Disaster Medicine and Public Health Preparedness

Introduction: Stroke care is time-sensitive, yet patients in low-resource settings may reach tertiary services only after passing through multiple formal and informal care options. This study examined documented care-seeking pathways and time to presentation among stroke cases recorded at the University of Medical Sciences Teaching Hospital (UNIMEDTH), Ondo State, Nigeria. Methods: A retrospective hospital record review was conducted using secondary data from the Stroke Registry, radiology department records, referral notes, and ambulance records at UNIMEDTH. The analysis included 371 stroke cases with documented time from symptom onset to UNIMEDTH presentation and reconstructable care pathways. First-contact routes were classified as hospital/biomedical, self/informal or traditional/faith-based care, and the number of documented steps defined pathway complexity before and including tertiary presentation. Frequencies and percentages described pathway patterns; median presentation times were compared using Mann-Whitney U and Kruskal-Wallis tests. Results: The median time to tertiary presentation was 24 hours (interquartile range [IQR] 9-72), and 317 patients (85.4%) presented after four hours. Only 30 patients (8.1%) presented directly to UNIMEDTH; 44 distinct care-pathway sequences were recorded. Hospital-facility first contact was documented for 81 patients (21.8%). It was associated with a median presentation time of 3 hours (IQR 2-6), compared with 48 hours (IQR 24-72) among patients whose initial contact was outside a hospital facility (U = 699.50, p < 0.001). The median time also differed across grouped first-contact categories and pathway complexity levels (both p < 0.001). Conclusion: Non-hospital or multi-step care-seeking pathways commonly preceded tertiary stroke presentations in this setting. The findings indicate that delayed tertiary arrival is partly embedded in the pathway followed after symptom onset. Interventions should combine public recognition of stroke warning signs with urgent referral linkages involving hospitals, patent medicine vendors, traditional and faith-based providers, and emergency transport systems.

Introduction: Early hospital presentation after stroke onset is necessary for rapid assessment and access to time-dependent acute management. This study examined the correlates of late presentation for stroke care among patients recorded at a tertiary hospital in Ondo State, Nigeria. Methods: A retrospective records review was conducted using secondary data from the Stroke Registry of the University of Medical Sciences Teaching Hospital, radiology department records, referral notes, and ambulance records. Records of stroke cases documented within the preceding 24 months were reviewed. Late presentation was defined as hospital presentation more than four hours after symptom onset. Frequencies, chi-square tests, and modified Poisson regression with robust standard errors were used to estimate adjusted prevalence ratios. Results: The analysis included 371 stroke cases. Of these, 317 (85.4%) presented after four hours, and the median time to presentation was 24 hours (interquartile range: 9-72 hours). Late presentation differed significantly by employment status, first-contact route, and pathway complexity at bivariate analysis. After adjustment, non-hospital first contact remained strongly associated with late presentation: patients whose first documented contact was non-hospital-based had almost 3 times the prevalence of delay compared with those whose first contact was hospital-based (adjusted prevalence ratio = 2.89; 95% confidence interval: 2.15-3.90; p < 0.001). Conclusion: Late presentation was pervasive in this tertiary hospital record cohort and was primarily associated with the initial direction of care-seeking. Stroke response interventions should emphasise immediate hospital presentation and strengthen urgent referral from non-hospital first-contact points.

Background: Mass gathering events (MGEs) are associated with several public health challenges and may cause a strain on healthcare services. Literature findings on the impact of MGEs on emergency departments (EDs) are heterogeneous. Objectives: To examine shifts in ED attendance characteristics during a major sporting tournament, namely the UEFA European Football Championship 2024 held in Germany. Methods: We conducted a retrospective observational study using ED data from the Emergency Department Data Registry. We compared baseline ED attendance characteristics between the tournament and the reference period, defined as two weeks before and two weeks after the tournament, and between Germany game days and non-Germany game days. Hourly attendance patterns were analysed for all Germany games using a reference range. Results: We included data from 41 EDs, totalling 253,493 attendances during the study period. A 1.57% increase in attendance was observed during the tournament compared to the reference period, with baseline characteristics remaining similar. The median daily attendance within all EDs was slightly lower on Germany game days (4066) compared to non-Germany game days (4128). Modest changes were observed in the hourly attendance on Germany game days, most notable during the last Germany game where a decrease in attendance below the reference range extended over three hours. Conclusions: The observed shifts in ED attendance were minimal, suggesting that no major changes of public health relevance occurred in ED attendance during the tournament. We highlight the utility of using ED data for monitoring and for enhancing the understanding of the public health risks and challenges associated with MGEs.

Background Despite existing road safety regulations, commercial motorcycle riders commonly referred to as "Boda Bodas" in Uganda continue to experience high rates of injuries due to road traffic accidents resulting from unsafe riding behaviours, contributing significantly to morbidity and mortality among both riders and passengers. Safe riding behaviours are less well documented, as well as factors associated with the observance of those behaviours. This study aimed to determine factors associated with safe riding behaviors for both boda-boda riders and their passengers in Kampala Central Division. Methods A cross-sectional survey study design was conducted using a convergent parallel mixed-methods design guided by the PRECEDE model. Quantitative data were collected from 424 riders through structured questionnaires administered by trained research assistants. Binary Logistic regression was used to determine the independent predictors of safe road riding behaviors, and Adjusted Odds ratios (AORs) have been reported. Data were analyzed using descriptive and inferential statistics, with a p-value <0.05 considered statistically significant. Qualitative data were collected simultaneously with quantitative data through in-depth semi-structured interviews with 10 passengers to capture perceptions of rider behaviors and safety practices. Thematic analysis was applied, and results were triangulated to highlight convergences and divergences between quantitative and qualitative findings, providing a comprehensive understanding of safety determinants for both riders and passengers. Results Of the 424 riders (mean rider age was 29.56 {+/-} 5.71), overall, 276 (65.1%) of riders exhibited unsafe riding behaviors. In the bivariate analysis with Logistic regression, predisposing factors (education, marital status, religion, and willingness to obey traffic regulations), and reinforcing factors (family encouragement) were significantly associated with safe riding behaviors. However, in the adjusted model, secondary (AOR=0.50; 95% CI:0.30-0.85) and post-secondary education (AOR=0.57; 95% CI:0.33-0.98), being married (AOR=0.56; 95% CI:0.34-0.91), Christian religion (AOR=2.98; 95% CI:1.63-5.47), willingness to obey traffic regulations (AOR=0.41; 95% CI:0.24-0.70), union advocacy (AOR=1.76; 95% CI:1.03-3.01), and well-maintained roads (AOR=1.65; 95% CI:1.07-2.55) were significant predictors of safe riding behaviors. Qualitative interviews further highlighted barriers to safety, including a lack of helmets, over-speeding, disregard for traffic regulations, and poor road infrastructure. Conclusions Rider and passenger safety is still low, interdependent, and influenced by multiple factors. Integrated interventions focusing on education, stronger families, religious affiliations, union safety advocacy, and stricter enforcement of traffic regulations are vital for enhancing safety for both riders and passengers.

Essential medicines are one of the cornerstones of financial protection and health equity. The REMEDIAR Program is an initiative of the Argentine Ministry of Health aimed at ensuring free access to essential medicines for the uninsured at the point of care in primary healthcare centers (PHC). This study analyzes the financing, procurement, and distribution of this program over two decades (2002 to 2024). It evaluates how the program's capacity to navigate economic and political challenges ensured an uninterrupted supply of essential drugs at the primary healthcare level in a federal country where health services are devolved to provinces. We adopted a mixed-methods approach to examine the duality between international concessional loans and domestic treasury funding. Findings reveal that while international financing enhanced predictability and efficiency, reducing procurement timelines from 458 to 235 days, it also constrained domestic planning through external conditionalities. Conversely, while national centralized procurement achieved superior price efficiency and lower dispersion, it faced rigidities in adapting to local needs. Territorial distribution analysis confirms that REMEDIAR reduced access barriers for vulnerable households without formal insurance. However, the program entered a stabilization phase, failing to consolidate robust coordination with subnational policies, becoming entrenched in its own operational logic. The study concludes that program effectiveness depends not only on resource volume but on management quality. To guarantee long-term sustainability, transition to national financing requires profound institutional redesign. This must integrate operational capacities with federal coordination and domestic regulations, ensuring that the primary healthcare supply chain remains resilient to macroeconomic volatility and political shifts, aligned with sub-national strategies.

Women shoulder the majority of water collection labor globally, yet how their water collection and water-related work experiences may change over time or by water source type remains insufficiently understood. We conducted a longitudinal, mixed-methods study in rural Kenya and Honduras to understand how women's experiences collecting water and performing water-related work varied between (a) two time points, (b) improved and unimproved water source types, and (c) water source location. Data were collected in 2023 and 2024 using interviews, observation, GPS-enabled watches, and scales to measure time and distance traveled, water weight and volume carried, and calories expended. 133 women participated in data collection (66 Kenya, 67 Honduras). We compared women's experience data by time point (2023 vs. 2024), source type (improved vs. unimproved), and source location (off-premises vs. on-premises) (t-test, Mann-Whitney U test). We also mapped participants' routes and activities to show which sources were visited, when, and for what activities. In Kenya, mean water collection time, distance, and caloric expenditure were significantly lower and water volume was significantly higher in 2024 when there were unexpected rains compared to 2023 when there was a persistent drought. When comparing source types during the 2023 drought, journeys to improved sources took significantly less time and energy and covered less distance than journeys to unimproved sources. These differences were not observed during the rainy conditions of 2024 when unimproved sources were closer and more accessible. In Honduras, water collection and water work burdens did not differ significantly by time point or source type. We found women with on-premises water access to still expend considerable time and caloric expenditure engaging in water work within their household compounds. Findings from Kenya suggest that water infrastructure improvements can reduce women's water collection burdens, though benefits may depend on and vary by season and source location. Findings from Honduras show that water labor does not end once water is in the household. Rather, substantial time and energy are expended carrying out water-related work even when sources are on premises, suggesting that efforts to assess water labor need to extend beyond collection alone. To meaningfully reduce burdens and ensure improved water sources are utilized during all seasons, initiatives need to consider source location, seasonal variability, and work beyond collection. Evaluations to assess infrastructure impacts on women's labor and well-being are needed and long overdue.

Introduction Gender norms and roles are important determinants of physical and mental health in the key period of adolescence. Yet, the gendered pathways to mental health in adolescents are not fully understood. Using a conceptual framework for global adolescent mental health that we developed based on a Delphi process, we empirically investigated the associations between six gender-related constructs and adolescent mental health. Methods We used cross-sectional Gender and Adolescence: Global Evidence (GAGE) data from Ethiopia (2020) to explore the associations between sex, gender norms, psychological competencies, gender attitudes, gender roles, with the latter two also serving as mediators, and psychological distress (GHQ-12), using Structural Equation Modelling (SEM). Results The SEM model contained measurements from 1,584 adolescents, including 843 girls and 741 boys, with a median age of 13 years. Out of 14 pathways tested, we found statistically significant associations between psychological competencies and psychological distress; sex and gender attitudes; and between gender norms and psychological competencies, gender attitudes, and gender roles. Hence, the gender-related constructs were mostly associated with each other, rather than with psychological distress. Conclusion The gender-related constructs are strongly interrelated, thereby attenuating their individual effects on psychological distress. The interplay of gender-related constructs should be considered when developing interventions to promote mental health in adolescents.

Women's disproportionate responsibility for unpaid domestic and care work, including water collection, remains a barrier to gender equality globally and may constrain women's ability to engage in income-generating activities. We compared women's and men's time use in rural Kenya and Honduras and assessed whether women's time spent on water collection and income-generating activities differed between communities that had or had not received an improved water source from World Vision. We also examined the measurement of time-use agency among women and men. In-person surveys were conducted in July-August 2024 with 95 participants (48 women, 47 men) in six Kenyan communities and 102 participants (53 women, 49 men) in six Honduran communities. Surveys included a 24-hour time-use recall module and items on time-use agency. Analyses compared time use by gender and by community intervention status (improved vs. not yet improved water supply), and confirmatory factor analysis assessed the validity of the time-use agency measure. Women in both study sites spent substantially more time than men on unpaid domestic and care work activities, including cooking, cleaning, laundry, and caregiving. In Kenya, women also spent significantly more time collecting water. Men spent more time sleeping (Kenya), on paid work (Honduras), unpaid agricultural work (both settings), and traveling (both settings). Across both countries, there were no significant differences between intervention and comparison communities in women's time spent on water collection or income-generating activities. In Kenya, most respondents reported high influence over their time, and six items showed strong validity for measuring instrumental time-use agency. Women's time burdens remained high even in communities that had received improved water sources, including at the household level. Our results suggest that more transformative water infrastructure, combined with interventions that address gendered social norms, may be needed to meaningfully reduce women's domestic work burden and support their economic empowerment.

Introduction Indigenous peoples in Canada face persistent health inequities rooted in colonialism, systemic racism, discrimination and social exclusion, all of which operate with particular intensity within healthcare institutions. Despite a growing qualitative literature documenting the discrimination and stigmatisation of Indigenous people by healthcare professionals, no validated instrument existed in the Canadian context to measure the stigmatizing attitudes and behaviors of clinicians toward this population. Aim This study aimed to co-develop and validate an instrument using clinical case vignettes designed to capture the affective, cognitive, and behavioral dimensions of stigmatization of indigenous peoples. Method Following Boateng et al.'s three-phase scale development approach, a multidisciplinary team including Indigenous patient partners, researchers, clinicians, and measurement experts generated 244 items across three paired clinical vignettes addressing type 2 diabetes, chronic back pain, and depressive disorder. Each vignette was developed in two versions, one featuring an Indigenous patient (test) and one featuring a non-Indigenous patient (control), distinguished solely by name and origin. Content validity was assessed by an expert committee using a Content Validity Index. The instrument was subsequently administered to a sample of nurses and physicians from two canadian health institutions using a twelve-arm randomization design. Analyses were carried to assess the internal structure of the instrument, convergent and concurrent validity as well as internal consistency. Results Our results show that the instrument developed has good psychometric qualities, particularly in terms of internal consistency, concurrent validity and factor structure, which reflects the theoretical structure assumed. Concurrent validity of the tool with the M-PATAS scale demonstrated weak to moderate significant correlations. Developed through a participatory process centering Indigenous expertise and lived experience, this instrument constitutes a significant methodological advance in the study of racialized stigmatization in Canadian healthcare.

Introduction: Malaria, primarily transmitted by Anopheles mosquitoes, remains a major public health concern in Maiduguri, Borno State, Nigeria. While conventional control methods (e.g., ITNs) face challenges due to insecticide resistance and accessibility constraints, many communities rely on locally sourced natural products. This study aimed to assess the prevalence, usage patterns, and associated factors of these natural alternatives. Methods: A cross-sectional survey was conducted across three purposefully selected communities in Maiduguri (Mairi, Furi, Lagos Street). A total of 450 household heads were interviewed using a structured questionnaire, collecting data on socio-demographics, specific natural products used, method of application, frequency, and perceived efficacy. Data were analyzed using descriptive statistics and binary logistic regression. Results: Overall usage prevalence of natural products was high at 68.4%. The most common products identified were Neem (Azadirachta indica) extract (45.9%) and burnt Lemon Grass (Cymbopogon citratus) (31.2%). Usage pattern was predominantly indoor fumigation (burning), and over 70% of users prepared the products crudely at home. Logistic regression revealed that rural residence (Odds Ratio (OR): 2.1; p<0.01) and low education level (OR: 1.8; p<0.05) were significant independent predictors of higher natural product reliance. Conclusion: Natural products constitute a widely adopted, community-driven vector control method in Borno State. The high prevalence and association with vulnerable populations suggest an urgent need to standardize the preparation and application of these products for potential integration into regional malaria control programs. Keywords: Anopheles, Adulticides, Borno State, Malaria, Natural Repellents, Vector Control, Usage Pattern.

Introduction: Cardiovascular diseases (CVDs) are the leading cause for death and disability worldwide accounting for 75% of deaths in low- and middle-income countries (LMICs) like Nepal. Urbanization and globalization remains the major cause of rise in CVDs among urban poor population along with growth in slum settlements. This study aims to assess the knowledge, attitude and practice (KAP) of CVDs and its risk factors among women of one such urban poor community in Nepal. Methodology: This cross-sectional study (n=388) in the Sinamangal-Minbhawan slum area was conducted using semi structured questionnaire based on STEPs survey and HARDIC study among the participants selected through convenient sampling. Descriptive analysis was done using SPSS version 21 and KAP scores were further categorized based on median score to perform multivariate logistic analysis. Additionally, Anthropometric and blood pressure measurements were also recorded and analyzed. Results: The median age (Interquartile range) of participants was 33 years (17) with majority of them being Dalit by ethnicity, housewives, with up to primary level education belonging to upper lower socioeconomic class. More than half (53.3%) of the participants were obese and over 23% were hypertensive. While half of the hypertensive women were aware of their status, only 3% had their blood pressure under control.The median knowledge, attitude and practice (KAP) scores were 12, 60 and 10 respectively. The KAP scores were positively associated with socioeconomic status of the participants. Conclusion: The study revealed low knowledge with high prevalence of behavioral risk factors of CVDs along with high prevalence of other metabolic risk factors like high body mass index, high waist hip ratio and hypertension among women of slum area with a positive attitude to prevent CVDs and its risk factors.

Between 2024 and 2025, Colombia universalized the Electronic Health Invoice with embedded Individual Health Services Delivery Records (RIPS -- Registro Background Between 2024 and 2025, Colombia universalized the Electronic Health Invoice with embedded RIPS records (FEV-RIPS) as the standard for financial and clinical data exchange. ADRES -- the entity responsible for administering the resources of Colombia's General Social Security Health System -- faced the challenge of processing information from multiple heterogeneous sources generated by more than 55,000 healthcare providers. Health systems in high-income countries converge clinical-financial data in consolidated platforms; Colombia started from a fragmented architecture with incompatible historical sources, no cross-database standardization, and no centralized analytical infrastructure until 2023. Objective We describe the design, technical challenges of integrating heterogeneous data, and operational performance of the analytical infrastructure built by ADRES to centralize large-scale processing of Colombian health system information, and derive transferable lessons for health system resource administrators in Latin America facing equivalent digitalization mandates. Methods Technical-descriptive report based on operational metrics from the ADRES Azure/Databricks environment during January-November 2025. We report indicators of data volume, processing speed, computational capacity, concurrent use by functional group, and governance structure. The architecture integrates VPN connectivity with MinSalud, automated processing of multiple formats (XML, relational tables, flat files), and a medallion data lake (Bronze/Silver/Gold). Data quality challenges include structural inconsistencies across sources, coding incompatibilities (municipalities, dates, diagnoses), format heterogeneities in unstructured data, and absent technical documentation. Results The platform manages 21 catalogs, 1,183 tables, and over 110,645 million stored records, with cumulative production exceeding 1 trillion processed records. It executes queries on 100 billion records in ten seconds using clusters of up to 32 TB RAM and 4,096 vCPU. During September-October 2025, monthly query peaks reached 78,028 across eleven functional groups. Integration required Python/PySpark parsers for variable-depth XML, equivalence tables for incompatible municipality codes, cleaning routines for extreme dates used as nulls (1900-01-01, 9999-12-31), and transformation logic bridging classic RIPS and FEV-RIPS. The platform supported econometric analyses, judicial mandate responses, and public interactive dashboards. Conversational AI integration (Genie, Copilot) extends analytical access to users without SQL knowledge. Conclusions ADRES built in one year an analytical infrastructure that provides, to our knowledge, the first published documentation of the systemic technical challenges of integrating heterogeneous data sources in a middle-income social security health system. Centralizing health system information at national scale is technically feasible under public institutional constraints -- but requires solving cross-source standardization problems the implementation literature does not document with quantitative precision. The derived lessons are transferable to health system resource administrators in Latin America facing equivalent challenges.

Introduction Menopause is a central marker of reproductive ageing, but national evidence on menstrual cessation among Nigerian women in the late reproductive ages remains limited. This study examined the prevalence and socio-demographic correlates of prolonged amenorrhea/possible menopausal transition among Nigerian women aged 30-49 years. Methods The study used the women's individual recode file from the 2024 Nigeria Demographic and Health Survey. The analytic sample was restricted to women aged 30-49 years, excluding women who were currently pregnant, currently or postpartum amenorrheic, and those with invalid or special responses on time since last menstrual period. The final sample comprised 14,223 women. The outcome combined women whose last menstrual period occurred 12 or more months before the survey, and women reported as being in menopause. Weighted descriptive statistics, design-adjusted bivariate tests and survey-weighted binary logistic regression were used. Results The weighted prevalence of prolonged amenorrhea/possible menopausal transition was 7.6%. Prevalence rose from 1.2% among women aged 30-34 years to 23.6% among women aged 45-49 years. In the adjusted model, women aged 35-39 years (OR=1.64; p=0.030), 40-44 years (OR=6.20; p<0.001) and 45-49 years (OR=24.51; p<0.001) had higher odds than women aged 30-34 years. Primary education (OR=1.65; p=0.004), middle wealth status (OR=1.37; p=0.043) and poorest wealth status (OR=1.60; p=0.024) were associated with higher odds. Muslim affiliation (OR=0.72; p=0.024) and traditional contraceptive use (OR=0.24; p<0.001) were associated with lower odds. Conclusion Prolonged amenorrhea/possible menopausal transition among Nigerian women aged 30-49 is strongly age-patterned and socially differentiated. The findings support the need to make midlife menstrual health more visible within reproductive, family planning and primary healthcare services. Because the measure is based on survey-reported menstrual recency, it should not be interpreted as clinically confirmed natural menopause.

While significant progress has been made in perinatal outcomes over recent decades in low- and middle-income countries (LMICs), maternal and newborn quality improvement initiatives often fail to account for the spatial conditions in which they are implemented. Health systems are increasingly deploying evidence-based care models into built environments that are not optimally structured to meet the needs of its patient population. As the principal users, patients and health care workers can offer pragmatic insights about improving these structural designs. Our objective was to gather insights from patients, providers, and companions about how the physical design of their health facilities influenced their experience receiving or delivering perinatal care. We conducted a prospective observational study using a human-centred design (HCD) approach to analyse perceptions of the quality of perinatal care across two low resource settings: Ethiopia and Bangladesh. Using engagement and assessment tools, we conducted interviews, focus groups, facility walk-throughs, co-design workshops, and infrastructural assessments with patients, companions, providers, and Ministry of Health representatives. Descriptive statistics and thematic analysis were used to identify key learnings and develop recommendations. Across both countries, participants identified the need for facility layouts that better support privacy, mobility during labour, alternative birth positions, companion involvement, cultural and religious practices, sanitation, and provider visibility. Based on these insights, we developed six recommendations to better align health facility infrastructure with maternal and newborn care delivery needs. Our findings suggest that investments in health facility infrastructure may improve care experiences and help enable respectful, safe, and evidence-based maternal and newborn care. Alongside targeted spatial improvements, government authorities responsible for health facility planning should incorporate participatory design processes to ensure infrastructure reflects the needs of patients, companions, and providers and supports high-quality care delivery.

Background. The 2026 FIFA World Cup will bring an estimated 1--5~million international visitors to 11~US host cities between June~11 and July~19, 2026---the largest tournament in history. Large-scale international gatherings accelerate importation of infectious diseases from diverse source populations. Advance estimation of importation risk is essential for public health preparedness and surveillance prioritization. Methods. We developed a Poisson importation framework applied to five diseases (dengue fever, influenza, malaria, measles, and pertussis) across the 11~US venue cities. Three nested travel models of increasing resolution were constructed: a baseline model using routine June~2024 arrival data; a World Cup--adjusted model incorporating projected visitor growth factors; and a schedule-driven model routing WC fans to specific cities based on match assignments. WHO incidence and BTS T-100 routing fractions were combined with Monte Carlo uncertainty propagation (5,000 Uniform draws on under-reporting and travel-while-infectious parameters) to yield median importation estimates with 95\% uncertainty intervals. Results. Dengue posed the highest importation risk at most venue cities under the schedule-driven model (median $\Lambda > 10$ expected importations from Brazil alone; 95\% uncertainty interval 5.9--33.1), robust across the full literature-supported parameter range; Atlanta was the exception, where malaria probability exceeded dengue, driven by direct travel from West and Central African nations. Influenza ranked second at most cities, coinciding with the Southern Hemisphere winter peak. Pertussis showed broad geographic spread but carries the widest relative uncertainty, as the assumed detection rate sits at the upper bound of the literature range. Background tourism accounted for the dominant share of total importation risk; the World Cup fan increment contributed approximately 8.3\% of projected arrivals for WC-qualified nations. Conclusions. This Poisson importation framework, built entirely from publicly available data, provides reproducible importation risk estimates for mass gathering events. The framework extends to additional diseases, cities, and gatherings, offering a transparent baseline complementary to proprietary modeling systems.

Introduction: Women aged 45-49 occupy a heterogeneous late-reproductive-life stage, but population research often treats them as a uniform group. This study examined correlates of Demographic and Health Survey (DHS)-defined infecund/menopausal status among Nigerian women aged 45-49. Methods: This cross-sectional secondary analysis used the 2024 Nigeria Demographic and Health Survey Women Recode dataset. Weighted descriptive statistics summarised reproductive exposure status among 3,237 women. Out of these, 3,110 women classified as either fecund or infecund/menopausal were subjected to Survey-adjusted Chi-square tests and Binary Logistic regression at p<0.05, where pregnant and postpartum amenorrhoeic women were excluded. Results: More than half of women were classified as infecund/menopausal (54.1%), while 41.5% were fecund; 3.2% were postpartum amenorrhoeic, and 1.3% were pregnant. Findings indicated that currently married/cohabiting women (AOR=4.87; 95% CI: 2.24-10.56) and formerly married women (AOR=8.30; 95% CI: 3.69-18.66) had higher odds of infecund/menopausal classification than women never in a union. Secondary education, higher education, middle-to-richest wealth quintiles, and five or more children ever born were associated with lower odds, while Northern minority ethnicity was associated with higher odds. Adding the current contraceptive method attenuated several education, wealth and parity associations; modern-method and traditional-method users had markedly lower odds than non-users. Conclusion: Late-reproductive-life exposure status among Nigerian women aged 45-49 is socially patterned, with union status showing the most stable association. DHS-defined infecund/menopausal status is a demographic exposure category rather than clinically confirmed menopause. It is therefore concluded that the cross-sectional associations should not be interpreted causally.

Abstract Background Malaria remains a major public health challenge in Ghana, despite recent reductions in cases due to various interventions. The endemicity of the disease varies across regions, influenced by diverse seasonal and temporal factors that support mosquito proliferation and malaria cases. This study used a Generalised Additive Models to explore the impact of weather conditions on malaria cases in Ghana. Methods Generalised Additive Models were used to examine the nonlinear effects of weather conditions on malaria cases. Monthly aggregated malaria cases from the District Health Information Management System II and average monthly rainfall and temperature data from the Ghana Meteorological Agency were analysed, covering 2012 to 2023. Regional Generalised Additive Models incorporating weather variables were developed, fitted, and validated against observed data using model diagnostics to identify the most suitable model for each region. Results The analysis revealed complex temporal patterns in malaria cases across Ghana, influenced by seasonal and long-term trends. Regions constituting the Coastal and Transitional Forest zones exhibited bimodal peak malaria seasons, while the Guinea Savannah showed a unimodal peak. Significant interactions between rainfall and temperature were identified, particularly in the Eastern region, where higher rainfall combined with temperatures around 27-28 {degrees}C were associated with higher malaria cases, reflecting the complex and region-specific nature of meteorological influences. Conclusions The findings point to the dynamic and heterogeneous nature of malaria caseloads in Ghana, emphasising the need for region-specific control strategies tailored to local climatic conditions. A key recommendation is the systematic integration of meteorological data into the National Malaria Data Repository to enable continuous monitoring of climatic influences and support timely, evidence-based intervention decisions. Future research should incorporate socio-economic factors, intervention coverage data, vector surveillance, and demographic characteristics into mathematical modelling frameworks for a more comprehensive understanding of malaria cases in Ghana.

Since the U.S. 2013/14 influenza season, the CDC's FluSight Challenge has provided a platform for evaluating influenza forecasting models and fostering collaboration across institutions. The Challenge aims to improve the science and enhance the utility of infectious disease forecasts for public health decision making. We analyzed ten years of submitted forecasts (2014/15-2019/20 (influenza-like illness seasons) and 2021/22-2024/25 (hospital admissions seasons)) across a range of model types, including statistical, mechanistic, machine learning, and hybrid models. Influenza-like illness (ILI) forecasts were evaluated using the exponentiated logarithmic score (skill metric) while hospital admissions forecasts were evaluated using the log transformed relative Weighted Interval Score. Corresponding potential performance differences were assessed using Wilcoxon rank-sum tests, and associations with team participation history were evaluated using Spearman's rank correlation. Model performance varied by season, and no single model type consistently outperformed others. In ILI seasons, statistical models generally performed better than mechanistic and machine learning models, though consistent differences were not observed in more recent hospital admissions seasons. Ensemble forecasts showed better overall performance across seasons, and the CDC's FluSight ensemble ranked among the top-performing forecasts every year. We also found a positive correlation between forecast accuracy and the number of years a team participated in the Challenge, with statistically significant associations in four seasons. These findings highlight the benefits of ensemble approaches and sustained engagement in improving forecasting performance, while also underscoring the continued value of forecast evaluation before and following the COVID-19 pandemic. Insights from the FluSight Challenge can guide future infectious disease forecasting efforts and support more effective public health preparedness.

Background: Cervical cancer is the fourth most common cancer in women worldwide and remains a major public health challenge. In Ethiopia, it is the second leading cause of cancer deaths, with around 8,000 new cases and 6,000 deaths each year. Region?specific data on the prevalence and predictors of precancerous lesions remain scarce, yet such information is vital for guiding targeted reproductive health strategies. This study therefore examined the prevalence and predictors of cervical precancerous lesions among women aged 21-60 years undergoing Pap smear screening in public hospitals in Hawassa City, Sidama Region. Methods: An institution-based cross-sectional study was conducted among 241 women attending Pap smear screening at public hospitals in Hawassa City from March to August 2025. Sociodemographic and clinical data were collected via interviews and medical records. Lesions were classified based on the standardized international framework for reporting cervical cytology results from Pap smears per the Bethesda system. Multivariable logistic regression identified predictors p<0.05). Result: Of 241 women screened (mean age 35.3 years), cervical epithelial abnormalities were detected in 52 (prevalence 21.6%). Atypical squamous cells of undetermined significance was the most common abnormality (16.6%). Multivariable analysis showed HIV infection was significantly associated with precancerous lesions (AOR = 3.7, 95% CI: 1.69-8.12, p<0.05), while hormonal contraceptive use was protective (AOR = 0.27, 95% CI: 0.11-0.67, p<0.05). Conclusion: These results underscore the urgent need to strengthen cervical cancer prevention through targeted screening and early intervention. Integrating routine HIV testing with Pap smear programs would be especially valuable. Health authorities should expand accessible screening for women aged 21-60, with particular attention to those living with HIV, to help reduce the burden of precancerous lesions.

Introduction Reducing delays in leprosy case detection is essential for achieving global leprosy targets. Accurate measurement of these delays and their determinants relies largely on patient-reported data, as routine health records are often inadequate. The leprosy case detection delay (CDD) questionnaire, developed under the Post Exposure Prophylaxis for Leprosy (PEP4LEP) project, has been validated in Ethiopia, Mozambique, Tanzania, and Indonesia. However, it has not been adapted or validated for Nigeria or any major Nigerian indigenous language. This study aimed to culturally adapt and validate the CDD questionnaire for Igbo-speaking populations in Nigeria. Methodology/Principal Findings The CDD questionnaire underwent a standardized cross-cultural adaptation process. Content validity was assessed using item- and scale-level content validity indices, while construct validity was evaluated through hypothesis testing. Reproducibility was assessed using test-retest and inter-rater reliability; agreement using the Bland-Altman method and the Wilcoxon Signed-Rank test; reliability using Spearmans rank correlation coefficient and the Intraclass Correlation Coefficient (ICC); and internal consistency using Cronbachs alpha. Data were collected through face-to-face interviews with persons affected by leprosy at two time points separated by at least two weeks. Participants (n=100) had a mean age of 45.1 years (SD=18.7). Mean CDD was 77.2 months at baseline and 77.9 months at retest. The instrument demonstrated excellent content validity (I-CVI/S-CVI: 0.90-1.00), good internal consistency (Cronbachs =0.77), and excellent test-retest reliability (ICC=0.996, 95% CI: 0.994-0.997). Test and retest measurements were highly correlated ({rho}=0.985, p<0.001), with no evidence of systematic change over time (p=0.864). Seventy-two percent of participants reported identical CDD values across assessments. All items from the original English version were retained without modification. Conclusion/Significance The Igbo version of the CDD questionnaire demonstrated good validity and reliability and is suitable for assessing leprosy case detection delay among Igbo-speaking populations in Nigeria