Pan African Medical Journal

Background: Abortion is safe when carried out using a method recommended by the World Health Organization (WHO), appropriate to the pregnancy duration, and by someone with the necessary skills. lobally, around 73 million induced abortions take place each year. Around 95% of maternal deaths occur in developing countries due to childbirth and pregnancy-related complications. Methodology: A descriptive cross-sectional study was used for the study among the married reproductive (20-45 years) age women using a non-probability purposive sampling technique. A self-developed semi-structured questionnaire was used via face-to-face interview for data collection. The collected data were analyzed using SPSS 16.0 version descriptive and inferential statistics were used to find the association between variables. Results: The findings of the study show that among 118 respondents, nearly two-thirds (57.6%) of the respondents had adequate knowledge and less than half (42.4%) of the respondents had inadequate knowledge regarding safe abortion. The study further shows that there was a significant association between the level of knowledge regarding safe abortion and education status and education level with p-value <0.05. Conclusion: The study concludes that nearly two third of the respondents have adequate knowledge regarding safe abortion. Educational status significantly influenced their level of knowledge. Thus, we could provide correct knowledge, education, and enhance awareness to married women in the reproductive age group.

Introduction: Professionalism is a conceptualization of obligations, attributes, interactions, attitudes, and role behaviors required for professionals with individual clients and to the society as a whole. Despite there is a known effect of low professionalism of nurses on health care delivery system, the study determining professionalism and affecting factors in Ethiopia is limited in to a few numbers. Therefore this study was aimed to assess perceived level of professionalism and associated factors among nurses working in Hadiya Zone public hospitals, south Ethiopia. Methods: An institution based concurrent mixed cross sectional study was conducted from May 09 to June 09/2022. A total of 376 nurses were selected by using Computer generated Simple random sampling techniques for quantitative study whereas Purposive sampling technique was used to select qualitative study participants. Epi data version 4.6 was used to enter the data whereas Statistical package for social science version 25 was used for the analysis of quantitative data. Ordinal logistic regression model was used to identify effects of independents on outcome variable. Results: A total of 360 nurses participated in the study with a response rate of 95.7%. The overall low perceived professionalism among nurses working in Hadiya zone found to be 40.3%. Variables such as Educational status (AOR= 0.045 (0.021, 0.096), Sense of accomplishment (AOR= 3.21(1.85, 5.55), and participating in professional associations (AOR= 5.302(2.82, 9.96) were significantly associated with professionalism. Qualitative study finding showed Salary, training, upgrading education; undermining nursing profession, inadequate facilities were the raised influencing factors of professionalism. Conclusion: This study revealed that professionalism among nurses was low and the associated factors were; level of education, taking training, participating in professional organizations, and sense of accomplishment. Ethiopian nursing association and Ministry of Health should focus on developing nurses professionalism.

ABSTRACT Background: Rapidly urbanising complex ecosystems present several challenges to the organisation, availability, and accessibility of healthcare services. This study describes the availability and distribution of health facilities offering services, with a focus on maternal and newborn health services in the seven health districts of Grand Conakry, Methods: This study using primary data from a census of health facilities (June 2025). Finally, healthcare landscape was drawn up using the GPS coordinates collected, based on the boundaries of the seven including health districts. The census started with an existing list of 459 facilities and snowball sampling was used to identify facilities that were not initially on the list. We collected information on basic facility characteristics and GPS coordinates. Results: A total of 795 health facilities exist in Grand Conakry, with 564 facilities which were not on the initial lists, 104 were either closed, out of service, or refused to participate. The questionnaire was completed by 691 health facilities. The private sector dominated the landscape and was mainly concentrated in the Ratoma and Matoto health districts; with most facilities (63%) not reporting to the national health information system, in contrast to those in public sector (85.7%). 332/691 facilities reported providing childbirth care, and 132 of them (40%) offered caesarean section, while 87 (26%) offered blood transfusions. Conclusion: Despite the high number of facilities, geographic imbalances in distribution exist. Equitable access to healthcare in rapidly urbanising Grand Conakry requires strengthening urban health planning and public-private collaboration regarding ongoing rapid urbanisation in Grand Conakry.

Background: Seasonal influenza, commonly known as flu, is an acute respiratory, highly contagious illness caused by influenza viruses. A clear understanding of influenza seasonality is crucial for guiding prevention and treatment strategies, including decisions on vaccination timing to prevent outbreaks. While well documented in temperate regions, data on influenza epidemiology in tropical areas, particularly sub-Saharan Africa, remain limited. We described the types, subtypes and positivity rate of seasonal influenza in Uganda during 2019-2023. Methods: We abstracted data from the National Influenza database on positive seasonal influenza cases confirmed by Polymerase Chain Reaction. The cases were disaggregated by age group, sex, region, month and year of reporting. Using Microsoft excel, we calculated the influenza positivity rate and disaggregated it by strain, sex, age, region and time. Test positivity rate was computed as the number of positive cases as a percentage of the total samples tested. Results: Among 17,957 individuals tested, the overall positivity rate for seasonal influenza was 5% (936 cases). Positivity was higher among males compared to females (7% vs. 4%), with children aged 5-9 years having the highest positivity rate (16%), while individuals aged 50-54 years had the lowest (1%). The median positivity rate was 4%, with a range of 1-16%. Regionally, the central region reported a positivity rate of 5%, with rates across all regions ranging from 5% to 8%. Over time, there was a gradual decline in positivity rates, decreasing from 16.5% in 2019 to 5.3% in 2023. Seasonal influenza exhibited bimodal peaks, with the primary peak occurring between March and May and a secondary peak from October to December. Influenza A was the predominant strain, accounting for 70% of seasonal influenza cases (669/936). Among the Influenza A subtypes, H3N2 was most common, representing 63% of cases (425/669). Conclusions: The declining seasonal influenza positivity rates from 2019 to 2023 and the predominance of Influenza A and H3N2 highlight the need for sustained surveillance in Uganda. Given Influenza A's high genetic variability and potential for novel strain emergence, monitoring circulating strains, informing vaccine development, and implementing targeted interventions for high-risk groups and regions are critical to controlling and preventing outbreaks.

Background: Tuberculosis (TB) remains a critical public health challenge in Pakistan. The SPOT-TB trial evaluated MATCH-AI; an AI tool designed to geographically target active case finding (ACF) by identifying sites for screening TB. Qualitative study was conducted to examine field team and stakeholder experiences to understand the human, organizational, and contextual factors effecting implementation. Methods: Five sub-recipients (SRs) were randomly selected; two districts per SR based on certain selection criteria. Thematic analysis was conducted on thirty In-Depth Interviews (IDIs) and two Focus Group Discussions (FGDs), guided by the Socio-Technical Systems (STS) framework. Findings: Themes included (1) MATCH-AI as a useful tool, (2) operational and contextual challenges, (3) challenges of the staff, (4) organizational readiness, and (5) stakeholder engagement across hierarchy. The staff valued MATCH-AI for reducing bias and external pressure, and it identified TB cases in previously overlooked areas. Local knowledge of staff was crucial as the AI didnot account for operational barriers and contextual issues in certain areas. Weak infrastructure, and inconsistent stakeholder engagement, the system lacked the readiness needed for a new technology to make optimal impact. Understanding of how MATCH-AI functioned varied across hierarchical levels diminishing the sense of ownership among field staff. Interpretation: MATCH-AI holds genuine potential to systematize TB screening and reduce selection bias. Yet it cannot replace the contextual intelligence of field staff like knowledge of community trust, gender norms, and security realities. Effective implementation demands reliable infrastructure, meaningful stakeholder engagement, and field staff orientation. AI integration succeeds only when technical solutions align with human and organizational readiness.

Background: The Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS) remain a major public health concern in Ghana. Despite sustained progress in treatment and prevention, regional prevalence variations persist, driven by healthcare access, urbanization, and socio-economic factors. This study identifies trends and hotspots to guide effective HIV surveillance and control strategies in Ghana. Methods: A retrospective ecological study was conducted using secondary HIV data confirmed by laboratory testing, from the Ghana District Health Information Management System (DHIMS2) for the period 2020 to 2024. HIV prevalence was calculated as the number of confirmed cases per 100,000 population, using denominators from the Ghana Statistical Service 2021 Population and Housing Census. Spatiotemporal variation in prevalence was visualized using choropleth maps. Global Morans Index examined whether overall spatial dependency existed, followed by local indicators of spatial association (LISA), comprising local Morans I and the Getis-Ord Gi* statistic, to identify local clusters, outliers, and hotspots or coldspots. Results: National HIV prevalence per 100,000 population rose from 0.68 in 2020 to 0.84 in 2024. The highest burden was in the southern and middle belt regions: Western North (2.16), Bono East (1.71), Eastern (1.30), Volta (1.06), and Ahafo (1.01). Northern regions remained consistently low throughout the study period, with Northern (0.32), Upper East (0.26), and Savannah (0.30) recording averages below 0.50 per 100,000. Global Morans Index indicated a dispersed pattern in 2020 (I = -0.43), spatially random pattern between 2021 and 2023, and weak positive spatial association in 2024 (I = 0.22). Conclusions: Regional disparity in HIV prevalence in Ghana is widening, with greater burden concentrated in the more urbanized southern regions. Interventions guided by surveillance data and tailored to specific regions, including strengthened testing infrastructure and a more equitable distribution of health resources, are needed to curb transmission and support HIV in Ghana and the AIDS control programme. Keywords: HIV, AIDS, spatiotemporal analysis, Morans I, Getis-Ord Gi*, Ghana

Introduction: Clinical students are a future health workforce, yet their roles during outbreaks of highly infectious diseases remain uncertain because of safety, training, supervision and welfare concerns. Ugandas 2022 outbreak of Ebola disease caused by Sudan ebolavirus highlighted the need to understand how clinical students perceive outbreak-related care. Aim: This study explored willingness to care for patients with Ebola virus disease among clinical students at a Ugandan medical school and examined how perceived risks, perceived benefits and support needs shaped that willingness. Methods: An exploratory descriptive qualitative study was conducted among clinical students of Makerere University in Kampala, Uganda. Fifteen undergraduate medical and nursing students in the later years of training were purposively selected. Data were collected through in-depth interviews, audio-recorded with consent, transcribed verbatim, de-identified and analysed using latent content analysis. The Health Belief Model sensitised interpretation, and reporting was strengthened using the COREQ guidance. Results: Five interrelated themes emerged, showing that willingness to care was conditional rather than simply present or absent. Students described an initial willingness grounded in professional duty, devotion to patients and the desire to save life. This willingness was restrained by perceived risks of contracting Ebola virus disease, dying, transmitting infection to family members or colleagues, emotional distress, lack of epidemic-readiness in the curriculum, inadequate preparedness and weak welfare support. Perceived benefits, including patient survival, professional learning, outbreak experience and personal fulfilment, strengthened willingness but did not override safety concerns. Students identified reliable personal protective equipment, epidemic-ready curricula, practical infection-prevention and control training, simulation, clear protocols, close supervision, psychosocial support, insurance and fair compensation as cues to action that could convert willingness into safe participation. Conclusions: Clinical students in this Ugandan teaching hospital expressed a strong sense of professional responsibility, but their willingness to participate in Ebola care was conditional upon preparedness, protection, epidemic-ready education and institutional trust. Professional duty and learning opportunities promoted participation, whereas perceived risks and inadequate support limited it. Medical education programmes and outbreak-response systems should develop ethical, supervised, competency-based student roles supported by practical curricula, reliable protective equipment and psychosocial and welfare safeguards.

Background: Academic achievement is crucial for university students, but various factors affect their performance. This study explores the impact of anxiety, sleep quality, social media use, and socioeconomic status on academic performance (CGPA) among public university students in Bangladesh. Data and Methods: Data were collected from 225 students using a structured questionnaire that assessed anxiety (GAD-7), sleep quality (PSQI), social media use (SMUQ), and socioeconomic status (income, parental education). Structural Equation Modeling (SEM) was used to analyze the relationships between these variables. Outcomes: The results showed that socioeconomic status had a strong positive effect on academic performance ({beta} = 0.745, p < 0.001), while anxiety negatively impacted academic outcomes ({beta} = -0.675, p < 0.001). Sleep quality was positively related to academic performance ({beta} = 0.113, p < 0.05), but with a weaker effect. Social media usage is found to have a negative significant effect on academic performance ({beta} = -0.137, p < 0.001). Conclusion: These findings highlight the importance of controlling social media usage and anxiety to enhance academic performance among adult students. Sleep quality and socioeconomic background of the students are also found to be meaningfully associated with their educational progress.

Background: South Africa adopted evidence-based antenatal care (ANC) frameworks to improve maternal health outcomes. However, the maternal mortality ratio remains above Sustainable Development Goal target 3.1 and routine data indicate declining ANC first-visit coverage. Aim: This study sought to explore implementation gaps, barriers and facilitators in the delivery and uptake of ANC. Setting: Ugu and uMzinyathi districts in KwaZulu-Natal, and Capricorn and Waterberg districts in Limpopo, South Africa. Methods: A qualitative descriptive design was utilised. Semi-structured interviews were conducted with 70 purposively sampled participants, comprising 30 health system providers and 40 service users. Data were analysed thematically using NVivo. Results: Health system providers attributed declining ANC coverage to fertility decline rather than reduced access alone. Providers identified mentorship, community outreach and enhanced screening as key strengths. Implementation was constrained by staffing and equipment shortages. While service users recognised the benefits of ANC, they reported that long waiting times, negative provider attitudes and limited privacy during consultations undermined the quality of service delivery. Providers and service users linked delayed ANC initiation to financial constraints, stigma and pregnancy concealment. Conclusion: Improving early ANC initiation requires an approach that addresses health system, socioeconomic and cultural barriers. Concerns about declining fertility as a driver of declining coverage warrant further investigation into coverage calculation methodologies. Contribution: The study provides insights into the interconnected factors influencing ANC delivery and uptake in primary healthcare settings. It further highlights the need to consider changing fertility patterns when interpreting ANC coverage. The findings can inform targeted interventions and strengthen maternal health planning, monitoring, and service delivery.

Background. The clinical course of coronavirus disease 2019 (COVID-19), and the ability to anticipate which patients will require intensive care, were poorly characterized in Central Asia during the first pandemic wave. We aimed to describe the clinical features of hospitalized COVID-19 patients at the Tashkent State Medical University, Uzbekistan, and to identify risk factors for intensive care unit (ICU) admission. Methods. In this single-centre cross-sectional study, we reviewed the records of 2500 consecutive patients hospitalized between 11 April and 8 August 2020. Patients were grouped as asymptomatic or symptomatic, and symptomatic patients were compared by ICU versus non-ICU status. Groups were compared with chi-square or Fisher's exact and Mann-Whitney U tests. Univariable and multivariable logistic regression identified risk factors for ICU admission. Results. Of 2500 patients (median age 36 years; 60.9% male), 989 (39.6%) were asymptomatic and 1511 (60.4%) symptomatic. In total, 129 (5.2%) were admitted to the ICU and 38 (1.5%) died. ICU patients were older (median 56 vs 40.5 years) and more often had bilateral pneumonia, oxygen desaturation and cardiometabolic comorbidity. In the multivariable model (AUC 0.82), the independent predictors of ICU admission were ischemic heart disease (aOR 4.20), shortness of breath (aOR 3.22), hypertensive heart disease (aOR 2.93) and male sex (aOR 2.00). Conclusions. Older age, cardiometabolic comorbidity and respiratory compromise identified patients at high ICU risk. As one of the first clinical COVID-19 descriptions from Uzbekistan, these data provide a baseline for preparedness in Central Asia.

Background: Ebola virus disease is a life-threatening illness caused by the Ebolavirus, with symptoms manifesting two to twenty-one days after infection. Although Uganda has faced multiple Ebola outbreaks, many patients survive only to encounter persistent challenges. Therefore, this study explored the post-discharge experiences of survivors following the 2022 Ebola Virus Disease outbreak in Uganda. Methods: An exploratory qualitative study comprising of in-depth participant interviews was conducted at Mubende Regional Referral Hospital in central Uganda. Interviews were face-to-face and data were analyzed manually by inductive content analysis. Ten male and female participants were Ebola Virus Disease survivors in Mubende district who had lived in the community for at least six months post-discharge from the Ebola Treatment Unit. Results: Four themes emerged: (i) Psychosocial Burdens and Social Exclusion, (ii) Economic Hardship and Loss of Financial Stability, (iii) Chronic Physical and Health Burdens Post-Recovery and (iv) Rebuilding Lives: Psychological, Social, and Medical Pathways to Recovery. Survivors faced significant emotional burdens such as survivor guilt, grief, trauma from loss, and anxiety about transmission risks. They experienced social isolation, stigma, and discrimination, which often led to their exclusion from community activities. Financially, they struggled with debt and the loss of livelihoods, compounded by ongoing health issues. Additionally, survivors endured chronic physical complications, including pain and fatigue, which hindered their recovery. Despite these challenges, survivors sought psychological, social, and medical pathways to recovery, including confirmation of their recovery, support from family and organizations, and health maintenance practices. Supportive medical care and community assistance were crucial in their physical and emotional rehabilitation. Conclusion: Ebola Virus Disease survivors in Uganda face significant psychosocial, health, social, and economic challenges post-discharge. The findings highlight the critical need for comprehensive medical and community-based support systems to aid survivors' recovery and well-being. Further research on long-term neurological effects and community reintegration programmes is needed to inform targeted interventions that support Ebola survivors and reduce stigma and discrimination.

Typhoid fever remains a significant burden in low- and middle-income countries (LMICs). The World Health Organization recommends incorporating typhoid conjugate vaccines (TCVs) into the routine immunization programs of typhoid-endemic countries. Although TCV has been shown to be safe, well tolerated, and effective, evidence on its delivery costs in African settings remains limited. This study provides economic evidence on the cost of implementing TCV catch-up campaigns. This retrospective provider-perspective costing study evaluated TCV catch-up vaccination campaigns conducted in the Asante-Akim North District of Ghana and the Kisantu Health Zone of the Democratic Republic of the Congo (DRC). The campaigns targeted children aged 9 months to 15 years. An incremental costing approach was used, and a Microsoft Excel-based tool was developed to estimate costs. The total number of vaccinated individuals was 54,814; 10,052 in Ghana and 44,762 in the DRC. The financial cost per fully immunized person (FIP), including vaccine and vaccination supply costs, was estimated at US$ 5.78 in Ghana and US$ 5.47 in the DRC. The corresponding economic costs were estimated at US$ 6.09 in Ghana and US$ 5.89 in the DRC. Vaccine procurement and vaccination supplies represented the largest cost component, accounting for US$ 2.76 per FIP in Ghana and US$ 2.39 per FIP in the DRC, followed by service delivery and service delivery support activities. This study provides empirical estimates of the financial and economic costs of TCV catch-up campaigns in Ghana and the DRC. These findings provide country-specific evidence to inform planning, budgeting, economic evaluation, and policy decisions regarding future TCV introduction in typhoid-endemic settings.

Introduction: Nutritional challenges are a global public health concern, especially among children under five in sub-Saharan African countries. The coexistence of an overweight/obese mother and an underweight child in the same household is recognized as a dual burden of malnutrition (DBM). Our study aimed to examine the prevalence and associated factors of DBM among mother-child dyads in Mozambique. Methods: We used nationally representative, cross-sectional data from the Mozambique Demographic and Health Survey 2022-2023 (n=3,605 mother-child dyads). The children's undernutrition condition and maternal BMI status were calculated using the WHO standard reference guidelines. The outcome variable, dual burden of malnutrition, was then created if the children had any undernutrition condition (stunting, wasting, or undernutrition) and the corresponding mother was overweight/obese. Multivariable binary logistic regression, Erreygers's concentration index, and concentration curve were analyzed to determine associated factors and social inequalities. Results: The prevalence of the dual burden of malnutrition was about 5.51%. Mothers aged [&ge;]34 years [aOR (95% CI): 4.01(1.44, 11.14); p<0.05] and mothers with four or more children [aOR (95% CI): 2.68(1.29, 5.57); p<0.05] had higher odds of DBM. Rural residence and using unimproved toilet facilities (latter an indicator) were also significantly associated with experiencing DBM. Additionally, maternal age modified the association between women's empowerment and mother-child DBM. Women aged 15-19 years at the lowest and highest empowerment levels were more likely to experience DBM compared to women 20 years or older. A positive and statistically significant concentration index indicates that wealth-related inequalities exist, with DBM more concentrated among wealthier mother-child dyads. Conclusion: Our study highlights the persistence of household-level DBM in Mozambique. These findings emphasize the need for targeted interventions addressing social and economic inequalities, including poor sanitation marker of broader household deprivation. Prioritizing integrated maternal-child nutrition interventions within national strategies is essential to improving equity in nutrition and health outcomes.

Abstract Background: Even though significant advances in diagnosis, treatment, and prevention strategies have been implemented, neonatal sepsis remains a common concern in clinical practice, especially in low-resource countries. It is one of the major causes of death during the first month of life. This study aimed to assess clinical outcomes and predictors of mortality among neonates with neonatal sepsis admitted to public hospitals in selected Hospitals in Addis Ababa, Ethiopia. Methods: A hospital-based prospective cohort study design was conducted among 466 neonates admitted with neonatal sepsis from September 2024 to January 2025. All neonates who were admitted to selected Hospitals of Addis Ababa city after being clinically or laboratory-diagnosed with neonatal sepsis by the attending physician were included in the study. Data were entered into EpiData 4.2 and analyzed by SPSS version 26. Bivariate and multivariate Cox regression were used to identify the relationship between dependent and independent variables. Finally, variables with p-value [&le;] 0.05 were taken as significant factors associated with poor clinical outcome. Results: The study was conducted among 466 neonates admitted with neonatal sepsis. Of all neonates admitted with neonatal sepsis, 372 (79.8%) were discharged with good outcomes, and 94 (20.2%) had a poor outcome/died. Duration of ruptured membrane being >12hr (AOR=7.02, 95 % (CI: 1.85, 26.57), marital status /divorced (AOR=3.12, 95 % (CI: 1.67, 7.45),rural residence (AOR= 6.05, 95 % (CI: 2.03-16.53), assisted instrumental delivery (AOR= 5.99, 95 % (CI: 1.46-17.11), meconium-stained amniotic fluid ((AOR= 9.48, 95 % (CI: 0.49-18.61)), no initiate exclusive breast feed within one hour (AOR= 3.20, 95 % (CI: 0.90-7.52), chest in drawing (AOR= 5.81, 95 % (CI: 1.75-11.23) were significantly associated with neonatal mortality. Conclusion: Neonatal mortality was moderately high. Meconium-stained amniotic fluid, prolonged duration of ruptured membrane (>12hr), Mode of delivery (instrumental delivery), and chest in drawing are among the predictors of neonatal mortality. Keywords: -Clinical outcome,Neonatal sepsis, Mortality, predictors, Ethiopia.

Background: Snakebite envenoming remains a major but neglected public health problem in sub-Saharan Africa, where access to antivenom is often limited and unevenly distributed. In Zambia, evidence on facility-level determinants of antivenom use is scarce. This study examined factors associated with antivenom administration among snakebite patients in selected health facilities. Methods: A retrospective cross-sectional study was conducted among 128 snakebite patients presenting to five health facilities in Zambia. Associations between antivenom administration and health facility, admission year, age group, and gender were assessed using Fisher's exact test, with statistical significance set at p < 0.05. Results: Overall, 16/128 patients (12.5%) received antivenom. Antivenom administration varied significantly by health facility (p < 0.0001). All patients at Kabwe General Hospital received antivenom (9/9, 100%), compared to 50% (2/4) at Commando Urban Health Centre and 22.7% (5/22) at Chipata Central Hospital. No patients received antivenom at Mpongwe Mission Hospital (0/70) or St. Dominic's Mission Hospital (0/23), where antivenom was not available. Admission year (2023 vs 2024; p = 0.78), age group (p = 0.53), and gender (p = 0.80) were not significantly associated with antivenom use. Conclusion: Antivenom administration in this setting is determined primarily by health facility-level availability rather than patient demographic or temporal factors. The very low overall treatment rate highlights critical inequities in access to life-saving therapy. Strengthening antivenom procurement, equitable distribution, and referral systems is urgently needed to reduce preventable morbidity and mortality from snakebite envenoming.

Despite significant progress in reducing vaccine-preventable diseases, Cameroons Expanded Programme on Immunisation operates within structures shaped by colonial history. Overreliance on external donor funding, centralised governance, and limited recognition of local knowledge raise concerns about equity, local ownership, and programme sustainability, particularly as the country plans for donor transition and self-financing. This study, aligned with the decolonising global health movement, examines how colonial legacies shape stakeholders experiences within the EPI and proposes practical steps towards a more locally owned immunisation programme. A qualitative case study was conducted in the Southwest Region of Cameroon from June to July 2025, comprising fifteen online semi-structured interviews in English with selected stakeholders (regional and district EPI managers, civil society members, and community leaders). Interviews were audio-recorded, transcribed verbatim, and analysed thematically using Clarke and Brauns six-step framework in NVivo version 11. Participants identified subtle colonial influences, including centralised decision-making, donor-driven priorities, pay disparities favouring international actors over local staff, and the marginalisation of local and traditional knowledge. The COVID-19 response was frequently cited as an example of inequity, with Western biomedical approaches prioritised over locally led solutions. Major structural issues included heavy reliance on external funding, outdated colonial-era training curricula, centralised governance, and a lack of local vaccine manufacturing capacity. Despite these issues, participants recognised the significant technical and financial support from international organisations. They proposed concrete pathways for decolonisation, including decentralised governance, participatory programme design, regulation and integration of traditional medicine, community engagement, domestic resource mobilisation, leveraging Cameroons emerging universal health coverage to reduce donor dependence, and investing in local vaccine production. Conclusion: Colonial legacies continue to influence Cameroons EPI, undermining local ownership and self-determination, even when external support is effective. Achieving decolonisation requires multifaceted efforts to strengthen domestic financing and governance, empower local stakeholders, and legitimise local knowledge alongside biomedical approaches. Policymakers should embed local ownership, governance reforms, and local capacity building in transition strategies while donor funding persists, ensuring immunisation gains are sustained beyond external support. These insights provide a context-specific roadmap for developing a sustainable, equitable, and locally driven immunisation programme in Cameroon and other countries facing similar donor transitions.

Mpox has re-emerged as a public-health priority across Nigeria, and successive international public-health emergencies were declared in 2022 and 2024. Facility-level descriptions of admitted, clinically suspected cases from northeastern Nigeria remain sparse. We conducted a register-based descriptive study of all admissions to the infectious-diseases isolation ward of Modibbo Adama University Teaching Hospital, Yola, in which mpox was recorded as the working or a differential diagnosis between February 2022 and January 2025. Age, sex, month of admission, locality, recorded clinical impression, and outcome were abstracted and summarised, with proportions reported using Wilson 95% confidence intervals. Fifteen suspected mpox admissions were identified, representing 4.5% (95% confidence interval 2.8-7.4) of 330 isolation-ward admissions. The median age was 20 years (interquartile range 13-37; range 7-57); six patients (40.0%) were children under 18 years and 12 (80.0%) were male, giving a male-to-female ratio of 4:1. Admissions clustered in 2022 (9 of 15; 60.0%), with six in July 2022, including a probable household cluster of four children and adolescents aged 7-14 years from a single locality who presented within eight days of one another. Three deaths were recorded (case fatality 20.0%, 95% confidence interval 7.0-45.2), including one disseminated case complicated by acute respiratory distress syndrome. The demographic profile closely matches previously reported Adamawa State and national surveillance data, whereas the elevated case fatality reflects referral concentration and diagnostic uncertainty rather than true mpox-attributable mortality. Cases were clinically suspected rather than laboratory-confirmed, which is the principal limitation of this study. We recommend targeted strengthening of laboratory diagnosis at facility and sub-national level, including dual monkeypox-varicella testing algorithms, use of existing molecular platforms rather than new infrastructure, and mandatory recording of laboratory results within ward registers.

Abstract: Background: Road traffic injuries (RTI) related trauma is associated with heavy psychosocial burdens for family members involved as informal caregivers after the event. Little is known about the quality of life (QoL) experience of family members of RTI survivors in sub-Saharan Africa. This study investigated the QoL outcomes of family members after the administration of the Friendship Bench psychosocial intervention among RTI survivors in Cameroon. Methods: A pre post study design was utilized in two trauma centers in Cameroon. The relatives underwent assessment both at baseline (Session 1) and follow up sessions (Session 6) using the WHOQOL BREF tool, without being exposed to any intervention. The domain scores were scaled from 0 to 100. Statistical analysis consisted in paired t-tests/Wilcoxon signed-rank tests along with effect sizes using Cohen s d. Results: The study involved twenty nine participants. Baseline assessment revealed overall poor quality of life across all domains, with scores in the poor range (Social = 33.33 [IQR: 25.00 47.92]; Environmental = 34.38 [IQR: 25.78 45.31]; Psychological = 45.83 [IQR: 34.38 50.00]; Physical = 46.43 [IQR: 39.29 56.25]). These scores had a statistically significant increases across all domains after the intervention (p < 0.001), accompanied by medium to large effect sizes (Cohen s d:Social = 1.35; Environmental = 1.57; Psychological = 1.46; Physical = 0.73). The relationship type was found to predict social QoL (F(6,22) = 4.57, p = 0.004), with children of patients demonstrating the greatest gains. Conclusion: Family members of RTI survivors showed a significant improvement in QoL during the Friendship Bench intervention. These results highlight the importance of evaluating family member outcomes in task shifted psychosocial programs in LMICs. Keywords: Quality of life, WHOQOL BREF, road traffic injuries, family caregivers, Friendship Bench, Cameroon, spillover effects

Background: Cutaneous leishmaniasis (CL) remains a major neglected tropical disease in Afghanistan; however, recent nationwide evidence on its geographical and temporal distribution is limited. This study assessed the reported burden, spatial distribution and seasonal variation of cutaneous leishmaniasis across Afghanistan during 2024. Methods: A nationwide retrospective ecological study was conducted using aggregated routine surveillance data obtained from the National Malaria and Other Vector-Borne Diseases Program. All cases reported from government health facilities across Afghanistans 34 provinces between 1 January and 31 December 2024 were included. Reported incidence rates were calculated per 10,000 population using national and subnational population estimates. Cases were analyzed by surveillance classification, province, city, rural district, month, and season. Results: A total of 87,245 cases were reported during 2024, corresponding to an overall incidence of 25.1/10,000 population. Anthroponotic and zoonotic CL accounted for 80,202 (91.9%) and 7,043 (8.1%) cases, respectively. Jowzjan recorded the highest provincial incidence (105.0/10,000), while Kabul and Herat contributed the largest absolute numbers of cases. Shiberghan had the highest urban incidence, whereas Panjwai, Ghoryan and Hazrat-e-Sultan recorded exceptionally high rural rates. May had the highest monthly burden, while August had the lowest. Autumn accounted for the largest seasonal proportion (27.92%), whereas summer had the lowest burden (16.98%). Considerable incompleteness in district-level reporting was observed. Conclusion: CL constituted a substantial but highly concentrated public health burden in Afghanistan during 2024. Strengthened surveillance, improved diagnostic confirmation and geographically targeted case-management and vector-control interventions are particularly needed in identified high-burden provinces, cities and rural districts.

Introduction: Antenatal depression is a major public health concern linked to adverse maternal and neonatal outcomes, including preterm birth, impaired fetal growth, low birth weight, infant malnutrition, and increased episodes of childhood illness. This study assessed the magnitude and factors associated with antenatal depression among pregnant women attending public health centers in Shire town, Tigray, Ethiopia. Methods: This facility-based cross-sectional study allocated the sample proportionally across health centers based on November-December 2025 antenatal care caseloads. After selecting the first participant by lottery, every third eligible attendee was enrolled through systematic sampling. Variables with p[&le;]0.25 in bivariable analysis were entered into a multivariable logistic regression model to identify factors associated with antenatal depression among pregnant women in post-war Shire Town, Tigray, Ethiopia. Results: All 463 participants were included (response rate: 100%). The magnitude of antenatal depression was 34.3% (95% CI: 30-38.7%). Increased odds of depression were observed among age group 25-34 years (AOR = 3.43; 95% CI: 1.7-7.2), those with unplanned pregnancies (AOR=2.2; 95% CI: 1.25-3.87), exposure to conflict-related traumatic events (AOR=2.6; 95% CI: 1.41-4.81), Internally displaced people (AOR=2.02; 95% CI: 1.05-3.92), experience of intimate partner violence (AOR=2.22; 95% CI: 1.31-3.8), poor partner relationship (AOR=2.17; 95% CI: 1.2-3.96), and low perceived neighborhood safety (AOR=2.7; 95% CI: 1.5-5.08). Protective factors included middle income (AOR=0.54;(95% CI:0.31-0.93), higher income (AOR=0.15; 95% CI: 0.065-0.33), and very good pre-war economic status (AOR=0.4; 95% CI: 0.16-0.94). Conclusion: Antenatal depression was common among pregnant women in this post-war population, with internally displaced women experiencing higher odds. Integrating mental health and psychosocial support into antenatal care, alongside interventions addressing conflict-related trauma, intimate partner violence, socioeconomic vulnerability, and community safety, is warranted.