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.

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.

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.

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: Healthcare-associated infections (HAIs) remain a major patient safety challenge in sub-Saharan Africa, where gaps in infection prevention and control (IPC) practices persist. Nursing and midwifery students are particularly vulnerable during clinical training, yet evidence on their IPC knowledge and compliance in Ghana remains limited. Objective: To assess knowledge of nosocomial infections and compliance with standard precautions among third-year nursing and midwifery students at Kwame Nkrumah University of Science and Technology (KNUST), Ghana. Methods: A descriptive cross-sectional study was conducted among 150 third-year nursing and midwifery students at KNUST, Kumasi, Ghana, between 28 June and 9 July 2021. Data were collected using a structured questionnaire adapted from WHO and CDC guidelines. Knowledge was assessed using a 19-item scale and compliance using a 17-item Likert-type scale. Chi-square tests, Fisher's exact test, and Spearman's rank correlation were used to examine associations between knowledge and compliance. Results: Overall, 143 respondents (95.3%) demonstrated high knowledge of nosocomial infections and standard precautions (mean score: 16.44/19; SD: 1.59). High compliance with standard precautions was reported by 112 respondents (74.7%; mean score: 59.13/68; SD: 5.89). Compliance was strongest for hand hygiene and glove use but lower for PPE use during splash-risk procedures and safe needle-handling practices. No statistically significant association was found between categorized knowledge and compliance levels (df = 1, p = 0.491; Fisher's exact p = 0.679). However, a modest positive correlation was observed between continuous knowledge and compliance scores (Spearman's rho = 0.326, p < 0.001). Conclusion: Although knowledge of nosocomial infections was high, compliance varied across standard precaution domains, with notable gaps in PPE use and safe needle-handling practices. Practical training, simulation-based learning, and supervised clinical reinforcement are needed to bridge the knowledge practice gap in nursing and midwifery education in Ghana.

Abstract Background: The current coverage of MCCD in India is only 22%. This is due to incomplete coverage of hospitals under MCCD and also lack of a system for non-institutional deaths in the country. The quality of MCCD in the country is also poor. One of the main reasons for this is the lack of review and feedback at the district level. This study would be the first of its kind study in the country to test the effectiveness and feasibility of involving the district level CRS/Health dept officials in review of MCCD Objectives: To assess the feasibility and effectiveness of a district level review system for MCCD in improving the coverage and quality of MCCD Methods: The study would be conducted in Chikkaballapura district for a period of 2 years. Local Registrars would do a first level of review of MCCD forms for completeness, use of abbreviations, legibility. They would also ensure that form 4/4A is written for all registered deaths in their area. A MCCD review committee would assess the quality of MCCD forms on a monthly basis and provide feedback to the certifying doctors. Comparison of the pre-test and post-test coverage and quality of MCCD will be done. Results: Constitution of the audit committee, training of local registrars, doctors and committee members and baseline assessment have been completed. Intervention has been started from Nov 2025. Expected Outcomes: Improved coverage and quality of MCCD and as a result cause of death data of the district

Bacterial contamination of Surgical sites could lead to Surgical Site infections (SSI) which may prolong hospital stay, increased treatment costs and increased mortality. This study determined the prevalence of bacterial contamination of surgical sites among post-operative wounds and theatre surfaces together with their resistance to commonly prescribed antibiotics. A cross-sectional study design was used where a total of 290 and 74 swabs were collected from patients and theatre surfaces respectively. Swabs were cultured on duplicate plates of Blood Agar, Chocolate Agar and MacConkey Agar. Gram-staining and Biochemical tests were performed to identify the isolates. Resistance to commonly prescribed antibiotics was determined using the Kirby Bauer (KB) method. Data were analyzed using SPSS version 23, and descriptive statistics, Chi square and student T- tests were used to describe the results. The prevalence of bacterial contamination in wounds was 30.7% and was significantly higher in women of child bearing age ({chi}2= 10.79, df=1, P=0.0010). Microbial growth increased with an increase in duration of antibiotic therapy ({chi}2=12.73, df=2, P=0.007). E. coli was responsible for the highest cases of wound contamination (34.9%). All microorganisms isolated from post-operative wounds showed considerable resistance to antimicrobials. All isolates from wounds were resitant to Trimethoprin Sulfamexathone and 76.9% showed resistance to Ciprofloxacin. Other than E.coli and Acinetobacter, the rest of the isolates were susceptible to imipinem. Fourty nine gram positive isolates were grown from theatre surfaces and a significant majority (86%) were from air. There was high resistance to Erythromycin in Coagulase Negative Staphylococcus (CNS) isolates (56.0%). Overall, our study demonstrated that wound contamination at the Hoima Regional Referral Hospital is high but not associated with theatre surface contamination.

Effective management of biomedical equipment prevents breakdowns, extends equipment lifespan, ensures perioperative safety and cost-efficiency. There are major challenges in managing biomedical equipment, particularly in low- and middle-income countries. This study aimed to assess the availability, functionality, and adherence to maintenance practices of biomedical equipment in operating rooms (ORs) and post-anaesthesia care units (PACUs) across Rwanda. A cross-sectional observational study was conducted at one Level 2 district hospital in each of Rwanda's five provinces (n=5 sites). Data were collected using three main tools: 1) a medical equipment checklist, 2) a checklist for hospital biomedical management, and 3) direct inspections of selected biomedical equipment. All tools underwent pretesting and face validation with support from biomedical experts prior to data collection in May 2024. Key measures, including the availability and functionality of biomedical equipment, and adherence to maintenance and management practices, were summarised using descriptive statistics. The five hospitals had a total of 16 ORs, 4 PACUs, and 226 pieces of equipment. The overall availability of biomedical equipment was 45%, and the functionality of the available equipment was 96%. The mean adherence rate to national management practices was 66%. The Rwandan government, non-governmental organisations, and hospitals were identified as direct funders of the equipment, accounting for 42%, 12%, and 4%, respectively. However, 42% of the equipment surveyed could not be linked to any of the above sources of acquisition. Among non-functional equipment, 75% was due to a lack of spare parts, while 25% was due to a lack of skills to maintain the equipment. In summary, we found low availability of perioperative biomedical equipment across Rwanda, although the available equipment was highly functional. Adherence to national management practice guidelines was relatively low, threatening the sustainability of functional equipment. We recommend that the government and hospital administrators implement robust, regular auditing systems to ensure proper management of biomedical equipment.

Background: Climate change is an escalating global health threat, with sub-Saharan Africa disproportionately affected due to entrenched spatial inequalities, high exposure to environmental hazards, and limited adaptive capacity. Increasingly frequent extreme weather events (EWEs), including floods and cyclones, are reshaping the material and social conditions of place, with implications for mental health and wellbeing. However, evidence remains limited, particularly multi-country qualitative research that examines how mental health impacts are produced through lived experiences of place in contexts of recurring environmental disruption and structural vulnerability. This study explored the mental health and wellbeing impacts of EWEs among individuals with lived experience of such events in Mozambique, Burkina Faso, South Africa, and Kenya, using participatory methods that centred community narratives and place-based accounts of everyday life. Methods: This qualitative study employed digital storytelling as a participatory visual method to examine how EWEs are experienced and narrated across diverse socio-spatial contexts. A total of 37 participants (8 to 10 per country) were recruited from rural, peri-urban, and informal urban settlements with recent exposure to flooding or cyclone events. Participants produced digital stories during facilitated five-day workshops. These narratives were analysed using inductive and deductive thematic analysis informed by Braun and Clarke's framework, with attention to the spatial and relational production of distress and coping. Results: Across Mozambique, Burkina Faso, South Africa, and Kenya, findings show that the mental health impacts of EWEs are deeply embedded in place-based conditions and are cyclical, cumulative, and relational rather than confined to discrete disaster events. Participants described how repeated environmental disruptions reconfigured everyday life in place, generating ongoing uncertainty, anticipatory anxiety during rainfall periods, and acute fear during floods and cyclones. Loss of housing, livelihoods, infrastructure, and social anchors of place contributed to enduring psychological distress, which was frequently reactivated by subsequent environmental cues such as heavy rain, wind, and deteriorating physical environments. Persistent anxiety, hypervigilance, sleep disturbance, and emotional distress were reported across all sites. While social and community networks constituted critical infrastructures of care within place, these were often simultaneously overwhelmed as entire communities experienced shared disruption. Limited and delayed institutional responses further compounded spatial and social precarity. Conclusions: This study provides a comparative participatory account of how EWEs shape mental health through their embeddedness in place across diverse sub-Saharan African contexts. The findings demonstrate that psychological distress is produced through the interaction of repeated environmental exposure, structural inequality, and disrupted place-based infrastructures of daily life, rather than emerging solely as a post-disaster outcome. These results underscore the need for climate-responsive mental health and psychosocial support that is integrated into place-based disaster risk governance, alongside strengthened social protection and community infrastructure that can sustain wellbeing in contexts of recurring environmental instability.

Tomato (Solanum lycopersicum L.) is one of the most important vegetable crops in Nigeria, serving as a major source of income, nutrition, and raw material for food industries. However, its production is severely constrained by Fusarium wilt, a destructive soil-borne disease caused by Fusarium oxysporum f. sp. lycopersici. This study investigated the prevalence and severity of Fusarium wilt on tomato in Chikun Local Government Area (LGA) of Kaduna State, Nigeria. Field survey and laboratory analyses were conducted on forty-five tomato samples from three tomato farms Kujama, Kakau, and Rido. The samples were examined for disease incidence and severity. Data were analyzed using descriptive statistics and Chi-square tests. The overall disease incidence was with Rido recording the highest infection rate (80.0%), followed by Kujama (60.0%) and Kakau (40.0%). Among plant parts, the stem exhibited the highest infection frequency (80.0%), while leaves and fruits had 60.0% and 40.0% incidence respectively. Chi-square analysis indicated no significant difference (p > 0.05) in disease incidence among farms and plant parts, suggesting uniform pathogen distribution. The research recommends the adoption of integrated disease management strategies and improved farmer awareness to mitigate the impact of the disease and ensure sustainable tomato production.

Health workforce performance is central to service quality, yet little empirical work has examined how performance management systems operate for physiotherapists in rehabilitation services in low- and middle-income settings. This cross-sectional study assessed the current state, perceived effectiveness, and process gaps of performance management systems among physiotherapists working in public rehabilitation centers in Dhaka, Bangladesh. A pretested semi-structured questionnaire was administered to 105 physiotherapists between September and October 2025. Descriptive statistics were used to summarize participant characteristics and performance management indicators. Wilson 95% confidence intervals were estimated for key proportions. A nine-item exploratory performance management system maturity score was constructed from process indicators. Fisher exact tests with Cramer's V were used to examine associations with perceived system effectiveness, and exploratory logistic regression estimated odds ratios for effective or moderately effective performance management. The mean age of respondents was 31.6 years, 56 of 105 were male, and 85 of 105 had graduate or postgraduate qualifications. Formal performance management systems were reported by 102 of 105 respondents (97.1%, 95% CI 91.9-99.0). Standardized appraisal timing and method, assessment form use, performance planning, and formal evaluation systems were each reported by about 60-70% of participants. Reward-performance linkage was perceived as motivating by 97 of 105 respondents (92.4%, 95% CI 85.7-96.1). Overall, 81 of 105 respondents (77.1%, 95% CI 68.2-84.1) rated the system as effective or moderately effective. Training recipient category was associated with perceived effectiveness (Fisher exact p=0.0035; Cramer's V=0.363), as was perceived appropriateness of the process (p=0.0323; Cramer's V=0.258). The maturity score was not independently associated with perceived effectiveness in exploratory regression. Public rehabilitation centers in Dhaka appear to have formal performance management systems, but the systems are only moderately developed. Strengthening training coverage, transparent evaluation criteria, routine feedback, and formal system review may improve staff confidence in performance management processes.

Domestic gender-based violence (DGBV) remains a major public health concern that undermines womens sexual and reproductive health (SRH). This study assessed the influence of DGBV on SRH-seeking behavior among women of reproductive age in the Lusaaze Zone, Kampala District, Uganda. A quantitative cross-sectional descriptive-correlational design was employed among 383 women aged 15 to 49 years selected through systematic random sampling. The data were analyzed using descriptive statistics, chi-square tests and modified Poisson regression. The prevalence of DGBV was high, with 61.6% of women reporting public humiliation, 60.0% reporting physical violence, 59.0% reporting forced sexual intercourse, and 45.1% reporting economic exclusion. Women exposed to DGBV were nearly twice as likely to report partner prevention of HIV service access (66.8% vs. 35.2%; p < 0.001). Household financial control emerged as the strongest predictor of DGBV exposure, with women whose partner-controlled household income was approximately 2.4 times more likely to experience violence. The primary indicator for SRH-seeking behavior was STI treatment-seeking status, which was not independently associated with DGBV after adjustment (aPR=0.99, 95% CI=0.65 to 1.49). The study concludes that DGBV is highly prevalent and driven largely by unequal household power relations. Strengthening community DGBV prevention programs, womens economic empowerment, and the integration of DGBV response services within SRH programs are recommended.

Ethnic minority and migrant populations experienced disproportionately severe COVID-19 outcomes across Europe, yet the mechanisms underlying these disparities, particularly inequities in healthcare access, remain insufficiently understood at the patient level. This qualitative study examines healthcare-seeking behaviours and access to care among ethnically diverse patients hospitalised with COVID-19 in Amsterdam between 2020 and 2022, and the contextual factors shaping their pathways to care. Twenty adults of Turkish, Moroccan, Surinamese, Ghanaian, and Dutch ethnic backgrounds, all hospitalised with COVID-19, were interviewed using a semi-structured retrospective approach to reconstruct individual care pathways from symptom onset to hospitalisation. Data were analysed thematically, guided by the Candidacy Framework and the Health Belief Model. Pandemic-induced structural disruptions, including healthcare system strain, capacity shortages, absent care protocols, and fragmented referral pathways, constituted the primary barriers to care across all ethnic groups. Participants with longer hospital stays tended to be older, less educated, and with more comorbidities, yet reported fewer barriers once hospitalised, as disease severity triggered prioritisation. Those with shorter stays or emergency department visits without admission encountered greater difficulties, including repeated discharge despite worsening symptoms. Language barriers and prior negative experiences with healthcare services compounded access challenges for some participants with migrant backgrounds, though pandemic phase and disease severity were the dominant determinants across the sample. Inequities in access to care were driven primarily by pandemic-induced structural factors rather than ethnic background. Pre-existing vulnerabilities among migrant groups, including reduced institutional trust and language barriers, intensified these structural barriers for some. These findings are directly relevant for equity-sensitive pandemic preparedness: crisis response frameworks must explicitly address structural accessibility alongside targeted support for groups facing compounding disadvantage.

Background: Hemorrhoids are among the most common anorectal disorders, yet traditional treatment practices remain widespread in Ethiopia. These remedies often involve corrosive chemicals, herbal preparations, or invasive procedures, and are associated with severe complications. Despite their prevalence, systematic evidence on outcomes and community perceptions is limited. Methods: A hospital?based cross?sectional study was conducted from December 30, 2024 to December 29, 2025 in Sidama, Ethiopia. A total of 450 patients diagnosed with hemorrhoids and managed across five government hospitals were enrolled. Structured questionnaires and medical record review were used to collect socio?demographic characteristics, clinical presentation, hospital management, traditional treatment practices, complications, and community perceptions. Descriptive statistics and independent sample t?tests were applied. Results: The mean age of participants was 35.2 years, with a predominance of males (63.1%) and urban residents (72%). Perianal pain (84%) and rectal bleeding (50%) were the most frequent symptoms. Independent samples t?test analysis demonstrated that patients who visited traditional healers were significantly older than those who did not (mean age 48.2 vs. 34.4 years; mean difference = 13.8 years, 95% CI: 8.8-18.8; p < 0.001). Hospital management, primarily hemorrhoidectomy (31.8%), achieved favorable outcomes, with 97.3% of patients improving. Twenty-eight patients (6.2%) reported using traditional healers, most commonly involving topical chemical applications (71.4%). Complications were frequent among traditional users, with 85.7% experiencing adverse outcomes such as persistent pain, anal stenosis, and perianal discharge. Despite these complications, community perceptions remained largely positive or neutral, influenced by family and peers. Conclusion: Traditional hemorrhoid treatment in Southern Ethiopia is associated with high complication rates, yet community perceptions remain favorable due to sociocultural influences. Hospital management demonstrates superior outcomes. Bridging the gap between biomedical care and community beliefs is essential to reduce morbidity and promote safe treatment .

Background: Human Tungiasis is a neglected tropical skin disease caused by the sand flea Tunga penetrans, associated with pain, inflammation, secondary bacterial infections, and significant morbidity. Despite its health impact on school children, it remained understudied in Kamushoko Parish, Bubaare Sub-County, Mbarara District, Uganda. Objectives: To determine the prevalence and identify associated factors of human Tungiasis among primary school children in Kamushoko Parish, Bubaare Sub-County, Mbarara District. Methods: A school-based cross-sectional descriptive study was conducted among 415 primary school children (P1-P7) at Katooma II and Komuyaga Primary Schools in March 2026. A census sampling approach enrolled all eligible pupils. Data were collected through structured face-to-face questionnaires and clinical examination of exposed areas. Tungiasis diagnosis was based on clinical identification of characteristic lesions with microscopic confirmation of extracted specimens. Bivariate and multivariate logistic regression analyses identified independently associated factors. Results: Of 415 children examined, 22 had active Tungiasis lesions, yielding an overall prevalence of 5.3% (95% CI: 3.53%-7.90%). Katooma II Primary School recorded a slightly higher prevalence (6.29%) than Komuyaga Primary School (4.78%), though the difference was not statistically significant (p = 0.499). Male children had higher odds of infection than females (7.1% vs. 3.7%). Children aged 9-10 years had the highest prevalence (7.7%). In the multivariate logistic regression, walking barefoot at school was the only independently significant predictor of infection (aOR = 0.18 for home vs. school; 95% CI: 0.04-0.78, p = 0.022). Conclusion: The prevalence of Tungiasis among primary school children in Kamushoko Parish was 5.3%, confirming ongoing transmission in the community. Walking barefoot at school was the only independent predictor of infection, highlighting the school environment as a critical intervention site. School-based strategies including grounds improvement, routine classroom cleaning, enforcing no-barefoot policies, and health education are recommended.

Catastrophic geopolitical conflicts increasingly disrupt the continuity of global medical education, placing immense pressure on clinical training pipelines and forced-migration student groups. While short-term, reactive, remote learning models exist, there are a profound lack of evidence-based implementation templates for medical schools within stable host nations to systematically host and integrate displaced clinical student cohorts mid-stream. This study explores the multi-level barriers and facilitators to hosting displaced medical students across diverse international environments, seeking to establish a rigorous, scalable model of educational sanctuary while advancing implementation science theory in crisis contexts. Employing a qualitative multi-site case study design guided by a critical realist ontology, this study analysed 66 semi-structured interviews with displaced Gazan medical students, hosting lecturers, clinical coordinators, and support staff across the United Kingdom, Malaysia, Pakistan, Turkey, and South Africa, mapping reflexive thematic analysis findings onto the Consolidated Framework for Implementation Research (CFIR). The analysis revealed that while rigid immigration policies, clinical placement caps, and severe cultural distance represent substantial barriers, key facilitators include assessment considerations, flexible placement models, sanctuary institutional cultures, peer networks, and decentralised administrative trust. Strategic administrative approaches, such as classifying displaced students as extended clinical elective visitors rather than full-time matriculants, enabled institutions to accommodate them within existing frameworks. This study demonstrates that public sector higher education institutions can act as vital global sanctuary networks to preserve clinical training pipelines. Crucially, the findings advance implementation science by proposing three novel constructs for the updated CFIR in crisis environments: Agile Implementation Over Perfection within the Implementation Process domain, Protective Leadership Shielding within the Inner Setting domain, and Bidirectional Boundary Subversion at the Inner/Outer Setting interface. This theoretical refinement transforms CFIR from a determinant model for stable, clinical interventions into an active, equity-driven framework for rapid humanitarian response in politically contested environments.

Rabies remains a significantly underreported fatal zoonosis in India, where the Arctic-like 1a (AL1a) lineage predominates in dog populations. While atypical clinical presentations in dogs can delay diagnosis and increase human exposure risk, genomic and clinical data on neonatal canine rabies remain limited. This study reports an exceptional case of rabies in a 54-day old unvaccinated German shepherd puppy which presented with severe pruritus and self-biting behaviour. The puppy was euthanized due to poor clinical response. Post-mortem testing revealed viral antigen (by Direct Fluorescent Antibody Test) and viral RNA (by real-time RTPCR) in the brain tissue. Whole-genome sequencing recovered a near-complete rabies virus genome (11,947 nucleotides; 99.5% genome coverage), classified within the AL1a_A1.1 sublineage. Phylogenetic analysis revealed close genetic relatedness to contemporary Indian rabies virus strains. Comparative genomic analysis identified 4, 3, 6, and 8 non-synonymous substitutions in the phosphoprotein, matrix, glycoprotein, and polymerase genes, respectively. This case is one of the youngest documented cases of canine rabies with atypical manifestations, caused by the AL1a viral clade. Our findings highlight the risks associated with neonatal canine rabies, the need for heightened clinical suspicion in atypical cases, and the importance of genomic surveillance to monitor evolving rabies virus lineages in endemic regions.

Abstract Background: Despite considerable reductions in under-five mortality during the Millennium Development Goal era, progress towards Sustainable Development Goal (SDG) 3.2 remains uneven across Africa. Identifying countries at greatest risk of missing the target is essential for prioritizing interventions and resource allocation. Methods: A Bayesian spatial forecasting ecological study was conducted using 2024 country-level data from 49 African countries obtained from UNICEF. Spatial dependence was assessed using Global Moran's I and Local Indicators of Spatial Association. Bayesian structured additive regression models with Gaussian, Gamma, and Exponential likelihoods were fitted using Integrated Nested Laplace Approximation (INLA) and compared using the Deviance Information Criterion (DIC), Watanabe-Akaike Information Criterion (WAIC), and conditional predictive ordinates. Posterior exceedance probabilities were estimated, an SDG Failure Index (SFI) and a Priority Intervention Index (PII) were developed, and Bayesian posterior predictive simulations were performed to estimate country-specific probabilities of attaining SDG 3.2 by 2030. Results: Significant spatial clustering of under-five mortality was observed with (Moran's I = 0.355, p < 0.001), and hotspots in Benin, Cameroon, and Nigeria. The Gamma model provided the best fit (DIC = 114.92; WAIC = 111.71). Diarrhoea was the only significant predictor (posterior mean=0.030; 95% credible interval: 0.004-0.056). Twenty-three countries (46.9%) were classified as high risk, whereas only five (10.2%) had achieved SDG 3.2. West Africa recorded the highest mean mortality (7.05%) and North Africa the lowest (1.64%). Bayesian projections indicated that only five countries were likely to achieve SDG 3.2 by 2030, while 41 (83.7%) were unlikely to do so. Conclusion: Considerable geographical inequalities in under-five mortality persist across Africa, and most countries remain off-track for achieving SDG 3.2 by 2030. The integration of exceedance probability mapping, the SDG Failure Index, the Priority Intervention Index, and Bayesian probability forecasting provides a practical framework for monitoring progress and prioritizing countries requiring accelerated action towards achieving SDG 3.2.

Background A small proportion of hospitalized patients generates a disproportionate share of inpatient admissions, bed-day utilization, and associated health expenditure globally. In Saudi Arabia, where Vision 2030 mandates measurable reductions in preventable hospitalizations and hospitals consume approximately 79% of public health expenditure, population-level evidence on inpatient frequent utilization is absent from the published literature. A key methodological limitation of existing studies is reliance on a single threshold that cannot distinguish acute high-frequency episodes from sustained multi-year hospital dependence. Methods A retrospective cross-sectional study analyzed electronic health records from three public hospitals in Jeddah - East Jeddah Hospital (EJH), King Abdul-Aziz Hospital (KAAH), and Thagher Hospital (TH) - for January 2022 to December 2024. Records from two clinical information systems (Oasis at KAAH and TH; Careware at EJH) were harmonized using an eight-stage data quality protocol applied to 258,391 raw encounters, yielding a final cohort of 82,160 unique patients and 100,685 valid inpatient visits. Three complementary definitions were applied: Frequent Utilizer (FU: >=3 admissions within any rolling 365-day window), Persistent Utilizer (PU: >=3 admissions with >=24 months between first and last), and Yearly Utilizer (YU: >=1 admission in each of 2022, 2023, and 2024). Analyses were conducted in JASP 0.95.4. Results FU prevalence was 2.96% (n=2,434), PU 0.60% (n=494), and YU 0.62% (n=507). Overlap analysis identified 177 compound utilizers (0.22%) satisfying all three criteria simultaneously, with a median of 7 admissions and 33.44 bed days - more than thirteen times the standard patient median. Compound utilizers had the youngest median age of any utilizer group (24 years), while Saudi nationality concentration rose progressively from 75.0% in standard patients to 87.6% in compound utilizers, and female predominance was highest in the persistence-defined groups (PU-only 62.9%, YU-only 63.6%). All three ANOVA models confirmed significant utilizer status x hospital interactions (all p<.001). Logistic regression confirmed age, Saudi nationality, and hospital as independent predictors across all definitions. A gender discrepancy - significant for males in FU Model 1 (OR=1.090, p=.039) but not Model 2 (p=.181) - was attributable to age confounding. Conclusions Approximately one in thirty-four inpatients meets the FU criterion in this Jeddah system, with significant between-hospital variation. The three-definition framework reveals clinically distinct utilization phenotypes invisible to any single threshold, including compound utilizers with extraordinary burden and unexpectedly young age, and persistent users entirely missed by annual-window definitions. Saudi nationality is the strongest and most consistent predictor across all definitions. Integrated clinical pathways connecting primary care and community services to hospital care, with shared accountability for quality across levels, are the recommended system response aligned with Vision 2030.

Snakebite envenoming is a neglected tropical disease with a disproportionate burden in sub-Saharan Africa, where weak surveillance, limited antivenom availability, and reliance on traditional remedies compound morbidity and mortality. Evidence on how snakebite cases are clinically managed in routine practice in Uganda remains scarce. We conducted a facility-based cross-sectional study with retrospective abstraction of records from four purposively selected health facilities in Gulu and Arua districts of Northern Uganda. Snakebite case records from outpatient, inpatient, paediatric, and intensive-care service points covering the period 2017-2021 were reviewed using a standardised abstraction tool. Descriptive statistics were computed in Stata version 14, with frequencies and proportions for categorical variables and medians with interquartile ranges (IQR) for continuous variables. A total of 227 snakebite case records were analysed, of which 58.6% were female, a median age of 21 years (IQR 13-38), and 31.3% were students. Most bites involved the lower limb (85.9%) and occurred in the second and third quarters of the year (59.9%). Snake species was undocumented in 76.2% of records. Pre-hospital first aid was either undocumented (59.1%) or inappropriate such as applying tourniquets (29.3%) and herbal remedies (8.9%). The dominant clinical manifestations were pain (60.8%), swelling/blisters (58.7%), and fang marks (26.9%), while 18.5% had features suggesting envenomation, of whom only 33.3% received antivenom. Overall, only 15.0% of cases received antivenom, while supportive care predominated (intravenous fluids 68.1%, analgesics 64.2%, antibiotics 53.1%). Coagulation testing was rare (20-minute whole blood clotting test 17.3%; INR 12.0%). Overall, 93.4% of patients recovered, 3.1% died, 0.9% were referred to other healthcare facilities, and the rest (2.6%) had missing information on the outcomes. Snakebite management in Northern Uganda is largely symptomatic, with critical gaps in species identification, syndromic assessment, coagulation testing, antivenom utilisation, and pre-hospital first aid practices. Strengthening health-worker training, improving documentation and surveillance, and community education on appropriate first aid are urgently needed to reduce preventable morbidity and mortality.