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.

IntroductionMalaria is still a pressing global health challenge, especially in sub-Saharan Africa, where behavioral factors such as alcohol consumption may exacerbate its impact. The present study is aimed at investigating the pathogenesis of alcohol-exacerbated malaria in Plasmodium berghei-infected an animal model (mice). MethodsMale mice were separated into four treatment groups: control, alcohol control, P. berghei and P. berghei plus acute alcohol treatment groups. Animals were infected with malaria through intraperitoneal injection of P. berghei and an acute dose of ethanol (20% v/v) was introduced 48 hours post-infection. Parasitaemia was monitored using the Giemsa-stained thin blood smears. Haematological parameters were assessed using automated blood analyser. Liver function was evaluated by measuring serum levels of AST and ALT and cytokine profiles (TNF-, INF-{gamma}, IL-6, IL-1{beta}) were quantified using ELISA kits. ResultsResults show that acute alcohol intake led to a significant increase in parasitaemia in the P. berghei group (p<0.01). Haematological analysis revealed a significant (p<0.001) reduction in RBC count, haemoglobin levels, haematocrit percentage, platelet count and others in the P. berghei plus acute alcohol group. Liver enzyme assays revealed an elevated AST and ALT levels (p<0.001) in the P. berghei group. Cytokine analysis revealed a significant (p<0.01) upregulation of pro-inflammatory cytokines (TNF- INF-{gamma}, IL-1{beta} and IL-6), due to acute alcohol. These results suggest that alcohol exacerbates malaria pathogenesis by increasing parasitaemia, promoting immune dysregulation and liver injury, mediated by a shift toward a pro-inflammatory cytokine profile.

BackgroundUnderstanding of context-specific retention strategies for doctors will guide targeted interventions and policy framework for strengthening the district health system in South Africa. Several strategies have been examined, some more impactful than others, with resilience playing a role in retention of staff, but data is lacking in the Eastern Cape Province, South Africa. AimTo assess factors influencing the retention and resilience of doctors at district hospitals in the Eastern Cape. SettingDistrict hospitals in Amathole and Buffalo City health district municipalities in the Eastern Cape. MethodsIn this cross-sectional survey, participants rated retention strategies as well as a validated resilience scale (the CD-RISC 25). ResultsA total of 74 doctors were surveyed; mostly [&le;]34 years (66%), Black Africans (69%), and [&le;]5 years of professional experience (59%). The majority had worked in their current facilities for [&le;]5 years (76%). Significant proportion of young (78%), single (59%), and Grade 1 medical officers (86%) intend to leave their current facilities. Improving hospital accommodation was significantly associated with the intention to stay longer at the rural district hospitals. While not statistically significant, factors affecting professional development and growth scored higher while those related to financial remuneration scored lowest. There were no associations between resilience and intention to stay. ConclusionEarly career doctors prioritise career growth and development, while more experienced doctors rated improved living condition as the main determinants of retention in the rural health facilities. Future studies should recruit representative sample of doctors from the various municipalities and across provinces in the country. ContributionImproving hospital accommodation and enhancing career growth and development may increase retention of doctors in the rural district hospitals.

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

Introduction: Stroke care is time-sensitive, yet patients in low-resource settings may reach tertiary services only after passing through multiple formal and informal care options. This study examined documented care-seeking pathways and time to presentation among stroke cases recorded at the University of Medical Sciences Teaching Hospital (UNIMEDTH), Ondo State, Nigeria. Methods: A retrospective hospital record review was conducted using secondary data from the Stroke Registry, radiology department records, referral notes, and ambulance records at UNIMEDTH. The analysis included 371 stroke cases with documented time from symptom onset to UNIMEDTH presentation and reconstructable care pathways. First-contact routes were classified as hospital/biomedical, self/informal or traditional/faith-based care, and the number of documented steps defined pathway complexity before and including tertiary presentation. Frequencies and percentages described pathway patterns; median presentation times were compared using Mann-Whitney U and Kruskal-Wallis tests. Results: The median time to tertiary presentation was 24 hours (interquartile range [IQR] 9-72), and 317 patients (85.4%) presented after four hours. Only 30 patients (8.1%) presented directly to UNIMEDTH; 44 distinct care-pathway sequences were recorded. Hospital-facility first contact was documented for 81 patients (21.8%). It was associated with a median presentation time of 3 hours (IQR 2-6), compared with 48 hours (IQR 24-72) among patients whose initial contact was outside a hospital facility (U = 699.50, p < 0.001). The median time also differed across grouped first-contact categories and pathway complexity levels (both p < 0.001). Conclusion: Non-hospital or multi-step care-seeking pathways commonly preceded tertiary stroke presentations in this setting. The findings indicate that delayed tertiary arrival is partly embedded in the pathway followed after symptom onset. Interventions should combine public recognition of stroke warning signs with urgent referral linkages involving hospitals, patent medicine vendors, traditional and faith-based providers, and emergency transport systems.

Introduction-India's immunization initiatives are among the largest globally, characterized by a substantial birth cohort of 27 million children annually, and have achieved significant progress in increasing coverage through the UIP. However, there are still challenges that persist, and multiple determinants contribute to the existing challenges; parental migration is one of them. Migration has always been a key driver of socio-economic and demographic changes, particularly in low and middle-income countries (LMICs). Specifically, there is a need to better understand the vulnerabilities of immunization among recent migrants. To examine this, the study explores the association between a mother's recent migration and the full immunization coverage of children aged 12-23 months in India. Data & Methods-Our study utilized data from the National Family Health Survey-5 (2019-21). The outcome variable of interest in this study is the receipt of all basic vaccinations (full immunization) for children. The primary predictor variable in this study is the children's migration status. We used a series of multivariate logistic regression models to examine the relationship between full Immunization and recent migration of children, with some data restrictions in the models. Results - The results show a 17% difference in full immunization between migrant and non-migrant children. The odds ratios for children who had recently migrated were lower for full immunization (OR: 0.39, 95% CI: 0.35-0.43) compared to children who had not recently migrated. Even across the household wealth quintile and social groups, the recent migration of children was associated with being less likely to be fully immunized among children 12-23 months. Conclusion- The findings of this study provide significant quantitative evidence that recent migration (less than 3 years) of children is a key factor influencing Immunization coverage and is a predictor of full vaccination among children aged 12-23 months in India. The recent migration was consistently linked to a lower likelihood of full immunization coverage across different household wealth levels and social groups. This study suggests that recently migrated children are a vulnerable subgroup of the population at risk of not receiving all basic vaccinations by their first birthday.

BackgroundHuman papillomavirus (HPV) infection is a major public health concern in Cameroon, where cervical cancer remains the second leading cause of cancer-related morbidity and mortality among women. Despite the availability of effective preventive measures, their uptake remains suboptimal and is influenced by population-level knowledge and awareness. This study aimed to synthesize existing evidence on HPV-related knowledge and its associated factors in Cameroon. MethodsThis review included studies assessing knowledge of HPV as a sexually transmitted infection (STI), its causal role in cervical cancer, and overall good HPV knowledge. A comprehensive and systematic search was conducted across PubMed, Scopus, Web of Science, Embase, the Cochrane Library, and local online databases. Study quality was appraised using the Joanna Briggs Institute critical appraisal tool. Pooled prevalence estimates were calculated using random-effects models (DerSimonian and Laird). Heterogeneity was assessed using the I{superscript 2} statistic and explored through subgroup analyses. ResultsA total of 32 studies involving 13,{square}457 participants were included. The pooled prevalence of overall good HPV knowledge was 27.4% (95% CI: 7.6-63.2; 7 studies; n = 3,312), with considerable heterogeneity (I{superscript 2} = 99.3%). Knowledge of HPV as a cause of cervical cancer was 27.9% (95% CI: 15.8-44.4; 26 studies; n = 8,688), while knowledge of HPV as an STI was 47.1% (95% CI: 31.4-63.5; 18 studies; n = 9,040). Healthcare workers demonstrated the highest levels of knowledge (80.2% for HPV as an STI; 78.7% for HPV as a cause of cervical cancer), whereas students (43.4% and 10.2%, respectively) and women from the general population (30.6% and 19.9%, respectively) showed substantially lower levels. Factors associated with poor knowledge included Christian affiliation (OR = 1.46; 95% CI: 0.08-26.06) and secondary level education (OR = 1.32; 95% CI: 0.66-2.63), although these associations were non-significant. ConclusionsThis study reveals that, HPV-related knowledge in Cameroon remains low, particularly regarding the causal link between HPV and cervical cancer. These findings highlight the urgent need for targeted, context-specific educational interventions and strengthened public health strategies to improve awareness and uptake of HPV prevention measures. Systematic review registrationPROSPERO CRD420261283152.

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

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

Abstract Background Malaria remains a major public health challenge in Ghana, despite recent reductions in cases due to various interventions. The endemicity of the disease varies across regions, influenced by diverse seasonal and temporal factors that support mosquito proliferation and malaria cases. This study used a Generalised Additive Models to explore the impact of weather conditions on malaria cases in Ghana. Methods Generalised Additive Models were used to examine the nonlinear effects of weather conditions on malaria cases. Monthly aggregated malaria cases from the District Health Information Management System II and average monthly rainfall and temperature data from the Ghana Meteorological Agency were analysed, covering 2012 to 2023. Regional Generalised Additive Models incorporating weather variables were developed, fitted, and validated against observed data using model diagnostics to identify the most suitable model for each region. Results The analysis revealed complex temporal patterns in malaria cases across Ghana, influenced by seasonal and long-term trends. Regions constituting the Coastal and Transitional Forest zones exhibited bimodal peak malaria seasons, while the Guinea Savannah showed a unimodal peak. Significant interactions between rainfall and temperature were identified, particularly in the Eastern region, where higher rainfall combined with temperatures around 27-28 {degrees}C were associated with higher malaria cases, reflecting the complex and region-specific nature of meteorological influences. Conclusions The findings point to the dynamic and heterogeneous nature of malaria caseloads in Ghana, emphasising the need for region-specific control strategies tailored to local climatic conditions. A key recommendation is the systematic integration of meteorological data into the National Malaria Data Repository to enable continuous monitoring of climatic influences and support timely, evidence-based intervention decisions. Future research should incorporate socio-economic factors, intervention coverage data, vector surveillance, and demographic characteristics into mathematical modelling frameworks for a more comprehensive understanding of malaria cases in Ghana.

Introduction: Women aged 45-49 occupy a heterogeneous late-reproductive-life stage, but population research often treats them as a uniform group. This study examined correlates of Demographic and Health Survey (DHS)-defined infecund/menopausal status among Nigerian women aged 45-49. Methods: This cross-sectional secondary analysis used the 2024 Nigeria Demographic and Health Survey Women Recode dataset. Weighted descriptive statistics summarised reproductive exposure status among 3,237 women. Out of these, 3,110 women classified as either fecund or infecund/menopausal were subjected to Survey-adjusted Chi-square tests and Binary Logistic regression at p<0.05, where pregnant and postpartum amenorrhoeic women were excluded. Results: More than half of women were classified as infecund/menopausal (54.1%), while 41.5% were fecund; 3.2% were postpartum amenorrhoeic, and 1.3% were pregnant. Findings indicated that currently married/cohabiting women (AOR=4.87; 95% CI: 2.24-10.56) and formerly married women (AOR=8.30; 95% CI: 3.69-18.66) had higher odds of infecund/menopausal classification than women never in a union. Secondary education, higher education, middle-to-richest wealth quintiles, and five or more children ever born were associated with lower odds, while Northern minority ethnicity was associated with higher odds. Adding the current contraceptive method attenuated several education, wealth and parity associations; modern-method and traditional-method users had markedly lower odds than non-users. Conclusion: Late-reproductive-life exposure status among Nigerian women aged 45-49 is socially patterned, with union status showing the most stable association. DHS-defined infecund/menopausal status is a demographic exposure category rather than clinically confirmed menopause. It is therefore concluded that the cross-sectional associations should not be interpreted causally.

Ethiopia has implemented acute flaccid paralysis (AFP) surveillance for nearly three decades as a core polio eradication strategy, yet remains at risk of outbreaks, particularly in pastoralist and conflict-affected areas. As Global Polio Eradication Initiative support declines, understanding factors affecting AFP surveillance and sustainability is critical. This study assessed facilitators, barriers, and adaptive strategies influencing AFP surveillance implementation in Ethiopia. A qualitative study using semi-structured interviews was conducted with 43 participants who had been involved in AFP surveillance for at least 12 months between 1996 and 2018. Guided by the Consolidated Framework for Implementation Research, participants were purposively chosen from the Ministry of Health, regional health bureaus, zonal and district health offices, and included surveillance officers, program managers, and frontline health workers from governmental and partner organizations. Data were analyzed thematically using deductive and inductive approaches in NVivo version 12. AFP surveillance implementation in Ethiopia was influenced by multilevel facilitators and barriers. Strong leadership, organizational structures, and partnerships with global and community actors supported coordination and resource mobilization. Community-based networks, including local volunteers and motivated health workers enhanced case detection and reporting in hard-to-reach areas. However, performance was constrained by high staff turnover, logistical challenges, limited subnational resources, weak supervision, and socio-cultural. Geographic inaccessibility and insecurity further limited implementation. Frontline health workers and volunteers used various adaptive strategies such as community engagement, informal reporting, and context-specific logistical solutions, to sustain surveillance activities. Continued reliance on external support posed a concern for long-term sustainability. Strong organizational systems and community engagement can sustain AFP surveillance in resource-limited settings. However, declining external support is a concern for sustainability. Integrating AFP surveillance into broader health systems, increasing domestic investment, and strengthening community-based approaches are essential for long-term resilience.

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.

BackgroundBefore obtaining professional medical care, many people in peri-urban and rural Pakistan contact herbalists, spiritual healers, and unlicensed caregivers. This study examined the social, economic, and cultural factors influencing the use of informal care by analysing the health-seeking behaviours of individuals in the Faisalabad District. MethodsAn exploratory mixed-methods study was conducted in Makkuana and the surrounding villages of Faisalabad District, Punjab. The quantitative component involved a cross-sectional survey of 69 adults using a structured questionnaire adapted from the I-CAM-Q. The qualitative component comprised twelve in-depth interviews and two focus group discussions. Descriptive statistics and chi-square analysis were used for quantitative data. Thematic analysis, guided by the Health Belief Model and Andersens Behavioural Model, was applied to qualitative data. ResultsThe mean age of participants was 40.4 years; 62.3% were female, and 79.7% had monthly household incomes below PKR 60,000. Of the 69 participants, 68 (98.6%) sought care from an informal provider first, most commonly an unqualified practitioner (50.7%), herbal practitioner (29.0%), or homeopath (17.4%). Trust was the leading reason for provider choice (43.5%), followed by proximity (24.6%) and low cost (15.9%). Complications were reported by 21.7% of participants, and 39.1% later required formal care for the same illness. Eight qualitative themes emerged: structural and economic barriers to formal care; proximity and convenience as determinants of informal care; trust, familiarity, and social networks; cultural and religious normalisation of traditional practices; poor doctor-patient communication in formal settings; perceived safety and naturalness of alternative remedies; awareness deficits about provider qualifications; and treatment-related harm and delayed escalation to formal care. ConclusionInformal health care seeking is nearly universal in this community, driven by intersecting economic, structural, cultural, and interpersonal factors. Enhancing primary care affordability, accessibility, and the quality of provider-patient communication together with culturally sensitive health literacy programs, is essential to redirect care seeking toward qualified providers.

BackgroundWomens autonomy in healthcare decision-making has become one of the most critical yet inequitably distributed determinants of health outcomes, gender equity, and sustainable development worldwide. In Northern Nigeria, the presence of ethnic and socio-cultural inequality is frequently concealed by the aggregated statistics of a region. MethodsThis cross-sectional secondary analysis utilized the 2024 Nigeria Demographic and Health Survey. The sample included 9,998 married women (15-49 years) identifying as Hausa, Fulani, or Kanuri in Northern Nigeria. Healthcare autonomy was categorized as husband/partner alone, respondent alone, or joint decision-making. Analysis included weighted descriptive statistics, Rao-Scott adjusted chi-square tests for residential associations, and complex sample multinomial logistic regression to identify multivariable correlates while adjusting for sampling weights, strata, and clusters. ResultsMean age was 30.38 years. Most participants lacked formal education (69.6%) and resided in rural areas (72.0%). Husband-only decision-making predominated (72.6%), while 22.5% reported joint and 4.9% independent autonomy. Joint decision-making was significantly higher in urban (33.3%) than rural areas (18.3%; Adjusted F=50.892, p<0.001). In adjusted models (Reference: Kanuri), Hausa and Fulani women had substantially lower odds of joint decision-making relative to husband-only outcomes. Rural residence correlated with lower odds of both independent and joint agency. Notably, wealth status was not a significant predictor after adjustment (p > 0.05). ConclusionsEthnicity and residence are robust determinants of healthcare autonomy among women in Northern Nigeria, persisting regardless of education or wealth. This "socio-cultural paradox" suggests that economic interventions alone are insufficient. Policies must complement socioeconomic approaches with culturally responsive strategies addressing household power dynamics and entrenched social norms.

ObjectiveThis study aimed to assess the effectiveness of SMS and voice message reminders in reducing the dropout rate in Lome-Togo, in 2026. MethodsWe conducted a cross-sectional study between October 2025 and March 2026 in the Grand Lome region. The intervention consisted of an integrated digital system used by health facilities to send automated SMS. Categorical variables were described in terms of frequency and proportion; Fishers exact test was used to compare proportions. Quantitative variables were described by their means accompanied by their standard deviation; the Wilcoxon rank-sum test was used to compare means. The significance level for statistical tests was set at 5%. ResultsA total of 30 health facilities were included. Seventy percent (70.0%) of the health facilities used messages associated with calls. Ninety percent (90.0%) of participants found the reminders useful, and 60.0% reported an improvement in Expanded Program on Immunization services related to their use. Among participants who received a reminder, 51.0% kept their vaccination appointments. The Penta 1/3 dropout rate decreased from 3.2% before the intervention to 1.3% (p < 0.001). Among the 323 parents of children included, only 20.74% reported receiving a reminder by phone. Sixty-point-five percent (60.5%) preferred to receive both text messages and voice calls. ConclusionThis study demonstrates the operational feasibility of an SMS/call-based reminder system in reducing dropout rate for childhood vaccination in Togo.

Introduction Recent respiratory illness, especially influenza, may trigger acute cardiac events via elevated inflammatory mediators. During the 2018 influenza season in Bangladesh, this study examined whether recent acute clinical respiratory illness (CRI) or laboratory-confirmed influenza was associated with elevated hs-CRP and IL-6, linked to acute cardiac events. Methods A total of 139 participants aged [&ge;]40 were recruited from a Dhaka cardiac hospital: 70 with acute myocardial infarction (AMI), 30 with other acute cardiac events, and 39 healthy individuals. CRI was defined as fever with cough and/or respiratory symptoms within seven days. Respiratory swabs were tested for influenza, and blood was analyzed for hs-CRP and IL-6. Results Median hs-CRP and IL-6 were higher in participants with CRI or influenza but not significantly. Cardiac patients had elevated hs-CRP (9.98 mg/L in other cardiac; 4.86 mg/L in AMI vs. 1.73 mg/L in healthy) and IL-6 (0.1 pg/mL in other cardiac; 0.145 pg/mL in AMI vs. 0.08 pg/mL in healthy) (p<0.001). CRI was not significantly associated with elevated hs-CRP or IL-6, though influenza in healthy participants was linked to higher IL-6. Cardiac patients had a higher risk of hs-CRP [&ge;]3 mg/L and elevated IL-6. Conclusion Cardiac patients showed significantly increased inflammatory markers, but CRI was not clearly linked to inflammation. Further research should assess biomarker utility for early cardiac risk.

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

Introduction: Cardiovascular diseases (CVDs) are the leading cause for death and disability worldwide accounting for 75% of deaths in low- and middle-income countries (LMICs) like Nepal. Urbanization and globalization remains the major cause of rise in CVDs among urban poor population along with growth in slum settlements. This study aims to assess the knowledge, attitude and practice (KAP) of CVDs and its risk factors among women of one such urban poor community in Nepal. Methodology: This cross-sectional study (n=388) in the Sinamangal-Minbhawan slum area was conducted using semi structured questionnaire based on STEPs survey and HARDIC study among the participants selected through convenient sampling. Descriptive analysis was done using SPSS version 21 and KAP scores were further categorized based on median score to perform multivariate logistic analysis. Additionally, Anthropometric and blood pressure measurements were also recorded and analyzed. Results: The median age (Interquartile range) of participants was 33 years (17) with majority of them being Dalit by ethnicity, housewives, with up to primary level education belonging to upper lower socioeconomic class. More than half (53.3%) of the participants were obese and over 23% were hypertensive. While half of the hypertensive women were aware of their status, only 3% had their blood pressure under control.The median knowledge, attitude and practice (KAP) scores were 12, 60 and 10 respectively. The KAP scores were positively associated with socioeconomic status of the participants. Conclusion: The study revealed low knowledge with high prevalence of behavioral risk factors of CVDs along with high prevalence of other metabolic risk factors like high body mass index, high waist hip ratio and hypertension among women of slum area with a positive attitude to prevent CVDs and its risk factors.

Background: Cervical cancer is the fourth most common cancer in women worldwide and remains a major public health challenge. In Ethiopia, it is the second leading cause of cancer deaths, with around 8,000 new cases and 6,000 deaths each year. Region?specific data on the prevalence and predictors of precancerous lesions remain scarce, yet such information is vital for guiding targeted reproductive health strategies. This study therefore examined the prevalence and predictors of cervical precancerous lesions among women aged 21-60 years undergoing Pap smear screening in public hospitals in Hawassa City, Sidama Region. Methods: An institution-based cross-sectional study was conducted among 241 women attending Pap smear screening at public hospitals in Hawassa City from March to August 2025. Sociodemographic and clinical data were collected via interviews and medical records. Lesions were classified based on the standardized international framework for reporting cervical cytology results from Pap smears per the Bethesda system. Multivariable logistic regression identified predictors p<0.05). Result: Of 241 women screened (mean age 35.3 years), cervical epithelial abnormalities were detected in 52 (prevalence 21.6%). Atypical squamous cells of undetermined significance was the most common abnormality (16.6%). Multivariable analysis showed HIV infection was significantly associated with precancerous lesions (AOR = 3.7, 95% CI: 1.69-8.12, p<0.05), while hormonal contraceptive use was protective (AOR = 0.27, 95% CI: 0.11-0.67, p<0.05). Conclusion: These results underscore the urgent need to strengthen cervical cancer prevention through targeted screening and early intervention. Integrating routine HIV testing with Pap smear programs would be especially valuable. Health authorities should expand accessible screening for women aged 21-60, with particular attention to those living with HIV, to help reduce the burden of precancerous lesions.