Pan African Medical Journal

Background Human T-cell lymphotropic virus - 1 (HTLV-1) is the causative agent of Adult T-cell Leukaemia/Lymphoma (ATLL), a malignancy of CD4+ cells, and HTLV-1-associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP), a demyelinating disease. Globally, 10-20 million people are infected, though most remain asymptomatic and about 5% progress to severe disease. Transmission occurs mainly through breastfeeding, sexual contact, contaminated needles, and blood transfusion. In Ghana, evidence on the role of HTLV-1 in haematological malignancies remains scarce. Methods This was a cross-sectional study involving 200 patients with haematological malignancies (Acute Lymphoblastic Leukaemia - 4, Acute Myeloid Leukaemia - 6, Chronic Lymphocytic Leukaemia - 27, Chronic Myeloid Leukaemia - 63, Hodgkin Lymphoma - 21, Multiple Myeloma - 31, Myelodysplasia - 6, Myeloproliferative Neoplasm - 11) at the Haematology Day Care of the Korle-Bu Teaching Hospital. After informed consent was obtained, sera from study participants were tested for anti-HTLV-1 using MP Diagnostics GmbH ELISA immunoassay. Data were analysed using R software version 4.0.2 and SPSS version 31.0.0. Results The study population had a mean age of 49.1{+/-}17.7 years, with majority being females (n=109, 54.5%). Of the 200 samples, 16 (8.0%) were seropositive for HTLV-1, and these were detected in 4 males and 12 females. No statistically significant association was found between HTLV-1 infection and haematological malignancy (exact p = 0.061), sex (p=0.061), and history of blood transfusion (exact p= 1.000). Conclusion The findings show the seroprevalence of HTLV-1 of 8.0% among patients with haematological malignancies. Although there was no probable association between HTLV-1 and haematological malignancies, screening for HTLV-1 in patients with haematological malignancies may help to unravel the exact contribution in these conditions.

Background: Returnee migrants in Nigeria often face significant psychosocial and economic challenges during reintegration, necessitating resilience to adapt and recover. This study examined factors influencing resilience among returnee migrants in Nigeria. Methodology: A mixed methods design was employed, involving 1316 returnees selected through multistage sampling across Nigeria six geopolitical zones. Quantitative data were collected using the Connor Davidson Resilience Scale and analyzed using SPSS version 28. Qualitative data was obtained through eight focus group discussions and analyzed thematically. Result: Social support from family and friends was inconsistent (70.8% reported occasional support), while community support was largely absent (85.9%). Financial insecurity was widespread (gt 90%). Male gender (AOR = 6.092, plt 0.001), ethnicity, and higher education were significant predictors of resilience. Qualitative findings highlighted the role of family support, faith, adaptive coping, and skill acquisition in strengthening resilience. Conclusion: Resilience among returnee migrants in Nigeria is limited by weak structural and economic support, despite moderate personal coping capacity. Strengthening economic opportunities, community integration, and access to mental health services is essential for sustainable reintegration. Keywords: Returnee migrants, resilience, Reintegration, and psychosocial factors.

Abstract Background: Human papillomavirus (HPV) infection is a leading cause of cervical cancer globally, disproportionately affecting women in developing countries like Ghana. Despite the recent introduction of national HPV vaccination programs, vaccine uptake among young adults remains suboptimal. This study aimed to assess the levels of knowledge, attitudes, and perceived barriers toward HPV, cervical cancer, and vaccination among undergraduate students in Ghana to inform future public health interventions. Methods: A cross-sectional study was conducted among 699 undergraduate students at the University of Cape Coast, Ghana. A multistage stratified random sampling technique was employed to ensure disciplinary representation. Data were collected using a validated, semi-structured digital questionnaire covering socio-demographics, knowledge of HPV, attitudes toward vaccination, and perceived barriers. Descriptive statistics were utilized to summarize findings. Chi-square tests were performed to assess bivariate associations, and binary logistic regression analysis was conducted to identify predictors of good knowledge and positive attitudes toward vaccination, with statistical significance set at p < 0.05. Results: 51.9% of students demonstrated good knowledge of HPV and vaccination. A significant gender disparity was observed: while male students displayed higher levels of clinical knowledge, female students held significantly more positive attitudes toward vaccination (p < 0.05). Major barriers included profound social stigma, with 77.9% of students expressing concern over partner perception and 65.6% reporting embarrassment regarding the association between the vaccine and sexually transmitted infections. Misconceptions were prevalent, with 46.6% of participants incorrectly believing the vaccine could cure existing infections. Conclusion: A clear knowledge-attitude gap exists among Ghanaian undergraduates, complicated by pervasive psychosocial barriers. Current vaccine delivery models, which often center on reproductive health or STI clinics, inadvertently reinforce stigma. To improve vaccination coverage, public health initiatives must transition toward a stigma-neutral model of care that integrates HPV immunization into routine primary health services, framing it as a preventive cancer-fighting strategy rather than a sexual health intervention.

Introduction Reliable information on service readiness is essential for strengthening health systems and advancing universal health coverage. In Cameroon, structural imbalances and the predominance of private-sector facilities raise concerns regarding the operational capacity of health facilities to deliver essential services. This study aimed to determine factors associated with health facility readiness in Yaounde to inform evidence-based policy and service delivery improvements. Methods A cross-sectional analytical study was conducted from November 4 to December 27 2024 among health facilities in Yaounde. Data were collected using the World Health Organization Service Availability and Readiness Assessment (SARA) tool. Readiness was measured across five domains (1) trained staff and guidelines; (2) essential equipment; (3) standard precautions for infection prevention; (4) diagnostic capacity; and (5) essential medicines), comprising 47 tracer items. Facilities scoring [&ge;]80% were classified as having good readiness. Bivariate analyses and multivariate logistic regression were performed to identify factors associated with good readiness. Results A total of 205 health facilities were surveyed; most were urban (97.6%), private secular (89.8%), and categorized as 6th level (86.8%). Overall, 57.1% (117/205) achieved good readiness. Readiness varied significantly across health districts (p=0.015), with Efoulan (78.8%) performing highest. In multivariate analysis, absence of Prevention of Mother-to-Child Transmission (PMTCT) services (aOR=0.17; 95% CI: 0.05-0.55; p=0.003) and absence of childbirth services (aOR=0.18; 95% CI: 0.06-0.55; p=0.003) were independently associated with lower odds of good readiness. Conclusions Only slightly more than half of facilities in Yaounde met the operational readiness benchmark. Availability of PMTCT and childbirth services appears to be a strong indicator of broader facility preparedness. Strengthening maternal and child health service capacity may serve as a strategic entry point for improving overall facility readiness and advancing equitable health system strengthening in Cameroon.

Abstract Aim: Low chemotherapy response is a major risk factor for early mortality in cancer patients; it is one of the biggest challenges in cancer treatment. Main aim of this study is to identify chemotherapy non-responder, prognostic significance of pre-chemotherapy baseline variables in survival, distinguish most effective anti-cancer drug classes and formulation. Methods: In this multi-center retrospective cohort (n=2459) patients deceased with NSCLC and received anti-cancer drugs were included for analyses. To identify chemotherapy non-responder, patient population was divided into three sub-groups based on chemotherapy prescription frequency [1-15] as group-A, [16-30] as group-B, and [[&ge;]31] as group-C. Multivariate analysis was performed to identify risk of 1-year mortality in these groups. To prognose chemotherapy response in resected and unresected NSCLC patients, 0-7 days pre-chemotherapy white blood cell (WBC) count total five-ranges were compared as per overall survival in abnormal Vs normal WBC counts. Results: Post-stratification in group-A there were (n=1289) patients, in group-B (n=648) patients, and in group-C (n=522) patients. In group-A (n=301) patients 23% were found to have no new metastasis post-diagnosis significantly less p-value (0.004) compared to Group-B (n=125) 19.3%, and group-C (n=110) 19.2% patients p-value (0.008). Metastasis during chemotherapy was found significantly less in 20% patients of group-A, compared to (33%) in group-B, and (43%) in group-C p-value (<0.001). Post-chemotherapy initiation OS in group-A patients were significantly less 9 months (95% CI 9.3 - 9.6) compared to group-B 19 months (95% CI 17.7 - 20.2) and group-C 36.6 months (95% CI 34.6 - 38.5) patients p-value (<0.0001). Despite of low new metastasis and post chemo metastasis, group-A patients survived significantly less based on these outcomes group-A patients were considered as chemotherapy non-responder. Males and NSCLC stage III/IV patients were at higher risk; clinical benefits are corelated to surgery and radiotherapy for chemotherapy non-responder. Leukocytosis in both resected/unresected NSCLC group-A (13%) patients were found to be bad prognostic factor of survival in unresected group-B (5%) patients. Oral formulation of receptor tyrosine kinase inhibitors (RTKI) was effective in non-responders. Conclusion: Stratification of patient population based on chemotherapy prescriptions could be a useful method to find chemotherapy response in retrospective analysis. Patients with pre-chemotherapy leukocytosis should be closely monitored prior to selection of chemotherapy dose and formulation.

Our study is an assessment of the knowledge, personal coverage, and related determinants of private health insurance as revealed by healthcare professionals in Freetown, the urban capital of Sierra Leone. This study stands as a precursor for Low- and Middle-Income Countries (LMICs), like Sierra Leone, seeking to establish Universal Health Coverage (UHC) to provide healthcare access and coverage through publicly arranged risk pooling, designed to help protect against unmanageable medical costs. In parallel, such countries face significant challenges with achieving sustainable universal coverage due to limited public resources, inefficient allocation systems, uneasy reliance on out-of-pocket payments, and large struggling populations. Our research sheds particular light on how healthcare professionals view their own participation with private healthcare options. A cross-sectional, analytical study was conducted, openly recruiting individuals from various facilities in Freetown. Using the Yamane Formula, a sample size of 109 participants was calculated. STATA 14.0 was used for data analysis. Our findings revealed that 96 (88.9%) participants did not have private health insurance, while 12 (11.1%) did have private coverage. However, 105 (97.2%) reported other modes of health insurance, with only 3 (2.8%) uninsured. Notably, 97.2% expressed willingness to join a private health insurance scheme. Our study found no statistically significant associations between selected indicators (demographic or socioeconomic fac tors) and current insurance coverage among study participants. These results highlight a low prevalence and understanding of private health insurance among healthcare professionals in a representative urban center in Sub-Saharan Africa (SSA), while acknowledging high willingness to enroll. The lack of any significant determinants suggests other unexamined factors, such as cost, accessibility, or awareness, capable of influencing the adoption and implementation of a universal health program.

Introduction Malaria is a global public health problem especially in sub Saharan Africa. In Kenya, it varies across ecological zones with limited evidence comparing vector ecology, climate, topography and risk of infection in western lowlands and central highlands. Objective To compare levels of malaria infection, vector densities, rainfall, temperature, relative humidity and topography in lowland Busia and highland Meru counties. Methods A cross sectional survey was conducted using larval dipping for aquatic habitats, pyrethrum spray catches for indoor resting mosquitoes, and malaria diagnosis using rapid diagnostic tests and microscopy. Rainfall, temperature, and relative humidity were recorded using automated data loggers. Topography was noted by ground truthing. Data were analysed using chi square tests, analysis of variance, and logistic regression. Results Early instar Anopheles larvae were significantly less likely to be detected in the highland site than in the lowland site (unadjusted Odds Ratio = 0.33; 95% CI: 0.11 - 0.97). Malaria prevalence by rapid diagnostic tests was 0% in the highland site and significantly higher in lowland sites (p < 0.001), with microscopy confirming the absence of infections in the highland area. Highland sites experienced significantly cooler temperatures, including more hours below 16 degrees Celsius (p = 0.006), whereas lowland sites recorded significantly higher minimum, mean, and maximum temperatures (p < 0.001). Rainfall did not differ significantly between the two ecological zones (p = 0.090), average minimum RH in the highland was significantly higher than in the lowland site (p < 0.001). Valleys in Baragu are mainly V-shaped while Maduwa and Budalangi are generally flat areas in the lower courses of rivers prone to flooding. Conclusion Cooler highland climates and topographic features likely limit vector presence, abundance, development and malaria transmission, while warmer lowland environments sustain residual transmission.

Bangladesh is facing a major resurgence of measles, with more than 60,000 suspected cases and over 600 deaths reported between March and May 2026. Despite the growing outbreak, hospital-based evidence in Bangladesh remains limited regarding measles vaccination status and its association with clinical complications. To address this critical gap, our study aimed to assess the vaccination status and its relationship with the development of clinical complications. A total of 260 children admitted to the measles ward were enrolled in this cross-sectional study. They were aged 2-72 months, had clinically confirmed measles, and were admitted to four dedicated measles treatment hospitals in Dhaka, Bangladesh, between 15 and 25 April 2026. Data on vaccination status, sociodemographic characteristics, feeding practices, Nutritional status, clinical symptoms, and complications were collected through caregiver interviews and hospital records. Adjusted odds ratios (AOR) with a corresponding 95% confidence interval (CI), and a p-value of <0.05 were considered statistically significant. Among enrolled children, 74.6% were unvaccinated, 18.8% were partially vaccinated, and only 6.5% were fully vaccinated. In the multivariable model, age below 9 months (aOR 0.077, 95% CI 0.025-0.236,p<0.001) was independently associated with lower odds of vaccination, while household income at or above the median (aOR 3.480, 95% CI 1.493-8.110,p=0.004) was associated with higher odds. Complications developed in 31.1% of cases, with respiratory involvement being most common. Absence of exclusive breastfeeding (aOR 2.336, 95% CI 1.027-5.313,p=0.043) and presenting with exactly three symptoms at admission (aOR 3.106, 95% CI 1.274-7.572,p=0.013) were independently associated with complications. Unvaccinated individuals exhibited markedly elevated odds of complications compared to those who were vaccinated (aOR 5.729,95% CI: 2.363-13.889, p<0.001). The overwhelming burden of measles in unvaccinated children, shaped by socioeconomic disadvantage and suboptimal feeding practices, underscores the urgent need to restore immunization coverage and strengthen equitable health services in Bangladesh.

Background This study aims to explore the initiation and implementation of Jamkesus Disabilitas, a health financing scheme for people with disabilities in Yogyakarta Province, using the UK Medical Research Council (MRC) Process Evaluation for Complex Intervention. Methods We interviewed 19 people with disabilities with different types of impairment as beneficiaries, 3 people from Organisations for People with Disabilities (OPDs), 4 government officials, and 4 health providers, either in person, online, or by phone. Interviews were conducted by LA, and took place in Yogyakarta Province in July-September 2024. Data were analysed using a thematic analysis approach using NVivo 15 software. Findings Jamkesus Disabilitas has improved access to assistive technology (AT) and demonstrated inclusive care through its one-stop service. It also highlights the importance of consistent leadership in disability-inclusive health systems. However, challenges persist, including uneven AT quality, low coverage, limited availability, and inadequate data for evaluation and planning persisted. Moreover, the absence of inclusive features in the regular service means the scheme has not fully closed the equity gap in healthcare access for people with disabilities. Conclusion Jamkesus Disabilitas has expanded access to AT overlooked by the national health insurance (JKN). However, implementation should prioritise AT quality standards, financial and operational sustainability, and stronger data systems. Broader systemic reforms are also needed to embed disability inclusive practices in regular healthcare service delivery. Keywords Health equity, inclusive health system, social protection, health insurance, health financing

Abstract Effective health communication is central to patient-centred care and improved health outcomes, particularly in culturally diverse healthcare settings. In clinical and assistive practice, communication breakdowns may negatively affect diagnosis, treatment adherence, and preventive care. A qualitative phenomenological design was employed, utilizing Semi-Structured interviews with purposively sampled twenty patients and healthcare professionals from Tamale Teaching Hospital, Yendi Hospital, and Bimbilla Hospital. The researchers adopted Content Analysis as the tool of analysis for the data. The findings of this study revealed that language discrepancies Poor attitudes of healthcare providers hinderer patient openness and the quality treatment. Logistical issues, such as inadequate medicines and medical supplies, resulted in delayed treatment and additional financial burden on patients and their relatives. Cultural and social factors discourage patients from discussing certain health conditions with healthcare providers, leading to delayed treatment. These hurdles adversely impact on treatment and assistive practice, specifically in culturally diverse environment and preventive care. The study recommends training and capacity-building programs for healthcare providers in cultural competence, fostering effective and ethical health communication between patients and healthcare providers, and recruiting professional interpreters to bridge the linguistics gap between patients and providers. Abstract Effective health communication is central to patient-centered care and improved health outcomes, particularly in culturally diverse healthcare settings. In clinical and assistive practice, communication breakdowns may negatively affect diagnosis, treatment adherence, and preventive care. A qualitative phenomenological design was employed, utilizing semi-structured interviews with twenty purposively sampled patients and healthcare professionals from Tamale Teaching Hospital, Yendi Hospital, and Bimbilla Hospital. The researchers adopted content analysis as the tool of analysis for the data. The findings of this study revealed that language discrepancies Poor attitudes of healthcare providers hinder patient openness and quality treatment. Logistical issues, such as inadequate medicines and medical supplies, resulted in delayed treatment and additional financial burden on patients and their relatives. Cultural and social factors discourage patients from discussing certain health conditions with healthcare providers, leading to delayed treatment. These hurdles adversely impact treatment and assistive practice, specifically in culturally diverse environments and preventive care. The study recommends training and capacity-building programs for healthcare providers in cultural competence, fostering effective and ethical health communication between patients and healthcare providers, and recruiting professional interpreters to bridge the linguistics gap between patients and providers.

The focus was on leadership, mentoring and promotion. Using short, structured activities alongside small-group discussion, the participants were encouraged to reflect on leadership, mentoring and the perceived gap between being ready and being recognised for promotion. Descriptive survey findings and free-text reflections highlight the demand for structured peer support, reciprocal mentoring opportunities, and clearer, more transparent promotion processes. Following the event, we performed a structured review of the impact. This highlighted that the workshop participants reported that the event allowed for greater self-awareness into their own leadership approaches, a stronger commitment to purposeful mentoring, and greater confidence and renewed motivation to take concrete steps towards promotion.

Health literacy (HL) is a critical determinant of health behaviours and outcomes. Vaccine literacy (VL), a domain-specific extension of HL, has emerged as an important determinant of vaccination attitudes. However, evidence examining the combined relationship of HL and VL with lifestyle behaviours remains limited, particularly among young adults in Pakistan. A cross-sectional study was conducted among 587 participants aged 18 years and above in Pakistan. HL was assessed using the European Health Literacy Population Survey 2019-2021 questionnaire (HLS19-Q; 17 items; 5-point Likert scale; score range 0-100) and VL was assessed using the HLS19 vaccine literacy instrument (HLS19-VAC), both developed by the Measuring Population and Organizational Health Literacy (M-POHL) Consortium. Data were analysed using IBM SPSS Statistics (v.29) with descriptive statistics, chi-square tests, Spearmans correlation, and multiple linear regression. Mean HL score was 86.29 {+/-} 22.04 and mean VL score was 18.29 {+/-} 2.72. HL was significantly associated with gender (p < 0.001) and was the strongest independent predictor of physical activity ({beta} = 0.735, R{superscript 2} = 0.627, p < 0.001). VL was strongly associated with vaccination attitudes (r = 0.735, p < 0.001) but not with physical activity or smoking. HL and VL function as enabling rather than deterministic factors for health behaviour. Multi-component public health interventions combining HL promotion with environmental and policy-level strategies are needed.

Background Diphtheria caused by toxigenic Corynebacterium diphtheriae re-emerged in Nigeria from December 2022 as the country's largest ever recorded outbreak, accumulating over 20,000 suspected cases and 872 confirmed deaths by December 2025. The Borno-Adamawa-Yobe (BAY) states zone in north-eastern Nigeria is a recognised high-vulnerability cluster, yet no facility-level, longitudinal epidemiological data from Adamawa State have been published. Methodology/Principal findings We conducted a retrospective cohort study of all patients admitted with diphtheria to the Isolation Ward of Modibbo Adama University Teaching Hospital (MAUTH), Yola -- the sole federal university teaching hospital in Adamawa State -- from January 2023 to April 2026, using prospective admission register records. Sixty-one patients were identified (17.9% of 330 total isolation admissions). Admissions escalated 580% from 5 (2023) to 34 (2025). Median age was 8.0 years; 91.8% were under 15 years. The overall in-hospital case fatality rate (CFR) was 41.5% (22/53 known outcomes; 95% confidence interval: 29.0-55.0%). Annual CFR declined from 60.0% (2023) to 28.6% (2025), temporally consistent with improving diphtheria antitoxin access. A critical operational finding was the persistent shortage of intravenous erythromycin -- the mandated antibiotic for patients unable to swallow -- compelling oral administration in patients with pharyngeal pseudomembrane and dysphagia. Respiratory distress at presentation carried an 80% CFR; cardiac complication, 100%. Age and sex were not statistically significant mortality predictors. Gombi local government area contributed 16.4% of cases -- the highest burden among non-capital communities -- consistent with its role as a population movement corridor from Borno State's outbreak epicentre. A September-October seasonal peak (47.5% of admissions) was identified, diverging from the national January-April pattern. Conclusions/Significance This study provides the first peer-reviewed, facility-level diphtheria epidemiological dataset from Adamawa State. The in-hospital CFR substantially exceeds national surveillance averages due to referral bias and historical drug supply constraints. The declining CFR against rising admissions signals improving case management. Pre-positioning of diphtheria antitoxin and intravenous erythromycin before each August-October peak, accelerated childhood immunisation catch-up, and strengthened surveillance in Adamawa State are identified as urgent priorities.

Background: In low- and middle-income countries, laboratory testing to rapidly detect measles outbreaks is limited by infrastructure availability and high costs. This study estimates the potential impact and cost-effectiveness of measles rapid diagnostic tests (RDTs) if implemented nationally in Ethiopia to either replace or expand current testing. Methods: An agent-based model to simulate measles outbreaks was calibrated to Ethiopian measles surveillance data. Modelled outbreak outcomes were aggregated over a 10-year period. Scenarios included using RDTs to (1) replace laboratory testing; (2) replace epidemiological linkage; and (3) increase case detection, in addition to replacing laboratory testing and epidemiological linkage. Testing and outbreak response costs (in 2025 US$) were obtained from Ethiopian Public Health Institute from a government perspective. Total costs and disability-adjusted life years (DALYs) for each scenario were compared to baseline. Results: All scenarios were cost saving compared to baseline. Replacing laboratory testing with RDTs saved US$4.2M (3.2M-4.9M) over 10-years, but due to very low testing rates the benefits of eliminating laboratory testing delays were offset by missed cases from the lower RDT sensitivity, leading to similar outbreak detection times and DALYs. Replacing epidemiological linkage with RDTs had similar DALYs but increased the cost savings to US$9.7M. Using RDTs to double case detection reduced outbreak detection time from 113 to 80 days, averted 17,000 DALYs, and saved US$4.3M. Conclusions: In Ethiopia, use of measles RDTs could be cost saving, and if used to expand testing could prevent measles infections through faster outbreak detection and response.

This scientific study aims to assess the level of awareness, nutritional knowledge, and actual behavioral practices among pregnant women in the Capital District of Sanaa, Republic of Yemen, and to determine their impact on the health and clinical indicators of the mother and fetus under complex conflict conditions. The study employed a descriptive-analytical approach based on a simple random sample of 200 pregnant women attending government-run hospitals and specialized medical centers in the Capital District. Field data were collected during December 2025 using a structured and validated questionnaire consisting of 42 items measuring demographic variables, awareness, practices, barriers, and health outcomes. The results of the statistical analysis using SPSS software showed a high level of nutritional awareness (87%) and healthy dietary practices (80%) among the sample participants. Simple and multiple linear regression tests revealed a statistically significant effect of awareness and practices in explaining 20.2% of the variance in the health status of the mother and fetus (R{superscript 2}= 0.204, p < 0.001). The study demonstrated that actual behavioral practices have greater predictive power ({beta}=0.316, p=0.001) compared to theoretical cognitive awareness ({beta}=0.232, p=0.005) in determining clinical outcomes for the mother and fetus, highlighting the widening gap between knowledge and behavior under structural pressures. "Morning sickness" (80%) and the deterioration of "family economic status" (71%) emerged as the greatest physiological and material barriers to proper nutrition. With their inferential impact established as an extension of the maternal-fetal resource allocation conflict in a physiologically and economically challenging environment, the study also identified significant differences in nutritional behavior and health outcomes in favor of housewives and mothers who are more educated and have higher incomes, while no significant differences were recorded attributable to obstetric variables such as stage or order of pregnancy. The study offers a unique theoretical and practical contribution by formulating an integrated causal model that demonstrates that the fetus acts as a biological drain on the mothers cellular and mineral reserves in a war environment, which necessitates directing antenatal care and support programs toward effective behavioral empowerment and nutritional support to overcome the structural and material barriers faced by pregnant women.

Background Persistent gaps in Neglected Tropical Diseases (NTDs) knowledge and skills among frontline health workers in endemic countries remain an important factor limiting progress toward elimination targets. Blended learning approaches offer a potentially scalable solution, but robust evidence from low- and middle-income countries (LMICs) remains scarce. This study evaluated the effectiveness, acceptability, behavioral effects, and cost of a blended learning program for NTD capacity building in India and Nigeria. Methods A mixed-methods intervention study was conducted in India and Nigeria. A total of 177 purposively selected health workers across three levels (frontline/community workers [Level 1], clinicians and primary care providers [Level 2], and district supervisors/program managers [Level 3]) participated in a blended training program combining interactive online modules with practical onsite skill sessions. Guided by the integrated frameworks of Implementation Science and Kirkpatrick, outcomes were assessed using pre/post knowledge tests, 3-6 month follow-up observations and interviews, focus group discussions, and comprehensive costing. Quantitative data were analyzed using Stata, and qualitative data underwent thematic analysis. Results The program achieved high acceptability across all cadres and settings. Knowledge scores improved significantly after training (average gains 5-42.5%, p<0.001, Cohens d 1.1-1.8) across the 3 training courses. At 3-6 months, workplace observations and supervisor feedback observed improved service delivery. Challenges included internet connectivity, language barriers, and lower online completion rates among Level 1 workers. Conclusions A contextually adapted blended learning approach is feasible, acceptable, effective, and cost-efficient for strengthening NTD workforce capacity in resource-limited settings. With targeted adaptations (local languages, offline access, and cadre-specific tailoring), this model offers a promising strategy to support the WHO NTD Roadmap 2021-2030 and Zero Leprosy goals.

Background Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is a key preventive strategy. However, optimal uptake remains inconsistent despite high antenatal care (ANC) attendance. This study assessed factors associated with IPTp-SP uptake and explored the experiences of postpartum women in rural Ghana. Methods A mixed-method study was conducted among 1,155 postpartum women attending child welfare clinics in Jomoro, Prestea-Huni Valley and Ellembelle districts of the Western Region of Ghana. Quantitative data were collected using structured questionnaires and analysed using descriptive statistics and chi-square tests. Qualitative data from in-depth interviews and focus group discussions were analysed thematically to explore womens experiences and perceptions. Results Overall, 73.5% (812/1105) of respondents received at least three doses of SP during pregnancy, in line with WHO recommendations. The most common number of doses received was three doses (31.5%, 348/1105), followed by four doses (26.4%, 292/1105), while a smaller proportion (8.1%, 90/1105) received only one dose. Knowledge of malaria in pregnancy was generally high: 92.7% (1027/1155) of respondents correctly identified its mode of transmission, while 75.1% (830/1155) and 83.5% (923/1155) were aware of the effects of malaria on pregnancy and the foetus, respectively. Uptake was not significantly associated with socio-demographic characteristics, including age, education, occupation, marital status, gravidity, and parity (p > 0.05). However, number of ANC visits was significantly associated with uptake (p = 0.006). Although not statistically significant, lower uptake was observed among peri-urban residents and uninsured women. Qualitative findings indicated that while women recognized the benefits of IPTp-SP, side effects such as nausea, dizziness, and discomfort, as well as challenges with tablet formulation and dosing negatively influenced adherence. Conclusions IPTp-SP uptake was high and largely independent of socio-demographic factors but strongly influenced by ANC attendance. Addressing experiential barriers and strengthening patient-centered counselling during ANC may further improve uptake and adherence.

Introduction: The advent of Endovascular surgery and the use of fluoroscopy-guided procedures have grown in the last decade, and with that increased the exposure of surgeons to cumulative ionizing radiation, increasing the risk of occupational health complications. Despite established radiation protection principles, adherence to radioprotection measures and surveillance practices remains uncertain in many settings. This study aimed to evaluate knowledge, availability, and implementation of radiation protection strategies among vascular surgeons in Brazil Metology: A national cross-sectional survey was conducted in February 2026 using an anonymous online questionnaire distributed to all active members of the Brazilian Society of Angiology and Vascular Surgery (SBACV). Associations between participant characteristics and radioprotection practices were explored using chi-square or Fishers exact tests. Results: Of 4,698 invited members, 192 vascular surgeons met the inclusion criteria. Most participants were male (67.4%), with a mean age of 45.9 years and a median of 12 years of experience performing fluoroscopy-guided procedures. Basic PPE use, particularly lead aprons, was nearly universal; however, adherence to other protective measures was substantially lower. Most respondents reported employing radiation-reduction strategies, including minimizing fluoroscopy time (98.9%), collimation (90.6%), optimized table and detector positioning (88.3%), procedural planning (87.2%), and pulsed fluoroscopy (81.0%). Only 19.4% reported undergoing annual medical surveillance for radiation-related health effects. Cataracts were the most frequently reported radiation-associated condition (6.2%). Greater age and professional experience were associated with higher utilization of selected protective measures and advanced imaging strategies. Conclusion: The study provides important insights into how radiation protection is currently understood and implemented in contemporary Brazilian vascular surgery practice. The incomplete use of personal protective equipment (PPE), with many justifications in addition to the low surveillance of the effects of radiation on health, brings us an alert about the reality in Brazil.

Colombia has been internationally recognised as a paradigmatic case of vaccine confidence crisis since the 2014 Carmen de Bolivar event, and national HPV vaccination coverage remains far below the World Health Organization 2030 target. Most published evidence focuses on female adolescents and on cervical cancer; the perception of the HPV vaccine in university-age populations of both sexes--and across the broader spectrum of HPV-attributable disease--remains comparatively understudied. We aimed to describe the influence of biopsychosocial determinants on HPV vaccine perception among university students of both sexes in Cucuta, Norte de Santander, Colombia. We conducted a cross-sectional study with a mixed quantitative-qualitative approach in 2024 among four universities (Universidad de Santander, Universidad Francisco de Paula Santander, Universidad de Pamplona and Universidad Libre; combined enrolment 21,033 students). Using convenience sampling stratified by institution, 750 actively enrolled undergraduate students of both sexes (18-60 years) completed a structured online questionnaire adapted from previously validated instruments. The instrument captured sociodemographic information, HPV knowledge and HPV vaccine perception. Data were analysed using Students t-test, one-way analysis of variance, Tukey post-hoc tests, effect sizes and 95% confidence intervals, with a 0.05 significance threshold. Of 750 respondents, 54.2% were women, 61.3% were under 20 years of age, and 75.1% attended public universities. HPV knowledge was high in 39.2%, intermediate in 42.4% and low in 18.4%; women and students aged 26 years or older displayed higher knowledge. Although 91.2% had heard of HPV and 82.5% knew that both sexes could acquire it, recognition of clinical manifestations and complications was uneven: cervical cancer 51.7%, penile cancer 30.5%, vaginal warts 45.9% and warts in the penis, larynx, anus or rectum 34.0%. Vaccine-specific knowledge was low in 77.1%, with men disproportionately represented (85.9% versus 69.5% in women). Overall positive perception of HPV vaccination was 66.6%, slightly higher in women (68.8%) than men (63.9%), in students aged 26 years or older (70.1%) and in students from private universities (68.1% versus 65.9%). Inferential analysis identified sex (Cohens d = -0.357), type of university (d = 0.189) and HPV knowledge (partial eta-squared = 0.096) as the only significant determinants. Age, socioeconomic stratum, age at sexual debut and vaccine-specific knowledge did not reach meaningful significance. HPV vaccine perception was predominantly positive but conditioned by three biopsychosocial determinants, with HPV knowledge as the primary driver. The persistent gender gap reflects historical anchoring of HPV messaging in cervical disease and female-targeted campaigns. Public-health strategies should adopt comprehensive, gender-inclusive educational interventions that explicitly visibilise non-cervical HPV-related cancers and address both sexes from a common evidence base.

Lassa fever (LF) is a viral disease that is widespread throughout West Africa, with significant global health consequences. Nigeria bears the highest burden (1309 confirmed cases in 2024) of LF among all endemic countries. Within Nigeria, Ebonyi State bears a high burden of cases. Clinical observations suggest that there may be an increase in the geographic spread and case fatality rate of LF across the State. Ebonyi State case-based data on confirmed cases from 2019 to 2023 collated on the Nigeria Centre for Disease Control and Prevention (NCDC) Surveillance, Outbreak Response Management and Analysis System (SORMAS) platform were analyzed. Descriptive statistics, spatial distribution and time series analysis were performed. Multivariate logistic regression analysis was used to identify predictors of LF mortality and factors associated with PCR positivity. A total of 1,624 suspected cases were reported, 1,343 and 273 were laboratory negative and positive respectively, while 8 probable cases were reported. The yearly number of cases remained stable throughout the study period. Out of the 273 confirmed, 107 died from LF, resulting in a case fatality rate (CFR) of 39.2%. CFR increased non-significantly over time, ranging from 28.6% to 55.8%. Variations in geographic distribution were observed; in 2019 ten local government areas (LGAs) were affected compared to twelve in 2020. A higher incidence was observed between January and March annually. Age above 44 years, bleeding and seizures were significant predictors of mortality. Lower incidence of cases was consistently reported in the Southern LGAs. PCR positivity was associated with individuals who reside in Ebonyi LGA and who have had contact with confirmed cases. The increase in CFR and identification of high-burden areas will help shape policies, allocate resources and provide actionable intervention strategies to combat LF in the State.