Pan African Medical Journal

Background: Hepatitis E virus (HEV) is highly endemic in several African countries with high mortality rate among pregnant women. The prevalence of HEV in Niger among pregnant women is unknown. We hereby aim to report the prevalence and risk factors of HEV among pregnant women in Niamey, Niger. Methods: Blood samples were collected from pregnant women attending antenatal consultation in three selected Health centers in Niamey. Data were collected for socio demographic characteristics using a structured questionnaire. Samples were tested using ELISA and qRT-PCR for anti- HEV IgM and RNA detection respectively. HEV associated risk factors were determined using multivariate logistic regression models. Results: A total of 491 pregnant women were enrolled with mean age of 26.5 years. The prevalence of anti-HEV IgM antibodies was 17.1%, while HEV RNA was detected in 3.46% of participants, indicating recent and active HEV infection. Anti-HEV IgM seropositivity was more frequent among women aged 26-30 years and those in the third trimester of pregnancy. Gravidity was significantly associated with HEV RNA positivity (p = 0.032). In multivariable analysis, the use of well water was independently associated with HEV infection (aOR = 75.70; 95% CI: 1.23-4643.20; p = 0.039). Conclusion: In view of the high seroprevalence of HEV among pregnant women, preventive measures including hygiene sensitization should be prioritized. Further studies should be conducted to assess the real impact of HEV infection on maternal and fetal health.

ABSTRACT Background: Poliomyelitis remains a major public health concern where population immunity is incomplete and circulating vaccine-derived poliovirus (cVDPV) persists. Although Nigeria interrupted wild poliovirus (WPV) transmission in 2020, cVDPV cases continue to pose challenges, particularly in parts of northern Nigeria. Modern control strategies require a synergy of routine immunization, supplementary campaigns, disease surveillance, and community trust. Methods: This multicentre descriptive cross-sectional study evaluated community knowledge and attitudes towards polio immunization across 37 Local Government Areas (LGAs) in 20 states and the Federal Capital Territory (FCT). A multistage sampling strategy was utilized to select 1,850 adult respondents (50 per LGA) spanning rural, semi-urban, and urban settlements. Results: Overall, 40.4% (n = 747) of respondents demonstrated good knowledge, while 58.4% (n = 1,080) displayed positive attitudes towards polio immunization. A striking disparity was observed across residence classifications: respondents in urban/semi-urban LGAs exhibited significantly higher levels of good knowledge (51.7%, 569/1,100) compared to those in rural LGAs (23.7%, 178/750; {chi} = 144.00, df = 1, p < 0.001). Main sources of information were Questionnaire responses (53.6%) and community and Traditional leaders(17.2%). Conclusion & Recommendations: Substantial knowledge deficits persist in rural northern Nigerian communities despite generally favorable attitudes. Interventions must prioritize localized risk communication, involvement of traditional/religious leaders, strengthening routine primary healthcare integration, and targeting zero-dose children in hard-to-reach areas. Keywords: Poliomyelitis, Oral Polio Vaccine, Vaccine Hesitancy, Northern Nigeria, Community Health, Routine Immunization.

BackgroundIn Ethiopia as other Sub-Sharan African countries malaria in pregnancy is a major public health threat particularly in the rural communities. Immunosuppression during pregnancy increases the risk of placental malaria; this, in turn, leads to anemia, low birth weight, preterm delivery, and stillbirth, causing severe complications that pose a life-threatening risk to both the mother and fetus. Hence, this study is aimed to assess the prevalence of malaria, and associated factors among pregnant women attending antenatal clinics in Damot Gale district, South Ethiopia. MethodAn institutional-based cross sectional study was conducted from March 1 to May 30, 2024. A multistage sampling technique and pre-tested semi-structured questionnaires were used for data collection. Using standard parasitological methods, blood samples collected from 389 participants were analyzed through microscopic examination of Giemsa-stained thick and thin blood films. Logistic regression was used to assess factors associated with malaria. Adjusted odds ratio with 95% confidence interval was calculated and P-value < 0.05 was considered statistically significant. ResultsIn this study the prevalence of malaria among pregnant women was 10.5% (95% CI: 7.7-13.6%). Among the malaria-positive pregnant women (9%) were P. falciparum infected, followed by P. vivax (1.3) and mixed infections (0.2%). In the multivariate analysis, multigravdae (AOR = 0.358; 95% CI: 0.14-0.92), utilization of LLINs (AOR = 0.286; 95% CI: 0.119-0.687) and use of IRS (AOR = 0.068; 95% CI: 0.027-0.172) were significantly associated with malaria among pregnant women. ConclusionMalaria is still a public health problem among pregnant women in Damote-gale district. The present study indicated that adequate distribution and proper utilization of bed nets In addition seasonal proper spray of IRS might be helpful to prevent and control malaria.

Introduction Preventing tuberculosis (TB) through TB Preventive Treatment (TPT) is an essential component of TB control and elimination. In recent years, many countries including Bangladesh, have revised their national programs to extend TPT to household contacts of TB patients. However, coverage remains well below the target, and evidence remains limited on context-specific barriers and facilitators. This study aimed to explore the barriers and facilitators to TPT uptake among household contacts in Bangladesh. Methods This study followed an exploratory qualitative approach. The setting was Moulvibazar district, Bangladesh. Qualitative data were collected through key-informant interviews with health providers and in-depth interviews with household contacts, and participants were selected through purposive sampling. Thematic analysis was used to explore the factors influencing TPT uptake. Results Perceived lack of need for treatment among household contacts and side effects of TPT medicines emerged as major barriers. Stigma associated with TB and resource shortage at the health facility level further hampered uptake. Counseling on the importance of TPT and its possible side effects, along with public awareness campaigns, facilitated TPT uptake by addressing household contacts concerns. Perceived risk of TB, free TPT services, support from family members, and health providers positive attitudes also supported uptake. Conclusion Addressing household contacts concerns about the need for treatment and potential side effects, along with strengthening health facility capacity, is required for improving TPT uptake. Both individual counseling and mass awareness campaigns can help address these concerns and facilitate uptake. These strategies may help increase TPT coverage in Bangladesh and beyond, contributing to global TB elimination efforts.

Background/Aims: In medical practice, the rising prevalence of infections in kidney transplant recipients (KTRs) is a notable concern. However, understanding the incidence and risk factors associated with infections in KTRs remains limited. This study aims to assess the incidence and factors associated infection among KTRs. Additionally, we also investigate the median time of each infection among KTRs. Methods: A retrospective cohort study was conducted from 1 January 2018- 31 December 2022 at Thailand's tertiary hospital. We performed univariable and multivariable logistic regression analyses to identify potential risk factors related infection and investigated for the incidence and median time of each infection among KTRs. Results: A total of 179 participants were included in this study. Our findings reveal the kidney from living donor was protective factor for infection among KTRs (aOR 0.063, 95% CI 0.005-0.792; p = 0.032). Urinary tract infections (UTIs)showed as the predominant pathogenic manifestation among KTRs (43%). The median time of UTIs, cytomegalovirus (CMV) infection and pneumocystis pneumonia (PCP) were 16, 57 and 94.5 days, respectively. Conclusions: Our study establishes that receiving a kidney from a living donor is a protective factor against post-kidney transplant infections. Particularly urinary tract infections were most common of infection. Monitoring urinary tract infections post-transplantation is recommended. Moreover, awareness of UTI, CMV infection and PCP should be concerned during 2-3 months after transplantation. However, due to a small sample size; we recommend to increase the number of particular participants in further investigations.

Abstract Background: Cyprus has transitioned into a high-alert zone for mosquito-borne viruses. This necessitates a proactive assessment of its future physicians. Following the 2022 re-establishment of Aedes aegypti in Larnaca and Aedes albopictus in Limassol, Cyprus, the island is now biologically primed for local outbreaks of dengue, Zika, and chikungunya, alongside Culex-borne West Nile virus. The study assessed medical students' knowledge and risk perception. Methods: A cross-sectional online survey administered the validated MosquitoWise Health Belief Model instrument to undergraduate-entry and graduate-entry students at a university in Cyprus in mid-2026. Results: Of 1023 students, 119 responded (11.6%), with pre-clinical students overrepresented (p<0.001). Mean knowledge was 5.43/9, stronger on mosquito biology (72.5%) than virus knowledge (54.2%). Median severity was 6.00/7 against susceptibility 4.25/7. Knowledge differed by study stage (p<0.001), correlated with severity (rs = 0.399) but not susceptibility. Conclusions: The study establishes a critical baseline for pre-clinical medical students in Cyprus. Overall, participants performed better on mosquito biology when compared to mosquito-borne viruses and how they spread. Our findings highlight the value of integrating theoretical microbiology with clinical practice in medical education to enhance physicians' preparedness for the changing landscape of newly emerging infections in Cyprus and across Europe as a whole. Key Words: Arboviruses, Cross-Sectional Studies, Cyprus, Health Belief Model, Medical Students, Risk Perception.

Introduction Bubble Continuous Positive Airway Pressure (bCPAP) is an effective intervention for managing respiratory distress syndrome among preterm newborns. However, its successful utilization depends on healthcare providers possessing adequate knowledge and practical skills. In Tanzania, competency-based equipment user training has been introduced to strengthen providers' capacity to use neonatal technologies, including bCPAP. Despite these efforts, there is limited qualitative evidence on how this training influences healthcare providers' competence and routine clinical practice. This study explored the role of competency-based equipment user training in enhancing healthcare providers' skills in utilizing bCPAP devices for newborn care in Dar es Salaam, Tanzania. Methods A phenomenological qualitative study was conducted in three regional referral hospitals implementing the NEST360 programme. Purposive sampling was used to recruit doctors and nurses who had completed competency-based equipment user training. Data were collected through in-depth interviews using a semi-structured interview guide and analysed using Braun and Clarke's thematic analysis approach. Findings Six major themes emerged. Participants described competency-based training as a great approach for improving practical skills, confidence, and clinical decision-making regarding patient selection, device operation, monitoring, and weaning. Participants also reported improved equipment maintenance practices, reduced preventable equipment damage, and stronger collaboration with biomedical engineering professional . The training promoted positive changes in provider behaviour, including greater autonomy, internal mentorship of newly recruited staff, and increased accountability for equipment management. Participants further perceived improvements in neonatal care through earlier initiation of bCPAP, fewer unnecessary referrals, and better management of preterm newborns within their facilities. Conclusion Competency-based equipment user training strengthened healthcare providers' competence and confidence in utilizing bCPAP for newborn care while improving equipment management and interdisciplinary collaboration. Integrating competency-based training into routine newborn care programmes may enhance the effective implementation and sustainability of life-saving neonatal technologies in resource-limited settings.

Background: Stillbirths are a neglected problem in India, and the data we have are often unreliable. This study aimed to assess stillbirth record quality in an urban setting and understand the experiences, health impacts, and perceived causes from both families and health workers. Methods: A mixed-methods study was conducted in Vadodara Municipal Corporation during January to December 2023. All reported stillbirths (>=28 weeks or >=1000 g) were reviewed. Families were interviewed at home using a standardized questionnaire, with in-depth interviews conducted with 9 families and 17 health workers (doctors, ANMs, ASHAs). Quantitative data were analysed using Excel and Jamovi; qualitative data were analysed thematically. Results: Of 61 stillbirths reported by VMC, quality audits revealed 7 errors (duplicates/misclassifications) and 2 data entry errors, yielding a true stillbirth rate of 1.7 per 1000 total births. The eastern zone recorded the most cases (21), while the southern zone had the highest rate (4.1 per 1000). Most deliveries occurred in government hospitals (64%). Common reported causes were intrauterine foetal death on routine ultrasound (26%) and premature delivery (19%). Families reported delayed care access, undertrained staff, poor facilities, and challenges accessing government scheme benefits. Health workers identified preventable factors (hypertension, diabetes, anaemia, meconium aspiration, growth restriction, birth defects) and non-preventable factors (extreme prematurity, multiple pregnancy). Interpretation & conclusions: Stillbirth data in Vadodara have serious quality problems which can be fixed. Many stillbirths could be avoided with better pregnancy monitoring, better communication, stronger referral systems and more awareness in the community.

Introduction:Although the COVID-19 pandemic clearly showed the potential consequences of a world without vaccinations, vaccine hesitancy is likely to be more pronounced in the post-COVID-19 era. The introduction of human papillomavirus (HPV) vaccines in this context is likely to raise particular concerns. In Tunisia, decision-makers have prioritized the introduction of HPV vaccine into the immunization schedule. This study assessed individual barriers and facilitators to HPV vaccine acceptability in Tunisia, with the aim of guiding an effective communication strategy for HPV vaccination campaigns in Tunisia and neighboring countries in a post-pandemic context.Methods: Using a qualitative design, we conducted 14 focus groups (FG) with healthcare professionals (HCP) (N=32) and community representatives (CR) (N=89) in five regions of the country. The discussion followed a semi-structured guide designed on the basis of vaccine hesitancy determinants matrix. Transcripts were deductively analyzed according to the 'social processes' and 'thinking and feeling' of the behavioural and social drivers (BeSD) Framework. Inductive approach was used to analyze participants suggestions for promoting HPV vaccination.Results:The FG analysis demonstrated that the historically strong trust in vaccination in Tunisia has weakened after the COVID-19 pandemic. Mistrust of health system and experts, the pandemic management and vaccine mandates measures had negative influence on the vaccine attitudes in a post pandemic Tunisian context. Persistent concerns about COVID-19 vaccines safety were frequently intertwined with widespread distrust of pharmaceutical companies and their profit motives, perceived as imposing inequitable access and lower-quality vaccines on countries in the Global South. These concerns fueled confusion about vaccines side effects. The weakening of immunity was recurring, as well as memory issues, impacts on fertility, and sudden deaths. Regarding information, our research revealed that although digital platforms were perceived as widely used, a significant part of the population interviewed considered public TV channel, as the most reliable source of health information.Conclusions: Emphasizing how the pandemic has shaped individual and collective perceptions and attitudes toward vaccination, our findings underline the importance of leveraging lessons learned from the pandemic to develop a context tailored and coherent communication strategy for successful HPV vaccine implementation.

Background: Chronic pharmaceutical stock outs hinder Universal Health Coverage in Ethiopia. To address this, the Ministry of Health introduced the electronic Logistics Management Information System for inventory visibility and Auditable Pharmaceutical Transactions and Services for financial management. However, no national study has tested their combined impact. This study evaluated the individual and synergistic effects of electronic Logistics Management Information System and Auditable Pharmaceutical Transactions and Services on essential commodity availability across Ethiopian public healthcare facilities. Methods; We conducted a secondary analysis of the 2024/2025 Ethiopian Service Provision Assessment dataset utilizing 1245 public facilities nested within 125 clusters. The primary outcome was optimal essential commodity availability (zero stock outs and 100% tracer commodity presence). A two-level mixed-effects logistic regression model with an interaction term evaluated synergy, reporting Adjusted Odds Ratios with 95% Confidence Intervals. Results; Overall optimal availability was 54.2% (95% CI; 51.4%-57.0%). Implementation rates were 41.2% for eLMIS, 38.2% for APTS and 26.5% for dual implementation. Facilities using eLMIS alone (AOR = 2.15; 95% CI: 1.52-3.04) and APTS alone (AOR = 1.82; 95% CI; 1.28-2.58) showed higher security. Dual implementation showed a profound synergistic effect (AOR = 4.32; 95% CI; 3.25-5.74, p < 0.001). Positive predictors included functional cold chains (AOR = 2.08), qualified staffing (AOR = 1.68), hub proximity (AOR = 1.58) and urban settings (AOR = 1.95). The model explained 66.2% of regional variance. Conclusion; Dual implementation of electronic Logistics Management Information System and Auditable Pharmaceutical Transactions and Services creates a powerful synergistic impact on pharmaceutical availability. Synchronized national scale-up and cold chain investments are urgently needed to achieve supply chain resilience and Universal Health Coverage in Ethiopia.

Globally, Hepatitis C Virus (HCV) infection is a leading cause of chronic liver disease and remains a significant public health threat in Ghana. However, there is a paucity of data on the prevalence and awareness of HCV among market sellers and informal workers in Ghana. This study sought to determine the prevalence and awareness of HCV among this population. This was a cross-sectional study conducted among 397 sellers and workers at Kejetia market from December 2024 to January 2025. HCV was diagnosed using the One Test Hepatitis C Virus Test Strip (Qingdao Hightop) for the qualitative detection of HCV antibodies. Data were analysed using SPSS version 26 and GraphPad Prism version 8.0. A p < 0.05 was considered statistically significant for awareness of HCV. The prevalence of HCV in this study was 4 (1.0%). Awareness of HCV was low at 112 (28.2%). Residence (p=0.021) and age group (p=0.040) were significantly associated with HCV awareness. Age 41-50 years was almost three times more likely to be aware of Hepatitis C infection compared to [&le;] 30 years. Although the prevalence of HCV was low, awareness of the infection was also limited; this highlights the need for public health authorities to implement targeted HCV education programs in major markets to effectively reach informal sector workers who are often overlooked by conventional campaigns.

Abstract Background: Birth preparedness and complication readiness (BPCR) knowledge is important for recognizing maternal and newborn danger signs and preparing for timely care. However, conventional translation of BPCR educational materials may not adequately address local linguistic and cultural contexts. This study evaluated whether a culturally adapted Swahili BPCR training manual improved knowledge more than a standard translated Swahili BPCR training manual among Hehe pregnant women in rural Iringa, Tanzania. Methods: A controlled pretest-posttest quasi-experimental study was conducted among 176 pregnant women attending antenatal care in Mufindi and Kilolo districts. Eighty-eight women received the Culturally Adapted Swahili BPCR Training Manual and 88 received the Standard Translated Swahili BPCR Training Manual. Both groups received comparable BPCR education with standardized session duration, delivery format, language, and follow-up procedures. BPCR knowledge was assessed using a 64-item questionnaire at baseline and four weeks after the intervention. The primary analysis used Difference-in-Differences regression to compare changes in knowledge between groups. Multiple linear regression was used to assess the association between intervention-group assignment and post-intervention knowledge after adjustment for baseline knowledge and participant characteristics. Results: All 176 participants completed both assessments. Mean knowledge scores increased from 21.01 (SD 7.42) to 38.49 (SD 7.54) in the culturally adapted group and from 22.51 (SD 5.80) to 32.81 (SD 5.55) in the standard translated group. The culturally adapted group demonstrated a 7.18-point greater increase in knowledge than the standard translated group ({beta} = 7.18, 95% CI: 4.40-9.97; p < 0.001). After adjustment for baseline knowledge, age, education, gravidity, marital status, living arrangement, reading ability, and occupation, intervention-group assignment remained significantly associated with higher post-intervention knowledge ({beta} = 5.88, 95% CI: 3.84-7.92; p < 0.001). Conclusion: Culturally adapted BPCR education was associated with greater short-term improvement in knowledge than standard translated education among Hehe pregnant women. Integrating culturally and linguistically appropriate terminology, contextual explanations, and locally meaningful communication into BPCR education may strengthen knowledge outcomes. Multisite studies with stronger allocation procedures and longer follow-up are needed to confirm these findings.

Background Drug-resistant tuberculosis (DR-TB) remains a major problem in Indonesia, with a significant low treatment initiation rate. This study identifies factors influencing treatment initiation and assess the impact of delay on patient outcomes. Methods We conducted a mixed-methods study using a parallel convergent design. The quantitative component analyzed the Tuberculosis Information System (TBIS) data from three hospitals in Jakarta and Bogor from January 2022 to December 2023. The qualitative component involved in-depth interviews and Focus Group Discussions (FGD) with DR-TB patients, healthcare workers, patient supporters, and program managers. Results Among 1,665 people with DR-TB included in this study, we found a pre-treatment attrition rate of 6.4%. We identified two factors of pre-treatment attrition: prior TB treatment (aOR=1.7, 95%CI 1.082-2.671) and distance to hospital (aOR=1.9, 95%CI: 1.136-3.180). Conversely, referred patients, treatment in suburban areas, and people with rifampicin-resistant (RR)-TB were 85%, 82%, and 63% less likely to experience attrition, respectively. Qualitative findings identify patient, social, and health system barriers to the treatment initiation, and alternative remedies emerged as a coping mechanism. Conclusion Strengthening referral systems, decentralizing care, and addressing socio-economic barriers are critical for ensuring timely DR-TB treatment initiation.

Background: Cervical cancer (CC), mostly associated with high-risk human papillomaviruses (hrHPV) infection, is the most common cancer that disproportionately affects women in developing countries, including Ethiopia. Early detection of CC and initiation of treatment are key to positive health outcomes. Identifying factors associated with delayed CC diagnosis is essential for effective prevention and control efforts. This study assessed the stage at diagnosis and examined associated clinical and sociodemographic factors. Methods: An institution-based cross-sectional study was conducted among 284 women newly diagnosed with CC who attended Tibebe Ghion Specialized Hospital (TGSH) between 1st January 2021 and 31st December 2022. A structured questionnaire was used to collect data on the participants' demographic, reproductive, and gynaecologic history, and clinical profiles. The CC stage at diagnosis was categorised as early (stage I-IIA) or late (stage IIB-IV). Logistic regression models (unadjusted and adjusted) were used to examine associations of sociodemographic or clinical factors with stage at CC diagnosis. Results: The mean age ({+/-}standard deviation) at presentation was 53.2 {+/-} 11.3 years, with an age range of 18 - 80 years. Most of the patients (73.6%) were from rural areas, and three-fifths (58.1%) had no medical insurance. Among participants, 74.6% (95% CI: 69.4, 79.6%) had late-stage CC. The odds of late-stage CC diagnosis were higher for women from rural areas (AOR: 2.21; 95% CI:1.18, 4.12; p<0.013), and those with anaemia (defined as <12 mg/dl haemoglobin) (AOR: 3.42; 95% CI: 1.88, 6.23; p<0.001). On the other hand, the odds of late-stage CC diagnosis were lower in HIV positive women (AOR:0.41; 95%CI:0.19, 0.88; p<0.021). Conclusion: The proportion of late-stage diagnosis among CC patients was high. Residential area, anaemia status, and HIV serostatus were factors associated with stage at CC diagnosis. These findings can inform screening efforts of CC and call for expanding of the screening services to the rural setting in order to reduce the burden of late-stage CC diagnosis.

Abstract Background: The risk of developmental delays among infants in the refugee camps is high due to prolonged exposure to adverse situations such as poverty, violence, lack of access to basic necessities, safety, poor maternal mental health and inadequate access to healthcare. To reduce the risk of developmental delays, a contextualized early child development and maternal mental health care package, was implemented through enabling and engaging the refugee women as community-based care providers. Methods: The process evaluation study was conducted using a mix-method design to explore the acceptability, feasibility, appropriateness, adoption, and cost of the Early Child Development (ECD) and maternal mental health care package in refugee camps, by applying Proctor et al framework. Data on quantitative indicators was reviewed for 348 mother-child dyads in the intervention arm. Qualitative interviews were conducted with 12 mothers, 5 community health workers, and 2 members of the implementing research team. Incremental Cost-Effectiveness Ratio (ICER) was calculated using the healthcare provider perspective to estimate the incremental cost-effectiveness of the ECD care package in reducing proportion of children with two or more developmental delays. Results: Home-based delivery of counselling sessions was a key facilitator in ensuring the successful implementation of intervention. The delivery of intervention by modestly educated refugee women reduced cultural and language barriers and facilitated the home-based delivery of sessions. Mothers found the recommended activities feasible to do in routine as they were culturally appropriate, and did not require maternal literacy or additional resources. The intervention was cost-effective with an ICER of 63 USD in reducing the proportion of children with two or more developmental delays by one percentage point. Conclusion: Contextualized ECD and maternal health care package is a potentially replicable and scalable intervention for refugee healthcare systems.

Background Despite substantial improvements in maternal and child health over the past two decades, preventable maternal and neonatal morbidity and mortality remain major public health concerns in rural Bangladesh. Community-based interventions involving Community Volunteers (CVs), Community Groups (CGs), and Community Support Groups (CSGs) have been introduced to strengthen maternal and child health (MCH) services through health promotion, community engagement, and improved linkage with primary healthcare facilities. This study explored the roles, challenges, and opportunities of these community-based platforms in improving maternal and child health services. Methods A qualitative study was conducted in Kalaroa Upazila of Satkhira District, Bangladesh, between July and October 2020. Data were collected through focus group discussions and in-depth interviews with mothers, Community Volunteers, Community Group members, and Community Support Group members. Participants were purposively selected to capture diverse experiences from intervention and comparison areas. Interviews were conducted using semi-structured guides, audio-recorded with informed consent, transcribed verbatim, translated into English, and analyzed thematically using an inductive approach. Results Participants from intervention areas demonstrated greater knowledge of birth preparedness, antenatal care, pregnancy danger signs, institutional delivery, postnatal care, and newborn care than those from comparison areas. Community Volunteers, CGs, and CSGs played important roles in identifying pregnant women, conducting household counselling, promoting skilled maternal healthcare, facilitating referrals, and strengthening community participation. Participants perceived that these activities increased maternal awareness, improved health-seeking behaviour, and enhanced utilization of maternal and newborn health services. However, persistent barriers, including socio-cultural beliefs, financial constraints, transportation difficulties, shortages of skilled healthcare providers, and inadequate logistical support for community volunteers, continued to limit equitable access to quality services. Participants recommended strengthening community awareness programmes, improving community clinic readiness, enhancing referral systems, and providing regular training and supportive supervision for community-based health workers. Conclusions Community-based maternal health interventions involving Community Volunteers, Community Groups, and Community Support Groups contribute to improved maternal knowledge, health-seeking behaviour, and utilization of essential maternal and newborn health services in rural Bangladesh. Sustaining these gains will require stronger primary healthcare services, continued community engagement, and targeted strategies to address persistent health system and socio-cultural barriers. These findings provide important evidence for strengthening community-based maternal and child health programmes in Bangladesh and similar resource-constrained settings.

Bangladeshi immigrants are a rapidly growing U.S. immigrant population, yet little is known about how pre-migration healthcare experiences shape healthcare use after migration. This qualitative study explored how healthcare norms from Bangladesh influence the health-seeking behaviors of Bangladeshi immigrants in the U.S., the barriers and facilitators they encounter, and their perceptions of care quality. Semi-structured interviews were conducted with 29 Bangladeshi-born adults living in the U.S. from September 2020 to January 2021 and analyzed using the constant comparative method. Participants described healthcare expectations shaped by the healthcare system of Bangladesh, which is mostly out-of-pocket and resource-limited, including symptom-driven rather than preventive care, self-treatment, and family-based caregiving. In the U.S., they faced barriers such as insurance confusion, long waits, difficulty establishing care, coverage disruptions, financial concerns, and language challenges. While participants valued culturally and linguistically concordant care, preferences for Bangla-speaking or co-ethnic providers varied, especially when perceived quality was low. Community networks, online information, self-education, and self-advocacy helped facilitate care. Provider communication strongly shaped perceptions of U.S. healthcare: feeling heard, respected, and well-informed promoted trust, while dismissal or delayed diagnosis led to skepticism and avoidance. These findings suggest that healthcare engagement of Bangldeshi immigrants is shaped by both structural barriers and pre-migration norms. Improving access will require attention to subgroup-specific histories, insurance navigation, language access, and the relational quality of care.

Healthcare workers are occupationally exposed to blood and body fluids and require effective protection against hepatitis B virus infection. Evidence on hepatitis B surface antibody (anti-HBs) seroprotection among healthcare workers in Namibia remains limited. We estimated the prevalence of anti-HBs seroprotection and examined associated factors among healthcare workers tested at Eastgate Clinic in Windhoek, Namibia. We conducted a cross-sectional analysis of routinely collected anti-HBs test records from 1 January to 31 December 2025. The first chronological test per individual was included. Anti-HBs concentrations [&ge;]10 mIU/mL were classified as seroprotective. Results outside the assay reporting range were treated as censored but remained classifiable for the binary outcome. Prevalence estimates were reported with Wilson 95% confidence intervals (CIs). Modified Poisson regression with robust standard errors was used to estimate adjusted prevalence ratios (aPRs). The register contained 304 test records representing 299 unique individuals. After excluding three individuals with missing anti-HBs results, 296 were analysed; 163 (55.1%) were female. Overall, 148 individuals were seroprotected, corresponding to a prevalence of 50.0% (95% CI 44.3-55.7%). Seroprotection was lowest among participants aged 18-29 years (35.3%) and highest among those aged 50-59 years (71.1%). Each 10-year increase in age was associated with a higher prevalence of seroprotection after adjustment for sex (aPR 1.14, 95% CI 1.06-1.24; p=0.001), whereas sex was not independently associated with seroprotection (aPR 0.97, 95% CI 0.78-1.22; p=0.797). The age association remained consistent across sensitivity analyses. Half of the healthcare workers tested had anti-HBs concentrations below the operational seroprotection threshold. These findings support systematic vaccination verification, appropriately timed post-vaccination testing, and documented follow-up of non-protective results. The absence of vaccination history, occupational characteristics, testing indications, and additional hepatitis B serological markers limited causal and clinical interpretation.

Introduction: Tuberculosis (TB) care is typically organised around biomedical and public health priorities, including diagnosis, infection control, treatment adherence, and prevention of transmission. Although qualitative research has described the burden of TB, lived experience is often treated as descriptive rather than as knowledge that can inform care. We examined how Aboriginal people in remote northern Australia experienced TB, and what these experiences reveal about how TB care can be strengthened in practice. Methods: We conducted an inductive qualitative study involving in-depth interviews with Aboriginal people with lived experience of TB. Interviews were supported by Aboriginal community health workers. Data were analysed using reflexive thematic analysis, with Aboriginal contributors involved in interpretive workshops to refine themes and guide culturally safe representation. Results: Twenty-one Aboriginal people contributed across 13 interviews. Three interrelated themes described the TB journey. Illness often challenged dominant biomedical expectations: symptoms were commonly normalised, which fear, ambivalence, and endurance were shaped by experiences of compromised health and cumulative loss. Distance from family, community, and Country was experienced as both protection and sacrifice; separation was endured to protect others but carried substantial costs, particularly when its purpose and duration were unclear. Recovery involved rebuilding strength, connection, and identity. Clear explanation, continuity, and opportunities for choice supported engagement in care, while survivors and community health workers provided important sources of trust, support, and shared responsibility. Conclusion: Lived experience is practice-relevant knowledge for TB programmes. Care should minimise avoidable harms of separation, support continuity and choice, and recognise survivors, Aboriginal health workers, and communities as partners in the design and delivery of care.

Abstract Background: The qualitative study was conducted to understand the socio-cultural factors (challenges and enabling factors) those influence the decisions and ability of the pregnant women and their families to make better use of the available safe birthing and EmONC services in two districts (Khanewal and Jhang) of Punjab, Pakistan. Objectives: To explore the key social, personal and professional considerations (factors) that influence the women (and family) decision and ability to utilise various birthing and EMONC services and to understand care providers interest and ability to offer these safe birthing services in the districts of Jhang and Khanewal in Pakistan. Study Design: The qualitative study was conducted, during the year 2013/14, on three rural health centers and two district headquarter hospitals in Kanewal and Jhang districts in Punjab. Through purposive sampling, 42 registered clients were interviewed to explain the different birthing experience along with 15 service providers, 2 district level programme managers and 2 transport vendors. The collected qualitative data from interviews were transcribed, and key emerging concepts/ themes were identified. A range and continuum of coded responses/ comments were compiled and discussed under each theme. Results: Main themes were structured birth planning; antenatal at health centres; skilled birth attendance; emergency obstetric and neonatal care (EmONC); and EmONC travel. The study found that pregnant women consult their husbands and mother in laws for taking birthing decisions; consult the skilled birth attendant for management of complication; private clinics are preferred for various social and logistic reasons; many private clinics doing caesarean are not adequately equipped; male reluctance (for cultural reasons) to make in-advance transport arrangement for possible EmONC; travel voucher utilisation remained low because of limited coverage and less-friendly procedures. Conclusion: Safe birthing decisions could be complex; and influenced by multiple social, cultural, economic, service access and quality considerations. Safe birthing practices can be improved if interventions remain sensitive to these preferences and realities. Keywords: Skilled birth attendance, social determinants, lady health workers, birth planning