Pan African Medical Journal

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

Background and Aims: Hepatitis B virus (HBV) infection remains a significant global public health concern, particularly in developing countries, where it poses a major challenge to safe blood transfusion services. Blood donors represent an important subset of the population for assessing HBV prevalence, as transfusions are a key route for transmission. This study aimed to determine the seroprevalence of HBV infection among blood donors at Methodist Hospital, Wenchi, Ghana. Methods: A retrospective analysis was conducted using data from the blood bank at Methodist Hospital, Wenchi from January 2022 to December 2023 and analyzed using SPSS version 25. Results: The overall HBV seroprevalence among blood donors was 6.8%, with a higher infection rate among females (16.7%) compared to males (6.3%). The highest seroprevalence (9.4%) occurred in donors aged 30 to 39 years and voluntary donors showed a higher infection rate (8.2%) than non-voluntary donors (6.5%). Among blood groups, individuals with blood groups A and B exhibited the highest infection rates (8.5%). Factors such as age (AOR: 2.62, 95% CI: 1.10 to 5.32, p-value =0.023), gender (AOR: 2.10, 95% CI: 1.05 to 4.35, p-value= 0.004) and Rhesus status (AOR: 1.68, 95% CI: 1.08 to 3.35, p-value= 0.031) were significantly associated with HBV infection. Conclusion: The study revealed a significant HBV seroprevalence of 6.8% among blood donors, classifying the region as medium-endemic per WHO guidelines. The findings underscore the urgent need for enhanced HBV screening, rigorous blood safety measures and targeted public health interventions including vaccination and education campaigns to mitigate the transmission risk. Keywords: Hepatitis B virus, Blood donors, Seroprevalence, Seropositive, Ghana

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

The present study aimed to assess 8 key Maternal and Child Health (MCH) indicators and their socio-demographic determinants in Afghanistan using the 2015 Demographic and Health Survey. It was quantitative analysis on cross-sectional data of ever-married women aged 15-49. The MCH indicators included possession of a health card, birth weight of the child, postnatal check-up, full immunization, exclusive breastfeeding, tetanus toxoid, place of delivery, and antenatal check-up (ANC). We employed multiple correspondence analysis (MCA) and a general linear model to identify associations of MCH indicators with their determinants. The analysis was conducted among 30,000 women. MCA yielded one strong latent construct that accounted for 76.7% of the total variation. The ANC visits, place of delivery, possession of health cards, postnatal visits, and tetanus toxoid vaccination were strongly discriminating items for this dimension. Women who were younger, had a girl child, belonged to the lower wealth quintile, were illiterate, and did not have access to improved drinking water had a higher probability of poor maternal and child health indicators (p<0.05). The MCH situation and their socio-demographic determinants need to be addressed as a priority with concurrent investment in health infrastructure, womens education, and health literacy of populations.

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

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.

Background Hepatitis B virus (HBV) is a global health concern and the leading cause of chronic liver disease, including liver cirrhosis and hepatocellular carcinoma. The Uganda Ministry of health recommends screening of HBV for all pregnant mothers during antenatal care (ANC). However, limited literature exists regarding couple testing and outcomes, particularly in Northern Uganda. Objective We determined HBV seroprevalence and associated factors among pregnant women and their partner attending ANC clinic of Gulu Regional Referral hospital (GRRH), Gulu, Uganda. Methods Between 1st December 2023 and 28th February 2024, a hospital-based, cross-sectional study was conducted among eligible pregnant women and their male partners attending ANC of GRRH, Gulu, Uganda. Following systematic random sampling, pretested questionnaire was administered by an interviewer. Blood samples were collected for HBV surface antigen (HBsAg) rapid test, which was performed according to manufacturers instructions. Qualitative data was analysed using logistic regression in STATA version 15 SE. P<0.05 was considered statistically significant. Results A total of 242 couple pairs were enrolled. Overall, 8.3% (n=40) participants were seropositive for HBsAg; Male partners [M] (10.7%, n=26) and pregnant women [F] (5.8%, n=14). Sero-concordance (M negative [-ve] and F [-ve]; 83.5%, n=202), (M positive [+ve] and F [+ve]; 4.1%, n=10) and sero-discordance (M +ve and F -ve; 8.7%, n=21), (M -ve and F +ve; 3.7%, n=9). Factors associated with positive HBsAg were, being male (adjusted odds ratio [aOR]: 2.45, 95% Confidence Interval [CI], 1.15 - 5.21, p=0.02), daily alcohol consumption (aOR: 4.73, 95% CI: 1.40 -16.04, p=0.01), and no prior vaccination against HBV (aOR: 12.01, 95% CI: 4.07 - 35.65, p<0.001). Conclusion There is a high HBsAg seropositivity rate, particularly among male partners of pregnant women. There is an urgent need to have couples who come for ANC to be screened for HBV and to strengthen and sensitise young people for premarital HBV screening.

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

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.

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

Background: Diabetes mellitus is a global major health concern, with increasing prevalence in Ghana, causing significant mortality and morbidity. Effective management of this chronic condition depends on resilient healthcare systems that adhere to evidence-based guidelines. This study aimed to evaluate the quality-of-care at the diabetic clinic of the Cape Coast Teaching Hospital (CCTH) using the American Diabetes Association (ADA) guidelines as the benchmarks to show the performance of the hospital clearly, reveal gaps in the management algorithm that need to be addressed, and to contribute to the body of knowledge in the health sector of our country. Methods: Retrospective chart review was done from January 2022 to March 2023. 261 patient records were used out of a total study population of 780. Primary process indicators (medical history, physical examination, laboratory check-ups, referrals) and outcome indicators (HbA1c<7%, BP<140/90 mmHg, lipid profile, liver function test, kidney function based on eGFR categories). In analyzing the data, the Statistical Package for Social Sciences (SPSS version 21) software and STATA vs.14 were used to generate frequencies, means, and percentages presented in tables, charts, and graphs to provide answers to the research questions. Results: The overall documented adherence rates were: medical history (17%), physical examination (58.4%), laboratory evaluation (24%), and referrals (5%). These were coupled with low rates of achievement of treatment targets for various clinical outcomes, specifically glycated hemoglobin (HbA1c), blood pressure, lipid profile and estimated glomerular filtration rate (eGFR), with corresponding percentages of 47.2%, 42%, 47.1%, and 48.8%, respectively. Conclusion: The study, therefore, revealed gaps in compliance and documentation, which should be addressed to improve clinical care and patient outcomes.

Background Surveillance of adverse events following immunization (AEFI) and appropriate reporting are essential ingredients of an effective immunization programme. Despite increasing recognition by caregivers, the response to it remains a major problem, with the majority being inappropriate. This study is therefore intended to determine the prevalence, pattern, and determinants of caregivers response regarding AEFI in Nigerian hospitals. Methodology A descriptive cross-sectional study was conducted among 368 caregiver-infant pairs across 3 Nigerian hospitals, using semi-structured questionnaires to document sociodemographic characteristics and the prevalence, pattern, and determinants of caregivers response. Statistical analyses were performed using SPSS version 27. Predictors of AEFI and determinants of caregivers response were assessed using Pearsons chi-square and logistic regression. A p-value < 0.05 was considered statistically significant. Results The prevalence of AEFI was 71.7%, with inconsolable crying/irritability, fever, and swelling at the vaccination site as the leading cases. Infant age, weight, and gestational status at birth were predictors of AEFI occurrence. Only 8 (3.0%) caregivers presented at a healthcare facility when AEFI was noticed (appropriate response), while 360 (97.0%) did not (inappropriate). The relationship of the caregiver to the vaccinated infant (mother) was found to be a determinant of caregivers response to the occurrence of AEFI. Conclusion An increasing prevalence of AEFI that was not followed by an optimally appropriate response from caregivers has been demonstrated. This calls for more public enlightenment focusing on the need to report AEFI at healthcare facilities, as this will help in ensuring vaccine safety and improvement in the immunization programme.

Introduction Nigeria is still one of the countries in the world that practices Female Genital Mutilation (FGM), which remains a significant public health issue in Nigeria, particularly in Ibadan, with a prevalence rate of 38%. Despite increased awareness and advocacy, FGM persists as a rite of passage, chastity, or cultural custom. In this study, participants revealed generational knowledge gaps of FGM and barriers to the effectiveness of awareness programs. Methods This was a narrative inquiry study conducted between August 2024 and December 2024 among female young adults of reproductive age (18-49 years) living across different local government areas of Ibadan metropolis. A purposive and snowballing sampling technique was adopted, where semi-structured in-depth interviews were used. Interviews were audio recorded and transcribed verbatim, where insights into participants' experiences, perspectives, and attitudes impacted by awareness programs, as well as the interaction of cultural phenomena with public health education, were discussed and analysed through thematic analysis to present findings. Results The participants were able to disclose that awareness programs in schools and community-based initiatives have proven to empower younger generations, but bridging generational knowledge gaps remains a challenge, with barriers like entrenched cultural norms, limited geographical accessibility, insufficient funding, and weak enforcement of anti-FGM laws, and suggestions on how awareness programs against FGM can be more effective. Conclusions Awareness programs on younger generations are effective in tackling the prevalence of FGM, although they still face some entrenched cultural norms. The integration and sustenance of culturally sensitive messages into the education and healthcare sectors, both in rural and urban areas, will be of great help to counter the entrenched cultural norms of people still practicing them. Similarly, the implementation and enforcement of laws and policies by the government, and the proper execution of sanctions against the practice of FGM in society, should be adopted.

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.

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

Background and aims- Patients for interventional pulmonary procedures (IPP) are inherently high risk due to various comorbidities as well as the procedure being variable in duration and adverse events. Incomplete muscle reversal can delay rapid recovery and lead to adverse events in the postoperative period. Sugammadex as a reversal agent, may offer distinct advantages when residual neuromuscular blockade is poorly tolerated. Limited data is available on use of suggamadex in high risk IPP regaurding extubation times and adverse events. Studies on pulmonary complications and anaphylaxis in this subset of pulmonary patients is controvertial. Moreover in the Indian setup optimizing the turnaround time to justify the cost of suggamadex for IPP is yet to be determined. In this retrospective study we will compare the advantages of using Sugammadex over the conventional reversal agent Neostigmine for time to extubation and time to shifting the patient to PACU in patients undergoing IPP. The hemodynamic parameters and adverse events will also be noted. Materials and methods-After ethics approval from institute (EC/OA- 48/2025) we conducted a retrospective cohort study of 70 adults (18-60yrs) for a duration of 6 months in our institute who underwent IPP under general anaesthesia ( tracheal dilation, tracheal biopsy, EBUS TBNA,BAL etc) . They were categorized into two groups: Group A- suggamadex vs. Group B- neostigmine. TOF monitoring was recorded and time to extubation and shift to PACU was noted along with hemodynamics and adverse effects. The statistical software SPSS version 16 was used for the analysis. Results-A total of 70 patients were included. Patients in Group sugammadex showed less time to extubate (5.80+/-0.96 vs 13.26+/-1.88 ,P value 0.0001) and discharge from PACU (10.49+/-1.44 vs 28.57+/-3.34 min, P = 0.000003) than in Group neostigmine. The difference between heart rate , blood pressure and respiratory rate and adverse events were not statistically significant. Conclusion-Sugammadex shortens the time to extubate and discharge from PACU in patients undergoing IPP, accelerating recovery and turnaround time. No additional adverse events or hemodynamic instability were noted with suggamadex in this subset of patients. No coughing irritable airway.

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

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

Sepsis and septic shock remain critical medical emergencies that require timely and effective interventions. This study evaluates the knowledge, attitudes, and practices (KAP) of healthcare professionals in Bahrain concerning the management of sepsis and septic shock. A cross-sectional survey was conducted among a sample of 260 healthcare professionals who consented to participate out of 310 approached, yielding a response rate of 83.9%. Data were collected using a structured, self-administered questionnaire designed to ensure anonymity and consistency in responses. Data were analyzed using descriptive and inferential statistics via IBM SPSS version 29. Most participants demonstrated sound general knowledge of sepsis, with 90.7% correctly identifying broad-spectrum antibiotics as the first-line treatment. However, awareness of certain clinical tools was lower--only 44.6% recognized the qSOFA score and 60% understood the use of capillary refill time. Knowledge levels were significantly higher among males (77.4%) than females (70.6%, p = 0.043), and among those with advanced degrees (p < 0.001), especially doctorate holders (84.5%). Physicians had the highest average knowledge scores (91.0%), followed by PharmD holders (82.2%). Positive attitudes toward early sepsis recognition were reported by 82.2% of participants, particularly among those with doctoral education and over 21 years of experience. In practice, 72.7% routinely assessed for organ dysfunction, and 51.9% initiated antibiotic therapy within the first hour of diagnosis. The study identified significant gaps in diagnostic tool familiarity and clinical practice consistency. These findings underscore the importance of initiatives to enhance adherence to sepsis management protocols in Bahrain.