IJID Regions

BackgroundThe Intensive care unit (ICU) service is highly limited in sub Saharan Africa countries due to varying of quantities and qualities infrastructures. However, the burden of critical ill patient in low resource countries is higher and possibly increasing with urbanization, developing epidemics and access to hospitals service. The main objective of this study was to assess the outcomes of ICU admission and identify the areas of improvement in critical care. Methodsan institutional based retrospective cross sectional study design was conducted on eligible patients who were recorded at intensive care unit registration log book from January 1, 2019 to June 30, 2020. The data was entered, edited and analyzed in stata software (version14). We performed the adjusted survival analysis between ICU mortality and independent variables by using logistic regression. We also showed patients mortality in ICU by Kaplan-Meier (KM) survival analysis. ResultsFrom January 1, 2019 to June 30, 2020 data were taken from 454 cases at Tibebe Ghion Specialized Teaching Hospital ICU registered log book through prepared questionnaire. The overall ICU mortality was 31.3%. The common leading causes of admission to ICU were head injury (19.6%) followed by non-tuberculosis respiratory problems (11.89%), post abdominal surgeries (8.37%) and myocardial infarction (6.82%). In this study, 36.3% of ICU admitted patients were served by mechanical ventilation. The logistic regression analysis ICU mortality showed that patient stayed in ICU with odds ratio (OR = 1.37 [95% CI, 1.16 - 1.62]; P = 0.000),needs for mechanical ventilation(OR = 0.18 [95% CI, 0.12 - 0.28]; P = 0.000), days on mechanical ventilation (OR = 0.73 [95% CI, 0.61 - 0.87]; P = 0.001) and non-infection (OR = 0.45 [95% CI, 0.24 - 0. 69]; P = 0.000) were associated with risk of ICU mortality. ConclusionThe mortality rate of our adult ICU was 31.3% with the most common causes of admission and deaths being on head injury. The highly statistical significant predictors of ICU mortality were infection, needs for mechanical ventilation, ICU stay and days on mechanical ventilation.

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.

IntroductionMalaria research in Zambia has largely focused on pregnant women and children under five, yet adults also play a critical role in sustaining transmission. This study assessed the prevalence and factors associated with malaria among adults aged [≥]18 years attending Chongwe District Hospital. MethodologyThe study used an analytical cross-sectional study design. Data was collected using a structured questionnaire capturing socio-demographic information, including age, sex, education level, occupation, and socio-economic status. Environmental and behavioural factors, such as water source and use of insecticide-treated nets (ITNs), were also assessed. Malaria infection was tested using rapid diagnostic tests (RDTs). Data was analysed using SPSS version 26, it was summarised using frequencies and percentages. Further, hypothesis tests such as Chi-square and Fishers exact test were done on categorical variables and multivariable logistic regression was used to test for associations. ResultsA total of 134 participants were enrolled in the study, and consisted of 73 females (54.5%) and 61 males (45.4%). The study revealed an adult malaria prevalence of 14.2% among those who visited the health facility. Those with low education were associated with increased odds (aOR 5.55, P-value 0.048) of malaria compared to those with secondary education. Other variables such as gender, age, occupation, use of ITNs and water source were not statistically significant. ConclusionThis study found that the prevalence of malaria among adults attending Chongwe district hospital for various ailments was higher than the expected prevalence of malaria in Lusaka district. The study further found that malaria was higher among those with lower education compared to those with higher education.

BackgroundAdolescent girls and young women (AGYW) are disproportionately vulnerable to HIV. Despite expanded HIV testing services (HTS), the majority of AGYW remain unaware of their HIV status. This study aimed to assess determinants of HIV testing uptake among AGYW in mainland Tanzania before and after stratifying by age group (15-19 and 20-24 years) using data from three national surveys conducted over time. MethodologyA cross-sectional secondary data analysis was conducted using data from the Tanzania HIV Impact Surveys (2016/17 and 2022/23), obtained from the Population-based HIV Impact Assessment on 23/04/2025. Data analysis was performed using STATA version 17. Modified Poisson regression models were used to identify factors associated with HIV testing uptake before and after stratifying by age group (15-19 and 20-24 years). Results were presented using the adjusted prevalence ratio (APR) with a 95% confidence interval. ResultsHIV testing uptake among adolescents remained 40% in the years 2016/17 and 2022/23, while it increased from 86% to 90% among young women, respectively. Key factors consistently associated with higher prevalence of HIV testing uptake included being in a union, cohabiting, or formerly married; having secondary or higher education levels; and a history of sexually transmitted infections (STIs). ConclusionHIV testing uptake among AGYW in Tanzania has improved over time, with significant disparities between adolescents and young women. These findings highlight the need for age-specific strategies, intensifying adolescent-focused interventions while sustaining efforts among young women and reinforcing integrated reproductive health and HIV services.

Sickle cell disease (SCD) is associated with chronic systemic morbidity that extends beyond acute crises. However, data describing the clinical and laboratory adolescents and young adults with SCD at steady state in sub-Saharan Africa are limited. We described clinical and laboratory characteristics of adolescents and young adults with SCD at steady state in Uganda. We conducted a hospital-based cross-sectional study of 60 adolescents and young adults with SCD in steady state at Mulago National Referral Hospital. Descriptive statistics were used to summarize participant characteristics and medication use. The mean age was 16.5 {+/-} 3.3 years, and 34 (56.7%) participants were female. Mean hemoglobin was 9.1 {+/-} 2.2 g/dl. Mean systolic and diastolic blood pressures were 107.9 {+/-} 15.5 mmHg and 60.3 {+/-} 12.6 mmHg, respectively; mean heart rate was 89.5 {+/-} 15.5 beats/min. Fifty-two (86.7%) participants reported using hydroxyurea. These observations show that adolescents and young adults with SCD at steady state exhibit hematologic abnormalities and distinctive hemodynamic profiles that underscore substantial chronic subclinical abnormalities that extend beyond acute complications.

IntroductionCentral line-associated bloodstream-infection (CLA-BSI) and catheter-related bloodstream infections (CR-BSI) remain a significant concern in pediatric inpatient units. ObjectiveTo analyze a case series of CLA-BSI and CR-BSI in hospitalized pediatric patients in hospitals with rigorous infection prevention measures. Materials and MethodsThis was an analytical, descriptive, and retrospective study conducted in patients aged 0 to 18 years, admitted between August 2023 and March 2025, with a diagnosis of CLA-BSI or CR-BSI in two pediatric hospitals in Rio de Janeiro, Brazil. Variables potentially associated with the occurrence of infection were analyzed. ResultsA total of 86 infections were evaluated, comprising 66 CLA-BSI and 20 CR-BSI. Sixty patients (69.8%) were male, with a mean age of 71.8 months. Sixty-five (83.7%) had previous comorbidities, 63 (73.2%) had a prior hospitalization, and 27 (31.4%) had another invasive device. The mean time from catheter insertion to infection diagnosis was 32.1 days, and the mean time from hospital admission to infection onset was 18.45 days. Gram-negative bacteria were isolated in 40/86 (46.5%) cases. At 30 days post-infection, 61/86 (70.9%) had been discharged, 20/86 (23.3%) remained hospitalized, and 5/86 (5.8%) had died. There was no correlation between the bacterial group and the type of catheter used (p=0.068), nor between infection type (CLA-BSI vs. CR-BSI) and mortality outcome (p=1). ConclusionsCLA-BSI and CR-BSI occurred predominantly in patients with prolonged hospital stays and underlying comorbidities, and were mainly caused by Gram-negative bacteria.

IntroductionHemophagocytic lymphohistiocytosis (HLH) is a serious condition induced by Dengue virus which becomes fatal if not detected early and treated appropriately. So objectives of the present study are to observe the different patterns of presentations, clinical features and outcome of HLH induced by Dengue. MethodsIn this observational study, 14 patients admitted and diagnosed HLH as per diagnostic criteria, were included after informed written consent. Study conducted in a period of six months from 01/07/2025 to 31/12/2025. All patients were followed up till discharge. After collection, all data were analyzed by Microsoft Excel 2010. Ethical clearance was taken from Ethical Review Board of the Medical College. ResultsAmong 14 cases, male were more affected then the female (78.6% VS 21.4%) and majority were in between 20 to 50 years age groups. Clinical data showed, all 14 cases had fever for >7 days, joint pain 3(21.4%), headache 11(78.6%), skin rashes 10(71.4%), retro-orbital pain 2(14.3%), vomiting 11(78.6%),bleeding 10(71.4%), cough 4(28.6%), loose motion 9(64.3%), abdominal pain 7(50.0%), anorexia 2(14.3%), Melaena 2(14.3%), jaundice 4(28.6%) and spleenomegaly 9(64.3%). One(7.1%) case had history of Hypertension. Laboratory data showed different level of Bi or Pancytopenia, high ferritin, high TG, low fibrinogen, raised liver enzymes and low sodium. Dengue RT PCR and serology results showed 8(42.9%) cases were both IG M and Ig G dengue antibody positive, 6 cases were RT PCR positive, 2 cases were IgM and another 4 cases were IgG positive. Outcome of patients revealed, among all 14 cases12(85.8%) patients improved uneventfully and 2 were shifted to ICU where one improved and one died. ConclusionDengue is prevailing for long time and different complications are evolving and HLH is a relatively newer incident among the dengue patients. Infection by different serotypes at different time or multiple dengue serotype infection may be related with HLH and it might be a future subject to explore and to evaluate.

Malaria remains the most significant vector-borne disease worldwide, with over 200 million cases reported annually, causing approximately 0.6 million deaths among children and pregnant women. In Pakistan, particularly in the southern regions of Khyber Pakhtunkhwa, malaria continues to pose a major public health challenge. This study aimed to determine the monthly prevalence of malaria parasites in the population of Dera Ismail Khan and to identify the patterns of parasite transmission. A retrospective analysis was conducted using laboratory-confirmed malaria case data obtained from the District Health Office (DHO) Dera Ismail Khan for the entire year of 2024. Cases were categorized by month and Plasmodium species, specifically P. vivax, P. falciparum, and mixed infections. Chi-square analysis was performed to assess the significance of monthly variations in species distribution. The results showed that P. vivax was the predominant species, with cases peaking from September to December. P. falciparum and mixed infections were comparatively rare. October recorded the highest number of cases, followed by September and November. Chi-square analysis confirmed a statistically significant association between month and species distribution ({chi}2 = 2314.40, df = 22, p < 0.0001), indicating a strong seasonal pattern. Malaria incidence was higher in males than females, and the majority of cases occurred among individuals aged 15-24 years. Overall, the study demonstrates that P. vivax is the most common malaria parasite in Dera Ismail Khan and that malaria transmission in the region exhibits a clear seasonal trend. These findings provide valuable insight for targeted malaria control and prevention strategies in endemic areas of Khyber Pakhtunkhwa. Author SummaryMalaria remains a major public health problem worldwide, but not all malaria parasites behave in the same way. In this study, we focused on malaria in District Dera Ismail Khan, Pakistan, with particular attention to Plasmodium vivax, a species that has historically received less attention than Plasmodium falciparum. Using routine health records from 2024, we analyzed nearly 37,000 laboratory-confirmed malaria cases to understand which parasite species were most common and how infections varied by age, sex, and season. We found that Plasmodium vivax caused more than four out of five malaria cases in the district, making it the dominant species across all age groups. Malaria was more common in males than females, and clear seasonal patterns were observed, with most cases occurring after the monsoon season between September and November. These findings are important because P. vivax can cause repeated illness through relapses, making malaria harder to control even when mosquito numbers are low. By documenting local patterns of malaria transmission, our study highlights the need for targeted control strategies that address P. vivax specifically. This information can help public health authorities plan more effective, seasonally timed interventions and move closer to malaria elimination.

BackgroundThis study of Malawian children with rheumatic heart disease (RHD) sought to detect demographic, clinical, and echocardiographic risk factors for mortality. MethodsPediatric patients with RHD were recruited from March to October, 2018 from clinic rosters and inpatient consults in Lilongwe and Blantyre, Malawi. An echocardiogram was performed upon study enrollment. Cox regression analyses were performed to assess for factors associated with mortality over nearly 2 years of follow-up. ResultsOf 118 patients, nearly two-thirds were female (64.4%) and median age was 12 (IQR 10-14). Just under half (47.0%) lived >40km from a tertiary care center. There was a high prevalence of severe mitral regurgitation (65.3%), and pericardial effusion was present in 18.6%. Nearly a quarter (23.7%) died during follow-up. In univariable Cox regression, living >40km from tertiary care, living in a remote area, moderate or severe malnutrition, taking a beta blocker, severe mitral stenosis, any severe valve disease, severe left atrial enlargement, and presence of a pericardial effusion were statistically significant risk factors for mortality (p<0.05). In the adjusted model, living >40km from tertiary care (HR 2.66, CI 1.06-6.07, p=0.037), malnutrition (mild HR 3.92, CI 1.03-14.91, p=0.045); moderate HR 7.41, CI 1.92-28.54, p=0.004; severe HR 4.91, CI 1.44-16.71, p=0.011), beta blocker use (HR 4.62, CI 1.63-13.10, p=0.004), and presence of a pericardial effusion (HR 6.96, CI 3.00-16.13, p<0.001) remained independent risk factors for mortality. ConclusionsThis study of Malawian children emphasizes the dire prognosis of RHD in under-resourced settings and provides potential area of focus for targeted intervention.

Acute pain in hospitalised patients is common and is associated with adverse outcomes, yet African data are scarce. We conducted an international prospective point-prevalence study of adult inpatients across Africa to determine pain prevalence and severity, and explored associations with critical illness and survival status. On a single day, investigators assessed patients worst pain in the preceding 24 hours using a 0-10 visual-numerical scale and recorded vital signs. Critical illness was defined as [&ge;]1 vital sign out of range, according to predefined definitions. Survival was assessed at day 7. Data are presented as median [IQR], n (%), and odds ratios with 95% confidence intervals. Between September and December 2023, 19438 patients from 180 hospitals in 22 African nations were included (age 40 [29; 59] years; 56% female). 67.9% of patients reported pain, with 2795 patients reporting severe pain (pain of [&ge;]7/10). Pain severity did not differ significantly by sex overall, but females [&le;]40 years old, with hypertension or cancer, admitted for trauma or infection, or in surgical wards had higher mean pain ranks than males. Severe pain odds decreased by 11% per standard deviation increase in age. Patients with severe pain had greater odds of critical illness and death within seven days. These findings provide the first large-scale evidence of acute pain burden in African hospitals. Pain is highly prevalent, with one in seven patients reporting severe pain. Future research of effective and feasible strategies to manage acute pain and reduce pain-related adverse clinical outcomes is needed in Africa.

Incidence of norovirus has strong seasonality in temperate and continental climates. Many studies have examined its association with climate variables, but evidence remains disparate. We address this gap by performing a systematic review to summarise and interpret the strength and directionality of associations between climate variables and norovirus incidence. Embase, Scopus, Web of Science and PubMed databases were screened for peer-reviewed studies on 2nd of December 2024. Articles were included if they described any climate or meteorological variable, in a categorical or numerical format, relative to a measurement of norovirus incidence risk in a human population, or prevalence or survivability outside the human host. Bias was assessed using a modified Critical Appraisal Skills Programme checklist. If dispersion of the effect in a human population was provided, the mean size was calculated using inverse variance weighting. The effect size outside the host was summarised as D-values, representing the time required to achieve a 90% reduction in the detected amount of virus. A total 139 studies were included. Predictors of risk were ambient and water temperature, relative and absolute humidity, anomalies of ambient temperature and precipitation, atmospheric and vapour pressure. High heterogeneity in direction and size of effects was observed due to regional differences in the factors driving norovirus seasonality and differences in outcome and exposure definitions. Our review suggests that the sensitivity of norovirus to individual climate variables is region and time specific, reflecting geographical differences in the relative importance of norovirus transmission via environmental pathways versus human-to-human contact. Plain Language SummaryNorovirus, a gastrointestinal virus, has a higher number of cases during specific months of the year. Regions with similar types of climate appear to have similar time periods when the increase in the number of infections occurs, which has been linked to norovirus case numbers being correlated to individual climate variables, such as temperature or rainfall. To understand how these associations compare globally and what are their potential explanations, we screened four major scientific databases, namely Embase, Scopus, Web of Science and PubMed. After the selection process, a total 139 peer-reviewed studies were included in this study. We found that ambient and water temperature, relative and absolute humidity, anomalies of ambient temperature and precipitation, atmospheric and vapour pressure were predictors of an increase in norovirus cases. However, the strength and direction of the relationships differed from region to region. A potential explanation is that geographies also differ in how important individual routes are for the transmission of norovirus, specifically via the environment as opposed to direct human-to-human contact, whereas climate is likely to have a greater influence on the former. Key pointsO_LIThe strength and direction of associations between climate variables and norovirus incidence varies by region and time period C_LIO_LIThe strength of associations vary across the transmission routes of norovirus, e.g., environmental versus human-to-human contact C_LIO_LIClimate variables impact norovirus survival and dissemination outside the host, which may inform models of environmental virus transmission C_LI

IntroductionClimate change is expected to alter daily patterns of sleep, sedentary behaviour and physical activity, yet empirically grounded projections across the full 24-hour movement spectrum are lacking. This study estimated how projected future warming may alter 24-hour movement behaviour patterns in adults. MethodsA Monte Carlo simulation framework estimated temperature-dependent distributions of daily movement behaviour duration using data from 368 adults in the Annual Rhythms in Adults (ARIA) study in Adelaide, Australia. A total of 85,182 valid person-days were linked to daily temperature data to determine empirical temperature-behaviour relationships. The resulting distributions were used to simulate behaviour under five Intergovernmental Panel on Climate Change warming scenarios (+1.5{degrees}C to +4.4{degrees}C above pre-industrial levels) across a full calendar year relative to current-climate conditions (+0.99{degrees}C above pre-industrial levels). ResultsSimulations projected small but consistent behavioural shifts with warming. Annual median increased for MVPA (+49min to +4h 22min per person) and LPA (+3h to +13h 1min per person), while sleep declined (-5h 29min to -23h 19min per person). Physical activity gains were concentrated in cooler months, whereas sleep losses persisted year-round. Changes in sedentary behaviour were minimal and inconsistent. DiscussionRising temperatures may modestly increase year-long physical activity but reduce sleep duration, in a temperate-zone Mediterranean climate geography producing meaningful cumulative health implications. However, these might be confounded by the effect of other meteorological changes such as rainfall and humidity, which warrant further investigation.

BackgroundSurgical site infections are potentially preventable complications following surgery and impose a significant burden in terms of patient morbidity, mortality, increased cost of treatment, and diminished quality of life for patients. The prevalence of SSIs in hepatopancreatobiliary surgery varies widely across different studies and settings. Therefore, this study aimed to determine the prevalence and risk factors associated with SSIs in HPB surgery in selected hospitals in Addis Ababa, Ethiopia. MethodsThis hospital-based prospective cross-sectional study was conducted in three major hospitals in Addis Ababa, Ethiopia: Tikur Anbessa Specialized Hospital, Yekatit 12 Specialized Hospital, and Menelik II Specialized Hospital. The study took place over a period of 6 months. It commenced on January 10, 2025 and concluded on June 30 2025. Bivariate and multivariate logistic regression analyses were performed to evaluate the associations of SSI in hepato-pancreaticobiliary surgery patients with each independent variable. ResultsA total of 150 patients were included in the study. The mean age was 49.99 years, with females accounting for 62% of the participants. Ninety-six percent of surgeries were elective. Surgical site infections (SSIs) occurred in 27 patients (18.0%), the most common of whom presented with superficial incisional infections (14.0%). The average time to SSI onset was 6.9 days post-operatively. Multivariate logistic regression revealed that coagulopathy (AOR = 14.604; 95% CI: 1.068-199.769; p = 0.045), the presence of jaundice (AOR = 6.214; 95% CI: 2.180-17.714; p = 0.001), and postoperative hospital stay (AOR = 1.202; 95% CI: 1.058-1.366; p = 0.005) were independently associated with an increased risk of SSI. ConclusionThe duration of stay in the hospital was a major factor in our study to impact the prevalence of surgical site infections; hence, it is important to carefully decide when to admit a patient and when to discharge.

BackgroundNigeria accounts for a significant share of global maternal mortality, and HIV remains a public health threat. Gombe State in northeastern Nigeria contends with profound barriers to healthcare access. This study evaluated the effectiveness of a community-based intervention using trained Community Health Workers (CHWs) to improve early identification of pregnancy and linkage to Antenatal Care (ANC) and HIV services. MethodsA quasi-experimental design was employed across six local government areas (LGAs) from January 2020 to June 2021. Three LGAs were randomly assigned to the intervention, where CHWs conducted home visits for pregnancy identification, health education, and referral facilitation. Three control LGAs received standard facility-based care. Data were collected via household surveys and facility records at baseline and endline. Analysis included Difference-in-Differences (DiD) estimation to determine the net intervention effect. ResultsThe intervention group showed significant improvements compared to the control. Early pregnancy identification (<20 weeks) increased from 45% to 78% (DiD: +29 pp, p<0.001). Attendance of at least one ANC visit rose from 58% to 85% (DiD: +22 pp, p<0.001), reducing the coverage gap by 89%. Subgroup analysis revealed the largest gains among adolescents (DiD: +31 pp) and rural residents (DiD: +27 pp). HIV testing uptake increased from 52% to 90% (DiD: +34 pp, p<0.001). Linkage to care for HIV-positive women improved from 65% to 92% (p=0.002). ConclusionA CHW-led, community-based strategy is highly effective in improving early engagement with ANC and HIV services in resource-limited settings. The intervention demonstrated a strong equity-promoting effect. Integration and scale-up of this model within primary healthcare systems is recommended.

BackgroundScabies is one of the common infectious skin conditions globally, with a significantly high burden in hot and tropical countries, resource-poor settings, and areas with high population density. Rohingya refugee camps in Coxs Bazar are one of the most protracted refugee crises in the world, sheltering approximately 1,143,096 refugees in 33 overcrowded refugee camps. While most existing literature focuses on mass drug administration (MDA) interventions or community-level estimates, the economic burden of scabies on health system is rarely studied and documented. MethodsThis is a retrospective cost study, where we have used financial and epidemiological data from January 2021 to December 2024. Costing was done from the providers perspective, focused on what International Organization for Migration (IOM) spent during the period as a health service provider. Acombination of standard stepdown approach and micro-costing methods were used. Financial data for the study period 2021 to 2024 were collected from the IOM health programmes annual budget and consumption reports. The study population included all individuals who were clinically diagnosed with scabies and received care at 35 IOM-supported health facilities in Ukhiya and Teknaf, Bangladesh. ResultsThe overall estimated financial cost for IOMs scabies outbreak response through its health facilities was USD 2.12 million, with an annual average of USD 531,729. The average cost per scabies management ranged between USD 5.33 and USD 6.54, with the highest in 2021 and the lowest in 2022. Drug costs accounted for 11.92% of the overall cost over 4 years. Of the total cost of $253,629.43 over 4 years, 79% was attributed to permethrin topical cream, which was used to manage an estimated 85% of the total managed cases. Scenario analysis demonstrates that the existing permethrin-based treatment preference is the most expensive treatment modality, compared with ivermectin-based treatment and mixed-treatment approaches. ConclusionAlthough the average cost of treating scabies is relatively low, overall, the treatment cost for such a large population has a significant economic impact. This study found a substantial effect of mass drug administration on reducing the financial burden on the healthcare system.

IntroductionUrinary tract infections are common to pregnant and nonpregnant women estimated to 150 million new cases annually. The incidence increases with pregnancy due changes that take place. Causative microbes are E.coli, Klebsiella pneumoniae and Staphylococci species. The disease presents symptomatically or asymptomatically, early investigation, detection and treatment to pregnant mothers are crucial to avoid maternal and foetal complications. Several effective antimicrobials are contraindicated using ineffective agents jeopardizes treatment outcome leading to multidrug resistance. We assessed UTI causative microbes and susceptibility patterns to common antibiotics. MethodsWe conducted a hospital based cross sectional study at Kairuki hospital involving 262 pregnant mothers attending ante-natal clinics. Mid-stream urine was collected and inoculated on Cysteine-lactose-electrolyte-deficient agar, MacConkey and blood agar. Eleven microbes were isolated and tested for susceptibility against antibiotics using Kirby-Bauer disk diffusion technique on Mueller-Hinton agar. Data analysed using SPSS package version 23. ResultsThe prevalence of UTI in pregnant mothers was 31.2% (82/262). The gram positive isolates were more prevalent than gram nmoste (59.3% versus 40.7%) Staphylococcus aureus 22/82 (26.2%) and S. saprophyticus 15/82 (17.9%) were the mostly isolated. Nitrofurantoin, Piperacillin/tazobactam have lowest resistant rate to both gram negative and gram positive isolates ranging from (0-26%) while Erythromycin and Ampicillin have the highest resistant rate ranging from (60-100%) therefore associated with multidrug resistant. ConclusionAsymptomatic UTI is prevalent to pregnant women at this hospital. We recommend culture and sensitivity results to guide treatment and usage of nitrofurantoin, piperacillin/tazobactam as first line treatment of UTI in pregnancy.

IntroductionThe true mortality impact of the COVID-19 pandemic is difficult to estimate at the national level due to limitations in testing, surveillance, and accurate attribution of cause of death. Therefore, developed nations have used estimates of excess mortality during the pandemic as an objective indicator based on historic national death registration data. This could not be estimated in developing African nations, including Zambia, due to incomplete death registration data hence the true impact of the pandemic in these regions remains potentially underestimated. Since the pandemic primarily concentrated in large cities, this study utilises burial records from Lusaka, Ndola, and Kitwe urban districts in Zambia to estimate COVID-19-associated excess mortalities. MethodologyLinear and Negative Binomial Regression were applied on burial permits data, some dating back to 2011, to estimate monthly expected all-cause mortalities and corresponding excess mortalities during the 2020 - 2021 pandemic period. Pearsons correlation and multivariate linear regression were also used to corroborate excess mortalities with COVID-19 incidence and other meteorological parameters. ResultsKitwe and Ndola had substantial gaps in burial records while Lusaka had minimal gaps. On average, Kitwe recorded no excess mortalities while Lusaka and Ndola recorded significant excess mortalities with overall 3,484 (P-score 11.1%) and 378 (P-score 6.1%) excess deaths respectively. This translates to an estimated 3.5 for Lusaka and 1.5 for Ndola COVID-19 deaths undercount ratio. Excess mortality positively correlated with COVID-19 incidence (P < 0.05) suggesting that it was caused by the pandemic and negatively correlated with temperature after controlling for average relative humidity and average hours of sunshine (P < 0.05). Discussion and conclusionThe findings of this study show that the mortality impact of COVID-19 was underestimated in Zambia and this may apply to other African nations. It further shows that pandemic excess mortalities can be tracked in African urban centres that have complete burial records data.

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.

IntroductionNeglected Tropical Diseases (NTDs) comprises over 20 preventable infectious illness that disproportionately affecting low- and middle-income countries, including Ethiopia. Although national control initiatives have expanded since 2013, evidence on recent national and subnational burden trends remains limited. This study aimed to assess trends in mortality and disability-adjusted life years attributable to neglected tropical diseases in Ethiopia at national and subnational level from 1990 to 2023. MethodsWe used data from the Global Burden of Disease 2023 study to estimate age-standardized and age-specific mortality and Disability-Adjusted Life Years (DALYs) attributable to neglected tropical diseases. Results are presented as absolute numbers and age-standardized rates (per 100,000 population), disaggregated by disease, sex, region, and year from 1990 to 2023, with 95% uncertainty intervals. ResultIn 2023, the national age-standardized DALY rate for all NTDs was 708.3 where, schistosomiasis accounted the largest share (228.7; 95% UI: 145.4-375.0), followed by other NTDs (104.4; 95% UI: 59.7-171.4), trachoma (100.0; 95% UI: 67.4-144.9), and rabies (78.3; 95% UI: 9.5-257.9), together contributed to over three-quarters DALYs due to NTDs. The national age-standardized mortality rate was 5.98 mostly contributed by schistosomiasis (2.01; 95% UI: 1.72-2.38) and rabies (1.40; 95% UI: 0.18-4.58). Substantial regional variation was observed, with Addis Ababa recording the lowest (200.5 and 1.2) and Afar the highest (860.3 and 8.9) DALYs and mortality rate due to all NTDs respectively. Between 1990 and 2023, DALYs and mortality rate declined by 87.5% and 91.6%, respectively, although declines slowed after 2010. During 2010-2023, increases in DALYs and mortality due to schistosomiasis were observed in Addis Ababa (+25%) and Harari (+13%), while trachoma increased in Oromia (+9%). ConclusionNTDs continue to impose a substantial burden of disability and mortality in Ethiopia, with pronounced regional disparities and a slowing pace of progress in recent years. The observed stagnation or increases in specific NTDs at the subnational level highlight the need for sustained monitoring and targeted control strategies.

BackgroundClimate change is increasingly recognised as a threat to population health and healthcare systems, yet the effects of environmental variability on pharmaceutical prescribing remain poorly characterised in the UK. Using a wide array of open-source datasets, we examine the effect of environmental, geographic and socioeconomic factors on prescribing habits in England. MethodsWe linked monthly, practice-level prescribing data for England (2010-2025) to meteorological, air-quality, flooding and demographic datasets using spatial nearest-neighbour matching. Prescribing volumes for cardiovascular, respiratory and antibiotic medications were analysed using log-transformed outcomes in mixed-effects models with practice-level random effects, adjusting for region, seasonality, deprivation and temporal trends, using both continuous environmental measures and extreme-condition indicators. A complementary Bayesian hierarchical model jointly estimated the conditional effects of multiple correlated environmental exposures, with partial pooling across practices and support for distributed lag effects. ResultsIn mixed-effects analyses, temperature showed the most consistent associations with prescribing, with higher temperatures linked to increased respiratory and cardiovascular prescriptions and reduced antibiotic use, while rainfall, flooding and most pollutants had small or negligible effects. Environmental predictors exhibited strong correlations, motivating multivariate modelling. Bayesian multivariate models confirmed temperature as the dominant environmental driver after adjustment for correlated exposures, with substantially larger variation attributable to regional and socioeconomic factors than to environmental conditions. ConclusionsTemperature is the most consistent environmental determinant of GP prescribing in England, with higher temperatures associated with increased cardiovascular and respiratory prescribing and reduced antibiotic use. Rainfall, flooding and most air pollutants show little evidence of meaningful effects once seasonal and meteorological structure is accounted for. Environmental associations are modest in magnitude relative to persistent socioeconomic and regional drivers of prescribing, indicating that climate-related influences operate within broader structural determinants of healthcare utilisation. These results suggest that, at monthly timescales, prescribing demand is relatively stable to environmental variability, supporting a focus on long-term adaptation and surveillance rather than short-term demand shocks in climate-resilient healthcare planning.