Pan African Medical Journal

Introduction: Uganda has the highest number of Malaria cases in East and Southern Africa and accounted for 3% of deaths in 2020. This calls for prevention, early diagnosis and treatment of Malaria most especially among children whose condition can progress to severe Malaria within 24 hours. While numerous interventions have been put into place to prevent malaria transmission, delays in diagnosis and treatment of Malaria when ill can lead to further mortality. Therefore, factors associated with delayed access of care among children under five with malaria and their outcomes need to be explored. Methods: A cross sectional study was carried out. The target population was parents/caretakers to children under five with malaria at Mbale Regional Referral Hospital. A consecutive sampling technique was used on the target population. Quantitative data was collected using researcher administered questionnaires designed consistent with the research objectives. Collected data was analyzed using STATA version 15. Results: Among the 216 children under five admitted at Mbale regional referral hospital with Malaria, 59.26% received care from a health facility 24 hours after symptom onset. The most significant predictors of delay in seeking care were the caregiver/ parent having attained tertiary education (AOR=7.1, p value=0.02) and initially implementing other measures other than giving medication/herbs before taking a child to the health center (AOR=4.1, p value=0.00). Conclusion: Despite the numerous interventions put into place to curb the spread of malaria and to manage malaria, delayed access of care remains a significant contributor to the adverse effects of malaria among children under five. Health education on the impact of delayed access of care should be intensified at all levels of healthcare.

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.

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: 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: 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.

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

Background 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.

Birth preparedness is a critical strategy aimed at promoting safe childbirth by encouraging pregnant women and their families to create thoughtful birth plans and prepare for potential complications. This approach ensures timely access to skilled maternity and health care services, which are essential for reducing maternal mortality. This study assessed the factors influencing birth preparedness among pregnant women attending Antenatal Care Clinics at the Regional Referral Hospital in Makeni City, Sierra Leone. A probability sampling method was used to select 112 pregnant women, and data were collected during 2023 with a structured questionnaire, using the Matturie Birth Preparedness Scale, as uniquely designed and prepared for this study. The collected data were analyzed using STATA software (version 14.0). Our findings revealed significant gaps in birth preparedness: 83.0% of respondents were unaware of their expected delivery date, 79.5 % did not register for antenatal care in their first trimester, and 72.3% had not chosen a delivery location. A striking 92.9% had not identified a potential blood donor. Knowledge gaps were evident, with 62.5% lacking childbirth knowledge and 55.4% unaware of pregnancy complications. Overall, only 17.86%(= 0) of respondents were genuinely prepared for childbirth. Our study highlights a significant lack of birth preparedness among pregnant women in Makeni City, Sierra Leone, with low awareness of critical factors such as expected delivery dates, danger signs, and prenatal emergency planning.

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.

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.

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

Snakebite envenoming remains a neglected tropical disease and an important public health challenge in Zambia. Effective management of snakebite patients requires healthcare workers who are adequately trained, familiar with treatment protocols, and aware of national management guidelines. However, evidence regarding healthcare worker preparedness for snakebite management in Zambia remains limited. This study explored healthcare worker preparedness for snakebite management in selected hospitals in Zambia. An exploratory cross-sectional study was conducted in seven hospitals in Zambia between collected between May and July 2025. Twenty-one healthcare workers, comprising senior clinicians, junior clinicians, and nurses, were purposively selected to participate. Data were collected using a structured questionnaire assessing training in snakebite management, clinical exposure to snakebite cases, confidence in management, use of local treatment protocols, and awareness of national snakebite management guidelines. Data were analysed using descriptive statistics and presented as frequencies and percentages. Twenty-one healthcare workers participated in the study. Eight participants (38.1%) reported having received no training in snakebite management, while six (28.6%) reported receiving bedside training. Most participants had recent experience managing snakebite patients, with 66.7% reporting management of at least one snakebite case within the preceding year. Fifteen participants (71.4%) reported being very or exceptionally confident in managing snakebite patients. However, only six participants (28.6%) reported using local snakebite treatment protocols, while eight (38.1%) had seen the latest national snakebite management guidelines. Nearly half of participants reported not using local protocols and had never seen national guidelines. The study identified important gaps in healthcare worker preparedness for snakebite management despite high levels of self-reported confidence. Limited formal training, poor guideline awareness, and low utilization of treatment protocols may affect the quality of snakebite care. Strengthening healthcare worker training and improving dissemination of national management guidelines should be prioritized as part of Zambia's snakebite control efforts.

Background: Flea infestation is an important companion-animal health problem and a prime source of zoonotic exposure. However, information on cat owners awareness and preventive behavior regarding fleas and flea-borne diseases (FBDs) in Bangladesh is limited. This study assessed the knowledge, attitudes and practices (KAP) of cat owners regarding flea infestation and flea-borne diseases in selected areas of central Bangladesh. Methods: A cross-sectional survey was conducted from November 2025 to July 2026 among 238 cat owners attending veterinary clinics in Savar, Dhamrai and Manikganj Upazila. Data were collected using a pretested structured questionnaire covering respondent characteristics, flea biology and transmission, perceived risks, and flea-prevention and control practices. Descriptive statistics were used to summarize the findings, and respondents were classified according to their overall KAP scores. Results: Of the respondents, 47.1% owned cats with outdoor access and 77.7% reported that their pets had previously experienced flea infestation. Although 65.5% used flea-control treatments, awareness of zoonotic and disease-transmission risks was limited. Only 14.7% recognized that fleas can parasitize humans, while 17.6% knew that fleas can transmit infectious agents. Overall, 83.2% of respondents had poor knowledge, whereas 69.7% demonstrated moderate attitudes and 63.9% showed moderate practices. Good knowledge and good practice were uncommon, accounting for only 3.8% and 4.6% of respondents, respectively. Veterinary recommendation was the most frequently reported motivation for using flea-control products. Conclusions: Cat owners attending in the surveyed areas frequently reported flea exposure and treatment use, but substantial gaps remained in their understanding of flea biology, zoonotic potential and comprehensive control. Targeted veterinary education emphasizing routine prevention, treatment of all susceptible household animals and environmental management is needed. These findings provide regional baseline evidence and should not be interpreted as nationally representative. Keywords: Bangladesh; cat owners; ectoparasites; flea-borne diseases; flea control; knowledge, attitudes and practices; One Health.

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

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

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

Pathogenesis inflicted by Entamoeba histolytica causes amoebic diarrhea and liver abscesses and is one of the leading causes of mortality from parasitic disease worldwide. Preventive therapeutics in the form of a vaccine could be highly effective at providing umbrella protection for a vulnerable community. In this study, a group of ten putative hypothetical surface N-linked glycoproteins was examined to assess their potential as vaccine candidates and/or diagnostic markers against amoebic intestinal colitis and liver abscesses. To evaluate the immunogenicity of putative surface glycoproteins, we used Entamoeba histolytica-infected patients sera from Bangladesh and then assessed the titer of antibody these glycoproteins elicited in patients by enzyme-linked immunosorbent assay (ELISA) and immunoblot. Based on this study, eight of ten surface glycoproteins were found immunogenic, as specific antibodies against these glycoproteins were detected in patients sera. Three of the immunogenic glycoproteins showed strong IgG antibody responses in both patients with intestinal amoebiasis and those with liver abscess. On the other hand, the other two glycoproteins showed the presence of specific serum antibodies exclusively in patients with amoebic liver abscesses, not in individuals with amoebic colitis. The remaining two glycoproteins showed more specific sera antibodies against ALA, but the preference was not very distinct. Immunolocalization with a specific antibody against the most immunogenic glycoproteins further confirmed their presence in the cell membrane. This differential immunogenicity of these glycoproteins in the two groups of patients qualifies them to become prospective sera-based diagnostic markers and also has the potential to become vaccine candidates for amoebiasis protection.

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

Background: Healthcare workers (HCWs) are at increased risk of exposure to vaccine-preventable diseases, including hepatitis B, tuberculosis (TB), and tetanus, due to their occupational environment. Despite the availability of safe and effective vaccines, vaccination coverage among HCWs remains suboptimal in many low- and middle-income countries. This study aimed to determine the vaccination coverage for hepatitis B, tuberculosis, and tetanus among HCWs in district hospitals in Yaounde, Cameroon, and to identify factors associated with incomplete vaccination. Methods: A cross-sectional analytical study was conducted from January to June 2024 across all seven district hospitals in Yaounde. A total of 406 HCWs were enrolled using a structured, self-administered questionnaire. Incomplete vaccination status was defined as nit having received three doses for hepatitis B, at least two doses for TB, and at least three doses for tetanus. Data were analyzed using R Statistics version 4.3.3. Bivariate and multivariate logistic regression models were used to identify predictors of incomplete vaccination, with statistical significance set at p < 0.05. Results: Most of participants were female (75.6%) and aged 30-44 years (65.5%). Full vaccination coverage was 36.2% for hepatitis B, 15.8% for tuberculosis, and 53.4% for tetanus. Unvaccinated proportions were 43.1% for hepatitis B, 0.5% for tuberculosis, and 17.2% for tetanus. Multivariate analysis revealed that HCWs aged 55-66 years were significantly less likely to be incompletely vaccinated against hepatitis B compared to those aged 19-29 years (aOR = 0.07; 95% CI: 0.01-0.39; p = 0.004). Nurses and laboratory technicians were more likely to be incompletely vaccinated than doctors (aOR = 7.06; 95% CI: 3.82-13.6; p < 0.001 and aOR = 3.78; 95% CI: 1.73-8.52; p = 0.001, respectively). Longer professional experience was protective against incomplete vaccination for all three vaccines (p < 0.05). The main barriers to vaccination included high cost, doubts about the need for vaccination, and concerns about side effects. Conclusions: Vaccination coverage for hepatitis B, tuberculosis, and tetanus among HCWs in Yaounde remains suboptimal, particularly for hepatitis B. Addressing financial barriers, improving access to vaccines, and implementing targeted educational interventions are essential to enhance vaccine uptake and protect both HCWs and their patients from preventable occupational infections.