune components alongside a mechanistic representation of symptom progression, quantified via host weight loss. Our analysis identifies inflammatory signaling, particularly TNF--mediated pathways, as a central driver linking immune activity to symptom severity. Importantly, we demonstrate that age-dependent alterations in immune regulation reshape this coupling: aged hosts exhibit prolonged inflammatory responses that amplify and sustain symptom burden despite comparable viral kinetics. These results highlight that disease severity cannot be inferred from viral load alone, but instead emerges from the dynamical interplay between immune regulation and host physiology. This framework provides a quantitative basis for understanding age-specific morbidity and offers a foundation for designing interventions that target immune-mediated pathology rather than viral replication alone.

Care workers are central to health systems and the broader care economy, but they often lack the legal protections afforded to other workers. Furthermore, there currently exists no single legal definition of "care worker" under any binding or non-binding international legal instrument. Drawing on the WHO Global Health and Care Worker Compact, we analyzed whether national laws and policies in 10 countries protect care workers. Using comparative legal methods and primary source legal and policy documents, we evaluated both care worker coverage and alignment with four indicators: guaranteed access to protective equipment, protection against discrimination on internationally recognized grounds, unemployment insurance, and the right to join independent unions. We reviewed 43 laws and policies and found that 56% fully or partially met the relevant indicator criteria. The United Kingdom was the only country meeting all four indicators. Overall, we found while many countries recognize these protections in law, care workers are often left outside their coverage, underscoring the need for clearer legal recognition and more inclusive worker protections.

Hemoglobinopathies are inherited disorders of hemoglobin, most notably sickle cell anemia and thalassemia. These conditions result from mutations in the globin genes, leading either to structural abnormalities in the globin chains or to reduced synthesis of normal globin chains. Hemoglobinopathies is a worldwide health problem according to the World Health Organization; it affects mostly the indigenous Tharu groups in Nepal. Both the global and local rates of illness and death associated with these diseases are on the rise. The objective of this study was to assess the presence of hemoglobinopathies and common mutations of the beta-globin gene within the Tharu population in western Nepal. A cross-sectional study of 1,400 Tharu individuals was conducted among individuals obtained through hospitals within the Banke district, Bardiya district, and Kailali district in western Nepal. A thorough hematological analysis was done with the use of a Sysmex XN-350 analyzer. Hemoglobin variants were detected via high-performance liquid chromatography (HPLC). The molecular characterization of the seven most common mutations of {beta}-thalassemia was performed on a subset of 20 confirmed cases by using a real-time PCR kit.The total number of cases diagnosed with hemoglobinopathies was 14.43% (n=202 out of 1,400). Sickle cell trait (HbAS) was reported as the most prevalent type of Hemoglobinopathies (8.50% of population), followed by {beta}-thalassemia trait (4.00%). In addition to these disorders were sickle cell disease (HbSS), HbE trait, and compound heterozygous states. Hematological parameters differed significantly across types of hemoglobinopathies, and the patterns of microcytic, hypochromic, and hemolytic anemia were also distinct. Commonly documented symptoms included fatigue and joint pain (42.5% and 23.1%, respectively). Molecular characterization of {beta}-thalassemia cases demonstrated that most individuals were compound heterozygotes with IVS1-6 (T>C) as the most prevalent variant. The research identified that the Tharu population in western Nepal has a significant burden of hemoglobinopathies (especially sickle cell trait and {beta}-thalassemia), highlighting the requirement for appropriate screening programs, genetic counseling and public health strategies to help manage and prevent these conditions within this particular region.

BackgroundSexual violence (SV) is a major public health problem with far-reaching consequences; however, adolescent survivors rarely seek help. This underestimates the prevalence of SV and undermines prevention and response efforts. This study was conducted to determine the prevalence and reporting of sexual violence among adolescents in Ibadan, Nigeria. MethodsBetween September and October 2021, a cross-sectional study was conducted among 360 in-school adolescents in Ibadan South-West local government area, Nigeria. Adolescents were selected using multi-stage sampling. Information on experience and reporting of sexual violence was obtained with the aid of an interviewer-administered questionnaire. Data were analysed using descriptive and inferential statistics at p[&le;]0.05 level. ResultsRespondents mean age was 14.6{+/-}1.7 years, and 50% were female. Thirty-five per cent reported at least one incident within the past 12 months. Forms of sexual violence experienced included unwanted sexual touch (25.6%), forced sex (19.2%), attempted rape (15.2%), and suggestive comments (9.6%). Seventy per cent of adolescents who experienced sexual violence did not report to anyone; reasons included fear of getting in trouble (46.6%), thinking it was not a problem (31.8%), feeling it was their fault (30.7%), and embarrassment for self/family (27.3%). Adolescents who were closer to their mothers and younger adolescents were more likely to report their experience of sexual violence (p=0.006 and p=0.038, respectively). ConclusionSexual violence is common among in-school adolescents in Ibadan, yet reporting remains low. This study highlights the need to strengthen prevention and address barriers to reporting among adolescent survivors. Key MessageO_ST_ABSWhat is already known on this topicC_ST_ABSSexual violence has physical, psychological, and social consequences on the health and well-being of adolescent survivors, and low levels of reporting and help-seeking contribute to these consequences. What this study addsThis study provides evidence on the prevalence and reporting patterns of sexual violence among adolescents in Ibadan, Nigeria. It highlights key barriers and facilitators of reporting. How this study might affect research, practice, or policyThis study provides information about factors at individual, relationship, societal and policy levels that are associated with reporting and help-seeking among adolescent survivors of sexual violence in Ibadan, Nigeria. This highlights the importance of training stakeholders, such as parents, teachers, health workers, other caregivers and the adolescents themselves, on responding to sexual violence experience and reporting. It underscores the need for improved adolescent-friendly services, policy implementation and collaboration across families, schools, communities and states to address sexual violence.

ABSTRACT Background: Malaria remains a leading public health burden in sub-Saharan Africa, disproportionately affecting children under five years. In response, Kenya introduced the RTS,S/AS01 malaria vaccine in selected regions, including Siaya County where malaria transmission is endemic. Despite this milestone, uptake has been inconsistent, with hesitancy emerging as a significant barrier. Objective: This study aimed to determine factors associated with malaria vaccine hesitancy among caregivers of children 6-59 months in Ugenya Subcounty, Siaya County. Methodology: A cross-sectional mixed methods design was employed involving 425 caregivers and 15 healthcare workers and County health officials between January to February 2025. Quantitative data were collected using structured questionnaires and analyzed in Stata version 17 through descriptive statistics, bivariate analysis at 20% significance threshold, and multivariable logistic regression at 5% level to determine key factors associated with malaria vaccine hesitancy. Qualitative data from 15 key informant interviews were transcribed verbatim and thematically analyzed using NVivo. Thematic analysis, guided by a predefined codebook, was used to identify recurring patterns and extract key themes, which were illustrated with direct quotations from participants Results: Overall, 42.9% of caregivers (n=181; 95% CI: 38.9%-47.3%) reported hesitancy. Significant predictors included caregiver age, marital status, family size, access to health facilities, and vaccine availability. Single caregivers, those from smaller households, and those facing health facility access challenges were more likely to be hesitant to malaria vaccine. Despite high levels of knowledge, misconceptions and misinformation about vaccine safety, often spread via social media persisted. Conversely, caregivers relying on healthcare workers and mainstream media showed greater acceptance of malaria vaccine. Conclusion and Recommendations: Malaria vaccine hesitancy remains significant at 42.9%, driven by demographic factors such as younger age, single status, and smaller household size. Structural barriers including limited vaccine availability and poor access to health facilities further contribute to reluctance. Although knowledge and awareness were high, misinformation, particularly from social media, persisted, while information from healthcare workers improved acceptance. Addressing these gaps through targeted community engagement, improved access, and trusted communication channels is essential to increase uptake of malaria vaccine.

Vaccine effectiveness (VE) against symptomatic SARS-CoV-2 infection has shown marked temporal variation across epidemic waves, driven by a combination of waning immunity and immune escape by emerging variants. Test-negative case-control designs have been central to VE monitoring, but they operate at a population level and provide limited insight into the underlying immune mechanisms. In parallel, longitudinal serological studies have characterised antibody trajectories after vaccination and infection, and quantitative models have linked neutralising antibody levels to protection against infection and severe disease. These two streams of evidence are usually analysed separately. We propose a Bayesian joint model that links individual-level antibody kinetics to test-negative VE estimates across successive epidemic waves. The model represents hybrid immunity as the combined effect of vaccination and documented or undocumented infection, with antibody titres following a boost-and-decay process after each immunising event. A titre-protection curve maps latent antibody levels to the risk of symptomatic infection with each variant, extending the correlates-of-protection framework. This allows us to decompose observed VE into contributions from waning, immune escape, and differences in exposure. Using simulated data calibrated on realistic vaccination schedules, infection histories and assay performance, we show that the joint model can recover the underlying titre-protection relationship and separate variant-specific immune escape from pure waning. In scenarios with hybrid immunity, the model captures higher and more durable titres, consistent with empirical observations. When applied to test-negative surveillance data enriched with nested serology, the approach yields VE trajectories that are more interpretable and more stable across time than conventional analyses. This framework provides a coherent way to combine serology and VE to quantify hybrid immunity, and offers practical summary measures for comparing vaccine strategies in the presence of evolving variants.

Antiviral therapies such as nirmatrelvir-ritonavir are widely used for COVID-19, yet their real-world effectiveness and sources of heterogeneity in treatment response remain incompletely understood. Here, we integrate longitudinal viral load data from a large cohort of SARS-CoV-2 BA.2-infected patients in Shanghai (n=48,243) with a mechanistic within-host viral dynamics model coupled to pharmacokinetic/pharmacodynamic principles to quantify in vivo antiviral efficacy. We estimate that nirmatrelvir-ritonavir reduces viral production by approximately 55% on average. Treatment response exhibits substantial heterogeneity, with higher efficacy observed in vaccinated individuals and reduced efficacy in older adults. Sensitivity analyses demonstrate that the vaccination effect is robust across model specifications, whereas age-related differences depend on assumptions about early viral kinetics, highlighting structural identifiability challenges when analyzing sparse real-world data. These findings provide a mechanistic interpretation of heterogeneous treatment effects and establish a generalizable framework for integrating real-world clinical data with within-host models to inform antiviral optimization and personalized treatment strategies.

Aim: To explore RSV knowledge and awareness, RSV vaccination perceptions and acceptability, and preferences for maternal vaccine delivery and communication amongst pregnant women and mothers of infants and toddlers in England. Methods: Between July and November 2024, semi-structured qualitative interviews were performed with 30 mothers (youngest child under 2 years), two of whom were pregnant with a subsequent child. The study was conducted as a follow-on to a UK Health Security Agency survey of attitudes towards RSV vaccination amongst pregnant and post-partum women in England. Findings: Although most mothers had heard of RSV, mothers with experience in health roles were more likely to understand the potential severity of RSV in infants. Likelihood of maternal RSV acceptance was reported as high, with most mothers considering RSV vaccination as beneficial in protecting infants. Most mothers preferred a hybrid approach to vaccine communication, with information available online (e.g. through the NHS website), via written sources (e.g. NHS produced leaflet), and through talking with midwives. For convenience, most mothers preferred the option of fitting vaccinations within the antenatal midwifery appointment schedule rather than going to general practice for a separate appointment. Conclusion: To support maternal RSV vaccination decision-making and access, women need vaccine information early in pregnancy; information provision through a range of different sources (i.e. online, paper, in-person); and vaccination delivery in a convenient location (i.e. as part of antenatal appointments).

BackgroundThe World Health Organization has developed several global template protocols for epidemiological investigations, including for household transmission investigations (HHTIs). These investigations facilitate rapid characterisation of novel or re-emerging respiratory pathogens and support evidence-based public health actions. Beyond technical readiness, community buy-in is central to the feasibility and acceptability of HHTIs. Research is needed to determine the perceived legitimacy among the community to inform local protocol adaptation and development of implementation plans that consider community attitudes and needs. MethodsIn 2025, we conducted a convenience survey of community members living in Victoria, Australia to explore: their understanding of emerging respiratory diseases; their willingness to take part in public health surveillance activities such as HHTIs; the acceptability of clinical and epidemiological data collection and respiratory/blood sample collection as main components of HHTIs, and; participant comfort towards including their companion animals in HHTIs. ResultsWe received 282 survey responses, of which 235 were included in the analysis dataset. Compared to the general Victorian population, our participants included a higher proportion of participants who reported being female, tertiary-educated, of Aboriginal and/or Torres Strait Islander heritage, born in Australia and speaking only English at home. Participants indicated overall high levels of comfort and acceptability towards participation in HHTIs, particularly in relation to clinical and epidemiological data collection, with lesser but still high levels of comfort with providing multiple respiratory specimens in a 14-day period. Participants were least comfortable with other specimens such as urine and blood. Involving companion animals in HHTIs was similarly acceptable as human-focused components. ConclusionsDespite our survey population being non-representative of the general Victorian population, our findings provide valuable descriptive insights into the acceptability of HHTIs in Victoria, Australia from which to benchmark future local and international surveys and community engagement activities.

This cross-sectional study assessed hygienic practices, microbial contamination, and associated factors among street food vendors in Mymensingh City, Bangladesh, from August 2024 to February 2025. Using purposive sampling, 300 vendors were evaluated through structured questionnaires, observational assessments, and laboratory analysis of food samples (n = 300) for bacterial load (log-transformed Total Viable Count, log_TVC). Results revealed that 87.33% (95% CI: 83.6-91.1) of vendors practiced poor hygiene: 90.7% (95% CI: 87.4-94.0) did not cover food, 7% (95% CI: 4.1-9.9) used disinfectants, and 81.00% (95% CI: 76.6-85.4) reused ingredients beyond one day. Knowledge gaps were stark, with 89.7% (95% CI: 86.3-93.1%) demonstrating insufficient basic hygiene knowledge and 90.7% (95% CI: 87.4-94.0%) lacking understanding of hygienic food processing. Education significantly influenced practices; secondary-educated vendors exhibited markedly better hygiene awareness (65.0% vs. 2.89% in uneducated groups). Bacterial loads varied across food types, with Velpuri showing the highest mean log_TVC (8.00, 95% CI: 7.65-8.35) and fast food the lowest (7.69, 95% CI: 7.34-8.03). Significant correlations emerged between hygiene knowledge and practices: vendors aware of foodborne diseases were more likely to use gloves (Spearman's r = 0.199, p = 0.001) and cover food (r = 0.118, p = 0.041). Challenges included financial constraints (62.25% [95% CI: 56.1-68.4] among uneducated vendors), knowledge gaps, and time limitations. The study underscores systemic issues in street food safety, driven by low education and economic barriers. Interventions targeting vendor education, affordable hygiene solutions, and stricter enforcement of ingredient freshness protocols are urgently needed to mitigate foodborne disease risks in urban Bangladesh.

Cameroon introduced Human papilloma virus vaccine (HPVV) into the routine immunization schedule in October 2020. By the end of 2022, coverage remained low. To increase coverage, Cameroon switched to a country-wide, gender-neutral vaccination (GNV) approach in 2023, coupled with a revamped delivery strategy consisting of Community Dialogues (CDs) and Periodic Intensification of Routine Immunization (PIRIs) activities in selected health districts (HDs). We assessed the impact of these programmatic changes, notably the GNV approach, on HPVV coverage. This retrospective, cross-sectional study measured the effect of GNV and CDs + PIRIs on HPVV coverage among 9-year-old girls in Cameroon (2022-2023). Data on HPVV coverage from all 203 HDs were extracted from DHIS2, and coverage was calculated at the HD level, based on the estimated population eligible of 9-year-old girls. Descriptive statistics and multiple regression models were employed to assess the impact of GNV on vaccination coverage while adjusting for CDs + PIRIs and urban/rural status. In 2023, of the 203 HDs, 115 (56.7%) conducted GNV only, 74 (36.5%) implemented GNV & CDs + PIRIs, and 75.9% (154) were classified as rural. Among age-eligible girls, there was an overall increase in HPV vaccination coverage, with coverage rising 39.2 percentage points from 2022 to 2023. Following multiple linear regression, there was a significant increase in HPVV coverage in HDs with GNV & CDs + PIRIs compared to those with no GNV and no CDs + PIRIs ({beta}:55.5%, 95%CI: 38.7, 72.3, p=0.000). Furthermore, there was a significant increase in HPVV coverage in HDs with GNV only compared to those with no GNV or no CDs + PIRIs ({beta}:28.7%, 95%CI: 12.5, 45.0 p=0.001). Overall, the GNV approach increased HPVV coverage for girls significantly, particularly when implemented alongside CDs + PIRIs.

The global ambition to end the human immunodeficiency virus (HIV) epidemic requires understanding which system-level policy levers, enacted under the framework of Universal Health Coverage (UHC), are most effective in achieving both transmission reduction and diagnostic coverage. This study addresses an important evidence gap by quantifying the within-country association between measurable UHC policy indicators and the estimated rate of new HIV infections across nine Southeast Asian countries between 2013 and 2022. Employing a Fixed-Effects panel data methodology, the analysis controls for time-invariant national heterogeneity, ensuring reliable estimates of policy impact. We found that marginal changes in total current health expenditure (CHE) as a percentage of gross domestic product (GDP) were not statistically significantly associated with changes in HIV incidence. However, increases in the UHC Infectious Disease Service Coverage Index were statistically significantly associated with concurrent reductions in HIV incidence (p < 0.001), suggesting the efficacy of targeted service implementation as the principal driver of curbing new HIV infections. In addition, the UHC Reproductive, Maternal, Newborn, and Child Health Service Coverage Index exhibited a statistically significant positive association with changes in HIV incidence (p < 0.01), which is interpreted as a vital surveillance artefact resulting from expanded detection and reporting of previously undiagnosed HIV cases. Furthermore, out-of-pocket (OOP) health expenditure as a percentage of CHE showed a counter-intuitive negative association with changes in HIV incidence (p < 0.01), suggesting this metric primarily shows ongoing indirect cost burdens on the established patient cohort, or, alternatively, presents a diagnostic access barrier that results in lower case finding. These findings suggest that policymakers should prioritise investment in targeted infectious disease service efficacy over aggregate fiscal commitment and utilise integrated sexual health platforms for strengthened HIV surveillance and case identification.

Background: Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool, yet uptake and adherence remain low in Kenya despite integration into national HIV prevention plans since 2017. Intimate partner violence (IPV) is a prevalent HIV-related syndemic that presents barriers to PrEP engagement. While IPV's impact on women's PrEP use has been documented, less is known about IPV prevalence among men and its association with PrEP eligibility. This study aimed to determine IPV prevalence and explore correlates among PrEP-eligible men and women in coastal Kenya. Methods: This secondary analysis used data from the "Tambua Mapema Plus" trial conducted at six healthcare facilities in coastal Kenya among HIV-negative participants who were sexually active in the last 6 weeks and PrEP-eligible based on Kenya's Rapid Assessment Screening Tool. IPV was assessed through screening questions covering physical, verbal, and sexual violence experiences. Participants with ongoing IPV were excluded for safety. Among 1,500 intervention participants, 638 (402 women, 236 men) met PrEP eligibility criteria. Modified Poisson regression with robust standard errors was used to identify factors associated with IPV. Results: Overall, 24.1% reported lifetime IPV exposure, with 5.6% reporting past-month IPV. Women experienced higher rates of verbal (14.9% vs 11.0%), physical (15.2% vs 9.7%), and sexual IPV (11.2% vs 6.4%). Participants who had children (adjusted risk ratio [ARR]=2.09, 95%CI 1.32?3.32) or engaged in sex work (ARR=1.81, 95%CI 1.13?2.80) had increased IPV risk. In multivariable analysis, women with children had higher IPV risk (ARR=2.30, 95%CI 1.29?4.24), while men engaging in sex work had elevated risk (ARR=2.37, 95%CI 1.15?4.68). Discussion: IPV prevalence was substantial. Sex work emerged as a risk factor for both sexes, while having children increased risk among women. High IPV prevalence among PrEP-eligible individuals underscores the need for integrated IPV risk assessment in PrEP programs to improve HIV prevention effectiveness in Kenya.