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.

BackgroundMeasles is a highly contagious infectious disease and a leading cause of childhood morbidity and mortality worldwide. In developing country like Ethiopia, effective immunization is a proven strategy for reducing measles related illness and deaths. However, measles second dose vaccination drop out has become a major public health concern. In a densely populated city such as Addis Ababa drop rate tends to be higher than the minimum acceptable threshold, leading to increased number of cases and recurrent outbreaks. Despite of this limited evidence exists on the determinants of second dose drop out and the problem is not well investigated, as a result this study will try to identify determinants of measles second dose vaccination dropout among children 24 - 35 months of age. ObjectivesTo identify determinants of measles second dose vaccination dropout among children 24 - 35 months of age Addis Ababa, Ethiopia in 2025. MethodCommunity based unmatched case control study was conducted in Addis Ababa from September 1/2024 to October /2025 with a total of 636 participants, consisting of 212 cases and 424 controls. Data were collected using structured Quesionariie and entered into EpiData 3.1 then StataSE 18 was used for detailed analysis including Descriptive statistics. Model fitness was checked using Hosmer-Lemeshow and multicollinearity were assessed using variance inflation factor. Furthermore, Bivariable and multivariable logistic regression analyses was employed and Adjusted odds ratio with 95% confidence intervals was used to identify significant variables. ResultsA total of 620 mothers/caregivers participants respond to the study, comprising 206 (97%) cases and 414(97.6%) controls, yielding a total response rate of 97.4%. In this study, waiting time longer than 30 minutes (AOR= 3.34, 95%CI: 1.86-5.9), Lack of counseling (AOR = 2.63, 95% CI: 1.60-4.30), Lack of reminders (AOR = 2.86, 95% CI: 1.89-4.30), Previous adverse event following immunization (AOR = 2.00, 95% CI: 1.39-3.00), postnatal care visit (AOR = 0.58, 95% CI: 0.40-0.85) and family size of greater than 3 (AOR = 1.96, 95% CI: 1.29-2.98) were significantly associated with measles second dose dropout. Conclusion and recommendationIn study shows measles second dose dropout is found to be associated with long waiting time, lack of counseling, lack of reminder, history of adverse event following immunization and postnatal visit. Which suggests Strengthening Immunization Counseling, reducing waiting time, establishing effective reminding system, integrating Immunization with postnatal services and promptly addressing concerns about adverse event following immunization can help reduce measles second dose dropout.

IntroductionTobacco smoking is especially high among males in the Kingdom of Saudi Arabia (KSA). In 2019, 27.5% of males ages 15+ reported smoking. Despite a minimum age requirement of 18 years, data indicate that 6.8% of youth ages 13-15 currently smoke tobacco products. To reduce youth smoking, countries have raised the minimum purchase age to 21, also referred to as Tobacco 21. Except for Kuwait, no other Middle Eastern country has done so. We develop a tobacco smoking simulation model to project the potential impact of a national Tobacco 21 policy in Saudi Arabia. MethodsWe used data from three nationally representative health surveys in Saudi Arabia to develop the KSA Tobacco Control Policy (TCP) model, estimating smoking initiation and cessation rates for males, as smoking rates are low among females. A national Tobacco 21 policy was operationalized as a 34% (15%-53%) reduction to smoking initiation for ages 18-20. Economic impact was evaluated using the 2024 KSA value of a statistical life which ranges from $1.65 million to $5.15 million USD. ResultsUnder a status quo scenario, tobacco smoking prevalence in males would decrease to 10.2% by 2100. Implementation of Tobacco 21 in 2026 would decrease smoking prevalence to 9.4% (8.9%, 9.8%) by 2100. While modest, these reductions would eventually translate into nearly 5000 (2200, 7800) premature deaths averted with up to 155000 (69000, 241000) life years gained from 2026-2100, respectively. The total expected economic benefit ranges from $1.67 to $5.19 billion USD, equivalent to 6.25 to 19.45 billion SAR. DiscussionTimely implementation would support the KSA in its goals to reduce non-communicable disease and death; however, even under best-case conditions, a Tobacco 21 alone would not achieve the Vision 2030 smoking prevalence target of 9%. Additional policies that substantially increase smoking cessation are needed. What is already known on this topicThe leading causes of death in Saudi Arabia are all linked to tobacco smoking. Tobacco 21 policies have been pursued by numerous governments to reduce youth smoking, but such policies are lacking in Middle Eastern nations. What this study addsA nationwide Tobacco 21 policy in Saudi Arabia would reduce smoking initiation, smoking prevalence, and smoking-related mortality. Overall smoking prevalence among males ages 15+ would decline, and nearly 5000 premature deaths would be averted with up to 155,000 life years gained from 2026-2100, valued at 6.25 to 19.45 billion SAR. How this study might affect research, practice or policyThis study quantified for the first time the potential long-term benefits of a Tobacco 21 policy in Saudi Arabia for the male population. A Tobacco 21 policy would benefit future generations of young people by reducing their risk for heart disease, stroke, and cancer, currently the leading causes of death in the nation. However, additional efforts are needed in addition to Tobacco 21 policies to achieve tobacco smoking reduction goals.

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.

BackgroundVaccination is a cost-effective intervention preventing causes of 48% of deaths among children Under-5 in sub-Saharan Africa. However, one in five African children still has not completed basic vaccination, and over six million children have not received a single dose of the Diphtheria, Tetanus and Pertussis vaccine, resulting in over half a million deaths annually. This study aims to understand the key factors influencing pediatrics health (vaccination) decision-making in sub-Saharan Africa. MethodsA cross-sectional design using a multi-stage stratified sampling approach was used. Data were collected from 2,451 households with children Under-5 in three countries and analyzed using R. Correlation analysis was used to understand the associations between variables, while regression analysis was used to control for covariates and identify influences on one another. ResultsThe findings show that beliefs in gender disparity, misinformation, and masculinity can undermine childhood vaccination outcomes. A childs gender (r = -0.33-0.40, p < 0.01) and misinformation (r = -0.38-0.54, p < 0.01) impact vaccination intentions and behavior. Meanwhile, positive attitudes (r = 0.36-0.49, p < 0.01), trust (r = 0.17-0.34, p < 0.01) and peer influence (r = 0.27-0.33, p < 0.01) significantly improve uptake. However, regressions show that male caregivers had weaker attitudes ({beta} = -0.31, p < 0.001), stronger beliefs about misinformation ({beta} = 0.33, p < 0.001) and lower vaccination intentions ({beta} = -0.12, p < 0.001). Country comparisons reveal that Kenyan and Malawian children are 3.6 (OR = 3.64, p < 0.001) and 13 (OR = 13.13, p < 0.001) times more likely to be vaccinated than Nigerian children, respectively. Furthermore, masculinity had a significant effect on men, Muslims and polygamous households. ConclusionTo address low vaccination uptake in sub-Saharan Africa, context-sensitive strategies are required that incorporate gender norms, counter misinformation, and engage fathers.

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.

Wildfire smoke (WFS) events are an important public health concern for communities in the Pacific Northwest of the United States. Previous studies of portable air cleaners, including high efficiency particulate air (HEPA) filtration and do-it-yourself (DIY) box fan filters built with MERV 13-rated filters, have indicated that their use in residential settings may be an effective way to reduce indoor exposures to fine particulate matter during WFS episodes. The lower-cost, easy to build instructions and availability of materials of DIY box fan filters have made their distribution by both public health agencies and community groups an attractive approach to improve community preparedness. Here, we describe a low-cost, easy-to-assemble, portable exposure chamber system that can be used to support a variety of community-engaged demonstrations of WFS removal efficiency as well as provide a mechanism to estimate the efficiency of filtration systems in a controlled environment. We conducted experiments using the portable chamber to assess the clean air delivery rate (CADR) of a MERV 13-rated DIY box fan filter, which was found to be 92.2 and 145.2 cfm at low and high fan speeds, respectively. In addition to using the chamber system to evaluate the CADR of DIY box fan filters, we also provide a case-study example, working with a tribal community in Central Washington, who used the tent system for a live demonstration of a DIY box fan filter experiment during their community gathering to promote WFS and air quality intervention knowledge and distribution of box fan filters.

Background Cutaneous leishmaniasis (CL) is highly prevalent in Ethiopia, including the Tigray region. However, there is a dearth of information on the levels of knowledge, attitude, and health seeking behavior among the communities in CL-endemic areas of Tigray region, northern Ethiopia. Objective This study aimed to investigate CL-related knowledge, attitude, treatment-seeking and prevention practices in disease-endemic areas of Tigray. Methods Between November and December 2022, a cross-sectional survey was conducted among communities living in seven districts of Tigray. A mixed sampling method was implemented. Data were collected using a pre-tested structured questionnaire and analyzed using SPSS 25 (IBM, Chicago). Results A total of 512 participants were included. Overall, 43%, 36% and 34% of participants had a good level of knowledge, a favorable attitude and a good treatment-seeking and prevention practices towards CL, respectively. However, nearly all participants did not know about CL transmission, about 25% perceived CL to be genetically acquired and about 67% believed it to be stigmatizing. Traditional medication was the preferred option over modern treatment for 63.3%. Rural dwelling participants (AOR = 1.60; 95% CI: 1.00-2.57) and participants living in households with CL episode (AOR = 10.19; 95% CI: 6.36-16.30) had good knowledge towards the disease. However, urban/ semi-urban residents (AOR = 2.17; 95% CI: 1.42-3.31) had favorable attitude towards CL. Gender (AOR = 1.49; 95% CI: 1.01-2.22) and education level (AOR = 0.39; 95% CI: 0.24-0.62) were significantly associated with treatment-seeking and prevention practices. Participants living in households with CL episode (AOR = 2.99; 95% CI: 1.96-4.57) had good treatment-seeking and prevention practices. Conclusion In this study, over one half of participants had poor knowledge about CL, nearly two-third of them had unfavorable attitude towards the disease and two-third of them had poor treatment-seeking and prevention practices. Residence and previous CL episode in households were determinants of respondents knowledge about CL and their attitude towards the disease. Level of education and living in households with CL episode were determinants of participants treatment-seeking and prevention practices. These findings support for an integrated intervention through health education focusing on CL transmission and preventive measures.

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.

BackgroundAvian Influenza (AI) is a potential pandemic threat, specifically when human-to-human transmission occurs. For outbreak management testing is essential. Current knowledge on testing behaviour is mostly derived from other infectious diseases such as COVID-19. It is necessary to identify determinants of testing behaviour for AI in an early phase. Therefore, this interview study aims to identify a wide range of behavioural determinants of testing during a hypothetical human-to-human transmissible AI outbreak. MethodsSemi-structured in-depth interviews, based on the Theoretical Domains Framework, were carried out between May 2024 and February 2025. Participants were included through purposive and convenience sampling. During the interviews an animation was shown illustrating a hypothetical AI outbreak. Verbatim transcripts were thematically analysed. ResultsWe included seventeen participants (median age 44, range 20-81; 71% women) with diverse backgrounds in terms of age, gender, educational level and country of birth. We found that having the freedom to decide to test would make testing more acceptable, whereas a decreased sense of autonomy would discourage testing. Most themes included individual rather than population-level benefits as drivers of testing behaviour. These included protecting loved ones, ones own health and gaining psychological reassurance. External conditions like being unable to go to work or an event would generally encourage testing behaviour. Lower trust in governmental authorities could hamper testing behaviour. Previous experiences from the COVID-19 pandemic shaped participants answers about AI testing behaviour. ConclusionKey considerations include balancing peoples need for autonomy with the external measures imposed by employers or the government, rebuilding trust in institutions and acknowledging how prior experiences with testing may shape testing behaviour in future AI outbreaks. Further research is needed to determine how these findings can be translated into effective communication and how trust in authorities can be build.

BackgroundMalawi has one of the highest incidences and mortality due to cervical cancer, which is caused by the human papillomavirus (HPV). Achieving high HPV vaccination coverage is critical for advancing the World Health Organization (WHO) cervical cancer elimination strategy. This study aims to describe the spatio-temporal uptake of the first and second doses of the HPV vaccine in Malawi and to investigate the covariates associated with the uptake. MethodsWe analysed HPV vaccination coverage data from routinely collected administrative data across 28 districts in Malawi from 2019 to 2024. We used spatio-temporal Bayesian models in R-INLA to investigate the association between environmental factors, such as urbanization and climatic conditions, and vaccination uptake. ResultsHPV vaccine uptake was 46.83% (95% Credible interval, CrI: 46.52%, 47.21%) for the first dose, and 32.44% (95% CrI: 32.09%, 32.96%) for the second dose, across the study period, with distinctive subnational heterogeneity. A negative relationship was observed between nighttime light intensity and vaccination coverage (first dose: posterior mean: -0.599, (95% CrI: -1.160, -0.040); second dose: posterior mean: -2.164, (95% CrI: -3.415, -0.967)). ConclusionsHPV vaccination uptake in Malawian districts remains below the WHO 90% vaccination target. These findings emphasise the need for decentralised planning to improve coverage. Targeted interventions, mobile outreach programmes, and strengthened community engagement, particularly in urban settings, may help close coverage gaps and accelerate progress toward cervical cancer elimination in Malawi.

World Health Organization recommendations to reduce road deaths were examined to assess the potential reductions that could be realized in countries that have not adopted them. Data from 72 countries on recommended speeding laws, alcohol laws, and vehicle safety standards were analyzed, controlling statistically for differences in average temperatures and population density per square kilometer. Using regression coefficients, estimates of the reductions that would be realized if each countermeasure were adopted in countries not currently employing it were calculated. The coefficient on alcohol laws was not significant, but deaths in these countries would likely decline by about 23 percent if speeding laws were improved. The road death would have been about 55 percent lower if vehicle safety standards for imported vehicles had been adopted. New and used vehicles that did not adhere to the standards were sold in low-income countries. Better data identifying clusters of specific collision types (pedestrians in the dark, animals, fixed objects) could lead to the adoption of countermeasures known to be effective.

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.

The measles outbreak in Jalisco, Mexico (January-February 2026) experienced vigorous sustained transmission with an exponential growth rate = 0.10 (95% CI: 0.10-0.11) per day, doubling time = 6.3 days (95% CI: 6.3-6.9), yielding the effective reproduction number at 3.34 (95% CI: 3.16-3.54), with elevated incidence among infants and young adults.

BackgroundRisk communication is critical in shaping public response during infectious disease outbreaks. This study quantitatively examined whether Nigerian media coverage during the 2024 cholera outbreak reflected a proactive or reactive risk communication pattern. MethodsA Python-based systematic content analysis was conducted on 352 unique news articles published by major Nigerian media sources in 2024. K-Means was used to cluster and quantify thematic patterns, TextBlob for sentiment polarity, and time-series analysis to determine the features of media engagement. ResultsThe analysis identified a dominant reactive, crisis-driven communication pattern with media coverage surging by over 400% in June, matching the peak of reported cholera cases. Thematic analysis portrayed a severe reporting imbalance focused on Outbreak Reports and Mortality (41.5% of articles), while structural and preventive themes such as WASH and Health Education received marginal attention (less than 25% of coverage). Furthermore, communication was overwhelmingly neutral (76.4%) in sentiment, potentially limiting the perceived urgency required for public action. ConclusionsMedia reporting on the 2024 cholera outbreak in Nigeria was reactive and focused disproportionately on threat rather than solutions. These findings support the need for a strategic dual-focus communication model that shifts from crisis-driven coverage to sustained, year-round preventive messaging centered on WASH accountability and community resilience.

BackgroundConsanguineous unions are defined as the matrimony between individuals who are blood relatives. Researchers in all over the world worked on this issue and they checked the ratio of prevalence and effects of consanguinity in different regions of world. This research was conducted in the District Faisalabad, upper Punjab. ObjectiveTo find rate of consanguinity, coefficient of inbreeding (F) and its impacts. MethodsThe data was collected from six tehsils of District Faisalabad by interviewing the subjects. The data collected within the time span of six months. Total of 2366 subjects were interviewed after their consent approval. ResultsThe rate of consanguinity was noted 41.83% with 0.03053 coefficient of inbreeding. High rate of consanguinity (23.36%) was noted among first cousins. The distantly related and not related unions were 35.64% and 22.56% respectively. The rate of consanguineous unions in six tehsils ranged from 33.99% in Jaranwala to 53.85% in Tandlianwala. Consanguineous marriages were noted high in Punjabi speaking subjects, in housewives, in reciprocal marital types, in grand-parents and one couple family types and Rajpoot castes. There was found no significant differences of consanguinity in rural and urban areas. The rate of still births was noted high (82.25%) in consanguineous unions while neonatal, post neonatal and child mortality was low such less as 6.45%, 8.06% and 3.22% respectively. The prenatal mortality was noted slightly high 44.94% in consanguineous unions as compared to non-consanguineous unions. The congenital malformation rate was 6.29% in all marital unions but this rate was high (59.06%) in consanguineous unions as compared to non-consanguineous unions (40.93%). This is a pilot study to analyze the potential of inbreeding coefficient (F) in the District Faisalabad.

Background: Infections of the central nervous system (CNS) in children remain a major cause of mortality and long-term disability globally, particularly in low- and middle-income countries (LMICs), where a high proportion of cases lack an identified pathogen. Sporadically, human parvovirus 4 (PARV4) has been detected in a small number of cerebrospinal fluid (CSF) from children with CNS infections, but its pathogenic role is unclear. We investigated the prevalence, clinical impact, and genomic characteristics of PARV4 in children with suspected meningitis. Methods: We retrospectively analyzed CSF samples collected from children with WHO-defined suspected meningitis at the largest pediatric hospital in Bangladesh between 2015-2022. All samples underwent routine diagnostics, including bacterial culture and serological testing. Additional testing for PARV4 and parvovirus B19 was performed using qPCR of samples with >9 white blood cell (WBC)/ul followed by metagenomic sequencing of a subset. Clinical and laboratory data were extracted from patient records. Associations between PARV4 detection and mortality were assessed using logistic regression, adjusting for age, WBC count, and co-infections. Genomic and phylogenetic analyses were conducted on PARV4-positive samples. Findings: Among 2,793 CSF samples with >9 WBC/ul, 526 (18.8%) were PARV4-positive. The median age of PARV4-positive cases was lower than that of PARV4-negative cases (4 vs 7 months, p<0.001). Co-infections were more common among PARV4-positive cases (49.6%) than PARV4-negative cases (16.4%). PARV4 positivity was independently associated with increased in-hospital mortality (adjusted odds ratio 2.09, 95%CI:1.46-2.96; p<0.001). Phylogenetic analysis indicated most strains belonged to genotype 2, with two sequences forming a distinct clade. Interpretation: PARV4 is frequently detected in the CSF of children with suspected meningitis and is associated with increased in-hospital mortality. Its high prevalence, detection early in life, and frequent co-infection with other pathogens highlight the need to investigate PARV4 as an emerging CNS pathogen in LMICs. Funding: Gates Foundation

IntroductionThe COVID-19 pandemic disrupted immunization services in Togo, resulting in 69,672 "zero-dose" and 24,846 "under-vaccinated" children by the end of 2023. This study assessed the effectiveness, acceptability, and feasibility of a social marketing approach deployed during the 2025 Big Catch-Up initiative in Togo. MethodsA convergent mixed-methods study was conducted in 17 priority health districts. The quantitative component compared vaccination coverage before and after the intervention using administrative data. Chi-squared test for linear trend compared district-level coverages, and statistical significance was set at p<0.05 for all tests. The qualitative component used in-depth interviews with key informants to collect data, followed by thematic content analysis. The intervention was grounded on the social marketing framework with 4 pillars (4Ps): Product, Price, Place, and Promotion. ResultsCoverage increased dramatically: Penta1 from 1% to 64%, Penta3 from 1% to 45%, MR1 from 4% to 50%, and MR2 from 6% to 49% (all p<0.001). Togo ranked 3rd out of 24 African countries for Penta1 progress. The approach demonstrated high community acceptability, with Vaccination Monitoring Committees praised as being culturally appropriate. Key concerns included sustainability and resource constraints. ConclusionSocial marketing proved to be effective for increased community adherence and immunization coverage improvement. However, long-term sustainability requires institutionalization of community structures with domestic funding and continued health system strengthening.

There is limited epidemiologic data on varicella zoster virus (VZV) infections from low- and middle-income countries including Kenya. We aimed to describe the seroepidemiology of VZV in Kilifi, Kenya, where varicella vaccine is not included in the national infant immunization program, in order to generate evidence to inform vaccine policy. We conducted a retrospective serosurvey utilizing archived plasma and serum samples from cross-sectional population-based serosurveys conducted within the Kilifi Health and Demographic Surveillance System between 2009 and 2021. We assayed immunoglobulin G (IgG) for VZV using a validated Luminex multiplex immunoassay and applied a seropositivity cutoff of [&ge;]0.26 International Units per millilitre (IU/mL), as determined by the assay developer. We calculated Bayesian-adjusted age-specific seroprevalence and tested differences in seroprevalence between groups using Chi square. We used a multivariable logistic regression model to estimate associations with VZV IgG antibody seropositivity. We fitted an age-dependent catalytic model to estimate the force of infection (FOI) in children aged 0.5-4, 5-9 and 10-14 years. A total of 2639 samples from children aged <15 years and 546 samples from persons aged [&ge;]15 years were tested. The overall population-weighted seroprevalence of VZV IgG antibodies among children aged 0-14 years was 38.4% (95%CI 27.5-49.5). Age-specific seroprevalence rose from 13.3% (95%CI 5.8-21.6) in children aged 0-4 years to 60.9% (95%CI 45.0-76.2) in those aged 10-14 years. Survey year and age were associated with VZV IgG antibody seropositivity. Children aged 5-9 years had the highest FOI (0.098; 95%CI 0.077-0.120) per susceptible year while mean age of infection was 24.3 years (95%CrI 17.6-30.1). Approximately 40% of individuals entering adulthood in Kenya remain susceptible to VZV infection, suggesting a substantial and underappreciated risk of severe VZV disease in older population including pregnant women. An infant varicella immunization program might avert disease across both paediatric and adult populations.